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Infections caused by filamentous fungi are rising in incidence and became a serious health concern. Their rapid and reliable identification in the clinical laboratory is essential for an early and accurate diagnosis to guide timely therapy. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) has been reported as a rapid and reliable method for identification of bacteria and yeasts isolated from clinical samples. However, it has less used for molds identification. The aim of this study was to evaluate Vitek® MS (a MALDI-TOF MS system) ability to identify molds and differentiate species within a complex. A collection of 90 filamentous fungi, 70 clinical and 20 environmental isolates, was studied by morphological and molecular methods and by Vitek® MS. Seventy-four isolates (82.2%) were identified using Vitek® MS v3.0 at Genus/Complex/Species group level; within these, 47/74 (63.5%) were correctly identified at species level and only one was misidentified. In contrast, 16/90 isolates (17.8%) were not identified, of which 13 were not present in the database. Results here expressed favor Vitek® MS v3.0 as a very useful system for identification of most common clinical isolates of filamentous fungi. Accordingly, it may be an important tool for clinical microbiology laboratories in their task to answer to clinicians, adequately and rapidly, helping in proper patient's management.

Aims Aspergillus sp. are ubiquitous saprophytic fungi and their conidia easily inhaled. This is particularly important in immunocompromised patients, more susceptible to developing invasive aspergillosis. In addition to A. fumigatus sensu stricto, cryptic species, many resistant to antifungal drugs, have been associated with invasive infections, making it important to assess their presence and diversity in different environments. Therefore, the aim of this study was to assess the presence, diversity and susceptibility to antifungal drugs of airborne fungi. Moreover, in azole-resistant A. fumigatus sensu stricto isolates the presence of underlying molecular mechanisms of resistance was investigated. Methods and results Eighty-four Aspergillus isolates were collected from the environment air in hospitals and the Water Treatment Plant. The use of molecular tools allowed to detect 12 different cryptic species, showing a prevalence of 21·4%. The majority of isolates (69·0%) belonged to A. fumigatus complex and 65·4% were A. fumigatus sensu stricto. Among these, 21·8% were resistant to itraconazole (ITZ), 38·2% to posaconazole and 87·3% to isavuconazole; none of them were resistant to voriconazole or amphotericin B. Sequencing of the cyp51A gene on the 12 A. fumigatus sensu stricto ITZ-resistant isolates revealed the presence of mutations. Conclusion Our study reports a large number of environmental-resistant Aspergillus species, including A. fumigatus sensu stricto that display an important role in invasive fungal infections. None of the environmental isolates showed mutations on cyp51A gene related to azole resistance. Significant and impact of the study This study is the first assessment of molecular resistance mechanisms in A. fumigatus sensu stricto environmental isolates, in Portugal. Since TR34/L98H and TR46/Y121F/T289A cyp51A mutations were already reported in the clinical setting in Portugal (Monteiro et al. J Glob Antimicron Resist 13: 190-191, 2018; Pinto et al. Front Microbiol 9: 1656, 2018), and have been linked to environmental route, it is utmost importance to perform surveillance network for azole-resistant A. fumigatus.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO), could be extremely helpful in the management of COVID-19 patients with refractory hypoxemic respiratory failure; however, to date, evidence on the true effecttiveness of ECMO in the COVID19 setting still hangs in the balance. METHODS: This was a prospective cohort study of 39 COVID-19 patients admitted to the intensive care unit (ICU) in an experienced ECMO center at a tertiary hospital during March/April 2020. Among the recruited participants, 10 (25.6%) required ECMO (ICU-ECMO group) and 29 (74.4%) did not have ECMO support (ICU group). Immunological parameters were assessed both at ICU admission and on a daily basis for 7 consecutive days. RESULTS: The absolute lymphocyte count increased significantly in the ICU-ECMO group compared to the ICU group in which it remained relatively stable: s for the time variable was 127.1 [95% CI 68.9 - 185.3], p < 0.001 and for the interaction term -141.36 [-208.95 - -73.77], p < 0.001. On the other hand, globally, no significant differences were observed over time for the lymphocyte percentage, although it was higher in the ICU patients. Neutrophil counts were overall higher in the ICU-ECMO group (s -4,275.38 [-6,845.21 - 1,705.55], p = 0.001). In regard to neutrophil percentage, a significant decrease over time was reported (s -1.76 [-3.16 - -0.36], p = 0.014), namely in the ICU-ECMO group (s for the interaction 2.09 [0.45 - 3.73], p = 0.013). CONCLUSIONS: Herein, we found ECMO support seems to provide a less aggressive immune response in COVID-19 patients with severe and refractory respiratory dysfunction.

Investigações da autoconsciência têm envolvido o uso de escalas na aferição de suas dimensões e relação com cognição e comportamento, como a Escala de Autorreflexão e Insight (EAI), desenvolvida para mensurar a dimensão privada da autoconsciência. O instrumento parte do pressuposto de que autorreflexão e insight, componentes metacognitivos, estariam envolvidos no processo de refletir, avaliar e regular os próprios pensamentos, sentimentos e comportamentos. Esta revisão sistemática procurou entender a relação entre autorreflexão e insight na cognição e no comportamento por meio da análise de estudos empíricos que utilizaram a EAI, publicados entre 2002 e 2017, disponíveis no Portal de Periódicos CAPES, e recuperados a partir dos termos “autoconsciência”; “autorreflexão”; “EAI”, e seus equivalentes em inglês, incluindo também “insight ”. Resultados apontam para uma associação entre insight e reações saudáveis, porém divergem sobre os benefícios da autorreflexão. Essa relação e os aspectos que a influenciam são discutidos.

Infections caused by filamentous fungi are rising in incidence and became a serious health concern. Their rapid and reliable identification in the clinical laboratory is essential for an early and accurate diagnosis to guide timely therapy. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) has been reported as a rapid and reliable method for identification of bacteria and yeasts isolated from clinical samples. However, it has less used for molds identification. The aim of this study was to evaluate Vitek

Objectives: To compare the concordance of ceftaroline MIC values by reference broth microdilution (BMD) and Etest (bioMérieux, France) for MSSA and MRSA isolates obtained from PREMIUM (D372SL00001), a European multicentre study. Methods: Ceftaroline MICs were determined by reference BMD and by Etest for 1242 MSSA and MRSA isolates collected between February and May 2012 from adult patients with community-acquired pneumonia or complicated skin and soft tissue infections; tests were performed across six European laboratories. Selected isolates with ceftaroline resistance in broth (MIC >1 mg/L) were retested in three central laboratories to confirm their behaviour. Results: Overall concordance between BMD and Etest was good, with >97% essential agreement and >95% categorical agreement. Nevertheless, 12 of the 26 MRSA isolates found resistant by BMD scored as susceptible by Etest, with MICs ≤1 mg/L, thus counting as very major errors, whereas only 5 of 380 MRSA isolates found ceftaroline susceptible in BMD were miscategorized as resistant by Etest. Twenty-one of the 26 isolates with MICs of 2 mg/L by BMD were then retested twice by each of three central laboratories: BMD MICs of 2 mg/L were consistently found for 19 of the 21 isolates. Among 147 Etest results for these 21 isolates (original plus six repeats per isolate) 112 were >1 mg/L. Conclusions: BMD and Etest have good overall agreement for ceftaroline against Staphylococcus aureus; nevertheless, reliable Etest-based discrimination of the minority of ceftaroline-resistant (MIC 2 mg/L) MRSA is extremely challenging, requiring careful reading of strips, ideally with duplicate testing., 0, SCOPUS: ar.j, info:eu-repo/semantics/published

Submitted by Divis??o de Documenta????o/BC Biblioteca Central (ddbc@ufam.edu.br) on 2017-04-24T13:33:47Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Reprodu????o N??o Autorizada.pdf: 47716 bytes, checksum: 0353d988c60b584cfc9978721c498a11 (MD5) Approved for entry into archive by Divis??o de Documenta????o/BC Biblioteca Central (ddbc@ufam.edu.br) on 2017-04-24T13:34:05Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Reprodu????o N??o Autorizada.pdf: 47716 bytes, checksum: 0353d988c60b584cfc9978721c498a11 (MD5) Approved for entry into archive by Divis??o de Documenta????o/BC Biblioteca Central (ddbc@ufam.edu.br) on 2017-04-24T13:34:23Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Reprodu????o N??o Autorizada.pdf: 47716 bytes, checksum: 0353d988c60b584cfc9978721c498a11 (MD5) Made available in DSpace on 2017-04-24T13:34:23Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Reprodu????o N??o Autorizada.pdf: 47716 bytes, checksum: 0353d988c60b584cfc9978721c498a11 (MD5) Previous issue date: 2016-05-31 FAPEAM - Funda????o de Amparo ?? Pesquisa do Estado do Amazonas Studies on biodiversity has great importance to the rational use of natural resources, especially in mega-diverse regions such as the Amazonia. The study of fungal diversity Agaricomycetes is important to contribute with the knowledge of the diversity of them in the state of Amazon and introduce new records to the region. The relevance of this research is to contribute to the knowledge about biodiversity and the prospect of bioactive products, identifying fungi Agaricomycetes wood-degrading potential insecticide against larvae of mosquito of dengue virus, chikungunya and zika the Aedes aegypti. The methodology used for classical taxonomic identification was performed through analysis of macro-and microscopically, basidiomatas from the collections held in 12 municipalities of the state of Amazon (Autazes; Anam??; Careiro da v??rzea; Coari; Babu; Borba; Novo Aripuan??; Nova Olinda do Norte; Manaus; Manicor??; Parintins and Presidente Figueiredo) in the period from January to March 2013 and from January to May 2014. In that sense, it was possible to expand knowledge about the diversity of the Agaricomycetes. 323 specimens were collected, 263 of them were identified, represented by 40 genera, 76 species, classified into 15 families and 4 orders of Agaricomycetes. The healthy basidiocarps were recovered, of which 43 were pure cultures. These were used for the production of extracts, molecular identification and identification by MALDI-TOF. Molecular identification was through the sequencing of the Its regions 1 and 2 of the rDNA, and by MALDI TOF mass spectrometry. Molecular identification analyses were performed by comparison of the sequences deposited in GenBank. The result of the molecular sequencing allowed an alignment with the nucleotide sequences that matches the identification of fungi as being of the group, the Agaricomycetes similarity above 96 %. In MALDI TOF only 26 specimens were possible be submitted to IC/MALDI TOF MS analysis. Spectral data were obtained with peak patterns (ions) exclusive to fungi with similarity of protein mixtures, which refers to the percentage of identity for the amount of identical values. Larvicidal activity performed effectively, six fungi showed bioactive compounds with lethal capability against larvae of third stage of A. aegypti. The extract of P. sanguineus, presented mortality of probit to 5.3 larvae of A. aegypti, which gives this fungus, a potential entomopatog??nico quite expressive. The other extracts were not possible being necessary for analysis, evaluation and increased sample number. Os estudos sobre a biodiversidade s??o de suma import??ncia para a utiliza????o racional dos recursos naturais, principalmente em regi??es mega-diversas, como a Amaz??nia. O estudo da diversidade de fungos Agaricomycetes ?? importante para contribuir com o conhecimento sobre a diversidade destes no Estado do Amazonas e apresentar novos registros para a regi??o. A relev??ncia dessa pesquisa est?? em contribuir para o conhecimento da biodiversidade e da prospec????o de produtos bioativos, identificando fungos Agaricomycetes degradadores de madeira com potencial inseticida contra larvas do mosquito transmissor do v??rus da dengue, chikungunya e zika o Aedes aegypti. A metodologia utilizada para identifica????o taxon??mica cl??ssica foi realizada atrav??s de an??lises dos basidiomas macro e microscopicamente, A partir das coletas realizadas em 12 munic??pios do Estado do Amazonas (Autazes; Anam??; Careiro da v??rzea; Coari; Barcelos; Borba; Novo Aripuan??; Nova Olinda do Norte; Manaus; Manicor??; Parintins e Presidente Figueiredo) no per??odo de janeiro a mar??o de 2013 e de janeiro a maio de 2014. Nesse sentido, foi poss??vel expandir o conhecimento sobre a diversidade de Agaricomycetes na regi??o. Foram coletados 323 esp??cimes, destes foram identificados 263, representados por 40 g??neros, 76 esp??cies, classificadas em 15 fam??lias e 4 ordens de Agaricomycetes. Os basidiocarpos saud??veis foram isolados, dos quais foram obtidas 43 culturas puras. Estes foram utilizados na produ????o de extratos, identifica????o molecular e identifica????o por MALDI- TOF. A identifica????o molecular foi atrav??s do sequenciamento das regi??es Its 1 e 2 do rDNA, e pela t??cnica de MALDI TOF Espectrometria de Massa. As an??lises da identifica????o molecular foram realizadas por compara????o das sequ??ncias depositadas no GenBank. O resultado do sequenciamento molecular permitiu um alinhamento com as sequ??ncias nucleot??dicas que corresponde a identifica????o dos fungos como sendo do grupo Agaricomycetes, com taxa de similaridade acima de 96 %. Na t??cnica de MALDI TOF apenas 26 esp??cimes foram poss??veis ser submetidas ?? an??lise IC /MALDI TOF MS. Foram obtidos dados espectrais com padr??es de pico (??ons) exclusivo para os fungos com similaridade das misturas de prote??nas, o que refere-se a porcentagem de identidade para a quantidade de valores id??nticos em massa. A atividade larvicida apresentou-se eficaz, seis fungos apresentaram subst??ncias bioativas com potencialidade letal contra larvas de 3?? est??dio de A. aegypti. O extrato de P. sanguineus, apresentou mortalidade de 5,3 probit para larvas de A. aegypti, o que confere a este fungo, um potencial entomopatog??nico bastante expressivo. Os demais extratos n??o foram poss??veis de an??lise sendo necess??rio para avalia????o, e aumento do n??mero amostral.

Introduction: Non-tuberculous mycobacteria are ubiquitous micro-organisms that rarely cause disease in humans, unless they are immunocompromised or have undergone trauma. Case presentation: We describe a case of spontaneous breast abscess due to Mycobacterium fortuitum in an immunocompetent patient, identified using DNA-STRIP technology. This is the third report that, apart from being caused by the same agent, has the localization on the left breast in common, raising the question of a laterality effect. Conclusion: Careful inspection of cultures and accurate agent identification are procedures to be emphasized in clinical microbiology laboratories. In fact, they may reveal unusual growth due to uncommon micro-organisms.

Beauveria bassiana is a ubiquitous fungus available as an insecticide. In humans, it has limited virulence; to our knowledge, only 3 cases of invasive disease and 10 cases of keratitis have been documented.We report the first case of B bassiana keratitis in a patient with aphakic bullous keratopathy. The fungal keratitis proved to be highly resistant to topical clotrimazole. Molecular identification was based on DNA sequence analysis. The minimal inhibitory concentrations (MIC) obtained were 2 µg/mL for voriconazole, 0.250 µg/mL for posaconazole, and128 µg/mL for fluconazole; amphotericin B MIC was16 µg/mL. In the absence of clinical improvement, a penetrating keratoplasty (PK) was performed. The patient was discharged on topical and systemic voriconazole and prednisolone 40 mg PO/day. The eye remained calm with a transparent cornea and clear anterior chamber.B bassiana keratitis is extremely rare, with only a few cases reported. Its risk factors are unknown. We report the first case in a patient with aphakic bullous keratopathy, which proved highly resistant to antifungal therapy (antifungal susceptibility results are presented). A PK was necessary for clinical improvement. A review of the literature is performed in an effort to define therapeutic strategies.

A avaliação da gravidade perante qualquer caso de pneumonia adquirida na comunidade (PAC) é de suma importância, pois dela decorrem decisões como a necessidade de internamento e o tratamento empírico inicial. Os autores apresentam um estudo retrospectivo, que incluiu doentes internados devido a pneumonia por Streptococcus pneumoniae durante o ano de 2006, no Hospital de São João. A confirmação etiológica de infecção foi feita por isolamentos no sangue, líquido pleural, secreções traqueobrônquicas, lavado brônquico, lavado broncoalveolar e pesquisa de antigenúria. Foram analisados os factores de risco e avaliados, com base nas normas PSI (Pneumonia Severity Index) e da British Thoracic Society (BTS) - CURB-65. A análise estatística foi efectuada utilizando teste T para amostras independentes e ANOVA, usando o programa de análise estatística SPSS 14.0. Foram incluídos 104 doentes com idade mediana de 63 anos, sendo 67,3% do sexo masculino. O estudo revelou existir uma associação com significado estatístico entre os resultados de PSI e CURB-65 e a evolução para a mortalidade. Apesar da melhoria dos meios diagnósticos e profilácticos, e da terapêutica antibiótica, a pneumonia pneumocócica permanece uma entidade de grande morbilidade e mortalidade. O valor preditivo das normas PSI e CURB-65 foi confirmado nesta população de doentes, documentando uma correlação entre o número de factores de risco e a evolução da doença.Probably the most important decision in the management of Community-Acquired Pneumonia (CAP) is patient site of care. Patients with Streptococcus pneumoniae-caused CAP admitted to our hospital between 1st January and 31st December 2006 were retrospectively analysed. Samples of blood, sputum, bronchial and bronchoalveolar lavage and urine were collected for microbiological testing using standard culture techniques and urine antigen detection. Pneumonia Severity Index (PSI) and British Thoracic Society (BTS) CURB-65 scoring tools were evaluated. The statistical treatment was performed using the SPSS 14.0 program. We included 104 patients, 67.3% male, median age 63 years old, mortality 13.4%. There was a significant association between the PSI and CURB-65

Probably the most important decision in the management of Community-Acquired Pneumonia (CAP) is patient site of care. Patients with Streptococcus pneumoniae-caused CAP admitted to our hospital between 1st January and 31st December 2006 were retrospectively analysed. Samples of blood, sputum, bronchial and bronchoalveolar lavage and urine were collected for microbiological testing using standard culture techniques and urine antigen detection. Pneumonia Severity Index (PSI) and British Thoracic Society (BTS) CURB-65 scoring tools were evaluated. The statistical treatment was performed using the SPSS 14.0 program. We included 104 patients, 67.3% male, median age 63 years old, mortality 13.4%. There was a significant association between the PSI and CURB-65 score and mortality. Despite advances, CAP is still an important health problem with a high atten - dant morbi-mortality. This study confirms the value of PSI and CURB-65 in the prediction of severe pneumonia. Resumo: A avaliação da gravidade perante qualquer caso de pneumonia adquirida na comunidade (PAC) é de suma importância, pois dela decorrem decisões como a necessidade de internamento e o tratamento empírico inicial. Os autores apresentam um estudo retrospectivo, que incluiu doentes internados devido a pneumonia por Streptococcus pneumoniae durante o ano de 2006, no Hospital de São João. A confirmação etiológica de infecção foi feita por isolamentos no sangue, líquido pleural, secreções traqueobrônquicas, lavado brônquico, lavado broncoalveolar e pesquisa de antigenúria. Foram analisados os factores de risco e avaliados, com base nas normas PSI (Pneumonia Severity Index) e da British Thoracic Society (BTS) - CURB-65. A análise estatística foi efectuada utilizando teste T para amostras independentes e ANOVA, usando o programa de análise estatística SPSS 14.0.Foram incluídos 104 doentes com idade mediana de 63 anos, sendo 67,3% do sexo masculino. O estudo revelou existir uma associação com significado estatístico entre os resultados de PSI e CURB-65 e a evolução para a mortalidade.Apesar da melhoria dos meios diagnósticos e profilácticos, e da terapêutica antibiótica, a pneumonia pneumocócica permanece uma entidade de grande morbilidade e mortalidade. O valor preditivo das normas PSI e CURB-65 foi confirmado nesta população de doentes, documentando uma correlação entre o número de factores de risco e a evolução da doença. Key-words: Community-acquired pneumonia, Streptococcus pneumoniae, Palavras-chave: Pneumonia adquirida na comunidade, Streptococcus pneumoniae

Introduction: Nocardiosis emerges as a serious infection in the immunocompromised patient, causing an aggressive clinical picture, which requires prolonged treatment. Case presentation: We present five cases of disseminated nocardiosis in patients under corticosteroid therapy with four different forms of clinical presentation. Conclusion: Immunocompromised patients are at increased risk of disseminated nocardiosis, which may require extended culture time for diagnosis and molecular methods. The cases emphasize the relevance of a careful evaluation of the central nervous system, a common target in nocardiosis dissemination.

Background Cryptococcal meningoencephalitis is an opportunistic infection that predominantly affects immunocompromised patients. Hyper immunoglobulin M syndrome is a primary immunodeficiency syndrome that increases susceptibility to several opportunistic infections. Here, we report a case of cryptococcal meningoencephalitis in the context of hyper immunoglobulin M syndrome, a situation that has been reported very few times and whose management is not clearly defined. We describe our management of this case and the outcome of the patient to help in future similar situations. Case presentation The patient is a 19-year-old Caucasian male student diagnosed with X-linked hyper immunoglobulin M syndrome and treated chronically with weekly intravenous immunoglobulin and daily sulfamethoxazole-trimethoprim. He was admitted to the infectious diseases ward because of headache, diplopia and a cerebral-spinal fluid analysis revealing cryptococcal meningoencephalitis. The patient was treated with liposomal amphotericin and flucytosine with a favorable outcome. Maintenance therapy with fluconazole has continued and will be sustained for 6 months following his upcoming bone marrow transplantation. Conclusion Monitoring for cryptococcal meningoencephalitis should be considered in patients with primary immunodeficiencies, as clinical manifestations may go unnoticed. In these patients, it is expected that chronic treatment with fluconazole will be the only treatment that will prevent reinfection or reactivation, and therefore should be kept at least until bone marrow transplant, the only curative treatment, is performed. It may, however, lead to intolerable side effects and hepatic toxicity.

Stress can affect all people, regardless of age, gender or ethnicity. The human body uses stress as an adaptive response against several situations, but it can cause physical, mental or emotional distress. In stress situation the nervous system evokes the same physiological responses, whatever the type of stress and these responses cause changes in the physical, cognitive, emotional and social performance. This paper proposes to develop a methodology for analyzing the stress level using electroencephalographic signals (EEG) based on asymmetry patterns of alpha waves. The subjects of this research are professionals from Vitoria's Fire Department. Activities of the Central Nervous System are capture using Emotiv Epoc Headset, placed on the volunteer's scalp. The signals are analyzed from the frontal cortex at positions Fp1 (AF3), Fp2 (AF4), F3 and F4, according to of the international 10-20 system. The results are analyzed together with some peripheral physiological signals, such as: heart beat rate (ECG), peripheral blood flow, skin conductance, breath rate, body temperature and change in level of salivary cortisone. In addition, a psychological assessment of voluntary's stress is performed through a questionnaire of LIPP-ISS (Inventory of Symptom Stress). A validation study is conducted through a comparison with data available in literature, as well as with evaluation conducted by a psychologist. The results are analyzed in order to get a correlation between EEG signals and physical, mental or emotional stress.

The identification of stress-related emotional states allows the use of a passive single-switch BCI (passive-ssBCI) together with a main multi-class BCI. Thus, the passive-ssBCI could work in the background of the main BCI, allowing it to recognize stress-related emotions and to switch to a “stress mode”, which allows a better adaptation to the user current mental state, leading the system to better success rates. Frontal cortex asymmetry gave evidence that greater right frontal activity seems to be more highly related to negative emotional states. In this work, index of asymmetry of alpha band was computed by comparing the power of contra-lateral frontal electrodes. Discrete Wavelet transformation was used to decompose the EEG signals in frequency bands. The power spectral density was then calculated using modified Hamming periodogram. Signals from a public database for the analysis of human affective states, which was labeled with volunteers self-assessment scores, were employed. In order to label negative stress-related emotional state, rules based on valence, arousal and dominance dimensional emotions were defined. The results were promissory, because computed index of asymmetry in the alpha band indicated activity into the right frontal hemisphere was higher than the left one for seven out of nine volunteers during negative emotional states. This index could be employed as switch to a “stress mode” in a passive-ssBCI.

Listeria monocytogenes infection (listeriosis) is an uncommon but severe foodborne illness that affects mainly individuals with recognized underlying conditions: the elderly, immunocompromised individuals, and pregnant women and their fetuses. The aim of this study was to obtain epidemiological data on cases of listeriosis occurring in Portugal from 2008 through 2012, collected in hospitals on a voluntary basis. L. monocytogenes isolates were characterized by genoserotyping by multiplex polymerase chain reaction, DNA macrorestriction pulsed-field gel electrophoresis (PFGE), and determination of minimal inhibitory concentration (MIC, μg/mL) for 12 antibiotics. During this period, 203 cases of listeriosis were detected. The annual incidence rate observed ranged from 0.2 to 0.7 cases per 100,000 inhabitants. Nineteen cases (9.5%) corresponded to maternal/neonatal (MN) infections. The mean age of the nonmaternal/neonatal (non-MN) cases with documented age was 59 years, and 46.4% occurred in patients aged over 65 years. The majority of listeriosis cases were caused by genoserogroup IVb isolates, and PFGE analysis revealed a high molecular diversity, suggesting that most were sporadic. Nevertheless, several clusters of isolates presenting different geographic and time distributions were detected. The incidence of antibiotic-resistant isolates of L. monocytogenes was low but significantly higher than in previous years (2003-2007). The implementation of a national surveillance system monitoring the incidence of listeriosis and antimicrobial resistance of strains would be most valuable, allowing identification of sporadic and outbreak cases, to detect general trends in antibiotic susceptibilities, and potentially identify food sources of clinical strains.

We describe a novel heterothallic species in Aspergillus section Fumigati, namely A. felis (neosartorya-morph) isolated from three host species with invasive aspergillosis including a human patient with chronic invasive pulmonary aspergillosis, domestic cats with invasive fungal rhinosinusitis and a dog with disseminated invasive aspergillosis. Disease in all host species was often refractory to aggressive antifungal therapeutic regimens. Four other human isolates previously reported as A. viridinutans were identified as A. felis on comparative sequence analysis of the partial β-tubulin and/or calmodulin genes. A. felis is a heterothallic mold with a fully functioning reproductive cycle, as confirmed by mating-type analysis, induction of teleomorphs within 7 to 10 days in vitro and ascospore germination. Phenotypic analyses show that A. felis can be distinguished from the related species A. viridinutans by its ability to grow at 45°C and from A. fumigatus by its inability to grow at 50°C. Itraconazole and voriconazole cross-resistance was common in vitro. © 2013 Barrs et al.

In contrast with the common hematogenous dissemination of invasive aspergillosis (IA), we present case with a protracted course through anatomical planes in an immunocompromised adult male. The unusual clinical features and laboratory findings led to fungal genotyping and identification of the mold as Aspergillus viridinutans. It appears to be the first described case of IA caused by this agent in an adult patient.

Quinolone resistance is an emerging problem in Streptococcus pyogenes , and recombination with Streptococcus dysgalactiae DNA has been implicated as a frequent mechanism leading to resistance. We have characterized a collection of S. dysgalactiae subsp. equisimilis isolates responsible for infections in humans ( n = 314) and found a high proportion of levofloxacin-resistant isolates (12%). Resistance was associated with multiple emm types and genetic lineages, as determined by pulsed-field gel electrophoretic profiling. Since we could not find evidence for a role of efflux pumps in resistance, we sequenced the quinolone resistance-determining regions of the gyrA and parC genes of representative resistant and susceptible isolates. We found much greater diversity among the parC genes (19 alleles) than among the gyrA genes (5 alleles). While single mutations in either GyrA or ParC were sufficient to raise the MIC so that the strains were classified as intermediately resistant, higher-level resistance was associated with mutations in both GyrA and ParC. Evidence for recombination with S. pyogenes DNA was found in some parC alleles, but this was not exclusively associated with resistance. Our data support the existence of a common reservoir of genes conferring quinolone resistance shared between S. dysgalactiae subsp. equisimilis and S. pyogenes , while no recombination with the animal pathogen S. dysgalactiae subsp. dysgalactiae could be found.

Streptococcus gallolyticus is a microorganism belonging to the Streptococcus bovis I group isolated in humans, bovines and equines pigeons, among other animals. Streptococcus bovis is a Streptococcus strain found in the rumen, and has been isolated in the milk of animals with mastitis. The authors describe a case of an adult immunocompetent patient with underlying valvular heart disease, with bacteraemia and infective endocarditis by Streptococcus gallolyticus, in whom adenomatous colonic polyps with dysplasia were identified.

O envelhecimento populacional vem produzindo mudanças nas ações de saúde, incluindo as da Saúde Pública. Cresce o número de pessoas que reconhecem a possibilidade de uma velhice bem-sucedida e destacam o potencial dessa fase da vida. Cada vez mais, governos, profissionais e pesquisadores acreditam que o viver mais deveria estar associado à manutenção da autonomia, da auto-estima e da participação sócio-política, fatores essenciais para a qualidade de vida e o bem-estar. Inserido nesta tendência, este estudo teve como objetivo verificar se a experiência participativa dos idosos no Grupo de Movimento (G.M.) - uma técnica de intervenção corporal, baseada em princípios reichianos- concorreu positivamente para a melhoria do seu bem-estar subjetivo, tendo participado desse estudo 18 idosos do Município de Castelo - ES, que freqüentaram sessões de G.M. Para a coleta dos dados foram organizados dois grupos focais, nos quais os participantes relataram suas experiências, enfatizando mudanças físicas, relacionais e de humor correlacionadas às atividades grupais. Os dados foram tratados com a técnica qualitativa de análise do discurso do sujeito coletivo (DSC), nos quais foram identificadas categorias analíticas, segundo o modelo do bem-estar subjetivo proposto por Ryff: auto-aceitação, relações positivas com os outros, autonomia, domínio sobre o ambiente, propósito de vida e crescimento pessoal. Os resultados indicam que (1) o G.M. favoreceu as relações interpessoais e promoveu mudanças, (2) as quais são percebidas pelas famílias dos idosos e (3) houve melhora nas condições físicas e de humor dos participantes. Em geral, o G. M. influiu positivamente no senso de bem-estar daqueles idosos. The aging of the population has been producing changes in health actions, including those ones carried out by Public Health Services. There has been a growing number of people who recognizes the possibility of successful aging and emphasize the potential of this life phase. More and more, governments, professionals and researchers believe that having a longer life should be associated to maintenance of autonomy, self-esteem, and socialpolitical participation - essential factors for getting life quality and well-being. This study is inserted in this trend and it aims at verifying if the participative experience of elderly people in Grupo de Movimento (G. M.) - a technique of body intervention based on Reichian principies - improved their subjective well-being. 18 elderly people who tive in Castelo - ES participated in the study attending G. M. sessions. To collect data, two focal groups were organized with the partakers in which they reported their experiences, focusing physical, relational, and mood changes in connection with the participation in these group activities. Data were dealt with according to a col/ective subject discourse technique (DSC). Each DSC analytic category was identified, according to Ryff\'s subjective wellbeing model: self-acceptance, positive relationships with others, autonomy, environmental mastery, purpose in life, and personal growth. Results indicated that 1) G.M. favored interpersonal relationships and promoted changes, 2) elderly person\'s families recognized those changes, and 3) there were improvements in the participants\' physical and mood conditions. In general, G.M. has positively influenced the participants\' sense of well-being.

Bacteremia due to Vibrio cholerae non-O1 and non-O139 is a rare condition and potentially fatal. We report a case of bacteremia due to V. cholerae non-O1 and non-O139 in a Portuguese male with Hepatitis C cirrhosis, admitted due to acute diarrhea, after consuming shrimp. He had no recent travels. To our knowledge, this is the first reported case of bacteremia due to V. cholerae non-O1 and non-O139 in Portugal.

The population of group B streptococci (GBS) associated with invasive infections in nonpregnant adults from 2001 to 2008 was analyzed in isolates submitted from 24 hospital laboratories in Portugal ( n = 225). The isolates were characterized by antimicrobial susceptibility, pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), and surface protein gene profiling. GBS invasive cases were found more frequently among men in all age groups. In addition, serotype Ia was the most frequent in our collection, whereas serotype V is dominant elsewhere. Serotype Ia was represented mainly by a single PFGE cluster defined by sequence type 23 (ST23) and surface protein gene eps and by ST24 and bca , similarly to neonatal invasive infections in Portugal, indicating that the same genetic lineages can be responsible for both vaginal colonization and invasive disease in all age groups. In contrast, the hypervirulent serotype III/ST17 neonatal lineage was responsible for a minority of infections. Serotype V isolates were distributed into two genetic lineages, one defined by ST1 and surface protein gene alp3 and macrolide resistant, and another presenting with ST2 and eps and fully susceptible to all antimicrobials tested. The erm (TR) gene was the most frequently found among erythromycin-resistant isolates, while the bovine-associated tet (O) gene was found in a minority of tetracycline-resistant isolates. Our data emphasize the importance of local identification of the genetic lineages responsible for GBS invasive infections in nonpregnant adults. The dominance of serotype Ia in invasive disease in Portugal highlights the importance of this serotype in GBS pathogenesis.

Resumo: A avaliação da gravidade perante qualquer caso de pneumonia adquirida na comunidade (PAC) é de suma importância, pois dela decorrem decisões como a necessidade de internamento e o tratamento empírico inicial. Os autores apresentam um estudo retrospectivo, que incluiu doentes internados devido a pneumonia por Streptococcus pneumoniae durante o ano de 2006, no Hospital de São João. A confirmação etiológica de infecção foi feita por isolamentos no sangue, líquido pleural, secreções traqueobrônquicas, lavado brônquico, lavado broncoalveolar e pesquisa de antigenúria. Foram analisados os factores de risco e avaliados, com base nas normas PSI (Pneumonia Severity Index) e da British Thoracic Society (BTS) -CURB-65. A análise estatística foi efectuada utilizando teste T para amostras independentes e ANOVA, usando o programa de análise estatística SPSS 14.0.Foram incluídos 104 doentes com idade mediana de 63 anos, sendo 67,3% do sexo masculino. O estudo revelou existir uma associação com significado estatístico entre os resultados de PSI e CURB-65 e a evolução para a mortalidade.Apesar da melhoria dos meios diagnósticos e profilácticos, e da terapêutica antibiótica, a pneumonia pneumocócica permanece uma entidade de grande morbilidade e mortalidade. O valor preditivo das normas PSI e CURB-65 foi confirmado nesta população de doentes, documentando uma correlação entre o número de factores de risco e a evolução da doença.Rev Port Pneumol 2008; XIV (5): 601-615 Abstract: Probably the most important decision in the management of Community-Acquired Pneumonia (CAP) is patient site of care. Patients with Streptococcus pneumoniae-caused CAP admitted to our hospital between 1st January and 31st December 2006 were retrospectively analysed. Samples of blood, sputum, bronchial and bronchoalveolar lavage and urine were collected for microbiological testing using standard culture techniques and urine antigen detection. Pneumonia Severity Index (PSI) and British Thoracic Society (BTS) CURB-65 scoring tools were evaluated. The statistical treatment was performed using the SPSS 14.0 program. We included 104 patients, 67.3% male, median age 63 years old, mortality 13.4%. There was a significant association between the PSI and CURB-65 score and mortality. Despite advances, CAP is still an important health problem with a high attendant morbi-mortality. This study confirms the value of PSI and CURB-65 in the prediction of severe pneumonia.Rev Port Pneumol 2008; XIV (5): 601-615 Palavras-chave: Pneumonia adquirida na comunidade, Streptococcus pneumoniae, Key-words: Community-acquired pneumonia, Streptococcus pneumoniae

Stress can affect all people, regardless of age, gender or ethnicity. The human body utilizes stress as a response in three different situations, classified according to the way it generates physical, mental or emotional stress. It is important to notice that the nervous system evokes the same physiological responses, no matter what type of stress, and those responses cause a change of level in physical and cognitive performance. This paper presents an analysis methodology of the stress level using brain's signals captured by Electroencephalogram (EEG). Professionals from Vitoria´s Fire Department, members of Projeto VIDA participate as volunteers. The EEG signals are captured through a cap placed over the volunteer's head in order to capture the brain´s signals, using electrodes specifically placed in the frontal cortex at positions Fp1, Fp2, F3 and F4. The results are analyzed together with the peripheral physiological signals, such as: heart beat rate (ECG), peripheral blood flow (at fingers and toes), skin conductance, breath rate and body temperature. A validation study is conducted through a comparison of data available in literature, as well as with evaluation conducted by a psychologist. The results are analyzed in order to get a correlation between EEG signals and physical mental or emotional stress.

The Aedes aegypti mosquito is an important vector in the transmission of dengue virus, urban yellow fever, zika and chikungunya. The main tool used to control this vector is conventional chemical insecticides. However, continuous use causes many negative factors, such as environmental contamination and selection of resistant populations. In this sense, the biological control by microorganisms is a biotechnological alternative in the control of vectors, mainly the bioinseticidas formulated with bacteria of the genus Bacillus. Considering the diversity of Bacillus, members of this genus are capable of synthesizing bioinsecticidal biomolecules against different orders of insects. In addition, they are able to synthesize biopolymers, antibiotics and enzymes such as chitinase expressed by the chi gene. These enzymes have the ability to hydrolyze β-1,4 glycosidic bonds between the chitin polymer units. After ingestion by the larvae of the insect, it causes degradation of the peritrophic membrane that separates the epithelium from the middle intestine of the intestinal lumen, whose main component is chitin. This factor is a favorable requirement for its use in the control programs of insect vectors and agricultural pests. In this study, 124 bacterial strains isolated from soil, water, plant and insect from different Amazonian environments were used. All strains were identified by phenotypic characteristics as belonging to the bacilli group, being one hundred and fourteen (91.4%) Gram positive and ten (8.6%) Gram negative. In the molecular identification by amplification and sequencing of the 16S (rDNA) gene, 33 lines were identified, 27 belonging to the genus Bacillus, 4 to the genus Serratia, 1 to the genus Paenibacillus and 1 to the genus Achromobacter. In the molecular detection of the chi gene, six lineages (4.5%), BTAM27LB, 103PHAISP2, BTAM138LB, BTAM18NA, K2NA and R11ISP2 showed positive amplification, of which two were identified, BTAM 27- Bacillus sp. and R11ISP2-Bacillus amyloliquefaciens. In the selective bioassays of 124 lineages, 21 showed activity in Aedes aegypti larvae. The bioassays with the metabolic extracts produced by these 21 lineages cultivated in NA, LB and ISP2 medium demonstrated that 7 presented pathogenicity in the lyophilized culture and only 3 in the filtered supernatant. In another step, metabolic extracts produced by 9 strains cultured in chitin medium were evaluated, of which only 1 presented mortality in both the supernatant and lyophilized culture, presenting values corresponding to 100%. Thus, the selected strains present potential for the development of microbial bioinsecticides. O mosquito Aedes aegypti é um importante vetor na transmissão do vírus dengue, febre amarela urbana, zika e chikungunya. A principal ferramenta utilizada no controle deste vetor são os inseticidas químicos convencionais, porém, o uso contínuo provoca fatores negativos destacando-se a contaminação do meio ambiente e a seleção de populações resistentes. Neste sentido, o controle biológico por microrganismos é uma alternativa biotecnológica no controle de vetores, principalmente os bioinseticidas formulados à base de bactérias do gênero Bacillus. Considerando a diversidade de Bacillus, estes apresentam capacidade de síntese de biomoléculas bioinseticidas contra diferentes ordens de insetos. Além disso, sintetizam biopolimeros, antibióticos e enzimas como, por exemplo, as quitinases expressas pelo gene Chi. Estas enzimas hidrolisam as ligações glicosídicas β-1,4 entre as unidades constituintes da quitina. Após a ingestão das quitinases pelas larvas do inseto, provoca a degradação da membrana peritrófica que separa o epitélio do intestino médio do lúmen intestinal, cujo principal componente é a quitina. Este fator é um requisito favorável para a sua utilização nos programas de controle de insetos vetores e pragas agrícolas. Neste estudo, foram utilizadas 124 linhagens bacterianas isoladas do solo, água, planta e inseto de diferentes ambientes amazônicos. Todas foram identificadas pelas características fenotípicas como pertencentes ao grupo dos bacilos, sendo, cento e quatorze (91,4%) Gram positivos e dez (8,6%) Gram negativos. Na identificação molecular pela amplificação e sequenciamento do gene 16S (rDNA), 33 linhagens foram identificadas, 27 pertencendo ao gênero Bacillus, 4 ao gênero Serratia, 1 ao gênero Paenibacillus e 1 ao gênero Achromobacter. Na detecção molecular do gene Chi, seis (4,5%) linhagens, BTAM27LB, 103PHAISP2, BTAM138LB, BTAM18NA, K2NA e R11ISP2, apresentaram amplificação positiva para este gene, dentre estas, duas foram identificadas, BTAM 27- Bacillus sp. e R11ISP2- Bacillus amyloliquefaciens. No bioensaio seletivo de 124 linhagens, 21 apresentaram atividade larvicida em Aedes aegypti. Os bioensaios com os extratos metabólicos produzidos por estas 21 linhagens ativas, cultivadas em meio NA, LB e ISP2, demonstraram que sete apresentaram patogenicidade nas células lisadas e apenas 3 no sobrenadante filtrado. Em outra etapa, foi avaliado os extratos metabólicos produzidos por 9 linhagens ativas cultivadas em meio contendo quitina, das quais apenas 1 apresentou mortalidade tanto no sobrenadante quanto em células liofilizadas, apresentando valores correspondentes a 100%. Sendo assim as linhagens selecionadas apresentaram potencial para o desenvolvimento de bioinseticidas microbianos.