RESUMO
Symptomatic candiduria often occurs in patients with indwelling bladder catheters or immunocompromised host. Isolation of Candida in urine in high-risk patients should primarily be considered as a marker for candidemia. Hematological and genitourinary malignancies are one of the main risk factors associated with Candida urinary tract infections (CUTI). Fluconazole is a choice for initial treatment of CUTI, but it is fluctuate depending on the patient's condition including renal failure, site of urinary infection and Candida species. Poor glomerular filtration is the main disadvantage echinocandins resulting in very low urinary concentrations. Therefore, echinocandins have prohibited their use in CUTI. Up to now, there are only 10 cases reported in the literatures with highly effective echinocandins in CUTI because of high concentrations in the tissue are needed to control invasive fungal disease. Herein, we report a candiduria followed by renal candidiasis caused by Candida albicans in a 6-year-old Iranian male with a history of Wilms tumor in left kidney. Direct examination of urine specimen revealed an infection due to budding yeast cells with numerous pseudohyphae and growths of C. albicans was reconfirmed by sequencing of ITS rDNA region. MICs in increasing order were as follows: caspofungin (0.016µg/ml), voriconazole (0.125µg/ml), amphotericin B (0.25µg/ml), itraconazole (0.5µg/ml) and fluconazole (2µg/ml). It seems that successful treatment with caspofungin owes achieved high renal tissue concentrations that are unrelated to glomerular filtration. In conclusion, predisposing factors for better outcome are more important than treatment of CUTI, therefore, management of UTI is essential for critically patients.
Assuntos
Candidíase/tratamento farmacológico , Equinocandinas/uso terapêutico , Neoplasias Renais/tratamento farmacológico , Lipopeptídeos/uso terapêutico , Infecções Urinárias/tratamento farmacológico , Tumor de Wilms/tratamento farmacológico , Antifúngicos/uso terapêutico , Candida/isolamento & purificação , Candidíase/complicações , Candidíase/urina , Caspofungina , Criança , Humanos , Irã (Geográfico) , Neoplasias Renais/complicações , Neoplasias Renais/microbiologia , Masculino , Resultado do Tratamento , Infecções Urinárias/complicações , Infecções Urinárias/microbiologia , Tumor de Wilms/complicações , Tumor de Wilms/microbiologiaRESUMO
OBJECTIVES: The increasing incidence of Candida spp., and the vital prognosis often compromise for patients with Candida species make urgent the exact knowledge of their distribution worldwide and exhaust action antifungals currently used in clinical. That why we carry out an epidemiological study of Candida species and testing their susceptibility against two antifungals: amphotericin B and caspofungin. MATERIALS AND METHODS: Samplings of peripheral venous catheters (PVC) were carried out from during 8months on the services of Internal medicine, Surgery A and Neonatology of Oran's University Hospital Center (UHC). The study of the susceptibility of Candida species to antifungal agents was performed according to the Clinical Laboratory Standards Institute (CLSI 2008). RESULTS: From 300 samples, 25 yeasts were isolated. The rate of colonization PVC was 8.33% by Candida spp. The most isolated strains were Candida parapsilosis with 64% of cases, followed by Candida albicans (12%) then 8% for Candida glabrata and Candida krusei. However, only 4% of isolates were Candida famata or Candida lusitaniae. Furthermore all isolated strains were susceptible to amphotericin B with Minimum Inhibitory Concentrations (MIC) ranging from 0.25 to 1µg/mL. MIC obtained with caspofungin vary from 0.0625 to 2µg/mL for all strains. Moreover, one strain of C. krusei is resistant to caspofungin with a MIC superior to 8µg/mL. CONCLUSION: All though caspofungin is at least as effective as amphotericin B, it is better tolerated for the treatment of invasive fungal infections.
Assuntos
Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Candida/isolamento & purificação , Candidíase/microbiologia , Infecções Relacionadas a Cateter/microbiologia , Catéteres/microbiologia , Farmacorresistência Fúngica/efeitos dos fármacos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Argélia/epidemiologia , Candida/crescimento & desenvolvimento , Candidíase/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Criança , Pré-Escolar , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Feminino , Hospitais Universitários , Humanos , Lactente , Recém-Nascido , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Adulto JovemRESUMO
Disseminated fungal infections due to Magnusiomyces capitatus are rare, occurring exclusively in immunocompromised patients. We report the first case in a liver transplant patient with chronic rejection and portal thrombosis who had a M. capitatus fungemia with a refractory septic shock. Despite an antibacterial and antifungal treatment with caspofungin empirical treatment, the patient died from multiple organ failure. Subsequently, mycological examinations of blood cultures, bronchoalveolar lavage fluid and urine were positive to M. capitatus identified by mass spectrometry and confirmed by sequencing respectively. The stain was resistant to caspofungin and fluconazole. The best treatment appears to be the combination of amphotericin B and voriconazole or amphotericin B and 5 fluorocytosine.
Assuntos
Fungemia/diagnóstico , Fungemia/microbiologia , Transplante de Fígado , Saccharomycetales/isolamento & purificação , Evolução Fatal , Fungemia/complicações , Rejeição de Enxerto/microbiologia , Humanos , Hospedeiro Imunocomprometido , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Sepse/complicações , Sepse/microbiologiaRESUMO
Candiduria may be a marker of serious fungal infections such as pyelonephritis. With the exception of fluconazole and flucytosine, antifungals drugs are not excreted into the urine as active drugs, making the management of infection due to fluconazole-resistant Candida difficult. We report a case of recurrent Candida parapsilosis candiduria in a kidney transplant recipient suffering from chronic ureteral obstruction requiring permanent ureteral catheterization (double-J stent). Attempts to remove the stent led to pyelonephritis episodes during which only Candida was isolated from the urine. Following several courses of azole-based therapy, the causative agent became resistant to fluconazole. Clinical and mycological cure were obtained combining irrigations of caspofungin through a percutaneous calicostomy catheter and oral flucytosine. This strategy may represent an interesting therapeutic alternative in case of fluconazole-resistant symptomatic candiduria.
Assuntos
Candidíase Invasiva/terapia , Equinocandinas/administração & dosagem , Flucitosina/administração & dosagem , Cálices Renais/cirurgia , Infecções Urinárias/terapia , Administração Oral , Adulto , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Candidíase Invasiva/urina , Caspofungina , Terapia Combinada , Farmacorresistência Fúngica , Fluconazol/uso terapêutico , Humanos , Cálices Renais/patologia , Lipopeptídeos , Masculino , Irrigação Terapêutica/métodos , Cateterismo Urinário/métodosRESUMO
Fungal infections are a major cause of morbidity and mortality, and are frequently associated with the implantation of vascular catheters, especially in immune-compromised patients. Unfortunately, the therapeutic arsenal available for the treatment of these infections, caused generally by the yeasts of the genus Candida is still limited because of the toxicity and/or of the emergence of resistance against some antifungal agents. That is why we have undertaken this study, which is to determine the incidence and the degree of sensitivity of Candida spp., isolated from peripheral venous catheters at the University Hospital of Tlemcen (Algeria) to caspofungin and amphotericin B. The results show that the rate of colonization of vascular catheters was 19 % by yeasts of Candida spp., of which 60 % are Candida parapsilosis, 20 % Candida albicans, 14.3 % Candida glabrata and 5.7 % Candida famata. The minimum inhibitory concentrations (MIC) for amphotericin B are between 0.5 and 2 µg/mL and for caspofungin, they are between 0.125 and 2 µg/mL.
Assuntos
Antifúngicos/uso terapêutico , Candidíase/tratamento farmacológico , Candidíase/epidemiologia , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Argélia/epidemiologia , Antifúngicos/farmacologia , Candidíase/microbiologia , Infecções Relacionadas a Cateter/microbiologia , Cateterismo/efeitos adversos , Cateterismo/estatística & dados numéricos , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Farmacorresistência Fúngica/efeitos dos fármacos , Hospitais Universitários , Humanos , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Fatores de Risco , Dispositivos de Acesso Vascular/efeitos adversos , Dispositivos de Acesso Vascular/microbiologiaRESUMO
Mucormycosis is a rare, invasive and fatal disease that occurs mainly in diabetes mellitus patients with uncontrolled blood glucose levels or in immunocompromised patients. The mortality rate of this disease is as high as 25 to 80%, despite aggressive surgical treatment and antifungal therapy. This high mortality requires alternative treatment approaches. The accepted treatment modality of invasive mucormycosis are amphotericin B lipid formulations. Although echinocandins generally show no activity against Mucorales, it was shown that Rhizopus oryzae expressed the target enzyme for echinocandins, 1,3-beta-glucan synthase. Additionally, there are some experimental studies in a diabetic mouse model and case reports regarding the effects of caspofungin. In this report, we present a rhinocerebral mucormycosis case treated with liposomal amphotericin B and caspofungin. There was regression of the patient's clinical and radiological condition with the addition of caspofungin, but she died due to discontinuation of her treatment and reasons other than mucormycosis.