Diagnóstico de infecção bacteriana do trato urinário inferior pelo exame à fresco de urina

Orientador: Maria Terezinha Carneiro Leão LemeCo-orientador: Daltro ZuninoDissertação (mestrado) - Universidade Federal do Parana, Setor de Ciencias da SaudeResumo: As infecções do trato urinário (ITU) representam uma das doenças infecciosas mais encontradas na atual prática médica. Este estudo focaliza a forma mais comum de ITU não complicada: a cistite bacteriana, também denominada infecção bacteriana do trato urinário inferior, em mulheres agudamente disúricas, não-grávidas. Os objetivos deste estudo foram detectar infecção bacteriana do trato urinário inferior através de fita reagente e de exame microscópico, realizados no momento da consulta. Foram estudadas 118 pacientes ambulatoriais, no Hospital de Clínicas da Universidade Federal do Paraná no período de julho a dezembro de 1991, cuja queixa principal era disúria (queimação e ardência para urinar foram os termos mais utilizados pelas pacientes). A duração ou exacerbação dos sintomas deveria ser, no máximo, de 3 semanas. Foram excluídas pacientes que fizeram uso de antibiótico nas 2 semanas precedentes ao atendimento. A urina era coletada no momento da consulta e imediatamente submetida à análise pela fita reagente, para pesquisa de leucócitos, hemácias e nitrito e ao exame microscópico, utilizando-se câmara de contagem de células (câmara de Neubauer), para contagem de leucócitos e hemácias e quantificação de bacteriúria. Baseado nos trabalhos mais recentes da literatura, considerouse como portadora de cistite bacteriana, toda paciente com urocultura com contagem de colónias maior que 100 bactérias / ml. A prevalência de ITU bacteriana, neste estudo, foi de 35,6%. A alta sensibilidade da leucocitúria (aproximadamente 90%) torna o diagnóstico de cistite bacteriana, na ausência de leucocitúria, muito pouco provável. Cerca de 1/2 a 2/3 das pacientes com ITU apresentaram hematúria. A especificidade de 100% à pesquisa de nitrito, significa dizer que nitrito positivo é igual à cistite bacteriana. A vantagem do exame microscópico é permitir a pesquisa de bacteriúria, que apresenta os índices de sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e acurácia de aproximadamente 90%, predicados de grande destaque para qualquer teste-diagnóstico. A maioria das ITU foi causada por bactérias gram-negativas (83,33%), destacandose Escherichia coli (69,05% do total). O germe gram-positivo mais freqüentemente isolado foi Staphylococcus saprophyticus (14,28% do total). Destaca-se a alta resistência das bactérias gram-negativas à ampicilina e à associação sulfametoxazol-trimetoprim, 50,00% e 43,74% respectivamente. O exame de urina não-corada e não-centrifugada, colhida no momento da consulta, através da fita reagente e do exame microscópico, demonstrou ser um método simples, de baixo custo, de fácil execução e eficaz no diagnóstico de cistite bacteriana em mulheres não-grávidas agudamente disúricas.Abstract: Urinary tract infections (UTI) are included among the most common infectious diseases in clinical practice. This project focused the most common form of non-complicated UTI: bacterial cystitis, also known as lower urinary tract infection, in non-pregnant acutely dysuric women. The purposes of this project were to detect bacterial infection of the lower urinary tract by means of reactive stripe and by light microscopic examination, in urine collected at the moment of consultation. One-hundred eighteen out-patients whose chief complaint was dysuria ("burning" was the most frequently used term by the patients) were studied at the Hospital de Clínicas of the Universidade Federal do Paraná from July through December 1991. The duration or exacerbation of symptoms should be of 3 weeks, at the most. Patients that had used antimicrobial drugs during the 2 weeks that preceded the consultaion were not included. Urine was collected at the moment of consultation and analyzed both by reagent stripe (searching for WBC, RBC and nitrite) and light microscopy, using the cell count chamber (Neubauer chamber) for WBC and RBC counting and measuring of bacteriuria. Based in recent literature data, was considered with bacterial cystitis every patient with colony counting greater than 100 bacteria / ml. Prevalence of bacterial UTI in this study was 35.6%. The high sensitivity of leucocyturia (approximately 90%) renders the diagnosis of bacterial cystitis very unlikely in the absense of this finding. Approximately one-half to two-thirds of patients with UTI had hematuria. The 100% specificity on the search for nitrite means that positive nitrite equals bacterial cystitis. The advantage of microscopic examination is to allow the search of bacteriuria, that has sensitivity, specificity, positive predictive value, negative predictive value indices and accuracy of approximately 90%, features of great significance for any diagnostic test. The majority of UTI was caused by Gram-negative bacteria (83,33%), mainly Escherichia coli (69,05% of total). The mainly Gram-positive germ isolated was Staphylococcus saprophyticus (14,28% of total). It is stressed the high resistance rate of Gram-negative bacteria to ampicillin and to the association sulphametoxazole-trimetoprim, 50,00% and 43,74%, respectively. Examination of fresh uncentrifugated and unstained urine, collected at the moment of consultation, showed to be a simple, effective, low-cost, and easily performed method for detection of bacterial cystitis in acutely dysuric non-pregnant women

A Phase III, randomized study to evaluate the immunogenicity and safety of an MF59®-adjuvanted A/H1N1 pandemic influenza vaccine in HIV-positive adults

AbstractBackground and aimsAntibody responses to vaccines are suboptimal in immunosuppressed HIV-positive individuals. This study aimed to evaluate the potential benefits of MF59® adjuvant or a second A/H1N1 influenza vaccine dose in HIV-positive adults.MethodHIV-positive adults (n=61) and HIV-negative controls (n=93) aged 18–60years received two doses of A/H1N1, either as MF59-adjuvanted A/H1N1 pandemic vaccine, or as part of a unadjuvanted seasonal influenza vaccine containing the pandemic strain. Immunogenicity was assessed against the vaccine strain, A/California/7/2009, by haemagglutination inhibition (HI) assay three weeks after the administration of each vaccine dose. Local and systemic reactions were recorded for three days after each vaccination. Unsolicited adverse events were recorded throughout the six-week study period.ResultsBoth adjuvanted and unadjuvanted vaccines met the European licensure criteria in HIV-positive and HIV-negative study groups after a single dose. Lower antibody titres were observed with both adjuvanted and unadjuvanted vaccine in HIV-positive compared to HIV-negative subjects. A second dose of either vaccine did not compensate for the lower response of HIV-infected subjects. In HIV-positive subjects, CD4+ T cell counts and levels of CD38 expression on CD8+ T cells remained stable throughout the study period. Both vaccine formulations were generally well tolerated, with no increased reactogenicity observed in response to the adjuvanted vaccine.ConclusionAntibody responses in HIV-positive subjects were acceptable but lower than those in healthy control subjects, whether subjects were immunized with one or two doses of adjuvanted or unadjuvanted vaccine. Vaccination did not affect rates of HIV replication, CD4+ T cells counts, or levels of CD38 expression among patients under successful antiretroviral treatment

Management Of Infection By The Zika Virus

A panel of national experts was convened by the Brazilian Infectious Diseases Society in order to organize the national recommendations for the management of zika virus infection. The focus of this document is the diagnosis, both clinical and laboratorial, and appropriate treatment of the diverse manifestations of this infection, ranging from acute mild disease to Guillain-Barre syndrome and also microcephaly and congenital malformations.1

Management of infection by the Zika virus

A panel of national experts was convened by the Brazilian Infectious Diseases Society in order to organize the national recommendations for the management of zika virus infection. The focus of this document is the diagnosis, both clinical and laboratorial, and appropriate treatment of the diverse manifestations of this infection, ranging from acute mild disease to Guillain-Barré syndrome and also microcephaly and congenital malformations.1

Diagnóstico de infecção bacteriana do trato urinário inferior pelo exame à fresco de urina

Orientador: Maria Terezinha Carneiro Leão LemeCo-orientador: Daltro ZuninoDissertação (mestrado) - Universidade Federal do Parana, Setor de Ciencias da SaudeResumo: As infecções do trato urinário (ITU) representam uma das doenças infecciosas mais encontradas na atual prática médica. Este estudo focaliza a forma mais comum de ITU não complicada: a cistite bacteriana, também denominada infecção bacteriana do trato urinário inferior, em mulheres agudamente disúricas, não-grávidas. Os objetivos deste estudo foram detectar infecção bacteriana do trato urinário inferior através de fita reagente e de exame microscópico, realizados no momento da consulta. Foram estudadas 118 pacientes ambulatoriais, no Hospital de Clínicas da Universidade Federal do Paraná no período de julho a dezembro de 1991, cuja queixa principal era disúria (queimação e ardência para urinar foram os termos mais utilizados pelas pacientes). A duração ou exacerbação dos sintomas deveria ser, no máximo, de 3 semanas. Foram excluídas pacientes que fizeram uso de antibiótico nas 2 semanas precedentes ao atendimento. A urina era coletada no momento da consulta e imediatamente submetida à análise pela fita reagente, para pesquisa de leucócitos, hemácias e nitrito e ao exame microscópico, utilizando-se câmara de contagem de células (câmara de Neubauer), para contagem de leucócitos e hemácias e quantificação de bacteriúria. Baseado nos trabalhos mais recentes da literatura, considerouse como portadora de cistite bacteriana, toda paciente com urocultura com contagem de colónias maior que 100 bactérias / ml. A prevalência de ITU bacteriana, neste estudo, foi de 35,6%. A alta sensibilidade da leucocitúria (aproximadamente 90%) torna o diagnóstico de cistite bacteriana, na ausência de leucocitúria, muito pouco provável. Cerca de 1/2 a 2/3 das pacientes com ITU apresentaram hematúria. A especificidade de 100% à pesquisa de nitrito, significa dizer que nitrito positivo é igual à cistite bacteriana. A vantagem do exame microscópico é permitir a pesquisa de bacteriúria, que apresenta os índices de sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e acurácia de aproximadamente 90%, predicados de grande destaque para qualquer teste-diagnóstico. A maioria das ITU foi causada por bactérias gram-negativas (83,33%), destacandose Escherichia coli (69,05% do total). O germe gram-positivo mais freqüentemente isolado foi Staphylococcus saprophyticus (14,28% do total). Destaca-se a alta resistência das bactérias gram-negativas à ampicilina e à associação sulfametoxazol-trimetoprim, 50,00% e 43,74% respectivamente. O exame de urina não-corada e não-centrifugada, colhida no momento da consulta, através da fita reagente e do exame microscópico, demonstrou ser um método simples, de baixo custo, de fácil execução e eficaz no diagnóstico de cistite bacteriana em mulheres não-grávidas agudamente disúricas.Abstract: Urinary tract infections (UTI) are included among the most common infectious diseases in clinical practice. This project focused the most common form of non-complicated UTI: bacterial cystitis, also known as lower urinary tract infection, in non-pregnant acutely dysuric women. The purposes of this project were to detect bacterial infection of the lower urinary tract by means of reactive stripe and by light microscopic examination, in urine collected at the moment of consultation. One-hundred eighteen out-patients whose chief complaint was dysuria ("burning" was the most frequently used term by the patients) were studied at the Hospital de Clínicas of the Universidade Federal do Paraná from July through December 1991. The duration or exacerbation of symptoms should be of 3 weeks, at the most. Patients that had used antimicrobial drugs during the 2 weeks that preceded the consultaion were not included. Urine was collected at the moment of consultation and analyzed both by reagent stripe (searching for WBC, RBC and nitrite) and light microscopy, using the cell count chamber (Neubauer chamber) for WBC and RBC counting and measuring of bacteriuria. Based in recent literature data, was considered with bacterial cystitis every patient with colony counting greater than 100 bacteria / ml. Prevalence of bacterial UTI in this study was 35.6%. The high sensitivity of leucocyturia (approximately 90%) renders the diagnosis of bacterial cystitis very unlikely in the absense of this finding. Approximately one-half to two-thirds of patients with UTI had hematuria. The 100% specificity on the search for nitrite means that positive nitrite equals bacterial cystitis. The advantage of microscopic examination is to allow the search of bacteriuria, that has sensitivity, specificity, positive predictive value, negative predictive value indices and accuracy of approximately 90%, features of great significance for any diagnostic test. The majority of UTI was caused by Gram-negative bacteria (83,33%), mainly Escherichia coli (69,05% of total). The mainly Gram-positive germ isolated was Staphylococcus saprophyticus (14,28% of total). It is stressed the high resistance rate of Gram-negative bacteria to ampicillin and to the association sulphametoxazole-trimetoprim, 50,00% and 43,74%, respectively. Examination of fresh uncentrifugated and unstained urine, collected at the moment of consultation, showed to be a simple, effective, low-cost, and easily performed method for detection of bacterial cystitis in acutely dysuric non-pregnant women

Antimicrobial therapy for community-acquired pneumonia in adults

This is part of the series of practice guidelines commissioned by the Brazilian Society for Infectious Diseases through its Practice Guidelines Committee. The purpose of these guidelines is to provide assistance to clinicians in the antimicrobial treatment of community-acquired pneumonia (CAP) in immunocompetent adults. Panel members and consultants are experts in adult infectious diseases. The guidelines are evidence based where possible. The recommendations included in this document were elaborated based on the most frequently isolated pathogens and their antimicrobial susceptibilities. The etiology was based mainly on international studies, since there are very few regional data. On the other hand, the antimicrobial susceptibilities of main bacterial causes of CAP were based on the results of several antimicrobial resistance surveillance studies recently performed in Brazil. Other reference guidelines for the treatment of CAP, such as those elaborated by the Infectious Diseases Society of America and by the Canadian Infectious Diseases Society, were also discussed by the group during the elaboration of this document