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1.
Int J Mol Sci ; 22(2)2021 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-33467014

RESUMO

Chronic tic disorder and Tourette syndrome are common childhood-onset neurological diseases. However, the pathophysiology underlying these disorders is unclear, and most studies have focused on the disinhibition of the corticostriatal-thalamocortical circuit. An autoimmune dysfunction has been proposed in the pathogenetic mechanism of Tourette syndrome and related neuropsychiatric disorders such as obsessive-compulsive disorder, autism, and attention-deficit/hyperactivity disorder. This is based on evidence from animal model studies and clinical findings. Herein, we review and give an update on the clinical characteristics, clinical evidence, and genetic studies in vitro as well as animal studies regarding immune dysfunction in Tourette syndrome.


Assuntos
Doenças Autoimunes/imunologia , Transtorno Obsessivo-Compulsivo/imunologia , Infecções Estreptocócicas/imunologia , Síndrome de Tourette/imunologia , Animais , Doenças Autoimunes/epidemiologia , Humanos , Linfócitos/imunologia , Microglia/imunologia , Neurônios/imunologia , Transtorno Obsessivo-Compulsivo/epidemiologia , Infecções Estreptocócicas/epidemiologia , Síndrome de Tourette/epidemiologia , Síndrome de Tourette/genética
2.
Am J Cardiol ; 142: 155-156, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33387471
3.
BMC Infect Dis ; 21(1): 73, 2021 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-33446117

RESUMO

BACKGROUND: In pregnant women Streptococcus agalactiae (GBS) can be transmitted to newborn causing severe infections. It is classified into 10 serotypes (Ia, Ib, II-IX). The severity of neonatal disease is determined by the capsular serotype and virulence factors such as the polysaccharide capsule, encoded by the cps gene, protein C, which includes the Cα surface proteins (bca gene), Rib (rib gene) and Cß (bac gene); the proteins Lmb (lmb gene), FbsB (fbsB gene), FbsA (fbsA gene), the cyl operon encoding a ß-hemolysin (hylB gene), the CAMP factor (cfb gene) and the C5a peptidase (scpB gene). The aim of this work was to determine the degree of GBS colonization in pregnant women, the serotypes distribution and to investigate virulence-associated genes. METHODS: We worked with 3480 samples of vagino-rectal swabs of women with 35-37 weeks of gestation. The identification of the strains was carried out using conventional biochemical tests and group confirmatory serology using a commercial latex particle agglutination kit. Two hundred GBS strains were selected. Their serotype was determined by agglutination tests. The monoplex PCR technique was used to investigate nine virulence-associated genes (cps, bca, rib, bac, lmb, fbsB, fbsA, hylB and scpB). RESULTS: The maternal colonization was 9.09%. The serotypes found were: Ia (33.50%), III (19.00%), Ib (15.50%), II (14.00%), V (7.00%) and IX (5.50%). 5.50% of strains were found to be non-serotypeable (NT). The nine virulence genes investigated were detected simultaneously in 36.50% of the strains. The genes that were most frequently detected were scpB (100.00%), fbsA (100.00%), fbsB (100.00%), cylB (95.00%), lmb (94.00%) and bca (87.50%). We found associations between serotype and genes bac (p = 0.003), cylB (p = 0.02), rib (p = 0.01) and lmb (p < 0.001). CONCLUSIONS: The frequency of vaginal-rectal colonization, serotypes distribution and associated virulence genes, varies widely among geographical areas. Therefore, epidemiological surveillance is necessary to provide data to guide decision-making and planning of prevention and control strategies.


Assuntos
Genes Bacterianos , Idade Gestacional , Sorogrupo , Infecções Estreptocócicas/epidemiologia , Streptococcus agalactiae/isolamento & purificação , Streptococcus agalactiae/patogenicidade , Fatores de Virulência/genética , Adulto , Argentina/epidemiologia , Proteínas de Bactérias/genética , Feminino , Humanos , Reação em Cadeia da Polimerase , Gravidez , Prevalência , Infecções Estreptocócicas/microbiologia , Virulência/genética
4.
BMC Infect Dis ; 21(1): 125, 2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509097

RESUMO

BACKGROUND: Streptococcus agalacticae (Group B Streptococcus, GBS) is one of the most important causative agents of serious infections among neonates. This study was carried out to identify antibiotic resistance and virulence genes associated with GBS isolated from pregnant women. METHODS: A total of 43 GBS isolates were obtained from 420 vaginal samples collected from HIV positive and negative women who were 13-35 weeks pregnant attending Antenatal Care at Chitungwiza and Harare Central Hospitals in Zimbabwe. Identification tests of GBS isolates was done using standard bacteriological methods and molecular identification testing. Antibiotic susceptibility testing was done using the modified Kirby-Bauer method and E-test strips. The boiling method was used to extract DNA and Polymerase Chain Reaction (PCR) was used to screen for 13 genes. Data was fed into SPSS 24.0. RESULTS: Nine distinct virulence gene profiles were identified and hly-scpB-bca-rib 37.2% (16/43) was common. The virulence genes identified were namely hly 97.8% (42/43), scpB 90.1% (39/43), bca 86.0% (37/43), rib 69.8% (30/43) and bac 11.6% (5/43). High resistance to tetracycline 97.7% (42/43) was reported followed by 72.1% (31/43) cefazolin, 69.8% (30/43) penicillin G, 58.1% (25/43) ampicillin, 55.8% (24/43) clindamycin, 46.5% (20/43) ceftriaxone, 34.9% (15/43) chloramphenicol, and 30.2% (13/43) for both erythromycin and vancomycin using disk diffusion. Antibiotic resistance genes among the resistant and intermediate-resistant isolates showed high frequencies for tetM 97.6% (41/42) and low frequencies for ermB 34.5% (10/29), ermTR 10.3% (3/29), mefA 3.4% (1/29), tetO 2.4% (1/42) and linB 0% (0/35). The atr housekeeping gene yielded 100% (43/43) positive results, whilst the mobile genetic element IS1548 yielded 9.3% (4/43). CONCLUSION: The study showed high prevalence of hly, scpB, bca and rib virulence genes in S. agalactiae strains isolated from pregnant women. Tetracycline resistance was predominantly caused by the tetM gene, whilst macrolide resistance was predominantly due to the presence of erm methylase, with the ermB gene being more prevalent. Multi-drug resistance coupled with the recovery of resistant isolates to antimicrobial agents such as penicillins indicates the importance of GBS surveillance and susceptibility tests. It was also observed that in vitro phenotypic resistance is not always accurately predicted by resistance genotypes.


Assuntos
Farmacorresistência Bacteriana/genética , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae/genética , Streptococcus agalactiae/isolamento & purificação , Fatores de Virulência/genética , Adulto , Antibacterianos/farmacologia , Farmacorresistência Bacteriana/efeitos dos fármacos , Feminino , Humanos , Testes de Sensibilidade Microbiana , Gestantes , Prevalência , Infecções Estreptocócicas/epidemiologia , Streptococcus agalactiae/efeitos dos fármacos , Streptococcus agalactiae/patogenicidade , Zimbábue/epidemiologia
5.
Autoimmun Rev ; 20(2): 102740, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33333234

RESUMO

Rheumatic heart disease (RHD) is a serious and long-term consequence of acute rheumatic fever (ARF), an autoimmune sequela of a mucosal infection by Streptococcus pyogenes (Group A Streptococcus, Strep A). The pathogenesis of ARF and RHD is complex and not fully understood but involves host and bacterial factors, molecular mimicry, and aberrant host innate and adaptive immune responses that result in loss of self-tolerance and subsequent cross-reactivity with host tissues. RHD is entirely preventable yet claims an estimated 320 000 lives annually. The major burden of disease is carried by developing nations and Indigenous populations within developed nations, including Australia. This review will focus on the epidemiology, pathogenesis and treatment of ARF and RHD in Australia, where: streptococcal pyoderma, rather than streptococcal pharyngitis, and Group C and Group G Streptococcus, have been implicated as antecedents to ARF; the rates of RHD in remote Indigenous communities are persistently among the highest in the world; government register-based programs coordinate disease screening and delivery of prophylaxis with variable success; and researchers are making significant progress in the development of a broad-spectrum vaccine against Strep A.


Assuntos
Febre Reumática , Cardiopatia Reumática , Infecções Estreptocócicas , Austrália , Humanos , Pesquisa , Febre Reumática/diagnóstico , Febre Reumática/epidemiologia , Febre Reumática/terapia , Cardiopatia Reumática/diagnóstico , Cardiopatia Reumática/epidemiologia , Cardiopatia Reumática/terapia , Infecções Estreptocócicas/epidemiologia , Streptococcus pyogenes
6.
PLoS One ; 15(12): e0244450, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33382792

RESUMO

OBJECTIVES: To study Group B Streptococcus (GBS) isolates associated with different clinical syndromes: asymptomatic carriage in pregnant women, intrauterine fetal death (IUFD), and early onset disease (EOD) in the newborn. METHODS: GBS isolates were collected from asymptomatic pregnant women admitted for labor, IUFD cases, and neonates with EOD. Serotypes and antibiotic susceptibilities were determined. Multilocus sequence typing (MLST) was performed to assess genetic epidemiology. RESULTS: GBS carriage rate was 26.1% (280/1074). The dominant serotype among asymptomatic pregnant women was VI [98/240 women (40.8%)], followed by serotypes III, V and IV in 42/240 (17.5%), 30/240 (12.5%) and 28/240 (11.7%) women, respectively. The dominant serotype in IUFD cases was serotype VI [10/13 (76.9%)]. In contrast the prevalent serotype among EOD cases was III [16/19 (84.2%)]. ST-1 was associated with IUFD [7/13 (53.8%)], ST-17 was associated with serotype III and EOD in the newborn 14/19 (73.7%)]. Erythromycin and clindamycin resistance reached 36.8%, 7.7% and 20.0%among EOD, vaginal carriage and IUFD, respectively. CONCLUSIONS: Serotypes VI and ST-1 were dominant among asymptomatic pregnant women and in IUFD cases while EOD was associated with serotype III and ST-17. Invasive mechanisms thus may differ between IUFD and EOD in the newborn and virulence may be related to capsule serotype. Resistance rates to erythromycin and clindamycin were high in EOD cases.


Assuntos
Portador Sadio/diagnóstico , Morte Fetal , Sepse Neonatal/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Infecções Estreptocócicas/diagnóstico , Streptococcus agalactiae/genética , Adulto , Idade de Início , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Portador Sadio/tratamento farmacológico , Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Clindamicina/farmacologia , Clindamicina/uso terapêutico , Farmacorresistência Bacteriana Múltipla/genética , Eritromicina/farmacologia , Eritromicina/uso terapêutico , Feminino , Humanos , Recém-Nascido , Tipagem de Sequências Multilocus , Sepse Neonatal/tratamento farmacológico , Sepse Neonatal/epidemiologia , Sepse Neonatal/microbiologia , Polissacarídeos Bacterianos/genética , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/microbiologia , Sorogrupo , Sorotipagem , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae/isolamento & purificação , Streptococcus agalactiae/patogenicidade , Virulência/genética , Adulto Jovem
7.
PLoS One ; 15(12): e0244283, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33347487

RESUMO

BACKGROUND: The selective impact of strategies for prevention of PD-related peritonitis (PDrP) may have modified, in the long term, the causal spectrum, clinical presentation and outcomes of these infections. OBJECTIVES: To compare trends in the incidence of PDrP by different microorganisms during a 30-year period, with a particular focus on streptococcal infections. To analyze the clinical presentation and outcomes of these infections. Secondarily, to investigate how the isolation of different species of streptococci can influence the clinical course of PDrP by this genus of bacteria. METHOD: Following a retrospective, observational design we investigated 1061 PDrP (1990-2019). We used joinpoint regression analysis to explore trends in the incidence of PDrP by different microorganisms, and compared the risk profile (Cox), clinical presentation and outcomes (logistic regression) of these infections. MAIN RESULTS: Our data showed a progressive decline in the incidence of PDrP by staphylococci and Gram negative bacteria, while the absolute rates of streptococcal (average annual percent change +1.6%, 95% CI -0.1/+3.2) and polymicrobial (+1.8%, +0.1/+3.5) infections tended to increase, during the same period. Remarkably, streptococci were isolated in 58.6% of polymicrobial infections, and patients who suffered a streptococcal PDrP had a 35.8% chance of presenting at least one other infection by the same genus. The risk profile for streptococcal infections was comparable to that observed for PDrP overall. Streptococcal PDrP were associated with a severe initial inflammatory response, but their clinical course was generally nonaggressive thereafter. We did not observe a differential effect of different groups of streptococci on the clinical presentation or outcome of PDrP. CONCLUSIONS: Time trends in the incidence of PDrP by different microorganisms have granted streptococci an increasing relevance as causative agents of these infections, during the last three decades. This behaviour suggests that current measures of prevention of PDrP may not be sufficiently effective, in the case of this genus of microorganisms.


Assuntos
Diálise Peritoneal/efeitos adversos , Peritonite/epidemiologia , Peritonite/etiologia , Adulto , Idoso , Antibacterianos/uso terapêutico , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/tendências , Peritonite/microbiologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/epidemiologia , Streptococcus
8.
Dis Aquat Organ ; 142: 197-201, 2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33331287

RESUMO

Streptococcus iniae causes high mortality in cultured and wild fish stocks globally. Since the first report in captive Amazon river dolphins Inia geoffrensis in 1976, it has emerged in finfish across all continents except Antarctica. In March 2016, an estimated 17000 fish were observed dead and dying along a remote 70 km stretch of the Kimberley coastline north of Broome, Western Australia. Affected species included finfish (lionfish Pterois volitans, angelfish Pomacanthus sp., stripey snapper Lutjanus carponotatus, sand bass Psammoperca waigiensis, yellowtail grunter Amniataba caudavittata, damselfish Pomacentridae sp.), flatback sea turtles Natator depressus, and olive (Aipysurus laevis) and black-ringed (Hydrelaps darwiniensis) sea snakes. Moribund fish collected during the event exhibited exophthalmia and abnormal behaviour, such as spiralling on the surface or within the water column. Subsequent histopathological examination of 2 fish species revealed bacterial septicaemia with chains of Gram-positive cocci seen in multiple organs and within brain tissue. S. iniae was isolated and identified by bacterial culture, species-specific PCR, Matrix-Assisted Laser Desorption Ionisation Time-Of-Flight (MALDI-TOF) and biochemical testing. This is the first report of S. iniae associated with a major multi-species wild marine fish kill in Australia. Extreme weather events in the region including a marked decrease in water temperatures, followed by an extended period of above-average coastal water temperatures, were implicated as stressors potentially contributing to this outbreak.


Assuntos
Doenças dos Peixes , Infecções Estreptocócicas , Animais , Austrália , Doenças dos Peixes/epidemiologia , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/veterinária , Streptococcus iniae , Austrália Ocidental/epidemiologia
9.
PLoS One ; 15(12): e0244063, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33332468

RESUMO

Streptococcus pyogenes or group A Streptococcus (GAS) causes diseases ranging from uncomplicated pharyngitis to life-threatening infections. It has complex epidemiology driven by the diversity, the temporal and geographical fluctuations of the circulating strains. Despite the global burden of GAS diseases, there is currently no available vaccination strategy against GAS infections. This study, based on a longitudinal population survey, aimed to understand the dynamic of GAS emm types and to give leads to better recognition of underlying mechanisms for the emergence of successful clones. From 2009 to 2017, we conducted a systematic culture-based diagnosis of GAS infections in a French Brittany population with a prospective recovery of clinical data. The epidemiological analysis was performed using emm typing combined with the structural and functional cluster-typing system for all the recovered strains. Risk factors for the invasiveness, identified by univariate analysis, were computed in a multiple logistic regression analysis, and the only independent risk factor remaining in the model was the age (OR for the entire range [CI95%] = 6.35 [3.63, 11.10]; p<0.0001). Among the 61 different emm types identified, the most prevalent were emm28 (16%), emm89 (15%), emm1 (14%), and emm4 (8%), which accounted for more than 50% of circulating strains. During the study period, five genotypes identified as emm44, 66, 75, 83, 87 emerged successively and belonged to clusters D4, E2, E3, and E6 that were different from those gathering "Prevalent" emm types (clusters A-C3 to 5, E1 and E4). We previously reported significant genetic modifications for emm44, 66, 83 and 75 types resulting possibly from a short adaptive evolution. Herein we additionally observed that the emergence of a new genotype could occur in a susceptible population having specific risk factors or probably lacking a naturally-acquired cluster-specific immune cross-protection. Among emergent emm types, emm75 and emm87 tend to become prevalent with a stable annual incidence and the risk of a clonal expansion have to be considered.


Assuntos
Genótipo , Infecções Estreptocócicas , Streptococcus pyogenes , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , França/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/genética , Infecções Estreptocócicas/metabolismo , Streptococcus pyogenes/genética , Streptococcus pyogenes/isolamento & purificação , Streptococcus pyogenes/metabolismo
10.
BMC Infect Dis ; 20(1): 958, 2020 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-33327946

RESUMO

BACKGROUND: Group B Streptococcus (GBS) is the leading cause of invasive neonatal disease in the industrialized world. We aimed to genomically and phenotypically characterise invasive GBS isolates in Slovenia from 2001 to 2018 and contemporary colonising GBS isolates from screening cultures in 2018. METHODS: GBS isolates from 101 patients (invasive isolates) and 70 pregnant women (colonising isolates) were analysed. Basic clinical characteristics of the patients were collected from medical records. Antimicrobial susceptibility and phenotypic capsular serotype were determined. Whole-genome sequencing was performed to assign multilocus sequence types (STs), clonal complexes (CCs), pathogenicity/virulence factors, including capsular genotypes, and genome-based phylogeny. RESULTS: Among invasive neonatal disease patients, 42.6% (n = 43) were females, 41.5% (n = 39/94) were from preterm deliveries (< 37 weeks gestation), and 41.6% (n = 42) had early-onset disease (EOD). All isolates were susceptible to benzylpenicillin with low minimum inhibitory concentrations (MICs; ≤0.125 mg/L). Overall, 7 serotypes were identified (Ia, Ib, II-V and VIII); serotype III being the most prevalent (59.6%). Twenty-eight MLST STs were detected that clustered into 6 CCs. CC-17 was the most common CC overall (53.2%), as well as among invasive (67.3%) and non-invasive (32.9%) isolates (p < 0.001). CC-17 was more common among patients with late-onset disease (LOD) (81.4%) compared to EOD (47.6%) (p < 0.001). The prevalence of other CCs was 12.9% (CC-23), 11.1% (CC-12), 10.5% (CC-1), 8.2% (CC-19), and 1.8% (CC-498). Of all isolates, 2.3% were singletons. CONCLUSIONS: A high prevalence of hypervirulent CC-17 isolates, with low genomic diversity and characteristic profile of pathogenicity/virulence factors, was detected among invasive neonatal and colonising GBS isolates from pregnant women in Slovenia. This is the first genomic characterisation of GBS isolates in Slovenia and provides valuable microbiological and genomic baseline data regarding the invasive and colonising GBS population nationally. Continuous genomic surveillance of GBS infections is crucial to analyse the impact of IND prevention strategies on the population structure of GBS locally, nationally, and internationally.


Assuntos
Genótipo , Doenças do Recém-Nascido/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Sorogrupo , Infecções Estreptocócicas/epidemiologia , Streptococcus agalactiae/genética , Adulto , Antibacterianos/farmacologia , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/microbiologia , Masculino , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Penicilina G/farmacologia , Filogenia , Polimorfismo de Nucleotídeo Único , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Prevalência , Estudos Retrospectivos , Eslovênia/epidemiologia , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae/efeitos dos fármacos , Streptococcus agalactiae/isolamento & purificação , Sequenciamento Completo do Genoma
11.
PLoS One ; 15(9): e0239294, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32941502

RESUMO

BACKGROUND AND HYPOTHESIS: The role of smoking as a risk factor for group B streptococcal (GBS) colonization in women during pregnancy has not been previously adequately explored. We hypothesized that women of term or near term neonates who smoked during pregnancy were more likely to have GBS colonization than their non-smoking counterparts. METHODS: The electronic health records (EHRs) of a convenience sample of women delivering in an inner-city university tertiary care center were reviewed. The outcome variable of interest was maternal GBS colonization during pregnancy. The primary independent variable of interest was tobacco smoking during pregnancy, determined from the EHRs by the number of cigarettes smoked during gestation. Descriptive statistics were conducted and categorical data were compared by the Fischer's exact test. Multiple logistic regression analysis was further conducted to determine the independent impact of tobacco smoke exposure on GBS colonization. RESULTS: The prevalence of maternal GBS colonization was 35% among the study population. In the univariate analyses, factors associated with maternal GBS colonization were tobacco smoking during pregnancy (P of trend <0.001), Race (P<0.001), maternal age <20 years (P = 0.006), low birthweight <2500 gm (P = 0.020), maternal drug use (P = 004), and gestational age <37 (P = 0.041). In a multiple logistic regression analysis, tobacco smoking during pregnancy remained the most significant predictor of GBS colonization. Women who smoked during pregnancy were more than twice more likely to be colonized than their non-smoking counterparts (OR = 2.6; 95% CI = 1.5-4.6; p<0.001). Maternal age was the only other significant predictor with younger mothers more than one and a half time more likely to be colonized than their older counterparts (OR = 1.65; 95% CI = 1.02-2.68; P = 0.04). CONCLUSION: The prevalence of GBS colonization in this institution was consistent with recent national rates. Smoking and maternal age were identified as two independent risk factors for GBS colonization during pregnancy. Further studies are needed to confirm these findings.


Assuntos
Complicações na Gravidez/epidemiologia , Fumar/epidemiologia , Infecções Estreptocócicas/epidemiologia , Adulto , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Gravidez , Prevalência , Centros de Atenção Terciária/estatística & dados numéricos , Virginia
12.
Public Health ; 186: 63-70, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32784097

RESUMO

OBJECTIVES: In England, notifications of invasive group A streptococcal (iGAS) infections have increased since 2015. We describe time trends, risk factors, as well as clinical and infection characteristics amongst iGAS cases in North West England, focussing on people who inject drugs (PWIDs), prisoners and homeless populations (referred to as risk groups), and analyse factors for fatal infection. STUDY DESIGN: The study design used was a cross-sectional study. METHODS: Data for all iGAS cases notified to Public Health England North West between January 2016 and May 2019 were used. Analysis consisted of time trend analysis, descriptive statistics, hypothesis testing to investigate differences in clinical and infection characteristics between risk and non-risk groups and binary logistic regression to identify factors associated with fatal infection. RESULTS: There were 1353 cases. Two hundred and two were amongst risk groups, who were predominantly PWIDs in Greater Manchester. Soft tissue risk factors were widespread. There were differences in strain-type between risk and non-risk groups. Female gender, cancer, emm1.0 and emm5.23 were associated with increased odds of death, whilst cellulitis was associated with reduced odds. The relationship between age and death was U-shaped. CONCLUSIONS: iGAS has increased in North West England since 2016, including amongst PWIDs. This may be due to emm-type replacement, barriers to good hygiene and increasing colonisation.


Assuntos
Infecções Estreptocócicas/epidemiologia , Streptococcus pyogenes/isolamento & purificação , Adulto , Idoso , Estudos Transversais , Inglaterra/epidemiologia , Feminino , Pessoas em Situação de Rua/estatística & dados numéricos , Humanos , Incidência , Injeções/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prisioneiros/estatística & dados numéricos , Fatores de Risco , Infecções Estreptocócicas/mortalidade
13.
PLoS Comput Biol ; 16(7): e1008010, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32628660

RESUMO

Antibiotic-resistant infections are a growing threat to human health, but basic features of the eco-evolutionary dynamics remain unexplained. Most prominently, there is no clear mechanism for the long-term coexistence of both drug-sensitive and resistant strains at intermediate levels, a ubiquitous pattern seen in surveillance data. Here we show that accounting for structured or spatially-heterogeneous host populations and variability in antibiotic consumption can lead to persistent coexistence over a wide range of treatment coverages, drug efficacies, costs of resistance, and mixing patterns. Moreover, this mechanism can explain other puzzling spatiotemporal features of drug-resistance epidemiology that have received less attention, such as large differences in the prevalence of resistance between geographical regions with similar antibiotic consumption or that neighbor one another. We find that the same amount of antibiotic use can lead to very different levels of resistance depending on how treatment is distributed in a transmission network. We also identify parameter regimes in which population structure alone cannot support coexistence, suggesting the need for other mechanisms to explain the epidemiology of antibiotic resistance. Our analysis identifies key features of host population structure that can be used to assess resistance risk and highlights the need to include spatial or demographic heterogeneity in models to guide resistance management.


Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Genética Populacional , Infecções Estreptocócicas/microbiologia , Algoritmos , Evolução Molecular , Geografia , Humanos , Modelos Teóricos , Prevalência , Análise de Regressão , Risco , Espanha/epidemiologia , Infecções Estreptocócicas/epidemiologia , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/genética
14.
Am J Nurs ; 120(8): 32-37, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32665509

RESUMO

If undiagnosed and untreated, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) can suddenly and drastically disrupt the lives of previously healthy children and their families. The key to prompt diagnosis of PANDAS and its appropriate treatment is provider awareness that streptococcal infection may present with neuropsychiatric symptoms. The authors discuss the signs and symptoms that characterize PANDAS, as well as its presumed pathogenesis, and illustrate, through a composite case history, a symptom presentation, diagnostic journey, treatment course, and recovery that is representative of many PANDAS cases.


Assuntos
Doenças Autoimunes/diagnóstico , Transtorno Obsessivo-Compulsivo/diagnóstico , Infecções Estreptocócicas/diagnóstico , Antibacterianos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Antipsicóticos/uso terapêutico , Doenças Autoimunes/tratamento farmacológico , Doenças Autoimunes/epidemiologia , Doenças Autoimunes/fisiopatologia , Criança , Feminino , Humanos , Masculino , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Transtorno Obsessivo-Compulsivo/epidemiologia , Transtorno Obsessivo-Compulsivo/fisiopatologia , Pais/educação , Educação de Pacientes como Assunto , Prevalência , Prognóstico , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/fisiopatologia
16.
Arch Dis Child ; 105(9): 825-829, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32601082

RESUMO

OBJECTIVE: Despite substantial variation of streptococcal antibody titres among global populations, there is no data on normal values in sub-Saharan Africa. The objective of this study was to establish normal values for antistreptolysin O (ASO) and antideoxyribonuclease B (ADB) antibodies in Uganda. DESIGN: This was an observational cross-sectional study. SETTING: This study was conducted at Mulago National Referral Hospital, which is located in the capital city, Kampala, and includes the Uganda Heart Institute. PATIENTS: Participants (aged 0-50 years) were recruited. Of 428 participants, 22 were excluded from analysis, and 183 (44.4%) of the remaining were children aged 5-15 years. MAIN OUTCOME MEASURES: ASO was measured in-country by nephelometric technique. ADB samples were sent to Australia (PathWest) for analysis by enzyme inhibition assay: 80% upper limit values were established. RESULTS: The median ASO titre in this age group was 220 IU/mL, with the 80th percentile value of 389 IU/mL. The median ADB titre in this age group was 375 IU/mL, with the 80th percentile value of 568 IU/mL. CONCLUSIONS: The estimated Ugandan paediatric population standardised 80% upper-limit-of-normal ASO and ADB titres is higher than many global populations. Appropriateness of using population-specific antibody cutoffs is yet to be determined and has important implications for the sensitivity and specificity of rheumatic fever diagnosis.


Assuntos
Anticorpos Antibacterianos/sangue , Streptococcus pyogenes/imunologia , Adolescente , Adulto , Fatores Etários , Anticorpos Antibacterianos/imunologia , Antiestreptolisina/imunologia , Criança , Pré-Escolar , Estudos Transversais , Desoxirribonucleases/imunologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Valores de Referência , Infecções Estreptocócicas/sangue , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/imunologia , Uganda/epidemiologia , Adulto Jovem
17.
Acta Vet Scand ; 62(1): 36, 2020 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-32580735

RESUMO

BACKGROUND: Streptococcus suis is a major cause of meningitis, arthritis, and pneumonia in pigs worldwide, and an emerging pathogen in humans. In Sweden, S. suis has previously received little attention but has in recent years become increasingly recognized as affecting the pig production. The aim of the present study was to investigate the occurrence, serotypes and antimicrobial susceptibility of S. suis in Swedish grower pigs from herds with and without reported S. suis associated disease, as well as possible associations between S. suis associated disease and selected environmental and production factors. Swab samples were taken from the tonsils of clinically healthy 8-13-week-old grower pigs from ten case herds and ten control herds. Isolates were cultured, identified using MALDI-TOF MS, and serotyped using latex agglutination. The antimicrobial susceptibility of 188 isolates was tested using broth microdilution. Production data was gathered and environmental parameters were measured on the farms. RESULTS: Streptococcus suis was isolated from 95% of the sampled pigs in both the case and the control herds. Serotypes 3, 4, 5, 7, 9, 10, 11, 15, 16, and 17-34 were detected, although a majority of the isolates (81.5%) were non-typeable. There was less diversity among the serotypes isolated from the case herds than among those from the control herds; four and nine different serotypes, respectively. Isolates resistant to penicillin (3.8%) were reported for the first time in Sweden. Tetracycline resistance was common (88.4%). No association was noted between the production and the environmental factors investigated, and the carriership of S. suis. CONCLUSIONS: The carriership of S. suis was found to be higher in clinically healthy Swedish pigs than previously estimated, and for the first time, the presence of Swedish isolates resistant to penicillin was reported. Many of the most commonly disease-associated serotypes, e.g. serotypes 2, 9, 3, and 7, were detected in healthy grower pigs although further studies are needed to investigate the virulence of these isolates.


Assuntos
Infecções Estreptocócicas/veterinária , Streptococcus suis/isolamento & purificação , Doenças dos Suínos/epidemiologia , Animais , Antibacterianos/farmacologia , Feminino , Incidência , Testes de Sensibilidade Microbiana/veterinária , Sorogrupo , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/microbiologia , Streptococcus suis/classificação , Streptococcus suis/efeitos dos fármacos , Sus scrofa , Suécia/epidemiologia , Suínos , Doenças dos Suínos/microbiologia
18.
Epidemiol Infect ; 148: e160, 2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32539874

RESUMO

London, Ontario is a mid-sized Canadian city which appears to be experiencing a syndemic predominately amongst its marginalized populations. Since 2014, rates of HIV, hepatitis A (HAV), hepatitis C (HCV), and invasive group A streptococcal disease have climbed well above provincial rates amid increasing use of injection drugs. Rates of infective endocarditis have also been on the rise. Extensive public health and community-based efforts were taken in response to these concurrent outbreaks. These efforts included establishing improved client care pathways, creating specialized teams to engage underhoused clients, providing mass immunization, and developing new health promotion campaigns. Rates of HIV and HAV were subsequently controlled locally while rates of HCV, iGAS and infective endocarditis remain high within the community and throughout the province.


Assuntos
Surtos de Doenças , Pessoas em Situação de Rua , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/microbiologia , Abuso de Substâncias por Via Intravenosa , Viroses/epidemiologia , Canadá/epidemiologia , Humanos , Estudos Retrospectivos , Streptococcus pyogenes
19.
Adv Clin Exp Med ; 29(6): 707-713, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32589825

RESUMO

BACKGROUND: Chlamydia trachomatis (C. trachomatis) and Streptococcus agalactiae (GBS) may be present in the female cervical canal without any symptoms of infection. Chronic chlamydial infections lead to many serious complications and perinatal infections, while the presence of GBS is a reservoir for infections of newborns or invasive streptococcal infection in adults. OBJECTIVES: To examine healthy women for C. trachomatis without symptoms from the reproductive system, assess the frequency of asymptomatic infections, detect GBS in the cervical canal, demonstrate differences in drug susceptibility, and determine the serotype of S. agalactiae strains and correlations among the ones present in the cervical canal. MATERIAL AND METHODS: A total of 315 cervical swabs were collected for genetic and microbiological analysis for the presence of C. trachomatis and S. agalactiae. Latex and diffusion-disk methods were used to determine the serotype and susceptibility of streptococci. RESULTS: Ten out of 315 women (3.2%) were C. trachomatis-positive. Using traditional methods of microscopy, culture and serology, 42 strains (13.3% of the subjects) obtained from patients were identified as S. agalactiae and further analyzed. The most common serotypes identified were II (18/42, 42.9%), V (11/42, 26.2%) and III (10/42, 23.8%). The less common serotypes found were VII (2/10, 4.8%), and Ib (1/10, 2.4%); no Ia, IV or VII serotypes were found. All the strains were susceptible to penicillin, while 71.4% of them were susceptible to erythromycin and 81.0% were susceptible to clindamycin. Seven isolates (16.7%) were concomitantly resistant to erythromycin and clindamycin. CONCLUSIONS: Chlamydia trachomatis was confirmed in 3.2% of the respondents, and GBS was found in 13.3%, despite a lack of symptoms of infection. The incidence of C. trachomatis infections and GBS colonization in Poland is similar to those in other European countries.


Assuntos
Infecções por Chlamydia , Chlamydia trachomatis , Infecções Estreptocócicas , Streptococcus agalactiae , Adulto , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/tratamento farmacológico , Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis/isolamento & purificação , Farmacorresistência Bacteriana , Feminino , Humanos , Recém-Nascido , Testes de Sensibilidade Microbiana , Polônia/epidemiologia , Gravidez , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/epidemiologia , Streptococcus agalactiae/isolamento & purificação
20.
PLoS Comput Biol ; 16(6): e1007182, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32502148

RESUMO

Group A Streptococcus (GAS) skin infections are caused by a diverse array of strain types and are highly prevalent in disadvantaged populations. The role of strain-specific immunity in preventing GAS infections is poorly understood, representing a critical knowledge gap in vaccine development. A recent GAS murine challenge study showed evidence that sterilising strain-specific and enduring immunity required two skin infections by the same GAS strain within three weeks. This mechanism of developing enduring immunity may be a significant impediment to the accumulation of immunity in populations. We used an agent-based mathematical model of GAS transmission to investigate the epidemiological consequences of enduring strain-specific immunity developing only after two infections with the same strain within a specified interval. Accounting for uncertainty when correlating murine timeframes to humans, we varied this maximum inter-infection interval from 3 to 420 weeks to assess its impact on prevalence and strain diversity, and considered additional scenarios where no maximum inter-infection interval was specified. Model outputs were compared with longitudinal GAS surveillance observations from northern Australia, a region with endemic infection. We also assessed the likely impact of a targeted strain-specific multivalent vaccine in this context. Our model produced patterns of transmission consistent with observations when the maximum inter-infection interval for developing enduring immunity was 19 weeks. Our vaccine analysis suggests that the leading multivalent GAS vaccine may have limited impact on the prevalence of GAS in populations in northern Australia if strain-specific immunity requires repeated episodes of infection. Our results suggest that observed GAS epidemiology from disease endemic settings is consistent with enduring strain-specific immunity being dependent on repeated infections with the same strain, and provide additional motivation for relevant human studies to confirm the human immune response to GAS skin infection.


Assuntos
Dermatopatias/epidemiologia , Infecções Estreptocócicas/epidemiologia , Streptococcus pyogenes , Animais , Austrália/epidemiologia , Austrália/etnologia , Número Básico de Reprodução , Modelos Animais de Doenças , Humanos , Camundongos , Modelos Teóricos , Dinâmica Populacional , Grupos Populacionais , Dermatopatias/imunologia , Dermatopatias/microbiologia , Dermatopatias/prevenção & controle , Infecções Estreptocócicas/imunologia , Infecções Estreptocócicas/prevenção & controle , Vacinas Estreptocócicas
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