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2.
Braz. j. infect. dis ; 22(1): 11-15, Jan.-feb. 2018. tab, graf
Article in English | LILACS | ID: biblio-951617

ABSTRACT

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.


Subject(s)
Humans , Adult , Middle Aged , Fluconazole/cerebrospinal fluid , Fluconazole/blood , Cryptococcosis/drug therapy , Antifungal Agents/cerebrospinal fluid , Antifungal Agents/blood , Reference Values , Candidiasis/cerebrospinal fluid , Candidiasis/drug therapy , Candidiasis/blood , Microbial Sensitivity Tests , Fluconazole/administration & dosage , Chromatography, High Pressure Liquid , Treatment Outcome , AIDS-Related Opportunistic Infections/drug therapy , Statistics, Nonparametric , Cryptococcosis/cerebrospinal fluid , Cryptococcosis/blood , Cryptococcus/isolation & purification , Cryptococcus/drug effects , Dose-Response Relationship, Drug , Histoplasmosis/cerebrospinal fluid , Histoplasmosis/drug therapy , Histoplasmosis/blood , Antifungal Agents/administration & dosage
3.
Rev. Soc. Bras. Clín. Méd ; 15(2): 124-126, 20170000. ilus
Article in Portuguese | LILACS | ID: biblio-875612

ABSTRACT

A criptococose é uma doença fúngica sistêmica causada por Cryptococcus neoformans, que acomete principalmente indivíduos imunocomprometidos, podendo eventualmente acometer imunocompetentes. Existem duas variedades da espécie (neoformans e gattii), com características diferentes, mas clinicamente semelhantes, sendo possível sua distinção apenas por do teste de identificação da espécie. O tratamento preconizado é constituído por anfotericina B e fluconazol endovenosos, com duração de meses, existindo pouco relato na literatura sobre resistência à terapêutica habitual ou tratamento alternativo. Neste trabalho, é relatado um caso de neurocriptococose por C. gattii resistente a fluconazol em imunocompetente, no qual foi realizada anfotericina B endovenosa associada a intratecal sem sucesso, evoluindo o paciente a óbito por provável complicações da hidrocefalia obstrutiva.(AU)


Cryptococcosis is a systemic fungal disease caused by Cryptococcus neoformans, which primarily affects immunocompromised individuals, but may occasionally affect immunocompetent individuals. There are two varieties of the species, with different, but clinically similar characteristics, with their distinction being possible only through the species identification test. The recommended treatment consists of intravenous amphotericin B and fluconazole, for some months. There are few reports in the literature on resistance to standard therapy, or an alternative treatment. In this study, we describe a case of fluconazole-resistant neurocryptococcosis by Cryptococcus gattii in immunocompetent individuals, who unsuccessfully received intravenous and intrathecal amphotericin B , with the patient progressing to death from probable complications of obstructive hydrocephalus.(AU)


Subject(s)
Humans , Male , Adult , Amphotericin B/administration & dosage , Amphotericin B/therapeutic use , Fluconazole/administration & dosage , Fluconazole/therapeutic use , Meningitis, Cryptococcal , Immunity
4.
Braz. j. infect. dis ; 21(3): 333-338, May-June 2017. tab, graf
Article in English | LILACS | ID: biblio-839209

ABSTRACT

ABSTRACT Objective: This article aims to review the use of antifungal prophylaxis with intravenous fluconazole in premature newborns and the occurrence of Invasive Candidiasis. Methods: This is a systematic review with search at databases: PubMed, Capes Portal, Virtual Health Library (BVS - Biblioteca Virtual em Saúde)/Lilacs, Scopus and Cochrane. The keywords used were: "Antifungal", "Candida" "Fluconazole prophylaxis" and "Preterm infants". Results: Invasive Candidiasis was evaluated in all the twelve items. In eleven of them, there was a statistically significant difference between the groups receiving prophylactic fluconazole, with lower frequency of Invasive Candidiasis, compared to placebo or no prophylaxis group. Colonization by Candida species was also evaluated in five studies; four of them presented statistically lower proportion of colonization in patients with Fluconazole prophylaxis, compared to placebo or no drugs. In one study, there was a significant difference, favoring the use of fluconazole, and reduction of death. Conclusion: Studies indicate the effectiveness of prophylaxis with fluconazole, with reduction in the incidence of colonization and invasive fungal disease. The benefits of prophylaxis should be evaluated considering the incidence of candidiasis in the unit, the mortality associated with candidiasis, the safety and toxicity of short and long-term medication, and the potential for development of resistant pathogens.


Subject(s)
Humans , Infant, Newborn , Infant, Premature , Fluconazole/administration & dosage , Candidiasis, Invasive/prevention & control , Infant, Premature, Diseases/prevention & control , Antifungal Agents/administration & dosage
5.
Gac. méd. boliv ; 38(1): 30-33, jun. 2015. ilus, graf, tab
Article in Spanish | LILACS | ID: lil-755479

ABSTRACT

La paracoccidioidomicosis es una micosis profunda y sistémica frecuente en las zonas tropicales y subtropicales de América Latina, cuyo agente etiológico es el Paracoccidioides sp. Es una enfermedad prevalente de la población adulta más del 95% de los casos secundario al largo período de latencia, por lo que existen pocos reportes en la edad pediátrica. Se presenta caso clínico de adolescente de 14 años de sexo masculino, quién cursó con múltiples adenopatías en todo el cuerpo, predominio en la región cervical, asociado a palidez mucocutanea generalizada y dolor abdominal inespecífico. Antecedente de presentar un mes atrás accesos de tos, fiebre e hiporexia. Se realizó el diagnóstico diferencial con: leucemia, linfomas, tuberculosis pulmonar y extrapulmonar. El diagnóstico se confirmó por histopatología de biopsia ganglionar y examen directo. El paciente fue tratado con Itraconazol, presentando una evolución favorable.


Paracoccidioidomycosis is a deep and systemic fungal infection common in tropical and subtropical areas of Latin America, whose etiologic agent is Paracoccidioides sp. It is a common disease of the adult population over 95% cases are secondary cases to the long latency period, so there are few reports in children. It present a clinical case of 14-year old male, who had attended multiple lymph nodes in all body, predominantly in the cervical region, associated with generalized mucocutaneous paleness and nonspecific abdominal pain. Antecedent to present a month ago coughing, fever and hyporexia. Presenting a favorable evolution Leukemia, lymphoma, pulmonary and extrapulmonary tuberculosis: the differential diagnosis was made. The diagnosis was confirmed by biopsy of histopathology node and direct examination. The patient was treated with itraconazole, presunting a favorable evolution.


Subject(s)
Paracoccidioidomycosis , Biopsy/methods , Fluconazole/administration & dosage , Cefotaxime/administration & dosage
6.
Rev. ciênc. farm. básica apl ; 35(2): 257-261, jun. 2014. ilus, tab
Article in English | LILACS | ID: lil-757772

ABSTRACT

O controle de qualidade de fármacos desempenha um papel importante na saúde pública ao garantir segurança e eficácia de medicamentos. No sistema de saúde pública,as farmácias magistrais também são importantes. Elas fornecem medicamentos personalizados como produtos dermatológicos e doses específicas para crianças.Infelizmente, muitos casos de produtos magistrais fabricados fora do padrão mínimo de qualidade têm sido relatados no Brasil. Neste trabalho, a qualidade das cápsulas magistrais de fluconazol 150 mg foi avaliada e os resultados foram comparados com os valores recomendados pela Farmacopeia Brasileira. Os resultados sugerem que é possível manipular produtos que satisfaçam as especificações farmacopeicas, mas estes ainda mostram que há farmácias magistrais onde o controle de qualidade é deficiente ou inexistente. O fluconazol é um fármaco importante no tratamento de infecções fúngicas. Seu uso como forma farmacêutica manipulada sem elevados padrões de qualidade é fortemente relacionado com a falha terapêutica e intoxicações, assim como o surgimento de microorganismos resistentes. Portanto, a necessidade de melhoria dos processos nas farmácias magistrais se torna mais enfático. Existem métodos validados que podem ser utilizados com sucesso para a análise de rotina de controle de qualidade e que podem ser implementados por qualquer farmácia de manipulação...


The quality control of drugs has an important role in public health, in ensuring the efficacy and safety of medicines. In the public health system, compounding pharmacies play a vital part. They provide medicines tailored to the individual patient, for example dermatological products and specific doses for children. Unfortunately, many cases of compounded products falling below the minimum quality standard have been reported in Brazil. In this study, the quality of compounded 150 mg fluconazole capsules was assessed and the results were compared with values stipulated in the Brazilian pharmacopoeia. The results suggest that, while it is certainly possible to prepare products meeting pharmacopoeial specifications, there are pharmacies where the quality control is deficient or nonexistent. Fluconazole is an important drug in combatting fungal infections. The use of fluconazole in dosage forms manufactured without high standards of quality control is strongly linked to treatment failure and cases of intoxication, as well as the emergence of resistant microorganisms. This highlights the urgent need for process improvement in compounding pharmacies. There are validated methods that can be successfully employed for routine quality control analysis that can be implemented by any compounding pharmacy...


Subject(s)
Humans , Drug Evaluation/methods , Fluconazole/administration & dosage , Fluconazole/metabolism , Quality of Homeopathic Remedies , Good Manipulation Practices , Capsules , Homeopathic Remedy
7.
Rev. chil. infectol ; 29(supl.1): 11-18, set. 2012.
Article in Spanish | LILACS | ID: lil-656320

ABSTRACT

Invasive fungal infections are an important cause of morbidity and mortality in SOT and HSCT recipients. The main species involved are Candida spp. and Aspergillus spp, less frequently Cryptococcus spp., causal agents of mucormycosis and Fusarium spp. Usually occur within the first six months post-transplant, but they do it later, especially during episodes of rejection, which maintains the state of immune system involvement. Prophylaxis recommendations are specific to each type of transplant. In liver transplantation use of fluconazole is recommended only in selected cases by high risk factor for invasive fungal infections (A1). If the patient has a high risk of aspergillosis, there are some suggestions for adults population to use amphotericin B-deoxycholate, liposomal amphotericin B or caspofungin (C2) without being validated none of these recommendations in pediatric population. In adult lung transplant patients where the risk of aspergillosis is higher than in other locations, we recommend universal prophylaxis with itraconazole 200 mg/day, nebulised liposomal amphotericin B or voriconazole (C2), no validated recommendations for pediatrics. In HSCT, universal prophylaxis is recommended only in allogeneic and autologous selected cases. The most accepted indication is fluconazole (A1), and posaconazole (A1) or micafungin (A1) in selected cases with high risk of aspergillosis.


Las infecciones fúngicas invasoras constituyen una importante causa de morbilidad y mortalidad en los pacientes receptores de TOS y TPH. Los principales agentes involucrados son Candida spp. y Aspergillus spp, menos frecuentemente Cryptococcus spp., agentes causales de mucormicosis y Fusarium spp. Se presentan habitualmente dentro de los primeros seis meses posttrasplante, pero también lo hacen en forma más tardía, especialmente durante episodios de rechazo, en que se mantiene el estado de compromiso del sistema inmune. Existen recomendaciones de proilaxis especíicas para cada tipo de trasplante. En trasplante hepático se recomienda el uso de fluconazol sólo en casos seleccionados por factores de riesgo (A1). Si existe riesgo de asper-gilosis, hay algunas sugerencias en adultos para el uso de anfotericina B-deoxicolato, anfotericina liposomal o caspofungina (todo en categoría C2), sin estar validada ninguna de estas recomendaciones en pediatría. En trasplante pulmonar en paciente adulto, donde el riesgo de aspergilosis es superior a otras localizaciones, se recomienda proilaxis universal, con itraconazol 200 mg/día, anfotericina liposomal nebulizada o voriconazol (C2), sin recomendaciones validadas para pediatría. En TPH, se recomienda proilaxis universal en trasplante alogénico y sólo para casos seleccionados en trasplantes autólogos. La indicación más aceptada es fluconazol (A1), siendo alternativas a evaluar dependiendo del riesgo de aspergilosis, posaconazol (A1) y micafungina (A1).


Subject(s)
Humans , Antifungal Agents/therapeutic use , Mycoses/prevention & control , Organ Transplantation , Stem Cell Transplantation , Antifungal Agents/administration & dosage , Aspergillus/pathogenicity , Candida/pathogenicity , Drug Administration Schedule , Evidence-Based Medicine , Fluconazole/administration & dosage , Incidence , Mycoses/epidemiology , Mycoses/microbiology , Practice Guidelines as Topic , Postoperative Complications/prevention & control
8.
Biomédica (Bogotá) ; 32(3): 386-398, jul.-set. 2012. ilus, graf, mapas, tab
Article in English | LILACS | ID: lil-663709

ABSTRACT

Introduction: A survey on cryptococcosis is being conducted regularly in Colombia since 1997. We present hereby the results corresponding to patients diagnosed from 2006 to 2010. Objective: To analyze the data obtained during this period. Materials and methods: Retrospective analysis of the corresponding surveys. Results: A total of 526 surveys originating from 72% of the Colombian political divisions were received during the 5-year period. Most patients (76.6%) were males and 74.9% were 21-50 years old. The most prevalent risk factor was HIV infection (83.5%) with cryptococcosis defining AIDS in 23% of the cases. In the general population the estimated mean annual incidence rate for cryptococcosis was 2.4 x 106 inhabitants while in AIDS patients this rate rose to 3.3 x 103. In 474 surveys stating clinical features, most frequent complaints were headache 84.5%, fever 63.4%, nausea and vomiting 57.5%, mental alterations 46.3%, meningeal signs 33.0%, cough 26.4% and visual alterations 24.5%. Neurocryptococcosis was recorded in 81.8% of the cases. Laboratory diagnosis was based on direct examination, culture and latex in 29.3% cases. From 413 Cryptococcus isolates analyzed, 95.6% were identified as C. neoformans var. grubii, 1% C. neoformans var. neoformans, and 3.4% C. gattii. Treatment was reported for 71.6% of the cases with amphotericin B alone or in combination with fluconazole prescribed in 28%. Conclusions: Surveys done through passive surveillance continue to be sentinel markers for HIV infection and represent a systematic approach to the study of opportunistic problems regularly afflicting AIDS patients since cryptococcosis requires no compulsory notification in Colombia.


Introducción. Desde 1997 se viene realizando un programa nacional de vigilancia sobre la criptococosis en Colombia. Se presentan los resultados correspondientes a los pacientes diagnosticados entre el 2006 y el 2010. Objetivo. Analizar los datos obtenidos durante este periodo. Materiales y métodos. Análisis retrospectivo de las encuestas. Resultados. Durante los cinco años mencionados se recibieron 526 encuestas representativas del 72 % de la división política colombiana. La mayoría de pacientes (76,6 %) eran hombres y 74,9 % estaban entre los 21 y los 50 años. El factor de riesgo prevalente fue la infección por VIH (83,5 %), y la criptococosis definió el sida en 23 % de los casos. La incidencia anual promedio en la población general fue de 2,4 por un millón de habitantes mientras que, en pacientes con sida, aumentó a 3,3 por 1.000. En 474 encuestas se informaron manifestaciones clínicas; las más frecuentes fueron: cefalea (84,5 %), fiebre (63,4 %), náuseas y vómito (57,5 %), alteraciones mentales (46,3 %), signos meníngeos (33 %), tos (26,4 %) y alteraciones visuales (24,5 %). La neurocriptococosis se reportó en 81,8 % de los casos. El diagnóstico se hizo por examen directo, cultivo y antigenemia en 29,3 % de los casos. De 413 aislamientos recuperados, 95,6 % fueron C. neoformans var. grubii, 1 % C. neoformans var. neoformans, y 3,4 % C. gattii. En 71,6 % de los casos para el tratamiento se administró anfotericina B y en 28 % se combinó con fluconazol. Conclusiones. La vigilancia pasiva continúa siendo un marcador centinela para la infección por VIH, y constituye una aproximación sistemática al estudio de infecciones oportunistas en pacientes con sida, debido a que la criptococosis no es de notificación obligatoria en Colombia.


Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Cryptococcosis/epidemiology , AIDS-Related Opportunistic Infections/epidemiology , Amphotericin B/administration & dosage , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Antigens, Fungal/blood , Colombia/epidemiology , Cryptococcosis/diagnosis , Cryptococcosis/drug therapy , Cryptococcosis/microbiology , Cryptococcus gattii/immunology , Cryptococcus gattii/isolation & purification , Cryptococcus neoformans/immunology , Cryptococcus neoformans/isolation & purification , Drug Resistance, Multiple, Fungal , Fluconazole/administration & dosage , Fluconazole/therapeutic use , Health Surveys , Incidence , Population Surveillance , Retrospective Studies , Symptom Assessment
9.
Braz. dent. j ; 23(6): 716-722, 2012. ilus
Article in English | LILACS | ID: lil-662433

ABSTRACT

This study aimed to evaluate the effects of fluconazole or nystatin exposure on developed Candida albicans biofilms regarding their exopolysaccharide matrix. The minimal inhibitory concentration (MIC) against fluconazole or nystatin was determined for C. albicans reference strain (ATCC 90028). Poly(methlymethacrylate) resin (PMMA) specimens were fabricated according to the manufacturer's instructions and had their surface roughness measured. Biofilms were developed on specimens surfaces for 48 h and after that were exposed during 24 h to fluconazole or nystatin prepared in a medium at MIC, 10 x MIC or 100 x MIC. Metabolic activity was evaluated using an XTT assay. Production of soluble and insoluble exopolysaccharide and intracellular polysaccharides was evaluated by the phenol-sulfuric method. Confocal laser scanning microscope was used to evaluate biofilm architecture and percentage of dead/live cells. Data were analyzed statistically by ANOVA and Tukey's test at 5% significance level. The presence of fluconazole or nystatin at concentrations higher than MIC results in a great reduction of metabolic activity (p<0.001). At MIC or 10 x MIC, fluconazole showed high amounts of intracellular polysaccharides (p<0.05), but did not affect the exopolysaccharide matrix (p>0.05). The exposure to nystatin also did not alter the exopolysaccharide matrix at all the tested concentrations (p>0.05). Biofilm architecture was not affected by either of the antifungal agents (p>0.05). Nystatin promoted higher proportion of dead cells (p<0.05). It may be concluded that fluconazole and nystatin above the MIC concentration reduced the metabolic activity of C. albicans biofilms; however, they were not able to alter the exopolysaccharide matrix and biofilm architecture.


Este estudo avaliou o efeito da exposição de fluconazol ou nistatina a biofilmes de Candida albicans desenvolvidos, considerando a matriz de polissacarídeos extracelulares. Inicialmente uma cepa referência de C. albicans (ATCC 90028) foi submetida ao teste de concentração inibitória mínima (CIM) utilizando-se o fluconazol ou nistatina como agentes antifúngicos. Após, espécimes foram confeccionados em resina acrílica de polimetilmetacrilato (PMMA) de acordo com as recomendações do fabricante e tiveram sua rugosidade de superfície padronizada. Após, biofilmes de C. albicans foram desenvolvidos na superfície dos espécimes durante 48 h. Em seguida, os biofilmes foram expostos a fluconazol ou nistatina nas concentrações de CIM, 10 x CIM ou 100 x CIM, por 24 h. A atividade metabólica dos biofilmes foi avaliada pelo teste de XTT. A produção de polissacarídeos extracelulares solúveis e insolúveis, bem como dos polissacarídeos intracelulares foi avaliada pelo método fenol-sulfúrico. A arquitetura dos biofilmes e proporção de células vivas e mortas foi investigada utilizando-se microscopia confocal a laser. Os resultados foram analisados por ANOVA seguido do teste de Tukey, utilizando-se o nível de significância de 5%. A presença do fluconazol ou nistatina em concentrações maiores que CIM resultaram em uma redução significativa da atividade metabólica (p<0,001). Nas concentrações de CIM e 10 x CIM, biofilmes expostos ao fluconazol apresentaram quantidades significativas de polissacarídeos intracelulares (p<0,05), enquanto não houve alterações na quantidade de polissacarídeos extracelulares (p>0,05). A presença de nistatina também não alterou a matriz de polissacarídeos extracelulares em todas as concentrações investigadas (p>0,05). A arquitetura dos biofilmes não foi afetada por ambos os agentes antifúngicos, em qualquer concentração testada (p>0,05). A nistatina apresentou maior proporção de células mortas (p<0,05). Conclui-se que tanto para o fluconazol quanto para a nistatina, concentrações maiores que CIM reduziram a atividade metabólica dos biofilmes de C. albicans; no entanto, tais concentrações não alteraram a matriz de polissacarídeos extracelulares nem a arquitetura dos biofilmes.


Subject(s)
Humans , Antifungal Agents/pharmacology , Biofilms/drug effects , Candida albicans/drug effects , Fungal Polysaccharides/analysis , Antifungal Agents/administration & dosage , Culture Media , Candida albicans/growth & development , Colorimetry/methods , Fluconazole/administration & dosage , Fluconazole/pharmacology , Fungal Polysaccharides/metabolism , Hyphae/drug effects , Indicators and Reagents , Microbial Sensitivity Tests , Microscopy, Confocal , Microbial Viability/drug effects , Nystatin/administration & dosage , Nystatin/pharmacology , Polymethyl Methacrylate/chemistry , Solubility , Surface Properties , Time Factors , Tetrazolium Salts
10.
Indian J Ophthalmol ; 2010 Sept; 58(5): 415-417
Article in English | IMSEAR | ID: sea-136098

ABSTRACT

Colletotrichum graminicola is a medically important fungus belonging to the order Melanconiales under the class Coelomycetes. The members of the genus Colletotrichum are primarily plant pathogens which cause anthracnoses (fungal infection in plants). In the past few decades, they are progressively being implicated as etiological agents of subcutaneous hyalohyphomycoses and keratomycoses. Of the five medically important members in the genus Colletotrichum, keratitis due to Colletotrichum graminicola is rare. We diagnosed Colletotrichum graminicola keratitis in a 44-year-old man who presented with a non-healing corneal ulcer since three weeks. Positive smears and cultures from the corneal scrapings established the causative organism as C. graminicola. The patient was treated with a combination of oral ketoconazole and topical fluconazole and natamycin. Infection resolved over 10 weeks and antimicrobials were stopped. We describe the clinical presentation and treatment outcome of Colletotrichum graminicola keratitis.


Subject(s)
Administration, Oral , Adult , Antifungal Agents/administration & dosage , Colletotrichum , Corneal Ulcer/microbiology , Drug Therapy, Combination , Fluconazole/administration & dosage , Humans , Keratitis/diagnosis , Keratitis/microbiology , Ketoconazole/administration & dosage , Male , Mycoses/diagnosis , Mycoses/drug therapy , Natamycin/administration & dosage , Treatment Outcome
12.
Botucatu; s.n; 2010. [105] p.
Thesis in Portuguese | LILACS | ID: lil-589824

ABSTRACT

As leveduras vêm se tornando um dos principais agentes etiológicos das infecções hospitalares encontrados em pacientes com imunossupressão, muitas vezes evoluindo para quadros de sepse fúngica, na qual a mortalidade é elevada. Vários fatores associados diferentes, para o desenvolvimento de candidemia, têm sido estudados. Porém, tem-se dificuldade para escolher o tratamento desses quadros sépticos, uma vez que os métodos utilizados atualmente para verificar sensibilidade necessitam de técnicas trabalhosas e com resultados demorados para uso em laboratórios de rotina médica. Os objetivos do presente trabalho foram: estudar os fatores associados para o desenvolvimento de candidemia, bem como, comparar a eficácia do antifungigrama, realizado por método de disco difusão em ágar 24 e 48 horas e pelo método do Etest®, para o fluconazol, com a metodologia da microdiluição; além de avaliar a viabilidade da identificação das espécies de Candida por metodologia automatizada, dos sistemas Vitek-Biomerieux (Durham NC, USA) e manual, chamada de mista (tubo germinativo e Chromagar Candida (Difco, Sparks, MD-EUA), com a metodologia tradicional de referência. Analisaram-se 98 prontuários retrospectivamente do período compreendido entre os anos de 2000 a 2006, que possuíam amostras viáveis de Candida spp para o estudo. Os fatores associados mais prevalentes para o desenvolvimento de candidemia no total geral dos pacientes foram: o uso de antimicrobianos e antifúngicos com 93,9% e 79,6% respectivamente; a utilização do cateter venoso central com 93,9%; a presença de ventilação mecânica com 73,5% além da nutrição parenteral com 60,2% dos casos. As principais espécies de Candida encontradas foram C. parapsilosis com 37,76% e C. albicans com 33,67%; Candida não-albicans somaram 66,33% dos casos. A C. glabrata apresentou o maior índice de mortalidade do estudo, com 75% dos casos, seguida pela C tropicalis com 57,1% e C. albicans com 54,5%...


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Adult , Aged , Aged, 80 and over , Candidiasis , Fluconazole/administration & dosage , Infant, Premature
13.
Article in English | WPRIM | ID: wpr-15543

ABSTRACT

Candidaemia associated with intravascular catheter-associated infections is of great concern due to the resulting high morbidity and mortality. The antibiotic lock technique (ALT) was previously introduced to treat catheter-associated bacterial infections without removal of catheter. So far, the efficacy of ALT against Candida infections has not been rigorously evaluated. We investigated in vitro activity of ALT against Candida biofilms formed by C. albicans, C. glabrata, and C. tropicalis using five antifungal agents (caspofungin, amphotericin B, itraconazole, fluconazole, and voriconazole). The effectiveness of antifungal treatment was assayed by monitoring viable cell counts after exposure to 1 mg/mL solutions of each antibiotic. Fluconazole, itraconazole, and voriconazole eliminated detectable viability in the biofilms of all Candida species within 7, 10, and 14 days, respectively, while caspofungin and amphotericin B did not completely kill fungi in C. albicans and C. glabrata biofilms within 14 days. For C. tropicalis biofilm, caspofungin lock achieved eradication more rapidly than amphotericin B and three azoles. Our study suggests that azoles may be useful ALT agents in the treatment of catheter-related candidemia.


Subject(s)
Amphotericin B/administration & dosage , Antifungal Agents/administration & dosage , Biofilms/drug effects , Candida albicans/drug effects , Candida glabrata/drug effects , Candida tropicalis/drug effects , Candidiasis/drug therapy , Catheter-Related Infections/drug therapy , Catheterization, Central Venous , Drug Administration Routes , Echinocandins/administration & dosage , Fluconazole/administration & dosage , Humans , Itraconazole/administration & dosage , Microbial Sensitivity Tests , Pyrimidines/administration & dosage , Triazoles/administration & dosage
14.
Bol. venez. infectol ; 19(1): 39-44, ene.-jun. 2008. tab
Article in Spanish | LILACS | ID: lil-721142

ABSTRACT

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.


Subject(s)
Humans , Male , Adolescent , Female , Infant, Newborn , Infant , Child, Preschool , Child , Amphotericin B/administration & dosage , Candida albicans/isolation & purification , Candida tropicalis/isolation & purification , Fluconazole/administration & dosage , Mycoses/transmission , Drug-Eluting Stents/microbiology , Infectious Disease Medicine , Cross Infection/epidemiology , Pediatrics
15.
Col. med. estado Táchira ; 17(2): 43-45, abr.-jun. 2008. ilus
Article in Spanish | LILACS | ID: lil-531280

ABSTRACT

El agente Etiológico es el Criptococcus (Torulosis, blastomicosis europea) es una de las infecciones fúngicas más frecuentes del SNC. Es un hongo común en el suelo encontrado en los lugares de permanencia de los pájaros. La vía respiratoria es generalmente la puerta de entrada, menos frecuente es la piel y membranas mucosas. Los cambios patológicos son los de una meningitis granulomatosa; meningoencefalitis o como una masa. La diseminación es por vía hematógena. La meningitis es la presentación más frecuente en pacientes inmunocompetentes y la infección diseminada es más común en pacientes con SIDA. En este trabajo presentamos el caso clínico de un paciente masculino de 35 años, quien consultó cefalea holocraneana (frontal, parietal y occipital) de carácter pulsátil que lo incapacitó de tal forma no pudiendo realizar ninguna actividad ingirió AINES sin mejoría se acompañó de hipertermia no cuantificada los 1eros 5 días. Acompañándose de convulsiones tónico clónicas por lo que deciden realizar paraclínica y punción lumbar, donde se evidencia, serología reactiva para VIH. En la punción lumbar reportó: Cantidad: 3cc; Gram: no se observaron gérmenes; células: 0; glucosa: 64, Proteínas: 19; Pandy: negativo. Exámen directo: levaduras en gemación moderada; aspecto: turbio. En la tinción con tinta china: criptococcus neoformans. Posteriormente se incia tratamiento específico antifúngico con buena evolución y se inicia tratamiento antiretroviral luego que se confirma el diagnóstico de SIDA. Este es el primer caso reportado en nuestro estado Mérida en los últimos cuatro años, en pacientes inmunológicamente comprometidos con VIH.


Subject(s)
Humans , Male , Adult , Anti-Retroviral Agents/administration & dosage , Amphotericin B/administration & dosage , Fever/diagnosis , Fluconazole/administration & dosage , Cerebrospinal Fluid/cytology , Meningitis, Cryptococcal/parasitology , Meningitis, Cryptococcal/pathology , Acquired Immunodeficiency Syndrome/diagnosis , Acquired Immunodeficiency Syndrome/pathology , Amphotericin B/pharmacology , Biopsy/methods , Fluconazole/pharmacology , Central Nervous System Fungal Infections/diagnosis , Central Nervous System Fungal Infections/cerebrospinal fluid , Meningococcal Infections/etiology
16.
Article in English | IMSEAR | ID: sea-40112

ABSTRACT

OBJECTIVE: To assess the efficacy of 2% fluconazole subconjunctival injection as an adjunctive treatment in severe recalcitrant fungal corneal ulcer. DESIGN: Retrospective, non-comparative interventional case series. MATERIAL AND METHOD: From January 2007 to August 2007, the present study included six eyes of six patients with severe fungal corneal ulcer that did not respond to therapy with topical antifungal drugs, oral itraconazole (200 mg) twice a day and 10 microg intracameral amphotericin B. All of them were treated with 0.5 ml of 2% fluconazole subconjunctival injection twice a day as adjunctive therapy for 5 days then once a day till 14 days RESULTS: Three patients were successfully treated within 14 days. Two patients partially responded, and one of them underwent evisceration. The last patient did not respond to treatment and enucleation was done. Severe local and systemic side effects were not found. CONCLUSION: 0.5 ml of 2% Fluconazole subconjunctival injection can be a very useful treatment as adjunctive therapy for severe fungal keratitis, with a few mild complications, especially in cases of impending perforation or post operative such as glue application for ruptured cornea.


Subject(s)
Adult , Aged , Antifungal Agents/administration & dosage , Corneal Ulcer/drug therapy , Female , Fluconazole/administration & dosage , Health Status Indicators , Humans , Male , Middle Aged , Mycoses/drug therapy , Retrospective Studies , Treatment Outcome
17.
Rev. Soc. Bras. Med. Trop ; 40(3): 332-337, maio-jun. 2007. tab
Article in Portuguese | LILACS | ID: lil-456330

ABSTRACT

O achado laboratorial de candidúria traz dilemas em relação a sua interpretação visto que pode refletir uma amplitude de possibilidades clínicas, incluindo colonização, infecção urinária alta ou doença sistêmica por Candida spp. Neste artigo, abordaremos a epidemiologia, o diagnóstico e a terapêutica da candidúria em diversos cenários clínicos, incluindo pacientes transplantados renais. De forma prática e para efeito de abordagem terapêutica, a interpretação do achado de candidúria é baseada na presença de dados clínicos e epidemiológicos Quando necessária, a terapêutica antifúngica para os casos de candidúria pode ser realizada com: anfotericina B sistêmica, anfotericina B tópica (irrigação vesical) ou fluconazol. A coleta de hemoculturas deve ser indicada em pacientes com candidúria sob risco para desenvolvimento de candidíase hematogênica. A retirada da sonda vesical de demora deve ser considerada sempre que possível, pois reduz a possibilidade de persistência ou recorrência da infecção urinária por Candida spp.


Candiduria remains a controversial issue for clinicians once that it may represent a broad variety of possibilities including colonization, local or systemic infection. We will discuss the epidemiology, diagnosis and treatment of candiduria in different settings of patients, including renal transplant recipients. Definitions on therapy are mostly based on epidemiological and clinical data. Once antifungal therapy is required the following antifungal treatment may be used: intravenous amphotericin B, bladder irrigation with amphotericin B or fluconazole. Blood cultures may be required in patients with candiduria and high risk for developing hematogenous infection. Removal of the urinary catheter must be considered in order to avoid persistent candiduria and recurrence.


Subject(s)
Humans , Amphotericin B/administration & dosage , Antifungal Agents/administration & dosage , Candida/isolation & purification , Candidiasis/urine , Fluconazole/administration & dosage , Urinary Tract Infections/microbiology , Candida/classification , Candidiasis/diagnosis , Candidiasis/drug therapy , Candidiasis/microbiology , Urinary Tract Infections/diagnosis , Urinary Tract Infections/drug therapy
18.
Bol. venez. infectol ; 18(1): 10-13, ene.-jun. 2007.
Article in Spanish | LILACS | ID: lil-721151

ABSTRACT

Rara vez el embarazo ha sido asociado con criptococosis. Se presentan 2 pacientes VIH seronegativas, hospitalizadas en el Hospital Universitario de Caracas por presentar criptococosis meníngea, en las cuales la única condición subyacente fue el embarazo. Se hace una revisión de la literatura.


Subject(s)
Humans , Adolescent , Adult , Female , Pregnancy , Abortion, Induced/methods , Headache/diagnosis , Fluconazole/administration & dosage , AIDS-Related Opportunistic Infections/pathology , Meningitis, Cryptococcal/diagnosis , Meningitis, Cryptococcal/therapy , Fluconazole/pharmacology , Infectious Disease Medicine , Neurology
19.
JPAD-Journal of Pakistan Association of Dermatologists. 2007; 17 (1): 28-31
in English | IMEMR | ID: emr-83937

ABSTRACT

To evaluate the efficacy and safety of single dose [450mg] of fluconazole in the treatment of pityriasis versicolor. Patients suffering from pityriasis versicolor presenting to department of dermatology, Hayatabad Medical Complex, Peshawar were enrolled in the study. Diagnosis of PV was made by Wood`s lamp and confirmed by examination of scales in KOH preparation. 30 patients were included in the study. 30 patients completed the study including 24 males and 6 females. Their age ranged from 14 years to 45 years [mean 25.3 years]. Eighteen patients [60%] had complete cure and their clinical and laboratory parameters remained negative at 3 weeks and 6 weeks after completion of treatment. Twelve [40%] had no response to treatment. Treatment was well-tolerated and there were no adverse affects reported with single 450mg of fluconazole. Fluconazole 450mg as a single dose was effective in the treatment of pityriasis versicolor and well tolerated. However, long term comparative studies should be done to establish the efficacy of fluconazole as a single dose treatment in PV


Subject(s)
Humans , Male , Female , Tinea Versicolor/drug therapy , Fluconazole/administration & dosage , Tinea Versicolor/diagnosis , Treatment Outcome
20.
Indian J Ophthalmol ; 2006 Dec; 54(4): 237-40
Article in English | IMSEAR | ID: sea-72443

ABSTRACT

PURPOSE: Candidal endophthalmitis is a sight-threatening ocular infection that most frequently occurs as a complication of candidemia. Fluconazole has been effective against Candida albicans in various animal models. Our objective was to evaluate retinal toxicity of plain and liposome formulation of fluconazole at various dose levels after intravitreal injection. MATERIALS AND METHODS: Twelve New Zealand albino rabbits weighing 2-2.5 kg were used. Two rabbits were used for every dose level. Liposome formulation containing 100 and 200 microg of fluconazole in sterile phosphate buffer solution and plain fluconazole at concentrations of 100, 200, 400 and 800 microg in 0.1 ml of sterile normal saline were injected intravitreally into the right eyes. The left eyes received 0.1 ml normal saline or 0.1 ml of liposome formulation without fluconazole. One week later, the animals were sacrificed, their eyes enucleated and processed for light microscopy and scanning electron microscopy. RESULTS: It showed that plain fluconazole at a concentration of 100 microg and above caused retinal changes, with disorganization of the photoreceptor outer segments. However, liposome formulation of fluconazole (200 microg/0.1 ml) did not show any significant microscopic changes of the retina. CONCLUSION: The liposome formulation decreased the retinal toxicity of fluconazole up to the studied concentration of 200 microg/0.1 ml.


Subject(s)
Animals , Antifungal Agents/administration & dosage , Disease Models, Animal , Dose-Response Relationship, Drug , Endophthalmitis/drug therapy , Eye Infections, Fungal/drug therapy , Female , Fluconazole/administration & dosage , Injections , Liposomes , Male , Microscopy, Electron, Scanning , Rabbits , Retina/drug effects , Retinal Diseases/chemically induced , Risk Factors , Vitreous Body
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