Microbiological epidemiological history of meningococcal disease in Rio de Janeiro, Brazil.

The main objectives of the present study were to investigate the clinical and laboratory features of meningococcal disease in the city of Rio de Janeiro, Brazil, during the overlap of 2 epidemics in the 1990s. We conducted a study of a series of cases of meningococcal disease admitted in a Meningitis Reference Hospital. All clinical isolates available were analyzed by means of microbiological epidemiological markers. In 1990, Neisseria meningitidis serogroup B:4,7:P1.19,15, 1.7,1 sulfadiazine-resistant of the ET-5 complex emerged causing epidemic disease. Despite mass vaccination campaign (VaMengoc B+C®), the ET-5 clone remained hyperendemic after the epidemic peaked. In 1993 to 1995, an epidemic of serogroup C belonged to the cluster A4 overlapped, with a significant shift in the age distribution toward older age groups and an increase of sepsis. Serogroup C epidemics are a recurrent problem in Rio de Janeiro, which can be hindered with the introduction of a conjugate vaccine. We hope the data presented here brings useful information to discuss vaccines strategies and early management of suspected cases.

Microbiological epidemiological history of meningococcal disease in Rio de Janeiro, Brazil

The main objectives of the present study were to investigate the clinical and laboratory features of meningococcal disease in the city of Rio de Janeiro, Brazil, during the overlap of 2 epidemics in the 1990s. We conducted a study of a series of cases of meningococcal disease admitted in a Meningitis Reference Hospital. All clinical isolates available were analyzed by means of microbiological epidemiological markers. In 1990, Neisseria meningitidis serogroup B:4,7:P1.19,15, 1.7,1 sulfadiazine-resistant of the ET-5 complex emerged causing epidemic disease. Despite mass vaccination campaign (VaMengoc B+C®), the ET-5 clone remained hyperendemic after the epidemic peaked. In 1993 to 1995, an epidemic of serogroup C belonged to the cluster A4 overlapped, with a significant shift in the age distribution toward older age groups and an increase of sepsis. Serogroup C epidemics are a recurrent problem in Rio de Janeiro, which can be hindered with the introduction of a conjugate vaccine. We hope the data presented here brings useful information to discuss vaccines strategies and early management of suspected cases.

Enterobactérias associadas a adultos de Musca domestica (Linnaeus, 1758) (Diptera: Muscidae) e Chrysomya megacephala (Fabricius, 1754) (Diptera: Calliphoridae) no Jardim Zoológico, Rio de Janeiro / Enterobacteria associated to adults of Musca domestica (Linnaeus, 1758) (Diptera: Muscidae) and Chrysomya megacephala (Fabricius, 1754) (Diptera: Calliphoridae) at the Zoo of Rio de Janeiro, Brazil

Enterobactérias foram identificadas em adultos de Musca domestica (Linnaeus, 1758) (Diptera: Muscidae) e Chrysomya megacephala (Fabricius, 1754) (Diptera: Calliphoridae). Ambas as espécies foram capturadas no Jardim Zoológico da cidade do Rio de Janeiro e tiveram a superfície externa do corpo lavada e o sistema digestivo dissecado, para análise bacteriológica. Identificaram-se Escherichia coli, Citrobacter sp., Proteus mirabilis, Morganella sp., Klebsiella sp., Pseudomonas sp., Enterobacter sp. e Salmonella Agona. P. mirabilis foi o isolado bacteriano mais freqüente. Em duas amostragens (8 por cento) de C. megacephala, isolou-se Salmonella Agona. As amostras de E. coli não foram enteropatogênicas. M. domestica e C. megacephala são potenciais veiculadoras de bactérias causadoras de enterites em humanos e animais.

Enterobacteria were identified in adults of Musca domestica (Linnaeus, 1758) (Diptera: Muscidae) and Chrysomya megacephala (Fabricius, 1754) (Diptera: Calliphoridae). Both species were captured in the Zoo of Rio de Janeiro. They had their external body surface washed and their digestive system dissected for bacteriological analysis. Escherichia coli, Citrobacter sp., Proteus mirabilis, Morganella sp., Klebsiella sp., Pseudomonas sp., Enterobacter sp. and Salmonella serovar Agona were isolated in the samples. P. mirabilis was the species most frequent isolated. Strains of Salmonella Agona were isolated from two samples (8 percent) of C. megacephala. Enteropathogenic E. coli was not isolated. M. domestica and C. megacephala showed themselves as potential vectors of agents related to enteric diseases in humans and other animals.

Detection and molecular characterization of a gentamicin-susceptible, methicillin-resistant Staphylococcus aureus (MRSA) clone in Rio de Janeiro that resembles the New York/Japanese clone.

Staphylococcus aureus is the leading cause of hospital-acquired infections in many countries, and multiple factors contribute to the ability of these bacteria to disseminate and spread in hospitals. In Brazil it has been demonstrated that a multiresistant methicillin-resistant S. aureus clone, the so-called Brazilian epidemic clone, is widespread geographically. This clone was first detected in 1992 in Brazil, and recently from many other countries within South America, Europe and Asia. The study describes the detection of a gentamicin-susceptible heterogeneous MRSA clone that resembles another MRSA clone widely spread in US and Japanese hospitals, and supports the premise that the detection of heterogeneous MRSA isolates by some recommended methods is a challenging task that may, occasionally, result in MRSA misidentification.

A new serovar and a new serological variant belonging to Salmonella enterica subspecies diarizonae.

Description of a new serovar (S. IIIb 16:k:e,n,x,z15) and a new serological variant (S. IIIb 42:z10:e,n,x,z15:z60 ) belonging to the genus Salmonella isolated from stool specimens of Brazilian snakes (Crotalus durissus).

A new serovar and a new serological variant belonging to Salmonella enterica subspecies diarizonae

Description of a new serovar (S. IIIb 16:k:e,n,x,z15) and a new serological variant (S. IIIb 42:z10:e,n,x,z15:z60 ) belonging to the genus Salmonella isolated from stool specimens of Brazilian snakes (Crotalus durissus)

Serosubtypes and PorA types of Neisseria meningitidis serogroup B isolated in Brazil during 1997--1998: overview and implications for vaccine development.

Meningococcal disease caused by N. meningitidis serogroup B (MenB) has been endemic in Brazil since 1997. In this study, we determined the prevalence of serosubtypes of MenB isolated in 10 Brazilian states and the Federal District during 1997 and 1998 and investigated the extent of PorA VR sequence variation among the most prevalent serosubtypes to evaluate the possible use of an outer membrane vesicle (OMV)-, PorA-based vaccine to prevent meningococcal disease in Brazil. During this period, a total of 8,932 cases of meningococcal disease were reported. Only 42% (n = 3,751) of the reported cases were laboratory confirmed, and about 60% (n = 2,255) of those were identified as MenB. Among 1,297 MenB strains selected for this study, the most prevalent serosubtypes were P1.19,15 (66%), P1.7,1 (11%), and P1.7,16 (4%). PorA VR typing showed that 91% of the P1.19,15 strains analyzed had VR1 and VR2 sequences identical to those of the prototype strain. No sequence variation was detected among the 40 strains representing all isolated MenB P1.7,16 strains in the three southern states, where this serosubtype accounts for 75% of the serosubtypes identified. Similarly, all P1.7,1 strains were identified by PorA typing as P1.7-1,1. Although further improvements in the reporting of cases and collection of strains in Brazil are needed, our data suggest that a trivalent OMV-based vaccine prepared with PorA types P1.19,15, P1.7-1,1, and P1.7,16 may be appropriate to control serogroup B meningococcal disease in most of the Brazilian states.

Epidemiological analysis of bacterial strains involved in hospital infection in a university hospital from Brazil.

Hospital infections cause an increase in morbidity and mortality of hospitalized patients with significant rise in hospital costs. The aim of this work was an epidemiological analysis of hospital infection cases occurred in a public University Hospital in Rio de Janeiro. Hence, 238 strains were isolated from 14 different clinical materials of 166 patients hospitalized in the period between August 1995 and July 1997. The average age of the patients was 33.4 years, 72.9% used antimicrobials before having a positive culture. The most common risk conditions were surgery (19.3%), positive HIV or AIDS (18.1%) and lung disease (16.9%). 24 different bacterial species were identified, S. aureus (21%) and P. aeruginosa (18.5%) were predominant. Among 50 S. aureus isolated strains 36% were classified as MRSA (Methicillin Resistant S. aureus). The Gram negative bacteria presented high resistance to aminoglycosides and cephalosporins. A diarrhea outbreak, detected in high-risk neonatology ward, was caused by Salmonella serovar Infantis strain, with high antimicrobial resistance and a plasmid of high molecular weight (98Mda) containing virulence genes and positive for R factor.

Proposed standardization of Neisseria meningitidis PorA variable-region typing nomenclature.

Neisseria meningitidis isolates are conventionally classified by serosubtyping, which characterizes the reactivities of the PorA outer membrane protein variable-region (VR) epitopes with monoclonal antibodies (MAbs). A newer method (PorA VR typing) uses predicted amino acid sequences derived from DNA sequence analysis. The resulting classification schemes are not standardized, offering conflicting and sometimes irreconcilable data from the two methods. In this paper, we propose a standardization of the PorA VR typing nomenclature that incorporates serologic information from traditional PorA serosubtyping with molecular data from predicted VR sequences. We performed a comprehensive literature and database search, generating a collection of strains and DNA sequences that reflects the diversity within PorA that exists to date. We have arranged this information in a comprehensive logical model that includes both serosubtype and PorA VR type assignments. Our data demonstrate that the current panel of serosubtype-defining MAbs underestimates PorA VR variability by at least 50%. Our proposal for VR typing is informative because amino acid sequence and serologic information, when serosubtype-defining MAbs are available, can be deduced simultaneously from the PorA VR designation. This scheme will be useful in future classification and applied epidemiologic studies of N. meningitidis, being a systematic way of selecting PorA vaccine candidates and analyzing vaccine coverage and failure.

Meningococcal disease caused by Neisseria meningitidis serogroup B serotype 4 in São Paulo, Brazil, 1990 to 1996.

A large epidemic of serogroup B meningococcal disease (MD), has been occurring in greater São Paulo, Brazil, since 1988. A Cuban-produced vaccine, based on outer-membrane-protein (OMP) from serogroup B: serotype 4: serosubtype P1.15 (B:4:P1.15) Neisseria meningitidis, was given to about 2.4 million children aged from 3 months to 6 years during 1989 and 1990. The administration of vaccine had little or no measurable effects on this outbreak. In order to detect clonal changes that could explain the continued increase in the incidence of disease after the vaccination, we serotyped isolates recovered between 1990 and 1996 from 834 patients with systemic disease. Strains B:4:P1.15, which was detected in the area as early as 1977, has been the most prevalent phenotype since 1988. These strains are still prevalent in the area and were responsible for about 68% of 834 serogroup B cases in the last 7 years. We analyzed 438 (52%) of these strains by restriction fragment length polymorphism (RFLPs) of rRNA genes (ribotyping). The most frequent pattern obtained was referred to as Rb1 (68%). We concluded that the same clone of B:4:P1.15-Rb1 strains was the most prevalent strain and responsible for the continued increase of incidence of serogroup B MD cases in greater São Paulo during the last 7 years in spite of the vaccination trial.

The use of oligonucleotide probes for meningococcal serotype characterization.

In the present study we examine the potential use of oligonucleotide probes to characterize Neisseria meningitidis serotypes without the use of monoclonal antibodies (MAbs). Antigenic diversity on PorB protein forms the bases of serotyping method. However, the current panel of MAbs underestimated, by at least 50% the PorB variability, presumably because reagents for several PorB variable regions (VRs) are lacking, or because a number of VR variants are not recognized by serotype-defining MAbs. We analyzed the use of oligonucleotide probes to characterize serotype 10 and serotype 19 of N. meningitidis. The porB gene sequence for the prototype strain of serotype 10 was determined, aligned with 7 other porB sequences from different serotypes, and analysis of individual VRs were performed. The results of DNA probes 21U (VR1-A) and 615U (VR3-B) used against 72 N. meningitidis strains confirm that VR1 type A and VR3 type B encode epitopes for serotype-defined MAbs 19 and 10, respectively. The use of probes for characterizing serotypes possible can type 100% of the PorB VR diversity. It is a simple and rapid method specially useful for analysis of large number of samples.

[Meningococcal disease: epidemiology and control of secondary cases]. / Doença meningocócica: epidemiologia e controle dos casos secundários.

Epidemiological features of meningococcal disease described as from the second half of the 80's inclusive, have motivated a revision of current guidelines for sporadic disease and outbreak control. The increase of disease among teenagers and linked cases involving schools are the two most significant aspects that have prompted the revision of control measures. Vaccination routines and advice for the disease management of clusters are also relevant features recently revised. This present paper describes the management and some epidemiological features of secondary cases.

Correlation between serological and sequencing analyses of the PorB outer membrane protein in the Neisseria meningitidis serotyping system.

The current serological typing scheme for Neisseria meningitidis is not comprehensive; a proportion of isolates are not serotypeable. DNA sequence analysis and predicted amino acid sequences were used to characterize the structures of variable-region (VR) epitopes on N. meningitidis PorB proteins (PorB VR typing). Twenty-six porB gene sequences were obtained from GenBank and aligned with 41 new sequences. Primary amino acid structures predicted from those genes were grouped into 30 VR families of related variants that displayed at least 60% similarity. We correlated VR families with monoclonal antibody (MAb) reactivities, establishing a relationship between VR families and epitope locations for 15 serotype-defining MAbs. The current panel of serotype-defining MAbs underestimates by at least 50% the PorB VR variability because reagents for several major VR families are lacking or because a number of VR variants within some families are not recognized by serotype-defining MAbs. These difficulties, also reported for serosubtyping based on the PorA protein, are shown as inconsistent results between serological and sequence analyses, leading to inaccurate strain identification and incomplete epidemiological data. The information from this study enabled the expansion of the panel of MAbs currently available for serotyping, by including MAbs of previously undetermined specificities. Use of the expanded serotype panel enabled us to improve the sensitivity of serotyping by resolving a number of formerly nonserotypeable strains. In most cases, this information can be used to predict the VR family placement of unknown PorB proteins without sequencing the entire porB gene. PorB VR typing complements serotyping, and a combination of both techniques may be used for full characterization of meningococcal strains. The present work represents the most complete and integrated data set of PorB VR sequences and MAb reactivities of serogroup B and C meningococci produced to date.

Helicobacter pylori in dyspeptic children and adults: endoscopic, bacteriologic and histologic correlations.

Using different bacteriological (urease test, Gram staining and culture) and histological (Steiner staining and modified Giemsa staining) techniques, we searched for the presence of Helicobacter pylori in the gastric antrum of 200 dyspeptic Brazilian patients (106 females and 94 males aged 19 days to 81 years). The presence of bacteria was then correlated with the endoscopic and histological findings. H. pylori was present in 59.5% of the population studied. In Brazil, colonization occurs early, involving 37% of the dyspeptic population by 20 years of age. The presence of H. pylori in the gastric antrum was strongly associated with duodenal ulcer (P < 0.001) and a normal endoscopic examination did not exclude the possibility of colonization of the gastric antrum by H. pylori. The most sensitive test was the preformed urease test (89%). We conclude that more than one diagnostic method should preferably be used for the detection of H. pylori and that the presence of H. pylori is closely correlated with active chronic gastritis (P < 0.001).

A Salmonella agona outbreak in a pediatric hospital in the city of Rio de Janeiro, Brazil.

Six Salmonella Agona strains from an outbreak of 15 days duration which occurred in a public hospital in Rio de Janeiro, Brazil, were analyzed. The outbreak involved six infants (mean age, 24 days; mean body weight, 1612 g), all of them with severe clinical signs and symptoms. Two of them had surgical implications, two were preterm and two had respiratory distress at birth. The Salmonella strains were resistant to nine antimicrobial agents (ampicillin, cefalotine, ceftriaxone, gentamicin, amikacin, trimethoprim-sulfamethoxazole, chloramphenicol, and tetracycline). Analysis of the plasmid pattern of the wild strains and of the transconjugants confirmed that these were identical strains.

[Frequency of pathogenic enterobacteria in infantile diarrheic processes in the city of Recife, Pernambuco, Brazil]. / Freqüencia de enterobactérias patogenicas em processors diarréicos infantis na cidade do Recife, Pernambuco, Brasil.

326 samples of diarrheal feces obtained from children whose ages ranged from zero to 5 years, admitted in two rehydration hospitals in the city of Recife, Pernambuco, were analyzed. Feces were placed in Cary-Blair medium (4 degrees C) for shipment to the laboratory. There was no difference in the rate of bacteria isolation if the samples were analyzed within the period from 3 to 7 days of collection. 19.02% of the analyzed samples were positives for at least one of the searched bacteria, 26 Salmonella belonging to 3 species, 21 classic enteropathogenic E. coli, 1 invasive E. coli, 10 Shigella belonging to 3 serotypes and 1 Yersinia enterocolitica were found.

[Salmonella serotypes isolated from human enteric processes in Recife, Pernambuco, during 1978-1980]. / Sorotipos de Salmonella isolados de processos entéricos humanos em Recife-Pernambuco, durante o trienio 1978-1980.

From 13,196 faecal cultures made in Recife-Pernambuco during the period from 1978 to 1980, 1,720 strains of Salmonella were isolated. Serological typing on 1,387 of the isolates recognized 63 serotypes, 73.18% of which belonged to group B. The prevalent serotypes adding up to 1,231 strains (88.75% of the total of the isolates) were: S. typhimurium, S. saint-paul, S. poona, S. derby, S. agona, S. newport, S. oranienburg, S. infantis, S. tshiongwe and S. ndolo.

[Microbial resistance of Salmonella agona from various regions of Brazil]. / Resistência antimicrobiana de Salmonella agona oriundas de várias regiões do Brasil.

The object of the investigation was the evaluation of the susceptibility to antibiotic and chemotherapeutic agents of 240 strains of Salmonella agona isolated from different sources (human, food and environment) obtained from five Brazilian states (Minas Gerais, São Paulo, Rio de Janeiro, Pernambuco and Rio Grande do Sul). The presence of R factors in 26 representative strains of the sample was also determined.