[Gastrointestinal bleeding and potentially inappropriate medication by NSAIDs]. / Hemorragia digestiva y prescripción potencialmente inadecuada de AINEs en mayores de 65 años.

OBJECTIVE: Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are widely used but they increase the risk of gastrointestinal haemorrage among other adverse effects. The objective of this study was to compare potentially inappropriate medications (PIM) by NSAIDs using the original Beers Criteria, a global reference for evaluating elderly people's prescriptions, and the Spanish adaptation of the same; and the relation between PIM of NSAIDs and gastrointestinal bleeding. METHODS: The study was a retrospective observational study carried out located in a primary care district in the province of de Murcia, south-eastern Spain. The study population (n=7.856) were citizens aged 65 and above, with at least one drug prescribed in a Spanish health district during the study period . We analized illnesses and treatments registered in the primary care's electronic medical history of patients and hospital admissions, during the 12 month study period (2012). The original Beers Criteria and their Spanish adaptation were used to evaluate PIM of NSAIDs in patients considering the medication globally and also each active substance. Gastrointestinal bleeding events recorded in the data bases studied were evaluated. RESULTS: Detection of PIM of NSAIDs was 5,6% with the original version and 7,0% (Δ=25,5%; p less than 0,001) with the adapted one. PIM of NSAIDs was related with an increased incidence of gastrointestinal bleeding without significant differences between PIM exposed and NSAID exposed patients AINE (RR=1,6; IC:0,2-14,5). CONCLUSIONS: The Spanish adaptation of the Beers criteria identified a greater degree of PIM of NSAIDs than the original version, and in both versions the detection of PIM was not related with a significant increase of gastrointestinal bleeding compared to patients exposed to NSAIDs.

OBJETIVO: Los Antiinflamatorios No Esteroideos (AINE) son un grupo de medicamentos con uso muy extendido en la población, su uso genera un mayor riesgo de hemorragia digestiva. El objetivo de este trabajo fue evaluar y comparar la prescripción potencialmente inadecuada (PPI) de AINE según los criterios de Beers en su versión original con su adaptación española y la relación de esta PPI con los eventos de sangrado gastrointestinal. METODOS: Estudio observacional longitudinal retrospectivo de 12 meses (año 2012) realizado en un área de salud de la Región de Murcia. La población estudiada fue los mayores de 65 años a los que se les había prescrito, al menos, 1 receta médica de AINE durante el periodo de estudio (7.856). Se utilizaron ambas versiones de los criterios de Beers para evaluar la PPI por AINE. Para evaluar el papel etiológico de la exposición a AINE potencialmente inadecuados, respecto a haber recibido AINE, en la hemorragia gastrointestinal se calculó la incidencia acumulada y el Riesgo Relativo. RESULTADOS: La detección de PPI por AINE pasó de 5,6% con la versión original, a 7,0% (Δ=25,5%; pmenor de 0,001) En los sujetos con prescripción de AINE la exposición a PPI por AINE presentó una mayor incidencia de sangrado gastrointestinal pero sin diferencias significativas respecto a la población que recibió AINE (RR=1,6; IC:0,2-14,5). CONCLUSIONES: El uso de la adaptación española de los criterios de Beers posibilita una mayor detección de PPI por AINE en comparación con el uso de la versión original, en ambas versiones, la PPI por AINE no genera un incremento significativo en el sangrado gastrointestinal respecto a recibir AINE.

Developing collaborative works for faster progress on fungal respiratory infections in cystic fibrosis.

Cystic fibrosis (CF) is the major genetic inherited disease in Caucasian populations. The respiratory tract of CF patients displays a sticky viscous mucus, which allows for the entrapment of airborne bacteria and fungal spores and provides a suitable environment for growth of microorganisms, including numerous yeast and filamentous fungal species. As a consequence, respiratory infections are the major cause of morbidity and mortality in this clinical context. Although bacteria remain the most common agents of these infections, fungal respiratory infections have emerged as an important cause of disease. Therefore, the International Society for Human and Animal Mycology (ISHAM) has launched a working group on Fungal respiratory infections in Cystic Fibrosis (Fri-CF) in October 2006, which was subsequently approved by the European Confederation of Medical Mycology (ECMM). Meetings of this working group, comprising both clinicians and mycologists involved in the follow-up of CF patients, as well as basic scientists interested in the fungal species involved, provided the opportunity to initiate collaborative works aimed to improve our knowledge on these infections to assist clinicians in patient management. The current review highlights the outcomes of some of these collaborative works in clinical surveillance, pathogenesis and treatment, giving special emphasis to standardization of culture procedures, improvement of species identification methods including the development of nonculture-based diagnostic methods, microbiome studies and identification of new biological markers, and the description of genotyping studies aiming to differentiate transient carriage and chronic colonization of the airways. The review also reports on the breakthrough in sequencing the genomes of the main Scedosporium species as basis for a better understanding of the pathogenic mechanisms of these fungi, and discusses treatment options of infections caused by multidrug resistant microorganisms, such as Scedosporium and Lomentospora species and members of the Rasamsonia argillacea species complex.

Prescripción potencialmente inadecuada en mayores de 65 años según los criterios de Beers originales y su versión adaptada / Identifying potentially inappropriate prescriptions in patients over 65 years-old using original Beers criteria and their Spanish adaptation

Objetivo: Comparar la detección de prescripción potencialmente inadecuada (PPI) con el uso de los criterios de Beers, referente global en la evaluación de la farmacoterapia del paciente aciano, en su versión original y en su adaptación española. Diseño: Estudio observacional retrospectivo. Emplazamiento: Un área de salud en la Región de Murcia. Participantes: Ciudadanos mayores de 65 años que hayan recogido, al menos, una receta médica durante el periodo de estudio (n = 7.856). Método: Análisis de la información de la historia clínica informatizada de atención primaria (enfermedades y prescripciones) durante el periodo de estudio (12 meses, año 2012). Se utilizaron los criterios de Beers en su versión original de 2012 y su adaptación española para evaluar la PPI. Se estudió la proporción de pacientes con PPI a nivel global y por cada criterio concreto, y la diferencia entre ambas versiones. Resultados: La mediana de edad de la población estudiada fue de 76años, con predominio del sexo femenino (56,6%). Respecto al uso de medicamentos, la muestra presentó una mediana de 13 principios activos y 66 recetas. Respecto a la población estudiada, el porcentaje de pacientes con PPI según la versión original de los criterios de Beers es del 44,8%, ascendiendo al 49,4% cuando se utiliza la adaptación. Conclusiones: La PPI es frecuente en nuestro entorno. La aplicación directa de los criterios de Beers en su versión original, sin tener en cuenta la idiosincrasia del mercado farmacéutico local, proporciona una infraestimación del volumen de PPI en el paciente mayor de 65 años (AU)

Objective: To compare the detection of potentially inappropriate medication (PIM) using the original Beers criteria, a global reference for evaluating prescriptions in the elderly, and their Spanish version. Design: Retrospective observational study Location: A Primary Care area in the province of Murcia, Spain. Participants: A total of 7,856 subjects aged 65 and over, with at least one drug prescribed in a Primary Care Area of Spain during study period. Method: Illnesses and treatments registered in the Primary Care computerised medical history of patients were analysed during a 12 month study period (2012). The original Beers criteria and their Spanish adaptation were used to evaluate PIM, considering both sets of criteria overall, and individually. Results: The median age of the patients was 76.0 years, with the majority females (56.6%). Patients received a median of 13 active substances and 66 medical prescriptions. The percentage of patients prescribed PIM ranged from 44.8% according to the original Beers criteria to 49.4% with the Spanish adaptation. Conclusions: PIMs are frequent in our context. The original Beers criteria, if not adapted to the local drug catalogue, underestimated the frequency of PIM in the elderly population studied (AU)

[Identifying potentially inappropriate prescriptions in patients over 65 years-old using original Beers criteria and their Spanish adaptation]. / Prescripción potencialmente inadecuada en mayores de 65 años según los criterios de Beers originales y su versión adaptada.

OBJECTIVE: To compare the detection of potentially inappropriate medication (PIM) using the original Beers criteria, a global reference for evaluating prescriptions in the elderly, and their Spanish version. DESIGN: Retrospective observational study LOCATION: A Primary Care area in the province of Murcia, Spain. PARTICIPANTS: A total of 7,856 subjects aged 65 and over, with at least one drug prescribed in a Primary Care Area of Spain during study period. METHOD: Illnesses and treatments registered in the Primary Care computerised medical history of patients were analysed during a 12month study period (2012). The original Beers criteria and their Spanish adaptation were used to evaluate PIM, considering both sets of criteria overall, and individually. RESULTS: The median age of the patients was 76.0years, with the majority females (56.6%). Patients received a median of 13 active substances and 66 medical prescriptions. The percentage of patients prescribed PIM ranged from 44.8% according to the original Beers criteria to 49.4% with the Spanish adaptation. CONCLUSIONS: PIMs are frequent in our context. The original Beers criteria, if not adapted to the local drug catalogue, underestimated the frequency of PIM in the elderly population studied.

Hemorragia digestiva y prescripción potencialmente inadecuada de aines en mayores de 65 años / Gastrointestinal bleeding and potentially inappropriate medication by NSAIDs

Fundamentos: Los Antiinflamatorios No Esteroideos (AINE) son un grupo de medicamentos con uso muy extendido en la población, su uso genera un mayor riesgo de hemorragia digestiva. El objetivo de este trabajo fue evaluar y comparar la prescripción potencialmente inadecuada (PPI) de AINE según los criterios de Beers en su versión original con su adaptación española y la relación de esta PPI con los eventos de sangrado gastrointestinal. Métodos: Estudio observacional longitudinal retrospectivo de 12 meses (año 2012) realizado en un área de salud de la Región de Murcia. La población estudiada fue los mayores de 65 años a los que se les había prescrito, al menos, 1 receta médica de AINE durante el periodo de estudio (7.856). Se utilizaron ambas versiones de los criterios de Beers para evaluar la PPI por AINE. Para evaluar el papel etiológico de la exposición a AINE potencialmente inadecuados, respecto a haber recibido AINE, en la hemorragia gastrointestinal se calculó la incidencia acumulada y el Riesgo Relativo. Resultados: La detección de PPI por AINE pasó de 5,6% con la versión original, a 7,0% (DELTA=25,5%; p<0,001) En los sujetos con prescripción de AINE la exposición a PPI por AINE presentó una mayor incidencia de sangrado gastrointestinal pero sin diferencias significativas respecto a la población que recibió AINE (RR=1,6; IC:0,2-14,5). Conclusiones: El uso de la adaptación española de los criterios de Beers posibilita una mayor detección de PPI por AINE en comparación con el uso de la versión original, en ambas versiones, la PPI por AINE no genera un incremento significativo en el sangrado gastrointestinal respecto a recibir AINE

Background: Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are widely used but they increase the risk of gastrointestinal haemorrage among other adverse effects. The objective of this study was to compare potentially inappropriate medications (PIM) by NSAIDs using the original Beers Criteria, a global reference for evaluating elderly people's prescriptions, and the Spanish adaptation of the same; and the relation between PIM of NSAIDs and gastrointestinal bleeding. Methods: The study was a retrospective observational study carried out located in a primary care district in the province of de Murcia, south-eastern Spain. The study population (n=7.856) were citizens aged 65 and above, with at least one drug prescribed in a Spanish health district during the study period . We analized illnesses and treatments registered in the primary care's electronic medical history of patients and hospital admissions, during the 12 month study period (2012). The original Beers Criteria and their Spanish adaptation were used to evaluate PIM of NSAIDs in patients considering the medication globally and also each active substance. Gastrointestinal bleeding events recorded in the data bases studied were evaluated. Results: Detection of PIM of NSAIDs was 5,6% with the original version and 7,0% (DELTA=25,5%; p<0,001) with the adapted one. PIM of NSAIDs was related with an increased incidence of gastrointestinal bleeding without significant differences between PIM exposed and NSAID exposed patients AINE (RR=1,6; IC:0,2-14,5). Conclusions: The Spanish adaptation of the Beers criteria identified a greater degree of PIM of NSAIDs than the original version, and in both versions the detection of PIM was not related with a significant increase of gastrointestinal bleeding compared to patients exposed to NSAIDs

Criterios Beers versus STOPP. Posibles implicaciones de la adaptación española de los criterios de Beers / Beers versus STOPP criteria and the possible implications of the Beers criteria’s Spanish adaptation

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Mucormycosis in children: a study of 22 cases in a Mexican hospital.

We present a single-centre, retrospective study (1985-2012) of 22 cases of mucormycosis in children. A total of 158 mucormycosis cases were identified, of which 22 (13.96%) were children. The mean age of the children was 10.3 years (range: 6 months-18 years), and 59% of the infections occurred in males. The rhinocerebral form was the main clinical presentation (77.27%), followed by the primary cutaneous and pulmonary patterns. The major underlying predisposing factors were diabetes mellitus in 68.18% of the patients and haematologic diseases in 27.7% of the patients. The cases were diagnosed by mycological tests, with positive cultures in 95.4% of the patients. Rhizopus arrhizus was the foremost aetiologic agent in 13/22 cases (59.1%). In 21 cultures, the aetiologic agents were identified morphologically and by molecular identification. In 10 cultures, the internal transcribed spacer region of the ribosomal DNA was sequenced. Clinical cure and mycological cure were achieved in 27.3% cases, which were managed with amphotericin B deoxycholate and by treatment of the underlying conditions.

Feohifomicosis cerebral: descripción de un caso y revisión de la literatura / Cerebral phaeohyphomycosis: description of a case and review of the literature

La feohifomicosis cerebral es una micosis invasiva infrecuente, de mal pronóstico, sin tratamiento estandarizado y con muy pocos casos referenciados en la literatura. Entre los hongos responsables de la feohifomicosis se encuentra Cladophialophora bantiana, un hongo con especial tropismo por el sistema nervioso central. Se presenta un caso de absceso cerebral por C. bantiana en un adulto con enfermedad de Crohn y tratado con inmunosupresores. A pesar de la identificación del agente etiológico y del tratamiento quirúrgico y farmacológico administrado, el paciente evoluciona desfavorablemente y fallece 32 días después de la cirugía. La descripción del caso clínico se acompaña de una revisión de los episodios de feohifomicosis cerebral por C. bantiana publicados en los últimos 10 años. Los avances diagnósticos, incluyendo las nuevas técnicas de imagen, y el empleo de los nuevos antifúngicos no han mejorado el mal pronóstico de la feohifomicosis cerebral por C. bantiana, siendo aconsejable la combinación de tratamiento quirúrgico y farmacológico, aunque ninguna pauta terapéutica descrita en la literatura destaca por el éxito obtenido (AU)

Cerebral phaeohyphomycosis is a rare invasive fungal infection with very few cases referenced in the literature. There is no standardized treatment, and it is associated with poor outcomes. Cladophialophora bantiana, a fungus with special tropism for the central nervous system, is one of the causal agents of phaeohyphomycosis. The case presented here deals with a brain abscess by C. bantiana in an adult with Crohn's disease had beed being treated with immunosuppressive drugs. Despite the correct etiological diagnosis, surgical and pharmacological treatments, the patient died 32 days after surgery. A description of the case is followed by a review of all cerebral C. bantiana phaeohyphomycosis cases published in the last 10 years. Regardless of the use of advanced new imaging techniques in the diagnosis and treatment with new antifungal agents, cerebral phaeohyphomycosis by C. bantiana continues to have very poor prognosis. While new more successful therapeutic treatments appear, a combined surgical and pharmacological approach seems to be more appropriate for this severe mycosis (AU)

Pithomyces species (Montagnulaceae) from clinical specimens: identification and antifungal susceptibility profiles.

The fungal genus Pithomyces comprises numerous dematiaceous saprobic species commonly found on dead leaves and stems of a great variety of plants. Occasionally, they have been recovered from clinical specimens. We morphologically and molecularly (rDNA sequences) investigated a set of 42 isolates tentatively identified as Pithomyces recovered from clinical specimens in the United States. The predominant species were P. chartarum and P. sacchari (33.3% each), followed by Pithomyces sp. I (28.6%) and P. maydicus (4.8%). Most of the isolates were obtained from samples of superficial tissue (50%), the respiratory tract (21.4%), and the nasal region (19%). In general, these fungi were highly susceptible in vitro to the eight antifungal agents tested.

Acremonium with catenate elongate conidia: phylogeny of Acremonium fusidioides and related species.

Acremonium is one of the largest and most complex genera of hyphomycetes. Its taxonomy is not yet resolved and the phylogenetic value of the most distinctive morphological features is unknown. The species of this genus produce conidia in chains or form slimy heads or both. We have studied a set of clinical and environmental Acremonium strains morphologically characterized by producing mostly catenate, elongate, more or less fusiform conidia. Based on phenotypic data and in the analysis of the sequences of the ITS region, the D1/D2 domains of the 28S rRNA gene and a fragment of the ß-tubulin gene, three new species morphologically similar to Acremonium fusidioides and belonging to the family Bionectriaceae (Hypocreales) are described and illustrated; they are Acremonium pilosum, Acremonium parvum and Acremonium citrinum. The first species produces two kinds of conidia: clavate with smooth walls and globose with abundant filiform projections. Acremonium parvum is characterized by slow growth and pyriform or slightly lanceolate conidia with an elongate and truncate base. Acremonium citrinum produces a diffusible yellow pigment and obovoid conidia.

[Cerebral phaeohyphomycosis: description of a case and review of the literature]. / Feohifomicosis cerebral: descripción de un caso y revisión de la literatura.

Cerebral phaeohyphomycosis is a rare invasive fungal infection with very few cases referenced in the literature. There is no standardized treatment, and it is associated with poor outcomes. Cladophialophora bantiana, a fungus with special tropism for the central nervous system, is one of the causal agents of phaeohyphomycosis. The case presented here deals with a brain abscess by C. bantiana in an adult with Crohn's disease had beed being treated with immunosuppressive drugs. Despite the correct etiological diagnosis, surgical and pharmacological treatments, the patient died 32 days after surgery. A description of the case is followed by a review of all cerebral C. bantiana phaeohyphomycosis cases published in the last 10 years. Regardless of the use of advanced new imaging techniques in the diagnosis and treatment with new antifungal agents, cerebral phaeohyphomycosis by C. bantiana continues to have very poor prognosis. While new more successful therapeutic treatments appear, a combined surgical and pharmacological approach seems to be more appropriate for this severe mycosis.

Coniochaeta polymorpha, a new species from endotracheal aspirate of a preterm neonate, and transfer of Lecythophora species to Coniochaeta.

A new species of Coniochaeta from endotracheal secretion of a preterm neonate, Coniochaeta polymorpha, is described. This anamorphic species is characterized by development of dark brown colonies after 1 week of incubation on culture medium, formation of abundant yeast-like cells and sclerotium-like structures producing discrete, brown, nearly globose phialidic conidiogenous cells and absence of chlamydospores. A combined sequence dataset of the ITS region, partial LSU rDNA, actin and ß-tubulin genes sufficiently resolved the unique phylogenetic status of this species. In response to recent changes in the nomenclature for pleomorphic fungi, we transfer the Lecythophora species to Coniochaeta, and propose the following new combinations: Coniochaeta canina, Coniochaeta cateniformis, Coniochaeta decumbens, Coniochaeta fasciculata, Coniochaeta hoffmannii, Coniochaeta lignicola, Coniochaeta luteorubra, Coniochaeta luteoviridis and Coniochaeta mutabilis.

In vitro antifungal susceptibility and molecular identity of 99 clinical isolates of the opportunistic fungal genus Curvularia.

The in vitro antifungal susceptibility of a set of 99 clinical isolates of Curvularia was tested against 9 drugs using a reference microdilution method. The isolates had been identified previously to species level by comparing their ITS rDNA and glyceraldehyde-3-phosphate dehydrogenase gene sequences with those of reference strains. We were able to reliably identify 73.2% of the isolates, the most frequent species being Curvularia aeria, Curvularia geniculata/Curvularia senegalensis, Curvularia lunata, Curvularia inaequalis, Curvularia verruculosa, and Curvularia borreriae. Most of these isolates had been recovered from nasal sinus, which is generally considered one of the most frequent sites of infection by these fungi. In addition, at least 3 phylogenetic species that have not yet been formally described were detected. The most active drugs were the echinocandins, amphotericin B, and posaconazole, whereas voriconazole and itraconazole showed poor activity.

In vitro antifungal susceptibility of clinically relevant species belonging to Aspergillus section Flavi.

The in vitro antifungal susceptibility of 77 isolates belonging to different clinically relevant species of Aspergillus section Flavi, including those of different phylogenetic clades of A. flavus, was tested for nine antifungal agents using a microdilution reference method (CLSI, M38-A2). Terbinafine and the echinocandins demonstrated lower MICs/MECs for all species evaluated, followed by posaconazole. Amphotericin B showed MICs ≥ 2 µg/ml for 38 (49.4%) of the 77 isolates tested.

Polyphasic analysis of Purpureocillium lilacinum isolates from different origins and proposal of the new species Purpureocillium lavendulum.

Purpureocillium is a genus recently proposed to accommodate Paecilomyces lilacinus, a well studied species that has biotechnological properties and an ability to cause human infections. Since contradictory data have been reported on the intraspecific genetic variability of P. lilacinum, we have carried out a polyphasic study of a set of clinical and environmental isolates of this species. Detailed morphological examination and sequence analysis of four different loci, including the ribosomal internal transcribed spacer, the domains D1 and D2 of the 28S rDNA, EF-1a and the largest subunit of RNA polymerase II (rpb1), showed that P. lilacinum formed a well supported phylogenetic clade with low intraspecific variability. The new species Purpureocillium lavendulum, which has vinaceous colonies similar to those of P. lilacinum, is proposed. It is characterized by the lack of growth at 35 C, the production of a yellow diffusible pigment and by subglobose or limoniform conidia.

Phialemoniopsis, a new genus of Sordariomycetes, and new species of Phialemonium and Lecythophora.

In molecular studies involving numerous clinical isolates of the genera Acremonium, Phialemonium and Lecytophora some of them could not be identified. To clarify the phylogenetic relationships among these fungi and other related taxa, we performed a polyphasic study based on a detailed morphological study and on the analysis of sequences of four loci: the internal transcribed spacer regions, the D1/D2 domains of the 28S rRNA, actin and ß-tubulin genes. The combination of the resulting data let us propose the new genus Phialemoniopsis to accommodate the opportunistic fungi Phialemonium curvatum and Sarcopodium oculorum and two new species, Phialemoniopsis cornearis and Phialemoniopsis pluriloculosa. The taxonomy of Phialemoniopsis has not been completely resolved, however, remaining incertae sedis within the Sordariomycetes. In addition, the new species Lecythophora luteorubra, Lecythophora cateniformis and Phialemonium globosum are described and the species Acremonium atrogriseum and Taifanglania inflata are transferred to the genus Phialemonium. Lecythophora and Phialemonium are currently monophyletic genera of the families Coniochaetaceae (Coniochaetales) and Cephalothecaceae (Sordariales) respectively, according to our results. Tables summarizing key morphological features to distinguish the current species of Lecythophora, Phialemonium and Phialemoniopsis are provided.

Rare arthroconidial fungi in clinical samples: Scytalidium cuboideum and Arthropsis hispanica.

We report the presence of the two arthroconidial anamorphic fungi, Scytalidium cuboideum and Arthropsis hispanica, in clinical samples from the USA. Both fungi were morphologically and molecularly identified. The antifungal susceptibility of four isolates of A. hispanica and five of S. cuboideum to eight antifungal drugs is provided.

Molecular phylogeny and phenotypic variability of clinical and environmental strains of Aspergillus flavus.

Aspergillus flavus is the second most common cause of aspergillosis infection in immunocompromised patients and is responsible for the production of aflatoxins. Little is known about the population structure of A. flavus, although recent molecular and phenotypic data seem to demonstrate that different genetic lineages exist within this species. The aim of this study was to carry out a morphological, physiological, and molecular analysis of a set of clinical and environmental isolates to determine whether this variability is due to species divergence or intraspecific diversity, and to assess whether the clinical isolates form a separate group. The amdS and omtA genes were more phylogenetically informative than the other tested genes and their combined analysis inferred three main clades, with no clear distinction between clinical and environmental isolates. No important morphological and physiological differences were found between the members of the different clades, with the exception of the assimilation of d-glucosamine, which differentiates the members of the clade II from the others.

Two new species of Acremonium from Spanish soils.

In a survey on the diversity of microfungi in Spanish soils, two new species of Acremonium were found. Both species were characterized as having more or less erect, mostly branched conidiophores bearing whorls of acicular phialides. In addition, one of these species, Acremonium asperulatum, produced abundant chlamydospores and globose rough-walled conidia. The other species, Acremonium variecolor, produced a brownish diffusible pigment and smooth-walled, subglobose conidia with apiculate base; sessile conidia inserted directly on vegetative hyphae also were present. The analysis of the sequences of the ITS region, the D1/D2 domains of the 28S rRNA gene and a fragment of the actin gene revealed relationships of both species with members of the Bionectriaceae (Hypocreales). Genetic differences were observed with morphologically similar species.