1
|
Faria NA, Touret T, Simões AS, Palos C, Bispo S, Cristino JM, Ramirez M, Carriço J, Pinto M, Toscano C, Gonçalves E, Gonçalves ML, Costa A, Araújo M, Duarte A, de Lencastre H, Serrano M, Sá-Leão R, Miragaia M. Genomic Insights into the expansion of Carbapenem-Resistant Klebsiella pneumoniae within Portuguese Hospitals. J Hosp Infect 2024:S0195-6701(24)00106-3. [PMID: 38554808 DOI: 10.1016/j.jhin.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/31/2024] [Accepted: 02/19/2024] [Indexed: 04/02/2024]
Abstract
Carbapenem-resistant Klebsiella pneumoniae complex (CR-KP) are a public health concern, causing infections with a high mortality rate, limited therapeutic options and challenging infection control strategies. In Portugal CR-KP rate has increased steeply, but the factors associated to this expansion are poorly explored. To address this question we compared, by phylogenetic and resistome analysis, the draft genomes of 200 CR-KP isolates collected in 2017-2019 from five hospitals in the Lisbon region, Portugal. We found that CR-KP belonged mainly to ST13 (29%), ST17 (15%), ST348 (13%), ST231 (12%) and ST147 (7%). Carbapenem resistance was conferred mostly by KPC-3 (74%) or OXA-181 (18%) presence, which were associated with IncF/IncN and IncX plasmids, respectively. Almost all isolates were multidrug resistant harbouring resistance determinants to aminoglycosides, beta-lactams, trimethoprim, fosfomycin, quinolones and sulphonamides. In addition, 11% of isolates were resistant to colistin. Colonizing and infection isolates were highly related and most colonized patients (89%) reported a previous hospitalization. Moreover, among the 171 events of cross-dissemination identified, by cgMLST data analysis (<5 alleles), 41 occurred between different hospitals and 130 within the same hospital. Our results suggest that CR-KP dissemination in the Lisbon region result from acquisition of carbapenemases in mobile genetic elements, influx of CR-KP into the hospitals by colonized ambulatory patients and transmission of CR-KP within and between hospitals. Our data reinforces that the prudent use of carbapenems, patients screening at hospital entrance, and improvement of infection control will be needed to decrease the burden of CR-KP infection in Portugal.
Collapse
Affiliation(s)
- Nuno Alexandre Faria
- Laboratory of Bacterial Evolution and Molecular Epidemiology, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa; Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa
| | - Tiago Touret
- Laboratory of Molecular Microbiology of Human Pathogens, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa
| | - Alexandra S Simões
- Laboratory of Molecular Microbiology of Human Pathogens, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa
| | | | | | | | - Mário Ramirez
- Centro Hospitalar Lisboa Norte; Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa
| | - João Carriço
- Centro Hospitalar Lisboa Norte; Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa
| | | | | | | | | | | | - Mariana Araújo
- Laboratory of Bacterial Evolution and Molecular Epidemiology, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa
| | - Aida Duarte
- Faculdade de Farmácia, Universidade de Lisboa; Centro de investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz
| | - Hermínia de Lencastre
- Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa; Laboratory of Microbiology and Infectious Diseases, The Rockefeller University, New York, New York
| | - Mónica Serrano
- Laboratory of Microbial Development, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa
| | - Raquel Sá-Leão
- Laboratory of Molecular Microbiology of Human Pathogens, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa
| | - Maria Miragaia
- Laboratory of Bacterial Evolution and Molecular Epidemiology, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa.
| |
Collapse
|
2
|
Francisco D, Ÿvila G, Jorge C, Mansinho K, Toscano C, Weigert A. Decision making - Should we perform kidney transplantation on a patient with a positive RT-PCR test for SARS-CoV-2? Nefrologia 2024; 44:297-299. [PMID: 36564231 PMCID: PMC9768597 DOI: 10.1016/j.nefroe.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/18/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
| | - Gonçalo Ÿvila
- Serviço de Nefrologia do Hospital de Santa Cruz, Portugal
| | - Cristina Jorge
- Serviço de Nefrologia do Hospital de Santa Cruz, Portugal
| | - Kamal Mansinho
- Serviço de Infecciologia do Hospital Egas Moniz, Portugal
| | - Cristina Toscano
- Laboratório de Microbiologia Clínica e Biologia Molecular do Hospital Egas Moniz, Portugal
| | - André Weigert
- Serviço de Nefrologia do Hospital de Santa Cruz, Portugal
| |
Collapse
|
3
|
Hedberg P, Parczewski M, Serwin K, Marchetti G, Bai F, Ole Jensen BE, Pereira JP, Drobniewski F, Reschreiter H, Naumovas D, Ceccherini-Silberstein F, Rubio Quintanares GH, Mwau M, Toscano C, König F, Pfeifer N, Zazzi M, Fanti I, Incardona F, Cozzi-Lepri A, Sönnerborg A, Nauclér P. In-hospital mortality during the wild-type, alpha, delta, and omicron SARS-CoV-2 waves: a multinational cohort study in the EuCARE project. Lancet Reg Health Eur 2024; 38:100855. [PMID: 38476753 PMCID: PMC10928271 DOI: 10.1016/j.lanepe.2024.100855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 03/14/2024]
Abstract
Background Investigating outcomes of hospitalised COVID-19 patients throughout the pandemic is crucial to understand the impact of different SARS-CoV-2 variants. We compared 28-day in-hospital mortality of Wild-type, Alpha, Delta, and Omicron variant infections. Whether the difference in risk by variant varied by age was also evaluated. Methods We conducted a cohort study including patients ≥18 years, hospitalised between 2020 and 02-01 and 2022-10-15 with a SARS-CoV-2 positive test, from nine countries. Variant was classified based on sequenced viruses or from national public metadata. Mortality was compared using the cumulative incidence function and subdistribution hazard ratios (SHR) adjusted for age, sex, calendar time, and comorbidities. Results were shown age-stratified due to effect measure modification (P < 0.0001 for interaction between age and variant). Findings We included 38,585 participants: 19,763 Wild-type, 6387 Alpha, 3640 Delta, and 8795 Omicron. The cumulative incidence of mortality decreased throughout the study period. Among participants ≥70 years, the adjusted SHR (95% confidence interval) for Delta vs. Omicron was 1.66 (1.29-2.13). This estimate was 1.66 (1.17-2.36) for Alpha vs. Omicron, and 1.34 (0.92-1.95) for Wild-type vs. Omicron. These were 1.21 (0.81-1.82), 1.21 (0.68-2.17), and 0.98 (0.53-1.82) among unvaccinated participants. When comparing Omicron sublineages, the aSHR for BA.1 was 1.92 (1.43-2.58) compared to BA.2 and 1.52 (1.11-2.08) compared to BA.5. Interpretation The herein observed decrease in in-hospital mortality seems to reflect a combined effect of immunity from vaccinations and previous infections, although differences in virulence between SARS-CoV-2 variants may also have contributed. Funding European Union's Horizon Europe Research and Innovation Programme.
Collapse
Affiliation(s)
- Pontus Hedberg
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Milosz Parczewski
- Department of Tropical Infectious Diseases and Immune Deficiency, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Karol Serwin
- Department of Tropical Infectious Diseases and Immune Deficiency, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Giulia Marchetti
- Department of Health Sciences, Clinic of Infectious Diseases, ASST Santi Paolo E Carlo, University of Milan, Milan, Italy
| | - Francesca Bai
- Department of Health Sciences, Clinic of Infectious Diseases, ASST Santi Paolo E Carlo, University of Milan, Milan, Italy
| | - Björn-Erik Ole Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University, Duesseldorf, Germany
| | - Joana P.V. Pereira
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University, Duesseldorf, Germany
| | - Francis Drobniewski
- Department of Infectious Disease, Imperial College, London, W12 0NN, UK
- University Hospital Dorset, Poole Hospital, Poole, Dorset, UK
| | | | - Daniel Naumovas
- Vilnius Santaros Klinikos Biobank, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | - Gibran Horemheb Rubio Quintanares
- Virus Security Department, Paul Ehrlich Institute, Langen, Germany
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Matilu Mwau
- Center for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya
| | - Cristina Toscano
- Microbiology Laboratory, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Florian König
- Institute for Bioinformatics and Medical Informatics and Medical Informatics (IBMI), University of Tübingen, Tübingen, Germany
- Methods in Medical Informatics Department of Computer Science, University of Tübingen, Tübingen, Germany
| | - Nico Pfeifer
- Institute for Bioinformatics and Medical Informatics and Medical Informatics (IBMI), University of Tübingen, Tübingen, Germany
- Methods in Medical Informatics Department of Computer Science, University of Tübingen, Tübingen, Germany
| | - Maurizio Zazzi
- Department of Medical Biotechnologies, University of Siena, Italy
| | - Iuri Fanti
- EuResist Network GEIE, Via Guido Guinizelli, 98/100, 00152, Roma, Italy
| | - Francesca Incardona
- EuResist Network GEIE, Via Guido Guinizelli, 98/100, 00152, Roma, Italy
- InformaPRO s.r.l., Via Guido Guinizelli, 98/100, 00152, Roma, Italy
| | - Alessandro Cozzi-Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME) Institute for Global Health UCL, Rowland Hill St, London, NW3 2PF, UK
| | - Anders Sönnerborg
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Pontus Nauclér
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
4
|
das Neves Coelho F, Borralho J, Baptista-Fernandes T, Toscano C, Carmo ME. Characterization of Lophomonas spp. Infection in a Population of Critical Care Patients. Infect Dis Rep 2024; 16:83-92. [PMID: 38391584 PMCID: PMC10888071 DOI: 10.3390/idr16010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
Lophomonas are flagellated protozoa that have been increasingly associated with upper and lower airway infection in humans. The prevalence and characterization of this disease in the critically ill remains poorly understood. We present a series of eleven ICU patients with confirmed Lophomonas spp. identification in respiratory samples.
Collapse
Affiliation(s)
- Francisco das Neves Coelho
- Intensive Care Department, Centro Hospitalar de Lisboa Ocidental, Hospital Egas Moniz, 1349-019 Lisboa, Portugal
| | - João Borralho
- Infectious Diseases Department, Centro Hospitalar de Lisboa Ocidental, Hospital Egas Moniz, 1349-019 Lisboa, Portugal
| | - Teresa Baptista-Fernandes
- Parasitology Department, Centro Hospitalar de Lisboa Ocidental, Hospital Egas Moniz, 1349-019 Lisboa, Portugal
| | - Cristina Toscano
- Microbiology Department, Centro Hospitalar de Lisboa Ocidental, Hospital Egas Moniz, 1349-019 Lisboa, Portugal
| | - Maria Eduarda Carmo
- Intensive Care Department, Centro Hospitalar de Lisboa Ocidental, Hospital Egas Moniz, 1349-019 Lisboa, Portugal
| |
Collapse
|
5
|
Palmeiro AG, Peres S, Mansinho K, Sabino R, Veríssimo C, Toscano C, Viana I. Asymptomatic Leg Ulcer in a HIV-2+ Veteran: Challenge. Am J Dermatopathol 2024; 46:e3-e4. [PMID: 38086092 DOI: 10.1097/dad.0000000000002511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
| | - Susana Peres
- Infectious Diseases Department, Hospital Egas Moniz, Lisboa, Portugal
| | - Kamal Mansinho
- Infectious Diseases Department, Hospital Egas Moniz, Lisboa, Portugal
| | - R Sabino
- Mycology Laboratory, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal; and
| | - C Veríssimo
- Mycology Laboratory, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal; and
| | - C Toscano
- Molecular Biology and Clinical Microbiology Laboratory, Hospital Egas Moniz, Lisboa, Portugal
| | - Isabel Viana
- Dermatology Department, Hospital Egas Moniz, Lisboa, Portugal
| |
Collapse
|
6
|
Palmeiro AG, Peres S, Mansinho K, Sabino R, Veríssimo C, Toscano C, Viana I. Asymptomatic Leg Ulcer in a HIV-2+ Veteran: Answer. Am J Dermatopathol 2024; 46:62-63. [PMID: 38086088 DOI: 10.1097/dad.0000000000002512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
| | - Susana Peres
- Infectious Diseases Department, Hospital Egas Moniz, Lisboa, Portugal
| | - Kamal Mansinho
- Infectious Diseases Department, Hospital Egas Moniz, Lisboa, Portugal
| | - Raquel Sabino
- Mycology Laboratory, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal; and
| | - Cristina Veríssimo
- Mycology Laboratory, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal; and
| | - Cristina Toscano
- Molecular Biology and Clinical Microbiology Laboratory, Hospital Egas Moniz, Lisboa, Portugal
| | - Isabel Viana
- Dermatology Department, Hospital Egas Moniz, Lisboa, Portugal
| |
Collapse
|
7
|
Arendrup MC, Arikan-Akdagli S, Jørgensen KM, Barac A, Steinmann J, Toscano C, Arsenijevic VA, Sartor A, Lass-Flörl C, Hamprecht A, Matos T, Rogers BRS, Quiles I, Buil J, Özenci V, Krause R, Bassetti M, Loughlin L, Denis B, Grancini A, White PL, Lagrou K, Willinger B, Rautemaa-Richardson R, Hamal P, Ener B, Unalan-Altintop T, Evren E, Hilmioglu-Polat S, Oz Y, Ozyurt OK, Aydin F, Růžička F, Meijer EFJ, Gangneux JP, Lockhart DEA, Khanna N, Logan C, Scharmann U, Desoubeaux G, Roilides E, Talento AF, van Dijk K, Koehler P, Salmanton-García J, Cornely OA, Hoenigl M. European candidaemia is characterised by notable differential epidemiology and susceptibility pattern: Results from the ECMM Candida III study. J Infect 2023; 87:428-437. [PMID: 37549695 DOI: 10.1016/j.jinf.2023.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/25/2023] [Accepted: 08/03/2023] [Indexed: 08/09/2023]
Abstract
The objectives of this study were to assess Candida spp. distribution and antifungal resistance of candidaemia across Europe. Isolates were collected as part of the third ECMM Candida European multicentre observational study, conducted from 01 to 07-07-2018 to 31-03-2022. Each centre (maximum number/country determined by population size) included ∼10 consecutive cases. Isolates were referred to central laboratories and identified by morphology and MALDI-TOF, supplemented by ITS-sequencing when needed. EUCAST MICs were determined for five antifungals. fks sequencing was performed for echinocandin resistant isolates. The 399 isolates from 41 centres in 17 countries included C. albicans (47.1%), C. glabrata (22.3%), C. parapsilosis (15.0%), C. tropicalis (6.3%), C. dubliniensis and C. krusei (2.3% each) and other species (4.8%). Austria had the highest C. albicans proportion (77%), Czech Republic, France and UK the highest C. glabrata proportions (25-33%) while Italy and Turkey had the highest C. parapsilosis proportions (24-26%). All isolates were amphotericin B susceptible. Fluconazole resistance was found in 4% C. tropicalis, 12% C. glabrata (from six countries across Europe), 17% C. parapsilosis (from Greece, Italy, and Turkey) and 20% other Candida spp. Four isolates were anidulafungin and micafungin resistant/non-wild-type and five resistant to micafungin only. Three/3 and 2/5 of these were sequenced and harboured fks-alterations including a novel L657W in C. parapsilosis. The epidemiology varied among centres and countries. Acquired echinocandin resistance was rare but included differential susceptibility to anidulafungin and micafungin, and resistant C. parapsilosis. Fluconazole and voriconazole cross-resistance was common in C. glabrata and C. parapsilosis but with different geographical prevalence.
Collapse
Affiliation(s)
- Maiken Cavling Arendrup
- Unit of Mycology, Statens Serum Institut, Copenhagen, Denmark; Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Sevtap Arikan-Akdagli
- Department of Medical Microbiology, Hacettepe University Medical School, Ankara, Turkey
| | | | - Aleksandra Barac
- Clinic for Infectious and Tropical Diseases, University Clinical Center of Serbia, Belgrade, Serbia
| | - Jörg Steinmann
- Institute for Clincal Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical University, Klinikum Nürnberg, Nuremberg, Germany
| | - Cristina Toscano
- Microbiology Laboratory, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Valentina Arsic Arsenijevic
- Faculty of Medicine University of Belgrade, Institute of Microbiology and Immunology, Medical Mycology Reference Laboratory (MMRL), Belgrade, Serbia
| | - Assunta Sartor
- SC Microbiology, Department of Laboratory Medicine, Friuli Centrale University Health Authority, Udin, Italy
| | - Cornelia Lass-Flörl
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Axel Hamprecht
- University of Cologne, University Hospital Cologne, Institute for Medical Microbiology, Immunology and Hygiene, Cologne, Germany; University of Oldenburg, Institute for Medical Microbiology and Virology, Oldenburg, Germany
| | - Tadeja Matos
- Institute of Microbiology and Immunology, Medical Faculty, University of Ljubljana, Slovenia
| | - Benedict R S Rogers
- Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Inmaculada Quiles
- Department of Microbiology, La Paz University Hospital, Madrid, Spain
| | - Jochem Buil
- Canisius Wilhelmina Hospital (CWZ), Medical Microbiology and Infectious Diseases, Nijmegen, the Netherlands; Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands; Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, the Netherlands
| | - Volkan Özenci
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Robert Krause
- Biotech Med, Graz, Austria; Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Matteo Bassetti
- Infectious Diseases Unit, IRCCS San Martino Polyclinic Hospital, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Laura Loughlin
- Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Blandine Denis
- Department of Infectious Diseases, Hôpital Saint-Louis, Fernand Widal, Lariboisière, AP-HP, Paris, France
| | - Anna Grancini
- U.O.S Microbiology - Analysis Laboratory, IRCCS Foundation, Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - P Lewis White
- Public Health Wales Microbiology Cardiff and Cardiff University School of Medicine, United Kingdom
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium; Department of Laboratory Medicine and National Reference Center for Mycosis University Hospitals Leuven, Leuven, Belgium
| | - Birgit Willinger
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Riina Rautemaa-Richardson
- Mycology Reference Centre Manchester and Department of Infectious Diseases, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Petr Hamal
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Beyza Ener
- Department of Medical Microbiology, Bursa Uludağ University Medical School, Bursa, Turkey
| | - Tugce Unalan-Altintop
- Department of Medical Microbiology, Hacettepe University Medical School, Ankara, Turkey
| | - Ebru Evren
- Department of Medical Microbiology, Ankara University Medical School, Ankara, Turkey
| | | | - Yasemin Oz
- Department of Medical Microbiology, Eskisehir Osmangazi University Medical School, Eskisehir, Turkey
| | - Ozlem Koyuncu Ozyurt
- Department of Medical Microbiology, Akdeniz University Medical School, Antalya, Turkey
| | - Faruk Aydin
- KTÜ Tıp Fakültesi Tıbbi Mikrobiyoloji AbD, Trabzon, Turkey
| | - Filip Růžička
- Masaryk University, Faculty of Medicine and St. Anne's Faculty Hospital, Department of Microbiology, Brno, Czech Republic
| | - Eelco F J Meijer
- Canisius Wilhelmina Hospital (CWZ), Medical Microbiology and Infectious Diseases, Nijmegen, the Netherlands; Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands; Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, the Netherlands
| | - Jean Pierre Gangneux
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, F-35000 Rennes, France
| | - Deborah E A Lockhart
- Department of Medical Microbiology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, United Kingdom; Institute of Medical Sciences, School of Medicine Medical Sciences & Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, United Kingdom
| | - Nina Khanna
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | - Clare Logan
- Clinical Infection Unit, St Georges University NHS Hospital Foundation Trust, Blackshaw Road, London, United Kingdom; Institute of Infection & Immunity, St Georges University London, Cranmer Terrace, London, United Kingdom
| | - Ulrike Scharmann
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Guillaume Desoubeaux
- Department of Parasitology-Mycology-Tropical medicine, CHRU Tours, Tours, France
| | - Emmanuel Roilides
- Hippokration General Hospital, Infectious Diseases Department, Medical School, Aristotle University of Thessaloniki, Greece
| | | | - Karin van Dijk
- Department of Medical Microbiology and Infection Control, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands
| | - Philipp Koehler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, and Excellence Center for Medical Mycology (ECMM), Cologne, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Institute of Translational Research, Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Jon Salmanton-García
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, and Excellence Center for Medical Mycology (ECMM), Cologne, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Institute of Translational Research, Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Oliver A Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, and Excellence Center for Medical Mycology (ECMM), Cologne, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Institute of Translational Research, Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Martin Hoenigl
- Biotech Med, Graz, Austria; Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
| |
Collapse
|
8
|
Hedberg P, Varisco B, Bai F, Sönnerborg A, Naucler P, Pfeifer N, Cozzi-Lepri A, Ceccherini-Silberstein F, Naumovas D, Drobniewski F, Jensen BEO, Toscano C, Parczewski M, Quintanares GHR, Mwau M, Pinto JA, Incardona F, Mommo C, Marchetti G. EuCARE-hospitalised study protocol: a cohort study of patients hospitalised with COVID-19 in the EuCARE project. BMC Infect Dis 2023; 23:690. [PMID: 37845624 PMCID: PMC10580565 DOI: 10.1186/s12879-023-08658-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), the virus responsible for coronavirus disease 2019 (COVID-19), can lead to hospitalisation, particularly in elderly, immunocompromised, and non-vaccinated or partially vaccinated individuals. Although vaccination provides protection, the duration of this protection wanes over time. Additional doses can restore immunity, but the influence of viral variants, specific sequences, and vaccine-induced immune responses on disease severity remains unclear. Moreover, the efficacy of therapeutic interventions during hospitalisation requires further investigation. The study aims to analyse the clinical course of COVID-19 in hospitalised patients, taking into account SARS-CoV-2 variants, viral sequences, and the impact of different vaccines. The primary outcome is all-cause in-hospital mortality, while secondary outcomes include admission to intensive care unit and length of stay, duration of hospitalisation, and the level of respiratory support required. METHODS This ongoing multicentre study observes hospitalised adult patients with confirmed SARS-CoV-2 infection, utilising a combination of retrospective and prospective data collection. It aims to gather clinical and laboratory variables from around 35,000 patients, with potential for a larger sample size. Data analysis will involve biostatistical and machine-learning techniques. Selected patients will provide biological material. The study started on October 14, 2021 and is scheduled to end on October 13, 2026. DISCUSSION The analysis of a large sample of retrospective and prospective data about the acute phase of SARS CoV-2 infection in hospitalised patients, viral variants and vaccination in several European and non-European countries will help us to better understand risk factors for disease severity and the interplay between SARS CoV-2 variants, immune responses and vaccine efficacy. The main strengths of this study are the large sample size, the long study duration covering different waves of COVID-19 and the collection of biological samples that allows future research. TRIAL REGISTRATION The trial has been registered on ClinicalTrials.gov. The unique identifier assigned to this trial is NCT05463380.
Collapse
Affiliation(s)
- Pontus Hedberg
- Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Benedetta Varisco
- Department of Health Sciences, University of Milan, Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo E Carlo, Milan, Italy
| | - Francesca Bai
- Department of Health Sciences, University of Milan, Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo E Carlo, Milan, Italy
| | - Anders Sönnerborg
- Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Pontus Naucler
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Nico Pfeifer
- Institute for Bioinformatics and Medical Informatics, University of Tübingen, Tübingen, Germany
| | - Alessandro Cozzi-Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, London, UK
| | | | - Daniel Naumovas
- Vilnius Santaros Klinikos Biobank, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Francis Drobniewski
- Department of Infectious Disease, Imperial College London, London, UK
- Department of Medical Microbiology, University Hospitals Dorset, Poole, UK
| | - Björn-Erik Ole Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Facultyand, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Cristina Toscano
- Microbiology Laboratory, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Miłosz Parczewski
- Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical Universityin, Szczecin, Szczecin, Poland
| | - Gibran Horemheb Rubio Quintanares
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Paul Ehrlich Institut, Virus Safety, Virology Department, Langen, Germany
| | - Matilu Mwau
- Center for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya
| | - Jorge A Pinto
- Department of Pediatrics, Pediatric Immunology Division, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | | | | | - Giulia Marchetti
- Department of Health Sciences, University of Milan, Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo E Carlo, Milan, Italy.
| |
Collapse
|
9
|
Mateus C, Martins AR, Toscano C, Matias P, Branco P. Pantoea in Peritoneal Dialysis: A Rare Cause of Peritonitis. Cureus 2022; 14:e26878. [PMID: 35978740 PMCID: PMC9375850 DOI: 10.7759/cureus.26878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 12/02/2022] Open
Abstract
Peritonitis is the most common complication of peritoneal dialysis (PD) and an important cause of PD failure. There are numerous etiological agents, mostly bacteria. Pantoea spp is a rare cause of peritonitis. We describe three cases of Pantoea peritonitis in three PD patients. Previous reports have identified risk factors such as close contact with plants and animals. We review the typical clinical presentation and prognosis. It is fulcral to teach patients about the risks regarding proximity to plants and animals to prevent this type of infection.
Collapse
|
10
|
Francisco D, Ávila G, Jorge C, Mansinho K, Toscano C, Weigert A. Decision making - Should we perform kidney transplantation on a patient with a positive RT-PCR test for SARS-CoV-2? Nefrologia 2022:S0211-6995(22)00085-6. [PMID: 35673541 PMCID: PMC9137248 DOI: 10.1016/j.nefro.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Gonçalo Ávila
- Serviço de Nefrologia do Hospital de Santa Cruz, Portugal
| | - Cristina Jorge
- Serviço de Nefrologia do Hospital de Santa Cruz, Portugal
| | - Kamal Mansinho
- Serviço de Infecciologia do Hospital Egas Moniz, Portugal
| | - Cristina Toscano
- Laboratório de Microbiologia Clínica e Biologia Molecular do Hospital Egas Moniz, Portugal
| | - André Weigert
- Serviço de Nefrologia do Hospital de Santa Cruz, Portugal
| |
Collapse
|
11
|
Toscano C, Cordoeiro M, Silva V, Aidos J, Torres I. 663 Pulmonary thromboembolism during the puerperium of a woman with covid-19 infection - a case report. Eur J Obstet Gynecol Reprod Biol 2022. [PMCID: PMC8941272 DOI: 10.1016/j.ejogrb.2021.11.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
12
|
Silva L, Sousa J, Toscano C, Viana I. Deep dermatophytosis caused by Trichophyton rubrum in immunocompromised patients. An Bras Dermatol 2022; 97:223-227. [PMID: 35065846 PMCID: PMC9073306 DOI: 10.1016/j.abd.2021.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/01/2021] [Accepted: 05/08/2021] [Indexed: 11/30/2022] Open
Abstract
In immunosuppressed patients, dermatophytosis can be more invasive, affecting the dermis and subcutaneous tissues. The authors describe the cases of two patients with kidney and heart transplanted, respectively, that developed a deep dermatophytosis caused by Trichophyton rubrum, confirmed by culture and DNA sequencing. Both patients had concomitant onychomycosis, and both were treated with itraconazole for about two months, which was interrupted due to pharmacological interactions with the immunosuppressive drugs and switched to terbinafine, leading to clinical resolution within four months. Deep dermatophytosis should be considered when dealing with immunocompromised patients, especially when a superficial dermatophytosis is present. Oral treatment is necessary and terbinafine is a preferable option in solid organ transplant recipients because it has less pharmacological interactions.
Collapse
Affiliation(s)
- Leandro Silva
- Department of Dermatology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.
| | - João Sousa
- Department of Dermatology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Cristina Toscano
- Microbiology Laboratory, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Isabel Viana
- Department of Dermatology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| |
Collapse
|
13
|
Serrano D, Santos-Reis A, Silva C, Dias A, Dias B, Toscano C, Conceição C, Baptista-Fernandes T, Nogueira F. Imported Malaria in Portugal: Prevalence of Polymorphisms in the Anti-Malarial Drug Resistance Genes pfmdr1 and pfk13. Microorganisms 2021; 9:microorganisms9102045. [PMID: 34683365 PMCID: PMC8538333 DOI: 10.3390/microorganisms9102045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/18/2021] [Accepted: 09/21/2021] [Indexed: 02/04/2023] Open
Abstract
Malaria is one of the ‘big three’ killer infectious diseases, alongside tuberculosis and HIV. In non-endemic areas, malaria may occur in travelers who have recently been to or visited endemic regions. The number of imported malaria cases in Portugal has increased in recent years, mostly due to the close relationship with the community of Portuguese language countries. Samples were collected from malaria-infected patients attending Centro Hospitalar Lisboa Ocidental (CHLO) or the outpatient clinic of Instituto de Higiene e Medicina Tropical (IHMT-NOVA) between March 2014 and May 2021. Molecular characterization of Plasmodium falciparum pfk13 and pfmdr1 genes was performed. We analyzed 232 imported malaria cases. The majority (68.53%) of the patients came from Angola and only three patients travelled to a non-African country; one to Brazil and two to Indonesia. P. falciparum was diagnosed in 81.47% of the cases, P. malariae in 7.33%, P. ovale 6.47% and 1.72% carried P. vivax. No mutations were detected in pfk13. Regarding pfmdr1, the wild-type haplotype (N86/Y184/D1246) was also the most prevalent (64.71%) and N86/184F/D1246 was detected in 26.47% of the cases. The typical imported malaria case was middle-aged male, traveling from Angola, infected with P. falciparum carrying wild type pfmdr1 and pfk13. Our study highlights the need for constant surveillance of malaria parasites imported into Portugal as an important pillar of public health.
Collapse
Affiliation(s)
- Debora Serrano
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa (IHMT-NOVA), Rua da Junqueira 100, 1349-008 Lisboa, Portugal; (D.S.); (A.S.-R.); (C.S.); (B.D.); (C.C.)
| | - Ana Santos-Reis
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa (IHMT-NOVA), Rua da Junqueira 100, 1349-008 Lisboa, Portugal; (D.S.); (A.S.-R.); (C.S.); (B.D.); (C.C.)
| | - Clemente Silva
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa (IHMT-NOVA), Rua da Junqueira 100, 1349-008 Lisboa, Portugal; (D.S.); (A.S.-R.); (C.S.); (B.D.); (C.C.)
| | - Ana Dias
- Laboratório de Microbiologia Clínica e Biologia Molecular, Serviço de Patologia Clínica, Centro Hospitalar Lisboa Ocidental (CHLO), Rua da Junqueira 126, 1349-019 Lisboa, Portugal; (A.D.); (C.T.); (T.B.-F.)
| | - Brigite Dias
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa (IHMT-NOVA), Rua da Junqueira 100, 1349-008 Lisboa, Portugal; (D.S.); (A.S.-R.); (C.S.); (B.D.); (C.C.)
| | - Cristina Toscano
- Laboratório de Microbiologia Clínica e Biologia Molecular, Serviço de Patologia Clínica, Centro Hospitalar Lisboa Ocidental (CHLO), Rua da Junqueira 126, 1349-019 Lisboa, Portugal; (A.D.); (C.T.); (T.B.-F.)
| | - Cláudia Conceição
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa (IHMT-NOVA), Rua da Junqueira 100, 1349-008 Lisboa, Portugal; (D.S.); (A.S.-R.); (C.S.); (B.D.); (C.C.)
| | - Teresa Baptista-Fernandes
- Laboratório de Microbiologia Clínica e Biologia Molecular, Serviço de Patologia Clínica, Centro Hospitalar Lisboa Ocidental (CHLO), Rua da Junqueira 126, 1349-019 Lisboa, Portugal; (A.D.); (C.T.); (T.B.-F.)
| | - Fatima Nogueira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa (IHMT-NOVA), Rua da Junqueira 100, 1349-008 Lisboa, Portugal; (D.S.); (A.S.-R.); (C.S.); (B.D.); (C.C.)
- Correspondence: ; Tel.: +351-213652600
| |
Collapse
|
14
|
Lawal OU, Fraqueza MJ, Bouchami O, Worning P, Bartels MD, Gonçalves ML, Paixão P, Gonçalves E, Toscano C, Empel J, Urbaś M, Domínguez MA, Westh H, de Lencastre H, Miragaia M. Foodborne Origin and Local and Global Spread of Staphylococcus saprophyticus Causing Human Urinary Tract Infections. Emerg Infect Dis 2021; 27:880-893. [PMID: 33622483 PMCID: PMC7920669 DOI: 10.3201/eid2703.200852] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Staphylococcus saprophyticus is a primary cause of community-acquired urinary tract infections (UTIs) in young women. S. saprophyticus colonizes humans and animals but basic features of its molecular epidemiology are undetermined. We conducted a phylogenomic analysis of 321 S. saprophyticus isolates collected from human UTIs worldwide during 1997–2017 and 232 isolates from human UTIs and the pig-processing chain in a confined region during 2016–2017. We found epidemiologic and genomic evidence that the meat-production chain is a major source of S. saprophyticus causing human UTIs; human microbiota is another possible origin. Pathogenic S. saprophyticus belonged to 2 lineages with distinctive genetic features that are globally and locally disseminated. Pangenome-wide approaches identified a strong association between pathogenicity and antimicrobial resistance, phages, platelet binding proteins, and an increased recombination rate. Our study provides insight into the origin, transmission, and population structure of pathogenic S. saprophyticus and identifies putative new virulence factors.
Collapse
|
15
|
Lawal OU, Barata M, Fraqueza MJ, Worning P, Bartels MD, Goncalves L, Paixão P, Goncalves E, Toscano C, Empel J, Urbaś M, Domiìnguez MA, Westh H, de Lencastre H, Miragaia M. Staphylococcus saprophyticus From Clinical and Environmental Origins Have Distinct Biofilm Composition. Front Microbiol 2021; 12:663768. [PMID: 34163443 PMCID: PMC8216562 DOI: 10.3389/fmicb.2021.663768] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Biofilm formation has been shown to be critical to the success of uropathogens. Although Staphylococcus saprophyticus is a common cause of urinary tract infections, its biofilm production capacity, composition, genetic basis, and origin are poorly understood. We investigated biofilm formation in a large and diverse collection of S. saprophyticus (n = 422). Biofilm matrix composition was assessed in representative strains (n = 63) belonging to two main S. saprophyticus lineages (G and S) recovered from human infection, colonization, and food-related environment using biofilm detachment approach. To identify factors that could be associated with biofilm formation and structure variation, we used a pangenome-wide association study approach. Almost all the isolates (91%; n = 384/422) produced biofilm. Among the 63 representative strains, we identified eight biofilm matrix phenotypes, but the most common were composed of protein or protein-extracellular DNA (eDNA)-polysaccharides (38%, 24/63 each). Biofilms containing protein-eDNA-polysaccharides were linked to lineage G and environmental isolates, whereas protein-based biofilms were produced by lineage S and infection isolates (p < 0.05). Putative biofilm-associated genes, namely, aas, atl, ebpS, uafA, sasF, sasD, sdrH, splE, sdrE, sdrC, sraP, and ica genes, were found with different frequencies (3-100%), but there was no correlation between their presence and biofilm production or matrix types. Notably, icaC_1 was ubiquitous in the collection, while icaR was lineage G-associated, and only four strains carried a complete ica gene cluster (icaADBCR) except one that was without icaR. We provided evidence, using a comparative genomic approach, that the complete icaADBCR cluster was acquired multiple times by S. saprophyticus and originated from other coagulase-negative staphylococci. Overall, the composition of S. saprophyticus biofilms was distinct in environmental and clinical isolates, suggesting that modulation of biofilm structure could be a key step in the pathogenicity of these bacteria. Moreover, biofilm production in S. saprophyticus is ica-independent, and the complete icaADBCR was acquired from other staphylococci.
Collapse
Affiliation(s)
- Opeyemi U. Lawal
- Laboratory of Bacterial Evolution and Molecular Epidemiology, Instituto de Tecnologia Química e Biológica António Xavier, Universidade NOVA de Lisboa, Oeiras, Portugal
- Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica António Xavier, Universidade NOVA de Lisboa, Oeiras, Portugal
| | - Marta Barata
- Laboratory of Bacterial Evolution and Molecular Epidemiology, Instituto de Tecnologia Química e Biológica António Xavier, Universidade NOVA de Lisboa, Oeiras, Portugal
| | - Maria J. Fraqueza
- Centre for Interdisciplinary Research in Animal Health, Faculdade de Medicina Veterinária, Universidade de Lisboa, Lisbon, Portugal
| | - Peder Worning
- Department of Clinical Microbiology, Hvidovre University Hospital, Hvidovre, Denmark
| | - Mette D. Bartels
- Department of Clinical Microbiology, Hvidovre University Hospital, Hvidovre, Denmark
| | | | | | | | | | - Joanna Empel
- Department of Epidemiology and Clinical Microbiology, Narodowy Instytut Leków, Warszawa, Poland
| | - Malgorzata Urbaś
- Department of Epidemiology and Clinical Microbiology, Narodowy Instytut Leków, Warszawa, Poland
| | | | - Henrik Westh
- Department of Clinical Microbiology, Hvidovre University Hospital, Hvidovre, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hermínia de Lencastre
- Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica António Xavier, Universidade NOVA de Lisboa, Oeiras, Portugal
- The Laboratory of Microbiology and Infectious Diseases, The Rockefeller University, New York, NY, United States
| | - Maria Miragaia
- Laboratory of Bacterial Evolution and Molecular Epidemiology, Instituto de Tecnologia Química e Biológica António Xavier, Universidade NOVA de Lisboa, Oeiras, Portugal
| |
Collapse
|
16
|
Borges V, Isidro J, Correia C, Cordeiro D, Vieira L, Lodhia Z, Fernandes C, Rodrigues AM, Azevedo J, Alves J, Roxo J, Rocha M, Côrte-Real R, Toscano C, Pessanha MA, Nissan I, Pilo S, Rorman E, Dveyrin Z, Paitan Y, Paran H, Wagner-Kolasko G, Beirnes J, Gibbons S, Severini A, Borrego MJ, Gomes JP. Transcontinental Dissemination of the L2b/D-Da Recombinant Chlamydia trachomatis Lymphogranuloma venereum (LGV) Strain: Need of Broad Multi-Country Molecular Surveillance. Clin Infect Dis 2021; 73:e1004-e1007. [PMID: 33512482 DOI: 10.1093/cid/ciab067] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/25/2021] [Indexed: 11/13/2022] Open
Abstract
Previously, we identified a Chlamydia trachomatis lymphogranuloma venereum (LGV) recombinant strain possessing a non-LGV ompA genotype. Here, culture-independent genome sequencing confirms its circulation in Europe, Middle East, and North America, and unveils emergence of antibiotic resistance. Broad surveillance is needed.
Collapse
Affiliation(s)
- Vítor Borges
- National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Joana Isidro
- National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Cristina Correia
- National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Dora Cordeiro
- National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Luís Vieira
- National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Zohra Lodhia
- National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Cândida Fernandes
- Centro Hospitalar e Universitário de Lisboa Central, Lisbon, Portugal
| | | | | | | | - João Roxo
- CheckpointLX, Grupo de Ativistas em Tratamentos, Lisbon, Portugal
| | - Miguel Rocha
- CheckpointLX, Grupo de Ativistas em Tratamentos, Lisbon, Portugal
| | - Rita Côrte-Real
- Centro Hospitalar e Universitário de Lisboa Central, Lisbon, Portugal
| | | | | | - Israel Nissan
- National Public Health Laboratories, Tel Aviv, Israel
| | - Shlomo Pilo
- National Public Health Laboratories, Tel Aviv, Israel
| | - Efrat Rorman
- National Public Health Laboratories, Tel Aviv, Israel
| | - Zeev Dveyrin
- National Public Health Laboratories, Tel Aviv, Israel
| | - Yossi Paitan
- Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine & Tel Aviv University, Tel Aviv, Israel.,Clinical Microbiology Lab, Meir Medical Center, Kfar Saba, Israel
| | - Haim Paran
- Department of General Surgery A, Meir Medical Center, Kfar Saba, Israel
| | - Gal Wagner-Kolasko
- Department of Family Medicine, Clalit Gan-Meir LGBT Clinic, Tel Aviv, Israel
| | | | | | - Alberto Severini
- Public Health Agency of Canada, Winnipeg, Manitoba, Canada.,Department of Medical Microbiology, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - João Paulo Gomes
- National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| |
Collapse
|
17
|
Sabino R, Gonçalves P, Martins Melo A, Simões D, Oliveira M, Francisco M, Viegas C, Carvalho D, Martins C, Ferreira T, Toscano C, Simões H, Veríssimo C. Trends on Aspergillus Epidemiology-Perspectives from a National Reference Laboratory Surveillance Program. J Fungi (Basel) 2021; 7:jof7010028. [PMID: 33418997 PMCID: PMC7825284 DOI: 10.3390/jof7010028] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/23/2020] [Accepted: 12/30/2020] [Indexed: 12/17/2022] Open
Abstract
Identification of Aspergillus to species level is important since sibling species may display variable susceptibilities to multiple antifungal drugs and also because correct identification contributes to improve the knowledge of epidemiological studies. Two retrospective laboratory studies were conducted on Aspergillus surveillance at the Portuguese National Mycology Reference Laboratory. The first, covering the period 2017–2018, aimed to study the molecular epidemiology of 256 Aspergillus isolates obtained from patients with respiratory, subcutaneous, or systemic infections and from environmental samples. The second, using our entire collection of clinical and environmental A. fumigatus isolates (N = 337), collected between 2012 and 2019, aimed to determine the frequency of azole-resistant A. fumigatus isolates. Aspergillus fumigatus sensu stricto was the most frequent species in both clinical and environmental samples. Overall, and considering all Aspergillus sections identified, a high frequency of cryptic species was detected, based on beta-tubulin or calmodulin sequencing (37% in clinical and 51% in environmental isolates). Regarding all Fumigati isolates recovered from 2012–2019, the frequency of cryptic species was 5.3% (18/337), with the identification of A. felis (complex), A. lentulus, A. udagawae, A. hiratsukae, and A. oerlinghauensis. To determine the frequency of azole resistance of A. fumigatus, isolates were screened for azole resistance using azole-agars, and 53 possible resistant isolates were tested by the CLSI microdilution reference method. Nine A. fumigatus sensu stricto and six Fumigati cryptic isolates showed high minimal inhibitory concentrations to itraconazole, voriconazole, and/or posaconazole. Real-time PCR to detect cyp51A mutations and sequencing of cyp51A gene and its promoter were performed. The overall frequency of resistance to azoles in A. fumigatus sensu stricto was 3.0%. With this retrospective analysis, we were able to detect one azole-resistant G54R mutant A. fumigatus environmental isolate, collected in 2015. The TR34/L98H mutation, linked to environmental transmission route of azole resistance, was the most frequently detected mutation (N = 4; 1.4%). Our findings underline the demand for correct identification and susceptibility testing of Aspergillus isolates.
Collapse
Affiliation(s)
- Raquel Sabino
- Infectious Diseases Department, National Health Institute Dr. Ricardo Jorge, 1649-016 Lisbon, Portugal; (P.G.); (A.M.M.); (D.S.); (M.O.); (M.F.); (H.S.); (C.V.)
- Correspondence: ; Tel.: +351-217519247
| | - Paulo Gonçalves
- Infectious Diseases Department, National Health Institute Dr. Ricardo Jorge, 1649-016 Lisbon, Portugal; (P.G.); (A.M.M.); (D.S.); (M.O.); (M.F.); (H.S.); (C.V.)
- European Programme for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control, 16973 Solna, Sweden
| | - Aryse Martins Melo
- Infectious Diseases Department, National Health Institute Dr. Ricardo Jorge, 1649-016 Lisbon, Portugal; (P.G.); (A.M.M.); (D.S.); (M.O.); (M.F.); (H.S.); (C.V.)
- Programa de Pós-Graduação em Microbiologia e Parasitologia, Instituto de Biologia, Universidade Federal de Pelotas, Avenida Eliseu Maciel, Pelotas 96010-610, Brazil
| | - Daniela Simões
- Infectious Diseases Department, National Health Institute Dr. Ricardo Jorge, 1649-016 Lisbon, Portugal; (P.G.); (A.M.M.); (D.S.); (M.O.); (M.F.); (H.S.); (C.V.)
| | - Mariana Oliveira
- Infectious Diseases Department, National Health Institute Dr. Ricardo Jorge, 1649-016 Lisbon, Portugal; (P.G.); (A.M.M.); (D.S.); (M.O.); (M.F.); (H.S.); (C.V.)
| | - Mariana Francisco
- Infectious Diseases Department, National Health Institute Dr. Ricardo Jorge, 1649-016 Lisbon, Portugal; (P.G.); (A.M.M.); (D.S.); (M.O.); (M.F.); (H.S.); (C.V.)
| | - Carla Viegas
- H&TRC—Health & Technology Research Center, ESTeSL—Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, 1990-096 Lisbon, Portugal;
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), 1169-056 Lisbon, Portugal
| | - Dinah Carvalho
- Centro Hospitalar Universitário Lisboa Norte EPE, 1649-028 Lisbon, Portugal; (D.C.); (C.M.)
| | - Carlos Martins
- Centro Hospitalar Universitário Lisboa Norte EPE, 1649-028 Lisbon, Portugal; (D.C.); (C.M.)
| | - Teresa Ferreira
- Centro Hospitalar Universitário Lisboa Central, 1050-099 Lisbon, Portugal;
| | - Cristina Toscano
- Microbiology Laboratory, Centro Hospitalar Lisboa Ocidental, Hospital Egas Moniz, 1349-019 Lisbon, Portugal;
| | - Helena Simões
- Infectious Diseases Department, National Health Institute Dr. Ricardo Jorge, 1649-016 Lisbon, Portugal; (P.G.); (A.M.M.); (D.S.); (M.O.); (M.F.); (H.S.); (C.V.)
| | - Cristina Veríssimo
- Infectious Diseases Department, National Health Institute Dr. Ricardo Jorge, 1649-016 Lisbon, Portugal; (P.G.); (A.M.M.); (D.S.); (M.O.); (M.F.); (H.S.); (C.V.)
| |
Collapse
|
18
|
Tavares AM, Pingarilho M, Batista J, Viveiros M, Dias S, Toscano C, Gomes P, Abecasis AB. Short Communication: HIV and Tuberculosis Co-Infection Among Migrants in Portugal: A Brief Study on Their Sociodemographic, Clinical, and Genomic Characteristics. AIDS Res Hum Retroviruses 2021; 37:34-37. [PMID: 32962419 DOI: 10.1089/aid.2020.0119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
HIV and tuberculosis (TB) are among the global deadliest diseases. Migrant populations are particularly vulnerable to these infections. Yet, literature is still scarce on the epidemiology of HIV-TB co-infection among migrants. In this study, we characterized native and migrant HIV patients followed in Portuguese hospitals, who were diagnosed with TB, regarding their sociodemographic, clinical, and genomic characteristics. Among 67 patients with HIV and TB diagnoses, there were 24 migrants, most from sub-Saharan Africa. Most patients had CD4+ T cell counts below 350 cells/μL, and were diagnosed simultaneously for HIV and TB. When compared to natives, migrants presented a higher proportion of non-B HIV-1 infections. Patients infected with these non-B HIV-1 strains presented higher viral loads, which can have an important impact for the transmissibility and pathogenicity of both diseases. Future studies should investigate different HIV strains and consequences for TB and HIV transmission and disease outcomes, especially among vulnerable populations.
Collapse
Affiliation(s)
- Ana Maria Tavares
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Marta Pingarilho
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Judite Batista
- Laboratório de Microbiologia Clínica e Biologia Molecular, Serviço de Patologia Clínica, Centro Hospitalar Lisboa Ocidental-Hospital Egas Moniz, Lisboa, Portugal
| | - Miguel Viveiros
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Sónia Dias
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa and Comprehensive Health Research Center, Lisboa, Portugal
| | - Cristina Toscano
- Laboratório de Microbiologia Clínica e Biologia Molecular, Serviço de Patologia Clínica, Centro Hospitalar Lisboa Ocidental-Hospital Egas Moniz, Lisboa, Portugal
| | - Perpétua Gomes
- Laboratório de Microbiologia Clínica e Biologia Molecular, Serviço de Patologia Clínica, Centro Hospitalar Lisboa Ocidental-Hospital Egas Moniz, Lisboa, Portugal
- Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Caparica, Portugal
| | - Ana B. Abecasis
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| |
Collapse
|
19
|
Hernández-García M, García-Castillo M, García-Fernández S, Melo-Cristino J, Pinto MF, Gonçalves E, Alves V, Vieira AR, Ramalheira E, Sancho L, Diogo J, Ferreira R, Silva T, Chaves C, Bou G, Cercenado E, Delgado-Valverde M, Oliver A, Pitart C, Rodríguez-Lozano J, Tormo N, Romano J, Pássaro L, Paixão L, López-Mendoza D, Díaz-Regañón J, Cantón R, Melo-Cristino J, Pinto MF, Marcelo C, Peres H, Lourenço I, Peres I, Marques J, Chantre O, Pina T, Gonçalves E, Toscano C, Alves V, Ribeiro M, Costa E, Vieira AR, Ferreira S, Diaz R, Ramalheira E, Schäfer S, Tancredo L, Sancho L, Rodrigues A, Diogo J, Ferreira R, Ramos H, Silva T, Silva D, Chaves C, Queiroz C, Nabiev A, Pássaro L, Paixao L, Romano J, Moura C. Distinct epidemiology and resistance mechanisms affecting ceftolozane/tazobactam in Pseudomonas aeruginosa isolates recovered from ICU patients in Spain and Portugal depicted by WGS. J Antimicrob Chemother 2020; 76:370-379. [DOI: 10.1093/jac/dkaa430] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/08/2020] [Indexed: 12/13/2022] Open
Abstract
Abstract
Objectives
To analyse the epidemiology, the resistome and the virulome of ceftolozane/tazobactam-susceptible or -resistant Pseudomonas aeruginosa clinical isolates recovered from surveillance studies in Portugal (STEP, 2017–18) and Spain (SUPERIOR, 2016–17).
Methods
P. aeruginosa isolates were recovered from intra-abdominal, urinary tract and lower respiratory tract infections in ICU patients admitted to 11 Portuguese and 8 Spanish hospitals. MICs were determined (ISO-standard broth microdilution, EUCAST 2020 breakpoints). A subset of 28 ceftolozane/tazobactam-resistant P. aeruginosa isolates were analysed and compared with 28 ceftolozane/tazobactam-susceptible P. aeruginosa strains by WGS.
Results
Clonal complex (CC) 235 (27%) and CC175 (18%) were the most frequent, followed by CC244 (13%), CC348 (9%), CC253 (5%) and CC309 (5%). Inter-hospital clonal dissemination was observed, limited to a geographical region (CC235, CC244, CC348 and CC253 in Portugal and CC175 and CC309 in Spain). Carbapenemases were detected in 25 isolates (45%): GES-13 (13/25); VIM type (10/25) [VIM-2 (4/10), VIM-20 (3/10), VIM-1 (2/10) and VIM-36 (1/10)]; and KPC-3 (2/25). GES-13-CC235 (13/15) and VIM type-CC175 (5/10) associations were observed. Interestingly, KPC-3 and VIM-36 producers showed ceftolozane/tazobactam-susceptible phenotypes. However, ceftolozane/tazobactam resistance was significantly associated with GES-13 and VIM-type carbapenemase production. Six non-carbapenemase producers also displayed ceftolozane/tazobactam resistance, three of them showing known ceftolozane/tazobactam resistance-associated mutations in the PBP3 gene, ftsI (R504C and F533L). Overall, an extensive virulome was identified in all P. aeruginosa isolates, particularly in carbapenemase-producing strains.
Conclusions
GES-13-CC235 and VIM type-CC175 were the most frequent MDR/XDR P. aeruginosa clones causing infections in Portuguese and Spanish ICU patients, respectively. Ceftolozane/tazobactam resistance was mainly due to carbapenemase production, although mutations in PBP-encoding genes may additionally be involved.
Collapse
Affiliation(s)
| | - María García-Castillo
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal-IRYCIS, Madrid, Spain
| | | | - José Melo-Cristino
- Serviço de Microbiologia Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Margarida F Pinto
- Laboratório de Microbiologia, Serviço de Patologia Clínica, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Elsa Gonçalves
- Laboratório de Microbiologia Clínica Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Valquíria Alves
- Laboratório de Microbiologia, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Ana Raquel Vieira
- Serviço de Patologia Clínica, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Elmano Ramalheira
- Serviço Patologia Clínica, Hospital Infante Dom Pedro, Aveiro, Portugal
| | - Luísa Sancho
- Serviço de Patologia Clínica, Hospital Prof. Dr. Fernando da Fonseca, Amadora, Portugal
| | - José Diogo
- Serviço de Microbiologia, Hospital Garcia de Orta, Almada, Portugal
| | - Rui Ferreira
- Serviço de Patologia Clínica–Microbiologia–CHUA–Unidade de Portimão, Portimão, Portugal
| | - Tânia Silva
- Serviço de Microbiologia do Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Catarina Chaves
- Serviço de Microbiologia, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Germán Bou
- Servicio de Microbiología, Hospital Universitario A Coruña, A Coruña, Spain
| | - Emilia Cercenado
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mercedes Delgado-Valverde
- UGC Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Antonio Oliver
- Servicio de Microbiología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Cristina Pitart
- Servicio de Microbiología, Hospital Clínic i Provincial, Barcelona, Spain
| | - Jesús Rodríguez-Lozano
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Nuria Tormo
- Servicio de Microbiología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | | | | | | | | | | | - Rafael Cantón
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal-IRYCIS, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Filippou G, Scanu A, Adinolfi A, Toscano C, Gambera D, Largo R, Naredo E, Calvo E, Herrero-Beaumont G, Zufferey P, Madelaine-Bonjour C, Maccarter D, Makman S, Weber Z, Figus F, Möller I, Gutierrez M, Pineda C, Clavijo Cornejo D, García H, Ilizaliturri V, Mendoza Torres J, Pichardo R, Rodriguez Delgado LC, Filippucci E, Cipolletta E, Serban T, Cirstoiu C, Vreju FA, Grecu D, Mouterde G, Govoni M, Punzi L, Damjanov N, Terslev L, Scirè CA, Iagnocco A. OP0317 ACCURACY OF THE OMERACT DEFINITIONS FOR IDENTIFICATION OF CALCIUM PYROPHOSPHATE CRYSTALS WITH ULTRASOUND: FINAL RESULTS OF THE OMERACT US IN CPPD SUB-TASK FORCE STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The OMERACT Ultrasound (US) in calcium pyrophosphate deposition disease (CPPD) sub-task force has been working on the use of US in CPPD since 2014 first creating definitions for CPPD identification and then assessing the reliability[1].Objectives:Objective of this study is to assess the diagnostic accuracy (truth) of US in CPPD.Methods:Consecutive patients waiting to undergo knee replacement surgery due to osteoarthritis were enrolled in 12 centres from 6 countries. Each patient underwent US examination of the knee, focusing on the menisci and the hyaline cartilage, the day prior to surgery, scoring each site for presence/absence of CPP as defined previously[1]. After surgery, the menisci and the condyles were retrieved and examined microscopically. Six samples were collected, both from the surface and from the internal part of menisci and cartilage trying to cover a large part of it. All slides were observed under transmitted light microscopy and by compensated polarised microscopy. A dichotomous score was given for the presence/absence of CPP. US and microscopic analysis were performed by different operators, blind to each other’s findings. Sensitivity and specificity of US were calculated using microscopic findings as the gold standard.Results:101 patients have been enrolled in the study. 33 patients have been excluded due to loss of anatomical pieces at surgery. The mean age of the remaining 68 pts was 71yo (±8), 44 women, 34 were affected by CPPD according to microscopy. Overall and per site diagnostic US accuracy results are presented in table 1Diagnostic accuracySensitivitySpecificityPositive Predictive valueNegative Predictive valueGlobal0.750.910.590.690.87Medial meniscus0.820.870.770.770.87Lateral meniscus0.750.830.680.680.83Medial cartilage0.860.790.920.880.85Lateral cartilage0.820.710.880.770.84Medial side (combined cartilage and meniscus)0.820.880.760.790.87Lateral side (combined cartilage and meniscus)0.780.880.690.730.86Conclusion:Our results demonstrate that US is an accurate exam for identification of CPPD. The best combination of sensitivity and specificity is achieved by examining the medial aspect of the knee.References:[1]Filippou G, Scirè CA, Adinolfi A,et al.Identification of calcium pyrophosphate deposition disease (CPPD) by ultrasound: reliability of the OMERACT definitions in an extended set of joints—an international multiobserver study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force.Ann Rheum Dis2018;:annrheumdis-2017-212542. doi:10.1136/annrheumdis-2017-212542Disclosure of Interests:Georgios Filippou: None declared, Anna Scanu: None declared, Antonella Adinolfi: None declared, Carmela Toscano: None declared, Dario Gambera: None declared, Raquel Largo: None declared, Esperanza Naredo: None declared, Emilio Calvo: None declared, Gabriel Herrero-Beaumont: None declared, Pascal Zufferey: None declared, Christel Madelaine-Bonjour: None declared, Daryl MacCarter: None declared, Stanley Makman: None declared, Zachary Weber: None declared, Fabiana Figus: None declared, Ingrid Möller: None declared, Marwin Gutierrez: None declared, Carlos Pineda: None declared, Denise Clavijo Cornejo: None declared, Héctor García: None declared, Victor Ilizaliturri: None declared, Jaime Mendoza Torres: None declared, Raul Pichardo: None declared, Luis Carlos Rodriguez Delgado: None declared, Emilio Filippucci Speakers bureau: Dr. Filippucci reports personal fees from AbbVie, personal fees from Bristol-Myers Squibb, personal fees from Celgene, personal fees from Roche, personal fees from Union Chimique Belge Pharma, personal fees from Pfizer, outside the submitted work., Edoardo Cipolletta: None declared, Teodora Serban: None declared, Catalin Cirstoiu: None declared, Florentin Ananu Vreju: None declared, Dun Grecu: None declared, Gael Mouterde: None declared, Marcello Govoni: None declared, Leonardo Punzi: None declared, Nemanja Damjanov Grant/research support from: from AbbVie, Pfizer, and Roche, Consultant of: AbbVie, Gedeon Richter, Merck, Novartis, Pfizer, and Roche, Speakers bureau: AbbVie, Gedeon Richter, Merck, Novartis, Pfizer, and Roche, Lene Terslev Speakers bureau: LT declares speakers fees from Roche, MSD, BMS, Pfizer, AbbVie, Novartis, and Janssen., Carlo Alberto Scirè: None declared, Annamaria Iagnocco Grant/research support from: Abbvie, MSD and Alfasigma, Consultant of: AbbVie, Abiogen, Alfasigma, Biogen, BMS, Celgene, Eli-Lilly, Janssen, MSD, Novartis, Sanofi and Sanofi Genzyme, Speakers bureau: AbbVie, Alfasigma, BMS, Eli-Lilly, Janssen, MSD, Novartis, Sanofi
Collapse
|
21
|
Fiel D, Calca R, Cacheira E, Rombo N, Querido S, Nascimento C, Jorge C, Weigert A, Birne R, Clemente B, Martinho A, Toscano C, Bruges M, Malvar B, Machado D. Cupriavius pauculus causing a respiratory tract infection in a post-kidney-transplant patient: A firstly described rare clinical case. ACTA ACUST UNITED AC 2020. [DOI: 10.15406/ppij.2020.08.00277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
22
|
Sáez-López E, Cristóvão P, Costa I, Pechirra P, Conde P, Guiomar R, Peres MJ, Viseu R, Lopes P, Soares V, Vale F, Fonseca P, Freitas L, Alves J, Pessanha MA, Toscano C, Mota-Vieira L, Veloso RC, Côrte-Real R, Branquinho P, Pereira-Vaz J, Rodrigues F, Cunha M, Martins L, Mota P, Couto AR, Bruges-Armas J, Almeida S, Rodrigues D. Epidemiology and genetic variability of respiratory syncytial virus in Portugal, 2014-2018. J Clin Virol 2019; 121:104200. [PMID: 31707201 PMCID: PMC7106440 DOI: 10.1016/j.jcv.2019.104200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/19/2019] [Accepted: 10/03/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) is associated with substantial morbidity and mortality since it is a predominant viral agent causing respiratory tract infections in infants, young children and the elderly. Considering the availability of the RSV vaccines in the coming years, molecular understanding in RSV is necessary. OBJECTIVE The objective of the present study was to describe RSV epidemiology and genotype variability in Portugal during the 2014/15-2017/18 period. MATERIAL AND METHODS Epidemiological data and RSV-positive samples from patients with a respiratory infection were collected through the non-sentinel and sentinel influenza surveillance system (ISS). RSV detection, subtyping in A and B, and sequencing of the second hypervariable region (HVR2) of G gene were performed by molecular methods. Phylogenetic trees were generated using the Neighbor-Joining method and p-distance model on MEGA 7.0. RESULTS RSV prevalence varied between the sentinel (2.5%, 97/3891) and the non-sentinel ISS (20.7%, 3138/16779), being higher (P < 0.0001) among children aged <5 years. Bronchiolitis (62.9%, 183/291) and influenza-like illness (24.6%, 14/57) were associated (P < 0.0001) with RSV laboratory confirmation among children aged <6 months and adults ≥65 years, respectively. The HVR2 was sequenced for 562 samples. RSV-A (46.4%, 261/562) and RSV-B (53.6%, 301/562) strains clustered mainly to ON1 (89.2%, 233/261) and BA9 (92%, 277/301) genotypes, respectively, although NA1 and BA10 were also present until 2015/2016. CONCLUSION The sequence and phylogenetic analysis reflected the relatively high diversity of Portuguese RSV strains. BA9 and ON1 genotypes, which have been circulating in Portugal since 2010/2011 and 2011/2012 respectively, predominated during the whole study period.
Collapse
Affiliation(s)
- Emma Sáez-López
- Department of Infectious Diseases, National Health Institute Doutor Ricardo Jorge (INSA), Avenida Padre Cruz, 1649-016, Lisbon, Portugal; European Centre for Disease Prevention and Control (ECDC), Gustav III:s Boulevard 40, 16973, Solna, Sweden.
| | - Paula Cristóvão
- Department of Infectious Diseases, National Health Institute Doutor Ricardo Jorge (INSA), Avenida Padre Cruz, 1649-016, Lisbon, Portugal.
| | - Inês Costa
- Department of Infectious Diseases, National Health Institute Doutor Ricardo Jorge (INSA), Avenida Padre Cruz, 1649-016, Lisbon, Portugal.
| | - Pedro Pechirra
- Department of Infectious Diseases, National Health Institute Doutor Ricardo Jorge (INSA), Avenida Padre Cruz, 1649-016, Lisbon, Portugal.
| | - Patrícia Conde
- Department of Infectious Diseases, National Health Institute Doutor Ricardo Jorge (INSA), Avenida Padre Cruz, 1649-016, Lisbon, Portugal.
| | - Raquel Guiomar
- Department of Infectious Diseases, National Health Institute Doutor Ricardo Jorge (INSA), Avenida Padre Cruz, 1649-016, Lisbon, Portugal.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Isidro J, Menezes J, Serrano M, Borges V, Paixão P, Mimoso M, Martins F, Toscano C, Santos A, Henriques AO, Oleastro M. Genomic Study of a Clostridium difficile Multidrug Resistant Outbreak-Related Clone Reveals Novel Determinants of Resistance. Front Microbiol 2018; 9:2994. [PMID: 30574133 PMCID: PMC6291485 DOI: 10.3389/fmicb.2018.02994] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/20/2018] [Indexed: 12/15/2022] Open
Abstract
Background:Clostridium difficile infection (CDI) is prevalent in healthcare settings. The emergence of hypervirulent and antibiotic resistant strains has led to an increase in CDI incidence and frequent outbreaks. While the main virulence factors are the TcdA and TcdB toxins, antibiotic resistance is thought to play a key role in the infection by and dissemination of C. difficile. Methods: A CDI outbreak involving 12 patients was detected in a tertiary care hospital, in Lisbon, which extended from January to July, with a peak in February, in 2016. The C. difficile isolates, obtained from anaerobic culture of stool samples, were subjected to antimicrobial susceptibility testing with Etest®strips against 11 antibiotics, determination of toxin genes profile, PCR-ribotyping, multilocus variable-number tandem-repeat analysis (MLVA) and whole genome sequencing (WGS). Results: Of the 12 CDI cases detected, 11 isolates from 11 patients were characterized. All isolates were tcdA-/tcdB+ and belonged to ribotype 017, and showed high level resistance to clindamycin, erythromycin, gentamicin, imipenem, moxifloxacin, rifampicin and tetracycline. The isolates belonged to four genetically related MLVA types, with six isolates forming a clonal cluster. Three outbreak isolates, each from a different MLVA type, were selected for WGS. Bioinformatics analysis showed the presence of several antibiotic resistance determinants, including the Thr82Ile substitution in gyrA, conferring moxifloxacin resistance, the substitutions His502Asn and Arg505Lys in rpoB for rifampicin resistance, the tetM gene, associated with tetracycline resistance, and two genes encoding putative aminoglycoside-modifying enzymes, aadE and aac(6′)-aph(2″). Furthermore, a not previously described 61.3 kb putative mobile element was identified, presenting a mosaic structure and containing the genes ermG, mefA/msrD and vat, associated with macrolide, lincosamide and streptogramins resistance. A substitution found in a class B penicillin-binding protein, Cys721Ser, is thought to contribute to imipenem resistance. Conclusion: We describe an epidemic, tcdA-/tcdB+, multidrug resistant clone of C. difficile from ribotype 017 associated with a hospital outbreak, providing further evidence that the lack of TcdA does not impair the infectious potential of these strains. We identified several determinants of antimicrobial resistance, including new ones located in mobile elements, highlighting the importance of horizontal gene transfer in the pathogenicity and epidemiological success of C. difficile.
Collapse
Affiliation(s)
- Joana Isidro
- Departamento de Doenças Infecciosas, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal.,Departamento de Genética Humana, Unidade de Tecnologia e Inovação, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Juliana Menezes
- Departamento de Doenças Infecciosas, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Mónica Serrano
- Instituto de Tecnologia Química e Biológica António Xavier, Oeiras, Portugal
| | - Vítor Borges
- Departamento de Doenças Infecciosas, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Pedro Paixão
- Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | | | | | | | - Andrea Santos
- Departamento de Doenças Infecciosas, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Adriano O Henriques
- Instituto de Tecnologia Química e Biológica António Xavier, Oeiras, Portugal
| | - Mónica Oleastro
- Departamento de Doenças Infecciosas, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| |
Collapse
|
24
|
Rato M, Costin A, Furtado C, Sousa C, Toscano C, Veríssimo C, Trindade F, Tavares Almeida F, Da Cunha Velho G, Catorze G, Raposo I, Selada J, A Ferreira J, Batista J, Santos L, Sereijo M, Silva M, Apetato M, Sanches M, Costa-Silva M, L Filipe P, Santos P, D. Fonseca P, Mascarenhas R, Bajanca R, Lopes V, Lewis V, Duarte MDL, Galhardas C, Anes M. Epidemiologia das infeções fúngicas superficiais em Portugal - revisão de 3 anos (2014-2016). SPDV 2018. [DOI: 10.29021/spdv.76.3.910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introdução: As infeções fúngicas superficiais são as dermatoses infeciosas mais frequentes e a sua incidência continua a aumentar. Os dermatófitos são os principais agentes causais apresentando, contudo, uma distribuição geográfica variável.Material e Métodos: O presente estudo teve como objetivo a caracterização epidemiológica das infeções fúngicas superficiais diagnosticadas nos Serviços/Unidades de Dermatologia pertencentes ao Serviço Nacional de Saúde Português entre janeiro de 2014 e dezembro 2016 através da análise retrospetiva dos resultados das culturas realizadas durante esse período.Resultados: Foram estudados 2375 isolamentos, pertencentes a 2319 doentes. O dermatófito mais frequentemente isolado foi o Trichophyton rubrum (53,6%), tendo sido o principal agente causal da tinha da pele glabra (52,4%) e das onicomicoses (51,1%). Relativamente às tinhas do couro cabeludo, globalmente o Microsporum audouinii foi o agente mais prevalente (42,6%), seguido do Trichophyton soudanense (22,1%). Enquanto na área metropolitana de Lisboa estes dermatófitos foram os principais agentes de tinha do couro cabeludo, nas regiões Norte e Centro o agente mais frequente foi o Microsporum canis (58,5%). Os fungos leveduriformes foram os principais responsáveis pelas onicomicoses das mãos (76,7%).Conclusão: Os resultados deste estudo estão globalmente concordantes com a literatura científica. O Trichophyton rubrum apresenta-se como o dermatófito mais frequentemente isolado em cultura. Na tinha do couro cabeludo, na área metropolitana de Lisboa, as espécies antropofílicas de importação assumem particular destaque.
Collapse
|
25
|
Baiao R, Baptista J, Carneiro A, Pinto R, Toscano C, Fearon P, Soares I, Mesquita AR. Assessing preschoolers interactive behaviour: A validation study of the "Coding System for Mother-Child Interaction". Child Care Health Dev 2018; 44:644-650. [PMID: 29766543 DOI: 10.1111/cch.12572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 04/11/2018] [Accepted: 04/17/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The preschool years are a period of great developmental achievements, which impact critically on a child's interactive skills. Having valid and reliable measures to assess interactive behaviour at this stage is therefore crucial. The aim of this study was to describe the adaptation and validation of the child coding of the Coding System for Mother-Child Interactions and discuss its applications and implications in future research and practice. METHODS Two hundred twenty Portuguese preschoolers and their mothers were videotaped during a structured task. Child and mother interactive behaviours were coded based on the task. Maternal reports on the child's temperament and emotional and behaviour problems were also collected, along with family psychosocial information. RESULTS Interrater agreement was confirmed. The use of child Cooperation, Enthusiasm, and Negativity as subscales was supported by their correlations across tasks. Moreover, these subscales were correlated with each other, which supports the use of a global child interactive behaviour score. Convergent validity with a measure of emotional and behavioural problems (Child Behaviour Checklist 1 ½-5) was established, as well as divergent validity with a measure of temperament (Children's Behaviour Questionnaire-Short Form). Regarding associations with family variables, child interactive behaviour was only associated with maternal behaviour. CONCLUSIONS Findings suggest that this coding system is a valid and reliable measure for assessing child interactive behaviour in preschool age children. It therefore represents an important alternative to this area of research and practice, with reduced costs and with more flexible training requirements. Attention should be given in future research to expanding this work to clinical populations and different age groups.
Collapse
Affiliation(s)
- R Baiao
- Psychology Research Center- CIPsi, School of Psychology, University of Minho, Braga, Portugal
| | - J Baptista
- Psychology Research Center- CIPsi, School of Psychology, University of Minho, Braga, Portugal
| | - A Carneiro
- Psychology Research Center- CIPsi, School of Psychology, University of Minho, Braga, Portugal.,Research Centre for Human Development, Catholic University of Portugal, Porto, Portugal
| | - R Pinto
- Psychology Research Center- CIPsi, School of Psychology, University of Minho, Braga, Portugal
| | - C Toscano
- Psychology Research Center- CIPsi, School of Psychology, University of Minho, Braga, Portugal
| | - P Fearon
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - I Soares
- Psychology Research Center- CIPsi, School of Psychology, University of Minho, Braga, Portugal
| | - A R Mesquita
- Psychology Research Center- CIPsi, School of Psychology, University of Minho, Braga, Portugal
| |
Collapse
|
26
|
Machado D, Antunes J, Simões A, Perdigão J, Couto I, McCusker M, Martins M, Portugal I, Pacheco T, Batista J, Toscano C, Viveiros M. Contribution of efflux to colistin heteroresistance in a multidrug resistant Acinetobacter baumannii clinical isolate. J Med Microbiol 2018; 67:740-749. [DOI: 10.1099/jmm.0.000741] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Diana Machado
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
| | - Jéssica Antunes
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
| | - Ana Simões
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
- Present address: Instituto Nacional de Investigação Agrária e Veterinária, I.P, Lisboa, Portugal
| | - João Perdigão
- iMed.ULisboa, Instituto de Investigação do Medicamento, Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal
| | - Isabel Couto
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
| | - Matthew McCusker
- School of Food Science and Environmental Health, College of Sciences and Health, Dublin Institute of Technology, Dublin, Ireland
| | - Marta Martins
- Department of Microbiology, Moyne Institute of Preventive Medicine, School of Genetics and Microbiology, Trinity College Dublin, Dublin, Ireland
| | - Isabel Portugal
- iMed.ULisboa, Instituto de Investigação do Medicamento, Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal
| | - Teresa Pacheco
- Serviço de Patologia Clínica, Laboratório de Microbiologia Clínica e Biologia Molecular – Hospital de Egas Moniz – Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Judite Batista
- Serviço de Patologia Clínica, Laboratório de Microbiologia Clínica e Biologia Molecular – Hospital de Egas Moniz – Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Cristina Toscano
- Serviço de Patologia Clínica, Laboratório de Microbiologia Clínica e Biologia Molecular – Hospital de Egas Moniz – Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Miguel Viveiros
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
| |
Collapse
|
27
|
Baptista-Fernandes T, Rodrigues M, Castro I, Paixão P, Pinto-Marques P, Roque L, Belo S, Ferreira PM, Mansinho K, Toscano C. Human gastric hyperinfection by Anisakis simplex: A severe and unusual presentation and a brief review. Int J Infect Dis 2017; 64:38-41. [PMID: 28882665 DOI: 10.1016/j.ijid.2017.08.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 08/24/2017] [Accepted: 08/26/2017] [Indexed: 11/30/2022] Open
Abstract
Anisakiasis is an emerging marine food-borne zoonosis resulting from the accidental ingestion of Anisakis larvae, through the consumption of raw or undercooked infected seafood products. The first case of human gastric hyperinfection by Anisakis simplex with an unusual and severe presentation, occurring in a Portuguese woman, is described in this article. Over 140 anisakid larvae were removed by gastroscopy. Massive infection is uncommon in areas where the consumption of raw fish is not part of the traditional diet, as is the case in Portugal. The increased consumption of raw seafood products is considered a health determinant in the rise in cases of anisakiasis. However, clinicians should be aware of the emergence of these infections, not only because of the new dietary habits of the population, but also because of the high prevalence of Anisakis larvae in the different fish species usually consumed by the population, collected on the Portuguese coast.
Collapse
Affiliation(s)
- Teresa Baptista-Fernandes
- Laboratório de Microbiologia Clínica e Biologia Molecular, Serviço de Patologia Clínica, Centro Hospitalar de Lisboa Ocidental, Hospital Egas Moniz, Rua da Junqueira 126, 1349-019 Lisbon, Portugal.
| | - Manuel Rodrigues
- Biopremier SA, Campus da Faculdade de Ciências da Universidade de Lisboa, Lisbon, Portugal.
| | - Isabel Castro
- Biopremier SA, Campus da Faculdade de Ciências da Universidade de Lisboa, Lisbon, Portugal.
| | - Paulo Paixão
- Centro de Estudos de Doenças Crónicas, CEDOC, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
| | | | - Lidia Roque
- Unidade de Gastroenterologia do Hospital Garcia da Orta, Almada, Portugal.
| | - Silvana Belo
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, UNL, Lisbon, Portugal.
| | - Pedro Manuel Ferreira
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, UNL, Lisbon, Portugal.
| | - Kamal Mansinho
- Serviço de Doenças Infecciosas e Medicina Tropical, Hospital Egas Moniz, Lisbon, Portugal.
| | - Cristina Toscano
- Laboratório de Microbiologia Clínica e Biologia Molecular, Serviço de Patologia Clínica, Centro Hospitalar de Lisboa Ocidental, Hospital Egas Moniz, Rua da Junqueira 126, 1349-019 Lisbon, Portugal.
| |
Collapse
|
28
|
Filippou G, Tacchini D, Adinolfi A, Bertoldi I, Picerno V, Toscano C, Carta S, Santoro P, Frediani B, Spina D. Histology of the synovial membrane of patients affected by osteoarthritis and calcium pyrophosphate dihydrate crystal deposition disease vs. osteoarthritis alone: a pilot study. Scand J Rheumatol 2016; 45:538-539. [PMID: 27093480 DOI: 10.3109/03009742.2016.1150508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- G Filippou
- a Department of Medicine, Surgery and Neurosciences, Rheumatology Section , University of Siena , Italy
| | - D Tacchini
- b Department of Medical Biotechnologies, Pathology Section , University of Siena , Italy
| | - A Adinolfi
- a Department of Medicine, Surgery and Neurosciences, Rheumatology Section , University of Siena , Italy
| | - I Bertoldi
- a Department of Medicine, Surgery and Neurosciences, Rheumatology Section , University of Siena , Italy
| | - V Picerno
- a Department of Medicine, Surgery and Neurosciences, Rheumatology Section , University of Siena , Italy
| | - C Toscano
- a Department of Medicine, Surgery and Neurosciences, Rheumatology Section , University of Siena , Italy
| | - S Carta
- c Department of Medicine, Surgery and Neurosciences, Orthopaedics Section , University of Siena , Italy
| | - P Santoro
- c Department of Medicine, Surgery and Neurosciences, Orthopaedics Section , University of Siena , Italy
| | - B Frediani
- a Department of Medicine, Surgery and Neurosciences, Rheumatology Section , University of Siena , Italy
| | - D Spina
- b Department of Medical Biotechnologies, Pathology Section , University of Siena , Italy
| |
Collapse
|
29
|
Simões AS, Couto I, Toscano C, Gonçalves E, Póvoa P, Viveiros M, Lapão LV. Prevention and Control of Antimicrobial Resistant Healthcare-Associated Infections: The Microbiology Laboratory Rocks! Front Microbiol 2016; 7:855. [PMID: 27375577 PMCID: PMC4895126 DOI: 10.3389/fmicb.2016.00855] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 05/23/2016] [Indexed: 12/30/2022] Open
Abstract
In Europe, each year, more than four milion patients acquire a healthcare-associated infection (HAI) and almost 40 thousand die as a direct consequence of it. Regardless of many stategies to prevent and control HAIs, they remain an important cause of morbidity and mortality worldwide with a significant economic impact: a recent estimate places it at the ten billion dollars/year. The control of HAIs requires a prompt and efficient identification of the etiological agent and a rapid communication with the clinician. The Microbiology Laboratory has a significant role in the prevention and control of these infections and is a key element of any Infection Control Program. The work of the Microbiology Laboratory covers microbial isolation and identification, determination of antimicrobial susceptibility patterns, epidemiological surveillance and outbreak detection, education, and report of quality assured results. In this paper we address the role and importance of the Microbiology Laboratory in the prevention and control of HAI and in Antibiotic Stewardship Programs and how it can be leveraged when combined with the use of information systems. Additionally, we critically review some challenges that the Microbiology Laboratory has to deal with, including the selection of analytic methods and the proper use of communication channels with other healthcare services.
Collapse
Affiliation(s)
- Alexandra S. Simões
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, LisbonPortugal
| | - Isabel Couto
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, LisbonPortugal
| | - Cristina Toscano
- Laboratório de Microbiologia Clínica e Biologia Molecular, Serviço de Patologia Clínica, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, LisbonPortugal
- Centro de Estudos de Doenças Crónicas, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, LisbonPortugal
| | - Elsa Gonçalves
- Laboratório de Microbiologia Clínica e Biologia Molecular, Serviço de Patologia Clínica, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, LisbonPortugal
- Centro de Estudos de Doenças Crónicas, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, LisbonPortugal
| | - Pedro Póvoa
- Centro de Estudos de Doenças Crónicas, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, LisbonPortugal
- Unidade de Cuidados Intensivos Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, LisbonPortugal
| | - Miguel Viveiros
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, LisbonPortugal
| | - Luís V. Lapão
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, LisbonPortugal
- WHO Collaborating Center for Health Workforce Policy and Planning, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, LisbonPortugal
| |
Collapse
|
30
|
Adinolfi A, Filippou G, Scirè C, Damjanov N, Carrara G, Picerno V, Toscano C, Bruyn G, D'Agostino M, Delle Sedie A, Filippucci E, Gutierrez M, Micu M, Moller I, Naredo E, Pascal Z, Pineda C, Porta F, Schmidt W, Terslev L, Vlad V, Zufferey P, Frediani B, Iagnocco A. FRI0517 The Omeract Ultrasonographic Criteria for Elementary Lesions in Calcium Pyrophosphate Deposition Disease: Results of A Delphi Process by Ultrasound Working Group. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
31
|
Toscano C, Adinolfi A, Bertoldi I, Di Sabatino V, Picerno V, Galeazzi M, Frediani B, Filippou G. SAT0542 The Prevalence of Calcium Pyrophosphate Deposits at Ultrasound Examination: Retrospective Analysis in A Cohort of Patients. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
32
|
Filippou G, Scirè C, Damjanov N, Adinolfi A, Carrara G, Picerno V, Toscano C, Bruyn G, D'Agostino M, Delle Sedie A, Filippucci E, Gutierrez M, Micu M, Moller I, Naredo E, Pineda C, Porta F, Schmidt W, Terslev L, Vlad V, Zufferey P, Frediani B, Iagnocco A. OP0122 Inter-Reader and Intra-Reader Reliability of The New Omeract Ultrasonographic Criteria for The Diagnosis of CPPD. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
33
|
Picerno V, Filippou G, Cantarini L, Adinolfi A, Di Sabatino V, Bertoldi I, Toscano C, Galeazzi M, Frediani B. SAT0564 Articular Involvement in Behçet Disease: An Ultrasonographic Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.6140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
34
|
Santos A, Isidro J, Silva C, Boaventura L, Diogo J, Faustino A, Toscano C, Oleastro M. Molecular and epidemiologic study of Clostridium difficile reveals unusual heterogeneity in clinical strains circulating in different regions in Portugal. Clin Microbiol Infect 2016; 22:695-700. [PMID: 27091093 DOI: 10.1016/j.cmi.2016.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/21/2016] [Accepted: 04/05/2016] [Indexed: 02/04/2023]
Abstract
Clostridium difficile infection (CDI) represents a great healthcare burden in developed countries. The emergence of the epidemic PCR ribotype (RT) 027 and its acquired fluoroquinolones resistance have accentuated the need for an active surveillance of CDI. Here we report the first countrywide study of CDI in Portugal with the characterization of 498 C. difficile clinical isolates from 20 hospitals in four regions in Portugal regarding RT, virulence factors and antimicrobial susceptibility. We identified 96 RTs with marked variations between and within regions, as only six RTs appeared in all four regions. RT027 was the most frequent RT overall (18.5%) and among healthcare facility-associated isolates (19.6%), while RT014 was the most common among community-associated isolates (12%). The north showed a high RT diversity among isolates and a low moxifloxacin (MXF) resistance rate (11.9%), being the only region in which RT027 was not predominant. In contrast, the isolates from the centre presented the highest RT027 frequency, and 53.4% were resistant to MXF. Overall, MXF resistance (33.2%) was associated (p <0.001) with the presence of binary toxin genes and mutations in tcdC regardless of the RT. Both traits appeared in almost 30% of the strains. RT027 showed a reduced susceptibility to metronidazole (p <0.01), and RT126 had higher minimum inhibitory concentrations to vancomycin (p = 0.03) compared to other RTs. The present study highlights an unusual heterogeneity of RTs in Portugal, with a high frequency of hypervirulent RTs and the emergence of virulence factors in non-027 RTs, emphasizing the need for a surveillance system for CDI in Portugal.
Collapse
Affiliation(s)
- A Santos
- National Reference Laboratory for Gastrointestinal Infections, Department of Infectious Diseases, National Institute of Health, Lisboa, Portugal
| | - J Isidro
- National Reference Laboratory for Gastrointestinal Infections, Department of Infectious Diseases, National Institute of Health, Lisboa, Portugal
| | - C Silva
- Innovation and Technology Unit, Human Genetics Department, National Institute of Health, Lisboa, Portugal
| | - L Boaventura
- Service of Clinical Pathology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Diogo
- Service of Clinical Pathology, Hospital Garcia de Orta, Almada, Portugal
| | - A Faustino
- Service of Clinical Pathology, Hospital de Braga, Braga, Portugal
| | - C Toscano
- Service of Clinical Pathology, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - M Oleastro
- National Reference Laboratory for Gastrointestinal Infections, Department of Infectious Diseases, National Institute of Health, Lisboa, Portugal.
| |
Collapse
|
35
|
Azevedo LCP, Toscano C, Andrade AL, Bierrenbach AL. Long-term outcomes of adult patients admitted with sepsis to brazilian public hospitals: a national retrospective matched cohort study. Intensive Care Med Exp 2015; 3:A86. [PMID: 27290453 PMCID: PMC4797912 DOI: 10.1186/2197-425x-3-s1-a86] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
36
|
Baptista-Fernandes T, Rodrigues M, Domingues D, Monteiro L, Paixão P, Pereira P, Tavares R, Rodrigues P, Maurício I, Belo S, Toscano C. Dirofilariasis by Dirofilaria repens: an imported case and a brief review. Parasitol Int 2015; 64:261-3. [PMID: 25769814 DOI: 10.1016/j.parint.2015.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/04/2015] [Accepted: 03/02/2015] [Indexed: 11/26/2022]
Abstract
Human infections caused by Dirofilaria repens, a cosmopolitan zoonotic parasitosis endemic in Southern and Eastern Europe and Asia still is an underdiagnosed infection due to parasite identification difficulties. Here, we report the first human case of subcutaneous dirofilariasis by D. repens diagnosed in Portugal. This was probably an imported case from India, as judged by epidemiological and clinical data. With this presentation we aim to alert clinicians for the emergence of vector-borne zoonoses associated with global warming and international travel. This case showed that differential diagnosis of D. repens in subcutaneous nodules is needed, in order to avoid further complications.
Collapse
Affiliation(s)
- Teresa Baptista-Fernandes
- Laboratório de Microbiologia Clínica e Biologia Molecular, Serviço de Patologia Clínica, Centro Hospitalar de Lisboa Ocidental, Hospital Egas Moniz, Rua da Junqueira no 126, 1349-019 Lisboa, Portugal.
| | - Manuel Rodrigues
- Biopremier, S.A. Edifício Teclabs, Campus da Faculdade de Ciências da Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal.
| | - Dulce Domingues
- Biopremier, S.A. Edifício Teclabs, Campus da Faculdade de Ciências da Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal.
| | - Lucília Monteiro
- Laboratório de Anatomia Patológica, Hospital Egas Moniz, Rua da Junqueira no 126, 1349-019 Lisboa, Portugal.
| | - Paulo Paixão
- Centro de Estudos de Doenças Crónicas, CEDOC, NOVA Medical School, Faculdade Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, no 130, 1169-056 Lisboa, Portugal.
| | - Patrícia Pereira
- Serviço Patologia Clinica, Hospital Beatriz Ângelo, Avenida Carlos Teixeira, no 3, 2674-514 Loures, Portugal.
| | - Raquel Tavares
- Serviço de Infecciologia, Hospital Beatriz Ângelo, Avenida Carlos Teixeira, no 3, 2674-514 Loures, Portugal.
| | - Paulo Rodrigues
- Serviço de Infecciologia, Hospital Beatriz Ângelo, Avenida Carlos Teixeira, no 3, 2674-514 Loures, Portugal.
| | - Isabel Maurício
- Unidade Parasitologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira no 100, 1349-008 Lisboa, Portugal.
| | - Silvana Belo
- Unidade Parasitologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira no 100, 1349-008 Lisboa, Portugal.
| | - Cristina Toscano
- Laboratório de Microbiologia Clínica e Biologia Molecular, Serviço de Patologia Clínica, Centro Hospitalar de Lisboa Ocidental, Hospital Egas Moniz, Rua da Junqueira no 126, 1349-019 Lisboa, Portugal.
| |
Collapse
|
37
|
Abstract
<strong>Introduction:</strong> Urinary tract infection is the most common infectious complication following renal transplantation and its frequency is insufficiently studied in Portugal. The aim of this study was to characterize the incidence of urinary tract infections and recurrent urinary tract infections in renal transplant recipients.<br /><strong>Material and Methods:</strong> This was a retrospective cohort observational study, obtained from clinical files of all patients who received a renal transplant at the Hospital of Santa Cruz, from January 2004 to December 2005, with a mean follow-up period of five years or until date of graft loss, death or loss of follow-up. After a descriptive analysis of the population, we used bivariate tests to identify risk factors for urinary tract infections.<br /><strong>Results:</strong> A total of 127 patients were included, with a 593 patients.year follow-up. We detected 53 patients (41.7%) presenting with at least one episode of urinary tract infection; 21 patients (16.5%) had recurrent urinary tract infection. Female gender was the only risk factor associated with the occurrence of urinary tract infections (p < 0.001, OR = 7.08, RR = 2.95) and recurrent urinary tract infections (p < 0.001, OR = 4.66, RR = 2.83). Escherichia coli (51.6%), Klebsiella pneumoniae (15.5%) and Enterobacter spp (9.9%) were the<br />most frequently identified pathogens. Patients did not reveal an increased mortality or allograft loss. However, urinary tract infections were the most important cause of hospital admissions.<br /><strong>Discussion:</strong> Female gender was the only risk factor for urinary tract infections in this population. Escherichia coli was the most frequent agent isolated.<br /><strong>Conclusion:</strong> Despite preventive measures, urinary tract infections remain an important cause of morbidity and hospital admissions.<br /><strong>Keywords:</strong> Urinary Tract Infections; Postoperative Complications; Risk Factors; Kidney Transplantation; Portugal.
Collapse
Affiliation(s)
- Ana Bispo
- Unidade de Transplantação Renal. Hospital de Santa Cruz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
| | - Milene Fernandes
- Instituto de Medicina Preventiva. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - Cristina Toscano
- Laboratório de Microbiologia Clínica e Biologia Molecular. Hospital Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
| | - Teresa Marques
- Laboratório de Microbiologia Clínica e Biologia Molecular. Hospital Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
| | - Domingos Machado
- Unidade de Transplantação Renal. Hospital de Santa Cruz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
| | - André Weigert
- Unidade de Transplantação Renal. Hospital de Santa Cruz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
| |
Collapse
|
38
|
|
39
|
Farinha A, Toscano C, Campos R, Bica A, Hadgraft J. Permeation of naproxen from saturated solutions and commercial formulations through synthetic membranes. Drug Dev Ind Pharm 2003; 29:489-94. [PMID: 12737541 DOI: 10.1081/ddc-120018383] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The release of naproxen through synthetic membranes, mounted in modified Franz-type diffusion cells, was evaluated, either from saturated solutions or from commercially available topical formulations containing 10% naproxen. The results obtained showed that the porous type synthetic membranes chosen (cellulose acetate and polyethersulphone) can be used for assessing product performance in quality control procedures. The formulations interacted with the solid membranes (silicone and EVA) to change their diffusional characteristics. However, transfer in the membrane, and not the formulation was rate controlling. These membranes could not therefore be used in assessing product release performance for quality control.
Collapse
|
40
|
Piccirillo B, Toscano C, Vetrano F, Santamato E. Orbital and spin photon angular momentum transfer in liquid crystals. Phys Rev Lett 2001; 86:2285-2288. [PMID: 11289910 DOI: 10.1103/physrevlett.86.2285] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2000] [Indexed: 05/23/2023]
Abstract
All-optical angular control of the molecular alignment in liquid-crystal films is demonstrated using a laser beam having an elliptically shaped intensity profile. The material birefringence is unimportant, as proven by the fact that good alignment is obtained with unpolarized light. This raises the possibility of achieving optical angular control of transparent isotropic bodies. A general theoretical approach, based on light and matter angular momentum conservation, shows that the optical alignment is due to the internal compensation between the transfer of the orbital and the spin part of angular momentum of the incident photons to the material.
Collapse
Affiliation(s)
- B Piccirillo
- Istituto Nazionale di Fisica della Materia, Dipartimento di Scienze Fisiche, via Cintia, 80126 Napoli, Italy
| | | | | | | |
Collapse
|
41
|
Abstract
Permeation of caffeine through human skin and artificial membranes (mounted in modified Franz type diffusion cells) was evaluated, either from saturated solutions or from commercially available topical formulations (all containing 3% caffeine). Data interpretation of the caffeine diffusion through human skin does not implicate transfer through pores despite caffeine being a relatively polar molecule. No correlation was found between transfer though the synthetic membranes (cellulose acetate impregnated with isopropyl myristate and silicone rubber soaked in isopropyl myristate) and that observed through skin. The synthetic membranes can be used for assessing product performance in quality assurance but will give little indication of its performance in vivo. The study investigated the percutaneous permeation of caffeine through human skin in order to obtain a mechanistic interpretation of its route of permeation. Synthetic membranes were also examined to determine if they could be used as models for human skin. Different commercial formulations investigated to determine the significance of enhancement strategies.
Collapse
Affiliation(s)
- M Dias
- Laboratorio de Estudos Famacêuticos (LEF), Rua Alto do Duque, 67, Lisbon, Portugal
| | | | | | | | | | | |
Collapse
|
42
|
Toscano C, Paixão P, Marques T. Streptococcal toxic shock syndrome: an unusual toxin gene profile. Clin Microbiol Infect 1998. [DOI: 10.1111/j.1469-0691.1998.tb00073.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
43
|
Toscano C, Di Marzo L, Sapienza P, Tedesco M, Cavallaro A. [A case of retroperitoneal fibrosis with spontaneous regression]. MINERVA CHIR 1997; 52:1123-7. [PMID: 9432588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Retroperitoneal fibrosis has an unknown pathogenesis. Medical treatment should be preferred to surgery. However, surgical treatment is required when an ureteral involvement is present. A case of retroperitoneal fibrosis with spontaneous regression is reported. Current knowledge on pathogenesis, diagnosis and preferred treatment is outlined.
Collapse
Affiliation(s)
- C Toscano
- I Istituto di Clinica Chirurgica, Università degli Studi di Roma La Sapienza, Roma
| | | | | | | | | |
Collapse
|
44
|
Cristino JM, Calado E, Calheiros IM, Costa D, Costa MN, Diogo J, Felicio ML, Ferro ML, Da Fonseca JC, Guimarães MA, Lito L, Marques J, Marques MT, Martins F, Pais MA, Pinto M, Ramos MH, Ribeiro G, Rodrigues LA, Salgado MJ, Simões J, Sobral MD, Toscano C. [Multicenter study of isolated micro-organisms resistant to antimicrobials in 10 Portuguese hospitals in 1994]. ACTA MEDICA PORT 1996; 9:141-50. [PMID: 9005687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In 1994, Microbiology Laboratories of ten Portuguese hospitals analysed isolated microorganisms found in blood and urine samples and studied antimicrobial susceptibilities of the most frequent bacterial pathogens. From 63780 blood samples, the most frequent were Staphylococcus spp. and from 69189 urine samples significant numbers of Escherichia coli, Enterococcus spp., Pseudomonas aeruginosa and Candida spp. were isolated. Escherichia coli strains (c.7000) revealed a low percentage of resistance to antibiotics with the exceptions of ampicillin (48%) and co-trimoxazol (25%). Klebsiella pneumoniae isolates (c.2000) revealed important resistance to ampicillin (98%), cephalotin (31%), co-trimoxazol (38%) and gentamicin (28%), while values for 3rd generation cephalosporins varied among hospitals, with several strains showing phenotype of extended-spectrum beta-lactamase. A great variation in resistance values of P. aeruginosa (c.4000) was found in relation to the antibiotics as well as to the hospitals. Resistance to methicillin in S. aureus (c.6000) was high, reaching an average of 47%, and it was even higher with S. epidermidis (c.3000) and S. haemolyticus (c.650). Only vancomycin was always active against these strains. In E. faecalis (c.2500) resistance was of 2% to ampicillin, 35% to gentamicin, 45% to streptomycin and 1% to vancomycin. E. faecium isolates (c.300) showed the most worrying results with 70% resistance to ampicillin, 42% to gentamicin, 59% to streptomycin and 9% (30 strains isolated in 5 hospitals) to vancomycin. Vancomycin resistant strains were also resistant to all other antibiotics.
Collapse
|
45
|
Tedesco M, Napoli F, Sapienza P, Cavallari N, Toscano C, De Simone N, di Marzo L, Cavallaro A. [Carotid thromboendarterectomy: personal experience and review of the literature]. Ann Ital Chir 1995; 66:313-8. [PMID: 8526299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Carotid endoarterectomy (CEA) is known to prevent cerebrovascular accidents. Between February 1987 and December 1993 we performed 97 CEA on 82 patients (62 male and 20 female, median age 66 +/- 7.6 years) 95.1% reported previous hemispheric neurological accidents; 4.9% were asymptomatic. Operative indications for asymptomatic patients were high degree stenosis (> 70%) of the internal carotid artery and ulcerated plaques with a moderate degree (50%) of stenosis. Major events (transient ischemic attack and stroke) were recorded in 73.2% cases. Preoperative investigations consisted of Duplex scan, arteriography, and cerebral CT scan or NMR. Operative mortality was 2.06% (2 cases) and perioperative stroke was 5.1% (5 cases). The sensibility, sensitivity and accuracy of Duplex scan to detect ulcerated plaques was 88.7%, 85.2% and 87.5% respectively. At a median follow-up of 33 months (range 6-81 months) 74 (92.5%) patients are free of strokes whereas 1 patient died for stroke. In our series the annual incidence of stroke was 0.5%. Our results suggest that Duplex scan is a reliable exam to investigate the carotid axis and CEA is a safe operation that prevents future cerebrovascular accidents.
Collapse
Affiliation(s)
- M Tedesco
- I Istituto di Clinica Chirurgica, Università degli Studi di Roma La Sapienza
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Lepore L, Longo F, Mascarin M, Toscano C. [Salivary IgA in a group of children with recurrent respiratory infections]. Minerva Pediatr 1989; 41:205-8. [PMID: 2770646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Salivary IgA were examined in a group of children with recurring respiratory infections (RRI) in order to complete research into the immunological profile of such children. IgA assays were performed in 21 children suffering from RRI both in the remission period (Summer) and during infections (Winter). No children revealed any real disorder in basic salivary IgA. Salivary IgA levels were however about ten times higher in the Winter (the infection period). In a control group of 15 healthy children in the same age range, IgA levels were also high in the winter but still lower than those found in the RRI group. It is therefore concluded that children with RRI do not, as has often been suggested, present any basic disorder in salivary IgA, but that the response of secretory IgA is far more sensitive to infection than the system as a whole.
Collapse
|
47
|
Santoro A, Sarrecchia C, Toscano C, Rossi A. [Chorea gravidarum: description of a case]. Medicina (Firenze) 1988; 8:197-8. [PMID: 3226269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
48
|
|
49
|
Mazzi V, Vellano C, Toscano C. [Prolactin, hydrotropism and spermatogenesis in the crested triton]. Ric Sci 1966; 36:646-647. [PMID: 6006092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
|
50
|
Mazzi V, Peyrot A, Anzalone MR, Toscano C. [Histophysiology of the adenophypophysis of the newt (Triturus cristatus carnifex Laur.)]. Z Zellforsch Mikrosk Anat 1966; 72:597-617. [PMID: 4293565 DOI: 10.1007/bf00319263] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|