Ação antifúngica e potencial antibiofilme de diferentes terapias alternativas frente a leveduras do gênero candida / Antifungal action and antibiofilm potential of different alternative therapies against yeasts of the genus candida

As candidoses usualmente são tratadas com antifúngicos. No entanto, o efeito desses fármacos é usualmente comprometido pela resistência microbiana e pelos efeitos adversos ocasionados. Nesse sentido, o aumento da prevalência e a complexidade de microrganismos multirresistentes a antimicrobianos têm incitado a busca por terapias complementares e alternativas capazes de atuar efetivamente frente à resistência emergente aos medicamentos. Diante disso, o objetivo desse trabalho foi avaliar comparativamente a ação antimicrobiana e o potencial antibiofilme, in vitro, entre a terapia fotodinâmica antimirobiana (TFDA) com azul de metileno, a fitoterapia, utilizando o extrato hidroetanólico de Spondias mombin L (EHSM), e o probiótico Lactobacillus rhamnosus (PLR) no controle de leveduras do gênero Candida, sendo elas: Candida albicans, Candida tropicalis e Candida parapsilosis. Trata-se de um estudo experimental, in vitro, analítico e quantitativo, em que foram investigadas, em triplicata, a atividade inibidora do crescimento microbiano e a atividade antibiofilme das seguintes terapias alternativas: TFDA, EHSM e PLR, utilizando como controle positivo a Nistatina 100.000UI/mL. Quanto à análise estatística, além da interpretação descritiva, foi aplicado o teste Two-Way ANOVA e o Teste de Tukey. Dessa forma, observou-se que todas as terapias testadas exibiram atividades antifúngica e antibiofilme. Todavia, quando comparadas tais atividades entre elas e ainda com a Nistatina, verificou-se que: a TFDA apresentou a maior atividade inibitória de crescimento microbiano (p<0,05), semelhante a Nistatina, seguida pelo EHSM, exibindo o PLR a menor atividade antifúngica e a TFDA juntamente com o EHSM representaram as terapias com maior atividade antibiofilme (p<0,0001), atuando ambas de forma semelhante a Nistatina. Nesse sentido, foi possível concluir que todas as terapias estudadas possuem atividades antifúngica e antibiofilme frente às cepas do gênero Candida testadas, com destaque para a atividade inibidora de crescimento microbiano da TFDA e a atividade antibiofilme da TFDA e do EHSM, sendo tais atividades semelhantes às atividades da Nistatina (AU).

Candidoses are usually treated with antifungals. However, the effect of these drugs is usually compromised by microbial resistance and adverse effects. In this sense, the increase in the prevalence and complexity of multidrug-resistant microorganisms to antimicrobials have incited the search for complementary and alternative therapies capable of acting effectively against the emerging resistance to medicines. Therefore, the objective of this study was to comparatively evaluate the antimicrobial action and antibiofilm potential, in vitro, between antimyrobial photodynamic therapy (PDT) with methylene blue, phytotherapy, using hydroethanolic extract of Spondias mombin L (EHSM)and the probiotic Lactobacillus rhamnosus (PLR) in the control of yeasts of the genus Candida: Candida albicans, Candida tropicalis and Candida parapsilosis. This is an experimental, in vitro, analytical and quantitative study in which the inhibitory activity of microbial growth and antibiofilm activity of the following alternative therapies were investigated in triplicate: TFDA, EHSM and PLR, using 100.000UI/mL as positive control. Regarding the statistical analysis, in addition to the descriptive interpretation, the Two-Way ANOVA test and the Tukey test were applied. Thus, it was observed that all therapies tested exhibited antifungal and antibiofilm activities. However, when comparing these activities between them and still with Nystatin, it was found that: TFDA showed the highest inhibitory activity of microbial growth (p <0.05), similar to Nystatin, followed by the EHSM, exhibiting the PLR the lowest antifungal activity and the TFDA together with the EHSM represented the therapies with higher antibiofilm activity (p <0.0001), acting both similarly to Nystatin. In this sense, it was possible to conclude that all the therapies studied have antifungal and antibiofilm activities against the strains of the genus Candida tested, especially the inhibitory activity of microbial growth of TFDA and the antibiofilm activity of TFDA and EHSM, similar to the activities of Nistatina (AU).

High Antifungal Activity against Candida Species of Monometallic and Bimetallic Nanoparticles Synthesized in Nanoreactors.

Among all novel challenges nowadays worldwide, infectious disease is probably one of the most important. It is well-known that common treatments used include high doses of antibiotics, which are very invasive therapies for patients. These treatments are more intensive when the infection is related to multidrug resistant microorganisms. In this sense, in this work we report the use of reverse micelles to form less than 5 nm gold, silver, and gold-silver nanoparticles (NPs) with biological activity against five opportunistic Candida strains responsible of several diseases in human beings. As a result, we evaluate the interface properties and droplet-droplet interactions of micelles founding high fluidity in the polar head of the surfactant, necessary to form a flexible interaction channel in the "dimmer" micelle-micelle. In this condition, we form monodispersed, highly reactive NPs with sizes less than 5 nm with high antifungal activity against C. parapsilosis, C. Krusei, C. glabrata, C. guillermondii, and C. albicans, with minimum inhibitory concentrations (MIC50) less than 0.7 ppm in all cases, the lowest reported to the best of our knowledge. These are very promising results to develop alternative therapies to treat fungal diseases in humans, animals, and plants, or to coat conventional surfaces in surgery rooms.

Infección sistémica por Candida en unidades de cuidados intensivos neonatales / Systemic infection by Candida in neonatal intensive care units

En las unidades de cuidados intensivos neonatales, los recién nacidos pretérmino pueden contraer infecciones micóticas invasivas, predominantemente por Candidas sp, causantes de una mayor morbilidad y mortalidad, así como también de frecuentes alteraciones del neurodesarrollo en los sobrevivientes. La candidiasis neonatal es de difícil diagnóstico, dado el carácter transitorio de la candidemia y la dificultad para eliminarla por su rápida invasión de los órganos y sistemas anatómicos. La mejor opción para disminuir la incidencia de la enfermedad, es prevenirla. En este artículo se actualiza lo concerniente a los principales elementos relacionados no solo con el diagnóstico, sino con el tratamiento profiláctico y específico de estos pacientes, referidos hasta el 2010 por grupos de expertos internacionales en esta materia de salud(A)

In neonatal intensive care units the preterm infants may develop invasive fungal infections, mainly by Candida sp, causative of increased morbidity and mortality, as well as of frequent neurodevelopmental disorders in survivors. Neonatal candidiasis is difficult to diagnose because of the transitory nature of candidemia and the difficulty to eliminate its rapid invasion from organs and anatomical systems. The best option to reduce the incidence of the disease is to prevent it. In this article the main elements related not only to the diagnosis, but also to the specific and prophylactic treatment of these patients are updated, which were referred to 2010 by groups of international experts in this field of health(AU)

Infección sistémica por candida en unidades de cuidados intensivos neonatales / Systemic infection by candida in neonatal intensive care units

En las unidades de cuidados intensivos neonatales, los recién nacidos pretérmino pueden contraer infecciones micóticas invasivas, predominantemente por Candidas sp, causantes de una mayor morbilidad y mortalidad, así como también de frecuentes alteraciones del neurodesarrollo en los sobrevivientes. La candidiasis neonatal es de difícil diagnóstico, dado el carácter transitorio de la candidemia y la dificultad para eliminarla por su rápida invasión de los órganos y sistemas anatómicos. La mejor opción para disminuir la incidencia de la enfermedad, es prevenirla. En este artículo se actualiza lo concerniente a los principales elementos relacionados no solo con el diagnóstico, sino con el tratamiento profiláctico y específico de estos pacientes, referidos hasta el 2010 por grupos de expertos internacionales en esta materia de salud.

In neonatal intensive care units the preterm infants may develop invasive fungal infections, mainly by Candida sp, causative of increased morbidity and mortality, as well as of frequent neurodevelopmental disorders in survivors. Neonatal candidiasis is difficult to diagnose because of the transitory nature of candidemia and the difficulty to eliminate its rapid invasion from organs and anatomical systems. The best option to reduce the incidence of the disease is to prevent it. In this article the main elements related not only to the diagnosis, but also to the specific and prophylactic treatment of these patients are updated, which were referred to 2010 by groups of international experts in this field of health.

Balance del contenido vaginal en el diagnóstico diferencial de vaginosis-vaginitis: Reacción inflamatoria vaginal en embarazadas sintomáticas / Balance of vaginal content in vaginosis-vaginitis differential diagnosis: Vaginal inflammatory reaction in symptomatic pregnant women

El objetivo del trabajo fue validar el alto valor predictivo de BACOVA (Balance del contenido vaginal, disponible en www.fba.org.ar/proeco) en el diagnóstico microscópico diferencial de vaginosis bacteriana (VB) y vaginitis microbiana inespecífica (VMI). Fueron estudiadas 299 embarazadas sintomáticas. Se determinó por microscopía el Valor Numérico (Nugent) (VN), células guía (CG), morfotipos extraños (Mex), leucocitos por campo (Lpc), tricomonas (TV) y levaduras (LE) con lectura a 400X. Los resultados globales fueron: VN de 7 a 10, 16,4% del total de casos. BACOVA permitió diferenciar 11,7% de los casos con VN de 7 a 10, con reacción inflamatoria vaginal (RIV) menor de 10 Lpc, como casos típicos de BV. Con igual VN se detectó 4,7% de casos con RIV con más de 10 Lpc, compatibles con VMI. En sólo 7,3% de los casos de LE detectadas por microscopía (20,4% en total), se confirmó una RIV significativa. Hubo 2,7% del total de casos con RIV significativa, pH<4,5 y resultado negativo para el resto de los criterios estudiados. La determinación de la RIV, fue imprescindible, junto al VN, en el diagnóstico diferencial de VB y VMI. La RIV también es necesaria para establecer la significación clínica de la presencia de levaduras. BACOVA detecta casos con RIV significativa (2,7%), como único marcador, con pH inferior a 4,5, compatibles con infección del tracto genital superior.

This study was undertaken to demonstrate the high diagnostic predictive value of BACOVA (Balance of Vaginal Content, www.fba.org.ar/proeco) for bacterial vaginosis and microbial non specific vaginitis, in pregnant women primary health care. BACOVA including Nugent score (Gram 1000X) and leucocyte count (Wet mount and Giemsa, using 400X) was evaluated in 299 symptomatic pregnant women. Nugent score 7 to 10 was detected in 16.4%. Crossing Nugent value 7 to 10 with leucocytes counts shows that only 11.7% were below 10 leucocytes per field and 4.7% had a significant vaginal inflammatory response. Yeasts were detected in 20.4% but only in 7.2% of cases they show a significant association with vaginal inflammatory response. In 2.7% of the cases there was a significant vaginal inflammatory response, with pH below 4.5, VN from 0 to 3 and negative for TV, fishy odor, and exogenous microbial morphotypes. Simultaneous study of vaginal inflammatory response and Nugent score is mandatory in order to detect true cases of bacterial vaginosis (11.7%) from those of potential microbial non specific vaginitis (4.7%) (Donders' "aerobic vaginitis") Besides, vaginal inflammatory response became a strong criterion to define yeast vulvovaginitis (7.2%). Cases (2.7%) with score 0 to 3, negative for other criteria, with a high vaginal inflammatory response, are predictors of upper genital infections.