Xanthogranulomatous pyelonephritis is associated with higher tissue expression of monocyte chemotactic protein-1.

TOPIC: Xanthogranulomatous pyelonephritis (XGP) is a chronic inflammation of the kidney characterized by destruction and replacement of its parenchyma with granulomatous tissue. It is associated with both chronic urinary obstruction and urinary tract infection (UTI). METHODS: We studied two children with chronic ureteropelvic junction obstruction (UPJO) and recurrent UTI nephrectomized for poor kidney function. An intraoperative renal biopsy was taken to relate the presence of infiltrating monocytes plus tubular atrophy to tissue expression of monocyte chemotactic protein-1 (MCP-1) and epidermal growth factor (EGF). XGP was diagnosed by a pathologist in both cases. RESULTS: MCP-1 expression was significantly higher in the two patients compared with the controls or patients with uncomplicated UPJO. It also correlated with the extent of monocyte infiltration, whereas EGF was only significantly downregulated when compared with the controls. CONCLUSIONS: MCP-1 would seem to play a key role in the pathogenesis of XGP by mediating the recruitment of circulating monocytes or by cells resident in the interstitial space.

El embarazo como única condición subyacente de una criptococosis: a propósito de 2 casos / The pregnancy like only underlying condition of a criptococosis: a purpose of 2 cases

Rara vez el embarazo ha sido asociado con criptococosis. Se presentan 2 pacientes VIH seronegativas, hospitalizadas en el Hospital Universitario de Caracas por presentar criptococosis meníngea, en las cuales la única condición subyacente fue el embarazo. Se hace una revisión de la literatura.

Well diffusion for antifungal susceptibility testing.

INTRODUCTION: The increasing clinical and microbiologic resistance of Candida spp. isolates to several antifungal agents is becoming a serious problem. It is now reasonable to propose the use of antifungal susceptibility testing in Candida spp. isolates from patients who have failed conventional therapy, before the selection of an empirical therapy. METHODS: One hundred and fifty eight isolates of Candida spp. were evaluated simultaneously by broth microdilution (NCCLS standard) and well diffusion testing (WD), a diffusion method similar to disc diffusion. RESULTS: According to the Wilcoxon Signed Ranks test performed, there was no significant difference (p>0.05) between both methodologies for all antifungal agents tested (fluconazole, itraconazole, posaconazole, caspofungin and amphotericin B, with C. tropicalis, C. krusei, C. dubliniensis, C. guillermondii, C. parapsilosis, C. albicans and C. glabrata). A significant difference was observed when comparing well diffusion with NCCLS for fluconazole WD 80% (p=0.008) in C. glabrata, as well as WD 80% (p=0.002) and WD 50% (p=0.002) in C. albicans. CONCLUSIONS: The well diffusion test is simple, easy to reproduce, inexpensive, easy both to read and interpret, and has a good correlation to the reference NCCLS microdilution test and may represent an alternative method for antifungal drug susceptibility testing of Candida spp., mainly in laboratories with few resources.

Identificación de cryptococcus neoformans var. gattii mediante el uso del medio canavaninaglicina-azul de bromotinol (CGB) / Identification of cryptococcus neoformans var. gattii by canavanine glycine bromothymol blue medium (CGB)

Se conocen 2 variedades de cryptococcus neoformans y 5 serotipos: cryptococcus neoformans var. neoformans (serotipos A,D y AD), usualmente aislados a partir de muestras clínicas, encontrándose cryptococcus neoformans var. neoformans serotipo A, con mayor incidencia en pacientes con SIDA; cryptococcus neoformans var. gattii (serotipos B y C), los cuales son aislados menos frecuentemente principalmente en pacientes VIH seronegativos y excepcionalmente han sido asociados con SIDA. Se estudiaron 43 cepas de cryptococcus neoformans. El medio de canavanina-glicina-azul de bromotinol (CGB) permite diferenciar en crytococcus la variedad gattii de la variedad neoformans. Nuestro estudio refleja que las 2 cepas (4,65 por ciento) de cryptococcus neoformans var. gattii, obtenidas a partir del aislamiento de muestras de líquido cefalorraquídeo, procedían de una paciente con inmunodeficiencia celular y humoral catalogada como ideopática, y de un paciente con SIDA, asociación rara vez reportada. Son escasos los estudios epidemiológicos de esta micosis en Venezuela, y pocos hacen identificación más allá de la especie, por lo cual es dificil comparar nuestros resultados

Utilidad del método LA-Sporothrix antibody system en el diagnóstico de la esporotricosis cutánea / LA-Sporothrix antibody system`s utility in cutaneous sprotrichosis diagnosis

La esporotricosis es la enfermedad causada por el hongo Sporothrix schenckii. El diagnóstico se obtiene por la demostración de los cuerpos asteroides en las lesiones, o por la identificación de S. schenkii en el cultivo. Existe una prueba, LA-SPOROTRIX ANTIBODY SYSTEM de IMMY, de aglutinación cualitativa de partículas de látex, para determinar la presencia de anticuerpos de tipo IgM a partir del suero en pacientes con esporotricosis. El objetivo de este estudio fue evaluar la utilidad de esta prueba en el diagnóstico certero de esporotricosis cutánea. Se analizaron 87 sueros, 10 con esporotricosis, 17 con leishmaniasis, 20 con paracoccidioidomicosis, 20 con histoplasmosis y 20 sueros de individuos sanos. La sensibilidad de la prueba fue del 100 por ciento con una especificidad del 54 por ciento. Esto sugiere que es una técnica útil para excluir el diagnóstico de esta enfermedad; sin embargo, no es la más apropiada para un diagnóstico confirmatorio

Histopathologic and histochemical characterization of calcified structures in hamsters inoculated with Paracoccidioides brasiliensis.

In pathogenicity studies of 31 Paracoccidioides brasiliensis isolates preserved using Castellani's method we intraperitoneally inoculated 104 young adult hamsters and found laminated concentric structures and calcified appearance that resembled Schaumann bodies, in 43 of them, especially in animals with apparently good condition. We characterized these structures histologically and histochemically using different stains (PAS, Grocott, haematoxylin-eosin, Von Kossa). The Von Kossa staining revealed calcium in these structures. Similar structures have been described in patients with sarcoidosis and also in hamsters inoculated with P. brasiliensis. We found no correlation between the presence of these calcifications and serum calcium levels.

Antifungal activity of Crotalus durissus cumanensis venom.

The susceptibility to Crotalus venom of 14 yeast and 10 mould fungal isolates was assessed. This venom was tested in a standardized well diffusion test, using 400 microg/20 microl well. The percentage of susceptibility to yeast isolates was 78.6% (> 8 mm); that for filamentous isolates was 50% (> 8 mm).

In vitro susceptibility of 137 Candida sp. isolates from HIV positive patients to several antifungal drugs.

Oropharyngeal candidiasis caused by various species of Candida is one of the most common infections in HIV seropositive or AIDS patients. Drug resistance among these yeasts is an increasing problem. We studied the frequency of resistance profile to fluconazole, itraconazole, ketoconazole, amphotericin B and terbinafine of 137 isolates of Candida sp. From HIV positive or AIDS patients with oropharyngeal candidiasis at Instituto de Inmunología, U.C.V. and the Hospital "Jose Ignacio Baldó", Caracas Venezuela, using the well diffusion susceptibility test (Magaldi et al.). We found that nearly 10% of C. albicans isolates were primarily fluconazole resistant, 45% of C. albicans isolates from patients with previous treatment were resistant to fluconazole, of which 93% showed cross-resistance to itraconazole, and even about 30% of C. tropicalis (n = 13) were resistant to fluconazole and/or itraconazole. To this respect, several recent reports have been described antifungal cross-resistance among azoles. Therefore, we consider that C. tropicalis should be added to the growing list of yeast in which antifungal drug resistance is common. This report could be useful for therapeutic aspect in AIDS patients with oral candidiasis.

"In vitro" antifungal activity of protease inhibitors.

In the last five years, as HAART has become standard therapy in HIV seropositive or AIDS patients, changes have been noted in the numbers and types of opportunistic fungal infections in these cohorts of patients. Particularly, oropharyngeal candidiasis have become rare in HIV infected patients since the introduction of new anti-HIV drugs of the protease inhibitors type. At the Immunology Institute of the Universidad Central de Venezuela the most frequent protease inhibitors (PIs) used for the treatment of these patients have been: Nelfinavir (Viracept, Roche), Indinavir (Crixivan Merck), Ritonavir (Norvir, Abbott), Saquinavir (Fortovase, Roche). Recently, we observed that recurrent candidiasis was less frequent and no Candida could be isolated in our patients. A direct relation to the PIs was suspected. In order to assess the "in vitro" antifungal activity of the afore mentioned protease inhibitors on Candida sp., we used both the well diffusion test and the NCCLS broth microdilution test to assay 100 Candida sp. isolates from HIV seropositive or AIDS patients with syntomatic oropharyngeal Candida infection. In general, the data obtained with the well diffusion test were in agreement with those obtained by the broth microdilution test. All 100 isolates were susceptible to Saquinavir and 32 were susceptible to Indinavir using the NCCLS microdilution test, while 97 were susceptible to Saquinavir and 52 to Indinavir by the well diffusion test. From 17 C. albicans resistant to fluconazole, all were susceptible to Saquinavir by the NCCLS micromethod and 16 by the well diffusion test. Our results showed anticandidal activity "in vitro" of PIs, mainly Saquinavir.

Reservárea y epidemiología de algunas micosis profunda endémicas en Venezuela / Reservárea and epidemiology of some mycosis profund endemic in Venezuela

En los países tropicales (Venezuela), los hongos proliferan en abundancia por lo que la incidencia de las enfermedades producidas por estos es importante. En el presente trabajo nos dedicamos a realizar una revisión de la reservárea y epidemiología de algunas de las micosis profundas, bien sean localizadas o sistémicas. Es indispensable resaltar estos aspectos de acuerdo a nuestra experiencia, debido a que son de gran utilidad a la hora de realizar una buena orientación diagnóstica en la práctica médica

Pruebas de sensibilidad de Candida albicans frente a los antimicóticos de uso comercial / Susceptibility tests of candida albicans front antifungal comercial used

Se analizaron los patrones de sensibilidad antimicótica in vitro de 20 cepas de Candida albicans provenientes de muestras clínicas del laboratorio Bio-médico "Dr. Oswaldo Carmona", de la ciudad de Caracas, utilizando el método de los pozos de difusión. El objetivo fue comparar la efectividad de 13 presentaciones comerciales de antimicóticos de libre venta en nuestro medio, con los principios activos puros de dichos antimicóticos, los cuales suelen ser utilizados comúnmente para la realización de las pruebas de sensibilidad. Los resultados evidenciaron una sensibilidad de las cepas estudiadas el 91,8 por ciento a los antimicóticos puros, similar a aquellas obtenidas por las presentaciones comerciales, la cual fue de 90 por ciento. Esta pequeña diferencia del 1,8 por ciento en la detección de cepas sensibles convierte a los antimicóticos comerciales en una alternativa válida para su utilización como reactivos adecuados para la determinación de la susceptibilidad de especies del género Candida, aisladas de muestras clínicas. Por otro lado, las presentaciones comerciales de antimicóticos ofrecen la ventaja de ser tan efectivos como los principios activos puros, en términos de la lectura, interpretación y reproductibilidad del método utilizado, además de la factibilidad para ser adquiridos

Comparison of antigens from agents of actinomycetoma by immunodiffusion and electrophoresis procedures.

Antigenic extracts were prepared from culture filtrates of the principal agents known to cause actinomycetoma, namely Actinomadura madurae, Actinomadura pelletieri, Nocardia asteroides, Nocardia brasiliensis, Nocardia otitidis-caviarum, and Streptomyces somaliensis. These antigenic preparations were compared by immunodiffusion (ID), counterimmunoelectrophoresis (CIE), line immunoelectrophoresis (LIE) and rocket line immunoelectrophoresis (RLIE), with rabbit antisera prepared against each of the extracts. Cross-reactivity between antigenic extracts from the different actinomycetes, measured by determining the number of precipitin lines in homologous and heterologous systems, was common. Reactions were always stronger and more precipitin lines were present when antigenic extracts were tested against homologous antisera. Similarities between A. madurae and A. pelletieri antigens were of a low order and cross-reactivity did not exceed 33%. A. pelletieri resembled N. asteroides more closely than A. madurae, with 44% of detectable antigenic components cross-reacting. The three species of Nocardia had common antigenic epitopes, but the overall degree of similarity was of a low order (between 12 and 27% by LIE and RLIE). Antigenic extracts of S. somaliensis had few components in common with the other species tested and only one of the 34 lines present in the RLIE system for N. asteroides showed any reaction of identity with an antigenic component in the S. somaliensis extract. Single cross-reacting lines were also present in the CIE and LIE systems.

Preparative isoelectric focusing of immunologically reactive components of Aspergillus fumigatus mycelium.

A water-soluble mycelial extract of Aspergillus fumigatus has been fractionated by preparative isoelectric focusing using carrier ampholytes in a layer of granulated gel. The separated components were located by staining paper prints from the gel. Within a narrow pH range of 2.5 units, multiple protein bands were visualized with Coomassie Brilliant Blue G. Periodate-Schiff-positive material was generally associated with the major protein zones. When these fractions were eluted the total recovery, calculated on the basis of protein and carbohydrate analyses of the isolated fractions, varied between 20 and 60% of the applied material. Low recoveries were associated with low recoveries of protein; recoveries of carbohydrate were higher and less variable. The immunological activity and specificity of the eluted fractions were assessed in an enzyme-linked immunosorbent assay for the detection of IgG antibodies to A. fumigatus.

Specificity of antigens from pathogenic Aspergillus species. I. Studies with ELISA and immunofluorescence.

Studies were made by enzyme linked immunosorbent assay (ELISA) and indirect fluorescent antibody (IFA) tests on the reactivities and specificities of 13 antigens prepared from four species of Aspergillus against antisera from immunized rabbits and 64 sera from patients with aspergillosis, other systemic mycoses and nocardiosis. Although reactions in both serological tests were invariably strongest with homologous antigen: antibody systems, antisera from rabbits immunized with A. fumigatus, Blastomyces dermatitidis, Candida albicans and Paracoccidioides brasiliensis reacted in the ELISA test with all of the Aspergillus antigens. In contrast, cross-reactivity was virtually non-existent with antiserum to Histoplasma capsulatum. Of five antigens prepared from A fumigatus tested by ELISA against human sera from patients with aspergillosis and other nocardial and systemic fungal infections, sensitivities varied from 81 to 100% for sera from 32 patients with aspergillosis, and specificities from 20 to 97% for sera from 30 patients with nocardiosis and other systemic mycoses. Purified A. fumigatus C antigen reacted weakly with sera from eight of these 30 patients, but the reactions were readily distinguishable from those obtained with sera from patients with aspergillosis. At optimal serum dilutions, cross-reactivities of A. fumigatus in the IFA studies were non-existent in the sera from 28 patients with candidosis, coccidioidomycosis, cryptococcosis, histoplasmosis, paracoccidioidomycosis and nocardiosis. Sensitivities of IFA were 94% for patients with aspergilloma and 83% for patients with allergic bronchopulmonary aspergillosis.

Specificity of antigens from pathogenic Aspergillus species. II. Studies with line immunoelectrophoresis.

Somatic (mycelial) and metabolic (culture filtrate) antigens of Aspergillus flavus, A. fumigatus, A. nidulans, A. niger and A. terreus were compared by line immunoelectrophoresis with sera from patients with allergic bronchopulmonary aspergillosis (ABPA) or aspergilloma, or from immunized animals. Number of lines observed when tested with human sera were similar for somatic and metabolic preparations of A. fumigatus, but up to 33 lines were present when both types of antigens were tested simultaneously. Cross-reactions between heterologous antigens and sera from patients with aspergilloma or ABPA were uncommon. In contrast, cross-reactions were common when standard antisera prepared in animals against heterologous species of Aspergillus were tested against A. fumigatus antigens. Lines of identity between homologous antigens and those from A. fumigatus were observed in 5 of 9 lines obtained with A. flavus, 4 of 16 lines of A. nidulans, 4 of 9 lines of A. niger and 4 of 8 lines of A. terreus.

[Mycosis of the foot in people over 40]. / Micosis del pie en humanos mayores de cuarenta años.

Some aspects of the ecology of the human foot in the stage of senescence have been studied. Systematically 200 hospitalized patients, chosen at random, between the ages of 40 and 96 years were examined. The following was observed: 1.) 133 patients (66,5%) presented lesions suspected as dermatomycoses. 2.) 67 patients (33,5%) were free from clinical lesions. 42 (31,5%) positive direct examinations were obtained from the first group and 8 (11,8%) from the second one. In culture were isolated different strains of Dermatophytes obtained from 50 patients as follows: a) From digital fold scales: Trichophyton mentagrophytes: 26 (v. granulosa: 9. v. gypsea: 16, v nivea: 1). Trichophyton rubrum: 18, Epidermophyton floccosum: 1. b) From toe nails: Trichophyton mentagrophytes v. granulosa: 3, Trichophyton rubrum: 7. c) From the sole: Trichophyton rubrum: 1. A series of fungi supposed contaminants were isolated among which because of frequency the following are specified: Aspergillus sp., Penicillium sp., Cephalosporium sp., Fusarium sp., some yeast and some Demataceae.