Immunohistochemical characterization of the immune cell response during chlamydial infection in the male and female koala (Phascolarctos cinereus) reproductive tract.

Chlamydiosis is one of the main causes of the progressive decline of koala populations in eastern Australia. While histologic, immunologic, and molecular studies have provided insights into the basic function of the koala immune system, the in situ immune cell signatures during chlamydial infection of the reproductive tract in koalas have not been investigated. Thirty-two female koalas and 47 males presented to wildlife hospitals with clinical signs suggestive of Chlamydia infection were euthanized with the entire reproductive tract collected for histology; immunohistochemistry (IHC) for T-cell (CD3ε, CD4, and CD8α), B-cell (CD79b), and human leukocyte antigen (HLA)-DR markers; and quantitative real-time polymerase chain reaction (rtPCR) for Chlamydia pecorum. T-cells, B-cells, and HLA-DR-positive cells were observed in both the lower and upper reproductive tracts of male and female koalas with a statistically significant associations between the degree of the inflammatory reaction; the number of CD3, CD4, CD79b, and HLA-DR positive cells; and the PCR load. CD4-positive cells were negatively associated with the severity of the gross lesions. The distribution of immune cells was also variable according to the location within the genital tract in both male and female koalas. These preliminary results represent a step forward towards further exploring mechanisms behind chlamydial infection immunopathogenesis, thus providing valuable information about the immune response and infectious diseases in free-ranging koalas.

¿Se puede prevenir el parto prematuro por infección bacteriana ascendente y sus resultados adversos en los hospitales públicos de Chile? / Can preterm birth be prevented from ascending bacterial infection and its adverse results in the public hospitals of Chile?

Resumen El parto prematuro (PP) es el principal contribuyente de la morbilidad/mortalidad perinatal. A pesar del conocimiento de los factores de riesgo y de la introducción de intervenciones médicas destinadas a la prevención del nacimiento prematuro, su frecuencia ha aumentado. La infección bacteriana ascendente (IBA) es la condición obstétrica más frecuente asociada al PP ocasionando un importante resultado perinatal adverso en un hospital público de Chile. Esta revisión muestra la asociación entre PP e IBA, analiza la fisiopatología y la inmunología de las infecciones vaginales en la mujer embarazada susceptible, como asimismo la aplicación en este grupo de medidas con evidencia clínica que han demostrado ser eficientes, tales como la pesquisa rutinaria y el tratamiento de las infecciones genitourinarias (IGU), el cerclaje profiláctico o terapéutico, uso de probióticos, de progesterona vaginal, control metabólico de la diabetes mellitus y del peso de la obesa. El tratamiento de las IGU, conjuntamente con el uso de intervenciones que mejoran la inmunidad vaginal en la población de riesgo, permiten predecir una reducción del PP por IBA, de sus consecuencias inmediatas y de largo plazo y costos asociados elevados, con el consiguiente beneficio de la salud pública de Chile.

Preterm birth (PB) is the main contributor to the perinatal morbidity/mortality. In spite of the knowledge of the risk factors and the introduction of medical interventions intended to prevent PB, its frequency has increased. Ascending bacterial infection (ABI) is the obstetric condition most frequently associated to PB causing an important adverse perinatal outcome in a public hospital in Chile. This review shows the association between PB and ABI, analyzes the physiopathology and immunology of vaginal infections in the susceptible pregnant woman., as well as their application in this group of effective measures demonstrated by evidence, such as routine control, treatment of genitourinary tract infections (GTI), prophylactic or therapeutic cerclage, use of probiotics, use of vaginal progesterone, metabolic control of diabetes mellitus and weight of the obese woman. Treatment GTI together with the use of medical interventions that improve the vaginal immunity in the risk population allow to predict a reduction of PB by ABI and of its immediate consequences, long term sequels and high associated costs, with the consequent benefit of the public health in Chile.

Caracterización clínica, microbiológica y de sensibilidad a antimicrobianos en pacientes con infección nosocomial del tracto urinario: cuatro años y medio de vigilancia epidemiológica / Clinical, microbiological and antimicrobial sensitivity in patients with hospital-adquired urinary tract infections: four and half years surveillance

Antecedentes: Las infecciones nosocomiales son entidades importantes por su aumento en la morbimortalidad y en los costos de tratamiento. En Medellín, Colombia, la del tracto urinario (ITU) es la segunda infección nosocomial más incidente, 16,3% del total. El objetivo del presente estudio fue realizar una caracterización de los aspectos clínicos y microbiológicos de los pacientes con infección nosocomial del tracto urinario en una clínica privada de Medellín, Colombia. Métodos: Estudio retrospectivo, longitudinal, descriptivo de las historias clínicas de los pacientes con infección nosocomial del tracto urinario entre enero/2005 y julio/2009. Resultados: Se diagnosticaron 134 casos en 130 pacientes (tasa institucional de 0,27 infecciones por 100 egresos), con alza de 0,21 por cada 100 egresos en 2005 a 0,59 en 2009. La mayoría de los pacientes fueron mujeres (67,7%), con edad promedio de 55 (IQ 27-72) años. Las comorbilidades más comunes fueron hipertensión arterial (48,5%) y enfermedad renal crónica (16,3%). Los gérmenes más comunes fueron E. coli (54,9%) y K. pneumoniae (12,8%). Hay alta proporción de resistencia a ciprofloxacina, ampicilina/sulbactam y trimetoprim/sulfametoxazol. Conclusión: La ITU nosocomial es una entidad relativamente común en la institución estudiada, aunque su tasa es consistentemente inferior a la encontrada en estudios similares. Para el manejo empírico de esta infección parece recomendable iniciar con amikacina o ceftriaxona, utilizando imipenem o meropenem en pacientes sépticos con comorbilidad seria o con alto riesgo de gérmenes multirresistentes. Para el tratamiento de ITU nosocomial por E. coli, la amikacina y la gentamicina parecen buenas opciones, al igual que la ceftriaxona.

Background: Hospital-acquired infections are important conditions because of their linked increase in morbimortality and in treatment costs. The objective of this study was to perform a characterization of clinical and microbiological aspects of patients with hospital-acquired urinary tract infection on a University Hospital in Medellín, Colombia. Methods: A retrospective, descriptive study was performed, in which the medical records of all patients such an infection were reviewed. Results: A total of 134 infections in 130 patients were detected (rate : 0,27 infections per every 100 hospital discharges), with an upward behavior from 0,21 cases/100 dischrges in 2005 to 0,59 in 2009. Most of the patients (67,7%) were female, with a median age of 55 (IQ 27-72) years. The most commonly found commorbidities were arterial hypertension (48,5%) and chronic kidney disease (16,3%). The most commonly isolated agents were E. coli (54,9%) and K. pneumoniae (12,8%). High rates of resistance t o ci pr of l oxaci n, ampi ci l i n/ sul bact am y t r i met opr i m/sulfametoxazol were found. Discussion: Our study is one of the few characterizations of hospital-acquired urinary tract infection in Colombia; it is shown that our ecology is, up to a point, similar, to that found by international authors, although a higher prevalence of E. coli was found. It is important to recall the relatively high resistance rates to first-line antibiotics. [Jiménez JG, Gaviria ME, Balparda JK, Castrillón DM, Marín AE, Escobar E. Clinical, microbiological and antimicrobial sensitivity in patients with hospital-adquired urinary tract infections: four and half years surveillance. MedUNAB 201 1; 14:145-150].