Increased peripheral blood TCD4+ counts and serum SP-D levels in patients with chronic paracoccidioidomycosis, during and after antifungal therapy

BACKGROUND The main clinical forms of paracoccidioidomycosis (PCM) are the acute/subacute form (AF) and the chronic form (CF), and they both display considerable clinical variability. The immune responses of PCM patients, during and after treatment, remain neglected, mainly in the case of CF patients, due to the high prevalence of pulmonary sequelae. OBJECTIVE To evaluate the distribution of whole blood T cell subsets, serum cytokines, and biomarkers of pulmonary fibrosis in PCM patients, according to the clinical form and at different time points, during the antifungal therapy. METHODS Eighty-seven PCM patients, from an endemic area in Brazil, were categorised into groups, according to the clinical form (AF or CF) and the moment of treatment. The peripheral blood T lymphocyte subsets of these patients were analysed using fluorescence-activated cell sorting. The serum levels of cytokines, basic fibroblast growth factor and surfactant protein-D (SP-D) were also analysed. FINDINGS In the CF patients, an expansion of the peripheral blood TCD4+ cells was observed during the treatment, and this persisted even after two years of antifungal treatment. In addition, these patients showed high serum levels of SP-D. CONCLUSION Our findings highlight the immunological changes CF patients undergo, during and after treatment, possibly due to the hypoxia triggered by pulmonary fibrosis and emphysema.

Evaluation of Staphylococcus aureus resistance profile isolated from nursing students in an institution of higher education / Avaliação do perfil de resistência de staphylococcus aureus isolados de estudantes de enfermagem de uma instituição de ensino superior

Staphylococcus aureus causes a large variety of infections, where many of them are acquired in the hospital environment. A significant part of the population is a nasal carrier of this type of microorganism. The present study evaluated the nasal colonization by S. aureus, identifying its resistance profile in nursing students from a private educational institute of higher education. Nasal swab samples were collected and identified for S. aureus. Moreover, an antibiogram assay was performed, followed by the search for ermA and ermC genes using PCR. Sixty -two students were included and we isolated 20 positive samples (32,5%) for S. aureus. For the phenotypic profile, 30% were found to be resistant to Erythromycin and 10% to Oxacillin and Cefoxitin. For the D-test in the genotypic profile, 25% presented mecA gene (MRSA), 5% of ermA gene, 35% of ermC gene and 10% with ermC and mecA genes. These data reinforce the necessity of monitoring bacterial colonization in hospital environment, which are potentially resistant in health professionals.

Staphylococcus aureus causa uma grande variedade de infecções, muitas delas adquiridas no ambiente hospitalar. Uma parcela significativa da população é carreadora nasal desses micro-organismos. O presente trabalho avaliou a colonização nasal por S. aureus identificando seu perfil de resistência em estudantes de enfermagem de uma instituição privada de ensino superior. Foram coletadas e identificadas amostras de swab nasal para S. aureus e realizado o antibiograma e a detecção por PCR dos genes mecA, ermA e ermC. Foram incluídos 62 alunos e isoladas 20 amostras (32,3%) positivas para S. aureus, no perfil fenotípico, 30% apresentaram resistência à Eritromicina e 10% para Oxacilina, Cefoxitina e para o teste D, no perfil genotípico 25% apresentaram gene mecA (MRSA), 5% do gene ermA e 35% do gene ermC, e 10% com genes ermC e mecA. Esses dados reforçam a necessidade de monitoramento de colonização por bactérias potencialmente resistente em profissionais da saúde.

Cryptic species of Paracoccidioides brasiliensis: impact on paracoccidioidomycosis immunodiagnosis

We aimed to evaluate whether the occurrence of cryptic species of Paracoccidioides brasiliensis, S1, PS2, PS3 and Paracoccidioides lutzii, has implications in the immunodiagnosis of paracoccidioidomycosis (PCM). Small quantities of the antigen gp43 were found in culture filtrates of P. lutzii strains and this molecule appeared to be more variable within P. lutzii because the synonymous-nonsynonymous mutation rate was lower, indicating an evolutionary process different from that of the remaining genotypes. The production of gp43 also varied between isolates belonging to the same species, indicating that speciation events are important, but not sufficient to fully explain the diversity in the production of this antigen. The culture filtrate antigen AgEpm83, which was obtained from a PS3 isolate, showed large quantities of gp43 and reactivity by immunodiffusion assays, similar to the standard antigen (AgB-339) from an S1 isolate. Furthermore, AgEpm83 was capable of serologically differentiating five serum samples from patients from the Botucatu and Jundiaí regions. These patients had confirmed PCM but, were non-reactive to the standard antigen, thus demonstrating an alternative for serological diagnosis in regions in which S1 and PS2 occur. We also emphasise that it is not advisable to use a single antigen preparation to diagnose PCM, a disease that is caused by highly diverse pathogens.

Perfil genômico e sensibilidade a antifúngicos de amostras sequenciais de Candida spp. isoladas da cavidade oral de indivíduos infectados pelo vírus da imunodeficiência humana / Genomic profile and sensitivity of sequential samples of Candida ssp. of the oral cavity of individuals infected with human immunodeficiency virus

A candidíase oral continua sendo a principal doença oportunística associada à infecção pelo vírus da imunodeficiência humana (HIV) e importante marcador da progressão da doença, com o aumento da imunodepressão. Os objetivos deste trabalho foram: Caracterizar por métodos fenotípicos as amostras de Candida spp. isoladas da cavidade bucal de indivíduos infectados pelo HIV; identificar a prevalência das espécies isoladas; identificar as espécies do complexo C. psilosis pelo método da reação em cadeia da polimerase (PCR) e análise do perfil genético gerado pela enzima de restrição “BanI” pela técnica de restrição de fragmentos de DNA polimórfico (RFLP); identificar as amostras de C. dubliniensis pelo método de PCR e determinar sua prevalência; analisar a similaridade genética das amostras de C. albicans coletadas em episódios sequenciais de colonização e infecção, pelo método de amplificação aleatória de DNA polimórfico (RAPD); determinar o perfil de sensibilidade das amostras isoladas aos antifúngicos fluconazol (FLC), cetoconazol (CTC), itraconazol (ITC) e anfotericina B (AMB), utilizando-se o método EUCAST. Foram avaliadas 318 amostras isoladas de indivíduos infectados pelo HIV, atendidos no Ambulatório Especial de Moléstias Infecciosas e Parasitárias ou na Enfermaria de Doenças Tropicais da Faculdade de Medicina de Botucatu – UNESP. O material da cavidade bucal foi colhido por meio de swabs estéreis, e semeado em Sabouraud Dextrose. A identificação foi realizada pelo CHROMagar ®TM Candida e pelo sistema Api 20C AUX bioMeriaux (St. Louis, Mo). C. albicans, C. parapsilosis, C.metapsilosis, C. tropicalis, C. glabrata, C. dubliniensis e C. krusei foram as espécies identificadas. A prevalência do complexo C. psilosis foi de 4.7, distribuídos em 2,2 de C. parapsilosis e 2,5 de C. metapsilosis; todas as amostras do complexo C. psilosis foram sensíveis aos antifúngicos FLC, CTC, ITC, e AMB...