Antifungal drug susceptibility profile of Pichia anomala isolates from patients presenting with nosocomial fungemia

In vitro susceptibility of 58 isolates of Pichia anomala to five antifungal drugs using two broth microdilution methods (CLSI and EUCAST) was analyzed. Low susceptibility to itraconazole was observed. Fluconazole, voriconazole, amphotericin B, and caspofungin showed good antifungal activity, although relatively high drug concentrations were necessary to inhibit the isolates.Inst Adolfo Lutz Registro, São Paulo, BrazilUniversidade Federal de São Paulo, Div Infect Dis, São Paulo, BrazilUniv Estadual Campinas, Fac Med Sci, Div Infect Dis, Campinas, SP, BrazilUniv Catolica Argentina, Fac Med, Buenos Aires, DF, ArgentinaUniv São Paulo, Hosp Clin, Lab Clin Micorbiol, São Paulo, BrazilUniv São Paulo, Hosp Clin, Hosp Infect Control Dept, LIM 54, São Paulo, BrazilHosp Sirio Libanes, São Paulo, BrazilUniv Fed Rio de Janeiro, Dept Internal Med, Rio de Janeiro, BrazilUniv São Paulo, Hosp Clin, Dept Infect Dis, São Paulo, BrazilUniversidade Federal de São Paulo, Div Infect Dis, São Paulo, BrazilWeb of Scienc

Immunohistochemical and molecular diagnosis of mucocutaneous and mucosal leishmaniasis

Leishmaniasis is a parasitic infection transmitted by the bite of infected female sandflies. It principally affects the skin, and the frequency of mucosal involvement is about 5% to 20%. Considering the rarity of leishmaniasis affecting the upper aerodigestive tract mucosa, we evaluated the characteristics of mucocutaneous leishmaniasis and mucosal leishmaniasis and the diagnostic difficulty when the parasites are scarce in tissue samples. The clinical, histopathological, histochemical, immunohistochemical, and molecular features of 17 cases of mucocutaneous leishmaniasis and mucosal leishmaniasis were assessed. Mucosal disease was principally found in the soft palate, oropharynx, and nose, manifesting mainly as a solitary ulcer. In hematoxylin and eosin-stained sections, 10 cases revealed abundant amastigotes within the macrophages. Giemsa staining was not shown to be helpful to confirm the diagnosis in 6 cases with scarce or nondetectable amastigotes. Immunohistochemistry (IHC) showed high sensitivity by positive staining in 14 out of 17 cases (82.3%). Polymerase chain reaction was shown to be more sensitive than IHC with 13 out of 14 (92.8%) positive cases, including the 3 IHC negative cases; however, this technique is not available in many endemic regions. In summary, we suggest that the IHC is a simple technique with rapid results and relatively low cost, when compared with other laboratorial procedures; thus, IHC is a helpful tool that should be implemented in the routine diagnosis of leishmaniaFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE MINAS GERAIS - FAPEMIGAPQ01122/1

Gene signatures of symptomatic and asymptomatic clinical-immunological profiles of human infection by Leishmania (L.) chagasi in Amazonian Brazil

This study was supported by the São Paulo Research Foundation (FAPESP): grant # 2014/50315-0, # 2020/02626-8; Nucleus of Tropical Medicine of Federal University of Pará State, Brazil, and Secretary of Health and Environment Surveillance of Ministry of Health, Brazil.Universidade de Sao Paulo. Faculdade de Medicina. Departamento de Patologia. Laboratorio de Patologia de Moléstias Infecciosas. Sao Paulo, SP, Brazil.Universidade de Sao Paulo. Faculdade de Medicina. Departamento de Patologia. Laboratorio de Patologia de Moléstias Infecciosas. Sao Paulo, SP, Brazil.Universidade de Sao Paulo. Faculdade de Medicina. Departamento de Patologia. Laboratorio de Patologia de Moléstias Infecciosas. Sao Paulo, SP, Brazil.Universidade de Sao Paulo. Faculdade de Medicina. Departamento de Patologia. Laboratorio de Patologia de Moléstias Infecciosas. Sao Paulo, SP, Brazil.Universidade de Sao Paulo. Faculdade de Medicina. Departamento de Patologia. Laboratorio de Patologia de Moléstias Infecciosas. Sao Paulo, SP, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Universidade de Sao Paulo. Faculdade de Medicina. Departamento de Patologia. Laboratorio de Patologia de Moléstias Infecciosas. Sao Paulo, SP, Brazil.Universidade de Sao Paulo. Faculdade de Medicina. Departamento de Patologia. Laboratorio de Patologia de Moléstias Infecciosas. Sao Paulo, SP, Brazil.Universidade de Sao Paulo. Faculdade de Ciências Farmaceuticas. Departamento de Análises Clínicas e Toxicológicas. Sao Paulo, SP, Brazil / Hospital Israelita Albert Einstein. Sao Paulo, SP, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil / Pará Federal University. Tropical Medicine Nucleus. Belém, PA, Brazil.Individuals infected with Leishmania (L.) chagasi may present different asymptomatic and symptomatic stages of infection, which vary in the clinical-immunological profiles that can be classified as asymptomatic infection (AI), subclinical resistant infection (SRI), indeterminate initial infection (III), subclinical oligosymptomatic infection (SOI), and symptomatic infection (SI) (=American visceral leishmaniasis, AVL). However, little is known about the molecular differences between individuals having each profile. Here, we performed whole-blood transcriptomic analyses of 56 infected individuals from Pará State (Brazilian Amazon), covering all five profiles. We then identified the gene signatures of each profile by comparing their transcriptome with those of 11 healthy individuals from the same area. Symptomatic individuals with SI (=AVL) and SOI profiles showed higher transcriptome perturbation when compared to those asymptomatic III, AI and SRI profiles, suggesting that disease severity may be associated with greater transcriptomic changes. Although the expression of many genes was altered on each profile, very few genes were shared among the profiles. This indicated that each profile has a unique gene signature. The innate immune system pathway was strongly activated only in asymptomatic AI and SRI profiles, suggesting the control of infection. In turn, pathways such as MHC Class II antigen presentation and NF-kB activation in B cells seemed to be specifically induced in symptomatic SI (=AVL) and SOI profiles. Moreover, cellular response to starvation was down-regulated in those symptomatic profiles. Overall, this study revealed five distinct transcriptional patterns associated to the clinical-immunological (symptomatic and asymptomatic) profiles of human L. (L.) chagasi-infection in the Brazilian Amazon