Microbiological survey of birds of prey pellets.

A microbiological survey of 73 pellets collected from different birds of prey species housed at the Wildlife Rescue and Rehabilitation Center of Napoli (southern Italy) was performed. Pellets were analyzed by culture and biochemical methods as well as by serotyping and polymerase chain reaction. We isolated a wide range of bacteria some of them also pathogens for humans (i.e. Salmonella enterica serotype Typhimurium, Campylobacter coli, Escherichia coli O serogroups). This study highlights the potential role of birds of prey as asymptomatic carriers of pathogenic bacteria which could be disseminated in the environment not only through the birds of prey feces but also through their pellets.

Therapeutic approach to Candida bezoar in children.

INTRODUCTION: Candida bezoar (CB) is a rare finding in neonates and infants with candiduria, presenting as necrotic debris with proliferating mycelia in the collecting system of the kidney. If initial antifungal medical treatment does not result in clearance of candiduria and disappearance of CB on ultrasound in dilated kidneys, invasive interventions like insertion of nephrostomy tubes (NT) or surgical interventions to drain the kidney are sometimes advocated(.). However, NT placement can be a technical challenge, especially in pre- and dysmature neonates, and NT displacement or obstruction by the CB can lead to suboptimal treatment. Identification of those children who will benefit from invasive renal drainage is important. OBJECTIVE: This study evaluates the management of patients with CB in three tertiary referral hospitals to determine criteria for intervention. MATERIALS AND METHODS: A retrospective multicenter chart analysis was conducted of children with candiduria and ultrasonographic demonstration of CB (diagnosed between March 1995 and August 2012). The indication for invasive renal drainage (if performed) and subsequent clinical outcome, serum creatinine levels and ultrasound findings were assessed. RESULTS: A total of 12 children were included, two of which were premature neonates. Eight children had congenital urogenital anomalies. One older child with acute myeloid leukemia had CB during chemotherapy and one ex-premature developed CB following cerebral candidiasis. All children received systemic antifungal medication; in seven children invasive treatment was added. Indications for invasive treatment were clinical deterioration, progressive renal dilation, pyonephrosis, rising creatinine levels and persistence of CB. Two underwent a Y-cutaneous ureterostomy and nephrostomy tubes were inserted in five children. Percutaneous renal drainage by nephrostomy led to complications in 3 of 6 procedures. In all patients, irrespective of therapeutic modality, follow-up ultrasound demonstrated no de novo changes. No additional parenchymal defects or deterioration of split renal function were seen on DMSA or MAG-3 scan. DISCUSSION: In the literature renal drainage is suggested in case of complete obstruction. However dilatation is a frequent finding in children as part of the congenital renal anomaly and does not necessarily mean that there is obstruction of the urinary tract. Even in children without candida infections the diagnosis of obstruction is not straightforward, while the results of a MAG 3 scan can be obscured by compromised kidney function, parenchymal bacterial infiltration and neonatal immaturity of the kidney. If candiduria and CB persist despite intensive medical treatment, intensive consultation is required before renal drainage, because NT insertion might be a surgical challenge. Complications such as displacement of the NT, urinoma development, or NT obstruction can occur and was seen in three of six procedures. Premature neonates seem to be more prone to complications due to their small anatomical proportions, requiring medical equipment with small diameters prone to displacement and obstruction. Some studies describe successful pharmaceutical management in the majority of patients with CB. Other studies describe unilateral surgical intervention in children with bilateral CB where unilateral drainage did not influence overall renal outcome. This is in line with our results. A limitation of the present study is its retrospective design. In this population, the motivation for invasive renal drainage or conservative management was not well documented in all cases, and was mainly based on clinical and diagnostic parameters like creatinine levels and radiographic findings. CONCLUSION: Renal drainage should be considered in selected cases after failure of systemic antifungal treatment. Inserting and maintaining a nephrostomy tube in young children is associated with a high rate of complications; conservative treatment is likely to be sufficient in the majority of patients with candiduria and CB.

Anuria in a solitary kidney with Candida bezoars managed conservatively.

UNLABELLED: Renal involvement is regularly encountered in neonates with invasive candidiasis, especially when risk factors like congenital malformations of the renal tract or poor bladder emptying and preterm birth are present. However, complete obstruction of the renal collecting system by fungal balls is rare. Although conservative management has been advocated for partial obstruction, complete obstruction is considered an indication for surgical drainage. We report a patient with anuria and Candida albicans bezoars in a solitary kidney, suggesting post-renal acute kidney injury. The patient was treated with systemic fluconazole and peritoneal dialysis for 4 days. The fungus balls disappeared and renal function recovered. CONCLUSION: Systemic antifungal therapy leads to clearance of obstructing fungus balls, and nephrostomy should be reserved for anuria due to bilateral complete obstruction with severe hydronephrosis. In these cases, temporary dialysis is a potential alternative.

Unilateral ureteral obstruction caused by Aspergillus, subgenus Nidulantes in a patient on steroid therapy: a case report and review of the literature.

Urinary tract obstructions caused by Aspergillus bezoars has been reported on rare occasions. We describe in this paper an unusual case caused by an isolate of the Aspergillus nidulantes subgenus, and review the literature on 13 additional cases of ureteral obstruction due to renoureteric aspergillosis so as to provide the characteristics of this disease entity. Our case presented with a unilateral ureteral obstruction and acute renal failure due to Aspergillus bezoars. The patient was immunocompromised having received corticosteroid therapy for chronic obstructive lung disease and bronchiectasis. She was treated successfully with antifungal chemotherapy, including amphotericin B followed by oral voriconazole for about two months and had a percutaneous nephrostomy for one month. The patient's renal function completely recovered after hemodialysis maintenance for six months.

Rapid monitoring of microbial contamination on herbal medicines by fluorescent staining method.

AIMS: To apply fluorescent staining method for fast assessment of microbial quality of herbal medicines. METHODS AND RESULTS: The number of total bacteria and esterase-active bacteria on powdered traditional Chinese medicines were enumerated by fluorescent staining method using 6-carboxyfluorescein diacetate (6CFDA) and 4',6-diamidino-2-phenylindole (DAPI), and they were compared with colony-forming units (CFU). The CFU was approximately 10(3) per gram in ginseng radix, and no bacterial colonies were detected from others. However, the total bacterial number (TDC) was more than 10(7) per gram, and number of bacteria possessing esterase activity ranged from 1 to 3% of TDC. CONCLUSIONS, SIGNIFICANCE AND IMPACT OF THE STUDY: Many bacteria in each Chinese medicine had enzyme activity and most of them could not be detected by conventional plate counting technique. Enumeration of bacterial cells on traditional Chinese medicines by fluorescent staining method requires less than 1 h. The double staining method with 6CFDA and DAPI could be applicable to rapid microbial monitoring of crude drugs.

[Imaging of urinary Candida bezoars]. / Imagerie des bézoards candidosiques urinaires.

OBJECTIVES: To describe the renewed interest in Candida infections in general and urinary tract infections in particular, due to a recrudescence of immunodepressed patients and a better knowledge of their clinical and radiological manifestations. MATERIAL AND METHODS: The authors report 2 cases of Candida bezoars diagnosed by IVU, ultrasonography and CT scan in two insulin-dependent diabetics. RESULTS: The first case presented with right renal involvement, in the form of delayed renal secretion on IVU with the presence of a pelvic filling defect, dilatation of the upper tract cavities on ultrasonography with a dilated renal pelvis occupied by an echogenic formation with no posterior acoustic shadow. CT showed a slightly heterogeneous low-density lesion with no contrast enhancement. The second case presented with right pelvic and vesical involvement. The diagnosis of urinary candidiasis was confirmed, in the first case, by the presence of whitish lumps on catheterization, for which analysis and culture were in favour of candidiasis and, in the second case, by direct examination and urine culture. Treatment with amphotericin B led to improvement followed by disappearance of the signs in both cases. CONCLUSION: In addition to laboratory examinations, noninvasive imaging techniques, mainly ultrasonography and CT, but also percutaneous aspiration, constitute a decisive element in the diagnostic and therapeutic management of urinary candidiasis.

[Bezoars and gigantic stomach ulcers associated with helicobacter pylori]. / Bezoary i gigantskie iazvy zheludka, assotsiirovannye s khelikobakter pilori.

Available are the results of examination and treatment of 8 patients with bezoars of the stomach (6 of them with gigantic ulcers) associated with Helicobacter pylori. The results showed in all patients a presence of chronic atrophic gastritis of various and hypoacidic condition. Gastritis and ulcer associated with Helicobacter pylori are a suitable background for phytobezoars formation. At the same time phytobezoars favour the progression of these diseases and development of complications. Pathognomonic symptoms of the disease and possible complications are determined, their prophylaxis and treatment are proposed.

[Renal candidiasis following treatment of infantile osteomyelitis]. / Csecsemökori osteomyelitis kezelését követó renalis candidiasis.

Systemic candidiasis with renal complications is a rather rare phenomenon in young infants. Authors report on a 4.5 month-old baby (preterm) who, during an antibiotic therapy of wide spectrum--because of osteomyelitis--acquired a mycotic infection causing bilateral pyelon and pyeloureteral obstruction. In addition to systemic antimycotic therapy surgical intervention was needed to eliminate the mycotic bezoar.

[Bilateral candida bezoar of the upper urinary tract]. / Bezoar candidiásico bilateral del tracto urinario superior.

Fungal urinary tract infections are due to candida albicans as first responsible germ. This sporulated oval fungus divides itself by gemmation and produces pseudohyphas when it is spread in culture mediums, organic tissues or their exudates. The most frequent predisposing factor is diabetes mellitus. Others predisposing factors are: long antibiotic administration, corticoids, immunosuppressors, neoplasias, neurogenic bladder, and catheter or foreign bodies into the urinary tract. Bezoar formation is a rare complication that sometimes produces obstructive uropathy. Although Candida albicans is the most frequent observed germ in bezoars, Candida tropicalis, Penicillium, Aspergillus, Mucor y Turolopsis have been found as well. We present the case of a diabetic patient with a bilateral bezoar formation into the upper urinary tract due to Candida albicans. Clinical features, diagnosis and treatment are described emphasizing in the are bilateral onset.

Acute renal failure caused by fungal bezoar: a late complication of Candida sepsis associated with central catheterization.

The authors report a case of acute renal failure caused by fungal bezoar in the renal pelvis. The patient was successfully treated with bilateral percutaneous nephrostomy drainage. He had been admitted because of necrotizing enterocolitis, at the age of 26 days. Eventually, his bowel was reduced to 40 cm of small intestine, including 5 cm of terminal ileum. Candida sepsis developed during central total parenteral nutrition, at the age of 76 days. Five weeks after the diagnosis of systemic candidiasis, sudden anuria developed, and ultrasonography showed echogenic material in both renal pelvises. Bilateral percutaneous nephrostomy catheters were placed in the renal pelvises, and local irrigation with amphotericin B was performed for 3 weeks. The renal function of the baby was completely recovered, without systemic antifungal treatment.

Urinary fungal bezoars in children--report of two cases.

We report two cases of urinary obstruction by fungal bezoars in full-term neonates who presented a uropathy detected antenatally. Early percutaneous urinary diversion was performed to relieve renal impairment secondary to a primary megaureter in the first case and to bilateral pelvi-ureteral obstruction in the second. Acute fungal obstruction occurred first on the side of the primary megaureter and then on the healthy side in the first patient. Symptoms of infection and impaired renal function led to a diagnosis of fungal bezoar. In the second patient the development of the bezoar was more insidious and occurred after surgical correction of the obstructive pelvi-ureteral junction on the left side. Candiduria was the first sign in both cases. Ultrasonography is the best method to visualize fungal masses within the collecting system. In most cases, percutaneous nephrostomy allows relief of the obstruction, sampling of urine for culture and irrigation with amphotericin B. However, additional surgical intervention may be necessary. Systemic antifungal treatment using mainly 5-flucytosine is also given.

[Urinary tract obstruction by Candida bezoars, or fungus balls]. / Obstruction des voies urinaires par des bézoars candidosiques, ou "fungus balls".

Two patients admitted to an intensive care unit for severe bacterial infection develops Candida albicans superinfection with obstruction of the urinary canals by "fungus balls". The development of medico-surgical techniques using antibiotics and immunosuppressive drugs accounts for the increasing incidence of disseminated candidiasis. The kidneys are particularly sensitive to Candida infections. Fungus balls are conglomerates of mycelium which may result in obstruction of the urinary tract. Their clinical, radiological and ultrasonic features, as well as the microbiological and serological diagnostic problems they raise are described. Ultrasonically guided percutaneous nephrostomy is a very interesting technique for the diagnosis of the condition and its local treatment by drainage and lavage with amphotericin B. This antifungal, combined with flucytosine is still used for the systemic treatment of candidiasis.

[A candida bezoar in the Chiari reticulum of the right heart atrium]. / Candidabezoar im Chiarischen Netz des rechten Herzvorhofes.

An incidental finding at autopsy in a 55-year-old woman who died of complications of uterine cervical carcinoma was a 3 cm long polyp attached to the rete of Chiari in the right atrium. The lesion was interpreted grossly as either a pedunculated metastasis to the heart or an unusual atrial tumor. Histologic examination revealed it to be a fungus ball composed of regularly grouped Candida mycelia. The patient's history revealed Candida septicemia several months prior to death for which she had been treated by heavy doses of antibiotics administered through indwelling catheter. The causes of this unusual anatomo-pathologic finding are discussed in the light of our observations and those reviewed in the literature.