Antifungal susceptibilities, varieties, and electrophoretic karyotypes of clinical isolates of Cryptococcus neoformans from Brazil, Chile, and Venezuela

One hundred clinical isolates of Cryptococcus neoformans from human immunodeficiency virus (HIV)-infected and non-HIV-infected patients from Brazil, Chile, and Venezuela were separated according to varieties and tested for antifungal susceptibility. A high susceptibility to antifungal agents was observed among all the isolates. The electrophoretic karyotyping of 51 strains revealed good discrimination among Cryptococcus neoformans var. neoformans strains.3962348235

Molecular epidemiology of systemic infection caused by Enterobacter cloacae in a high-risk neonatal intensive care unit

OBJECTIVE: To investigate the molecular epidemiology of systemic nosocomial infections caused by Enterobacter cloacae. SETTING: Neonatal intensive care unit (NICU) of a tertiary-care university hospital. PATIENTS: Forty-two high-risk neonates with systemic infections caused by E. cloacae. METHODS: From 1995 to 1997, the variables associated with death in these patients were evaluated. The molecular epidemiology of the strains responsible for the systemic infections, and 14 unrelated strains, was studied using plasmid analysis and pulsed-field gel electrophoresis (PFGE). RESULTS: The overall mortality rate for infection caused by E. cloacae was 34%, whereas the crude mortality rate during the study period was 8.12% (P < .001). Gestational age (preterm neonates) and birth weight (small for gestational age) were not associated with a higher risk of death. Insertion of a venous catheter by dissection of a peripheral vein was the only invasive procedure related to death (P = .016) in this study, A molecular analysis showed that three outbreaks, each occurring in a different year, were caused by strains with distinctive DNA profiles. Only one outbreak was identified by the infection control service, in the NICU. Plasmid analysis and PFGE showed similar ability to discriminate control strains from the E. cloacae strains isolated from the neonates. CONCLUSIONS: Systemic infections caused by E. cloacae in our NICU were associated with a high mortality rate and occurred as small, unrecognized outbreaks. These results may not be generalizable because the data were from a single center.o TEXTO COMPLETO DESTE ARTIGO, ESTARÁ DISPONÍVEL À PARTIR DE AGOSTO DE 2015.24749049

The internal transcribed spacers and 5.8S rRNA gene show extensive diversity among isolates of the Cryptococcus neoformans species complex

Sequences of the internal transcribed spacer (ITS) region including the 5.8S rRNA gene delineated seven genotypes within the three varieties of Cryptococcus neoformans via specific combinations of eight nucleotide differences located at positions 10, 11, 15, 19, 108 (ITS1), 221 (5.8S), 298 and 346 (ITS2). The ITS types correlated to polymerase chain reaction fingerprint/random amplification of polymorphic DNA (RAPD) molecular types: with ITS type 1 (ATACTAGC) = C neoformans var. grubii, molecular types VNI+VNII and the serotype A allele of the AD hybrid, VNIIIA; ITS type 2 (ATATAGGC) = the serotype D allele of the AD hybrid, VNIIIB, and C neoformans var. neoformans, VNIV; and ITS type 3 (GCGCTGGC) and ITS type 7 (ACGCTGGC) = VGI = RAPID type 111, ITS type 4 (ACACTGAC) = VGII = RAPD type II, ITS type 5: (ACACTGGG) = VGIII = RAPD type 1, ITS type 6 (ACACTGGC) = VGIV = RAPD type IV, all corresponding to C. neoformans var. gattii. Cloned sequences from serotype AD revealed that the hybrid serotype is diploid at the ITS1-5.8S-ITS2 locus carrying the ITS type I (ATACTAGC) and the ITS type 2 (ATATAGGC) alleles. ITS sequencing is a useful technique for genotyping the three C. neoformans varieties and for subtyping within C neoformans var. gattii. (C) 2003 Federation of European Microbiological Societies. Published by Elsevier B.V. All rights reserved.44176337738

First isolation of Candida dubliniensis in Rio grande do sul, Brazil

Candida dubliniensis is a newly recognized species closely phylogenetically related to Candida albicans and is commonly associated with oral candidiasis in human immunodeficiency virus-positive patients. In this paper we report the isolation of three strains of C. dubliniensis, from AIDS patients, in the state of Rio Grande do Sul (Brazil). The phenotypic identification was based on germ tube emission, abundant production of chlamydospores, assimilation of sucrose but not of xylose and the inability to grow at 42 degreesC. Randomly amplified polymorphic DNA (RAPD) analysis and genomic DNA sequencing confirmed the distinct genetic nature C. dubliniensis. Topics related to the epidemiology, isolation, phenotypical and genotypical identification of C, dubliniensis are also discussed. (C) 2001 Elsevier Science Inc. All rights reserved.39316516

Bacterial Meningitis In The Elderly: An 8-year Review Of Cases In A University Hospital.

The clinical and laboratory characteristics of bacterial meningitis in subjects over 59 years-old were evaluated to establish variables related to prognosis. All patients with clinical and laboratory findings of acute meningitis were included. Sixty-four episodes in 64 patients were registered. S. pneumoniae was responsible for 19 cases (27.5%); L. monocytogenes - 3; S. aureus - 1; S. bovis - 1; S. agalactie - 1 and Corynebacterium jeikeium 1. Gram negative bacilli caused seven cases; two cases were due to N. meningitidis and one to H. influenzae. In 50% of the cases no microorganisms were isolated. The main symptom was fever (67.8%). Headache and neck rigidity were absent in about one-half of the cases and the predominant symptoms were psychomotor agitation, stupor or coma. The presence of concomitant diseases, such as diabetes mellitus (26.6%) and pneumonia (17.2%), were common. The mortality was high (51.5%). This poor prognosis was related to L.monocytogenes (100%), Gram negatives rods (83%) andS.pneumoniae (58%). The univariate analysis showed that absence of headache (p=0.002), presence of coma (p=0.04), pneumonia (p=0.01) and immunocompromised status (p=0.01) were associated with risk of death. The type of the microorganisms isolated in the elderly patients with meningitis were often unusual ones. The clinical symptoms were minimal and in many cases, the only clinical presentation was change in mental status. Poor prognosis was observed in spite of intensive care. A high index of suspicion for meningitis while caring for elderly with changes in mental status must be maintained to avoid delays in initiating appropriate therapy.3111-11

Trichosporon species infection in bone marrow transplanted patients

Trichosporon species are emerging as opportunistic agents that cause systemic diseases in immunocompromised patients. Patients undergoing bone marrow transplant are submitted to intense and prolonged periods of neutropenia and consequently to several risk factors to fungal infections as the use of broad spectrum antibiotics and invsive devices. Two cases of fungal infecitons caused by Trichosporon asahii var, asahii and T. inkin in patients with bone marrow transplant are described T. asahii var, asahii was responsible for fungemia and the identification of this microorganism was later performed. T. inkin caused vascular accesses infection and was recovered from an implanted Hickman-Broviac catheter. Both patients were under oral fluconazole prophylaxis. The patient with systemic infection died despite the therapy with amphotericin B and the patient with catheter-related infection recovered from the fungal infection after catheter removal. Difficulties in the identification of this microorganism lead to delays in treatment and post-mortem diagnosis. (C) 2001 Elsevier Science Inc. All rights reserved.39316116

Pichia anomala outbreak in a nursery: exogenous source?

Background. Pichia anomala is a rare cause of fungemia. From February to April, 1998, eight cases of fungemia occurred in the intensive care and high risk units of the Nursery. There were four infants with P. anomala infection, one of whom also had Candida parapsilosis infection, two cases with C. parapsilosis infection and two with Candida albicans infection. Objective. To determine factors associated with fungemia in the intensive care and high risk units of the Nursery, especially P. anomala. Methods. A cohort study with 59 newborns. Results. Factors associated with fungemia were: central venous catheter (CVC) (P = 0.0006); total parenteral nutrition (TPN) (P = 0.0005); lipid emulsion (P = 0.002); previous antimicrobial use (P = 0.002); and other invasive procedures (P = 0.002). Factors associated with P. anomala fungemia were: CVC (P = 0.004); TPN (P = 0.018); previous antibiotic use (P = 0.037); and other invasive procedures (P = 0.037). Evaluation of the units demonstrated that there were several technical problems involving administration of TPN that was manipulated in the Nursery without precautions. Changes in TPN formulation and education as to adequate technique were implemented. During follow-up (1998 to 1999) only two fungemias occurred that were caused by C. albicans. Cultures of hands of personnel were negative for P. anomala. Electrophoretic karyotyping of P. anomala showed three profiles. Conclusions. Factors associated with fungemia were catheter use, invasive procedures and total parenteral nutrition, suggesting that the acquisition of P. anomala was exogenous.20984384

Phaeohyphomycosis caused by Chaetomium globosum in an allogeneic bone marrow transplant recipient

Bone marrow transplant recipients are highly susceptible to opportunistic fungal infections. This is the report, of the first case of a Chaetomium systemic infection described in Brazil. A 34 year-old patient with chronic myeloid leukemia underwent an allogeneic sibling matched bone marrow transplant. Seven months later, he developed systemic infection with enlargement of the axillary and cervical lymph nodes. Culture of the aspirates from both lymph nodes yielded Chaetomium globosum. The infection was successfully treated with amphotericin B. The increasing population of immunosupressed patients requires a careful microbiologic investigation for uncommon fungal infections.156430931