RESUMO
The quality of routine malaria diagnosis is a crucial topic of malaria control. The aim of this assessment was to monitor and evaluate the quality of routine malaria diagnosis in Amazonas (Venezuela) and to improve the quality control system. The traditional non-blinded quality control system was found to be overburdened with diagnostic samples. A modified sampling system with fewer samples to be tested was proposed. Expert microscopists blindly double-checked 1000 slides and 550 rapid diagnostic tests (RDT) (OptiMAL-IT) from health posts (HP). For Plasmodium vivax, HP microscopy and OptiMAL-IT showed sensitivies of 86% and 63%, respectively. For P. falciparum, HP microscopy and OptiMAL-IT showed sensitivities of 68% and 89%, respectively. Both methods lost accuracy when fewer parasites occurred in the sample. HP microscopists from different municipalities displayed significant differences in diagnostic quality. Overall, quality of routine malaria diagnosis in the Venezuelan Amazon is good but not optimal. The change from the traditional non-blinded quality control system to blinded cross-checking of a minimal selection of samples is - comparatively - a low cost intervention with possibly high impact on the quality of routine malaria diagnosis. The introduction of RDTs should be discussed carefully in order not to displace an existing network of HP microscopists.
Assuntos
Malária/diagnóstico , Microscopia/normas , Plasmodium falciparum/isolamento & purificação , Plasmodium vivax/isolamento & purificação , Kit de Reagentes para Diagnóstico/normas , Animais , Método Duplo-Cego , Humanos , Malária/epidemiologia , Microscopia/métodos , Controle de Qualidade , Sensibilidade e Especificidade , Venezuela/epidemiologiaRESUMO
Anopheles (Anopheles) neomaculipalpus Curry (Diptera: Culicidae) collected by human landing catches and light traps in southern Venezuela were assayed by enzyme-linked immunosorbent assay (ELISA) for detection of Plasmodium circumsporozoite (CS) protein. A total of 356 An. neomaculipalpus were collected, of which three (0.84%) were positive for P. vivax, two for the variant 247 and one for the variant 210. The overall sporozoite rate in An. neomaculipalpus was similar to that for the principal vector An. (Nyssorhynchus) darlingi Root (0.82%) and higher than in An. (Nys.) marajoara Galvão & Damasceno (0.27%). This is the first report of An. neomaculipalpus naturally infected with Plasmodium parasites in Venezuela.
Assuntos
Anopheles/classificação , Insetos Vetores , Malária/transmissão , Animais , Anopheles/anatomia & histologia , Anopheles/parasitologia , Plasmodium vivax/isolamento & purificação , VenezuelaRESUMO
Trichosporon asahii is a yeast that may cause systemic infection, especially in neutropenic patients. To our knowledge, only two cases of invasive infection with Trichosporon were previously described in liver transplant recipients. We describe an additional case of T. asahii infection after orthotopic liver transplantation in a non-neutropenic patient who had no known risk factor for invasive fungal infection, and died in spite of amphotericin B therapy.
Assuntos
Transplante de Fígado/efeitos adversos , Micoses/microbiologia , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Evolução Fatal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/diagnóstico , Micoses/tratamento farmacológico , Neutropenia , Trichosporon/isolamento & purificaçãoRESUMO
Many studies have attempted to evaluate the importance of airborne fungi in the development of invasive fungal infection, especially for immunocompromised hosts. Several kinds of instruments are available to quantitate fungal propagule levels in air. We compared the performance of the most frequently used air sampler, the Andersen sampler with six stages, with a portable one, the Reuter centrifugal sampler (RCS). A total of 84 samples were analyzed, 42 with each sampler. Twenty-eight different fungal genera were identified in samples analyzed with the Andersen instrument. In samples obtained with the RCS only seven different fungal genera were identified. The three most frequently isolated genera in samples analyzed with both devices were Penicillium, Aspergillus and Cladophialophora. In areas supplied with a high efficiency particulate air filter, fungal spore levels were usually lower when compared to areas without these filters. There was a significant correlation between total fungal propagule measurements taken with both devices on each sampling occasion (Pearson coefficient = 0.50). However, the Andersen device recovered a broader spectrum of fungi. We conclude that the RCS can be used for quantitative estimates of airborne microbiological concentrations. For qualitative studies, however, this device cannot be recommended
Assuntos
Humanos , Microbiologia do Ar , Poluição do Ar em Ambientes Fechados , Monitoramento Ambiental , Fungos , Hospitais , Centrifugação , Monitoramento Ambiental , Filtração , FungosRESUMO
Many studies have attempted to evaluate the importance of airborne fungi in the development of invasive fungal infection, especially for immunocompromised hosts. Several kinds of instruments are available to quantitate fungal propagule levels in air. We compared the performance of the most frequently used air sampler, the Andersen sampler with six stages, with a portable one, the Reuter centrifugal sampler (RCS). A total of 84 samples were analyzed, 42 with each sampler. Twenty-eight different fungal genera were identified in samples analyzed with the Andersen instrument. In samples obtained with the RCS only seven different fungal genera were identified. The three most frequently isolated genera in samples analyzed with both devices were Penicillium, Aspergillus and Cladophialophora. In areas supplied with a high efficiency particulate air filter, fungal spore levels were usually lower when compared to areas without these filters. There was a significant correlation between total fungal propagule measurements taken with both devices on each sampling occasion (Pearson coefficient = 0.50). However, the Andersen device recovered a broader spectrum of fungi. We conclude that the RCS can be used for quantitative estimates of airborne microbiological concentrations. For qualitative studies, however, this device cannot be recommended.
Assuntos
Microbiologia do Ar , Poluição do Ar em Ambientes Fechados/análise , Monitoramento Ambiental/instrumentação , Fungos/isolamento & purificação , Hospitais , Centrifugação/instrumentação , Monitoramento Ambiental/métodos , Filtração/instrumentação , Fungos/classificação , HumanosRESUMO
Forty-two patients with active paracoccidioidomycosis were randomized to receive itraconazole (50-100 mg d(-1)), ketoconazole (200-400 mg d(-1)) or sulfadiazine (100-150 mg kg d(-1) up to 6 g d(-1)) for 4-6 months, followed by slow release sulfa until negativity of serological tests. All 14 patients in itraconazole and sulfadiazine groups and 13 in the ketoconazole group showed an adequate clinical response to the chemotherapy. One patient in the latter group showed treatment failure according to clinical and mycological criteria. The test of the hypothesis that the drugs reduced antibody levels up to ten months of treatment showed a p value equal to 0.0001 for itraconazole, 0.017 for ketoconazole and 0.0012 for sulfadiazine; this reduction was similar for the three groups. In this first randomized study for the treatment of paracoccidioidomycosis we could not show superiority of any one regimen over the others in the clinical and serological responses of patients with the moderately severe form of the disease.
Assuntos
Antifúngicos/uso terapêutico , Paracoccidioidomicose/tratamento farmacológico , Adolescente , Adulto , Feminino , Humanos , Itraconazol/uso terapêutico , Cetoconazol/análogos & derivados , Cetoconazol/uso terapêutico , Masculino , Pessoa de Meia-Idade , Sulfadiazina/uso terapêutico , Resultado do TratamentoRESUMO
We report a case of cutaneous infection caused by Phialemonium curvatum GAMS et COOKE, 1983, after bone marrow transplantation. The genus Phialemonium was created by GAMS & MCGINNIS in 1983 including three new species: Ph. obovatum, Ph. curvatum and Ph. dimorphosporum, and represents an intermediate genus between Acremonium and Phialophora. Nowadays, the genus Phialemonium is considered to be a pheoid fungus which may cause the eventual lesions observed in pheo- and hyalohyphomycosis. Species of this genus have been described as opportunistic agents in humans and animals, mainly as a result of immunosuppression. In the present case, the patient had multiple myeloma and received an allogenic bone marrow transplant from his HLA-compatible brother. Two months after transplantation, he developed purplish and painful nodular lesions on the right ankle. Some of these lesions drained spontaneously and apparently hyaline mycelial filaments were observed, whose culture was initially identified as Acremonium sp. Subsequent studies showed that the fungus was Phialemonium curvatum. The infection was treated with amphotericin B, followed by ketoconazole. The patient was submitted to surgical debridement followed by two skin grafts to repair the bloody area. The duration of the treatment was 4 months and secondary prophylaxis with ketoconazole alone was maintained for one additional month. No recurrence was observed after discontinuation of treatment. The authors comment on the pathogenicity of the genus Phialemonium.
Assuntos
Transplante de Medula Óssea/efeitos adversos , Dermatomicoses/microbiologia , Fungos Mitospóricos/isolamento & purificação , Infecções Oportunistas/complicações , Adulto , Dermatomicoses/tratamento farmacológico , Humanos , Hospedeiro Imunocomprometido , MasculinoRESUMO
A case of phaeohyphomycosis is reported in a male renal transplant recipient with a nodular lesion in the right leg who was treated with immunosuppressing drugs. The lesion consisted of a purulent cyst with thick walls. The cyst was excised surgically, and the patient did not receive any antifungal therapy. One year later he remains well. Histological study of the lesion showed a granulomatous reaction of epithelioid and multinucleate giant cells, with a central area of necrosis and pus. Fontana-Masson staining demonstrated the presence of pigmented hyphal elements. The fungus Colletotrichum crassipes was grown in different cultures from the cyst. The in vitro inhibitory activities of eight antifungal drugs against the isolate were tested. Clotrimazole and UR-9825 were the most active drugs. This case represents the first known reported infection caused by this rare species.
Assuntos
Colletotrichum/isolamento & purificação , Cistos/diagnóstico , Dermatomicoses/diagnóstico , Adulto , Colletotrichum/classificação , Colletotrichum/crescimento & desenvolvimento , Meios de Cultura , Cistos/microbiologia , Cistos/cirurgia , Dermatomicoses/microbiologia , Dermatomicoses/cirurgia , Humanos , Transplante de Rim , MasculinoRESUMO
The authors report the first case of dermatophytosis caused by Trichophyton raubitschekii in a patient from the State of São Paulo with Tinea corporis lesions localized on the buttocks. Culture on Sabouraud-agar with cycloheximide permitted the isolation and identification of the fungus, and the diagnosis was confirmed by Dr. Lynne Sigler, University of Alberta, Canada. Systemic treatment with fluconazole, 150 mg/week for 4 weeks, in combination with topical treatment with isoconazole initially yielded favorable results, with recurrence of the lesions after the medication was discontinued. This is the fifth case of this dermatophytosis published in the Brazilian medical literature.
Assuntos
Tinha/microbiologia , Trichophyton/isolamento & purificação , Antifúngicos/uso terapêutico , Brasil/epidemiologia , Feminino , Fluconazol/uso terapêutico , Humanos , Miconazol/análogos & derivados , Miconazol/uso terapêutico , Tinha/tratamento farmacológico , Tinha/epidemiologia , Trichophyton/classificação , Trichophyton/citologiaRESUMO
The authors report two cases of onychomycosis in the dystrophic form, one of them involving an HIV-positive patient, provoked by Scytalidium dimidiatum, previously called Scytalidium lignicola. The subject is reviewed from the taxonomic viewpoint, considering the anamorph Hendersonula toruloidea as a synonym of Nattrassia mangiferae, and having Scytalidium dimidiatum as the major synanamorph. According to many mycologists, Scytalidium hyalinum may be a separate species or a hyaline mutant of Scytalidium dimidiatum. Scytalidium lignicola Pesante 1957 was considered to be the type-species of the genus by ELLIS (1971)13 and later to be a "conidial state" of Hendersonula toruloidea by the same author, today known as Nattrassia mangiferae. The microorganism lives only on the roots of certain plants (mainly Platanus and Pinus). It produces pycnidia and is not considered to be a pathogen, although it is considered as a possible emerging agent capable of provoking opportunistic fungal lesions. The importance of this topic as one of the most outstanding in fungal taxonomy, so likely to be modified over time, as well as its interest in the field of dermatologic mycology, are emphasized.