Epidemiological cutoff values for fluconazole, itraconazole, posaconazole, and voriconazole for six Candida species as determined by the colorimetric Sensititre YeastOne method.

In the absence of clinical breakpoints (CBP), epidemiological cutoff values (ECVs) are useful to separate wild-type (WT) isolates (without mechanisms of resistance) from non-WT isolates (those that can harbor some resistance mechanisms), which is the goal of susceptibility tests. Sensititre YeastOne (SYO) is a widely used method to determine susceptibility of Candida spp. to antifungal agents. The CLSI CBP have been established, but not for the SYO method. The ECVs for four azoles, obtained using MIC distributions determined by the SYO method, were calculated via five methods (three statistical methods and based on the MIC50 and modal MIC). Respectively, the median ECVs (in mg/liter) of the five methods for fluconazole, itraconazole, posaconazole, and voriconazole (in parentheses: the percentage of isolates inhibited by MICs equal to or less than the ECVs; the number of isolates tested) were as follows: 2 (94.4%; 944), 0.5 (96.7%; 942), 0.25 (97.6%; 673), and 0.06 (96.7%; 849) for Candida albicans; 4 (86.1%; 642), 0.5 (99.4%; 642), 0.12 (93.9%; 392), and 0.06 (86.9%; 559) for C. parapsilosis; 8 (94.9%; 175), 1 (93.7%; 175), 2 (93.6%; 125), and 0.25 (90.4%; 167) for C. tropicalis; 128 (98.6%; 212), 4 (95.8%; 212), 4 (96.0%; 173), and 2 (98.5; 205) for C. glabrata; 256 (100%; 53), 1 (98.1%; 53), 1 (100%; 33), and 1 (97.9%; 48) for C. krusei; 4 (89.2%; 93), 0.5 (100%; 93), 0.25 (100%; 33), and 0.06 (87.7%; 73) for C. orthopsilosis. All methods included ≥94% of isolates and yielded similar ECVs (within 1 dilution). These ECVs would be suitable for monitoring emergence of isolates with reduced susceptibility by using the SYO method.

Epidemiology and antifungal susceptibility of bloodstream fungal isolates in pediatric patients: a Spanish multicenter prospective survey.

Data on fungemia epidemiology and antifungal susceptibility of isolates from children are scarce, leading frequently to pediatric empirical treatment based on available adult data. The present study was designed to update the epidemiological, mycological, and in vitro susceptibility data on fungal isolates from children with fungemia in Spain. All fungemia episodes were identified prospectively by blood culture over 13 months at 30 hospitals. Tests of susceptibility to amphotericin B, flucytosine, fluconazole, itraconazole, posaconazole, voriconazole, anidulafungin, caspofungin, and micafungin were performed at participant institutions by a microdilution colorimetric method. New species-specific clinical breakpoints for fluconazole, voriconazole, and echinocandins were also applied. A total of 203 episodes of fungemia in 200 children were identified. A higher proportion of fungal isolates was from general wards than intensive care units (ICU). Candida parapsilosis (46.8%), Candida albicans (36.5%), Candida tropicalis (5.9%), Candida glabrata (3.9%), and Candida guilliermondii (2.5%) were the leading species. C. parapsilosis was the predominant species except in neonates. C. albicans was the most frequent in neonatal ICU settings (51.9%). Intravascular catheter (79.3%), surgery (35%), prematurity (30%), and neutropenia (11%) were the most frequent predisposing factors. Most Candida isolates (95.1%) were susceptible to all antifungals. When the new species-specific clinical breakpoints were applied, all C. parapsilosis isolates were susceptible to echinocandins except one, which was micafungin resistant. This is the largest published series of fungemia episodes in the pediatric setting. C. parapsilosis is the most prevalent species in Spain, followed by C. albicans and C. tropicalis. Resistance to azole and echinocandin agents is extremely rare among Candida species. The fluconazole resistance rate in Spain has decreased in the last 10 years.

Adenocarcinoma colónico originado en adenoma túbulo velloso asociado a endometriosis intestinal: a propósito de un caso / Malign tubule-hairy adenoma synchronized with intestinal endometriosis: a case proposal

Paciente femenina, blanca, de 56 años de edad, con historia de infertilidad por endometriosis pélvica y sangramiento digestivo bajo al defecar. Se realiza rectosigmoidoscopia y se visualiza lesión polipoidea de aproximadamente 3 cm pediculada. Se realiza resección y se analiza por biopsia, la cual informa adenoma tubulovelloso con áreas de adenocarcinoma bien diferenciado. Se repite la colonoscopia y biopsia de esa área la cual informa adenocarcinoma. Se decide intervenir quirúrgicamente realizándose rectosigmoidectomía por video laparoscopia. La biopsia informa no presencia de tumor y endometriosis de la pared del recto sigmoides. Se presenta el caso de forma ilustrativa y se revisa lo hasta ahora reportado.

A white, 56-years-old female patient, with a history of infertility caused by pelvic endometriosis and low digestive bleeding when defecating was attended. We made a rectosigmoidioscopy and found a tumoral hairy lesion of around 3 cm. A resection was made and a biopsy, resulting a tubule-hairy adenoma with a well-differentiated adenocarcinoma areas. We repeated the colonoscopy and biopsy of this area, showing adenocarcinoma as a result. We decided the surgical intervention making a rectosigmoidectomy by video laparoscopy. The biopsy showed neither tumor nor endometriosis at the recto sigmoid wall. We present the case in an illustrative way and reviewed the existent literature.

Adenocarcinoma colónico originado en adenoma túbulo velloso asociado a endometriosis intestinal: a propósito de un caso / Malign tubule-hairy adenoma synchronized with intestinal endometriosis: a case proposal

Paciente femenina, blanca, de 56 años de edad, con historia de infertilidad por endometriosis pélvica y sangramiento digestivo bajo al defecar. Se realiza rectosigmoidoscopia y se visualiza lesión polipoidea de aproximadamente 3 cm pediculada. Se realiza resección y se analiza por biopsia, la cual informa adenoma tubulovelloso con áreas de adenocarcinoma bien diferenciado. Se repite la colonoscopia y biopsia de esa área la cual informa adenocarcinoma. Se decide intervenir quirúrgicamente realizándose rectosigmoidectomía por video laparoscopia. La biopsia informa no presencia de tumor y endometriosis de la pared del recto sigmoides. Se presenta el caso de forma ilustrativa y se revisa lo hasta ahora reportado(AU)

A white, 56-years-old female patient, with a history of infertility caused by pelvic endometriosis and low digestive bleeding when defecating was attended. We made a rectosigmoidioscopy and found a tumoral hairy lesion of around 3 cm. A resection was made and a biopsy, resulting a tubule-hairy adenoma with a well-differentiated adenocarcinoma areas. We repeated the colonoscopy and biopsy of this area, showing adenocarcinoma as a result. We decided the surgical intervention making a rectosigmoidectomy by video laparoscopy. The biopsy showed neither tumor nor endometriosis at the recto sigmoid wall. We present the case in an illustrative way and reviewed the existent literature(AU)