Epidemiology and echinocandin susceptibility of Candida parapsilosis sensu lato species isolated from bloodstream infections at a Spanish University Hospital

Objectives: The aims of this work were to study the epidemiological profiles, differences in echinocandin susceptibilities and clinical relevance of the Candida parapsilosis sensu lato species isolated from proven fungaemia cases at La Fe University Hospital of Valencia (Spain) from 1995 to 2007.The aims of this work were to study the epidemiological profiles, differences in echinocandin susceptibilities and clinical relevance of the Candida parapsilosis sensu lato species isolated from proven fungaemia cases at La Fe University Hospital of Valencia (Spain) from 1995 to 2007. Results: The prevalence of these species was: C. parapsilosis sensu stricto, 74.4%; Candida orthopsilosis, 23.54%; and Candida metapsilosis, 2.05%. The incidence of the species complex as agents of fungaemia remained stationary until 2005 and doubled in 2006. The incidence of C. orthopsilosis showed an increasing trend during the study period, while C. parapsilosis sensu stricto incidence diminished. Also, an important epidemiological change was observed starting in 2004, when 86.5% of the C. parapsilosis sensu lato strains were found in adult patients, while before that year only 13.5% of the isolates were found in this population. Conclusions: Echinocandin drug susceptibility testing using the CLSI M27-A3 document showed a wide range of MIC values (0.015?4 mg/L), with micafungin being the most potent in vitro inhibitor followed by anidulafungin and caspofungin (MIC geometric mean of 0.68, 0.74 and 0.87 mg/L, respectively). C. metapsilosis was the most susceptible species of the complex to anidulafungin and micafungin in vitro (MIC50 for anidulafungin and micafungin: 0.06 mg/L), while there were no differences between C. parapsilosis sensu lato species when caspofungin MIC50s were compared (MIC50 1.00 mg/L). Differences in caspofungin in vitro susceptibility were observed between the different clinical service departments of La Fe Hospital.Echinocandin drug susceptibility testing using the CLSI M27-A3 document showed a wide range of MIC values (0.015?4 mg/L), with micafungin being the most potent in vitro inhibitor followed by anidulafungin and caspofungin (MIC geometric mean of 0.68, 0.74 and 0.87 mg/L, respectively). C. metapsilosis was the most susceptible species of the complex to anidulafungin and micafungin in vitro (MIC50 for anidulafungin and micafungin: 0.06 mg/L), while there were no differences between C. parapsilosis sensu lato species when caspofungin MIC50s were compared (MIC50 1.00 mg/L). Differences in caspofungin in vitro susceptibility were observed between the different clinical service departments of La Fe Hospital.Fil: Garcia, Guillermo Manuel. Public Health Research Institute; Estados Unidos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe; ArgentinaFil: Canton, Emilia. Hospital Universitario la Fe; EspañaFil: Pemán, Javier. Hospital Universitario la Fe; EspañaFil: Dilger, Amanda. Public Health Research Institute; Estados UnidosFil: Romá, Eva. Hospital Universitario la Fe; EspañaFil: Perlin, David S.. Public Health Research Institute; Estados Unido

Thyroid mass from a malignant glomus tumor: Case report and literature review

Objectives: Glomus tumors arise in the dermal glomus body and are most commonly found in the subungual region of the digits, the dermis or the subcutis of the palm, wrist, forearm or foot. They are typically benign and localized but rare cases of malignant glomus tumor have been described. Here, we describe the first reported case of glomus tumor metastasizing to the thyroid gland. Study design: Case report and literature review. Methods: A 40-year old male with a history of glomus tumor of the dorsal aspect of his left foot status-post wide local excision with metastatic disease that was well controlled for four years with chemotherapy and radiation presents with a slowly enlarging left thyroid mass. The mass was first identified on surveillance CT and enlarged from 1.3 cm to 2.4 cm over the course of six months. Fine-needle aspiration of the mass demonstrated atypical epitheliod cells with conspicuous nuclei and scatter mitosis with immunostains positive for SMA, focally positive for calponin and negative for PAX-8 consistent with metastatic malignant glomus tumor. Results: The patient underwent total thyroidectomy and final pathology was consistent with metastatic glomus tumor. Conclusion: This is the first reported case of a glomus tumor metastasizing to the thyroid gland. This case illustrates several important points for otolaryngologists and highlights the differences between glomus tumors and paragangliomas, which were formerly also called glomus tumors. Although rare, malignant glomus tumors are an additional entity to consider when assessing a patient with an unusual appearing thyroid mass

Rhabdomyosarcoma of the Paranasal Sinuses Initially Diagnosed as Acute Sinusitis

Rhabdomyosarcoma (RMS) is an uncommon soft tissue malignancy that is typically found in the pediatric population. Here we describe a rare case of widely metastatic alveolar RMS of the right paranasal sinuses in an adult woman who presented with several months of unilateral sinus symptoms that was initially misdiagnosed as acute sinusitis. A middle-aged female presented with two months of right sinus pressure and unilateral epistaxis. She had previously been diagnosed with acute sinusitis and was treated with antibiotics without improvement. Nasal endoscopy demonstrated a fungating right nasal cavity mass. On computed tomography scan (CT), she was found to have metastatic disease in the mediastinum, lungs, bones, pancreas, and right ovary. Pathology of the nasal cavity mass was consistent with alveolar RMS. The patient initially responded well to chemotherapy, but subsequently developed brain and leptomeningeal metastases. This case of sinonasal rhabdomyosarcoma is unique in the extent of metastatic disease at the time of diagnosis and the initial misdiagnosis despite concerning unilateral symptoms and imaging. This thus highlights the importance of maintaining a high index of suspicion for malignancy in patients with unilateral sinus symptoms

Assessment of two new molecular based methods for identification of Candida parapsilosis sensu lato species

Candida parapsilosis sensu stricto, C. orthopsilosis, and C. metapsilosis replaced C. parapsilosis groups I, II, and III in 2005. Since then, an increased interest in studying their epidemiology has arisen based on the observed differences in antifungal susceptibilities and virulence the three species. A strict differentiation of these species cannot be achieved by phenotypic methods. We evaluate two new molecular methodologies to differentiate among these species by the use of a collection of 293 bloodstream infection isolates of C. parapsilosis sensu lato. For the first method, the isolates were studied using PCR amplification of a fragment of the C. parapsilosis sensu lato FKS1 gene and a universal primer pair followed by EcoRI enzyme digestion. The other method used the allele discrimination ability of molecular beacons in a multiplex real-time PCR format. Both methods of identification showed 100% concordance with internal transcribed spacer 1 (ITS1)/ITS2 sequencing and proved to be effective for clinical applications, even with mixed-species DNAs.Fil: Garcia, Guillermo Manuel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. New Jersey Medical School. Public Health Research Institute; Estados UnidosFil: Canton, Emilia. Hospital Universitario La Fe. Centro de Investigación. Unidad de Microbiología Experimental; EspañaFil: Pemán, Javier. Hospital Universitario La Fe. Servicio de Microbiología; EspañaFil: Dilger, Amanda. New Jersey Medical School. Public Health Research Institute; Estados UnidosFil: Romá, Eva. Hospital Universitario La Fe. Servicio de Farmacia; EspañaFil: Perlin, David S.. Public Health Research Institute; Estados Unido

Cochlear implant outcomes in patients with superior canal dehiscence

Objective: To determine whether adult cochlear implant (CI) users with superior canal dehiscence syndrome (SCDS) or asymptomatic superior semicircular canal dehiscence (SCD) have different surgical, vestibular, and audiologic outcomes when compared to CI users with normal temporal bone anatomy. Methods: A retrospective single institution review of CI users with either superior semicircular canal dehiscence syndrome or asymptomatic superior semicircular canal dehiscence identified eight postlingually deafened adults with unilateral or bilateral cochlear implantation between 2006 and 2010. Preoperative and postoperative speech perception scores as well as medical and epidemiological data were recorded and analyzed. Results: One patient with superior canal dehiscence syndrome and seven patients with asymptomatic superior semicircular canal dehiscence were identified, representing 7% or 8/113 of CI patients that fulfilled selection criteria. Average dehiscence length was 3.3 mm±0.79 SEM. Three patients received bilateral implants and five patients received a unilateral implant. Among asymptomatic superior semicircular canal dehiscence patients, subjective rates of post-operative dizziness were similar to those seen in patients with normal temporal bone anatomy (12.5 % vs. 15.9%, respectively). Speech perception abilities after surgery were poorer in SCD patients compared to the non-SCD cohort (Consonant Nucleus Consonant 33.7±7.78 SEM vs. 56.7±2.15 SEM P=0.011), although both groups improved substantially relative to pre-operative performance. We also completed detailed analyses of auditory and vestibular outcomes in one patient with SCDS who underwent CI surgery in the symptomatic ear, which demonstrated preservation of vestibular function post-operatively, improved quality-of-life measures, and reduced dizziness symptomatology. Conclusions: Our data suggest that patients with asymptomatic superior canal dehiscence at the time of CI surgery have similar albeit decreased speech perception scores compared to non-SCD adult CI users. Subjective rate of dizziness or vertigo following CI surgery was similar in both asymptomatic SCD and non-SCD cohorts, with detailed analyses of a single symptomatic SCD patient revealing improved vestibular function and reduced SCD symptoms following CI

Rapid Detection of Triazole Antifungal Resistance in Aspergillus fumigatus▿

Triazole resistance in Aspergillus fumigatus is an uncommon but rising phenomenon. Susceptibility testing is rarely performed and can take 48 h or longer, which is an impediment to effective therapy. Molecular diagnostic probing of well-defined resistance mechanisms, which serve as surrogate markers, provides an alternative approach to rapidly (within hours) and efficiently identify resistant strains. The mechanisms of triazole resistance in A. fumigatus are limited to amino acid substitutions in the drug target Cyp51A and include amino acid substitutions at the positions Gly 54, Gly 138, Met 220, and Leu 98, coupled with a tandem repetition in the gene promoter. We report the development of a real-time PCR assay utilizing molecular beacons to assess triazole resistance markers in A. fumigatus. When combined in a multiplex platform, the assay provides a comprehensive evaluation of drug resistance in A. fumigatus