The echinocandins are large lipopeptide molecules that, since their discovery approximately 41 years ago, have emerged as important additions to the expanding armamentarium against invasive fungal diseases. Echinocandins exert in vitro and in vivo fungicidal action against most Candida species and fungistatic action against Aspergillus species. However, the population of patients at risk for developing invasive fungal infections continues to increase. New therapeutic strategies using echinocandins are needed to improve clinical outcomes in patients with invasive fungal disease.
Two unusual occurrences of pleural trichomonosis due to a new Tetratrichomonas species previously reported but not named were confirmed. In one patient, Trichomonas tenax and a Tetratrichomonas species were also detected in the oral cavity by molecular methods. We suggest that this new Tetratrichomonas species be named Tetratrichomonas empyemagena. CASE REPORTSC ase 1 is that of a 54-year-old male from Mexico City with uncontrolled type 2 diabetes who was admitted to the hospital with a history of 1 week of malaise, poor food intake, chills, and fever after developing right thoracic pain, dyspnea, and fatigue; he denied any history of choking or trauma in recent days. Dullness on percussion and decreased breathing sounds were noted over his right chest. His blood pressure was 120/50 mmHg, his heart rate was 120 beats/min, his respiratory rate was 30 breaths/min, his white blood cell count was 45,000/mm 3 , his platelet count was 565,000/mm 3 , his glucose level was 503 mg/dl, his albumin level was 1.6 g/dl, and his arterial HCO 3 level was 5.6 meq/liter. An initial chest X-ray and computed tomography (CT) scan showed a right pleural effusion that was drained (700 ml), and the pleural fluid was sent for microbiological analysis. Its macroscopic appearance was that of a brownish purulent fluid. Microscopic examination revealed Gram-positive cocci and Gram-negative bacilli, as well as numerous motile and flagellated protozoa that were initially identified as trichomonads because of their morphological characteristics (form, size, and motility). These flagellates were not cultured, and their identification was confirmed by microscopic examination of an empyema fluid smear. Samples were mixed with whole blood at 1:3, spread onto glass slides, air dried, methanol fixed, and stained with Giemsa stain (Fig. 1A and B). Some aliquots of empyema fluid were stored at Ϫ20°C for molecular analysis. Bacteriological cultures of the fluid were performed for aerobic and anaerobic microorganisms, yielding Staphylococcus auricularis, but no bacilli were identified until after PCR sequencing of an empyema fluid sample. A Prevotella species was demonstrated by using universal primers for the 16S rRNA gene (1). Antibiotic therapy with metronidazole and piperacillin-tazobactam was administered.Case 2 is that of a 33-year-old man from Mexico City with a history of smoking and alcohol consumption who was admitted to the hospital with a 2-week nonproductive cough and chills, dyspnea, and left pleural chest pain. His blood pressure was 70/40 mmHg, his heart rate was 150 beats/min, and his respiratory rate was 40 breaths/min. During subsequent days, fever and diaphoresis were added to the clinical course, as well as worsening of dyspnea until he developed acute respiratory failure and septic shock. Thorax auscultation revealed bilateral crackles and diminished breath sounds on the left side; he was placed on mechanical ventilation. A chest X-ray and a thorax CT scan showed a right pneumothorax and left pleural effusion. He underwent bilater...
National HIV preventive programs in Mexico focus on high-risk groups that do not consider women, apart from prenatal screening. Nonetheless, the epidemic in women is growing, and there is a need to better understand sociodemographic factors in women living with HIV (WLH). We performed a case–control study in Mexico City, including HIV+ and HIV− women with a recent pregnancy to compare their sociodemographic characteristics and describe the circumstances of diagnosis in HIV+ women, as well as prenatal screening frequency in both groups. Fifty cases and 102 controls were interviewed. HIV+ women were more frequently the only economic support of the family (20% vs 0%, P < .0001). Thirty-eight percent of cases had their first pregnancy at ≤18 years, versus 16% of controls (odds ratio 2.47, 95% confidence interval 1.07–5.72, P = .03); 16% of cases had lived in the street; 6% reported transactional sex, versus none of the controls (P < .0001). In the multivariate analysis, there was strong evidence of an association between HIV infection and age at the time of the interview, history of sexually transmitted diseases, substance abuse, history of violence, and civil status. Only 6% of controls were tested for HIV during prenatal follow-up. WLH in this study faced important social vulnerability. Targeting women living in these social contexts might increase early diagnosis and could tailor HIV prevention strategies. Prenatal coverage needs to be improved and should represent a national priority.
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