Cristina Verissimo

• master's degree in Biology
• Principal Investigator at National Institute of Health Dr. Ricardo Jorge

Cutaneous fungal infections represent a significant burden worldwide with a high impact on public health. Accurate identification of dermatophyte species causing these infections is vital for an appropriate treatment. Terbinafine is the primary agent against Trichophyton species due to its clinical efficacy; however, cases of elevated minimum inhib...

ABSTRACT Fungal infections are increasing worldwide, and one potential exposure route is through beach environments, which are currently not routinely monitored for fungal pathogens. Monitoring of the microbial quality of beaches is commonly conducted through measurements of enterococci, a fecal indicator bacterium, known to persist and regrow in b...

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...

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...

Background In‐house real‐time PCR (qPCR) is increasingly used to diagnose the so‐called endemic mycoses as commercial assays are not widely available. Objectives To compare the performance of different molecular diagnostic assays for detecting Histoplasma capsulatum and Coccidioides spp. in five European reference laboratories. Methods Two blinde...

The 2021 revised guidelines of the World Health Organization recommend monitoring the quality of sand in addition to water at recreational beaches. This review provides background information about the types of beaches, the characteristics of sand, and the microbiological parameters that should be measured. Analytical approaches are described for q...

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 c...

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...

Biofilm-associated infections are a public health concern especially in the context of healthcare-associated infections such as catheter-related bloodstream infections (CRBSIs). We evaluated the biofilm formation and antimicrobials resistance (AMR) of Enterobacter cloacae complex and Candida parapsilosis co-isolated from a CRBSI patient. Antimicrob...

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...

Background Depressive symptomatology is prevalent among female university students with adverse effects on their quality of life and academic performance. Previous research suggested associations between depressive symptomatology and oxytocin levels and between depressive symptomatology and Temperament Traits. Despite this evidence, to the best of...

Background Genomic surveillance of SARS-CoV-2 in Portugal was rapidly implemented by the National Institute of Health in the early stages of the COVID-19 epidemic, in collaboration with more than 50 laboratories distributed nationwide. Methods By applying recent phylodynamic models that allow integration of individual-based travel history, we reco...

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 to...

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...

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...

Invasive pulmonary aspergillosis (IPA) optimal duration of antifungal treatment is not known. In a joint effort, four international scientific societies/groups performed a survey to capture current practices in European haematology centres regarding management of IPA. We conducted a cross‐sectional internet‐based questionnaire survey in 2017 to ass...

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...

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...

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...

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...

Introduction: Superficial fungal infections are the most frequent infectious dermatoses and their incidence continues to increase. Dermatophytes are the principal agents presenting, however, a variable geographic distribution. Material and Methods: This study aimed to characterize the epidemiology of superficial fungal infections diagnosed in Der...

Fusarium solani infections in elasmobranchs are described mainly with skin, lateral line, skeletal muscle, and cartilage involvement.1,2,3 We described F. solani cases with head subcutaneous abscess of the endolymphatic tubes, labyrinthitis and meningitis in 4 Port Jackson sharks, occurring c. twenty years ago. Last year, we had a new case with a s...

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...

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...

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...

Histoplasmosis is a systemic mycosis caused by Histoplasma capsulatum. Rare in Europe but endemic in some regions of Brazil, United States, Africa and Asia. Most of the cases are asymptomatic. Disseminated form is defined by the presence of an extra-pulmonary focus, particularly associated with immunosuppression. We report a case of an unilateral p...

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...

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...

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...

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...

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...

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...

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...

A variety of data support the concept that certain opportunistic fungal infections are increasing in frequency over time. Several reasons have been proposed for the increase in invasive fungal infections, including the use of antineoplastic and immunosuppressive agents, broad-spectrum antibiotics, prosthetic devices, grafts and more aggressive surg...

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...

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 therefore be considered for inclusion in regulatory programmes aimed at protecting recreational beach users from infectious disease. Here, we review the literatur...

Fungal invasive infections are rare in general population but are an emergent cause of infection in the immunocompromized population, especially in the solid organ transplant recipients. Herein the authors report a clinical case of a liver transplanted patient suffering a cutaneous co-existent infection with A. alternata as well as A. infectoria....

Fungal infections have acquired high relevance all over the world. A preliminary estimate of the fungal burden in Portugal was done using deterministic scenario modelling and published incidence and prevalence data. Vaginal candidiasis was the most frequent fungal infection detected in this study, followed by severe asthma with fungal sensitization...

Background: Aspergillus respiratory infection is a common complication in cystic fibrosis (CF) and is associated with loss of pulmonary function and allergic disease. Methods: Fifty-three Aspergillus isolates recovered from CF patients were identified to species by Internal Transcribed Spacer Region (ITS), β-tubulin, and calmodulin sequencing....

Environmental microbiology is an evolving science. This is in part driven by changes and development of new analytical techniques that are becoming more varied and powerful. Before application, emerging issues and techniques need to be discussed among scientists, technical professionals, practitioners, and students. The TEMPH2014 provided a forum t...

Particulate matter (PM) can have a significant impact on human health and on artifacts stored and kept inside museums and archives. To the author's knowledge, its immediate and/or long-term concentrations and distribution on Portuguese archives has never been determined. Four Portuguese archives (with and without HVAC/air filtration systems) were s...

Clinical and environmental samples from Portugal were screened for the presence of Aspergillus and the distributions of the species complexes were determined in order to understand how their distributions differ based on their source. Fifty-seven Aspergillus isolates from clinical samples were collected from 10 health institutions. Six species comp...

Purpose: Samples from different environmental sources were screened for the presence of Aspergillus, and the distribution of the different species-complexes was determined in order to understand differences among that distribution in the several environmental sources and which of these species complexes are present in specific environmental setting...

In this study, we characterize the first autochthone case of human sporotrichosis reported in Lisbon, Portugal. Phenotypic and genotypic characterization revealed that the infection was caused by Sporothrix globosa. We conclude that sporotrichosis may be underdiagnosed particularly in Southern Europe and suggest Portugal as an emerging area for thi...

Beaches worldwide provide recreational opportunities to hundreds of millions of people and serve as important components of coastal economies. Beach water is often monitored for microbiological quality to detect the presence of indicators of human sewage contamination so as to prevent public health outbreaks associated with water contact. However,...

Epidemiological studies showed increased prevalence of respiratory symptoms and adverse changes in pulmonary function parameters in poultry workers, corroborating the increased exposure to risk factors, such as fungal load and their metabolites. This study aimed to determine the occupational exposure threat due to fungal contamination caused by the...

Although the adverse health consequences of ingestion of food contaminated with aflatoxin B1 (AFB1) are known, relatively few studies are available on the adverse effects of exposure in occupational settings. Taking this into consideration, our study was developed aiming to elucidate the possible effects of occupational exposure to AFB1 in Portugue...

Although the adverse health consequences of ingestion of food contaminated with aflatoxin B1 (AFB1) are known, relatively few studies are available on the adverse effects of exposure in occupational settings. Taking this into consideration, our study was developed aiming to elucidate the possible effects of occupational exposure to AFB1 in Portugue...

Fungal infections constitute a relevant problem in hospitals from all over the world. Their easy transmission through the air, water, or by direct or indirect contact with contaminated persons, surfaces or objects lead to an increasing preoccupation with those infections, particularly in immunocompromised patients. Regarding the enormous importance...

Social concerns for environmental impact on air, water and soil pollution have grown along with the accelerated growth of pig production. This study intends to characterize air contamination caused by fungi and particles in swine production, and, additionally, to conclude about their eventual environmental impact. Fiftysix air samples of 50 litters...

Social concerns for environmental impact on air, water and soil pollution have grown along with the accelerated growth of pig production. This study intends to characterize air contamination caused by fungi and particles in swine production, and, additionally, to conclude about their eventual environmental impact. Fiftysix air samples of 50 litters...

The impact of mycotoxins on human and animal health is well recognized. Aflatoxin B1 (AFB1) is by far the most prevalent and the most potent natural carcinogen and is usually the major aflatoxin produced by toxigenic fungal strains. Data available, points to an increasing frequency of poultry feed contamination by aflatoxins. Since aflatoxin residu...

A number of studies have shown that exposure to airborne dust and microorganisms can cause respiratory diseases in humans. Agricultural workers, such as pig farmers, have been found to be at high risk of exposure to airborne particles. The aim of this study was to detect contamination caused by particles and fungi in 7 swine farms located in Lisbon...

Although there is an abundance of literature concerning the ingestion of food contaminated with aflatoxin B1 (AFB1), only a small number of studies explore mycotoxin exposure in occupational settings. Taking this into consideration, our study was developed with the intention of elucidating whether there is occupational exposure to AFB1 in Portugue...

Background: Diabetic patients are particularly susceptible to fungal infections due to modifications that occur in their immunological system. These modifications compromise natural defences, such as skin and nails, especially from lower limbs. Aims: Assessing the presence of dermatomycosis in lower limbs of Portuguese diabetic patients followed...