Isolates from hospital environments are the most virulent of the Candida parapsilosis complex.

BACKGROUND: Candida parapsilosis is frequently isolated from hospital environments, like air and surfaces, and causes serious nosocomial infections. Molecular studies provided evidence of great genetic diversity within the C. parapsilosis species complex but, despite their growing importance as pathogens, little is known about their potential to cause disease, particularly their interactions with phagocytes. In this study, clinical and environmental C. parapsilosis isolates, and strains of the related species C. orthopsilosis and C. metapsilosis were assayed for their ability to induce macrophage cytotocixity and secretion of the pro-inflammatory cytokine TNF-α, to produce pseudo-hyphae and to secrete hydrolytic enzymes. RESULTS: Environmental C. parapsilosis isolates caused a statistically significant (p = 0.0002) higher cell damage compared with the clinical strains, while C. orthopsilosis and C. metapsilosis were less cytotoxic. On the other hand, clinical isolates induced a higher TNF-α production compared with environmental strains (p < 0.0001). Whereas the amount of TNF-α produced in response to C. orthopsilosis strains was similar to the obtained with C. parapsilosis environmental isolates, it was lower for C. metapsilosis strains. No correlation between pseudo-hyphae formation or proteolytic enzymes secretion and macrophage death was detected (p > 0.05). However, a positive correlation between pseudo-hyphae formation and TNF-α secretion was observed (p = 0.0119). CONCLUSIONS: We show that environmental C. parapsilosis strains are more resistant to phagocytic host defences than bloodstream isolates, being potentially more deleterious in the course of infection than strains from a clinical source. Thus, active environmental surveillance and application of strict cleaning procedures should be implemented in order to prevent cross-infection and hospital outbreaks.

New polymorphic microsatellite markers able to distinguish among Candida parapsilosis sensu stricto isolates.

Among the Candida species causing bloodstream infections, Candida parapsilosis is one of the most frequently isolated. The objective of the present work was the identification of new microsatellite loci able to distinguish among C. parapsilosis isolates. DNA sequences with trinucleotide repeats were selected from the C. parapsilosis genome database. PCR primer sets flanking the microsatellite repeats were designed and tested with 20 independent isolates. On the basis of the amplification efficiency, specificity, and observed polymorphism, four of the sequences were selected for strain typing. Two hundred thirty-three independent C. parapsilosis sensu stricto isolates were genotyped by using these markers. The polymorphic loci exhibited from 20 to 42 alleles and 39 to 92 genotypes. In a multiplex analysis, 192 genotypes were obtained and the combined discriminatory power of the four microsatellites was 0.99. Reproducibility was demonstrated by submission of subcultures of 4 isolates each, in triplicate, interspersed with unique numbers among a group of 30 isolates for blind testing. Comparison of the genotypes obtained by microsatellite analysis and those obtained by randomly amplified polymorphic DNA analysis, restriction fragment length polymorphism analysis, and internal transcribed sequence grouping was performed and showed that the microsatellite method could distinguish individual isolates; none of the other methods could do that. Related species, C. orthopsilosis and C. metapsilosis, were not confused with C. parapsilosis sensu stricto. These new microsatellites are a valuable tool for use for the differentiation of C. parapsilosis sensu stricto strains, vital in epidemiology to answer questions of strain relatedness and determine pathways of transmission.

Chromoblastomycosis associated with Fonsecaea pedrosoi in a carpenter handling exotic woods.

Chromoblastomycosis is a rare, hard to diagnose disease that arises mostly in the tropics, especially in humid areas, affecting mainly males and rural workers. It is characterized by verrucous plaques or nodules that are slow growing and attributed to infection by different pigmented (dematiaceous) fungi. Usually the infection develops after injury, being primarily located on the lower extremities. The authors present the case of a healthy, 60-year-old man observed with a one year history of an erythematous violaceous 5cm tumor located on the right thigh. A biopsy specimen for histopathology revealed single or clustered brown pigmented cells, with a single or double septum and thick cell walls. Cultural smears showed growth of Fonsecaea Pedrosoi. The patient was treated with oral itraconazole (200mg per day), with a good response and clinical cure in 6 months that left only an atrophic scar.

Grado de satisfacción e impacto social y medioambiental en pacientes incluidos en un programa de seguimiento remoto de marcapasos / Degree of satisfaction and social and environmental impact in patients included in a remote pacemaker monitoring program

Resumen Objetivo: Describir el grado de satisfacción y el impacto sociolaboral y medioambiental de los pacientes de un programa de seguimiento remoto de marcapasos. Método: Estudio observacional prospectivo que incluyó 160 pacientes del programa de seguimiento remoto entre 2016 y 2017. Se pasó una encuesta de satisfacción a dichos pacientes y se cuantificó la disminución del CO2 emitido al reducir el número de visitas. Resultados: Los pacientes acudían acompañados (86%) y en coche (66%) la mayoría de las veces, y mostraron un grado de satisfacción «bueno o excelente¼ en un 96%. Se estima un ahorro de emisión de CO2 de casi un 10% por ciclo de seguimiento. Conclusiones: El seguimiento remoto de marcapasos implantado en nuestra unidad de arritmias reduce el impacto sociolaboral, económico y medioambiental.

Abstract Objective: To describe the degree of satisfaction and social, occupational and environmental impact of patients on our remote pacemaker monitoring programme run. Method: Prospective observational study including 160 patients on the remote pacemaker monitoring programme between 2016 and 2017. We handed out a satisfaction survey and quantified the decrease in CO2 emitted by reducing the number of visits. Results: The patients attended visits accompanied (86%) and by car (66%) most of the time. 96% of respondents said their degree of satisfaction was "good or excellent". We estimated a saving in CO2 emissions of almost 10% for each remote monitoring cycle. Conclusions: The remote monitoring of pacemakers implemented by our arrhythmia unit reduces the social, occupational, financial and environmental impact.

Dermatomycosis in lower limbs of diabetic patients followed by podiatry consultation.

BACKGROUND: Diabetic patients are particularly susceptible to fungal infections due to modifications that occur in their immunological system. These modifications compromise natural defences, such as skin and nails, especially from lower limbs. AIMS: Assessing the presence of dermatomycosis in lower limbs of Portuguese diabetic patients followed on Podiatry consultation. Determination of possible predisposing factors and the most frequent fungal species associated with the cases are included in the study. METHODS: A six-month prospective study was carried out in 163 diabetic patients with signs and symptoms of dermatomycosis followed by Podiatry at the Portuguese Diabetes Association in Lisbon. Samples from the skin and/or nails of the lower limbs were collected and demographic and clinical data of those patients were recorded. RESULTS: Trichophyton rubrum was the most frequently isolated dermatophyte (12.1%), followed by Trichophyton mentagrophytes (7.7%) and Trichophyton tonsurans (4.4%). Our study showed positive associations between type 2 diabetes and the presence of dermatomycosis in the studied population (p=0.013); this association was also shown between the occurrence of dermatomycosis and the localization of the body lesion (p=0.000). No other predisposing factor tested was positively associated with infection (p>0.05). CONCLUSIONS: Data on superficial fungal infections in diabetic patients are scarce in Portugal. This study provides information on the characterization of dermatomycosis in lower limbs of diabetic patients.

Ecografía pulmonar como herramienta diagnóstica de neumonía adquirida en la comunidad en niños / Pulmonary echography as a diagnostic tool of pneumonia acquired in the community in children

Resumen La neumonía se define clínicamente como la presencia aguda de fiebre acompañada de síntomas y signos respiratorios que pueden estar o no acompañados de hallazgos radiográficos. Sin embargo, los signos y síntomas que acompañan la enfermedad en la edad pediátrica son inespecíficos. La radiografía de tórax continúa siendo la prueba de referencia para el diagnóstico de neumonía. Contrario a esto, la radiografía de tórax no se recomienda de forma rutinaria ante la sospecha de neumonía. La tomografía y la resonancia magnética ofrecen mejores herramientas diagnósticas, aunque todas conllevan a una exposición a radiación ionizante y a un mayor costo en los servicios de salud. Es conocido que la radiación ionizante es capaz de causar potencialmente daños a los tejidos y más aún en los niños. En los últimos años, diferentes estudios proponen la ecografía pulmonar como ayuda diagnóstica para la neumonía al ofrecer ventajas como no requerir uso de sedantes, no expone a radiación ionizante, fácil transporte y ofrece mejor resolución en lo referente al diagnóstico de septos. Muchos estudios han demostrado la efectividad de la ecografia pulmonar para el diagnóstico de la neumonía. Un metaanálisis reciente reportó una sensibilidad de 96 % (IC95 % 94-97 %) y una especificidad del 93 % (IC95 % 90-96 %) de la ecografía pulmonar para el diagnóstico para la neumonía. Deduciendo que la ecografía pulmonar se proyecta como una herramienta diagnóstica para la neumonía, llegando a ser igual o superior a la radiografía de tórax.

Abstract Pneumonia is defined clinically as the acute presence of fever accompanied by respiratory symptoms and signs that may or may not be accompanied by radiographic findings. However, the signs and symptoms that accompany the disease in the pediatric age are nonspecific. Chest radiography continues to be the gold standard for the diagnosis of pneumonia. Contrary to this, chest radiography is not routinely recommended in case of suspected pneumonia. The tomography and the magnetic resonance offer better diagnostic tools, nevertheless these, along with the x-ray, lead to an exposure to ionizing radiation and to a greater cost in the health services. It is known that ionizing radiation is capable of potentially causing damage to tissues and even more so in children. In recent years, different studies have proposed pulmonary ultrasound as a diagnostic aid for pneumonia, offering advantages such as not requiring the use of sedatives, exposure to ionizing radiation, easy transport and offering better resolution regarding the diagnosis of septa. Many studies have demonstrated the effectiveness of pulmonary ultrasound for the diagnosis of pneumonia. A recent meta-analysis reported a sensitivity of 96% (95% CI 94-97%) and a specificity of 93% (95% CI 90-96%) for pulmonary ultrasound for the diagnosis of pneumonia. Deducing that the pulmonary ultrasound is projected as a diagnostic tool for pneumonia, being equal or superior to chest radiography.

Comparison of Enzymatic Method Rapid Yeast Plus System with RFLP-PCR for Identification of Isolated Yeast from Vulvovaginal Candidiasis.

OBJECTIVES: To compare two identification methods, i.e., restriction fragment length polymorphism (RFLP)-PCR analysis and enzymatic method Rapid TM Yeast Plus System to identify different species causing vulvovaginal candidiasis (VVC). MATERIALS AND METHODS: Vaginal discharges of women who had attended the gynecology outpatient clinic of Mobini Hospital in Sabzevar, Iran were collected using cotton swabs and were cultured on Sabouraud dextrose agar. Isolated yeasts were identified by germ-tube testing and Rapid TM Yeast Plus System (Remel USA). For molecular identification, the isolated DNA was amplified with ITS1 and ITS4 universal primers and PCR products digested with the enzyme HpaІІ followed by agarose gel electrophoresis. Epidemiological and clinical features of women with respect to identified species were also evaluated. RESULTS: Out of 231 subjects enrolled, 62 VVC cases were detected. The isolated species were identified as follows: Candida albicans, 24 (38.7%), C. glabrata, 15 (24.2%), C. kefyr, 13 (21.0%) C. krusei, 9 (14.5%), and Saccharomyces cerevisiae, 1 (1.6%) by RFLP-PCR method; whereas findings by Rapid TM Yeast Plus System were C. albicans, 24 (38.7%), C. glabrata, 5 (8%), C. kefyr, 11 (17.7%) C. krusei, 2 (3.2%), S. cerevisiae, 9 (14.5%), and C. tropicalis, 6 (9.6%) as well as other nonpathogenic yeasts, 4 (6.9%). CONCLUSION: Statistical comparison showed that there is no significant difference in identification of C. albicans by the two methods; although, in this study, it was not true about other species of yeasts. A correlation between clinical and laboratory findings is important as it enables us to administer an appropriate treatment on time.

Pathogenic fungi: an unacknowledged risk at coastal resorts? New insights on microbiological sand quality in Portugal.

Whilst the potential impact on beach users from microorganisms in water has received considerable attention, there has been relatively little investigation into microbial contaminants in sand. Thirty three beaches across Portugal were analyzed during a five year period (2006-2010) to determine the presence of yeasts, pathogenic fungi, dermatophytes, total coliforms, Escherichia coli and intestinal enterococci in sand. Our results showed that 60.4% of the samples were positive for fungi and that 25.2% were positive for the bacterial parameters. The most frequent fungal species found were Candida sp. and Aspergillus sp., whereas intestinal enterococci were the most frequently isolated bacteria. Positive associations were detected among analyzed parameters and country-regions but none among those parameters and sampling period. Regarding threshold values, we propose 15 cfu/g for yeasts, 17 cfu/g for potential pathogenic fungi, 8 cfu/g for dermatophytes. Twenty-five cfu/g for E. coli, and 10 [corrected] cfu/g for intestinal enterococci.

Persistence of immunological alterations after thymectomy in Good's syndrome: a clue to its pathogenesis.

Analyzing the phenotypic characterization of the immune system cells involved in the pathogenesis of immunodeficiency with thymoma (Good's syndrome) is difficult due to the low number of studies on that subject. We describe the immunological alterations observed in a case of Good's syndrome, and we summarize the pathogenic explanations found in the literature.