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1.
Zhonghua Er Ke Za Zhi ; 58(5): 403-407, 2020 May 02.
Artigo em Chinês | MEDLINE | ID: mdl-32392957

RESUMO

Objective: To explore the value of nucleic acid detection methods in pharyngeal swabs in the etiological diagnosis of Mycoplasma pneumoniae (MP) infection in children. Methods: Four hundred and fifty-four (male 210, female 244) children with pneumonia in Department of Pulmonology, Children's Hospital of Zhejiang University School of Medicine were enrolled from July, 2018 to October, 2018. Pharyngeal swabs and venous blood were obtained on the first or the second day after hospitalization. Fluorescence detection quantitative amplification of DNA, thermostatic amplification of RNA, MP culture and MP-IgM were used to detect MP simultaneously. MP infection is diagnosed if MP culture is positive or the two of the other three methods are positive. Pharyngeal swabs were acquired and detected using fluorescence quantitative amplification of DNA, thermostatic amplification of RNA and MP culture again for children with confirmed MP infection before discharge. The detection rates and quantitative changes of the three methods were compared, and χ(2) test was used for comparison among groups. Results: A total of 454 hospitalized children with pneumonia were included in this study. The detection rates of fluorescence quantitative amplification of DNA, thermostatic amplification of RNA, MP culture and MP-IgM IgM were 43.6% (198/454), 43.2% (196/454), 40.0% (180/454) and 30.6% (139/454) respectively. The difference of detection rates of the four methods was statistically significant (χ(2)=20.8, P<0.05),but no significant difference between the detection rates of fluorescence quantitative amplification of DNA and thermostatic amplification of RNA was found (χ(2)=0.018, P=0.900). They both had higher detection rates than MP-IgM or MP culture. MP infection is diagnosed if MP culture is positive or the two of the other three methods are positive, and two hundred and nine children were diagnosed as MP infection. In the second test of MP infection in 209 children before discharge, the positive rate of MP culture was 67.5% (141/209), with 39.4% (13/33) changed from negative to positive, and 27.3% (48/176) changed from positive to negative. The positive rate of thermostatic amplification of RNA was 82.3% (172/209), with 16.2% (31/191) turned from positive to negative, and 66.7% (12/18) turned from negative to positive. The positive rate of fluorescence quantitative amplification of DNA was 67.0% (140/209), with 52.9% (18/34) cases changed from negative to positive, and 30.3% (53/175) cases changed from positive to negative. MP-DNA load decreased in 141 cases (67.5%) and increased in 68 cases (32.5%) in the second test among the positive samples tested by fluorescence quantitative amplification of DNA. The detection rates of the four methods in the non-severe group and the severe group were similar, and the differences among the groups were not statistically significant (all P>0.05). In the second test, the proportion of changing from negative to positive in the severe group was higher than that in the non-severe group, but only the difference in the thermostatic amplification of RNA was statistically significant (P=0.038) and the cases of changing from negative to positive of thermostatic amplification of RNA in the severe group and non-severe group are 7 and 5 respectively. Conclusions: The methods of pharyngeal swab nucleic acid detection have high sensitivity and application value in the etiological diagnosis of acute MP infection in children. The results of fluorescence quantitative amplification of DNA and thermostatic amplification of RNA are highly consistent, and they are both more advantageous than MP-IgM. Repeated testing in the acute phase is helpful to find MP infection children whose first test is negative. The load of MP-DNA did not decrease in some children in the acute stage after antibiotic treatment.


Assuntos
DNA Bacteriano/análise , Técnicas de Amplificação de Ácido Nucleico/métodos , Pneumonia por Mycoplasma/diagnóstico , Anticorpos Antibacterianos/sangue , Criança , Feminino , Hospitalização , Humanos , Imunoglobulina M/sangue , Masculino , Mycoplasma pneumoniae , Faringe/microbiologia , Sensibilidade e Especificidade
2.
Sex Transm Infect ; 96(6): 417-421, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32404400

RESUMO

OBJECTIVES: As Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the most commonly reported STIs in Belgium and the majority of women infected are asymptomatic, targeted screening of patients in specified risk groups is indicated. To prevent long-term complications and interrupt transmission, extragenital samples should be included. As this comes with a substantial extra cost, analysis of a pooled sample from vaginal and extragenital sites could be a solution. In this study, we evaluated the feasibility of molecular testing for CT and NG in pooled versus single-site samples in a large cohort of female sex workers. METHODS: Women were sampled from three anatomical sites: a pharyngeal, a vaginal and a rectal swab. Each sample was vortexed, and 400 µL of transport medium from each sample site was pooled into an empty tube. NAAT was performed using the Abbott RealTime CT/NG assay on the m2000sp/rt system. RESULTS: We included 489 patients: 5.1% were positive for CT; 2.0% were positive for NG and 1.4% were coinfected, resulting in an overall prevalence of 6.5% (95% CI 4.5% to 9.1%) for CT and 3.5% (95% CI 2.0% to 5.5%) for NG. From the 42 patients positive on at least one non-pooled sample, only 5 gave a negative result on the pooled sample, resulting in a sensitivity of 94% (95% CI 79% to 99%) for CT and 82% (95% CI 57% to 96%) for NG. The missed pooled samples were all derived from single-site infections with low bacterial loads. The possibility of inadequate self-sampling as a cause of false negativity was excluded, as 4/5 were collected by the physician. Testing only vaginal samples would have led to missing 40% of CT infections and 60% of NG infections. CONCLUSIONS: Pooling of samples is a cost-saving strategy for the detection of CT and NG in women, with minimal decrease in sensitivity. By reducing costs, more patients and more extragenital samples can be tested, resulting in higher detection rates.


Assuntos
Infecções por Chlamydia/diagnóstico , Gonorreia/diagnóstico , Técnicas de Amplificação de Ácido Nucleico/métodos , Faringe/microbiologia , Reto/microbiologia , Profissionais do Sexo , Vagina/microbiologia , Infecções Assintomáticas/epidemiologia , Bélgica/epidemiologia , Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis , Feminino , Gonorreia/epidemiologia , Humanos , Sensibilidade e Especificidade , Manejo de Espécimes/métodos
6.
PLoS One ; 15(3): e0230332, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32182260

RESUMO

BACKGROUND: Penicillin non-susceptible (PNSP) and multi-resistant pneumococci have been prevalent in Iceland since early nineties, mainly causing problems in treatment of acute otitis media. The 10-valent protein conjugated pneumococcal vaccine (PHiD-CV) was introduced into the childhood vaccination program in 2011. The aim of the study was to investigate the changes in antimicrobial susceptibility and serotype distribution of penicillin non-susceptible pneumococci (PNSP) in Iceland 2011-2017. METHODS AND FINDINGS: All pneumococcal isolates identified at the Landspítali University Hospital in 2011-2017, excluding isolates from the nasopharynx and throat were studied. Susceptibility testing was done according to the EUCAST guidelines using disk diffusion with chloramphenicol, erythromycin, clindamycin, tetracycline, trimethoprim/sulfamethoxazole and oxacillin for PNSP screening. Penicillin and ceftriaxone minimum inhibitory concentrations (MIC) were measured for oxacillin resistant isolates using the E-test. Serotyping was done using latex agglutination and/or multiplex PCR. The total number of pneumococcal isolates that met the study criteria was 1,706, of which 516 (30.2%) were PNSP, and declining with time. PNSP isolates of PHiD-CV vaccine serotypes (VT) were 362/516 (70.2%) declining with time, 132/143 (92.3%) in 2011 and 17/54 (31.5%) in 2017. PNSP were most commonly of serotype 19F, 317/516 isolates declining with time, 124/143 in 2011 and 15/54 in 2017. Their number decreased in all age groups, but mainly in the youngest children. PNSP isolates of non PHiD-CV vaccine serotypes (NVT) were 154/516, increasing with time, 11/14, in 2011 and 37/54 in 2017. The most common emerging NVTs in 2011 and 2017 were 6C, 1/143 and 10/54 respectively. CONCLUSIONS: PNSP of VTs have virtually disappeared from children with pneumococcal diseases after the initiation of pneumococcal vaccination in Iceland and a clear herd effect was observed. This was mainly driven by a decrease of PNSP isolates belonging to a serotype 19F multi-resistant lineage. However, emerging multi-resistant NVT isolates are of concern.


Assuntos
Antibacterianos/farmacologia , Portador Sadio/microbiologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/uso terapêutico , Streptococcus pneumoniae/isolamento & purificação , Antibacterianos/uso terapêutico , Portador Sadio/diagnóstico , Portador Sadio/epidemiologia , Pré-Escolar , Farmacorresistência Bacteriana Múltipla , Feminino , Implementação de Plano de Saúde/organização & administração , Implementação de Plano de Saúde/estatística & dados numéricos , Humanos , Islândia/epidemiologia , Programas de Imunização/organização & administração , Programas de Imunização/estatística & dados numéricos , Esquemas de Imunização , Lactente , Recém-Nascido , Masculino , Testes de Sensibilidade Microbiana , Otite Média , Resistência às Penicilinas , Faringe/microbiologia , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/microbiologia , Avaliação de Programas e Projetos de Saúde , Sorotipagem/estatística & dados numéricos , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/imunologia
7.
J Nippon Med Sch ; 87(4): 211-214, 2020 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-32009072

RESUMO

BACKGROUND: Streptococcus pyogenes, or group A streptococcus (GAS), is one of the most common bacterial pathogens in children. GAS can cause such nonserious and noninvasive diseases as pharyngitis and skin infection, as well as serious, invasive diseases like streptococcal toxic shock syndrome. One factor that makes GAS pathogenic is the type-specific M protein on its cell surface. To identify emm types and their characteristics, we previously examined GAS strains isolated from children with noninvasive infections at our hospital. The present study was conducted 8 years later, for comparison. METHODS: The 23 participants were inpatients and outpatients at Nippon Medical School Tama Nagayama Hospital during 2016 and 2017. A pharyngeal swab specimen was obtained from each child, and genes encoding M proteins were amplified by polymerase chain reaction. RESULTS: emm type analysis identified emm1 in 11 of the 23 strains and emm12 in 4. Three group G streptococcus (GGS) strains carried M-like protein genes. CONCLUSIONS: The predominant emm type was emm12 in our previous report and emm1 in this study. This study also identified 3 GGS strains among the isolates, which carried either the stg245, stg6795, or stg840 M-like protein gene. One GAS strain carried stg485, a gene associated with GGS rather than GAS.


Assuntos
Faringite/microbiologia , Faringe/microbiologia , Infecções Estreptocócicas , Streptococcus pyogenes/isolamento & purificação , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Streptococcus pyogenes/classificação , Streptococcus pyogenes/genética , Streptococcus pyogenes/patogenicidade , Fatores de Tempo
8.
Orv Hetil ; 161(2): 50-55, 2020 Jan.
Artigo em Húngaro | MEDLINE | ID: mdl-31902236

RESUMO

Introduction: Exudative tonsillitis is a common clinical picture during childhood. The majority of these cases are caused by viruses (Epstein-Barr virus [EBV], cytomegalovirus [CMV], influenza virus, parainfluenza virus, and adenovirus), and only some infections are caused by bacteria, mainly group A streptococci (GAS). On the basis of international guidelines, routine use of early antibiotic treatment is not recommended in these cases, because it seems not to prevent GAS-associated complications. Aim: Our aim was to determine those laboratory results which are useful to distinguish between bacterial and viral infections in children with exudative tonsillitis to reduce antibiotic overuse. Method: In our study, we evaluated 135 clinical data from 133 children with exudative tonsillitis. Patients were grouped according to the following criteria: the first group contained patients with acute CMV or EBV infections, while in the second group, CMV or EBV infections were not confirmed using serology. Results: On the basis of our results, EBV or CMV infections (66/135, 48.8%) were serologically confirmed in the majority of cases with exudative tonsillitis between 2016 and 2017, while the causative role of GAS was minimal in this patient group (3/65, 4.61%). In spite of this finding, the majority of patients (92%) were treated with antibiotics. Conclusion: Our retrospective findings confirmed that it is not possible to determine the causative agent of this clinical picture on the basis of symptoms, and physical findings, moreover laboratory results, such as high white blood cell count could not confirm bacterial infection. At the same time, elevated transaminase levels may refer to viral origin of infection, especially EBV or CMV with high predictive value; the use of extended laboratory tests may reduce the unnecessary antibiotic consumption. Orv Hetil. 2020; 161(2): 50-55.


Assuntos
Infecções Estreptocócicas/etiologia , Tonsilite/etiologia , Viroses/etiologia , Antibacterianos/uso terapêutico , Anticorpos Antibacterianos/análise , Anticorpos Antivirais/análise , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/tratamento farmacológico , Criança , Humanos , Faringe/microbiologia , Faringe/virologia , Estudos Retrospectivos , Tonsilite/tratamento farmacológico , Viroses/diagnóstico , Viroses/tratamento farmacológico
9.
PLoS One ; 15(1): e0227985, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31945133

RESUMO

Pharyngeal gonorrhoea is a common sexually transmitted infection among 'men having sex with other men' (MSM). Neisseria gonorrhoeae (NG) pharyngeal infections are usually characterized by the absence of symptoms, acting as an important reservoir for their further spread. To the best of our knowledge, no information about the composition of the pharyngeal microbiome during an ongoing NG infection is currently available. Therefore, in this study, we characterized the pharyngeal bacterial community profiles associated with NG infection in a well-selected cohort of HIV-negative MSM reporting unsafe oral intercourse. A total of 70 pharyngeal swabs were considered, comparing non-infected subjects (n = 45) versus patients with pharyngeal gonorrhoea (n = 25) whose microbiota composition was analyzed from pharyngeal swabs through sequencing of hypervariable V3-V4 regions of the 16S rRNA gene. The pharyngeal microbiome of all subjects was dominated by Prevotellaceae, Veillonellaceae and Streptococcaceae families. Patients with pharyngeal gonorrhoea harboured a pharyngeal microbiome quite similar to negative subjects. Nevertheless, when looking to less-represented bacterial species (relative abundance approximately 1% or less), an imbalance between aerobe and anaerobe microorganisms was observed in NG-infected patients. In particular, the pharyngeal microbiome of NG-positive individuals was richer in several anaerobes (e.g. Treponema, Parvimonas, Peptococcus, Catonella, Filifactor) and poorer in various aerobe genera (i.e. Pseudomonas, Escherichia), compared to non-infected controls. No significant differences were noticed in the distribution of commensal Neisseria species of the oropharynx between NG-positive and negative subjects. Metabolic variations induced by changes in the microbiome abundance were assessed by a functional prediction of the bacterial metabolic pathways: a more abundant involvement of D-glutamine and D-glutamate metabolism, carbohydrate metabolism, as well as a greater activation of the energy metabolism was observed in patients with pharyngeal gonorrhoea compared to non-infected individuals. Information about the bacterial composition of the pharyngeal microbiome in case of gonorrhoea could shed light on the pathogenesis of the infection and open new perspectives for the prevention and control of this condition.


Assuntos
Gonorreia/microbiologia , Microbiota/genética , Doenças Faríngeas/microbiologia , Faringe/microbiologia , RNA Ribossômico 16S , Estudos de Coortes , Humanos , Itália , Masculino , Minorias Sexuais e de Gênero , Sexo sem Proteção
10.
Int J Infect Dis ; 93: 245-251, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31972290

RESUMO

OBJECTIVES: Group A ß-hemolytic Streptococcus (GAS), also known as Streptococcus pyogenes, is responsible for an annual 600 million cases of acute pharyngitis globally, with 92% of those infections occurring in low-resource settings. Further knowledge of the acute streptococcal pharyngitis burden in low-resource settings is essential if serious post-streptococcal complications - rheumatic fever (RF) and its long-term sequel rheumatic heart disease (RHD) - are to be prevented. METHODS: Two studies were conducted in school-aged children (5-16 years): a cross-sectional study of streptococcal pharyngeal carriage followed by a prospective cohort study of streptococcal sore throat over 4 weeks from March to April 2017. RESULTS: The cross-sectional study revealed an overall prevalence of GAS carriage of 15.9% (79/496, 95% confidence interval 12.8-19.5%). Among 532 children enrolled in the prospective cohort study, 358 (67%) reported 528 sore throats, with 221 (41.1%) experiencing at least one GAS-positive sore throat. The overall GAS-positive rate for sore throat was 41.8% (221/528). CONCLUSIONS: The GAS pharyngeal carriage rates seen in Uganda (15.9%, 95% confidence interval 12.8-19.5%) are higher than the most recent pooled results globally, at 12% (range 6-28%). Additionally, pilot data suggest a substantially higher percentage of sore throat that was GAS-positive (41.8%) compared to pooled global rates when active recruitment is employed.


Assuntos
Faringite/epidemiologia , Infecções Estreptocócicas/epidemiologia , Streptococcus pyogenes , Adolescente , Estudos Transversais , Feminino , Humanos , Masculino , Faringite/microbiologia , Faringe/microbiologia , Prevalência , Estudos Prospectivos , Febre Reumática/prevenção & controle , Escarlatina/prevenção & controle , Uganda/epidemiologia
11.
Biomed Res Int ; 2020: 9814916, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31998803

RESUMO

Background: Extensive studies have focused on the diagnosis and treatment of Mycoplasma pneumoniae infection; however, rare studies investigated the posttreatment conditions. We analyzed the carrying status of M. pneumoniae in the respiratory tract of children before and after treatment. Methods: Ninety-two children with M. pneumoniae pneumonia were included in this study. Clinical data were obtained from each patient, and pharyngeal swab sampling was performed at preliminary diagnosis and discharge. Real-time PCR and dilution quantitative culture were utilized to determine the DNA quantification and number of viable M. pneumoniae from samples collected upon preliminary diagnosis and discharge. Results: All the 92 cases showed DNA positivity upon preliminary diagnosis, serum IgM antibody was detected in 80 patients, and positivity of M. pneumoniae culture was observed in 82 cases. Upon discharge, the M. pneumoniae nucleotide and culture positivity were detected in 87 and 49 cases, respectively. The content of viable M. pneumoniae was 10-104 CCU/mL and 10-102 CCU/mL in the preliminary diagnosis samples and discharge samples, respectively. Conclusions: Real-time PCR was rapid and effective for the qualitative diagnosis of M. pneumoniae at the early stage, but it cannot be used to evaluate the prognosis of patients with M. pneumoniae infection. Quantitative analysis for M. pneumoniae DNA could not directly reflex the viable strain content.


Assuntos
Anticorpos Antibacterianos/sangue , Imunoglobulina M/sangue , Mycoplasma pneumoniae , Faringe/microbiologia , Pneumonia por Mycoplasma , Reação em Cadeia da Polimerase em Tempo Real , Adolescente , Criança , Pré-Escolar , DNA Bacteriano/genética , DNA Bacteriano/metabolismo , Feminino , Humanos , Masculino , Mycoplasma pneumoniae/genética , Mycoplasma pneumoniae/crescimento & desenvolvimento , Mycoplasma pneumoniae/isolamento & purificação , Pneumonia por Mycoplasma/sangue , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/genética , Pneumonia por Mycoplasma/microbiologia
12.
Acta Clin Belg ; 75(2): 91-95, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30415606

RESUMO

Objectives: To investigate the efficacy of performing a pooling strategy of triple-anatomical site samples (pharyngeal, anorectal and urine samples) for simultaneous Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) nucleic acid amplification detection.Methods: A total of 117 specimen sets (pharyngeal, anorectal and urine) were collected from 98 men between 2014 and 2016. Double sampling of pharyngeal, anorectal and urine samples allowed for pooled and unpooled analyses using a multiplex Abbott Real Time CT/NG assay, together with confirmatory PCR testing in case of CT/NG positivity. Clinical and demographic data were analyzed.Results: The positivity rate for the triple-site pooled testing for CT and NG was 8.5% (10/117) and 6.8%, (8/117), respectively, compared to the single-site testing total positivity rate, which was 9.4% (11/117) and 4.3% (5/117) for CT and NG, respectively. Pooled analysis missed one CT-positive urine sample and one CT-positive anorectal sample could not be confirmed. In addition, less PCR inhibition was reported for the pooled sample (PS) testing and ERV-3 qPCR testing revealed ineffective sampling of self-collected anorectal swabs in two cases. No pharyngeal samples were positive for CT, nor were any urine samples positive for NG.Conclusion: This small study showed that PS testing is a possible testing strategy for screening high-risk men who have sex with men attending pre-exposure prophylaxis (PrEP) clinics. However, due to the low positivity rate of CT/NG in this study, larger evaluations are needed to confirm the effectiveness of CT/NG screening with multiple-site PS nucleic acid amplification test (NAAT) screening practices.


Assuntos
Infecções por Chlamydia , Chlamydia trachomatis/genética , Gonorreia , Tipagem Molecular/métodos , Neisseria gonorrhoeae/genética , Adulto , Canal Anal/microbiologia , Bélgica , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/epidemiologia , Estudos Transversais , Gonorreia/diagnóstico , Gonorreia/epidemiologia , Homossexualidade Masculina , Humanos , Masculino , Pessoa de Meia-Idade , Técnicas de Amplificação de Ácido Nucleico , Faringe/microbiologia , Manejo de Espécimes
13.
Clin Microbiol Infect ; 26(2): 207-212, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31419483

RESUMO

OBJECTIVES: The aim was to evaluate the efficacy and tolerability of gentamicin 240 mg plus azithromycin 2 g for treatment of uncomplicated rectal and pharyngeal gonorrhoea compared to ceftriaxone 500 mg plus azithromycin 2 g, the recommended European first-line gonorrhoea treatment. METHODS: A non-inferiority, open-label, single-centre randomized controlled trial was conducted in Prague, Czech Republic. Patients, 18-75 years of age, diagnosed with uncomplicated rectal or pharyngeal gonorrhoea by nucleic acid amplification test (NAAT) were randomized to treatment with gentamicin 240 mg intramuscularly plus azithromycin 2 g orally or ceftriaxone 500 g intramuscularly plus azithromycin 2 g orally. The primary outcome was negative culture and negative NAAT, i.e. 1 week and 3 weeks, respectively, after treatment. RESULTS: Both clinical cure and microbiological clearance was achieved by 100% (95% CI 0.95-1.00) of patients in the gentamicin/azithromycin arm (n = 72; 40 rectal, 17 pharyngeal and 15 rectal+pharyngeal infections both localizations) and 100% (95% CI 0.95-1.00) in ceftriaxone/azithromycin arm (n = 71; 38 rectal, 14 pharyngeal and 19 rectal+pharyngeal infections). The absolute difference between the two arms was 0.0% (CI95% -5.1 to 5.1), thus less than the pre-specified margin of 7%. Administration of gentamicin was not more painful than ceftriaxone according to the visual analogue scale (1.8 vs. 3.4; p <0.001). Gastrointestinal adverse events were similar in the ceftriaxone arm (33/71, 46.5%) and the gentamicin arm (29/72, 40.3%), and overall in most (52/62, 83.9%) cases they were mild. CONCLUSIONS: Gentamicin 240 mg plus azithromycin 2 g is an effective alternative for treatment of extragenital gonorrhoea.


Assuntos
Antibacterianos/administração & dosagem , Azitromicina/administração & dosagem , Ceftriaxona/administração & dosagem , Gentamicinas/administração & dosagem , Gonorreia/tratamento farmacológico , Administração Oral , Adolescente , Adulto , Idoso , Antibacterianos/efeitos adversos , Azitromicina/efeitos adversos , Ceftriaxona/efeitos adversos , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Feminino , Gentamicinas/efeitos adversos , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Faringe/microbiologia , Reto/microbiologia , Resultado do Tratamento , Adulto Jovem
14.
Sex Transm Infect ; 96(1): 10-18, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31217322

RESUMO

OBJECTIVES: There are limited data on the prevalence of Mycoplasma genitalium (Mgen) coinfection with rectal chlamydia (Chlamydia trachomatis (CT)) and rectal gonorrhoea (Neisseria gonorrhoeae (NG)) infections and few studies examining the prevalence of pharyngeal Mgen in men who have sex with men (MSM). Using transcription-mediated amplification assay, this study aimed to determine the proportion of rectal CT and rectal NG infections in MSM who are coinfected with rectal Mgen, and the proportion of MSM with Mgen detected in the pharynx in order to inform clinical practice. METHODS: This was a cross-sectional study conducted at Melbourne Sexual Health Centre in Australia. Consecutively collected rectal swabs from MSM that tested positive for CT (n=212) or NG (n=212), and consecutively collected pharyngeal samples (n=480) from MSM were tested for Mgen using the Aptima Mycoplasma genitalium Assay (Hologic, San Diego). Samples were linked to demographic data and symptom status. RESULTS: Rectal Mgen was codetected in 27 of 212 rectal CT (13%, 95% CI 9 to 18) and in 29 of 212 rectal NG (14%, 95% CI 9 to 19) samples, with no difference in the proportion positive for Mgen. MSM with rectal CT/Mgen coinfection had more sexual partners than those with rectal CT monoinfection (mean 6 vs 11, p=0.06). MSM with rectal NG/Mgen coinfection were more likely to be HIV-positive than those with rectal NG monoinfection (OR=2.96, 95% CI 1.21 to 7.26, p=0.023). MSM with rectal CT/Mgen coinfection were more likely to be using pre-exposure prophylaxis than MSM with rectal NG/Mgen coinfection (OR 0.25, 95% CI 0.10 to 0.65, p=0.002). Pharyngeal Mgen was uncommon and detected in 8 of 464 samples (2%, 95% CI 1% to 3%). Pharyngeal Mgen was associated with having a rectal STI (OR=10.61, 95% CI 2.30 to 48.87, p=0.002), and there was a borderline association with being HIV-positive (p=0.079). CONCLUSION: These data indicate one in seven MSM treated for rectal CT or rectal NG will have undiagnosed Mgen that is potentially exposed to azithromycin during treatment of these STIs. Rectal Mgen coinfection was associated with specific risk factors which may inform testing practices. Pharyngeal Mgen was uncommon.


Assuntos
Homossexualidade Masculina/estatística & dados numéricos , Infecções por Mycoplasma/epidemiologia , Doenças Retais/epidemiologia , Reto/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/microbiologia , Chlamydia trachomatis/classificação , Chlamydia trachomatis/genética , Chlamydia trachomatis/isolamento & purificação , Coinfecção/epidemiologia , Coinfecção/microbiologia , Estudos Transversais , Gonorreia/epidemiologia , Gonorreia/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Mycoplasma/microbiologia , Mycoplasma genitalium/classificação , Mycoplasma genitalium/genética , Mycoplasma genitalium/isolamento & purificação , Neisseria gonorrhoeae/classificação , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/isolamento & purificação , Faringe/microbiologia , Doenças Retais/microbiologia , Comportamento Sexual , Adulto Jovem
15.
Sex Transm Infect ; 96(6): 432-435, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-31624177

RESUMO

OBJECTIVES: Pharyngeal gonorrhoea disproportionately affects men who have sex with men (MSM). We explored temporal trends in pharyngeal gonorrhoea positivity among MSM compared with anorectal and urogenital positivity. METHODS: Data (2011-2015) were extracted from 41 publicly funded sexual health clinics participating in a national surveillance network. Positivity was defined as the proportion of first-visit testing occasions where gonorrhoea was detected. Logistic regression explored trends in positivity and correlates of positive pharyngeal tests. RESULTS: From 2011 to 2015, 24 792 MSM tested (16 710 pharyngeal, 19 810 urogenital and 15 974 anorectal first-visit tests). Pharyngeal positivity increased by 183% from 139/3509 (4.0%) in 2011 to 397/3509 (11.3%) in 2015, p-trend <0.001; urogenital positivity by 39% from 257/4615 (5.6%) to 295/3783 (7.8%), p-trend=0.006; and anorectal positivity by 87% from 160/3469 (4.6%) to 286/3334 (8.6%), p-trend <0.001. The annual temporal increase in positivity was greater in the pharynx (OR 1.33; 95% CI 1.27 to 1.38) than at urogenital (OR 1.06; 95% CI 1.02 to 1.10) and anorectal (OR 1.16; 95% CI 1.11 to 1.21) sites. Factors independently associated with pharyngeal gonorrhoea were: younger age (p<0.001), higher numbers of recent sexual partners (p-trend=0.004), contact with a person with a diagnosed STI (p<0.001), injecting drug use (p<0.001), anogenital symptoms (p<0.001) and HIV-positive status (p=0.050). CONCLUSION: Temporal increases in gonorrhoea positivity occurred at all anatomical sites, with the greatest increase in the pharynx. Risk factors could be used to help to develop testing and prevention strategies among MSM at highest risk. Strengthening sexual health service delivery, testing and surveillance remain priorities for pharyngeal gonorrhoea control.


Assuntos
Gonorreia/epidemiologia , Doenças Faríngeas/epidemiologia , Faringe/microbiologia , Minorias Sexuais e de Gênero , Adulto , Fatores Etários , Doenças do Ânus/epidemiologia , Austrália/epidemiologia , Doenças dos Genitais Masculinos/epidemiologia , Infecções por HIV/epidemiologia , Humanos , Modelos Logísticos , Masculino , Razão de Chances , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/epidemiologia , Infecções Urinárias/epidemiologia
16.
Microb Pathog ; 139: 103805, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31790791

RESUMO

Studies on understanding the human microbiome continue to grow rapidly; nonetheless, reports on alterations in the microbiome post HIV infection are limited. Human microbiome is an aggregate of bacteria, fungi, viruses and archaea that have co-evolved with humans. These microbes have important roles in immune modulation, vitamin synthesis, metabolism etc. The human pharyngeal microbiome, which resides in the junction between digestive and respiratory tracts, might have a key role in the prevention of respiratory tract infections, akin to the actions of the intestinal microbiome against enteric infections. The respiratory tract is constantly exposed to various environmental and endogenous microbes; however, unlike other similar mucosal surfaces, there has been limited investigation of the microbiome of the respiratory tract. HIV infection is associated with alterations in the respiratory microbiome. The aim of this study was to use next-generation sequencing to determine the composition of the oropharyngeal microbiome in a HIV-positive individual. The bacterial composition was determined by illumina sequencing using MiSeq of partial 16S rRNA genes (V3-V4). A total of 3, 57,926 reads were analyzed. Overall, the genera Proteus, Enterococcus, Bacteroides, Prevotella and Clostridium were most prevalent bacterial populations in the oropharynx of an HIV positive patient.


Assuntos
Infecções por HIV/microbiologia , Microbiota , Orofaringe/microbiologia , Bacteroides/isolamento & purificação , Bacteroides/metabolismo , Clostridium/isolamento & purificação , Clostridium/metabolismo , DNA Bacteriano/genética , DNA Bacteriano/isolamento & purificação , Enterococcus/isolamento & purificação , Enterococcus/metabolismo , Microbioma Gastrointestinal , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Micrococcus/isolamento & purificação , Micrococcus/metabolismo , Faringe/microbiologia , Filogenia , Prevotella/isolamento & purificação , Prevotella/metabolismo , Proteus/isolamento & purificação , Proteus/metabolismo , RNA Ribossômico 16S/genética , RNA Ribossômico 16S/isolamento & purificação , Sistema Respiratório/metabolismo , Sistema Respiratório/microbiologia , Infecções Respiratórias/microbiologia , Análise de Sequência de DNA
17.
Int Arch Allergy Immunol ; 181(3): 191-199, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31822014

RESUMO

INTRODUCTION: Little is known about the association between bacterial infections and exacerbations of bronchial asthma. OBJECTIVE: To elucidate the effect of bacterial infections on bronchial asthma, we examined pharyngeal bacterial colonization, duration of wheezing, and serum levels of cytokines and chemokines during acute exacerbations of asthma in children. METHODS: Potential bacterial pathogens were investigated in pharyngeal samples and viruses obtained from nasal secretions of 111 children who were outpatients and/or in patients with acute exacerbations of asthma (mean/median age: 2.8/2.6, respectively). We also measured serum levels of 27 different cytokines/chemokines. RESULTS: Pharyngeal bacterial cultures were positive in 110 of 111 children. The 3 major bacterial pathogens were Streptococcus pneumoniae (29.7%), Moraxella catarrhalis (11.7%), and Haemophilus influenzae (10.8%). M. catarrhalis was detected more frequently in patients with pneumonia. Furthermore, patients with S. pneumoniae colonization had significantly shorter wheezing episodes than those without it. In contrast, the duration of wheezing did not differ significantly among cases with other bacteria such as M. catarrhalis and H. influenzae. Furthermore, the length of wheezing episode in patients with S. pneumoniae colonization showed significant inverse correlation with peripheral white blood cell count, neutrophil count, and C-reactive protein, while there was no significant correlation between duration of wheezing and these 3 parameters among patients with M. catarrhalis or H. influenza. Among the 27 cytokines/chemokines, only serum tumor necrosis factor (TNF)-α was significantly lower in patients with S. pneumoniae colonization than in those without it. CONCLUSIONS: These results suggested that pharyngeal S. pneumoniae colonization plays a suppressive role on the pathophysiology during acute exacerbations of asthma.


Assuntos
Asma/imunologia , Neutrófilos/imunologia , Faringe/microbiologia , Infecções Pneumocócicas/imunologia , Streptococcus pneumoniae/fisiologia , Proteína C-Reativa/metabolismo , Criança , Pré-Escolar , Progressão da Doença , Feminino , Humanos , Tolerância Imunológica , Lactente , Masculino , Pneumonia , Sons Respiratórios , Fator de Necrose Tumoral alfa/sangue
18.
BMC Infect Dis ; 19(1): 1023, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791276

RESUMO

BACKGROUND: Staphylococcus aureus carriage is a known risk factor for staphylococcal disease. However, the carriage rates vary by country, demographic group and profession. This study aimed to determine the S. aureus carriage rate in children in Eastern Uganda, and identify S. aureus lineages that cause infection in Uganda. METHODS: Nasopharyngeal samples from 742 healthy children less than 5 years residing in the Iganga/Mayuge Health and Demographic Surveillance Site in Eastern Uganda were processed for isolation of S. aureus. Antibiotic susceptibility testing based on minimum inhibitory concentrations (MICs) was determined by the BD Phoenix™ system. Genotyping was performed by spa and SCCmec typing. RESULTS: The processed samples yielded 144 S. aureus isolates (one per child) therefore, the S. aureus carriage rate in children was 19.4% (144/742). Thirty one percent (45/144) of the isolates were methicillin resistant (MRSA) yielding a carriage rate of 6.1% (45/742). All isolates were susceptible to rifampicin, vancomycin and linezolid. Moreover, all MRSA were susceptible to vancomycin, linezolid and clindamycin. Compared to methicillin susceptible S. aureus (MSSA) isolates (68.8%, 99/144), MRSA isolates were more resistant to non-beta-lactam antimicrobials -trimethoprim/sulfamethoxazole 73.3% (33/45) vs. 27.3% (27/99) [p < 0.0001]; erythromycin 75.6% (34/45) vs. 24.2% (24/99) [p < 0.0001]; chloramphenicol 60% (27/45) vs. 19.2% (19/99) [p < 0.0001]; gentamicin 55.6% (25/45) vs. 25.3% (25/99) [p = 0.0004]; and ciprofloxacin 35.6% (16/45) vs. 2% (2/99) [p < 0.0001]. Furthermore, 42 MRSA (93.3%) were multidrug resistant (MDR) and one exhibited high-level resistance to mupirocin. Overall, 61 MSSA (61.6%) were MDR, including three mupirocin and clindamycin resistant isolates. Seven spa types were detected among MRSA, of which t037 and t064 were predominant and associated with SCCmec types I and IV, respectively. Fourteen spa types were detected in MSSA which consisted mainly of t645 and t4353. CONCLUSIONS: S. aureus carriage rate in healthy children in Eastern Uganda is high and comparable to rates for hospitalized patients in Kampala. The detection of mupirocin resistance is worrying as it could rapidly increase if mupirocin is administered in a low-income setting. S. aureus strains of spa types t064, t037 (MRSA) and t645, t4353 (MSSA) are prevalent and could be responsible for majority of staphylococcal infections in Uganda.


Assuntos
Antígenos de Bactérias/análise , Portador Sadio/epidemiologia , Farmacorresistência Bacteriana , Nariz/microbiologia , Faringe/microbiologia , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus/isolamento & purificação , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Antígenos de Bactérias/classificação , Antígenos de Bactérias/genética , Portador Sadio/microbiologia , Pré-Escolar , Estudos Transversais , Farmacorresistência Bacteriana/genética , Feminino , Técnicas de Genotipagem/métodos , Humanos , Lactente , Recém-Nascido , Masculino , Staphylococcus aureus Resistente à Meticilina/genética , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Testes de Sensibilidade Microbiana , Tipagem Molecular/métodos , Mupirocina/farmacologia , Mupirocina/uso terapêutico , Mucosa Nasal/microbiologia , Vigilância da População/métodos , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/classificação , Staphylococcus aureus/genética , Uganda/epidemiologia
19.
BMC Infect Dis ; 19(1): 1041, 2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31823768

RESUMO

BACKGROUND: Chlamydia trachomatis (CT) infection is one of the most pervasive sexually transmitted infections and has high prevalence in urogenital and extra-urogenital sites among men who have sex with men (MSM). This study investigated anatomical site-specific prevalence and genotypes of CT among MSM recruited from three geographic areas in China. METHODS: We collected urine specimens and anorectal, pharyngeal swab specimens from 379 MSM. CT infection was identified using polymerase chain reaction and CT genotyping was determined by sequences of the ompA gene. RESULTS: The results indicated that the overall prevalence of CT infection was 18.2% (95% confidence intervals [CIs], 13.9-22.5%) and significantly different between the cities (p = 0.048). The infection was most common at the anorectal site (15.6, 95%CIs 11.6-19.5%) followed by urethral (3.2, 95%CIs 1.4-5.0%) and oropharyngeal sites (1.6, 95%CIs 0.3-2.9%). Genotypes D and G were the most common CT strains in this population but genotype D was significantly predominated in Nanjing while genotype G was in Wuhan. No genotype related to lymphogranuloma venereum was found. CT infection was significantly related to the infection of Neisseria gonorrhoeae (adjusted odds ratio [aOR] 14.27, 95%CIs 6.02-33.83, p < 0.001) and age. Men older than 40 years old were less likely to have a CT infection as compared to men under 30 years old (aOR 0.37, 95% CIs 0.15-0.93, p = 0.03). CONCLUSION: The high CT infection prevalence, particularly in the anorectal site, among MSM suggests the necessity to development an integrated CT screening and treatment program specifically focusing on this high-risk population. Surveillance of CT infections should be improved by including both infection and genotype based surveys into the current surveillance programs in China.


Assuntos
Infecções por Chlamydia/diagnóstico , Chlamydia trachomatis/genética , Doenças Sexualmente Transmissíveis/diagnóstico , Adulto , China/epidemiologia , Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis/isolamento & purificação , DNA Bacteriano/química , DNA Bacteriano/metabolismo , Genótipo , Homossexualidade Masculina , Humanos , Masculino , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/isolamento & purificação , Faringe/microbiologia , Prevalência , Doenças Sexualmente Transmissíveis/epidemiologia , Inquéritos e Questionários
20.
Sex Transm Dis ; 46(12): 777-779, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31764766

RESUMO

We conducted a cross-sectional analysis using sexually transmitted disease clinic data to determine test of cure rates among persons diagnosed with pharyngeal gonococcal infections who were treated with a nonceftriaxone, nonazithromycin therapy. Less than 10% returned for a test of cure, highlighting the need to understand factors that can lead to improved compliance.


Assuntos
Gonorreia/epidemiologia , Neisseria gonorrhoeae/isolamento & purificação , Faringe/microbiologia , Adulto , Antibacterianos/uso terapêutico , Estudos Transversais , Feminino , Gonorreia/diagnóstico , Gonorreia/tratamento farmacológico , Humanos , Masculino , Neisseria gonorrhoeae/efeitos dos fármacos , Cooperação do Paciente/estatística & dados numéricos , Vigilância de Evento Sentinela , Estados Unidos/epidemiologia
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