RESUMO
Previous studies have demonstrated reduced virulence in the species that comprise the Candida parapsilosis complex. We investigated a cohort of 93 patients with candidemia caused by this complex. Most infections were caused by C. parapsilosis (80.6%), followed by C. orthopsilosis (18.3%) and C. metapsilosis (1.1%). Renal failure (P < 0.001) and chronic liver diseases (P = 0.019) were more frequently encountered with infections caused by the C. orthopsilosis group, suggesting an association with patients who had a greater state of immune suppression in comparison with infections caused by C. parapsilosis sensu stricto.
Assuntos
Candida/classificação , Candida/isolamento & purificação , Candidemia/epidemiologia , Candidemia/microbiologia , Candidemia/complicações , Estudos de Coortes , Humanos , Hepatopatias/epidemiologia , Hepatopatias/etiologia , Prevalência , Insuficiência Renal/epidemiologia , Insuficiência Renal/etiologia , Medição de Risco , Fatores de RiscoRESUMO
We conducted a retrospective study of 58 cases of cryptococcosis (1986-2008) with urine test positive for Cryptococcus sp, in Mycology Laboratory, Santa Casa-Hospital Complex, Porto Alegre, RS, Brazil. The diagnosis of cryptococcuria was based on microscopic examination and culture of urinary sediment. Cryptococcus was isolated from other clinical specimens such as blood, cerebrospinal fluid, ascitic and pleural fluids, respiratory secretions, biopsies of skin, nasal and bone marrow. Cryptocccus neoformans was present in 55 cases and Cryptocccus gattii in three cases. Males predominated (79.3%); age ranged from 12 to 86 years. Acquired Immune Deficiency Syndrome (AIDS) were present in 60.3%, 31.1% did not have AIDS and 5.2% were apparently immunocompetent patients. The most frequent signs and symptoms were headache (53.4%) and fever (51.7%). The most widely used medication was the amphotericin B (43 patients). The mortality rate was 45%. We conclude that the mycological examination of the urine can be an alternative simple, non-invasive and useful in diagnosis of disseminated cryptococcosis, especially when used in conjunction with techniques for demonstration of the capsule (nigrosine) and/or production of melanin in special culture media (Staib agar).
Assuntos
Criptococose/diagnóstico , Criptococose/microbiologia , Cryptococcus/isolamento & purificação , Meios de Cultura/química , Técnicas Microbiológicas/métodos , Micologia/métodos , Urina/microbiologia , Adolescente , Adulto , Ágar , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Brasil , Criança , Criptococose/tratamento farmacológico , Criptococose/patologia , Cryptococcus/citologia , Cryptococcus/crescimento & desenvolvimento , Feminino , Humanos , Masculino , Microscopia , Pessoa de Meia-Idade , Estudos Retrospectivos , Seleção Genética , Distribuição por Sexo , Adulto JovemRESUMO
The issue of central venous catheter (CVC) removal in adult patients with candidaemia remains controversial. Although removal of CVCs has been advocated as an adjunctive strategy for treating patients with candidaemia, most studies have failed to control for important variables, e.g., the severity of illness and persistence of neutropenia. Multivariate analysis has failed to identify a significant effect of CVC removal on the prognosis for patients with candidaemia. A properly designed randomised trial that controls for confounding variables is necessary to clarify the importance of CVC removal in such patients. Until this evidence is available, systematic removal of all CVCs in these patients seems not to be justified.
Assuntos
Candidíase/terapia , Cateterismo Venoso Central/efeitos adversos , Fungemia/terapia , Assistência ao Paciente/métodos , Adulto , Humanos , Resultado do TratamentoRESUMO
Candidaemia is perceived as a nosocomial infection. The aim of this study was to describe all cases of candidaemia that occurred in the outpatient setting, and to compare risk factors and outcome among patients with outpatient-acquired and nosocomial candidaemia. During 1995 and 2003, 210 patients developed candidaemia at our institution, and 9.0% were outpatient acquired. Major underlying diseases were cancer (47.4%) and chronic renal failure (36.8%). Most occurred within 24 h of hospitalization (63.2%), and 83.7% were caused by species other than Candida albicans, mainly Candida parapsilosis (36.8%). Candida spp. were isolated from catheters in 21% of cases, and 52.6% of patients had been admitted to hospital in the 60 days preceding candidaemia. Compared with patients with nosocomial candidaemia, chronic renal failure was more frequent in the outpatient group, who were also more commonly exposed to haemodialysis. Ileus, gastrointestinal bleeding, previous bacteraemia, use of proton pump inhibitors, previous stay in the intensive care unit and requirement for antibiotics, blood transfusion, vasopressors and invasive medical procedures were more frequent in the nosocomial group. Overall mortality was high in both groups. Candidaemia must be considered as a potential cause of sepsis in the community, and it is associated with a high mortality rate.
Assuntos
Candidíase/etiologia , Infecções Comunitárias Adquiridas/etiologia , Infecção Hospitalar/etiologia , Adolescente , Adulto , Idoso , Antibacterianos/efeitos adversos , Brasil/epidemiologia , Candidíase/epidemiologia , Candidíase/terapia , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/terapia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/terapia , Complicações do Diabetes/complicações , Feminino , Hemorragia Gastrointestinal/complicações , Mortalidade Hospitalar , Humanos , Lactente , Controle de Infecções , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Pacientes Ambulatoriais/estatística & dados numéricos , Vigilância da População , Estudos Retrospectivos , Fatores de RiscoRESUMO
Cases of syngamosis due to Mammomanogamus laryngeus are reported, with a discussion of diagnostic aspects. A pulmonary cycle for M. laryngeus is proposed, suggested by the appearance of a transient area of homogeneous consolidation of the lung, detected by X-ray.
Assuntos
Pneumopatias Parasitárias/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Infecções por Strongylida/diagnóstico por imagem , Adulto , Animais , Brasil , Feminino , Helmintos/fisiologia , Interações Hospedeiro-Parasita , Humanos , Pulmão/parasitologia , Pneumopatias Parasitárias/parasitologia , Pessoa de Meia-Idade , RadiografiaRESUMO
Three cases of Cryptococcus neoformans var. gattii infection in AIDS patients observed in Rio Grande do Sul (Brazil) are related. A brief comment on the epidemiology of cryptococcosis in Brazil is also made.
RESUMO
We report a case of black grain mycetoma in a 74-years-old man who presented with a 50-yr. history of sinus-tract formation in the right foot. This is the first case of an Exophiala jeanselmeimycetoma successfully treated with itraconazole. In addition a review of the literature on this subject was done.
RESUMO
A case of cutaneous cryptococcosis due to Cryptococcus neoformans var. gattii in an immunocompetent host is presented. In addition a review of the literature on this subject was carried out and a brief comment made on occurrence of the variety gattii in Brazil.
RESUMO
We describe three cases of adiaspiromycosis with acute clinical manifestations and diffuse lung lesions. Sixteen previously reported similar cases are also reviewed. The best designation for this syndrome is acute pulmonary adiaspiromycosis.
RESUMO
Although early age is an important risk factor for the occurrence of acute disseminated histoplasmosis in non immunosuppressed infants, cases of this condition have been rarely reported, even in highly endemic areas. This is a reason to add a new case, the first one diagnosed in the state of Rio Grande do Sul, and, also, to review and comment on the Brazilian literature of histoplasmosis in patients under three years of age.
RESUMO
A retrospective review of paracoccidioidomycosis cases seen between January 1966 to January 1997 revealled 27 of the 627 cases occurred in women (male to female ratio 27.3:1). Data for 23 of these 27 cases demonstrated the protective effect of female hormones.
RESUMO
Although sporotrichosis is not an AIDS-defining infection, reports of sporotrichosis in individuals infected with HIV are increasing. We report an unusual case of this co-infection in a man with progressive deep cutaneous ulcerations with numerous pleomorphic yeast cells of Sporothrix schenckii. In addition a review of the literature on this subject was carried out and commented upon.
RESUMO
In this study we have compared clinical data obtained from 40 reported cases of pulmonary Aspergillus niger intracavitary colonization in the literature and those of our series 23 cases. Additionaly six of our cases have been summarized. Our findings revealed a similar occurrence of male sex, active tuberculosis, diabetes mellitus, systemic oxalosis, and lethal outcome in both groups. In conclusion, A. niger is not the most frequent causative agent of saprophytic aspergillosis neither is the most pathogenic species of Aspergillus. Despite that, when pulmonary A. niger intracavitary colonization is associated with diabetes the prognosis is generaly poor, probably due to acute oxalosis.
RESUMO
Twenty five cases of disseminated histoplasmosis in patients with AIDS are presented. Mucocutaneous involvement established the diagnosis of disseminated histoplasmosis in 68% of the cases. We point out the importance of histoplasmosis as an opportunistic infection in patients with HIV.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Dermatomicoses/complicações , Histoplasmose/complicações , Infecções Oportunistas Relacionadas com a AIDS/complicações , Adulto , Dermatomicoses/patologia , Feminino , Histoplasmose/patologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
We inquiry, in the epidemiologic history of 42 patients with cryptococcosis, the contact with pigeon, trying to find the possible source of infection. Of these patients, the information compatible with ecologic niche of Cryptococcus neoformans was positive in 16. Fifty nine samples were recovered from soil, associated with pigeon habitat. We found C. neoformans in four occasions, one in the capital and three in the interior of state. C. neoformans, serotype A, recovered from a central spine fluid coincides with the serotype of the fungus recovered downtown Porto Alegre, in a place suggested by the patient as possible source of infection, characterizing of a case of Cryptococcus neoformans. var. neoformans.
Assuntos
Cryptococcus neoformans/isolamento & purificação , Microbiologia do Solo , Animais , Columbidae , Criptococose/transmissão , Cryptococcus neoformans/patogenicidade , Fezes/microbiologia , HumanosRESUMO
A case of sporotrichosis in a woman presenting 63 cutaneous lesions distributed all over the tegument is related. The patient had both humoral (Immunoglobulins) and cellular (Lymphocytes subpopulations) immunity within normal limits, but was under treatment with steroid during a long time (Prednisone 10 mg daily for 2 years), due to a sciatic pain. In addition a review of the Brazilian literature on this type of lesions was carried out and commented.
Assuntos
Anti-Inflamatórios/efeitos adversos , Dermatopatias/induzido quimicamente , Sporothrix , Esporotricose/tratamento farmacológico , Idoso , Feminino , Humanos , Dermatopatias/microbiologia , Dermatopatias/patologia , Esporotricose/microbiologia , Esporotricose/patologia , Esteroides , Fatores de TempoRESUMO
A case of a solitary pulmonary nodule due to Scedosporium apiospermum (Pseudallescheria boydii) is related. A review of the pertinent literature was done and, in addition, similar lesions caused by other opportunistic fungi are commented.
Assuntos
Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/microbiologia , Pseudallescheria/isolamento & purificação , Nódulo Pulmonar Solitário/diagnóstico , Nódulo Pulmonar Solitário/microbiologia , Adulto , Feminino , HumanosRESUMO
Two cases of subcutaneous scedosporiosis, caused by Scedosporium apiospermum, are reported. Both patients had lesions localized in the forearm: a solitary ulceration in one and a sporotrichoid-like lesion in the other. The literature is reviewed.
Assuntos
Micoses , Pseudallescheria , Úlcera Cutânea/microbiologia , Idoso , Antifúngicos/uso terapêutico , Feminino , Antebraço , Humanos , Itraconazol/uso terapêutico , Micoses/tratamento farmacológico , Micoses/patologia , Úlcera Cutânea/tratamento farmacológico , Úlcera Cutânea/patologiaRESUMO
The first case of eumycetoma by Madurella grisea occurred in Southern Brazilian Region is herein related. In addition, Brazilian literature on this subject was reviewed and, the geographic distribution of this eumycetoma is presented.
Assuntos
Antifúngicos/uso terapêutico , Itraconazol/uso terapêutico , Madurella , Micetoma/diagnóstico , Micetoma/tratamento farmacológico , Adulto , Idoso , Brasil , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Micetoma/patologiaRESUMO
A case of peritonitis due to Scedosporium apiospermum in a boy undergoing continuous ambulatory peritoneal dialysis is reported. The finding of suggestive tissual form of the fungus in the effluent hastened the diagnosis of the infection.