ABSTRACT Cryptococcal meningitis is the most common cause of opportunistic meningitis in HIV-infected patients in Brazil and causes unacceptable high mortality rates. In this study, HIV-infected patients with a first episode of culture-proven cryptococcal meningitis in cerebrospinal fluid (CSF) were prospectively included in order to evaluate sensitivity of cryptococcal antigen (CrAg) lateral flow assay (LFA) in serum, CSF, whole blood (fingerstick), and fresh urine. In addition, HIV-infected patients with other neurological confirmed diseases were included in order to evaluate the specificity of CrAg LFA in serum. Twenty patients with cryptococcal meningitis were included and in 19 of them, CrAg LFA in CSF, serum, and whole blood were positive (95% sensitivity). In 18 patients, India ink test was positive in CSF (90% sensitivity), and in 16 cases, CrAg LFA was positive in urine (80% sensitivity). Thirty-six HIV-infected patients with other neurological diseases had negative results of CrAg LFA in serum (100% specificity). In conclusion, CrAg LFA in serum, CSF, and whole blood showed high sensitivity and specificity. Whole blood CrAg LFA seems to be a good and reliable strategy to improve AIDS-related cryptococcal meningitis diagnosis in Brazil.

During the past decade, studies on the composition of human microbiota and its relation to the host became one of the most explored subjects of the medical literature. The development of high-throughput molecular technologies allowed a deeper characterization of human microbiota and a better understanding of its relationship with health and disease. Changes in human habits including wide use of antimicrobials can result in dysregulation of host–microbiome homeostasis, with multiple consequences. The purpose of this review is to highlight the most important evidence in the literature of host–microbiome interactions and illustrate how these intriguing relations may lead to new treatment and prevention strategies.

Com o objetivo de avaliar as diferentes frações fibrosas da silagem de resíduo de manga em mistura com diferentes aditivos, em níveis crescentes de adição, foi conduzido este estudo. O delineamento experimental utilizado foi o inteiramente casualizado, com três repetições, sendo os tratamentos dispostos em um esquema fatorial do tipo (4 x 3) + 1, sendo quatro aditivos (milho desintegrado com palha e sabugo (MDPS), palha de feijão (PF), sabugo de milho (SM) e casca de café (CC)) em três níveis de adição (10, 20 e 30%) e um tratamento testemunha (resíduo de manga puro ensilado). O material experimental foi ensilado em silos de PVC adaptados com válvula tipo "Bunsen" com capacidade para aproximadamente 3 kg cada. Todos os aditivos utilizados elevaram os teores de MS. Os aditivos PF, SM e CC elevaram os teores de FDN, FDA e celulose. Quanto aos teores de hemicelulose, apenas o aditivo SM promoveu aumento com a elevação dos níveis de adição. Comportamento semelhante foi observado para o aditivo PF em relação à lignina. Os valores registrados para as diferentes frações fibrosas das silagens, quando se utilizou o MDPS, sofreram reduções em relação ao resíduo de manga ensilado puro, não diferindo, no entanto, com o aumento dos níveis de adição. De maneira geral, a utilização dos demais aditivos, promoveu elevações nos teores das variáveis estudadas.

This study was undertaken with the goal of evaluating the different fibrous fractions of mango residue silage in mixture with different additives at growing levels of addition. The experimental design used was the completely randomized, with three replicates, the treatments being arranged in a 4 x 3 + 1 factorial arrangement, the additives being four (ground ears with husks (GEWH), bean straw (BS), corn cob (CC) and coffee hull (CH)) at three levels of addition (10, 20 and 30%) and a control treatment (ensiled unmixed mango residue). The experimental material was ensiled in PVC silos, fitted with a "Bunsen" type valve, with a capacity of about 3 kg each. All the additives utilized raised the DM contents. The additives BS, CC and CH raised the contents of NDF, ADF and cellulose. As regards hemicellulose contents, only the additive CC promoted increases with the rise of the levels of addition. A similar behavior was observed for the additive BS in relation to lignin. When GEWH was used in different levels of addition the fibrous fractions decreased when compared to the control treatment, but the values obtained did not differ statistically. In a general way, the other additives increased the content of the fibrous fractions as well.

Várias alterações epidemiológicas ocorreram no perfil das doenças infecciosas hospitalares e comunitárias nos últimos 25 anos. Mudanças sociais e demográficas possivelmente relacionadas com esse fenômeno incluem o rápido crescimento populacional, o aumento da migração urbana e deslocamento através de fronteiras internacionais por turistas e imigrantes, alterações nos habitats de animais e artrópodes que transmitem doença assim como o aumento no número de pacientes com deficiências nas respostas de defesa. Os programas contínuos de vigilância de patógenos emergentes e resistência antimicrobiana são necessários para a detecção em tempo real de novos patógenos assim como para caracterizar mecanismos moleculares de resistência. Para serem mais efetivos, os programasde vigilância dos patógenos emergentes devem ser organizados em uma rede de laboratórios multicêntricos ligados aos principais centros de controle de infecções, públicos e privados. Os dados microbiológicos devem ser integrados a guias terapêuticos adaptando práticas terapêuticas à ecologia local eaos padrões de resistência. O artigo apresenta uma revisão dos dados gerados pela Disciplina de Infectologia, Universidade Federal de São Paulo, contemplando sua participação nos diferentes programas de vigilância de doenças infecciosas hospitalares e adquiridas na comunidade.

Several epidemiological changes have occurred in the pattern of nosocomial and community acquired infectious diseases during the past 25 years. Social and demographic changes possibly related to this phenomenon include a rapid population growth, the increase in urban migration and movement across international borders by tourists and immigrants, alterations in the habitats of animals and arthropods that transmit disease, as well as the raise of patients with impaired host defense abilities. Continuous surveillance programs of emergent pathogens and antimicrobial resistance are warranted for detecting in real time new pathogens, as well as to characterize molecular mechanisms of resistance. In order to become more effective, surveillance programs of emergent pathogens should be organized as a multicenter laboratory network connected to the main public and private infection control centers. Microbiological data should be integrated to guide therapy, adapting therapy to local ecology and resistance patterns. This paper presents an overview of data generated by the Division of Infectious Diseases, Federal University of São Paulo, along with its participation in different surveillance programs of nosocomial and community acquired infectious diseases.

O objetivo do nosso estudo foi avaliar a eficácia do meio cromogênico Albicans ID2<FONT FACE=Symbol>Ò</FONT> (bioMérieux, France) na identificação de Candida albicans entre 330 amostras de leveduras. As cepas de C. albicans (100) e C. dubliniensis (20) exibiram coloração azul quando semeadas em Albicans ID2<FONT FACE=Symbol>Ò</FONT>. Contudo, a coloração azul também foi verificada em culturas de C. rugosa (30/30) e C. tropicalis (3/50).

The aim of our study was to evaluate the accuracy of the chromogenic media Albicans ID2<FONT FACE=Symbol>Ò</FONT> (bioMérieux, France) for the identification of Candida albicans among 330 yeast strains. All C. albicans (100) and C. dubliniensis (20) strains exhibited blue color when cultured on Albicans ID2<FONT FACE=Symbol>Ò</FONT>. However, the blue color was also exhibited by cultures of C. rugosa (30/30) and C. tropicalis (3/50) isolates.

Dezenove culturas de C. dubliniensis isoladas no Brasil, previamente identificadas através de métodos genotípicos, foram avaliadas pelo kit comercial ID 32C (bioMerieux). Treze culturas foram identificadas como C. dubliniensis, mas as demais (seis) evidenciaram perfil duvidoso, embora o software do sistema sugerisse 83,6% de chances das mesmas pertencerem à espécie C. dubliniensis. A literatura tem registrado grande variabilidade fenotípica com esta espécie e, por isto, as identificações obtidas com este sistema deverão ser consideradas como presuntivas.

The purpose of the present study was to evaluate the identification of 19 Brazilian C. dubliniensis based on the biochemical profile exhibited when tested by the commercial identification kit ID 32C (bioMerieux). Thirteen of the isolates were rigorously identified as C. dubliniensis and the remaining isolates (six) were considered as having a doubtful profile but the software also suggested that there was 83.6% of chances for them to be C. dubliniensis. As well as pointed by the literature the identification obtained by phenotypic tests should be considered presumptive for C. dubliniensis due to variability of this new species.

The increasing magnitude of antifungal resistance as well as the advent of new antifungal drugs has generated a renewed interest in fungal susceptibility testing. We used a previously described disk diffusion method to evaluate the susceptibility profile of a large collection of recent clinical Candida spp. isolates against fluconazole. A total of 1,784 yeast isolates were tested, including the following species: Candida albicans (1,036), C. tropicalis (279), C. parapsilosis (202), C. glabrata (119), C. guilliermondii (90), C. krusei (32), C. lusitaniae (7), Candida spp. (14) and other yeasts (5). Susceptibility ranking to fluconazole obtained with all yeasts tested was: C. parapsilosis <FONT FACE=Symbol>@</FONT> C. tropicalis <FONT FACE=Symbol>@</FONT> C. guilliermondii > C. glabrata > C. krusei. The majority (94%) of all yeast isolates tested were susceptible to fluconazole. Isolates of C. glabrata and C. krusei exhibited the highest rate of DDS/resistance among all isolates tested but they represented only 9% of all yeasts routinely sent to our lab. Careful periodical surveillance is needed in order to identify any changes in the susceptibility patterns of fluconazole with the increased use of this antifungal agent in Brazilian tertiary care hospitals.

Problems with resistance to antifungal drugs have emerged due to an increase in the incidence of systemic fungal infections and widespread use of antifungal agents. Accordingly, efforts have been made to develop adequate fungal susceptibility tests. The ideal test should have high intra and inter-laboratory reproducibility, good correlation with the clinical outcome, and should be easy to perform. While no such test has yet been developed, advances have been made. Over the past decade, many reports of fungal resistance have been published, most of them in AIDS patients. Though the frequency of resistant strains is still low in neutropenic cancer patients, and is mostly limited to Candida glabrata and Candida krusei, resistance to Candida albicans has also been reported.