Molecular characterisation and antifungal susceptibility of clinical Cryptococcus deuterogattii (AFLP6/VGII) isolates from Southern Brazil.

Cryptococcosis, caused by Cryptococcus gattii sensu lato, is an emerging disease that was initially found in (sub)tropical regions but recently expanded to temperate regions. Cryptococcus gattii s.l. infections are mostly encountered in healthy individuals, frequently affecting both lungs and the central nervous system (CNS). Usually, C. gattii s.l. is less susceptible to antifungal compounds than its counterpart, C. neoformans s.l. We studied 18 clinical C. gattii s.l. isolates with amplified fragment length polymorphism (AFLP) fingerprinting, mating-typing, multi-locus sequence typing (MLST) and antifungal susceptibility testing. All isolates were C. deuterogattii (genotype AFLP6/VGII), 14 were mating-type α and four were type a. Amphotericin B, itraconazole, voriconazole, posaconazole and isavuconazole showed high activity, with minimum inhibitory concentration (MIC) ranges of 0.063-0.25, 0.031-0.25, 0.031-0.25, 0.031-0.25 and <0.016-0.25 µg mL-1, respectively. Fluconazole and flucytosine had high geometric mean MICs of 2.07 and 3.7 µg mL-1, respectively. Most cases occurred in immunocompetent patients (n = 10; 55.6 %) and CNS involvement was the most common clinical presentation (n = 14; 77.8 %). Three patients (16.7 %) showed sequelae, hyperreflexia, dysarthria, diadochokinesia, anosmia and upper limb weakness. In conclusion, all infections were caused by C. deuterogattii (AFLP6/VGII) and the majority of patients were immunocompetent, with the CNS as the most affected site. All antifungal drugs had high in vitro activity against C. deuterogattii isolates, except fluconazole and flucytosine.

Occurrence of Candida orthopsilosis in Brazilian tomato fruits (Lycopersicum esculentum Mill.).

We aimed to isolate and identify yeasts found in the tomato fruit in order to obtain isolates with biotechnological potential, such as in control of fungal diseases that damage postharvest fruits. We identified Candida orthopsilosis strains LT18 and LT24. This is the first report of this yeast on Lycopersicum esculentum fruits in Brazil.

Occurrence of Candida orthopsilosis in Brazilian tomato fruits (Lycopersicum esculentum Mill)

We aimed to isolate and identify yeasts found in the tomato fruit in order to obtain isolates with biotechnological potential, such as in control of fungal diseases that damage postharvest fruits. We identified Candida orthopsilosis strains LT18 and LT24. This is the first report of this yeast on Lycopersicum esculentum fruits in Brazil.

Central nervous system Aspergillus fumigatus infection after near drowning.

AIMS: To report the case of a 26 year old white man, who developed chronic meningitis and intracerebral granulomata 15 days after an episode of near drowning in a swamp. METHODS: Aspergillus fumigatus was isolated from cerebrospinal fluid cultures. RESULTS: The patient died 70 days after the symptoms were first noticed, and seven days after a subarachnoid haemorrhage. Aspergillus has never been reported before as a cause of intracranial infection after near drowning. CONCLUSIONS: Physicians must be aware of this possibility when confronted with such a situation, because there are now effective therapeutic options for systemic aspergillosis.

Infection of the CNS by Scedosporium apiospermum after near drowning. Report of a fatal case and analysis of its confounding factors.

This report describes a fatal case of central nervous system pseudallescheriasis. A 32 year old white man presented with headache and meningismus 15 days after nearly drowning in a swine sewage reservoir. Computerised tomography and magnetic resonance imaging of the head revealed multiple brain granulomata, which vanished when steroid and broad spectrum antimicrobial and antifungal agents, in addition to dexamethasone, were started. Cerebrospinal fluid analysis disclosed a neutrophilic meningitis. Treatment with antibiotics and amphotericin B, together with fluconazole and later itraconazole, was ineffective. Miconazole was added through an Ommaya reservoir, but was insufficient to halt the infection. Pseudallescheria boydii was finally isolated and identified in cerebrospinal fluid cultures, a few days before death, three and a half months after the symptoms began. Diagnosis was delayed because of a reduction in the lesions after partial treatment, which prevented a stereotactic biopsy. Physicians should be aware of this condition, and provide prompt stereotactic biopsy. Confirmed cases should perhaps be treated with voriconazole, probably the most effective, currently available treatment for this agent.

[Preservation of the liver using a new solution of phosphate-buffered saccharose]. / Preservação do fígado com uma nova solução de sacarose tamponada com fosfato.

The efficacy of the new phosphate-buffered sucrose solution (PBS), was compared with the conventional Euro-Collins (EC) and the lactated Ringer solution (LR), in its capacity to preserve the canine liver in cold storage. Three groups of 6 canine livers, each group in one of those solutions, were put in cold storage for 24 h at 4 degrees centigrade. At the end of this period the effect of warm hepatic reperfusion was studied in relationship with the following parameters: weight of the liver, bile excretion, hepatic biopsy, Na, K, Ca, P and some tests used to evaluate the hepatic function. The results obtained confirm, that PBS has an important impermeant effect over the hepatocyte, simulating that described recently by Lam et al to the kidney. Contrary to the EC and LR, the PBS inhibits hypothermic cell swelling, is more effective in the preservation of the liver histology, and has an opposed effect to the weight gain tendency induced by cold storage. During the period of warm reperfusion, high volumes of bile excretion and lesser levels of K depletion were observed in the PBS model. PBS is easy to prepare, and it is not expensive. For these reasons PBS could be an advantageous substitute of the EC in liver preservation.

[Hyponatremia--new concepts and therapy. Apropos of a clinical case]. / Hiponatrémia--novos conceitos e terapêutica. A propósito de um caso clínico.

The therapeutic approach of hyponatremia is reviewed, and the authors describe their recent experience of a clinical case of a woman with acute hyponatremia. After analysing the main publications of the last years, they conclude that the way of correcting hyponatremia largely depends of its acute or chronic character. Chronic hyponatremia must be corrected with slow rate infusion of sodium chloride (0.5 mmol/l/h), and acute hyponatremia with a rapid (2 mmol/l/h) or intermediate (1-1.5 mmol/l/h) rate of infusion of the same solution. This is the current advisable approach, until a new better orientation will virtually be clarified by further prospective studies.

[Oral contraceptives and arterial hypertension]. / Contraceptivos orais e hipertensão arterial.

PIP: Arterial hypertension (AH) was reported for the 1st time as a side effect 5 years after the introduction of oral contraceptives (OCs) in the early 1960s. Most of the information associated with the risks of OC use was derived from the UK Royal College of General Practitioner's (RCGP) Oral Contraception Study of 1968, the UK Oxford/Family Planning Associates Contraceptive Study of 1968, and the US Walnut Creek/Kaiser Permanente Study of 1968 and 1977. These studies showed that AH and the risk of cardiovascular morbidity and mortality was significantly higher in women over 35 and who smoked because of the increased estradiol metabolism. In the 1960s the estrogen content in OCs was 50-150 mcg and the prostagen content was 10-10 mg. An average of 50 mcg estrogen and 1.5 mg of progestogen has been used since 1969. Low dose preparations in use since 1973 contain 30 mcg of estrogen and an equal dose of progestogen. The RCGP study of 1977 implicated norethisterone acetate (1, 3, and 4 mg used with 50 mcg of ethinyl estradiol EE), a progestogen, in hypertension. In a study of 78 women 15 were using an OC with 30 mcg of EE with 150 or 250 mcg of norgestrel and 63 women used a pill with 50 mcg of EE or mestranol with 1, 3, or 4 mg of norethisterone. The lower EE dose produced higher arterial pressure attributable to norgestrel. In 9 women taking OCs with 30 mcg of EE blood pressure dropped in a 1978 study of 50 women taking such low-dose pills, while the pressure increased in 100 other women taking on OC with 50 mcg of EE. Most relevant studies indicated a dose-response or type-response relationship between the progestogen component and arterial pressure. The estrogen component was also a major factor in OC-induced AH. The data implicate the involvement of the renin-angiotensin-aldosterone system, the direct effects of mineralocorticoids, and the adrenergic nervous system in the etiology of high blood pressure under OC use.^ieng