Case Series Study of Invasive Pulmonary Aspergillosis.

Diagnosis of invasive pulmonary aspergillosis (IPA) is challenging. The objective of the study was to assess the value of microbiological tests to the diagnosis of IPA in the absence of non-specific radiological data. A retrospective study of 23 patients with suspicion of IPA and positivity of some microbiological diagnostic tests was performed. These tests included conventional microbiological culture, detection of Aspergillus galactomannan (GM) antigen and in some patients (1 â†’ 3)-ß-D-glucan (BDG) and Aspergillus fumigatus DNA using the LightCycler® SeptiFast test. In 10 patients with hematological malignancy, 6 cases were considered 'probable' and 4 'non-classifiable.' In 8 patients with chronic lung disease, 7 cases were classified as 'probable' and 1 as 'proven,' and in 5 patients with prolonged ICU stay (>7 days), there were 2 'proven' cases, 2 'non-classifiable' and 1 putative case. Microbiological culture was positive in 17 cases and 18 Aspergillus spp. were isolated (one mixed culture). A. fumigatus was the most frequent (44.4%) followed by A. tubingensis. The Aspergillus galactomannan (GM) antigen assay was positive in 21 cases (91.3%). The GM antigen and the (1 â†’ 3)-ß-D-glucan (BDG) assays were both performed in 12 cases (52.2%), being positive in 9. The SeptiFast test was performed in 7 patients, being positive in 4. In patients with non-classifiable pulmonary aspergillosis and one or more positive microbiological tests, radiological criteria may not be considered a limiting factor for the diagnosis of IPA.

Epidemiología, factores de riesgo y sensibilidad in vitro en candidemias por especies diferentes de Candida albicans / Epidemiology, risk factors and in vitro susceptibility in candidaemia due to non-Candida albicans species

Antecedentes. La infección fúngica invasora ha aumentado en los últimos años por el incremento de los factores de riesgo; la candidemia es la principal manifestación clínica. Candida albicans es la especie más frecuente, aunque actualmente se ha observado un aumento en otras especies del género. Objetivos. Analizar la epidemiología, los factores de riesgo y la sensibilidad antifúngica de los aislamientos en hemocultivos de especies de Candida diferentes de C.albicans en nuestro hospital en los últimos 12años. Métodos. Se estudiaron retrospectivamente las características epidemiológicas de 107 pacientes con candidemia ingresados en nuestro hospital. Se determinó la sensibilidad de las especies de Candida al fluconazol, el itraconazol, el voriconazol, la anfotericinaB, la 5-fluorocitosina, la caspofungina, la micafungina y la anidulafungina mediante el método de microdilución Sensititre Yeast One (Izasa, España). Resultados. De los 109 aislamientos, 59 correspondieron a las siguientes especies de Candida (diferentes de C.albicans): 25 Candida parapsilosis complex, 14 Candida glabrata complex, 13 Candida tropicalis, 4 Candida krusei, una Candida lipolytica, una Candida membranaefaciens y una Candida pulcherrima. El factor de riesgo más frecuente en adultos y niños con candidemias por estas especies fue ser portador de catéter. El 8,5% de estos aislamientos fueron resistentes al fluconazol. Conclusiones. El resultado de nuestro trabajo confirma la necesidad de conocer la epidemiología de las especies de Candida diferentes de C.albicans, su sensibilidad in vitro y los factores de riesgo asociados, especialmente en pacientes con dichos factores (AU)

Background. Invasive fungal infection (IFI) has increased in recent years due to there being a greater number of risk factors. IFI caused by Candida is the most frequent, and although Candida albicans is the most isolated species, there is currently a decrease of C. albicans and an increase of other species of the genus. Aims. To analyse the epidemiology, risk factors, and antifungal susceptibility of blood culture isolates of non-C.albicans Candida species in our hospital in the last 12years. Methods. A retrospective study was conducted on 107 patients with candidaemia admitted to our hospital. Candida isolates susceptibility to fluconazole, itraconazole, voriconazole, amphotericinB, 5-fluorocytosine, caspofungin, micafungin, and anidulafungin was determined by means of a microdilution technique (Sensititre Yeast One; Izasa, Spain). Results. From a total of 109 strains, 59 belonged to non-C. albicans Candida species: 25 Candida parapsilosis complex, 14 Candida glabrata complex, 13 Candida tropicalis, 4 Candida krusei, 1 Candida lipolytica, 1 Candida membranaefaciens, and 1 Candida pulcherrima. The most common risk factor in adults and children was catheter use. It was observed that 8.5% of those non-C.albicans strains were resistant to fluconazole. Conclusions. The results of this work confirm that it is necessary to know the epidemiology of non-C.albicans Candida species, the in vitro susceptibility of the species involved, and the main risk factors, especially in patients with predisposing conditions (AU)

[Epidemiology, risk factors and in vitro susceptibility in candidaemia due to non-Candida albicans species]. / Epidemiología, factores de riesgo y sensibilidad in vitro en candidemias por especies diferentes de Candida albicans.

BACKGROUND: Invasive fungal infection (IFI) has increased in recent years due to there being a greater number of risk factors. IFI caused by Candida is the most frequent, and although Candida albicans is the most isolated species, there is currently a decrease of C. albicans and an increase of other species of the genus. AIMS: To analyse the epidemiology, risk factors, and antifungal susceptibility of blood culture isolates of non-C.albicans Candida species in our hospital in the last 12years. METHODS: A retrospective study was conducted on 107 patients with candidaemia admitted to our hospital. Candida isolates susceptibility to fluconazole, itraconazole, voriconazole, amphotericinB, 5-fluorocytosine, caspofungin, micafungin, and anidulafungin was determined by means of a microdilution technique (Sensititre Yeast One; Izasa, Spain). RESULTS: From a total of 109 strains, 59 belonged to non-C. albicans Candida species: 25 Candida parapsilosis complex, 14 Candida glabrata complex, 13 Candida tropicalis, 4 Candida krusei, 1 Candida lipolytica, 1 Candida membranaefaciens, and 1 Candida pulcherrima. The most common risk factor in adults and children was catheter use. It was observed that 8.5% of those non-C.albicans strains were resistant to fluconazole. CONCLUSIONS: The results of this work confirm that it is necessary to know the epidemiology of non-C.albicans Candida species, the in vitro susceptibility of the species involved, and the main risk factors, especially in patients with predisposing conditions.

Diagnóstico de hiperplasia ductal atípica en biopsias mamarias percutáneas de alteraciones sub-clínicas con cánulas de corte y vacío: parámetros a evaluar para considerar la conducta a seguir / Atypical ductal hyperplasia in percutaneous vacuum assisted breast biopsy in non palpable lesions: parameters to consider for the follow up

Objetivos: El objetivo de este trabajo es aportar elementos que permitan resolver las controversias planteadas en el diagnóstico y ulterior manejo de la Hiperplasia Ductal Atípica (HDA), en muestras de alteraciones subclínicas obtenidas por biopsias mamarias percutáneas con cánulas de corte y vacío, tomando en cuenta parámetros como: tipo de alteración imagenológica, tamaño de la alteración imagenológica, porcentaje de la alteración resecada con la biopsia y las características histológicas en cuanto al número de focos involucrados y la relación de la imagen con la alteración patológica. Método: Ciento cuarenta y seis biopsias mamarias percutáneas (BMP) con agujas de corte y vacío, realizadas en nuestro centro durante un periodo de 87 meses, con resultados de HDA. Los resultados fueron comparados con la anatomía patológica de la biopsia quirúrgica en 46 pacientes y seguimiento radiológico en 51 pacientes. Los parámetros que pueden incidir en el subdiagnóstico son discutidos. Resultados: En el 93,4% de los casos de HDA no cambió el diagnóstico en la biopsia quirúrgica. El tamaño promedio de las alteraciones fue de 10.1mm. En el 92,46% de los casos se reseco la imagen que motivó la biopsia y el 92,46% de las HDA presentaban dos o menos focos. El subdiagnóstico fue reportado en tres casos (6,6%) correspondiendo a dos lesiones resecadas incompletas (mayor de 2cm) y una se plantó como diagnóstico diferencial en la biopsia percutánea.Conclusiones: Las biopsias percutáneas de corte y vacío, representan un método confiable y seguro para el diagnóstico de las lesiones mamarias no palpables. En el diagnóstico de la HDA el porcentaje de la lesión resecada por la biopsia, el número de focos de HDA involucrados y la reafición de la imagen con el hallazgo patológico son variables a tomar en cuenta para la decisión de la conducta a seguir

Background: The aim of this study is to help shed more light on the actual controversy in the diagnosis and final management of the Atypical Ductal Hyperplasia (ADH) in a sub clinical mammography lesion obtained by percutaneos vacuum assisted breast biopsy (PVBB). We analyzed the data including mammography changes, lesion's size, percentage of lesion harvested by biopsy, the histological pattern in numbers of foci involved and relation between the image and the pathologic diagnosis. Method: A retrospective analysis of one hundred and forty six PVBB made in 87 months, reported ADH. The biopsies were compared with a final surgical pathology in 46 patients and mammography follow up in 51 patients. The variables that could miss the diagnosis are discussed Result: 93,4% of the ADH patients still had the same diagnosis after surgical biopsy. The median size of the lesion was 10.1mm. In the 92.46% of the cases the lesions were completely harvested by biopsy and 92,46% of the lesions had two foci or less of ADH. The sub diagnosis was reported in three cases (6.6%), two of them were incompletely harvested lesions (>20mm) and the other case the DCIS diagnosis was suggested in the previous PVBB.Conclusion: The PVBB represent a safe and reliable method for the diagnosis of non-palpable mammary lesions. In the ADH cases the amount of lesion harvested by biopsy, the number of foci and the relation between the image and the pathologic diagnosis are variables that could determine the treatment and follow up