Resumo
Causative agent in majority of VVC is Candida albicans, but infection due to non-C. albicans is common. Use of empiric antifungal therapy in Brazil due to syndromic management of vulvovaginitis could act as risk factor for increase resistance among VVC causative agents. From Mato Grosso patients, 160 with culture-proved among 404 women who had clinical symptoms of VVC, were enrolled in this study. 70 non-pregnant women and 90 pregnant women were included. Candida albicans was the most prevalent, representing 72.9% in the non-pregnant group and 92.3% in the pregnant group. Differences in species distribution were noted between the two groups, being C. parapsilosis the second more prevalent species among non-pregnant women. Susceptibility testing revealed high susceptibility to fluconazole (except for C. krusei), itraconazole, ketoconazole, and amphotericin B regardless the species (C. albicans, C. parapsilosis, C. tropicalis, C. glabrata, C. krusei) analyzed.
Resumo
Most pathogenic fungi show dual morphology features in their saprophytic and parasitic stage. Occasionally, yeast cells produce short and aberrant hyphae, or large cells which can be seen on granulomas histological analysis, and otherwise as giant forms in fresh pus from abscesses, or also as highly encapsulated - serotype B in tissue specimens. The present study reports a HIV positive 39 years old single male patient, who presented oral candidiasis, pulmonary tuberculosis, cardiac insufficiency, Corynebacterium sp meningitis, and neurocryptococcosis due to C. neoformans var. neoformans. The patient was treated with amphotericin B for 45 days, who received approximately a total of 1,960 mg of drug. Atypical C. neoformans cells in diverse sizes and blastoconidia forms were isolated from cerebrospinal fluid (CSF). CSF stained with a China ink preparation revealed the presence of ovoid, branched, and pseudohyphae forms surrounded by a thick capsule. The isolate variety was identified as C. neoformans var. neoformans. Antifungal susceptibility testing performed by means of EUCAST5 technique indicated that the strain was sensitive to amphotericin B (MIC = 0.12g/mL), fluconazole (2g/mL), and itraconazole (0.06 g/mL). The previous reports on atypical yeast cells form described the occurrence of multiple and irregular blastoconidia in human clinical samples.
Muitos fungos patogênicos apresentam morfologias diferentes nas formas parasíticas e saprofíticas. Essas leveduras podem apresentar morfologias diversas como hifas curtas e aberrantes, formas gigantes em pus fresco, abscesso cerebral, cortes histológicos e presença de cápsula espessa geralmente no sorotipo B em tecidos. No presente relato é descrito o caso de um homem de 39 anos de idade, solteiro e HIV positivo, com os seguintes sintomas clínicos: candidíase oral, tuberculose pulmonar, insuficiência cardíaca, meningite por Corynebacterium sp e neurocriptococose por C. neoformans var. neoformans. O paciente foi tratado com anfotericina B durante 45 dias, com dose total de 1960mg. Foram observadas e isoladas do líquido cefalorraquidiano (LCR) células atípicas de C. neoformans de diferentes tamanhos e formas de blastoconídios. O exame direto do LCR em tinta da China apresentou células ovóides, ramificadas, com pseudo-hifas envolvidas por uma fina cápsula. A variedade foi identificada como C. neoformans var. neoformans. O teste de suscetibilidade aos antifúngicos realizados segundo a técnica de EUCAST indicou que a cepa isolada era sensível a: anfotericina B (Concentração Inibitória Mínima - MIC = 0,12g/mL), Fluconazol (2g/mL) e itraconazol (0,06g/mL). Os relatos anteriores sobre leveduras atípicas descrevem a ocorrência de blastoconídios múltiplos e irregulares em materiais bi