RESUMO
OBJECTIVES: This study was conducted to assess the prevalence of azole resistance in Aspergillus isolates from patients with haematological malignancies or who were undergoing haematopoietic stem cell transplantation and to identify the molecular mechanism of resistance. METHODS: In this 28-month prospective study involving 18 Italian centres, Aspergillus isolates from surveillance cultures were collected and screened for azole resistance, and mutations in the cyp51A gene were identified. Resistant isolates were genotyped by microsatellite analysis, and the allelic profiles were compared with those of resistant environmental and clinical isolates from the same geographical area that had been previously genotyped. RESULTS: There were 292 Aspergillus isolates collected from 228 patients. The isolates belonged mainly to the section Fumigati (45.9%), Nigri (20.9%), Flavi (16.8%) and Terrei (4.8%). Three isolates showed itraconazole resistance: Aspergillus fumigatus sensu stricto, Aspergillus lentulus (section Fumigati) and Aspergillus awamori (section Nigri). The itraconazole resistance rates were 1% and 1.48% considering all Aspergillus spp. isolates and the Aspergillus section Fumigati, respectively. The prevalence of azole resistance among all the patients was 1.3%. Among patients harbouring A. fumigatus sensu stricto isolates, the resistance rate was 0.79%. The A. fumigatus isolate, with the TR34/L98H mutation, was genotypically distant from the environmental and clinical strains previously genotyped. CONCLUSIONS: In this study, the Aspergillus azole resistance rate was 1% (3/292). In addition to A. fumigatus sensu stricto, A. lentulus and A. awamori azole-resistant isolates were identified. Therefore, it is important have a correct identification at the species level to address a rapid therapy better, quickly understand the shift towards cryptic species and have an updated knowledge of the local epidemiology.
Assuntos
Azóis , Farmacorresistência Fúngica , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Aspergillus/genética , Azóis/farmacologia , Humanos , Itália/epidemiologia , Testes de Sensibilidade Microbiana , Estudos ProspectivosRESUMO
Schizophyllumcommune is an environmental basidiomycetous fungus, causing occasional, predominantly respiratory, infections in humans. Although S. commune is considered an emerging pathogen, some authors pointed out the possibility that the increase in the diagnosed cases may be also due to recent advances in diagnostic technologies now allowing a more prompt and precise identification at the species level. Here we describe the first Italian case of chronic non-invasive fungal rhinosinusitis due to S. commune in an immunocompetent subject and update the literature review on S. commune sinusitis published between 2012-2019. A timely diagnosis is important to avoid local and systemic complications due to infection with this fungus. In our case, prompt identification at species level was only possible with the use of MALDI-TOF mass spectrometry and confirmed by sequence analysis of ribosomal DNA ITS regions, due to the difficulty in achieving a correct and rapid identification using routine morphological analysis.
Assuntos
Micoses/diagnóstico , Schizophyllum/isolamento & purificação , Sinusite/diagnóstico , Sinusite/microbiologia , Doença Crônica , Face/diagnóstico por imagem , Face/microbiologia , Feminino , Humanos , Imunocompetência , Itália , Pessoa de Meia-Idade , Micoses/microbiologia , Schizophyllum/genética , Schizophyllum/patogenicidade , Análise de Sequência de DNA , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Tomografia Computadorizada por Raios XRESUMO
The majority of invasive fungal infections observed in non-neutropenic patients hospitalized in an intensive care unit are caused by Candida spp and current guidelines recommend echinocandins as the first-line treatment. Fungemias caused by filamentous or arthrosporic fungi such as Saprochaete capitata (previously named Geotrichum capitatum) are extremely rare. In fact, invasive infections due to S. capitata have been reported almost exclusively in neutropenic oncohematological patients. In this report, we describe a case of fungemia caused by S. capitata in a non-neutropenic patient hospitalized in an intensive care unit after aortic valve replacement. The prompt identification of S. capitata is extremely important because of its intrinsic resistance to echinocandins.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Fungemia/microbiologia , Hospitalização , Unidades de Terapia Intensiva , Saccharomycetales/isolamento & purificação , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/reabilitação , Infecções Relacionadas a Cateter/microbiologia , Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/microbiologia , Farmacorresistência Fúngica , Equinocandinas/uso terapêutico , Fungemia/tratamento farmacológico , Fungemia/patologia , Humanos , Masculino , Testes de Sensibilidade MicrobianaRESUMO
An ECMM epidemiological prospective survey of candidaemia was performed in one Italian region (Lombardy; population: 8 924 870) by the National Society of Medical Mycology (FIMUA) from September 1997 to December 1999. In total, 569 episodes were reported with an overall rate of 0.38/1000 admissions, 4.4/100000 patient days. Predisposing factors included presence of an intravascular catheter (89%), antibiotic treatment (88%), surgery (56%), intensive care (45%), solid tumour (28%), steroid treatment (15%), haematological malignancy (7%), HIV infection (6%), fetal immaturity (4%). Mucous membrane colonization preceded candidaemia in 83% of patients. Candida albicans was identified in 58% of cases, followed by Candida parapsilosis (15%), Candida glabrata (13%), Candida tropicalis (6%). Septic shock occurred in 95 patients. Crude mortality was 35%, the highest in C. tropicalis fungaemia (44%), the elderly (64%) and solid tumour cancer patients (43%). Intravascular catheter removal was associated with higher survival rate (71 vs. 47%). This survey underscores the importance of candidaemia in hospital settings.
Assuntos
Candidíase/epidemiologia , Infecção Hospitalar/epidemiologia , Fungemia/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Candidíase/microbiologia , Candidíase/mortalidade , Causalidade , Criança , Pré-Escolar , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Fungemia/microbiologia , Fungemia/mortalidade , Tamanho das Instituições de Saúde , Humanos , Incidência , Lactente , Recém-Nascido , Itália/epidemiologia , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
We report a case of primary cutaneous cryptococcosis in an HIV-negative patient, who presented with painless, ulcerated lesions involving the right forearm (fingers and elbow), which developed over 45 days. On the basis of the clinical appearance, serological and cultural examinations were performed to confirm the diagnosis; the histological evaluation of a skin biopsy showed an acute inflammatory infiltrate containing several PAS + Cryptococci. Subsequently, the patient was treated with fluconazole (400 mg/day for 10 days, then a maintenance therapy of 200 mg/day); after one month, the cutaneous lesions were remarkably improved, but, although a series of further laboratory and clinical examinations was scheduled, the patient repeatedly refused any other re-evaluation, and he was lost from follow-up.
Assuntos
Criptococose/diagnóstico , Dermatomicoses/diagnóstico , Idoso , Biópsia , Criptococose/patologia , Dermatomicoses/patologia , Humanos , Imunocompetência , Masculino , Úlcera Cutânea/microbiologia , Úlcera Cutânea/patologiaRESUMO
We report a prospective, randomized, controlled study of antifungal chemoprophylaxis in forty immunocompromised children with hematologic malignancies, receiving respectively itraconazole, ketoconazole, amphotericin-B and no prophylaxis. Fungal isolates from patients' saliva or stools were obtained from 19/40 patients (Candida albicans from 15 patients). Disseminated infection was never observed. Fungal isolates were significantly less frequent in the ketoconazole group of patients vs any other group. Systemic antifungal chemoprophylaxis with ketoconazole appears more effective even than the recently introduced itraconazole.
Assuntos
Antifúngicos/uso terapêutico , Micoses/prevenção & controle , Neoplasias/tratamento farmacológico , Adolescente , Anfotericina B/uso terapêutico , Criança , Pré-Escolar , Fezes/microbiologia , Feminino , Humanos , Lactente , Itraconazol , Cetoconazol/análogos & derivados , Cetoconazol/uso terapêutico , Masculino , Faringe/microbiologia , Estudos ProspectivosRESUMO
Opportunistic mycotic infections have a significant influence on the morbidity and mortality of children whose immune systems are depressed by the onset of AML. The present paper assesses the incidence of the pathogenic mycotic flora and the in vitro efficacy of the main antimycotic drugs. Candida was che most commonly encountered pathogen and its in vitro response to the polyenic antibiotics was good.