RESUMO
AIMS: To examine the occurrence of and to determine the antimicrobial susceptibility of Corynebacterium pseudodiphtheriticum among patients with bacterial infections at a teaching hospital. METHODS AND RESULTS: A total of 113 Coryne. pseudodiphtheriticum strains identified by conventional biochemical methods and API-Coryne System were recovered from patients from different age groups: 65.48% adults (18 to < or =59 years old), 9.73% aged (> or =60 years old); 14.15% infants (<18 years old); 4.42% newborns (0-7 days). Micro-organisms were mostly related to infections in the urinary (29.2%) and respiratory tracts (27.45%) and intravenous sites (18.6%). Clinical samples were obtained only from 32.7% patients (26 adults, four aged, four infants and three newborns) presenting at least one of the predisposing conditions: end-stage renal disease; renal transplant; AIDS and Mycobacterium tuberculosis infection; cancer, hepatic cirrhosis; haemodialysis and catheter use. Antimicrobial susceptibility tests identified multiresistant phenotypes. Most strains (>50%) were resistant to oxacillin, erythromycin and clindamycin. CONCLUSIONS: Despite significant differences in age and functional status of patients Coryne. pseudodiphtheriticum may be implicated as a cause of respiratory and nonrespiratory human infections. SIGNIFICANCE AND IMPACT OF THE STUDY: Data are valuable for practitioners indicating the occurrence of multiresistant phenotypes and the possibility of severe infections due to Coryne. pseudodiphtheriticum, a pathogen usually overlooked in emerging countries.
Assuntos
Antibacterianos/farmacologia , Infecções por Corynebacterium/epidemiologia , Infecções por Corynebacterium/microbiologia , Corynebacterium/efeitos dos fármacos , Corynebacterium/isolamento & purificação , Hospitais de Ensino/estatística & dados numéricos , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Criança , Pré-Escolar , Corynebacterium/classificação , Farmacorresistência Bacteriana , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/microbiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia , Adulto JovemRESUMO
Invasive diseases caused by Corynebacterium diphtheriae have been described increasingly. Several reports indicate the destructive feature of endocarditis attributable to nontoxigenic strains. However, few reports have dealt with the pathogenicity of invasive strains. The present investigation demonstrates a phenotypic trait that may be used to identify potentially invasive strains. The study also draws attention to clinical and microbiological aspects observed in 5 cases of endocarditis due to C. diphtheriae that occurred outside Europe. Four cases occurred in female school-age children (7-14 years) treated at different hospitals in Rio de Janeiro, Brazil. All patients developed other complications including septicemia, renal failure and/or arthritis. Surgical treatment was performed on 2 patients for valve replacement. Lethality was observed in 40% of the cases. Microorganisms isolated from 5 blood samples and identified as C. diphtheriae subsp mitis (N = 4) and C. diphtheriae subsp gravis (N = 1) displayed an aggregative adherence pattern to HEp-2 cells and identical one-dimensional SDS-PAGE protein profiles. Aggregative-adhering invasive strains of C. diphtheriae showed 5 distinct RAPD profiles. Despite the clonal diversity, all 5 C. diphtheriae invasive isolates seemed to display special bacterial adhesive properties that may favor blood-barrier disruption and systemic dissemination of bacteria. In conclusion, blood isolates from patients with endocarditis exhibited a unique adhering pattern, suggesting a pathogenic role of aggregative-adhering C. diphtheriae of different clones in endocarditis. Accordingly, the aggregative-adherence pattern may be used as an indication of some invasive potential of C. diphtheriae strains.
Assuntos
Aderência Bacteriana/fisiologia , Corynebacterium diphtheriae/patogenicidade , Endocardite Bacteriana/microbiologia , Adolescente , Técnicas de Tipagem Bacteriana , Células Cultivadas , Criança , Corynebacterium diphtheriae/genética , Corynebacterium diphtheriae/isolamento & purificação , Eletroforese em Gel de Poliacrilamida , Feminino , Genótipo , Humanos , Fenótipo , Técnica de Amplificação ao Acaso de DNA Polimórfico , Especificidade da EspécieRESUMO
Invasive diseases caused by Corynebacterium diphtheriae have been described increasingly. Several reports indicate the destructive feature of endocarditis attributable to nontoxigenic strains. However, few reports have dealt with the pathogenicity of invasive strains. The present investigation demonstrates a phenotypic trait that may be used to identify potentially invasive strains. The study also draws attention to clinical and microbiological aspects observed in 5 cases of endocarditis due to C. diphtheriae that occurred outside Europe. Four cases occurred in female school-age children (7-14 years) treated at different hospitals in Rio de Janeiro, Brazil. All patients developed other complications including septicemia, renal failure and/or arthritis. Surgical treatment was performed on 2 patients for valve replacement. Lethality was observed in 40 percent of the cases. Microorganisms isolated from 5 blood samples and identified as C. diphtheriae subsp mitis (N = 4) and C. diphtheriae subsp gravis (N = 1) displayed an aggregative adherence pattern to HEp-2 cells and identical one-dimensional SDS-PAGE protein profiles. Aggregative-adhering invasive strains of C. diphtheriae showed 5 distinct RAPD profiles. Despite the clonal diversity, all 5 C. diphtheriae invasive isolates seemed to display special bacterial adhesive properties that may favor blood-barrier disruption and systemic dissemination of bacteria. In conclusion, blood isolates from patients with endocarditis exhibited a unique adhering pattern, suggesting a pathogenic role of aggregative-adhering C. diphtheriae of different clones in endocarditis. Accordingly, the aggregative-adherence pattern may be used as an indication of some invasive potential of C. diphtheriae strains.
Assuntos
Adolescente , Criança , Feminino , Humanos , Aderência Bacteriana/fisiologia , Corynebacterium diphtheriae/patogenicidade , Endocardite Bacteriana/microbiologia , Técnicas de Tipagem Bacteriana , Células Cultivadas , Corynebacterium diphtheriae/genética , Corynebacterium diphtheriae/isolamento & purificação , Eletroforese em Gel de Poliacrilamida , Genótipo , Fenótipo , Técnica de Amplificação ao Acaso de DNA Polimórfico , Especificidade da EspécieRESUMO
The frequency and severity of human infections associated with Corynebacterium ulcerans appear to be increasing in different countries. Here, we describe the first C. ulcerans strain producing a diphtheria-like toxin isolated from an elderly woman with a fatal pulmonary infection and a history of leg skin ulcers in the Rio de Janeiro metropolitan area.
Assuntos
Broncopneumonia/microbiologia , Infecções por Corynebacterium/microbiologia , Corynebacterium/metabolismo , Toxoide Diftérico/biossíntese , Úlcera da Perna/microbiologia , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Broncopneumonia/diagnóstico , Corynebacterium/isolamento & purificação , Infecções por Corynebacterium/diagnóstico , Infecções por Corynebacterium/epidemiologia , Evolução Fatal , Feminino , Humanos , Úlcera da Perna/diagnósticoRESUMO
The frequency and severity of human infections associated with Corynebacterium ulcerans appear to be increasing in different countries. Here, we describe the first C. ulcerans strain producing a diphtheria-like toxin isolated from an elderly woman with a fatal pulmonary infection and a history of leg skin ulcers in the Rio de Janeiro metropolitan area.
Assuntos
Idoso de 80 Anos ou mais , Feminino , Humanos , Broncopneumonia/microbiologia , Infecções por Corynebacterium/microbiologia , Corynebacterium/metabolismo , Toxoide Diftérico/biossíntese , Úlcera da Perna/microbiologia , Brasil/epidemiologia , Broncopneumonia/diagnóstico , Infecções por Corynebacterium/diagnóstico , Infecções por Corynebacterium/epidemiologia , Corynebacterium/isolamento & purificação , Evolução Fatal , Úlcera da Perna/diagnósticoRESUMO
AIMS: To examine the value of the DNase test as an alternative procedure for differentiating Corynebacterium diphtheriae from Corynebacterium-like colonies. METHODS AND RESULTS: DNase test medium was inoculated by spotting a loopful of bacterial growth and incubated aerobically at 37 degrees C. The DNase production was detectable following both 24 and 48 h incubation periods. The DNase activity was detected in all 91 C. diphtheriae (37 toxigenic and 54 nontoxigenic) strains examined, previously identified by both conventional biochemical methods and API Coryne System. Conversely, DNase test results were negative in 93.9% of the 564 nondiphtherial Gram-positive rod clinical strains. CONCLUSIONS: The DNase test emerged as an easily interpretable and cost-effective alternative screening procedure for C. diphtheriae laboratory identification. SIGNIFICANCE AND IMPACT OF THE STUDY: The method should facilitate routine laboratory diagnosis of toxigenic and nontoxigenic C. diphtheriae.
Assuntos
Técnicas de Tipagem Bacteriana , Corynebacterium diphtheriae/classificação , Desoxirribonucleases/metabolismo , Difteria/diagnóstico , Programas de Rastreamento/métodos , Técnicas Bacteriológicas , Corynebacterium/classificação , Corynebacterium/enzimologia , Corynebacterium/isolamento & purificação , Corynebacterium diphtheriae/enzimologia , Corynebacterium diphtheriae/isolamento & purificação , Meios de Cultura , Difteria/microbiologia , HumanosRESUMO
AIMS: This investigation aimed to isolate enteric rods from subgingival sites of patients presenting chronic periodontitis lesions, and to assess antimicrobial resistance and expression of hydrolytic enzymes. METHODS AND RESULTS: Enterobacteriaceae were isolated from 20% patients, and assayed for antimicrobial susceptibility and hydrolytic enzymes with specificity to different substrates. Isolates comprised seven Enterobacter cloacae (43.75%), five Serratia marcescens (31.25%), one Klebsiella pneumoniae (6.25%), one Enterobacter aerogenes (6.25%), one Pantoea agglomerans (6.25%), and one Citrobacter freundii (6.25%). Gelatinase activity was observed for 75% strains; caseinase and elastase was produced by six and two strains, respectively. DNase, lecithinase and lipase were expressed by S. marcescens. Most of strains were resistant to ampicillin (93.75%) and amoxicillin/clavulanic acid (81.25%). The majority of strains were susceptible to cephalosporins and aztreonam. Enterobacteria remained susceptible to imipenem, streptomycin and fluoroquinolones. Resistance to gentamicin, amikacin, sulfamethoxazole/thrimethoprim, tetracycline, and chloramphenicol were also observed. Eight strains presented multiple drug resistance. CONCLUSIONS: Subgingival sites from periodontal diseases contain multi-resistant and hydrolytic enzyme-producing enterobacteria that may contribute to overall tissue destruction and spreading. SIGNIFICANCE AND IMPACT OF THE STUDY: Enterobacteria isolated from patients generally considered as healthy individuals poses periodontal diseases as reservoir for systemic infections particularly in immunocompromised and hospitalized hosts.
Assuntos
Antibacterianos/farmacologia , Enterobacteriaceae/efeitos dos fármacos , Enterobacteriaceae/isolamento & purificação , Hidrolases/metabolismo , Doenças Periodontais/microbiologia , Adulto , Brasil , Farmacorresistência Bacteriana , Enterobacteriaceae/enzimologia , Enterobacteriaceae/patogenicidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Caracteres SexuaisRESUMO
The lack of information on the immunity of adults in Brazil against diphtheria prompted us to analyse sera from 234 blood donors aged 18-61 years (30.3% females and 69.7% males). IgG diphtheria antitoxin levels determined by means of an ELISA, validated by toxin neutralization test in Vero cells, showed that 30.7% (95% CI 25.0-37.1) of the population was fully protected (>or=1 IU/ml). The highest percentage of subjects fully protected was in the 31-40 years age group. Most of the subjects with uncertain or no protection (<1 IU/ml) were found in the 18-30 years age group (43.8%, OR 2.18, P=0.01). Antitoxin levels were not influenced by the increase in age. Males were more protected than females (80.5%, OR 0.44, P=0.01). The prevalence of 30% of individuals fully protected against diphtheria in blood donors in Rio de Janeiro supports the fact that immunity to diphtheria among healthy Brazilian adults is inadequate. To avoid diphtheria epidemics in the future the immunity among adults should be raised in the coming years.