Changes in peripheral blood inflammatory factors (TNF-α and IL-6) and intestinal flora in AIDS and HIV-positive individuals / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

OBJECTIVE@#In this study, we investigated the changes in peripheral blood inflammatory factors and intestinal flora in acquired immune deficiency syndrome (AIDS) and human immunodeficiency virus (HIV)-positive individuals (AIDS/HIV patients), and explored the relationships among intestinal flora, peripheral blood inflammatory factors, and CD4+ T lymphocytes.@*METHODS@#Thirty blood and stool samples from an AIDS group and a control group were collected. The levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were determined by enzyme-linked immunosorbent assay (ELISA), and the number of CD4+ T lymphocytes by a FACSCount automated instrument. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to determine the messenger RNA (mRNA) levels of Bifidobacterium, Lactobacillus, Escherichia coli, Enterococcus faecalis, and Enterococcus faecium. Correlations among intestinal flora, inflammatory factor levels, and CD4+ T lymphocyte values were evaluated using the Spearman correlation coefficient.@*RESULTS@#The levels of TNF-α and IL-6 in the AIDS group were higher than those in the control group, while the number of CD4+ T lymphocytes was lower. The amounts of Bifidobacterium and Lactobacillus in the AIDS group were significantly lower than those in control group, while the amounts of E. coli, E. faecalis, and E. faecium were much higher. The amounts of Bifidobacterium and Lactobacillus were negatively correlated with the content of TNF-α and IL-6 and the CD4+ T lymphocyte count, while those correlations were reversed for E. coli, E. faecalis, and E. faecium.@*CONCLUSIONS@#The intestinal microbiota of AIDS/HIV patients were disordered, and there was a correlation between the amount of intestinal flora and the number of CD4+ T lymphocytes and the levels of TNF-α and IL-6.

Caso Clínico: Histoplasmosis Cutánea Diseminada en un Paciente Inmunocomprometido / Case Report: Cutaneous Histoplasmosis Disseminated in an Immunocompromised Patient

INTRODUCCIÓN: La histoplasmosis es una micosis sistémica frecuente en pacientes inmunocomprometidos. La clínica es variable y se considera la micosis respiratoria más frecuente a nivel mundial, presentando mayor prevalencia en zonas tropicales incluida Sur América. Se estima que existen cuarenta millones de enfermos, calculándose doscientos mil nuevos casos anualmente. En Ecuador se desconoce la epidemiología de la enfermedad pero se calcula que el 11.1 % de pacientes con SIDA tienen histoplasmosis. CASO CLÍNICO: Paciente masculino de 23 años, procedente del Oro - Ecuador, con antecedentes de SIDA diagnosticado hace cuatro años, con mala adherencia al tratamiento antirretroviral y tuberculosis pulmonar, es ingresado por presentar fiebre de dos semanas de evolución, astenia, tos productiva, pérdida de peso, pápulas eritemato-violáceas costrosas diseminadas en todo el tegumento, con afectación mucosa. Los factores de riesgo que presentó el paciente para histoplasmosis la falta de cumplimiento al tratamiento antirretroviral y vivir en un área rural con exposición a excrementos de aves de corral. EVOLUCIÓN: El paciente fue hospitalizado con diagnóstico de histoplasmosis cutánea diseminada, SIDA, tuberculosis pulmonar, candidiasis oral y herpes anal. Se continuó con el tratamiento antirretroviral, antituberculoso e inició Anfotericina-B e Itraconazol; posteriormente el paciente fue dado de alta con mejoría clínica. CONCLUSIÓN: Las dermatosis juegan un papel importante para realizar el diagnóstico precoz de histoplasmosis. Cuando existen comorbilidades asociadas a la enfermedad, como el SIDA y tuberculosis pulmonar, es necesario replantear el tratamiento, por la interacción medicamentosa que puede existir entre el Itraconazol y la Rifampicina. El paciente recibió Anfotericina­B hasta presentar mejoría clínica. Para la prevención de enfermedades oportunistas una correcta adhesión al tratamiento antirretroviral, evitar el hábitat del hongo como criaderos de aves o cuevas y ante el riesgo de exposición, el uso adecuado de mascarilla.

BACKGROUND: Histoplasmosis is a frequent systemic mycosis in immunocompromised patients. The clinic is variable and is considered the most common respiratory mycosis worldwide, presenting a higher prevalence in tropical areas including South America. It is estimated that there are forty million patients, calculating two hundred thousand new cases annually. In Ecuador, the epidemiology of the disease is unknown, but it is estimated that 11.1% of patients with AIDS have histoplasmosis. CASE REPORT: Male patient of 23 years old, from Oro - Ecuador, with a history of AIDS diagnosed four years ago, with poor adherence to antiretroviral treatment and pulmonary tuberculosis, is admitted for presenting fever of two weeks evolution, asthenia, productive cough, weight loss, scaly erythematous-violaceous papules spread throughout the integument, with mucosal involvement. The risk factors presented by the patient for histoplasmosis were the lack of compliance with antiretroviral treatment and living in a rural area with exposure to poultry excrement. EVOLUTION: The patient was hospitalized with diagnosis of disseminated cutaneous histoplasmosis, AIDS, pulmonary tuberculosis, oral candidiasis and anal herpes. Antiretroviral, antituberculous treatment was continued and Amphotericin-B and itraconazole were started; later the patient was discharged with clinical improvement. CONCLUSION: Dermatoses play an important role in the early diagnosis of histoplasmosis. When there are comorbidities associated with the disease, such as AIDS and pulmonary tuberculosis. It is necessary to rethink the treatment, due to the drug interaction that may exist between Itraconazole and Rifampicin. The patient received Amphotericin-B until clinical improvement. For the prevention of opportunistic diseases, a correct adherence to the antiretroviral treatment, avoid the habitat of the fungus as bird or cave farms and before the risk of exposure, the adequate use of a mask.

Frequency of indeterminate results from an interferon-gamma release assay among HIV-infected individuals / Taxa de resultados indeterminados de ensaio de liberação de interferon-gama entre pessoas infectadas pelo HIV

ABSTRACT Objective: To evaluate the frequency of and factors associated with indeterminate interferon-gamma release assay (IGRA) results in people living with HIV/AIDS (PLWHA). Methods: We tested 81 PLWHA in the central-west region of Brazil, using the tuberculin skin test and an IGRA. Information on sociodemographic and clinical variables was gathered through the use of questionnaires and from medical records. The association of those variables with indeterminate results was analyzed by calculating the adjusted ORs in a multivariate logistic regression model. Concordance was evaluated by determining the kappa statistic. Results: Among the 81 patients evaluated, the tuberculin skin test results were positive in 18 (22.2%) of the patients, and the IGRA results were positive in 10 (12.3%), with a kappa of 0.62. The IGRA results were indeterminate in 22 (27.1%) of the patients (95% CI: 17.8-38.1%). The odds of obtaining indeterminate results were significantly higher in smokers (adjusted OR = 6.0; 95% CI: 1.4-26.7) and in samples stored for less than 35 days (adjusted OR = 14.0; 95% CI: 3.1-64.2). Patients with advanced immunosuppression (CD4+ T-cell count < 200 cells/mm3) were at a higher risk for indeterminate results (OR adjusted for smoking and inadequate duration of sample storage = 4.7; 95% CI: 0.91-24.0), although the difference was not significant. Conclusions: The high prevalence of indeterminate results can be a major limitation for the routine use of IGRAs in PLWHA. The need to repeat the test increases its costs and should be taken into account in cost-effectiveness studies. The processing of samples can significantly alter the results.

RESUMO Objetivo: Avaliar a frequência de resultados indeterminados de um interferon-gamma release assay (IGRA, ensaio de liberação de interferon-gama) e os fatores relacionados com esses resultados em pessoas vivendo com HIV/AIDS (PVHA). Métodos: Foram avaliadas 81 PVHA na região Centro-Oeste do Brasil, por meio do teste tuberculínico e de um IGRA. Informações a respeito de variáveis sociodemográficas e clínicas foram obtidas por meio de questionários e prontuários médicos. A relação entre essas variáveis e os resultados indeterminados foi avaliada por meio do cálculo da OR ajustada em um modelo de regressão logística multivariada. A concordância foi avaliada por meio do coeficiente kappa. Resultados: Os resultados do teste tuberculínico e do IGRA foram positivos em 18 (22,2%) e 10 (12,3%), respectivamente, dos 81 pacientes avaliados (κ = 0,62). O resultado do IGRA foi indeterminado em 22 (27,1%) dos pacientes (IC95%: 17,8-38,1%). A chance de resultados indeterminados foi significativamente maior em fumantes (OR ajustada = 6,0; IC95%: 1,4-26,7) e em amostras armazenadas durante menos de 35 dias (OR ajustada = 14,0; IC95%: 3,1-64,2). Pacientes com imunossupressão avançada (contagem de células T CD4+ < 200 células/mm3) apresentaram maior risco de resultados indeterminados (OR ajustada para tabagismo e tempo inadequado de armazenamento das amostras = 4,7; IC95%: 0,91-24,0), embora a diferença não tenha sido significativa. Conclusões: A alta prevalência de resultados indeterminados pode ser um grande obstáculo ao uso rotineiro de IGRAs em PVHA. A necessidade de repetir o teste aumenta seu custo e deve ser levada em conta em estudos da relação entre custo e eficácia. O processamento das amostras pode alterar significativamente os resultados.

Nasal colonization with Staphylococcus aureus in individuals with HIV/ AIDS attended in a Brazilian Teaching Hospital / Colonização nasal por Staphylococcus aureus em indivíduos com HIV/Aids atendidos em um hospital-escola brasileiro / Colonización nasal por Staphylococcus aureus en individuos con VIH/SIDA atendidos en un Hospital Escuela brasileño

OBJECTIVE: to evaluate the prevalence of nasal colonization with Staphylococcus aureus in individuals with HIV/AIDS under inpatient treatment in a teaching hospital in the state of São Paulo (Brazil). METHOD: a cross-sectional study undertaken in two units specialized in attending people living with HIV/AIDS, in the period August 2011 - July 2012. Socio-demographic and clinical data was collected through individual interviews and from the medical records; samples of nasal secretion were collected with Stuart swabs on the first day of inpatient treatment. Ethical aspects were respected. RESULT: of the 229 individuals with HIV/AIDS hospitalized in this period, 169 participated in the study, with Staphylococcus aureus being identified in the culture tests of 46 (27.2%) of the individuals, resistance to oxacillin being evidenced in 10 (21.8%) participants. CONCLUSION: the results of the research indicate that the prevalence of colonization with Staphylococcus aureus in individuals with HIV/AIDS in the specialized units was considered relevant, possibly contributing to future investigations and, moreover, to the implementation of measures to prevent and control this pathogen in this population. .

OBJETIVO: avaliar a prevalência da colonização nasal por Staphylococcus aureus em indivíduos com HIV/Aids internados em um hospital-escola do Estado de São Paulo (Brasil). MÉTODO: estudo de corte transversal, realizado em duas unidades especializadas no atendimento a pessoas que vivem com HIV/ Aids, no período de agosto 2011 a julho 2012. Foram coletados dados sociodemográficos e clínicos, por entrevista individual e prontuário; as amostras de secreção nasal foram coletadas por meio de swab Stuart no primeiro dia de internação. Os aspectos éticos foram contemplados. RESULTADOS: dos 229 indivíduos com HIV/Aids internados no período, 169 participaram do estudo, sendo identificado Staphylococcus aureus nos exames de cultura de 46 (27,2%) dos indivíduos, evidenciando-se resistência à oxacilina em 10 (21,8%) participantes. CONCLUSÃO: os resultados da pesquisa apontam que a prevalência da colonização por Staphylococcus aureus em indivíduos com HIV/Aids internados nas unidades especializadas foi considerada relevante, podendo contribuir para novas investigações e, ainda, para implementar medidas de prevenção e de controle desse patógeno nessa população. .

OBJETIVO: evaluar la prevalencia de la colonización nasal por Staphylococcus aureus en individuos con VIH/sida internados en un hospital escuela del Estado de São Paulo (Brasil). MÉTODO: estudio trasversal, desarrollado en dos unidades especializadas en la atención a personas que viven con VIH/ sida, en el período de agosto del 2011 a julio del 2012. Fueron recolectados datos sociodemográficos y clínicos, mediante entrevista individual y archivo; las muestras de secreción nasal fueron recolectadas mediante Swab Stuart en el primer día de internación. Los aspectos éticos fueron contemplados. RESULTADOS: de los 229 individuos con VIH/sida internados en el período, 169 participaron del estudio, siendo identificado Staphylococcus aureus en las pruebas de cultura de 46 (27,2%) de los individuos, evidenciándose resistencia a la oxacilina en 10 (21,8%) participantes. CONCLUSIÓN: los resultados de la investigación indican que la prevalencia de la colonización por Staphylococcus aureus en individuos con VIH/sida internados en las unidades especializadas fue considerada relevante y puede contribuir a otras investigaciones y, además, para implementar medidas de prevención y de control de ese patógeno en esa población. .

Impacto de la histoplasmosis diseminada en pacientes HIV positivos / Impact of disseminated histoplasmosis in HIV positive patients

Introducción: la histoplasmosis constituye la segunda micosis sistémica en orden de frecuencia en Argentina, después de criptococosis, en pacientes HIV positivos. En éstos, la forma clínica diseminada progresiva es marcadora de sida. La coinfección HIV-Histoplasmosis diseminada (HD) en nuestro país ha sido reportada entre 5,3 y 6 %. Métodos: estudio descriptivo, retrospectivo, realizado en un hospital de agudos de CABA, que incluyó pacientes HIV positivos con HD, en el período 2000-2011. Resultados: n:80. Edad, media (desvío estándar, DE): 37 años (8,1). Varones: 81,2%. CD4, mediana (rango intercuartil, RIC): 19,5 cél/µL (7-54). HD como primera marcadora de sida: 70%; serología HIV previa desconocida: 38,7 %. El 11,8% recibía terapia antirretroviral (TARV) al diagnóstico de HD. Otra infección oportunista concomitante al diagnóstico: 29,4%. Clínica 84,7% fiebre, 75% síndrome de impregnación, 72,2% síntomas respiratorios, 56,9% lesiones cutáneo-mucosas, 30,5% hepatosplenomegalia. Laboratorio: 76,2% anemia, 60,3% leucopenia, 42,1% plaquetopenia. Aislamientos: hemocultivos: 81,8%; muestras positivas: piel y mucosas: 39 pacientes, respiratorias: 16 pacientes, médula ósea: 6 pacientes. Radiografía de tórax patológica: 77,6%. Tratamiento: anfotericina B: 58,5%; itraconazol: 91%. Recaída: 21,2%. Mortalidad global: 20,2%, atribuible a HD: 5,9%. Conclusión: HD fue la primera marcadora en el 70% de los pacientes, alrededor de un 40% desconocían su serología y sólo 1 de cada 10 recibía TARV, lo que refleja un retraso en el diagnóstico de HIV en nuestra población. Las principales manifestaciones clínicas semejan otras infecciones oportunistas siendo importante la sospecha diagnóstica para el tratamiento temprano.

Introduction: Histoplasmosis is the second most frequente fungal infection in Argentina, after cryptococcosis in HIV positive patients. In these patients the disseminated clinical presentation is an AIDS-defining condition. Disseminated histoplasmosis (DH) and HIV coinfection has been reported between 5.3 and 6 % in Argentina. Methods: Retrospective, descriptive study, performed in an acute care hospital of Buenos Aires city, including HIV positive patients with DH, between 2000-2011. Results: n: 80. Mean age (standard deviation, SD): 37 years (8.1). Male: 81.2%. Median CD4 (interquartile range, IQR): 19.5 cells/uL (7-54). DH as the first AIDS defining condition: 70%; unknown prior HIV test: 38.7%. ONly 11.8% were receiving antiretroviral treatment at the time of diagnosis of DH. Other concomitant oportunistic infections: 29.4 %. Clinical manifestations: fever 84.7%, constitutinal symptoms 75%, respiratory symptoms 72.2 %, mucocutaneous lesions 56.9%, liver and/or spleen enlargement 30.5%. Laboratory abnormalities: anemia 76.2 %, leucopenia 60.3%, thrombocytopenia 42.1% Microbiological isolates: blood culture 81.8%; others positive samples: 39 of skin and mucosa, 16 of respiratory specimens, 6 of bone marrow. X-ray chest abnormalities: 77.6%. Treatment: amphotericin B: 58.5%; itraconazole: 91%. Relapse: 21.2%. Global mortality: 20.2%, DH atributable mortality: 5.9%. Conclusion: DH was the first AIDS defining condition in 70% of our patients, about 40% were unaware of their serostatus and only one in ten received antiretroviral treatment, reflecting a delay in diagnosis of HIV in our population. The main clinical manifestations resemble other oportunistic infections, so diagnostic of DH should be for considered in order to provide timely treatment.

Bacteriemia por Kocuria rosea en un paciente con SIDA / Bacteremia by Kocuria rosea in an AIDS patient

Kocuria rosea is an uncommon pathogen may cause opportunistic infections in immunocompromised patient. We report a HIV patient, who presented bacteremia caused by Kocuria rosea. He was successfully treated with vancomycin and by catheter removal.

Rhodococcus equi en paciente VIH/sida: primera detección molecular en Cuba / First molecular detection of Rhodococcus equi in a HIV/aids patient in Cuba

Introducción: Rhodococcus equi es reconocido como un patógeno emergente que causa importante morbilidad y mortalidad entre los pacientes inmunocomprometidos. Objetivo: confirmar la presencia de R. equi en líquido pleural mediante la técnica del polimorfismo en la longitud de los fragmentos de restricción. Métodos: se empleó muestra de líquido pleural de un paciente sida con síntomas respiratorios. Se realizaron cultivos microbiológicos, pruebas de tinción, fenotípicas, bioquímicas y la técnica del polimorfismo en la longitud de los fragmentos de restricción para el diagnóstico del microorganismo. Resultados: las técnicas de tinción, fenotípicas y bioquímicas brindaron un diagnóstico sugestivo de infección por R. equi, el cual fue confirmado por las técnicas moleculares utilizadas. Conclusiones: este trabajo reporta la detección molecular, por primera vez en Cuba, de R. equi en paciente VIH/sida. Los resultados obtenidos permiten sugerir que técnicas de biología molecular pueden ser aplicadas en el diagnóstico y la identificación de R. equi.

Introduction: Rhodococcus equi is recognized as an emerging pathogen that causes important morbidity and mortality among immunocompromised patients. Objective: to confirm the presence of R. equi in pleural fluid through the restriction fragment length polymorphism technique. Methods: the pleural fluid sample from one AIDS patient with respiratory symptoms was used. Microbiologic culture, staining tests, phenotypic and biochemical tests and restriction fragment length polymorphism technique for the diagnosis of microorganism were performed. Results: the staining technique along with the phenotypic and biochemical tests provided the presumptive diagnosis of R. equi infection, which was further confirmed by the molecular techniques. Conclusions: this paper reported the molecular detection of R. equi from one HIV/aids patient for the first time in Cuba. The results suggested that the molecular biology techniques could be used in the diagnosis and identification of R. equi.

Enfermedad por Mycobacterium simiae y "Mycobacterium sherrisii" en la Argentina / Disease due to Mycobacterium simiae and "Mycobacterium sherrisii" in Argentina

Se presenta información reunida retrospectivamente sobre casos de micobacteriosis originados por Mycobacterium simiae (n = 4) y "M. sherrisii" (n = 6). Los casos ocurrieron entre pacientes con sida (n = 6), historia de silicosis (n = 2) o tuberculosis previa (n = 1). Un caso se perdió luego de diagnosticado y nueve fueron tratados con esquemas terapéuticos basados en claritromicina, etambutol y quinolonas. La respuesta fue muy pobre: cinco pacientes fallecieron (cuatro eran HIV positivos), tres permanecieron crónicos y sólo uno curó. Estas micobacterias originaron 2.1% de los casos de micobacteriosis registrados en un período de ocho años. La distinción de estas micobacterias raras de otras más frecuentes por métodos moleculares rápidos, parece ser clínicamente útil para advertir sobre la dificultad que puede presentar el tratamiento. Sin embargo, la diferenciación genotípica entre M. simiae y "M. sherrisii" parecería no ser clínicamente relevante, dado que no quedaron expuestas características que distingan a los pacientes afectados por los dos microorganismos tan estrechamente relacionados.

A revision of mycobacterial disease due to M simiae (n = 4) and "M. sherrisii" (n = 6) identified during an eight-year period is presented. Cases occurred among patients with AIDS (n = 6), previous history of silicosis (n = 2) or tuberculosis (n = 2). One case was lost to follow-up and the remaining nine responded poorly to chemotherapy based on clarithromycin, ethambutol and fluoroquinolones. Five patients died of whom four were HIV-positive, three remained chronic and one was cured. These microorganisms originated 2.1% of mycobacterioses cases detected in an eight-year period. Timely identification of this group of uncommon mycobacteria by molecular methods seems to be clinically relevant in order to warn of difficulties inherent to the treatment. However, the distinction between both closely related microorganisms might not be crucial for case management as no distinctive characteristics were evident among patients affected by M. simiae or "M. sherrisii".

case of invasive aspergillosis in a patient with no identifiable immunodeficiencies

Invasive fungal infections usually affect patients with immunodeficiencies and very rarely patients with no known or identifiable risk factors. Diagnosis could be delayed in patients without previously known immunodeficiencies due to a low index of suspicion, leading to a delay in treatment and a potential poor outcome. We report a case of a postpartum woman with no history of immuno-compromised disease who developed left hemiparesis with evidence of invasive aspergollosis affecting the nervous system, and leading to fatal outcome. The patient had a mass-like lesion in the neuroimaging with soft tissue shadowing in the chest x-ray leading to initial diagnosis of tuberculosis. The brain biopsy showed changes consistent with a diagnosis of aspergillosis. The source of the aspergillus infection was not clear. Aspergillus infection should be considered in patients with no identifiable immunodeficiencies who have abnormal brain imaging and chest x-ray, as early treatment may alter the outcome

Estudo de colonização por Candida sp. na cavidade oral de indivíduos soropositivos e soronegativos para HIV-1 no Noroeste Paulista, Brasil / Candida sp. in the oral cavities of HIV-1 serum positive and serum negative individuals from the Northeastern São Paulo State region, Brazil

Este estudo avaliou Candida sp. isolada da mucosa orofaríngea e sua sensibilidade antifúngica em 52 portadores do HIV/Aids, residentes na Região Noroeste Paulista e respectivos controles. Para tanto, foram utilizados testes clássicos, o “kit” API20IDAUX e a disco difusão para: anfotericina B, fluconazol, itraconazol e cetoconazol. O isolamento de Candida sp. foi maior (p < 0,05) em pacientes e controles, sendo o índice de colonização/infecção superior entre usuários de próteses dentárias, em ambos os grupos (p < 0,05). A freqüência de espécies “não-albicans” não diferiu (21%) nesses grupos. Todas as cepas obtidas foram sensíveis a anfotericina B, enquanto uma cepa de C. albicans foi resistente a todos os azóis. Treze por cento das cepas foram resistentes ao fluconazol, em ambos os grupos. Nossos resultados mostram que o grupo HIV/Aids é mais colonizado por Candida sp. que os soronegativos para este vírus, sem mudança na proporção Candida albicans/“não-albicans” ou no perfil de resistência aos azóis.

Adherence to HeLa cells, typing by killer toxins and susceptibility to antifungal agents of Candida dubliniensis strains

The aim of this study was to evaluate the adherence capability to HeLa cells, the susceptibility to killer toxins and the in vitro susceptibility to antifungal agents (eTest? method - AB Biodisk, Solna, Sweden) of 9 Candida dubliniensis isolates recovered from HIV+ and AIDS patients. The adherence test was strongly positive for strain ATCC 777 and positive for all other strains. Typing by killer toxins revealed two different biotypes among the 9 isolates studied: 888 and 688. Only biotype 688 (ATCC 777) was susceptible to the K2 toxin. There was a significant inverse correlation between adherence and killer toxin susceptibility (r = -0.8525 - p = 0.0035). No strains presented resistance to fluconazole, itraconazole, ketoconazole, voriconazole, flucytosine or amphotericin-B. With the exception of ATCC 777, all the other isolates presented similar behavior.

O objetivo do presente trabalho foi avaliar o comportamento de cepas de Candida dubliniensis recuperadas de pacientes HIV+ e com AIDS por meio da pesquisa de capacidade de adesão a células HeLa, susceptibilidade a toxinas "Killer" e resistência in vitro a antifúngicos (eTest® AB Biodisk, Solna, Suécia). O ensaio de adesão foi fortemente aderente para a amostra padrão ATCC 777, e aderente para os demais isolados. Os testes de tipagem das amostras frente às cepas-padrão produtoras de toxinas "Killer" mostraram dois biótipos diferentes dos 9 isolados estudados: 888 e 688. Somente o biótipo 688 (ATCC 777) de C. dubliniensis foi sensível à toxina K2. Houve correlação inversa significativa entre adesão e sensibilidade a toxinas "killer" (r = -0,8525 - p = 0,0035). Em relação à pesquisa de resistência a antifúngicos, as amostras de C. dubliniensis foram sensíveis ao fluconazol, itraconazol, cetoconazol, voriconazol, à flucitosina e anfotericina B. Com exceção da amostra ATCC 777, todas as demais mostraram comportamento similar.

Antiretroviral drug resistance testing.

While antiretroviral drugs, those approved for clinical use and others under evaluation, attempt in lowering viral load and boost the host immune system, antiretroviral drug resistance acts as a major impediment in the management of human immune deficiency virus type-1 (HIV-1) infection. Antiretroviral drug resistance testing has become an important tool in the therapeutic management protocol of HIV-1 infection. The reliability and clinical utilities of genotypic and phenotypic assays have been demonstrated. Understanding of complexities of interpretation of genotyping assay, along with updating of lists of mutation and algorithms and determination of clinically relevant cut-offs for phenotypic assays are of paramount importance. The assay results are to be interpreted and applied by experienced HIV practitioners, after taking into consideration the clinical profile of the patient. This review sums up the methods of assay currently available for measuring resistance to antiretroviral drugs and outlines the clinical utility and limitations of these assays.

Mycobacterium avium restriction fragment lenght polymorphism-IS IS1245 and the simple double repetitive element polymerase chain reaction typing method to screen genetic diversity in Brazilian strains

Simple double repetitive element polymerase chain reaction (MaDRE-PCR) and Pvu II-IS1245 restriction fragment length polymorphism (RFLP) typing methods were used to type 41 Mycobacterium avium isolates obtained from 14 Aids inpatients and 10 environment and animals specimens identified among 53 mycobacteria isolated from 237 food, chicken, and pig. All environmental and animals strains showed orphan patterns by both methods. By MaDRE-PCR four patients, with multiple isolates, showed different patterns, suggesting polyclonal infection that was confirmed by RFLP in two of them. This first evaluation of MaDRE-PCR on Brazilian M. avium strains demonstrated that the method seems to be useful as simple and less expensive typing method for screening genetic diversity in M. avium strains on selected epidemiological studies, although with limitation on analysis identical patterns except for one band.

Cándida y su acción sobre dos sustratos hidrocarbonados / Candida and its action on two hydrocarbonated substrates

Con el objetivo de contribuir al conocimiento de la etiología de caries, se investigó la capacidad de 60 cepas de Candida albicans (C.a.) de diferentes orígenes (15 de drogadictos, 15 de pacientes con sida, 15 de inmunocomprometidos no sida y 15 de sanos) para metabolizar dos hidratos de carbono (HC), glucosa (G) y sacarosa (S). Se sembró 0,1 ml de suspensiones homologadas (Nº3 de la escala de McFarland) en 3 series de tubhos con medio líquido (agua peptonada al 1 por ciento, AP) una serie con 2 por ciento de G, otra con 2 por ciento de S y otra sin HC (control). Se leyó el pH inicial de todos los medios antes de sembrar. Se repitieron las lecturas a las 18, 48 y 72 horas de incubación a 37ºC en condiciones aeróbicas. Se hizo el análisis estadístico. Todas las cepas produjeron un marcado descenso del pH en los medios que contenían HC. En AP no hubo variación significativa. La variación de pH con G (3,2) fue mayor que con S (2,02). No hubo diferencias según el origen de las cepas. Se postula que C.a. podría contribuir al proceso cariogénico.

Pathogenicity characteristics of stocked and fresh yeasts strains

Com o objetivo de avaliar a patogenicidade de leveduras de interesse médico, foram selecionadas 15 amostras preservadas em óleo mineral na Micoteca URM, Centro de Ciências Biológicas, Universidade Federal de Pernambuco e 15 isolados recentes, provenientes de amostras clínicas de pacientes com AIDS, internados no Hospital das Clínicas, Centro de Ciências da Saúde, Universidade Federal de Pernambuco. Com relacão as características de patogenicidade, foram avaliados a capacidade desses microorganismos crescerem a 37ºC, bem como apresentarem atividade de fosfolipase e protease. As 30 amostras cresceram a 37ºC e apresentaram atividade quantitativa de protease, entretanto não apresentaram essa atividade quando testadas em meio sólido. Das 15 amostras preservadas, 13 (86,66 per center) apresentaram atividade fosfolipase positiva e duas (13,34 per center) atividade fosfolipásica negativa e das 15 amostras isoladas de pacientes com AIDS, quatro (26,66 per center) apresentaram atividade de fosfolipase positiva e 11 (73,34 per center) apresentaram atividade fosfolipásica negativa.

Cryptococcus neoformans causing meningitis in AIDS patients

Cryptococcus neoformans causes meningitis in AIDS patients. In the Säo José Hospital, reference center for patients with AIDS in Fortaleza - Ceará State - Brazil, 54 samples of the cerebrospinal fluid were analyzed from January 1st through December 31st 2000. Direct examination with India ink and culture in Sabouraud's agar at 37°C were done. Of the specimens studied 5(9.25 percent) were positive