RESUMO
OBJECTIVE: To describe tuberculosis (TB) characteristics in the adolescent 10-19 years age group that is often underrepresented in surveillance and studies despite the high global TB burden estimated for this group.SETTING AND DESIGN: We use the case-based data reported to the European Surveillance System (TESSy) from European Union (EU)/European Economic Area (EEA) countries between 2007 and 2016 to describe notification rates, TB characteristics and treatment outcomes among adolescent TB cases. We also compare TB characteristics in young adolescents (10-14 years) and older adolescents (15-19 years).RESULTS: For the period 2007 to 2016, 705 826 TB cases were reported to TESSy by 29 EU/EEA countries, 38 054 (5.4%) of which were adolescents. The overall EU/EEA notification rate among adolescents was 6.9 per 100 000 population, 3.5 among young adolescents and 10.1 among older adolescents. The two adolescent groups had differences regarding sex distribution, site of disease, sputum smear microscopy positivity, laboratory confirmation and treatment outcome.CONCLUSION: Younger and older adolescents should be analysed as separate groups when studying and reporting TB, particularly to inform better targeting of TB prevention and care interventions in the future, in order to improve outcomes.
Assuntos
Vigilância em Saúde Pública , Tuberculose , Adolescente , Humanos , Europa (Continente)/epidemiologia , União Europeia , Incidência , Distribuição por Sexo , Resultado do Tratamento , Tuberculose/epidemiologia , Adulto JovemRESUMO
SETTING: Mbeya, Tanzania. OBJECTIVE: To develop a new liquid culture method to detect Mycobacterium tuberculosis complex (MTC) in sputum using 2,3-diphenyl-5-thienyl-(2)-tetrazolium (STC), the nitrate reductase assay (NRA) and p-nitrobenzoic acid (PNB). DESIGN: Ninety-three sputum samples collected from 18 tuberculosis patients were decontaminated with N-acetyl-L-cysteine-sodium hydroxide using MGIT™ 960 and in STC-NRA cultures, both in the presence and in the absence of PNB, an inhibitor of MTC growth. The reduction of STC by colour change indicated mycobacterial growth; NRA was then performed to confirm MTC. RESULTS: STC-NRA culture was positive for acid-fast bacilli in 66/93 (71%) samples, of which 60/93 (64.5%) were identified as MTC-positive and 6/93 (6.5%) as indeterminate mycobacteria. MGIT indicated MTC in 59/93 (63.4%) cultures. Contamination was detected in 12/93 (13%) STC-NRA cultures vs. 29/93 (31.2%) MGIT cultures. The mean time to detection (TTD) of MTC using STC-NRA was 14 days and 7 days using MGIT. CONCLUSION: The STC-NRA method is sensitive for the detection of MTC in sputum. TTD increased with duration of anti-tuberculosis treatment, highlighting the value of this method in monitoring treatment success. The method is simple and inexpensive and, unlike MGIT, does not require technical equipment. The preliminary performance characteristics of the method should be further evaluated in larger studies.
Assuntos
Colorimetria/métodos , Mycobacterium tuberculosis/isolamento & purificação , Escarro/microbiologia , Tuberculose Pulmonar/diagnóstico , Antituberculosos/uso terapêutico , Monitoramento de Medicamentos/métodos , Estudos de Viabilidade , Humanos , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/crescimento & desenvolvimento , Valor Preditivo dos Testes , Tanzânia , Fatores de Tempo , Resultado do Tratamento , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/microbiologiaRESUMO
A prospective surveillance system for extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-E) and ESBL-producing Klebsiella spp. (ESBL-K) was implemented in 39 German hospitals with the aim of determining the incidence densities (IDs) of community-onset and hospital-onset cases and of identifying risk factors for high IDs of hospital-onset cases. During 2008, 2081 ESBL-E/K cases were documented. ESBL-E cases (n=1330, 63·9%) were more common than ESBL-K cases (n=751, 36·1%), but a higher proportion of ESBL-K cases (59%) than of ESBL-E cases (39·5%) were hospital-onset cases. The mean IDs were 0·54 (range 0-2·53) per 1000 patient-days for all ESBL-EK cases, 0·29 (range 0-1·81) per 1000 patient-days for community-onset ESBL-EK cases and 0·25 (range 0-1·82) per 1000 patient-days for hospital-onset ESBL-EK cases. Regression analysis showed a linear association between the IDs of community-onset and hospital-onset cases. The wide dissemination of ESBL-E and ESBL-K emphasizes the need for hospital-wide surveillance to guide control measures.
Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Infecção Hospitalar/epidemiologia , Infecções por Escherichia coli/microbiologia , Escherichia coli/enzimologia , Infecções por Klebsiella/microbiologia , Klebsiella/enzimologia , beta-Lactamases/metabolismo , Infecções Comunitárias Adquiridas/microbiologia , Infecção Hospitalar/microbiologia , Escherichia coli/isolamento & purificação , Alemanha/epidemiologia , Hospitais , Humanos , Incidência , Klebsiella/isolamento & purificação , Estudos ProspectivosAssuntos
Carcinoma Hepatocelular/diagnóstico , Equinococose Hepática/diagnóstico , Neoplasias Hepáticas/diagnóstico , Adulto , Animais , Biópsia , Diagnóstico Diferencial , Echinococcus multilocularis/isolamento & purificação , Humanos , Fígado/diagnóstico por imagem , Fígado/parasitologia , Fígado/patologia , Masculino , Tomografia Computadorizada por Raios XRESUMO
Infection control personnel performing surveillance activities noticed a cluster of patients with isolates of carbapenem-resistant Pseudomonas aeruginosa (CRPA) in the surgical intensive care unit (SICU) of a German University Hospital. An outbreak investigation including a descriptive analysis, a case-control study comparing 15 CRPA case patients with 18 patients with carbapenem-susceptible P. aeruginosa, environmental sampling and pulsed-field gel electrophoresis (PFGE) typing of P. aeruginosa isolates was carried out. Fifteen patients acquired CRPA in the SICU during the outbreak period between 1 July 2006 and 31 October 2006 and PFGE typing of 11 available patient isolates revealed two outbreak strains as well as sporadic CRPA isolates. Both outbreak strains were resistant to penicillins, cephalosporins, carbapenems, aminoglycosides and quinolones, and remained susceptible only to colistin. The most likely mode of transmission was cross-transmission between patients during postoperative wound care with abdominal and/or thoracic drains (odds ratio: 64.33; 95% confidence interval: 5.32-999) and therapy with quinolones (48.37; 3.71-999) being independent risk factors for acquisition of CRPA. No further clusters of CRPA cases were observed after implementation of contact isolation precautions and after healthcare workers were made aware of the likely mode of transmission. This study shows the complex epidemiology of CRPA in a SICU including cross-transmission of two CRPA strains related to postoperative wound care.
Assuntos
Antibacterianos/farmacologia , Carbapenêmicos/farmacologia , Infecção Hospitalar/epidemiologia , Surtos de Doenças , Infecções por Pseudomonas/epidemiologia , Pseudomonas aeruginosa/efeitos dos fármacos , Resistência beta-Lactâmica , Idoso , Idoso de 80 Anos ou mais , Técnicas de Tipagem Bacteriana , Estudos de Casos e Controles , Análise por Conglomerados , Cuidados Críticos , Infecção Hospitalar/microbiologia , Infecção Hospitalar/transmissão , Eletroforese em Gel de Campo Pulsado , Microbiologia Ambiental , Alemanha/epidemiologia , Hospitais Universitários , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Infecções por Pseudomonas/microbiologia , Infecções por Pseudomonas/transmissão , Pseudomonas aeruginosa/isolamento & purificação , Fatores de RiscoRESUMO
A new surveillance module for multidrug-resistant (MDR) bacteria was added to the intensive care component of the German Nosocomial Infection Surveillance System. Participating intensive care units (ICUs) report data on all patients colonised or infected with meticillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae (ESBL-EC/KP). To determine the regional distribution of MRSA, VRE and ESBL-EC/KP in Germany, incidence densities (IDs) of these bacteria per 1000 patient-days were calculated for each ICU and pooled for ICUs of five German regions for the years 2005 and 2006. A total of 176 ICUs including 284 142 patients and 1 021 579 patient-days reported data concerning 5490 cases of MDR bacteria. The pooled IDs were 4.54, 0.54 and 0.29 cases per 1000 patient-days for MRSA, ESBL-EC/KP and VRE cases and 1.56, 0.32 and 0.13 per 1000 patient-days for MRSA, ESBL-EC/KP and VRE infections, respectively. While there were no significant differences in the incidence densities of MRSA infections between regions, the IDs of VRE and ESBL-EC/KP infections showed significant regional variation. The regions also differed in the proportion of ICUs per region that reported at least one infection with MRSA, ESBL-EC/KP or VRE in 2005-2006 and these differences ranged from 82% to 91% for MRSA, from 34% to 76% for ESBL-EC/KP and from 8% to 42% for VRE. This new surveillance module enables ICUs to monitor the occurrence of MDR bacteria by comparing local incidence densities with a national reference and shows significant regional variation of MDR bacteria in Germany.
Assuntos
Infecções Bacterianas , Infecção Hospitalar , Surtos de Doenças , Farmacorresistência Bacteriana Múltipla , Unidades de Terapia Intensiva/estatística & dados numéricos , Vigilância da População/métodos , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Enterococcus/efeitos dos fármacos , Enterococcus/isolamento & purificação , Escherichia coli/efeitos dos fármacos , Escherichia coli/enzimologia , Escherichia coli/isolamento & purificação , Alemanha/epidemiologia , Humanos , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/enzimologia , Klebsiella pneumoniae/isolamento & purificação , Tempo de Internação , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Resistência a Vancomicina , beta-Lactamases/metabolismoRESUMO
This study analysed the time-trends for bacteria associated with nosocomial lower respiratory tract infections (LRTIs), bloodstream infections (BSIs) and urinary tract infections (UTIs) that were reported to the German Nosocomial Infection Surveillance System for intensive care units (ICUs). Data concerning 19 822 nosocomial infections were submitted by 139 ICUs between 2000 and 2005. There was a significant increase in the proportion of Gram-negative bacteria causing LRTIs (from 63.9% to 68.4%) and UTIs (from 65.3% to 68.6%). The proportion of BSIs caused by Gram-negative bacteria declined significantly, from 36.4% to 22.7%. The frequency of methicillin-resistant Staphylococcus aureus among all S. aureus isolates increased from 19.8% to 37.2%.
Assuntos
Infecção Hospitalar/epidemiologia , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Positivas/epidemiologia , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Infecção Hospitalar/microbiologia , Alemanha/epidemiologia , Humanos , Unidades de Terapia Intensiva , Resistência a Meticilina , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/microbiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologiaRESUMO
CD34 most probably acts as a receptor molecule on hematopoietic progenitor cells; however, its precise function remains to be elucidated. To track the intracellular pathway of CD34 after binding of a stimulatory antibody (anti-HPCA-1), immuno-electron microscopical analysis was performed on cells of normal bone marrow (NBMPC), acute leukemias, and the KG1a cell line. Before stimulation, CD34 was evenly distributed over the cell surface. After binding of the anti-HPCA-1, but not the anti-HPCA-2 antibody to CD34 and labeling with 30-nm immunogold, a rapid capping of CD34 and a subsequent internalization from the cell surface via clathrin-coated pits and coated vesicles was observed. The percentage of internalized CD34/immunogold complexes ranged from 8 to 80% in the NBMPC and the leukemic blasts, whereas KG1a cells showed an internalization rate of only 0.42%. Moreover, in the KG1a cells, the CD34/immunogold complexes were not associated with the coated pits. These differences in CD34 internalization did not correlate to the mRNA expression for the full-length or truncated CD34 assessed by isotype-specific real-time PCR. Taken together, evidence was found that CD34 is a surface receptor molecule that is modulated by receptor-mediated endocytosis. CD34 on KG1a cells appears to have a functional and/or structural defect, preventing modulation of this epitope.
Assuntos
Antígenos CD34/metabolismo , Endocitose , Células-Tronco Hematopoéticas/metabolismo , Receptores de Superfície Celular/metabolismo , Doença Aguda , Anticorpos Monoclonais/farmacologia , Antígenos CD34/genética , Antígenos CD34/imunologia , Células da Medula Óssea/metabolismo , Células da Medula Óssea/patologia , Humanos , Leucemia/metabolismo , Leucemia/patologia , Microscopia Eletrônica , Isoformas de Proteínas/imunologia , Isoformas de Proteínas/metabolismo , Agregação de Receptores/efeitos dos fármacos , Receptores de Superfície Celular/imunologia , Células Tumorais CultivadasRESUMO
OBJECTIVE: To evaluate the benefit of the new Clarion speech processor 1.2. STUDY DESIGN: Fifty-two subjects who received a Clarion cochlear implant during 1993 and 1995 were upgraded with the new Clarion speech processor 1.2. All subjects were tested with a speech test battery in quiet and in noise, first with the 1.0 processor and 1 month later with the new 1.2 processor. To avoid ceiling or floor effects, the subjects were divided into three groups according to their test results with the Freiburger Monosyllabic Word Test (group A < 10%, group B 10-50%, and group C > 50%). RESULTS: The results indicated that all subjects had an improvement with the new speech processor. This improvement was statistically significant (p < 0.05) for group C in all conditions, and for group B in the tests with noise. CONCLUSION: While the better and good performers improved their test scores significantly, low performers seemed to derive little benefit from the technical improvements of the same speech processing strategy. Perhaps this group might gain more from a different processing scheme.