What is the role/function of the Diagnostics and Therapeutics Technician in the Mycology Laboratory of the Dermatology Service?
The functions of the Diagnostics and Therapeutics Technician in dermatology are basically all of those in the functional content for clinical pathology in the area of microbiology, yet as it is an area with a very specific character it requires a long period of theoretical and practical training.

The Mycology Laboratory of the Dermatological Clinic of the Dermatology Service was created about fifty years ago by Professor Juvenal Esteves, then director of the service, with the aim of promoting clinical and laboratory assistance, as well as scientific research in the field of medical mycology.

Nowadays the laboratory receives about 2,000 samples per year, mainly coming from the dermatology out-patients, as well as from different services of the North Lisbon Hospital Centre and other hospital centres from different regions throughout the country.

Among cutaneous infectious diseases, fungus infections are the most frequent ones in dermatological clinical practice. Dermatophyties are surface infections caused by dermatophytes. One of the specific functions of the technician for this area is to take samples of palm or sole skin, nails and hair in order to carry out a direct examination and take the respective cultures in different mediums, thus allowing a confirmation of the diagnostic. Subcutaneous and deep mycoses are less frequent; in some the infecting fungus is cosmopolitan, and in others the causal agent is importation. As a rule, mycological study – the direct examination of cultures in different mediums and temperatures – is carried out through biopsies, scabs and other biological products.

Fungus spores are present in the atmosphere and in a large number of different substrata, thus being is a possible source of contagion, particularly in patients in immune-suppression. It is up to the technician to harvest samples for research into fungi on inert material: soil, beach sand, several different surfaces such as walls, shower plugholes; on foodstuffs, flours, juices, condiments, etc. Besides the technical functions related to care, my functions as a technician in this university clinic laboratory have been added to by collaboration on activities as an educator on mycology training periods for other dermatology therapeutics technicians from other hospitals, or on training periods for dermatology interns in this service and in other dermatology services in Portugal. Recently there have also been requests for training clinical pathologists from several different hospitals.

My collaboration has also been requested at theoretical-practical classes in the subject of Dermatology, as well as at the Faculty of Pharmacy of the University of Lisbon.

This clinic is sponsored by the Portuguese Dermatology Society, and has organised courses in Medical Mycology, in which I was a monitor in the initial phase, and nowadays the experience acquired over my career has allowed me to have the responsibility for the programming, preparation of practical classes and teaching.

The work done over the years, of special note among which are the works in epidemiology, prospection and dermatophitic endemies, integrated within the field of Public Health, have led to my presenting several oral communications, posters in congresses and other scientific meetings in Portugal and abroad. Most of these works have been published in co-authorship or as the sole author in several Portuguese and foreign mycology magazines.

Besides the above-mentioned functions it is also up to the laboratory technician to draw up the monthly and annual statistics.

What are the complementary means of diagnosis and therapy that are carried out in the Mycology Laboratory of the University Dermatology Clinic?
1 - Assembly, microscope observation and interpretation of the respective results in the clinical context of the various different biological products.
2 – Seeding in order to obtain primocultures in selective culture mediums;
3 – Subcultures in chemically-defined mediums to obtain gender and species fructification organs, thus allowing the classification of different isolated fungi.
4- Study of lipophilic yeast
5- Technique of blade culture
6- Research into germinative tubes
7- Carbon auxanogram – classical method
Auxacolor®- micromethod
8- “In vitro” susceptibility: disk diffusion method.
E Test. of several anti-fungi.
9- Research into de Cryptococus neoformans antigen:
In liquor, serum, urine and L.B.A.-Elisa.


Is continuous learning strongly supported? In what way?
My professional life has involved a commitment that stimulated me from very early on and alerted me to the need for continuous learning, which has only been possible to achieve through the unconditional support and stimulus of all the directors with whom I have had the privilege to work.

I started out in the Mycology Laboratory of the University Dermatology Clinic as a preparer, under the guidance of Dr Júlia Cabrita, the principal researcher of the Faculty of Medicine of the University of Lisbon, from whom I received all the training based on scientific evidence and also on the rigour of information and methods.

In February 1981, through the Training Nucleus of the Portuguese Oncology Institute, Dr. Francisco Gentil proposed that I should frequent the Course for Technician of Clinical Analyses at the Dr Ricardo Jorge National School of Public Health. This course turned out to be of great important for me because it increased and consolidated my technical knowledge in general and allowed me to enter the technical career.

As my activity has been exclusively carried out in the field of Medical Mycology and the experience I have gained over the years have allowed me to carry out tasks with a greater degree of complexity and responsibility, it was suggested by Dr Júlia Cabrita, with the support of Professor Guerra Rodrigo, then Director of Service, that I should attend, and was accepted exceptionally (the course was for graduates only) in March 1989 on the “Cours de Specialization en Mycologie Medical et Veterinaire” at the Institut de Medecine Tropicale Prince Leopold. Autwerp, Belgium. This course was completed in June of the same year, after I had drawn up a personal research work with an original theme referring to “Trichophyton Rosaceum”. The monograph was classified in first place among thirty candidates from several different countries. From this day on I have annually attended refresher training periods and knowledge assessment courses in the same laboratory.

In order to apply to the competition for Access to the category of First Class Specialist Technician in Clinical Analyses and Public Health in the career of Diagnostic and Therapeutic technician, I drew up a monograph entitled ”Vaginal Candiasis. Laboratory Diagnosis/ Susceptibility Tests”.

Training Course at the Mycology Laboratory of the Institute of Tropical Medicine – Antwerp, Belgium from 1/10/1984 to 12/10/84, under the direct supervision of Professor Charles De Vroey. This training course intended to refresh knowledge in the field of Medical Mycology. I was able to come into contact with techniques of determining sexuality of the dermatophytes used by Dr Takashio. I was given strains of polarity (+) and (-) of Arthroderma simii, and all the material indispensable for carrying out this technique. My stay in Antwerp was supported by Janssen Pharmaceuticals. I spent a day at the Department of Microbiology headed by Dr Van Cutsen, where I witnessed the performing of techniques allowing one to obtain experimental disease in animals, having attended therapeutic tests.

Training Course at the Mycology Laboratory of the Institute of Tropical Medicine – Antwerp, Belgium, from 01/03/1989 to 01/07/1989, under the direct supervision of Professor Charles De Vroey. This training course was held while I was taking the specialisation course in Medical Mycology, and on it I was allowed to actively participate in all the routine work – diagnosis of surface mycoses. I drew up a personal research work referring to “TRICOPHYTON ROSACEUM” – Monograph. Learned: 1 – Techniques of “in vitro” susceptibility – Method of diffusion in Casiton medium; 2 – Immunological Technique of antigen research of C. neoformans no liquor, urine, L.B.A; serum. ELISA Method.

Training Course at the Mycology Laboratory of the Institute of Tropical Medicine – Antwerp, Belgium, from 02/10/1989 to 13/10/1989 under the direct supervision of Professor Charles De Vroey. This training course intended to update and consolidate knowledge previoulsy acquired in Medical Micoilogy and also to take details on “TECHNIQUES OF IN VITRO SUSCEPTIBILITY” and of “ANTIGEN RESEARCH OF C. NEOFORMANS” and on all the material necessary for them to be put into practice in the laboratory where I work. These techniques, as they are non-existent in our country, were or Great use in support for clinical practice, guiding and monitoring the therapeutic approach. Nowadays they are routine in most Mycology and Microbiology laboratories.

Training Course at the Mycology Laboratory of the Institute of Tropical Medicine – Antwerp, Belgium, from 15/04/1997 to 19/04/1997, under the direct supervision of Professor Danielle Swinne. This training course intended to update and consolidate knowledge. It was thus seen that the susceptibility techniques learnt in previous training periods had the micro-method “Fungitest”® as a novelty. The same manufacturer had a technique to more quickly identify the yeasts of importance to human pathology: “AUXACOLOR”®. Studies were carried out compared to both the classical methods, which are now laboratory routine, and the results obtained were communicated in scientific meetings.

Training Course at the Mycology Laboratory of the Institute of Tropical Medicine – Antwerp, Belgium, from 16/03/1998 to 21/03/1998, under the direct supervision of Professor Danielle Swinne. On this training course I was able to accompany all the work carried out during this period, to confirm the identification of some fungi that are rare in Portugal, which I could isolate and classify. I updated previously acquired knowledge. I was also able to attend a conference on “Mucorales” given by Professor Danielle Swinne, where I became aware of the fact that some fungi, usually saprophytes, are gaining particular importance in Human Pathology and are being resistant to the majority of anti-fungi.

Training Course at the Mycology Laboratory of the Institute of Tropical Medicine – Antwerp, Belgium, from 22/04/2002 to 25/04/2002, under the direct supervision of Professor Danielle Swinne. On this training course I was able to observe/manipulate rare fungi that are a part of the collection of the same institute. I was also able to attend a class in the course I attended on “Updating on Therapeutrics of Tinea Capitis” given by Professor Danielle Swinne.

Training Course at the Mycology Laboratory of the Institute of Tropical Medicine – Antwerp, Belgium, from 26/03/2003 to 28/03/2003, under the direct supervision of Professor Danielle Swinne. On this training course I was able to refresh my knowledge in the different areas of Medical Mycology.

Training Course at the Mycology Laboratory of the Institute of Tropical Medicine – Antwerp, Belgium, from 03/05/2004 to 07/05/2004, under the direct supervision of Professor Danielle Swinne. On this training course I was able to learn two new techniques, to accompany the laboratory routine and also to attend a conference on “Micetomes” given by Professor Danielle Swinne.

Training Course at the Mycology Laboratory of the Institute of Tropical Medicine – Antwerp, Belgium, from 12/09/2005 to 16/09/2005, under the direct supervision of Professor Danielle Swinne. I did a refresher course at the invitation of Professor Danielle Swinne and directly supervised by Dr Marjan Van Esbroeck. On this training course I dedicated particular attention to updating my knowledge in the field of Hygiene and Safety at Work.

The learning was varied according to the attending of training and laboratory courses held in Portugal and abroad, and, over time, with my participation on mycological research works, lecturing classes and supervising training periods at the Mycology Laboratory, with the presentation of scientific works in congresses and other Portuguese and international meetings, and the publication of works in Portuguese and international magazines.

Hortênsia Sequeira is a member of the following scientific societies:

Sociedade Portuguesa de Dermatologia e Venereologia.
Grupo de Micologia da Sociedade Portuguesa de Dermatologia.
Societé Belge de Mycologie Humaine et Animale.
International Society for Humans and Animal Mycology – ISHAM.

Hortênsia de Sequeira