RESUMO
Aspergillus spp. are among the most common causes of opportunistic invasive fungal infections in tertiary care hospitals. Little is known about the prevalence and in vitro susceptibility of Aspergillus species in Latin America, because there are few medical centers able to perform accurate identification at the species level. The purpose of this study was to analyze the distribution of cryptic and rare Aspergillus species among clinical samples from 133 patients with suspected aspergillosis admitted in 12 medical centers in Brazil and to analyze the in vitro activity of different antifungal drugs. The identification of Aspergillus species was performed based on a polyphasic approach, as well as sequencing analysis of the internal transcribed spacer (ITS) region, calmodulin, and ß-tubulin genes and phylogenetic analysis when necessary. The in vitro susceptibility tests with voriconazole, posaconazole, and itraconazole were performed according to the CLSI M38-A2 document (2008). We demonstrated a high prevalence of cryptic species causing human infection. Only three isolates, representing the species Aspergillus thermomutatus, A. ochraceus, and A. calidoustus, showed less in vitro susceptibility to at least one of the triazoles tested. Accurate identifications of Aspergillus at the species level and with in vitro susceptibility tests are important because some species may present unique resistance patterns against specific antifungal drugs.
Assuntos
Antifúngicos/farmacologia , Aspergilose/epidemiologia , Aspergilose/microbiologia , Aspergillus/classificação , Aspergillus/efeitos dos fármacos , Triazóis/farmacologia , Aspergillus/isolamento & purificação , Brasil/epidemiologia , Calmodulina/genética , Análise por Conglomerados , DNA Fúngico/química , DNA Fúngico/genética , DNA Espaçador Ribossômico/química , DNA Espaçador Ribossômico/genética , Humanos , Itraconazol/farmacologia , Testes de Sensibilidade Microbiana , Dados de Sequência Molecular , Filogenia , Prevalência , Análise de Sequência de DNA , Tubulina (Proteína)/genética , Voriconazol/farmacologiaRESUMO
Candidemia in cancer patients may differ according to the type of cancer. To characterise the epidemiology and outcome of candidemia in cancer patients from Brazilian hospitals, we compared the characteristics of patients with hematologic malignancies (HM) and solid tumours (ST). A retrospective study was performed, based on data collected from laboratory-based surveillance studies in 18 tertiary care hospitals between March/2003 and December/2007. The characteristics of patients with HM (n = 117) were compared with patients with ST (n = 248). Predictors of 30-day mortality were identified by uni- and multivariate analyses. Candidemia in HM was more likely to occur in the setting of chemotherapy, corticosteroids, neutropenia, mucositis and tunnelled central venous catheter (CVC), whereas surgery, intensive care unit admission and invasive procedures (mechanical ventilation, parenteral nutrition and CVC) were more frequent in ST. The 30-day mortality rate was higher in the ST group (65% vs. 46%, P = 0.001). Factors significantly associated with 30-day mortality were older age and intensive care unit admission. Important differences in the epidemiology and outcome of candidemia in HM and ST were observed. The characterisation of the epidemiology is important to drive preventive measures and to select appropriate therapies.
Assuntos
Candida/isolamento & purificação , Candidemia/epidemiologia , Neoplasias Hematológicas/complicações , Neoplasias/complicações , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Brasil/epidemiologia , Candida/patogenicidade , Candidemia/complicações , Candidemia/tratamento farmacológico , Criança , Pré-Escolar , Infecção Hospitalar , Feminino , Neoplasias Hematológicas/microbiologia , Mortalidade Hospitalar , Humanos , Lactente , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Neoplasias/microbiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Análise de Sobrevida , Centros de Atenção Terciária , Adulto JovemRESUMO
Invasive fungal disease (IFD) shows distinct regional incidence patterns and epidemiological features depending on the geographic region. We conducted a prospective survey in eight centres in Brazil from May 2007 to July 2009. All haematopoietic cell transplant (HCT) recipients and patients with acute myeloid leukaemia (AML) or myelodysplasia (MDS) were followed from admission until 1 year (HCT) or end of consolidation therapy (AML/MDS). The 12-month cumulative incidence (CI) of proven or probable IFD was calculated, and curves were compared using the Grey test. Among 237 AML/MDS patients and 700 HCT recipients (378 allogeneic, 322 autologous), the 1-year CI of IFD in AML/MDS, allogeneic HCT and autologous HCT was 18.7%, 11.3% and 1.9% (p <0.001), respectively. Fusariosis (23 episodes), aspergillosis (20 episodes) and candidiasis (11 episodes) were the most frequent IFD. The 1-year CI of aspergillosis and fusariosis in AML/MDS, allogeneic HCT and autologous HCT were 13.4%, 2.3% and 0% (p <0.001), and 5.2%, 3.8% and 0.6% (p 0.01), respectively. The 6-week probability of survival was 53%, and was lower in cases of fusariosis (41%). We observed a high burden of IFD and a high incidence and mortality for fusariosis in this first multicentre epidemiological study of IFD in haematological patients in Brazil.
Assuntos
Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Hospedeiro Imunocomprometido , Leucemia Mieloide Aguda/complicações , Micoses/epidemiologia , Síndromes Mielodisplásicas/complicações , Transplante , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aspergillus/isolamento & purificação , Brasil/epidemiologia , Candida/isolamento & purificação , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Fusarium/isolamento & purificação , Humanos , Incidência , Lactente , Recém-Nascido , Leucemia Mieloide Aguda/terapia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Micoses/microbiologia , Síndromes Mielodisplásicas/terapia , Adulto JovemRESUMO
Mucormycosis is a rare but emerging fungal infection complicating solid organ transplantation (SOT), with a cumulative incidence of around 2% during the first year after SOT. The associated mortality rate is high, and surgical debridement is frequently required as part of the treatment along with antifungal therapy based mostly on amphotericin B formulations, We describe here an unusual case of hepatic mucormycosis in a liver transplant recipient that was successfully treated with clinical therapy based on liposomal amphotericin B followed by posaconazole, without surgical resection.
Assuntos
Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Hepatopatias/tratamento farmacológico , Transplante de Fígado/efeitos adversos , Mucormicose/tratamento farmacológico , Triazóis/administração & dosagem , Esquema de Medicação , Feminino , Humanos , Imunossupressores/efeitos adversos , Hepatopatias/diagnóstico , Hepatopatias/microbiologia , Mucormicose/diagnóstico , Mucormicose/microbiologia , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae is spreading globally and represents a challenge in infection control and treatment. Solid organ transplant (SOT) recipients are especially at risk for infection by multidrug-resistant bacteria, and little is known about infection with KPC-producing organisms in this setting. The aim of this study was to describe the clinical and microbiologic aspects of KPC-producing K. pneumoniae infections in SOT recipients. A KPC-2-producing K. pneumoniae outbreak was identified in a public teaching tertiary care hospital in São Paulo, Brazil, in June 2009. During the outbreak, cases of KPC-2-producing K. pneumoniae infection in SOT recipients occurred between July 2009 and February 2010; these cases were retrospectively reviewed. Overall, 12 episodes of infection with KPC-producing K. pneumoniae occurred in 2 heart, 4 liver, and 6 kidney transplant recipients with incidence rates of 16.7%, 12.9%, and 26.3% in heart, liver, and kidney transplantation, respectively. Infection occurred at a median time of 20 days after transplantation. Primary infection sites were as follows: 4 urinary tract infections, 4 bloodstream infections, 2 pneumonias, and 2 surgical site infections. All patients except one had received antibiotics in the last 30 days, mostly piperacillin-tazobactam or glycopeptides. All strains exhibited susceptibility to amikacin and gentamicin. Patients were treated with tigecycline plus polymyxin B (3 cases), polymyxin B plus carbapenem (3 cases), polymyxin B alone (3 cases), or tigecycline plus imipenem (1 case). In 2 cases, patients received only carbapenem, and death occurred before the final culture result. The overall 30-day mortality rate was 42%. In this series of KPC-producing K. pneumoniae infection in SOT recipients, the infection occurrence was high during an institutional outbreak and was potentially life threatening.
Assuntos
Proteínas de Bactérias/metabolismo , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/enzimologia , Transplante de Órgãos/efeitos adversos , beta-Lactamases/metabolismo , Adulto , Idoso , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana , Feminino , Regulação Bacteriana da Expressão Gênica , Regulação Enzimológica da Expressão Gênica , Humanos , Infecções por Klebsiella/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Experiments were carried out in vivo by injecting Tityus serrulatus crude venom in rats followed by biological assays on the isolated guinea-pig ileum, to show the effects of scorpion venom on kallikrein-kinin system. Our results showed effects such as significant decrease of total kinin rate and a decrease of total kinin rate and a decrease of Zn++, Na+, Cl- and K+ ions in rat urine 24 and 48 hours after the injection of Tityus serrulatus crude venom.
Assuntos
Masculino , Feminino , Ratos , Bradicinina/urina , Cloro/urina , Potássio/urina , Proteinúria/urina , Ratos Endogâmicos , Escorpiões , Sódio/urina , Urina/química , Venenos de Escorpião/urina , Zinco/urinaRESUMO
A kininogenase from bovine erythrocyte membranes has been purified 140-fold by affinity chromatography on pepstatin A-Agarose followed by ion exchange chromatography on CM Cellulose. The purified enzyme showed an apparent molecular weight of 31,000 daltons as measured by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Its pH optimum is 7.5, and it was totally inhibited by soybean trypsin inhibitor, phenylmethyl-sulfonylfluoride, aprotinin, pepstatin, and dithiotreitol, suggesting the presence of a disulfide bond(s) whose integrity is(are) essential for maintaining the native three-dimensional structure. The referred enzyme was able to release kinin from a substrate partially purified from rat plasma. The kininogenase was activated by Zn2+, Ca2+, and cysteine-HCl.