Chronic infection with P. aeruginosa is expected in patients with cystic fibrosis (CF), but the ability to delay, prevent, or better manage infection with multiply-resistant P. aeruginosa (MRPA) can potentially increase quality of life and extend survival. The Texas Children’s Hospital CF Care Center has identified an endemic MRPA strain (dominant clone), and this study aimed to identify risk factors for acquisition of the clone as well as determine differences in patient outcome associated with subsequent infection with the clone. The study included 71 patients with CF with documented MRPA infection. Designation of patients as members of the dominant clone or a non-dominant clone group was based on molecular typing by rep-PCR of MRPA isolates from respiratory cultures. Patient data was collected from Port CF, the national patient registry of the CF Foundation. Patient demographic information and clinical parameters prior to MRPA infection were analyzed by logistic regression as potential risk factors. Differences in patient outcome including change in BMI, change in FEV1, and hospitalization rate were evaluated by MANOVA. Recent hospitalization (< 90 days) was a statistically significant (p = 0.035) risk factor for acquisition of the dominant clone. Patients hospitalized < 90 days prior to MRPA diagnosis were four times more likely to be infected with the dominant clone, and patients hospitalized 91-180 days prior were almost three times more likely. Increased hospitalization rates were seen in the dominant clone group both pre- (11 more days/year) and post-infection (14 more days/year) as compared to the non-dominant clone group. Patients infected with the endemic strain exhibited poorer outcomes in terms of nutritional status (3.73% decrease/year in BMI %ile) and lung function (3.7% decrease/year in FEV1 %ile). Significant overlap in hospitalization episodes of patients known to be infected with the dominant clone and patients subsequently infected with the dominant clone was observed. Recent hospitalization was a significant risk factor for infection with the dominant MRPA clone, and following infection, patients infected with the endemic strain exhibited declines in nutritional status and lung function and increased hospitalization rates. The results suggest potentially increased virulence and transmissibility of the endemic MRPA strain.

O Brasil é o maior exportador de carne de frango e o terceiro maior produtor desta carne. O consumo desta fonte de proteína tem aumentado bastante nos últimos anos, tendo passado de 23,2 Kg/habitante em 1995 para 35,5 Kg/habitante em 2005. O mercado internacional tem se tornado cada vez mais exigente com relação aos padrões microbiológicos destes produtos. Pela importância das aves para a economia brasileira e por Listeria monocytogenes apresentar alta taxa de mortalidade, além de ser facilmente encontrada em carne de aves, decidiu-se verificar a ocorrência deste patógeno em dois matadouros, um com evisceração automática (Planta A) e outro com evisceração manual (Planta M), e traçar as possíveis rotas da disseminação do microrganismo na linha de processamento. Do total de 851 amostras coletadas de produtos, das superfícies de contato e de não contato com o produto, das mãos dos manipuladores e da água utilizada durante o processo de abate, 423 amostras foram da Planta A e 428 da Planta M. O teste VIP&#174; Listeria foi utilizado para a triagem das amostras, sendo que aquelas positivas foram submetidas à caracterização fenotípica (provas bioquímicas e ágar cromogênico). A identificação e a tipagem das cepas foi realizada por técnicas moleculares (BAX® System, multiplex-PCR 16S rRNA, multiplex-PCR, ribotipagem e PFGE). L. monocytogenes foi isolada de 20,1% das amostras da Planta A, sendo 61,6% pertencentes ao sorogrupo 4b, 4d ou 4e; 19,2% ao sorogrupo 1/2a ou 3a; 15,2% ao sorogrupo 1/2c ou 3c; e 4,0% ao sorogrupo 1/2b, 3b ou 7. Na Planta M, 16,4% das amostras foram positivas para L. monocytogenes, havendo predomínio do sorogrupo 1/2a ou 3a (72,9%), seguido do sorogrupo 4b, 4d ou 4e (27,1%). Baseado nos resultados dos testes para caracterização fenotípica e genotípica, verificou-se que L. monocytogenes presente no produto final apresentou características semelhantes àquelas presentes na planta, e não no animal. Apenas uma cepa foi isolada na zona suja da Planta A, piso da seção de depenagem, e todas as demais foram isoladas da zona limpa de ambas as plantas. / Brazil is the first exporter of chicken meat and the third producer of this kind of meat in the world. The consumption of this protein source in Brazil has been increasing, having passed from 23.2 Kg/inhabitant in 1995 to 35.5 Kg/inhabitant in 2005. The international market has become more demanding for safety of these products. Because of the importance of this food commodity to Brazilian economy and because of Listeria monocytogenes importance as a foodborne pathogen this study was conducted. The presence of the pathogen in two facilities, one with automatic evisceration (Plant A) and another with manual evisceration (Plant M), was evaluated to identify possible routes of microorganism dissemination in the processing line. From a total of 851 collected samples of products, food contact and non-food contact surfaces, workers\' hands and water used in the process, 423 samples were from Plant A and 428 from Plant M. VIP&#174; Listeria was used for the samples screening, positive ones were plated and suspected characteristic colonies submitted to biochemical characterization. Selected strains were submitted to identification and typing by molecular techniques (BAX® System, multiplex-PCR 16S rRNA, multiplex-PCR, ribotyping and PFGE). L. monocytogenes was isolated in 20.1% of the samples from Plant A with 61.6% belonging to serogroup 4b, 4d or 4e; 19.2% to serogroup 1/2a or 3a; 15.2% to serogroup 1/2c or 3c; and 4.0% to serogroup 1/2b, 3b or 7. From Plant M 16.4% of the samples were positive for L. monocytogenes, with predominance of serogroup 1/2a or 3a (72.9%) followed by serogroup 4b, 4d or 4e (27.1%). Based on the results of phenotypic and genotypic characterization, it was verified that L. monocytogenes present in the final product had similar characteristics to those isolated in the plant, and not in the animals. Only one strain was isolated in the dirty zone of Plant A, on the floor of defeathering section, and all others were isolated in the clean zone of both plants.

Cryptococcus neoformans e C. gattii são as principais espécies do gênero que causam infecção no homem, C. albidus e C. laurentii são espécies menos envolvidas. O presente trabalho teve por objetivos avaliar a patogenicidade in vivo, os fatores e os genes relacionados à virulência, e verificar o perfil de suscetibilidade ao fluconazol de 10 isolados ambientais de cada uma das espécies: C. neoformans, C. albidus e C. laurentii, antes e após a inoculação em camundongos BALB/c imunocompetentes; pesquisar os sorotipos, mating types e realizar a tipagem molecular. Proteinase, fosfolipase, urease, produção de melanina e crescimento à 37ºC foram pesquisados utilizando metodologias clássicas, e a pesquisa dos genes e determinação dos sorotipos e mating types foram feitas por PCR. A tipagem molecular foi realizada por PCR-fingerprinting, com os iniciadores (GACA)4 e M13. A determinação da CIM do fluconazol foi realizada pelo método da microdiluição em caldo. Todos os isolados de C. neoformans foram sorotipos A e MAT-alfa. A inoculação em animais mostrou que 9 isolados de C. neoformans mataram 100% deles em até 33 dias, e 1 levou os animais à morte num período entre 40 e 82 dias; 9 isolados foram recuperados dos pulmões e cérebro dos animais em 7 e 14 dias, e um deles levou todos os animais à morte em 12 dias, sendo possível recuperá-lo somente no 7º dia. Os animais inoculados com C. albidus e C. laurentii permaneceram vivos até negativação das culturas dos órgãos avaliados. C. albidus foi isolado principalmente do fígado e dos pulmões até 10 dias após a inoculação, C. laurentii dos pulmões e do cérebro até 120 dias. Todos os isolados das 3 espécies produziram cápsula antes e após a inoculação. Todos C. neoformans, 6 C. albidus e 6 C. laurentii cresceram à 37ºC antes e depois da inoculação. Melanina foi produzida por todos os isolados de C. neoformans e nenhum C. albidus nas duas ocasiões; e por 6 e 9 isolados de C. laurentii, antes e depois da inoculação, respectivamente. Seis isolados de C. neoformans e 1 de C. laurentii produziram proteinase nas duas ocasiões. Sete isolados de C. albidus produziram proteinase antes e todos depois da inoculação. Fosfolipase foi produzida por todos C. neoformans e C. albidus, e por 6 C. laurentii nas duas ocasiões. A avaliação da atividade da urease realizada em meio líquido foi positiva em 24 a 48 horas pelos isolados de C. neoformans e C. laurentii, e em 24 a 96 horas por C. albidus. A CIM de fluconazol variou de 2 a 8 ug/mL para C. neoformans, de 8 a >= 64 ug/mL para C. albidus, e de 1 a 64 ug/mL para C. laurentii, nas duas ocasiões. Todos os isolados de C. neoformans apresentaram os genes lacase (Lac1), fosfolipase (PLB1), proteinase (cnap1), calcineurina (CNA1), urease (URE1), e ERG11, com os oligonucleotídeos utilizados. A PCR com ERG11 mostrou uma banda no gel de agarose para todos C. albidus, porém nenhum dos outros genes pesquisados foram amplificados em C. albidus e C. laurentii. A tipagem molecular por PCR-fingerprinting dos isolados de C. neoformans revelou 2 tipos moleculares: VNI (7 isolados) e VNII (3 isolados). A maioria dos isolados de C. albidus apresentou homogeneidade nos padrões de bandas gerados, e C. laurentii foi a espécie que demonstrou maior diversidade genética por esta metodologia. Concluímos que a passagem dos isolados pelos animais não alterou os fenótipos estudados e nenhuma alteração foi detectada pela análise molecular. No entanto, verificamos a grande heterogeneidade molecular dos isolados de C. laurentii estudados. / Species of Cryptococcus neoformans and C. gattii are the main ones in the genus causing infection in man while C. albidus and C. laurentii are less involved. This study evaluated the in vivo pathogenicity, factors and genes related to virulence and the susceptibility to fluconazole before and after inoculation in immunocompetent BALB/c mice of ten environmental isolates of C. neoformans, C. albidus and C. laurentii. Serotypes, mating types and molecular typing were also determined to complete the evaluation. Enzymes like proteinases, phospholipase, urease, production of melanin and growth at 37oC were investigated by classical methods, but gene characterization and determination of serotypes and mating types were investigated by PCR. Molecular typing was done by PCR-fingerprinting with primers (GACA)4 and M13. The microdilution method was used to determine the minimum inhibitory concentration (MIC) of flucozanole. All C. neoformans isolates were serotype A and MAT-alfa and 9 of them when inoculated in animals killed 100% in up to 33 days. One isolate inoculated killed the animals in 40 to 82 days. Nine isolates were recovered from the animal lungs and brain in 7 and 14 days and the one which killed all animals in 12 days was only recovered on the 7th day. Animals inoculated with C. albidus and C. laurentii were alive until the tissue cultures of evaluated organs were negative. C. albidus was isolated mainly from the liver and lungs in up to 10 days after inoculation and strains of C. laurentii from the lungs and brain in up to 120 days. All isolates in the 3 species were capsule producers before and after inoculation. All strains of C. neoformans, 6 C. albidus and 6 C. laurentii grew at 37oC both before and after inoculation. All C. neoformans produced melanin and 6 C. laurentii produced it before inoculation and nine after. None was produced by C. albidus. Six isolates of C. neoformans and one of C. laurentii produced proteinases in both situations, before and after inoculation. Seven C. albidus isolates produced the protein hydrolyzing enzyme before inoculation and all after. Phospholipase enzyme was produced by all C. neoformans, and C. albidus and by 6 C. laurentii in both conditions, before and after inoculation. Urease activity was detected between 24 and 48 hours after incubation in a liquid medium for C. neoformans and C. laurentii cultures and after 24 to 96 hours for C. albidus. Fluconazole MICs ranged from 2 to 8 ug/ mL for C. neoformans isolates, from 8 to >= 64 ug/mL for C. albidus and from 1 to 64 ug/mL for C. laurentii in both conditions. Genes laccase (Lac1), phopholipase (PLB1) proteinase (cnap1), calcineurine (CNA1), urease (URE1) and ERG11, detected with the primers used were present in all C. neoformans. With exception of ERG11, which showed a band in agarose electrophoresis by all C. albidus, the other genes were not amplified in C. albidus and C. laurentii. Molecular typing by PCR-fingerprinting showed two molecular types in C. neoformans: VNI in 7 isolates and VNII in 3 isolates. Most C. albidus showed homogenous patterns in the bands generated and C. laurentii was the species with the higher genetic diversity by this methodology. It is concluded that isolate inoculations in animals does not alter phenotypes and no alteration is detected by molecular analysis. However, the high molecular heterogeneity of C. laurentii was detected.

Οι εντεροϊοί έχουν ιδιαίτερη σημασία για τη δημόσια υγεία, δεδομένου ότι σχετίζονται με επιδημίες γαστρεντερίτιδας (μη βακτηριογενούς προέλευσης) από την κατανάλωση μολυσμένου νερού. Οι ιοί αυτοί μπορούν να απομονωθούν σε μεγάλες ποσόστητες από κόπρανα και ούρα ανθρώπινης προέλευσης, καθώς και από λύματα και μολυσμένα νερά. Επιπλέον, οι Αδενοϊοί είναι παθογόνοι για τον άνθρωπο και η παρουσία τους σε περιβαλλοντικά δείγματα δύναται να προκαλέσει σημαντικές μολύνσεις. Οι Αδενοϊοί είναι ιοί ανθρώπινης εντερικής προέλευσης που περιέχουν DNA και ορισμένοι ορότυποι τους είτε δεν καλλιεργούνται, είτε καλλιεργούνται δύσκολα στις συνήθεις κυτταρικές σειρές. Γι’ αυτόν το λόγο, η ανίχνευσή τους σε μολυσμένο νερό και ο ρόλος τους ως παραγόντων πρόκλησης γαστρεντερίτιδας έχουν υποτιμηθεί. Οι Ρότα ιοί είναι υπεύθυνοι για οξεία περιστατικά γαστρεντερίτιδας στον άνθρωπο και τα ζώα. Κατόπιν του διπλασιασμού του γενετικού τους υλικού στον γαστρεντερικό σωλήνα οι ιοί αυτοί εκκρίνονται και δύνανται να διασπαρούν στο περιβάλλον και το νερό. Γενικά, οι Ρότα ιοί έχουν εμπλακεί σε περιστατικά γαστρεντερίτιδας σε πολλές χώρες. Η σταθερότητα των ανθρωπίνων Ρότα ιών στο νερό και η ανθεκτικότητά τους σε φυσικοχημικές διαδικασίες εξυγίανσης κατά την επεξεργασία των λυμάτων συντείνουν στην εξάπλωσή τους. Στην παρούσα διατριβή ανιχνεύθηκαν και απομονώθηκαν εντεροϊοί, αδενοϊοί και ρότα ιοί από ακατέργαστα λύματα, τα οποία ελήφθησαν από την είσοδο τεσσάρων σταθμών βιολογικού καθαρισμού (δύο στην Αττική και δύο στην Αχαΐα). Συνολικά ελήφθησαν 118 δείγματα ακατέργαστων λυμάτων κατά την περίοδο Σεπτέμβριο 2000 – Σεπτέμβριο 2003. Η μεθοδολογία αφορούσε στην συμπύκνωση των ιών ακολουθούμενη από RT-nested PCR, προκειμένου να επιτευχθεί αύξηση της ευαισθησίας απομόνωσης των ιών. Μετά την απομόνωση γενετικού υλικού των ιών πραγματοποιήθηκε τυποποίησή τους εφαρμόζοντας nucleotide sequencing analysis. Οι Ρότα ιοί ανιχνεύθηκαν σε 17 δείγματα (14.2%). Τα αποτελέσματα της τυποποίησής τους ήταν rotavirus τύπος G1 (88.2%) και τύπος G2 (11.8%). Οι Αδενοϊοί βρέθηκαν σε 55 δείγματα (45.8%). Η Sequencing ανάλυση είχε ως αποτέλεσμα την παρουσία στα δείγματα αδενοϊών της ομάδας F [τύποι 40 (34.6%) και 41 (63.6%)] και της ομάδας C [τύπος 2 (1.8%)]. Οι Εντεροϊοί ανιχνεύθηκαν σε 30 δείγματα (40%) και η sequencing ανάλυση είχε ως αποτέλεσμα την παρουσία αρκετών τύπων όπως (α) coxsackievirus (τύποι A6 - 3.3%, A9 - 3.3%, A16 - 3.3%, B4 - 16.7%, B5 - 3.3%), (β) echovirus (τύποι 2 -6.7%, 6 - 13.3%, 30 -10%), (γ) εντεροϊοί τύποι 68 - 3.3%, 71 - 13.3% καθώς και porcine εντεροϊός (6.7%), poliovirus 1 (6.7%) και poliovirus 2 (10%). Η μικροβιολογική ποιότητα του νερού επομένως και η ανθρώπινη υγεία επηρεάζονται σημαντικά από την παρουσία μικροοργανισμών εντερικής προέλευσης, οι οποίοι προέρχονται από λύματα που καταλήγουν στο υδάτινο περιβάλλον. Πολλές επιδημίες από ιούς εντερικής προέλευσης έχουν κατά καιρούς συνδυαστεί με το νερό. Οι υδατογενείς επιδημίες γενικά εξαπλώνονται στον πληθυσμό από κατανάλωση μολυσμένου νερού, κολύμβηση σε ακατάλληλα νερά αναψυχής καθώς επίσης μεταδίδονται απο τη σωματική επαφή και την εισπνοή. Τα μη επεξεργασμένα λύματα της μελέτης περιέχουν πολλούς και διαφορετικούς τύπους ιών εντερικής προέλευσης οι οποίοι κατά κύριο λόγο προκαλούν γαστρεντερίτιδα. Επομένως καθίσταται αναγκαία η επξεργασία των λυμάτων στο μέγιστο δυνατό βαθμό στους σταθμούς βιολογικού καθαρισμού. Η Sequencing ανάλυση έδειξε την παρουσία ανθρώπινων Ρότα ιών A (τύποι G1 και G2), οι οποίοι προκαλούν παγκοσμίως διάρροια σε παιδιά καθώς επίσης και την παρουσία αδενοϊών τύπου 40 και 41, οι οποίοι είναι σημαντικοί αιτιολογικοί παράγοντες γαστρεντερίτιδας, κυρίως σε θερμά κλίματα. Από την άλλη πλευρά η ποικιλία των εντεροϊών που ανιχνεύθηκε στα ακατέργαστα λύματα ήταν μεγαλύτερη συγκρινόμενη με την αντίστοιχη των υπολοίπων ιών της μελέτης. Η παρούσα διατριβή αναδεικνύει την αποτελεσματικότητα της μεθόδου «nucleotide sequencing analysis», ως μέσου επιδημιολογικής μελέτης και ανάλυσης της συσχέτισης ιών που εμπλέκονται σε ανθρώπινες ασθένειες κι εκέινων που ανιχνεύονται σε ακατέργαστα λύματα. / Enteroviruses have been associated with outbreaks of waterborne non-bacterial gastroenteritis and are of important concern for public health. Significant numbers of viruses can be isolated from faeces and urine of humans as well as from sewage and polluted waters. Adenoviruses are also pathogenic to humans and their presence in environmental samples (polluted waters) may cause infections. Like rotaviruses, adenoviruses are causative agents of gastroenteritis, are the only human enteric viruses to contain DNA and many serotypes are difficult to culture in regular cell lines For this reason, and because adenoviruses are slow growing, their presence in polluted water and their role as originators of gastroenteritis have probably been underestimated. Rota viruses are responsible for severe gastroenteritis in humans and animals. After replicating in the gastrointestinal tract, these viruses are excreted and may be dispersed in environmental waters. Rota viruses have been implicated in waterborne gastroenteritis outbreaks in many countries. The stability of human rotaviruses in environmental water and their resistance to physicochemical treatment processes in sewage treatment plants may facilitate their transmission. In the present study, enteroviruses, adenoviruses and rota viruses were detected in raw sewage samples from inlets of four biological treatment plants in Greece (two in Athens, two in Patras}. Raw sewage samples (118) were analyzed for the presence of these viruses during the period September 2000 to September 2003. Our approach consisted of a simple concentration of viruses from raw sewage followed by RT-nested PCR in order to increase the sensitivity of virus detection. The viral sequences detected were then characterized by nucleotide sequencing analysis. Rota viruses were detected in 17 samples (14.2%). Sequencing analysis of the positive sewage samples revealed the presence of rotavirus type G1 (88.2%) and type G2 (11.8%). Adenoviruses were found in 55 samples (45.8%). Sequencing analysis of the positive sewage samples revealed the presence of adenovirus group F type 40 (34.6%), type 41 (63.6%) and group C type 2 (1.8%). Enteroviruses were detected in 30 samples (40%) and sequencing analysis of the positive sewage samples revealed the presence of several types such as (a) coxsackievirus types (A6 - 3.3%, A9 - 3.3%, A16 - 3.3%, B4 - 16.7%, B5 - 3.3%), (b) echovirus types (2 -6.7%, 6 - 13.3%, 30 -10%), (c) enterovirus types (68 - 3.3%, 71 - 13.3%) as well as porcine enterovirus (6.7%). poliovirus 1 (6.7%) and poliovirus 2 (10%). Water quality and, therefore human health, may be significantly affected by the presence of pathogenic enteric microorganisms derived from sewage discharged to the aquatic environment. Outbreaks of enteric virus disease have been linked to water at various times and to different causes. Waterborne disease may be transmitted by consumption of polluted drinking water, by immersion in recreational water or by contact with skin or inhalation. Raw sewage was found to be contaminated by different types of enteric viruses that mainly cause gastroenteritis; therefore, it is necessary to use the most efficient water treatment measures in sewage treatment plants. Sequencing analysis showed the presence of human rotavirus A type G1 and G2 which cause childhood diarrhea worldwide and enteric adenoviruses (types 40 and 41) which are important etiological agents of pediatric gastroenteritis, principally in temperate climates. On the other hand, the variety of enteroviruses identified in the raw sewage samples was more extensive compared to the other viruses of the study. The present study demonstrated the efficiency of the nucleotide sequencing analysis for studying epidemiological relationships between strains involved in human infections and those found in raw sewage.

Gonorrhea is caused by the human pathogen Neisseria gonorrhoeae. More than 106 million new cases of N. gonorrhoeae infections occur each year worldwide. There is no vaccine available against gonococcal infections and treatment of gonorrhea with antibiotics is the only way to eradicate infection. The high prevalence of antibiotic resistance (AMR) in this microorganism makes the effective treatment of gonococcal infections increasingly problematic. The emergence of AMR, especially to extended spectrum cephalosporins (i.e. cefixime and ceftriaxone) which are the last possibilities for single dose treatment options for gonococcal infections, is a serious concern. Gonorrhea may become an untreatable infection in the near future. Saskatchewan (SK) has one of the highest rates of gonorrhea in Canada. In order to better characterize the gonorrhea epidemic in SK, the objectives of the present research were to determine the prevalence and trends of AMR and emerging AMR mechanisms in N. gonorrhoeae isolates. AMR mechanisms were ascertained for the first time in SK in order to identify genetic causes of resistance. This was completed by determining and analyzing the DNA sequences of various genes - penA, mtrR, porB ponA, gyrA, parC mtrR, 23S rRNA alleles and erm –implicated in gonococcal AMR. The population dynamics of the N. gonorrhoeae isolates in SK was investigated by DNA based molecular methods to determine strain distribution, evolution of AMR phenotypes, and association between strain types (STs) and AMR genotypes and phenotypes. N. gonorrhoeae isolates (n=427) from Saskatchewan (2003-2011) were susceptible to antibiotics now recommended for treatment - cefixime, ceftriaxone and spectinomycin. Over 95% of the isolates tested were also susceptible to penicillin (96%) and ciprofloxacin (95.5%), antibiotics no longer recommended for treatment, and azithromycin (99.4%). Tetracycline resistance was also high (50.1%). N. gonorrhoeae isolates that were resistant to the antibiotics tested and also those isolates with MICs ≥0.003 mg/L to cefixime and ceftriaxone were analyzed (n=146) to determine their resistance mechanisms. This analysis revealed that reduced susceptibility to ceftriaxone and cefixime and resistance to penicillin is mediated by specific mutations in penicillin binding protein 2 (PBP2), in the promoter and dimerization domains of MtrR and porin protein (PorB). Novel mutations and combinations of mutations were noted. Ciprofloxacin resistant N. gonorrhoeae isolates carried double mutations in GyrA (S91F and D95G/N) and a S87R or S88P substitution in ParC. Isolates resistant to azithromycin had specific mutations in all the four alleles of 23S rRNA as well as in the DNA binding domain of MtrR. Most resistance was chromosomally mediated while plasmid-mediated resistance to penicillin (0.93% of penicillin resistant isolates) and tetracycline (3.3%) was low. DNA based strain typing methods such as porB-DNA sequencing, N. gonorrhoeae multi-antigen sequence typing (NG-MAST) and multilocus sequence typing (MLST) showed that the gonococcal population in SK differs appreciably from both other Canadian provinces and from strains reported internationally. MLST analysis, which ascertains the evolution of isolates over time, demonstrated that penicillin and tetracycline resistant isolates in SK evolved through spontaneous mutations in established lineages. Ciprofloxacin and azithromycin resistant N. gonorrhoeae isolates, on the other hand, were introduced into SK from outside the province. Significant associations between particular mutation pattern combinations in resistance determining genes and specific NG-MAST STs were identified e.g. NG-MAST ST 25 was associated with specific combined mutation patterns in PBP2, MtrR and PorB and antibiotic susceptibility; and, NG-MAST ST 3654 was associated with another PBP2/MtrR/PorB mutation pattern, chromosomal resistance to penicillin and tetracycline and elevated MICs to cefixime. This research shows the importance of regional antimicrobial susceptibility monitoring. In the context of SK, this means that local surveillance of gonococcal AMR may be used to develop policies for regional treatment guidelines which promote the prudent use of antimicrobials for treatment, including those antibiotics which may no longer be used in other regions due to higher AMR rates. Further, the significant association between particular AMR mutation pattern combinations and specific STs indicates that AMR might be predicted. These results should assist in the development of non-culture-based tests for the diagnosis of gonococcal AMR similar to nucleic acid amplification tests used to diagnose N. gonorrhoeae infections.

Made available in DSpace on 2014-06-11T19:30:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-11-24Bitstream added on 2014-06-13T20:00:40Z : No. of bitstreams: 1 baeza_lc_dr_arafcf.pdf: 2250737 bytes, checksum: 666c7d374ebfa4ff8507fbfbe951a4b8 (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Universidade Estadual Paulista (UNESP) / As dermatofitoses são processos infecciosos de pele, pêlo e unhas muito comuns no mundo inteiro. Trichophyton rubrum é o dermatófito mais freqüentemente isolado em lesões superficiais de pele e unha. Estudos envolvendo este patógeno são cada vez mais importantes devido ao aparecimento de linhagens resistentes aos medicamentos antifúngicos disponíveis no mercado e ao comportamento invasivo deste agente em pacientes com o sistema imune comprometido. Estes fatos e poucos estudos levam à necessidade de se ampliar o conhecimento sobre a biologia deste agente. Visando colaborar nesse sentido, o presente trabalho teve dois objetivos centrais: 1) Realizar a tipagem molecular de isolados clínicos de T. rubrum com e sem relação epidemiológica por RAPD (Amplificação Randômica de DNA Polimórfico) com duas seqüências randômicas diferentes (denominadas de 1 e 6), bem como a análise dos elementos repetitivos (TRS-1 e TRS-2) do espaço não transcrito (NTS) do DNA ribossomal (DNAr) e 2) Identificar transcritos envolvidos na interação deste patógeno com fonte humana de queratina, através do RDA (Análise de Diferença Representacional). A aplicação do RDA permitiu pela primeira vez a identificação de alguns transcritos expressos, provavelmente relacionados à patogênese deste microrganismo. / Dermatophytosis is common infection process which occurs in skin, hair and nails and Trichophyton rubrum is the most frequently isolated dermatophyte. Studies on this pathogen are becoming increasingly important because of frequent reports on resistant strains to antifungal drugs commercially available and the invasive behavior of these agents in immunocompromised patients. These facts, associated with few studies with this agent, indicate the need to expand the information about the fungal biology. As a contribution to this goal, the present study had two central objectives: 1) To compare different methodologies for molecular typing of clinical isolates of T. rubrum epidemiologically related and unrelated for RAPD (Randomly Amplified Polymorphic DNA) with two different random primers (denominated of 1 and 6); as well as the analysis of the repetitive elements (TRS-1 and TRS-2) of the space non-transcribed (NTS) of the ribosomal DNA (DNAr) and 2) To identify transcripts involved in the interaction of this pathogen with human keratin by RDA (Representational Difference Analysis). The application of the RDA allowed for the first time the identification of expressed transcripts during the microorganism proliferation that could be related to the T. rubrum virulence.

Orientador: Maria José Soares Mendes Giannini / Banca: Clarice Queico Fujimura Leite / Banca: Celia Maria de Almeida Soares / Banca: Paulo Inácio da Costa / Banca: Mário Hiroyuki Hirata / Resumo: As dermatofitoses são processos infecciosos de pele, pêlo e unhas muito comuns no mundo inteiro. Trichophyton rubrum é o dermatófito mais freqüentemente isolado em lesões superficiais de pele e unha. Estudos envolvendo este patógeno são cada vez mais importantes devido ao aparecimento de linhagens resistentes aos medicamentos antifúngicos disponíveis no mercado e ao comportamento invasivo deste agente em pacientes com o sistema imune comprometido. Estes fatos e poucos estudos levam à necessidade de se ampliar o conhecimento sobre a biologia deste agente. Visando colaborar nesse sentido, o presente trabalho teve dois objetivos centrais: 1) Realizar a tipagem molecular de isolados clínicos de T. rubrum com e sem relação epidemiológica por RAPD (Amplificação Randômica de DNA Polimórfico) com duas seqüências randômicas diferentes (denominadas de 1 e 6), bem como a análise dos elementos repetitivos (TRS-1 e TRS-2) do espaço não transcrito (NTS) do DNA ribossomal (DNAr) e 2) Identificar transcritos envolvidos na interação deste patógeno com fonte humana de queratina, através do RDA (Análise de Diferença Representacional). A aplicação do RDA permitiu pela primeira vez a identificação de alguns transcritos expressos, provavelmente relacionados à patogênese deste microrganismo. / Abstract: Dermatophytosis is common infection process which occurs in skin, hair and nails and Trichophyton rubrum is the most frequently isolated dermatophyte. Studies on this pathogen are becoming increasingly important because of frequent reports on resistant strains to antifungal drugs commercially available and the invasive behavior of these agents in immunocompromised patients. These facts, associated with few studies with this agent, indicate the need to expand the information about the fungal biology. As a contribution to this goal, the present study had two central objectives: 1) To compare different methodologies for molecular typing of clinical isolates of T. rubrum epidemiologically related and unrelated for RAPD (Randomly Amplified Polymorphic DNA) with two different random primers (denominated of 1 and 6); as well as the analysis of the repetitive elements (TRS-1 and TRS-2) of the space non-transcribed (NTS) of the ribosomal DNA (DNAr) and 2) To identify transcripts involved in the interaction of this pathogen with human keratin by RDA (Representational Difference Analysis). The application of the RDA allowed for the first time the identification of expressed transcripts during the microorganism proliferation that could be related to the T. rubrum virulence. / Doutor

Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / Klebsiella pneumoniae à um bacilo gram-negativo responsÃvel por uma parcela significativa de infecÃÃes do trato urinÃrio, respiratÃrio e corrente sanguÃnea de adultos em hospitais, alÃm de infecÃÃes em recÃm-nascidos em unidades de terapia intensiva. Sua importÃncia tem aumentado devido ao surgimento de cepas produtoras de beta-lactamases de espectro estendido (ESBL). Estas enzimas medeiam resistÃncia aos oxyimino-&#946;-lactÃmicos. Em K. pneumoniae, a maioria das ESBL identificadas sÃo dos tipos TEM, SHV e CTX-M. Em adiÃÃo, &#946;-lactamases que hidrolisam carbapenÃmicos dos tipos KPC e GES tem sido detectadas nestes isolados. Surtos de infecÃÃo hospitalar causados por clones de K. pneumoniae multiressistentes tem sido descritos em vÃrias regiÃes do paÃs. No entanto, este à o primeiro relato de caracterizaÃÃo genÃtica de isolados de K. pneumoniae produtores de ESBL no estado do CearÃ, Brasil. Este estudo teve como objetivo, em primeiro lugar, detectar os principais genes responsÃveis pela produÃÃo de ESBL em cepas de K. pneumoniae obtidas a partir de pacientes que desenvolveram infecÃÃes hospitalares em um hospital de cuidados terciÃrios na regiÃo norte do estado do CearÃ, de novembro de 2013 a agosto de 2014 e, em segundo lugar, analisar a similaridade genÃtica destes isolados. Trinta e seis isolados clÃnicos de K. pneumoniae produtores de ESBL foram avaliados. A detecÃÃo dos genes blaCTX-M dos grupos 1 e 2, blaSHV-like, blaTEM-like, blaKPC-like e blaGES-like foi realizada por PCR. A tipagem molecular dos isolados foi realizada por Pulsed-Field Gel Electrophoresis (PFGE). Os genes blaCTX-M dos grupos 1 ou 2 e blaSHV-like foram detectados em 100% dos isolados e os genes blaTEM-like em 55,6%. Em adiÃÃo, 55,6% dos produtores de CTX-M tambÃm produziram SHV e TEM. Nenhum gene blaKPC-like e blaGES-like foi detectado. A tipagem molecular por PFGE mostrou grande diversidade entre os isolados, contudo dois isolados coletados em diferentes clÃnicas mostraram o mesmo perfil de bandas e tinham os mesmos genes bla e, entÃo, foram considerados como pertencentes a uma Ãnica cepa. A detecÃÃo dos genes blaCTX-M em 100% dos isolados sugere que as enzimas CTX-M sÃo as principais ESBL responsÃveis pelo fenÃtipo de resistÃncia aos beta-lactÃmicos nos isolados estudados. Dados apresentados neste estudo chamam atenÃÃo para um problema de resistÃncia endÃmico causado por cepas multiclonais de K. pneumoniae multirresistentes cujo controle passa essencialmente pelo aprimoramento das polÃticas de prescriÃÃo de antimicrobianos e pela implantaÃÃo de programas de prevenÃÃo e controle da disseminaÃÃo destes patÃgenos no hospital pesquisado. / Klebsiella pneumoniae is a Gram-negative bacillus responsible for a significant portion of urinary tract infections, respiratory, and bloodstream of adults in hospitals, besides infections in neonates in intensive care units. Its importance has increased due the emergence of extended-spectrum beta-lactamase-producing strains (ESBLs). These enzymes mediate resistance to oxyimino-&#946;-lactams. In K. pneumoniae, most of the identified ESBLs are of the TEM, SHV, and CTX-M types. In addition, carbapenem-hydrolyzing beta-lactamases of KPC and GES types has been detected in these isolates. Outbreaks of nosocomial infections caused by multidrug-resistant K. pneumoniae clones have been described in various regions of the country. However, this is the first report of the genetic characterization of ESBL-producing K. pneumoniae in the state of CearÃ, Brazil. This study aimed firstly to detect the main genes responsible for ESBL production in K. pneumoniae strains obtained from patients who developed nosocomial infections in a tertiary support hospital in the northern region of the Cearà state, from November 2013 to August 2014 and, secondly, to analyze the genetic similarity of these isolates. Thirty-six clinical isolates of ESBL-producing K. pneumoniae were evaluated. The detection of blaCTX-M groups 1 and 2, blaSHV-like, blaTEM-like, blaKPC-like, and blaGES-like genes was performed by PCR. Molecular typing of isolates was performed by pulsed-field gel electrophoresis PFGE. Groups 1 or 2 blaCTX-M and blaSHV-like genes were detected in 100% of the isolates and blaTEM-like genes in 55.6%. In addition, 55.6% of CTX-M-producers also produced SHV and TEM. No blaKPC-like and blaGES-like genes were detected. Molecular typing by PFGE showed great diversity between the isolates, although two isolates collected in different wards showed the same banding profile and had the same bla genes and so were considered to belong to a single strain. Detection of blaCTX-M genes in 100% of the isolates suggests that CTX-M enzymes are the major ESBLs responsible for the beta-lactam resistance phenotypes of the studied isolates. Data presented in this study call attention to an endemic resistance problem caused by multiclonal strains of multidrug-resistant K. pneumoniae whose control passes essentially the improvement of antimicrobial prescription policies and the implementation of prevention and control programs the spread of these pathogens in the studied hospital.

Cryptococcus neoformans e C. gattii são as principais espécies do gênero que causam infecção no homem, C. albidus e C. laurentii são espécies menos envolvidas. O presente trabalho teve por objetivos avaliar a patogenicidade in vivo, os fatores e os genes relacionados à virulência, e verificar o perfil de suscetibilidade ao fluconazol de 10 isolados ambientais de cada uma das espécies: C. neoformans, C. albidus e C. laurentii, antes e após a inoculação em camundongos BALB/c imunocompetentes; pesquisar os sorotipos, mating types e realizar a tipagem molecular. Proteinase, fosfolipase, urease, produção de melanina e crescimento à 37ºC foram pesquisados utilizando metodologias clássicas, e a pesquisa dos genes e determinação dos sorotipos e mating types foram feitas por PCR. A tipagem molecular foi realizada por PCR-fingerprinting, com os iniciadores (GACA)4 e M13. A determinação da CIM do fluconazol foi realizada pelo método da microdiluição em caldo. Todos os isolados de C. neoformans foram sorotipos A e MAT-alfa. A inoculação em animais mostrou que 9 isolados de C. neoformans mataram 100% deles em até 33 dias, e 1 levou os animais à morte num período entre 40 e 82 dias; 9 isolados foram recuperados dos pulmões e cérebro dos animais em 7 e 14 dias, e um deles levou todos os animais à morte em 12 dias, sendo possível recuperá-lo somente no 7º dia. Os animais inoculados com C. albidus e C. laurentii permaneceram vivos até negativação das culturas dos órgãos avaliados. C. albidus foi isolado principalmente do fígado e dos pulmões até 10 dias após a inoculação, C. laurentii dos pulmões e do cérebro até 120 dias. Todos os isolados das 3 espécies produziram cápsula antes e após a inoculação. Todos C. neoformans, 6 C. albidus e 6 C. laurentii cresceram à 37ºC antes e depois da inoculação. Melanina foi produzida por todos os isolados de C. neoformans e nenhum C. albidus nas duas ocasiões; e por 6 e 9 isolados de C. laurentii, antes e depois da inoculação, respectivamente. Seis isolados de C. neoformans e 1 de C. laurentii produziram proteinase nas duas ocasiões. Sete isolados de C. albidus produziram proteinase antes e todos depois da inoculação. Fosfolipase foi produzida por todos C. neoformans e C. albidus, e por 6 C. laurentii nas duas ocasiões. A avaliação da atividade da urease realizada em meio líquido foi positiva em 24 a 48 horas pelos isolados de C. neoformans e C. laurentii, e em 24 a 96 horas por C. albidus. A CIM de fluconazol variou de 2 a 8 ug/mL para C. neoformans, de 8 a >= 64 ug/mL para C. albidus, e de 1 a 64 ug/mL para C. laurentii, nas duas ocasiões. Todos os isolados de C. neoformans apresentaram os genes lacase (Lac1), fosfolipase (PLB1), proteinase (cnap1), calcineurina (CNA1), urease (URE1), e ERG11, com os oligonucleotídeos utilizados. A PCR com ERG11 mostrou uma banda no gel de agarose para todos C. albidus, porém nenhum dos outros genes pesquisados foram amplificados em C. albidus e C. laurentii. A tipagem molecular por PCR-fingerprinting dos isolados de C. neoformans revelou 2 tipos moleculares: VNI (7 isolados) e VNII (3 isolados). A maioria dos isolados de C. albidus apresentou homogeneidade nos padrões de bandas gerados, e C. laurentii foi a espécie que demonstrou maior diversidade genética por esta metodologia. Concluímos que a passagem dos isolados pelos animais não alterou os fenótipos estudados e nenhuma alteração foi detectada pela análise molecular. No entanto, verificamos a grande heterogeneidade molecular dos isolados de C. laurentii estudados. / Species of Cryptococcus neoformans and C. gattii are the main ones in the genus causing infection in man while C. albidus and C. laurentii are less involved. This study evaluated the in vivo pathogenicity, factors and genes related to virulence and the susceptibility to fluconazole before and after inoculation in immunocompetent BALB/c mice of ten environmental isolates of C. neoformans, C. albidus and C. laurentii. Serotypes, mating types and molecular typing were also determined to complete the evaluation. Enzymes like proteinases, phospholipase, urease, production of melanin and growth at 37oC were investigated by classical methods, but gene characterization and determination of serotypes and mating types were investigated by PCR. Molecular typing was done by PCR-fingerprinting with primers (GACA)4 and M13. The microdilution method was used to determine the minimum inhibitory concentration (MIC) of flucozanole. All C. neoformans isolates were serotype A and MAT-alfa and 9 of them when inoculated in animals killed 100% in up to 33 days. One isolate inoculated killed the animals in 40 to 82 days. Nine isolates were recovered from the animal lungs and brain in 7 and 14 days and the one which killed all animals in 12 days was only recovered on the 7th day. Animals inoculated with C. albidus and C. laurentii were alive until the tissue cultures of evaluated organs were negative. C. albidus was isolated mainly from the liver and lungs in up to 10 days after inoculation and strains of C. laurentii from the lungs and brain in up to 120 days. All isolates in the 3 species were capsule producers before and after inoculation. All strains of C. neoformans, 6 C. albidus and 6 C. laurentii grew at 37oC both before and after inoculation. All C. neoformans produced melanin and 6 C. laurentii produced it before inoculation and nine after. None was produced by C. albidus. Six isolates of C. neoformans and one of C. laurentii produced proteinases in both situations, before and after inoculation. Seven C. albidus isolates produced the protein hydrolyzing enzyme before inoculation and all after. Phospholipase enzyme was produced by all C. neoformans, and C. albidus and by 6 C. laurentii in both conditions, before and after inoculation. Urease activity was detected between 24 and 48 hours after incubation in a liquid medium for C. neoformans and C. laurentii cultures and after 24 to 96 hours for C. albidus. Fluconazole MICs ranged from 2 to 8 ug/ mL for C. neoformans isolates, from 8 to >= 64 ug/mL for C. albidus and from 1 to 64 ug/mL for C. laurentii in both conditions. Genes laccase (Lac1), phopholipase (PLB1) proteinase (cnap1), calcineurine (CNA1), urease (URE1) and ERG11, detected with the primers used were present in all C. neoformans. With exception of ERG11, which showed a band in agarose electrophoresis by all C. albidus, the other genes were not amplified in C. albidus and C. laurentii. Molecular typing by PCR-fingerprinting showed two molecular types in C. neoformans: VNI in 7 isolates and VNII in 3 isolates. Most C. albidus showed homogenous patterns in the bands generated and C. laurentii was the species with the higher genetic diversity by this methodology. It is concluded that isolate inoculations in animals does not alter phenotypes and no alteration is detected by molecular analysis. However, the high molecular heterogeneity of C. laurentii was detected.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The Salmonella infection is a relevant problem in the public health, being one of the most important causes of the world´s enteric pathologies, with 1,3 million ill people, resulting in 600 deaths/year. The Salmonella spp. transmission occurs especially through water consumption and contaminated food. The diagnosis is realized using biochemical, serologic, and molecular tests. The RAPD (Randomly Amplified Polymorphic DNA) test is able to detect the genetic variation present in the isolated Salmonella spp. samples, allowing a molecular typing. This research aimed at achieving molecular typing from Salmonella spp. samples isolated from various resources (oyster, chicken, potable water, blood, and human feces) utilizing the RAPD technique. 33 Salmonella spp. samples, that came from bacteria located at the Laboratório de Virologia Comparada-DMO/CCBS/UFS, and two standard samples were utilized. Six randomized primers were used from the Ready-To-Go System RAPD; the products amplified were submitted to an electrophoretic run in a 5% polyacrilamid gel, and silver dyed. The band standard observed was analyzed by the NTSYS program. After a computational analysis it was possible to discriminate the 35 Salmonella spp. samples, resulting in 35 RAPD individual and distinct patterns, showing that the samples are genetically diversed and that there is an ample genetic biodiversity in the circulating samples in Aracaju-SE. To the grouping the Salmonella spp. samples was observed the epidemiological relationship between human samples and chicken. / A infecção por Salmonella é um relevante problema de saúde pública, sendo uma das mais importantes causas de patologias entéricas do mundo, com 1,3 milhões de doentes, resultando em aproximadamente 16000 hospitalizações e 600 mortes/ano. A transmissão da Salmonella spp. ocorre principalmente através do consumo de água e alimentos contaminados. O diagnóstico é realizado através de testes bioquímicos, sorológicos e moleculares. A técnica de RAPD (Randomly Amplified Polymorfhic DNA) é capaz de detectar as variações genéticas presente nos isolados, permitindo a tipagem molecular. Este estudo teve como objetivo realizar a tipagem molecular das amostras de Salmonella spp. isoladas de diversas fontes (ostra, frango, água residual, sangue e fezes humanas) utilizando a técnica de RAPD. Foram utilizadas 33 amostras de Salmonella spp. da bacterioteca do Laboratório de Virologia Comparada DMO/CCBS/UFS e duas amostras padrões. Foram utilizados seis primers randômicos do Sistema Read-To-Go RAPD, os produtos amplificados foram submetidos à corrida eletroforética em gel de poliacrilamida 5% e corado pela prata. O padrão de bandas observadas foi analisado pelo programa NTSYS. Após análise computacional foi possível discriminar as 35 amostras de Salmonella spp., resultando em 35 padrões de RAPD individuais e distintos, mostrando que as amostras são geneticamente diversas e que existe uma ampla biodiversidade genética nas amostras circulantes em Aracaju-SE. Ao grupar as amostras de Salmonella spp. observou-se o relacionamento epidemiológico entre as amostras humanas e de frango.