Candida Infection-caused Lumbar Vertebral Osteomyelitis:Report of One Case / 中国医学科学院学报

Candida vertebral osteomyelitis,a rare but challenging clinical disease without specific clinical manifestations,is prone to delay in diagnosis,with potential risks of serious complications.Therefore,early diagnosis is the key to improving the cure rate of this disease.A case of invasive candida lumbar osteomyelitis after gastrointestinal surgery is reported in this paper.We analyzed the clinical characteristics of the patient and reviewed the relevant literature,aiming to improve the early diagnosis and treatment of this disease.

Recent progress on anti-Candida natural products / 中国天然药物

Candida is an intractable life-threatening pathogen. Candida infection is extremely difficult to eradicate, and thus is the major cause of morbidity and mortality in immunocompromised individuals. Morevover, the rapid spread of drug-resistant fungi has led to significant decreases in the therapeutic effects of clinical drugs. New anti-Candida agents are urgently needed to solve the complicated medical problem. Natural products with intricate structures have attracted great attention of researchers who make every endeavor to discover leading compounds for antifungal agents. Their novel mechanisms and diverse modes of action expand the variety of fungistatic agents and reduce the emergence of drug resistance. In recent decades, considerable effort has been devoted to finding unique antifungal agents from nature and revealing their unusual mechanisms, which results in important progress on the development of new antifungals, such as the novel cell wall inhibitors YW3548 and SCY-078 which are being tested in clinical trials. This review will present a brief summary on the landscape of anti-Candida natural products within the last decade. We will also discuss in-depth the research progress on diverse natural fungistatic agents along with their novel mechanisms.

Efficacy of copper sulphate on candida albicans on heat-polymerized acrylic resin / Eficacia del sulfato de cobre sobre candida albicans en resinas acrílicas de termocurado

The ageing of population is increasing, and a great percentage of these patients wear removable prostheses, and can suffer denture stomatitis, a condition that has been associated with candidiasis. Aims: To evaluate in vitro the effectiveness of Copper Sulfate against Candida albicans in samples of heat-polymerized acrylic resin, compared to nystatin, sodium hypochlorite and chlorhexidine. Materials and Methods: Initially, the minimum inhibitory concentration (MIC) of copper sulfate for Candida albicans was determined by microdilution. Then, 54 resin samples were divided into 6 treatment groups corresponding to Nystatin 100.000 UI, Sodium Hypochlorite 0.5%, chlorhexidine 0.12%, Copper Sulfate 4.7µg/ml, Copper Sulfate 9.4µg/ml and physiological saline solution, in which samples were submerged for 6 hours. Resin samples were then washed and cultured on solid media at 37°C for 72 hours. The number of colony-forming units was determined using a Quebec colony counter. The statistical analysis was performed using the Kruskal-Wallis test and the Mann-Whitney U test. Results: Copper sulfate at a concentration of 9.4µg/ml presented a similar effectiveness as the other control products regarding the reduction in the number of colonies of Candida albicans post-treatment. Conclusion: The effectiveness of copper sulfate against Candida albicans on acrylic resin was similar to that of nystatin, sodium hypochlorite and chlorhexidine.

En las últimas décadas se ha observado un aumento de la población de adultos mayores, de los cuales un gran porcentaje es portador de prótesis removible, y dos tercios pueden sufrir estomatitis subprotésica, enfermedad que es asociada a infecciones como candidiasis. Objetivo: Evaluar la efectividad antimicótica in vitro del sulfato de cobre en placas de resinas acrílicas de termocurado inoculadas con Candida albicans, frente a Nistatina, Hipoclorito de Sodio y Clorhexidina. Material y Métodos: Inicialmente, y mediante microdilución del sulfato de cobre, se determinó la concentración mínima inhibitoria (CMI) para Candida albicans. En la fase experimental, 54 muestras de resina se dividieron en 6 grupos correspondientes a Nistatina 100.000 UI, Hipoclorito 0.5%, Clorhexidina 0.12%, Sulfato de Cu 4.7µg/ml, Sufato de Cu 9.4 µg/ml y suero fisiológico. Las muestras fueron sumergidas en estos agentes por 6 horas, para posteriormente ser lavadas y cultivada en medios solidos a 37°C por 72 horas. Luego se realizó el conteo de unidades formadoras de colonias mediante contador tipo Quebec. El análisis estadístico se realizó mediante la prueba de Kruskal-Wallis y la prueba U de Mann-Whitney. Resultado: El sulfato de cobre a una concentración de 9.4µg/ ml presentó una efectividad similar a los otros productos, en la reducción de colonias de Candida albicans. Conclusión: La efectividad del sulfato de cobre contra Candida albicans fue semejante a la de Nistatina, Hipoclorito y Clorhexidina.

Primer aislamiento de Candida auris en Chile / First isolation de Candida auris in Chile

Resumen Candida auris es una levadura multi-resistente emergente con rápida diseminación mundial. Desde el primer reporte el 2009, varios aislados a través de los cinco continentes han sido identificados como agentes de infecciones asociadas a la atención en salud. Brotes independientes y simultáneos por C. auris se han vuelto prioridad para la comunidad hospitalaria y científica. Además, los errores en identificación y los perfiles de multi-resistencia, raramente observados para otras especies de Candida, resultan en una difícil erradicación y fallas terapéuticas frecuentes en infecciones por C. auris. Presentamos el primer aislamiento de una cepa de C. auris en un hospital en Santiago, en un paciente proveniente de la India, que fue admitido para tratamiento de su pie diabético. La cepa fue recuperada de un cultivo de tejido e identificada por VITEK® 2 Compact. La identificación de C. auris fue confirmada por MALDI-TOF MS y secuenciación. El aislado fue resistente a fluconazol y susceptible a anfotericina y caspofungina, según puntos de corte recomendados por el CDC. La emergencia de C. auris es alarmante debido a que el modo de transmisión dentro del ambiente hospitalario no es claro y probablemente es multifactorial.

Candida auris is an emerging multi-drug-resistant fungus that is rapidly spreading worldwide. Since the first reports in 2009, many isolates across five continents have been identified as agents of hospital-associated infections. Independent and simultaneous outbreaks of C. auris are becoming a major concern for healthcare and scientific community. Moreover, laboratory misidentification and multi-drug-resistant profiles, rarely observed for other non-albicans Candida species, result in difficult eradication and frequent therapeutic failures of C. auris infections. In this article we present the first case of isolation of a strain of C. auris at a hospital in Santiago, in a patient coming from India, who was admitted for treatment of diabetic foot complications. The strain was recovered from a tissue culture and identified by VITEK® 2 Compact. The accurate identification of C. auris was confirmed by means of MALDI-TOF MS and DNA sequence analysis. The isolate was resistant to fluconazole, retaining only susceptibility to amphotericin and caspofungin with MIC breakpoints recommended by CDC. The emergence of C. auris is alarming because the mode of transmission within the healthcare environment is not clear and is likely to be multifactorial.

Candida auris infection in the central catheter of a patient without sepsis symptoms / Infección por Candida auris en el catéter central de un paciente sin síntomas de sepsis

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.

Lactoferrin, chitosan and Melaleuca alternifolia-natural products that show promise in candidiasis treatment

Abstract The evolution of microorganisms resistant to many medicines has become a major challenge for the scientific community around the world. Motivated by the gravity of such a situation, the World Health Organization released a report in 2014 with the aim of providing updated information on this critical scenario. Among the most worrying microorganisms, species from the genus Candida have exhibited a high rate of resistance to antifungal drugs. Therefore, the objective of this review is to show that the use of natural products (extracts or isolated biomolecules), along with conventional antifungal therapy, can be a very promising strategy to overcome microbial multiresistance. Some promising alternatives are essential oils of Melaleuca alternifolia (mainly composed of terpinen-4-ol, a type of monoterpene), lactoferrin (a peptide isolated from milk) and chitosan (a copolymer from chitin). Such products have great potential to increase antifungal therapy efficacy, mitigate side effects and provide a wide range of action in antifungal therapy.

Fluconazole levels in serum and cerebrospinal fluid according to daily dosage in patients with cryptococcosis and other fungal infections

ABSTRACT Fluconazole is extensively used for the treatment of candidiasis and cryptococcosis. Among other factors, successful treatment is related to appropriate fluconazole levels in blood and cerebrospinal fluid. In the present study, fluconazole levels were determined in 15 patients, 14 of whom had AIDS and 13 had neurocryptococcosis. The only selection criterion was treatment with fluconazole, which was performed with a generic or similar form of the drug. Fluconazole level was determined by high performance liquid chromatography and the susceptibility profile of Cryptococcus spp. isolated from the patients was assessed by broth microdilution. Blood and cerebrospinal fluid fluconazole levels were found to be related to the fluconazole daily dose, and exceeded the minimum inhibitory concentration of this antifungal for the Cryptococcus spp. isolates. A good correlation was observed between serum and cerebrospinal fluid drug concentration. In conclusion, treatment with non-original fluconazole under usual medical practice conditions results in appropriate blood and cerebrospinal fluid levels of the drug for inhibiting Cryptococcus spp. susceptible to this antifungal drug. The relatively common failures of neurocryptococcosis treatment appear not to be due to insufficient fluconazole levels in the cerebrospinal fluid, especially with the use of daily doses of 400-800 mg.

Activador tisular del plasminógeno recombinante para el tratamiento de la vegetación intracardíaca en un lactante de muy bajo peso al nacer / Recombinant tissue plasminogen activator treatment for intracardiac vegetation in a very low birth weight infant

Las nuevas opciones de tratamiento prolongan la hospitalización y aumentan las infecciones intrahospitalarias bacterianas y fúngicas, pero también mejoran la sobrevida de los recién nacidos hospitalizados en la unidad de cuidados intensivos neonatales. Las infecciones fúngicas invasivas en neonatos están asociadas con una morbimortalidad significativa. También pueden diseminarse a órganos específicos y causar endocarditis, endoftalmitis, artritis séptica, nefropatía obstructiva y meningitis. En el caso de la endocarditis, se recomiendan tratamientos antimicóticos sistémicos agresivos y, en algunos casos, la intervención quirúrgica del neonato. Informamos el caso de un lactante prematuro, de bajo peso al nacer, con vegetación intracardíaca. Esta es una complicación rara y potencialmente mortal de infecciones fúngicas invasivas. El paciente recibió tratamiento con caspofungina y un activador tisular del plasminógeno recombinante, en vez de una intervención quirúrgica.

Developing treatment options have resulted in prolonged admission and increased bacterial and fungal nosocomial infections as well as improved survival in neonatal intensive care unit. Invasive fungal infections in newborns are associated with significant morbidity and mortality and can cause endorgan dissemination such as endocarditis, endophthalmitis, septic arthritis, obstructive nephropathy and meningitis. Endocarditis requires aggressive systemic antifungal therapy and sometimes surgical intervention in neonates. We report a low birth weight premature infant with intracardiac vegetation that is rare and a life-threatening complication of invasive fungal infections. He was treated with caspofungin and recombinant tissue plasminogen activator in stead of surgical intervention.

Antifungal pharmacodynamics: Latin America's perspective

Abstract The current increment of invasive fungal infections and the availability of new broad-spectrum antifungal agents has increased the use of these agents by non-expert practitioners, without an impact on mortality. To improve efficacy while minimizing prescription errors and to reduce the high monetary cost to the health systems, the principles of pharmacokinetics (PK) and pharmacodynamics (PD) are necessary. A systematic review of the PD of antifungals agents was performed aiming at the practicing physician without expertise in this field. The initial section of this review focuses on the general concepts of antimicrobial PD. In vitro studies, fungal susceptibility and antifungal serum concentrations are related with different doses and dosing schedules, determining the PD indices and the magnitude required to obtain a specific outcome. Herein the PD of the most used antifungal drug classes in Latin America (polyenes, azoles, and echinocandins) is discussed.

Endocarditis fúngica, una causa infrecuente de lesión en válvula cardiaca nativa / Fungal endocarditis, an uncommon cause of native cardiac valve disease

Introducción: La endocarditis fúngica (EF) es una forma grave de endocarditis infecciosa (EI), asociada a una alta morbimortalidad. Su incidencia es baja y se puede presentar después de una cirugía cardiaca, uso de válvula cardiaca protésica, catéteres endovenosos centrales (CVC), etc. Presentación del caso: Hombre de 17 años con antecedente de enfermedad renal crónica en hemodiálisis y múltiples hospitalizaciones por septicemia asociada a CVC, presentó cuadro febril el cual fue tratado con antibióticos y cambio de CVC. Estudio con hemocultivos resultó positivo para Candida parapsilosis. Se decidió hospitalización domiciliaria y tratamiento con Fluconazol. Persistió febril por lo que se decidió hospitalización por sepsis fúngica persistente y continuar tratamiento antimicótico. Estudio con ecocardiograma mostró endocarditis mitral con vegetación móvil en velo anterior e insuficiencia moderada. Se decidió tratamiento quirúrgico, realizándose reemplazo de válvula mitral con prótesis cardiaca biológica. En el intraoperatorio se observó vegetación verrugosa y móvil. Cultivos y estudio histopatológico confirmó EF. Evolucionó con candidemia persistente, pero sin hallazgos ecográficos de endocarditis. Control con tomografía computada demostró hallazgos sugerentes de candidiasis crónica diseminada (CCD), modificándose el tratamiento con Caspofungina y Voriconazol. Al cuarto mes postoperatorio fue dado de alta con tratamiento antifúngico crónico. Discusión: La EF es un tipo infrecuente de endocarditis infecciosa constituyendo un 6% de los casos. Se asocia a una alta mortalidad a pesar de tratamiento médico y quirúrgico combinado. La CCD es una forma infrecuente de candidemia, casi exclusiva de pacientes oncohematológicos. El antecedente de factores de riesgo obliga a sospecharlo.

Introduction: Fungal endocarditis (EF) is a severe form of infectious endocarditis (IE) associated with high morbidity and mortality. Its incidence is low and may be related to heart surgery using prosthetic heart valve, central intravenous catheters (CVC), etc. Case report: Man aged 17 with a history of chronic kidney disease on hemodialysis, and multiple hospitalizations for sepsis associated to CVC, presented febrile illness, which was treated with antibiotics and CVC change. Blood culture study was positive for Candida parapsilosis. Home hospitalization and treatment with Fluconazole was decided. He persisted febrile so hospitalization it was decided by persistent fungal sepsis and to continue antifungal therapy. Echocardiogram study showed mitral endocarditis with mobile vegetation anterior leaflet and mitral insufficiency. Surgical treatment was decided. Mitral valve replacement surgery with biological cardiac prosthesis is performed. A warty and mobile vegetation was observed in the surgery. Cultures and histopathology confirmed EF. He evolved with persistent candidemia, but without sonographic findings of endocarditis. Control with computed tomography showed suggestive findings of chronic disseminated candidiasis (CCD), modifying treatment with Caspofungin and Voriconazole. The fourth postoperative month was discharged with chronic antifungal treatment. Discussion: EF is a rare type of EI constitutes 6% of cases. It is associated with high mortality despite combined medical and surgical treatment. The CCD is an almost exclusive rare form of candidemia in oncohematological patients. The history of risk factors forcing suspect.

Candida auris: emergence and epidemiology of a highly pathogenic yeast

Candida auris is a multidrug-resistant emerging yeast, which was responsible for healthcare-associated infection outbreaks, and was cataloged as a new species in 2009, after being isolated from a patient's ear canal secretion in Japan. Since the notification of this first occurrence, numerous cases have been reported throughout the world, including Brazil. C. auris affects mainly inpatients, patients in intensive care units, exposed to broad-spectrum antifungal medications and who make use of vascular catheters. Currently, this yeast is one of the main responsible for invasive infections in hospitals and has been cause of concern by authorities and organs due to its rapid dissemination and difficult treatment caused by its low susceptibility to antifungal agents traditionally used in clinical practice. As a contributor to the severity of infections associated with C. auris, the transmission mechanism is still unknown, which implies in a lack of control of the microorganism and high mortality rates. Thus, this literature review presents relevant information in order to alert the importance of C. auris as an etiological agent of systemic infections, as well as its epidemiology and the real challenges of the treatment (AU)

Resistencia bacteriana de cultivos de orina en un hospital oncológico: seguimiento a diez años / Bacterial resistance from urine cultures at an oncological center: follow-up to 10 years

Resumen: Objetivo: Describir los patrones de resistencia bacteriana en cultivos de orina de pacientes de un hospital oncológico en la Ciudad de México, de 2004 a 2013. Material y métodos: Se obtuvo el porcentaje de susceptibilidad para diferentes antibióticos, describiendo por separado las bacterias multidrogorresistentes (MDR). Se analizaron por separado las cepas obtenidas de pacientes hospitalizados de las de la comunidad. Resultados: Se realizaron 51 202 cultivos, de los cuales se identificaron 14 480 bacterias (28.3%). De éstas, se reportaron 11 427 Gram negativos (78.9%); 2 080 Gram positivos (14.4%); y 973 (6.6%) levaduras. Escherichia coli fue el principal microorganismo aislado (56.1%); 24% de las cepas de la comunidad y 66% de las nosocomiales fueron productoras de beta-lactamasas de espectro extendido (BLEE). Klebsiella pneumoniae se identificó en 705 cultivos (4.8%), 115 de los cuales fueron BLEE (16%): 13.1% de la comunidad y 29.8% nosocomiales. Pseudomonas aeruginosa se identificó en 593 cultivos (4.1%): 9% de la comunidad y 51% nosocomiales. Conclusiones: Las cepas MDR son mucho más frecuentes en muestras de origen nosocomial. Es prioritario intensificar el uso racional de antibióticos en la comunidad y el programa de desescalamiento de antimicrobianos en el hospital.

Abstract: Objective: To describe the incidence and patterns of bacterial resistance in urine samples from a tertiary care oncology hospital in Mexico, from 2004 to 2013. Materials and methods: We included the strains obtained from urine cultures, describing separately multidrug-resistant (MDR) bacteria. We analyzed the susceptibility to different antibiotics. Results: 51 202 urine cultures were processed during the study; 14 480 (28.3%) cultures were positive. In 11 427 samples Gram negative (79%) were isolated, 2 080 Gram positive (14.4%), and 973 yeasts (6.6%). Escherichia coli was the most frequent bacteria identified (56.1%); 24% of the community strains and 65.7% of the nosocomial were extended-spectrum beta-lactamase producers (ESBL). Klebsiella pneumoniae was isolated in 705 samples (4.8%); 115 were ESBL (16%), 13.1% from community and 29.8% from nosocomial source. Pseudomonas aeruginosa was identified in 593 cultures (4.1%): 9% from community and 51% nosocomial. Conclusions: MDR bacteria were more frequent in nosocomial isolates. It should be a priority to intensify the rational use of antimicrobials in the community and antibiotic stewardship in the hospital.

Atividade antimicrobiana de produtos obtidos de espécies de Piper (Piperaceae) / Actividad antimicrobiana de productos obtenidos a partir de especies de Piper (Piperaceae) / Antimicrobial activity of products obtained from Piper species (Piperaceae)

Introdução: espécies do gênero Piper são encontradas nas regiões tropicais do globo e possuem inúmeras indicações terapêuticas. Objetivos: avaliar a atividade antimicrobiana de extratos e frações de quatro espécies de Piper, além de dois flavonoides isolados de Piper montealegreanum e determinar a concentração inibitória mínima dos produtos ativos. Métodos: o material vegetal foi coletado em diferentes regiões do estado da Paraíba e na cidade de Belém (Pará) submetido à extração com etanol e partição com solventes em grau crescente de polaridade. Os flavonoides foram isolados por meio de técnicas cromatográficas. A avaliação da atividade antimicrobiana foi realizada pelo método de disco-difusão frente a três espécies bacterianas: Staphylococcus aureus ATCC 25923, Escherichia coli ATCC 25922, Pseudomonas aeruginosa ATCC 27853 e três espécies fúngicas: Candida albicans ATCC 76645, Candida tropicalis ATCC 13803 e Candida glabrata ATCC 15545. Resultados: quase metade dos produtos testados foi capaz de inibir o crescimento de S. aureus com halos de inibição variando entre 8-16 mm. O extrato etanólico bruto e as frações hexânica e CHCl3 das folhas de P. mollicomum mostraram atividade antibacteriana frente as três linhagens testadas. As frações hexânicas de P. arboreum, de P. caldense e de P. mollicomum apresentaram atividade antifúngica, enfatizando a formação do halo de inibição de 28 mm para a fração de P. mollicomum. Os dois flavonoides isolados de P. montealegreanum não apresentaram atividade antimicrobiana. Conclusões: os resultados preliminares deste estudo sugerem que alguns dos produtos obtidos das espécies de Piper são uma fonte promissora de compostos com atividade antimicrobiana(AU)

Introducción: el género Piper se encuentra en las regiones tropicales del mundo y numerosas indicaciones terapéuticas. Objetivos: evaluar la actividad antimicrobiana de extractos y fracciones de cuatro especies de Piper, además de dos flavonoides aislados de Piper montealegreanum y determinar la concentración inhibitoria mínima de los productos activos. Métodos: el material vegetal fue recolectado en diferentes regiones del estado de Paraíba y en Belém (Pará) y sometido a extracción con etanol y partición com disolventes en grado creciente de polaridad. Los flavonoides fueron aislados por medio de técnicas cromatográficas. La evaluación de la actividad antimicrobiana se realizó por el método de difusión en disco frente a tres especies bacterianas:Staphylococcus aureus ATCC 25923, Escherichia coli ATCC 25922, Pseudomonas aeruginosa ATCC 27853 y três especies de hongos: Candida albicans ATCC 76645, Candida tropicalis ATCC 13803 y Candida glabrata ATCC 15545. Resultados: casi la mitad de los productos ensayados fueron capaces de inhibir el crecimiento de S. aureus con zonas de inhibición entre 8-16 mm. Los extractos etanolicos crudo y fracciones hexano y CHCl3 de las hojas de P. mollicomum mostraron actividad antibacteriana contra todas las cepas probadas. Las fracciones hexano de P. arboreum, P. caldense y P. mollicomum mostraron actividad antifúngica, con énfasis en la zona de inhibición de 28 mm para la fracción de P. mollicomum. Los dos flavonoides aislados de P. montealegreanum no mostraron actividad antimicrobiana. Conclusiones: los resultados preliminares de este estudio sugieren que algunos de los productos obtenidos de especies de Piper son una fuente prometedora de compuestos con actividad antimicrobiana(AU)

Introduction: The species of the genus Piper are widely found in the tropical regions of the globe and have numerous therapeutic indications. Objective: To evaluate the antimicrobial activity of extracts and fractions of four species of Piper and two flavonoids isolated from Piper montealegreanum and determine the minimum inhibitory concentration of the active products. Methods: The plant material was collected in different regions of the state of Paraíba and in Belém (Pará) and subjected to extraction with ethanol and partition with solvents in increasing degree of polarity. Flavonoids were isolated through chromatographic techniques. The evaluation of antimicrobial activity was performed by disk diffusion method front the three bacterial species: Staphylococcus aureus ATCC 25923, Escherichia coli ATCC 25922, Pseudomonas aeruginosa ATCC 27853 and three fungi species: Candida albicans ATCC 76645, Candida tropicalis ATCC 13803 and Candida glabrata ATCC 15545. Results: Almost half of the products tested were able to inhibit the growth of S. aureus with inhibition zones between 8-16 mm. The crude ethanolic extract and hexane fractions and CHCl3 of P. mollicomum leaves showed antibacterial activity against all the tested strains. The hexane fractions of P. arboreum, P. caldense and P. mollicomum showed antifungal activity, emphasizing the formation of 28 mm inhibition zone for the fraction of P. mollicomum. The two flavonoids isolated from P. montealegreanum showed no antimicrobial activity. Conclusions: preliminary results suggest that some the products obtained from Piper species are a promising source of compounds with antimicrobial activity(AU)

Sucessfull management of bilateral presumed Candida endogenous endophtalmitis following pancreatitis / Tratamento bem sucedido de caso de endoftalmite endógena bilateral presumida por Candida pós pancreatite

ABSTRACT Endogenous endophthalmitis is a rare, and frequently devastating, ophthalmic disease. It occurs mostly in immunocompromised patients, or those with diabetes mellitus, cancer or intravenous drugs users. Candida infection is the most common cause of endogenous endophthalmitis. Ocular candidiasis develops within days to weeks of fungemia. The association of treatment for pancreatitis with endophthalmitis is unusual. Treatment with broad-spectrum antibiotics and total parenteral nutrition may explain endogenous endophthalmitis. We report the case of a patient with pancreatitis treated with broad-spectrum antibiotics and total parenteral nutrition who developed bilateral presumed Candida endogenous endophthalmitis that was successfully treated with vitrectomy and intravitreal amphotericin B.

RESUMO Endoftalmite endógena é uma condição oftalmológica rara e frequentemente devastadora. Ocorre principalmente em pacientes imunocomprometidos, diabéticos, com neoplasias ou usuários de drogas intravenosas. Infecção por Candida é a causa mais comum de endoftalmite endógena. A candidíase ocular ocorre de dias a semanas após a fungemia. A associação de endoftalmite e o tratamento para pancreatite é rara. O tratamento com antibióticos de amplo espectro e alimentação parenteral total podem explicar uma endoftalmite endógena. Neste estudo, reportamos o caso de um paciente com pancreatite tratado com antibióticos de amplo espectro e alimentação parenteral total que desenvolveu endoftalmite endógena bilateral presumida por Candida que foi tratado com sucesso com vitrectomia e injeção intravítrea de amfotericina B.

Caracterização química e avaliação da atividade antioxidante, antifúngica e moduladora do extrato etanólico de Anadenanthera macrocarpa (BERTH) BRENAN / Caracterización química y actividad antioxidante, antifúngica y moduladora del extracto alcohólico de Anadenantera macrocarpa (Berth) Brenan / Chemical characterization and antioxidant, antifungal and modulating activity of the alcohol extract from Anadenantera macrocarpa (Berth) Brenan

Introdução: o estudo com plantas medicinais tem sido usado para assistência médica e farmacêutica, mais principalmente utilizadas como forma alternativa ou complementar ao tratamento terapêutico. Objetivo: este trabalho teve como objetivo elucidar os principais metabólitos secundários e atividade antioxidante, bem como avaliar a atividade antifúngica e moduladora do extrato etanólico de folhas de Anadenanthera macrocarpa frente às linhagens do gênero Candida. Métodos: na elucidação dos constituintes químicos foi utilizado o método de Cromatografia Líquida de Alta Eficiência, sendo que a verificação da atividade antioxidante foi realizada por método de FRAP. A atividade antifúngica do extrato foi mensurada através da determinação da Concentração Inibitória Mínima, sendo a modulação realizada por ensaio de microdiluição, realizado para verificar as interações entre o produto natural e o antifúngico utilizando a amostra em uma concentração subinibitória. Resultados: demonstrou-se pela análise do Cromatografia Líquida de Alta Eficiência a presença de metabólitos secundários, como a: quercitrina, quercetina, isoquercitrina, apigenina, ácido gálico e ácido caféico. No ensaio FRAP, a redução ocorreu em uma equivalência de 2,72 mg de FeSO4 por g de extrato. Na avaliação da concentração inibitória mínima foram obtidos resultados ≥512 µg/mL e na avaliação dos ensaios para efeito modulador, o extrato etanólico não potencializou o efeito do antifúngico, não havendo nem sinergismo nem antagonismo. Conclusão: através dos resultados podemos concluir que o presente extrato pode ser uma alternativa terapêutica uma vez que possui constituintes químicos com reconhecidas atividades biológicas e antioxidantes com baixo potencial tóxico(AU)

Introduction: the study of medicinal plants has been used for medical and pharmaceutical services, but mainly used as an alternative or in addition to therapeutic treatment. Objective: this study aimed to elucidate the main secondary metabolites and antioxidant activity and to evaluate the antifungal and modulating activity of the ethanol extract from Anadenanthera macrocarpa leaves against genus Candida strains. Methods: the chemical component clearance was made by using high-performance liquid chromatography, and checking of the antioxidant activity was performed by FRAP method. The antifungal activity of the extract was measured by determining the minimum inhibitory concentration, the modulation performed by microdilution test, carried out to verify the interactions between the natural product and the antifungal product using the sample at a subinhibitory concentration. Results: high-performance liquid chromatography showed the presence of secondary metabolites, such as: quercitrin, quercetin, isoquercitrin, apigenin, caffeic acid and gallic acid. In the FRAP assay, the reduction was 2,72 mg per equivalence grams of FeSO4 extract. The results of the assessment of minimum inhibitory concentration were ?512 µg/mL and in the evaluation of tests for modulating effect, the extract ethanol did not potentiate the antifungal effect, with neither synergism nor antagonism. Conclusions: from the results we can conclude that this extract can be an alternative since it has chemical constituents with known biological activities and antioxidants with low toxic potential(AU)

Introducción: el estudio de las plantas medicinales se han utilizado para la asistencia médica y farmacéutica, la mayoría utiliza principalmente como una alternativa o complemento al tratamiento terapéutico. Objetivo: el objetivo del estudio para dilucidar los principales metabolitos secundarios y la actividad antioxidante, así como evaluar la actividad antifúngica modulando el extracto de etanol de Anadenanthera macrocarpa frente las cepas del género Candida. Métodos: el esclarecimiento de los componentes químicos se utilizó cromatografía líquida de alta eficiencia y la comprobación de la actividad antioxidante se realizó por el método FRAP. La actividad antifúngica del extracto se midió mediante la determinación de la concentración mínima inhibitoria, y la modulación realizó por la prueba de microdilución, llevado a cabo para comprobar las interacciones entre el producto natural y el antifúngico utilizando la muestra a una concentración subinibitória. Resultados: se demostró mediante análisis por cromatografía líquida de alta eficiencia, de la presencia de metabolitos secundarios, tales como: quercitrina, quercetina, isoquercitrina, apigenina, ácido gálico y ácido cafeico. El ensayo FRAP, la reducción fue de 2,72 mg por equivalencia g de FeSO4 extrato. Na evaluación de la concentración inhibitoria mínima se obtuvieron resultados ≥512 µg/mL y la evaluación de las pruebas para el efecto de modulación, el extracto etanol no potenció el efecto de antifúngico, ni con sinergismo o antagonismo. Conclusión: de los resultados se puede concluir que el extracto puede ser una terapia alternativa, ya que tiene componentes químicos con actividades biológicas reconocidas y antioxidantes con bajo potencial tóxico(AU)

Brazilian guidelines for the management of candidiasis - a joint meeting report of three medical societies: Sociedade Brasileira de Infectologia, Sociedade Paulista de Infectologia and Sociedade Brasileira de Medicina Tropical

Candida infections account for 80% of all fungal infections in the hospital environment, including bloodstream, urinary tract and surgical site infections. Bloodstream infections are now a major challenge for tertiary hospitals worldwide due to their high prevalence and mortality rates. The incidence of candidemia in tertiary public hospitals in Brazil is approximately 2.5 cases per 1000 hospital admissions. Due to the importance of this infection, the authors provide a review of the diversity of the genus Candida and its clinical relevance, the therapeutic options and discuss the treatment of major infections caused by Candida. Each topography is discussed with regard to epidemiological, clinical and laboratory diagnostic and therapeutic recommendations based on levels of evidence.

Condição odontológica em pacientes internados em unidade de terapia intensiva / Oral conditions of patients admitted to an intensive care unit

Objetivo: Avaliar clinicamente a condição odontológica de pacientes internados em Unidade de Terapia Intensiva (UTI). Método: Foi realizado estudo exploratório, descritivo e transversal com avaliação clínica odontológica de 50 pacientes internados em UTI do Hospital São Vicente de Paula (João Pessoa/PB). Foram coletados os dados dos prontuários médicos relativos à idade, sexo, fator causal da internação e comorbidades relacionadas a problemas pulmonares. A análise da condição bucal foi qualificada em três categorias: boa (condição aceitável de higiene sem sangramento ao toque ou focos de infecção aparentes); regular (paciente apresentava pouco sangramento ao toque e/ou candidíase observada clinicamente como placas esbranquiçadas sobre mucosa inalterada ou avermelhada, removidas mecanicamente); e ruim (presença de abscessos e candidíase disseminada incluindo orofaringe). Resultados: A idade média dos examinados era de 53,8 (±18,5) sendo 23 (46%) do sexo masculino. As causas das internações de 24 (48,0%) pacientes foram neurológicas e de 26 (52%) por problemas renais, cardíacos, metabólicos, respiratórios e septicemia. Foram registrados quadros de pneumonia em 56% dos pacientes. Quanto à distribuição das condições de saúde bucal, observaram-se porcentagens significativamente maiores (p menor que 0,001) da condição de higiene ruim, comparadas às outras condições.Conclusões: A maioria dos pacientes internados em Unidade de Terapia Intensiva apresentava condição odontológica ruim, e a candidíase foi a infecção mais prevalente.

Objective: To evaluate clinically the oral conditions of the patients admitted to an Intensive Care Unit (ICU). Method: An exploratory, descriptive and transversal study was developed with clinical oral evaluation of 50 patients admitted to the ICU of the São Vicente de Paula Hospital (João Pessoa, PB, Brazil). The data were collected from the medical files concerning age, gender, cause of admission and comorbidities relative to lung problems. The oral condition was classified into three categories: good (acceptable hygiene, no gingival bleeding to touch or visible infection foci); regular (little gingival bleeding to touch and/or clinically visible candidiasis as white plaques on healthy or reddish mucosa, removed mechanically) and poor (presence of abscesses and widespread candidiasis, including the oropharynx). Results: The mean age of the patients was 53.8 (±18.5) years, 23 (46%) of them being male. Twenty-four (48%) patients were hospitalized due to neurological causes and 26 (52%) due to kidney, cardiac, metabolic or respiratory problems and septicemia. Pneumonia was present in 56% of the patients. As for the oral health conditions, there were significantly higher percentages (p less than 0.001) of poor conditions compared with the other conditions. Conclusion: Most patients admitted to the ICU presented poor oral condition and candidiasis was the prevalent infection.

Fungal infections of the oral mucosa.

Fungal infections in humans occur as a result of defects in the immune system. An increasing emergence in oral Candidal and non-Candidal fungal infections is evident in the past decade owing to the rise in the immunodeficient and immunocompromised population globally. Oral Candidal infection usually involves a compromised host and the compromise may be local or systemic. Local compromising factors include decreased salivation, poor oral hygiene, wearing dentures among others while systemic factors include diabetes mellitus, nutritional deficiency, HIV infection/AIDS and others. Oral candidiasis is generally a localized infection and rarely appears as a systemic fungal disease whereas oral non-Candidal fungal infections are usually signs of disseminated disease. Some of the non-Candidal fungi that were once considered exotic and geographically restricted are now seen worldwide, beyond their natural habitat, probably attributed to globalization and travels. Currently infections from these fungi are more prevalent than before and they may present either as primary oral lesions or as oral manifestations of systemic mycoses. This review discusses the various predisposing factors, clinical presentations, clinical differential diagnosis, diagnosis and management of oral candidiasis, as well as briefly highlights upon a few of the more exotic non-Candidal fungi that infect the oral mucosa.

Antifungigrama para comprovar o potencial de ação dos extratos vegetais hidroglicólicos sobre Candida sp. (Berkhout) / Etest to confirm the action potential of plant hydroglycol extracts on Candida sp. (Berkhout)

A candidíase vaginal é uma doença causada, na maioria das vezes, pelo fungo do gênero Candida sp, que habita o trato gastrintestinal e geniturinário da espécie humana e pode tornar-se patogênico sob determinadas condições. A maioria dos indivíduos desenvolve defesas imunológicas que impedem a proliferação e desenvolvimento de candidíase localizada ou disseminada. Embora a causa exata do aumento de espécies não-albicans seja desconhecida, há evidências de que a própria terapia antifúngica possa estar contribuindo para o processo. Linhagens de C. glabrata são mais resistentes aos imidazólicos do que a C. albicans, sendo necessária uma concentração 10 vezes superior de miconazol para eliminar a C. glabrata quando comparada a C. albicans. Foi realizado um antifungigrama testando o potencial de ação de produtos vegetais sobre o fungo Candida sp. Foi observado que, ocorreu inibição do fungo no contato com os extratos hidroglicólicos das plantas Arctium lappa L., Calendula officinalis L., Stryphnodendron adstringens (Mart.) Coville e Tabebuia avellanedae Lorentz ex Griseb. A importância deste trabalho reside na possibilidade de desenvolvimento de tratamento complementar, menos agressivo, de menor custo e sem toxidade, o que possibilitaria melhor qualidade de vida para portadoras de candidíase vaginal recorrente ou não.

Vaginal candidiasis is a disease caused, in most cases, by the fungus of the genus Candida sp., which inhabits the gastrointestinal and genitourinary tracts of the human species and can become pathogenic under certain conditions. Most individuals develop immune defenses that prevent the proliferation and the development of localized or disseminated candidiasis. Although the exact cause of the increase in non-albicans species is unknown, there is evidence that antifungal therapy itself may have contributed to it. Strains of C. glabrata are more resistant to imidazole than C. albicans, and a 10-fold higher concentration of miconazole is required to eliminate C. glabrata compared to C. albicans. Etest was performed by testing the action potential of plant products on the fungus Candida sp. Inhibition of the fungus occurred when it was in contact with the hydroglycol extracts of plants Arctium lappa L., Calendula officinalis L., Stryphnodendron adstringens (Mart.) Coville and Tabebuia avellanedae Lorentz ex Griseb. The importance of this study lies in the possibility of developing a complementary treatment, less aggressive, of lower cost and without toxicity, which would allow better life quality for women with vaginal candidiases that are recurrent or not.