Search

Chromoblastomycosis (CBM) is a chronic subcutaneous infection caused by melanotic fungi, affecting mainly rural workers in tropical and subtropical regions. Secondary bacterial infections (SBIs) in CBM lesions bring complications to the disease, but little is known about the agents involved. Fungal and bacterial identification and epidemiological profile of 50 patients with CBM were analyzed in this study. Bacteria were tested for susceptibility to antibacterial drugs. Fonseacea pedrosoi and Rhinocladiella aquaspersa were the fungal agents isolated. 88% of the patients presented SBI. Gram-positive bacteria coinfected mainly upper limbs, and Gram-negative bacteria were more isolated from lower limbs. Streptococcus pyogenes and mixed bacterial microbiota were associated with severe lesions. Staphylococcus aureus was associated with mixed infections and consequently with the severity of the infection. Resistance to β-lactams and methicillin was detected. Our results emphasize the necessity of bacterial culture and susceptibility testing as part of routine monitoring CBM cases.

Attalea speciosasynOrbignya phalerataMart. (babassu) has been used in the treatment of inflammatory and infectious diseases.Aim of the study. To investigate the antimicrobial and immunological activity of babassu mesocarp extract (EE).Material and Methods.Thein vitroantimicrobial activity was evaluated by disk diffusion assay and by determination of the minimum inhibitory concentration (MIC) toEscherichia coli,Pseudomonas aeruginosa,Enterococcus faecalis,Staphylococcus aureus,and methicillin-resistantStaphylococcus aureus(MRSA). The flavonoids and phenolic acids content were determined by chromatography. Thein vivoassays were performed in Swiss mice submitted to sepsis by cecal ligation and puncture (CLP). The mice received EE subcutaneously (125 or 250 mg/Kg), 6 hours after the CLP. The number of lymphoid cells was quantified and the cytokines production was determined by ELISA after 12 h.Results.EE was effective as antimicrobial toE. faecalis,S. aureus, and MRSA. EE is rich in phenolic acids, a class of compounds with antimicrobial and immunological activity. An increased survival can be observed in those groups, possibly due to a significant inhibition of TNF-αand IL-6.Conclusions.The EE showed specific antimicrobial activityin vitroand an important antiseptic effectin vivopossibly due to the antimicrobial and immunomodulatory activity.

Propolis is a resinous substance made by bees. It possesses many biological activities, and many studies have reported its potential application in the control of dental caries. However, variability in the chemical composition of propolis is a potential problem in its quality control, especially since propolis has already been incorporated into products for oral use. Therefore, a critical analysis of the available data on propolis is warranted. The present review discusses the in vitro and in vivo studies published in the period between 1978 and 2008 regarding the effects of propolis on Streptococcus mutans growth, bacterial adherence, glucosyltransferase activity, and caries indicators. Several investigations carried out with crude propolis extracts, isolated fractions, and purified compounds showed reductions in Streptococcus mutans counts and interference with their adhesion capacity and glucosyltransferase activity, which are considered major properties in the establishment of the cariogenic process. Data from in vivo studies have demonstrated reductions in Streptococcus mutans counts in saliva, the plaque index, and insoluble polysaccharide formation. These findings indicate that propolis and/or its compounds are promising cariostatic agents. However, the variation in the chemical composition of propolis due to its geographical distribution is a significant drawback to its routine clinical use. Thus, further studies are needed to establish the quality and safety control criteria for propolis in order for it to be used in accordance with its proposed activity.

We report the case of an alternative treatment for a patient with a severe form of chromoblastomycosis that responded poorly to the traditional antifungal therapy. We hereby show, in this study, the improvement of lesions after treatment with itraconazole associated with an intramuscular administration of glucan. We observed that the regression of lesions was associated with an improvement of the cellular immune response. This favourable response that we observed suggests that the therapeutic regimen we used might be an option for the treatment of patients with a severe form of chromoblastomycosis.

Rigorous control of water quality in hemodialysis services is extremely important in order to guarantee a better quality of life of the patients submitted to this treatment. The lack of adequate water monitoring has caused the death of various patients in the past. The objective of the present study was to determine the physicochemical and bacteriological characteristics of water used by hemodialysis services in hospitals of the city of São Luís, Maranhão, Brazil. Bacteriological analyses included the membrane filter method for the determination of total coliform bacteria, the Cult-Dipcombi-TTC-agar method for heterotrophic bacteria and the limulus amebocyte lysate method for the determination of endotoxins. Eighteen water samples obtained from three hospital units, six samples per hemodialysis service, collected directly at the pre- and post-treatment points, were analyzed. Microorganisms were detected in the water used by the hemodialysis services in two of the three hospital units (B and C) studied. No contamination with heterotrophic bacteria was observed in pretreatment samples, while endotoxin production was detected in 100% of the samples. In post-treatment samples, heterotrophic bacteria were detected in 66.6% of the samples and endotoxins in 33.3%. The microorganisms identified in unit B were Burkholderia cepacia, Alcaligenes xylosoxidans,Pseudomonas aeruginosa and Stenotrophomonas maltophilia In unit C Flavimonas oryzihabitans,Ralstonia pickettii and Burkholderia cepacia were identified. A significant correlation was observed between the presence of endotoxins and the physicochemical characteristics of water such as turbidity and conductivity. These data indicate that two of the three hospital units studied should revise the control of their hemodialysis water system.A necessidade de um controle rigoroso no serviço de hemodiálise tornou-se algo de extrema importância para garantir uma melhor qualidade de vida aos pacientes submetidos a este tratamento, uma vez que, a falta de controle de qualidade da água, tem levado a óbito vários pacientes. Este estudo teve como objetivo avaliar as características físico-químicas e bacteriológicas da água utilizada pelos serviços de hemodiálise em hospitais da cidade de São Luís. A metodologia utilizada para as análises bacteriológicas foi: método da membrana filtrante para determinação de coliformes totais, método Cult-Dipcombi-ttc-ágar para bactérias heterotróficas e método limulus amebocyte lysate para endotoxinas. Foram analisadas dezoito amostras de água em três unidades hospitalares, sendo seis amostras provenientes de cada serviço de hemodiálise, colhidas diretamente dos pontos pré e pós-tratamento. Quanto à presença de microrganismos na água utilizada pelos serviços de hemodiálise, observou-se positividade nas unidades hospitalares B e C. Não foi encontrada contaminação por bactérias heterotróficas nas amostras examinadas no pré-tratamento, entretanto a contaminação por endotoxinas foi em 100% das amostras. Nas amostras pós-tratamento encontrou-se para bactérias heterotróficas 66,6% e endotoxinas 33,3%. Os microrganismos identificados na unidade hospitalar B foram: Burkholderia cepacia, Alcalígenes xilosoxidans, Pseudomonas aeruginosa e Stenotrophomonas maltophilia. Na unidade C, foram identificados: Flavimonas oryzihabitans, Ralstônia pickettii e Burkholderia cepacia. Houve uma correlação significativa entre a presença de endotoxinas e características físico-químicas da água tais como: turbidez e condutividade. Estes dados revelaram que duas das três unidades hospitalares avaliadas necessitam rever o controle do sistema de água de hemodiálise.

Chromoblastomycosis is a chronic, often debilitating, suppurative, granulomatus mycosis of the skin and subcutaneous tissues beginning after inoculation trauma. It occurs world-wide, but is more frequently observed in tropical countries such as Brazil. The disease is usually insidious, and the lesions increase slowly but progressively, not responding to the usual treatments and quite often reappearing. The host defense mechanism in chromoblastomycosis has not been extensively investigated. Some studies have focused on fungus-host interaction, showing a predominantly cellular immune response, with the activation of macrophages involved in fungus phagocytosis. Although phagocytosis did occur, death of fungal cells was rarely observed. The ability of Fonsecaea pedrosoi to produce secreted or cell wall-associated melanin-like components, protects against destruction by host immune cells in vitro. Until now, the T cell immune response in chromoblastomycosis is undefined. In the present work, it was shown that, in patients with the severe form of the disease, predominant production of IL-10 cytokine, low levels of IFN-gamma and inefficient T cell proliferation were induced. In contrast, in patients with a mild form of the disease, predominant production of IFN-gamma cytokine, low levels of IL-10 and efficient T cell proliferation were observed.

The number of ESBL-producing Enterobacteriaceae in community-acquired urinary tract infections worldwide is probably underestimated because of the technical difficulties encountered with their detection. In this study, out of 5,672 urine samples analyzed, 916 were positive for uropathogens, 472 of them being enterobacteria of which 7.6% produced β-lactamases. Analysis of the isolated from 36 patients showed a high level of antibiotic resistance, with 52.7% and 80.5% of isolates expressing blaTEM and blaCTX-M, respectively.

Introduction Acquired metallo-β-lactamases (MβL) are emerging determinants of resistance in Pseudomonas aeruginosa and Acinetobacter baumannii. The objectives of this study were to phenotypically detect MβL in imipenem-resistant P. aeruginosa and A. baumannii, to investigate the association between MβL-positive strains and hospitals, and to compare the resistance profiles of MβL-producing and non-MβL-producing strains. Methods The approximation disk and combined disk assay methods were used in this study. Results A total of 18 (38.3%) P. aeruginosa isolates and 1 (5.6%) A. baumannii isolate tested positive for the presence of MβL. Conclusions These results demonstrate the need for strict surveillance and for the adoption of preventive measures to reduce the spread of infection and potential outbreaks of disease caused by MβL-producing microorganisms.

INTRODUCTION: Extended spectrum β-lactamases (ESBLs) are enzymes that degrade β-lactam antibiotics and have been reported to be an important cause of nosocomial infection in worldwide. METHODS: During 2009, 659 enterobacteria strains were isolated from different clinical specimens and tested for ESBL production. The disk approximation test, combined disk method and addition of clavulanic acid were used for phenotypic detection of the ESBL-producing strains and PCR for detection of the blaTEM and blaCTX-M genes. RESULTS: Among the isolates, 125 were ESBL producers. The blaCTX-M and blaTEM genes were detected in 90.4% and 75% of the strains, respectively. Most strains were isolated from urine. Klebsiella pneumoniae was the most prevalent organism. Microorganisms presented high resistance to the antibiotics. CONCLUSIONS: These results support the need for extending ESBL detection methods to different pathogens of the Enterobacteriaceae family because these methods are only currently standardized by the CLSI for Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca and Proteus mirabilis. Carbapenems were the antibiotic class of choice for the treatment of infections caused by ESBL-producing Enterobacteriaceae.

The host defense mechanism in chromoblastomycosis has not been thoroughly investigated. It has been suggested that cell-mediated immunity in patients with long-standing chromoblastomycosis is somehow impaired. As a result, these individuals became unable to develop an efficient immune reaction. Many studies have shown that monocyte-derived macrophages exhibit critical activities in immunity to microorganisms. Moreover, the ability of cells from the monocytic lineage to process and present antigens, to produce cytokines, and to provide costimulatory signals confirms their pivotal role in the initiation of specific immune responses. In the present study, it was observed that monocytes from patients with a severe form of disease had a higher production of IL-10 and a lower expression of HLA-DR and costimulatory molecules when stimulated with specific antigen or LPS. Immune modulation with recombinant IL-12 or anti-IL-10 can restore the antigen-specific Th1-type immune response in chromoblastomycosis patients by up-regulating HLA-DR and costimulatory molecules in monocytes. Therefore, our data show that monocytes from patients with different clinical forms of chromoblastomycosis present distinct phenotypic and functional profiles. This observation suggests possible mechanisms that control the T cell response and influence their role in the development of pathology.

OBJECTIVE: To evaluate the antibacterial action of an extract of geopropolis produced by the bee Melipona compressipes fasciculata on the concentration of Streptococcus mutans colonizing the oral cavity of young patients. Forty-one young volunteers performed 21 mouth rinses divided into three rinses per day for 7 days, with no other changes in their oral hygiene and dietary habits. Saliva was collected at three time points: before the first rinse, and one hour and 7 days after the first rinse. A reduction in the concentration of S. mutans was observed in 49% of all samples collected after use of the extract, 26% showed no alterations, and an increasing in S. mutans was observed in 25%. Was performed with the Statistica for Windows 5.9 program using the Kruskal-Wallis test for analysis of variance and the Mann-Whitney U test, with the level of significance set at 5%. The propolis extract possesses in vivo antimicrobial activity against S. mutans present in the oral cavity and might be used as an alternative measure to prevent dental caries.

Rigorous control of water quality in hemodialysis services is extremely important in order to guarantee a better quality of life of the patients submitted to this treatment. The lack of adequate water monitoring has caused the death of various patients in the past. The objective of the present study was to determine the physicochemical and bacteriological characteristics of water used by hemodialysis services in hospitals of the city of São Luís, Maranhão, Brazil. Bacteriological analyses included the membrane filter method for the determination of total coliform bacteria, the Cult-Dipcombi-TTC-agar method for heterotrophic bacteria and the limulus amebocyte lysate method for the determination of endotoxins. Eighteen water samples obtained from three hospital units, six samples per hemodialysis service, collected directly at the pre- and post-treatment points, were analyzed. Microorganisms were detected in the water used by the hemodialysis services in two of the three hospital units (B and C) studied. No contamination with heterotrophic bacteria was observed in pretreatment samples, while endotoxin production was detected in 100% of the samples. In post-treatment samples, heterotrophic bacteria were detected in 66.6% of the samples and endotoxins in 33.3%. The microorganisms identified in unit B were Burkholderia cepacia, Alcaligenes xylosoxidans,Pseudomonas aeruginosa and Stenotrophomonas maltophilia In unit C Flavimonas oryzihabitans,Ralstonia pickettii and Burkholderia cepacia were identified. A significant correlation was observed between the presence of endotoxins and the physicochemical characteristics of water such as turbidity and conductivity. These data indicate that two of the three hospital units studied should revise the control of their hemodialysis water system. A necessidade de um controle rigoroso no serviço de hemodiálise tornou-se algo de extrema importância para garantir uma melhor qualidade de vida aos pacientes submetidos a este tratamento, uma vez que, a falta de controle de qualidade da água, tem levado a óbito vários pacientes. Este estudo teve como objetivo avaliar as características físico-químicas e bacteriológicas da água utilizada pelos serviços de hemodiálise em hospitais da cidade de São Luís. A metodologia utilizada para as análises bacteriológicas foi: método da membrana filtrante para determinação de coliformes totais, método Cult-Dipcombi-ttc-ágar para bactérias heterotróficas e método limulus amebocyte lysate para endotoxinas. Foram analisadas dezoito amostras de água em três unidades hospitalares, sendo seis amostras provenientes de cada serviço de hemodiálise, colhidas diretamente dos pontos pré e pós-tratamento. Quanto à presença de microrganismos na água utilizada pelos serviços de hemodiálise, observou-se positividade nas unidades hospitalares B e C. Não foi encontrada contaminação por bactérias heterotróficas nas amostras examinadas no pré-tratamento, entretanto a contaminação por endotoxinas foi em 100% das amostras. Nas amostras pós-tratamento encontrou-se para bactérias heterotróficas 66,6% e endotoxinas 33,3%. Os microrganismos identificados na unidade hospitalar B foram: Burkholderia cepacia, Alcalígenes xilosoxidans, Pseudomonas aeruginosa e Stenotrophomonas maltophilia. Na unidade C, foram identificados: Flavimonas oryzihabitans, Ralstônia pickettii e Burkholderia cepacia. Houve uma correlação significativa entre a presença de endotoxinas e características físico-químicas da água tais como: turbidez e condutividade. Estes dados revelaram que duas das três unidades hospitalares avaliadas necessitam rever o controle do sistema de água de hemodiálise.

A sample survey with 843 interviews in São Luís, Maranhão State, Brazil was conducted to assess community knowledge and concepts regarding dengue. The population's understanding and its socioeconomic, health, and environmental conditions were evaluated. Potential vector breeding sites were found in all the areas surveyed. Media (TV, radio, etc.) were the most important source of public information on the disease. However, a gap was observed between knowledge and attitudes towards vector prevention. Strategies are also needed to involve the population in more effective prevention of vector proliferation, thus helping control the disease in São Luís.

A cromoblastomicose (CBM) é uma infecção fúngica crônica da pele e tecido celular subcutâneo, causada por vários fungos melaninogênicos da ordem Chaetotrhyales. Fonsecaea pedrosoi é o principal agente etiológico da doença. Este trabalho teve como objetivos avaliar os aspectos clinico-epidemiológicos de pacientes com CBM e caracterizarfenotípica e genotípicamente os agentes isolados de amostras clínicas e ambientais provenientes de uma região da Amazônia do Maranhão-Brasil. Foram avaliados 41 pacientes procedentes do estado do Maranhão com diagnóstico clínico de CBM, no período de setembro de 2006 a outubro de 2009. Entre as amostras ambientais (236), foram isolados 64 fungos dematiáceos. Fonsecaea pedrosoi foi o agente predominante das amostras clínicas (95,2%), seguido de Phialophora verrucosa (2,4%) e Rhinocladiella aquaspersa (2,4%). Entre os isolados ambientais, Exophiala sp. foi a mais prevalente (45,3%). Nestapesquisa predominaram os pacientes do sexo masculino, analfabetos, lavradores, com média de idade de 58±10,6 anos e tempo de evolução de doença que variou de 8,8 ± 7,8 anos. Os membros inferiores foram os mais acometidos, sendo as lesões moderadas e de placa vegetante as mais prevalentes. O polimorfismo lesional foi verificado na maioria dos indivíduos. A presença de infecção secundária bacteriana foi verificada em 92,7% dos indivíduos, sendo Staphylococcus aureus a bactéria mais prevalente, enquanto a infecção bacteriana mista foi associada com a gravidade da lesão p=0,01. O teste de susceptibilidadeaos antifúngicos foi realizado pela técnica da microdiluição do CLSI (Clinical and Laboratory Standards Institute) e o perfil de susceptibilidade aos antibacterianos pelo método de difusão em ágar. Itraconazol e terbinafina foram as drogas mais ativas contra osfungos avaliados. Os valores das CIMs de itraconazol e voriconazol obtidos frente às amostras ambientais foram as menores dentre os antifúngicos testados. Quanto à sensibilidade aos antimicrobianos, 27 (100%) dos cocos Gram-positivos aeróbios mostraram-se sensíveis a vancomicina e linezolida. Os isolados de S. aureus e Staphylococcus coagulase negativa (SCN) apresentaram elevado nível de sensibilidadepara ampicilina/sulbactam, cefazolina, clindamicina, gentamicina, oxacilina e rifampicina. Esses agentes demonstraram maior índice de resistência para eritromicina, penicilina e sulfametoxazol+trimpetoprim. A caracterização genética dos fungos isolados de 40 amostras clínicas e de 16 ambientais foi realizada pela técnica do RAPD utilizandoiniciadores específicos para F. pedrosoi. A análise do dendograma e da similaridade genética entre os perfis gerados, demonstrou a formação de quatro grupos distintos, sendo que a maioria das amostras de origem clínica se agruparam no grupo II e as de origem ambiental no grupo IV. O sequenciamento de cinco amostras de biópsias de pacientes com CBM, cinco amostras ambientais e nove linhagens de fungos isolados das lesões de pacientes com CBM identificadas como F. pedrosoi apresentaram índices de similaridades nucleotídicas que variaram de 92 a 100% para F. pedrosoi. A determinação do perfil desusceptibilidade aos antimicrobianos das bactérias causadoras de infecção secundária poderá vir a ser de grande importância para a realização de uma terapia mais eficaz. A extração do DNA dos fungos causadores da CBM diretamente da biópsia de tecido poderátornar mais ágil o diagnóstico e melhorar o controle da doença. The chromoblastomycosis (CBM) is a chronic fungal infection of skin and subcutaneous tissue caused by several melanized fungi of Chaetotrhyales order. Fonsecaea pedrosoi is the major causative agent of the disease. This study aimed to evaluate the clinical andepidemiological aspects of patients with CBM and phenotypic and genotypic characterization of the agents isolated from clinical and environmental samples from an Amazon region of Maranhão state, Brazil. We evaluated 41 patients from the state of Maranhão with a clinical diagnosis of CBM, from September 2006 to October 2009. Among the environmental samples (236), were isolated 64 dematiaceous fungi. F. pedrosoi was the predominant agent of clinical specimens (95.2%), followed by Phialophora verrucosa (2.4%) and Rhinocladiella aquaspersa (2.4%). Among the environmental isolates, Exophiala sp. was the most prevalent (45.3%). In this study the patients aremainly male rural workers, illiterate, with an average age of 58 ± 10.6 years and time course of disease ranged from 8.8 ± 7.8 years. The lower limbs were most affected; the moderate and vegetating plaque-type lesions are the most prevalent. The lesional polymorphism was observed in most individuals. The presence of secondary bacterialinfection was found in 92.7% of individuals, and Staphylococcus aureus was the most prevalent bacteria, while the mixed bacterial infection was associated with severity injury (p = 0.01). The antifungal susceptibility testing was performed by the microdilution technique of CLSI (Clinical and Laboratory Standards Institute) and the profile of susceptibility to antibacterial agents by agar diffusion method. Itraconazole and terbinafine were the most active drugs against the fungi evaluated. The MIC values of itraconazole and voriconazole obtained against the environmental samples were the lowest among the tested antifungals. Twenty seven (100%) of Gram-positive aerobes were sensitive tovancomycin and linezolid. The isolates of S. aureus and S. aureus negative coagulase (SCN) showed a high sensitivity to ampicillin/sulbactam, cefazolin, clindamycin, gentamicin, oxacillin and rifampin. These agents showed a higher rate of resistance toerythromycin, penicillin and trimethoprim + trimpetoprim. Genetic characterization of the isolates from 40 clinical samples and 16 of environmental source was carried out by RAPD using primers specific to F. pedrosoi. Analysis of the dendrogram obtained and the similarity between the genetic profiles generated showed the formation of four distinct groups, where the most samples of clinical origin were grouped in group II and those of environmental origin in group IV. Sequencing of five biopsies of patients with CBM, five environmental samples and nine strains of fungi isolated from lesions of patients with CBM identified as F. pedrosoi showed high nucleotide similarities ranging from 92 to100% for F. pedrosoi. The determination of antimicrobial susceptibility of bacteria causing secondary infection in the lesions of CBM could be of great importance for the implementation of more effective therapy for the disease. Direct DNA extraction of fungi that cause the CBM from tissue biopsy could be important for improving and speeding the diagnosis and control of the disease.