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Rev. Bras. Saúde Mater. Infant. (Online) ; 21(2): 547-552, Apr.-June 2021. tab
Article in English | LILACS | ID: biblio-1340650


Abstract Objectives: to describe the epidemiology of invasive candidiasis in a neonatal intensive care unit. Methods: cross-sectional study that included all neonates with invasive candidiasis confirmed by blood culture from April 2015 to June 2018. Demographic, clinical and microbiological data were analyzed, comparing neonates with extreme low birth weight (ELBW) with neonates ≥ 1000g birth weight, considering a p <0.05 as statistically significant. Results: there were 38 cases of invasive candidiasis, resulting in an overall incidence of 2.5%. Twelve (32%) were ELBW neonates and 26 (68%) neonates ≥ 1000g birth weight, an incidence of 4.4% and 2.0%, respectively. Abdominal surgery was more frequent among neonates with birth weight ≥ 1000g compared to ELBW neonates (85% vs. 17%; p <0.01), as well as the median in days of antibiotics use (18 vs. 10.5; p = 0.04). The median in days of mechanical ventilation was more frequent among ELBW neonates (10 vs. 5.5; p = 0.04). The majority of Candida species were non-albicans (64%). Fatality rate was 32%. Conclusions: the incidence of invasive candidiasis among neonates with birth weight ≥ 1000g was higher than that found in the literature. This group has a higher proportion of gastrointestinal malformations that require surgery. Thus, fluconazole prophylaxis may be necessary for a broader group of neonates.

Resumo Objetivos: descrever a epidemiologia de candidíase invasiva em uma unidade de terapia intensiva neonatal. Métodos: estudo transversal que incluiu todos recém-nascidos com candidíase invasiva confirmada por hemocultura de abril de 2015 a junho de 2018. Foi analisado dados demográficos, clínicos e microbiológicos, comparando recém-nascidos de extremo baixo peso ao nascer (EBPN) com os recém-nascidos com peso ao nascer ≥1000g, considerando um valor de p<0,05 como estatisticamente significativo. Resultados: houve 38 casos de candidíase invasiva, resultando em uma incidência global de 2,5%. Doze (32%) eram neonatos de EBPN e 26 (68%) neonatos com peso ao nascer ≥1000g, resultando em uma incidência de 4,4% e 2,0%, respectivamente. A realização de cirurgia abdominal foi mais frequente nos neonatos com peso ao nascer ≥1000g em comparação com os neonatos de EBPN (85% vs. 17%; p<0,01), assim como a mediana dos dias de uso de antibióticos (18 vs. 10,5; p =0,04). Já o a mediana dos dias de ventilação mecânica foi mais frequente entre recém-nascido de EBPN (10 vs. 5,5; p = 0,04). A maioria das espécies de Candida eram não-albicans (64%). A letalidade foi de 32%. Conclusões: a incidência de candidíase invasiva entre os recém-nascidos ≥1000g ao nascer foi superior ao encontrado na literatura. Este grupo tem uma maior proporção de malformações gastrointestinais que requerem cirurgia. Assim, a profilaxia com fluconazol pode ser necessária para um grupo mais amplo de recém-nascidos.

Humans , Infant, Newborn , Intensive Care Units, Neonatal , Fluconazole/therapeutic use , Candidiasis, Invasive/prevention & control , Candidiasis, Invasive/therapy , Candidiasis, Invasive/epidemiology , Tertiary Healthcare , Birth Weight , Brazil/epidemiology , Cross-Sectional Studies , Statistical Data , Infant, Extremely Low Birth Weight
Braz. j. infect. dis ; 23(6): 451-461, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1089312


ABSTRACT Background: Papiliotrema laurentii is one of several non-neoformans cryptococci that have rarely been associated with human infection, since it was previously considered saprophyte and thought to be non-pathogenic to humans. Nevertheless, increasing number of reports of human infection have emerged in recent years, mostly in oncologic patients. Aim: To report a case of a female patient with pyloric obstructive cancer with a catheter-related Papiliotrema laurentii blood stream infection and systematically review the available evidence on P. laurentii infection in humans. Methods: Retrieval of studies was based on Medical Subject Headings and Health Sciences Descriptors, which were combined using Boolean operators. Searches were run on the electronic databases Scopus, Web of Science, MEDLINE (PubMed), BIREME (Biblioteca Regional de Medicina), LILACS (Latin American and Caribbean Health Sciences Literature), Cochrane Library for Systematic Reviews and Opengray.eu. There was no language or date of publication restrictions. The reference lists of the studies retrieved were searched manually. Results: The search strategy retrieved 1703 references. In the final analysis, 31 references were included, with the description of 35 cases. Every patient but one had a previous co-morbidity - 48.4 % of patients had a neoplasm. Amphotericin B was the most used treatment and only a single case of resistance to it was reported. Most patients were cured of the infection. Conclusion: P. laurentii infection in humans is usually associated to neoplasia and multiple co-morbidities, and amphotericin B seems to be a reliable agent for treatment.

Humans , Female , Aged , Stomach Neoplasms/diagnostic imaging , Catheter-Related Infections/diagnostic imaging , Stomach Neoplasms/microbiology , Stomach Neoplasms/therapy , Biopsy , Vancomycin/therapeutic use , Tomography, X-Ray Computed , Fluconazole/therapeutic use , Amphotericin B/therapeutic use , Bacteremia/microbiology , Cryptococcus/isolation & purification , Catheter-Related Infections/etiology , Catheter-Related Infections/microbiology , Catheter-Related Infections/drug therapy , Piperacillin, Tazobactam Drug Combination/therapeutic use , Anti-Bacterial Agents/therapeutic use
An. bras. dermatol ; 94(6): 744-746, Nov.-Dec. 2019. graf
Article in English | LILACS | ID: biblio-1054899


Abstract This report describes a case of unusual deep skin ulcers with tortuous sinus tract formation in an immunocompetent woman. She was initially diagnosed with a Staphylococcus aureus skin infection and histopathologically diagnosed with pyoderma gangrenosum. However, culture from the deep end of ribbon gauze inserted into the subcutaneous sinus tract revealed shiny, light-yellow mucoid colonies, which were identified as Cryptococcus neoformans var. grubii. She was treated with fluconazole for nine months and completely healed. Cryptococcosis is an opportunistic infection caused by variants of C. neoformans species. Cutaneous manifestations of cryptococcosis are quite divergent, rarely occurring as deep skin ulcers with sinus formation.

Humans , Female , Adult , Skin Ulcer/microbiology , Skin Ulcer/pathology , Cryptococcosis/pathology , Cryptococcus neoformans/isolation & purification , Dermatomycoses/pathology , Immunocompetence , Skin Ulcer/drug therapy , Fluconazole/therapeutic use , Immunocompromised Host , Cryptococcosis/microbiology , Cryptococcosis/drug therapy , Dermatomycoses/microbiology , Dermatomycoses/drug therapy , Antifungal Agents/therapeutic use
Mem. Inst. Invest. Cienc. Salud (Impr.) ; 17(1): 16-24, abr. 2019. tab
Article in Spanish | LILACS, BDNPAR | ID: biblio-1007865


Las úlceras corneales de origen infeccioso son una emergencia oftalmológica que amenaza la visión y la integridad estructural del ojo, causando ceguera en 1,5 a 2 millones de casos al año por lo que requiere tratamiento inmediato. El objetivo fue determinar el patrón epidemiológico, factores de riesgo y efectividad del tratamiento en pacientes con úlcera corneal en la Fundación Visión en el periodo 2015-2017. Estudio de cohorte prospectivo donde se evaluó 53 pacientes con úlcera corneal de causa infecciosa que consultaron en la Fundación Visión en el periodo 2015-2017, y tuvieron un seguimiento mínimo de 4 meses. Se encontró un predominio del sexo masculino (69,8%), edad 45-65 años (49,1%), casados (54,7%), de condición socioeconómica baja (56,6%), agricultores (26,4%), con antecedente de traumatismo corneal (69,8%) o uso de lentes de contacto (17%). El agente etiológico fue bacteriano en el 49,1% y micótico en el 37,7%; para los de origen bacteriano el tratamiento más empleado fueron colirios fortificados de Cefazolina + Gentamicina y Natamicina/Fluconazol en caso de ser micótico. La evolución fue favorable en 90,9% y 80,0% de los bacterianos y micóticos, respectivamente. Los grupos de riesgo detectados fueron pacientes varones, agricultores, de condición socioeconómica baja, con antecedente de traumatismo corneal o uso de lentes de contacto. La efectividad del tratamiento utilizado fue mayor al 80%, siendo en su mayoría patógenos bacterianos(AU)

Humans , Male , Female , Adult , Middle Aged , Aged , Corneal Ulcer/drug therapy , Corneal Ulcer/epidemiology , Gentamicins/therapeutic use , Visual Acuity , Fluconazole/therapeutic use , Cefazolin/therapeutic use , Corneal Ulcer/microbiology , Natamycin/therapeutic use , Prospective Studies , Risk Factors , Treatment Outcome , Keratitis/complications , Anti-Bacterial Agents/therapeutic use , Antifungal Agents/therapeutic use
Arch. argent. pediatr ; 116(5): 663-666, oct. 2018. tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-973669


La Candida haemulonii forma parte de la especie Candida no albicans. La candidemia por C. haemulonii es sumamente infrecuente, pero mortal, en los recién nacidos. Se informa sobre los dos primeros recién nacidos con candidemia por C. haemulonii en China tratados con fluconazol y se revisan dos artículos informados con anterioridad. Nuestro informe incrementa la sensibilización sobre la candidemia por C. haemulonii en recién nacidos críticos y resalta la importancia de un diagnóstico y un tratamiento tempranos de esta infección mortal.

Candida haemulonii forms part of the non-albicans Candida species. The candidemia caused by C. haemulonii is extremely rare but fatal in neonates. We reported the first two neonates with C. haemulonii candidemia in China which were treated with fluconazole and reviewed two papers previously reported. Our report adds further awareness on C. haemulonii candidemia in critical neonates and points out the importance of an early diagnosis and treatment of this fatal infection.

Humans , Male , Female , Infant, Newborn , Fluconazole/therapeutic use , Catheter-Related Infections/drug therapy , Candidemia/drug therapy , Candida/isolation & purification , China , Treatment Outcome , Catheter-Related Infections/microbiology , Candidemia/etiology , Candidemia/microbiology , Antifungal Agents/therapeutic use
Rev. chil. infectol ; 35(4): 377-385, ago. 2018. tab
Article in Spanish | LILACS | ID: biblio-978048


Resumen Introducción: Se desconocen los factores asociados a la candidiasis oral en población pediátrica con infección por VIH de los países en desarrollo. Objetivo: Identificar los factores asociados a la colonización por Candida, candidiasis oral y la susceptibilidad in vitro a antifúngicos, en niños y adolescentes con infección por VIH institucionalizados en la ciudad de Tijuana, México. Materiales y Métodos: Se examinó la cavidad oral de 30 niños y adolescentes con infección por VIH, se obtuvo una muestra de la mucosa oral para identificar las especies de Candida mediante cultivo y auxonograma. La susceptibilidad a los antifúngicos se determinó de acuerdo al CLSI. Los indicadores del estado inmunológico y falla virológica se clasificaron conforme a la OMS. Resultados: Se identificaron seis especies de Candida, 53% colonizantes y 47% causantes de candidiasis. Los factores asociados a candidiasis fueron alta carga viral (p = 0,001), menor recuento de LTCD4+ (p = 0,002) y esquema TARAA (p ≤ 0,014). La especie prevalente fue C. glabrata (33%); sin embargo, C. albicans (27%) fue más resistente a fluconazol (p = 0,001). Las especies resistentes a itraconazol se identificaron en esquemas que incluyen un INNTR (p = 0,041). Conclusiones: Los niños y adolescentes con infección por VIH institucionalizados mostraron una prevalencia elevada de Candida spp. colonizante y resistencia a los antifúngicos relacionada con los INNTR .

Background: Factors associated with candidiasis and colonization in HIV-positive children and adolescents in developing countries are not well understood. Aim: To identify the factors associated with oral Candida colonization and candidiasis in institutionalized HIV-positive children and adolescents in Tijuana, México, as well as the response of the isolates to antifungals. Materials and Methods: Sample of the oral mucosa of 30 HIV positive children and adolescents were obtained to isolate and identify Candida species by culture and metabolic profile. Antifungal drugs susceptibility was determined according to CLSI. Indicators of immunological and virologic failure were classified in accordance to WHO criteria. Results: Six Candida species were identified from oral mucosa, 53% colonizers and 47% in candidiasis. Factors associated with candidiasis and oral colonization were viral load (p = 0,001), CD4+ counts (p = 0,002) and HAART regimen (p ≤ 0,014). The most prevalent species was C. glabrata (33%), but C. albicans (27%) was more resistant to fluconazole (p = 0,001). Itraconazol resistant species were identified in regimens that include an NNRTI (p = 0,041). Conclusion: HIV-positive children and adolescents living in an orphanage showed high prevalence of colonizing Candida spp. and resistance to antifungals, related to NNRTI.

Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Young Adult , Candida albicans/isolation & purification , Candidiasis, Oral/microbiology , HIV Infections/complications , AIDS-Related Opportunistic Infections/microbiology , Mouth Mucosa/microbiology , Candida albicans/classification , Candidiasis, Oral/classification , Candidiasis, Oral/drug therapy , Fluconazole/therapeutic use , HIV Infections/drug therapy , Cross-Sectional Studies , Prospective Studies , Risk Factors , AIDS-Related Opportunistic Infections/drug therapy , Itraconazole/therapeutic use , Viral Load , Drug Resistance, Fungal , Mexico , Antifungal Agents/therapeutic use
Rev. chil. infectol ; 35(4): 420-423, ago. 2018.
Article in Spanish | LILACS | ID: biblio-978053


Resumen Introducción: La criptococcosis es una infección micótica oportunista grave, Cryptococcus neoformans es la principal especie de importancia médica, pudiendo manifestarse como meningitis, neumonía o criptococcemia. Objetivo: Caracterizar a los pacientes con infección por Cryptococcus sp. entre el 01/01/13 y 30/06/16, en el HCVB. Materiales y Métodos: Se identificaron los cultivos con desarrollo de Cryptococcus sp., y a partir de éstos se obtuvo los registros de los pacientes, los que fueron analizados por dos revisores independientes. Resultados: Se recopiló la información de 13 pacientes, que presentaron 15 casos de infección por C. neoformans. De los 13 pacientes, 11 (84,6%) eran de sexo masculino, con una mediana de edad de 35 años. 11 pacientes (84,6%) padecían infección por VIH, uno (7,7%) tenía el antecedente de leucemia linfática crónica, y uno (7,7%) de etilismo crónico. De los 15 casos, nueve (60%) presentaron infección meníngea; cinco (33,3%) presentaron criptococcemia sin compromiso del LCR; y uno (6,6%) presentó infección pulmonar. De los 13 pacientes, ocho (53,3%) se encontraban fallecidos al año de seguimiento. Conclusiones: La infección por Cryptococcus sp. es una patología que debe ser sospechada en pacientes con inmunodeficiencia de predominio celular. La infección meníngea fue la forma más frecuente de presentación. Persiste presentando una elevada mortalidad.

Background: Cryptococcosis is a severe opportunistic mycotic infection, caused mainly by Cryptococcus neoformans. It can present as meningitis, pneumonia or cryptococcemia. Aim: To characterize patients with Cryptococcus infection between January 1°, 2013 and June 30, 2016, in Hospital Carlos van Buren, Valparaíso, Chile. Methods: We identified retrospectively those cultures with Cryptococcus sp. growth, and then obtained their clinical files which were analyzed by two independent reviewers. Results: We were able to obtain data from 13 of 15 patients who presented with Cryptococcus neoformans infection. Out of all, 11 (84.6%) were males, with a median age of 35 years old. 11 (84,6%) were HIV positive, 1 (7,7%) had chronic lymphocytic leukemia, and 1 (7,7%) refered alcohol abuse. Out of the 15 episodes, 9 (60%) had meningeal infection; 5 (33.3%) were cryptococcemia without meningeal involvement and 1 (6.6%) presented as a pulmonary infection. Eight patients were deceased at one year follow up. Conclusions: Cryptococcus sp. infection must be suspected in patients with cellular immunodeficiencies. Meningeal involvement is the most frequent form of clinical presentation. It still has a high mortality rate.

Humans , Male , Female , Adult , Cryptococcosis/diagnosis , CD4-Positive T-Lymphocytes , Fluconazole/therapeutic use , Chile , Retrospective Studies , Cryptococcosis/drug therapy , Cryptococcus neoformans/isolation & purification , Deoxycholic Acid/therapeutic use
Rev. Soc. Bras. Med. Trop ; 51(3): 318-323, Apr.-June 2018. tab, graf
Article in English | LILACS | ID: biblio-957424


Abstract INTRODUCTION Pentavalent antimonials (Sbv) are the most commonly used drugs for the treatment of mucosal leishmaniasis (ML), despite their high toxicity and only moderate efficacy. The aim of this study was to report therapeutic responses with different available options for ML. METHODS This study was based on a review of clinical records of 35 patients (24 men and 11 women) treated between 2009 and 2015. RESULTS The median age of patients was 63 years, and the median duration of the disease was 24 months. Seventeen patients received Sbv, while nine patients were treated with liposomal amphotericin B (AmB), and another nine patients were treated with fluconazole. Patients treated with AmB received a total median accumulated dose of 2550mg. The mean duration of azole use was 120 days, and the daily dose ranged from 450 to 900mg. At the three-month follow-up visit, the cure rate was 35%, 67%, and 22% for Sbv, AmB, and azole groups, respectively. At the six-month follow-up visit, the cure rates for Sbv, AmB, and azole groups were 71%, 78%, and 33%, respectively. CONCLUSIONS There is a scarcity of effective ML treatment alternatives, and based on our observations, fluconazole is not a valid treatment option.

Humans , Male , Female , Adult , Aged , Aged, 80 and over , Leishmaniasis, Mucocutaneous/drug therapy , Fluconazole/therapeutic use , Amphotericin B/therapeutic use , Antimony/therapeutic use , Antiprotozoal Agents/therapeutic use , Severity of Illness Index , Treatment Outcome , Middle Aged
An. bras. dermatol ; 93(3): 462-464, May-June 2018. tab
Article in English | LILACS | ID: biblio-1038269


Abstract: The number of new cases of emerging fungal infections has increased considerably in recent years, mainly due to the large number of immunocompromised individuals. The objective of this study was to evaluate the susceptibility of emerging fungi to fluconazole, itraconazole and amphotericin B by disk diffusion method. In 2015, 82 emerging fungi were evaluated in IPB-LACEN/RS and 13 (15.8%) were resistant: 10/52 were from superficial mycoses and 3/30 from systemic mycoses. The data from the study point to the need for permanent vigilance regarding the careful evaluation in the prescription and clinical and laboratory follow-up of patients affected by fungal infections.

Humans , Male , Female , Adult , Aged , Drug Resistance, Fungal , Fungi/drug effects , Antifungal Agents/therapeutic use , Microbial Sensitivity Tests , Fluconazole/therapeutic use , HIV Infections/complications , Amphotericin B/therapeutic use , Itraconazole/therapeutic use , Fungi/isolation & purification , Mycoses/microbiology , Mycoses/drug therapy , Antifungal Agents/pharmacology
Rev. Soc. Bras. Clín. Méd ; 15(2): 124-126, 20170000. ilus
Article in Portuguese | LILACS | ID: biblio-875612


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)

Humans , Male , Adult , Amphotericin B/administration & dosage , Amphotericin B/therapeutic use , Fluconazole/administration & dosage , Fluconazole/therapeutic use , Meningitis, Cryptococcal , Immunity
Rev. chil. infectol ; 34(5): 431-440, oct. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-899739


Resumen Introducción: La epidemiologia de las candidemias varía en cada región. Objetivos: Conocer la epidemiología de las candidemias en un hospital durante 16 años. Material y Métodos: Se revisaron los episodios de candidemia ocurridos en el Hospital de Clínicas de Buenos Aires desde 01/01/98 al 31/12/13. Resultados: Se identificaron 374 episodios de candidemia. La incidencia fue de 2,21/1.000 egresos y aumentó de 1,96 (1998-2005) a 2,25 (2006-2013) (p = 0,023). Se diagnosticaron: 5,4% en neonatos, 1,7% en lactantes, 6,5% en niños mayores, 31,8% en adultos y 52,7% en adultos mayores de 64 años. Los episodios fueron causados por C. albicans (40,9%), C. parapsilosis (21,7%), C. tropicalis (15,5%), C. glabrata (13,9%), otras especies de Candida (5,1%) y candidemias multiespecies (2,9%). El 5,3% de los aislados fue resistente a fluconazol. Setenta y cuatro por ciento de los pacientes recibió tratamiento; 70,3% lo inició con fluconazol, 25% con anfotericina B desoxicolato y 4,7% con equinocandinas o anfotericinas lipídicas. Se retiró 81% de los catéteres venosos centrales. La mortalidad fue de 47,9%, pero fue de 60,8% para los adultos mayores. Conclusión: La incidencia de candidemias se incrementó a través de los años, fue mayor en los adultos mayores y esta población tuvo peor evolución.

Background: The epidemiology of candidemia vary by region. Aim: To determine the epidemiology of candidemia in a hospital for 16 years. Material and Methods: Episodes of candidemia occurred in the Hospital de Clinicas of Buenos Aires were reviewed, from 01/01/98 to 31/12/13. Results: 374 episodes of candidemia were identified. The incidence was 2.21/1,000 discharges and increased from 1.96 (1998-2005) to 2.25 (2006-2013) (p = 0.023). Candidemia was diagnosed: 5.4% in neonates, 1.7% in infants, 6.5% in children, 31.8% in adults and 52.7% in elderly adults over 64 years old. The episodes were caused by C. albicans (40.9%), C. parapsilosis (21.7%), C. tropicalis (15.5%), C. glabrata (13.9%), other species of Candida (5.1%) and more than one species of Candida (2.9%). The 5.3% of the isolates were resistant to fluconazole. 74% of patients were treated. Initial treatments were with fluconazole (70.3%), amphotericin B deoxycholate (25%), echinocandins or lipidic amphotericin (4,7%). The 81% of central venous catheters were taken off. Mortality rate was of 47.9%, but in the elderly adults was of 60.8%. Conclusion: The incidence of candidemia showed an increase over the years. It was higher in the elderly adults, being the group with worse outcomes.

Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Candida/isolation & purification , Fluconazole/therapeutic use , Cross Infection/drug therapy , Cross Infection/epidemiology , Candidemia/drug therapy , Candidemia/epidemiology , Antifungal Agents/therapeutic use , Argentina/epidemiology , Time Factors , Candida/drug effects , Microbial Sensitivity Tests , Cross Infection/microbiology , Incidence , Multivariate Analysis , Retrospective Studies , Risk Factors , Age Distribution , Drug Resistance, Fungal , Candidemia/microbiology , Central Venous Catheters/adverse effects , Hospitals, University
Rev. cuba. med. trop ; 68(3): 248-254, sep.-dic. 2016. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1042913


Introducción: la vulvovaginitis constituye una de las principales afecciones ginecológicas, y su causa más frecuente es la candidiasis. Candida albicans se considera el agente etiológico más importante de esta entidad; sin embargo, estudios recientes revelan un incremento en la incidencia de otras especies del género. Algunas de estas tienen la particularidad de presentar resistencia a los tratamientos usuales con antimicóticos. Objetivo: evaluar la susceptibilidad antifúngica de aislados vaginales de pacientes cubanas con sospecha de candidiasis vulvovaginal que se obtuvieron en el 2015. Métodos: a 28 aislados pertenecientes al género Candida, se les realizó las pruebas de susceptibilidad in vitro con la galería ATBTM Fungus 3 frente a diferentes antifúngicos (5-fluorocitosina, anfotericina B, fluconazol, itraconazol y voriconazol). Resultados: todos los aislados fueron sensibles a la anfotericina B y uno de C. albicans se informó resistente a los azoles estudiados. Todas las especies diferentes de C. albicans fueron susceptibles al voriconazol (CMI≤ 1 mg/L). Conclusiones: el estudio de patrones de susceptibilidad en aislados de Candida provenientes de mujeres con vulvovaginitis permite profundizar en cómo abordar la terapéutica de esta afección; el fluconazol resultó el tratamiento de elección. Los resultados alertan sobre la emergencia de C. glabrata, C. krusei, C. parapsilosis, C. tropicalis, C. inconspicua y C. lusitaniae como agentes causales de la candidiasis vulvovaginal(AU)

Introduction: vulvovaginitis is one of the main gynecological diseases frequently caused by candidiasis. Candida albicans is considered as the most important etiological agent for the disease; however, recent students have revealed an increased incidence of other species of the genus. Some of them may show particular resistence to usual antimycotic treatments. Objective: to evaluate the antifungal susceptibility of vaginal isolates from Cuban female patients suspected of vulvovaginal candidiasis in 2015. Methods: twenty eight Candida genus isolates underwent in vitro susceptibility tests with ATBTM Fungus 3 using several antifungal agents (5 fluorocytosine, anphotericin B, fluconazole, itraconazole and vorixonazole). Results: all isolates were susceptible to B anphotericin and one C. albicans isolate was reported as resistant to the studied azoles. All the species other thanC. albicans were susceptible to voriconazole (CMI≤ 1mg/L). Conclusions: the study of susceptibility patterns in Candida isolates from women with vulvovaginitis allow delving into the different ways of approaching the therapeutics of this disease; fluconazole was the treatment of choice. The results show emergence of C. glabrata,C. krusei, C. parapsilosis, C. tropicalis, C. inconspicua and C. lusitaniae as causative agents of vulvovaginal candidiasis(AU)

Humans , Female , Vulvovaginitis/microbiology , Candida albicans/isolation & purification , Candidiasis, Vulvovaginal/epidemiology , Fluconazole/therapeutic use , Disease Susceptibility/diagnosis
Autops. Case Rep ; 6(4): 27-33, Oct.-Dec. 2016. ilus
Article in English | LILACS | ID: biblio-905080


Histoplasmosis is the most common endemic mycoses among HIV-infected people. Patients with suppressed cell immunity mainly due to HIV are at increased risk of disseminated disease. Dermatological manifestations of immune reconstitution inflammatory syndrome (IRIS) and cutaneous manifestations of histoplasmosis similar to an IRIS event have been previously described. We report the case of a 43-year-old male who presented with cutaneous disseminated histoplasmosis due to Histoplasma capsulatum var. capsulatum 4 months after the onset of the antiretroviral therapy and some improvement in the immune reconstitution. After 2 weeks of amphotericin B and itraconazole therapy, the scheduled treatment involved fluconazole maintenance therapy, which resulted in an improvement of his skin lesions.

Humans , Male , Adult , Histoplasmosis/drug therapy , Immune Reconstitution Inflammatory Syndrome/drug therapy , Amphotericin B/therapeutic use , Antiretroviral Therapy, Highly Active , Fluconazole/therapeutic use , Itraconazole/therapeutic use , Skin/injuries
Rev. bras. oftalmol ; 75(3): 228-230, graf
Article in English | LILACS | ID: lil-787697


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.

Humans , Male , Adult , Eye Infections, Fungal/surgery , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/drug therapy , Endophthalmitis/surgery , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Pancreatitis/complications , Pancreatitis/drug therapy , Vitrectomy , Candida , Candidiasis/drug therapy , Fluorescein Angiography , Eye Infections, Fungal/etiology , Fluconazole/therapeutic use , Amphotericin B/therapeutic use , Endophthalmitis/etiology , Administration, Oral , Ultrasonography , Parenteral Nutrition , Intravitreal Injections , Anti-Bacterial Agents/therapeutic use
Rev. otorrinolaringol. cir. cabeza cuello ; 76(1): 7-14, abr. 2016. ilus, tab
Article in Spanish | LILACS | ID: lil-784877


Introducción: La laringitis fúngica es una patología poco planteada en pacientes inmunocompetentes, sin embargo se debería tener en consideración en el diagnóstico diferencial de leucoplaquias en estos pacientes, más aún con factores predisponentes como reflujo faringolaríngeo, tabaquismo crónico y/o uso de corticoides. Objetivo: Presentar una serie de casos de pacientes inmunocompetentes con diagnóstico clínico de laringitis fúngica y tratamiento antimicótico empírico. Describir la asociación con factores predisponentes claves. Material y método: Estudio retrospectivo que incluyó a 11 pacientes con diagnóstico clínico de laringitis fúngica por correlación de la clínica, factores predisponentes y hallazgos en la videoestroboscopía laríngea (leucoplaquias múltiples en los pliegues vocales) sumado a la respuesta a tratamiento empírico con fluconazol oral. Se realizó además una revisión de la literatura disponible hasta el año 2015. Resultados: Todos los diagnósticos fueron clínicos correlacionando síntomas con hallazgo de leucoplaquias características en la laringe. El principal factor asociado fue el reflujo faringolaríngeo (91%) seguido por uso de corticoides (55%). Todos los pacientes fueron tratados con un esquema empírico de fluconazol oral por 14-21 días. El 100% de los pacientes respondió de forma exitosa al uso de este fármaco con remisión de los síntomas y de las lesiones laríngeas. Conclusión: El diagnóstico clínico y tratamiento con fluconazol oral como tratamiento de primera línea generarían buena tasa de respuesta, siempre que se correlacionen los síntomas y signos del paciente con los hallazgos encontrados en la laringe.

Introduction: The fungal laryngitis is an unusual disease in immunocompetent patients, however should take into consideration in the differential diagnosis of leukoplakias, especially in patients with predisposing factors such as pharyngolaryngeal reflux, use of inhaled, oral or intravenous corticosteroids. Aim: Describe a series of cases of fungal laryngitis in immunocompetent patients with clinical diagnosis and empirical antifungal treatment. In addition, finding the association with predisposing factors keys. Material and method: Retrospective study of 11 patients with diagnosis of fungal laryngitis according to clinical presentation, predisposing factors and findings in the laryngeal videostroboscopy (vocal folds leukoplakias) joined the response to empirical treatment with oral fluconazole. Also an extensive literature review was conducted until 2015. Results: The main predisposing factor was the pharyngolaryngeal reflux (91%) followed by use of corticosteroids (55%). All patients were treated empirically with fluconazole for 14-21 days. 100% of patients responded successfully, with remission of symptoms and laryngeal lesions. Conclusion: Clinical diagnosis and treatment with fluconazole as first-line treatment generate good response rate, provided that the patient's symptoms and signs with the findings in the larynx are correlated.

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Laryngitis/epidemiology , Laryngitis/microbiology , Adrenal Cortex Hormones/therapeutic use , Diabetes Complications , Fluconazole/therapeutic use , Gastroesophageal Reflux/complications , Immunocompetence , Laryngitis/drug therapy , Laryngitis/immunology , Retrospective Studies , Risk Factors , Vocal Cords
Rev. Soc. Bras. Clín. Méd ; 13(3)dez. 2015. ilus
Article in Portuguese | LILACS | ID: lil-774727


A cândida sp. são fungos comensais dos seres humanos e consideradasflora normal do trato gastrointestinal e genitourinário.Entretanto alterações na imunidade do hospedeiro podem culminarem infecção por estes fungos, definida como candidíase.Uma causa importante do desequilíbrio imunológico são asdoençasendócrinas, principalmente o Diabetes tipo 2. Pacientesdiabéticos estão mais propensos a desenvolver formas infecciosasde candidíase, destacando o comprometimento esofágicoque muitas vezes, não é diagnosticado. O objetivo deste estudofoi relatar um caso de paciente diabético tipo 2 com processoinfeccioso importante à esclarecer decorrente de extensa cândidíaseesofágica. Paciente masculino, 55 anos, procedente deItacoatiara-AM, tabagista de longa data. Após história prévia deinternação hospitalar para tratamento de Diabetes tipo 2 descompensadae piomiosite de coxa esquerda, evoluiu com asteniainsidiosa, anorexia, mal-estar e febre diária (38,5 ºC), intermitente,vespertina, sendo diagnosticado e tratado para infecçãodo trato urinário, sem melhora. Após piora do quadro, acrescidode disfagia para sólidos e perda ponderal, foi re-internado paraelucidaçãodiagnóstica. Durante a investigação apurou-se sangueoculto nas fezes positivo, seguida de endoscopia digestivaalta mostrando várias placas elevadas esbranquiçadas linearese confluentes ocupando todo o trajeto do esôfago, compatívelcom candidíase esofágica grau III de KODSI. As sorologias paraHIV e Hepatites B e C, foram negativas. A biopsia revelou esofagiteaguda erosiva. Devemos estar atentos à possibilidade de infecção por cândida, em especial, o comprometimento esofágico,nos pacientes diabéticos descompensados que apresentemfatores de risco associados a sinais e sintomas da doença e/ouinfecciosos, sem foco definido.(AU)

Candida sp. are commensal fungi of humans and are considerednormal flora of the gastrointestinal and genitourinary tracts.However, changes in the host immunity may lead to infection bythese fungi, defined as candidiasis. A major cause of the imbalanceare immune endocrine diseases, especially type 2 diabetesmellitus. Diabetic patients are more likely to develop infectiousforms of candidiasis, in particular the esophageal involvementthat often goes undiagnosed. The aim of this study was to reporta case of a type 2 diabetic patient with an infectious processwhich is important to clarify the result of extensive esophagealcandidiasis. Male patient, 55 years, coming from Itacoatiara-AM,a longtime smoker. After a history of hospitalization for treatmentof decompensated diabetes mellitus type 2 and pyomyositis of theleft thigh, it progressed with insidious asthenia, anorexia, malaiseand intermittent evening daily fever (38.5 °C), he was diagnosedand treated for urinary tract infection with no improvement.After the condition worsened, followed by dysphagia for solidsand weight loss, he was re-admitted for diagnosis. During theinvestigation it was found positive fecal occult blood, upperendoscopy showed multiple elevated confluent whitish linearplaques occupying the entire course of the esophagus, esophagealcandidiasis compatible with grade III KODSI. Serology forHIV and Hepatitis B and C were negative. The biopsy revealed acute erosive esophagitis. We must be alert to the possibility ofinfection by Candida, in particular, esophageal involvement inpatients presenting decompensated diabetic risk factors associatedwith signs and symptoms of disease and/or infections, without adefined focus.(AU)

Humans , Male , Middle Aged , Candidiasis/etiology , Diabetes Mellitus, Type 2/pathology , Esophagitis/drug therapy , Candida/isolation & purification , Fluconazole/therapeutic use
Braz. j. infect. dis ; 19(5): 546-548, graf
Article in English | LILACS | ID: lil-764497


ABSTRACTFungal arthritis is a rare complication of arthroscopic surgeries, but its possibility should always be considered due its deleterious effects on any joint. Infection caused by the fungus Histoplasma capsulatum is the most common cause of respiratory tract infections by fungi, meanwhile histoplasmosis arthritis is more rare than all other fungal infections. However, their atypical forms of arthritis and the importance of early diagnosis and treatment cannot be over-emphasized. Herein we report a case of knee monoarthritis in an immunocompetent patient with histoplasmosis arthritis following an arthroscopic meniscetomy, diagnosed by synovial biopsy and culture performed during a second arthroscopic procedure. The joint was debrided in this second intervention and the patient received itraconazole initially and fluconazole latter on. The arthritis subsided after 10 months of treatment.

Aged , Female , Humans , Arthritis, Infectious/diagnosis , Arthroscopy/adverse effects , Histoplasma/isolation & purification , Histoplasmosis/diagnosis , Knee Joint/microbiology , Antifungal Agents/therapeutic use , Arthritis, Infectious/drug therapy , Arthritis, Infectious/etiology , Fluconazole/therapeutic use , Histoplasmosis/drug therapy , Histoplasmosis/etiology , Itraconazole/therapeutic use