Plantas medicinais: uma abordagem sobre o uso seguro e racional / Medicinal plants: an approach to rational and safe use

Resumo Muitas plantas são utilizadas com finalidades medicinais, constituindo alternativas terapêuticas complementares ao tratamento de doenças, trazendo inúmeros benefícios à saúde, quando utilizadas racionalmente e de maneira adequada. No entanto, as plantas constituem um arsenal grande de constituintes químicos, que podem ser benéficos, mas também podem representar um risco potencial à saúde. Desse modo, é importante que o usuário, os profissionais de saúde, e os prescritores, tenham conhecimentos sobre a planta, a correta identificação, conservação, modo de preparo e uso, além dos possíveis efeitos colaterais. As plantas medicinais, seus riscos e benefícios, são discutidos à luz das publicações científicas contemporâneas, atentando para a contribuição dos profissionais de saúde em relação ao seu papel de educadores e promotores de saúde atuantes em comunidades, especialmente aquelas usuárias do Sistema Único de Saúde.

Abstract Many plants are used for medicinal purposes, constituting therapeutic alternatives complementary to the medical treatment, bringing numerous health benefits, when used rationally and in an appropriate way. However, plants constitute a large arsenal of chemicals constituents, which may be beneficial, but may also pose a potential health risk. So, it is important that the user, the health professionals, and the prescribers, have knowledge about the plant, ensuring correct identification, conservation, preparation and use, as well as possible side effects. The study of the medicinal plants, their risks and benefits, and efficacy confirmation by carefully designed studies will be discussed in the light of contemporary scientific publications, paying attention to the contribution of health professionals in relation to their role as active educators and health promoters in communities, especially those users of the Unified Health System.

Risk factors associated with mortality among patients who had candidemia in a university hospital

Abstract INTRODUCTION: Bloodstream infection due to Candida spp. is a primary cause of morbidity and mortality in tertiary hospitals. METHODS: In this retrospective study, we included patients with a positive blood culture for Candida spp. after 48 h of hospitalization. RESULTS A total of 335 patients who had candidemia were included in this study. Risk factors associated with mortality were hospitalization in internal medicine units and surgical clinics, age >60 years, mechanical ventilation, orotracheal intubation, hemodialysis, corticosteroids use, and C. parapsilosis infection. CONCLUSIONS: This study highlights the importance of health care related to invasive procedures and actions to improve patient immunity.

Identificação, Prevenção e Tratamento da Síndrome Mão-Pé Induzida por Quimioterapia: Revisão Sistemática / Identification, Prevention and Treatment of Hand-Foot Syndrome Induced by Chemotherapy: Systematic Review / Identificación, Prevención y Tratamiento de la Enfermedad Mental por Quimioterapia: Revisión Sistemática

Introdução: A síndrome mão-pé é uma reação adversa experimentada por vários pacientes em tratamento para o câncer e fator preditor de morbidade e mortalidade. Objetivo: Avaliar as evidências científicas relacionadas à identificação, prevenção e tratamento da síndrome mão-pé induzida por agentes quimioterápicos, identificar os principais sinais e sintomas que possibilitam o reconhecimento da síndrome e, ainda, discutir a ocorrência de onicomicoses no contexto da síndrome mão-pé. Método: Trata-se de uma revisão sistemática na MEDLINE/PubMed, Biblioteca Virtual da Saúde e Scopus, incluindo literatura cinzenta e busca manual. Os 29 estudos incluídos na revisão foram analisados e classificados segundo a hierarquia dos níveis de evidência Grading of Recommendations Assessment, Development and Evaluations (GRADE) e a confiabilidade entre os examinadores (coeficiente Kappa) foi calculada. Resultados: Foram identificados estudos que demonstraram eficácia na prevenção da síndrome mão-pé com o uso da crioterapia e hidroterapia. Evidenciaram-se resultados satisfatórios com o uso do creme de ureia na prevenção e tratamento, e o uso de piridoxina não apresentou resultados conclusivos. Foram encontrados mecanismos para identificação da síndrome e para classificação dos agentes indutores. O grupo dos taxanos predominou entre os medicamentos indutores da síndrome mão-pé. Conclusão: Existem evidências consistentes, porém não contemplam todos os fármacos indutores da síndrome e não exploram outras manifestações relacionadas às onicólises e onicomicoses. O estudo apresentou resultados que poderão auxiliar os prescritores na identificação da síndrome mão-pé, além de alternativas para prevenção e tratamento. Contudo, vale destacar a necessidade de pesquisas futuras para elucidar a etiologia e protocolos de tratamento.

Introduction: Hand-foot syndrome is an adverse reaction experienced by many cancer patients and a predictor of morbidity and mortality. Objective:To evaluate the scientific evidence related to the identification, prevention and treatment of chemotherapeutic-induced hand-foot syndrome, to identify the main signs and symptoms that enable the recognition of the syndrome, and to discuss the occurrence of onychomycosis in the context of the hand-foot syndrome. Method: This is a systematic review at MEDLINE/PubMed, Virtual Health Library and Scopus, including gray literature and manual search. The 29 studies included in the review were analyzed and graded according to the hierarchy of evidence levels Grading of Recommendations Assessment, Development and Evaluations (GRADE) and reliability among examiners (Kappa coefficient) was calculated. Results:It were identified studies that demonstrated efficacy in preventing hand-foot syndrome using cryotherapy and hydrotherapy. Satisfactory results were evidenced with the use of urea cream for prevention and treatment, and the use of pyridoxine showed inconclusive results. Mechanisms for identification of the syndrome and classification of inducing agents were found. The taxane group predominated among hand-foot syndrome inducing drugs. Conclusion: There are consistent evidences but do not include all drugs inducing the syndrome and do not explore other manifestations related to onycholysis and onychomycosis. The study presented results that may help prescribers to identify hand-foot syndrome, as well as alternatives for prevention and treatment. However, it is worth highlighting the need for future studies to elucidate the etiology and treatment protocols.

Introducción: El síndrome de pies y manos es una reacción adversa experimentada por muchos pacientes con cáncer y un predictor de morbilidad y mortalidad. Objetivo: Evaluar la evidencia científica relacionada con la identificación, prevención y tratamiento del síndrome de pies y manos inducido por quimioterapia, identificar los principales signos y síntomas que permiten el reconocimiento del síndrome y analizar la aparición de onicomicosis en el contexto del síndrome mano-pie. Método:Esta es una revisión sistemática en MEDLINE/PubMed, Virtual Health Library y Scopus, que incluye literatura gris y búsqueda manual. Los 29 estudios incluidos en la revisión se analizaron y clasificaron de acuerdo con la jerarquía de los niveles de evidencia Grading of Recommendations Assessment, Development and Evaluations (GRADE). Resultados: Identificamos estudios que demostraron eficacia en la prevención del síndrome mano-pie usando crioterapia e hidroterapia. También mostraron resultados satisfactorios con el uso de crema de urea en la prevención y el tratamiento, y el uso de piridoxina no mostró resultados concluyentes. Se encontraron mecanismos para la identificación del síndrome y la clasificación de los agentes inductores. El grupo de taxanos predominó entre los fármacos inductores del síndrome mano-pie. Conclusión: Existe evidencia consistente pero no incluye todas las drogas que inducen el síndrome y no explora otras manifestaciones relacionadas con la onicólisis y la onicomicosis. El estudio presentó resultados que pueden ayudar a los prescriptores a identificar el síndrome de manos y pies, así como alternativas para la prevención y el tratamiento. Sin embargo, vale la pena destacar la necesidad de futuras investigaciones para dilucidar la etiología y los protocolos de tratamiento.

Impact of a medication therapy management service offered to patients in treatment of breast cancer

ABSTRACT Cancer has high morbidity and mortality rates related to medication use and produce a costly impact in health care. Thus, patients require constant monitoring and proper coordination of care between different professionals. This study aimed to evaluate the impact generated by a Medication Therapy Management service (MTM) offered to patients with breast cancer in use of polypharmacy. Observational, exploratory, descriptive and retrospective study of a MTM service that included 93 patients. Sociodemographic and clinical data related to pharmacotherapy and the processes associated with the systematization of the service were collected and analyzed. Patients were followed-up by the MTM service on average for 18 months (±4.31) and 185 drug-related problems (DRP) were identified, an average of two DRP per patient. Of these DRP, 48.11% were resolved and 49.73% were in the resolution process. The most common DRP were in the categories of Indication (37.84%), followed by Safety (23.78%). The safety category showed the highest resolution rate (59.09%). The study revealed an increased risk of DRP for patients with three or more comorbidities and using 5 or more medications. The process of systematization of a MTM service in oncology was associated with positive outcomes.

The epidemiology of cryptococcosis and the characterization of Cryptococcus neoformans isolated in a Brazilian University Hospital

ABSTRACT Cryptococcosis, a systemic disease caused by the fungus Cryptococcus neoformans/ Cryptococcus gattii is more severe in immunocompromised individuals. This study aimed to analyze the epidemiology of the disease, the molecular characteristics and the antifungal susceptibility of C. neoformans isolated from patients treated in a Brazilian university hospital. This retrospective study was conducted in the Clinical Hospital, Federal University of Uberlândia, and evaluated cases of cryptococcosis and strains of C. neoformans isolated from 2004 to 2013. We evaluated 41 patients, 85% of whom were diagnosed with AIDS. The fungus was isolated from the cerebrospinal fluid (CSF) of 21 patients (51%); 19.5% had fungemia and in 24% the agent was isolated from the CSF and blood, concurrently. Meningoencephalitis was the most frequent (75%) manifestation of infection. Despite adequate treatment, the mortality of the disease was 58.5%. Most isolates (97.5%) presented the VNI genotype (serotype A, var. grubii) and one isolate was genotyped as C. gattii (VGI); all the isolates were determined as mating type MATa and showed susceptibility to the tested antifungals (fluconazole, voriconazole, amphotericin B and 5-flucytosine). Although AIDS detection rates remain stable, opportunistic infections such as cryptococcosis remain as major causes of morbidity and mortality in these patients.

RELATED FACTORS FOR COLONIZATION BY Candida SPECIES IN THE ORAL CAVITY OF HIV-INFECTED INDIVIDUALS / Fatores relacionados a colonização da cavidade bucal de indivíduos portadores do HIV por espécies de Candida

The colonization of the oral cavity is a prerequisite to the development of oropharyngeal candidiasis. Aims: The aims of this study were: to evaluate colonization and quantify Candida spp. in the oral cavity; to determine the predisposing factors for colonization; and to correlate the levels of CD4+ cells and viral load with the yeast count of colony forming units per milliliter (CFU/mL) in HIV-positive individuals treated at a University Hospital. Saliva samples were collected from 147 HIV patients and were plated on Sabouraud Dextrose Agar (SDA) and chromogenic agar, and incubated at 30 ºC for 72 h. Colonies with similar morphology in both media were counted and the result expressed in CFU/mL. Results: Of the 147 HIV patients, 89 had positive cultures for Candida spp., with a total of 111 isolates, of which C. albicans was the most frequent species (67.6%), and the mean of colonies counted was 8.8 × 10³ CFU/mL. The main predisposing factors for oral colonization by Candida spp. were the use of antibiotics and oral prostheses. The use of reverse transcriptase inhibitors appears to have a greater protective effect for colonization. A low CD4+ T lymphocyte count is associated with a higher density of yeast in the saliva of HIV patients.

RESUMO A colonização da cavidade oral pode ser considerada um pré-requisito para o desenvolvimento de candidíase orofaríngea. Os objetivos deste estudo foram: avaliar e quantificar espécies de Candidaisoladas da cavidade oral, para determinar os fatores predisponentes para a colonização, e correlacionar os níveis de células CD4+ e carga viral em indivíduos HIV-positivos atendidos em um hospital universitário. Foram coletadas amostras de saliva de 147 pacientes portadores do HIV, as quais foram semeadas em Ágar Sabouraud Dextrose (ASD) e ágar cromogênico e incubadas a 30 °C por 72 horas. As colônias com morfologia semelhante em ambos os meios foram contadas e o resultado expresso em unidade formadora de colônias por mililitro (UFC/mL). Dos 147 pacientes HIV positivos, 89 apresentaram culturas positivas para Candidaspp., totalizando 111 isolados, e C. albicansfoi a espécie mais frequente (67,6%). A contagem média de colônias foi de 8.8 × 10³ UFC/mL. Os principais fatores predisponentes para colonização oral por Candidaspp. foram a utilização de antibióticos e de próteses orais. O uso de antirretroviral da classe de inibidores da transcriptase reversa pareceu ter maior efeito protetor para a colonização. Baixa contagem de linfócitos T CD4+ está relacionada com maior densidade de leveduras na saliva de indivíduos HIV positivos.

FREQUENCY OF Candida SPECIES IN A TERTIARY CARE HOSPITAL IN TRIANGULO MINEIRO, MINAS GERAIS STATE, BRAZIL / Frequência de espécies de Candida em hospital terciário do Triângulo Mineiro, Minas Gerais, Brasil

Infections by Candida species are a high-impact problem in public health due to their wide incidence in hospitalized patients. The goal of this study was to evaluate frequency, susceptibility to antifungals, and genetic polymorphism of Candida species isolated from clinical specimens of hospitalized patients. The Candida isolates included in this study were obtained from blood cultures, abdominal fluids, and central venous catheters (CVC) of hospitalized patients at the Clinical Hospital of the Federal University of Uberlândia during the period of July 2010 - June 2011. Susceptibility tests were conducted by the broth microdilution method. The RAPD-PCR tests used employed initiator oligonucleotides OPA09, OPB11, and OPE06. Of the 63 Candida isolates, 18 (28.5%) were C. albicans, 20 (31.7%) were C. parapsilosis complex species, 14 (22.2%) C. tropicalis, four (6.4%) C. glabrata, four (6.4%) C. krusei, two (3.3%) C. kefyr, and one (1.6%) C. lusitaniae. In vitro resistance to amphotericin B was observed in 12.7% of isolates. In vitro resistance to azoles was not detected, except for C. krusei. The two primers, OPA09 and OPB11, were able to distinguish different species. Isolates of C. albicans and C. parapsilosis complex species presented six and five clusters, respectively, with the OPA09 marker by RAPD-PCR, showing the genetic variability of the isolates of those species. It was concluded that members of the C. parapsilosis complex were the most frequent species found, and most isolates were susceptible to the antifungals amphotericin B, flucozanole, and itraconazole. High genetic polymorphisms were observed for isolates of C. albicans and C. parapsilosis complex species, mainly with the OPA09 marker.

As infecções causadas por espécies de Candida são problema de grande impacto para a saúde pública, devido à alta incidência em pacientes hospitalizados e como causa de mortalidade. O presente estudo teve como objetivo avaliar a frequência de Candida spp. isoladas de pacientes hospitalizados, assim como a sensibilidade aos antifúngicos e o polimorfismo genético por RAPD-PCR. Os microrganismos incluíram isolados de hemocultura, líquido abdominal e ponta de cateter venoso central de pacientes internados no Hospital de Clínicas da Universidade Federal de Uberlândia, região do Triângulo Mineiro, Minas Gerais, Brasil, no período de julho de 2010-junho de 2011. Os testes de sensibilidade aos antifúngicos foram realizados por microdiluição em caldo e na análise por RAPD-PCR foram utilizados os oligonucleotídeos OPA09, OPB11, e OPE06. Dos 63 isolados, 18 (28,5%) foram C. albicans, 20 (31,7%) C. parapsilosis, 14 (22,2%) C. tropicalis, quatro (6,4%) C. glabrata, quatro (6,4%) C. krusei, dois (3,3%) C. kefyr, e um (1,6%) C. lusitaniae. Resistência in-vitro à anfotericina B foi observada em 12,7% dos isolados. Não foi observada resistência in-vitro aos azólicos, exceto para os isolados de C. krusei. Os oligonucleotídeos OPA09 e OPB11 possibilitaram distinguir diferentes espécies. Isolados de C. albicans apresentaram seis clusters e o complexo C. parapsilosis, cinco clusters, com o iniciador OPA09, por RAPD-PCR, mostrando a variabilidade genética daquelas espécies. Conclui-se que o complexo C. parapsilosis foi a espécie mais frequente, e a maioria dos isolados foi sensível in vitro aos antifúngicos testados. Alto polimorfismo genético foi observado para os isolados de C. albicans e complexo C. parapsilosis, principalmente com o oligonucleotídeo OPA09.

Sensibilidade de isolados de candida spp. a antifúngicos por disco-difusão em ágar e microdiluição em caldo / Antifungal susceptibility of isolates of candida spp. by disk diffusion and broth microdilution

Os testes de sensibilidade aos antifúngicos realizados pelo método de disco-difusão em ágar são práticos e bem conhecidos pelos profissionais do laboratório de microbiologia, entretanto apresentam particularidades que os diferem dos testes realizados para bactérias. O objetivo deste trabalho foi comparar as técnicas de disco-difusão em ágar e microdiluição em caldo na determinação da sensibilidade in vitro de isolados de Candida spp. a antifúngicos. Foram analisados 63 isolados clínicos de leveduras, que incluíram as espécies Candida parapsilosis complex (n = 20), Candida albicans (n = 18), Candida tropicalis (n = 14), Candida glabrata (n = 4), Candida krusei (n = 4), Candida kefyr (n = 2) e Candida lusitaniae (n = 1). As técnicas de disco-difusão em ágar e de microdiluição em caldo foram utilizadas para testar a sensibilidade em relação aos antifúngicos fluconazol, itraconazol e anfotericina B. A sensibilidade ao voriconazol foi determinada somente pela técnica de disco-difusão. Os halos ao redor dos discos de fluconazol variaram de 14 mm a 50 mm, e a CIM de 0,125 µg/mL a 32 µg/mL; para itraconazol, os halos variaram de 9 mm a 27 mm e a CIM de 0,03 µg/mL a 0,25 µg/mL; para anfotericina B, 9 mm a 21mm e 0,5 µg/mL a 2 µg/mL, respectivamente; para voriconazol, o diâmetro dos halos variaram de 19 mm a 50 mm. Para as três espécies, C. albicans, C. parapsilosis e C. tropicalis, a técnica de disco-difusão apresentou boa concordância com a microdiluição, especialmente em relação ao fluconazol, representando, assim, um recurso importante para os laboratórios reportarem os resultados dos testes de sensibilidade dos isolados dessas espécies ao fluconazol.

Antimicrobial susceptibility tests performed by disk diffusion method are practical and well known by professionals that work in the microbiology laboratory. The disk diffusion methodology used to verify the susceptibility of fungi to antifungal agents, however, has characteristics that differ from the tests for bacteria. The objective of this study was to evaluate the disk diffusion method to determine the in vitro susceptibility to antifungal agents of Candida species. We analyzed 63 clinical isolates of yeasts, which included Candida parapsilosis complex species (n = 20), Candida albicans (n = 18), Candida tropicalis (n = 14), Candida glabrata (n = 4), Candida krusei (n = 4), Candida kefyr (n = 2) and Candida lusitaniae (n = 1). The susceptibility tests to antifungal drugs was performed by disk diffusion methods and broth microdilution for antifungal fluconazole, itraconazole and amphotericin B. Voriconazole was used to test the susceptibility only by the disk diffusion method. The inhibition halos of growth around disks of fluconazole ranged from 14 mm to 50 mm and the MIC from 0.125 µg/mL to 32 µg/mL, for itraconazole, halos ranged from 9 mm to 27 mm and the MIC from 0.03 µg/mL to 0.25 µg/mL, for amphotericin B, 9 mm to 21 mm and 0.5 µg/mL to 2 µg/mL, respectively. The diameter of voriconazole disks varied from 19 mm to 50 mm. For the three species, C. albicans, C. parapsilosis and C. tropicalis, the disk diffusion method showed good agreement with the microdilution, especially to fluconazole, thus representing an important resource for medical laboratories reporting results of susceptibility testing of isolates of these species to fluconazole.

Características in vitro de isolados do complexo Cryptococcus laurentii em diferentes meios de cultura / In vitro characteristics of isolates of Cryptococcus laurentii complex in different culture media

Cryptococcus laurentii é um fungo distribuído em diversos ambientes e, eventualmente, causa infecção no homem. Por ser uma espécie considerada emergente, requer, para sua identificação laboratorial, conhecimento técnico mais especializado, provas ou testes laboratoriais específicos que nem sempre estão disponíveis. O objetivo deste trabalho foi descrever características fenotípicas invitro de isolados do complexo C. laurentii em meios de cultura utilizados na rotina de laboratório de microbiologia. Foram estudados isolados do complexo C. laurentii em diferentes meios de culturae condições...

Cryptococcus laurentii is a fungus distributed in different environments, where individuals comeinto contact with it, become colonized and develop infections that vary according to their immunestatus. This species is considered emerging, and for its laboratory identification specialized technical knowledge is required, as well asspecific laboratory tests that are not always available. The objective was to describe the phenotypic characteristics of in vitro C. laurentii complexes in culture mediathat are routinely used in microbiology laboratories...

Comparison of primers for RAPD-PCR from environmental isolates of Cryptococcus neoformans, Cryptococcus albidus and Cryptococcus laurentii complex

Various organisms have been characterized by molecular methods, including fungi of the genus Cryptococcus. The purposes of this study were: to determine the discriminatory potential of the RAPD (Random Amplified Polymorphic DNA) primers, the pattern of similarity of the Cryptococcus species, and discuss their useful application in epidemiological studies. We analyzed 10 isolates of each specie/group: C. albidus, C. laurentii complex, C. neoformans var. grubii, all from environmental source, and two ATCC strains, C. neoformans var. grubii ATCC 90112, and C. neoformans var. neoformans ATCC 28957 by RAPD-PCR using the primers CAV1, CAV2, ZAP19, ZAP20, OPB11 and SEQ6. The primers showed a good discriminatory power, revealing important differences between them and between species; the SEQ6 primer discriminated a larger number of isolates of three species. Isolates of C. laurentii showed greater genetic diversity than other species revealed by all six primers. Isolates of C. neoformans were more homogeneous. Only the primer CAV2 showed no amplification of DNA bands for C. albidus. It was concluded that the use of limited number of carefully selected primers allowed the discrimination of different isolates, and some primers (e.g., CAV2 for C. albidus) may not to be applied to some species.

Different culture media containing methyldopa for melanin production by Cryptococcus species / Avaliação de diferentes meios de cultura contendo metildopa para a produção de melanina por espécies de Cryptococcus

INTRODUCTION: Melanin production by species of Cryptococcus is widely used to characterize C. neoformans complex in mycology laboratories. This study aims to test the efficacy of methyldopa from pharmaceutical tablet as a substrate for melanin production, to compare the production of melanin using different agar base added with methyldopa, and to compare the melanin produced in those media with that produced in Niger seed agar and sunflower seed agar by C. neoformans, C. laurentii, and C. albidus. Two isolates of each species, C. neoformans, C. laurentii, and C. albidus, and one of Candida albicans were used to experimentally detect conditions for melanin production. METHODS: The following media were tested: Mueller-Hinton agar (MHA), brain and heart infusion agar (BHIA), blood agar base (BAB), and minimal medium agar (MMA), all added with methyldopa, and the media Niger seed agar (NSA) and sunflower seed agar (SSA). RESULTS: All isolates grew in most of the culture media after 24h. Strains planted on media BAB and BHIA showed growth only after 48h. All isolates produced melanin in MMA, MHA, SSA, and NSA media. CONCLUSIONS: Methyldopa in the form pharmaceutical tablet can be used as a substrate for melanin production by Cryptococcus species; minimal medium plus methyldopa was more efficient than the BAB, MHA, and BHIA in the melanin production; and NSA and SSA, followed by MMA added with methyldopa, were more efficient than other media studied for melanin production by all strains studied.

INTRODUÇÃO: A produção de melanina por espécies de Cryptococcus é uma característica amplamente utilizada em laboratórios de micologia para caracterização do complexoC. neoformans. O objetivo deste estudo foi verificar a eficácia da metildopa na forma farmacêutica de comprimido, como substrato para a produção de melanina por Cryptococcus, comparar diferentes bases de meios de cultura acrescidas de metildopa para produção de melanina e comparar o pigmento produzido nestes meios com o produzido em ágar Níger e ágar girassol por C. neoformans, C. laurentii e C. albidus. MÉTODOS: Foram testados dois isolados de cada uma das espécies, C. neoformans, C.laurentii e C.albidus, e um de C. albicans para avaliar a produção de melanina nos meios de cultura ágar Müeller-Hinton (MH), ágar brain heart infusion (BHI), ágar base sangue (BS), meio mínimo (MM), todos acrescidos de metildopa, e ainda ágar girassol e ágar Níger. RESULTADOS: Todos os isolados cresceram na maioria dos meios após 24h. O crescimento nos meios BS e BHI somente ocorreu após 48h. Todos os isolados produziram melanina nos meios MM, MH, girassol e Niger. CONCLUSÕES: A metildopa de origem farmacêutica pode ser utilizada como substrato para a produção de melanina por espécies de Cryptococcus; o MM acrescido de metildopa mostrou-se mais eficiente na produção de melanina do que os meios BS, MH e BHI; ágar girassol e ágar Níger seguidos de MM acrescido de metildopa foram os mais eficientes na produção de melanina pelos isolados estudados.

Prevalence of intestinal parasites in preschool children in the region of Uberlândia, State of Minas Gerais, Brazil / Prevalência de parasitoses intestinais em crianças institucionalizadas na região de Uberlândia, Estado de Minas Gerais

INTRODUCTION: Children are an important high-risk group for helminth and protozoa infections. Daycare centers are environments where children have proven to be more susceptible to acquiring intestinal parasites. Thus, the purpose of this study was to verify the prevalence of intestinal parasites in children who attended the two daycare centers maintained by the local government of Uberlândia, State of Minas Gerais, Brazil. METHODS: Fecal samples were collected from 133 children (73 children at the Public Preschool for Early Childhood Education, PPECE A, and 60 at the PPECE B) following identification according to sex and age and agreement to participate by parents or guardians who signed the free, informed consent form. The samples were examined by the Lutz method. RESULTS: Coproparasitological tests performed on 133 children showed that 29.3 percent of them were parasitized for enteroparasites or commensals, 6.7 percent of the children presented polyparasitism. Among the protozoa, Giardia lamblia were the most prevalent and Hymenolepis nana were the most frequent among the helminths. CONCLUSIONS: Thus, analysis of the results showed that intestinal parasites still represent a public health problem, especially among children and in areas where the socioeconomic and educational conditions are less favorable.

INTRODUÇÃO: As crianças são importantes grupos de risco para infecções por helmintos e protozoários. Os centros de educação infantil são ambientes onde as crianças estão mais expostas à infecção por parasitas intestinais. O objetivo deste estudo foi verificar a prevalência de parasitas intestinais em crianças de duas creches mantidas pelo governo municipal de Uberlândia, Minas Gerais, Brasil. MÉTODOS: Os exames coproparasitológicos foram realizados em 133 crianças (73 crianças da Escola Municipal de Educação Infantil - EMEI A e 60 da EMEI B), depois da identificação da criança de acordo com a idade e sexo, e concordância dos responsáveis através do Termo de Consentimento Livre e Esclarecido. As amostras foram examinadas pelo método de Lutz. RESULTADOS: Os exames coproparasitológicos demonstraram que 29,3 por cento delas estavam parasitadas por enteroparasitos ou comensais e 6,7 por cento das crianças apresentaram poliparasitismo. Entre os protozoários, Giardia lamblia foi o mais prevalente, enquanto Hymenolepis nana foi mais frequente dentre os helmintos. CONCLUSÕES: Assim, podemos observar que as parasitoses intestinais ainda representam um problema de saúde pública, especialmente entre as crianças e em áreas onde as condições socioeconômicas e educacionais são menos favoráveis.

Dermatophyte susceptibilities to antifungal azole agents tested in vitro by broth macro and microdilution methods / Suscetibilidade in vitro de dermatófitos a azóis pelos métodos macro e microdiluição em caldo

The in vitro susceptibility of dermatophytes to the azole antifungals itraconazole, fluconazole and ketoconazole was evaluated by broth macro and microdilution methods, according to recommendations of the CLSI, with some adaptations. Twenty nail and skin clinical isolates, four of Trichophyton mentagrophytes and 16 of T. rubrum were selected for the tests. Itraconazole minimal inhibitory concentrations (MIC) varied from < 0.03 to 0.25 µg/mL in the macrodilution and from < 0.03 to 0.5 µg/mL in the microdilution methods; for fluconazole, MICs were in the ranges of 0.5 to 64 µg/mL and 0.125 to 16 µg/mL by the macro and microdilution methods, respectively, and from < 0.03 to 0.5 µg/mL by both methods for ketoconazole. Levels of agreement between the two methods (± one dilution) were 70 percent for itraconazole, 45 percent for fluconazole and 85 percent for ketoconazole. It is concluded that the strains selected were inhibited by relatively low concentrations of the antifungals tested and that the two methodologies are in good agreement especially for itraconazole and ketoconazole.

Foi avaliada a suscetibilidade in vitro de dermatófitos aos antifúngicos itraconazol, fluconazol e cetoconazol, pelos métodos macro e microdiluição em caldo, de acordo com as recomendações do CLSI, com algumas modificações. Foram estudados 20 isolados clínicos de lesões de unha e pele, sendo quatro Trichophyton mentagrophytes e 16 T. rubrum. A concentração inibitória mínima (CIM) para itraconazol variou de < 0,03 a 0,25 µg/mL pelo método da macrodiluição, e de < 0,03 a 0,5 µg/mL pela microdiluição em caldo; de 0,5 a 64 µg/mL e de 0,125 a 16 µg/mL para fluconazol, respectivamente, pela macro e microdiluição; e de < 0,03 a 0,5 µg/mL por ambos os métodos para cetoconazol. A concordância entre os dois métodos (considerando ± uma diluição) foi de 70 por cento para itraconazol, 45 por cento para fluconazol e 85 por cento para cetoconazol. Conclui-se que os isolados estudados foram inibidos por concentrações relativamente baixas dos antifúngicos testados, e os dois métodos apresentam boa concordância, especialmente para itraconazol e cetoconazol.

Avaliação da produção de melanina por espécies de Cryptococcus em quatro diferentes meios de cultura / Evaluation of melanin production by Cryptococcus species in four different culture media

A capacidade de Cryptococcus spp produzir melanina em meios contendo compostos fenólicos é amplamente utilizada na identificação destas espécies no laboratório. O objetivo do presente trabalho foi comparar a produção desse pigmento em quatro meios de cultura por Cryptococcus sp. Foram testadas 16 cepas de Cryptococcus neoformans, 17 de Cryptococcus albidus, 13 de Cryptococcus laurentii, e 2 de Cryptococcus uniguttulatus nos meios: ágar batata e cenoura, ágar alpiste, ágar semente de girassol e ágar L-dopa. A produção de melanina foi avaliada com base na pigmentação das colônias, e demonstrada em 5 dias de incubação por 93,8 por cento das cepas de Cryptococcus neoformans nos meios ágar batata e cenoura, ágar semente de girassol e ágar L-dopa. Dos isolados de Cryptococcus albidus, 29,4 por cento produziram o pigmento em ágar batata e cenoura e L-dopa, 11,8 por cento em ágar alpiste, e 36 por cento em ágar girassol. De Cryptococcus laurentii, 53,8 por cento produziram em batata e cenoura e em semente de girassol, 61,5 por cento em L-dopa, 84,6 por cento em ágar alpiste. Somente uma cepa de Cryptococcus uniguttulatus produziu fracamente o pigmento em ágar batata e cenoura.

The capacity of Cryptococcus spp to produce melanin in media containing phenol compounds is widely used for identifying these species in the laboratory. The aim of the present study was to compare the production of this pigment by Cryptococcus spp. in four culture media. Sixteen strains of Cryptococcus neoformans, 17 of Cryptococcus albidus, 13 of Cryptococcus laurentii and two of Cryptococcus uniguttulatus were tested in the following media: potato-carrot agar, Niger seed agar, sunflower seed agar and L-dopa agar. The melanin production was evaluated on the basis of colony pigmentation. Its production after five days of incubation was demonstrated by 93.8 percent of the strains of Cryptococcus neoformans in the media of potato-carrot agar, sunflower seed agar and L-dopa agar. From the isolates of Cryptococcus albidus, 29.4 percent produced the pigment in potato-carrot agar and L-dopa agar, 11.8 percent in Niger seed agar and 36 percent in sunflower seed agar. From Cryptococcus laurentii, 53.8 percent produced the pigment in potato-carrot agar and sunflower seed agar, 61.5 percent in L-dopa agar and 84.6 percent in Niger seed agar. Only one strain of Cryptococcus uniguttulatus presented slight production of the pigment, in potato-carrot agar.

In vitro susceptibility to antifungal agents of environmental Cryptococcus spp. isolated in the city of Ribeirão Preto, São Paulo, Brazil

Infections by Cryptococcus strains other than C. neoformans have been detected in immunocompromised patients. Of these strains, three are considered human pathogens: C. albidus, C. laurenttii, and C. uniguttulatus. This study deals with the in vitro susceptibility of Cryptococcus to drugs such as amphotericin B, itraconazole, fluconazole, and 5-fluorocytosine. Environmental Cryptococcus isolates (50) distributed as follows: C. neoformans var. neoformans (16), C. albidus (17), C. laurentii (14), and C. uniguttulatus (3) were evaluated by the micro and macrodilution techniques, according to EUCAST and NCCLS recommendations, respectively. Considering both methodologies the respective minimal inhibitory concentrations (MIC) were 0.125 and 2 æg/ml for amphotericin B, 0.06 and 8 æg/ml for itraconazole, and 0.5 and more than 64 æg/ml for fluconazole and 5-fluorocytosine. Agreement percentages for the two methodologies were 100 percent for amphotericin B and fluconazole for all the strains tested. For itraconazole, the agreement percentage was 81.3 percent in the C. neoformans strain and 100 percent for all the others. All species had a agreement percentage of 94.1 to 100 percent when susceptibility to 5-fluorocytosine was tested. It is concluded that environmental isolates of C. neoformans var. neoformans, C. albidus, C. laurentii, and C. uniguttulatus may show high MICs against certain drugs, suggesting in vitro primary resistance to the antifungals tested.