RESUMEN
Infections caused by uncommon Candida species have dramatically increased in recent decades, mostly among hematological malignancies. This report aims to present a case of Candida pararugosa bloodstream infection, review previous cases with C. pararugosa infections, and provide a concise review of the clinical background, risk factors, and brief the management of infections. A 3-year-old boy with a history of acute myeloid leukemia was hospitalized in Omid Hospital, Isfahan, Iran. Two consecutive blood cultures were taken from the peripheral vein and port catheter; after that, empirically meropenem was administered. Candida pararugosa were isolated from blood-based on conventional and molecular assays. Furthermore, the antifungal susceptibility profiles of the isolate were determined, which exhibited resistance to fluconazole (8 µg/mL). Antifungal therapy with caspofungin and removing the patient's port led to a significant clinical improvement of the patient's conditions. So far, in the literature review, 10 cases of clinical C. pararugosa isolates were found, of which 5 patients had bloodstream infections. Most patients with C. pararugosa infection presented with specific underlying conditions, such as malignancy, sarcoma, surgery, and adult acute myeloid leukemia. Patients with indwelling catheters run a high risk of acquiring C. pararugosa bloodstream infection. Therefore, special consideration should be given to opportunistic fungal infections in immunocompromised individuals using catheters.
Asunto(s)
Infecciones Relacionadas con Catéteres , Leucemia Mieloide Aguda , Sepsis , Masculino , Adulto , Humanos , Preescolar , Antifúngicos/farmacología , Fluconazol , Infecciones Relacionadas con Catéteres/diagnóstico , Infecciones Relacionadas con Catéteres/tratamiento farmacológico , Infecciones Relacionadas con Catéteres/microbiología , Leucemia Mieloide Aguda/complicaciones , Leucemia Mieloide Aguda/tratamiento farmacológico , Catéteres , Pruebas de Sensibilidad Microbiana , Farmacorresistencia FúngicaRESUMEN
BACKGROUND: The incidence of fungal keratitis has increased in recent years. While the epidemiology and clinical roles of various Candida and Fusarium species have been relatively well-identified in infections of the eye, data regarding keratitis caused by Aspergillus species are scant. Accurate and rapid diagnosis is important for successful management of this infection. OBJECTIVES: To present the first molecular epidemiological data from Mexico during a 4-year period of cases admitted with Aspergillus keratitis to a tertiary care eye institution in Mexico City. PATIENTS/METHODS: A total of 25 cases of keratitis were included in the study. Aspergillus isolates were identified by sequencing the calmodulin gene. Antifungal susceptibility was tested according to CLSI. RESULTS: The aetiological agents belonged to Aspergillus flavus (n = 13), Aspergillus effusus (n = 1), Aspergillus tamarii (n = 4), Aspergillus sydowii (n = 1), Aspergillus protuberus (n = 3) and Aspergillus terreus (n = 3). All strains had low minimum inhibitory concentrations (MICs) of itraconazole and voriconazole (VCZ). Amphotericin B and natamycin showed moderate elevated MICs. CONCLUSIONS: Early diagnosis and application of topical VCZ 1% were associated with good outcome. Monitoring of local epidemiological data plays an important role in clinical practice.
Asunto(s)
Aspergilosis/epidemiología , Aspergillus/aislamiento & purificación , Infecciones Fúngicas del Ojo/epidemiología , Queratitis/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antifúngicos/farmacología , Aspergilosis/microbiología , Aspergillus/clasificación , Aspergillus/efectos de los fármacos , Aspergillus/genética , Calmodulina/genética , Infecciones Fúngicas del Ojo/microbiología , Femenino , Proteínas Fúngicas/genética , Humanos , Incidencia , Queratitis/microbiología , Masculino , México/epidemiología , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Centros de Atención Terciaria , Adulto JovenRESUMEN
We present a severe case of disseminated phaeohyphomycosis due to Veronaea botryosa. A 32-year-old female, native from Cuautla, Morelos, Mexico, presented a chronic dermatosis which started 10 years earlier with multiple exophytic, multilobulated, soft, and pedunculated or sessile neoformations of diverse sizes from 2 to 10 cm in diameter, which became verrucose and increased in size. The patient was immunocompetent, and no hereditary or familiar precedents of importance were known. No treatment was given, and the dermatosis remained relatively stable until the patient became pregnant in 2001 and 2003. The infection then exacerbated and worsened, leading to dissemination to the extremities, trunk, and face. The initial diagnosis was chromoblastomycosis which was treated with terbinafine and itraconazole but without visible improvement. Histopathology revealed pigmented, irregular, unbranched, and septate hyphae. Veronaea botryosa was isolated (CBS 127264 = JX566723), and its identity was confirmed by sequencing the internal transcribed spacer (ITS) rDNA. Therapy with posaconazole (800 mg/day) was started showing a gradual improvement of lesions with a reduction in size and flattening of the eruptions.
Asunto(s)
Ascomicetos/aislamiento & purificación , Feohifomicosis/diagnóstico , Feohifomicosis/patología , Adulto , Antifúngicos/uso terapéutico , ADN de Hongos/química , ADN de Hongos/genética , ADN Espaciador Ribosómico/química , ADN Espaciador Ribosómico/genética , Femenino , Histocitoquímica , Humanos , México , Feohifomicosis/tratamiento farmacológico , Feohifomicosis/microbiología , Embarazo , Análisis de Secuencia de ADN , Piel/patología , Resultado del Tratamiento , Triazoles/uso terapéuticoRESUMEN
We report two cases of chromoblastomycosis due to Fonsecaea pedrosoi and F. monophora in otherwise healthy Cuban males. Direct microscopic examination of biopsies revealed muriform cells, the hallmark of chromoblastomycosis. The suspected agents were recovered in culture, identified on the basis of morphological criteria and confirmed by sequencing of the internal transcribed spacer regions of rDNA. Final treatment consisted of surgical excision. The patients were successfully cured since there was no relapse after a follow-up of more than a year. In vitro antifungal susceptibility testing of both isolates showed that itraconazole and posaconazole had potent activity. High MICs of amphotericin B (2 µg/ml), fluconazole (>64 µg/ml), anidulafungin (8 µg/ml) and caspofungin (8 µg/ml) were found.