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Biomedical subjects

B Petrini

Publications and source records attributed to B Petrini.

At least 19 recordsLinked to original sources

Mycobacterium marinum: ubiquitous agent of waterborne granulomatous skin infections.

Mycobacterium marinum is a waterborne mycobacterium that commonly infects fish and amphibians worldwide. Infection in humans occurs occasionally, in most cases as a granulomatous infection localized in the skin, typically following minor trauma on the hands. For this reason, infection is especially common among aquarium keepers. Such local infection may-though infrequently-spread to tendon sheaths or joints. Disseminated disease, which is rare, can occur in immunosuppressed patients. In order to obtain a definitive diagnosis, culture and histopathological examination of biopsies from skin or other tissues are recommended. Infections sometimes heal spontaneously, but drug treatment is usually necessary for several months in order to cure the infection. Doxycycline or clarithromycin is used most commonly, although in severe cases, a combination of rifampicin and ethambutol is recommended.

Animals↗

Clinico-mycological profile of dermatophytosis in a reference centre for leprosy and dermatological diseases in Addis Ababa.

To assess the clinical and fungal species spectrum of dermatophyte infection in a reference centre in Addis Ababa, 539 dermatological patients with signs of dermatophytosis were investigated. Seventy-one percent were female and 29% male, aged 2-66 years (median 9). Four hundred-fifteen (77%) had at least one skin lesion. Tinea capitis was diagnosed in 138/155 males (89%) as compared to 214/384 females (40%) (p < 0.05). T. capitis was diagnosed in 69% of the 374 children. Fingernails were affected in 132/145 (91%) of onychomycosis, 118 (90%) of these patients were females and 14 males (p < 0.05). Tinea corporis was observed in 45, and other types of tinea in 12 patients. Thirty-six percent of all patients had also other skin lesions, mostly impetigo. Of 490 cultured samples 364 (74%) grew dermatophytes: Trichophyton violaceum in 84%, Trichophyton verrucosum in 9.6%, Trichophyton tonsurans in 1.4% and T. rubrum in 0.5%. Additionally, 15 isolates were identified as white variants of T. violaceum, in 3 cases confirmed by sequencing of the rDNA ITS 2 region. T. capitis in young males and T. unguium of fingernails in females were the most common manifestations of dermatophytosis in Addis Ababa, usually caused by T.violaceum.

Adolescent↗

Prevalence of tinea capitis in Ethiopian schoolchildren.

The prevalence of dermatophytosis and the spectrum of dermatophyte species were determined in children attending two schools in Addis Ababa, Ethiopia. Demographic and clinico-dermatological data were collected. Specimens were taken for microscopy and culture from all suspected lesions. Dermatophyte species were identified by morphology and biochemical tests, supplemented by sequencing of the rDNA ITS 2 region in selected isolates. From the Biruh Tesfa Elementary School (BTES) 824 students, and from Mount Olive Academy (MOA) all 124 students, were included. In BTES 513 (62.3%) students were clinically diagnosed with dermatophytosis, 463 (90.3 %) of them with tinea capitis. In 200 consecutive samples from BTES, and in 66 from MOA, 75 and 62%, respectively, contained fungal elements at microscopy. From BTES, 163/496 (33%) samples were culture-positive, of which 149 (91.4%) grew with dark purple colonies identified as Trichophyton violaceum, while 244 (49.4%) samples were contaminated. A few strains grew slowly developing white to cream colonies, two were identified as T. verrucosum, and 12 as white T. violaceum. From MOA 44 (66.7%) of samples were culture-positive, 38 (87%) were identified as T. violaceum, and one (2.3%) as T. verrucosum, while 33% showed no growth. Four white isolates of T.violaceum were confirmed by DNA-sequencing. Dermatophytosis was thus diagnosed in 55-62% of children screened at two schools of different socioeconomic standards in the Ethiopian capital. Trichophyton violaceum constituted 87-90% of all isolates. White variants of T. violaceum were diagnosed in 16 cases.

Adolescent↗

White variants of Trichophyton violaceum isolated in Ethiopia.

Certain dermatophytes are geographically restricted and endemic in particular parts of the world, while other species may have a sporadic but worldwide distribution. Trichophyton violaceum is one of the most common dermatophytes causing tinea capitis, and is the predominant cause of tinea in Africa, South America and the Indian subcontinent. Among 1187 dermatophyte isolates collected from Ethiopian patients with various types of tinea, 32 isolates had uncharacteristic phenotypic features. Based on conventional methods complemented by sequence analysis of the rDNA ITS2 region, these isolates were identified as white variants of T. violaceum. This is the first time that white isolates of T. violaceum have been identified in Ethiopia.

Adolescent↗

Vulvovaginal candida in a young sexually active population: prevalence and association with oro-genital sex and frequent pain at intercourse.

OBJECTIVE: To study the prevalence of vulvovaginal candida among sexually active adolescents. To determine past and present symptoms, including pain at intercourse and potential behavioural risk factors associated with vulvovaginal candidiasis. METHODS: At an adolescent centre, 219 sexually active women who underwent genital examination, also completed a questionnaire on a history of genital symptoms and infections, sexual and hygiene habits, and the use of contraceptives. Symptoms and clinical signs were registered. Vaginal samples were analysed for candida species and urine for Chlamydia trachomatis. RESULTS: Candida culture was positive in 42% of the women and only 15% were asymptomatic. A history of recurrent candidiasis was given by 22%. Frequent pain at intercourse was reported by 24% and frequent oro-genital sex by 42% of the women. Frequent pain at intercourse was significantly associated with both the growth of candida and a history of recurrent candidiasis. Oro-genital sex was an independent risk factor for the growth of candida. CONCLUSION: In sexually active adolescents, who underwent genital examination, candida cultures were positive in 42%. The habit of frequent oro-genital sex was associated with the growth of candida. Pain at intercourse was associated with the growth of candida and recurrent candidiasis.

Adolescent↗

Evaluation of the BacT/ALERT 3D system for recovery and drug susceptibility testing of Mycobacterium tuberculosis.

We evaluated the BacT/ALERT 3D system for recovery and drug susceptibility testing (DST) of Mycobacterium tuberculosis (MTB). Of 2659 clinical specimens, MTB was detected in 92 using BacT/ALERT, compared to 94 using Löwenstein-Jensen culture. Detection time was 25% shorter with BacT/ALERT. Sensitivities were 92%, 96%, 78% and 100% for resistance to rifampicin, isoniazid, streptomycin and ethambutol, respectively, while specificity was 100% for all antibiotics, when BacT/ALERT was compared with the BACTEC 460 method on 50 MTB isolates. The BacT/ALERT system is fully automated and creates no radioactive waste. It seems to be a valid alternative for primary isolation, but further evaluation is needed regarding DST.

Humans↗

Early chemotherapy for non-tuberculous mycobacterial infections in patients with cystic fibrosis.

AIM: To evaluate the response rate to antimycobacterial drug therapy in patients with cystic fibrosis (CF) suffering from infection by non-tuberculous mycobacteria (NTM). METHODS: Ten patients, aged 10-34 y, out of 180 CF patients, were diagnosed with NTM disease. They had been regularly checked and examined for pulmonary symptoms, and had had chest X-rays and sputum cultures (including for mycobacteria) performed. One additional 36-y-old female received her CF diagnosis soon after the NTM diagnosis. RESULTS: Mycobacterium avium-intracellulare complex (MAC) was found in 10 out of 11 patients and M. kansasii in 1 patient. Treatment with antimycobacterial drugs resulted in clinical improvement (weight gain or stabilization of weight and/or improved or stabilized lung function in 8 out of 11 patients) and mycobacterial culture turned negative in 10 out of 1. CONCLUSION: Promising results may be associated with early intervention with antimycobacterial therapy in CF patients.

Adolescent↗

Bone and joint infection after traumatic implantation of Scedosporium prolificans treated with voriconazole and surgery.

UNLABELLED: Scedosporium prolificans is an environmental mould that may cause local infection in bone and joints after traumatic implantation, or generalized infection in immunocompromised patients. The fungus is highly drug resistant, both in vitro and in vivo. We present a case of osteomyelitis and arthritis caused by S. prolificans in a 9-y-old boy whose knee had been punctured by a hawthorn spike. Treatment with different drugs was difficult and arthrodesis was necessary. Concomitantly, voriconazole was given, and after three months bone biopsies were sterile despite a high in vitro MIC-value of the fungus against voriconazole. Reversible skin depigmentation and fingernail oncholysis appeared toward the end of 17 months of voriconazole treatment. Twelve months after discontinuation of treatment, no signs of relapse were detected. CONCLUSION: Voriconazole may be a valuable adjunct to surgical treatment of bone and joint infection by Scedosporium prolificans.

Arthritis, Infectious↗

Drug susceptibility testing of Mycobacterium tuberculosis to fluoroquinolones: first experience with a quality control panel in the Nordic-Baltic collaboration.

In the first attempt to establish a quality assurance programme for susceptibility testing of Mycobacterium tuberculosis to fluoroquinolones, 20 strains with different fluoroquinolone susceptibility patterns were distributed by the Supranational Reference Laboratory in Stockholm to the other mycobacterial reference laboratories of the Nordic and Baltic countries. Susceptibility testing to fluoroquinolones was performed according to routine procedures in each laboratory. Results were compared to sequence analysis of the gyrA gene and minimal inhibitory concentration determination. Most laboratories found identical susceptibility patterns. The two resistant strains were correctly identified by all laboratories, but three laboratories each falsely reported one susceptible strain as resistant. These results indicate that the participating laboratories yield reliable results in detection of fluoroquinolone-resistant strains, although the need for a standardised quality assurance programme for drug susceptibility testing for fluoroquinolones is stressed by the strains falsely reported as resistant.

Antitubercular Agents↗

[Botryomycosis--peculiar bacterial granuloma].

Botryomycosis is a chronic granulomatous infection, usually of skin or mucous membranes in predisposed individuals. Infection in internal organs may occur in immunosuppressed persons and is serious but uncommon. Trauma or foreign bodies and defective immune defense mechanisms predispose for the disease, which is mainly caused by Staphylococcus aureus, but also by other bacteria. The histopathological picture is diagnostic and biopsy is encouraged in granulomatous infections. Differential diagnoses may be mycobacteriosis, mycosis and parasitosis. If excision, the preferred treatment, is not radical, prolonged antibiotic treatment is required. The disease may become more widespread in connection with the common use of piercing in young immunocompetent persons.

Aged↗

Liposomal amphotericin B and surgery in the successful treatment of invasive pulmonary mucormycosis in a patient with acute T-lymphoblastic leukemia.

Pulmonary mucormycosis is a usually fatal opportunistic infection in immunocompromised patients. We describe the first case of an adult patient with hematological malignancy and profound neutropenia to survive a disseminated pulmonary Rhizomucor pusillus infection. Early diagnostic procedures combined with high doses of liposomal amphotericin B and surgical resection may have contributed to the successful outcome.

Amphotericin B↗

Malassezia pachydermatis fungaemia in a neonatal intensive care unit.

UNLABELLED: Malassezia pachydermatis, a non-obligatory lipophilic yeast, has occasionally been implicated in nosocomial fungaemias. This study investigated a cluster of eight cases of M. pachydermatis infection and colonization in a neonatal intensive care unit over a 6 mo period. All patients were preterm with very low birthweight and suffered from various underlying diseases. Prolonged use of indwelling catheters and parenteral lipid formulations were important predisposing factors for their infection. All M. pachydermatis strains were susceptible to amphotericin B, fluconazole and itraconazole but resistant against flucytosine. CONCLUSION: Molecular typing by random amplification of polymorphic DNA showed distinct banding profiles for each blood isolate. Since no epidemiological association among the strains could be shown, the reason for this cluster of nosocomial fungaemias remains unclear.

Antifungal Agents↗

[BCG vaccination--controversy and compromise].

In Sweden, BCG-vaccination is recommended to certain risk groups only, as the incidence of TB is very low. Children from high-endemic areas, as well as health care personnel, especially those working in risk areas, are the most important target groups. The efficacy of BCG vaccination has varied in different investigations, but early Nordic studies have shown approximately 80 percent protection. Vaccination prevents disseminated but not localized pulmonary disease. There are no data supporting revaccination. Today some Swedish children are vaccinated without a clear indication, due to caretakers' fear of TB. The risk of new infection is very low in Sweden today, and is for all practical purposes limited to the closest family members of affected individuals. If large numbers of refugees from high-endemic countries arrive in Sweden, the epidemiological situation must be closely monitored.

BCG Vaccine↗

Identification of non-tuberculous mycobacteria: 16S rRNA gene sequence analysis vs. conventional methods.

In a retrospective study, 45 clinical isolates of non-tuberculous mycobacteria were identified to the species level by biochemical profile, gas liquid chromatography and partial sequence analysis of 16S rRNA, and were found to represent 13 different species. The results of sequence analysis showed 100% identity with conventional tests for 34 isolates (76%) and could identify species such as M. bohemicum which are difficult to characterise with conventional methods. Most of the discrepant results for the remaining 11 isolates resulted in species of the same group of mycobacteria. Based on these findings. we concluded that direct sequence analysis of amplified 16S rRNA gene is a promising rapid and accurate method for species determination of non-tuberculous mycobacteria.

Bacterial Typing Techniques↗

Coccidioidomycosis as imported atypical pneumonia in Sweden.

Coccidioidomycosis, an endemic fungal infection of the western hemisphere causes serious disease in immunocompromised individuals. In immunocompetent patients, a moderate flu-like disease may develop. We report here an imported Scandinavian case of a culture-proven coccidioidomycosis, initially presenting as an atypical pneumonia. Pleuritic symptoms, positive epidemiology and eosinophilia led to suspicion of the diagnosis, which was further supported by serology.

Aged↗