Espécies e suscetibilidade antifúngica in vitro de leveduras isoladas em unhas de pacientes com vírus da imunodeficiência humana / In vitro species and antifungal susceptibility of yeast from the nails of patients with the human immunodeficiency virus

RESUMO

Objetivo Identificar leveduras do gênero Candida responsáveis por onicomicose e as respectivas suscetibilidades antifúngicas in vitro em pacientes ambulatoriais com vírus da imunodeficiência humana e alterações ungueais sugestivas de onicomicose. Métodos Avaliaram-se 23 cepas de leveduras isoladas de 21 amostras ungueais das mãos e/ou pés. As colônias foram identificadas por CHROMagar Candida® e testes padrões. Para o antifungigrama, utilizou-se o ATB-Fungus 3®, e quando o fluconazol apresentou resistência neste kit, utilizou-se, para confirmação, o teste de disco difusão. Resultados Em dois casos houve infecção mista por duas espécies de Candida. Das 23 espécies, 48% eram C. albicans, 26% C. parapsilosis, 8,5% C. tropicalis, 8,5% C. glabrata, 4,3% C. guilliermondii e 4,3% C. famata. Nos testes de suscetibilidade, 48% das espécies apresentaram resistência aos azólicos, sendo 36% C. albicans e 64% espécies não albicans. Todas as cepas resistentes ao fluconazol no ATB-Fungus 3® apresentaram resistência no método de disco difusão. Pacientes com cepas resistentes utilizaram antifúngicos previamente para tratamento de candidíase oral ou onicomicose recorrente. Conclusão Candida albicans é a espécie mais isolada nos casos de onicomicoses causadas por leveduras do gênero Candida em unhas de pacientes com vírus da imunodeficiência humana. Entretanto, neste grupo de pacientes, as espécies não albicans isoladas nas unhas mostram-se menos suscetíveis aos azólicos. A resistência das leveduras ao fluconazol, droga frequentemente utilizada para candidíase, pode ter sido consequência de seu uso prévio. Desta forma, os antifúngicos devem ser utilizados com cautela e apenas quando houver certeza do diagnóstico micológico e da suscetibilidade antifúngica.

ABSTRACT

Objective The objective of this study was to identify yeasts from the genus Candida responsible for onychomycosis and their respective in vitro antifungal susceptibilities in outpatients with the human immunodeficiency virus and nail changes suggestive of onychomycosis. Methods Twenty-three strains of yeasts from 21 nail samples from fingers or toes were assessed. The colonies were identified using CHROMagar Candida® and standard tests. ATB-Fungus 3® method was used for the antifungal susceptibility testing and when there was resistance to fluconazole, the disk diffusion test was used for confirmation. Results A mixed infection with two species of Candida was found in two cases. Out of the 23 species found, 48% were C. albicans, 26% were C. parapsilosis, 8.5% were C. tropicalis, 8.5% were C. glabrata, 4.3% were C. guilliermondii and 4.3% were C. famata. In the susceptibility tests, 48% of the species were resistant to azoles, where 36% were C. albicans and 64% were non-albicans species. All luconazoleresistant strains in the ATB-Fungus 3® method were also resistant in the disk diffusion test. Patients with resistant strains had used antifungal agents before to treat oral candidiasis or recurrent onychomycosis. Conclusion Candida albicans is the most commonly isolated species in cases of onychomycosis caused by yeasts of the Candida genus in nails of patients with the human immunodeficiency virus. However, in this group of patients, the albicans species isolated from the nails are less susceptible to azoles. Yeast resistance to fluconazole, a drug routinely used to treat candidiases, could be due to its previous use. Thus, antifungal agents should be used with caution and only when the diagnosis and antifungal susceptibility are proven.