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Ants associated with pathogenic microorganisms in brazilian hospitals: attention to a silent vector/Formigas associadas a microorganismos patogenicos em hospitais brasileiros: a atencao para um vetor.

Introduction

Ants are social insects found almost everywhere and have higher diversity in tropical regions. These insects cause problems in hospitals worldwide (BEATSON, 1972), was the first reporting the occurrence of ants in nine hospitals in the United Kingdom, then in England (EDWARD; BACKER, 1981), Chile (IPINZA-REGLA et al., 1981); Germany (EICHELER; 1990) and Trinidad (CHADEE; MAITRE, 1990), Colombia (OLAYA-MASMELA et al., 2005), Spain (ESPALDER; ESPEJO, 2002), United States (KLOTZ et al., 1995; NELDER et al., 2006), Malaysia (NA; LEE, 2001), and Korea (KIM et al., 2005).

In Brazil, studies have initiated in the 90's with the identification of 14 ant species (FOWLER et al., 1993), Bueno and Fowler (1994) investigated 20 hospitals in Brazil, and the ant fauna in each hospital consisted of between 10 and 23 species.

Among the factors affecting the presence of ants in hospitals, highlights the architectural structure, proximity to residences, weather interferences, temperature variations that stimulate the migration of these insects to electronic devices searching for thermal stability and/or packages of drugs that provide suitable conditions for nesting, besides foodstuffs that function as extra attractive (BEATSON, 1972; ZARZUELA et al., 2002).

With the growing concern about the occurrence of ants in these environments, several studies have been undertaken in Brazil aiming to verify the potential of these organisms to carry pathogenic microorganisms, and the results have indicated their role as mechanical vector, contaminating the environment and collaborating to nosocomial infections (BUENO; FOWLER, 1994; FOWLER et al., 1993, MOREIRA et al., 2005). This discussion is justified because it is essential that health professionals to know and be aware of the need to control and monitor the presence of these insects, since currently hospital infections are a serious public health problem in the country.

Although ants are not considered the major source of hospital infections, are viewed as any other vehicle of transmission (FOWLER et al., 1993). For immunosuppressed patients, susceptible to develop infections, this exposure may change the prognosis, increasing the length and cost of hospitalization (IPINZA-REGLA et al., 1981).

This study examined the occurrence of ants in Brazilian hospital environments over the last decade, by means of a literature review, focusing on the distribution and potential of ants to carry pathogenic microorganisms, once ants in hospital settings may transport diverse bacterial species (gram-positive and gram-negative), considering that some strains may be multidrug-resistant. The Table 1 lists results from 13 studies performed in Brazil, with the species of ants collected in hospitals, microorganisms carried by them, and hospital wards in which they were collected.

Material and methods

For this study we used the systematic review using meta-analysis to integrate the results, allowing to describe current knowledge, indicating those aspects that are science-based and those that do not have a solid base of support and require further investigation.

The criteria for selection and inclusion of articles has occurred as the objectives of this study to maintain the rigor and uniformity in the choice of these were complied with some criteria: articles that address the topic, articles indexed in databases LILACS (Latin American Literature in Health Sciences) and MEDLINE (Medical Literature Analysis and Retrieval Sistem online); articles published in national journals within the defined time period from 2001 to 2011.

The key words used for this literature in LILACS and MEDLINE were ants, hospital and vectors.

Results and discussion

The ant diversity registered in Brazil with potential to act as mechanical vector of pathogenic microorganisms in hospital environments is significantly higher than in European countries. M. pharaonis is the species found in European hospitals (BEATSON, 1972; EICHLER, 1990; ULLOA, 2003). Fowler et al. (1993) considered that the ant species predominant in Brazil are the exotic M. pharaonis and T. melanocephalum.

Surveys in five Brazilian states indicated that some species are predominant in hospitals, and the occurrence of T. melanocephalum was predominant (TANAKA et al., 2007; TEIXEIRA et al., 2009), followed by P. longicornis. These and other species listed in Table 1 are mechanical vectors for nosocomial infections, since were identified pathogens such as Staphylococcus, Enterococcus, Klebsiela, Escherichia coli, Pseudomonas and Streptococcus carried by them in different hospital wards (BELEI et al., 2006; COSTA et al., 2006; FOWLER et al., 1993; GARCIA et al., 2011; LISE et al., 2006; MOREIRA et al., 2005; PESQUERO et al., 2008; RANDO et al., 2009; SANTOS et al., 2009; TANAKA et al., 2007; TEIXEIRA et al., 2009).

The identification of pathogenic microorganisms in the ants analyzed, along with biological traits, can define ants as potential carriers of pathogens and the infestation in hospitals is a risk to public health (BEATSON, 1972). The association between enterobacteria and ants has been observed in some Brazilian hospitals, which always represents a risk to hospitalized patients. Enterobacteria are common among insects, and horizontally transmitted from one to another individual, but can be acquired from the environment, showing thus capacity of propagation and maintenance of the microorganism in the environment (MOREIRA et al., 2005, PEREIRA; UENO, 2008, PESQUERO et al., 2008).

Ants can move upon human material such as urine, feces, sputum, and carry the microorganisms to the utensils and surfaces in general. Among the microorganisms identified in the ants is the group of fecal coliforms, including Escherichia, Enterobacter and Klebsiella, present in human feces by being part of the intestinal flora; and Staphylococcus aureus, on the human skin and nasopharynx, is the responsible for the most of nosocomial infections (TRABULSI, 1991).

Regarding the Escherichia coli, even being part of the gastrointestinal tract of humans it has been reported as one of the most important agents for extraintestinal infections, such as diarrhea in adults and children, and experimental keratoconjunctivitis, an infection similar to shigellosis (JAWETZ et al., 1998). Thus, the problem becomes relevant in the studied hospitals, once this bacterium was identified in ants Odontomachus sp and Pheidole sp1 and sp2 found in areas with the presence of children, such as nursery and maternity (SANTOS et al., 2009).

Ants have great capacity to maintain the association between bacteria and fungi, including some antibiotic-resistant pathogenic species, characterizing a condition of risk of nosocomial infection (PANTOJA et al., 2009; PEREIRA; UENO, 2008). Among the multiresistant strains, stand out the genera Acinetobacter, Streptococcus, Gemella, Enterococcus faecalis and Klebsiella (MOREIRA et al., 2005; TRABULSI, 1991) and K Pneumomiae (TANAKA et al., 2007). Thus, it is evident the importance of the problem in the public health area, once these bacteria are becoming increasingly resistant to a higher number of antibiotics.

The inpatient units for adults and children, Intensive Care Units (ICU) for adults and children, as well as nursery, surgical centers, nursing stations, sterilizing rooms, kitchens and laboratories are among the wards with high infestation of ants (COSTA et al., 2006; LISE et al., 2006; MOREIRA Ants in brazilian hospitals: atention to a silent vector et al., 2005; PESQUERO et al., 2008; RANDO et al., 2009; SANTOS et al., 2009; TANAKA et al., 2007; TEIXEIRA et al., 2009). Among them, some units with critically ill patients such as ICU, surgical centers and nurseries, receive a lower flow of people and materials, and have a higher frequency of environmental hygiene, then it was expected a lower index of infestation of ants than observed (BRAGANCA; LIMA, 2010). However, their presence was not related to the lack of cleaning, some species are attracted to sterilized materials, serum and medications used.

Multiresistant bacterial strains isolated from ants in places such as nurseries indicate a direct effect on disease transmission and consequently on increased rates of infection and severity of nosocomial infections. Undoubtedly, this needs to be discussed with sectors related to prevention of hospital infection (TANAKA et al., 2007).

According to these studies, ants in hospitals should be considered a threat to human health, because they are vectors of pathogenic bacteria, but not associate the presence of ants with indices of nosocomial infections, nor neglect their presence, without controlling or monitoring their presence in these environments (CINTRA-SOCOLOWSKI, 2007).

Conclusion

The presence of ants in hospitals should receive attention since they can carry diverse bacterial species, including multiresistant strains. In this way, ants in this environment should warn the CCIH and all multidisciplinary team for the effective control of nosocomial infections, because only with the participation of the entire hospital community it will be possible to develop from basic measures, such as hand washing, and the maintenance of a clean working environment, to the control of ants, but the professional awareness comes to the fore as prevention.

This problem can be minimized by adopting some measures to control ants in hospitals, such as the ban on entry of food and flowers, cover small cracks on the walls, removal of tree branches close to the windows and outside walls, removal of debris in the outer area. Because several factors favor the occurrence of ants in hospitals, including the deficient structure, even with efforts of a committee on hospital infection control, given the circulation of a large amount of people (patients, relatives, employees, suppliers) and goods (clothes, foodstuffs, flowers, and other objects) that favor the entry of these insects, in addition to the drugs that attract them.

Doi: 10.4025/actascihealthsci.v35i1.10471

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Received on Junee 22, 2010.

Accepted on August 16, 2011.

Flavio Roberto Mello Garcia * and Fernanda Lise

Laboratorio de Ecologia de Insetos, Departamento de Zoologia e Genetica, Instituto de Biologia, Universidade Federal de Pelotas, Cx. Postal 354, 96010-900, Pelotas, Rio Grande do Sul, Brazil. * Author for correspondence. E-mail: flavio.garcia@pq.cnpq.br
Table 1. Species of ants, microorganisms carried by them, and
hospital units examined by the 14 Brazilian studies.

Title                  Authors                Ant species

Ants as carriers of    Moreira et al.         Tapinoma
resistant bacteria     (2005)                 melanocephalum;
in hospitals                                  Paratrechina
                                              longicornis;
                                              Monomorium
                                              pharaonis;
                                              Solenopsis
                                              saevissima;

Occurrence,            Barros et al. (2006)   Camponotus sp.,
behavior, and                                 Camponotus crassus;
vectoring of fungi                            C. atriceps; C.
by ants in the                                renggeri; Wasmannia
hospital of the                               auropuntata;
Federal University                            Paratrechina
of Juiz de Fora,                              longicornis; M.
Minas Gerais State                            floricola; Pheidole
                                              sp., Tapinoma
                                              melanocephalum;
                                              Odontomachus sp.

Ants: analysis on      Belei et al. (2006)    Not specified
microorganisms
carried in the
hospital environment

Ants as mechanical     Costa et al. (2006)    Tapinoma
vectors of                                    melanocephalum;
microorganisms in                             Pheidole sp. and
the school hospital                           Paratrechina
of the Federal                                Longicornis.
University of
triangulo mineiro

Association between    Lise et al. (2006)     Monomorium
ants (Hymenoptera:                            pharaonis;
Formicidae) and                               Solenopsis
bacteria in                                   saevissima;
hospitals of Santa                            Paratrechina
Catarina State                                longicornis;
                                              Brachymyrmex sp.;
                                              Solenopsis sp.;
                                              Camponotus sp.;
                                              Tapinoma
                                              melanocephalu.

Urban ants and the     Rodovalho et al.       Tapinoma
transport of           (2007)                 melanocephalum and
nosocomial bacteria                           C. vittatus

Bacteria carried by    Tanaka et al. (2007)   Monomorium pharaonis
ants in hospital                              and Tapinoma
environment                                   melanocephalum.

Ants as                Pereira e Ueno         125 ants of the same
microorganism          (2008)                 not- specified
carriers in                                   species
hospitals

Ants in hospital       Pesquero et al.        Pheidole sp1;
environment and        (2008)                 Hipoponera sp1;
their potential to                            Dorymyrmex
transmit bacteria                             pyramicus;
                                              Linepitthema humile;
                                              Camponotus sp1;
                                              Brachymyrmex sp1;
                                              Brachymyrmex sp2;
                                              Paratrechina fulva;
                                              Cardiocondyla sp1;

Ants (Hymenoptera:     Santos et al. (2009)   Pheidole sp1 and
Formicidae) as                                sp2; Linepithema
bacterial vectors in                          humile; Wasmannia
two hospitals of the                          auropunctata;
municipality of                               Camponotus sp.;
Divinopolis, Minas                            Odontomachus sp;
Gerais State                                  Solenopsis sp.;
                                              Acromyrmex sp. and
                                              Tapinoma
                                              melenocephalum.

Characterization of    Rando et al. (2009)    Tapinoma
ant fauna in                                  melanocephalu;
establishments of                             Paratrechinafulva;
health area in the                            Monomorium
municipality of                               pharaonis; C.
Bandeirantes, Parana                          atriceps;
State.                                        Brachymyrmex sp.;
                                              Pheidole sp.4;
                                              Pheidole sp.3;
                                              Pheidole sp.2;
                                              Pheidole sp.1;
                                              Dorymyrmex sp.

Microbiota             Teixeira et al.        Tapinoma
associated with        (2009)                 melanocephalum.
urban ants in a
Brazilian university
hospital.

Ants (Hymenoptera:     Pantoja et al.         Tapinoma
Formicidae) as         (2009)                 melanocephalum;
carriers of fungi in                          Paratrechina
hospitals: emphasis                           longicornis;
on genera Tapinoma                            Camponotusand Pheidole                                  Solenopsis;
                                              Pheidole.

Association between    Goncalves et al.       Cardiocondyla emeryi
ants G (Hymenoptera:   (2011)                 Pheidole nubila,
Formicidae) and                               Pheidole spininodis,
pathogenic bacteria                           Pheidole sp.1, S.
in five hospitals in                          saevissima,
the city of Pelotas                           Tetramorium
                                              bicarinatum,

Title                  Microorganisms            Hospital unit

Ants as carriers of    Bacillus spp.;            Adult and pediatric
resistant bacteria     Enterobacter              wards, Cardiology,
in hospitals           amnigenus;                gynecology, trauma,
                       Enterobacter              postopoerative;
                       cloacae;                  Adult and pediatric
                       Enterococcus              ICU.
                       faecalis; Klebsiella
                       pneumoniae;
                       Staphylococcus
                       saprophyticus;
                       Acinetobacter
                       baumanni; Gemella
                       morbillorum;
                       Staphylococcus
                       epidermidis;
                       Staphylococcus
                       equorum; Klebsiella
                       oxytoca;
                       Staphylococcus
                       aureus;
                       Staphylococcus
                       simulans;
                       Staphylococcus
                       warneri; Serratia
                       rubidae
                       Staphylococcus
                       cohnii Bacillus spp.
                       Enterobacter
                       agglomerans;
                       Gemellaha emolysans;
                       Enterococcus
                       faecium; Gemellaha
                       emolysans;
                       Streptococcus
                       acidominimus;
                       Staphylococcus
                       lugdunensis.

Occurrence,            Aspergillus sp.;          Not specified
behavior, and          Cladosporium sp.;
vectoring of fungi     Penicillium sp.;
by ants in the         Candida sp. and
hospital of the        Aspergillus niger.
Federal University
of Juiz de Fora,
Minas Gerais State

Ants: analysis on      Filamentous fungi,        NICU and other
microorganisms         Coagulase negative        hospital units.
carried in the         staphylococci,
hospital environment   acinetobacter sp.;
                       micrococcus sp.; and
                       bacillus sp..

Ants as mechanical     Staphylococcus sp.;       Wards, service of
vectors of             Gram-positive             nutrition and
microorganisms in      bacilli, Pseudomonas      dietetics, and
the school hospital    sp.; and Micrococcus      pediatric ICU
of the Federal         sp..
University of
triangulo mineiro

Association between    Acinetobacter sp.;        Adult inpatient
ants (Hymenoptera:     Acinetobacter             unit, surgical,
Formicidae) and        haemolyticu;              oncology and
bacteria in            Oerskovia sp.;            pediatrics.
hospitals of Santa     Corynebacterium sp.;
Catarina State         Corynebacterium
                       diphtheriae;
                       Corynebacterium
                       jeikeium;
                       Enterococcus sp.;
                       Listeria
                       monocytogenes;
                       Neisseria sp.;
                       Planococcus sp.;
                       Pseudomonas luteola;
                       Sphingobacterium
                       sp.; Sphingomonas
                       paucimobilis;
                       Staphylococcus sp.;
                       Staphylococcus
                       intermedius;
                       Staphylococcus
                       saprophyticus;
                       Stenotrophomonas
                       maltophilia;
                       Streptococcus
                       agalactiae;
                       Streptococcus
                       bovis;. Neisseria
                       sp.; Planococcus sp.
                       and S. agalactiae.

Urban ants and the     Coagulase positive        Unit of infectious
transport of           staphylococci,            diseases, emergency
nosocomial bacteria    Coagulase negative        room, and burn unit
                       staphylococci and
                       Gram-negative
                       bacilli.

Bacteria carried by    Corinebacterium sp.;      Nursery, surgical
ants in hospital       Klebsiella                center, nursing
environment            pneumoniae; K.            station, sterilizing
                       ozaenae; Escherichia      room, blood donation
                       coli.                     room, and ICU

Ants as                Hafnia alvei;             Medical clinic,
microorganism          Klebsiella p neu          blood unit, laundry,
carriers in            moniae; Enterobacter      and orthopedics.
hospitals              aglomerans;
                       Enterobacter
                       cloacae;
                       Enterobacter
                       sakazakii; Serratia
                       liquefaciens;
                       Serratia marcescens.
                       Epidermopgyton
                       floccosum;
                       Trichophyton rubrum;
                       Trichophyton
                       verrucosun;
                       Clodosparium
                       carruoni;
                       Aurobasidium
                       pullulans; Wangiella
                       dermatitidis;
                       Conidiobolus
                       coronalus; Fonsecaea
                       pedrosoi;
                       Aspergillus niger;
                       Aspergillus jlavus;
                       Aspergillus
                       fumigatus; Monilia
                       sitophita.

Ants in hospital       Escherichia coli;         Restrooms, nursery,
environment and        Staphylococcus sp.;       medical offices,
their potential to     Enterococcus sp.;         kitchen, sterilizing
transmit bacteria      Klebsiella sp.;           room, hematology,
                       Salmonella sp. and        laboratory, milk
                       Aeromonas sp.             kitchen unit,
                                                 nursing station,
                                                 suture room, plaster
                                                 room, Adult and
                                                 pediatric ICU

Ants (Hymenoptera:     Escherichia coli;         Warehouse, nursery,
Formicidae) as         Pseudomonas               chapel, sterilizing
bacterial vectors in   aeruginosa';              room, surgical
two hospitals of the   pathogenic and non-       center, medical
municipality of        pathogenic                clinic, drugstore,
Divinopolis, Minas     Staphylococcus spp;       kitchen, bedrooms,
Gerais State           Streptococcus             laboratory,
                       faecalis and other        maternity, ICU,
                       Enterococcus sp.          radiology.

Characterization of    Staphylococcus sp.;       Surgical center,
ant fauna in           Serratia sp.;             hallways, drugstore,
establishments of      Klebsiella sp.;           laundry, nursing
health area in the     Escherichia coli;         stations, reception,
municipality of        Salmonella sp.; and       adult and pediatric
Bandeirantes, Parana   Pseudomonas sp..          inpatient units, and
State.                                           ICU

Microbiota             Gram-positive             Surgical center, and
associated with        bacilli, Gram-            ICU.
urban ants in a        negative bacilli,
Brazilian university   Gram-positive cocci,
hospital.              Filamentousfungi,
                       Pseudomonas;
                       Staphylococcus; and
                       Streptococcus.

Ants (Hymenoptera:     Absidia sp.;              NICU, adult ICU,
Formicidae) as         Acremonium sp.;           surgical center,
carriers of fungi in   Acremonium                transplant units,
hospitals: emphasis    hyalinulum;               pediatrics,
on genera Tapinoma     AspergiHusflavus;         hematology, surgery,
and Pheidole           Aspergillus niger;        gynecology.
                       Aspergilluso
                       chraceus;
                       Aspergillus oryzae;
                       Aspergillus sydowii;
                       Aspergillus
                       versicolor;
                       Chrysosporium inops;
                       Cladosporium
                       Sphaerospermum;
                       Cokeromyces sp.;
                       Cunninghamella
                       Bertholletiae;
                       Cyphellophora sp.;
                       Fusarium sp.;
                       Fusarium
                       proliferatum;
                       Fusarium solani;
                       Mortierella;
                       polycephala; Mucor
                       sp.;
                       Mycocentrospora;
                       acerina; Ochroconis
                       gallopava;
                       Paecilomyces
                       marquandii;
                       Paealomyces
                       variotii;
                       Penicillium sp.
                       Rhinocladiella
                       aquaspersa;
                       Scopulariopsis
                       koningii;
                       Scytalidium sp.;
                       Tritirachium oryzae;
                       Candida albicans;
                       Candida glabrata;
                       Candida
                       guilliermondii;
                       Candida

Association between    Enterobacteria,           Surgical center,
ants G (Hymenoptera:   Pseudomonas               hallways, drugstore,
Formicidae) and        aeruginosa,               laundry, nursing
pathogenic bacteria    Pseudomonasfluorescens,   stations, reception,
in five hospitals in   Pseudomonas putida,       adult and pediatric
the city of Pelotas    Staphylococcus            inpatient units, and
                       epidermidis and           ICU
                       Staphylococcus
                       saprophyticus
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Author:Garcia, Flavio Roberto Mello; Lise, Fernanda
Publication:Acta Scientiarum. Health Sciences (UEM)
Date:Jan 1, 2013
Words:3759
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