Infection and colonisation due to Scedosporium in Northern Spain. An in vitro antifungal susceptibility and molecular epidemiology study of 60 isolates.

Since the latest taxonomical changes in the genus Scedosporium by Gilgado et al. in 2010, no species-specific studies on epidemiology and antifungal susceptibility patterns (AFSP) have so far been published. This study aimed to provide qualitative epidemiological data of Scedosporium spp. isolated from cystic fibrosis (CF) patients and immunocompromised patients from Northern Spain. Isolates were identified by using amplified fragment length polymorphism (AFLP), and species-specific AFSP were generated for all currently available antifungal compounds. AFLP was a useful tool for identification to species-level and for the discrimination of inter- and intra-patient isolates. Scedosporium prolificans represents the most prevalent species in the respiratory tract of CF patients and immunocompromised patients in Northern-Spain, followed by Pseudallescheria boydii, P. apiosperma, and P. ellipsoidea. CF patients were exclusively colonised with either P. boydii or S. prolificans. Patients were colonised over years exclusively with isolates affiliated to one species, but some patients were colonised with multiple strains with different AFSP. The sum of those co-colonising strains in one patient, may appear in vitro and in vivo as a multi-resistant S. prolificans isolate, as strains are morphologically identical and might therefore be regarded as only one strain. A majority of Scedosporium strains (with exception of S. prolificans) were found susceptible for voriconazole and micafungin.

Cavitary pneumonia caused by Nocardia otitidiscaviarum.

We report a case of cavitary pneumonia caused by N. otitidiscaviarum in a man with diabetes mellitus and thrombocytopenia treated with systemic corticosteroid. Taxonomic identification involved phenotypic testing and molecular identification that was carried out by DNA sequencing of the 16SrRNA gene.

First Spanish case of nocardiosis caused by Nocardia takedensis.

Nocardia takedensis is a recently described species isolated from soil. The first clinical isolate in Japan has recently been reported. This report describes the first clinical isolate of N. takedensis in Spain from a respiratory specimen.

[Nd-YAG capsulotomy and intravitreal antibiotics as treatment of chronic endophthalmitis]. / Capsulotomía Nd-YAG y antibióticos intravítreos como tratamiento de la endoftalmitis crónica.

PURPOSE: To study the effectiveness of Yag capsulotomy, therapeutic vitreal aspiration and intravitreal injection of antibiotics combination on the treatment of chronic postoperative endophthalmitis. METHODS: Six patients with symptoms of refractory postoperative endophthalmitis after extracapsular cataract extraction, with an intraocular lens were treated following a protocol that included: YAG capsulotomy, vitreal aspiration and intravitreal injection of antibiotics. RESULTS: In four cases -66%- the micro-organism was isolated -three cases of coagulase- negative staphylococci and one case Corynebacterium spp. In all the cases the inflammatory process decreased, and a noticeable improvement of visual acuity was achieved. No recurrent cases were observed (two patients died before the end of the study). CONCLUSIONS: As way of conclusion we can state that the initial capsulotomy allows the destruction of the infection reservoir in order to eradicate the agent. This endophthalmitis therapeutic alternative is effective, easy and reliable for the ophthalmologist.

Cavitary pneumonia caused by nocardia otitidiscaviarum

We report a case of cavitary pneumonia caused by N. otitidiscaviarum in a man with diabetes mellitus and thrombocytopenia treated with systemic corticosteroid. Taxonomic identification involved phenotypic testing and molecular identification that was carried out by DNA sequencing of the 16SrRNA gene.

"Blind" protected specimen brushing versus bronchoscopic techniques in the aetiolological diagnosis of ventilator-associated pneumonia.

The aetiological diagnosis of nosocomial pneumonia in intensive care unit (ICU) patients requires a valid, cheap and safe method. This method should be suitable for all mechanically-ventilated patients and all ICUs. The aim of this study was to assess the diagnostic yields of three methods: "blind" bronchial brushing (Accu-Cath)(protective specimen brush-nonbronchofibroscopic (PSB-non BF)); bronchofibroscopic protected specimen brushing (PSB-BF) and bronchoalveolar lavage (BAL). We prospectively studied the diagnostic values of the three methods as well as the agreement between microbiological results in 74 patients with 88 episodes of clinically suspected ventilator-associated pneumonia (VAP) and 22 control subjects. VAP episodes were also divided into those with (n = 24) and without antibiotic pretreatment (n = 64), and into those with (n = 78) and without (n = 10) right lower lobe infiltrates on chest radiography. No differences were found as regards the bacteriological yield of the three techniques. Furthermore, the rate of concordant results was high; 92% for PSB-BF and BAL; 84% for PSB-nonBF and BAL; 85% for PSB-nonBF and PSB-BF; and 85% for PSB-nonBF combined with both bronchoscopic techniques. The diagnostic yields in suspected VAP were 66, 59 and 56% for PSB-nonBF, PSB-BF and BAL, respectively. We conclude that "blind" bronchial brushing has similar accuracy to bronchoscopic techniques commonly used in the diagnosis of ventilator-associated pneumonia, constituting an interesting alternative in hospitals where fibreoptic bronchoscopy is not available.

Prosthetic valve endocarditis caused by Mycoplasma hominis.

Mycoplasma hominis endocarditis is extremely uncommon and difficult to diagnose. Atypical growth characteristics in routine bacterial culture and an inability to demonstrate the organism using Gram staining can lead to a delayed diagnosis of Mycoplasma hominis infections, and the organism is often missed. This report describes a patient with Mycoplasma hominis prosthetic valve endocarditis. The microorganism was recovered from the mitral prosthesis but was missed in blood cultures. This finding suggests that Mycoplasma hominis should be considered in the differential diagnosis of culture-negative endocarditis.