Antimicrobial susceptibility patterns of unusual nonfermentative gram-negative bacilli isolated from Latin America: report from the SENTRY Antimicrobial Surveillance Program (1997-2002)

The antimicrobial susceptibility of 176 unusual non-fermentative gram-negative bacilli (NF-GNB) collected from Latin America region through the SENTRY Program between 1997 and 2002 was evaluated by broth microdilution according to the National Committee for Clinical Laboratory Standards (NCCLS) recommendations. Nearly 74% of the NF-BGN belonged to the following genera/species: Burkholderia spp. (83), Achromobacter spp. (25), Ralstonia pickettii (16), Alcaligenes spp. (12), and Cryseobacterium spp. (12). Generally, trimethoprim/sulfamethoxazole (MIC50, 16 µg/ml; 18.8% susceptible) and meropenem (MIC50, 8 µg/ml; 50% susceptible) against Ralstonia pickettii. Since selection of the most appropriate antimicrobial agents for testing and reporting has not been established by the NCCLS for many of NF-GNB species, results from large multicenter studies may help to guide the best empiric therapy.Universidade Federal de São Paulo (UNIFESP) Departamento de MedicinaJMI Laboratories The Jones GroupUNIFESP, Depto. de MedicinaSciEL

Resistance trends of Acinetobacter spp. in Latin America and characterization of international dissemination of multi-drug resistant strains: five-year report of the SENTRY Antimicrobial Surveillance Program

Objectives: To analyze the antimicrobial susceptibility of Acinetobacter spp. isolates collected from Latin American medical centers as part of the SENTRY Antimicrobial Surveillance Program and also to evaluate the dissemination of mutti-drug resistant Acinetobacter spp. strains in the region.Methods: A total of 826 isolates of Acinetobacter spp. from multiple infection sites were collected from January 1997 to December 2001 in ten medical centers and susceptibility tested to >25 selected agents by broth microdilution. Multi-drug resistant Acinetobacter spp. isolates were molecular typed.Results: Resistance rates to carbapenems varied significantly among countries. A continued annual increase occurred in the Argentinean medical centers. in contrast, carbapenem resistance was rare in Chilean centers, and decreased significantly in the Brazilian institutions. Acinetobacter spp. isolates recovered from lower respiratory tract and bloodstream infections were associated with lower antimicrobial susceptibility rates. Resistance rates to imipenem were higher among isolates collected from intensive care units (13.5%) than among isolates from other units. A major ribogroup pattern (521-1) was detected among eight Acinetobocter spp. strains isolated from three distinct Latin American countries.Conclusions: This study found that antimicrobial resistance is still a major issue among Acinetobacter spp. isolates collected from some Latin American countries. the dissemination of a major bacterial cluster in different regions reinforces the importance of longitudinal surveillance programs, such as SENTRY, as valuable tools for monitoring antimicrobial susceptibility rates and guiding local interventions. (C) 2004 International Society for Infectious Diseases. Published by Elsevier B.V. All rights reserved.Universidade Federal de São Paulo, Lab Especial Microbiol Clin, Disciplina Doencas Infecciosas & Parasitarias, BR-04025010 São Paulo, BrazilUniv Estadual Maringa, Dept Anal Clin, Maringa, Parana, BrazilJones Grp, JMI Labs, N Liberty, IA USAUniversidade Federal de São Paulo, Lab Especial Microbiol Clin, Disciplina Doencas Infecciosas & Parasitarias, BR-04025010 São Paulo, BrazilWeb of Scienc

In vitro activity of tigecycline, a new glycylcycline, tested against 1,326 clinical bacterial strains isolated from Latin America

The in vitro activity of tigecycline (former GAR-936), a new semisynthetic tetracycline, was evaluated in comparison with tetracycline and other antimicrobial agents. MATERIAL AND METHODS: A total of 1,326 contemporary clinical isolates collected from the Latin American region were collected in 2000-2002 period and tested with microdilution broth according to the CLSI guidelines. The bacterial pathogens evaluated included Staphylococcus aureus (505), Streptococcus pneumoniae (269), coagulase-negative staphylococci (CoNS; 227), Haemophilus influenzae (129), Enterococcus spp. (80), Moraxella catarrhalis (54), beta-haemolytic streptococci (28), viridans group streptococci (26), and Neisseria meningitidis (8) RESULTS:Tigecycline demonstrated excellent activity against all Gram-positive cocci, with 90% of penicillin-resistant S. pneumoniae strains being inhibited at 0.12 µg/mL, while the same isolates had an MIC90 of > 16 µg/mL for tetracycline. All Enterococcus spp. were inhibited at 0.25 µg/mL of tigecycline. Tigecycline (MIC50, 0.25 µg/mL) was eight-fold more potent than minocycline (MIC50, 2 µg/mL) against oxacillin-resistant S. aureus (ORSA); all ORSA were inhibited at < 2 µg/mL of tigecycline. Tigecycline demonstrated excellent activity (MIC50, 0.5 µg/mL) against CoNS with reduced susceptibility to teicoplanin (MIC, 16 µg/mL). Tigecycline also showed high potency against respiratory pathogens such as M. catarrhalis (MIC50, 0.12 µg/mL) and H. influenzae (MIC50, 0.5 µg/mL). No tigecycline resistant isolates were detected when the proposed susceptible breakpoints (< 4 µg/mL) was applied. CONCLUSIONS: This results indicate that tigecycline has potent in vitro activity against clinically important pathogenic bacteria, including Gram-positive isolates resistant to both tetracycline and minocycline.Federal University of São Paulo Division of Infectious DiseasesDepartment of MedicineThe JMI LaboratoriesUNIFESP, Division of Infectious DiseasesSciEL

Evaluation of the Susceptibility profiles, genetic similarity and presence of qnr gene in Escherichia coli resistant to ciprofloxacin isolated in Brazilian hospitals

Increasing quinolone resistance has been reported worldwide, mainly among clinical isolates of Escherichia coli. The objectives of this study were to determine the susceptibility profile, the genetic relatedness, and the prevalence of the qnr gene among ciprofloxacin-resistant Escherichia coli isolated from distinct Brazilian hospitals. A total of 144 ciprofloxacin-resistant Escherichia coli were isolated from 17 Brazilian hospitals between January/2002 and June/2003. The antimicrobial susceptibility testing was performed by microdilution according to NCCLS. The presence of the qnr gene was initially screened by colony blotting, and then confirmed by PCR followed by DNA sequencing. Ninety-five urinary ciprofloxacin-resistant Escherichia coli were further selected for molecular typing by pulsed-field gel electrophoresis (PFGE). Imipenem and meropenem showed the highest susceptibility rates (100.0% for both compounds) followed by amikacin (91.0%) and piperacillin/tazobactan (84.8%). A single ciprofloxacin-resistant Escherichia coli isolate was positive for qnr among the 144 ciprofloxacin-resistant Escherichia coli. Forty-six PFGE patterns were observed among the 95 ciprofloxacin-resistant Escherichia coli type. This study shows that therapeutic options are limited for treatment of ciprofloxacin-resistant Escherichia coli due to the presence of additional mechanisms of antimicrobial resistance, such as ESBL production. The qnr gene was uncommon among ciprofloxacin-resistant Escherichia coli clinical isolates, but its identification might indicate the emergence of this mechanism of quinolone resistance in Brazil. The great genomic variability found among the ciprofloxacin-resistant Escherichia coli highlights the importance of the appropriate use of quinolone to restrict the selection of resistant isolates.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Federal University of São Paulo Special Laboratory of MicrobiologyJMI LaboratoriesUNIFESP, Special Laboratory of MicrobiologySciEL

Production of water soluble quercetin formulations by pressurized ethyl acetate-in-water emulsion technique using natural origin surfactants

Producción CientíficaQuercetin is a strong antioxidant flavonoid with several bioactive properties such as anti-inflammatory and anticarcinogenic activities, becoming an interesting compound to be incorporated into pharmaceutical, cosmetic or food products. However, these applications are limited by the low bioavailability of this flavonoid. Quercetin is poorly soluble in aqueous media, such as gastrointestinal fluids, being also degraded by gut flora. Thus, it is necessary the development of quercetin's formulations capable of improving its water solubility resulting in increased bioavailability and thus higher biological activity of this compound. The aim of the present work was the formulation of quercetin using three distinct natural origin surfactants, namely OSA-starch, Lecithin and b-glucan, by precipitation from a pressurized ethyl acetatein- water emulsion. Formulations of quercetin with encapsulation efficiencies up to near 76% and a micellar particle size in the range of nanometers were obtained using lecithin. An improved antioxidant activity (3-fold higher per unit mass of quercetin) was also observed in these formulations, demonstrating that lecithin is a good emulsifier for the encapsulation of quercetin. Furthermore, the addition of glycerol as co-solvent increased the colloidal stability of the suspension and the encapsulation efficiency of the flavonoid.Junta de Castilla y León (programa de apoyo a proyectos de investigación – Ref. VA225U14)Ministerio de Economía, Industria y Competitividad (Proyecto JCI-2012-14992)

O serviço público de saúde no município de Araraquara. Do Posto Sanitário ao Health Training Center: análise de uma trajetória

The extension of health services towards the countryside is a topic which has attracted the attention pf academic investigation due to some insufficiently analyzed components, such as the dynamics established with state, philanthropic and care-providing institutions, international funds and local arrangements. In the context of such diversity, the municipality of Araraquara, in the countryside of São Paulo state, was an atypical case as it had city funded services since the early Republic. Another unique element was the presence of the Public Health School of the São Paulo University, which has, since 1947, maintained the “Serviço Especial de Saúde de Araraquara” (SESA). This paper analyzes the path of the health care services in the city of Araraquara in the first half of the 20th century, covering two central aspects: the creation of the first health post in the 1920s and the founding of SESA in the 1940s. The sources used for this paper were collected from national and international archives, city and state government reports, as well as reports produced by the Rockefeller Foundation, all of which allow us to understand the path of the health care services. Thus, the city of Araraquara represented a different experience when compared to other cities, which underwent state interventions to organize their health services. The city distinguished itself for developing services funded, at different moments, by the city itself, with financial aid from the Rockefeller Foundation through either the Health Service or the State Health Department.Keywords: public health, Rockefeller Foundation, Serviço Especial de Saúde de Araraquara.A interiorização dos serviços de saúde é um tema que tem despertado a atenção da investigação acadêmica a partir de alguns componentes ainda insuficientemente analisados, tais como a dinâmica estabelecida com instituições estatais, filantrópicas, assistenciais, presença de capitais internacionais, além dos arranjos locais. No contexto de tal diversidade, o município de Araraquara, no interior de São Paulo, foi um caso atípico e contava com serviços bancados pela municipalidade desde os primórdios da República. Outro diferencial foi a presença da Faculdade de Saúde Pública da Universidade de São Paulo, que, desde 1947, mantém na cidade o Serviço Especial de Saúde de Araraquara (SESA). O artigo analisa a trajetória dos serviços de saúde no município de Araraquara na primeira metade do século XX, abrangendo dois aspectos centrais: a criação do primeiro Posto Sanitário na década de 1920 e a fundação do SESA, na década de 1940. Para a realização do artigo, foram empregadas fontes recolhidas em arquivos nacionais e internacionais, relatórios do poder público municipal e estadual, além dos produzidos pela Fundação Rockefeller que permitem entender a trajetória dos serviços de saúde. Assim, a cidade de Araraquara representou uma experiência diferenciada quando comparada a outros municípios que sofreram a intervenção do poder estadual para organizar seus serviços de saúde. A cidade diferenciou-se por desenvolver serviços custeados em diferentes momentos pela própria municipalidade, contando com os financiamentos da Fundação Rockefeller, via Serviço Sanitário ou Secretaria de Saúde. Palavras-chave: saúde pública, Fundação Rockefeller, Serviço Especial de Saúde de Araraquara

The public health service in the municipality of Araraquara. From the Health Post to the Health Training Center: Analysis of a path

A interiorização dos serviços de saúde é um tema que tem despertado a atenção da investigação acadêmica a partir de alguns componentes ainda insuficientemente analisados, tais como a dinâmica estabelecida com instituições estatais, filantrópicas, assistenciais, presença de capitais internacionais, além dos arranjos locais. No contexto de tal diversidade, o município de Araraquara, no interior de São Paulo, foi um caso atípico e contava com serviços bancados pela municipalidade desde os primórdios da República. Outro diferencial foi a presença da Faculdade de Saúde Pública da Universidade de São Paulo, que, desde 1947, mantém na cidade o Serviço Especial de Saúde de Araraquara (SESA). O artigo analisa a trajetória dos serviços de saúde no município de Araraquara na primeira metade do século XX, abrangendo dois aspectos centrais: a criação do primeiro Posto Sanitário na década de 1920 e a fundação do SESA, na década de 1940. Para a realização do artigo, foram empregadas fontes recolhidas em arquivos nacionais e internacionais, relatórios do poder público municipal e estadual, além dos produzidos pela Fundação Rockefeller que permitem entender a trajetória dos serviços de saúde. Assim, a cidade de Araraquara representou uma experiência diferenciada quando comparada a outros municípios que sofreram a intervenção do poder estadual para organizar seus serviços de saúde. A cidade diferenciou-se por desenvolver serviços custeados em diferentes momentos pela própria municipalidade, contando com os financiamentos da Fundação Rockefeller, via Serviço Sanitário ou Secretaria de Saúde. Palavras-chave: saúde pública, Fundação Rockefeller, Serviço Especial de Saúde de Araraquara.The extension of health services towards the countryside is a topic which has attracted the attention pf academic investigation due to some insufficiently analyzed components, such as the dynamics established with state, philanthropic and care-providing institutions, international funds and local arrangements. In the context of such diversity, the municipality of Araraquara, in the countryside of São Paulo state, was an atypical case as it had city funded services since the early Republic. Another unique element was the presence of the Public Health School of the São Paulo University, which has, since 1947, maintained the “Serviço Especial de Saúde de Araraquara” (SESA). This paper analyzes the path of the health care services in the city of Araraquara in the first half of the 20th century, covering two central aspects: the creation of the first health post in the 1920s and the founding of SESA in the 1940s. The sources used for this paper were collected from national and international archives, city and state government reports, as well as reports produced by the Rockefeller Foundation, all of which allow us to understand the path of the health care services. Thus, the city of Araraquara represented a different experience when compared to other cities, which underwent state interventions to organize their health services. The city distinguished itself for developing services funded, at different moments, by the city itself, with financial aid from the Rockefeller Foundation through either the Health Service or the State Health Department.Keywords: public health, Rockefeller Foundation, Serviço Especial de Saúde de Araraquara

Primary Diffuse Large B Cell Lymphoma Mimicking Hyperplastic Reactive Lesion (Lymphoma of the Oral Cavity)

Objective. To report a case of a challenging oral diagnosis involving a primary diffuse large B cell lymphoma of the oral cavity mimicking a hyperplastic reactive lesion. Case Report. A 72-year-old male patient was referred to the Department of Stomatology presenting a proliferative nodular lesion in the anterior region of the mandible involving the anterior teeth. The clinical examination revealed anterior teeth affected by periodontal disease, suggesting the nodular cession hyperplastic reaction. Incisional biopsy was performed under local anesthesia. The histopathological examination revealed a diffuse proliferation of atypical large lymphoid cells. The tumor cells showed immunopositivity for CD20 and Ki67 (100%) and negativity for CD3, CD30, and CD15. The diagnosis of diffuse large B cell lymphoma was established. The patient underwent chemotherapy and progressed to death after nine months. Conclusion. Lymphomas of the oral cavity are rare and may have nonspecific clinical features, mimicking inflammatory and reactive lesions. Therefore, a detailed clinical evaluation associated with histopathological and immunohistochemical analysis should be performed to enable early and accurate diagnoses in suspected oral lesions

Exames gratuitos: exames laboratoriais para cães e gatos fornecidos pelo LPV – Instituto Federal Catarinense – Campus Concórdia

The growing number of pets in large urban centers and the close contact with humans contribute to an increase in the risk of zoonoses for the human population.  By offering free parasitological examinations of feces of domestic animals, it is possible to carry out routine analyzes and monitor the health of the animals; it also is possible to measure the most frequent parasitological agents and which constitute zoonosis.  To provide free services to the community that uses the veterinary clinic of the Instituto Federal Catarinense - Campus Concórdia, feces samples from dogs and cats, collected by the tutors individually, were identified and placed in a box with the identification of the project Free exams: Laboratory tests for dogs and cats provided by the LVP. The tests were performed at the same institution, at the Veterinary Parasitology Laboratory (LPV).  These samples were subjected to Willis' qualitative methods; Hoffman, Pons &amp; Janer and centrifugal flotation in sucrose solution (d = 1.203g / cm3).  96 samples were examined, totaling 238 parasitological exams.  29 animals with parasitosis were diagnosed, in which eggs of the genera Ancylostoma, Trichuris, Cystoisospora, Giardia, Toxocara and Dipylidium were found.  In addition, other parasites were accidentally found in stool tests, such as the arthropod Demodex canis and mites.  The diagnosed and properly identified dogs and cats had their owners notified.  Considering the diagnoses made by the project, it is notable that the tests help in the care and attention to the animal's health and consequently to the human´s.O crescente número de animais de companhia nos grandes centros urbanos e o estreito convívio com o homem fazem com que haja um aumento no risco de zoonoses para a população humana. Ao oferecer exames parasitológicos gratuitos de fezes de animais domésticos, é possível realizar análises de rotina e acompanhamento da saúde dos animais, além de tornar possível a mensuração de quais são os agentes parasitológicos mais frequentes e quais constituem zoonose. Com objetivo de fornecer serviços gratuitos à comunidade que usufrui da clínica veterinária do Instituto Federal Catarinense – Campus Concórdia, amostras de fezes provenientes de cães e gatos, colhidas pelos tutores individualmente, foram identificadas e então colocadas em uma caixa com a identificação do projeto Exames gratuitos: Exames laboratoriais para cães e gatos fornecidos pelo LVP, sendo os exames realizados na mesma instituição, no Laboratório de Parasitologia Veterinária (LPV). Estas amostras foram submetidas aos métodos qualitativos de Willis; Hoffman, Pons &amp; Janer e centrífugo-flutuação em solução de sacarose (d=1,203g/cm3). Foram examinadas 96 amostras, totalizando 238 exames parasitológicos. Foram diagnosticados 29 animais com parasitoses, nos quais foram encontrados ovos dos gêneros Ancylostoma, Trichuris, Cystoisospora, Giardia, Toxocara e Dipylidium. Além destes, outros parasitas foram acidentalmente encontrados nos exames de fezes, como o artrópode Demodex canis e ácaros. Os cães e gatos diagnosticados e devidamente identificados tiveram seus proprietários notificados. Levando-se em consideração os diagnósticos realizados pelo projeto, é notável que os exames auxiliam nos cuidados e na atenção à saúde do animal e consequentemente à humana