[Clinical problems in Medical Mycology: Problem number 56]. / Problemas clínicos en Micología Médica: problema número 56.

We present the case of a twenty six year-old woman with rheumatoid arthritis, treated with certolizumab. She sought medical attention due to cough, fever and night sweats. X-ray exam showed a miliary pneumonia. She was treated for tuberculosis and 50days later she presented with aphasia. Magnetic nuclear resonance revealed brain lesions. Histoplasma capsulatum PCR test and urinary antigen were positive, so an antifungal treatment with voriconazole was started. Visual adverse effects forced to change the antifungal schedule in both the length of treatment and the antifungal drug. With this measure the patient progressed favorably. The test of urinary Histoplasma capsulatum antigen and PCR amplification were key to make a diagnosis and also for a follow-up.

Disaster mycology / Micología de desastres

Natural and human-made disasters have long played a role in shaping the environment and microbial communities, also affecting non-microbial life on Earth. Disaster microbiology is a new concept based on the notion that a disaster changes the environment causing adaptation or alteration of microbial populations -growth, death, transportation to a new area, development traits, or resistance- that can have downstream effects on the affected ecosystem. Such downstream effects include blooms of microbial populations and the ability to colonize a new niche or host, cause disease, or survive in former extreme conditions. Throughout history, fungal populations have been affected by disasters. There are prehistoric archeological records of fungal blooms after asteroid impacts and fungi implicated in the fall of the dinosaurs. In recent times, drought and dust storms have caused disturbance of soil fungi, and hurricanes have induced the growth of molds on wet surfaces, resulting in an increased incidence of fungal disease. Probably, the anticipated increase in extreme heat would force fungi adaptation to survive at high temperatures, like those in the human body, and thus be able to infect mammals. This may lead to a drastic rise of new fungal diseases in humans.

Los desastres naturales o los causados por el hombre impactan la formación de ecosistemas y comunidades microbianas, y también afectan las formas de vida no microbianas. Este concepto es conocido como "microbiología de desastres", una subespecialización de la microbiología, basada en los cambios ambientales generados por un desastre y las posibles adaptaciones o alteraciones de las poblaciones microbianas ­crecimiento, muerte, trasporte a una nueva región, o adquisición de resistencia o de nuevas características­ que influirán en el moldeamiento del ecosistema transformado. Algunos de los efectos de estas adaptaciones pueden ser: el surgimiento de poblaciones microbianas, la habilidad de colonizar nuevos nichos u huéspedes, la generación de nuevas enfermedades, o el crecimiento de microorganismos en condiciones que antes eran "extremas" para ellos. A lo largo de la historia, varias poblaciones de hongos han sido afectadas por desastres. Existen registros arqueológicos prehistóricos que evidencian la presencia y el crecimiento de hongos luego del impacto de asteroides, y otros de hongos relacionados con la extinción de los dinosaurios. Actualmente, las sequías y las tormentas de polvo causan perturbaciones en las comunidades de hongos del suelo, y los huracanes inducen el crecimiento de hongos filamentosos en superficies húmedas, lo que aumenta la cantidad de enfermedades por hongos. Además, con el aumento de las temperaturas extremas es posible que los hongos puedan adaptarse para sobrevivir a temperaturas más altas, equivalentes a las temperaturas corporales, y nuevas especies puedan infectar mamíferos. Esto puede llevar a un aumento drástico de las infecciones fúngicas en humanos.

Palynology and mycology as biological evidence in a homicide case.

Criminal cases are studied from several disciplines to link a suspect with a criminal act. In this case, a man was reported missing in a coastal area in Buenos Aires Province, Argentina. The victim's relatives pointed to a possible suspect, and the local police carried out the investigation. We contributed to this research by applying palynological and mycological techniques. Palynomorphs and fungal spores offer valuable trace evidence, as they can be easily transferred between objects and crime scenes due to their minute size and persist on them for a long time. The victim was found 25 days later, lying on sandy soil, which partially covered the body, 35 km from where the suspect was arrested. Comparative samples were collected from the crime scene and the suspect's home and belongings (clothes, footwear, and seized vehicle). The palynological associations obtained from the crime scene and the defendant's belongings were dominated by diatoms and acritarchs (Acantomorphitae), all elements of marine origin, and a high CFU number of Bipolaris cynodontis, which allowed the defendant's clothing to be related to the place of corpse discovery. Soil from the defendant's home had an entirely continental composition, and the fungal biota was characteristic of prairie areas which were different from those of the crime scene.

Micheli y el género Aspergillus / Micheli and genus Aspergillus

Pier Antonio Micheli nació en Florencia, Italia, en el año 1697. Fue un destacado científico, botánico y se le considera el padre de la micología. Dedicó su vida a la taxonomía y al estudio de especies no conocidas de plantas, hongos y líquenes. En 1729 publicó el libro Nova Plantarum Genera, donde describió 1900 plantas, entre las que se encontraban 900 hongos y líquenes. Aquí describió especies de hongos como Botrytis, Mucor y Aspergillus, las cuales tienen importancia en patología médica, animal y vegetal hasta el día de hoy. Murió el 1 de enero de 1737, en su natal Florencia, de una enfermedad pulmonar cuya causa no está bien clara. El legado de Micheli sigue presente y constituye un ejemplo para todos aquellos que se dedican al difícil arte de la taxonomía en sus distintas áreas y en especial a la micología

Pier Antonio Micheli was born in Florence, Italy, in 1697. He was a prominent scientist, botanist and is considered the father of mycology. He dedicated his life to taxonomy and the study of unknown species of plants, fungi, and lichens. In 1729 he published the book Nova Plantarum Genera, where he described 1900 plants, including 900 fungi and lichens. There he described fangal species such as Botrytis, Mucor and Aspergillus, wich are of importance in medical, animal, and plant pathology to this day. He died on January 1, 1737, in his native Florence, due to a lung disease whose cause is unclear. Micheli's legacy is still present, constituting an example for all those who are dedicated to the difficult art of taxonomy in its different areas, especially to mycology.

Professor Luiz R. Travassos and the study of surface structures of fungal pathogens.

Brazilian medical mycology considerably expanded in the last decades due to the efforts of several pioneers who started and expanded mycology during the twentieth century. In this manuscript, we highlight some of the contributions of one of these pioneers: Professor Luiz R. Travassos, who started his career in the field of microbiology in the 1960s. We will discuss his contributions to the areas of medical mycology and glycobiology, with a focus on glycosphingolipids, sialic acids, and surface enzymes.

Brote de tinea capitis tricofítica en un grupo de niños escolares en un área rural del departamento del Cauca, Colombia / An outbreak of trichophytic tinea capitis in a group of schoolchildren in a rural area of the department of Cauca, Colombia

Introducción. La tiña de la cabeza es una micosis que se presenta en el tejido queratinizado, afecta al cuero cabelludo y puede causar alopecia, prurito y descamación. Este tipo de micosis es más frecuente en niños de edad escolar, por lo que puede desencadenar un problema de salud pública. En Colombia, los principales agentes etiológicos reportados son los dermatofitos zoofílicos. Objetivo. En el presente estudio se buscó caracterizar un brote de tinea capitis en 32 niños de un colegio de la zona rural del departamento del Cauca. Materiales y métodos. Se llevó a cabo una investigación epidemiológica de campo en la que se aplicó una encuesta estructurada para caracterizar aspectos sociodemográficos y factores predisponentes para su ocurrencia. Se recolectaron muestras de escamas de cuero cabelludo y cabellos afectados para estudios micológicos. Finalmente, por medio de la Secretaría Departamental del Cauca y del hospital local, se manejó el brote de tinea capitis y se hicieron recomendaciones a los niños, los padres de familia y la población en general para prevenir estas micosis. Este estudio contó con el consentimiento informado verbal por parte de los padres de familia y los niños. Resultados. El agente etiológico aislado en el 63 % de las muestras recolectadas fue Trichophyton tonsurans y el principal factor predisponente para esta micosis fue compartir máquinas rasuradoras (87,5 %). El agente etiológico de este brote de tinea capitis no inflamatoria fue un dermatofito antropofílico. Conclusión. Idealmente, se deben practicar los estudios micológicos con el fin de establecer el agente etiológico y, así, plantear las terapéuticas y recomendaciones según las guías de manejo. Además, se debe realizar un trabajo multidisciplinario para el control del brote y la educación de la población respecto a esta micosis.

Introduction. Tinea capitis is a mycosis of keratinized tissue, which affects the scalp and may cause alopecia, pruritus, and desquamation. This type of mycosis is more frequent in school-age children, and it may represent a public health problem; the main etiological agents reported for Colombia are zoophilic dermatophytes. Objective. To characterize an outbreak of Tinea capitis in 32 children from a rural school in the department of Cauca. Materials and methods. We conducted an epidemiological field study using a structured survey to characterize sociodemographic aspects and predisposing factors for this mycosis. We collected samples of affected scalp scales and hair for mycological studies. The children and the general population received recommendations, about these mycoses' prevention, from Cauca's health authorities and the local hospital. The parents verbally approved the informed consent. Results. The etiological agent isolated in 63% of the collected samples was Trichophyton tonsurans, an anthropophilic dermatophyte, and the main predisposing factor was sharing razors (87.5%). Conclusions. Ideally, mycological studies define the etiological agent to propose therapeutics and recommendations in agreement with management guidelines. Implementation of multidisciplinary measures to control the outbreak and educate the population is required.

Disaster mycology / Micología de desastres

Natural and human-made disasters have long played a role in shaping the environment and microbial communities, also affecting non-microbial life on Earth. Disaster microbiology is a new concept based on the notion that a disaster changes the environment causing adaptation or alteration of microbial populations-growth, death, transportation to a new area, development traits, or resistance-that can have downstream effects on the affected ecosystem. Such downstream effects include blooms of microbial populations and the ability to colonize a new niche or host, cause disease, or survive in former extreme conditions. Throughout history, fungal populations have been affected by disasters. There are prehistoric archeological records of fungal blooms after asteroid impacts and fungi implicated in the fall of the dinosaurs. In recent times, drought and dust storms have caused disturbance of soil fungi, and hurricanes have induced the growth of molds on wet surfaces, resulting in an increased incidence of fungal disease. Probably, the anticipated increase in extreme heat would force fungi adaptation to survive at high temperatures, like those in the human body, and thus be able to infect mammals. This may lead to a drastic rise of new fungal diseases in humans.

Los desastres naturales o los causados por el hombre impactan la formación de ecosistemas y comunidades microbianas, y también afectan las formas de vida no microbianas. Este concepto es conocido como "microbiología de desastres", una subespecialización de la microbiología, basada en los cambios ambientales generados por un desastre y las posibles adaptaciones o alteraciones de las poblaciones microbianas -crecimiento, muerte, trasporte a una nueva región, o adquisición de resistencia o de nuevas características- que influirán en el moldeamiento del ecosistema transformado. Algunos de los efectos de estas adaptaciones pueden ser: el surgimiento de poblaciones microbianas, la habilidad de colonizar nuevos nichos u huéspedes, la generación de nuevas enfermedades, o el crecimiento de microorganismos en condiciones que antes eran "extremas" para ellos. A lo largo de la historia, varias poblaciones de hongos han sido afectadas por desastres. Existen registros arqueológicos prehistóricos que evidencian la presencia y el crecimiento de hongos luego del impacto de asteroides, y otros de hongos relacionados con la extinción de los dinosaurios. Actualmente, las sequías y las tormentas de polvo causan perturbaciones en las comunidades de hongos del suelo, y los huracanes inducen el crecimiento de hongos filamentosos en superficies húmedas, lo que aumenta la cantidad de enfermedades por hongos. Además, con el aumento de las temperaturas extremas es posible que los hongos puedan adaptarse para sobrevivir a temperaturas más altas, equivalentes a las temperaturas corporales, y nuevas especies puedan infectar mamíferos. Esto puede llevar a un aumento drástico de las infecciones fúngicas en humanos.

Micólogas en Chile: la desconocida historia de grandes científicas del siglo XX / Mycologists in Chile: the unknown story of great women scientists of the 20th century

La mayoría de las mujeres que realizan ciencia en Chile y en otros países, son mujeres invisibles para la sociedad. Muchas mujeres que realizaron grandes esfuerzos para estudiar una carrera científica a la que dedicaron toda su vida, son olvidadas al momento de su retiro o de su muerte. Esto incluye a micólogas que vivieron o estuvieron de paso en nuestro país en el siglo XX y que realizaron grandes aportes al conocimiento de esta disciplina, comúnmente conocida como el estudio de los hongos y de especies afines. En esta revisión bibliográfica, se dan a conocer algunos nombres de las micólogas o de científicas que contribuyeron de manera significativa al desarrollo de la Micología Chilena durante el siglo XX, época donde en nuestro país la Micología era más desarrollada por hombres que por mujeres. Gran parte de las micólogas que mencionamos han fallecido, pero no por ello debemos olvidar quiénes fueron, al contrario, es importante conocer su historia que podría ser inspiradora para las próximas generaciones de mujeres micólogas en nuestro país. (AU)

Una experiencia de siete años en el laboratorio de Micología del Hospital de Pediatría Juan P. Garrahan / A seven-year experience in the Mycology Laboratory of Hospital de Pediatría Juan P. Garrahan

En noviembre del año 2015 nos incorporamos al Laboratorio de Micología del Servicio de Microbiología del Hospital Garrahan. En este breve resumen queremos compartir los avances logrados a través de nuestra experiencia durante siete años de trabajo profesional. Debido a los diagnósticos realizados y su complejidad, consideramos que el Hospital Garrahan, sus pacientes y la comunidad toda necesitan contar con un laboratorio de Micología que responda a sus necesidades. Creemos haber iniciado un camino que esperamos continúe y culmine con la creación de la Unidad de Micología (AU)

In November 2015 we joined the Mycology Laboratory of the Microbiology Service of the Hospital Garrahan. In this brief summary we want to share the advances achieved through our experience during seven years of professional work. Due to the diagnosis made and their complexity, we believe that the Hospital Garrahan, its patients and the entire community, need to have a Mycology laboratory that responds to their requirements. We believe we have started a path that we hope will continue and culminate with the creation of the Mycology Unit (AU)

The current state of clinical mycology in Africa: a European Confederation of Medical Mycology and International Society for Human and Animal Mycology survey.

Africa, although not unique in this context, is a favourable environment for fungal infections, given the high burden of risk factors. An online survey was developed asking about laboratory infrastructure and antifungal drug availability. We received 40 responses (24·4% response rate) of 164 researchers contacted from 21 African countries. Only five institutions (12·5%) of 40 located in Cameroon, Kenya, Nigeria, Sudan, and Uganda potentially fulfilled the minimum laboratory requirements for European Confederation of Medical Mycology Excellence Centre blue status. Difficulties included low access to susceptibility testing for both yeasts and moulds (available in only 30% of institutions) and Aspergillus spp antigen detection (available in only 47·5% of institutions as an in-house or outsourced test), as well as access to mould-active antifungal drugs such as amphotericin B deoxycholate (available for 52·5% of institutions), itraconazole (52·5%), voriconazole (35·0%), and posaconazole (5·0%). United and targeted efforts are crucial to face the growing challenges in clinical mycology.

Mass spectrometry in research laboratories and clinical diagnostic: a new era in medical mycology.

Diagnosis by clinical mycology laboratory plays a critical role in patient care by providing definitive knowledge of the cause of infection and antimicrobial susceptibility data to physicians. Rapid diagnostic methods are likely to improve patient. Aggressive resuscitation bundles, adequate source control, and appropriate antibiotic therapy are cornerstones for success in the treatment of patients. Routine methods for identifying clinical specimen fungal pathogen are based on the cultivation on different media with the subsequent examination of its phenotypic characteristics comprising a combination of microscopic and colony morphologies. As some fungi cannot be readily identified using these methods, molecular diagnostic methods may be required. These methods are fast, but it can cost a lot. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) is suitable for high-throughput and rapid diagnostics at low costs. It can be considered an alternative for conventional biochemical and molecular identification systems in a microbiological laboratory. The reliability and accuracy of this method have been scrutinized in many surveys and have been compared with several methods including sequencing and molecular methods. According to these findings, the reliability and accuracy of this method are very high and can be trusted. With all the benefits of this technique, the libraries of MALDI-TOF MS need to be strengthened to enhance its performance. This review provides an overview of the most recent research literature that has investigated the applications and usage of MT-MS to the identification of microorganisms, mycotoxins, antifungal susceptibility examination, and mycobiome research.

The current state of Clinical Mycology in Eastern and South-Eastern Europe.

The ability of medical centers in Eastern and South-Eastern Europe to diagnose and treat fungal infections remains unknown. In order to investigate that, here we conducted a cross-sectional online survey, released at both The International Society for Human & Animal Mycology (ISHAM) and European Confederation of Medical Mycology (ECMM) websites. A total of 31 institutions responded to the questionnaire. Most centers (87.1%, n = 27) had access to Aspergillus spp. ELISA galactomannan testing as well as to Cryptococcus spp. antigen testing (83.9%, n = 26). Serological tests were mostly available for Aspergillus species (80.6%, n = 25); and most institutions reported access to mold-active antifungal drugs (83.9%; n = 26), but 5-flucytosine was available to only 29% (n = 9) of the participant centers. In conclusion, this study represents the first attempt to document the strengths and limitations of the Eastern and South-Eastern European region for diagnosing and treating fungal diseases. LAY SUMMARY: Our article is about the availability of diagnostic and treatments tools related to fungal infections in the countries of Eastern and South-Eastern region. Surveys like these are important to understand the gaps and point towards the fungal infections as a global health issue.

Fungal dermatitis by Scopulariopsis brevicaulisin Guinea pig (Cavia porcellus) / Dermatite fúngica por Scopulariopsis brevicaulis em Porquinho da Índia (Cavia porcellus)

Fungal dermatitis is classified into superficial, cutaneous and subcutaneous mycoses. However, the incidence of fungal dermatitis in small mammals is relatively low. Among rodents guinea pig the most affected specie, however it usually has an asymptomatic pattern. The present text reports an unusual case of fungal dermatitis in Caviaporcelluscaused by Scopulariopsis brevicaulis. The animal was received with complaint of alteration of coat around the neck, as well as report of incorrect feeding management. During the physical examination the presence of a dry and crusty dermatitis, negative on fluorescence test of wood. Samples of blood, skin, scabs and hair were collected for parasitic and mycological analysis. The hematological evaluation showed only a discrete eosinophilia; no ectoparasites were observed, but it was noticed the presence of Scopulariopsis brevicaulis. The animal underwent terbinafine and griseofulvin protocol, with total regression of the lesions after 30 days. S. brevicaulis is an unusual geophilic fungus causing animal mycosis, presenting more pathological reports in human mycoses, thus, representing a zoonotic potential. According to the clinical findings and results obtained from mycology assay, it was diagnosed dermatitis by Scopulariopsis brevicaulis, secondary to nutritional deficiency. The combined use of topical terbinafine with systemic griseofulvin was efficient in the treatment. Finally, it was recommended a dietary correction.(AU)

As dermatites fúngicas são classificadas em micoses superficiais, micoses cutâneas e micoses subcutâneas. No entanto, a ocorrência de dermatites fúngicas em pequenos mamíferos é incomum, sendo que entre os roedores o porquinho da Índia é a espécie mais acometida e a infecção costuma ser assintomática. O presente artigo relata um caso incomum de dermatite fúngica em Cavia porcellus causado pelo fungo Scopulariopsis brevicaulis. O animal foi atendido devido à queixa de alteração de pelagem ao redor do pescoço e erros no manejo alimentar. Durante o exame físico observou-se a presença de uma derma-tite crostosa de aparência seca, negativa no teste de fluorescência sob lâmpada de Wood para detectar dermatófitos. Foi cole-tado sangue e também amostras de pele, crostas e pelos para análise parasitária e cultivo micológico. Na avaliação hematoló-gica observou-se apenas uma eosinofilia discreta, no parasitológico não foram observados ectoparasitas. No cultivo micológico foi isolado Scopulariopsis brevicaulis. O animal foi tratado com terbinafina e griseofulvina havendo regressão total das lesões após 30 dias de terapia antifúngica. S. brevicaulis é um fungo geofílico incomum em casos de micose em animais, sendo mais relatado em micoses humanas e havendo um potencial zoonótico. Assim, baseado nos achados clínicos e exames laboratoriais concluiu-se que o caso se tratava de uma dermatite fúngica causada por Scopulariopsis brevicaulis secundária a deficiência nutri-cional, sendo que o uso combinado de terbinafina tópica com a griseofulvina sistêmica foi eficiente no tratamento em com-binação com a correção da dieta alimentar.(AU)