ESPÉCIES DO GÉNERO CURVULARIA (FUNGOS ANAMÓRFICOS: HYPHOMYCETES) NA ILHA DE SANTIAGO, CABO VERDE

Nos estudos sobre a micoflora de muitos ecossistemas os fungos do género Curvularia Boedijn 1933, constituem um dos mais fascinantes grupos, devido à frequência com que são observados especímenes do género e ao elevado número de espécies que são normalmente identificadas. Apesar da maioria dos táxones do género ser conhecida como saprófita em diferentes substratos vegetais e no solo, podendo ainda ser isolada a partir do solo e do ar, muitas espécies são fitopatogénicas, sobretudo em gramíneas e em regiões de clima tropical e subtropical (SIVANESAN 1987). Um pequeno número de espécies pode raramente originar doenças em animais, incluindo humanos, surgindo como agentes de onicomicoses, sinusite alérgica, pneumonia, endocardite e alergia broncopulmonar (CARTER & BOUDREAUX 2004). Descrito com a espécie tipo C. lunata (Wakker) Boedijn, o género Curvularia permitiu acomodar espécies da família Dematiaceae que possuíam conidióforos macronematosos, mononematosos, direitos ou flexuosos, frequentemente geniculados, por vezes nodosos, células conidiogénicas politétricas, integradas, terminais e simpodiais, fragmoconídios solitários, acropleurógenos por proliferação subterminal do conidióforo, oliváceos a castanhos, elipsóides, cilíndricos, obovóides ou piriformes, três ou mais septos transversais, terceira célula ou segunda e terceira distintamente maiores e escuras, muitas vezes desigualmente curvos devido ao alargamento de uma ou duas células centrais, raramente direitos, septos rígidos, hilo truncado ou protuberante (ELLIS 1971). O género actualmente é composto por mais de 40 táxones que se distinguem por diferenças mais ou menos evidentes na morfologia dos conídios, número de septos e aspectos culturais (SIVANESAN 1987, HOSOKAWA et al. 2003, SIVANESAN et al. 2003, ZHANG-MENG & ZHANG 2003, ZHANG-MENG et al. 2004, CHUNG 2005). Algumas espécies possuem teleomorfo conhecido no género Cochliobolus Drechsler 1934, formando ascósporos filiformes paralelos ou frouxamente enrolados em espiral, característica não evidenciada pela espécie tipo do género, C. heterostrophus (Drechsler) Drechsler, teleomorfo de Bipolaris maydis (Nisik. & Miyake) Shoem., na qual os ascósporos se mostram enrolados formando uma espiral fechada. Por isso, teleomorfos dos fungos do género Curvularia são considerados por alguns autores como sendo do género Pseudocochliobolus Tsuda, Ueyama & Nishih. 1978, que é tido como uma sinonímia de Cochliobolus (ALCORN 1983, SIVANESAN 1987). De notar, no entanto, que sendo filogeneticamente próximo do género Bipolaris Shoem. 1959, as suas espécies apresentam semelhanças morfológicas com espécies do género Bipolaris que têm conídios pequenos e direitos e estudos com análise de sequências ITS e com o marcador enzimático gliceraldeído-3-P desidrogenase mostraram que partilham teleomorfo no grupo 2 do género Cochliobolus (BERBEE et al. 1999). A variabilidade morfológica observada nos fungos enquadrados em Curvularia levou a que ao ser criado o género as espécies fossem separadas em três grupos, ‘geniculata’, com a espécie-tipo C. geniculata (Tracy & Earle) Boedijn, ‘lunata’, com a espécie-tipo C. lunata (Tracy & Earle) Boedijn, e ‘maculans’, com a espécie-tipo C. maculans (Bancroft) Boedijn (=C. eragrostidis (Henn.) Mey.), que se diferenciaram pela forma dos conídios e número de septos (CORBETTA 1964). Nos grupos ‘lunata’ e ‘maculans’ ficaram colocadas as espécies com conídios 3-septados e no grupo ‘geniculata’ as espécies que tinham conídios 4- septados ou com maior número de septos. As espécies do grupo ‘lunata’ distinguiram-se das do grupo ‘maculans’ principalmente por apresentarem curvatura mais pronunciada, célula mediana mais volumosa e habitual presença de estroma em cultura. O reconhecimento das características principais do género Curvularia é relativamente fácil, o que permite que seja normalmente possível a identificação ao género de um qualquer espécimen. No entanto, a identificação em espécie é por vezes complicada pelas descrições vagas e ausência de ilustrações em trabalhos mais antigos, inconstância de características morfológicas e biométricas dos esporos, causada por diferentes condições em que ocorre o crescimento, e sobreposição dos valores das medidas apresentadas por diferentes autores (TSUDA & UEYAMA 1982, HOSOKAWA et al. 2003). Contudo, esta situação não impede que a identificação das espécies continue a ser feita numa aproximação fenotípica, com base em características morfológicas e culturais. Recentemente, as espécies C. fallax Boedijn, C. geniculata (Tracy & Earle) Boedijn e C. senegalensis (Speg.) Subram., do grupo ‘geniculata’, que eram aceites como táxones válidos em monografias clássicas do género (ELLIS 1971, SIVANESAN 1987) mostraram-se interférteis (HOSOKAWA et al. 2003), vindo a ser consideradas, com base em características morfológicas e análise de DNA total por RFLP (HOSOKAWA et al. 2003) e na análise da sequência do gene Brn1 (SUN et al. 2003), como espécie única e sinonimizadas com C. geniculata. Sabido que a diversidade dos fungos que ocorrem nos diferentes ecossistemas de Cabo Verde tem sido pouco estudada, iniciou-se um levantamento da micoflora associada a gramíneas, tendo-se obtido uma colecção de Magnaporthe grisea (Hebert) Barr (LIMA & DUCLOS 2001) e de espécies dos géneros Bipolaris, Exserohilum Leonard & Suggs e Curvularia. O presente trabalho tem como objectivo descrever e ilustrar as espécies de Curvularia identificadas na ilha de Santiago e contribuir para o melhor conhecimento do género naquele país. Na bibliografia consultada não foram encontradas referências a fungos do género Curvularia para Cabo Verde.

Bionomia dos estágios imaturos de duas espécies de Peckia (Diptera, Sarcophagidae) em suíno em decomposição em área de floresta no norte do Brasil

Descreveu-se a duração dos estádios larvais de Peckia (Pattonella) smarti (Lopes 1941) e Peckia (Pattonella) pallidipilosa (Curran & Walley 1934) obtidos em suínos em decomposição na natureza durante as estações chuvosa e seca na Reserva Florestal Adolpho Ducke, Manaus, Amazonas. As larvas foram colocadas em recipientes com serragem úmida e carne suína com 12 horas de decomposição para puparem. Os recipientes com as larvas foram mantidos em viveiro próximo ao local de coleta. A idenficação foi baseada nos adultos e posteriormente foram correlacionados com as larvas. O período de larva até a emergência dos adultos, na estação chuvosa, foi de 17,93 dias para P. smarti e 15,87 dias para P. pallidipilosa. Na estação seca foi de 16,05 dias para P. smarti e 15,96 dias para P. pallidipilosa. Peckia smarti e P. pallidipilosa estão sendo registradas pela primeira vez para o Estado do Amazonas e para o Brasil, respectivamente.

Predicting adverse events in children with fever and chemotherapy-induced neutropenia: the prospective multicenter SPOG 2003 FN study.

PURPOSE To develop a score predicting the risk of adverse events (AEs) in pediatric patients with cancer who experience fever and neutropenia (FN) and to evaluate its performance. PATIENTS AND METHODS Pediatric patients with cancer presenting with FN induced by nonmyeloablative chemotherapy were observed in a prospective multicenter study. A score predicting the risk of future AEs (ie, serious medical complication, microbiologically defined infection, radiologically confirmed pneumonia) was developed from a multivariate mixed logistic regression model. Its cross-validated predictive performance was compared with that of published risk prediction rules. Results An AE was reported in 122 (29%) of 423 FN episodes. In 57 episodes (13%), the first AE was known only after reassessment after 8 to 24 hours of inpatient management. Predicting AE at reassessment was better than prediction at presentation with FN. A differential leukocyte count did not increase the predictive performance. The score predicting future AE in 358 episodes without known AE at reassessment used the following four variables: preceding chemotherapy more intensive than acute lymphoblastic leukemia maintenance (weight = 4), hemoglobin > or = 90 g/L (weight = 5), leukocyte count less than 0.3 G/L (weight = 3), and platelet count less than 50 G/L (weight = 3). A score (sum of weights) > or = 9 predicted future AEs. The cross-validated performance of this score exceeded the performance of published risk prediction rules. At an overall sensitivity of 92%, 35% of the episodes were classified as low risk, with a specificity of 45% and a negative predictive value of 93%. CONCLUSION This score, based on four routinely accessible characteristics, accurately identifies pediatric patients with cancer with FN at risk for AEs after reassessment.

Relatório dos Processos Realizados para Atingir os - ODM - Foco Monicipal - Relatório 2007 - 2009 - Cabo Verde

Com o virar do século a Organização das Nações Unidas (ONU) decidiu que era propício e muito simbólico dar um novo impulso à própria Organização e comprometeu-se a combater a pobreza e as doenças que vitimam milhões de crianças em todo o mundo, a maioria das quais com menos de cinco anos, devido a causas totalmente evitáveis como a malária, a diarreia e a pneumonia. Assim, a 8 de Setembro de 2000, 189 Estados membros das ONU adoptaram os “Objectivos de Desenvolvimento do Milénio” (ODM) surgidos da Declaração do Milénio. Foram definidos oito objectivos — cada um deles, um compromisso específico para inverter a propagação da pobreza e das doenças — que são suportados por um Plano de Acção com 18 metas quantificáveis para combater a pobreza, a fome, a doença, o analfabetismo, a discriminação contra a mulher e a degradação ambiental. Muitas das metas dos ODM reflectem um nível de ambição modesto em termos de desenvolvimento humano que os países da ONU se comprometeram a atingir até 2015. Os Objectivos representam igualmente uma parceria entre países desenvolvidos e em desenvolvimento tendo em vista criar um clima a nível nacional e mundial conducente ao desenvolvimento e à eliminação da pobreza. Essa parceria atribui responsabilidades muito claras aos países ricos em termos de prestação de mais ajuda; estabelecimento de regras comerciais mais justas; e alívio significativo da dívida dos países em desenvolvimento. Por seu turno os países em desenvolvimento comprometem-se a vencer o desafio que os ODM colocam. Cabo Verde aceitou o desafio lançado pela ONU para implementar um conjunto de acções estratégicas para que até o ano 2015 um conjunto de objectivos e metas seja realizado. Essa assumpção impõe a integração das metas e indicadores ODM nas políticas públicas nacionais.

Parachlamydia and rhabdochlamydia: emerging agents of community-acquired respiratory infections in children.

T O THE E DITOR-Besides viruses, Mycoplasma pneumoniae and Chlamydia pneumoniae are common causes of community-acquired respiratory infections (CARI) in children. However, the causal agent of CARI remains unknown in many cases [ 1]. Growing evidence suggests that Chlamydia-related bacteria might have a pathogenic role in humans [ 2, 3]. Parachlamydia acanthamoebae and Protochlamydia naegleriophila have been detected in respiratory clinical samples [ 4, 5], and the role of Parachlamydia acanthamoebae in pneumonia is supported by in vitro studies and animal models [ 6]. Rhabdochlamydia crassificans and Rhabdochlamydia porcellionis are intracellular pathogens of arthropods that also belong to the Chlamydiales order [ 7, 8]. A recent analysis suggests that Rhabdochlamydia species might affect morbidity and mortality in premature newborns [ 9], but their role ...

Multicenter, Prospective Clinical Evaluation of Respiratory Samples from Subjects at Risk for Pneumocystis jirovecii Infection by Use of a Commercial Real-Time PCR Assay.

Pneumocystis jirovecii pneumonia (PCP) is a common opportunistic infection. Microscopic diagnosis, including diagnosis using the Merifluor-Pneumocystis direct fluorescent antigen (MP-DFA) test, has limitations. Real-time PCR may assist in diagnosis, but no commercially validated real-time PCR assay has been available to date. MycAssay Pneumocystis is a commercial assay that targets the P. jirovecii mitochondrial large subunit (analytical detection limit, ≤3.5 copies/μl of sample). A multicenter trial recruited 110 subjects: 54 with transplants (40 with lung transplants), 32 with nonmalignant conditions, 13 with leukemia, and 11 with solid tumors; 9 were HIV positive. A total of 110 respiratory samples (92% of which were bronchoalveolar lavage [BAL] specimens) were analyzed by PCR. Performance was characterized relative to investigator-determined clinical diagnosis of PCP (including local diagnostic tests), and PCR results were compared with MP-DFA test results for 83 subjects. Thirteen of 14 subjects with PCP and 9/96 without PCP (including 5 undergoing BAL surveillance after lung transplantation) had positive PCR results; sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) were 93%, 91%, 59%, and 99%, respectively. Fourteen of 83 subjects for whom PCR and MP-DFA test results were available had PCP; PCR sensitivity, specificity, PPV, and NPV were 93%, 90%, 65%, and 98%, respectively, and MP-DFA test sensitivity, specificity, PPV, and NPV were 93%, 100%, 100%, and 98%. Of the 9 PCR-positive subjects without PCP, 1 later developed PCP. The PCR diagnostic assay compares well with clinical diagnosis using nonmolecular methods. Additional positive results compared with the MP-DFA test may reflect low-level infection or colonization.

Influenza and Other Respiratory Virus Weekly Activity Report, May 16, 2009 Week 19

The Iowa Influenza Surveillance Network (IISN) is comprised of physicians, schools, child care centers, businesses, and long term care facilities who track the occurrence on influenza-like illness. In addition, the state influenza coordinator tracks the number of deaths due to pneumonia and influenza in Des Moines weekly as part of the 122-Cities Morbidity and Mortality reporting system sponsored by CDC.

Influenza and Other Respiratory Virus Weekly Activity Report, May 9, 2009 Week 18

The Iowa Influenza Surveillance Network (IISN) is comprised of physicians, schools, child care centers, businesses, and long term care facilities who track the occurrence on influenza-like illness. In addition, the state influenza coordinator tracks the number of deaths due to pneumonia and influenza in Des Moines weekly as part of the 122-Cities Morbidity and Mortality reporting system sponsored by CDC.

Predicting Adverse Events in Children with Fever and Chemotherapy-Induced Neutropenia. Results of the Prospective Multicenter SPOG 2003 FN Study

PURPOSE To develop a score predicting the risk of adverse events (AEs) in pediatric patients with cancer who experience fever and neutropenia (FN) and to evaluate its performance. PATIENTS AND METHODS Pediatric patients with cancer presenting with FN induced by nonmyeloablative chemotherapy were observed in a prospective multicenter study. A score predicting the risk of future AEs (ie, serious medical complication, microbiologically defined infection, radiologically confirmed pneumonia) was developed from a multivariate mixed logistic regression model. Its cross-validated predictive performance was compared with that of published risk prediction rules. Results An AE was reported in 122 (29%) of 423 FN episodes. In 57 episodes (13%), the first AE was known only after reassessment after 8 to 24 hours of inpatient management. Predicting AE at reassessment was better than prediction at presentation with FN. A differential leukocyte count did not increase the predictive performance. The score predicting future AE in 358 episodes without known AE at reassessment used the following four variables: preceding chemotherapy more intensive than acute lymphoblastic leukemia maintenance (weight = 4), hemoglobin > or = 90 g/L (weight = 5), leukocyte count less than 0.3 G/L (weight = 3), and platelet count less than 50 G/L (weight = 3). A score (sum of weights) > or = 9 predicted future AEs. The cross-validated performance of this score exceeded the performance of published risk prediction rules. At an overall sensitivity of 92%, 35% of the episodes were classified as low risk, with a specificity of 45% and a negative predictive value of 93%. CONCLUSION This score, based on four routinely accessible characteristics, accurately identifies pediatric patients with cancer with FN at risk for AEs after reassessment.

De Novo Assembly of the Pneumocystis jirovecii Genome from a Single Bronchoalveolar Lavage Fluid Specimen from a Patient.

ABSTRACT Pneumocystis jirovecii is a fungus that causes severe pneumonia in immunocompromised patients. However, its study is hindered by the lack of an in vitro culture method. We report here the genome of P. jirovecii that was obtained from a single bronchoalveolar lavage fluid specimen from a patient. The major challenge was the in silico sorting of the reads from a mixture representing the different organisms of the lung microbiome. This genome lacks virulence factors and most amino acid biosynthesis enzymes and presents reduced GC content and size. Together with epidemiological observations, these features suggest that P. jirovecii is an obligate parasite specialized in the colonization of human lungs, which causes disease only in immune-deficient individuals. This genome sequence will boost research on this deadly pathogen. IMPORTANCE Pneumocystis pneumonia is a major cause of mortality in patients with impaired immune systems. The availability of the P. jirovecii genome sequence allows new analyses to be performed which open avenues to solve critical issues for this deadly human disease. The most important ones are (i) identification of nutritional supplements for development of culture in vitro, which is still lacking 100 years after discovery of the pathogen; (ii) identification of new targets for development of new drugs, given the paucity of present treatments and emerging resistance; and (iii) identification of targets for development of vaccines.

Mycoplasma hominis necrotizing pleuropneumonia in a previously healthy adolescent.

BACKGROUND: Mycoplasma hominis is a fastidious micro-organism causing systemic infections in the neonate and genital infections in the adult. It can also be the cause of serious extra-genital infections, mainly in immunosuppressed or predisposed subjects. CASE PRESENTATION: We describe a case of severe pneumonia and pericarditis due to Mycoplasma hominis in a previously healthy adolescent who did not respond to initial therapy. CONCLUSIONS: Mycoplasma hominis could be an underestimated cause of severe pneumonia in immunocompetent patients and should be particularly suspected in those not responding to standard therapy.

A qui administrer le vaccin anti-pneumococcique? [We should received and pneumococcal immunization?]

Alors que l'immunisation active contre l'influenza semble être actuellement largement entrée dans la pratique médicale, force est de constater que c'est loin d'être le cas pour les infections à pneumocoque. La vaccination anti-pneumocoque. La vaccination anti-pneumococcique, qui est incluse dans les schémas d'immunisation de nombreux pays, ne fait actuellement pas l'objet de recommendations particulières en Suisse et son utilisation y reste marginale. Compte tenu du nombre élevé d'infections sévères et de décès potentiellement évitables, sa généralisation à tous les groupes à risque doit être encouragée. De plus, cette stratégie pourrait se révéler utile face à la progression inexorable de la proportion de souches résistantes à la pénicilline et aux autres microbes.

Head-to-head comparison of length of stay, patients' outcome and satisfaction in Switzerland before and after SwissDRG-Implementation in 2012 in 2012: an observational study in two tertiary university centers.

On 1 January 2012 Swiss Diagnosis Related Groups (DRG), a new uniform payment system for in-patients was introduced in Switzerland with the intention to replace a "cost-based" with a "case-based" reimbursement system to increase efficiency. With the introduction of the new payment system we aim to answer questions raised regarding length of stay as well as patients' outcome and satisfaction. This is a prospective, two-centre observational cohort study with data from University Hospital Basel and the Cantonal Hospital Aarau, Switzerland, from January to June 2011 and 2012, respectively. Consecutive in-patients with the main diagnosis of either community-acquired pneumonia, exacerbation of COPD, acute heart failure or hip fracture were included. A questionnaire survey was sent out after discharge investigating changes before and after SwissDRG implementation. Our primary endpoint was LOS. Of 1,983 eligible patients 841 returned the questionnaire and were included into the analysis (429 in 2011, 412 in 2012). The median age was 76.7 years (50.8% male). Patients in the two years were well balanced in regard to main diagnoses and co-morbidities. Mean LOS in the overall patient population was 10.0 days and comparable between the 2011 cohort and the 2012 cohort (9.7 vs 10.3; p = 0.43). Overall satisfaction with care changed only slightly after introduction of SwissDRG and remained high (89.0% vs 87.8%; p = 0.429). Investigating the influence of the implementation of SwissDRG in 2012 regarding LOS patients' outcome and satisfaction, we found no significant changes. However, we observed some noteworthy trends, which should be monitored closely.

Prevalence of respiratory viruses among febrile children with or without acute respiratory symptoms in Tanzania

Background Respiratory viruses are the most frequent cause of febrile illnesses in infants and young children but few investigations have assessed their impact and epidemiology in Africa . We investigated their rate in febrile outpatient children attending in Tanzania. Methods Children aged 2 months -10 years with fever >38 _C were recruited prospectively between April and December 2008. Medical history and clinical examination were recorded in a standardized fashion and nasopharyngeal swabs analyzed for the presence of 12 viruses by real-time PCR (FLUAV, FLUBV, RSV, MPV, HPIV-1/3, four types of HCoV, HBoV, PIC and HAdV). Ct values were used to provide semi-quantitative viral loads.Results Of 1005 febrile children enrolled, 623 (62%) had respiratory symptoms (URTI in 66%, bronchiolitis in 7% and clinical pneumonia in 27%); 156 (16%) had febrile illness that remained of unspecified etiology and 226 (22%) had other infectious diseases and no ARI (62 malaria, 56 gastroenteritis, 36 urinary tract and 72 others). The proportions of patients with at least one respiratory virus were 70%, 61% and 47% (Pvalue < 0.001) in these three groups. When excluding picornavirus and adenovirus these proportions were 48%, 24% and 26% (P-value < 0.001). Apart from picornavirus and adenovirus, influenza A and B viruses were the most frequent followed by coronavirus and RSV. The proportion of children with presumably high viral titers (Ct < 25) was higher in the group with respiratory symptoms (31%) than in the two other groups (21% and 16%). Influenza genotyping revealed strains that were similar to the ones circulating elsewhere in the world.Conclusion In African children with febrile illness, the prevalence of respiratory viruses, especially influenza A and B, is high particularly in the presence of respiratory symptoms, but also, although less so, in those with unspecified etiology or other infectious diseases. This highlights that these viruses are commonly circulating in Tanzanian children.

Cross-neutralization of four paramyxoviruses by a human monoclonal antibody.

Broadly neutralizing antibodies reactive against most and even all variants of the same viral species have been described for influenza and HIV-1 (ref. 1). However, whether a neutralizing antibody could have the breadth of range to target different viral species was unknown. Human respiratory syncytial virus (HRSV) and human metapneumovirus (HMPV) are common pathogens that cause severe disease in premature newborns, hospitalized children and immune-compromised patients, and play a role in asthma exacerbations. Although antisera generated against either HRSV or HMPV are not cross-neutralizing, we speculated that, because of the repeated exposure to these viruses, cross-neutralizing antibodies may be selected in some individuals. Here we describe a human monoclonal antibody (MPE8) that potently cross-neutralizes HRSV and HMPV as well as two animal paramyxoviruses: bovine RSV (BRSV) and pneumonia virus of mice (PVM). In its germline configuration, MPE8 is HRSV-specific and its breadth is achieved by somatic mutations in the light chain variable region. MPE8 did not result in the selection of viral escape mutants that evaded antibody targeting and showed potent prophylactic efficacy in animal models of HRSV and HMPV infection, as well as prophylactic and therapeutic efficacy in the more relevant model of lethal PVM infection. The core epitope of MPE8 was mapped on two highly conserved anti-parallel β-strands on the pre-fusion viral F protein, which are rearranged in the post-fusion F protein conformation. Twenty-six out of the thirty HRSV-specific neutralizing antibodies isolated were also found to be specific for the pre-fusion F protein. Taken together, these results indicate that MPE8 might be used for the prophylaxis and therapy of severe HRSV and HMPV infections and identify the pre-fusion F protein as a candidate HRSV vaccine.