The emergence of β-lactamase-producing Enterobacteriaceae in the last few decades has become major challenge faced by hospitals. In this study, isolates of Klebsiella pneumoniae carbapenemase-2 (KPC-2)-producing K. pneumoniae from a tertiary hospital in Mato Grosso do Sul, Brazil, were characterized. Bacterial identification was performed by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF; Bruker Daltonics, Germany) mass spectrometry. The minimum inhibitory concentrations of carbapenems were determined using the agar dilution method as recommended by the Clinical Laboratory Standards Institute guidelines. Carbapenemase production was detected using the modified Hodge test (MHT) and polymerase chain reaction (PCR), followed by DNA sequencing. Of 360 (12.2%) K. pneumoniae isolates obtained between May 2009 and May 2010, 44 (12.2%) were carbapenem nonsusceptible. Of these 44 isolates, thirty-six K. pneumoniae isolates that were positive by MHT and PCR carried the bla KPC-2 gene. Thus, KPC-2producing Klebsiella pneumoniae has been present in a Brazilian hospital located in the Midwest region since at least 2009.

To study the factors associated with the risk of discontinuing active tuberculosis treatment among patients in an outpatient referral unit and to analyze the association between patients' abandonment risk score and their odds of discontinuing the treatment. Patients and Methods: In this cohort study, tuberculosis patients were prospectively followed up from June 2012 through July 2019 at a secondary tuberculosis referral unit in Mato Grosso do Sul, Brazil. At initial consultation, patients were interviewed using a standardized questionnaire and were assigned a score for the risk of treatment abandonment by the nurse. Univariate and multivariate analyses were performed using logistic regression. Results: One hundred and forty-eight patients were included in the study, of which 65.0% (96/148) were male. Their mean age was 43.3 ± 14.8 years (range: 18-89 years). Smoking, drug use, repeated admissions, and a high abandonment risk score were the variables associated with the highest risk of discontinuing the treatment. The rate of tuberculosis and human immunodeficiency virus coinfection was 37.2%. The overall rate of global treatment abandonment was 10.8% (95% confidence interval [CI]: 6.1-16.2). Upon stratification of patients that abandoned by the risk score, 22.9% (8/35) of the ones that abandoned had a high risk, 10.9% (6/55) had an intermediate risk, and 3.5% (2/58) had a low risk of treatment abandonment. In multivariate analysis, the factors associated with abandoning the treatment were smoking [adjusted odds ratio (aOR) = 4.91 (95% CI: 1.08, 22.32)] and undergoing retreatment (aOR) = 3.66 (95% CI: 1.04, 12 88). Conclusion: Smoking and undergoing retreatment were independent risk factors for tuberculosis treatment abandonment in this center. Risk stratification can help prioritize the strengthening of treatment adherence among patients at higher risk of abandoning treatment in referral units.

Chronic pulmonary aspergillosis (CPA) is a slow and progressive disease that develops in preexisting lung cavities of patients with tuberculosis sequelae, and it is associated with a high mortality rate. Serological tests such as double agar gel immunodiffusion test (DID) or counterimmunoelectrophoresis (CIE) test have been routinely used for CPA diagnosis in the absence of positive cultures. However, these tests have been replaced with enzyme-linked immunoassay (ELISA) and, a variety of methods. This systematic review compares ELISA accuracy to reference test (DID and/or CIE) accuracy in CPA diagnosis. It was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The study was registered in PROSPERO under the registration number CRD42016046057. We searched the electronic databases MEDLINE (PubMed), EMBASE (Elsevier), LILACS (VHL), Cochrane library, and ISI Web of Science. Gray literature was researched using Google Scholar and conference abstracts. We included articles with patients or serum samples from patients with CPA who underwent two serological tests: ELISA (index test) and IDD and/or CIE (reference test). We used the test accuracy as a result. Original articles were considered without a restriction of date or language. The pooled sensitivity, specificity, and summary receiver operating characteristic curves were estimated. We included 14 studies in the review, but only four were included in the meta-analysis. The pooled sensitivities and specificities were 0.93 and 0.97 for the ELISA test. These values were 0.64 and 0.99 for the reference test (DID and/or CIE). Analyses of summary receiver operating characteristic curves yielded 0.99 for ELISA and 0.99 for the reference test (DID and/or CIE). Our meta-analysis suggests that the diagnostic accuracy of ELISA is greater than the reference tests (DID and/or CIE) for early CPA detection.

We describe a case of infection with Cronobacter sakazakii sequence type 494 causing bacteremia and meningitis in a hospitalized late premature infant in Brazil. We conducted microbiological analyses on samples of powdered infant formula from the same batch as formula ingested by the infant but could not identify the source of contamination.

22Chronic pulmonary aspergillosis (CPA) is a disease that benefits from cavities as after-effects of 23 tuberculosis, presenting a high mortality rate. Serological tests like double agar gel 24 immunodiffusion test (DID) or the counterimmunoelectrophoresis (CIE) test have been routinely 25 used for CPA diagnosis in the absence of positive cultures; however, they have been replaced by 26 enzyme-linked immunoassay (ELISA), with a variety of methods. 27 This systematic review aims to compare the accuracy of the ELISA test with the reference test 28 (DID and/or CIE) in CPA diagnosis. It was conducted according to the Preferred Reporting Items 29 for Systematic Reviews and Meta-Analyzes (PRISMA). 30 The study was registered in PROSPERO under the registration number CRD42016046057. We 31 searched the electronic databases MEDLINE (PubMed), EMBASE (Elsevier), LILACS (VHL), 32 Cochrane library, and ISI Web of Science. Gray literature was researched in Google Scholars and 33 conference abstracts. We included articles with patients or serum samples from CPA patients who 34 underwent two serological tests: ELISA (index test) and IDD and/or CIE (reference test), using 35 the accuracy of the tests as a result. Original articles were considered without a restriction of date 36 or language. The pooled sensitivity, specificity, and summary receiver operating characteristic 37 curves were estimated. 38 We included 13 studies in the review, but only four studies were included in the meta-analysis. 39 The pooled sensitivities and specificities were 0.93 and 0.97 for the ELISA test. For the reference 40 test (DID and/or CIE), these values were 0.64 and 0.99. Analyses of summary receiver operating 41 characteristic curves yielded 0.99 for ELISA and 0.99 for the reference test (DID and/or CIE). Our 46 Chronic pulmonary aspergillosis (CPA) is a slow and progressive lung disease caused by 47 Aspergillus spp. that develops in preexisting cavities of patients with chronic respiratory diseases, 48 and pulmonary tuberculosis is its main predisposing factor, with a global prevalence estimated at 49 1.2 million cases [1].I Its prognosis is poor, with 38-85% mortality in five years [1,2]. 50CPA presents five clinical forms: 1. aspergillus nodule, 2. pulmonary simple aspergilloma, 51 3. chronic cavitary pulmonary aspergillosis (CCPA), also called complex aspergilloma, 4. chronic 52 fibrosing pulmonary aspergillosis (CFPA), and 5. subacute invasive pulmonary aspergillosis 53 (SAIA) [3]. Aspergilloma is present in only one-third of patients with CPA [1,4]. 54The diagnosis of CPA is based on suggestive images, preferably tomographic images (CT 55 scan), on evidence of microbiological infection by Aspergillus or on the presence of an immune 56 response to this agent, maintained for at least 3 months [3,5]. 57Serologic tests are indispensable for the diagnosis in the absence of positive cultures and 58 are considered the best noninvasive tests to diagnose this entity [6,7]. These tests may be over 90% 59 positive with preci...

Background Data on the prevalence of chronic pulmonary aspergillosis (CPA) in patients with active or cured tuberculosis (TB) are scarce, mainly due to diagnostic difficulties. The diagnosis of CPA is based on pulmonary symptoms and chest computed tomography (CT) scans and is considered confirmed when there is microbiological or serological evidence of Aspergillus spp. infection. Objectives To estimate the prevalence of CPA in patients treated or undergoing treatment for PTB, seen in two referral hospitals in Mato Grosso do Sul, Brazil. Patients and Methods A total of 193 consecutive patients who were treated or previously treated for pulmonary tuberculosis underwent prospective evaluation: (a) clinical evaluation; (b) chest CT scan; (c) sputum examination—culture for fungi and smears for direct mycology; (d) detection of anti‐Aspergillus fumigatus antibodies using an enzyme‐linked immunosorbent assay Platelia® test; and (e) anti‐Aspergillus spp. antibodies were assessed via a DID test. Results The global prevalence of CPA was 10.9% (95% confidence interval, 7.2%–16.1%), but it increased with the time of TB diagnosis. The variables independently associated with CPA were previous pulmonary tuberculosis over 4 years ago and haemoptysis. Cavities, pleural thickening and the presence of a fungal ball were the most frequent tomographic findings in patients with CPA. Conclusions The high prevalence observed and its increase over time suggest the need for continuous surveillance of CPA in patients with active or previous pulmonary tuberculosis and throughout life, with clinical, tomographic and serological evaluations (ELISA) for a timely diagnosis and a better prognosis.

This is an open-access article distributed under the terms of the Creative Commons Attribution License.

Rationale: Melioidosis is an emerging infectious disease in Brazil and caused by Burkholderia pseudomallei, with high morbidity and mortality rates. A total of 28 melioidosis cases were reported in Brazil until 2015. The majority of melioidosis cases were reported in the Northwest region of Brazil and such cases were not previously detected in the Midwest region of Brazil. Patient concerns: A 42-year-old man was admitted with a non-productive cough, dyspnea, myalgia, diffuse abdominal pain. Pulmonary auscultation revealed a vesicular murmur, snoring sounds, and the presence of basal crackling rales in the left hemithorax. The patient evolved with several respiratory failures and he was diagnosed as the first case of community-acquired pneumonia with sepsis caused by B pseudomallei in Mato Grosso do Sul, Midwest state of Brazil. Diagnosis: The cell isolates were subjected to 16S rRNA gene sequencing to confirm the bacterial species. Interventions: Administration of trimethoprim/sulfamethoxazole and meropenem stabilized the clinical condition of the patient. Subsequently upon discharge, the patient was also treated with trimethoprim/sulfametothoxazole for a year. Outcome: We reported the first case of community-acquired pneumonia with sepsis caused by B pseudomallei in Mato Grosso do Sul, Midwest state of Brazil and the patient survived. Lessons: The emergence of melioidosis in the Midwest region is being neglected and underestimated and melioidosis must be considered of the differential diagnosis in community infections.