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Critically ill COVID-19 patients have higher pro-inflammatory (IL-1, IL-2, IL-6, tumor necrosis alpha) and anti-inflammatory (IL-4, IL-10) cytokine levels, less CD 4 interferon-gamma expression, and fewer CD 4 and CD 8 cells. This severe clinical situation increases the risk of serious fungal infections, such as invasive pulmonary aspergillosis, invasive candidiasis or Pneumocystis jirovecii pneumonia. However, few studies have investigated fungal coinfections in this population. We describe an update on published reports on fungal coinfections and our personal experience in three Spanish hospitals. We can conclude that despite the serious disease caused by SARS-CoV-2 in many patients, the scarcity of invasive mycoses is probably due to the few bronchoscopies and necropsies performed in these patients because of the high risk in aerosol generation. However, the presence of fungal markers in clinically relevant specimens, with the exception of bronchopulmonary colonization by Candida, should make it advisable to early implement antifungal therapy., (Copyright © 2020 Asociación Española de Micología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Candida parapsilosis, Candida metapsilosis and Candida orthopsilosis are emerging as relevant causes of candidemia. Moreover, they show differences in their antifungal susceptibility and virulence. The echinocandins are different in terms of in vitro antifungal activity against Candida. Time-kill (TK) curves represent an excellent approach to evaluate the fungicidal activity of antifungal drugs., Aims: To compare the fungicidal activities of anidulafungin, caspofungin and micafungin against C. parapsilosis species complex by TK curves., Methods: Antifungal activities of three echinocandins against C. parapsilosis, C. metapsilosis and C. orthopsilosis were studied by TK curves. Drug concentrations assayed were 0.25, 2 and 8μg/ml. CFU/ml were determined at 0, 2, 4, 6, 24 and 48h., Results: Killing activities of echinocandins were species-, isolates- and concentration-dependent. Anidulafungin reached the fungicidad endpoint for 6 out of 7 isolates (86%); it required between 13.34 and 29.67h to reach this endpoint for the three species studied, but more than 48h were needed against one isolate of C. orthopsilosis (8μg/ml). Caspofungin fungicidal endpoint was only achieved with 8μg/ml against one isolate of C. metapsilosis after 30.12h (1 out of 7 isolates; 14%). Micafungin fungicidal endpoint was reached in 12.74-28.38h (8μg/ml) against one isolate each of C. parapsilosis and C. orthopsilosis, and against both C. metapsilosis isolates (4 out of 7 isolates; 57%)., Conclusions: C. metapsilosis was the most susceptible species to echinocandins, followed by C. orthopsilosis and C. parapsilosis. Anidulafungin was the most active echinocandin against C. parapsilosis complex., (Copyright © 2019 Asociación Española de Micología. Publicado por Elsevier España, S.L.U. All rights reserved.)

The landscape of invasive mycoses is in a continuous evolution with important implications for their diagnosis and treatment. The overall burden remains high, particularly in neonates and the elderly, patients admitted to intensive care units, using prostheses, catheters or other intravenous devices, those receiving different immunosuppressant treatments or antineoplastic chemotherapy, or transplant recipients. In addition, opportunistic mycoses can be associated with HIV infection. Many fungal infections are acquired by inhalation, direct contact or ingestion, but fungi can also enter into the bloodstream through needles or catheters. Invasive candidiasis remains the most frequent mycosis, but its aetiology progressively shifts from Candida albicans to other species of Candida, such as Candida parapsilosis, Candida glabrata, or the multiresistant Candida auris. However, aspergillosis can be predominant in specific conditions, such as bone marrow transplant recipients. Moreover, Pneumocystis, Cryptococcus, Fusarium and Rhizopus can cause devastating illnesses. There are significant variations among hospitals and countries that are related to many factors, such as local characteristics of mycoses and patients, or different practices between medical and surgical wards. The attributed mortality remains high, ranging from 30% in invasive candidiasis to 90-100% in some clinical presentations of scedosporiosis and mucormycosis. The extremely complexity of patients and the growing diversity of pathogenic fungi are major challenges for improving diagnosis, creating surveillance networks, and implementing control measures for these invasive infections., (Copyright © 2018. Publicado por Elsevier España, S.L.U.)

Background: A high quality integrated process in the clinical setting of non-neutropenic critically ill patients at risk for invasive candidiasis is a necessary tool to improve the management of these patients., Aims: To identify the key points on invasive candidiasis in order to develop a set of recommendations with a high level of consensus required for the creation of a total quality integrated process for the management of non-neutropenic critically ill patients at risk of invasive candidiasis., Methods: After a thorough review of the literature of the previous five years, a Spanish prospective questionnaire, which measured consensus by the Delphi technique, was anonymously conducted by e-mail, including 31 national multidisciplinary experts with extensive experience in invasive fungal infections, from six national scientific societies. The experts included a specialist in intensive care medicine, anesthetists, microbiologists, pharmacologists, and specialists in infectious diseases that responded 27 questions prepared by the coordination group. The educational objectives considered six processes that included knowledge of the local epidemiology, the creation and development of multidisciplinary teams, the definitions of the process, protocols, and indicators (KPI), an educational phase, hospital implementation, and the measurement of outcomes. The level of agreement among experts in each category to be selected should exceed 70%. In a second phase, after drawing up the recommendations of the selected processes, a face to face meeting with more than 60 specialists was held. The specialists were asked to validate the pre-selected recommendations., Measures and Main Outcomes: Firstly, 20 recommendations from all the sections were pre-selected: Knowledge of local epidemiology (3 recommendations), creation and development of multidisciplinary teams (3), definition of the process, protocols and indicators (1), educational phase (3), hospital implementation (3), and measurement of outcomes (7). After the second phase, 18 recommendations were validated, and it was concluded that the minimum team or core necessary for the development of an efficient program in the use of antifungal drugs in non-neutropenic critically ill patients must consist of a specialist in infectious diseases, a clinical pharmacist, a microbiologist, a specialist in intensive care medicine, a specialist in anesthesia and recovery, and an administrator or member of the medical management team, and, in order to be cost-effective, it should be implemented in hospitals with over 200 beds. In addition, it is recommended to apply a consensual check list for the evaluation of the diagnostic process and treatment of invasive candidiasis in patients that have started an antifungal treatment. The management of external knowledge and individual learning stand out as active educational strategies. The main strategies for measuring patient safety outcomes are the analysis of the results achieved, and learning activities; assess, review and refine the deployment of the processes; quality control; epidemiological surveillance and applied research; benchmarking; and basic research. The results of the integrated process should be annually disseminated outside the hospital., Conclusions: Optimizing the management of invasive candidiasis requires the application of the knowledge and skills detailed in our recommendations. These recommendations, based on the Delphi methodology, facilitate the creation of a total quality integrated process in critically-ill patients at risk for invasive candidiasis., (Copyright © 2017 Asociación Española de Micología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Invasive candidiasis is the most common invasive fungal disease causing an unacceptably high mortality. Candida albicans remains the predominant origin, but an epidemiological shift has been described in the last decades. Some species of Candida have emerged as an important cause of severe candidaemia and can exhibit reduced susceptibility to the current antifungal agents. Candida parapsilosis has been associated with candidaemia in neonates and young adults, whereas Candida glabrata, Candida tropicalis, and Candida krusei are most frequently isolated in blood cultures from older patients (>65 years). Other yeasts are becoming important causes of invasive mycoses, such as Cryptococcus, Trichosporon, Malassezia, Geotrichum or Saprochaete/Magnusiomyces. Cryptococcosis is more relevant as a cause of meningitis in HIV-infected people, but cryptococcal infections are also a clinical challenge in transplant recipients. Diagnosis remains an important problem, causing unacceptable delays in starting a correct and direct treatment. However, there are some new approaches that can help in the prompt and specific diagnosis of invasive yeast infections, such as in situ hybridisation using PNA-FISH probes, causal agent identification in blood cultures using MALDi-TOF MS, or new and rapid nucleic acids detection assays., (Copyright © 2015 Asociación Española de Micología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Fungi of the genus Fusarium are primarily plant pathogens and saprobes that produce disseminated infections in immunologically deficient humans. After aspergillosis, disseminated fusariosis is the second most common cause of invasive infection by filamentous fungi in patients with hematologic malignancies or those undergoing transplants of hematopoietic progenitors., Aims: Disseminated fusariosis (DF) is considered an extremely rare infection and has reached a stable incidence rate, but its high mortality rate and the lack of an optimal management protocol have raised increasing interest in this mycosis., Methods: We present three cases of DF produced by Fusarium oxysporum species complex, Fusarium solani species complex and the highly unusual Fusarium dimerum in patients with advanced hematological malignancies diagnosed in our hospital between 2007 and 2011. The species level identification of the Fusarium isolates was established by sequencing their TEF1 gene., Results: The isolates showed low susceptibility to most of the antifungal agents analyzed, except that observed for F. dimerum to amphotericin B (AmB) and terbinafine, and F. oxysporum species complex to AmB. Interestingly, the strain of F. solani species complex exhibited high MIC values for AmB and voriconazole, notwithstanding these drugs were used for treatment with good results. Other relevant aspects to be considered in the treatment of DF are surgically cleaning foci of infection, withdrawing presumably contaminated catheters and recovery from neutropenia., Conclusions: The prevention of infection in colonized patients, the maintenance of a high level of diagnostic suspicion for early diagnosis, and the combined, vigorous and prolonged use of L-AmB and voriconazole are essential to decrease the mortality rate of this devastating infection., (Copyright © 2014 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.)

Invasive fungal infections have become a major cause of morbimortality in intensive care patients, persons suffering from cancer or immune deficiencies, and other diseases with impaired immunity. Candida albicans remains the most frequent fungal pathogen, but advances in the diagnosis, prevention and treatment of invasive candidiasis are leading to important etiological changes. Among the emerging invasive mycoses, are those caused by filamentous fungi, such as Aspergillus, Lomentospora/Scedosporium, Fusarium or the Mucorales. Invasive aspergillosis is difficult to diagnose, and although there are diagnostic tools available, their use is not widespread, and their effectiveness vary depending on the group of patients. Clinical suspicion in high-risk patients, radiological diagnosis and the use of biomarkers, such as 1,3-β-D-glucan and galactomannan, can be of great help. However, diagnostic resources are limited in other mycoses, but radiology, pathological studies and the microbiological diagnosis can be useful. The high mortality of these mycoses requires early empirical antifungal treatment in many cases. Voriconazole is the first choice for treatment of the majority of aspergillosis, scedosporiasis, fusariosis and other hyalohyphomycoses. The treatment of mucormycoses, Lomentospora prolificans infections or mycoses by dematiaceous fungi are more complicated. Amphotericin B is active against many mucoralean fungi, but the combination of two or more antifungal agents could be a therapeutic alternative in many amphotericin B-refractory mycoses. Current clinical challenges include improving the diagnosis and the treatment of these mycoses, along with improving the adequate prevention in patients at high risk of suffering from them., (Copyright © 2014 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.)

Invasive candidiasis is a leading cause of mortality. Candidaemia is the most common clinical presentation of invasive candidiasis but more that 30% of these infections do not yield positive blood cultures. Candida albicans remains the predominant aetiology, accounting for 50% of all cases. However, there has been an epidemiological shift in the last decades. Some species of Candida different to C. albicans have emerged as an important cause of severe candidaemia as they can exhibit resistance to fluconazole and other antifungal agents. Moreover, there is a different distribution of non C. albicans Candida species in relationship to patients' and hospital characteristics. Thus, Candida parapsilosis has been associated to candidaemia in neonates and young adults. This species usually has an exogenously origin and contaminates medical devices, causing central venous catheter-associated candidaemias. Candida glabrata, Candida tropicalis and Candida krusei are isolated in blood cultures from older patients (>65 years) with important risk factors, such as major abdominal surgery, solid tumours and haematologic malignancies, transplants, and/or prolonged treatment with corticoids. Moreover, important geographical differences in the distribution of the Candida species different to C. albicans causing invasive candidiasis have been reported: C. parapsilosis predominates in Australia, Latin America and Mediterranean countries of Africa, Asia and Europe. In contrast, C. glabrata has an important aetiological role in USA and Central and Northern Europe. Finally, an important and worrying issue is that mortality due to invasive candidiasis remains unacceptably high. This manuscript is part of the series of works presented at the "V International Workshop: Molecular genetic approaches to the study of human pathogenic fungi" (Oaxaca, Mexico, 2012)., (Copyright © 2013 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.)

Invasive fungal diseases (IFD) are important causes of solid organ transplant-related morbidity and mortality. Modifications and improvements in the transplant surgical procedures, supportive care, and advances in the diagnosis and treatment of these IFD have produced notable changes in their epidemiology and outcome. Candida and other yeast genera continue to play an important etiological role, but Aspergillus and other filamentous fungi are the cause of most IFD in lung transplant recipients. This review is an update of the relevant findings in the literature related to the epidemiology, diagnosis and treatment of IFD in solid organ transplant recipients, with a main focus on invasive aspergillosis and candidiasis., (Copyright © 2011 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.)

Despite advances made in the last decades, invasive fungal infections (IFI) continue to be a major cause of morbidity and mortality in solid organ transplant recipients. The most common pathogens causing IFI are Candida species, followed by Aspergillus and Cryptococcus. A shift in the epidemiology of IFI has been reported in the last few years. Non-Candida albicans Candida species and non-Aspergillus filamentous moulds have been increasingly observed in transplant patients. A change in the IFI onset time has also been described recently. In the RESITRA (Spanish Network of Infection in Transplantation) study, at least 50% of invasive aspergillosis (IA) infections and 40% of invasive Candida infections had been observed after 180 days of transplant. Some cases of cryptococcal infection, traditionally considered as a late onset infection, have been observed in the early post transplant period. Mortality due to IFI is still high, particularly in patients with IA. However, the progressive improvement achieved in diagnosis and prevention of IFI has led to a lower mortality rate., (Copyright © 2011 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.)

Background: The need to evaluate curricula for sponsorship for research projects or professional promotion, has led to the search for tools that allow an objective valuation. However, the total number papers published, or citations of articles of a particular author, or the impact factor of the Journal where they are published are inadequate indicators for the evaluation of the quality and productivity of researchers. The h index, proposed by Hirsch, categorises the papers according to the number of citations per article. This tool appears to lack the limitations of other bibliometric tools but is less useful for non English-speaking authors., Aims: To propose and debate the usefulness of the existing bibliometric indicators and tools for the evaluation and categorization of researchers and scientific journals., Methods: Search for papers on bibliometric tools., Results: There are some hot spots in the debate on the national and international evaluation of researchers' productivity and quality of scientific journals. Opinions on impact factors and h index have been discussed. The positive discrimination, using the Q value, is proposed as an alternative for the evaluation of Spanish and Iberoamerican researchers., Conclusions: It is very important de-mystify the importance of bibliometric indicators. The impact factor is useful for evaluating journals from the same scientific area but not for the evaluation of researchers' curricula. For the comparison of curricula from two or more researchers, we must use the h index or the proposed Q value. the latter allows positive discrimination of the task for Spanish and Iberoamerican researchers.

Background: The laboratory diagnosis of invasive candidiasis is based on the demonstration of tissue invasion by Candida, the culture of the fungus in specimens from sterile body sites and the detection of a number of biomarkers including some antibodies, mannan, beta-1,3-D-glucan and Candida DNA., Aims: Description and evaluation of results obtained in published studies on the usefulness of biomarkers in the diagnosis of invasive candidiasis., Methods: A search was performed in the PubMed/Medline database from the National Library of Medicine since January 2000 on the usefulness of biomarkers in the diagnosis of invasive candidiasis. Key words used included candidiasis, Candida, diagnosis, biomarkers, antigen, antibodies, DNA, mannan, and beta-1,3-D-glucan., Results: Forty one papers dealing with the use of biomarkers in the diagnosis of invasive candidiasis were selected and evaluated, paying special attention to the sensitivity and specificity obtained with the tests used., Conclusions: Important advances are being reached in the use of biomarkers for the diagnosis of invasive candidiasis, and some of them are being used to start a preemptive therapy strategy.

Background: Most recalcitrant infections are associated to colonization and microbial biofilm development. These biofilms are difficult to eliminate by the immune response mechanisms and the current antimicrobial therapy., Aim: To describe the antifungal of micafungin against fungal biofilms based in the scientific and medical literature of recent years., Methods: We have done a bibliographic retrieval using the scientific terms "micafungin", "activity", "biofilm", "Candida", "Aspergillus", "fungi", "mycos"*, susceptibility, in PubMed/Medline from the National Library of Medicine from 2006 to 2009., Results: Most current antifungal agents (amphotericin B and fluconazole) and the new azole antifungals have no activity against fungal biofilms. However, micafungin and the rest of echinocandins are very active against Candida albicans, Candida dubliniensis, Candida glabrata, and Candida krusei biofilms but their activities are variable and less strong against Candida tropicalis and Candida parapsilosis biofilms. Moreover, they have not activities against the biofilms of Cryptococcus y Trichosporon., Conclusions: The activity of micafungin against Candida biofilms gives more strength to its therapeutic indication for candidaemia and invasive candidiasis associated to catheter, prosthesis and other biomedical devices.

Background: Micafungin is a new and very useful pharmacological tool for the treatment of invasive mycoses with a wide antifungal spectrum for the most common pathogenic fungi. Micafungin is especially active against the genera Candida and Aspergillus. Its antifungal mechanism is based on the inhibition of the beta-1,3- D-glucan synthesis, an essential molecule for the cell wall architecture, with different con sequences for Candida and Aspergillus, being micafungin fungicide for the former and fungistatic for the latter., Aim: To describe the in vitro antifungal spectrum of micafungin based in the scientific and medical lite rature of recent years., Methods: We have done a bibliographic retrieval using the scientific terms, "micafungin", "activity", "Candida", "Aspergillus", "fungi", "mycos*", "susceptibility", in PubMed/Medline from the National Library of Medicine de EE.UU. from 2005 to 2009., Results: We can underline that most than 99% of Candida isolates are susceptible to < or = 2microg/ml of micafungin. MIC are very low (< or = 0.125microg/ml) for most clinical isolates of the species Candida albicans, Candida glabrata, Candida tropicalis and Candida krusei while Candida parapsilosis and Candida guilliermondii isolates are susceptible to anidulafungin concentrations < or = 2microg/ml. The activity of micafungin is excellent against those medical important species of Aspergillus. However, its activity is very low against Cryptococcus and the Zygomycetes., Conclusions: The excellent activity of micafungin has made this antifungal a first line therapeutic indication for candidemia and invasive candidiasis in non-neutropenic patients.

Anidulafungin is a new and very useful pharmacological tool for the treatment of invasive mycoses. The antifungal spectrum of anidulafungin reaches the most common pathogenic fungi. Anidulafungin is especially active against the genera Candida and Aspergillus. Its antifungal mechanism is based on the inhibition of the beta-1,3-D-glucan synthesis, an essential molecule for the cell wall architecture, with different consequences for Candida and Aspergillus, being anidulafungin fungicide for the former and fungistatic for the latter. This review describes the in vitro antifungal spectrum of anidulafungin based in the scientific and medical literature of recent years. We can underline that most than 99% of Candida isolates are susceptible to < or = 2 microg/ml of anidulafungin. MIC are very low (< or =0.125 microg/ml) for most clinical isolates of the species Candida albicans, Candida glabrata, Candida tropicalis and Candida krusei while Candida parapsilosis and Candida guilliermondii isolates are susceptible to anidulafungin concentrations < or = 2 microg/ml. An excellent activity of anidulafungin has been also described against Aspergillus, Pneumocystis and other fungi. However, its activity is very low against Cryptococcus and the Zygomycetes. The excellent activity of anidulafungin has made this antifungal a first line therapeutic indication for candidemia and invasive candidiasis in non-neutropenic patients.

The fungal cell wall is a structure with a high plasticity that protects the cell from different types of environmental stresses including changes in osmotic pressure. In addition to that, the cell wall allows the fungal cell to interact with its environment, since some of its proteins are adhesins and receptors. Some of its components are highly immunogenic. The structure of the fungal cell wall is unique to the fungi, and it is composed of glucan, chitin and glycoproteins. Since humans lack the components present in the cell walls of fungi, this structure is an excellent target for the development of antifungal drugs. Anidulafungin, like the rest of echinocandins acts on beta-1,3-D-glucan synthase inhibiting the formation of beta-1,3-D-glucan and causing, depending on the type of fungus, a fungicidal or either a fungistatic effect.

ATB Fungus 2 and SensititreYeastOne are commercial methods for antifungal susceptibility testing of yeasts. The agreement between these two methods was assessed with a total of 133 Candida strains (60 Candida albicans, 18 Candida dubliniensis, 29 Candida glabrata, and 26 Candida krusei). MIC endpoints were established after 24 h of incubation at 36-/+1 degrees C by each method. Intra-laboratory reproducibility of both methods was excellent (=or>99%). Overall agreement between ATB Fungus 2 and Sensititre YeastOne 3 MICs (within 2 dilutions) was 91.2-97.7% for amphotericin B, 5-fluorocytosine and itraconazole, and 82.7% for fluconazole. The categorical agreement when ATB Fungus 2 results were compared to those by SensititreYeastOne 3 was 93.2-98.5% for 5-fluorocytosine and amphotericin B, but lower for the triazoles (72.9-75.9%). This easy to perform method could be an alternative for routine use in the clinical microbiology laboratory for susceptibility testing of common Candida spp.

Since the foundation of the "Asociación Española de Micología" thirty years ago, we have consolidated the Spanish mycological community and also witnessed remarkable changes, not only in the Spanish society but in the scientific community as a whole. As it usually happens to human beings, during this time the "Asociación Española de Micología" has matured transforming itself into a solid scientific society. However, the "Asociación Española de Micología" will have to continue its transformation to adapt to new changes. This article shows the most relevant aspects in the history of the "Asociación Española de Micología" as well as new challenges that the society might face in the future.

Voriconazole has been developed to meet the increasing need for new and useful antifungal agents for the treatment of invasive mycoses. This review describes the spectrum of voriconazole antifungal activity based on data from in vitro studies published during the last three years. This survey demonstrates that voriconazole has a broad antifungal spectrum against the most common fungal pathogens being its action fungistatic for Candida and fungicidal for Aspergillus and other filamentous fungi. Overall, more than 95% of all Candida isolates tested are susceptible to voriconazole and less than 3% are resistant. Similar or even better activity rates have been described for Aspergillus, Cryptococcus and most of yeasts and moulds of medical importance. We also discuss the limitations related to the azole cross-resistance observed in some Candida glabrata isolates, the poor activity of voriconazole against Scedosporium prolificans, its activity against fungal biofilms and the great potential usefulness of combination of voriconazole with other antifungal drugs.

In the last years, the main advances in the serological diagnosis of mycoses caused by yeasts have occurred in the area of antibody and (1-3)-beta-D-glucan detection. Commercialization of the Candida albicans IFA IgG test and detection of antibodies against recombinant antigens Hwp1 and enolase are the most important contributions to the first area. Detection of (1-3)-beta-D-glucan confirms its usefulness as a good marker for the diagnosis of invasive candidiasis. The most recent studies suggest that combination of two tests to detect antígen, antibodies, (1-3)-beta-D-glucan and DNA will be needed to optimize the diagnosis of systemic yeast infections.

Two milestones have characterized the last decades in Medical Mycology: the continuous increase in incidence of invasive mycoses and the discovery of new antifungal drugs that have allowed the successful treatment of these severe infections. This monography presents the most relevant studies on the present situation of invasive mycoses, its diagnosis and treatment, as well as data confirming the important role of voriconazole in their treatment.

Issatchenkia occidentalis was isolated from an esophageal biopsy of a young leukemic male patient who underwent bone marrow transplantation. At the time the specimen was collected, the patient was also suffering from esophageal herpetic lesions. The identification of the isolate was not possible by the use of the available commercial methods. Thus, its identification was done by PCR and DNA sequencing using panfungal primers.

The white wine Chacolía de Vizcaya/Bizkaiko Txakolina is characteristic from The Basque Country region and regulated under Appellation Contrôlée standards (BOPV 14/6/94). The objective of this study was the identification and selection of autochthonous yeast strains, to improve the conditions used to maintain the typical characteristics of this region wines. Yeasts identified as Saccharomyces bayanus isolated around these fields from 1996 to 1998, were subjected to a selective procedure based on enological characteristics and fermentative behaviour. Three of the selected strains were used to inoculate, at winery scale, two grape juice varieties accepted by the Appellation Contrôlée (Hondarrabi Zuri and Folle Blanche). The inoculated strains on the respective vinifications was followed by restriction fragment length polymorphism of mitochondrial DNA (REAmt) method with AluI enzyme, due to their specificity, short outcome, and technological simplicity compared with other molecular typing methods such as: chromosomal karyotyping analyzed by pulsed field gel electrophoresis, Random Amplified Polymorphic DNA-PCR (RAPD-PCR) and restriction fragment length polymorphism using the infrequently cutting enzyme SfiI (REA infrequent). This study demonstrated that strains with different phenotypic traits could show indistinguishable restriction patterns with REAmt, but could be discriminated using other typing methods such as RAPD-PCR, which although showing low reproducibility could be used as complementary to REAmt. Our results demonstrate that in spite of using autochthonous selected strains, the inoculation of musts with a particular strain do not guarantee its predominance and driving fermentation features. Of all yeast strains studied, strain no. 2 showed the best results in sensory testing and at the implantation process. Therefore, it could be used with commercial purposes for the production of Chacolí de Vizcaya/Bizkaiko Txakolina, especially when using musts from Folle Blanche.

Kefir is a fermented milk beverage. The milk fermentation is achieved by the of kefir grains, a cluster of microorganisms held together by a polysaccharide matrix named kefiran. Kefir grains are an example of symbiosis between yeast and bacteria. They have been used over years to produce kefir, a fermented beverage that is consumed all over the world, although its origin is Caucasian. A vast variety of different species of organisms forming the kefir grains, comprising yeast and bacteria, have been isolated and identified. Kefir is a probiotic food. Probiotics have shown to be beneficial to health, being presently of great interest to the food industry. Kefir has been accredited with antibacterial, antifungal and antitumoural activities among other beneficial attributes. This review includes a critical revision of the microbiological composition of kefir along with its beneficial properties to human health.

The usefulness of surrogate markers in the diagnosis of invasive candidiasis is based on their ability to detect the infection caused by the different Candida spp. and to differentiate when the fungus is a colonizer or it is causing an invasive disease. This differentiation has been tried by detecting antigens, antibodies and other Candida components in the patient's sera. In this paper we will review the antigens, antibodies and other Candida components which may be useful in the laboratory diagnosis of invasive candidiasis in the non-neutropenic critically ill patient.

We have conducted a longitudinal study over a 3-year period to address the point prevalence, microbiological characteristics and antifungal susceptibility patterns of yeast isolates colonizing or infecting the oral cavities of 111 HIV-infected (51 adults, 60 children) and 201 non HIV-infected (109 adults, 92 children) Mexican persons. Regarding the epidemiology of oral candidiasis, Candida albicans was the most frequent species isolated. Seventy-one out of 85 isolates from colonized persons were C. albicans (83.5%), 27 isolates of them were from HIV-infected children and 44 from non HIV-infected patients. Sixty-two isolates belonged to serotype A which was the most prevalent serotype of C. albicans. Non-albicans species (Candida glabrata, Candida tropicalis and Candida parapsilosis, and Saccharomyces cerevisiae) were isolated from 16.5% of colonized patients and from 38.5% patients with candidiasis or Candida-related lesions. There were nine episodes of infection or colonization by at least 2 different yeast species. In the case of HIV/AIDS patients, it was determined that yeast carriage was not associated with the number of CD4+ cells or the viral load, but HAART reduced the prevalence of oral candidiasis. Overall, most patients harbored strains in vitro susceptible to fluconazole, however 10.8% of the yeasts were resistant to one or more azole antifungal agents and 29% were intermediate susceptible to them. On the contrary, 5-fluorocytosine was very active against all isolates tested, and amphotericin B was active against 97.9% of them.

Aspergillus fumigatus causes a wide range of diseases that include mycotoxicosis, allergic reactions and systemic diseases (invasive aspergillosis) with high mortality rates. Pathogenicity depends on immune status of patients and fungal strain. There is no unique essential virulence factor for development of this fungus in the patient and its virulence appears to be under polygenetic control. The group of molecules and genes associated with the virulence of this fungus includes many cell wall components, such as beta-(1-3)-glucan, galactomannan, galactomannanproteins (Afmp1 and Afmp2), and the chitin synthetases (Chs; chsE and chsG), as well as others. Some genes and molecules have been implicated in evasion from the immune response, such as the rodlets layer (rodA/hyp1 gene) and the conidial melanin-DHN (pksP/alb1 gene). The detoxifying systems for Reactive Oxygen Species (ROS) by catalases (Cat1p and Cat2p) and superoxide dismutases (MnSOD and Cu, ZnSOD), had also been pointed out as essential for virulence. In addition, this fungus produces toxins (14 kDa diffusible substance from conidia, fumigaclavin C, aurasperon C, gliotoxin, helvolic acid, fumagilin, Asp-hemolysin, and ribotoxin Asp fI/mitogilin F/restrictocin), allergens (Asp f1 to Asp f23), and enzymatic proteins as alkaline serin proteases (Alp and Alp2), metalloproteases (Mep), aspartic proteases (Pep and Pep2), dipeptidyl-peptidases (DppIV and DppV), phospholipase C and phospholipase B (Plb1 and Plb2). These toxic substances and enzymes seems to be additive and/or synergistic, decreasing the survival rates of the infected animals due to their direct action on cells or supporting microbial invasion during infection. Adaptation ability to different trophic situations is an essential attribute of most pathogens. To maintain its virulence attributes A. fumigatus requires iron obtaining by hydroxamate type siderophores (ornitin monooxigenase/SidA), phosphorous obtaining (fos1, fos2, and fos3), signal transductional falls that regulate morphogenesis and/or usage of nutrients as nitrogen (rasA, rasB, rhbA), mitogen activated kinases (sakA codified MAP-kinase), AMPc-Pka signal transductional route, as well as others. In addition, they seem to be essential in this field the amino acid biosynthesis (cpcA and homoaconitase/lysF), the activation and expression of some genes at 37 degrees C (Hsp1/Asp f12, cgrA), some molecules and genes that maintain cellular viability (smcA, Prp8, anexins), etc. Conversely, knowledge about relationship between pathogen and immune response of the host has been improved, opening new research possibilities. The involvement of non-professional cells (endothelial, and tracheal and alveolar epithelial cells) and professional cells (natural killer or NK, and dendritic cells) in infection has been also observed. Pathogen Associated Molecular Patterns (PAMP) and Patterns Recognizing Receptors (PRR; as Toll like receptors TLR-2 and TLR-4) could influence inflammatory response and dominant cytokine profile, and consequently Th response to infec tion. Superficial components of fungus and host cell surface receptors driving these phenomena are still unknown, although some molecules already associated with its virulence could also be involved. Sequencing of A. fumigatus genome and study of gene expression during their infective process by using DNA microarray and biochips, promises to improve the knowledge of virulence of this fungus.

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.

During the last decades, the use of antibody tests for the diagnosis of invasive mycoses has declined as a consequence of the general belief that they are insensitive and non-specific. However, there is a clear evidence that antibodies can be detected in highly immunodeficient patients (such as bone marrow transplant recipients), and that those antibodies are useful for the diagnosis. Antibody tests are currently in use as diagnostic tools for some primary mycoses, such as the endemic mycoses, aspergilloma, allergic bronchopulmonary aspergilosis and sporothrichosis. For invasive candidiasis, diagnostic methods must differentiate Candida colonization of mucous membranes or superficial infection from tissue invasion by this microorganism. Substantial progress has been made in diagnosis of invasive candidiasis with the development of a variety of methods for the detection of antibodies and antigens. However, no single test has found widespread clinical use and there is a consensus that diagnosis based on a single specimen lacks sensitivity. It is necessary to test sequential samples taken while the patient is at greatest risk for developing invasive candidiasis to optimize the diagnosis. Results obtained from a panel of diagnostic tests in association with clinical aspects will likely be the most useful strategy for early diagnosis and therapy.

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.

The usefulness of galactomannan detection using the Platelia Aspergillus test for the diagnosis of invasive aspergillosis was studied in 849 sera from 54 hematological patients with prolonged neutropenia, which were classified according to the risk for invasive aspergillosis. Three patients developed a proven invasive aspergillosis, one a probable invasive aspergillosis and 17 patients a possible invasive aspergillosis. Thirty-three patients showed no evidence of invasive aspergillosis. All patients with proven invasive aspergillosis had a high risk for invasive aspergillosis, while the one having probable invasive aspergillosis had intermediate risk. Detection of galactomannan in this study showed a sensitivity of 66.7% for patients with proven invasive aspergillosis and 50% for patients with proven and probable invasive aspergillosis. The specificity was 98% or higher in all groups studied. The predictive positive and negative values for patients with proven invasive aspergillosis were 66.7% and 98%, respectively. A rise in the concentration of galactomannan was observed in patients who failed to respond to the antifungal treatment. Galactomannan antigenemia preceded post-mortem histological diagnosis of invasive aspergillosis in two patients by 17 and 81 days, respectively. In conclusion, detection of galactomannan by the Platelia Aspergillus test allows for a specific and relatively sensitive diagnosis of invasive aspergillosis in hematological patients with a high and intermediate risk for invasive aspergillosis.

The ability of Candida glabrata to switch between different colony phenotypes on a Sabouraud's-chloramphenicol agar supplemented with phloxine B was assessed in 14 C. glabrata isolates. Three phenotypes (pale pink smooth, dark pink smooth and fuchsia petite) were observed in vitro and two of them (pale pink smooth and dark pink smooth) in fresh clinical isolates plated directly from vaginal specimens from patients with C. glabrata vaginitis and patients colonized with C. glabrata. The pale pink smooth phenotype was the predominant and the remaining phenotypes can be derived from it. No changes in susceptibility to different antifungals were observed in the pale pink smooth, dark pink smooth, fuchsia petite phenotypes but they showed differences in cell wall antigens.

Heat-shock and infection induce changes in protein expression in C. albicans. To investigate if these alterations induce changes in antigenicity, we have compared the reactivity mediated by IgA antibodies of protein extracts from a strain of C. albicans and the same strain recovered from an infected animal, both at 24 degrees C and 37 degrees C. The antigenic variability was detected mainly in antigens recognized by salivary IgA. Antigens of 223, 205, 180 and 140 kDa were over-expressed in both strains at 37 degrees C, indicating that variations due to heat shock were present before and after infection. The antigens were characterized as mannoproteins located at the outer side of the cell wall. An antigen of 61 kDa was also detected in which the expression decreased significantly after infection This was independent of heat shock.

Candidiasis is a frequent human infection caused mainly by Candida albicans. However, other species are emerging as important pathogens, as Candida glabrata, Candida parapsilosis, Candida tropicalis, Candida krusei or Candida guilliermondii. Rapid identification of clinical isolates could facilitate diagnosis and treatment. Candida ID (bioMerieux, Spain) is a new medium for the isolation and presumptive identification of yeasts: C. albicans grows as blue colonies, and C. tropicalis, C. guilliermondii, Candida kefyr and Candida lusitaniae as pink ones. The utility of Candida ID was evaluated with more than 700 clinical isolates and type culture collection strains from different genera including Candida, Cryptococcus, Saccharomyces, and Rhodotorula. Presumptive identification was confirmed by germ tube test, microscopic morphology and chlamydoconidia production on corn meal agar and carbohydrate assimilation on API-ATB ID 32C or Vitek (bioMerieux). Growth on Candida ID was rapid (18-24 h) for most of the yeast strains tested. Sensitivity and specificity of identification of C. albicans was significantly high (>98%), since a very low number of isolates were found to be false negative or false positive. A better result was obtained for species growing as pink colonies (>99.5%). Detection of different species of medical important yeasts was easy with Candida ID, as perfectly distinct colors and textures of colonies were observed on this medium. Candida ID allowed the discrimination between C. glabrata (creamy and smooth) and C. krusei (rough and white) colonies. Other species showed different colony textures and colours, white being the predominant colour. Candida ID was very useful for the presumptive identification C. albicans isolates.

The current importance of nosocomial aspergillosis has prompted this symposium to review the most important issues in the field: taxonomy and identification of species involved, clinical presentations, diagnosis, treatment, prevention and molecular epidemiology applied to the detection of outbreaks of nosocomial aspergillosis.

Candida dubliniensisis a recently described species closely related to Candida albicans. Since the discrimination between both species by conventional mycological methods is not easy, many researchers have been trying DNA-related techniques in order to identify C. dubliniensis correctly. In this study, we propose the use of the random amplification of polymorphic DNA (RAPD) with a commercialized short primer which discriminates between both species. This oligonucleotide, AB1-12, allowed also separating C. albicans isolates into four different genotypes. These genotypes were different from the unique genotype observed in C. dubliniensis.

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.