Antifungal Resistance in Cryptococcal Infections

Antifungal therapy, especially with the azoles, could promote the incidence of less susceptible isolates of Cryptococcus neoformans and C. gattii species complexes (SC), mostly in developing countries. Given that these species affect mostly the immunocompromised host, the infections are severe and difficult to treat. This review encompasses the following topics: 1. infecting species and their virulence, 2. treatment, 3. antifungal susceptibility methods and available categorical endpoints, 4. genetic mechanisms of resistance, 5. clinical resistance, 6. fluconazole minimal inhibitory concentrations (MICs), clinical outcome, 7. environmental influences, and 8. the relevance of host factors, including pharmacokinetic/pharmacodynamic (PK/PD) parameters, in predicting the clinical outcome to therapy. As of now, epidemiologic cutoff endpoints (ECVs/ECOFFs) are the most reliable antifungal resistance detectors for these species, as only one clinical breakpoint (amphotericin B and C. neoformans VNI) is available.

Structure of arboreal and herbaceous strata in a neotropical seasonally flooded monodominant savanna of Tabebuia aurea

Large areas in the Pantanal wetland are covered by monodominant formations, e.g. typical landscapes with local names such as "paratudal", dominated by T. aurea. Studies on structure of these formations generally include only woody strata, consequently the species richness registered is usually low due to the absence of the 'ground layer' of herbaceous and others low species. We recorded 13 species, 12 genera and 11 families for the arboreal stratum. Considering arboreal flora without the dominant (T. aurea) individuals showed great establishment in relation to the flood level between 35 - 45 cm while the individuals of the dominant species of 30 - 45 cm. The diameter distribution revealed that the population of T. aurea did not show the reverse J curve, the usual pattern for species in constant regeneration, also evidenced in inconstant Licourt quotient, indicating an episodic recruitment that could lead to future changes in structure. In the herbaceous strata we recorded 78 species, included in 62 genera and 27 families. Using plots method we sampled 46 species, 40 genera and 22 families, while in line interception we found 65 species distributed in 57 genera and 26 families. The floristic similarity of Sørensen between both methods was 59.4%, with 33 species in common, and the method of line interception was more efficient in detecting richness, with 35% more species found in the same time. According to the methods of plots and line interception applied on the woody stratum, our results gave similar detailed information on the structure of this type of savanna, and in spite of being monodominant it shows high species richness when the herbaceous stratum is taken into account. Plots and line interception methods showed similar results for the woody stratum and high species richness of the herbaceous stratum.