Clinical and mycological analysis of colonization by Candida spp. in oral leukoplakia and oral lichen planus.

OBJECTIVE: This study aims to analyze the prevalence of Candida spp. colonization in oral leukoplakia and oral lichen planus lesions, verify the influence of systemic and local factors, besides identify and determine the in vitro antifungal susceptibility profile of Candida species. MATERIALS AND METHODS: Samples were collected by swabbing from oral lesions and healthy mucosa and cultured on Sabouraud Dextrose and CHROMagar® Candida plates. Species identification was confirmed with MALDI-TOF MS analysis. RESULTS: Candida spp. was found in 36.8% of cases of oral leukoplakia and 18.2% of cases of oral lichen planus. Candida albicans was the only species found in oral lichen planus lesions (n = 2, 100%) and the most prevalent in oral leukoplakia (n = 5, 76.4%). Among the non-albicans Candida species found in oral leukoplakia were C. parapsilosis (n = 2, 25.5%) and C. tropicalis (n = 1, 14.1%). Candida isolates were susceptible to all antifungals tested. CONCLUSION: C. albicans was the most commonly found species in the studied lesions. No correlation was found between systemic and local factors with positive cases of oral lichen planus. However, smoking and alcohol consumption may be associated with positive cases of oral leukoplakia, especially the non-homogeneous clinical form. In addition, there is a possible predisposition to associated Candida colonization in cases of epithelial dysplasia found in oral leukoplakia. The antifungal medications tested showed excellent efficacy against isolates.

Paracoccidioidomycosis cases by Paracoccidioides lutzii in southeastern Brazil.

BACKGROUND AND OBJECTIVE: Paracoccidioidomycosis (PCM) is a systemic fungal disease caused by the thermodimorphic fungi Paracoccidioides spp. Their distribution is highly variable. Paracoccidioides lutzii is predominantly found in North and Middle-West Brazil and Ecuador. This study evaluated the clinicopathological characteristics of 10 patients diagnosed with PCM caused by P. lutzii in a reference center located in southeastern Brazil. DESIGN: Double immunodiffusion assay (DID) was used to investigate 35 patients' sera with negative serology for P. brasiliensis against a P. lutzii CFA (cell-free antigen). RESULTS: Out of the 35 retested patients, 10 (28.6%) were positive for P. lutzii CFA. Four patients did not report any displacement to P. lutzii endemic areas. Our results reinforce the importance of using different antigens when testing patients with clinical manifestations of PCM and negative serological tests for P. brasiliensis, primarily in cases of the report of displacement to or former residence in P. lutzii endemic regions. CONCLUSIONS: The availability of tests for different Paracoccidioides species antigens is fundamental for reaching an adequate diagnosis, patient follow-up, and definition of prognosis.

Trichosporon asahii causing subcutaneous mycoses in an immunocompetent patient: case report and a minireview.

Trichosporon spp. are a constituent of the normal flora of humans that can cause both superficial and invasive infections, mainly in immunocompromised and immunocompetent hosts, respectively. Herein, we a report of Trichosporon asahii causing subcutaneous fungal infection (SFI) in an immunocompetent patient after carpal tunnel surgery. Although susceptible to fluconazole, the treatment of SFI failed even using high doses of this azole. The skin lesion improved following the administration of voriconazole. We conducted a literature minireview searching reports on SFI in immunocompetent patients to check for epidemiological, diagnostic, therapeutic, and outcome characteristics. A total of 32 cases were reported. Despite being uncommon, the clinical suspicion and early diagnosis of SFI in immunocompetent patients undergoing previous surgery are important. Our study indicated that the azoles are the most active antifungal agents against Trichosporon spp., except for fluconazole, and voriconazole can be considered the first therapeutic option.

Screening paracoccidioidomycosis by double immunodiffusion test in a referred diagnostic center in Brazilian southeastern: an accessible tool.

PURPOSE: This article shows reports of the clinical-epidemiological characteristics and serological screening in patients assisted by a reference center for PCM care, University Hospital Cassiano Antonio Moraes, Federal University of Espirito Santo, Brazil. METHODS: The patient's sera with PCM were analyzed by DID test at the beginning and the end treatment. Clinical and demographic data were also collected to characterize the sample. RESULTS: One hundred patients with a suspected diagnosis of PCM were evaluated. Serology by DID test was used as a screen in all patients. The test was positive for 79 patients (72 for Paracoccidioides brasiliensis and 7 for Paracoccidioides lutzii). Serology was negative in 21 sera, although all of them were diagnosed PCM by histopathologic or direct exam. Serological follow-up was performed during the treatment of all patients. After treatment, 58(58%) had negative serology and 33(33%) low levels of antibodies (≤ 1:16). CONCLUSION: Our results indicate the importance of the DID test for the screening and monitoring of PCM and that the incidence of P. lutzii might be greater than expected in areas where it is not the predominant PCM species. Therefore, this article may contribute to improving the knowledge and clinical management about this disease.

Paracoccidioidomycosis due to Paracoccidioides brasiliensis S1 associated with acquired immunodeficiency syndrome: A case report.

BACKGROUND: Paracoccidioidomycosis (PCM) is an endemic disease in Latin America. In immunocompetent hosts, PCM occurs in two main clinical forms: acute and chronic. However, in HIV-infected patients PCM may show up simultaneous manifestations of acute and chronic forms. CASE REPORT: We present the case of a patient diagnosed with HIV who had disseminated skin lesions and generalized lymphadenopathy, as well as respiratory and central nervous system involvement. The PCM diagnosis was confirmed by direct KOH examination, double immunodiffusion and the isolation of the fungus in samples of an abscess in the subcostal region. The isolate was identified as Paracoccidioides brasiliensis S1 by species-specific PCR using primers for protein-coding gene GP43 (exon 2) followed by PCR-RFLP of the alpha-tubulin gene. CONCLUSIONS: There are few data in literature reporting species-specific molecular identification of Paracoccidioides in HIV/PCM patients. Therefore, this case report may contribute to improve the knowledge about this severe disease, its causative cryptic species, and its consequences to patients.

Evaluation of the antifungal activity of plant extracts and oral antiseptics against Candida albicans / Avaliação da atividade antifúngica de extratos vegetais e antissépticos bucais em Candida albicans

Objective: Oral candidiasis is the most common fungal infection of the oral cavity, and Candida albicans is the most frequently isolated species. Material and Methods: In this study, the potential antifungal effect of extracts from Gossypium hirsutum L., Arctium lappa, Equisetum sp., Cecropia pachystachya Trécul and Pogostemon heyneanus plants were evaluated on non-adhered cells of C. albicans, and the effect of oral antiseptics A (cetylpyridinium chloride 0.500 mg), B (chlorhexidine gluconate 0.12%), C (hydrogen peroxide 1.5%) and D (thymol, eucalyptol, menthol and methyl salicylate) were evaluated on non-adhered cells and biofilms of C. albicans, using turbidimetry and minimal inhibitory concentration (MIC) of the extracts and the maximal inhibitory dilution (MID) of the antiseptics. Results: The most promising results on non-adhered cells were obtained with Cecropia pachystachya Trécul extracts, with MIC values between 7.81 and 3.91 μg/mL. Antiseptics A and B showed the lowest MID values, between 0.20 and 0.10% (Kruskal-Wallis, p < 0.0001). Regarding biofilm inhibition, the MID values found were similar for the tested antiseptics, varying from 50% to 0.20% (Kruskal-Wallis, p = 0.6915). Conclusion: These results show that some plant extracts has potential use in the prevention and treatment of oral candidiasis...

Objetivo: A candidíase oral é a infecção fúngica mais comum na cavidade oral e Candida albicans é a espécie frequentemente relacionada. Material e Métodos: Neste estudo foi avaliado o potencial efeito antifúngico de extratos das plantas Gossypium hirsutum L., Arctium lappa, Equisetum sp., Cecropia pachystachya Trécul. e Pogostemon heyneanus sobre células não aderidas de C. albicans e o efeito dos antissépticos bucais A (cloreto de cetilpiridínio 0,500 mg); B (gluconato de clorexidina 0,12%); C (peróxido de hidrogênio 1,5%) e D (timol, eucaliptol, mentol e salicilato de metila) sobre células não aderidas e biofilmes de Candida albicans. A susceptibilidade dos isolados clínicos de C. albicans foi avaliada através da determinação da inibição de crescimento celular por turbidimetria e por determinação da Concentração Inibitória Mínima (CIM) dos extratos e da Máxima Diluição Inibitória (MDI) dos antissépticos. Resultados: Os resultados mais promissores dos testes com células não aderidas foram obtidos com extratos de Cecropia pachystachya Trécul., com valores de CIM entre 7,81 e 3,91 μg/ mL. Os antissépticos A e B apresentaram os menores valores de MDI, entre 0,20 e 0,10% (Kruskal-Wallis, p < 0,0001). Em relação a inibição de formação de biofilmes, os valores de MDI encontrados foram similares para os antissépticos testados, variando de 50% a 0,20% (Kruskal-Wallis, p = 0,6915). Conclusão: Os resultados mostraram que todos os antissépticos bucais e extratos vegetais analisados apresentaram atividade antifúngica contra os isolados de C. albicans, e as espécies medicinais apresentam potencial uso na prevenção e tratamento de candidíase oral...