RESUMO
Fusarium species are hyaline moulds belonging to the hyalohyphomycosis group that are usually found in the soil and plants. This organism has emerged as a cause of disseminated invasive disease. The correlation between in vitro value and clinical efficacy is low and many patients remain unresponsive to treatment despite in vitro susceptibility. We determined growth control for Fusarium solani using the BioCell-Tracer system that measures the growth rate of a single fungal hypha, and the effect of different concentrations of amphotericin B and itraconazole. The MIC for these two drugs was also determined by a broth microdilution technique, using RPMI 1640. Different MICs for amphotericin B were obtained by the two different methods. This paper describes a case of infection due to Fusarium solani in an allogeneic bone marrow transplanted patient, the microbiological diagnostic, antifungal susceptibility tests for conidia and hypha and clinical correlation.
Assuntos
Anfotericina B/farmacologia , Antifúngicos/farmacologia , Fusarium/efeitos dos fármacos , Micoses/microbiologia , Sepse/microbiologia , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Transplante de Medula Óssea/efeitos adversos , DNA Fúngico/química , DNA Fúngico/genética , Evolução Fatal , Feminino , Fusarium/crescimento & desenvolvimento , Fusarium/isolamento & purificação , Humanos , Hospedeiro Imunocomprometido , Micoses/tratamento farmacológico , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Sepse/tratamento farmacológicoRESUMO
Infection is a major cause of morbidity and mortality in bone marrow transplant recipients and in patients with hematological malignancies. The source of infection is almost always endogenous flora or the hospital environment. The present study evaluated bone marrow transplant recipients and patients with hematological malignancies colonized and/or infected with filamentous fungi. During 1 year, environmental air samples were also taken from the bone marrow transplant unit by a modification of gravity air-setting plate (GASP) methodology. Fusarium spp. were the most prevalent genus in the fall and Cladosporium spp. in the winter. Clinically isolated strains grew better at 37 degrees C than environmental strains. According to NCCLS M-38P methods, environmental Aspergillus strains showed higher MICs to miconazol and itraconazol, and clinical Fusarium strains were less susceptible to fluconazole.
Assuntos
Microbiologia do Ar , Antifúngicos/farmacologia , Hospedeiro Imunocomprometido , Fungos Mitospóricos/efeitos dos fármacos , Fungos Mitospóricos/patogenicidade , Micoses/microbiologia , Aspergillus/efeitos dos fármacos , Aspergillus/isolamento & purificação , Aspergillus/patogenicidade , Transplante de Medula Óssea/efeitos adversos , Cladosporium/efeitos dos fármacos , Cladosporium/isolamento & purificação , Cladosporium/patogenicidade , Fusarium/efeitos dos fármacos , Fusarium/isolamento & purificação , Fusarium/patogenicidade , Neoplasias Hematológicas/complicações , Hospitais de Ensino , Humanos , Testes de Sensibilidade Microbiana , Fungos Mitospóricos/classificação , Fungos Mitospóricos/isolamento & purificaçãoRESUMO
Bone marrow transplant recipients are highly susceptible to opportunistic fungal infections. This is the report, of the first case of a Chaetomium systemic infection described in Brazil. A 34 year-old patient with chronic myeloid leukemia underwent an allogeneic sibling matched bone marrow transplant. Seven months later, he developed systemic infection with enlargement of the axillary and cervical lymph nodes. Culture of the aspirates from both lymph nodes yielded Chaetomium globosum. The infection was successfully treated with amphotericin B. The increasing population of immunosupressed patients requires a careful microbiologic investigation for uncommon fungal infections.