RESUMO
Lichtheimia corymbifera (syn. Absidia corymbifera, Mycocladus corymbifer) is an ubiquitous cosmopolitan mold that can cause primary cutaneous and deep tissue infection in healthy individuals. We report a subcutaneous L. corymbifera infection in a 13-year-old immune-competent child, with a severe traumatic injury, with a successful outcome after early diagnosis and treatment with lipid amphotericin B, early debridement, and vacuum-assisted closure (VAC).
Assuntos
Absidia/isolamento & purificação , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Síndromes Compartimentais/cirurgia , Desbridamento , Mucormicose/microbiologia , Tratamento de Ferimentos com Pressão Negativa , Infecções Oportunistas/microbiologia , Infecção da Ferida Cirúrgica/microbiologia , Acidentes de Trânsito , Adolescente , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Terapia Combinada , Síndromes Compartimentais/etiologia , Diagnóstico Precoce , Fraturas Ósseas/complicações , Humanos , Imunocompetência , Ossos da Perna/lesões , Masculino , Mucormicose/diagnóstico , Mucormicose/tratamento farmacológico , Mucormicose/cirurgia , Traumatismo Múltiplo , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/cirurgia , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/cirurgia , Infecção dos Ferimentos/complicaçõesRESUMO
A case of colonization of a prosthetic mitral valve in a 73-year-old Spanish male by the fungus Acremonium strictum W. Gams is described. The valve was replaced due to paravalvular leak and severe insufficiency and the patient died of multiorgan failure. The identity of the fungus was determined by morphological studies and it was confirmed by the analysis of the ITS region sequence analysis. Molecular studies seem to demonstrate that A. strictum is a species complex. The case emphasizes the potential high risk of fungal infection for patients with prosthetic valves.
Assuntos
Acremonium/isolamento & purificação , Endocardite/microbiologia , Próteses Valvulares Cardíacas/efeitos adversos , Valva Mitral/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Acremonium/efeitos dos fármacos , Idoso , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Bacteriemia/complicações , Sequência de Bases , Infecção Hospitalar/microbiologia , Farmacorresistência Fúngica Múltipla , Endocardite/complicações , Próteses Valvulares Cardíacas/microbiologia , Humanos , Masculino , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/microbiologia , Dados de Sequência Molecular , Insuficiência de Múltiplos Órgãos/etiologia , Pneumonia Bacteriana/complicações , Infecções Relacionadas à Prótese/complicações , RNA Fúngico/genética , RNA Ribossômico/genética , ReoperaçãoRESUMO
BACKGROUND: Invasive candidiasis (IC) is the most frequent fungal disease in children and adults. AIMS: To critically review and update the current epidemiology of Candida spp. disease in neonates, children and adults (critically ill patients and in oncohematologic patients and in solid organ transplant recipients). METHODS: We searched the PubMed/Medline, discussing the current data. RESULTS AND CONCLUSIONS: IC is associated with high attributable morbimortality and increased healthcare costs. In the last decades the incidence of invasive Candida spp. disease has increased in critically ill patients, has decreased in oncohematologic patients, although currently the involvement of non-albicans Candida species in the etiology of this disease is increasing steadily.
Assuntos
Candidíase/epidemiologia , Infecções Oportunistas/epidemiologia , Adulto , Criança , Estado Terminal , Transplante de Células-Tronco Hematopoéticas , Humanos , Incidência , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/microbiologia , Neoplasias/complicações , Neoplasias/imunologia , Neutropenia/complicações , Infecções Oportunistas/microbiologia , Transplante de Órgãos , Complicações Pós-Operatórias , Estudos Prospectivos , Estudos RetrospectivosRESUMO
This single-center observational prospective study evaluated the performance of (1-->3)-beta-D-glucan as an adjunct diagnostic tool in 12 patients with proven invasive fungal disease with different risk factors. The infections were due to either uncommon fungal pathogens such as dematiaceous molds (Scedosporium apiospermum, Alternaria infectoria, and Cladosporium macrocarpum) and hyaline septate molds (Fusarium solani and Blastoschizomyces capitatus) or Aspergillus spp. with unusual clinical presentations.
Assuntos
Micoses/diagnóstico , beta-Glucanas/sangue , Idoso , Alternaria/isolamento & purificação , Aspergillus/isolamento & purificação , Pré-Escolar , Cladosporium/isolamento & purificação , Dipodascus/isolamento & purificação , Feminino , Fusarium/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Proteoglicanas , Scedosporium/isolamento & purificaçãoRESUMO
Aspergillus lentulus was first described in the year 2005, and since it cannot be phenotypically distinguished from Aspergillus fumigatus, it is conceivable that earlier descriptions (before 2005) could be attributed to this new species. Currently invasive infections caused by A. lentulus are rare and very few cases have been previously published in neutropenic patients, all of them with fatal outcome. Here we report a critically ill non neutropenic patient with chronic obstructive pulmonary disease (COPD) who was admitted to the medical intensive care unit with an exacerbation of COPD and who had been treated with long term corticosteroids. A. fumigatus was cultured from two bronchial aspirates and in a third bronchial aspirate both A. lentulus and A. fumigatus were isolated. On two consecutive days detection of galactomannan in serum was negative whilst detection of (1-3) beta-D glucan was positive (> 518 pg/ml). Minimal inhibitory concentrations (MIC) for itraconazole, voriconazole, caspofungin and amphotericin B were high for this strain of A. lentulus. Given the high MIC values of A. lentulus to available antifungals, the accurate identification of this new species is warranted. To our knowledge, this is the first report of the isolation of A. lentulus in a non-neutropenic critically ill patient, although we note that since it was isolated only once from respiratory specimens, its implication as an etiologic agent of infection for this patient remains to be established.
Assuntos
Aspergilose/microbiologia , Aspergillus/isolamento & purificação , Pneumopatias Fúngicas/microbiologia , Infecções Oportunistas/microbiologia , Doença Pulmonar Obstrutiva Crônica/complicações , Corticosteroides/efeitos adversos , Corticosteroides/uso terapêutico , Idoso , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Aspergilose/etiologia , Aspergillus/patogenicidade , Aspergillus fumigatus/isolamento & purificação , Líquido da Lavagem Broncoalveolar/microbiologia , Estado Terminal , Farmacorresistência Fúngica Múltipla , Evolução Fatal , Humanos , Pneumopatias Fúngicas/etiologia , Masculino , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/etiologia , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/imunologia , Respiração Artificial , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Fumar/efeitos adversos , Especificidade da EspécieAssuntos
Infecções por Pneumocystis/diagnóstico , Pneumocystis carinii/isolamento & purificação , Soro/química , beta-Glucanas/análise , Adulto , Idoso , Feminino , Infecções por HIV/complicações , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Pneumocystis carinii/química , Estudos Prospectivos , ProteoglicanasRESUMO
Invasive candidiasis is the most important opportunistic fungal infection, causing high morbidity and mortality. Traditional methods of diagnosis, which include blood culture and biopsy, usually lack both sensitivity and specificity, or become positive late in the course of the infection. Therefore, new nonculture-based methods are being developed. In this review, we will discuss the most recent studies concerning the use of serum biomarkers in the diagnosis of invasive Candida infections.
Assuntos
Biomarcadores/sangue , Candidíase/sangue , Animais , Candida , Candidíase/diagnóstico , Candidíase/microbiologia , Contagem de Colônia Microbiana/métodos , Humanos , Sensibilidade e EspecificidadeRESUMO
The latest antifungal drugs introduced for clinical use are echinocandins; they possess a distinctive mechanism of action based on the inhibition of the beta-1,3-D-glucan sintesis, through the damage of the fungal cell wall without impairment of human cells because these do not contain beta-1,3-D-glucan. Among echinocandins, anidulafungin is the last that has received the FDA approval in the USA for the treatment of candidemia in non-neutropenic patients, intra-abdominal abscesses, peritonitis and esofagitis caused by Candida. In Europe, the EMEA has also approved its use for invasive candidiasis in non-neutropenic patients and for candidal esofagitis. The characteristics of anidulafungin are close to those of the ideal antifungal since it has a wide spectrum, is active at low minimal inhibitory concentrations and it is fungicidal for Candida. In addition, it is well tolerated, has few pharmacological interactions, is active intravenously, has a long half life and is auto-biodegradable. Finally, anidulafungin has shown a higher therapeutic efficiency when compared with the conventional treatment of candidemia, since although it is more expensive, the treatment with anidulafungin is highly cost effective.
Assuntos
Antifúngicos/uso terapêutico , Candidíase/tratamento farmacológico , Equinocandinas/uso terapêutico , Anidulafungina , HumanosRESUMO
We report a rare case of invasive rhinocerebral Saksenae vasiformis infection in a 71-year-old man with type 2 diabetes mellitus ketoacidosis. Combined histological and microbiological examination of two biopsy specimens taken at four days' intervals showed broad non-septate hyphae on direct smears of biopsies and necrosis and angioinvasion by hyphae were seen in the tissue. S. vasiformis was cultured from both biopsies. The patient had a fatal outcome even though partial debridement, liposomal amphotericin B treatment and control of diabetes were instituted. Permission for necropsy was denied. Clinical, epidemiological and pathological features of the case and manifestations of S. vasiformis infections are discussed. Most cases involve cutaneous sites and only two cases of rhinocerebral infections (both with fatal outcome) have been described. The present case is the third documented case of involvement of the sinuses and the second case of S. vasiformis infection documented in Europe.
Assuntos
Encefalopatias/microbiologia , Complicações do Diabetes , Fungos/isolamento & purificação , Doenças Nasais/microbiologia , Zigomicose/diagnóstico , Idoso , Evolução Fatal , Fungos/classificação , Humanos , Masculino , EspanhaRESUMO
Two milestones have characterized the last decades in Medical Mycology: the continuous increase in incidence of invasive mycoses and the discovery of new antifungal drugs that have allowed the successful treatment of these severe infections. This monography presents the most relevant studies on the present situation of invasive mycoses, its diagnosis and treatment, as well as data confirming the important role of voriconazole in their treatment.
Assuntos
Antifúngicos/uso terapêutico , Micoses/tratamento farmacológico , Pirimidinas/uso terapêutico , Triazóis/uso terapêutico , Humanos , Micoses/diagnóstico , VoriconazolRESUMO
The usefulness of surrogate markers in the diagnosis of invasive fungal infections caused by Aspergillus and other emerging mycelial fungi is based on the ability of surrogate markers to detect the infection caused by different species of mycelial fungi. Conventional microbiological methods for diagnosis of fungal disease are slow and insensitive. Antigen based assays or measurement of (1-3)-beta-D-glucan in blood have been developed and validated in clinical laboratories. We review these diagnostic contemporary tools, their clinical application and impact.
Assuntos
Aspergilose/diagnóstico , Doenças Transmissíveis Emergentes/diagnóstico , Zigomicose/diagnóstico , Anticorpos Antifúngicos/sangue , Antígenos de Fungos/sangue , Aspergilose/sangue , Aspergilose/epidemiologia , Biomarcadores , Ensaios Clínicos como Assunto , Doenças Transmissíveis Emergentes/sangue , Doenças Transmissíveis Emergentes/epidemiologia , DNA Fúngico/sangue , Diagnóstico Precoce , Fungemia/diagnóstico , Fungemia/epidemiologia , Galactose/análogos & derivados , Humanos , Técnicas Imunológicas , Mananas/sangue , Valor Preditivo dos Testes , Proteoglicanas , Fatores de Risco , Zigomicose/sangue , Zigomicose/epidemiologia , beta-Glucanas/sangueRESUMO
In the last years, the main advances in the serological diagnosis of mycoses caused by yeasts have occurred in the area of antibody and (1-3)-beta-D-glucan detection. Commercialization of the Candida albicans IFA IgG test and detection of antibodies against recombinant antigens Hwp1 and enolase are the most important contributions to the first area. Detection of (1-3)-beta-D-glucan confirms its usefulness as a good marker for the diagnosis of invasive candidiasis. The most recent studies suggest that combination of two tests to detect antígen, antibodies, (1-3)-beta-D-glucan and DNA will be needed to optimize the diagnosis of systemic yeast infections.
Assuntos
Micoses/diagnóstico , Anticorpos Antifúngicos/sangue , Antígenos de Fungos/sangue , Biomarcadores , Candida albicans/genética , Candida albicans/imunologia , Candida albicans/isolamento & purificação , Candidíase/sangue , Candidíase/diagnóstico , DNA Fúngico/sangue , Diagnóstico Precoce , Fungemia/sangue , Fungemia/diagnóstico , Fungemia/microbiologia , Humanos , Micoses/sangue , Micoses/microbiologia , Proteoglicanas , Leveduras/genética , Leveduras/imunologia , Leveduras/isolamento & purificação , beta-Glucanas/sangueRESUMO
In this prospective study including 78 adult patients with haematological malignancy (90 episodes) we performed galactomannan (GM) (Platelia Aspergillus) screening twice weekly for the diagnosis of invasive aspergillosis. There were five proven and four probable invasive aspergillosis cases. The sensitivity, specificity and positive and negative predictive values were 100, 88, 47 and 100%, respectively. There were eight patients with false positive GM (10.2%). In six patients the false GM reactivity was due to the administration of piperacillin-tazobactam (P-T). A significant association was found between false positive GM (= or > 0.5) and the administration of P-T (p < 0.01). Two other patients with no invasive aspergillosis (2.5%) and false GM reactivity had graft versus host disease (GVHD) and one of them had also mucositis grade IV. The kinetic patterns of false positive GM due to P-T is discussed.
Assuntos
Antibacterianos/uso terapêutico , Artefatos , Aspergilose/diagnóstico , Ensaio de Imunoadsorção Enzimática , Fungemia/diagnóstico , Neoplasias Hematológicas/sangue , Mananas/sangue , Adolescente , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Aspergilose/sangue , Biomarcadores , Terapia Combinada , Reações Falso-Positivas , Feminino , Fungemia/sangue , Galactose/análogos & derivados , Doença Enxerto-Hospedeiro/sangue , Doença Enxerto-Hospedeiro/complicações , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/tratamento farmacológico , Neoplasias Hematológicas/cirurgia , Transplante de Células-Tronco Hematopoéticas , Humanos , Masculino , Pessoa de Meia-Idade , Mucosite/sangue , Mucosite/complicações , Neutropenia/induzido quimicamente , Neutropenia/complicações , Ácido Penicilânico/análogos & derivados , Ácido Penicilânico/farmacologia , Ácido Penicilânico/uso terapêutico , Piperacilina/farmacologia , Piperacilina/uso terapêutico , Combinação Piperacilina e Tazobactam , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: The diagnosis of invasive candidiasis is difficult because there are no specific clinical manifestations of the disease and colonization and infection are difficult to distinguish. In the last decade, much effort has been made to develop reliable tests for rapid diagnosis of invasive candidiasis, but none of them have found widespread clinical use. RESULTS: Antibodies against a recombinant N-terminal fragment of the Candida albicans germ tube-specific antigen hyphal wall protein 1 (Hwp1) generated in Escherichia coli were detected by both immunoblotting and ELISA tests in a group of 36 hematological or Intensive Care Unit patients with invasive candidiasis and in a group of 45 control patients at high risk for the mycosis who did not have clinical or microbiological data to document invasive candidiasis. Results were compared with an immunofluorescence test to detect antibodies to C. albicans germ tubes (CAGT). The sensitivity, specificity, positive and negative predictive values of a diagnostic test based on the detection of antibodies against the N-terminal fragment of Hwp1 by immunoblotting were 27.8 %, 95.6 %, 83.3 % and 62.3 %, respectively. Detection of antibodies to the N-terminal fragment of Hwp1 by ELISA increased the sensitivity (88.9 %) and the negative predictive value (90.2 %) but slightly decreased the specificity (82.6 %) and positive predictive values (80 %). The kinetics of antibody response to the N-terminal fragment of Hwp1 by ELISA was very similar to that observed by detecting antibodies to CAGT. CONCLUSION: An ELISA test to detect antibodies against a recombinant N-terminal fragment of the C. albicans germ tube cell wall antigen Hwp1 allows the diagnosis of invasive candidiasis with similar results to those obtained by detecting antibodies to CAGT but without the need of treating the sera to adsorb the antibodies against the cell wall surface of the blastospore.
Assuntos
Anticorpos Antifúngicos/imunologia , Candida albicans/química , Candidíase/diagnóstico , Ensaio de Imunoadsorção Enzimática/métodos , Proteínas Fúngicas/isolamento & purificação , Glicoproteínas de Membrana/isolamento & purificação , Sequência de Aminoácidos , Anticorpos Antifúngicos/isolamento & purificação , Antígenos de Fungos/química , Antígenos de Fungos/imunologia , Antígenos de Fungos/isolamento & purificação , Candida albicans/imunologia , Candidíase/imunologia , Proteínas Fúngicas/química , Proteínas Fúngicas/imunologia , Humanos , Immunoblotting/métodos , Glicoproteínas de Membrana/química , Glicoproteínas de Membrana/imunologia , Dados de Sequência Molecular , Alinhamento de SequênciaRESUMO
The performance of a new test to detect antibodies to Candida albicans recombinant enolase was investigated in 47 immunocompromised and 51 immunocompetent patients. The sensitivity, specificity, and positive and negative predictive values of the test for the diagnosis of invasive candidiasis were 81.0, 83.9, 79.1, and 85.5%, respectively.