Rapid CD4 cell count determination and Cryptococcus and Histoplasma antigen detection in people living with HIV: Implementation of a package of care strategy in a pilot study, Argentina.

Objectives: Despite advancements in HIV diagnosis and treatment, advanced HIV disease (AHD) is still a significant concern worldwide, especially in countries with a high percentage of undiagnosed cases and late-stage diagnoses. Methods: A prospective pilot study was conducted in Buenos Aires, Argentina to assess the feasibility of implementing a package for people living with HIV, integrating a point-of-care clusters of differentiation (CD4) test, followed by rapid Cryptococcus and Histoplasma antigen (Ag) detection. Results: A total of 105 people living with HIV were enrolled, during June 2021 to October 2021. The VISITECT CD4 Advanced Disease Lateral Flow Assay (CD4-LFA) (Accubio) classified 98 (93%) patients with AHD. Compared with flow cytometry, the CD4-LFA performed with a high sensitivity (100%) but low specificity (19%) and limited accuracy (47%). In the 98 patients classified with AHD using the CD4-LFA, 16 tested positive for any of the rapid Ag used, including 12 patients positive for the Histoplasma Ag test and four positive for Cryptococcus Ag; all four patients with positive Cryptococcus Ag in sera and were diagnosed with meningitis. In the 30-day follow-up, one death was recorded. Conclusions: The CD4-LFA correctly classified all patients with CD4 ≤200 cells/µL by flow cytometry, but a high frequency of patients misclassified with AHD was recorded. We also observed a high prevalence of opportunistic fungal infections, as previously observed in the hospital where this pilot study was conducted; however, in contrast with those previous reports, mortality was lower. The study underscores the importance of scaling up comprehensive care strategies and collaborating with governmental and non-governmental partners to enhance access to essential diagnostic tools and treatments for people living with HIV. Further research with larger sample sizes is needed to validate these findings.

Epidemiology of coccidioidomycosis in Argentina, an update.

The National Reference Laboratory in Clinical Mycology of Argentina conducted a retrospective review of human coccidioidomycosis cases diagnosed by the National Mycology Laboratory Network of Argentina between 2010 and 2022 to determine the burden of the disease in the country. A total of 100 human coccidioidomycosis cases were documented, with a higher prevalence in male patients (male-to-female ratio of 1.9:1), with a median age of 41 years. Comparing the number of cases between two 10-year periods (2000-2009 and 2010-2019), the increase was 36.51% (from 63 to 86 cases). Among the 100 recorded cases, 79 tested positive using the double immunodiffusion test. Spherules were observed in 19 cases through histopathology or direct microscopic examination and the fungus was isolated in 39 cases. Thirty-six isolates were identified as Coccidioides posadasii through partial sequencing of the Ag2/PRA gene. Catamarca province had the highest number of cases, comprising 64% of the total, with an incidence rate above 1.0-2.5/100,000 inhabitants until 2018. However, there has been a recent downward trend in the region from 2018 to 2022. It is concerning that more than half of diagnosed cases were chronic pulmonary or disseminated forms, indicating a lack of early disease detection. To rectify this issue, it is imperative to conduct targeted training programs for healthcare personnel and enhance public awareness within the endemic area. This will contribute to a better understanding of the true burden of coccidioidomycosis and enable the implementation of appropriate sanitary control measures.

Evaluation of the MALDI-TOF mass spectrometry technique for the identification of dermatophytes: Use of an extended database.

BACKGROUND: Identification of dermatophytes is usually performed through morphological analyses. However, it may be hindered due to the discovery of new species and complexes and, with some isolates, by the absence of fructification. Matrix-assisted laser desorption/ionisation-time-of-flight mass spectrometry (MALDI-TOF MS) seems to be an option for improving identification. AIMS: To develop a database (DB) for the identification of dermatophytes with MALDI-TOF MS, including 32 isolates from the Red de Micología de la Ciudad Autónoma de Buenos Aires [Mycology Network of the Autonomous City of Buenos Aires] (RMCABA) and one reference isolate (RMCABA DB), and evaluate its performance when added to the DB from the supplier, Bruker (Bruker DB). METHODS: All the isolates in the RMCABA DB were identified based on morphology and sequencing. To evaluate the performance of the extended DB (Bruker DB plus RMCABA DB), 136 clinical isolates were included. RESULTS: The percentages of identification at the species level increased from 45% to 88%, but the identification at the genus level decreased from 23% to 7%. CONCLUSIONS: MALDI-TOF MS yielded better performance in the identification of dermatophytes after including the RMCABA DB, which encompassed local isolates.

Clinical and Demographic Features of Paracoccidioidomycosis in Argentina: A Multicenter Study Analysis of 466 Cases.

Information on paracoccidioidomycosis (PCM) in Argentina is fragmented and has historically been based on estimates, supported only by a series of a few reported cases. Considering the lack of global information, a national multicentric study in order to carry out a more comprehensive analysis was warranted. We present a data analysis including demographic and clinical aspects of a historical series of 466 cases recorded over 10 years (2012-2021). Patients were aged from 1 to 89 years. The general male: female (M:F) ratio was 9.5:1 with significant variation according to the age group. Interestingly, the age range 21-30 shows an M:F ratio of 2:1. Most of the cases (86%) were registered in northeast Argentina (NEA), showing hyperendemic areas in Chaco province with more than 2 cases per 10,000 inhabitants. The chronic clinical form occurred in 85.6% of cases and the acute/subacute form occurred in 14.4% of cases, but most of these juvenile type cases occurred in northwestern Argentina (NWA). In NEA, the incidence of the chronic form was 90.6%; in NWA, the acute/subacute form exceeded 37%. Diagnosis by microscopy showed 96% positivity but antibody detection displays 17% of false negatives. Tuberculosis was the most frequent comorbidity, but a diverse spectrum of bacterial, fungal, viral, parasitic, and other non-infectious comorbidities was recorded. This national multicenter registry was launched in order to better understand the current status of PCM in Argentina and shows the two endemic zones with a highly diverse epidemiology.

Utilidad del panel FilmArray® BCID en la detección de bacteriemia: estudio multicéntrico latinoamericano / Usefulness of the FilmArray® BCID panel in the detection of bacteremia: Latin American multicenter study

Resumen Los objetivos de este estudio fueron determinar el desempeño del panel BCID de FilmArray® y establecer el impacto de estos resultados en el tratamiento antimicrobiano de pacientes con bacteriemia en 11 hospitales de Latinoamérica. Se incluyeron 397 episodios de bacteriemia y se documentaron 551 microorganismos aislados de hemocultivos. La identificación microbiana fue correcta en el 91,4% (504/551) de los aislados y en el 98,6% (504/511) si se consideran solo los microorganismos incluidos en el panel BCID. La sensibilidad en la detección de los genes mecA, vanA/B y blaKPC fue del 100% y la especificidad fue del 97%, 100% y 99,6% respectivamente. La notificación temprana del resultado permitió cambios terapéuticos en 242 episodios (60,9%). El panel BCID es un método confiable y rápido para la detección de mecanismos críticos de resistencia y de los microorganismos más frecuentemente aislados de bacteriemias y permite la optimización temprana del tratamiento antimicrobiano.

Abstract The objectives of this study were to determine the performance of the BCID panel and to establish the impact of these results on the antimicrobial treatment of patients with bacteremia in 11 hospitals in Latin America. Three hundred and ninety-seven episodes of bacteremia were included and 551 microorganisms isolated from blood cultures were documented. Microbial identification was correct in 91.4% (504/551) of the isolates and in 98.6% (504/511) if only the microorganisms included in the BCID panel are considered. The sensitivity in the detection of the genes mecA, vanA/B and blaKPC was 100% and the specificity was 97%, 100% and 99.6% respectively. Early notification of the outcome allowed therapeutic changes in 242 episodes (60.9%). The BCID panel is a reliable and rapid method for the detection of critical resistance mechanisms and of the microorganisms most frequently isolated from bacteremia and it enables early optimisation of antimicrobial treatment.

Resumo Os objetivos deste estudo foram determinar o desempenho do painel BCID do FilmArray® e estabelecer o impacto desses resultados no tratamento antimicrobiano de pacientes com bacteremia em 11 hospitais da América Latina. Trezentos e noventa e sete episódios de bacteremia foram incluídos e 551 microrganismos isolados de hemoculturas foram documentados. A identificação microbiana foi correta em 91,4% (504/551) dos isolados e em 98,6% (504/511) considerando apenas os microrganismos incluídos no painel BCID. A sensibilidade na detecção dos genes mecA, vanA/B e blaKPC foi de 100% e a especificidade foi de 97%, 100% e 99,6% respectivamente. A notificação precoce do desfecho permitiu mudanças terapêuticas em 242 episódios (60,9%). O painel BCID é um método confiável e rápido para a detecção de mecanismos críticos de resistência e dos microrganismos mais frequentemente isolados da bacteremia e permite a otimização precoce do tratamento antimicrobiano.

Hemophagocytic lymphohistiocytosis secondary to AIDS-related histoplasmosis and visceral leishmaniasis.

Hemophagocytic Lymphohistiocytosis (HLH) is a rare, highly aggressive syndrome involving dysregulated immune response. Most cases are secondary to underlying diseases including infections, autoimmune disorders and malignancies. The burden of disease of histoplasmosis and leishmaniosis associated with advanced HIV is still significant in low-and-middle income countries (LMIC). We present a case of histoplasmosis and leishmaniasis associated HLH in a man with an AIDS diagnosis.

Utilidad del panel Sensititre YeastOne® para detectar especies de Candida resistentes a los antifúngicos / Usefulness of the Sensititre YeastOne® panel to detect Candida species resistant to antifungal drugs

Resumen Evaluamos las concordancias interlaboratorio, esencial y categórica entre el panel Sensititre YeastOne™ y los métodos de referencia correspondientes al M27 4.a ed. (Clinical and Laboratory Standards Institute [CLSI]) y al EDef 7.3.1 (European Committee on Antifungal Susceptibility Testing [EUCAST]). Estudiamos 67 cepas de Candida de distintas muestras clí nicas y un panel de 9 cepas resistentes a fluconazol y equinocandinas. El mayor porcentaje de concordancia interlaboratorio se observó con anfotericina B (96,8%) y el menor porcen taje con voriconazol (77,2%). La caspofungina mostró un 5,8% de discrepancias muy mayores con el método de referencia del CLSI. Con el del EUCAST, el itraconazol, el posaconazol y la anidulafungina mostraron porcentajes de discrepancias mayores: el 17,6, el 18,1 y el 19,6%, respectivamente. El panel Sensititre YeastOne™ es una alternativa confiable y fácil de usar, que permite detectar especies de Candida resistentes a los antifúngicos, con algunas limitaciones para las equinocandinas. Los resultados son equiparables a los de los métodos de referencia.

Abstract We evaluated the interlaboratory agreement, the essential agreement, and the cate- gorical agreement between the Sensititre YeastOne™ panel and the reference methods M27 4th Edition of the Clinical and Laboratory Standards Institute (CLSI), and the EDef 7.3.1 of the Euro- pean Committee on Antifungal Susceptibility Testing (EUCAST). We studied 67 Candida strains isolated from different clinical samples and 9 Candida strains with resistance to fluconazole and echinocandins. The highest percentage of interlaboratory agreement was observed with amp- hotericin B (96.8%), and the lowest percentage with voriconazole (77.2%). Caspofungin showed 5.8% of very major errors when compared with the CLSI reference method. For EUCAST, itraconazole, posaconazole, and anidulafungin showed high percentages of major errors: 17.6%, 18.1%, and 19.6%, respectively. Sensititre YeastOne™ is a reliable alternative, and easy to perform for detecting Candida species resistant to antifungal drugs, with some limitations for echinocandins. Results are comparable to those of the reference methods.

[Usefulness of the Sensititre YeastOne® panel to detect Candida species resistant to antifungal drugs]. / Utilidad del panel Sensititre YeastOne® para detectar especies de Candida resistentes a los antifúngicos.

We evaluated the interlaboratory agreement, the essential agreement, and the categorical agreement between the Sensititre YeastOneTM panel and the reference methods M27 4th Edition of the Clinical and Laboratory Standards Institute (CLSI), and the EDef 7.3.1 of the European Committee on Antifungal Susceptibility Testing (EUCAST). We studied 67 Candida strains isolated from different clinical samples and 9 Candida strains with resistance to fluconazole and echinocandins. The highest percentage of interlaboratory agreement was observed with amphotericin B (96.8%), and the lowest percentage with voriconazole (77.2%). Caspofungin showed 5.8% of very major errors when compared with the CLSI reference method. For EUCAST, itraconazole, posaconazole, and anidulafungin showed high percentages of major errors: 17.6%, 18.1%, and 19.6%, respectively. Sensititre YeastOneTM is a reliable alternative, and easy to perform for detecting Candida species resistant to antifungal drugs, with some limitations for echinocandins. Results are comparable to those of the reference methods.

Validation of a Lateral Flow Assay for Rapid Diagnosis of Histoplasmosis in Advanced HIV Disease, Buenos Aires, Argentina.

Histoplasmosis is a major cause of mortality in individuals with advanced human immunodeficiency virus (HIV) disease (AHD). We evaluated in patients with AHD a lateral flow assay (LFA) developed by MiraVista® Diagnostics (MVD LFA). Histoplasmosis was defined based on the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) case definitions. We also compared the results of this LFA with those obtained using a commercial enzyme immunoassay (EIA) developed by IMMY, Clarus Histoplasma GM EIA, IMMY (HGM EIA). A retrospective observational study was conducted at Hospital Juan A. Fernández, located in Buenos Aires, Argentina. The study included 48 urine specimens from patients aged >18 years with AHD. Urine specimens included 17 patients with disseminated histoplasmosis and 31 specimens from patients without evidence of histoplasmosis. Specimens were tested using the MVD LFA and the HGM EIA. The MVD LFA and the HGM EIA had similar analytical performance, with a sensitivity of 94%, specificity of 100%, positive predictive value of 100%, negative predictive value of 97%, and an accuracy of 98%. Comparison of the MVD LFA with the HGM EIA demonstrated a Kappa agreement index of 0.906. The LFA evaluated in this study had high analytical performance; it provided rapid diagnosis of histoplasmosis with minimal requirements for laboratory training, equipment, and laboratory infrastructure.

Testing of In Vitro Susceptibility of Neisseria gonorrhoeae to Azithromycin: Comparison of Disk Diffusion and Reference Agar Dilution Methods.

Azithromycin in combination with ceftriaxone is recommended as the first-line treatment for uncomplicated gonorrhea in many countries. Therefore, monitoring of azithromycin susceptibility of Neisseria gonorrhoeae isolates is essential. In 2019, the Clinical and Laboratory Standards Institute (CLSI) listed the MIC breakpoint for a susceptible-only category to azithromycin, but breakpoints for disk diffusion are not yet available. In this study, we evaluated the usefulness of disk diffusion for testing the susceptibility of N. gonorrhoeae isolates to azithromycin. A total of 189 clinical isolates susceptible and nonsusceptible to azithromycin were used. Agar dilution MICs were correlated with inhibition zone diameters of azithromycin disks (15-µg) manufactured by BBL and Oxoid. In addition, an interlaboratory study involving two clinical microbiology laboratories was conducted. There was a strong correlation between disk diffusion and agar dilution for BBL disks (r = -0.74; P < 0.001) and Oxoid disks (r = -0.75; P < 0.001). Using a zone diameter breakpoint of ≥27 mm (susceptible) and ≤26 mm (nonsusceptible) yielded good separation between susceptible and nonsusceptible isolates and the least number of discrepancies. Compared to agar dilution, disk diffusion showed high agreement and kappa values of 95.2% and 0.899 (P < 0.001) for BBL disks and 96.8% and 0.933 (P < 0.001) for Oxoid disks, respectively. Major and very major discrepancies were observed in isolates with azithromycin MICs (1 and 2 µg/ml, respectively) near to the breakpoint. These data illustrate that disk diffusion could be a reliable method in clinical laboratories to test susceptibility to azithromycin in N. gonorrhoeae isolates.

Absceso de psoas iliaco: un desafío diagnóstico / Psoas-Iliac Abscess a dignotic challengen

El absceso de músculo psoas iliaco se considera una rare-za. Su detección ha mejorado con la utilización de imágenes como la tomografía computada o la resonancia magnética. Presentamos una revisión de casos de absceso de psoas-iliaco internados entre julio de 2015 y febrero de 2018 en un hospital de CABA, Argentina.En este periodo se diagnosticaron un paciente conside-rado de origen primario y ocho de origen secundario. Se observó predominio de colecciones asociadas a es-pondilodiscitis. El síntoma más frecuente fue la fiebre. Staphylococcus aureus fue el germen más rescatado en muestras microbiológicas. Se debe tener alto índice de sospecha de esta patología ante la presencia de fiebre, dolor lumbar y en ocasiones alteración de la marcha. El empleo de antibióticos de amplio espectro sumado a la evacuación de colecciones constituyen la estrategia más efectiva

Psoas-iliac muscle abscess is considered a rarity, the use of images such as computed tomography or magnetic reso-nance imaging has improved its detection.This study reviews cases of psoas-iliac abscess in hospi-talized patients between July 2015 and February 2018 in a hospital in CABA, Argentina.In one of the patients the origin was considered primary ,while in the other eight it was secondary. There was a pre-dominance of collections associated with spondylodiscitis. The most frequent symptom was fever. Staphylococcus au-reus was the most frequent organism obtained in microbio-logical samples. A high level of suspicion must be held in the presence of fever, lumbar pain and sometimes alteration of the gait. The use of broad spectrum antibiotics in addition to evacuation of collections is the most effective strategy.

Neuroparacoccidioidomicosis: para tener presente / Neuroparacoccidiodomycosis to keep in mind:

La paracoccidioidomicosis (PCM) es una micosis endémica de zonas tropicales y subtropicales, con mayor prevalencia en América Latina, producida por especies del género Para-coccidioides. Es una micosis profunda sistémica que en su forma crónica afecta principalmente a varones adultos. La afectación del sistema nervioso central (SNC) está descrita en un 10-27%. Nosotros presentamos dos casos con mani-festación neurológica al ingreso

Paracoccidioidomycosis (PCM) is an endemic mycosis, from tropical and subtropical zones, with a higher prevalence in Latin America, produced by species of the genus Paracoccidioides. It is a deep chronic systemic my-cosis, which mainly affects adult males. The involvement of the central nervous system (CNS) is described in 10-27%. We present two cases with neurological manifestation upon admission.

Development and validation of an extended database for yeast identification by MALDI-TOF MS in Argentina.

Matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) has revolutionized the identification of microorganisms in clinical laboratories because it is rapid, relatively simple to use, accurate, and can be used for a wide number of microorganisms. Several studies have demonstrated the utility of this technique in the identification of yeasts; however, its performance is usually improved by the extension of the database. Here we developed an in-house database of 143 strains belonging to 42 yeast species in the MALDI Biotyper platform, and we validated the extended database with 388 regional strains and 15 reference strains belonging to 55 yeast species. We also performed an intra- and interlaboratory study to assess reproducibility and analyzed the use of the cutoff values of 1.700 and 2.000 to correctly identify at species level. The creation of an in-house database that extended the manufacturer's database was successful in view of no incorrect identification was introduced. The best performance was observed by using the extended database and a cutoff value of 1.700 with a sensitivity of .94 and specificity of .96. A reproducibility study showed utility to detect deviations and could be used for external quality control. The extended database was able to differentiate closely related species and it has potential in distinguishing the molecular genotypes of Cryptococcus neoformans and Cryptococcus gattii.

Comparison of the identification results of Candida species obtained by BD PhoenixT and Maldi-TOF (Bruker Microflex LT Biotyper 3.1) / Comparación de los resultados de identificación de especies del género Candida obtenidos por BD PhoenixT y Maldi-TOF (Bruker Microflex LT Biotyper 3.1)

In patients with invasive fungal infections, the accurate and rapid identification of the genus Candida is of utmost importance since antimycotic sensitivity is closely related to the species. The aim of the present study was to compare the identification results of species of the genus Candida obtained by BD PhoenixT (Becton Dickinson -#91;BD-#93;) and Maldi-TOF MS (Bruker Microflex LT Biotyper 3.1). A total of 192 isolates from the strain collection belonging to the Mycology Network of the Autonomous City of Buenos Aires, Argentina, were analyzed. The observed concordance was 95%. Only 10 strains (5%) were not correctly identified by the BD PhoenixT system. The average identification time with the Yeast ID panels was 8h 22 min. The BD PhoenixT system proved to be a simple, reliable and effective method for identifying the main species of the genus Candida.

En pacientes con infecciones fúngicas invasoras, la identificación certera y rápida de las especies del género Candida es de suma importancia, ya que la sensibilidad a los antifúngicos está íntimamente relacionada con la especie. El objetivo del presente estudio fue comparar los resultados de identificación de especies del género Candida obtenidos con el equipo comercial BD PhoenixT (Becton Dickinson -#91;BD-#93;) y con la técnica de Maldi-TOF MS (Bruker Microflex LT Biotyper 3.1.) Se analizaron 192 aislamientos provenientes del cepario perteneciente a la Red deMicología de la Ciudad Autónoma de Buenos Aires, Argentina. La concordancia observada fue del 95%. Solo 10 cepas (5%) no fueron identificadas correctamente por el sistema BD PhoenixT. El tiempo promedio de identificación con los paneles Yeast ID fue de 8 h 22 min. El sistema BD PhoenixT demostró ser un método simple, confiable y efectivo para la identificación de las principales especies del género Candida.

[Identification of Candida yeasts: Conventional methods and MALDI-TOF MS]. / Identificación de levaduras del género Candida: los métodos convencionales frente a MALDI-TOF MS.

BACKGROUND: Invasive fungal infections are increasing, and Candida yeasts are the main cause. Species other than Candida albicans are becoming more frequent, and some of them may have variable patterns of susceptibility to antifungal agents, making it important to identify them correctly. Conventional identification methods used by most laboratories may present with drawbacks. Mass spectrometry (MALDI-TOF MS) has emerged as an alternative method. AIMS: The aim of this study was to evaluate the concordance of the identification, at species level, by conventional methods (API) and MALDI-TOF MS. METHODS: The following species and number of isolates were studied: Candida parapsilosis (28), Candida glabrata (34), Candida krusei (24), Candida tropicalis (45), Candida guilliermondii (30), C. albicans (28), Candida dubliniensis (6), Candida kefyr (1), and Candida lipolytica (1) from the strain collection of Autonomous City of Buenos Aires Mycology Network (RMCABA). The strains C. parapsilosis 22019, C. glabrata 90030, C. krusei 6258 and C. albicans 68548 from the American Type Culture Collection (ATCC) were also included. Discrepancies were resolved by genotyping. RESULTS AND CONCLUSIONS: The direct concordance between the conventional identification method and MALDI-TOF MS was 92.5% (186/201).

Comparison of the identification results of Candida species obtained by BD Phoenix™ and Maldi-TOF (Bruker Microflex LT Biotyper 3.1).

In patients with invasive fungal infections, the accurate and rapid identification of the genus Candida is of utmost importance since antimycotic sensitivity is closely related to the species. The aim of the present study was to compare the identification results of species of the genus Candida obtained by BD Phoenix™ (Becton Dickinson [BD]) and Maldi-TOF MS (Bruker Microflex LT Biotyper 3.1). A total of 192 isolates from the strain collection belonging to the Mycology Network of the Autonomous City of Buenos Aires, Argentina, were analyzed. The observed concordance was 95%. Only 10 strains (5%) were not correctly identified by the BD Phoenix™ system. The average identification time with the Yeast ID panels was 8h 22min. The BD Phoenix™ system proved to be a simple, reliable and effective method for identifying the main species of the genus Candida.

Prevalence of cryptococcal infection among advanced HIV patients in Argentina using lateral flow immunoassay.

BACKGROUND: Globally, Latin America ranks third among regions with most cases of AIDS related cryptococcal meningitis. In 2009, a lateral flow immunoassay (LFA) for the detection of cryptococcal antigen (CrAg) was developed as a potential point-of-care test for diagnosis of cryptococcal infection. In 2011 World Health Organizations recommended on CrAg screening for HIV positive persons with CD4 below 100 cells/µL, followed by preemptive fluconazole treatment. However, in Argentina no formal recommendations for CrAg screening have been issued. METHODS: HIV positive patients > = 18 years with advanced immunosuppression (CD4 counts ≤100 cells/µL within 3 months or WHO stage III/IV), who visited the hospital between April 1, 2014 and January 31, 2015, were included. The LFA was performed according to the manufacturer's instructions on all serum samples. When CrAg detection was positive, a lumbar puncture was performed to rule out cryptococcal meningitis. Patients without evidence of meningeal involvement were treated with preemptive oral fluconazole in ambulatory care. RESULTS: We included 123 patients. Prevalence of CrAg-positivity was 8.1%. Among the 10 CrAg-positive patients, 6 had meningeal involvement detected through the CSF analysis (CSF India-ink testing, CSF CrAg and culture). The remaining 4 patients with positive CrAg received targeted preemptive treatment with oral fluconazole and were free of cryptococcal disease during the follow-up period. None of the 113 patients with a negative CrAg test result developed cryptococcal disease. CONCLUSIONS: This is the first study in Argentina, to our knowledge, describing the prevalence of cryptococcosis and usefulness of CrAg screening. LFA provided early diagnosis to determine a high prevalence of CrAg in our hospital, and that screening for subclinical infection with preemptive antifungal treatment, prevented a substantial proportion of meningeal disease.

Evaluación del rendimiento del sistema Rapid™ Yeast Pluz (Remel) a partir de 2 medios de cultivo diferentes / Performance evaluation of Rapid™ Yeast Plus (Remel) system from two different culture media

Dentro del género Candida, la especie más frecuentemente aislada de materiales clínicos es Candida albicans. Debido a la emergencia de otras especies que pueden presentar mayor índice de resistencia a los antifúngicos, se hace necesaria la identificación rápida de aquellas. El objetivo del presente trabajo fue evaluar el rendimiento del sistema RapID™ Yeast Plus a partir de subcultivos en 2 formulaciones diferentes, agar Sabouraud dextrosa modificado por Emmons (medio indicado en el inserto del equipo) y agar Sabouraud glucosado, que es el utilizado habitualmente en los laboratorios de la Ciudad Autónoma de Buenos Aires. Se estudiaron 166 cepas de muestras clínicas provenientes de los distintos hospitales que integran la Red de Micología de la Ciudad de Buenos Aires. De los resultados obtenidos se concluye que se deben mantener las condiciones y el medio de cultivo indicado por el fabricante

Within the genus Candida, Candida albicans is the most commonly isolated species from clinical samples. Due to the emergence of other species which can show a higher index of antifungal resistance, a fast identification of these species is necessary. The aim of this work was to evaluate the performance of the RapID Yeast Plus system from two different subculture media formulations: Sabouraud dextrose agar adjusted by Emmons (the medium is indicated in the equipment insert) and Sabouraud glucose agar, which is the most frequently used in Buenos Aires City laboratories. One hundred and sixty-six clinical sample strains coming from different hospitals belonging to the Mycology Network of Buenos Aires City were studied. From the obtained results, we conclude that the conditions and culture medium indicated by the manufacturer should be followed

[Performance evaluation of Rapid™ Yeast Plus (Remel) system from two different culture media]. / Evaluación del rendimiento del sistema Rapid™ Yeast Plus (Remel) a partir de 2 medios de cultivo diferentes.

Within the genus Candida, Candida albicans is the most commonly isolated species from clinical samples. Due to the emergence of other species which can show a higher index of antifungal resistance, a fast identification of these species is necessary. The aim of this work was to evaluate the performance of the RapID Yeast Plus system from two different subculture media formulations: Sabouraud dextrose agar adjusted by Emmons (the medium is indicated in the equipment insert) and Sabouraud glucose agar, which is the most frequently used in Buenos Aires City laboratories. One hundred and sixty-six clinical sample strains coming from different hospitals belonging to the Mycology Network of Buenos Aires City were studied. From the obtained results, we conclude that the conditions and culture medium indicated by the manufacturer should be followed.

[Yeast urinary tract infections. Multicentre study in 14 hospitals belonging to the Buenos Aires City Mycology Network]. / Infecciones urinarias nosocomiales por levaduras. Estudio multicéntrico de 14 hospitales de la red de micología de la Ciudad Autónoma de Buenos Aires.

BACKGROUND: Urinary tract infections are a frequent ailment in patients in intensive care units. Candida and other yeasts cause 5-12% of these infections. The value of the finding of any yeast is controversial, and there is no consensus about which parameters are adequate for differentiating urinary infections from colonization or contamination. AIMS: To analyse the epidemiological characteristics of patients with funguria, to determine potential cut-off points in cultures (to distinguish an infection from other conditions), to identify the prevalent yeast species, and to determine the value of a second urine sample. METHODS: A multicentre study was conducted in intensive care units of 14 hospitals in the Buenos Aires City Mycology Network. The first and second samples of urine from every patient were cultured. The presence of white cells and yeasts in direct examination, colony counts, and the identification of the isolated species, were evaluated. RESULTS: Yeasts grew in 12.2% of the samples. There was no statistical correlation between the number of white cells and the fungal colony-forming units. Eighty five percent of the patients had indwelling catheters. Funguria was not prevalent in women or in patients over the age of 65. Candida albicans, followed by Candida tropicalis, were the most frequently isolated yeasts. Candida parapsilosis and Candida glabrata appeared less frequently. The same species were isolated in 70% of second samples, and in 23% of the cases the second culture was negative. CONCLUSIONS: It was not possible to determine a useful cut-off point for colony counts to help in the diagnosis of urinary infections. As in other publications, C. albicans, followed by C. tropicalis, were the most prevalent species.