Technical and economic evaluation of different types of control of Brevipalpus phoenicis (Acari: Tenuipalpidae) in citrus leprosies management

The objective of this work was to evaluate the effect of acaricide applications and pruning of symptomatic branches in citrus leprosis management in Brazil. It was conducted in an orange plantation of the 'Pera' variety, grafted onto the 'Cleopatra' tangerine, in two seasons (2006-2007 and 2007-2008). The experimental design was randomized blocks in a factorial scheme consisting of the following factors: (A) acaricide, in three levels: spirodiclofen and cyhexatin applied in rotation, lime sulphur; no acaricides; (B) pruning to remove branches that showed symptoms of leprosis, with two levels: with pruning, without pruning. We carried out periodic assessments of Brevipalpus phoenicis (Geijskes) populations (vector of the leprosis virus), leprosis incidence and severity, fruit yield, and the economic feasibility of the applied strategies. Based on the results, we concluded that spirodiclofen and cyhexatin were more effective than lime sulphur in B. phoenicis control. Control with lime sulphur required more applications than spirodiclofen and cyhexatin in rotation, making it more expensive. Pruning of symptomatic branches used in isolation was not sufficiently effective to control leprosis and significantly increased control costs. Profits were higher when the control involved sprayings of spirodiclofen and cyhexatin in alternation, with or without pruning

Genomic surveillance of Neisseria gonorrhoeae in the Philippines, 2013-2014

This work was supported by a Newton Fund award from the Medical Research Council (United Kingdom) MR/N019296/1 and the Philippine Council for Health Research and Development. Additional support was provided by the National Institute for Health Research (United Kingdom), the Global Health Research Unit on genomic surveillance of AMR (16/136/111) and by research grant U01CA207167 from the US National Institutes of Health.Antimicrobial-resistant Neisseria gonorrhoeae is a major threat to public health and is of particular concern in the Western Pacific Region, where the incidence of gonorrhoea is high. The Antimicrobial Resistance Surveillance Program (ARSP) has been capturing information on resistant gonorrhoea since 1996, but genomic epidemiology studies on this pathogen are lacking in the Philippines. We sequenced the whole genomes of 21 N. gonorrhoeae isolates collected in 2013-2014 by ARSP. The multilocus sequence type, multiantigen sequence type, presence of determinants of antimicrobial resistance and relatedness among the isolates were all derived from the sequence data. The concordance between phenotypic and genotypic resistance was also determined. Ten of 21 isolates were resistant to penicillin, ciprofloxacin and tetracycline, due mainly to the presence of the blaTEM gene, the S91F mutation in the gyrA gene and the tetM gene, respectively. None of the isolates was resistant to ceftriaxone or cefixime. The concordance between phenotypic and genotypic resistance was 92.38% overall for five antibiotics in four classes. Despite the small number of isolates studied, they were genetically diverse, as shown by the sequence types, the N. gonorrhoeae multiantigen sequence typing types and the tree. Comparison with global genomes placed the Philippine genomes within global lineage A and led to the identification of an international transmission route. This first genomic survey of N. gonorrhoeae isolates collected by ARSP will be used to contextualize prospective surveillance. It highlights the importance of genomic surveillance in the Western Pacific and other endemic regions for understanding the spread of drug-resistant gonorrhoea worldwide.Publisher PDFPeer reviewe

Immunocompromised patients with acute respiratory distress syndrome : Secondary analysis of the LUNG SAFE database

The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p < 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p < 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013