Rising Incidence of Sporothrix brasiliensis Infections, Curitiba, Brazil, 2011-2022.

Zoonotic outbreaks of sporotrichosis are increasing in Brazil. We examined and described the emergence of cat-transmitted sporotrichosis (CTS) caused by the fungal pathogen Sporothrix brasiliensis. We calculated incidence and mapped geographic distribution of cases in Curitiba, Brazil, by reviewing medical records from 216 sporotrichosis cases diagnosed during 2011-May 2022. Proven sporotrichosis was established in 84 (39%) patients and probable sporotrichosis in 132 (61%). Incidence increased from 0.3 cases/100,000 outpatient visit-years in 2011 to 21.4 cases/100,000 outpatient visit-years in 2021; of the 216 cases, 58% (n = 126) were diagnosed during 2019-2021. The main clinical form of sporotrichosis was lymphocutaneous (63%), followed by localized cutaneous (24%), ocular (10%), multisite infections (3%), and cutaneous disseminated (<0.5%). Since the first report of CTS in Curitiba in 2011, sporotrichosis has increased substantially, indicating continuous disease transmission. Clinician and public awareness of CTS and efforts to prevent transmission are needed.

Breakthrough candidemia after the introduction of broad spectrum antifungal agents: A 5-year retrospective study.

Candidemia is the main invasive fungal disease among hospitalized patients. Several breakthrough candidemia (BrC) cases have been reported, but few studies evaluate the epidemiology, risk factors, molecular characterization, antifungal susceptibility profile and outcome of those patients, especially in developing countries and including patients using broad spectrum antifungals. We conducted a retrospective study from 2011 to 2016, including patients aged 12 years or older with candidemia. Epidemiological characteristics and risk factors for candidemia were evaluated and compared with patients with BrC using univariate and multivariate analysis. Sequential Candida isolates from BrC were identified by internal transcribed spacer sequencing, genotyped with amplified fragment length polymorphism fingerprinting (AFLP), and tested for antifungal susceptibility. From 148 candidemia episodes, 27 breakthrough episodes (18%) were identified, with neutropenia and mucositis being independent risk factors for BrC. Candida non-albicans was more frequent in the BrC group (P < .001). AFLP showed high correlation with conventional methods of identification among breakthrough isolates and a high genetic similarity among isolates from the same patient was observed. C. albicans was the most susceptible species with low MIC values for all antifungal agents tested. In contrast, we found isolates of C. glabrata, C. parapsilosis and C. tropicalis resistant to triazoles and echinocandins. In conclusion, BrC occurred mainly in severely immunosuppressed patients, with neutropenia and mucositis. Mortality did not differ between the groups. Candida non-albicans species were more recovered from BrC, with C. albicans being the most susceptible to antifungals.

Positive tip culture with Candida and negative blood culture: to treat or not to treat? A systematic review with meta-analysis.

BACKGROUND: Invasive candidiasis is a major invasive fungal infection. It has high lethality, and even higher if not treated early. There is no consensus on antifungal treatment in patients with positive catheter tip culture for Candida spp. The objective of this study was to evaluate the impact of antifungal therapy and mortality of patients with positive culture for Candida spp. in catheter tip that have negative blood culture. METHODS: The PubMed database was searched to identify articles related to Candida and catheter. Articles with adequate data were included. RESULTS: Of 1208 studies initially screened, 5 met the selection criteria. All were retrospective studies. In all, 265 patients were evaluated for outcomes 'candidemia' and 'invasive candidiasis' and 158 for the outcome 'mortality.' Antifungal therapy had no impact on the development of invasive fungal disease (Odds ratio (OR) = 1.41; 95% confidence interval (CI) = 0.56-3.52). Also there was no benefit of therapy on mortality (OR = 1.02; 95% CI = 0.54-1.95). CONCLUSION: Due to the poor quality of the studies no conclusion can be made. Randomized prospective studies are needed to better evaluate this therapeutic strategy.

Thirty-day readmission rates in a cohort of people living with HIV in southern Brazil, 2015 to 2017.

BACKGROUND: The intense use of antiretroviral therapy (ART) has reduced morbidity and mortality of HIV infection. In Brazil, the specific contribution of diseases related to HIV infection leading to hospital admission and readmission is not well known. AIMS: The study aimed to determine the clinico-epidemiological profile, 30-day readmission rate, and factors associated with this outcome in a cohort of adults with HIV infection in southern Brazil. METHODS: Unicentric retrospective cohort, with data collection through the review of medical records and databases. RESULTS: We analyzed 574 index hospitalizations and 451 individuals. Of these, 57.6% were men and the mean (±SD) age was 42.2 ± 12.3 years. Only 43.4% used ART regularly and low CD4 count and high frequency of detectable viral load were observed. HIV/AIDS-related diseases were identified in 55.2%, and tuberculosis was the most frequent etiology leading to index hospitalization. We found a 30-day readmission rate of 11.5% and hospitalization for HIV/AIDS-related illness was associated with a higher risk for the outcome. CONCLUSIONS: These findings highlight the need to expand resources for prevention, early diagnosis, retention, and treatment of people living with HIV in the region to reduce HIV/AIDS-associated diseases and possibly minimize consequent hospital readmission of these individuals.

High-Flow Nasal Cannula Therapy in Patients With COVID-19: Predictive Response Factors.

BACKGROUND: COVID-19 pneumonia has been responsible for many ICU patients' admissions with hypoxemic respiratory failure, and oxygen therapy is one of the pillars of its treatment. The current pandemic scenario has limited the availability of ICU beds and access to invasive ventilation equipment. High-flow nasal cannula (HFNC) can reduce the need for orotracheal intubation compared with conventional oxygen therapy, providing better results than noninvasive respiratory support. However, HFNC use has been controversial due to concerns about the benefits and risks of aerosol dispersion. In this context, we evaluated the performance of the HFNC therapy in patients with COVID-19 and investigated factors that can predict favorable responses. METHODS: A prospective observational study was conducted, which included hospitalized adult subjects with COVID-19 in the respiratory wards who needed oxygen therapy. Clinical and laboratory parameters were collected to compare HFNC therapy use and the outcomes. RESULTS: In 6 months, 128 subjects were included and the success rate of HFNC therapy was 53%. Logistic regression analysis showed that the Charlson comorbidity score, need for oxygen flow, [Formula: see text], and breathing frequency predicted therapy failure. The mortality rate increased among the non-responders versus the responders (47% vs 3%), 48% of failure occurred in the first 24 h of the HFNC therapy. A ROX (respiratory frequency - oxygenation) index > 4.98 in 6 h and > 4.53 in 24 h predicted success of the HFNC therapy with an area under the curve of 0.7, and a ROX index < 3.47 predicted failure with 88% of specificity. CONCLUSIONS: HFNC in the subjects with COVID-19 was associated with reduced mortality and improved oxygenation in the subjects with respiratory distress. Close monitoring of specific parameters defines eligible patients and rapidly identifies those in need of invasive ventilatory support.

Fulminant hepatitis in a patient with secondary syphilis.

Despite the increasing incidence of syphilis and due to its wide variety of clinical manifestations, syphilis remains an under-diagnosed condition. We report an unusual case of secondary syphilis presenting with acute hepatitis and skin lesions, confirmed based on positive treponemal and non-treponemal assays. Despite adequate diagnosis and treatment, the patient developed fulminant hepatitis and brain death. This atypical presentation emphasizes the importance of high clinical suspicion in recognizing syphilis as an etiology for unexplained acute hepatitis, allowing early diagnosis and treatment and possibly avoiding severe complications such as fulminant hepatic failure.