Raquel Sabino

National Institute of Health Dr. Ricardo Jorge | INSA · Department of Infectious Diseases

The success of the clinical management of invasive fungal diseases (IFD) is highly dependent on suitable tools for timely and accurate diagnosis for effective treatment. An in-depth analysis of the ability of European institutions to promptly and accurately diagnose IFD was previously conducted to identify limitations and aspects to improve. Here,...

Fungal flora in coastal/inland beach sand and recreational water is a neglected field of study, despite its potential impact on human health. A joint International Society for Human and Animal Mycology/European Confederation for Medical My cology (ISHAM/ECMM) w orking group w as formed in 2019 with the task to set up a vast international initiative...

The success of the clinical management of invasive fungal diseases (IFD) is highly dependent on the availability of suitable tools for the timely and accurate diagnosis for effective treatment. Unfortunately, the lack of appropriate diagnostic tools remains still one major hurdle contributing to the high mortality rates associated with these infect...

Candida auris is an opportunistic human pathogen that has rapidly spread to multiple countries and continents and has been associated with a high number of nosocomial outbreaks. Herein, we report the first case of C. auris in Portugal, which was associated with a patient transferred from Angola to an ICU in Portugal for liver transplantation after...

E.A.) Definition: Impact of fungi in plants, human, and animal health. The role of the environment as an influencing factor on these elements. Abstract: Fungi constitute a diverse group with highly positive and negative impacts in different environments, having several natural roles and beneficial applications in human life, but also causing severa...

Background: Aspergillus fumigatus is a saprophytic fungus, ubiquitous in the environment and responsible for causing infections, some of them severe invasive infections. The high morbidity and mortality, together with the increasing burden of triazole-resistant isolates and the emergence of new risk groups, namely COVID-19 patients, have raised a...

We evaluated the mortality due to aspergillosis in free-ranging Magellanic penguins during their migration and the reproductive season. Ninety-eight carcasses of penguins were collected along 370 km of coastline in Southern Brazil, between June 2017 and October 2019, and from reproductive colonies at Patagonian Argentina, in January 2019. All anima...

Aspergillosis is a mycosis, most commonly affecting the airways. This mycosis can worsen the clinical condition of patients with concurrent lung diseases. We assayed for the presence of serum anti-A. fumigatus IgG in bronchiectasis patients from a tertiary hospital in south Brazil and evaluated the relationship with clinical outcome. Thirty-one pat...

Objective Aspergillosis diagnosis depends on the detection of Aspergillus in biological samples ─ usually using cultural and immunoenzyme techniques ─ but their sensitivity and specificity varies. We aimed to study the prevalence of Aspergillus in patients at higher risk of chronic pulmonary aspergillosis (i.e., HIV-infected patients and individual...

The present study employed data collected during the Mycosands survey to investigate the environmental factors influencing yeasts and molds distribution along European shores applying a species distribution modelling approach. Occurrence data were compared to climatic datasets (temperature, precipitation, and solar radiation), soil datasets (chemic...

The diagnosis and initiation of appropriate treatment against invasive fungal infections depend upon accurate identification of pathogens by pathologists and clinical microbiologists. Histopathology is often critical in providing diagnostic insight in patients with suspected fungal infections, and such findings are incorporated into the definitions...

Invasive fungal infections (IFI) have significantly increased over the past years due to advances in medical care for the at-risk immunocompromised population. IFI are often difficult to diagnose and manage, and can be associated with substantial morbidity and mortality. This study aims to contribute to understanding the etiology of invasive and su...

Persons with cystic fibrosis (CF) frequently suffer from Pseudomonas aeruginosa and Aspergillus fumigatus co-infections. There is evidence that co-infections with these interacting pathogens cause airway inflammation and aggravate deterioration of lung function. We recently showed that P. aeruginosa laboratory isolates synergistically interact with...

In recent years, research in the areas of Aspergillus and aspergillosis has continued to advance rapidly, including advancements in genomics, immunological studies, clinical areas, and diagnostic areas. Recently, new risk groups for the development of aspergillosis have emerged—patients with influenza- or COVID-19-ssociated pulmonary aspergillosis....

Invasive pulmonary aspergillosis (IPA) has become a recognizable complication in coronavirus disease 2019 (COVID-19) patients admitted to intensive care units (ICUs). Alveolar damage in the context of acute respiratory distress syndrome (ARDS) appears to be the culprit in facilitating fungal invasion in COVID-19 patients, leading to a COVID-19-asso...

Aspergillus section Fumigati is reported in up to 99% of aspergillosis cases in penguins. So far, no data regarding molecular epidemiology and azole resistance are available for A. fumigatus isolates collected from Magellanic penguins. The aim of this work was to perform molecular identification of Aspergillus section Fumigati at species level, to...

Dermatophytoses are superficial and contagious infections caused by dermatophyte fungi. They are the most frequent infectious dermatosis in clinical practice, and can affect the skin, hair and nails. Its correct diagnosis allows the understanding of clinical, ecological and epidemiological aspects associated with these microorganisms. Clinical pres...

The goal of most studies published on sand contaminants is to gather and discuss knowledge to avoid faecal contamination of water by run-offs and tide-retractions. Other life forms in the sand, however, are seldom studied but always pointed out as relevant. The Mycosands initiative was created to generate data on fungi in beach sands and waters, of...

Identification of Aspergillus to species level is important since sibling species may display variable susceptibilities to multiple antifungal drugs and also because correct identification contributes to improve the knowledge of epidemiological studies. Two retrospective laboratory studies were conducted on Aspergillus surveillance at the Portugues...

Introduction: The frequency in detection of azole-resistant Aspergillus fumigatus isolates has increased since 2010. In Portugal, the section Fumigati is one of the most frequent, and resistant strains to have been found in clinical and environmental contexts. Although several cryptic species within the Fumigati section show intrinsic resistance t...

Culturing is still the most widely used method for determining fungal growth. Thus, is important to identify the most suitable culture media to assess Aspergillus spp. The aim of this study was to analyze data obtained from previous studies, aiming at identifying the most suitable culture media (malt extract agar (MEA) or dichloran-glycerol agar (D...

The One Health context considers health based on three pillars: humans, animals, and environment. This approach is a strong ally in the surveillance of infectious diseases and in the development of prevention strategies. Aspergillus spp. are fungi that fit substantially in this context, in view of their ubiquity, as well as their importance as plan...

Since the beginning of the current COVID-19 pandemic, laboratory diagnosis has been and continues to be an essential tool in the identification of new cases of infection by the SARS-CoV-2 coronavirus. Laboratory diagnosis has been essential to identify symptomatic and in particular asymptomatic cases and is crucial in the implementation of strategi...

We retrospectively analyzed a cohort of 146 patients with suspicion of respiratory fungal infection The prevalence of Aspergillus was calculated, as well as the frequency of each section and species of these fungi isolated from respiratory samples Resistance to azoles was determined for the Aspergillus of the Fumigati section. Fifty seven (39.0%) o...

This pilot study aimed to characterize the pulmonary mycobiome of patients with suspicion of fungal infection of the respiratory tract as well as to identify potentially pathogenic fungi infecting their lungs. DNA was extracted from the respiratory samples of a cohort of 10 patients with suspicion of respiratory fungal infection. The internal trans...

Candida auris was first described as a new species back in 2009. Although it differs markedly from other Candida species, this species can be misidentified as other yeasts in the routine microbiology laboratories. Therefore, its identification to species level should be confirmed by reference laboratories. Candida auris exhibits potential to cause...

Association between selection pressure caused by the use of azole fungicides in sawmills and the development of fungal resistance has been described. The aim of this study was to implement an algorithm to assess the presence of Aspergillus section Fumigati resistant strains in sawmills. Eighty-six full-shift inhalable dust samples were collected fr...

A Portuguese isolate of Aspergillus fumigatus was found to contain three double-stranded (ds) RNA elements ranging in size from 1.1 to 1.8 kbp and comprising the genome of a strain of Aspergillus fumigatus partitivirus 1 (AfuPV-1) previously thought to contain only the two largest dsRNA elements. The sequence of the smallest dsRNA element is descri...

Thirty people (mostly children) experienced an episode of skin rash days after a sand sifting beach operation at Porto Pim Beach in Faial, Azores during June 2019. An environmental and epidemiologic investigation was conducted to identify the cause of the outbreak of skin rash. The epidemiologic investigation found that some of the patients experie...

Schizophyllum commune is a basidiomycetes worldwide distributed that has emerged as cause of invasive infections in immunosuppressed patients. We present a case of a man who was simultaneously diagnosed with a small cell non-Hodgkin lymphoma and a sphenoid sinusitis by S. commune. Intraoperative observation and histology description were crucial to...

Background Due to the difficulty in the access to free-ranging birds, data regarding Aspergillus infections in wild avian species is rare compared to captive wild and domestic birds. Objective: report three cases of Aspergillus section Fumigati causing fungal disease in free-ranging aquatic birds, with the identification of the causal agent to the...

Background: Invasive pulmonary aspergillosis (IPA) optimal duration of antifungal treatment is not known. Objectives: In a joint effort, four international scientific societies/groups performed a survey to capture current practices in European hematology centers regarding management of IPA. Methods: We conducted in 2017 a cross-sectional inter...

To determine the potential of a real-time PCR (rt-PCR) in the detection of Aspergillus spp. DNA in respiratory samples from a cohort of patients with suspicion of fungal respiratory infection and whose samples had been previously analyzed by culture and/or immunoenzymatic techniques. We focused particularly on HIV+ patients and patients with active...

The emergence of Candida auris is considered as one of the most serious problems associated with nosocomial transmission and with infection control practices in hospital environment. This multidrug resistant species is rapidly spreading worldwide, with several described outbreaks. Until now, this species has been isolated from different hospital su...

Diagnosis of invasive fungal infections is complex, and the lack of standardization of molecular methods is still a challenge. Several methods are available for the diagnosis of invasive aspergillosis, but their effectiveness will depend on the studied population, the patients’ comorbidities, and the use of mold active prophylaxis, among others. Th...

Filamentous fungi and yeast are ubiquitous in nature, including bathing areas and therefore, sand. However, certain fungal species can cause infections or allergies in humans. Previous studies have shown that there are opportunistic or pathogenic microorganisms that can survive and grow in sand. Since bathing areas are used by a large numbers of pe...

Environmental health is at the intersection between health and the environment. However, it still has a recent (and narrow) history as a scientific area, mainly addressing human biomonitoring and toxicological issues. Only recently additional environmental 'layers', other than the traditional chemical, biological and physical environmental determin...

Aspergillosis is a respiratory fungal disease of importance in captive marine birds. The aim of this study was to describe the occurrence of aspergillosis in Thalassarche melanophris during rehabilitation events and to identify the etiological agent. All the albatrosses that were received for rehabilitation and died within a 2-year period were incl...

Background: The molecular epidemiology and antifungal susceptibility of Aspergillus nidulans species complex has not been well studied. Objectives: To evaluate the genetic diversity and antifungal susceptibility patterns of clinical and environmental isolates of Aspergillus nidulans complex METHODS: Sixty clinical and environmental isolates of A...

Background: Although substantial efforts have been made to investigate about the composition of the microbiota, fungi that constitute the mycobiota play a pivotal role in maintaining microbial communities and physiological processes in the body. Objectives: Here, we conducted an international-survey focusing on laboratory's current procedures re...

Exposure to Aspergillus conidia is an increased risk factor for the development of respiratory symptoms. The emergence of azole resistance in Aspergillus fumigatus is a major concern for the scientific community. The aim of this study was to perform the molecular identification of Aspergillus species collected from different occupational and non-oc...

Background: Recent outbreaks of Candida auris further exemplify that invasive Candida infections are a substantial threat to patients and health care systems. Even short treatment delays are associated with higher mortality rates. Epidemiological shifts towards more resistant Candida spp. require careful surveillance. Objectives: Triggered by th...

The diversity of fungal species comprising the lung mycobiome is a reflection of exposure to environmental and endogenous filamentous fungi and yeasts. Most lung mycobiome studies have been culture-based. A few have utilized next generation sequencing (NGS). Despite the low number of published NGS studies, several themes emerge from the literature:...

Aspergillus spp. have a high nutritional versatility and good growth on a large variety of construction materials. They also colonize soil or food, but decaying vegetation is their primary ecological niche. Therefore, exposure to fungi may occur at home, during hospitalization, during specific leisure activities, or at the workplace. The developmen...

[This corrects the article DOI: 10.3389/fmicb.2018.00516.].

Aspergillosis causes high morbidity and mortality in avian species. The main goal of this study was to use molecular techniques to identify Aspergillus species collected from different avian species with aspergillosis. A subsample of those isolates was also screened for resistance to itraconazole. Over a 2-year period, clinical samples were recover...

Purpose: Tissue samples from patients with suspicion of deep or subcutaneous fungal infections were analysed at the Portuguese Reference Mycology Laboratory according to a proposed diagnostic approach, which aims to constitute a rapid and accurate diagnosis for these fungal infections. Methodology: Forty-six tissue biopsy samples were analysed o...

Methods: Airborne fungi were collected using an impaction air sampler and surface samples were also performed. Fourteen air samples were collected for direct detection of fungal DNA from filamentous fungi and dermatophytes. Overall, 63.6 % of the evening samples and 46 % of the morning samples surpassed the threshold values (150 CFU/m3). Molecular...

Purpose Fungal burden has traditionally been detected by conventional culture analysis. This method allows the identification and quantification of organisms posing high health/occupational risk and is widely used by the scientific community. However, this method is limited by several factors, including, for example, incubation conditions such as t...

Objectives : The United Nations sustainable development goal #3, aims to “By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination” (New York, September 2015). This study ’ s objective is to assess the European drinking and bathing water regulations and detect miss...

The increasing number of invasive procedures and clinical therapies has led to an increase number of patients at-risk of suffering invasive fungal infections. The prophylaxis with antifungals is now broader used in specific groups of patients. Therefore, it is not surprising the emergence of antifungal resistance. In the following chapter this issu...

This book intends to provide information about detection and health effects due to bacteria, fungi and viruses in indoor environments. The book will cover also information about preventive and protective measures to avoid health-hazardous. Case studies will be also addressed to enrich the book with the expertise of each invited author. The book als...

There is a lack of knowledge on the epidemiology of fungal infections worldwide because there are no reporting obligations. The aim of this study was to estimate the burden of fungal disease in Portugal as part of a global fungal burden project. Most published epidemiology papers reporting fungal infection rates from Portugal were identified. Where...

Microbiological drinking water safety is traditionally monitored mainly by bacterial parameters that indicate faecal contamination. These parameters correlate with gastro-intestinal illness, despite the fact that viral agents, resulting from faecal contamination, are usually the cause. This leaves behind microbes that can cause illness other than g...

Candida albicans is a common microbe, colonizer and potential pathogen found in respiratory cultures of cystic fibrosis (CF) patients. Because of possible development of resistance in patient isolates resulting from residence in the abnormal milieu of CF patient airways, or from exposure to antifungals, and considering the possibility of patient-to...

A next-generation sequencing (NGS) approach, in conjunction with culture-based methods, was used to examine fungal and prokaryotic communities for the presence of potential pathogens in beach sands throughout Portugal. Culture-based fungal enumeration revealed low and variable concentrations of the species targeted (yeasts and dermatophytes), which...

The molecular detection and identification of fungi in the environment is still an area under development. Conventional methods applied to the analysis of fungi in the air, in the water, or on surfaces imply the growth of fungal colonies and their macro- and microscopic observation. Difficulties in performing these analyses raise the importance of...

The hospital environment is one of the major concerns in nosocomial fungal infections. A high number of environmental factors may contribute to indoor environmental quality in hospital settings. Transmission of fungi occurs via contact, aspiration of contaminated particles, aerosolization of drinking water, and the hands of health-care workers, amo...

The permanent contact with cork may lead to constant exposure to fungi, raising awareness as a potential occupational hazard in the cork industry. In fact, the presence of fungi belonging to the Penicillium glabrum complex has been associated with the development of respiratory diseases such as suberosis, one of the most prevalent diseases among wo...

Health effects resulting from organic dust inhalation in occupational environments may be more strongly associated with specific microbial components, such as fungi, than to the particles. The aim of the present study is to characterize the occupational exposure to the fungal burden in four different occupational settings (two feed industries, one...

As areias das praias contêm por vezes microrganismos nocivos para a saúde humana, frequentemente em superiores às que existem na água. Atualmente (Brandão et al. 2002; Sabino et al. 2012; Solo-Gabriele et al. 2015) não existe regulamentação para a amostragem, análise e apreciação da qualidade microbiológica de areias. O Programa Nacional de Avaliaç...

Objectives: Mycological contamination of occupational environments can be a result of fungal spores' dispersion in the air and on surfaces. Therefore, it is very important to assess it in both types of the samples. In the present study we assessed fungal contamination in the air and in the surface samples to show relevance of surfaces sampling in...

Background: Very few studies regarding fungal and particulate matter (PM) exposure in feed industry have been reported, although such contaminants are likely to be a significant contributing factor to several symptoms reported among workers. The purpose of this study has been to characterize fungal and dust exposure in one Portuguese feed industry...

Some environmental Aspergillus spp. isolates have been described as resistant to antifungals, potentially causing an emerging medical problem. In the present work, the antifungal susceptibility profile of 41 clinical and 134 environmental isolates of Aspergillus was determined using the CLSI microdilution method. The aim of this study was to compar...

Within the Aspergillus genus, Aspergillus fumigatus species is one of the most ubiquitous saprophytic fungi and is considered the section of species with higher clinical relevance. This section is the most common cause of invasive aspergillosis and a major source of infection-related mortality in immunocompromised patients. One of the most abundant...

Sandpits used by children are frequently visited by wild life which constitutes a source of fungal pathogens and allergenic fungi. This study aimed to take an unannounced snapshot of the urban levels of fungal contaminants in sands, using for this purpose two public recreational parks, three elementary schools and two kindergartens. All samples wer...

In slaughterhouses, the biological risk is present not only from the direct or indirect contact with animal matter, but also from the exposure to bioaerosols. Fungal contamination was already reported from the floors and walls of slaughterhouses. This study intends to assess fungal contamination by cultural and molecular methods in poultry, swine/b...

Purpose This study intended to characterize fungal contamination in two swine farms, in one feed production unit, and also in one swine slaughterhouse. We aimed to identify where the highest occupational exposure to Aspergillus spp. was detected during the production line. Methods Twenty two air and 22 surfaces samples were collected from the four...

Aspergillus fumigatus is one of the major ubiquitous saprophytic fungi and it is considered one of the fungal species with higher clinical relevance. This study aimed at characterising the prevalence of A. fumigatus complex in one waste-sorting plant and also in one incineration plant. Conventional and molecular methodologies were applied in order...

Workers from feed production often develop allergic respiratory symptoms and fungi are likely to be a significant contributing factor to these symptoms. This study intended to characterize fungal contamination in two feed production units, one for poultry and other for swine consumption. We aimed at identifying which unit presented the highest risk...

Clinical Mycology is traditionally recognised as being of low relevance in non-immunocompromised contexts, associated therefore mainly to patients with acquired immunodeficiency, diabetes, cancer, cystic fibrosis, burns and little more. But is it really so? This article is an update on the fungal infection in Portugal, contextualizing it in the pre...

Book Description: Exposure to certain types of mycotoxins, the bioactive secondary metabolites of filamentous fungi, significantly impact the animal industry as well as human health. The contamination of food with mycotoxins is a worldwide problem in animal production and direct consequences are the reducing of food intake and production. In this...

Poultry farmers are occupationally exposed to many respiratory hazards, being the two most reported the fungal burden and particles. In this study we aimed to access fungal and particles’ exposure in seven poultries with floor-housed operations and in one poultry slaughterhouse to compare occupational exposure to both risk factors in the two occup...

No information has been generated so far on the concentration of fungi in different caves. However, several fungal outbreaks have been reported and this can be a serious risk for cave workers and visitors. Besides, the presence of bats in caves is epidemiologically important, as they can increase the chance of human acquisition of pathogens. In th...

Feed contamination by potential toxigenic fungi Carla Viegas1, 2; Tiago Faria1; Raquel Sabino1, 3; Anita Quintal Gomes1, 4; Susana Viegas1,5 1 Environmental Health RG, Lisbon School of Health Technology, Polytechnique Institute of Lisbon, Lisbon, Portugal. 2 Environmental Health Institute – Faculty of Medicine from Lisbon University 3 Mycology Labo...

Recent studies suggest that sand can serve as a vehicle for exposure of humans to pathogens at beach sites, resulting in increased health risks. Sampling for microorganisms in sand should be considered for inclusion in regulatory programmes aimed at protecting recreational beach users from infectious disease. In an effort to provide recommendations...

Environmental Mycology in Public Health: Fungi and Mycotoxins Risk Assessment and Management provides the most updated information on fungi, an essential element in the survival of our global ecology that can also pose a significant threat to the health of occupants when they are present in buildings. As the exposure to fungi in homes is a signif...

Sand serves as a reservoir for potentially pathogenic microorganisms. Children, a high-risk group, can acquire infections from sand in sandboxes, recreational areas, and beaches. This paper reviews the microbes in sands, with an emphasis on fungi. Recreational areas and beach sands have been found to harbor many types of fungi and microbes. A newly...

Cork oak is the second most dominant forest species in Portugal and makes this country the world leader in cork export. Occupational exposure to Chrysonilia sitophila and the Penicillium glabrum complex in cork industry is common, and the latter fungus is associated with suberosis. However, as conventional methods seem to underestimate its presence...

Candida parapsilosis emerged as an important opportunistic pathogen, causing candidemia worldwide. Nosocomial outbreaks triggered by this species have been frequently described, particularly in cancer patients. For a better understanding of its epidemiology, several typing methods are used and microsatellite analysis has been reported as highly dis...