An epidemic of infections after video-assisted surgery (1,051 possible cases) caused by rapidly growing mycobacteria (RGM) and involving 63 hospitals in the state of Rio de Janeiro, Brazil, occurred between August 2006 and July 2007. One hundred ninety-seven cases were confirmed by positive acid-fast staining and/or culture techniques. Thirty-eight hospitals had cases confirmed by mycobacterial culture, with a total of 148 available isolates recovered from 146 patients. Most (n ‫؍‬ 144; 97.2%) isolates presented a PRA-hsp65 restriction pattern suggestive of Mycobacterium bolletii or Mycobacterium massiliense. Seventy-four of these isolates were further identified by hsp65 or rpoB partial sequencing, confirming the species identification as M. massiliense. Epidemic isolates showed susceptibility to amikacin (MIC at which 90% of the tested isolates are inhibited [MIC 90 ], 8 g/ml) and clarithromycin (MIC 90 , 0.25 g/ml) but resistance to ciprofloxacin (MIC 90 , >32 g/ml), cefoxitin (MIC 90 , 128 g/ml), and doxycycline (MIC 90 , >64 g/ml). Representative epidemic M. massiliense isolates that were randomly selected, including at least one isolate from each hospital where confirmed cases were detected, belonged to a single clone, as indicated by the analysis of pulsed-field gel electrophoresis (PFGE) patterns. They also had the same PFGE pattern as that previously observed in two outbreaks that occurred in other Brazilian cities; we designated this clone BRA100. All five BRA100 M. massiliense isolates tested presented consistent tolerance to 2% glutaraldehyde. This is the largest epidemic of postsurgical infections caused by RGM reported in the literature to date in Brazil.Outbreaks, pseudooutbreaks, and cases of health-care-associated infections caused by rapidly growing mycobacteria (RGM) have been reported since the first case was described in 1938 (13). In virtually all nosocomial infections caused by this group of microorganisms, there were failings in the sterilization processes of solutions, surgical instruments, or medical devices (13,14,45). Recent publications indicate an increasing number of infections secondary to breast augmentation and video-assisted surgeries (7,9,19,23,25,(40)(41)(42)(43).The growing number of cases and reports may be due, at least in part, to the well-known tolerance to alkaline glutaraldehyde among Mycobacterium chelonae-Mycobacterium abscessus group isolates and to the low susceptibility to high-level disinfectants (20,22,39).Outbreaks of RGM infections unrelated to medical procedures also can occur and usually are associated with exposure to recreational water containing a large number of bacteria and inadequate chlorination (15,44), highlighting the ubiquity of these organisms in the environment. In fact, RGM have been recovered from many different environmental sources, including soil and water distribution systems (8,45). RGM are considered opportunistic pathogens and can cause chronic lung disease, particularly the species included in the M. chelonae-M. abscessus group (8, 46)...

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BackgroundGermline mutations in p53 are associated with the Li-Fraumeni Syndrome which is characterized by childhood cancers, including pediatric adrenal cortical carcinomas and early onset breast cancer. The high incidence of adrenal cortical carcinomas in southern Brazil is mostly attributed to the R337H mutation in TP53. The relatively high population frequency of this mutation in southern Brazil, along with the clustering of early onset breast cancer in Li-Frameni families, suggests this mutation may also be a low-penetrance breast cancer susceptibility polymorphism.MethodsWe undertook this study to evaluate the frequency of the R337H mutation in breast cancer patients from Rio de Janeiro, Brazil. R337H mutation status was determined in 390 unselected breast cases and 324 controls identified from clinics in Rio de Janeiro, Brazil using a PCR-based assay.ResultsTwo of the breast cancer cases (0.5%) and none of the controls carried the mutation. Both cases had an early age at diagnosis (< 40 years old) and a family history of breast and other cancers.ConclusionsThese data suggest genetic screening of young onset breast cancer patients should include testing for the R337H mutation.