Epidemiological indicators and predictors of lethality associated with fungal infections in a NICU: a historical series

Abstract Objectives: Fungal infections (FI) pose a public health concern and significantly increase mortality rates, especially within Neonatal Intensive Care Units (NICU). Thus, this study aimed to investigate epidemiological indicators, risk factors, and lethality predictors associated with FI in a NICU. Methods: This study included 1,510 neonates admitted to the NICU of a reference hospital in Brazil between 2015 and 2022. Demographic data, such as sex, birth weight, gestational age, and use of invasive devices were analyzed. Results: Thirty neonates developed invasive FI, totaling 33 episodes and an incidence of 1.2 per 1,000 patient days. Candida albicans was the most frequent species (52.9 %), the bloodstream was the most affected site (78.9 %), and 72.7 % of infections occurred between 2015 and 2018. The lethality rate associated with FI was 33.3 %, and 90 % of deaths occurred within 30 days of diagnosis of infection. Weight < 750 g, prolonged hospital stay, use of parenteral nutrition, and broad-spectrum antimicrobials were independent risk factors for infection occurrence, especially glycopeptides and 4th generation cephalosporins, having a considerable role in the increase in fungal infections. Weight < 750 g was considered a significant predictor of lethality, and C. albicans had the highest lethality rate (40 %). Conclusion: These findings highlight the elevated lethality rate associated with these infections, reinforcing the importance of developing strategies to control FI within NICU.

Susceptibilidad in vitro a antifúngicos de especies de Cándida / In vitro antifungal susceptibility of Candida spp

Resumen Objetivo. Analizar la susceptibilidad in vitro de aislamientos de Candida spp. provenientes de onicomicosis obtenidos entre 2016 y 2019, para contribuir con el conocimiento sobre la necesidad o no de realizar pruebas de susceptibilidad a los microorganismos aislados antes de prescribir el tratamiento. Métodos. El estudio consistió en identificar 23 aislamientos de Candida spp. utilizando el sistema automatizado Vitek2® (bioMérieux, Francia). Se determinó la susceptibilidad in vitro de estos aislamientos ante dos antifúngicos tópicos (amorolfina y ciclopirox) y dos antifúngicos sistémicos (fluconazol e itraconazol) por el método de microdilución en caldo M27-A3 del Instituto Estándares para el Laboratorio Clínico (CLSI por sus siglas en inglés) de los Estados Unidos de América. Resultados. La mayoría de los aislamientos correspondieron a Candida parapsilosis (34,8 %), seguido por C. albicans (30,3 %), C. guilliermondii (17,4 %), C. tropicalis (8,7 %), C. dubliniensis (4,4 %) y C. krusei (4,4 %). No se encontraron diferencias estadísticamente significativas entre las CIMs de los diferentes antifúngicos y en promedio hubo susceptibilidad para todos los antifúngicos analizados. Sin embargo, para fluconazol se encontró un aislamiento con CIM alta de C. guilliermondii y un aislamiento resistente de C. parapsilosis. Conclusiones. Las directrices internacionales recomiendan pruebas de susceptibilidad para Candida spp. de hemocultivos o tejidos tras infecciones sistémicas. En todas las demás candidiasis se identifica la especie y se revisan sus patrones de susceptibilidad en la literatura. Por lo tanto, es de importancia conocer que aislamientos de onicomicosis de Candida no-albicans, especialmente de C. guilliermondii y C. parapsilosis, presentan una susceptibilidad disminuida a ciertos antifúngicos que se utilizan como tratamiento, por lo que se recomienda realizar pruebas de susceptibilidad en caso de no tener una buena respuesta al tratamiento en casos de onicomicosis por estas levaduras.

Abstract Aim. The purpose of this investigation was to determine the in vitro susceptibility patterns of Candida spp. isolated from onychomycosis, in order to contribute with strategies for optimal clinical laboratory management of patients with onychomycosis infected with these yeasts. Methods . A total of 23 isolates of Candida spp. were identified with the automatized system Vitek®2 (system bioMérieux, France). In vitro susceptibility patterns were evaluated with two topic antifungals (amorolfine and ciclopirox) and two systemic antifungals (fluconazole and itraconazole) using the Clinical Laboratory and Standards Institute (CLSI) broth microdilution M27-A3 guidelines. Results . Most of the isolates were identified as Candida parapsilosis (34,8 %), followed by C. albicans (30,3 %), C. guilliermondii (17,4 %), C. tropicalis (8,7 %), C. dubliniensis (4,4 %) and C. krusei (4,4 %). There were no statistically significant differences among the MICs of the antifungals tested. However, there was one isolate of C. guilliermondii with high MIC for fluconazole and one fluconazole resistant isolate of C. parapsilosis. Conclusions. Susceptibility tests are only recommended internationally for Candida spp. isolated from blood stream or tissue in systemic infections. In every other candidiasis there is only a species identification, while its susceptibility pattern for treatment is reviewed in literature. Therefore, it is important to report that Candida no-albicans isolates from onychomycosis, especially C. guilliermondii and C. parapsilosis, have a reduced susceptibility to some antifungals commonly used for treatment. According to the obtained in vitro results, we recommend performing antifungal susceptibility testing in those cases of onychomycosis caused by Candida spp. no responsive to treatment.

Diversidad de especies de Candida recuperadas de la cavidad bucal de pacientes oncológicos en Barranquilla, Colombia Candida spp bucal y cáncer / Species diversity of the genus Candida in the oral cavity of cancer patients in Barranquilla, Colombia

Resumen Se caracterizaron especies de Candida recuperadas de la cavidad bucal de pacientes oncológicos en una institución prestadora de salud de Barranquilla, Colombia. La investigación tuvo un diseño de corte transversal, mediante un muestreo a conveniencia se seleccionaron 60 pacientes oncológicos con candidiasis oral. Las muestras obtenidas se cultivaron en agar Sabouraud cloranfenicol, CHROMagar® Candida y agar Sabouraud dextrosa. Los microorganismos aislados se identificaron y se estableció el perfil de sensibilidad a los antifúngicos. Se aplicó estadística descriptiva, prueba de X 2 y análisis bivariado utilizando el programa Statgraphics Centurión XVII, con razón de momios (OR) para probabilidad de ocurrencia. Se identificaron un total de 107 cepas de Candida correspondientes a 15 especies, distribuidas del siguiente modo: C. albicans 23%, C. glabrata 18%, C. tropicalis 13%, C. krusei 10%, C. intermedia y C. lipolytica con 1,5%. En 77% de los casos estuvieron implicadas especies diferentes de C. albicans. Se identificó la existencia de relación entre cáncer del sistema reproductor y C. guilliermondii (p = 0,0001, < 0,05; OR 17) y entre C. colliculosa y cánceres respiratorios (p = 0,0003 < 0,05; OR 19,5). El 99% de las especies de Candida identificadas fueron sensibles a los antifúngicos: fluconazol, voriconazol, caspofungina y micafungina. Solo una cepa de C. krusei fue resistente. Se concluye que existió diversidad de especies de Candida en la cavidad bucal de pacientes oncológicos, ya sea como colonizantes únicos o en combinación, de modo que más de una especie de Candida podría ser responsable de la infección micótica en la cavidad bucal de estos enfermos.

Abstract Candida spp. was characterized in the oral cavity of cancer patients in a health care center in Barranquilla, Colombia. This is a cross-sectional investigation including 60 oncological patients with oral candidiasis, selected by convenience sampling, from whom samples were subjected to culture in Sabouraud chloramphenicol agar, CHROMagar® Candida and Sabouraud dextrose agar were taken. The antifungal susceptibility profile was then identified and established. Descriptive statistics, Chi square test, and bivariate analysis were conducted using the Statgraphics Centurion XVII software with odds ratio (OR) for the probability of occurrence. A total of 107 Candida strains were identified belonging to 15 species, C. albicans with 23%, C. glabrata with 18%, C. tropicalis 13%, C. krusei 10%, C intermedia, and C. lipolytica with 1.5%. Species other than C. albicans were identified in 77% of the cases. A relationship between reproductive system cancer and C. guilliermondii was identified (p = 0.0001, <0.05) OR: 17.0. Between C. colliculosa and respiratory cancer (p = 0.0003, <0.05) OR 19.5. With regard to antifungal susceptibility, 99% of the identified Candida species were susceptible to the following antifungals: fluconazole, voriconazole, caspofungin, and micafungin. Only one strain of C. krusei was resistant. It is concluded that there was a diversity of Candida species, either single or mixed in cancer patients, which could determine that only one species is not responsible for fungal infection in the oral cavity.

Study of the interactions of di- and tri-terpenes from Stillingia loranthacea with the enzyme NSP16-NSP10 of SARS-CoV-2 / Estudo das interações de di- e tri-terpenos de Stillingia loranthacea com a enzima NSP16-NSP10 de SARS-CoV-2

Objective: This study aimed to evaluate the interactions of di- and tri-terpenes from Stillingia loranthacea with the enzyme NSP16-NSP10 of SARS-CoV-2, important for viral replication. Methods: The molecular docking technique was used to evaluate this interaction. Results: The analysis showed that the evaluated compounds obtained RMSD values of 0.888 to 1.944 Å and free energy of -6.1 to -9.4 kcal/mol, with the observation of hydrogen bonds, salt bridges, and pi-sulfur, pi-alkyl, and hydrophobic interactions. Conclusion: Thus, the results obtained show the potential of the compounds analyzed against the selected target. Since computer simulations are only an initial step in projects for the development of antiviral drugs, this study provides important data for future research.

Objetivo: avaliar as interações de di- e tri-terpenos de Stillingia loranthacea com a enzima NSP16-NSP10 de SARS-CoV-2, importante para a replicação viral. Métodos: A técnica de docking molecular foi utilizada para avaliar essa interação. Resultados: A análise mostrou que os compostos avaliados obtiveram valores de RMSD de 0,888 a 1,944 Å e energia livre de -6,1 a -9,4 kcal/mol, observando-se ligações de hidrogênio, pontes salinas e pi-enxofre, pi-alquil, e interações hidrofóbicas. Conclusão: Assim, os resultados obtidos mostram o potencial dos compostos analisados frente ao alvo selecionado. Como as simulações computacionais são apenas um passo inicial nos projetos de desenvolvimento de medicamentos antivirais, este estudo fornece dados importantes para pesquisas futuras.

Evaluation of interactions of silibinin with the proteins ALS3 and SAP5 against Candida albicans / Avaliação das interações da silibinina com as proteínas ALS3 e SAP5 contra Candida albicans

Objective: to evaluate the molecular interaction of silibinin with the targets ALS3 and SAP5. Methodology: Molecular docking protocols were conducted to analyze the binding interaction of silibinin with ALS3 and SAP5. Results: Eleven interactions of ALS3 with silibinin and four with fluconazole were found, while six interactions were observed of SAP5 with silibinin and four with fluconazole. Conclusion: Molecular docking between silibinin and ALS3 identified important interactions, but no significant interactions were observed with SAP5, even though silibinin can exhibit affinity and interactions with other SAP5 sites.

Objetivo: Avaliar a interação molecular da silibinina com os alvos ALS3 e SAP5. Metodologia: Protocolos de docking molecular foram conduzidos para analisar a interação de ligação da silibinina com ALS3 e SAP5. Resultados: Foram encontradas onze interações de ALS3 com silibinina e quatro com fluconazol, enquanto seis interações foram observadas de SAP5 com silibinina e quatro com fluconazol. Conclusão: Docking molecular entre silibinina e ALS3 identificou interações importantes, mas não foram observadas interações significativas com SAP5, embora a silibinina possa apresentar afinidade e interações com outros sítios SAP5.

Caracterización clínico-epidemiológica de endocarditis infecciosa en pediatría

La endocarditis infecciosa es un proceso inflamatorio infeccioso causado por distintos microorganismos afectando el endocardio. Es una entidad poco frecuente en niños previamente sanos; no obstante, no es rara su ocurrencia en niños con ciertas cardiopatías congénitas; encontrándose un aumento en la incidencia en los extremos de las edades pediátricas. Objetivo: Describir las características clínicas y epidemiológicas de los pacientes pediátricos hospitalizados en el Hospital Universitario de Caracas, durante el período comprendido entre enero 2001 a diciembre 2020. Metodología: Estudio descriptivo y retrospectivo, utilizando como criterio de inclusión todo paciente pediátrico entre 0-12 años que ingresa con el diagnóstico de endocarditis infecciosa. Se recolectaron datos como edad, sexo, nivel socioeconómico, comorbilidades, factores predisponentes, hallazgos clínicos, paraclínicos, ecocardiográficos y terapéutica indicada; analizándose con estadística descriptiva, con el fin de establecer tablas de distribución de frecuencias. Resultados: Se incluyeron 17 pacientes en el estudio; el género masculino, los recién nacidos y preescolares fueron los que desarrollaron mayormente esta patología, observándose una supervivencia del 70,8 %. El principal factor predisponente para su desarrollo fue la presencia de catéter venoso central. En el 42,9 % de los hemocultivos se aisló Candida spp. Conclusión: En endocarditis infecciosa, a pesar de su baja incidencia, las complicaciones y mortalidad pueden ser altas; por lo cual ante todo paciente portador de catéter venoso central, con clínica de fiebre, taquicardia y soplo cardíaco, con hallazgos paraclínicos de leucocitosis, anemia y elevación de reactantes de fase aguda se sugiere el descarte de la misma.

Infective endocarditis is an infectious inflammatory process caused by different microorganisms affecting the endocardium. It is a rare entity in previously healthy children; however, its occurrence in children with certain congenital heart diseases is not uncommon; finding an increase in incidence at the extremes of pediatric ages. Objective: To describe the clinical and epidemiological characteristics of pediatric patients hospitalized at the Hospital Universitario de Caracas, during the period from January 2001 to December 2020. Method: Descriptive and retrospective study, using as inclusion criteria all pediatric patients between 0-12 years of age who are admitted with the diagnosis of infective endocarditis. Data such as age, sex, socioeconomic level, comorbidities, predisposing factors, clinical, paraclinical, echocardiographic findings, and indicated therapy were collected; being analyzed with descriptive statistics, in order to establish frequency distribution tables. Results: 17 patients were included in the study, the male gender, the newborns and preschoolers were the ones who developed this pathology with survival of 70.8 %. The main predisposing factor for its development was the presence of central venous catheter. Candida spp was isolated in 42.9 % of blood cultures. Conclusion: In infective endocarditis, despite having low incidence, complications and mortality can be high; therefore, in all patients with a central venous catheter, with symptoms of fever, tachycardia and heart murmur, with paraclinical findings of leukocytosis, anemia and elevation of acute phase reactants, it is suggested to discard it.

Antifungal Effect of Henna (Lawsonia inermis) Extract on Pathogenic Fungi

The study aimed at undertaking preliminary phytochemical studies and antifungal activities of Lawsonia inermis leaf extracts against clinical Candida isolates from female patients attending Dalhatu Araf Specialist Hospital (DASH) Lafia, Nasarawa State. HVS (High Vaginal Swab) samples were collected from 185 subjects and transported to the laboratory for analysis. Microbial culture and isolations were done on Sabouraud dextrose agar (SDA), Blood agar, Potato dextrose agar (PDA) and Sabouraud dextrose broth. Identification of clinical isolates was done following standard guideline for Candida identification including microscopic, cultural and biochemical characteristics (sugar utilization and fermentation). Antifungal susceptibility tests of the plant extracts at different concentrations were carried out against Candida isolates. Distilled water and ketoconazole drug served as negative and positive control respectively. Zones of inhibitions, the minimum inhibitory concentration (MIC) and the minimum fungicidal concentration (MFC) of the extracts were determined. Data were analysed on the Minitab 16.0 software for descriptive (mean with standard error) and inferential statistics and Chi Square at 95% confidence limit. In conclusion, L.inermis leaf has been shown to have antifungal properties since it contained quality phytochemicals in sufficient quantity that may be explored in the synthesis of drugs against some species of Candida. This finding is crucial in the management and control of candidiasis in the study.

Utilidad del panel Sensititre YeastOne® para detectar especies de Candida resistentes a los antifúngicos / Usefulness of the Sensititre YeastOne® panel to detect Candida species resistant to antifungal drugs

Resumen Evaluamos las concordancias interlaboratorio, esencial y categórica entre el panel Sensititre YeastOne™ y los métodos de referencia correspondientes al M27 4.a ed. (Clinical and Laboratory Standards Institute [CLSI]) y al EDef 7.3.1 (European Committee on Antifungal Susceptibility Testing [EUCAST]). Estudiamos 67 cepas de Candida de distintas muestras clí nicas y un panel de 9 cepas resistentes a fluconazol y equinocandinas. El mayor porcentaje de concordancia interlaboratorio se observó con anfotericina B (96,8%) y el menor porcen taje con voriconazol (77,2%). La caspofungina mostró un 5,8% de discrepancias muy mayores con el método de referencia del CLSI. Con el del EUCAST, el itraconazol, el posaconazol y la anidulafungina mostraron porcentajes de discrepancias mayores: el 17,6, el 18,1 y el 19,6%, respectivamente. El panel Sensititre YeastOne™ es una alternativa confiable y fácil de usar, que permite detectar especies de Candida resistentes a los antifúngicos, con algunas limitaciones para las equinocandinas. Los resultados son equiparables a los de los métodos de referencia.

Abstract We evaluated the interlaboratory agreement, the essential agreement, and the cate- gorical agreement between the Sensititre YeastOne™ panel and the reference methods M27 4th Edition of the Clinical and Laboratory Standards Institute (CLSI), and the EDef 7.3.1 of the Euro- pean Committee on Antifungal Susceptibility Testing (EUCAST). We studied 67 Candida strains isolated from different clinical samples and 9 Candida strains with resistance to fluconazole and echinocandins. The highest percentage of interlaboratory agreement was observed with amp- hotericin B (96.8%), and the lowest percentage with voriconazole (77.2%). Caspofungin showed 5.8% of very major errors when compared with the CLSI reference method. For EUCAST, itraconazole, posaconazole, and anidulafungin showed high percentages of major errors: 17.6%, 18.1%, and 19.6%, respectively. Sensititre YeastOne™ is a reliable alternative, and easy to perform for detecting Candida species resistant to antifungal drugs, with some limitations for echinocandins. Results are comparable to those of the reference methods.

Agents causing genital infections in routine cytological tests: frequency and characteristics of Papanicolaou smears / Agentes causadores de infecções genitais em exames citológicos de rotina: frequência e características dos esfregaços de papanicolaou

Urinary tract infections are responsible for most human infections, these are caused by bacteria, fungi, protozoa and associated microorganisms. The goal of this study was to determine the rate of vaginal infection-causing agents in routine cytological exams and also to evaluate the characteristics of positive tested Pap smears. A retrospective documental with descriptive aspect research was performed in a Clinical Pathology laboratory from Maceió-AL. The results of the Pap smears exams for Trichomonas vaginalis, Gardnerella vaginalis, Candida spp and HPV were arranged in a database as well as other data such as bacterial, protozoan, fungal and viral coinfections. The sample was composed by 18.645 women who have undergone Pap smear exams from 2013 to 2017. Of these analyzed exams, 27.4% in 2013, 10.9% in 2014, 10.6% in 2015, 15.2% in 2016 and 13.67% in 2017 were within normal range, however more than half of these exams presented some infections caused by unspecific or microbiological agents. By analyzing all the reports, 4.073 (21.84%) presented inflammations caused by some species of infectious agent with the following rate order: G. vaginalis and T. vaginalis. Furthermore, it was possible to confirm high rates of coinfection by and Candida spp. The rate of genital infections in this study highlights that there is a public health matter that must be controlled, which points a greater need for monitoring, guidance and actions towards greater awareness in order to prevent these problems.

Infecções do trato urinário são responsáveis pela maior parte das infecções humanas, sendo causadas por bactérias, fungos, protozoários, e por microrganismos associados. O objetivo deste trabalho foi determinar a frequência de agentes causadores de infecções vaginais nos exames citológicos de rotina, bem como avaliar as características dos esfregaços positivos. Foi realizada uma pesquisa do tipo documental retrospectiva de aspecto descritivo, com abordagem quantitativa, em um Laboratório de Patologia Clínica de Maceió-AL. Nesse sentido, os resultados dos exames colpocitológicos para Trichomonas vaginalis, Gardnerella vaginalis, Candida spp e HPV foram organizados em um banco de dados, contendo os resultados para estes agentes, bem como a coinfecção bacteriana, protozoária, fúngica e viral. A amostra foi composta por 18.645 mulheres que realizaram exame colpocitológico, no período de 2013 a 2017. Destes exames analisados 27,4% em 2013, 10,9% em 2014, 10,6% em 2015, 15,2% em 2016 e 13,67% em 2017, estavam dentro do limite da normalidade, porém mais que a metade desses exames analisados apresentou algumas infecções causadas por agentes inespecíficos ou microbiológicos. Do total de laudos analisados, 4.073 (21,84%), apresentaram inflamações causadas por algum tipo de agente infeccioso, com a seguinte ordem de frequência: G. vaginalis, e T. vaginalis. Além disto, foi possível confirmar a elevada frequência de coinfecção entre G. vaginalis e Candida spp. Os índices de infecções genitais nesse trabalho mostram que há um problema de saúde pública que deve ser controlado, apontando uma necessidade maior de acompanhamento, orientações e de ações para uma maior conscientização para prevenir esses problemas.

Agents causing genital infections in routine cytological tests: frequency and characteristics of Papanicolaou smears

Abstract Urinary tract infections are responsible for most human infections, these are caused by bacteria, fungi, protozoa and associated microorganisms. The goal of this study was to determine the rate of vaginal infection-causing agents in routine cytological exams and also to evaluate the characteristics of positive tested Pap smears. A retrospective documental with descriptive aspect research was performed in a Clinical Pathology laboratory from Maceió-AL. The results of the Pap smears exams for Trichomonas vaginalis, Gardnerella vaginalis, Candida spp and HPV were arranged in a database as well as other data such as bacterial, protozoan, fungal and viral coinfections. The sample was composed by 18.645 women who have undergone Pap smear exams from 2013 to 2017. Of these analyzed exams, 27.4% in 2013, 10.9% in 2014, 10.6% in 2015, 15.2% in 2016 and 13.67% in 2017 were within normal range, however more than half of these exams presented some infections caused by unspecific or microbiological agents. By analyzing all the reports, 4.073 (21.84%) presented inflammations caused by some species of infectious agent with the following rate order: G. vaginalis and T. vaginalis. Furthermore, it was possible to confirm high rates of coinfection by and Candida spp. The rate of genital infections in this study highlights that there is a public health matter that must be controlled, which points a greater need for monitoring, guidance and actions towards greater awareness in order to prevent these problems.

Resumo Infecções do trato urinário são responsáveis pela maior parte das infecções humanas, sendo causadas por bactérias, fungos, protozoários, e por microrganismos associados. O objetivo deste trabalho foi determinar a frequência de agentes causadores de infecções vaginais nos exames citológicos de rotina, bem como avaliar as características dos esfregaços positivos. Foi realizada uma pesquisa do tipo documental retrospectiva de aspecto descritivo, com abordagem quantitativa, em um Laboratório de Patologia Clínica de Maceió-AL. Nesse sentido, os resultados dos exames colpocitológicos para Trichomonas vaginalis, Gardnerella vaginalis, Candida spp e HPV foram organizados em um banco de dados, contendo os resultados para estes agentes, bem como a coinfecção bacteriana, protozoária, fúngica e viral. A amostra foi composta por 18.645 mulheres que realizaram exame colpocitológico, no período de 2013 a 2017. Destes exames analisados 27,4% em 2013, 10,9% em 2014, 10,6% em 2015, 15,2% em 2016 e 13,67% em 2017, estavam dentro do limite da normalidade, porém mais que a metade desses exames analisados apresentou algumas infecções causadas por agentes inespecíficos ou microbiológicos. Do total de laudos analisados, 4.073 (21,84%), apresentaram inflamações causadas por algum tipo de agente infeccioso, com a seguinte ordem de frequência: G. vaginalis, e T. vaginalis. Além disto, foi possível confirmar a elevada frequência de coinfecção entre G. vaginalis e Candida spp. Os índices de infecções genitais nesse trabalho mostram que há um problema de saúde pública que deve ser controlado, apontando uma necessidade maior de acompanhamento, orientações e de ações para uma maior conscientização para prevenir esses problemas.

Antifungal activity of silver nanoparticles and clotrimazole against Candida spp

Abstract The aim of present study was calculate the Minimum inhibitory concentrations (MICs) of silver nanoparticles and clotrimazole for Candida species and their interaction by the adaptation of standarized methods. The MICs values of clotrimazole were 9 E-04-3 E-03 ug/ml, 0.1-0.6 ug/ml, 3 E-03- 0.1 ug/ml and 3 E-03-0.3 ug/ml for Candida albicans susceptible to fluconazole, Candida albicans resistance to fluconazole, Candida krusei and Candida parapsilosis respectively. The MICs values of silver nanoparticles were 26.50- 53 ug/ml; 26.50-106 ug/ml; 106-212 ug/ ml and 26.50- 53 ug/ml for Candida albicans susceptible to fluconazole, Candida albicans resistance to fluconazole, Candida krusei and Candida parapsilosis respectively. Synergism between clotrimazole and silver nanoparticles was measured by checkerboard BMD (broth microdilution) test and shown only for C. albicans susceptible to fluconazole because the fractional inhibitory concentrations (FICs) values were 0.07 - 0.15 ug/ml. Indifference was shown for the other species tested because the FICs values were between 0.5 - 2- 3.06 ug/ml. The results suggest synergistic activity depending on the fungus species analysed, however we recommend the incorporation of others measurement methodologies to confirm our results. As for measurement methodologies of MICs of silver nanoparticles and clotrimazole international normative were respected to guarantee reproducible and comparable results.

Agents causing genital infections in routine cytological tests: frequency and characteristics of Papanicolaou smears / Agentes causadores de infecções genitais em exames citológicos de rotina: frequência e características dos esfregaços de papanicolaou

Urinary tract infections are responsible for most human infections, these are caused by bacteria, fungi, protozoa and associated microorganisms. The goal of this study was to determine the rate of vaginal infection-causing agents in routine cytological exams and also to evaluate the characteristics of positive tested Pap smears. A retrospective documental with descriptive aspect research was performed in a Clinical Pathology laboratory from Maceió-AL. The results of the Pap smears exams for Trichomonas vaginalis, Gardnerella vaginalis, Candida spp and HPV were arranged in a database as well as other data such as bacterial, protozoan, fungal and viral coinfections. The sample was composed by 18.645 women who have undergone Pap smear exams from 2013 to 2017. Of these analyzed exams, 27.4% in 2013, 10.9% in 2014, 10.6% in 2015, 15.2% in 2016 and 13.67% in 2017 were within normal range, however more than half of these exams presented some infections caused by unspecific or microbiological agents. By analyzing all the reports, 4.073 (21.84%) presented inflammations caused by some species of infectious agent with the following rate order: G. vaginalis and T. vaginalis. Furthermore, it was possible to confirm high rates of coinfection by and Candida spp. The rate of genital infections in this study highlights that there is a public health matter that must be controlled, which points a greater need for monitoring, guidance and actions towards greater awareness in order to prevent these problems.

Infecções do trato urinário são responsáveis pela maior parte das infecções humanas, sendo causadas por bactérias, fungos, protozoários, e por microrganismos associados. O objetivo deste trabalho foi determinar a frequência de agentes causadores de infecções vaginais nos exames citológicos de rotina, bem como avaliar as características dos esfregaços positivos. Foi realizada uma pesquisa do tipo documental retrospectiva de aspecto descritivo, com abordagem quantitativa, em um Laboratório de Patologia Clínica de Maceió-AL. Nesse sentido, os resultados dos exames colpocitológicos para Trichomonas vaginalis, Gardnerella vaginalis, Candida spp e HPV foram organizados em um banco de dados, contendo os resultados para estes agentes, bem como a coinfecção bacteriana, protozoária, fúngica e viral. A amostra foi composta por 18.645 mulheres que realizaram exame colpocitológico, no período de 2013 a 2017. Destes exames analisados 27,4% em 2013, 10,9% em 2014, 10,6% em 2015, 15,2% em 2016 e 13,67% em 2017, estavam dentro do limite da normalidade, porém mais que a metade desses exames analisados apresentou algumas infecções causadas por agentes inespecíficos ou microbiológicos. Do total de laudos analisados, 4.073 (21,84%), apresentaram inflamações causadas por algum tipo de agente infeccioso, com a seguinte ordem de frequência: G. vaginalis, e T. vaginalis. Além disto, foi possível confirmar a elevada frequência de coinfecção entre G. vaginalis e Candida spp. Os índices de infecções genitais nesse trabalho mostram que há um problema de saúde pública que deve ser controlado, apontando uma necessidade maior de acompanhamento, orientações e de ações para uma maior conscientização para prevenir esses problemas.

Espécies de Candida causadoras de vulvovaginites e resistência aos antifúngicos utilizados no tratamento / Candida species cause vulvovaginitis and resistance to antifungals used for treatment

Neste estudo foram identificadas espécies de Candida em isolados de secreção vaginal, avaliados os perfis de suscetibilidade in vitro a antifúngicos e correlacionados com os antifúngicos prescritos para pacientes em um serviço de atenção primária. A identificação das espécies pela Reação em Cadeia da Polimerase mostrou que 36,5% dos isolados foram caracterizados como espécie não-C.albicans. Nos testes de sensibilidade a maioria dos isolados foi suscetível a cetoconazol, fluconazol e itraconazol, contudo cerca de 40% e 50% apresentaram resistência ou sensibilidade dose-dependente a miconazol e nistatina, respectivamente. A análise dos fármacos prescritos para as pacientes revelou que 34,2% dos isolados foram considerados resistentes aos agentes utilizados no tratamento. Diversas espécies de Candida podem causar vulvovaginite com variados perfis de suscetibilidade aos antifúngicos comumente utilizados no tratamento. A identificação das espécies de Candida é relevante para o gerenciamento epidemiológico das infecções, além de ser útil, assim como os testes de suscetibilidade, na escolha do tratamento farmacológico mais eficaz para a paciente.

In this study were identified Candida species from vaginal secretion isolates, evaluated their in vitro antifungal susceptibilities, and correlated these features with antifungal agents prescribed for patients assisted in a primary care service. Species identification by Polymerase Chain Reaction showed that 36.5% of isolates were characterized as non-C. albicans species. In antifungal susceptibility tests most isolates were susceptible to ketoconazole, fluconazole, and itraconazole, although between 40% and 50% of isolates show resistance or dose-dependent susceptibility to miconazole and nystatin, respectively. Analysis of drugs prescribed to patients revealed that 34.2% of the isolates were considered resistant to agents used in treatment. Several Candida species can cause vulvovaginitis and exhibit different susceptibility profiles to antifungal drugs used in treatment. The identification of Candida species is relevant and useful to the epidemiological management of infections. The antifungal susceptibility test may also be useful for choosing most effective drug treatment for each patient.

Identificación fúngica en pacientes quemados. Un estudio retrospectivo y factores de riesgo / Fungal identification in burn patients. A retrospective study and risk factors

Resumen Se realizó un estudio retrospectivo de las infecciones fúngicas atendidas en un centro de quemados de alta complejidad situado en Buenos Aires, entre 2011 y 2014, mediante el análisis de las histo rias clínicas (n = 36). Las edades de los pacientes estuvieron entre 18 y 87 años, y 23 (63.9%) fueron mujeres. La extensión de la superficie corporal afectada más prevalente varió entre 30 y 50% (p = 0.03), y entre 71% y 100% en pacientes de menor edad, relacionándose con intentos de femicidio. En el 69.4% la profundidad de la quemadura fue grado 4, y en el 50% de los casos se observaron lesiones por inhalación, con una alta mortali dad (p = 0.04). El Candida score resultó de 3 en el 77.7% de los casos. Se usaron vías centrales y ventilación mecánica. Todos los pacientes recibieron tratamiento antibiótico y en 33 (91.7%) antifúngicos. La escisión qui rúrgica de la quemadura se practicó en 33 (91.7%) y los autoinjertos de piel en 29 (80.6%). La infección fúngica se desarrolló en una media de 21.4 días del ingreso en UCI. Se estudiaron 52 muestras de levaduras que se aislaron de urocultivo (42.3%), hemocultivo (26.9%), biopsia cutánea (9.6%), punta de catéter (15.4%) y aspirado traqueal (5.8%). Por cultivo microbiológico y métodos moleculares se identificaron a Candida albicans (53.8%), C. tropicalis (23.1%), C. parapsilosis sensu stricto (13.5%), C. krusei (5.8%), C. glabrata (1.9%) y C. dubliniensis (1.9%). Las infecciones fúngicas representan severas complicaciones en quemados con factores de riesgo.

Abstract A retrospective analysis of fungal infections was carried out in a health-care burn center between 2011 and 2014 using the patients' medical records (n = 36). Patients ranged from 18 to 87 years of age, with 23 (63.9%) being women. The most prevalent widespread total body surface area affected (TBSA) was 30-50% (p = 0.03), and 71-100% in younger patients, mainly associated with femicide. Fourth degree burns were revealed in 69.4% of the patients while in 50%, inhalation injuries were observed to represent a higher mortality rate (p = 0.04). The Candida score was 3 in 77.7% of cases respectively. Central venous catheter and mechanical ventilation were used. All patients received antibiotic treatment and 91.7% antifungal treatment. Surgical excision of the burn was performed in 33 (91.7%) patients, and skin autografting in 29 (80.6%). The median of the fungal infection devel oped was 21.4 days after admission to the ICU. The specimens analyzed involved 52 yeast samples isolated from different cultures: urine (42.3%), blood (26.9%), skin biopsy (9.6%), catheter tip (15.4%) and tracheal aspirate (5.8%). The use of microbiological culture and molecular methods allowed for the identification of Candida albicans (53.8%), C. tropicalis (23.1%), C. parapsilosis sensu stricto (13.5%), C. krusei (5.8%), C. glabrata (1.9%) and C. dubliniensis (1.9%). Fungal infections observed in skin burns lead to severe complications in at-risk patients.

Micosis en tiempos de COVID-19 / Mycosis in times of COVID-19

El brote mundial del SARS-CoV-2, descrito a partir del 2019, provocó la pandemia de COVID-19, originando un riesgo para la salud de las personas, una amenaza a la vida y una emergencia de salud pública internacional, que hasta Julio del 2021 no se ha logrado controlar. La coinfección en estos pacientes, por virus, bacterias y hongos, aumenta la dificultad de diagnóstico, tratamiento y pronóstico de la enfermedad. Es importante profundizar los conocimientos sobre el virus SARS-CoV-2 y las coinfecciones que podrían presentarse, en particular, en pacientes con COVID-19 que presentan micosis. El objetivo de esta revisión bibliográfica es, determinar la importancia de las micosis, como enfermedad oportunista, en pacientes con COVID-19. Se realizó una revisión bibliográfica sistemática, en la base de datos "PubMed-NCBI". Se utilizaron las palabras claves: "COVID-19", "SARS-CoV-2", "Coronavirus", "COVID-19 and coinfection", "Mycosis", "Aspergillus spp.", "Candida spp.", "COVID-19 and Aspergillus spp.", "COVID-19 and Candida spp.". Del análisis de la bibliografía, se concluye la importancia de las micosis respiratorias, originadas por diversos hongos en pacientes con COVID-19. Hay poca información del manejo de estas, siendo necesario fortalecer la investigación de la coinfección, para así, mejorar los flujogramas de sospecha clínica, contribuyendo a diagnósticos, tratamientos precisos y fomentar la prevención frente a esta pandemia.

The global outbreak of SARS-CoV-2, described as of 2019 whose expansion caused the COVID-19 pandemic, has created a risk to people's health, presenting itself as a threat to life and an international public health emergency, which to the date cannot be controlled. Coinfection in these patients, by viruses, bacteria and fungi, increases the difficulty of diagnosis, treatment and prognosis of the disease. It's important to deepen the knowledge about the SARS-CoV-2 virus and the co-infections that could occur, in particular, in patients with COVID-19 who present with mycosis. The objective of this bibliographic review is to determine the importance of mycosis, as an opportunistic disease, in patients affected by SARS-CoV-2. A systematic bibliographic review was carried out in the "PubMed-NCBI" database, using the keywords and / or headings: "COVID-19", "SARS-CoV-2", "Coronavirus", "COVID-19 and coinfection" ,"Mycosis", "Aspergillus spp.", "Candida spp." COVID-19 and Aspergillus spp.", "COVID-19 and Candida spp.". From the analysis of the literature, one can conclude the importance of respiratory mycoses, caused by various fungal pathogens in patients with COVID-19. The disease was described in 2019 and there is few a information on cases and their management, making it necessary to strengthen the investigation of coinfection in these patients, in order to improve the flow charts of clinical suspicion, contributing to diagnoses, accurate treatments and promoting prevention against to this pandemic.

Clinical and epidemiological aspects of Candidemia in eight medical centers in the state of Parana, Brazil: Parana Candidemia Network

ABSTRACT Objectives: Candida spp. has been reported as one of the common agents of nosocomial bloodstream infections and is associated with a high mortality. Therefore, this study evaluated the clinical findings, local epidemiology, and microbiological aspects of candidemia in eight tertiary medical centers in the state of Parana, South of Brazil. Methods: In this study, we reported 100 episodes of candidemia in patients admitted to eight different hospitals in five cities of the state of Parana, Brazil, using data collected locally (2016 and 2017) and tabulated online. Results: The incidence was found to be 2.7 / 1000 patients / day and 1.2 / 1000 admissions. C. albicans was responsible for 49% of all candidemia episodes. Cancer and surgery were the two most common underlying conditions associated with candidemia. The mortality rate within 30 days was 48%, and removal of the central venous catheter (p = 0.029) as well as empirical or prophylactic exposure to antifungals were both related to improved survival (p = 0.033). Conclusions: This study highlights the high burden and mortality rates of candidemia in hospitals from Parana as well as the need to enhance antifungal stewardship program in the enrolled medical centers.

Molecular Detection of Medically Important Candida species from Droppings of Pigeons (Columbiformes) and Captive Birds (Passeriformes and Psittaciformes)

Abstract Passeriformes and Psittaciformes birds and pigeons (Columba livia) are known to be reservoirs of microorganisms, and their stool allows fungi development. Since accumulated avian excreta can interfere with public health, this study aimed to perform a molecular screening of medically important Candida species in pigeon droppings in public places and birds raised in captivity. Excreta collected from captive birds (3 residences) and pigeons (4 districts) were inoculated on Sabouraud dextrose agar with chloramphenicol for Gram staining and subculture on Hicrome® Candida. Three DNA extraction methods were performed for comparison (commercial kit, in-house and by boiling) and PCR to screen 6 clinically important Candida species among the isolates. The correlation between phenotypic and molecular methods was calculated by kappa/K. Only 6 C. parapsilosis (20%) were identified from captive birds' feces among 30 isolates (80% not identified), while pigeons' feces harbored a greater diversity, with the 6 pathogenic species confirmed among 41 isolates: C. albicans (31.70%/13), C. krusei (14.63%/6), C. tropicalis (14.63%/6), C. parapsilosis (17.10%/7), C. glabrata (14.63%/6) and C. guilliermondii (7.31%/3); 100% correlation between tested methods (K = 1) for the first 3 species. Boiling DNA extraction method was fast and efficient to obtain viable DNA from Candida spp. for PCR. Our results indicate that pigeon droppings harbor more potentially pathogenic species than birds in residential captivity, which probably have non-albicans Candida less frequently isolated in infectious processes. The greater availability of nutrients may have contributed to a diversity of Candida spp. in feces from public environments.

Relation between CANDIDA species isolated from vaginal mucosa and lesions caused by high-risk human papillomavirus hpv for cervical cancer

This study characterized and related yeasts of the genus Candida isolated from vaginal mucous membranes of women with lesions caused by high-risk HPV for cervical cancer. Forty-two women treated at the Lower Genital Tract Pathology Clinic of the University of São Paulo Medical School Hospital of Clinics were examined, with 30 high-grade (G1) uterine lesions with a mean age of 36.5 years ± 11. 1 and 12 with low grade (G2) uterine lesions with a mean age of 34.7 years ± 15.5. Clinical conditions and laboratory data on HPV were collected from patients' medical records; the socio-demographic data obtained from an appropriate questionnaire. For the study of association between the variables, Odds Ratio analysis was used from the STATA 13.1 program. Patients G1 had a higher prevalence for diabetes and the results indicated 27% prevalence of Candida spp. in vaginal mucosa, in G2 this was 33% in vaginal mucosa. Among the species found in vaginal mucosa of patients, Candida albicans was the most isolated with 88%, followed by C. tropicalis (8%) and C. glabrata (4%). The strains of C. albicans isolated from mucosa presented sensitivity to all antifungal agents tested, unlike the C. tropicalis strain isolated in G2 in vaginal mucosa, which presented a resistance profile to fluconazole. Thus, monitoring and supervision through clinical and laboratory testing of HPV patients is important, reinforcing the need for care, treatment and prevention of HPV-related infections and Candida spp.

A novel nano-sulphur and essential oil-based room freshener

Introducción: Alternaria spp y Candida spp. son hongos patógenos de ambientes interiores como la casa, la oficina, el aula, etc., causan enfermedades como asma crónica e infecciones sistémicas en individuos inmunodeprimidos a través de la secreción de diversas sustancias tóxicas. Los ambientadores a base de productos químicos disponibles comercialmente que se utilizan para controlar la carga de hongos en el ambiente interior no son beneficiosos para la salud humana. Objetivo: proporcionar una alternativa viable en forma de enfoque basado en nanopartículas para el manejo de hongos transmitidos por el aire. Metodología: aislamiento, identificación microscópica y bioquímica de hongos de interior; Síntesis de nanopartículas de azufre (SNP) mediadas por Azadirachta indica, su detección y caracterización; y evaluación in vitro de SNP contra hongos aislados presentes en el ambiente interior. Resultado: Los hongos aislados se identificaron como especies de Alternaria spp y Candida spp. Los SNP mostraron máximos de absorbancia a 291 nm. El análisis NTA mostró un tamaño medio de 188,4 nm y un potencial zeta de -4,94 mV, lo que representa una síntesis de SNP estables. El patrón XRD confirmó la naturaleza cristalina cúbica centrada en la cara de los SNP. El espectro FTIR representó la presencia de compuestos polihidroxilo, nitrilo, ceto, aromáticos y carboxílicos que estabilizaron los SNP. Los ensayos antifúngicos demostraron la actividad significativa de los SNP formulados y del ambientador infundido con aceite de eucalipto. Conclusión: Los SNP mediados por A. indica se pueden aplicar en la formulación y fabricación de un ambientador ecológico para el manejo de hongos patógenos de interior como Alternaria spp y Candida spp.

Introduction: Alternaria spp. and Candida spp. are the main fungal pathogen of indoor environment like house, office, classroom, etc. These may cause various diseases and infections like systemic infections, or chronic asthma in immunocompromised individuals through secretion of various toxic substances. Chemical-based commercially available room fresheners used to control the fungal load of indoor environment are not beneficial to human health. Objective: was to provide viable alternative in the form of nanoparticle-based approach for the management of air-borne fungi. Methodology: The present study primarily focuses on the isolation, microscopic and biochemical identification of indoor fungi; Azadirachta indica-mediated sulphur nanoparticles (SNPs) synthesis, their detection and characterization; and in vitro assessment of SNPs against isolated fungi present in indoor environment. Result: The isolated fungi were identified as Alternaria spp and Candida spp. The SNPs showed absorbance maxima at 291 nm. NTA analysis showed average size of 188.4 nm, and zeta potential of -4.94 mV which represented synthesis of stable SNPs. XRD pattern confirmed the face centered cubic, crystalline nature of SNPs. FTIR spectrum depicted the presence of polyhydroxyl, nitrile, keto, aromatic and carboxylic compounds which stabilized the SNPs. The antifungal assays demonstrated the significant activity of the formulated SNPs and eucalyptus oil infused air freshener. Conclusion: It can be concluded that A. indica-mediated SNPs can be applied in the formulation and manufacture of an ecofriendly air freshener for the management of indoor fungal pathogens like Alternaria spp. and Candida spp.

Infección invasiva por Candida spp. En pacientes inmunocomprometidos: Descripción de curso clínico experiencia diagnóstica, manejo y seguimiento en centro de alta complejidad / Invasive infection by Candida spp. in immunocompromised patients: A description of clinical, diagnostics, therapeutic and follow up experience in high complexity healthcare center

Introducción: Candida spp. Es la principal causa de fungemia, cuya incidencia ha aumentado en los últimos años. Existen datos locales insuficientes sobre este tipo de infecciones. Materiales y métodos: Este fue un estudio observacional retrospectivo de 44 pacientes diagnosticados con candidiasis invasiva hospitalizados en la Fundación Valle del Lili, el cual es un centro de cuarto nivel afiliado a la Universidad Icesi en el Suroccidente Colombiano, entre los años 2012 a 2017. Resultados: Se identificaron 44 pacientes con candidiasis invasiva, 27 de ellos mujeres (61%). La mediana de edad fue de 56 años (36 - 70). Más del 50% tenían una enfermedad crónica subyacente, uso de antibióticos (84%), catéter venoso central (80%), ventilación mecánica (68%) y nutrición enteral (66%) El 80% requirió manejo en unidad de cuidados intensivos (UCI) donde debutaron con sepsis (68%) y falla respiratoria (61%). En el 90% de los casos se aisló alguna especie de Candida spp. A partir de hemocultivo y sólo al 22% se le realizó prueba de sensibilidad. El tratamiento de elección fue con fluconazol (80%), asociado a caspofungina (70%). La tasa de mortalidad fue del 49%, con una mediana de 33 (22-49,5) días desde el ingreso hasta el fallecimiento. C. albicans fue el principal microorganismo aislado. La resistencia a azoles en especies no albicans existe en nuestro medio. Conclusión: La candidiasis se presenta como candidemia asociada a infección bacteriana concomitante, que cobra mayor importancia en el contexto del paciente inmunosuprimido asociado a elevadas tasas de mortalidad.

Introduction: Candida spp. is the main cause of fungemia, whose incidence has increased in recent years. There are insufficient local data about this pathology. Materials and methods: This was an observational, retrospective chart review of 44 patients diagnosed with invasive candida who were hospitalized at Fundación Valle del Lili, which is a fourth level center affiliated to Icesi university between 2012 and 2017. Results: We identified 44 patients with invasive candidiasis, 27 of them women (61%). The median age was 56 years (36 - 70). More than 50% had an underlying chronic disease, use of antibiotics (84%), central venous catheter (80%), mechanical ventilation (68%) and enteral nutrition (66%). 80% required management in an intensive care unit. Sepsis (68%) and respiratory failure (61%) were the most common clinical presentation. Almost 90% of the cases, had positive blood cultures, but only 22% presented susceptibility tests. The treatment was mainly fluconazole (80%), associated with caspofungin (70%). The mortality rate was 49%, median of 33 (22-49.5) days from admission to death. Candida albicans was the main isolated organism. Azole resistance in non-albicans species was observed. Conclusion: Candidiasis presents as bacterial infection associated candidemia, which becomes more important in the context of the immunosuppressed patient with high mortality rates.