[Reliability and agreement of two smear reading scales for classification and monitoring of multidrug therapy in leprosy patients]. / Confiabilidad y concordancia de dos escalas de lectura de baciloscopias para clasificación y seguimiento del tratamiento con múltiples medicamentos de los pacientes con lepra.

INTRODUCTION: After the clinical diagnosis of leprosy, classification methods are necessary to define a treatment and prognosis of patients consistent with bacterial load. Bacteria are detected in skin smear, and bacterial load typically is established by the internationally used Ridley's logarithmic scale, However, in Colombia an alternative semiquantitative scale is used. OBJECTIVE: The interobserver reproducibility was established for the Ridley and Colombia scales, and the level of correlation-matching was identified between the bacillary indices obtained in order to assess the degree of interchangeability. MATERIALS AND METHODS: Standardization was attained by a reading of the smears by 2 readers with subsequent, blinded evaluation of inter-observer agreement. Each reader quantified the bacterial load of for each sample (n=325) using the Colombian and the Ridley scales. The degree of interobserver agreement was assessed with weighted kappa coefficient. The level of correlation and agreement between the measurements of the bacillary index was established with coefficient of Lin. RESULTS: The interobserver weighted kappa coefficient was 0.83 for the Colombia scale and 0.85 for the Ridley scale. The Lin coefficient was 0.96 for the correlation-matching of bacillary indexes. CONCLUSIONS: Interobserver agreement obtained for both scales was excellent as the correlation-matching bacillary indices determined with both methods. With the cut-off points yielded a good level of agreement, ensuring interchangeability between the scales defining the high or low bacterial load.

Possible mode of emergence for drug-resistant leprosy is revealed by an analysis of samples from Mexico.

Mexico is a country with sporadic leprosy cases, and the reemergence of drug resistance is a concern. In this study, molecular analysis of Mycobacterium leprae was employed to clarify the spread of drug-resistant leprosy. Thus, drug resistance-determining regions in the folP1, rpoB, and gyrA genes, which are associated with resistance to dapsone, rifampicin, and ofloxacin, respectively, were analyzed by direct sequencing of the PCR product. No mutations in the folP1 gene were observed in any of the 72 slit skin samples obtained from 38 patients, although two samples carrying a mutation at codon 425 in the rpoB gene, which confers resistance to rifampicin, a key component of multidrug therapy, were identified. In addition, a mutation at codon 91 in the gyrA gene, which correlates with ofloxacin resistance, was found in one sample. These results demonstrate the existence of rifampicin- and ofloxacin-resistant leprosy. Interestingly, wild-type and mutant sequences in the gyrA gene were found to coexist in one clinical sample. In addition, all three drug resistance-related mutations were found in only one of the two earlobes of the patients concerned, suggesting a possible pathway for the spread of drug-resistant M. leprae.

Microbiota indígena de seres humanos / Indigenous microbiota of human beings

As superfícies do corpo humano são colonizadas por uma comunidade de organismos, principalmente bactérias, que constitui a microbiota indígena. A composição desta microbiota se altera ao longo da vida e é influenciada por diversos fatores, tais como dieta e status imunológico do hospedeiro. A microbiota pode agir de maneira benéfica ou, em algumas situações, pode ser prejudicial para o indivíduo. Podem ser distinguidas a microbiota residente, constituída por organismos específicos, encontrados, freqüentemente, em determinadas áreas e a microbiota transitória, que consiste de microrganismos provenientes do ambiente, que habitam a pele e as superfícies mucosas por horas ou poucas semanas. Trato gastrointestinal, vagina, cavidade oral e pele possuem a microbiota mais rica e diversificada do corpo humano. O conhecimento da constituição da microbiota indígena é extremamente relevante para os médicos, principalmente para orientar a interpretação de resultados de exames microbiológicos e a escolha da terapia antimicrobiana empírica mais adequada. Deve-se salientar que a microbiota geralmente é benéfica. Por esse motivo, é fundamental que se tenha consciência dos riscos do rompimento da homeostasia entre microbiota e hospedeiro.

Body surfaces are colonized by a community of organisms that are recognized as indigenous microbiota, that is mainly constituted by bacteria. Its constitution changes with time and is influenced by several conditions such as diet and the immune status of the individual, among others. There are now evidences that the microbiota could be beneficial or, in some instances, dangerous to human health. It could be classified as resident, composed by fixed organisms, frequently found in certain areas, or as transitory, consisting of organisms from the environment that inhabits skin and mucosa for hours to few weeks. The gastrointestinal tract, vagina, oral cavity and skin show the richest and most diverse microbiota of the human body. The knowledge of the constitution of the indigenous microbiota is extremely important for clinicians, mainly because it can help them to interpret results of microbiological tests and to choose appropriate empirical therapy. It should be pointed out that microbiota is, in general, harmless and beneficial; for these reason, physicians must keep in mind that the disruption of the homeostasis between microbiota and host should be avoided.

[Viability of Malassezia pachydermatis strains maintained in various storage mediums]. / Viabilidade de cepas de Malassezia pachydermatis mantidas em diferentes métodos de conservação.

The maintenance of Malassezia pachydermatis in fungal collections is very important for retrospective and prospective studies. The aim of this study was to evaluate the behavior of Malassezia pachydermatis in different storage methods. After the identification process, M. pachydermatis strains were stored for six and nine months, in saline and saline plus mineral oil at 28 degrees C, as well as in Dixon's agar, Dixon's agar plus glycerol and Dixon's agar plus dimethyl-sulfoxide (DMSO), at -20 degrees C. Dixon's agar and Dixon's agar plus glycerol were the most adequate methods (p < 0.05) for the maintenance of Malassezia pachydermatis viability, after six and nine months of storage. All the methods used were capable of maintaining the urease activity at six months of storage, but only Dixon's agar and Dixon's agar plus glycerol were statistically adequate at nine months (p < 0.05). Thus, to assure Malassezia pachydermatis recovery and to maintain its characteristics, Dixon's agar or Dixon's agar plus glycerol should be used.

Factors associated with the prevalence of Malassezia species in the external ears of cattle from the state of Minas Gerais, Brazil.

Swabs collected from the external ears of 942 cattle, including both European and zebu breeds, were used to evaluate the epidemiology of Malassezia species. High numbers of Malassezia isolates were significantly associated with maturity of the animals and with diagnosed otitis. In healthy animals, a particularly low prevalence of the genus was found in Holstein cows, especially in the summer months, a finding perhaps correlating with the open, air-exposed ears of this breed. Pendutlous-eared zebu breeds and hybrids had higher levels of colonization, although this effect was more pronounced in humid regions, and was least in the dry north and west of the state. The most common species seen was M. sympodialis, which accounted for 47.1% of isolates from healthy cattle and 39.1% from cattle with otitis. In cattle with otitis sampled in summer, we found that the relatively thermotolerant M. sympodialis made up 80.8% of isolates. By contrast, during the winter the less thermotolerant M. globosa was the most common species from otitis, making up 56% of the isolates. Humidity and temperature may be the main factors explaining the epidemiology of Malassezia diseases and colonizations in both animals and humans.

Auricular chromoblastomycosis caused by Rhinocladiella aquaspersa.

An unusual case of chromoblastomycosis localized in the ear and caused by R. aquaspersa is presented. The patient was a 60-year-old male urban resident, who had had the disease for 5 years. The lesion was darkly pigmented, infiltrative and crusty. Sclerotic cells were seen on direct examinations and the fungus was recovered in culture and identified on the basis of the characteristic sporulation. Itraconazole therapy at a dose of 200 mg day-1 for 7 months produced complete healing.

Human immunodeficiency virus and acquired immune deficiency syndrome AIDS-related hearing disorders.

After a brief discussion of the nature of the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) disease process and its consequences, the article considers implications for the ear and hearing. One of the newest etiologic considerations for audiologists is pediatric autoimmune deficiency syndrome (PAIDS). Babies born to HIV-AIDS-positive mothers, and children who have acquired the disease, represent a new challenge to clinics. Symptoms, audiologic care, and management are considered.

Cromoblastomicose auricular: relato de um caso / Auricular chromoblastomycosis : case report

E apresentado um caso de cromoblastomicose auricular apresentado sob forma de lesao eritemato-escamosa, tendo tido o diagnostico de eczema. Os AA discutem sobre a raridade desta localizacao e aspecto clinico. Embora os poucos casos relatados de cromoblastomicose auricular tenham sido causados pela Fonsecaea pedrosoi, neste o agente etiologico foi a Phialophora verrucosa.

Surface colonization with coagulase-negative staphylococci in premature neonates.

To follow the emergence of surface colonization with coagulase-negative staphylococci in neonates, we sampled four surface sites (axilla, ear, nasopharynx, and rectum) in 18 premature infants during the first 4 weeks of life. Swabs were obtained on the first day of life, twice weekly for 2 weeks, and weekly thereafter. Isolates were characterized by species, biotype, antibiotic susceptibility patterns, and slime production. Over 4 weeks the percentage of infants with Staphylococcus epidermidis as the only surface coagulase-negative staphylococci rose from 11% to 100%. Predominance of a single S. epidermidis biotype increased from none to 89%. Multiple antibiotic resistance rose from 32% to 82% of isolates, and the prevalence of slime production increased from 68% to 95%. This microbiologic pattern was established by the end of the first week of life and persisted throughout the month of study. In three infants, S. epidermidis sepsis developed with organisms identical to their predominant surface isolate. We conclude that species, multiple antibiotic resistance, and slime production appear to confer a selective advantage for the surface colonization of premature newborn infants in the intensive care nursery environment. Infants so colonized may be at greater risk for subsequent infection with these strains of coagulase-negative staphylococci.

Malignant external otitis in children.

Malignant external otitis in the pediatric population is primarily a disease of children with chronic illness or immunosuppression. The presence of severe, unrelenting otalgia, otorrhea with isolation of Pseudomonas aeruginosa, a markedly elevated erythrocyte sedimentation rate, and evidence of bone destruction on computed tomography scan should alert the clinician to the diagnosis. Unlike adults, children have a higher incidence of seventh nerve paralysis earlier in the course of the infection. They also manifest more frequent involvement of the middle ear with tympanic membrane destruction. The short interval between the onset of symptoms and facial nerve dysfunction highlights the necessity of prompt diagnosis and institution of anti-Pseudomonas therapy. Our review suggests that this destructive bacterial infection is an emerging clinical entity in children; 73% of the cases have been reported since 1980. Pediatricians should therefore be familiar with the clinical presentation of this treatable infection. Substantial morbidity could be alleviated by prompt diagnosis and early antibiotic treatment.

The role of respiratory syncytial virus and other viral pathogens in acute otitis media.

We utilized recently developed enzyme immunoassay techniques to examine the role of selected viruses in the etiology of acute otitis media. Viral pathogens were found in middle ear fluids obtained from 13 (24%) of 53 children with acute otitis media; respiratory syncytial virus accounted for ten of the 13 viral agents identified. In addition, respiratory syncytial viral antigen was found in nasopharyngeal washings obtained from 15 of the 53 children. Seven of these children had RSV identified as the sole middle ear pathogen, whereas six children had otitis caused by Streptococcus pneumoniae as either the sole middle ear pathogen or in combination with RSV. Similarly, all three children with respiratory infections caused by influenza virus had ear infections caused by bacterial pathogens, either alone or in combination with influenza virus. These findings suggest that, in patients with viral respiratory infection, coexisting acute otitis media may be associated with the recovery of either viruses or bacteria from the middle ear exudates.