Coinfección pulmonar por Aspergillus y citomegalovirus tras tratamiento corticoideo crónico / Coinfection pulmonary by Aspergillus and Citomegalovirus after chronic corticosteroid treatment

Presentamos el caso clínico de una paciente en tratamiento corticoideo crónico que desarrolla infección pulmonar por citomegalovirus y Aspergillus. Tras el ingreso la paciente presenta empeoramiento radiológico y clínico, por lo que ante la posibilidad de infecciones oportunistas dado el tratamiento previo con corticoides a dosis altas de forma prolongada se decide el inicio con antimicrobianos de amplio espectro, con cobertura para hongos, virus y bacterias. Posteriormente, la estabilización de la paciente permitió la realización de pruebas diagnósticas confirmando una coinfección por Aspergillus fumigatus y citomegalovirus, con lo que se pudo realizar un tratamiento dirigido tras el cual la paciente presenta recuperación completa tanto clínica como radiológica, sin complicaciones por toxicidades farmacológicas. Aunque algunos autores dudan sobre el uso de varios antimicrobianos de forma empírica debido a las posibles toxicidades, en situaciones urgentes sin diagnostico con sospecha de patología oportunista puede ser necesaria su cobertura

We present the clinical case of a patient in chronic corticosteroid treatment who develops lung infection with Cytomegalovirus and Aspergillus. After admission, the patient presented with radiological and clinical worsening, with the suspect of opportunistic infections because of previous prolonged treatment with high doses of corticosteroids, we decided to start with broad-spectrum antimicrobials, covering fungi, viruses and bacteria. Subsequently, the stabilization of the patient allowed the performing of diagnostic tests wich confirming a coinfection by Aspergillus fumigatus and Cytomegalovirus, making possible to carry out a directed treatment after which the patient presented complete recovery both clinical and radiological, without complications due to pharmacological toxicities. Although some authors doubt about the use of multiples antimicrobials drugs at the same time empirically due to the possible toxicities, in emergency without diagnosis and suspected opportunistic pathology their coverage may be necessary

Effect of microwave heating during alkaline-cooking of aflatoxin contaminated maize.

UNLABELLED: To evaluate the effectiveness of maize detoxification achieved with a modified tortilla-making process (MTMP), maize contaminated with aflatoxin B(1) (AFB(1)) and aflatoxin B(2) (AFB(2)) at levels of 22.46, 69.62, and 141.48 ng/g (AFB(1)+ AFB(2)) was processed into tortillas. Aflatoxin content was determined according to the 991.31 AOAC official method. Based on the results obtained with spiked samples (0.78 to 25 ng/g), the mean recovery was 92%, with a standard error of 1.2, and a coefficient variation value of 4.4%. The MTMP caused 68, 80, and an 84% decrease in aflatoxin content, respectively. Extract acidification (as occurs during digestion) prior to mycotoxin quantification caused some reformation of the aflatoxin structure in tortillas (up to 3%). According to these results, the MTMP seems to be safe for decontamination since a low percentage of the initial aflatoxin concentration can be reverted to the original fluorescent form upon acidification. PRACTICAL APPLICATION: The potential presence of aflatoxins in maize destined for human consumption is a serious problem to the Mexican food supply, as these toxic compounds may persist during the traditional alkaline-process for tortilla elaboration. Consequently, new detoxification procedures are needed that eliminate or at least minimize the aflatoxin risk, through lowering aflatoxin concentration in maize-based products. Under these considerations, the use of MTMP is recommended, since it has definite advantages including non-production of wastewater and reduced energy/time consumption.

Biodetoxification of aflatoxin-contaminated chick feed.

Two studies were done to study detoxification of aflatoxin (AF)-contaminated chick feed with Nocardia corynebacteroides (NC). In the first study, pathogenicity of the bacteria was studied; in the second, the nutritional value of detoxified feed was evaluated. Commercial corn was divided into 2 sublots, one of which was contaminated with AF. Both lots were divided into 2 parts; the first was inoculated with NC. Four corn-soybean diets were prepared from the 4 corn lots. A completely randomized design was used with 2 x 2 factorial arrangement in which the factors were AF contaminated or not and NC inoculated or not. One hundred Ross 308 chicks (1-d-old, male) were used in 4 treatments with 5 repetitions and 5 chickens per cage. Bird weight and feed consumption were recorded weekly. Each week, 1 chick per treatment repetition was killed for histopathologic analysis of liver, kidney, bursa of Fabricius, pancreas, and small intestine (duodenum, jejunum, and ileum) and for analysis by scanning electron microscopy of the 3 sections of the intestine. At 21 d (the end of both experiments), 1 chick per treatment repetition was killed, and moisture, lipid content, and residual AF in liver were detected. Results at 3 wk did not show differences between treatments (P > 0.05) in any of the variables. In the second study, the same methodology was used except that greater levels of AF were used (800 and 1,200 mug of AFB1/kg of feed). Results showed differences (P < 0.05) in body weight, lipid content, and residual AF in liver. Histopathologic studies showed statistical differences in lesion severity in liver, duodenum, and kidney. Scanning electron microscopy analysis showed severe lesions of intestinal mucosa that mainly affected tight junctions in AF treatments. It can be concluded that NC is safe for chicks and may be used to partly detoxify chicken feed contaminated with AF.

Effect of lactic and citric acid on the stability of B-aflatoxins in extrusion-cooked sorghum.

AIMS: To evaluate the effect of the extrusion-cooking process with the addition of different acids concentration on the stability of B-aflatoxins in sorghum. METHODS AND RESULTS: Experimental units (EU) of sorghum flour contaminated with B-aflatoxins (140 ppb) were extrusion cooked with aqueous lactic or citric acid at six different concentrations. The effects of the two extrusion variables (moisture content and acid concentration) were analysed as a completely randomized factorial 3 x 6 design. Under some conditions, the aflatoxin reduction is more effective when using aqueous citric acid (up to 92%), than when using aqueous lactic acid (up to 67%). CONCLUSIONS: With citric acid, some extrusion treatments produced higher aflatoxin degradation rates, than those produced with lactic acid. SIGNIFICANCE AND IMPACT OF THE STUDY: Aflatoxin contamination is a great risk both for human as well as for animal health in underdeveloped countries; consequently, practical and economical detoxification procedures are needed that eliminate or at least minimize the aflatoxin risk, through lowering aflatoxin concentrations in grains. Under these considerations, extrusion process can be used for reduction in the aflatoxin content in contaminated grains.

Safety and efficacy evaluation of aqueous citric acid to degrade B-aflatoxins in maize.

Chemical inactivation of aflatoxin B1 (AFB1) and aflatoxin B2 (AFB2) in maize grain by means of 1N aqueous citric acid was confirmed by the AFLATEST immunoaffinity column method, high performance liquid chromatography (HPLC), and the Ames test (Salmonella-microsomal screening system). The AFLATEST assay showed that aflatoxins in the maize grain with an initial concentration of 29 ng/g were completely degraded and 96.7% degradation occurred in maize contaminated with 93 ng/g when treated with the aqueous citric acid. Aflatoxin fluorescence strength of acidified samples was much weaker than untreated samples as observed in HPLC chromatograms. On the other hand, the Ames test results indicated that the mutagenic activity of acidified samples was greatly reduced compared with that of untreated samples based on his- --> his+ reversions in the Salmonella TA100 strain. Chemical inactivation appears to be a promising method of removing aflatoxin from food commodities.

Aflatoxins in pozol, a nixtamalized, maize-based food.

To determine whether pozol, a nixtamalized maize-based food was contaminated with aflatoxins, samples of non-fermented pozol were collected during the period November 2002 to April 2003 from local markets at Comitan in Chiapas, Mexico. The samples were analyzed for the presence of aflatoxins. Nineteen out of one hundred and eleven samples were contaminated with aflatoxin B2 (AFB2) and traces of aflatoxin B1 (AFB1). The percentage of samples contaminated with AFB2 in pozol prepared with white maize was 5.4%. Pozol mixed with toasted cacao paste had a contamination rate of 41.5%. No aflatoxins were detected in pozol prepared with yellow maize. It was found that only 1 of 19 contaminated samples had aflatoxin concentrations above 20 ppb.

[Effects of cooking and steep time of nixtamalized corn grain (sea mayz L.) on the physicochemical, rheological, structural and textural characteristics of grain, mass and tortillas]. / Efecto del tiempo de cocimiento y reposo del grano de maíz (Zea mayz L.) nixtamalizado, sobre las características fisicoquímicas, reológicas, estructurales y texturales del grano, masa y tortillas de maíz.

The corn tortilla is elaborated using corn grain masa processed by the traditional nixtamalization method, which consists of two steps: cooking and steeping. In these steps the physicochemical and structural properties are strongly affected, resulting in changes in the textural characteristics of the tortilla produced. In this work the effects of cooking and steeping time on the moisture content, amylographic profiles, crystallinity, weigh loss from masa to tortilla, starch damage, rollability, elasticity and cutting force for grain, masa and corn tortillas, were evaluated. The milling of the nixtamalized grain and the cooking of tortilla conditions were the same in all treatments. All tortillas samples showed a good rollability. The results show that the moisture content of corn grain was increased up to 42 g/100 g during the total cooking time (45 min), and it further increased to 52-53 g/100 g after when the cooked grain was steeped for 4 h. All evaluated parameters showed high correlation coefficients with the texture properties of tortillas. The starch damage was the variable with the best correlation among all evaluated parameters. The correlation coefficients between starch damage and moisture content, weigh loss and maximum viscosity for corn grain, masa and tortillas were larger than 0.92 (p < 0.01). The best tortillas were produced using nixtamal with the follow characteristics: moisture content of nixtamal, 42-44 g/100 g and tortilla, 43-44 g/100 g; adhesiveness of masa, 30-50 g; maximum viscosity of nixtamal, 860-880 cp and tortilla 490-510 cp; starch damage of nixtamal, 14 g/100 g and tortilla, 35-37 g/100 g, and weigh loss of tortilla during cooking, 16 g/100 g.