Agentes etiológicos de infecções urinárias em ambulatório

As infeções do trato urinário (ITU), depois das infeções respiratórias, são as mais comuns na comunidade, sendo a Escherichia coli o principal agente etiológico. Afeta predominantemente o sexo feminino e, anualmente, estima-se que ocorram em todo o Mundo cerca de 150 milhões de episódios de ITU, sendo responsável por 15% dos antibióticos prescritos em ambulatório. Os objetivos deste estudo foram caracterizar os agentes etiológicos das ITU e determinar o seu padrão de resistência aos antimicrobianos na região litoral norte de Portugal, de modo a contribuir para o uso racional na terapêutica empírica. Foi realizado um estudo observacional, descritivo e transversal, sendo obtidos 80 967 resultados de uroculturas de um Laboratório de Análises Clínicas de prestação de serviços à comunidade, relativos ao período entre Abril de 2007 e Março de 2015. Registaram-se 13 541 bacteriúrias positivas (16,72%). Escherichia coli foi o microrganismo mais isolado (71,62%), seguida de Klebsiella pneumoniae (12,41%), Proteus mirabilis (7,84%), Enterococcus. faecalis (3,97%) e Pseudomonas aeruginosa (1,42%), tendo-se observado diferenças estatisticamente significativas entre sexos e idades. Verificou-se uma diminuição da resistência aos antimicrobianos a partir do ano de 2012. E. coli apresentou em 2015 a menor taxa de resistência respetivamente de 4,46% e 12,37% para a fosfomicina e nitrofurantoína. A combinação de amoxicilina+ácido clavulânico registou uma taxa de resistência superior a 20% (22,03%). O baixo nível de resistência à fosfomicina permite que este antibiótico se apresente como a opção terapêutica de primeira linha no tratamento empírico de ITU não complicada na mulher em ambulatório, pelo que, estes resultados permitem corroborar as indicações de 2011 da Direção Geral de Saúde sobre a substituição de fluoroquinolonas por fosfomicina.

Educação sexual em contexto escolar: uma intervenção contra a vulnerabilidade na vivência da sexualidade adolescente

A sexualidade estando presente desde o nascimento, na adolescência assume novo significado. Descobre-se o primeiro amor através de uma relação de intimidade e partilha de afectos, o corpo adquire um novo sentido, o grupo torna-se importante enquanto fonte de suporte, partilha de angústias e confiança, contribuindo para o desenvolvimento do adolescente. Na adolescência, perscrutam alguns factores de risco, nomeadamente a vivência da sexualidade de forma não informada e responsável, com repercussões para a saúde física e psicológica, pelo que é imperioso intervir através de programas formativos no âmbito da sexualidade que promovam vivência desta de forma responsável. São objectivos do estudo: Promover um modelo de intervenção formativa baseado no debate e reflexão crítica sobre sexualidade em contexto de sala de aula; Construir e validar instrumentos que permitam avaliar as atitudes face à sexualidade e ainda os conhecimentos dos adolescentes sobre reprodução, planeamento familiar e infecções de transmissão sexual; Testar a eficácia de um programa de intervenção formativo a nível dos conhecimentos sobre planeamento familiar, infecções de transmissão sexual, reprodução e atitudes face à sexualidade; Testar a efectividade do programa de intervenção formativo numa amostra alargada de adolescentes, analisando também o papel das variáveis sociodemográficas, sociopsicológicas e sexuais. O trabalho de campo desenvolveu-se em três estudos distintos, no primeiro e terceiro participaram 840 adolescentes e no segundo 90. No primeiro estudo construímos e validamos os instrumentos para colheita de dados, no segundo, experimental de campo, validamos o modelo da intervenção formativa no âmbito da sexualidade e no terceiro, descritivo e correlacional, testamos a efectividade de um programa de intervenção numa amostra mais alargada. O protocolo de recolha de informação incluiu quatro escalas construídas para o efeito com o intuito de avaliar as atitudes face à sexualidade, os conhecimentos sobre planeamento familiar, infecções de transmissão sexual e reprodução e ainda a escala de insatisfação com a imagem corporal em adolescentes e a escala de satisfação com o suporte social. As raparigas e residentes na zona urbana são as que têm mais conhecimentos sobre planeamento familiar e possuem atitudes face à sexualidade mais favoráveis. Os interlocutores preferenciais sobre sexualidade são os amigos, seguidos da mãe. São os adolescentes com pouca ou moderada prática religiosa que já iniciaram a actividade sexual. São as raparigas que têm maior satisfação com o suporte social nas dimensões, satisfação com as amizades, intimidade, actividades sociais e suporte social total. Os adolescentes que já iniciaram a actividade sexual, revelam maior percepção de suporte social na dimensão satisfação com a amizade. O modelo de formação construído e aplicado influenciou as atitudes face à sexualidade, conhecimentos sobre reprodução, sobre infecções de transmissão sexual e sobre planeamento familiar. Do nosso ponto de vista, pensamos ser urgente a aplicação de programas de intervenção formativos em contexto escolar, ou outro, que integrem de uma forma harmoniosa as várias facetas da sexualidade humana, promovendo a aquisição de uma postura responsável, flexível e gratificante nos adolescentes enquanto seres sexuados.

Carbapenemases of Serratia fonticola UTAD54

As carbapenemases, serínicas e metalo-β-lactamases (MBLs), formam um grupo cada vez mais importante de β-lactamases capazes de tornar as bactérias resistentes a antibióticos β-lactâmicos, incluindo carbapenemos utilizados como antibióticos de último recurso no tratamento de infecções causadas por bactérias multirresistentes. De modo a compreender melhor a relação estrutura-função deste grupo de enzimas, prosseguimos com a caracterização bioquímica e estrutural das carbapenemases SFC-1 e Sfh-I específicas de Serratia fonticola UTAD54, uma estirpe ambiental isolada previamente de águas de consumo não tratadas no Nordeste de Portugal. Ambas as β-lactamases foram sobre-expressas em Escherichia coli e purificadas por cromatografia líquida. A SFC-1 recombinante, uma carbapenemase serínica, hidrolisa eficientemente antibióticos β-lactâmicos de todas as classes e exibe, comparativamente a enzimas relacionadas (ex. KPC), uma maior eficiência contra a ceftazidima e uma menor susceptibilidade aos inibidores convencionais das β-lactamases. As estruturas do cristal da SFC-1 nativa e de complexos de mutantes, obtidos por mutagénese dirigida, com o meropenemo não hidrolisado e na forma de acetilenzima foram determinados por substituição molecular utilizando cristalografia de raios-X. A estrutura da SFC-1 contém todas as características conservadas do centro activo das carbapenemases de classe A. Nas estruturas dos mutantes o meropenemo aparece orientado no centro activo por Thr236 e Thr238, posicionando-o próximo da Ser130 para a transferência do protão. Nas enzimas de classe A inibidas por carbapenemos, a interacção com a Arg244 impõe uma orientação diferente do meropenemo ligado, prejudicando a transferência do protão. Estas constituem as primeiras estruturas de uma carbapenemase de classe A com um carbapenemo no centro activo e revelam que estas enzimas alteram a orientação do meropenemo ligado para promover a catálise, sem alteração significativa da estrutura geral. A Sfh-I, tal como as outras MBLs da subclasse B2, apresenta um perfil de substratos reduzido, que inclui maioritariamente os carbapenemos. A Sfh-I hidrolisa imipenemo e meropenemo com um kcat de 51 e 109 s-1 e um KM de 79 e 215 μM, respectivamente. A Sfh-I liga um equivalente de zinco, como demonstrado por espectrometria de massa. Contrariamente a enzimas da subclasse B2 previamente caracterizadas, a Sfh-I hidrolisa a cefepima, mostrando que a Sfh-I é uma MBL da subclasse B2 com propriedades únicas. Por espectroscopia de fluorescência mostrou-se que a Sfh-I é capaz de ligar até 3 equivalentes de zinco (Kd2 = 95 μM; Kd3 = 2.3 mM). A estrutura do cristal da Sfh-I, determinada por substituição molecular utilizando a CphA como modelo, é a primeira para uma MBL da subclasse B2 não ligada. Esta estrutura revela a disposição das moléculas de água no centro activo corroborando um mecanismo catalítico para as MBLs da subclasse B2 no qual a His118, em vez do Asp120 proposto anteriormente, activa a molécula de água nucleofílica.

Resistance to last-resort antibiotics in natural environments

Last-resort antibiotics are the final line of action for treating serious infections caused by multiresistant strains. Over the years the prevalence of resistant bacteria has been increasing. Natural environments are reservoirs of antibiotic resistance, highly influenced by human-driven activities. The importance of aquatic systems on the evolution of antibiotic resistance is highlighted from the assumption that clinically-relevant resistance genes have originated in strains ubiquitous in these environments. We hypothesize that: a) rivers are reservoirs and disseminators of antibiotic resistance; b) anthropogenic activities potentiate dissemination of resistance to last-resort antibiotics. Hence, the main goal of the work is to compare the last-resort antibiotics resistome, in polluted and unpolluted water. Rivers from the Vouga basin, exposed to different anthropogenic impacts, were sampled. Water quality parameters were determined to classify rivers as unpolluted or polluted. Two bacterial collections were established enclosing bacteria resistant to cefotaxime (3rd generation cephalosporin) and to imipenem (carbapenem). Each collection was characterized regarding: phylogenetic diversity, antibiotic susceptibility, resistance mechanisms and mobile genetic elements. The prevalence of cefotaxime- and imipenem-resistant bacteria was higher in polluted water. Results suggested an important role in the dissemination of antibiotic resistance for Enterobacteriaceae, Pseudomonas and Aeromonas. The occurrence of bacteria resistant to non-beta-lactams was higher among isolates from polluted water as also the number of multiresistant strains. Among strains resistant to cefotaxime, extended-spectrum beta-lactamase (ESBL) genes were detected (predominantly blaCTX-M-like) associated to mobile genetic elements previously described in clinical strains. ESBL-producers were often multiresistant as a result of co-selection mechanisms. Culture-independent methods showed clear differences between blaCTX-M-like sequences found in unpolluted water (similar to ancestral genes) and polluted water (sequences identical to those reported in clinical settings). Carbapenem resistance was mostly related to the presence of intrinsically resistant bacteria. Yet, relevant carbapenemase genes were detected as blaOXA-48-like in Shewanella spp. (the putative origin of these genes), and blaVIM-2 in Pseudomonas spp. isolated from polluted rivers. Culture-independent methods showed an higher than the previously reported diversity of blaOXA-48-like genes in rivers. Overall, clear differences between polluted and unpolluted systems were observed, regarding prevalence, phylogenetic diversity and susceptibility profiles of resistant bacteria and occurrence of clinically relevant antibiotic resistance genes, thus validating our hypotheses. In this way, rivers act as disseminators of resistance genes, and anthropogenic activities potentiate horizontal gene transfer and promote the constitution of genetic platforms that combine several resistance determinants, leading to multiresistance phenotypes that may persist even in the absence of antibiotics.

Development of polymeric materials to inhibit bacterial quorum sensing

Bacterial infections are an increasing problem for human health. In fact, an increasing number of infections are caused by bacteria that are resistant to most antibiotics and their combinations. Therefore, the scientific community is currently searching for new solutions to fight bacteria and infectious diseases, without promoting antimicrobial resistance. One of the most promising strategies is the disruption or attenuation of bacterial Quorum Sensing (QS), a refined system that bacteria use to communicate. In a QS event, bacteria produce and release specific small chemicals, signal molecules - autoinducers (AIs) - into the environment. At the same time that bacterial population grows, the concentration of AIs in the bacterial environment increases. When a threshold concentration of AIs is reached, bacterial cells respond to it by altering their gene expression profile. AIs regulate gene expression as a function of cell population density. Phenotypes mediated by QS (QSphenotypes) include virulence factors, toxin production, antibiotic resistance and biofilm formation. In this work, two polymeric materials (linear polymers and molecularly imprinted nanoparticles) were developed and their ability to attenuate QS was evaluated. Both types of polymers should to be able to adsorb bacterial signal molecules, limiting their availability in the extracellular environment, with expected disruption of QS. Linear polymers were composed by one of two monomers (itaconic acid and methacrylic acid), which are known to possess strong interactions with the bacterial signal molecules. Molecularly imprinted polymer nanoparticles (MIP NPs) are particles with recognition capabilities for the analyte of interest. This ability is attained by including the target analyte at the synthesis stage. Vibrio fischeri and Aeromonas hydrophila were used as model species for the study. Both the linear polymers and MIP NPs, tested free in solutions and coated to surfaces, showed ability to disrupt QS by decreasing bioluminescence of V. fischeri and biofilm formation of A. hydrophila. No significant effect on bacterial growth was detected. The cytotoxicity of the two types of polymers to a fibroblast-like cell line (Vero cells) was also tested in order to evaluate their safety. The results showed that both the linear polymers and MIP NPs were not cytotoxic in the testing conditions. In conclusion, the results reported in this thesis, show that the polymers developed are a promising strategy to disrupt QS and reduce bacterial infection and resistance. In addition, due to their low toxicity, solubility and easy integration by surface coating, the polymers have potential for applications in scenarios where bacterial infection is a problem: medicine, pharmaceutical, food industry and in agriculture or aquaculture.

Infection mechanism of Diplodia corticola

Diplodia corticola is regarded as the most virulent fungus involved in cork oak decline, being able to infect not only Quercus species (mainly Q. suber and Q. ilex), but also grapevines (Vitis vinifera) and eucalypts (Eucalyptus sp.). This endophytic fungus is also a pathogen whose virulence usually manifests with the onset of plant stress. Considering that the infection normally culminates in host death, there is a growing ecologic and socio-economic concern about D. corticola propagation. The molecular mechanisms of infection are hitherto largely unknown. Accordingly, the aim of this study was to unveil potential virulence effectors implicated in D. corticola infection. This knowledge is fundamental to outline the molecular framework that permits the fungal invasion and proliferation in plant hosts, causing disease. Since the effectors deployed are mostly proteins, we adopted a proteomic approach. We performed in planta pathogenicity tests to select two D. corticola strains with distinct virulence degrees for our studies. Like other filamentous fungi D. corticola secretes protein at low concentrations in vitro in the presence of high levels of polysaccharides, two characteristics that hamper the fungal secretome analysis. Therefore, we first compared several methods of extracellular protein extraction to assess their performance and compatibility with 1D and 2D electrophoretic separation. TCA-Acetone and TCA-phenol protein precipitation were the most efficient methods and the former was adopted for further studies. The proteins were extracted and separated by 2D-PAGE, proteins were digested with trypsin and the resulting peptides were further analysed by MS/MS. Their identification was performed by de novo sequencing and/or MASCOT search. We were able to identify 80 extracellular and 162 intracellular proteins, a milestone for the Botryosphaeriaceae family that contains only one member with the proteome characterized. We also performed an extensive comparative 2D gel analysis to highlight the differentially expressed proteins during the host mimicry. Moreover, we compared the protein profiles of the two strains with different degrees of virulence. In short, we characterized for the first time the secretome and proteome of D. corticola. The obtained results contribute to the elucidation of some aspects of the biology of the fungus. The avirulent strain contains an assortment of proteins that facilitate the adaptation to diverse substrates and the identified proteins suggest that the fungus degrades the host tissues through Fenton reactions. On the other hand, the virulent strain seems to have adapted its secretome to the host characteristics. Furthermore, the results indicate that this strain metabolizes aminobutyric acid, a molecule that might be the triggering factor of the transition from a latent to a pathogenic state. Lastly, the secretome includes potential pathogenicity effectors, such as deuterolysin (peptidase M35) and cerato-platanin, proteins that might play an active role in the phytopathogenic lifestyle of the fungus. Overall, our results suggest that D. corticola has a hemibiotrophic lifestyle, switching from a biotrophic to a necrotrophic interaction after plant physiologic disturbances.This understanding is essential for further development of effective plant protection measures.

Identification of molecules and pathways regulating mistranslation in Candida albicans

Candida albicans is the major fungal pathogen in humans, causing diseases ranging from mild skin infections to severe systemic infections in immunocompromised individuals. The pathogenic nature of this organism is mostly due to its capacity to proliferate in numerous body sites and to its ability to adapt to drastic changes in the environment. Candida albicans exhibit a unique translational system, decoding the leucine-CUG codon ambiguously as leucine (3% of codons) and serine (97%) using a hybrid serine tRNA (tRNACAGSer). This tRNACAGSer is aminoacylated by two aminoacyl tRNA synthetases (aaRSs): leucyl-tRNA synthetase (LeuRS) and seryl-tRNA synthetase (SerRS). Previous studies showed that exposure of C. albicans to macrophages, oxidative, pH stress and antifungals increases Leu misincorporation levels from 3% to 15%, suggesting that C. albicans has the ability to regulate mistranslation levels in response to host defenses, antifungals and environmental stresses. Therefore, the hypothesis tested in this work is that Leu and Ser misincorporation at CUG codons is dependent upon competition between the LeuRS and SerRS for the tRNACAGSer. To test this hypothesis, levels of the SerRS and LeuRS were indirectly quantified under different physiological conditions, using a fluorescent reporter system that measures the activity of the respective promoters. Results suggest that an increase in Leu misincorporation at CUG codons is associated with an increase in LeuRS expression, with levels of SerRS being maintained. In the second part of the work, the objective was to identify putative regulators of SerRS and LeuRS expression. To accomplish this goal, C. albicans strains from a transcription factor knock-out collection were transformed with the fluorescent reporter system and expression of both aaRSs was quantified. Alterations in the LeuRS/SerRS expression of mutant strains compared to wild type strain allowed the identification of 5 transcription factors as possible regulators of expression of LeuRS and SerRS: ASH1, HAP2, HAP3, RTG3 and STB5. Globally, this work provides the first step to elucidate the molecular mechanism of regulation of mistranslation in C. albicans.