Caracterización clínico epidemiológica de 183 niños cubanos con infección por SARS-CoV-2

Introducción: La epidemiologia y los patrones clínicos de la COVID-19 aún no están bien esclarecidos, particularmente en la edad pediátrica. Objetivo: Caracterizar clínica y epidemiológicamente 183 casos pediátricos infectados por SARS-CoV-2 en Cuba. Métodos: Estudio descriptivo, trasversal realizado en el periodo comprendido entre 11 de marzo y 29 de abril del 2020 en Cuba. Resultados: Se diagnosticaron 1619 pacientes, 183 casos (11,30%) fueron niños, porcentaje mayor de pacientes pediátricos infectados por SARS-CoV-2 en Cuba que en la mayoría de las informaciones internacionales. Los mayores de 5 años constituyeron el grupo de edad más afectado, el promedio de edad fue de 10,36 años, 54 % del sexo masculino, 46 % del femenino; 59% asintomáticos. La fuente de infección quedó definida en 98,36 % de los casos. Los síntomas clínicos predominantes fueron la fiebre y la tos, 24,59 y 17,49 %, respectivamente. Presentaron alteraciones radiológicas 8,7 % de los casos y se registraron complicaciones en 0,5 %. No hubo fallecido. La excreción viral no se detectó en 96,18 % de los casos a los 14 días del diagnóstico. Conclusiones: La sintomatología clínica de los pacientes infectados por SARS-CoV-2 no difiere de las infecciones respiratorias virales comunes, con predominio de fiebre y tos; la excreción viral en las secreciones respiratorias se aclaró en menos de 14 días en más de 90 % de los pacientes. La posibilidad de manifestaciones neurológicas, aunque infrecuente, constituye una complicación de elevada severidad en el curso de la COVID-19. No se registran fallecidos.

Introduction: Epidemiology and clinical patterns of COVID-19 are not yet distinguished, particularly in pediatric ages. Objective: To characterize 183 pediatric cases infected by SARS-CoV-2 in Cuba clinically and epidemiologically. Methods: Descriptive, cross-sectional study carried out in the period from 11 March to 29 April, 2020 in Cuba. Results: 1619 patients were diagnosed, 183 cases (11.30%) were children, a higher percentage of pediatric patients infected by SAR-CoV-2 in Cuba that in most of the international reports. Children over 5 years were the most affected age group, the average age was 10.36 years, 54% were males, 46% were females, and 59% were asymptomatic. The source of infection was determined in 98.36% of the cases. Predominant clinical symptoms were fever (24.59%) and cough (17.49%). 8.7% of the cases presented radiologic changes, and complications were recorded in 0.5%. There were no deceased patients. Viral excretion was not detected in 96.18% of the cases after 14 days of being diagnosed. Conclusions: Clinical symptomatology of the patients infected is not different from the common viral respiratory infections, prevailing fever and cough; viral excretion in respiratory secretions was cleared in less than 14 days in more than 90% of the patients. The possibility of presenting neurologic manifestations, although infrequent, is a complication of high seriousness in the evolution of COVID-19. There are no records of deceased patients.

[Presence of multidrug resistant Enterobacteriaceae and Escherichia coli in meat purchased in traditional markets of Lima]. / Presencia de Enterobacteriaceae y Escherichia coli multirresistente a antimicrobianos en carne adquirida en mercados tradicionales en Lima.

OBJECTIVE.: The objective of this study was to describe the presence of Enterobacteriaceae in meat samples collected in traditional markets of Lima and to establish the levels of antimicrobial resistance and the presence of extended spectrum beta-lactamases (BLEE) and AmpC in Escherichia coli. MATERIALS AND METHODS.: A total of 138 meat samples, 64 (46.4%) chicken, 44 (31.9%) beef and 30 (21.7%) pork were collected. The isolated bacteria belonged to 17 different genera and, specifically, 14 were classified as Enterobacteriaceae. Sensitivity to ten antimicrobial agents was analyzed using the Kirby-Bauer disc diffusion method, BLEE and AmpC were determined by double disc and imipenem-ceftazidime induction tests, respectively. RESULTS.: Antimicrobial resistance levels were high against trimethoprim-sulfamethoxazole, ampicillin, tetracycline, nalidixic acid, ciprofloxacin and chloramphenicol. There are significant differences in antibiotic resistance levels depending on the type of meat (chicken, beef and pork) (p <0.05). Multiple drug resistance (MDR) levels were particularly high in chicken and pork (98.2% and 86.4%, respectively). In addition, the presence of BLEE in Escherichia coli isolated from chicken meat was 59.4%. CONCLUSIONS.: Multiple drug resistance levels were high compared to antibiotics frequently used in humans; chicken and beef are highlighted as potential reservoirs of BLEE and pAmpC-producing Escherichia coli, respectively.

OBJETIVOS.: El objetivo del presente estudio fue describir la presencia de Enterobacteriaceae en muestras de carne recolectadas en mercados tradicionales de Lima y establecer los niveles de resistencia a antimicrobianos y la presencia de betalactamasas de espectro extendido (BLEE) y AmpC en Escherichia coli. MATERIALES Y MÉTODOS.: Se recolectaron un total de 138 muestras de carne, 64 (46,4 %) de pollo, 44 (31,9 %) de carne de res y 30 (21,7%) de carne de cerdo. Las bacterias aisladas pertenecieron a 17 géneros diferentes, y específicamente 14 fueron clasificados como Enterobacteriaceae. Se analizó la sensibilidad frente a diez agentes antimicrobianos mediante el método de difusión de disco Kirby-Bauer, se determinó la presencia de BLEE y AmpC mediante las pruebas de doble disco y de inducción de imipenem-ceftazidima, respectivamente. RESULTADOS.: Los niveles de resistencia a los antimicrobianos fueron altos frente a trimetoprima-sulfametoxazol, ampicilina, tetraciclina, ácido nalidíxico, ciprofloxacino y cloranfenicol. Existen diferencias significativas en los niveles de resistencia a los antibióticos según el tipo de carne (pollo, carne de res y cerdo) (p <0,05). Los niveles de resistencia a múltiples antimicrobianos (MDR) fueron particularmente altos en pollo y cerdo (98,2 % y 86,4 %, respectivamente). Además, la presencia de BLEE en Escherichia coli aisladas de carne de pollo fue del 59,4 %. CONCLUSIONES.: Los niveles de resistencia a los antimicrobianos fueron altos frente a los antibióticos usados frecuentemente en humanos, se destaca el pollo y la res como potenciales reservorios de Escherichia coli productoras de BLEE y pAmpC, respectivamente.

Presencia de Enterobacteriaceae y Escherichia coli multirresistente a antimicrobianos en carne adquirida en mercados tradicionales en Lima / Presence of multidrug resistant Enterobacteriaceae and Escherichia coli in meat purchased in traditional markets of Lima

RESUMEN Objetivos. El objetivo del presente estudio fue describir la presencia de Enterobacteriaceae en muestras de carne recolectadas en mercados tradicionales de Lima y establecer los niveles de resistencia a antimicrobianos y la presencia de betalactamasas de espectro extendido (BLEE) y AmpC en Escherichia coli. Materiales y métodos. Se recolectaron un total de 138 muestras de carne, 64 (46,4 %) de pollo, 44 (31,9 %) de carne de res y 30 (21,7%) de carne de cerdo. Las bacterias aisladas pertenecieron a 17 géneros diferentes, y específicamente 14 fueron clasificados como Enterobacteriaceae. Se analizó la sensibilidad frente a diez agentes antimicrobianos mediante el método de difusión de disco Kirby-Bauer, se determinó la presencia de BLEE y AmpC mediante las pruebas de doble disco y de inducción de imipenem-ceftazidima, respectivamente. Resultados. Los niveles de resistencia a los antimicrobianos fueron altos frente a trimetoprima-sulfametoxazol, ampicilina, tetraciclina, ácido nalidíxico, ciprofloxacino y cloranfenicol. Existen diferencias significativas en los niveles de resistencia a los antibióticos según el tipo de carne (pollo, carne de res y cerdo) (p <0,05). Los niveles de resistencia a múltiples antimicrobianos (MDR) fueron particularmente altos en pollo y cerdo (98,2 % y 86,4 %, respectivamente). Además, la presencia de BLEE en Escherichia coli aisladas de carne de pollo fue del 59,4 %. Conclusiones. Los niveles de resistencia a los antimicrobianos fueron altos frente a los antibióticos usados frecuentemente en humanos, se destaca el pollo y la res como potenciales reservorios de Escherichia coli productoras de BLEE y pAmpC, respectivamente.

ABSTRACT Objective. The objective of this study was to describe the presence of Enterobacteriaceae in meat samples collected in traditional markets of Lima and to establish the levels of antimicrobial resistance and the presence of extended spectrum beta-lactamases (BLEE) and AmpC in Escherichia coli. Materials and Methods. A total of 138 meat samples, 64 (46.4%) chicken, 44 (31.9%) beef and 30 (21.7%) pork were collected. The isolated bacteria belonged to 17 different genera and, specifically, 14 were classified as Enterobacteriaceae. Sensitivity to ten antimicrobial agents was analyzed using the Kirby-Bauer disc diffusion method, BLEE and AmpC were determined by double disc and imipenem-ceftazidime induction tests, respectively. Results. Antimicrobial resistance levels were high against trimethoprim-sulfamethoxazole, ampicillin, tetracycline, nalidixic acid, ciprofloxacin and chloramphenicol. There are significant differences in antibiotic resistance levels depending on the type of meat (chicken, beef and pork) (p <0.05). Multiple drug resistance (MDR) levels were particularly high in chicken and pork (98.2% and 86.4%, respectively). In addition, the presence of BLEE in Escherichia coli isolated from chicken meat was 59.4%. Conclusions. Multiple drug resistance levels were high compared to antibiotics frequently used in humans; chicken and beef are highlighted as potential reservoirs of BLEE and pAmpC-producing Escherichia coli, respectively.

Resistance to quinolones, cephalosporins and macrolides in Escherichia coli causing bacteraemia in Peruvian children.

OBJECTIVES: To characterise the ß-lactam, quinolone and macrolide resistance levels and mechanisms in 62 Escherichia coli isolates causing bacteraemia in Peruvian children. METHODS: Minimum inhibitory concentrations (MICs) of ciprofloxacin, nalidixic acid (NAL) and azithromycin were determined in the presence and absence of Phe-Arg-ß-naphthylamide. Susceptibility to other 14 antimicrobial agents was also established. Extended-spectrum ß-lactamases (ESBLs) were identified, and mutations in gyrA and parC as well as the presence of transferable mechanisms of quinolone resistance (TMQR) and macrolide resistance (TMMR) were determined. RESULTS: Fifty isolates (80.6%) were multidrug-resistant. High proportions of resistance to ampicillin (93.5%), NAL (66.1%) and trimethoprim/sulfamethoxazole (66.1%) were observed. No isolate showed resistance to carbapenems and only two isolates were resistant to nitrofurantoin. Twenty-seven isolates carried ESBL-encoding genes: 2 blaSHV-12; 13 blaCTX-M-15; 4 blaCTX-M-2; 6 blaCTX-M-65; and 2 non-identified ESBLs. Additionally, 27 blaTEM-1 and 9 blaOXA-1-like genes were detected. All quinolone-resistant isolates showed target mutations, whilst TMQR were present in four isolates. Efflux pumps played a role in constitutive NAL resistance. The association between quinolone resistance and ESBL production was significant (P=0.0011). The mph(A) gene was the most frequent TMMR (16 isolates); msr(A) and erm(B) genes were also detected. Only one TMMR-carrying isolate [presenting mph(A) and erm(B) concomitantly] remained resistant to azithromycin when efflux pumps were inhibited. CONCLUSIONS: A variety of ESBL-encoding genes and widespread of blaCTX-M-15 in Lima has been shown. The role of efflux pumps in azithromycin resistance needs to be further evaluated, as well as effective control of the use of antimicrobial agents.

Macrolide resistance mechanisms in Enterobacteriaceae: Focus on azithromycin.

From its introduction in 1952 onwards, the clinical use of macrolides has been steadily increasing, both in human and veterinary medicine. Although initially designed to the treatment of Gram-positive microorganisms, this antimicrobial family has also been used to treat specific Gram-negative bacteria. Some of them, as azithromycin, are considered in the armamentarium against Enterobacteriaceae infections. However, the facility that this bacterial genus has to gain or develop mechanisms of antibiotic resistance may compromise the future usefulness of these antibiotics to fight against Enterobacteriaceae infections. The present review is focused on the mechanisms of macrolide resistance, currently described in Enterobacteriaceae.

Succinyl-CoA Synthetase: New Antigen Candidate of Bartonella bacilliformis.

BACKGROUND: Bartonella bacilliformis is the causative agent of Carrion's disease, a neglected illness with mortality rates of 40-85% in the absence of treatment. The lack of a diagnostic technique to overcome misdiagnosis and treat asymptomatic carriers is of note. This study aimed to identify new B. bacilliformis antigenic candidates that could lead to a new diagnostic tool able to be implemented in endemic rural areas. METHODOLOGY/PRINCIPAL FINDINGS: Blood (n = 198) and serum (n = 177) samples were collected in northern Peru. Clinical data were recorded. Specific 16S rRNA amplification by RT-PCR, IFA and ELISA for IgM/IgG with whole cells as antigens was done. Western blot analysis and N-terminal amino acid sequencing detected seroreactive proteins. ELISAs for IgM/IgG for the antigenic candidates were performed. Of the population 33.3% reported at least one symptom compatible with Carrion's disease; 25.4% (IFA), 27.1% (ELISA-IgG), 33.9% (ELISA-IgM) and 38.9% (RT-PCR) of samples were positive. Four proteins were considered potential antigenic candidates, including two new antigenic candidates, succinyl-CoA synthetase subunit α (SCS-α) and succinyl-CoA synthetase subunit ß (SCS-ß). On Western blot both Pap31 and SCS-α interacted with IgM, while GroEL and SCS-ß interacted with IgG. The presence of specific antibodies against the antigenic candidates varied from 34.5% (IgG against SCS-α) to 97.2% (IgM against Pap31). CONCLUSIONS/SIGNIFICANCE: RT-PCR and the high levels of positivity for specific ELISAs demonstrate high levels of B. bacilliformis exposure and asymptomatic carriers among inhabitants. The new antigens identified might be used as a new rapid diagnostic tool to diagnose acute Carrion's disease and identify asymptomatic carriers.

Enfermedad Cerebro Vascular Isquémica. Comportamiento preventivo. Policlínico No. 1. Manzanillo / Ischemic Cerebrovascular Disease. A preventive treatment. Polyclinic I. Manzanillo

Se realizó un estudio del comportamiento de la Enfermedad Cerebro Vascular Isquémica en 23 pacientes, pertenecientes a 10 Consultorios del Médico de la Familia del Policlínico Integral Docente No 1 de Manzanillo, en el período comprendido entre febrero 2010 y diciembre 2013, se analizaron variables del comportamiento intrahospitalario y extrahospitalario. Más de la mitad estuvo comprendido entre 50 y 69 años de edad con predominio en el sexo femenino, 14 pacientes de estos debutaron en su forma aterotrombótica. La evaluación neurológica manifestó su mayor representatividad entre 13 y 15 puntos para la escala de Glasgow en la evaluación inicial. El antecedente patológico personal de hipertensiónarterial alcanzó su mayor representación en la forma aterotrombótica, y la cardiopatía isquémica para la forma cardioembólica(AU)

It was carried out a study of the behavior of the Ischemic Cerebrovascular disease in 23 patients belonging to 10 Family medical offices of the Teaching Integrated Polyclinic I in Manzanillo, during the period of February 2010 to December 2013. There were analyzed the variables of the intrahospital and extrahospital behavior. More than a half were in the group of 50-69 years old, prevailing the female sex, 14 patients presented the atherothrombotic form. The neurologic assessment had its greatest representativity about 13-15 scores for the Glasgow scale in the initial evaluation. The personal pathological antecedent of hypertension reached its greatest representation in the atherothrombotic form and the ischemic cardiopathy for the cardioembolic form(EU)

Virulence factors profiles and ESBL production in Escherichia coli causing bacteremia in Peruvian children.

The presence of 25 virulence genes (VGs), genetic phylogroups, quinolone-resistance and Extended Spectrum ß-lactamase (ESBL)-production was assessed in 65 Escherichia coli isolates from blood cultures in children <5 years in Peru. The most frequent VGs were fimA (89.2%), iutA (83.1%), agn43 (72.3%), iucA (67.7%), and fyuA (49.2%). The isolates belonged to D (47.7%), A (26.1%), B1 (21.5%), and B2 (4.6%) phylogroups. D + B2 isolates presented a high number of fimA, hly, papC, sat, and fyuA genes. Quinolone-susceptible (22 isolates - 33.8%) and ESBL-negative (31 isolates - 47.7%) isolates carried more VGs that their respective counterparts (5.7 vs. 4.7 and 5.3 vs. 4.4 respectively); the frequency of the fyuA, aat, aap, and hly genes significantly differed between quinolone-resistant and quinolone-susceptible isolates. Neonatal sepsis isolates tended to be more quinolone-resistant (P = 0.0697) and ESBL-producers (P = 0.0776). Early-onset neonatal sepsis isolates possessed a high number of VGs (5.2 VGs), especially in neonates of ≤1 day (5.9 VGs).

Resultados del tratamiento microquirúrgico de la hernia discal lumbar / Results of the microsurgical treatment of lumbar discal hernia

Se realizó un estudio prospectivo de intervención a 168 pacientes con el diagnóstico de hernia discal lumbar. A todos se les practicaron estudios radiológicos simples pre y postoperatorios: Tomografía Axial Computarizada o Resonancia Magnética Nuclear. Se evaluaron elementos del cuadro clínico en el pre y postoperatorios. Se realizó la investigación con el objetivo de describir la aplicación de la técnica microquirúrgica, que permitió la aplicación de la discectomía simple por foraminotomía en la mayoría de los pacientes, con verdadera herniación discal y en el nivel l5-S1(AU)

It was performed a prospective intervention study to 168 patients with the diagnosis of lumbar discal hernia. There were carried out simple pre and post operative radiological studies: Computerized Axial Tomography or Nuclear Magnetic Resonance. There were evaluated some elements of the pre and post operative clinical setting. It was performed the research with the objective to describe the application of the microsurgical technique, what allowed the application of simple discectomy with foraminotomy in most of the patients with real discal hernia in the level 15-SI(AU)

Enfermedad Cerebro Vascular Isquémica. Comportamiento preventivo. Policlínico No. 1. Manzanillo / Ischemic Cerebrovascular Disease. A preventive treatment. Polyclinic I. Manzanillo

Se realizó un estudio del comportamiento de la Enfermedad Cerebro Vascular Isquémica en 23 pacientes, pertenecientes a 10 Consultorios del Médico de la Familia del Policlínico Integral Docente No 1de Manzanillo, en el período comprendido entre febrero 2010 y diciembre 2013, se analizaron variables del comportamiento intrahospitalario y extrahospitalario. Más de la mitad estuvo comprendido entre 50 y 69 años de edad con predominio en el sexo femenino, 14 pacientes de estos debutaron en su forma aterotrombótica. La evaluación neurológica manifestó su mayor representatividad entre 13 y 15 punto para la escala de Glasgow en la evaluación inicial. El antecedente patológico personalde hipertensiónarterial alcanzó su mayor representación en la forma aterotrombótica, y la cardiopatía isquémica para la forma cardioembólica(AU)

It was carried out a study of the behavior of the Ischemic Cerebrovascular disease in 23 patients belonging to 10 Family medical offices of the Teaching Integrated Polyclinic I in Manzanillo, during the period of February 2010 to December 2013. There were analyzed the variables of the intrahospital and extrahospital behavior. More than a half were in the group of 50-69 years old, prevailing the female sex, 14 patients presented the atherothrombotic form. The neurologic assessment had its greatest representativity about 13-15 scores for the Glasgow scale in the initial evaluation. The personal pathological antecedent of hypertension reached its greatest representation in the atherothrombotic form and the ischemic cardiopathy for the cardioembolic form(EU)