Radiographical vignette: an apical lung density in an elderly man with hemoptysis.

An Aspergilloma is a "ball" of fungal mycelia composed of Aspergillus species developing in a pre-existing lung cavity. This uncommon entity may cause hemoptysis and may be a diagnostic challenge. We present imaging and review the literature of a recent case managed in our institution.

Geographic variation in the frequency of isolation and fluconazole and voriconazole susceptibilities of Candida glabrata: an assessment from the ARTEMIS DISK Global Antifungal Surveillance Program.

Geographic differences in frequency and azole resistance among Candida glabrata may impact empiric antifungal therapy choice. We examined geographic variation in isolation and azole susceptibility of C. glabrata. We examined 23 305 clinical isolates of C. glabrata during ARTEMIS DISK global surveillance. Susceptibility testing to fluconazole and voriconazole was assessed by disk diffusion, and the results were grouped by geographic location: North America (NA) (2470 isolates), Latin America (LA) (2039), Europe (EU) (12 439), Africa and the Middle East (AME) (728), and Asia-Pacific (AP) (5629). Overall, C. glabrata accounted for 11.6% of 201 653 isolates of Candida and varied as a proportion of all Candida isolated from 7.4% in LA to 21.1% in NA. Decreased susceptibility (S) to fluconazole was observed in all geographic regions and ranged from 62.8% in AME to 76.7% in LA. Variation in fluconazole susceptibility was observed within each region: AP (range, 50-100% S), AME (48-86.9%), EU (44.8-88%), LA (43-92%), and NA (74.5-91.6%). Voriconazole was more active than fluconazole (range, 82.3-84.2% S) with similar regional variation. Among 22 sentinel sites participating in ARTEMIS from 2001 through 2007 (84 140 total isolates, 8163 C. glabrata), the frequency of C. glabrata isolation increased in 14 sites and the frequency of fluconazole resistance (R) increased in 11 sites over the 7-year period of study. The sites with the highest cumulative rates of fluconazole R were in Poland (22% R), the Czech Republic (27% R), Venezuela (27% R), and Greece (33% R). C. glabrata was most often isolated from blood, normally sterile body fluids and urine. There is substantial geographic and institutional variation in both frequency of isolation and azole resistance among C. glabrata. Prompt species identification and fluconazole susceptibility testing are necessary to optimize therapy for invasive candidiasis.

Effect of the vehicle on the topical itraconazole efficacy for treating corneal ulcers caused by Aspergillus fumigatus.

BACKGROUND: The clinical behaviour of mycotic keratitis is aggressive, and the options for treating it are limited. This poses a need to explore new options for efficacious, low-cost treatment. Recent evidence suggests that topical itraconazole may be useful for treating this entity and that it may be possible to improve its efficacy using a suitable vehicle. METHODS: We included 12 New Zealand white (NZW) rabbits (24 eyes). The rabbits were infected with pathogenic strains of Aspergillus fumigatus and subsequently randomized to receive every 2 h for 5 weeks two different preparations of topical itraconazole 1%. In group 1 (12 eyes), ricinus oil and in group 2 (12 eyes), Systane were used as vehicle. Rabbits were evaluated every week by a masked ophthalmologist to determine the treatment response. RESULTS: The size of the ulcers was similar in the two groups at the baseline: group 1: 12.7 +/- 2.7 mm (median 12.8, range 9.8-15.5 mm); and group 2: 12.3 +/- 3.1 mm (median 12.1, range 9.8-20.8; P = 0.67). Although both groups responded well to the treatment, the response was better in the group 2, especially in weeks 2 and 3: week 1: 12.7 +/- 2.7 vs. 9.3 +/- 4.61 mm (P = 0.1); week 2: 9.4 +/- 3.4 vs. 4.1 +/- 2.9 mm (P = 0.004); week 3: 5.0 +/- 3.4 vs. 1.7 +/- 1.0 mm (P = 0.004); week 4: 1.9 +/- 1.9 vs. 1.0 +/- 1.2 mm (P = 0.1); and week 5: 0.68 +/- 1.2 vs. 0.0 +/- 0.0 mm (P = 0.3). CONCLUSION: Topical itraconazole may be useful for treating corneal ulcers caused by Aspergillus fumigatus, and its efficacy seems to be related with the vehicle solubility.

Susceptibilidad in vitro de histoplasma capsulatum al ajoene usando los métodos de difusión en agar con discos y pozos / In vitro susceptibility of histoplasma capsulatum to ajoene using disk and holes diffusion methods

Se evaluó la actividad antifúngica de ajoene sobre Histoplasma capsulatum, mediante los métodos de difusión en agar con discos (MDD) y pozos (MDP), usando agar Sabouraud dextrosa (SDA) y Müeller-Hinton modificado (MHM). El inóculo fúngico, obtenido de la fase exponencial y ajustado a 0,5 Mac-Farland, se distribuyó (0,2 ml) sobre las placas de agar. Para el MDD, se siguió el protocolo M44-A-NCCLS, con modificaciones; para el MDP, se abrieron pozos de 4 mm y se procedió como en MDD. Se usaron concentraciones de ajoene de 3,75 a 120 mg. Las placas se incubaron a temperatura ambiente y la inhibición se leyó al séptimo y al 16º día. Los ensayos se realizaron por duplicado. El MDD, al séptimo día, reveló inhibición del crecimiento desde 15 mg de ajoene en SDA y desde 30 mg en MHM. Con el MDP, se observó este efecto a partir de 7,5 y 30 mg en SDA y MHM, respectivamente. La disminución de las zonas de inhibición, al 16º día, en ambos métodos, evidenció efecto fungistático de ajoene sobre H. capsulatum. Con los resultados obtenidos, se podría considerar que H. capsulatum (fase micelial) es sensible a 15 µg de ajoene usando ambos métodos con SDA, y con MHM, a 30 (MDD) y 60 mg (MDP). Ambas metodologías demostraron ser válidas para realizar pruebas de susceptibilidad en H. capsulatum utilizando SDA o MHM. Estos resultados abren las puertas para estudios futuros con el fin de ratificar estos hallazgos.

[A comparative study of blood culture conventional method vs. a modified lysis/centrifugation technique for the diagnosis of fungemias]. / Comparación del método de hemocultivo convencional con el de lisis/centrifugación modificado para el diagnóstico de fungemias.

The purpose of this work was to compare the efficacy of blood culture conventional method vs. a modified lysis/centrifugation technique. Out of 450 blood specimens received in one year, 100 where chosen for this comparative study: 60 from patients with AIDS, 15 from leukemic patients, ten from febrile neutropenic patients, five from patients with respiratory infections, five from diabetics and five from septicemic patients. The specimens were processed, simultaneously, according to the above mentioned methodologies with daily inspections searching for fungal growth in order to obtain the final identification of the causative agent. The number (40) of isolates recovered was the same using both methods, which included; 18 Candida albicans (45%), ten Candida spp. (25%), ten Histoplasma capsulatum (25%), and two Cryptococcus neoformans (5%). When the fungal growth time was compared by both methods, growth was more rapid when using the modified lysis/centrifugation technique than when using the conventional method. Statistical analysis revealed a significant difference (p<0.05) between them. The modified lysis/centrifugation technique showed to be more efficacious than the conventional one, and therefore the implementation of this methodology is highly recommended for the isolation of fungi from blood.

[Evaluation of Candida species' susceptibility to fluconazole with the disk diffusion method]. / Evaluación de la susceptibilidad de especies de Candida al fluconazol por el método de difusión de disco.

Infections caused by yeasts belonging to the genus Candida have increased dramatically in the last decades, especially in hospital settings. Concomittantly, antimycotic resistance has emerged, as well as the appearance of non-Candida albicans isolates. To standardize in vitro antifungal susceptibility tests, the agar diffusion test was developed using disks impregnated with the antimycotic compound. Electronic recording of the inhibition zone (BIOMIC), furnishes objective values for the minimal inhibitory concentration (MIC). The fluconazole susceptibility patterns were determined for Candida species isolated from 2.139 patients seen in outpatient clinics or in health-care centers in Colombia, Ecuador and Venezuela. Candida albicans was the species most frequently isolated (62%), followed at a distance by Candida parapsilosis (11%), Candida tropicalis (8.5%), Candida glabata (3.5%) and Candida krusei (2.2%). MIC determinations showed that 88.1% of these isolates were susceptible to fluconazole, 5.1% were susceptible-dose-dependant and 6.8% resistant. An important proportion (92.1%) of the C. albicans isolates proved susceptible while resistance predominated in the remaining species. These results indicate that the BIOMIC method is rapid and simple, constituting a suitable tool for the epidemiologic surveillance of resistance in Candida species.

Evaluación de la susceptibilidad de especies de Candida al fluconazol por el método de difusión de disco / Resistance to fluconazol by Candida species detected using the disk diffusion method

Las infecciones causadas por levaduras del género Candida han aumentado en forma dramática en las últimas décadas, especialmente a nivel hospitalario. Paralelamente con este aumento, se ha notado la aparición de resistencia a los antimicóticos, así como la selección de especies diferentes a Candida albicans, todo lo cual ha hecho necesaria la estandarización de pruebas de susceptibilidad in vitro. Entre las varias pruebas disponibles está la de difusión en agar con discos impregnados de antifúngicos, cuya lectura se hace electrónicamente (BIOMIC), lo que proporciona indicaciones objetivas de la concentración inhibitoria mínima (CIM). Se realizó el estudio para determinar la sensibilidad in vitro al fluconazol de 2.139 aislamientos de especies de Candida provenientes de pacientes atendidos en consulta externa o en salas de hospitalización de centros asistenciales en Colombia, Ecuador y Venezuela (región CELA). Candida albicans fue el microorganismo más frecuentemente aislado (62 por ciento), seguido a distancia por Candida parapsilosis (11 por ciento) , Candida tropicalis (8,5 por ciento), Candida glabrata (3,5 por ciento) y Candida krusei (2,2 por ciento). La CIM demostró que el 88,1 por ciento de estos aislamientos eran susceptibles al fluconazol, 5,1 por ciento eran susceptibles-dosisdependiente y 6,8 por ciento resistentes. El 92,1 por ciento de la especie C. albicans fue susceptible mientras que la resistencia al fluconazol fue más notoria en las restantes especies. El BIOMIC es un método r pido y sencillo para la vigilancia epidemiológica de resistencia en levaduras del género Candida ecuperadas de pacientes atendidos en centros hospitalarios.

Coccidioidosis extrapulmonar: reporte de un caso y revisión de la literatura / Extrapulmonary coccidioidosis: a case report and literature review

La coccidioidomicosis es una micosis profunda producida por el hongo dimórfico coccidioides immitis, cuyo espectro clínico puede variar desde una infección pulmonar de curso autolimitado hasta formas extrapulmonares con compromiso de múltiples órganos. Nosotros presentamos un caso de coccidioidomicosis extrapulmonar, diagnosticado en el Hospital Universitario de Caracas (HUC), debido a sospecha de la enfermedad en relación a sus antecedentes epidemiológicas y presentación clínica