Assuntos
Antifúngicos/uso terapêutico , Seleção do Doador/métodos , Doenças Endêmicas , Fungos/efeitos dos fármacos , Micoses/tratamento farmacológico , Transplante de Órgãos/métodos , Doadores de Tecidos , Transplantados , Antifúngicos/efeitos adversos , Seleção do Doador/normas , Fungos/isolamento & purificação , Fungos/patogenicidade , Interações Hospedeiro-Patógeno , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , América Latina , Micoses/diagnóstico , Micoses/microbiologia , Micoses/transmissão , Transplante de Órgãos/efeitos adversos , Transplante de Órgãos/normas , Guias de Prática Clínica como Assunto , Medição de Risco , Fatores de Risco , Resultado do TratamentoRESUMO
The Recommendations for Management of Endemic Diseases and Travel Medicine in Solid-Organ Transplant Recipients and Donors: Latin America clinical practice guideline is intended to guide clinicians caring for solid-organ transplant (SOT) donors, candidates and recipients regarding infectious diseases (ID) issues related to this geographical region, mostly located in the tropics. These recommendations are based on both systematic reviews of relevant literature and expert opinion from both transplant ID and travel medicine specialists. The guidelines provide recommendations for risk evaluation and laboratory investigation, as well as management and prevention of infection of the most relevant endemic diseases of Latin America. This summary includes a brief description of the guideline recommendations but does not include the complete rationale and references for each recommendation, which is available in the online version of the article, published in this journal as a supplement. The supplement contains 10 reviews referring to endemic or travel diseases (eg, tuberculosis, Chagas disease [ChD], leishmaniasis, malaria, strongyloidiasis and schistosomiasis, travelers diarrhea, arboviruses, endemic fungal infections, viral hepatitis, and vaccines) and an illustrative section with maps (http://www.pmourao.com/map/). Contributors included experts from 13 countries (Brazil, Canada, Chile, Denmark, France, Italy, Peru, Spain, Switzerland, Turkey, United Kingdom, United States, and Uruguay) representing four continents (Asia, the Americas and Europe), along with scientific and medical societies.
Assuntos
Doenças Endêmicas , Infecções/terapia , Guias de Prática Clínica como Assunto , Doadores de Tecidos , Transplantados , Medicina de Viagem , Humanos , América LatinaRESUMO
Amphotericin B (AMB) is an antifungal drug that binds to ergosterol and forms pores at the cell membrane, causing the loss of ions. In addition, AMB induces the accumulation of reactive oxygen species (ROS), and although these molecules have multiple deleterious effects on fungal cells, their specific role in the action mechanism of AMB remains unknown. In this work, we studied the role of ROS in the action mechanism of AMB. We determined the intracellular induction of ROS in 44 isolates of different pathogenic yeast species (Candida albicans, Candida parapsilosis, Candida glabrata, Candida tropicalis, Candida krusei, Cryptococcus neoformans, and Cryptococcus gattii). We also characterized the production of ROS in AMB-resistant isolates. We found that AMB induces the formation of ROS in all the species tested. The inhibition of the mitochondrial respiratory chain by rotenone blocked the induction of ROS by AMB and provided protection from the killing action of the antifungal. Moreover, this phenomenon was absent in strains that displayed resistance to AMB. These strains showed an alteration in the respiration rate and mitochondrial membrane potential and also had higher catalase activity than that of the AMB-susceptible strains. Consistently, AMB failed to induce protein carbonylation in the resistant strains. Our data demonstrate that the production of ROS by AMB is a universal and important action mechanism that is correlated with the fungicidal effect and might explain the low rate of resistance to the molecule. Finally, these data provide an opportunity to design new strategies to improve the efficacy of this antifungal.
Assuntos
Anfotericina B/farmacologia , Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Cryptococcus/efeitos dos fármacos , Espécies Reativas de Oxigênio/metabolismo , Candida/genética , Candidíase/tratamento farmacológico , Candidíase/genética , Candidíase/microbiologia , Catalase/metabolismo , Membrana Celular/efeitos dos fármacos , Criptococose/tratamento farmacológico , Criptococose/microbiologia , Farmacorresistência Fúngica , Transporte de Elétrons/efeitos dos fármacos , Ergosterol/metabolismo , Potencial da Membrana Mitocondrial/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Estresse Oxidativo/efeitos dos fármacos , Consumo de Oxigênio/efeitos dos fármacos , Rotenona/farmacologia , Desacopladores/farmacologiaRESUMO
BACKGROUND: Histoplasmosis and paracoccidioidomycosis (PCM) have increased in Spain in recent years, due firstly to the migration from endemic regions and secondly to travelers returning from these regions. In non-endemic areas, diagnosis of both diseases is hampered by the lack of experience, long silent periods, and the resemblance to other diseases such as tuberculosis and sarcoidosis. METHODS: A total of 39 cases of imported histoplasmosis and 6 cases of PCM diagnosed in the Spanish Mycology Reference Laboratory since 2006 were analyzed. Microbiological diagnosis was performed using classical methods and also a specific real-time polymerase chain reaction (RT-PCR) assay for each microorganism. RESULTS: We had 9 cases of probable histoplasmosis in travelers and 30 cases in immigrants, 29 of whom were defined as proven. Paracoccidioidomycosis (PCM) cases were either immigrants or people who had lived for a long period of time in endemic regions, all of whom were classified as proven cases. Cultures showed a good sensitivity in detecting Histoplasma capsulatum in immigrants with proven histoplasmosis (73%); however, growth was very slow. The fungus was never recovered in traveler patients. Paracoccidioides brasiliensis was isolated in a culture only in one case of the proven PCM. Serological methods were not very reliable in immunocompromised patients with histoplasmosis (40%). A PCR-based technique for histoplasmosis detected 55.5% of the cases in travelers (probable cases) and 89% of the cases in immigrants (proven). The PCR method for PCM detected 100% of the cases. CONCLUSIONS: These kinds of mycoses are increasingly frequent in non-endemic areas, and newer and faster techniques should be used to reach an early diagnosis. The RT-PCR techniques developed appear to be sensitive, specific, and fast and could be helpful to detect those mycoses. However, it is also essential that physicians perform differential diagnosis in individuals coming from endemic areas.
Assuntos
Emigração e Imigração/estatística & dados numéricos , Histoplasma/isolamento & purificação , Histoplasmose/diagnóstico , Paracoccidioides/isolamento & purificação , Paracoccidioidomicose/diagnóstico , Viagem/estatística & dados numéricos , Adulto , África , Antifúngicos/administração & dosagem , América Central , Doenças Endêmicas , Feminino , Histoplasmose/tratamento farmacológico , Histoplasmose/epidemiologia , Histoplasmose/genética , Humanos , Masculino , Pessoa de Meia-Idade , Paracoccidioidomicose/tratamento farmacológico , Paracoccidioidomicose/epidemiologia , Paracoccidioidomicose/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Sensibilidade e Especificidade , América do Sul , Espanha/epidemiologia , Adulto JovemRESUMO
The susceptibility profile of 91 Sporothrix schenckii isolates in both growth phases was determined by microdilution test (Antifungal Susceptibility Testing of the European Committee for Antimicrobial Susceptibility Testing; AFST-EUCAST). Amphotericin B (AMB), itraconazole (ITC), posaconazole, ravuconazole and terbinafine were found active in vitro against both phases but minimum inhibitory concentrations values for mycelial phase were significantly higher. Fluconazole (FLC) and voriconazole (VRC) were inactive in vitro against both phases. The E-test technique was also performed with 41 representative isolates for AMB, FLC, ITC and VRC. Average agreement rates between yeast phase microdilution results and E-test results were high for AMB (77.5%) and FLC (87.8%), but low for ITC and VRC with rates of 56.4% and 54.5%, respectively. AFST-EUCAST is not the most recommended test to perform drug susceptibility testing of S. schenckii in clinical laboratories, and E-test could be an alternative methodology for this purpose, mainly when the activity in vitro of antifungal agents of AMB and FLC are evaluated.
Assuntos
Antifúngicos/farmacologia , Sporothrix/efeitos dos fármacos , Humanos , Testes de Sensibilidade Microbiana/métodos , Micélio/efeitos dos fármacos , Sporothrix/isolamento & purificação , Esporotricose/microbiologia , Leveduras/efeitos dos fármacosRESUMO
In this study the molecular identification and susceptibility profile of 21 clinical isolates, from a Brazilian hospital, belongs to six different species of Trichosporon were described. Trichosporon asahii was the predominant species and corresponded to 43% of isolates. Eighty three percent of the strains isolated from deep sites were identified as T. asahii, while only 17% belong to a non-T. asahii species (Trichosporon inkin). In general, the MICs were high and independent of the species of Trichosporon as well as the clinical origin of strain. Amphotericin B and fluconazole were less effective against Trichosporon spp. and high MIC values of voriconazole, posaconazole and ravuconazole were observed. Fifty-six percent (5/9) of T. asahii strains were isolated from deep sites, whereas 8% (1/12) of non-T. asahii species were isolated from those sites. A total of 89% of T. asahii isolates exhibited resistance to amphotericin B in vitro.
Assuntos
Infecção Hospitalar/microbiologia , Farmacorresistência Fúngica , Micoses/microbiologia , Trichosporon/isolamento & purificação , Anfotericina B/farmacologia , Antifúngicos/farmacologia , Brasil/epidemiologia , Infecção Hospitalar/epidemiologia , Dermatomicoses/microbiologia , Equinocandinas/farmacologia , Feminino , Flucitosina/farmacologia , Fungemia/microbiologia , Hospitais Universitários/estatística & dados numéricos , Humanos , Técnicas de Tipagem Micológica/métodos , Micoses/epidemiologia , Onicomicose/microbiologia , Infecções Oportunistas/epidemiologia , Infecções Oportunistas/microbiologia , Especificidade de Órgãos , Triazóis/farmacologia , Trichosporon/classificação , Trichosporon/efeitos dos fármacos , Urina/microbiologia , Vaginite/microbiologiaRESUMO
Since 1998 a cat-transmitted epidemic of sporotrichosis has been observed in Rio de Janeiro (RJ), Brazil. Besides the lymphocutaneous and fixed forms, other presentations, such as disseminated cutaneous and mucosal involvement, as well as for the first time, erythema nodosum and erythema multiforme have been reported associated with sporotrichosis. This study investigates the phenotypes and genotypes of Sporothrix schenckii isolates recovered from different clinical forms of the disease noted as part of this epidemic. A total of 88 isolates recovered from 59 cases associated with the epidemic and 29 controls (from cases in other Brazilian regions and Spain) were included in this study. In vitro susceptibility testing was conducted as part of the phenotypic analysis, while the genotypic analysis involved a DNA fingerprinting method with primer M13 and ribosomal DNA sequencing of the internal transcribed spacer (ITS). MIC values of amphotericin B, itraconazole, posaconazole, ravuconazole, and terbinafine were found to be significantly lower (P<0.01) for isolates associated with the epidemic than for control strains. No differences in MIC values were observed related to clinical forms of the infection. Fingerprinting analysis showed that RJ epidemic strains were genetically related. Although nine subtypes were found, they were not associated with specific clinical forms. Similar results were obtained with the ITS sequence analysis. These data suggest that the strains isolated from the epidemic cases of sporotrichosis in RJ all originated from a common source.
Assuntos
Sporothrix/genética , Sporothrix/isolamento & purificação , Esporotricose/epidemiologia , Esporotricose/transmissão , Animais , Antifúngicos , Brasil , Gatos , DNA Espaçador Ribossômico/análise , Testes de Sensibilidade Microbiana , Epidemiologia Molecular , Técnicas de Tipagem Micológica , Esporotricose/etiologia , Esporotricose/patologia , Zoonoses/transmissãoRESUMO
This article describes the general objectives of the Regional Laboratory Network for Surveillance of Invasive Fungal Infections and Antifungal Susceptibility in Latin America. Formation of the Network was coordinated by the Essential Medicines, Vaccines, and Health Technologies Unit of the Pan American Health Organization, with the technical and financial support of the National Center for Microbiology of the Carlos III Health Institute (Spain), and the technical support of the Microbiology Department of the Dr. C. Malbrán National Institute on Infectious Diseases (Argentina) and the Microbiology Unit of the Parasitology Service of the Adolfo Lutz Institute (Brazil). The Network's principle objectives are epidemiological surveillance of invasive fungal infections through detection of antifungal resistance and identification of emergent, invasive fungal infections; establishment of norms and common protocols for early diagnosis of mycoses; and strengthening coordination, communications, and transference mechanisms among countries. The Network must be gradually implemented and must include staff training, a systematic process for sharing technology, evaluation of diagnostic techniques, identification of fungal species, and standardized tests for antifungal susceptibility.
Assuntos
Humanos , Sistemas de Informação em Laboratório Clínico , Micoses/tratamento farmacológico , Micoses/epidemiologia , Vigilância da População , Antifúngicos/uso terapêutico , Sistemas de Informação em Laboratório Clínico/organização & administração , Farmacorresistência Fúngica , América LatinaRESUMO
The sequence polymorphisms of intergenic transcribed spacer and the antifungal susceptibility profile of 18 Trichosporon asahii isolates from Spain, Argentina, and Brazil together with 43 intergenic transcribed spacer 1 sequences deposited in the GenBank were analyzed. Six genotypes were detected instead of 5 genotypes described previously. Genotype 1 was the most common found comprising 57.3% of all strains, followed by genotype 3 (14.7%) and genotype 5 (13.1%). Spanish strains had members in all genotypes except 2, whereas South American isolates were grouped with genotypes 1, 3, and 6. Our results indicate that all genotypes are present in at least 2 countries suggesting a worldwide distribution. On the other hand, genotype 6 was not previously described but was only composed of 2 South American strains isolated from a subcutaneous abscess and skin. All isolates showed amphotericin B MICs>or=2 mg/L supporting the in vitro resistance of this species to this antifungal. Three isolates from South America showed high MICs to all antifungals analyzed. The true epidemiologic usefulness of classifying T. asahii in genotypes should be ascertaining analyzing a high number of isolates from many countries.
Assuntos
DNA Fúngico/química , DNA Fúngico/genética , DNA Espaçador Ribossômico/química , DNA Espaçador Ribossômico/genética , Micoses/microbiologia , Trichosporon/classificação , Trichosporon/genética , Antifúngicos/farmacologia , Argentina/epidemiologia , Brasil/epidemiologia , Genótipo , Humanos , Testes de Sensibilidade Microbiana , Epidemiologia Molecular , Dados de Sequência Molecular , Técnicas de Tipagem Micológica , Micoses/epidemiologia , Análise de Sequência de DNA , Espanha/epidemiologia , Trichosporon/efeitos dos fármacos , Trichosporon/isolamento & purificaçãoRESUMO
OBJECTIVE: Evaluation of the usefulness of a quantitative real-time polymerase chain reaction-based (RT-PCR) technique for clinical diagnosis of histoplasmosis. METHODS: Primers and probes were designed on the basis of sequences from the ITS regions of ribosomal DNA of 20 clinical strains of Histoplasma capsulatum. LightCycler procedures (Roche Applied Science) were used with probes marked by fluorescence resonance energy transfer (FRET). Reproducibility, sensitivity, and specificity were analyzed. In addition, an internal control was designed to identify false negative results by PCR inhibition. The RT-PCR assay was tested in 22 clinical samples from 14 patients with proven histoplasmosis. In addition, 30 samples from patients with febrile neutropenia or mycoses other than histoplasmosis, and from healthy volunteers were analyzed as controls. RESULTS: The limit of detection of the assay was 1 fg of genomic DNA per microl of sample. The PCR-based technique was reproducible and highly specific. Positive results were obtained in 11/14 (78.6%) patients and in 17/22 (77.3%) clinical samples. RT-PCR was positive in 100% of respiratory secretions and bone marrow samples, but only 70% of sera (p < 0.01). Mean fungal DNA value was 23.1 fg/microl in serum and 4.85 x 10(3) fg/microl in respiratory and bone marrow samples. RT-PCR results were positive in serum from three HIV patients for which antibody detection by immunodiffusion was negative. Specificity was 100%, since PCR results were negative for all the control samples. CONCLUSION: Thes RT-PCR technique is a sensitive, specific method for early diagnosis of histoplasmosis, particularly when respiratory secretions or bone marrow samples are analyzed. The reliability is lower in serum, but it can be used as an additional, complementary technique to culture and serology in HIV patients.
Assuntos
DNA Fúngico/isolamento & purificação , DNA Ribossômico/isolamento & purificação , Histoplasma/isolamento & purificação , Histoplasmose/diagnóstico , Reação em Cadeia da Polimerase/métodos , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , África/etnologia , Líquidos Corporais/microbiologia , Medula Óssea/microbiologia , América Central/etnologia , Sistemas Computacionais , DNA Fúngico/genética , DNA Ribossômico/genética , Emigração e Imigração , Infecções por HIV/complicações , Histoplasma/genética , Histoplasmose/complicações , Histoplasmose/epidemiologia , Histoplasmose/microbiologia , Histoplasmose/transmissão , Imunodifusão , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , América do Sul/etnologia , Espanha/epidemiologia , ViagemRESUMO
The physiological patterns, the sequence polymorphisms of the internal transcriber spacer (ITS), and intergenic spacer regions (IGS) of the rRNA genes and the antifungal susceptibility profile were evaluated for their ability to identify Trichosporon spp. and their specificity for the identification of 49 clinical isolates of Trichosporon spp. Morphological and biochemical methodologies were unable to differentiate among the Trichosporon species. ITS sequencing was also unable to differentiate several species. However, IGS1 sequencing unambiguously identified all Trichosporon isolates. Following the results of DNA-based identification, Trichosporon asahii was the species most frequently isolated from deep sites (15 of 25 strains; 60%). In the main, other Trichosporon species were recovered from cutaneous samples. The majority of T. asahii, T. faecale, and T. coremiiforme clinical isolates exhibited resistance in vitro to amphotericin B, with geometric mean (GM) MICs >4 mug/ml. The other species of Trichosporon did not show high MICs of amphotericin B, and GM MICs were <1 mug/ml. Azole agents were active in vitro against the majority of clinical strains. The most potent compound in vitro was voriconazole, with a GM MIC
Assuntos
DNA Intergênico , DNA Espaçador Ribossômico , Polimorfismo Genético , Trichosporon/classificação , Trichosporon/genética , Trichosporon/fisiologia , Anfotericina B/farmacologia , Antifúngicos/farmacologia , Argentina/epidemiologia , DNA Fúngico/análise , DNA Fúngico/genética , DNA Intergênico/análise , DNA Intergênico/genética , DNA Ribossômico/análise , DNA Ribossômico/genética , DNA Espaçador Ribossômico/análise , DNA Espaçador Ribossômico/genética , Suscetibilidade a Doenças , Farmacorresistência Fúngica/genética , Humanos , Testes de Sensibilidade Microbiana , Filogenia , RNA Fúngico/análise , RNA Fúngico/genética , RNA Ribossômico/análise , RNA Ribossômico/genética , Estudos Retrospectivos , Análise de Sequência de DNA , Espanha/epidemiologia , Trichosporon/efeitos dos fármacos , Trichosporon/crescimento & desenvolvimento , Trichosporon/isolamento & purificaçãoRESUMO
Five sequential Cryptococcus neoformans isolates recovered from an AIDS patient with recurrent meningitis were analyzed. Four isolates were fluconazole susceptible, while the fifth isolate developed fluconazole resistance. Analysis of the 14-alpha lanosterol demethylase gene (ERG11) showed a point mutation in the resistant strain responsible for the amino acid substitution G484S.
Assuntos
Antifúngicos/farmacologia , Cryptococcus neoformans/efeitos dos fármacos , Sistema Enzimático do Citocromo P-450/genética , Farmacorresistência Fúngica/genética , Fluconazol/farmacologia , Meningite Criptocócica/microbiologia , Oxirredutases/genética , Síndrome da Imunodeficiência Adquirida/complicações , Adulto , Sequência de Aminoácidos , Substituição de Aminoácidos , Clonagem Molecular , Genótipo , Humanos , Masculino , Testes de Sensibilidade Microbiana , Dados de Sequência Molecular , Plasmídeos , Mutação Puntual/genética , Recidiva , Esterol 14-DesmetilaseRESUMO
BACKGROUND: Fungi are important causal agents of nosocomial infections, that usually have high mortality rates. AIM: To evaluate the species distribution and susceptibility patterns of deep yeast infections in a General Hospital and to correlate those results with patient survival. MATERIAL AND METHODS: Twenty one strains (from five pediatric and 16 from adult patients) were studied. Antifungal Susceptibility Testing (AST) to Amphotericin B (Anfb), Fluorocytosine (5FC), Fluconazole (FZ) and Itraconazole (IZ) was performed according to the EUCAST document. Clinical data of patients was obtained and survival to the infection was recorded. RESULTS: C. albicans was isolated in 11 samples (52%), C. parapsilosis in three samples (14%), C. glabrata in two samples (9%), C. tropicalis in one sample (5%) and C. neoformans in four samples (19%). Twenty three percent of fungi were recovered at the Surgical Intensive Care Unit. The MICs ranged between 0.25 and 0.5 microgram/mL for Anfb; between 0.25 and 16 micrograms/ml for SFC, between 0.12 and 32 micrograms/mL for FZ and 0.015 and 0.5 microgram/mL for IZ. No association between antifungal susceptibility and patient survival was observed. CONCLUSIONS: C. albicans continues to be the most frequently isolated yeast, however, non-albicans species are an emergent group causing nosocomial infections. Surgical procedures are the main source of fungal infections in this sample.
Assuntos
Antifúngicos/uso terapêutico , Candida/efeitos dos fármacos , Candidíase/microbiologia , Infecção Hospitalar/microbiologia , Adulto , Candida/classificação , Candidíase/tratamento farmacológico , Candidíase/mortalidade , Criança , Chile/epidemiologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/mortalidade , Intervalo Livre de Doença , Farmacorresistência Fúngica , Humanos , Testes de Sensibilidade Microbiana , Fatores de RiscoRESUMO
The aim of this study was to identify retrospectively trends in species distribution and susceptibility patterns of Candida species causing bloodstream infections in 99 medical centres (55 in Spain and 44 in Argentina) from 1996 to 1999. A total of 744 Candida isolates were sent to the mycology reference laboratories during the study period (514 to the Spanish laboratory and 230 to the Argentinian laboratory). Candida non-albicans strains caused more episodes of fungaemia than Candida albicans isolates in both Spain and Argentina. C. albicans was isolated in 30.2% (155/514) and 40.9% (94/230) of episodes in Spain and in Argentina, respectively. In addition, Candida parapsilosis was the second most commonly isolated pathogen (36.4%). Candida tropicalis caused 13.7% of infections and Candida glabrata 7.4%. The amphotericin B MIC was Assuntos
Antifúngicos/farmacologia
, Candida/efeitos dos fármacos
, Argentina
, Candida/isolamento & purificação
, Candida/metabolismo
, Distribuição de Qui-Quadrado
, Humanos
, Testes de Sensibilidade Microbiana/métodos
, Testes de Sensibilidade Microbiana/estatística & dados numéricos
, Estudos Retrospectivos
, Espanha
RESUMO
Background: Fungi are important causal agents of nosocomial infections, that usually have high mortality rates. Aim: To evaluate the species distribution and susceptibility patterns of deep yeast infections in a General Hospital and to correlate those results with patient survival. Material and methods: Twenty one strains (from five pediatric and 16 from adult patients) were studied. Antifungal Susceptibility Testing (AST) to Amphotericin B (Anfb), Fluorocytosine (5FC), Fluconazole (FZ) and Itraconazole (IZ) was performed according to the EUCAST document. Clinical data of patients was obtained and survival to the infection was recorded. Results: C. albicans was isolated in 11 samples (52 percent), C. parapsilosis in three samples (14 percent), C. glabrata in two samples (9 percent), C. tropicalis in one sample (5 percent) and C. neoformans in four samples (19 percent). Twenty three percent of fungi were recovered at the Surgical Intensive Care Unit. The MICs ranged between 0.25 and 0.5 µg/mL for Anfb; between 0.25 and 16 µg/ml for SFC, between 0.12 and 32 µg/mL for FZ and 0.015 and 0.5 µg/mL for IZ. No association between antifungal susceptibility and patient survival was observed. Conclusions: C. albicans continues to be the most frequently isolated yeast, however, non-albicans species are an emergent group causing nosocomial infections. Surgical procedures are the main source of fungal infections in this sample
Assuntos
Humanos , Adulto , Criança , Candidíase , Antifúngicos/farmacologia , Infecção Hospitalar/etiologia , Candida albicans , Candidíase , Contagem de Colônia Microbiana , Fluconazol , Anfotericina B , Controle de Infecções , Intervalo Livre de Doença , Cryptococcus neoformans , Flucitosina , Infecção Hospitalar/tratamento farmacológicoRESUMO
A bloodstream infection due to Candida haemulonii afflicting a patient with fever and a medical history of megaloblastic anemia is reported. The clinical isolate was misidentified by the API 20C and VITEK identification systems. The results of susceptibility tests showed that the MIC of amphotericin B for C. haemulonii was 4 microg/ml. Additional susceptibility testing procedures based on the use of antibiotic medium 3 and Iso-Sensitest broth were performed, and killing curves were determined. Two collection strains of C. haemulonii were employed as controls. The three isolates exhibited resistance to amphotericin B in vitro regardless of the antifungal susceptibility testing method employed. In addition, the MICs of fluconazole for the three isolates were high. Further studies are needed in order to ascertain whether this species exhibits innate or acquired resistance to amphotericin B and other antifungal agents.