Programa de Pós-graduação em Medicina Tropical e Saúde Pública
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Item Epidemiologia molecular e riscos associados ao portador nasal de Staphylococcus aureus isolados de crianças de creches de Goiânia(Universidade Federal de Goiás, 2009-04-15) CARDOSO, Juliana Lamaro; KIPNIS, André; http://lattes.cnpq.br/4434965360286741; ANDRADE, Ana Lúcia Sampaio Sgambatti de; http://lattes.cnpq.br/7770363683068899Objectives: (i) to assess the prevalence of Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) nasal carriage in children attending day-care centers (DCC) in the municipality of Goiânia; (ii) to determine the potential risk factors related to S. aureus carriage and MRSA; (iii) to characterize MRSA isolates circulating in DCCs using molecular typing methods. Methods: Between August and December 2005, nasal swabs were collected from children who attended 62 DCCs. Clinical and socio-demographic information associated with the acquisition of S. aureus and MRSA were obtained through questionnaires applied to parents or guardians. The swabs were processed following the standard methods for identification and isolation of S. aureus. Amplification femB gene by polymerase chain reaction (PCR) was used to confirm the specie. The presence of mecA gene was detected by PCR and the positive isolates were identified as MRSA. Susceptibility to MRSA was determined by disk diffusion method. MRSA molecular typing was performed by PFGE, MLST, spa typing and SCCmec multiplex PCR. Results: 371 (31.1%) out of the 1.192 collected swabs were positive for S. aureus and 14 (1.2%) were identified as MRSA. The factors independently associated with risks for nasal colonization by S. aureus were children higher than two years of age (OR = 1.83, 95% CI 1.27-2.65) and previous DCC attendance (OR = 1.48; 95% CI 1.01-2.16). Mother s high degree of education was a protective factor for S. aureus carriage (OR = 0.43, 95% CI 0.23-0.80). A multidrug resistant dominant MRSA lineage was identified comprising 8 out of the 14 MRSA isolates. This cluster was characterized as SCCmec type IIIA, ST239 and spa type t037 sharing 82.7% genetic similarity with the Brazilian clone. One MRSA strain was classified as SCCmec type V and ST1120. This strain showed features of CA-MRSA although it has been recovered from a healthy child who presented risk factors for HA-MRSA acquisition. The remaining MRSA strains showed a diverse genetic background. Conclusions: Children attending DCCs are often colonized with S. aureus and although the prevalence of MRSA was low, they can represent potential vectors of spread of resistant pathogens to the community. The detection of a MRSA lineage circulating within DCCs suggests a two-way flow spread of MRSA between hospitals and community.Item FATORES DE RISCO E EPIDEMIOLOGIA MOLECULAR DE Streptococcus pneumoniae NÃO SUSCETÍVEIS À PENICILINA ISOLADOS DE NASOFARINGE DE CRIANÇAS QUE FREQUENTAM CRECHES EM GOIÂNIA-GO, BRASIL(Universidade Federal de Goiás, 2009-02-17) FRANCO, Cáritas Marquez; ANDRADE, Ana Lúcia Sampaio Sgambatti de; http://lattes.cnpq.br/7770363683068899Objectives: (i) to identify risk factors for S. pneumoniae penicillin nonsusceptible isolates (PNSp) in children attending day-care centers (DCCs) in Goiânia, Brazil and to assess the genetic patterns of pneumococcal isolates; (ii) to estimate the coverage for carriage serotypes for the 7-valente (PCV7) pneumococcal conjugate vaccine, and for the investigational 10 (PCV10) and 13-valent (PCV13) vaccines; (iii) to assess the genetic relatedeness between isolates expressing capsular type 14 and those non(sero)- typeable isolates (NTPn); (iv) to investigate if carriage isolates match genetically to any international pneumococcal clone (PMEN network). Methods: A cross-sectional survey of carriage PNSp was conducted among 1.192 children, 2 months to 5 years of age, attending 62 DCCs in Central Brazil. Capsular typing was performed in PNSp isolates (CLSI, 2007) and in a sample of isolates susceptible to penicillin (PSSp) matched to PNSp and DCCs whenever possible. Serotyping was performed by Quellung reactions and confirmed by multibead assay. NTPn isolates and serotype 14 were tested by PCR for capsule genes. Odds ratio for PNSp carriage and respective 95% confidence interval (95%CI) were assessed by logistic regression. Pulsed field gel electrophoresis (PFGE) was applied to assess the genetic similarity between PNSp serotype 14 and NTPn isolates. PCR was performed for the presence of pneumococcal capsule gene locus. For comparison purpose we also evaluated the genetic profile of PNSp serotype 14 invasive strains derived from the current pneumococcal invasive disease surveillance for the same pediatric population. Isolates were epidemiologically related if they shared ≥80% similarity on the dendrogram (Dice coefficient). A cluster was defined as three or more related isolates. Results: A total of 686 pneumococci were isolated for a colonization rate of 57.6% and 178 (25.8%) were PNSp. Among the PNSp isolates the usual common types were found: 14 (53%), 23F (10.2%), 6B (6%), 19F (4.8%) and 19A (4.2%). PSSp isolates displayed 30 different serotypes although serotype 14 was the most common. Overall a high prevalence of NTPn (11.1%) was observed with 62.9% PNSp. Serotypes coverage xvi for the PCV7, PCV10 and PCV13 vaccines were 55.2%, 55.9% and 65.1%, respectively. Being less than 24 months of age (OR=1.79; p=0.006), hospitalization in the previous three months (OR=2.19; p=0.025), and recurrent acute otitis media (OR=2.89; p=0.013) were independently associated with PNSp in a multivariate model. Among the 123 PNSp submitted to PFGE (106/carriage and 17/ invasive isolates) a major group of 34 serotype 14 strains (8 invasive and 26 carriage) was identified and found to be genetically related to the global pneumococcal clone Spain 9V-3 (82.7% similarity). All NTPn presented capsule gene locus and 10 (45.4%) of them presented capsule gene locus to type 14. Conclusions: (i) DCC attendees with history of recurrent AOM could significantly contribute to the spread of nasopharyngeal PNSp strains into the community; (ii) epidemiologic and molecular evidences support the findings that pneumococcal nonypeable carriage isolates are genetically similar to carriage and invasive isolates expressing capsular type 14; (iii) carriage and invasive isolates circulating in Goiânia belong to a serotype 14 variant of the Spain 9V -3 clone and play a critical role in the spread of PNSp strains to the entire pediatric community of GoiâniaItem Pneumonia e pobreza, uma abordagem espacial: Dois anos de vigilância populacional do estudo LEAP-Brazil(Universidade Federal de Goiás, 2012-12-06) MELO, Lícia Kamila Assis; ANDRADE, Ana Lúcia Sampaio Sgambatti de; http://lattes.cnpq.br/7770363683068899Item Mortalidade por causas violentas em jovens de Goiânia(Universidade Federal de Goiás, 2010-05-19) MINAMISAVA, Ruth; ANDRADE, Ana Lúcia Sampaio Sgambatti de; http://lattes.cnpq.br/7770363683068899Background: Deaths due to homicides and traffic accidents among youth are a public health issue worldwide. Studies of the complex network of cause and effect on this topic point to both poverty and health inequalities. Different investigational approaches to intentional and unintentional deaths combined with socioeconomic variables can help create a better understanding of the association between violence and socioeconomic conditions. This study analyzed the spatial distribution and potential clusters of risk for intentional and unintentional deaths among youths aged 15-24 years in Goiânia, a newly urbanized city in central Brazil. Methods: Death data and residential addresses were extracted from the national Mortality Information System and validated by household visits. To detect all potential cases, we prospectively investigated every death classified as a transport accident, assault, legal intervention,intentional self-harm, unknown underlying cause, and undetermined intent according to the ICD-10. The Geographical Information System was used to plot residential addresses, and cases were interactively geocoded to the residential address level using a digital map of the municipality. Spatial scan statistic was applied (Poisson model) to identify clusters of census tracts with high mortality due to intentional injuries and traffic accidents. The socioeconomic variables obtained using census data were compared between the most likely cluster and other areas of the municipality. Results: The most violent deaths among young people were due to intentional injuries. Between August 2005 and August 2006, 145 addresses for cases of intentional injuries and traffic accidents were located and geocoded. No significant clusters for deaths due to traffic accidents were found within the municipality. One significant cluster (RR = 4.65; p = 0.029) composed of 14 cases of intentional deaths, mostly homicides, was detected in an emergent, populated, and very poor area on the outskirts of the town. This cluster had a significantly higher proportion of people with the lowest educational status, lowest income, and poor housing conditions in comparison to the remainder of the municipality. Conclusion: Our findings highlight the link between social inequalities and intentional deaths, clearly showing the need for urgent social interventions to reduce violence and premature mortality.Item Estudo epidemiológico e molecular de portador nasal de Staphylococcus aureus e de Staphylococcus aureus meticilinaresistente em Pronto Atendimento Pediátrico e em Unidades de Terapia Intensiva Neonatal de Goiânia(Universidade Federal de Goiás, 2010-07-05) VIEIRA, Maria Aparecida da Silva; ANDRADE, Ana Lúcia Sampaio Sgambatti de; http://lattes.cnpq.br/7770363683068899Nasal carriage of Staphylococcus aureus methicillin-resistant (MRSA) is known to be a risk for subsequent infection. The MRSA carriers are an emergent and hidden reservoir in community and in the health-care environment. The aim of this investigation were to assess the prevalence and risk factors for MRSA nasal carriage in children attending emergency departments (ED) and Neonatal Intensive Care Units (NICU), and to describe the molecular features of such isolates. Methods: Nasal swabs were obtained from children less than 60 months of age attending ED, and from newborns of the four NICUs of Goiânia city, central Brazil, in 2007 and 2008. The definition of MRSA followed the CLSI criteria. Exposure variables to S. aureus and MRSA carriers were gathered through in-person interviews with mothers and hospital records. Univariate and multivariate logistic regression were performed to identify risk factors for S. aureus and MRSA carriage. Molecular typing was evaluated by pulsed field gel electrophoresis, staphylococcal cassette chromosome mec (SCCmec) typing, and multilocus sequence type (MLST). Results: A total of 2,735 children were enrolled. At the ED (n=2.034), the prevalence respectively of nasal carriages for S. aureus and MRSA were 20% (n=408) and 0.2% (n=4). Among NICUs (total of infants = 701), the prevalence of nasal carriage ranged from 0.03% to 15.7% for S. aureus and, from 0.0% to 2.0% for MRSA. At the ED, MRSA carriage was independently associated with child-care attendance in the previous 6 months (OR=10.6; p=0.045) and congenital malformation (OR=26.8; p=0.002). All nasal carriers at NICUs were from private hospitals. Only length of hospitalization was associated with MRSA nasal carriage at NICUs (p=0.023). Among four MRSA nasal carrier at ED, one harbored SCCmec type III, and three SCCmec type IV. Among four children from at the NICUs two infants harbored SCCmec type III, and two SCCmec type IV. All MRSASCCmec type III were multidrug-resistants. Strains related to Pediatric/USA800 and Brazilian MRSA clones were detected in both, ED and NICUs. One MRSA cluster related to Western Australia/USA400 was detected in ED. Conclusions: Children visiting ED, especially those reporting day-care attendance, and neonates from NICUs may play a role in spreading MRSA in healthcare settings. The study suggests cross transmission of MRSA type III and type IV between ED and hospital environments.