RESUMEN
Species from Candida parapsilosis complex are frequently found in neonatal candidemia. The antifungal agents to treat this infection are limited and the occurrence of low in vitro susceptibility to echinocandins such as micafungin has been observed. In this context, the chaperone Hsp90 could be a target to reduce resistance. Thus, the objective of this research was to identify isolates from the C. parapsilosis complex and verify the action of Hsp90 inhibitors associated with micafungin. The fungal identification was based on genetic sequencing and mass spectrometry. Minimal inhibitory concentrations were determined by broth microdilution method according to Clinical Laboratory and Standards Institute. The evaluation of the interaction between micafungin with Hsp90 inhibitors was realized using the checkerboard methodology. According to the polyphasic taxonomy, C. parapsilosis sensu stricto was the most frequently identified, followed by C. orthopsilosis and C. metapsilosis, and one isolate of Lodderomyces elongisporus was identified by genetic sequencing. The Hsp90 inhibitor geladanamycin associated with micafungin showed a synergic effect in 31.25% of the isolates, a better result was observed with radicicol, which shows synergic effect in 56.25% tested yeasts. The results obtained demonstrate that blocking Hsp90 could be effective to reduce antifungal resistance to echinocandins.
Asunto(s)
Antifúngicos , Candida parapsilosis , Candidemia , Proteínas HSP90 de Choque Térmico , Micafungina , Humanos , Recién Nacido , Antifúngicos/farmacología , Benzoquinonas/farmacología , Candida parapsilosis/efectos de los fármacos , Candida parapsilosis/aislamiento & purificación , Candida parapsilosis/genética , Candidemia/microbiología , Farmacorresistencia Fúngica , Sinergismo Farmacológico , Equinocandinas/farmacología , Proteínas HSP90 de Choque Térmico/antagonistas & inhibidores , Proteínas HSP90 de Choque Térmico/metabolismo , Proteínas HSP90 de Choque Térmico/genética , Lactamas Macrocíclicas/farmacología , Lipopéptidos/farmacología , Micafungina/farmacología , Pruebas de Sensibilidad MicrobianaRESUMEN
Candidemia is responsible for substantial morbidity and mortality in neonatal intensive care units and represents a challenge due to the complexity of hospitalized neonates, the deficiency in approved and precise diagnostic techniques, and the increasing number of species resistant to antifungal agents. Thus, the objective of this study was to detect candidemia among neonates evaluating the risk factors, epidemiology, and antifungal susceptibility. Blood samples were obtained from neonates with suspected septicemia, and the mycological diagnosis was based on yeast growth in culture. The fungal taxonomy was based on classic identification, automated system, and proteomic, when necessary molecular tools were used. The in vitro susceptibility tests were performed according to the broth microdilution method from Clinical and Laboratory Standards Institute. Statistical analysis was performed using the R software version R-4.2.2. The prevalence of neonatal candidemia was 10.97%. The major risk factors involved were previous use of parenteral nutrition, exposure to broad-spectrum antibiotics, prematurity, and prior use central venous catheter, but only this last was statistically associated with mortality risk. Species from Candida parapsilosis complex and C. albicans were the most frequent. All isolates were susceptible to amphotericin B, except C. haemulonii that also exhibited elevated MICs to fluconazole. C. parapsilosis complex and C. glabrata exhibit the highest MICs to echinocandins. Considering these data, we emphasize that an effective management strategy to reduce the impact of neonatal candidemia should involve the knowledge of risk factors, rapid and precise mycological diagnostic, and tests of antifungal susceptibility to help in the selection of an appropriate treatment.
Asunto(s)
Candidemia , Recién Nacido , Humanos , Candidemia/microbiología , Antifúngicos/farmacología , Antifúngicos/uso terapéutico , Candida , Brasil/epidemiología , Unidades de Cuidado Intensivo Neonatal , Proteómica , Fluconazol , Farmacorresistencia Fúngica , Factores de Riesgo , Candida glabrata , Candida albicans , Candida parapsilosis , Pruebas de Sensibilidad MicrobianaRESUMEN
We report a case of invasive infection due to Saprochaete capitata in a patient with hematological malignancies after chemotherapy treatment and empiric antifungal therapy with caspofungin. Although severely immunocompromised the patient survived been treated with amphotericin B lipid complex associated with voriconazole.
Asunto(s)
Fungemia/diagnóstico , Fungemia/patología , Neoplasias Hematológicas/complicaciones , Saccharomycetales/aislamiento & purificación , Adolescente , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Caspofungina , Equinocandinas/uso terapéutico , Fungemia/microbiología , Humanos , Lipopéptidos , Pulmón/patología , Masculino , Pruebas de Sensibilidad Microbiana , Técnicas Microbiológicas , Microscopía , Radiografía Torácica , Resultado del Tratamiento , Voriconazol/uso terapéuticoRESUMEN
Neonatal candidemia can occur, however, infections caused by Candida pelliculosa are rare. Here, we describe an outbreak of candidemia caused by C. pelliculosa among babies hospitalized in a neonatal intensive care unit.
Asunto(s)
Candida/clasificación , Candida/aislamiento & purificación , Candidemia/epidemiología , Infección Hospitalaria/epidemiología , Brotes de Enfermedades , Antifúngicos/farmacología , Análisis por Conglomerados , ADN de Hongos/genética , Electroforesis en Gel de Agar , Femenino , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Masculino , Pruebas de Sensibilidad Microbiana , Repeticiones de Microsatélite , Epidemiología Molecular , Tipificación Molecular , Técnicas de Tipificación Micológica , Reacción en Cadena de la PolimerasaRESUMEN
Fungal infections are being increasingly reported in patients with malignancies. Pseudozyma aphidis is an opportunistic yeast usually isolated from plants and rarely from human samples. In this study, we report the first case of pulmonary infection due to P. aphidis in a Burkitt lymphoma patient.
Asunto(s)
Linfoma de Burkitt/complicaciones , Enfermedades Pulmonares Fúngicas/diagnóstico , Enfermedades Pulmonares Fúngicas/patología , Ustilaginales/aislamiento & purificación , Adolescente , ADN de Hongos/química , ADN de Hongos/genética , ADN Espaciador Ribosómico/química , ADN Espaciador Ribosómico/genética , Humanos , Enfermedades Pulmonares Fúngicas/microbiología , Masculino , Datos de Secuencia Molecular , Radiografía Torácica , Análisis de Secuencia de ADN , Ustilaginales/clasificación , Ustilaginales/genéticaRESUMEN
Non-albicans Candida species are being increasingly reported as causes of nosocomial fungal infections. For example, invasive candidiasis caused by C. tropicalis has been associated with hematologic malignancies. In this study, we report a fatal case of fungemia and a possible urinary and pulmonary infection in a leukemia patient that was due to a strain of C. tropicalis resistant to 2 triazole antifungals.