Antimicrobials and resistant bacteria in global fish farming and the possible risk for public health / Antimicrobianos e bactérias resistentes na piscicultura global e o possível risco para a saúde pública

The use of antimicrobials in fish farming is a reflection of the fast aquaculture development worldwide. The intensification of aquaculture to achieve market demands could lead to an increase in infectious diseases by pathogenic bacteria. Consequently, antimicrobials act as controls for emerging infectious diseases, but their use must follow the rules and regulations of the country where the activity is performed. Although the regulations impose limits to the use of antimicrobials in fish farming, many studies show that resistant bacteria are isolated from this system. The selection of resistant bacteria is not limited only to the use of antimicrobials, but also to co-selection of resistance genes or even with cross-resistance processes. Resistant bacteria from fish farming are a serious concern because they can be acquired by humans with handling or food chain, which may represent a public health problem. In the present review, we present an overview of antimicrobials use in aquaculture, the antimicrobial resistance and the impact of antimicrobial and bacterial resistance from a public health perspective.(AU)

O uso de antimicrobianos na piscicultura é um reflexo do rápido desenvolvimento da aquicultura em todo o mundo. A intensificação da aquicultura para suprir as demandas do mercado pode levar ao aumento de doenças infecciosas por bactérias patogênicas. Consequentemente, os antimicrobianos atuam no controle de doenças infecciosas emergentes, mas seu uso deve seguir as regras e regulamentos do país onde a atividade é realizada. Embora os regulamentos imponham limites ao uso de antimicrobianos na piscicultura, muitos estudos mostram que bactérias resistentes são isoladas desse sistema. A seleção de bactérias resistentes não se limita apenas ao uso de antimicrobianos, mas também à cosseleção de genes de resistência ou mesmo por meio do processo de resistência cruzada. As bactérias resistentes da piscicultura são uma preocupação séria, uma vez que tais bactérias podem ser adquiridas pelos seres humanos no manuseio ou na cadeia alimentar, o que pode representar um problema de saúde pública. Nesta revisão, apresentamos uma visão geral do uso de antimicrobianos na aquicultura, a resistência antimicrobiana e o impacto da resistência antimicrobiana e bacteriana do ponto de vista da saúde pública.(AU)

Caracterización epidemiológica de la infección por Leptospira spp. en caballos de trabajo y en personas ocupacionalmente expuestas en seis unidades de la Policía Nacional de Colombia / Epidemiological characterization of Leptospira spp. infection in working horses and in an occupationally exposed population in six Colombian police stations

Resumen Introducción. Los caballos de trabajo de la Policía Nacional tienen un estrecho contacto con sus manejadores y la población en general durante las actividades recreativas y de patrullaje, lo cual puede favorecer la transmisión de la leptospirosis en los caballos y el personal ocupacionalmente expuesto. Objetivo. Caracterizar epidemiológicamente la leptospirosis mediante pruebas de serología, urocultivo y reacción en cadena de la polimerasa (Polymerase Chain Reaction, PCR) en caballos de trabajo y personal con riesgo ocupacional pertenecientes a seis unidades de la Policía Nacional de Colombia. Materiales y métodos. Se evaluaron 153 caballos machos castrados y 123 personas en las seis unidades en los municipios de Manizales, Pereira, Armenia, Ibagué, Tuluá y Cali. Se utilizaron tres formatos estructurados para recabar información y se obtuvieron muestras sanguíneas de las personas y de los caballos, las cuales se procesaron con la prueba de aglutinación microscópica (Macroscopic Agglutination Test, MAT) para 24 serogrupos. Se practicó el examen clínico de los caballos y se obtuvieron muestras de orina para el urocultivo y la PCR convencional. Resultados. La seroprevalencia de Leptospira spp. fue de 3,25 % (n=4) en las personas y de 85 % (n=130) en los caballos. Entre los caballos, los serogrupos Djasiman y Shermani fueron los más prevalentes. El urocultivo fue positivo en el 64,7 % (99/153) de las muestras, en tanto que los análisis de PCR fueron negativos. Se encontró una asociación estadísticamente significativa de la frecuencia de salida de las instalaciones (p=0,009) y la presencia de fauna silvestre (p=0,051) con la infección por el serogrupo Shermani. Conclusión. Las características epidemiológicas de la leptospirosis en los caballos sugieren una presentación endémica de la infección y su papel como reservorios de la bacteria; sin embargo, debe dilucidarse la patogenia de la enfermedad con estudios complementarios.

Abstract Introduction: Police working horses are in close contact with their managers and the general population during recreational and patrol activities, which can favor the transmission of leptospirosis among the horses and the occupationally exposed personnel. Objective. To characterize epidemiologically leptospirosis through serology, urine culture and PCR in working horses and in the occupationally exposed population in six police stations in Colombia. Materials and methods. We tested 153 castrated male horses and 123 people in six police stations in the municipalities of Manizales, Pereira, Armenia, Ibagué, Tuluá, and Cali. Three structured formats were applied and blood samples were obtained from people and horses, which were processed with the Macroscopic Agglutination Test, (MAT) for 24 serogroups. Horses were subject to a clinical examination, and urine samples were obtained for urine culture and conventional PCR. Results. The seroprevalence of human Leptospira spp. was 3.25% (n=4) while in horses it was 85% (n=130). Among the horses, serogroups Djasiman and Shermani were the most prevalent. The urine culture was positive in 64.7% (99/153) of the samples, whereas PCR analyzes were negative. A statistically significant association was found between the frequency of exiting the facilities (p=0.009) and the presence of wildlife (p=0.0051) with the infection by serogroup Shermani. Conclusion. The epidemiological characteristics of leptospirosis in horses suggest an endemic presentation of the infection and its role as reservoirs of the bacteria; however, it is necessary to elucidate the pathogenesis of the disease with complementary studies.

Legionelosis ocupacional en mayores de 18 años: revisión sistemática / Occupational legionella in adults over 18 years pf age: a systematic review

Resumen El objetivo es revisar la literatura científica sobre los problemas de salud derivados de la exposición laboral a Legionella spp. Revisión sistemática de la literatura científica recogida en las bases de datos MEDLINE (Pubmed), ISI-Web of Science (Institute for Scientific Information), Cochrane Library Plus, Literatura Latinoamericana de Información en Ciencias de la Salud (LILACS) y SCOPUS, hasta febrero 2015. Los descriptores utilizados fueron: "Legionnaires' Disease" "Legionellosis" "Occupational Exposure" "Occupational Diseases". Se obtuvieron 222 referencias, que tras aplicar los criterios de inclusión y exclusión, se seleccionaron 13 artículos a texto completo. De ellos 9 artículos describen la aparición de neumonía, 4 Fiebre de Pontiac, 1 legionelosis o presunta legionelosis y 3 muerte. El principal agente causal en los profesionales expuestos fue Legionella pneumophila serogrupo 1. La infección por legionela está ligada a las profesiones donde existe nebulización por agua, principalmente en los trabajadores sometidos a largas exposiciones o incluso a la re-exposición. Los brotes se producen de forma estacional, sobre todo en los meses más cálidos.

Abstract The scope of this paper is to review the available scientific literature about the effects on health of occupational exposure to Legionella spp. A systematic review of the scientific literature retrieved from the MEDLINE (via PubMed), ISI-Web of Science (Institute for Scientific Information), Cochrane Library, LILCAS and SCOPUS databases through February 2015 was conducted. The key words used were ««Legionnaires' Disease¼ «Legionellosis¼ «Occupational Exposure¼ «Occupational Diseases¼. Two hundred and twenty-two references were retrieved of which, after applying inclusion/exclusion criteria, 13 complete articles were selected. Of these, 9 describe pneumonia, 4 list Pontiac Fever, 1 reveals legionellosis and 3 result in death. The main causative agent of disease in workers exposed was Legionella pneumophila serogroup 1. Legionella spp infection is closely related to professions where there is nebulization with water, mainly among workers subjected to long exposure or even re-exposure. Outbreaks occurs seasonally, especially in the hottest months.

Tuberculosis infection among primary health care workers / Infecção por tuberculose entre profissionais de saúde da atenção básica

ABSTRACT Objective: To estimate the prevalence of and determine the risk factors associated with latent Mycobacterium tuberculosis infection (LTBI) among primary health care workers in the city of Vitória, Brazil. Methods: This was a cross-sectional study with data collected through a survey regarding socio-demographic, occupational, clinical, and exposure characteristics, as well as knowledge about tuberculosis, conducted between 2011 and 2012. All participants underwent a tuberculin skin test (TST), and TSTs were read at 72 h by a trained professional. Results: A total of 218 primary health care workers participated in the study. The prevalence of TST positivity at the ≥ 10-mm and ≥ 5-mm cut-off points was, respectively, 39.4% (95% CI: 32.9-45.9) and 54.1% (95% CI: 47.4-60.7). Regarding occupational categories, community health agents had the highest proportion of TST positivity, regardless of the cut-off point (≥ 10 mm: 47.5%; and ≥ 5 mm: 60.5%). Regarding factors associated with TST results, "having had a previous TST" showed a statistically significant association with TST positivity at the ≥ 10-mm and ≥ 5-mm cut-off points (OR = 2.5 [95% CI: 1.17-5.30] and OR = 2.18 [95% CI: 1.23-3.87], respectively). Conclusions: The prevalence of LTBI was found to be high among the primary health care workers in this sample. Therefore, we recommend the establishment of a periodic screening program for LTBI and implementation of effective biosafety policies for the prevention of this infection among primary health care workers.

RESUMO Objetivo: Estimar a prevalência de infecção latente pelo Mycobacterium tuberculosis (ILTB) e identificar os fatores de risco associados a essa infecção entre profissionais de saúde da atenção básica no município de Vitória (ES). Métodos: Estudo transversal cujas informações foram obtidas por meio de inquérito sobre dados sociodemográficos, ocupacionais, clínicos, de exposição e de conhecimento sobre tuberculose, realizado entre 2011 e 2012. Todos os participantes foram submetidos ao teste tuberculínico (TT), e a leitura do resultado foi realizada após 72 h por um profissional capacitado. Resultados: Participaram do estudo 218 profissionais de saúde. A prevalência de positividade ao TT foi de 39,4% (IC95%: 32,9-45,9) e de 54,1% (IC95%: 47,4-60,7), respectivamente, para os pontos de corte do TT ≥ 10 mm e ≥ 5 mm. Em relação às categorias profissionais, os agentes comunitários de saúde apresentaram a maior proporção de positividade ao teste, independentemente do ponto de corte considerado (≥ 10 mm: 47,5%; e ≥ 5 mm: 60,5%). Em relação aos fatores associados ao resultado do teste, "ter feito TT anteriormente" apresentou associações estatisticamente significativas com o resultado positivo ao TT para os pontos de corte ≥ 10 mm e ≥ 5 mm [OR = 2,5 (IC95%: 1,17-5,30) e OR = 2,18 (IC95%: 1,23-3,87), respectivamente]. Conclusões: Os profissionais de saúde da atenção básica dessa amostra apresentaram uma alta prevalência de ILTB. Logo, recomendam-se a instituição de um programa de triagem periódica para ILTB e a implantação de políticas efetivas de biossegurança para a prevenção dessa infecção nos profissionais de saúde na atenção básica.

Prevalence and risk factors for latent tuberculosis infection among primary health care workers in Brazil / Prevalência de infecção latente da tuberculose e fatores de risco entre profissionais de saúde na atenção primária no Brasil / Prevalencia de infección latente de la tuberculosis y factores de riesgo entre profesionales de salud en la atención primaria en Brasil

Health care workers (HCW) are at increased risk of latent tuberculosis infection (LTBI) from occupational exposure to Mycobacterium tuberculosis. The objective was to determine the prevalence of and risk factors for LTBI among primary HCW in five Brazilian cities. We conducted a cross-sectional study, from 2011 to 2013, among primary HCW, using a structured questionnaire and an evaluated for LTBI using the Quantiferon-TB Gold in-tube test. The magnitude of the associations was assessed using hierarchical logistic regression models. Among 708 HCW, the LTBI prevalence was 27% (n = 196; 95%CI: 24%-31%). We found that the following factors were positively associated with LTBI in primary HCW: age > 50 years (OR = 2.94; 95%CI: 1.44-5.99), absence of a BCG scar (OR = 2.10; 95%CI: 1.28-3.43), self-reported ex-smoker status (OR = 1.80; 95%CI: 1.04-3.11), being a nurse (OR = 2.97; 95%CI: 1.13-7.83), being a nurse technician (OR = 3.10; 95%CI: 1.26-7.60), being a community health agent (OR = 2.60; 95%CI: 1.06-6.40), and irregular use of N95 masks (OR = 2.51; 95%CI: 1.11-5.98). In contrast, HCWs who do not work in health care facilities with a TB control program were less likely to have LTBI (OR = 0.66; 95%CI: 0.45-0.97). This study demonstrated a substantial occupational risk of LTBI among primary HCW in Brazil. The Brazilian TB control program, as well as local programs, need to target these high-risk HCW with education, as well as with better personal protective equipment to prevent acquisition of new TB infection.

Os profissionais de saúde apresentam risco aumentado de infecção latente da tuberculose (ILTB) em função da exposição ocupacional ao Mycobacterium tuberculosis. O estudo teve como objetivo estimar a prevalência da ILTB e fatores de risco entre profissionais de saúde na atenção primária em cinco cidades brasileiras. Realizamos um estudo transversal entre 2011 e 2013 entre profissionais de saúde na atenção primária, usando um questionário estruturado, e avaliamos a ILTB com o teste Quantiferon-TB Gold In-Tube. A magnitude das associações foi avaliada com o uso de modelos de regressão logística hierárquica. Entre 708 profissionais de saúde, a prevalência de ILTB era 27% (n = 196; IC95%: 24%-31%). Os seguintes fatores mostraram associação positiva com ILTB entre profissionais de saúde na atenção primária: idade > 50 anos (OR = 2,94; IC95%: 1,44-5,99), ausência de cicatriz de BCG (OR = 2,10; IC95%: 1,28-3,43), ex-tabagista (OR = 1,80; IC95%: 1,04-3,11), profissão enfermeiro (OR = 2,97; IC95%: 1,13-7,83), profissão técnico de enfermagem (OR = 3,10; IC95%: 1,26-7,60), profissão agente comunitário de saúde (OR = 2,60; IC95%: 1,06-6,40) e uso irregular de máscaras N95 (OR = 2,51; IC95%: 1,11-5,98). Enquanto isso, os profissionais de saúde que não trabalham em serviços de saúde que dispõem de programa de controle da TB tem menor probabilidade de apresentar ILTB (OR = 0,66; IC95%: 0,45-0,97). O estudo demonstrou risco ocupacional substancial de ILTB entre profissionais de saúde na atenção primária no Brasil. O programa brasileiro de controle da tuberculose, assim como os programas locais, devem focar esses profissionais de saúde, de risco elevado, através de atividades educativas, assim como, equipamento de proteção individual melhor para prevenir a aquisição de novos casos de infecção pela tuberculose.

Los profesionales de salud presentan un riesgo aumentado de infección latente de la tuberculosis (ILTB), en función de la exposición ocupacional al Mycobacterium tuberculosis. El objetivo del estudio fue estimar la prevalencia de la ILTB y sus factores de riesgo entre profesionales de salud en la atención primaria en cinco ciudades brasileñas. Realizamos un estudio transversal entre 2011 y 2013 entre profesionales de salud en la atención primaria, usando un cuestionario estructurado, y evaluamos la ILTB con el test Quantiferon-TB Gold In-Tube. La magnitud de las asociaciones fue evaluada con el uso de modelos de regresión logística jerárquica. Entre 708 profesionales de salud, la prevalencia de ILTB era 27% (n = 196; IC95%: 24%-31%). Los siguientes factores mostraron una asociación positiva con ILTB entre profesionales de salud en la atención primaria: edad > 50 años (OR = 2,94; IC95%: 1,44-5,99), ausencia de cicatriz de BCG (OR = 2,10; IC95%: 1,28-3,43), ex-fumador (OR = 1,80; IC95%: 1,04-3,11), profesión enfermero (OR = 2,97; IC95%: 1,13-7,83), profesión técnico de enfermería (OR = 3,10; IC95%: 1,26-7,60), profesión agente comunitario de salud (OR = 2,60; IC95%: 1,06-6,40) y uso irregular de máscaras N95 (OR = 2,51; IC95%: 1,11-5,98). Por otra parte, los profesionales de salud que no trabajan en servicios de salud que disponen de programa de control de la TB tienen una menor probabilidad de presentar ILTB (OR = 0,66; IC95%: 0,45-0,97). El estudio demostró riesgo ocupacional substancial de ILTB entre profesionales de salud en la atención primaria en Brasil. El programa brasileño de control de la tuberculosis, así como los programas locales, deben centrarse en esos profesionales de salud, de riesgo elevado, a través de actividades educativas, así como un mejor equipamiento de protección individual para prevenir el surgimiento de nuevos casos de infección por tuberculosis.

Características de população de profissionais do sexo e sua associação com presença de doença sexualmente transmissível / Characteristics of a population of sex workers and their association with the presence of sexually transmitted diseases / Características de población de profesionales del sexo y su asociación con presencia de enfermedades de transmisión sexual

Este estudo teve como objetivo descrever a população de profissionais do sexo, considerando características sociodemográficas, antecedentes gineco-obstétricos e comportamentais, e verificar a associação com a presença de doença sexualmente transmissível. Trata-se de estudo epidemiológico e transversal, realizado com 102 mulheres profissionais do sexo. Os dados foram obtidos por meio de entrevista e exames padrão-ouro para diagnóstico das doenças de interesse. A média de idade das mulheres foi de 26,1 anos, sendo que a maioria tinha nove ou mais anos de aprovação escolar, era solteira e teve coitarca antes dos 15 anos. A prática de sexo oral nos parceiros foi citada por 90,2% das mulheres, 99% delas relataram fazer uso de preservativo no trabalho, apenas 26,3% com parceiros fixos e 42,2% usavam drogas ilícitas. Não houve associação entre fatores sociodemográficos, antecedentes gineco-obstétricos e fatores comportamentais com presença de doença sexualmente transmissível e isso pode ser decorrente da escolaridade e do fato da população estudada possuir características muito semelhantes, dificultando o aparecimento de tais associações.

The objectives of this study were to describe a population of sex workers considering their sociodemographic characteristics, gyneco-obstetric history and behavioral factors, and to verify the association of these characteristics with the presence of sexually transmitted diseases. This epidemiological cross-sectional study was performed with 102 female sex workers. Data were collected using structured interviews and gold-standard exams for diagnosis of the diseases of interest. The women's mean age was 26.1 years. Most of them had attended school for nine years or more, were single and reported becoming sexually active before 15 years of age. Performing oral sex on partners was cited by 90.2% of women, and 99% reported the use of condoms at work; only 26.3% used condoms with permanent partners, and 42.2% used illicit drugs. No association was observed between sociodemographic factors, gyneco-obstetric history or behavioral factors and sexually transmitted diseases, which may have been due to their educational status and the fact that the population had very similar characteristics, thus making it difficult to determine such associations.

Se objetivó describir la población de profesionales del sexo, considerándose características sociodemográficas, antecedentes gineco-obstétricos y conductuales, verificando la asociación con la presencia de enfermedad de transmisión sexual. Estudio epidemiológico transversal realizado con 102 mujeres profesionales del sexo. Datos obtenidos mediante entrevistas y exámenes patrón de oro para diagnóstico de enfermedades de interés. Edad promedio de las mujeres: 26,1; la mayoría con nueve o más años de escolarización, solteras, con coitarca antes de los 15 años. El 90,2% refirió practicar sexo oral con sus clientes, 99% trabajaban con preservativos, apenas 26,3% tenía compañero fijo y 42,2% utilizaba drogas ilegales. No existió asociación entre factores sociodemográficos, antecedentes gineco-obstétricos y factores conductuales con presencia de enfermedad de transmisión sexual. Eso puede derivar de la escolarización y del hecho de que la población estudiada poseyera características muy semejantes, dificultándose la aparición de tales asociaciones.

Importancia del estudio del balance del contenido vaginal (BACOVA) en el control preventivo de las trabajadoras sexuales / Importance of studying the balance of vaginal content (BAVACO) in the preventive control of sex workers

El objetivo de este trabajo fue estudiar a un grupo de 229 trabajadoras sexuales de Comodoro Rivadavia (Chubut), atendidas en centros públicos de salud de dicha ciudad, mediante la aplicación del método conocido como balance del contenido vaginal (BACOVA). Este método comprende el estudio morfológico de la microbiota vaginal, como así también de la reacción infamatoria. Incluye el análisis del contenido vaginal en fresco y por tinciones de Gram y de Giemsa, de modo de integrar la exploración de todo el panorama biológico. El 35,37 % de estas mujeres presentó microbiota normal (MN); el 15,72 %, microbiota intermedia (MI); el 23,14 %, vaginosis bacteriana (VB) y el 10,48 %, vaginitis microbiana inespecífca (VMI). Los casos de vaginitis por levaduras y por Trichomonas vaginalis comprendieron el 8,30 % y 6,99 % de las mujeres, respectivamente. Se observó el desplazamiento de la MN hacia una MI, que se correspondió con el predominio de bacterias corineformes. Por otra parte, no se reconoció un marcado desequilibrio del contenido vaginal ante la colonización e infección por levaduras o por T. vaginalis: el 48 % de los casos de estas vaginitis convencionales no presentaron reacción infamatoria vaginal (RIV). El 24,89 % de los casos de MN presentaron una signifcativa RIV, y en más del 50 % de las mujeres se diagnosticaron disfunciones vaginales en ausencia de sintomatología. Estos resultados se podrían asociar a un incremento del riesgo gineco-obstétrico, lo que afecta la salud sexual y reproductiva de la población estudiada.

The aim of this work was to study the vaginal microenvironment in sex workers from Comodoro Rivadavia, Chubut. For that purpose, BAVACO procedures were applied. A total of 229 female sex workers attended public health centers. Vaginal secretions were analyzed by Gram and Giemsa stains. The following results were obtained: normal microbiota 35.37 %, intermediate microbiota 15.72 %, bacterial vaginosis 23.14 %, microbial nonspecifc vaginitis, Donders'"aerobic vaginitis" 10.48 %, yeast vulvovaginitis 8.30 %, and trichomoniasis 6.99 %. The intermediate microbiota was characterized by a decrease in the number of lactobacilli and the presence of diphtheroid bacilli cell types. The population studied shared increased values of vaginal dysfunctions. These results are considered risk factors for obstetric and gynecologic diseases.

Prevalencia de vaginosis bacteriana en trabajadoras sexuales chilenas / Prevalence of bacterial vaginosis in Chilean sex workers

OBJETIVO: Determinar la prevalencia de vaginosis bacteriana (VB) en trabajadoras sexuales chilenas y relacionar los hallazgos con variables sociodemográficas, sexuales y clínicas. MÉTODO: Se estudió una muestra de 379 trabajadoras sexuales que asistían para control a Unidades de Atención y Control de Salud Sexual de Chile. A todas se las entrevistó para obtener antecedentes sociodemográficos y sexuales, se les realizó evaluación clínica que incluyó características del flujo vaginal, pH y prueba de aminas, y se les tomó una muestra vaginal para tinción de Gram. Para el diagnóstico de VB se empleó el criterio de Nugent. Los datos fueron analizados con EPI-INFO 3.4.1 y BioStat, utilizándose un grado de significación de P < 0,005. RESULTADOS: La prevalencia de VB fue de 69,1 por ciento. El síndrome no se asoció a las variables sociodemográficas edad y escolaridad. Las mujeres que vivían (casadas o no) con su pareja tuvieron menos frecuencia de VB en comparación con las mujeres solteras (P < 0,001). No hubo variables sexuales asociadas a VB, en tanto que el empleo del dispositivo intrauterino (DIU) sí lo estuvo (P < 0,0001). La presencia de descarga vaginal, pH vaginal alterado y prueba de aminas positiva se asociaron a la infección (P < 0,0001). CONCLUSIONES: En coincidencia con otros estudios realizados distintos países, el presente trabajo observó que las trabajadoras sexuales chilenas tienen una alta prevalencia de VB, con mayor riesgo para aquellas que usan DIU como método de anticoncepción o que no conviven (casadas o no) con su pareja.

OBJECTIVE: To determine the prevalence of bacterial vaginosis (BV) in Chilean sex workers and relate the findings to sociodemographic, sexual, and clinical variables. METHODS: A sample of 379 sex workers seen in Chilean Sexual Health Monitoring and Care Units for check-ups was studied. All of them were interviewed to obtain their sociodemographic and sexual history. A clinical examination was performed that included the characteristics of vaginal discharge, pH, and amine test. A vaginal sample was taken for Gram stain. The Nugent criteria were used for the diagnosis of BV. The data was analyzed with EPI-INFO 3.4.1 and BioStat, using a degree of significance of P < 0.005. RESULTS: BV prevalence was 69.1 percent. The syndrome was not associated with the sociodemographic variables, age or education. BV was less common in women (married or unmarried) who lived with their partners than in single women (P < 0.001). There were no sexual variables associated with BV, whereas use of intrauterine devices was related (P < 0.0001). The presence of vaginal discharge, abnormal vaginal pH, and positive amine test were associated with infection (P < 0.0001). CONCLUSIONS: Like other studies conducted in different countries, this study observed that Chilean sex workers have a high prevalence of BV, with greater risk for women who use IUDs for birth control or women (married or unmarried) who do not live with their partners.

Primera evidencia de circulación de Chlamydophila psittaci en Colombia: posible riesgo de salud pública / First evidence of Chlamydophila psittaci circulation in Colombia: a possible public health risk

Objetivo Establecer la seroprevalencia de Chlamydophila psittaci en aves del género Amazona spp y en trabajadores de algunos zoológicos y CAV (centros de atención y valoración de fauna silvestre). Metodología Se analizaron 138 sueros de aves del género Amazona spp, 24 sueros de otras especies de aves y 39 sueros humanos por ELISA indirecta. Se utilizó el antígeno RMOMP (major outer membrane protein of Chlamydophila psittaci). Para el conjugado de aves se utilizo una anti-IgG de turkey-chicken marcado con biotina para el conjugado humano se utilizo una anti-IgG marcada con peroxidasa. Los sueros fueron diluidos 1:100. Resultados De los 138 sueros de aves del género Amazona spp 118 (85 por ciento) resultaron positivos. La seroprevalencia por región fue la siguiente: CAV Torre cuatro de Caldas 36 (90 por ciento), Zoológico de Barranquilla 14 (87 por ciento), CAV Montería 28 (85 por ciento), Zoológico de Cali 21 (84 por ciento) y CAV Victoria del Oriente Caldense 19 (79 por ciento). En humanos la seroprevalencia total fue del 78 por ciento (30/39) la distribución fue la siguiente: CAV Montería 9 trabajadores (100 por ciento), Zoológico de Barranquilla 9 (90 por ciento), CAV Torre 4 de Caldas 4 trabajadores (80 por ciento), CAV Victoria del Oriente Caldense 3 (75 por ciento) y 5 (45 por ciento) trabajadores del Zoológico de Cali. Conclusiones La alta seroprevalencia de Chlamydophila psittaci en aves (86,4 por ciento) y humanos (78 por ciento) representa la primera evidencia de la circulación de este microorganismo en Colombia, la presencia del agente etiologico de la ornitosis podría representar un riesgo de salud publica.

Objective To establish the seroprevalence of Chlamydophila psittaci in birds of Amazona spp genus and workers from some zoos and CAVs (centers for attention and evaluation of wildlife) of Colombia. Methods We analyzed 138 sera from birds of the genus Amazona spp, 24 sera from other species of birds and 39 human sera by indirect ELISA. RMOMP was used as antigen (major outer membrane protein of Chlamydophila psittaci). For the conjugate of birds it was used an anti-turkey-chicken IgG labeled with biotin, for the human conjugate we used an anti-IgG labeled with peroxidase. Sera were diluted 1:100. Results Of the 138 sera from birds of the genus Amazona spp 118 (85 percent) were seropositive. Regional seroprevalence was as follow: Caldas CAV Torre cuatro 36 (90 percent), CAVâs Monteria 28 (85 percent), Barranquillaâs Zoo 14 (87 percent), Caliâs Zoo 21 (84 percent) and from the CAV Victoria del Oriente Caldense 19 (79 percent) sera were seropositive. Regarding seroprevalence in humans, 30 of the 39 (78 percent) were seropositive, regional seroprevalence was as follow: Montería 9 (100 percent) workers, Barranquillaâs Zoo 9 (90 percent), CAV Caldas Tower four 4 (80 percent), Caliâs Zoo 5 (45 percent) and CAV Caldense Victoria del oriente 3 (75 percent) were seropositive. Conclusions The high seroprevalence of Chlamydophila psittaci in birds (86,4 percent) and humans (78 percent) showed the first evidence of circulation of this microorganism in Colombia; the circulation of the etiological agent of psittacosis may represent a public health risk.

Brucella Endocarditis with Splenic Abscess: A Report of the First Case Diagnosed in Korea

Human brucellosis has a broad spectrum of clinical manifestations, which includes endocarditis, a focal complication that is uncommon yet responsible for the majority of associated deaths. The most successful treatment outcomes of Brucella endocarditis have been reported with usage of both antimicrobial agents and surgery. However, there are few reports on the treatment of Brucella endocarditis using antibiotics only. We report the first case in Korea of Brucella endocarditis with aortic valve vegetations and an accompanying splenic abscess, which were treated successfully with antibiotic therapy alone.

Coccidioidomicosis osteoarticular: estudio clinicopatológico de una serie de 36 pacientes mexicanos / Osteoarticular coccidioidomicosis clinical and pathological: study of 36 Mexican patients

Coccidioidomycosis (CM) is primarily a lung disease. Systemic spread occurs in 1% of cases and one of its manifestation is osteoarthritis. Aim. To describe the clinical and pathological characteristics of 36 patients with osteoarthritis by Coccidioides immitis (COA). Material and methods. The surgical pathology records of two medical institutions were reviewed; patients with clinical diagnosis of osteoarthritis and definitive histopathological diagnosis of COA were included in the study. Results were analyzed by contingence tables (RXC) and test. Results. Twenty six adults (19 men, seven women) and 10 children (seven males, three females) were studied. The analysis demonstrated a predominance of disease in men (72.2%, p - 0.008). There was no difference between males and females in relation to history of mycotic disease or diagnosis of lung disease after the diagnosis of COA. Bone involvement (76% of cases) was more frequent that pure joint lesions and the predominant radiological lesion was of lytic type. 30.5% of patients (11 cases) had multiple bone lesions and eight of them were men with multiple vertebral bone lesions. Discussion. The COA was the only manifestation of disease in 83% of the patients. Therefore is important to consider this etiology in patients of endemic area. The clinical and radiological spectrum of COA is wide and may include a dentigerous and synovial cyst or simulates metastatic disease. The recognition of the clinical manifestations of COA may contribute to an opportune diagnosis and treatment.

La coccidioidomicosis (CM) es una enfermedad primariamente pulmonar. La diseminación sistémica ocurre en 1% de los casos y una de sus manifestaciones es la osteoartritis. Objetivo. Conocer las características clínicas y patológicas de 36 pacientes con osteoartritis por Coccidioides immitis (OAC). Material y métodos. Se revisaron los archivos de patología quirúrgica de dos instituciones y se incluyeron aquellos pacientes que consultaron por enfermedad osteoarticular y cuyo diagnóstico final histopatológico fue de CM. Los resultados se analizaron con tablas de contingencia (programa RXC) y prueba de . Resultados. Se estudiaron 26 adultos (19 hombres, siete mujeres) y 10 niños (siete hombres y tres mujeres). La prueba de mostró un predominio de casos en hombres (72.2%, p = 0.008). No hubo diferencia entre hombres y mujeres en relación con antecedentes de enfermedad micótica ni en el diagnóstico de enfermedad pulmonar posterior al diagnóstico de OAM. El compromiso óseo (76% de los casos) fue más frecuente que las lesiones articulares puras y la imagen radiológica predominante fue la osteolítica. De los casos estudiados, 30.5% (11 casos) presentaban lesiones óseas múltiples. De estos 11 casos, ocho eran hombres que en su mayoría presentaban lesiones vertebrales dorsales bajas y lumbares. Discusión. En 83% de los pacientes que se presentaron por OAC, esta fue la única manifestación de la enfermedad. El espectro clínico y radiológico de OAC es muy amplio y puede presentarse como un quiste dentígero, un quiste sinovial o simular enfermedad metastásica. El reconocimiento de esta variedad de presentaciones clínicas en individuos de zonas endémicas puede contribuir a un diagnóstico oportuno y tratamiento específico.

An investigation of leptospirosis in a laboratory animal house.

A study was undertaken to investigate the possible involvement of leptospires in causing infection and persistent deaths among albino mice and wistar rats of a laboratory animal house. The serological study revealed that 79.2% of mice, 90% of wistar rats, 71.4% of guinea pigs and 81.8% of rabbits had leptospiral antibodies to one or more of serogroups. Autumnalis predominated in guinea pigs and mice, while Javanica predominated in wistar rats. Rabbits exhibited equal seroprevalence of Autumnalis and Javanica. The animal house workers had 91.0% sero positivity, predominantly Autumnalis while control human group had only 20%. All isolations made from a mice (M2) and six wistar rats (W1, W4, W8 W9, W12 & W13) were serovar javanica and incidentally the isolate from a trapped house rat (R1) also belonged to the same serovar javanica. The house rat was perhaps the source of virulent leptospires for causing infection and mortality among laboratory animals like mice and wistar rats.

Prevalence of coagulase negative Staphylococcus species among hospital personnel and surgical patients.

Two hundred and fourteen strains of Coagulase negative Staphylococci (CNS) isolated from hospital personnel (114 strains) and patients (100 strains) were identified upto species level. The prevalence rate of CNS in relation to sex, sources and type of specimens were analysed. Most of the CNS strains belonged to S. epidermidis (49.1% among carriers and 39% in clinical isolates) and S. hominis (36% each). Besides, five more CNS species, namely S. saprophyticus, S. capitis, S. haemolyticus, S. cohnii and S. xylosus were also isolated. (0.5 to 10.3% isolation rates). Maximum S. hominis isolated were from hospital personnel and urine from patients (63.4% and 72.2%, respectively), 50.0% and 33.3% of S. hominis were found from urine and blood, respectively. The present study revealed that the leading species S. epidermidis and S. hominis may play an important role in the nosocomial infections, especially among immunocompromised hosts during their hospital stay.

Prevalência da infecçäo pelo vírus B na comunidade hospitalar / Prevalence of virus B infecction in a hospital community

Estudou-se a prevalência de marcadores para a hepatite B (HBsAg, AntiHBc e AntiHBs) em profissionais de saúde, a fim de identificar grupos de maior risco onde estaria indicada a vacinaçäo pré-exposiçäo. Comparando-os com os funcionários administrativos do mesmo hospital, observamos índices significativamente superiores em grupos como cirurgiöes (40,0%) e profissionais de hemodiálise (36,4%), que aprresentaram taxas de ferimentos no trabalho, de, respectivamente, 93,3% e 77,3%. Outros grupos mostram grande aumento da prevalência em funçäo do maior tempo de atuaçäo profissional, comprovando seu risco. Outras formas de transmissäo, como transfusäo e contato íntimo como portadores de hepatite, näo tiveram significância. Os autores concluiram que a vacinaçäo está indicada em cirurgiöes e profissionais de hemodiálise, bem como dentistas e técnicos de laboratório