Synergistic antimicrobial effect of photodynamic therapy and ciprofloxacin.

The occurrence of a variety of pathogens resistant to current antibiotics remains the major problem in medical care, especially when bacterial infections are established as biofilms. In this study, we propose the use of photodynamic therapy (PDT) as a monotherapy and associated with antibiotic as an alternative treatment. The aim of this study was to analyze the effects of PDT mediated by methylene blue (MB) on Staphylococcus aureus (ATCC 25923) and Escherichia coli (ATCC 25922) in both biofilm and planktonic phases. Several concentrations of MB and light doses were tested. The bactericidal effects of PDT as a monotherapy did not increase with the concentration of photosensitizer, but were light dose-dependent. In addition, bacteria in biofilms were less affected than cells in the planktonic phase. Although not concentration-dependent, the disruption effect of PDT on biofilms was clearly illustrated by scanning electron microscopy (SEM). We also carried out experiments that evaluated the synergistic effect of photodynamic therapy and the antibiotic ciprofloxacin. The best results were obtained after combination treatment of photodynamic therapy followed by ciprofloxacin on biofilms, which increased bacterial reduction on biofilms, resulting in a 5.4 log reduction for S. aureus biofilm and approximately 7 log for E. coli biofilm.

Enolase from Paracoccidioides brasiliensis: isolation and identification as a fibronectin-binding protein.

Paracoccidioides brasiliensis yeast cells can enter mammalian cells and may manipulate the host cell environment to favour their own growth and survival. Moreover, fibronectin and several other host extracellular matrix proteins are recognized by various components of the yeast cell extracts. The present study was designed to isolate and characterize a fibronectin-binding protein from P. brasiliensis. We also compared P. brasiliensis strain 18, tested before (Pb18a) and after (Pb18b) animal passage, in relation to its adhesion and invasion processes. Extracts from both samples, when cultured on blood agar solid medium, showed higher levels of protein expression than when the same samples were cultured on Fava-Netto solid medium, as demonstrated by two-dimensional electrophoresis and SDS-PAGE. Also, both Pb18a and Pb18b exhibited stronger adhesion to A549 epithelial cells when cultured on blood agar medium than when cultured on Fava-Netto medium. Ligand affinity binding assays revealed a protein of 54 kDa and pI 5.6 in P. brasiliensis cell-free extracts with the properties of a fibronectin-binding adhesin, which was characterized by tryptic digestion and mass spectroscopy as a homologue of enolase from P. brasiliensis. Antibody raised against this 54 kDa protein abolished 80 % of P. brasiliensis adhesion to A549 epithelial cells. Our results demonstrate that P. brasiliensis produces a fibronectin-binding adhesin, irrespective of the culture medium, and that this activity can be inhibited by a specific antibody and is involved in the adhesion of the fungus to pulmonary epithelial cells.

Interactions of Paracoccidioides brasiliensis with host cells: recent advances.

Host-fungal interactions are inherently complex and dynamic. In order to identify new microbial targets and develop more effective antifungal therapies, it is important to understand the cellular and molecular mechanisms of disease. Paracoccidioidomycosis provokes a variety of clinical symptoms, and Paracoccidioides brasiliensis can reach many tissues, but primarily attacks the lungs. The ability of the pathogen to interact with the host surface structures is essential to further colonization, invasion, and growth. Epithelial cells may represent the first host barrier or the preferential site of entry of the fungus. For this reason, interactions between P. brasiliensis and Vero/A549 epithelial cells were evaluated, with an emphasis on the adherence, induction of cytoskeletal alterations, and differential signaling activity of the various surface molecules. The adhesion to and invasion of epithelial cells by P. brasiliensis may represent strategies employed to thwart the initial host immune response, and may help in the subsequent dissemination of the pathogen throughout the body.

Genetic relatedness of commensal strains of Candida albicans carried in the oral cavity of patients' dental prosthesis users in Brazil.

The aim of this study is to describe the degree of yeast-colonization in diabetic and hemodialysed-users of dental prostheses. Individuals (306) were examined using an oral rinse technique in order to evaluate the incidence of yeast-carriage, and genotype of C. albicans. Yeasts were isolated from 68.4% (91/133) individual's dental prostheses users. Dental prostheses were found to be a significant factor for the yeast colonization (P < 0.05). Overall, the intensity of carriage was higher in diabetic patients as compared with health and hemodialysed individuals (P < 0.05). The isolation rates were: C. albicans (51.7%), C. parapsilosis (20.9%), C. tropicalis (14.3%), C. glabrata (6.6%), C. krusei (3.3%), C. rugosa (1.1%), and Pichia (Pichia ohmeri, 2.2%). Ready-To-Go RAPD Analysis Beads were used and primer OPJ 6 distinguished the C. albicans isolates found in prostheses users. All the isolates were grouped into 11 RAPD profiles in four main clusters and, the average S (AB) for the entire collection of 47 C. albicans isolates were 0.779 +/- 0.178. Over 85% of isolates had a similarity level higher than or equal to 0.8 reinforcing the idea that the use of dental prostheses, independently of the host's clinical condition, probably provides the necessary conditions for these strains to gain a growth-specific advantage over others.

Species diversity of yeast in oral colonization of insulin-treated diabetes mellitus patients.

The aim of this study was to investigate oral yeast colonization, antifungal susceptibility and strain diversity in insulin-dependent diabetes mellitus patients (175), as well as to evaluate the influence of dental prostheses. Oral rinse samples were cultured on selective media, in order to isolate, count and identify the yeasts recovered. More than half of the diabetic subjects (53%) carried significant amounts of Candida cells in the buccal cavity and these organisms were recovered at higher densities in diabetics wearing dentures. A total of 93 yeast strains were isolated from these patients, including: Candida spp. (n = 89); Pichia (n = 02); Trichosporon (n = 1), and Geotrichum (n = 1). C. albicans represented 56% of these strains, non-albicans Candida 39.8%, and other genera of yeast 4.3%. C. albicans was prevalent, followed by C. parapsilosis, C. tropicalis, C. glabrata, C. krusei, C. rugosa and C. guilliermondii. Agar disk-diffusion tests of the susceptibility of non-albicans Candida and other genera of yeast to fluconazole showed resistance in 21.9%, mainly in C. rugosa (100%), C. glabrata (57%) and C. krusei (50%). Local oral factors, such as the presence of dentures, in association with diabetes, seemed to have the effect of increasing the amount and variety of Candida species in the oral cavities, mainly those with lower drug susceptibilities.

[Monitoring of airborne fungus and yeast species in a hospital unit]. / Monitoramento de fungos anemófilos e de leveduras em unidade hospitalar.

OBJECTIVE: To monitor and characterize airborne filamentous fungi and yeasts from abiotic and biotic sources within a hospital unit. METHODS: Collections were carried out on a monthly basis, at two different time periods, from the adult and pediatric intensive care units and surgical center of a hospital in Araraquara, Southeastern Brazil. Collection of airborne fungi was carried out using a simple-stage Andersen sample. The presence of yeasts was investigated in samples taken from the hands and oropharynx of staff members as well as from the surface of beds and doorknobs inside the critical areas. RESULTS: Thirty-two genera of airborne fungi and were recovered from the surgical center and 31 from the intensive care units. Genera most frequently isolated were Cladophialophora spp., Fusarium spp., Penicillium spp., Chrysosporium spp. e Aspergillus spp. During the study period, a new unit was built in the hospital, which coincided with an increase in Cladophialophora spp., Aspergillus spp., and Fusarium spp. colony counts. Yeasts were found in 39.4% of samples obtained from healthcare staff (16.7% from interdigital spaces, 12.1% from nailbeds, and 10.6% from oropharynx) and in 44% of furniture samples, with a predominance of the Candida genus ((C. albicans, C. guilliermondii, C. parapsilosis e C. lusitaniae), followed by Trichosporon spp. CONCLUSIONS: We found a relatively high number of airborne fungi (potentially pathological) in special areas and expressive levels of yeasts in both biotic and abiotic samples. Microbiological and environmental monitoring should be conducted, especially in special areas which include immunocompromised patients, who are more susceptible to the exposure to environmental and staff-derived pathogens.

Monitoramento de fungos anemófilos e de leveduras em unidade hospitalar / Monitoring of airborne fungus and yeast species in a hospital unit

OBJETIVO: Monitorar e caracterizar fungos anemófilos e leveduras de fontes bióticas e abióticas de uma unidade hospitalar. MÉTODOS: As coletas foram realizadas mensalmente e em dois períodos, do centro cirúrgico e unidades de terapia intensiva adulto e neonatal em hospital de Araraquara, Estado de São Paulo. Para coleta de fungos anemófilos foi utilizado amostrador tipo Andersen de simples estágio. A pesquisa de leveduras foi feita das mãos e de orofaringe de profissionais de saúde, bem como de superfícies de leitos e de maçanetas das áreas críticas. RESULTADOS: Foram recuperados do centro cirúrgico 32 gêneros de fungos anemófilos e 31 das unidades de terapia intensiva. Os gêneros mais freqüentemente isolados foram Cladophialophora spp., Fusarium spp., Penicillium spp., Chrysosporium spp. e Aspergillus spp. Durante o período de estudo, houve reforma e implantação de uma unidade dentro do hospital, que coincidiu com o aumento na contagem de colônias de Cladophialophora spp., Aspergillus spp. e Fusarium spp. Leveduras foram encontradas em 39,4 por cento dos profissionais de saúde (16,7 por cento das amostras dos espaços interdigitais, 12,1 por cento do leito subungueal e 10,6 por cento da orofaringe) e, em 44 por cento das amostras do mobiliário, com predomínio do gênero Candida (C. albicans, C. guilliermondii, C. parapsilosis e C. lusitaniae) seguido por Trichosporon spp. CONCLUSÕES: Observou-se número relativamente elevado de fungos anemófilos (potencialmente patogênicos) em áreas especiais e níveis expressivos de leveduras em fontes bióticas e abióticas. O monitoramento microbiológico ambiental deve ser realizado, principalmente em salas especiais com pacientes imunocomprometidos, sujeitos à exposição de patógenos do meio ambiente, assim como, advindos de profissionais de saúde.