Candidaemia due to Candida parapsilosis species complex at a hospital in Brazil: Clinical characteristics and antifungal susceptibility profile / Candidemia por especies del complejo Candida parapsilosis en un hospital de Brasil: características clínicas y perfil de sensibilidad a los antifúngicos

Background. Recent decades have seen a global emergence of candidaemia caused by non-Candida albicans Candida species, particularly the Candida parapsilosis complex. Aims. To evaluate the clinical features and antifungal susceptibility profiles of isolates belonging to the C. parapsilosis species complex in patients with candidaemia in a midwestern Brazilian tertiary-care teaching hospital. Methods. Yeast identification was performed using an automated Vitek 2 Compact system. PCR-RFLP was employed for species differentiation. Results. Five cases of infection by C. parapsilosis sensu stricto and two by Candida orthopsilosis were found. Of the seven cases, five were adult patients undergoing haemodialysis. The only isolate of C. parapsilosis sensu stricto resistant to fluconazole (MIC=8μg/ml) was obtained from a patient on a long-term regimen with this drug. This was the only patient who evolved to death. Conclusions. Resistance to antifungal agents poses a therapeutic challenge, especially for non-C. albicans Candida species, and requires continuous monitoring using susceptibility tests because resistance in vitro can be predictive of treatment failure. In the present study, in vitro antifungal susceptibility proved consistent with clinical outcome (AU)

Antecedentes. En las últimas décadas se ha visto un surgimiento mundial de la candidemia causada por especies de Candida no-C. albicans, en particular del complejo Candida parapsilosis. Objetivos. Evaluar las características clínicas y los perfiles de sensibilidad antifúngica en aquellos aislamientos del complejo de especies C. parapsilosis responsables de candidemia en un hospital universitario de tercer nivel en la región centro-oeste de Brasil. Métodos. La identificación se realizó en un sistema automatizado Vitek 2 compact. Se utilizó PCR-RFLP para la diferenciación de las especies. Resultados. Se encontraron cinco casos de candidemia por C. parapsilosis sensu stricto y dos por Candida orthopsilosis. Cinco eran pacientes adultos sometidos a hemodiálisis. El único aislamiento de Candida parapsilosis sensu stricto resistente a fluconazol (CIM, 8μg/ml) se obtuvo de un paciente en régimen largo de tratamiento con este antifúngico. Este fue el único paciente que murió. Conclusiones. La resistencia a los antifúngicos constituye un desafío terapéutico, en especial contra las especies de Candida no-C. albicans, que requieren la monitorización continua por medio de pruebas de sensibilidad en vista de que la resistencia in vitro puede ser predictiva de fracaso del tratamiento. En el presente estudio la sensibilidad antifúngica in vitro resultó consistente con el curso clínico (AU)

Candidaemia due to Candida parapsilosis species complex at a hospital in Brazil: Clinical characteristics and antifungal susceptibility profile.

BACKGROUND: Recent decades have seen a global emergence of candidaemia caused by non-Candida albicans Candida species, particularly the Candida parapsilosis complex. AIMS: To evaluate the clinical features and antifungal susceptibility profiles of isolates belonging to the C. parapsilosis species complex in patients with candidaemia in a midwestern Brazilian tertiary-care teaching hospital. METHODS: Yeast identification was performed using an automated Vitek 2 Compact system. PCR-RFLP was employed for species differentiation. RESULTS: Five cases of infection by C. parapsilosis sensu stricto and two by Candida orthopsilosis were found. Of the seven cases, five were adult patients undergoing haemodialysis. The only isolate of C. parapsilosis sensu stricto resistant to fluconazole (MIC=8µg/ml) was obtained from a patient on a long-term regimen with this drug. This was the only patient who evolved to death. CONCLUSIONS: Resistance to antifungal agents poses a therapeutic challenge, especially for non-C. albicans Candida species, and requires continuous monitoring using susceptibility tests because resistance in vitro can be predictive of treatment failure. In the present study, in vitro antifungal susceptibility proved consistent with clinical outcome.

First molecular typing of cryptococcemia-causing cryptococcus in central-west Brazil.

Molecular epidemiology studies on cryptococcemia are limited. This study aimed to describe the clinical features of patients with bloodstream infections by Cryptococcus sp. in a public tertiary hospital in Mato Grosso do Sul, as well as identify the fungus' molecular type and determine its antifungal susceptibility. Molecular typing was performed using URA5 restriction fragment length polymorphism PCR, and antifungal susceptibility was determined by microdilution method standardized by the Clinical and Laboratory Standards Institute. Over 14 years, 48 patients were diagnosed with cryptococcemia. The majority (72.9 %) was male with a median age of 40 years; 81.3 % of the patients had HIV/AIDS and 72.9 % died. Cryptococcus neoformans was the most commonly isolated species (97.9 %). Molecular analysis identified the genotypes C. neoformans VNI (93.7 %), C. neoformans VNII (4.2 %), and Cryptococcus gattii VGII (2.1 %). In vitro, these fungi were not resistant to fluconazole, itraconazole, voriconazole, and amphotericin B. This is the first description of the molecular types of cryptococcemia agents in central-west Brazil. Its high lethality, especially in HIV-negative patients, suggests that early diagnosis and prompt antifungal therapy are crucial for a good clinical outcome.

Pericardite bacteriana com subsequente desenvolvimento de endocardite mural por levedura do complexo Candida parapsilosis / Bacterial pericarditis with subsequent development of mural endocarditis caused by Candida parapsilosis complex yeast

A infecção primária do pericárdio e do endocárdio é rara. Este estudo descreve a evolução de uma criança com cardite reumática aguda, complicada com pericardite infecciosa bacteriana, secundária a abscessos de pele e endocardite fúngica. O tempo prolongado de internação, o uso de cateter venoso central e a antibioticoterapia de amplo espectro foram os fatores que provavelmente favoreceram a colonização, a candidíase invasiva e o desenvolvimento da endocardite por levedura do complexo Candida parapsilosis.

Detecção de anticorpos anti-Paracoccidioides brasiliensis em pacientes suspeitos de tuberculose / Detection of Anti-Paracoccidioides brasiliensis antibodies in suspected tuberculosis patients

Paracoccidioidomycosis (PCM) is an important systemic mycosis in Latin America that occurs as active disease in 1-2% of Paracoccidioides brasiliensis infected people. Like PCM, tuberculosis (TB) affects mainly the lungs and the clinical and radiological aspects do not always allow differentiation between them. The aim of this study was to carry out serological investigation for detecting anti-P. brasiliensis antibodies, by three serological methods, in patients with symptoms suggestive of pulmonary TB. From August 2005 to September 2006, 76 patients with pulmonary symptoms suspected for TB were attended at the Regional Specialties Center Laboratory in the city of Paranavaí, Paraná, Brazil and submitted to microbiological TB research, ELISA, immunodiffusion and immunoblotting for PCM. Of all the individuals, 21 (27.63%) were reactive to P. brasiliensis by ELISA and 11 (14.47%) showed a laboratory diagnosis of pulmonary TB. Of all the individuals serologically reactive to P. brasiliensis, by ELISA, none had positive results by immunodiffusion and one reacted with antigen 43 kDa when Immunobloting was carried out. Our results lead us to reflect a necessity to obtain a more specific serologic test for diagnosis of PCM disease in patients with respiratory symptoms considering the high number of individuals reactive to P. brasiliensis especially in endemic areas

Paracoccidioidomicose (PCM) é importante micose sistêmica na América Latina, que ocorre como doença ativa em 1-2% dos indivíduos infectados com Paracoccidioides brasiliensis. Assim como a PCM, a tuberculose (TB) afeta principalmente os pulmões, porém os aspectos clínicos e radiológicos nem sempre permitem a diferenciação entre essas doenças. O objetivo deste estudo foi realizar um inquérito sorológico para a detecção de anticorpos anti-P. brasiliensis, utilizando três métodos sorológicos, em pacientes com sintomas sugestivos de tuberculose pulmonar. De agosto de 2005 a setembro de 2006, 76 pacientes sintomáticos foram atendidos no Laboratório do Centro Regional de Especialidades de Paranavaí, Paraná, Brasil e submetidos à investigação microbiológica para TB e de anticorpos por ELISA, imunodifusão e immunobloting para PCM. Destes, 21 (27,63%) foram reativos para P. brasiliensis por ELISA e 11 (14,47%) apresentaram diagnóstico laboratorial de tuberculose pulmonar. Dos indivíduos sorologicamente reativos para P. brasiliensis, por ELISA, nenhum apresentou resultado positivo pela técnica de imunodifusão e um reagiu com antígeno de 43 kDa quando do uso de immunobloting. Os resultados obtidos nos levam a refletir da necessidade de se obter um teste sorológico mais específico para o diagnóstico de PCM doença em pacientes com sintomas respiratórios, considerando o elevado número de indivíduos reativos para P. brasiliensis principalmente em áreas endêmicas