Evaluación antifúngica del ozono contra Candida albicans: estudio in vitro / Antifungal evaluation of ozone against Candida albicans: in vitro study

Introducción: la Candida albicans (C. albicans) es un patógeno fúngico que puede causar infecciones superficiales o potencialmente mortales. Los biofilms de C. albicans muestran rasgos fenotípicos únicos, el más destacado es su notable resistencia a una amplia variedad de agentes antimicóticos. Una de las alternativas para inhibir el crecimiento de este microorganismo es el ozono debido a sus propiedades bactericidas, fungicidas y virucidas; sin embargo, escasa información ha sido reportada en C. albicans. Objetivo: el objetivo de este estudio fue evaluar el efecto fungicida del ozono en C. albicans. Material y métodos: la metodología consistió en agregar ozono a tubos de ensayo con medios de caldo nutritivo en diversas concentraciones y tiempos de ozonización. El efecto fungicida fue determinado con la determinación del número de colonias de C. albicans en agar nutritivo a través de procedimiento microbiológicos estandarizados por triplicado. Resultados: todas las muestras con ozono mostraron adecuados niveles de inhibición de crecimiento del microorganismo. Además, el efecto fungicida del ozono se encontró para ser significativamente dependiente del tiempo de ozonización y de la concentración. Conclusión: el uso de terapia con ozono podría tener potencial en el control de infecciones micóticas causadas por la presencia de C. albicans (AU)

Introduction: Candida albicans (C. albicans) is a fungal pathogen that can cause superficial or life-threatening infections. Biofilms of C. albicans display unique phenotypic traits, the most prominent being their remarkable resistance to a wide variety of antifungal agents. One of the alternatives to inhibit the growth of this microorganism is ozone due to its bactericidal, fungicidal and virucidal properties; however, little information has been reported on C. albicans. Objective: the objective of this study was to evaluate the fungicidal effect of ozone on C. albicans. Material and methods: the methodology consisted in adding ozone to test tubes with nutrient broth media in various concentrations and ozonation times. The fungicidal effect was determined by determining the number of colonies of C. albicans in nutrient agar through standardized microbiological procedures in triplicate. Results: all the ozone samples showed adequate levels of growth inhibition of the microorganism. Furthermore, the fungicidal effect of ozone was found to be significantly dependent on ozonation time and concentration. Conclusion: the use of ozone therapy could have potential in the control of fungal infections caused by the presence of C. albicans (AU)

Conservação de peças anatômicas em cloreto de sódio: um estudo com produto de fecundação / Conservation of anatomical parts in sodium chloride: a study with fertilization product / Conservación de partes anatómicas en cloruro sódico: un estudio con producto de fertilización

Introdução: Os materiais de origem humana geralmente são conservados em formaldeído, para possibilitar o estudo da anatomia humana, tal conservante possui baixo custo e boa fixação, contudo é toxico. Diante do exposto é necessário, o estudo de outros métodos de conservação, menos prejudiciais, como a solução de NaCl 30%. Objetivo: Comparar a conservação de peças anatômicas em solução de NaCl à 30% e formaldeído a 10%. Método: Pesquisa experimental, exploratória e descritiva, realizada com dois produtos de abortamento, no laboratório de anatomia de uma universidade pública, no estado do Paraná/BR. Foi realizada fixação em solução de formol 10%, em seguida uma amostra foi lavado em água corrente e armazenado em solução de NaCl à 30%. Após 6 meses da conservação em solução salina, foram coletadas amostras, estas foram submetidas a análise de crescimento bacteriano. Avaliou-se tonalidade e turgor cutâneo, odor e peso, bem como crescimento bacteriano. O estudo seguiu os preceitos éticos (CAAE: 53740121.9.0000.9247). Resultados: Foram realizadas observações após 24h, 7, 30, 60, 90 e 180 dias. O feto em solução de NaCl não possui odor, e diminuição do turgor da pele. Ambas a amostras não apresentaram crescimento bacteriano. Considerações finais: A solução de NaCl a 30% desidrata a pele, mas não altera significativamente a forma e estrutura, ainda não possui odor e nem toxicidade, o que garante benefícios a saúde de quem os manipula, bem como tal concentração de NaCl inibe de forma efetiva o crescimento bacteriano nos tecidos e na própria solução, se demostrando eficaz na conservação.

Introduction: The materials of human origin are usually preserved in formaldehyde, to enable the study of human anatomy, this preservative has low cost and good fixation, however it is toxic. Therefore, it is necessary to study other less harmful preservation methods, such as 30% NaCl solution. Objective: To compare the preservation of anatomical specimens in 30% NaCl solution and 10% formaldehyde solution. Method: Experimental, exploratory and descriptive research, carried out with two abortion products, in the anatomy laboratory of a public university, in the state of Paraná/BR. Fixation in 10% formaldehyde solution was performed, after which a sample was washed in running water and stored in a 30% NaCl solution. After 6 months of preservation in saline solution, samples were collected and submitted to bacterial growth analysis. Skin tone and turgor, odor, weight, and bacterial growth were evaluated. The study followed the ethical precepts (CAAE: 53740121.9.0000.9247). Results: Observations were made after 24h, 7, 30, 60, 90 and 180 days. The fetus in NaCl solution had no odor, and decreased skin turgor. Both samples showed no bacterial growth. Final considerations: The 30% NaCl solution dehydrates the skin, but does not alter significantly the shape and structure, and also has no odor or toxicity, which guarantees health benefits to those who handle them, and such concentration of NaCl inhibits effectively the bacterial growth in the tissues and in the solution itself, proving to be effective in conservation.

Introducción: Los materiales de origen humano suelen conservarse en formol, para posibilitar el estudio de la anatomía humana, este conservante tiene bajo coste y buena fijación, sin embargo es tóxico. Por ello, es necesario estudiar otros métodos de conservación menos nocivos, como la solución de NaCl al 30%. Objetivo: Comparar la conservación de especímenes anatómicos en solución de NaCl al 30% y en solución de formaldehído al 10%. Método: Investigación experimental, exploratoria y descriptiva, realizada con dos abortos, en el laboratorio de anatomía de una universidad pública, en el estado de Paraná/BR. Fue realizada fijación en solución de formaldehído al 10%, después de lo cual la muestra fue lavada en agua corriente y almacenada en solución de NaCl al 30%. Tras 6 meses de conservación en solución salina, se recogieron las muestras y se sometieron a análisis de crecimiento bacteriano. Se evaluaron el tono y la turgencia de la piel, el olor, el peso y el crecimiento bacteriano. El estudio siguió los preceptos éticos (CAAE: 53740121.9.0000.9247). Resultados: Las observaciones se realizaron después de 24h, 7, 30, 60, 90 y 180 días. El feto en solución de NaCl no tenía olor, y la turgencia de la piel disminuyó. Ambas muestras no mostraron crecimiento bacteriano. Consideraciones finales: La solución de NaCl al 30% deshidrata la piel, pero no altera significativamente la forma y estructura, además no tiene olor ni toxicidad, lo que garantiza beneficios para la salud de quienes los manipulan, y dicha concentración de NaCl inhibe eficazmente el crecimiento bacteriano en los tejidos y en la propia solución, demostrando ser eficaz en la conservación.

Nanopartículas de plata contra bacterias presentes en biofilm dental de pacientes pediátricos / Silver nanoparticles against bacteria present in dental biofilm of pediatric patients

Introducción: el biofilm dental microbiano es el precursor de diversas enfermedades orales, una de ellas la caries, ésta representa la enferme- dad oral más significativa a nivel mundial, con una incidencia de 1.76 billones de niños afectados. Las nanopartículas de plata (AgNPs) se están usando como alternativa para el control y prevención del biofilm dental, ya que poseen propiedades antimicrobianas contra bacterias relacionadas a estas enfermedades. Sin embargo, no hay estudios que evalúen este comportamiento en pacientes pediátricos. Objetivo: eva- luar la actividad antimicrobiana de las AgNPs en bacterias de aislados clínicos tomados de pacientes pediátricos. Material y métodos: se tomó muestra del biofilm dental de 22 pacientes pediátricos, el efecto micro- biológico se evaluó mediante ensayos microbiológicos estandarizados internacionalmente por triplicado, usando dos diferentes tamaños de AgNPs. Resultados: los dos tamaños de AgNPs mostraron inhibición bacteriana, sin embargo, sólo se vio una diferencia estadísticamente significativa entre el género (p < 0.05), además, en general, hubo una correlación positiva significativa en relación a la concentración de las AgNPs y la velocidad del crecimiento bacteriano (p < 0.05). Conclusión: las AgNPs se pueden considerar como una alternativa para la prevención del biofilm dental y de esta manera para el control de diferentes enfermedades orales (AU))

Introduction: dental biofilm is the precursor of oral diseases, one of them dental caries, this represents the most significant oral disease worldwide with an incidence of 1.76 billion affected children. Silver nanoparticles (AgNPs) are being used as an alternative for the control and prevention of dental biofilm since they have antimicrobial properties against bacteria related to these diseases. However, there are no studies evaluating this behavior in pediatric patients. Objective: to evaluate the antimicrobial activity of AgNPs in bacteria from clinical isolates taken from pediatric patients. Material and methods: a sample of dental biofilm was taken from 22 pediatric patients, the microbiological effect was evaluated by international standardized microbiological tests in triplicate, using two different sizes of AgNPs. Results: the two sizes of AgNPs showed bacterial inhibition, however, only a statistically significant difference was seen between gender (p < 0.05), in addition, in general, there was a significant positive correlation in relation to the concentration of AgNPs and the speed bacterial growth (p < 0.05). Conclusion: AgNPs can be considered as an alternative for the prevention of dental biofilm and thus for the control of different oral diseases (AU)

Sustained release varnish containing chlorhexidine for prevention of Streptococcus mutans biofilm formation on voice prosthesis surface: an in vitro study / Barniz de liberación sostenida que contiene clorhexidina para la prevención de la formación de biopelículas de Streptococcus mutans en la superficie de la prótesis de voz: un estudio in vitro

Objectives: In this study, we aimed to develop a novel, sustained release varnish (SRV) for voice prostheses (VP) releasing chlorhexidine (CHX), for the prevention of biofilm formation caused by the common oral bacteria Streptococcus mutans on VP surfaces. Methods: This study was performed in an in vitro model as a step towards future in vivo trials. VPs were coated with a SRV containing CHX (SRV-CHX) or SRV alone (placebo-SRV) that were daily exposed to S. mutans. The polymeric materials of SRV were composed of ethylcellulose and PEG-400. Biofilm formation was assessed by DNA quantification (qPCR), crystal violet staining, confocal laser scanning microscopy (CLSM), scanning electron microscopy (SEM), and kinetics experiments. Results: The amount of DNA in the biofilms formed by S. mutans on VP surfaces coated once with SRV-CHX (1.024 ± 0.218 ng DNA/piece) was 58.5 ± 8.8% lower than that of placebo-SRV-coated VPs (2.465 ± 0.198 ng DNA/piece) after a 48-h exposure to S. mutans (p = 0.038). Reduced biofilm mass on SRV-CHX-coated VPs was visually confirmed by CLSM and SEM. CV staining of SRV-CHX single-coated VPs that have been exposed to S. mutans nine times showed a 98.1 ± 0.2% reduction in biofilm mass compared to placebo-SRV-coated VPs (p = 0.003). Kinetic experiments revealed that SRV-CHX triple-coated VPs could delay bacterial growth for 23 days. Conclusions: Coating VPs with SRV-CHX has an inhibitory effect on biofilm formation and prevents bacterial growth in their vicinities. This study is a proof-of-principle that paves the way for developing new clinical means for reducing both VPs’ bacterial biofilm formation and device failure.(AU)

Avaliação da ação germicida da luz ultravioleta de cabine de segurança biológica frente às espécies bacterianas / Evaluation of the germicidal action of ultraviolet light in biosafety cabinet concerning bacterial species

RESUMO: Introdução: A cabine de segurança biológica (CBS) é um equipamento de proteção coletiva, utilizado para efe-tuar a contenção de aerossóis produzidos nos procedimentos laboratoriais. A CBS protege tanto os trabalhadores, quanto o material manipulado e o meio ambiente. Dispõe de lâmpadas de luz ultravioleta (UV) que possui ação germicida, alterando os ácidos nucleicos dos micro-organismos. Objetivo: O objetivo do presente estudo foi avaliar a ação germicida da luz UV da CBS classe II, tipo A2, frente à cultura de duas espécies de bactérias com diferentes condições de exposição a luz UV. Material e Métodos: Para o desenvolvimento da pesquisa foram utilizadas as bactérias Staphylococcus aureus ATCC 25923 e Klebsiella pneumoniae ATCC 10031, na concentração de 1,5x108 Unidades Formadoras de Colônias/ml (UFC/ml), que após a semeadura em biplacas de Petri foram expostas à luz UV em diferentes condições e tempos. Resultados: Os resultados obtidos revelaram que as espécies de bactérias apresentaram igual perfil de crescimento ou inibição quando submetidas às diferentes condições de exposição. As biplacas de Petri com as tampas abertas e protegidas ou não com embalagem de esterilização apresentaram, nos tempos 15 e 20 minutos, inibição bacteriana. Nas biplacas protegidas pelo papel alumínio e nas biplacas com a tampa fechada, independentemente do tempo e da condição, os micro-organismos apresentaram crescimento bacteriano. Conclusão: Com os resultados obtidos, sugere-se que a ação germicida da luz UV foi eficaz, garantindo a descontaminação adequada e assegurando a qualidade na biossegurança laboratoria. (AU)

ABSTRACT: Introduction: The biological safety cabinet (BSC) is a collective protective device used to hold aerosols produced in laboratory procedures. The BSC protects workers, material handling, and the environment. It relies on ultraviolet light (UV) lamps that have germicidal action, altering the nucleic acids of microorganisms. Objective: The objective of the present study was to evaluate the germicidal action of BSC class II type A2 UV light against the culture of two bacterial species with different conditions of exposure to UV light. Methods: For the research, the bacteria Sta-phylococcus aureus ATCC 25923 and Klebsiella pneumoniae ATCC 10031 were used, at a concentration of 1.5x108Colony Forming Units/ml (CFU/ml), which were seeded in Petri biplates. Use UV light under different conditions and times. Results: The bacterial species showed the same growth or inhibition profile when subjected to different exposure conditions. Petri dishes with the cover open and protected or not with sterilization packaging showed bacterial inhibition at 15 and 20 minutes. The microorganisms in the biplates protected by the aluminum foil and in the biplates with the cover on, regardless of the time and condition, showed bacterial growth. Conclusion: With the results obtained, it is suggested that the germicidal action of UV light was effective, ensuring adequate decon-tamination and ensuring quality in laboratory biosafety. (AU)

Evaluación de la sangre ovina como suplemento nutritivo en medios de cultivo: citratada y desfibrinada / Evaluation of sheep blood as nutritive suplement in culture media: citratated and defibrinated

Introducción: La sangre ovina constituye un suplemento esencial en la elaboración de medios de cultivo, dado que aporta factores nutricionales indispensables para el crecimiento y la recuperación de diversos microorganismos. Objetivo: Evaluar comparativamente el efecto de la sangre ovina, tanto citratada como desfibrinada, en medios de cultivo de base agar en cuanto al crecimiento bacteriano y la producción de hemólisis de cepas de referencia de diferentes bacterias patógenas, así como la recuperación o el aislamiento de microorganismos de muestras clínicas. Métodos: Se realizó un estudio observacional, descriptivo y transversal en 6 laboratorios de microbiología de la ciudad de Santiago de Cuba durante el año 2017, en los cuales se empleó sangre de ovinos de la raza pelibuey, para la elaboración de medios de cultivo. A cada laboratorio se le suministró tanto sangre citratada como desfibrinada y se le entregó una encuesta para valorar los resultados. Resultados: Existió un mejor crecimiento y aislamiento bacteriano en el medio suplementado con sangre desfibrinada, a pesar de que el rendimiento o los resultados en el caso de la sangre citratada resultaron satisfactorios. Conclusiones: Se confirmó la pertinencia del uso de la sangre desfibrinada como suplemento de enriquecimiento nutritivo en medios de cultivo; no obstante, quedó demostrada la utilidad de la sangre citratada en la labor de rutina del laboratorio de microbiología clínica.

Introduction: Sheep blood is an essential supplement in the elaboration of culture media, as it provides important nutritional factors for the growth and recovery of different organisms. Objective: To evaluate comparatively the effect of sheep citrated and defibrinated sheep blood in culture media with agar base as for the bacterial growth and the production of hemolysis in reference strains from different pathogen bacteria, as well as the recovery or isolation of microorganisms from clinical samples. Method: An observational, descriptive and cross-sectional was carried out in 6 microbiology laboratories in Santiago de Cuba city during 2017, in which male sheeps blood from the pelibuey breed for elaborating culture media. Each laboratory received either citrated blood or defibrinated and a survey was delivered to evaluate the results. Results: There was a better growing and bacterial isolation in the media supplemented with defibrinated blood, although yielding or results were favorable with citrated blood. Conclusions: The pertinence of the use of defibrinated blood as a supplement of nutritive enrichment in culture media was confirmed; however, the use of citrated blood was demonstrated in the routine work of the clinical microbiology laboratory.

Crescimento bacteriano nas mãos dos profissionais de saúde: implicações na prevenção de infecções hospitalares / Bacterial growth on the hands of health care workers: implications for preventing nosocomial infections

RESUMO Objetivo analisar o crescimento bacteriano em amostras coletadas das mãos de profissionais de saúde após higiene com água e sabão. Métodos estudo transversal analítico, realizado com profissionais de saúde por meio da coleta de amostras (print) das polpas digitais da mão dominante, em placas contendo meio de cultura cromogênico, para análise microbiológica em relação à presença das colônias. Utilizaram-se o Teste de Fisher e Qui-quadrado. Resultados foram coletadas 73 amostras e 67 (91,8%) apresentaram crescimento bacteriano. O Staphylococcus aureus metilcilina resistente foi detectado em 19 (26,0%). Destaca-se associação significativa entre colônias com perfil de multirresistência e o tempo de atuação (p=0,030) e profissão (p=0,041). Conclusão houve crescimento bacteriano nas amostras após higiene das mãos, com maior crescimento de bactérias multirresistentes entre profissionais de enfermagem e àqueles com maior tempo de atuação. Estes resultados podem contribuir para detectar as lacunas acerca das medidas adotadas para a prevenção de infeções.

ABSTRACT Objective to analyze bacterial growth in samples collected from the hands of health professionals after hygiene with soap and water. Methods cross-sectional analytical study, carried out with healthcare professionals by collecting samples (print) from the digital pulp of the dominant hand on plates containing chromogenic culture medium for microbiological analysis regarding the presence of colonies. Fisher's and Chi-square tests were used. Results 73 samples were collected and 67 (91.8%) showed bacterial growth. Methicillin-resistant Staphylococcus aureus was detected in 19 (26.0%). A significant association between colonies with multidrug-resistance profile and the time of performance (p=0.030) and profession (p=0.041) was highlighted. Conclusion there was bacterial growth in samples after hand hygiene, with higher growth of multidrug-resistant bacteria among nursing professionals and those with longer time of work. These results may contribute to detect the gaps about the measures adopted for infection prevention.

Legionella pneumophila: un patógeno emergente en Argentina / Legionella pneumophila: an emerging pathogen in Argentina

La enfermedad del Legionario es causada por bacterias pertenecientes al género Legionella, siendo la especie pneumophila el principal agente etiológico de esta patología. Esta bacteria se describió por primera vez en 1977 como causa de un brote de neumonía grave registrado en 1976 en un centro de convenciones en los Estados Unidos de América. La enfermedad se presenta como una neumonía atípica, responsable del 1 al 15 % de los casos de neumonías adquiridas en la comunidad (NAC), del 5 al 10% de neumonías del adulto y del 1% en menores de 15 años. Los miembros de la familia Legionellaceae son bacilos aeróbicos gramnegativos que crecen lentamente y se encuentran ampliamente distribuidos en cuerpos de agua. La forma más común de transmisión de Legionella spp es la inhalación de aerosoles contaminados generados a partir de fuentes de agua artificiales. Se asocian con la aparición de brotes esporádicos y epidémicos en la comunidad y en infecciones nosocomiales. Las especies pertenecientes al género Legionella se consideran patógenos emergentes transmitidos por el agua. El objetivo de este trabajo es realizar una revisión sobre las manifestaciones y presentaciones clínicas de la infección causada por L. pneumophila, en virtud de que es considerado mundialmente un patógeno emergente y por existir evidencias de su presencia en sistemas de almacenamiento de agua tratada en la región nordeste de la República Argentina, razón primordial para alertar y actualizar conocimientos al respecto

Legionnaires' disease is caused by bacteria belonging to the genus Legionella, being the pneumophila specie the main etiological agent of this pathology. This bacterium was first described in 1977 as the cause of a severe pneumonia outbreak in 1976 at a convention center in the United States of America. The disease presents as an atypical pneumonia, responsible for 1% to 15% of cases of community-acquired pneumonia (CAP), 5% to 10% of pneumonia in adults and 1% in children under 15 years of age. Members of the Legionellaceae family are aerobic, gram-negative rods that grow slowly and are widely distributed in water bodies. The most common way of transmission of Legionella spp is the inhalation of contaminated aerosols generated from artificial water sources. They are associated with the appearance of sporadic and epidemic outbreaks in the community and in nosocomial infections. Species belonging to the genus Legionella are considered emerging waterborne pathogens.The aim of this work is to carry out a review on the manifestations and clinical presentations of the infection caused by L. pneumophila, due to that it is considered an emerging pathogen worldwide and because there is evidence of its presence in storage systems of treated water in the Northeast region of the Argentine Republic, primary reason to alert and update knowledge in this regard.

Caracterización del estado inmunometabólico de los pacientes con diagnóstico de pie diabético / Characterization of the immunometabolic status of patients with diagnosis of diabetic foot

Introducción: El pie diabético es una alteración clínica inducida por la hiperglucemia mantenida, con o sin isquemia y previo traumatismo, lesión y/o ulceración del pie. La hiperglucemia favorece las infecciones, pero no potencia el crecimiento bacteriano, lo que sugiere la participación del sistema inmune en esta susceptibilidad. Objetivo: Caracterizar el estado inmunometabólico de los pacientes con diagnóstico pie diabético. Métodos: Se realizó un estudio descriptivo de corte transversal en 25 pacientes ingresados con diagnóstico de pie diabético, entre septiembre y diciembre de 2018 en el Hospital Universitario "Manuel Ascunce Domenéch". Las variables estudiadas fueron: edad, sexo, formas clínicas de presentación del pie diabético, complementos 3 y 4, inmunoglobulinas G y A, y hemoglobina glucosilada. Se empleó la estadística descriptiva para el análisis de los datos. Resultados: El sexo femenino representó el 60 por ciento y los pacientes con más de 70 años el 40 por ciento. La inmunoglobulina G sérica se encontró disminuida en un 28 por ciento de los pacientes con pie diabético y aumentada en otro 28 por ciento. La hemoglobina glucosilada reflejó un desbalance en el 48 por ciento de los casos. De los pacientes con descontrol metabólico, 8 (32 por ciento) mostraron alteraciones de la inmunoglobulina G y 2 del componente C3. Conclusiones: Existió un grupo de pacientes con pie diabético que presentaron alteraciones inmunológicas variables y/o descontrol metabólico. Estos podrían beneficiarse con un manejo integral a partir del uso de inmunoterapia y la prevención de complicaciones infecciosas del pie diabético(AU)

Introduction: Diabetic foot is a clinic alteration induced by persistent hyperglycemias, with or without ischemia and previous trauma, lesion and/or ulceration of the foot. Hyperglycemia favours infections, but it does not increase the bacterial growth which suggests the participation of the immune system in this sensitivity. Objective: To characterize the immunometabolic status of patients with diagnosis of diabetic foot. Methods: It was carried out a descriptive, cross-sectional study in 25 patients hospitalized with diagnosis of diabetic foot among September and December, 2018 in "Manuel Ascunce Domenech" University Hospital. The studied variables were: age, sex, clinical forms of diabetic foot, complement 3 and 4, G and A, immunoglobulins and glycosylated hemoglobine. It was used descriptive statistic for data analysis. Results: Females represented the 60 percent and patients older than 70 years were the 40 percet. Seric G immunoglobulin was found as decreased in 28 percent of the patients with diabetic foot and increased in the 28 percent. Glycosylated hemoglobine presented unbalanced in 48 percent of the cases. From the patients with metabolic decontrol, 8 (32 percent) showed alterations of G immunoglobulin and 2 in the component C3. Conclusions: There was a group of patients with diabetic foot who presented variable immunological alterations and/or metabolic decontrol. Those patients can benefit with an integral management using immunotherapy and the prevention of infectious complications of the diabetic foot(AU)

Perfil microbiológico da colonização do sítio de inserção do cateter venoso central considerando dois curativos transparentes / Microbiological assessment of the colonization of a central venous catheter insertion site considering two transparent dressings

RESUMO: Modelo do Estudo: estudo transversal da fase prospectiva de um ensaio clínico. Objetivo: identificar os microrganismos e a sensibilidade antimicrobiana no sítio de inserção do cateter venoso central coberto pelo curativo gel de clorexidina ou pelo filme transparente de poliuretano. Metodologia: estudo transversal, descritivo, realizado com adultos críticos no período de abril a dezembro de 2014 em um hospital universitário no interior do estado de São Paulo. Imediatamente após a retirada do curativo, foi coletada amostra de swab da pele do sítio de inserção do cateter, semeado em placas de Agar sangue e Agar MacConkey e incubadas em estufas bacteriológicas a 35 °C. Nas amostras que apresen-taram crescimento bacteriano após 24 horas de incubação, foram realizados testes de sensibilidade aos antimicrobianos utilizando o equipamento automatizado Vitek II (Biomerieux®). Resultados: 45 pacientes fizeram uso do curativo gel de clorexidina e 47 utilizaram o filme transparente de poliuretano. No grupo com o curativo gel de clorexidina houve crescimento dos microrganismos Acinetobacter baumannii, Pseudomonas aeruginosa, Morganella morganii, Enterobacter cloacae, Staphylococcus aureus e Staphylococcus epidermidis em 13 amostras de swabs. O Staphylococcus aureusapresentou resistência a oxacilina. No grupo do filme transparente de poliuretano seis amostras foram positivas com o crescimento de Serratia marcescens, Acinetobacter baumannii, Staphylococcus epidermidis, Staphylococcus haemolyticus e Klebsiella pneumoniae, esta resistente a amicacina (Klebsiella pneumoniae carbapenemase - KPC). Conclusão: os resultados demonstram maior crescimento bacteriano no sítio de inserção do cateter venoso central coberto pelo curativo gel de clorexidina quando comparado ao filme transparente de poliuretano. (AU)

ABSTRACT: Study design: a prospective, cross-sectional study. Objectives: identify microbiological growth at the insertion site of the central venous catheter covered by a chlorhexidine impregnated dressing or a transparent polyurethane dressing, and identify antimicrobial sensitivity. Methods: immediately after dressing removal, a skin swab was collected from the catheter insertion site and seeded in blood agar plates and MacConkey agar, then incubated in bacteriological incubators at 35 °C. After 24 hours, the plates were analyzed to verify the presence of microbial growth. In the samples that displayed microbial growth, the identification and the sensitivity test were performed using the automated equipment Vitek II (Biomerieux®). Results: A total of 45 patients were treated with chlorhexidine impregnated dressing and 47 with transparent polyurethane dressing. In the chlorhexidine dressing group, 13 swabs samples presented with microbial growth of the following bacterial populations: Acinetobacter baumannii, Pseudomonas aeruginosa, Morganella morganii, Enterobacter cloacae, Staphylococcus aureus, and Staphylococcus epidermidis. Staphylococcus aureus presented resistance to oxacillin. In the transparent polyurethane dressing group, six samples were positive for the growth of Serratia marcescens, Acinetobacter baumannii, Staphylococcus epidermidis, Staphylococcus haemolyticus, and amikacin resistant Klebsiella pneumoniae (Klebsiella pneumoniaecarbapenemase - KPC). Conclusion: The results demonstrate higher bacterial growth in the chlorhexidine impregnated dressing compared to the transparent polyurethane dressing. (AU)

Análisis comparativo de la contaminación en barras de gutapercha / Comparative analysis of gutta-percha bar contamination

Se realizó una investigación analítica realizada in vitro en el laboratorio general del Hospital "Carlos Andrade Marín". La población estuvo compuesta por 20 barras de gutapercha marca Meta®Biomed (Korea), distribuidas en cuatro grupos compuestos por 5 barras atendiendo a características preestablecidas en cuanto a realización de termoplastificación y manipulación. Solo el 15% de las muestras se registró indicios de crecimiento bacteriano, de las que el 66,67% pertenecieron al grupo de barras sólidas de gutapercha que fueron manipuladas, estableciéndose diferencias significativas con respecto al resto de los grupos (p≤0.01), según la prueba de T-stu-dents. La mayoría de las muestras no mostró indicios de crecimiento bacteriano. Sin embargo, dos de las tres muestras que manifestaron esa actividad microbiológica pertenecieron al grupo de las barras sólidas de gutapercha que fueron manipuladas.

An in vitro analytical research was carried out in the general laboratory of the "Carlos Andrade Marín" Hospital. The population consisted of 20 bars of Meta®Biomed brand gutta-percha (Korea) distributed in four groups made up of 5 bars according to the pre-established characteristics in terms of thermoplasticization and handling. Only 15% of the selected samples showed signs of bacterial growth, of which 66.67% belonged to the group of solid gutta-percha bars that were manipulated, establishing specific differences with respect to the rest of the groups (p≤0.01), according to the T-students test. Most of the samples have no evidence of bacterial growth. However, two of the three samples that showed this microbiological activity belonged to the group of solid gutta-percha bars that were manipulated

Factores asociados a la presencia de valores alterados de calprotectina fecal en pacientes con estudio endoscópico panentérico normal / No disponible

INTRODUCCIÓN: la calprotectina fecal es un parámetro útil a la hora de decidir si un paciente se puede beneficiar de la realización de estudios endoscópicos. No obstante, cierto número de individuos sintomáticos y con cifras elevadas de este marcador no tendrán lesiones endoscópicas. El objetivo de este estudio es determinar qué factores se asocian a cifras alteradas de calprotectina fecal en pacientes con estudios endoscópicos de intestino delgado y colon normales. MÉTODOS: estudio prospectivo y observacional de pacientes con síntomas digestivos. Se ha analizado la asociación de diferentes variables con cifras alteradas de calprotectina y estudios endoscópicos (cápsula de intestino delgado y colonoscopia) negativos. RESULTADOS: se incluyen 143 pacientes (98 mujeres - 68,5 %), con una edad media 40,06 ± 16,42 (15-82) años. El consumo de tabaco y la toma de antiinflamatorios no esteroideos se asoció a la presencia de cifras alteradas de calprotectina y estudios endoscópicos negativos (p: 0,029 y p: 0,006). Los valores medios de calprotectina fecal fueron significativamente mayores entre los fumadores, consumidores de antiinflamatorios y pacientes con test positivo de sobrecrecimiento bacteriano de intestino delgado. El tabaquismo (OR: 3,505; p: 0,028), la toma de antiinflamatorios (OR: 3,473; p: 0,021) y el sobrecrecimiento bacteriano (OR: 3,172; p: 0,013) son factores de riesgo independientes para presentar una calprotectina alterada sin lesiones endoscópicas. No se obtuvo asociación con ninguna otra variable. CONCLUSIONES: el consumo de tabaco y de antiinflamatorios no esteroideos tiene una fuerte asociación con la presencia de valores elevados de calprotectina en ausencia de lesiones endoscópicas. Se ha observado también asociación con el sobrecrecimiento bacteriano de intestino delgado

No disponible

Antisepsis Techniques in Orthopedic Surgical Procedures: A Comparative Study / Técnicas de antissepsia em procedimentos cirúrgicos ortopédicos: Um estudo comparativo

Abstract Objective To compare antisepsis techniques using chlorhexidine-based soap associated with ethyl alcohol and alcohol-based chlorhexidine or chlorhexidine-based soap associated with alcohol-based chlorhexidine alone in surgical orthopedic procedures. Methods This is a primary, randomized, analytical and single-center clinical trial consisting of 170 patients, who were divided into 2 groups. The combinations chlorhexidine-based soap + alcohol-based chlorhexidine (CSAC) and chlorhexidine-based soap + 70% ethyl alcohol + alcohol-based chlorhexidine (CSAAC) were tested in each group. The cultures were grown in mannitol and eosin methylene blue (EMB) after collection before skin preparation (time point 0), after skin preparation (time point 1) and at the end of the surgical procedure (time point 2). Results There was no statistically significant difference regarding bacterial growth in mannitol and EMB between the groups at any time point. Moreover, there was no statistical difference between groups and time points regarding the type of bacterial growth in culture media. Conclusion There was no difference between these antisepsis techniques for the prevention of surgical site infection in orthopedic procedures; in addition, a protocol containing measures to prevent infection in such procedures was developed.

Resumo Objetivo Comparar as técnicas de antissepsia utilizando clorexidina degermante associada a álcool etílico e a clorexidina alcoólica versus clorexidina degermante associada a clorexidina alcoólica, em procedimentos cirúrgicos ortopédicos. Métodos Trata-se de um estudo clínico, primário, randomizado, analítico e de centro único, constituído por 170 pacientes ortopédicos submetidos a abordagem cirúrgica, alocados em 2 grupos aleatórios, nos quais foram testados clorexidina degermante + clorexidina alcoólica (grupo CDCA) e clorexidina degermante + álcool etílico a 70% + clorexidina alcoólica (grupo CDACA). Foram realizadas culturas nos meios manitol e eosina azul de metileno (EAM) de amostras colhidas nos períodos de pré-degermação (0), pós-degermação (1) e após a incisão suturada (2). Resultados Em relação ao crescimento bacteriano nos meios de cultura manitol e EAM entre os grupos, em cada período de estudo (0, 1 e 2), não ocorreu diferença estatística significativa nesta pesquisa. Na avaliação do tipo de crescimento bacteriano nos meios de cultura manitol e EAM, também não foi constatada significância estatística entre os grupos. Conclusão Não ocorreu diferença entre as técnicas utilizadas na antissepsia para prevenção de infecção de sítio cirúrgico em procedimentos ortopédicos, mas, ao final do trabalho, foi possível a elaboração de um protocolo de medidas para realização de prevenção infecciosa nesses procedimentos.

Influence of lipids and proteins amounts and pH values on the inhibitory effects of Origanum vulgare L. essential oil against Escherichia coli and Salmonella Typhimurium

Origanum vulgare L. (OVEO) essential oil has been considered a candidate antimicrobial for use in food conservation systems. However, studies on the influence of concomitant variations of different food components or physicochemical parameters on the antibacterial properties of OVEO are scarce. This study assessed the influence of concomitant variations in amounts of proteins - PTN (4.0, 6.0 or 8.0 g/100 mL) and lipids - LIP (3.75, 5.0 or 6.25 g/100 mL) and pH values (5.0, 5.5 or 6.0) in cultivation medium on the inhibitory effects of OVEO against Escherichia coli (EC) and Salmonella Typhimurium (ST). Lowest minimum inhibitory concentration values of OVEO against EC and ST were observed in media with the highest LIP amounts regardless the PTN amount and pH value. In absorbance based microtiter plate assay (MPA), for both EC and ST, OVEO caused the lowest Grmax values in medium containing the highest LIP and PTN amounts and lowest pH value. Highest Grmax values for EC and ST were observed in medium containing the lowest LIP and PTN amount and highest pH value. Grmax values estimated from viable counts of EC and ST in tested media with OVEO confirmed bacterial growth behavior similar to that observed in MPA. Overall, the LIP amount in media was as the most influential factor to enhance the antibacterial effects of OVEO. These results indicate that the concomitant influence of LIP and PTN amounts and pH values on the antibacterial effects of OVEO should be considered for optimizing its antimicrobial efficacy in foods.

Inhibición de Streptococcus mutans aislado de cavidad oral de niños sin caries mediante sustancia antagónica producida por Lactobacillus spp / Inibição do Streptococcus mutans isolado da cavidade oral de crianças sem cárie por substância antagônica produzida por Lactobacillus spp / Streptococcus mutans inhibition by antagonistic substance produced by Lactobacillus spp isolated from oral cavity in children without caries

La caries es considerada todavía una de las enfermedades más prevalentes del mundo. Por este motivo, diversas estrategias de prevención se han desarrollado en los últimos años con el propósito de controlar esta enfermedad. Diferentes especies bacterianas de la microbiota normal de la cavidad oral producen sustancias antagónicas antibacterianas. Objetivo: El objetivo de este trabajo fue identificar alguna especie del género Lactobacillus productor de sustancias antagónicas contra Streptococcus mutans a partir de saliva de niños con y sin caries. Materiales y métodos: Se aislaron desde saliva de 60 niños con caries, sin caries activa (rehabilitados) y libres de caries, diferentes cepas de Lactobacillus a las cuales se les estudió su capacidad antagónica contra cepas de Streptococcus mutans , mediante ensayos en doble capa, test del pocillo y sobre crecimiento bacteriano. Resultados: Las cepas que elaboran sustancias con mayor capacidad antagónica fueron identificadas como Lactobacillus fermentum mediante Api test 50 CH. Conclusión: Se demostró que Lactobacillus fermentum está presente en mayor porcentaje en el grupo de niños sin caries, lo cual podría sugerir un efecto natural de control biológico en la cavidad oral de este grupo de niños.

A cárie dentária ainda é considerada uma das doenças mais prevalentes no mundo. Por esta razão, várias estratégias de prevenção foram desenvolvidas nos últimos anos com o objetivo de controlar esta doença. Diferentes espécies bacterianas da microbiota normal da cavidade oral produzem substâncias antagonistas antibacterianas. Objetivo:O objetivo deste estudo foi identificar algumas espécies do gênero Lactobacillus produtoras de substâncias antagonistas contra Streptococcus mutans da saliva de crianças com e sem cárie. Materiais e Métodos: Foram isolados a partir da saliva de 60 crianças com cavidades, sem cavidades ativas (restaurada) e livre de lesões de cárie, diferentes tipos de Lactobacillus que foram estudados pela sua capacidade antagonista contra Streptococcus mutans, por testes camada dupla e bem sobre o crescimento bacteriano. Resultados: As cepas que elaboraram substâncias com maior capacidade antagônica foram identificadas como Lactobacillus fermentum pelo teste Api 50 CH. Conclusões: Foi demonstrado que o Lactobacillus fermentum está presente em maior porcentagem no grupo de crianças sem cárie, o que poderia sugerir um efeito natural do controle biológico na cavidade bucal desse grupo de crianças

Caries is still considered one of the most prevalent diseases worldwide. For this reason, in recent years various prevention strategies have been developed with the purpose of managing this disease. Different oral cavity bacterial species part of the normal microbiota produce antibacterial antagonistic substances. Objective: The objective of this study was to identify some species of Lactobacillus genus that produce antagonistic substances against Streptococcus mutans from saliva of children with and without caries. Materials and methods: Different Lactobacillus strains were isolated from saliva of 60 children with caries, without active decay (rehabilitated) and free of caries. The antagonistic capacity against strains of Streptococcus mutans was studied, by means of tests in double layer, test of the well and about bacterial growth Results: Lactobacillus strains that produced substances with greater antagonistic capacity were identified as Lactobacillus fermentum by Api test 50 CH. Conclusions: It was found that Lactobacillus fermentum is present in a larger percentage among children without caries which could suggest a natural biological control effect by this bacterial strain.

Sérum anidro fluido como veículo para formulações de drug delivery: resultados do teste de esterilidade para crescimento bacteriano e fúngico / Anhydrous fluid serum as vehicle for drug delivery formulations: sterility test results for bacterial and fungal growth

Introdução: A entrega tópica de medicamentos é essencial na Dermatologia. Devido à dificuldade de permeação do estrato córneo, as técnicas de drug delivery vêm recebendo destaque. O uso de formulações não específicas para este fim nos faz atentar para possíveis efeitos adversos e para a segurança microbiológica destas formulações. Objetivo: Avaliar crescimento bacteriano e fúngico no sérum anidro fluido por meio do teste de esterilidade simples. Materiais e métodos: O teste de esterilidade simples foi realizado em um sérum anidro contendo ativos lipofílicos e hidrofílicos. Este teste foi realizado três meses após a manufatura do produto. Resultados: A formulação estudada foi aprovada no teste de esterilidade simples realizado três meses após a manufatura do produto, mesmo sem uso de conservantes na formulação. A formulação em estudo foi aprovada no teste de esterilidade possivelmente devido ao fato de o veículo sérum ser de origem mineral e anidra, características que não favorecem a proliferação de micro-organismos. Conclusões: Embora somente o veículo contando ativos específicos tenha sido testado, os resultados deste estudo são promissores e demonstram a necessidade de estudos futuros que englobem de forma mais ampla o assunto.

Introduction: Topical delivery of drugs is essential in Dermatology. Due to the difficulty of permeation of the stratum corneum, drug delivery techniques have been highlighted. The use of non-specific formulations for this purpose makes raises the concern of possible adverse events and the microbiological safety of these formulations. Objective: To assess bacterial and fungal growth in anhydrous fluid serum through simple sterility test. Materials and methods: The simple sterility test was performed on an anhydrous serum containing lipophilic and hydrophilic active substances. This test was performed three months after the manufacture of the product. Results: The formulation studied was approved in the simple sterility test conducted three months after the manufacture of the product, even without the use of preservatives in the formulation. Discussion: The assessed formulation was approved in the sterility test possibly due to the fact that the serum vehicle has mineral and anhydrous origin, characteristics that do not favor the proliferation of microorganisms. Conclusions: Although only the vehicle counting specific assets has been tested, the results of this study are promising and demonstrate the need for future studies broadly encompassing this subject.

Análise comparativa da técnica de baciloscopia no diagnósticoda tuberculose pulmonar frente ao GeneXpert em amostras depacientes da cidade de Recife, Pernambuco / Comparative analysis of the bacilloscopy technique in the diagnosis of pulmonary tuberculosis against GeneXpert in samples of patients in the city of Recife, Pernambuco

Objetivo: Considerando que atualmente ainda existem algumas limitações quanto à escolha do teste ideal para diagnóstico da TB, ligadas principalmente aos custos e realização adequada das técnicas, o presente estudo teve por objetivo verificar a eficácia do teste de baciloscopia no diagnóstico da tuberculose pulmonar, a partir da comparação dos resultados obtidos através dos testes de baciloscopia e GeneXpert de pacientes da cidade de Recife-PE. Métodos: Foram analisadas neste estudo amostras de escarro com os resultados já positivos para TB através da cultura microbiológica. As espécimes foram submetidas ainda aos testes de baciloscopia e GeneXpert para uma análise comparativa dos resultados. Resultados: Foi analisado um total de 100 amostras, com positividade para todos os testes realizados no estudo (cultura microbiológica, GeneXpert e baciloscopia). Conclusão: O diagnóstico através do GeneXpert representa um ganho expressivo quando levado em conta sua sensibilidade, rapidez e confiabilidade dos resultados, em contrapartida, os custos para realização deste teste ainda são elevados. Este fato reforça a importância das metodologias convencionais de baciloscopia e cultura, quando utilizadas dentro dos parâmetros de controle de qualidade adequados.

Objective: Considering that currently there are still some limitations regarding the choice of the ideal test for diagnosis of TB, related mainly to costs and adequate performance of the techniques, the present study aimed to verify the efficacy of the bacilloscopy test in the diagnosis of pulmonary tuberculosis, based on the comparison of the results obtained through the bacilloscopy and GeneXpert tests of patients from the city of Recife-PE. Methods: Sputum samples with already positive results for TB were analyzed in this study through the microbiological culture. The specimens were also submitted to bacilloscopy and GeneXpert tests for a comparative analysis of the results. Results: A total of 100 samples were analyzed, with positivity for all tests performed in the study (microbiological culture, GeneXpert and smear microscopy). Conclusion: The diagnosis through GeneXpert represents an expressive gain when taking into account its sensitivity, speed and reliability of results, in contrast, the costs to perform this test are still high. This fact reinforces the importance of conventional bacilloscopy and culture methodologies when used within the appropriate quality control parameters

Evidencia molecular de la ocurrencia de bacterias celulolíticas del género Cohnella en especies neotropicales de Nasutitermitinae colectadas en el NEA / Molecular evidence that cellulolytic bacterial genus Cohnella is widespread among Neotropical Nasutitermitinae from NE Argentina

Cohnella is a highly cellulolytic bacterial genus, which can be found in a variety of habitats. The aim of this study was to assess its presence in the digestive tract of termite species collected in North-eastern Argentina: Nasutitermes aquilinus, N. corniger and Cortaritermes fulviceps. Gut homogenates were incubated with cellulosic substrate for bacterial growth. Bacterial 16S rDNA was partially amplified using new primers for Cohnella spp. and cloned. Sequences obtained showed highest similarity (97.2-99.9%) with those of Cohnella spp. previously reported from diverse environments. Phylogenetic analysis tended to group the clones according to their host species and sampling sites. These results indicate the association of Cohnella-related intestinal symbionts with three common Neotropical termites. Their potential industrial application encourages further research.

Cohnella es un género de bacterias celulolíticas que puede ser encontrado en una variedad de hábitats. El propósito de este estudio fue registrar su presencia en el tracto digestivo de termitas (Nasutitermes aquilinus, N. corniger y Cortaritermes fulviceps) colectadas en el noreste argentino (NEA). Se incubaron homogenados de intestinos en sustrato celulósico para multiplicar las bacterias. Utilizando nuevos cebadores para Cohnella spp., se amplificó una porción del ADN ribosomal 16S bacteriano, el cual fue posteriormente clonado. Las secuencias obtenidas mostraron su mayor porcentaje de similitud (97,2-99,9%) con Cohnella spp., previamente reportadas en diversos ambientes. El análisis filogenético tendió a agrupar a los clones de acuerdo a la especie hospedante y al sitio de muestreo. Estos resultados indican que especies de termitas frecuentes en el NEA albergan simbiontes intestinales relacionados con el género Cohnella. Las potenciales aplicaciones industriales de estos microorganismos animan a profundizar los estudios.

Evaluación económica de la implantación del autoanalizador Alfred 60/AST de detección de crecimiento bacteriano con sembrador automático / Economic evaluation of the Alfred 60/AST device implantation for bacterial growth detection with automatic sewing machine

Introducción: En los laboratorios de microbiología se impone cada vez más utilizar sistemas de cribado automatizados para descartar las orinas negativas. Nuestro objetivo fue estimar el umbral presupuestario a partir del cual el autoanalizador Alfred-60/AST sería rentable para nuestro hospital. Material y métodos: Estudio de minimización de costes mediante árboles de decisión, realizado en un Hospital General. Se comparó el coste del urocultivo tradicional con el procesamiento automático mediante Alfred-60/AST. El procesamiento tradicional supone el cultivo manual de todas las orinas recibidas en agar sangre y MacConkey e identificación de todos los microorganismos aislados con el sistema Vitek-2. El autoanalizador sembraría solo las orinas positivas en un medio cromogénico que identificaría directamente los aislamientos de Escherichia coli. Resultados: Las variables con mayor impacto económico en el modelo fueron la probabilidad de obtener un cultivo positivo, la prevalencia de E. coli en los urocultivos y el coste por muestra del sembrador. El análisis de sensibilidad multivariante mostró que el modelo es sólido. El análisis de sensibilidad bivariable mostró que el modelo es sensible a la modificación de los costes, principalmente del sembrador automático. A un valor umbral de 1,40 euros por determinación, el procesamiento automático reduciría los costes anuales en 2.879 euros. Conclusión: La introducción del autoanalizador Alfred-60/AST en nuestro laboratorio a un precio de 1,40 euros por determinación reduciría la carga de trabajo en el procesamiento de orinas, ahorrando tiempo y costes

Introduction: It is becoming increasingly necessary to automatize screening of urine samples to culture at Microbiology laboratories. Our objective was to estimate the budget threshold from which the Alfred 60/AST device would be profitable for our hospital. Material and methods: Cost minimization study by decision trees, carried out in a General Hospital. The cost of traditional urine culture and urine processing using Alfred-60/AST were compared. Traditional processing involves the culture of all urine specimens received onto blood and MacConkey agar, and identification of every microorganism isolated by Vitek-2 system. The autoanalyzer would only inoculate the positive urines onto a chromogenic media, directly identifying the Escherichia coli isolates. Results: The variables with the greatest economic impact in the model were the probability of obtaining a positive culture, the prevalence of E. coli in the urine cultures and the cost per sample using Alfred-60/AST. The multivariate sensitivity analysis showed that the model was solid. The bivariate sensitivity analysis showed that the model is suceptible to cost modification, mainly of the automatic device. At a threshold value of 1.40 euros/determination, the automatic processing would decrease the annual costs in 2,879 euros. Conclusion: The introduction of the Alfred-60/AST device in our laboratory at 1.40 euros/determination would reduce urine processing workload, saving time and costs

Ehrlichiosis monocítica humana y babesiosis en Venezuela / Human monocytic ehrlichiosis and babesiosis in Venezuela

Resumen La babesiosis o "Fiebre de garrapatas" es una enfermedad febril y anemizante, producida en animales domésticos y salvajes y ocasionalmente en humanos por especies del genero Babesia, las cuales son protozoarios intraeritrocíticos. Se denomina ehrlichiosis y anaplasmosis a un grupo de infecciones bacterianas transmitidas por garrapatas duras (Ixodidae), que afectan al ser humano y a los animales. Son de distribución universal, y están relacionadas con varias especies de los géneros Anaplasma y Ehrlichia (familia Anaplasmataceae). La fiebre de origen desconocido en pacientes con historia de viajes a zonas endémicas de Ixodes resulta con alto índice de sospecha para la búsqueda de infecciones por Babesia, Borrelia y Ehrliquia, ya que pueden ocurrir simultáneamente, particularmente con estos dos últimos géneros. Se reporta un caso de paciente femenina de 49 años de edad, procedente de Tumeremo estado Bolívar, ocupación minera, quien consultó por fiebre con escalofríos, cefalea y mialgias predominantes en miembros inferiores. Ingresó a Terapia intensiva por cuadro de distres respiratorio y shock séptico. Se descartó malaria por gota gruesa seriada negativas, el hemocultivo y urocultivo reportaron ausencia de crecimiento bacteriano. Se realizó frotis de capa blanca siendo positiva para Ehrliquia monocítica y Babesia bigemina. La paciente evolucionó satisfactoriamente luego del tratamiento con Doxiciclina, clindamicina más meropenem. El fin de este reporte es concientizar a la comunidad médica de la existencia de la ehrlichiosis como entidad clínica emergente en nuestro país y la posibilidad de coexistir con otros microorganismos que comparten el mismo vector, con el fin de considerar tratamiento empírico oportuno en pacientes con factores de riesgo en las zonas rurales.

Abstract Babesiosis or "Tick fever" is a feverish and anemic disease, produced in domestic and wild animals and occasionally in humans by species of the genus Babesia, which are intra-erythrocytic protozoans. Ehrlichiosis and anaplasmosis are called a group of bacterial infections transmitted by hard ticks (Ixodidae), which affect humans and animals. They are of universal distribution, and are related to several species of the genera Anaplasma and Ehrlichia (family Anaplasmataceae). Fever of unknown origin in patients with a history of travel to endemic areas of Ixodes results in a high index of suspicion for the search for Babesia, Borrelia and Ehrliquia infections, since they can occur simultaneously, particularly with these last two genera. We report a case of female patient, 49 years old, from Tumeremo Bolívar state, mining occupation, who consulted for fever with chills, headache and myalgias predominant in lower limbs. He entered intensive therapy for respiratory distress and septic shock. Malaria was ruled out by gross negative strains, blood culture and urine culture showed no bacterial growth. White-coat smears were positive for monocytic Ehrliquia and Babesia bigemina. The patient progressed satisfactorily after treatment with Doxycycline, clindamycin plus meropenem. The purpose of this report is to make the medical community aware of the existence of ehrlichiosis as an emerging clinical entity in our country and the possibility of coexisting with other microorganisms that share the same vector in order to consider timely empirical treatment in patients with factors risk in rural areas.