STREPTOCOCCUS INIAE, TÁC NHÂN GÂY BỆNH ?ĐEN THÂN? TRÊN CÁ RÔ ĐỒNG (ANABAS TESTUDINEUS)

Nghiên cứu mô tả lần đầu tiên phân lập vi khuẩn Streptococcus iniae là tác nhân gây bệnh ?đen thân? trên cá rô đồng (Anabas testudineus). Nghiên cứu đã thu được 114 mẫu cá rô đồng bệnh có dấu hiệu đen thân ở các ao nuôi thâm canh khác nhau ở các tỉnh đồng bằng sông Cửu Long. Cá bệnh có dấu hiệu khắp vùng lưng màu đen, mắt cá mờ đục, xuất huyết nội quan, gan, thận và tùy tạng sưng to. Các mẫu cá được kiểm tổng quát các tác nhân gây bệnh. Sau thời gian ủ 24-36 giờ ở 28°C, các khuẩn lạc thuần dạng nhỏ li ti, trắng đục được phân lập từ các mẫu gan, thận, tỳ tạng, máu, mắt và não cá bệnh xuất hiện nhiều trên môi trường brain heart infusion  agar (BHI ) và thạch máu (BA). Quan sát tế bào vi khuẩn nhuộm Gram có hình cầu, dạng chuỗi, Gram dương. Kết quả kiểm tra đặc điểm hình thái, sinh lý, sinh hóa, kít API 20Strep và giải trình tự gen 16S rRNA đã xác định vi khuẩn phân lập trên cá rô đồng bệnh ?đen thân? là Streptococcus iniae. Hai chủng vi khuẩn S. iniae điển hình được sử dụng để gây thí nghiệm cảm nhiễm trên cá rô đồng giống khỏe (trọng lượng 3-6 g) bằng phương pháp tiêm 4 nồng độ từ 103 đến 106 CFU/mL. ..

Antibiotic use and prescription and its effects on Enterobacteriaceae in the gut in children with mild respiratory infections in Ho Chi Minh City, Vietnam. A prospective observational outpatient study.

BACKGROUND AND OBJECTIVES: Treatment guidelines do not recommend antibiotic use for acute respiratory infections (ARI), except for streptococcal pharyngitis/tonsillitis and pneumonia. However, antibiotics are prescribed frequently for children with ARI, often in absence of evidence for bacterial infection. The objectives of this study were 1) to assess the appropriateness of antibiotic prescriptions for mild ARI in paediatric outpatients in relation to available guidelines and detected pathogens, 2) to assess antibiotic use on presentation using questionnaires and detection in urine 3) to assess the carriage rates and proportions of resistant intestinal Enterobacteriaceae before, during and after consultation. MATERIALS AND METHODS: Patients were prospectively enrolled in Children's Hospital 1, Ho Chi Minh City, Vietnam and diagnoses, prescribed therapy and outcome were recorded on first visit and on follow-up after 7 days. Respiratory bacterial and viral pathogens were detected using molecular assays. Antibiotic use before presentation was assessed using questionnaires and urine HPLC. The impact of antibiotic usage on intestinal Enterobacteriaceae was assessed with semi-quantitative culture on agar with and without antibiotics on presentation and after 7 and 28 days. RESULTS: A total of 563 patients were enrolled between February 2009 and February 2010. Antibiotics were prescribed for all except 2 of 563 patients. The majority were 2nd and 3rd generation oral cephalosporins and amoxicillin with or without clavulanic acid. Respiratory viruses were detected in respiratory specimens of 72.5% of patients. Antibiotic use was considered inappropriate in 90.1% and 67.5%, based on guidelines and detected pathogens, respectively. On presentation parents reported antibiotic use for 22% of patients, 41% of parents did not know and 37% denied antibiotic use. Among these three groups, six commonly used antibiotics were detected with HPLC in patients' urine in 49%, 40% and 14%, respectively. Temporary selection of 3rd generation cephalosporin resistant intestinal Enterobacteriaceae during antibiotic use was observed, with co-selection of resistance to aminoglycosides and fluoroquinolones. CONCLUSIONS: We report overuse and overprescription of antibiotics for uncomplicated ARI with selection of resistant intestinal Enterobacteriaceae, posing a risk for community transmission and persistence in a setting of a highly granular healthcare system and unrestricted access to antibiotics through private pharmacies. REGISTRATION: This study was registered at the International Standard Randomised Controlled Trials Number registry under number ISRCTN32862422: http://www.isrctn.com/ISRCTN32862422

Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial

Background Trials of fluoxetine for recovery after stroke report conflicting results. The Assessment oF FluoxetINe In sTroke recoverY (AFFINITY) trial aimed to show if daily oral fluoxetine for 6 months after stroke improves functional outcome in an ethnically diverse population. Methods AFFINITY was a randomised, parallel-group, double-blind, placebo-controlled trial done in 43 hospital stroke units in Australia (n=29), New Zealand (four), and Vietnam (ten). Eligible patients were adults (aged ≥18 years) with a clinical diagnosis of acute stroke in the previous 2–15 days, brain imaging consistent with ischaemic or haemorrhagic stroke, and a persisting neurological deficit that produced a modified Rankin Scale (mRS) score of 1 or more. Patients were randomly assigned 1:1 via a web-based system using a minimisation algorithm to once daily, oral fluoxetine 20 mg capsules or matching placebo for 6 months. Patients, carers, investigators, and outcome assessors were masked to the treatment allocation. The primary outcome was functional status, measured by the mRS, at 6 months. The primary analysis was an ordinal logistic regression of the mRS at 6 months, adjusted for minimisation variables. Primary and safety analyses were done according to the patient's treatment allocation. The trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12611000774921. Findings Between Jan 11, 2013, and June 30, 2019, 1280 patients were recruited in Australia (n=532), New Zealand (n=42), and Vietnam (n=706), of whom 642 were randomly assigned to fluoxetine and 638 were randomly assigned to placebo. Mean duration of trial treatment was 167 days (SD 48·1). At 6 months, mRS data were available in 624 (97%) patients in the fluoxetine group and 632 (99%) in the placebo group. The distribution of mRS categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio 0·94, 95% CI 0·76–1·15; p=0·53). Compared with patients in the placebo group, patients in the fluoxetine group had more falls (20 [3%] vs seven [1%]; p=0·018), bone fractures (19 [3%] vs six [1%]; p=0·014), and epileptic seizures (ten [2%] vs two [<1%]; p=0·038) at 6 months. Interpretation Oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and epileptic seizures. These results do not support the use of fluoxetine to improve functional outcome after stroke

A rare case of a primary central nervous system neuroblastoma mimicking a trigeminal schwannoma in an adult

Neuroblastoma is a malignant extra-cranial tumor that frequently arises in the pediatric population aged <5 years but is rare in adults. Only a few cases of primary central nervous system neuroblastoma (PCN-NB) have been documented, with most occurring in young patients. In this article, we report an adult case with a PCN-NB in the cerebellopontine angle-middle cranial fossa region that mimicked another neoplasm. We also discuss the magnetic resonance imaging features and pathological characteristics of PCN-NB and differential diagnosis strategies

The co-selection of fluoroquinolone resistance genes in the gut flora of Vietnamese children.

Antimicrobial consumption is one of the major contributing factors facilitating the development and maintenance of bacteria exhibiting antimicrobial resistance. Plasmid-mediated quinolone resistance (PMQR) genes, such as the qnr family, can be horizontally transferred and contribute to reduced susceptibility to fluoroquinolones. We performed an observational study, investigating the copy number of PMQR after antimicrobial therapy. We enrolled 300 children resident in Ho Chi Minh City receiving antimicrobial therapy for acute respiratory tract infections (ARIs). Rectal swabs were taken on enrollment and seven days subsequently, counts for Enterobacteriaceae were performed and qnrA, qnrB and qnrS were quantified by using real-time PCR on metagenomic stool DNA. On enrollment, we found no association between age, gender or location of the participants and the prevalence of qnrA, qnrB or qnrS. Yet, all three loci demonstrated a proportional increase in the number of samples testing positive between day 0 and day 7. Furthermore, qnrB demonstrated a significant increase in copy number between paired samples (p<0.001; Wilcoxon rank-sum), associated with non-fluoroquinolone combination antimicrobial therapy. To our knowledge, this is the first study describing an association between the use of non-fluoroquinolone antimicrobials and the increasing relative prevalence and quantity of qnr genes. Our work outlines a potential mechanism for the selection and maintenance of PMQR genes and predicts a strong effect of co-selection of these resistance determinants through the use of unrelated and potentially unnecessary antimicrobial regimes

The validation of quantitative real-time PCR assays targeting <i>qnrA</i>, <i>qnrB</i> and <i>qnrS</i>.

<p>The inter-assay and intra-assay variability were checked on bacterial nucleic acid extracted from pure culture with and without internal control PhHV. No differences were observed between these two batches.</p><p>CV: Coefficient of variance.</p

Baseline demographic characteristics of participants and the prevalence of <i>qnr</i> genes prior to antimicrobial therapy.

*<p>Districts within HCMC with population densities <10,000 (low), 10,000–30000 (medium) and >30,000 people/km² (high).</p

Comparison of gene copy number for <i>qnrA</i>, <i>qnrB</i> and <i>qnrS</i> before and after three different alternative treatment regimes.

*<p><i>p</i><0.05. Statistical significance calculated by paired Wilcoxon rank-sum test.</p>a<p><i>p</i> value calculated by comparing <i>qnr</i> gene copy number between Day 0 and Day 7.</p>b<p><i>p</i> value calculated by comparing <i>qnr</i> gene copy number between Day 0 and Day 7 after adjusting for <i>Enterobacteriaceae</i> CFU ml⁻¹.</p

The median gene copy number of <i>qnrA</i>, <i>qnrB and qnrS</i> on enrolment and after antimicrobial therapy.

<p>Box plots showing the median and interquartile ranges of <i>qnrA</i>, <i>qnrB and qnrS</i> gene copy numbers in stool samples collected from children with ARIs on enrolment (Day 0) and after antimicrobial treatment (Day 7). Statistical significance between the <i>qnr</i> genes was calculated using the paired Wilcoxon rank-sum test; significant variation in gene copy number between the <i>qnr</i> genes is denoted at the head of the figure (*), all <i>p</i> values<0.001.</p