Phenotypic, molecular and antimicrobial susceptibility assessment in isolates from chronic ulcers of cured leprosy patients: a case study in Southern Brazil.

BACKGROUND: One of the most stigmatizing physical sequelae of leprosy in cured patients is the development of chronic lower extremity ulcers. The bacterial diversity present in ulcers is considered one of the factors that can delay the healing process, as well as serve as a focus for severe secondary infections. OBJECTIVE: To identify the microbiota and antimicrobial resistance profile of bacteria isolated from skin ulcers in patients cured of leprosy. METHODS: After obtaining informed consent, material was collected from ulcers of 16 patients treated at the Outpatient Public Health Dermatology Clinic of Rio Grande do Sul and Hospital Colônia Itapuã. Samples were collected during dressing, and the material sent to the Microbiology Laboratory of the Federal University of Health Sciences of Porto Alegre for microbiological culture. Methicillin-resistant Staphylococcus aureus (MRSA) was characterized by two molecular methods, including detection of the mecA gene by PCR and SCCmecgene typing. RESULTS: Cultures revealed microorganisms in all ulcers: Gram-negative bacilli in 80%, Gram-positive cocci in 63%, and mixed microflora in 36%. Staphylococcus aureus and Pseudomonas aeruginosa were the most prevalent bacteria. Assessment of the antimicrobial resistance profile was notable for the presence of MRSA. Molecular analysis of this isolate revealed presence of the mecA gene contained in a type IV staphylococcal cassette chromosome mec (SCCmec). CONCLUSIONS: In patients with leprosy, laboratory culture of skin ulcers is essential for correct antibiotic selection and to control emerging pathogens, such as MRSA carrying SCCmec type IV.

Phenotypic, molecular and antimicrobial susceptibility assessment in isolates from chronic ulcers of cured leprosy patients: a case study in Southern Brazil

BACKGROUND: One of the most stigmatizing physical sequelaeof leprosy in cured patients is the development of chronic lower extremity ulcers. The bacterial diversity present in ulcers is considered one of the factors that can delay the healing process, as well as serve as a focus for severe secondary infections. OBJECTIVE: To identify the microbiota and antimicrobial resistance profile of bacteria isolated from skin ulcers in patients cured of leprosy. METHODS: After obtaining informed consent, material was collected from ulcers of 16 patients treated at the Outpatient Public Health Dermatology Clinic of Rio Grande do Sul and Hospital Colônia Itapuã. Sampleswere collected during dressing, and the material sent to the Microbiology Laboratory of the Federal University of Health Sciences of Porto Alegre for microbiological culture. Methicillin-resistant Staphylococcus aureus (MRSA) was characterized by two molecular methods, including detection of the mecA gene by PCR and SCCmecgene typing. RESULTS: Cultures revealed microorganisms in all ulcers: Gram-negative bacilli in 80%, Gram-positive cocci in 63%, and mixed microflora in 36%. Staphylococcus aureus and Pseudomonas aeruginosa were the most prevalent bacteria. Assessment of the antimicrobial resistance profile was notable for the presence of MRSA. Molecular analysis of this isolate revealed presence of the mecA gene contained in a type IV staphylococcal cassette chromosome mec (SCCmec). CONCLUSIONS: In patients with leprosy, laboratory culture of skin ulcers is essential for correct antibiotic selection and to control emerging pathogens, such as MRSA carrying SCCmec type IV. .

Genetic adaptation by Pseudomonas aeruginosa to the airways of cystic fibrosis patients.

In many human infections, hosts and pathogens coexist for years or decades. Important examples include HIV, herpes viruses, tuberculosis, leprosy, and malaria. With the exception of intensively studied viral infections such as HIV/AIDs, little is known about the extent to which the clonal expansion that occurs during long-term infection by pathogens involves important genetic adaptations. We report here a detailed, whole-genome analysis of one such infection, that of a cystic fibrosis (CF) patient by the opportunistic bacterial pathogen Pseudomonas aeruginosa. The bacteria underwent numerous genetic adaptations during 8 years of infection, as evidenced by a positive-selection signal across the genome and an overwhelming signal in specific genes, several of which are mutated during the course of most CF infections. Of particular interest is our finding that virulence factors that are required for the initiation of acute infections are often selected against during chronic infections. It is apparent that the genotypes of the P. aeruginosa strains present in advanced CF infections differ systematically from those of "wild-type" P. aeruginosa and that these differences may offer new opportunities for treatment of this chronic disease.

Avaliaçäo da microbiota bacteriana nasal de hansenianos / Evaluation of the nasal bacterial microbiota of bearers of Hansen's Disease

Este estudo teve como objetivo comparar a microbiota bacteriana nasal de portadores de hanseníase lepromatosa, tratados sistematicamente com Rifampicina, Clofazimina e Sulfa, com um grupo de indivíduos sadios sem o uso de antibióticos. Foram coletadas amostras de mucosa nasal de 57 hansenianos, internos do Hospital de Dermatologia Sanitária de Curitiba, e de 40 indivíduos com mucosa normal. Na coleta, as mucosas nasais foram avaliadas quanto à presença de lesöes, e as amostras semeadas em meios para pesquisa de Saureus e enterobactérias. Nos hansenianos observou-se S. aureus em 100 por cento; Proteus mirabilis em 91 por cento; E. coli, Enterobacter aerogenes, Klebsiella pneumonia e Pseudomonas aeruginosa em 24 por cento, resistentes aos antibióticos testados no antibiograma. Nos indivíduos sadios isolou-se S. aureus em 100 por cento e P. aeruginosa em 0,5 por cento, sensíveis aos antibióticos testados, e näo foram isoladas amostras do gênero Proteus. Conclui-se que nos portadores de hanseníase estudados, a microbiota nasal encontra-se alterada e resistente devido ao emprego sistemático dos antibióticos do esquema tríplice

Bacteriological study of trophic ulcers in leprosy patients (a preliminary study).

Swabs from trophic ulcers from 108 cases were studied by culture. 37 cases yielded single organism (Ps. aeruginosa, 18, Proteus species 11, Staph. pyogenes 4, Others 4). 71 cases yielded mixed growth with two or more organisms. Ps. aeruginosa, Proteus species and Diphtheroids were the predominant organisms in these cultures. Ps. aeruginosa was sensitive to Gentamycin (96.6%), Streptomycin (62.7%) and Chloramphenicol (33.9%). Other organisms although comparatively more sensitive showed a similar pattern.