Estudio de Infecciones diseminadas por candida en pacientes con neutropenia febril asociada a enfermedades hemato-oncológicas / Study disseminated Candida infections in patients with febrile neutropenia associated with hemato-oncological diseases

RESUMEN

Mundialmente, en las últimas dos décadas se ha observado un incremento en la frecuencia de las infecciones micóticas diseminadas, con alta morbi-mortalidad, particularmente importante en las infecciones por Candida. El objetivo es determinar la frecuencia de candidiasis diseminada, en pacientes con enfermedades hemato-oncológicas o aplasia medular que ingresaron a los servicios de medicina interna del hospital universitario de caracas, con fiebre y neutropenia, entre enero y septiembre de 2010, realizándose evaluación exhaustiva y tomándose muestras de sangre, además de otras muestras en caso de presencia de lesiones, para el diagnóstico micológico. Se evaluaron 48 pacientes en el período del estudio, diagnósticandose 21 casos (43,75%) de micosis diseminadas, catalogadas como infecciones probadas en 13 y probables en 8 casos. De las infecciones probadas 8 (38%) correspondieron a infecciones por Candida en uno se aisló Candida albicans y en 7, Candida no albicans 2 pacientes con candida tropicalis, 2 con candida glabatra y uno con candida guillermondii. Dos cepas fueron informadas como candida spp, y 5 por otros hongos. Las infecciones micóticas diseminadas contribuyen sustancialmente a la morbimortalidad de los pacientes con neutropenia, por lo tanto es fundamental la sospecha y diagnóstico temprano de estas entidades en los pacientes con cáncer de origen hematológico y aplasia medular.

ABSTRACT

Wordwide, there has been an increase in the incidence of disseminated fungal diseases during the last two decades, with high morbidity and mortality particularly importante in Candida infections. To determine the frequency of disseminated candidiasis in patients with hemato-oncological diseases or bone marrow aplasia and febrile neutropenia. A descriptive, prospective and analytical study was conducted. Patients with hemato-oncological diseases or bone marrow aplasia who were hospitalized at the internal medicine service of the hospital universitrio de caracas, with fever and neutropenia, between january and september, 2010 were included, making torough assessment and taking blook samples as well as other clinical specimen when other lesions were present, for mycological diagnosis. During the study period, 48 patients were evaluated. Twenty one cases were diagnosed (43.75%) as disseminated fungal disease. They were classified as proven in 13 cases and probable in 8. From the proven diseases, 8 (38%) corresponded to Candida infections in one, Candida albicans was isolated and in 7, Candida non-albicans 2 patients with Candida tropicalis were found, 2 with Candida glabrata and one with Candida guillermondii. Two were reported as Candida spp. In 5 patients other fungi were found. Dissemiated fungal infections substantially contribute to morbidity and mortality in neutropenic patients. For this reason, awareness and early diagnosis of this disease are crucial are crucial in patients with hematological cancer and bone marrow aplasis.