RESUMO
Background: The aim of this study was to demonstrate colonization by Malassezia species in the central lines of very low birth weight newborns on total parental nutrition (TPN). We also aimed to perform scanning electron microscopy (SEM) of central line tip cut sections to document the quality of the biofilm, cell structure, micro-colony characteristics, and the presence of extracellular matrix.Methods: We collected central line tips of very low birth weight newborns (<1.5 kg) over a one-year period. We included a total of 63 samples, which were cultured on SDA slants with and without olive oil along with controls purchased from CBS Netherlands. We incubated the cultures at 32癈 and observed them every two days for three weeks. Once growth occurred, we phenotypically identified the cultures and observed the central line tip cut sections with SEM.Results: Among the 63 central line tips, two (3.1%) were colonized by Malassezia. We observed a visible biofilm on the tips. We confirmed the phenotypic identification of the isolates as M. furfur and M. restricta by gene sequencing.Conclusions: Our study revealed Malassezia colonization in the central line used for total parenteral nutrition. Hence, it is important to have a high index of suspicion towards Malassezia catheter-related blood stream infection in newborns on TPN with a clinical picture of fever (in spite of antibiotic therapy), leukocytosis, thrombocytopenia with cardiac disease, and pulmonary infiltrates. The outbreak potential of Malassezia warrants preventive steps, early identification and treatment.
RESUMO
Background: Pneumonia is one of the leading causes of under 5 mortality among children in developing countries. Zinc deficiency is postulated as cause of severe pneumonia, but evidences shows conflicting results on whether serum zinc levels predicts the severity of pneumonia. So prospective study was undertaken to study the relationship between serum zinc levels and severity of pneumonia in children with community acquired pneumonia.Methods: Fifty cases of pneumonia (group 1) and 50 cases of severe pneumonia (group 2) according to WHO classification were enrolled into the study. Demography, anthropometry and immunization status were recorded. A single zinc measurement was performed for all the patients within 24 hours of admission. The severity, clinical course including recovery to discharge was compared between two groups with respect to their serum zinc levels.Results: Mean ('SD) age group of the study population was 22 months'16.05 and 21.88 months'15.97 months in boys and girls respectively. Pneumonia was high in girls (59%) and children between 2 to <12 months had higher (36%) infection rate. Mean zinc level in pneumonia and severe pneumonia group were 68.69'g/dl'28.77 and 68.08'g/dl'27.55 respectively. There was no difference in the nutritional status (weight for height and height for age) of the study group. Serum Zn level was low in 56 % and 52% of pneumonia and severe pneumonia group respectively. Comparison of serum zinc levels between the ARTI groups did not achieve statistical significance (p=0.430). However, the duration of recovery is earlier than 1 week in pneumonia cases when compared to severe pneumonia patients (p<0.001, OR 1.375).Conclusions: Normal zinc levels was associated with early recovery in simple pneumonia patient, so study of serum zinc levels in severe pneumonia patients has prognostic value.