Chlamydia trachomatis anorectal infections by LGV (L1, L2 and L2b) and non-LGV serotypes in symptomatic patients in Buenos Aires, Argentina.

BACKGROUND: Chlamydia trachomatis (CT) can infect the anorectum producing various signs and symptoms. There is scarce literature regarding the differences between LGV and non-LGV CT anorectal manifestations. We compare the clinical spectrum of LGV and non-LGV infections. METHODS: Patients over 18 years with presumptive infectious anorectal symptoms were examined in two healthcare centres in Buenos Aires. The patients were studied and treated according to current sexually transmitted infection guidelines. Anorectal swabs were collected to detect and genotype CT. RESULTS: A three-year-long study on 317 patients with anorectal symptoms showed 45.11% CT infection (85% LGV strains). Of 140 samples, 92 were sequenced: 80/119 LGV (L2b 45%, L1 32.5% and L2 22.5%) and 12/21 non-LGV. Older age and HIV+ status were significantly higher in the LGV group. Anal discharge, bleeding, severe proctitis and anal ulcers were more common in the LGV group. Multivariate logistic regression analysis revealed that HIV infection, anorectal bleeding and oro-anal sex are independent predictors of LGV infection. CONCLUSIONS: In patients with anorectal symptoms, LGV serovars predominate over non-LGV ones. Clinical manifestations are not pathognomonic of a specific biovar. If genotyping is not available, having clinical predictors may help to presume an LGV infection and define length of treatment.

Decreased relative risk of pneumococcal pneumonia during the last decade, a nested case-control study.

BACKGROUND: Streptococcus pneumoniae (SP) is one of the most common pathogens of Community-Acquired Pneumonia (CAP), but recent reports suggest that its incidence may be declining in relation to the use of the conjugate 13-valent pneumococcal vaccine in children. We compared the result of the immunochromatographic SP urinary antigen test (SPUAT) and clinical outcomes in patients with CAP admitted in two periods of time: 2001-2002(CAP1) and 2015-2016(CAP2). METHODS: This was a matched nested case-control study of two prospectively recorded cohorts of patients admitted with CAP, with SPUAT and blood culture performed in all patients. CAP2 cases and CAP1 controls were matched for age ± 4 years, sex, and Pneumonia Severity Index (PSI) score ± 10 points. Odds ratios (OR) for having SPUAT positive was estimated by conditional logistic regression. A multivariate model assessed the contribution of individual variables. RESULTS: Four hundred ninety-eight patients were recruited; 307 during the CAP1 and 191 during the CAP2 periods. Comparing both periods we observed differences, in age, PSI score, and the percentage of smokers, outpatients, previously immunized with pneumococcal vaccine, and positive SPUAT. On the other hand, mortality, admission from nursing homes, pneumococcal bacteremia and hospital admission were not different. After matching, pneumonia due to SP per the SPUAT was observed in 34(23.4%) of CAP1 and in 12(8.3%) of CAP2 patients (p < 0.001), and 6/145 CAP1 vs 33/145 CAP2 patients had received pneumococcal immunization before their admission (p < 0.001). A multivariate analysis confirmed that, independent of falling into PSI class 5, having not received the pneumococcal vaccine and having not survived the episode of pneumonia, there were two factors that increased the probability of having SPUAT positive: developing pneumonia during the CAP1 period (OR = 1.23) and having pneumococcal bacteremia (OR = 2.66). CONCLUSION: We observed a reduction of the role of SP as pathogen, along with an increase in the number of patients who received pneumococcal immunization before admission, in 2015-2016 compared to 2001-2002. In addition, the use of conjugate 13-valent vaccine, starting in 2012 for childhood immunization, could be an additional factor contributing to these changes, as a result of early herd immunity in adults pneumonia.

[Clinical polymorphism of anorectal lymphogranuloma venereum in Buenos Aires City]. / Polimorfismo clínico de linfogranuloma venéreo anorrectal en la ciudad de Buenos Aires.

From 2003 to date there has been a rising number of reports from developed countries on cases of lymphogranuloma venereum with anorectal localization in HIV-infected men who have sex with men. This localization differs from the classical inguinal abscesses which are typical of the disease in the tropics. The objective of this work is to document the presence of anorectal lymphogranuloma venereum in Buenos Aires and to describe its varied clinical manifestations. In the context of a systematic survey of rectal chlamydial infection, in just one trimester, eight cases of lymphogranuloma venereum caused by Chlamydia trachomatis biovar LGV were identified in HIV-infected men who have sex with men. The most frequent anorectal manifestations were pus, tenesmus, rectal urgency, and mucous or haemopurulent discharge. The proctitis was mostly mild or moderate and, in some cases, it was accompanied by perianal lesions. Given the great polymorphism and unspecificity of the clinical manifestations of the disease, we warn on the presence of this form of rectal lymphogranuloma venereum in our setting. If Chlamydia trachomatis is detected, it should be genotyped, not only for the correct diagnosis and treatment but also for epidemiological surveillance. Where genotyping is not available, the disease must be considered as caused by the LGV biovar and treated accordingly.

Polimorfismo clínico de linfogranuloma venéreo anorrectal en la Ciudad de Buenos Aires / Clinical polymorphism of anorectal lymphogranuloma venereum in Buenos Aires City

Desde 2003, en los países desarrollados han aumentado las comunicaciones sobre casos de linfogranuloma venéreo con cuadros clínicos diferentes de la forma inguinal clásica. Las presentaciones anorrectales, hasta hace poco atípicas, predominan en hombres infectados por HIV que tienen sexo con hombres. El objetivo de este trabajo es informar sobre la presencia de esta infección en la Ciudad Autónoma de Buenos Aires y describir sus variadas manifestaciones clínicas. En el contexto de una pesquisa sistemática de la infección rectal por clamidias, en apenas un trimestre fueron identificados ocho casos de linfogranuloma venéreo por Chlamydia trachomatis biovar LGV en hombres HIV positivos que tienen sexo con hombres. Las manifestaciones anorrectales más frecuentes fueron pujo, tenesmo, urgencia evacuatoria y secreción mucosa o hemopurulenta. En su mayoría presentaban proctitis leve o moderada, acompañada en algunos casos de lesiones perianales. Dados el polimorfismo y la inespecificidad de las manifestaciones clínicas del linfogranuloma venéreo rectal, se advierte sobre la circulación de esta infección en nuestro medio. En caso de detectar Chlamydia trachomatis, es importante genotipificarla para el correcto diagnóstico y tratamiento de la enfermedad y también para su vigilancia epidemiológica. Si la genotipificación no es posible, se debe considerar el caso como producido por el biovar LGV y aplicar el tratamiento correspondiente.

From 2003 to date there has been a rising number of reports from developed countries on cases of lymphogranuloma venereum with anorectal localization in HIV-infected men who have sex with men. This localization differs from the classical inguinal abscesses which are typical of the disease in the tropics. The objective of this work is to document the presence of anorectal lymphogranuloma venereum in Buenos Aires and to describe its varied clinical manifestations. In the context of a systematic survey of rectal chlamydial infection, in just one trimester, eight cases of lymphogranuloma venereum caused by Chlamydia trachomatis biovar LGV were identified in HIV-infected men who have sex with men. The most frequent anorectal manifestations were pus, tenesmus, rectal urgency, and mucous or haemopurulent discharge. The proctitis was mostly mild or moderate and, in some cases, it was accompanied by perianal lesions. Given the great polymorphism and unspecificity of the clinical manifestations of the disease, we warn on the presence of this form of rectal lymphogranuloma venereum in our setting. If Chlamydia trachomatis is detected, it should be genotyped, not only for the correct diagnosis and treatment but also for epidemiological surveillance. Where genotyping is not available, the disease must be considered as caused by the LGV biovar and treated accordingly.