The Use of Multiple Biomarkers to Assess the Health of Anuran Amphibians in the Brazilian Cerrado Savanna: An Ecotoxicological Approach.

Changes in the natural landscape and the indiscriminate use of pesticides can have a major impact on aquatic environments and have contributed to the worldwide decline of amphibian populations. In the present study, we sampled tadpoles of three anuran amphibians (Boana albopunctata, Physalaemus cuvieri, and Dendropsophus minutus) from ponds in six different agricultural landscapes of the Brazilian Cerrado savanna and evaluated whether and to what extent genotoxic and mutagenic damage was related to land use (the amount of forest and agricultural remnants, and related physicochemical factors) and the presence of pesticides in the water of the study ponds. We also evaluated the hepatotoxicity in P. cuvieri, which was the most abundant species at five of the six sampling points. Clomazone and atrazine were the most common pesticides found in the ponds. The B. albopunctata and P. cuvieri tadpoles presented similar patterns of DNA damage among the sampling points. The least DNA damage was found in the D. minutus tadpoles, although this species was present in only one of the study ponds. More binucleated and anucleated cells were observed in B. albopunctata, but there was no significant variation among species in terms of the number of micronuclei or other erythrocytic nuclear abnormalities. Land use and physicochemical factors did not explain the variation in the DNA damage observed in the three anurans. The hepatotoxicity analyses of P. cuvieri revealed the presence of a series of alterations, including the enlargement of the sinusoids, vacuolization of the hepatocytes, the infiltration of inflammatory cells, hepatic steatosis, and dilation of the blood vessels. The interaction between physicochemical factors and the biomarkers analyzed in the present study is complex. In particular, it will be important to better elucidate which factors are contributing, either directly or indirectly, to the decline of anuran amphibian populations, especially in threatened biomes, such as the Brazilian Cerrado. In this case, we would encourage further in situ studies that assess the ecotoxicology of the landscape, together with the systematic monitoring of aquatic environments, to guarantee the long-term integrity of amphibian populations, and those of other organisms that play an essential functional role in the ecosystem. Environ Toxicol Chem 2023;42:2422-2439. © 2023 SETAC.

Assessment of multiple biomarkers in Lithobates catesbeianus (Anura: Ranidae) tadpoles exposed to zinc oxide nanoparticles and zinc chloride: integrating morphological and behavioral approaches to ecotoxicology.

The ecotoxicological risk to vertebrates posed by zinc oxide nanoparticles (ZnO NPs) is still poorly understood, especially in animals with a biphasic life cycle, which have aquatic and terrestrial phases, such as amphibians. In the present study, we investigated whether acute exposure (7 days) to ZnO NPs and zinc chloride (ZnCl2) at three environmentally relevant concentrations (0.1, 1.0, and 10 mg L-1) induces changes in the morphology, chondrocranium, and behavior of the tadpoles of Lithobates catesbeianus (Anura: Ranidae). Tadpoles exposed to both forms of Zn did not undergo any morphological or behavioral changes at the lowest concentrations (0.1 and 1.0 mg L-1). However, the animals exposed to the highest concentration (10 mg L-1) lacked oral disc structures, were smaller in size, had a longer tail, and presented changes in the position and coiling of the intestine and malformations of the chondrocranium in comparison with the control group. This indicates that ZnO NPs and ZnCl2 altered the development of the tadpoles, causing delays in their metamorphosis and even reducing individual fitness. The tadpoles exposed to both forms of Zn at 10 mg L-1 also had reduced mobility, especially in the presence of conspecifics. Based on these findings, we emphasize the importance of studying morphological, skeletal, and behavioral biomarkers to evaluate the toxic effects of metal-based nanoparticles in amphibians.

Titanium dioxide nanoparticles as a risk factor for the health of Neotropical tadpoles: a case study of Dendropsophus minutus (Anura: Hylidae).

The production and use of titanium dioxide (TiO2) nanoparticles are increasing worldwide. The release of this substance into the environment can induce toxic effects in aquatic invertebrates and vertebrates, although the exact nature of its impacts on Neotropical amphibians is still poorly understood. In this context, the present study evaluated the toxicity of TiO2 nanoparticles and their counterpart-dissolved titanium dioxide (TiO2)-in the tadpoles of Dendropsophus minutus. The biometric parameters, DNA damage, and behavioral changes were verified in tadpoles exposed to three different concentrations (0.1 mg·L-1, 1.0 mg·L-1, and 10 mg·L-1) of TiO2 nanoparticles and dissolved TiO2 for 7 days. We verified significant DNA damage in the D. minutus tadpoles exposed to both forms of Ti, in comparison with the control group. We also identified a reduction in total size, body length, and width, and the height of the musculature of the tail of the tadpoles exposed to all concentrations of both substances in comparison with the control. In the behavioral test, the tadpoles exposed to nanoparticles and dissolved TiO2 presented reduced mobility and a tendency to be less aggregated than normal. Here, the simultaneous use of multiple biomarkers was fundamental for the reliable assessment of the adverse effects of nanomaterials on anuran amphibians and the establishment of a systematic approach to the biomonitoring of aquatic ecosystems. The present study expands our understanding of the genotoxic, morphological, and behavioral effects of TiO2 nanoparticles and dissolved TiO2 on anuran amphibians, and contributes to the establishment of further research for the more systematic assessment of the environmental risk of nanomaterials.

Evaluation of the genotoxic, mutagenic, and histopathological hepatic effects of polyoxyethylene amine (POEA) and glyphosate on Dendropsophus minutus tadpoles.

Herbicides improve the productivity of a monoculture by eliminating weeds, although they may also be toxic and have negative effects on non-target organisms, such as amphibians. The present study evaluated the genotoxic, mutagenic, and histopathological hepatic responses of Dendropsophus minutus tadpoles to acute exposure (96 h) to the herbicide glyphosate (GLY, 65, 130, 260 and 520 µg/L) and the surfactant polyoxyethylene amine (POEA, 1.25, 2.5, 5 and 10 µg/L). On average, 174 % more genomic damage was observed in the tadpoles exposed to all concentrations of POEA in comparison with the control, while up to seven times more micronuclei were recorded, on average, at a concentration of 5 µg/L of POEA. All the individuals exposed to 10 µg/L of POEA died. The tadpoles exposed to GLY presented 165 % more DNA damage than the control, on average, at the highest concentrations (260 and 520 µg/L), and up to six times more micronuclei at 520 µg/L. The Erythrocyte Nuclear Abnormality test (ENA) detected a relatively high frequency of cells with lobed nuclei in the tadpoles expose to POEA at 5 µg/L and binucleated cells in those exposed to GLY at 520 µg/L. The hepatic histopathological observations revealed several types of lesions in the tadpoles exposed to both GLY and POEA. Overall, then, the results of the study indicate that both GLY and POEA have potential genotoxic, mutagenic, and hepatotoxic effects in D. minutus tadpoles. We emphasize the need for further studies to monitor the amphibian populations, such as those of D. minutus, which breed in aquatic environments associated with agricultural areas. The release of pollutants into natural habitats may have significant long-term impacts on the survival of anuran tadpoles.

Ichthyofauna of sandy beaches along the Acre river, Brazil / Ictiofauna de praias arenosas ao longo do rio Acre, Brasil

Abstract: Despite increasing efforts in recent years to catalog the fish diversity of Amazonian rivers, many regions are still under-sampled, and sandy beach environments are particularly poorly understood. The present study focused on a 300 km stretch of the Acre river, in the southwestern Amazon basin, where we sampled 30 sandy beaches separated by a mean interval of 10 km. We collected 15,329 fish representing 80 species, 26 families, and nine orders. The Characiformes were the most abundant order, providing 88.24% of the individuals collected, followed by the Siluriformes, with 10.03%, while the Siluriformes had the highest species richness, with 37 species (45.0%), followed by the Characiformes, with 30 (37.5%). The most abundant species were the characiforms Knodus orteguasae and Creagruto barrigai. Reliable data on a region's biota is fundamental for the evaluation of patterns of biodiversity, and the occurrence and management of threatened species. As fish are directly affected by pollutants and the degradation of aquatic environments, further research in areas that are still poorly sampled will be essential for the elaboration of effective conservation strategies.

Resumo: Apesar dos crescentes esforços para catalogar a diversidade de peixes nos rios amazônicos, muitas regiões ainda estão sub-amostradas e os ambientes de praias arenosas são particularmente pouco compreendidos. Este estudo foi realizado ao longo de um trecho de 300 km do Rio Acre, no sudoeste da bacia amazônica, onde foram amostradas 30 praias, separadas por uma distância média de 10 km. Foram coletados 15.329 peixes, representados em 80 espécies, 26 famílias e nove ordens. Characiformes foi a ordem mais abundante, representando 88,24% dos indivíduos coletados, seguidos pelos Siluriformes, com 10,03%, enquanto os Siluriformes apresentaram a maior riqueza, com 37 espécies (45,0%), seguidas pelos Characiformes, com 30 espécies (37,5%). As espécies mais abundantes foram os characiformes Knodus orteguasae e Creagruto barrigai. Dados confiáveis sobre a biota de uma região são fundamentais para a avaliação dos padrões de biodiversidade e conhecimento sobre a ocorrência e manejo de espécies ameaçadas. Como os peixes são diretamente afetados por poluentes e pela degradação dos ambientes aquáticos, mais pesquisas em áreas que ainda são pouco amostradas serão essenciais para a elaboração de estratégias eficazes de conservação.

Anthropogenic substrate-borne vibrations impact anuran calling.

Anthropogenic disturbance is a major cause of the biodiversity crisis. Nevertheless, the role of anthropogenic substrate vibrations in disrupting animal behavior is poorly understood. Amphibians comprise the terrestrial vertebrates most sensitive to vibrations, and since communication is crucial to their survival and reproduction, they are a suitable model for investigating this timely subject. Playback tests were used to assess the effects of substrate vibrations produced by two sources of anthropogenic activity- road traffic and wind turbines- on the calling activity of a naïve population of terrestrial toads. In their natural habitat, a buried tactile sound transducer was used to emit simulated traffic and wind turbine vibrations, and changes in the toads' acoustic responses were analyzed by measuring parameters important for reproductive success: call rate, call duration and dominant frequency. Our results showed a significant call rate reduction by males of Alytes obstetricans in response to both seismic sources, whereas other parameters remained stable. Since females of several species prefer males with higher call rates, our results suggest that anthropogenically derived substrate-borne vibrations could reduce individual reproductive success. Our study demonstrates a clear negative effect of anthropogenic vibrations on anuran communication, and the urgent need for further investigation in this area.

Ecotoxicity of nanomaterials in amphibians: A critical review.

Nanomaterials (NMs) have been used in a growing number of commercial products, and their rapid expansion could lead to their release into the aquatic environments. However, there is limited knowledge about the impact of NMs in the biota, especially the amphibians. The present study revised the historical use of amphibian species as a model system for nanoecotoxicological studies and summarized the data available in the scientific literature about the genotoxic, mutagenic, histopathological, embryotoxic and reproductive effects of NMs in different groups of amphibians. The interaction, bioaccumulation, mode of action (MoA) and ecotoxicity of NMs on amphibians were also revised. The nanoecotoxicological studies were conducted with 11 amphibian species, being eight species of the order Anura and three species of the order Caudata. Xenopus laevis was the most studied species. The studies were conducted mainly with inorganic NMs (72%) compared to organic ones. The nanoecotoxicity depends on NM behavior and transformation in the environment, as well as the developmental stages of amphibians. The known effects of NMs in amphibians were mainly reported with reactive oxygen species (ROS) production, oxidative stress, and genotoxic effects. Results emphasize the need for further studies testing the ecotoxicity of different NMs, concentrations and exposure periods at environmentally relevant approaches. Furthermore, standard protocols for nanoecotoxicological tests using amphibians are required. Revised data showed that amphibians are suitable organisms to assess the environmental impact of NMs and indicated significant research gaps concerning the ecotoxicity of NMs on freshwater ecosystems and recommendations for future researches.

Efficacy of bilevel ventilatory support in the treatment of stable patients with obesity hypoventilation syndrome: systematic review and meta-analysis.

OBJECTIVE: To systematically review the effects of bilevel ventilatory support (BVS) in patients with Obesity Hypoventilation Syndrome (OHS). METHODS: A search of databases (MEDLINE accessed by PubMed, Cochrane CENTRAL, EMBASE and LILACS) was conducted from inception to June 2018. Randomized trials comparing BVS to other therapeutic modalities such as lifestyle counseling, continuous positive airway pressure (PAP) or BVS with average volume assured pressure support for the treatment of patients with OHS were included. The primary outcome was a change in daytime arterial carbon dioxide levels (PaCO2). Secondary outcome measures included arterial partial pressure of oxygen (PaO2), blood bicarbonate (HCO3), percentage of total sleep time (TST) with oxygen saturation <90%, transcutaneous pressure of carbon dioxide (PtcCO2), Epworth Sleepiness Scale (ESS), Medical Outcome Survey Short Form (SF36), Functional Outcomes of Sleep Questionnaire (FOSQ), Severe Respiratory Insufficiency Questionnaire (SRI), compliance with treatment, and weight loss. RESULTS: Of 176 articles identified, seven studies were included. When BVS was compared to lifestyle counseling, the intervention was superior in improving PaCO2 (-2.90 mmHg; 95%CI -4.28 to -1.52), PaO2 (2.89 mmHg; 95%CI 0.33 to 5.46), HCO3 (-2.55 mmol/L; 95%CI -3.28 to -1.81), percentage of TST<90% (-30.55%; 95%CI -37.98 to -23.12), ESS (-2.52; 95%CI -4.16 to -0.88) and FOSQ (6.33; 95%CI 1.78 to 10.88). However, when BVS was compared to other PAP modalities, there was no difference in any of the outcomes evaluated. CONCLUSIONS: Treatment using BVS therapy is superior to lifestyle counseling. Different PAP modalities appear to be equally effective in improving outcomes. CRD42017065326.

Cytogenetics of two hylid frogs from Brazilian Cerrado.

Cytogenetic data can be useful for taxonomic and phylogenetic studies, as well as to provide information about chromosome evolution. Therefore, it may help design conservation priorities for some threatened species, such as anurans. Herein, we describe the karyotypes of Scinax constrictus and Ololygon centralis, native endemic species from the Brazilian Cerrado. Chromosome preparations for both species were stained with Giemsa for morphological analyses and then impregnated by the Ag-NOR method for localization of the nucleolar organizer region (NOR). Both species had 24 chromosomes, as confirmed by meiotic analyses, which showed 12 bivalents. Chromosome morphologies presented the same pattern for Scinax and Ololygon compared to species already karyotyped in both genera. The NOR was interstitially located in the long arm of pair 7 in S. constrictus, whereas in O. centralis it was found near the centromere in the long arm of pair 1, thus diverging from what is commonly found for other Ololygon species. Therefore, we provide the first description of the karyotype of O. centralis and the first report of the localization of the NOR for the karyotype of both species. Our study increases the cytogenetic knowledge in species of the genera Scinax and Ololygon, and provide support for further studies on the taxonomy, ecology, and evolution of hylid anurans.

The aggressive call of Dendropsophus cruzi (Pombal Bastos, 1998) (Anura; Hylidae) in Central Brazil.

Dendropsophus cruzi (Pombal Bastos, 1998) is a small hylid (male snout-to-vent length = 16.3-19.4 mm; female SVL = 21.3-25.0 mm) that is allocated in the D. microcephalus group (Faivovich et al. 2005). It is commonly found in Open and forested areas from Central Brazil to Provincia Velasco, Departamento de Santa Cruz, Bolivia (Frost 2017; Tessarolo et al. 2016). Pombal Bastos (1998) described the advertisement call of D. cruzi as a single pulsed note. Posteriorly, studies uncovered relationships between dominant frequency variation in the advertisement calls of D. cruzi and variation in the SVL and mass of males (Bastos et al. 2003), as well as the existence of a clinal geographic pattern in the variation of acoustic parameters of these calls (Tessarolo et al. 2016). However, the acoustic communication in anurans is usually mediated by more than one vocalization type (Toledo et al. 2015). Due the importance of call types in the social context of anurans (e.g., Reichert 2011; Forti et al. 2017), we expand the vocal repertoire of D. cruzi by describing its aggressive call.

The advertisement calls of Brazilian anurans: Historical review, current knowledge and future directions.

Advertisement calls are often used as essential basic information in studies of animal behaviour, ecology, evolution, conservation, taxonomy or biodiversity inventories. Yet the description of this type of acoustic signals is far to be completed, especially in tropical regions, and is frequently non-standardized or limited in information, restricting the application of bioacoustics in science. Here we conducted a scientometric review of the described adverstisement calls of anuran species of Brazil, the world richest territory in anurans, to evaluate the amount, standard and trends of the knowledge on this key life-history trait and to identify gaps and directions for future research strategies. Based on our review, 607 studies have been published between 1960 to 2016 describing the calls of 719 Brazilian anuran species (68.8% of all species), a publication rate of 10.6 descriptions per year. From each of these studies, thirty-one variables were recorded and examined with descriptive and inferential statistics. In spite of an exponential rise over the last six decades in the number of studies, described calls, and quantity of published metadata, as revealed by regression models, clear shortfalls were identified with regard to anuran families, biomes, and categories of threat. More than 55% of these species belong to the two richest families, Hylidae or Leptodactylidae. The lowest percentage of species with described calls corresponds to the most diverse biomes, namely Atlantic Forest (65.1%) and Amazon (71.5%), and to the IUCN categories of threat (56.8%), relative to the less-than-threatened categories (74.3%). Moreover, only 52.3% of the species have some of its calls deposited in the main scientific sound collections. Our findings evidence remarkable knowledge gaps on advertisement calls of Brazilian anuran species, emphasizing the need of further efforts in standardizing and increasing the description of anuran calls for their application in studies of the behaviour, ecology, biogeography or taxonomy of the species.

Parasitism by larval tapeworms genus Spirometra in South American amphibians and reptiles: new records from Brazil and Uruguay, and a review of current knowledge in the region.

Spargana are plerocercoid larvae of cestode tapeworms of the genus Spirometra, Family Diphyllobothriidae, parasitic to frogs, reptiles, birds and mammals. This parasitic disease in humans can be transmitted through the use and consumption of amphibians and reptiles. The available knowledge about Spirometra in South America is scarce, and there are only a few reports on the occurrence of sparganum in amphibians and reptiles, many of them published in old papers not easily available to researchers. In this work we present a review on this topic, provide new records in two species of amphibians and 7 species of reptiles from Brazil and Uruguay respectively. We also summarize current knowledge of Spirometra in the continent, along with an updated of host taxonomy. We could gather from the literature a total of 15 studies about amphibian and reptile hosts, published between 1850 and 2016, corresponding to 43 case reports, mostly from Brazil (29) and Uruguay (8), Argentina (3), Peru (2), and Venezuela (1); the majority of them related to reptiles (five lizards and 26 snake species), and 14 corresponded to amphibians (9 anurans). Plerocercoid larvae were located in different organs of the hosts, such as subcutaneous tissue, coelomic cavity, peritoneum, and musculature. The importance of amphibians and reptiles in the transmission of the disease to humans in South America is discussed. Relevant issues to be studied in the near future are the taxonomic characterization of Spirometra in the region and the biological risk of reptile meat for aboriginal and other rural communities.

Alternative diagnoses based on CT angiography of the chest in patients with suspected pulmonary thromboembolism.

OBJECTIVE: To determine the prevalence of alternative diagnoses based on chest CT angiography (CTA) in patients with suspected pulmonary thromboembolism (PTE) who tested negative for PTE, as well as whether those alternative diagnoses had been considered prior to the CTA. METHODS: This was a cross-sectional, retrospective study involving 191 adult patients undergoing CTA for suspected PTE between September of 2009 and May of 2012. Chest X-rays and CTAs were reviewed to determine whether the findings suggested an alternative diagnosis in the cases not diagnosed as PTE. Data on symptoms, risk factors, comorbidities, length of hospital stay, and mortality were collected. RESULTS: On the basis of the CTA findings, PTE was diagnosed in 47 cases (24.6%). Among the 144 patients not diagnosed with PTE via CTA, the findings were abnormal in 120 (83.3%). Such findings were consistent with an alternative diagnosis that explained the symptoms in 75 patients (39.3%). Among those 75 cases, there were only 39 (20.4%) in which the same alterations had not been previously detected on chest X-rays. The most common alternative diagnosis, made solely on the basis of the CTA findings, was pneumonia (identified in 20 cases). Symptoms, risk factors, comorbidities, and the in-hospital mortality rate did not differ significantly between the patients with and without PTE. However, the median hospital stay was significantly longer in the patients with PTE than in those without (18.0 and 9.5 days, respectively; p = 0.001). CONCLUSIONS: Our results indicate that chest CTA is useful in cases of suspected PTE, because it can confirm the diagnosis and reveal findings consistent with an alternative diagnosis in a significant number of patients.

Alternative diagnoses based on CT angiography of the chest in patients with suspected pulmonary thromboembolism / Diagnósticos alternativos corroborados por angiotomografia computadorizada de tórax em pacientes com suspeita de tromboembolia pulmonar

Objective : To determine the prevalence of alternative diagnoses based on chest CT angiography (CTA) in patients with suspected pulmonary thromboembolism (PTE) who tested negative for PTE, as well as whether those alternative diagnoses had been considered prior to the CTA. Methods : This was a cross-sectional, retrospective study involving 191 adult patients undergoing CTA for suspected PTE between September of 2009 and May of 2012. Chest X-rays and CTAs were reviewed to determine whether the findings suggested an alternative diagnosis in the cases not diagnosed as PTE. Data on symptoms, risk factors, comorbidities, length of hospital stay, and mortality were collected. Results : On the basis of the CTA findings, PTE was diagnosed in 47 cases (24.6%). Among the 144 patients not diagnosed with PTE via CTA, the findings were abnormal in 120 (83.3%). Such findings were consistent with an alternative diagnosis that explained the symptoms in 75 patients (39.3%). Among those 75 cases, there were only 39 (20.4%) in which the same alterations had not been previously detected on chest X-rays. The most common alternative diagnosis, made solely on the basis of the CTA findings, was pneumonia (identified in 20 cases). Symptoms, risk factors, comorbidities, and the in-hospital mortality rate did not differ significantly between the patients with and without PTE. However, the median hospital stay was significantly longer in the patients with PTE than in those without (18.0 and 9.5 days, respectively; p = 0.001). Conclusions : Our results indicate that chest CTA is useful in cases of suspected PTE, because it can confirm the diagnosis and reveal findings consistent with an alternative diagnosis in a significant number of patients.

Objetivo : Determinar a prevalência de diagnósticos alternativos corroborados por angiotomografia computadorizada (angio-TC) de tórax em pacientes com suspeita de tromboembolia pulmonar (TEP) e com resultados negativos para TEP, assim como investigar se esses diagnósticos alternativos já haviam sido identificados antes dos resultados da angio-TC. Métodos : Estudo transversal, retrospectivo, com 191 pacientes adultos que realizaram angio-TC por suspeita de TEP no período entre setembro de 2009 e maio de 2012. As radiografias de tórax e as angio-TCs foram revisadas para determinar se os achados poderiam fornecer um diagnóstico alternativo nos casos não diagnosticados como TEP. Dados sobre sintomas, fatores de risco, comorbidades, tempo de internação e mortalidade foram coletados. Resultados : A angio-TC foi positiva para tromboembolia pulmonar em 47 casos (24,6%). Entre os 144 pacientes sem tromboembolia pulmonar, achados anormais foram observados em 120 (83,3%). Tais achados foram compatíveis com um diagnóstico alternativo que explicava os sintomas do paciente em 75 casos (39,3%). Desses 75 casos, os achados não haviam sido detectados previamente na radiografia de tórax em apenas 39 (20,4%) dos casos. O diagnóstico alternativo mais frequente, identificado somente por angio-TC, foi pneumonia (em 20 casos). Sintomas, fatores de risco, comorbidades e taxa de óbito intra-hospitalar não diferiram significativamente entre os pacientes com ou sem TEP. Entretanto, a mediana de tempo de internação foi significativamente maior nos pacientes com TEP do que naqueles sem TEP (18,0 e 9,5 dias, respectivamente; p = 0,001). Conclusões : Nossos resultados demonstram que a angio-TC de tórax é útil em casos com suspeita de TEP, pois pode confirmar o diagnóstico e evidenciar achados sugestivos de um diagnóstico alternativo em um significativo número de pacientes.

Community-acquired staphylococcal pneumonia.

OBJECTIVE: Staphylococcal pneumonia typically presents high rates of morbidity and mortality. It typically occurs in cases of influenza (airborne transmission) or during episodes of bacteremia (blood-borne transmission). METHODS: A retrospective and descriptive study was conducted in patients admitted to our hospital between January of 1992 and December of 2003. All of he patients included had been diagnosed with community-acquired pneumonia caused by Staphylococcus aureus. All were older than 14 years of age, and none were intravenous drug users. RESULTS: Community-acquired pneumonia was identified in 332 cases, of which 24 (7.3%) were identified as cases of staphylococcal pneumonia. Age ranged from 14 to 89 years. Fifteen patients were male, and nine were female. Twelve patients met the criteria for severe pneumonia. Chest X-rays showed unilateral consolidation in 14 cases, bilateral consolidation in 10, pleural effusion in 15, rapid radiological progression of pulmonary lesions in 14, cavitation in 6 and pneumothorax in 1. Most of the patients presented comorbidities, of which diabetes mellitus was the most common. Twelve patients presented complications such as empyema and septic shock. Four patients died, translating to a mortality rate of 16.6% in our sample. CONCLUSIONS: The clinical presentation of pneumonia caused by S. aureus is similar to that of pneumonia caused by other etiological agents. Radiological findings, epidemiological data and risk factors provide important clues to the diagnosis. These factors are important for clinical suspicion, since S. aureus is not typically addressed in empirical treatment.

Pneumonia estafilocócica adquirida na comunidade / Community-acquired staphylococcal pneumonia

OBJETIVO: A pneumonia estafilocócica geralmente apresenta uma elevada taxa de morbidade e mortalidade. Normalmente ocorre em infecções por influenza (via aerógena) ou durante episódios de bacteremia (via hematogênica). MÉTODOS: Um estudo retrospectivo e descritivo foi realizado com os pacientes que foram admitidos em nosso hospital entre janeiro de 1992 e dezembro de 2003 com diagnóstico de pneumonia adquirida na comunidade causada por Staphylococcus aureus. Todos eles eram maiores de 14 anos e não usuários de drogas endovenosas. RESULTADOS: De um total de 332 casos de pneumonia adquirida na comunidade, foram encontrados 24 pacientes (7,3 por cento) com pneumonia estafilocócica. A idade mínima e máxima eram de, respectivamente, 14 anos e 89 anos. Quinze pacientes eram homens e nove eram mulheres. Doze pacientes preenchiam critérios para pneumonia grave. O radiograma de tórax evidenciou consolidação unilateral em 14 casos, bilateral em 10, derrame pleural em 15, rápida progressão radiológica das lesões pulmonares em 14, presença de cavitação em 6 e pneumotórax em 1 paciente. A maioria dos pacientes apresentou co-morbidades e diabetes mellitus foi a mais freqüente. Doze pacientes apresentaram complicações como empiema e choque séptico. Houve quatro óbitos, o que representou 16,6 por cento da amostra. CONCLUSÕES: A apresentação clínica da pneumonia causada por S. aureus é similar à apresentação das pneumonias originadas por outros agentes etiológicos. Os achados radiológicos, os dados epidemiológicos e os fatores de risco fornecem importantes indícios para o diagnóstico. Estes fatores são importantes para uma suspeição clínica, já que o S. aureus normalmente não é incluído nos tratamentos empíricos.

OBJECTIVE: Staphylococcal pneumonia typically presents high rates of morbidity and mortality. It typically occurs in cases of influenza (airborne transmission) or during episodes of bacteremia (blood-borne transmission). METHODS: A retrospective and descriptive study was conducted in patients admitted to our hospital between January of 1992 and December of 2003. All of he patients included had been diagnosed with community-acquired pneumonia caused by Staphylococcus aureus. All were older than 14 years of age, and none were intravenous drug users. RESULTS: Community-acquired pneumonia was identified in 332 cases, of which 24 (7.3 percent) were identified as cases of staphylococcal pneumonia. Age ranged from 14 to 89 years. Fifteen patients were male, and nine were female. Twelve patients met the criteria for severe pneumonia. Chest X-rays showed unilateral consolidation in 14 cases, bilateral consolidation in 10, pleural effusion in 15, rapid radiological progression of pulmonary lesions in 14, cavitation in 6 and pneumothorax in 1. Most of the patients presented comorbidities, of which diabetes mellitus was the most common. Twelve patients presented complications such as empyema and septic shock. Four patients died, translating to a mortality rate of 16.6 percent in our sample. CONCLUSIONS: The clinical presentation of pneumonia caused by S. aureus is similar to that of pneumonia caused by other etiological agents. Radiological findings, epidemiological data and risk factors provide important clues to the diagnosis. These factors are important for clinical suspicion, since S. aureus is not typically addressed in empirical treatment.