In Brazil, 4.5% of the AIDS-related opportunistic infections are caused by Cryptococcus neoformans. This pathogen is a ubiquitous environmental basidiomycetous encapsulated yeast, commonly found in soil and avian excreta. The present study investigates further the population structure of clinical and environmental C. neoformans isolates from south Brazil. One hundred five clinical and 19 environmental (pigeon excreta and Eucalyptus spp.) isolates from the Brazilian state Rio Grande do Sul were characterized based on morphological, biochemical, molecular and serological data. The majority of the clinical and environmental isolates analyzed belonged to C. neoformans var. grubii serotype A (89.5 and 52.6%, respectively), were mating type alpha (98.1 and 94.7%, respectively) and were phospholipase-positive (94.3 and 73.7%, respectively). PCR-fingerprinting with the microsatellite-specific primer M13 and the minisatellite-specific primer (GACA)(4) grouped the majority of the isolates into the molecular type VNI (89.5 of the clinical and 52.6% of the environmental isolates). Our results add considerable new information to the few available data on ecology, molecular biology and epidemiology of C. neoformans in the southern region of Brazil.
Na tentativa de identificar a possível fonte de infecção, inquiriu-se, na história epidemiológica de 42 pacientes portadores de criptococose, o contato com pombos. Informações compatíveis com nicho ecológico do Cryptococcus neoformans foram positivas em 16. Foram colhidas 59 amostras de solo contendo fezes de pombos, penas e material orgânico. O C. neoformans foi detectado em 4. Uma das amostras era originada da capital e três do interior do estado. O sorotipo A do C. neoformans isolado de um liquor coincidiu com o sorotipo da amostra isolada do centro de Porto Alegre, local apontado pelo paciente como possível fonte de infecção, caracterizando caso de Cryptococcus neoformans var. neoformans.
SUMMARYMycobacterium tuberculosis was isolated from a central venous catheter in a non-immunosuppressed patient with systemic tuberculosis.This case report represents a very uncommon form of isolation of Mycobacterium tuberculosis. A total improvement was obtained after treatment. KEYWORDS:Mycobacterium tuberculosis ; Bacteremia; Sepsis; Blood. CASE REPORTA 45 year-old man, with fever, cough and weight loss (4 kg/30 days) was admitted to the hospital. The chest X-ray shows left pleural effusion, and infiltration on both lungs. The patient underwent a central venous catheterization and after the catheter removal Mycobacterium tuberculosis was identified from it at the microbiology laboratory. The anti-HIV test was negative.The patient received antimycobacterial therapy for six months with total improvement. Microbiological investigationThe material obtained from the luminal side of the catheter was Gram-stained and a neutral gram bacilli were observed, suggesting mycobacteria. In the presence of acid fast bacilli by the Ziehl-Neelsen, the material was planted in Lowenstein-Jensen and 30 days after, a Mycobacterium spp was isolated. The germ was sent to the Reference Mycobacteriology Laboratory and was identified as Mycobacterium tuberculosis. Growth more than 7 days, non pigmented colonies, niacin positive, in Ogawa with drugs (PNB negative and TCH positive). DICUSSIONDespite their medical therapeutic qualities, catheters serve as a major focal point for infections, either as consequence of colonization of the canula wound or of the surface and/or luminal side of the catheter itself. In most instances the offending microorganisms have been species of Staphylococcus, Streptococcus, gram-negative bacilli, Corynebacterium, and Candida 5,7 .The recognition of nontuberculous mycobacteria, especially Mycobacterium chelonae, as cause of infection in the setting of long-term indwelling intravascular catheters has only recently gained the appreciation of clinicians and microbiologists 1,2,4 .In the present report, we describe a patient with pleural and pulmonary tuberculosis who developed a central venous catheter-associated bacteremia caused by M. tuberculosis.The M. chelonae is now being increasingly recognized as the cause of catheter-related infections, specially in patients with cancer 1,4 . They can cause exit site infections, tunnel infections or catheter associated bacteremia with disseminated disease. These rapidly growing mycobacteria are ubiquitous in nature, found in soil, water and dust. They also have been isolated from the respiratory and gastrointestinal tracts of humans without evidence of disease. On the Gram-stained smear they appear to be Gram-positive bacilli and are often mistaken by Corynebacterium species 6 .The report of a M. tuberculosis catheter associated infection seems to be very unusual, and it was possible to detect this germ, in this report, because of the meticulous routine done during the processment of the specimen. It was crucial to detect the organisms. The microscopy was very helpful...
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