Two cases of fungal cyst infection in ADPKD: is this really a rare complication?

BACKGROUND: Cyst infection is a prevalent complication in autosomal dominant polycystic kidney disease (ADPKD) patients, however therapeutic and diagnostic approaches towards this condition remain unclear. The confirmation of a likely episode of cyst infection by isolating the pathogenic microorganism in a clinical scenario is possible only in the minority of cases. The available antimicrobial treatment guidelines, therefore, might not be appropriate to some patients. CASE PRESENTATION: We describe two unique cases of kidney cyst infection by Candida albicans, a condition that has not been previously described in literature. Both cases presented clear risk factors for Candida spp. infection. However, since there was no initial indication of cyst aspiration and culture, antifungal therapy was not immediately started and empirical treatment was initiated as recommended by the current guidelines. Antifungal treatment was instituted in both cases along the clinical course, according to their specificities. CONCLUSION: Our report highlights the possibility of Candida spp. cyst infection. Failure of clinical improvement with antibiotics should raise the suspicion of a fungal infection. Identification of infected cysts should be pursued in such cases, particularly with PET-CT, and when technically possible followed by cyst aspiration and culture to guide treatment. Risk factors for this condition, such as Candida spp. colonization, previous antimicrobial therapy, hemodialysis, necrotizing pancreatitis, gastrointestinal/hepatobiliary surgical procedure, central venous catheter, total parenteral nutrition, diabetes mellitus and immunodeficiency (neutropenia < 500 neutrophils/mL, hematologic malignancy, chemotherapy, immunosuppressant drugs), should be also considered accepted criteria for empirical antifungal therapy.

Avaliação da gasometria arterial de ratos desnutridos submetidos à anestesia inalatória por éter etílico em vaporizador artesanal / Evaluation of arterial blood of malinourished rats subjected toinhalation anesthesia by diethyl etker with vaporizer in craftsmanship

Objetivo: analisar a influência do estado nutricional sobre o equilíbrio ácido-básico atravésda gasometria arterial em ratos anestesiados com vaporizador artesanal de éter. Método:foram utilizados vinte ratos (Rattus novergicus albinus) da linhagem Wistar, machos, jovens,com peso entre 100 a 150 gramas, distribuídos, randomicamente, em dois grupos: GrupoNormonutridos e Grupo Desnutridos, subdivididos em quatro subgrupos cada, de acordo como tempo da coleta de sangue. Os animais induzidos à desnutrição protéico-calórica foramsubmetidos à dieta aprotéica, por 21 dias e foram avaliados seu peso e albumina sérica. No21º dia, foram anestesiados por inalação contínua de éter etílico com auxílio de vaporizadorartesanal de éter. Realizou?se cervicotomia, dissecção e cateterização da artéria carótidacomum. Procedeu?se a coleta de três amostras de sangue (0,5 ml cada) em cada rato emdiferentes tempos, para a obtenção dos valores dos parâmetros gasométricos e iônicos.Realizou-se, então, a análise estatística comparativa pelo teste de Anoua com ?.= 0,05 ou 5%.Resultados: o processo de desnutrição foi efetivo, com a redução de peso e da albuminasérica dos animais. Ao analisar o bicarbonato no sangue de animais normonutridos edesnutridos, constatou-se diminuição desse íon nos animais desnutridos (p<0,05). A análisede pCO2 e pO2 nos dois grupos não revelou diferença estatística significativa (p>0,05), bemcomo Na+ e K+.Conclusão: verificou-se que a desnutrição dos animais provoca alterações nagasometria arterial, de modo que houve diferença estatística significativa nos níveis debicarbonato, íons Na+ e K+ entre os grupos estudados

Objective: to evaluate the influence of nutritional status on the acid-base balance through thearterial gas in rats anesthetized with ether vaporizer craft . Method: it was used twenty rats(Rattus norvegicus Albinus) Wistar, male, young, weighing between 100 to 150 grams,randomized into two groups: Group Nourished and Malnourished group, each divided into foursubgroups, according to the time of blood collection. The animals induced with malnutritionunderwent no protein diet for 21 days and were evaluated their weight and serum albumin. Onday 21, were anesthetized by continuous inhalation of ethyl ether with of ether vaporizer craft.Neck incision was performed, the common carotid artery dissected and catheterized. Proceededto collect three blood samples (0.5 ml each) in each rat at different times to obtain the values ofthe ionic parameters and blood gas . The statistical analysis was performed with Anova Testwith ? .= 0.05 or 5%. Results: the process of malnutrition was effective, with reduced weightand serum albumin of animals. When analyzed the HCO3- in the animals blood, a decrease ofthis ion in malnourished animals (p <0.05) was noticed. The analysis of pCO2 and pO2 in thetwo groups revealed no statistically significant difference (p> 0.05), as well as Na+ and K+.Conclusion: there was malnutrition in animals causes changes in arterial blood gases, so therewas a statistically significant difference levels of bicarbonate, Na+ and K+ between the groups.and serum albumin of animals. When analyzed the HCO3- in the animals blood, a decrease ofthis ion in malnourished animals (p <0.05) was noticed. The analysis of pCO2 and pO2 in thetwo groups revealed no statistically significant difference (p> 0.05), as well as Na+ and K+.Conclusion: there was malnutrition in animals causes changes in arterial blood gases, so therewas a statistically significant difference levels of bicarbonate, Na+ and K+ between the groups.