[Identification and susceptibility against fluconazole and albaconazole of 100 yeasts' strains isolated from vaginal discharge]. / Identificación y sensibilidad frente a fluconazol y albaconazol de 100 cepas de levaduras aisladas de flujo vaginal.

Vulvovaginal candidiasis is a condition that affects a great number of fertile women. It is considered the second cause of genital infection after vaginosis due to GAM complex. Candida albicans is the most frequent isolated species from vaginal discharge. However, sometimes more than one yeast species could be found in the same clinical sample that are more resistant to antifungal drugs. Nowadays, it is necessary to identify properly up to species level the isolated microorganism and to determine the antifungal susceptibility profile. One hundred strains obtained from vaginal discharge of 94 patients suffering acute vulvovaginal candidiasis were studied. The identification of the isolates showed: C. albicans 86%, Candida glabrata 6%, Candida inconspicua 3%, Candida krusei 2% and Candida intermedia, Candida holmii and Trichosporon asahii one case each. Minimal inhibitory concentrations (MIC) of all the yeasts against fluconazole and albaconazole were performed. C. glabrata, C. krusei and C. inconspicua were the most resistant against fluconazole, on the other hand albicans was susceptible to this drug. All the isolates presented MIC against albaconazole much lower than fluconazole.

[Interruption of antifungal secondary prophylaxis in AIDS-related histoplasmosis]. / Interrupción de la profilaxis secundaria antifúngica en la histoplasmosis asociada al sida.

The clinical data of 21 patients, suffering AIDS-related histoplasmosis, who were able to interrupt antifungal secondary prophylaxis, after achieving a partial restoration of the cell mediated immunity by HAART administration, are presented. They were 16 males and five females, whose ages varied between 32 and 54 years (mean = 38.5 years). All of them presented disseminated progressive forms of histoplasmosis, with multiple locations (skin, mucous membranes, liver, spleen, lymph nodes and lungs). The majority of the cases suffered other concomitant diseases (specially tuberculosis and Kaposi sarcoma), 66.6 % of the patients had less than 50 CD4+ cells/microl at the start of treatment and the average viral burden was 278,385 RNA copies/ml. The initial treatment consisted in 400 mg/day of itraconazole, by oral route, in 14 cases and the remaining seven patients were treated with amphotericin B, intravenously, at a daily dose of 0.7 mg/kg of body weight. One patient who did not tolerate amphotericin B and presented a partial response to itraconazole, was treated with posaconazole orally at a daily dose of 800 mg. Fourteen patients received oral itraconazole at a daily dose of 200 mg as a secondary prophylaxis, the remaining three patients were treated with intravenous amphotericin B, 50 mg twice a week. After HAART for an average lapse of 16.7 months (10 to 32 months), five cases showed CD4+ cells counts above 150 cells/microl and the remaining 16 presented more than 200 cells/microl; 18 of them had undetectable viral burden and all cases were asymptomatic. The follow up after secondary prophylaxis discontinuation varied between six months and six years (mean= 33.6 months). Twenty out of 21 patients (95 %) were clinically stable, without any manifestation of relapses, including two patients who abandoned HAART. One patient, who discontinued HAART, contracted a fatal bacterial pneumonia. Even though the limited number of cases, the data presented in this study seem to suggest that it is possible to interrupt antifungal secondary prophylaxis of histoplasmosis, when the patient is clinically asymptomatic and the CD4+ cells counts are above 150 cells/microl.

Identificación y sensibilidad frente a fluconazol y albaconazol de 100 cepas de levaduras aisladas de flujo vaginal / Identification and susceptibility against fluconazole and albaconazole of 100 yeasts’ strains isolated from vaginal discharge

La candididiasis vulvovaginal aguda afecta a una elevada proporciónde mujeres en edad fértil y es la segunda causa de vulvovaginitis después dela vaginosis bacteriana debida al complejo GAM (Gardnerella vaginalis-Anaerobios-Mycoplasma).La especie de Candida que se aísla con mayor asiduidad de las secrecionesvaginales es Candida albicans. Sin embargo, la aparición de más de unaespecie de levadura en la misma muestra, o de otras con mayor resistenciafrente a las medicaciones de uso habitual, hacen necesaria la identificacióncorrecta a nivel de especie del microorganismo aislado y la determinación delpatrón de sensibilidad antifúngica.En este estudio se incluyeron 100 aislamientos provenientes de 94 pacientescon vulvovaginitis micótica aguda. La identificación de las cepas demostróque el 86% correspondía a C. albicans, el 6% a Candida glabrata, y el restose identificaron como Candida inconspicua (3%), Candida krusei (2%), yCandida intermedia, Candida holmii y Trichosporon asahii con un únicoaislamiento cada una (1%).Se determinaron las concentraciones inhibitorias mínimas de fluconazol yde albaconazol para estas levaduras. C. glabrata, C. krusei y C. inconspicuafueron las especies con mayor resistencia a fluconazol, en tanto que todas lascepas de C. albicans fueron sensibles. La concentración mínima inhibitoria(CMI) de albaconazol fue mucho menor en todos los aislamientos(AU)

Vulvovaginal candidiasis is a condition that affects a great number of fertilewomen. It is considered the second cause of genital infection after vaginosisdue to GAM complex.Candida albicans is the most frequent isolated species from vaginal discharge.However, sometimes more than one yeast species could be found in the sameclinical sample or appear other different yeast that are more resistant toantifungal drugs. Nowadays, it is necessary to identify properly up to specieslevel the isolated microorganism and to determine the antifungal susceptibilityprofile.One hundred strains obtained from vaginal discharge of 94 patients sufferingacute vulvovaginal candidiasis were studied. The identification of the isolatesshowed: C. albicans 86%, Candida glabrata 6%, Candida inconspicua 3%,Candida krusei 2% and Candida intermedia, Candida holmii and Trichosporonasahii one case each.Minimal inhibitory concentrations (MIC) of all the yeasts against fluconazoleand albaconazole were performed. C. glabrata, C. krusei and C. inconspicuawere the most resistant against fluconazole, on the other hand C. albicans wassusceptible to this drug. All the isolates presented MIC against albaconazolemuch lower than fluconazole(AU)