RESUMO
Background: Streptococcus pneumoniae, a prominent human pathogen linked to various systemic diseases, includes non-typeable pneumococci marked by the absence of a detectable capsule. However, the majority of invasive infections are attributed to encapsulated strains. This case report details the first documented instance of invasive disease caused by non-typeable S. pneumoniae in Argentina since 2017. Case Presentation: A 19-year-old woman presented with haemorrhagic injuries attributed to chronic oral mucosa irritation. Subsequent hospitalization revealed bone marrow aplasia, leading to antibiotic, antifungal, antiviral, and immunosuppressive treatments, culminating in her discharge. Two weeks later, she was readmitted with sepsis related to a respiratory focus, exhibiting a negative COVID-PCR test. After ten days, ICU admission revealed additional infections: positive COVID-PCR test, fungal sinusitis, and S. pneumoniae bacteremia. Targeted treatments led to improvement, and the patient was subsequently discharged. S pneumoniae characterization: Verification of the capsule's absence utilized traditional methods such as the Quellung reaction, transmission electron microscopy, molecular assays, and Whole Genome Sequencing (WGS). The isolate, identified as ST18335, displayed genetic features and antibiotic resistance patterns, concordant between WGS and the agar dilution method. It demonstrated non-susceptibility to penicillin and cefotaxime, based on meningitis breakpoints, as well as meropenem and cotrimoxazole. Conclusion: This case underscores the clinical significance of non-typeable S. pneumoniae, emphasizing the necessity for a comprehensive approach to identification and characterization. The findings contribute to ongoing discussions regarding the challenges posed by non-typeable strains in vaccine development, understanding clinical impacts, and addressing antibiotic resistance. As the pneumococcal epidemiological landscape evolves, this case serves as a valuable addition to the evolving knowledge surrounding non-typeable S. pneumoniae, highlighting the continued need for surveillance and research in infectious diseases.
RESUMO
Resumen Blastocystis es el parásito unicelular del intestino del hombre y de otros animales más prevalente en seres humanos. Presenta gran variedad genética con múltiples subtipos (ST). Aunque se ha asociado a desórdenes intestinales y extraintestinales, su patogenicidad es discutida. Se analizaron 461 muestras de materia fecal de pacientes sintomáticos (n=380) y asintomáticos (n=81) de hospitales de Bahía Blanca, Argentina; se solicitó consentimiento informado y se completó una ficha epidemiológica. Se realizaron análisis coproparasitológicos, morfometría, recuento y tipificación de Blastocystis ST3 por PCR. La población fue: 57,3% de sexo femenino y 42,7% masculino. La prevalencia de Blastocystis fue de 31% y de Blastocystis ST3 62%. Se hallaron formas vacuolares, granulares y quísticas; las vacuolares fueron las más frecuentes. En el 64,8% de las muestras los Blastocystis fueron pequeños y escasos. El 88,4% de los pacientes sintomáticos presentó trastornos gastrointestinales, el 4% urticaria y el 7,6% fiebre, anemia y bajo peso. El 66,7% de los pacientes con urticaria presentó Blastocystis. La presencia de síntomas se asoció significativamente con Blastocystis (p<0,002). No se hallaron asociaciones estadísticas entre Blastocystis, la edad, el sexo, la disponibilidad de agua potable, de cloacas y el contacto con animales. Dentro de los síntomas sólo se encontró asociación estadística de Blastocystis con urticaria (p<0,007). No hubo asociación entre Blastocystis ST3 y sintomatología. Los resultados destacan la alta prevalencia de Blastocystis y de Blastocystis ST3, la necesidad de hacer un coproparasitológico minucioso, su asociación estadística con urticaria y la importancia de no ignorarlo en el proceso salud-enfermedad.
Abstract Blastocystis is the unicellular parasite of the intestine of man and other animals,most prevalent in humans. It has a great genetic variety with multiple subtypes (ST). Although it has been associated with intestinal and extraintestinal disorders, its pathogenicity remains unclear. Four hundred and sixty one stool samples from symptomatic (n=380) and asymptomatic(n=81) patients from hospitals in Bahía Blanca, Argentina were analysed; informed consent was requested and an epidemiological file was completed. Coproparasitological analysis, morphometry, counting and typing of Blastocystis ST3 were performed by PCR. The population was: 57.3% female and 42.7% male.The prevalence of Blastocystis was 31.0% and that of Blastocystis ST3 62%. Vacuolar, granular and cystic forms were found, with vacuolar forms being the most frequent. Blastocystis were small and scarce in 64.8% of the samples. Most of the symptomatic patients (88.4%) presented gastrointestinal disorders, urticaria 4% and fever, anemia and low weight 7.6%; 66.7% of the urticaria patients presented Blastocystis. The presence of symptoms was significantly associated with Blastocystis (p<0.002). No statistical associations were found between Blastocystis, age, sex, availability of drinking water, sewage, and contact with animals. Within the symptoms, only statistical association of Blastocystis with urticaria was found (p<0.007). There was no association between Blastocystis ST3 and symptomatology. The results highlight the high prevalenceof Blastocystis and Blastocystis ST3, the need for a thorough coproparasitology, their statistical association with urticaria and the importance of not ignoring it in the health-disease process.
Resumo Blastocystis é o parasita unicelular do intestino do homem e outros animais, mais prevalente em seres humanos. Apresenta grande variedade genética com múltiplos subtipos (ST). Embora tenha sido associada a distúrbios intestinais e extraintestinais, sua patogenicidade é debatida. Foram analisadas 461 amostras de fezes de pacientes sintomáticos (n=380) e assintomáticos (n= 81) de hospitais de Bahía Blanca, Argentina; foi solicitado consentimento informado e preenchida uma ficha epidemiológica. Foram realizadas análises coproparasitológicas, morfometria, contagem e tipificação de Blastocystis ST3 por PCR. A população era: 57,3% sexo feminino e 42,7% masculino. A prevalência de Blastocystis foi de 31,0% e de Blastocystis ST3 62%. Foram encontradas formas vacuolares, granulares e císticas, sendo as vacuolares as mais frequentes. Em 64,8% das amostras, os Blastocystis foram pequenos e escassos; 88,4% dos pacientes sintomáticos apresentaram distúrbios gastrointestinais, 4% urticária e 7,6% febre, anemia e baixo peso; 66,7% dos pacientes com urticária apresentaram Blastocystis. A presença de sintomas foi associada significativamente com Blastocystis (p˂0,002). Não foram encontradas associações estatísticas entre Blastocystis, a idade, sexo, a disponibilidade de água potável, de esgoto e o contato com animais. Dentro dos sintomas, só foi encontrada associação estatística de Blastocystis com urticária (p˂0,007). Não houve associação entre Blastocystis ST3 e sintomatologia. Os resultados destacam a alta prevalência de Blastocystis e Blastocystis ST3, a necessidade de fazer um coproparasitologico minucioso, sua associação estatística com urticária e a importância de não ignorá-lo no processo saúde-doença.
Assuntos
Associação , Água Potável , Blastocystis , FezesRESUMO
La disfunción vaginal (vaginosis/vaginitis) es la patología genital hoy reconocida más prevalente. El objetivo del trabajo fue generar información sobre la prevalencia de Disfunción vaginal y los factores de riesgo asociados en mujeres sintomáticas y asintomáticas. Se incorporó además la detección de C. trachomatis y N. gonorrhoeae. Se consolida la validez del Balance del Contenido Vaginal (BACOVA) en el diagnóstico integral de disfunción vaginal y de la amplificación génica en la detección de C. trachomatis. Se estudiaron 295 mujeres que asistieron al Hospital Municipal de Bahía Blanca. La mayor prevalencia correspondió a vaginosis bacteriana (21,36%), luego levaduras (13,90%), T. vaginalis (3,73%) y C. trachomatis (3,05%). No se detectó ningún caso de gonococia. Los factores de riesgo encuadran en el marco de valores de la región centro sur del país, pero se debe destacar la frecuencia significativa de alteraciones de la función vaginal (68,87%) y la infección por clamidias (4,35%) detectadas en mujeres asintomáticas. Esto impone la necesidad de revisar y optimizar la política de cumplimiento de las Normas Ministeriales de prevención y control con la aplicación de una metodología de laboratorio normatizada en el protocolo de control de mujeres en edad fértil, embarazadas o no.
Vaginal dysfunction (vaginosis/vaginitis) is the most prevalent genital pathology recognized today. The objective of the work was to generate information on the prevalence of vaginal dysfunction and the associated risk factors in symptomatic and asymptomatic women. The detection of C. trachomatis and N. gonorrhoeae was also incorporated. The validity of the Vaginal Content Balance (BACOVA) in the comprehensive diagnosis of vaginal dysfunction and of gene amplification in the detection of C. trachomatis is consolidated. A total of 295 women who attended the Municipal Hospital of Bahía Blanca were studied. The highest prevalence corresponded to bacterial vaginosis (21.36%), then yeasts (13.90%), T. vaginalis (3.73%) and C. trachomatis (3.05%). No cases of gonorrhea were detected. The risk factors fit within the framework of values of the south central region of the country, but the significant frequency of alterations of vaginal function (68.87%) and chlamydial infection (4.35%) detected in asymptomatic women should be noted. This imposes the need to review and optimize the compliance policy of the Ministerial Standards of prevention and control, with the application of a standardized laboratory methodology, in the control protocol for women of childbearing age, pregnant or not.
A disfunção vaginal (vaginose/vaginite) é a patologia genital mais prevalente hoje reconhecida. O objetivo do trabalho foi gerar informações sobre a prevalência de disfunção vaginal e os fatores de risco associados em mulheres sintomáticas e assintomáticas. A detecção de C. trachomatis e N. gonorrhoeae também foi incorporada. A validade do Equilíbrio do Conteúdo Vaginal (BACOVA) no diagnóstico integral da Disfunção Vaginal e da amplificação gênica na detecção de C. trachomatis está consolidada. Estudamos 295 mulheres que freqüentaram o Hospital Municipal de Bahía Blanca. A maior prevalência correspondeu à vaginose bacteriana (21,36%), depois leveduras (13,90%), T. vaginalis (3,73%) e C. trachomatis (3,05%). Nenhum caso de gonorreia foi detectado. Os fatores de risco enquadram-se no quadro de valores da região centro-sul do país, mas deve-se notar a frequência significativa de alterações da função vaginal (68,87%) e infecção por clamídia (4,35%), detectadas em mulheres assintomáticas. Isso impõe a necessidade de rever e otimizar a política de compliance das Normas Ministeriais de prevenção e controle, com a aplicação de metodologia laboratorial padronizada, no protocolo de controle para mulheres em idade fértil, gestantes ou não.
Assuntos
Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Vaginite por Trichomonas/epidemiologia , Candidíase Vulvovaginal/epidemiologia , Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Vaginose Bacteriana/epidemiologia , Argentina/epidemiologia , Prevalência , Fatores de Risco , Vaginose Bacteriana/diagnóstico , Vaginose Bacteriana/microbiologiaRESUMO
OBJECTIVE To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and the INICC Surveillance Online System (ISOS) on central line-associated bloodstream infection (CLABSI) rates in 14 intensive care units (ICUs) in Argentina from January 2014 to April 2017. DESIGN This prospective, pre-post surveillance study of 3,940 ICU patients was conducted in 11 hospitals in 5 cities in Argentina. During our baseline evaluation, we performed outcome and process surveillance of CLABSI applying Centers for Disease Control and Prevention/National Health Safety Network (CDC/NHSN) definitions. During the intervention, we implemented the IMA through ISOS: (1) a bundle of infection prevention practice interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback on CLABSI rates and consequences, and (6) performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention on the CLABSI rate. RESULTS During the baseline period, 5,118 CL days and 49 CLABSIs were recorded, for a rate of 9.6 CLABSIs per 1,000 central-line (CL) days. During the intervention, 15,659 CL days and 68 CLABSIs were recorded, for a rate of 4.1 CLABSIs per 1,000 CL days. The CLABSI rate was reduced by 57% (incidence density rate: 0.43; 95% confidence interval, 0.34-0.6; P<.001). CONCLUSIONS Implementing IMA through ISOS was associated with a significant reduction in the CLABSI rate in ICUs in Argentina. Infect Control Hosp Epidemiol 2018;39:445-451.
Assuntos
Bacteriemia , Infecções Relacionadas a Cateter , Cateteres Venosos Centrais/efeitos adversos , Infecção Hospitalar , Controle de Infecções , Argentina/epidemiologia , Bacteriemia/epidemiologia , Bacteriemia/etiologia , Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/etiologia , Infecções Relacionadas a Cateter/prevenção & controle , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Humanos , Incidência , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Avaliação de Processos e Resultados em Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Fatores de RiscoRESUMO
BACKGROUND: To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach (IMA) on ventilator-associated pneumonia (VAP) rates in 11 hospitals within 5 cities of Argentina from January 2014-April 2017. METHODS: A multicenter, prospective, before-after surveillance study was conducted through the use of International Nosocomial Infection Control Consortium Surveillance Online System. During baseline, we performed outcome surveillance of VAP applying the definitions of the Centers for Disease Control andPrevention's National Healthcare Safety Network. During intervention, we implemented the IMA, which included a bundle of infection prevention practice interventions, education, outcome surveillance, process surveillance, feedback on VAP rates and consequences, and performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention. RESULTS: We recorded 3,940 patients admitted to 14 intensive care units. At baseline, there were 19.9 VAPs per 1,000 mechanical ventilator (MV)-days-with 2,920 MV-days and 58 VAPs, which was reduced during intervention to 9.4 VAPs per 1,000 MV-days-with 9,261 MV-days and 103 VAPs. This accounted for a 52% rate reduction (incidence density rate, 0.48; 95% confidence interval, 0.3-0.7; P .001). CONCLUSIONS: Implementing the IMA was associated with significant reductions in VAP rates in intensive care units within Argentina.
Assuntos
Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Controle de Infecções/métodos , Unidades de Terapia Intensiva , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Cidades/epidemiologia , Feminino , Hospitais , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
La infección genital por Chlamydia trachomatis es considerada en la actualidad una de las causas más frecuentes de infecciones transmisibles sexualmente (ITS) a nivel mundial y afecta principalmente al grupo de jóvenes menores de 25 años. El objetivo de este estudio fue determinar la prevalencia de la infección por C. trachomatis en alumnos ingresantes a la Universidad Nacional del Sur (Bahía Blanca, Argentina) y evaluar los factores de riesgo para la adquisición de ITS. Participaron en el estudio 204 jóvenes de edad media de 19 años, que remitieron una muestra de orina de primera micción y respondieron a una encuesta anónima. La investigación de C. trachomatis se realizó sobre 114 muestras válidas mediante una técnica de amplificación génica, cuyo blanco molecular es el gen ompA. Se detectaron 4 casos de infección por C. trachomatis, lo que implicó una prevalencia del 3,5 %. Los factores de riesgo que demostraron estar asociados con la adquisición de esta ITS fueron un historial de 7 o más parejas desde el comienzo de las relaciones sexuales y el contacto con una nueva pareja sexual en los últimos 4 meses. La prevalencia de infección por C. trachomatis reflejó una moderada circulación de este microorganismo en la población estudiada. Si bien algunos aspectos revelados en las encuestas sugieren una población de bajo riesgo para la adquisición de ITS en general, otros datos evidencian lo contrario y alertan sobre la necesidad de incrementar la vigilancia y desarrollar acciones de concienciación y prevención en esta población.
Chlamydia trachomatis genital infection is nowadays considered one of the most frequent causes of sexually transmitted infections (STI) in the world, mainly affecting the group of young people under 25 years old. The aim of this study was to determine the prevalence of C. trachomatis infection in newly admitted students to Universidad Nacional del Sur, Bahía Blanca, Argentina, and to evaluate the risk factors to acquire STI. For that purpose, 204 young college students with a mean age of 19 were involved in this study. Each participant delivered a sample of first-void urine and completed a questionnaire which was then submitted anonymously. The research for C. trachomatis was done on 114 valid samples through a technique of DNA amplification, whose molecular target was the gene ompA. Four cases of infection by C. trachomatis were detected with a prevalence of 3.5 %. The risks factors associated to the infection were a history of 7 or more partners since the start of sexual activity and contact with a new sexual partner in the last 4 months. The prevalence of such infection reflects a moderate circulation of this microorganism in the studied population. This fact, along with some aspects shown by the questionnaire results, would characterize a population having a low risk profile for acquiring STIs. However, some other information obtained from the questionnaires gave some opposite evidence, which would alert us on the need of keeping watch, raising awareness and implementing preventive actions in this population.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Adulto Jovem , Chlamydia trachomatis , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/transmissão , Estudos Transversais , Prevalência , Fatores de Risco , Estudantes , Inquéritos e Questionários , Doenças Bacterianas Sexualmente Transmissíveis/epidemiologia , Doenças Bacterianas Sexualmente Transmissíveis/transmissão , UniversidadesRESUMO
Chlamydia trachomatis genital infection is nowadays considered one of the most frequent causes of sexually transmitted infections (STI) in the world, mainly affecting the group of young people under 25 years old. The aim of this study was to determine the prevalence of C. trachomatis infection in newly admitted students to Universidad Nacional del Sur, Bahía Blanca, Argentina, and to evaluate the risk factors to acquire STI. For that purpose, 204 young college students with a mean age of 19 were involved in this study. Each participant delivered a sample of first-void urine and completed a questionnaire which was then submitted anonymously. The research for C. trachomatis was done on 114 valid samples through a technique of DNA amplification, whose molecular target was the gene ompA. Four cases of infection by C. trachomatis were detected with a prevalence of 3.5%. The risks factors associated to the infection were a history of 7 or more partners since the start of sexual activity and contact with a new sexual partner in the last 4 months. The prevalence of such infection reflects a moderate circulation of this microorganism in the studied population. This fact, along with some aspects shown by the questionnaire results, would characterize a population having a low risk profile for acquiring STIs. However, some other information obtained from the questionnaires gave some opposite evidence, which would alert us on the need of keeping watch, raising awareness and implementing preventive actions in this population.
Assuntos
Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/transmissão , Chlamydia trachomatis , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Doenças Bacterianas Sexualmente Transmissíveis/epidemiologia , Doenças Bacterianas Sexualmente Transmissíveis/transmissão , Estudantes , Inquéritos e Questionários , Universidades , Adulto JovemRESUMO
Chlamydia trachomatis es considerada actualmente como uno de los agentes más comunes de enfermedades transmitidas sexualmente. En mujeres es causa de uretritis y cervicitis, y puede llevar a complicaciones, tales como enfermedad inflamatoria pélvica, embarazo ectópico e infertilidad tubaria. La transmisión al neonato durante el parto puede ocasionar infecciones graves. En el hombre, es responsable de uretritis y epididimitis. Los reportes de la OMS señalan una prevalencia del 4,4 al 6,6%. El objetivo del presente estudio fue investigar la prevalencia de C. trachomatis en mujeres sexualmente activas, atendidas en el Laboratorio del Hospital Municipal de la ciudad de Bahía Blanca (Argentina) incluyendo las trabajadoras sexuales. Para ello, se utilizó la técnica de amplificación génica, mediante la Reacción de la Polimerasa en Cadena (PCR). Se estudiaron 225 pacientes (140 mujeres sintomáticas y 85 Trabajo Original trabajadoras sexuales que tramitaban su libreta sanitaria). Los estudios demostraron que, en los 225 hisopados endocervicales efectuados, se encontró una tasa de prevalencia total de infección por C. trachomatis del 4,4%, siendo significativamente mayor en mujeres trabajadoras sexuales (8,2%), respecto de las mujeres que no practicaban el comercio sexual (2,2 %) χ2 = 4,62 p = 0,031 OR = 4,10. Estos primeros datos de prevalencia de infección por C. trachomatis en Bahía Blanca, permiten alertar respecto de la necesidad de continuar con otras investigaciones e implementar directivas, para que se incluya la búsqueda de C. trachomatis en mujeres trabajadoras sexuales, cuando solicitan su libreta sanitaria.
At present, Chlamydia trachomatis is considered as one of the most common agents for sexually transmitted diseases. In women, it causes uretritis and cervicitis, and can lead to complications, such as pelvic inflammatory disease, ectopic pregnancy or tubal infertility. Transmission to the newborn during delivery can cause serious infections. In men, it is responsible for uretritis and epididymitis. WHO reports show a 4.4 to 6.6% prevalence. The aim of this study was to find out the prevalence of C. trachomatis in sexually active women assisted at the Laboratory of the Municipal Hospital at Bahía Blanca city (Argentina) including sexual workers. For such purpose, the genic amplification technique, by means of Polymerase Chain Reaction (PCR) was used. 225 patients were studied (140 symptomatic women and 85 sexual workers who were requesting their health booklet). The studies showed that, in the 225 endocervical swabs performed, a total prevalence infection rate by C. trachomatis of 4.4% was found, being significantly higher in women sexual workers (8.2%), with regard to those women who were not (2.2 %) χ2 = 4,62 p = 0,031 OR = 4,10. These first data on the prevalence of infection by C. trachomatis in Bahía Blanca, allow us to alert on the need to continue with further research and to implement guidelines to include C. trachomatis detection tests in sexual workers when they request their health booklet.