Irina Netsvyetayeva

Candida nivariensis in comparison to different phenotypes of Candida glabrata

The purpose of the study was to establish the prevalence of new Candida glabrata complex species: Candida nivariensis and Candida bracarensis isolated from clinical material, evaluate their phenotypes and the prevalence of gene family encoding extracellular glycosylphosphatidylinositol‐linked aspartyl proteases, crucial for C. glabrata virulence. Study material included 224 C. glabrata clinical strains. Candida glabrata phenotypes were identified using CHROMagar Candida medium. Strains were analysed by using C. glabrata‐specific PCR for the internal transcribed spacer region to confirmed the identification. To identify C. nivariensis and C. bracarensis strains, the D1/D2 region of 26S rRNA was sequenced. The prevalence of YPS‐family proteases genes was detected using standard PCR method. Candida nivariensis amounted about 6% among the total number of C. glabrata strains. Candida nivariensis strains had a white phenotype on chromogenic agar media and assimilated two sugars – trehalose and glucose. Among the 13 C. nivariensis strains, 10 did not present any YPS‐family protease genes. Coexistence of all detected YPS‐family protease genes was specific for C. glabrata species. This study identified C. nivariensis strains; however, no C. bracarensis strains were identified. The white phenotype of C. nivariensis was confirmed. Most strains of the new species do not present any of the tested YPS genes.

Staphylococcus aureus nasal carriage in Ukraine: antibacterial resistance and virulence factor encoding genes

BackgroundThe number of studies regarding the incidence of multidrug resistant strains and distribution of genes encoding virulence factors, which have colonized the post-Soviet states, is considerably limited. The aim of the study was (1) to assess the Staphylococcus (S.) aureus nasal carriage rate, including Methicillin Resistant S. aureus (MRSA) strains in adult Ukrainian population, (2) to determine antibiotic resistant pattern and (3) the occurrence of Panton Valentine Leukocidine (PVL)-, Fibronectin-Binding Protein A (FnBPA)- and Exfoliative Toxin (ET)-encoding genes.MethodsNasal samples for S. aureus culture were obtained from 245 adults. The susceptibility pattern for several classes of antibiotics was determined by disk diffusion method according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. The virulence factor encoding genes, mecA, lukS-lukF, eta, etb, etd, fnbA, were detected by Polymerase Chain Reaction (PCR).ResultsThe S. aureus nasal carriage rate was 40%. The prevalence of nasal MRSA carriage in adults was 3.7%. LukS-lukF genes were detected in over 58% of the strains. ET-encoding genes were detected in over 39% of the strains and the most prevalent was etd. The fnbA gene was detected in over 59% of the strains. All MRSA isolates tested were positive for the mecA gene. LukS-lukF genes and the etd gene were commonly co-present in MRSA, while lukS-lukF genes and the fnbA gene were commonly co-present in Methicillin Sensitive S. aureus (MSSA) isolates. No significant difference was detected between the occurrence of lukS-lukF genes (P > 0.05) and the etd gene (P > 0.05) when comparing MRSA and MSSA. The occurrence of the fnbA gene was significantly more frequent in MSSA strains (P < 0.05).ConclusionsIn Ukraine, S. aureus is a common cause of infection. The prevalence of S. aureus nasal carriage in our cohort of patients from Ukraine was 40.4%. We found that 9.1% of the strains were classified as MRSA and all MRSA isolates tested positive for the mecA gene. We also observed a high prevalence of PVL- and ET- encoding genes among S. aureus nasal carriage strains. A systematic surveillance system can help prevent transmission and spread of drug resistant toxin producing S. aureus strains.

Diagnosis of Invasive Pulmonary Aspergillosis

Culturing strains from clinical samples is the main method to diagnose invasive pulmonary aspergillosis. Detecting the galactomannan antigen in serum samples is an auxiliary examination. The goal of this study was to determine the frequency with which Aspergillus fumigatus was cultured in clinical samples taken from patients hospitalized in the the Infant Jesus Teaching Hospital in Warsaw, Poland, in the period of 2013-2014. Specimens from the respiratory tract and blood were cultured for mycological and serological assessments. Strain isolation was performed in chloramphenicol Sabouraud agar. Species identification was based on morphological traits in macro-cultures and on microscopic examination. The galactomannan antigen was detected by ELISA method. Out of 2000 clinical samples with positive mycological results, 200 were obtained from the respiratory tract. A. fumigatus was cultured in 13 cases from the respiratory group. Ten cases were cultured out of tracheal aspirates and three from bronchoalveolar lavage fluid. The galactomannan antigen was detected in a serum sample from only one out of the 13 patients with cultures positive for A. fumigatus. It also was detected in serum samples of three other patients in whom A. fumigatus culture yielded a negative result. We conclude that culture-confirmed invasive pulmonary aspergillosis represents a scarce finding. A. fumigatus cultured from clinical samples may not always be confirmed by ELISA assay and vice versa a positive ELISA result does not attest the successful culture.

Skin bacterial flora as a potential risk factor predisposing to late bacterial infection after cross-linked hyaluronic acid gel augmentation

Introduction Cross-linked hyaluronic acid (HA) gel is widely used in esthetic medicine. Late bacterial infection (LBI) is a rare, but severe complication after HA augmentation. The aim of this study was to determine whether patients who underwent the HA injection procedure and developed LBI had qualitatively different bacterial flora on the skin compared to patients who underwent the procedure without any complications. Methods The study group comprised 10 previously healthy women with recently diagnosed, untreated LBI after HA augmentation. The control group comprised 17 healthy women who had a similar amount of HA injected with no complications. To assess the difference between the two groups, their skin flora was cultured from nasal swabs, both before and after antibiotic treatment in the study group. Results A significant increase in the incidence of Staphylococcus epidermidis was detected in the control group (P=0.000) compared to the study group. The study group showed a significantly higher incidence of Staphylococcus aureus (P=0.005), Klebsiella pneumoniae (P=0.006), Klebsiella oxytoca (P=0.048), and Staphylococcus haemolyticus (P=0.048) compared to the control group. Conclusion The bacterial flora on the skin differed in patients with LBI from the control group. The control group’s bacterial skin flora was dominated by S. epidermidis. Patients with LBI had a bacterial skin flora dominated by potentially pathogenic bacteria.

Vascular Complication in Aesthetic Medicine Treated with Hyperbaric Oxygenation

Abstract The most hazardous adverse reactions following hyaluronic acid injections in aesthetic medicine involve vascular complications, known as the Nicolau Syndrome. This article presents a vascular complication in the area of the upper part of the nasolabial fold following subcutaneous administration of 0.5 ml of hyaluronic acid. At the time of the injection, paling occurred, which was followed by livedo racemosa appearing an hour later. Upon the lapse of a week, an ulceration appeared. It was not until the tenth day after the hyaluronic acid injection that hyaluronidase was administered. After 15 hyperbaric oxygen exposures, the ulcer was completely healed

Handling of Fungal Infections in Patients with Chronic Immunosuppression Post Renal Transplant

Invasive fungal infections (IFI) are serious diagnostics-therapeutic problem in recipients of vascularised organs. The nature of the IFI is determined by the type of the transplanted organ. Invasive candidiasis mostly occurs in liver recipients and invasive aspergilosis – in lung recipients. The greatest risk of IFI is in recipients of simultaneous lung and heart and liver transplants. Morbidity for IFI in the first year after transplantation is estimated to be in recipients of heart and lungs 8.6%, liver 4.7%, pancreas and kidneys 4% and heart 3.4%. Incidents of IFI among kidney recipients is estimated by differed sources to lay between 0.01 – 1.5%. Although, IFI occur rarely in kidney recipients in comparison to recipients of other organs, invasive fungal infections carries a high risk of graft loss and high mortality in this population of patients. Among recipients which have developed an IFI the risk of graft loss was determined in approx. 50% of patients, and mortality in this group was approx. 15%. Yearly survival of patients after an episode of invasive aspergilosis is 59%, for mycosis caused by mould fungi from species other then Aspergillus sp. 61%, invasive candidosis 66%, cryptococcosis 73%. There is definitely a greater risk for recipients of kidneys collected from cadavers, compared to living donors related to the recipient, respectively 16.5% and 7.3%. Additionally in cases of a deceased donor there is a high transfer risk for yeast-like fungi colonising in the urinary tract of a terminal state patient, in result of the breakdown of the defensive mechanism and contamination of preservative fluids, to the uninfected recipient. Mortality is determined by the virulence of the microorganism, localisation of the infection, weakened inflammatory response of the macroorganism, frequent co-occurring of renal insufficiency and diabetes and other predisposing factors. Unspecific clinical symptoms, fast progression of the disease and, what appears to be particularly important, lack of a precisely set algorithms of diagnostic procedure, contribute to the fact that IFI in kidney recipients are a diagnostics challenge and has a questionable therapeutic result.