Bacteraemia due to extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) in cancer patients: clinical features, risk factors, molecular epidemiology and outcome

OBJECTIVES

To assess the clinical features, risk factors, molecular epidemiology and outcome of extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) bacteraemia in hospitalized cancer patients.

METHODS

Episodes of ESBL-EC bacteraemia were compared with a susceptible control group in a 3 year prospective study. ESBL-EC strains were studied by PCR and isoelectric focusing, and molecular typing was performed by PFGE.

RESULTS

Out of 531 episodes of bacteraemia, 135 were caused by E. coli. Seventeen of these cases involved ESBL-EC-producing strains (12.6%). In the multivariate analysis, female gender [odds ratio (OR) 3.43; 95% confidence interval (CI) 1.03-11.4] and previous antibiotic therapy (OR 3.22; 95% CI 1.00-10.3) were found to be independent risk factors for ESBL acquisition. An analysis of ESBL-EC isolates revealed a polyclonal distribution with CTX-M predominance (59%). Patients with ESBL-EC bacteraemia were more likely to have received an inadequate empirical antibiotic therapy (65% versus 6%; P = 0.000), and the time to adequate therapy was longer in this group (0 versus 1.50 days; P = 0.000). The overall mortality rate was 22%, ranging from 20% to 35% (P = 0.20). Risk factors for mortality were solid tumour (OR 19.41; 95% CI 4.66-80.83), corticosteroid therapy (OR 3.04 95% CI 1.05-8.81) and intensive care unit admission (OR 248.24, 95% CI 18.49-3332.14). In neutropenic patients, ESBL-EC bacteraemia was associated with poorer outcome and a higher overall mortality rate (37.5% versus 6.5%; P = 0.01).

CONCLUSIONS

In our centre, ESBL-EC bacteraemia is frequent among cancer patients, especially in those exposed to antibiotic pressure. All ESBL-EC strains were unrelated and most of them carried a CTX-M group enzyme. Patients with ESBL-EC bacteraemia received inadequate empirical antibiotic therapy more frequently than patients carrying a susceptible strain, but significant differences in mortality could not be demonstrated.

Could the bug Triatoma sherlocki be vectoring Chagas disease in small mining communities in Bahia, Brazil?

Searches for Chagas disease vectors were performed at the type locality from which Triatoma sherlocki Papa et al. (Hemiptera: Reduviidae: Triatominae) was described in the municipality of Gentio do Ouro, in the state of Bahia, Brazil, and in a small artisan quarry-mining community approximately 13 km distant in a remote area of the same municipality. The latter site represents a new locality record for this species. Adults, nymphs and exuviae of T. sherlocki were found in 21% of human dwellings, indicating that the species is in the process of domiciliation. Prevalence of Trypanosoma cruzi infection in collected bugs was 10.8%. Simple predictive approaches based on environmental similarity were used to identify additional sites likely suitable for this species. The approach successfully predicted an additional five sites for the species in surrounding landscapes. Ecological and entomological indicators were combined to discuss whether this scenario likely represents an isolated case or an emerging public health problem.

Tuberculosis in a child - search for the infected adult nearby; case report, Portugal, 2007

Tuberculosis (TB) transmission in a non-household setting is difficult to detect, because contact with the source case is often not obvious. Here, we report on a case of a four-year-old child who got infected through sporadic non-household exposure at a coffee shop. The source case was a woman who had suffered from weight loss, productive cough and fatigue for two months before being diagnosed with TB. Screening the child s contacts revealed two active TB cases within its family. Overall 148 contacts were screened for both cases and 18 cases of latent TB infection detected. The connection between the child and the source case, who were not aware of their contact, was confirmed by molecular fingerprinting. Our case report illustrates the difficulty in detecting non-household transmission between individuals that do not have significant contact, and draws attention to the need to look for the infected adult whenever a child falls ill with TB. This report is a reminder of the importance to consider possibly neglected ways of TB transmission and highlights once again the need of early diagnosis of TB.

Tuberculosis in a child – search for the infected adult nearby; case report, Portugal, 2007

Tuberculosis (TB) transmission in a non-household setting is difficult to detect, because contact with the source case is often not obvious. Here, we report on a case of a four-year-old child who got infected through sporadic non-household exposure at a coffee shop. The source case was a woman who had suffered from weight loss, productive cough and fatigue for two months before being diagnosed with TB. Screening the child’s contacts revealed two active TB cases within its family. Overall 148 contacts were screened for both cases and 18 cases of latent TB infection detected. The connection between the child and the source case, who were not aware of their contact, was confirmed by molecular fingerprinting. Our case report illustrates the difficulty in detecting non-household transmission between individuals that do not have significant contact, and draws attention to the need to look for the infected adult whenever a child falls ill with TB. This report is a reminder of the importance to consider possibly neglected ways of TB transmission and highlights once again the need of early diagnosis of TB.

Tuberculosis in a shopping centre, Portugal, 2004-5

Genotyping enables to confirm or exclude a tuberculosis (TB) cluster. Excluding the link between cases is particularly important in countries with intermediate/high incidence of TB where the emergence of several TB cases in a particular location in space or time (higher than the expected) could be explained by chance alone. During 2004 and 2005, five TB cases occurred in five shops of a Portuguese shopping centre which employed a total of about 1000 workers. After an epidemiological survey, 52 close contacts were identified and screened. Latent tuberculosis infection was diagnosed in 10 contacts (eight family members and two work colleagues of cases). Genotyping of the Mycobacterium tuberculosis isolates revealed no link between the cases. For this reason no screening of all staff of the shopping centre was carried out. However, close contacts (52) and all fellow workers (1000) were kept under surveillance for two years, and no additional cases were diagnosed. The present analysis demonstrates that the exclusion of a chain of ongoing transmission by genotyping for the investigation of a cluster is cost-effective from the perspective of the public health service, because it allows to avoid unnecessary large scale screening operation and instead to direct resources to more effective measures of TB control.

Tuberculosis in a shopping centre, Portugal, 2004-5

Genotyping enables to confirm or exclude a tuberculosis (TB) cluster. Excluding the link between cases is particularly important in countries with intermediate/high incidence of TB where the emergence of several TB cases in a particular location in space or time (higher than the expected) could be explained by chance alone. During 2004 and 2005, five TB cases occurred in five shops of a Portuguese shopping centre which employed a total of about 1000 workers. After an epidemiological survey, 52 close contacts were identified and screened. Latent tuberculosis infection was diagnosed in 10 contacts (eight family members and two work colleagues of cases). Genotyping of the Mycobacterium tuberculosis isolates revealed no link between the cases. For this reason no screening of all staff of the shopping centre was carried out. However, close contacts (52) and all fellow workers (1000) were kept under surveillance for two years, and no additional cases were diagnosed. The present analysis demonstrates that the exclusion of a chain of ongoing transmission by genotyping for the investigation of a cluster is cost-effective from the perspective of the public health service, because it allows to avoid unnecessary large scale screening operation and instead to direct resources to more effective measures of TB control.

Genetic polymorphism in Trypanosoma cruzi I isolated from Brazilian Northeast triatomines revealed by low-stringency single specific primer-polymerase chain reaction

Different molecular markers have been employed for typing Trypanosoma cruzi strains from endemic areas of Chagas disease. The low-stringency single specific primer-polymerase chain reaction (LSSP-PCR) has been a sensitive and informative technique that uses the variable region of kinetoplast DNA minicircles as a genetic marker, allowing detection of DNA sequence variation. In the present study, we analyzed the intra-lineage genetic variability of the T. cruzi strains obtained from triatomine feces collected on filter paper FTA card by LSSP-PCR. The hybridization of the PCR products with a probe for the subgenus Schizotrypanum and a clone-specific probe from Dm28c confirmed the subgenus as T. (S.) cruzi and respective lineages as T. cruzi I. Phenetic analysis showed the presence of three clusters that diverged by different coefficients of similarity. Thirteen T. cruzi I genotypes were observed circulating among Triatoma pseudomaculata and Rhodnius nasutus from peridomiciliary and natural environments in five peri-urban and urban localities of Jaguaruana, Ceará, Brazil. These data indicate the importance of the circulation of T. cruzi I genotypes among T. pseudomaculata and R. nasutus in different environments and the possible risk of Chagas disease domestic transmission.

Sub-cellular partitioning of Zn, Cu, Cd and Pb in the digestive gland of native Octopus vulgaris exposed to different metal concentrations (Portugal)

Concentrations of Zn, Cu, Cd and Pb and their sub-cellular distributions were determined in composite samples of digestive glands of the common octopus, Octopus vulgaris caught from two areas of the Portuguese coast characterised by contrasting metal contamination. Minor contents of Zn (1%), Cu (2%), Cd (6%) and Pb (7%) were found in the insoluble fraction, consisting of nuclei, mitochondria, lysosomes and microsome operationally separated from the whole digestive gland through a sequential centrifugation. A tendency for linear relationships between metal concentrations in nuclei, mitochondria, lysosomes and whole digestive gland was observed. These relationships suggest that despite low metal content organelles responded to the increasing accumulated metals, which means that detoxifying mechanism in cytosol was incomplete. Poorer correlations between microsome and whole digestive gland did not point to metal toxicity in the analysed compartments. However, the high accumulated Cd indicated that O. vulgaris is an important vehicle of this element to its predators in the coastal environment.

Comparison of the sedative, cognitive, and analgesic effects of nitrous oxide, sevoflurane, and ethanol

BACKGROUND

Anaesthetics which work by different mechanisms may have different patterns of effect. Measurement of these patterns thus may elucidate their mechanisms of action and allow therapeutic choices between the agents.

METHODS

We compared the effects of ethanol (approximately 80 mg per 100 ml), and different end-tidal concentrations of nitrous oxide (15% and 25%) and sevoflurane (0.3% and 0.5%) in volunteers. We measured speed and accuracy in psychomotor tests, reaction time and memory, touch and pain sensitivity to von Frey filaments, and subjective mood for a range of descriptors.

RESULTS

All treatments caused the same degree of overall abnormal feelings, but sevoflurane caused more obtunding (subjective drowsiness, slow reaction times, and loss of memory function) and nitrous oxide was more analgesic. Ethanol caused a marked feeling of drunkenness, but little drowsiness or analgesia.

CONCLUSIONS

In the same volunteer subjects, direct comparison of sub-anaesthetic doses of these agents showed a clear and characteristic pattern of effects. These support the possible mechanisms for these disparate agents and may help choose appropriate agents for specific desired anaesthetic outcomes such as sedation or analgesia.

Avaliação de dois sensores portáteis para mensuração da glicemia em cães

Avaliou-se a precisão analítica e clínica de dois sensores portáteis para mensuração da glicemia em cães. Os valores da mensuração da glicemia obtidos com os sensores foram comparados com aqueles obtidos pelo método padrão da glicose oxidase, por meio da análise de correlação e da análise da grade de erros. Os resultados gerados pelos sensores não foram diferentes do método padrão. Conclui-se que ambos os sensores são adequados para mensuração da glicemia em cães.

Histopathology of graft versus host disease of the liver

AIMS

To analyse the histological features of 33 patients (48 biopsy specimens) with a clinicopathological diagnosis of graft vs. host disease of the liver (L-GVHD).

RESULTS

The time of biopsy post-haematopoietic stem cell transplantation (HSCT) ranged from 22 to 1082 days (median 144 days). Bile duct damage (BDD) was present in all biopsies except one. The bile duct to portal ratio ranged from 0.3 to 1 (median 0.8). Moderate/severe lobular hepatitis was present in 11 biopsies. Endotheliitis was present in four biopsies (8%). The majority of the biopsies showed none [25 (52%)] or mild [17 (35%)] fibrosis. The only significant difference between biopsies earlier ("acute") or later ("chronic" GVHD) than 100 days post-HSCT was the presence of portal inflammation in the "chronic" GVHD group.

CONCLUSION

BDD is the predominant change in L-GVHD. In about a quarter of biopsies the appearance may be of a lobular hepatitis. L-GVHD is not a fibrogenic process. The significance of separating acute versus chronic L-GVHD based on a cut-off of 100 days post-HSCT is questionable. Further studies are needed to understand the relationships between the mechanisms of BDD, bile duct loss and regeneration.

[Pulmonary function in Portuguese firefighters]

INTRODUCTION

Portugal has had a high rate of forest fires in recent years. Inhaled wood smoke can have short- and long-term effects on the lung function of people exposed to it.

STUDY OBJECTIVES

To assess the lung function of active wildland (forest) firefighters.

METHODS

Cross-sectional study. A self-questionnaire on personal and work habits was used and spirometry values were obtained using Piko-6 for a 209 people sample.

RESULTS

We found a high rate of smoking (42.9%) and an 11.8% prevalence of obstruction. 41.7% of the obstructed individuals were non-smokers, did not state a knowledge of any respiratory disease, engaged in no other activity that could be related to lung function decrease and did not wear airway protection apparatus. 85.7% did not use any airway protection apparatus when firefighting due to lack of such equipment in their brigades.

CONCLUSIONS

Data showed that there is a high pre- valence of smoking habits in this sample of Portuguese firefighters; there is an unsatisfactory usage of airway protection apparatus and the prevalence of airway obstruction is higher than the COPD prevalence in the Portuguese population. We recommend stopping smoking and use of equipment for respiratory protection.

Eritrocitose associada a tumor venéreo transmissível em cão: relato de caso

Descreve-se um caso de eritrocitose absoluta (hematócrito: 74%, hemoglobina: 24,2g/dl) em um cão com tumor venéreo transmissível cutâneo. A concentração de hemoglobina e o hematócrito retornaram ao valor normal após o tratamento com vincristina. A remissão da eritrocitose após o tratamento é sugestiva de uma associação entre o tumor e a alteração hematológica.

The Importance of Age, Fludarabine, and Total Body Irradiation in the Incidence and Severity of Chronic Renal Failure after Allogeneic Hematopoietic Cell Transplantation

Nonmalignant late effects, including chronic renal failure (CRF), impair the quality of life of long-term survivors after allogeneic hematopoietic cell transplantation. One of the major risk factors is the use of total body irradiation (TBI) in the preparative regimen; TBI is currently fractionated in an attempt to reduce toxicity. We analyzed 241 patients who had TBI-based preparative regimens for allogeneic hematopoietic cell transplantation. TBI was delivered as a single fraction of 7.5 Gy (7.5S group), 12 Gy in 6 fractions (12F group), or 14.4 Gy in 8 fractions (14.4F group). The cumulative incidence of CRF at 2 years was 12%. Statistical analysis revealed that older age (P < .001) and fludarabine administration (P = .016) had a significant effect on the incidence of CRF. Furthermore, single-fraction TBI was also significantly associated with CRF severity, because 7 (6.3%) of 111 patients in the 7.5S group developed severe CRF, as opposed to 1 (0.8%) of 130 patients in the 12F and 14.4F groups combined (P = .044). However, these conclusions should be regarded as preliminary in view of the retrospective and nonrandomized nature of this study.

Trypanosoma cruzi: Influence of predominant bacteria from indigenous digestive microbiota on experimental infection in mice

To verify the influence of some predominant components from indigenous microbiota on systemic immunological responses during experimental Chagas disease, germ-free NIH Swiss mice were mono-associated with Escherichia coli, Enterococcus faecalis, Bacteroides vulgatus or Peptostreptococcus sp. and then infected with the Y strain of Trypanosoma cruzi. All the mono-associations predominantly induced a Th1 type of specific immune response to the infection by T. cruzi. A direct correlation was observed between a higher survival rate and increased IFN-gamma and TNF-alpha production (P<0.05) in E. faecalis-, B. vulgatus-, and Peptostreptococcus-associated mice. Moreover, higher levels of anti-T. cruzi IgG1 and anti-T. cruzi IgG2a were also found in mono-associated animals after infection. On the other hand, with the exception of E. faecalis-associated mice, mono-association induced a lower IL-10 production after infection (P<0.05) when compared with germ-free animals. Interestingly, spleen cell cultures from non-infected germ-free and mono-associated mice spontaneously produced higher levels (P<0.05) of IL-10 than cultures from infected mono-associated mice, except again for E. faecalis-associated animals. In conclusion, the presence of the components of the indigenous microbiota skews the immune response towards production of inflammatory cytokines during experimental infection with T. cruzi in gnotobiotic mice. However, the degree of increase in production of cytokines depends on each bacterial component.

Positional isomers of sulfated oligosaccharides obtained from agarans and carrageenans: preparation and capillary electrophoresis separation

Partial reductive hydrolysis was used to produce oligosaccharide alditols from repetitive sulfated galactans obtained from four Rhodophyta species: kappa-carrageenan (from Kappaphycus alvarezii), theta-carrageenan (Gigartina skottsbergii-alkali-treated lambda-carrageenan), agarose 6-sulfate (Gracilaria domingensis), and pyruvylated agarose 2-sulfate (Acanthophora spicifera-alkali-treated pyruvylated agaran sulfate). Each hydrolyzate was submitted to anion-exchange and gel-filtration chromatography, and the isolated oligosaccharide alditols were identified by 1D and 2D NMR spectroscopy and by ESI mass spectrometry. The positional isomers of the sulfated oligosaccharide alditols were then completely resolved by capillary electrophoresis in a borate buffer. Attempts to correlate the availability of the hydroxyl groups for borate complexation with the relative migration of the oligosaccharides are presented.

Effect of Bifidobacterium longum ingestion on experimental salmonellosis in mice

AIMS

The effect of lactic acid bacteria on the immune system is well established under normal conditions and generally by in vivo determinations, but few data are available, in vivo, during an infectious challenge. The objective of this study was to obtain data on the putative protective role of bifidobacteria upon challenge with an intestinal pathogen.

METHODS AND RESULTS

The effect of oral treatment with Bifidobacterium longum Bb46 on intragastric challenge with Salmonella Typhimurium was studied. Faecal bacterial levels were determined in gnotobiotic (GN) mice and mortality, histopathology (intestines, liver), immunoglobulin levels (IgM, IgG, IgG1, IgG2a) and cytokine production (IFN-gamma, IL-10) were determined in conventional (CV) mice. Conventional mice received 0.1 ml probiotic milk (10(8) CFU) daily, 10 days before the oral pathogenic challenge (10(2) CFU). Then, probiotic treatment was continued until the end of the experiment. Probiotic treatment in germ-free mice consisted of a single dose at the beginning of the experiment. Control groups were treated with sterile skim milk and submitted to the same procedure. A higher survival (40%) was observed for probiotic-treated animals when compared with the control group (0%). This protective effect was confirmed by the histopathological and morphometric data. However, S. Typhimurium population levels in the faeces were similar among control and probiotic-treated groups. During the challenge with S. Typhimurium, a decrease in IFN-gamma and IgG2a productions was observed in probiotic-treated mice.

CONCLUSIONS

The protective effect against the pathogenic challenge may be due to a reduced inflammatory response, mediated by the probiotic treatment, but not to a population antagonism.

SIGNIFICANCE AND IMPACT OF THE STUDY

Results suggest that dietary supplementation with B. longum could provide benefits against enteric infection.