Tiña capitis por Microsporum gypseum, una especie infrecuente / Tinea capitis by Microsporum gypseum, an infrequent species

La tiña capitis es considerada la infección por dermatofitos más frecuente en los niños. Los agentes etiológicos varían con el tiempo y según la zona geográfica, aunque, normalmente, son dermatofitos de origen zoofílico y, en los últimos años, también dermatofitos antropofílicos. Se presenta un caso de tiña capitis inflamatoria en un niño de 6 años de edad causada por Microsporum gypseum, un hongo geofílico patógeno para humanos y animales. Las fuentes de infección humana son el suelo, los gatos, los perros y pequeños mamíferos. Esta especie es poco frecuente como causa de dermatofitosis en el hombre, descrita, sobre todo, en tiña corporis y, raramente, en tiña capitis. En el diagnóstico de tiña capitis, identificar la especie causal es un factor determinante para el tratamiento.

Tinea capitis is considered the most frequent dermatophyte infection in children. The etiological agents vary from time to time and by geographical area, although they normally are zoophilic dermatophytes and in the last years also anthropophilic species. We report a clinical case of inflammatory tinea capitis in a 6-year-old child caused by Microsporum gypseum, a geophilic fungus pathogenic to humans and animals. The sources of human infection are soil, cats, dogs and small mammals. This species is less frequent as a cause of dermatophytosis in humans, described mainly in tinea corporis and rarely in tinea capitis. In the diagnosis of tinea capitis identifying the causative species is a determinant of the treatment.

[Tinea capitis by Microsporum gypseum, an infrequent species]. / Tiña capitis por Microsporum gypseum, una especie infrecuente.

Tinea capitis is considered the most frequent dermatophyte infection in children. The etiological agents vary from time to time and by geographical area, although they normally are zoophilic dermatophytes and in the last years also anthropophilic species. We report a clinical case of inflammatory tinea capitis in a 6-year-old child caused by Microsporum gypseum, a geophilic fungus pathogenic to humans and animals. The sources of human infection are soil, cats, dogs and small mammals. This species is less frequent as a cause of dermatophytosis in humans, described mainly in tinea corporis and rarely in tinea capitis. In the diagnosis of tinea capitis identifying the causative species is a determinant of the treatment.

La tiña capitis es considerada la infección por dermatofitos más frecuente en los niños. Los agentes etiológicos varían con el tiempo y según la zona geográfica, aunque, normalmente, son dermatofitos de origen zoofílico y, en los últimos años, también dermatofitos antropofílicos. Se presenta un caso de tiña capitis inflamatoria en un niño de 6 años de edad causada por Microsporum gypseum, un hongo geofílico patógeno para humanos y animales. Las fuentes de infección humana son el suelo, los gatos, los perros y pequeños mamíferos. Esta especie es poco frecuente como causa de dermatofitosis en el hombre, descrita, sobre todo, en tiña corporis y, raramente, en tiña capitis. En el diagnóstico de tiña capitis, identificar la especie causal es un factor determinante para el tratamiento.

Nosocomial Candiduria in the Elderly: Microbiological Diagnosis.

Candiduria is associated with high morbidity, mortality, and long hospitalization, involving high costs for the healthcare system. The use of increasingly aggressive treatments has prolonged the lives of patients susceptible to candiduria, namely the immunosuppressed, the premature, and the elderly. Our objective was to evaluate the incidence of nosocomial candiduria and the implicated species in hospitalized patients aged over 80 years old from three Spanish centers during 2012 and 2013. Urine samples received from these patients were cultured and analyzed by flow cytometry in search of leukocyturia, hematuria, proteinuria, and microbial nitrate reductase activity. The isolated yeast species were identified microscopically, by germ tube formation in serum, colony morphology after subculture onto CHROMagar Candida (Becton-Dickinson, UK), assimilation of carbon compounds ID32C (bioMérieux, France), matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDITOF) (Bruker Daltonics, Germany) and, in case of inconsistency, by sequencing of the ITS regions of ribosomal DNA (ITS1-5, 8S-ITS2). Susceptibility tests were also performed. The incidence of candiduria in the elderly population was 10.3%. A total of 155 strains of yeasts were isolated. The predominant species was Candida albicans, followed by Candida glabrata and then Candida tropicalis. Several infrequent species were found; among them, the first isolate of candiduria-producing Candida pulcherrima described in the literature. Our finding should raise concerns about the elderly population, which is probably the most important risk group for candiduria in the present moment, and the emergence of unusual yeast species producing candiduria, which are resistant against the commonly used antifungal agents.

Urinary tract infection in the oldest old: a work overload for the microbiology laboratory / Infecciones del tracto urinario en los más mayores: una sobrecarga para el laboratorio de Microbiología

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Utilidad de la espectrometría de masas en el diagnóstico microbiológico de la candiduria / Utility of mass spectrometry in the microbiological diagnosis of candiduria

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Infecciones por Mycobacterium simiae / Infections due to Mycobacterium simiae

Mycobacterium simiae es una micobacteria ambiental de crecimiento lento, fotocromógena, descrita por primera vez en 1965. Se asocia raramente a infecciones humanas, posiblemente por su limitada patogenicidad, principalmente a infección pulmonar en pacientes inmunocompetentes de edad avanzada con enfermedad pulmonar subyacente, e infección diseminada en pacientes jóvenes inmunodeprimidos con sida. El cultivo microbiológico es necesario para confirmar la sospecha clínica, y las técnicas de secuenciación genética son indispensables para identificar la especie. El tratamiento de las infecciones por M. simiae es complicado por su multirresistencia a los fármacos antituberculosos y por la falta de correlación de los datos de sensibilidad in vitro con la respuesta in vivo. El tratamiento adecuado aún está por definir, pero debe incluir claritromicina asociada a otros antimicrobianos, como moxifloxacino y cotrimoxazol. Es posible que las infecciones por M. simiae estén infradiagnosticadas

Mycobacterium simiae is a slow-growing photochromogenic environmental mycobacterium, first described in 1965. Rarely associated with human infections, possibly due to its limited pathogenicity, it mainly produces lung infection in immunocompetent elderly patients with underlying lung disease, and in disseminated infections in immunosuppressed young patients with AIDS. A microbiological culture is needed to confirm the clinical suspicion, and genetic sequencing techniques are essential to correctly identify the species. Treating M. simiae infections is complicated, owing to the multiple resistance to tuberculous drugs and the lack of correlation between in vitro susceptibility data and in vivo response. Proper treatment is yet to be defined, but must include clarithromycin combined with other antimicrobials such as moxifloxacin and cotrimoxazole. It is possible that M. simiae infections are undiagnosed

Evaluación de la espectrometría de masas en la identificación de levaduras de interés clínico / Evaluation of mass spectrometry for the identification of clinically interesting yeasts

INTRODUCCIÓN: La identificación de levaduras se basa en el estudio de las características morfológicas, bioquímicas y nutricionales, y en la utilización de métodos moleculares. La espectrometría de masas matrix-assisted laser desorption ionization time-of-fligh (MALDI-TOF) constituye un nuevo método de identificación de microorganismos que ha demostrado gran utilidad. Nuestro objetivo ha sido evaluar este nuevo método en la identificación de levaduras. MÉTODOS: Ensayamos un total de 600 cepas aisladas de muestras clínicas pertenecientes a 9 géneros y 43 especies. La identificación se realizó mediante secuenciación de las regiones ITS del ADN ribosómico, asimilación de compuestos de carbono (ID 32C) y espectrometría de masas en un espectrómetro Microflex (Bruker Daltonics GmbH, Alemania). RESULTADOS: Un total de 569 cepas (94,8%) fueron identificadas a nivel de especie por ID 32C, y 580 (96,7%) por MALDI-TOF. La concordancia entre ambos métodos comprendió un total de 553 cepas (92,2%), elevándose al 100% en las especies de interés clínico: Candida albicans, C. glabrata, C. parapsilosis, C. tropicalis, y casi del 100% en C. krusei. MALDI-TOF identificó especies que precisan métodos moleculares: Candida dubliniensis, C. nivariensis, C. orthopsilosis y C. metapsilosis. Observamos cierta irregularidad en la identificación de levaduras formadoras de artroconidias y de basidiomicetos. CONCLUSIÓN: La espectrometría de masas MALDI-TOF es un método rápido, rentable y económico que permite la identificación de la mayoría de las levaduras aisladas en clínica, así como la diferenciación de especies estrechamente relacionadas. Sería conveniente la inclusión de más especies en su base de datos para ampliar su rentabilidad

INTRODUCTION: The aim of the study was to analyze the incidence, management and cost associated to hematological and dermatological adverse effects (AE) in chronic hepatitis C patients on triple therapy (TT) with telaprevir (TVR) or boceprevir (BOC). METHODS: An analysis was made on the data recorded on patients who started treatment with TVR or BOC associated with peginterferon alfa and ribavirin in a 12-week follow-up period. RESULTS: Fifty-three patients were included (TVR n = 36; BOC n = 17). Thrombocytopenia (83% TVR vs. 88% BOC) followed by neutropenia (89% TVR vs. 82% BOC) were the most common AE. Dermatological AE were observed in 32% of patients. Eleven patients required treatment discontinuation (all of them received TVR), and toxicity was the main reason for discontinuation (64%). The percentage of patients who required supportive treatment for management of AE was 66%. The most used supportive treatment was erythropoietin. Eight patients required emergency health care, and 2 were hospitalized due to AE. Total cost of additional supportive resources was 32,522 Euros (625 [SD = 876] Euros/patient) (TVR 759 [SD = 1,022] Euros/patient vs. BOC 349 [SD = 327] Euros/patient; P > .05). Patients with grade iii-iv toxicity required greater supportive care with higher costs, compared to patients with grade i-ii toxicity (849 [SD = 1,143] Euros/patient vs. 387 [SD = 397] Euros/patient; P = .053). CONCLUSION: The addition of new protease inhibitors to conventional treatment leads to a higher incidence of hematological AE in our study, compared to data described in clinical trials. The elevated incidence of AE involves the use of supportive care, increasing total costs of therapy

Prevalencia de Candida orthopsilosis y Candida metapsilosis en muestras clínicas / Prevalence of Candida orthopsilosis and Candida metapsilosis in clinical samples

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Fungemia por Trichosporon asahii en un paciente con neoplasia hematológica / Fungemia due to Trichosporon asahii in a patient with hematological malignancy

Antecedentes. La tricosporonosis es una infección oportunista debida a hongos levaduriformes del género Trichosporon. La mayoría de los casos de tricosporonosis invasiva acontecen en individuos inmunodeficientes. Caso clínico. Describimos un caso de infección diseminada por Trichosporon asahii en un paciente hematológico. Se trata de un varón de 52 años diagnosticado de leucemia linfoblástica aguda que desarrolla un cuadro febril durante el tercer ciclo de quimioterapia de inducción. A las 24 h de incubación se observó positividad en los hemocultivos extraídos, visualizándose en la tinción de Gram estructuras alargadas compatibles con elementos fúngicos. La identificación del hongo como Trichosporon asahii se llevó a cabo mediante la asimilación de compuestos de carbono y la amplificación y secuenciación de los dominios D1/D2 y la región espaciadora interna transcrita del ADN ribosómico. El hongo se aisló además de unas lesiones pustulosas que presentaba el paciente en la región pectoral. Tras tratamiento con anfotericina B, el paciente evolucionó favorablemente de las lesiones y del proceso febril. Conclusiones. Trichosporon asahii es un patógeno emergente en pacientes inmunodeprimidos y su presencia no debe ser considerada como colonización, pues existe riesgo de infección invasiva (AU)

Background. Trichosporonosis is an opportunistic infection caused by the genus Trichosporon. The majority of cases of invasive trichosporonosis occurs in immunocompromised individuals. Case report. We describe a case of disseminated infection by Trichosporon asahii in a hematology patient. A 52-year-old man diagnosed with acute lymphoblastic leukemia developed a febrile episode during the third cycle of the induction chemotherapy. The blood cultures were positive after 24 h incubation, showing elongated structures compatible with fungal elements in the Gram stain. The identification of the fungus as Trichosporon asahii was carried out by the assimilation of compounds of carbon and the amplification and sequencing of the D1/D2 domain and the internal transcribed spacer of the ribosomal DNA. The fungus was also isolated from the pustular lesions that the patient had in the chest. After treatment with amphotericin B, the patient progressed satisfactorily. Conclusions. Trichosporon asahii is an emergent pathogen in immunosupressed patients and its presence should not be considered as colonization, as there is risk of invasive infection (AU)

Diferenciación de especies del complejo Mycobacterium fortuitum mediante espectrometría de masas / Differentiation of Mycobacterium fortuitum complex species using mass spectrometry

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[Fungemia due to Trichosporon asahii in a patient with hematological malignancy]. / Fungemia por Trichosporon asahii en un paciente con neoplasia hematológica.

BACKGROUND: Trichosporonosis is an opportunistic infection caused by the genus Trichosporon. The majority of cases of invasive trichosporonosis occurs in immunocompromised individuals. CASE REPORT: We describe a case of disseminated infection by Trichosporon asahii in a hematology patient. A 52-year-old man diagnosed with acute lymphoblastic leukemia developed a febrile episode during the third cycle of the induction chemotherapy. The blood cultures were positive after 24h incubation, showing elongated structures compatible with fungal elements in the Gram stain. The identification of the fungus as Trichosporon asahii was carried out by the assimilation of compounds of carbon and the amplification and sequencing of the D1/D2 domain and the internal transcribed spacer of the ribosomal DNA. The fungus was also isolated from the pustular lesions that the patient had in the chest. After treatment with amphotericin B, the patient progressed satisfactorily. CONCLUSIONS: Trichosporon asahii is an emergent pathogen in immunosupressed patients and its presence should not be considered as colonization, as there is risk of invasive infection.

[Infections due to Mycobacterium simiae]. / Infecciones por Mycobacterium simiae.

Mycobacterium simiae is a slow-growing photochromogenic environmental mycobacterium, first described in 1965. Rarely associated with human infections, possibly due to its limited pathogenicity, it mainly produces lung infection in immunocompetent elderly patients with underlying lung disease, and in disseminated infections in immunosuppressed young patients with AIDS. A microbiological culture is needed to confirm the clinical suspicion, and genetic sequencing techniques are essential to correctly identify the species. Treating M. simiae infections is complicated, owing to the multiple resistance to tuberculous drugs and the lack of correlation between in vitro susceptibility data and in vivo response. Proper treatment is yet to be defined, but must include clarithromycin combined with other antimicrobials such as moxifloxacin and cotrimoxazole. It is possible that M. simiae infections are undiagnosed.

[Evaluation of mass spectrometry for the identification of clinically interesting yeasts]. / Evaluación de la espectrometría de masas en la identificación de levaduras de interés clínico.

INTRODUCTION: Identification of yeasts is based on morphological, biochemical and nutritional characteristics, and using molecular methods. Matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry, a new method for the identification of microorganisms, has demonstrated to be very useful. The aim of this study is to evaluate this new method in the identification of yeasts. METHODS: A total of 600 strains of yeasts isolated from clinical specimens belonging to 9 genera and 43 species were tested. Identification was made by sequencing of the ITS regions of ribosomal DNA, assimilation of carbon compounds (ID 32C), and mass spectrometry on a Microflex spectrometer (Bruker Daltonics GmbH, Germany). RESULTS: A total of 569 strains (94.8%) were identified to species level by ID 32C, and 580 (96.7%) by MALDI-TOF. Concordance between both methods was observed for 553 strains (92.2%), with 100% in clinically relevant species: C. albicans, C. glabrata, C. parapsilosis, C. tropicalis, and almost 100% in C. krusei. MALDI-TOF identified species requiring molecular methods: Candida dubliniensis, C. nivariensis, C. metapsilosis and C. orthopsilosis. Some irregularities were observed in the identification of arthroconidia yeast and basidiomycetes. CONCLUSION: MALDI-TOF is a rapid, effective and economic method, which enables the identification of most clinically important yeasts and the differentiation of closely related species. It would be desirable to include more species in its database to expand its performance.

Candida galli as a cause of tinea unguium-molecular characterization of a rare clinical fungal entity.

We present the first clinical report of an infection caused by Candida galli, an anamorphic yeast species in the Yarrowia clade. C. galli has been described in the literature only four times, but never before it has been isolated from clinical samples. The colony morphology on Sabouraud medium and morphotype on CHROMagar Candida medium were similar to C. lipolytica as well as the carbon assimilation profile. The phenotypic differences with C. lipolytica were the non-assimilation of N-acetyl glucosamine, the absence of urease activity, growth in 10 % NaCl with 5 % glucose and in vitamin-free medium. MALDI-TOF MS could not generate reliable identification of the strain. Molecular analysis based on amplification of the ITS1-5.8S-ITS2 rDNA regions confirmed the identity as C. galli. Antifungal susceptibility test clearly demonstrated high MICs to 5-fluorocytosine, amphotericin B and fluconazole, as in the species belonging to the Yarrowia clade.