Detecção de Staphylococcus aureus e Staphylococcus aureus resistentes à meticilina em profissionais da saúde lotados no Instituto Lauro de Souza Lima, Bauru-SP / Detection of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus in health care workers packed the Instituto Lauro de Souza Lima, Bauru-SP

O Staphylococcus aureus (S. aureus) é um patógeno comumente isolado de amostras biológicas humanas. É encontrado com freqüência na pele e fossas nasais de indivíduos saudáveis, podendo provocar desde simples infecções ate graves enfermidades. Cerca de 40% da população adulta saudável é portadora nasal de S. aureus e esta taxa pode ser ainda maior em ambientes hospitalares, especialmente entre os pacientes internados e equipe médica. O surgimento da resistência à meticilina, uma penicilina sintética, pelo S. aureus e sua disseminação tornaram as medidas de controle epidemiológico ainda mais importantes no que diz respeito à prevenção de infecções hospitalares e, mais recentemente, comunitárias. Profissionais da área de saúde que são portadores nasais de S. aureus e Staphylococcus aureus resistentes a meticilina (MRSA) são considerados importantes fontes de disseminação do patógeno e estão intimamente envolvidos na epidemiologia dos mesmos. Investigação constante e adoção de medidas de controle na admissão dos pacientes em áreas de alta endemicidade para MRSA, tais com CTIs e centros de dermatologia, são consideradas estratégias efetivas em termos de custo-benefício contra as ionfecções hospitalares, bem como o estudo da prevalência de MRSA em profissionais de saúde que atuam nos referidos lugares. O objetivo do estudo foi verificar a colonização por S. aureus e MRSA nas fossas nasais de profissionais das equipes médicas de enfermagem e dos laborat´rios em um hospital de dermatologia de nível terciário - Instituto Lauro de Souza Lima - Bauru/SP...

Antibody production to heat shock proteins with Mr 65 kD (HSP65) in cutaneous inflammation: a possible relation to focal infection.

In order to correlate the immunomodulatory roles of homologous heat shock proteins with Mr 65 kD (HSP65) to skin diseases, antibody level to recombinant-HSP65 of Mycobacterium leprae was quantified with enzyme-linked immunosorbent assay (ELISA) in the sera of patients. In psoriasis, an insignificant increase was observed in anti-HSP65 IgG (0.111 +/- 0.053, mean +/- SD in 0D492 nm, n = 22), compared with a normal group (0.080 +/- 0.032, n = 9). However, psoriasis of acute guttate-type (PGA), which is often induced after tonsillar infection, showed a significant increase (0.178 +/- 0.032 n = 4, p <0.001), but psoriasis vulgaris did not (PV) (0.101 +/- 0.053, n = 12), nor generalized psoriasis pustulosa (PP) (0.087 +/- 0.025, n = 6). Similarly, patients with palmoplantar pustulosis (PPP) with tonsillar or periodontal infection showed significantly high anti-H5P65 IgG (0.230 +/- 0.065, n = 7, p <0.0001), compared with only a mild increase in PPP without suspected infectious foci (0.139 +/- 0.066, n = 13, p <0.05). Possible staphylococcal infection in the oral cavity was suggested by an additional ELISA assay to staphylococcal antigen: anti-staphylokinase IgG showed a significant increase in PPP with infectious foci (0.110 +/- 0.028 n = 3, p <0.01) compared with the normal group (0.039 +/- 0.014), while PPP without them showed only a mild change (0.060 +/- 0.017, n = 6, p <0.05). We assume that immunoreaction to H5P65 may be involved in psoriatic skin inflammation associated with focal infection.

Effect of tuftsin stimulation on the microbicidal activity exerted by blood monocyte-macrophages of leprosy patients.

The ability of blood monocyte/macrophages from normal donors, tuberculoid leprosy (BT/TT) and lepromatous leprosy (BL/LL) patients to exert enhanced microbicidal activity was assayed after stimulating with 0.8 microM tuftsin, as a function of the duration of cultures in vitro. Normal and BT/TT macrophage cultures showed a statistically significant increase in microbicidal activity against Staphylococcus aureus at all ages of culture (6 h to 14 days), though the overall magnitude of the enhancement shows a decrease with increasing culture age in the same populations. However, 14-day old BL/LL macrophage cultures were unable to undergo tuftsin-mediated stimulation of microbicidal activity against S. aureus and even, fresh 6 h-old cultures exhibited a tuftsin-stimulated response profile similar to 14-day old normal and BT/TT cultures. Also, 7 and 14-day cultures of normal, BT/TT and BL/LL macrophages were unable to inhibit/kill intracellular Mycobacterium leprae after a single stimulation with 0.8 microM tuftsin. However, serial, daily stimulation with 0.8 microM tuftsin resulted in 77-140% inhibition of 3H-thymidine uptake by the 12th day of cultures in vitro in the three groups. These results suggest that BL/LL macrophages exhibit a premature inability to undergo tuftsin stimulated microbicidal activity, which may possibly be reversed by serial dosage of tuftsin.

Antigens of Mycobacterium leprae identified by immunoprecipitation with sera from leprosy and tuberculosis patients.

Mycobacterial antigens which react with human B lymphocytes were investigated by immunoprecipitation of radiolabelled sonicates of Mycobacterium leprae and M. bovis (BCG) with sera from patients with leprosy and tuberculosis in the presence of Staphylococcus aureus. SDS-PAGE analysis of the immunoprecipitates demonstrated that dense bands of Mr 12,000 (12K), 15K, 27K, 32-33K, 36K and 48K were the major antigens of M. leprae recognized by antibodies in lepromatous leprosy sera. Of these, only the 15-16K band reacted significantly with sera from patients with tuberculoid leprosy and tuberculosis. Other antigens including the T cell immunogens of Mr 18K and 70K reacted with some of the BL/LL sera tested. There were differences in the pattern of antigens precipitated from BCG sonicate by leprosy sera with the 65K antigen and a high molecular weight band (greater than 94K) being readily detected. These results differ in part to these obtained by probing immunoblots of M. leprae sonicate with leprosy sera. Factors contributing to these differences are discussed.

Leukocyte antimicrobial function in patients with leprosy.

Patients with lepromatous leprosy are unresponsive to lepromin skin-test material and possess defective lymphocyte function in vitro, including impaired mitogenesis in response to antigens of Mycobacterium leprae. It has been claimed that their macrophages cannot digest M. leprae in vitro; such a defect could explain both lepromin nonreactivity and impaired lymphocyte function on the basis of failure of the afferent limb of the immune response (i.e., defective macrophage "processing" of M. leprae). The present studies indicate that macrophages from patients with lepromatous and tuberculoid leprosy and from normal donors do not differ in their ability to digest heat-killed M. leprae in vitro, or in their ability to sustain the viability of M. leprae in tissue culture; that monocytes, macrophages, and polymorphonuclear leukocytes of leprosy patients and controls possess equivalent microbicidal activity against Listeria monocytogenes, Escherichia coli, Proteus vulgaris, Staphylococcus aureus, and Candida albicans; and that polymorphonuclear leukocytes from patients with lepromatous leprosy iodinate ingested bacteria normally. Whether the basic immune defect leading to the development of lepromatous leprosy resides in the lymphocyte or in the macrophage remains to be determined. However, the present study shows that phagocytic cells from patients with either principal form of leprosy function normally in a variety of sophisticated tests of antimicrobial function.