Extended-spectrum cephalosporin-resistant Escherichia coli isolated from chickens and chicken meat in Brazil is associated with rare and complex resistance plasmids and pandemic ST lineages.

Objectives: Brazil is the greatest exporter of chicken meat (CM) in the world. It is of utmost importance to monitor resistance to extended-spectrum cephalosporins (ESCs) in this sector because resistance to ESCs in Escherichia coli isolated from food-producing animals may contaminate humans through the food chain. Thus, the aim of this study was to characterize and compare ESC-resistant E. coli isolated from chickens and retail CM produced in south-eastern Brazil. Methods: Five CM samples and 117 chicken cloacal swabs (CCSs) were inoculated on MacConkey agar supplemented with cefotaxime. Presumptive E. coli colonies were identified and antimicrobial susceptibility was tested. Virulence and acquired blaESBL and blaAmpC genes were sought and genetic environments characterized. Isolates were typed by phylogenetic grouping, XbaI-PFGE and MLST. Results: All five CM samples and 36 CCSs (30.8%) were positive for the presence of ESC-resistant E. coli, leading to the selection of 58 resistant isolates. ESC resistance was mostly due to the presence of the chromosome-encoded blaCTX-M-2 gene, but plasmid-mediated blaCTX-M-2, blaCTX-M-8, blaCTX-M-15, blaCTX-M-55 and blaCMY-2 were also detected. Multireplicon plasmids were sporadically identified, such as IncHI2/P-blaCTX-M-2 and IncFII/N-blaCTX-M-55. Phylogroup D predominated, while PFGE and MLST revealed a high genetic diversity. Conclusions: Live Brazilian chickens and CM act as reservoirs of ESC-resistant E. coli and resistance genes are located on highly diverse genetic determinants. Potentially pathogenic strains, which may represent a threat to human health and a source of environmental contamination, were also identified. Active surveillance is therefore essential in Brazil's chicken production line.

Mycobacterium tuberculosis e micobactérias não tuberculose em paciente com síndrome da imunodeficiência adquirida e câncer: relato de caso / Mycobacterium tuberculosis and non-tuberculous mycobacteria in a patient with acquired immunodeficiency syndrome and cancer: case report

O presente estudo relata o caso de um paciente de difícil tratamento com infecção mista por tuberculose (TB) e micobactérias não tuberculosas (MNT). O paciente é portador de HIV, câncer e outras doenças associadas. A TB foi elucidada em internação devido a quadro de hemoptise. No período da TB/MNT, a carga viral manteve-se indetectável e o Linfócito T CD4+ variou de 117 a 622 cél/mm3. Os principais sintomas foram febre, tosse, emagrecimento e sudorese. O exame de Raio-X mostrou suspeita de TB bilateral cavitária, a baciloscopia foi negativa e várias culturas apresentaram resultado positivo. As identificações dos isolados foram: Complexo Mycobacterium tuberculosis, Mycobacterium intracelullare/chimaera e M. fortuitum, isolados de amostras pulmonares. Iniciado tratamento para TB em outubro de 2015, atualmente tratando de MNT e mantendo cultura positiva com identificação de M. intracelullare. Os Testes de suscetibilidade aos fármacos para M. intracelullare mostraram resistência a Isoniazida, Rifampicina, Ciprofloxacina, Etambutol e Rifabutina. A terapia para a síndrome da imunodeficiência adquirida (AIDS) aumentou a sobrevida do paciente, trazendo novos desafios para o diagnóstico, controle de tratamento e cuidados da atenção básica para os pacientes com TB/micobacterioses/HIV. Este caso exemplifica que a decisão por um tratamento empírico pode ser uma escolha acertada em casos com clínica e imagem compatíveis e baciloscopia ou TRM negativos.

The present study is a case report of a difficult-to-treat patient with mixed tuberculosis (TB) and non-tuberculous mycobacteria (NTM) infection. The patient has HIV, cancer and other associated diseases. TB was elucidated upon hospitalization due to hemoptysis. In the TB/NTM period, the viral load remained undetectable and CD4 ranged from 622 to 117 cells/mm3. The main symptoms were fever, cough, weight loss and sweating. The X-ray examination showed suspicion of bilateral cavitary TB; the bacilloscopy was negative and several cultures presented positive results. The following isolates were identified: Mycobacterium tuberculosis complex, Mycobacterium intracelullare/chimaera and M. fortuitum, isolated from lung samples. The TB treatment was initiated in October 2015, currently treating NTM and maintaining positive culture with identification of M. intracelullare. Antimicrobial sensitivity tests for M. intracelullare showed resistance to Isoniazid, Rifampicin, Ciprofloxacin, Ethambutol and Rifabutin. Acquired Immune Deficiency Syndrome (AIDS) therapy has increased patient survival, bringing new challenges for diagnosis, treatment control, and basic care for TB/mycobacterial/HIV patients. This case exemplifies that the decision of an empirical treatment may be the correct choice in cases with compatible clinical and imaging tests and negative smear microscopy or molecular tests.