[Fungal identification in burn patients. A retrospective study and risk factors]. / Identificación fúngica en pacientes quemados. Un estudio retrospectivo y factores de riesgo.

A retrospective analysis of fungal infections was carried out in a health-care burn center between 2011 and 2014 using the patients' medical records (n = 36). Patients ranged from 18 to 87 years of age, with 23 (63.9%) being women. The most prevalent widespread total body surface area affected (TBSA) was 30-50% (p = 0.03), and 71-100% in younger patients, mainly associated with femicide. Fourth degree burns were revealed in 69.4% of the patients while in 50%, inhalation injuries were observed to represent a higher mortality rate (p = 0.04). The Candida score was 3 in 77.7% of cases respectively. Central venous catheter and mechanical ventilation were used. All patients received antibiotic treatment and 91.7% antifungal treatment. Surgical excision of the burn was performed in 33 (91.7%) patients, and skin autografting in 29 (80.6%). The median of the fungal infection developed was 21.4 days after admission to the ICU. The specimens analyzed involved 52 yeast samples isolated from different cultures: urine (42.3%), blood (26.9%), skin biopsy (9.6%), catheter tip (15.4%) and tracheal aspirate (5.8%). The use of microbiological culture and molecular methods allowed for the identification of Candida albicans (53.8%), C. tropicalis (23.1%), C. parapsilosis sensu stricto (13.5%), C. krusei (5.8%), C. glabrata (1.9%) and C. dubliniensis (1.9%). Fungal infections observed in skin burns lead to severe complications in at-risk patients.

Se realizó un estudio retrospectivo de las infecciones fúngicas atendidas en un centro de quemados de alta complejidad situado en Buenos Aires, entre 2011 y 2014, mediante el análisis de las historias clínicas (n = 36). Las edades de los pacientes estuvieron entre 18 y 87 años, y 23 (63.9%) fueron mujeres. La extensión de la superficie corporal afectada más prevalente varió entre 30 y 50% (p = 0.03), y entre 71% y 100% en pacientes de menor edad, relacionándose con intentos de femicidio. En el 69.4% la profundidad de la quemadura fue grado 4, y en el 50% de los casos se observaron lesiones por inhalación, con una alta mortalidad (p = 0.04). El Candida score resultó de 3 en el 77.7% de los casos. Se usaron vías centrales y ventilación mecánica. Todos los pacientes recibieron tratamiento antibiótico y en 33 (91.7%) antifúngicos. La escisión quirúrgica de la quemadura se practicó en 33 (91.7%) y los autoinjertos de piel en 29 (80.6%). La infección fúngica se desarrolló en una media de 21.4 días del ingreso en UCI. Se estudiaron 52 muestras de levaduras que se aislaron de urocultivo (42.3%), hemocultivo (26.9%), biopsia cutánea (9.6%), punta de catéter (15.4%) y aspirado traqueal (5.8%). Por cultivo microbiológico y métodos moleculares se identificaron a Candida albicans (53.8%), C. tropicalis (23.1%), C. parapsilosis sensu stricto (13.5%), C. krusei (5.8%), C. glabrata (1.9%) y C. dubliniensis (1.9%). Las infecciones fúngicas representan severas complicaciones en quemados con factores de riesgo.

Identificación fúngica en pacientes quemados. Un estudio retrospectivo y factores de riesgo / Fungal identification in burn patients. A retrospective study and risk factors

Resumen Se realizó un estudio retrospectivo de las infecciones fúngicas atendidas en un centro de quemados de alta complejidad situado en Buenos Aires, entre 2011 y 2014, mediante el análisis de las histo rias clínicas (n = 36). Las edades de los pacientes estuvieron entre 18 y 87 años, y 23 (63.9%) fueron mujeres. La extensión de la superficie corporal afectada más prevalente varió entre 30 y 50% (p = 0.03), y entre 71% y 100% en pacientes de menor edad, relacionándose con intentos de femicidio. En el 69.4% la profundidad de la quemadura fue grado 4, y en el 50% de los casos se observaron lesiones por inhalación, con una alta mortali dad (p = 0.04). El Candida score resultó de 3 en el 77.7% de los casos. Se usaron vías centrales y ventilación mecánica. Todos los pacientes recibieron tratamiento antibiótico y en 33 (91.7%) antifúngicos. La escisión qui rúrgica de la quemadura se practicó en 33 (91.7%) y los autoinjertos de piel en 29 (80.6%). La infección fúngica se desarrolló en una media de 21.4 días del ingreso en UCI. Se estudiaron 52 muestras de levaduras que se aislaron de urocultivo (42.3%), hemocultivo (26.9%), biopsia cutánea (9.6%), punta de catéter (15.4%) y aspirado traqueal (5.8%). Por cultivo microbiológico y métodos moleculares se identificaron a Candida albicans (53.8%), C. tropicalis (23.1%), C. parapsilosis sensu stricto (13.5%), C. krusei (5.8%), C. glabrata (1.9%) y C. dubliniensis (1.9%). Las infecciones fúngicas representan severas complicaciones en quemados con factores de riesgo.

Abstract A retrospective analysis of fungal infections was carried out in a health-care burn center between 2011 and 2014 using the patients' medical records (n = 36). Patients ranged from 18 to 87 years of age, with 23 (63.9%) being women. The most prevalent widespread total body surface area affected (TBSA) was 30-50% (p = 0.03), and 71-100% in younger patients, mainly associated with femicide. Fourth degree burns were revealed in 69.4% of the patients while in 50%, inhalation injuries were observed to represent a higher mortality rate (p = 0.04). The Candida score was 3 in 77.7% of cases respectively. Central venous catheter and mechanical ventilation were used. All patients received antibiotic treatment and 91.7% antifungal treatment. Surgical excision of the burn was performed in 33 (91.7%) patients, and skin autografting in 29 (80.6%). The median of the fungal infection devel oped was 21.4 days after admission to the ICU. The specimens analyzed involved 52 yeast samples isolated from different cultures: urine (42.3%), blood (26.9%), skin biopsy (9.6%), catheter tip (15.4%) and tracheal aspirate (5.8%). The use of microbiological culture and molecular methods allowed for the identification of Candida albicans (53.8%), C. tropicalis (23.1%), C. parapsilosis sensu stricto (13.5%), C. krusei (5.8%), C. glabrata (1.9%) and C. dubliniensis (1.9%). Fungal infections observed in skin burns lead to severe complications in at-risk patients.

Fungemia following Saccharomyces cerevisiae var. boulardii probiotic treatment in an elderly patient / Fungemia posterior al tratamiento con Saccharomyces cerevisiae var. boulardii como probiótico en una paciente anosa

Abstract The yeast Saccharomyces cerevisiae var. boulardii is a biotherapeutic agent used for the prevention and treatment of several gastrointestinal diseases. We report a case of fungemia in a patient suffering from Clostridium difficile-associated diarrhea and treated with metronidazole and a probiotic containing S. cerevisiae var. boulardii. The yeasts isolated from the blood culture and capsules were identified by MALDI-TOF MS and API ID 32 C as S. cerevisiae, and showed the same appearance and color on CHROMAgar Candida. Treatment with fluconazole 400mg/day was initiated and the probiotic was stopped. The patient was discharged from hospital in good condition and was referred to a rehabilitation center. We suggest that the potential benefit of S. cerevisiae var. boulardii should be accurately evaluated, especially in elderly patients. Moreover, all physicians should be trained in the use of probiotic agents and enquire whether the use probiotics was included in the patients'medical histories. © 2019 Asociación Argentina de Microbiología. Published by Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Resumen Saccharomyces cerevisiae var. boulardii es un agente bioterapéutico usado en la prevención y el tratamiento de varias enfermedades gastrointestinales. Informamos de un caso de fungemia en una paciente con diarrea asociada a Clostridium difficile, y tratada con metron-idazol y un probiótico que contenía S. cerevisiae var. boulardii. Las levaduras aisladas a partir del hemocultivo y del contenido de las cápsulas tomadas por la paciente se identificaron como S. cerevisiae mediante MALDI-TOF MS y API® ID 32C, las colonias mostraron el mismo color y aspecto en el medio CHROMAgar™ Candida. Se instauró un tratamiento con fluconazol 400mg/día y se suspendió el probiótico. La paciente fue dada de alta del hospital en buenas condiciones, y remitida a un centro de rehabilitación. Sugerimos que el beneficio potencial del uso de S. cerevisiae var. boulardii debe ser evaluado en cada paciente, especialmente en personas añosas. El uso de probióticos debería incluirse en los interrogatorios orientados al diagnóstico y formar parte de la historia clínica. © 2019 Asociación Argentina de Microbiología. Publicado por Elsevier España, S.L.U. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Fungemia following Saccharomyces cerevisiae var. boulardii probiotic treatment in an elderly patient.

The yeast Saccharomyces cerevisiae var. boulardii is a biotherapeutic agent used for the prevention and treatment of several gastrointestinal diseases. We report a case of fungemia in a patient suffering from Clostridiumdifficile-associated diarrhea and treated with metronidazole and a probiotic containing S. cerevisiae var. boulardii. The yeasts isolated from the blood culture and capsules were identified by MALDI-TOF MS and API ID 32 C as S. cerevisiae, and showed the same appearance and color on CHROMAgar Candida. Treatment with fluconazole 400mg/day was initiated and the probiotic was stopped. The patient was discharged from hospital in good condition and was referred to a rehabilitation center. We suggest that the potential benefit of S. cerevisiae var. boulardii should be accurately evaluated, especially in elderly patients. Moreover, all physicians should be trained in the use of probiotic agents and enquire whether the use probiotics was included in the patients'medical histories.

Osteomyelitis of the rib cage by Aspergillus flavus / Osteomielitis en la parrilla costal por Aspergillus flavus

Background: Aspergillus osteomyelitis of the ribs is relatively uncommon. It is a debilitating and severe form of invasive aspergillosis. Case report: A 61year-old female presented with spontaneous chest pain on the right side of the rib cage and a palpable soft-tissue mass. FDG-PET/CT scan identified activity in the infected site. The lesion was punctured, and purulent material was sent to the laboratory. Aspergillus complex Flavi was isolated. An antifungal treatment with voriconazole was started. The lesion healed, and no recurrence was observed at 8-month follow-up. Molecular identification of the isolate was based on PCR amplification and sequencing of β-tubulin gene. Aspergillus flavus was identified. Conclusions: Our case highlights the relevance of microbiological studies in patients with osteomyelitis and the involvement of soft tissue. The FDG-PET/CT scan was found to be a useful tool for revealing the extent of the disease and evaluating the response to the antifungal therapy

Antecedentes: La osteomielitis en la parrilla costal por Aspergillus es una forma debilitante, grave y poco frecuente de aspergilosis invasora. Caso clínico: Mujer de 61 años que presentaba dolor en la parrilla costal derecha y una masa palpable en partes blandas. La FDG-PET/CT identificó actividad en el sitio infectado. Se obtuvo por punción material purulento y se envió al laboratorio. El aislamiento se identificó por cultivo como Aspergillus perteneciente al complejo Flavi. Se indicó tratamiento antifúngico con voriconazol durante 8 meses y la lesión curó sin recurrencia. Mediante la amplificación del gen de la ß-tubulina por PCR y su posterior secuenciación se identificó el aislamiento como Aspergillus flavus. Conclusiones: Destacamos la importancia del estudio microbiológico en pacientes con osteomielitis y con compromiso en los tejidos blandos. El estudio con FDG PET/CT es útil para revelar la extensión de la enfermedad y evaluar la respuesta a la terapia antimicótica

Osteomyelitis of the rib cage by Aspergillus flavus.

BACKGROUND: Aspergillus osteomyelitis of the ribs is relatively uncommon. It is a debilitating and severe form of invasive aspergillosis. CASE REPORT: A 61year-old female presented with spontaneous chest pain on the right side of the rib cage and a palpable soft-tissue mass. FDG-PET/CT scan identified activity in the infected site. The lesion was punctured, and purulent material was sent to the laboratory. Aspergillus complex Flavi was isolated. An antifungal treatment with voriconazole was started. The lesion healed, and no recurrence was observed at 8-month follow-up. Molecular identification of the isolate was based on PCR amplification and sequencing of ß-tubulin gene. Aspergillus flavus was identified. CONCLUSIONS: Our case highlights the relevance of microbiological studies in patients with osteomyelitis and the involvement of soft tissue. The FDG-PET/CT scan was found to be a useful tool for revealing the extent of the disease and evaluating the response to the antifungal therapy.

Saksenaea erythrospora infection following a serious sailing accident.

Saksenaea erythrospora is a species of the order Mucorales recently described and reported as a cause of human mucormycosis. We report a case of S. erythrospora in a man involved in a serious sailing accident causing deep skin and soft tissue contamination with soil and water. Direct microscopic examination of the clinical sample with Giemsa stains showed hyaline and non-septate hyphae belonging to the order Mucorales. Fungal identification was performed by culture of biopsy material on SDA, and identification of species by floating an agar block containing the fungus in a nutritionally deficient medium consisting of sterile distilled water supplemented with 0.05 % yeast extract; and by sequencing the ITS region of the rDNA. This is the first report to our knowledge of infection with S. erythrospora in Argentina, confirming the presence of this fungus in this country.

Evaluación de la actividad de caspofungina comparada con anfotericina B en un modelo experimental de histoplasmosis en hámsters (Mesocrisetus auratus) / Determination of the therapeutic activity of caspofungin compared with the amphotericin B in an animal experimental model of histoplasmosis in hamster (Mesocrisetus auratus)

Antecedentes. La anfotericina B es un fármaco efectivo para el tratamiento de la histoplasmosis. La caspofungina es activa contra especies de Candida y Aspergillus. Estudios in vitro han demostrado el efecto inhibitorio de este fármaco en Histoplasma capsulatum. Objetivo. Evaluar la eficacia de la caspofungina comparada con la anfotericina B para el tratamiento de histoplasmosis en un modelo experimental en hámster. Métodos. Se utilizaron tres cepas de Histoplasma capsulatum var. capsulatum. El tratamiento comenzó una semana tras la inoculación y los animales fueron distribuidos aleatoriamente en 6 grupos, según los fármacos utilizados: anfotericina B 6mg/kg/día, caspofungina en dosis de 2, 4 y 8mg/kg/día, solución fisiológica y dextrosa al 5%. Se tomaron muestras semanales para hemocultivos a partir del séptimo día postinfección y a los 7 días de finalizado el tratamiento los animales fueron sacrificados, realizándose cultivos del bazo. Resultados. Los resultados obtenidos de los hemocultivos realizados al finalizar el tratamiento fueron negativos en un 100% en el grupo tratado con anfotericina B, frente al 30% en el grupo tratado con caspofungina y el 32% en el grupo control (p=0,59). Los cultivos de bazo fueron negativos en el grupo de anfotericina B, mientras que en el grupo de caspofungina los valores fluctuaron entre el 25 y el 100%, y en el grupo control entre el 35 y el 94,8% (p=0,07). En el análisis estadístico del cultivo de la suspensión de bazo sin diluir el uso de anfotericina B fue el único predictor independiente de cultivos negativos (p=0,001). Conclusiones. La anfotericina B es un fármaco efectivo para el tratamiento de la histoplasmosis. La administración de caspofungina no demostró mayor eficacia en comparación con el grupo control(AU)

Background. Treatment with amphotericin B is highly effective in histoplasmosis. Caspofungin has shown good activity against Candida and Aspergillus spp. In vitro studies have demonstrated that Histoplasma capsulatum is inhibited by caspofungin. Objectives. The purpose of this study was to evaluate the effectiveness of caspofungin in the treatment of histoplasmosis in an animal experimental model. Methods. Three strains of Histoplasma capsulatum var. capsulatum were used. Treatment started one week post-inoculation and the animals were randomly assigned to six groups: amphotericin B 6mg/Kg/d, caspofungin 2mg/Kg/d, 4mg/Kg/d, 8mg/Kg/d and the other two groups received saline solution and dextrose solution. Blood samples for culture were obtained once a week, from day 7 to 35 post-inoculation. One week after the end of the treatment the animals were sacrificed and spleen cultures were performed. Results. Blood cultures were negative in all the hamsters which received amphotericin B (100%, P<0.001); those treated with caspofungin and the control animals presented 30 and 32% of positive cultures respectively (P=0.59). Spleen cultures were negative in the animals treated with amphotericin B, while the percentage of positive spleen cultures in the caspofungin groups varied from 25 to 100%, and in the control groups from 35 to 94.8% (P=0.07). The statistical analysis of the undiluted cultures showed the use of amphotericin B as the only independent predictor of negative culture (P<0.001). Conclusions. The efficacy of amphotericin B is well known for the treatment of histoplasmosis, though we could not demonstrate that caspofungin is better than control(AU)

Determination of the therapeutic activity of caspofungin compared with the amphotericin B in an animal experimental model of histoplasmosis in hamster (Mesocrisetus auratus).

BACKGROUND: Treatment with amphotericin B is highly effective in histoplasmosis. Caspofungin has shown good activity against Candida and Aspergillus spp. In vitro studies have demonstrated that Histoplasma capsulatum is inhibited by caspofungin. OBJECTIVES: The purpose of this study was to evaluate the effectiveness of caspofungin in the treatment of histoplasmosis in an animal experimental model. METHODS: Three strains of Histoplasma capsulatum var. capsulatum were used. Treatment started one week post-inoculation and the animals were randomly assigned to six groups: amphotericin B 6mg/Kg/d, caspofungin 2mg/Kg/d, 4mg/Kg/d, 8mg/Kg/d and the other two groups received saline solution and dextrose solution. Blood samples for culture were obtained once a week, from day 7 to 35 post-inoculation. One week after the end of the treatment the animals were sacrificed and spleen cultures were performed. RESULTS: Blood cultures were negative in all the hamsters which received amphotericin B (100%, P<0.001); those treated with caspofungin and the control animals presented 30 and 32% of positive cultures respectively (P=0.59). Spleen cultures were negative in the animals treated with amphotericin B, while the percentage of positive spleen cultures in the caspofungin groups varied from 25 to 100%, and in the control groups from 35 to 94.8% (P=0.07). The statistical analysis of the undiluted cultures showed the use of amphotericin B as the only independent predictor of negative culture (P<0.001). CONCLUSIONS: The efficacy of amphotericin B is well known for the treatment of histoplasmosis, though we could not demonstrate that caspofungin is better than control.