RESUMO
People living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) (PLH/PLHA) are increasing worldwide (29.8 million in 2001 and 36.9 million in 2014) mainly owing to the aversion of AIDS related deaths by effective antiretroviral therapy (ART). Although the prevalence is increasing, the new HIV infections decreased from 3.4 million in 2001 to 2 million in 2014, and AIDS-related deaths were decreased from the peak of 2.4 million in 2005 to 1.2 million in 2014. Implementation of ART with wide coverage and free access, especially in low- and middle-income countries is an important reason for the decline of AIDS-related deaths. Further, it is expected that the recent understanding in the mechanisms of latent infection and importance of reservoir could help to achieve a "functional cure" from HIV infection in near future.
Assuntos
Síndrome da Imunodeficiência Adquirida , Infecções por HIV , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/epidemiologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Índia/epidemiologia , PrevalênciaAssuntos
Farmacorresistência Bacteriana/genética , Infecções por Escherichia coli/tratamento farmacológico , Escherichia coli/efeitos dos fármacos , Infecções por Klebsiella/tratamento farmacológico , Klebsiella/efeitos dos fármacos , Carbapenêmicos/uso terapêutico , Escherichia coli/genética , Escherichia coli/patogenicidade , Infecções por Escherichia coli/genética , Infecções por Escherichia coli/microbiologia , Humanos , Índia/epidemiologia , Klebsiella/genética , Klebsiella/patogenicidade , Infecções por Klebsiella/genética , Infecções por Klebsiella/microbiologia , Testes de Sensibilidade Microbiana , beta-Lactamases/genéticaRESUMO
Background: Dengue fever (DF) is caused by an arthropod-borne dengue virus (DENV), has four serotypes and several genotypes. Although having clinical and epidemiological significance, the information on the circulating serotypes/genotypes is scarce in India. Materials and Methods: Blood specimens were collected from the patients suspected of DF and they are tested for DENV NS1 antigen and DENV IgM by ELISA. Antigen-positive samples were further serotyped by reverse transcriptase polymerase chain reaction. Representative samples from each serotype were sequenced to identify the genotypes. Results: All the four DENV serotypes were detected with the pre-dominance of DENV-1 (n = 49; 41.9%). Cases with multiple DENV serotype infections were also identified. Genotyping showed that DENV-1 belonging to genotype I, DENV-2 cosmopolitan (IV), DENV-3 genotype III and DENV-4 genotype I were active in the circulation during the outbreak in 2017. Conclusion: Our study documents the molecular characteristics of DENV circulating in our geographical locality. The detection of heterologous DENV serotypes highlights the importance of regular molecular monitoring for the early recognition of any switch in pre-dominant serotype.
Assuntos
Vírus da Dengue/genética , Dengue/virologia , Variação Genética , Doença Aguda , Adolescente , Adulto , Proteínas do Capsídeo/genética , Criança , Dengue/epidemiologia , Vírus da Dengue/classificação , Vírus da Dengue/imunologia , Surtos de Doenças , Humanos , Imunoglobulina M/sangue , Índia/epidemiologia , Pessoa de Meia-Idade , Filogenia , Análise de Sequência de DNA , Sorogrupo , Adulto JovemRESUMO
OBJECTIVES: The emergence and dissemination of carbapenem-resistant Enterobacteriaceae (CRE) is an important public health problem. This study aimed to understand the prevalence and mechanisms of carbapenem resistance in clinically important members of Enterobacteriaceae in rural South India. METHODS: Routine clinical isolates of Escherichia coli and Klebsiella spp. were tested for Ertapenem (ETP) non-susceptibility by the disk diffusion method over a 3-year period (2012-2014). The ETP non-susceptible isolates were preserved, and tested for the MIC of carbapenems and the carriage of major carbapenemase-encoding genes. Representative genes were sequenced and selective isolates were tested for the production of carbapenemase by carbapenem inactivation method. RESULTS: A total of 444 ETP non-susceptible isolates were identified in increasing incidence over the study period. Among them, MIC50 and MIC90 of carbapenems (excluding ETP) were 0.25-0.5µg/mL and 8-16µg/mL, respectively, and the prevalence of non-ETP carbapenem resistance was estimated as 3%. Among the 177 tested isolates, 65 (37%) had one or more carbapenemase-encoding genes with a predominance of New Delhi Metallo-ß-lactamase (NDM; 32 of 65; 49.2%). CONCLUSIONS: This study documented the MIC range for carbapenems, prevalence and mechanisms of carbapenem resistance among Enterobacteriaceae in rural South India. It substantiated NDM as a leading mechanism of carbapenem resistance and highlighted the importance of MIC testing in patient management.
Assuntos
Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Enterobacteriáceas Resistentes a Carbapenêmicos/efeitos dos fármacos , Enterobacteriáceas Resistentes a Carbapenêmicos/genética , beta-Lactamases/genética , Proteínas de Bactérias/metabolismo , Enterobacteriáceas Resistentes a Carbapenêmicos/enzimologia , Carbapenêmicos/farmacologia , Estudos Transversais , Farmacorresistência Bacteriana Múltipla , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/microbiologia , Escherichia coli/efeitos dos fármacos , Escherichia coli/enzimologia , Humanos , Índia/epidemiologia , Klebsiella/efeitos dos fármacos , Klebsiella/enzimologia , Testes de Sensibilidade Microbiana , Prevalência , População Rural , beta-Lactamases/metabolismoRESUMO
BACKGROUND: While the spectrum of opportunistic infections due to HIV infection has been widely discussed, there are very limited data available in south India on certain incident infections especially urinary tract infections (UTI) in HIV-infected subjects. METHODS: Bacterial aetiology of 350 symptomatic UTI in HIV-infected subjects and the drug resistance pattern of the Escherichia coli isolates tested between June 2005 and July 2007 at the YRG Centre for AIDS Research and Education, a tertiary HIV Referral Centre in Chennai has been described here. RESULTS: E. coli was the most common etiological agent of UTI in HIV patients, followed by Staphylococcus aureus, Klebsiella pneumoniae, Enterococcus faecalis, Pseudomonas aeruginosa, Proteus spp. and Staphylococcus epidermidis. Twenty-nine E. coli isolates were multi-drug-resistant and 83.3% of the isolates were resistant to sulfamethoxazole-trimethoprim. CONCLUSIONS: Urinary pathogens in HIV-infected patients demonstrate high antimicrobial resistance and with majority of therapy for UTIs being empiric, constant updates of the aetiological agents and their drug susceptibility pattern would largely be beneficial to clinicians in choosing the right drug.
Assuntos
Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Infecções por Escherichia coli/tratamento farmacológico , Escherichia coli/efeitos dos fármacos , Infecções por HIV/microbiologia , Infecções Urinárias/tratamento farmacológico , Adolescente , Adulto , Idoso , Anti-Infecciosos Urinários/uso terapêutico , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Índia/epidemiologia , Pessoa de Meia-Idade , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologiaRESUMO
Gut immune components are severely compromised among persons with AIDS, which allows increased translocation of bacterial lipopolysaccharides (LPS) into the systemic circulation. These microbial LPS are reportedly increased in chronically HIV-infected individuals and findings have correlated convincingly with measures of immune activation. Immune reconstitution inflammatory syndrome (IRIS) is an adverse consequence of the restoration of pathogen-specific immune responses in a subset of HIV-infected subjects with underlying latent infections during the initial months of highly active antiretroviral treatment (HAART). Whether IRIS is the result of a response to a high antigen burden, an excessive response by the recovering immune system, exacerbated production of pro-inflammatory cytokines or a lack of immune regulation due to inability to produce regulatory cytokines remains to be determined. We theorize that those who develop IRIS have a high burden of proinflammatory cytokines produced also in response to systemic bacterial LPS that nonspecifically act on latent mycobacterial antigens. We also hypothesize that subjects that do not develop IRIS could have developed either tolerance (anergy) to persistent LPS/tubercle antigens or could have normal FOXP3+ gene and that those with defective FOXP3+ gene or those with enormous plasma LPS could be vulnerable to IRIS. The measure of microbial LPS, anti-LPS antibodies and nonspecific plasma cytokines in subjects on HAART shall predict the role of these components in IRIS.
RESUMO
OBJECTIVE: To measure the frequency of antimicrobial resistance in pediatric blood culture isolates of Escherichia coli and Klebsiella spp. with focus on carbapenem resistance. METHODS: Over a period of three years, pediatric blood culture isolates were tested for antimicrobial susceptibility, including molecular investigations for carbapenem resistance. RESULTS: Amikacin, carbapenems, colistin and tigecycline had an antimicrobial efficacy of >70% (n=140). 7 of the 15 randomly selected isolates were positive for carbapenemase gene; among them, five were New Delhi Metallo b-lactamase (NDM). CONCLUSION: There was a high prevalence of Klebsiella spp. in pediatric bacteremia and dissemination of NDM-mediated carbapenem resistance in pediatric wards.
Assuntos
Antibacterianos/farmacologia , Bacteriemia , Enterobacteriáceas Resistentes a Carbapenêmicos/efeitos dos fármacos , Farmacorresistência Bacteriana , Infecções por Enterobacteriaceae , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Criança , Pré-Escolar , Estudos Transversais , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/microbiologia , Escherichia coli/efeitos dos fármacos , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Klebsiella/efeitos dos fármacos , Testes de Sensibilidade MicrobianaRESUMO
OBJECTIVES: The aim of this study was to validate the use of LML antimicrobial gradient strips for quantitative determination of carbapenem susceptibility in Enterobacteriaceae. METHODS: A total of 95 non-redundant Enterobacteriaceae strains isolated during 2012-2014 were used for this validation study. Initially, LML antimicrobial gradient strips were validated for their performance in comparison with the agar dilution method. The test strip was then validated in comparison with broth microdilution (BMD) and Etest with 24 selected strains using the same inocula and other laboratory parameters. RESULTS: The LML strip showed 83%, 68% and 86% essential agreement (within ±1 log2 dilution) with the reference methods of agar dilution, BMD and Etest, respectively; furthermore, essential agreement was >90% within ±2 log2 dilution. Categorical agreement was ≥87% with all reference methods according to Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints. However, the meropenem strip requires performance improvements to fulfil US Food and Drug Administration (FDA) and International Organization for Standardization (ISO) requirements for an antimicrobial susceptibility test device. CONCLUSIONS: In LML antimicrobial gradient strip minimum inhibitory concentrations (MICs) were comparable with Etest MICs and it might serve as a reasonable, cost-effective alternative to Etest for quantitative determination of carbapenem susceptibility in Enterobacteriaceae.
Assuntos
Anti-Infecciosos/farmacologia , Carbapenêmicos/farmacologia , Enterobacteriaceae/efeitos dos fármacos , Testes de Sensibilidade Microbiana/métodos , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão/instrumentação , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão/métodos , Farmacorresistência Bacteriana , Humanos , Testes de Sensibilidade Microbiana/instrumentação , Projetos Piloto , Análise de Regressão , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeAssuntos
Resistência a Ampicilina , Antibacterianos/uso terapêutico , Enterococcus faecium/efeitos dos fármacos , Administração Oral , Antibacterianos/administração & dosagem , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Enterococcus faecium/isolamento & purificação , Trato Gastrointestinal/microbiologia , HumanosRESUMO
The emergence and dissemination of antimicrobial resistance (AMR) is an important public health problem as resistant organisms cause difficult-to-treat infections. In this study, the prevalence of AMR in Escherichia coli and Klebsiella spp. in rural South India was examined in order to aid empirical therapy. A cross-sectional prospective study was conducted during the period from January 2012 to December 2014. Routine clinical isolates of E. coli and Klebsiella spp. were tested for antimicrobial susceptibility to ß-lactams, aminoglycosides, fluoroquinolones, tetracyclines, colistin and nitrofurantoin by the Kirby-Bauer disk diffusion method and the data were documented and analyzed with one per patient analysis using WHONET software. A total of 2292 non-duplicate clinical isolates were recovered during the study period, including 1338 E. coli and 954 Klebsiella spp. The prevalence of AMR in the total isolates was as follows: amikacin, 17.3%; ertapenem, 14.4%; doripenem, 4.5%; colistin, 13.2%; and tigecycline, 4.1%. The study results indicate a high prevalence of carbapenem resistance in Klebsiella spp. especially from pus and urinary isolates, whilst the prevalence of aztreonam and fluoroquinolone resistance was very high in E. coli.
Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Escherichia coli/efeitos dos fármacos , Klebsiella/efeitos dos fármacos , Estudos Transversais , Humanos , Índia , Testes de Sensibilidade Microbiana , Prevalência , Estudos ProspectivosAssuntos
Aminoglicosídeos/farmacologia , Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Enterococcus faecalis/efeitos dos fármacos , Enterococcus faecium/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/epidemiologia , Aminoglicosídeos/uso terapêutico , Antibacterianos/uso terapêutico , Enterococcus faecalis/isolamento & purificação , Enterococcus faecium/isolamento & purificação , Fezes/microbiologia , Gentamicinas/farmacologia , Gentamicinas/uso terapêutico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Índia/epidemiologia , Testes de Sensibilidade Microbiana/normas , Prevalência , Estreptomicina/farmacologia , Estreptomicina/uso terapêuticoAssuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções por Uncinaria/complicações , Isospora , Isosporíase/complicações , Strongyloides stercoralis , Estrongiloidíase/complicações , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Adulto , Animais , Contagem de Linfócito CD4 , Feminino , Infecções por Uncinaria/imunologia , Humanos , Isosporíase/imunologia , Estrongiloidíase/imunologiaAssuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Enterobacteriaceae/efeitos dos fármacos , Ertapenem/farmacologia , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Infecções por Enterobacteriaceae/microbiologia , Humanos , Índia , Testes de Sensibilidade Microbiana , Estudos ProspectivosRESUMO
INTRODUCTION: Constant vigilance of the dynamics of HIV prevalence is important in estimating, regulating, and implementing prevention programs. The objective of this study was to investigate the trend in the prevalence of HIV infection over six years among specific demographic groups in the remote district of southern India. METHODOLOGY: All high-risk attendees of the Integrated Counseling and Testing Centre, Government Theni Medical College between April 2005 and December 2010 were included in this study. Characteristics including age, sex, place of residence, literacy, and HIV sero-status were collected as per the guidelines of the National AIDS Control Organization. RESULTS: A total of 50,043 data sets were analyzed; 3,282 (6.6%) tested positive for HIV infection. The prevalence of HIV infection among the ≤ 25 age group was significantly lower as compared to the elderly (4.4% vs. 6.9%; odds ratio 0.62; 95% confidence interval 0.55-0.71; p < 0.01). There was a decline in HIV prevalence among both age groups (P(trend) < 0.01 for ≤ 25 year-old; -82.3% and P(trend) < 0.01 for > 25-year old, -14.2%), males (P(trend) < 0.01; -50.9%), the urban population (P(trend) < 0.01; -45.9%), and illiterates (P(trend) < 0.01; -68%). The trend of HIV prevalence among females (P(trend) = 0.48; +9.1%), the rural population (P(trend) = 0.95; -7.1%), and literate population (P(trend) = 0.44; +28%) was statistically insignificant. CONCLUSION: HIV prevalence is stable in the female population, while it is decreasing in male population, indicating that current interventions must be strengthened to reduce HIV prevalence among females.