Frequency of the Mating-Type (MAT1) in Histoplasma capsulatum Isolates from Buenos Aires, Argentina.

Sex is genetically determined in Histoplasma capsulatum, governed by a sex-specific region in the genome called the mating-type locus (MAT1). We investigate the distribution of isolates of two H. capsulatum mating types in the clades circulating in Buenos Aires, Argentina. Forty-nine H. capsulatum isolates were obtained from the culture collection of the Mycology Center. The MAT1 locus was identified by PCR from the yeast suspension. The analysis of forty-eight isolates from clinical samples exhibited a ratio of 1.7 (MAT1-1:MAT1-2) and the only isolate from soil was MAT1-1. Forty-five H. capsulatum isolates belonged to the LAm B clade (H. capsulatum from Latin American group B clade) and showed a ratio of 1.8 (MAT1-1:MAT1-2). These results suggest an association between the mating types in isolates belonging to the LAm B clade. It remains to be defined whether a greater virulence should be attributed to the differences between the strains of the opposite mating type of the LAm B clade.

Fungemia following Saccharomyces cerevisiae var. boulardii probiotic treatment in an elderly patient.

The yeast Saccharomyces cerevisiae var. boulardii is a biotherapeutic agent used for the prevention and treatment of several gastrointestinal diseases. We report a case of fungemia in a patient suffering from Clostridiumdifficile-associated diarrhea and treated with metronidazole and a probiotic containing S. cerevisiae var. boulardii. The yeasts isolated from the blood culture and capsules were identified by MALDI-TOF MS and API ID 32 C as S. cerevisiae, and showed the same appearance and color on CHROMAgar Candida. Treatment with fluconazole 400mg/day was initiated and the probiotic was stopped. The patient was discharged from hospital in good condition and was referred to a rehabilitation center. We suggest that the potential benefit of S. cerevisiae var. boulardii should be accurately evaluated, especially in elderly patients. Moreover, all physicians should be trained in the use of probiotic agents and enquire whether the use probiotics was included in the patients'medical histories.

[Disseminated histoplasmosis in patients with AIDS. Buenos Aires, 2009-2014]. / Histoplasmosis diseminada en pacientes HIV/Sida. Buenos Aires, 2009-2014.

A retrospective study was carried out on 171 cases of disseminated histoplasmosis diagnosed in HIV/AIDS patients during the period 2009-2014. Although HIV diagnosis rates remained stable over the study period, a sensible increase in the number of histoplasmosis cases was observed in the last three years. Disseminated histoplasmosis was prevalent in males with an average age of 37.8 years. At diagnosis, only 54/171 (31.6%) were receiving HAART, and CD4+ T-lymphocyte counts ranged from 4 to 264 cells/upsilon. Cutaneous lesions, including ulcerated papules or molluscoid plaques, were present in 110/171 (64.3%), with Histoplasma capsulatum being observed in all skin scraping specimens upon Giemsa staining. Respiratory manifestations were second in frequency with bronchoalveolar lavage showing a high diagnostic performance. Radiological findings included milliary patterns, interstitial infiltrates, and focalized condensations. Out of 141 blood cultures performed, H. capsulatum was isolated in 82 (58.2%). No significant difference in diagnostic performance was found between blood cultures and skin scraping (p = 0.6164). Other opportunistic infections were observed in 70/171 (40.9%) prior to or concomitantly with histoplasmosis. Association with Mycobacterium tuberculosis was recorded in 16/171 (9.4%) and one had a multi-drug resistant isolate. The severity of histoplasmosis determined the monotherapy with amphotericin B deoxycholate in 115 (67.3%), itraconazole in 42 (24.5%), and combined therapies in 14 (8.2%). Mortality was 19.9% (34/171). Finally, we emphasize that the higher prevalence in the last three years of the study should prompt the medical community to consider the diagnosis of histoplasmosis to reduce mortality of AIDS patients.

[The transition process from paediatric to adult services: A perspective from hospitalised adolescent sufferers of chronic diseases]. / El proceso de transición de servicios pediátricos a adultos: visión de adolescentes hospitalizados portadores de enfermedades crónicas.

INTRODUCTION: Chronic illnesses during adolescence are a big challenge for the patient, his or her family, and health care providers. The transition from paediatric health services to adult health services involves a programmed and planned transfer process of adolescent sufferers of chronic illnesses, in order to maintain a high quality of life and bio-psycho-social development. There is currently no transition model. The objective of the study is to understand the transition process from the perspective of hospitalised adolescents to collaborate towards the design of a model that meets the needs studied. PATIENTS AND METHOD: Semi-structured interviews with 13 adolescent sufferers of chronic illnesses, hospitalised in two healthcare centres in Santiago, Chile, in one analytical-relational study, supported by qualitative methodology. RESULTS: In the analysis, 5 major themes stand out: experience of living with the illness, the importance of the doctor-patient relationship, the concept of limited autonomy to the pharmacology, the absence of the transition process as such, and the identification of barriers and needs for an adequate transition. CONCLUSIONS: This study is new in Chile in that it explores the phenomenom of the transition of adolescents with chronic illnesses. It emphasises the need to reinforce the concept of self-care and autonomy from early stages of care, and the importance of early planning of a healthy transition process, in accordance to the detected needs of the adolescents themselves.

Genetic diversity of Histoplasma capsulatum strains isolated from Argentina based on nucleotide sequence variations in the internal transcribed spacer regions of rDNA.

The internal transcribed spacer (ITS) regions of rDNA genes of 49 Histoplasma capsulatum (48 from clinical samples and one from soil) isolates were examined. Nucleotide sequence heterogeneity within this region was useful for phylogenetic classification of H. capsulatum and species identification. Thus, in 45 of 49 isolates we observed higher percentages of identity in the nucleotide sequences of ITS regions when the isolates studied herein were compared with those reported in our country in the South America B clade. Phylogenetic analyses of rDNA sequences corresponding to the 537 bp of the ITS region obtained from H. capsulatum isolates assigned South America type B clade (45 isolates), North America type 1 and Asia clade (2 isolates each one). H. capsulatum strains isolated from soil and from patients living in Argentina (45 of 49) clustered together with the H. capsulatum isolates of the South America B clade. The high level of genetic similarity among our isolates suggests that almost one genetic population is present in the microenvironment. Isolates described as H. capsulatum var. capsulatum or var. farciminosum (2 isolates) did not form a monophyletic group and were found in the Asia clade. Subsequent studies are needed to properly identify these isolates.

Rapid identification of Histoplasma capsulatum directly from cultures by multiplex PCR.

The multiplex PCR developed from a suspension of the yeast fungi correctly identified fifty-one clinical of H. capsulatum var. capsulatum strains isolated from clinical samples and soil specimens. The multiplex PCR was developed by combining two pairs of primers, one of them was specific to the H. capsulatum and the other one, universal for fungi, turned out to be specific to H. capsulatum, regardless of the fungus isolate studied. Primers designed to amplify a region of about 390-bp (Hc I-Hc II) and a region of approximately 600-bp (ITS1-ITS4) were used to identify a yeast isolated as H. capsulatum when both regions could be amplified. Absolute agreement (100 % sensitivity) could be shown between this assay and the cultures of H. capsulatum according to their morphological characteristics. Failure to amplify the target DNA sequence by PCR with primers Hc I-Hc II in the presence of the ITS1-ITS4 amplicon in isolates of P. brasiliensis, Cryptococcus neoformans, Trichosporon spp, Candida glabrata, C. albicans, C. tropicalis, C. parapsilosis, C. krusei, or Penicillium marneffei was an unequivocal sign of the high specificity of this assay. The assay specificity was also found to be 100 %. Incipient yeast forms obtained from clinical samples were identified as H. capsulatum by the PCR assay described before the morphological characteristics were registered shortening the time of diagnosis.

[Fungal identification in burn patients. A retrospective study and risk factors]. / Identificación fúngica en pacientes quemados. Un estudio retrospectivo y factores de riesgo.

A retrospective analysis of fungal infections was carried out in a health-care burn center between 2011 and 2014 using the patients' medical records (n = 36). Patients ranged from 18 to 87 years of age, with 23 (63.9%) being women. The most prevalent widespread total body surface area affected (TBSA) was 30-50% (p = 0.03), and 71-100% in younger patients, mainly associated with femicide. Fourth degree burns were revealed in 69.4% of the patients while in 50%, inhalation injuries were observed to represent a higher mortality rate (p = 0.04). The Candida score was 3 in 77.7% of cases respectively. Central venous catheter and mechanical ventilation were used. All patients received antibiotic treatment and 91.7% antifungal treatment. Surgical excision of the burn was performed in 33 (91.7%) patients, and skin autografting in 29 (80.6%). The median of the fungal infection developed was 21.4 days after admission to the ICU. The specimens analyzed involved 52 yeast samples isolated from different cultures: urine (42.3%), blood (26.9%), skin biopsy (9.6%), catheter tip (15.4%) and tracheal aspirate (5.8%). The use of microbiological culture and molecular methods allowed for the identification of Candida albicans (53.8%), C. tropicalis (23.1%), C. parapsilosis sensu stricto (13.5%), C. krusei (5.8%), C. glabrata (1.9%) and C. dubliniensis (1.9%). Fungal infections observed in skin burns lead to severe complications in at-risk patients.

Se realizó un estudio retrospectivo de las infecciones fúngicas atendidas en un centro de quemados de alta complejidad situado en Buenos Aires, entre 2011 y 2014, mediante el análisis de las historias clínicas (n = 36). Las edades de los pacientes estuvieron entre 18 y 87 años, y 23 (63.9%) fueron mujeres. La extensión de la superficie corporal afectada más prevalente varió entre 30 y 50% (p = 0.03), y entre 71% y 100% en pacientes de menor edad, relacionándose con intentos de femicidio. En el 69.4% la profundidad de la quemadura fue grado 4, y en el 50% de los casos se observaron lesiones por inhalación, con una alta mortalidad (p = 0.04). El Candida score resultó de 3 en el 77.7% de los casos. Se usaron vías centrales y ventilación mecánica. Todos los pacientes recibieron tratamiento antibiótico y en 33 (91.7%) antifúngicos. La escisión quirúrgica de la quemadura se practicó en 33 (91.7%) y los autoinjertos de piel en 29 (80.6%). La infección fúngica se desarrolló en una media de 21.4 días del ingreso en UCI. Se estudiaron 52 muestras de levaduras que se aislaron de urocultivo (42.3%), hemocultivo (26.9%), biopsia cutánea (9.6%), punta de catéter (15.4%) y aspirado traqueal (5.8%). Por cultivo microbiológico y métodos moleculares se identificaron a Candida albicans (53.8%), C. tropicalis (23.1%), C. parapsilosis sensu stricto (13.5%), C. krusei (5.8%), C. glabrata (1.9%) y C. dubliniensis (1.9%). Las infecciones fúngicas representan severas complicaciones en quemados con factores de riesgo.

Osteomyelitis of the rib cage by Aspergillus flavus.

BACKGROUND: Aspergillus osteomyelitis of the ribs is relatively uncommon. It is a debilitating and severe form of invasive aspergillosis. CASE REPORT: A 61year-old female presented with spontaneous chest pain on the right side of the rib cage and a palpable soft-tissue mass. FDG-PET/CT scan identified activity in the infected site. The lesion was punctured, and purulent material was sent to the laboratory. Aspergillus complex Flavi was isolated. An antifungal treatment with voriconazole was started. The lesion healed, and no recurrence was observed at 8-month follow-up. Molecular identification of the isolate was based on PCR amplification and sequencing of ß-tubulin gene. Aspergillus flavus was identified. CONCLUSIONS: Our case highlights the relevance of microbiological studies in patients with osteomyelitis and the involvement of soft tissue. The FDG-PET/CT scan was found to be a useful tool for revealing the extent of the disease and evaluating the response to the antifungal therapy.

Strengthening universal health: development of a nursing and midwifery education quality improvement toolkit.

OBJECTIVE: to present the development of a toolkit for education quality improvement in universal health and primary health care, targeting schools of nursing and midwifery in Latin American and Caribbean countries. METHODS: an expert work group conducted a systematic literature review, selected key content and completed toolkit drafting, using an iterative consensus approach. International partners reviewed the toolkit. Cognitive debriefing data were analyzed, revisions and new tools were integrated, and the final version was approved. RESULTS: twenty-two articles were identified and mapped as resources. The Model for Improvement, a data-driven approach to performance analysis, was selected for its widespread use and simplicity in carrying out the following steps: 1) organize a team, 2) assess improvement need regarding universal health and primary health care education, 3) set an aim/goal and identify priorities using a matrix, 4) establish metrics, 5) identify change, 6) carry out a series of Plan-Do-Study-Act learning cycles, and 7) sustain change. CONCLUSIONS: the Education Quality Improvement Toolkit, developed through stakeholder consensus, provides a systematic, and potentially culturally adaptable approach to improve student, faculty, and program areas associated with universal health coverage and access.

Scleral buckle versus pneumatic retinopexy for rhegmatogenous retinal detachments. / ¿Retinopexia neumática o implante de silicona para pacientes con desprendimiento regmatógeno de retina?

INTRODUCTION: Rhegmatogenous retinal detachment is caused by a tear in the retina and is a frequent cause of vision loss. Its treatment is mainly surgical and the following alternatives can be identified: scleral buckling or classic surgery, pneumatic retinopexy and vitrectomy. Between the first two options, most professionals prefer scleral buckling over pneumatic retinopexy, but the latter is a simpler, cheaper and lower-risk procedure, so it is still considered as an option for selected patients. However, there is little evidence comparing both interventions. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified three systematic reviews including six studies overall, of which three were randomized trials. We concluded the anatomic result might be better with scleral buckling in terms of retinal reattachment and risk of recurrence, but the risk of ocular adverse events might be lower with pneumatic retinopexy.

INTRODUCCIÓN: El desprendimiento de retina de tipo regmatógeno es aquel causado por un desgarro o ruptura de la retina, y es causa frecuente de pérdida de visión. Dentro del manejo quirúrgico existen varias opciones, entre ellas el implante de silicona o cirugía convencional y la retinopexia neumática. A pesar de que la mayoría de los profesionales prefiere el uso de implante de silicona, la retinopexia neumática es un procedimiento más simple, de menor costo y sigue siendo considerada como alternativa en algunos casos de desprendimiento de retina regmatógeno, sin embargo hay poca evidencia que compare ambas intervenciones. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos tres revisiones sistemáticas que en conjunto incluyeron seis estudios primarios, de los cuales tres corresponden a ensayos aleatorizados. Concluimos que el resultado anatómico podría ser mejor con el uso de implante de silicona en términos de re-aplicación de la retina y del riesgo de recurrencia del desprendimiento, pero la retinopexia neumática podría disminuir la incidencia de efectos adversos quirúrgicos oculares.

[Examination of the genetic variability among biofilm-forming Candida albicans clinical isolates]. / Estudio de la variabilidad genética entre aislamientos clínicos de Candida albicans formadores de biopelículas.

Biofilms are microbial communities encased in a self-produced polymeric matrix and represent a common mode of microbial growth. Candida albicans is able to colonize the surface of catheters, prostheses, and epithelia, forming biofilms that are highly resistant to antimicrobial drugs. The objective of this study was the genotypic characterization of biofilm-forming C. albicans clinical isolates using RAPD (Random Amplified Polymorphic DNA). We have studied 25 clinical isolates of C. albicans from oral cavities, blood, skin, nail, stool, oesophagus biopsy and vaginal fluids from patients suffering from candidiasis. For each strain biofilm formation was analysed by measuring the ability to adhere to and grow on polystyrene plastic surfaces using XTT [2,3-bis(2-methoxi-4nitro-5sulfophenil)-2H tetrazolium-5carboxanilide] reduction assay. The similarity coefficients generated by RAPD using four different primers varied from 49 to 91%, indicating a high degree of genetic variability between the clinical isolates. The dendrogram clustered the isolates in four related groups, all groups included strains with very different abilities to form biofilms. The isolates with similar genotypes often showed very different biofilm formation abilities. Strains were grouped into clusters independently of their clinical sources. Our results suggested that a direct correlation does not exist between the biofilm-forming ability of natural populations of C. albicans and the genotype as determined by RAPD.

Prevalence of Candida albicans, Candida dubliniensis and Candida africana in pregnant women suffering from vulvovaginal candidiasis in Argentina.

BACKGROUND: Vulvovaginal candidiasis (VVC) is a vulvovaginitis commonly diagnosed in gynecology care. In recent years, the taxonomy of the most important pathogenic Candida species, such as Candida albicans have undergone significant changes. AIMS: This study examined the prevalence of C. albicans, Candida africana, and Candida dubliniensis in vaginal specimens from 210 pregnant women suffering from vulvovaginitis or having asymptomatic colonization. METHODS: Phenotypic and molecular methods were used for the identification of the species. RESULTS: During the studied period, 55 isolates of Candida or other yeasts were obtained from specimens collected from 52 patients suffering from vulvovaginitis (24.8%). C. albicans was the predominant Candida species in 42 isolates (80.7%), either alone or in combination with other species of the genus (5.7%, n=3). Additionally, nine isolates of C. albicans (50%) were obtained from asymptomatic patients (n=18). C. dubliniensis was the causative agent in 2 (3.8%) cases of VVC, and was also isolated in one asymptomatic patient. Molecular assays were carried out using specific PCR to amplify the ACT1-associated intron sequence of C. dubliniensis. The amplification of the HWP1 gene also correctly identified isolates of the species C. albicans and C. dubliniensis. No C. africana was isolated in this work. Some C. albicans isolates were either homozygous or heterozygous at the HWP1 locus. The distribution of heterozygous and homozygous C. albicans isolates at the HWP1 locus was very similar among patients suffering from VVC and asymptomatic patients (p=0.897). CONCLUSIONS: The presence of C. albicans and C. dubliniensis, and the absence of C. africana in pregnant is noteworthy.

Subcutaneous infection by Graphium basitruncatum in a heart transplant patient.

Graphium basitruncatum, a synanamorph of Pseudoallescheria has been rarely reported in human infections. We report a case of subcutaneous phaeohyphomycosis caused by this fungus in a heart transplant recipient. We also describe the phenotypic, molecular methods and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) used to achieve isolate identification.

Identificación fúngica en pacientes quemados. Un estudio retrospectivo y factores de riesgo / Fungal identification in burn patients. A retrospective study and risk factors

Resumen Se realizó un estudio retrospectivo de las infecciones fúngicas atendidas en un centro de quemados de alta complejidad situado en Buenos Aires, entre 2011 y 2014, mediante el análisis de las histo rias clínicas (n = 36). Las edades de los pacientes estuvieron entre 18 y 87 años, y 23 (63.9%) fueron mujeres. La extensión de la superficie corporal afectada más prevalente varió entre 30 y 50% (p = 0.03), y entre 71% y 100% en pacientes de menor edad, relacionándose con intentos de femicidio. En el 69.4% la profundidad de la quemadura fue grado 4, y en el 50% de los casos se observaron lesiones por inhalación, con una alta mortali dad (p = 0.04). El Candida score resultó de 3 en el 77.7% de los casos. Se usaron vías centrales y ventilación mecánica. Todos los pacientes recibieron tratamiento antibiótico y en 33 (91.7%) antifúngicos. La escisión qui rúrgica de la quemadura se practicó en 33 (91.7%) y los autoinjertos de piel en 29 (80.6%). La infección fúngica se desarrolló en una media de 21.4 días del ingreso en UCI. Se estudiaron 52 muestras de levaduras que se aislaron de urocultivo (42.3%), hemocultivo (26.9%), biopsia cutánea (9.6%), punta de catéter (15.4%) y aspirado traqueal (5.8%). Por cultivo microbiológico y métodos moleculares se identificaron a Candida albicans (53.8%), C. tropicalis (23.1%), C. parapsilosis sensu stricto (13.5%), C. krusei (5.8%), C. glabrata (1.9%) y C. dubliniensis (1.9%). Las infecciones fúngicas representan severas complicaciones en quemados con factores de riesgo.

Abstract A retrospective analysis of fungal infections was carried out in a health-care burn center between 2011 and 2014 using the patients' medical records (n = 36). Patients ranged from 18 to 87 years of age, with 23 (63.9%) being women. The most prevalent widespread total body surface area affected (TBSA) was 30-50% (p = 0.03), and 71-100% in younger patients, mainly associated with femicide. Fourth degree burns were revealed in 69.4% of the patients while in 50%, inhalation injuries were observed to represent a higher mortality rate (p = 0.04). The Candida score was 3 in 77.7% of cases respectively. Central venous catheter and mechanical ventilation were used. All patients received antibiotic treatment and 91.7% antifungal treatment. Surgical excision of the burn was performed in 33 (91.7%) patients, and skin autografting in 29 (80.6%). The median of the fungal infection devel oped was 21.4 days after admission to the ICU. The specimens analyzed involved 52 yeast samples isolated from different cultures: urine (42.3%), blood (26.9%), skin biopsy (9.6%), catheter tip (15.4%) and tracheal aspirate (5.8%). The use of microbiological culture and molecular methods allowed for the identification of Candida albicans (53.8%), C. tropicalis (23.1%), C. parapsilosis sensu stricto (13.5%), C. krusei (5.8%), C. glabrata (1.9%) and C. dubliniensis (1.9%). Fungal infections observed in skin burns lead to severe complications in at-risk patients.

Fungemia following Saccharomyces cerevisiae var. boulardii probiotic treatment in an elderly patient / Fungemia posterior al tratamiento con Saccharomyces cerevisiae var. boulardii como probiótico en una paciente anosa

Abstract The yeast Saccharomyces cerevisiae var. boulardii is a biotherapeutic agent used for the prevention and treatment of several gastrointestinal diseases. We report a case of fungemia in a patient suffering from Clostridium difficile-associated diarrhea and treated with metronidazole and a probiotic containing S. cerevisiae var. boulardii. The yeasts isolated from the blood culture and capsules were identified by MALDI-TOF MS and API ID 32 C as S. cerevisiae, and showed the same appearance and color on CHROMAgar Candida. Treatment with fluconazole 400mg/day was initiated and the probiotic was stopped. The patient was discharged from hospital in good condition and was referred to a rehabilitation center. We suggest that the potential benefit of S. cerevisiae var. boulardii should be accurately evaluated, especially in elderly patients. Moreover, all physicians should be trained in the use of probiotic agents and enquire whether the use probiotics was included in the patients'medical histories. © 2019 Asociación Argentina de Microbiología. Published by Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Resumen Saccharomyces cerevisiae var. boulardii es un agente bioterapéutico usado en la prevención y el tratamiento de varias enfermedades gastrointestinales. Informamos de un caso de fungemia en una paciente con diarrea asociada a Clostridium difficile, y tratada con metron-idazol y un probiótico que contenía S. cerevisiae var. boulardii. Las levaduras aisladas a partir del hemocultivo y del contenido de las cápsulas tomadas por la paciente se identificaron como S. cerevisiae mediante MALDI-TOF MS y API® ID 32C, las colonias mostraron el mismo color y aspecto en el medio CHROMAgar™ Candida. Se instauró un tratamiento con fluconazol 400mg/día y se suspendió el probiótico. La paciente fue dada de alta del hospital en buenas condiciones, y remitida a un centro de rehabilitación. Sugerimos que el beneficio potencial del uso de S. cerevisiae var. boulardii debe ser evaluado en cada paciente, especialmente en personas añosas. El uso de probióticos debería incluirse en los interrogatorios orientados al diagnóstico y formar parte de la historia clínica. © 2019 Asociación Argentina de Microbiología. Publicado por Elsevier España, S.L.U. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Saksenaea erythrospora infection following a serious sailing accident.

Saksenaea erythrospora is a species of the order Mucorales recently described and reported as a cause of human mucormycosis. We report a case of S. erythrospora in a man involved in a serious sailing accident causing deep skin and soft tissue contamination with soil and water. Direct microscopic examination of the clinical sample with Giemsa stains showed hyaline and non-septate hyphae belonging to the order Mucorales. Fungal identification was performed by culture of biopsy material on SDA, and identification of species by floating an agar block containing the fungus in a nutritionally deficient medium consisting of sterile distilled water supplemented with 0.05 % yeast extract; and by sequencing the ITS region of the rDNA. This is the first report to our knowledge of infection with S. erythrospora in Argentina, confirming the presence of this fungus in this country.

Phenotypic and molecular identification of Coccidioides posadasii in a patient evaluated for bilateral lung transplantation.

BACKGROUND: Coccidioidomycosis is an endemic fungal infection caused by Coccidioides immitis and Coccidioides posadasii. It can be particularly severe in transplant recipients that have a current or a previous coccidioidal infection. Fatal case of coccidioidomycosis has been described in this group of patients. AIMS: We report a severe case of pneumonia caused by C. posadassi in a 29 year-old white woman that had been admitted to hospital as part of the evaluation for bilateral lung transplantation. The patient was a native and resident of Catamarca, Argentina. Molecular methodologies contributed to the species identification. METHODS: Clinical, laboratory records and microbiological tests were carried out to diagnose the infection and to identify C. posadasii. RESULTS: A fungus was isolated from BAL culture. Phenotypic characterization, specific PCR and experimental animal inoculation demonstrated the presence of C. posadasii. The patient responded well to amphotericin B deoxycholate. Lung transplantation was postponed. CONCLUSIONS: Specific PCR can be an important alternative for the correct identification of C. immitis or C. posadasii in laboratories with implemented molecular biology tools. This case emphasizes the need for a systematic assessment in organ transplant units of patients inhabiting endemic areas of coccidioidomycosis.

Subcutaneous infection by Graphium basitruncatum in a heart transplant patient

ABSTRACT Graphium basitruncatum, a synanamorph of Pseudoallescheria has been rarely reported in human infections. We report a case of subcutaneous phaeohyphomycosis caused by this fungus in a heart transplant recipient. We also describe the phenotypic, molecular methods and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) used to achieve isolate identification.

Histoplasmosis diseminada en pacientes HIV/SIDA: Buenos Aires, 2009-2014 / Disseminated histoplasmosis in patients with AIDS. Buenos Aires, 2009-2014

Durante 2009-2014, en nuestro hospital fueron diagnosticados 171 casos de histoplasmosis en pacientes con HIV/sida: 64 en 2009-2011, y 107 en 2012-2014. El mayor número de casos durante el segundo trienio no tuvo relación con la infección por HIV, cuya tasa de diagnóstico permaneció estable. La relación hombre/mujer fue 3.7:1 y la edad media 37.4 años. Al diagnóstico, solo 54/171 (31.6%) recibían TARGA y el recuento de linfocitos T CD4+ varió entre 4 y 264 células/μl. El 64.3% (n = 110) presentó lesiones cutáneas (pápulas ulceradas o "moluscoides") positivas para Histoplasma capsulatum al examen microscópico con tinción Giemsa. Siguieron en frecuencia las manifestaciones respiratorias y el lavado broncoalveolar fue positivo en 41/171 (24.0%) pacientes. Las imágenes radiológicas más frecuentes en orden decreciente fueron patrón miliar, infiltrados intersticiales y condensaciones focales. Se aisló H. capsulatum en 82 (58.2%) de los 141 hemocultivos realizados. No hubo diferencia significativa entre el rendimiento diagnóstico del hemocultivo y el de las escarificaciones cutáneas (p = 0.6164). Otras infecciones oportunistas previas o concomitantes con la histoplasmosis se observaron en 70/171 (40.9%). Se registró asociación con tuberculosis en 16/171 (9.4%) y un aislamiento de Mycobacterium tuberculosis resultó multirresistente. La gravedad del caso determinó el tratamiento con anfotericina B desoxicolato en 115 (67.3%), con itraconazol en 43 (25.1%), y con terapias combinadas en 14 (8.2%). La letalidad fue 19.9% (34/171). La mayor prevalencia en el segundo trienio debe alertar a la comunidad médica a considerar el diagnóstico de la histoplasmosis en pacientes con HIV/sida para disminuir la mortalidad.

A retrospective study was carried out on 171 cases of disseminated histoplasmosis diagnosed in HIV/AIDS patients during the period 2009-2014. Although HIV diagnosis rates remained stable over the study period, a sensible increase in the number of histoplasmosis cases was observed in the last three years. Disseminated histoplasmosis was prevalent in males with an average age of 37.8 years. At diagnosis, only 54/171 (31.6%) were receiving HAART, and CD4+ T-lymphocyte counts ranged from 4 to 264 cells/μl. Cutaneous lesions, including ulcerated papules or molluscoid plaques, were present in 110/171 (64.3%), with Histoplasma capsulatum being observed in all skin scraping specimens upon Giemsa staining. Respiratory manifestations were second in frequency with bronchoalveolar lavage showing a high diagnostic performance. Radiological findings included milliary patterns, interstitial infiltrates, and focalized condensations. Out of 141 blood cultures performed, H. capsulatum was isolated in 82 (58.2%). No significant difference in diagnostic performance was found between blood cultures and skin scraping (p = 0.6164). Other opportunistic infections were observed in 70/171 (40.9%) prior to or concomitantly with histoplasmosis. Association with Mycobacterium tuberculosis was recorded in 16/171 (9.4%) and one had a multi-drug resistant isolate. The severity of histoplasmosis determined the monotherapy with amphotericin B deoxycholate in 115 (67.3%), itraconazole in 42 (24.5%), and combined therapies in 14 (8.2%). Mortality was 19.9% (34/171). Finally, we emphasize that the higher prevalence in the last three years of the study should prompt the medical community to consider the diagnosis of histoplasmosis to reduce mortality of AIDS patients.