Brain Abcess due to Cladophialophora bantiana: first case in Portugal

Clinical case reporting a brain abscess caused by Cladophialophora bantiana in an male patient with 56 years old. This is a rare case of a brain abscess caused by this species. Few cases have been reported in the literature world-wide, being this one the first reported in Portugal. The fungal isoltate was identified by morphological and molecular methods. After 16 months of the first brain abscess excision and after 5 months under therapy with voriconazol, the patient improved clinical and imagiologicaly, maintaining only minimal neurological deficits

Um Caso Clínico de Lepra Multibacilar com Vários Surtos de Eritema Nodoso Leproso

Leprosy is a chronic granulomatous disease with a long incubation period caused by Mycobacterium leprae that mainly affects the skin, mucous membranes and the peripheral nervous system. It carries the risk of per-manent sequels with a significant impact on the patient’s quality of life. It has a considerable clinically diver-sity and possible atypical presentations. We present a case of a 31-year-old, skin phototype V woman with multibacillary leprosy characterized by multiple outbreaks of erythema nodosum leprosum, as an inaugural manifestation of the disease. The disease was acquired within a group of children and adolescents from an endemic region of Africa, evolved untreated for 3 years, and presented with unusual features and remarkable lymphatic involvement. We highlight the importance of building and maintaining collaboration between expert centers and institutional partnerships in order to provide the adequate diagnostic resources and appropriate care to the affected populations.A lepra é uma doença granulomatosa crónica com longo período de incubação causada pelo bacilo Mycobacte- -rium leprae que afeta principalmente a pele, mucosas e sistema nervoso periférico. Tem risco de sequelas permanentes e impacto significativo na qualidade de vida do paciente. É clinicamente heterogénea com possíveis apresentações atípicas. Descrevemos o caso de uma mulher de 31 anos, fototipo V, com lepra multibacilar caracterizada por múltiplos surtos de eritema nodoso leproso como manifestação inaugural. A doença foi adquirida num grupo de crianças e adolescentes de uma região endémica de África, evoluiu sem tratamento durante 3 anos, e manifestou-se com algumas características clínicas incomuns e notável envolvimento linfático. Destacamos a importância da colaboração entre centros especializados e parcerias institucionais, a fim de fornecer os recursos de diagnósti-co e os cuidados adequados às populações afetadas

Lower prevalence of congenital cytomegalovirus infection in Portugal: possible impact of COVID-19 lockdown?

Cytomegalovirus (CMV) is the most frequent cause of congenital infection all over the world. Its prevalence ranges from 0.2 to 2.2%. Transmission from children to their pregnant mothers is a well-known risk factor, particularly if they attend a childcare centre. This study aims to compare the prevalence of CMV congenital infection (CMV_CI) in Portugal (Lisbon) between two studies, performed respectively in 2019 and 2020. In the 2019 study, performed in two hospitals, we found a 0.67% CMV_CI prevalence, using a pool strategy previously tested with saliva samples. In the 2020 study, using the same pool approach in four hospitals (the previous and two additional), and based on 1277 samples, the prevalence was 0.078%.Conclusion: The close temporal coincidence with COVID-19 lockdown suggests that these measures may have had a significant impact on this reduction, although other explanations cannot be ruled-out. What is Known: • Cytomegalovirus is the leading cause of congenital infection. • Behavioural measures decrease cytomegalovirus seroconversion in pregnant women. What is New: • From 2019 to 2020 there was a significant reduction in the prevalence of congenital CMV infection.info:eu-repo/semantics/publishedVersio

Streptococcus canis Are a Single Population Infecting Multiple Animal Hosts Despite the Diversity of the Universally Present M-Like Protein SCM

Streptococcus canis is an animal pathogen which occasionally causes infections in humans. The S. canis M-like protein (SCM) encoded by the scm gene, is its best characterized virulence factor but previous studies suggested it could be absent in a substantial fraction of isolates. We studied the distribution and variability of the scm gene in 188 S. canis isolates recovered from companion animals (n = 152), wild animal species (n = 20), and humans (n = 14). Multilocus sequence typing, including the first characterization of wildlife isolates, showed that the same lineages are present in all animal hosts, raising the possibility of extensive circulation between species. Whole-genome analysis revealed that emm-like genes found previously in S. canis correspond to divergent scm genes, indicating that what was previously believed to correspond to two genes is in fact the same scm locus. We designed primers allowing for the first time the successful amplification of the scm gene in all isolates. Analysis of the scm sequences identified 12 distinct types, which could be divided into two clusters: group I (76%, n = 142) and group II (24%, n = 46) sharing little sequence similarity. The predicted group I SCM showed extensive similarity with each other outside of the N-terminal hypervariable region and a conserved IgG binding domain. This domain was absent from group II SCM variants found in isolates previously thought to lack the scm gene, which also showed greater amino acid variability. Further studies are necessary to elucidate the possible host interacting partners of the group II SCM variants and their role in virulence

Growth of Mycobacterium tuberculosis in Conventional BacT/ALERT FA Blood Culture Bottles Allows Reliable Diagnosis of Mycobacteremia

The conventional BacT/ALERT FA blood cultures supported the ample growth of Mycobacterium tuberculosis in seeding experiments and appeared to perform as reliably as the BACTEC Myco/F-Lytic vials in the recovery of M. tuberculosis from blood in HIV-infected patients. Overall, blood cultures were positive in 39% of patients with tuberculosis

Eumicetoma causado por Parathyridaria percutanea num doente imunodeprimido - caso importado

Eumicetoma é uma infeção fúngica subcutânea crónica caracterizada por edema, fistulização e libertação de grânulos. Parathyridaria percutanea é uma causa rara de feohifomicose subcutânea, não havendo casos descritos de formação de fistulas ou drenagem de grãos devido a este fungo. Apresenta-se um caso clínico de eumicetoma causado por Parathyridaria percutaneaN/

Eumycetoma due to Parathyridaria percutânea in an immunosuppressed patient - an imported case in Portugal

Abstract publicado em: J Fungi (Basel). 2021 Nov; 7(11):916. pp. 223-24. (P262). doi: 10.3390/jof7110916Objectives: Eumycetoma is a chronic subcutaneous fungal infection characterized by swelling, fistulization and discharge of fungal granules. These infections occur after traumatic inoculation and progress slowly over months or even years into a chronic form. Parathyridaria percutanea is a rare cause of subcutaneous phaeohyphomycoses and there are no published reports of discharging sinus or granuloma formation due to this fungus. We present a rare case of eumycetoma due to Parathyridaria percutanea in a 10-years-old patient from Angola, presenting after allogeneic hematopoietic stem cell transplant (alloHSCT) for severe aplastic anemia. Material and methods: A 10-year-old boy from Angola with severe aplastic anemia was transferred to Portugal and submitted to alloHSCT from a mismatched unrelated donor at a single HLA-locus (9/10). After secondary graft failure due to post-transplant hemophagocytic lymphohistiocytosis, he underwent a second alloHSCT, without engraftment. Twenty-three days after the 3rd alloHSCT from the same donor and seven days under prophylaxis with posaconazole, the patient presented with febrile neutropenia with no clear focus. He complained of painless swelling of the right knee, with slight fluctuation. An ultrasound was performed revealing a heterogeneous hypoechogenic area with imprecise contours, inside of which there was a nodular formation of approximately 10 mm. Two weeks later, a spontaneous drainage of a grossly spherical grain from the right knee occurred. It was characterized as extra-articular, subcutaneous with filamentous aspect. The material was sent to the laboratory where its macroscopic observation allowed the identification of a granule of possible mycotic etiology, consistent with the diagnosis of eumycetoma. This sample was promptly processed for bacteriology (aerobic and anaerobic) and mycology studies. Results: Direct microscopic examination of the grain revealed septate hyphae with irregular hyphal swellings. Cultures for bacteria (aerobic and anaerobic) were sterile. After 1 week, slow growing colonies appeared on Sabouraud dextrose agar (SDA) incubated at 25 °C. Those colonies were flat, spreading with sparse aerial hyphae, become creamy after 5 to 10 days and with orange reverse and then turned dark brown after 4 weeks. Lactophenol cotton blue mount revealed nonsporulating dematiceous hyphae with clamidospores. Phenotypic identification of the organism was uncertain but sequencing of the internal transcribed spacer (ITS) region of ribosomal DNA identified as Parathyridaria percutanea (100% homology, 99% coverage). The isolate showed in vitro resistance to itraconazole, fluconazole and anidulofungin and susceptibility to posaconazole, voriconazole and amphotericin B. As this pathogen is extremely rare, no antifungal guidelines have been proposed so far. The patient received dual coverage with posaconazole and liposomal amphotericin-B but died 2 weeks later of complications of the underlying disease. Conclusions: The presented case maybe the first described case of eumycetoma caused by Parathyridaria percutanea associated with fistulae presentation. Molecular identification of rare fungi is essential, especially when they are poorly sporulated, as in this case. Moreover, rare fungi can present with odd clinical signs, as in this case, emphasizing the relevance of a polyphasic approach to identify the etiological agent.info:eu-repo/semantics/publishedVersio