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

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The aim of this work was to determine the susceptibility, molecular profile, and clonal relationship in Streptococcus agalactiae (group B Streptococcus [GBS]) isolated from vaginal-rectal swab samples. We worked with 200 isolates collected from pregnant women between 35 and 37 weeks of gestation. The macrolide-lincosamide-streptogramin B (MLSB) resistance phenotypes were determined using the double-disc assay. Susceptibility to erythromycin (ERI) and clindamycin (CLI) was performed with the E-test. Resistance genes ermB and ermTR were detected by polymerase chain reaction. Clonal studies were performed using the random amplification of polymorphic DNA. Twelve (6%) of the isolates were resistant to ERI and 10 (5%) of them to CLI. Fifty percent of the resistant strains corresponded to serotype III, 25% to serotype V, and the remaining 25% to serotype Ia, II, and nontypeable strains. The cMLSB phenotype was detected in eight strains (66.67%) and the iMLSB phenotype in four (33.33%). The minimum inhibitory concentration values were between 1.5 and 16 µg/mL for ERI, and between 1 and 32 µg/mL for CLI. Out of the 25 strains susceptible to ERI and CLI, the presence of the ermB gene was detected in eight of them and the ermTR gene in one strain. The ermB gene was detected in the 12 strains that initially had some macrolide resistance phenotype. The ermTR gene was detected in three out of the four strains with the iMLSB phenotype. The resistance to macrolides in the province of Misiones is due to multiclonal spread. The phenotypic and genotypic characterization of macrolide resistance in GBS strains are crucial to contribute to the correct intrapartum prophylactic antibiotic therapy of allergic pregnant women and the epidemiological surveillance of these strains.

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Streptococcus agalactiae (GBS) cause severe infections in newborns under three months. Meningitis, pneumonia and sepsis are the main infectious diseases in these children. These infections are among the most serious that an individual can suffer in his first twelve hours of life. The child acquires the infection by vertical transmission of the colonized mother. To prevent neonatal disease, penicillin is recommended as the drug of choice for intrapartum prophylaxis (PIP) in pregnant women colonized. However, strains with decreased susceptibility to penicillin have been detected so it is important to monitor the susceptibility to penicillin to ensure its usefulness during prophylaxis. The aim of this study was to determine the sensitivity to penicillin in GBS strains recovered from pregnant women with 35-37 weeks of gestation. Ninety-six isolates were studied and sensitivity was determined by the epsilometric method Etest® (LIOFILCHEM, Italy), following the recommendations of the Clinical Laboratory Standards Institute (CLSI). Minimum Inhibitory Concentration (MIC) was obtained for each bacterial isolation. 100% (96) of the strains studied were sensitive to penicillin with MIC values between 0.012 and 0.094 ?g mL-1. These results indicate that penicillin remains the antimicrobial of choice during intrapartum prophylaxis, for the prevention of neonatal disease caused by GBS in our region. The importance of epidemiological surveillance of sensitivity to penicillin and other antimicrobials is highlighted in order to alert new resistance mechanisms and to adapt treatment strategies.

Streptococcus agalactiae (SGB) es causa de infecciones severas en menores de tres meses. Meningitis, neumonía y sepsis son los principales cuadros en estos niños. Estas infecciones se encuentran entre las más graves que puede sufrir un individuo en sus primeras doce horas de vida. El niño adquiere la infección por transmisión vertical de la madre colonizada. Para prevenir la enfermedad neonatal se recomienda penicilina como droga de elección en la profilaxis intraparto (PIP) en embarazadas colonizadas. Sin embargo, actualmente se han detectado cepas con sensibilidad disminuida a penicilina por lo que resulta importante realizar la vigilancia de la sensibilidad al mismo para asegurar su utilidad durante la profilaxis. El objetivo de este trabajo fue determinar la sensibilidad a penicilina en cepas de SGB recuperados de mujeres embarazadas de 35-37 semanas de gestación. Se estudiaron 96 aislamientos y se determinó la sensibilidad por método epsilométrico Etest® (LIOFILCHEM, Italia), siguiendo las recomendaciones del Clinical Laboratory Standards Institute (CLSI). Se obtuvo la Concentración Inhibitoria Mínima (CIM) para cada aislamiento bacteriano. El 100% (96) de las cepas estudiadas fue sensible a penicilina con valores de CIM comprendidos entre 0,012 y 0,094 µg mL-1. Estos resultados indican que penicilina sigue siendo el antimicrobiano de elección durante la profilaxis intraparto, para la prevención de la enfermedad neonatal causada por SGB en nuestra región. Se destaca la importancia de la vigilancia epidemiológica de la sensibilidad a penicilina y a otros antimicrobianos para alertar sobre nuevos mecanismos de resistencia y adecuar estrategias de tratamiento.

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BACKGROUND: Liver transplantation is the only therapy for end-stage liver disease. Cirrhosis secondary to autoimmune hepatitis (AIH) is an indication in 4-6% of adult transplants. AIMS: To describe the outcomes and recurrence of AIH in liver transplant patients. MATERIAL AND METHODS: Twenty patients were retrospectively studied. RESULTS: The female/male ratio was 3:1, the median age was 36.7 years (range, 16 to 39 years), and the median MELD score was 18.5. According to serological analysis, 19 patients were AIH type 1 and one patient was AIH type 2. AIH was associated with human leukocyte antigen (HLA) DR13+ and DR4+. The overall 5-year patient and graft survival rates were 94 and 85%, respectively. Three (15.7%) cases of recurrent AIH were diagnosed based on histological evidence. Clinical and histological features of acute and chronic rejection were present in four (20%) and three (16.6%) patients, respectively. CONCLUSION: AIH frequently affected young women, was the most frequent indication for liver transplantation. Rejection and recurrence were commonly associated with AIH, but did not affect patient survival. No significant relationship between HLA-DR type and recurrence was found. Rapid progression to cirrhosis should be considered in severe recurrences.

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Objetivo: evaluar la forma en que se establece el diagnostico de infección urinaria en el niño. Materiales y métodos: Se reviso las historias clínicas de 103 niños con dignóstico de nefritis interstciial bacteriana. El diagnóstico se sustento por el compromiso evidente del parénquima renal, cuestión que no es sugerida con el calificativo de "infección urinaria. Resultados. De los 103 niños, 49 eran menores de 2 años, 33 pacientes tenían edades entre signos físicos que pueden comprender signos físicos que pueden comprender signos atribuibles al compromiso de la función renal palidez, piel seca, lengua seca, disminución de la densidad urinaria y signos relacionados con la respuesta inflamatoria al agente infeccioso, hepatomegalia, anemia, leucocituria y hematuria. Conclusiones: En nuestro trabajo, el niños expresó características clínicas y fisiológicas no evidentes en el adultos lo que hace ecesario su conocimiento por parte de los médicos para facilitar el diagnóstico de enfermedad en el niño.

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