Efeito de extratos vegetais de Hamamelis virginiana, Persea americana, Cynara scolymus L e Stryphnodendron barbatiman Msobre a expressão fenotípica dos fatores de virulência em biofilmes de Candida albicans / Effect of Hamamelis virginiana, Persea americana, Cynara scolymus L and Stryphnodendron barbatiman M plant extracts on the phenotypic expression of virulence factors in biofilms of the Candida albicans

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)

In vitro sensitivity of Malassezia furfur isolates from HIV-positive and negative patients to antifungal agents / Sensibilidad in vitro a antifúngicos de aislamientos de Malassezia furfur de pacientes positivos y negativos para HIV

Introduction. Malassezia is a lipophilic and lipid-dependent yeast genus belonging to the skin microbiota of humans and other animals. However, due to dysbiosis processes or other factors in the host, this yeast can cause different pathologies, ranging from skin diseases, such as seborrheic dermatitis, to fungemia. Isolation of Malassezia furfur has been reported in HIV-positive patients with or without skin lesions. Due to its opportunistic nature and its variable resistance to antifungal compounds, it is relevant to know the Malassezia sensitivity profiles. Objective. To determine the sensitivity to different antifungal agents, of clinical isolates of M. furfur obtained from HIV-positive or negative patients, with or without seborrheic dermatitis. Materials and methods. Assessment of isolates sensitivity to itraconazole, voriconazole, fluconazole, and amphotericin B was performed by two techniques: (1) Broth microdilution using Clinical and Laboratory Standards Institute (CLSI) protocol M27-A3 with modifications; and (2) agar tests using Etest®. Results. Isolates obtained from HIV patients showed an increase in the minimum inhibitory concentration of fluconazole, voriconazole, and amphotericin B, compared with those of non-HIV patients. Itraconazole was the antifungal with the lowest minimum inhibitory concentration (MIC) in most isolates. Conclusion. We observed differences in the sensitivity profiles of M. furfur isolates according to the context of the patient. High MIC of antifungals like fluconazole, commonly used for treating pathologies caused by Malassezia, were identified.

Introducción. Malassezia es un género de levaduras lipofílicas que dependen de los lípidos y hacen parte de la microbiota de la piel de humanos y otros animales. No obstante, debido a procesos de disbiosis u otros factores en el huésped, esta levadura puede llegar a causar diferentes enfermedades: desde cutáneas (como dermatitis seborreica) hasta fungemias. Se han reportado aislamientos de Malassezia furfur en pacientes positivos para HIV, con lesiones cutáneas o sin ellas. Por su carácter oportunista y sensibilidad variable a los compuestos antifúngicos, es relevante conocer los perfiles de sensibilidad. Objetivo. Determinar la sensibilidad a diferentes antifúngicos de aislamientos clínicos de M. furfur obtenidos de pacientes positivos o negativos para HIV, con dermatitis seborreica o sin ella. Materiales y métodos. La sensibilidad de los aislamientos a itraconazol, voriconazol, fluconazol y anfotericina B, se determinó mediante dos técnicas: microdilución en caldo según el protocolo M27-A3 del Clinical & Laboratory Standards Institute (CLSI), con modificaciones, y pruebas en agar mediante Etest®. Resultados. Los aislamientos obtenidos de pacientes con HIV mostraron aumento de la concentración inhibitoria mínima a fluconazol, voriconazol y anfotericina B, en comparación con los de pacientes sin HIV. Por otro lado, al evaluar la mayoría de los aislamientos, el itraconazol fue el antifúngico con la menor concentración inhibitoria mínima. Conclusión. Se evidencian diferencias en los perfiles de sensibilidad de los aislamientos de M. furfur, según el contexto del paciente, y elevadas concentraciones inhibitorias mínimas de antifúngicos como el fluconazol, usados comúnmente para el tratamiento de las enfermedades causadas por Malassezia spp.

Aspergilosis invasiva: definiciones, diagnóstico y tratamiento / Invasive aspergillosis: definitions, diagnosis, and treatment

Resumen La aspergilosis invasiva (AI) es una enfermedad grave y con alta mortalidad. Existen factores de riesgo y se describen brotes intrahospitalarios relacionados con construcciones. También se des cribe una entidad relacionada con la infección por COVID-19, conocida como aspergilosis pulmonar asociada a COVID-19 (APAC). Es de vital importancia implementar un tratamiento adecuado y precoz, especialmente en pacientes inmunocomprometidos y críticamente enfermos. El diagnóstico se basa en reconocer los factores predisponentes, la clínica, la obtención de imágenes, exámenes directos, cultivos, histopatología y biomarca dores como el galactomanano. La droga de elección es el voriconazol, pero se deben conocer las alternativas terapéuticas dada la creciente presencia de aislamientos resistentes.

Abstract Invasive aspergillosis (IA) is a serious disease with high mortality. There are several risk factors and in-hospital outbreaks related with construction have been described. An entity related to COVID-19 infection, known as COVID-19 associated pulmonary aspergillosis (CAPA), has recently appeared. Early and appropriate treatment is of paramount importance, especially in immunocompromised and critically ill patients. Diagnosis is based on recognition of predisposing factors, clinical signs, imaging, direct examination, culture, histopathology, and biomarkers such as galactomannan. The drug of choice is voriconazole, but alternative therapies must be taken into account given the increasing presence of resistant isolates.

Antifungal effect of Arnica montana and Hamamelis virginiana against Candida species

Objetivo ­ Avaliar a atividade antifúngica dos extratos glicólicos de Arnica montana e Hamamelis virginiana contra cepas de Candida spp. A candidíase é uma infecção fúngica comum, portanto, a pesquisa de novos agentes antifúngicos tem sido um alvo interessante. Várias plantas apresentaram atividades biológicas e, portanto, podem ser fontes promissoras de produtos naturais com atividades an-tifúngicas. Métodos ­ As atividades antifúngicas dos extratos glicólicos foram avaliadas por meio da determinação da concentração inibitória mínima (CIM) de acordo com o protocolo M27-S3 do Clinical and Laboratory Standards Institute (2008). Resultados ­ O ex-trato glicólico de A. montana apresentou a atividade antifúngica mais forte contra C. tropicalis, com concentração inibitória mínima (CIM) de 10% v/v e concentração fungicida mínima (MFC) de 80% v/v, seguido por C. krusei e C. glabrata, com valores de MIC e MFC de 20% v/v. Além disso, avaliamos a toxicidade dos dois extratos glicólicos no modelo Galleria mellonella usando as curvas de sobre-vivência de larvas tratadas com os extratos. Nossos resultados demonstraram que os extratos glicólicos de A. montana e H. virginiana não exibiram toxicidade contra larvas de G. mellonella e demonstraram atividade antifúngica contra espécies de Candida spp. Con-clusão ­ Assim, ambos os extratos são candidatos promissores para o desenvolvimento de novos agentes antifúngicos.

Objective ­ To evaluate the antifungal activity of Arnica montana and Hamamelis virginiana glycolic extracts against Candida strains. Methods ­ The antifungal activities of glycolic extracts were investigated by determination of the minimum inhibitory concentration (MIC) according to protocol M27-S3 of Clinical and Laboratory Standards Institute (2008). Results ­ A. montana glycolic extract showed the strongest antifungal activity against C. tropicalis, with a minimum inhibitory concentration (MIC) of 10% v/v and a minimum fungicidal concentration (MFC) of 80% v/v, then C. krusei and C. glabrata, with MIC and MFC values of 20% v/v. H. virginiana glycolic extract ex-hibited stronger activity against C. albicans and C. tropicalis, with MIC and MFC values of 10% v/v, than against C. glabrata, C. krusei, and C. parapsilosis, with MIC and MFC values of 20% v/v. Moreover, we evaluated the toxicity of the two glycolic extracts in the Galleria mellonella model using the survival curves of larvae treated with the two extracts. Our results demonstrated that the glycolic extracts of A. montana and H. virginiana exhibited no toxicity against G. mellonella larvae and demonstrated antifungal activity against Candida spe-cies. Conclusion ­ Thus, both extracts are promising candidates for the development of novel antifungal agents.

Una experiencia de siete años en el laboratorio de Micología del Hospital de Pediatría Juan P. Garrahan / A seven-year experience in the Mycology Laboratory of Hospital de Pediatría Juan P. Garrahan

En noviembre del año 2015 nos incorporamos al Laboratorio de Micología del Servicio de Microbiología del Hospital Garrahan. En este breve resumen queremos compartir los avances logrados a través de nuestra experiencia durante siete años de trabajo profesional. Debido a los diagnósticos realizados y su complejidad, consideramos que el Hospital Garrahan, sus pacientes y la comunidad toda necesitan contar con un laboratorio de Micología que responda a sus necesidades. Creemos haber iniciado un camino que esperamos continúe y culmine con la creación de la Unidad de Micología (AU)

In November 2015 we joined the Mycology Laboratory of the Microbiology Service of the Hospital Garrahan. In this brief summary we want to share the advances achieved through our experience during seven years of professional work. Due to the diagnosis made and their complexity, we believe that the Hospital Garrahan, its patients and the entire community, need to have a Mycology laboratory that responds to their requirements. We believe we have started a path that we hope will continue and culminate with the creation of the Mycology Unit (AU)

Avaliação da interação farmacológica de antifúngicos e quimioterápicos: uma revisão sistemática / Evaluation of pharmacological interaction of antifungals and chemotherapy: a systematic review

Objetivo: avaliar, por meio da literatura existente, a interação farmacológica de antifúngicos e quimioterápicos. Métodos: foi realizado um estudo de revisão sistemática de acordo com o diagrama de fluxo do processo de pesquisa PRISMA. Os descritores escolhidos foram: drug interactions, CYP inhibitors, antifungal e antineoplastic, mediante análise realizada no MESH. As bases de dados escolhidas foram: Pubmed, Lilacs e Scielo. O período considerado para busca de artigos publicados foi de 2015 a 2020. Resultados: no banco de dados PubMed, foram encontrados 54 artigos, enquanto, nas bases Lilacs e Scielo, não foram encontrados artigos de acordo com os critérios estabelecidos. Dos 54 artigos, 7 foram selecionados para esta revisão. O intervalo com maior número de publicações foi de 2015-2016. Os antifúngicos mais citados nos resultados foram os inibidores fortes da CYP (Cetoconazol, Itraconazol e Voriconazol). Conclusão: a revisão sistemática da literatura mostrou que não existe uma correlação exata entre a interação farmacológica dos antifúngicos com os antineoplásicos, quando administrados de forma simultânea. São necessários mais estudos atuais que possam monitorar e estabelecer, de forma precisa, a relação dessas interações.

Objective: to evaluate, through the existing literature, the pharmacological interaction of antifungals and chemotherapeutics. Methods: a systematic review study was conducted according to the PRISMA research process flow diagram. The descriptors were chosen by analysis performed in MESH. The descriptors chosen were: drug interactions, CYP inhibitors, antifungal and antineoplastic. The databases chosen were: Pubmed, Lilacs, and Scielo. The period considered for the search of published articles was from 2015 to 2020. Results: in the PubMed database, 54 articles were found, while in the Lilacs and Scielo databases, no articles were found according to the established criteria. Of the 54 articles, 8 were selected for this review. The interval that had the highest number of publications was 2015-2016. The most cited antifungal drugs in the results were the strong CYP inhibitors. Conclusion: the systematic review of the literature showed that there is no exact correlation between the pharmacological interaction of antifungals with antineoplastic drugs when administered simultaneously. More current studies are needed that can accurately monitor and establish the relationship between these interactions.

Scedosporiosis pulmonar post COVID-19 en paciente diabético: a propósito de un caso

Las especies de Scedosporium son consideradas patógenos oportunistas emergentes, que afectan a pacientes inmunocomprometidos o con respuesta inmunológica normal. La enfermedad invasiva grave supera tasas de mortalidad del 80 %. Se describe caso con afectación pulmonar causada por el complejo de especies de Scedosporium en un paciente masculino de 75 años de edad, procedente de Caracas, Venezuela, con diabetes mellitus tipo 2, infección respiratoria baja, dos infecciones previas por enfermedad por coronavirus 2019 (COVID-19) e imagen radiológica de lesión de ocupación de espacio pulmonar basal izquierdo. Se envió al laboratorio de microbiología porción de aproximadamente 1 cm2 de tejido pulmonar, solicitando estudios micológicos y para micobacterias. Al examen directo con KOH al 20 % se observó un fragmento de hifa hialina tabicada. A los 12 días de incubación hubo crecimiento en agar Sabouraud dextrosa más gentamicina de colonias vellosas con pigmentado difusible color amarillo pálido a mostaza. Se realizó examen directo a las colonias con azul de algodón, observándose estructuras compatibles con el complejo de especies de Scedosporium. Scedosporium spp., es el segundo hongo filamentoso, después de Aspergillus spp., causante de infecciones respiratorias bajas. El paciente fue tratado con voriconazol después del diagnóstico micológico con una evolución satisfactoria. Las infecciones por especies de Scedosporium afectan órganos internos como los pulmones, similar al caso descrito. La infección por COVID-19 es un factor predisponente para adquirir infecciones fúngicas poco frecuentes. El laboratorio de microbiología cumple un rol importante en el diagnóstico de micosis causadas por hongos inusuales.

Scedosporium species are considered emerging opportunistic pathogens affecting immunocompromised patients or patients with normal immune response. Mortality rates exceed 80 % in severe invasive disease. We describe a case of lung involvement caused by Scedosporium species complex in a 75-year-old male patient from Caracas, Venezuela, with type 2 diabetes mellitus, lower respiratory tract infection, two previous coronavirus disease infections 2019 (COVID-19) and radiological findings of a left basal lung space-occupying lesion. A piece of lung tissue measuring approximately one cm2 was sent to the microbiology laboratory, requesting mycology and mycobacteria studies. Direct examination with 20 % KOH revealed a hyaline septate hyphal fragment. Growth of hairy colonies with diffusible pale yellow to mustard pigment was observed on Sabouraud dextrose plus gentamicin agar after 12 days of incubation. Structures compatible with the Scedosporium species complex were observed on direct examination of the colonies with cotton blue. Scedosporium spp. is the second most common filamentous fungus causing infections of the lower respiratory tract after Aspergillus spp. The patient was treated with voriconazole after mycological diagnosis with satisfactory outcome. Infections with Scedosporium spp. affect internal organs such as the lungs, similar to the case described. COVID-19 infection predisposes to the acquisition of uncommon fungal infections. The microbiology laboratory plays an important role in the diagnosis of mycoses caused by unusual fungi.

Análisis fitoquímico preliminar y actividad antifúngica In vitro del extracto etanólico de las hojas de Solanum hispidum pers. Colectadas en la localidad Obraje - Perú / Preliminary phytochemical analysis and in vitro antifungal activity of the ethanolic extract of the leaves of Solanum hispidum pers. collected in the locality in Obraje - Peru

RESUMEN Objetivo . Analizar y determinar la actividad antifúngica in vitro del extracto etanólico de las hojas de Solanum hispidum Pers. Materiales y métodos . Se realizó el análisis fitoquímico preliminar cualitativo mediante reacciones de color y precipitación. Se investigó la actividad antifúngica in vitro frente a Candida albicans, Aspergillus brasilensis y Trichophyton mentagrophytes usando el método de difusión en pozo de agar y el ensayo de la concentración mínima inhibitoria (CMI). Resultados . El análisis fitoquímico preliminar cualitativo mostró la presencia de compuestos fenólicos, taninos, flavonoides, esteroides, alcaloides y saponinas. La actividad antifúngica in vitro fue demostrada para todos cultivos fúngicos con halos de inhibición entre 23 a 26 mm. Los valores de la CMI fueron de 125, 250 y 125 µg/mL para C. albicans, A. brasilensis y T. mentagrophytes, respectivamente. Conclusiones. El extracto etanólico de las hojas de Solanum hispidum Pers contiene importantes metabolitos secundarios y tiene moderada actividad antifúngica.

ABSTRACT Objective. To analyze and determine the in vitro antifungical activity of the ethanolic extract of the leaves of Solanum hispidum Pers. Materials and methods. We carried out a preliminary qualitative phytochemical analysis by color and precipitation reactions. We evaluated the in vitro antifungical activity against Candida albicans, Aspergillus brasilensis and Trichophyton mentagrophytes by using the agar well diffusion method and the minimum inhibitory concentration (MIC) assay. Results. Preliminary qualitative phytochemical analysis showed the presence of phenolic compounds, tannins, flavonoids, steroids, alkaloids and saponins. In vitro antifungal activity was demonstrated for all fungal cultures with inhibition halos between 23 to 26 mm. The MIC values were 125, 250, and 125 μg/mL for C. albicans, A. brasilensis, and T. mentagrophytes, respectively. Conclusions. The ethanolic extract of the leaves of Solanum hispidum Pers. contains important secondary metabolites and has moderate antifungical activity.

Infección fúngica invasiva por Saprochaete capitata en un niño con aplasia medular / Invasive fungal infection by Saprochaete capitata in a child with bone marrow aplasia

RESUMEN Saprochaete capitata es una causa rara de infección fúngica invasiva en pacientes inmunocomprometidos con alta mortalidad y resistencia antifúngica. Presentamos el caso de un niño de cinco años con diagnóstico de aplasia medular, sometido a trasplante de progenitores hematopoyéticos (TPH), que cursó con neutropenia febril persistente, dolor abdominal intenso, aparición de lesiones maculopapulares en piel y deterioro de la función renal. Se identificó la presencia de S. capitata, en hemocultivos transcatéter venoso central. Esta infección fúngica invasiva resulta ser rara, pero emergente y potencialmente mortal, en pacientes con neutropenia febril persistente y uso prolongado de dispositivos invasivos intravasculares como catéter venoso central.

ABSTRACT Saprochaete capitata is a rare cause of invasive fungal infection in immunocompromised patients with high mortality and antifungal resistance. We present the case of a 5-year-old boy with bone marrow aplasia, who underwent hematopoietic stem cell transplantation (HSCT) and presented persistent febrile neutropenia, abdominal pain, appearance of maculopapular lesions on the skin, and impaired renal function. The presence of S. capitata was identified by blood culture from a central venous catheter. This invasive fungal infection is rare but emergent and life-threatening, especially in immunocompromised patients with persistent febrile neutropenia and prolonged use of invasive devices such as central venous catheters.

Plant metabolite 5-pentadecyl resorcinol is produced by the Amazonian fungus Penicillium sclerotiorum LM 5679 / O metabólito vegetal 5-pentadecil resorcinol é produzido pelo fungo amazônico Penicillium sclerotiorum LM 5679

Since the classic studies of Alexander Flemming, Penicillium strains have been known as a rich source of antimicrobial substances. Recent studies have identified novel metabolites produced by Penicillium sclerotiorum that have antibacterial, antifouling and pharmaceutical activities. Here, we report the isolation of a P. sclerotiorum (LM 5679) from Amazonian soil and carry out a culture-based study to determine whether it can produce any novel secondary metabolite(s) that are not thus-far reported for this genus. Using a submerged culture system, secondary metabolites were recovered by solvent extract followed by thin-layer chromatography, nuclear magnetic resonance, and mass spectroscopy. One novel secondary metabolite was isolated from P. sclerotiorum (LM 5679); the phenolic compound 5-pentadecyl resorcinol widely known as an antifungal, that is produced by diverse plant species. This metabolite was not reported previously in any Penicillium species and was only found once before in fungi (that time, in a Fusarium). Here, we discuss the known activities of 5-pentadecyl resorcinol in the context of its mode-of-action as a hydrophobic (chaotropicity-mediated) stressor.

Desde os estudos clássicos de Alexander Flemming, as cepas de Penicillium são conhecidas como uma fonte rica em substâncias antimicrobianas. Estudos recentes identificaram novos metabólitos produzidos pela espécie Penicillium sclerotiorum com atividades antibacteriana, anti-incrustante e farmacêutica. Aqui, relatamos o isolamento de uma colônia de P. sclerotiorum (LM 5679) do solo amazônico e relatamos também o estudo baseado em cultura para determinar se ele pode produzir qualquer novo metabólito (s) secundário (s) que não foram relatados até agora para este gênero. Usando um sistema de cultura submerso, os metabólitos secundários foram recuperados por extrato de solvente seguido por cromatografia em camada delgada, ressonância magnética nuclear e espectroscopia de massa. Um novo metabólito secundário foi isolado de P. sclerotiorum (LM 5679); o composto fenólico 5-pentadecil resorcinol que é amplamente conhecido como um antifúngico que é produzido por diversas espécies de plantas. Este metabólito não foi relatado anteriormente em nenhuma espécie de Penicillium, e foi encontrado apenas uma vez em fungos (Fusarium). Aqui, discutimos as atividades conhecidas do 5-pentadecil resorcinol no contexto de seu modo de ação como um estressor hidrofóbico (mediado pela caotropicidade).

Forma aguda de histoplasmose em paciente imunocompetente: relato de caso / Acute form of histoplasmosis in immunocompetent patient: case report

A histoplasmose é uma doença granulomatosa infecciosa sistêmica cuja transmissão é aerógena e a contaminação se dá pelo contato com fezes de aves e morcegos, depende da exposição e da imunidade do paciente. Trata-se de uma doença com difícil diagnóstico, dada a semelhança dos sintomas com os de outras doenças granulomatosas infecciosas, principalmente em pacientes imunocompetentes, visto que a regressão é geralmente espontânea. Um homem de 34 anos, branco, natural e procedente de Atibaia, previamente hígido, iniciou quadro de dor e edema no tornozelo esquerdo, e evoluiu com dispneia progressiva, com piora ao decúbito, acompanhada de sudorese noturna, tosse seca e febre baixa. Foi realizado o exame de tomografia computadorizada (TC) de tórax sem contraste, que evidenciou espessamento difuso das paredes brônquicas, de aspecto inflamatório, micronódulos esparsos bilateralmente. Paciente apresentou PCR elevado, COVID, sorologias, BAAR e hemoculturas negativas, punção articular e ecocardiograma sem alterações. Optado por COXCIP 4, sulfametoxazol-trimetoprim e anfotericina B de forma empírica. Pesquisa de fungos em escarro positivo; leveduras e lavado brônquico sugestivos de histoplasmose. Evoluiu com insuficiência respiratória necessitando de intubação orotraqueal, posteriormente, traqueostomia e apesar do tratamento antifúngico, evoluiu com óbito após 21 dias. A histoplasmose é uma doença grave, com diversas formas clínicas e prognóstico normalmente autolimitado, mas que pode ser fatal, mesmo em pacientes previamente imunocompetentes.

Histoplasmosis is a systemic infectious granulomatous disease whose transmission is airborne, and contamination occurs through contact with bird and bat feces, depending on the exposure and immunity of the patient. It is a disease with difficult diagnosis, given the similarity of symptoms with those of other infectious granulomatous diseases, especially in immunocompetent patients since regression is usually spontaneous. A 34-year-old Caucasian man from Atibaia, previously healthy, developed pain and swelling in his left ankle, progressing to progressive dyspnea, worsening in recumbency, accompanied by night sweats, dry cough and low-grade fever. A non-contrast-enhanced computed tomography (CT) scan of the chest was performed, which showed diffuse thickening of the bronchial walls, with an inflammatory appearance, and bilaterally sparse micronodules. Patient had high C-reactive protein, COVID, serology, BAAR and negative blood cultures, joint puncture, and echocardiogram without changes. Empirically opted for COXCIP 4, trimethoprim-sulfamethoxazole and amphotericin B. Search for fungi in positive sputum, yeasts, and bronchial lavage suggestive of histoplasmosis. He envolved with respiratory failure requiring orotracheal intubation, later tracheostomy and despite antifungal treatment, he died after 21 days. Histoplasmosis is a serious disease, with several clinical forms and a prognosis that is usually self-limiting, but it can be fatal, even in previously immunocompetent patients

Antifungals from plants: a bibliometric analysis of the last two decades (2000-2020) / Antifúngicos de plantas: un análisis bibliométrico de las últimas dos décadas (2000-2020)

This study aimed to analyse the world scientific production on antifungals from plants indexed in the Scopus database (2000-2020), highlighting the Cuban scientific production on this topic as a case study. Scopus raw data based on antifungal and plants hits were cleaned using the OpenRefine tool to eliminate similar and duplicate results. Cleaned data was processed using VOSviewer software for keyword-based bibliometric analysis. The 5000 most common words from the Corpus of Contemporary American English were excluded. A co-occurrence analysis was performed taking into account only authors keywords and using the complete count method. 24 084 documents were identified, of which 85.8percent were original articles and 9.6percent were reviews. The most productive journals were Journals of Ethnopharmacology, Natural Product Research and Fitoterapia. The annual scientific production was uniform with a linear growth. The thematic structure according to the co-occurrence network indicates that the most frequent terms were essential oils, antioxidant, medicinal plants, Candida albicans and flavonoids. In the case of Cuba, of the 64 publications on the subject, 90.6percent were original articles and 6.3percent were reviews. The Cuban magazines with the highest production were Revista Cubana de Plantas Medicinales and Biotecnología Aplicada. The most frequent terms according to the co-occurrence network in Cuban publications were Staphylococcus aureus, Candida albicans, plant leaf, antimicrobial activity, medicinal plants and flavonoids. These results prove that the global scientific community as well as the Cuban scientist are interested on the topic, further demonstrating that plants could become a reliable source of antifungal drugs(AU)

El objetivo del presente estudio fue analizar la producción científica mundial sobre antifúngicos de plantas recogida en la base de datos Scopus (2000-2020), con atención a la producción científica cubana como caso/estudio. Los datos resultantes de la búsqueda por coincidencia de las palabras antifungal y plants se filtraron con la herramienta OpenRefine, que eliminó resultados similares y duplicados. Se empleó el programa VOSviewer para el análisis bibliométrico basado en palabras claves, que excluyó las 5000 más comunes del Corpus of Contemporary American English. Se realizó un análisis de coocurrencia que consideró las palabras clave definidas por los autores en cada artículo a través del método de conteo completo. Se identificaron 24 084 documentos, de los cuales un 85,8 por ciento resultaron artículos originales y un 9,6 por ciento, artículos de revisión. Las revistas más productivas fueron Journals of Ethnopharmacology, Natural Product Research y Fitoterapia. La producción científica anual fue uniforme, con un crecimiento lineal. La red de coocurrencia indicó que los términos más frecuentes fueron aceites esenciales, antioxidante, plantas medicinales, Candida albicans y flavonoides. En Cuba, de las 64 publicaciones sobre el tema, el 90,6 por ciento resultaron ser artículos originales y 6,3 por ciento, artículos de revisión. Las revistas cubanas con mayor producción fueron Revista Cubana de Plantas Medicinales y Biotecnología Aplicada. Los términos más frecuentes en las publicaciones cubanas fueron Staphylococcus aureus, Candida albicans, hojas de plantas, actividad antimicrobiana, plantas medicinales y flavonoides. Estos resultados demuestran que, tanto la comunidad científica mundial como la cubana, manifiestan creciente interés en el tema, lo cual evidencia el potencial de las plantas como fuente confiable de medicamentos antifúngicos(AU)

Plant metabolite 5-pentadecyl resorcinol is produced by the Amazonian fungus Penicillium sclerotiorum LM 5679 / O metabólito vegetal 5-pentadecil resorcinol é produzido pelo fungo amazônico Penicillium sclerotiorum LM 5679

Since the classic studies of Alexander Flemming, Penicillium strains have been known as a rich source of antimicrobial substances. Recent studies have identified novel metabolites produced by Penicillium sclerotiorum that have antibacterial, antifouling and pharmaceutical activities. Here, we report the isolation of a P. sclerotiorum (LM 5679) from Amazonian soil and carry out a culture-based study to determine whether it can produce any novel secondary metabolite(s) that are not thus-far reported for this genus. Using a submerged culture system, secondary metabolites were recovered by solvent extract followed by thin-layer chromatography, nuclear magnetic resonance, and mass spectroscopy. One novel secondary metabolite was isolated from P. sclerotiorum (LM 5679); the phenolic compound 5-pentadecyl resorcinol widely known as an antifungal, that is produced by diverse plant species. This metabolite was not reported previously in any Penicillium species and was only found once before in fungi (that time, in a Fusarium). Here, we discuss the known activities of 5-pentadecyl resorcinol in the context of its mode-of-action as a hydrophobic (chaotropicity-mediated) stressor.

Desde os estudos clássicos de Alexander Flemming, as cepas de Penicillium são conhecidas como uma fonte rica em substâncias antimicrobianas. Estudos recentes identificaram novos metabólitos produzidos pela espécie Penicillium sclerotiorum com atividades antibacteriana, anti-incrustante e farmacêutica. Aqui, relatamos o isolamento de uma colônia de P. sclerotiorum (LM 5679) do solo amazônico e relatamos também o estudo baseado em cultura para determinar se ele pode produzir qualquer novo metabólito (s) secundário (s) que não foram relatados até agora para este gênero. Usando um sistema de cultura submerso, os metabólitos secundários foram recuperados por extrato de solvente seguido por cromatografia em camada delgada, ressonância magnética nuclear e espectroscopia de massa. Um novo metabólito secundário foi isolado de P. sclerotiorum (LM 5679); o composto fenólico 5-pentadecil resorcinol que é amplamente conhecido como um antifúngico que é produzido por diversas espécies de plantas. Este metabólito não foi relatado anteriormente em nenhuma espécie de Penicillium, e foi encontrado apenas uma vez em fungos (Fusarium). Aqui, discutimos as atividades conhecidas do 5-pentadecil resorcinol no contexto de seu modo de ação como um estressor hidrofóbico (mediado pela caotropicidade).

Plant metabolite 5-pentadecyl resorcinol is produced by the Amazonian fungus Penicillium sclerotiorum LM 5679

Abstract Since the classic studies of Alexander Flemming, Penicillium strains have been known as a rich source of antimicrobial substances. Recent studies have identified novel metabolites produced by Penicillium sclerotiorum that have antibacterial, antifouling and pharmaceutical activities. Here, we report the isolation of a P. sclerotiorum (LM 5679) from Amazonian soil and carry out a culture-based study to determine whether it can produce any novel secondary metabolite(s) that are not thus-far reported for this genus. Using a submerged culture system, secondary metabolites were recovered by solvent extract followed by thin-layer chromatography, nuclear magnetic resonance, and mass spectroscopy. One novel secondary metabolite was isolated from P. sclerotiorum (LM 5679); the phenolic compound 5-pentadecyl resorcinol widely known as an antifungal, that is produced by diverse plant species. This metabolite was not reported previously in any Penicillium species and was only found once before in fungi (that time, in a Fusarium). Here, we discuss the known activities of 5-pentadecyl resorcinol in the context of its mode-of-action as a hydrophobic (chaotropicity-mediated) stressor.

Resumo Desde os estudos clássicos de Alexander Flemming, as cepas de Penicillium são conhecidas como uma fonte rica em substâncias antimicrobianas. Estudos recentes identificaram novos metabólitos produzidos pela espécie Penicillium sclerotiorum com atividades antibacteriana, anti-incrustante e farmacêutica. Aqui, relatamos o isolamento de uma colônia de P. sclerotiorum (LM 5679) do solo amazônico e relatamos também o estudo baseado em cultura para determinar se ele pode produzir qualquer novo metabólito (s) secundário (s) que não foram relatados até agora para este gênero. Usando um sistema de cultura submerso, os metabólitos secundários foram recuperados por extrato de solvente seguido por cromatografia em camada delgada, ressonância magnética nuclear e espectroscopia de massa. Um novo metabólito secundário foi isolado de P. sclerotiorum (LM 5679); o composto fenólico 5-pentadecil resorcinol que é amplamente conhecido como um antifúngico que é produzido por diversas espécies de plantas. Este metabólito não foi relatado anteriormente em nenhuma espécie de Penicillium, e foi encontrado apenas uma vez em fungos (Fusarium). Aqui, discutimos as atividades conhecidas do 5-pentadecil resorcinol no contexto de seu modo de ação como um estressor hidrofóbico (mediado pela caotropicidade).

Especies y sensibilidad a antifúngicos de cepas de Candida spp. aisladas de la cavidad bucal de pacientes con VIH de Paraguay

RESUMEN Candida albicans es la levadura más aislada de la cavidad oral de personas con VIH. Sin embargo, el uso de antifúngicos ha incrementado el aislamiento de especies no C. albicans resistentes o con sensibilidad reducida. El objetivo del estudio fue determinar las especies de Candida y la sensibilidad a los antifúngicos de aislamientos de la cavidad bucal de pacientes con VIH, que acudieron al Instituto de Medicina Tropical entre julio a diciembre de 2019. Las levaduras se sembraron en Agar Cromogénico Candida (CONDA®, España) para la identificación presuntiva. Las colonias verdes se identificaron por PCR dúplex y las de coloración distinta o PCR negativa mediante el sistema comercial VITEK®2. La susceptibilidad antifúngica de C. albicans se determinó por VITEK®2, y las no albicans por el método de difusión de discos. De 278 levaduras, C. albicans se aisló en 70,9 %, seguido de C. tropicalis (8,3 %) y C. krusei (5 %). C. albicans presentó 93 % de sensibilidad y 2 % de sensibilidad dosis dependiente al fluconazol; 87 % sensibles y 3 % con sensibilidad intermedia frente a voriconazol; 97, 98 y 100 % sensibilidad a flucitosina, anfotericina B y equinocandinas, respectivamente. C. parapsilosis y C. tropicalis no registraron resistencias a fluconazol y voriconazol. Todos los aislamientos de C. glabrata fueron sensibles dosis dependientes a fluconazol y todos los aislamientos de C. krusei resultaron sensibles a voriconazol. La portación oral de Candida spp. resistentes a azoles podría llevar a fracasos terapéuticos en pacientes con VIH que desarrollen candidiasis orofaríngea.

ABSTRACT Candida albicans is the most isolated yeast from the oral cavity of people with HIV. However, the use of antifungals has increased the isolation of non-C. albicans resistant species or those with reduced sensitivity. The objective of the study was to determine the Candida species and the sensitivity to antifungals of isolates from the oral cavity of patients with HIV who attended the Institute of Tropical Medicine between July and December 2019. The yeasts were plated in Candida Chromogenic Agar (CONDA®, Spain) for presumptive identification. Green colonies were identified by duplex PCR and those with different staining or negative PCR using the commercial VITEK®2 system. The antifungal susceptibility of C. albicans was determined by VITEK®2, and non albicans by the disk diffusion method. Of 278 yeasts, C. albicans was isolated in 70.9 %, followed by C. tropicalis (8.3 %) and C. krusei (5 %). C. albicans presented 93 % sensitivity and 2 % dose-dependent sensitivity to fluconazole; 87 % sensitive and 3 % intermediate sensitivity to voriconazole; 97, 98, and 100 % sensitive to flucytosine, amphotericin B, and echinocandins, respectively. C. parapsilosis and C. tropicalis did not register resistance to fluconazole and voriconazole. All C. glabrata isolates were dose-dependently sensitive to fluconazole and all C. krusei isolates were sensitive to voriconazole. The oral carriage of Candida spp. resistant to azoles may lead to therapeutic failures in HIV patients who develop oropharyngeal candidiasis.

Avaliação in vitro do potencial antifúngico de sais imidazólicos frente à Candida albicans / In vitro evaluation of antifungal potential of imidazolium salts against Candida albicans

Objetivo: O objetivo deste estudo foi avaliar o potencial antifúngico de um conjunto de sais imidazólicos (SI) frente a Candida albicans. Materiais e métodos: A avaliação an-tifúngica dos SI foi realizada por meio do teste de difusão em ágar, utilizando uma cepa de Candida albicans (ATCC 90028). Cinco diferentes SI foram sintetizados e testados no presente estudo: brometo de 1,8-bis(metilimidazólio-1-il) octano (MImC8MImBr2), metanossulfonato de 1,12-bis(-metilimidazólio-1-il) dodecano (MImC12MIm(MeS)2), clo-reto de 1-n-hexadecil-2,3-dimetilimidazólio (C16DMImCl), metanossulfonato de 1,10-bis(metilimidazólio-1-il) decano (MImC10MIm(MeS)2) e brometo de 1,10-bis(metilimidazólio--1-il) decano (MImC10MImBr2). O cloreto de cetilpiridíneo (C16PyrCl) foi utilizado como composto de referência e as soluções de digluconato de clorexidina (C34H54Cl2N10O14) e salina (NaCl 0,9%) foram utilizadas como controles po-sitivo e negativo, respectivamente. Resultados: Dentre os SI testados, MImC12MIm(MeS)2, MImC10MIm(MeS)2 e MImC10MImBr2 apresentaram os seguintes valores para os halos de inibição formados: 28,00 mm, 20,50 mm e 18,75 mm, respectivamente. Esses valores foram similares ou superiores inclusive aos encontrados para o controle positivo (14,87 mm) e o composto de referência (0 mm). Discussão: Os SI podem apresentar uma alternativa promissora às terapias com antifúngicos convencionais, concordando com estudos prévios. Entretanto, mais estudos in vitro e in vivosão necessários para avaliar o potencial antifúngico destes compostos frente a biofilmes multiespécies de C. albicans. Conclusão: Baseado nestes resultados, três dos SI testados apresentam atividade antifúngica in vitro promissora frente à Candida albicans.

Aim: This study aims to evaluate the antifungal potential of imidazolium salts (IS) against Candida albicans. Material and methods: Antifungal evaluation of the IS was perfor-med using the disk diffusion test, using a strain of Candida albicans (ATCC 90028). Five different IS were synthesized and tested in the present study: 1,8-bis(methylimidazolium-1-yl) octane bromide (MImC8MImBr2), 1,12-bis(methylimida-zolium-1-yl) dodecane methanesulfonate (MImC12MIm(-MeS)2), 1-n-hexadecyl-2,3-dimethylimidazolium chloride (C16DMImCl), 1,10-bis(methylimidazolium-1-yl) decane methanesulfonate (MImC10MIm(MeS)2) e 1,10-bis(me-thylimidazolium-1-yl) decane bromide (MImC10MImBr2). Cetylpyridinium chloride (C16PyrCl) was used as a reference substance. Chlorhexidine (C34H54Cl2N10O14) and saline (NaCl 0,9%) solutions were positive and negative controls, respectively. Results: Among the tested IS, MImC12MIm(-MeS)2, MImC10MIm(MeS)2 and MImC10MImBr2 showed the following values for inhibition halos: 28,00 mm, 20,50 mm and 18,75 mm, respectively. These values were similar or superior than those found for the positive control (14.87 mm) and reference (0 mm) substances. Discussion: IS can be a promising alternative to antifungal conventional therapies, as exemplified in previous studies. However, further in vitro and in vivo studies are needed to assess the antifungal potential of these compounds against Candida--mixed biofilms.Conclusion: Based on these results, three IS, tested in this study, have in vitro promissing antifungal potential against Candida albicans.

Phytochemical composition, antifungal activity, in vitro and in vivo toxicity of Syzygium cumini (L) Skeels leaves extract / Composición fitoquímica, actividad antifúngica, toxicidad in vitro e in vivo del extracto de hojas de Syzygium cumini (L) Skeels

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.

Identificación y susceptibilidad de Candida spp. en el área ginecológica

Resumen La candidiasis es una infección causada por la acción patógena de Candida spp., catalogada como la segunda causa a nivel mundial de infección vaginal en mujeres con edades comprendidas entre 15 y 45 años. Siendo Candida albicans la más prevalente con distribución global. Uno de los problemas de importancia clínica es la resistencia a los antifúngicos debido al uso irracional de los mismos como terapia empírica y profilaxis. Objetivo . Caracterizar la infección por Candida spp., según: perfiles de susceptibilidad y frecuencias de candidiasis vulvo - vaginal relacionada con el balance de contenido vaginal. Así como, la presencia de coinfecciones en mujeres de edad fértil en las ciudades Cuenca - Azogues, que asisten a consulta en el Hospital Monte Sinaí, periodo enero - noviembre de 2020. Materiales y métodos . Estudio de tipo descriptivo, documental de corte transversal, la muestra estuvo conformada por 136 aislados clínicos, se utilizó un muestreo por cobertura total. Resultados . El grupo etario que prevaleció fue de 19 - 39 años. Candida albicans fue la más prevalente en muestras de secreción vaginal con 92.6 %, seguido de Candida glabrata 6.6 % y Candida parapsilosis con 0.7 %. Las tasas de resistencia se diferenciaron en Miconazol con 19.9 %, Itraconazol 16.9 %, y Fluconazol 14%. Conclusiones . El agente etiológico causal de candidiasis vulvo - vaginal fue Candida albicans. La interpretación del balance de contenido vaginal y perfiles de susceptibilidad, son herramientas clave para el óptimo tratamiento de la paciente con infecciones vaginales, evitando la automedicación y la farmacorresistencia.

Abstract Candidiasis is an infection caused by the pathogenic action of Candida spp., Classified as the second worldwide cause of vaginal infection in women aged between 15 and 45 years. Being Candida albicans the most prevalent with global distribution. One of the clinically important problems is resistance to antifungals due to their irrational use as empirical therapy and prophylaxis. Objective : To characterize the infection by Candida spp., according to: susceptibility profiles and frequencies of vulvo-vaginal candidiasis related to the balance of vaginal content. As well as, the presence of co-infections in women of childbearing age in Cuenca - Azogues cities, who attend a consultation at the Monte Sinaí Hospital, January - November 2020 period. Materials and methods . A descriptive, observational cross-sectional study, the sample consisted of 136 clinical isolates, a full coverage sampling was used. Results. The age group that prevailed was 19 - 39 years. Candida albicans was the most prevalent in vaginal discharge samples with 92.6%, followed by Candida glabrata 6.6% and Candida parapsilosis with 0.7%. Resistance rates differed in Miconazole with 19.9%, Itraconazole 16.9%, and Fluconazole 14%. Conclusions . The causative etiological agent of vulvo-vaginal candidiasis was Candida albicans. The interpretation of the balance of vaginal content and susceptibility profiles are a key tool for the optimal treatment of the patient with vaginal infections, avoiding self-medication and drug resistance.

Resumo Candidíase é uma infecção causada pela ação patogênica de Candida spp., Classificada como a segunda causa mundial de infecção vaginal em mulheres com idade entre 15 e 45 anos. Sendo Candida albicans a mais prevalente com distribuição global. Um dos problemas clinicamente importantes é a resistência aos antifúngicos devido ao seu uso irracional como terapia empírica e profilaxia. Objetivo . Caracterizar a infecção por Candida spp., De acordo com: perfis de suscetibilidade e frequências de candidíase vulvovaginal relacionadas ao equilíbrio do conteúdo vaginal. Assim como, a presença de coinfecções em mulheres em idade fértil nos municípios de Cuenca - Azogues, atendidas em consulta no Hospital Monte Sinaí, período janeiro - novembro de 2020. Materiais e métodos . Estudo descritivo, observacional, transversal, a amostra foi composta por 136 isolados clínicos, foi utilizada uma amostra de cobertura total. Resultados . A faixa etária prevalente foi de 19 a 39 anos. Candida albicans foi a mais prevalente nas amostras de corrimento vaginal com 92,6%, seguida por Candida glabrata 6,6% e Candida parapsilosis com 0,7%. As taxas de resistência diferiram no Miconazol com 19,9%, Itraconazol 16,9% e Fluconazol 14%. Conclusões . O agente etiológico causador da candidíase vulvovaginal foi Candida albicans. A interpretação do equilíbrio do conteúdo vaginal e dos perfis de suscetibilidade é uma ferramenta fundamental para o tratamento ideal da paciente com infecções vaginais, evitando a automedicação e a resistência aos medicamentos

Candidiasis y Candida albicans / Candidiasis and Candida albicans

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)

Mucormicosis cutánea extensa: reporte de caso

La mucormicosis es una enfermedad oportunista causada por un grupo de hongos filamentosos del subfilo Mucormycotina, tiene una presentación clínica variada: rino-orbito-cerebral, pulmonar, cutánea, gastrointestinal, diseminada y de sitios poco frecuentes. La mucormicosis cutánea se presenta en el 19% de los casos. Se presenta un caso de mucormicosis cutánea extensa en un paciente adulto joven, luego de quemadura por sustancia desconocida y aplicación de emplastos medicinales herbales. Tras recibir curaciones en varias oportunidades en un establecimiento de salud fue referido a un hospital de nivel 3 donde se le realizó limpieza quirúrgica y administración de antibióticos por vía endovenosa, sin mejoría clínica. Se le realizó estudio histológico de la piel afectada, cuyo informe fue inflamación intensa mixta a nivel del tejido subcutáneo, con moderado predominio de granulocitos, focos de necrosis grasa en parches, con variable inflamación. En el interior de los adipocitos necróticos, se observaron algunas estructuras con morfología de hifas fúngicas anchas, de contorno irregular morfológicamente consistentes con mucor. El paciente recibió antifúngicos combinados con curas quirúrgicas del tejido afectado en varias oportunidades, sin detener progresión de la infección. El paciente falleció.

SUMMARY Mucormycosis is an opportunistic disease caused by a group of filamentous fungi of the subphylum Mucormycotina, it has a varied clinical presentation: rhino-orbito-cerebral, pulmonary, cutaneous, gastrointestinal, disseminated and with infrequent sites. Cutaneous mucormycosis occurs in 19% of cases. A case of extensive cutaneous mucormycosis is presented in a young adult patient, after a burn caused by an unknown substance and the application of herbal medicinal plasters. After receiving cures on several occasions in a health facility, he was referred to a level 3 hospital where he underwent surgical cleaning plus administration of intravenous antibiotics, without clinical improvement; A histological study of the affected skin was performed, where intense mixed inflammation is reported at the subcutaneous tissue level, with a moderate predominance of granulocytes; as well as foci of fat necrosis in patches, with variable inflammation. Inside the necrotic adipocytes, there are some structures with wide fungal hyphae morphology, with an irregular contour morphologically consistent with mucor. The patient received antifungals combined with surgical cures of the affected tissue on several occasions, without stopping the progression of the infection; patient dies.