This article reports the spread of bla KPC-2 in the Sao Paulo and Rio de Janeiro states, facilitated by globally spread K. pneumoniae clonal complex 258 (CC258) clones (ST258, ST11, and ST437) and a diversity of plasmids (IncFII, IncN, and IncL/M, two untypeable plasmids carrying Tn4401a or Tn4401b) successfully disseminated among species of the Enterobacteriaceae (Enterobacter cloacae, Serratia marcescens, and Citrobacter freundii). It also constitutes the first description of sequence type 258 (ST258) in Brazil, which was associated with a nosocomial hospital outbreak in Ribeirao Preto city.

Aims:  To determine the ability of probiotic lactobacilli to improve the treatment of vulvovaginal candidiasis (VVC) using a randomized, double‐blind and placebo‐controlled trial. Methods and Results:  Fifty‐five women diagnosed with VVC by vaginal discharge positive for Candida spp. (according to culture method) associated with at least one of the symptoms (itching and burning vaginal feeling, dyspareunia and dysuria), were treated with single dose of fluconazole (150 mg) supplemented every morning for the following 4 weeks with two placebo or two probiotic capsules (containing Lactobacillus rhamnosus GR‐1 and Lactobacillus reuteri RC‐14). At 4 weeks, the probiotic treated group showed significantly less vaginal discharge associated with any of the above mentioned symptoms (10·3%vs 34·6%; P = 0·03) and lower presence of yeast detected by culture (10·3%vs 38·5%; P = 0·014). Conclusion:  This study has shown that probiotic lactobacilli can increase the effectiveness of an anti‐fungal pharmaceutical agent in curing disease. Significance and Impact of the Study:  This novel finding of probiotic lactobacilli augmenting the cure rate of yeast vaginitis, not only offers an alternative approach to a highly prevalent condition that adversely affects the quality of life of women around the world, but also raises the question of how this combination works.

We consider integral operators defined by positive definite kernels K : X × X → C, where X is a metric space endowed with a strictly-positive measure. We update upon connections between two concepts of positive definiteness and upgrade on results related to Mercer like kernels. Under smoothness assumptions on K, we present decay rates for the eigenvalues of the integral operator, employing adapted to our purposes multidimensional versions of known techniques used to analyze similar problems in the case where X is an interval. The results cover the case when X is a subset of R m endowed with the induced Lebesgue measure and the case when X is a subset of the sphere S m endowed with the induced surface Lebesgue measure. (2000). Primary 45P05; Secondary 42A82, 45C05, 43A35, 41A99. Mathematics Subject Classification

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Yeasts of the Cryptococcus genus are distributed in nature associated to animal and vegetal organic residues. Occasionally, species other than C. neoformans may be responsible for infectious diseases in human and animals. This study aims to determine the occurrence of Cryptococcus species in the atmosphere and bird droppings in the city of Ribeirão Preto, São Paulo, Brazil, and to evaluate three virulence factors: capsule formation, growth at 37 degrees C and melanin production. We analyzed 86 environmental samples (54 droppings and 32 air). Of the 41 strains isolated, 15 were C. neoformans var. neoformans (12 droppings and 3 air), 15 C. albidus (12 droppings and 3 air), 9 C. laurentii (7 droppings and 2 air) and 2 C. uniguttulatus (from droppings). Capsules were produced by 93.3% of C. neoformans var. neoformans, 66.7% of C. albidus, 88.9% of C. laurentii and 50% (1/2) of C. uniguttulatus. All strains of C. neoformans, 20% of C. albidus and 44.4% of C. laurentii were able to grow at 37 degrees C. The melanin production on DOPA agar was verified in C. neoformans (93.3%), C. albidus (26.7%) and C. laurentii (66.7%). We concluded that different Cryptococcus species coexist in the same ecological niche and they are able to produce virulence factors.