RESUMO
The emerging opportunistic pathogens comprising the Candida haemulonii complex (C. haemulonii [Ch], C. duobushaemulonii [Cd] and C. haemulonii var. vulnera[Chv]) are notable for their intrinsic antifungal resistance. Different clinical manifestations are associated with these fungal infections; however, little is known about their biology and potential virulence attributes. Herein, we evaluated some surface properties of 12 clinical isolates of Ch (n = 5), Cd (n = 4) and Chv (n = 3) as well as their virulence on murine macrophages and Galleria mellonella larvae. Scanning electron microscopy demonstrated the presence of homogeneous populations among the species of the C. haemulonii complex, represented by oval yeasts with surface irregularities able to form aggregates. Cell surface hydrophobicity was isolate-specific, exhibiting high (16.7%), moderate (25.0%) and low (58.3%) hydrophobicity. The isolates had negative surface charge, except for one. Mannose/glucose- and N-acetylglucosamine-containing glycoconjugates were evidenced in considerable amounts in all isolates; however, the surface expression of sialic acid was poorly detected. Cd isolates presented significantly higher amounts of chitin than Ch and Chv. Membrane sterol and lipid bodies, containing neutral lipids, were quite similar among all fungi studied. All isolates adhered to inert surfaces in the order: polystyrene > poly-L-lysine-coated glass > glass. Likewise, they interacted with murine macrophages in a quite similar way. Regarding in vivo virulence, the C. haemulonii species complex were able to kill at least 80% of the larvae after 120 hours. Our results evidenced the ability of C. haemulonii complex to produce potential surface-related virulence attributes, key components that actively participate in the infection process described in Candida spp.
Assuntos
Adesividade/efeitos dos fármacos , Antifúngicos/uso terapêutico , Candida/isolamento & purificação , Candidíase/tratamento farmacológico , Candidíase/fisiopatologia , Farmacorresistência Fúngica Múltipla/efeitos dos fármacos , Virulência/efeitos dos fármacos , Arthrodermataceae/isolamento & purificação , Brasil , Humanos , Macrófagos/efeitos dos fármacos , Esporos Fúngicos/ultraestruturaRESUMO
AIMS: Multiple sclerosis (MS) is an immune-mediated demyelinating disorder of the central nervous system (CNS). We described that Candida albicans (Ca) aggravates experimental autoimmune encephalomyelitis (EAE) that is a model to study MS. We also observed that vaccination with a myelin peptide (MOG) in the presence of vitamin D (VitD) protected mice against EAE. In this work, we investigated whether Ca infection interferes with the efficacy of this vaccine. METHODS: EAE was induced in C57BL/6 female mice previously vaccinated with MOG+VitD and then infected 3 days before encephalomyelitis induction. RESULTS: Vaccination was able to control EAE development in infected mice. These animals gained weight, and only a few progressed to very low clinical scores. Protection was confirmed by a lower inflammatory infiltration in the CNS and was also associated with a reduced production of encephalitogenic cytokines by spleen and CNS cell cultures. The elevated percentage of CD25(+) FoxP3(+) cells suggests that regulatory T cells are involved in the protection. Adoptive transfer of splenocytes from mice vaccinated with MOG+VitD supports the view that protection is mediated by immunoregulatory cells. CONCLUSION: Together, these experiments provide evidence demonstrating that EAE can be prevented by the inverse vaccination with MOG+VitD even in the presence of a disease-aggravating infectious agent.
Assuntos
Candidíase/terapia , Colecalciferol/uso terapêutico , Encefalomielite Autoimune Experimental/prevenção & controle , Glicoproteína Mielina-Oligodendrócito/imunologia , Vitaminas/uso terapêutico , Animais , Peso Corporal/efeitos dos fármacos , Candida albicans/patogenicidade , Candidíase/imunologia , Candidíase/fisiopatologia , Células Cultivadas , Sistema Nervoso Central/patologia , Citocinas/genética , Citocinas/metabolismo , Células Dendríticas/efeitos dos fármacos , Células Dendríticas/imunologia , Células Dendríticas/patologia , Modelos Animais de Doenças , Regulação para Baixo/efeitos dos fármacos , Regulação para Baixo/imunologia , Encefalomielite Autoimune Experimental/imunologia , Encefalomielite Autoimune Experimental/patologia , Encefalomielite Autoimune Experimental/terapia , Feminino , Fatores de Transcrição Forkhead/genética , Fatores de Transcrição Forkhead/metabolismo , Indolamina-Pirrol 2,3,-Dioxigenase/metabolismo , Linfonodos/patologia , Camundongos , Camundongos Endogâmicos C57BLAssuntos
Candida tropicalis/fisiologia , Candida tropicalis/patogenicidade , Candidíase/microbiologia , Células Epiteliais/microbiologia , Mariposas/microbiologia , Animais , Candidíase/fisiopatologia , Morte Celular , Modelos Animais de Doenças , Células Epiteliais/citologia , Humanos , Larva/citologia , Larva/microbiologia , Mariposas/citologia , Fenótipo , VirulênciaRESUMO
In this study, we evaluated the interactions between Candida albicans, Candida krusei and Candida glabrata in mixed infections. Initially, these interactions were studied in biofilms formed in vitro. CFU/mL values of C. albicans were lower in mixed biofilms when compared to the single biofilms, verifying 77% and 89% of C. albicans reduction when this species was associated with C. glabrata and C. krusei, respectively. After that, we expanded this study for in vivo host models of experimental candidiasis. G. mellonella larvae were inoculated with monotypic and heterotypic Candida suspensions for analysis of survival rate and quantification of fungal cells in the haemolymph. In the groups with single infections, 100% of the larvae died within 18 h after infection with C. albicans. However, interaction groups achieved 100% mortality after 72 h of infection by C. albicans-C. glabrata and 96 h of infection by C. albicans-C. krusei. C. albicans CFU/mL values from larvae hemolymph were lower in the interacting groups compared with the monoespecies group after 12 h of infection. In addition, immunosuppressed mice were also inoculated with monotypic and heterotypic microbial suspensions to induce oral candidiasis. C. albicans CFU/mL values recovered from oral cavity of mice were higher in the group with single infection by C. albicans than the groups with mixed infections by C. albicans-C. glabrata and C. albicans-C. krusei. Moreover, the group with single infection by C. albicans had a higher degree of hyphae and epithelial changes in the tongue dorsum than the groups with mixed infections. We concluded that single infections by C. albicans were more harmful for animal models than mixed infections with non-albicans species, suggesting that C. albicans establish competitive interactions with C. krusei and C. glabrata during biofilm formation and development of experimental candidiasis.
Assuntos
Biofilmes , Candida/fisiologia , Candidíase/fisiopatologia , Animais , Candida/classificação , Candidíase/microbiologia , Camundongos , Especificidade da EspécieRESUMO
Vulvar pruritus can be caused by a wide spectrum of diseases, that depend on age, environmental and genetic factors. The most common causes are candidiasis, contact dermatitis and lichen simplex chronicus. Candidiasis is the most common cause of acute vulvar pruritus and is characterized by burning, itching and vaginal whitish secretion. Contact dermatitis is caused by irritants or allergens that are in contact with the genital area, which causes imbalance in the skin barrier causing irritation, swelling, burning, among other manifestations. Lichen simplex chronicus is characterized by lichenification (thickening of the skin) secondary to the chronic itch-scratch cycle in vulvar area. It is an illnes with a tendency to chronicity, but with topical corticosteroids treatment usually might be controlled. Prompt treatment, multidisciplinary and careful attention to irritants and secondary infections prevent these entities become an important and permanent problem.
Assuntos
Prurido/etiologia , Doenças da Vulva/etiologia , Candidíase/complicações , Candidíase/fisiopatologia , Candidíase/terapia , Dermatite de Contato/complicações , Dermatite de Contato/etiologia , Dermatite de Contato/terapia , Feminino , Humanos , Neurodermatite/complicações , Neurodermatite/fisiopatologia , Neurodermatite/terapia , Doenças da Vulva/fisiopatologia , Doenças da Vulva/terapiaRESUMO
Over the last few decades, inhaled corticosteroids (ICs) became the cornerstone in the treatment of persistent asthma. Their use improved asthma control, decreased mortality and also minimized adverse reactions associated with systemic steroid. Esophageal candidiasis is a rare complication resulting from the use of ICs. Although, in recent years, as their prescriptions has increased, more cases have been reported, especially in Japan. Listed are 4 case reports regarding esophageal candidiasis in asthmatic patients associated with inhaled budesonide administration. In the cases reported herein, the use of a different device of dry powder budesonide might have favored esophageal drug deposition and Candida infection. Patients denied using systemic corticosteroids in the previous 6 months. Furthermore, none of the patients presented Diabetes mellitus, malignant disease, HIV infection, or other immunosuppressive conditions. We conclude that patients treated with high doses of ICs are at higher risk of developing esophageal candidiasis. These patients should undergo upper gastrointestinal endoscopy whenever they present symptoms. Nevertheless, we must keep in mind that infection might also be asymptomatic and esophageal candidiasis prevalence may be higher than that reported thus far.
Assuntos
Asma/tratamento farmacológico , Budesonida/efeitos adversos , Candidíase/induzido quimicamente , Doenças do Esôfago/induzido quimicamente , Administração por Inalação , Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Idoso , Asma/diagnóstico , Asma/imunologia , Budesonida/administração & dosagem , Candidíase/epidemiologia , Candidíase/fisiopatologia , Relação Dose-Resposta a Droga , Doenças do Esôfago/epidemiologia , Doenças do Esôfago/fisiopatologia , Etanolaminas/administração & dosagem , Etanolaminas/efeitos adversos , Feminino , Seguimentos , Fumarato de Formoterol , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Medição de Risco , Estudos de AmostragemRESUMO
Candida tropicalis is the 2nd most frequent agent of candidemia in Brazil (20-24%). We attempted to characterize the epidemiology, microbiology, and outcome of candidemia due to C. tropicalis by comparing patients with candidemia due to C. tropicalis with those with candidemia due to Candida albicans. Among the 924 episodes of candidemia, 188 (20%) were caused by C. tropicalis. These cases were compared with 384 candidemias due to C. albicans. C. tropicalis was the 2nd most frequent species in adults (21.6%) and elderly patients (23.2%), and 3rd in neonates (11.9%) and children (18.5%). Cancer was the most frequent underlying disease, and in adults and elderly patients, diabetes was the 2nd most frequent underlying disease. The only difference between C. tropicalis and C. albicans candidemia was a higher proportion of neutropenic patients in C. tropicalis candidemia. C. tropicalis is a leading cause of candidemia in Brazil, and its epidemiology is similar to that of C. albicans.
Assuntos
Candida tropicalis , Candidíase , Fungemia , Hospitais Gerais , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/farmacologia , Brasil/epidemiologia , Candida albicans/efeitos dos fármacos , Candida albicans/isolamento & purificação , Candida albicans/patogenicidade , Candida tropicalis/efeitos dos fármacos , Candida tropicalis/isolamento & purificação , Candida tropicalis/patogenicidade , Candidíase/epidemiologia , Candidíase/microbiologia , Candidíase/fisiopatologia , Criança , Pré-Escolar , Feminino , Fungemia/epidemiologia , Fungemia/microbiologia , Fungemia/fisiopatologia , Humanos , Lactente , Recém-Nascido , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Neutropenia/complicaçõesRESUMO
The liver constitutes the first barrier in the control of hematogenous dissemination of Candida albicans of intestinal origin. In rats infected with C. albicans, this organ limits the growth of the yeast and mounts an efficient inflammatory reaction. However, in rats infected and exposed to chronic varied stress, the hepatic inflammatory reaction is compromised and the outcoming of the infection is more severe. Although in both groups the fungal burden is associated with hepatotoxicity, steatosis, increment of hepatic enzymes and lipid peroxidation, stress-related differences are clearly evident. Herein, we evaluated in infected and infected-stressed hosts the involvement of apoptosis and pro-apoptotic signals in the hepatic injury during the acute step of C. albicans infection. We studied in situ apoptosis by 4',6-diamidino-2-phenylindole dihydrochloride and terminal deoxynucleotidyl transferase dUTP nick-end labeling reactions, the levels of local tumor necrosis factor (TNF)-alpha mRNA by reverse transcription-PCR and the Fas/Fas-L expression by immunohistochemistry and western blot. We also purified intrahepatic lymphocytes (IHLs) to evaluate the dynamic of recruitment following the infection and to characterize the in vivo and in vitro interaction of C. albicans with this subset evaluating the kinetic of Fas-L and Toll-like receptor-2 (TLR-2) expression. This work shows, for the first time, the occurrence of in situ apoptosis of hepatocytes as well as the kinetic of IHL recruitment early during the C. albicans infection. Moreover, our results demonstrate the ability of the fungus to up-regulate the Fas-L and TLR-2 expression in this subset. In the scenario of early liver injury, the recruited IHLs and the modulated expression of TNF-alpha, Fas-L and TLR-2 molecules could act coordinately in delivering death signals.
Assuntos
Apoptose , Candida albicans/patogenicidade , Candidíase/fisiopatologia , Proteína Ligante Fas/metabolismo , Hepatócitos/microbiologia , Receptor 2 Toll-Like/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Animais , Animais não Endogâmicos , Candidíase/imunologia , Candidíase/microbiologia , Feminino , Hepatócitos/imunologia , Hepatócitos/patologia , Fígado/citologia , Fígado/imunologia , Fígado/microbiologia , Fígado/patologia , Ativação Linfocitária , Linfócitos/imunologia , Linfócitos/metabolismo , Ratos , Ratos Wistar , Regulação para CimaRESUMO
Although there are numerous studies of candidaemia in adults, data on paediatrics are still limited. The aim of this study was to compare risk factors, aetiology, therapy, and the outcome of nosocomial candidaemia among paediatric and adult patients in a large Brazilian tertiary hospital (1995-2003). During this period, 78 paediatrics and 113 adults were studied. Species other than Candida albicans caused 78.2% of episodes of candidaemia in paediatrics. Compared to adults, paediatrics received more frequently broad-spectrum antibiotics, vasopressors, blood transfusions, arterial catheter, chest tube, cardiothoracic surgery, mechanical ventilation, and parenteral nutrition. Candidaemia caused by Candida parapsilosis was more common in paediatrics, as was the isolation of Candida spp. from catheters. Amphotericin B treatment was more common in paediatrics. Mortality rate was higher in adults than in paediatrics with nosocomial candidaemia. We reinforce the necessity of continuous epidemiologic surveillance to follow the dynamics of candidaemia.
Assuntos
Candida/isolamento & purificação , Candidíase/epidemiologia , Infecção Hospitalar/epidemiologia , Fungemia/epidemiologia , Doenças do Prematuro/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Candida/classificação , Candida albicans/isolamento & purificação , Candidíase/microbiologia , Candidíase/fisiopatologia , Criança , Estudos de Coortes , Infecção Hospitalar/microbiologia , Infecção Hospitalar/fisiopatologia , Feminino , Fungemia/microbiologia , Fungemia/fisiopatologia , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/microbiologia , Doenças do Prematuro/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de RiscoRESUMO
The genetic diversity of 47 clinical and reference strains of Candida glabrata from several geographical origins and diverse clinical disorders, with different antifungal susceptibilities, as well as their genetic relationships were studied through multilocus enzyme electrophoresis (MLEE) and randomly amplified polymorphic DNA (RAPD) techniques. The genetic diversity estimated for 11 MLEE loci measured as average heterozygosity (h) was 0.055. A high level of genetic relatedness among isolates was established by cluster analysis. Forty-nine RAPD markers were analyzed, and the average genetic diversity among isolates, estimated by Shannon's index (Ho), was 0.372. The PhiST values estimated through an analysis of molecular variance to assess genetic differentiation among isolates revealed no genetic differentiation among them. Our results revealed very low genetic diversity among isolates, a lack of differentiation, and no association with their geographic origin and the clinical characteristics.
Assuntos
Candida glabrata/classificação , Candidíase/microbiologia , Variação Genética , Antifúngicos/farmacologia , Candida glabrata/efeitos dos fármacos , Candida glabrata/genética , Candida glabrata/isolamento & purificação , Candidíase/fisiopatologia , Eletroforese em Gel de Amido/métodos , Enzimas/análise , Humanos , Testes de Sensibilidade Microbiana , Técnicas de Tipagem Micológica , Técnica de Amplificação ao Acaso de DNA PolimórficoRESUMO
Candida tropicalis is a frequent cause of fungemia in hospitals in Latin America. Candida albicans (33%) was the most frequently isolated species, followed by Candida parapsilosis (27%), and Candida tropicalis (24%) in tertiary care hospital in Brazil. We identified and retrospectively reviewed 27 cases of C. tropicalis fungemia that occurred at Hospital de Clinicas de Porto Alegre from 1996 to 1999. The mean age of the patients was 32 years (range 6 months to 88 years). Eight patients (29.6%) had hematological malignancy, and four (14.8%) had solid tumors. All the patients were taking broad-spectrum antibiotics, including vancomycin for at least 7 days. Antibiotics were given through a central venous catheter for the majority of the patients (77.7%). Relevant risk factors for candidemia in our patients included neutropenia (59.2%), and use of corticosteroids (37.0%) or cytotoxic drugs (40.7%). The onset of fever was the most frequent clinical manifestation (92.5%) of fungemia. Most of the patients (81.4%) were treated with amphotericin B or fluconazole. Overall mortality was 48.1%, and 7 (53.4%) of 13 deaths occurred within 10 days of the detection of candidemia. Results of the in vitro susceptibility testing of nine isolates of C. tropicalis from seven patients did not show resistance to fluconazole and amphotericin B.C. tropicalis presents as an important cause of fungemia in oncological and nononcological patients with central venous catheters taking broad-spectrum antibiotics. Although there was no evidence of resistance of C. tropicalis to amphotericin B and fluconazole, patients treated with antifungal agents presented with a high mortality rate in the hospital setting.
Assuntos
Antifúngicos/uso terapêutico , Candida tropicalis/isolamento & purificação , Candidíase , APACHE , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Candida tropicalis/classificação , Candida tropicalis/patogenicidade , Candidíase/tratamento farmacológico , Candidíase/epidemiologia , Candidíase/fisiopatologia , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Paracoccidioides brasiliensis, a thermodimorphic fungus, is the causative agent of the prevalent systemic mycosis in Latin America, paracoccidioidomycosis. We present here a survey of expressed genes in the yeast pathogenic phase of P. brasiliensis. We obtained 13,490 expressed sequence tags from both 5' and 3' ends. Clustering analysis yielded the partial sequences of 4,692 expressed genes that were functionally classified by similarity to known genes. We have identified several Candida albicans virulence and pathogenicity homologues in P. brasiliensis. Furthermore, we have analyzed the expression of some of these genes during the dimorphic yeast-mycelium-yeast transition by real-time quantitative reverse transcription-PCR. Clustering analysis of the mycelium-yeast transition revealed three groups: (i) RBT, hydrophobin, and isocitrate lyase; (ii) malate dehydrogenase, contigs Pb1067 and Pb1145, GPI, and alternative oxidase; and (iii) ubiquitin, delta-9-desaturase, HSP70, HSP82, and HSP104. The first two groups displayed high mRNA expression in the mycelial phase, whereas the third group showed higher mRNA expression in the yeast phase. Our results suggest the possible conservation of pathogenicity and virulence mechanisms among fungi, expand considerably gene identification in P. brasiliensis, and provide a broader basis for further progress in understanding its biological peculiarities.
Assuntos
Candida albicans/genética , Candidíase/genética , Etiquetas de Sequências Expressas , Regulação Fúngica da Expressão Gênica/genética , Genoma Fúngico , Paracoccidioides/genética , Paracoccidioidomicose/genética , Sequência de Bases/genética , Candida albicans/enzimologia , Candida albicans/patogenicidade , Candidíase/enzimologia , Candidíase/fisiopatologia , DNA Complementar/análise , DNA Complementar/genética , Enzimas/biossíntese , Enzimas/genética , Regulação Enzimológica da Expressão Gênica/genética , Humanos , Micélio/enzimologia , Micélio/genética , Micélio/crescimento & desenvolvimento , Paracoccidioides/enzimologia , Paracoccidioides/patogenicidade , Paracoccidioidomicose/enzimologia , Paracoccidioidomicose/fisiopatologia , RNA Mensageiro/genéticaRESUMO
Candida albicans and related species pathogenic for man become resistent to antifungal agents, in particular triazole compounds, by expression of efflux pumps that reduce drug accumulation, alteration of the structure or concentration of antifungal target proteins, and alteration of membrane sterol composition. The clinical consequences of antifungal resistence can be seen in treatment failures in patients and in changes in the prevalence of Candida species causing disease. These effects were seen unequivocally in HIV-infected patients with oropharyngel candida infections, but their incidence has decreased dramatically with the introduction of highly active antiretroviral therapy. The evidence for similar emergence of antifungal-resistant yeast strains and species in other types of candida infections is confounded by non-standardised susceptibillity testing methods and definitions of a resistent fungal isolate. Recent large-scale surveys of yeasts isolated from blood cultures, based on standardised methodology and resistence definitions, do not support the view that antifungal resistance in pathogenic yeasts contitutes a significant or growing therapeutic problem
Assuntos
Humanos , Candida albicans/fisiologia , Candida albicans/imunologia , Candida albicans/metabolismo , Candidíase/diagnóstico , Candidíase/fisiopatologiaRESUMO
Fungal urinary tract infections are an increasing problem in hospitalized patients. Funguria may be a result of contamination of the urine specimen, colonization of hte urinary tract, or may be indicative of true invasive infection. In this study, we report the risk factors, clinical features, treatments and outcome in a group of 68 hospitalized patients (adults and children) with fungal isolates recovered from 103 urinary samples. Underlying medical conditions were present in most patients. In the pediatric group, urinary tract abnormalities (86) and prematurity (19)accounted for the majority of the cases. Diabetes mellitus (28), nephrolithiasis, and benign prostatic hyperplasia were the most common diseases in adults. Indwelling urethral catheters were noted in 38 of the pediatric patients and in 43 of adults during hospitalization. Candida albicans strains were responsible for 97 and 75 of positive cultures in children and adults, respectively. Symptoms such as fever, dysuria, frequency and flank pain were generally absent in both groups. Fluconazole was the most frequent antifungal utilized (61) in children and ketoconazole in the adult group (42). Removing the urinary catheter was attempted in 6 pediatric patients (29) and in only 8 adults (17). One patient (4) in the pediatric group died compared to 10 in the adult group (21, p=0.04). Successful diagnosis and treatment of funguria depends on a clear understanding of the risk factors and awareness of fungal epidemiology.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Antifúngicos/uso terapêutico , Fungos , Hospitalização , Micoses , Infecções Urinárias , Idoso de 80 Anos ou mais , Candida albicans , Candidíase/tratamento farmacológico , Candidíase/epidemiologia , Candidíase/microbiologia , Candidíase/fisiopatologia , Meios de Cultura , Fungos , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia , Infecções Urinárias/fisiopatologia , Micoses , Fatores de Risco , Resultado do Tratamento , UrinaRESUMO
Fungal urinary tract infections are an increasing problem in hospitalized patients. Funguria may be a result of contamination of the urine specimen, colonization of hte urinary tract, or may be indicative of true invasive infection. In this study, we report the risk factors, clinical features, treatments and outcome in a group of 68 hospitalized patients (adults and children) with fungal isolates recovered from 103 urinary samples. Underlying medical conditions were present in most patients. In the pediatric group, urinary tract abnormalities (86%) and prematurity (19%)accounted for the majority of the cases. Diabetes mellitus (28%), nephrolithiasis, and benign prostatic hyperplasia were the most common diseases in adults. Indwelling urethral catheters were noted in 38% of the pediatric patients and in 43% of adults during hospitalization. Candida albicans strains were responsible for 97% and 75% of positive cultures in children and adults, respectively. Symptoms such as fever, dysuria, frequency and flank pain were generally absent in both groups. Fluconazole was the most frequent antifungal utilized (61%) in children and ketoconazole in the adult group (42%). Removing the urinary catheter was attempted in 6 pediatric patients (29%) and in only 8 adults (17%). One patient (4%) in the pediatric group died compared to 10 in the adult group (21%, p=0.04). Successful diagnosis and treatment of funguria depends on a clear understanding of the risk factors and awareness of fungal epidemiology.
Assuntos
Antifúngicos/uso terapêutico , Fungos , Fungos/isolamento & purificação , Hospitalização , Micoses , Infecções Urinárias , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Candida albicans/isolamento & purificação , Candidíase/tratamento farmacológico , Candidíase/epidemiologia , Candidíase/microbiologia , Candidíase/fisiopatologia , Criança , Pré-Escolar , Meios de Cultura , Feminino , Fungos/classificação , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Micoses/tratamento farmacológico , Micoses/epidemiologia , Micoses/microbiologia , Micoses/fisiopatologia , Fatores de Risco , Resultado do Tratamento , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia , Infecções Urinárias/fisiopatologia , Urina/microbiologiaRESUMO
OBJECTIVE: Candidiasis is a prototypic opportunistic fungal disease that may follow severe modulations of the immune system of the host. The purpose of this study was to evaluate which innate immune mechanisms involved in the protection against fungal invasion are impaired under stress conditions. METHODS: Wistar rats were infected intraperitoneally with Candida albicans and immediately exposed to chronic varied stress (CVS) over 10 days (CVS; Ca-S); the fungal burden (CFU), histopathological lesion and ACTH levels were evaluated. Additionally, functional assessment of peritoneal cells (PC) included the phagocytic and anticandidacidal activities and the production of H(2)O(2) and NO. RESULTS: In the only infected animals (Ca), C. albicans colonization stimulated an efficient inflammatory response, while in Ca-S rats poor tissue reactions were associated with increased CFU in livers and kidneys (p < 0.05, Ca vs. Ca-S). Whereas the phagocytic process was not modified, the candidacidal activity of PC was significantly decreased after the application of CVS (p < 0.001, Ca vs. Ca-S). The H(2)O(2) production by macrophages and neutrophils was downregulated by the infection, and while at early intervals these cells possessed a residual oxidative capacity, by day 10, the production of this metabolite was blocked. Spontaneous NO production by macrophages was significantly increased in both Ca and Ca-S animals (p < 0.001), but in stressed rats, this reactive nitrogen intermediate was noticeably downregulated (p < 0.05, Ca vs. Ca-S). The hyperactivity of hypothalamus-pituitary-adrenal axis after exposure to stress was confirmed by an increase in baseline plasma ACTH levels. CONCLUSION: These results show that during infection with C. albicans, the exposure to CVS contributes to the spread of the fungus and downregulates critical functions of phagocytic cells involved in the control of this opportunistic pathogen.
Assuntos
Candidíase/imunologia , Macrófagos Peritoneais/fisiologia , Neuroimunomodulação/fisiologia , Peritonite/imunologia , Fagocitose , Estresse Fisiológico/imunologia , Hormônio Adrenocorticotrópico/sangue , Animais , Candidíase/complicações , Candidíase/fisiopatologia , Aglomeração , Progressão da Doença , Feminino , Privação de Alimentos , Abrigo para Animais , Peróxido de Hidrogênio/metabolismo , Rim/microbiologia , Fígado/microbiologia , Ativação de Macrófagos , Neutrófilos/fisiologia , Óxido Nítrico/biossíntese , Odorantes , Infecções Oportunistas/complicações , Infecções Oportunistas/imunologia , Infecções Oportunistas/fisiopatologia , Cavidade Peritoneal/microbiologia , Peritonite/complicações , Sistema Hipófise-Suprarrenal/fisiopatologia , Ratos , Ratos Wistar , Restrição Física , Estresse Fisiológico/fisiopatologia , Natação , Privação de ÁguaRESUMO
No presente estudo, comparou-se o percentual de viabilidade da candida albicans em suspensäo, utilizando-se dois métodos de coloraçäo vital: o azul algodäo e associaçäo entre os corantes fluorescentes diacetato de fluoresceína (DF) e brometo de etídeo (BE). A análise histológica das lesöes induzidas por precauçöes, cuja concentraçäo fúngica foi ajustada segundo cada um dos métodos, associado ao fato do percentual de célulacs vivas indicado pelo método fluorescente ser cerca de 50 por cento menor que o obtido através da coloraçäo pelo azul algodäo, sugere seu emprego ao invés da coloraçäo pelo DF- BE em estudos envolvendo a determinaçäo da viabilidade da Candida albicans em suspensäo
Assuntos
Animais , Cricetinae , Candida/patogenicidade , Candidíase/fisiopatologia , Coloração e Rotulagem/métodos , Corantes Fluorescentes , Fungos/patogenicidade , MicroscopiaRESUMO
No presente estudo, comparou-se o percentual de viabilidade da candida albicans em suspensäo, utilizando-se dois métodos de coloraçäo vital: o azul algodäo e associaçäo entre os corantes fluorescentes diacetato de fluoresceína (DF) e brometo de etídeo (BE). A análise histológica das lesöes induzidas por precauçöes, cuja concentraçäo fúngica foi ajustada segundo cada um dos métodos, associado ao fato do percentual de célulacs vivas indicado pelo método fluorescente ser cerca de 50 por cento menor que o obtido através da coloraçäo pelo azul algodäo, sugere seu emprego ao invés da coloraçäo pelo DF- BE em estudos envolvendo a determinaçäo da viabilidade da Candida albicans em suspensäo.