Coxiella burnetii est l’agent pathogène responsable de la fièvre Q. Dans le cadre de cette thèse nous nous sommes intéressés à l'étude de souches de C.burnetii responsables d'événements épidémiques. Nous avons séquencé une souche de génotype MST33 (Z3055), proche de la souche responsable de l'épidémie de fièvre Q aux Pays-Bas, et une souche de génotype MST17 (Cb175) clone provoquant l'une des formes les plus virulentes de fièvre Q aiguë jamais décrite auparavant et retrouvée à ce jour uniquement en Guyane Française. Les résultats de ces analyses montrent que le génome de la souche Z3055 était très similaire à celui de la souche de référence Nine Mile I. Les différences observées sont liées à la présence de mutations non synonymes dans le génome de Z3055. Le pourcentage élevé de protéines membranaires mutées pourrait expliquer l’ampleur de cette épidémie en Hollande. En effet, le changement de profil antigénique pourrait être à l’origine de la formation d’un nouveau sérotype capable d'échapper à la réponse immunitaire de l'hôte et de diffuser facilement dans une population au système immunitaire naïf. Nous avons d’ailleurs montré que la souche responsable de la fièvre Q en Guyane (Cb175) présente des différences chromosomiques importantes par rapport à NMI. Ces différences se manifestent principalement par la présence d’une délétion d’une région de 6105pb contenant l’opéron hlyCABD du système de sécrétion de type 1 (T1SS). Ce résultat est cohérent avec ce qui a été observé chez les bactéries épidémiques les plus dangereuses comparées à leurs espèces non-épidémiques plus proches qui ont un génome réduit et contiennent moins de protéines du système de sécrétion. / Coxiella burnetii is a human pathogen that causes the zoonotic disease Q fever. In this work, we focused on the study of strains responsible for epidemic events. Particularly, we sequenced the clone of the strain responsible for Netherlands outbreak having genotype MST33 (Z3055), and strain having MST17 (Cb175) responsible for one of the most severe form of acute Q fever never reported in literature and uniquely described in French Guiana. Our findings showed that the Netherlands outbreak responsible strain (clone Z3055) was highly similar to the reference strain Nine Mile I. Only slight differences were observed, which were related to non-synonymous mutations in Z3055 genome. The high proportion of mutated membrane proteins could explain this large-scale outbreak. Change of antigenic profile may have led to a new serotype, conferring to the novel clone the capacity to escape the host immune response and to disseminate easily in a immunologically naïve population. On the contrary, the type strain responsible for Q fever in Guiana (Cb175) showed an important difference in its chromosome sequence compared to the reference NMI because of the deletion of a sequence of 6105bp containing the Type 1 secretion systems (T1SS) hlyCABD operon. This result appear consistent with previous findings that showed the most dangerous epidemic bacteria compared with their closest non-epidemic species are characterized by reduced genomes accompanied by significant decrease in ORF content and contain less secretion system proteins.

Endocardite infecciosa é uma doença associada à elevada morbidade e letalidade. O diagnóstico precoce e o reconhecimento de sua etiologia podem contribuir para o sucesso do tratamento antibiótico; entretanto, cerca de um quarto das endocardites permanece sem diagnóstico etiológico. Este estudo teve como objetivo principal identificar a frequência de endocardite por Bartonella spp. e Coxiella burnetii dentre as endocardites com culturas negativas comunitárias e avaliar os fatores preditores dessas infecções. Como objetivo secundário compararam-se as características clínicolaboratoriais e prognósticas entre as endocardites comunitárias com culturas negativas e positivas. Foram avaliados também os fatores associados à letalidade intra-hospitalar das endocardites com culturas negativas. Entre janeiro de 2004 e janeiro de 2009, foram investigados 369 episódios consecutivos de endocardite em pacientes atendidos no Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - InCor HC-FMUSP. Foram estudados os casos que ocorreram em adultos, classificados pelos critérios de Duke modificados como \"endocardite definida\" e de origem comunitária. Assim, foram incluídos 221 episódios de endocardite, 170 com culturas positivas e 51 com culturas negativas. Neste último grupo, foram feitas as pesquisas sorológicas (reação de imunofluorescência indireta) e histopatológica de Bartonella spp. e Coxiella burnetii. Consideraram-se positivos títulos de imunoglobulina G (IgG) >= 800 para Bartonella henselae e ou Bartonella quintana, e IgG antifase I para C. burnetii > 800. O estudo histopatológico das valvas cardíacas foi capaz de identificar morfologicamente a etiologia de 87% das endocardites com culturas negativas, enquanto que o método de Gram do tecido a fresco o fez em somente 10% dos casos. As endocardites com culturas negativas apresentaram maior frequência de dispneia à admissão (p=0,001), menor valor de proteína C reativa (p=0,009), menor Fração de Ejeção do Ventrículo Esquerdo (Feve) (p=0,022) e necessitaram de mais tempo para o início do tratamento antibiótico para endocardite (p < 0,001) quando comparadas àquelas com culturas positivas. Não houve diferença estatisticamente significante entre os grupos na letalidade intra-hospitalar e na sobrevida após alta hospitalar. Verificou-se que a presença de diabetes mellitus (p=0,009) ou sepse grave na admissão (p=0,01) esteve independentemente associada ao óbito intra-hospitalar entre as endocardites com culturas negativas. Dez casos de endocardite por Bartonella spp. (frequência 19,6% [IC95%: 9,8 - 33,1]) e quatro casos de endocardite por Coxiella burnetii (frequência 7,8% [IC95%: 2,2 - 18,9]) foram diagnosticados dentre os 51 episódios de endocardite com culturas negativas. As endocardites por Bartonella spp. apresentavam menor Feve (p=0,025), associação com a identificação de cocobacilo Gram-negativo no exame histológico da valva cardíaca (p=0,001) e presença de gato no domicílio (p=0,001). Conclusões: Bartonella spp. e Coxiella burnetii foram as etiologias de quase um terço (27,5%) das endocardites comunitárias com culturas negativas. A presença de gato no domicílio, Feve <= 45%, e a identificação de cocobacilo Gramnegativo no exame histológico da valva cardíaca em pacientes com endocardite com culturas negativas parecem estar associadas à infecção por Bartonella spp. O exame histológico da valva cardíaca permitiu a identificação morfológica do micro-organismo na maioria dos casos, mesmo quando as hemoculturas estavam negativas. Não se observou diferença na letalidade intra-hospitalar e na sobrevida em longo prazo entre os dois grupos. A presença de diabetes mellitus ou sepse grave à admissão associou-se ao óbito hospitalar nas endocardites com culturas negativas / Infective endocarditis is associated with high morbidity and lethality. Early diagnosis and recognition of the specific etiology can contribute to successful antibiotic treatment. However, approximately one-fourth of endocarditis cases remain without an etiologic diagnosis. This study aimed to identify the frequency of endocarditis caused by Bartonella spp. and Coxiella burnetii among cases of community-acquired culture-negative endocarditis and to also assess risk factors for such infections. As a secondary objective, the clinical, laboratory and prognostic features of community-acquired endocarditis were compared. Factors related to the in-hospital lethality of culture-negative endocarditis were also assessed. Between January 2004 and January 2009, 369 consecutive cases of endocarditis were investigated in patients attending the no Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - InCor HC-FMUSP. Cases occurring in adults, those classified by the modified Duke criteria as \"defined endocarditis\" and community-acquired cases were studied. In total, 221 cases of endocarditis comprising 170 culture-positive and 51 culturenegative cases were included. For the culture-negative cases, serology (indirect immunofluorescence reaction) and histopathological analyses for Bartonella spp. and Coxiella burnetii were performed. Cases were considered positive for Bartonella henselae or Bartonella quintana with IgG titers >= 800 and for Coxiella burnetii with antiphase I IgG titers > 800. Histopathological studies of the cardiac valves were capable of morphologically identifying the etiology in 87% of the culture-negative endocarditis cases, whereas the Gram stain was only positive in 10% of cases using fresh tissue. Culture-negative endocarditis patients presented a greater frequency of dyspnea on admission (p=0.001), lower C-reactive protein levels (p=0.009), and a lower left ventricular ejection fraction (LVEF) (p=0.022), and they required more time to start antibiotic therapy (p < 0.001) when compared with culture-positive patients. There was no statistically significant difference between the two groups regarding in-hospital lethality or survival after hospital discharge. Diabetes mellitus (p=0.01) or severe sepsis on admission (p=0.01) were independently associated with in-hospital death for culture-negative endocarditis. Ten cases of endocarditis caused by Bartonella spp. (frequency 19.6% [IC95%: 9.8 - 33.1]) and 4 caused by Coxiella burnetii (frequency 7.8% [IC95%: 2.2 - 18.9]) were diagnosed among the 51 cases of culture-negative endocarditis. Endocarditis caused by Bartonella spp. was associated with lower LVEF values (p=0.025), the identification of Gram-negative coccobacilli in cardiac valve histology (p=0.001) and the presence of a cat in the patient\'s residence (p=0.001). Conclusions: Bartonella spp. and Coxiella burnetii were the causative etiology of almost one-third (27.5%) of the community-acquired cases of culture-negative endocarditis. The presence of a cat in the patient\'s residence, a LVEF <= 45% and the identification of Gram-negative coccobacilli in the histological examination of the cardiac valve in patients with culturenegative endocarditis appear to be associated with Bartonella spp. as the causative etiology. Histological examination of the cardiac valves allowed for morphological identification of the causative microorganism in the majority of cases, even when blood cultures were negative. There was no difference in in-hospital lethality or long-term survival between the two groups. The presence of diabetes mellitus or severe sepsis at admission was associated with in-hospital death in cases of culture-negative endocarditis

Parmi les nombreuses pathologies infectieuses dignes d’intérêt en Guyane, deux d’entre elles, deux zoonoses, ont connu récemment un regain d’intérêt conduisant en quelques années à améliorer nettement leur connaissance, mais également découvrir des particularités épidémiologiques inattendues qui nous ont amené à nous poser la question de leur caractère émergent ou réémergent. Bien que cosmopolite et à tropisme tropical, la leptospirose n’a que peu été décrite en Guyane et sur le bouclier des Guyanes. La littérature repose sur des cas cliniques ou série de cas anciens, la dernière publication remontant à 1995. Sont présentées ici plusieurs études qui ont permis d’en savoir un peu plus sur cette infection bactérienne : revue exhaustive de la littérature, étude rétrospective des rapports du CNR, étude rétrospective multicentrique sur les leptospiroses prises en charge en Guyane entre 2007 et 2014, avec analyse de ses déterminants, démographiques, écologiques, cliniques, séro-épidémiologique, comparaison de ses formes graves à celles d’Afrique du Nord. Bien que sa présence ait été identifiée dès les années 50 en Guyane, la fièvre Q ou infection à Coxiella burnetii, n’avait suscité localement aucun intérêt jusqu’à la fin des années 1990. Le travail ici présente la progression des connaissances sur cette infection bactérienne, également cosmopolite, mais avec des spécificités locales tout à fait inédites. Au fil des découvertes sur cette bactérie à la sauce guyanaise, nous présenterons la contribution de notre équipe à la progression du savoir sur cette pathologie et l’apport de réponses amenant tout autant de nouvelles. Ainsi les réflexions portent autour de ce génotype si particulier, le MST17, trouvé exclusivement en Guyane, qui entraine l’incidence la plus élevée au monde de la fièvre Q, une prévalence élevée parmi les pneumopathies retrouvée nulle ailleurs. En outre, le cycle épidémiologique de la bactérie, habituellement fondé sur le bétail, semble ici suivre un tout autre chemin et trouver son réservoir dans la faune sauvage. L’on s’interroge également sur le contraste entre le problème de santé publique majeur que cette maladie représente en Guyane et le caractère tout juste anecdotique dans le reste de l’Amérique latine.Finalement, bien que ces deux zoonoses puissent être qualifiées de « maladies nouvelles » en Guyane, il s’agit probablement pour la leptospirose d’une augmentation récente du nombre de cas lié à l’amélioration des techniques diagnostiques et à la sensibilisation des médecins à cette maladie, tandis que la fièvre Q semble présenter un véritable profil émergent, avec augmentation récente de son incidence, et de nombreuses inconnues lié à un génotype très particulier.Plusieurs questions concernant ces deux infections restent encore sans réponse, et le travail est immense pour mieux comprendre les enjeux de ces deux maladies, tant à l’échelle de la Guyane qu’à celle du continent latino-américain. / Among the numerous infectious diseases of interest in French Guiana (FG), two of them, two zoonoses, have recently experienced a revival of interest leading in a few years to a marked improvement in their knowledge. Several studies allowed as well discovering unexpected epidemiological features that have led us to question their emerging or reemerging character.Although cosmopolitan and with tropical a tropism, leptospirosis has been barely described in FG and on the Guiana Shield. The literature is old and reports only clinical cases or series, the most recent publication dating back to 1995. Several studies are presented in this work which have allowed to know a little more about this bacterial infection: exhaustive review of the literature, retrospective study of the reference national center reports, a retrospective multicenter study on leptos-piroses managed in FG between 2007 and 2014, with analysis of its determinants, demographic, ecological, clinical, sero-epidemiological, and a study comparing Guianese severe forms to those of North Africa.Although its presence had been suspected as early as the 1950s in FG, Q fever or Coxiella burnetii infection had not aroused interest locally until the late 1990s. The work here presents the progression of the knowledge of this bacterial infection, also cosmopolitan, but with unusual local specificities. In the course of the discoveries around this Guianese outbreak, we will present the contribution of our team to the progression of knowledge on this pathology and the contribution of answers bringing as much new questions. Thus the discussion will focus on this particular genotype, MST17, found exclusively in FG, which results in the highest incidence of Q fever in the world, a prevalence among pneumonias never found elsewhere. Moreover, the epidemiological cycle of the bacterium, usually based on livestock, seems to follow a completely different path and find its reservoir in wildlife. We also wonder about the contrast between the major public health problems that this disease represents in FG and the anecdotal character in the rest of Latin America.Finally, although these two zoonotic diseases may be described as "new diseases" in FG, it is likely that leptospirosis presents a recent increase in the number of cases related to the improvement of diagnostic techniques and the sensitization of physicians to this disease, but without real emergence, while Q fever seems to present a true emergent profile, with a recent increase in its incidence, and many unknowns linked to a very particular genotype.Many questions concerning these two infections remain unanswered, and the work is immense to better understand the stakes of these two diseases, both on the scale of FG and that of the Amazonian region and the Latin American continent.

Afin de déjouer les défenses immunitaires de l’hôte et créer les niches nécessaires à leur survie, les bactéries pathogènes mettent on œuvre de nombreux mécanismes ciblant les voies de signalisation de la cellule hôte. L’un de ces mécanismes repose sur la sécrétion de protéines bactériennes dans les cellules cibles afin de moduler directement leurs réseaux de signalisation. Cependant, les signaux, les senseurs et les effecteurs impliqués dans ces régulations sont encore peu ou mal connus. La détection de l’environnement dans la cellule hôte lors de l'infection est l’élément clé d’une réponse adaptée, et les systèmes de signalisation basés sur les mécanismes de phosphorylation sont indispensables à l'adaptation hôte-pathogène. L’aspect innovant de ce projet repose sur l’étude du rôle des Ser/Thr kinases et phosphatases sécrétées lors des interactions hôte-pathogène, modifiant ainsi la réponse globale de l’hôte durant l’infection. Pendant ma thèse, j’ai tout d’abord étudié le rôle d’une nouvelle protéine kinase bactérienne identifiée chez Coxiella burnetii, nommée CstK (Coxiella serine threonine Kinase). C. burnetii, l’agent étiologique de la zoonose appelée fièvre Q, modifie les défenses de la cellule hôte, permettant sa réplication dans des vacuoles spécifiques à l’intérieur de la cellule hôte. Par ailleurs, la sécrétion d’un grand nombre d’effecteurs bactériens est indispensable au détournement du phagosome par Coxiella. Nous ainsi avons démontré que cette potentielle protéine kinase, identifiée in silico dans le génome de C. burnetii, est capable de s’autophosphoryler et par conséquent possède une activité kinase. De plus, nous avons identifié différentes protéines spécifiques de la cellule hôte interagissant avec CstK à l'aide du modèle amibe Dictyostelium discoideum, un phagocyte professionnel eucaryote, permettant des études génétiques et biochimiques. Dans la deuxième partie de mon projet, je me suis intéressée au rôle d’une probable protéine sécrétée, la tyrosine phosphatase PtpA, durant l’infection par Staphylococcus aureus. Bien connue dans les hôpitaux, où elle est responsable de nombreuses maladies nosocomiales, cette bactérie possède un grand nombre de facteurs de virulence, responsables d’infections variées, et l’apparition exponentielle de souches multi-résistantes en font un problème majeur. Ce pathogène est capable d’envahir et de persister dans un grand nombre de types cellulaires différents chez l’Homme, en sécrétant des protéines effectrices qui vont moduler les réponses cellulaires. Nous avons démontré que PtpA était sécrétée durant la phase de croissance bactérienne, et pu déterminer que PtpA possédait une activité tyrosine phosphatase, régulée par la tyrosine kinase CapA1B2 de S. aureus. Enfin, en utilisant le modèle D. discoideum, nous avons pu identifier des protéines de l’hôte qui interagissent avec PtpA, mais leur rôle dans l’infection n’est pas encore connu. / Bacterial pathogens have developed diverse strategies towards host signalling pathways, in order to subvert the immune response and/or create permissive niches for their survival. One such strategy is based on the secretion of bacterial signalling proteins into the target host cells, thereby directly modulating the status of host signalling networks. Because the mechanisms involved are largely intractable to most in vivo analyses, very little is known about the signals, sensors, and effectors mediating these adaptations. Sensing the host environment is a key component to execute appropriate developmental programs, and the eukaryotic-like phosphosignaling systems in prokaryotes are emerging as equally important regulatory systems as the well-known eukaryotic systems, but the study of their functions is still in its infancy. The innovative aspect of this project resides in the study of the emerging role of secreted Ser/Thr kinases and phosphatases in the control of host-pathogen interactions thus modifying the global host response during infection. During my thesis, I first investigated the role of a novel bacterial protein kinase identified in Coxiella burnetii that we named CstK (Coxiella serine threonine Kinase). C. burnetii, the etiological agent of the emerging zoonosis Q fever, subverts host cell defenses, permitting its intracellular replication in specialized vacuoles within host cells. Secretion of a large number of bacterial effectors into host cell is absolutely required for rerouting the Coxiella phagosome. We demonstrated that this putative protein kinase identified by in silico analysis of the C. burnetii genome is able to autophosphorylate and undergoes in vitro phosphorylation. Moreover, we identified specific host cell proteins interacting with CstK, by the use of the model amoeba Dictyostelium discoideum, an eukaryotic professional phagocyte amenable to genetic and biochemical studies. In the second part of my project, I was interested in the role of a putative secreted protein tyrosine phosphatase (PtpA) during Staphylococcus aureus infection. Well-known in hospital-acquired diseases, this bacteria produces multiple virulence factors that lead to various severe diseases, and the increase of multi-resistant strains is a major concern. This pathogen has the ability to invade and persist in a number of different human host cell types, secreting effector proteins to modulate cellular responses. Here we demonstrated that PtpA is secreted during the bacterial growth. We also determined that PtpA presents a tyrosine phosphatase activity that is regulated by the tyrosine protein kinase CapA1B2 of S. aureus. At last, using the D. discoideum model, we identified some host proteins that interact with PtpA, but their link with infection still remain to be studied.

Submitted by Geandra Rodrigues (geandrar@gmail.com) on 2018-01-08T17:55:42Z No. of bitstreams: 1 letíciascafuttodefaria.pdf: 1095599 bytes, checksum: 1c63329ef1875b3086d3531350f36ccc (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-01-23T11:12:07Z (GMT) No. of bitstreams: 1 letíciascafuttodefaria.pdf: 1095599 bytes, checksum: 1c63329ef1875b3086d3531350f36ccc (MD5) / Made available in DSpace on 2018-01-23T11:12:07Z (GMT). No. of bitstreams: 1 letíciascafuttodefaria.pdf: 1095599 bytes, checksum: 1c63329ef1875b3086d3531350f36ccc (MD5) Previous issue date: 2017-08-22 / O objetivo desse trabalho foi estimar a prevalência de Coxiella burnetii em Queijo Minas Artesanal da microrregião do Serro e identificar os fatores associados à presença desse microrganismo nas propriedades estudadas. Foram sorteados aleatoriamente 55 produtores cadastrados no Instituto Mineiro de Agropecuária (IMA) para participar da pesquisa. Os produtores responderam a um questionário e foi coletada uma amostra de queijo de cada propriedade para representá-la. Nas amostras de queijo coletadas, foram realizadas as análises de Reação de Cadeia da Polimerase (PCR) para C. burnetii e sequenciamento dos produtos de DNA amplificados. Os dados provenientes das entrevistas e resultados das análises laboratoriais, uma vez sistematizados, formaram a base de dados do trabalho. A presença de DNA de C. burnetii foi considerada a variável dependente e as variáveis explicativas foram divididas em três grupos hierárquicos: distal (socioeconômicas e demográficas), intermediário (produção de queijo) e proximal (características do rebanho, produção de leite e ordenha). Os fatores associados à presença de C. burnetii nos queijos foram identificados por análises de regressão logística univariada e multivariada. Do total de amostras analisadas (n = 53), cinco (9,43%) apresentaram DNA de C. burnetii confirmado por sequenciamento. Os fatores associados com a presença de DNA de C. burnetii nos queijos foram: uso do pingo (soro- fermento) para a fabricação dos queijos (OR= 12,09), tipo de ordenha (OR= (16,45) e número de vacas em lactação (OR= 1,05). As variáveis que permaneceram no modelo final como explicativas para presença de C. burnetii nos queijos foram: número de vacas em lactação, tipo de ordenha e uso do pingo. A presença de DNA de C. burnetii nos queijos artesanais enfatiza, por um lado, a necessidade de medidas de controle mais rigorosas para que essa bactéria não esteja presente nos rebanhos de propriedades produtoras de queijos artesanais. Por outro lado, o conhecimento dos fatores associados à presença de C. burnetii nos queijos artesanais poderá auxiliar no estabelecimento de medidas preventivas e na criação de novas normas e legislação para a produção de queijos artesanais, já que essa lacuna na legislação seria algo para reflexão, dada a importância da febre Q para a saúde pública. / The objective of this study was to estimate the prevalence of Coxiella burnetii in Artisan Minas cheese of region of Serro and identify the factors associated with the presence of this organism in the properties studied. Were drawn at random 55 registered producers in the Instituto Mineiro de Agropecuária (IMA) to participate in the research. The producers responded to a questionnaire and was collected a sample of cheese at a property to represent her. The cheese samples collected, the analysis of reaction of polymerase chain reaction (PCR) to C. burnetii and sequencing of amplified DNA products. Data from the interviews and results of laboratory tests, once organized, form the basis of work data. The presence of DNA of C. burnetii was considered as the dependent variable and the explanatory variables were divided into three groups: hierarchical distal (socioeconomic and demographic), intermediate (cheese production) and proximally (characteristics of the herd, milk production and milk). The factors associated with the presence of C. burnetii in cheeses were identified by analysis of univariate and multivariate logistic regression. Of the total samples analyzed (n = 53), five (9.43%) presented DNA of C. burnetii confirmed by sequencing. The factors associated with the presence of DNA of C. burnetii in cheeses were: use of the pingo (serum- baking) for the manufacture of the cheeses (OR = 12.09), type of milking (OR = (16.45) and number of lactating cows (OR = 1.05). The variables that remained in the final model as explanatory for the presence of C. burnetii in cheeses were: number of lactating cows, milking and type use the pingo. The presence of DNA of C. burnetii in artisanal cheeses emphasizes, on the one hand, the need for more stringent control measures so that this bacteria is not present in flocks of artisanal cheese-producing properties. On the other hand, the knowledge of the factors associated with the presence of C. burnetii in artisanal cheeses may assist in establishing preventive measures and the creation of new standards and legislation for the production of artisanal cheeses, since this gap in the legislation would be something for reflection, given the importance of Q fever to public health.

C. burnetii est une bactérie intracellulaire strcite. Récemment, un milieu axénique, nommé ACCM 2 a été développé, et permet la culture de cette bactérie en atmosphère microaérophile. Nous avons testé si l’ajout d’acide urique dans le milieu de culture pouvait permettre une culture en milieu aérobie. Nous avons observé une croissance de C. burnetii incubée en conditions aérobies dans le milieu ACCM2 enrichi en acide urique. A Cayenne, en Guyane Française, les pneumopathies causées par C. burnetii sont fréquentes et sévères. Nous avons analysé le génome d’une souche isolée à Cayenne. Ce travail a mis en évidence une délétion de 6105 pb intéressant le gène du système de sécrétion de type 1 (T1SS). Cette réduction de génome est probablement impliquée dans l’hypervirulence des souches de Cayenne. Enfin, nous avons testé la sensibilité aux antibiotiques de 6 souches isolées à partir de patients vivant à Cayenne. Ces souches étaient toutes sensibles à la doxycycline et résistantes aux macrolides. Dans une troisième partie nous avons analysé l’apport du TEP scanner dans le diagnostic des infections à C. burnetii. 167 patients atteints d’infections à C. burnetii ont bénéficié d’un TEP scanner. Nous avons retrouvé une proportion élevée de fixations ostéo-articulaires (21) et ganglionnaires (27), et nous avons proposé de nouvelles définitions pour ces localisations. Nous avons ensuite étudié l’impact du traitement chirurgical chez les patients atteints d’infections vasculaires. Une analyse rétrospective de 86 patients atteints d’infections vasculaires a montré que la chirurgie était associée à une diminution de la mortalité à 2,5 ans et à une meilleure évolution sérologique / C. burnetii is an intracellular bacterium. Recently, an axenic medium, named ACCM 2, has been developed and allows the culture of this bacterium in a microaerophilic atmosphere. We tested if the addition of uric acid in the medium could allow an aerobic culture. We observed growth of C. burnetii incubated under aerobic conditions in the ACCM2 medium enriched with uric acid. In Cayenne, French Guiana, pneumonia caused by C. burnetii are frequent and severe. We analyzed the genome of a strain from Cayenne. This work revealed a 6105 bp deletion in the gene of the type 1 secretion system (T1SS). This genome reduction is probably involved in the hypervirulence of Cayenne strains. Finally, we tested the antibiotic suceptibility of 6 strains isolated from patients living in Cayenne. These strains were all susceptible to doxycycline and resistant to macrolides. In a third part we analyzed the contribution of PET scanner in the diagnosis of C. burnetii infections. 167 patients with C. burnetii infections benefited from a PET scan. We found a high proportion of osteo-articular (21) and lymphadenitis (27) fixations, and we proposed new definitions for these locations. We then investigated the impact of surgical treatment in patients with vascular infections. A retrospective analysis of 86 patients with vascular infections showed that surgery was associated with a lower mortality at 2.5 years and a better serological outcome

Endocardite infecciosa é uma doença associada à elevada morbidade e letalidade. O diagnóstico precoce e o reconhecimento de sua etiologia podem contribuir para o sucesso do tratamento antibiótico; entretanto, cerca de um quarto das endocardites permanece sem diagnóstico etiológico. Este estudo teve como objetivo principal identificar a frequência de endocardite por Bartonella spp. e Coxiella burnetii dentre as endocardites com culturas negativas comunitárias e avaliar os fatores preditores dessas infecções. Como objetivo secundário compararam-se as características clínicolaboratoriais e prognósticas entre as endocardites comunitárias com culturas negativas e positivas. Foram avaliados também os fatores associados à letalidade intra-hospitalar das endocardites com culturas negativas. Entre janeiro de 2004 e janeiro de 2009, foram investigados 369 episódios consecutivos de endocardite em pacientes atendidos no Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - InCor HC-FMUSP. Foram estudados os casos que ocorreram em adultos, classificados pelos critérios de Duke modificados como \"endocardite definida\" e de origem comunitária. Assim, foram incluídos 221 episódios de endocardite, 170 com culturas positivas e 51 com culturas negativas. Neste último grupo, foram feitas as pesquisas sorológicas (reação de imunofluorescência indireta) e histopatológica de Bartonella spp. e Coxiella burnetii. Consideraram-se positivos títulos de imunoglobulina G (IgG) >= 800 para Bartonella henselae e ou Bartonella quintana, e IgG antifase I para C. burnetii > 800. O estudo histopatológico das valvas cardíacas foi capaz de identificar morfologicamente a etiologia de 87% das endocardites com culturas negativas, enquanto que o método de Gram do tecido a fresco o fez em somente 10% dos casos. As endocardites com culturas negativas apresentaram maior frequência de dispneia à admissão (p=0,001), menor valor de proteína C reativa (p=0,009), menor Fração de Ejeção do Ventrículo Esquerdo (Feve) (p=0,022) e necessitaram de mais tempo para o início do tratamento antibiótico para endocardite (p < 0,001) quando comparadas àquelas com culturas positivas. Não houve diferença estatisticamente significante entre os grupos na letalidade intra-hospitalar e na sobrevida após alta hospitalar. Verificou-se que a presença de diabetes mellitus (p=0,009) ou sepse grave na admissão (p=0,01) esteve independentemente associada ao óbito intra-hospitalar entre as endocardites com culturas negativas. Dez casos de endocardite por Bartonella spp. (frequência 19,6% [IC95%: 9,8 - 33,1]) e quatro casos de endocardite por Coxiella burnetii (frequência 7,8% [IC95%: 2,2 - 18,9]) foram diagnosticados dentre os 51 episódios de endocardite com culturas negativas. As endocardites por Bartonella spp. apresentavam menor Feve (p=0,025), associação com a identificação de cocobacilo Gram-negativo no exame histológico da valva cardíaca (p=0,001) e presença de gato no domicílio (p=0,001). Conclusões: Bartonella spp. e Coxiella burnetii foram as etiologias de quase um terço (27,5%) das endocardites comunitárias com culturas negativas. A presença de gato no domicílio, Feve <= 45%, e a identificação de cocobacilo Gramnegativo no exame histológico da valva cardíaca em pacientes com endocardite com culturas negativas parecem estar associadas à infecção por Bartonella spp. O exame histológico da valva cardíaca permitiu a identificação morfológica do micro-organismo na maioria dos casos, mesmo quando as hemoculturas estavam negativas. Não se observou diferença na letalidade intra-hospitalar e na sobrevida em longo prazo entre os dois grupos. A presença de diabetes mellitus ou sepse grave à admissão associou-se ao óbito hospitalar nas endocardites com culturas negativas / Infective endocarditis is associated with high morbidity and lethality. Early diagnosis and recognition of the specific etiology can contribute to successful antibiotic treatment. However, approximately one-fourth of endocarditis cases remain without an etiologic diagnosis. This study aimed to identify the frequency of endocarditis caused by Bartonella spp. and Coxiella burnetii among cases of community-acquired culture-negative endocarditis and to also assess risk factors for such infections. As a secondary objective, the clinical, laboratory and prognostic features of community-acquired endocarditis were compared. Factors related to the in-hospital lethality of culture-negative endocarditis were also assessed. Between January 2004 and January 2009, 369 consecutive cases of endocarditis were investigated in patients attending the no Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - InCor HC-FMUSP. Cases occurring in adults, those classified by the modified Duke criteria as \"defined endocarditis\" and community-acquired cases were studied. In total, 221 cases of endocarditis comprising 170 culture-positive and 51 culturenegative cases were included. For the culture-negative cases, serology (indirect immunofluorescence reaction) and histopathological analyses for Bartonella spp. and Coxiella burnetii were performed. Cases were considered positive for Bartonella henselae or Bartonella quintana with IgG titers >= 800 and for Coxiella burnetii with antiphase I IgG titers > 800. Histopathological studies of the cardiac valves were capable of morphologically identifying the etiology in 87% of the culture-negative endocarditis cases, whereas the Gram stain was only positive in 10% of cases using fresh tissue. Culture-negative endocarditis patients presented a greater frequency of dyspnea on admission (p=0.001), lower C-reactive protein levels (p=0.009), and a lower left ventricular ejection fraction (LVEF) (p=0.022), and they required more time to start antibiotic therapy (p < 0.001) when compared with culture-positive patients. There was no statistically significant difference between the two groups regarding in-hospital lethality or survival after hospital discharge. Diabetes mellitus (p=0.01) or severe sepsis on admission (p=0.01) were independently associated with in-hospital death for culture-negative endocarditis. Ten cases of endocarditis caused by Bartonella spp. (frequency 19.6% [IC95%: 9.8 - 33.1]) and 4 caused by Coxiella burnetii (frequency 7.8% [IC95%: 2.2 - 18.9]) were diagnosed among the 51 cases of culture-negative endocarditis. Endocarditis caused by Bartonella spp. was associated with lower LVEF values (p=0.025), the identification of Gram-negative coccobacilli in cardiac valve histology (p=0.001) and the presence of a cat in the patient\'s residence (p=0.001). Conclusions: Bartonella spp. and Coxiella burnetii were the causative etiology of almost one-third (27.5%) of the community-acquired cases of culture-negative endocarditis. The presence of a cat in the patient\'s residence, a LVEF <= 45% and the identification of Gram-negative coccobacilli in the histological examination of the cardiac valve in patients with culturenegative endocarditis appear to be associated with Bartonella spp. as the causative etiology. Histological examination of the cardiac valves allowed for morphological identification of the causative microorganism in the majority of cases, even when blood cultures were negative. There was no difference in in-hospital lethality or long-term survival between the two groups. The presence of diabetes mellitus or severe sepsis at admission was associated with in-hospital death in cases of culture-negative endocarditis

Orientador: Marcos Rogério André / Coorientador: José Maurício Barbanti Duarte / Banca: Karina Paes Bürger / Banca: Ana Patrícia Yatsuda Natsui / Resumo: Coxiella burnetii é uma bactéria Gram-negativa intracelular obrigatória, que além de considerado agente zoonótico causador da Febre Q em vários países do mundo, foi classificado como um potencial agente de bioterrorismo. Bovinos, ovinos e caprinos representam as fontes de infecção mais frequentemente associadas à ocorrência da enfermidade em humanos, entretanto animais selvagens também podem atuar como importantes fontes de infecção. Desta forma, o presente estudo tem como objetivo investigar a ocorrência de Coxiella burnetii em ruminantes domésticos e selvagens no Brasil. Para tal, 188 amostras de sangue de cervídeos (143 Blastocerus dichotomus, 11 Ozotocerus bezoarticus, 27 Mazama gouazobira, 4 M. bororo e 3 M. americanum), capturados nos estados de MS, SP e MG, foram submetidas à extração de DNA e, subsequentemente, à nested (n)PCR para C. burnetii baseada no elemento de inserção repetitivo IS1111 do gene heat shock protein (htpAB). Além disso, 169 amostras de soro de cervídeos foram submetidas à Reação de Imunofluorescência para detecção de anticorpos IgG anti-C. burnetii. Amostras de soros de bovinos apresentando desordens reprodutivas foram submetidas às Reações de Vírus Neutralização para BoHV-1 e BVD, Soroaglutinação Microscópica para Leptospira spp., Reação de Imunofluorescência Indireta for C. burnetii e Toxoplasma gondii, e Ensaio de Imunoabsorção Enzimática Indireto para Neospora caninum e Trypanosoma vivax. Todas as amostras de sangue mostraram-se negativas na nP... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Coxiella burnetii is an obligate intracellular Gram-negative bacterium, which, in addition to being considered a zoonotic agent that causes Q fever in several countries of the world, has been classified as a potential bioterrorism agent. Cattle, sheep and goats represent the most frequent sources of infection associated with the occurrence of the disease in humans, however, wild animals can also act as important sources of infection. In this way, the present study aims to investigate the occurrence of Coxiella burnetii in domestic and wild ruminants in Brazil. To this end, 188 cervus blood samples (143 Blastocerus dichotomus, 11 Ozotocerus bezoarticus, 27 Mazama gouazobira, 4 M. bororo and 3 M. americanum), captured in the states of MS, SP and MG, were subjected to DNA extraction and, subsequently to the nested (n) PCR for C. burnetii based on the heat shock protein (htpAB) gene IS1111 insertion element. In addition, 169 cervical serum samples were submitted to Immunofluorescence Reaction for the detection of anti-C. burnetii IgG antibodies. Adicionaly, samples of bovine sera presenting reproductive disorders were submitted to the Virus Reaction Neutralization for BoHV-1 and BVD, Microscopic Soroagglutination for Leptospira spp., Indirect Immunofluorescence Reaction for C. burnetii and T. gondii, and Indirect Enzyme Immunoabsorption Assay for N caninum and T. vivax. All blood samples were negative in nPCR, evidencing absence of circulating DNA of C. burnetii in the sampled c... (Complete abstract click electronic access below) / Mestre

Submitted by Michele Mologni (mologni@unoeste.br) on 2019-02-06T17:06:34Z No. of bitstreams: 1 Maykon Ramos Brasileiro.pdf: 195879 bytes, checksum: 8506daf0073cf47f0b9ce3020a93c843 (MD5) / Made available in DSpace on 2019-02-06T17:06:34Z (GMT). No. of bitstreams: 1 Maykon Ramos Brasileiro.pdf: 195879 bytes, checksum: 8506daf0073cf47f0b9ce3020a93c843 (MD5) Previous issue date: 2018-10-31 / . / A coxielose é uma zoonose associada à bactéria intracelular Coxiella burnetii sendo uma infecção comum em ruminantes e humanos de países asiáticos e europeus. No Brasil estudos epidemiológicos sobre a enfermidade são escassos. O presente estudo avaliou a presença de anticorpos anti-Coxiella (fase II) em 231 amostras de soro bovino provenientes de doze fazendas de leite e corte da região Oeste do estado de São Paulo, colhidas entre os anos de 2012-2018, que estavam mantidas em estoque sob congelamento a -25oC, utilizadas em outras rotinas diagnósticas. As amostras foram testadas pelo método ELISA, utilizando kit comercial importado (Bio-X - Diagnostics®). Do total avaliado, 176 (76,2%) animais foram sorologicamente positivos. Onze (91,6%) das 12 propriedades apresentaram ao menos um animal positivo, com prevalências variando entre 20 e 100%. Os resultados denotam alta prevalência da coxielose em bovinos de leite e corte na região Oeste Paulista, sugerindo que a enfermidade deve ser avaliada com relação aos potencias impactos na reprodução dos animais, incluindo diagnóstico diferencial com patógenos abortivos. Considerando-se o risco de transmissão zoonótica e o desconhecimento acerca da doença, as autoridades de saúde locais devem estar atentas a possíveis casos humanos subdiagnosticados ou confundidos com outras enfermidades similares.

Diss. (sammanfattning) Uppsala : Sveriges lantbruksuniv. / Härtill 4 uppsatser.