Evaluation of the CHROMagar Candida Plus medium for presumptive identification of yeasts and MALDI-TOF MS identification.

Rapid and accurate yeasts species identification in clinical laboratories is important for appropriate and timely antifungal treatment. We evaluate the performance of the new medium CHROMagar™ Candida Plus for presumptive identification of yeasts species and MALDI-TOF identification. We identify 303 strains belonging to 60 clinically relevant yeasts species by using the new medium. Presumptive identification was correct at the Candida albicans complex, Candida tropicalis and Pichia kudriavzevii (Candida krusei) species. However, although this medium was able to identify all Candida auris and Candida glabrata strains, other species were misidentified as C. auris or C. glabrata. A total of 215 strains were identified by using MALDI-TOF and evaluated two incubation temperatures (30°C and 37°C) and two incubation times (24 h and 72 h). Most strains (94%; 202/215) were correctly identified at the species (n:190) or complex level (n:12) at both temperatures and incubation times. However, we observed that the time of incubation (24 h vs. 72 h) affects the score values when yeasts are incubated at 37°C, but does not affect score values when yeasts are incubated at 30°C. In conclusion, the new medium has a good performance in the presumptive identification of the C. albicans complex, C. tropicalis and P. kudriavzevii (C. krusei). In addition, this medium is useful for the screening of C. auris and C. glabrata isolates, but identification should be confirmed by other more specific techniques, like MALDI-TOF.

Genotypic Diversity and Antifungal Susceptibility of Clinical Isolates of Cryptococcus Gattii Species Complex from Argentina.

The aim of this study was to determine the genotypic diversity of 22 Cryptococcus gattii species complex clinical isolates from Argentina and to place these genotypes within the diversity of clinical, veterinary and environmental isolates from Latin America. Mating type and antifungal susceptibility of the isolates were also determined. By URA5-RFLP, nine isolates were identified as molecular type VGI, 10 as VGII, one as VGIII and two as VGIV. Multilocus sequence typing (MSLT), following the International Society for Human and Animal Mycology (ISHAM) consensus MLST scheme, was used to determine the genotypic diversity. Our results suggest that, in Argentina, VGI isolates have low genetic diversity, while VGII isolates have high genetic diversity. Both isolates identified as VGIV by URA5-RFLP were genotyped by MLST as belonging to the currently named VGVI clade. From all isolates, eight sequence types (STs) were unique for Argentina, while five STs have been reported already in other countries, being of high interest the genotypes ST20 and ST7 since they belong to the subtypes VGIIa and VGIIb, respectively, which are associated with hypervirulent strains responsible for outbreaks in North America. To note, geographical analysis showed that some genotypes may be associated with some regions in Argentina. Most isolates were MATα, but we are reporting one isolate MATa for the first time in the country. Antifungal susceptibility tests showed that itraconazole, voriconazole and posaconazole had high activity against all isolates, while amphotericin B, fluconazole and 5-fluorocytosine were the least active drugs against all studied isolates.

Epidemiology of Invasive Infections Caused by Streptococcus agalactiae in Argentina.

In recent years, an increase in the number of cases of invasive infections due to Streptococcus agalactiae (group B Streptococcus [GBS]) in adults has been reported. During 2014 and 2015, a multicentric, observational, and prospective study, including 40 health centers, was developed to describe the phenotypic and genotypic characteristics of GBS isolates circulating in Argentina and to analyze the clinical and demographic characteristics of patients with invasive infections. We recovered 162 invasive (GBSi) isolates from adult patients (n = 130, 80.2%), neonates (n = 24, 15%), and children below 18 years of age (n = 8, 4.8%), and colonizing (GBSc) isolates were recovered in prenatal GBS screening. GBS infection in adults was associated with underlying diseases, mainly diabetes mellitus. All isolates were penicillin susceptible. Resistance rates to erythromycin (25%) and clindamycin (26%) among the GBSc isolates were significantly higher than those from GBSi strains (17.3% and 16.1%, respectively); by contrast, levofloxacin resistance was significantly higher in GBSi isolates (14.8% vs. 7%). Serotype Ia was the most frequent in neonates and Ib was most frequent in adults. Serotypes Ia and III were prevalent in GBSc isolates. The increase of levofloxacin resistance was associated with the presence of a serotype Ib clone. This work emphasizes the need for GBS infection surveillance studies to implement correct treatments and adequate prevention strategies.

[Design of a real and perceived academic workload measurement instrument for health care undergraduate students]. / Diseño y validación de un instrumento de medición de la carga académica de estudiantes de carreras de la salud.

BACKGROUND: A high academic workload may have adverse consequences among university students. AIM: To design and validate an instrument to measure both real and perceived academic workload for health care students. MATERIAL AND METHODS: The questionnaire was designed based on a bibliographic revision and the conduction of two focus groups conformed by undergraduate students from a Faculty of Medicine. Afterwards, it was submitted to qualitative pre-tests. The final instrument consists of a self-applied questionnaire with both a characterization section (10 questions) and one concerning academic workload by subject and semester (five and two questions, respectively). A national and international panel of 14 experts evaluated the survey content's validity. The analysis was performed according to the Content Validity Ratio and the Content Validity Index. RESULTS: The complete instrument was validated with an 84% consensus between the judges. Each section of the instrument was approved separately with a 77% and a 94% agreement, respectively. After being individually analyzed by the judges, each question was validated. The wording of questions was improved taking the experts comments into consideration. CONCLUSIONS: The proposed instrument constitutes a contribution for the measurement of real and perceived academic workload for students.

Diseño y validación de un instrumento de medición de la carga académica de estudiantes de carreras de la salud / Design of a real and perceived academic workload measurement instrument for health care undergraduate students

Background: A high academic workload may have adverse consequences among university students. Aim: To design and validate an instrument to measure both real and perceived academic workload for health care students. Material and Methods: The questionnaire was designed based on a bibliographic revision and the conduction of two focus groups conformed by undergraduate students from a Faculty of Medicine. Afterwards, it was submitted to qualitative pre-tests. The final instrument consists of a self-applied questionnaire with both a characterization section (10 questions) and one concerning academic workload by subject and semester (five and two questions, respectively). A national and international panel of 14 experts evaluated the survey content's validity. The analysis was performed according to the Content Validity Ratio and the Content Validity Index. Results: The complete instrument was validated with an 84% consensus between the judges. Each section of the instrument was approved separately with a 77% and a 94% agreement, respectively. After being individually analyzed by the judges, each question was validated. The wording of questions was improved taking the experts comments into consideration. Conclusions: The proposed instrument constitutes a contribution for the measurement of real and perceived academic workload for students.

Fluoroquinolone-Resistant Streptococcus agalactiae Invasive Isolates Recovered in Argentina.

Background: Streptococcus agalactiae or group B Streptococcus (GBS) is an important pathogen in neonates and nonpregnant individuals. Epidemiological studies of GBS resistance to fluoroquinolones (FQs) in Latin America are scarce. This study aimed to determine the local prevalence of FQ resistance in the frame of a national, prospective multicenter study of invasive GBS infections and to investigate mechanisms of resistance, serotype distribution, and clonal relationships among resistant isolates. Methods: From July 2014 to July 2015, 162 invasive GBS isolates were collected from 86 health care centers in 32 Argentinean cities. All isolates were screened for FQ nonsusceptibility using a five-disc scheme: levofloxacin (LVX), ciprofloxacin, norfloxacin (NOR), ofloxacin, and pefloxacin (PF). LVX minimal inhibitory concentration (MIC) was determined by the agar dilution method. Sequencing of internal regions of gyrA and parC genes was performed. Capsular typing and genetic characterization of nonsusceptible isolates were assessed by latex agglutination, pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing. Results: Twenty-four of one hundred sixty-two GBS isolates exhibited no inhibition zones to all tested FQs with an MIC range of 16-32 mg/L for LVX, and one isolate with MIC = 1 mg/L showed no inhibition zones around NOR and PF discs. In all resistant isolates, point mutations were detected in both genes. Serotype Ib was prevalent (88%). One PFGE type accounted for 84% of the FQ-resistant isolates and belonged to serotype Ib, sequence type 10. Conclusions: The prevalence of FQ resistance was 14.8% likely to be associated with dissemination of an ST10/serotype Ib clone. The unexpected high rate of resistance emphasizes the relevance for continuous surveillance of GBS epidemiology and antibiotic susceptibility.

Argentinian multicenter study on urinary tract infections due to Streptococcus agalactiae in adult patients.

INTRODUCTION: Streptococcus agalactiae (group B streptococcus, GBS) is a recognized urinary pathogen both in males and pregnant or non-pregnant women. Data regarding GBS serotypes recovered from urinary tract infections (UTIs) are scarce. The aim of this study was to describe the clinical and microbiological characteristics of UTIs caused by GBS in adult patients in Argentina. METHODOLOGY: A prospective multicenter study involving 86 centers was conducted in Argentina between July 1st, 2014 and June 30th, 2015. Antimicrobial susceptibility and serotype distribution of GBS isolated from the urinary tract of adult patients were determined. Susceptibility tests were performed by the disk diffusion and/or agar dilution methods. Epidemiological and clinical characteristics of the patients were considered to identify associated comorbilities. RESULTS: Seven hundred and one GBS were sent to the reference laboratory in the above mentioned period, however, only 211 fulfilled our selection criteria (demographic data availability, underlying diseases reported, colony counts greater than 105 CFU/mL, single organism isolated from the urine sample). No penicillin-resistant GBS was found but fluoroquinolone resistance was high (12.8%), especially among GBS isolated from men and non-pregnant women. UTIs due to GBS were associated to underlying diseases in men and non-pregnant women, particularly diabetes mellitus. Most of the isolates showed serotypes Ia and III. CONCLUSIONS: GBS are still susceptible to penicillin but fluoroquinolone resistance is a growing concern, at least in Argentina. There are underlying conditions that could be associated to urinary infections caused by GBS.

Linfoma de Burkitt en niña de Botswana / Burkitt lymphoma in a girl from Botswana

El linfoma de Burkitt es una forma de linfoma no Hodgkin. Es uno de los tumores malignos de más rápido crecimiento en humanos, alto grado de malignidad, indiferenciado y difuso, que aparece preferentemente en niños. Actualmente se aceptan tres tipos de linfomas de Burkitt: el endémico (forma africana), esporádico (forma americana) y el tipo asociado a formas de inmunodeficiencias. Se presenta el caso de una niña de dos años de edad, con fiebre elevada de tres meses de evolución, linfadepatias cervicales, ennegrecimiento de las piezas dentales, edema facial con masa tumoral, hipertelorismo, proptosis bilateral con quemosis moderada en ojo izquierdo y severa en ojo derecho. Con limitación de la motilidad ocular. Se indican estudios de laboratorio, ultrasonido abdominal, Rx de tórax y tomografía de cráneo y órbita. Se comienza tratamiento por diagnóstico de linfoma de Burkitt, confirmado en el estudio histológico. Se realizan ciclos de quimioterapia y seguimiento en consulta de oncología. Se observa mejoría clínica de la quemosis y proptosis, con fondo de ojo normal. A pesar de la respuesta clínica favorable después de la primera semana, el pronóstico de evolución del caso es reservado (AU)

Burkitt lymphoma is a form of non-Hodgkin lymphoma. It is one of the fastest-growing malignant tumors in human beings, with a high degree of malignancy, undifferentiated and diffuse, that most commonly occurs in children. Nowadays there are three types of Burkitt lymphoma: the endemic variant (African variant), the sporadic type (American variant) and the immunodeficiency-associated type. This study presents the case of a 2-year-old girl with high fever of three months of progress, cervical lymphadenopathy, tooth blackening, facial edema with tumoral mass, hypertelorism, bilateral proptosis with moderate chemosis in the left eye and severe in the right eye. She had limitation of the ocular motility. Lab studies were ordered, as well as abdominal ultrasound, chest x-ray and skull and orbit CT scan. Treatment was started for a diagnosis of Burkitt lymphoma, which was confirmed with the histological study. Chemotherapy cycles were performed and oncology follow-ups were conducted. There was a clinical improvement of chemosis and proptosis, with a normal ophthalmoscopy. In spite of the favorable clinical response after the first week, prognosis of the case progress was guarded(AU)

Melanoma maligno de coroides / Choroidal Malignant Melanoma

El melanoma maligno de coroides es el tumor intraocular primario más frecuente en adultos entre 40 y 60 años, siempre es maligno, afectando un solo ojo; su crecimiento es rápido, generalmente es fatal en pocos años, si no es diagnosticado y tratado a tiempo el paciente. Se presenta el caso de una paciente femenina de 54 años de edad, que acude a la consulta de retina por alteración en la visión de confusión de los colores; de varios meses de evolución. Se le realizó estudio de oftalmoscopia indirecta, que confirmó el diagnóstico etiológico de melanoma maligno de coroides. Se toma la decisión de realizar la enucleación en ojo izquierdo, la paciente evolucionó favorablemente (AU)

Choroidal malignant melanoma is the most frequent primary intraocular tumor in adults between 40 and 60 years old; it is always malignant, affecting only one eye; it grows quickly; if the patient is not early diagnosed and treated, it will usually be fatal in a few years. This is the case of a 54-year-old female patient, who comes to the retina specialized consultation due to an alteration in her color vision with several months of evolution; accordingly, she underwent indirect ophthalmoscopy studies, which confirmed the etiological diagnosis of choroidal malignant melanoma. Enucleation of her left eye was decided, and consequently the patient progressed favorably (AU)

Caracterización de pacientes con retinopatía diabética atendidos en el Servicio de Retina del Centro Oftalmológico de Las Tunas / Characterization of patients with Diabetic Retinopathy in the Retina Service of the Ophthalmological Center of Las Tunas

Se realizó un estudio descriptivo de corte transversal, en pacientes diabéticos remitidos a consulta de retina del Hospital General Docente Dr Ernesto Guevara De La Serna, en la provincia de Las Tunas, desde febrero 2012 a diciembre 2013, con el objetivo de caracterizar los referidos pacientes. La muestra quedó integrada por 211 diabéticos tipo I y II con retinopatía diabética. Las variables analizadas fueron edad, sexo, agudeza visual, tiempo de evolución de la enfermedad, tipo de retinopatía diabética y tiempo medio de la última consulta oftalmológica. El sexo femenino se presentó en el 54 por ciento, la edad comprendida entre 61-70 años fue la más frecuente, con un 26,5 por ciento. Como factor atenuante de la retinopatía se destacó el glaucoma de ángulo abierto, con 10,9 por ciento, y la miopía, con un 5,6 por ciento. El 53 por ciento de los pacientes tenían más de 15 años de evolución de la diabetes. La retinopatía diabética no proliferativa severa estuvo en el 27,9 por ciento. Se evidenció la entidad en una muestra de pacientes no vistos antes en consulta de oftalmología (AU)

A descriptive, cross-sectional study was carried out in diabetic patients referred to the retinal service of the ophthalmology department at Dr Ernesto Guevara Hospital of Las Tunas, from February, 2012 to December, 2013, with the objective to characterize the patients. The sample was made up by 211 type 1 and 2 diabetic patients with diabetic retinopathy. The variables analyzed in the study were age, gender, visual acuity, the patients progress time, the type of diabetic retinopathy and the average time elapsed since the last ophthalmological consultation. The female sex was present in a 54 percent and the 61 to 70 age group was the most frequent one with a 26,5 percent. The mitigating factors of retinopathy were open angle glaucoma with a 10,9percent and myopia with a 5,6 percent. A 53 percent of the patients had been suffering from diabetes for more than 15 years. Severe non-proliferative diabetic retinopathy was within a 27,9 percent. The condition was observed in a sample of patients not seen at the ophthalmology department before (AU)