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Workload assessment: cross-cultural adaptation, content validity and instrument reliability
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Ciofi-Silva, Caroline Lopes

; Cordeiro, Luciana

; Oliveira, Naila Albertina

; Mainardi, Giulia Marcelino

; Levin, Anna Sara

; Almeida, Rodrigo Maximiano Antunes de

; Falasco-Fantinatti, Juliana

; Padoveze, Maria Clara

Revista Brasileira de Enfermagem

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2023, Volume 76 Nº 3 elocation e20220556

Resumo: En Es Pt | Texto: En Es Pt | PDF: En | PDF: Es | PDF: Pt

ABSTRACT Objectives: to adapt, validate the content and assess the reliability of the instrument National Aeronautics and Space Administration – Task Load Index, translated into Brazilian Portuguese. Methods: a methodological study, divided into five steps: translation; synthesis; back-translation; assessment of the Portuguese version by an expert committee; pre-test and content validity of the final version by health professionals working in inpatient units. The Content Validity Index (CVI) (minimum 0.80) and Cronbach’s alpha (minimum 0.70) were calculated. Results: in the first round, in the agreement analysis of the translated version, three items did not reach the minimum CVI value. It was decided to remove the statement. The instrument title and items “performance” and “effort” were changed. There was consensus and approval of the final version in the pre-test step. Conclusions: the NASA Task Load Index instrument, adapted to Brazilian Portuguese, presents reliability and content validity evidence.

RESUMEN Objetivos: adaptar, validar el contenido y evaluar la confiabilidad del instrumento National Aeronautics and Space Administration – Task Load Index , traducido al portugués brasileño. Métodos: estudio metodológico, dividido en cinco etapas: traducción; síntesis; traducción inversa; evaluación de la versión portuguesa por un comité de expertos; pretest y validación de contenido de la versión final por profesionales de la salud que actúan en unidades de hospitalización. Se calculó el Índice de Validez de Contenido (IVC) (mínimo 0,80) y el alfa de Cronbach (mínimo 0,70). Resultados: en la primera ronda, en el análisis de concordancia de la versión traducida, tres ítems no alcanzaron el valor mínimo de IVC. Se decidió eliminar la declaración. Se modificó el título del instrumento y los ítems “desempeño” y “esfuerzo”. Hubo consenso y aprobación de la versión final en la etapa de pre-prueba. Conclusiones: el instrumento NASA Task Load Index , adaptado al portugués brasileño, presenta evidencias de confiabilidad y validez de contenido.

RESUMO Objetivos: adaptar, validar o conteúdo e avaliar a confiabilidade do instrumento National Aeronautics and Space Administration – Task Load Index , traduzido para o português brasileiro. Métodos: estudo metodológico, dividido em cinco etapas: tradução; síntese; retrotradução; avaliação da versão em português por comitê de especialistas; pré-teste e validação de conteúdo da versão final por profissionais de saúde atuantes em unidades de internação. Foram calculados o Índice de Validade de Conteúdo (IVC) (mínimo 0,80) e o alfa de Cronbach (mínimo 0,70). Resultados: na primeira rodada, na análise de concordância da versão traduzida, três itens não alcançaram o valor mínimo do IVC. Optou-se pela remoção do enunciado. O título do instrumento e os itens “desempenho” e “esforço” foram alterados. Houve consenso e aprovação da versão final na etapa de pré-teste. Conclusões: o instrumento Índice NASA de carga de tarefa, adaptado para o português brasileiro, apresenta evidências de confiabilidade e validade de conteúdo.

https://doi.org/10.1590/0034-7167-2022-0556

Cutaneous Naganishia albida (Cryptococcus albidus) infection: a case report and literature review
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Oliveira, Vítor Falcão de

; Funari, Alexandre Pereira

; Taborda, Mariane

; Magri, Adriana Satie Gonçalves Kono

; Levin, Anna Sara

; Magri, Marcello Mihailenko Chaves

Revista do Instituto de Medicina Tropical de São Paulo

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2023, Volume 65 elocation e60

Resumo: En | Texto: En | PDF: En

ABSTRACT Naganishia albida (Cryptococcus albidus) is considered saprophytic fungi, and is rarely reported as a human pathogen. Cutaneous infections caused by non-neoformans cryptococcus are rare. We describe a case of an immunocompetent older male with cutaneous cryptococcosis caused by Naganishia albida following skin trauma, and conduct a literature review in PubMed, Lilacs, and Embase. Only six previous similar reports were found. The seven cases (including ours) were widely distributed geographically (Brazil, the US, the UK, Hungary, South Korea, and Iran), all males, and their ages varied, ranging from 14 to 86 years. Four individuals had underlying skin diseases (Sezary Syndrome, psoriasis, and skin rash without etiology) plus potentially immunosuppressive underlying conditions (diabetes mellitus, kidney transplantation, and the use of etanercept, adalimumab, and methylprednisolone). Cutaneous presentation was polymorphic, with lesions characterized as warts, ulcers, plaques, and even macules. Two patients presented disseminated disease. Serum cryptococcal antigen was negative in six patients, and diagnosis was made by fungal culture in all. There is a lack of data on optimal antifungal treatment and outcomes.

https://doi.org/10.1590/s1678-9946202365060

Evaluation of eleven immunochromatographic assays for SARS-CoV-2 detection: investigating the dengue cross-reaction
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Oliveira, Beatriz Araujo

; Oliveira, Lea Campos de

; Oliveira, Franciane Mendes de

; Pereira, Geovana Maria

; Souza, Regina Maia de

; Manuli, Erika Regina

; Marchini, Fabricio Klerynton

; Espinoza, Evelyn Patrícia Sanchez

; Park, Marcelo

; Taniguchi, Leandro

; Mendes, Pedro Vitale

; Franco, Lucas Augusto Moyses

; Nastri, Ana Catharina

; Oliveira, Maura Salaroli de

; Vieira Junior, José Mauro

; Kallas, Esper Georges

; Levin, Anna Sara

; Sabino, Ester Cerdeira

; Costa, Silvia Figueiredo

Revista do Instituto de Medicina Tropical de São Paulo

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2022, Volume 64 elocation e63

Resumo: En | Texto: En | PDF: En

ABSTRACT COVID-19 disease is spread worldwide and diagnostic techniques have been studied in order to contain the pandemic. Immunochromatographic (IC) assays are feasible and a low-cost alternative especially in low and middle-income countries, which lack structure to perform certain diagnostic techniques. Here we evaluate the sensitivity and specificity of eleven different IC tests in 145 serum samples from confirmed cases of COVID-19 using RT-PCR and 100 negative serum samples from blood donors collected in February 2019. We also evaluated the cross-reactivity with dengue using 20 serum samples from patients with confirmed diagnosis for dengue collected in early 2019 through four different tests. We found high sensitivity (92%), specificity (100%) and an almost perfect agreement (Kappa 0.92) of IC assay, especially when we evaluated IgG and IgM combined after 10 days from the onset of symptoms with RT-PCR. However, we detected cross-reactivity between dengue and COVID-19 mainly with IgM antibodies (5 to 20% of cross-reaction) and demonstrated the need for better studies about diagnostic techniques for these diseases.

https://doi.org/10.1590/s1678-9946202264063

Colistin-resistant Escherichia coli belonging to different sequence types: genetic characterization of isolates responsible for colonization, community- and healthcare-acquired infections
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Paiva, Yrving

; Nagano, Debora Satie

; Cotia, Andre Luis Franco

; Guimarães, Thais

; Martins, Roberta Cristina Ruedas

; Perdigão Neto, Lauro Vieira

; Côrtes, Marina Farrel

; Marchi, Ana Paula

; Corscadden, Louise

; Machado, Anna Silva

; Paula, Alexandre Inácio de

; Franco, Lucas Augusto Moyses

; Neves, Patricia Regina

; Levin, Anna Sara

; Costa, Silvia Figueiredo

Revista do Instituto de Medicina Tropical de São Paulo

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2021, Volume 63 elocation e38

Resumo: En | Texto: En | PDF: En

ABSTRACT The plasmid-mediated colistin-resistance gene named mcr-1 has been recently described in different countries and it became a public health challenge. Of note, few studies have addressed the spread of Escherichia coli harboring the mcr-1 gene in both, community and hospital settings. A total of seven colistin-resistant E. coli carrying mcr-1, collected from 2016 to 2018, from community (n=4), healthcare-acquired infections (n=2) and colonization (n=1) were identified in three high complexity hospitals in Sao Paulo, Brazil. These colistin-resistant isolates were screened for mcr genes by PCR and all strains were submitted to Whole Genome Sequencing and the conjugation experiment. The seven strains belonged to seven distinct sequence types (ST744, ST131, ST69, ST48, ST354, ST57, ST10), and they differ regarding the resistance profiles. Transference of mcr-1 by conjugation to E. coli strain C600 was possible in five of the seven isolates. The mcr-1 gene was found in plasmid types IncX4 or IncI2. Three of the isolates have ESBL-encoding genes (blaCTX-M-2, n=2; blaCTX-M-8, n=1). We hereby report genetically distinct E. coli isolates, belonging to seven STs, harboring the mcr-1 gene, associated to community and healthcare-acquired infections, and colonization in patients from three hospitals in Sao Paulo. These findings point out for the potential spread of plasmid-mediated colistin-resistance mechanism in E. coli strains in Brazil.

https://doi.org/10.1590/s1678-9946202163038 332 downloads

Are mobile phones part of the chain of transmission of SARS-CoV-2 in hospital settings?
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Espinoza, Evelyn Patricia Sánchez

; Cortes, Marina Farrel

; Noguera, Saidy Vasconez

; Paula, Anderson Vicente de

; Guimarães, Thais

; Boas, Lucy Santos Villas

; Park, Marcelo

; Silva, Cristina Carvalho da

; Morales, Ingra

; Perdigão Neto, Lauro Vieira

; Tozetto-Mendoza, Tania Regina

; Boszczowski, Icaro

; Sabino, Ester Cerdeira

; Mendes-Correa, Maria Cássia

; Levin, Anna Sara

; Costa, Silvia Figueiredo

Revista do Instituto de Medicina Tropical de São Paulo

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2021, Volume 63 elocation e74

Resumo: En | Texto: En | PDF: En

ABSTRACT Mobile phones (MPs) have become an important work tool around the world including in hospitals. We evaluated whether SARS-CoV-2 can remain on the surface of MPs of first-line healthcare workers (HCW) and also the knowledge of HCWs about SARS-CoV-2 cross-transmission and conceptions on the virus survival on the MPs of HCWs. A cross-sectional study was conducted in the COVID-19 Intensive Care Unit of a teaching hospital. An educational campaign was carried out on cross-transmission of SARS-CoV-2, and its permanence in fomites, in addition to the proper use and disinfection of MPs. Herewith an electronic questionnaire was applied including queried conceptions about hand hygiene and care with MP before and after the pandemic. The MPs were swabbed with a nylon FLOQ Swab™, in an attempt to increase the recovery of SARS-CoV-2. All MP swab samples were subjected to SARS-CoV-2 RT-PCR; RT-PCR positive samples were subjected to viral culture in Vero cells (ATCC® CCL-81™). Fifty-one MPs were swabbed and a questionnaire on hand hygiene and the use and disinfection of MP was applied after an educational campaign. Most HCWs increased adherence to hand hygiene and MP disinfection during the pandemic. Fifty-one MP swabs were collected and two were positive by RT-PCR (4%), with Cycle threshold (Ct ) values of 34-36, however, the cultures of these samples were negative. Although most HCWs believed in the importance of cross-transmission and increased adherence to hand hygiene and disinfection of MP during the pandemic, SARS-CoV-2 RNA was detected in MPs. Our results suggest the need for a universal policy in infection control guidelines on how to care for electronic devices in hospital settings.

https://doi.org/10.1590/s1678-9946202163074 177 downloads

Susceptibility to chlorhexidine and mupirocin among methicillin-resistant Staphylococcus aureus clinical isolates from a teaching hospital
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Bes, Taniela Marli

; Perdigão-Neto, Lauro

; Martins, Roberta Ruedas

; Heijden, Inneke

; Trindade, Priscila de Arruda

; Camilo, Gaspar

; Nagano, Debora Satie

; Mongelos, Diego

; Marchi, Ana Paula

; Tomaz, Mariama

; Oliveira, Larissa Marques de

; Rossi, Flavia

; Levin, Anna Sara

; Costa, Silvia Figueiredo

Revista do Instituto de Medicina Tropical de São Paulo

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2021, Volume 63 elocation e27

Resumo: En | Texto: En | PDF: En

ABSTRACT Despite the widespread use of chlorhexidine (CHX) to prevent infection, data regarding the in vitro action of CHX against methicillin-resistant Staphylococcus aureus (MRSA) are limited. Clinical isolates from Hospital das Clinicas, Sao Paulo, Brazil, identified during 2002/2003 and 2012/2013 were studied to describe the susceptibility to CHX and mupirocin, molecular characteristics, and virulence profile of MRSA. Susceptibility test to Mupirocin was performed by the disk diffusion method and to CHX by the agar dilution technique. PCR for virulence genes, mecA gene and Staphylococcal Cassette Chromosome mec (SCCmec) types were investigated as well. Mupirocin- and CHX-resistant isolates were sequenced using the IlluminaTM plataform. Two hundred and sixteen MRSA clinical isolates were evaluated: 154 from infected and 62 from colonized patients. Resistance to mupirocin was observed in four isolates assigned as SCCmec type III and STs (ST05; ST239 and ST105) carrying mupA and blaZ, two of them co-harboring the ileS gene. Only one isolate assigned as SCCmec type III was resistant to CHX (MIC of 8.0 μg.mL-1) and harbored the qacA gene. Resistance to chlorhexidine and mupirocin were found in isolates carrying qacA and mupA in our hospital. Since these genes are plasmid-mediated, this finding draws attention to the potential spread of resistance to mupirocin in our hospital.

https://doi.org/10.1590/s1678-9946202163027 431 downloads

Conjugative transfer of plasmid p_8N_qac(MN687830.1) carrying qacA gene from Staphylococcus aureus to Escherichia coli C600: potential mechanism for spreading chlorhexidine resistance
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Bes, Taniela Marli

; Nagano, Debora Satie

; Marchi, Ana Paula

; Camilo, Gaspar

; Perdigão-Neto, Lauro Vieira

; Martins, Roberta Ruedas

; Levin, Anna Sara

; Costa, Silvia Figueiredo

Revista do Instituto de Medicina Tropical de São Paulo

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2021, Volume 63 elocation e82

Resumo: En | Texto: En | PDF: En

ABSTRACT The methicillin resistant Staphylococcus aureus (MRSA) is recognized by its ability to acquire and transferring resistance genes through interspecies conjugative plasmids. However, transference of plasmids from Gram-positive cocci to Gram-negative bacilli is not well characterized. In this report, we describe the transfer of a conjugative plasmid carrying qacA from MRSA to Escherichia coli C600. We performed a conjugation experiment using a chlorhexidine resistant MRSA isolate (ST-105/SCCmec type III) carrying the gene qacA and qacC as the donor and a chlorhexidine susceptible E. coli C600 isolate as the receptor. Transconjugants were selected using MacConkey agar plates containing chlorhexidine in concentrations ranging from 0.25 to 16 g.L-1. To genotypically confirm the transfer of the resistance gene, the transconjugants were screened by Polymerase Chain Reaction (PCR) and submitted to Sanger’s sequencing. MRSA isolates successfully transferred the chlorhexidine resistance gene (qacA) to the recipient E. coli strain C600. The E. coli transconjugant exhibited an important reduction of chlorhexidine susceptibility, with MICs increasing from ≤ 0.25 to ≥ 16 g.L-1 after conjugation. The qacA gene was detected by PCR as well as in the Sanger’s sequencing analysis of DNA from transconjugant plasmids. To the best of our knowledge, this is the first report of the plasmid p_8N_qac(MN687830.1) carrying qacA and its transfer by conjugation from a MRSA to an E. coli. These findings increase concerns on the emergence of resistance dissemination across the genus and emphasizes the importance of continuous antiseptic stewardship.

https://doi.org/10.1590/s1678-9946202163082

Use and misuse of biomarkers and the role of D-dimer and C-reactive protein in the management of COVID-19: A post-hoc analysis of a prospective cohort study
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Gonçalves, Fabio Augusto Rodrigues

; Besen, Bruno Adler Maccagnan Pinheiro

; Lima, Clarice Antunes de

; Corá, Aline Pivetta

; Pereira, Antônio José Rodrigues

; Perazzio, Sandro Félix

; Gouvea, Christiane Pereira

; Fonseca, Luiz Augusto Marcondes

; Trindade, Evelinda Marramon

; Sumita, Nairo Massakazu

; Duarte, Alberto José da Silva

; Lichtenstein, Arnaldo

; Bonfa, Eloisa

; Utiyama, Edivaldo M.

; Segurado, Aluisio C.

; Perondi, Beatriz

; Miethke-Morais, Anna

; Montal, Amanda C.

; Harima, Leila

; Fusco, Solange R. G.

; Silva, Marjorie F.

; Rocha, Marcelo C.

; Marcilio, Izabel

; Rios, Izabel Cristina

; Kawano, Fabiane Yumi Ogihara

; Jesus, Maria Amélia de

; Kallas, Ésper George

; Carmo, Carolina

; Tanaka, Clarice

; Souza, Heraldo Possolo de

; Marchini, Julio F. M.

; Carvalho, Carlos

; Ferreira, Juliana C.

; Levin, Anna Sara Shafferman

; Oliveira, Maura Salaroli

; Guimarães, Thaís

; Lázari, Carolina dos Santos

; Sabino, Ester

; Magri, Marcello M. C.

; Barros-Filho, Tarcisio E. P.

; Francisco, Maria Cristina Peres Braido

; Costa, Silvia F.

Clinics

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2021, Volume 76 elocation e3547

Resumo: En | Texto: En | PDF: En

OBJECTIVE: Coronavirus disease 2019 (COVID-19) is associated with high mortality among hospitalized patients and incurs high costs. Severe acute respiratory syndrome coronavirus 2 infection can trigger both inflammatory and thrombotic processes, and these complications can lead to a poorer prognosis. This study aimed to evaluate the association and temporal trends of D-dimer and C-reactive protein (CRP) levels with the incidence of venous thromboembolism (VTE), hospital mortality, and costs among inpatients with COVID-19. METHODS: Data were extracted from electronic patient records and laboratory databases. Crude and adjusted associations for age, sex, number of comorbidities, Sequential Organ Failure Assessment score at admission, and D-dimer or CRP logistic regression models were used to evaluate associations. RESULTS: Between March and June 2020, COVID-19 was documented in 3,254 inpatients. The D-dimer level ≥4,000 ng/mL fibrinogen equivalent unit (FEU) mortality odds ratio (OR) was 4.48 (adjusted OR: 1.97). The CRP level ≥220 mg/dL OR for death was 7.73 (adjusted OR: 3.93). The D-dimer level ≥4,000 ng/mL FEU VTE OR was 3.96 (adjusted OR: 3.26). The CRP level ≥220 mg/dL OR for VTE was 2.71 (adjusted OR: 1.92). All these analyses were statistically significant (p<0.001). Stratified hospital costs demonstrated a dose-response pattern. Adjusted D-dimer and CRP levels were associated with higher mortality and doubled hospital costs. In the first week, elevated D-dimer levels predicted VTE occurrence and systemic inflammatory harm, while CRP was a hospital mortality predictor. CONCLUSION: D-dimer and CRP levels were associated with higher hospital mortality and a higher incidence of VTE. D-dimer was more strongly associated with VTE, although its discriminative ability was poor, while CRP was a stronger predictor of hospital mortality. Their use outside the usual indications should not be modified and should be discouraged.

https://doi.org/10.6061/clinics/2021/e3547

Clinical and microbiological characteristics of patients colonized or infected by Stenotrophomonas maltophilia: is resistance to sulfamethoxazole/trimethoprim a problem?
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Mendes, Elisa Teixeira

; Paez, Jorge Isaac Garcia

; Ferraz, Juliana Rosa

; Marchi, Ana Paula

; Silva, Ivan Leonardo Avelino França e

; Batista, Marjorie Vieira

; Lima, Ana Lucia Munhoz de

; Rossi, Flávia

; Levin, Anna Sara

; Costa, Silvia Figueiredo

Revista do Instituto de Medicina Tropical de São Paulo

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2020, Volume 62 elocation e96

Resumo: En | Texto: En | PDF: En

ABSTRACT Stenotrophomonas maltophilia has emerged as an important opportunistic pathogen in the last decade. Increased resistance to sulfamethoxazole/trimethoprim (SMX/TMP) has been reported in S. maltophilia strains in the past few years, leading to few therapeutic options. We conducted a prospective multicenter study at two Brazilian teaching hospitals that identified S. maltophilia isolates and evaluated their antimicrobial susceptibility profile, SMX/TMP resistance genes and their clonality profile. A total of 106 non-repeated clinical samples of S. maltophilia were evaluated. Resistance to SMX/TMP was identified in 21.6% of the samples, and previous use of SMX/TMP occurred in 19 (82.6%). PCR detected the sul1 gene in 14 of 106 strains (13.2%). Of these isolates, nine displayed resistance to SMX/TMP. The resistant strains presented a polyclonal profile. This opportunistic pathogen has emerged in immunocompromised hosts, with few therapeutic options, which is aggravated by the description of emerging resistance mechanisms, although with a polyclonal distribution profile.

https://doi.org/10.1590/s1678-9946202062096 518 downloads

10.

How new molecular tools can help bugbusters: a Burkholderia cepacia complex outbreak investigation
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Maciel, Amanda Luiz Pires

; Schmitt, Cristiane

; Baraldi, Marcia Maria

; Silva, Caio de Lima

; Oliveira, Luiz Felipe Valter de

; Sampaio, Jorge Luiz Mello

; Lourenço, Rogerio Ferreira

; Levin, Anna Sara

; Boszczowski, Icaro

Revista do Instituto de Medicina Tropical de São Paulo

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2020, Volume 62 elocation e59

Resumo: En | Texto: En | PDF: En

ABSTRACT An outbreak of bloodstream infection (BSI) caused by members of the Burkholderia cepacia complex (Bcc) took place from March 2012 until April 2014 involving thirteen patients. Aim. To describe an outbreak investigation of BSI Bcc and showing how genetic sequencing tools contributed to confirm the hypothesis of extrinsic contamination proposed by an observational study. Methods. The Infection Control Department revised and reinforced good practices of infusion therapy and catheter care, visits to affected wards, a case control study, and environmental screening based on the case-control findings. Results. Data from the case-control study found an association of cases with central venous catheter (OR 1.36; CI 1.15-1.67) and intravenous cisatracurium use (OR 10.75; CI 1.67-68.89). Visits to the operatory block revealed problems related to the cold chain used for the preservation of thermolabile cisatracurium. We could not retrieve Bcc from environmental samples using classic microbiology. New samples from the same surfaces were obtained for genetic sequencing. Bcc was identified in the cooler box, refrigerator and reusable ice packages. Conclusion. Environmental screening using genetic sequencing proved to be a useful tool for confirming our hypothesis of extrinsic contamination raised by the case-control study.

https://doi.org/10.1590/s1678-9946202062059 696 downloads

11.

Bloodstream infection in hematopoietic stem cell transplantation outpatients: risk factors for hospitalization and death
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Russo, Rachel

; Mendes, Elisa Teixeira

; Levin, Anna Sara

; Dulley, Frederico

; Oliveira, Maura S.

; Shikanai-Yasuda, Maria Aparecida

; Costa, Silvia Figueiredo

Revista do Instituto de Medicina Tropical de São Paulo

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2019, Volume 61 elocation e3

Resumo: En | Texto: En | PDF: En

ABSTRACT We described 235 bloodstream infection (BSI) episodes in 146 hematopoietic stem cell transplantation (HSCT) outpatients and evaluated risk factors for hospitalization and death. Records of outpatients presenting with positive blood cultures over a 5-year period (January 2005 to December 2008) were reviewed. Variables with p< 0.1 in bivariate analysis were used in a regression logistic model. A total of 266 agents were identified, being 175 (66.7%) gram-negative, 80 (30.3%) gram-positive bacteria and 9 (3.4%) fungi. The most common underlying disease was acute leukemia 40 (27.4%), followed by lymphoma non-Hodgkin 26 (18%) and 87 patients (59.6%) were submitted to allogeneic hematopoietic stem cell transplant (HSCT). BSI episodes were more frequent during the first 100 days after transplantation (183 or 77.8%), and ninety-one (38.7%) episodes of BSI occurred up to the first 30 days. Hospitalization occurred in 26% of the episodes and death in 10% of cases. Only autologous HSCT was protector for hospitalization. Although, central venous catheter (CVC) withdrawal and the Multinational Association of Supportive Care in Cancer (MASCC) score up to 21 points were protector factors for death in the bivariate analysis, only MASCC remained as protector.

https://doi.org/10.1590/s1678-9946201961003 2050 downloads

12.

Zika virus infection among symptomatic patients from two healthcare centers in Sao Paulo State, Brazil: prevalence, clinical characteristics, viral detection in body fluids and serodynamics
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Tozetto-Mendoza, Tania Regina

; Avelino-Silva, Vivian Iida

; Fonseca, Silvia

; Claro, Ingra Morales

; Paula, Anderson Vicente de

; Levin, Anna Sara

; Sabino, Ester Cerdeira

; Mendes-Correa, Maria Cassia

; Figueiredo, Walter Manso

; Felix, Alvina Clara

; Souza, Nathalia C. Santiago

; Costa, Angela Aparecida

; Inenami, Marta

; Silva, Rosangela M. Gasparetto da

; Levi, José Eduardo

; Romano, Camila Malta

; Paranhos-Baccalà, Glaucia

; Segurado, Aluisio Cotrim

; Mayaud, Philippe

Revista do Instituto de Medicina Tropical de São Paulo

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2019, Volume 61 elocation e19

Resumo: En | Texto: En | PDF: En

ABSTRACT Zika virus (ZIKV) clinical presentation and frequency/duration of shedding need further clarification. Symptomatic ZIKV-infected individuals identified in two hospitals in Sao Paulo State, Brazil, were investigated regarding clinical characteristics, shedding in body fluids, and serodynamics. Ninety-four of 235 symptomatic patients (Site A: 58%; Site B: 16%) had Real-Time PCR-confirmed ZIKV infection; fever, headache and gastrointestinal symptoms were less frequent, and rash was more frequent compared to ZIKV-negative patients. Real-Time PCR in serum had worse performance compared to plasma, while urine had the highest sensitivity. Shedding in genital fluids and saliva was rare. IgM positivity was the highest <14 days after the symptoms onset (86%), decreasing >28 days (24%); IgG positivity increased >14 days (96%) remaining positive in 94% of patients >28 days. ZIKV prevalence varied importantly in two neighboring cities during the same transmission season. Urine Real-Time PCR can improve diagnostic sensitivity; serum testing is less useful. Accurate serological tests are needed to improve diagnosis and surveillance.

https://doi.org/10.1590/s1678-9946201961019 2345 downloads

13.

Prevalence of methicillin-resistant Staphylococcus aureus colonization in individuals from the community in the city of Sao Paulo, Brazil
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Bes, Taniela Marli

; Martins, Roberta Ruedas

; Perdigão, Lauro

; Mongelos, Diego

; Moreno, Luisa

; Moreno, Andrea

; Oliveira, Gerson Salvador de

; Costa, Silvia Figueiredo

; Levin, Anna Sara

Revista do Instituto de Medicina Tropical de São Paulo

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2018, Volume 60 elocation e58

Resumo: En | Texto: En | PDF: En

ABSTRACT Staphylococcus aureus (SA) is a commensal habitant of nasal cavities and skin. Colonization by community-acquired methicillin-resistant SA (CA-MRSA) is associated with infections in patients who have not been recently hospitalized. The aim of this study is to determine the prevalence of MRSA colonization in an outpatient population, currently unknown in Brazil. Three-hundred patients or caregivers from two teaching hospitals were included. A questionnaire was applied and nasal swabs were obtained from patients. Swabs were inoculated in brain heart infusion (BHI) with 2.5% NaCl and seeded in mannitol. Suspicious colonies were subjected to MALDI-TOF MS Microflex™ identification. Antimicrobial susceptibility test for oxacillin was performed for SA-positive samples by microdilution. Polymerase chain-reactions for detection of mecA and coA genes were performed for resistant samples. Data about MRSA carriers were compared with non-carriers. There were 127 S. aureus isolates, confirmed by MALDI-TOF. Only seven (2.3%) were MRSA and positive for mecA and coA genes. Factors associated with MRSA carriage were African ethnicity, skin diseases or antibiotic use. The majority of them were from Dermatology clinics. Prevalence of MRSA colonization in individuals from the community was low in our study (2.3%). This finding raises the hypothesis of inter-household transmission of SA, although we did not find any association between MRSA-colonization and the shared use of personal objects. Given the low prevalence of MRSA carriers observed, empirical antimicrobial coverage for MRSA in community-acquired infections should be not necessary.

https://doi.org/10.1590/s1678-9946201860058 1489 downloads

14.

COMPARISON OF METHODS TO IDENTIFY Neisseria meningitidis IN ASYMPTOMATIC CARRIERS
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RIZEK, Camila F.

; LUIZ, André Machado

; ASSIS, Gracilene Ramos de

; COSTA, Silvia Figueiredo

; LEVIN, Anna Sara

; LOPES, Marta Heloisa

Revista do Instituto de Medicina Tropical de São Paulo

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2016, Volume 58 elocation 60

Resumo: En | Texto: En | PDF: En

SUMMARY Neisseria meningitidis is a cause of several life-threatening diseases and can be a normal commensal in the upper respiratory tract of healthy carriers. The carrier rate is not well established especially because there is no standard method for the isolation of N. meningitidis. Therefore, the aim of this study was to compare identification methods for the carrier state. Two swabs were collected from 190 volunteers: one was cultured and the other had DNA extracted directly from the sample. The Polymerase Chain Reaction (PCR) was performed to determine species and serogroups and compared the results between the methods. PCR for species determination used two pairs of primers and when there was only one amplicon, it was sequenced. The culture technique was positive in 23 (12.1%) subjects while the direct extraction method was positive in 132 (69.5%), p < 0.001. Among the 135 subjects with positive N. meningitides tests, 88 (65.2%) were serogroup C; 3 (2.2%) serogroup B; 5 (3.7%) were positive for both serogroup B and C, and 39 (28.9%) did not belong to any of the tested serogroups. In this study, PCR from DNA extracted directly from swabs identified more N. meningitidis asymptomatic carriers than the culture technique.

https://doi.org/10.1590/S1678-9946201658060 2486 downloads

15.

INCIDENCE OF DIARRHEA BY Clostridium difficile IN HEMATOLOGIC PATIENTS AND HEMATOPOIETIC STEM CELL TRANSPLANTATION PATIENTS: RISK FACTORS FOR SEVERE FORMS AND DEATH
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Spadão, Fernanda

; Gerhardt, Juliana

; Guimarães, Thais

; Dulley, Frederico

; Almeida Junior, João Nóbrega de

; Batista, Marjorie Vieira

; Shikanai-Yasuda, Maria Aparecida

; Levin, Anna Sara

; Costa, Silvia Figueiredo

Revista do Instituto de Medicina Tropical de São Paulo

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Jul 2014, Volume 56 Nº 4 Páginas 325 - 331

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Descrevemos a taxa de incidência de diarreia associada a Clostridium difficile (CDAD) em pacientes hematológicos e submetidos a transplante de células-tronco hematopoiéticas (TCTH) internados no HC-FMUSP no período de janeiro de 2007 a junho de 2011 usando dois denominadores 1.000 paciente e 1.000 dias de neutropenia e os fatores de risco associados à forma grave da doença e morte. O método de ELISA (Ridascreen-Biopharm, Germany) de detecção de toxinas A/B foi utilizado para o diagnóstico de C. difficile. Análise multivariada usando regressão logística múltipla foi conduzida para avaliar os potenciais fatores de risco associados com forma grave de CDAD e morte em até 14 dias do diagnóstico. Sessenta e seis episódios foram identificados em 64 pacientes entre 439 pacientes que apresentaram diarreia durante o período do estudo. A taxa de incidência de CDAD variou de 0,78 a 5,45 por 1.000 dias de neutropenia e de 0,65 para 5,45 por 1.000 pacientes-dias. A doença de base mais comum foi leucemia mielóide aguda 30/64(44%), 32/64 (46%) pacientes estavam neutropênicos, 31/64 (45%) foram submetidos à TCTH alogênico, 61/64 (88%) usaram antibióticos previamente e 9/64 (13%) apresentaram forma grave da doença. A maioria dos pacientes (89%) utilizou metronidazol oral no tratamento da CDAD e 19/64 (26%) evoluiram para óbito. Os fatores de risco independentes associados à morte foram forma grave da doença e uso de linezolida.

We describe the rate of incidence of Clostridium difficile-associated diarrhea (CDAD) in hematologic and patients undergone stem cell transplant (HSCT) at HC-FMUSP, from January 2007 to June 2011, using two denominators 1,000 patient and 1,000 days of neutropenia and the risk factors associated with the severe form of the disease and death. The ELISA method (Ridascreen-Biopharm, Germany) for the detections of toxins A/B was used to identify C. difficile. A multivariate analysis was performed to evaluate potential factors associated with severe CDAD and death within 14 days after the diagnosis of CDAD, using multiple logistic regression. Sixty-six episodes were identified in 64 patients among 439 patients with diarrhea during the study period. CDA rate of incidence varied from 0.78 to 5.45 per 1,000 days of neutropenia and from 0.65 to 5.45 per 1,000 patient-days. The most common underlying disease was acute myeloid leukemia 30/64 (44%), 32/64 (46%) patients were neutropenic, 31/64 (45%) undergone allogeneic HSCT, 61/64 (88%) had previously used antibiotics and 9/64 (13%) have severe CDAD. Most of the patients (89%) received treatment with oral metronidazole and 19/64 (26%) died. The independent risk factors associated with death were the severe form of CDAD, and use of linezolid.

https://doi.org/10.1590/S0036-46652014000400010 2843 downloads Citado 2 vezes em SciELO

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