Abstract Introduction: The vaginal flora consists in different microorganisms that promote a balanced interaction between the vaginal microbiome, hormonal status, products of microbial metabolism, and the host’s immune response. The instability of the vaginal ecosystem can lead to vulvovaginitis, which is a reason for frequent consultation in primary health care, as bacterial vaginosis, vaginal candidiasis, and trichomoniasis, are responsible for most diagnoses. There are other pathologies with similar presentations but less frequent. However, these are not considered to result in wrong diagnoses and treatments, such as cytolytic vaginosis. Case description: A 20-year-old woman complained of abundant vaginal discharge, use of daily sanitary pads, itching, and odor change within one month of evolution. The physical examination highlights the redness of the external lips and vaginal introitus, as abundant, non-adherent, non-airy, and odorless mucous discharge. Cervicovaginal cytology was performed on a slide that showed inflammation and was negative for intraepithelial lesions or malignancies. A culture of vaginal exudate was requested, which showed abundant epithelial cells and numerous Doderlein bacilli. Considering the presented case, the most likely diagnosis of cytolytic vaginosis was assumed. Recommendations were given, sitz baths with sodium bicarbonate were prescribed, and the patient remained asymptomatic. Comment: In the case of a patient with symptoms of vaginal discharge and itching, the first diagnostic hypothesis should consider the prevalence of the most frequent vulvovaginal infections. However, the culture of the exudate allowed us to exclude the presence of bacteria, fungi, and parasites. The patient’s symptoms and physical examination findings are characteristic of cytolytic vaginosis. The culture of the exudate confirmed the suspicion, and the appropriate diagnosis and treatment were performed. This case is intended to alert clinicians to the existence of this pathology that can often go unnoticed, compromising women’s health.

Resumo Introdução: A flora vaginal é constituída por diferentes microorganismos que promovem uma interação equilibrada entre o microbioma vaginal, estado hormonal, produtos do metabolismo microbiano e resposta imune do hospedeiro. A instabilidade do ecossistema vaginal pode levar a vulvovaginites, que são um motivo de consulta frequente nos cuidados de saúde primários, sendo a vaginose bacteriana, candidíase vaginal e tricomoníase responsáveis pela maioria dos diagnósticos. Existem outras patologias com apresentações semelhantes que, por serem menos frequentes, não são ponderadas e resultam em diagnósticos e tratamentos errados como a vaginose citolítica. Descrição do caso: Mulher de 20 anos de idade, com queixas de corrimento vaginal abundante, necessidade de uso de penso diário, prurido e alteração de odor com um mês de evolução. Ao exame objetivo destaca-se a ruborização dos lábios externos e introito vaginal, corrimento mucoso abundante, não aderente, não arejado e sem cheiro. É efetuada citologia cervico-vaginal em lâmina, que apresentava inflamação e foi negativa para lesão intraepitelial ou malignidade. Foi pedida cultura de exsudado vaginal, que apresentava abundantes células epiteliais e numerosos bacilos de Doderlein. Tendo em conta o quadro apresentado foi assumido como diagnóstico mais provável vaginose citolítica. Foram dadas recomendações e prescritos banhos de assento com bicarbonato de sódio, tendo a utente ficado assintomática. Comentário: Perante uma doente com sintomas de corrimento vaginal e prurido, a primeira hipótese diagnóstica deverá considerar a prevalência das infeções vulvovaginais mais frequentes. Contudo, a cultura do exsudado permitiu excluir a presença de bactérias, fungos e parasitas. A sintomatologia apresentada pela doente e os achados do exame físico são característicos da vaginose citolítica. A cultura do exsudado corroborou a suspeita, sendo feito o diagnóstico e o tratamento adequados. Com este caso pretende-se alertar os clínicos para a existência desta patologia, que pode muitas vezes passar despercebida, comprometendo a saúde da mulher.

ABSTRACT Sugarcane-duck symbiosis (SDS) is an ecological breeding production method wherein meat ducks are released in sugarcane (Saccharum officinarum L.) fields during the middle and late stages of sugarcane growth. The effects of SDS on sugarcane rhizobacterial diversity remain poorly understood. We conducted field experiments with sugarcane monoculture (SC) and SDS and performed genetic analyses on the rhizobacterial communities based on 16S rRNA across different growth stages of sugarcane. The effects of soil physicochemical factors on the bacterial community structure were analyzed via redundancy analysis. We found that soil organic matter (SOM), total N (TN), nitrate N (NN), and ammonium N (AN) contents of sugarcane rhizosphere soils increased during different growth periods in SDS. During the perennial root stages, the Shannon-, Ace-, and Chao1 indices increased, whereas the available P (AP) content decreased. The soil pH was more balanced and its effect on the soil bacterial community was insignificant. The dominant sugarcane rhizosphere flora were Actinobacteria, Proteobacteria, Chloroflexi, Acidobacteria, Firmicutes, norank_f__norank_o__Gaiellales, Sphingomonas, norank_f__Roseiflexaceae, Bacillus, and norank_f__Xanthobacteraceae, but with significant inter-annual variations. Redundancy analysis showed that SOM, TN, NN, AN, AP, catalase (CAT) and invertase (INV) activity were closely associated with the diversity of the soil bacterial communities, and TN and INV activity were the main drivers of sugarcane rhizobacterial communities in the SDS groups. In conclusion, SDS improves the fertilizer supply capacity and soil quality of sugarcane soils by regulating major soil nutrient content, available nutrients, and microbial diversity. This study provides a theoretical basis for scientifically managing SDS and the screening of biocontrol bacteria.

Abstract Brain abscess is a focal suppurative process pro duced in most cases by bacterial agents. Aggregati bacter aphrophilus is a gram-negative bacteria belong ing to the HACEK group, which causes infective endo carditis, liver abscesses, among others. Brain abscesses secondary to this germ are rare and, in most cases, it is associated with contact with pets, poor dental hygiene or dental procedures. Treatment consists of drainage of the abscess (greater than 2.5 cm) combined with antibiotic therapy, ideally beta-lactams. The case of a 64-year-old male patient with no relevant history is here presented. He was admitted to the emergency service due to headache, hemianopsia of a week’s duration and later tonic-clonic seizures, in whom imaging studies and culture of a brain lesion subse quently revealed a brain abscess due to A. aphrophilus. This case aims to illustrate about the rarity of this infection, because A. aphrophilus is a normal part of the oropharyngeal flora and respiratory tract, in which it rarely causes invasive bacteremia.

Resumen El absceso cerebral es un proceso supurativo focal producido en la mayoría de los casos por agentes bacte rianos. Aggregatibacter aphrophilus es una bacteria gram negativa perteneciente al grupo HACEK, causante de endocarditis infecciosa, abscesos hepáticos, entre otras. Los abscesos cerebrales secundarios a este germen son infrecuentes y en la mayoría de los casos asociados a contactos con animales domésticos, pobre higiene dental o procedimientos odontológicos. El tratamiento consiste en drenaje del absceso (mayores de 2.5 cm) combinado con terapia antibiótica, idealmente betalactámicos. Se presenta el caso de un paciente varón de 64 años sin antecedentes de relevancia quien ingresó al servicio de emergencias por cuadro de cefalea, hemianopsias de una semana de evolución y posteriormente crisis tónico clónicas, en quien posteriormente en estudios imageno lógicos y cultivo de lesión cerebral se arribó al diagnóstico de absceso cerebral por A. aphrophilus. Este informe tiene como objetivo ilustrar al lector sobre la rareza de esta infección, debido a que A. aphrophilus forma parte normal de la flora orofaríngea y del tracto respiratorio, en los que rara vez ocasiona bacteriemias invasivas.

Resumen Streptococcus Constellatus ssp pharingi pertenece al grupo de Streptococcus Anginosus, constituye flora normal de tracto respiratorio, gastrointestinal y genitourinario, infrecuentemente produce infecciones localizadas o diseminadas en pacientes con factores de riesgo. Se reporta el caso de un paciente masculino de 41 años, con antecedente de resección de macroadenoma hipofisario en 2003, en tratamiento, quien consultó al servicio de urgencias por 4 días de cefalea holocraneana intensa, fiebre, emesis, asociado a desorientación temporoespacial y debilidad en miembros inferiores las últimas 24 horas. Requirió manejo en la unidad de cuidados intensivos, ventilación mecánica, soporte vasopresor y traqueostomía, por deterioro respiratorio y hemodinámico. En estudios de extensión se documentó meningitis por Streptococcus Constellatus ssp pharingi en presencia de sinusitis, fístula de líquido cefalorraquídeo y compromiso vascular cerebral multiinfarto, producto de una vasculitis de origen infeccioso, una manifestación severa de la meningitis bacteriana, no reportada previamente por este microorganismo.

Abstract Streptococcus Constellatus ssp pharingi belongs to the group of Streptococcus Anginosus, it constitutes normal flora of the respiratory, gastrointestinal and genitourinary tracts, it infrequently produces localized or disseminated infections in patients with risk factors. The case of a 41-year-old male patient is reported, with a history of pituitary macroadenoma resection in 2003, undergoing treatment, who consulted the emergency department for 4 days with intense holocranial headache, fever, emesis, associated with temporospatial disorientation and weakness in lower limbs in the last 24 hours. He required management in the intensive care unit, mechanical ventilation, vasopressor support, and tracheostomy, due to respiratory and hemodynamic deterioration. In extension studies, meningitis due to Streptococcus Constellatus ssp pharingi was documented in the presence of sinusitis, cerebrospinal fluid fistula and multi-infarct cerebral vascular compromise, product of vasculitis of infectious origin, a severe manifestation of bacterial meningitis, not previously reported by this microorganism.

This was a cross-sectional study with the aim of characterising Naja nigricincta nigricinctas oral bacterial flora as well as accompanying sensitivities and resistance towards antibiotics. Naja nigricincta nigricincta (zebra snake) is a spitting cobra indigenous to Namibia. Nasopharyngeal and venom swabs for bacterial culture and antibiotic sensitivity were taken from 37 native zebra snakes originating from the Khomas region that were captured for removal and relocation. Enterococcus faecalis, Proteus spp., Morganella morganii and Pseudomonas spp. were the organisms most often cultured. The antibiotic sensitivity profiles of these organisms suggest ciprofloxacin or a third-generation cephalosporin plus gentamicin or piperacillin-tazobactam as prophylactic antibiotics in case of Naja nigricincta nigricincta bites.

Resumen: Streptococcus pneumoniae forma parte de la flora bacteriana normal de la mucosa nasal y faríngea, coloniza principalmente la nasofaringe y provoca que esta portación preceda a la enfermedad neumocócica, convirtiéndose así en la principal fuente de propagación entre las personas, especialmente en niños. A partir del año 1983, fecha en que se autorizó la primera vacuna antineumocócica de 23 componentes, se han desarrollado diferentes vacunas conjugadas, según los serotipos circulantes y causantes de enfermedades neumocócicas invasivas (ENI), de esta manera, se ha logrado disminuir en gran medida la incidencia y mortalidad de las enfermedades asociadas a neumococo. En noviembre del 2021, un grupo de expertos llevó a cabo una reunión virtual para analizar y actualizar el impacto que estas vacunas neumocócicas han generado en la salud pública de los países, especialmente durante la pandemia de la COVID-19, y como parte de las recomendaciones que surgieron se planteó que, ante el reemplazo de serotipos luego de la introducción de las vacunas antineumocócicas conjugadas (PCV) en los esquemas nacionales, es necesario buscar alternativas en vacunas independientes del serotipo, y de igual manera se deben unir esfuerzos para fortalecer la vigilancia de los serotipos, enfatizando en los no incluidos en las vacunas actuales. El objetivo de este reporte es comunicar las conclusiones del grupo de expertos que en noviembre 2021 analizó el impacto de las vacunas neumocócicas en la salud pública de los países, para generar recomendaciones aplicables en Latinoamérica.

Abstract: Streptococcus pneumoniae (also known as pneumococcus) is part of the natural bacterial flora of the nasal and pharyngeal mucosa, colonizes mainly the nasopharynx, and causes this carriage to precede pneumococcal disease, thus becoming the main source of propagation among people, especially in children. Since 1983, when the first 23-component anti-pneumococcal vaccine was authorized, different conjugated vaccines have been developed according to the circulating serotypes that cause invasive pneumococcal diseases (IPD), reducing the incidence and mortality of these diseases considerably. In November 2021, a group of experts held a virtual meeting to update and analyze the impact that pneumococcal vaccines have generated on the countries’ public health, especially during the COVID-19 pandemic. The recommendations that emerged included the need to look for alternatives in serotype-independent vaccines after the introduction of pneumococcal conjugate vaccines (PCV) in the national immunization schedules, as well as to strengthen the surveillance of serotypes, focusing on those not included in the current vaccines. The objective of this report is to communicate the conclusions of the group of experts that in November 2021 analyzed the impact of pneumococcal vaccines on public health in the countries, in order to generate recommendations applicable in Latin America.

Resumen: Streptococcus pneumoniae forma parte de la flora bacteriana normal de la mucosa nasal y faríngea, coloniza principalmente la nasofaringe y provoca que esta portación preceda a la enfermedad neumocócica, convirtiéndose así en la principal fuente de propagación entre las personas, especialmente en niños. A partir del año 1983, fecha en que se autorizó la primera vacuna antineumocócica de 23 componentes, se han desarrollado diferentes vacunas conjugadas, según los serotipos circulantes y causantes de enfermedades neumocócicas invasivas (ENI), de esta manera, se ha logrado disminuir en gran medida la incidencia y mortalidad de las enfermedades asociadas a neumococo. En noviembre del 2021, un grupo de expertos llevó a cabo una reunión virtual para analizar y actualizar el impacto que estas vacunas neumocócicas han generado en la salud pública de los países, especialmente durante la pandemia de la COVID-19, y como parte de las recomendaciones que surgieron se planteó que, ante el reemplazo de serotipos luego de la introducción de las vacunas antineumocócicas conjugadas (PCV) en los esquemas nacionales, es necesario buscar alternativas en vacunas independientes del serotipo, y de igual manera se deben unir esfuerzos para fortalecer la vigilancia de los serotipos, enfatizando en los no incluidos en las vacunas actuales. El objetivo de este reporte es comunicar las conclusiones del grupo de expertos que en noviembre 2021 analizó el impacto de las vacunas neumocócicas en la salud pública de los países, para generar recomendaciones aplicables en Latinoamérica.

Abstract: Streptococcus pneumoniae (also known as pneumococcus) is part of the natural bacterial flora of the nasal and pharyngeal mucosa, colonizes mainly the nasopharynx, and causes this carriage to precede pneumococcal disease, thus becoming the main source of propagation among people, especially in children. Since 1983, when the first 23-component anti-pneumococcal vaccine was authorized, different conjugated vaccines have been developed according to the circulating serotypes that cause invasive pneumococcal diseases (IPD), reducing the incidence and mortality of these diseases considerably. In November 2021, a group of experts held a virtual meeting to update and analyze the impact that pneumococcal vaccines have generated on the countries’ public health, especially during the COVID-19 pandemic. The recommendations that emerged included the need to look for alternatives in serotype-independent vaccines after the introduction of pneumococcal conjugate vaccines (PCV) in the national immunization schedules, as well as to strengthen the surveillance of serotypes, focusing on those not included in the current vaccines. The objective of this report is to communicate the conclusions of the group of experts that in November 2021 analyzed the impact of pneumococcal vaccines on public health in the countries, in order to generate recommendations applicable in Latin America.

Abstract Background: Acne vulgaris is an inflammatory skin disorder leading to an impairment of quality of life and is therefore not only a cosmetic issue. Its pathogenesis is multifactorial - of particular importance is the colonization with the bacterium Propionibacterium acnes. A wide range of different treatment options exists including topical and systemic treatments depending on severity. High Frequency (HF) therapy, historically developed in the 19th century, claims antimicrobial effects on acne skin, but solid data on its efficacy and mechanism of action is lacking. Objective: The main objective of this study was to determine the efficacy of HF therapy on skin flora and P. acnes in vitro using a commercial device as well as to review studies on the mechanism of action. Methods: The plasma source was investigated regarding electrical settings, heat, and ozone development. Bacterial skin flora, fungal isolates, and P. acnes were exposed to HF in vitro and compared to unexposed controls by evaluating the number of colonies on agar plates. To further analyze bacterial species from normal skin flora, 16S-sequencing was performed. Statistical analyses were carried out using row analysis and unpaired t-test. Results: HF treatment led to a significant reduction of almost every bacterial and fungal species investigated in this study. Moreover, the number of colonies forming units was significantly decreased in P. acnes after HF treatment compared to controls in vitro. Study limitations: The experiments were performed in vitro only. To assess clinical effects further in vivo experiments are necessary. Conclusions: The results collected in this study, although in vitro, provide a mechanistic basis for HF as a complementary treatment option for patients with acne. It might also have a beneficial effect on patients with superficial infectious skin of the skin.

Resumen Introducción: la leche humana es el patrón oro en la nutrición de los neonatos. Por ello, los bancos de leche se convierten en elementos esenciales para garantizar su disponibilidad y seguridad cuando la leche materna no está disponible. La manipulación que se realiza de la leche es un punto crítico para asegurar la seguridad microbiológica de las muestras. Por ello, analizar la flora de la leche donada es fundamental para tomar medidas de mejora de los bancos de leche. Objetivos: analizar los resultados microbiológicos positivos en un banco de leche humana entre las muestras de leche cruda donadas y tras su pasteurización y evaluar si existe relación entre los aislamientos, el perfil de la donante y los circuitos de leche donada. Métodos: estudio observacional descriptivo que analiza las características de la leche donada y los resultados microbiológicos positivos de muestras de leche donadas en nuestro banco desde junio de 2016 hasta diciembre de 2020. Todas las donantes firmaron un consentimiento informado. Resultados: durante el período de estudio fueron donados 1587 litros de leche cruda por 266 mujeres destacando que, a pesar de la pandemia, 2020 ha sido el año en el que más volumen se ha dispensado (280 L). Se obtuvieron 221 lotes de leche con al menos un aislamiento microbiológico positivo (14,2 % total), de ellos 149 previos y 46 posteriores a la pasteurización. La tasa de descarte pre y pospasteurización es variable a lo largo de los años con descenso en 2020 prepasteurización (3,9%) e incremento pospasteurización (5,3%). Los gérmenes más frecuentemente aislados fueron cocos grampositivos, seguidos por Enterobacterias prepasteurización detectándose un descenso en la positividad a S. aureus tras establecerse un protocolo de erradicación. En las muestras pospasteurización predomina el género Bacillus. Se ha encontrado una relación aunque no estadísticamente significativa (p > 0,05) entre mujeres con mayor volumen de donación y/o ingreso de su hijo/a en Neonatología y una mayor frecuencia cultivos positivos. Conclusiones: el análisis bacteriológico de las muestras es parte fundamental del control de calidad. Nuestros resultados traducen una buena sistemática de extracción y transporte, así como un buen entrenamiento de los profesionales del banco. No obstante, es necesario mejorar los procesos para reducir la tasa de contaminación y la cantidad de leche desechada.

Abstract Introduction: breastfeeding is the gold standard for infant’s nutrition. Human milk bank is an essential tool to guarantee availability and safety in those situations when breastfeeding is not an option. The manipulation during the extraction of the human milk by the donors is a critical point to ensure an adequate microbiological safety. Therefore, knowing the bacterial flora that prevails in donated milk is essential to draw conclusions that can lead to taking measures in the management of the bank. Objectives: to analyze the prevalence of microorganisms in milk samples donated to the milk bank and how the bacterial flora behaves according to the profile of the donors and the donor milk circuits. Methods: the present work is a retrospective descriptive observational study that analyzes characteristics and the positive microbiological results within our milk bank samples from June 1, 2016 to December 31, 2020. All milk bank donors voluntarily signed an informed consent that authorizes the use of data to investigation. Results: during the study period, a total of 1,587 liters of raw milk were donated by 266 women, highlighting that, despite the SARS-CoV-2 virus pandemic, 2020 has been the year in which more volume of milk has been dispensed. The results show that 221 batches had at least one positive microbiological isolation (149 of them were before and 46 after pasteurization). Pre and post-pasteurization rate varies over the years with a decrease in the pre-pasteurization discard rate (3,9%) and increase in the post-pasteurization rate (5,3%). The most frequently isolated germs found in pre-pasteurization cultures were gram positive cocci and Enterobacter and a decrease in the positivity to S. aureus after establishing an eradication protocol. In post-pasteurization cultures, the most commonly found germs are Bacillus. Regarding the donor’s profile, it was found a non statistically significant that those women with the highest donation volume and/or admission of their offspring in Neonatology were associated with higher frequency of positive cultures. Conclusions: bacteriological analysis of milk samples is an essential part of quality control for a milk bank. Our results reflect a good extraction system and transportation, as well as good training from the bank’s professionals. Nevertheless, improvement of processes is necessary to reduce the rate of contamination and the amount of discarded milk.

Abstract Introduction: Over the last decade, a shift in the spontaneous bacterial peritonitis (SBP) microbial pattern toward an increasing incidence of gram-positive and multidrug-resistant (MDR) bacteria has been reported. Systematic surveillance of the local microbiological scenario and antibiotic resistance is crucial to SBP treatment success. The main objective of this study was to evaluate the microbiological profile and bacterial resistance of SBP pathogens in a Portuguese cohort to allow selection of the most appropriate empirical antibiotics. Methods: This is a single-center retrospective study including 63 adult cirrhotic patients with culture-positive SBP. Patients were identified using a hospital general diagnostic database and searching for all SBP events (neutrophil count in ascitic fluid ≥250/mm3) from January 1, 2012, to December 31, 2017. Patients were excluded if they had culture-negative SBP, secondary peritonitis, peritoneal dialysis, a liver transplant, or immunodeficiency. The site of SBP acquisition was classified as nosocomial if it was diagnosed 48 h or longer after hospitalization or as nonnosocomial if it was diagnosed within the first 48 h. MDR bacteria were those with an acquired resistance to at least 1 agent in 3 or more antimicrobial categories. All statistical analyses were carried out using IBM SPSS Statistics software version 22 (IBM, New York, USA). Results: The study cohort comprised 53 (84.1%) men. The mean age of the patients was 60.6 ± 11.2 years. Alcohol was the most common etiology (88.9%) and most patients had advanced liver cirrhosis (87.1%, Child C). Gram-negative bacteria were slightly more frequent than gram-positive bacteria (56.9 vs. 43.1%). Escherichia coli was the most common pathogen (33.8%). Nineteen (31.7%) bacteria were classified as MDR. Resistance to third-generation cephalosporins, quinolones, piperacillin-tazobactam, and carbapenems was found in 31.7, 35, 26.7, and 18.3% of the cases, respectively. The rates of gram-positive bacteria were similar between nosocomial and nonnosocomial episodes (45 vs. 42.2%; p = 0.835). MDR bacteria were more common in the nosocomial group (50 vs. 23.8%; p = 0.046). Resistance to third-generation cephalosporins (50 vs. 23.8%; p = 0.046), piperacillin-tazobactam (44.4 vs. 19.1%; p = 0.041), and carbapenems (33.3 vs. 11.9%; p = 0.049) occurred more frequently in nosocomial episodes. Resistance to first-line antibiotic occurred in 29.3% of the patients, being more common in the nosocomial group (44.4 vs. 22.5%; p = 0.089). Conclusion: Although gram-negative bacteria remain the most common causative microorganisms, our results emphasize the shift in SBP microbiological etiology, as almost half of the isolated microorganisms were gram positive. The emergence of bacteria resistant to traditionally recommended empirical antibiotics underlines the importance of basing this choice on local flora and antibiotic susceptibility data, allowing a more rational and successful use of antibiotics.

Resumo Introdução: Na última década assistiu-se a uma mudança no padrão microbiológico da peritonite bacteriana espontânea (PBE), com aumento da incidência de bactérias gram-positivas e multirresistentes. Uma vigilância sistemática do cenário microbiológico e da resistência antibiótica é crucial para o sucesso do tratamento da PBE. O principal objetivo deste estudo foi avaliar o perfil microbiológico e os padrões de resistência antibiótica dos agentes bacterianos responsáveis pelos casos de PBE numa coorte portuguesa de doentes cirróticos, de modo a permitir uma seleção mais apropriada da antibioterapia empírica. Métodos: Estudo retrospetivo unicêntrico, que incluiu 63 doentes adultos cirróticos com PBE cultura-positiva. A identificação dos doentes foi efetuada a partir da base de dados eletrónica do centro hospitalar, pesquisando todos os internamentos por PBE (contagem de neutrófilos no líquido ascítico ≥250/mm3) entre 1 janeiro de 2012 e 31 de dezembro de 2017. Foram aplicados como critérios de exclusão: cultura de líquido ascítico negativa, peritonite secundária, diálise peritoneal, transplante hepático ou imunodeficiência. O local de aquisição da PBE foi classificado como nosocomial se diagnóstico após as primeiras 48 horas de hospitalização, e não-nosocomial se diagnóstico nas primeiras 48 horas. Multirresistência foi definida como resistência adquirida a pelo menos um agente em três ou mais categorias antimicrobianas. A análise estatística foi efetuada com recurso ao software IBM SPSS Statistics versão 22 (IBM, New York, USA). Resultados: A coorte incluiu 53 (84.1%) doentes cirróticos do género masculino. A idade média dos doentes foi de 60.6 ± 11.2 anos. O álcool constituiu a etiologia mais comum (88.9%) e a maioria dos doentes apresentava uma cirrose em estadio avançado (87.1%, Child-C). As bactérias gram-negativas revelaram-se ligeiramente mais frequentes que as gram-positivas (56.9 vs. 43.1%). Escherichia coli foi o microrganismo mais frequente (33.8%). Dezanove (31.7%) das bactérias isoladas foram classificadas como multirresistentes. As resistências às cefalosporinas de terceira-geração, às quinolonas, à piperacilina-tazobactam e aos carbapenemes foram de 31.7, 35, 26.7 e 18.3%, respetivamente. A taxa de bactérias gram-positivas foi similar entre PBE nosocomial e não-nosocomial (45 vs. 42.2%; p = 0.835). As bactérias multirresistentes foram mais frequentes no grupo nosocomial (50 vs. 23.8%; p = 0.046). A resistência às cefalosporinas de terceira-geração (50 vs. 23.8%; p = 0.046), à piperacilina-tazobactam (44.4 vs. 19.1%; p = 0.041) e aos carbapenemes (33.3 vs. 11.9%; p = 0.049) foi significativamente superior nas infeções nosocomiais. A resistência à antibioterapia empírica de primeira linha ocorreu em 29.3% dos doentes, sendo mais frequente no grupo nosocomial (44.4 vs. 22.5%; p = 0.089). Conclusão: Apesar de as bactérias gram-negativas constituírem, nesta coorte, a maioria dos microrganismos responsáveis pela PBE, os nossos resultados enfatizam a mudança na etiologia microbiológica da PBE, na medida em que, quase metade dos microrganismos isolados foram gram-positivos. A emergência de bactérias resistentes aos antibióticos empíricos tradicionalmente recomendados sublinha a importância de basear esta escolha nos dados locais sobre flora bacteriana e susceptibilidade antibiótica, permitindo uma escolha mais racional e um uso bem-sucedido dos antibióticos.

Abstract Actinomycosis is a rare chronic infection, caused by gram-positive bacteria from the Actinomyces species, which is part of the endogenous flora of the oral cavity, gastrointestinal and female genital tracts. In order to cause infection, disruption of the mucosal barrier is imperative. Long-standing IUD (intra-uterine device) is a risk factor. We, hereby, present a case of a 32-year-old woman who presented with lower abdominal pain and a tender mass. The inflammatory parameters increased progressively. There was a history of IUD usage. Ultrasound, Computed Tomography and Magnetic Resonance Imaging demonstrated a heterogeneous enhancing mass-like extending from the bladder to the rectus abdominis muscle, with restricted diffusion and extensive regional oedema. Aspiration cytology revealed bacteria Parvimonas micra and polymorphonuclear leukocytes. However, the patient underwent surgery and the histopathological findings showed an abscess with microorganisms compatible with Actinomyces.

Resumo A actinomicose é uma infeção crónica rara, causada por bactérias gram-positivas da espécie Actinomyces, integrantes da flora endógena da cavidade oral, gastrointestinal e genital feminina. Para causar infeção é necessário existir uma disrupção da mucosa. A presença de um dispositivo intra-uterino (DIU) de longa duração é um factor de risco. Apresentamos um caso de uma mulher de 32 anos que recorre ao Serviço de Urgência com dor abdominal, massa hipogástrica dolorosa e aumento progressivo dos parâmetros inflamatórios. Tinha como antecedente de relevo a utilização de um DIU. Foram realizadas ecografia, Tomografia Computadorizada e Ressonância Magnética que demonstraram uma lesão desde a cúpula vesical até ao músculo recto abdominal, com captação heterogénea e restrição à difusão, associada a marcado edema regional. A citologia aspirativa identificou a bactéria Parvimonas micra e leucócitos polimorfonucleares. Foi submetida a resseção cirúrgica com resultado anatomopatológico de abcesso por Actinomyces.

Abstract In the Amazonian Forest, diverse plants have bioactive compounds, which can potentially be used as modulators of ruminal fermentation. Despite the importance, few studies have been developed to evaluate the use of extracts from Amazonian plants as natural feed additives in ruminant nutrition. Thus, the objective of this study is to present a brief overview of the scientific data in the literature regarding the effects of the use of extracts of açaí, copaíba, sage-do-marajó, peach palm, and bacuri on the ruminal fermentation and their potential for use in the diet of ruminants. Açaí (Euterpe oleracea Mart.) has 16.08 mg/g of dry matter of flavonoids, compounds with potent antimicrobial activity. Studies with açaí oil supplementation have shown modulatory effects on rumen fermentation and milk production in sheep and cows. Additionally, the copaiba oleoresin (Copaifera spp.) and the bacuri (Platonia insignis Mart.) seed butter have 88% and 41% of terpenes, respectively; the phytochemical composition of marajó sage oil (Hyptis crenata Pohl ex Benth) is not completely resolved, but this source is mostly composed of the terpenes, camphor (33.62%), 1,8-cineole (19.76%) and α-pinene (15.24%), which have in vitro antimicrobial effects against different bacterial strains. The findings of this review demonstrate the potential of Amazonian extracts in maximizing animal production, due to the possible effects on the modulation of ruminal fermentation, being encouraged to carry out additional studies aiming at a greater exploration of them. Although, there are no current studies associated with the effects of açaí, sage, peach palm, and bacuri on rumen fermentation, it is inferred that, due to their phytochemical composition, they may have a similar effect to ionophores on ruminant production.

Resumen En la selva amazónica, innumerables plantas poseen compuestos bioactivos, que potencialmente pueden ser utilizados como moduladores de la fermentación ruminal. A pesar de la importancia, han sido desarrollados pocos estudios evaluando el uso de extractos de plantas amazónicas como aditivos alimentarios naturales en la nutrición de rumiantes. Así, el objetivo de este estudio es presentar un breve panorama de los datos científicos en la literatura sobre los efectos del uso de extractos de açaí, copaíba, salvia-do-marajó, chontaduro y bacuri en la fermentación ruminal y su potencial de uso en la dieta de los rumiantes. Açaí (Euterpe oleracea Mart.) tiene 16,08 mg/g de materia seca de flavonoides, compuestos con potente acción antimicrobiana. Los estudios con suplementos de aceite de açaí han demostrado efectos moduladores sobre la fermentación ruminal y la producción de leche en ovejas y vacas. Adicionalmente, la oleorresina de copaiba (Copaifera spp.) y la mantequilla de semilla de bacuri (Platonia insignis Mart.) poseen 88% y 41% de terpenos, respectivamente; la composición fitoquímica del aceite de salvia de marajó (Hyptis crenata Pohl ex Benth) no está completamente resuelta, sin embargo esta fuente está mayoritariamente compuesta de los terpenos alcanfor (33,62%), 1,8-cineol (19,76%) y α-pineno (15,24%), los cuales poseen efecto antimicrobiano in vitro frente a diferentes cepas bacterianas. Los hallazgos de esta revisión demuestran el potencial de los extractos amazónicos en la maximización de la producción animal, debido a sus posibles efectos sobre la modulación de la fermentación ruminal, siendo incentivados a realizar estudios adicionales con el objetivo de una mayor exploración de estos. Aunque actualmente no existen estudios asociados a los efectos del açaí, la salvia, el chontaduro y el bacuri en la fermentación ruminal, se supone que, por su composición fitoquímica, podrían tener un efecto similar a los ionóforos en la producción de rumiantes.

Resumo Na flora amazônica, incontáveis plantas possuem compostos bioativos, que potencialmente podem ser utilizados como moduladores da fermentação ruminal. Apesar da importância, poucos estudos têm sido desenvolvidos para avaliar a utilização de plantas amazônicas como aditivos alimentares naturais na nutrição de ruminantes. Assim, objetiva-se apresentar um panorama dos dados científicos da literatura sobre os efeitos do uso dos extratos de açaí, copaíba, salva-do-marajó, pupunha e bacuri na fermentação ruminal e os seus potenciais de utilização na dieta de ruminantes. O açaí (Euterpe oleracea Mart.), possui 16,08 mg/g de matéria seca de flavonoides, compostos com potente ação antimicrobiana. Estudos com suplementação do óleo de açaí tem mostrado efeitos modulatórios na fermentação ruminal e na produção de leite de ovelhas e vacas. Adicionalmente, a oleoresina de copaíba (Copaifera spp.) e a manteiga das sementes de bacuri (Platonia insignis Mart.), possuem, respectivamente, 88% e 41% de terpenos; a composição fitoquímica do óleo de salva-do-marajó (Hyptis crenata Pohl ex Benth) ainda não está completamente caracterizada, mas esta fonte está majoritariamente composta por terpenos cânfora (33,62%), 1,8-cineol (19,76%) e α-pineno (15,24%), que apresentam atividade in vitro antimicrobiana, capaz de reduzir a produção total de gás em ambiente ruminal in vitro. A pupunha, fruto da pupunheira (Bactris gasipaes Kunth.), possui 355,95 mg/kg de carotenoides, com efeito antimicrobiano in vitro contra algumas cepas bacterianas. Os achados desta revisão demonstram as potencialidades dos extratos amazônicos na maximização da produção animal, em razão dos possíveis efeitos na modulação da fermentação ruminal, sendo encorajada a realização de estudos adicionais visando uma maior exploração deles. Embora, atualmente, não existam estudos associados aos efeitos do açaí, salva-do-marajó, pupunha e bacuri na fermentação ruminal, pressupõe-se que pela sua composição fitoquímica, poderiam ter um efeito semelhante aos ionóforos na produção de ruminantes.

ABSTRACT Introduction: The cross or hospital infections constitute an important health problem in all the hospitals of the world. Objective: To describe the clinical and epidemiological characteristics of patients with hospital infections. Methods: A descriptive and cross-sectional study of 57 patients with hospital acquired infections was carried out. They were admitted to the Internal Medicine Service of Saturnino Lora Clinical-surgical Teaching Provincial Hospital of Santiago de Cuba, from October to December, 2019, for which the variables age, associated diseases, predisposing factors, type of infection and isolated germs were analyzed. Results: In the series the 60-69 years age group and hypertension as concomitant chronic disease (26.0 %) were notable. Among the predisposing factors nicotine addiction (32.8 %) was more frequent and the preponderant type of infection was the bacterial bronchopneumonia (47.0 %) whose causal germ in most of the cases (35.1 %) was the Klebsiella pneumoniae. Conclusions: The hospital acquired infections mainly afflicted patients of advanced age with associated chronic diseases, as diabetes mellitus and hypertension. It is necessary to highlight the importance of knowing the existent microbial flora in the service where the infection is acquired, in order to achieve boththe prevention, the opportune diagnosis and the appropriate treatment.

RESUMEN Introducción: La infección nosocomial o intrahospitalaria constituye un importante problema de salud en todos los hospitales del orbe. Objetivo: Describir las características clínicas y epidemiológicas de pacientes con infecciones intrahospitalarias. Métodos: Se realizó un estudio descriptivo y transversal de 57 pacientes con infecciones intrahospitalarias, ingresados en el Servicio de Medicina Interna del Hospital Provincial Docente Clínico-Quirúrgico Saturnino Lora de Santiago de Cuba, de octubre a diciembre de 2019, para lo cual se analizaron las variables edad, enfermedades asociadas, factores predisponentes, tipo de infección y gérmenes aislados. Resultados: En la serie sobresalieron el grupo etario de 60-69 años y la hipertensión arterial como enfermedad crónica concomitante (26,0 %). Entre los factores predisponentes resultó más frecuente el tabaquismo (32,8 %) y el tipo de infección preponderante fue la bronconeumonía bacteriana (47,0 %), cuyo germen causal en la mayoría de los casos (35,1 %) fue la Klebsiella pneumoniae. Conclusiones: Las infecciones intrahospitalarias aquejaron principalmente a pacientes de edad avanzada con enfermedades crónicas asociadas, como la diabetes mellitus y la hipertensión arterial. Cabe destacar la importancia de conocer la flora microbiana existente en el servicio donde se adquiere la infección, a fin de lograr tanto la prevención como el diagnóstico oportuno y el tratamiento adecuado.

ABSTRACT Introduction: No bacterium has been reported as causative of breast cancer, but the presence of different species that are related in a beneficial or detrimental way. Objective: To identify the microbiota present in breast nodules and its morphological effects on the MCF-7 cell line. Methods: Exploratory, experimental study of a population of 57 women with breast nodules, operated for needle biopsy in a diagnostic center. Of these, 17 samples were chosen by non-probabilistic sampling for metagenomic analysis. Infection was performed with MCF-7 cells and Staphylococcus saprophyticus at MOI of 1:1, 5:1 and 10:1 (48 hours of exposure). Results: Of the 57 samples taken, only 7 yielded positive results (12.28%) and the rest (50) had no bacterial growth. The following microbiota was obtained by metagenomics: Proteobacteria (47%), Escherichia (9.4%) and Yokenella (8.2%), among others. Controls were negative. Only two patients tested positive for cancer, and S. saprophyticus was the common species. In the infection, morphological changes were evidenced from MOI 5:1. Conclusion: The bacteriome extracted from the nodules of a female population is mostly endogenous flora of the mammary glands.

RESUMEN Introducción: En el cáncer de mama no se ha reportado una bacteria como causante, pero sí la presencia de diferentes especies que se relacionan de forma beneficiosa o perjudicial. Objetivo: Identificar la microbiota presente en nódulos mamarios y sus efectos morfológicos sobre la línea celular MCF-7. Métodos: Estudio exploratorio experimental de una población de 57 mujeres con nódulos mamarios, intervenidas para biopsia por punción en un centro de diagnóstico. De estas, se escogieron 17 muestras mediante muestreo no probabilístico para el análisis metagenómico. Se realizó una infección con células MCF-7 y Staphylococcus saprophyticus a MOI de 1:1, 5:1 y 10:1 (48 horas de exposición). Resultados: De las 57 muestras tomadas, solo en 7 pacientes se obtuvo resultado positivo (12,28 %) y en el resto (50) no hubo crecimiento bacteriano. Por metagenómica se obtuvo la microbiota siguiente: Proteobacteria (47 %), Escherichia (9,4 %) y Yokenella (8,2 %), entre otros. Los controles fueron negativos. Solo dos pacientes resultaron positivas para cáncer, entre ellas la especie común fue S. saprophyticus. En la infección, los cambios morfológicos se evidenciaron desde la MOI 5:1. Conclusión: El bacterioma extraído de los nódulos de una población femenina es en su mayoría flora endógena del órgano mamario.