Diagnóstico molecular de paracoccidioidomicose associada à tuberculose em amostras de escarro / Paracoccidioidomycosis molecular diagnosis associated with tuberculosis in sputum samples

Introdução: A paracoccidioidomicose (PCM) é uma micose sistêmica endêmica causada pelo fungo Paracoccidioides spp. O objetivo deste estudo foi determinar a associação entre tuberculose (TB) e PCM em pacientes com exame micológico negativo. Métodos: Estudo prospectivo de diagnóstico molecular de amostras de escarro, com resultado positivo para bacilo álcool ácido resistente (BAAR) e negativo no exame direto e cultivo micológico. Resultados: A aplicação de técnicas moleculares resultou em 18,4% de pacientes coinfectados com PCM e TB. Conclusão: O conhecimento das diferenças clínicas, epidemiológicas e laboratoriais da PCM quando associada à TB é importante para prevenir a disseminação da doença, complicações e o aumento da letalidade (AU)

Introduction: Paracoccidioidomycosis (PCM) is a systemic endemic mycosis caused by Paracoccidioides spp. The aim of this study was to determine the association between tuberculosis (TB) and PCM in patients with negative mycological examination results. Methods: Prospective study of molecular diagnosis of sputum samples, with positive results for bacilli resistant acid (BAAR) and negative results on direct examination and mycological culture. Results: The application of molecular techniques resulted in 18.4% of patients co-infected with PCM and TB. Conclusion: The knowledge of clinical, epidemiological, and laboratory differences of PCM when associated with TB is important to prevent the spread of disease, complications, and increased mortality (AU)

Characteristics of Actinomyces spp. and Nocardia spp. simulating neoplasia

Actinomyces and Nocardia are filamentous bacteria that can simulate neoplastic diseases, mainly in lungs. Methods: A retrospective study based on the analysis of the medical records of five cases of actinomycosis and nocardiosis, which has been primarily misdiagnosed as lung cancer according to their radiographic findings. Cases were selected from a sample of 38 patients diagnosed with actinomycosis and 29 patients diagnosed with nocardiosis at the Mycology Laboratory of Irmandade de Misericórdia Santa Casa de Porto Alegre (state of Rio Grande do Sul, Brazil) between January 1977 to December 2012. The diagnosis was established by culture and histological examination. The literature was also critically reviewed. Results: We reported data of three cases of nocardiosis and two cases of actinomycosis that was primary diagnosed as lung cancer. The patients’ mean age was 50.6 (ranged from 43-63), four were male and 80% (4/5) of patients were immunocompetent. In more than 50% of patients, diagnosis and also treatment of lesions required surgical intervention. Conclusions: The complete knowledge of disease manifestations accelerates diagnosis and treatment and decreases unnecessary surgical interventions and morbidity and mortality rates, which are high in these infections...

Infecções que mimetizam câncer: avaliação retrospectiva e prospectiva de micoses e actinomicetoses / Infections mimicking cancer: retrospective and prospective evaluation of mycosis and actinomicetoses

As infecções que mimetizam neoplasia são incomuns. Por meio de um estudo retrospectivo, reunimos todos os casos de histoplasmose, criptococose por Cryptococcus gattii, actinomicose e nocardiose que mimetizaram neoplasia. A casuística foi constituída por 80 casos extraídos de uma população de 1.365 no período de 1981 a 2012. Revisamos criticamente os casos relatados na literatura (n=67). As manifestações clínico-radiológicas das lesões pulmonares nas doenças infecciosas (especialmente granulomatosas) e neoplasias não permitem realizar, com segurança, o diagnóstico diferencial...

Molecular characterization of clinical multiresistant isolates of Acinetobacter sp. from hospitals in Porto Alegre, State of Rio Grande do Sul, Brazil / Caracterização molecular de isolados clínicos Acinetobacter sp. multirresistentes em hospitais de Porto Alegre, Estado do Rio Grande do Sul, Brasil

INTRODUCTION: Hospitals around the world have presented multiresistant Acinetobacter sp. outbreaks. The spread of these isolates that harbor an increasing variety of resistance genes makes the treatment of these infections and their control within the hospital environment more difficult. This study aimed to evaluate the occurrence and dissemination of Acinetobacter sp. multiresistant isolates and to identify acquired resistance genes. METHODS: We analyzed 274 clinical isolates of Acinetobacter sp. from five hospitals in Porto Alegre, RS, Brazil. We evaluated the susceptibility to antimicrobial, acquired resistance genes from Ambler's classes B and D, and performed molecular typing of the isolates using enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR) technique. RESULTS: A high (68 percent) percentage of multiresistant isolates of Acinetobacter sp. was observed, and 69 percent were resistant to carbapenems. We identified 84 percent of isolates belonging to species A. baumannii because they presented the gene blaOXA-51. The gene blaOXA-23 was detected in 62 percent of the isolates, and among these, 98 percent were resistant to carbapenems. Using the ERIC-PCR technique, we identified clones of Acinetobacter sp. spread among the four hospitals analyzed during the sampling period. CONCLUSIONS: The data indicate the dissemination of Acinetobacter sp. isolates among hospitals and their permanence in the hospital after one year.

INTRODUÇÃO: Hospitais no mundo todo têm apresentado surtos de Acinetobacter sp. multirresistentes. A disseminação destes isolados com uma variedade cada vez maior de genes de resistência torna difícil o tratamento destas infecções e seu controle dentro do ambiente hospitalar. Este trabalho teve como objetivo avaliar a ocorrência e disseminação de isolados de Acinetobacter sp. multirresistentes e identificar genes de resistência adquirida. MÉTODOS: Foram avaliados 274 isolados clínicos de Acinetobacter sp. obtidos de cinco hospitais da Cidade de Porto Alegre, RS, Brasil. Avaliamos o perfil de suscetibilidade a antimicrobianos, genes de resistência adquirida das classes B e D de Ambler e realizamos a tipificação molecular dos isolados utilizando a técnica de enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR). RESULTADOS: Encontramos uma alta (68 por cento) porcentagem de isolados de Acinetobacter sp. multirresistentes e 69 por cento dos isolados apresentaram resistência aos carbapenêmicos. Foram identificados 84 por cento de isolados pertencentes a espécie A. baumannii, pois apresentaram o gene blaOXA-51. Em 62 por cento dos isolados, foi detectado o gene blaOXA-23, sendo que 98 por cento destes isolados foram resistentes aos carbapenêmicos. Através da tipificação molecular pela técnica de ERIC-PCR identificamos clones de Acinetobacter sp. disseminados entre quatro dos hospitais analisados e nos anos de 2006 e 2007. CONCLUSÕES: Os dados obtidos indicam a disseminação de isolados de Acinetobacter sp. entre hospitais assim como sua permanência no ambiente hospitalar após um ano.