Reinvestigation of Strychnos usambarensis Gilg resulted in the isolation of a tertiary phenolic bisindole alkaloid, 10‘-hydroxyusambarensine (1), which was identified by detailed spectroscopic ...methods. Compound 1 was moderately active against two strains of Plasmodium falciparum in vitro.
Background: Malaria in Loreto department remains a public health problem, accounting for more than 90% of reported cases in Peru. This is the first study in the Peruvian Amazon aimed at assessing the ...risk of malaria transmission using satellite imagery and Boosted Regression
Trees (BRT).
Methods: Villages with at least one malaria case between 2010 and 2015 from the routine surveillance data in Loreto were georeferenced and their cases aggregated by year and species. Social and environmental variables were derived from Landsat satellite imagery and other spatial data, then included as explanatory variables into a crossvalidated Poisson BRT model for malaria incidence at the local level.
Time-dependent explanatory variables included forest coverage (FC, %), annual forest loss (FL,%), cumulative annual rainfall (CAR, mm), annual-mean land surface temperature (LST, oC), normalised difference vegetation index (NDVI), and normalised difference water index (NDWI).
Other variables were Euclidean shortest distance to rivers (SDR, meters), time to major populated villages/towns (TPV, minutes), and night-time lights (NTL, mean value 2010-2013) as proxy of population density. BRT accounts for nonlinearities and interactions between factors with high
predictive accuracy for disease risk mapping.
Results: A total of 1524 villages were included in the analysis (70% of total Loreto’s villages). More than 90% of relative influence in the overall malaria incidence was explained by five variables: NTL (67.8%), TPV (8.1%), FC (6.5%), CAR (5%) and SDR (4.6%). The analysis
by species showed a higher influence of environmental variables (CAR, LST, NDVI and NDWI) for P. falciparum (18.4%) than for P. vivax incidence (9.7%). Malaria risk maps were generated based on model predictions taking into account the relative influence of variables.
Conclusions: Remotely sensed data analysed using BRT allowed for maps delimiting areas of high malaria risk in Loreto. These maps will help malaria stakeholders to prioritise areas for control interventions.
Introduction: Until now, Belgium has been considered as a low-risk country for alveolar echinococcosis (AE). However it was recently demonstrated by necropsy series that up to 51% of the red foxes ...(Vulpes vulpes) may be infected by E. multilocaris in some parts of Southern Belgium. The first local Belgian human AE cases were described in the early 2000's. Aim: The aim of this study was to report the experience of a tertiary university hospital of Southern Belgium with AE management.
Methods: The authors retrospectively collected data from the parasitology laboratory (serologies), the hospital pharmacy in charge of supplying albendazole, and by searching through patient’s files with medico-economic information service of a tertiary university hospital. The medical files were retrospectively reviewed.
Results: Twenty-one cases (66% male) of local AE have been recorded from 1999 to 2016. All patients were Belgian citizens with more than 30 years of life in Southern Belgium (Liege province: 10 cases (47.4%), Luxembourg province: 8 cases (36.8%), Namur Province: 3 cases (15.8 %)). Mean age of diagnosis was 66 years (ranges: (35-85y). Eighteen patients had hepatic involvement: 14 underwent surgical resection and 5 had unresectable liver lesions and underwent albendazole palliative therapy until death. During the same period, the faculty of veterinary medicine observed an increased rate of lethal hepatic AE in dogs, another indication of high AE incidence.
Conclusions: AE appears to be spreading in Belgium and has actually an uneven geographical distribution with endemicity in areas of Southern and Eastern Belgium. However, it is probable that local AE cases will be diagnosed in the whole country, considering that there is no reason that infected foxes remain in Southern Belgium and also the fact that some people from Northern Belgium might spend long period in Southern Belgium, with or without their dogs. The liver is the most frequently involved organ and the only cure can be achieved by complete R0 resection of all AE lesions. In reaction to this experience, the authors created a multidisciplinary group for AE diagnosis and management, including hepatologists, infectiologists, microbiologists, pathologists, radiologists, nuclear medicine specialists, surgeons and veterinarians. The authorities should be aware of this medical issue and should facilitate the access to Albendazole for AE patients. A complete national survey should be encouraged, and BASL might have an important role in this study.
Case report We report the case of a young Cameroonian woman who presented with cough, hyperthermia, weight loss, pancytopenia, and hepatosplenomegaly. A positive HIV serology was discovered and a ...chest radiography revealed a 'miliary pattern'. Bone marrow aspiration pointed out yeast inclusions within macrophages. Given the morphological aspect, the clinical presentation and immunosuppression, histoplasmosis was retained as a working hypothesis. Antiretroviral and amphotericin B treatments were promptly initiated.
Review Given the immigration wave that Europe is currently experiencing, we think it is important to share experience and knowledge, especially in non-endemic areas such as Europe, where clinicians are not used to face this disease. Histoplasmosis is due to Histoplasma capsulatum var. capsulatum, a dimorphic fungus. Infection occurs by inhaling spores contained in soils contaminated by bat or bird droppings. The clinical presentation depends on the immune status of the host and the importance of inoculum, varying from asymptomatic to disseminated forms. AIDS patients are particularly susceptible to develop a severe disease. Antigen detection, molecular biology techniques, and microscopic examination are used to make a rapid diagnosis. However, antigen detection is not available in Europe and diagnosis needs a strong clinical suspicion in non-endemic areas. Because of suggestive imagery, clinicians might focus on tuberculosis. Our case illustrates the need for clinicians to take histoplasmosis in the differential diagnosis, depending on the context and the patient's past history.
Objectives
Dermatophytosis refers to superficial fungal infections of keratinized tissues caused by keratinophilic dermatophytes. They are the most common cause of superficial fungal infections ...worldwide. Epidemiological studies regarding dermatophyte infections have been conducted in several countries and differences in the incidence and in etiological agents have been reported for different geographical areas. That is why national surveillance of circulating strains causing dermatophytosis is crucial. The Belgian National Reference Center (NRC) for Mycoses conducted a survey on dermatophytes strains circulating from 2012 to 2014. The present study was performed to assess the profile of dermatophytosis and to identify the species involved.
Methods
The Belgian NRC for Mycosis collected 9138 strains between January 2012 and December 2014. The isolates were cultured from patients clinically suspected for fungal infections of skin, hair and nails. Isolates were sent by Belgian laboratories to the two labs of the Belgian NRC (UZ Leuven and CHU of Liège) in order to identify the fungus or to confirm the identification. All isolates cultured from patients of UZ Leuven and CHU of Liège were also included. Fungal identification was performed by microscopy after subculture and in case of doubtful identifications by ITS sequencing.
Results
.Among the 9138 samples (results of UZ Leuven and CHU of Liège combined), 3587 were identified as dermatophytes. Trichophyton. rubrum (T. rubrum) was the most prevalent species accounting for 56,17% (n=2015) of the infections from all sources, followed by T. mentagrophytes complex (21,83%, n=783). The other main etiological agents of dermatophytosis recorded in this study in descending order of prevalence were M. audouinii (n=303), M. canis (n=120), T. violaceum (n=112), T. tonsurans (n= 95), T. soudanense (n=66), M. praecox (n=59), E. floccosum (n=14) Our data reveal the predominance of anthropophilic species causing tinea capitis especially M. audouinii responsible for 36,49% (n=163/448) of hair/scalp infection. Trichophyton violaceum rarely observed in our country is frequently found as 12,8% (n=57) of the reported cases of tinea capitis are due to this species. The retrospective evaluation of data collected also shows that zoophilic strains as M. canis well represented in the past epidemiology of tinea capitis, is decreasing in frequency accounting for only 7,2% (n=32) of clinical cases. Finally, our data confirm the high prevalence of T. rubrum commonly observed in Europe as causal agent of onychomycosis (70,9%, n=1603) followed by T. mentagrophytes complex (20,9%, n=455). T. rubrum and T. mentagrophytes complex are also responsible for the majority of skin infections as they represent respectively 40% (n=386) and 24,75% (n=239) of skin dermatophytosis during the study period.
Conclusions
The present work has provided recent data on the prevalence of several dermatophytes species circulating in Belgium. Such data is critical for the establishment of therapeutic strategies and measures for prevention and control of dermatophytes infections. Our study confirms the predominance of T. rubrum followed by T. mentagrophytes in the Belgian population but also highlights the emergence of new anthropophilic species such as M. audouinii and T. violaceum as causative agents of tinea capitis in children in relation with African immigration.
The primary aim of this study was to collect national epidemiological data on candidaemia and to determine the reporting time of species identification and antifungal susceptibility in clinical ...practice. During a 1-year period (March 2013 until February 2014), every first Candida isolate from each episode of candidaemia was included prospectively from 30 Belgian hospitals. Identification and susceptibility testing were performed according to local procedures and isolates were sent to the National Reference Center for Mycosis. Species identification was checked by matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS) and internal transcribed spacer (ITS) sequencing in case no reliable identification was obtained by MALDI-TOF MS. Antifungal susceptibility testing was performed according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) methodology. A total of 355 isolates were retrieved from 338 patients. The mean incidence rate of candidaemia was 0.44 (range: 0.07 to 1.43) per 1000 admissions or 0.65 (range: 0.11 to 2.00) per 10,000 patient days. Candida albicans was most frequently found (50.4 %), followed by C. glabrata (27.3 %) and C. parapsilosis sensu lato (9.8 %). The overall resistance to fluconazole was 7.6 %, ranging from 3.9 % in C. albicans to 20.0 % in C. tropicalis. Only one C. glabrata isolate was resistant to the echinocandins. Four days after blood culture positivity, 99.7 % of the identifications and 90.3 % of the antifungal profiles were reported to the treating clinician. Candidaemia incidence rates differed up to 20-fold among Belgian hospitals; no clear factors explaining this difference were identified. The overall antifungal resistance rates were low but high azole resistance rates were recorded in C. tropicalis.
The antimycotic activity of a new parenteral solution containing miconazole was compared to that of a marketed solution (Daktarin IV solution). This solution has been withdrawn from the belgian ...market probably because of the toxic effects related to the presence of polyoxyl 35 castor oil. We propose a new formulation containing 10 mg of miconazole per ml (as the marketed solution), in combination with HP-beta cyclodextrin and lactic acid. The MIC of these two solutions were determined by broth microdilution method (following the NCCLS guidelines) against 15 yeasts and 16 filamentous fungi isolates. This study showed that MIC obtained with these two solutions are not significantly different. In vitro, the cyclodextrin solution has the same antimycotic activity as the Daktarin IV solution and can be proposed as a safe and effective parenteral solution to replace the previous surfactant solution.
PDF
