Percorrer por autor "Parada, H."
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- Dermatomycosis in lower limbs of diabetic patients followed by Podiatry consultationPublication . Parada, H.; Veríssimo, C.; Brandão, João; Nunes, Baltazar; Boavida, J.; Duarte, R.; Peerally, Z.; Rosado, L.; Sabino, R.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. OBJECTIVES: 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 AND PATIENTS: 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 T. mentagrophytes (7.7%) and T. tonsurans (4.4%). Our study showed positive associations between type 2 diabetes and the presence of dermatomycosis in the studied population (p=0.013); also between the occurrence of dermatomycosis and localization of 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.
- Fungal Meningitis in an Immunocompetent PatientPublication . Louro, R.; Ferreira, R.; Pinheiro, C.; Parada, H.; Faria, D.; Monteiro, E.Cryptococcal meningitis is a rare entity among immunocompetent hosts but, when it occurs, it is associated with significant morbidity and mortality. Clinical presen- tation as well as the course of the disease is usually subtle and indolent with headache and altered mental status. The authors present the case of a 59-year-old man, who sought medical help with a 2-week history of headaches accompanied by nausea and visual and hearing disturbances. On admission the patient was afebrile, presented visual and hearing deficits and had a normal magnetic resonance image of the brain. A lumbar puncture was performed and microscopic examination of the cerebrospinal fluid revealed yeasts that were identified as Cryptococcus spp. and later, by means of molecular biology techniques, as Cryptococcus neoformans, var. grubii. The patient was treated with liposomal amphotericin B plus fluconazole for 28 weeks. At follow-up after 1 year the patient was asymptomatic and received fluconazole 400 mg/day as prophylactic therapy. The outcome of Cryptococcus infections in immunocompetent hosts is reported to be poor as a result of a delayed diagnosis and suboptimal initial antifungal therapy. The influence of the normal immune response is unclear.
- Molecular screening of 246 Portuguese Aspergillus isolates among different clinical and environmental sourcesPublication . Sabino, R.; Veríssimo, C.; Parada, H.; Brandão, João; Viegas, C.; Carolino, E.; Clemons, K.V.; Stevens, D.A.Clinical and environmental samples from Portugal were screened for the presence of Aspergillus and the distribution of the different species-complexes determined to understand differences in their distribution from different sources. Fifty-seven Aspergillus isolates from clinical samples were collected from 10 health institutions. Six species-complexes were detected by ITS sequencing: Fumigati, Flavi, and Nigri were the most frequent (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. tubigensis, and Emmericella echinulata) being identified among the 57 isolates. Thirty-nine isolates of Aspergillus were recovered from beach sand and poultries, 31 from swineries, 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 the most frequently (23.8%). There was a significant association between the different environmental sources and the distribution of the several species-complexes; the hospital environment had greater variability of species-complexes than other environmental locations. A high prevalence of cryptic species within Circumdati complex was detected in several environments and 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 or corrective measures to be taken, which may result in decreased exposure to those organisms and a better prognosis.
- Pathogenic fungi: an unacknowledged risk at coastal resorts? New insights on microbiological sand quality in PortugalPublication . Sabino, R.; Veríssimo, C.; Cunha, M.A.; Wergikoski, B.; Ferreira, F.C.; Rodrigues, R.; Parada, H.; Falcão, L.; Rosado, L.; Pinheiro, C.; Paixão, E.; Brandão, JoãoWhilst 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, 25 cfu/g for E. coli, and 10 cfu/g for intestinal enterococci.
- Screening of cryptic species among clinical Aspergillus isolates collected during one year period in a Portuguese reference laboratoryPublication . Sabino, R.; Veríssimo, C.; Parada, H.; Clemons, K.V.; Stevens, D.A.Objectives: Correct identification of Aspergillus species is important given that sibling species may show variable susceptibilities to multiple antifungal drugs and also because sharper definition of species may facilitate epidemiological studies. Thus, we screened Aspergillus clinical isolates from Portuguese hospitals to determine which, if any, of the cryptic species of Aspergillus were involved in patient infections. Methods: Over a one year period, Aspergillus isolates from Portuguese health institutions were collected. These isolates were identified on the basis of microscopic morphology and through the use of molecular tools. Genomic DNA was prepared from each isolate and the sequencing of the Internal Transcribed Spacers (ITS) regions, specifically the ITS1 and ITS2 non-coding regions flanking the 5.8S rDNA was used to determine the species complex, whereas β-tubulin and calmodulin sequencing was done to achieve the correct species identification. Results: Over the study period, 57 Aspergillus isolates from clinical samples were collected from 10 Portuguese health institutions. According to the morphological observations, 29 isolates were identified as Aspergillus fumigatus, 11 A. flavus, 8 A. niger, 3 A. nidulans, 2 A. terreus, 2 A. candidus and 2 Aspergillus sp. Among those isolates, six species-complexes were detected by ITS sequencing, and were distributed as follows: fumigati (50.1%), flavi (21.0%), nigri (15.8%), terrei (5.3%), nidulantes (3.6%) and versicolores (3.6%). β-tubulin and calmodulin sequencing resulted in ten (17.5%) cryptic species being identified among the 57 isolates. Six of those isolates belonged to the nigri complex (A. brasiliensis, A. awamorii and A. tubigensis), two to the versicolores complex (A. sidowii and A. fructus), one to the fumigati complex (A. lentulus) and one to the nidulantes complex (Emmericella echinulata). Conclusion: With rigorous application of molecular tools, cryptic species of Aspergillus are not uncommon in the clinic. The identification of cryptic species among the collected clinical isolates of Aspergillus alerts the clinician to isolates with reduced susceptibilities to antifungal drugs and emphasizes a correct identification to species level.