Imported histoplasmosis: two distinct profiles in travelers and immigrants.

BACKGROUND: Histoplasmosis is acquiring importance in nonendemic areas due to the increase in travel and immigration, being the most common systemic mycosis acquired by European travelers. Epidemiological studies show that the incidence of Histoplasma infection in these patients may be higher than previously believed and a wide clinical spectrum of disease may be observed. METHODS: Cases of histoplasmosis diagnosed at a Tropical Medicine Referral Unit in Madrid, Spain, during the period January 1996 to December 2006 were reviewed. RESULTS: Ten cases of histoplasmosis in travelers and immigrants are described. Five HIV-positive patients (four immigrants and one expatriate) all presented with progressive disseminated disease. Five HIV-negative patients (travelers) all presented with pulmonary disease: four with an acute pulmonary form (one with pleural involvement) and one patient was found to have residual pulmonary disease (lung nodule). Three of the travelers also had rheumatologic manifestations (arthromyalgias or arthritis). CONCLUSIONS: Clinicians in nonendemic areas may be faced with patients with a diagnosis of histoplasmosis and although Histoplasma infection can have a varied and nonspecific clinical presentation, imported histoplasmosis may have two distinct profiles. Previously, healthy travelers may be exposed in endemic areas and mainly develop acute forms of the disease with a favorable outcome. Immigrants or expatriates from endemic areas who may be immunosuppressed due to HIV infection may experience reactivation of latent disease developing disseminated forms with high mortality rates. This infection should be considered in the differential diagnosis of diseases affecting travelers and immigrants.

False-positive results of Aspergillus galactomannan antigenemia in liver transplant recipients.

BACKGROUND: Aspergillus galactomannan (GM) antigenemia is an early marker of invasive aspergillosis (IA), but may yield false-positive results. A prospective study, testing GM periodically in serum samples of liver transplant recipients, was performed. METHODS: An index more than or equal to 0.5 were considered positive. Positive GM in samples from patients without any other criteria of proven or probable IA was considered as false-positive. The test was performed weekly during the first month after transplantation. RESULTS: Three patients developed IA. In total, 414 serum samples from 85 liver transplant recipients were analyzed. Mean number of samples per patient (out of those who could be assessed) was 4.8. The number of false-positive GM samples was 40 (9.6%), corresponding to 28 patients. The frequency of false-positive results in samples obtained during the first week posttransplantation was 36% (27 of 75), significantly higher than the number of false-positive samples obtained after the first week (3.8%; 13 of 339; P<0.001). Multivariate analysis showed that antibacterial prophylaxis with ampicillin was the only independent factor associated with a false-positive result. Different vials of beta-lactam antibiotics were tested for GM. We obtained a positive GM value (>0.5) in four of the six vials of ampicillin, in three of the six vials of piperacillin-tazobactam, in none of the six vials of cefotaxime, and in none of the six controls. CONCLUSIONS: The present study suggests that the administration of ampicillin as antibacterial prophylaxis during the first days after transplantation could be a possible cause of false-positive GM results.

[Aspergillus fumigatus and Candida albicans in cystic fibrosis: clinical significance and specific immune response involving serum immunoglobulins G, A, and M]. / Aspergillus fumigatus y Candida albicans en la fibrosis quística: significado clínico e inmunorrespuestas séricas específicas de inmunoglobulinas G, A y M.

OBJECTIVE: The aim of this study was to analyze the clinical significance of Aspergillus fumigatus and Candida albicans in respiratory secretions from patients with cystic fibrosis and to assess the immune response to these fungi in serum. PATIENTS AND METHODS: The study included 66 patients with cystic fibrosis (34 men; mean age, 16.2 years). Sera from 15 healthy individuals were used as controls. RESULTS: The serum concentrations of immunoglobulin (Ig) G, IgA, and IgM against A fumigatus and C albicans were higher in patients than in the control group. There was no correlation between the presence of A fumigatus in respiratory secretions and the immune response to the fungus measured in serum. In contrast, the presence of C albicans in respiratory secretions was correlated with the immune response to that fungus. The likelihood of obtaining A fumigatus cultures from respiratory secretions increased with age. The presence of these fungi in respiratory samples was not a risk factor for greater respiratory impairment. CONCLUSIONS: In response to increased colonization of the lower respiratory tract by A fumigatus and C albicans, patients with cystic fibrosis have elevated serum levels of IgG, IgA, and IgM against those fungi. In patients with cystic fibrosis, culture of sputum and oropharyngeal secretions is adequate for the assessment of lower respiratory tract colonization by C albicans but not A fumigatus. Fungal colonization of the lower respiratory tract is not a risk factor for greater respiratory impairment in patients with cystic fibrosis.

Aspergillus fumigatus y Candida albicans en la fibrosis quística: significado clínico e inmunorrespuestas séricas específicas de inmunoglobulinas G, A y M / Aspergillus fumigatus and candida albicans in cystic fibrosis: clinical significance and specific immune response involving serum immunoglobulins G, A, and M

Objetivo: Estudiar el significado clínico de Aspergillus fumigatus y Candida albicans en las secreciones respiratorias de los pacientes con fibrosis quística (FQ) y las inmunorrespuestas séricas frente a estos hongos. Pacientes y métodos: Se estudió a 66 pacientes con FQ (34 varones; edad media: 16,2 años). Como grupo control se utilizaron los sueros de 15 individuos sanos. Resultados: Las concentraciones de inmunoglobulina (Ig) G, IgA e IgM frente a A. fumigatus y C. albicans estuvieron más elevadas en los pacientes con FQ que en el grupo control. No hubo correlación entre el hallazgo de A. fumigatus en las secreciones respiratorias y las inmunorrespuestas séricas frente al hongo. Sí hubo correlación entre la presencia de C. albicans en las secreciones respiratorias y las inmunorrespuestas frente a C. albicans. A medida que aumentaba la edad de los pacientes, aumentaba la probabilidad de cultivar A. fumigatus en las secreciones respiratorias. La presencia de estos hongos en muestras respiratorias no fue un factor de riesgo para un mayor deterioro respiratorio. Conclusiones: Como respuesta a la elevada colonización del aparato respiratorio inferior por A. fumigatus y C. albicans, los pacientes con FQ presentan respuestas séricas elevadas de IgG, IgA e IgM frente a estos hongos. En los pacientes con FQ el cultivo de esputos y aspirados orofaríngeos no sirve para evaluar la colonización del aparato respiratorio inferior por A. fumigatus, pero sí por C. albicans. En estos pacientes, la colonización fúngica del aparato respiratorio inferior no es un factor de riesgo para el deterioro respiratorio

Objective: The aim of this study was to analyze the clinical significance of Aspergillus fumigatus and Candida albicans in respiratory secretions from patients with cystic fibrosis and to assess the immune response to these fungi in serum. Patients and methods The study included 66 patients with cystic fibrosis (34 men; mean age, 16.2 years). Sera from 15 healthy individuals were used as controls. Results: The serum concentrations of immunoglobulin (Ig) G, IgA, and IgM against A fumigatus and C albicans were higher in patients than in the control group. There was no correlation between the presence of A fumigatus in respiratory secretions and the immune response to the fungus measured in serum. In contrast, the presence of C albicans in respiratory secretions was correlated with the immune response to that fungus. The likelihood of obtaining A fumigatus cultures from respiratory secretions increased with age. The presence of these fungi in respiratory samples was not a risk factor for greater respiratory impairment. Conclusions: In response to increased colonization of the lower respiratory tract by A fumigatus and C albicans, patients with cystic fibrosis have elevated serum levels of IgG, IgA, and IgM against those fungi. In patients with cystic fibrosis, culture of sputum and oropharyngeal secretions is adequate for the assessment of lower respiratory tract colonization by C albicans but not A fumigatus. Fungal colonization of the lower respiratory tract is not a risk factor for greater respiratory impairment in patients with cystic fibrosis

Secular trends of candidemia in a large tertiary-care hospital from 1988 to 2000: emergence of Candida parapsilosis.

OBJECTIVE: To analyze the secular trends of candidemia in a large tertiary-care hospital to determine the overall incidence, as well as the incidence by ward and by species, and to detect the occurrence of outbreaks. DESIGN: Retrospective descriptive analysis. Secular trends were calculated using the Mantel-Haenszel test. SETTING: A large tertiary-care referral center in Spain with a pediatric intensive care unit (ICU) to which more than 500 children with congenital cardiac disease are admitted annually. PATIENTS: All patients with candidemia occurring from 1988 to 2000 were included. Cases were identified from laboratory records of blood cultures. RESULTS: There were 331 episodes of candidemia. The overall incidence of nosocomial candidemia was 0.6 episode per 1,000 admissions and remained stable throughout the study period (P = .925). The species most frequently isolated was Candida albicans, but the incidence of C. parapsilosis candidemia increased (P = .035). In the pediatric ICU, the incidence of C. parapsilosis was 5.6 episodes per 1,000 admissions and it was the predominant species. Outbreaks occurred occasionally in the pediatric ICU, suggesting nosocomial transmission. CONCLUSIONS: During this 13-year period, the incidence of candidemia remained stable in this hospital, but C. parapsilosis increased in frequency. Occasional outbreaks of candidemia suggested nosocomial transmission of Candida species.

Sensititre YeastOne caspofungin susceptibility testing of Candida clinical isolates: correlation with results of NCCLS M27-A2 multicenter study.

The ability of Sensititre YeastOne to discriminate isolates with reduced caspofungin susceptibility was determined against 36 Candida spp. (6 with a known FKS1 mutation). Results were compared with those of M27-A2. The MIC endpoint was 100% growth inhibition. Overall agreement (+/-2 log2) was 87.16%. Sensititre YeastOne detected strains with reduced caspofungin susceptibility.

The making of "The Genoma Music.".

Both genetic and musical sequences are ordered structures composed of combinations of a small number of elements, of nucleotides and musical notes. In the case of the genome, the emergence of cellular functions makes the order meaningful; in the case of musical sequences, the consequence of order is the production of mysterious esthetical effects in the human mind. Can any musical significance be found in DNA sequence? In this work, we present the technique used to convert DNA sequences into musical sequences. The musical equivalent of the sequence of a number of genes, either of fungal origin, such as Candida albicans or Sacharomyces cerevisiae (SLT2), or belonging to the human genome (genes involved in Alzheimer syndrome, blindness, and deafness such as Connexine 26 gene) has been obtained. Non-coding sequences are also important in life and music. The non-coding alphoid sequence has also been translated into a musical sequence, in this case using Fibonacci golden number basic series as structural helper. The elementary musical sequence derived from DNA sequence has served as an imposing frame in which rhythms, sounds, and melodies have been harmonically inserted. The Genoma Music Project is essentially a creative metaphor of the basic unity between the human mind and the natural ordered structure of life.

Morphotypic and genotypic characterization of sequential Candida parapsilosis isolates from an outbreak in a pediatric intensive care unit.

Candidemia outbreaks that due to cross-infection are an emerging problem in hospitals. Typing of microorganisms is an essential tool for understanding the epidemiologic aspects of the infection. Techniques based on phenotypic characteristics are inexpensive and easy to perform but are limited by their lack of reproducibility. This study assessed the value of several phenotypic and genotypic techniques that are used in epidemiologic investigations of Candida parapsilosis in clinical practice and used a combination of these methods to analyze outbreak of C. parapsilosis candidemia. Random amplification of polymorphic DNA polymerase chain reaction with several primers was unsatisfactory because it lacked discriminatory power. By simplifying the reading of the morphotypes, we increased their reproducibility for each malt agar and 2,3,5-triphenyltetrazolium media (97% and 90%) and thus their suitability for its use. The combination of electrophoretic karyotype and the simplified morphotypes was rapid and practical to characterize the different clusters involved in the intensive care unit outbreak.

Comparison of the susceptibilities of Candida spp. to fluconazole and voriconazole in a 4-year global evaluation using disk diffusion.

From June 1997 to December 2001, results of in vitro susceptibility tests of yeast isolates from 35 countries were collected. For 2001 alone, fluconazole results were reported for 22,111 yeast isolates from 77 institutions in 30 countries. Of these isolates, 18,569 were also tested for susceptibility to voriconazole. All study sites tested clinical yeast isolates by recently endorsed NCCLS disk diffusion method M44-P. Disk test plates were automatically read and results were recorded with the BIOMIC Image Analysis System. Species, drug, zone diameter, susceptibility category, MIC, and quality control results were electronically submitted by e-mail quarterly for analysis. Duplicate test results (same patient and same species with same sensitivity-resistance profile and biotype results during any 7-day period) and uncontrolled test results were eliminated from this analysis. The proportion of Candida albicans isolates decreased from 69.7% in 1997 to 1998 to 63.0% in 2001, and this decrease was accompanied by a concomitant increase in C. tropicalis and C. parapsilosis. The susceptibility (susceptible [S]or susceptible-dose dependent [S-DD]) of C. albicans isolates to fluconazole was virtually unchanged, from 99.2% in 1997 to 99% in 2001; the C. glabrata response to fluconazole was unchanged, from 81.5% S or S-DD in 1997 to 81.7% in 2001, although the percentage of resistant isolates from blood and upper respiratory tract samples appeared to increase over the study period; the percentage of S C. parapsilosis isolates decreased slightly, from 98% S or S-DD in 1997 to 96% in 2001; and the percentage of S isolates of C. tropicalis increased slightly, from 95.7% in 1997 to 96.9% in 2001. The highest rate of resistance to fluconazole among C. albicans isolates was noted in Ecuador (7.6%, n = 250). Results from this investigation indicate that the susceptibility of yeast isolates to fluconazole has changed minimally worldwide over the 4.5-year study period and that voriconazole demonstrated 10- to 100-fold greater in vitro activity than fluconazole against most yeast species.

Serologic IgE immune responses against Aspergillus fumigatus and Candida albicans in patients with cystic fibrosis.

OBJECTIVES: The objectives of this study were to determine the prevalence of Aspergillus fumigatus and Candida albicans in the sputa of patients with cystic fibrosis (CF), to assess serologic IgE responses of these patients to the presence of fungi in the sputum, to evaluate what effect this may have on clinical status, and to determine how the above-mentioned factors relate to allergic bronchopulmonary aspergillosis (ABPA). PATIENTS: Seventy-six CF patients (40 male and 36 female patients; age, 15.3 plus minus 8.7 years [mean plus minus SD]) were studied. MEASUREMENTS AND RESULTS: A total of 1,239 sputum samples from 66 patients were cultured for fungi. A fumigatus was grown in 256 sputum specimens (20.7%), and C albicans was grown in 588 sputum samples (47.5%). Forty patients (60.6%) had at least one positive culture finding for A fumigatus, and 58 patients (87.9%) had at least one positive culture finding for C albicans. Forty-nine patients (64.5%) were sensitized to A fumigatus, and 20 patients (26.7%) were sensitized to C albicans. No correlation was found between the finding of A fumigatus in sputum and IgE to A fumigatus. Only patients who had at least one positive culture finding for C albicans had IgE to C albicans develop. Lung function values and chest radiograph scores were not significantly lower in patients sensitized to either A fumigatus or C albicans as compared to nonsensitized patients. Of the 20 patients sensitized to C albicans, 10 patients had confirmed ABPA and 10 patients had some immunologic characteristics of ABPA. CONCLUSIONS: A high prevalence of colonization and sensitization to A fumigatus and C albicans in CF patients was observed. The sensitization to these fungi was not related to the clinical severity. IgE to C albicans may be an immunologic marker related to the development of ABPA in patients with CF.