Epidemiological Profile of Patients with Infective Endocarditis at three Tertiary Centers in Brazil from 2003 to 2017

Abstract Background Infective endocarditis (IE) is a disease with high morbimortality and an increasing incidence. With improved diagnosis and treatment, a number of epidemiological changes have been reported over time. Objectives We sought to describe the epidemiological profile, mortality predictors, and analysis of a possible microbiological transition in patients admitted to three tertiary centers in Brazil. Methods In this cross-sectional retrospective study, data from 211 patients with definite or probable IE were analyzed according to the modified Duke criteria between 2003 and 2017. The association between categorical variables was assessed using the chi-square or Fisher's exact test, and binary logistic models were built to investigate mortality. We considered p <0.05 statistically significant. Results The median age of the sample was 48 (33-59) years old, 70.6% were men, and the most prevalent pathogen was Staphylococcus spp. (19%). Mortality was 22.3%, with increasing age being the leading risk factor for death (p = 0.028). Regarding the location of the disease, native valves were the most affected site, with the aortic valve being more affected in men than women (p = 0.017). The mean number of cases of Staphylococcus spp. (τ = 0.293, p = 0.148) and Streptococcus spp. (τ = -0.078, p = 0.727) has remained stable over the years. Conclusion No trend towards reduced or increased mortality was evident between 2003 and 2017. Although Staphylococcus spp. were the most prevalent pathogen, the expected epidemiological transition could not be observed.

Potencial antimicrobiano de los enjuagues bucales para niños / Potencial antimicrobiano dos enxaguantes bucais para crianças / Antimicrobial potential of child mouthwashes

Objetivo: Poco se sabe del potencial antimicrobiano de los enjuagues bucales sobre la bacteria Streptococcus mutans. El objetivo de este estudio in vitro fue investigar los efectos antimicrobianos de los enjuagues bucales para niños contra esas bacterias. Materiales y Métodos: Se utilizó la cepa de S. mutans para realizar zonas de inhibición mediante prueba de difusión en agar. Las placas de agar Brain Heart Infusion (BHI) se dividieron en cuadrantes: G1 - cloruro de cetilpiridinio (Cepacol Teen®); G2 - xilitol y triclosán (Dentalclean Garfield®); G3: Malva sylvestris, xilitol (Malvatrikids Jr®) y G4: solución de tampón fosfato salino (PBS). Después del ajuste de las bacterias, se sembró una alícuota de cada grupo en el agar BHI y se transfirió a una atmósfera a 37ºC durante 48 horas para realizar las mediciones de las zonas de inhibición. Los datos se analizaron mediante ANOVA de un factor para la comparación entre grupos (α = 0,05). Resultados: Se verificaron zonas de inhibición solo para G1 (10,82 ± 2,13) ​​y G3 (12,75 ± 1,04). No se verificó diferencia estadística significativa entre G1 y G3 (p = 0,287) y G2 y G4 (p ≥ 0,05). Conclusión: A pesar de los efectos beneficiosos de los enjuagues bucales, una combinación de xilitol y triclosán no fue eficaz para controlar el crecimiento de S. mutans en esta condición in vitro. Se deben implementar restricciones adicionales para regular la venta de sustancias antimicrobianas y proporcionar aclaraciones adicionales a la población.

Introdução: Pouco se sabe sobre o potencial antimicrobiano dos enxaguantes bucais em relação à bacteria Sreptococcus mutans. O objetivo deste estudo in vitro foi investigar o efeito antimicrobiano de enxaguatórios bucais infantis contra essa bactéria. Materiais e métodos: Este estudo in vitro utilizou a cepa de Streptococcus mutans para gerar zonas de inibição por meio do teste de difusão em ágar. As placas de ágar BHI foram divididas em quatro quadrantes, seguindo os grupos: G1- Cloreto de Cetilperidíneo (Cepacol Teen®); G2- xilitol e triclosan (Dentalclean Garfield®); G3- Malva silvestres e xilitol (Malvatrikids Jr®) e G4- solução salina tamponada com fosfato. Após o ajuste das bactérias, uma alíquota de cada grupo foi semeada no ágar BHI e transferida para uma atmosfera a 37ºC por 48 horas, para medir as zonas de inibição. Os dados foram analisados, utilizando ANOVA one-way, para comparação intergrupos (α = 0.05). Resultado: As zonas de inibição foram verificadas em G1(10.82±2.13) e G3(12.75 ±1.04), com ausência de zonas de inibição para outros grupos estudados. Não foi verificada diferença estatisticamente significante entre G1 e G3 (p=0,287) e G2 e G4 (p≥0.05). Conclução Apesar dos efeitos benéficos dos enxaguantes bucais, uma combinação de xilitol e triclosan não foi eficaz no controle do crescimento de S. mutans nessa condição in vitro.

Introduction: Little is known about the antimicrobial potential of mouthwashes in Streptococcus mutans bacteria. The objective of this in vitro study was to investigate the antimicrobial effects of infant mouthwashes against those bacteria. Materials and methods: This in vitro study used S. mutans strain to perform inhibition zones by agar diffusion test. Brain Heart Infusion (BHI) agar dishes were divided into quadrants: G1 ­ cetylperidinium chloride (Cepacol Teen®); G2 ­ xylitol and triclosan (Dentalclean Garfield®); G3 ­ Malva sylvestris, xylitol (Malvatrikids Jr®) and G4 - phosphate buffer saline (PBS). After adjustment of bacteria, an aliquot of each group was plated on the BHI agar and transferred to an atmosphere at 37ºC for 48 hours to perform the inhibition zones measurements. The data was analyzed by one-way ANOVA for intergroup comparison (α = 0.05). Results: Inhibition zones were verified only to G1 (10.82 ± 2.13) and G3 (12.75 ± 1.04). No significant statistical difference was verified between G1 and G3 (p = 0.287) and G2 and G4 (p ≥ 0.05). Conclusion: Despite of the beneficial effects of mouthwashes, a combination of xylitol and triclosan was not effective to control S. mutans growth in this in vitro condition.

Causes of abortion, stillbirth, and perinatal mortality in horses / Causas de aborto, natimortalidade e morte perinatal em equinos

Causes of abortion, stillbirth, and perinatal mortality in horses were investigated in the Department of Veterinary Pathology of the Federal University of Rio Grande do Sul (SPV-UFRGS) from 2000 to 2015. In this period, 107 cases were analyzed using macroscopic, microscopic, and complementary tests. Of these, 77 were aborted fetuses, 16 were stillbirths, and 14 were perinatal deaths. Conclusive diagnosis was established in 42.8% of the fetuses analyzed, with 28.6% classified as infectious origin, 9.1% as non-infectious, and 5.1% as other. Bacterial infections, especially those related to Streptococcus spp. were the most frequently observed. In stillborn foals, diagnosis was established in 62.5% of cases, and 50% of these were related to non-infectious causes, such as dystocia and birth traumas. As for perinatal mortality, a conclusive diagnosis was reached in 78.57% of cases, and infectious causes associated with bacterial infections accounted for 64.1% of these diagnoses.

Causas de aborto, natimortalidade e mortalidade perinatal em equinos foram investigadas no Setor de Patologia Veterinária da Universidade Federal do Rio Grande do Sul (SPV-UFRGS) durante o período de 2000 a 2015. Nesse período, foram analisados 107 casos através de exames macroscópico, microscópico e exames complementares, desses 77 correspondiam a fetos abortados, 16 natimortos e 14 mortes perinatais. Diagnóstico conclusivo foi estabelecido em 42,8% dos fetos analisados e classificados como origem infecciosa em 28,6% dos casos, não infecciosa com 9,1% e outros com 5,1% dos casos. As infecções bacterianas, em especial as relacionadas a Streptococcus spp. foram as mais frequentemente observadas. Em potros natimortos, diagnostico foi estabelecido em 62,5% dos casos, e destes, 50% foram relacionados a causas não infecciosas, como distocia e traumas durante o parto. Quanto a mortalidade perinatal, em 78,57% dos casos houve um diagnostico conclusivo, e as causas infecciosas associadas a infecções bacterianas corresponderam a 64,1% desses diagnósticos.

Causes of abortion, stillbirth, and perinatal mortality in horses / Causas de aborto, natimortalidade e morte perinatal em equinos

Causes of abortion, stillbirth, and perinatal mortality in horses were investigated in the Department of Veterinary Pathology of the Federal University of Rio Grande do Sul (SPV-UFRGS) from 2000 to 2015. In this period, 107 cases were analyzed using macroscopic, microscopic, and complementary tests. Of these, 77 were aborted fetuses, 16 were stillbirths, and 14 were perinatal deaths. Conclusive diagnosis was established in 42.8% of the fetuses analyzed, with 28.6% classified as infectious origin, 9.1% as non-infectious, and 5.1% as other. Bacterial infections, especially those related to Streptococcus spp. were the most frequently observed. In stillborn foals, diagnosis was established in 62.5% of cases, and 50% of these were related to non-infectious causes, such as dystocia and birth traumas. As for perinatal mortality, a conclusive diagnosis was reached in 78.57% of cases, and infectious causes associated with bacterial infections accounted for 64.1% of these diagnoses.(AU)

Causas de aborto, natimortalidade e mortalidade perinatal em equinos foram investigadas no Setor de Patologia Veterinária da Universidade Federal do Rio Grande do Sul (SPV-UFRGS) durante o período de 2000 a 2015. Nesse período, foram analisados 107 casos através de exames macroscópico, microscópico e exames complementares, desses 77 correspondiam a fetos abortados, 16 natimortos e 14 mortes perinatais. Diagnóstico conclusivo foi estabelecido em 42,8% dos fetos analisados e classificados como origem infecciosa em 28,6% dos casos, não infecciosa com 9,1% e outros com 5,1% dos casos. As infecções bacterianas, em especial as relacionadas a Streptococcus spp. foram as mais frequentemente observadas. Em potros natimortos, diagnostico foi estabelecido em 62,5% dos casos, e destes, 50% foram relacionados a causas não infecciosas, como distocia e traumas durante o parto. Quanto a mortalidade perinatal, em 78,57% dos casos houve um diagnostico conclusivo, e as causas infecciosas associadas a infecções bacterianas corresponderam a 64,1% desses diagnósticos.(AU)

Multiple Brain Abscesses by an Air Gun Shot: A Case Report

Introduction Low-velocity penetrating brain injury is not prevalent. In some conditions such as childhood, and with the penetration of a pellet in weak spots of skull, low-velocity penetrating brain injury is expected; however, high-velocity projectiles have also been reported as the cause of severe brain injuries. One of the complications of penetrating brain injury is infection, in which different types ofmicroorganisms play a role. The Streptococcus genus is the leading cause of abscess formation in nontraumatic patients. Multiple brain abscesses are not common. Case Presentation A 10-year-old boy with penetrating brain injury caused by an air gun pellet, who developed signs and symptoms of high intracranial pressure 18 days after the trauma. After the imaging scans and the detection of multiple brain abscesses and severe brain edema, prompt surgical intervention was performed for all three lesions in a single operation. The culture of a pus specimen was positive for Streptococcus species, and, with adequate antibiotic therapy, the patient was discharged from the hospital in good condition. Conclusion Brain injurywith air gun shot is not prevalent. The penetration of a low-velocity air gun pellet in weak points of the skull (such as the orbit, the squamous portion of the temporal bone, and the cranial suture), specially in children, can cause significant brain injuries.

Calidad microbiológica del aire en seis áreas de la microestación biológica- Zoocriadero de la Universidad Nacional Agraria de la Selva ­ Tingo María ­ Perú / Microbiological quality of air in six areas of the biological micro station - Zoocriadero of the Universidad Nacional Agraria de la Selva - Tingo Maria ­ Peru

El presente trabajo de investigación tiene como objetivo evaluar la calidad microbiológica del aire en seis áreas de la Microestación Biológica-Zoocriadero de la Universidad Nacional Agraria de la Selva-Tingo María-Perú; procediéndose de la siguiente manera: Se seleccionaron seis áreas de muestreo (A1: Boletería, A2: Caseta gallito de las rocas, A3: Zona de las tortugas, A4: Caseta del otorongo, A5: Caseta de los monos y A6: Cocina), de los cuales para la determinación de los parámetros físicos (PAS, temperatura, humedad relativa, precipitación y rosa de viento) se obtuvo información de la estación meteorológica de la UNAS y de lecturas directas en campo, para la determinación de las PAS se realizó por el método pasivo obteniéndose la mayor concentración de PAS en el área 1 "Boletería" (12.61 t/km2/mes, 11.08 t/km2/mes y 8.4 t/km2/mes) y la más baja en el área 5 "caseta de los monos" (2.80 t/km2/mes, 2.80 t/km2/mes y 3.2 t/km2/mes); para el análisis microbiológico se realizó por el método de borboteo en líquidos, identificándose 27 géneros entre bacterias y hongos, siendo las bacterias más frecuentes Bacillus sp., Staphylococcus sp., Enterobacter agglomerans, Klebsiella pneumoniae, Enterobacter hafniae y algunas bacterias patógenas para el hombre como Streptococcus sp., Clostridium perfringens, Bacillus anthracis. Los hongos de mayor frecuencia son Penicillium sp., Aspergillius sp., Geotrichum sp., algunos hongos patógenos identificados: Microsporum sp., Epirophyton sp. Por otro lado, para la percepción del público como trabajadores se aplicó encuestas, donde indicaron que la calidad microbiológica del aire en la Microestación Biológica-Zoocriadero es regular(AU)

The objective of this research paper is to assess the microbiological quality of the air in six areas of the Biologial Micro-station and animal breeding farm of the Peruvian Univeristy "Universidad Nacional Agraria de la Selva in Tingo María, Perú", proceeding as follows: Six sampling areas were selected (A1: Ticket Office, A2: Cock-of-the-Rock hut, A3: Turtle area, A4: Otorongo hut, A5: Monkey hut, A6: Kitchen), of wich for the determination of the phisical parameters (SBP, temperature, relative humidity, precipitation and wind rose) information was obtained from the UNAS meteorological station and direct readings in the field. For the determination of SBP was performed by the passive method obtaining the high concentration of SBP in area 1 "Ticket Office" (12.61 t/km2/month, 11.08 t/km2/month and 8.4 t/km2/month) and the lowest in area 5 "monkey house" (2.80 t/km2/month, 2.80 t/km2/month and 3.2 t/km2/month); microbiological analysis was performed by the liquid bubbling method, identifying 27 genera incluiding bacteria and fungi, with the most frequent bacteria being Bacillus sp., Staphylococcus sp., Enterobacter agglomerans, Klebsiella pneumoniae, Enterobacter hafniae and some bacteria pathogenic for humans such as Streptococcus sp., Clostridium perfringens and Bacillus anthracis. The most frequent fungi are Penicillium sp., Aspergillius sp. and Geotrichum sp.; some pathogenic fungi identified: Microsporum sp., Epirophyton sp. On the other hand,regarding the perception of the public and workers, surveys were applied, wich indicated that the microbiologial quality of the air in the Biological Micro-station and animal breeding farm is regular(AU)

Streptococcus gallolyticus subsp. pasteurianus: un agente inusual ocasionando una infección común / Streptococcus gallolyticus subsp. pasteurianus: a common infection caused by an unusual agent

Resumen Introducción: Streptococcus gallolyticus subsp. pasteurianus es un coco grampositivo, catalasa negativo, perteneciente al grupo D de Lancefield, que se encuentra relacionado con cuadros de sepsis neonatal, específicamente con meningitis. Caso clínico: Se reporta el caso de un paciente de 2 meses con un cuadro de meningitis por S. gallolyticus subsp. pasteurianus. Se describen la sintomatología y el abordaje diagnóstico y terapéutico. Asimismo, se realiza una revisión de la literatura que evidencia el subdiagnóstico de este agente como causa de meningitis en pediatría. Conclusiones: Este caso representa el primer aislamiento de este agente en el Hospital Nacional de Niños de Costa Rica, de la Caja Costarricense de Seguro Social.

Abstract Background: Streptococcus gallolyticus subsp. pasteurianus is a positive Gram stain, catalase negative coccus that belongs to the Lancefield group D. It is associated with clinical manifestations such as neonatal sepsis and meningitis. Case report: The case of a 2-month-old male patient with meningitis caused by S. gallolyticus subsp. pasteurianus is described. Moreover, the symptoms, diagnosis, and management of the patient are discussed. Also, a review of the literature was conducted showing the sub-diagnosis of this agent as a cause of meningitis in pediatrics. Conclusions: This case represents the first detection of this agent in the National Children's Hospital of Costa Rica, which is part of the Caja Costarricense de Seguro Social.

Capsular genotype distribution of Group B Streptococcus colonization among at-risk pregnant women in Sao Paulo, Brazil

ABSTRACT Background: Vaccines in development against Group B Streptococcus (GBS) should contain the most prevalent capsular genotypes screened in the target population. In low- and middle-income countries epidemiological data on GBS carriage among pregnant women, a prerequisite condition for GBS neonatal sepsis, is needed to inform vaccine strategies. Objective: To investigate the prevalence of different GBS capsular genotypes that colonizes at-risk pregnant women in a private maternity hospital in São Paulo, Brazil. Methods: GBS strains isolated in routine maternity procedures from at-risk pregnant women from 2014 to 2018 were confirmed by mass spectrometry (MALDI-TOF) with subsequent DNA extraction for identification of capsular genotype through polymerase chain reaction (PCR). Demographic and gestational data were analyzed. Results: A total of 820 Todd-Hewitt broths positive for GBS were selected for streptococcal growth. Recovery and confirmation of GBS by MALDI-TOF were possible in 352. Strains were processed for determination of capsular genotype by PCR. From the total of 352 GBS isolates, 125 strains (35.5%) were genotyped as Ia; 23 (6.5%) as Ib; 41 (11.6%) as II; 36 (10.2%) as III; 4 (1.1%) as IV; 120 (34.1%) as V and 1 strain (0.3%) as VIII. Two isolates (0.7%) were not genotyped by used methodology. No statistically significant correlation between gestational risk factors, demographic data and distribution of capsular genotypes were found. Conclusions: GBS capsular genotypes Ia, Ib, II, III, and V were the most prevalent isolates colonizing at risk pregnant women in the present study. The inclusion of capsular genotypes Ia and V in the composition of future vaccines would cover 69.6% of capsular genotypes in the studied population. No statistically significant differences were observed between capsular genotype and gestational and demographic data and risk factors.

Una neumonía complicada por un germen inusual: Reporte de caso / A pneumonia complicated by an unusual germ: Case report

Resumen El Streptococcus pseudoporcinus es un germen de la clasificación Beta hemolítico, con similitud a Streptococcus agalactiae, con baja incidencia en producción de infección pero principalmente aislado en tracto genitourinario de mujeres embarazadas y relacionado con complicaciones materno-fetales. Reportes en la literatura como infección fuera de este sitio son inusuales, por lo cual presentamos un caso de un hombre de 48 años con infección de tracto respiratorio bajo, compatible con colección neumónica y un derrame paraneumonico complicado, con requerimiento de manejo antibiótico y drenaje por toracostomia. Al realizar el estudio microbiológico se reportó aislamiento de un Streptococcus pseudoporcinus. No hay reportes previos en la literatura como causa de infección en este sitio anatómico.

Abstract Streptococcus pseudoporcinus in a germ of the Beta hemolytic group, similar to Streptococcus agalactiae, with low incidence in the production of infection, and isolated in most of cases from the genitourinary tract of pregnant women and related to maternal and fetal complications; the reports in the literature as infection outside this site are unusual. We describe a case of one 48-year-old man with a low respiratory tract infection with a pneumonic collection and a complicated parapneumonic effusion, requiring antibiotic management and thoracostomy drainage. Isolation of a Streptococcus pseudoporcinus. There is no report in the literatura as a cause of infection in this anatomical site.

Epiglotite na era pós-vacinal ao Haemophilus influenzae tipo B / Epiglottitis in the post Haemophilus influenzae type B vaccine era

A epiglotite, conhecida recentemente como supraglotite, é uma infecção grave da epiglote e estruturas supraglóticas, com consequente obstrução da via aérea superior e risco iminente de morte. Trata-se de emergência médica, e a via aérea do paciente deve ser garantida o mais breve possível. Com o desenvolvimento e introdução da vacinação contra o Haemophilus influenzae tipo B (Hib), houve queda expressiva de sua incidência e mortalidade na faixa etária pediátrica, principalmente em crianças menores de cinco anos, porém, tal redução não foi tão significativa em adultos. A doença passou a ser mais comum em crianças acima de cinco anos e na faixa etária adulta, e agentes como Streptococcus e Staphylococcus tornaram-se os principais responsáveis. Embora rara, ela ainda não foi eliminada, fazendo-se necessário o seu rápido reconhecimento e tratamento, a fim de evitar mortalidade. (AU)

Epiglottitis, recently known as supraglottitis, is a severe infection of the epiglottis and supraglottic structures, leading to upper airway obstruction and imminent risk of death. It is considered a medical emergency and the patient's airway must be cleared as soon as possible. With the development and introduction of the vaccination against Haemophilus influenzae type B (Hib), there has been a significant decline in its incidence and mortality in the pediatric age range, especially in children younger than five years old, yet not so much in adults. The disease has become more common in children older than five years old and in adults, with Streptococcus and Staphylococcus being the main responsible pathogens. Although it is a rare condition, it has not yet been eradicated, making its fast recognition and treatment necessary to decrease the chance of mortality. (AU)

Causes of equine abortion, stillbirth, and perinatal mortality in Brazil / Causas de abortamento, natimortalidade e mortalidade em equinos no Brasil

Abortion and complications in reproduction are important causes of economic loss in horse breeding. Studies of its causal agents can help to identify the primary pathogens or other factors involved and define appropriate measures to reduce its occurrence. This research aimed to investigate the primary causes of equine abortion, stillbirth, and perinatal mortality in regions of Brazil. Tissue from aborted fetuses, stillbirths, neonates and foals submitted to the Biological Institute of São Paulo, Brazil, from January 2010 to July 2013 were processed for viral and bacterial isolation, polymerase chain reaction (PCR), histology, and immunohistochemistry. Bacterial infection was the primary detected cause of abortion, found in 16 of the 53 animals submitted for bacterial analysis followed by viruses analysis in 2 of 105 animals, and noninfectious causes (neonatal isoerythrolysis) in 2 of 105 animals. Fungi were found in a single sample of 53 tested. The most frequent bacteria recovered were Escherichia coli, Enterobacter aerogenes, combined E. coli and Streptococcus spp., Staphylococcus spp., and Bacillus spp. The following agents were each observed in a single sample: Arcanobacterium pyogenes, Streptococcus spp., Corynebacterium spp., Actinobacillus spp., and Rhodococcus equi. The predominant identification of fecal and other opportunistic bacteria as opposed to pathogens commonly associated with equine abortion, such as Leptospira spp. and equine herpesvirus type 1 (EHV-1), suggests the need of improving hygiene management of breeding mares to prevent bacterial infection that may cause fetal loss, stillbirth, and perinatal mortality.(AU)

Abortamento e complicações na reprodução são importantes causas de perda econômica na equideocultura. Estudos dos agentes causais podem ajudar a identificar patógenos ou outros fatores envolvidos e definir medidas apropriadas para reduzir sua ocorrência. Esta pesquisa investigou as causas primárias de aborto, natimortalidade e mortalidade perinatal em equinos de diversas regiões do Brasil. Tecidos de fetos abortados, natimortos e potros submetidos ao Instituto Biológico de São Paulo, Brasil, no período de janeiro de 2010 a julho de 2013, foram processados por meio de técnicas de isolamento viral e bacteriano, PCR, histologia e imuno-histoquímica. Infecção bacteriana foi a causa mais detectada, encontrada em 16 de 53 amostras submetidas à análise bacteriana, seguida de causa viral em 2 de 105 amostras, e causas não infecciosas (isoeritrólise neonatal) em 2 de 105 amostras. Fungo foi encontrado em uma única amostra de 53 testadas. As bactérias isoladas mais frequentemente foram Escherichia coli, Enterobacter aerogenes, E. coli associada a Streptococcus spp., Staphylococcus spp. associado a Bacillus spp. Os seguintes agentes foram observados em uma única amostra cada: Arcanobacterium pyogenes, Streptococcus spp., Corynebacterium spp., Actinobacillus spp. e Rhodococcus equi. A identificação predominante de bactérias fecais e outras bactérias oportunistas, ao invés de outros patógenos comumente associados a quadros de abortamento equino, tais como Leptospira spp. e Herpesvírus equino tipo 1, sugere a necessidade de maior atenção no manejo higiênico das éguas em reprodução, a fim de prevenir infecções bacterianas que possam causar perda fetal, natimortalidade e mortalidade perinatal.(AU)

Antimicrobial resistance in bacteria isolated from pigs with respiratory clinical signs in Brazil / Resistência a antimicrobianos em bactérias isoladas de suínos com sinais clínicos respiratórios no Brasil

Antimicrobial resistance is a current and important issue to public health, and it is usually associated with the indiscriminate use of antimicrobials in animal production. This study aimed to evaluate the antimicrobial susceptibility profile in bacterial isolates from pigs with clinical respiratory signs in Brazil. One hundred sixty bacterial strains isolated from pigs from 51 pig farms in Brazil were studied. In vitro disk-diffusion method was employed using 14 antimicrobial agents: amoxicillin, penicillin, ceftiofur, ciprofloxacin, enrofloxacin, chlortetracycline, doxycycline, oxytetracycline, tetracycline, erythromycin, tilmicosin, florfenicol, lincomycin, and sulfadiazine/trimethoprim. The majority of isolates were resistant to at least one antimicrobial agent (98.75%; 158/160), while 31.25% (50/160) of the strains were multidrug resistant. Streptococcus suis and Bordetella bronchiseptica were the pathogens that showed higher resistance levels. Haemophilus parasuis showed high resistance levels to sulfadiazine/trimethoprim (9/18=50%). We observed that isolates from the midwestern and southern regions exhibited four times greater chance of being multidrug resistant than the isolates from the southeastern region studied. Overall, the results of the present study showed a great level of resistance to lincomycin, erythromycin, sulfadiazine/trimethoprim, and tetracycline among bacterial respiratory pathogens isolated from pigs in Brazil. The high levels of antimicrobial resistance in swine respiratory bacterial pathogens highlight the need for the proper use of antimicrobials in Brazilian pig farms.(AU)

A resistência antimicrobiana é uma questão atual e muito importante para a saúde pública, geralmente associada ao uso indiscriminado de antimicrobianos na produção animal. Diante disso, foi investigado o perfil de sensibilidade-antimicrobiana em isolados bacterianos de suínos com sinais clínicos respiratórios no Brasil. Foram estudadas 96 isolados provenientes de 51 granjas de suínos do Brasil. O método de disco-difusão foi empregado usando 14 antimicrobianos: amoxicilina, penicilina, ceftiofur, ciprofloxacina, enrofloxacina, clortetraciclina, doxiciclina, oxitetraciclina, tetraciclina, eritromicina, tilmicosina, florfenicol, lincomicina e sulfadiazina/trimetoprim. Streptococcus suis e Bordetella bronchiseptica foram os patógenos que apresentaram maiores níveis de resistência. Haemophilus parasuis apresentou altos níveis de resistência à sulfadiazina/trimetoprim (9/18=50%). Observou-se que isolados das regiões Centro-Oeste e Sul apresentaram quatro vezes mais chance de serem multirresistentes do que os isolados da região Sudeste. A maioria foi resistente a pelo menos um agente antimicrobiano (98,75%; 158/160) e 31,25% (50/160) das estirpes isoladas eram multirresistentes. No geral, os resultados do presente estudo mostraram grande nível de resistência à lincomicina, eritromicina, sulfadiazina/trimetoprim e tetraciclina entre patógenos respiratórios bacterianos isolados de suínos no Brasil. Os altos níveis de resistência antimicrobiana em patógenos bacterianos respiratórios em suínos reforçam a necessidade do uso criterioso de antimicrobianos na suinocultura brasileira.(AU)

Efecto antibacteriano y antioxidante de frutos rojos ecuatorianos sobre streptococcus mutans: estudio in vitro / Antibacterial and antioxidant effect of ecuadorian red fruits on streptococcus mutans: in vitro study

Resumen Objetivo: Evaluar mediante cuantificación de halos de inhibición el efecto antibacteriano de la cáscara y pulpa del capulí (Prunus serotina capulí) y del mortiño (Vaccinium floribundum), sobre cepas de Streptococcus mutans (ATCC 35668) a las 24 y 48 horas, comparado con arándano deshidratado y gluconato de clorhexidina al 0,12%. Materiales y métodos: Estudio experimental transversal in vitro, 15 cajas petri fueron utilizadas para sembrar 20ml de cultivo de cepas de Streptococcus mutans. En cada caja fueron colocados discos de fieltro impregnados con 20 μl de las sustancias evaluadas; mortiño y capulí, en pulpa y en cáscara, arándano deshidratado y gluconato de clorhexidina al 0,12% como control, distribuidos a una distancia equidistante. El análisis del efecto antibacteriano se realizó midiendo la zona de inhibición en un tiempo de 24 y 48 horas de incubación, los datos obtenidos se analizaron estadísticamente en el programa SPSS 22 mediante las pruebas paramétricas y de Kruskal Wallis. Resultados: No existió diferencia estadística significativa entre las variables analizadas, capulí y mortiño tanto en cáscara como en pulpa y clorhexidina empleada como control, en los dos períodos evaluados (p= > 0,05). Conclusiones: Los frutos rojos analizados tienen un efecto antibacteriano a las 24 y 48 horas, lo cual guarda relación con su capacidad antioxidante.

Abstract Objective: To evaluate by quantification of halos of inhibition, the antibacterial effect of the shell and pulp of capulí, (Prunus serotina capuli) and mortiño (Vaccinium floribundum), on strains of Streptococcus mutans (ATCC 35668) at 24 and 48 hours, compared with dehydrated cranberry and chlorhexidine gluconate at 0,12%. Materials and methods: In vitro cross-sectional experimental study, 15 petri dishes were used to plant 20 ul of the evaluated substances were placed in each box, mortiño, and capuli, in pulp and in shell, dehydrated cranberry and 0,12% chlorhexidine gluconate as control, distributed at an equidistant distance. The analysis of the antibacterial effect was performed by measuring the zone of inhibition in a time of 24 and 48 hours of incubation, the dataobtained were statistically analyzed in the SPSS 22 program by parametric and Kruskal Wallis tests. Results: There was no significant statistical difference between the analyzed variables, capuli and mortiño, both in skin and pulp and chlorhexidine used as control, in the two evaluated periods of time (p=>0,05). Conclusions: The red fruits analyzed have an antibacterial effect 24 and 48 hours, which is related to its antioxidant capacity.

Toxic shock syndrome caused by Streptococcus dysgalactiae subsp. equisimilis in a Mexican preschool patient / Síndrome de choque tóxico por Streptococcus dysgalactiae subsp. equisimilis en un paciente preescolar mexicano

Abstract Background: Severe infections due to Streptococcus dysgalactiae subsp. equisimilis (SDSE) have been identified in adults and may cause toxic shock syndrome, although with a low frequency. Case report: A preschool-age female patient, who started with an upper respiratory tract infection developing a gradual deterioration in the following three days, is described. She was admitted to the hospital in severe conditions, with tachypnea, tachycardia (200/min), hypotension (blood pressure 68/40 mmHg), capillary refill of 7 s, and erythematous maculopapular rash in thorax, abdomen and lower extremities. She received intensive management with an inadequate response. Furthermore, she developed multiple organ failure and died 8 h after admission. The blood culture was positive for S. dysgalactiae subsp. equisimilis. Conclusions: SDSE is a rare pathogen in children. In Mexico, cases of SDSE have not been reported probably due to an inaccurate identification. Mexican pediatricians should be alert to this situation.

Resumen Introducción: En adultos, se han identificado infecciones graves por Streptococcus dysgalactiae subsp. equisimilis (SDSE), que pueden causar el síndrome de choque tóxico causado por SDSE, aunque es de baja frecuencia. Caso clínico: Paciente de sexo femenino en edad preescolar. Comenzó con una infección del tracto respiratorio superior, y desarrolló un deterioro gradual en los siguientes tres días. Ingresó en el hospital en condiciones graves, con taquipnea, taquicardia (200/min), hipotensión (tensión arterial, TA 68/40 mmHg), llenado capilar de 7 s y erupción maculopapular eritematosa en el tórax, abdomen y extremidades inferiores. Recibió manejo intensivo, sin una buena respuesta. Posteriormente, desarrolló datos de falla orgánica múltiple y murió 8 h después de su ingreso. El hemocultivo fue positivo para S. dysgalactiae subsp. equisimilis. Conclusiones: El SDSE es un patógeno raro en los niños. En México, no se han reportado casos de SDSE probablemente debido a una identificación errónea. Los pediatras mexicanos deben estar atentos a esta situación.

Endocardite infecciosa por aggregatibacter actinomycetemcomitans em pacientes predispostos / Infective endocarditis by aggregatibacter actionomycetemcomitans in predisposed patients

A endocardite infecciosa (EI) corresponde a uma infecção microbiana do endocárdio com presença de coágulo de plaquetas e fibrina em seu interior. Quando é de origem periodontal, a Aggregatibacter actinomycetemcomitans (Aa) é a bactéria mais relacionada com a ocorrência dessa doença. Foi avaliada a presença de Aa em gengivites e periodontites de pacientes hospitalizados e sua associação na predisposição à EI. Métodos: Realizou-se a sondagem periodontal em 15 pacientes de um hospital de Itajaí, SC com gengivites e periodontites, entre 18 a 75 anos de idade, de ambos os sexos, considerados em risco de EI. Usou-se um dente de cada paciente como amostra, coletado em cones de papel esterilizado, transferência em recipientes e processamento no laboratório. As amostras foram homogeneizadas e alíquotas de 0,1 ml foram semeadas em duplicata em placas de ágar sangue, incubadas por cinco dias em microaerofilia a 37 O C. Depois da visualização das colônias bacterianas características, foram realizadas provas bioquímicas e reação de catalase. O diagnóstico de EI foi realizado seguindo os critérios de Duke modificado. Conclusão: Não houve incidência de pacientes com risco de EI relacionada com presença da Aa nos participantes avaliados

Objective: Infective endocarditis (IE) corresponds to a microbial infection of the endocardium with the presence of platelet and fibrin clotting in its interior. When it is of periodontal origin, Aggregatibacter actinomycetemcomitans (Aa) is the bacterium most often related to the occurrence of this disease. The presence of Aa in the gingivitis and periodontitis of hospitalized patients and its association with predisposition to IE were evaluated. Methods: Periodontal probing was performed in 15 patients with gingivitis and periodontitis, aged 18 and 75 years, of both genders, and considered at risk for IE at a hospital in Itajaí ­ SC. One tooth of each patient was used for the sample, which was collected in cones of sterilized paper, transferred in containers, and processed in the laboratory. The samples were homogenized and aliquots of 0.1 ml were seeded in duplicate in blood agar plates, incubated for five days in microaerophylia at 37ºC. Following visualization of characteristic bacterial colonies, biochemical and catalase reaction tests were conducted. The diagnosis of IE was performed following the modified Duke criteria. Conclusion: There was no incidence of patients at risk of IE related to the presence of Aa in the participants evaluated

Frequency of microorganisms isolated at different stages of lactation and milk production loss associated with somatic cell count and to mastitis-causing pathogens / Frequência de microrganismos isolados em diferentes fases da lactação e perda de produção de leite associada à contagem de células somáticas e aos patógenos causadores de mastite

The aim of this study was to evaluate the frequency of isolation of agents causing subclinical mastitis in a herd and to estimate production losses associated with SCC> 200,000cells/mL. Three 7-day interval microbiological cultures were performed in all lactating animals from the same farm that was evaluated from June to July. To evaluate the negative and positive isolation frequencies between the lactation phases, a Chi-square test was performed. Simple linear regressions were performed to evaluate the lactation curve of animals grouped by pathogens isolated from negative cows in the microbiological culture and with SCC <200,000cells/mL. To estimate the production losses between the groups, regression coefficients were used. Results found in this experiment were: Culture-negative cows with SCC ≥ 200,000cells/mL, cows testing positive in milk culture, with SCC <200,000cells/mL and cows testing positive in milk culture, with SCC ≥ 200,000cells/mL. Milk production was -3.5; -0.5 and -4.27kg, respectively, when compared to culture-negative cows with SCC <200,000cells/mL. Cows infected with yeast cells, Coagulase-negative staphylococci (CNS), Staphylococcus aureus and environmental streptococci produced -3.42; -0.5; -0.168 and -2.5kg of milk when compared to culture-negative cows with SCC <200,000cells/mL. SCC indicates an inflammatory reaction in the mammary gland and it is directly associated with milk production losses and with presence of microorganisms in the mammary gland.(AU)

O objetivo deste estudo foi avaliar a frequência de isolamento de agentes causadores de mastite subclínica em um rebanho e estimar as perdas de produção associadas com CCS>200.000 cél./mL. Três cultivos microbiológicos intervalados por sete dias foram realizados em todos os animais em lactação da propriedade avaliada, no período de junho a julho. Para avaliar as frequências de isolamento negativo e positivo entre as fases da lactação, foi realizado um teste de qui-quadrado. Foram realizadas regressões lineares simples para avaliar a curva de lactação dos animais agrupados por patógenos isolados em relação a vacas negativas na cultura microbiológica e com CCS < 200.000 cél./mL. Os coeficientes das regressões foram utilizados para estimar as perdas de produção entre os grupos. Vacas com resultado negativo na microbiologia, mas com CCS ≥ 200.000 cél./mL, positivas na microbiologia com CCS < 200.000 cél./mL e positivas com CCS ≥ 200.000 cél./mL, produziram por dia, respectivamente, -3,5; -0,5 e -4,27kg de leite em relação às vacas negativas com CCS < 200.000 cél./mL. Vacas infectadas com células leveduriformes, Staphylococcus coagulase negativa, Staphylococcus aureus e Streptococcus ambientais produziram, respectivamente, -3,42; -0,5; -0,168 e -2,5kg de leite, comparadas a vacas negativas com CCS < 200.000 cél./mL. A CCS, indicativa de reação inflamatória, encontra-se diretamente associada às perdas de produção de leite, assim como a presença do microrganismo na glândula mamária.(AU)

Comparison of rRNA-based reverse transcription PCR and rDNA-based PCR for the detection of streptococci in root canal infections

Abstract Objective The rDNA-based method is unable to distinguish between alive and dead cells. Alternatively, bacterial viability can be assessed by molecular methods based on ribosomal RNA (rRNA). Therefore, this study aimed to detect viable streptococci in root canal samples using rRNA-based reverse transcription polymerase chain reaction (RT-PCR), compared to an rDNA-based PCR assay. Methodology Microbiological root canal samples were obtained from 32 teeth with primary endodontic infections before (S1) and after chemomechanical preparation (S2), and after removal of intracanal medication (S3). RNA and DNA were extracted, and complementary DNA (cDNA) was synthesized from RNA using RT reaction. cDNA and genomic DNA were subjected to PCR with primers complementary to the 16S rRNA sequences of Streptococcus spp. McNemar's test was used to compare the detection rate of both assays (P<0.05). Results Streptococci were detected in 28.12% (9/32) and 37.5% (12/32) of S1 samples using rRNA- and rDNA-based PCR assays, respectively. In contrast, they were detected in only 6.25% (2/32) of S2 samples using rRNA-based RT-PCR, compared to 15.62% (5/32) using rDNA-based PCR. Finally, in S3 samples, streptococci were not detected by rRNA, whereas rDNA-based PCR still detected the bacteria in 12.5% (4/32) of the samples. The total number of PCR-positive reactions in the rDNA-based PCR was higher than in the rRNA-based assay (P<0.05). Conclusions The rRNA-based RT-PCR showed a lower detection rate of streptococci when compared to the rDNA-based PCR, suggesting that the latter may have detected dead cells of streptococci in root canal samples.

Evaluation of an antibacterial orthodontic adhesive incorporated with niobium-based bioglass: an in situ study

Abstract This in situ study aimed to evaluate the antibacterial and anti-demineralization effects of an experimental orthodontic adhesive containing triazine and niobium phosphate bioglass (TAT) around brackets bonded to enamel surfaces. Sixteen volunteers were selected to use intra-oral devices with six metallic brackets bonded to enamel blocks. The experimental orthodontic adhesives were composed by 75% BisGMA and 25% TEGDMA containing 0% TAT and 20% TAT. Transbond XT adhesive (TXT) was used as a control group. Ten volunteers, mean age of 29 years, were included in the study. The six blocks of each volunteer were detached from the appliance after 7 and 14 days to evaluate mineral loss and bacterial growth including total bacteria, total Streptococci, Streptococci mutans, and Lactobacilli. Statistical analysis was performed using GLM model - univariate analysis of variance for microhardness and 2-way ANOVA for bacterial growth (p<0.05). The 20% TAT adhesive caused no difference between distances from bracket and the sound zone at 10-µm deep after 7 and 14 days. After 14 days, higher mineral loss was shown around brackets at 10- to 30-µm deep for TXT and 0% TAT adhesives compared to 20% TAT. S. mutans growth was inhibited by 20% TAT adhesive at 14 days. Adhesive with 20% TAT showed lower S. mutans and total Streptococci growth than 0% TAT and TXT adhesives. The findings of this study show that the adhesive incorporated by triazine and niobium phosphate bioglass had an anti-demineralization effect while inhibiting S. mutans and total Streptococci growth. The use of this product may inhibit mineral loss of enamel, preventing the formation of white spot lesions.

Susceptibility to β-lactams in β-hemolytic streptococci / Sensibilidad a los β-lactámicos en estreptococos β-hemolíticos

Group A (GAS), B (GBS), c (GCS) and G (GGS) β-hemolytic streptococci are important human pathogens. They cause infections of different severity and frequency. Nowadays, after 70 years of use, penicillin is still universally active against GAS, GCS and GGS. However, therapeutic failures have been recorded in 2-28% of pharyngitis cases (median: 12%) attributable to different causes. By contrast, some GBS with reduced susceptibility to penicillin have been described, especially in Japan. In this group of bacteria, it is important to highlight that confirmation by reference methods is mandatory when decreased susceptibility to penicillin is suspected as well as checked for the detection of the mechanisms involved.

Los estreptococos β-hemolíticos de los grupos A (GAS), B (GBS), C (GCS) y G (GGS) son importantes patógenos humanos. Ellos producen infecciones de diversa gravedad y frecuencia. Aún después de más de 70 años de uso, la penicilina sigue siendo activa in vitro frente al 100% de los GAS, GCS y GGS. No obstante se han producido fallas terapéuticas entre el 2-28% de los casos de faringitis (media: 12%), atribuibles a diversas causas. En cambio se han descrito aislados de GBS con sensibilidad reducida a la penicilina, especialmente en Japón. Es importante que toda sospecha de sensibilidad disminuida a la penicilina en este grupo de bacterias sea confirmada por los métodos de referencia y comprobada mediante la detección de los mecanismos involucrados.

Direct identification of bovine mastitis pathogens by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry in pre-incubated milk

ABSTRACT The present study aimed to compare two MALDI-TOF identification methods [(a) direct sample identification after pre-incubation; or (b) use of bacteria isolated on pre-culture)] to standard, traditional bench microbiology. A total of 120 quarter milk samples from 40 Holstein lactating cows were screened based on culture-positive results obtained by microbiological culture (reference method) with the following numbers of quarters positive per cow: 4 cows with 1, 8 cows with 2, 12 cows with 3 and 16 cows with 4 infected quarters per cow. For direct identification method, quarter milk samples (n = 120) were skimmed by centrifugation (10,000 × g/10 min) and pre-incubated at 37 ºC for 12 h. After pre-incubation, quarter milk samples were submitted to total bacterial count by flow cytometry and for a preparation protocol for bacterial ribosomal protein extraction followed by MALDI-TOF MS analysis. The direct MALDI-TOF MS identification method compared to microbiological culture correctly identified isolates of coagulase-negative Staphylococci (27.2%), Streptococcus agalactiae (21.8%), Staphylococcus aureus (14.2%), and Streptococcus uberis (5.2%). The pre-incubation protocol of milk samples, associated to the direct identification method by MALDI-TOF MS, did not increase the identification at species level (score >2.0) of pathogens causing subclinical mastitis in comparison to the method without previous incubation.