Identification and antifungal susceptibility of fungi isolated from dermatomycoses.

BACKGROUND: Dermatomycoses are superficial fungal infections of the skin, hair and nails that affect more than 20-25% of the people worldwide. These infections can be caused by yeasts, dermatophytes and non-dermatophyte filamentous fungi (NDFF) and are considered a public health problem. Despite this, few studies have investigated the prevalence and antifungal susceptibility of causative agents of dermatomycoses in the developing world. OBJECTIVES: The aims of this study were to identify and determine the antifungal susceptibility profile of yeast and filamentous fungi isolated from dermatomycoses in Uberaba, Minas Gerais, Brazil. METHODS: Specimens were obtained from patients with clinically diagnosed and laboratory confirmed dermatomycosis between July 2009 and July 2011. Fungal identification was based on classical methods and antifungal susceptibility testing was performed by broth microdilution method. RESULTS: Of the 216 fungal isolates, 116 (53.8%) were yeasts, 70 (32.4%) dermatophytes and 30 (13.8%) NDFF. Onychomycosis was the most common clinical condition. Candida parapsilosis (24.1%) and Trichophyton rubrum (17.1%) were the fungi most frequently isolated. Voriconazole, ketoconazole and itraconazole were the most potent antifungal agents against yeast, whereas terbinafine, voriconazole and itraconazole had a high in vitro activity against dermatophytes. Overall, the antifungal agents had little or no activity against NDFF and the highest minimum inhibitory concentrations were those against Fusarium spp. CONCLUSION: Yeasts, particularly C. parapsilosis, play an important role as causative agents of dermatomycosis in our region. Our results suggest that the antifungal susceptibility testing coupled with proper identification of the fungi may be useful to assist clinicians in determining the appropriate therapy for dermatomycoses.

Prolonged QTc intervals on the electrocardiograms of hospitalized malnourished adults.

We investigated whether hospitalized malnourished adults would have longer QTc intervals on their electrocardiograms (ECGs) than non-malnourished adults. Seventy-five consecutive adults hospitalized in the Internal Medicine wards of our teaching hospital were prospectively studied. Main diagnoses, anthropometry, including body mass index (kg/m(2)), ECGs, and simultaneous serum levels of sodium, potassium, magnesium, phosphorus, and calcium were recorded. All QT intervals on ECGs were measured in a semiautomatic image analysis system; and QTc intervals were determined with the Bazett formula. Protein-energy malnutrition (PEM) was diagnosed with body mass index below 18.5 kg/m(2). There was no statistical difference between malnourished (n = 30) and non-malnourished (n = 45) with regard to age (40.7 +/- 18.9 y versus 41.4 +/- 16.2 y), male predominance (66.7% versus 80%), or associated diagnoses. Compared with non-malnourished, malnourished patients had higher percentages of positive C-reactive protein (66.7 versus 23.8%), lower serum levels of albumin (2.51 +/- 0.89 g/dL versus 3.41 +/- 0.74 g/dL) and potassium (3.64 +/- 0.65 mEq/L versus 4.12 +/- 0.65 mEq/L), and increased QTc lengths on ECGs (0.423 +/- 0.033 ms versus 0.396 +/- 0.031 ms). Malnourished adults hospitalized in general clinical wards are more likely to have longer QTc intervals on their ECGs, a phenomenon possibly linked to malnutrition and associated electrolyte disturbances.

Nutritional assessment of vitamin E in malnourished patients with AIDS.

Malnourished patients with acquired immunodeficiency syndrome (AIDS) may have low serum levels and reduced intake of alpha-tocopherol, mainly in the presence of acute-phase response. The aims of this study were to compare intake and serum levels of alpha-tocopherol between malnourished (MN) and non-malnourished (NMN) AIDS patients and to correlate alpha-tocopherol intake and serum levels. Undernutrition was defined as having a body mass index lower than 18. 5 kg/m(2) or a height-creatinine index lower than 70%. A semiquantitative food frequency questionnaire assessed alpha-tocopherol intake. High-performance liquid chromatography determined vitamin serum levels. The patients were divided into MN (n = 14) and NMN (n = 15) groups. There were no statistical differences in relation to clinical findings between MN and NMN, respectively, including moniliasis (7/14 versus 4/15), neurocryptoccocosis and neurotoxoplasmosis (6/14 versus 6/15), pulmonary tuberculosis (4/14 versus 2/15), and fever (1/14 versus 3/15). MN and NMN groups had similar peripheral blood CD(4) levels (111.4+/-87.1 versus 124.4+/-90.9 cells/mm(3)), and both groups had similar and adequate alpha-tocopherol intake (MN = 50.0+/-11.0 versus NMN = 47.2+/-16.5 mg) and serum levels (MN = 17.8+/-7.2 versus NMN = 19.8+/-6.3 micromol/L). Vitamin E intake and serum levels did not show a significant correlation (r = -0.22, P 0.05). Protein-energy nutrition status and acute-phase response were not factors determining vitamin status among AIDS patients.

[Inquérito epidemiológico com paracoccidioidina e histoplasmina em área agrícola de café em Ibiá, Minas Gerais, Brasil.]. / Epidemiological survey with paracoccidioidin and histoplasmin in agricultural coffee area in Ibia, Minas Gerais State, Brazil.

An epidemiological survey in an endemic area for paracoccidioidomycosis in Ibiá town, Minas Gerais state, Brazil was carried out. For this, we used a standard form for each household and intradermal antigens of histoplasmin and paracoccidioidin. Out of 194 individuals, 109(56%) were engaged in the survey showing reactivity of 44% and 49.5% for these antigens respectively. The reactivity to paracoccidioidin was observed in 50% of children below ten years. Individuals who revealed reactivity to paracoccidiodin with prior history of coffee growing activities, and those reporting the grain collection as the main work, showed statistically significant association p = 0.0092, p = 0.0007 and p = 0,01 respectively. These results could suggest that activities related to coffee crops, may favour the transmission of Paracoccidioides brasiliensis, specially among the grain collectors. In addition, the reactivity for histoplasmin antigen, suggest that this region is endemic for both fungi.

Histoplasma capsulatum isolated from Didelphis albiventris (Marsupialia: Didelphidae) in the State of Minas Gerais, Brazil.

We report the isolation of Histoplasma capsulatum from a culture of the viscera of Didelphis albiventris, one of the marsupial species found in Brazil. To our knowledge, this is the first report of the isolation of this fungus from this mammalian species. This finding confirms the ubiquitous presence of H. capsulatum in nature.

[Neurologic and laboratory findings in a population of an endemic area for taeniasis-cysticercosis, Lagamar, MG, Brazil (1992-1993)]. / Achados neurológicos e laboratoriais em população de área endêmica para teníase-cisticercose, Lagamar, MG, Brasil (1992-1993).

A clinic-epidemiological enquiry was conducted on in an endemic area for teniasis-cysticercosis. From the whole population 1080 (32.2%) individuals were examined. We found 198 (18.3%) individuals referring teniasis-bearing in the past, and 103 (9.5%) affirming to have had convulsions, either in the past or present. From the last group, 39 (37.8%) indicated that the crisis had begun in adulthood. From the group of patients presenting convulsions, 62 (62%) had laboratory tests performed. Computed tomography showed intracranial calcifications in 21 (33.8%) patients, variable in number and location, suggesting neurocysticercosis and no evidence of disease activity. Electroencephalograms showed abnormal waves in 21 (33.8%) patients and cerebrospinal fluid analyses were altered in 27 (43.5%) cases, having detected eosinophils only in 3 (4.8%) patients. Spinal fluid tests for cysticercosis through enzyme linked immunosorbent assay (ELISA) or indirect immunofluorescence were taken in only 26 (41.9%) patients, obtaining positive results in 6 (23%) samples. Varying upward shifts of protein levels were found in spinal fluid analysis. Assuming that all epidemiologic risk factors for teniasis-cysticercosis in the studied region and its correlation with the laboratory alterations described in convulsing crisis, a prevalence of 1.9% for neurocysticercosis was found.

[Psoriasis in HIV positive patients]. / Psoríase em pacientes HIV positivo.

Two patients with the acquired immunodeficiency syndrome (AIDS) developed psoriasis, one of them presenting the more severe form and the other one the milder form of the disease, were treated with zidovudine per oral via, 200mg 3 times a day. In the first case the therapeutical response was complete. No lesion was verified in the patient after 9 months under maintenance schedule. In the second case, despite the response being clear, after 6 months of treatment, the patient still presented furfuraceous scalings at limbs ever under the medication schedule.

[Paracoccidioidomycosis in a patient with human immunodeficiency virus infection. A necropsy case]. / Paracoccidioidomicose em paciente com a infecção pelo vírus da imunodeficiência humana. Relato de necrópsia.

This is a case report of the association of Paracoccidioidomycosis and Acquired Immunodeficiency Syndrome (AIDS) occurring in a 43-year old male. This is, to the best of our knowledge, the first detailed pathological account of that association. Also discussed are the low rates of that association, its natural history and treatment results. It is emphasised the importance of the associations of AIDS and tropical infectious diseases in this country.

[Progressive multifocal leukoencephalopathy as initial manifestation of acquired immunodeficiency]. / Leucoencefalopatia multifocal progressiva como manifestação inicial da síndrome da imunodeficiência adquirida.

This is a report of a man with acquired immunodeficiency syndrome (AIDS) who presented acutely ill with severe progressive multifocal leukoencephalopathy (PML) as the first manifestation of AIDS. PML was diagnosed in the brain after gross and microscopical examination as well as by immunohistochemistry with an antibody against JC virus.

[Clinical and laboratory renal alterations in patients with acquired immunodeficiency syndrome in relation to anatomopathological findings]. / Alterações renais clínico-laboratoriais em pacientes com a síndrome da imunodeficiência adquirida em relação aos achados anatomopatológicos.

Clinical as well as renal anatomopathological data of 119 patients with acquired immunodeficiency syndrome from the Hospital of the Faculty of Medicine of Triângulo Mineiro, Uberaba, MG, Brazil, were studied. Mean age was 33 +/- 10.4 years (range 18 to 67 years). White (59%) and male (80%) individuals predominated. Ninety percent of patients came from Uberaba or neighborhood. There were 59 (50%) heterosexual, 25 (21%) homosexual, 17 (14%) bisexual and 18 (15%) unknown. Forty three percent were drug abusers. Fourteen (12.2%) of patients had serum creatinine higher than 3mg/dl, ten days before death, 64% of them showed acute tubular necrosis. Seventy one (61%) patients presented hyponatremia and 8 (7%) had hypernatremia. Hypokalemia was detected in 28 (24%) and hyperkalemia in 8 (7%) patients. Twenty four hours urinary protein was detected in 12 patients, 7 of them presenting more than 1g/24h. Two patients showed segmentar focal glomerulosclerosis, one of them with 24h urinary protein level of 5.5 g and serum creatinine 1.5 mg/dl and no edema. The most (56%) patients had tubulointerstitial nephritis. Clinical, laboratory and types of renal disorders in patients with acquired immunodeficiency syndrome are variable. The glomerular diseases were relatively scarce however, tubulointerstitial lesions are quite frequent, mainly interstitial nephritis and acute tubular necrosis. Not always an anatomoclinical correlation could be observed, because many times the electrolyte disorders were frequently observed only functionally.

[The epidemiological aspects of taeniasis-cysticercosis in an endemic area of Lagamar, Minas Gerais]. / Aspectos epidemiológicos da teníase-cisticercose na área endêmica de Lagamar, MG.

An epidemiological inquiry of humancysticercosis due to Taenia solium was carried out in Lagamar, Minas Gerais State, Brazil, in 1992. A survey of 1109 houses with 3344 inhabitants was made. The inquiry included 875 (86%) families and the questionnaire was answered by an informer, who was the father in 80% of the cases. One hundred pigsties, sheltering 406 swines in extremely precarious conditions, were found in 100 (11.4%) houses. A history on taeniasis in some member of the family was verified in 300 (34.2%) houses. A history of seizures was referred to by 125 (14.2%) of families. The outset of convulsion in adult age was characterized in 39 (37.8%) families. A history of mental disorder was reported in 53 (6.0%) of houses. Stool examinations were positive for Taenia spp in 24 (1.3%) of samples examined.

[Monitoring AIDS patients for the development of cytomegalovirus (CMV) disease using multiplex PCR]. / Monitoramento de pacientes com AIDS para o desenvolvimento de doença por citomegalovirus (CMV) usando-se PCR multiplex.

The human cytomegalovirus is an important pathogen in patients infected with the human immunodeficiency virus (HIV). The CMV viral load seems to be predictor of the development of the CMV disease in these patients. We used a multiplex PCR protocol that also provides quantitative information in those samples from which a single band is amplified and contains fewer viral genomes than those from which both targets are amplified. Monthly blood samples were collected from 270 AIDS patients. From twenty patients, two CMV targets were amplified three or more consecutive times and these patients developed CMV related disease during the study. In contrast, patients who did not result positive for both viral targets, for three or more consecutive times, or who had alternating positive and negative samples during the follow up did not present CMV related disease. The results suggest that the PCR multiplex can be used for the identification of HIV positive patients with higher risk of development of CMV disease.

Risk factors associated with taeniasis-cysticercosis in Lagamar, Minas Gerais State, Brazil.

An epidemiological survey was carried out in 3,344 people of an urban town in Lagamar, Minas Gerais, Brazil--during 1992-1993, to evaluate the main risk factors related to taeniasis and cysticercosis. A total number of 875 (78.9%) houses were visited and 1080 (32.3%) subjects were clinically examined. Poor sanitary conditions were positively associated with former history of taeniasis or seizures in households (p < 0.05). It was remarkable the positive relationship between taeniasis and seizures when households were questioned and subjects were clinically evaluated (p < 0.05). The relative risk of seizures was 2.3 between households and 1.7 for individuals clinically examined respectively. The breeding of swine nearby and the chronic carriers of taeniasis are determinant factors in the maintenance of the epidemiological link between taeniasis and cysticercosis in endemic areas.

[Hanseniasis virchowiana in Chagas cardiopathy: an autopsy report]. / Hanseníase virchowiana em cardiopata chagásico: relato de necropsia.

This is a case report of lepromatous infection diagnosed at necropsy, with cardiac alterations directly caused by mycobacteria, in a 34-year-old black male with the cardiac form of Chagas' disease. The possible role of inflammatory mediators on cardiac dysfunction, and the possibility that immune depression may be due to factors associated with heart failure, as congestive splenomegaly and splenic infarctions, are emphasized.

[Effectiveness of aminosidine sulphate in severe visceral leishmaniasis, resistant to the treatment with pentavalent antimony]. / Eficácia do sulfato de aminosidine na leishmaniose visceral grave, resistente ao tratamento com antimonial pentavalente.

A grave kala-azar infection in a 14 years old boy is described. The leishmanial infection failed to respond to ten interrupted courses of glucantime of variable duration (14-56 days) at a dose of 20mg Sb5/kg/day. However a favorable response occurred to intramuscular aminosidine sulphate (20mg/kg/day) for 20 days. This same regimen was repeated 20 days later. After the first treatment splenic puncture parasite density fell from 50 amastigotes per oil immersion field to 3 amastigotes in 10 fields. A further splenic puncture 7 months after treatment was negative. The marked hepatoesplenomegaly gradually resolved over 26 months follow up and he gained 13 kilograms in weight. After aminosidine sulphate therapy his Montenegro reaction become positive and his lymphocytes responded to leishmania antigens.

[Cryptococcus infection limited to the prostate in an AIDS patient with disseminated mycobacteriosis. A necropsy report]. / Infecção por Cryptococcus limitada à próstata em paciente aidético com micobacteriose disseminada. Relato de necropsia.

This is a case report of asymptomatic and restrained cryptococcal prostatic infection in a 32-year-old black male with the acquired immunodeficiency syndrome, whose death was caused by systemic mycobacteriosis probably pertaining to MAI complex. The importance of autopsy studies to evaluate the real prevalence of fungus infections in AIDS patients, specially in cases of persistent silent focuses, is emphasized.

[Iron status, malnutrition and acute phase response in HIV-positive patients]. / Resposta de fase aguda, subnutrição e estado nutricional do ferro em adultos com AIDS.

Nutritional status and some iron metabolism parameters of acute phase response (APR) positive and APR-negative AIDS patients were studied. Twenty-nine AIDS patients were submitted to 24h food intake recall, anthropometry, and albumin, C-reactive protein (CRP), hemoglobin, ferritin, and total iron binding capacity (TIBC) measurements. Infection plus serum CRP > 7 mg/dl were criteria for APR presence. Protein-energy malnutrition (PEM) was ascertained by body mass index (BMI) lower than 18.5 kg/m2 and height-creatinine index (HCI < 70%). PEM (77.8 vs 40%) and pulmonary tuberculosis (44. 4 vs 9.5%) were more frequent in APR-positive patients, which also had lower serum albumin (3.7 +/- 0.9 vs 4.3 +/- 0.9 g/dl), TIBC (165. 8 +/- 110.7 vs 265.9 +/- 74.6 mg/dl) and blood hemoglobin (10.5 +/- 1. 8 vs 12.6 +/- 2.3g/dl). Iron intake was similar between groups; however, serum ferritin levels (median, range) were higher among APR-positive (568, 45.3-1814 vs 246, 18.4-1577 ng/ml) patients. HIV-positive adults with systemic response to invading pathogens showed worse nutritional status than those APR-negative. In APR-positive AIDS patients, anemia appears to be unrelated to recent iron intake.

Isolation of a Paracoccidioides brasiliensis strain from the soil of a coffee plantation in Ibiá, State of Minas Gerais, Brazil.

Paracoccidioides brasiliensis has rarely been isolated from its habitat in rural areas. In order to investigate the hypothesis that human infection with this fungus is linked to coffee plantations (Coffea arabica), material was collected monthly over a period of 1 year from farms in the town of Ibiá, State of Minas Gerais, Brazil. A total of 760 samples of soil, coffee leaves and fruits was cultured and inoculated into mice. A fungus isolated from the liver of a mouse inoculated with soil showed temperature-dependent dimorphism and in vitro mycelium and yeast phases characteristic of P. brasiliensis. Yeast cells of this fungus caused disseminated infection after intraperitoneal inoculation in Wistar rats from which the fungus was re-isolated. An antigen reacting with sera from patients with paracoccidioidomycosis was obtained from this P. brasiliensis strain; antigenic identity with strain 339 and with four other P. brasiliensis strains was detected by gel immunodiffusion. However, when the exo-antigen was submitted to SDS-PAGE, we observed low gp43 expression in this new strain, which we called Ibiá. The isolation of P. brasiliensis from the soil at a coffee plantation suggests that this is one of its habitats and supports the hypothesis of acquisition of paracoccidioidomycosis during agricultural activity in these areas.

Isolation of Paracoccidioides brasiliensis from armadillos (Dasypus novemcinctus) in an area where the fungus was recently isolated from soil.

Natural infection of armadillos (Dasypus novemcinctus) with Paracoccidioides brasiliensis in Northern Brazil was reported in 1986, raising great interest in the understanding of the role of this mammal in the epidemiological cycle of the fungus. Recently, P. brasiliensis was isolated from the soil of Ibiá, State of Minas Gerais, southeastern Brazil. Armadillos captured in this area were evaluated for the presence of P. brasiliensis in the viscera and infection was detected in 4/16 animals (25%). Fungal yeast phase cells were observed in three of the four infected armadillos by direct microscopic examination and by the indirect immunofluorescence test carried out on homogenized tissues. P. brasiliensis was isolated from three armadillos whose homogenized viscera had been injected into Swiss mice. The new strains (Ibiá-T1, Ibiá-T2 and Ibiá-T3) were identified as P. brasiliensis on the basis of macro- and micromorphology, thermodimorphism, production and serologic activity of exoantigens, and by polymerase chain reaction (PCR)-detection of the gp43 gene. The lethality and lesions caused to the mice from which the strains were recovered confirmed the virulence of the isolates. We conclude that P. brasiliensis infects armadillos in locations with different geoclimatic characteristics and vegetation cover. The direct observation of yeast cells in tissues and the multiple visceral involvement, including the lungs, suggests the occurrence of paracoccidioidomycosis disease in these mammals and supports their role as wild hosts in the epidemiological cycle of the fungus.

The marsupial Didelphis albiventris is an improbable host of Paracoccidioides brasiliensis in an endemic area of paracoccidioidomycosis in Minas Gerais, Brazil.

To determine whether Didelphis albiventris is naturally infected with Paracoccidioides brasiliensis, 20 specimens of this mammal were studied by both direct cultivation of their viscera (spleen, liver and lungs) and by inoculation of Swiss mice by the intraperitoneal route with a suspension of fragments of these viscera. No fungal growth or structures similar to this fungus were detected. Probably D. albiventris is not frequently infected with P. brasiliensis.