The Potential of Phenothiazines against Endodontic Pathogens: A Focus on Enterococcus-Candida Dual-Species Biofilm.

Persistent apical periodontitis occurs when the endodontic treatment fails to eradicate the intraradicular infection, and is mainly caused by Gram-positive bacteria and yeasts, such as Enterococcus faecalis and Candida albicans, respectively. Phenothiazines have been described as potential antimicrobials against bacteria and fungi. This study aimed to investigate the antimicrobial potential of promethazine (PMZ) and chlorpromazine (CPZ) against E. faecalis and C. albicans dual-species biofilms. The susceptibility of planktonic cells to phenothiazines, chlorhexidine (CHX) and sodium hypochlorite (NaOCl) was initially analyzed by broth microdilution. Interaction between phenothiazines and CHX was examined by chequerboard assay. The effect of NaOCl, PMZ, CPZ, CHX, PMZ + CHX, and CPZ + CHX on biofilms was investigated by susceptibility assays, biochemical and morphological analyses. Results were evaluated through one-way ANOVA and Tukey's multiple comparison post-test. PMZ, alone or in combination with irrigants, was the most efficient phenothiazine, capable of reducing cell counts, biomass, biovolume, carbohydrate and protein contents of dual-species biofilms. Neither PMZ nor CPZ increased the antimicrobial activity of CHX. Further investigations of the properties of phenothiazines should be performed to encourage their use in endodontic clinical practice.

Knowledge of the patients regarding leprosy and adherence to treatment.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae. It is known for its great disfiguring capacity and is considered an extremely serious disease to public health worldwide. The state of Ceará ranks 13th in number of cases of leprosy in Brazil, and fourth in Northeastern region, with an average of 2,149 new cases diagnosed every year. This study aimed to evaluate the knowledge of leprosy patients regarding treatment, and to assess the level of treatment adherence and its possible barriers. The study was conducted in the reference center for dermatology, from September 2010 to October 2010, in Fortaleza, Ceará. The study data were collected by means of a structured interview, along with the Morisky-Green test, in order to assess treatment adherence and barriers to adherence. A total of 70 patients were interviewed, out of whom 66 were new cases. The majority of patients were between 42 and 50 years old, and 37 (52.9%) were male. Most patients were clinically classified as presenting multibacillary leprosy (80%), and 78.6% of them were from Fortaleza, Brazil. The Morisky-Green test indicated that 62.9% of patients presented a low level of adherence (p<0.005), despite claiming to aware of the disease risks. However, it was observed that 57.1% of the patients had no difficulty adhering to treatment, while 38.6% reported little difficulty. This study shows that despite the patients claiming to be familiar with leprosy and its treatment, the Morisky-Green test clearly demonstrated that they actually were not aware of the principles of therapy, which is evidenced by the low degree of treatment adherence.

Candida species isolated from the gastrointestinal tract of cockatiels (Nymphicus hollandicus): In vitro antifungal susceptibility profile and phospholipase activity.

Over the past years, the incidence of yeast infections, especially candidiasis, has increased. It is known that birds, including cockatiels, harbor potentially pathogenic yeasts to human beings in their gastrointestinal tract. Thus, this work aims at determining the in vitro antifungal susceptibility and phospholipase activity of Candida spp. isolated from the gastrointestinal tract and stools of cockatiels. Sixty cockatiels were assessed and samples were collected from oral cavity, crop and cloaca and stools were collected from cages where birds were kept. Yeast species were identified according to morphological and biochemical characteristics. Amphotericin B, itraconazole and fluconazole were tested against 39 C. albicans; 12 C. tropicalis; 7 C. parapsilosis and 1 C. krusei, through broth microdilution test. These same isolates were also tested for phospholipase production, on egg yolk agar. For amphotericin B, itraconazole and fluconazole, MICs were 0.25-1 µg/mL, 0.03125 to ≥16 µg/mL and 0.5 to ≥64 µg/mL, respectively, and resistance to itraconazole and fluconazole was observed in 14 (35.89%) and 4 (10.26%) C. albicans isolates, respectively. All C. albicans were positive for phospholipase production, out of which 74.36% presented high enzymatic activity. Among non-albicans Candida species, 40% produced phospholipase. The results show that cockatiels might represent a hazard to human health, as sources of infections caused by resistant Candida spp., especially to immunocompromised individuals, children and elderly.