Fungal infections in marrow transplant recipients under antifungal prophylaxis with fluconazole

Fungal infection is one of the most important causes of morbidity and mortality in bone marrow transplant (BMT) recipients. The growing incidence of these infections is related to several factors including prolonged granulocytopenia, use of broad-spectrum antibiotics, conditioning regimens, and use of immunosuppression to avoid graft-versus-host disease (GvHD). In the present series, we report five cases of invasive mold infections documented among 64 BMT recipients undergoing fluconazole antifungal prophylaxis: 1) A strain of Scedosporium prolificans was isolated from a skin lesion that developed on day +72 after BMT in a chronic myeloid leukemic patient. 2) Invasive pulmonary aspergillosis (Aspergillus fumigatus) was diagnosed on day +29 in a patient with a long period of hospitalization before being transplanted for severe aplastic anemia. 3) A tumoral lung lesion due to Rhizopus arrhizus (zygomycosis) was observed in a transplanted patient who presented severe chronic GvHD. 4) A tumoral lesion due to Aspergillus spp involving the 7th, 8th and 9th right ribs and local soft tissue was diagnosed in a BMT patient on day +110. 5) A patient with a history of Ph1-positive acute lymphocytic leukemia exhibited a cerebral lesion on day +477 after receiving a BMT during an episode of severe chronic GvHD. At that time, blood and spinal fluid cultures yielded Fusarium sp. Opportunistic infections due to fungi other than Candida spp are becoming a major problem among BMT patients receiving systemic antifungal prophylaxis with fluconazole.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Disciplina de Hematologia e HemoterapiaCasa de Saúde Santa Marcelina Serviço de HematologiaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PatologiaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Divisão de Moléstias InfecciosasUNIFESP, EPM, Disciplina de Hematologia e HemoterapiaUNIFESP, EPM, Depto. de PatologiaUNIFESP, EPM, Divisão de Moléstias InfecciosasSciEL

The electromagnetic counterpart of the binary neutron star merger LIGO/Virgo GW170817. I. Discovery of the optical counterpart using the Dark Energy Camera

We present the Dark Energy Camera (DECam) discovery of the optical counterpart of the first binary neutron star merger detected through gravitational wave emission, GW170817. Our observations commenced 10.5 hours post-merger, as soon as the localization region became accessible from Chile. We imaged 70 deg2 in the i and z bands, covering 93% of the initial integrated localization probability, to a depth necessary to identify likely optical counterparts (e.g., a kilonova). At 11.4 hours post-merger we detected a bright optical transient located 10:600 from the nucleus of NGC4993 at redshift z = 0:0098, consistent (for H0 = 70 km s-1 Mpc-1) with the distance of 40±8 Mpc reported by the LIGO Scientific Collaboration and the Virgo Collaboration (LVC). At detection the transient had magnitudes i=17.3 and z=17.4, and thus an absolute magnitude of Mi = -15.7, in the luminosity range expected for a kilonova. We identified 1,500 potential transient candidates. Applying simple selection criteria aimed at rejecting background events such as supernovae, we find the transient associated with NGC4993 as the only remaining plausible counterpart, and reject chance coincidence at the 99.5% confidence level. We therefore conclude that the optical counterpart we have identified near NGC4993 is associated with GW170817. This discovery ushers in the era of multi-messenger astronomy with gravitational waves, and demonstrates the power of DECam to identify the optical counterparts of gravitational-wave sources

Extractive use, management and in situ domestication of a weedy palm, Astrocaryum tucuma, in the central Amazon

Of particular interest for extractivism in tropical forest areas are useful species that occur at high density, such as the palm tucuma (Astrocaryum tucuma Martius-syn. A. aculeatum G.F.W. Meyer), a colonizer of disturbed areas in the central Amazon, whose edible fruits have found an interesting market in that region. However, with an expected increase of tucuma plantations, the future of tucuma extractivism will depend on its capacity to produce fruits not only of sufficient quantity but also of consistently high quality. We studied the productivity and fruit quality of an extractively used population of tucuma palms in an area of 9 ha within a 25 ha shifting cultivation landscape composed of crop fields, homegardens, fallows and secondary forests in the proximity of Manaus during a 24-month period. The average density of tucuma palms was 30.4 ha-1, with highest values in secondary forests (43 ha-1) and lowest values in homegardens (19 ha-1). In contrast, the percentage of productive palms was higher in fields (93%) and homegardens (88%) than in fallows (66%) and secondary forests (50%), apparently as a combined effect of previous management and delayed reproduction under shade. Fruit yield per productive palm was significantly higher in homegardens (47 kg) than in fallows (16 kg) and secondary forests (15 kg), with intermediate values in the fields (27 kg). The most productive palms produced fruits of intermediate quality as measured through a taste index, while few palms producing high-quality fruits were also high yielding. A management plan was developed that allows maximization of fruit yields while progressively improving the quality characteristics of the extractively used population in an in situ domestication process. Being a low-cost and low-risk strategy, "improved extractivism" can be an appropriate way of growing the arboreal weed, tucuma, and can contribute to increased farm income while increasing the economic value of disturbed areas in the central Amazo

Significância clínica de estafilococos coagulase-negativa isolados de recém-nascidos Clinical significance of coagulase-negative staphylococci isolated from neonates

Objetivo: avaliar a significância clínica de estafilococos coagulase-negativa (ECN) isolados de processos infecciosos em recém-nascidos da unidade neonatal do Hospital das Clínicas da Faculdade de Medicina de Botucatu. Método: as linhagens de ECN isoladas foram identificadas e classificadas em significativas e contaminantes, com base em uma série de dados clínicos e laboratoriais obtidos dos prontuários dos pacientes internados na unidade neonatal. Foram pesquisados os dados referentes a fatores perinatais de risco para infecção, evolução clínica, alterações do hemograma e/ou positividade de proteína C-reativa e antibioticoterapia. Resultados: das 117 linhagens de ECN isoladas, 60 (51,3%) foram classificadas como significativas, e 57 (48,7%) como contaminantes. Das 54 crianças com infecção por ECN, 43 (79,6%) eram prematuras, e 27 (50,0%) tiveram peso ao nascimento Conclusões: a maioria dos recém-nascidos com infecção por ECN apresentou fatores predisponentes importantes para a instalação do processo infeccioso, incluindo o peso de nascimento < 1.500g, a não remoção de corpo estranho e a antibioticoterapia prévia. A identificação de espécies de ECN constitui um marcador útil de infecção, visto que o S. epidermidis foi o agente etiológico mais freqüentemente associado aos processos infecciosos.<br>Objective: to evaluate the clinical significance of coagulase-negative staphylococci (CNS) isolated from newborns’ infections at Neonatal Unit of Hospital das Clínicas da Faculdade de Medicina de Botucatu. Methods: the CNS strains isolated were identified and classified as clinically significant and contaminant, based on a series of clinical and laboratory data obtained from patients who stayed in the Neonatal Unit. The following data were analyzed: risk factors for infections, clinical evolution, abnormal blood cell counts and/or C-reactive protein e antibiotic therapy. Results: among the 117 CNS strains isolated, 60 (51.3%) were classified as significant and 57 (48.7%) as contaminant. Among the 54 infants infected by CNS, 43 (79.6%) presented very low birthweight (< 1,500g). Most of the infants infected by CNS were submitted to two or more invasive procedures (77.8%), including use of catheter (88.9%), parenteral nutrition (64.8%) and mechanical ventilation (61.1%). Staphylococcus epidermidis was the most frequently isolated species (77.8%) and more often associated with infection (86.7%) than with contamination (68.4%). Other species of CNS, including two strains of S. haemolyticus, three strains of S. lugdunensis, one strain of S. simulans, one strain of S. warneri and one strain of S. xylosus were also isolated from infants with clinical evidence of pneumonia, necrotizing enterocolitis and sepsis Conclusions: most newborns infected by CNS presented important risk factors for infection onset, including birthweight < 1,500g, foreign body presence and previous use of antibiotics. The identification of CNS species constitutes a useful marker of infection, since S. epidermidis was the species more frequently associated with infection

Biomass components and structure of massai grass fertilized with nitrogen and grazed by sheep

ABSTRACT To evaluate the biomass components of massai grass subjected to nitrogen (N) fertilization levels (control - 0; 400; 800 and 1200 kg ha-1 year-1 of N) and under rotational stocking with sheep, this study was undertaken using a completely randomized design with measurements repeated in time. A quadratic response was observed reaching maximum values as the levels of nitrogen fertilization increased for green forage biomass, green leaf biomass, green stem biomass (5,172.9; 4,146.3; 1,033.9 kg ha-1 cycle-1, respectively), forage total density (179.1 kg ha-1 cm-1), canopy height (36.8 cm) and live material/dead material ratio (4.0) at levels 896; 934; 797; 879.2; 751.4 and 1,161 kg ha-1 year-1 of N, respectively. For all variables, oscillation was observed between the grazing cycles studied. Nitrogen fertilization has a positive response on the biomass components and canopy structure of massai grass.</jats:p