Emergency response for evaluating SARS-CoV-2 immune status, seroprevalence and convalescent plasma in Argentina.

We report the emergency development and application of a robust serologic test to evaluate acute and convalescent antibody responses to SARS-CoV-2 in Argentina. The assays, COVIDAR IgG and IgM, which were produced and provided for free to health authorities, private and public health institutions and nursing homes, use a combination of a trimer stabilized spike protein and the receptor binding domain (RBD) in a single enzyme-linked immunosorbent assay (ELISA) plate. Over half million tests have already been distributed to detect and quantify antibodies for multiple purposes, including assessment of immune responses in hospitalized patients and large seroprevalence studies in neighborhoods, slums and health care workers, which resulted in a powerful tool for asymptomatic detection and policy making in the country. Analysis of antibody levels and longitudinal studies of symptomatic and asymptomatic SARS-CoV-2 infections in over one thousand patient samples provided insightful information about IgM and IgG seroconversion time and kinetics, and IgM waning profiles. At least 35% of patients showed seroconversion within 7 days, and 95% within 45 days of symptoms onset, with simultaneous or close sequential IgM and IgG detection. Longitudinal studies of asymptomatic cases showed a wide range of antibody responses with median levels below those observed in symptomatic patients. Regarding convalescent plasma applications, a protocol was standardized for the assessment of end point IgG antibody titers with COVIDAR with more than 500 plasma donors. The protocol showed a positive correlation with neutralizing antibody titers, and was used for clinical trials and therapies across the country. Using this protocol, about 80% of convalescent donor plasmas were potentially suitable for therapies. Here, we demonstrate the importance of providing a robust and specific serologic assay for generating new information about antibody kinetics in infected individuals and mitigation policies to cope with pandemic needs.

Microbiota unbalance in relation to high-risk human papillomavirus cervical infection.

OBJECTIVES: To assess vaginal dysfunction using basic vaginal states and the presence of lactobacillary microbiota in patients with human papillomavirus (HPV) infection with no squamous intra-epithelial lesions (SIL), with low-grade squamous intra-epithelial lesions (L-SIL), and with high-grade squamous intra-epithelial lesions (H-SIL) or squamous cell carcinoma compared with a control group (HPV-negative); to establish the prevalence of bacterial vaginosis, candidiasis, and trichomoniasis in the different age groups; and to characterize the species of lactobacilli according to the type of lesion. METHODS: A cross-sectional study was carried out of patients who underwent clinical examination and collection of vaginal fornixes to study basic vaginal states and culture. Species identification of lactobacilli was performed by mass spectrometry. The results were analyzed using the χ2 and Fisher's tests; p<0.05 was considered significant. High-risk viral types were determined using a multiplex real-time polymerase chain reaction test. RESULTS: A total of 741 patients were analyzed and divided into three age groups: Group 1 aged 18-24 years (n=138), Group 2 aged 25-50 years (n=456), and Group 3 aged >50 years (n=147). All groups were further divided into an HPV-negative (control) group and an HPV-positive group without lesions, with L-SIL, or with H-SIL/squamous cell carcinoma. The prevalence of unbalanced basic vaginal states in patients with H-SIL/squamous cell carcinoma was 72.7% (p=0.03) in Group 1, 53.1% (p=0.05) in Group 2, and no cases of unbalance were detected in Group 3. The prevalence of bacterial vaginosis in women with H-SIL/squamous cell carcinoma in Group 1 was 54.5% and in Group 2 was 43.7%. Patients with H-SIL/squamous cell carcinoma had a prevalence of 21.4% of Lactobacillus crispatus, 42.9% of L. jensenii, and 14.3% of L. iners. CONCLUSIONS: A greater unbalance of vaginal microbiota was observed in patients with SIL, especially in those with H-SIL/squamous cell carcinoma. In this group, an increase in L. jensenii and L. iners compared with control was found. L. crispatus had a similar prevalence to the control group. It is important to characterize the lactobacilli species since the unbalance alters the vaginal microenvironment and acts as a co-factor in the persistence of HPV infection.

[Neisseria meningitidis isolated from patients in men who have sex with men]. / Neisseria meningitidis aislada de muestras de hombres que tienen sexo con hombres.

During the periods 2000-2004 and 2014-2015, Neisseria meningitidis was investigated in men who have sex with men, 1143 and 544 respectively, who consulted in the sexually-transmitted disease program. Prevalence, serogroup distribution and susceptibility to antibiotics were determined. Pharyngeal, rectal and urethral swabs were cultivated on selective Thayer-Martin modified medium. The identification was performed by biochemical tests and mass spectrometry by MALDI-TOF. Serogroups B, C, W and Y were investigated by PCR in 85 isolates recovered from the pharynx belonging to the second period. MICs of penicillin, ceftriaxone, rifampicin, azithromycin and ciprofloxacin were determined for 66 and 102 isolates from periods 1 and 2 respectively, according to CLSI. The prevalence of N. meningitidis was 17.8% and 28.1%, in periods 1 and 2 respectively; the isolates were mainly recovered from the pharynx. The distribution of serogroups was B 31.5%; Y 7.6%; W 3.3% and 9.8% non-capsulated and the rest would belong to other serogroups. Isolates classified as intermediate to penicillin were 34.8% and 63.7% (first and second periods, respectively); moreover, 11.8% of the isolates from the second period were resistant. All isolates were susceptible to ceftriaxone, to ciprofloxacin (except 3 isolates with MIC values between 0.25 and 0.5µg/ml), 3% were resistant to rifampicin and 2% were not susceptible to azithromicin. The prevalence of N. meningitidis carriage in men who have sex with men was high with a high rate of penicillin non-susceptible isolates. B was the prevalent serogroup.

[Microbiological analysis of the maternal genital tract and umbilical cord blood and its association with neonatal damage]. / Análisis microbiológico del tracto genital materno y de la sangre del cordón umbilical en relación con el daño neonatal.

The etiology leading to neonatal damage is multifactorial, being genital infections one of the causes. The objective of the study was to identify microorganisms of the maternal genital tract that are associated with neonatal damage, in order to prevent future perinatal complications. Seven hundred and eleven pregnant patients attended their prenatal control during the period January 2010-July 2013. Ureaplasma urealyticum and Mycoplasma hominis presence was investigated in umbilical cord blood by metabolic substrates (Micofast-Biomerieux) and that of T.vaginalis, by PCR using specific primers. The microbiological study of the vaginal contents of 288 pregnant patients at weeks 35 to 37 was performed by conventional methods, adding the modified thioglycolate culture for T.vaginalis. GroupB streptococcus (GBS) was investigated in anorectal and vaginal introitus swabs, using selective broth enrichment and subsequent isolation in chromogenic medium. The χ2 Yates test and Fisher's test were used for independent samples. A p value <0.05 was considered statistically significant. The pathogens significantly related to neonatal damage were M.hominis (p=0.03), T.vaginalis (p=0.03), and BV (p=0.02). Main complications were preterm birth, premature rupture of membranes (PRM), low weight and Apgar score ≤7. U.urealyticum (p=0.35), Candidaspp. (p=0.94) and GBS (p=0.18) were not related to neonatal damage. Since different microorganisms of the maternal genital tract were related to neonatal damage, it is very important to perform the microbiological study of vaginal contents during pregnancy to prevent possible maternal and perinatal complications.

Optimization of Trichomonas vaginalis Diagnosis during Pregnancy at a University Hospital, Argentina.

The aim of this study was to evaluate different methods for Trichomonas vaginalis diagnosis during pregnancy in order to prevent maternal and perinatal complications. A total of 386 vaginal exudates from pregnant women were analyzed. T. vaginalis was investigated by 3 types of microscopic examinations direct wet mount with physiologic saline solution, prolonged May-Grunwald Giemsa (MGG) staining, and wet mount with sodium-acetate-formalin (SAF)/methylene blue method. PCR for 18S rRNA gene as well as culture in liquid medium were performed. The sensitivity and specificity of the microscopic examinations were evaluated considering the culture media positivity or the PCR techniques as gold standard. The frequency of T. vaginalis infection was 6.2% by culture and/or PCR, 5.2% by PCR, 4.7% by culture, 3.1% by SAF/methylene blue method and 2.8% by direct wet smear and prolonged MGG staining. The sensitivities were 83.3%, 75.0%, 50.0%, and 45.8% for PCR, culture, SAF/methylene blue method, and direct wet smear-prolonged MGG staining, respectively. The specificity was 100% for all the assessed methods. Microscopic examinations showed low sensitivity, mainly in asymptomatic pregnant patients. It is necessary to improve the detection of T. vaginalis using combined methods providing higher sensitivity, such as culture and PCR, mainly in asymptomatic pregnant patients, in order to prevent maternal and perinatal complications.

[Evaluation of vaginal dysfunction in symptomatic and asymptomatic pregnant women by using the analysis of basic vaginal states (BVS) and its comparison with the conventional microbiological study]. / Evaluación de la disfunción vaginal en mujeres embarazadas sintomáticas y asintomáticas mediante la utilización de los estados vaginales básicos (EVB) y su comparación con el estudio microbiológico convencional.

Infections of the lower genital tract associated to maternal and perinatal complications frequently occur during pregnancy. The aim of this study was to evaluate vaginal dysfunction through the analysis of basic vaginal states (BVS) using the methodology of balance of the vaginal content (BAVACO) and to compare it with the microbiological study of candidiasis, trichomoniasis and bacterial vaginosis (BV). Pregnant patients (1238) were examined from 2010 to 2012. In asymptomatic (A) (n: 1046) and symptomatic pregnant women (S) (n: 192) BVS I was 59.5% and 26% of the patients, respectively. BVS II was observed in 19.7% of A and in 17.2% of S. BVS III was only detected in A in 0.4%. BVS IV was observed in 14.4% of A and in 38% of S. BVS V was detected in 6% of A and in 18.8% of S. Yeasts were associated to BVS I and II in 55.5% and 23.2% of A, respectively; and in 32.4% and 31% of S, respectively. Trichomonas were associated to BVS I in 50% of A, to IV in 44.4% of S and to V in 33.3% of S. BAVACO susceptibility to detect yeasts was 80.4% and 85.5% in A and S, respectively; 40% and 75% in A and S, respectively, to detect trichomonas and 100% in A and S to detect BV. BAVACO specificity was 100% for all pathogens in A and S. The study of BVS proved useful as a guide to evaluate vaginal dysfunction, regardless of symptomatology. Therefore, this study is recommended as prenatal control.

The Changing Epidemiology and Antimicrobial Susceptibility of Staphylococcus aureus Isolated from Blood Cultures in a University Hospital from Argentina.

Staphylococcus aureus bacteremia (SAB) is one of the most common serious bacterial infections worldwide. In this study, we demonstrated changes in SAB epidemiology in an Argentinean University Hospital during an 8-year period (2009-2016). A total of 326 S. aureus clinical isolates were recovered in three periods: P1: 2009-2010, P2: 2012-2014, and P3: 2015-2016. Among these, 127 were methicillin-resistant S. aureus (MRSA) and were characterized by phenotypic and molecular methods. We hereby report a significant decline in multiple drug resistance among MRSA isolates associated with an increase in SCCmec IV between the three periods. A diversity of MRSA-IV clones (mainly ST30-MRSA-IV, ST5-MRSA-IV, and ST8-MRSA-IV) replaced between 2009 and 2016 the previous prevalent MRSA clone causing bloodstream infections at this hospital (ST5-MRSA-I). MRSA population structure continued to diversify between P2 and P3. Notably, ST8-MRSA-IV-t008 related to USA300 was first detected during P2, and ST8-MRSA-IV together with ST30-MRSA-IV related to the Southwest Pacific clone were the more prevalent MRSA genotypes circulating during P3.

High-grade cervical neoplasia during pregnancy: diagnosis, management and postpartum findings.

OBJECTIVES: To study the prevalence of high-grade cervical intraepithelial neoplasia (CIN 2-3) during pregnancy and compare the rates of persistence, progression and regression of CIN 2-3 by colposcopically guided biopsy during pregnancy with respect to the postpartum period. Also to assess biopsy results during pregnancy and postpartum in relation to histopathology after treatment of lesions. POPULATION: Pregnant women with a histological diagnosis of CIN 2-3 confirmed by colposcopically guided biopsy during pregnancy. METHODS: Between 1989 and 2008, 11 700 pregnant women had cytologic and simultaneous colposcopic examinations during pregnancy. A colposcopically guided biopsy was performed when colposcopically suspicious high-grade lesions were detected, regardless of cytological results. Women with a histopathological diagnosis of CIN 2-3 during pregnancy were re-evaluated by colposcopically guided biopsy and treated during the postpartum period. RESULTS: CIN 2-3 was diagnosed in 56 of 11 700 (0.48%) pregnant women by biopsy. Thirty women complying with the protocol were assessed postpartum by histopathological studies, of whom 70% exhibited persistence, 13.3% progression and 16.7% regression of CIN 2-3. Twenty-nine were diagnosed by conization and one by colposcopically guided biopsy during the postpartum period, which revealed invasive cervical carcinoma. CONCLUSIONS: Due to the high rates of CIN 2-3 persistence during the postpartum period, we suggest that all patients in whom CIN 2-3 was diagnosed during pregnancy are biopsied and treated if necessary during the postpartum period, with at least a two-year follow-up control to prevent lesion recurrence.

[Septic pulmonary embolism of cutaneous origin]. / Embolia pulmonar séptica de origen cutáneo.

Septic pulmonary embolism is a serious and rare illness characterized by pulmonary infiltrates associated with an extrapulmonary infectious focus. It is mainly related to right-sided endocarditis, pelvic thrombophlebitis, vascular access and less frequently to deep infections such as osteomyelitis, septic arthritis and pyomyositis. The community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is an emerging pathogen with high virulence and rapid spread involving subjects without previous related diseases or known risk factors. It causes infections of skin and soft tissue and less frequently other serious infections such as necrotizing fascitits, septic arthritis, osteomyelitis, pyomyositis and necrotizing pneumonia. Epidemiologically, pathogenesis and clinical manifestations differ from those caused by MRSA acquired in the hospital. We present the case of a 67 year-old male with septic pulmonary embolism caused by community acquired MRSA that started with a skin infection.

Vaginal States: Detection of Conversion Processes in Women Using Contraception and Characterization of Vaginal Lactobacillus Species.

BACKGROUND: The vaginal microenvironment, regulated by an immune system, can be protected or altered by many factors, including contraceptive methods. OBJECTIVE: The objective of this study is to evaluate the impact of contraceptive methods on the basic vaginal states (BVSs) and to identify culturable vaginal Lactobacillus species. METHODS: This is a prospective, consecutive, longitudinal, and descriptive study. The vaginal contents of 208 women were sampled prior to initiating contraception and six months later. The BVSs were established using the balance of vaginal content (BAVACO) methodology that evaluates microbiota and vaginal inflammatory reaction (VIR). Lactobacillus species were characterized by biochemical tests and mass spectrometry. The following contraceptive methods were evaluated: combined oral contraceptive pill (COCP), condom (CON) and rhythm method (RHYT). McNemar's test was used. RESULTS: Of the 208 women, 171 attended both examinations. In the COCP group (n=127), 83 vaginal contents maintained a normal microbiota, 1 sample became dysbiotic, and 37/43 dysbiotic microbiota samples reverted to normal (p<0.0001). A conversion to BVS with VIR was detected in the CON group (n=31) (p=0.001). The RHYT group (n=13) maintained its initial BVSs. The predominant Lactobacillus species found were L. crispatus and L. gasseri, with a trend toward a positive association between L. crispatus and COCP (OR=2.82; p=0.058). CONCLUSION: Hormone administration corrected the dysbiosis and preserved a normal BVS. The CON increased the VIR. The protection of the microbiota observed in the rhythm method probably responds to a systemic hormonal influence. The trend toward a positive association between COCP and L. crispatus, with its protective properties, evidenced an effective hormonal relationship.

Biochemical profiling study in umbilical cord blood in mothers with metabolic disorders.

BACKGROUND: During pregnancy metabolic disorders that affect differently the fetus, are known. These could be early or late disorders. OBJECTIVES: To analyze different biochemical parameters in umbilical cord blood (UCB) of healthy and pathological newborns from mothers with metabolic disorders. MATERIALS AND METHODS: Samples from UCB (121) were analyzed of newborn from mothers with metabolic disorders who attended at Obstetrics Division. Patients were consecutive, prospective and transversally studied. Newborn were classified as healthy (n = 65) and pathological (n = 56). The maternal metabolic disorders were gestational or non-gestational diabetes, glucose intolerance, insulin resistance and/or obesity).The disorders of the pathological newborns were intrauterine growth restriction (IUGR) and/or fetal distress. Glucose (Glu), urea, creatinine, uric acid (UA), total bilirubin (TB), total proteins (TP), albumin (Alb), transaminases (ALT/AST), alkaline-phosphatase (ALP), gammaglutamyltranspeptidase (GGT), creatinkinasa (CK), lactatedehydrogenase, amylase (amy), pseudocholinesterase, iron, calcium, phosphorus, magnesium (Mg), sodium, potassium, chlorine, cholesterol (Chol), HDL-Chol, LDL-Chol, triglycerides (TG), high sensitivity C reactive protein (hsCRP) were determined by recommended methods. T-Student's and Mann Withney tests were applied, p < .05. RESULTS: Pathological neonates (n: 56) showed a significant decrease in maternal gestation weeks (GW) and in newborn weight (NW) with respect to healthy newborns (n: 65) from mothers with metabolic disorders (p < .0001). Pathological neonates from mothers with metabolic pathologies (n: 56) showed significant increases in Chol, TG, TB (p < .01), LDL-Chol, UA, Mg, hsCRP, ALP levels (p < .05) and significant decreases in TP, Alb (p < .0001) and Glu, ALT, CK, GGT, amy (p < .05) in UCB with respect to healthy newborns. CONCLUSIONS: In pathological newborn, the decrease in GW and NW would be related to IUGR that accompany these metabolic disorders. The increases observed of the analyzed parameters would be related to cellular destruction associated to maternal pathology and decreases of the parameters to IUGR with hepatic immaturity.

Remnant cholesterol levels are associated with severity and death in COVID-19 patients.

Coronavirus disease-19 (COVID-19) patients with severe complications present comorbidities like cardiovascular-disease, hypertension and type-2 diabetes mellitus (DM), sharing metabolic alterations like insulin resistance (IR) and dyslipidemia. Our objective was to evaluate the association among different components of the lipid-lipoprotein profile, such as remnant lipoprotein (RLP)-cholesterol, in patients with COVID-19, and to analyze their associations with the severity of the disease and death. We studied 193 patients (68 (29-96) years; 49.7% male) hospitalized for COVID-19 and 200 controls (46 (18-79) years; 52.5% male). Lipoprotein profile, glucose and procalcitonin were assessed. Patients presented higher glucose, TG, TG/HDL-cholesterol and RLP-cholesterol levels, but lower total, LDL, HDL and no-HDL-cholesterol levels (p < 0.001). When a binary logistic regression was performed, age, non-HDL-cholesterol, and RLP-cholesterol were associated with death (p = 0.005). As the COVID-19 condition worsened, according to procalcitonin tertiles, a decrease in all the cholesterol fractions (p < 0.03) was observed with no differences in TG, while levels of RLP-cholesterol and TG/HDL-cholesterol increased (p < 0.001). Lower levels of all the cholesterol fractions were related with the presence and severity of COVID-19, except for RLP-cholesterol levels and TG/HDL-cholesterol index. These alterations indicate a lipid metabolic disorder, characteristic of IR states in COVID-19 patients. RLP-cholesterol levels predicted severity and death in these patients.

[Bacterial etiology of nosocomial pneumonia and antimicrobial resistance in patients with and without antimicrobial treatment]. / Etiología bacteriana de la neumonía nosocomial y resistencia a los antimicrobianos en pacientes con y sin tratamiento antimicrobiano previo.

Nosocomial pneumonia (NP) is associated with high morbimortality, representing the second cause of nosocomial infection after urinary tract infection. The objective of this work was to become acquainted with the etiology of NP and to evaluate the antimicrobial resistance profile of the isolated microorganisms from adult patients with and without previous antimicrobial treatment admitted in the intensive care unit (ICU). From 2000 to 2005, 430 bronchoalveolar lavages from 430 adult patients diagnosed with pneumonia admitted in the ICU were analyzed. Seventy-four percent (199/ 269) of the patients with previous treatment had positive cultures, whereas in the group without previous treatment the percentage was 83% (134/161) (p = 0,03). The main agents in both groups of patients were: Acinetobacter spp. (37.9% vs 36.1%), Staphylococcus aureus (21.3% vs 26.6% ) and Pseudomonas aeruginosa (20.9% vs 17.7%), respectively (p > 0,05). The antimicrobial resistance in Acinetobacter spp., P. aeruginosa and S. aureus from previously treated patients was higher than that from patients without previous antimicrobial treatment (p < 0,05), except in the case of trimethoprim-sulfamethoxazole in S. aureus (p = 0,29). In conclusion, previous antimicrobial treatment did not modify the etiology of NP, but caused an increase in overall antimicrobial resistance and a lower percentage of positive cultures.

Prevalence and comparison of diagnostic methods for Trichomonas vaginalis infection in pregnant women in Argentina.

The objectives of this study were to conduct a prevalence survey of trichomoniasis in pregnant women and to evaluate the utility of different methods for its diagnosis. A total of 597 vaginal exudates from pregnant women who were examined at the Hospital de Clinicas in Buenos Aires, Argentina from 1 August 2005 to 31 January 2007, were prospectively and consecutively evaluated. The investigation of Trichomonas vaginalis was made by different microscopic examinations, and culture on liquid medium. The sensitivity and specificity of the microscopic examinations were assessed considering culture on liquid medium as the "gold standard". The prevalence of T. vaginalis obtained by culture on liquid medium was 4.0% (24/597). The prevalence of T. vaginalis obtained by direct wet smear, prolonged May-Grunwald Giemsa staining, and sodium acetate-formalin (SAF)/methylene blue staining-fixing technique was 1.8%, 2.3% and 2.5%, respectively. The sensitivity of the direct wet smear was 45.8%, that of the prolonged May-Grunwald Giemsa staining was 58.3%, and that of the SAF/methylene blue method was 62.5%. Considering the 3 microscopic examinations altogether, the sensitivity rose to 66.7% and the specificity was 100% for all of them. This is the first time that the prevalence data of T. vaginalis by culture in pregnant women are published in Argentina. Due to the low sensitivity obtained by microscopy in asymptomatic pregnant women, the use of the liquid medium is recommended during pregnancy, in order to provide an early diagnosis and treatment.

Fetal coenzyme Q10 deficiency in intrahepatic cholestasis of pregnancy.

AIM: Intrahepatic cholestasis of pregnancy (ICP) is considered a high-risk condition because it may have serious consequences for the fetus health. ICP is characterized by the accumulation of bile acids in maternal serum which contribute to an imbalance between the production of reactive oxygen species and the antioxidant defenses increasing the oxidative stress experienced by the fetus. Previously, it was reported a significant decrease in plasma coenzyme Q10 (CoQ10) in women with ICP. CoQ10 is a redox substance integrated in the mitochondrial respiratory chain and is recognized as a potent antioxidant playing an intrinsic role against oxidative damage. The objective of the present study was to investigate the levels of CoQ10 in umbilical cord blood during normal pregnancy and in those complicated with ICP, all of them compared to the maternal ones. METHODS: CoQ10 levels and bile acid levels in maternal and umbilical cord blood levels during normal pregnancies (n=23) and in those complicated with ICP (n=13), were investigated. RESULTS: A significant decrease in neonate CoQ10 levels corrected by cholesterol (0.105±0.010 vs. 0.069±0.011, P<0.05, normal pregnancy vs. ICP, respectively), together with an increase of total serum bile acids (2.10±0.02 vs. 7.60±2.30, P<0.05, normal pregnancy vs. ICP, respectively) was observed. CONCLUSIONS: A fetus from an ICP mother is exposed to a greater risk derived from oxidative damage. The recognition of CoQ10 deficiency is important since it could be the starting point for a new and safe intervention strategy which can establish CoQ10 as a promising candidate to prevent the risk of oxidative stress.

[Ciprofloxacin resistance of Neisseria gonorrhoeae according to sexual habits]. / Resistencia de Neisseria gonorrhoeae a ciprofloxacina según hábitos sexuales.

The first isolates of Neisseria gonorrhoeae resistant to fluoroquinolones in Argentina were reported in 2000. Since January 2005 to June 2007 Neisseria gonorrhoeae was studied in 595 men who have sex with men (MSM) and 571 heterosexual men. The gonorrhea prevalence in MSM and heterosexual men was 0.091(91/1000) and the Neisseria gonorrhoeae ciprofloxacin resistant (CRNG) was 20% in MSM and 3.8% in heterosexual men (p: 0.0416). Thirteen out of 106 isolates from 11 MSM and 2 heterosexual men were CRNG. Six out of eleven MSM had urethritis, one also carried Neisseria gonorrhoeae in rectum and 5 patients were asymptomatic carriers (rectum 2, pharynx 2, urethra 1). No epidemiological relation was found among the patients. Two heterosexual men had urethritis. The 8 symptomatic men were treated with ciprofloxacin but treatment failed in all of them. These patients and the asymptomatic ones were treated with ceftriaxone, 500 mg IM. The post treatment microbiological controls were negative. The CRNG isolates had ciprofloxacin MIC between 2 and 32 (microg/ml), all were negative to penicillinase, 4 out of 13 were chromosomally resistant to penicillin (MIC: 1 microg/ml). The MICs (microg/ml) ranges for several antimicrobial agents were: penicillin: 0.016-1; tetracycline: 0.125-2; ceftriaxone: 0.004-0.008; erythromycin: 0.032-2; azithromycin: 0.032-0.5; spectinomycin: 8-32. Due to the high level of ciprofloxacin-resistant N. gonorrhoeae isolated from MSM in our hospital, another antimicrobial agent for empirical therapy should be used in these patients.

Contraception: Influence on Vaginal Microbiota and Identification of Vaginal Lactobacilli Using MALDI-TOF MS and 16S rDNA Sequencing.

BACKGROUND: The vaginal microbiome is influenced by a wide variety of factors, including contraceptive methods. AIM: To evaluate the effect of contraceptive methods on vaginal microbiota and to compare MALDI-TOF MS and 16S rDNA sequencing for lactobacilli identification. PATIENTS AND METHODS: One hundred and one (101) women consulting for birth control were included in a prospective study. Their vaginal content was sampled and analyzed once before they started using the contraceptive method of their choice, and twice after the initiation of contraception, at three months (94/101 women attended) and at six months (89/101 women attended). The relative frequencies of yeasts and trichomonas were analyzed. MALDI-TOF MS and 16S rDNA sequence analysis were applied for the identification of lactobacilli in their vaginal microbiota. The following contraceptive methods were assessed: Combined Oral Contraceptive Pill (COCP), Condom (CON) and The Rhythm Method (RHYT). McNemar's statistical test was applied. RESULTS: A statistically significant association between COCP and normal microbiota was observed after three months (p< 0.01) and after six months (p< 0.0001), when the vaginal microbiota was modified. At six months, inflammatory reaction was detected in 3/7 women in the CON group, while 6/7 patients using RHYT showed the same state. Yeast colonization increased with the COCP. Identification of lactobacilli by MALDI-TOF MS analysis compared to 16S rDNA sequencing yielded 92.9% concordant results. Lactobacillus gasseri and L. crispatus were the predominant species. CONCLUSION: The pattern of vaginal states was significantly modified. Hormone administration apparently corrected the alterations and retained a normal vaginal state. MALDI-TOF MS has the potential of being an accurate tool for the identification of vaginal lactobacilli species L. murinus was for the first time isolated from the vagina.

New Biochemical Parameters in the Differential Diagnosis of Ascitic Fluids.

BACKGROUND: In the cases of ascitis, it is essential to determine their origin using the parameters obtained by the cytological and biochemical examinations. The aim of this study was to evaluate the usefulness of different biochemical markers and the number of cells in the differential diagnosis of ascitic fluid (AF). METHODS: One hundred ninety-one cases of AF were studied, who were admitted to the hospital from January 01, 2009 to December 31, 2014. One hundred fifty-two of them were included in the analysis, and the remaining 39 were excluded because they had more than one associated pathology, clotted or hemolyzed. RESULTS: The more frequent etiologies of AF were the cirrhosis (29%), the infections (22%) and the neoplasies (19%). Other pathologies reached 16%. Cutoff > 300 cells/mm3 detected the 78% of exudates. The AF/serum (S) of aspartate aminotransferase (AST) (> 0.5), lactate dehydrogenase (LDH) (> 0.6), proteins (PT) (> 0.5), cholesterol (COL) (> 0.4), and alanine aminotransferase (ALT) (> 0.5) correctly detected 80%, 78%, 72%, 70% and 70% of the exudates, respectively. CONCLUSION: We proposed the utilization of a new cutoff of cellular counting, major of 300/mm3, since it would allow improving the detection of exudate ascites, without including the transudate ascites. AST AF/serum ratio (AF/S) showed the major usefulness in the differentiation and characterization of AF; LDH, proteins, cholesterol and ALT might be also acceptable in the above mentioned differentiation. The serum-ascites albumin gradient (SAAG) turned out to be a good marker of portal hypertension associated with cirrhotic processes. Creatine kinase (CK), alkaline phosphatase (ALP), amylase (AMI), total bilirubin (TB), triglycerides (TG) and glucose (GLU) did not allow differentiating exudates from transudates.

Increase in IS256 transposition in invasive vancomycin heteroresistant Staphylococcus aureus isolate belonging to ST100 and its derived VISA mutants.

In Staphylococcus aureus, transposition of IS256 has been described to play an important role in biofilm formation and antibiotic resistance. This study describes the molecular characterization of two clinical heterogeneous vancomycin-intermediate S. aureus (hVISA) isolates recovered from the same patient (before and after antibiotic treatment) and two VISA derivatives obtained by serial passages in the presence of vancomycin. Our results showed that antibiotic treatment (in vivo and in vitro) could enhance IS256 transposition, being responsible for the eventual loss of agr function. As far as we know this is the first study that reports the increase of IS256 transposition in isogenic strains after antibiotic treatment in a clinical setting.

Estudio multicéntrico de disfunción vaginal de la Red Nacional de Laboratorios BACOVA de la República Argentina: prevalencia, influencia de factores seleccionados, evaluación clínica y distribución de casos por región / Multicenter study on vaginal dysfunction of the National Network of BACOVA Laboratories in Argentina: prevalence, influence of selected factors, clinical evaluation and case distribution by region / Estudo multicêntrico de disfunção vaginal da Rede Nacional de Laboratórios BACOVA da República Argentina: prevalência, influência de fatores selecionados, avaliação clínica e distribuição dos casos por região

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Abstract The aims of this study were to update the prevalence of vaginal dysfunction (VD) in non-pregnant women of childbearing age, pregnant women and menopausal women, to analyse microbiological aspects, to evaluate the influence of parity and contraception in the vaginal microenvironment, to analyse case studies, and to compare the prevalence in the five regions of Argentina: Northeast, Northwest, Centre, Cuyo and South. Eight thousand three hundred twenty-four (8324) vaginal content samples of patients from 39 institutions, examined between May 2019 and June 2020, were prospectively and consecutively studied. The samples were analysed applying the standardized BAVACO-VIR methodology (study of the balance of vaginal content and genital inflammatory response). Of the 8324 samples, 5947 (71.5%) corresponded to women of childbearing age; 1627 (19.5%) to pregnant women and 750 (9.0%) to menopausal women. The most frequent basic vaginal state (BVS) in the three groups was BVS I with normal microbiota, accounting for 33.5% of the entire studied population. Moreover, 66.5% of vaginal dysfunction states were detected. In the pregnant women and menopausal women group there was a significant increase in the frequency of normal BVS I, in contrast with the group of women of childbearing age, where a significant increase of vaginosis and vaginitis was observed. In asymptomatic women, a predominance of BVS I was detected in the three groups. In symptomatic women, there was a predominance of BVS II and V in pregnant women, of BVS II, IV and V in women of childbearing age, and of BVS III and V in menopausal women. Asymptomatic VD was detected in 56.6% of pregnant women, 62.8% of women of childbearing age and 50.9% of menopausal women. A significantly positive association was detected between the presence of yeasts and BVS II and V and the presence of trichomonas and BVS V. The multiparity history variable showed a statistically significant positive association with BVS V and a negative association with BVS I. With regard to contraception, in women who used hormonal contraceptives it was observed that oral contraceptives increased the frequency of BVS I and II and decreased the frequency of BVS III, IV and V of VD; in those who used an intradermal device, there was a decrease in the frequency of BVS I, II and III and an increase in the frequency of BVS IV and V, whereas in women using injectable contraceptives, there was no association. The intrauterine device decreased the frequency of BVS I and II and increased the frequency of BVS V; the condom increased the frequency of BVS IV and the rhythm method decreased the frequency of BVS II. In BVS I, a decrease in the frequency of signs and symptoms was detected. The prevalence of VD in some regions accounted for values over 80%, a higher figure than that described at the national and international levels, which reflects the poor and insufficient action in Sexual and Reproductive Health. The high percentage of asymptomatic women with VD highlights the importance of studying the vaginal content, even in the absence of symptoms. A history of multiparity and contraception showed a link with vaginal function, reflecting the importance of considering this fact in a gynecological evaluation. Although the relationship of BVS with signs and symptoms does not constitute a diagnostic tool, it contributes to the understanding of pathogenic mechanisms.

Resumo Os objetivos deste estudo foram: atualizar a prevalência de disfunção vaginal (DV) em mulheres não grávidas em idade fértil (MEF), mulheres grávidas (EMB) e mulheres menopausadas (MPN), analisar aspectos microbiológicos, avaliar a influência da paridade e contracepção no microambiente vaginal, analisar quadros clínicos e comparar as prevalências das 5 regiões do nosso país: Nordeste, Noroeste, Centro, Cuyo e Sur. 8324 conteúdos vaginais de pacientes de 39 instituições, que compareceram entre maio de 2019 e junho de 2020, foram estudados prospectiva e facilitadoconsecutivamente. As amostras foram analisadas aplicando-se a metodologia padronizada BACOVA-ERIGE (estudo do equilíbrio do conteúdo vaginal e resposta inflamatória genital). Das 8324 amostras de conteúdo vaginal, 5947 (71,5%) corresponderam às MEF; 1627 (19,5%) às EMB e 750 (9,0%) às MNP. O estado vaginal básico (EVB) mais frequente nos três grupos foi EVB I de microbiota normal e representou 33,5% de toda a população global. Foram detectados 66,5% dos estados de disfunção vaginal. No grupo EMB e MNP, um aumento significativo na frequência de EVB I normal foi registrado, em contraste com o grupo MEF, onde foi reconhecido um aumento significativo de EVB de vaginose e vaginite. Em mulheres assintomáticas, foi detectado predomínio de EVB I nos três grupos. Em mulheres sintomáticas foi detetado: nas EMB, predomínio de EVB II e V; nas MEF, predominância de EVB II, IV e V, e nas MNP, predominância de EVB III e V. 56,6% das EMB, 62,8% das MEF e 50,9% das MNP apresentaram DV na ausência de sintomas. Foi detectada associação significativamente positiva entre a presença de leveduras e EVB II e V e a presença de tricomonas e EVB V. A variável antecedente de multiparidade apresentou associação positiva estatisticamente significativa com EVB V e associação negativa com EVB I. Em relação à contracepção, observou-se em mulheres que usavam anticoncepcionais hormonais, que os anticoncepcionais orais aumentaram a frequência de EVB I e II e diminuíram a frequência de EVB III, IV e V de DV; Em mulheres com dispositivo intradérmico, foi observada uma diminuição na frequência de EVB I, II e III e um aumento na frequência de EVB IV e V, e finalmente em mulheres com anticoncepcionais injetáveis, nenhuma associação foi demonstrada. O dispositivo intrauterino diminuiu a frequência de EVB I e II e aumentou a frequência de EVB V; o preservativo aumentou a frequência de EVB IV e o método do ritmo diminuiu a frequência de EVB II. Na EVB I, foi detectada diminuição da frequência de sinais e sintomas. A prevalência de DV em algumas regiões ultrapassou valores de 80%, valor superior ao descrito a nível nacional e internacional, o que reflete a atuação precária e insuficiente em Saúde Sexual e Reprodutiva. O alto percentual de mulheres assintomáticas com DV demonstra a importância da realização do estudo do conteúdo vaginal, mesmo na ausência de sintomas. A história de multiparidade e contracepção mostrou ligação com a função vaginal, refletindo a importância da sua consideração na avaliação ginecológica. Embora a relação da EVB com os sinais e sintomas não constitua uma ferramenta diagnóstica, ela contribui para o entendimento dos mecanismos patogênicos.