Rhinocerebral mucormycosis to the rise? The impact of the worldwide diabetes epidemic

Abstract The authors present seven cases of rhinocerebral mucormycosis associated to diabetes mellitus, which is a disease with epidemic proportions affecting individuals worldwide, particularly in developing countries, and which poses significant morbidity and mortality. Mucormycosis is an opportunistic fungal infection with high mortality and requires an invasive therapeutic approach to save the patient's life with significant morbidity and sequelae, thus prevention is crucial.

Chromoblastomycosis caused by Rhinocladiella aquaspersa: first case report in Guatemala

Abstract The authors report a case of 40-year-old male patient with a five-year history of chromoblastomycosis on his right leg. Diagnosis was performed by direct 40% KOH exam of skin scales, culture with micro- and macromorphologic analysis, and genotypic characterization (sequencing of a fragment of the ITS region and phylogenetic analysis) of the isolated fungus. Rhinocladiella aquaspersa was identified as the etiological agent. Initially, the treatment was with oral itraconazole 200 mg/day for one year. However, the presence of "sclerotic cells" with filaments ("Borelli spiders") resulted in a change of medical treatment: a higher dose of itraconazole (400 mg/day) and surgery, achieving clinical and mycological cure in one year. This is the first report of chromoblastomycosis caused by R. aquaspersa in Guatemala.

Variabilidad genética de aislados del complejo Candida parapsilosis en dos servicios de un hospital terciario de la Ciudad de México / Genetic variability of isolates of Candida parapsilosis complex in two services of a tertiary hospital in Mexico City

La infección causada por el complejo Candida parapsilosis puede presentarse esporádicamente o en forma de brotes, por lo que el estudio de la variabilidad genética de los aislados clínicos puede revelar la presencia de genotipos endémicos y la ocurrencia de transmisión horizontal. Este estudio analizó, mediante Amplificación al Azar del ADN Polimórfico (RAPD) con cuatro oligonucleótidos (M13, AP3, T3B y R108), la variabilidad genética de 11 aislados clínicos del complejo C. parapsilosis, obtenidos en los servicios de Medicina Interna y Cirugía General de un hospital de la Ciudad de México, e identificar si los pacientes fueron infectados por el mismo genotipo. La cepa ATCC® 22019™ fue incluida en el análisis. Los aislados se identificaron por VITEK 2 Compact® y PCR. Con base en los perfiles polimórficos,se construyó un dendrograma por UPGMA y se calcularon el coeficiente de correlación cofenética(CCCr), el índice de asociación (I A) y los indicadores de diversidad genética. Todos los aislados fueron identificados como C. parapsilosis sensu stricto. El dendrograma mostró dos grupos (I y II), en el I se encontraron tres genotipos integrados por la cepa 22019 y cinco aislados asociados en su mayoría a candidiasis invasiva; el II mostró seis genotipos integrados por seis aislados asociados en su mayoría a candidiasis mucocutánea. El I A y los indicadores de diversidad genética obtenidos revelaron un sistema de reproducción recombinante. El RAPD con los oligonucleótidos M13, AP3, T3B y R108 es útil en la investigación de posibles brotes causados por C. parapsilosis y en la determinación de su variabilidad genética.

The infection caused by the Candida parapsilosis complex may occur sporadically or in the form of outbreaks, so the study of the genetic variability in clinical isolates may reveal the presence of endemic genotypes and the occurrence of horizontal transmission. This study analyzed the genetic variability of 11 clinical isolates of the C. parapsilosis complex obtained from Internal Medicine and General Surgery services of a hospital in Mexico City, using Random Amplification of Polymorphic DNA (RAPD) with four oligonucleotides (M13, AP3, T3B and R108), also evaluated whether the patients were infected by the same genotype. The strain ATCC® 22019 ™ was included in the analysis. Isolates were identified by VITEK 2 Compact® and PCR. With the polymorphic profiles, a dendrogram was constructed by UPGMA and the cophenetic correlation coefficient (CCCr), the association index (I A), and the indicators of genetic diversity were calculated. All isolates were identified as C. parapsilosis sensu stricto. The dendrogram showed two groups (I and II). Three genotypes integrated by the strain 22019 and five isolates, mostly associated with invasive candidiasis, were found in the group I. The group II showed six genotypes composed of six isolates, mostly associated with mucocutaneous candidiasis. The I A and the indicators of genetic diversity obtained, revealed a recombinant reproduction system. The RAPD with the oligonucleotides M13, AP3, T3B and R108 is useful in the investigation of possible outbreaks caused by C. parapsilosis and in the determination of their genetic variability.

Radicales libres y mecanismos de daño tisular en la diabetes mellitus / Free radicals and mechanisms of tissue damage in diabetes mellitus

La diabetes mellitus (DM) es una enfermedad crónico-degenerativa de elevada incidencia y prevalencia a nivel mundial. La hiperglucemia crónica, característica de la diabetes, genera mayor producción de radicales de superóxido, que juegan un papel principal en los mecanismos de daño tisular responsables de las complicaciones clínicas de la DM: la glucosilación de proteínas y acumulación de productos de la glucosilación avanzada, y la activación de las vías del sorbitol, de las hexosaminas y de la proteína cinasa C. Aunque se han desarrollado diferentes fármacos para inhibir las vías de daño, aún no se ha demostrado su verdadero beneficio en diabéticos. Por lo tanto, el buen control de la glucemia sigue siendo el factor fundamental para evitar o retardar el daño tisular.

Diabetes mellitus (DM) is a chronic-degenerative disease with a high incidence and prevalence around the world. Chronic hyperglycemia, a feature of diabetes, induces a higher production of superoxide free radicals, which play a major role in the mechanisms of tissue damage responsible for the clinical complications of DM: advanced glycosylation and activation of sorbitol, hexosamines, and protein kinase C pathways. Although different drugs that inhibit the damaging pathways have been developed, their actual benefit in diabetic patients has not been proved yet. Therefore, adequate glycemia control is still the fundamental factor to prevent or delay tissue damage.