Formes de presentació clínica de les infeccions causades per Streptococcus pyogenes / Formas de presentación clínica de las infecciones causadas por Streptococcus pyogenes / Clinical presenting features of infections caused by Streptococcus pyogenes

Fonament. L’Streptococcus pyogenes és un bacteri causantde diverses i freqüents infeccions en infants, en la majoriade casos lleus, si bé pot causar infeccions invasives quesuposen un risc vital. Des de setembre de 2022 s’ha detectat un increment important de la incidència d’infeccionsper aquest bacteri, i se n’han registrat diversos casos mortals en poc temps. Malgrat que pot causar patologia greu,és sensible a la penicil·lina i altres ß-lactàmics en el 100% dels casos. El diagnòstic precoç és essencial per establir-neel tractament adequat i millorar-ne el pronòstic. Objectiu. Fer una revisió de les formes de presentació clínica de la infecció per Streptococcus pyogenes, els factors de risc i els signes d’alarma d’infecció greu. Mètode. Revisió bibliogràfica. Resultats. Es descriuen les formes de presentació clínicamés importants de la infecció per Streptococcus pyogenes,tant invasives com no invasives. Es defineixen com a formes invasives les que presenten l’aïllament del bacteri en una localització estèril. Es descriuen els diferents factors de riscde presentar formes més greus i amb evolució més tòrpida. Conclusions. La situació epidemiològica actual posa de manifest la necessitat que el pediatre mantingui un nivell altde sospita clínica i conegui totes les formes de presentació de la infecció, així com els factors de risc que fan sospitar d’una evolució a malaltia greu. El tractament antibiòtic precoç i correcte és l’eina principal per al maneig d’aquestes infeccions. La possibilitat de presentacions d’evolució fulminant en infants sans requereix d’un sistema de vigilància epidemiològica que en permeti la identificació i la definició. (AU)

Fundamento. Streptococcus pyogenes es una bacteria causante dediversas y frecuentes infecciones en niños, leves en la mayoría decasos, si bien puede causar infecciones invasivas que suponen un riesgo vital. Desde septiembre de 2022 se ha detectado un incremento importante de la incidencia de infecciones por esta bacteria, y se han registrado varios casos mortales en poco tiempo. Aunque puede causar patología severa, es sensible a penicilina yotros ß-lactámicos en el 100% de los casos. El diagnóstico precozes esencial para establecer su tratamiento adecuado y mejorar supronóstico. Objetivo. Realizar una revisión de las formas de presentación clínica de la infección por Streptococcus pyogenes, los factores deriesgo y los signos de alarma de infección grave. Método. Revisión bibliográfica. Resultados. Se describen las formas de presentación clínica más importantes de la infección por Streptococcus pyogenes, tanto invasivas como no invasivas. Se definen como formas invasivas aquellas que presentan el aislamiento de la bacteria en una localización estéril. Se describen los distintos factores de riesgo depresentar formas más graves y con evolución más tórpida. Conclusiones. La situación epidemiológica actual pone de manifiesto la necesidad de que el pediatra mantenga un nivel alto desospecha clínica y conozca todas las formas de presentación de la infección, así como los factores de riesgo que hacen sospechar deuna evolución a enfermedad grave. El tratamiento antibiótico precoz y correcto es la principal herramienta para el manejo de estas infecciones. La posibilidad de presentaciones de evolución fulminante en niños sanos requiere de un sistema de vigilancia epidemiológica que permita su identificación y definición. (AU)

Background. Streptococcus pyogenes is a bacterium that causesfrequent and very diverse infections in children. Although they aremild in most cases, Streptococcus pyogenes can also cause lifethreatening invasive infections. A significant increase in the incidence of Streptococcus pyogenes infections has been seen sinceSeptember 2022, with several fatal cases being reported in a short period of time. Although this bacterium can cause severe pathology, it is sensitive to penicillin and other ß-lactam antibiotics in100% of the cases. Early diagnosis is essential to establish itsproper treatment and improve its prognosis. Objective. To review the different clinical presentations of the Streptococcus pyogenes infection, its risk factors, and the warning signs of severe infection. Method. Bibliographic review. Results. We describe the most important clinical presentations of Streptococcus pyogenes infection, both invasive and non-invasive. Invasive infections are defined by the isolation of Streptococcus pyogenes from a normally sterile site. The risk factors for presenting a more severe or torpid evolution are described. Conclusions. The current epidemiological situation highlights theneed for pediatricians to have a high index of clinical suspicionand to be aware of all the presenting forms of the infection, as wellas the risk factors related to bad prognosis or adverse evolution. Early and correct antibiotic treatment is the main tool for managing these infections. The possibility of a sudden and fatal presentation in previously healthy children requires an epidemiological surveillance system to identify and define these cases. (AU)

Mucormicosis asociada a COVID-19: revisión de la literatura para odontólogos / COVID-19 associated mucormycosis: a literature review for dentists

La mucormicosis es una infección fúngica rara, con alta morbilidad y mortalidad. Se presenta principalmente en pa- cientes con diabetes mellitus no controlada, inmunocompro- metidos, con tratamiento crónicos con esteroides, entre otros. Actualmente, se cree que la pandemia de COVID-19 y los tratamientos con corticosteroides podrían estar implicados en el aumento de casos de esta micosis. Este hongo invade el sistema vascular, ocluyendo el flujo sanguíneo arterial y generando una rápida trombosis e isque- mia, lo que provoca la necrosis de los tejidos duros y blandos, con invasión rápida a los tejidos circundantes. Hay varias formas clínicas. En la cavidad bucal se presenta la variante rino-orbito-cerebral, que afecta el paladar en forma de lesión eritematosa o grisácea que puede progresar hacia la formación de una masa necrótica o ulceración con muy escaso sangrado de mucosa. Se manifiesta con síntomas típicos de una rinosinusitis con fiebre y dolor en las piezas dentarias superiores. El tratamiento consta de tres pilares fundamentales: el diagnóstico, un manejo adecuado de las comorbilidades y la combinación de las terapias antifúngica y quirúrgica. Desde el año 2020, la mucormicosis asociada a COVID-19 pasó a ser un evento de notificación obligatoria inmediata al Sistema Nacional de Vigilancia de la Salud (SNVS2.0) me- diante el Sistema Integrado de Información Sanitaria Argen- tina (SISA). Es importante destacar que se han reportado casos de mu- cormicosis luego de extracciones dentales; lo que impulsa a afianzar los conocimientos sobre esta enfermedad, extremar las medidas preventivas e incentivar el diagnóstico precoz en la atención odontológica, debido a la rapidez en la evolución de la patología (AU))

Mucormycosis is a rare fungal infection, with high mor- bidity and mortality. It occurs mainly in patients with uncon- trolled diabetes mellitus, immunocompromised, on chronic treatment with steroids, among others. Currently, it is believed that the COVID-19 pandemic and the corticosteroid treatments could be one of the causes of increased cases. This fungus invades the vascular system, occluding arteri- al blood flow and generating rapid thrombosis and ischemia, which causes necrosis of hard and soft tissues, with rapid in- vasion to the surrounding tissues. There are several clinical forms. In the oral cavity, the rhino-orbito-cerebral variant presents itself affecting the pal- ate in the form of an erythematous or grayish lesion that can progress towards the formation of a necrotic mass or ulcera- tion with very little mucosal bleeding. It manifests itself with typical symptoms of rhinosinusitis, with fever and pain in the upper teeth. The treatment consists of three fundamental pillars: diag- nosis, proper management of comorbidities and the combina- tion of antifungal and surgical therapies. Since 2020, COVID-19 associated mucormycosis became an event of mandatory immediate notification to the National Health Surveillance System (SNVS2.0,) through the Argentina Integrated Health Information System (SISA). It is important to emphasize that mucormycosis cases had been reported following tooth extractions, which drives to strengthen knowledge about this disease, extreme preventive measures and encourage early diagnosis in dental care, due to the speed of the evolution of the pathology (AU))

Differential Impact of Nonpharmaceutical Interventions on the Epidemiology of Invasive Bacterial Infections in Children During the Coronavirus Disease 2019 Pandemic.

BACKGROUND: Invasive bacterial infection (IBI) remains a major burden of mortality and morbidity in children. As coronavirus disease 2019 (COVID-19) emerged, stringent nonpharmaceutical interventions (NPIs) were applied worldwide. This study aimed to evaluate the impact of NPIs on pediatric IBI in Korea. METHODS: From January 2018 to December 2020, surveillance for pediatric IBIs caused by 9 pathogens (S. pneumoniae, H. influenzae, N. meningitidis, S. agalactiae, S. pyogenes, S. aureus, Salmonella species, L. monocytogenes and E. coli) was performed at 22 hospitals throughout Korea. Annual incidence rates were compared before and after the COVID-19 pandemic. RESULTS: A total of 651 cases were identified and the annual incidence was 194.0 cases per 100,000 in-patients in 2018, 170.0 in 2019 and 172.4 in 2020. Most common pathogen by age group was S. agalactiae in infants < 3 months (n = 129, 46.7%), S. aureus in 3 to < 24 months (n = 35, 37.2%), Salmonella spp. in 24 to < 60 months (n = 24, 34.8%) and S. aureus in children ≥ 5 years (n = 128, 60.7%). Compared with 2018 to 2019, the incidence rate in 2020 decreased by 57% for invasive pneumococcal disease (26.6 vs. 11.5 per 100,000 in-patients, P = 0.014) and 59% for Salmonella spp. infection (22.8 vs. 9.4 per 100,000 in-patients, P = 0.018). In contrast, no significant changes were observed in invasive infections due to S. aureus, S. agalactiae and E. coli. CONCLUSIONS: The NPIs implemented during the COVID-19 pandemic reduced invasive diseases caused by S. pneumoniae and Salmonella spp. but not S. aureus, S. agalactiae and E. coli in children.

A worldwide systematic review and meta-analysis of bacteria related to antibiotic-associated diarrhea in hospitalized patients.

INTRODUCTION: Antibiotic-associated diarrhea (AAD) is a major hospital problem and a common adverse effect of antibiotic treatment. The aim of this study was to investigate the prevalence of the most important bacteria that cause AAD in hospitalized patients. MATERIALS AND METHODS: PubMed, Web of Science and Scopus databases were searched using multiple relevant keywords and screening carried out based on inclusion/exclusion criteria from March 2001 to October 2021. The random-effects model was used to conduct the meta-analysis. RESULTS: Of the 7,377 identified articles, 56 met the inclusion criteria. Pooling all studies, the prevalence of Clostridioides (Clostridium) difficile, Clostridium perfringens, Klebsiella oxytoca, and Staphylococcus aureus as AAD-related bacteria among hospitalized patients were 19.6%, 14.9%, 27%, and 5.2%, respectively. The prevalence of all four bacteria was higher in Europe compared to other continents. The highest resistance of C. difficile was estimated to ciprofloxacin and the lowest resistances were reported to chloramphenicol, vancomycin, and metronidazole. There was no or little data on antibiotic resistance of other bacteria. CONCLUSIONS: The results of this study emphasize the need for a surveillance program, as well as timely public and hospital health measures in order to control and treat AAD infections.

Kawasaki Disease Patient Stratification and Pathway Analysis Based on Host Transcriptomic and Proteomic Profiles.

The aetiology of Kawasaki disease (KD), an acute inflammatory disorder of childhood, remains unknown despite various triggers of KD having been proposed. Host 'omic profiles offer insights into the host response to infection and inflammation, with the interrogation of multiple 'omic levels in parallel providing a more comprehensive picture. We used differential abundance analysis, pathway analysis, clustering, and classification techniques to explore whether the host response in KD is more similar to the response to bacterial or viral infections at the transcriptomic and proteomic levels through comparison of 'omic profiles from children with KD to those with bacterial and viral infections. Pathways activated in patients with KD included those involved in anti-viral and anti-bacterial responses. Unsupervised clustering showed that the majority of KD patients clustered with bacterial patients on both 'omic levels, whilst application of diagnostic signatures specific for bacterial and viral infections revealed that many transcriptomic KD samples had low probabilities of having bacterial or viral infections, suggesting that KD may be triggered by a different process not typical of either common bacterial or viral infections. Clustering based on the transcriptomic and proteomic responses during KD revealed three clusters of KD patients on both 'omic levels, suggesting heterogeneity within the inflammatory response during KD. The observed heterogeneity may reflect differences in the host response to a common trigger, or variation dependent on different triggers of the condition.

Peryton: a manual collection of experimentally supported microbe-disease associations.

We present Peryton (https://dianalab.e-ce.uth.gr/peryton/), a database of experimentally supported microbe-disease associations. Its first version constitutes a novel resource hosting more than 7900 entries linking 43 diseases with 1396 microorganisms. Peryton's content is exclusively sustained by manual curation of biomedical articles. Diseases and microorganisms are provided in a systematic, standardized manner using reference resources to create database dictionaries. Information about the experimental design, study cohorts and the applied high- or low-throughput techniques is meticulously annotated and catered to users. Several functionalities are provided to enhance user experience and enable ingenious use of Peryton. One or more microorganisms and/or diseases can be queried at the same time. Advanced filtering options and direct text-based filtering of results enable refinement of returned information and the conducting of tailored queries suitable to different research questions. Peryton also provides interactive visualizations to effectively capture different aspects of its content and results can be directly downloaded for local storage and downstream analyses. Peryton will serve as a valuable source, enabling scientists of microbe-related disease fields to form novel hypotheses but, equally importantly, to assist in cross-validation of findings.

Late-onset Neonatal Infections 1997 to 2017 Within a Cohort in Western Sweden-The Last 21 Years of a 43-Year Surveillance.

BACKGROUND: The objective of the study was to assess the epidemiology of late-onset (LO) neonatal invasive infections with surveillance covering 43 years, starting from 1975. METHODS: Observational epidemiologic, retrospective study including a cohort of infants born in western Sweden in 1997-2017, who had a positive blood and cerebral spinal fluid culture between 3 and 120 days of age. A comparison was made of the incidence between 1997-2007 and 2008-2017. Data on LO infections during 3-27 days of life were assessed from 1975. RESULTS: A total of 473 cases of LO infections were registered in 437 patients. The incidence increased from 2.0 to 3.1/1000 live births (LB) between 1997-2007 and 2008-2017 (P < 0.001). The increase in incidence was most pronounced among infants born <28 weeks gestation (from 255 to 398/1000 LB, P < 0.001). The most frequent pathogens were Staphylococcus aureus (25%), coagulase-negative staphylococci (17%), and Escherichia coli (13%). Infections due to group B Streptococci rose from 0.16/1000 LB to 0.33 (P = 0.03). During the whole surveillance period from 1975 to 2017, there were 579 cases between 3 and 27 days of life. Although the incidence increased in 2008-2017 to 1.9/1000 LB after first declining in 1997-2007, the case-fatality rate continued to decline from 27/284 (9.5%) between 1975 and 1996 to 6/182 (3.3%) in 2008 and 2017 (P = 0.01). CONCLUSIONS: The incidence of LO neonatal invasive infections increased during the study period (1997-2017), but the case-fatality rate remained lower than in the previous surveillance period (1975-1996). Further surveillance and interventions with focus on prevention is critical to counteract the increasing incidence among high-risk infants.

Gallbladder stone formation in Iraqi patients is associated with bacterial infection and HLA class II-DRB1 antigens.

BACKGROUND: Gallbladder stone is recently increased among the Iraqi society due to many risk factors such as bacterial infection and some HLA class II antigens. AIM(S): This study investigates the types of bacterial infection and HLA-DRB1 antigens' ratio that may be correlated with gallbladder stone formation. Setting and Design: The study included 45 patients and the same number of healthy individuals as a control group. Patients were with multiple gallstones. Gallstone bacterial culture was demonstrated to diagnose viable bacteria. HLA-DRB1 alleles' frequency was investigated using sequence-specific oligonucleotide probes (PCR-SSOP). RESULTS: Irrespective of gallstone type and size, different types of living viable bacteria were isolated from the cores of the studied gallstones in 80% of the studied cases versus 20% of sterile gallstones. Gram-negative bacteria cultures were the dominant (89.3%), including Escherichia coli, Klebsiella spp., Proteus spp., Acinetobacter spp., and Enterobacter spp. Mixed infection of Gram-positive and negative bacteria was noted: Escherichia coli and Enterococus spp. and the others of Escherichia coli and Acitobacter spp., and Klebsiella spp. and Pseudomonas spp. Gram-positive bacteria cultures were also detected at lower rate (10.7%) including Staphylococci spp. The frequency of HLA-DRB1*03:01, HLA-DRB1*4:03, HLA-DRB1*13:22, and HLA-DRB1*15:10 alleles was significantly elevated in patients compared to the healthy control group. CONCLUSION: Results ensured the viability of the bacteria isolated from the core of gallstones and showed positive correlation between gallbladder stone and different bacterial infection. In addition, HLA-DRB1 alleles were significantly high in patients compared to healthy control group suggesting them as risk factors (P < 0.05).

Causes of swine polyserositis in a high-density breeding area in Italy.

We assessed the causes of polyserositis in pigs, categorized by causative agents and ages of animals affected. In a 3-y study, 246 pigs from 80 different farms with recurrent problems of polyserositis, in a high-density breeding area, were submitted for autopsy; 154 pigs with typical fibrinous serosal lesions were sampled for further bacterial and viral investigation. The most common gross lesions were pleuritis and pericarditis (141 of 154; 92%). The animals most affected were weaned pigs (139 of 154; 90%). Haemophilus parasuis and Mycoplasma hyorhinis were the most common bacteria detected and were present at the same rate (85 of 154; 55%). Other bacteria isolated were Streptococcus sp. (44 of 154; 29%), Pasteurella multocida (21 of 154; 14%), Escherichia coli (19 of 154; 12%), Actinobacillus pleuropneumoniae (7 of 154; 5%), and Trueperella pyogenes (4 of 154; 3%). Porcine reproductive and respiratory syndrome virus (PRRSV; 119 of 154; 77%) predominated among the viruses detected, followed, with lesser prevalence, by porcine circovirus 2 (40 of 154; 26%) and swine influenza A virus (19 of 154; 12%). Bacterial coinfection and coinfection of bacteria and viruses were common (128 of 154; 83%). A strong positive correlation was found between coinfection by H. parasuis and M. hyorhinis and also by H. parasuis with PRRSV.

Comparison and assessment of necropsy lesions in end-of-lay laying hens from different housing systems in Denmark.

Apperantly healthy laying hens at the end of production (60 to 91 wk) were investigated for the occurrence of pathology and bacterial infections. In total, 7,477 hens from 15 flocks representing the following production systems: Enriched cages, barn housed layers, and organic/free range layers were necropsied. Indications of bacterial infection were investigated by bacteriological cultivation. The overall prevalence of lesions was 16.60%, including lesions of both infectious and non-infectious origin. The most prevalent lesions were bursitis presternalis (6.65%), reproductive tract lesions (e.g., salpingitis and/or peritonitis and/or oophoritis) (3.50%), serosal scarification (e.g., fibrotic adhesive peritonitis) 1.55%, and neoplasm 1.73%. Significant differences were observed between different production systems and/or flocks in the prevalence of reproductive tract lesions, bursitis presternalis, serosal scarification, skin infections, juvenile hens, and traumas/fractures. No significant difference was observed between different production systems in the prevalence of neoplasia, infection of septicemic etiology, and pododermatitis. In total, 3.4% of the hens were out of lay, with significantly higher rate in organic flocks. Infections of the reproductive tract were the most prevalent lesions with bacterial etiology in all productions systems. In total, 40% of the hens with lesions associated to the oviduct were out of lay and significant difference between production systems were observed. Escherichia coli was the most commonly isolated bacteria and in 90% of the cases they were isolated from the reproductive tract lesions. The second most prevalent bacteria was Gallibacteruim anatis. Significant difference in the prevalence of E. coli positive hens was observed between production systems (P < 0.05). In conclusion, the prevalence of reproductive tract lesions in apparently healthy end-of-lay laying was higher than indicated in previous reports. These findings support the previous suggestions that E. coli and G. anatis are the major pathogens causing reproductive tract lesions.

Prognostic accuracy of the quick Sequential Organ Failure Assessment (qSOFA)-lactate criteria for mortality in adults with suspected bacterial infection in the emergency department of a hospital with limited resources.

BACKGROUND: Routine use of the Sequential Organ Failure Assessment (SOFA) score to prognosticate patients with sepsis is challenged by the requirement to perform numerous laboratory tests. The prognostic accuracy of the quick SOFA (qSOFA) without or with lactate criteria has not been prospectively investigated in low and middle income countries. We assessed the performance of simplified prognosis criteria using qSOFA-lactate criteria in the emergency department of a hospital with limited resources, in comparison with SOFA prognosis criteria and systemic inflammatory response syndrome (SIRS) screening criteria. METHODS: This prospective cohort study was conducted between March and December 2017 in adult patients with suspected bacterial infection visiting the emergency department of the Indonesian National Referral Hospital. Variables from sepsis prognosis and screening criteria and venous lactate concentration at enrolment were recorded. Patients were followed up until hospital discharge or death. Prognostic accuracy was measured using area under the receiver operating characteristic curve (AUROC) of each criterion in the prediction of in-hospital mortality. RESULTS: Of 3026 patients screened, 1213 met the inclusion criteria. The AUROC of qSOFA-lactate criteria was 0.74 (95% CI 0.71 to 0.77). The AUROC of qSOFA-lactate was not statistically significantly different to the SOFA score (AUROC 0.75, 95% CI 0.72 to 0.78; p=0.462). The qSOFA-lactate was significantly higher than qSOFA (AUROC 0.70, 95% CI0.67 to 0.74; p=0.006) and SIRS criteria (0.57, 95% CI0.54 to 0.60; p<0.001). CONCLUSIONS: The prognostic accuracy of the qSOFA-lactate criteria is as good as the SOFA score in the emergency department of a hospital with limited resources. The performance of the qSOFA criteria is significantly lower than the qSOFA-lactate criteria and SOFA score.This abstract has been translated and adapted from the original English-language content. Translated content is provided on an "as is" basis. Translation accuracy or reliability is not guaranteed or implied. BMJ is not responsible for any errors and omissions arising from translation to the fullest extent permitted by law, BMJ shall not incur any liability, including without limitation, liability for damages, arising from the translated text.

Epidemiology and Drug Resistance Analysis of Mixed Infection in Orthopedic Surgical Sites.

Background: Infection, including mixed infection, is not uncommon in orthopedic surgical incision. This study aimed to investigate the epidemiology and drug resistance of mixed infections after orthopedic surgical procedures. Methods: We retrospectively analyzed 533 orthopedic surgical site infections (SSIs) in a university hospital from 2012 to 2017. Eighty-six patients (218 strains) with bacterial culture results showing more than one strain were screened to explore their epidemiology and drug resistance. Results: Of 218 bacterial strains, 2-7 bacterial infections were noted in each wound. Most infections were caused by two kinds of bacteria (65.1%). The number of infections decreased with increased number of strains. The combinations of pathogenic micro-organisms were all gram-negative, 55.81%; gram-positive and gram-negative, 30.23%; all gram-positive, 12.79%; and gram-positive and fungi, 1.16%. Their resistance is consistent with the bacterial resistance of 447 cases of single bacterial SSI during the same period. Hospitalization duration was longer (9.8-20.6 d). Conclusion: Our study shows no significant changes in epidemiology and drug resistance caused by mixed infections in the orthopedic surgical site because of coordination and competition among micro-organisms. These bacteria are difficult to control, leading to extended hospitalization. Antibiotic agents should be chosen strictly according to drug sensitivity, and ineffective antibiotic agents must be avoided.

A standard area diagram set for assessing severity of eucalyptus bacterial blight caused by Erwinia psidii / Uma escala diagramática para a avaliação da severidade da seca-de-ponteiros do eucalipto causada por Erwinia psidii

This study aimed to develop and validate a standard area diagram (SAD) set to estimate the severity of bacterial blight of eucalyptus caused by Erwinia psidii. For this purpose, an eight-level SAD was developed and validated by ten inexperienced raters. Accuracy and precision of the estimates by each rater, with and without the SAD, were determined based on Lin's concordance correlation coefficient. The proposed SAD improved the accuracy and precision of the estimates. The SAD set studied here is a useful tool in assessments of bacterial blight of eucalyptus for epidemiological research and breeding programs.(AU)

Este trabalho objetivou o desenvolvimento de uma escala para estimar a severidade da seca-de-ponteiros do eucalipto causada por Erwinia psidii. Para isso, uma escala de oito níveis foi desenvolvida e validada por dez avaliadores inexperientes. A acurácia e precisão das estimativas de cada avaliador, com e sem a escala, foram determinadas baseadas no coeficiente de correlação concordante de Lin. A escala proposta melhorou a acurácia e a precisão das estimativas. A escala estudada se mostrou uma ferramenta útil na avaliação da seca-de-ponteiros do eucalipto para estudos epidemiológicos e em programas de melhoramento.(AU)

Vaccines in adults.

The proportion of adult population has increased globally and the current projections indicate that, by 2050, the group of 60 years and older will represent 21.1%. There are now vaccines exclusively designed for adults and others that are applied in early life but need to be updated later in life. Vaccines for adults are not only based on their respective age group but are also linked to risk factors like occupation, life style, health situation, among others. At the same time, longevity brings with it a weakening of the immune response to vaccines, a process known as immunosenescence representing an increasing challenge to adequately protect this age group. For some time, WHO has been promoting the term "Vaccination through the life course" allowing for an extension of the vaccination vision and taking adults as an integral part into the national vaccination programs and calendars. There are several vaccine preventable diseases affecting adults, but those associated with influenza virus and pneumococcus are the ones that affect the largest age group. Several recommendations include, additionally, others to prevent diphtheria, tetanus, whooping cough, hepatitis A and B, meningococcus, chickenpox, measles, rubella, mumps, herpes zoster, human papilloma virus and others. There are still many challenges to overcome in order to fully include adults, particularly health personnel, and to make vaccines extensively valued as a prevention tool in order to achieve a healthy life.

La proporción de población de adultos se ha incrementado globalmente y las proyecciones muestran que para el año 2050 los mayores de 60 años representarán el 21.1%. Actualmente se dispone de vacunas dirigidas exclusivamente a adultos y otras que se aplican en niños pero que se deben actualizar a lo largo de la vida. Las vacunas en adultos se administran, no solo por el grupo de edad al que pertenecen, sino también por factores como ocupación, estilos de vida o estado de salud. Al mismo tiempo, la longevidad disminuye la respuesta inmune a las vacunas por el fenómeno de inmunosenescencia, lo cual representa un desafío para proteger adecuadamente a este grupo. Desde hace varios años la OMS, ha propiciado la utilización del término "Vacunación en el curso de la vida" lo cual permite extender la visión de la vacunación y considerar al adulto como una parte integral de los planes y calendarios de inmunización. Existen varias enfermedades prevenibles por vacunas en adultos, pero aquellas asociadas al virus de influenza y al neumococo, son las que comprenden el grupo más extenso. Diversas recomendaciones incluyen, además de estas vacunas, otras dirigidas a prevenir difteria, tétanos, tos convulsa, hepatitis A y B, meningococo, varicela, sarampión, rubéola, parotiditis, herpes zóster, virus del papiloma humano y otras enfermedades. Se reconocen muchos desafíos a superar para poder incorporar plenamente al adulto, incluyendo al personal de salud, y lograr que la vacunación sea una herramienta de prevención valorada ampliamente para el desarrollo de una vida saludable.

Definition of Opportunistic Infections in Immunocompromised Children on the Basis of Etiologies and Clinical Features: A Summary for Practical Purposes.

Opportunistic Infections (OIs) still remain a major cause of morbidity and death in children with either malignant or nonmalignant disease. OIs are defined as those infections occurring due to bacteria, fungi, viruses or commensal organisms that normally inhabit the human body and do not cause a disease in healthy people, but become pathogenic when the body's defense system is impaired. OIs can also be represented by unusually severe infections caused by common pathogens. An OI could present itself at the onset of a primary immunodeficiency syndrome as a life-threatening event. More often, OI is a therapyassociated complication in patients needing immunosuppressive treatment, among long-term hospitalised patients or in children who undergo bone marrow or solid organ transplantation. The aim of the present review is to provide a comprehensive and 'easy to read' text that briefly summarises the currently available knowledge about OIs in order to define when an infection should be considered as opportunistic in pediatrics as a result of an underlying congenital or acquired immune-deficit.

Multidrug-resistant bacterial infections in patients with decompensated cirrhosis and with acute-on-chronic liver failure in Europe.

BACKGROUND & AIMS: Antibiotic resistance has been increasingly reported in patients with decompensated cirrhosis in single-center studies. Prospective investigations reporting broad epidemiological data are scarce. We aimed to analyze epidemiological changes in bacterial infections in patients with decompensated cirrhosis. METHODS: This was a prospective evaluation of 2 series of patients hospitalized with decompensated cirrhosis. The Canonic series included 1,146 patients from Northern, Southern and Western Europe in 2011. Data on epidemiology, clinical characteristics of bacterial infections, microbiology and empirical antibiotic schedules were assessed. A second series of 883 patients from Eastern, Southern and Western Europe was investigated between 2017-2018. RESULTS: A total of 455 patients developed 520 infections (39.7%) in the first series, with spontaneous bacterial peritonitis, urinary tract infections and pneumonia the most frequent infections. Nosocomial episodes predominated in this series. Nearly half of the infections were culture-positive, of which 29.2% were caused by multidrug-resistant organisms (MDROs). MDR strains were more frequently isolated in Northern and Western Europe. Extended-spectrum beta-lactamase-producing Enterobacteriaceae were the most frequent MDROs isolated in this series, although prevalence and type differed markedly among countries and centers. Antibiotic resistance was associated with poor prognosis and failure of antibiotic strategies, based on third-generation cephalosporins or quinolones. Nosocomial infection (odds ratio [OR] 2.74; p < 0.001), intensive care unit admission (OR 2.09; p = 0.02), and recent hospitalization (OR 1.93; p = 0.04) were identified as independent predictors of MDR infection. The prevalence of MDROs in the second series (392 infections/284 patients) was 23%; 38% in culture-positive infections. A mild increase in the rate of carbapenem-resistant Enterobacteriaceae was observed in this series. CONCLUSIONS: MDR bacterial infections constitute a prevalent, growing and complex healthcare problem in patients with decompensated cirrhosis and acute-on-chronic liver failure across Europe, negatively impacting on prognosis. Strategies aimed at preventing the spread of antibiotic resistance in cirrhosis should be urgently evaluated. LAY SUMMARY: Infections caused by bacteria resistant to the main antibiotic families are prevalent in patients with cirrhosis. This study demonstrates that this healthcare problem is increasing and extends through all European regions. Infections caused by these difficult to treat bacteria resolve less frequently and often cause the death of the patient. The type of resistant bacteria varies markedly among different hospitals.

Osteomyelitis of the jaw: time to rethink the bone sampling strategy?

This work aims at describing the diversity of osteomyelitis of the jaw (OJ) and at assessing the relevance of a new method designed to avoid salivary contamination during bone sampling in order to improve microbiological analysis and clinical decision-making. We reviewed medical and microbiological data of patients with a suspected OJ based on clinical and/or CT-scan signs and at least one bone sample made for microbiological analysis. During the study period, a new procedure for intraoral bone sampling was elaborated by surgeons and infectious diseases specialists authoring this article (based on stratified samples, cleaning of the surgical site and change of instruments between each sample). A comparison of the microbiological analyses between the two procedures was performed. From 2012 to 2017, 56 patients were included. Median age was 58 years (11-90), sex ratio: 1.24. Main risk factors were having a dental disease (n = 24) or cancer (n = 21). Nineteen patients with the new sample procedure were compared to 37 patients with standard procedure, especially non-cancer patients (n = 16 and 19, respectively). With the new procedure, a median of 3 (1-7) microorganisms per sample was recovered, vs. 7 (1-14) with the former (p < 0.001), a significant decrease of the microbial density was observed for all types of microbes, especially in deeper samples and cultures were more frequently sterile. The way sampling is managed deeply influences microbiological analysis. This strategy facilitates the distinction between pathogens and contaminants and should constitute the first step toward an evidence-based antimicrobial strategy for OJ.

Lifestyle transitions and adaptive pathogenesis of Pseudomonas aeruginosa.

Pseudomonas aeruginosa acute and chronic infections are of great concern to human health, especially in hospital settings. It is currently assumed that P. aeruginosa has two antagonistic pathogenic strategies that parallel two different lifestyles; free-living cells are predominantly cytotoxic and induce an acute inflammatory reaction, while biofilm-forming communities cause refractory chronic infections. Recent findings suggest that the planktonic-to-sessile transition is a complex, reversible and overall dynamic differentiation process. Here, we examine how the Gac/Rsm regulatory cascade, a key player in this lifestyle switch, endows P. aeruginosa with both a permissive lifecycle in nature and flexible virulence strategy during infection.