Urethritis caused by Neisseria meningitidis in heterosexual patients is presumed to occur via orogenital contact, but confirmation has not been possible in most cases. Presented here is a case of urethritis caused by N. meningitidis, serogroup C, and the isolation of the same microorganism from the nasopharynx and endocervix of the patient's sexual partner. The similarity of the urethral and nasopharyngeal isolates' electrophoretic patterns, obtained using pulsed-field gel electrophoresis, proves the infection was transmitted via orogenital contact.
The usefulness of single-enzyme amplified-fragment length polymorphism (AFLP) analysis for the subtyping of Mycobacterium kansasii type I isolates was evaluated. This simplified technique classified 253 type I strains into 12 distinct clusters. The discriminating power of this technique was high, and the technique easily distinguished between the epidemiologically unrelated control strains and our clinical isolates. Overall, the technique was relatively rapid and technically simple, yet it gave reproducible and discriminatory results. This technique provides a powerful typing tool which may be helpful in solving many questions concerning the reservoirs, pathogenicities, and modes of transmission of these isolates.Mycobacterium kansasii is the most common cause of pulmonary nontuberculous mycobacterial infection in the nonhuman immunodeficiency virus-infected population in many parts of the world (4,6,9,12,16,19,25). Of all nontuberculous mycobacterial diseases, the clinical course of M. kansasii lung disease most closely parallels that caused by M. tuberculosis infection (12,36). Although it has seldom been recovered from soil (10, 22), M. kansasii has frequently been isolated from tap water and is thought to be acquired from the environment rather than by case-to-case transmission (8,17,18,20,24,29,31,37).The first typing method developed for M. kansasii was phage typing. Other features, especially catalase activity, have been used to type M. kansasii isolates. Isolates with high catalase activities were considered more virulent (23). Analysis of the 16S rRNA sequence (27), amplification of the 16S-23S rRNA spacer region (1), PCR-restriction fragment length polymorphism (RFLP) analysis of the hsp65 gene (7, 33), and detection of insertion sequence element IS1652 (38) showed that M. kansasii contains a subspecies genetically distinct from the typical M. kansasii isolates.M. kansasii has been classified into five subspecies or types (types I to V) on the basis of PCR-RFLP analysis of the hsp65 gene (7, 33). These results have been confirmed by differences in the sequences of the 16S-23S rRNA spacer region (2) and by RFLP analysis with the major polymorphic tandem repeat probe (23). Recently, two new types (types VI and VII) have been described (26,32). Of the seven types identified, M. kansasii type I is the most prevalent type from human sources worldwide. Moreover, large restriction fragment-pulsed-field gel electrophoresis (LRF-PFGE) (2, 14, 23), amplified-fragment length polymorphism (AFLP) analysis (23), and randomly amplified polymorphic DNA analysis (2) have produced polymorphic patterns within each type.By use of these typing methods, minimal genetic polymorphism was noted among type I strains. These results gave the impression that type I shows substantial clonality (21). This apparent clonality may have resulted from the insufficient discriminatory powers of the techniques used. Solutions to questions about the reservoirs, pathogenicities, and modes of transmission of these isolates require more discrim...
We analyzed 239 febrile infants <3 months of age with a positive urine culture to examine their characteristics. Patients with altered urine dipstick showed more commonly alterations of the biologic markers for bacterial infection, and Escherichia coli was more commonly isolated. Febrile young infants with positive urine culture and negative urine dipstick may not have a urinary tract infection and less aggressive management can be considered.
Recent studies suggest an increasing prevalence of nontuberculous mycobacteria (NTM) lung disease. The aim of the present study was to describe incidence rates of NTM lung disease and trends therein in our area over a 20-year period.This was a retrospective study of all cases of NTM lung disease between 1997 and 2016 that met the 2007 American Thoracic Society criteria. We analysed the annual incidence rates, species of mycobacteria isolated, trends over time and annual mortality in 327 patients.Mycobacterium kansasii was the most common mycobacterium isolated (84%), followed by Mycobacterium avium complex (MAC) (13%). We compared two periods: 1997–2006 (257 cases, 79%) and 2007–2016 (70 cases, 21%). The incidence rates tended to decrease across these years, with a peak of incidence in 2000 with 10.6 cases per 100 000. There was a clearly decreasing trend in M. kansasii infection, not only in the first period (incident rate ratio (IRR) 0.915, 95% CI 0.88–0.90; p<0.0001) but also in the second (IRR 0.869, 95% CI 0.780–1.014; p=0.080), reaching 1.8 per 100 000 in 2016. In contrast, MAC infection tended to increase across the two periods (IRR 1.251, 95% CI 1.081–1.447; p=0.003).In our region, the incidence of NTM lung disease has notably decreased in recent years. M. kansasii had high incidence rates in the first decade but clearly decreased in the second decade.
Yersinia enterocolitica synthesized an exocellular antigen common to the serotypes associated with enterocolitis but absent from other serotypes or from other Yersinia species. Both virulent Ca2+-dependent and avirulent Ca2+-independent isogenic pairs derived from the enterocolitis-associated serotypes synthesized the common antigen. Requirements for the synthesis of this common antigen were (i) the presence of metabolizable sugars and (ii) growth on a solid medium at 37°C. The antigen was identified as a 24,000-dalton protein loosely associated with the cell surface but absent from either the cell envelope or the cytoplasmic fraction.
SARS-CoV-2 is the agent responsible for COVID-19, the current pandemic, which is characterized by developing respiratory disturbances that are associated with severe hypoxemia associated with symptoms of non-bacterial pneumonia, ARDS up to multi-organ failure. It has been characterized by presenting 2 different phenotypes (phenotype L and phenotype H), with phenotype H being a stage of progressive deterioration of phenotype L, which depends on the earliness with which ventilatory management begins and the degree of inflammatory compromise. However, since VMI can generate VILI, the use of protective ventilation has been recommended as a ventilatory strategy for COVID-19. This review aims to comment on the available evidence of the essential aspects of protective IMV in the context of ARDS associated with COVID-19, in addition to the use of neuromuscular blockade and prone strategies.
Molecular epidemiology of circulating clinical isolates is crucial to improve prevention strategies. The Spanish Working Group on multidrug resistant tuberculosis (MDR-TB) is a network that monitors the MDR-TB isolates in Spain since 1998. The aim of this study was to present the study of the MDR-TB and extensively drug-resistant tuberculosis (XDR-TB) patterns in Spain using the different recommended genotyping methods over time by a national coordinated system. Based on the proposed genotyping methods in the European Union until 2018, the preservation of one method, MIRU-VNTR, applied to selected clustered strains permitted to maintain our study open for 20 years. The distribution of demographic, clinical and epidemiological characteristics of clustered and non-clustered cases of MDR/XDR tuberculosis with proportion differences as assessed by Pearson’s chi-squared or Fisher’s exact test was compared. The differences in the quantitative variables using the Student's-t test and the Mann–Whitney U test were evaluated. The results obtained showed a total of 48.4% of the cases grouped in 77 clusters. Younger age groups, having a known TB case contact (10.2% vs 4.7%) and XDR-TB (16.5% vs 1.8%) were significantly associated with clustering. The largest cluster corresponded to a Mycobacterium bovis strain mainly spread during the nineties. A total of 68.4% of the clusters detected were distributed among the different Spanish regions and six clusters involving 104 cases were grouped in 17 and 18 years. Comparison of the genotypes obtained with those European genotypes included in The European Surveillance System (TESSy) showed that 87 cases had become part of 20 European clusters. The continuity of MDR strain genotyping in time has offered a widespread picture of the situation that allows better management of this public health problem. It also shows the advantage of maintaining one genotyping method over time, which allowed the comparison between ancient, present and future samples.
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