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1.
Article in Chinese | WPRIM | ID: wpr-923034

ABSTRACT

Objective To better carries out the review of the interaction between triazole antifungal drugs and statins, ensure drug safety for patients and improve the efficiency of the manual review of pharmacists. Methods The advantageous combination with less interaction between the two kinds of drug was obtained by summarizing the interaction information of triazole antifungal drugs and statins. At the same time, optimizing the process of full manual reviews for drug interaction, and the advantageous combination of the two kinds of drug will be set up in advance on the doctor side of the review system. Doctors can adjust the drug in time according to the prompts of the information system when there is a significant interaction of the two kinds of drug in the prescription or medical order, which is issued by the doctors. Results After optimization, most doctors choose the drug combination of less interaction between the two kinds of drug according to the system prompts. The number of drug combinations of significant interaction which is manually reviewed by pharmacists is significantly reduced (P<0.05), and the review efficiency is improved, the drug safety risks brought by drug interactions to patients are reduced. Conclusion Refinement review of drug interactions between triazole antifungal agents and statins based on the optimization of the pre-audit system plays a positive role in improving the safety of patients’ medication and the efficiency of pharmacists' manual auditing.

2.
Braz. j. oral sci ; 20: e210219, jan.-dez. 2021. ilus
Article in English | LILACS, BBO | ID: biblio-1253954

ABSTRACT

Aim: This study evaluated the chemical composition of Lippia thymoides (Lt) essential oil and its antimicrobial activity against fungal strains of Candida albicans (Ca) and Gram-negative bacteria Prevotella intermedia (Pi) and Fusobacterium nucleatum (Fn). Methods: Lt essential oil was obtained by hydrodistillation apparatus with a modified Clevenger extension. The chemical analysis was analyzed by gas phase chromatography and mass spectrometry on Shimadzu QP 2010 plus. Sample sensitivity evaluation was performed by ABHb-inoculum and culture plates were developed with triphenyltetrazolium chloride, also Fn and Pi samples analysis were in anaerobic environment and Ca sample analysis was performed in aerobic environment. The minimum inhibitory concentration (CIM) was determinated by microdilution in eppendorfs tubes. Results: The chemical analysis showed that Thymol (59,91%) is the main compound found in Lt essential oil, also other antifungal and antimicrobial agents were present γ-terpinene (8.16%), p-cymene (7.29%) and ß-caryophyllene (4.49%), Thymol is a central ingredient of many medicinal plants and has a potent fungicidal, bactericidal and antioxidant activity, it has been previously shown to have anti-inflammatory activity against Periodontal Disease (PD) cause can reduces prostanoids, interleukins, leukotrienes levels in periodontium. CIM result Pi was 6.5 µg/mL, Fn was 1.5 µg/mL and Ca was 0.19 µg/mL. Conclusion: The antimicrobial activity of L. thymoides, through the compound Thymol, has been shown promising potential against gram-negative periodontopathogenic bacteria and fungi whose therapeutic arsenal is still very restricted


Subject(s)
Periodontitis , Oils, Volatile , Plant Extracts , Lippia , Microbiota , Antifungal Agents
3.
Rev. méd. Urug ; 37(1): e37107, mar. 2021. tab, graf
Article in Spanish | LILACS, BNUY | ID: biblio-1289844

ABSTRACT

Resumen: Una proporción importante de infecciones en el pie diabético consisten en onicomicosis y tinea pedis, problema común en el pie, amenazante de la viabilidad del tejido que puede provocar infecciones bacterianas secundarias. Requieren períodos prolongados de tratamiento antimicótico con alta tasas de recaídas y reinfección. Diversos estudios han mostrado la seguridad y eficacia de las nanopartículas de plata (NP Ag) como agente antimicrobiano. Realizamos un estudio donde se evaluó el tratamiento con NP Ag en dermatomicosis del pie de pacientes diabéticos. Método: estudio piloto, abierto, prospectivo, randomizado y controlado en pacientes que asisten a una policlínica de pie diabético. Dieciocho pacientes cumplieron con los criterios de inclusión conformándose dos grupos homogéneos. Ambos grupos recibieron tratamiento estándar que consistió en antimicótico tópico y desbastado mecánico. El grupo intervención utilizó un textil (medias) confeccionadas con hilos con NP Ag. Se realizó control clínico y microbiológico hasta las 12 semanas. Se evaluó el porcentaje de remisión y el tiempo hasta alcanzar el mismo. Resultados: predominó la onicomicosis y el germen Trichophyton rubrum. En el grupo intervención se logró un mayor porcentaje de remisión de lesiones y en un tiempo menor que el grupo control. Conclusiones: el uso de medias confeccionadas con hilos de NP Ag se asoció con una mayor probabilidad de curación completa en un período de 12 semanas a pesar de que el número de pacientes no permitió llegar al nivel de significación estadística, pudiendo contribuir a la prevención de infecciones o úlceras suplementarias en el pie diabético.


Summary: Onychomycosis and tinea pedis represent a significant proportion of infections in the diabetic foot, a common foot problem, and they constitute a threat to the viability of tissues that may provoke secondary bacterial infections. To combat them, antifungal treatments are required for long periods of time, the rates of relapse and reinfection being high. Several studies have proved the safety and effectiveness of silver nano particles (NP Ag) as an antimicrobial agent. A study was conducted to assess nanoparticle agents for foot dermatomycosis in diabetic patients. Method: pilot, open, prospective randomized and controlled study in patients who are assisted in a diabetic foot policlinic. 18 patients complied with the inclusion criteria and two homogeneous groups were formed. Both groups received standard treatment consisting in topic antifungal and mechanical roughing. The intervention groups used a textile (stockings) made with silver nanoparticle threads. Clinical and microbiological control was made during 12 weeks, also assessing the remission percentage and the time it took to achieve it. Resultados: onychomycosis and trichophyton rubrum prevailed. The intervention group showed a greater percentage of remission of lesions in a period of time that was shorter than that of the control group. Conclusions: the use of stockings made with NP Ag threads was associated with a greater probability of complete healing, in a 12-week period, despite the fact that the number of patients was not statistically significant. This could contribute to the prevention of supplementary infections or ulcers in the diabetic foot.


Resumo: Uma proporção significativa de infecções do pé diabético consiste em onicomicose e Tinea pedis, um problema comum nos pés que ameaça a viabilidade do tecido e pode causar infecções bacterianas secundárias. Requerem períodos prolongados de tratamento antifúngico com altas taxas de recidiva e reinfecção. Vários estudos têm demonstrado a segurança e a eficácia das nanopartículas de prata (NP Ag) como agente antimicrobiano. Realizamos um estudo onde o tratamento com NP Ag foi avaliado na dermatomicose do pé de pacientes diabéticos. Método: estudo piloto, aberto, prospectivo, randomizado e controlado em pacientes atendidos em uma policlínica de pé diabético. Dezoito pacientes preencheram os critérios de inclusão, formando dois grupos homogêneos. Ambos os grupos receberam tratamento padrão que consiste em antifúngico tópico e moagem mecânica. O grupo intervenção utilizou um tecido (meias) confeccionado com fios NP Ag. O controle clínico e microbiológico foi realizado até 12 semanas. A porcentagem de remissão e o tempo para alcançá-la foram avaliados. Resultados: predominaram a onicomicose e o germe Trichophyton rubrum. No grupo intervenção, obteve-se maior percentual de remissão das lesões e em menor tempo que o grupo controle. Conclusões: o uso de meias confeccionadas com fios NP Ag esteve associado a uma maior probabilidade de cura completa, no período de 12 semanas, apesar do número de pacientes não permitir atingir o nível de significância estatística, podendo contribuir para a prevenção de infecções ou úlceras adicionais no pé diabético.


Subject(s)
Silver/therapeutic use , Onychomycosis/therapy , Diabetic Foot , Metal Nanoparticles/therapeutic use
4.
ABCS health sci ; 46: e021203, 09 fev. 2021. tab
Article in English | LILACS | ID: biblio-1147180

ABSTRACT

INTRODUCTION: The resistance of fungal species to drugs usually used in clinics is of great interest in the medical field. OBJECTIVE: To evaluate susceptibility and in vitro response of species of Trichophyton spp. to antifungal drugs of interest in clinical medicine. METHODS: 12 samples of clinical isolates from humans were used, nine of T. mentagrophytes and three of T. tonsurans. Susceptibility tests were performed according to the agar diffusion (AD) and broth microdilution (BM) methods. RESULTS: In the AD method, the species T. tonsurans presented a percentage of sensitivity of 33% in relation to amphotericin B and 66% to itraconazole, with 100% resistance to ketoconazole and fluconazole. T. mentagrophytes also showed 100% resistance to ketoconazole in this technique, with 11% sensitivity to ketoconazole, 22% to itraconazole and 22% of samples classified as sensitive dose dependent. In the MC method, the species T. tonsurans presented a sensitivity percentage of 66%, 55% and 33% in relation to ketoconazole, fluconazole and itraconazole, respectively. The T. mentagrophytes species presented sensitivity percentages of 11%, 11%, 33% and 55% for amphotericin B, itraconazole, ketoconazole and fluconazole, respectively. CONCLUSION: There was resistance in vitro of the species of T. mentagrophytes and T. tonsurans against the antifungal fluconazole and relative resistance against ketoconazole in the AD method. In BM, however, important percentages of sensitivity were observed for the two species analyzed in relation to the antifungals fluconazole and ketoconazole when compared to itraconazole and amphotericin B.


INTRODUÇÃO: A resistência de espécies fúngicas às drogas usualmente empregadas no meio clínico é motivo de grande interesse na área médica. OBJETIVO: Avaliar susceptibilidade e resposta in vitro de espécies de Trichophyton spp. a drogas antifúngicas de interesse em clínica médica. MÉTODOS: Foram utilizadas 12 amostras de isolados clínicos de humanos, sendo nove de T. mentagrophytes e três de T. tonsurans. Foram realizados testes de susceptibilidade segundo os métodos de difusão em ágar (DA) e microdiluição em caldo (MC). RESULTADOS: No método de DA, a espécie T. tonsurans apresentou percentual de sensibilidade de 33% em relação à anfotericina B e de 66% ao itraconazol, com 100% de resistência frente ao cetoconazol e ao fluconazol. A espécie T. mentagrophytes também apresentou 100% de resistência frente ao cetoconazol nesta técnica, com 11% de sensibilidade ao cetoconazol, 22% ao itraconazol e 22% das amostras classificadas como sensível dose dependente. No método de MC, a espécie T. tonsurans apresentou percentual de sensibilidade de 66%, 55% e 33% em relação ao cetoconazol, fluconazol e itraconazol, respectivamente. A espécie T. mentagrophytes apresentou percentuais de sensibilidade de 11%, 11%, 33% e 55% para anfotericina B, itraconazol, cetoconazol e fluconazol, respectivamente. CONCLUSÃO: Houve resistência in vitro das espécies do T. mentagrophytes e T. tonsurans frente ao antifúngico fluconazol e resistência relativa frente ao cetoconazol no método de DA. Na MC, no entanto, foram observados importantes percentuais de sensibilidade das duas espécies analisadas frente aos antifúngicos fluconazol e cetoconazol quando comparadas ao itraconazol e à anfotericina B.


Subject(s)
Trichophyton/drug effects , Microbial Sensitivity Tests , Drug Resistance, Fungal , Disease Susceptibility/microbiology , Antifungal Agents/pharmacology , Tinea/microbiology , Tinea/drug therapy , Colony Count, Microbial , Fluconazole/pharmacology , Amphotericin B/pharmacology , Itraconazole/pharmacology , Ketoconazole/pharmacology
5.
Arq. odontol ; 57: 141-148, jan.-dez. 2021. ilus, tab
Article in English | LILACS, BBO | ID: biblio-1343550

ABSTRACT

Aim: To evaluate the effect of three natural antifungal agents combined with routine denture care on the treatment of DS, using a quantitative mycological culture analysis. Methods: Thirty denture wearers with denture stomatitis DS were treated using five substances: sterile distilled water (G1), nystatin oral suspension (G2), 20% alcoholic extract propolis (G3), Punica granatumLinné gel (G4), and Uncaria tomentosa gel (G5). The substances were used 3 times a day for 14 days. Quantitative mycological culture analysis of samples collected from the palatal mucosa was performed at three stages: before treatment (T0), after 14 days of treatment (T1), and 30 days after treatment completion (T2). Data were evaluated using Kruskal-Wallis and Friedman tests (p < 0.05). Results: Palatal mucosa intragroup analysis showed a significant reduction of Candida CFU/mL values for all groups at T1 compared to T0 (p < 0.05). However, they did not present statistical differences when comparing T1 and T2 (p > 0.05). The intergroup analysis demonstrated that there are no statistical differences, regardless of the evaluation time (p > 0.05). Conclusion:The natural products tested showed a satisfactory result on DS treatment, which proved to be equivalent to conventional topical therapy with nystatin and to treatment using only regular oral hygiene procedures.


Objetivo: Avaliar o efeito de três antifúngicos naturais combinados com o cuidado rotineiro com próteses dentárias no tratamento da EP, por meio de uma análise quantitativa de cultura micológica. Métodos: Trinta usuários de próteses dentárias com EP foram tratados com cinco substâncias: água destilada estéril (G1), suspensão oral de nistatina (G2), extrato alcoólico de própolis 20% (G3), gel Punica granatum L. (G4) e gel Uncaria tomentosa (G5). As substâncias foram utilizadas 3 vezes ao dia durante 14 dias. A análise micológica quantitativa das amostras coletadas da mucosa palatina foi realizada em três etapas: antes do tratamento (T0), após 14 dias do tratamento (T1) e 30 dias após o término do tratamento (T2). Os dados foram avaliados pelos testes de Kruskal-Wallis e Friedman (p < 0,05). Resultados: A análise intragrupo da mucosa palatina mostrou uma redução significativa dos valores de Candida UFC/mL para todos os grupos em T1 em comparação com T0 (p < 0,05). No entanto, não apresentaram diferenças estatísticas na comparação de T1 e T2 (p > 0,05). A análise intergrupos demonstrou que não há diferenças estatísticas, independentemente do tempo de avaliação (p > 0,05). Conclusão: Os produtos naturais testados apresentaram resultado satisfatório no tratamento da EP, sendo equivalente à terapia tópica convencional com nistatina e ao tratamento apenas com procedimentos rotineiros de higiene bucal.


Subject(s)
Stomatitis, Denture , Biological Products , Candida albicans , Colony Count, Microbial , Antifungal Agents , Propolis , Distilled Water , Nystatin
6.
Rev. bras. cir. cardiovasc ; 35(5): 789-796, Sept.-Oct. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137325

ABSTRACT

Abstract Introduction: Although it is the most common agent among the fungal causes of endocarditis, Candida albicans endocarditis is rare. Objective: To evaluate the efficacy of amphotericin B in the treatment of C. albicans endocarditis beyond a systematic review. Data search: Articles in English, Spanish and Portuguese, conducted in the following databases: MEDLINE, LILACS, IBECS and SciELO, in humans and published in the last 25 years. Study selection: Observational studies, clinical trials, and case series providing data on the amphotericin B use in patients with a C. albicans endocarditis diagnosis without age limitations. Data synthesis: From the initial search (n=79), 25 articles were fully evaluated, of which 19 were excluded for meeting one or more exclusion criteria, remaining five articles (two observational studies and three case series). Patients using amphotericin B demonstrated improvement in survival rates, and its main use was in association with the surgical method as well as with caspofungin association. Conclusion: Literature lacks evidence to conclude about efficacy and safety of amphotericin B in the treatment of fungal endocarditis. Randomized clinical trials are necessary to provide better evidence on the subject.


Subject(s)
Humans , Infant, Newborn , Child , Candida albicans , Amphotericin B/therapeutic use , Endocarditis/microbiology , Endocarditis/drug therapy , Antifungal Agents/therapeutic use , Cross-Sectional Studies
7.
Rev. bras. oftalmol ; 79(5): 315-319, set.-out. 2020. tab, graf
Article in English | LILACS | ID: biblio-1137981

ABSTRACT

Abstract Purpose: To report etiological diagnosis, predisposing risk factors, therapeutic strategies and visual outcome of patients treated at the Department of Ophthalmology of Federal University of São Paulo. Methods: This is a retrospective, descriptive, and observational study from medical and laboratory records of the Department of Ophthalmology of Federal University of São Paulo, including all patients with culture proven fungal keratitis in 5 years, from October 2012 through October 2017. Results: There were 2260 fungi microbiologic test requests. Of these, 140 samples had positive cultures for fungi and sixty-six patients were followed at our clinic. Forty-five patients (68.2%) were men, and the mean age was 48.06 (±17.39) years. Fusarium spp. was the most frequently isolated fungus (32 cases; 48.5%), followed by Candida parapsilosis (12 cases; 18.2%). Thirty-four patients (51.5%) underwent intracameral injection of amphotericin B (5 µg per 0.1 ml). In 11 patients (32.3%), infection was eradicated after intracameral amphotericin B associated to topical antifungal treatment and, in 23 patients (67.7%), therapeutic keratoplasty was needed. No complication related to intracameral amphotericin B injection was observed in this series. Forty-three patients (65.1%) ended up with therapeutic keratoplasty. Three patients (4.5%) evolved to evisceration or enucleation. At the last follow-up visit, 53 patients (80.3%) had visual acuity worse than 20/200. Conclusion: Despite current antifungals drugs and distinct administration strategies, fungal keratitis remains challenging. Delayed antifungal therapy may explain poor clinical outcomes. Intracameral amphotericin B associated to topical antfungal treatment seems to be a safe and helpful alternative for non-responsive fungal keratitis. But it is important to formulate other treatment strategies, hence to improve patients' outcomes, since most patients ended-up with significant visual impairment even after current treatment.


Resumo Objetivo: Descrever diagnósticos etiológicos, fatores de risco, estratégias terapêuticas e resultados visuais de pacientes com ceratite fúngica tratados no Departamento de Oftalmologia da Universidade Federal de São Paulo. Métodos: Trata-se de um estudo retrospectivo, descritivo e observacional, a partir da análise de prontuários médicos e laboratoriais do Departamento de Oftalmologia da Universidade Federal de São Paulo, incluindo todos os pacientes com ceratite fúngica comprovada por cultura no período de outubro de 2012 a outubro de 2017. Resultados: Foram realizadas 2260 solicitações de testes microbiológicos. Destas, 140 amostras apresentaram culturas positivas para fungos, e 66 pacientes foram acompanhados em nosso serviço. Quarenta e cinco pacientes (68,2%) eram do sexo masculino, e a média de idade foi de 48,06 (± 17,39) anos. Fusarium spp. foi o fungo mais freqüentemente isolado (32 casos; 48,5%), seguido por Candida parapsilosis (12 casos; 18,2%). Trinta e quatro pacientes (51,5%) foram submetidos à injeção intracameral de anfotericina B (5 µg por 0,1 ml). Destes, 11 pacientes (32,3%) tiveram a infecção erradicada. Nos outros 23 pacientes (67,7%), o transplante terapêutico foi necessário. Nenhuma complicação relacionada à injeção intracameral de anfotericina B foi observada neste estudo. No total, 43 pacientes (65,1%) evoluíram para transplante terapêutico, e 3 pacientes (4,5%) foram submetidos à evisceração ou enucleação. Cinquenta e três pacientes (80,3%) apresentaram acuidade visual final pior que 20/200. Conclusões: Apesar dos diversos medicamentos antifúngicos atuais e vias de administração, o tratamento das ceratites fúngicas permanece desafiador. O atraso no início do tratamento adequado pode justificar o desfecho clínico desfavorável de grande parte dos pacientes. A injeção intracameral de anfotericina B mostrou-se uma alternativa terapêutica segura para ceratites fúngicas refratárias. Mas outras estratégias de tratamento devem ser formuladas, visando melhorar os resultados visuais dos pacientes.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Eye Infections, Fungal/drug therapy , Amphotericin B/therapeutic use , Corneal Transplantation , Candida parapsilosis/isolation & purification , Fusarium/isolation & purification , Keratitis/microbiology , Antifungal Agents/therapeutic use , Brazil , Medical Records , Epidemiology, Descriptive , Retrospective Studies , Observational Study
8.
Rev. méd. hered ; 31(3): 169-174, jul-sep 2020. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1150061

ABSTRACT

Resumen Los líquenes son asociaciones simbióticas mutualistas que se dan entre un hongo y organismos fotoautótrofos tales como algas o cianobacterias. Presentan altas concentraciones de sustancias liquénicas, las cuales son químicamente complejas y han presentado una marcada actividad antifúngica y antibacteriana. Objetivo: Evaluar la actividad antifúngica y antibacteriana (in vitro) del extracto etanólico de Usnea laevis frente a Candida albicans, Staphylococcus aureus y Pseudomonas aeruginosa. Material y métodos: Las sustancias liquénicas presentes en Usnea laevis fueron extraídas mediante el método de Soxhlet y fueron analizadas químicamente por cromatografía acoplado a espectrometría de masas. Para la evaluación de la actividad antifúngica y antibacteriana se utilizó la técnica de Kirby-Bauer. Resultados: Dentro de la composición química del extracto liquénico se tuvo ácido úsnico, eugenol, ergosterol entre otros. Para una concentración de 27 mg/ml del extracto etanólico de Usnea laevis, Staphylococcus aureus fue encontrado sensible siendo esta concentración la que mejores resultados de inhibición arrojó; mientras que la concentración de 11 mg/ml no fue efectiva frente a las cepas evaluadas. Conclusiones: El extracto etanólico de Usnea laevis posee propiedades antifúngicas y antibacterianas frente a Candida albicans, Pseudomonas aeruginosa y Staphylococcus aureus.


Summary Lichens are symbiotic associations between fungi and seaweed or cyanobacteria. Objective: to evaluate the in-vitro antifungal and antibacterial activity of the ethanolic extract of Usnea laevis against Candida albicans, Staphylococcus aureus and Pseudomonas aeruginosa. Methods: lichened substances present in Usnea laevis were extracted using the Soxhlet methods and were analyzed by chromatography coupled to mass spectrometry. The Kirby-Bauer method was used to evaluate both the antibacterial and antifungal activity. Results: Usnic acid, eugenol, and ergosterol were the compounds found. S. aureus was sensitive at a concentration of 27 mg/ml of the enolic extract, the 11 mg/ml concentration was not effective. Conclusions: The ethanolic extract of Usnea laevis has antibacterial and antifungal properties against the pathogens tested.

9.
Säo Paulo med. j ; 138(1): 40-46, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1099387

ABSTRACT

BACKGROUND: Statins are used as cholesterol-lowering drugs and may also have direct antimicrobial effects. OBJECTIVE: To evaluate synergic interactions between simvastatin and both amphotericin B and fluconazole, against environmental strains of Cryptococcus neoformans isolated from captive birds' droppings. DESIGNAND SETTING: Experimental study conducted at Federal University of Piauí, Parnaíba, in collaboration with Federal University of Triângulo Mineiro, Uberaba, Brazil. METHODS: Statin susceptibility tests of Cryptococcus neoformans samples were performed as prescribed in standards. Interactions of simvastatin with amphotericin and fluconazole were evaluated using the checkerboard microdilution method. Presence of these interactions was quantitatively detected through determining the fractional inhibitory concentration index (FICI). RESULTS: Isolates of Cryptococcus neoformans were obtained from 30 of the 206 samples of dry bird excreta (14.5%) that were collected from pet shops and houses. Ten isolates were selected for susceptibility tests. All of them were susceptible to amphotericin and fluconazole. All presented minimum inhibitory concentration (MIC) > 128 µg/ml and, thus, were resistant in vitro to simvastatin. An in vitro synergic effect was shown through combined testing of amphotericin B and simvastatin, such that six isolates (60%) presented FICI < 0.500. Two isolates showed considerable reductions in MIC, from 1 µg/ml to 0.250 µg/ml. No synergic effect was observed through combining fluconazole and simvastatin. CONCLUSION: These results demonstrate that simvastatin should be considered to be a therapeutic alternative, capable of potentiating the action of amphotericin B. However, further studies are necessary to clarify the real effect of simvastatin as an antifungal agent.


Subject(s)
Humans , Amphotericin B/pharmacology , Simvastatin/pharmacology , Cryptococcus neoformans , Brazil , Microbial Sensitivity Tests , Fluconazole , Prospective Studies , Drug Synergism , Antifungal Agents/pharmacology
10.
Arq. bras. oftalmol ; 83(1): 65-68, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088960

ABSTRACT

ABSTRACT We describe a case of keratomycosis caused by Arthographis kalrae after excimer laser keratomileusis. A 38-year-old female developed stromal keratitis eight weeks after refractive surgery. She developed severe corneal stromal infiltration and mild anterior segment inflammation, which could not be treated with topical voriconazole 1%, but topical natamycin 5% ameliorated her condition. A reactivation of keratomycosis symptoms was observed; therefore, longer treatment was administered to the patient. It has been reported that A. kalrae keratomycosis is associated with exposure to soil and contact lens usage. However, the patient, who lived in a rural location, was neither involved in gardening activities nor had a history of wearing contact lenses. This is the first case of post-refractive A. kalrae keratomycosis.


RESUMO Descrevemos um caso de ceratomicose por Arthographis kalrae após ceratomileusis por excimer laser. Uma mulher de 38 anos desenvolveu ceratite estromal oito semanas após a cirurgia refrativa. Ela desenvolveu infiltração estromal grave da córnea e uma leve inflamação do segmento anterior, que não pode ser tratada com voriconazol tópico a 1%, mas a natamicina tópica a 5% melhorou sua condição. Uma reativação dos síntomas de ceratomicose foi observada; portanto, tratamento mais prolongado foi administrado a paciente. Tem sido relatado que a ceratomicose por A. kalrae está associada à exposição ao solo e ao uso de lentes de contato. No entanto, a paciente, que vivía em um local rural, não estava envolvida em atividades de jardinagem e nem tinha histórico de uso de lentes de contato. Este é o primeiro caso de ceratomicose pós-refrativa por A. kalrae.


Subject(s)
Humans , Female , Adult , Eye Infections, Fungal/microbiology , Keratitis/microbiology , Ascomycota/isolation & purification , Eye Infections, Fungal/drug therapy , Natamycin/therapeutic use , Keratomileusis, Laser In Situ/adverse effects , Voriconazole/therapeutic use , Keratitis/drug therapy
11.
Rev. Soc. Bras. Med. Trop ; 53: e20190214, 2020. tab, graf
Article in English | LILACS | ID: biblio-1057290

ABSTRACT

Abstract INTRODUCTION: The aim of this study was to evaluate some virulence factors in Candida albicans isolates from patients with onychomycosis and determine the correlation between these factors and the antifungal resistance profile. METHODS: Seventy species of C. albicans were confirmed using polymerase chain reaction amplification of the HWP1 gene. According to the Clinical & Laboratory Standards Institute guidelines, the susceptibility profile of four antifungal agents was investigated, and the production of aspartyl protease, phospholipase, haemolysin, and biofilm was determined. The correlation between these profiles was also investigated. RESULTS: The isolates indicated different levels of resistance and production of virulence factors. Significant correlations were observed between the minimum inhibitory concentration (MIC) of fluconazole/itraconazole and biofilm production, between phospholipase production and fluconazole/itraconazole MIC, and between fluconazole MIC and hemolytic activity in C. albicans isolates. The results also showed significant correlations between phospholipase activity and biofilm production. CONCLUSIONS: Our findings will contribute to a better understanding of the pathogenesis of C. albicans and characterize the relationship between virulence factors and antifungal resistance, which may suggest new therapeutic strategies considering the possible involvement of the virulence mechanism in the effectiveness of treatment.


Subject(s)
Humans , Candida albicans/pathogenicity , Onychomycosis/microbiology , Virulence Factors , Antifungal Agents/pharmacology , Nails/microbiology , Phospholipases/biosynthesis , Candida albicans/drug effects , Candida albicans/ultrastructure , Microscopy, Electron, Scanning , Microbial Sensitivity Tests , Polymerase Chain Reaction , Biofilms/growth & development , Drug Resistance, Fungal , Aspartic Acid Proteases/biosynthesis , Hemolysis
12.
Chinese Journal of Burns ; (6): 37-41, 2020.
Article in Chinese | WPRIM | ID: wpr-798927

ABSTRACT

Objective@#To retrospectively analyze the diagnosis time, pathogen distribution, and drug resistance of fungal bloodstream infection in severe burn patients.@*Methods@#Blood samples were collected from 55 severe burn patients with fungal bloodstream infection (including 46 males and 9 females, aged 42 (1, 78) years) admitted to the intensive care unit of the Institute of Burn Research of the First Affiliated Hospital of Army Medical University (the Third Military Medical University) from July 2011 to May 2019 for retrospective analysis. Microbial monitoring system was used to cultivate pathogens, API yeast identification kit and Candida chromogenic medium were used to identify pathogens, and Kirby-Bauer paper disk diffusion method was used to detect drug resistance of fungi to fluconazole, amphotericin B, itraconazole, ketoconazole, and voriconazole. The positive rate of blood fungal culture, mortality rate, distribution of local fungal proliferation sites, the diagnosis time distribution of fungal bloodstream infection, the distribution of fungal species, resistance to commonly-used antifungal drugs, and the use of antibiotics were assessed. The WHONET 5.6 software was applied to analyze the distribution and drug resistance of fungi.@*Results@#(1) Totally 4 839 blood samples were collected during the 9 years, and 122 strains of fungi were isolated, with positive rate of 2.52%. The mortality rate was 14.55% (8 patients) in 55 patients. Catheter fungal proliferation ranked the first among 30 cases of local fungal proliferation. (2) The diagnosis time of fungal bloodstream infection mainly distributed in ≤1 week of hospitalization [32.73% (18/55)]. (3) Among the 55 strains of fungi detected, the detection rate of Candida parapsilosis ranked the first (21.82%, 12 strains), Candida glabrata was the second (18.18%, 10 strains), and Candida tropicalis was tied with Candida albicans in the third place (14.55%, 8 strains). All the detected fungi were sensitive to amphotericin B, and the resistance rates to voriconazole, fluconazole, itraconazole, and ketoconazole were between 4.5% and 9.1%. (4) Droad-spectrum antibiotics were used in all the 55 patients, ≥3 kinds of antibiotics were used in 44 patients, and 37 patients used antibacterial drugs ≥7 days.@*Conclusions@#The diagnosis time of fungal bloodstream infection in the 55 severe burn patients was mainly within 1 week of hospitalization. Candida parapsilosis is the most commonly detected fungal species. Catheter fungal proliferation occurs most commonly among the 30 patients with local fungal proliferation. All the detected fungi were sensitive to amphotericin B, with low drug resistance to voriconazole, fluconazole, itraconazole, and ketoconazole. Broad-spectrum antibiotics were overused in the severe burn patients with fungal bloodstream infection.

13.
International Eye Science ; (12): 1567-1572, 2020.
Article in Chinese | WPRIM | ID: wpr-823393

ABSTRACT

@#AIM:To investigate the<i> in vitro</i> interaction between antifungals and tacrolimus acting alone or in combination against Fusarium solani.<p>METHODS: According to Clinical and Laboratory Standards Institute(CLSI)M27-Ed4 and M38-A3, 22 strains of Fusarium solani were used to perform drug sensitivity tests with chessboard microdilution method by cyclosporin A combined with 4 kinds of antifungal drugs <i>in vitro</i>.<p>RESULTS: The MIC ranges of natamycin, voriconazole, amphotericin B and fluconazole against 22 strains of Fusarium solani were 2-8, 1-8, 1-8 and 8-512μg/mL respectively. When combined with tacrolimus <i>in vitro</i>, the synergistic effects of fluconazole and Amphotericin B were observed in 64% and 41% strains respectively. There were no antagonistic effects observed in all combined drug tests. With the combination, the sensitivity of Fusarium to amphotericin B was significantly increased from 4.5% to 68.2%(<i>P</i><0.001).<p>CONCLUSION: Fusarium solani is sensitive to natamycin <i>in vitro</i> and is partially sensitive to voriconazole. When combined with cyclosporine A, it can produce synergistic effects with fluconazole and amphotericin B, and significantly increase the sensitivity of Fusarium solani to amphotericin B drugs.

14.
J. appl. oral sci ; 28: e20190039, 2020. tab, graf
Article in English | LILACS, BBO | ID: biblio-1090769

ABSTRACT

Abstract This study aimed to evaluate the physical properties and antifungal activities of polymethyl methacrylate (PMMA) acrylic resins after the incorporation of chlorhexidine diacetate salt (CDA). Methodology: First, acrylic resin specimens were fabricated with Vipi Cor® and DuraLay® resins with and without the incorporation of 0.5%, 1.0% or 2.0% CDA. The residual monomer and CDA release were measured at intervals ranging from 2 hours to 28 days using ultraviolet spectrometry combined with high-performance liquid chromatography. The antifungal activity against C. albicans was evaluated with the agar diffusion method. Fourier transform infrared spectroscopy was used to analyze the degree of resin conversion. Finally, the water sorption values of the resins were also measured. Results: The incorporated CDA concentration significantly changed the rate of CDA release (p<0.0001); however, the brand of the material appeared to have no significant influence on drug release. Subsequently, the inhibition zones were compared between the tested groups and within the same brand, and only the comparisons between the CDA 2% and CDA 1% groups and between the CDA 1% and CDA 0.5% groups failed to yield significant differences. Regarding the degrees of conversion, the differences were not significant and were lower only in the CDA 2% groups. Water sorption was significantly increased at the 1.0% and 2.0% concentrations. Conclusions: We concluded that the incorporation of CDA into PMMA-based resins enabled the inhibition of C. albicans growth rate, did not alter the degrees of conversion of the tested resins and did not change the release of residual monomers.


Subject(s)
Chlorhexidine/analogs & derivatives , Polymethyl Methacrylate/chemistry , Antifungal Agents/chemistry , Reference Values , Time Factors , Acrylic Resins/chemistry , Materials Testing , Candida albicans/drug effects , Water/chemistry , Chlorhexidine/pharmacology , Reproducibility of Results , Chromatography, High Pressure Liquid , Spectroscopy, Fourier Transform Infrared , Polymethyl Methacrylate/pharmacology , Antifungal Agents/pharmacology
15.
Colomb. med ; 50(4): 293-298, Oct.-Dec. 2019.
Article in English | LILACS-Express | LILACS | ID: biblio-1114722

ABSTRACT

Abstract Background: Candida auris is an emerging yeast frequently reported as resistant to multiple antifungal drugs commonly used to treat Candida infections. This specie can colonize the patient's skin and has great ability for producing outbreaks in hospitals. C. auris is phylogenetically related to other Candida species, can be misidentified using conventional biochemical or commercial methods and requires specific technology for its identification. Case report: We report the first isolate of C. auris in Cali, Colombia, from a central venous catheter in a 37-year-old patient with rheumatoid arthritis and endocarditis who did not have symptoms of sepsis. The yeast was initially misidentified as C. haemulonii using the Phoenix system and subsequently identified as C. auris by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS). The broth microdilution method was used to determine the minimum inhibitory concentration; the isolate was susceptible to fluconazole, itraconazole, voriconazole and amphotericin B. Conclusions: This report contributes to knowledge of the epidemiology of C. auris infections in individuals with underlying disease and describes an isolate with a behavior different from what is usually reported.


Resumen Antecedentes: Candida auris es una levadura emergente, informada con frecuencia como resistente a diversos antifúngicos usados comúnmente para tratar infecciones por Candida. Esta especie puede colonizar la piel y tiene gran capacidad de producir brotes en ambientes hospitalarios. Está filogenéticamente relacionada con otras especies de Candida, es mal identificada por los métodos bioquímicos o comerciales, y requiere tecnología específica para su identificación. Reporte de caso: Se informa el primer aislamiento de C. auris en Cali, Colombia en un paciente de 37 años con artritis reumatoide y endocarditis, sin síntomas de sepsis, a partir de la punta de catéter venoso central. La levadura inicialmente se identificó como C. haemulonii por el sistema Phoenix® y posteriormente como C. auris por espectrometría de masas desorción/ionización láser asistida por una matriz con detección de masas por tiempo de vuelo (MALDI-TOF MS). Se determinó la concentración inhibitoria mínima por el método de microdilución en caldo que mostró un aislamiento sensible a fluconazol, itraconazol, voriconazol y anfotericina B. Conclusión: Este informe contribuye al conocimiento de la epidemiología de las infecciones por C. auris en individuos con enfermedad subyacente y describe un aislamiento con un comportamiento diferente a lo indicado en otros estudios.

16.
Article | IMSEAR | ID: sea-201712

ABSTRACT

Background: Candidemia causing increased mortality rates and emergence of antifungal drug resistance needs an urgent intervention to salvage immunocompromised and severely ill patients. This study aimed to isolate and identify Candida species and evaluate their antifungal susceptibility profile from blood stream infections in children.Methods: Fungal cultures from blood recovered positive for yeasts were subcultured on Sabouraud dextrose agar. Suspected purified colonies of Candida were confirmed and identified upto species level by both conventional and automated techniques. Antifungal susceptibility testing of isolates was evaluated using agar based E-test method for fluconazole, voriconazole and caspofungin on Mueller-Hinton agar supplemented with 2% glucose.Results: Total of 43 isolates of Candida species were recovered from blood samples. Non albicans Candida species accounted for 88.30% of cases; whereas 11.60% of cases were caused by C. albicans, C. tropicalis (39%) was the most frequent isolate recovered in candidemia patients followed by C. parapsilosis (18%), C. albicans (12%), C. glabrata (12%), C. kefyr (9%), C. pelliculosa (5%), and C. krusei (5%). Antifungal susceptibility results revealed Caspofungin demonstrated good activity against all Candida spp. C. parapsilosis followed by C. tropicalis and C. glabrata demonstrated high resistance to fluconazole. For voriconazole, maximum resistance was shown by C. tropicalis as compared to others.Conclusions: Candidemia is a threatening prognostic sign in children and an important entity in our hospital. Identification of Candidaspecies and antifungal sensitivity testing is a must to select a suitable and effective antifungal therapy to abrogate the emerging resistance to antifungals.

17.
Rev. otorrinolaringol. cir. cabeza cuello ; 79(3): 366-373, set. 2019. graf
Article in Spanish | LILACS | ID: biblio-1058709

ABSTRACT

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 use
18.
Braz. j. infect. dis ; 23(3): 197-199, May-June 2019. graf
Article in English | LILACS | ID: biblio-1019556

ABSTRACT

ABSTRACT We report a patient with fungal keratitis caused by a multiresistant Fusarium solani in a tertiary care hospital located in southern Brazil. A 55-year-old man with a history of ocular trauma presented with keratitis in left eye. The patient has a complicated clinical course and failed to respond to local and systemic antifungal treatment, and required eye enucleation. Despite multiple topical, intraocular and systemic antifungal treatments, hyphal infiltration persisted in the corneal transplant causing continuous recurrences. The cultures of corneal biopsy scrapings were positive for Fusarium spp. The organism was identified to species level by multi-locus sequencing for translation elongation factor 1 alpha (EF-1α), and RNA polymerase II subunit (RPB2). In vitro antifungal susceptibility testing of the isolate by the broth microdilution method, according to CLSI M38-A2, disclosed susceptibility to natamycin and resistance to amphotericin B, voriconazole, itraconazole and fluconazole. Considering previous unsuccessful antifungal treatments due to multiple drug resistance, the eye was enucleated. Our case report illustrates that management of fungal keratitis remains a therapeutic challenge. Optimal treatment for F. solani infection has not yet been established and should include susceptibility testing for different antifungal agents.


Subject(s)
Humans , Male , Middle Aged , Fusarium/drug effects , Keratitis/microbiology , Antifungal Agents/administration & dosage , Severity of Illness Index , Eye Enucleation , Microbial Sensitivity Tests , Treatment Failure , Keratitis/surgery , Antifungal Agents/pharmacology
19.
Chinese Journal of Burns ; (6): 221-223, 2019.
Article in Chinese | WPRIM | ID: wpr-804892

ABSTRACT

From June to November 2016, 5 patients with severe burns were admitted to our unit. Broad-spectrum antibiotic and fluconazole were used on patients as earlier empirical anti-infection therapy of bacteria and fungi. Seven to twenty-one days after injury, 5 patients developed fungal infection. Antifungal agents of caspofungin, voriconazole, and amphotericin B liposomewere were used according to the results of fungal culture, and the infected wounds were also treated with repeated debridement and dressing change. Multiple autologous skin grafts were performed after infection control of wounds. With the above antifungal infection treatment for 5 to 11 days, 2 patients′ condition tended to be stable, and no fungus was found in wound secretion after cultured for many times. The patients were discharged with wounds healed after 52 to 54 days′ hospital stay. Due to severe burns degree and or elder age, fungal infection aggravated and expanded to the trunk in the other 3 patients, then developed into burn sepsis, resulting in patients died of multiple organ failure secondary to sepsis.

20.
Article in Korean | WPRIM | ID: wpr-766600

ABSTRACT

Onychomycosis is a fungal nail infection caused by various fungal species, including dermatophytes, non-dermatophytes, and yeast. It is one of most bothersome nail problems, because it may cause permanent deformity of the nail, local pain, paresthesia, and difficulties performing activities of daily living and engaging in social interactions. Additionally, the treatment of onychomycosis is considered to be challenging because of the long duration of treatment, high recurrence and treatment failure rates, and drug interactions. In this article, we review the prognostic factors for onychomycosis treatment, the treatment options that have been approved, and off-label therapies and devices. Furthermore, we describe preventive therapy for recurrence and emerging methods to achieve a high cure rate. For successful treatment of onychomycosis, the risk factors should be clarified according to the patient's status and the clinical characteristics of onychomycosis. Recently, combinations of various treatment options, such as systemic therapy with simultaneous topical antifungal agents and boost therapy, have been reported as effective treatments of onychomycosis. In addition, laser therapy, photodynamic therapy, and plasma therapy have been proposed as emerging curative options. Providing patient-specific treatment based on an understanding of these treatments plays a pivotal role in achieving better treatment results. This article suggested the updated treatment options for onychomycosis to help clinicians make proper plans and achieve better results.


Subject(s)
Activities of Daily Living , Antifungal Agents , Arthrodermataceae , Congenital Abnormalities , Drug Interactions , Interpersonal Relations , Laser Therapy , Onychomycosis , Paresthesia , Photochemotherapy , Plasma , Recurrence , Risk Factors , Treatment Failure , Yeasts
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