Urinary tract infection (UTI) is the most frequent bacterial infection. Some uropathogenic
(UPEC) genes have been associated with disease severity and antibiotic resistance. The aim was to determine ...the association of nine UPEC virulence genes with UTI severity and antibiotic resistance of strains collected from adults with community-acquired UTI.
A case-control study (1:3) (38 urosepsis/pyelonephritis and 114 cystitis/urethritis) was conducted. The
, and
(the last five are siderophore genes) virulence genes were determined by PCR. The information of antibiotic susceptibility pattern of the strains was collected from medical records. This pattern was determined using an automated system for antimicrobial susceptibility testing. Multidrug-resistant (MDR) was defined as resistance to three or more antibiotic families.
was the most frequently detected virulence gene (94.7%), and
was the least frequently detected (9.2%); 55.3% (83/150) of the strains were MDR. The evaluated genes were not associated with UTI severity. Associations were found between the presence of
and carbapenem resistance (Odds ratio OR = 7.58, 95% confidence interval CI, 1.50-35.42),
and fluoroquinolone resistance (OR = 2.35, 95% CI, 1.15-4.84, and
(OR = 2.8, 95% CI, 1.20-6.48) and
(OR = 2.95, 95% CI, 1.33-6.69) with penicillin resistance. In addition,
was the only gene associated with MDR (OR = 2.09, 95% CI,1.03-4.26).
There was no association among virulence genes and UTI severity. Three of the five iron uptake genes were associated with resistance to at least one antibiotic family. Regarding the other four non-siderophore genes, only
was associated with antibiotic resistance to carbapenems. It is essential to continue studying bacterial genetic characteristics that cause the generation of pathogenic and multidrug-resistant phenotypes of UPEC strains.
In the late phase of Trypanosoma cruzi infection, parasite persistence and an exaggerated immune response accompanied by oxidative stress play a crucial role in the genesis of Chronic Chagasic ...Cardiomyopathy (CCC). Current treatments (Benznidazole (BNZ) and Nifurtimox) can effect only the elimination of the parasite, but are ineffective for late stage treatment and for preventing heart damage and disease progression. In vivo trypanocidal and cardioprotective activity has been reported for Lippia alba essential oils (EOs), ascribed to their two major terpenes, limonene and caryophyllene oxide. To investigate the role of antioxidant and immunomodulatory mechanisms behind these properties, chronic-T. cruzi-infected rats were treated with oral synergistic mixtures of the aforementioned EOs. For this purpose, the EOs were optimized through limonene-enrichment fractioning and by the addition of exogenous caryophyllene oxide (LIMOX) and used alone or in combined therapy with subtherapeutic doses of BNZ (LIMOXBNZ). Clinical, toxicity, inflammatory, oxidative, and parasitological (qPCR) parameters were assessed in cardiac tissue. These therapies demonstrated meaningful antioxidant and immunomodulatory activity on markers involved in CCC pathogenesis (IFN-γ, TNF-α, IL-4, IL-10, and iNOS), which could explain their significant trypanocidal properties and their noteworthy role in preventing, and even reversing, the progression of cardiac damage in chronic Chagas disease.
•A successfully model of chronic Chagas disease was induced in rats.•An oral therapy was developed from fractions of Lippia alba essential oils.•Echocardiographycal and histopathological test ...confirmed a cardioprotective effect.•The therapy showed a trypanocidal action similar to Benznidazole by qPCR analysis.•The treatment scheme was apparently non-toxic by clinical and pathological test.
The present study reports the trypanocidal and cardioprotective properties of fractions derived from Lippia alba (Verbenaceae family) essential oils (EOs), in a murine model of chronic Chagas disease (ChD). This infection represents one of the most serious public health problems in Latin American countries, without an effective therapy for chronic infection and its eventual cardiac complications. In the model established herein, the therapeutic scheme which involved 30 oral and daily doses of OxiLim (a mix composed by fractions enriched in citral, caryophyllene oxide, and limonene) was not toxic and exhibited trypanocidal activity comparable to benznidazole (assessed by parasitic DNA quantification - qPCR); but with an additional protective effects against cardiomyopathy progression. This last finding was confirmed by both echocardiography (reduction in the maximum diameter of the cardiac silhouette), and heart histopathology (tissue recovery, abundant fibroblasts, and mild separation of cardiac fibers). Conversely, rats treated only with benznidazole showed a significant increase in cardiac diameter with severe fiber dilation, angiogenesis, and high diversity of immune infiltrate. This research reports a highly trypanocidal (similar to benznidazole) therapeutic scheme based on L. alba essential oil fractions (OxiLim), which also exhibits a positive cardioprotective effect in the course of chronic chagasic cardiomyopathy, in rats.
Outbreaks of acute Chagas disease associated with oral transmission are easily detected nowadays with trained health personnel in areas of low endemicity, or in which the vector transmission has been ...interrupted. Given the biological and genetic diversity of Trypanosoma cruzi, the high morbidity, mortality, and the observed therapeutic failure, new characteristics of these outbreaks need to be addressed at different levels, both in Trypanosoma cruzi as in patient response. The aim of this work was to evaluate the patient's features involved in six outbreaks of acute Chagas disease which occurred in Santander, Colombia, and the characteristics of Trypanosoma cruzi clones isolated from these patients, to establish the potential relationship between the etiologic agent features with host behavior.
The clinical, pathological and epidemiological aspects of outbreaks were analyzed. In addition, Trypanosoma cruzi clones were biologically characterized both in vitro and in vivo, and the susceptibility to the classical trypanocidal drugs nifurtimox and benznidazole was evaluated. Trypanosoma cruzi clones were genotyped by means of mini-exon intergenic spacer and cytochrome b genes sequencing.
All clones were DTU I, and based on the mini-exon intergenic spacer, belong to two genotypes: G2 related with sub-urban, and G11 with rural outbreaks. Girón outbreak clones with higher susceptibility to drugs presented G2 genotype and C/T transition in Cyt b. The outbreaks affected mainly young population (±25.9 years), and the mortality rate was 10 %. The cardiac tissue showed intense inflammatory infiltrate, myocardial necrosis and abundant amastigote nests. However, although the gastrointestinal tissue was congestive, no inflammation or parasites were observed.
Although all clones belong to DTU I, two intra-DTU genotypes were found with the sequencing of the mini-exon intergenic spacer, however there is no strict correlation between genetic groups, the cycles of the parasite or the clinical forms of the disease. Trypanosoma cruzi clones from Girón with higher sensitivity to nifurtimox presented a particular G2 genotype and C/T transition in Cyt b. When the diagnosis was early, the patients responded well to antichagasic treatment, which highlights the importance of diagnosis and treatment early to prevent fatal outcomes associated with these acute episodes.
Chagasic megacolon has been reported in the southern cone countries of South America and is mainly associated with Trypanosoma cruzi II infection. Herein, we report the first case in Colombia of ...chagasic megacolon with cardiomyopathy associated with the T. cruzi I lineage. This finding suggests that in Colombia, as well as in other northern countries of South America and throughout Central America, where T. cruzi I is endemic, cardiomyopathy may not be the only clinical form of Chagas disease.
Objectives
To analyse the effect of parasite load assessed by quantitative reverse transcription PCR (RT‐qPCR) in serum on the prognosis of patients with chronic Chagas cardiomyopathy (CCM) after a ...2‐year follow‐up.
Methods
Prospective cohort study conducted between 2015 and 2017. One hundred patients with CCM were included. Basal parasitaemia levels of Trypanosoma cruzi (T. cruzi) were measured using a quantitative polymerase chain reaction (qPCR) test. The primary composite outcome (CO) was all‐cause mortality, cardiac transplantation and implantation of a left ventricular assist device. Secondary outcomes were the baseline levels of serum biomarkers and echocardiographic variables.
Results
After a 2 years of follow‐up, the primary CO rate was 16%. A positive qPCR was not associated with a higher risk of the CO. However, when parasitaemia was evaluated by comparing tertiles (tertile 1: undetectable parasitaemia, tertile 2: low parasitaemia and tertile 3: high parasitaemia), a higher risk of the CO (HR 3.66; 95% CI 1.11–12.21) was evidenced in tertile 2. Moreover, patients in tertile 2 had significantly higher levels of high‐sensitivity troponin T and cystatin C and more frequently exhibited an ejection fraction <50%.
Conclusion
Low parasitaemia was associated with severity markers of myocardial injury and a higher risk of the composite outcome when compared with undetectable parasitaemia. This finding could be hypothetically explained by a more vigorous immune response in patients with low parasitaemia that could decrease T. cruzi load more efficiently, but be associated with increased myocardial damage. Additional studies with a larger number of patients and cytokine measurement are required to support this hypothesis.
Objectifs
Analyser l'effet de la charge parasitaire évaluée par PCR quantitative de transcription inverse (RT‐qPCR) dans le sérum sur le pronostic des patients atteints de cardiomyopathie chronique de Chagas (CCM) après un suivi de deux ans.
Méthodes
Etude de cohorte prospective menée entre 2015 et 2017. Une centaine de patients atteints de CCM ont été inclus. Les niveaux de parasitémie basale de Trypanosoma cruzi (T. cruzi) ont été mesurés en utilisant un test de réaction en chaîne de la polymérase quantitative (qPCR). Le principal résultat composite (RC) était la mortalité toutes causes, la transplantation cardiaque et l'implantation d'un dispositif d'assistance ventriculaire gauche. Les critères secondaires étaient les niveaux de base des biomarqueurs sériques et des variables échocardiographiques.
Résultats
Après 2 ans de suivi, le taux de RC primaire était de 16%. Une qPCR positive n'était pas associée à un risque plus élevé de RC. Cependant, lorsque la parasitémie était évaluée en comparant les tertiles (tertile 1: parasitémie indétectable, tertile 2: parasitémie faible et tertile 3: parasitémie élevée), un risque plus élevé de RC (HR: 3,66; IC95%: 1,11–12,21) a été mis en évidence dans le tertile 2. De plus, les patients du tertile 2 avaient des niveaux significativement plus élevés de troponine T et de cystatine‐C à haute sensibilité et présentaient plus fréquemment une fraction d'éjection <50%.
Conclusion
Une faible parasitémie était associée à des marqueurs de sévérité des lésions myocardiques et à un risque plus élevé de résultat composite par rapport à une parasitémie indétectable. Cette découverte pourrait être hypothétiquement expliquée par une réponse immunitaire plus vigoureuse chez les patients présentant une faible parasitémie qui pourrait diminuer la charge de T. cruzi plus efficacement mais être associée à une augmentation des lésions myocardiques. Des études supplémentaires avec un plus grand nombre de patients et une mesure des cytokines sont nécessaires pour étayer cette hypothèse.
Summary
In this study, we investigated the association between single‐nucleotide polymorphisms (SNPs) of the interleukin‐4 (IL4), interleukin‐4 receptor‐α (IL4RA) and interleukin‐10 (IL10) genes with ...the development of chagasic heart disease. This study included 260 patients from Colombia who were serologically positive for Trypanosoma cruzi antigens (cardiomyopathic, n = 130; asymptomatic, n = 130). Genotypes were determined by polymerase chain reaction (PCR)–restriction fragment length polymorphism or sequence‐specific primer methods. We found statistically significant differences in the distribution of the IL4RA +148 AA (P = 0·025, OR = 1·89, CI = 1·04–3·43) genotype when comparing asymptomatic and symptomatic patients. No statistically significant differences in the genotype and allele frequency of IL4 and IL10 gene polymorphisms between symptomatic and asymptomatic patients were observed. Our experimental evidence suggests that the IL4RA +148 AA genotype has a weak association with the development of chagasic cardiomyopathy in the population under study.
Introducción: La enfermedad de Chagas (ECh) es causada por la infección con Trypanosoma cruzi. En Latinoamérica afecta cerca de 8 a 9 millones de personas y es un problema de salud pública. Existen ...varias vías de transmisión del parásito como: transfusión sanguínea, congénita, vía oral y vectorial, siendo esta última la más común. Sin embargo, en los últimos años la vía oral ha adquirido relevancia por el registro de diferentes brotes de ECh agudo asociados a la ingesta de alimentos contaminados, en países como Brasil, Venezuela y Colombia. El mecanismo de infección de T. cruzi por vía oral involucra un proceso de interacción hospedero-parásito en el cual las formas infectantes del parásito deben alcanzar la mucosa gástrica a través de un proceso de adherencia e invasión celular dado por la expresión diferencial de glicoproteínas de superficie tales como Gp82, Gp90, Gp30 y Gp35/50. Objetivo: Esta revisión tiene como objetivo describir y relacionar las moléculas de superficie de T. cruzi involucradas en la transmisión por vía oral. Materiales y métodos: Estudio cualitativo, de tipo interpretativo-descriptivo, con un diseño no experimental y de corte transversal. Se realizó una revisión de literatura científica con documentos bibliográficos localizados en diferentes fuentes en español, inglés y portugués, los criterios de selección tenidos en cuenta fueron la transmisión de ECh por vía oral, principales moléculas de superficie del parásito, relación de las diferentes DTUs con la expresión de estas moléculas y la severidad de la enfermedad. Esta revisión se realizó en bases de datos como: ELSEVIER, PubMed, EBSCO HOST, ebrary, Scopus, entre otras, incluyendo palabras claves como: transmisión oral, enfermedad de Chagas, Trypanosoma cruzi, Gp82, Gp90, adhesión, invasión y mucosa gástrica, utilizando artículos publicados entre los años 2008 y 2015. Resultados: En nuestra búsqueda se localizaron 101 estudios experimentales, epidemiológicos y/o revisiones sistemáticas, que describían los mecanismos de invasión y las moléculas involucradas de forma específica como Gp82 y Gp90. Se compararon los análisis de la expresión de dichas moléculas en diferentes cepas y DTUs del parásito. 81 de estos artículos fueron relevantes en la discusión y elaboración del trabajo. Conclusiones: La enfermedad de Chagas aguda con transmisión oral pone en evidencia la capacidad invasiva de las formas infectantes de T. cruzi a través de la mucosa gástrica. Glicoproteínas como Gp82 y Gp90 están involucradas en el establecimiento de la infección y se expresan diferencialmente en tripomastigotes. Estas diferencias de expresión también se observan entre cepas, por lo tanto este hecho plantea diferencias en la capacidad infectiva por vía oral de las distintas cepas de T. cruzi.
INTRODUCCIÓN Y OBJETIVOSA pesar de la importancia de conocer la proporción de casos de enfermedad respiratoria causada por los diferentes virus, en el departamento de Santander se carece de dicha ...información, que podría servir de ayuda para planear actividades de salud pública. OBJETIVO GENERAL Determinar la prevalencia de 15 virus en casos de infección respiratoria aguda en menores de 5 años en Bucaramanga y las provincias Comunera y de García Rovira.MATERIALES Y MÉTODOSTipo de estudio: descriptivo, de corte transversal.Población: menores de 5 años con infección respiratoria aguda diagnosticada por un médico.Inclusión: máximo 5 días desde el comienzo de los síntomas, residencia en Santander, sin salir del departamento en los 14 días anteriores a dicho comienzo.Exclusión: uso de antivirales para influenza.Muestra: estratificada por institución pública o privada, proporcional a la distribución del aseguramiento. En cada estrato se seleccionaron las IPS con mayor cobertura. Se recolectaron 199 muestras de igual número de niños.Procedimiento:muestras obtenidas por hisopado nasofaríngeo y conservadas a 4 ºC en medio de recuperación viral por un máximo por 72 horas. El ADN y el ARN virales se extrajeron con el estuche comercial Gene-spinTM y la amplificación se hizo por PCRRT con el test cualitativo Seeplex® RV15 OneStep ACE Detection, un ensayo de PCR múltiplex para 15 virus.RESULTADOSNiñas: 41,7%; niños 58,3%. Menores de un año: 46,7%; de un año: 9%; de dos años: 29,3%; de 3 años: 7% y de 4 años: 8%. Pertenecían al régimen contributivo 49%, al régimen subsidiado 46%, a regímenes especiales 1% y no tenían afiliación 4%. El 46% de las muestras fueron positivas para virus. De ellas, 76% correspondieron a pacientes atendidos en Bucaramanga; 18,5% en la provincia Comunera y 5,5% en la provincia de García Rovira. En 9% de las muestras positivas había más de un virus (8% con dos y 1% con tres virus). En la estación lluviosa los virus más frecuentes fueron: Sincitial Respiratorio A (27,3%) y B (10,8%), Parainfluenza 3 (10,8%), Adenovirus, Metapneumovirus, Influenza A y Rhinovirus A/B/C. En la estación seca predominaron Rhinovirus A/B/C (24,6%), Sincitial Respiratorio (15,8%), Parainfluenza 1 (12,3%) y 3, Metapneumovirus e Influenza A. En la estación lluviosa se encontró Bocavirus humano 1/2/3/4 y en la seca, Coronavirus OCE43 y 229E/NL63. En ambas hubo identificación de Enterovirus. CONCLUSIONESEn Santander circulan los 15 virus respiratorios buscados en menores de 5 años y en Bucaramanga se encontraron 13 de ellos. El virus Sincitial Respiratorio A fue el más prevalente en Bucaramanga y las provincias Comunera y de García Rovira entre diciembre del 2012 y diciembre del 2013. Hubo diferencias estacionales importantes en los virus hallados. En Santander se identificó la presencia de Metapneumovirus, Enterovirus, Coronavirus humano y Bocavirus.
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