Corynebacterium diphtheriae still represents a global medical challenge, particularly due to the significant number of individuals susceptible to diphtheria and the emergence of non-toxigenic strains as the causative agents of invasive infections. In this study, we characterized the clinical and microbiological features of what we believe to be the first case of C. diphtheriae infection of a percutaneous nephrostomy catheter insertion site in an elderly patient with a fatal bladder cancer. Moreover, we demonstrated the potential role of adherence, biofilm formation and fibrin deposition traits in C. diphtheriae from the catheter-related infection. Non-toxigenic C. diphtheriae isolated from the purulent discharge (named strain BR-CAT5003748) was identified by the API Coryne system (code 1 010 324) and a multiplex PCR for detection of dtxR and tox genes. Strain BR-CAT5003748 showed resistance to oxacillin, ceftazidime and ciprofloxacin. In experiments performed in vitro, the catheter isolate was classified as moderately hydrophobic and as moderately adherent to polystyrene surfaces. Glass provided a more effective surface for biofilm formation than polystyrene. Micro-organisms adhered to (.1.5¾10 6 c.f.u.) and multiplied on surfaces of polyurethane catheters. Microcolony formation (a hallmark of biofilm formation) and amorphous accretions were observed by scanning electron microscopy on both external and luminal catheter surfaces. Micro-organisms yielded simultaneous expression of localized adherence-like and aggregative-like (LAL/AAL) adherence patterns to HEp-2 cells. Interestingly, the coagulase tube test resulted in the formation of a thin layer of fibrin embedded in rabbit plasma by the non-toxigenic BR-CAT5003748 strain. In conclusion, C. diphtheriae should be recognized as a potential cause of catheter-related infections in at-risk populations such as elderly and cancer patients. LAL/AAL strains may be associated with virulence traits that enable C. diphtheriae to effectively produce biofilms on catheter surfaces. Biofilm formation and fibrin deposition could have contributed to the persistence of C. diphtheriae at the infected insertion site and the obstruction of the nephrostomy catheter.
INTRODUCTIONInfections due to bacteria that form biofilms are a clinical problem (Donlan, 2001;Rao et al., 2008 Non-diphtherial corynebacteria have been reported to be infecting pathogens or copathogens in at-risk populations such as immunocompromised patients and patients with indwelling medical devices (Cavendish et al., 1994;Esteban et al., 1999;Wang et al., 2001;Dobler & Braveny, 2003;Schiffl et al., 2004;Lee et al., 2005;Teixido et al., 2007;Dalal & Likhi, 2008).Corynebacterium diphtheriae infections represent a global medical challenge, particularly due to the significant rise in the percentage of adults susceptible to diphtheria (MattosGuaraldi et al., 2001) and the emergence of non-toxigenic strains as the causative agents of endocarditis and other systemic infections . This pathogen is also becoming successful i...
The increasing problems with multidrug resistance in relation to mupirocin, aztreonam, ceftazidime, and/or oxacillin, ampicillin, penicillin, tetracycline, clindamycin, lincomycin, and erythromycin. This study presents the antimicrobial susceptibility profiles of Brazilian C. diphtheriae isolates. The data are of value to practitioners, and suggest that some concern exists regarding the use of penicillin.
Corynebacterium ulcerans was isolated from nares of one asymptomatic dog kept in an animal shelter in the metropolitan area of Rio de Janeiro, Brazil. The RNA polymerase beta subunit-encoding gene was sequenced to confirm the species identity. C. ulcerans strains producing phospholipase D, but not diphtheria toxin, are able to cause severe disease in humans, such as pneumonia and granulomatous nodules in pulmonary tissues. The infection rate varies really widely by region, probably because of the variations in the reported infection rates. Dogs with unapparent C. ulcerans infections may be considered as potentially capable of infecting other animals and humans, including pet owners. Medical and veterinary staff should be aware that asymptomatic animals can carry C. ulcerans and cooperate in eliminating infections and monitoring animals also in the developing countries.
This study sought to compare the myoelectric activity of the hip adductors (HAs) and rectus femoris (RF) when the hip was in a neutral position or externally rotated by 30° or 50° (H0, H30, and H50, respectively) during a parallel squat. Ten healthy subjects performed 10 repetitions of squats in each of the 3 hip positions and the myoelectric activities of the HAs and RF were recorded. The signal was then divided into categories representing concentric (C) and eccentric (E) contractions in the following ranges of motion: 0-30° (C1 and E1), 30-60° (C2 and E2), and 60-90° (C3 and E3) of knee flexion. From those signals, an root mean square (RMS) value for each range of motion in each hip position was obtained. All values were normalized to those obtained during maximum voluntary isometric contraction. We found that HAs showed a significant increase in myoelectric activity during C3 and E3 in the H30 and H50 positions, as compared with H0. Meanwhile, RF activity did not significantly differ between hip positions. Both muscles showed higher activation during 60-90° (C3 and E3) of knee flexion, as compared with 0-30° (C1 and E1) and 30-60° (C2 and E2). The results suggest that if the aim is to increase HA activity despite the low percentage of muscle activation, squats should be performed with 30° of external rotation and at least 90° of knee flexion.
The frequency and severity of human infections associated with Corynebacterium ulcerans appear to be increasing in different countries. Here, we describe the first C. ulcerans strain producing a diphtheria-like toxin isolated from an elderly woman with a fatal pulmonary infection and a history of leg skin ulcers in the Rio de Janeiro metropolitan area.
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