Características de las fungemias en un centro de referencia del Perú: retrospectiva de cinco años / Characteristics of fungemia in a peruvian referral center: 5-year retrospective analysis

RESUMEN Con el objetivo de conocer las características de las fungemias en 285 pacientes oncológicos hospitalizados del 2012 al 2016 en el Instituto Nacional de Enfermedades Neoplásicas se realizó un estudio descriptivo retrospectivo. Se evaluó información demográfica, clínica y microbiológica. Las fungemias por C. albicans predominaron en pacientes con tumores sólidos y sin neutropenia, mientras las causadas por C. tropicalis predominaron en pacientes con neoplasias hematológicas y neutropenia. C. tropicalis fue el agente más aislado (47,0%). Las fungemias aumentaron con el tiempo en los pacientes sin neutropenia. Las fungemias causadas por C. albicans aumentan con la edad en pacientes con tumores sólidos sin neutropenia. Se concluye que las fungemias son mayormente causadas por C. tropicalis en pacientes con neoplasias hematológicas con neutropenia y por C. albicans en pacientes con tumores sólidos sin neutropenia. Además, las fungemias en pacientes sin neutropenia aumentan en el tiempo y las causadas por C. albicans, en tumores sólidos sin neutropenia, aumentan con la edad.

ABSTRACT Retrospective descriptive study carried out to determine the characteristics of fungemia in 285 cancer patients hospitalized from 2012 to 2016 at the Instituto Nacional de Enfermedades Neoplásicas (INEN). Demographic, clinical and microbiological information was evaluated. Fungemia by C. albicans predominated in patients with solid tumors and without neutropenia, while those caused by C. tropicalis predominated in patients with hematological neoplasia and neutropenia. C. tropicalis was the agent isolated in most cases (47.0%). Fungemia increased over time in patients without neutropenia. Fungemia caused by C. albicans increases with age in patients with solid tumors without neutropenia. It is concluded that fungemia are mainly caused by C. tropicalis in patients with hematological neoplasia with neutropenia and by C. albicans in patients with solid tumors without neutropenia. In addition, fungemia in patients without neutropenia increases over time; and those caused by C. albicans increase with age in patients with solid tumors without neutropenia.

Fungoma vesical por Candida tropicalis: un caso clínico pediátrico / Bladder fungus ball by Candida tropicalis: a pediatric case report

Vesical fungus ball is a mobile, oval and echogenic mass as a result of accumulation of long and wide numerous hyphae. Fungal urinary tract infection incidence has increased notoriously and there are isolated yeast in 7 to 8% of urine cultures. Different species of Candida are cause of urinary tract infection. Epidemiologically, the first isolated pathogen is Candida albicans, followed by Candida tropicalis. Bladder poll has been documented as the most important risk factor for candiduria in critical patients into intensive care.

Un fungoma vesical es una masa móvil, oval y ecogénica en la vejiga resultante del acúmulo de hifas largas y anchas. La incidencia de la infección urinaria de etiología fúngica se ha incrementado notablemente. Se aíslan levaduras en 7 a 8% de los urocultivos. Diferentes especies de Candida son causantes de infección urinaria, siendo Candida albicans la más frecuente, seguida de Candida tropicalis. Presentamos el caso de un niño varón de cuatro años, con un síndrome de Guillain Barré, catéter urinario permanente, estadía prolongada en UCI y expuesto a tratamiento antibacteriano de amplio espectro que desarrolló un fungoma vesical, diagnosticado por ecotomografía, con aislamiento de C. tropicalis en orina. Se trató con anfotericina B deoxicolato y extracción del fungoma por cistoscopia, con buena respuesta clínica. El cateterismo vesical se ha documentado como el factor de riesgo más importante para candiduria en pacientes de terapia intensiva.

Evaluación de la portación de cándida spp en pinzas ortodóncicas post utilización / Evaluation of candida spp carriage on orthodontic pliers, after using them

Objetivo: evaluar el nivel de contaminación por Candida spp, post uso del instrumental de ortodoncia que se utiliza intrabucalmente en pacientesColombianos y Argentinos. Materiales y métodos: Se incluyeron pacientesentre 16 y 65 años, de ambos sexos, con armado de brackets superior e inferior. Criterios de Exclusión: pacientes con brackets de autoligado, con enfermedades autoinmunes, con enfermedades sistémicas con manifestaciones en el periodonto, pacientes fumadores, menores de 16 años y con armado de brackets en un solo maxilar. Se analizaron los alicates de corte distal Hu Friedy luego de ser utilizados para seccionar el arco por distal del último tubo presente enboca. Se estudiaron 80 pacientes agrupados en: Grupo A 40 pacientesColombianos, Grupo B 40 pacientes argentinos. Se realizó una primer tomaintrabucal con un hisopo estéril y se llevó a un tubo con medio de Stuart. Se cortaron las 4 secciones distales de los arcos en boca tardando al menos 1 minuto. Con un segundo hisopo estéril se frota toda la superficie del alicate post uso y se llevaron a otro tubo. Se sembraron en Chromagar Candida y se realizaron pruebas microbiológicas convencionales. Resultados: Las pinzas estériles aparecen contaminadas post corte distal delos alambres en el 95% de los casos en ambos países. Hubo diferencia entrelos pacientes colombianos y los argentinos respecto a las especies, ya que enlos primeros la especie con mayor prevalencia fue Candida tropicalis tanto en lapinza como en la cavidad bucal, mientras que en los argentinos fue Candidaalbicans. Conclusión: las pinzas de ortodoncias se contaminan con Candidaspp post utilización en boca y son un fómite a partir del cual puede generarsediseminación sistémica así como infección cruzada.

Thyroid abnormalities in term infants with fungal sepsis / Alterações tireoidianas no recém-nascido de termo com sepse fúngica

Summary Objective: To describe thyroid alterations in term newborns (TNB) with fungal sepsis during NICU hospitalization. Method: The study included six TNB that during the clinical and laboratory manifestations of sepsis with positive cultures for fungus showed changes in thyroid hormones, called low T3 syndrome and low T3-T4 syndrome. TNB that could present hormonal changes caused by disease as those born to mothers with thyroid disease, or who had perinatal asphyxia and major surgeries were excluded. Results: Of six TNB with fungal sepsis, five had positive culture for Candida albicans and one had positive culture for Candida tropicalis. Low T3 syndrome was observed in two TNB (50%), while T3-T4 syndrome was observed in other two (100%). The four children progressed to septic shock. Conclusion: Fungal sepsis is becoming more common among newborns admitted to NICU. Thyroid insufficiency could be a marker of disease severity with possible need for hormone supplementation.

Resumo Objetivo: descrever as alterações tireoidianas em recém-nascidos de termo (RNT) que apresentaram sepse fúngica durante internação na UTI neonatal. Método: foram incluídos seis RNT que, durante as manifestações clínicas e laboratoriais de sepse, com culturas positivas para fungo, apresentaram alterações dos hormônios tireoidianos, denominadas síndrome do T3 baixo e síndrome do T3 e T4 baixo. Foram excluídos RNT que apresentaram alteração hormonal por doença, como RNT filhos de mães com doença tireoidiana, asfixia perinatal e cirurgias de grande porte. Resultados: dos seis RNT com sepse fúngica, cinco apresentavam cultura positiva para Candida albicans e um para C. tropicalis. A síndrome do T3 baixo foi observada em duas crianças (50%) e a do T3 e T4 baixo em dois RN (100%). As quatro crianças evoluíram com choque séptico. Conclusão: a sepse fúngica é cada vez mais frequente nos recém-nascidos internados em UTI neonatal. A insuficiência tireoidiana pode vir a ser marcadora de gravidade da doença, e a suplementação hormonal pode ser necessária.

Perfil de suscetibilidade de Candida tropicalis a antfúngicos sistêmicos / Susceptibility profile of Candida tropicalis to systemic antifungals

Infecções fúngicas invasivas são uma ameaça crescente à saúde humana. Tem ocorrido um aumento considerável na taxa de infecções nosocomiais no sangue, causadas por espécies de Candida. C. albicans é a principal levedura isolada de candidemias, no entanto o isolamento de C. tropicalis e C.parapsilosis também tem sido frequente. Este estudo teve como objetivos isolar, identificar e avaliaro perfil de suscetibilidade de C. tropicalis a antifúngicos sistêmicos. Foram utilizadas 50 cepas de C.tropicalis provenientes de amostras clínicas de sangue, urina e lavado bronco alveolar de pacientes atendidos no Ceará. Foi avaliado o perfil de sensibilidade das cepas aos antifúngicos sistêmicos anfotericina B, fluconazol, itraconazol e voriconazol pela metodologia de microdiluição em caldoRPMI. As cepas de C. tropicalis não apresentaram resistência, mas foram encontradas cepas com CIM elevada para o fluconazol, portanto deve ter continuidade o monitoramento de Candida spp. isoladas no Ceará com o fim de avaliar a evolução da resistência.

Candida spp. isoladas da urina de recém-nascidos de uma Unidade deTerapia Intensiva Neonatal / Candida spp. isolated from the urine of a newborns Neonatal Intensive Care Unit

Espécies de Candida são responsáveis por cerca de 80% das infecções fúngicas no ambiente hospitalar. O objetivo do trabalho foi detectar a presença de espécies de Candida na urina de recém-nascidos [RNs] internados em Hospital Universitário. Foram coletadas cinquenta urinas de RNs e realizado exame direto com hidróxido de potássio a 20% e cultura em ágar de Sabouraud dextrosado. A identificação foi realizada através do sistema automatizado MicroScan®. Dos RNs analisados, 21 (42%) apresentaram positividade para candidíase. As espécies isoladas foram C. albicans, 8 (38,1%), C. tropicalis, 5 (23,8%), C. famata, 4 (19%), C. stellatoidea, 2 (9,5%), C. zeylanoides e C. catenulata, 1 (4,8%). Ao exame direto, houve positividade em 95% das amostras e em 100% das cultura. A mortalidade associada à candidíase foi de 9,5% em pacientes com baixo peso e idade gestacional inferior a 34 semanas. É indispensável a realização de estudos que contribuam para a valorização dosquadros de colonização por leveduras e que visem diminuir as taxas de infecção...

Antifungal susceptibility testing of Candida tropicalis biofilms against fluconazole using calorimetric indicator resazurin.

Background: C.tropicalis is an important cause of nosocomial infections particularly in immunocompromised patients. Infections caused by Candida spp. are often associated with biofilm formation on implanted medical devices or on epithelial cell surfaces. Phenotypic characteristics of sessile cells in biofilms are known to be different from those of their free-living, planktonic counterparts. Biofilm forming strains often show increased resistance to antimicrobial agents. Materials and Methods : We measured susceptibility to fluconazole of fifty C.tropicalis isolates from immunocompromised (29) and immunocompetent (21) patients by minimum inhibitory concentration (MIC) and minimum biofilm inhibitory concentration (MBIC) assays. MBIC was done using the calorimetric indicator resazurin, to measure the metabolically active cells. Results : Biofilm forming cells showed increased resistance to fluconazole. Conclusion : The resazurin dye test was found to be a good method for determining MBIC.

Candida tropicalis as an emerging pathogen in Candida meningitis: case report and review

Candida species are an uncommon cause of meninigitis. Given the rarity of this infection, the epidemiology, prognosis, and optimal therapy for Candida meningitis are poorly defined. The authors report on a paraplegic patient due to spinal cord injury who developed C. tropicalis meningitis. In addition, we review and discuss other reported cases of C. tropicalis meningitis in the medical literature.

Photodynamic inactivation of four Candida species induced by photogem®

This study evaluated the in vitro susceptibility of C. albicans, C. dubliniensis, C. tropicalis and C. krusei to photodynamic therapy (PDT) induced by Photogem® and light emitting diode (LED). Suspensions of each Candida strain were treated with three photosensitizer (PS) concentrations (10, 25 and 50 mg/L) and exposed to 18.0, 25.5 and 37.5 J/cm² LED light fluences (λ ~ 455 nm). Control suspensions were treated only with PS concentrations, only exposed to the LED light fluences or not exposed to LED light or PS. Sixteen experimental conditions were obtained and each condition was repeated three times. From each sample, serial dilutions were obtained and aliquots were plated on Sabouraud Dextrose Agar. After incubation of plates (37 ºC for 48 hours), colonies were counted (cfu/mL) and the data were statistically analyzed by ANOVA and the Tukey test (α=0.05). Complete killing of C. albicans was observed after 18.0 J/cm² in association with 50 mg/L of PS. C. dubliniensis were inactivated after 18.0 J/cm² using 25 mg/L of PS. The inactivation of C. tropicalis was observed after photosensitization with 25 mg/L and subsequent illumination at 25.5 J/cm². For C. krusei, none of the associations between PS and light resulted in complete killing of this species. PDT proved to be effective for the inactivation of C. albicans, C. dubliniensis and C. tropicalis. In addition, reduction in the viability of C. krusei was achieved with some of the PS and light associations.

Resistência a antifúngicos de Candida tropicalis isoladas no Estado do Ceará / Antifungal resistance of Candida tropicalis isolated in the State of Ceará

Neste estudo, foi avaliada a resistência a drogas antifúngicas em 51 cepas de Candida tropicalis isoladas de amostras clínicas no Estado do Ceará, Brasil. Resistência antifúngica foi um evento raro no nosso estudo e foi restrita a 3 (5,9 por cento) das cepas de Candida tropicalis, que exibiram resistência a fluconazol e itraconazol.

In this study, the resistance to antifungal drugs was investigated among 51 strains of Candida tropicalis isolated from clinical samples in the State of Ceará, Brazil. Antifungal resistance was a rare finding in our study and was restricted to three (5.9 percent) of the strains of Candida tropicalis. These exhibited resistance to both fluconazole and itraconazole.

Vinegar as an antimicrobialagent for control of Candida spp. in complete denture wearers

The use of denture is known to increase the carriage of Candida in healthy patients, and the proliferation of Candida albicans strains can be associated with denture-induced stomatitis. The aim of this study was to evaluate the use of vinegar as an antimicrobial agent for control of Candida spp. in complete upper denture wearers. Fifty-five patients were submitted to a detailed clinical interview and oral clinical examination, and were instructed to keep their dentures immersed in a 10%vinegar solution (pH less than 3) overnight for 45 days. Before and after the experimental period, saliva samples were collected for detection of Candida, counting of cfu/mL and identification of species by phenotypical tests (germ tube formation, chlamidoconidia production, and carbohydrate fermentation and assimilation). The results were analyzed using Spearman's correlation and Student's t-test (p£0.05). Candida yeasts were present in 87.3% of saliva samples before the treatment. A significant reduction was verified in CFU/mL counts of Candida after treatment. A positive correlation between Candida and denture stomatitis was verified, since the decrease of cfu/mL counts was correlated with a reduction in cases of denture stomatitis. Although it was not able to eliminate C. albicans, the immersion of the complete denture in 10% vinegar solution, during the night, reduced the amounts (cfu/mL) of Candida spp. in the saliva and the presence of denture stomatitis in the studied patients.

Candidemia en niños y factores de riesgo asociados / Candidemia in children and associate factors of risk

Cada vez es más frecuente la adquisición de infecciones fúngicas intrahospitalarias, generando una mayor morbilidad y mortalidad, sobre todo en pacientes que presentan factores de riesgo. Determinar la prevalencia, en los pacientes hospitalizados en el Hospital de Niños "JM de Los Ríos" (Caracas-Venezuela), de infecciones sistémicas ocasionadas por las distintas especies de Candida en el período 2002-2006. Estudio retrospectivo, transversal, descriptivo y no experimental. Se ubicaron las historias clínicas de estos pacientes y se recopilaron de un formato los siguientes datos: edad, sexo, servicio de hospitalización, diagnóstico de egreso, factores de riesgo relacionados con la infección. Se utilizó como prueba de análisis estadístico medidas de tendencia central. Se logró el aislamiento de microorganismos en un 21,68 por ciento (7,14 por ciento correspondieron a cepas de Candida). El sexo masculino predominó con un 58,61 por ciento, los lactantes fueron el grupo más afectado con un 38,14 por ciento. El uso de antibióticos de amplio espectro predominó entre los factores de riesgo. El 71,16 por ciento de los aislamientos correspondieron a cepas del grupo de Candida no albicans, representando las especies de Candida parapsilosis y Candida tropicalis casi las dos terceras partes de los aislamientos y asociándose con mayor frecuencia al uso de catéteres venosos centrales. El 75 por ciento de las cepas de Candida aisladas en hemocultivo han sido reportadas como sensibles a fluconazol y anfotericina B por la literatura médica mundial.

Comparação de quatro sistemas de amplificação de DNA polimórfico (RAPD) para avaliar a distância genética e susceptibilidade ao fluconazol de amostras de Candida tropicalis isoladas de pacientes pediátricos / Camparison of four random amplified polymorphic DNA (raPD) systems to assess genetic relatedness and fluconazole susceptibility of Candida tropicalis pediatric isolates

O isolamento de Candida através de culturas pode resultar em falhas na identificação de espécies não albicans. A tipagem molecular po RAPD é rápida e capaz de identificar as espécies. Vinte e seis isolados de Candida tropicalis (20 sensíveis e 6 resistentes ao fluconazol...

Isolation of Candida sp by cultures may be faulty in the identification of nonalbicans species. This task has been promptly and accurately attained through molecular typing by RAPD. Twenty-six samples of Candida tropicalis, 20 sensitive and 6 resistants to fluconazole...

Burning mouth syndrome: clinical profile of Brazilian patients and oral carriage of candida species

Burning mouth syndrome (BMS) is a complex disease of unknown cause. It is characterized by a burning sensation in the oral mucosa, notwithstanding its clinical normal aspect. BMS is particularly seen in postmenopausal women. The purpose of this study was to investigate this syndrome on a clinical basis and, in addition, to analyze its possible relation to the frequency of Candida species. Thirty-one patients (28 women and 3 men; 13 Caucasians and 18 non-Caucasians; mean age = 61.3, range 30-85 years) were evaluated. Most patients (80.6 percent) were under long-term medication, antihypertensive, ansiolitic and antidepressant drugs being the most used. Burning mouth complaint was associated with other secondary oral complaints in 83.8 percent of the cases. Tongue was the most commonly affected site (70.9 percent), followed by the vermillion border of the lower lip (38.7 percent) and hard palate (32.2 percent). The association of the burning sensation with oral cancer (cancer phobia) was reported by 67.7 percent of the patients. Haematologic examination (hematocrit, haemoglobin and fasting blood glucose level) revealed 2 cases each of anemia and type 2 diabetes. Local factors, tooth extractions and dentures wearing, were associated with the onset of symptoms in 35.5 percent of the cases. Daily activities were changed as a consequence of BMS in 29 percent of the patients. Among the species of the genus Candida, C. albicans was the most frequent in BMS patients (9 - 29.03 percent) and controls (12 - 38.70 percent), followed respectively by C. parapsilosis (2 - 6.45 percent and 0 - 0 percent); C. tropicalis (1 - 3.22 percent and 2 - 6.45 percent); C. krusei and C. kefyr (1 - 3.22 percent and 0 - 0 percent). Therefore, such difference did not reach valuable results. In conclusion, these data were similar to those reported in other studies. The highlights of the present findings were the possible relation of BMS with chronic drug...

A Síndrome de ardência bucal (SAB) é uma doença complexa, de etiologia desconhecida. Caracteriza-se por uma sensação de queimação na mucosa bucal, não obstante seu aspecto clínico normal, sendo bastante freqüente em mulheres após a menopausa. O propósito deste estudo foi o de investigar a SAB em bases clínicas e, em adição, analisar sua possível relação com a freqüência de espécies do gênero Candida isoladas da cavidade bucal desses indivíduos. Foram estudados trinta e um pacientes, 28 mulheres e 3 homens, 13 caucasianos e 18 não caucasianos, média de idade 61,3 (faixa dos 30 - 85 anos). A maioria deles (80,6 por cento) estava sob medicação por longo período. Anti-hipertensivos, ansioliticos e antidepressivos foram as drogas mais utilizadas. A ardência bucal estava associada a outras queixas secundárias em 83,8 por cento dos pacientes. A língua foi o sítio mais afetado (70,9 por cento), seguida pelo vermelhão do lábio inferior (38,7 por cento) e palato duro (32,2 por cento). A associação de sensação de ardência com câncer bucal (cancerofobia) foi referida por 67,7 por cento dos pacientes. Exames hematológicos (hematócrito, hemoglobina e glicemia em jejum) revelaram dois casos cada, de anemia e diabetes tipo 2. Fatores locais, exodontias, e uso de próteses estavam associados com o conjunto de sintomas em 35,5 por cento dos casos. Foram referidas alterações importantes nas atividades cotidianas, em conseqüência da SAB, em 29 por cento dos pacientes. Leveduras do gênero Candida foram isoladas da cavidade bucal de 45,16 por cento dos indivíduos com SAB e igualmente do grupo-controle, não constituindo dado qualitativamente importante. Dentre as espécies do Gênero Candida, C. albicans foi a mais freqüente (9 - 29,03 por cento e 12 - 38,70 por cento), seguida de C. parapsilosis (2 - 6,45 por cento e 0 - 0 por cento), C. tropicalis (1 - 3,22 por cento e 2 - 6,45 por cento), C. krusei e C. kefyr (1 - 3,22 por cento e 0 - 0 por cento). Em conclusão, nossos...

Risk factors for central venous catheter-related infections in pediatric intensive care

OBJECTIVES: To identify risk factors for short-term percutaneously inserted central venous catheter-related infections in children and to evaluate the accuracy of a mortality score in predicting the risk of infection. METHOD: After reviewing the charts of patients who developed catheter-related infection in a university hospital's pediatric intensive care unit, we conducted a case-controlled study with 51 pairs. Variables related to patients and to catheter insertion and use were analyzed. Risk factors were defined by logistic regression analysis. The accuracy of the Pediatric Risk of Mortality score to discriminate the risk for infection was tested using the Receiver Operating Characteristic curve. RESULTS: Infection was associated with respiratory failure, patient's length of stay, duration of tracheal intubation, insertion of catheter in the intensive care unit and parenteral nutrition. Insertion site (femoral or internal jugular) was unimportant. Multivariate logistic regression analysis identified the following variables. Risk factors included more than one catheter placement (p=0.014) and duration of catheter use (p=0.0013), and protective factors included concomitant antibiotic use (p=0.0005) and an intermittent infusion regimen followed by heparin filling compared to continuous infusion without heparin (p=0.0002). Pediatric Risk of Mortality did not discriminate the risk of infection. CONCLUSIONS: Central parenteral nutrition and central venous catheters should be withdrawn as soon as possible. Femoral vein catheterization carries a risk of infection similar to internal jugular catheterization. The Pediatric Risk of Mortality score should not be used to predict the risk of central catheter-related infections.

OBJETIVOS: Identificar fatores de risco para as infecções relacionadas a cateter venoso central de curta permanência, inserido por punção, em crianças e avaliar a eficiência de um escore de mortalidade pediátrica em prever o risco de infecção. MÉTODOS: Revisão dos casos de infecção relacionada a cateter ocorridos na unidade de terapia intensiva pediátrica de um hospital universitário seguida de estudo caso-controle com 51 pares. Foram analisadas variáveis relacionadas aos pacientes e à inserção e utilização dos cateteres, sendo definidos fatores de risco por análise de regressão logística. A eficiência de Pediatric Risk of Mortality em discriminar o risco de infecção foi testada pela curva receiver operating characteristic. RESULTADOS: Foram variáveis associadas à infecção: insuficiência respiratória, duração da internação, tempo de intubação, inserção do cateter na unidade de terapia intensiva e nutrição parentérica. O sítio de inserção foi indiferente quando comparadas as veias jugular interna e femoral. Foram fatores de risco: inserção de mais de um cateter (p=0,014) e tempo de permanência do cateter (p=0,0013). Foram fatores de proteção: uso concomitante de antibióticos (p=0,0005) e infusão intermitente seguida de heparinização quando comparada à infusão contínua sem heparinização (p=0,0002). Pediatric Risk of Mortality não discriminou o risco de infecção. CONCLUSÕES: Deve-se suspender a nutrição parentérica e retirar o cateter venoso central assim que possível. A cateterização da veia femoral implica em risco de infecção semelhante ao da veia jugular interna. O escore Pediatric Risk of Mortality não deve ser utilizado para estimar o risco de infecção relacionada ao cateter venoso central.

Candida tropicalis causing prosthetic valve endocarditis.

The incidence of endocarditis produced by the so-called "opportunists" as a complication of prosthetic valve surgery is progressively increasing in frequency and gradually transforming the clinical picture habitually associated with this disease. Candida endocarditis is an unusual but severe complication caused by Candida albicans or other fungal species. This case and a review of the literature indicate that Candida endocarditis treated with amphotericin B and prosthetic valve replacement may recur months after treatment, and that late recurrent Candida endocarditis, which is difficult to diagnose and treat, may be best prevented by lifelong antifungal suppressive therapy.

Comparación de diferentes métodos para la identificación de especies del género Candida / Comparison of different methods for species identification of genus Candida

Las diferentes especies del género Candida producen una variedad de enfermedades, desde infecciones mucocutáneas leves a formas diseminadas graves. Tradicionalmente, la taxonomía de las levaduras se ha llevado a cabo en base a estudios morfológicos y fisiológicos, pero éstos dependen de las condiciones de cultivo de las cepas, por lo que se han observado diversas dificultades. Por tal motivo, recientemente, se han probado técnicas de biología molecular. El objetivo de este trabajo es correlacionar los estudios taxonómicos de las especies correspondientes a las principales patógenas: C. albicans, C. krusei, C. parapsilosis, C. tropicalis y C. glabrata, realizados por técnicas fenotípicas tradicionales, métodos comerciales y por PCR fingerprinting. Al comparar las técnicas que identifican Candida albicans, agar harina de maíz y formación de tubos germinativos, estadísticamente se observa que no existen diferencias significativas entre ambos métodos (valor de la estadística X2 = 0,5 p = 0,4795). Comparando los métodos que discriminan especies de Candida: pruebas fisiológicas, CHROMagar, API20C y PCR fingerprinting se observó que no existen diferencias significativas en las proporciones de resultados que identifican cualquier Candida entre las pruebas fisiológicas, API20C y PCR fingerprinting. La proporción de resultados definitivos es mayor a la obtenida usando el método CHROMagar (p< 0,001).

Different species of genus Candida can cause a wide range of pathologies, since mucocutaneous trivial infections to disseminated serious forms. Traditionally, taxonomy of yeast has been performed taking into account morphologic and physiologic studies, but they depend on the culture conditions of strains, what cause certain difficulties. Thus, recently, molecular biology methods have been tried. The aim of this work is to correlate taxonomic studies of most important pathogenic species -C. albicans, C. krusei, C. parapsilosis, C. tropicalis and C. glabrata- all of them performed by phenotypic traditional methods, commercial ones, and by a molecular method, PCR fingerprinting. Comparing useful methods for C. albicans identification, corn flour agar and germinative tube formation, no statistical differences between them are observed (X2 =0.5, p=0.4795). By comparison between methods to discriminate different Candida species, physiological tests, CHROMagar, API 20C and PCR fingerprinting we observed no significative differences in proportion of accurate results, in test that can identify any Candida species, such as physiological assays, API 20C and PCR fingerprinting. The proportion of unequivocal results is greater than the obtained performing the CHROMagar culture method (p< 0.001).

Prevalencia de Candida albicans y Candida no albicans en diferentes muestras clínicas: Período 1999-2001 / Prevalence of Candida albicansand Candida no albicans inclinical samples during 1999-2001

Las levaduras implicadas en procesos patológicos son de indiscutible importancia debido al incremento experimentado por estas infecciones en las últimas décadas, a los cambios observados en las especies causales y al uso empírico de antifúngicos. En el Centro de Micología se estudiaron 1006 aislamientos provenientes de una amplia gama de muestras clínicas durante el periodo 1999-2001. Candida albicans con 40,3% resultó la especie de mayor frecuencia de aislamiento, pero las especies de Candida no albicans con 54,9% resultaron de mayor prevalencia y el 4,8% fueron otras levaduras. En los hemocultivos Candida parapsilosis con 34,9%, C. albicans con 30,2% y C. tropicalis con 25,6% resultaron las más recuperadas, mientras que C. glabrata se presentó con un 2,3%. En las secreciones mucosas C.albicans con 60%-80% fue la especie preponderante. Hemos detectado especies de Candida causantes de mediastinitis, lo que nos alerta sobre su importancia en estos procesos. Las infecciones del tracto urinario por levaduras se detectaron en mayor frecuencia en individuos hospitalizados, resultando C. albicans con 47,7% la especie más aislada, y dentro de Candida no albicans, C. glabrata con 24,8% y C. tropicalis con 20,0%. En las onixis candidiásicas C. parapsilosis con 37,7% desplazó a C.albicans con 22,0% de este lugar anatómico. Los estudios de sensiblidad al fluconazol de las especies de Candida nos permiten concluir que C.albicans es una especie sensible y que los mayores porcentajes de resistencia se observaron en C. glabrata (21,41%) y and C. krusei (69,23%).

The importance of epidemiological monitoring of yeasts involved in pathologic processes is unquestionable due to the increase of these infections over the last decade, the changes observed in species causing candidiasis, and empirical antifungal treatment. At the Mycology Center, 1006 isolates from a wide range of clinical samples were studied during 1999-2001. Candida albicans (40.3%) was the most isolated species, although, the Candida no albicans species with 54.9% showed the major prevalence. In blood cultures Candida parapsilosis (34.9%), C. albicans (30.2%) and C. tropicalis (25.6%) were recovered most frequently while C. glabrata represented only 2.3%. C. albicans with 60%-80% was the predominant specie in mucosal surface. We also detected Candida mediastinistis, which alert us over the importance at this location. Urinary tract infections caused by yeasts were more frequent in hospitalized patients, being C. albicans (47.7%), the most commonly isolated, followed by C. glabrata (24.8%) and C. tropicalis (20.0%). In the candidal onychomycoses, C. parapsilosis (37.7%) outplaced C. albicans (22.0%). Fluconazole susceptibility studies of Candida species allowed us to conclude that the majority of C. albicans islolates are susceptible, and that the highest resistance averages were observed in C. glabrata (21.41%) and C. krusei (69.23%).