Identification of Differentially Expressed Genes in Nocardia brasiliensis Induced by Progesterone and Dihydrotestosterone Using Differential Display PCR.

Sex steroid hormones have an important physiological role in humans. They can also affect the gene expression of many organisms, including bacteria. In Mexico, Nocardia brasiliensis is the main causative agent of actinomycetoma, a granulomatous disease more frequent in men than women, which is thought to be related to a higher occupational risk in men. Therefore, it has been suggested that differences in clinical presentation could be related to sex steroid hormone levels. Attempting to explain the differences in actinomycetoma prevalence between men and women, in this work, the effect of progesterone and dihydrotestosterone on the genetic expression of N. brasiliensis was investigated using a differential display polymerase chain reaction assay. The results showed that both hormones affected the expression of genes encoding proteins related to central metabolism and hypothetical proteins with unknown functions. This study also demonstrated the utility of differential display in this modern era and provided a first approach to the effect of sex hormones on N. brasiliensis gene expression.

Esophageal candidiasis in patients from a specialty hospital / Candidiasis esofágica en pacientes de un hospital de especialidades

Background: Esophageal candidiasis (EC) is the most common cause of infectious esophagitis. So far, its main risk factor has been HIV infection; in recent years, EC has been favoured by the increasing of diabetes mellitus, wide-spread use of acid-lowering agents, broad-spectrum antibiotics, and inhaled steroids. In Mexico EC has been poorly studied. Objectives: To determine the clinical and epidemiological characteristics of EC, and to identify its etiological agents as well as its antifungal susceptibility. Methods: Patients who revealed the presence of scattered white spots through an upper gastrointestinal system endoscopy, in a period of one year, in a tertiary care hospital, were included. Samples from patches were collected for microscopic examination, culture, and susceptibility tests. Results: Out of 1763 patients studied, 23 had scattered white spots, and most of them presented Kodsi grade I; 13 were men; half of the patients were between the ages 20 to 40; main comorbidity was liver cirrhosis; use of omeprazole was significant. 22 isolates were obtained from 17 patients. The most frequent species were C. albicans (14) and C. parapsilosis (3). In five cases we found a two-species association v. g. Candida famata with Trichosporon mucoides. Half of the isolates showed resistance to one or several antifungal drugs. Conclusions: EC frequency in this study was similar to other studies' results. Obtained isolates showed high resistance to azolic compounds and to caspofungin, which is relevant information to take a therapeutic decision.

Introducción: la candidiasis esofágica (CE) es la causa más común de esofagitis infecciosa. Su principal factor de riesgo ha sido la infección por VIH. En México ha sido poco estudiada. Objetivos: determinar las características clínico-epidemiológicas de la CE e identificar sus agentes etiológicos y su sensibilidad a antifúngicos. Métodos: se incluyeron pacientes a quienes se les detectaron placas blanquecinas durante una endoscopía esofágica, en un periodo de un año, en un hospital de tercer nivel de atención. Se tomó muestra de las placas para examen microscópico, cultivo, y estudios de sensibilidad. Resultados: de 1763 pacientes estudiados, 23 presentaron placas blanquecinas; 13 fueron hombres; la mitad tenía de 20 a 40 años de edad; la principal comorbilidad fue cirrosis hepática; el uso de omeprazol fue significativo. Se obtuvieron 22 aislados de 17 pacientes; predominaron Candida albicans (14) y Candida parapsilosis (3). En cinco casos se encontró asociación de dos especies v. g. Candida famata con Trichosporon mucoides. La mitad de los aislados mostró resistencia a antimicóticos. Conclusiones: la frecuencia de CE fue similar a la de otras casuísticas. Los aislados obtenidos mostraron resistencia elevada a compuestos azólicos y a caspofungina, información relevante para tomar una decisión terapéutica.

Single-tube, dual channel pentaplexing for the identification of Candida strains associated with human infection.

Invasive candidiasis is one of the most common nosocomial fungal infections worldwide. Delayed implementation of effective antifungal treatment caused by inefficient Candida diagnosis contributes to its notoriously high mortality rates. The availability of better Candida diagnostic tools would positively impact patient outcomes. Here, we report on the development of a single-tube, dual channel pentaplex molecular diagnostic assay based on Multiplex Probe Amplification (MPA) technology. It allows simultaneous identification of C. auris, C. glabrata and C. krusei, at species-level as well as of six additional albicans and non-albicans pathogenic Candida at genus level. The assay overcomes the one-channel one-biomarker limitation of qPCR-based assays. Assay specificities are conferred by unique biomarker probe pairs with characteristic melting temperatures; post-amplification melting curve analysis allows simple identification of the infectious agent. Alerting for the presence of C. auris, the well-characterised multi-drug resistant outbreak strain, will facilitate informed therapy decisions and aid antifungal stewardship. The MPA-Candida assay can also be coupled to a pan-Fungal assay when differentiation between fungal and bacterial infections might be desirable. Its multiplexing capacity, detection range, specificity and sensitivity suggest the potential use of this novel MPA-Candida assay in clinical diagnosis and in the control and management of hospital outbreaks.

Esporotricosis: la micosis subcutánea más frecuente en México / Sporotrichosis: the most frequent subcutaneous mycosis in Mexico

Resumen La esporotricosis es una micosis causada por especies del complejo Sporothrix schenckii. Basado en estudios epidemiológicos y moleculares. Se reconocen seis especies de Sporothrix como causantes de la esporotricosis humana. Algunas especies de este complejo, tienen un potencial zoonótico relevante para la transmisión al humano, y muchas otras son exclusivamente fitopatógenas. Es considerada la micosis subcutánea más frecuente en México. El principal mecanismo de infección es el traumatismo con pérdida de continuidad de la piel seguido por la contaminación con el hongo Sporothrix spp. Las principales formas clínicas son la esporotricosis linfangítica, la forma cutánea fija y la forma diseminada. Los procedimientos de laboratorio más útiles para confirmar el diagnóstico, son el cultivo de especímenes como exudado y tejido, así como el estudio histopatológico. La forma parasitaria está representada por levaduras en el tejido o exudados. Los medicamentos más útiles en el tratamiento son el yoduro de potasio y el itraconazol. La prevención es difícil; sin embargo, el uso de equipo protector durante las actividades laborales puede contribuir a evitar este padecimiento.

Abstract Sporotrichosis is a mycosis caused by fungal species that are part of the Sporothrix schenckii complex. Epidemiological and molecular studies have found only six species of the Sporothrix schenckii complex that cause infections in humans. Some species of this complex have a relevant zoonotic potential for transmission to humans, and some others only have phytopathogenic properties. It is considered the most frequent form of subcutaneous mycosis in Mexico. The main mechanism of infection a wound with loss of continuity of the skin followed by contamination with the fungus Sporothrix spp. The main clinical manifestations are lymphangitic sporotrichosis, fixed skin manifestation and disseminated manifestation. The most useful laboratory procedures to confirm the diagnosis are the cultivation of specimens such as exudate and tissue, as well as the histopathological study. The parasitic manifestation is represented by yeasts in the tissue or exudates. The most useful medications for its treatment are potassium iodide and itraconazole. Prevention is difficult; however, the use of protective equipment during work activities can help prevent this condition.

Detección y genotipificación de Pneumocystis jirovecii en muestras de pacientes mexicanos VIH positivos y negativos.

INTRODUCTION: Pneumocystis jirovecii is an atypical fungus particularly detected in HIV-positive or transplant patients. OBJECTIVE: To detect and genotype Pneumocystis jirovecii in patient samples from two hospitals in Mexico City. METHOD: Eighty-nine respiratory tract samples, corresponding to 53 patients (30 HIV-positive and 23 HIV-negative) with respiratory symptoms and to 11 healthy individuals included as negative control, were processed. DNA was extracted from the ITS region and amplified by nested polymerase chain reaction from the internal transcribed spacer, with one fragment being obtained at each round (693 and 550 bp). Genotypes and their phylogenetic relationship were determined by sequencing the 550 bp fragment. RESULTS: Forty-eight samples from 30 HIV-positive patients were received from a single hospital, out of which 11 (36.6 %) were positive for Pneumocystis jirovecii. No sample was positive in HIV-negative patients or healthy subjects. The most frequently detected haplotypes were Eg and Em. CONCLUSIONS: The frequency of Pneumocystis jirovecii infection was high in the studied Mexican population. The most common genotype was different from those reported in other countries. It is necessary to address this health problem through early detection of this infection.

INTRODUCCIÓN: Pneumocystis jirovecii es un hongo atípico detectado particularmente en pacientes VIH-positivos o con trasplante. OBJETIVO: Detectar y genotipificar Pneumocystis jirovecii en muestras de pacientes de dos hospitales de la ciudad de México. MÉTODO: Fueron procesadas 89 muestras respiratorias, correspondientes a 53 pacientes (30 VIH positivos y 23 VIH negativos) con sintomatología respiratoria y 11 personas sanas incluidas como control negativo. El DNA fue extraído y amplificado por PCR anidada de la región del espaciador transcrito interno, obteniendo un fragmento en cada ronda (de 693 y 550 pb). Los genotipos y su relación filogenética fueron determinados por secuenciación del fragmento de 550 pb. RESULTADOS: Cuarenta y ocho muestras de 30 pacientes VIH-positivos provenían de un solo hospital, de las cuales 11 (36.6 %) fueron positivas a Pneumocystis jirovecii. Ninguna fue positiva en pacientes VIH-negativos o personas sanas. Los haplotipos detectados con mayor frecuencia fueron Eg y Em. CONCLUSIONES: La frecuencia de infección por Pneumocystis jirovecii fue alta en la población mexicana estudiada. El genotipo más frecuente fue diferente a los reportados en otros países. Es necesario encauzar este problema de salud hacia la detección temprana de esta infección.

Detección y genotipificación de Pneumocystis jirovecii en muestras de pacientes mexicanos VIH positivos y negativos / Detection and genotyping of Pneumocystis jirovecii in samples from HIV positive and negative Mexican patients

Resumen Introducción: Pneumocystis jirovecii es un hongo atípico detectado particularmente en pacientes VIH-positivos o con trasplante. Objetivo: Detectar y genotipificar Pneumocystis jirovecii en muestras de pacientes de dos hospitales de la ciudad de México. Método: Fueron procesadas 89 muestras respiratorias, correspondientes a 53 pacientes (30 VIH positivos y 23 VIH negativos) con sintomatología respiratoria y 11 personas sanas incluidas como control negativo. El DNA fue extraído y amplificado por PCR anidada de la región del espaciador transcrito interno, obteniendo un fragmento en cada ronda (de 693 y 550 pb). Los genotipos y su relación filogenética fueron determinados por secuenciación del fragmento de 550 pb. Resultados: Cuarenta y ocho muestras de 30 pacientes VIH-positivos provenían de un solo hospital, de las cuales 11 (36.6 %) fueron positivas a Pneumocystis jirovecii. Ninguna fue positiva en pacientes VIH-negativos o personas sanas. Los haplotipos detectados con mayor frecuencia fueron Eg y Em. Conclusiones: La frecuencia de infección por Pneumocystis jirovecii fue alta en la población mexicana estudiada. El genotipo más frecuente fue diferente a los reportados en otros países. Es necesario encauzar este problema de salud hacia la detección temprana de esta infección.

Abstract Introduction: Pneumocystis jirovecii is an atypical fungus particularly detected in HIV-positive or transplant patients. Objective: To detect and genotype Pneumocystis jirovecii in patient samples from two hospitals in Mexico City. Method: Eighty-nine respiratory tract samples, corresponding to 53 patients (30 HIV-positive and 23 HIV-negative) with respiratory symptoms and to 11 healthy individuals included as negative control, were processed. DNA was extracted from the ITS region and amplified by nested polymerase chain reaction from the internal transcribed spacer, with one fragment being obtained at each round (693 and 550 bp). Genotypes and their phylogenetic relationship were determined by sequencing the 550 bp fragment. Results: Forty-eight samples from 30 HIV-positive patients were received from a single hospital, out of which 11 (36.6 %) were positive for Pneumocystis jirovecii. No sample was positive in HIV-negative patients or healthy subjects. The most frequently detected haplotypes were Eg and Em. Conclusions: The frequency of Pneumocystis jirovecii infection was high in the studied Mexican population. The most common genotype was different from those reported in other countries. It is necessary to address this health problem through early detection of this infection.

First report of infectious endocarditis due to Histoplasma capsulatum in Mexico / Primer reporte de endocarditis infecciosa por Histoplasma capsulatum en México

Background: Infectious endocarditis of fungal origin is rare but of high mortality. The agents involved are mainly opportunists of the genus Candida and Aspergillus; however other fungi can also cause this disease. Clinical case: The case of a woman who suffered unknown origin intermittent fever for several months; and in who, by blood culture (after lysis-centrifugation) and molecular biology techniques, Histoplasma capsulatum was identified as etiological agent. The histological study showed abundant intracellular yeasts and hyphae in intracardiac vegetations. Conclusion: This first report of infectious endocarditis by H. capsulatum in Mexico highlights the importance of using in addition to manual blood culture (lysis-centrifugation) and histological study, faster and more sensitive diagnostic methods, such as serology and molecular biology, to confirm or rule out an invasive fungal infection and identify the agents.

Introducción: la endocarditis infecciosa de etiología micótica es una patología poco frecuente, pero con elevada mortalidad. Los agentes implicados generalmente son oportunistas de los géneros Candida y Aspergillus; sin embargo, otros hongos también pueden ocasionar la enfermedad. Caso clínico: se presenta el caso de una mujer quien cursó con fiebre intermitente de causa desconocida por varios meses y en la que, por medio de estudios de imagen, hemocultivo manual (después de lisis-centrifugación) y técnicas de biología molecular, se identificó Histoplasma capsulatum. El estudio histológico de las vegetaciones intracardiacas mostró abundantes levaduras e hifas. Conclusión: este primer reporte de endocarditis infecciosa por H. capsulatum en México pone en evidencia la importancia de utilizar, además del hemocultivo manual (lisis-centrifugación) y el estudio histológico, métodos de diagnóstico más rápidos y sensibles, como la serología y la biología molecular, para confirmar o descartar una infección fúngica invasiva e identificar los agentes.

First case of chromoblastomycosis due to Phoma insulan / Primer caso de cromoblastomicosis causado por Phoma insulan

Chromoblastomycosis is a chronic infection, caused by pigmented fungi affecting skin and subcutaneous tissues characterized by verrucous nodules or plaques. Fonsecaea pedrosoiand Cladophialophora carrionii are the prevalent agents in the endemic areas. Phoma is an uncommon agent of human infection and involved mainly with phaeohyphomycosis cases. The case of a patient with a history of laceration in foot followed by verrucous aspect and scaly lesions, which had evolved for 27 years is presented. On physical examination disease was clinically compatible with chromoblastomycosis and the microscopic examination of scales showed fumagoid cells. On culture a dematiaceous fungus was grown. The agent was confirmed to be Phoma insulana based on its morphology and PCR-sequencing. This fungal agent has not been previously reported in association with this pathology (AU)

La cromoblastomicosis es una infección crónica causada por hongos pigmentados que afecta la piel y el tejido subcutáneo y que se caracteriza por nódulos o placas verrugosas. Fonsecaea pedrosoi y Cladophialophora carrionii son los agentes prevalentes en las áreas endémicas. Phoma es un agente raro de infección humana y está involucrado principalmente en casos de feohifomicosis. Se presenta el caso de un paciente con antecedente de laceración en el pie, seguida de lesiones de aspecto verrugoso y descamativas, que evolucionaron durante 27años. En el examen físico la enfermedad fue clínicamente compatible con cromoblastomicosis y el examen microscópico de escamas mostró células fumagoides. En el cultivo creció un hongo dematiáceo. El agente fue confirmado como Phoma insulana en base a su morfología y PCR seguida de secuenciación. Este agente fúngico no ha sido reportado previamente en asociación con esta patología (AU)

First case of chromoblastomycosis due to Phoma insulana.

Chromoblastomycosis is a chronic infection, caused by pigmented fungi affecting skin and subcutaneous tissues characterized by verrucous nodules or plaques. Fonsecaea pedrosoi and Cladophialophora carrionii are the prevalent agents in the endemic areas. Phoma is an uncommon agent of human infection and involved mainly with phaeohyphomycosis cases. The case of a patient with a history of laceration in foot followed by verrucous aspect and scaly lesions, which had evolved for 27 years is presented. On physical examination disease was clinically compatible with chromoblastomycosis and the microscopic examination of scales showed fumagoid cells. On culture a dematiaceous fungus was grown. The agent was confirmed to be Phoma insulana based on its morphology and PCR-sequencing. This fungal agent has not been previously reported in association with this pathology.

Molecular detection of candida species from hospitalized patient's specimens. / Detección molecular de especies de Candida en especímenes de pacientes hospitalizados.

Objective: To identify the most frequent Candida species in specimens from patients hospitalized in different medical centers of Mexico City, with suspected fungal infection. Methods: Specimens were grown on Sabouraud dextrose agar at 28°C for 72 h. In addition, DNA was extracted. Isolates were grown on CHROMagar Candida™, at 37°C for 48 h. The molecular identification was performed by polymerase chain reaction (PCR) using primers specific for four species. Results: Eighty one specimens were processed and included: bronchial lavage, pleural, cerebrospinal, peritoneal, ascites and bile fluids; blood, sputum, bone marrow, oro-tracheal cannula and ganglion. By culture, 30 samples (37%) were positive, and by PCR, 41 (50.6%). By PCR, the frequency of species was: Candida albicans 82.9%, Candida tropicalis 31.7%, Candida glabrata 24.4%, and Candida parapsilosis 4.9%. In 34.1% of specimens a species mixture was detected suggesting a co-infection: Two species in five specimens (C. albicans-C tropicalis and C. albicans-C glabrata), and three species in three specimens (C. albicans-C. glabrata-C. tropicalis). Conclusions: The PCR is an useful tool for detection the most common Candida species causing infection in hospitalized patients, it avoids the requirement of culture weather we start from clinical specimen and it favors the early diagnosis of invasive candidiasis.

Non-Coding RNAs are Differentially Expressed by Nocardia brasiliensis in Vitro and in Experimental Actinomycetoma.

INTRODUCTION: Nocardia spp. are common soil-inhabiting bacteria that frequently infect humans through traumatic injuries or inhalation routes and cause infections, such as actinomycetoma and nocardiosis, respectively. Nocardia brasiliensis is the main aetiological agent of actinomycetoma in various countries. Many bacterial non-coding RNAs are regulators of genes associated with virulence factors. OBJECTIVE: The aim of this work was to identify non-coding RNAs (ncRNAs) expressed during infection conditions and in free-living form (in vitro) in Nocardia brasiliensis. METHODS AND RESULT: The N. brasiliensis transcriptome (predominately < 200 nucleotides) was determined by RNA next-generation sequencing in both conditions. A total of seventy ncRNAs were identified in both conditions. Among these ncRNAs, 18 were differentially expressed, 12 were located within intergenic regions, and 2 were encoded as antisense of 2 different genes. Finally, 10 of these ncRNAs were studied by rapid amplification of cDNA ends and/or quantitative reverse transcription polymerase chain reaction. Interestingly, 3 transcripts corresponded to tRNA-derived fragments (tRNAsCys, Met, Thr), and one transcript was overlapped between an intergenic region and the 5´end of the 23S rRNA. Expression of these last four transcripts was increased during N. brasiliensis infection compared with the in vitro conditions. CONCLUSION: The results of this work suggest a possible role for these transcripts in the regulation of virulence genes in actinomycetoma pathogenesis.

[Frequency of invasive fungal infections in a Mexican High-Specialty Hospital. Experience of 21 years]. / Frecuencia de micosis invasivas en un hospital mexicano de alta especialidad. Experiencia de 21 años.

BACKGROUND: Factors such as cancer, HIV infection, use of corticosteroids and antibiotics, favors the increase in the number of invasive fungal infections (IFI) worldwide. METHODS: To determine the frequency and epidemiological aspects of IFI at a mexican, a review of the proven cases diagnosed over the past 21 years (1993-2013) in the Laboratory of Medical Mycology was performed. RESULTS: A total of 472 cases were identified as: 261 candidiasis, 82 mucormycosis, 60 cryptococcosis, 43 aspergillosis and 16 histoplasmosis. A decrease in the frequency of candidiasis was observed, with 74 cases in the first 6 years and 48 in the last five. C. albicans was the most common agent and pulmonary infection the most prevalent. Cryptococcosis also declined from 24 to 10 cases, mainly caused by C. neoformans; two cases of C. laurentii and C. terreus and C unigutulatus were isolated once. Mucormycosis remained steady, but aspergillosis increased significantly, and from 2 cases found in the first studied period, it rose to 23 in the last one. CONCLUSIONS: It is important that High Specialty Hospitals have well-equipped laboratories of Medical Mycology. We suggest the creation of a National Reference Center for Mycoses to collect all the data of these infections, in order to help to the development of strategies for health education, prevention, diagnosis and treatment of them.

Introducción: Factores como el cáncer, la infección por VIH, así como el uso de esteroides y antibióticos, incrementan el número de micosis invasivas (MI). Métodos: Para conocer la frecuencia y algunos aspectos epidemiológicos de las MI en un hospital del IMSS, se revisaron los casos probados diagnosticados en los últimos 21 años (1993-2013) en el Laboratorio de Micología Médica. Resultados: Se identificaron 472 casos, distribuidos en: 261 candidosis, 82 mucormicosis, 60 criptococosis, 43 aspergilosis y 16 histoplasmosis. La candidosis disminuyó de 74 casos en los primeros 6 años, a 48 en los cinco últimos. La localización principal fue pulmonar y el principal agente fue C. albicans. La criptococosis también disminuyó de 24 a 10 casos, principalmente fue causada por C. neoformans, aunque hubo dos casos de C. laurentii, uno de C. terreus y uno de C. unigutulatus. La mucormicosis se mantuvo constante, pero la aspergilosis se incrementó pasando de 2 casos en el primer periodo a 23 en el último. Conclusiones: Es importante que los hospitales de alta especialidad, cuenten con laboratorios de micología médica para realizar el diagnóstico de MI. Se sugiere crear un Centro Nacional de Referencia de Micosis donde se concentren los datos de estas infecciones y contribuya en la elaboración de planes de educación para la salud, prevención, diagnóstico y tratamiento de las mismas.

Endophthalmitis of probable endogenous origin caused by Scedosporium boydii: a case report / Endoftalmitis de probable origen endógeno causada por Scedosporium boydii. Informe de un caso

Background. Mycotic ocular infections caused by the Scedosporium apiospermum species complex are challenging to treat because of the delayed diagnoses and poor responses to antifungal drugs and surgical treatment. Case report. A case of a 69-year-old male patient with a history of diabetes mellitus type 2 and prior surgery on the right femur is described. In the 10 days prior to the ophthalmic consultation he started with ocular pain, adding to a previous and progressive loss of visual acuity in his right eye. The diagnosis of endophthalmitis of probable endogenous origin was established. Despite medical treatment, the patient's condition worsened and, due to the imminent risks, an enucleation was performed. Smears of the enucleation tissue revealed fungal cells, and the cultures yielded a fungus belonging to the S. apiospermum species complex, which was identified as Scedosporium boydii by morphological characteristics and sequencing of a PCR amplicon. Conclusions. A diagnosis of endophthalmitis of probable endogenous origin in the right eye was based on a previous right femur surgery. Potential risk to the patient led to enucleation (AU)

Antecedentes. Las infecciones micóticas oculares causadas por el complejo de especies de Scedosporium apiospermum son un reto en el tratamiento por su diagnóstico tardío y la pobre respuesta a los antimicóticos y al tratamiento quirúrgico. Caso clínico. Se describe el caso de un paciente de sexo masculino de 69 años con antecedentes de diabetes mellitus de tipo 2 y cirugía previa del fémur derecho. Diez días antes de la consulta oftalmológica comenzó con dolor ocular que se sumaba a una pérdida previa y progresiva de la capacidad visual en el ojo derecho. Se estableció el diagnóstico de endoftalmitis de posible origen endógeno. A pesar del tratamiento, el paciente no presentó mejoría y por los inminentes riesgos se decidió llevar a cabo una enucleación. El frotis a partir del tejido enucleado mostró células fúngicas y los cultivos revelaron un hongo perteneciente al complejo S. apiospermum, identificado como Scedosporium boydii por procedimientos morfológicos y por secuenciación de un amplicón de PCR. Conclusiones. El diagnóstico de endoftalmitis de probable origen endógeno en el ojo derecho se basó en el antecedente de una cirugía previa de fémur, cuyos riesgos para el paciente condujeron a una enucleación (AU)

Cutaneous blastomycosis. An imported case with good response to itraconazole / Blastomicosis cutánea. Caso clínico importado con buena respuesta al itraconazol

Background. Blastomycosis is a subacute or chronic deep mycosis caused by a dimorphic fungus called Blastomyces dermatitidis, which generally produces a pulmonary form of the disease and, to a lesser extent, extra-pulmonary forms such as cutaneous, osteoarticular and genitourinary, among others. Cutaneous blastomycosis is the second clinical presentation in frequency. It is considered as primary when it begins by inoculation of the fungus due to traumas, and secondary when the lung fails to contain the infection. Case-report. We present the case of a 57 year-old male who had a 5 year-history of an irregularly shaped verrucous infiltrative plaque related to and insect bite and posterior trauma due to the manipulation of the lesion. B. dermatitidis was identified using direct examination, stains, isolation in culture media, histopathology, and molecular studies. An antifungal susceptibility test was performed using method M38-A2 (CLSI). Clinical and mycological cure was achieved with itraconazole. Conclusions. This cutaneous blastomycosis case acquired in the United States (Indianapolis) is rather interesting and looks quite similar to other mycoses such as coccidioidomycosis or sporotrichosis. The presented case shows one of the multiple issues concerning migration between neighboring countries (AU)

Antecedentes. La blastomicosis es una micosis profunda, subaguda o crónica, causada por el hongo dimorfo Blastomyces dermatitidis, que generalmente produce una enfermedad pulmonar y, en menor proporción, formas extrapulmonares (cutánea, osteoarticular y genitourinaria). La blastomicosis cutánea es la segunda forma clínica más observada; es de tipo primario cuando se presenta por la inoculación del hongo a través de traumatismos, y de tipo secundario cuando se disemina a partir de un foco pulmonar. Caso clínico. Se presenta el caso de un varón de 57 años con blastomicosis cutánea verrugosa de 5 años de evolución, relacionada con la picadura de un insecto, que empeora con la manipulación de la lesión. El caso fue confirmado por la identificación de B. dermatitidis en exámenes directos, tinciones, aislamiento en medios de cultivo habituales, análisis histopatológico y estudios moleculares. Se realizó una prueba de sensibilidad antifúngica por el método M38-A2 (CLSI). La curación clínica y micológica se logró con itraconazol oral. Conclusiones. Este caso de blastomicosis cutánea adquirida en Estados Unidos (Indianápolis) es de gran interés y resulta similar a los de otras micosis, como la coccidioidomicosis y la esporotricosis. Este caso refleja uno de los múltiples factores relacionados con la migración entre países cercanos (AU)

Endophthalmitis of probable endogenous origin caused by Scedosporium boydii: A case report.

BACKGROUND: Mycotic ocular infections caused by the Scedosporium apiospermum species complex are challenging to treat because of the delayed diagnoses and poor responses to antifungal drugs and surgical treatment. CASE REPORT: A case of a 69-year-old male patient with a history of diabetes mellitus type 2 and prior surgery on the right femur is described. In the 10 days prior to the ophthalmic consultation he started with ocular pain, adding to a previous and progressive loss of visual acuity in his right eye. The diagnosis of endophthalmitis of probable endogenous origin was established. Despite medical treatment, the patient's condition worsened and, due to the imminent risks, an enucleation was performed. Smears of the enucleation tissue revealed fungal cells, and the cultures yielded a fungus belonging to the S. apiospermum species complex, which was identified as Scedosporium boydii by morphological characteristics and sequencing of a PCR amplicon. CONCLUSIONS: A diagnosis of endophthalmitis of probable endogenous origin in the right eye was based on a previous right femur surgery. Potential risk to the patient led to enucleation.

Cutaneous blastomycosis. An imported case with good response to itraconazole.

BACKGROUND: Blastomycosis is a subacute or chronic deep mycosis caused by a dimorphic fungus called Blastomyces dermatitidis, which generally produces a pulmonary form of the disease and, to a lesser extent, extra-pulmonary forms such as cutaneous, osteoarticular and genitourinary, among others. Cutaneous blastomycosis is the second clinical presentation in frequency. It is considered as primary when it begins by inoculation of the fungus due to traumas, and secondary when the lung fails to contain the infection. CASE-REPORT: We present the case of a 57 year-old male who had a 5 year-history of an irregularly shaped verrucous infiltrative plaque related to and insect bite and posterior trauma due to the manipulation of the lesion. B. dermatitidis was identified using direct examination, stains, isolation in culture media, histopathology, and molecular studies. An antifungal susceptibility test was performed using method M38-A2 (CLSI). Clinical and mycological cure was achieved with itraconazole. CONCLUSIONS: This cutaneous blastomycosis case acquired in the United States (Indianapolis) is rather interesting and looks quite similar to other mycoses such as coccidioidomycosis or sporotrichosis. The presented case shows one of the multiple issues concerning migration between neighboring countries.

[Onychomycosis frequency in psoriatic patients in a tertiary care hospital]. / Frecuencia de onicomicosis en pacientes con psoriasis en un hospital de especialidades.

BACKGROUND: The changes in psoriatic nails can closely resemble an onychomycosis. Therefore, the fungal infection may be underdiagnosed. It was investigated the frequency of mycosis in fingernails and toenails in 150 patients with psoriasis in a dermatology department. METHODS: The clinical data suggestive of onychomycosis were investigated. Nail scales were obtained and cultured on Sabouraud dextrose agar with and without antibiotic. A direct examination with KOH was also performed. RESULTS: Out of 150 patients, 67 (45 %) had healthy nails; 42 (28 %) presented onychomycosis and 41 (27 %) showed nail changes without infection. Fingernail changes were more associated with psoriatic onychopathy (82.5 %), unlike toenail changes that were more frequently caused by fungal infection (26.4 % vs. 9.45 % in psoriasis). Out of 20 positive cultures, 22 fungi were isolated, of which 11 belonged to Candida spp. (50 %). As risk factor to develope an onychomycosis, only the psoriasis evolution time showed a significant difference (p = 0.033). CONCLUSIONS: In patients with psoriasis, fingernail disorders are mainly due to the own disease, while toenail disorders changes can be associated with onychomycosis. The main etiological agents were yeasts from the genus Candida. The only factor associated with a higher incidence of onychomycosis in these patients was a long lasting psoriasis.

Introducción: los cambios ungueales en los pacientes con psoriasis pueden ser muy parecidos a la onicomicosis y, por lo tanto, las infecciones fúngicas pueden ser subdiagnosticadas. Se investigó la frecuencia de onicomicosis en manos y pies de 150 pacientes con psoriasis de un servicio de dermatología. Métodos: se obtuvieron los datos clínicos de la psoriasis. Se cultivaron escamas de las uñas en agar dextrosa Sabouraud con y sin antibióticos y se hizo un examen directo con KOH. Resultados: de los 150 pacientes, 67 (45 %) presentaron uñas sanas; 42 (28 %) tuvieron onicomicosis, y 41 (27 %) onicopatía sin infección. Las alteraciones ungueales en las manos estuvieron más asociadas con onicopatía psoriásica (82.5 %); los cambios de las uñas de los pies se asociaron más frecuentemente a infección fúngica (26.4 frente a 9.45 % en psoriasis). De 20 cultivos positivos, se aislaron 22 agentes: 11 Candida spp. (50 %). Como factor de riesgo para desarrollar onicomicosis, el tiempo de evolución de la psoriasis mostró una diferencia significativa (p = 0.03). Conclusión: en los pacientes con psoriasis, las alteraciones ungueales de manos se deben principalmente a psoriasis, mientras que los cambios ungueales en los pies se asocian a onicomicosis. Esta fue causada principalmente por Candida sp. El único factor de riesgo asociado para onicomicosis fue la larga evolución de la psoriasis.

Sporothrix schenckii yeasts induce ERK pathway activation and secretion of IL-6 and TNF-α in rat mast cells, but no degranulation.

Sporothrix schenckii is a dimorphic fungus that causes sporotrichosis, a subcutaneous mycosis found throughout the world in humans and other mammals. After contact with conidia, transition to the yeast stage is required for establishment of infection. Mast cells are one of the first components of the immune system to make contact with invading pathogens. They release potent mediators that are decisive in initiating and directing the course of immune and inflammatory responses in the host. It remains unknown whether or not yeast cells of S. schenckii activate mast cells. Our aim in this study was to evaluate the in vitro response of mast cells to S. schenckii yeasts cells. Mast cells became activated after interaction with the yeasts, although exocytosis of preformed mediators was not stimulated. Sporothrix schenckii yeasts induced the release of early response cytokines such as tumor necrosis factor alpha (TNF-α) and interleukin (IL)-6 and activation of the extracellular signal-regulated kinase (ERK) signaling pathway in mast cells. As TNF-α and IL-6 are considered crucial mediators in the defense of the host against fungal disease, the release of both mediators from mast cells may contribute to the overall response of the host immune system during S. schenckii infection.

Paracoccidioidomycosis in Mexico: clinical and epidemiological data from 93 new cases (1972-2012).

Paracoccidioidomycosis (PCM) is an endemic systemic infection in several countries of Latin America. The few registered cases in Mexico most likely do not reflect the real frequency. Disseminate the epidemiological and clinical data of unreported cases of PCM in Mexico from 1972 until 2012 is the aim of this work. Epidemiological and clinical information of non-published cases of PCM was requested from the principal mycological diagnosis centres in Mexico. A total of 93 cases were received. The infection was found predominantly in men (95.7%), peasants (88.5%) and individual between 31 and 60 years of age. Most of the cases were found in tropical areas of the Gulf of Mexico (54.84%) and the Pacific littoral (20.3%). The main sites of dissemination were the oral mucosa (39.38%) and skin (34.05%). The most effective treatments were itraconazole alone and the combination of itraconazole with sulfamethoxazole-trimethoprim. PCM is a subdiagnosed pathology in Mexico. Therefore, adequate training is necessary to determine the current status of this mycosis.

[Update on the epidemiology of mycetoma in Mexico. A review of 3933 cases]. / Actualización de la epidemiología del micetoma en México. Revisión de 3,933 casos.

UNLABELLED: Mycetoma is one of the most frequent chronic subcutaneous infections in many tropical and subtropical regions. OBJECTIVE: To update the epidemiological data of mycetoma cases in Mexico. METHOD: A survey in the main mycological diagnosis centers in this country was performed. Each mycologist was requested for number of diagnosed mycetoma cases, age, sex, occupation, geographic origin, type of mycetoma, and etiological agents. RESULTS: Until 2012, we have registered 3,933 cases in the last 54 years. Sex distribution corresponds to 75.6% for men and 24.4% for women. In 75.72% is present in adults between 16-50 years old. The predominant work group of patients is farmers (58.41%) followed by housewives (21.79%). Most of patients come from Jalisco, Morelos, Nuevo Leon, Guerrero, Veracruz and Michoacan states. The most affected body areas are limbs (60.29%) and trunk (19.76%). Actinomycetoma has a frequency of 96.52%, and the commonest etiological agent is Nocardia brasiliensis (65.58%). Eumycetoma (3.48%) is mainly caused by Madurella grisea (28.47%) and M. mycetomatis (26.28%). CONCLUSIONS: Mycetoma is an under-diagnosed pathology representing a health problem in rural regions and must be attended with more interest by the health institutions.