Streptococcus suis, an Emerging Drug-Resistant Animal and Human Pathogen

Streptococcus suis, a major porcine pathogen, has been receiving growing attention not only for its role in severe and increasingly reported infections in humans, but also for its involvement in drug resistance. Recent studies and the analysis of sequenced genomes have been providing important insights into the S. suis resistome, and have resulted in the identification of resistance determinants for tetracyclines, macrolides, aminoglycosides, chloramphenicol, antifolate drugs, streptothricin, and cadmium salts. Resistance gene-carrying genetic elements described so far include integrative and conjugative elements, transposons, genomic islands, phages, and chimeric elements. Some of these elements are similar to those reported in major streptococcal pathogens such as Streptococcus pyogenes, Streptococcus pneumoniae, and Streptococcus agalactiae and share the same chromosomal insertion sites. The available information strongly suggests that S. suis is an important antibiotic resistance reservoir that can contribute to the spread of resistance genes to the above-mentioned streptococci. S. suis is thus a paradigmatic example of possible intersections between animal and human resistomes

Methicillin-Resistant Staphylococcus aureus USA400 Clone, Italy

Lette

Growth of Chlorella vulgaris and Nannochloris oculata in effluents of Tilapia farming for the production of fatty acids with potential in biofuels

The use of microalgae in wastewater treatment and its biotechnological exploitation for the production of biofuels is a potential environmental application. Some species of microalgae are notable due to their lipid composition and fatty acid profile suitable for biofuel production. During the present study, a factorial 23 experimental design was conducted, which assessed three factors: i) two species of microalgae (Chlorella vulgaris and Nannochloris oculata), ii) two types of culture media [wastewater of tilapia farming (WTF) and bold’s basal medium (BB)], and iii) two types of lighting (multi-LED lamps and white light). Microalgae were inoculated in photobioreactors in 6 L of medium (WTF or BBM) at an initial concentration of 1.0 × 106 cells ml-1 at 20 ± 2°C. The highest average cell density as well as the highest productivity of biomass observed in the treatments was C. vulgaris treatment in BBM and multi-LED lighting (8.83 × 107 cells ml-1 and 0.0854 g l-1 d-1, respectively). Although the majority of lipid productivity was obtained in the exponential phase of N. oculata cultivated in multi-LEDs in both treatments (BBM with 58% and WTF with 52%), cultivation of both species was generally maintained in WTF and were those that presented the major lipid productivity (2-18 mg l-1 d-1) in comparison with those cultivated in BBM. Palmitic, stearic, oleic, linoleic, linolenic and eicosanoic (C16–C20) fatty acids were present in both species of microalgae in concentrations between 26 and 74%. Based on the results of the present study, we conclude that cultivation of N. oculata and/or C. vulgaris in WTF illuminated with multi-LEDs is an economic and sustainable alternative for biodiesel production because it can represent up to 58% of lipids with a fatty acid profile optimal up to 74% of the total fatty acids.Key words: Chlorella vulgaris, Nannochloris oculata, production of fatty acids, wastewater of tilapia farming, production of biofuels

Human case of autochthonous West Nile virus lineage 2 infection in Italy, September 2011.

Binary file ES_Abstracts_Final_ECDC.txt matche

Streptococcus suis Meningitis without History of Animal Contact, Italy

Streptococcus suis, a major swine pathogen worldwide, is emerging as a zoonotic agent capable of causing a variety of serious infections in swine as well as in persons exposed to pigs or to pork products. These infections include meningitis, septicemia, pneumonia, endocarditis, arthritis, and septic shock (1,2). Despite recent outbreaks among persons in China, S. suis disease in humans is a rare, probably underdiagnosed infection that usually occurs as sporadic cases (1,2). Persons in close occupational or accidental contact with pigs or pork products and those who eat uncooked or undercooked pork may be at higher risk than others. However, most infected persons are likely healthy carriers, and S. suis is believed to induce overt disease (especially meningitis) in only some circumstances (2). We describe a case of S. suis meningitis in a 68-year-old man from Sardinia, Italy, who had no reported contact with swine, other animals, or any animal products; the patient also had cancer, which was discovered incidentally during the workup

Streptococcus suis Meningitis without History of Animal Contact, Italy

Streptococcus suis, a major swine pathogen worldwide, is emerging as a zoonotic agent capable of causing a variety of serious infections in swine as well as in persons exposed to pigs or to pork products. These infections include meningitis, septicemia, pneumonia, endocarditis, arthritis, and septic shock (1,2). Despite recent outbreaks among persons in China, S. suis disease in humans is a rare, probably underdiagnosed infection that usually occurs as sporadic cases (1,2). Persons in close occupational or accidental contact with pigs or pork products and those who eat uncooked or undercooked pork may be at higher risk than others. However, most infected persons are likely healthy carriers, and S. suis is believed to induce overt disease (especially meningitis) in only some circumstances (2). We describe a case of S. suis meningitis in a 68-year-old man from Sardinia, Italy, who had no reported contact with swine, other animals, or any animal products; the patient also had cancer, which was discovered incidentally during the workup

Characterization of a Multiresistance Plasmid Carrying the optrA and cfr Resistance Genes From an Enterococcus faecium Clinical Isolate

open13noEnterococcus faecium E35048, a bloodstream isolate from Italy, was the first strain where the oxazolidinone resistance gene optrA was detected outside China. The strain was also positive for the oxazolidinone resistance gene cfr. WGS analysis revealed that the two genes were linked (23.1 kb apart), being co-carried by a 41,816-bp plasmid that was named pE35048-oc. This plasmid also carried the macrolide resistance gene erm(B) and a backbone related to that of the well-known Enterococcus faecalis plasmid pRE25 (identity 96%, coverage 65%). The optrA gene context was original, optrA being part of a composite transposon, named Tn6628, which was integrated into the gene encoding for the ζ toxin protein (orf19 of pRE25). The cfr gene was flanked by two ISEnfa5 insertion sequences and the element was inserted into an lnu(E) gene. Both optrA and cfr contexts were excisable. pE35048-oc could not be transferred to enterococcal recipients by conjugation or transformation. A plasmid-cured derivative of E. faecium E35048 was obtained following growth at 42°C, and the complete loss of pE35048-oc was confirmed by WGS. pE35048-oc exhibited some similarity but also notable differences from pEF12-0805, a recently described enterococcal plasmid from human E. faecium also co-carrying optrA and cfr; conversely it was completely unrelated to other optrA- and cfr-carrying plasmids from Staphylococcus sciuri. The optrA-cfr linkage is a matter of concern since it could herald the possibility of a co-spread of the two genes, both involved in resistance to last resort agents such as the oxazolidinones.openMorroni, Gianluca; Brenciani, Andrea; Antonelli, Alberto; Maria D’Andrea, Marco; Di Pilato, Vincenzo; Fioriti, Simona; Mingoia, Marina; Vignaroli, Carla; Cirioni, Oscar; Biavasco, Francesca; Varaldo, Pietro E.; Rossolini, Gian Maria; Giovanetti, EleonoraMorroni, Gianluca; Brenciani, Andrea; Antonelli, Alberto; Maria D’Andrea, Marco; Di Pilato, Vincenzo; Fioriti, Simona; Mingoia, Marina; Vignaroli, Carla; Cirioni, Oscar; Biavasco, Francesca; Varaldo, Pietro E.; Rossolini, Gian Maria; Giovanetti, Eleonor

Chronic myeloid leukemia in blast crisis treated with imatinib 600 mg: outcome of the patients alive after a 6-year follow-up

Background Imatinib mesylate is the first line treatment for chronic myeloid leukemia. In patients with advanced phase of the disease, the advent of imatinib significantly increased survival. However, few long-term data, based on large, prospective and controlled trials are available on the outcome of these patients. Design and Methods We conducted a phase II trial of imatinib 600 mg daily in patients with chronic myeloid leukemia in blast crisis. The return to chronic phase was defined as <15% blasts and <30% blasts plus promyelocytes in blood or bone marrow and <20% peripheral basophils. A complete hematologic response required the normalization of platelet and white cell differential counts and absence of extramedullary involvement. Cytogenetic response was assessed by the standard banding technique and rated as usual. Results Ninety-two patients were enrolled (20 with lymphoid blast crisis and 72 with myeloid blast crisis). Forty-six patients (50%) returned to chronic phase, and 24 patients (26%) achieved also a complete hematologic response. Sixteen patients (17%) had a cytogenetic response (9 complete, 1 partial, and 6 minor or minimal). The complete cytogenetic response was subsequently lost by all but two patients between 2 and 12 months after first having achieved it: the median duration of complete cytogenetic response was 7 months. All responses were sustained for a minimum of 4 weeks. The median survival of all the patients was 7 months. After a median observation time of 66 months, seven (8%) patients are alive. Three of these patients are on imatinib treatment (1 in complete hematologic remission, 1 in partial cytogenetic response and 1 in complete cytogenetic remission). Three patients are in complete remission after allogeneic stem cell transplantation. One patient is alive in blast crisis, on therapy with a second-generation tyrosine kinase inhibitor. Conclusions Imatinib was effective and safe in the short-term treatment of chronic myeloid leukemia in blast crisis, but longer-term outcome was not significantly influenced (ClinicalTrials.gov identifier: [NCT00514969][1]). [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00514969&atom=%2Fhaematol%2F93%2F12%2F1792.ato

Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study

Background Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours.Methods In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186.Findings Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78 center dot 6%] female patients and 4922 [21 center dot 4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1 center dot 4 [IQR 0 center dot 6-3 center dot 4]) compared with the prepandemic phase (2 center dot 0 [0 center dot 9-3 center dot 7]; p&lt;0 center dot 0001) and pandemic decrease phase (2 center dot 3 [1 center dot 0-5 center dot 0]; p&lt;0 center dot 0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69 center dot 0%] of 3704 vs 1515 [71 center dot 5%] of 2119; OR 1 center dot 1 [95% CI 1 center dot 0-1 center dot 3]; p=0 center dot 042), lymph node metastases (343 [9 center dot 3%] vs 264 [12 center dot 5%]; OR 1 center dot 4 [1 center dot 2-1 center dot 7]; p=0 center dot 0001), and tumours at high risk of structural disease recurrence (203 [5 center dot 7%] of 3584 vs 155 [7 center dot 7%] of 2006; OR 1 center dot 4 [1 center dot 1-1 center dot 7]; p=0 center dot 0039).Interpretation Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation.Funding None.Copyright (c) 2023 Published by Elsevier Ltd. All rights reserved