Penicillin-resistant pneumococcus and risk of treatment failure in pneumonia

Objective: To determine whether the presence of in vitro penicillin-resistant Streptococcus pneumoniae increases the risk of clinical failure in children hospitalised with severe pneumonia and treated with penicillin/ampicillin. Design: Multicentre, prospective, observational study. Setting: 12 tertiary-care centres in three countries in Latin America. Patients: 240 children aged 3-59 months, hospitalised with severe pneumonia and known in vitro susceptibility of S pneumoniae. Intervention: Patients were treated with intravenous penicillin/ampicillin after collection of blood and, when possible, pleural fluid for culture. The minimal inhibitory concentration (MIC) test was used to determine penicillin susceptibility of the pneumococcal strains isolated. Children were continuously monitored until discharge. Main outcome measures: The primary outcome was treatment failure (using clinical criteria). Results: Overall treatment failure was 21%. After allowing for different potential confounders, there was no evidence of association between treatment failure and in vitro resistance of S pneumoniae to penicillin according to the Clinical Laboratory Standards Institute (CLSI)/National Committee for Clinical Laboratory Standards (NCCLS) interpretative standards ((adj)RR = 1.03; 95%Cl: 0.49-1.90 for resistant S pneumoniae). Conclusions: Intravenous penicillin/ampicillin remains the drug of choice for treating penicillin-resistant pneumococcal pneumonia in areas where the MIC does not exceed 2 mu g/ml.

Análise dos compostos flavorizantes da cana-de-açúcar e otimização da aplicação de extratos ricos em β-glicosidases para liberação de aroma na produção de aguardente de cana

Pós-graduação em Química - IBILCE

Aplicação de β-glicosidases produzidas pelos microorganismos Aureobasidium pullulans e Thermoascus aurantiacus ao processo fermentativo da aguardente de cana com foco na produção de terpenos

Pós-graduação em Alimentos e Nutrição - FCFAR

Purificação, carcterização físico-química e termodinâmica de ß-glicosidases produzidas pelos microrganismos Aureobasidium pullulans e Thermoascus aurantiacus: aplicação em isoflavonas e terpenos glicosilados

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Vaccination in Brazilian HIV-infected adults: A cross-sectional study

HIV-infected patients are at risk for vaccine-preventable infections. The Brazilian National Immunization Program provided recommendations for this population. However, the vaccine coverage reached by this program is unknown. This study aimed at evaluating the vaccine coverage of HIV-infected adults followed at Hospital das Clinicas, University of Sao Paulo School of Medicine. Data were collected on age, gender, mode of HIV transmission, Centers for Disease Classification 1993 classification (CDC/93), antiretrovirals, CD4 count, HIV viral load, and immunization charts, from April 2003 to August 2004. We interviewed 144 randomly selected patients, 74% male; mean age, 39.95 years; CDC classification: A, 40.6%; B, 19.6%; and C, 39.9%. Most of patients were undergoing highly active antiretroviral therapy (HAART; 86.8%). Mean CD4 count 442.6 cells/mm(3). Viral load less than 400 copies per milliliter in 59.4% of patients. Only 36.1% of patients were adequately immunized for diphtheria/tetanus, 54.9% for pneumococcus, 24.3% for flu, and 76.9% for hepatitis B. In relation to live attenuated vaccines, 5 patients received measles, mumps, and rubella vaccine and 7 patients yellow fever vaccine. Two patients were vaccinated against yellow fever despite CD4 less than 200 cell/mm(3). We verified poor vaccine coverage in HIV-infected patients. Vaccination campaigns and incorporation of vaccine rooms in sexually transmitted disease (STD)/AIDS clinics could improve this situation.

Endocardites sépticas: (contribuição etiopatogênica)

In the present paper the A. A. reviewed the more fundamental problems in the ethiopathogenic process of bacterial endocardits and report the bacte¬riological observations done by them in 20 cases of the disecase observed at the Section of Pathological Anatomy and Bacteriology of the Hospital S. Francisco de Assis in charge of the Instituto Oswaldo Cruz. The A.A. isolated Pneumococcus from 10 out the 20 cases, Gonococcus from 2, Staphylococcus from 2, Streptococcus from 5 and Friedlaender bacil¬lus from 1 . The A.A. mainly lay stress on the necessity of the bacteriological exa¬minations being made by a specialist, owing to the difficulties sometimes met with and to the consequences of a detailed examination of the isolated germ.

Influence of mucin on the metabolism of pnemococcus

1. The appearance of meta-hemoglobin in pneumococcus cultures in blood media must be consequential to the formation of hydogen peroxide, according to the observation of several authors as well as of our own. 2. We emphasize the rôle of mucin in the production of hydrogen peroxide by pneumococcus, a circumstance which has been neglected by the authors who dealt with the matter. 3. In the metabolism of pneumococcus, the existence or formation of mucin is necessary for the maintenance of certain biological properties of the germ. 4. In cultures media containing blood and mucin, the production of meta-hemoglobin by pneumococcus is much larger than in those which contain no mucin. 5. We venture the hypothesis that mucin plays a very important rôle in the implantation of pneumonia, as in the periods preceeding this disease theres is an increase of bronchial secretion, and this secretion is almost entirely constintuted by mucin. 6. Mucin increases the pathogenic power of pneumococcus in mice according to the studies of several authors, which comes to favour our hypothesis.

Estudos sôbre o pneumococo: 4a. nota - Influência do pH do meio sôbre a formação da cápsula pelo pneumococo

One of the features of pneumococcus which has deserved the attention of investigators is the capsule. Since Pasteur, Chamberland and Roux (1881) several functions have been ascribed to it as well as peculiar properties. In the present paper, we take into consideration one only aspect of this problem; it is the relationship which there possibly may be between acidity of the culture medium and the power of capsule formation by pneumococcus. As it is known, this germ requires for its development 7.8 as an optimum pH, but maintains its biological activities down to 5.6. These variations do not take place without large alterations, particularly of the capsule, not only from the morphological but also from the chemical viewpoint. The diameter of the mucous envelopment of the pneumococcus decreases in proportion to the increase of acidity down to its complete extinction. This fact has been regarded by investigators as a biological feature inhe¬ring to the germ itself and as proceeding of self-defense. In an acid medium the existing capsule is destroyed and the germ does not produce it again; consequently, acidity inhibits the formation of the capsule. We tried to check how this phenomenon comes to pass and to elucidated it. As we know, the fundamental compound of the pneumococcus capsule is mucin. In the first place, we experimented the action of acidity on same in the following manner: Mucin extracted from bovine submaxillary gland is precipitated by HC1 at a determined concentration degree; the mucin dissolves again and precipi¬tates in function of this concentration. This property of mucin (solubility in acid medium) modifies a little the interpretation of the mechanism of disappearance of the capsule from the said germ in the culture medium. Indeed: The acidification of the medium consecutive to the growth of pneumococcus reduces the dimensions of the capsule until causing its com¬plete disappearance; but on transferring this strain to new optimum cultiva¬ting conditions the capsule appears again exhuberantly, at times as anteriorly, although with biased virulence. Linking these two facts we draw the following conclusions: Pneumo¬coccus does not lose its capacity of capsule formation in an acid medium; but mucin, whilst being produced, is entirely dissolved in this medium by the aid of acidity; we venture to state that, in spite of medium acidity, the capacity of capsule production is a constant feature of pneumococcus and that the disappearance of the capsule does not depend on the pneumococcus in itself when it produces smooth colonies, but on the chemical properties of mucin, mainly on its solubility in acid medium.

Influência da glicose no cultivo do pneumococo

I - Pneumococcus develops more actively on media containing 1% of glucose. II - When smaller percentages of glucose are used, growth is not so abundant. When percentages above 1% are used, the number of germs per cubic centimeter of medium is in a lower proportion, the higher the concentration of glucose is, up to the limit of 20% in which no growth at all is observed. III - Final pH in 1% glucose broth medium is approximately 4.5 to 5.0.

Maladies infectieuses [Infectious diseases]

In 2008, several publications have highlighted the role of climate change and globalization on the epidemiology of infectious diseases. Studies have shown the extension towards Europe of diseases such as Crimea-Congo fever (Kosovo, Turkey and Bulgaria), leismaniosis (Cyprus) and chikungunya virus infection (Italy). The article also contains comments on Plasmodium knowlesi, a newly identified cause of severe malaria in humans, as well as an update on human transmission of the H5NI avian influenza virus. It also mentions new data on Bell's palsy as well as two vaccines (varicella-zoster and pneumococcus), and provides a list of recent guidelines for the treatment of common infectious diseases.

Sub-inhibitory concentrations of vancomycin prevent quinolone-resistance in a penicillin-resistant isolate of Streptococcus pneumoniae.

BACKGROUND: The continuous spread of penicillin-resistant pneumococci represents a permanent threat in the treatment of pneumococcal infections, especially when strains show additional resistance to quinolones. The main objective of this study was to determine a treatment modality impeding the emergence of quinolone resistance. RESULTS: Exposure of a penicillin-resistant pneumococcus to increasing concentrations of trovafloxacin or ciprofloxacin selected for mutants resistant to these drugs. In the presence of sub-inhibitory concentrations of vancomycin, development of trovafloxacin-resistance and high-level ciprofloxacin-resistance were prevented. CONCLUSIONS: Considering the risk of quinolone-resistance in pneumococci, the observation might be of clinical importance.