Multifocal Aggressive Squamous Cell Carcinomas Induced by Prolonged Voriconazole Therapy: A Case Report

Voriconazole is a treatment for severe fungal infections. Prolonged voriconazole therapy may induce skin reactions, with 1% of severe photosensitivity accidents. Recently the imputability of voriconazole in skin carcinogenesis has been suggested. This report concerns a 55-year-old man suffering from pulmonary aspergillosis who presented a phototoxic reaction a few months after introduction of voriconazole, followed by multiple squamous cell carcinomas of sun-exposed skin areas. After voriconazole discontinuation, no new carcinoma was observed. The detection of EBV and HPV in skin lesions was negative. Exploration of gene mutations involved in skin carcinogenesis showed two variants of the MICR gene. The occurrence of multiple, recurrent, aggressive squamous cell carcinomas is rare with voriconazole, but its imputability is strongly suggested. A plausible hypothesis is that several factors including voriconazole uptake, immunosuppression, and genetic background could explain the phenotype of fast-developing skin carcinomas. Voriconazole therapy should be accompanied by stringent photoprotection and skin monitoring

Biochemical Diagnosis of a Fatal Case of Günther’s Disease in a Newborn with Hydrops Foetalis

Peer Reviewe

AsrR Is an Oxidative Stress Sensing Regulator Modulating Enterococcus faecium Opportunistic Traits, Antimicrobial Resistance, and Pathogenicity

Oxidative stress serves as an important host/environmental signal that triggers a wide range of responses in microorganisms. Here, we identified an oxidative stress sensor and response regulator in the important multidrug-resistant nosocomial pathogen Enterococcus faecium belonging to the MarR family and called AsrR (antibiotic and stress response regulator). The AsrR regulator used cysteine oxidation to sense the hydrogen peroxide which results in its dissociation to promoter DNA. Transcriptome analysis showed that the AsrR regulon was composed of 181 genes, including representing functionally diverse groups involved in pathogenesis, antibiotic and antimicrobial peptide resistance, oxidative stress, and adaptive responses. Consistent with the upregulated expression of the pbp5 gene, encoding a low-affinity penicillin-binding protein, the asrR null mutant was found to be more resistant to \u3b2-lactam antibiotics. Deletion of asrR markedly decreased the bactericidal activity of ampicillin and vancomycin, which are both commonly used to treat infections due to enterococci, and also led to over-expression of two major adhesins, acm and ecbA, which resulted in enhanced in vitro adhesion to human intestinal cells. Additional pathogenic traits were also reinforced in the asrR null mutant including greater capacity than the parental strain to form biofilm in vitro and greater persistance in Galleria mellonella colonization and mouse systemic infection models. Despite overexpression of oxidative stress-response genes, deletion of asrR was associated with a decreased oxidative stress resistance in vitro, which correlated with a reduced resistance to phagocytic killing by murine macrophages. Interestingly, both strains showed similar amounts of intracellular reactive oxygen species. Finally, we observed a mutator phenotype and enhanced DNA transfer frequencies in the asrR deleted strain. These data indicate that AsrR plays a major role in antimicrobial resistance and adaptation for survival within the host, thereby contributes importantly to the opportunistic traits of E. faecium

Lipidna peroksidacija i aktivnost antioksidativnih enzima u eritrocitima radnika profesionalno izloženih aluminiju

Current research indicates that lipid peroxidation could have a role in aluminium toxicity. The aim of this study was to asses lipid peroxidation and antioxidative enzyme activity in erythrocytes of workers occupationally exposed to aluminium. We investigated a group of 59 workers (Al group) exposed to aluminium fumes (contamination factor F=8.07 to 13.47, national maximal allowed concentration value is 2 mg m-3). The control group (C group) consisted of 75 subjects employed in lime production who had not been occupationally exposed to aluminium or any known toxic substance. Erythrocyte aluminium concentrations were significantly higher in the exposed group than controls [Al group (8.41±3.66) µg L-1, C group (5.60±0.86) µg L-1, p<0.001]. In the Al group, erythrocyte malondialdehyde concentration was also significantly higher [Al group (189.59±81.27) µmol L-1, C group (105.21±49.62) µmol L-1, p<0.001] and antioxidative enzyme activity reduced for glucoso-6-phosphatedehydrogenase [Al group (5.05±1.70) IU g-1 Hb, C group (12.53±4.12) IU g-1 Hb, p<0.001], glutathione reductase [Al group (1.41±0.56) IU g-1 Hb, C group (1.89±0.57) IU g-1 Hb, p<0.001], glutathione peroxidase [Al group (12.37±5.76) IU g-1 Hb, C group (15.54±4.85) IU g-1 Hb, p<0.001], catalase [Al group (116.76±26.60) IU g-1 Hb, C group (158.81±71.85) IU g-1 Hb, p<0.001] and superoxide dismutase [Al group (1175.8±149.9) IU mg-1 Hb, C group (1377.9±207.5) IU mg-1 Hb, p<0.001].Rezultati suvremenih istraživanja pokazuju da lipidna peroksidacija može imati važnu ulogu u toksičnosti aluminija. Cilj istraživanja bio je da se ispita lipidna peroksidacija i aktivnost antioksidativnih enzima u eritrocitima kod radnika profesionalno izloženih aluminiju. Ispitivanjem je obuhvaćena skupina od 59 radnika (Al skupina) profesionalno izloženih aluminiju (faktor onečišćenja F=8,07 do 13,47, nacionalna maksimalno dopuštena koncentracija je 2 mg m-3). Kontrolna skupina sastojala se od 75 osoba zaposlenih u proizvodnji vapna koje nikada nisu bile profesionalno izložene aluminiju ni drugim toksičnim tvarima. U skupini izloženoj aluminiju utvrđene su statistički signifikantno više koncentracije aluminija u eritrocitima nego u kontrolnoj skupini [Al skupina (8,41±3,66) µg L-1, kontrolna skupina (5,60±0,86) µg L-1, p<0,001]. U Al skupini utvrđene su statistički značajno više koncentracije malondialdehida u eritrocitima [Al skupina (189,59±81,27) µmol L-1, kontrolna skupina (105,21±49,62) µmol L-1, p<0,001]. Također, u Al skupini utvrđene su i statistički značajno niže aktivnosti antioksidativnih enzima u eritrocitima: glukozo- 6-fosfatdehidrogenaza [Al skupina (5,05±1,70) IU g-1 Hb, kontrolna skupina (12,53±4,12) IU g-1 Hb, p<0,001], glutationreduktaza [Al skupina (1,41±0,56) IU g-1 Hb, kontrolna skupina (1,89±0,57) IU g-1 Hb, p<0,001], glutationperoksidaza [Al skupina (12,37±5,76) IU g-1 Hb, kontrolna skupina (15,54±4,85) IU g-1 Hb, p<0,001], katalaza [Al skupina (116,76±26,60) IU g-1 Hb, kontrolna skupina (158,81±71,85) IU g-1 Hb, p<0,001] i superoksiddizmutaza [Al skupina (1175,8±149,9) IU mg-1 Hb, kontrolna skupina (1377,9±207,5) IU mg-1 Hb, p<0,001]

The Transcriptome of the Nosocomial Pathogen Enterococcus faecalis V583 Reveals Adaptive Responses to Growth in Blood

gains access to the bloodstream and establishes a persistent infection is not well understood.. infections

Comparative Genomic Analysis of Pathogenic and Probiotic Enterococcus faecalis Isolates, and Their Transcriptional Responses to Growth in Human Urine

Urinary tract infection (UTI) is the most common infection caused by enterococci, and Enterococcus faecalis accounts for the majority of enterococcal infections. Although a number of virulence related traits have been established, no comprehensive genomic or transcriptomic studies have been conducted to investigate how to distinguish pathogenic from non-pathogenic E. faecalis in their ability to cause UTI. In order to identify potential genetic traits or gene regulatory features that distinguish pathogenic from non-pathogenic E. faecalis with respect to UTI, we have performed comparative genomic analysis, and investigated growth capacity and transcriptome profiling in human urine in vitro. Six strains of different origins were cultivated and all grew readily in human urine. The three strains chosen for transcriptional analysis showed an overall similar response with respect to energy and nitrogen metabolism, stress mechanism, cell envelope modifications, and trace metal acquisition. Our results suggest that citrate and aspartate are significant for growth of E. faecalis in human urine, and manganese appear to be a limiting factor. The majority of virulence factors were either not differentially regulated or down-regulated. Notably, a significant up-regulation of genes involved in biofilm formation was observed. Strains from different origins have similar capacity to grow in human urine. The overall similar transcriptional responses between the two pathogenic and the probiotic strain suggest that the pathogenic potential of a certain E. faecalis strain may to a great extent be determined by presence of fitness and virulence factors, rather than the level of expression of such traits

Constraints on simulated past Arctic amplification and lapse rate feedback from observations

The Arctic has warmed more rapidly than the global mean during the past few decades. The lapse rate feedback (LRF) has been identified as being a large contributor to the Arctic amplification (AA) of climate change. This particular feedback arises from the vertically non-uniform warming of the troposphere, which in the Arctic emerges as strong near-surface and muted free-tropospheric warming. Stable stratification and meridional energy transport are two characteristic processes that are evoked as causes for this vertical warming structure. Our aim is to constrain these governing processes by making use of detailed observations in combination with the large climate model ensemble of the sixth Coupled Model Intercomparison Project (CMIP6). We build on the result that CMIP6 models show a large spread in AA and Arctic LRF, which are positively correlated for the historical period of 1951–2014. Thus, we present process-oriented constraints by linking characteristics of the current climate to historical climate simulations. In particular, we compare a large consortium of present-day observations to co-located model data from subsets that show a weak and strong simulated AA and Arctic LRF in the past. Our analyses suggest that the vertical temperature structure of the Arctic boundary layer is more realistically depicted in climate models with weak (w) AA and Arctic LRF (CMIP6/w) in the past. In particular, CMIP6/w models show stronger inversions in the present climate for boreal autumn and winter and over sea ice, which is more consistent with the observations. These results are based on observations from the year-long Multidisciplinary Drifting Observatory for the Study of Arctic Climate (MOSAiC) expedition in the central Arctic, long-term measurements at the Utqiaġvik site in Alaska, USA, and dropsonde temperature profiling from aircraft campaigns in the Fram Strait. In addition, the atmospheric energy transport from lower latitudes that can further mediate the warming structure in the free troposphere is more realistically represented by CMIP6/w models. In particular, CMIP6/w models systemically simulate a weaker Arctic atmospheric energy transport convergence in the present climate for boreal autumn and winter, which is more consistent with fifth generation reanalysis of the European Centre for Medium-Range Weather Forecasts (ERA5). We further show a positive relationship between the magnitude of the present-day transport convergence and the strength of past AA. With respect to the Arctic LRF, we find links between the changes in transport pathways that drive vertical warming structures and local differences in the LRF. This highlights the mediating influence of advection on the Arctic LRF and motivates deeper studies to explicitly link spatial patterns of Arctic feedbacks to changes in the large-scale circulation