RESUMEN
We determined the echinocandin susceptibility and FKS1 genotypes of 13 clinical isolates of Candida auris that were recovered from 4 patients at a tertiary care center in Salvador, Brazil. Three isolates were categorized as echinocandin-resistant, and they harbored a novel FKS1 mutation that led to an amino acid change W691L located downstream from hot spot 1. When introduced to echinocandin-susceptible C. auris strains by CRISPR/Cas9, Fks1 W691L induced elevated MIC values to all echinocandins (anidulafungin, 16 to 32×; caspofungin, >64×; micafungin, >64×).
Asunto(s)
Antifúngicos , Candida auris , Humanos , Antifúngicos/farmacología , Proteínas Fúngicas/genética , Proteínas Fúngicas/metabolismo , Equinocandinas/farmacología , Caspofungina , Pruebas de Sensibilidad Microbiana , Farmacorresistencia Fúngica/genéticaRESUMEN
We analyzed 19 cases of breakthrough candidemia from a referral pediatric cancer center in Brazil. All patients had neutropenia and were under antifungal prophylactic regimens, mostly micafungin (68%). Most of the patients were treated with amphotericin B formulations and 30-day mortality was 21%. Candida parapsilosis was the main etiologic agent (63%), and horizontal transmission was not evidenced by microsatellite analysis.
Asunto(s)
Antifúngicos/uso terapéutico , Candidemia/complicaciones , Neoplasias/complicaciones , Brasil , Candida/clasificación , Infecciones Relacionadas con Catéteres/tratamiento farmacológico , Infecciones Relacionadas con Catéteres/microbiología , Niño , Humanos , Estudios RetrospectivosRESUMEN
IMPORTANCE: To our knowledge, these are the first reports of bloodstream infections by Trichosporon inkin in patients with pemphigus. OBSERVATIONS: Trichosporon inkin, a novel organism causing bloodstream infection, was detected in 2 patients with pemphigus. An elderly man with pemphigus foliaceus died despite treatment with liposomal amphotericin B, 3 mg/kg/d, and a young girl with pemphigus vulgaris responded to treatment with voriconazole, 8 mg/kg/d, for 24 days. One of the T inkin isolates had a minimal inhibitory concentration of 2 mg/L against amphotericin B, suggesting resistance to the drug. CONCLUSIONS AND RELEVANCE: Delayed suspicion of invasive infection by T inkin may result in a poor outcome in patients with severe forms of pemphigus. This opportunistic infection is highly refractory to conventional potent antifungal treatment.
Asunto(s)
Antifúngicos/uso terapéutico , Pénfigo/tratamiento farmacológico , Trichosporon/aislamiento & purificación , Tricosporonosis/diagnóstico , Anciano , Anfotericina B/uso terapéutico , Niño , Farmacorresistencia Fúngica , Resultado Fatal , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/microbiología , Pénfigo/patología , Índice de Severidad de la Enfermedad , Trichosporon/efectos de los fármacos , Tricosporonosis/tratamiento farmacológico , Tricosporonosis/patología , Voriconazol/uso terapéuticoRESUMEN
Twenty-nine Candida parapsilosis, seventeen Candida orthopsilosis and two Candida metapsilosis bloodstream isolates were submitted for identification by VITEK-MS™ mass spectrometer. Four isolates, two C. orthopsilosis and two C. metapsilosis, were not identified. Inclusion of Superspectra of both species in this database is required to improve its discrimination power.
