Genomic epidemiology of Staphylococcus aureus isolated from bloodstream infections in South America during 2019 supports regional surveillance

Staphylococcus aureus remains one of the leading causes of infections worldwide and a common cause of bacteraemia. However, studies documenting the epidemiology of S. aureus in South America using genomics are scarce. We hereby report on the largest genomic epidemiology study to date of both methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) in South America, conducted by the StaphNET-SA network. We characterised 404 genomes recovered from a prospective observational study of S. aureus bacteraemia in 58 hospitals from Argentina, Bolivia, Brazil, Paraguay and Uruguay between April and October 2019. We show that a minority of S. aureus isolates are phenotypically multi-drug resistant (5.2%), but more than a quarter are resistant to macrolide-lincosamide-streptogramin B (MLSb). MSSA were more genetically diverse than MRSA. Lower rates of associated antimicrobial resistance in community-associated(CA)-MRSA versus hospital-associated (HA)-MRSA were found in association with three S. aureus genotypes dominating the MRSA population: CC30-MRSA-IVc-t019-lukS/F-PV+, CC5-MRSA-IV-t002-lukS/F-PV- and CC8-MRSA-IVc-t008-lukS/F-PV+-COMER+. These are historically from a CA origin, carry on average fewer antimicrobial resistance determinants, and often lack key virulence genes. Surprisingly, CC398-MSSA-t1451-lukS/F-PV- related to the CC398 human-associated lineage is widely disseminated throughout the region, and is described here for the first time as the most prevalent MSSA lineage in South America. Moreover, CC398 strains carrying ermT (largely responsible for the MLSb resistance rates of MSSA strains: inducible iMLSb phenotype) and sh_fabI (related to triclosan resistance) were recovered from both CA and HA origin. The frequency of MRSA and MSSA lineages differed between countries but the most prevalent S. aureus genotypes are high-risk clones widely distributed in the South American region without a clear country-specific phylogeographical structure. Therefore, our findings underline the need for continuous genomic surveillance by regional networks such as StaphNET-SA. This article contains data hosted by Microreact.

[Update on endocrine hypertension]

Endocrine disorders are the most common causes of secondary hypertension. Early diagnosis and specific treatment are crucial for improvement of the prognosis. This article provides an overview on which clinical constellations point to an increased risk of secondary causes of hypertension. These include spontaneous hypokalemia, young age at onset of hypertension, adrenal incidentaloma and therapy refractive arterial hypertension. The basic diagnostics include determination of the aldosterone to renin ratio, measurement of free plasma metanephrines and a 1 mg dexamethasone suppression test. Borderline results require repeated control testing and/or confirmatory testing under standardized test conditions. In cases of repeatedly conspicuous results referral to a specialized clinic should be considered for further clarification and confirmation of the diagnosis. Imaging diagnostics may constitute an adjunct to laboratory testing after the diagnosis has been confirmed. Therapeutic algorithms vary depending on the underlying endocrine disease.

[Incidence of Streptococcus pyogenes pharyngitis in Bariloche, Argentina]

The incidence and seasonality of pharyngitis by S. pyogenes in Bariloche, a city where long periods of low temperatures result in extended indoor activities were studied. A total of 5276 throat swab specimens collected during 2000-2003 in the clinical microbiology laboratories of the three main medical institutions of the city, were analyzed. Samples were cultured on blood-agar media containing 5% defibrinated sheep blood, and incubated for 24-48 h at 35 degrees C. Strains were identified using standard procedures. Monthly means for throat swabs, S. pyogenes isolates, and percent of S. pyogenes pharyngitis, were estimated. The incidence of pharyngitis by this microorganism was greater than 24% for every month within the April-December period, reaching a maximum in November (33%). February was the month with the lowest incidence (13%). It was observed an increasing trend since March through November with a through in July, and a marked decrease that began in December, reaching its lowest rate in January and February, the warmest months. This seasonal pattern differs from those observed for temperate climates. The incidence of S. pyogenes pharyngitis in Bariloche was high through the greater part of the year, since about the middle of autumn to the beginning of summer.

Erythromycin-resistant Streptococcus pyogenes in Argentina

Erythromycin (ERY) resistance in Streptococcus pyogenes has recently emerged as a problem of growing concern all through the world. We are presenting the comparison of results of the continuous surveillance of erythromycin resistance in S. pyogenes performed since 1989 in the Hospital de Pediatría J.P. Garrahan of Buenos Aires City, with independently observed rates in other five centers of Buenos Aires and seven centers of six other Argentinian cities, obtained between 1999 and 2001. A significant increase of erythromycin resistance was observed among S. pyogenes isolated in the Hospital Garrahan (6.6% in 1998-1999 to 9.9% in 2000). Similar trends were also detected in other centers of other Argentinian cities when recent data were compared to results of a multicenter study performed in 1995. However, lower rates of resistance were recorded in Mendoza, Cipolletti and Neuquén in comparison with data of 1995, 1998 and 1998 respectively. The reason of such decreasing resistance rates deserves to be investigated. The average of ERY-resistance rates obtained in the surveyed centers was 6.7% (range 0.5-14.1%). Control of antimicrobial use should be performed to warrant the future effectiveness of macrolide antibiotics regarding the positive association between use and resistance. These results also suggest that susceptibility tests for macrolides should be performed whenever S. pyogenes is isolated in Argentina.

Sex-role reversal and clinical judgment of mental health

The separation between nonconformist lifestyles and mental disorders plays a central role in behavioral therapeutic orientations, where emphasis is put on the client's definition of the problem, and in existential and humanistic orientations, which encourage the development of the client's individuality. In the present study, 621 psychotherapists and students intending to practice psychotherapy ranked the mental state of a male client suffering from social phobia related to examination situations. Half of the subjects received a case history of a law intern (married to a teacher), suffering from social phobia related to the oral bar. The other half received a case history of a student in a teachers' college (married to a lawyer) suffering from social phobia related to being tested in teaching a class. The mental state of the latter has been perceived as significantly more severe than that of the former. This difference in perception was not related to the subject's sex, professional experience, and the frequency of a similar client in their practice. Results are discussed in the context of the liberal political attitudes and the secular orientation of the subjects.

Characterization of psoriasis in vivo by reflectance confocal microscopy

Among available non-invasive imaging tools, confocal reflectance microscopy (CM) provides the highest-resolution optical sectioning of skin in vivo, to a controlled depth of 200-350 microns, the level of the upper reticular dermis. In this study, CM was used to view the histological features of psoriasis in vivo in lesional and non-lesional skin of five patients with stable psoriasis vulgaris. Stereohistological analysis of non-invasive confocal sections, and the correlation with transverse (en face) hematoxylin- and eosin-stained sections from biopsies, was also performed. In psoriatic lesions, nucleated corneocytes and collections of infiltrating inflammatory cells were clearly seen. Morphometric parameters such as epidermal height, length of papillary dermis, and the count of dermal papillae were also easily quantified. In the upper dermis, dilated capillary loops were always present. Since CM sections are en face, the presence or absence of the granular layer could not be visualized in single frames, but could be monitored in a sequence of real-time videotaped images. In summary, CM provides a new technique for histologically evaluating psoriasis in vivo.

Attitudes of Israeli gay students toward other minorities: an exploratory study

Notwithstanding significant changes in the legal and psychiatric status of homosexuals, they are still very much victims of public prejudice. It may be asked, however, how they view other minority groups. The present study compared the political attitudes of members of a gay political party at the Hebrew University with a control group of heterosexual university students matched for demographic characteristics. Homosexual subjects showed significantly more support for left-wing parties (particularly Meretz). A significant difference was also found in the party nominated by subjects as most opposed to their own views. Homosexual subjects showed a much higher rate of opposition to Moledet (a right-wing extremist party) and Shas (a religious party), whereas heterosexual subjects were more often opposed to left-wing extremist parties. Notwithstanding this finding, levels of political tolerance for the party most opposed to their own views was higher among homosexual subjects than among the control group. Whether these results are related to the minority status of homosexuals, or to the ideology of the political left is not clear, and is recommended as a topic for further research.

In vivo abnormal keratinazation in Darier-White's disease as viewed by real-time confocal imaging

Darier-White's disease is a rare autosomal-dominant disorder of keratinization. The underlying pathology for the clinical presentation is acantholysis, and various types of dyskeratosis and acanthosis. In this study, we utilized a non-invasive optical imaging modality, confocal reflectance microscopy, to identify specific histologic features of Darier-White's disease in vivo. Micrographic findings in the confocal images were corps ronds, suprabasal clefts, acantholytic suprabasal keratinocytes, and villi. Real-time confocal images are illustrative and can be well correlated with known light microscopic phenomena, particularly in the case of keratinization abnormalities in Darier-White's disease.

Long-term association of tomato yellow leaf curl virus with its whitefly vector Bemisia tabaci: effect on the insect transmission capacity, longevity and fecundity

The association between tomato yellow leaf curl geminivirus (TYLCV, Israeli isolate) and its insect vector, the whitefly Bemisia tabaci, was investigated. Insects that emerged during a 24 h period were caged with TYLCV-infected plants for a 48 h acquisition access period, then with egg-plants--a TYLCV non-host--for the rest of their lives. While TYLCV DNA was associated with the whiteflies during their entire adult life, the amount of capsid protein rapidly decreased and was not detectable in the insect after approximately 12 days of age. The ability of the infected whiteflies to transmit TYLCV to tomato test plants steadily decreased with age but did not disappear completely. Transmission by viruliferous insects decreased from 100% to 10-20% during their adult lifetime, compared with a decrease from 100% to 50% for non-viruliferous insects. The association of TYLCV with adult B. tabaci led to a reduction of 17-23% in their life expectancy compared with insects that had not acquired the virus, and to a 40-50% decrease in the mean number of eggs laid. These results suggest that TYLCV has some features reminiscent of an insect pathogen.

Schizophrenia, rheumatoid arthritis and natural resistance genes

The strong negative correlation between schizophrenia and rheumatoid arthritis might provide clues as to the aetiology of these two diseases. An immunological explanation has been sought in the HLA sector of the major histocompatibility complex, which has been shown to have a role in the development of rheumatoid arthritis. The search for an association between schizophrenia and HLA haplotypes, however, has yielded only controversial results. Nevertheless, an autoimmune aetiology is still suspected. The recent demonstration of geographical co-occurrence of high rates of schizophrenia and flavivirus infection suggests, for the first time, that a natural resistance gene (NRG) might be involved in the aetiology of schizophrenia. Such a NRG is carried by the C3H/RV mouse, providing protection against lethal infection by flavivirus, but not by the histocompatible C3H/He mouse. Furthermore, the C3H/He mouse has proved to be a good model for the development of Lyme arthritis, resulting from infection by Borrelia burgdorferi. It is suggested that there is a possibility that the C3H/RV mouse, which is known to be resistant to both flavivirus and rickettsia, may also be resistant to borrelia, since the Ixodid tick vector of flavivirus is the vector for all three of these organisms. If so, then the C3H/RV mouse would resist infection by borrelia, and could not develop Lyme arthritis. It is hypothesised, therefore, that despite the histocompatibility of these two strains, while the C3H/He mouse is vulnerable to Lyme arthritis, the C3H/RV mouse may be resistant. As a consequence, NRGs may play a part in triggering autoimmune disease, with HLA antigens responsible for its further development. This would indicate that the negative association of schizophrenia and rheumatoid arthritis could result from resistance or vulnerability to certain infections.

The decision to remove homosexuality from the DSM: twenty years later

Twenty years have passed since the American Psychiatric Association (APA) voted, in 1973, to remove "Ego-syntonic Homosexuality" from the Diagnostic and Statistical Manual of Mental Disorders (DSM). The present study investigates the influence of the patient's sexual orientation on the therapist's perception of the former's mental health. Four hundred and seventeen Israeli therapists (psychiatrists, clinical psychologists, and social workers) participated in the study, representing a cross-section of professionals in the mental health services in Israel. The measures included a demographic questionnaire and a perceived-severity scale of rating. Participants were assigned case histories where a hypothetical patient was heterosexual or ego-syntonic homosexual. Attributions of severity of mental status were found to differ as a function of sexual orientation of patient. Results are discussed in terms of the latent function of psychotherapy, considering the contrast between the liberal political attitudes and the secular way of life of the therapists on the one hand and their conservatism in the clinical domain on the other hand.

Political attitudes and religiosity levels of Israeli psychotherapy practitioners and students

This study investigated the political attitudes (PA) and religiosity level (RL) of a practitioners sample, comprising 82 psychiatrists, 222 clinical psychologists, and 113 psychiatric social workers, and a students sample comprising 69 B.A. and 65 M.A. students in psychology, and 73 B.A. students in social work, who intended to practice psychotherapy. PAs were measured by the subjects' voting intentions, self-definition, and attitudes toward Capitalism-Socialism and the occupied territories. RL was judged by special measures developed for the Jewish population in Israel, which were adapted for secular psychotherapists. Subjects also defined both themselves and their parents regarding PA and RL. The results are similar to findings of previous studies, indicating that psychotherapists support the political left and conduct a secular way of life. No significant differences were found between practitioners and students regarding PA and RL. A significant decrease in subjects' right-wing attitudes and RL relative to their parents was found. It is suggested that the similarity between practitioners and students regarding PA and RL could imply that supporting the political left and low RL preceded the decision to practice psychotherapy. The therapeutic implications of the differences between therapists and clients regarding PA and RL are also discussed.

Cooperation patterns of Israeli mental health practitioners

The cooperation patterns of Israeli mental health practitioners were examined. Psychiatrists, psychologists, and psychiatric social workers were asked to fill out a questionnaire for a study investigating the influence of therapists' authoritarianism and ideology on their therapeutic attitudes. The cooperation level in mental health clinics was higher than that in psychiatric hospitals, student counseling centers, and psychiatric departments of general hospitals. In all three professions, the trainees were more cooperative than the experts. The cooperation level of the psychiatrists was the lowest, and women were generally more cooperative than men, although there was a significant Gender x Profession interaction. The fact that the psychologists and social workers were more cooperative may be attributed to their training, which places more emphasis on the therapist's personality and attitudes. The high cooperation level in the mental health clinics may be explained by the almost exclusive focus on psychotherapy, which encourages introspection.

Schizophrenia, infection and temperature. An animal model for investigating their interrelationships

Two factors which seem to have a significant role in schizophrenia are infection and temperature. Evidence is presented that the schizophrenic population may be part of a sub-population which has preferential resistance to epidemic infection. This characteristic alone may not be responsible for vulnerability to schizophrenia. Part at least of the genetic predisposition to schizophrenia may lie in an abnormal response to hormonal disturbances in the intrauterine environment which may result from prenatal viral infection; this abnormal response may cause neurodevelopmental damage. Then in effect the vulnerability of some to schizophrenia will be the cost of population survival in epidemics. Dopamine is involved in central thermoregulation, and may be involved in response to infection. In two inbred mouse strains, one virus-resistant and the other virus-susceptible, there is also a difference in core body temperature response to dopamine. Because of the connection of dopamine sensitivity, temperature and resistance to infection the paired mouse strains are suggested as an animal model for studies relevant to schizophrenia.

A new antidepressant butriptyline: plasma levels and clinical response

Ten patients who suffered from a primary depressive illness were treated with a new antidepressant drug butriptyline (150 mg/day). Six of the patients showed marked clinical improvement, as judged by depression rating scores, at the end of 22 days of treatment. No simple relationship was found between clinical response and plasma butriptyline concentration. Butriptyline is an effective antidepressant agent, well tolerated and with few side effects.

Cigarette smoking and plasma nortriptyline levels

Cigarette smoking was found to have no effect on the steady-state plasma levels of nortriptyline in a group of 22 smokers and 31 nonsmokers. Smokers achieved a mean steady-state nortriptyline concentration of 191.2 +/- 141.3 ng/ml; nonsmokers had a level of 169.3 +/- 92.4 ng/ml. Age, sex, and number of cigarettes smoked had no effect on the plasma concentrations achieved.