The increasing infection of Cryptococcus species and Tricosporon asahii emerged in clinical patients who were immunocompromised. They usually induce lung, skin, brain and systemic infection. Morbidity and mortality of immunocompromised patients are higher than normal healthy people. Cryptococcus neoformans var. grubii ¡]serotype A¡^ infections were reported in clinical cases predominantly and they were isolated from birds¡¦ droppings in large amount. Cryptococcus neoformans var. gattii ¡]serotype B, C¡^ had a natural life in plants, especially Eucalypticus trees. Isolations from other trees were reported increasingly in the tropical and subtropical areas. Comparing to Cryptococcus species, Tricosporon asahii is the normal mycoses of soil. In this study, we performed an environmental investigation concerning Cryptococcus species and Tricosporon asahii in Southern Taiwan. 120 droppings of racing pigeons and 114 samples from Eucalypticus trees were obtained. The results revealed that 30 Cryptococcus neoformans were isolated from racing pigeons¡¦ droppings ¡]25%¡^, as well as 4 Cryptococcus laurentii ¡]3.3%¡^ and 2 Cryptococcus albidus ¡]1.7%¡^. In addition, 25 Tricosporon asahii ( 20.8% ) were isolated from droppings of racing pigeons. But, none of Cryptococcus species or Tricosporon asahii is isolated from Eucalypticus trees ¡]0%¡^. All of Cryptococcus neoformans isolated from pigeons¡¦ droppings were var. grubii ¡]serotype A¡^ and their drug susceptibility tests showed sensitive to Amphotericin B ¡]minimal inhibitory concentration ¡Ø0.25£gg/ml¡^ and Fluconazole ¡]minimal inhibitory concentration 2£gg/ml¡^ and Flucytosine ¡]minimal inhibitory concentration ¡Ø1£gg/ml¡^. To sum up, both Cryptococcus species and Tricosporon asahii were isolated from droppings of racing pigeons in our study, especially Tricosporon asahii in large amount. Opportunistic infection caused by these species should be given more attention to racing pigeons which have close contact with human . Intensive investigation and surveillance should be carried out in the future to provide an information for the control and prevention of diseases.

BACKGROUND: Multi drug resistant Tuberculosis (MDR-TB) is a serious public health concern in many parts of the world. As per the WHO- 2010 global report on Surveillance and response 3.6% of all incident TB cases globally are multidrug resistant. In this regard, there is an increasing demand for timely, reliable and comprehensive drug susceptibility testing (DST) as MDR-TB surveillance is being geared up. The intent of this analysis is to determine whether there is a need to continue routine confirmatory DST testing at CDC in addition to just sending the isolates for genotyping. Analysis is done by measuring the discordance between the results of laboratory DST at CDC and the local labs drug type, drug testing concentrations, and study sites. METHODS: The data for this analysis was provided by the Tuberculosis Trials Consortium (TBTC), CDC. Data for this analysis was collected over nearly two decades (1993-2011), gathered from 7 clinical trials. Discordance between the local and CDC lab DST results was measured using Kappa statistic. Sensitivity and specificity analysis was done by taking the CDC DST lab results as the gold standard. Discordance levels were calculated by local sites and baseline drug resistance for each antibiotic in each study was measured. RESULTS: Average Kappa values for inter rater agreement for all the studies was 0.6444 whereas the overall level of discordance across all studies is 7.786%. Drug resistance at baseline was highest for Isoniazid and Streptomycin (except Study 23 and 22). CONCLUSION: Though the current results show few DST result discordances between local and CDC labs, it is better to continue to send isolates to the centralized lab (CDC) in view of the worldwide threat of drug resistant TB epidemic, the recommendations of the current literature and the benefits of reliable confirmatory testing services and availability of other molecular diagnostic methods.

Orientadores: Mariangela Ribeiro Resende, Maria Luiza Moretti / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-14T14:58:52Z (GMT). No. of bitstreams: 1 Ferrari_MichelaDeLuca_M.pdf: 2800534 bytes, checksum: 6c0f0dc17633a5c05f98eaf42e330cb7 (MD5) Previous issue date: 2009 / Resumo: Os objetivos do presente estudo foram estimar a prevalência de resistência do M. tuberculosis aos fármacos de primeira linha entre pacientes com tuberculose diagnosticados no Hospital de Clínicas da Unicamp e avaliar o desempenho do método de microdiluição em placa com [3-(4,5-dimethylthiazol-2-yl)- 2,5diphenyl-tetrazolium bromide] (MTT) comparado ao Bactec MGIT 960®. No período foram notificados 360 casos de tuberculose. Destes 211 casos apresentaram cultura positiva para Mycobacterium sp, sendo incluídos 105 casos, nos quais foi identificado o M. tuberculosis. Dentre estes pacientes a apresentação pulmonar da TB ocorreu em 64,8% e co-infecção pelo HIV em 37,1%. A prevalência de resistência a qualquer fármaco foi de 6,7%; multidrogarresistência (RMP e INH) e resistência a INH e SM foram detectadas em 1%, em 3,8% e em 3,8% dos casos, respectivamente. Todos os isolados foram susceptíveis ao EMB. A resistência primária foi encontrada em quatro casos e resistência adquirida em três. Houve associação entre tratamento prévio e resistência (p=0,0181), as demais variáveis estudadas não foram associadas. Dentre os 119 isolados de M. tuberculosis incluídos para a avaliação do desempenho do MTT, ocorreu concordância de 100% para INH e EMB entre os métodos MTT e Bactec MGIT960®, de 99% para RMP (sensibilidade: 90%), enquanto que para SM houve concordância inferior aquela apresentada pelos outros fármacos (95,2%; sensibilidade: 90,9%). A prevalência de resistência entre os casos novos atendidos no Hospital de Clínicas da Unicamp no período de estudo foi de 3,8% para isoniazida, 1% para rifampicina, 3,8% para etambutol e 1% multidrogarresistente. Resistência a qualquer fármaco foi observada em 6,7% dos casos. O método colorimétrico com MTT apresentou bom desempenho e representa uma alternativa acurada, simples e de reduzidos custos, viável e sustentável para locais e países com limitados recursos. / Abstract: This cross-sectional, hospital-based study conducted between January 2006 and March 2008 sought to estimate the resistance of M. tuberculosis to first-line drugs among patients with tuberculosis confirmed by culture at a Brazilian hospital and evaluate the performance of the [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazolium bromide] (MTT) microplate assay in comparison to the Bactec MGIT 960. During the study period were reported to the surveillance system 360 tuberculosis cases, 211 out of these were confirmed by positive culture for Mycobacterium sp and 105 out of these had M. tuberculosis isolated on culture and were included to the prevalence study. Pulmonary involvement was present in 64.8% of cases and HIV co-infection was found in 37.1%. The prevalence of M. tuberculosis resistance was 6.7%; multidrug-resistance [rifampin (RMP) and isoniazid (INH)] and resistance to INH and streptomycin (SM) were detected in 1%, in 3.8% and in 3.8% of cases, respectively. All isolates were susceptible to ethambutol (EMB). The resistance was primary in four cases and acquired in three cases. Previous treatment was associated with resistance (p=0.0181). Among 119 isolates of M. tuberculosis included to the MMTT performance evaluation, there was 100% observed agreement for INH and EMB between the MTT and Bactec MGIT 960¿ methods. For RMP, the observed agreement was 99% (sensitivity: 90%), and for SM, the level of agreement was lower (95.2%; sensibility 90.9%) than those of the other drugs. The prevalence of M. tuberculosis resistance among the new cases during the study period was 6.7%; multidrug-resistance and resistance to INH and streptomycin (SM) were detected in 1%, in 3.8% and in 3.8% of cases, respectively. The colorimetric method with tetrazolium (MTT) represents an accurate, simple and low cost alternative that is both viable and sustainable for settings with limited resources. / Mestrado / Ciencias Basicas / Mestre em Clinica Medica