RESUMO
Azole-resistant Aspergillus fumigatus (ARAF) has been reported in the domestic environment of patients at risk for aspergillosis. Here, we assessed the mother's and father's homes of an 18-year-old cystic fibrosis patient harbouring chronic colonisation with H285Y CYP51A azole-resistant isolate, in order to explore the link between environmental exposure and ARAF infection. In one dwelling, a very high overall contamination level was found (710-7.240â¯CFU/m3), with a predominance of A. fumigatus (640-6.490â¯CFU/m3), and ARAF showing the TR34/L98H mutation was isolated. Mycological follow-up of the patient showed the persistence of H285Y isolates, but no acquisition of TR34/L98H isolates was observed. This could be due to the low proportion of TR34/L98H isolates (<3%), or the establishment of preventative measures and dwelling remediation taken after the environmental investigation. Our data underlines the value of an environmental assessment to establish preventative measures and limit the risk of A. fumigatus exposure and ARAF acquisition.
Assuntos
Poluição do Ar em Ambientes Fechados , Antifúngicos , Aspergilose Broncopulmonar Alérgica , Aspergillus fumigatus , Azóis/farmacologia , Fibrose Cística , Adolescente , Poluição do Ar em Ambientes Fechados/análise , Poluição do Ar em Ambientes Fechados/prevenção & controle , Antifúngicos/administração & dosagem , Antifúngicos/efeitos adversos , Antifúngicos/classificação , Aspergilose Broncopulmonar Alérgica/diagnóstico , Aspergilose Broncopulmonar Alérgica/etiologia , Aspergilose Broncopulmonar Alérgica/terapia , Aspergillus fumigatus/efeitos dos fármacos , Aspergillus fumigatus/isolamento & purificação , Fibrose Cística/microbiologia , Fibrose Cística/fisiopatologia , Fibrose Cística/terapia , Farmacorresistência Fúngica , Exposição Ambiental/análise , Exposição Ambiental/prevenção & controle , Humanos , Masculino , Resultado do TratamentoAssuntos
Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Pneumopatias Parasitárias/etiologia , Toxoplasmose/etiologia , Adolescente , Adulto , Antiprotozoários/uso terapêutico , Transplante de Células-Tronco de Sangue do Cordão Umbilical/efeitos adversos , Feminino , Genótipo , Humanos , Hospedeiro Imunocomprometido , Leucemia Linfocítica Crônica de Células B/terapia , Pneumopatias Parasitárias/tratamento farmacológico , Pneumopatias Parasitárias/parasitologia , Masculino , Síndromes Mielodisplásicas/terapia , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/etiologia , Infecções Oportunistas/parasitologia , Fatores de Risco , Toxoplasma/classificação , Toxoplasma/genética , Toxoplasma/isolamento & purificação , Toxoplasmose/tratamento farmacológico , Toxoplasmose/parasitologia , Transplante HomólogoRESUMO
In order to improve invasive pulmonary aspergillosis (IPA) diagnosis, a real-time polymerase chain reaction (PCR) assay detecting Aspergillus spp. was developed. Its detection limit reached 2-20 conidia. The retrospective evaluation on 64 bronchoalveolar lavage (BAL) fluids from 57 patients at risk for IPA, including 20 probable and five proven IPA patients, revealed a 88% or 38% sensitivity in direct examination (DE)/culture-positive or culture-negative BAL, respectively, whereas galactomannan (GM) sensitivity reached 88% or 58%, respectively. Influence on the Aspergillus-PCR yield of BAL fluid volume, cellular count and DNA content (evaluated by human beta-globin quantification) was assessed. Significantly higher beta-globin levels were detected in Aspergillus PCR-positive (median 5,112 pg/microl) than negative (median 1,332 pg/microl) BAL fluids, suggesting that the beta-globin level could reflect BAL yields and DNA extraction. Using beta-globin for the interpretation of fungal PCR could improve the negative predictive value of this test.