Terapia fotodinámica con azul de metileno en úlceras cutáneas infectadas con Pseudomonas aeruginosa y Fusarium spp / Photodynamic Therapy With Methylene Blue for Skin Ulcers Infected With Pseudomonas aeruginosa and Fusarium spp

La terapia fotodinámica tiene una importante acción antimicrobiana. Se presentan 2 casos clínicos de úlceras crónicas en las extremidades inferiores sobreinfectadas por hongos y bacterias de difícil manejo, en los que el tratamiento fotodinámico con azul de metileno como fotosensibilizante resultó en la curación clínica y microbiológica. No se presentaron efectos adversos reseñables. La posibilidad de utilizar la terapia fotodinámica con azul de metileno en el manejo de las úlceras crónicas sobreinfectadas constituye una interesante alternativa para reducir el uso de antibióticos y disminuir la aparición de resistencias (AU)

Photodynamic therapy (PDT) is a therapeutic modality with significant antimicrobial activity. We present 2 cases of chronic lower limb ulcers in which fungal and bacterial superinfection complicated management. PDT with methylene blue as the photosensitizer led to clinical and microbiological cure with no significant adverse effects. PDT with methylene blue is a valid option for the management of superinfected chronic ulcers, reducing the use of antibiotics and the induction of resistance (AU)

Photodynamic Therapy With Methylene Blue for Skin Ulcers Infected With Pseudomonas aeruginosa and Fusarium spp. / Terapia fotodinámica con azul de metileno en úlceras cutáneas infectadas con Pseudomonas aeruginosa y Fusarium spp.

Photodynamic therapy (PDT) is a therapeutic modality with significant antimicrobial activity. We present 2 cases of chronic lower limb ulcers in which fungal and bacterial superinfection complicated management. PDT with methylene blue as the photosensitizer led to clinical and microbiological cure with no significant adverse effects. PDT with methylene blue is a valid option for the management of superinfected chronic ulcers, reducing the use of antibiotics and the induction of resistance.

Características diferenciales en las bacteriemias según la edad en un hospital comunitario / Differential characteristics of bacteraemias according to age in a community hospital

Objetivo. Describir las características de las bacteriemias, según la edad, en un hospital comunitario. Material y método. Estudio prospectivo de las bacteriemias en el año 2011. Los pacientes se clasificaron en 3 grupos de edad: menos de 65, de 65 a 79 y 80 o más años. Se recogieron variables de los pacientes y de los episodios. Resultados. Se analizaron 233 bacteriemias en 227 pacientes (23,8% en<65; 38,3% entre 65 y 79; y 37,9% en≥80 años). La enfermedad de base más frecuente en todos los grupos fue la diabetes mellitus. En los pacientes muy ancianos el índice de Charlson fue mayor, hubo una menor proporción de factores exógenos y casi un 25% eran dependientes graves (índice de Barthel<20). Escherichia coli fue el germen más frecuente y el foco principal fue el urológico. En los pacientes≥80 años predominó el origen de la infección asociado a cuidados sanitarios, la expresividad clínica menos grave (sepsis) (66,3%) y la mortalidad más elevada (29,1%), respecto a los de menor edad. Conclusiones. Los pacientes muy ancianos con bacteriemia presentaron menos factores exógenos, más comorbilidad y una situación funcional peor; el foco más frecuente fue el urológico y el origen el asociado a cuidados sanitarios. A pesar de que su presentación clínica fue menos grave, su mortalidad fue superior, siendo el grado de dependencia una variable de riesgo independiente muy relevante (AU)

Objective. To describe the characteristics of bacteraemias, according to age, in a community hospital. Material and method. A prospective study of bacteraemias was conducted in 2011. The patients were classified into 3 age groups: younger than 65 years, 65 to 79, and 80 or older. The study collected variables on the patients and episodes. Results. The study analysed 233 bacteraemias in 227 patients (23.8% in those younger than 65 years; 38.3% in the 65 to 79 age group; and 37.9% in the 80 years or older group). The most common underlying disease in all the groups was diabetes mellitus. In the most elderly patients, the Charlson index was highest, there was a lower proportion of exogenous factors, and almost 25% were severely dependent (Barthel index<20). Escherichia coli was the most common germ, and the main focus was urological. The patients aged 80 years or older had predominantly healthcare-associated infections, less severe symptoms (sepsis) (66.3%) and higher mortality (29.1%) compared with the younger patients. Conclusions. The very elderly patients with bacteraemia presented fewer exogenous factors, greater comorbidity and a poorer functional situation. The most common focus was urological and the origin was healthcare related. Despite their less severe clinical presentation, these patients’ mortality was greater, and their degree of dependence was a highly relevant independent risk factor (AU)

Methyl aminolevulinate photodynamic therapy for onychomycosis: a multicentre, randomized, controlled clinical trial.

BACKGROUND: Onychomycosis is a common fungal nail infection that responds poorly to antifungals. OBJECTIVE: To investigate the efficacy and safety of methyl aminolevulinate (MAL) photodynamic therapy (PDT) in the treatment of onychomycosis. METHODS: A multicentre (3), randomized, placebo-controlled clinical trial compared the effects of three sessions of urea (40%) plus conventional MAL-PDT with urea (40%) plus placebo (red light) photodynamic therapy (pPDT) in onychomycosis patients. Efficacy, both clinical (onychomycosis severity index, OSI) and microbiological, was blindly evaluated after 36 weeks of follow-up. RESULTS: Forty patients were analysed in the trial. Twenty-two received MAL-PDT and 18 pPDT. A complete response (OSI = 0) was observed for four patients (18.18%) in the MAL-PDT group and one (5.56%) in the pPDT group (NTT 7.92, 95% CI: 2.98-9.69, P = 0.23). A decrease in OSI score of over 75% (OSI75) was achieved by 40.91% of the patients in the MAL-PDT group and 16.67% in the pPDT group (P = 0.096). Microbiological cure was achieved by seven patients (31.82%) in the MAL-PDT group and two (11.11%) in the pPDT group (P = 0.178). MAL-PDT resulted in better rates of clinical response [OSI >75%: 53.85% vs. 18.75% (P =0.048)] and microbiological cure [41.56% vs. 7.14% (P = 0.037)] in non-dystrophic vs. dystrophic onychomycosis patients. No significant side-effects were reported. The limitations of the study were the reduced sample size and the unexpected efficacy of the control treatment, which was attributed to the 40% urea pre-treatment. CONCLUSION: This study did not show significant differences between urea 40% + MAL-PDT and urea 40% + pPDT in the treatment of onychomycosis. However, some results suggest that this treatment may constitute an alternative for dermatophyte and non-dermatophyte mould onychomycosis in patients not eligible for systemic treatment, particularly in the absence of total nail dystrophy.

Differential characteristics of bacteraemias according to age in a community hospital. / Características diferenciales en las bacteriemias según la edad en un hospital comunitario.

OBJECTIVE: To describe the characteristics of bacteraemias, according to age, in a community hospital. MATERIAL AND METHOD: A prospective study of bacteraemias was conducted in 2011. The patients were classified into 3 age groups: younger than 65 years, 65 to 79, and 80 or older. The study collected variables on the patients and episodes. RESULTS: The study analysed 233 bacteraemias in 227 patients (23.8% in those younger than 65 years; 38.3% in the 65 to 79 age group; and 37.9% in the 80 years or older group). The most common underlying disease in all the groups was diabetes mellitus. In the most elderly patients, the Charlson index was highest, there was a lower proportion of exogenous factors, and almost 25% were severely dependent (Barthel index<20). Escherichia coli was the most common germ, and the main focus was urological. The patients aged 80 years or older had predominantly healthcare-associated infections, less severe symptoms (sepsis) (66.3%) and higher mortality (29.1%) compared with the younger patients. CONCLUSIONS: The very elderly patients with bacteraemia presented fewer exogenous factors, greater comorbidity and a poorer functional situation. The most common focus was urological and the origin was healthcare related. Despite their less severe clinical presentation, these patients' mortality was greater, and their degree of dependence was a highly relevant independent risk factor.

Interacción de Pseudomonas aeruginosa y hongos dermatofitos: repercusión en el curso clínico y en el diagnóstico microbiológico de la tinea pedis / Interaction between Pseudomonas aeruginosa and dermatophyte fungi: Repercussions on the clinical course and microbiological diagnosis of tinea pedis

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Utilidad de la terapia fotodinámica en el manejo de la onicomicosis / Usefulness of Photodynamic Therapy in the Management of Onychomycosis

La onicomicosis, o infección fúngica de las uñas, constituye una de las enfermedades micóticas más prevalentes en la población. Su tratamiento tiene una efectividad limitada, además de ser largo y tedioso y, en el caso de los antifúngicos sistémicos, no está exento de efectos adversos. La terapia fotodinámica (TFD) podría ser una buena alternativa para las infecciones cutáneas superficiales, entre ellas la onicomicosis. El presente artículo revisa la experiencia publicada, tanto in vitro como in vivo, acerca de la utilidad de la TFD en las onicomicosis, mostrando el potencial de diversos fotosensibilizantes, así como sus limitaciones. Desde el punto de vista clínico el azul de metileno y el ácido 5-aminolevulínico muestran tasas de curación del 80% y el 43% respectivamente al año de seguimiento. Finalmente, basado en la bibliografía y en la propia experiencia, se propone un protocolo de 3 sesiones de TFD, usando metil-aminolevulinato 16% como fotosensibilizante y luz roja (lambda = 630 nm, 37J.cm−2), separadas por 1 o 2 semanas. Estas irán precedidas de la aplicación de urea 40% durante unos días. Nuevos ensayos clínicos deben optimizar los protocolos y establecer qué pacientes se benefician especialmente de recibir este tratamiento

Onychomycosis, or fungal infection of the nails, is one of the most prevalent fungal diseases in the general population. Treatment is of limited effectiveness, tedious, and must be administered for long periods. Furthermore, systemic antifungal agents are associated with adverse effects. Photodynamic therapy (PDT) may prove to be a viable alternative in the treatment of superficial skin infections, including onychomycosis. We review articles relating to the usefulness of PDT in onychomycosis in both in vitro and in vivo settings and discuss the potential and limitations of various photosensitizing agents. In vivo, methylene blue and 5-aminolevulinic acid have led to cure rates in 80% and 43% of cases, respectively, at 12 months. Finally, based on data in the literature and our own experience, we propose a protocol of 3 PDT sessions, separated by an interval of 1 or 2 weeks, using methyl aminolevulinate 16% as a photosensitizing agent and red light (Lambda = 630 nm, 37J.cm -2). Each session is preceded by the topical application of urea 40% over several days. Clinical trials are needed to optimize PDT protocols and to identify those patients who will benefit most from this treatment

Usefulness of Photodynamic Therapy in the Management of Onychomycosis.

Onychomycosis, or fungal infection of the nails, is one of the most prevalent fungal diseases in the general population. Treatment is of limited effectiveness, tedious, and must be administered for long periods. Furthermore, systemic antifungal agents are associated with adverse effects. Photodynamic therapy (PDT) may prove to be a viable alternative in the treatment of superficial skin infections, including onychomycosis. We review articles relating to the usefulness of PDT in onychomycosis in both in vitro and in vivo settings and discuss the potential and limitations of various photosensitizing agents. In vivo, methylene blue and 5-aminolevulinic acid have led to cure rates in 80% and 43% of cases, respectively, at 12 months. Finally, based on data in the literature and our own experience, we propose a protocol of 3 PDT sessions, separated by an interval of 1 or 2 weeks, using methyl aminolevulinate 16% as a photosensitizing agent and red light (λ=630 nm, 37 J.cm(-2)). Each session is preceded by the topical application of urea 40% over several days. Clinical trials are needed to optimize PDT protocols and to identify those patients who will benefit most from this treatment.

Malassezia growth on peritumoral skin after routine methyl-5-aminolevulinate photodynamic therapy for actinic keratosis and nonmelanoma skin cancer / Crecimiento de Malassezia en Piel Peritumoral Tras Terapia Fotodinámica con Metil-5-aminolevulinato para Queratosis Actínica y Cáncer de Piel No Melanoma

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Photodynamic fungicidal efficacy of hypericin and dimethyl methylene blue against azole-resistant Candida albicans strains.

Antimicrobial photodynamic therapy (aPDT) is an emerging alternative to treat infections based on the use of photosensitisers (PSs) and visible light. To investigate the fungicidal effect of PDT against azole-resistant Candida albicans strains using two PSs with a different mechanism of action, hypericin (HYP) and 1,9-dimethyl methylene blue (DMMB), comparing their efficacy and the reactive oxygen species (ROS) species involved in their cytotoxicity. Azole-resistant and the azole-susceptible C. albicans strains were used. Solutions of 0.5 and 4 McFarland inoculum of each Candida strain were treated with different concentrations of each PS, and exposed to two light-emitting diode light fluences (18 and 37 J cm⁻²). Mechanistic insight was gained using several ROS quenchers. The minimal fungicidal concentration of HYP for ≥3 log10 CFU reduction (0.5 McFarland) was 0.62 µmol l⁻¹ for most strains, whereas for DMMB it ranged between 1.25 and 2.5 µmol l⁻¹. Increasing the fluence to 37 J cm⁻² allowed to reduce the DMMB concentration. Higher concentrations of both PSs were required to reach a 6 log10 reduction (4 McFarland). H2O2 was the main phototoxic species involved in the fungicidal effect of HYP-aPDT whereas ¹O2 was more important for DMMB-based treatments. aPDT with either HYP or DMMB is effective in killing of C. albicans strains independent of their azole resistance pattern. HYP was more efficient at low fungal concentration and DMMB at higher concentrations.

La terapia fotodinámica con metilaminolevulinato puede ser útil en el manejo de las infecciones por Scytalidium / Photodynamic Therapy With Methyl-aminolevulinate can be Useful in the Management of Scytalidium Infections

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Meningitis caused by an unusual genotype (ST3) of Streptococcus suis.

We describe a case of meningitis due to Streptococcus suis with the unusual ST3 genotype. The bacterial pathogen was isolated from blood samples. S. suis genotype ST3 was initially isolated from carrier pigs, but it has not been previously associated with invasive human infections. The patient developed serious endogenous bilateral endophthalmitis which resulted in severe visual deficiency.

Detection and characterization of a ST6 clone of vanB2-Enterococcus faecalis from three different hospitals in Spain.

Thirteen vancomycin-resistant and teicoplanin-susceptible Enterococcus faecalis isolates were recovered from unrelated patients in three Spanish hospitals from November 2009 to December 2010. All isolates carried the vanB2 gene, showed indistinguishable or closely-related PFGE patterns and were ascribed to the sequence type ST6 (included into the high-risk clonal-complex CC2). They showed a multiresistance phenotype (erythromycin, tetracycline, ciprofloxacin and high-level-resistance to streptomycin, gentamicin and kanamycin) and harboured the aac(6')-aph(2"), ant(6)-Ia, and tet(M)+/-tet(L) genes. All isolates produced gelatinase and harboured the gelE gene, but not the esp or hyl genes. The inclusion of the vanB2 gene into the Tn5382 transposon was demonstrated in one isolate. Clonal dissemination of vanB2-containing the E. faecalis strain is demonstrated.

Methicillin-resistant Staphylococcus aureus (MRSA) ST398 in a farmer with skin lesions and in pigs of his farm: clonal relationship and detection of lnu(A) gene.

Skin infection associated with methicillin-resistant Staphylococcus aureus (MRSA)-ST398 was detected in a pig-farmer, and MRSA-ST398 isolates were also detected in nasal samples of the patient and of 11/12 pigs on his farm. Twelve MRSA isolates were obtained from skin lesions (n = 6) and nasal samples (n = 6) of the patient in two sampling moments and 11 MRSA isolates from nasal samples of pigs. They were typed as t011-SCCmecIVa-agrI and t108-SCCmecV-agrI (patient and pigs) and t588-SCCmecV-agrI (patient). The following resistance genes were detected (number isolates): tet(K) (1), tet(L) (23), tet(M) (13), erm(A) (13), erm(C) (13), msr(A) (11), lnu(A) (21), aph(2'')-acc(6') (3), ant(4') (13), aph(3') (12), dfrS1 (15) and dfrK (22). Seventeen human and animal MRSA-ST398 isolates showed indistinguishable PFGE patterns (A1-spa-t011 or B2-spa-t108) and similar phenotypic-genotypic characteristics, including the presence of the lnu(A) gene, associated with lincomycin resistance. Potential pig-to-human transference of ST398 is suggested in this study. The first detection of the lnu(A) gene in MRSA-ST398 is reported.

Alternariosis cutánea múltiple en un paciente receptor de trasplante cardiaco / Cutaneous alternariosis in a heart transplant recipient

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