Helena Parada

Pathogenic fungi: an unacknowledged risk at coastal resorts? New insights on microbiological sand quality in Portugal

Whilst the potential impact on beach users from microorganisms in water has received considerable attention, there has been relatively little investigation into microbial contaminants in sand. Thirty three beaches across Portugal were analyzed during a five year period (2006-2010) to determine the presence of yeasts, pathogenic fungi, dermatophytes, total coliforms, Escherichia coli and intestinal enterococci in sand. Our results showed that 60.4% of the samples were positive for fungi and that 25.2% were positive for the bacterial parameters. The most frequent fungal species found were Candida sp. and Aspergillus sp., whereas intestinal enterococci were the most frequently isolated bacteria. Positive associations were detected among analyzed parameters and country-regions but none among those parameters and sampling period. Regarding threshold values, we propose 15 cfu/g for yeasts, 17 cfu/g for potential pathogenic fungi, 8 cfu/g for dermatophytes. Twenty-five cfu/g for E. coli, and 10 [corrected] cfu/g for intestinal enterococci.

Molecular screening of 246 Portuguese Aspergillus isolates among different clinical and environmental sources

Clinical and environmental samples from Portugal were screened for the presence of Aspergillus and the distributions of the species complexes were determined in order to understand how their distributions differ based on their source. Fifty-seven Aspergillus isolates from clinical samples were collected from 10 health institutions. Six species complexes were detected by internal transcribed spacer sequencing; Fumigati, Flavi, and Nigri were found most frequently (50.9%, 21.0%, and 15.8%, respectively). β-tubulin and calmodulin sequencing resulted in seven cryptic species (A. awamorii, A. brasiliensis, A. fructus, A. lentulus, A. sydowii, A. tubingensis, Emericella echinulata) being identified among the 57 isolates. Thirty-nine isolates of Aspergillus were recovered from beach sand and poultry farms, 31 from swine farms, and 80 from hospital environments, for a total 189 isolates. Eleven species complexes were found in these 189 isolates, and those belonging to the Versicolores species complex were found most frequently (23.8%). There was a significant association between the different environmental sources and distribution of the species complexes; the hospital environment had greater variability of species complexes than other environmental locations. A high prevalence of cryptic species within the Circumdati complex was detected in several environments; from the isolates analyzed, at least four cryptic species were identified, most of them growing at 37ºC. Because Aspergillus species complexes have different susceptibilities to antifungals, knowing the species-complex epidemiology for each setting, as well as the identification of cryptic species among the collected clinical isolates, is important. This may allow preventive and corrective measures to be taken, which may result in decreased exposure to those organisms and a better prognosis.

Epidemiology of candidemia in oncology patients: a 6-year survey in a Portuguese central hospital.

This study presents data on the incidence of candidemia in a Portuguese oncology hospital during a 6-year period. The species distribution and their antifungal susceptibility, as well as the clinical outcomes associated with candidemia were evaluated. A total of 119 episodes were reported, with the majority occurring among patients older than 56 years. The most common underlying medical conditions were solid tumors (64.5%) and hematological disease (28.2%). The most frequent species found was Candida albicans (48.7%), followed by C. parapsilosis (20.2%), C. tropicalis (8.4%), C. krusei (6.7%) and C. glabrata (5.0%), but Saccharomyces cerevisiae and Rhodotorula mucilaginosa were also isolated. Candida albicans was more frequently associated with solid tumors of the gastrointestinal and genitourinary tracts and breast (P=0.005), while non-C. albicans Candida species were most frequently recovered from hematological patients (P=0.007). The mortality rate associated with candidemia was 31.9% (P=0.016). All C....

Dermatomycosis in lower limbs of diabetic patients followed by podiatry consultation

BACKGROUND Diabetic patients are particularly susceptible to fungal infections due to modifications that occur in their immunological system. These modifications compromise natural defences, such as skin and nails, especially from lower limbs. AIMS Assessing the presence of dermatomycosis in lower limbs of Portuguese diabetic patients followed on Podiatry consultation. Determination of possible predisposing factors and the most frequent fungal species associated with the cases are included in the study. METHODS A six-month prospective study was carried out in 163 diabetic patients with signs and symptoms of dermatomycosis followed by Podiatry at the Portuguese Diabetes Association in Lisbon. Samples from the skin and/or nails of the lower limbs were collected and demographic and clinical data of those patients were recorded. RESULTS Trichophyton rubrum was the most frequently isolated dermatophyte (12.1%), followed by Trichophyton mentagrophytes (7.7%) and Trichophyton tonsurans (4.4%). Our study showed positive associations between type 2 diabetes and the presence of dermatomycosis in the studied population (p=0.013); this association was also shown between the occurrence of dermatomycosis and the localization of the body lesion (p=0.000). No other predisposing factor tested was positively associated with infection (p>0.05). CONCLUSIONS Data on superficial fungal infections in diabetic patients are scarce in Portugal. This study provides information on the characterization of dermatomycosis in lower limbs of diabetic patients.

Diagnóstico da Tinea pedis e onicomicose em pacientes do Instituto Nacional de Saúde em Portugal: estudo de 4 anos

Since 2004, formaldehyde (FA) has been classified by the International Agency for Cancer Research as a carcinogen. The FA ranks 25th in the overall United States chemical production, with more than 5 million tons produced each year. Due to its economic importance and varied use, many individuals are exposed to FA at their occupational settings. This study aimed to assess the exposure to FA in two occupational settings – FA production factory and pathology anatomy (PA) laboratories – and relate it to possible health effects by comparing frequency of micronuclei (MN) in peripheral bloodIntroducao: As desigualdades em saude sao reconhecidamente um problema de saude publica. A relacao entre determinantes sociais e as desigualdades em saude sao um achado robusto. Enquanto nos adultos e claro que estas desigualdades socioeconomicas se manifestam no seu estado de saude, a situacao e menos clara nas criancas e adolescentes. Foi entao efetuada uma revisao da literatura sobre a influencia dos determinantes sociais na saude na idade pediatrica. De forma a contribuir para um melhor conhecimento sobre a materia. Metodologia: A pesquisa foi efetuada segundo as normas PRISMA, com base nos termos MeSH: Social Class, Pediatric, Hospital, Emergency Treatment, Socioeconomic factor e Healthcare Disparities, na PubMed, Scielo e nas bases de dados da Cochrane. Foram excluidos artigos de revisao, opiniao bem como artigos que tratavam de questoes de acesso aos cuidados. Foi efetuada uma descricao quantitativa e qualitativa dos resultados. Resultados: Foram selecionadas 17 publicacoes, exceto uma do tipo descritiva, todas referentes a estudos observacionais analiticos, a maioria usando dados retrospetivos. Encontrou-se forte evidencia na relacao entre desigualdades em saude e os fatores socio economicos na idade pediatrica. Conclusao: Apesar de nenhuma das publicacoes selecionadas apresentar dados colhidos em Portugal, e seguro afirmar que e possivel encontrar a mesma relacao na idade pediatrica. E importante estudar mais esta area, identificar os determinantes sociais mais importantes bem como as populacoes mais vulneraveis, para melhor poder planear os cuidados de saude e combater as desigualdades. Palavras-Chave: Desigualdades em Saude, Determinantes Sociais da Saude, Fatores Socio-economicos, Pediatria

Keratinophilic Fungi: a microscopic approach by in vitro hair perforation analysis

Nowadays, environmental moulds are often being referred as also being the cause of superficial mycosis. Keratinophilic activity is one of the characteristics involved in the infectious process of some fungal species. With these findings some problems appear: 1) Do these species really act on keratinized tissues?; 2) How do these fungi perform their keratinophilic activity?; 3) Should we validate the results as positives in the case of isolating from the lesions only species considered as environmental? To answer to these questions, the in vitro hair perforation test was performed in 60 different species, including dermatophytes and environmental isolates. In vitro perforation capability, believed to be one of the characteristics involved in some fungal infectious processes, was assessed with aid of optic-, fluorescence-, electron scanning- and transmission-microscopy, followed by calculation of keratinophilic activity. According to Ali-Shtayeh et al. , each hair degradation factor has a specific weight in a keratinolytic activity intensity index called “IKA”, which ranges between 0 and 100%. Changes in the hair structure may occur in the two following different ways: (a) Superficial Erosion, where there is an even hair degradation from the outside to the inside (b) Radial Penetration where there is a localized degradation of hair surface, often in a pocket-like structure. Different types of hyphae are observed: of narrow diameter called boring hyphae , of larger diameter called wider boring hyphae ) and swollen boring hyphae (with dilated tips). Hyphae may also produce highly specialized perforation organs.