ABSTRACT
Objetivo: Analisar a expressão fenotípica de fatores de virulência em biofilmes de Candida albicans frente a extratos glicólicos de plantas. Material e Métodos: Os biofilmes de Candida albicans (ATCC 18804) obtidos a partir de incubação de 48 horas foram expostos por 5 minutos e 24 horas a diferentes concentrações de extratos glicólicos de Hamamelis virginiana e Persea americana, Cynara scolymus L e Stryphnodendron barbatiman M, a fim de verificar a ação antifúngica da proteinase, fosfolipase e hemolisina. Resultados: Todos os extratos foram eficazes na redução do biofilme. Em contato por 5 minutos. os extratos reduziram 50% do biofilme. Após 24 horas. o extrato de Persea americana apresentou o biofilme em 90%, seguido de Cynara scolymus, que o interrompeu em 85%. Houve mudança na intensidade da proteinase após 5 minutos e 24 horas, com uma atividade enzimática média de 0,69 em comparação com o controle de 0,49. Cynara scolymus foi o extrato com maior concentração média de 100 mg/ml; a intensidade da fosfolipase foi alterada com Stryphnodendron barbatiman sendo mais efetivo em 24 horas em relação ao controle (p< 0,0001). A secreção de hemolisina foi modificada por Hamamelis virginiana (12,5 mg/ml) após 5 minutos de exposição e em 24 horas. todos os extratos foram capazes de causar alterações na secreção. Conclusão: Os extratos testados apresentam potencial antifúngico em biofilmes de Candida albicans, implicando em redução significativa dos fatores de virulência. Assim, estes podem ser indicados como uma ferramenta terapêutica alternativa para reduzir a morbidade dessas infecções, já que em ambos os tempos de exposição investigados, eles foram capazes de reduzir a secreção enzimática do fungo (AU)
Objective: Analyze the phenotypic expression of virulence factors in Candida albicans biofilms against plant glycolicextracts. Material and Methods: The biofilms of Candida albicans (ATCC 18804) obtained from incubation for 48 hours were exposed for 5 minutes and 24 hours to different concentrations of glycolic extracts of Hamamelis virginiana and Persea americana, Cynara scolymus L and Stryphnodendron barbatiman M, in order to verify the antifungal activity of the proteinase, phospholipase and hemolysin. Results: All extracts were effective in reducing biofilm. In contact for 5 minutes. the extracts reduced 50% of the biofilm. After 24 hours, the Persea americanaextract showed the biofilm at 90%, followed by Cynara scolymus, which interrupted it at 85%, There was a change in proteinase intensity after 5 minutes and 24 hours. with an average enzymatic activity of 0.69 compared to the control of 0.49. Cynara scolymus was the extract with the highest mean concentration of 100 mg/ml; the phospholipase intensity was changed with Stryphnodendron barbatiman being more effective in 24 hours compared to the control (p< 0.0001). The hemolysin secretion was modified by Hamamelis virginiana (12.5 mg/ml) after 5 minutes of exposure, and in 24 hours. all extracts were capable to cause changes in secretion. Conclusion: The tested extracts have antifungal potential in Candida albicans biofilms, implying a significant reduction in virulence factors. Thus, these can be indicated as an alternative therapeutic tool to reduce the morbidity of these infections, as in both investigated exposure times. they were able to reduce theenzymatic secretion of the fungus (AU)
Subject(s)
Candida albicans , Plant Extracts , Virulence Factors , Infections , Antifungal AgentsABSTRACT
This study determined phytochemical composition, antifungal activity and toxicity in vitro and in vivo of Syzygium cumini leaves extract (Sc). Thus, was characterized by gas chromatography coupled to mass spectrometry and submitted to determination of Minimum Inhibitory (MIC) and Fungicidal concentrations (MFC) on reference and clinical strains of Candida spp. and by growth kinetics assays. Toxicity was verified using in vitro assays of hemolysis, osmotic fragility, oxidant and antioxidant activity in human erythrocytes and by in vivo acute systemic toxicity in Galleria mellonella larvae. Fourteen different compounds were identified in Sc, which showed antifungal activity (MIC between 31.25-125µg/mL) with fungistatic effect on Candida. At antifungal concentrations, it demonstrated low cytotoxicity, antioxidant activity and neglible in vivotoxicity. Thus, Sc demonstrated a promising antifungal potential, with low toxicity, indicating that this extract can be a safe and effective alternative antifungal agent.
Este estudio determinó la composición fitoquímica, la actividad antifúngica y la toxicidad in vitro e in vivo del extracto de hojas de Syzygium cumini (Sc). Así, se caracterizó mediante cromatografía de gases acoplada a espectrometría de masas y se sometió a determinación de Concentraciones Mínimas Inhibitorias (CMI) y Fungicidas (MFC) sobre cepas de referencia y clínicas de Candida spp. y mediante ensayos de cinética de crecimiento. La toxicidad se verificó mediante ensayos in vitro de hemólisis, fragilidad osmótica, actividad oxidante y antioxidante en eritrocitos humanos y por toxicidad sistémica aguda in vivo en larvas de Galleria mellonella. Se identificaron catorce compuestos diferentes en Sc, que mostraron actividad antifúngica (CMI entre 31.25-125 µg/mL) con efecto fungistático sobre Candida. En concentraciones antifúngicas, demostró baja citotoxicidad, actividad antioxidante y toxicidad in vivo insignificante. Por lo tanto, Sc demostró un potencial antifúngico prometedor, con baja toxicidad, lo que indica que este extracto puede ser un agente antifúngico alternativo seguro y eficaz.
Subject(s)
Humans , Plant Extracts/pharmacology , Plant Extracts/chemistry , Syzygium/chemistry , Antifungal Agents/pharmacology , Antifungal Agents/chemistry , Candida/drug effects , Plant Extracts/toxicity , Microbial Sensitivity Tests , Toxicity Tests , Plant Leaves/chemistry , Phenolic Compounds/analysis , Gas Chromatography-Mass Spectrometry , Antifungal Agents/toxicity , AntioxidantsABSTRACT
La candidiasis es una enfermedad micótica debida a levaduras pertenecientes al género Candida. Dentro del gran conjunto de microorganismos que colonizan al ser humano, Candida albicans es el agente etiológico más comúnmente detectado ya que habita como comensal en las superficies mucosas y la piel. C. albicans participa en procesos de fermentación de azúcares y asimilación de nutrientes, pero, en algunas ocasiones se relaciona con procesos patológicos. En los últimos años los avances tecnológicos y médicos; así como el aumento en la incidencia de infecciones por el virus de la inmunodeficiencia humana, el auge creciente de la terapia inmunomoduladora y el uso de antibióticos de amplio espectro durante largos períodos de tiempo se han convertido en los factores de riesgo más importantes para la creciente incidencia de infecciones por microorganismos del género Candida. Debido a esto, resulta imperativo el conocimiento de esta enfermedad y sus formas clínicas más importantes, así como el abordaje diagnóstico y el tratamiento actual; información que recolectamos en este documento para brindar una visión general sobre esta patología(AU)
Candidiasis is a fungal disease caused by yeasts belonging to the genus Candida. Within the large group of microorganisms that colonize humans, candida albicans is the most commonly detected etiological agent since it inhabits mucosal surfaces and skin as a commensal. C. albicans participates in sugar fermentation processes and assimilation of nutrients but, on some occasions, it is related to pathological processes. In recent years, technological and medical advances; As well as the increase in the incidence of human immunodeficiency virus infections, the growing boom in immunomodulatory therapy and the use of broad-spectrum antibiotics for long periods of time have become the most important risk factors for the increasing incidence of infections by microorganisms of the genus Candida. Due to this, knowledge of this disease and its most important clinical forms, as well as the current diagnostic approach and treatment, is imperative; information that we collect in this document to provide an overview of this condition(AU)
Subject(s)
Humans , Candidiasis/etiology , Candidiasis, Cutaneous/diagnosis , Candidiasis, Vulvovaginal/diagnosis , Risk Factors , Candida albicans , Incidence , Esophagitis , ImmunomodulationABSTRACT
RESUMEN La rinosinusitis fúngica invasiva aguda (RSFIA) es una enfermedad poco frecuente caracterizada por una infiltración fúngica de la submucosa y vasos sanguíneos de las cavidades nasal y paranasal. Afecta a pacientes con grados variables de inmunosupresión, destacando entre estas patologías subyacentes la diabetes mellitus y las neoplasias malignas hematológicas. Presenta una alta tasa de mortalidad, pudiendo reducirse significativamente si el diagnóstico y el tratamiento se realizan precozmente. Este artículo tiene por objetivo presentar una revisión actualizada de la literatura respecto a la presentación clínica, microbiología, factores de riesgos, métodos diagnósticos, tratamiento y pronóstico de la RSFIA, tanto en adultos como en niños.
ABSTRACT Acute invasive fungal rhinosinusitis (AIFS) is a rare disease characterized by fungal infiltration of the submucosa and blood vessels of the nasal y paranasal cavities. It affects almost exclusively patients with different degrees of immunosuppression, with underlying pathologies such as diabetes mellitus and hematological malignancies. AIFS has a high mortality rate, but it can be significantly reduced if the diagnosis and treatment are carried out early in the course of disease. This article aims to present an updated literature review regarding clinical presentation, microbiology, risk factors, diagnostic methods, treatment and prognosis of AIFS, both in adults and children.
Subject(s)
Humans , Child , Adult , Sinusitis/diagnosis , Sinusitis/microbiology , Sinusitis/therapy , Rhinitis/diagnosis , Rhinitis/microbiology , Rhinitis/therapy , Prognosis , Acute Disease , Risk Factors , Immunocompromised Host , Debridement , Mycoses , Antifungal Agents/therapeutic useABSTRACT
Candida albicans is the main yeast isolated from vulvovaginal candidiasis(VVC) and a major antifungal used to treat VVC is miconazole (MZ), it shows local toxic effects, such as irritation and burns. The lidocaine (LD) is a local anesthetic. The aim of this study was to evaluate the synergistic activity of LD/MZ against 19 strains of C. albicans isolated from vaginal secretion. 78.9% of the strains were susceptible to the combination LD/MZ, demonstrating synergism of drugs. These drugs can be used to produce vaginal creams to treat VVC, especially drug resistant.
Candida albicans é a principal levedura isolada de candidíase vulvovaginal (CVV) e o principal antifúngico usado para tratar a VVC é miconazol (MZ), que apresenta efeitos tóxicos locais, tais como irritação e queimaduras. A lidocaína (LD) é um anestésico local. O objetivo deste estudo foi avaliar a atividade sinérgica de LD/MZ contra 19 cepas de C. albicans isoladas de secreção vaginal. Foram suscetíveis à combinação LD/MZ, 78.9% das cepas testadas, demonstrando sinergismo de drogas. Estes fármacos podem ser utilizados para a produção de cremes vaginais para tratar VVC, especialmente aquelas resistentes aos fármacos disponíveis.
Subject(s)
Candidiasis, Vulvovaginal , Anesthetics , Antifungal AgentsABSTRACT
Vulvovaginal candidiasis (VVC) is a common fungal infection that affects healthy women of all ages. At least 75% of women will develop one or more infections once during their lifetime, with 6 to 9% of those individuals developing recurrent infections. In view of this context, this study sought to evaluate the antifungal potential of the isolated (R)-(+)-citronellal [(R)-(+)-CT] and associated to therapeutic agents of clinical importance. The enantiomer was solubilized in tween 80 and dimethylsulfoxide (DMSO). Posteriorly diluted in sterile distilled water up to the concentration of 2048µg/mL. The minimum inhibitory concentration (MIC) of the product was determined by microdilution in RPMI-1640 obtaining dilutions of 1024-4µg/mL. The minimum fungicidal concentration (MFC) was determined by the Sabouraud dextrose agar (SDA) depletion technique from aliquots of 1µL of the MIC, MIC × 2 and MIC × 4. The MIC and the MFC values of (R)-(+)-CT for 90% of the C. albicans strains were 16 and 32µg/mL respectively. In the susceptibility test, C. albicans presented a high resistance to fluconazole and to itraconazole, 12 (92.30%) of the strains. However, for ketoconazole and miconazole the resistance was of 4 (30.76%) and 3 (23.07%) of the strains respectively. In the combination testing of the (R)-(+)-CT with ketoconazole and miconazole, the resistance was completely reverted. For fluconazole and itraconazole, the resistance was reverted in 9 (75%) and 7 (58.33%) of the strains respectively. The (R)-(+)-CT presented fungicide activity with MFC of MIC × 2. When in combination with ketoconazole, fluconazole, itraconazole and miconazole increased the inhibition zones of these antifungal drugs, reducing the resistance against C. albicans.
Candidíase vulvovaginal (CVV) é uma infecção fúngica comum que afeta mulheres saudáveis de todas as idades. Pelo menos 75% das mulheres irão desenvolver uma ou mais infecções uma vez durante a vida, com 6 a 9% dos indivíduos desenvolvendo infecções recorrentes. Diante deste contexto, buscou-se avaliar neste estudo o potencial antifúngico do (R)-(+)-citronelal [(R)-(+)-CT] isolado e associado a agentes terapêuticos de importância clínica. O enantiômero foi solubilizado em tween 80 e dimetilsulfóxido (DMSO). Posteriormente diluiu-se em água destilada estéril até a concentração de 2048µg/mL. A concentração inibitória mínima (CIM) do produto foi determinada por microdiluição em meio RPMI-1640 obtendo diluições de 4-1024µg/mL. A concentração fungicida mínima (CFM) foi determinada pela técnica de esgotamento em agar Sabouraud dextrose (ASD) a partir de alíquotas de 1mL da CIM, CIM × 2 e CIM × 4. A CIM e a CFM do (R)-(+)-CT para 90% das cepas de C. albicans foram 16 e 32µg/mL respectivamente. No ensaio de suscetibilidade, C. albicans apresentou alta resistência ao fluconazol e ao itraconazol, 12 (92.30%) das cepas. No em tanto, para o cetoconazol e o miconazol a resistência foi de 4 (30.76%) e 3 (23.07%) das cepas respectivamente. No ensaio de combinação do (R)-(+)-CT com cetoconazol e miconazol, a resistência foi completamente revertida. Para o fluconazol e o itraconazol, a resistências foi revertida em 9 (75%) e 7 (58.33%) das cepas respectivamente. O (R)-(+)-CT apresentou atividade fungicida com CFM igual à CIM × 2. Quando em combinação com cetoconazol, fluconazol, itraconazol e miconazol ampliou as zonas de inibição desses antifúngicos, diminuindo a resistência contra C. albicans.
Subject(s)
Candida albicans , Candidiasis, Vulvovaginal , Antifungal AgentsABSTRACT
Las feohifomicosis comprenden un grupo de infecciones causadas por hongos pigmentados, negros o dematiáceos. En las últimas dos décadas se ha incrementado la frecuencia de reportes y la diversidad de los agentes etiológicos implicados, especialmente en los individuos inmunosuprimidos. Los principales géneros involucrados incluyen Alternaria, Bipolaris, Cladophialophora y Exophiala. Estos hongos típicamente se encuentran en el suelo y son introducidos al cuerpo a través de la inhalación o el trauma. El espectro de las enfermedades asociadas también se ha ampliado e incluye infecciones cutáneas superficiales y profundas, enfermedad alérgica, neumonía, abscesos cerebrales e infección diseminada. El diagnóstico de laboratorio está basado en las características morfológicas de los agentes según lo observado en el examen microscópico directo y la histopatología. El tratamiento es a menudo difícil y depende del síndrome clínico. No hay terapias estandarizadas, pero voriconazol, posaconazol e itraconazol han demostrado la actividad in vitro más consistente contra este grupo de hongos. La rareza de estas micosis justifica describir las características clínicas, epidemiológicas y diagnósticas para ayudar a un reconocimiento inmediato y un tratamiento oportuno
Phaeohyphomycosis comprises a group of infections caused by black pigmented or dematiaceous fungi. In the last two decades the frequency of reporting and diversity of etiologic agents involved have increased, especially in immunosuppressed individuals. The main genera involved include Alternaria, Bipolaris, Cladophialophora and Exophiala. These fungi are typically found in the soil and introduced through inhalation or trauma. The spectrum of associated diseases also has broadened and includes superficial and deep cutaneous infections, allergic disease, pneumonia, brain abscess and disseminated infection. The laboratory diagnosis is based on the morphological characteristics of the agents as observed by direct microscopic examination and histopathology. Treatment is often challenging and depends uponthe clinical syndrome. There are no standardized therapies but voriconazole, posaconazole and itraconazole demonstrate the most consistent in vitro activity against this group of fungi. The rarity of this mycosis justifies describe the clinical, epidemiological and diagnostic characteristics to aid in its immediate recognition and early treatment
ABSTRACT
Objectives: The aim of this study was to verify if there are poly (methyl methacrylate) (PMMA) absorptionand releasing of nystatin (NYS) and fluconazole (FLZ) after simulated treatment of oral candidosis. Materialsand methods: Specimens (30 × 25 × 5 mm) prepared with PMMA polymerized by hot water bath or microwaveenergy were immersed into NYS (3.12 μg/mL), FLZ (2.56 μg/mL) or deionized water (control) during14 days at 35 ± 2 °C. After treatment simulation, specimens were immersed into distilled water during 3, 7, 10and 14 days. The immersion liquid was changed after each analysis. Higher performance liquid chromatographywas used in order to detect antifungal compounds. In order to determine if there was surface depositionof drugs on PMMA resin, specimens were analyzed with electronic microscopy (SEM). Results: None of theantifungal agents was released from the PMMA resins. Conclusion: Within the limitations of this study, itcould be concluded that PMMA resins had no drug absorption with posterior release.
Objetivos: O objetivo deste estudo foi verificar se o poli (metil metacrilato) (PMMA) é capaz de absorver e liberar nistatina (NYS) e fluconazol (FLZ) após simular um tratamento para candidose oral. Materiais e métodos:Espécimes (30 × 25 × 5 mm) foram preparados em resina de PMMA por banho de água quente ou energia demicro-ondas e, em seguida, imersos em solução contendo NYS (3.12 μg/mL), FLZ (2.56 μg/mL) ou água deionizada(controle) durante 14 dias a 35 ± 2 °C. Após a simulação de tratamento, os espécimes foram imersos em água destilada durante 3, 7, 10 e 14 dias. O líquido de imersão foi trocado após cada análise. Cromatografia líquida de alta performance foi utilizada para detectar a presença dos agentes antifúngicos. Para determinar se houve deposição dos agentes antifúngicos na superfície de PMMA, os espécimes foram analisados por microscopia eletrônica de varredura(MEV). Resultados: Não houve liberação de agentes antifúngicos dos espécimes. Conclusão: Considerando as limitações deste estudo, pode-se concluir que a resina de PMMA não absorve ou libera agentes antifúngicos.
Subject(s)
Antifungal Agents/chemistry , Fluconazole/chemistry , Nystatin/chemistry , Polymethyl Methacrylate/chemistry , Absorption , Chromatography, High Pressure Liquid , Candida albicans , Candidiasis, Oral/drug therapy , Stomatitis, Denture/drug therapy , Materials Testing , Microscopy, Electron, Scanning , Dental Prosthesis/microbiology , Surface Properties , Time FactorsABSTRACT
Se describe el caso de un paciente varón, agricultor de 54 años, procedente de Bagua con lesiones nodulares gomosas abscedadas circunscritas al trayecto linfático del miembro superior izquierdo de aproximadamente 6 semanas de evolución a quien luego del cultivo micológico a temperatura ambiental se halló conidios simpodiales compatibles con el complejo Sporothrix Schenckii por lo que recibió tratamiento antibiótico y antimicótico con respuesta clínica favorable.(AU)
We describe the case of a male patient, 54 year old farmer, from Bagua with gummy abscessed nodular lesions confined to the path node in the left upper limb about 6 weeks duration whose mycological culture after sympodial conidia were found compatible with the complex Sporothrix Schenckii. For which he received antibiotic and antifungal treatment with a favorable clinical response.(AU)
ABSTRACT
Un número creciente de pacientes críticamente enfermos son atendidos por sepsis secundaria a infecciones bacterianas o micóticas. En este grupo de pacientes la sepsis per se es un factor de riesgo para el desarrollo de falla renal, la cual implica un mayor riesgo de mortalidad. Un panel de expertos en las áreas de infectología, cuidado crítico y nefrología prepararon un consenso basado en la información actual (evidencia) sobre el uso de antimicrobianos (antibióticos y antifúngicos) en pacientes críticamente enfermos con falla renal o en riesgo de padecerla. Se identificó la literatura científica relevante mediante un proceso de búsqueda sistemática y se generaron recomendaciones por medio del método presencial Delphi. Se propone que las recomendaciones de este consenso sean utilizadas por los trabajadores de la salud que manejen este grupo de pacientes,con el fin de identificar aquellos en mayor riesgo de progresión a falla renal y establecer las estrategias terapéuticas que tengan el mayor beneficio con la menor probabildad de efectos secundarios serios sobre la función renal. Se adicionó una estrategia para la implmentación de estas recomendaciones.
A growing number of critically ill patients are being taken care with sepsis secondary to bacterial or mycotic infections. In this group of patients, sepsis per se is a risk factor for the development of renal failure, which has been related to an increased risk of hospital mortality. An expert panel in infectious diseases, critical care and renal diseases prepared an evidence based consensus over the use of antimicrobials (antibacterial and antifungal agents) in critically ill patients with renal failure or at risk of suffering it. A sytematic review of the scientific literature was performed and recommendations were established by means of a consensus using the Delphi method. Recommendations proposed by this consensus are intended to be use by healthcare workers who are in charge of this kind of patients with the aim to identify the group of patients with higher risk of developing renal failure and to establish the therapeutic measures theat have the best outcome and lower frequenc of severe side effects in renal function. An implementation strategy was added with the recommendations.
Subject(s)
Humans , Consensus , Renal Insufficiency , Antifungal Agents , Toxicology , Risk Factors , Acute Kidney Injury , Antigens, BacterialABSTRACT
Objetivo: comparar los métodos de referencia de microdilución en caldo de la CLSI M27-A2 y EUCAST, identificando la utilidad y las principales diferencias de cada uno de ellos para los agentes antifúngicos anfotericina B (1), fluconazol (FCZ) e itraconazol (ITZ), contra aislamientos clínicos de Candidaspp. de pacientes con cáncer. Materiales y métodos: se estudiaron 136 aislamientos de C. albicans, 36 de C. tropicalis y 17 de Candidaspp. Se utilizó el índice Kappa ponderado para medir el grado de acuerdo entre los dos métodos. Resultados: se estableció que el grado de concordancia entre los dos métodos para el total de los aislamientos fue alto con AB (κ: 1) y FCZ (κ: 0.74) y bajo al utilizar ITZ (κ: 0.49). La concordancia fue variable y especie-específica: para ITZ y FCZ en C. albicans fue de 0,45 y 0,64; en C. tropicalis, de 0,48 y 0,91; y en Candidaspp. de 0,73 y 0,87, respectivamente. Discusión: este estudio sugiere que las pruebas de sensibilidad antifúngica para los dos métodos son equivalentes en lo esencial. Deben considerarse las diferencias y discrepancias asociadas a la especie implicada, el tipo de antifúngico utilizado y los tiempos de incubación, que puede producir variaciones al interpretar los resultados obtenidos de acuerdo con la metodología empleada.
Objective: compare the broth microdilution testing reference standards CLSI M27-A2 and EUCAST, identifying the usefulness of each one of them and their main differences, against the antifungal agents amphotericin B (1), fluconazole (FCZ), and itraconazole (ITZ) using clinical isolates of Candidaspp. in cancer patients. Methods: isolates of C. albicans (n=136), C. tropicalis (n=36), and Candidaspp. (n=17) were tested by the two methods. The Kappa index was used to establish the degree of agreement between the methods. Results: the degree of agreement between the two methods was high for AB (κ: 1) and FCZ (κ: 0.74) and was low for ITZ (κ: 0.49). Agreement was variable and specific for the various species: for ITZ and FCZ in C. albicans, it was 0.45 and 0.64, respectively. In C. tropicalis, it was of 0.48 and 0.91, and in Candidaspp., it was 0.73 and 0.87 respectively. Discussion: this study suggests that antifungal susceptibility testing using both methods is equivalent. Attention should be focused on differences and discrepancies associated with the species tested, the type of antifungal agent, and the incubation times, which can cause variations at the moment of interpreting the results obtained.
Subject(s)
Humans , Candida , Amphotericin B , Antifungal Agents , Candida/drug effects , Candidiasis/microbiology , Fluconazole , Itraconazole , Calendula , Antifungal Agents/pharmacology , NeoplasmsABSTRACT
Introducción: la sensibilidad antifúngica in vitro en hongos filamentosos no ha tenido el mismo desarrollo que en levaduras. Se dispone de limitada información sobre la susceptibilidad en este tipo de aislamientos en Colombia. Materiales y métodos: se determinó la actividad in vitro de fluconazol, voriconazol, itraconazol, anfotericina B y caspofungina mediante el método de E-Test, de los géneros Aspergillus (36 A. fumigatus, 12 A. flavus, 9 A. niger, 6 A. terreus, 4 A. nidulans y 1 A. versicolor) e hifomicetes hialinos (9 Fusarium sp., 2 Geotrichum sp. y 2 Paecilomyces sp.), provenientes en su mayoría de lavados broncoalveolares (30%) y biopsias pulmonares (36%); 9% provenían de hemocultivos. Resultados: el perfil de resistencia general fue 28% para itraconazol, 15% para caspofungina, 14% para anfotericina B y 5% para voriconazol. En general, todos los aislamientos presentaron una sensibilidad disminuida para fluconazol e itraconazol. La mejor actividad farmacológica la presentaron voriconazol, caspofungina y anfotericina B. Fusarium sp. presentó una mayor actividad con el voriconazol. Se encontraron diferencias entre el tipo de micelio (Aspergillus vs no Aspergillus) y la susceptibilidad a voriconazol, anfotericina B y caspofungina. Conclusión: en general, los antimicóticos disponibles para el tratamiento de infecciones por miceliales muestran una sensibilidad disminuida in vitro en relación con el género y la especie identificada.
Introduction: fungal susceptibility against micelial fungi has not been developed at the same pace as susceptibility against yeasts. Scarce information is available about that kind of isolates in Colombia. Materials and methods: in vitro susceptibility against micelial isolates from patients with cancer was determined. The E-test method was used to find out susceptibility against fluconazole, voriconazole, itraconazole, amphotericin B, and caspofungin. Isolates of the genera Aspergillus (36 A. fumigatus, 12 A. flavus, 9 A. niger, 6 A. terreus, 4 A. nidulans and one A. versicolor isolate), Fusarium (n=9), Geotrichum and Paecilomyces (n=2 each one) obtained from patients with cancer were tested. These isolates were obtained from bronchoalveolar lavage (30%), pulmonary biopsies (36%) and bloodstream infections (9%). Results: The general pattern of resistance was 28% against intraconazole, 15% against caspofungin, 14% against amphotericin B, and 5% against voriconazole. In general, susceptibility against fluconazole and itraconazole showed a diminishing trend. Voriconazole, caspofungin, and amphotericin B showed the best pharmacologic potency. Fusarium sp. presented a higher activity level against voriconazole. There were differences in the susceptibility against voriconazole, anphotericin B, and caspofungin depending on the type of micelial isolate (Aspergillus vs. Non- Aspergillus). Conclusion: In general, the available antifungal treatments against mycelial fungi identified in the cancer center show diminished susceptibility.
Subject(s)
Humans , Microbial Sensitivity Tests , Disk Diffusion Antimicrobial Tests , Fungi , Neoplasms , Aspergillosis , Aspergillus , Drug Resistance , Antifungal AgentsABSTRACT
Purpose: To assess the number of Streptococcus mutans in saliva of patients with denture stomatitis before and after antifungal therapy. Methods: After examining 93 patients, 47 were selected for fungal test. Then, from this sample, thirty patients were selected: 15 with positive and 15 with negative diagnosis for candidiasis that were evaluated for S. mutans counting, salivary flow and buffer capacity evaluation. Oral hygiene and prosthesis hygiene, period using prosthesis, lesion type and salivary data were related with clinical laboratorial characteristics of the patients with Candida. Results: The most frequent lesions were type I (43.5%) and II (53.5%). The amount of S. mutans was six times higher in patients with candidiasis and it was associated with low salivary flow and poor oral hygiene. After therapy, a reduction of S. mutans was verified particularly in patients with normal salivary flow. The values ranged from 0.01 to 3.88 x 10
Objetivo: Verificar o número de Streptococcus mutans em saliva de pacientes com estomatite protética antes e após a terapia antifúngica. Metodologia: Após exame clínico de 93 pacientes, 47 foram selecionados para exame micológico e desta amostra foram selecionados trinta pacientes: 15 com diagnóstico positivo e 15 com diagnóstico negativo de candidose foram avaliados para contagem de S. mutans, determinação de fluxo salivar e capacidade tampão. Higiene bucal e da prótese, tempo de confecção, tipo de lesão e dados salivares foram relacionados com características clínicas e laboratoriais de Candida. Resultados: As lesões frequentes foram dos tipos I (43,5%) e II (53,5%). A quantidade de S. mutans foi seis vezes maior em pacientes com candidose e foi associada com baixo fluxo salivar e higiene oral deficiente. Após a terapia, a redução de S. mutans foi verificada particularmente em pacientes com fluxo salivar normal. Os valores variaram de 0,01 a 3,88 UFC/ml x 10
Subject(s)
Humans , Male , Female , Antifungal Agents/therapeutic use , Candidiasis, Oral/therapy , Stomatitis, Denture , Streptococcus mutansABSTRACT
Scedosporium species can cause colonization, superficial and deep localized infection or systemic disease, espe-cially in irnmunocompromised hosts. We report a case of localized infection due to Scedosporium apiospermum in a 47 year oíd woman, with previous nasal surgery. She consulted for recurrent mucopurulent post-nasal discharge not responding to antibiotics. Computed tomography showed opacification of right maxillary sinus. Surgery was performed to removed abnormal tissue from sinus; biopsy revealed chronic sinusitis with aggregate of tightly packed hyphae suggestive of filamentous fungi. The microbiology fungal culture reported Scedosporium apiospermum.
Las infecciones por Scedosporium sp pueden traducirse en colonización, infecciones localizadas superficiales y profundas, o enfermedad diseminada. Presentamos un caso clínico de infección rinosinusal por Scedosporium apiospermum en una paciente de 47 años, con antecedente de cirugía por cuerpo extraño en la fosa nasal derecha. Consultó por descarga posterior muco-purulenta y recurrente, sin respuesta a tratamiento antibacteriano. Las imágenes de cavidades paranasales mostraron opacidad del seno maxilar derecho. Se realizó cirugía de remoción de contenido sinusal cuyo estudio histológico reveló sinusitis crónica erosiva, colonias de hongos con morfología sugerente de hongo filamentoso y desarrollo de S. apiospermum en el cultivo.
Subject(s)
Female , Humans , Middle Aged , Immunocompetence , Mycetoma/microbiology , Rhinitis/microbiology , Scedosporium/isolation & purification , Sinusitis/microbiology , Chronic Disease , Mycetoma/diagnosis , Mycetoma/surgery , Rhinitis/diagnosis , Rhinitis/surgery , Sinusitis/diagnosis , Sinusitis/surgeryABSTRACT
Neste estudo, foi avaliada a resistência a drogas antifúngicas em 51 cepas de Candida tropicalis isoladas de amostras clínicas no Estado do Ceará, Brasil. Resistência antifúngica foi um evento raro no nosso estudo e foi restrita a 3 (5,9 por cento) das cepas de Candida tropicalis, que exibiram resistência a fluconazol e itraconazol.
In this study, the resistance to antifungal drugs was investigated among 51 strains of Candida tropicalis isolated from clinical samples in the State of Ceará, Brazil. Antifungal resistance was a rare finding in our study and was restricted to three (5.9 percent) of the strains of Candida tropicalis. These exhibited resistance to both fluconazole and itraconazole.
Subject(s)
Humans , Antifungal Agents/pharmacology , Candida tropicalis/drug effects , Amphotericin B/pharmacology , Brazil , Candida tropicalis/isolation & purification , Disk Diffusion Antimicrobial Tests , Drug Resistance, Fungal , Fluconazole/pharmacology , Itraconazole/pharmacologyABSTRACT
Introducción. Las micosis sistémicas generan un gran incremento en los costos de la atención médica. Se evaluó el medicamento más costo-efectivo para el tratamiento empírico de aspergilosis sistémica entre la anfotericina B, caspofungina y voriconazol en pacientes con fiebre persistente y neutropenia. Métodos. Modelo tipo árbol de decisiones para estimar los resultados clínicos esperados y los costos asociados del tratamiento de la aspergilosis sistémica. La perspectiva del estudio fue la del proveedor de servicios públicos de salud (Instituto Mexicano del Seguro Social [IMSS]). Temporalidad: 12 semanas. Medida de efectividad: tasa de remisión completa de la infección micótica. Se desarrollaron análisis de sensibilidad univaridos y probabilísticos. Resultados. Los costos totales promedio por paciente esperados para el tratamiento empírico de aspergilosis resultaron convoriconazol en $57 378.58 US; $72 833.96 US con anfotericina B, y de $49 962.37 US con caspofungina. La tasa de remisión total sin eventos adversos fue de 37% para caspofungina, 43.6% para voriconazol y de 51.1% para anfotericina B. El análisis de sensibilidad probabilístico muestra que voriconazol sería el tratamiento más costo-efectivo en 65% de los casos, independientemente de la disposición a pagar por el IMSS. Conclusiones. Los resultados presentados concuerdan con la afirmación de que el tratamiento estándar de primera línea recientemente propuesto para el tratamiento empírico de aspergilosis sistémica debe ser voriconazol.
Introduction. Systemic mycosis has a great impact on medical care costs. The objective of this study was to assess the most cost-effective empirical treatment for systemic aspergillosis, evaluating amphotericin B, caspofungin and voriconazole in patients with persistent fever and neutropenia. Methods. A decision-tree model was used to estimate expected clinical results and costs associated with the treatment for systemic aspergillosis. The study used a healthcare payer's perspective (Mexican Institute of Social Security, IMSS). Time frame was 12 weeks. Effectiveness measure was complete remission of mycotic infection. One-way and probabilistic sensitivity analyses were performed. Results. Average total expected costs per patient for the voriconazole treatment were US $57 378.58, for amphotericin B US $72 833.96, and for caspofungin were US $49 962.37. Thetotal expected remission rate without any adverse events was 37% for caspofungin, 43.6% for voriconazole and 51.1% for amphotericin B. Probabilistic sensitivity analysis showed that voriconazole would be a cost-effective treatment with 65% confidence, regardless of the willingness to pay the IMSS. Conclusions. The results of the study agree with the recommendation that voriconazole must be the empirical treatment for systemic aspergillosis, proposed as a standard first-line antifungal drug.
ABSTRACT
La Candida es un hongo dimorfo de distribución universal que forma parte de la flora residente de la boca, tracto digestivo y genital femenino de sujetos sanos. Bajo algunas condiciones, por razones a veces bien establecidas y en otros casos no bien conocidos, pudieran ser responsables de patologías de alto riesgo y en ocasiones fatales. Pueden producir lesiones en piel, uñas, cavidad oral, bronquios, pulmones y alcanzar todos los órganos y sistemas mediante la diseminación sanguínea de la levadura, lo que se denomina fungemia o candidemia. El aumento de las infecciones causadas por levaduras es un fenómeno creciente a nivel mundial y Perú no escapa a esta problemática. El tratamiento antifúngico se ha enriquecido, recientemente, con nuevos preparados que están mejorando las opciones terapéuticas de muchos de estos pacientes. Las determinaciones de este estudio experimental nos dan ciertas esperanzas en una posible alternativa para tratamiento antimicótico para Cándida albicans. Se demostró mediante un estudio in vitro, según el método de difusión con discos en agar Sabouraud, el efecto antifúngico de una crema elaborada con las hojas de Plantago major en una concentración de 18.5 g de sólidos por cada gramo de crema; ésta resultó muy efectiva frente a la Candida albicans los halos de inhibición producidos por las cremas de Plantago major L., nistatina y ketoconazol 2% en cepas de Candida albicans, se observo una diferencia minina entre sus diámetros, las cuales corresponden 0.15 ± 0.05 mm. y 0.32 ± 0.05 para crema de Plantago major - Crema de Ketoconazol 2% y Crema de Plantago de major L.- Nistatina. El porcentaje de inhibición de la crema de Plantago Major L. frene a los fármacos ( ketoconazol 2% y Nistatina), es 95.63 % y de 99.06 %, lo cual indica que existe un buen efecto antifúngico; el análisis estadísticos de los datos obtenidos en el experimento, con un valor de significancia del 0.95 y con un valor de P< 0.05; se obtuvo un valor de P > 0.05, lo cual indica que no existe significancia entre las cremas antifúngicas utilizadas con respecto a la puesta en evaluación
Subject(s)
Plants, Medicinal , Antifungal Agents , Peru , Plantago major , Antifungal AgentsABSTRACT
Denture stomatitis is an inflammatory condition that occurs in denture wearers and is frequently associated with Candida yeasts. Antifungal susceptibility profiles have been extensively evaluated for candidiasis patients or immunosupressed individuals, but not for healthy Candida carriers. In the present study, fluconazole, itraconazole, voriconazole, terbinafine and 5-flucytosin were tested against 109 oral Candida spp. isolates. All antifungal agents were effective against the samples tested except for terbinafine. This work might provide epidemiological information about Candida spp. drug susceptibility in oral healthy individuals.
A estomatite protética é uma condição inflamatória que ocorre em usuários de prótese total e está frequentemente associada a leveduras do gênero Candida, Os perfis de suscetibilidade a antifúngicos têm sido extensivamente estudados em pacientes com candidíase ou em indivíduos imunossuprimidos, mas não em portadores sadios de Candida. No presente estudo, fluconazol, itraconazol, voriconazol, terbinafina e 5-flucitosina foram testados contra 109 isolados orais de Candida spp. Todos os agentes antifúngicos mostraram-se eficazes contra as amostras avaliadas, exceto a Terbinafina. O presente trabalho pode fornecer dados epidemiológicos com relação à susceptibilidade a antifúngicos de Candida spp em indivíduos com saúde oral.
Subject(s)
Humans , Candidiasis, Oral , Candida albicans/isolation & purification , Mouth Mucosa , Prosthodontics , Stomatitis , Yeasts , Epidemiology , Methods , MethodsABSTRACT
Este trabalho identificou variedades de Cryptococcus neoformans e avaliou a suscetibilidade a antifúngicos pelo protocolo M27-A2 do National Committee for Clinical Laboratory Standards em isolados de 35 pacientes do Hospital Escola da Universidade Federal do Triângulo Mineiro. A variedade gatti foi identificada em 11.4 por cento (nº = 4) dos casos. A concentração inibitória mínima (mg/ml) dos isolados de Cryptococcus neoformans neoformans variou de 0,062 - 2,000 (anfotericina B), 0,250 - 8,000 (fluconazol), 0,062 - 1,000 (itraconazol) e 0,125 - 1,000 (cetoconazol). A variedade gattii apresentou concentração inibitória mínima de 0,125 - 2,000 (anfotericina B), 0,250 - 16,00 (fluconazol), 0,062 - 1,000 (itraconazol) e 0,125 - 4,000 (cetoconazol). Detectaram-se 2 isolados resistentes ao itraconazol e 2 a anfotericina B (1 isolado de cada variedade por antifúngico). Os dados mostram a importância da determinação da variedade e da concentração inibitória mínima de isolados de Cryptococcus neoformans para monitorar o desenvolvimento de resistência e possibilitar uma terapia mais adequada na criptococose.
This study identified Cryptococcus neoformans varieties isolated from 35 patients at teaching hospital of the Federal University of the Triângulo Mineiro and evaluated the susceptibility to antifungal agents among these samples using the protocol M27-A2 from the National Committee for Clinical Laboratory Standards. The gattii variety was identified in 11.4 percent of the cases (n = 4). The minimum inhibitory concentration (mg/ml) of Cryptococcus neoformans neoformans isolates ranged from 0.062 to 2.000 (amphotericin B), 0.250 to 8.000 (fluconazole), 0.062 to 1.000 (itraconazole) and 0.125 to 1.000 (ketoconazole). The gattii variety presented a minimum inhibitory concentration range of 0.125 to 2.000 (amphotericin B), 0.250 to 16.00 (fluconazole), 0.062 to 1.000 (itraconazole) and 0.125 to 4.000 (ketoconazole). Two isolates resistant to itraconazole and two resistant to amphotericin B (one isolate of each variety per antifungal agent) were found. These data show the importance of determining the variety and minimum inhibitory concentration of Cryptococcus neoformans isolates, in order to monitor resistance development and enable better treatment for cryptococcosis.
Subject(s)
Adult , Female , Humans , Male , Antifungal Agents/pharmacology , Cryptococcus neoformans/drug effects , Amphotericin B/pharmacology , Brazil , Cryptococcosis/microbiology , Cryptococcus neoformans/isolation & purification , Fluconazole/pharmacology , Hospitals, University , Itraconazole/pharmacology , Ketoconazole/pharmacology , Microbial Sensitivity TestsABSTRACT
Se describen 3 casos pediátricos de meningoencefalitis por Criptococcus neoformans serotipo A. El diagnóstico se realizó por examen directo del líquido cefalorraquídeo con tinta china. La cefalea, fiebre, fotofobia y signos meníngeos fueron las manifestaciones clínicas predominantes. Aunque se descartó la infección por VIH se demostró compromiso de la inmunidad celular en todos los pacientes. La evolución fue desfavorable en 1 caso, y coincide con un diagnóstico tardío de la enfermedad. El tratamiento con antifúngicos de acción sistémica (anfotericín B y/o fluconazol) fue efectivo en todos los casos.
3 pediatric cases of meningoencephalitis caused by Cryptococcus neoformans serotype A are described. The diagnosis was made by direct examination of the cerebrospinal fluid with India ink. Headache, fever, photophobia and meningeal signs were the predominant clinical manifestations. Although the HIV infection was discarded, cellular immunity compromise was observed in all patients. The evolution was unfavorable in one case and coincided with a late diagnosis of the disease. The treatment with antifungal agents of systemic action (amphotericin B and/or fluconazole) was effective in all cases.