Candida Tropicalis Spondylodiscits in an Immunocompetent Host: A Case Report and Literature Review

Background Fungal spondylodiscitis is not common but should be suspected in some cases. Candida tropicalis infections are being more frequently diagnosed due to some factors related to the microorganism. Case Description A C. tropicalis spondylodiscitis is described in a 72-year-old man who was treated with a combination of echinocandin (micafungin) and surgery. Conclusion The presence of some risk factors should promptly raise the suspicion of fungal spondylodiscitis. Treatment should be instituted as early as possible for the best outcome for the patient.

Efectividad de la tintura de propóleos al 10 % en pacientes con estomatitis subprótesis / Effectiveness of 10 % propolis tinction in patients with subprosthesis stomatitis

Se efectuó un estudio de intervención terapéutica en 50 pacientes con estomatitis subprótesis, quienes acudieron a la consulta de prótesis de la Clínica Estomatológica Ramón Guevara Montano de Baracoa, provincia de Guantánamo, desde abril del 2015 hasta junio del 2016, con vistas a determinar la efectividad del tratamiento con tintura de propóleos al 10 por ciento en los afectados. Se conformaron 2 grupos: uno de estudio (A) y otro de control (B), con 25 integrantes cada uno; el primero fue tratado con propóleos y el segundo con medicina alopática (nistatina en suspensión). La evaluación se realizó a los 4, 8 y 12 días. Al finalizar la terapia se observó que en 100,0 por ciento de los pacientes del grupo A se eliminó la lesión; por tanto, esta alternativa terapéutica resultó efectiva. Se recomendó extender dicha aplicación a otras afecciones bucales.

A study of therapeutic intervention was carried out in 50 patients with subprosthesis stomatitis who went to the Prosthesis department of "Ramón Guevara Montano" Stomatological Clinic in Baracoa, Guantánamo province, from April, 2015 to June, 2016, aimed at determining the effectiveness of the treatment with 10 percent propolis tinction in the affected patients. Two groups were formed: a study group (A) and a control group (B), with 25 members each; the first one was treated with propolis tinction and the second with allopathic medicine (nystatin in suspension). The evaluation was carried out at 4.8 and 12 days. When concluding the therapy it was observed that in 100.0 percent of the patients of the group A the lesion was eliminated; therefore, this therapeutic alternative was effective. It was recommended to extend this procedure to other oral disorders.

Candidiasis diseminada en paciente inmunocompetente. Revisión bibliográfica a propósito de un caso / Disseminated candidiasis in an immunocompetent patient. Case report and literature review

La candidiasis es la micosis más común entre los pacientes inmunocompetentes de los países desarrollados. Comprende la candidemia, mas frecuente y la candidiasis de los tejidos profundos. La candidiasis de los tejidos profundos tiene una mortalidad de hasta el 40%, incluso en los pacientes que reciben tratamiento oportuno. Además, el desplazamiento global a favor de las especies de cándida no albicans es preocupante, al igual que los nuevos perfiles de resistencia a los antimicóticos actuales.

Candidiasis is the most common mycosis among immunocompetent patients in developed countries. It includes candidemia, more frequent, and candidiasis of deep tissues. Candidiasis of deep tissues has a mortality of up to 40%, even in patients receiving timely treatment. In additioin, the global shift in favor of non-albicans candida species is worrisome, as are the new profiles of resistance to current antifungals.

Experiencia clínica pediátrica en endocarditis infecciosa por Candida spp / Pediatric clinical experience in infectious endocarditis due to Candida spp

Resumen Introducción: El tratamiento y evolución de endocarditis infecciosa por Candida spp en niños debe basarse en guías de manejo; sin embargo, aún existen controversias al respecto. Objetivo: Describir nuestra experiencia en el tratamiento de EI por Candida spp en pacientes pediátricos. Métodos: Estudio prospectivo, analítico, realizado entre enero de 2006 y diciembre 2017. Análisis paramétrico de variables cuantitativas; razones, proporciones, comparación por medio de χ2 y prueba exacta de Fisher con IC al 95% para variables no paramétricas. Tasa de mortalidad. Resultados: Veinticinco episodios de endocarditis por Candida spp recibieron tratamiento anti fúngico estándar. La mortalidad fue superior en pacientes sometidos a resección de la vegetación endocárdica (66,7%) RR 3,16, χ2 p = 0,029, en niños con síndrome linfo-hemofagocítico SLHF (50%), RR= 1,18 (χ2 NS), en co infección con bacterias multi-resistentes (57,1 %) RR= 2, (χ2 NS) y en EI trombótica (88,9%) RR = 4,74 (χ2 p = 0,004). Conclusiones: Co-infección de EI por Candida sp con bacterias multi-resistentes, SLHF y/o manejo quirúrgico de la vegetación endocárdica, pueden considerarse factores de mal pronóstico.

Background: Treatment and outcome of Candida spp infectious endocarditis in children it most be based on treatment guidelines, however there are some controversies. Aim: To describe our experience on treatment of pediatric candidal infective endocarditis. Methods: Analytic prospective study, from January 2006 to December 2017. Parametric analysis for quantitative variable. Proportions were compared by χ2 and exact Fisher Test CI 95%. Mortality rate. Results: 25 episodes of Candida spp infective endocarditis were treated with standard antifungal drugs. Mortality rate was higher on patients submited to endocardic vegetation resection (66.7%) RR= 3.16, (χ2 p = 0.029), children with lymphohemophagocytic syndrome (LHFS) (50 %) RR= 1.18 (χ2 = N.S.), in multidrug resistant bacterial co infection (57.14%), RR = 2, (χ2 = NS) also thrombotic endocarditis (88.9%) RR= 4.74 (χ2 p = 0.004). Conclusion: Multidrug resistant bacteria co infection with Candida sp IE, LHFS, and/or surgical treatment of endocardic vegetation, might be considered as bad prognostic factors.

Clinical analysis of candidemia in immunocompetent patients / 北京大学学报(医学版)

OBJECTIVE@#To investigate the etiological and clinical characteristics of immunocompetent patients with candidemia.@*METHODS@#The clinical and microbiological data of patients diagnosed as candidemia admitted in Peking University Third Hospital from January 2010 to June 2016 were retrospectively analyzed. Underlying diseases, Candida spp. colonization, clinical manifestations, microbiological data, treatment and the outcome were compared between the HIV-negative immunocompromised (IC) and nonimmunocompromised (NIC) patients.@*RESULTS@#A total of 62 cases diagnosed as candidemia were analyzed including 36 men and 26 women, with 16 to 100 years of age [(66.02±17.65) years]. There were 30 NIC and 32 HIV-negative IC patients respectively. In the NIC patients, there were 19 cases (19/30, 63.33%) with admission in intensive care unit (ICU), 21 (21/30, 70.00%) associated diabetes mellitus or uncontrolled hyperglycemia and 22 (22/30,73.33%) receiving invasive mechanical ventilation, while in the HIV-negative IC patients, there were 8 (8/32, 25.00%), 13 (13/32, 40.63%) and 7 (7/32, 21.88%) respectively (P<0.05). The NIC patients had higher acute physiology and chronic health evaluation (APACHE II) scores and sequential organ failure assessment (SOFA) scores both at admission (19.98±5.81, 6.04±6.14) and candidemia onset (25.61±6.52, 12.75±8.42) than the HIV-negative IC patients (APACHEII 15.09±5.82, 22.15±5.98) and SOFA 2.87±2.73, 7.66±5.64 respectively (P<0.05). In the NIC patients, twenty-one cases (21/30, 70.00%) died in hospital, while 14 cases (14/32, 43.75%) in HIV-negative IC. The crude mortality was significantly different between the two groups (P<0.05). By blood culture, Canidia albicans remained the the most prevalent isolates in all the patients. Clinical manifestation, Candida spp. colonization, etiology and drug susceptibility were also similar between NIC and HIV-negative IC patients (P>0.05).@*CONCLUSION@#Candidemia in NIC patients tends to occur in those who are much more critically ill, more often admitted in ICU, and more frequently have diabetes mellitus or uncontrolled hyperglycemia and receive invasive mechanical ventilation than HIV-negative IC patients. NIC patients also have poorer prognosis than HIV-negative IC patients. Clinical manifestations, and microbiological characteristics are similar between HIV-negative IC and NIC patients.

Actividad antimicrobiana in vitro de Pteris vittata L / In vitro antimicrobial activity of Pteris vittata L

Introducción: las hojas de Pteris vittata L (helecho) son utilizadas por la población para el tratamiento de la candidiasis y en enfermedades producidas por bacterias en la piel. Objetivo: identificar preliminarmente las familias de metabolitos secundarios presentes en las hojas de la planta y evaluar su posible actividad antimicrobiana. Métodos: se recolectaron las hojas de Pteris vittata L. El material vegetal fue lavado, desinfectado, secado y seguidamente se procedió a su pulverización. Este polvo se utilizó en la elaboración de los diferentes extractos y tintura. La tintura obtenida se concentró y se fraccionó sucesivamente con n-hexano, cloroformo y acetato de etilo. A estos extractos se les realizó el tamizaje fitoquímico, ensayos microbiológicos y cromatografía de capa fina. Resultados: las pruebas in vitro efectuadas a los extractos obtenidos a partir de la tintura 20 por ciento, demostraron que éstos presentan actividad antimicrobiana frente a Escherichia coli, Staphylococcus aureus, destacándose los resultados obtenidos frente a Candida sp para los extractos de acetato de etilo y clorofórmico. En estas fracciones están presentes en mayor proporción alcaloides y quinonas, que podrían ser los responsables de esta actividad, lo cual se corrobora con la identificación de estos metabolitos secundarios mediante la cromatografía de capa fina y el tamizaje fitoquímico realizado. Conclusiones: el estudio combinado mediante la cromatografía de capa fina y el tamizaje fitoquímico de los extractos hexánico, acetato de etilo y clorofórmico permite inferir que la actividad antimicrobiana puede deberse a la presencia de quinonas y alcaloides(AU)

Introduction: Pteris vittata L. leaves (fern) are used by people on the candidiasis treatment and some skin illnesses caused by bacteria. Objective: to identify preliminarily the secondary metabolites present in the leaves of the plant and to evaluate their possible antimicrobial activity. Methods: Pteris vittata L. leaves were collected. The plant material was washed, disinfected, dried and pulverized. The powder obtained was used to make the various extracts and the tincture. The latter was concentrated and successively fractionated with n-hexane, chloroform, and ethyl acetate. The extracts underwent phytochemical screening, microbiological assays and thin-layer chromatography. Results: in vitro tests performed in the obtained extracts from the 20 percent tincture proved that they have antimicrobial activity against Escherichia coli and Staphylococcus aureus, emphasizing the accomplished results against Candida of the ethyl and chloroform acetate extracts. Alkaloids and quinones, which are found in large proportion in the extracts, would be responsible of the above- mentioned antibacterial activity. This was corroborated by the identification of these secondary metabolites through thin-layer chromatography and phytochemical screening. Conclusions: the combined study through thin-layer chromatography and phytochemical screening of the ethyl and chloroform acetate extracts showed that the antimicrobial activity could be possible due to the alkaloids and quinones presence(AU)

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.

Micosis superficiales / Superficial mycoses

Las micosis superficiales constituyen una patología prevalente en Dermatología. Son producidas por dos grandes grupos de hongos: las levaduras y los dermatofitos (tiñas). Las primeras ocurren por una alteración de la microbiota que lleva a una proliferación del hongo y las segundas son infecciones exógenas en que el contagio está dado por transmisión de un animal u otra persona. A las tiñas se les denomina por el nombre del área anatómica afectada. En el presente artículo, se entregan las herramientas para el manejo de estas patologías por parte del médico no especialista, se señalanlos aspectos más relevantes de la clínica y los medicamentos usados en los diferentes tratamientos orales y tópicos. Se sugieren también los criterios de derivación al especialista.

Superficial mycoses are a prevalent dermatological pathology. These are produced by two major groups of fungi, yeasts and dermatophytes (tinea infections or ringworm). The former occur by an alteration of the microbiota that leads to a proliferation of yeasts and the latter are exogenous infections transmitted by an animal or another person. Tinea infections are called by the name of the affected anatomicalarea. This paper provides tools to non-specialist physicians to manage these conditions, identifying the most relevant clinical aspects and oral and topical treatment options. It alsosuggests criteria for referral to a specialist.

Candidíase crônica / Chronic candidiasis: case-report

Introdução: Paciente de 62 anos, primeira consulta em outubro de 2006, com diagnóstico de candidíase crônica. Durante o primeiro ano de tratamento foram prescritos Natrum muriaticum 1MFC, 10MFC, 50MFC (dose única) sem melhora; Ignatia amara 50CH, 60CH, 70CH (dose única) sem melhora e Pulsatilla pratensis 12LM, (diariamente durante 1 mês) sem melhora. Em agosto de 2007 foi prescrito o medicamento Cyclamen europaeum com resolução do quadro. Os sintomas utilizados para repertorização foram: 1) Ilusão que negligenciou seu dever; 2) Sensação deabandono.

Candidiasis esofágica / Esophageal candidiasis

La Candidiasis esofágica es una entidad frecuente en pacientes con VIH, cáncer, usuarios de corticoides, algorra orofaringea. La Candida es un organismo comensal y puede infectar al ser humano. Existe una serie de factores locales y sistémicos del huésped que favorecen la infección por Candida. El cuadro clínico se presenta frecuentemente con odinofagia, disfagia y dolor retroesternal. El diagnóstico de certeza es histológico. El estudio endoscópico entrega un estudio de alta calidad, altamente sensible y permite diferenciar distintas causas de esofagitis. La candidiasis esofágica debe ser tratada con terapia sistémica. El fármaco más recomendado es el fluconazol.

Esophageal candidiasis is a frequently occurring entity in corticoid users, patients with HIV and oropharyngeal involvement. Candida is a commensal organism, and it can infect humans. There are many local and systemic factors of the host that favor Candida infection. Frequently clinical manifestations are odynophagia, dysphagia and retrosternal pain. Diagnostic certainty reached by histological assays. Endoscopic studies provide high-quality and highly-sensitive results that allow to differentiate esophagitis causes. Esophageal Candidiasis must receive systemic treatment. The most recommended drug is Fluconazol.

Uma paciente Cyclamen europaeum portadora de candidíase crônica / Cyclamen europaeum a patient suffering from chronic candidiasis

Paciente de 57 anos, primeira consulta em outubro de 2006, com diagnóstico de candidíase. No primeiro ano de tratamento foram prescritos os medicamentos Natrum muriaticum, Ignatia amara, Silicea, Platina, Pulsatilla nigricans, Sepia e Alumina sem melhora. Em agosto de 2007 foi prescrito o medicamento Cyclamen europaeum com resolução do quadro. Foram utilizadas doses nas diluições de 1.000 FC até 1.000.000, de 50cH a 1000cH. Assintomática após a dose de 600cH em outubro de 2008. No momento usando a 30LM. A substância foi escolhida pelos temas: culpa, abandono e busca da perfeição, sendo que a modalidade manifesta durante o quadro agudo, “sem alegria” confirmava um tema central na hipótese da dinâmica miasmática do medicamento. A paciente continua evoluindo bem sem retorno da entidade clínica e em equilíbrio na psora latente até a última consulta, em outubro de 2010.

A 57 year-old patient consulted in October 2006 for candidiasis. During the first year of treatment it was prescribed Natrum muriaticum, Ignatia amara, Silicea, Platina, Pulsatilla nigricans, Sepia and Alumina without improvement. In August 2007 it was prescribed Cyclamen europaeum, followed by resolution of the complaint. The remedy was given in dilutions 1.000 FC to 1.000.000 and from 50cH to 1000cH. The patient became asymptomatic after dilution 600cH, taken in October 2008. Currently, he is taking dilution 30LM. The remedy was chosen on the grounds of the following themes: guilt, forsakenness and search for perfection, whereas a modality manifest during an acute intercurrence, “joyless” confirmed a central theme of the miasmatic dynamics of the remedy. The progression of the picture remains positive, the disease never came back, and the patient was equilibrated in latent psora when last seen in October 2010.

Eucalyptus globulus [Eucalyptus] treatment of candidiasis in normal and diabetic rats

The leaves of Eucalyptus globulus [eucalyptus] are used for treatment of diabetes mellitus in traditional medicine. The aim of this study was to evaluate the effects of eucalyptus in treatment of established systemic infection with Candida albicans in normal and streptozotocin-induced diabetic rats. Sixty normoglycemic male Wistar rats, weighing 200-250 g, were selected and randomly divided into six groups [n= 10]: normal control, control + C. albicans, control + eucalyptus + C. albicans, diabetic control, diabetic + C. albicans, diabetic + eucalyptus + C. albicans. Diabetes was induced after a single intraperitoneal injection of streptozotocin [60 mg/kg body weight] and eucalyptus was added to the diet [62.5 g/kg] and drinking water [2.5 g/L] of treated animals for 4 weeks. The concerned groups were inoculated with C albicans 15 days after diabetes induction. At the end of one month experiment, fasted rats were killed by cervical decapitation. Blood was collected from neck vein for estimation of glucose. C. albicans concentrations were estimated in liver and kidneys using serial dilution culture of tissue homogenates. Eucalyptus administration significantly improved the hyperglycemia, polydipsia, polyphagia, and it also compensated weight loss of diabetic rats [P<0.05]. Moreover, eucalyptus caused a significant reduction in C. albicans concentration in liver and kidney homogenates [P<0.01]. The results revealed that eucalyptus improves Candidia infection in normal and diabetic rats that in some ways validates the traditional use of this plant in treatment of diabetic patients

[Review of routine therapeutic management of common oral lesions]

Since there are not specific pathogens for most of the intraoral lesions and there is not unique protocol for their therapies and also some of these drugs are not accessible in Iran, we decided to introduce the drugs most available and appropriate in our country. This study has been done by review discussion procedures. The articles were extracted from native, foreign and international journals, medline, books and theses. Whole part of therapies were considered in these articles. The following lesions were discussed in this study: 1- Primary and secondary herpetic gingivostomatitis, 2- Recurrent Aphthus stomatitis, 3- Lichen planus, 4-Candidiasis, 5- Burning sensation in oral cavity, 6- Xerostomia and 7- taste disorder. As we know there are several kinds of medications for each lesion, although most of them have side effects, and some of them can not be found in our country, we have tried to do our best to suggest appropriate drugs for each intraoral disorders

Candidosis en pacientes HIV o con otras inmunodeficiencias secundarias en hospitales de la ciudad de Tucumán (Argentina) / Candidosis in HIV patients or with other secondary immunodeficiencies detected in hospitals of the city of Tucumán (Argentina)

Con el objeto de conocer las especies causantes de candidosis humanas en pacientes HIV positivos o con otras inmunodeficiencias secundarias y la incidencia de especies con capacidad de resistencia a antifúngicos, se estudiaron 76 aislamientos de Candida procedentes de 61 casos de candidosis superficiales y profundas de niños y adultos. Obtenidas desde piel, anexos, mucosas, abscesos, catéteres y secreciones diversas, entre otras. La identificación de las especies fue realizada por estudios de características morfológicas, cromogénicas y bioquímicas (CHROMagar , Candifast, API 20 y API 32). Los resultados revelan predominio de especies noalbicans (52.7 por ciento), obteniéndose las siguientes frecuencias de aislamientos: C.albicans (47,3 por ciento), C. parapsilosis: 15,8 por ciento, C. glabrata: 13,2 por ciento, C. krusei: 11,8 por ciento, C. tropicalis: 10,6 por ciento y C. dubliniensis: 1,3 por ciento. Algunas de ellas pueden presentar resistencia primaria o secundaria a algunos antifúngicos de uso habitual, por lo cual es necesario incluir estudios de sensibilidad a estos, para una mejor conducta terapéutica.

In order to find out species causing human candidosis in positive HIV patients or in individuals suffering from other secondary immunodeficiencies and the incidence of species bearing a resistance ability to antifungal agents, 76 Candida isolations obtained from 61 cases of superficial and deep candidosis in children and adults were studied. Samples were collected from skin, annexa, mucosities, abscesses, catheters and diverse secretions, among others. The identification of species was carried out through studies on morphological, chromogenic and biochemical characteristics (CHROMagar, Candifast, API 20 and API 32). Results reveal a predominance of non-albican species (52,7 percent), and the following frequencies of isolation: C.albicans (47.3 percent), C. parapsilosis: 15.8 percent, C.glabrata: 13.2 percent, C. krusei: 11.8 percent, C. tropicalis: 10.6 percent and C. dubliniensis: 1.3 percent. Some of them may exhibit some primary or secondary resistance to certain antifungal agents of common use, this is why it is necessary to include studies on sensitivity of them so as to attain a better therapeutical behaviour.

Candida dubliniensis y Candida albicans: patógenos orales oportunistas fenotípicamente y filogenéticamente relacionados / Candida Dubliniensis and Candida Albicans, two phenotypically-phylogenetically closed related oportunistic oral pathogens

Las infecciones de hongos oportunistas y en particular aquellas causadas por especies de Candida, tienen gran importancia comocausa de morbilidad y aun de mortalidad. Aunque Candida albicans parece ser la levadura más frecuentemente aislada como unpatógeno oral oportunista, otras levaduras orales, tal como Candida dubliniensis son a menudo identificadas en pacientesinmunocomprometidos.Consideramos de importancia el estudio de Candida dubliniensis ya que tiene muchas características fenotípicas y genéticasíntimamente relacionadas con Candida albicans y debido a que ha surgido como una causa de importancia significativa decandidosis (superficiales y profundas), no solamente en pacientes infectados con VIH sino en pacientes no infectados.

Fungal opportunistic infections, and in particular those caused by Candida species, have gained considerable significance as acause of morbility and often mortality. Although Candida albicans, remains to be the most frequently isolated fungal species asan opportunistic oral pathogen, other yeast species are often in immunocompromised patients. We consider it is important thestudy of Candida dubliniensis because it shares phenotypic characteristics with Candida albicans and it is phylogeneticallyclosed related to it. Candida dubliniensis has appeared as a cause of mycosis in HIV-positive patients and in healthy patientstoo.

Candidíase extragenital / Extragenital candidiasis

As vulvovaginites constituem-se um dos diagnósticos mais frequêntes na prática diária em ginecologia. Os ginecologistas enfrentam o problema da candidíase genital näo complicada com algum sucesso, entretanto, conhecem pouco da doença, quando esta assume formas extragenitais ou recorrentes, tendo sérias dificuldades no manuseio das pacientes. Breve resumo do diagnóstico e tratamento da infecçäo extragenital nas seguintes formas de candidíase: oral, cutânea, mucocutânea crônica, esofágica, gastrointestinal, urinária, do sistema nervoso central, respiratório, cardíaca, ocular, entre outras

Candidiasis sistémica. Experiencia en el Hospital San Juan de Dios 1996-1998 / Systemic Candidiasis. Experience of the Hospital San Juan de Dios 1996-1998

La sobrevida de los pacientes con enfermedades crónicas así como de aquellos expuestos a terapias médicas y quirúrgicas agresivas ha aumentado. Entre otras cosas, gracias al empleo de antibióticos de amplio espectro, al uso de nutrición parenteral, a la aplicación de medicamentos inmunomoduladores, al transplante de órganos y al desarrollo de las unidades de cuidado intensivo. No obstante, esto ha conllevado a la aparición de complicaciones como son las infecciones por hongos. Dentro de éstas, en los últimos años se ha demostrado que las diversas especies de cándida tienen un papel importante. La candidiasis sistémica puede ser una complicación severa en estos pacientes, con una alta morbimortalidad. En nuestro medio, desconocemos estudios donde se analice esta patología, razón por la cual se llevó a cabo este trabajo. Se estudiaron retrospectivamente los pacientes con candidiasis sistémica diagnosticados en el Hospital San Juan de Dios, hospital nacional de aproximadamente 700 camas, entre los meses de enero de 1996 a diciembre de 1998. Se analizaron 48 episodios de candidiasis sistémica en 47 pacientes. La edad promedio fue de 53 años, 60 por ciento fueron hombres. La mortalidad fue de 36 por ciento. En 77 por ciento de los pacientes se logró identificar alguna patología de base (enfermedad hemato-oncológica, diabetes mellitus, cirugía abdominal, enfermedad por VIH, quemaduras extensas). Los principales factores de riesgo demostrados fueron el uso previo de antibióticos de amplio espectro (87 por ciento), presencia de catéter venoso central (72 por ciento), candidiasis en otros sitios (64 por ciento), cirugía abdominal previa (25 por ciento), empleo de nutrición parenteral (23 por ciento), y uso de corticoesteroides (23 por ciento). En todos los pacientes se logró identificar al menos un factor de riesgo. Las principales especies de cándida aisladas fueron C albicans (47 por ciento), C tropicalis (19 por ciento), C parapsilosis (11 por ciento), C krusei (4 por ciento) y C glabrata (2 por ciento). Se analizó la relación entre la especie aislada y los factores de riesgo. Se encontró que C krusei y C parapsilosis se relacionaron con el uso previo de antimicóticos azoles. La mortalidad fue mayor en aquellos pacientes no tratados con antimicóticos. Se discuten estos hallazgos y se correlacionan con lo publicado en la literatura médica, llamándose la atención sobre el aumento en la incidencia de candidiasis sistémicas por candidas...