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1.
Antimicrob Agents Chemother ; 66(12): e0110122, 2022 12 20.
Artículo en Inglés | MEDLINE | ID: mdl-36374073

RESUMEN

We analyzed a cohort of Trichosporon asahii strains with different MICs of fluconazole and voriconazole and evaluated the presence of ERG11 mutations. ERG11 mutation conferring an amino acid change was found and its resistance potential was evaluated by cloning into Saccharomyces cerevisiae susceptible host strain. Transformants were not resistant to either fluconazole nor voriconazole. Our results suggest that ERG11 variants exist among T. asahii isolates, but are not responsible for resistance phenotypes.


Asunto(s)
Azoles , Sistema Enzimático del Citocromo P-450 , Trichosporon , Antifúngicos/farmacología , Azoles/farmacología , Sistema Enzimático del Citocromo P-450/genética , Farmacorresistencia Fúngica/genética , Fluconazol/farmacología , Pruebas de Sensibilidad Microbiana , Saccharomyces cerevisiae/genética , Trichosporon/genética , Voriconazol/farmacología
2.
Curr Opin Infect Dis ; 34(6): 619-626, 2021 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-34751181

RESUMEN

PURPOSE OF REVIEW: To investigate the peculiarities of invasive fusariosis (IF) in pediatric patients. METHODS: We conducted a systematic literature review to identify human cases of locally invasive and systemic fusariosis documented in children (up to 18 years) published between 1973 (first case report) and 2021. RECENT FINDINGS: One hundred and six cases were retrieved, and hematologic malignancy was reported in 64% (68/106) of the cases. The most frequent anatomic sites involved were skin 66% (70/106), blood 47% (50/106), and lungs 35% (37/106), bone and joint (8%, 09/106), and eye/central nervous system involvement (8%, 9/106). Fusarium solani, followed by Fusarium oxysporum, were the most commonly reported species. In disseminated fusariosis, relapsed or refractory baseline disease (P < 0.001, OR=10.555, CI 95% 3.552-31.365) was associated with poor outcome, whereas voriconazole-based therapy was associated with better prognosis (P  = 0.04, OR = 0.273, CI 95% 0.076-0.978). SUMMARY: Hematologic malignancies and solid tumors requiring intensive immunosuppression are the main conditions related to IF in children where other organs than skin, blood, and lungs were frequently involved. Voriconazole therapy appears to be also effective in children with IF, despite the wide pharmacokinetic variability of this triazole in pediatric patients.


Asunto(s)
Fusariosis , Neoplasias Hematológicas , Adulto , Antifúngicos/uso terapéutico , Niño , Fusariosis/diagnóstico , Fusariosis/tratamiento farmacológico , Humanos , Triazoles , Voriconazol/uso terapéutico
3.
J Antimicrob Chemother ; 76(7): 1907-1915, 2021 06 18.
Artículo en Inglés | MEDLINE | ID: mdl-33890055

RESUMEN

BACKGROUND: Trichosporon fungaemia (TF) episodes have increased in recent years and mortality rates remain high despite the advances in the management of sepsis. New concepts about its clinical course, treatment and microbiology need to be investigated for the better management of this infection. OBJECTIVES: To describe the aetiology, natural history, clinical management and prognostic factors of TF. METHODS: TF episodes documented between 2005 and 2018 in 23 South American centres were retrospectively investigated by using a standard clinical form. Molecular identification, antifungal susceptibility testing and biofilm production were also performed. RESULTS: Eighty-eight TF episodes were studied. Patients had several underlying conditions, including haematological diseases (47.7%), post-operative status (34%), solid organ transplants (n = 7, 7.9%), among others. Seventy-three (82.9%) patients had a central venous catheter (CVC) at TF diagnosis. The 30 day mortality rate was 51.1%. Voriconazole-based therapy was given to 34 patients (38.6%), with a 30 day mortality rate of 38.2%. Multivariate predictors of 30 day mortality were age (OR 1.036), mechanical ventilation (OR 8.25) and persistent neutropenia (OR 9.299). CVC removal was associated with over 75% decreased risk of 30 day mortality (OR 0.241). Microbiological analyses revealed that 77.7% of the strains were identified as Trichosporon asahii, and voriconazole showed the strongest in vitro activity against Trichosporon spp. Most of the strains (63%) were considered medium or high biofilm producers. CONCLUSIONS: Older age, mechanical ventilation and persistent neutropenia were associated with poor prognosis. CVC may play a role in the pathogenicity of TF and its removal was associated with a better prognosis.


Asunto(s)
Fungemia , Trichosporon , Anciano , Antifúngicos/uso terapéutico , Basidiomycota , Fungemia/tratamiento farmacológico , Fungemia/epidemiología , Humanos , Pruebas de Sensibilidad Microbiana , Pronóstico , Estudios Retrospectivos , Trichosporon/genética
4.
Mycoses ; 64(8): 817-822, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34091966

RESUMEN

OBJECTIVES: To investigate the occurrence of Trichosporon asahii fungemia among critically ill COVID-19 patients. METHODS: From 1 July to 30 September 2020, cases of T asahii fungemia (TAF) in a Brazilian COVID-19 referral centre were investigated. The epidemiology and clinical courses were detailed, along with a mycological investigation that included molecular species identification, haplotype diversity analysis and antifungal susceptibility testing. RESULTS: Five critically ill COVID-19 patients developed TAF in the period. All five patients had common risk conditions for TAF: central venous catheter at fungemia, previous exposure to broad-spectrum antibiotics, prior echinocandin therapy and previous prolonged corticosteroid therapy. The average time of intensive care unit hospitalisation previous to the TAF episode was 23 days. All but one patient had voriconazole therapy, and TAF 30-day mortality was 80%. The five T asahii strains from the COVID-19 patients belonged to 4 different haplotypes, mitigating the possibility of skin origin and cross-transmission linking the 5 reported episodes. The antifungal susceptibility testing revealed low minimal inhibitory concentrations for azole derivatives. CONCLUSIONS: Judicious prescription of antibiotics, corticosteroids and antifungals needs to be discussed in critically ill COVID-19 patients to prevent infections by hard-to-treat fungi like T asahii.


Asunto(s)
Corticoesteroides/administración & dosificación , Antifúngicos/administración & dosificación , Basidiomycota/aislamiento & purificación , COVID-19/complicaciones , Sobreinfección/complicaciones , Tricosporonosis/complicaciones , Corticoesteroides/farmacología , Anciano , Antifúngicos/farmacología , Basidiomycota/clasificación , Basidiomycota/efectos de los fármacos , Basidiomycota/genética , Brasil/epidemiología , COVID-19/epidemiología , Candidemia/complicaciones , Femenino , Fungemia/complicaciones , Haplotipos , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Filogenia , Factores de Riesgo , Sobreinfección/epidemiología , Tricosporonosis/epidemiología
5.
Mycoses ; 64(9): 1062-1072, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34009677

RESUMEN

OBJECTIVES: To describe the first outbreak of Candida auris in Brazil, including epidemiological, clinical and microbiological data. METHODS: After the first Candida auris-colonised patient was diagnosed in a COVID-19 ICU at a hospital in Salvador, Brazil, a multidisciplinary team conducted a local C. auris prevalence investigation. Screening cultures for C. auris were collected from patients, healthcare workers and inanimate surfaces. Risk factors for C. auris colonisation were evaluated, and the fungemia episodes that occurred after the investigation were also analysed and described. Antifungal susceptibility of the C. auris isolates was determined, and they were genotyped with microsatellite analysis. RESULTS: Among body swabs collected from 47 patients, eight (n = 8/47, 17%) samples from the axillae were positive for C. auris. Among samples collected from inanimate surfaces, digital thermometers had the highest rate of positive cultures (n = 8/47, 17%). Antifungal susceptibility testing showed MICs of 0.5 to 1 mg/L for AMB, 0.03 to 0.06 mg/L for voriconazole, 2 to 4 mg/L for fluconazole and 0.03 to 0.06 mg/L for anidulafungin. Microsatellite analysis revealed that all C. auris isolates belong to the South Asian clade (Clade I) and had different genotypes. In multivariate analysis, having a colonised digital thermometer was the only independent risk factor associated with C. auris colonisation. Three episodes of C. auris fungemia occurred after the investigation, with 30-day attributable mortality of 33.3%. CONCLUSIONS: Emergence of C. auris in Salvador, Brazil, may be related to local C. auris clade I closely related genotypes. Contaminated axillary monitoring thermometers may facilitate the dissemination of C. auris reinforcing the concept that these reusable devices should be carefully cleaned with an effective disinfectant or replaced by other temperature monitoring methods.


Asunto(s)
Antifúngicos/uso terapéutico , Candida/efectos de los fármacos , Candidiasis/diagnóstico , Candidiasis/tratamiento farmacológico , Candidiasis/epidemiología , Transmisión de Enfermedad Infecciosa , Termómetros/microbiología , Adulto , Anciano , Anciano de 80 o más Años , Anidulafungina/uso terapéutico , Brasil/epidemiología , COVID-19/complicaciones , COVID-19/microbiología , Cuidados Críticos , Brotes de Enfermedades , Femenino , Fluconazol/uso terapéutico , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Prevalencia , SARS-CoV-2 , Voriconazol/uso terapéutico
6.
J Clin Microbiol ; 53(4): 1383-6, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25631803

RESUMEN

Isolates of Paracoccidioides brasiliensis and Paracoccidioides lutzii, previously characterized by molecular techniques, were identified for the first time by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). All isolates were correctly identified, with log score values of >2.0. Thus, MALDI-TOF MS is a new tool for differentiating species of the genus Paracoccidioides.


Asunto(s)
Paracoccidioides/clasificación , Paracoccidioides/genética , ADN de Hongos/genética , ADN Espaciador Ribosómico/genética , Proteínas HSP70 de Choque Térmico/genética , Reacción en Cadena de la Polimerasa/métodos , ARN de Hongos/genética , Especificidad de la Especie , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción
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