Epidemiological profile of patients hospitalized with candiduria in the Central-Western region of Brazil / Perfil epidemiológico de pacientes hospitalizados con candiduria en la región centro-oeste de Brasil

Background: Candida yeasts are considered the main agents of nosocomial fungal infections. Aims: This study aimed to establish the epidemiological profile of patients with candiduria hospitalized in the capital of the State of Mato Grosso, in the Central-Western region of Brazil. Methods: Patients from three private hospitals and a public hospital participated in the study. This was an observational and cross-sectional study including analysis of patients mortality. It was carried out from March to August 2015. Results: A total of 93 patients with candiduria were evaluated. Candida tropicalis was found most commonly (37.6%; n=35), followed by Candida albicans (36.6%; n=34), Candida glabrata (19.3%; n=18), psilosis complex (4.3%; n=4), Candida lusitaniae (1.1%; n=1) and Candida krusei (1.1%; n=1). Antibiotic therapy (100%) and the use of an indwelling urinary catheter (89.2%; n=83) were the most frequent predisposing factors. Antifungal treatment was given to 65.6% of the patients, and anidulafungin was the most used antifungal. Mortality rates were 48% higher among patients with candiduria who had renal failure. Micafungin was the antifungal most prescribed among the patients who died. Candidemia concomitant with candiduria occurred in eight (8.6%; n=8) cases. Considering the species recovered in the blood and urine, only one patient had genetically distinct clinical isolates. Conclusions: Non-C. albicans Candida species were predominant, with C. tropicalis being the most responsible for most cases of candiduria

Antecedentes: Las levaduras del género Candida están consideradas los principales agentes de infecciones micóticas nosocomiales. Objetivos: El objetivo del presente estudio fue establecer el perfil epidemiológico de los pacientes con candiduria hospitalizados en la capital de Mato Grosso, estado situado en la Región centro-oeste de Brasil. Métodos: Participaron en el estudio pacientes de tres hospitales privados y un hospital público. Se trataba de un estudio observacional y transversal que incluía el análisis de la mortalidad de los pacientes. Se llevó a cabo de marzo a agosto de 2015. Resultados: Se incluyó en el estudio a un total de 93 pacientes con candiduria. Candida tropicalis se encontró con mayor frecuencia (37,6%; n=35), seguida por Candida albicans (36,6%; n=34), Candida glabrata (19,3%; n=18), Candida psilosis complex (4,3%; n=4), Candida lusitaniae (1,1%; n=1) y Candida krusei (1,1%; n=1). El tratamiento antibiótico (100%) y el uso de una sonda urinaria permanente (89,2%; n=83) fueron los factores predisponentes más frecuentes. Se prescribió tratamiento antimicótico al 65,6% de los pacientes y la anidulafungina fue el antimicótico utilizado con más frecuencia. Las tasas de mortalidad fueron un 48% superiores entre los pacientes con candiduria con insuficiencia renal. Los pacientes que murieron presentaron la mayor proporción de prescripción del antimicótico micafungina. La candidemia concomitante con candiduria se produjo en ocho casos (8,6%; n=8). Si se tienen en cuenta las especies recuperadas en sangre y orina, solo en un paciente se encontraron aislamientos clínicos genéticamente diferentes. Conclusiones: Las especies de Candida no C. albicans fueron predominantes. C. tropicalis fue la responsable de la mayoría de los casos de candiduria

Epidemiological profile of patients hospitalized with candiduria in the Central-Western region of Brazil.

BACKGROUND: Candida yeasts are considered the main agents of nosocomial fungal infections. AIMS: This study aimed to establish the epidemiological profile of patients with candiduria hospitalized in the capital of the State of Mato Grosso, in the Central-Western region of Brazil. METHODS: Patients from three private hospitals and a public hospital participated in the study. This was an observational and cross-sectional study including analysis of patients mortality. It was carried out from March to August 2015. RESULTS: A total of 93 patients with candiduria were evaluated. Candida tropicalis was found most commonly (37.6%; n=35), followed by Candida albicans (36.6%; n=34), Candida glabrata (19.3%; n=18), psilosis complex (4.3%; n=4), Candida lusitaniae (1.1%; n=1) and Candida krusei (1.1%; n=1). Antibiotic therapy (100%) and the use of an indwelling urinary catheter (89.2%; n=83) were the most frequent predisposing factors. Antifungal treatment was given to 65.6% of the patients, and anidulafungin was the most used antifungal. Mortality rates were 48% higher among patients with candiduria who had renal failure. Micafungin was the antifungal most prescribed among the patients who died. Candidemia concomitant with candiduria occurred in eight (8.6%; n=8) cases. Considering the species recovered in the blood and urine, only one patient had genetically distinct clinical isolates. CONCLUSIONS: Non-C. albicans Candida species were predominant, with C. tropicalis being the most responsible for most cases of candiduria.

1340nm LASER THERAPY FOR ONYCHOMYCOSIS: Negative Results of Prospective Treatment of 72 Toenails and a Literature Review.

Onychomycosis is an infection of the nail plate by fungal microorganisms. This infection has an important social impact on women and men and poses a major challenge for its treatment. The traditional treatment of onychomycosis involves the use of topical and oral antifungal agents. However, the presence of adverse effects frequently associated with oral antifungals, their high cost, and their potential interactions with other drugs reflect some of the problems associated with conventional therapy. The current report details the evaluation of a 1340nm laser as monotherapy for toenails affected by onychomycosis. A 1340nm, neodymium-yttrium:yttrium-aluminum-perovskite (Nd:YAP) (e) laser (Etherea, Industra technologies, Brazil) was used with the following treatment parameters: a spot size of 6mm, pulse duration of 5ms, fluence of 22 to 25J/cm2, and repetition rate of 1.5 to 2.5Hz. In all, 72 toenails were evaluated in 30 patients who had clinical and laboratory confirmation of onychomycosis. The efficacy of treatment was measured by the degree of patient satisfaction on a scale of 0 to 10 and by mycological cure evidenced by direct mycological exam and culture. Considering three applications of laser therapy and a clinical/laboratory follow-up period of 12 weeks, monotherapy with 1340nm laser was not effective, since 93.3 percent of the assessed patients remained without clinical and mycological cure. Despite reports of variable success rates with the use of different lasers for the treatment of onychomycosis, it is not yet possible to state that this therapeutic alternative is indicated for the treatment of these infections, mainly due to the limited number of patients and/or nail plates evaluated and the controversial results described in the literature.

Fatal Cryptococcus gattii genotype AFLP6/VGII infection in a HIV-negative patient: case report and a literature review.

Cryptococcus gattii, a species belonging to the Cryptococcus complex which occurs endemically in tropical and subtropical regions, has been reported as a causative agent of cryptococcosis in healthy individuals. We report a case of meningitis in HIV-negative patient from Cuiaba, MT, in the Midwestern region of Brazil. Cryptococcus gattii AFLP6/VGII was isolated from cerebrospinal fluid and molecular typing was performed by URA5-RFLP. The in vitro susceptibility profile was determined using the standard method according to the document M27A3, CLSI 2008. C. gattii AFLP6/VGII was shown to be susceptible to the antifungals tested. Treatment with 0.8 mg/kg of amphotericin B was initiated; however, the patient died 2 days after the onset of therapy.

Características epidemiológicas y clínicas de la candidiasis nosocomial en hospitales universitarios de Cuiabá − Mato Grosso, Brasil / Epidemiological and clinical characteristics of nosocomial candidiasis in university hospitals in Cuiabá - Mato Grosso, Brazil

Antecedentes. Las micosis están emergiendo como una importante causa de enfermedad en el ser humano, en especial entre pacientes hospitalizados con enfermedades subyacentes graves y otros factores de riesgo. Objetivos. Examinar las características epidemiológicas y clínicas de los pacientes con candidiasis nosocomial en hospitales universitarios de Cuiabá, Mato Grosso, Brasil. Métodos. Durante un período de 20 meses, se realizó un estudio descriptivo de 91 pacientes ingresados en hospitales universitarios de Cuiabá, Mato Grosso, con un diagnóstico clínico y de laboratorio de candidiasis nosocomial. Resultados. Se determinó una tasa de infección nosocomial por Candida de 5 por cada 1.000 ingresos; la tasa de mortalidad fue del 14,4% y la de letalidad del 53,8%. Las edades de los pacientes variaron entre 29 días y 82 años. El 74,7% de los pacientes estaban en la edad adulta y el 25,3% eran niños. Las unidades de cuidados intensivos contribuyeron con el mayor número de casos de infección por Candida (69,2%). La enfermedad subyacente más importante fue un proceso del tracto gastrointestinal (11%). La prematuridad y el bajo peso al nacer fueron los factores de riesgo más importantes entre los recién nacidos. La administración de antibióticos, los procedimientos cruentos, el uso de antagonistas H2, las múltiples transfusiones de sangre y una duración de la estancia hospitalaria ≥ 21 días fueron los factores de riesgo más frecuentes entre los adultos. C. albicans fue la especie más habitual en todos los casos. Conclusiones. En el presente estudio, C. albicans fue la especie detectada con más frecuencia en las candidiasis y las exposiciones de riesgo aumentaron la predisposición de los pacientes hospitalizados a adquirir una infección nosocomial por Candida spp(AU)

Background. Fungal infections are emerging as an important cause of human disease, especially among hospitalized patients with serious underlying disease and several risk factors. Aims. To evaluate epidemiological and clinical characteristics of patients with nosocomial candidiasis in university hospitals in Cuiabá - MT, Brazil. Methods. A descriptive study of 91 patients admitted to university hospitals in Cuiabá - MT, with clinical and laboratory diagnosis of nosocomial candidiasis, over a 20-month period. Results. A rate for nosocomial infections by Candida spp. of 5 per 1000 admissions, proportional mortality of 14.4% and lethality of 53.8% were determined. The patient age ranged from 29 days to 82 years-old, among which, 74.7% were adults and 25.3% children. The intensive care units contributed with the highest number of cases of infection by Candida spp. (69.2%). The most important underlying disease was gastrointestinal tract disease (11%). Prematurity and low birth weight were the most important risk factors among newborns. The use of antibiotics, invasive procedures, H2 blockers, multiple blood transfusions and stay length of ≥21 days were the most frequent risk factors among adults. Candida albicans was the most common species in all cases. Conclusions. In this study, C. albicans was the most frequently detected species in candidiasis and risk factors increased the susceptibility of hospitalized patients to acquiring a nosocomial infection by Candida spp(AU)

Epidemiological and clinical characteristics of nosocomial candidiasis in university hospitals in Cuiabá--Mato Grosso, Brazil.

BACKGROUND: Fungal infections are emerging as an important cause of human disease, especially among hospitalized patients with serious underlying disease and several risk factors. AIMS: To evaluate epidemiological and clinical characteristics of patients with nosocomial candidiasis in university hospitals in Cuiabá - MT, Brazil. METHODS: A descriptive study of 91 patients admitted to university hospitals in Cuiabá - MT, with clinical and laboratory diagnosis of nosocomial candidiasis, over a 20-month period. RESULTS: A rate for nosocomial infections by Candida spp. of 5 per 1000 admissions, proportional mortality of 14.4% and lethality of 53.8% were determined. The patient age ranged from 29 days to 82 years-old, among which, 74.7% were adults and 25.3% children. The intensive care units contributed with the highest number of cases of infection by Candida spp. (69.2%). The most important underlying disease was gastrointestinal tract disease (11%). Prematurity and low birth weight were the most important risk factors among newborns. The use of antibiotics, invasive procedures, H(2) blockers, multiple blood transfusions and stay length of ≥21 days were the most frequent risk factors among adults. Candida albicans was the most common species in all cases. CONCLUSIONS: In this study, C. albicans was the most frequently detected species in candidiasis and risk factors increased the susceptibility of hospitalized patients to acquiring a nosocomial infection by Candida spp.

Mucormycosis in Mato Grosso, Brazil: a case reports, caused by Rhizopus microsporus var. oligosporus and Rhizopus microsporus var. rhizopodiformis.

We identified the etiological agents responsible for two fatal cases of rhinocerebral mucormycosis with the classical risk factor for uncontrolled type II diabetes mellitus. Their initial symptoms did not point immediately to the suspicion of mucormycosis. Case 1, caused by Rhizopus microsporus var. oligosporus, was a 52-year-old man who presented with a painful pimple on his nose, which evolved with swelling, erythema, and a central pustule on his right hemiface suspected to be cellulitis. After 7 days of antibiotic treatment, the patient worsened with signs of sepsis and the lesion evolved to necrosis involving all his right face. Case 2, caused by Rhizopus microsporus var. rhizopodiformis, was a 57-year-old woman placed on continuous therapy with azathioprine and corticoids after a renal transplant due to chronic arterial hypertension and uncontrolled type II diabetes mellitus. Because she was suspected to have sepsis, the patient was treated with broad-spectrum antibiotics and mechanical ventilation, yet she deteriorated. Because Candida spp. were isolated from urine and a BAL, she was treated with fluconazole for 10 days, then substituted by caspofungin. Two weeks later, she presented with exophthalmus of the left eye that was surrounded by a large inflammatory and necrotic area. Both patients were the diagnosed with mucormycosis via direct microscopy of necrotic material prior to their death.

Vulvovaginal candidiasis in Mato Grosso, Brazil: pregnancy status, causative species and drugs tests

Causative agent in majority of VVC is Candida albicans, but infection due to non-C. albicans is common. Use of empiric antifungal therapy in Brazil due to syndromic management of vulvovaginitis could act as risk factor for increase resistance among VVC causative agents. From Mato Grosso patients, 160 with culture-proved among 404 women who had clinical symptoms of VVC, were enrolled in this study. 70 non-pregnant women and 90 pregnant women were included. Candida albicans was the most prevalent, representing 72.9 percent in the non-pregnant group and 92.3 percent in the pregnant group. Differences in species distribution were noted between the two groups, being C. parapsilosis the second more prevalent species among non-pregnant women. Susceptibility testing revealed high susceptibility to fluconazole (except for C. krusei), itraconazole, ketoconazole, and amphotericin B regardless the species (C. albicans, C. parapsilosis, C. tropicalis, C. glabrata, C. krusei) analyzed.

Vulvovaginal candidiasis in Mato Grosso, Brazil: pregnancy status, causative species and drugs tests.

Causative agent in majority of VVC is Candida albicans, but infection due to non-C. albicans is common. Use of empiric antifungal therapy in Brazil due to syndromic management of vulvovaginitis could act as risk factor for increase resistance among VVC causative agents. From Mato Grosso patients, 160 with culture-proved among 404 women who had clinical symptoms of VVC, were enrolled in this study. 70 non-pregnant women and 90 pregnant women were included. Candida albicans was the most prevalent, representing 72.9% in the non-pregnant group and 92.3% in the pregnant group. Differences in species distribution were noted between the two groups, being C. parapsilosis the second more prevalent species among non-pregnant women. Susceptibility testing revealed high susceptibility to fluconazole (except for C. krusei), itraconazole, ketoconazole, and amphotericin B regardless the species (C. albicans, C. parapsilosis, C. tropicalis, C. glabrata, C. krusei) analyzed.