Fusariosis cutánea por una especie del complejo Fusarium dimerum en una paciente con leucemia mieloblástica aguda / Cutaneous fusariosis by a species of the Fusarium dimerum species complex in a patient with acute mieloblastic leukemia

Antecedentes. La fusariosis es una hialohifomicosis oportunista, emergente, producida por hongos pertenecientes al género Fusarium. Estos hongos pueden provocar enfermedades que amenazan la vida en pacientes inmunodeficientes, en especial en portadores de leucemia. También se ha descrito en individuos inmunocompetentes, en los que induce lesiones localizadas, no invasivas. En pacientes inmunodeficientes, la fusariosis se asocia a una elevada morbimortalidad, sobre todo debido a la falta de sensibilidad de estos hongos a los antimicóticos disponibles. Caso clínico. Describimos el caso de una paciente con leucemia mieloblástica aguda que experimentó una fusariosis por una especie del complejo Fusarium dimerum. El diagnóstico precoz se estableció en función de la observación microscópica de muestras de las lesiones cutáneas y se prescribió tratamiento con voriconazol. Más tarde, un estudio completo del aislamiento fúngico por cultivo y métodos moleculares permitió la identificación de F. dimerum, una especie apenas descrita como patógeno en el ser humano. La sensibilidad de la cepa se examinó con el método comercializado Sensititre YeastOne®, que reveló su sensibilidad a voriconazol y posaconazol, al igual que a anfotericina B. La paciente falleció a los 7 días del ingreso debido a una insuficiencia hemodinámica. Conclusiones. La identificación completa de nuevos aislamientos de Fusarium y su patrón de sensibilidad a los antimicóticos suscita un gran interés para incrementar nuestros conocimientos sobre la epidemiología de la enfermedad y el tratamiento óptimo de los pacientes(AU)

Fusariosis is an emergent opportunistic hyalohyphomycosis produced by fungi belonging to the genus Fusarium. These molds are capable of producing life-threatening diseases in immunocompromised hosts, especially in those suffering from leukemia. It has also been described in immunocompetent patients, where it usually causes non-invasive localized lesions. Fusariosis in immunocompromised individuals has a high morbidity and mortality mainly because of the low sensitivity of these fungi to the antifungal drugs available. Case report. We describe here the case of a patient with acute mieloblastic leukemia who developed fusariosis by a species of the Fusarium dimerum species complex. The early diagnosis was made on the basis of microscopic observation of samples from cutaneous lesions, and voriconazole treatment was prescribed. A subsequent complete study of the fungal isolate by culture and molecular methods allowed the identification of F. dimerum, a species rarely described as a human pathogen. The sensitivity of the strain was tested using the Sensititre YeastOne® commercial system, which showed sensitivity to voriconazole and posaconazole, as well as to amphotericin B. The patient died after 7 days at hospital due to an hemodynamic failure. Conclusions. Complete identification of new isolates of Fusarium and their antifungal susceptibility patterns is of high interest to improve our knowledge about the epidemiology of the disease and how to best manage patients(AU)

Perfil epidemiológico y patrón de sensibilidad de aislamientos causantes de infección fúngica invasora frente a aislamientos fúngicos de colonización en pacientes críticos no neutropénicos / Epidemiological profile and sensitivity pattern of isolates causing invasive fungal infection vs. colonizing isolates in non-neutropenic critically ill patients

Antecedentes. Los pacientes ingresados en unidades de críticos suelen presentar un importante número de aislamientos fúngicos, responsables, en ocasiones, de infecciones fúngicas invasoras (IFI). Objetivos. Describir el perfil epidemiológico y patrón de sensibilidad antifúngica de los aislamientos fúngicos en nuestra unidad, e identificar los principales factores de riesgo relacionados con el desarrollo de la IFI. Métodos. Se realizó un estudio de cohortes, descriptivo y retrospectivo de pacientes ingresados en una unidad de críticos polivalente de un hospital universitario, con aislamiento al menos de una especie fúngica en cultivo de muestras biológicas, en un periodo de 48 meses. Resultados. Se estudiaron 232 pacientes, de los que 20 desarrollaron IFI. Los sujetos del grupo con IFI presentaron mayor mortalidad y puntuación en la escala de estratificación Candida score 48h previas al diagnóstico clínico. Los factores de riesgo asociados al desarrollo de IFI fueron la existencia de enfermedad pulmonar obstructiva crónica (EPOC), la cirugía digestiva, la nutrición parenteral total y la corticoterapia sistémica prolongada. La especie fúngica predominante en ambos grupos fue Candida albicans, con una resistencia global a fluconazol e itraconazol del 1,94%. Conclusiones. La especies del género Candida no-C. albicans tuvieron una baja incidencia. La tasa de resistencia a azoles para C. albicans fue similar a la de series en similar contexto clínico. Se identifican como factores de riesgo asociados al desarrollo de IFI los antecedentes de cirugía digestiva y de EPOC, así como el tratamiento prolongado con corticoides y la administración de nutrición parenteral(AU)

Background. Patients admitted to critical care units can be infected with a large number of fungal isolates that are occasionally responsible for invasive fungal infections (IFI). Aims. To describe the epidemiological profile and antifungal susceptibility patterns of fungal isolates in our unit, and to identify key risk factors associated with the development of IFI. Methods. A descriptive cohort and retrospective study with patients admitted to a polyvalent Critical Care Unit of a university hospital was carried out. The isolation of at least one fungal species in a culture of biological samples, over a period of 48 months was considered. Results. Twenty patients out of 232 developed IFI. Patients in the IFI group had a higher mortality and higher Candida score value 48h prior to clinical diagnosis. Risk factors associated with the development of IFI were chronic obstructive pulmonary disease, gastrointestinal surgery, total parenteral nutrition, and prolonged systemic corticosteroid therapy. The predominant fungal species in both groups was Candida albicans, with global resistance to fluconazole and itraconazole of 1.94%. Conclusions. We found a low incidence of species of Candida non-C. albicans in our unit. The rate of resistance to azoles in C. albicans was similar to that of larger series. Gastrointestinal surgery, COPD, prolonged treatment with corticosteroids, and parenteral nutrition administration are risk factors associated with the development of IFI(AU)

[Epidemiological profile and sensitivity pattern of isolates causing invasive fungal infection vs. colonizing isolates in non-neutropenic critically ill patients]. / Perfil epidemiológico y patrón de sensibilidad de aislamientos causantes de infección fúngica invasora frente a aislamientos fúngicos de colonización en pacientes críticos no neutropénicos.

BACKGROUND: Patients admitted to critical care units can be infected with a large number of fungal isolates that are occasionally responsible for invasive fungal infections (IFI). AIMS: To describe the epidemiological profile and antifungal susceptibility patterns of fungal isolates in our unit, and to identify key risk factors associated with the development of IFI. METHODS: A descriptive cohort and retrospective study with patients admitted to a polyvalent Critical Care Unit of a university hospital was carried out. The isolation of at least one fungal species in a culture of biological samples, over a period of 48 months was considered. RESULTS: Twenty patients out of 232 developed IFI. Patients in the IFI group had a higher mortality and higher Candida score value 48 h prior to clinical diagnosis. Risk factors associated with the development of IFI were chronic obstructive pulmonary disease, gastrointestinal surgery, total parenteral nutrition, and prolonged systemic corticosteroid therapy. The predominant fungal species in both groups was Candida albicans, with global resistance to fluconazole and itraconazole of 1.94%. CONCLUSIONS: We found a low incidence of species of Candida non-C. albicans in our unit. The rate of resistance to azoles in C. albicans was similar to that of larger series. Gastrointestinal surgery, COPD, prolonged treatment with corticosteroids, and parenteral nutrition administration are risk factors associated with the development of IFI.

Cutaneous fusariosis by a species of the Fusarium dimerum species complex in a patient with acute myeloblastic leukemia.

BACKGROUND: Fusariosis is an emergent opportunistic hyalohyphomycosis produced by fungi belonging to the genus Fusarium. These molds are capable of producing life-threatening diseases in immunocompromised hosts, especially in those suffering from leukemia. It has also been described in immunocompetent patients, where it usually causes non-invasive localized lesions. Fusariosis in immunocompromised individuals has a high morbidity and mortality mainly because of the low sensitivity of these fungi to the antifungal drugs available. CASE REPORT: We describe here the case of a patient with acute mieloblastic leukemia who developed fusariosis by a species of the Fusarium dimerum species complex. The early diagnosis was made on the basis of microscopic observation of samples from cutaneous lesions, and voriconazole treatment was prescribed. A subsequent complete study of the fungal isolate by culture and molecular methods allowed the identification of F. dimerum, a species rarely described as a human pathogen. The sensitivity of the strain was tested using the Sensititre YeastOne(®) commercial system, which showed sensitivity to voriconazole and posaconazole, as well as to amphotericin B. The patient died after 7 days at hospital due to an hemodynamic failure. CONCLUSIONS: Complete identification of new isolates of Fusarium and their antifungal susceptibility patterns is of high interest to improve our knowledge about the epidemiology of the disease and how to best manage patients.

Estudio de consistencia de una metodología para cuantificar la carga viral vaginal del virus de la inmunodeficiencia humana / Reproducibility of a method to quantify vaginal human immunodeficiency virus viral load

Objetivo Estudio de consistencia de un método de obtención y cuantificación de ácidos nucleicos del virus de la inmunodeficiencia humana (VIH) en secreciones vaginales. Métodos Muestras vaginales emparejadas en 52 mujeres con infección del VIH obtenidas por aspiración directa. Cuantificación de ácidos nucleicos mediante Cobas Amplicor HIV-1 Monitor versión 1.5 (Roche Diagnostics, Branchburg, NJ, EE.UU). Monitor modificado con extracción QIAamp Viral RNA kit (Qiagen, Alemania).Resultados Índice de correlación intraclase entre muestras emparejadas: 0,99. Diferencia inferior a 0,40uLog en la cuantificación de ácidos nucleicos totales (ARN+ADN) y ARN viral en el 95% de las muestras (método Bland-Altman).Conclusiones El método utilizado es un procedimiento estandarizado y reproducible que permite cuantificar la carga vaginal de VIH (AU)

Objective To assess the reproducibility of a method to collect and quantify HIV nucleic acids in vaginal secretions. Methods We analysed two consecutive vaginal samples collected by direct aspiration from 52 HIV infected women. Nucleic acids were extracted by QIAamp RNA-viral and quantified with a modified Cobas Amplicor HIV-1 Monitor. Results Intra-class correlation coefficient between matched samples: 0.99. Differences of pooled HIV DNA+RNa and RNA were <0.40uLog for 95% of all samples (Bland-Altman plots).Conclusions This method is a standard and reproducible assay to detect and measure HIV vaginal viral load (AU)

Estudio de consistencia de una metodología para cuantificar la carga viral vaginal del virus de la inmunodeficiencia humana / Reproducibility of a method to quantify vaginal human immunodeficiency virus viral load

Objetivo Estudio de consistencia de un método de obtención y cuantificación de ácidos nucleicos del virus de la inmunodeficiencia humana (VIH) en secreciones vaginales. Métodos Muestras vaginales emparejadas en 52 mujeres con infección del VIH obtenidas por aspiración directa. Cuantificación de ácidos nucleicos mediante Cobas Amplicor HIV-1 Monitor versión 1.5 (Roche Diagnostics, Branchburg, NJ, EE.UU). Monitor modificado con extracción QIAamp Viral RNA kit (Qiagen, Alemania).Resultados Índice de correlación intraclase entre muestras emparejadas: 0,99. Diferencia inferior a 0,40uLog en la cuantificación de ácidos nucleicos totales (ARN+ADN) y ARN viral en el 95% de las muestras (método Bland-Altman).Conclusiones El método utilizado es un procedimiento estandarizado y reproducible que permite cuantificar la carga vaginal de VIH (AU)

Objective To assess the reproducibility of a method to collect and quantify HIV nucleic acids in vaginal secretions. Methods We analysed two consecutive vaginal samples collected by direct aspiration from 52 HIV infected women. Nucleic acids were extracted by QIAamp RNA-viral and quantified with a modified Cobas Amplicor HIV-1 Monitor. Results Intra-class correlation coefficient between matched samples: 0.99. Differences of pooled HIV DNA+RNa and RNA were <0.40uLog for 95% of all samples (Bland-Altman plots).Conclusions This method is a standard and reproducible assay to detect and measure HIV vaginal viral load (AU)

[Reproducibility of a method to quantify vaginal human immunodeficiency virus viral load]. / Estudio de consistencia de una metodología para cuantificar la carga viral vaginal del virus de la inmunodeficiencia humana.

OBJECTIVE: To assess the reproducibility of a method to collect and quantify HIV nucleic acids in vaginal secretions. METHODS: We analysed two consecutive vaginal samples collected by direct aspiration from 52 HIV infected women. Nucleic acids were extracted by QIAamp RNA-viral and quantified with a modified Cobas Amplicor HIV-1 Monitor. RESULTS: Intra-class correlation coefficient between matched samples: 0.99. Differences of pooled HIV DNA+RNa and RNA were <0.40 uLog for 95% of all samples (Bland-Altman plots). CONCLUSIONS: This method is a standard and reproducible assay to detect and measure HIV vaginal viral load.

Susceptibility to tigecycline of isolates from samples collected in hospitalized patients with secondary peritonitis undergoing surgery.

Activity of tigecycline against nosocomial secondary peritonitis isolates collected along 18 months in 29 Spanish hospitals was tested by Etest in a central laboratory, considering Food and Drug Administration (FDA)/British Society for Antimicrobial Chemotherapy (BSAC)/European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints. A total of 600 facultative/aerobic isolates (392 Gram negative, 208 Gram positive) and 100 anaerobes were tested. None of the 220 Escherichia coli isolates was resistant to tigecycline (MIC(50)/MIC(90) = 0.25/0.5 microg/mL), with 0.5% (FDA breakpoint) and 3.6% (BSAC/EUCAST breakpoint) intermediate strains. All Extended-spectrum beta-lactamase (ESBL)-producing E. coli isolates (15 strains), all Klebsiella pneumoniae, and Klebsiella oxytoca isolates (42 strains) were susceptible to tigecycline. No isolates resistant to tigecycline were found among Streptococcus viridans, Staphylococcus aureus, and Enterococcus faecium, but 18.9% of Enterococcus faecalis strains were intermediate following BSAC/EUCAST breakpoints. All (but 1) isolates of the Bacteroides fragilis group (n = 45) were tigecycline susceptible, as well as Gram-positive anaerobes. Tigecycline offers an adequate activity profile against isolates from secondary peritonitis when tested by Etest regardless of the breakpoints used for categorization.

Immunovirologic consequences and safety of short, non-structured interruptions of successful antiretroviral treatment.

OBJECTIVES: The aim was to evaluate the safety of short antiretroviral treatment interruptions and their virologic and immunologic consequences in HIV-infected adults on highly active antiretroviral treatment (HAART) with suppressed viral replication. The viral efficacy upon reintroduction was also evaluated. PATIENTS AND METHODS: All patients with undetectable viral load while on HAART were prospectively followed to detect any treatment interruption. We analysed viral and cellular kinetics, incidence of resistance mutations, clinical outcome and results after therapy resumption. RESULTS: Twenty patients were included, mean time since HIV diagnosis was 95 months and time with undetectable viral load 16 months. Treatment was interrupted because of adverse effects, cancer, tuberculosis or patient will. Treatment was reintroduced after 4 weeks using, if possible, the same combination. HIV viral load was detectable on day 28 after interruption in 18 patients (90%). Median of CD4 cell count (p25-p75) decreased from 478/mm3 (96-716) to 257/mm3 (118-663) (p=0.5). Resistance mutations were found in 9 patients (45%) after interruptions. Treatment was reintroduced in 14 patients; all of them achieved viral suppression. CONCLUSIONS: In patients receiving HAART who have undetectable viral load, an interruption, no longer than 4 weeks, due to any intercurrent problem seems to be safe. Response to resumption can usually be achieved. Due to the frequent development of resistance, a genotypic test during interruption might be helpful.