RESUMEN
Sex is genetically determined in Histoplasma capsulatum, governed by a sex-specific region in the genome called the mating-type locus (MAT1). We investigate the distribution of isolates of two H. capsulatum mating types in the clades circulating in Buenos Aires, Argentina. Forty-nine H. capsulatum isolates were obtained from the culture collection of the Mycology Center. The MAT1 locus was identified by PCR from the yeast suspension. The analysis of forty-eight isolates from clinical samples exhibited a ratio of 1.7 (MAT1-1:MAT1-2) and the only isolate from soil was MAT1-1. Forty-five H. capsulatum isolates belonged to the LAm B clade (H. capsulatum from Latin American group B clade) and showed a ratio of 1.8 (MAT1-1:MAT1-2). These results suggest an association between the mating types in isolates belonging to the LAm B clade. It remains to be defined whether a greater virulence should be attributed to the differences between the strains of the opposite mating type of the LAm B clade.
Asunto(s)
Genes del Tipo Sexual de los Hongos/fisiología , Histoplasma/fisiología , Argentina , ADN de Hongos/genética , Proteínas Fúngicas/genética , Proteínas Fúngicas/metabolismo , Genes del Tipo Sexual de los Hongos/genética , Histoplasma/genética , Histoplasma/metabolismoRESUMEN
The yeast Saccharomyces cerevisiae var. boulardii is a biotherapeutic agent used for the prevention and treatment of several gastrointestinal diseases. We report a case of fungemia in a patient suffering from Clostridiumdifficile-associated diarrhea and treated with metronidazole and a probiotic containing S. cerevisiae var. boulardii. The yeasts isolated from the blood culture and capsules were identified by MALDI-TOF MS and API ID 32 C as S. cerevisiae, and showed the same appearance and color on CHROMAgar Candida. Treatment with fluconazole 400mg/day was initiated and the probiotic was stopped. The patient was discharged from hospital in good condition and was referred to a rehabilitation center. We suggest that the potential benefit of S. cerevisiae var. boulardii should be accurately evaluated, especially in elderly patients. Moreover, all physicians should be trained in the use of probiotic agents and enquire whether the use probiotics was included in the patients'medical histories.
Asunto(s)
Fungemia/etiología , Micosis/etiología , Probióticos/efectos adversos , Saccharomyces boulardii , Saccharomyces cerevisiae/aislamiento & purificación , Anciano de 80 o más Años , Femenino , HumanosRESUMEN
BACKGROUND: Aspergillus osteomyelitis of the ribs is relatively uncommon. It is a debilitating and severe form of invasive aspergillosis. CASE REPORT: A 61year-old female presented with spontaneous chest pain on the right side of the rib cage and a palpable soft-tissue mass. FDG-PET/CT scan identified activity in the infected site. The lesion was punctured, and purulent material was sent to the laboratory. Aspergillus complex Flavi was isolated. An antifungal treatment with voriconazole was started. The lesion healed, and no recurrence was observed at 8-month follow-up. Molecular identification of the isolate was based on PCR amplification and sequencing of ß-tubulin gene. Aspergillus flavus was identified. CONCLUSIONS: Our case highlights the relevance of microbiological studies in patients with osteomyelitis and the involvement of soft tissue. The FDG-PET/CT scan was found to be a useful tool for revealing the extent of the disease and evaluating the response to the antifungal therapy.
Asunto(s)
Aspergilosis/complicaciones , Aspergillus flavus/aislamiento & purificación , Osteomielitis/microbiología , Caja Torácica , Antifúngicos/uso terapéutico , Aspergilosis/diagnóstico por imagen , Aspergilosis/tratamiento farmacológico , Aspergillus flavus/genética , Femenino , Humanos , Persona de Mediana Edad , Osteomielitis/diagnóstico por imagen , Osteomielitis/tratamiento farmacológico , Tomografía Computarizada por Tomografía de Emisión de Positrones , Caja Torácica/microbiología , Tomografía Computarizada por Rayos X , Voriconazol/uso terapéuticoRESUMEN
The multiplex PCR developed from a suspension of the yeast fungi correctly identified fifty-one clinical of H. capsulatum var. capsulatum strains isolated from clinical samples and soil specimens. The multiplex PCR was developed by combining two pairs of primers, one of them was specific to the H. capsulatum and the other one, universal for fungi, turned out to be specific to H. capsulatum, regardless of the fungus isolate studied. Primers designed to amplify a region of about 390-bp (Hc I-Hc II) and a region of approximately 600-bp (ITS1-ITS4) were used to identify a yeast isolated as H. capsulatum when both regions could be amplified. Absolute agreement (100 % sensitivity) could be shown between this assay and the cultures of H. capsulatum according to their morphological characteristics. Failure to amplify the target DNA sequence by PCR with primers Hc I-Hc II in the presence of the ITS1-ITS4 amplicon in isolates of P. brasiliensis, Cryptococcus neoformans, Trichosporon spp, Candida glabrata, C. albicans, C. tropicalis, C. parapsilosis, C. krusei, or Penicillium marneffei was an unequivocal sign of the high specificity of this assay. The assay specificity was also found to be 100 %. Incipient yeast forms obtained from clinical samples were identified as H. capsulatum by the PCR assay described before the morphological characteristics were registered shortening the time of diagnosis.
Asunto(s)
Histoplasma/aislamiento & purificación , Histoplasmosis/microbiología , Reacción en Cadena de la Polimerasa Multiplex/métodos , Cartilla de ADN/genética , ADN de Hongos/genética , Histoplasma/genética , Histoplasma/crecimiento & desarrollo , Histoplasmosis/diagnóstico , HumanosRESUMEN
BACKGROUND: Coccidioidomycosis is an endemic fungal infection caused by Coccidioides immitis and Coccidioides posadasii. It can be particularly severe in transplant recipients that have a current or a previous coccidioidal infection. Fatal case of coccidioidomycosis has been described in this group of patients. AIMS: We report a severe case of pneumonia caused by C. posadassi in a 29 year-old white woman that had been admitted to hospital as part of the evaluation for bilateral lung transplantation. The patient was a native and resident of Catamarca, Argentina. Molecular methodologies contributed to the species identification. METHODS: Clinical, laboratory records and microbiological tests were carried out to diagnose the infection and to identify C. posadasii. RESULTS: A fungus was isolated from BAL culture. Phenotypic characterization, specific PCR and experimental animal inoculation demonstrated the presence of C. posadasii. The patient responded well to amphotericin B deoxycholate. Lung transplantation was postponed. CONCLUSIONS: Specific PCR can be an important alternative for the correct identification of C. immitis or C. posadasii in laboratories with implemented molecular biology tools. This case emphasizes the need for a systematic assessment in organ transplant units of patients inhabiting endemic areas of coccidioidomycosis.
Asunto(s)
Coccidioides/genética , Coccidioides/aislamiento & purificación , Coccidioidomicosis/diagnóstico , Enfermedades Pulmonares Fúngicas/diagnóstico , Adulto , Coccidioidomicosis/microbiología , Femenino , Humanos , Enfermedades Pulmonares Fúngicas/microbiología , Trasplante de Pulmón , FenotipoRESUMEN
Allergic fungal rhinosinusitis is a benign and non-invasive sinusal disease related to a hypersensitivity reaction to fungal antigens. This process can cause tissue edema with chronic inflammatory disturbances of the respiratory mucosa. We present the case of a 17 year-old immunocompetent male, with history of seasonal allergic rhinosinusitis, nasal polyps and previous surgery for mucocele of the frontal sinus. Sticky material was removed in the last surgery that revealed pigmented and septed filaments on direct examination, and yielded Curvularia on Sabouraud dextrose agar. After a course of amphotericin B, treatment was switched to itraconazole, with good tolerance and favorable clinical outcome.
Asunto(s)
Micosis , Rinitis/microbiología , Sinusitis/microbiología , Adolescente , Humanos , Masculino , Rinitis/complicaciones , Sinusitis/complicacionesAsunto(s)
Exophiala , Micosis/microbiología , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Dermatomicosis/tratamiento farmacológico , Dermatomicosis/microbiología , Farmacorresistencia Fúngica , Endoftalmitis/tratamiento farmacológico , Endoftalmitis/microbiología , Exophiala/efectos de los fármacos , Exophiala/aislamiento & purificación , Exophiala/fisiología , Femenino , Fungemia/tratamiento farmacológico , Fungemia/microbiología , Humanos , Itraconazol/uso terapéutico , Persona de Mediana Edad , Micosis/tratamiento farmacológico , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/microbiología , Osteólisis/etiología , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/microbiología , Pirimidinas/uso terapéutico , Recurrencia , Células Th2/inmunología , Triazoles/uso terapéutico , VoriconazolAsunto(s)
Coccidioidomicosis/diagnóstico , Enfermedades Pulmonares Fúngicas/diagnóstico , Adulto , Anticuerpos Antifúngicos/sangre , Argentina , Coccidioides/inmunología , Coccidioides/aislamiento & purificación , Coccidioidomicosis/transmisión , Susceptibilidad a Enfermedades , Polvo , Granuloma de Células Gigantes/microbiología , Humanos , Enfermedades Pulmonares Fúngicas/transmisión , Masculino , Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/microbiología , Policia , Enfermedades Reumáticas/microbiología , Fumar , Microbiología del Suelo , Esputo/microbiologíaAsunto(s)
Dermatosis del Pie/diagnóstico , Madurella/aislamiento & purificación , Micetoma/diagnóstico , Infecciones Estafilocócicas/complicaciones , Adulto , Antifúngicos/uso terapéutico , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/microbiología , Dermatosis del Pie/tratamiento farmacológico , Dermatosis del Pie/microbiología , Dermatosis del Pie/patología , Humanos , Itraconazol/uso terapéutico , Imagen por Resonancia Magnética , Masculino , Micetoma/complicaciones , Micetoma/tratamiento farmacológico , Micetoma/microbiología , Micetoma/patología , Osteítis/diagnóstico , Osteítis/tratamiento farmacológico , Osteítis/microbiología , Infecciones Estafilocócicas/tratamiento farmacológico , Combinación Trimetoprim y Sulfametoxazol/uso terapéuticoAsunto(s)
Epiglotitis/diagnóstico , Histoplasmosis/diagnóstico , Laringitis/diagnóstico , Anciano , Antifúngicos/uso terapéutico , Diagnóstico Diferencial , Epiglotitis/tratamiento farmacológico , Epiglotitis/microbiología , Histoplasmosis/tratamiento farmacológico , Humanos , Pruebas Inmunológicas , Itraconazol/uso terapéutico , Laringitis/tratamiento farmacológico , Laringitis/microbiología , Leishmaniasis Cutánea/diagnóstico , Masculino , Paracoccidioidomicosis/diagnósticoAsunto(s)
Infecciones por VIH/complicaciones , Úlcera Cutánea/etiología , Sífilis/diagnóstico , Enfermedad de Chagas/complicaciones , Diagnóstico Diferencial , Dermatosis Facial/etiología , Dermatosis Facial/microbiología , Histoplasmosis/diagnóstico , Humanos , Huésped Inmunocomprometido , Masculino , Persona de Mediana Edad , Úlcera Cutánea/microbiología , Sífilis/complicaciones , Serodiagnóstico de la Sífilis , Tiña del Pie/complicaciones , Trichophyton/aislamiento & purificación , Tuberculosis/diagnósticoRESUMEN
The clinical data of 21 patients, suffering AIDS-related histoplasmosis, who were able to interrupt antifungal secondary prophylaxis, after achieving a partial restoration of the cell mediated immunity by HAART administration, are presented. They were 16 males and five females, whose ages varied between 32 and 54 years (mean = 38.5 years). All of them presented disseminated progressive forms of histoplasmosis, with multiple locations (skin, mucous membranes, liver, spleen, lymph nodes and lungs). The majority of the cases suffered other concomitant diseases (specially tuberculosis and Kaposi sarcoma), 66.6 % of the patients had less than 50 CD4+ cells/microl at the start of treatment and the average viral burden was 278,385 RNA copies/ml. The initial treatment consisted in 400 mg/day of itraconazole, by oral route, in 14 cases and the remaining seven patients were treated with amphotericin B, intravenously, at a daily dose of 0.7 mg/kg of body weight. One patient who did not tolerate amphotericin B and presented a partial response to itraconazole, was treated with posaconazole orally at a daily dose of 800 mg. Fourteen patients received oral itraconazole at a daily dose of 200 mg as a secondary prophylaxis, the remaining three patients were treated with intravenous amphotericin B, 50 mg twice a week. After HAART for an average lapse of 16.7 months (10 to 32 months), five cases showed CD4+ cells counts above 150 cells/microl and the remaining 16 presented more than 200 cells/microl; 18 of them had undetectable viral burden and all cases were asymptomatic. The follow up after secondary prophylaxis discontinuation varied between six months and six years (mean= 33.6 months). Twenty out of 21 patients (95 %) were clinically stable, without any manifestation of relapses, including two patients who abandoned HAART. One patient, who discontinued HAART, contracted a fatal bacterial pneumonia. Even though the limited number of cases, the data presented in this study seem to suggest that it is possible to interrupt antifungal secondary prophylaxis of histoplasmosis, when the patient is clinically asymptomatic and the CD4+ cells counts are above 150 cells/microl.