Disseminated Pulmonary Mycosis Caused by Candida tropicalis in an 11-Year-Old Male Patient with Chronic Granulomatous Disease.

Invasive fungal infection is a major threat to chronic granulomatous disease (CGD) patients. We present a rare case of invasive mycosis in a CGD boy. An 11-year-old preadolescent boy presented with fever, hypoxia, and dyspnea. Physical examination revealed left neck enlarged lymph nodes with healed scars. The chest revealed bilateral diminished air entry with bilateral coarse crackles. Peripheral blood leukocyte count was 28.260/µL with 84% neutrophil, 11% lymphocyte, and 4.4% monocyte. The patient's condition deteriorated regardless of the empirical antibacterial against MRSA and suspected tuberculosis. A sputum sample was submitted for mycological investigation, and budding yeasts with pseudohyphae were detected in the direct smear and were isolated in pure culture using Sabouraud agar. Candida tropicalis was identified from cultural and microscopic features and confirmed by the Vitek 2 automated system. This result confirmed the invasive mycosis, obviously due to the underlying primary immunodeficiency, chronic granulomatous disease (CGD). Amphotericin was added, and he also received IV methylprednisolone for seven days. The patient improved and was weaned off oxygen with no fever. However, the patient was referred to a higher center for further workup, which confirmed CGD's diagnosis. He is on the list for HLA-identical bone marrow transplantation (BMT).

Changes of th1 and th2 cytokines levels among sudanese tuberculosis patients during treatment.

Background: The interaction of T cells with infected macrophages depends on the interplay of cytokines produced in each cell, and this mechanism is a key to protective immunity against Mycobacterium tuberculosis. Extensive research has been devoted to studying the changes in systemic cytokine levels in patients with tuberculosis (TB), but the results are inconclusive. Determine Th1 and Th2 cytokine immune response levels among new TB patients compared to follow-up and healthy control. . Design: Cross-sectional laboratory-based study. Setting: Immunology Laboratory, National Center for Research. Methods: Blood samples (n = 145) were collected from confirmed new TB cases, follow-up TB cases, and from healthy controls. Participants were initially diagnosed by microcopy using Ziehl-Neelsen smear method and confirmed by polymerase chain reaction using IS6110. Cytokine levels (interleukin-10 [IL-10], tumor necrosis factor alpha [TNF-α], and Interferon-gamma [IFN-γ]) were measured directly from plasma using sandwich enzyme-linked immunosorbent assay. Main Outcome Measures: Measuring Th1 cytokines (IFN-γ and TNF-α) and Th2 cytokine (IL-10). One hundred and forty-five cases (new TB cases, 85; follow-up, 25; and healthy control, 35) were included in this study. Results: The study population were mainly males (70.3%) compared to females (29.7%) and 87.5% aged between 21 to 60 year. The plasma IFN-γ levels were found significantly higher in new TB cases (mean 35.38 pg/m; confidence interval: 29.32-41.43) than in the follow-up patients and the healthy control (P = 0.000). There were no significant differences in TNF-α and IL-10 levels among the new TB cases and the follow-up and healthy control (P = 0.852 and P = 0.340, respectively). Conclusions: Direct plasma IFN-γ level can be used in TB patient follow-up as a recovery marker as it correlated well with the appearance of the disease and treatment response.

Basidiobolus haptosporus-like fungus as a causal agent of gastrointestinal basidiobolomycosis.

Basidiobolus species were isolated from colonic biopsy samples of patients with gastrointestinal basidiobolomycosis (GIB) in southern Saudi Arabia. Isolated fungi were initially identified using classical mycological tools and confirmed by sequence analysis of the large subunit ribosomal RNA gene. Phenotypic tests revealed zygomycete-like fungi which conform to those of Basidiobolus species. Five sequenced strains formed a monophyletic clade in the 28S ribosomal RNA gene phylogenetic tree. They shared 99.97% similarity with B. haptosporus and 99.97% with B. haptosporus var. minor, and relatively lower similarity with B. ranarum (99.925%). The study suggests a new and a serious causal agent of GIB related to Basidiobolus haptosporus. These isolates are not related to B. ranarum, which is commonly linked to this disease.

Trend analysis of bacterial uropathogens and their susceptibility pattern: A 4-year (2013-2016) study from Aseer region, Saudi Arabia.

PURPOSE: To analyze the prevalence and resistance rates of bacterial agents causing urinary tract infections (UTIs) in Aseer, Saudi Arabia (2013-2016). PATIENTS AND METHODS: This was a 4-year (2013-2016) retrospective study undertaken in Aseer Central Hospital, Saudi Arabia. A total of 49,779 urine and other UT specimens obtained from patients suspected of having a UTI were analyzed. Urine specimens were inoculated onto cystine lactose electrolyte deficient agar following standard procedures. Cultures showing significant bacteriuria were subjected to identification and sensitivity testing using VITEK 2 system. Data of patients and uropathogens were assembled, checked, and analyzed using SPSS software. RESULTS: Culture positive samples were 49,779 (59.9% males, 40.1% females; P = 0.000). Year trend showed significant variations (P = 0.000) and the forecast trend line hypothesized a clear rise. Age groups 70-79 years were the most vulnerable group (22.3%). Gram-negative bacilli were 91.8% and the major species were Escherichia coli - 39.7%, Klebsiella pneumoniae - 15.8%; Pseudomonas aeruginosa - 13.8%, Proteus mirabilis - 10.6%, and Acinetobacter baumannii - 5%. Antimicrobials with high sensitivity rate were linezolid (99.1%), daptomycin (89.3%), vancomycin (86.7%), teicoplanin (85.5%), ertapenem (85.1%), fosfomycin (82.1%), and tigecycline (80.2%). High resistant rates to uropathogens were encountered with cephalothin (89.8%), nalidixic acid (86.7%), and ampicillin (81.9%). CONCLUSIONS: The majority of uropathogens were resistant to antibiotics commonly used in clinical practice. Linezolid, daptomycin, and vancomycin showed the lowest resistance to all uropathogens; this can be revised for empirical treatment of UTIs. Continuous surveillance of uropathogens and their susceptibility is important.

Aggressive cutaneous zygomycosis caused by Apophysomyces variabilis in an immunocompetent child.

A zygomycetous fungus was observed in a biopsy of a 9-year-old male. The patient was presented with severe cutaneous lesions subsequent to a traumatic car accident. Following fungal detection, antifungal treatment was prescribed but condition deteriorated rapidly and above knee amputation was done as lifesaving and to control fungal infection. Analysis of the 28 S rRNA gene (accession KT149770) aligned the isolate with members of the genus Apophysomyces and the pathogen was identified as Apophysomces variabilis.

Vaginal infections among pregnant women at Omdurman Maternity Hospital in Khartoum, Sudan.

INTRODUCTION: Microbial infections of the vagina in pregnant women are health problems that lead to serious medical complications and consequences. This study aimed to investigate and determine antimicrobial susceptibilities of the causative agents of vaginal infections in pregnant women. METHODOLOGY: A cross-sectional study of pregnant women (n = 200) was conducted between August and December 2008 at Omdurman Maternity Hospital, Khartoum, Sudan. Vaginal and cervical swabs were obtained from each subject and processed for isolation and identification of pathogenic microorganisms using standard methods of wet mount preparation, direct Gram smear, Nugent scoring system, direct immunofluorescence, and cultural techniques. Antimicrobial susceptibility testing of bacterial isolates was performed using standard procedures. Statistical analysis was done using SPSS program version 12.0.1. A p value < 0.05 was considered statistically significant. RESULTS: Of the 200 pregnant women enrolled, BV was detected in 49.8%, followed by Chlamydia trachomatis (31.3%) and Candida albicans (16.6%), with low frequencies of Neisseria gonorrhoeae (1.8%) and Trichomonas vaginalis (0.5%). Higher infection rates were recorded among subjects in the third trimester (71.6%) than in the second trimester of gestation (28.4%). No significant association (p = 0.7) between history of abortions and C. trachomatis infections was found. Gentamicin was the most active agent against Gram-positive and Gram-negative bacteria. Clarythromycin was the most active against Mycoplasma species. CONCLUSIONS: Pregnant women with vaginal complaints revealed various positive microbiology results. Such cases may require specific medication. Routine culture of vaginal and cervical samples should be performed on all pregnant women during prenatal visits.

Epidemiology, pathology, immunology and diagnosis of bovine farcy: a review.

Bovine farcy (which is caused by Mycobacterium farcinogenes and Mycobacterium senegalense) is a chronic suppurative granulomatous inflammation of the skin and lymphatics of cattle and is seen mostly in sub-Saharan Africa. It is not yet certain whether Nocardia farcinica causes cutaneous nocardiosis (farcy) in animals that mimics bovine farcy. Epidemiological data have steadily reported finding bovine farcy in adult cattle of the transhumance pastoralist tribes of the Sahel and the Sudanian savannah zones. M. farcinogenes and or M. senegalense do not affect other domestic or non-domestic animals; it is not known whether these bacteria are zoonotic. The disease--once widespread in many regions--has disappeared from some countries historically known to have it. Reports of bovine farcy prevalence seem to be linked to the existence of survey initiatives by governments and diagnostic capabilities in each country. Farcy causes economic loss due to damaged hides and also is a public-health burden (because the lymphadenitis due to farcy resembles the lesions of bovine tuberculosis in carcasses and the meat is considered inappropriate for human consumption). The current literature is deficient in establishing definitely the prevalence, transmission patterns, and risk factors of bovine farcy. Ixodid ticks transmit other skin diseases (such as dermatophilosis) and might play a role in bovine farcy (given the similarity in the bio-physiology and geographic distribution of the disease). In addition, the tick-resistance of cattle breeds such as the N'Dama, Fulani or the Nilotic might explain their resistance to bovine farcy. Apart from the judicious use of conventional smear-and-culture methods, few diagnostic tests have been developed; the molecular and serological tests have not been evaluated for reproducibility and accuracy. This review points out aspects of bovine farcy that need further research and updates available data on the prevalence, distribution, risk factors, economic and public health implications, diagnosis, and control.

Variable antibiotic susceptibility patterns among Streptomyces species causing actinomycetoma in man and animals.

BACKGROUND: Drug therapy is recommended in conjunction with surgery in treatment of actinomycetoma. The specific prescription depends on the type of bacteria (actinomycetoma) or fungi (eumycetoma) causing the disease and their in vitro antimicrobial susceptibility. OBJECTIVES: To investigate the antimicrobial susceptibility among isolates of Streptomyces spp. isolated from cases of actinomycetoma in man and animals in Sudan. METHODS: Streptomyces strains (n = 18) isolated from cases of actinomycetoma were tested in vitro against 15 commonly prescribed antibacterial agents using MIC agar dilution method as per standard guidelines. RESULTS: Streptomyces strains isolated from actinomycetoma fall into various phenotypic groups. All of the strains were inhibited by novobiocin (8 µg/mL), gentamycin (8, 32 µg/mL) and doxycycline (32 µg/mL). Fusidic acid (64 µg/mL) inhibited 94.4% of the strains; bacitracin, streptomycin, cephaloridine, clindamycin, ampicillin, rifampicin and tetracycline (64 µg/mL) inhibited between 61.1 and 77.8% of the strains. All strains were found resistant to amphotericin B (64 µg/mL), penicillin (20 µg/mL) and sulphamethoxazole (64 µg/mL). CONCLUSIONS: Saprophytic Streptomyces spp. cause actinomycetoma in man and animal belong to separate phenotypes and have a wide range of susceptibility patterns to antimicrobial agents, which pose a lot of difficulties in selecting effective in vivo treatment for actinomycetoma.

Streptomyces sudanensis sp. nov., a new pathogen isolated from patients with actinomycetoma.

Nine strains isolated from mycetoma patients and received as Streptomyces somaliensis were the subject of a polyphasic taxonomic study. The organisms shared chemical markers consistent with their classification in the genus Streptomyces and formed two distinct monophyletic subclades in the Streptomyces 16S rRNA gene tree. The first subclade contained four organisms, including the type strain of S. somaliensis, and the second clade the remaining five strains which had almost identical 16S rRNA sequences. Members of the two subclades were sharply separated using DNA:DNA relatedness and phenotypic data which also showed that the subclade 1 strains formed an heterogeneous group. In contrast, the subclade 2 strains were assigned to a single genomic species and had identical phenotypic profiles. It is evident from these data that the subclade 2 strains should be recognised as a new species of Streptomyces. The name proposed for this new species is Streptomyces sudanensis sp. nov. The type strain is SD 504(T) (DSM = 41923(T) = NRRL B-24575(T)).