Infection of bats with Histoplasma species.

Histoplasma species infect humans and animals, notably bats. Histoplasma species are thermally dimorphic fungi existing in mycelial form in the natural environment and in yeast form in infected tissues. In this narrative literature review, we summarize the occurrence of Histoplasma spp. in different species of bat tissues (n = 49) and in soil admixed with bat guano where the species of bat dwelling nearby has been identified (an additional 18 species likely infected) to provide an up-to-date summary of data. Most positive isolations are from the Americas and Caribbean, with some studies from Thailand, Malaysia, Nigeria, Slovenia, France, and Australia. We also summarize some of the early experimental work to elucidate pathogenicity, latency, immune response, and faecal excretion in bats. Given the recent recognition of the global extent of histoplasmosis, thermal dimorphism in Histoplasma spp., and global heating, additional work on understanding the complex relationship between Histoplasma and bats is desirable.

The fungal genus Histoplasma causes lung, disseminated, gut and adrenal disease in humans, many with AIDS, but also people with normally functioning immune systems. Exposure and outbreaks are often linked to visiting caves where bats reside. In some locations, considerable quantities of Histoplasma fungus are found in bat guano and, when airborne, can cause infection. There are over 1400 species of bat worldwide. We reviewed the literature from 1962, the first recorded description of bat infection by Histoplasma, and found 49 different species of bat recorded as being infected. Most of the data are from the Americas, very little from Africa, and some from hyperendemic areas in SE Asia. Histoplasma are temperature sensitive fungi and bats, especially those which hibernate and use torpor to survive winter-time shortages of insect prey, occupy environments with a wide range of temperatures. Our understanding of bat infection or latency, in a world with extremes of weather and general heating, is likely to change the Histoplasma/bat relationship in uncertain ways.

Burden of serious fungal infections in Trinidad and Tobago.

The information on the prevalence of fungal infections in the Caribbean region including Trinidad and Tobago (population 1,339,000 million) is scanty. Tinea capitis is common in children, being predominant in those of African descent, with no definitive estimate. Asthma is also common affecting 77,000-139,000 adults with an estimated 1927-3491 affected by allergic bronchopulmonary aspergillosis (ABPA) and 2544-4608 with severe asthma and fungal sensitisation (SAFS). An estimated 23,763 women have ≥4 attacks of vaginal candidiasis annually. Among the estimated 14,000 HIV-infected patients, 750 cases of oesophageal candidiasis, 400 cases of Pneumocystis pneumonia (PCP) and 50 cases of cryptococcal meningitis are anticipated. Histoplasma capsulatum is endemic in the islands with a 49% skin positivity rate in those <60 years old. Three cases of cutaneous histoplasmosis in AIDS patients have been reported. Three cases of pulmonary histoplasmosis were reported among German biologists following exposure to bats in a cave in Trinidad. Using a low mean international incidence figure for candidaemia of 5/100,000, 67 cases of candidaemia are estimated. The burden of fungal infections in Trinidad and Tobago is considerable and requires appropriate diagnostic and clinical expertise.

Occurrence of Cryptococcus neoformans and other yeast-like fungi in environmental sources in Bonaire (Dutch Caribbean).

INTRODUCTION: We report here the presence of Cryptococcus neoformans, and other potentially pathogenic yeasts and yeast-like fungi in environmental sources in Bonaire. METHODS: Seventy environmental samples comprising 40 samples of old pigeon droppings, 18 of woody debris from hollows of living trees of Caesalpinia ('Divi Divi'), Ziziphus jujuba (Red Indian date), Tamarindus indica (Tamarind), Terminalia catappa (Tropical almond), Azadirachta indica (Neem) and 3 of other unidentified species of trees, 3 of latex from a rubber tree and 6 of coral dust were processed for isolation of pathogenic Cryptococcus spp. and other potentially pathogenic yeasts and yeast-like fungi. A variety of mycological media were employed. Identification of the isolates was done with conventional techniques and species identification was done by matrix-assisted laser desorption ionization-time of flight mass spectrometry. RESULTS: Three of the 40 samples from old pigeon droppings yielded Cryptococcus neoformans, constituting the first record of environmental occurrence of this important pathogenic yeast in the Dutch Caribbean. Other potentially pathogenic yeasts and yeast-like fungi recovered from these environmental samples included 6 isolates each of Candida albicans, 8 of Candida parapsilosis, 4 each of Candida metapsilosis and Candida orthopsilosis, 2 each of Candida carpophila, Candida famata, Candida fabianii and Candida pelliculosa, 7 of Candida spp., 5 of Trichosporon spp. and 2 of Sporobolomyces spp. CONCLUSIONS: This study has demonstrated for the first time the occurrence of C. neoformans in a natural habitat in the Dutch Caribbean. The recovery of many species of potentially pathogenic yeast-like fungi and yeasts from environmental sources is remarkable.

Successful Limb Salvage in a Case of Advanced Long-Standing Eumycetoma of the Foot Using Adjunctive Local Amphotericin B Delivery Through Bioabsorbable Beads.

Mycetoma is a chronic, granulomatous infection mainly involving the foot and is caused either by bacteria (actinomycetoma) or fungi (eumycetoma). Eumycetoma is notoriously resistant, posing a therapeutic challenge. There are no specific treatment guidelines but generally a combination of systemic antifungals and local surgical treatment is the accepted standard. Advanced unresponsive lesions generally require amputation. We present a case of eumycetoma of 15-year duration with extensive involvement of foot including bones. Patient had been advised amputation from various tertiary care centers but we decided to give a limb salvage trial. The patient underwent soft tissue debridement along with oral antifungal therapy. Additionally, amphotericin B-impregnated bioabsorbable beads were inserted locally into the bony cavities to supplement the treatment. There has been no recurrence till date. This case is reported in view of successful limb salvage in an advanced eumycetoma case with an unprecedented use of adjunctive local antifungal delivery.

Typhoid fever among febrile Nigerian patients: Prevalence, diagnostic performance of the Widal test and antibiotic multi-drug resistance.

Background: Over-dependence on clinical presentation and/or the Widal agglutination test for the diagnosis of typhoid fever in developing countries can lead to antibiotic abuse. In Nigeria, the antibiotic resistance of typhoid organisms is poorly characterized. In this study, we determined the prevalence of culture positivity among patients suspected of having typhoid fever, evaluated the diagnostic value of the Widal test and the burden created by the multi-drug resistance of typhoid organisms in South-East Nigeria. Methodology: This was a prospective and case-controlled study carried out between 2013 and 2016. We acquired samples of blood/stool/urine cultures, and data relating to the Widal agglutination test and malaria parasites from 810 febrile patients (suspected of having typhoid) and 288 apparently healthy controls. Individuals with a history of antibiotic use within the previous 14 days were excluded. We then carried out antibiotic susceptibility tests on all isolates. Multi-drug resistance was defined as a resistance to ≥3 of the antibiotics tested. We determined the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of Widal test for typhoid laboratory diagnosis compared to bacterial culture which is the gold standard. A P-value <0.05 was considered to be statistically significant. Results: The mean age of typhoid suspects was 33.1±6.5 years and 50.7% were women. Of the 810 typhoid suspects tested, 114 (14.1%) had positive cultures for the typhoid organisms Salmonella enterica serovar paratyphi (72) and S. enterica serovar Typhi (42). Sample-specific rates of culture positivity were as follows: stool (72; 8.9%), blood (21; 2.6%) and urine (21; 2.6%), P<0.001. None of the controls had typhoid isolates. The sensitivity, specificity, PPV and NPV of the Widal test were 49.1%, 90.7%, 46.2% and 91.6%, respectively. Malaria parasitaemia was detected in 180 (22.2%) febrile patients, out of whom 115 (63.9%) had a positive Widal test for O/H antigens vs. 1% (6/630) in those with negative malaria parasite test results (P<0.001). The rate of false-positive Widal titres was 48%. Antibiotic multi-drug resistance was detected in 52.6% of patients. The antibiotics with the highest susceptibility were ciprofloxacin, levofloxacin and meropenem (all 100% susceptibility) and ceftriaxone (95.6% susceptibility). Conclusion: Our data showed that while typhoid fever is common in Nigeria, malaria is more prevalent. Our analysis showed that the Widal test performed poorly as a diagnostic test and that the burden created by multi-drug resistance was high. Our data indicate that periodic surveillance of antibiotic susceptibility is critical for optimal typhoid therapy.

Subcutaneous phaeohyphomycosis caused by Wallemia sebi in an immunocompetent host.

We report a case of subcutaneous phaeohyphomycosis due to Wallemia sebi in a 43-year-old-female, the first case reported since 1950. The lesion presented as a nonhealing ulcer on the dorsum of the left foot. Diagnosis was based on histological demonstration of the fungus and its recovery in culture.

Burden of serious fungal infections in the Dominican Republic.

The Dominican Republic (DR) is the second largest Caribbean nation and, with Haiti, the DR accounts for nearly three-quarters of the cases of human immunodeficiency virus (HIV) infection in the Caribbean region and the highest rates of TB in the Americas. The present study estimated the burden of serious fungal infections and some other mycoses in the DR. The data were extracted from the World Health Organization Stop Tuberculosis (WHO STOP TB) program, the Joint United Nations Program on HIV/AIDS (UNAIDS), and searches for relevant literature via MEDLINE, PubMed, MedFacts, and so on. The chronic pulmonary aspergillosis (CPA), allergic bronchopulmonary aspergillosis (ABPA), and severe asthma with fungal sensitization (SAFS) rates were derived from the asthma and TB rates. When no data regarding mycoses were available, we used specific populations at risk and the frequencies of fungal infection in each of these populations to estimate the national prevalence. Among its population of 10,090,000, we estimated that 221,027 (2.2%) have a serious fungal infection, including 158,134 women with recurrent vulvovaginal candidiasis. We estimated high numbers of 25,150 for ABPA and 34,000 for severe asthma fungal sensitization (SAFS) (250 and 529/100,000, respectively). CPA was common, with an estimated 2122 cases, of which 707 followed pulmonary TB. The annual prevalence of CPA was estimated to be 1374 cases. Four cases of histoplasmosis and several cases of chromoblastomycosis have also been reported. Pityriasis versicolor and tinea capitis are frequent in children, and 11% have kerion. Local epidemiological investigations are urgently required to validate or modify these estimates of serious fungal infections in the DR.

Prevalence of virulence genes of biofilm producing strains of Staphylococcus epidermidis isolated from clinical samples in Iran.

Coagulase negative staphylococci are recognized as opportunistic pathogens and are widespread in the environment. It is possible to prevent and control infections due to these bacteria if their virulence factors are recognized. Eighty isolates of Staphylococcus epidermidis (S. epidermidis) including 42 from urine (52.5%), 23 from blood (28.75%), 15 from dialysis bags (18.75%) were studied for biofilm production on Congo red agar (CRA). The virulence genes in S. aureus were investigated using polymerase chain reaction (PCR) with primers. Out of 80 isolates studied, 40 isolated (50%) formed black colonies (biofilm-forming strains) on CRA. In 22 of these isolates (25%) reaction was strongly positive; in 12 isolates (15%) reaction was moderately positive, and in the remaining 6 isolates, reaction was weakly positive. In the 22 isolates that had strong positive reaction and produced black colonies on biofilm, all virulent genes (icaC, icaD, icaA icaB, icaR) were expressed. In the 12 isolates that had moderate positive reaction, 8 expressed all genes (icaC, icaD, icaA icaB, icaR) expressed while the remaining 4 expressed only ica A, and ica D genes. Of the 6 isolated which had weak positive reaction, only 1 isolate (2.5%) expressed all the genes, in the other 5 isolates no gene was observed. Urinary isolates more frequently form biofilms than the isolates from other clinical samples. Statistical analysis using Chi square test showed that there was a significant correlation between the type of sample and the biofilm production (P < 0.05). The results of biofilm production on CRA were largely in agreement with microtiter plate assay and PCR assay. The capacity of bacteria to produce biofilm is an important factor in infectivity and happens via expression of ica genes. Recognition of bacteria that produce biofilm is thus important to control infection due to these bacteria.

Distribution of Candida species in different clinical sources in Delhi, India, and proteinase and phospholipase activity of Candida albicans isolates.

Eighty-five isolates of Candida recovered from three hundred and fifty diverse clinical sources, viz. respiratory tract (sputum, bronchial washing,bronchoalveolar lavage, tracheal aspirate), blood, urine, high vaginal swab, skin and plastic devices, were studied in detail for their morphological and biochemical characters. Seven species of Candida were identified, viz., C. albicans (45.8%), C. tropicalis (24.7%), C. parapsilosis (10.5%), C. krusei (7.0%), C. kefyr (7.0%), C. guilliermondii (3.5%), and C. glabrata (1.1%). C. albicans was the predominant species isolated from all clinical specimens, except blood from which C. krusei was most frequently (38.4%) recovered. Out of 39 isolates of C. albicans, 26 (66.6%) and 19 (48.7%) exhibited strong proteinase and phospholipase activity respectively. There was a higher prevalence of proteinase producing strains amongst the vaginal and skin isolates than that in urinary and respiratory isolates. Also a greater number of phospholipase producing strains was observed in the vaginal and urinary isolates than that in the respiratory and skin isolates.

A preliminary study on the occurrence of keratinophilic fungi in soils of Jamaica.

This report represents the first study of keratinophilic fungi present in soils of Jamaica. Out of the 40 soil samples examined from different habitats, 30 (75%) were positive for the presence of keratinophilic fungi, yielding 36 isolates of keratinophilic fungi. Microsporum gypseum complex (represented by 16 isolates of M. gypseum, and four of M. fulvum) was most frequent, being present in 50% of the samples. A very high occurrence of this dermatophyte in Jamaican soil is of public health significance. The remaining isolates of keratinophilic fungi were represented by Chrysosporium spp (mainly C. indicum and C. tropicum) and Sepedonium sp.

Ocular rhinosporidiosis: a case report from Delhi.

Rhinosporidiosis caused by Rhinosporidium seeberii, a protistal microorganism, is endemic in several parts of India. Infection involves mucous membranes of the nose and paranasal sinuses and usually manifests as vascular friable polyps. A few cases of rhinosporidoisis have been reported from Delhi, in patients who were migrants from other states. The present case constitutes the first report of rhinosporidiosis in a Delhi resident; the lesion occurred as polypoidal mass of the palpebral conjunctiva.

Disseminated Penicillium marneffei infection in a Myanmar refugee from Mizoram state.

A 30-year-old female, a Myanmar refugee, settled in Mizoram for last three years, reported to our hospital with respiratory symptoms and numerous characteristic skin lesions on multiple sites. Histology and culture of a biopsy from a facial skin lesion established the diagnosis of penicilliosis marneffei. This is first known case of Penicillium marneffei infection from Mizoram state, India to the best of our knowledge. It is possible that several undetected cases of the disease exist in Mizoram, and in the neighboring country, Myanmar and several such cases may be presenting in metropolitan cities.

A preliminary suudy on the occurrence of keratinophilic fungi in soils of Jamaica / Estudo preliminar sobre a ocorrência de fungos queratinofílicos em solos da Jamaica

This report represents the first study of keratinophilic fungi present in soils of Jamaica. Out of the 40 soil samples examined from different habitats, 30 (75%) were positive for the presence of keratinophilic fungi, yielding 36 isolates of keratinophilic fungi. Microsporum gypseum complex (represented by 16 isolates of M. gypseum, and four of M. fulvum) was most frequent, being present in 50% of the samples. A very high occurrence of this dermatophyte in Jamaican soil is of public health significance. The remaining isolates of keratinophilic fungi were represented by Chrysosporium spp (mainly C. indicum and C. tropicum) and Sepedonium sp.

Esta comunicação representa o primeiro estudo sobre fungos queratinofílicos presentes em solos da Jamaica. De 40 amostras de solo examinadas de diferentes localidades, 30 (75%) foram positivas para a presença de fungos queratinofílicos permitindo 36 isolamentos dos mesmos. O complexo Microsporum gypseum (representados por 16 isolamentos de M. gypseum e quatro de M. fulvum) foi o mais frequente, estando presente em 50% das amostras. A muito alta ocorrência deste dermatófito no solo da Jamaica é significante para a saúde pública. Os isolados remanescentes de fungos queratinofílicos foram representados pelo Chrysosporium spp (principalmente C. indicum e C. tropicum) e Sepedonium sp.

Mucocutaneous nasal histoplasmosis in an immunocompetent young adult.

A case of mucocutaneous nasal histoplasmosis in an immunocompetent host is described below. A 30-year-old male had a broadened nose with swelling and repeated blockage of nasal passages for the past six months. Diagnosis was made on the basis of histological demonstration of characteristic yeast cells of Histoplasma capsulatum var. capsulatum occurring within histiocytes and extracellularly in stained smears of fine needle aspirates and biopsy from the lesions in ala of the nose and perioral region. The patient showed appreciable regression of lesions after three weeks of itraconazole therapy but was not available for re-assessment.

Onychomycosis due to Emericella quadrilineata.

Nondermatophytic fungi are increasingly being reported as etiological agents of onychomycosis. We describe here a case of hand nail infection caused by Emericella quadrilineata (anamorph Aspergillus tetrazonus), a species not so far known to be an etiological agent of onychomycosis.