In vitro inhibitory activity of sertraline against clinical isolates of Sporothrix schenckii / Actividad inhibitoria in vitro de la sertralina frente a aislamientos clínicos de Sporothrix schenckii

Background: Sertraline (SRT) is an antidepressant that has proven its activity in vitro against Cryptococcus, Coccidioides, Trichosporon and other fungi. Disseminated sporotrichosis, although rare, has a high mortality and its treatment is difficult and prolonged, often relying in combining two or more antifungals. Aims: In our study we evaluate the antifungal activity of SRT, alone and in combination with itraconazole (ITC), voriconazole (VRC) and amphotericin B (AMB), against 15 clinical isolates of Sporothrix schenckii. Methods: We used the broth microdilution method as described by the CLSI to test the susceptibility to antifungals, and the checkerboard microdilution method to evaluate drug interactions. Results: The minimum inhibitory concentration (MIC) with SRT was in the range of 4-8μg/ml, while for AMB, VRC and ITC were 0.5-4μg/ml, 0.5-8μg/ml and 0.125-2μg/ml, respectively. In addition, SRT showed synergy with ITC in one strain, mainly additivity with VRC, and indifference with AMB in others. Conclusions: The MIC values with SRT for the isolates studied show the potential role of this drug as an adjuvant in the treatment of sporotrichosis, especially in disseminated or complicated cases

Antecedentes: La sertralina (SRT) es un antidepresivo que ha demostrado actividad in vitro contra Cryptococcus, Coccidioides, Trichosporon y otros hongos. La esporotricosis diseminada, aunque rara, tiene una mortalidad elevada y su tratamiento es complicado, requiriendo, a menudo, la combinación de dos o más antifúngicos. Objetivos: En este estudio evaluamos la actividad antifúngica de SRT, sola y en combinación con itraconazol (ITC), voriconazol (VRC) y anfotericina B (AMB), frente a 15 aislamientos clínicos de Sporothrix schenckii. Métodos: Se usó la técnica de microdilución en caldo para evaluar la sensibilidad a los antifúngicos y el método de tablero de damas para las interacciones entre estos fármacos. Resultados: La concentración mínima inhibitoria (CMI) de SRT estuvo en el rango de 4-8μg/ml, mientras que para AMB, VRC e ITC fue de 0,5-4 μg/ml, 0,5-8 μg/ml y 0,125-2 μg/ml, respectivamente. La SRT mostró sinergia con ITC frente a una cepa, efecto aditivo principalmente con VRC, e indiferencia con AMB. Conclusiones: Los valores de la CMI de SRT para los aislamientos ensayados son indicativos del potencial de este fármaco como adyuvante en el tratamiento de la esporotricosis, especialmente en casos complicados o de enfermedad diseminada

In vitro inhibitory activity of sertraline against clinical isolates of Sporothrix schenckii.

BACKGROUND: Sertraline (SRT) is an antidepressant that has proven its activity in vitro against Cryptococcus, Coccidioides, Trichosporon and other fungi. Disseminated sporotrichosis, although rare, has a high mortality and its treatment is difficult and prolonged, often relying in combining two or more antifungals. AIMS: In our study we evaluate the antifungal activity of SRT, alone and in combination with itraconazole (ITC), voriconazole (VRC) and amphotericin B (AMB), against 15 clinical isolates of Sporothrix schenckii. METHODS: We used the broth microdilution method as described by the CLSI to test the susceptibility to antifungals, and the checkerboard microdilution method to evaluate drug interactions. RESULTS: The minimum inhibitory concentration (MIC) with SRT was in the range of 4-8µg/ml, while for AMB, VRC and ITC were 0.5-4µg/ml, 0.5-8µg/ml and 0.125-2µg/ml, respectively. In addition, SRT showed synergy with ITC in one strain, mainly additivity with VRC, and indifference with AMB in others. CONCLUSIONS: The MIC values with SRT for the isolates studied show the potential role of this drug as an adjuvant in the treatment of sporotrichosis, especially in disseminated or complicated cases.

Rapid spread of an ongoing outbreak of Zika virus disease in pregnant women in a Mexican hospital

Abstract In the first nine weeks of implementation of a Zika Virus Preparedness Plan in a Mexican Public Hospital, we cared for 221 pregnant women with any signal or symptom suggesting Zika virus infection and 99 (44.8%) patients were found to be positive for Zika virus.The median age of patients was 25.3 years (range 13-49). Symptoms in PCR-positive patients were rash (91.4%) followed by headache (53.1%), myalgia (46.9%), arthralgia (45.7%), pruritus (35.8%), retroocular pain (29.6%), conjunctivitis (21%), and fever (21%). The women's epidemiologic exposure history indicates local transmission and a community outbreak.

Rapid spread of an ongoing outbreak of Zika virus disease in pregnant women in a Mexican hospital.

In the first nine weeks of implementation of a Zika Virus Preparedness Plan in a Mexican Public Hospital, we cared for 221 pregnant women with any signal or symptom suggesting Zika virus infection and 99 (44.8%) patients were found to be positive for Zika virus. The median age of patients was 25.3 years (range 13-49). Symptoms in PCR-positive patients were rash (91.4%) followed by headache (53.1%), myalgia (46.9%), arthralgia (45.7%), pruritus (35.8%), retroocular pain (29.6%), conjunctivitis (21%), and fever (21%). The women's epidemiologic exposure history indicates local transmission and a community outbreak.

Major depressive episodes are associated with poor concordance with therapy in rheumatoid arthritis patients: the impact on disease outcomes.

OBJECTIVES: Our objective was to investigate associations between major depressive episodes (MDE), concordance with therapy (CwT) and disease outcomes in rheumatoid arthritis patients. METHODS: Seventy-eight outpatients receiving ≥1 disease modifying anti-rheumatic drug and without significant comorbidity had concomitant rheumatic and psychiatric evaluations. CwT was defined according to a questionnaire. MDE was defined using the Mini International Neuropsychiatric Interview and the severity of depressive symptoms was assessed with the Beck Depression Inventory (BDI-II). Appropriated statistic was used. IRB approval was obtained. RESULTS: Patients included (73 ♀) had (mean±SD) age of 44±10 years and (median, range) disease duration of 10 years (5.2-15.8). Current MDE were diagnosed in 24 patients (30.8%); 60 patients (76.9%) were CwT. Patient-non-CwT were more frequently diagnosed with MDE and tend to have higher BDI scores. They had significantly more disease activity according to patient-pain VAS and swollen joint counts. Both groups were similar regarding demographic variables, treatment and comorbid conditions. Forty-one patients (53%) had clinically important depressive symptoms (BDI≥10), among them 20 had mild depression, 14 moderate and 7 severe depression. Patient-non-CwT had more frequently moderate depression (according to BDI score) than their counterparts and similar tendency was found regarding severe depression. Patient-CwT who additionally had lower BDI scores had better disease outcomes than concordant patients with higher BDI scores. Similar results were found in non-CwT patients but statistical significance was limited to disease activity. CONCLUSIONS: Prevalence of current MDE in RA patients was of 31%; those patients had poorer CwT and worse outcomes than mentally healthy patients.

Life cycle of Triatoma ryckmani (Hemiptera: Reduviidae) in the laboratory, feeding patterns in nature and experimental infection with Trypanosoma cruzi.

A cohort initiated with 121 eggs, yielding 105 first instar nymphs (eclosion rate: 86.78%), allowed us to observe the entire life cycle of Triatoma ryckmani under laboratory conditions (24 degrees C and 62% relative humidity), by feeding them on anesthetized hamsters. It was possible to obtain 62 adults and the cycle from egg to adult took a mean of 359.69 days with a range of 176-529 days (mortality rate of nymphs: 40.95%). Mean life span of adults was of 81 days for females and 148 days for males. The developmental periods of 4th and 5th nymphs were longer than those of the other instars. This suggests that young siblings have a better chance of taking a hemolymph meal from older ones, in order to survive during fasting periods during prolonged absences of vertebrate hosts from natural ecotopes. The stomach contents of 37 insects showed blood from rodents (15 cases), lizards (7 cases), birds (6 cases) and insect hemolymph (7 cases). Out of 10 insects fed by xenodiagnosis on a Trypanosoma cruzi infected mouse, all but one became infected with the parasite.

Life cycle of Triatoma ryckmani (Hemiptera: Reduviidae) in the laboratory, feeding patterns in nature and experimental infection with Trypanosoma cruzi

A cohort initiated with 121 eggs, yielding 105 first instar nymphs (eclosion rate: 86.78 percent), allowed us to observe the entire life cycle of Triatoma ryckmani under laboratory conditions (24ºC and 62 percent relative humidity), by feeding them on anesthetized hamsters. It was possible to obtain 62 adults and the cycle from egg to adult took a mean of 359.69 days with a range of 176-529 days (mortality rate of nymphs: 40.95 percent). Mean life span of adults was of 81 days for females and 148 days for males. The developmental periods of 4th and 5th nymphs were longer than those of the other instars. This suggests that young siblings have a better chance of taking a hemolymph meal from older ones, in order to survive during fasting periods during prolonged absences of vertebrate hosts from natural ecotopes. The stomach contents of 37 insects showed blood from rodents (15 cases), lizards (7 cases), birds (6 cases) and insect hemolymph (7 cases). Out of 10 insects fed by xenodiagnosis on a Trypanosoma cruzi infected mouse, all but one became infected with the parasite.

Dispersion and colonization of Triatoma ryckmani (Hemiptera: Reduviidae) in artificial environments in a semiarid region of a Chagas disease endemic area in Guatemala.

The colonization capacity and dispersal of sylvatic populations of Triatoma ryckmani Zeledón and Ponce were investigated by means of experimental chicken coops installed within the semiarid region in the Department of El Progreso, Guatemala. In the four artificial habitats a total of 672 T. ryckmani was found as well as two males of T. dimidiata (Latreille). Triatomine densities were not the same in the four chicken coops. From one chicken coop 53.4% (359) of the triatomines were collected. Full colonization, i.e. all stages from egg to adult found at the same time, took place in the fourth month after the first female's arrival. High dispersal and colonization capacity of T. ryckmani was evident; adult dispersal occurs mainly during the dry and coolest season (November-February). The overall female/male sex ratio was 2:1; more females than males were found throughout the year. Most of the triatomines in the shelter inside the chicken coops were found on the northern (43%; with less heat and sunlight) and eastern side (35%; more windy). This is the first report on the colonization capacity and population dynamics of T. ryckmani in artificial habitats in a Chagas disease endemic area of Central America.

Triatoma ryckmani (Hemiptera: Reduviidae) in the epiphyte Tillandsia xerographica (Bromeliaceae) in the semiarid region of Guatemala.

For the first time, the reduviid bug Triatoma ryckmani Zeledón and Ponce (Hemiptera; Reduviidae) was recorded to inhabit the epiphyte Tillandsia xerographica Rohweder (Bromeliaceae) in the semiarid region of Guatemala. These bromeliads grow mainly in drought-resistant trees with rough bark such as Pereskia lychnidiflora (Cactaceae). In our study site, we investigated 30 T. xerographica, and 53 specimens of T. ryckmani were found. Most T. ryckmani (68.5%) were unfed. Ants (Formicidae) were the predominant (92.2%) insect taxon in T. xerographica. Other insects such as Blattidae (3.0%), Reduviidae (T. ryckmani: 2.5%), Blaberidae (2.2%), Gryllidae (0.1%), and Acrididae (0.1%) were recorded in the bromeliads. T. xerographica is illegally commercialized without previous inspection. This may cause accidental introduction of T. ryckmani to houses and to other countries.

A mass collection of Triatoma ryckmani (Hemiptera: Reduviidae) from Stenocereus Eichlamii (Cactaceae) in the semiarid region of Guatemala.

A population of 216 specimens of Stenocereus eichlamii (Cactaceae, Subfamily Cereoideae) was surveyed for Triatoma ryckmani (vector of Chagas disease) in a one hectare plot of semiarid habitat in Guatemala. Out of 44 plants that had dead and dry sections, 24 plants had a total of 103 specimens of T. ryckmani. In comparison with other areas of Guatemala, T ryckmani is well established in the semiarid ecosystem (Infestation index 54.5, density = 2.3 and crowding index 4.3). The insects were mainly found (52.4%) in the dead portions of S. eichlamii 2.0 to 3.2 m above the ground (X2 = 26.0, P < 0.00001), followed by dry cactus sections between 3.2 and 5.0 m (35.9%). They were less frequent 0.2 to 2.0 m above the ground. A considerable proportion (75.7%) had no aparent blood in their digestive systems. To determine the presence of flagellates, 43 of the bugs were dissected, but none were found. This is the first report on T. ryckmani population dynamics in this habitat.