La vulvovaginitis candidiásica recurrente / Recurrent vulvovaginal candidiasis

La vulvovaginitis candidiásica recurrente (VVCR) es una entidad presente en la práctica diaria en las consultas y en urgencias. Sus síntomas causan molestias crónicas que repercuten seriamente en la calidad de vida de la mujer, empujándola a buscar constantemente una solución que no siempre llega. El diagnóstico debe confirmarse siempre mediante cultivo y el tratamiento debe basarse en el uso de antifúngicos imidazoles, tópicos u orales, con un tratamiento inicial con triple terapia para eliminar los síntomas e intentar eliminar los reservorios; seguida de un tratamiento de mantenimiento durante 6 a 12 meses. Las opciones para la prevención de la VVCR son muy limitadas y, exceptuando la eliminación del agente causal, ninguna otra medida preventiva ha resultado eficaz. Presentamos esta actualización de la VVCR en un intento de ayudar al profesional y colaborar en mejorar la atención de la mujer afecta de VVCR(AU)

Recurrent vulvovaginal candidiasis (RVVC) is a common infection in daily clinical and emergency practice. The symptoms of this infection cause distressing chronic conditions that seriously affect women's quality of life, prompting them to seek solutions that are sometimes hard to find. Diagnosis should always be confirmed by culture and treatment should be based on the use of topical or oral antifungal imidazoles. Triple therapy focused on symptom and reservoir elimination should initially be used, followed by maintenance therapy for 6 to 12 months. The options to prevent RVVC are highly limited and, except for elimination of the causative agent, no other preventive measures have been effective. We provide an updated review of RVVC in an attempt to aid health professionals and improve the care of women with this infection(AU)

Respiratory allergy to fungi in Barcelona, Spain: Clinical aspects, diagnosis and specific treatment in a general allergy unit

Background: The importance of hypersensitivity to fungal allergens is a relatively unknown and somewhat controversial subject. Methods: An open prospective study was carried out in just one centre to determine the clinical and epidemiological characteristics as well as the diagnostic usefulness of skin prick and conjunctiva provocation tests, associated with total and specific IgE determination in two groups of patients, one of which was monosensitised to fungi and the other of which had multiple sensitisations, including fungi. Results: Rhinitis, exclusive or associated with asthma, was the main consultation cause (88% in monosensitised patients). Severe asthma was rarely found. In the polysensitised group, 64% were simultaneously allergic to moulds and mites. Alternaria alternata was the most common sensitising fungus, although a considerable number of cases were associated with other species such as Cladosporium, Penicillium and/or Aspergillus. The skin prick test gave the highest sensitivity and specificity. In 67% of the cases, the specific IgE was found between classes 3 and 4. The conjunctival provocation test was an innocuous and highly useful method for verifying the diagnosis and determining the degree of clinical sensitisation. A large number of patients exclusively allergic to fungi received specific immunotherapy, and it was generally well tolerated. Conclusions: This protocolised study shows the importance of Alternaria and other fungi sensitisations in rhinitis alone or associated with asthma. Combined diagnosis of prick test, specific IgE and conjunctiva provocation test is very useful for deciding specific immunotherapy(AU)

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Autochthonous and dormant Cryptococcus gattii infections in Europe.

Until recently, Cryptococcus gattii infections occurred mainly in tropical and subtropical climate zones. However, during the past decade, C. gattii infections in humans and animals in Europe have increased. To determine whether the infections in Europe were acquired from an autochthonous source or associated with travel, we used multilocus sequence typing to compare 100 isolates from Europe (57 from 40 human patients, 22 from the environment, and 21 from animals) with 191 isolates from around the world. Of the 57 human patient isolates, 47 (83%) were obtained since 1995. Among the 40 patients, 24 (60%) probably acquired the C. gattii infection outside Europe; the remaining 16 (40%) probably acquired the infection within Europe. Human patient isolates from Mediterranean Europe clustered into a distinct genotype with animal and environmental isolates. These results indicate that reactivation of dormant C. gattii infections can occur many years after the infectious agent was acquired elsewhere.

Respiratory allergy to fungi in Barcelona, Spain: clinical aspects, diagnosis and specific treatment in a general allergy unit.

BACKGROUND: The importance of hypersensitivity to fungal allergens is a relatively unknown and somewhat controversial subject. METHODS: An open prospective study was carried out in just one centre to determine the clinical and epidemiological characteristics as well as the diagnostic usefulness of skin prick and conjunctiva provocation tests, associated with total and specific IgE determination in two groups of patients, one of which was monosensitised to fungi and the other of which had multiple sensitisations, including fungi. RESULTS: Rhinitis, exclusive or associated with asthma, was the main consultation cause (88% in monosensitised patients). Severe asthma was rarely found. In the polysensitised group, 64% were simultaneously allergic to moulds and mites. Alternaria alternata was the most common sensitising fungus, although a considerable number of cases were associated with other species such as Cladosporium, Penicillium and/or Aspergillus. The skin prick test gave the highest sensitivity and specificity. In 67% of the cases, the specific IgE was found between classes 3 and 4. The conjunctival provocation test was an innocuous and highly useful method for verifying the diagnosis and determining the degree of clinical sensitisation. A large number of patients exclusively allergic to fungi received specific immunotherapy, and it was generally well tolerated. CONCLUSIONS: This protocolised study shows the importance of Alternaria and other fungi sensitisations in rhinitis alone or associated with asthma. Combined diagnosis of prick test, specific IgE and conjunctiva provocation test is very useful for deciding specific immunotherapy.

Levaduras causantes de onicomicosis en cuatro centros dermatológicos mexicanos y su sensibilidad antifúngica a compuestos azólicos / Onychomycosis-causing yeasts in four Mexican dermatology centers and their antifungal susceptibility to azolic compounds

Antecedentes. Las levaduras representan la segunda causa mundial de infecciones fúngicas ungueales, donde Candida albicans y Candida parapsilosis son las dos especies más frecuentes. Objetivos. Conocer la frecuencia de especies de levaduras y su sensibilidad antifúngica in vitro, obtenidas de pacientes con manifestaciones clínicas sugestivas de onicomicosis. Métodos. En México se realizó un estudio prospectivo en pacientes atendidos en cuatro centros de atención dermatológica de 2004 a 2007. El diagnóstico clínico fue corroborado por examen directo y cultivo. La especie de levadura fue determinada por pruebas morfológicas y bioquímicas. A cada aislamiento se le determinó la sensibilidad a ketoconazol, itraconazol y fluconazol mediante el método de microdilución en caldo (documento M27-A2). Resultados. Se obtuvieron 166 aislamientos levaduriformes; las especies más frecuentes fueron C. parapsilosis (31,9%), C. albicans (22,4%) y Candida guilliermondii (12,7%). De todos los aislamientos, 51 mostraron resistencia a uno o varios de los azoles probados: 33 a itraconazol, 12 a ketoconazol y 6 a fluconazol. Fue notable que los 4 aislamientos de Candida glabrata fueron resistentes a los tres compuestos azólicos; C. guilliermondii y Candida famata fueron resistentes a itraconazol en el 42,9% y en el 54,5%, respectivamente. Conclusión. Los resultados obtenidos demuestran la importancia de identificar al agente etiológico y realizar pruebas de sensibilidad para evitar fracasos terapéuticos en las onicomicosis(AU)

Background. Yeasts represent the second cause of nail fungal infection in the world, and Candida albicans and Candida parapsilosis are the two most common species. Objectives. To determine the yeast species frequency and their in vitro antifungal susceptibility, obtained from patients with clinical features suggestive of onychomycosis. Methods. A prospective study was carried out in four dermatological care centers in Mexico from 2004 to 2007. Clinical diagnosis was corroborated by direct examination and culture. The yeast species was determined by morphological and biochemical tests. An antifungal susceptibility test to ketoconazole, itraconazole and fluconazole by the broth microdilution method was performed on each isolate (document M27-A2). Results. One hundred sixty-six yeast isolates were obtained; the most frequently found species were C. parapsilosis (31.9%), C. albicans (22.4%) and Candida guilliermondii (12.7%). Of all isolates, 51 showed resistance to one or several of the azole compounds: 33 to itraconazole, 12 to ketoconazole and 6 to fluconazole. It was remarkable that the four Candida glabrata isolates were resistant to the three azole compounds; C. guilliermondii and Candida famata were resistant to itraconazole in 42.9% and 54.5%, respectively. Conclusion. The results obtained show the importance of identifying the aetiological agent and antifungal susceptibility testing in order to avoid therapeutic failures in onychomycosis(AU)

[Onychomycosis-causing yeasts in four Mexican dermatology centers and their antifungal susceptibility to azolic compounds]. / Levaduras causantes de onicomicosis en cuatro centros dermatológicos mexicanos y su sensibilidad antifúngica a compuestos azólicos.

BACKGROUND: Yeasts represent the second cause of nail fungal infection in the world, and Candida albicans and Candida parapsilosis are the two most common species. OBJECTIVES: To determine the yeast species frequency and their in vitro antifungal susceptibility, obtained from patients with clinical features suggestive of onychomycosis. METHODS: A prospective study was carried out in four dermatological care centers in Mexico from 2004 to 2007. Clinical diagnosis was corroborated by direct examination and culture. The yeast species was determined by morphological and biochemical tests. An antifungal susceptibility test to ketoconazole, itraconazole and fluconazole by the broth microdilution method was performed on each isolate (document M27-A2). RESULTS: One hundred sixty-six yeast isolates were obtained; the most frequently found species were C. parapsilosis (31.9%), C. albicans (22.4%) and Candida guilliermondii (12.7%). Of all isolates, 51 showed resistance to one or several of the azole compounds: 33 to itraconazole, 12 to ketoconazole and 6 to fluconazole. It was remarkable that the four Candida glabrata isolates were resistant to the three azole compounds; C. guilliermondii and Candida famata were resistant to itraconazole in 42.9% and 54.5%, respectively. CONCLUSION: The results obtained show the importance of identifying the aetiological agent and antifungal susceptibility testing in order to avoid therapeutic failures in onychomycosis.

Müeller-Hinton methylene blue media as an alternative to RPMI 1640 for determining the susceptibility of Cryptococcus neoformans and Cryptococcus gattii to posaconazole with Etest.

Mueller-Hinton modified agar (MH-GMB) was compared with RPMI + 2% glucose-agar to determine the MICs of 80 isolates of Cryptococcus neoformans and C. gattii to posaconazole with Etest. MH-GMB minimised trailing and agreement between both media was 94%. Agreement of M27-A2 microbroth reference method was 98% with RPMI and 94% with MB-GMB.

Histoplasmosis en un varón inmunocompetente manifestada 45 años después de la infección / Histoplasmosis in an immunocompetent man manifested 45 years after infection

ResumenSe presenta el caso de un paciente de 68 años, inmunocompetente, natural de Barcelona (España), donde reside habitualmente, en el que se desarrolló una hemoptisis debida a un infiltrado pulmonar, consecuencia de la reactivación pulmonar de una histoplasmosis adquirida en África Ecuatorial 45 años antes.El diagnóstico se realizó por la observación de levaduras características de Histoplasma capsulatum var. capsulatum en una biopsia del pulmón y por la detección de anticuerpos contra antígenos de este hongo. El tratamiento con itraconazol (400mg durante 3 meses) condujo a la desaparición del nódulo y a la negativización de las pruebas serológicas a los 4 años de seguimiento(AU)

AbstractWe report a case of a lung reactivation of a latent histoplasmosis in a 68 year-old patient without immunologic dysfunction living in Barcelona (Spain).The Histoplasma capsulatum var. capsulatum infection was probably acquired in a previous stay in Equatorial Guinea 48 years before.Diagnosis of mild chronic pulmonary histoplasmosis was performed by histopathology of lung biopsy plus antibodies detection against H. capsulatum. Treatment with oral itraconazol during three months leaded to a complete clinical cure, and antibodies disappeared after four years of follow up

[Histoplasmosis 45 years after infection in an immunocompetent man]. / Histoplasmosis en un varón inmunocompetente manifestada 45 años después de la infección.

We report a case of a lung reactivation of a latent histoplasmosis in a 68-year-old patient without immunologic dysfunction living in Barcelona (Spain). The Histoplasma capsulatum var. capsulatum infection was probably acquired in a previous stay in Equatorial Guinea 45 years before. Diagnosis of mild chronic pulmonary histoplasmosis was performed by histopathology of lung biopsy plus antibodies detection against H. capsulatum. Treatment with oral itraconazol during three months leaded to a complete clinical cure, and antibodies disappeared after four years of follow up.

MICs and minimum fungicidal concentrations of amphotericin B, itraconazole, posaconazole and terbinafine in Sporothrix schenckii.

The in vitro susceptibility of 62 isolates of Sporothrix schenckii in its mycelial form, from Latin-American countries (Peru, Venezuela, Brazil and Uruguay) and Spain, to amphotericin B (AB), itraconazole (IZ), posaconazole (PZ) and terbinafine (TB) was determined by measuring the MICs and minimum fungicidal concentrations (MFCs) using a standardized Clinical and Laboratory Standards Institute method. In general, TB was the most active drug, with the lowest geometric mean (GM) MIC and MFC values amongst isolates from the five countries tested. IZ and PZ showed almost the same activity against all strains tested, except for isolates from Uruguay where IZ gave the highest GM MIC (10.68 mg l(-1)). AB showed the widest MIC range (0.03-16.0 mg l(-1)); however, this drug was less active against 79 % of isolates (MICs above 1 mg l(-1)). MFCs were 5 to 20 times higher than the MICs, but the lowest GM MFC and range values were found for TB. IZ and PZ gave the highest GM MFC. MFC may be a better predictor of therapeutic response than MIC, especially in immunosuppressed patients, making the use of IZ and PZ an inappropriate treatment. There were some differences in susceptibility according to the geographical source of the isolates, with the MIC being lower for TB in Venezuelan strains (P=0.066) and the MFC higher for PZ in Peruvian strains (P=0.02). Thus, geographical origin may be important for appropriate treatment, and may relate to the identification of species of the S. schenckii complex.

Laccase activity in Cryptococcus gattii strains isolated from goats.

Cryptococcosis is a life-threatening infection in humans and animals caused by encapsulated yeasts of the genus Cryptococcus. Cryptococcus neoformans and Cryptococcus gattii are the main agents of this mycosis. Until 2002 C. gattii was classified as a variety of C. neoformans but now is accepted as an independent species. The laccase (phenoloxydase) enzyme produced by these yeasts is considered one of the main pathogenic factors for its ability to induce melanin from dihydroxyphenolic compounds. The vast majority of the studies in laccase and melanin synthesis have been developed using isolates of C. neoformans. The main objective of this study was to evaluate laccase activity in strains of C. gattii, serotype B isolated from immunocompetent goats that died of lung and disseminated cryptococcosis, in several outbreaks occurring in Spain. The laccase activities of these isolates were compared with those of other strains of C. gattii and C. neoformans. After fungal cell rupture, the supernatant of each isolate was analyzed for its laccase activity using as substrate an L-dopa 20 mM solution. The degree of enzymatic activity was assessed according to its absorbance at 450 nm and scored using Enzymatic Units (EU). The maximum values were observed in three strains of C. gattii from goats (EU > 12). The smallest values were observed in one environmental isolate of C. gattii serotype C (EU = 0.7). The highest recorded value for C. neoformans was 6.3 EU in a serotype A isolate from one human case of meningitis. C. gattii serotype B obtained from goats showed different degrees of laccase activity, being the highest in those isolated from severe outbreaks of cryptococcosis. This enzyme appears to represent a major, though nonexclusive, pathogenic factor for Cryptococcus gattii.

[Urease activity in Cryptococcus neoformans and Cryptococcus gattii]. / Diferencias en la actividad de la enzima ureasa entre Cryptococcus neoformans y Cryptococcus gattii.

Urease is an enzyme considered one of the main virulence factors in Cryptococcus neoformans. Quantitative differences in urease production between C. neoformans and the new species Cryptococcus gattii have not been so far documented. Using a standardized method, 25 isolates of C. neoformans and 19 of C. gattii were seeded in Christensen urea broth medium for urease activity detection. Approximately, the 50% of activity of one unit of commercial jack beans urease (A550=0.215) was considered as a reference to classified the Cryptococcus in two cathegories, low (A550<0.215) or high (A550=or>0.215) urease producers. After 72 hours of incubation, 76% of C. neoformans and 15.8% of C. gattii strains were high urease producers (p=0.016). Based on these results, the species C. neoformans appeared as the highest urease producer. Other virulence factors should also be investigated to explain C. gattii pathogenicity.

[Candiduria in type 2 diabetes mellitus patients and its clinical significance. Candida spp. antifungal susceptibility]. / Candiduria en pacientes con diabetes mellitus tipo 2. Sensibilidad antifúngica in vitro.

BACKGROUND: Candida is frequently seen in urinalysis studies in patients with diabetes mellitus. The objective was to determine the presence and clinical significance of candiduria, and to identify the different isolated Candida species and their in vitro susceptibility pattern to different antifungal agents by means of the broth microdilution method. METHODS: We studied the urine from 50 type 2 diabetes mellitus (DMT2) patients. 24 patients had controlled DMT2 and 26 non-controlled DMT2. RESULTS: Twenty-three Candida spp. positive cultures were obtained, of which 17 were obtained from the non-controlled DMT2 patients; 30.7% of the isolates were caused by Candida infection. The main isolated species were C. glabrata (48%) and C. albicans (35%). Itraconazole, amphotericine B, and ketoconazole showed less antifungal activity in C. glabrata isolates, whereas fluconazole and voriconazole displayed higher antifungal activity. CONCLUSIONS: It is important to search routinely for yeast in the urine of DMT2 patients to detect candidiasis, and to perform antifungal susceptibility tests to Candida isolates in order to establish antifungal therapy for these patients.

Diferencias en la actividad de la enzima ureasa entre Cryptococcus neoformans y Cryptococcus gattii / Urease activity in Cryptococcus neoformans and Cryptococcus gattii

Se considera que la capacidad de Cryptococcus neoformans para sintetizarureasa es uno de sus principales factores de virulencia. Desde 2002 se aceptaque la variedad gattii de C. neoformans reúne los atributos necesarios paraconsiderarse como una nueva especie, Cryptococcus gattii. No existenestudios experimentales controlados que comparen el grado de actividadureasa de ambas especies. El objetivo de este trabajo ha sido analizar laproducción de esta enzima en aislamientos de C. neoformans y C. gattii,considerando la distribución en serotipos de los aislamientos y su origen(clínico o ambiental), utilizando un nuevo método semicuantitativoestandarizado. Veinticinco aislamientos de C. neoformans y 19 de C. gattiifueron sembrados en medio líquido de urea de Christensen para determinar laproducción de ureasa por espectrofotometría. Como referencia se determinóla actividad de una unidad de ureasa (jack beans urease®, Sigma) sobre elmismo medio de cultivo y se observó que el 50% de la actividad enzimáticacorrespondía a una densidad óptica de A550 = 0,215. Esta absorbancia permitióclasificar la actividad ureasa para cada aislamiento de Cryptococcus.Los resultados mostraron que bajo las mismas condiciones, estas levaduraspodían agruparse en dos categorías, bajas productoras de ureasa(A550 < 0,215) y altas productoras (A550 >= 0,215). A las 72 horas de incubación,el 76% de los aislamientos de C. neoformans y el 15,8% de los de C. gattiiresultaron altos productores de ureasa. El análisis estadístico mostródiferencias significativas entre ambas especies (p = 0,016). Los resultadosobtenidos muestran que C. neoformans es mayor productor de ureasa queC. gattii(AU)

Urease is an enzyme considered one of the main virulence factors inCryptococcus neoformans. Quantitative differences in urease productionbetween C. neoformans and the new species Cryptococcus gattii have notbeen so far documented. Using a standardized method, 25 isolates ofC. neoformans and 19 of C. gattii were seeded in Christensen urea brothmedium for urease activity detection. Approximately, the 50% of activity ofone unit of commercial jack beans urease (A550 = 0.215) was considered as areference to classified the Cryptococcus in two cathegories, low (A550 < 0.215)or high (A550 >= 0.215) urease producers. After 72 hours of incubation, 76% ofC. neoformans and 15.8% of C. gattii strains were high urease producers(p = 0.016). Based on these results, the species C. neoformans appeared asthe highest urease producer. Other virulence factors should also beinvestigated to explain C. gattii pathogenicity(AU)

Laccase activity in Cryptococcus gattii strains isolated from goats

Cryptococcus neoformans y Cryptococcus gattii son los principales agentesde criptococosis, una grave micosis del hombre y los animales. Entre losfactores de patogenicidad de estas especies cabe destacar la lacasa(fenoloxidasa), enzima producida por éstas y otras especies fúngicas, queinduce la síntesis de melanina a partir de compuestos di-hidroxifenólicos.La gran mayoría de los numerosos estudios sobre la lacasa se han efectuadocon C. neoformans, y la información específica en C. gattii es muy escasa.El objetivo de este estudio ha sido evaluar la actividad de la lacasa enaislamientos de C. gattii serotipo B procedentes de cabrasinmunocompetentes muertas por criptococosis durante varios brotesepidémicos desarrollados en Cáceres (Extremadura, España).La producción de lacasa de estos aislamientos se ha comparado con la deotros de la misma especie y también con cepas de C. neoformans.Se procedió a la ruptura de las levaduras por métodos físicos, y elsobrenadante de cada aislamiento se añadió a una solución 20 mM de L-dopa. La actividad enzimática se midió a través de la absorbancia como unidadesenzimáticas (EU) a 450 nm. Los valores máximos de EU se observaron en trescepas de C. gattii aisladas de cabras (EU >12), mientras que el valor mas bajose observó en una cepa ambiental de C. gattii serotipo C (EU = 0,7).Para C. neoformans la mayor actividad lacasa se obtuvo en una cepa delserotipo A aislada en un paciente con meningitis criptocócica.Todos los aislamientos de C. gattii procedentes de los animales muertos enbrotes epidémicos mostraron diferentes grados de actividad lacasa.Esta enzima parece representar un factor de patogenicidad importante,aunque no exclusivo, en esta especie(au)

Cryptococcosis is a life-threatening infection in humans and animals causedby encapsulated yeasts of the genus Cryptococcus. Cryptococcus neoformansand Cryptococcus gattii are the main agents of this mycosis Until 2002C. gattii was classified as a variety of C. neoformans but now is accepted asan independent species. The laccase (phenoloxydase) enzyme produced bythese yeasts is considered one of the main pathogenic factors for its ability toinduce melanin from dihydroxyphenolic compounds. The vast majority of thestudies in laccase and melanin synthesis have been developed using isolatesof C. neoformans. The main objective of this study was to evaluate laccaseactivity in strains of C. gattii, serotype B isolated from immunocompetentgoats that died of lung and disseminated cryptococcosis, in several outbreaksoccurring in Spain. The laccase activities of these isolates were compared withthose of other strains of C. gattii and C. neoformans. After fungal cell rupture,the supernatant of each isolate was analyzed for its laccase activity using assubstrate an L-dopa 20 mM solution. The degree of enzymatic activity wasassessed according to its absorbance at 450 nm and scored using EnzymaticUnits (EU). The maximum values were observed in three strains of C. gattiifrom goats (EU > 12). The smallest values were observed in one environmentalisolate of C. gattii serotype C (EU = 0.7). The highest recorded value forC. neoformans was 6.3 EU in a serotype A isolate from one human case ofmeningitis. C. gattii serotype B obtained from goats showed different degreesof laccase activity, being the highest in those isolated from severe outbreaksof cryptococcosis. This enzyme appears to represent a major, thoughnonexclusive, pathogenic factor for Cryptococcus gattii(AU)

Dos casos de pitiriasi versicolor en lactants / Two cases of pityriasis versicolor in infants

Introducció. La pitiriasi versicolor (PV) és una dermatosicausada per llevats lipofílics ubicada a la superfície de l’estratcorni, més freqüent en zones humides i de calor. Potafectar a qualsevol edat, però habitualment s’hi pensa enedats adolescents o en adults. Entre els infants, la formade presentació de la PV, comparada amb adolescents iadults, és atípica.Observació clínica. Es presenten dos casos de lactantsde 40 i 50 dies que presenten lesions anulars al clatell detipus descamatiu i hipocròmic o eritematós. L’examen directede les escates permet fer el diagnòstic etiològic.Comentaris. La presència de Malassezia sp com a sapròfita la pell de l’individu sa des dels primers dies de vida indicala possibilitat que, en aquestes edats, ja es presentininfants amb lesions. Les característiques diferenciades enrelació amb l’adolescent i l’adult són la localització facial ial coll, on acostuma a dominar la hipopigmentació ambmínima descamació i amb tendència a la confluència. Calrecordar que en lactants sotmesos a nutrició parenterals’ha de comptar amb la possibilitat de desenvolupar sèpsiarelacionada amb el catèter, a partir dels focus de colonitzaciócutània

Introduction. Pityriasis versicolor is a dermatomycosis caused by lipophilic yeasts that infect the superficial layersof the stratum corneum of the skin, more frequently inareas of higher humidity and temperature. The majority ofcases occur in adolescents and adults. In comparison withthe typical presentation in adolescents and adults, pityriasisversicolor in children has atypical features.Case report. We report two infants aged 40 and 50days who presented with annular macules in the nape. Thelesions were hypopigmented or faint pink, and with faintscaling. Microscopic examination of the scales was diagnosticfor pityriasis versicolor.Discussion. The presence of Malasezzia sp as an opportunisticpathogen in the skin since the first days of lifeexplains the possibility of an infection at young ages.The characteristics of this infection in young children arethe facial and cervical localizations, with typical hypopigmentationwith minimal desquamation, and tendency toconfluence. Infants receiving parenteral nutrition maydevelop a septic syndrome related to central line infection originating in the skin colonization (AU)

In vitro susceptibilities to yeasts using the ATB FUNGUS 2 method, compared with Sensititre Yeast One and standard CLSI (NCCLS) M27-A2 methods.

OBJECTIVES: The microbroth ATB FUNGUS 2 (ATBF2) method (bioMérieux, La Balme-les Grottes, France), designed for in vitro determination of the susceptibility of Candida spp. and Cryptococcus neoformans to antifungal agents, was evaluated with 100 yeasts and compared with Sensititre Yeast One (SYO; Trek Diagnostic Systems, UK), considering CLSI M27-A2 as the reference method. METHODS: ATBF2 consists of ready-to-use strips including amphotericin B (AMB), 5-flucytosine, fluconazole and itraconazole for MIC determinations. Reproducibility of ATBF2 was determined. Two quality control strains and a panel of eight Candida isolates were tested five different times with the three methods. The essential agreements within +/-2 log2 dilution between the ATBF2, SYO and M27-A2 methods were assessed. The yeast clinical isolates included were nine species of Candida (n = 80) and C. neoformans (n = 20). RESULTS: Inter- and intra-laboratory reproducibility, tested with the Candida panel, was >or=99%. MICs for the ATCC strains were within the expected ranges with the three methods. Visual and automated readings of ATBF2 presented good concordance, being lower with itraconazole. The overall essential agreements with the M27-A2 method were 94% and 99% for automated ATBF2 and visual ATBF2 readings, respectively. For SYO, the agreement was 91%. Percentages of agreements by drugs (automated ATBF2/visual ATBF2/SYO) were: 5-flucytosine, 97/100/90; AMB, 97/100/85; fluconazole, 93/97/95; and itraconazole, 89/98/95. Disagreement was higher between M27-A2 and SYO than between M27-A2 and ATBF2. CONCLUSIONS: ATBF2 is an objective, reproducible and simple method for the accurate determination of MICs of the most common antifungal drugs in yeasts.

[Nasal fungal microbiota in allergic and healthy subjects]. / Microbiota fúngica nasal en sujetos alérgicos y sanos.

Environmental fungi, moulds and yeasts could reach the nasal cavity with the inhaled air causing respiratory symptoms in atopic subjects, but little is known about the fungal flora of this site. In the present study samples of the nasal cavities of 135 subjects aged 18-35 years (48 allergic patients to fungi, mites and/or cat fur and from 87 normal subjects--healthy, control group) were cultured. All of them lived in the metropolitan area of Barcelona. Fungi were isolated from 41.5% of healthy people and in 14.8% of allergy patients (p = 0.011). Morphologically, 50.4% of the isolates were located within 4 genera: Cladosporium, Penicillium, Aspergillus and Alternaria, fungi which are considered the most allergenic. The most prevalent species were: Cladosporium herbarum and C. cladosporioides (23.6%). Alternaria alternata was isolated only in 8.8% of samples from the allergic group, although most subjects were sensitive to this species. There were not differences in the isolation rate between genera and smoking-no-smoking groups. The lower prevalence of nasal fungi from allergic patients could be related to the nasal insufficiency, the hypersecretion and the larger use of handkerchiefs.