Thesis (MScMedSc (Pathology. Medical Microbiology))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: INTRODUCTION Mycobacterium tuberculosis (MTB) and Cryptococcus neoformans are the most common causes of chronic meningitis in South Africa. Conventional microbiology has limited utility in diagnosing these pathogens due to the paucibacillary nature of cerebrospinal fluid (CSF) and the diagnostic delay associated with culturing methods. This study aimed to evaluate the utility of an in-house polymerase chain reaction (PCR) method for the detection of the etiological agent of chronic meningitis. METHODS CSF samples (where volume exceeded 5ml) were submitted to the Medical Microbiology diagnostic laboratory of the Tygerberg Hospital from patients with suspected tuberculosis meningitis (TBM). Following routine bacteriology, the sample was used to inoculate two mycobacterial growth indicator tubes (MGIT A and B) and subsequently incubated in the BACTEC 960 automated system. MGIT A followed standard operating procedures and the time to culture positivity was noted. Weekly aliquots (up to 6 weeks) were removed from MGIT B. These samples were boiled to inactivate the bacteria and then the DNA was extracted using the Promega Wizard SV Genomic DNA kit. The DNA was then speciated by PCR and high-resolution melting analysis (HRM) by using primers specific to either the RD9 region of MTB complex or primers specific to the partial internal transcribed spacer 1 (ITS1), 5.8S rRNA gene and partial ITS2 sequence of C. neoformans. RESULTS Routine CSF microscopy indicated that 14 of the 78 patients (17.9%) had typical CSF findings of TBM (lymphocytes predominant, increased protein levels and decreased glucose levels). IV Ziehl-Neelsen (ZN) stains were positive for 12 (15.4%) samples, and MTB was cultured from 19 samples (24.4%). Our optimized PCR and HRM method was able to detect M. tuberculosis in 17 of the 19 culture positive specimens with a sensitivity of 89.5% and a specificity of 62.7%. The sensitivity of this method was higher than that of direct microscopy. In all of the PCR positive samples, the time to detection, compared to culture, could be shortened by 1 to 2 weeks. Only one sample was positive for Cryptococcus culture and another sample was positive with a Cryptococcus latex test. PCR for Cryptococcus was positive in 2 cases (n=78), sensitivities and specificities could not be reported due to the low number of positive cases. CONCLUSION We demonstrated that a short culture period and the use of commercial DNA extraction kit on CSF samples increases the sensitivity of molecular tests to diagnose tuberculosis. Furthermore, the molecular techniques could significantly reduce the time to positivity of results, when compared to culture. Due to the low occurrence of Cryptococcus in the samples included in our study, we could not comment on the diagnostic utility of PCR in the diagnosis of Cryptococcal meningitis, when compared to the conventional methods. / AFRIKAANSE OPSOMMING: INLEIDING Mycobacterium tuberculosis (MTB) en Cryptococcus neoformans is die mees algemeenste oorsake van kroniese meningitis in Suid-Afrika. Routine mikroskopie dra beperkte waarde in die diagnose van hierdie patogene as gevolg van die klein hoeveelhede organismes wat in die SSV (serobrospinale vog) voorkom en die lang tyd wat dit benodig om hierdie organisms te kweek. Hierdie studie beoog om die diagnostiese waarde van ‘n polymerase ketting reaksie (PKR) metode wat intern ontwerp is te evalueer vir die identifikasie van patogene verantwoordelik vir kroniese meningitis. METODES SSV monsters (waarvan die volume 5ml oorskry) en waar daar ‘n kliniese vermoede van tuberkulose meningitis (TBM) was, is na die diagnostiese Mediese Mikrobiologie laboratorium van Tygerberg hospitaal gestuur vir roetine bakteriologiese ontleding. Die oorblywende monsters is gebruik om twee mikobakteriële groei-indikasiebuise (MGIT A en B) te innokuleer en hulle is geïnkubeer in ‘n BACTEC 960 geautomatiseerde sisteem. MGIT A is volgens roetine diagnostiese metodes geanaliseer en die tyd tot ‘n positiewe resultaat is aangeteken Weeklikse monsters (tot en met week 6) is uit MGIT B verwyder en die monsters is gekook om sodoende die bakterië te inaktiveer. Die Promega Wizard SV Genomiese DNS ekstraksiemetode is gebruik om die DNS te versuiwer. Spesiëring van die DNS is deur middel van ‘n intern ontwerpte PKR en hoëresolusiesmeltingsmetode (HRS) gedoen met inleiers wat spesifiek is tot die RD9 gedeelte van die MTB kompleks en inleiers spesifiek tot die gedeeltelike interne getranskribeerde spasieerder 1 (ITS1), 5.8S rRNS geen en die gedeeltelike ITS2 DNS volgorde van C. neoformans. VI RESULTATE Roetine SSV mikroskopie het aangedui dat 14 uit 78 (17.9%) pasiënte tipiese SSV bevindings van TBM (oorwegend limfosiete, verhoogde proteïene en verlaagde glukose) gehad het. Ziehl- Neelsen (ZN) kleurings was positief vir 12 (15.4%) monsters, en MTB is gekweek in 19 (24.4%) van hierdie monsters. Ons geoptimaliseerde PKR en HRS metode het daarin geslaag om M. tuberculosis in 17 van die 19 kultuurpositiewe monsters aan te toon met ‘n sensitiviteit van 89.5% en ‘n spesifisitiet van 62.7%. Die sensitiwiteit van die direkte PKR was hoër in vergelyking met mikroskopie. In al die PKR positiewe monsters was die tyd tot aantoning, in vergelyking met kultuur, verkort met 1 tot 2 weke. Slegs een monster het C. neoformans gekweek en ‘n ander monster was positief met die kriptokokkale latekstoets. PKR vir C. neoformans was positief in 2 gevalle (n=78). Die sensitiwiteit en spesifisiteit van die C. neoformans PKR kon nie bepaal word nie weens te min gevalle. GEVOLGTREKKINGS Ons het aangetoon dat ‘n verkorte inkubasieperiode en die gebruik van ‘n kommersiële DNS ekstraksiemetode op SSV monsters die sensitiwiteit van die molekulêre tegniek vir die diagnose van tuberkulose verhoog en dat hierdie metode die tyd na positiwiteit aansienlik verkort in vergelyking met kultuur. Weens die lae getalle van kriptokokkale meningitis in ons studie kon ons nie kommentaar lewer op die akkuraatheid van PKR in die diagnose van kriptokokkale meningitis, in vergelyking met meer konvensionele metodes, nie.

Maintaining balance in the human immune system is critical for the body’s ability to discriminate between foreign and self-antigens. This balance is achieved, in part, by a subpopulation of T cells known as induced regulatory T cells (iTregs). Dysregulation of this population may contribute to the onset and progression of cancer, chronic inflammation and autoimmune diseases. Therefore, manipulation of iTreg development holds promising therapeutic potential; however, studying this vital population has proven difficult due to low numbers, heterogeneous cell populations, substantial phenotypic differences between mouse and human cells, and the high plasticity seen in iTregs. These current limitations have prevented a full understanding of the molecular signaling events that govern their development and function. Our lab has established a novel cell culture system that mimics in vivo human iTreg development. This system allows for the discrimination and comparison of naïve, memory and iTreg T cell populations simultaneously within a single donor. These iTregs exhibit high levels of CD25, FoxP3, CTLA4, GITR, low levels of CD127 and display strong suppressor activity. Using this innovative system, we have demonstrated a rewiring of T cell receptor (TCR) signaling in iTregs compared to conventional T cells. We found that the voltage gated K+ ion channel-Kv1.3 is not active in response to TCR engagement in iTregs, even though Ca2+ influx remains intact. Kv1.3 and the linked Src-family kinase Lck were redistributed to the highly active IL2-Receptor (IL2-R) complex. Additionally, we have shown that there is increased AKT protein expression in iTregs versus conventional T cell populations that does not correlate with the TCR-induced increase in its active (phosphorylated) form. This blockage appears to be due to an imbalance of kinase to phosphatase activity in iTregs with a specific TCR-induced inhibition of mTOR activity. We have also demonstrated that AKT accumulation in iTregs leads to its physical association with SMAD3, suggesting a novel, non-enzymatic function of AKT through transcription factor inhibition. This study sheds light on the reciprocal cross talk between the IL-2R and TCR signaling pathways and uncovers the mechanism of AKT blockade in primary human iTregs, thus opening novel avenues for therapeutic manipulation

Escherichia coli enteroinvasora (EIEC) e Shigella sp causam disenteria bacilar que é caracterizada pela invasão e destruição da mucosa do cólon humano. Amostras de EIEC possuem características bioquímicas, genéticas patogênicas semelhantes às espécies de Shigella, porém a doença causada por EIEC se apresenta numa forma mais branda e autolimitante. As células do epitélio intestinal participam ativamente da imunidade da mucosa, expressando e secretando uma série de mediad ores inflamatórios como citocinas, quimiocinas, moléculas de adesão e óxido nítrico. Para melhor entendimento da patogênese de EIEC, estudamos a resposta inflamatória modulada por este microrganismo em células epiteliais intestinais da linhagem Caco-2, comparando-a com Shigella flexneri. Células Caco-2 foram infectadas com EIEC ou S. flexneri por diferentes intervalos de tempo, para posterior analise da capacidade de invasão e disseminação bacterianas (UFC, PLAQUE ASSA Y), indução de morte celular (FACS), analise relativa de genes envolvidos no reconhecimento bacteriano e na resposta inflamatória (RT-PCR, RPA), dosagem de citocinas e quimiocinas pró-inflamatórias (ELISA) e óxido nítrico (GRIESS). Neste trabalho foi possível observar que: (i) a capacidade de disseminação e (ii) a indução da morte celular em células Caco-2 foi significativamente maior na infecção por S. flexneri do que EIEC; (iii) há diferenças em relação à expressão relativa de genes das células Caco-2 envolvidos no reconhecimento das duas cepas bacterianas. Foi evidenciado o papel essencial dos receptores intracelulares no reconhecimento bacteriano das células Caco-2, sendo a expressão relativa do mRNA do receptor intracelular Nod1 foi maior para EIEC quando comparado com S. flexneri; (iv) há diferenças significativas na cinética de produção de NO pelas células Caco¬2 infectadas, em que EIEC induziu mais precocemente a produção de NO quando comparado com S. flexneri. Estes dados sinalizam que as células epiteliais intestinais reconhecem e respondem de forma diferente frente a essas duas espécies bacterianas, apresentando uma resposta inflamatória mais eficiente no controle da infecção induzida por EIEC. / Escherichia coli enteroinvasive (EIEC) and Shigella sp cause bacillary dysentery which is characterized by the invasion and destruction of the human colon mucosa. Samples of EIEC have characteristics biochemical, genetic and pathogenic similar to those of Shigella species, however the disease caused by EIEC is more lenient. The cells of the intestinal epithelium actively participate in the mucosal immunity by expression and production of several inflammatory mediators such as cytokines, chemokines, adhesion molecules and nitric oxide. For better understanding of the EIEC pathogenesis, we studied the inflammatory response modulated by this microorganism in intestinal epithelial cells Caco-2, comparing it with Shigella flexneri. Caco-2 cells were infected with EIEC or S. flexneri during different intervals of time and analyzed the invasiveness and spread bacteria capacity (CFU, PLAQUE ASSAY), induction of cell death (FACS), analysis of genes involved in the recognition of bacterial and inflammatory response (RT-PCR, RPA), production of pro-inflammatory cytokines and chemokines (ELISA) and nitric oxide (NO) (GRIESS). In this work was possible to observe that: (i) the ability to spread and (ii) the induction of cell death in Caco-2 cells was significantly higher in S. flexneri infection than EIEC, (iii) there are differences regarding the relative expression of genes of Caco-2 cells involved in the recognition of two bacterial strains. It was highlighted the essential role of intracellular receptors in recognition of bacterial by Caco-2 cells, and the expression of mRNA of the intracellular receptor Nod 1 was higher for EIEC when compared with S. flexneri, (iv) there are significant differences in the kinetics of NO production by Caco-2 infected cells, EIEC induced a early NO production when compared with S. flexneri. These data indicate that the intestinal epithelial cells recognize and respond in a different way to these bacterial species and induce an inflammatory response more efficient in control of the infection induced by EIEC.

Leptospirose é uma zoonose causada pela espiroqueta pertencente ao gênero Leptospira. LipL32 é um antígeno de superfície altamente conservado somente entre as espécies de leptospiras patogênicas e é expresso em altos níveis tanto in vitro com in vivo. HlyX é relatada como sendo uma proteína que possui um provável peptídeo sinal e cinco tetratricopeptídeos repetidos (TPR) em sua sequência de aminoácidos. Neste trabalho, mostrou-se que HlyX é expressa somente em cepas patogênicas, não sendo detectada a sua expressão na cepa saprofítica. HlyX foi reconhecida somente por soros de pacientes da fase convalescente da doença. Em constraste, LipL32 foi reconhecida por soros de pacientes colhidos tanto na fase aguda quanto na fase convalescente da infecção. Nossos resultados de immunoblot indicam que os domínios imunodominantes da proteína são os fragmentos C-terminal e intermediário. Uma resposta IgM foi detectada exclusivamente contra o fragmento C-terminal de LipL32 em ambas as fases da infecção. Com relação à capacidade de LipL32 e HlyX de interagir com componentes de matriz extracelular (CME), foi observada uma interação específica e dose-dependente de LipL32 e HlyX com colágeno tipo IV e fibronectina plasmática. O fragmento C-terminal de LipL32 é responsável por esta interação. Tanto a heparina quanto a gelatina foram capazes de inibir a ligação de LipL32 à fibronectina plasmática de forma dose-dependente, indicando que os domínios de ligação à heparina (30 kDa) e gelatina (45 kDa) da fibronectina estão envolvidos nesta interação. Por outro lado, apenas o domínio de ligação à heparina participa da interação da fibronectina com a proteína HlyX. A capacidade protetora das duas proteínas estudadas foi avaliada através de ensaios de imunização e desafio realizados em modelo animal (hamsters). A proteína HlyX induziu altos títulos de anticorpos IgG (1:128.000), mas somente a co-administração HlyX e LipL32 e a proteína LipL32 pura conferiram proteção, 100% e 80% respectivamente. HlyX não foi capaz de conferir proteção quando administrada apenas com o adjuvante Al(OH)3. Em conclusão, os resultados indicam que o domínio C-terminal de LipL32 é reconhecido desde o início da infecção e este domínio é responsável por mediar a interação de LipL32 com CME. Os dados obtidos com HlyX demonstram um possível papel desta proteína na patogênese, pelo fato de ser expressa e conservada em cepas patogênicas, e também por interagir com CME. Porém, apesar de HlyX apresentar altos títulos de anticorpos IgG, não conferiu atividade protetora quando administrada individualmente. / Leptospirosis, a spirochaetal zoonotic disease caused by Leptospira, has been recognized as na important emerging infectious disease. LipL32 is a surface lipoprotein which is highly conserved among pathogenic Leptospira species and is also expressed at high levels either during cultivation and natural infection. Regarding HlyX, it has been annotated as a protein containing a signal peptide and five tetratricopeptide repeats (TPR). Immunoblot analyses concerning HlyX distribution on Leptospira spp. indicate that this protein is expressed exclusively by pathogenic species. Moreover, HlyX was only recognized by sera of patients in the second week of leptospirosis infection. In contrast, LipL32 was recognized by acute and convalescent sera from leptospirosis patients. Our immunoblot results indicate that both the C-terminal and the intermediate domains of LipL32 are recognized by sera of patients. An IgM response was detected exclusively against the LipL32 C-terminus in both the acute and convalescent phases of illness. Concerning the capacity of LipL32 and HlyX to interact with extracellular matrix (ECM) components, a dose-dependent specific binding of LipL32 and HlyX to collagen IV and plasma fibronectin was observed. The LipL32 binding capacity could be attributed to the C-terminal portion of this molecule. Both heparin and gelatin could inhibit LipL32 binding to fibronectin in a concentration-dependent manner, indicating that the 30-kDa heparin- and the 45-kDa gelatin-binding domains of fibronectin are involved in this interaction. However, HlyX binding to fibronectin could only be inhibited by heparin in a concentration-dependent manner. We also evaluated whether HlyX and LipL32 could induce protective immunity against the challenge with a homologous serovar in hamsters. Although high anti-HlyX (IgG) titers (1:128,000) have been achieved upon immunization, no protection was observed. However, a combined HlyX and LipL32 immunization could induce a protective response (100%). The protection observed for LipL32 immunization was 80%. Altogether, the results provide evidence that the LipL32 C-terminus is recognized early in the course of infection and is the domain responsible for mediating interaction with ECM proteins. HlyX protein may contribute to the pathogenesis of the disease by interacting with host proteins. However, HlyX is not a protective antigen when administered alone.

Os dermatófitos são um grupo de fungos que têm a capacidade de invadir o tecido queratinizado (pele, pêlos e unhas) de seres humanos e animais para produzir uma infecção denominada de dermatofitose. O Trichophyton rubrum é o principal patógeno causador de dermatofitose. As lesões causadas por estas espécies são crônicas e de carater pouco inflamatória. A doença apresenta evolução lenta e pacientes cronicamente infectados não respondem bem a terapia antifúngica. Assim como na maioria dos patógenos, o sistema imune inato é determinante na resposta antifúngica. Neutrófilos, macrófagos e células dendríticas constituem as células efetoras do sistema imune. A resposta imune aos dermatófitos ainda não está bem elucidada. Atualmente é aceito que a resposta imune mediada por células é responsável pelo controle da infecção. Poucos estudos têm focado a resposta imune inata a esses fungos. Assim, fomos estudar a interação de células dendríticas de pacientes com dermatofitose com conídios de T. rubrum. Nossos resultados mostraram que células dendríticas derivadas de monócitos (CDDM) foram capazes de fagocitar conídios de T. rubrum e ainda verificamos que estas células permaneceram viáveis após fagocitose. Quando analisamos a viabilidade dos conídios de T. rubrum, após 24 e 48 horas de interação com CDDM, verificamos que após 48horas houve um aumento no número de conídios viáveis quando estes foram fagocitados por células de pacientes, mostrando que CDDM de paciente não conseguem matar os conídios após fagocitose. Avaliamos a liberação de óxido nítrico por CDDM e a análise dos resultados mostrou que não houve diferença significativa na liberação de NO pela CDDM na presença de conídio de T. rubrum. Analisamos a expressão de moléculas co-estimulatórias como CD80, CD86, CD83, CD40 e HLA-DR em pacientes com dermatofitose e em indivíduos controle, observamos que não houve diferença na expressão dessas moléculas na presença de conídios de T. rubrum quando comparadas com culturas de CDDM sem conídios. Entretanto, houve uma diminuição do número de células de pacientes que expressam estas moléculas na presença de conídio de T. rubrum. Foi detectado um aumento significativo na secreção de TNF-α e de IL-12 pelas CDDM de pacientes quando em contato com conídio de T. rubrum. Avaliamos a capacidade das CDDM de indivíduos controle e pacientes pulsadas com concentrações crescentes de tricofitina em ativar linfócitos T CD4 e também verificamos o perfil de citocinas secretadas pelos linfócitos T CD4 após proliferação. Os resultados demonstraram que as CDDM foram capazes de estimular a proliferação de linfócitos somente em pacientes com dermatofitose. Foi detectado um aumento significativo na secreção de IL-4 pelos LT CD4 de indivíduos controle. Nossos resultados sugerem uma diferença no perfil de secreção de citocinas em indivíduos controle e pacientes. Indivíduos controle não produzem IL-12 e estimulam preferencialmente linfócitos T CD4 secretores de IL-4. Por outro lado, células dendríticas de pacientes produzem IL-12 e induzem a ativação de linfócitos T produtores de IL-4 e IL-10 / The dermatophytes are a group of fungi that have the capacity to invade the keratinized tissue (skin, hair and nails) of humans and animals to produce an infection called dermatophytosis. The Trichophyton rubrum is the main causative pathogen of dermatophytosis. Injuries caused by these species are chronic inflammatory and little character. The disease shows slow evolution and chronically infected patients do not respond well to antifungal therapy. Like most pathogens, the innate immune system is crucial in the antifungal response. Neutrophils, macrophages and dendritic cells are the effector cells of the immune system. The immune response to dermatophytes is not yet well elucidated. Currently it is accepted that the immune response mediated by cells is responsible for controlling the infection. Few studies have focused on the innate immune response to these fungi. Thus, we study the interaction of dendritic cells from patients with dermatophytosis with conidia of T. rubrum. Our results showed that dendritic cells derived from monocytes (CDDM) were capable of phagocytosed conidia of T. rubrum and found that these cells remained viable after phagocytosis. When we analyze the viability of conidia of T. rubrum after 24 and 48 hours of interaction with CDDM shows that after 48hours an increase in the number of viable conidia when they were phagocytized by cells of patients, showing that CDDM not kill the patient after the conidia phagocytosis. Evaluated the release of nitric oxide by CDDM and analysis of results showed that there was no significant difference in the release of NO by CDDM in the presence of conidia of T. rubrum. We analyzed the expression of co-stimulatory molecules such as CD80, CD86, CD83, CD40 and HLA-DR in patients with dermatophytosis and in control subjects, we observed that there was no difference in expression of these molecules in the presence of conidia of T. rubrum compared with cultures of CDDM without conidia . However, there was a decrease in the number of cells of patients who express these molecules in the presence of conidia of T. rubrum. It was observed a significant increase in the secretion of TNF-α and IL-12 by CDDM of patients when in contact with conidia of T. rubrum. Evaluate the capacity of individuals to control and CDDM patients pulsed with increasing concentrations of trichophytin to activate CD4 T lymphocytes and also see the profile of cytokines secreted by CD4 + T lymphocytes after proliferation. The results showed that the CDDM were able to stimulate the proliferation of lymphocytes only in patients with dermatophytosis. We observed a significant increase in the secretion of IL-4 by CD4 L T to control individuals. Our results suggest a difference in the profile of secretion of cytokines in control subjects and patients. Control subjects did not produce IL-12 and preferentially stimulate CD4 T lymphocytes secreting IL-4. Furthermore, dendritic cells of patients produce IL-12 and induce the activation of T lymphocytes producing IL-4 and IL-10

Para determinar a prevalência e epidemiologia dos enteropatógenos bacterianos e parasitários na diarréia aguda infantil, foram estudadas 290 crianças menores de 24 meses com diarréia e 290 crianças controles, que procuraram o serviço de emergência do Hospital Infantil Arlinda Marques em João Pessoa, Nordeste do Brasil. Enteropatógenos foram identificados em 78,2% dos casos e em 12,4% dos controles; Escherichia coli enteroagregativa (EAEC) foi o patógeno mais freqüente sendo detectada em 25% dos casos e em 8,3% dos controles; seguida por E. coli enteropatogênica (EPEC) em 11% dos casos (dos quais 9,3% foram cepas atípicas) e em 0,3% dos controles; E. coli Enterotoxigência (ETEC) em 10% dos casos e 2,8% dos controles; Salmonella sp em 7,9% dos casos; Shigella sp em 4,1% dos casos; E. coli enteroinvasora (EIEC) em 1,7% dos casos; Campylobacter sp em 2,4% dos casos e enteroparasitas foram detectados em 15,5% dos casos e 1,0% dos controles. Infecções mistas foram verificadas em 32 (11%) casos e em apenas 1 (0,3%) controle. A faixa etária mais atingida foi a dos menores de um ano e as associações mais frequentes ocorreram entre EAEC + Salmonella e EAEC + EPEC atípica. Neste estudo foram identificados fatores de risco associados com episódios de diarréia em crianças de acordo com o agente etiológico bacteriano. As análises estatísticas demonstram uma importante associação de EAEC com diarreia aguda infantil em João Pessoa, Brasil, sendo a ingestão de leite de vaca em pó e a exposição a aglomerados e creche os fatores de risco mais associados a diarreia causada por EAEC. / In order to determine the prevalence and epidemiology of enteropathogens in acute infantile diarrhoea, 290 infants younger than 24 months of age with diarrhoea and 290 age-matched control subjects who came to ER of the Hospital Infantil Arlinda Marques in João Pessoa, Northeastern of Brazil were studied. Enteropathogens were identified in 78,2% of case infants and 12,4% of controls. Enteroagregative Escherichia coli (EAEC) was the most frequently found pathogen and was detected in 25,0% of cases and 8,3% of controls. The second most frequent pathogen was Enteropathogenic E. coli (EPEC), in 11,0% of cases and 0,3% of controls, followed by Enterotoxigenic E. coli (ETEC) in 10% of cases and 2,7% of controls; Salmonella sp was found in 7,9% of cases, Shigella sp in 4,1% of cases, Enteroinvasive E. coli (EIEC) in 1,7% of cases and Campylobacter sp in 2,4% of cases. Enteroparasites were detected in 15,5% of cases and 1,0% of controls. Mixed infections (more than one pathogen) were found in 32 (11%) of cases and in only 1 (0,3%) control. The most affected age group was of those smaller than 1 year of age and the most frequent associations were of EAEC + Salmonella e EAEC + atypical EPEC. In this study risk factors associated with episodes of diarrhoea among infants by bacterial etiological pathogens were identified. Statistical analysis demonstrated a significant association of Enteroagregative E. coli (EAEC) with acute infantile diarrhoea in João Pessoa, Brazil. The risk factors most strongly associated diarrhoea caused by EAEC were the ingestion of powdered cow milk and exposure to crowds and day care centres.

O presente estudo teve como objetivo a caracterização genômica das espécies: Mycoplasma hominis, Ureaplasma urealyticum e Ureaplasma parvum em amostras cervicais de gestantes. Cepas de Mycoplasma hominis e de Ureaplasma spp., foram identificadas através do cultivo e por PCR utilizando-se primers genéricos e específicos. Os achados na literatura são contraditórios quanto a participação dessas bactérias nas doenças humanas, especialmente quanto a participação destas em casos de infertilidade e alterações perigestacionais. Considerando a marcante heterogeneidade das cepas de Mycoplasma hominis, utilizamos a reação de RAPD com a finalidade de definir os perfis genômicos das cepas isoladas. A caracterização dos biótipos 1 e 2 do gênero Ureaplasma, respectivamente, Ureaplasma urealyticum e Ureaplasma parvum, através da análise da MBA (Múltipla Banda Antigênica) por PCR, teve como finalidade determinar a predominância de cada uma dessas espécies. Foram estudadas amostras de material cervical de 163 gestantes em várias idades gestacionais. Os resultados obtidos neste trabalho foram: M. hominis foi detectado em 14,7% (24/163) das amostras, sendo a RAPO realizada em 7 das amostras positivas e puras de M. hominis. A reação RAPD demonstrou similaridade do perfil gênico entre as amostras 3 e 4 e entre as amostras 6 e 8, enquanto que as amostras 2, 5 e 7 demonstraram uma grande heterogeneidade. O gênero Ureaplasma foi isolado em 54,6% (89/163) das amostras, sendo 31,5% (28/89) cepas de U. urealyticum e 68,5% (61/89) U. parvum. Foram detectados 10,4% (17/163) casos de co-infecções M. hominis e Ureaplasma spp. O estudo da suscetibilidade das cepas isoladas frente a tetraciclina foi realizado com o intuito de se determinar a freqüência de cepas resistentes a essa droga. Considerando ser este antibiótico o de eleição no tratamento das micoplasmoses humanas e devido aos altos índices de resistência apresentados, resistência esta conferida pela presença do plasmídeo tetM, submetemos nossas amostras à pesquisa deste plasmídeo através da PCR. A presença do plasmídeo tetM foi detectada em 29,5% (7/24) das amostras positivas para Mycoplasma hominis e em 60,7% (54/89) das amostras positivas para Ureaplasma spp., sendo que dentre estas, 57,4% (31/54) foram detectados na espécie U. parvum e 42,6% (23/54) na espécie Ureaplasma urealyticum. O estudo da heterogeneidade intra-espécie das cepas de Mycoplasma hominis pela técnica de RAPD é inédito no Brasil. Da mesma maneira a caracterização das espécies do gênero Ureaplasma em U. parvum e U. urealyticum, através da PCR pela análise da MBA, foi pioneiramente realizada pelo nosso grupo de pesquisa. Esperamos com esse trabalho poder contribuir para um conhecimento melhor da freqüência dessas espécies na nossa população e tentar explicar as divergências das avaliações nas interações entre os micoplasmas e o hospedeiro. / The objective of this study was to characterize the species Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum in cervical samples from pregnant women. Strains of Mycoplasma hominis and Ureaplasma spp., were identified by means of culture and by PCR using generic and specific primers. The findings in the literature with regard to the involvement of these bacteria in human diseases are contradictory, especially regarding their involvement in cases of infertility and perigestational changes. In view of the strong heterogeneity among Mycoplasma hominis strains, we used RAPD to define the profiles of the strains isolated. Biotypes 1 and 2 of the genus Ureaplasma - Ureaplasma urealyticum and Ureaplasma parvum respectively - were characterized by means of MBA (Multiple Banded Antigenic) analysis using PCR to determine the predominance of each of these species. Samples of cervical material from 163 pregnant women at various stages of pregnancy were studied. The results obtained in this study were: M. hominis was detected in 14.7% (24/163) of the samples, and RAPD analyses carried out in 7 M. hominis strains. The RAPD similarly gene profile was showed: between strains 3 and 4, and between strains 6 and 8. The strains 2, 5 and 7 showed a pronounced heterogeneity in the gene profile. The genus Ureaplasma was isolated in 54.6% (89/163) of the samples, of which 31.5% (28/89) were U. urealyticum and 68.5% (61/89) U. parvum. Mycoplasma hominis and Ureaplasma spp., coinfection were detected in 10.4% (17/163) of the samples. The study of the susceptibility of the isolated strains to tetracycline was carried out with a view to determining the frequency of strains resistant to this drug. As this is the antibiotic of choice in the treatment of human mycoplasmoses, and in view of the high resistance indices observed, which are conferred by the presence of the \"tetM\" plasmid, we looked for this plasmid in our samples using PCR. The presence of the tetM plasmid, was detected 57,1% (4/7) of the Mycoplasma hominis - positive samples and in 40,2% (29/72) of the Ureaplasma spp - positive samples. Of the latter, 41,6% (25/72) were detected in the species U. parvum and 33,4% (4/12) were detected in the species Ureaplasma urealyticum. This is the first time that a study of the intraspecies heterogeneity of Mycoplasma hominis strains using RAPD has been carried out in Brazil. Characterization of the genus Ureaplasma species into U. parvum and U. urealyticum by means of PCR using MBA analysis was likewise pioneering effort by our research group. We hope that our work will contribute to a greater knowledge of the frequency of these species in our population and that it will help to explain differences in the assessment of the interaction between mycoplasma and the host.

Orientador: Mara Correa Lelles Nogueira / Banca: Doroti de Oliveira Garcia / Banca: Aripuanã S. Aranha Watanabe / Banca: Nilton Erbet Lincopan Huenuman / Banca: Mânlio Tasso de Oliveira Mota / Resumo: O gênero Enterobacter compreende bactérias anaeróbias facultativas, fermentadores de glicose e ubíquo na natureza. Atualmente, existem 28 espécies de Enterobacter spp que podem ser identificadas por métodos bioquímicos, moleculares ou por espectrometria de massa. As infecções mais causadas por Enterobacter spp são de pele e tecidos moles, pneumonias e bacteremias, e, para o tratamento destas, os antimicrobianos mais utilizados são carbapênemicos, cefalosporinas e quinolonas. Entretanto, a resistência aos antimicrobianos tem aumentado no gênero Enterobacter, principalmente, devido à mecanismos enzimáticos codificados por genes plasmidiais. Os objetivos deste estudo foram avaliar o perfil de susceptibilidade aos antimicrobianos, investigar genes de beta-lactamases (blaTEM-like, blaSHVlike, blaVEB-like, blaPER-like, blaGES-like, blaCTX-M-like), carbapenemases (blaKPC, blaIMP, blaVIM, blaNDM, blaGES e blaOXA-48) e de enzimas que conferem resistência as quinolonas (qnrA, qnrB, qnrS, -Ib-cr e qepA) e determinar a similaridade genética entre os isolados de Enterobacter spp. Sessenta isolados de Enterobacter spp resistentes aos carbapenêmicos, cefalosporinas de terceira e quarta geração e quinolonas provenientes de pacientes admitidos em diferentes unidades de internação do Hospital de Base de São José do Rio Preto (HB) foram encaminhados ao laboratório CIM-Centro de Investigação de Microrganismos da Faculdade de Medicina de São José do Rio Preto (FAMERP), onde foram realizadas a extração de DNA, a investigação dos genes por PCR e a tipagem molecular por ERIC-PCR. O gene de resistência blaKPC foi detectado em 22% dos isolados. Os genes blaTEM-like e blaCTX-Mlike em 82% e blaSHV-like em 3% dos isolados respectivamente. O grupo 1 de CTX-M foi detectado em 56,5%, do grupo 2 em 41,3% e do grupo 8/25 em 2,2% dos isolados. Os genes de resistência a quinolonas detectados foram qnrA, qnrB e qnrS em 40%, 22% 2% dos isolados... / Abstract: The Enterobacter genus comprises facultative anaerobic bacteria, glucose fermenters and ubiquitous in nature. Currently, there are 25 species of Enterobacter spp and two which can be identified by biochemical, molecular methods or by mass spectrometry. Infections caused by Enterobacter spp are skin and soft tissues, bacteremia and pneumonia, and for the treatment of these, the most commonly used antimicrobials are carbapenems, cephalosporins and quinolones. However, antimicrobial resistance has increased the Enterobacter spp mainly due to enzymatic mechanisms encoded by plasmid genes. The objectives of this study were to evaluate the antimicrobial susceptibility profile, investigate beta-lactamase genes (blaTEM-like, blaSHV-like, blaVEB-like, blaPER-like, blaGES-like, blaCTX-M-like), carbapenemases (blaKPC, blaIMP, blaVIM, blaNDM, blaGES and blaOXA-48) and enzymes that confer resistance to quinolones (qnrA, qnrB, qnrS, aac (6') - Ib-cr and qepA) and determine the genetic similarity among isolates of Enterobacter spp. Sixty isolates of Enterobacter spp resistant to carbapenems, cephalosporins ( third and fourth generation) and quinolones from patients admitted to the Base Hospital (HB), were send Laboratory - Microorganisms Research Centre the School of Medicine of São José do Rio Preto (FAMERP), where DNA extraction, the investigation of genes and molecular typing by ERIC-PCR were carried out. The blaKPC resistance gene was detected in 22% of the isolates. The genes blaTEM-like and blaCTX-M-like 82%, blaSHV-like 3% of the isolates. The group 1 CTX-M was detected in 56.5%, of group 2 in 41.3% and 8/25 group at 2.2% of the isolates. The quinolone resistance genes qnrA, qnrB, and qnrS were detected in 40% 22% 2% of the isolates, respectively. The ERIC-PCR typing by genetic generated twelve groups (G1 to G12) for E. cloacae and one group (G1) for E. aerogenes, horizontal transfer of resistance genes in some groups was observed, but the ... / Mestre

Candida albicans is an opportunistic pathogen that is present in the normal flora in a majority of individuals. One key factor in C. albicans virulence is the ability to change its morphology from yeast to an elongated or hyphal form. The regulation of this morphogenesis relies in part upon quorum sensing (QS) molecules. C. albicans often exists as part of a mixed culture alongside other microbes and is influenced by their presence as well as the presence of QS molecules that they produce. In this study, a library of diploid homozygous transcriptional regulator knockout (TRKO) mutants were screened to identify strains capable of forming hyphae in the presence of Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli. We identified three strains that showed increased hyphae development compared to wild type C. albicans. The strains identified had deletions of the transcriptional regulating genes Orf19.3928, Orf19.2842 (GZF3), and Orf19.3865 (RFX1). These strains were tested for alterations of filamentation in liquid media, and biofilm formation. All three strains showed increased rates of biofilm formation compared to the wild type. Orf19.3928 showed altered response to farnesol, a marked in biofilm formation and no inhibition of filamentation when farnesol was present in liquid media. The GZF3 deletion strain showed enhanced filamentation with all three bacterial species while the RFX1 deletion strain showed increased filamentation only with E. coli and S. aureus. In spent media, GZF3 showed slight increases in filamentation in E. coli and S. aureus while RFX1 had moderate increases in filamentation in E. coli and S. aureus and slight increases with P. aeruginosa.

More so than ever, Multiple Drug Resistant (MDR) bacteria are on the rise due to overuse of antibiotics along with natural selection for adaptations that enhance drug-resistant properties. One particular bacterial family, Enterobacteriaceae, has been problematic, exhibiting several bacterial members that have developed a precipitous resistance to modern antibiotics and are also primary causative agents of nosocomial, or hospital acquired, infections. Citrobacter freundii (CF) and Enterobacter cloacae (ECL) are two species of the Enterobacteriaceae family causing significant medical concern due to their role in producing numerous opportunistic infections such as bacteremia, lower respiratory tract infections, urinary tract infections, and endocarditis. Adding to the difficulty of this situation is the ability of bacteria to produce biofilms. These biofilms are communities of bacteria that exhibit increased resistance to antibiotic treatment and eradication. Previous work in the laboratory of Dr. Fox at ETSU has identified an uncharacterized product secreted by Klebsiella pneumoniae (KP), another member of the Enterobacteriaceae family, which appears to have inhibitory effects toward CF and ECL. The current study was designed to characterize the effects this secreted product has on CF and ECL biofilms. Through a high throughput microtiter plate assay, the effects of this secreted product were examined on CF and ECL phases of biofilm attachment and maturation. Based on our findings, we have concluded that this secreted product can be categorized as a possible bacteriostatic agent against biofilm cell density, biofilm mass, and cell viability for both biofilm phases of attachment and maturation.