Fungemia in a university hospital: an epidemiological approach

INTRODUCTION: Fungemia corresponds to the isolation of fungi in the bloodstream and occurs mostly in immunosuppressed patients. The early diagnosis and treatment of these infections are relevant given the serious threat to the affected patients and possible spread to other organs, often becoming fatal. The growing number of fungemia associated with poor prognosis resulted in this research aiming to diagnose and assess the epidemiological aspects of hematogenous infections by fungi. METHODS: The study included 58 blood samples collected within a 1-year period, from patients at the Hospital das Clinicas, Federal University of Pernambuco, by venipuncture in vacuum tubes. Blood samples were processed for direct examination and culture and identification, conducted by observing the macroscopic and microscopic characteristics, as well as physiological characteristics when necessary. RESULTS: Eight (13.8%) episodes of fungemia were identified, accounting for the total sample, and these pathogens were Candida, Histoplasma, Trichosporon, Cryptococcus, and a dematiaceous fungus. C. albicans was the prevalent species, accounting for 37.5% of the cases. Most affected patients were adult males. There was no predominance for any activity, and the risk of acquired immunodeficiency syndrome was the underlying pathology most often cited. CONCLUSIONS: The isolation of fungi considered as emergent species, such as C. membranifaciens and dematiaceous species, highlights the importance of epidemiological monitoring of cases of fungemia in immunocompromised patients, as the therapy of choice depends on the knowledge of the aethiological agent.

Clinical and microbiological features of cryptococcal meningitis

Introduction In this study, the clinical features, underlying diseases and clinical outcomes of patients with cryptococcosis were investigated. In addition, a molecular analysis of the Cryptococcus neoformans species complex isolated from these patients was performed. Methods A prospective study of 62 cases of patients with cryptococcal infection was conducted at the Hospital de Doenças Tropicais de Goiás Dr. Anuar Auad from 2009-2010. Cryptococcal meningitis cases were diagnosed by direct examination and cerebrospinal fluid (CSF) sample culture. The profiling of these patients was assessed. The CSF samples were submitted to India ink preparation and cultured on Sabouraud dextrose agar, and C. neoformans was identified by the production of urease, a positive phenoloxidase test and assimilation of carbohydrates. C. neoformans and C. gattii isolates were distinguished by growth on L-canavanine-glycine-bromothymol blue medium, and molecular analysis was conducted via PCR fingerprinting reactions using M13 and (GACA)4 primers. Results From the 62 patients with cryptococcosis, 71 isolates of CSF were obtained; 67 (94.4%) isolates were identified as C. neoformans var. grubii/VNI, and 4 (5.6%) were identified as C. gattii/VGII. Of these patients, 53 had an HIV diagnosis. The incidence of cryptococcosis was higher among patients 20-40 years of age, with 74.2% of the cases reported in males. Cryptococcus-related mortality was noted in 48.4% of the patients, and the symptoms were altered sensorium, headache, fever and stiff neck. Conclusions The high morbidity and mortality observed among patients with cryptococcosis demonstrate the importance of obtaining information regarding the epidemiological profile and clinical course of the disease in the State of Goiás, Brazil.

In vitro antifungal activities of leaf extracts of Lippia alba (Verbenaceae) against clinically important yeast species

Introduction There are few studies reporting the antifungal activities of Lippia alba extracts. Methods A broth microdilution assay was used to evaluate the antifungal effects of Lippia alba extracts against seven yeast species of Candida and Cryptococcus. The butanol fraction was investigated by gas chromatography-mass spectrometry. Results The butanol fraction showed the highest activity against Candida glabrata. The fraction also acted synergistically with itraconazole and fluconazole against C. glabrata. The dominant compounds in the butanol fraction were 2,2,5-trimethyl-3,4-hexanedione, 3,5-dimethyl-4-octanone and hexadecane. Conclusions The butanol fraction may be a good candidate in the search for new drugs from natural products with antifungal activity.

Puerperal brain cryptococcoma in an HIV-negative woman successfully treated with fluconazole: a case report

Cryptococcus spp. cerebral abscesses are uncommon in immunocompetent subjects. The recommended induction treatment is the administration of amphotericin B plus flucytosine combined with resection for lesions ≥3cm. In this paper, we describe an HIV-negative woman diagnosed with a large cryptococcoma in the immediate postpartum period. The lesion was not resected, and due to amphotericin B intolerance, she received an extended course of fluconazole monotherapy. There was no disease recurrence during the 4 years of follow-up. The abrupt onset of her symptoms following delivery suggests that she developed a postpartum immune reconstitution syndrome. This case also demonstrates that in specific situations fluconazole monotherapy can be attempted in immunocompetent patients with cryptococcoma.

Ventriculoperitoneal shunts for treating increased intracranial pressure in cryptococcal meningitis with or without ventriculomegaly

Introduction Cryptococcosis is an opportunistic mycosis, especially in patients that are human immunodeficiency virus (HIV)-positive, and frequently involves the central nervous system. Methods We assessed the potential of ventriculoperitoneal shunting (VPS) in preventing mortality due to uncontrollable intracranial hypertension (ICH) in 15 patients with acquired immunodeficiency syndrome (AIDS)-related cryptococcal meningitis. Results After 2 weeks of antifungal therapy consisting of amphotericin B deoxycholate with or without fluconazole, patients with persistent ICH underwent VPS, despite having persistent Cryptococcus neoformans infection. In 12 patients, the uncontrollable ICH was resolved by VPS. Conclusions Patients with cryptococcal meningoencephalitis who have ICH must be considered for VPS even with positive cerebrospinal fluid cultures.

Cryptococcosis in Atlántico, Colombia: an approximation of the prevalence of this mycosis and the distribution of the etiological agent in the environment

ABSTRACTINTRODUCTION:Cryptococcosis is an invasive disease acquired by inhalation of infectious propagules from the environment. Currently, compulsory notification of the spread of this disease is not required in Colombia. However, reporting of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome cases to the National Surveillance System has suggested that there is a growing population at risk of contracting cryptococcosis. Few studies have described the occurrence of cryptococcosis in Colombia. Therefore, in this study, we examined the pathology of this disease in Atlántico, Colombia and determined the distributions of Cryptococcus neoformans and Cryptococcus gattii in the environment.METHODS:Clinical samples/isolates were gathered from cases of cryptococcosis previously diagnosed at health institutions in Atlántico, and surveys were completed by clinicians. The environmental study considered 32 sampling points and three tree species, i.e., Quickstick ( Gliricidia sepium ), Almond ( Terminalia catappa ), and Pink trumpet ( Tabebuia rosea ). Environmental and clinical samples/isolates were analyzed for phenotypic and genotypic confirmation.RESULTS:From 1997-2014, 41 cases of cryptococcosis were reported. The mean patient age was 40.5 years (range: 18-63 years); 76% were men, and 78% were HIV positive. Isolation was possible in 38 cases ( C. neoformans , molecular type VNI in 37 cases and C. gattii , molecular type VGI in one case). In 2012-2014, 2,068 environmental samples were analyzed with a positivity of 0.4% ( C. neoformans , molecular type VNI) in Almond and Pink trumpet trees.CONCLUSIONS:Cryptococcus neoformans , molecular type VNI had a higher prevalence than C. gattii and was associated with human exposure and the pathogenesis of cryptococcosis in this geographical region.

Neuroptera of the Amazon basin. Part 11a. Introduction and chrysopint.

33 species of Chrisopini are described and illustrated, of wich 30 are recorded from the Amazon Basin. Ten new species are described in Chrisopodes(duckei, spínella, nebulosa, lineafrons, polygonica, indetata, conisetosa, breviata, mediocris, and tetifera(, and nine in Ceraesochrysa(squalidens, acutipuppis, rafaeli, reddyi, nigripes, teneuícornis, ariasi, falceifera, and michaelmuris). Neosuarus (type species collaris (Schneider), a new subgenus of Chrysopodes, also contains divisa (Walker), escomeli (Navás) porterina (Navás), and flavescens (Blanchard). Orlandsia Navás and Ancylochrysa Navás are synonymized with Chrysopodes limbata (Navás), Chrysoperla asoralis (Banks) and Suarius nesotala (Banks). A neotype is designate for Ceraeochrysa cubana (Hagen). Ceraeochrysa caligata(Banks) and scapularis (Navás) are valid species. C. gloriae Alayo is synonymized with Ceraeochrysa everes (Banks).

Efeito de duas intensidades de colheita de madeira na estrutura de uma floresta natural na região de Paragominas, Pará

Foram estudadas as mudanças na estrutura de 108ha de uma floresta primária submetida a duas intensidades de colheita de madeira, na Fazenda Rio Capim, pertencente à Cikel Brasil Verde Madeiras Ltda., no município de Paragominas, Pará. Os dados foram coletados, em dois períodos (2003, antes da exploração, e 2004, após a exploração) em 36 parcelas permanentes quadradas de 0,25ha, estabelecidas aleatoriamente na área, sendo12 em floresta não-explorada: Testemunha - T0; 12 em floresta explorada com colheita apenas do fuste comercial das árvores: Tratamento - T1; e 12 em floresta explorada com colheita do fuste e dos resíduos lenhosos: Tratamento - T2. Em 2003 foram registrados 4469 indivíduos com DAP > 10cm, nas 36 parcelas amostradas (9ha). Sete meses após a exploração (2004), foram observados na área 4531 indivíduos com DAP > 10cm, sendo 4330 vivos. Lecythis idatimon, Poecilanthe effusa, Rinorea flavescens, Eschweilera grandiflora, Eschweilera pedicellata, Inga sp., Protium spp., Vouacapoua americana, Guatteria poeppigiana e Eschweilera coriacea foram as dez espécies mais importantes, tanto antes como após a exploração. A estrutura da floresta, tanto no T1 como no T2, sofreu alterações significantes devido à exploração a que foi submetida. Entretanto, não foram verificadas diferenças significativas entre os três tratamentos, sugerindo que com a intensidade de exploração aplicada, mais a retirada adicional dos resíduos, a floresta manteve as características semelhantes à floresta original, apesar do menor estoque de árvores adultas de espécies comerciais. Recomendam-se estudos sobre a regeneração natural (DAP < 10cm), silvicultura pós-colheita e crescimento da floresta.

Modificación de la actividad de células inmunocompetentes en criptococosis y distomatosis experimental

El objetivo de este proyecto es profundizar los conocimientos en las células que regulan las interacciones huésped-parásito en dos modelos experimentales diferentes donde se involucra la participación de Cryptococcus neoformans y Fasciola hepatica. En el primer modelo se continuará analizando el modelo de infección experimental con Cryptococcus neoformans. Para ello se estudiarán las modificaciones que ocurran en los mecanismos de activación del macrófago respecto a la generación de derivados tóxicos del oxígeno y derivados tóxicos del nitrógeno. Por otra parte, considerando que en células tímicas y células esplénicas de animales infectados con Cryptococcus neoformans se ha evideniciado la presencia de células con funciones supresoras; se determinará si el metabolismo de la L-arginina participa en esta actividad supresora. Cultivando células de timo y bazo se determinará la sensibilidad de estas células al óxido nítrico por medio de dadores químicos de NO y por el NO generado por macrófagos activados. Por otra parte se desarrollará un modelo de distomatosis experimental en ratas, en el cual se estudiarán las funciones accesorias de CP de ratas infectadas con Fasciola hepatica y la participación de los productos de excreción-secreción de este parásito en la modificación de estas funciones. Se analizarán las capacidades fagocíticas y presentadoras de antígeno en CP de ratas infectadas como así también en CP de animales inoculados con los productos excretores-secretores del parásito. Además se estudiará la acción de la CP de ratas infectadas con Fasciola hepatica sobre la respuesta proliferativa de células mononucleares de bazo de ratas normales estimuladas con mitógenos.

Teor de macro e micronutrientes em folhas de diferentes idades de algumas essências florestais nativas

No presente trabalho, foram determinados os teores de N, P, K, Ca, Mg, Fe, Zn, Cu e Mn em folhas de diferentes idades nas espécies: Astronium rurndeuva, Aspidospcrma ramiflorum Muell, Tabcbula flavescens Grise, Terminal ia cutappa e Joannesia princeps Veil. Os teores médios observados encontram-se dentro dos valores considerados médios para outras espécies, quando se adota a amplitude máxima de observações feitas por diversos autores. Com relação aos teores de nutrientes em folhas de idade diferente numa mesma espécie, com exceção de Terminalia catappa, não foram observadas variações regulares para os três níveis de idade fisiológica considerados. Os valores das folhas da espécie Astronium urindeuva evidenciaram suas características de planta calcícola.

The Adolpho Lutz collection of Tabanidae: (Diptera): I. The described genera and species, condition of the collection, and selection of lectotypes

A study of the Adolpho Lutz Collection of Tabanidae at the Instituto Oswaldo Cruz and of additional Lutz material at the Instituto Butantan in São Paulo is reported. Of the ninety-four species of Tabanidae validly described by Lutz, type material of eighty-four was recognized, either holotypes, allotypes or syntypes. Lectotypes were selected from among syntype series or remaining specimens and all type material was labelled. Of the ten species of which no type material could be found, neotypes were designated in the case of two species, Erephosis nigricans and Erephosis pseudo-aurimaculata. Types of three species, Chrysops ecuadoriensis, Dichelacera salvadorensis and Esenbeckia nigricorpus are believed to have been in Hamburg and destroyed during the last war. Types of two species, Esenbeckia biscutellata and E. dubia, and additional type material of several others are believed to have been in Montevideo. A request for information about them remains unanswered. Types of the remaining three species, Dichelacera intermedia, Dichelacera laceriascia and Esenbeckia distinguenda could not be found, and it is believed that at least the type of the last species was accidentally destroyed. Three specific of subspecific names proposed by Lutz but palaced by others in synonymy have been revalidated, Acanthocera intermedia, Erephosis brevistria and Esenbeckia fenestrata. Generic placement of two names has been changed, Esenbeckia arcuata ricardoae to Proboscoides, and Selasoma giganteum to Stibasoma. Seven specific names proposed by Lutz appear to be synonyms of earlier names, as follows: Bombylopsis juxtaleonina Lutz and Castro, 1936 = B. leonina Lutz, 1909. Bombylopsis pseudoanalis Lutz, 1909 = B. erythronotata (Bigot, 1892). Esenbeckia fuscipennis var. flavescens Lutz, 1909 = Esenbeckia fuscipennis Wied., 1828. Fidena chrysopyga Lutz and Castro, 1936 = F. atra Lutz and Castro, 1936. Laphriomyia longipalpis Lutz and Castro, 1937 = L. mirabilis Lutz, 1911. Stibasoma semiflavum Lutz, 1915 = St. bicolor Bigot, 1892. Tabanus hesperus Lutz, 1912 = Chlorotabanus (Cryptolylus) innotescens (Walker, 1854). Four Lutz names appear to antedate names proposed by others, viz.: Diachlorus angustifrons Kröber, 1930 and D. ochraceus Kröb., 1928 not Macquart, 1850 = Diachlorus fuscistigma Lutz, 1913. Psalidia fairchildi Barretto, 1950 = dicladocera conspicua Lutz and Neiva, 1914. Fidena pseudo-fulvithorax Kröb., 1931 = Erephopsis flavicrinis Lutz, 1909. Esenbeckia lemniscata Enderlein, 1925 = Esenbeckia clari Lutz, 1909. Some comments on Lutz' system of classification are given together with notes on the genotypes and included species of his genera as revaled by his collection and notes.

Mites (Acari: Laelapidae) associated with sigmodontinae rodents in Entre Ríos Province, Argentina

The richness, diversity, abundance and prevalence of mite species associated with sigmodontine rodents of different species in Entre Ríos province, Argentina are studied. Five of the six species of mites were reported for the first time in the study area. The richness and diversity of mites was higher on Oligoryzomys flavescens and O. delticola than on Akodon azarae. Androlaelaps rotundus was dominant and exhibited higher values of mean abundance and prevalence on A. azarae, Mysolaelaps microspinosus on O. flavescens and Gigantolaelaps mattogrossensis on O. delticola.

Interrelationship between ectoparasites and wild rodents from northeastern Buenos Aires province, Argentina

Infestation parameters and indices of mites, ticks and fleas associated with wild rodents from northeastern Buenos Aires Province, Argentina, were studied. Host species similarity was also analyzed in relation to their ectoparasites. Fifty-five rodents were captured from January 2000 to March 2001. In total, 1,022 ectoparasites were collected and three ectoparasite-host associations were new records. However, this is the first study on Craneopsylla minerva wolffhuegeli infesting parameters. Ectoparasite total mean abundance and total prevalence were higher in Holochilus brasiliensis (MA = 47.7; P = 100%) and Scapteromys aquaticus (MA = 25.4; P = 95.4%), meanwhile specific richness and diversity were higher in Oligoryzomys flavescens (S = 6; H = 1.3) and Akodon azarae (S = 4; H = 1.0). On the other hand, the only individual of Calomys laucha was not parasited. S. aquaticus-H. brasiliensis, which preferred similar microhabitats, shared the same ectoparasite species (Css = 100). Whereas, A. azarae, which was mostly associated with grassland, showed the highest difference with the other hosts (Css < 0.4). Considering every ectoparasite species, H. brasiliensis showed the highest mean abundance, prevalence and preference. The results suggest that the particular characteristics of this rodent would give it better possibilities not only of being infested by ectoparasites, but also of transmitting them to its progeny.

Arthropod and filarioid parasites associated with wild rodents in the northeast marshes of Buenos Aires, Argentina

During 1995, 16 species of arthropods and 2 species of filarioids, totaling 1 287 specimens were collected from 64 wild rodents captured in the Hudson Natural Reserve, Buenos Aires, Argentina. Infestation parameters and indexes were analyzed. Host specific richness was S = 6, diversity H = 1.48, and relative density RDI = 40%. High values of parasite species richness and diversity were found on Oligoryzomys delticola (S = 9; H = 1.40), Oxymycterus rufus (S = 9; H = 1.37), and Oligoryzomys flavescens (S = 9; H = 1.28), followed by Scapteromys aquaticus (S = 6; H = 0.17), and Akodon azarae (S = 4; H = 1.20). Deltamys kempi was infested only by Androlaelaps rotundus. O. delticola and O. flavescens showed the highest similarity index (O = 74.19%), followed by O. flavescens with S. aquaticus, as a result of historical processes and shared microhabitats. Considering arthropods-filarioids associations, significant affinity was observed in Litomosoides bonaerensis with Hoplopleura travassosi, Laelaps paulistanensis, and Gigantolaelaps wolffsohni.

Prevalence of infection with hantavirus in rodent populations of central Argentina

We studied hantavirus seroprevalence and virus variability in rodent populations in Diego Gaynor, northwest of Buenos Aires province, Argentina. Rodent samplings were conducted in railroads and cropfield borders in March and July 1999, September and December 2000, and March 2001. Antibody detection was performed by an enzyme link immunosorbent assay (ELISA), using the recombinant nucleoprotein of Andes (AND) virus as antigen. Tissue samples were taken from positive antibody individuals in order to confirm the presence of hantavirus genomic material and to identify virus genotypes. Akodon azarae was the most abundant species, followed by Oligoryzomys flavescens, while Calomys laucha and C. musculinus were rarely caught. We found a rate of seroprevalence of 9.3% for a total sample of 291 A. azarae and 13.5% for 37 O. flavescens. After molecular analyses of hantavirus, we confirmed the presence of hantavirus genomic material in 16 individuals with ELISA (+) results and two individuals with ELISA (-). Four amplimers for each species were sequenced and compared to the corresponding sequences of representative hantaviruses. We identified the AND Cent Lec from three O. flavescens, and the Pergamino virus from four A. azarae and from one O. flavescens. A. azarae males had higher seroprevalence than females, and heavier individuals showed higher seroprevalence than lighter ones. We did not find seroprevalence differences according to sex in O. flavescens, although this result may have been produced by the low sample size. The lowest seroprevalence was found in a period of high rodent density, when juveniles prevailed in the population. We found higher seroprevalences than those detected in previous studies for other localities of central Argentina where cases of hantavirus pulmonary syndrome (HPS) have been reported. The presence of AND Cent Lec virus in rodent populations of the study area, which is responsible of HPS cases in central Argentina, suggests that human populations are at risk of HPS disease, although there were not reported cases of this disease until today.