Isolated cerebral mucormycosis associated with intravenous drug use.

We present an uncommon case of isolated basal ganglia mucormycosis in a patient without any known cause of immunosuppression, but with a history of drug injection. The patient presented a good clinical and radiological response to antifungal treatment without aggressive surgical debridement (liposomal amphotericin B combined with isavuconazole for 4 weeks followed by isavuconazole as maintenance therapy for 10 months).

A prospective international Aspergillus terreus survey: an EFISG, ISHAM and ECMM joint study.

OBJECTIVES: A prospective international multicentre surveillance study was conducted to investigate the prevalence and amphotericin B susceptibility of Aspergillus terreus species complex infections. METHODS: A total of 370 cases from 21 countries were evaluated. RESULTS: The overall prevalence of A. terreus species complex among the investigated patients with mould-positive cultures was 5.2% (370/7116). Amphotericin B MICs ranged from 0.125 to 32 mg/L, (median 8 mg/L). CONCLUSIONS: Aspergillus terreus species complex infections cause a wide spectrum of aspergillosis and the majority of cryptic species display high amphotericin B MICs.

Association between source control and mortality in 258 patients with intra-abdominal candidiasis: a retrospective multi-centric analysis comparing intensive care versus surgical wards in Spain.

Early empiric therapy and adequate resuscitation have been identified as main predictors of outcome in patients with candidemia or bacteremia. Moreover, source control is a major determinant in infectious sites when feasible, as a main technique to reduce microbiological burden. A retrospective, multicenter, cohort study was performed at surgical wards and intensive care units (ICU) of three University Hospitals in Spain between 2010 and 2014, with the aim of improving understanding of the interaction between source control, early antifungal therapy, and use of vasoactives in patients with intra-abdominal candidiasis (IAC). Source control was defined as all physical actions taken to control a focus of infection and reduce the favorable conditions that promote microorganism growth or that maintain the impairment of host defenses. Two hundred and fifty-eight patients with IAC were identified. Sixty-one patients were at ICU for diagnosis. Mortality was higher in the ICU group compared to what was documented for the non-ICU group (35 % vs 19.5 %, p = 0011). Adequate source control within 48 h of diagnosis was achieved in 60 % of the cohort. In multivariate analysis, inadequate source control was identified as the only common risk factor for 30-day mortality in both groups (ICU group OR: 13.78 (95% CI: 2.60-72.9, p = 0.002) and non-ICU group OR: 6.53 (95% CI: 2.56-16.61, p = <0.001). The population receiving both adequate source control and adequate antifungal treatment was the one associated with a higher survival rate, in both the ICU and surgical groups. Source control remains a key element in IAC, inside and outside the intensive care unit. Early antifungal treatment among ICU patients was associated with lower mortality.

Predictors of choice of initial antifungal treatment in intraabdominal candidiasis.

Intraabdominal candidiasis (IAC) is the second most frequent form of invasive candidiasis, and is associated with high mortality rates. This study aims to identify current practices in initial antifungal treatment (IAT) in a real-world scenario and to define the predictors of the choice of echinocandins or azoles in IAC episodes. Secondary analysis was performed of a multinational retrospective cohort at 13 teaching hospitals in four countries (Italy, Greece, Spain and Brazil), over a 3-year period (2011-2013). IAC was identified in 481 patients, 323 of whom received antifungal therapy (classified as the treatment group). After excluding 13 patients given amphotericin B, the treatment group was further divided into the echinocandin group (209 patients; 64.7%) and the azole group (101 patients; 32.3%). Median APACHE II scores were significantly higher in the echinocandin group (p 0.013), but IAT did not differ significantly with regard to the Candida species involved. Logistic multivariate stepwise regression analysis, adjusted for centre effect, identified septic shock (adjusted OR (aOR) 1.54), APACHE II >15 (aOR 1.16) and presence in surgical ward at diagnosis (aOR 1.16) as the top three independent variables associated with an empirical echinocandin regimen. No differences in 30-day mortality were observed between groups. Echinocandin regimen was the first choice for IAT in patients with IAC. No statistical differences in mortality were observed between regimens, but echinocandins were administered to patients with more severe disease. Some disagreements were identified between current clinical guidelines and prescription of antifungals for IAC at the bedside, so further educational measures are required to optimize therapies.

Epidemiology of invasive respiratory disease caused by emerging non-Aspergillus molds in lung transplant recipients.

OBJECTIVES: Our aim was to assess the impact of positive cultures for non-Aspergillus molds on the risk of progression to invasive fungal infection (IFI), and the effect of prophylactic nebulized liposomal amphotericin B (n-LAB) on these pathogens. METHODS: This was an observational study (2003-2013) including lung transplant recipients (LTR) receiving lifetime n-LAB prophylaxis, in whom non-Aspergillus molds were isolated on respiratory culture before and after transplantation (minimum 1-year follow-up). RESULTS: We studied 412 patients, with a mean postoperative follow-up of 2.56 years (interquartile range 1.01-4.65). Pre- and post-transplantation respiratory samples were frequently positive for non-Aspergillus molds (11.9% and 16.9% of LTR respectively). Post transplantation, 10 (2.42%) patients developed non-Aspergillus mold infection (4 Scedosporium species, 4 Purpureocillium species, 1 Penicillium species, and 1 Scopulariopsis species); 5 (1.21%) had IFI, with 60% IFI-related mortality. Non-Aspergillus molds with intrinsic amphotericin B (AB) resistance were more commonly isolated in bronchoscopy samples than AB-variably sensitive or AB-sensitive molds (54.5% vs. 25%, P = 0.04) and were associated with a higher risk of infection (56.3% vs. 1.3%%, P < 0.01). CONCLUSIONS: In LTR undergoing n-LAB prophylaxis, pre- and post-transplantation isolation of non-Aspergillus molds is frequent, but IFI incidence (1.21%) is low. Purpureocillium is an emerging mold. AB-resistant non-Aspergillus species were found more often in bronchoscopy samples and were associated with a higher risk of infection.

Classifying honeys from the Soria Province of Spain via multivariate analysis.

A total of 73 different honeys from seven botanical origins [ling (Calluna vulgaris L.), heather (Erica sp.), rosemary (Rosmarinus officinalis L.), thyme (Thymus vulgaris L.), honeydew (Quercus sp.), spike lavender (Lavandula latifolia M.) and french lavender (Lavandula stoechas L.)] have been classified by applying discriminant analysis to their metal content data and other common physicochemical parameters. Fifteen minerals were identified and quantified using atomic emission spectroscopy (AES) for K and Na, and inductively coupled plasma atomic emission spectrometry (ICP-AES) for Mg, Ca, Al, Fe, Mn, Zn, B, Cu, Co, Cr, Ni, Cd and Pb. Moreover, eight physicochemical parameters were analysed following the Harmonised Methods of the International Honey Commision: ash content, moisture, insoluble matter, reducing sugars, apparent sucrose, diastase activity, free acidity and hydroxymethylfurfural. The honeys analysed were characterised and distinguished using chemometrics. ANOVA highlighted significant differences between the honeys in terms of the mean contents of all variables except apparent sucrose, HMF, Fe and Zn. Principal component analysis was used as a descriptive tool to visualise the data structure in two dimensions, finding relationships between variables and types of honey. Likewise, discriminant analysis, together with various methods (stepwise, forward and backward), was used to select the variables with the highest discriminating power, which allowed us to classify all of the botanical origins considered in this work, achieving a global success rate close to 90% following cross-validation.

[Ureaplasma urealyticum and pertussis-like syndrome]. / Ureaplasma urealyticum y síndrome pertusoide.

BACKGROUND: Ureaplasma urealyticum is associated with respiratory pathology in the neonates and preterm neonates. However, this association has been poorly studied in infants and during early infancy. To address this issue, a clinic evaluation of patients with whooping cough and isolation of U. urealyticum in their nasopharyngeal aspirates has been done. METHODS: Over a period of 11 years, 1063 nasopharyngeal aspirates from 905 infants were studied. Clinical samples were cultured for Bordetella spp., other bacteria, viruses and mycoplasma. Data of patients with positive cultures for U. urealyticum were obtained from clinical records. RESULT: U. urealyticum was isolated from 26 patients with a median age of 5 months (range: 23 days-22 months). The gestational age of 9 patients (34.6%) was less than 37 weeks. All the patients were hospitalised because of pertussis-like syndrome, which was associated with respiratory distress due to bronchospasm in 18 patients (69.2%). Twelve patients (46.1%) had fever and 15 (57.7%) showed lymphocytosis. The chest roentgenogram was abnormal in 18 patients (69.2%): pulmonary hyperaeration, with or without atelectasis. Clinical evolution was good in all patients. In 16 patients (61.5%) U. urealyticum was isolated together with other microorganisms: in 9 samples with bacteria (H. influenzae, S. pneumoniae, B. pertussis, M. catarrhalis), in 5 with viruses (respiratory syncytial virus, cytomegalovirus, adenovirus, enterovirus) and in 2 samples with respiratory syncytial virus and S. pneumoniae and B. pertussis respectively. CONCLUSIONS: Likely U. urealyticum cannot be considered clearly as the etiologic agent of whooping cough, mainly because in the 61.5% of patients U. urealyticum has been isolated together with other microorganisms considered pathogens or potentially pathogens. Future studies would be necessary in order to establish the pathogenic role of U. urealyticum after the neonatal period.