Streptococcus pneumoniae Clonal Complex 199: Genetic Diversity and Tissue-Specific Virulence

Streptococcus pneumoniae is an important cause of otitis media and invasive disease. Since introduction of the heptavalent pneumococcal conjugate vaccine, there has been an increase in replacement disease due to serotype 19A clonal complex (CC)199 isolates. The goals of this study were to 1) describe genetic diversity among nineteen CC199 isolates from carriage, middle ear, blood, and cerebrospinal fluid, 2) compare CC199 19A (n = 3) and 15B/C (n = 2) isolates in the chinchilla model for pneumococcal disease, and 3) identify accessory genes associated with tissue-specific disease among a larger collection of S. pneumoniae isolates. CC199 isolates were analyzed by comparative genome hybridization. One hundred and twenty-seven genes were variably present. The CC199 phylogeny split into two main clades, one comprised predominantly of carriage isolates and another of disease isolates. Ability to colonize and cause disease did not differ by serotype in the chinchilla model. However, isolates from the disease clade were associated with faster time to bacteremia compared to carriage clade isolates. One 19A isolate exhibited hypervirulence. Twelve tissue-specific genes/regions were identified by correspondence analysis. After screening a diverse collection of 326 isolates, spr0282 was associated with carriage. Four genes/regions, SP0163, SP0463, SPN05002 and RD8a were associated with middle ear isolates. SPN05002 also associated with blood and CSF, while RD8a associated with blood isolates. The hypervirulent isolate's genome was sequenced using the Solexa paired-end sequencing platform and compared to that of a reference serotype 19A isolate, revealing the presence of a novel 20 kb region with sequence similarity to bacteriophage genes. Genetic factors other than serotype may modulate virulence potential in CC199. These studies have implications for the long-term effectiveness of conjugate vaccines. Ideally, future vaccines would target common proteins to effectively reduce carriage and disease in the vaccinated population

Avaliação de oficinas de autocuidado aos portadores de periodontite crônica: cuidando dos usuários e cirurgiões-dentistas The evaluation of self-care workshops to carriers of chronic periodontitis: taking care of users and dentists

O objetivo deste artigo é avaliar as oficinas de "aceitação ao paciente" para os cirurgiões-dentistas e de autocuidado para os portadores de periodontite crônica. Pacientes em atendimento nas clínicas de periodontia dos cursos de graduação e pós-graduação em odontologia e alunos de especialização em periodontia, em Fortaleza (CE), participaram de oficinas educativas. Os pacientes do grupo de intervenção e controle responderam a um questionário estruturado no início e no final do tratamento. Foi realizado o diário de campo em todas as oficinas. Para a comparação entre os momentos antes e depois, nos dois grupos, foi realizado o teste McNemar, com uma probabilidade de p < 0,05. No grupo de intervenção, houve um incremento do conhecimento em relação ao nome, às causas e aos fatores relacionados à doença (p < 0,05). No grupo-controle, não houve aumento na compreensão do caráter crônico, ao contrário do grupo de intervenção. Os cirurgiões-dentistas demonstraram pouca habilidade em lidar com pacientes crônicos. As oficinas educativas aos portadores de periodontite crônica acrescentam conhecimentos sobre a doença, suas causas e seu caráter crônico, principalmente pela metodologia pedagógica utilizada e o diálogo com a cultura popular.<br>The objective of this article is to evaluate the workshops of "accepting the patient" for dentists and of self-care for carriers of chronic periodontitis. The patients assisted at the periodontics clinics of graduation and post-graduation Dentistry courses and periodontics specialty students, in Fortaleza, Ceará State, Brazil, took part of educative workshops. A field diary was done in all workshops. The patients of both interventions and control groups answered a structured questionnaire at the beginning and at the end of the treatment. In order to compare the previous and post moments, in both groups, a McNemar test was performed, with a probability of p<0.05. In the intervention group, there was an increase in knowledge related to the name, the causes and related factors of the disease (p < 0.05). In the control group there wasn't a rise in the understanding of the diseases' chronic character, unlike the intervention group. The dentists showed few abilities in dealing with chronic patients. It can be concluded that the educative workshops for carriers of chronic periodontitis increase the knowledge about the illness, its causes and its chronic character, especially by the pedagogical methodology used and the dialogue with the popular culture