Persistent oral and urinary Candida spp. carriage in Italian HIV-seropositive asymptomatic subjects

The aim of the present study was to ascertain frequency and persistence of Candida spp. oral and urinary carriage in asymptomatic, HAART-naive HIV-seropositive subjects who had not undergone therapy with antimycotic drugs, and whose CD4+ lymphocyte count was greater than 200/microl. Oral carriage was the most common Candida spp. carriage (63.0% of the subjects), while candiduria was more rarely observed (6.5%). C. albicans was recovered from the majority of the subjects examined (56.5%), followed by C. krusey (4.3%), C. tropicalis (2.2%) and C. dubliniensis (2.2%). C. albicans was also isolated from two urinary carriers (4.3%) and C. glabrata from another one (2.2%). The same C. albicans clone was repeatedly isolated from 14 out of 15 oral carriers while the same clone of C. dubliniensis was repeatedly isolated from one carrier, as shown by the persistence of RAPD fingerprint of serial isolates during one year of follow-up. Since persistence of Candida spp. carriage may influence the development of clinical candidiasis in immunocompromised hosts, monitoring of the carrier status could be useful for preventing clinical thrush in HIV-seropositive subjects.

Carbohydrate assimilation profiles of the first Italian Candida dubliniensis clinical isolates recovered from an HIV-infected individual

A total of six Candida dubliniensis isolates were obtained during 1 year of monitoring by monthly swabs from the oral cavity of an asymptomatic human immunodeficiency virus-infected individual in Catania, Italy. To the authors' knowledge, this constitutes the first recovery of C. dubliniensis from a human in Italy. Our identification procedure was based on colony color on CHROMagar Candida and carbohydrate assimilation profiles obtained by two commercial systems: API ID 32C and API 20C AUX. Karyotyping by pulsed-field gel electrophoresis confirmed the phenotypic identification. The biocodes obtained with API 20C AUX and with API ID 32C were 6172134 and 7142140015, respectively, for all six isolates. Both biocodes corresponded to those described in the literature as being produced by most C. dubliniensis isolates with each of the two identification systems. Our results confirm that both API 20C AUX and API ID 32C are able to rapidly and accurately differentiate C. dubliniensis from C. albicans.

[Etiologic and epidemiologic study of dermatomycoses in Navarra (Spain)]

We review the etiology of the dermatophytosis in Navarra (Spain) over a 5-year period and it is compared with previous studies. We have isolated 312 strains of dermatophyte fungi in 285 patients (188 men and 97 women). Trichophyton rubrum was the most frequently isolated species (58.6%) followed by Trichophyton mentagrophytes (26.2%) and Microsporum canis (10.5%). Concerning the location of the lesions, tinea pedis was the clinical pattern found in the greatest number of patients, followed by tinea corporis, tinea unguium and tinea capitis. Twenty eight percent of the isolations were accomplished in October and November. More than half of those patients questioned had had epidemiological contact with animals or practiced sports. The rise of tinea pedis in our region is emphasised. The possible causes of this increment are analyzed and some recommendations for its control are made.

[A-V conduction in atrial flutter. Electrocardiographic study]

One hundred and twenty-nine cases of atrial flutter were analyzed to assess the A-V conduction. The R-R intervals, the A-V conduction ratio, and the F-R intervals were measured in each case. Conduction in atrial flutter was defined either as constant or as variable depending on whether the A-V conduction ratio was fixed or variable. Furthermore, atrial flutter was defined as regular whenever the R-R intervals were mathematically related to each other, any interval being a multiple of the F-F cycle. On the other hand, atrial flutter was defined as irregular when the R-R cycles did not reflect a precise mathematical relationship. The R-R intervals in irregular atrial flutter were not exactly multiples of the F-F cycle. This was because the F-R intervals were variable. Sixty-five cases of atrial flutter had constant A-V conduction, whereas 64 cases were associated with variable A-V conduction. Eighty-eight per cent of cases with constant conduction were regular. On the contrary, 91% of cases with variable A-V conduction were irregular. These data reflect a relationship between the constancy of the A-V conduction ratio and the regularity of the R-R intervals. Several mechanisms were identified as being responsible for atrial flutter irregularity. Alternation of the F-R intervals was the most frequent mechanism leading to irregularity of atrial flutter with constant A-V conduction. Alternating Wenckebach periodicity was the most common cause of irregularity in atrial flutter with variable conduction ratio. Concealed conduction of blocked impulses was also frequently involved in determining atrial flutter irregularity.

[Epidemiologic aspects of sepsis]

Sepsis is increasingly common and is now emerging as a iatrogenic condition, though the increase relates to both hospital-acquired and community-acquired infections. The causes and modalities of sepsis are reviewed with particular emphasis on the invasive treatment now extensively employed in patients with severe concomitant pathologies and immune deficiencies. The changing aetiology of the various forms of sepsis is analysed. These days common opportunistic Gram negative bacilli such as Enterobacteriacea and Pseudomonas as well as Candida mycetes are the most frequent cause of sepsis. The diagnostic importance of blood culture analysis is emphasised.

[Comparative study of the in vitro activity of 5 new antibiotics on strains isolated from urinary infections]

In vitro activity of Cefotaxime, Ceftriaxone, Ceftazidime, Piperacillin and Netilmicin against 189 urinary isolates of Enterobacteriaceae, Pseudomonas and Enterococcus has been evaluated. To assess the minimal inhibitory concentrations (MIC), the broth dilution method and the Sensititre system were employed. No considerable differences were found between the two methods. Cefotaxime showed the highest activity against Enterobacteriaceae, the great majority of the isolates being susceptible to 1 microgram/ml or less. Piperacillin showed good activity against Enterococci. Ceftazidime resulted the most active against Pseudomonas.

[Biochemical profile of mycobacteria isolated from clinical and environmental material]

Biochemical characteristics employed to identify tuberculous and non tuberculous mycobacteria were evaluated. Tests for detection of nitrate reductase, catalase, gamma-glutamyl-transferase, niacin assay and growth on TCH media (2-thiophene carboxylic-acid hydrazide) were regarded of discriminating value. These tests have been applied to identification of 78 clinical isolates of mycobacteria. All strains were identified as Mycobacterium tuberculosis, that suggest the infrequency of human infections from Mycobacterium bovis and mycobacteria other than tubercle bacilli in our geographic area. It is also outlined that the gamma-glutamyl-transferase test constitute a rapid and simple assay for discriminating Mycobacterium tuberculosis from other closely related mycobacteria.

[Resistance to antibiotics and resistance factors in Salmonella wien strains isolated in Sicily]

The majority of the strains of S. wien isolated in Sicily were resistant to six different antibiotics, showing the same resistance pattern (ASKCTSu) observed in strains isolated in other provinces of Italy. After conjugation with E. coli K12, the transfer of the whole pattern or of various groups of resistances was observed, which suggests the presence of several co-existent R plasmids. The results obtained suggest that the various outbreaks occurred in Italy have the same origin. They can be correlated with the epidemic of S. wien with the same transferable pattern of antibiotic resistance, spread in France in recent years from Algiers.

[Characteristics of the Salmonella and Shigella strains isolated from diarrhea patients during antibiotic therapy]

Drug resistant strains of Salmonella and Shigella were isolated from diarrhoeic children during antibiotic treatment. Two strains of Sh. flexneri serotype 2a, resistant to sulfonamides, streptomycin,chloramphenicol, and tetracyclines, were able to transfer "en bloc" their resistances to E. coli K12.