Las infecciones del tracto urinario (ITU) se encuentran entre las enfermedades infecciosas más frecuentes que afectan a los seres humanos y representan un importante problema de salud pública con una carga de morbilidad y de altos costos sanitarios especialmente cuando se complican. Los objetivos de este estudio son actualizar los patrones de resistencia a los antibióticos utilizados para las ITU causadas por E. coli comunitaria, comparar la resistencia antimicrobiana con otros datos publicados en Ecuador y sugerir varias estrategias para superar los desafíos que se presentan en el trabajo diario del laboratorio y la práctica clínica asociados con este importante problema. Resultados: Se aislaron 3341 Escherichia coli (79,38%), 299 Klebsiella pneumoniae (7,1%), 192 Enterococcus faecalis (4,56%), y otros microorganismos en el resto de muestras. Las alternativas de tratamiento empírico para E. coli son: nitrofurantoina, fosfomicina, amoxicilina/clavulanato, cefuroxima, ampicilina/sulbactam. E. coli productora de BLEE se encontró en 612 muestras (18,4%). Conclusión: es fundamental vigilar la resistencia bacteriana a nivel de comunidad, los datos obtenidos de la vigilancia hospitalaria no deben ser extrapolados a la comunidad.

Background: Fabry disease (FD) is the second most common lysosomal storage disorder. This disorder affects multiple systems that include the cardiac, renal, and nervous system. The pulvinar sign (PS) is a relatively common sign seen in patients with FD. The PS is a bilateral, symmetrical pulvinar high signal relative to the signal intensity seen on unenhanced T1-weighted brain MR imaging. Methods: We conducted a systematic review with metanalysis to analyze the pool prevalence of the disorder. We used the Moose Guidelines and PRISMA Protocol for this systematic review and Robins 1 to access the BIAS of the study. To analyze the pool prevalence, we used “Open Meta-Analysis” software for analyzing the study. We used “Review Manager 5.4” to analyze the odds ratio between patients with and without the PS and patients with and without stroke among patients with FD. Results: We gather 12 studies from 2003 to 2021 for the analysis of this study. The pool prevalence of the study was 0.146 (0.076–0.217) (62/385 cases) with a 95% CI (0.0945–0.415) (p < 0.01). The prevalence was much higher in men (59 cases) than in women (3 cases). There was no relationship between the pulvinar sign and patients with stroke among patients with Fabry disease. Odds ratio 1.97 95% CI (0.35–11.21), p = 0.44; Tau2 = 0.77. There seems to be a correlation with renal failure (RF), but there were very few studies to conduct a metanalysis with RF. Conclusions: The prevalence of the PS among all studies was 23.9%; the prevalence of this sign is higher among males. We found that FD patients who had strokes did not have higher odds of presenting with the Pulvinar Sign than the FD patients who did not suffer a stroke. Patients with renal failure and FD seem to have a higher tendency to have the PS, but there were not enough studies to analyze that theory. Overall, we think the pulvinar sign has a poor prognostic value in patients with Fabry’s disease.

Aims: To evaluate the diversity, prevalence, and phenotypic and genotypic characteristics of carbapenem-resistant Gram-negative bacteria (CR-GNB) causing bloodstream infections, and assess the mechanisms driving their dissemination through a multi-center study in nine hospitals of Ecuador. Methods and results: Between November 2021 and May 2022, 297 Gram-negative bacteria (GNB) were isolated from 273 patients across nine hospitals in Ecuador. Genotypic characterization of carbapenem-resistant GNB from blood cultures was performed by whole genome sequencing (WGS). CR-GNB accounted for 18.8% (56/297), predominantly Klebsiella pneumoniae (41.1%), followed by Enterobacter cloacae complex (16.1%), Acinetobacter baumannii (12.5%), and Pseudomonas aeruginosa (7.1%). CR-GNB showed high resistance to cephalosporins (80%–95%), piperacillin-tazobactam (85.7%), ampicillin-sulbactam (91.1%), and ciprofloxacin (78.6%). Genomic analysis revealed carbapenemase genes blaKPC-2 (most frequent), blaNDM-1, and blaOXA-181 across high-risk clones (e.g. K. pneumoniae ST307, ST258, ST147; A. baumannii ST1187). Carbapenemase genes were plasmid-borne (IncA/C, IncM, IncN, IncF, IncHI2, IncX3, and non-typeable) and associated with transposons (Tn4401, Tn125, and Tn3). Also, blaVIM-2 in Pseudomonas spp. was plasmid- and chromosomally encoded. Conclusions: Our findings demonstrate a high burden of CR-GNB, primarily due to K. pneumoniae and E. cloacae complex. Furthermore, the widespread distribution of blaKPC-2, blaNDM-1, and blaOXA-181 in high-risk clones, coupled with the frequent plasmid- and transposon-mediated mobilization of these genes, highlights the crucial role of horizontal gene transfer in the dissemination of resistance.

A 65-year-old man from the Northeastern United States presented in the summer with headaches, fever, and severe encephalopathy. Cerebrospinal fluid (CSF) demonstrated lymphocytic pleocytosis and hyperproteinorachia. Neuroimaging is shown in [Figures 1] and [2]. Serum and CSF showed positive immunoglobulin M (IgM) antibodies to Eastern equine encephalitis virus (EEEV). EEEV is a mosquito-borne alphavirus. Although rare, it can cause severe arboviral encephalitis, with mortality >33%.[1] Magnetic resonance imaging features such as the “parenthesis sign” ([Figure 1]) can help distinguish between Eastern equine encephalitis and other encephalitides.[2] Although most publications on EEEV originate from North America, EEEV and other related alphaviruses also circulate in the Caribbean, Central America, and South America.[3] [4] [5] MBS: case concept and design, literature review, manuscript writing; ACA: interpretation of data, manuscript revision for intellectual content; MV: case concept and design, acquisition of data, figure editing, manuscript revision for intellectual content. Received: 06 February 2022 Accepted: 20 March 2022 Article published online: 04 October 2022 © 2022. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/) Thieme Revinter Publicações Ltda. Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

Over the last years, several studies on bloodstream infections (BSI) have ranked P. aeruginosa in the top 5 list of Gram-negative causal agents. However, there is very limited data regarding the incidence of Pseudomonas bacteremia in Latin America. The aim of this study was to establish the incidence of bacteremia caused by Pseudomonas species During the period from November 2021 to May 2022 in 9 hospitals in Ecuador, blood culture samples were taken according to the clinical requirements of each patient. The bacteria identification was carried out using automated system (Vitek2 and Phoenix1000) and was confirmed by proteomic (MALDITOF) and molecular sequencing. Antimicrobial susceptibility was performed according to CLSI 2021. This study provided relevant information on BSI caused by Pseudomonas in Ecuador.There are only few population-based studies evaluating bacteremia epidemiology in Latin America. SENTRY in 1997 estimated that P. aeruginosa contributed to 10.6% of gram-negative nosocomial and community-acquired bloodstream infections. Lower incidence levels, as seen in this study (0.043%), could help better understand population trends and help guide treatment. Jeannete Zurita, n/a, Pfizer: Grant/Research Support