Cryptococcosis in HIV-AIDS patients from Southern Brazil: Still a major problem.

INTRODUCTION: Cryptococcus neoformans is an opportunistic pathogen that causes ∼15% mortality in AIDS patients. Rio Grande City, Rio Grande do Sul (RS), Brazil, has the highest national rate of HIV/AIDS, considering cities with population more than 100,000 habitants. OBJECTIVE: We aimed to evaluate the clinical and epidemiological profile of cryptococcosis in a reference service for HIV-AIDS patients in the South region of Brazil, over seven years. Material and methods A retrospective study was performed including all cryptococcosis cases diagnosed at the University Hospital, Federal University of Rio Grande (UH-FURG) between January 2010 and December 2016. RESULTS: Seventy cases of cryptococcosis were diagnosis from 2010 to 2016 in the UH-FURG in the seven years of the study. These numbers were responsible for 2.1% to 8.1% of the hospitalizations/year for HIV patients. All were caused by C. neoformans infection (95% C. neoformans var. grubii VNI and 5% C. neoformans var. grubii VNII). Neurocryptococcosis was the major clinical manifestation and cryptococcosis was the HIV- defining condition in 40% of patients. The period of hospitalization was an average of 39.3 days (SD=31.3), and more than half of patients (53%; 37/70) died after a mean of 82 days. DISCUSSION: The present study showed the importance of cryptococcosis as an AIDS-defining disease in HIV-AIDS patients in a tertiary hospital from Southern Brazil. More investment is necessary to reduce the impact of this opportunistic mycosis in HIV-AIDS patients from southern Brazil.

Applicability of the Platelia EIA® Aspergillus test for the diagnosis of aspergilosis in penguins / Aplicabilidade do Platelia EIA® Aspergillus como teste diagnostico da aspergilose em pinguins

Abstract Even today, an effective diagnostic test for aspergillosis in penguins is unknown, being the gold standard post-mortem examinations. The fungal antigen galactomannan (GM) has been used as a biomarker of disease in humans and is detected by the Platelia Aspergillus EIA (BioRad)®, a commercial kit based on the sandwich ELISA technique. It is standardized for use in neutropenic patients, however studies have demonstrated its usefulness also possible for birds. The aim of our study was to evaluate the effectiveness of Platelia Aspergillus EIA® test (BioRad-US) in the diagnosis of aspergillosis in Magellanic penguins, determining sensitivity, specificity, and positive and negative predictive values for different cut-off points. Were included in the study, blood serum samples (n = 29) Magellanic penguins in captivity that died by aspergillosis. Detection of GM was performed following manufacturer's instructions and the GM index was obtained by dividing the average value of OD of the duplicate of the clinical sample by duplicate OD of the average value of the cut-off sample provided by the kit. Through information database results were obtained for the presence of anti-Aspergillus fumigatus antibodies detected by agar gel immunodiffusion (AGID) for all serum samples. Results were analyzed using chi-square test and Kruskal-Wallis from SPSS 20.0, IBM®. ROC curve was obtained and from this, rates of sensitivity, specificity, positive and negative predictive values were also calculated based on four different cutoff points (0.5, 1.0, 1.5 and 2.0). The serum GM index did not differ between animals of the case and control group (pkw =0.097). In determining the ROC curve for serum GM detection the value of area under the curve was 0.635. From the values ​​determined by the coordinate of the curve, four different cut points (0.5, 1.0, 1.5 and 2.0) were analyzed, resulting in sensitivity rates ranging from 86.2 to 34.5% % and specificity between 87% and 26.1%. By comparing the serum GM index in group case as the presence or absence of antibodies detected by AGID was found p=0.503. The detection of GM the Platelia Aspergillus EIA® test seems is not be useful for the diagnosis of aspergillosis in naturally infected penguins.

Resumo Ainda hoje, um teste diagnóstico eficaz para aspergilose em pinguins não é conhecido, sendo o padrão-ouro os exames post-mortem. O antígeno fúngico galactomanana (GM) tem sido utilizado como biomarcador da doença em humanos, sendo detectado pelo Platelia Aspergillus EIA (BioRad)®, um kit comercial que se baseia na técnica ELISA sanduíche. É padronizado para utilização em pacientes neutropênicos, no entanto estudos tem demonstrado sua possível utilidade também para aves.O objetivo de nosso estudo foi avaliar a eficácia do teste Platelia Aspergillus EIA® (BioRad-US) no diagnóstico da aspergilose em pinguins-de-Magalhães, determinando sensibilidade, especificidade e valores preditivos positivos e negativos em diferentes pontos de corte. Foram incluídas no estudo, amostras de soro sanguíneo (n=29) de pinguins-de-Magalhães em cativeiro que vieram a óbito por aspergilose. A detecção de GM foi realizada seguindo instruções do fabricante e o índice de GM foi obtido dividindo o valor da média da DO da duplicata da amostra clínica pelo valor da média da DO da duplicata da amostra de cut-off fornecida pelo kit. Através de informações em banco de dados foram obtidos resultados sobre a presença de anticorpos anti-Aspergillus fumigatus, detectada por Imunodifusão em gel de ágar (IDGA) em todas as amostras séricas. Os resultados foram analisados utilizando-se teste de qui-quadrado e Kruskal-Wallis a partir do programa estatístico SPSS 20.0, IBM®. Curva ROC foi obtida e a partir desta, taxas de sensibilidade, especificidade, valores preditivo positivo e negativo foram igualmente calculados considerando quatro diferentes pontos de corte (0.5, 1.0, 1.5 e 2.0). O índice de GM sérica não diferiu entre os animais do grupo caso e controle (pKW = 0.097). Na determinação da curva ROC para detecção de GM sérica o valor da área sobre a curva foi de 0.635. A partir dos valores determinados pelas coordenadas da curva, quatro diferentes pontos de corte (0.5, 1.0, 1.5 e 2.0) foram analisados, resultando em taxas de sensibilidade variando de 86.2% a 34.5%, e de especificidade entre 87% e 26.1%. Ao comparar o índice de GM sérica nos animais do grupo caso quanto a presença ou não de anticorpos detectados pela IDGA foi encontrado p=0.503. A detecção de GM pelo teste Platelia Aspergillus EIA® não parece ser útil para o diagnóstico da aspergilose em pinguins naturalmente infectados.

Applicability of the Platelia EIA® Aspergillus test for the diagnosis of aspergilosis in penguins.

Even today, an effective diagnostic test for aspergillosis in penguins is unknown, being the gold standard post-mortem examinations. The fungal antigen galactomannan (GM) has been used as a biomarker of disease in humans and is detected by the Platelia Aspergillus EIA (BioRad)®, a commercial kit based on the sandwich ELISA technique. It is standardized for use in neutropenic patients, however studies have demonstrated its usefulness also possible for birds. The aim of our study was to evaluate the effectiveness of Platelia Aspergillus EIA® test (BioRad-US) in the diagnosis of aspergillosis in Magellanic penguins, determining sensitivity, specificity, and positive and negative predictive values for different cut-off points. Were included in the study, blood serum samples (n = 29) Magellanic penguins in captivity that died by aspergillosis. Detection of GM was performed following manufacturer's instructions and the GM index was obtained by dividing the average value of OD of the duplicate of the clinical sample by duplicate OD of the average value of the cut-off sample provided by the kit. Through information database results were obtained for the presence of anti-Aspergillus fumigatus antibodies detected by agar gel immunodiffusion (AGID) for all serum samples. Results were analyzed using chi-square test and Kruskal-Wallis from SPSS 20.0, IBM®. ROC curve was obtained and from this, rates of sensitivity, specificity, positive and negative predictive values were also calculated based on four different cutoff points (0.5, 1.0, 1.5 and 2.0). The serum GM index did not differ between animals of the case and control group (pkw =0.097). In determining the ROC curve for serum GM detection the value of area under the curve was 0.635. From the values ​​determined by the coordinate of the curve, four different cut points (0.5, 1.0, 1.5 and 2.0) were analyzed, resulting in sensitivity rates ranging from 86.2 to 34.5% % and specificity between 87% and 26.1%. By comparing the serum GM index in group case as the presence or absence of antibodies detected by AGID was found p=0.503. The detection of GM the Platelia Aspergillus EIA® test seems is not be useful for the diagnosis of aspergillosis in naturally infected penguins.

Blood parameters and measurements of weight in the rehabilitation of Magellanic penguins (Spheniscus magellanicus, Foster 1781) / Parâmetros sanguíneos e medidas de peso na reabilitação de pinguins-de-Magalhães (Spheniscus magellanicus, Foster 1781)

During the austral winter the appearance of the Magellanic penguin (Spheniscus magellanicus) is common on the southern coast of Brazil. The oil pollution constitutes a major cause of death of these birds. The monitoring of the weight and blood variables is important to make decisions during the rehabilitation and release of these animals. Thus, the aim of this study was to evaluate the relationship between the penguins' survival during rehabilitation and the values of hematocrit (Hct), total plasma protein (TPP) and body weight (BW) of the birds received at Centro de Recuperação de Animais Marinhos (Recovery Centre for Sea Animals) between 2006 and 2009. The analysis took place weekly, and penguins were classified according to the outcome of the rehabilitation process, when 101 specimens were rehabilitated and released, and 67 died. Released animals showed a decrease in the Hct in the second and third weeks (41±6% and 40±5% respectively) followed by recovery of the values in the fourth and fifth week (41±4% and 43±4% respectively). TPP levels increased steadily over the collections, stabilizing at 7.3±0.8g/dL in the fourth week. On the other hand, animals that died, although following the same response for TPP, showed no significant difference in Hct between collections, and showed a tendency for loss of BW in the last weeks of rehabilitation. The curves of BW and Hct during rehabilitation were considered a potential prognostic indicator of penguins in rehabilitation. Animals that arrived at the recovery centre with BW, Hct and TPP above 2.700g, 45% and 5.6 g / dL, respectively, have a greater chance of recovery, making these parameters crucial points in decision making regarding the treatment to be conducted during rehabilitation.

Durante o inverno austral, é comum o aparecimento do pinguim-de-Magalhães (Spheniscus magellanicus) no litoral sul do Brasil. A poluição por petróleo constitui a maior causa de morte dessas aves. O acompanhamento do peso e de variáveis sanguíneas é importante para a tomada de decisões durante a reabilitação e liberação desses animais. O objetivo deste estudo foi avaliar a relação entre a sobrevivência dos pinguins durante a reabilitação e os valores de hematócrito (Ht), proteínas plasmáticas totais (PPT) e peso corpóreo (PC) das aves recebidas no Centro de Recuperação de Animais Marinhos entre 2006 e 2009. As análises ocorreram semanalmente, e os pinguins foram classificados em função do desfecho do processo de reabilitação, quando 101 espécimes foram reabilitados e liberados e 67 foram a óbito. Animais liberados apresentaram queda no Ht na segunda e terceira semanas (41±6% e 40±5%, respectivamente), seguida de recuperação dos valores na quarta e quinta semanas (41±4% e 43±4%, respectivamente). Os níveis de PPT aumentaram progressivamente ao longo das coletas, estabilizando na quarta semana em 7,3±0,8g/dL. Em contrapartida, animais que foram a óbito, apesar de seguirem a mesma resposta para as PPT, não apresentaram diferença significativa do Ht, entre as coletas, e demonstraram tendência à perda de PC nas últimas semanas de reabilitação. As curvas de PC e Ht foram consideradas indicadoras potenciais de prognóstico durante a reabilitação dos pinguins. Animais que chegaram ao centro de recuperação com PC, Ht e PPT acima de 2.700g, 45% e 5,6g/dL, respectivamente, apresentaram maior chance de recuperação, fazendo desses parâmetros pontos críticos na tomada de decisão quanto ao tratamento a ser conduzido durante a reabilitação.

Fungi in the respiratory tract of horses with recurrent airway obstruction / Presença de fungos no trato respiratório de equinos e sua associação com obstrução recorrente das vias aéreas

This study aims to compare the concentration of viable fungi, especially those of the genus Aspergillus in the respiratory tract of stabled horses with and without Recurrent Airway Obstruction (RAO). Thirty two housed horses from four equestrian centers in Brazil were included in the study. These animals were submitted to clinical examination and to a respiratory sample collection. They were categorized into two groups: healthy and RAO-affected horses. Samples obtained by tracheobronchial washes were evaluated for fungal microscopy, quantitative culture and Aspergillus spp. quantification. Eighteen healthy and 14 RAO-affected horses were studied. Fungi were more frequently recovered in the RAO group, in comparison to controls, for both fungal microscopy (P<0.0001), fungal culture (P<0.0001) and Aspergillus spp. quantitative culture (p=0.001). In conclusion, horses with RAO have significantly higher fungal load in the respiratory tract in comparison to healthy horses. The implications of these findings in terms of the pathogenesis of RAO deserve additional investigation...

Este estudo objetivou comparar a concentração de fungos viáveis, especialmente do gênero Aspergillus, no trato respiratório de equinos estabulados com e sem obstrução recorrente das vias aéreas (ORVA). Trinta e dois equinos provenientes de quatro centros de treinamento equestre do Brasil foram incluídos no estudo. Os animais foram submetidos a exame clínico e coleta de amostra respiratória, sendo categorizados em dois grupos: sadios e ORVA. Os lavados traqueobrônquicos obtidos foram avaliados por exame micológico direto e cultivo quantitativo. Ao todo, 18 equinos saudáveis e 14 com ORVA foram estudados. Fungos foram mais frequentemente detectados em amostras do grupo ORVA em comparação com o grupo controle, tanto no exame micológico direto (P<0,0001) e cultivo quantitativo (P<0,0001) quanto na concentração de unidades formadoras de colônias (UFC) de Aspergillus spp. isolada em cultivo (p=0,001). Equinos com ORVA têm maior concentração de propágulos fúngicos no trato respiratório em comparação com animais sadios. As implicações desses achados na patogenia da ORVA merecem maior atenção e investigação...

Wild animals as sentinels of Paracoccidioides brasiliensis in the state of Rio Grande do Sul, Brazil.

Paracoccidioides brasiliensis, a dimorphic pathogenic fungus, causes the principal form of systemic mycosis in Brazil. The literature furnishes only limited data on the ecology of this fungus in the state of Rio Grande do Sul, the southernmost state of Brazil. The purpose of this study was to evaluate the prevalence of fungal infection in wild animals, using serological tests and using the animals as sentinels of the presence of P. brasiliensis in three specified mesoregions of Rio Grande do Sul. A total of 128 wild animals from the three mesoregions were included in the study. The serum samples were evaluated by immunodiffusion and the enzyme-linked immunosorbent assay (ELISA) technique to detect anti-gp43 antibodies from P. brasiliensis. Two conjugates were tested and compared with the ELISA technique. Although no positive samples were detected by immunodiffusion, 26 animals (20%), belonging to 13 distinct species, were found to be seropositive by the ELISA technique. The seropositive animals were from two mesoregions of the state. The results were similar according to the gender, age, and family of the animals, but differed significantly according to the conjugate used (p < 0.001), showing more sensitivity to protein A-peroxidase than to protein G-peroxidase. The finding that wild animals from the state of Rio Grande do Sul are exposed to P. brasiliensis suggests that the fungus can be found in this region despite the often-rigorous winters, which frequently include below-freezing temperatures.

Study of bacteria isolated from the foot pad of Spheniscus magellanicus with and without bumblefoot / Estudo de bactérias isoladas de coxins plantares de Spheniscus magellanicus com e sem bumblefoot

The bumblefoot or pododermatitis is among the diseases with the highest morbidity in Magellanic penguins, sometimes evolving to septicemia and death. Therefore, this study aimed to relate the main species involved in the disorder, as well as the in vitro susceptibility profile of the microorganisms against routine antimicrobial usage in Veterinary Medicine. During two years in vivo material was harvested from 200 footpads (n=100 animals) for microbiological analysis and in vitro susceptibility tests against the Antibiotic enrofloxacin, streptomycin, penicillin and cephalosporin. Bacteria have been identified both as part of permanent and transient microbiota, also being associated to 100% of the pododermatitis cases. The most prevalent genus were Staphylococcus and Corynebacterium. The antibiograms of all the isolated bacteria resulted in greater susceptibility of the strains facing cephalosporin, followed by enrofloxacin, streptomycin and penicillin.

O bumblefoot ou pododermatite está entre as afecções de maior morbidade em pinguins-de-magalhães, podendo evoluir para septicemia e óbito. Portanto, o presente estudo objetivou relacionar as principais espécies bacterianas envolvidas na afecção, bem como o perfil de susceptibilidade in vitro destes microrganismos frente a antimicrobianos de uso rotineiro em medicina veterinária. Durante o período de dois anos, foi realizada colheita de material in vivo de 200 coxins plantares (n=100 animais) para análise microbiológica e testes de susceptibilidade in vitro frente aos antibióticos enrofloxacina, estreptomicina, penicilina e cefalosporina. Bactérias foram identificadas tanto como parte da microbiota permanente quanto da transitória, bem como estiveram associadas a 100% dos casos de pododermatite. Os gêneros mais prevalentes foram Staphylococcus e Corynebacterium. Os antibiogramas de todas as bactérias isoladas resultaram em maior sensibilidade das cepas frente à cefalosporina, seguida de enrofloxacina, estreptomicina e penicilina.

Atividade inibitória do óleo essencial de orégano em fungos de importância médica e veterinária / Inhibitory activity of origanum essential oil against important fungus in veterinary

The in vitro activity of Origanum vulgare essential oil against fungal isolates was evaluated. A total of 27 clinical isolates were used, including: C. albicans, S. schenckii, M. pachydermatis, Aspergillus flavus, and A. fumigatus. Microdilution in broth technique (NCCLS M27-A2 and M-38) was used and susceptibility was expressed as Minimum Inhibitory Concentration (MIC). Essential oil was obtained by hydrodistillation in Clevenger and analyzed by gas chromatography, showing the presence of 4-terpineol, alpha-terpineol, 4-terpinene, thymol and carvacrol, as the main compounds. Origanum oil MIC for C. albicans varied from 125 to 500mL/mL; for S. schenckii, from 250 to 500mL/mL; for M. pachydermatis, from 15 to 30mL/mL; and for Aspergillus, from 30 to 60mL/mL. Isolates sensitivity showed to the origanum oil stimulates the accomplishment of new studies, including in vivo tests, contributing to the search of alternative treatments to mycosis.

Eficácia da clorexidina-cetrimida na desinfecção ambiental contra Aspergillus spp. / Chlorexidine-cetrimide efficacy in ambient disinfection against Aspergillus spp

Avaliou-se a ação in loco da clorexidina-cetrimida no controle de Aspergillus spp., considerando-se a influência de fatores climáticos e populacionais, em um centro de recuperação de animais marinhos. Durante dois anos, realizaram-se colheitas de amostras de ar por meio da técnica de sedimentação, com implantação no segundo ano de um programa de desinfecção com clorexidina-cetrimida. Os resultados do isolamento fúngico nos dois anos foram comparados estatisticamente pelo programa Epinfo 8.0. Demonstrou-se que o isolamento de Aspergillus spp. não apresentou relação significativa com fatores climáticos e populacionais e que a diminuição da concentração de conídios de Aspergillus spp. do ambiente ocorreu devido ao programa eficaz de desinfecção com a clorexidina-cetrimida.

The study evaluated the in loco activity of chlorexidine-cetrimide for environmental control of Aspergillus spp. considering the climatic influence and population variations, in a recuperation center of marine animals. Samples of air were collected throughout two years by the sediment method, and the disinfection program was established in the second year. Data collected during the two years were statistically compared by Epinfo 8.0. program. It was demonstrated that both population and climate had no influence on the fungal isolation, and the disinfection program with chlorexidine-cetrimide was considered effective in the reduction of conidia Aspergillus concentration indoor.

Esporotricose experimental sistêmica em ratos Wistar: avaliação hematológica e perfil hepático / Systemic experimental sporotrichosis in Wistar rats: hematological evaluation and hepatic profile

Alanine aminotransferase (ALT) and alkaline phosphatase (AP) hepatic enzymes, hematological values, and total plasmatic proteins (TPP) of 12 Wistar rats with systemic experimental sporotrichosis were evaluated. Inoculation was performed at 2x10³ cells of S. schenckii/ml. The values ranged from 35 to 48UI/l for ALT and 67 to 251.3UI/l for AP. Fifty percent of the AP values were above the physiological limits. TPP was elevated in 66.7 percent (8/12) of the rats with values varying from 7.9 to 8.5g percent. In 75 percent (9/12) of the animals, it was observed that hemoglobin and red blood cells count were below the physiologic limits, and 8.3 percent (1/12) of the animals showed anemia masked by dehydration. At the necropsy, it was observed local and/or disseminated nodular lesions. At the histological analysis, cells compatible to S. schenckii were found. The observed alterations are aggravating factors for the recurrence and treatment of the mycosis.