Paracoccidioidomycosis: advances and unmet needs 100 years after its initial description by Lutz

Universidade Federal de São Paulo (UNIFESP) Departamento de MedicinaUNIFESP, Depto. de MedicinaSciEL

Epidemiology of hematogenous infections due to Candida spp

Candida spp is associated to almost 80% of all nosocomial fungal infections and is considered a major cause of blood stream infections. Candida spp is the fourth most common cause of blood stream infections in the United States, where this agent is responsible for 8% of all invasive infections documented in this site. At the present, non-albicans species are related to at least 50% of all invasive infections due to Candida spp and they present differences in terms of clinical outcome as well as susceptibility to antifungal drugs. The crude mortality rate of candidemia is between 40 and 60% which makes this infection an important challenge for all clinicians from tertiary care hospitals of diverse different countries.O gênero Candida spp é responsável por cerca de 80% das infecções fúngicas no ambiente hospitalar e constitui causa relevante de infecções de corrente sanguínea. Nos Estados Unidos da América, Candida spp é a quarta causa mais comum de infecções de corrente sanguínea, respondendo por cerca de 8% dos casos das infecções documentadas neste sítio. Espécies não-albicans respondem hoje por ao menos 50% das infecções invasivas por Candida spp, apresentando peculiaridades de história natural e sensibilidade a antifúngicos. A mortalidade geral de fungemias por Candida spp é da ordem de 40 a 60%, tornado esta complicação infecciosa um grande desafio para os clínicos que trabalham em hospitais terciários em diferentes países.Universidade Federal de São Paulo (UNIFESP)Hospital do Servidor Público Estadual de São PauloUNIFESPSciEL

Candida auris: What Have We Learned About Its Mechanisms of Pathogenicity?

Candida auris has emerged globally as a multidrug-resistant (MDR) medical care-associated fungal pathogen. Recent reports have demonstrated that C. auris usually expresses fewer virulence factors than does Candida albicans. However, the tendency of C. auris transmission within and between healthcare facilities is unique among Candida spp. and is possibly promoted by virulence and pathogenicity factors that facilitate skin colonization and environmental persistence. To understand the ability of this yeast to cause disease, we herein discuss several virulence and pathogenicity aspects of C. auris

Systematic review and new insights into the molecular characterization of the Candida rugosa species complex

Recently, Candida rugosa was characterized as a species complex comprising four taxa: C rugosa sensu stricto, Candida pseudorugosa, Candida neorugosa and Candida mesorugosa. Although considered relatively rare, several clusters of candidemia due to C rugosa complex had been reported presenting mortality rates close to 70%. in this work we discuss the systematization, phenotyping and molecular methods based on internal transcribed spacer region (ITS) sequencing and proteomic analyses for species identification, as well as clinical aspects of the C rugosa complex. We performed a Bayesian phylogenetic analysis using 72 ITS sequences representative of C rugosa complex isolates and related species within the genus. Biochemical, morphological and MALDI-TOF MS analyses were processed with C rugosa complex type strains and related species isolates. We described that the phylogeny showed four distinct clades inferred with high posterior probabilities, corresponding to the four species within the C. rugosa complex, excluding C. pararugosa. Biochemical and morphological aspects distinguished only C rugosa sensu strict but were not sufficient to accurately identify species within the rest of the complex. Protein spectrum profiles differentiated all reference strains from different species analyzed. To our knowledge, we presented the first phylogenetic analysis using a large collection of ITS sequences as well as proteomic profiles generated from isolates of the C rugosa complex and related species that can enlighten systematics, diagnostics and clinical research fields. (C) 2013 Elsevier Inc. All rights reserved.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo, Disciplina Infectol, Lab Especial Micol, BR-04039032 São Paulo, BrazilUniversidade Federal de São Paulo, Disciplina Infectol, Lab Especial Micol, BR-04039032 São Paulo, BrazilFAPESP: 2007/08575-1FAPESP: 2009/10155-6CAPES: PNPD 02640-09-0Web of Scienc

Bloodstream infections in late-stage acquired immunodeficiency syndrome patients evaluated by a lysis centrifugation system

Opportunistic infections, which affect acquired immunodeficiency syndrome (Aids) patients, are frequently disseminated and may cause bloodstream infections (BSI). The aim of this study was to evaluate the main causes of BSI in Aids patients with advanced stage of the disease, with special emphasis on the identification of fungemia. During a 21 months period, all patients with Aids (CD4 < 200) and febrile syndrome admitted to 3 university hospitals were systematically evaluated. For each patient presenting fever, a pair of blood cultures was collected and processed by using a commercial lysis-centrifugation system. One hundred and eleven patients (75 males) with a mean age of 36 years (median 33 years) and mean CD4 count of 64 cells/ml were included. Among the 111 patients evaluated we documented 54 episodes of BSI, including 46 patients with truly systemic infections and 8 episodes considered as contaminants. BSI were caused by gram-positive bacteria (43%), fungi (20%), gram-negative bacteria (15%), mycobacteria (15%), and mixed flora (7%). The crude mortality rate of our patients was 39%, being 50% for patients with BSI and 31% for the others. In conclusion, BSI are a common related to systemic infections on Aids patients with advanced stage of disease and is associated with a high rate of mortality.Universidade Federal de São Paulo (UNIFESP) Hospital São PauloHospital e Maternidade Santa MarcelinaHospital HeliópolisUNIFESP, Hospital São PauloSciEL

Epidemiology of fungal infections in liver transplant recipients: a six-year study of a large Brazilian liver transplantation centre

Liver transplant seems to be an effective option to prolong survival in patients with end-stage liver disease, although it still can be followed by serious complications. Invasive fungal infections (ifi) are related to high rates of morbidity and mortality. The epidemiology of fungal infections in Brazilian liver transplant recipients is unknown. The aim of this observational and retrospective study was to determine the incidence and epidemiology of fungal infections in all patients who underwent liver transplantation at Albert Einstein Israeli Hospital between 2002-2007. A total of 596 liver transplants were performed in 540 patients. Overall, 77 fungal infections occurred in 68 (13%) patients. Among the 77 fungal infections, there were 40 IFI that occurred in 37 patients (7%). Candida and Aspergillus species were the most common etiologic agents. Candida species accounted for 82% of all fungal infections and for 67% of all IFI, while Aspergillus species accounted for 9% of all fungal infections and for 17% of all IFI. Non-albicans Candida species were the predominant Candida isolates. Invasive aspergillosis tended to occur earlier in the post-transplant period. These findings can contribute to improve antifungal prophylaxis and therapy practices in Brazilian centres.Universidade Federal de São Paulo (UNIFESP)Hospital Israelita Albert EinsteinUNIFESPSciEL

Intraspecific comparative genomics of Candida albicans mitochondria reveals non-coding regions under neutral evolution

The opportunistic fungal pathogen Candida albicans causes serious hematogenic hospital acquired candidiasis with worldwide impact on public health. Because of its importance as a nosocomial etiologic agent, C albicans genome has been largely studied to identify intraspecific variation and several typing methods have been developed to distinguish closely related strains. Mitochondrial DNA can be useful for this purpose because, as compared to nuclear DNA, its higher mutational load and evolutionary rate readily reveals microvariants. Accordingly, we sequenced and assembled, with 8-fold coverage, the mitochondria( genomes of two C albicans clinical isolates (L296 and L757) and compared these sequences with the genome sequence of reference strain SC5314. the genome alignment of 33,928 positions revealed 372 polymorphic sites being 230 in coding and 142 in non-coding regions. Three intergenic regions located between genes tRNAGly/COX1, NAD3/COB and ssurRNA/NAD4L, named IG1, IG2 and IG3, respectively, which showed high number of neutral substitutions, were amplified and sequenced from 18 clinical isolates from different locations in Latin America and 2 ATCC standard C albicans strains. High variability of sequence and size were observed, ranging up to 56 bp size difference and phylogenies based on IG1, IG2 and IG3 revealed three groups. Insertions of up to 49 bp were observed exclusively in Argentinean strains relative to the other sequences which could suggest clustering by geographical polymorphism. Because of neutral evolution, high variability, easy isolation by PCR and full length sequencing these mitochondrial intergenic regions can contribute with a novel perspective in molecular studies of C albicans isolates, complementing well established multilocus sequence typing methods. (C) 2012 Elsevier B.V. All rights reserved.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)International Program of the Howard Hughes Medical InstituteUniversidade Federal de São Paulo, Lab Genom Evolut & Biocomplexidade, Dept Microbiol Imunol & Parasitol, Disciplina Microbiol, BR-04039032 São Paulo, BrazilUniversidade Federal de São Paulo, Disciplina Infectol, Lab Especial Micol, BR-04039032 São Paulo, BrazilUniversidade Federal de São Paulo, Lab Genom Evolut & Biocomplexidade, Dept Microbiol Imunol & Parasitol, Disciplina Microbiol, BR-04039032 São Paulo, BrazilUniversidade Federal de São Paulo, Disciplina Infectol, Lab Especial Micol, BR-04039032 São Paulo, BrazilWeb of Scienc

Brain abscess by Nocardia sp in immunocompromised patient

Pacient with autoimmune haemolytic anaemia and thrombocytopenic purpura (Evans Syndrome), treated with immunosuppressive therapy (prednisone and azathioprine) developed brain abscess unresponsive to antimicrobial therapy, in spite of its 23 days duration. Diagnosis could be possible after recover secretion of peribulbar abscess and maintenance of this material over seven days in incubation.Paciente portadora de anemia hemolítica autoimune e púrpura trombocitopênica idiopática (Síndrome de Evans) em uso de terapia imunossupressora (predinisona e azatioprina), desenvolveu quadro de abscesso cerebral não responsivo a 23 dias de terapia antimicrobiana. O diagnóstico de nocardiose foi possível após coleta de material de abscesso peribulbar e observação deste material por período superior há uma semana.Faculdade de Medicina do Triângulo Mineiro Disciplina de Doenças Infecciosas e ParasitáriasFaculdade de Medicina do Triângulo Mineiro Disciplina de HematologiaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Disciplina de Doenças Infecciosas e ParasitáriasUNIFESP, EPM, Disciplina de Doenças Infecciosas e ParasitáriasSciEL

Candida dubliniensis identification in Brazilian yeast stock collection

We investigated the presence of Candida dubliniensis among isolates previously identified as Candida albicans and maintained in a yeast stock collection from 1994 to 2000. All isolates were serotyped and further evaluated for antifungal susceptibility profile. After doing a screening test for C. dubliniensis isolates based on the capability of colonies to grow at 42°C, its final identification was obtained by randomly amplified polymorphic DNA (RAPD) analysis using three different primers. A total of 46 out of 548 screened isolates did not exhibit growth at 42°C and were further genotyped by RAPD. Eleven isolates were identified as C. dubliniensis with RAPD analysis. Regarding serotypes, 81.5% of C. albicans and all C. dubliniensis isolates belonged to serotype A. Of note, 9 out of 11 C. dubliniensis isolates were obtained from patients with acquired immunodeficiency syndrome (Aids) and all of them were susceptible to azoles and amphotericin B. We found 17 (3%) C. albicans isolates that were dose-dependent susceptibility or resistant to azoles. In conclusion, we found a low rate of C. dubliniensis isolates among stock cultures of yeasts previously identified as C. albicans. Most of these isolates were recovered from oral samples of Aids patients and exhibited high susceptibility to amphotericin B and azoles. C. albicans serotype A susceptible to all antifungal drugs is the major phenotype found in our stock culture.Universidade Federal de São Paulo (UNIFESP) Laboratório Especial de MicologiaUniversidade Federal do Rio Grande do Norte Departamento de Microbiologia e ParasitologiaUNIFESP, Laboratório Especial de MicologiaSciEL