Silvio Gomes Monteiro

In vitro differential activity of phospholipases and acid proteinases of clinical isolates of Candida

INTRODUCTION Candida yeasts are commensals; however, if the balance of normal flora is disrupted or the immune defenses are compromised, Candida species can cause disease manifestations. Several attributes contribute to the virulence and pathogenicity of Candida, including the production of extracellular hydrolytic enzymes, particularly phospholipase and proteinase. This study aimed to investigate the in vitro activity of phospholipases and acid proteinases in clinical isolates of Candida spp. METHODS Eighty-two isolates from hospitalized patients collected from various sites of origin were analyzed. Phospholipase production was performed in egg yolk medium and the production of proteinase was verified in a medium containing bovine serum albumin. The study was performed in triplicate. RESULTS Fifty-six (68.3%) of isolates tested were phospholipase positive and 16 (44.4%) were positive for proteinase activity. C. tropicalis was the species with the highest number of positive isolates for phospholipase (91.7%). Statistically significant differences were observed in relation to production of phospholipases among species(p<0,0001) and among the strains from different sites of origin (p=0.014). Regarding the production of acid protease, the isolates of C. parapsilosis tested presented a larger number of producers (69.2%). Among the species analyzed, the percentage of protease producing isolates did not differ statistically (χ2=1.9 p=0.5901 (χ2=1.9 p=0.5901). CONCLUSIONS The majority of C. non-albicans and all C. albicans isolates were great producers of hydrolytic enzymes and,consequently, might be able to cause infection under favorable conditions.

Conhecimentos e atitudes da população sobre dengue no Município de São Luís, Maranhão, Brasil, 2004

A sample survey with 843 interviews in Sao Luis, Maranhao State, Brazil was conducted to assess community knowledge and concepts regarding dengue. The populations understanding and its socioeconomic, health, and environmental conditions were evaluated. Potential vector breeding sites were found in all the areas surveyed. Media (TV, radio, etc.) were the most important source of public information on the disease. However, a gap was observed between knowledge and attitudes towards vector prevention. Strategies are also needed to involve the population in more effective prevention of vector proliferation, thus helping control the disease in Sao Luis.

MICROBIOLOGICAL ANALYSES OF WATER FROM HEMODIALYSIS SERVICES IN SÃO LUÍS, MARANHÃO, BRAZIL

A necessidade de um controle rigoroso no servico de hemodialise tornou-se algo de extrema importância para garantir uma melhor qualidade de vida aos pacientes submetidos a este tratamento, uma vez que, a falta de controle de qualidade da agua, tem levado a obito varios pacientes. Este estudo teve como objetivo avaliar as caracteristicas fisico-quimicas e bacteriologicas da agua utilizada pelos servicos de hemodialise em hospitais da cidade de Sao Luis. A metodologia utilizada para as analises bacteriologicas foi: metodo da membrana filtrante para determinacao de coliformes totais, metodo Cult-Dipcombi-ttc-agar para bacterias heterotroficas e metodo limulus amebocyte lysate para endotoxinas. Foram analisadas dezoito amostras de agua em tres unidades hospitalares, sendo seis amostras provenientes de cada servico de hemodialise, colhidas diretamente dos pontos pre e pos-tratamento. Quanto a presenca de microrganismos na agua utilizada pelos servicos de hemodialise, observou-se positividade nas unidades hospitalares B e C. Nao foi encontrada contaminacao por bacterias heterotroficas nas amostras examinadas no pre-tratamento, entretanto a contaminacao por endotoxinas foi em 100% das amostras. Nas amostras pos-tratamento encontrou-se para bacterias heterotroficas 66,6% e endotoxinas 33,3%. Os microrganismos identificados na unidade hospitalar B foram: Burkholderia cepacia, Alcaligenes xilosoxidans, Pseudomonas aeruginosa e Stenotrophomonas maltophilia. Na unidade C, foram identificados: Flavimonas oryzihabitans, Ralstonia pickettii e Burkholderia cepacia. Houve uma correlacao significativa entre a presenca de endotoxinas e caracteristicas fisico-quimicas da agua tais como: turbidez e condutividade. Estes dados revelaram que duas das tres unidades hospitalares avaliadas necessitam rever o controle do sistema de agua de hemodialise.

Cobertura vacinal do esquema básico para o primeiro ano de vida nas capitais do Nordeste brasileiro

O estudo SERVIDIAH (Avaliacao de Servicos de Atencao Basica a Saude para Diabeticos e Hipertensos) foi realizado em 2010 no Estado de Pernambuco, Brasil. Foi constituida uma amostra aleatoria de 785 hipertensos e 823 diabeticos oriunda dos cadastros de 208 equipes da Estrategia Saude da Familia (ESF) sorteadas em 35 municipios do estado. Os usuarios foram entrevistados por meio de formulario padronizado, e tiveram afericao de peso, altura e pressao arterial e, para os diabeticos, da hemoglobina glicada (HbA1c). A idade media foi em torno de 60 anos, com sobrerrepresentacao de mulheres (70%). A pressao arterial foi controlada em 43,7% dos hipertensos e 25,8% dos diabeticos; 30,5% dos diabeticos apresentaram HbA1c abaixo de 7%. Apesar de 70% apresentarem sobrepeso ou obesidade, poucos referiram estar seguindo dieta para perder peso. O estudo, nesta amostra representativa de hipertensos e diabeticos cadastrados na ESF de Pernambuco, mostra que melhorias devem ser buscadas a fim de aprimorar a prevencao das complicacoes desses agravos, cuja incidencia esta crescente.

Transient Receptor Potential Ankyrin 1 Channel Expression on Peripheral Blood Leukocytes from Rheumatoid Arthritic Patients and Correlation with Pain and Disability

Patients with rheumatoid arthritis (RA) suffer from pain and joint disability. The transient receptor potential ankyrin 1 (TRPA1) channel expressed on sensory neurones and non-neuronal cells mediates pain transduction and inflammation and it has been implicated in RA. However, there is little information on the contribution of TRPA1 for human disease. Here, we investigated the expression of TRPA1 on peripheral blood leukocytes and the circulating levels of its endogenous activators 4-hydroxynonenal (4-HNE) and hydrogen peroxide (H2O2) in RA patients treated or not with the anti-rheumatic leflunomide (LFN) or the anti-TNFα adalimumab (ADA). We also assessed whether TRPA1 expression correlates with joint pain and disability, in addition to the immune changes in RA. TRPA1 expression on peripheral blood leukocytes correlated with pain severity and disability. TRPA1 levels on these cells were associated with the numbers of polymorphonuclear and the activation of CD14+ cells. No correlations were found between the lymphocyte population and TRPA1 expression, pain or disability. Patients recently diagnosed with RA expressed increased levels of TRPA1 on their leukocytes whilst treatment with either LFN or ADA down-regulated this receptor probably by reducing the numbers of polymorphonuclears and the activation of CD14+ cells. We suggest that the activation levels of CD14+ cells, the numbers of PMNs in the peripheral blood and the expression of TRPA1 on peripheral blood leukocytes correlate with RA progression, affecting joint pain sensitivity and loss of function.

Phenotypic and molecular detection of the bla KPC gene in clinical isolates from inpatients at hospitals in São Luis, MA, Brazil

BackgroundBacteria that produce Klebsiella pneumoniae carbapenemases (KPCs) are resistant to broad-spectrum β-lactam antibiotics. The objective of this study was to phenotypically and genotypically characterize the antibiotic susceptibility to carbapenems of 297 isolates recovered from clinical samples obtained from inpatients at 16 hospitals in São Luis (Maranhão, Brazil).MethodsThe study was conducted using phenotypic tests and molecular methods, including polymerase chain reaction (PCR), sequencing and enterobacterial repetitive intergenic consensus (ERIC)-PCR. The nonparametric chi-square test of independence was used to evaluate the associations between the bacterial blaKPC gene and the modified Hodge test, and the chi-square adherence test was used to assess the frequency of carbapenemases and their association with the blaKPC gene.ResultsThe most frequently isolated species were Acinetobacter baumannii (n = 128; 43.0%), K. pneumoniae (n = 75; 25.2%), and Pseudomonas aeruginosa (n = 42; 14.1%). Susceptibility assays showed that polymixin B was active against 89.3% of the bacterial isolates. The Acinetobacter spp. and K. pneumoniae strains were susceptible to amikacin and tigecycline, and Pseudomonas spp. were sensitive to gentamicin and amikacin. Among the 297 isolates, 100 (33.7%) were positive for the blaKPC gene, including non-fermentative bacteria (A. baumannii) and Enterobacteriaceae species. Among the isolates positive for the blaKPC gene, K. pneumoniae isolates had the highest positivity rate of 60.0%. The blaKPC gene variants detected included KPC-2, which was found in all isolates belonging to species of the Enterobacteriaceae family. KPC-2 and KPC-3 were observed in A. baumannii isolates. Importantly, the blaKPC gene was also detected in three Raoultella isolates and one isolate of the Pantoea genus. ERIC-PCR patterns showed a high level of genetic diversity among the bacterial isolates; it was capable of distinguishing 34 clones among 100 strains that were positive for blaKPC and were circulating in 11 of the surveyed hospitals.ConclusionsThe high frequency of the blaKPC gene and the high degree of clonal diversity among microorganisms isolated from patients from different hospitals in São Luis suggest the need to improve the quality of health care to reduce the incidence of infections and the emergence of carbapenem resistance in these bacteria as well as other Gram-negative pathogens.

Phenotypic detection of metallo-β-lactamases in Pseudomonas aeruginosa and Acinetobacter baumannii isolated from hospitalized patients in São Luis, State of Maranhão, Brazil

INTRODUCTION Acquired metallo-β-lactamases (MβL) are emerging determinants of resistance in Pseudomonas aeruginosa and Acinetobacter baumannii. The objectives of this study were to phenotypically detect MβL in imipenem-resistant P. aeruginosa and A. baumannii, to investigate the association between MβL-positive strains and hospitals, and to compare the resistance profiles of MβL-producing and non-MβL-producing strains. METHODS The approximation disk and combined disk assay methods were used in this study. RESULTS A total of 18 (38.3%) P. aeruginosa isolates and 1 (5.6%) A. baumannii isolate tested positive for the presence of MβL. CONCLUSIONS These results demonstrate the need for strict surveillance and for the adoption of preventive measures to reduce the spread of infection and potential outbreaks of disease caused by MβL-producing microorganisms.

PREVALÊNCIA E PRODUÇÃO DE ENZIMAS POR ISOLADOS DE Candida PROVENIENTES DE AMOSTRAS DE SECREÇÃO VAGINAL

Vulvovaginal candidiasis (VVC) ranks second among causes of vaginitis. Candida albicans is responsible for the majority of symptomatic episodes of VVC. However, one fact to consider is the increase of infections by species of non-C. albicans, which contribute to high rates of recurrence and resistance. The purpose of this study was to isolate Candida spp. samples from vaginal discharge, determine the prevalence of the species and assess the production of hydrolytic enzymes (proteases, phospholipases, hemolysins, catalase, and gelatinases) in clinical isolates. 144 samples from patients treated at a public hospital in São Luis-MA were analyzed. The production of hydrolytic enzymes was determined in triplicate with specific methods. Statistical analysis was performed using the x2, Kruskal-Wallis and Student-Newman-Keuh tests. Ninety patients had positive cultures for Candida spp. Candida parapsilosis was the main isolated species (43.3%). Forty-three patients (47.8%) showed clinical manifestations that suggested VVC. The correlation between the presence of Candida species and the presence or absence of symptoms was not statistically significant (x = 3.22, p = 0.073). The expression of enzymes by Candida spp. isolates was recorded with percentages: hemolysins (80%), phospholipases (8.9%), proteinases (17.8%), catalase (64.4%) and gelatinases (10.0%). Statistically significant differences were observed among the isolates for expression of phospholipases (p=0.0005), with C. albicans being the largest producer and for catalase (p=0.0045) with C. parapsilosis and C. albicans the species with increased expression. This study shows a predominance of non-albicans species in vulvovaginal samples and most of the isolates were producers of hemolysin and catalase, which may contribute to the virulence of the strains of Candida spp. and the development of vaginal infection under appropriate conditions.

Human papillomavirus genotypes 68 and 58 are the most prevalent genotypes in women from quilombo communities in the state of Maranhão, Brazil

OBJECTIVES To determine the frequency of human papillomavirus (HPV) types and behavioral characteristics related to cytological abnormalities in women descendants of slaves, who live in isolated communities known as quilombos in the state of Maranhão, Brazil. METHODS Cervicovaginal specimens of 353 women were analyzed by conventional cytology and genotyping. HPV detection and genotyping was performed using a linear array HPV genotyping test kit. Behavioral factors and their association with cytological abnormalities were analyzed, as well as the association between cytological abnormalities and HPV infection. RESULTS The frequency of HPV infection was 13%, and infection with high-risk HPV types was more frequent than with low-risk types (10.2% vs. 2.8%). The most prevalent genotypes were HPV 68 (3.1%) and HPV 58 (2.6%). HPV-positive women were 6.5 times more likely than HPV-negative women to be diagnosed with cytological abnormalities. There was a significant association between HPV infection and the presence of cytological abnormalities in women 31-40 years of age and in women 51-60 years of age. CONCLUSIONS A distinct profile of high-risk HPV genotypes was detected, with predominance of types 68 and 58. It is possible that the results of the present study are due to specific characteristics of the population, which is geographically isolated and maintains conservative sexual habits.

Resistant tuberculosis in Maranhão, Brazil: a case series

BackgroundMycobacterium tuberculosis multidrug resistance, especially against rifampicin and isoniazid, places pulmonary tuberculosis in the list of emerging diseases. The misuse of therapeutic regimens is one of its main predisposing factors.Case presentationFour clinical cases (three were brown and one black) with multidrug-resistant tuberculosis, treated in a reference hospital in the state of Maranhão, Brazil, were reported to evaluate the importance of radiological framework on disease evolution.ConclusionThe clinical framework showed a bad evolution and drug resistance, while radiology showed lung lesions, ranging from exudative infiltrates to lung parenchyma disintegration.