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The evolution of the incidence and the epidemiology of ocular candidiasis in our hospital during the past 12 y, as well as the factors associated with poor functional outcome were analysed. A retrospective study of all cases of ocular candidiasis admitted to a university hospital between 1993 and 2004 was performed. Epidemiological, clinical and final outcome data were recorded. 37 episodes of ocular candidiasis in 36 patients were studied. 28 (75%) episodes occurred between 1993 and 1998 (13.09 episodes/100,000 admissions/y), and all of these patients were intravenous drug users. In contrast, only 9 episodes of ocular candidiasis were recorded between 1999 and 2004 (4.42 episodes/100,000 admissions/y; p<.0001) and 3 (33%) patients were not drug users (p<0.01). 19 (57%) cases had final visual acuity <0.1. Treatment with conventional amphotericin B instead of other newer antifungal drugs was associated with poor visual prognosis in the univariate (p = 0.03) and multivariate (p = 0.03) analysis. In conclusion, the incidence of ocular candidiasis has decreased significantly in recent y and the epidemiology has changed. Currently, one-third of patients are immunocompromised non-drug users. Therapy with conventional amphotericin B instead of newer antifungal drugs appears to be associated with a poorer functional outcome.

Scedosporium prolificans is an emerging opportunistic fungal agent encountered in severely neutropenic patients. The purpose of this paper is to describe the main cranial CT findings from a retrospective review of six patients (four men and two women, 18-66 years old) afflicted with disseminated infection by S. prolificans with neurological symptoms. They were severely neutropenic and presented with severe respiratory failure and conscience deterioration, with a subsequent 100% mortality. The final diagnosis was established by autopsy (performed in five patients) and blood culture findings. Cranial CT showed multiple low-density lesions in four patients without contrast enhancement located in the basal ganglia and corticomedullary junction. Autopsy findings of these lesions demonstrated necrosis and hyphae proliferation inside brain infarcts. Also, two of the patients had a subarachnoid hemorrhage, but angiography could not be performed. CT and autopsy findings were fairly similar to those encountered in cerebral aspergillosis; however, possibly because of its rapid and fatal evolution, no edema or ring enhancing lesions were encountered. Thus, Scedosporium can be included as a rare but possible cause of invasive fungal disseminated central nervous system infections in severely neutropenic patients.

Aspergillus fumigatus endocarditis is one of the rarest and severest complications in cardiological patients. We describe a patient with an intracardial pacemaker who was diagnosed as having Aspergillus fumigatus endocarditis. Postmortem examination showed a large, Aspergillus-infected thrombus encased in the right ventricle, pulmonary trunk and main pulmonary branches.

We report a case of Strongyloides stercoralis hyperinfection in a Spanish patient who had never traveled to an endemic area and in whom HIV infection and long-term immunosuppressive treatment most likely contributed to the dissemination of strongyloidiasis.

The aim of this study was to determine the prevalence of primary resistance to 5-fluorocytosine (5FC) among clinical isolates of yeasts in Spain where this drug is not currently available for therapy. We have tested the in vitro activity of 5FC against 1,021 recent yeast clinical isolates, including 522 Candida albicans, 140 Candida parapsilosis, 68 Candida glabrata, 41 Candida dubliniensis, 50 Candida guilliermondii, 34 Candida tropicalis, 28 Candida krusei, 20 Candida famata, 11 Cryptococcus neoformans, 5 Cryptococcus albidus, 43 Rhodotorula spp., 24 Trichosporon spp., 5 Saccharomyces cerevisiae, 9 Pichia spp., and 21 isolates from other 11 yeast species. The MICs were determined by the ATB Fungus agar microdilution test (bioMerieux, France) and the following interpretive breakpoints were used: susceptible, > 4 microg/ml; intermediate, 8 to 16 microg/ml; resistant, > 32 microg/ml. 5FC was very active against Candida spp. and other medically important yeasts as 852 (83.4%) of the studied isolates were susceptible (MIC < 4 microg/ml). The species most susceptible to 5FC were C. dubliniensis (100%of isolates; MIC90, 0.25 microg/ml), C. famata (100% of isolates; MIC90, 0.25 microg/ml), C. guilliermondii (98%of isolates; MIC90, 0.25 microg/ml), C. glabrata (95.5% of isolates; MIC90, 0.25 microg/ml), and C. neoformans (90.9% of isolates; MIC90, 2 microg/ml). Primary resistance to 5FC was very uncommon, and a MIC > 32 microg/ml, indicator of in vitro resistance, was observed in 106 isolates (10.4%): 77 C. albicans (16.5% of isolates; MIC90, > 128 microg/ml), 9 C. parapsilosis (6.4% of isolates; MIC90, 8 microg/ml), 4 C. albidus (80% of isolates, MIC50, > 128 microg/ml), 3 C. glabrata (4.4% of isolates; MIC90, 0.25 microg/ml), 3 C. tropicalis (8.8% of isolates; MIC90, 4 microg/ml), 2 C. krusei (7.1% of isolates; MIC90, 8 microg/ml), 2 Rhodotorula spp. (4.6% of isolates, MIC90, 1 microg/ml), 8 Trichosporon spp. (33.3% of isolates; MIC90, 64 microg/ml), and 1 C. lipolytica (50% of isolates). Interestingly, most C. albicans (67 out of 77 isolates) resistant to 5FC were serotype B isolates.

Amplification of specific sequences of the ITS1 and ITS2 regions and the intervening 5.8S rRNA gene has lead to the identification of four separate genotypes in Candida dubliniensis. Using primers specific for each genotype, we have studied the prevalence of these genotypes among 68 clinical isolates, mostly from Spanish patients infected by HIV. The majority of the isolates tested belonged to genotype 1 (97%), while only one isolate each from genotypes 2 (1.5%) and 3 (1.5%) were detected in the oral cavity of two patients with HIV infection.

We report a case of fungemia caused by Candida dubliniensis in a non-HIV infected patient. Multiple cultures of blood performed over a period of 13 days were positive for this recently described yeast species. The C. dubliniensis isolates recovered were susceptible to fluconazole in vitro and the patient responded to intravenous therapy with this antifungal agent. It was possible to differentiate the fungemia caused by C. dubliniensis in this patient from that caused by C. albicans in other patients on the basis of the analysis of the antibody response since the C. dubliniensis-infected patient exhibited a characteristic and specific antibody response against a cell wall component of 160-170 kDa.

Twelve Spanish laboratories collected 325 yeast clinical isolates during a 30 day's period, among them 224 Candida albicans, 30 Candida glabrata, and 27 Candida parapsilosis. In vitro antifungal susceptibility to amphotericin B, ketoconazole, fluconazole and itraconazole was determined by an agar diffusion test (Neo-Sensitabs, Rosco, Denmark). All the isolates tested were susceptible in vitroto amphotericin B and nearly all (97.2%) to itraconazole. In vitrosusceptibility to fluconazole and ketoconazole was high (90.2% and 91.4% of isolates, respectively) but showed variations depending on the species tested. Resistance to fluconazole and ketoconazole was low in C. albicans (4% and 3%, respectively), but 30% of Candida guilliermondii and 36% of C. glabrata isolates were resistant to fluconazole. Ketoconazole resistance was observed in 40% of C. glabrata, and 17% of Candida tropicalis. Resistance to antifungal drugs is very low in Spain and it is related to non-C. albicans isolates.

Fingerprinting by randomly amplified polymorphic DNA (RAPD) analysis was used to differentiate Scedosporium prolificans isolates. A total of 59 arbitrary primers were screened with six unrelated S. prolificans isolates, and a panel of 12 primers was selected. The 12 primers were then used to detect DNA polymorphisms among 17 S. prolificans isolates from 11 patients with systemic S. prolificans infections diagnosed in three hospitals located in geographically different areas of Spain. Eight patients were diagnosed with S. prolificans infection in a single institution over a 6-year period, and two other patients were diagnosed with S. prolificans infection in a different hospital over a 1-year period. No single primer allowed for the discrimination of all the isolates from different patients, but this was possible by combining the RAPD patterns from three primers (UBC 701, AB1.08, and AB1.11 or UBC 701, AB1.08, and UBC 707). However, multiple isolates from the same patient were identical. In this study, we also compared a visual method and a computerized method for the analysis of the RAPD patterns. Both methods were satisfactory and gave few discordances, but given the advantages and disadvantages of each method, both systems should be used together. RAPD analysis provided a fast and economical means of typing S. prolificans isolates, with a high level of discrimination among unrelated isolates. Typing by RAPD analysis confirmed that the S. prolificans infections were epidemiologically unrelated.

Cervical lymphadenopathy due to Coccidioides immitis occurred as the sole opportunistic infection in a Spanish patient with the acquired immunodeficiency syndrome. Twelve years earlier the patient had lived in the desert regions of the southwestern USA. After an initial course of high doses of fluconazole, the patient recovered without any sequelae. This is the first case of coccidioidomycosis in Spain.

A fatal case of meningoencephalitis caused by Scedosporium inflatum (Scedosporium prolificans) in a 5-year-old boy with acute myeloblastic leukemia who was given intrathecal treatment is reported. Itraconazole treatment was ineffective. The fungus was identified on brain sections at autopsy and was not observed in any other organ. As no other portal of entry was detected, meningoencephalitis may have originated via direct introduction of the fungus at therapeutic lumbar puncture.

Cases of human infestation by Fasciola hepatica are not uncommon in Spain and other European countries. We report our experience with 20 patients diagnosed from 1982 to 1991 and present a critical review of published cases from western countries. Because F. hepatica has a special tropism for the liver, abdominal pain, hepatomegaly, and constitutional symptoms are among the most common manifestations of acute-stage fascioliasis. However, in the chronic stage, biliary colic and cholangitis are the predominant manifestations. The clinical spectrum of fascioliasis is variable, and patients may present with extrahepatic abnormalities, such as pulmonary infiltrates, pleuropericarditis, meningitis, or lymphadenopathy. Therefore, a high index of suspicion is required to establish a correct diagnosis. Eosinophilia is the most frequent laboratory abnormality. The CT scan has become a useful technique in the diagnostic work-up. A definitive diagnosis may be established by the observation of parasite ova in the feces, but most cases may be diagnosed by serologic methods. Triclabendazole and bithionol are the most effective drugs against F. hepatica. The efficacy of praziquantel is controversial.

The micromethod for yeast susceptibility testing, ATB Fungus, was evaluated with 30 reference strains in three laboratories. Ready-to-use strips with 5-fluorocytosine, amphotericin B, nystatin, miconazole, econazole and ketoconazole were used. The test allowed the categorization of each strain as susceptible, intermediate or resistance to all the antifungals tested, and 5-fluorocytosine and amphotericin B MIC determination. The results were compared with the MIC for each reference strain obtained by a microdilution method on RPMI 1640 buffered with MOPS. The repeatability and intralaboratory and interlaboratory reproducibility were evaluated. ATB Fungus was a reliable and reproducible method with a repeatability of 96.6%, a reproducibility of 95.4% and showed an excellent correlation 91.7%) with reference MICs.

We report four cases of Scedosporium inflatum (S. inflatum) infection in severely immunocompromised haematological patients. Six well-documented cases of S. inflatum disseminated infection in haematological patients have been reported: four in Australia and two in Spain. Their clinical and pathological characteristics are heterogenous, particularly in the Australian cases. However, the clinical and pathological profile emerging from our and other Spanish cases is homogenous and very similar to the clinico-pathological spectrum of other disseminated mycoses, including Aspergillus and S. apiospermum. The optimal treatment of S. inflatum infection is unknown and the outcome in haematological patients is very poor. Eight patients died despite systemic antifungal treatment.

A case of disseminated infection caused by Scedosporium inflatum is reported in a patient undergoing autologous bone marrow transplantation for acute myeloblastic leukemia. The fungus was isolated from a blood culture and necropsy studies showed a disseminated infection involving numerous organs. In vitro studies showed the isolate to be resistant to amphotericin B, 5-fluorocytosine, ketoconazole and miconazole.

We report the treatment of cerebral aspergillosis with amphotericin B, flucytosine, surgery, and liposomal amphotericin B (L-AmB) after a liver transplant. The patient died 2 months after cessation of antifungal therapy, as a consequence of multiple-system organ failure. The only relevant postmortem finding in the brain was a small, encapsulated abscess containing hyphae. This case indicates that L-AmB is an effective alternative drug for cerebral aspergillosis.

Candida pelliculosa Redaelli (syn. Hansenula anomala) was isolated from blood cultures of a patient with acquired immunodeficiency syndrome. The transient candidaemia was apparently associated with intravenous drug addiction. The isolate was identified by standard methods such as API 20 C Aux and 16 discs carbon auxanogram. The isolate was sensitive to amphotericin B, 5-fluorocytosine and ketoconazole. This organism adds to the growing list of Candida species associated with acquired immunodeficiency syndrome.