To devise a system for surveying the frequency of nosocomial infections in a tertiary care hospital in a developing country.
Prospective selective surveillance by nurses of the charts of patients at ...high risk for nosocomial infections, as identified by a form completed by resident physicians. The sensitivity, specificity, and predictive value of this method of selective surveillance were compared with those for total prospective chart review by two infectious disease specialists.
A university hospital in northeastern Brazil.
All patients hospitalized for more than 72 hours with an identified risk factor for nosocomial infection.
The ratio of nosocomial infections to 100 discharges was 13.4 and the incidence density was 11.2/1,000 patient days. The surveillance method demonstrated a sensitivity of 74% and a specificity of 99.7%. Positive predictive value was 93%, negative predictive value was 99%, and overall accuracy was 98%.
This method of selective surveillance for nosocomial infections based on risk factors identified by physicians demonstrated excellent predictive value and overall accuracy and may be of use to other hospitals that lack a nursing care plan book such as the Kardex. The relative frequency of nosocomial infections significantly exceeded the rates reported from hospitals in developed countries.
We have studied the differences between erythrocytes and erythrocyte ghosts as target membranes for the study of Sendai virus fusion activity. Fusion was monitored continuously by fluorescence ...dequenching of R 18-labeled virus. Experiments were carried out either with or without virus/target membrane prebinding. When Sendai virus was added directly to a erythrocyte/erythrocyte ghost suspension, fusion was always lower than that obtained when experiments were carried out with virus already bound to the erythrocyte/erythrocyte ghost in the cold, since with virus prebinding fusion can be triggered more rapidly. Although virus binding to both erythrocytes and erythrocyte ghosts was similar, fusion activity was much more pronounced when erythrocyte ghosts were used as target membranes. These observations indicate that intact erythrocytes and erythrocyte ghosts are not equivalent as target membranes for the study of Sendai virus fusion activity. Fusion of Sendai virus with both target membranes was inhibited when erythrocytes or erythrocyte ghosts were pretreated with proteinase K, suggesting a role of target membrane proteins in this process. Treatment of both target membranes with neuraminidase, which removes sialic acid residues (the biological receptors for Sendai virus) greatly reduced viral binding. Interestingly, this treatment had no significant effect on the fusion reaction itself.
Diffuse and enteroaggregative patterns of adherence of Escherichia coli isolated from stools of children in northeastern Brazil Scaletsky, Isabel Cristina Affonso(Universidade Federal de São Paulo Departamento de Microbiologia, Imunologia e Parasitologia); Fabbricotti, Sandra Hilde(Universidade Federal de São Paulo Departamento de Microbiologia, Imunologia e Parasitologia); Carvalho, Rozane de Lima Bigelli(Universidade Federal de São Paulo Disciplina de Gastroenterologia Pediátrica) ...
Brazilian journal of microbiology,
12/2001, Letnik:
32, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Childhood diarrheal diseases remain highly endemic in northeastern Brazil. The attributable fraction of all diarrheal diseases among children less than 2 years of age due to Escherichia coli was ...examined in a 2-year prospective study in two large urban centers of Brazil. Between May 1997 and June 1999, fecal E. coli isolates from 237 children with diarrhea (217 acute and 20 persistent cases) and 231 children without diarrhea (controls) attending two hospitals in Northeast Brazil were tested for their pattern of adherence to HEp-2 cells and for colony hybridization with DNA probes specific for the six pathotypes of diarrheagenic E. coli. Enteroinvasive E. coli, enterotoxigenic E. coli and enterohemorrhagic E. coli were not isolated from any children. Diffusely adherent E. coli (DAEC) and enteroaggregative E. coli (EAEC) were the most frequent isolates with similar frequencies from children with or without diarrhea. Atypical EPEC (EAF-negative) strains were isolated with similiar frequency from both cases (5.5%) and controls (5.6%). Enteropathogenic E. coli (typical EPEC) strains, characterized by localized adherence pattern of adherence, hybridization with the EAF probe, and belonging to the classical O serogroups, were significantly associated with diarrhea (P = 0.03). These E. coli strains associated with diarrhea accounted for 9% of all children with diarrhea. Collectively, in Northeast Brazil, E. coli strains comprise a small proportion of severe diarrhea prevalence in children.
Na região nordeste do Brasil a doença diarréica na infância continua sendo altamente endêmica. Com o objetivo de determinar a prevalência das diferentes categorias de E. coli diarreiogênica foi realizado um estudo prospectivo de dois anos em dois grandes centros urbanos dessa região. Entre maio de 1997 a junho de 1999, foram examinadas amostras de Escherichia coli isoladas de 237 fezes de crianças com diarréia (217 aguda e 20 persistente casos) e 231 de crianças sem diarréia (controles) atendidas em dois hospitais na região nordeste do Brasil quanto a adesão a células HEp-2 e hibridização com sondas genéticas especîficas para as seis categorias de E. coli diarreiogênica. E. coli que adere difusamente (DAEC) e E. coli enteroagregativa (EAEC) foram as categorias mais frequentemente isoladas tanto em casos como em controles. E. coli enteropatogênica atípica (EPEC) foi isolada tanto em casos (5.5%) como em controles (5.6%). Amostras de E. coli enteropatogênica (EPEC típica), caracterizadas pelo padrão de adesão localizada, hibridização positiva com a sonda EAF e pertencentes aos sorogrupos clássicos foram mais frequentes em casos do que em controles, significantemente relacionadas com diarréia (P = 0.03). Essas amostras constituíram o terceiro patógeno, depois de rotavirus e Shigella spp, com predomínio significantemente maior entre os casos. Concluindo, na região nordeste do Brasil as EPEC respondem por 9% dos casos de diarréia grave em crianças menores de dois anos.
Clinical and Laboratory evaluation of measleslike rash in children and young adults Stewien, Klaus Eberhard(Universidade de São Paulo Instituto de Ciências Biomédicas Departamento de Microbiologia); Lima, Lourdes Rehder de Andrade Vaz de(Instituto Adolfo Lutz Seção de Imunologia e Seção de Virologia); Botosso, Viviane Fongaro(Instituto Butantan Serviço de Virologia) ...
Brazilian journal of microbiology,
10/2000, Letnik:
31, Številka:
4
Journal Article
Recenzirano
Odprti dostop
A clinical and laboratory evaluation of 11 children and young adults with measleslike rash was done during the measles outbreak in the Greater São Paulo Metropolitan area at the end of 1996 and ...spread over the country during 1997. Measles was laboratory confirmed in 07 patients by specific IgM detection in acute serum specimens using an IgM-capture EIA, by specific IgG seroconversion in serum pairs, and by reverse transcription PCR and virus isolation in peripheral blood lymphocytes. Clinical presentations were not always classic; one of the 07 cases had received measles vaccine and corresponded to modified clinical case of measles. The 4 remaining cases were negative for measles and were diagnosed as exanthem subitum (2 cases), scarlet fever and Kawasaki disease. The present study reinforces the view that clinical features alone are not sufficient for establishing an accurate diagnosis in the post-vaccine era, and a surveillance system based on sensitive laboratory results is needed so that it can confirm IgM-negative measles cases.
Apresenta-se um estudo sobre a avaliação clínica e laboratorial de crianças e adultos jovens com exantema semelhante ao sarampo, durante a ocorrência do surto epidêmico de sarampo na região metropolitana da Grande São Paulo no final de 1996 que se alastrou por todo o país durante o ano de 1997. O diagnóstico laboratorial de sarampo foi firmado em 7 dos 11 pacientes examinados, por detecção direta de IgM específico em amostras de soro da fase aguda da doença, por soroconversão de IgG em um par de amostras da fase aguda e convalescente, pelo isolamento do vírus em culturas de linhagem B95a e pela detecção do RNA viral por PCR em linfócitos do sangue periférico e na urina. O quadro clínico apresentado pelos pacientes nem sempre correspondeu à forma clássica do sarampo. Um jovem adulto, que havia sido vacinado contra o sarampo, apresentou um quadro clínico modificado. Os 4 casos restantes foram negativos em todas as provas laboratoriais para o sarampo, tendo diagnóstico final de exantema súbito (2 casos), escarlatina e Doença de Kawasaki. O presente estudo reforça o ponto de vista de que os sinais e sintomas clínicos são geralmente insuficientes para estabelecer um diagnóstico preciso de sarampo na era pós-vacinal, sendo indispensável um sistema de vigilância baseado em resultados laboratoriais que confirmam todos os casos suspeitos, inclusive os casos de sarampo com sorologia IgM-negativa
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