Isolation of and risk factors for airway infection with Pseudomonas aeruginosa in patients with non-cystic fibrosis bronchiectasis / Isolamento de Pseudomonas aeruginosa e fatores de risco de infecção das vias aéreas pela bactéria em pacientes com bronquiectasias não fibrocísticas

ABSTRACT Objective: To identify microorganisms in sputum samples of patients with stable non-cystic fibrosis bronchiectasis and to determine risk factors related to the isolation of Pseudomonas aeruginosa (PA) in those patients. Methods: Consecutive patients were recruited from a tertiary hospital outpatient clinic in the city of Fortaleza, Brazil. The patients were submitted to spirometry, six-minute walk test, HRCT, and sputum collection. Data on serum fibrinogen levels, disease severity, sputum color, and history of azithromycin treatment were collected. Results: The study included 112 patients, and females predominated (68%). The mean age was 51.6 ± 17.4 years. Most patients presented with mild-to-moderate disease (83%). The mean six-minute walk distance was 468.8 ± 87.9 m. Mean FEV1 and FVC, in % of predicted values, were 60.4 ± 21.8% and 69.9 ± 18.5%, respectively. The mean serum fibrinogen level was 396.1 ± 76.3 mg/dL. PA was isolated in 47 patients, other potentially pathogenic microorganisms (PPMs) were isolated in 31 patients, and non-PPMs were isolated in 34 patients. Purulent sputum was identified in 77 patients (68%). The patients with PA, when compared with those without it, presented with more severe disease, higher serum fibrinogen levels, and lower FVC%. In addition, purulent sputum and long-term azithromycin treatment were more common in those with PA. The multivariate regression analysis showed that the independent factors associated with PA were serum fibrinogen level > 400 mg/dL (OR = 3.0; 95% CI: 1.1-7.7) and purulent sputum (OR = 4.3; 95% CI: 1.6-11.3). Conclusions: In our sample, the prevalence of PA in sputum was 42%. Sputum color and inflammatory markers were able to predict the isolation of PA, emphasizing the importance of routine sputum monitoring.

RESUMO Objetivo: Identificar microrganismos em amostras de escarro de pacientes com bronquiectasia não fibrocística estável e determinar os fatores de risco relacionados com o isolamento de Pseudomonas aeruginosa (PA) nesses pacientes. Métodos: Pacientes consecutivos foram recrutados em um ambulatório de um hospital terciário em Fortaleza (CE). Os pacientes foram submetidos a espirometria, teste de caminhada de seis minutos, TCAR e coleta de escarro. Foram coletados dados referentes ao fibrinogênio sérico, gravidade da doença, cor do escarro e histórico de tratamento com azitromicina. Resultados: O estudo incluiu 112 pacientes, com predomínio do sexo feminino (68%). A média de idade foi de 51,6 ± 17,4 anos. A maioria dos pacientes apresentou doença leve a moderada (83%). A média da distância percorrida no teste de caminhada de seis minutos foi de 468,8 ± 87,9 m. A média do VEF1 em % do previsto foi de 60,4 ± 21,8%, e a da CVF em % do previsto foi de 69,9 ± 18,5%. A média do fibrinogênio sérico foi de 396,1 ± 76,3 mg/dL. PA foi isolada em 47 pacientes; outros microrganismos potencialmente patogênicos (MPP) foram isolados em 31; não MPP foram isolados em 34. Escarro purulento foi identificado em 77 pacientes (68%). Os pacientes com PA, em comparação com aqueles sem, apresentaram doença mais grave, fibrinogênio sérico mais elevado e menor CVF%. Além disso, escarro purulento e tratamento prolongado com azitromicina foram mais comuns naqueles com PA. A análise de regressão multivariada mostrou que os fatores independentes relacionados com PA foram fibrinogênio sérico > 400 mg/dL (OR = 3,0; IC95%: 1,1-7,7) e escarro purulento (OR = 4,3; IC95%: 1,6-11,3). Conclusões: Em nossa amostra, a prevalência de PA no escarro foi de 42%. A cor do escarro e os marcadores inflamatórios foram capazes de prever o isolamento de PA, o que enfatiza a importância do monitoramento rotineiro do escarro.

Características sociodemográficas de los pacientes con úlceras por presión infectadas y su perfil microbiológico. Serie de casos / Sociodemographic characteristics of patients with pressure ulcers and their microbiological profile. A case series

Introducción Las ulceras por presión (UPP) son una condición frecuente en los pacientes con movilidad restringida, su sobreinfección implica un esfuerzo adicional en el tratamiento, ya que se asocia a complicaciones como osteomielitis crónica y sepsis. El objetivo del estudio es describir las características clínicas y sociodemográficas de los pacientes con UPP enfatizando en el perfil microbiológico de aquellos con sobreinfección. Materiales y métodos Se realizó un estudio descriptivo retrospectivo que incluyó a 76 pacientes adultos con diagnóstico de UPP sobreinfectadas sometidos a cirugía entre 2013 y 2015. Se obtuvo información demográfica, clínica y microbiológica. Se describieron los resultados según la naturaleza de la variable. Resultados De los 76 pacientes, 56 (73.7%) fueron hombres. La mediana de edad fue de 45 años. La mediana de hospitalización fue de 22.5 días, el principal motivo de inmovilidad fue la lesión medular (69,7%). Los patógenos más comunes fueron Enterococcus faecalis (46%), Escherichia coli (43.4%), Streptococcus spp (35.5%) y Proteus spp (30.2%). En el 77,6% de los pacientes se aislaron dos o más microorganismos en los cultivos. Discusión La lesión medular en la condición más asociada a ulceras por presión en nuestro medio, principalmente en hombres jóvenes. La sobreinfección generalmente es polimicrobiana, lo que nos muestra la gran importancia de los cultivos para poder realizar un tratamiento específico y efectivo. Al conocer las características clínicas y demográficas se pueden direccionar estrategias de prevención y rehabilitación que impacten de manera positiva en la calidad de vida de los pacientes y la sostenibilidad del sistema de salud. Nivel de evidencia IV

Background Pressure ulcers (PU) are a frequent condition in patients with restricted mobility. Their infection requires an additional effort in the treatment, since it is associated with complications, such as chronic osteomyelitis and sepsis. The aim of this study is to describe the clinical and sociodemographic characteristics of patients with PU, emphasising the microbiological profile of those with infection. Materials and methods A retrospective descriptive study was carried out on 76 adult patients diagnosed with infected PU who underwent surgery between 2013 and 2015. Demographic, clinical, and microbiological information was obtained. The results were described according to the nature of the variable. Results Of the 76 patients, 56 (73.7%) were men. The median age was 45 years. The median number of days hospitalised was 22.5 days, and the main cause of immobility was spinal cord injury (69.7%). The most common pathogens were Enterococcus faecalis (46%), Escherichia coli (43.4%), Streptococcus spp (35.5%), and Proteus spp (30.2%). Two or more microorganisms were isolated in the cultures in 77.6% of the patients, Discussion Spinal cord injury is the condition most associated with pressure ulcers in this study, mainly in young men. Infection is usually polymicrobial, which shows the great importance of the cultures, in order to be able to carry out a specific and effective treatment. By knowing the clinical and demographic characteristics, prevention and rehabilitation strategies can be directed at having a positive impact on the quality of life of PU patients, and the sustainability of the health care system. Evidence Level IV

Estudo epidemiológico das queratites infeciosas internadas num centro hospitalar terciário - revisão de 5 anos / Epidemiological study of infeccious keratitis in inpatients of a terciary hospital center - revision of 5 years

Resumo Objetivo: A queratite infeciosa é uma doença de incidência relativamente elevada e é responsável por um número importante de internamentos. Neste estudo pretende-se estudar diversas características epidemiológicas e clínicas associadas às queratites infeciosas de alto risco num hospital terciário em Portugal. Métodos: Realizou-se um estudo retrospetivo, onde foram incluídos todos os doentes internados por abcesso da córnea no Centro Hospitalar Universitário do Porto (CHUP), entre Abril de 2013 a Março de 2018. Caracterizou-se a população em relação aos fatores de risco, apresentação clínica, tempo de internamento, resultados de culturas, resistência antibiótica in vitro, tratamento efetuado e resultado funcional. Resultados: O estudo incluiu 105 doentes. Os principais fatores de risco foram antecedentes de cirurgia de córnea, uso de lentes de contacto e história recente de trauma ocular. 74,3% dos doentes tiveram cultura positiva com 87,9% a corresponderem a cultura bacteriana pura, sendo a Pseudomonas aeruginosa e o Streptococcus pneumoniae os agentes etiológicos mais frequentes. 27,9% das culturas positivas eram resistentes a 3 ou mais classes de antibióticos. Todos os doentes iniciaram tratamento com colírios fortificados. 29,5% dos doentes necessitaram de realizar transplante de córnea. Ao final de 6 meses de seguimento, apenas 20,9% apresentavam AV>20/40. Conclusão: Na maioria dos casos, a etiologia foi bacteriana. Observou-se um número considerável de bactérias multirresistentes. Apesar do tratamento ter permitido uma melhoria da visão na maioria dos casos, um número considerável de doentes ficou com sequelas visuais importantes.

Abstract Objective: Infectious keratitis is a pathology with a high incidence and is responsible for a large number of prolonged stay hospital admissions. The purpose was to analyze the epidemiological and clinical data associated with high risk microbial keratitis at a central hospital in Portugal. Methods: A retrospective study of all inpatients presenting with corneal abscess in Centro Hospitalar Universitário do Porto, from April 2013 to March 2018 was performed. Target population was characterized by risk factors, clinical features, length of stay, culture results, in vitro antibiotic resistance, treatment and outcome. Results: This study included 105 patients. The main risk factors were previous corneal surgery, contact lenses wear and recent history of ocular trauma. 74.3% of patients had a positive culture, 87.9% of these corresponding to a pure bacterial culture, with Pseudomonas aeruginosa and Streptococcus pneumoniae being the most common pathogens. 27.9% of positive cultures were resistant to 3 or more classes of antibiotics. All patients began treatment with fortified drops. 29.5% of patients required a corneal transplant. After 6 months of follow-up, only 20.9% presented a VA>20/40. Conclusion: Most cases were caused by bacteria. A considerable number of multi-resistant bacteria was identified. Despite most cases having improved after treatment, a large number of patients had a significant visual acuity sequelae.

Microbiological characterization of severe exacerbations in Chronic Obstructive Pulmonary Disease (COPD) in patients admitted to the ICU with or without associated pneumonia: A retrospective cross-sectional study / Caracterización microbiológica de pacientes con enfermedad pulmonar obstructiva crónica (EPOC) ingresados a UCI con exacerbación grave o neumonía: un estudio transversal retrospective

Objective: The goal of this study was to compare the microbiology of severe exacerbations of chronic obstructive pulmonary disease (COPD) requiring admission to the intensive care unit (ICU), in patients with pneumonia compared to those that did not have. Methods: We conducted a retrospective cross-sectional study that included patients with severe COPD exacerbation. We took microbiologic and serologic samples to study the etiology of the exacerbation and chest X-ray to see whether or not it had associated pneumonia. Results: Ninety-one patients were included in the study. 53/91 (58%) had pneumonia. The most prevalent bacteria isolated were H. influenzae (25.3%), Moraxella spp (22%), H. parainfluenza (14.3%), Serratia marcescens (13.2%), mixed flora (9.9%) and methicillin-susceptible Staphylococcus aureus (9.9%). A statistically significant difference could not be demonstrated between the two groups. We detected 24.2% of bacterial resistance in both groups, the most frequent being AMPc (13 cases). Discussion: Bacterial pneumonia in COPD patients is higher in comparison with patients with acute exacerbation. Even though we did not find a significant difference in the microbiology of the groups with or without pneumonia, there are variables such as past smoking related to having pneumonia. Patients with pneumonia also had higher severity scores.

Objetivo: Comparar la microbiología de las exacerbaciones graves de EPOC (Enfermedad Pulmonar Obstructiva Crónica) que requieren ingreso a la unidad de cuidados intensivos, con y sin neumonía Métodos: se realizó un estudio transversal retrospectivo que incluyó pacientes con exacerbación grave de EPOC que requieren ingreso a la Unidad de Cuidados Intensivos (UCI). Tomamos muestras microbiológicas y serológicas para estudiar la etiología de la exacerbación y radiografía de tórax para ver si tenía o no una neumonía asociada. Seguimos a los pacientes durante su ingreso en la UCI y evaluamos el resultado de la hospitalización. Resultados: se incluyeron 91 pacientes en el estudio. 53/91 ( 58%) tuvieron confirmación de neumonía. Las bacterias más prevalentes aisladas fueron H. influenzae (25.3%), Moraxella spp (22%), H. parainfluenza (14.3%), Serratia marcescens (13.2%), flora mixta (9.9%) y S. aureus meticilino sensible. (9.9% ). No se pudo demostrar una diferencia estadísticamente significativa entre los dos grupos. Detectamos una resistencia bacteriana del 24,2% en ambos grupos, siendo la más frecuente AMPc (13 casos). Discusión: la neumonía bacteriana en pacientes con EPOC es más alta cuando se compara con pacientes con exacerbación aguda. Aunque no encontramos una diferencia significativa en la microbiología de los grupos con o sin neumonía, existen variables como antecedente de cigarrillo asociadas a tener neumonía. Los pacientes con neumonía así mismo tuvieron mayores índices de severidad.

A new technique for tongue brushing and halitosis reduction: the X technique

Abstract The tongue is one of the primary sources of halitosis. The manual or mechanical removal of biofilm is known to decrease oral malodor. Objective: To evaluate a new tongue hygiene technique hereby referred to as "the X technique" and its effects on both halitosis and the number of microorganisms based on microbiological parameters and diagnostic features of the breath. Material and Methods: The study included thirty patients divided into a control group (patients without systematized guidelines of lingual hygiene, but who performed the mechanical cleaning of tongue dorsum, each in its own way), the 3R group (instructed to perform the movements of the X technique for 3 repetitions at each brushing), and the 6R group (instructed to perform 6 repetitions of the technique at each brushing). After two weeks, a new data collection was performed. Results: Patients in the 6R group presented the lowest score on the organoleptic assessment scale at the second consultation, followed by the 3R group and the controls. Regarding the self-perception of breath by the method of Visual Analog Scale (VAS), the control group did not perceive improvements in oral malodor; the results of the 3R group and the 6R group were similar. Conclusion: These results indicate that the X technique improves both measurements and perceptions of halitosis. Microbiological analyses revealed greatest reduction in the 6R group. The findings show that the X technique reduces both organoleptic scores and the number of bacterial colonies, and improves users' perceptions of their breath.

Características clínicas de la neumonía adquirida en la comunidad del adulto inmunocompetente hospitalizado según el agente causal / Features of community-acquired pneumonia in immunocompetent hospitalized adults according to the causal agent

Background: Molecular biological techniques allow the identification of more pathogens associated with community-acquired pneumonia (CAP). Aim: To compare clinical and laboratory parameters of patients with CAP caused by different groups of pathogens. Material and Methods: In a prospective study, immunocompetent adult patients hospitalized with CAP were tested for the presence of a broad range of possible respiratory pathogens using bacterial cultures, polymerase chain reaction, urinary antigen testing and serology. Results: Pathogens were detected in 367 of 935 patients with CAP (39.2%). Streptococcus pneumoniae (10.7%) and influenza virus (6%) were the most frequently identified bacterial and viral pathogens, respectively. Pneumococcal pneumonia predominated in older adults, with multiple comorbidities, with elevation of inflammatory parameters and hypoxemia, like other bacterial pneumonias. Viral pneumonia predominated in elderly patients with multiple comorbidities, with a shorter hospital length of stay and lower mortality. Pneumonia associated with atypical microorganisms predominated in young adults, smokers, with subacute clinical evolution. Their hospital stays and lethality was similar to other bacterial pneumonias. Viral and classical bacterial pneumonias predominated in high risk pneumonia severity index categories. Although several variables were associated with the detection of a pathogen group, substantial overlap avoided the identification of reliable clinical predictors to distinguish etiologies. Conclusions: The clinical and radiographic characteristics were similar in pulmonary infections caused by classical bacteria, respiratory viruses and atypical microorganisms. Therefore, microbial testing for common respiratory pathogens is still necessary to optimize treatment.

Risk factors for mortality in ventilator-associated tracheobronchitis: a case-control study / Fatores de risco para mortalidade em traqueobronquite associada à ventilação mecânica: estudo caso-controle

ABSTRACT Objective To describe the microbiological characteristics and to assess the risk factors for mortality of ventilator-associated tracheobronchitis in a case-control study of intensive care patients. Methods This case-control study was conducted over a 6-year period in a 40-bed medical-surgical intensive care unit in a tertiary care, private hospital in São Paulo, Brazil. Case patients were identified using the Nosocomial Infection Control Committee database. For the analysis of risk factors, matched control subjects were selected from the same institution at a 1:8.8 ratio, between January 2006 and December 2011. Results A total of 40 episodes of ventilator-associated tracheobronchitis were evaluated in 40 patients in the intensive care unit, and 354 intensive care patients who did not experience tracheobronchitis were included as the Control Group. During the 6-year study period, a total of 42 organisms were identified (polymicrobial infections were 5%) and 88.2% of all the microorganisms identified were Gram-negative. Using a logistic regression model, we found the following independent risk factors for mortality in ventilator-associated tracheobronchitis patients: Acute Physiology and Chronic Health Evaluation I score (odds ratio 1.18 per unit of score; 95%CI: 1.05-1.38; p=0.01), and duration of mechanical ventilation (odds ratio 1.09 per day of mechanical ventilation; 95%CI: 1.03-1.17; p=0.004). Conclusion Our study provided insight into the risk factors for mortality and microbiological characteristics of ventilator-associated tracheobronchitis.

RESUMO Objetivo Descrever as características microbiológicas e avaliar os fatores de risco para mortalidade na traqueobronquite associada à ventilação mecânica em um estudo caso-controle de pacientes de terapia intensiva. Métodos Estudo realizado ao longo de 6 anos em uma unidade de terapia intensiva médico-cirúrgica de 40 leitos, em um hospital privado e de nível terciário em São Paulo, Brasil. O Grupo Caso foi identificado usando o banco de dados da Comissão de Controle de Infecção Hospitalar. O Grupo Controle foi pareado na proporção de 1:8,8 entre janeiro de 2006 e dezembro de 2011. Resultados Quarenta episódios de traqueobronquites associadas à ventilação foram avaliados em 40 pacientes na unidade de terapia intensiva, e 354 pacientes não apresentaram traqueobronquite Grupo Controle. Foram identificados 42 microrganismos (dos quais 5% foram infecções polimicrobianas), sendo que 88,2% de todos os microrganismos eram bactérias Gram-negativas. Usando um modelo de regressão logística, encontramos os seguintes fatores de risco independentes para mortalidade em pacientes com traqueobronquites associadas à ventilação: pontuação da Acute Physiology and Chronic Health Evaluation I (odds ratio 1,18 por uma unidade de pontuação; IC95%: 1,05-1,38; p=0,01) e duração da ventilação mecânica (odds ratio 1,09 por dia de ventilação mecânica; IC95%: 1,03-1,17; p=0,004). Conclusão Nosso estudo forneceu informações sobre os fatores de risco para mortalidade e características microbiológicas da traqueobronquite associada à ventilação mecânica.

Changes in the conjunctival bacterial flora of patients hospitalized in an intensive care unit / Mudanças na flora bacteriana conjuntival de pacientes internados em unidade de terapia intensiva

ABSTRACT Purpose: To identify the changes in aerobic conjunctival bacterial flora and to correlate culture results with physical health and the duration of patients' hospitalization in an intensive care unit (ICU). Methods: Patients hospitalized in the ICU were included in this study. Conjunctival cultures from all patients were obtained using a standard technique on days 1, 3, 7, and 14. Swabs were plated on nonselective (blood agar) and enriched (chocolate agar) media within one hour. Visible colonies were isolated, and standard microbiological techniques were used to identify the bacteria. The frequency, identity, and correlation of culture results with patients' physical findings and the duration of hospitalization were determined. Results: We obtained 478 cultures (day 1, 270; day 3, 156; day 7, 36; and day 14, 16) from 135 patients; 288 (60.2%) cultures were positive, and 331 microorganisms were isolated. The most frequently isolated microorganism from the cultures was coagulase-negative Staphylococcus species (n=210/331, 63.5%), and the others were Corynebacterium diphtheriae (n=52/331, 15.7%), S. aureus (n=26/331, 7.9%), gram-negative bacilli other than Pseudomonas (n=14/331, 4.2%), Neisseria species (n=8/331, 2.4%), Pseudomonas aeruginosa (n=6/331, 1.8%), Haemophilus influenzae (n=7/331, 2.1%), Acinetobacter species (n=6/331, 1.8%), and Streptococcus species (n=2/331, 0.6%). The frequency of positive cultures significantly increased (p<0.03) with time. Conclusions: Prolonged hospitalization significantly predisposes to bacterial colonization. The colonization rate of S. aureus and Neisseria spp. increased significantly after one week.

RESUMO Objetivo: Identificar as mudanças na flora bacteriana aeróbia da conjuntiva e correlacionar os resultados da cultura com o estado de saúde física e a duração da hospitalização em pacientes em uma unidade de terapia intensiva (UTI). Método: Pacientes que estavam na UTI foram incluídos neste estudo. Culturas conjuntivais foram obtidas nos dias 1, 3, 7 e 14 de todos os pacientes com uma técnica normalizada. Zaragatoas foram semeadas em placas não seletivas (ágar sangue) e enriquecidas (ágar chocolate) dentro de uma hora. Colônias visíveis foram separadas, isoladas, e identificadas utilizando técnicas microbiológicas convencionais. A frequência, identificação e correlação da cultura resulta com achados físicos e a duração da hospitalização foram determinados. Resultados: Um total de 478 culturas (no primeiro dia 270, terceiro dia 156, sétimo dia 36 e dia catorze 16 culturas) foram obtidas de 135 pacientes hospitalizados durante o estudo. Duzentos e oitenta e oito (60,2% de todas as culturas obtidas) culturas foram positivas. Trezentos e trinta e um microrganismos foram isolados a partir dessas culturas. Em todos os grupos, o microrganismo mais frequentemente isolado foi o Staphylococcus species coagulase negativo (n=210/331, 63,5% de todos os microrganismos isolados). Outras bactérias isoladas foram Corynebacterium diphteriae (n=52/331, 15,7%), Staphylococcus aureus (n=26/331, 7,9%), bacilos Gram-negativos que não sejam Pseudomonas (n=14/331, 4,2%), Neisseria species (n=8/331, 2,4%), Pseudomonas aeruginosa (n=6/331, 1,8%), Haemophilus influenzae (n=7/331, 2,1%), Acinetobacter species (n=6/331, 1,8%), e Streptococcus species (n=2/331, 0,6%). Como o tempo de hospitalização prolongada, a positividade em culturas aumentou significativamente (p<0,03). Conclusões: hospitalização prolongada predispõe significativamente a frequência de colonização bacteriana. A taxa de colonização de S. aureus e Neisseria spp. aumentou significativamente depois de uma semana.

Aspectos clínicos, microbiológicos e tratamento periodontal em pacientes fumantes portadores de doença periodontal crônica: revisão de literatura / Clinical and microbiological aspects of periodontal treatment in smoker patients with chronic periodontal disease: literature review

Objetivo: o propósito deste estudo foi avaliar, através da revisão de literatura, os aspectos clínicos (índice de placa, índice gengival, profundidade de sondagem, recessão gengival e nível clínico de inserção) e microbiológicos (presença qualitativa e quantitativa de periodontopatógenos) e a resposta de pacientes tabagistas à terapia periodontal. Material e Métodos: foram selecionados artigos científicos publicados entre os anos de 1978 a 2014, através dos bancos de dados MEDLINE, PUBMED e LILACS. Resultados: existem divergências em relação à influência do tabagismo nos parâmetros clínicos e microbiológicos. Conclusão: baseado nos estudos avaliados pode-se concluir que há diferenças clínicas e microbiológicas significativas no paciente tabagista e comprometimento da resposta à terapia periodontal.

Objective: the aim of this study was to evaluate, through literature review, clinical aspects (plaque index, gingival index, probing depth, gingival recession and clinical attachment level) and microbiological (qualitative and quantitative presence of periodontal pathogens) in smokers patients and the response to periodontal therapy. Material and Methods: it was selected scientific articles published between the years 1978 and 2014. We were selected scientific articles from MEDLINE, PUBMED and LILACS databases. Results: there are controversies between tobacco and clinical and microbiological parameters. Conclusion: based on the evaluated studies we can conclude that there are significant clinical and microbiological differences in smoking patients and impaired response to periodontal therapy.

Microbiological analysis of bile in patients with benign and malignant biliopancreatic diseases and its consequences / Análise microbiológica da bile em pacientes com doenças biliopancreáticas benignas e malignas e suas consequências

ABSTRACT Background Bactibilia has several consequences to human health. Objetive Assessing the bile microbiology of patients with biliopancreatic diseases in order to identify bacteria and their possible infectious complications. Methods Retrospective study of 30 bile culture samples from patients with benign and malignant biliopancreatic diseases. The samples were assessed to set the bile microbiological flora and to search for its possible link with comorbidity, carcinogenesis and postoperative infectious complications. Results Thirty bile samples from patients at mean age ≈57.7 years, mostly female (n=18), were assessed. Bactibilia was found in 12 cases, mostly in patients with benign diseases (n=8), older than 50 years (n=23) and female (n=10). Adenocarcinoma of the duodenal papilla (n=9) and cholelithiasis (n=8) were the most common diseases. Escherichia coli (n=5) and Klebsiella sp (n=3) were predominantly found in patients with benign diseases; and Klebsiella sp (n=2) and Streptococcus sp (n=2) were prevalent in cancer patients. There were postoperative infectious complications in seven cases, five of them in bactibilia-associated patients (P=0.084). Conclusion Bactibilia was found in 12 samples and Escherichia coli and Klebsiella sp were most often identified in patients with benign diseases, as well as Streptococcus sp and Klebsiella sp in cancer patients. There was a trend of higher postoperative infectious complication incidence in patients with bactibilia.

RESUMO Contexto Bacteriobilia pode produzir várias consequências para a saúde humana. Objetivo Avaliar a microbiologia da bile de pacientes com doenças biliopancreáticas para identificar bactérias e possíveis consequências. Métodos Estudo retrospectivo microbiológico. Trinta amostras de bile de pacientes com doenças biliopancreáticas benignas e malignas foram avaliadas para determinar a flora microbiológica da bile e procurar alguma possível relação dessa com comorbidades, carcinogênese e complicações infecciosas pós-operatórias. Resultados As amostras de bile foram avaliadas em pacientes, com idade média ≈57,7 anos, a maioria mulheres (n=18). Evidenciou-se bacteriobilia em 12 casos, a maioria em pacientes com doenças benignas (n=8); pacientes com mais de 50 anos (n=23) e mulheres (n=10). As doenças mais comuns foram o adenocarcinoma de papila duodenal (n=9) e a colelitíase (n=8). Escherichia coli (n=5) e Klebsiella sp (n=5) foram as bactérias mais identificadas em pacientes com doenças benignas; sendo a Klebsiella sp (n=2) e o Streptococcus sp (n=2) as que predominaram nos pacientes com cânceres. As complicações pós-operatórias exclusivamente infecciosas ocorreram em sete casos, sendo em cinco desses associados à bacteriobilia (P=0,084). Conclusão Bacteriobilia foi evidenciada em 12 amostras, sendo as bactérias mais identificadas Escherichia coli e Klebsiella sp em pacientes com doenças benignas; e Streptococcus sp e Klebsiella sp nos pacientes com câncer. Existiu uma tendência a maior incidência de complicações infecciosas pós-operatórias em pacientes com bacteriobilia.

Características clínicas y microbiológicas de la infección intra-abdominal complicada en Colombia: un estudio multicéntrico / Clinical and microbiological characteristics of complicated intra-abdominal infection in Colombia: a multicenter study

Introducción: La infección intra-abdominal complicada adquirida en la comunidad (IIAc-AC) es una causa frecuente de abdomen agudo. Objetivo: Identificar el perfil clínico y microbiológico de la IIAc-AC en cuatro hospitales de Colombia. Métodos: Estudio descriptivo, prospectivo entre 07-2012 y 09-2014 en pacientes de 15 o más años con IIAc-AC. Se midieron las frecuencias de variables socio-demográficas, clínicas, diagnóstico, aislamientos y susceptibilidad antimicrobiana del primer cultivo obtenido asépticamente del sitio de infección. Resultados: 192 pacientes incluidos, 62% hombres, edad media 47,3 años; 38,4% con co-morbilidad, 13% hospitalizados en el último año y 9,4% recibieron antimicrobianos en los últimos seis meses. Fueron admitidos 44,3%, por apendicitis 17,7% por peritonitis y 16,7% por perforación intestinal. El 64,1% de las IIAc-AC fue moderada y tratada con ampicilina/sulbactam (SAM) y ertapenem. En 70,8% se aisló al menos un microorganismo en: 65,1% bacilos gramnegativos (80,0% Escherichia coli, 44,8% susceptible a piperacilina/tazobactam, 65,7% a SAM y 11,2% Klebsiella pneumoniae, 85% susceptibles a SAM) y en 16,7% especies grampositivas (28,1% Streptococcus grupo viridans). La mediana de hospitalización fue siete días y 15,1% fallecieron. Conclusión: Escherichia coli y K. pneumoniae en IIAc-AC son los principales microorganismos a cubrir en la terapia empírica y es necesario conocer la susceptibilidad antimicrobiana en cada región para seleccionar un tratamiento empírico adecuado.

Introduction: Complicated community-acquired intra-abdominal infections (CA-cIAI) are a common cause of acute abdomen. Objective: To identify the clinical and microbiology profile of CA-cIAI in four Colombian hospitals. Methods: This is a prospective, descriptive study, between 08-2012 and 09-2014, including patients with CA-cIAI > 15 years. Data collected included: socio-demographic, clinical, diagnosis, and isolates of the first culture obtained aseptically during surgery with antimicrobial susceptibility. Results: 192 patients were included, 62% men, median age 47.3 years. Co-morbidities were present in 38.4%, 13% had been hospitalized in the previous year 13%, and 9.4% had received antibiotics in the last 6 months; 44.3% were admitted for appendicitis, 17.7% for peritonitis and 16.7% for bowel perforation. CA-cIAI were assessed as moderate in 64.1% of the cases and were treated with ampicillin/sulbactam (SAM) and ertapenem. In 70.8% of cases a bacteria was isolated: 65.1% were gramnegative rods (80.0% Escherichia coli, 44.8% of them susceptible to pipercillin/tazobactam, 65.7% to SAM; 11.2 % were K.pneumoniae, 85% was susceptible for SAM; 16.7% were grampositive cocci (28.1% Streptococci viridans group). The median hospital stay was 7 days and 15.1% died. Conclusions: E. coli, K. pneumoniae and S. viridans were the main organisms to consider in an empiric therapy for CA-cIAI and it is important to know the local epidemiology in order to choose the right antibiotic.

Perfil microbiológico de las neumonías asociadas con el ventilador (NAV) en la unidad de terapia intensiva (UTI) de la Clínica Universitaria Bolivariana (CUB), años 2009-2011 / Microbiological profile of ventilator-associated pneumonia (VAP) at the Intensive Care Unit (ICU) of the Clínica Universitaria Bolivariana, 2009-2011 / Perfil microbiológico das pneumonias associadas com o ventilador (NAV) na Unidade de Tratamento intensivo (UTI) da Clínica Universitária Bolivariana (CUB), anos 2009-2011

Objetivo: Describir el perfil microbiológico de las neumonías asociadas con el ventilador (NAV) en la unidad de terapia intensiva (UTI) de la Clínica Universitaria Bolivariana, 2009-2011. Metodología: Estudio descriptivo, retrospectivo de único centro. Diagnóstico microbiológico por aspirado endotraqueal. Las variables cuantitativas se analizaron con medidas de agrupación, media y mediana y de dispersión como la desviación estándar, mínimos y máximos. Las variables categóricas se analizaron como proporciones. Resultados: Ingresaron 34 pacientes, 19 hombres (56%); media de edad de 60 (DE 17.75) y una mediana en el puntaje Apache II de 17 (8-36). Los diagnósticos más frecuentes de ingreso fueron: patología pulmonar (24%), sepsis (18%) y trauma (18%). La Klebsiella pneumoniae (23%) y la Pseudomonas aeruginosa (21%) fueron los gérmenes más frecuentes. Se encontró una correlación del 59% entre los gérmenes aislados y los gérmenes implicados con la NAV tardía. En los cultivos de faringe el Estreptococo viridans fue el principal germen (20%), seguido por la K. pneumoniae (16%) y la Escherichia Coli (16%). Solo hubo una correlación del 38% entre el cultivo de faringe y el aspirado endotraqueal. Conclusiones: La K. pneumoniae y la P. aeruginosa fueron los gérmenes más frecuentes, con una mala correlación entre el cultivo de faringe y el aspirado endotraqueal.

Objective: To describe the microbiological profile of ventilator-associated pneumonia (VAP) at the intensive care unit (ICU) of the Clínica Universitaria Bolivariana from 2009 to 2011. Methodology: A single-center retrospective study was conducted. Endotracheal aspirate was used for microbiological diagnosis. Quantitative variables were described using measures of central tendency, (mean or median) and dispersion, such as standard deviation or range. Categorical variables were analyzed as proportions. Results: Thirty-four patients were included, of which 19 were men (56%); the mean age was 60 (SD17.75); the median APACHE II score was 17 (8-36). The most common diagnoses upon admission were lung disease (24%), sepsis (18%), and trauma (18%). Klebsiella pneumoniae (23%) and Pseudomonas aeruginosa (21%) were the most common germs. We found a correlation of 59% between the isolates and germs associated with late VAP. Streptococcus viridans was the principal germ (20%) in throat cultures, followed by K. pneumoniae (16%) and E. Coli (16%). There was only a 38% correlation between the throat culture and endotracheal aspirates. Conclusions: K. pneumoniae and P. aeruginosa germs were the most frequent, with a poor correlation between the throat cultures and endotracheal aspirates.

Objetivo: Descrever o perfil microbiológico das pneumonias associadas com o ventilador (NAV) na Unidade de Tratamento intensivo (UTI) da Clínica Universitária Bolivariana, 2009-2011. Metodologia: Estudo descritivo, retrospectivo de único centro. Diagnóstico microbiológico por aspirado endotraqueal. As variáveis quantitativas se analisaram com medidas de agrupação, média e mediana e de dispersão como a desvio padrão, mínimos e máximos. As variáveis categóricas se analisaram como proporções. Resultados: Ingressaram 34 pacientes, 19 homens (56%); idade média de 60 anos (DE 17.75) e uma média na pontuação Apache II de 17 (8-36). Os diagnósticos mais frequentes de ingresso foram: patologia pulmonar (24%), sepse (18%) e trauma (18%). A Klebsiella pneumoniae (23%) e a Pseudomonas aeruginosa (21%) foram os gérmenes mais frequentes. Se encontrou uma correlação de 59% entre os gérmenes isolados e os gérmenes implicados com a NAV tardia. Nos cultivos de faringe o Estreptococo viridans foi o principal germe (20%), seguido pela K. pneumoniae (16%) e a Escherichia Coli (16%). Somente houve uma correlação de 38% entre o cultivo de faringe e o aspirado endotraqueal. Conclusões: A K. pneumoniae e a P. aeruginosa foram os gérmenes mais frequentes, com uma má correlação entre o cultivo de faringe e o aspirado endotraqueal.

Detection of Mycobacterium tuberculosis complex by nested polymerase chain reaction in pulmonary and extrapulmonary specimens / Detecção do complexo Mycobacterium tuberculosis por nested polymerase chain reaction em espécimes pulmonares e extrapulmonares

OBJECTIVE: To compare the performance of nested polymerase chain reaction (NPCR) with that of cultures in the detection of the Mycobacterium tuberculosis complex in pulmonary and extrapulmonary specimens. METHODS: We analyzed 20 and 78 pulmonary and extrapulmonary specimens, respectively, of 67 hospitalized patients suspected of having tuberculosis. An automated microbial system was used for the identification of Mycobacterium spp. cultures, and M. tuberculosis IS6110 was used as the target sequence in the NPCR. The kappa statistic was used in order to assess the level of agreement among the results. RESULTS: Among the 67 patients, 6 and 5, respectively, were diagnosed with pulmonary and extrapulmonary tuberculosis, and the NPCR was positive in all of the cases. Among the 98 clinical specimens, smear microscopy, culture, and NPCR were positive in 6.00%, 8.16%, and 13.26%, respectively. Comparing the results of NPCR with those of cultures (the gold standard), we found that NPCR had a sensitivity and specificity of 100% and 83%, respectively, in pulmonary specimens, compared with 83% and 96%, respectively, in extrapulmonary specimens, with good concordance between the tests (kappa, 0.50 and 0.6867, respectively). CONCLUSIONS: Although NPCR proved to be a very useful tool for the detection of M. tuberculosis complex, clinical, epidemiological, and other laboratory data should also be considered in the diagnosis and treatment of pulmonary and extrapulmonary tuberculosis. .

OBJETIVO: Comparar o desempenho da técnica nested polymerase chain reaction (NPCR) com aquele de culturas na detecção do complexo Mycobacterium tuberculosis em espécimes pulmonares e extrapulmonares. MÉTODOS: Analisamos 20 e 78 espécimes pulmonares e extrapulmonares, respectivamente, de 67 pacientes hospitalizados com suspeita de tuberculose. Um sistema automatizado foi utilizado na identificação de culturas de Mycobacterium spp., e M. tuberculosis IS6110 foi utilizada como sequência alvo na NPCR. A estatística kappa foi utilizada para verificar a concordância entre os resultados. RESULTADOS: Entre os 67 pacientes, 6 e 5, respectivamente foram diagnosticados com tuberculose pulmonar e extrapulmonar, e a NPCR foi positiva em todos os casos. Entre os 98 espécimes clínicos, a baciloscopia, cultura e NPCR foram positivas em 6,00%, 8,16% e 13,26%, respectivamente. Comparando-se os resultados da NPCR com aqueles da cultura (padrão ouro) nos espécimes pulmonares, a sensibilidade e a especificidade foram 100% e 83%, respectivamente, enquanto essas nos espécimes extrapulmonares foram 83% e 96% respectivamente, com boa concordância entre os testes (kappa, 0,50 e 0,6867, respectivamente). CONCLUSÕES: Embora a NPCR tenha se mostrado uma ferramenta muito útil na detecção do complexo M. tuberculosis, No entanto, os resultados positivos da NPCR devem ser associados à clínica, dados clínicos, epidemiológicos e outros dados laboratoriais devem também ser considerados no diagnóstico e tratamento da tuberculose pulmonar e extrapulmonar. .

Clinical and microbiological evaluation of one-stage full-mouth disinfection: a short-term study / Avaliação clínica e microbiológica do protocolo one-stage full-mouth disinfection: estudo de curto prazo

Introduction: Patients seem to adhere better to short-term periodontal treatment schemes. Besides, time-reduced treatments are more cost-effective. However, the degree of benefits related to this type of treatment still requires additional investigations. Aim: The present short-term study evaluated clinical and microbiological outcomes, from baseline to 3-months, of chronic periodontitis subjects treated by the one-stage full-mouth disinfection protocol. Material and Method: Sixteen chronic periodontitis subjects (mean-age 49.87 ± 8.22) who met inclusion/exclusion criteria were included. A calibrated examiner measured whole-mouth plaque and gingival indices, periodontal pocket depth and clinical attachment level at baseline and at 3-months. Subgingival samples were also collected from the 5 most diseased periodontal sites to determine total bacterial load and levels of P. gingivalis and S. oralis by real time qPCR. Periodontal treatment consisted of full-mouth manual debridement plus wide intraoral use of chlorhexidine in gel and solution. Additionally, after debridement, individuals rinsed 0.12% chlorhexidine at home twice a day for the following 2 months. Data monitored were compared by paired Student-t test (p<0.05). Result: Statistical analysis revealed that, in general, one-stage full-mouth disinfection treatment provided significant clinical and microbiological improvements at 3-months. Total bacterial load showed one of the most pronounced reductions from baseline to 3-months (p=0.0001). Also, subgingival levels P. gingivalis and S. oralis reduced overtime. Conclusion: After a short period of monitoring, chronic periodontitis subjects showed clinical and microbial improvements following one-stage full-mouth disinfection treatment.

Introdução: Os pacientes parecem aderir melhor ao tratamento periodontal de curto prazo. Além disso, tratamentos de tempo curto possuem melhor custo-benefício. No entanto, os benefícios associados a este tipo de tratamento ainda requerem investigações adicionais. Objetivo: O presente estudo avaliou longitudinalmente indivíduos com periodontite crônica clínica e microbiologicamente tratados pelo protocolo one-stage full-mouth disinfection. Material e Método: Dezesseis indivíduos (49,87 ± 8,22), que se enquadraram nos critérios de inclusão/exclusão foram incluídos. Um examinador calibrado, avaliou índice de placa e gengival, profundidade de bolsa e nível clínico de inserção pré e pós terapia. Amostras subgengivais coletadas dos cinco sítios periodontais mais doentes estabeleceram a carga bacteriana total e níveis de P. gingivalis e S. oralis por qPCR. One-stage full-mouth disinfection foi realizado com instrumentos manuais associado a gel de clorexidina e solução. Após, os indivíduos utilizaram clorexidina 0,12% para bochecho, duas vezes ao dia, durante os dois meses. Dados foram comparados pelo teste pareado t de Student (p<0,05). Resultado: A análise estatística revelou que o tratamento proporcionou melhorias clínicas e microbianas significativas em três meses. A carga bacteriana total evidenciou reduções mais pronunciadas do pré para o pós-tratamento (p=0,0001). Similarmente, P. gingivalis e S. oralis mostraram redução no pós-tratamento. Conclusão: Após 3 meses de monitoramento, indivíduos com periodontite crônica apresentaram melhora clínica e microbiana com o protocolo one stage full-mouth disinfection.

Effect of non-surgical periodontal treatment on the subgingival microbiota of patients with chronic kidney disease

This study investigated the effect of non-surgical periodontal therapy on the composition of subgingival microbiota of patients with chronic kidney disease (CKD). Sixteen CKD pre-dialysis individuals (CKD) and 14 individuals without clinical evidence of kidney disease (C) presenting chronic periodontitis were treated by scaling and root planing. Subgingival samples were collected from each patient and analyzed for their composition by checkerboard at baseline and 3 months post-therapy. Significant differences between groups at baseline were sought by the Mann-Whitney and χ² tests. Changes over time were examined by the Wilcoxon test. At baseline, the CKD group had significantly lower counts of E. faecalis compared to the C group (p < 0.05). After treatment, the levels of a greater number of species were reduced in the C group. Higher levels of A. israelii, C. rectus, F. periodonticum, P. micra, P. nigrescens, T. forsythia, N. mucosa, and S. anginosus (p < 0.05) were found in the CKD group compared to the C group. Also, non-responsive sites in CKD individuals harbored significantly higher levels of pathogenic species (T. forsythia, P. gingivalis, T. denticola, Fusobacterium spp., D. pneumosintes, E. faecalis and S. aureus; p < 0.05) than sites that responded to therapy, as well as non-responsive sites in the C group. The periodontitis-associated subgingival microbiota of CKD and systemically healthy individuals was similar in composition. However, high levels of pathogenic species persisted in the subgingival microbiota of patients with CKD after treatment.

Investigação comparativa de dados clínicos e microbiológicos entre indivíduos geneticamente suscetíveis e não suscetíveis à periodontite / Clinical and microbiological data investigation from individuals genetically susceptible and non-susceptible to periodontitis

A Doença Periodontal (DP) tem caráter multifatorial, com influência da presença de microrganismos periodontopatogênicos, suscetibilidade genética do hospedeiro, entre outros. O tecido periodontal inflamado produz dentre outras citocinas, a Interleucina 8 (IL-8). Na literatura científica há informações conflitantes acerca dos níveis de IL-8 em fluido crevicular gengival de pacientes com e sem DP. Estudos prévios realizados por nosso grupo identificaram que pacientes carregando o haplótipo ATC/TTC no gene IL8 foram 2 vezes mais suscetíveis à DP e que esses pacientes mesmo com menor desafio microbiano, pareciam desenvolver a DP mais exacerbadamente comparados aos indivíduos considerados não suscetíveis à DP pela ausência daquele haplótipo. Como esses resultados foram obtidos de um estudo clínico, estudos in vitro se mostraram necessários para investigar a funcionalidade dos haplótipos no gene IL8. O objetivo deste trabalho foi verificar na literatura científica se os níveis de IL-8 estão aumentados ou não mediante a presença da DP e se, por meio de ensaios in vitro controlados, os mencionados haplótipos no gene IL8 podem influenciar a funcionalidade e expressão deste e outros genes importantes para a resposta imune. Realizamos uma criteriosa revisão sistemática da literatura seguida de meta-análise enfocando a quantificação de mRNA e proteína IL-8 em tecido gengival, saliva e fluido crevicular gengival (FCG) de pacientes com DP comparados a indivíduos periodontalmente saudáveis. Verificamos maior expressão gênica de IL8 e da proteína IL-8 nos tecidos gengivais de pacientes com DP, enquanto níveis proteicos de IL-8 mostraram níveis variáveis na saliva e FCG. Também investigamos em células isoladas do sangue periférico de pacientes carregando diferentes haplótipos no gene IL8, a possível influência destes na expressão de genes do sistema imune. A funcionalidade destes haplótipos no gene IL8 foi também investigada após edição genética em linhagem celular por meio do sistema CRISPR-CAS9 seguida de recombinação homóloga. Conjuntamente observamos que perante estímulos microbianos o haplótipo ATC/TCC foi associado à maior expressão gênica e funcionalidade do gene IL8 em comparação ao outro haplótipo ATT/TCC. Como conclusão geral notou-se que em tecido gengival há concordância na literatura sobre maiores níveis de mRNA e proteicos de IL-8 associados à DP, e que o haplótipo no gene IL8 previamente associado com suscetibilidade à DP mostrou-se funcional influenciando a expressão gênica

Periodontal disease (PD) is a multifactorial disease, influenced by the periodontopathogenic microorganisms' presence, host genetic susceptibility, among others. The inflamed periodontal tissue produces amongst other cytokines the Interleukin8 (IL-8). In the scientific literature there are conflicting information about the IL-8 levels in gingival crevicular fluid of patients with and without DP. Previous studies of our group found that patients carrying the haplotype ATC/TTC in IL8 gene were 2 times more susceptible to PD and these same patients with lower microbial challenge develop PD more exaggeratedly compared to individuals considered not susceptible to PD by absence of that haplotype. As these results were obtained from a clinical study, in vitro studies are necessary to investigate the functionality of the IL8 gene haplotypes. The objective of this study was to investigate whether IL-8 levels are increased or not by the presence of PD and, through controlled in vitro assays, the aforementioned haplotypes in IL8 gene can influence the functionality and expression of this and other important genes to the immune response. We conducted a rigorous literature systematic review followed by meta-analysis focusing on the mRNA and IL-8 protein quantification in gingival tissue, saliva and gingival crevicular fluid (GCF) of patients with PD compared to periodontally healthy individuals. We found a higher IL8 gene expression and IL-8 protein in the gingival tissues of PD patients, whereas protein levels of IL-8 showed varying levels in GCF and saliva. We also investigated cells from the patient's peripheral blood carrying different haplotypes in IL8 gene, their possible influence on the expression genes of the immune system. The functionality of these haplotypes in IL8 gene was also investigated after genetic edition in cell line using CRISPR-CAS9 followed by homologous recombination system. It was observed that against microbial stimuli the ATC/TTC haplotype was associated with increased gene expression and function of the IL8 gene compared to the ATT/TCC haplotype. As a general conclusion it was noted that in gingival tissue there is an agreement in the literature on higher levels of mRNA and protein for IL-8 associated with PD, and that the IL8 haplotype previously associated with susceptibility to chronic periodontitis proved functional, influencing gene expression

The presence of periodontopathogens associated with the tumour necrosis factor-alpha expression in patients with different periodontal status / Presencia de periodontopatogenos asociados con expresión de factor-alpha necrosis tumoral - en pacientes con diferente estado periodontal

El propósito de este trabajo fue fue investigar la relación entreP. gingivalis, T. forsythia, T. denticola, P.intermedia, y A. actinomycetemcomitanspresentes en surcos y/o bolsas de pacientes con gingivitis (G), periodontitis crónica leve (MiCP), periodontitis crónica moderada (MoCP) y periodontitis severa (PS) y la expresi¨®n de TNF-¦Á en tejido gingival segun el estado clínico periodontal. Para ello se seleccionaron seis pacientes con G, 7 con MiCP, 23 con MoCP y 7 con PS. Los patogenos extraidos de los surcos y/o bolsas se identificaron mediante PCR con cebadores especificos para cada especie, Se detectó la expresión de TNF-¦Á en tejido gingival. Se registraron los siguientes parametros clinicos: profundidad al sondaje (PD), perdida de inserción clónica (CAL) y perdida de hueso. Se detectó P. gingivalis con la siguiente frecuencia: 16,6 por ciento en sujetos con G, 57,1 por ciento en MiCP, 57.8 por ciento en MoCP y 58.1 por ciento en PS (p < 0,05). P. intermedia no fue detectada en pacientes con G y A. actinomycetemcomitans fue solamenteidentificado en MoCP (31,5 por ciento) y PS (42.8 por ciento) T denticola y T. forsythia se identificaron en todos los grupos. Las combinaciones bacterianas P. denticola + P. intermedia y P. intermedia + T. forsythia se identificaron asociadas significativamente (p = 0,04, p =0,02) con la presencia de mRNA TNF-¦Á en 20 por ciento y 25 por ciento de los sujetos, respectivamente. P. gingivalis + A. actinomycetemcomitans y A. actinomycetemcomitans + T. forsythia se asociaron con valores de PD y CAL de gravedad. La asociación entre la presencia de P. intermedia y los niveles de expresi¨®n de TNF-¦Á fue significativa(p = 0,05). Estos resultados indican que la proporción de pacientes con P. gingivalis aumenta con la progresión de la enfermedad. Observamos que la presencia de P.intermedia desencadenaria la expresión de TNF-¦Á y provocaria un empeoramiento del estado clinico del paciente.

Diagnóstico diferencial de la rinosporidiosis: a propósito de un caso / Differential diagnosis of rhinosporidiosis: report of a case

Se informa un caso de rinosporidiosis, enfermedad granulomatosa crónica rara, producida por Rhinosporidium seeberi. El paciente fue un hombre procedente de área rural en el departamento de Bolívar (Colombia) que consultó por obstrucción nasal y epistaxis unilateral. Se le encontró una masa nasal de aspecto polipoide vegetante, similar a la de un papiloma invertido rinosinusal, cuya biopsia fue leída como granulomatosis por rinosporidiosis. Se le hicieron resección endoscópica y tratamiento complementario con diaminodifenilsulfona 100 mg/día por tres meses. La evolución fue favorable. Se debe tener en cuenta la rinosporidiosis en el diagnóstico diferencial de las masas nasales benignas no solo en pacientes que proceden de zonas endémicas. El estudio anatomopatológico es imprescindible para el diagnóstico definitivo. Por los casos esporádicos en Colombia se sugiere el reporte epidemiológico para identificar posibles fuentes de contagio y personas con manifestaciones extranasales de esta enfermedad.

We report the case of a man with rhinosporidiosis, an infrequent, chronic granulomatous disease; he lived in a rural area in northwestern Colombia, and came to the hospital because of nasal obstruction and unilateral epistaxis. A polypoid mass was found similar to that of an inverted sinusal papilloma. Biopsy revealed a granulomatous lesion due to rhinosporidiosis. Endoscopic resection was carried out and diaminodiphenylsulfone was administered (100 mg/day for 3 months). Evolution was favorable. Rhinosporidiosis must be taken into account in the differential diagnosis of benign nasal masses, not only in endemic areas. Histopathological study is necessary for diagnosis. We suggest that epidemiological report of rhinosporidiosis cases is done in order to identify possible sources of the infection as well as persons with extra-nasal manifestations of this disease.

Análise microbiológica em secreção de seio maxilar nos pacientes com rinossinusite crônica / Maxillary sinuses microbiology from patients with chronic rhinosinusitis

Não existem dados definitivos e consistentes sobre a real distribuição dos microorganismos presentes em pacientes com Rinossinusite Crônica (RSC). A variabilidade dos resultados de estudos em RSC deve-se às diferentes técnicas utilizadas como método de coleta, variações nos métodos de cultura, uso prévio de antibiótico, dificuldade de se distinguir agentes colonizadores e patogênicos. FORMA DE ESTUDO: Clínico-prospectivo. OBJETIVO: Estudar a incidência dos microrganismos presentes nos pacientes com RSC na nossa região, através da cultura da secreção do seio maxilar, coletada sob visão endoscópica. MATERIAIS E MÉTODOS: Estudo transversal em 62 pacientes com RSC, submetidos à coleta de secreção de seio maxilar por via endoscópica, com material enviado para cultura para diagnóstico microbiológico. RESULTADOS: Das 62 amostras estudadas, em 33 (53,2 por cento) não houve crescimento de microrganismos; 29 (45,2 por cento) apresentaram isolamento de aeróbios; um caso (1,6 por cento) mostrou crescimento de fungo; não houve o isolamento de microrganismos anaeróbios. Pseudomonas aeruginosa foi isolada com maior frequência - em 8 amostras (27,6 por cento), Staphylococcus aureus e Staphylococcus epidermidis em 4 amostras cada um (13,9 por cento), Streptococcus pneumoniae em 3 amostras (10,4 por cento), outros Gram-negativos em 17 amostras (31 por cento). CONCLUSÃO: Pseudomonas aeruginosa, outras bactérias Gram-negativas e Staphylococcus spp constituíram a microbiota predominante nos seios paranasais de pacientes com RSC.

There isn't definitive and consistent data concerning the distribution of bacterial species in patients with Chronic Sinusitis (CS). The variability of the results from studies in CS may be due to the different techniques used as collection method, variations in culture methods, previous antibiotic use, and difficulty in distinguishing bacterial flora from pathogenic agents. STUDY DESIGN: Clinical prospective. AIM: To identify the incidence of microorganisms in patients with CRS by growing bacteria from the secretion of the maxillary sinus. PATIENTS AND METHODS: Cross-sectional study in 62 patients that had undergone FESS for treatment of chronic sinusitis; cultures from the maxillary sinus were obtained. RESULTS: 62 samples, 33 (53.2 percent) had no growth; 29 (45.2 percent) counts of aerobic bacteria; one case (1.6 percent) of fungus growth; we did not find anaerobic bacteria. Pseudomonas aeruginosa was the one more frequently found - 8 samples (27.6 percent), Staphylococcus aureus and Staphylococcus epidermidis in 4 samples each; Streptococcus pneumoniae in 3 samples (10.4 percent); other Gram negative agents in 17 samples (31 percent). CONCLUSION: In the present study we concluded that Pseudomonas aeruginosa, other Gram negatives bacteria and Staphylococcus spp were the representatives of the bacterial flora found in the paranasal sinuses of patients with CS.

The ability of the BANA test to detect different levels of P. gingivalis, T. denticola and T. forsythia

The aim of this study was to evaluate the ability of the BANA Test to detect different levels of Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia or their combinations in subgingival samples at the initial diagnosis and after periodontal therapy. Periodontal sites with probing depths between 5-7 mm and clinical attachment level between 5-10 mm, from 53 subjects with chronic periodontitis, were sampled in four periods: initial diagnosis (T0), immediately (T1), 45 (T2) and 60 days (T3) after scaling and root planing. BANA Test and Checkerboard DNA-DNA hybridization identified red complex species in the subgingival biofilm. In all experimental periods, the highest frequencies of score 2 (Checkerboard DNA-DNA hybridization) for P. gingivalis, T. denticola and T. forsythia were observed when strong enzymatic activity (BANA) was present (p < 0.01). The best agreement was observed at initial diagnosis. The BANA Test sensitivity was 95.54 percent (T0), 65.18 percent (T1), 65.22 percent (T2) and 50.26 percent (T3). The specificity values were 12.24 percent (T0), 57.38 percent (T1), 46.27 percent (T2) and 53.48 percent (T3). The BANA Test is more effective for the detection of red complex pathogens when the bacterial levels are high, i.e. in the initial diagnosis of chronic periodontitis.