Approach of clinicians to candiduria and related outcome in the elderly

OBJECTIVE

Candiduria is increasingly frequent in hospitalized debilitated patients. We aimed to evaluate the approach of clinicians to candiduria in the oldest old, and its effect on clearance and mortality.

MATERIAL AND METHODS

An observational study without intervention was carried out during 2012 and 2013 in three Spanish hospitals over patients with nosocomial candiduria aged 80 and over. Following a diagnostic algorithm, we assessed the appropriateness of antifungal therapy and analyzed the impact of the clinical approach (antifungal therapy, antibiotics discontinuation and catheter removal or replacement) on the outcome (mortality at 60 days and resolution, persistence or recurrence of candiduria).

RESULTS

Hundred and forty eight patients were included. Symptomatology was attributable to candiduria in 31 instances and 19 asymptomatic patients were found at risk of developing candidemia. In response to culture-results, 77 (52%) of patients were treated with antifungals, mainly fluconazole (97.4%). The use of pharmacological therapy was appropriate (P<0.05) but subtherapeutical doses of fluconazole were widely used and follow-up samples were scarcely submitted. At 60 days of diagnosis the mortality was high (29.7%). The replacement or removal of the catheter resulted in a decrease in mortality and the use of antifungal treatment was associated with recurrence (P<0.05).

CONCLUSIONS

In the absence of clinical practice guidelines with enough evidence, our study suggests that catheter removal should always be tried in the elderly with candiduria, since it reduces the mortality. The repetition of culture should help to better characterize the asymptomatic episodes, which are predominant, and to reduce the use of antifungals.

Candiduria: impacto ecológico de los antibióticos

[No disponible]

[Tinea capitis by Microsporum gypseum, an infrequent species]

Tinea capitis is considered the most frequent dermatophyte infection in children. The etiological agents vary from time to time and by geographical area, although they normally are zoophilic dermatophytes and in the last years also anthropophilic species. We report a clinical case of inflammatory tinea capitis in a 6-year-old child caused by Microsporum gypseum, a geophilic fungus pathogenic to humans and animals. The sources of human infection are soil, cats, dogs and small mammals. This species is less frequent as a cause of dermatophytosis in humans, described mainly in tinea corporis and rarely in tinea capitis. In the diagnosis of tinea capitis identifying the causative species is a determinant of the treatment.

Nosocomial Candiduria in the Elderly: Microbiological Diagnosis

Candiduria is associated with high morbidity, mortality, and long hospitalization, involving high costs for the healthcare system. The use of increasingly aggressive treatments has prolonged the lives of patients susceptible to candiduria, namely the immunosuppressed, the premature, and the elderly. Our objective was to evaluate the incidence of nosocomial candiduria and the implicated species in hospitalized patients aged over 80 years old from three Spanish centers during 2012 and 2013. Urine samples received from these patients were cultured and analyzed by flow cytometry in search of leukocyturia, hematuria, proteinuria, and microbial nitrate reductase activity. The isolated yeast species were identified microscopically, by germ tube formation in serum, colony morphology after subculture onto CHROMagar Candida (Becton-Dickinson, UK), assimilation of carbon compounds ID32C (bioMérieux, France), matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDITOF) (Bruker Daltonics, Germany) and, in case of inconsistency, by sequencing of the ITS regions of ribosomal DNA (ITS1-5, 8S-ITS2). Susceptibility tests were also performed. The incidence of candiduria in the elderly population was 10.3%. A total of 155 strains of yeasts were isolated. The predominant species was Candida albicans, followed by Candida glabrata and then Candida tropicalis. Several infrequent species were found; among them, the first isolate of candiduria-producing Candida pulcherrima described in the literature. Our finding should raise concerns about the elderly population, which is probably the most important risk group for candiduria in the present moment, and the emergence of unusual yeast species producing candiduria, which are resistant against the commonly used antifungal agents.

[Infections due to Mycobacterium simiae]

Mycobacterium simiae is a slow-growing photochromogenic environmental mycobacterium, first described in 1965. Rarely associated with human infections, possibly due to its limited pathogenicity, it mainly produces lung infection in immunocompetent elderly patients with underlying lung disease, and in disseminated infections in immunosuppressed young patients with AIDS. A microbiological culture is needed to confirm the clinical suspicion, and genetic sequencing techniques are essential to correctly identify the species. Treating M. simiae infections is complicated, owing to the multiple resistance to tuberculous drugs and the lack of correlation between in vitro susceptibility data and in vivo response. Proper treatment is yet to be defined, but must include clarithromycin combined with other antimicrobials such as moxifloxacin and cotrimoxazole. It is possible that M. simiae infections are undiagnosed.

[Antifungal susceptibility of clinical isolates of Scopulariopsis species]

INTRODUCTION

Scopulariopsis is a common soil saprophyte. In the last years the infections caused by Scopulariopsis species have increased, included superficial and invasive mycoses. This fungi has been reported resistant in vitro to some antifungal agents, although there is little information about this. The aim of the study was to establish in vitro antifungal susceptibility of clinical isolates of Scopulariopsis species against to broad-spectrum antifungal agents.

METHODS

A total of 28 Scopulariopsis strains (10 S. brevicaulis, 7 S. koningii, 3 S. acremonium, 3 S. candida, 3 S. flava, 1 S. brumptii and 1 S. fusca) were tested using Sensititre Yeast One and broth microdilution methods to determine the minimum inhibitory concentrations (MICs) to amphotericin B, fluconazole, itraconazole, posaconazole, voriconazole and 5-fluorocytosine, and minimun effective concentration (MECs) to anidulafungin, caspofungin and micafungin.

RESULTS

Our data confirm the high in vitro resistance of Scopulariopsis to antifungal agents. Anidulafungin, caspofungin, micafungin (MICs ≥ 8 mg/L), 5-fluorocytosine (MICs ≥ 64 mg/L), and fluconazole (MICs ≥ 128 mg/L) were inactive in vitro in all species. MICs of amphotericin B (range 2 to ≥ 8 mg/L) and itraconazole (0.5 to ≥ 16 mg/L) were high. The best antifungal activity was observed for posaconazole and voriconazole (0.5 to ≥ 8 mg/L). With Sensititre Yeast One method MICs obtained slightly lower. Scopulariopsis candida, S. flava and S. fusca were the most resistant species, while S. acremonium and S. brevicaulis showed the lowest MICs.

CONCLUSIONS

MICs of all tested antifungal agents for Scopulariopsis were very high. Infections caused by Scopulariopsis species may not respond to antifungal treatment. Voriconazole is the drug of choice for treatment. We consider it appropriate to add amphotericin B in serious infections.

[Fungemia due to Trichosporon asahii in a patient with hematological malignancy]

BACKGROUND

Trichosporonosis is an opportunistic infection caused by the genus Trichosporon. The majority of cases of invasive trichosporonosis occurs in immunocompromised individuals.

CASE REPORT

We describe a case of disseminated infection by Trichosporon asahii in a hematology patient. A 52-year-old man diagnosed with acute lymphoblastic leukemia developed a febrile episode during the third cycle of the induction chemotherapy. The blood cultures were positive after 24h incubation, showing elongated structures compatible with fungal elements in the Gram stain. The identification of the fungus as Trichosporon asahii was carried out by the assimilation of compounds of carbon and the amplification and sequencing of the D1/D2 domain and the internal transcribed spacer of the ribosomal DNA. The fungus was also isolated from the pustular lesions that the patient had in the chest. After treatment with amphotericin B, the patient progressed satisfactorily.

CONCLUSIONS

Trichosporon asahii is an emergent pathogen in immunosupressed patients and its presence should not be considered as colonization, as there is risk of invasive infection.

[Maternal chorioamnionitis and neonatal conjunctive infection due to an infrequent pathogen]

Chorioamnionitis generates significant neonatal mortality and morbidity. Its incidence in premature birth can reach 30% and up to 30-40% of cases of premature rupture of membranes is due to this entity. We describe a case of chorioamnionitis by a commensal of the oral flora (Eikenella corrodens) in a pregnant woman with premature rupture of membranes and preterm delivery, which caused conjunctivitis in the newborn. On occasion of this case, we review the issue, delving into the diagnosis and clinical significance of this pathogen.

[Diagnosis of vaginitis-vaginosis by hibridization with DNA strands]

BACKGROUND

Vaginal infections lie among the most common causes women ask for medical advice. In order of frequency bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis are responsible for 90% of vaginitis/vaginosis.

OBJECTIVE

To evaluate a DNA hybridization test for simultaneous molecular detection of Gardnerella vaginalis, Candida species and Trichomonas vaginalis, as an alternative to conventional microbiological methods.

MATERIAL AND METHODS

Cohort, cross-sectional, and comparative study of 1,003 vaginal samples from symptomatic women from our health-care area. Two swabs were obtained from each woman, one for routine microbiological diagnosis of vaginal infection (wet mount, Gram stain, and mycological culture) and the other for the DNA hybridization test (Affirm VPIII, Becton Dickinson). This method detects clinically significant levels of G. vaginalis (2 x 10(5) CFU/ml), Candida spp. (1 x 10(4) cells) and T. vaginalis (5x103 trichomonads).

RESULTS

Out of the 1,003 women studied, 30.6% tested positive for bacterial vaginosis, 23.3% for vulvovaginal candidiasis, and 0.5% for trichomoniasis. The Affirm VPIII method turned out positive in 27.5%, 27.4% and 0.5% of cases, respectively. No statistically significant differences were found between the molecular technique and conventional methods for microbiological diagnosis of vaginitis/ vaginosis (p < 0.05).

CONCLUSION

The Affirm VPIII test correlated well with wet mount, Gram stain and mycological culture. Although its cost is relatively high, it is fast, reproducible, easy, and can be done in either clinical laboratories or Gynecology offices, which permits prescribing a specific early treatment.

Evaluation of the Sensititre Yeast One microdilution method for susceptibility testing of Candida species to anidulafungin, caspofungin, and micafungin

INTRODUCTION

Echinocandins represent a new antifungal group with potent activity against Candida species. The purpose of our study was to evaluate the utility of the Sensititre Yeast One method to determine the in vitro activity of anidulafungin, micafungin, and caspofungin against Candida species isolated from clinical specimens.

METHODS

A total of 131 Candida strains were tested using Sensititre Yeast One colorimetric microdilution method. They belonged to the following species: 42 C. albicans, 36 C. glabrata, 21 C. parapsilosis, 12 C. tropicalis, 10 C. krusei, 3 C. guilliermondii, 2 C. famata, 3 C. kefyr, 1 C. lusitaniae, 1 C. zeylanoides, and 1 C. lipolytica. For being considered susceptible the strains had to be inhibited by concentrations ≤2 mg/L of anidulafungin, caspofungin or micafungin.

RESULTS

The 80.1% of the strains tested were inhibited by concentrations ≤0.25 mg/L of anidulafungin and micafungin. The activity of caspofungin was slightly lower (78.6% of strains inhibited by concentrations ≤0.25 mg/L). The 96.9% of strains turned out susceptible to concentrations ≤2 mg/L against the three echinocandins. Two strains of C. parapsilosis (9.5%), one of C. guilliermondii, and two of C. famata showed non-susceptible to one or more echinocandins.

CONCLUSIONS

In our series, anidulafungin, micafungin, and caspofungin were effective against C. albicans, C. glabrata, C. tropicalis, C. krusei, C. kefyr, C. lusitaniae and C. lipolytica. The 96.9% of strains were susceptible to all three echinocandins. Thus, echinocandins are proved to exhibit excellent activity to the Candida species most frequently involved in human infections, except Candida parapsilosis.

[Susceptibility to fluconazole of clinical interest yeasts: new breakpoints]

INTRODUCTION

Recently, Pfaller et al (Drug Resist Update 2010; 13:180-95), have proposed new breakpoints for determining the in vitro susceptibility to fluconazole of Candida albicans, C. parapsilosis and C. tropicalis. The aim of this study was to establish the variations in sensitivity of these species applying these breakpoints, in relation to those of the Clinical and Laboratory Standards Institute (CLSI).

METHODS

We analyzed 112 strains of Candida: 49 C. albicans, 40 C. parapsilosis and 23 C. tropicalis. Susceptibility to fluconazole was performed by the method Sensititre YeastOne. The breakpoints used to determine the minimum inhibitory concentration (MIC) were identified by CLSI and the ones proposed by Pfaller et al.

RESULTS

According to the CLSI criteria, all isolates were susceptible to fluconazole. MIC50 and MIC90 were 0.5 mg/L and 2 mg/L for C. albicans and C. parapsilosis, 0.5 mg/L and 1 mg/L for C. tropicalis. With the new criteria, 109 (97%) strains were susceptible. Variations were seen in C. albicans, with 3 strains (6%) susceptible dose-dependent.

CONCLUSIONS

When applying the breakpoints recommended by Pfaller et al, and EUCAST, the number of fluconazole-susceptible strains decreased according to the CLSI criteria, especially C. albicans.

[Infections due to rapidly growing mycobacteria]

Rapidly growing mycobacteria (RGM) are ubiquitous in nature and widely distributed in water, soil and animals. During the past three decades we have observed a notable increment of infections caused by RGM, both localized and disseminated, as well as nosocomial outbreaks of contaminated medical equipment. The microbiological diagnosis of RGM infections includes direct microscopic observation and culture. The taxonomic identification is performed by phenotypic, biochemical, chromatographic and molecular biology techniques. The treatment differs from that of other mycobacteriosis like tuberculosis, owing to the variable in vitro susceptibility of the species of this group. The RGM are resistant to conventional antituberculous drugs, but can be susceptible to broad spectrum antimicrobial agents. In this study we comment on the significant aspects of human infections by RGM, including their biology, epidemiology, pathology, microbiological diagnosis, taxonomic identification, antimicrobial susceptibility and treatment.

Evaluation of INNO-LiPA mycobacteria v2 assay for identification of rapidly growing mycobacteria

A total of 54 rapidly growing mycobacteria (RGM) isolated from patients attended in the two hospitals of Cádiz Bay (Spain) were selected during a seven-year-period (2000–2006) in order to evaluate the INNO-LiPA Mycobacteria v2 assay for mycobacterial identification, based on the reverse hybridization principle. The strains were cultured in Löwenstein-Jensen and Middlebrook 7H9 media and identified to the species level by sequencing of the 16S rRNA, PCR-restriction enzyme analysis of the hsp65 gene, conventional tests and INNO-LiPA Mycobacteria v2 assay. By the molecular methods we identified a total of 12 different species: 23 Mycobacterium fortuitum, 11 M. chelonae, 10 M. abscessus, 2 M. senegalense, 1 M. alvei, 1 M. brumae, 1 M. mageritense, 1 M. mucogenicum, 1 M. neoaurum, 1 M. peregrinum, 1 M. septicum and 1 M. smegmatis. Fifty two strains (96.3%) were correctly identified by conventional techniques and 47 strains (87.0%) by INNO-LiPA Mycobacteria v2 assay. We find INNO-LiPA Mycobacteria v2 assay simple to perform but it provides few advantages in comparison with conventional methods and sometimes needs complementary tests to identify Mycobacterium fortuitum complex, M. chelonae complex and specific species due to the great heterogeneity in the RGM group.

[Antimicrobial susceptibility of methicillin-resistant Staphylococcus aureus strains from outpatient individuals]

BACKGROUND

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged worldwide as a cause of infections among patients without risk factors. This CA-MRSA is different from nosocomial strains in terms of epidemiology, microbiology and clinical manifestations. We report the epidemiologic characteristics and resistance to antimicrobial agents of CA-MRSA strains isolated in the last three years in the Microbiology Lab of Hospital General La Mancha-Centro (Alcázar de San Juan, Ciudad Real).

METHODS

We performed a retrospective analysis of microbiological cultures in patients with S. aureus diagnosed from 2007 to 2009 in La Mancha-Centro Health-Care Area, within Castilla-La Mancha Community.

RESULTS

The distribution of CA-MRSA in the studied period was 26 out of a total of 97 S. aureus isolates in 2007 (26.8%), 40/113 in 2008 (35.4%) and 57/157 in 2009 (36.3%). The percentage from purulent skin and soft tissue infections was 63.4%. All strains were susceptible to linezolid, quinupristin/dalfopristin, and glycopeptides. The resistance was high to fluoroquinolones (94.3%), erythromycin (87.0%), tobramycin (82.9%), and clindamycin (65.3%).

CONCLUSIONS

CA-MRSA isolates percentage increased along the period of the study. The majority were obtained from skin and soft tissue specimens. The most commonly associated antimicrobial resistance was to fluoroquinolones, erythromycin, tobramycin and clindamycin. An understanding of the CAMRSA epidemiology is important to prevent these organisms from becoming endemic in the world.

[Rapid identification of Mycobacterium tuberculosis complex from broth cultures by immunochromatographic assay]

BACKGROUND

Recently, a simple and rapid commercial assay (BD MGIT TBc ID) has been developed using a monoclonal antibody anti-MPT64 for the differentiation of Mycobacterium tuberculosis complex from other mycobacteria by immunochromatography.

METHODS

We evaluate in this work the clinical usefulness of the test for the identification of 51 strains of M. tuberculosis complex and 24 strains of other mycobacteria belonging to 14 different species, compared with the method of hybridization with DNA probes.

RESULTS

Immunochromatographic method performance was excellent, with sensitivity, specificity, positive and negative predictive values of 98, 100, 96.1, and 98.7%, respectively.

CONCLUSIONS

These results indicate that immunochromatographic assay can be safely used for rapid identification of M. tuberculosis complex in combination with culture in liquid media. The test is extremely simple, provides results in just 15 minutes, requires no complex equipment or specialized personnel and may be a good alternative to molecular methods, especially in small laboratories.

[Tuberculous spondylodiscitis. Report of six patients]

BACKGROUND

Tuberculous spondylodiscitis is relatively uncommon but represents the most common location of osseous tuberculosis.

AIM

To describe clinical features, imaging studies and laboratory tests to establish the diagnosis in a group of patients living in Cádiz (Spain).

MATERIAL AND METHODS

Retrospective analysis of medical records of patients with tuberculous spondylodiscitis diagnosed between 2000 and 2009. The diagnosis was based on microorganism recovery from vertebral samples obtained by imaging guided biopsies.

RESULTS

Six patients with positive Mycobac-terium tuberculosis cultures from vertebral samples, were identified (10% of extra-pulmonary tuberculosis). In only 2 patients the Ziehl-Nielsen stain was positive, and histology was compatible in 4 cases. Four patients were females, their mean age was 54.3 years and the mean duration of symptoms was 7.3 months. Three patients had lumbar location and a positive Mantoux test. A soft tissue abscess was present in 4 cases. None of these patients had neurological complications. The treatment with four tuberculostatic agents (isoniazid, rifampicin, pyrazinamide and ethambutol) was effective in 5 patients.

CONCLUSIONS

Tuberculous spondylodiscitis may become a serious disease due to diagnostic and treatment delays. The main examinations to establish diagnosis are magnetic resonance imaging and biopsy with microbiological culture. Generally, antituberculous therapy is effective in this clinical situation.

[Dermatophytoses due to anthropophilic fungi in Cadiz, Spain, between 1997 and 2008]

BACKGROUND AND OBJECTIVES

Cutaneous fungal infections are a major public health problem. The distribution of the dermatophytoses varies between countries and geographical areas. The aim of this study was to determine the incidence, epidemiology, etiology, and clinical course of the dermatophytoses caused by anthropophilic fungi in Cadiz, Spain, over the past 12 years.

MATERIAL AND METHODS

The study, conducted between 1997 and 2008, included 2,235 samples from lesions of the skin, hair, and nails of 2,220 patients with a clinical suspicion of mycosis. Samples were examined by microscopy using potassium hydroxide and were cultured on mycological media. The dermatophytes were identified by their macroscopic and microscopic characteristics.

RESULTS

Cultures were positive in 283 cases (12.7%). Anthropophilic dermatophytes (53.3%) were more common than zoophilic (41.3%) and geophilic (5.3%) dermatophytes. Trichophyton rubrum (38.2%) was the predominant pathogen isolated, followed by Microsporum canis (22.3%) and Trichophyton mentagrophytes (15.5%). Five other species of anthropophilic fungi were identified: Trichophyton tonsurans (5.6%), Trichophyton violaceum (4.9%), Epidermophyton floccosum (2.8%), Trichophyton soudanense (1.0%), and Trichophyton schoenleinii (0.7%). Infections caused by the anthropophilic fungi included tinea unguium (29.1%), tinea corporis (25.8%), tinea pedis (19.2%), tinea cruris (11.9%), tinea capitis (5.3%), and tinea faciei (3.3%).

CONCLUSIONS

The principal fungus responsible for dermatomycosis in Cadiz was T. rubrum, and its incidence has been rising since 2000. The prevalence of other anthropophilic fungi, such as T. tonsurans and T. violaceum, has increased, though this is not directly related to immigration. E. floccosum, T. soudanense, and T. schoenleinii are isolated occasionally.

[Assessment of in vitro susceptibility to antimicrobials of rapidly growing mycobacteria by E-test]

BACKGROUND

Rapidly growing mycobacteria (RGM) are considered opportunistic pathogens. An increasing number of post traumatic or surgical infections are caused by these microorganisms.

AIM

To determine the antimicrobial susceptibility of RGM using the E-test method.

MATERIAL AND METHODS

A total of 54 isolates of RGM was obtained from several clinical samples and selected for this study Strains were identified to the species level by phenotypic and biochemical characteristics, PCR-restriction enzyme analysis of the hsp65 gene (PRA) and sequencing of the 16S rRNA. Susceptibility was investigated by E-test to amikacin, cefoxitin, ciprofioxacin, clarithromycin, imipenem, quinupristin/dalfopristin, linezolid and tigecycline.

RESULTS

Twelve different species of RGM were identified: Mycobacterium fortuitum (23 strains), M chelonae (11), M abscessus (10), Msenegalense (2), Malvei (1), Mbrumae (1), Mmageritense (1), mucogenicum (1), M neoaurum (1), Mperegrinum (1), M septicum (1) y M smegmatis (1). All the strains were inhibited by low concentrations of amikacin and tigecycline. Susceptibility to cefoxitin, fluoroquinolones, clarithromycin, imipenem and linezolid was variable. All but two strains were resistant to quinupristin/ dalfopristin.

CONCLUSIONS

Due to the uneven antimicrobial susceptibility of different species of RGM, an antimicrobial susceptibility test is mandatory for these microorganisms. The E-test method is well suited to determine minimum inhibitory concentrations.

[Susceptibility to antimicrobial agents of rapidly growing mycobacteria]

Rapidly growing mycobacteria are often associated with human diseases. We investigated the in vitro susceptibilities of 40 isolates to six antimicrobial agents: 17 Mycobacterium fortuitum, 11 M. chelonae and 12 M. abscessus isolated from several human sources: 29 respiratory secretions, 5 cutaneous abscesses, 4 corneal ulcers and 2 urine samples of patients treated at "Hospital Puerta del Mar" (Cádiz). Susceptibility studies were determined by the broth microdilution method for amikacin, clarithromycin, ciprofloxacin, levofloxacin, imipenem and cefoxitin. Results suggest that amikacin is the most effective antimicrobial agent for treating infections due to rapidly growing mycobacteria. Clarithromycin and imipenem show good activity against M. fortuitum and M. abscessus, but not against M. chelonae. Quinolones are only effective against M. fortuitum. It's important to identify, in rapidly growing mycobacteria infections, the etiologic agent to determine correct treatment.

[In vitro activity of amphotericin B, itraconazole and voriconazole against 20 species of Aspergillus using the Sensititre microdilution method]

BACKGROUND

The in vitro activity of antifungal agents against Aspergillus has been recently investigated. We studied the susceptibility to amphotericin B, itraconazole and voriconazole of 68 strains belonging to 20 different Aspergillus species.

METHODS

The minimum inhibitory concentrations (MICs) for 10 strains of A. fumigatus, 9 A. flavus, 8 A. niger, 5 A. tamarii, 5 A. versicolor, 4 A. terreus, 3 A. glaucus, 3 A. ochraceus, 3 A. oryzae, 2 A. candidus, 2 A. chevalieri, 2 A. rubrobrunneus, 2 A. sclerotiorum, 2 A. sydowii, 2 A. unguis, 2 A. ustus, 1 A. clavatus, 1 A. nidulans, 1 A. pseudofischeri y 1 A. reptans, were determined using the Sensititre Yeast One microdilution method.

RESULTS

Voriconazole was more active in vitro than amphotericin B and itraconazole, with 95.6% (65/68) of strains exhibiting MICs of < or = 2 mg/l. A. flavus, A. versicolor, A. terreus, A. ochraceus, A. sclerotiorum, A. ustus and A. reptans species presented reduced susceptibility to amphotericin B (MIC > or = 2 mg/l); A. niger, A. versicolor, A. sclerotiorum and A. ustus showed in vitro resistance to itraconazole (MIC > or = 1 mg/l); and A. sclerotiorum and A. ustus displayed poor susceptibility to voriconazole (MIC > or = 2 mg/l).

CONCLUSIONS

The susceptibility of Aspergillus species to itraconazole and voriconazole was generally good; nevertheless, susceptibility to amphotericin B was low. These results suggest that Aspergillus susceptibility testing to this antifungal agent would be advisable to guide treatment.

[Dermatophytoses due to Microsporum gypseum: report of eight cases and literature review]

Microsporum gypseum is a geophilic fungus infrequent agent of human dermatophytoses and world-wide in distribution. In Cadiz, Spain, between 1997 and 2003, a study of 133 positive cases showed that the fifth more isolated dermatophyte was M. gypseum (6.0%), followed by Trichophyton mentagrophytes (24,8%), Microsporun canis (24,6%), Trichophyton rubrum (21,8%) y Trichophyton violaceum (6,8%). During 2003 the infection due to this fungus has been repeatedly observed in our area (17.5%). We report herein eight new cases of infection by M. gypseum. Our epidemiological data were compared with those obtained by other authors in other regions of Spain and in those reported in other countries.

[Candida ciferrii in an immunocompromised patient]

A case of possible infection due to Candida ciferrii in an immunocompromised patient is presented. This fungal species has been rarely reported as cause of human infection. The isolate showed in vitro resistance to fluconazole.

[Carbohydrate assimilation by clinical and environmental Rhodotorula glutinis strains]

This study was carried to determine the carbohydrate assimilation patterns of Rhodotorula strains isolated from clinical and environmental specimens. We have tested the commercial system ID 32C (bioMerieux, France) on 80 different strains of Rhodotorula glutinis: 47 strains from clinical samples and 33 strains from environmental samples. The assimilation percentages obtained in our study for galactose, cellobiose, gluconate and sorbose were lower than those showed in the identification table of the method. However, the assimilation percentages for mannitol and esculin were higher. According to our results, we conclude that the numerical profiles and the identification software of the commercial system present limitations for the characterization of some R. glutinis strains.

Extracellular enzymatic activity in 11 Cryptococcus species

The extracellular enzymatic activity of 36 strains of yeast belonging to 11 species of the genus Cryptococcus, has been investigated, using the API-ZYM (BioMérieux, France) commercial system, with the objective of determining the differences in the enzymatic profiles of the various species. The strains studied were: 9 of C. neoformans, 7 of C. albidus, 6 of C. laurentii, 5 of C. uniguttulatus, 3 of C. humicolus, and 1 each of C. ater, C. curvatus, C. dimennae, C. hungaricus, C. infirmo-miniatus and C. magnus. All the strains showed enzymatic activity with positivity to Phosphatase alkaline, Esterase lipase C8, Leucine arylamidase, Phosphatase acid and Naphthol-AS-BI-phosphohydrolase, and negativity to Lipase C14, Trypsin, Chemotrypsin, beta-galactosidase, beta-glucuronidase and alpha-manosidase. Variable enzymatic activity was shown to Esterase C4, Valine arylamidase, Cystine arylamidase, alpha-galactosidase, alpha-glucosidase, beta-glucosidase, N-acetyl-beta-glucosaminidase and alpha-fucosidase. This allowed 11 separate enzymatic patterns to be established. The species C. neoformans and C. laurentii each presented two distinct patterns; C. uniguttulatus, C. hungaricus and C. magnus shared the same pattern; C. albidus, C. ater, C. curvatus, C. dimennae, C. humicolus and C. infirmo-miniatus presented an individual enzymatic pattern. The results obtained suggest that the API-ZYM system could be useful for the identification of species of the genus Cryptococcus and for the differentiation of the enzymotypes for epidemiological purposes.