Cerebrospinal fluid: a target of some fungi and an overview

Meningitis is a potentially life-threatening infection characterised by the inflammation of the leptomeningeal membranes. The estimated annual prevalence of 8.7 million cases globally and the disease is caused by many different viral, bacterial, and fungal pathogens. Although several genera of fungi are capable of causing infections in the central nervous system (CNS), the most significant number of registered cases have, as causal agents, yeasts of the genus Cryptococcus. The relevance of cryptococcal meningitis has changed in the last decades, mainly due to the increase in the number of people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and medications that impair the immune responses. In this context, coronavirus disease 19 (COVID-19) has also emerged as a risk factor for invasive fungal infections (IFI), including fungal meningitis (FM), due to severe COVID-19 disease is associated with increased pro-inflammatory cytokines, interleukin (IL)-1, IL-6, and tumour necrosis factor-alpha, reduced CD4-interferon-gamma expression, CD4 and CD8 T cells. The gold standard technique for fungal identification is isolating fungi in the culture of the biological material, including cerebrospinal fluid (CSF). However, this methodology has as its main disadvantage the slow or null growth of some fungal species in culture, which makes it difficult to finalise the diagnosis. In conclusions, this article, in the first place, point that it is necessary to accurately identify the etiological agent in order to assist in the choice of the therapeutic regimen for the patients, including the implementation of actions that promote the reduction of the incidence, lethality, and fungal morbidity, which includes what is healthy in the CNS.

COVID-19 Associada à Aspergilose Pulmonar (CAPA): uma revisão sistemática / COVID-19 Associated Pulmonary Aspergillosis (CAPA): A systematic review

Os esforços envidados para o controle e extinção da pandemia do novo Coronavírus-2019 (COVID-19) não estão obtendo êxito, e já atingiram critérios epidemiológicos alarmantes, tendo infectado mais de dez milhões de pessoas no Brasil e mais de 100 milhões no mundo. A infecção por este vírus pode causar a síndrome respiratória aguda grave, com danos diretos ao epitélio das vias aéreas, permitindo a instalação de patógenos secundários de origem bacteriana e fúngica, como exemplo os fungos do gênero Aspergillus, que podem causar complicações nas manifestações clínicas e aumentar a taxa de mortalidade. Porém, mesmo com a alta probabilidade de infecção por estes fungos, verifica-se que são poucos os estudos direcionados a este assunto, como também, em alguns países, não há critério para identificar os fungos patógenos em geral, sendo possível que o verdadeiro número de coinfecções e a necessidade de internação em UTI seja maior. Portanto, neste artigo, revisamos estudos anteriores sobre a CAPA em bancos de dados eletrônicos e discutimos a necessidade do diagnóstico da aspergilose invasiva para aumento da sobrevida dos pacientes envolvidos. Neste trabalho recomendamos o diagnóstico correto e precoce das infecções fúngicas invasivas em pacientes com COVID-19, e que novos estudos sobre o tema sejam realizados para padronizar um diagnóstico eficaz e comprovado.

The new corona virus 2019 (COVID-19) is becoming unstoppable, and has already reached alarming epidemiological criteria, having infected more than 10,000,000 in Brazil and more than 100,000,000 worldwide. Infection with this virus can cause severe acute respiratory syndrome, which causes direct damage to the airway epithelium, allowing the invasion of secondary pathogens of bacterial and fungal origin, such as fungi of the genus Aspergillus, which can cause complications in clinical manifestations. and increase the mortality rate, however, even with the high probability of infection by these fungi, it appears that there are few studies directed to this subject, and also, in some countries there is no criterion to identify pathogenic fungi in general, it is possible that the true number of co-infections and the need for ICU admission is greater. Therefore, in this article, we reviewed previous studies on CAPA in electronic databases, and discussed the need for the diagnosis of invasive aspergillosis to increase the survival of the patients involved. Therefore, in this work, we recommend the correct and early diagnosis of invasive fungal infections in patients with COVID-19, and that further studies on the subject be carried out to standardize an effective and proven diagnosis.

Cryptococcus laurentii fungaemia in a cervical cancer patient

ABSTRACT Infections caused by emerging Cryptococcus non-neoformans species are being reported with increasingly frequency. Here, we present a case of fungaemia byCryptococcus laurentii in a woman receiving aggressive immunosuppressive therapy for cervical neoplasia. Three venous blood samples were aseptically collected on consecutive days and C. laurentiiwas isolated and identified through phenotypic and molecular methods. After central venous catheter removal and appropriate antifungal therapy, the patient showed significant improvement and blood culture became negative. Thus, patients following immunosuppressive therapies and using invasive medical devices are at risk of C. laurentii blood infections.

Invasive infection due to Saprochaete capitata in a young patient with hematological malignancies

We report a case of invasive infection due to Saprochaete capitata in a patient with hematological malignancies after chemotherapy treatment and empiric antifungal therapy with caspofungin. Although severely immunocompromised the patient survived been treated with amphotericin B lipid complex associated with voriconazole.

Infecções oportunistas por leveduras e perfil enzimático dos agentes etiológicos / Opportunistic yeast infections and enzymatic profile of the etiological agents

Infecções por leveduras são freqüentes em imunocomprometidos, contudo espécies emergentes têm alterado o perfil epidemiológico. A habilidade de secretar proteases tem sido associada à patogenicidade do gênero Candida. Esta pesquisa teve como objetivos diagnosticar leveduroses em pacientes imunocomprometidos e avaliar a virulência dos agentes etiológicos baseado em teste de secreção de protease utilizando soro de albumina bovina como substrato. Do total de 104 pacientes estudados, 19 apresentaram episódios de leveduroses. O trato respiratório (63,2 por cento), seguido pelo trato urinário (10,5 por cento) foram os locais mais comuns de infecção. Candida albicans, Candida parapsilosis, Candida tropicalis e espécies emergentes como Candida krusei e Candida guilliermondii foram isoladas. Cinco isolados de Candida parapsilosis e um de Candida albicans e Candida guilliermondii exibiram alta atividade enzimática. Concluímos que a caracterização enzimática de isolados de Candida pode ser um útil marcador prognóstico, especialmente em imunocomprometidos, uma vez que leveduroses nestes pacientes são geralmente graves.

Yeast infections are common in immunocompromised patients, although emerging species have been changing the epidemiological profile. The ability to secrete proteinases has been associated with pathogenicity within the genus Candida. This study had the aims of diagnosing yeast infections in immunocompromised patients and evaluating the virulence of the etiological agents, based on a proteinase secretion assay using bovine serum albumin as a substrate. Out of a total of 104 patients studied, 19 presented episodes of yeast infection. The respiratory tract (63.2 percent), followed by the urinary tract (10.5 percent), were the most common sites of infection. Candida albicans, Candida parapsilosis, Candida tropicalis and emerging species such as Candida krusei and Candida guilliermondii were isolated. Five isolates of Candida parapsilosis and one of Candida albicans and Candida guilliermondii exhibited high enzymatic activity. We conclude that enzymatic characterization of Candida isolates may be a useful prognostic marker, especially among immunocompromised individuals, since yeast infections in such patients are generally serious.