Group A Streptococcus emm gene types in pharyngeal isolates, Ontario, Canada, 2002-2010

Group A Streptococcus (GAS) is a human-adapted pathogen that causes a variety of diseases, including pharyngitis and invasive infections. GAS strains are categorized by variation in the nucleotide sequence of the gene (emm) that encodes the M protein. To identify the emm types of GAS strains causing pharyngitis in Ontario, Canada, we sequenced the hypervariable region of the emm gene in 4,635 pharyngeal GAS isolates collected during 2002-2010. The most prevalent emm types varied little from year to year. In contrast, fine-scale geographic analysis identified inter-site variability in the most common emm types. Additionally, we observed fluctuations in yearly frequency of emm3 strains from pharyngitis patients that coincided with peaks of emm3 invasive infections. We also discovered a striking increase in frequency of emm89 strains among isolates from patients with pharyngitis and invasive disease. These findings about the epidemiology of GAS are potentially useful for vaccine research.     

Clinical Outcomes of Eradication of Helicobacter pylori in Nonulcer Dyspepsia in a Population with a High Prevalence of Infection: Results of a 12-Month Randomized, Double Blind, Placebo-Controlled Study

Ninety-one Helicobacter pylori-positive patients with nonulcer dyspepsia were randomized to receive either lansoprazole, amoxicillin, and clarithromycin or lansoprazole and placebo. A validated questionnaire assessed dyspeptic symptoms at baseline and at 3, 6, and 12 months. Endoscopies and biopsies were performed at baseline and at 3 and 12 months. There was an overall trend, although not statistically significant, for a benefit of H. pylori eradication. Of the patients in the antibiotics group, 16 of 46 (35%) had symptomatic improvement, versus 9 of 43 (21%) in the control group (P = 0.164). In a secondary analysis, it was found that of the patients without endoscopic gastric erosions, 15 of 34 (44%) in the antibiotics group and 5 of 33 (15%) of controls had symptomatic improvement (P = 0.015). Helicobacter pylori eradication did not prove to be clinically beneficial, although a tendency to symptomatic benefit was detected. Further studies are necessary to confirm the implications of endoscopic gastric erosions in these patients. Abbott Laboratórios do Brasil Ltda. donated the drugs used in this clinical trial. The Research Incentive Fund (FIPE) and the Graduate Research Group at Hospital de Clínicas de Porto Alegre provided editorial support. No member of the research team received any remuneration to conduct this study.     

Assessment of the perception of physical competence in Brazilian adolescents of different nutritional status

Purpose

Considering the increase in the prevalence of overweight and obese adolescents, this study aimed to analyze the perception of physical competence in Brazilian adolescents of different nutritional status.

Methods

A population-based cross-sectional study was performed and included 2.757 (15?±?4 years-old) adolescent students (1.302 boys, 1.455 girls) from south of Brazil. Strength, flexibility, and aerobic endurance questions were used to evaluate the perception of physical competence. To evaluate nutritional status, body mass index (BMI) was used.

Results

The prevalence of overweight and obesity in adolescents was 21.2%, with 25.4% for boys and 17.5% for girls. Girls with lower perception of aerobic endurance were more likely to be overweight/obese. Boys with a poor perception of flexibility were about 10 times more likely to be overweight/obese. Adolescents with a weak and moderate perception of strength were less likely to be overweight/obese.

Conclusion

We concluded that perception of physical competence differs depending on the nutritional status of adolescents. Lower perceptions of aerobic endurance and flexibility favor the development of overweight and obese adolescents. However, greater perception of strength competence mostly appears in overweight/obese adolescents.

     

Treatment of tinea pedis with a single pulse of itraconazole

An open-design, prospective, non-comparative study was conducted to evaluate the efficacy and safety of itraconazole in the treatment of tinea pedis (interdigital-type, hyperkeratotic-type and the combination of both). Treatment consisted of one pulse of itraconazole, meaning that each patient received 400 mg/day for one week. Clinical and mycologic control examinations were performed at baseline and at the end of treatment; follow-up visits took place at 30 and 60 days after the last medication administration. A total of 44 patients were evaluated. The major causal agent isolated was Trichophyton rubrum (93%). At the final follow-up visit (60 days), 37 cases (84.4%) achieved clinical and mycologic cure; 5 (11.3%) had improvement and 2 cases (4.5%) failed. Three cases reported side effects attributable to itraconazole (6.6%); one patient had a moderate headache and two reported moderate dyspepsia. None of the 3 cases required discontinuation of the medication. We concluded that the administration of one pulse of itraconazole is an effective, safe and short regimen to treat tinea pedis.     

Onychomycosis in children: treatment with bifonazole-urea

We assessed the safety and efficacy of a two-phase topical treatment with bifonazole-urea ointment in children with onychomycosis. Twenty-five children younger than 16 years old with proved onychomycosis were included in the study. Bifonazole-urea ointment was administered under occlusion until the nontraumatic removal of the nail was achieved. Bifonazole cream was then applied for 4 weeks and a follow-up visit 4 weeks after cessation of medication was scheduled. During the study, periodic clinical and mycologic evaluations were carried out. Of the 25 patients included, 17 were cured (68%), 6 improved, and 2 failed treatment. The main etiologic agent isolated was Trichophyton rubrum (92%). Two patients had minor side effects, both during the occlusive phase, one each with mild pain and a probable dermatitis from the adhesive strips. Treatment was not discontinued in both of these cases. We concluded that a two-phase treatment with bifonazole-urea is effective and safe, and represents a new therapeutic choice for onychomycosis in children.     

Cutaneous histoplasmosis associated with acquired immunodeficiency syndrome (AIDS)

A 30‐year‐old man, who had originally been admitted to the Centro Dermatológico Pascua for medical attention and was later transferred to the Hospital General de México, presented with a 2‐month history of progressive dermatosis affecting the head (face, ear lobes, oral cavity), trunk (all faces), upper and lower limbs (including the palms and soles), external genitalia, and the perianal region. The patient had no history of homosexuality, but did have a long history of sexual intercourse with prostitutes in the city of Ciudad del Carmen (island in southeastern Mexico), where he was born and lives. The dermatosis consisted of multiple nodules and ulcerative lesions, some of them isolated and others with junctions between them, forming verrucous plaques. He complained of mild pruritus and pain. The lesions had first appeared on the face and, over the course of 2 months, had increased in size and number and were accompanied by malaise, fever, and loss of 6 kg of body weight ( Fig. 1 ). The presumptive clinical diagnosis was leishmaniasis, an endemic disease in the area where he lives. Laboratory parameters at presentation included the following: hemoglobin 11.5 g/dL; hematocrit 34%; white blood cells (WBC) total 7900 cells/mm³ ; lymphocytes total 1414 cells/mm³ ; platelets 449,000/mm³ ; CD4+ lymphocytes 1.5% and CD8+ lymphocytes 81.0%, with a CD4/CD8 ratio of 0.18 cells/mm^3. Blood chemistry, hepatic function tests, and serum electrolyte determinations were all within normal ranges. A chest roentgenogram was also normal. Human immunodeficiency virus (HIV) seropositivity was tested by enzyme‐linked immunosorbent assay (ELISA) and confirmed by Western blot.

Figure 1 Open in figure viewer PowerPoint Initial lesions: nodules, ulcers, and verrucous lesions involving the face     

Chromoblastomycosis: clinical and mycologic experience of 51 cases

This is a study of 51 cases of chromoblastomycosis detected in a 17-year period, all of which were clinically and mycologically proven by direct examinations, cultures and biopsies. The therapeutic results of the various treatments used are reported. Most cases were males (36 of 51; 70%), the mean age was 35 years and farmers predominated (74%); the most frequent lesions were in the lower limbs (54%). Major clinical presentations were nodular (41%) and verrucous (26%). The principal aetiologic agent isolated was Fonsecaea pedrosoi (90%). Overall results of the various treatments were as follows: 31% were cured, 57% improved and 12% failed. The best results were obtained with cryosurgery for small lesions, with itraconazole for large ones, and in some cases the combination of both treatments.     

Current antifungal treatment of fusariosis

Fungi of the genus Fusarium are well known as major plant pathogens and soil inhabitants, but also cause a broad spectrum of human infections. Fusariosis is the second most common mould infection after aspergillosis, and keratitis is the most encountered implantation infection in immunocompetent individuals. Natamycin is active against Fusarium species both in vitro and in vivo, and is used along with voriconazole as the mainstay of treatment for Fusarium keratitis. Onychomycosis is treated with terbinafine, voriconazole and sometimes itraconazole. Cure is possible despite high in vitro minimum inhibitory concentrations (MICs). Recently, disseminated infections have increased dramatically, mainly affecting severely immunocompromised patients. The remarkable intrinsic resistance of Fusarium species to most antifungal agents results in high mortality rates in this patient population. Recovery of neutropenia is essential for patient survival and treatment should include voriconazole or amphotericin B as first–line and posaconazole as salvage therapy.     

What is the minimum length of gltA gene required for phylogenetic analyzes in Bartonella?

Bartonellosis is an emerging serious diseases of zoonotic relevance caused by an expanding number of recently discovered species of Bartonella. Many studies use partial gltA gene sequencing as the method of choice for species attribution, and a plethora of studies have utilized only this gene to describe Bartonella diversity. We observe a lack of correspondence between the phylogenies constructed using the complete gltA gene sequences and the small gene fragment usually used in phylogenetic analyzes. Everything indicates that important changes occurred by using larger fragments. Therefore, it is of great importance to define a minimum gltA fragment length to be used in future phylogenetic analyzes, besides the use of other genes.