ABSTRACT
Introducción: las infecciones fúngicas invasivas (IFI) son un problema de salud en creciente aumento. Objetivo: describir las características epidemiológicas, microbiológicas y clínicas de los menores de 15 años con IFI hospitalizados en el Hospital Pediátrico, Centro Hospitalario Pereira Rossell entre 2010- 2019. Metodología: estudio retrospectivo, mediante revisión de historias clínicas. Variables: edad, sexo, comorbilidades, factores de riesgo, clínica, patógenos, tratamiento y evolución. Resultados: se registraron 26 casos de IFI en 23 niños. La mediana de edad fue 8 años, de sexo femenino 17, con comorbilidades 17: infección por VIH 5, enfermedad hematooncológica 4. Todos presentaban factores de riesgo para IFI. Las manifestaciones clínicas de sospecha fueron: fiebre en 19, síntomas neurológicos 11, respiratorios 9, gastrointestinales 6, urinarios 2, sepsis/shock en 3. Los agentes identificados fueron: Candida spp en 14, Cryptococcus neoformans complex 8 y Aspergillus fumigatus complex 4. Tratamiento: se indicó fluconazol en 15, asociado a anfotericina B 11. Todas las infecciones por candida fueron sensibles a los azoles. Fallecieron 7 niños, la mediana de edad fue 1 año. En 4 se identificó Candida spp, Aspergillus fumigatus complex 2 y Cryptococcus neoformans complex 1. Conclusiones: las IFI son poco frecuentes, afectan en su mayoría a niños inmunocomprometidos asociando elevada mortalidad. El diagnóstico requiere alto índice de sospecha. Candida spp y Cryptococcus spp fueron los agentes más involucrados. El inicio precoz del tratamiento acorde a la susceptibilidad disponible se asocia a menor mortalidad.
Summary: Introduction: invasive fungal infections (IFI) are an increasing health problem. Objective: describe the epidemiological, microbiological and clinical characteristics of children under 15 years of age with IFI hospitalized at the Pereira Rossell Hospital Center between 2010-2019. Methodology: retrospective study, review of medical records. Variables: age, sex, comorbidities, risk factors, symptoms, pathogens, treatment and evolution. Results: 26 cases of IFI were recorded involving 23 children. Median age 8 years, female 17, comorbidities 17, HIV infection 5, hematological-oncological disease 4. All with risk factors. Suspicion symptoms: fever 19, neurological symptoms 11, respiratory 9, gastrointestinal 6, urinary 2, sepsis / shock 3. Identified agents: Candida spp 14, Cryptococcus neoformans complex 8 and Aspergillus fumigatus complex 4. Treatment: fluconazole 15, associated with amphotericin B 11. All candida infections were sensitive to azoles. 7 died, median age 1 year. In 4, Candida spp was isolated, Aspergillus fumigatus complex in 2 and Cryptococcus neoformans complex in 1. Conclusions: IFI are rare, mostly affecting immunocompromised children, associated with high mortality. The diagnosis requires a high index of suspicion. Candida spp and Cryptococcus spp were the most involved agents. Early treatment according to available susceptibility is associated with lower mortality.
Introdução: as infecções fúngicas invasivas (IFI) são um problema de saúde crescente. Objetivo: descrever as características epidemiológicas, microbiológicas e clínicas de crianças menores de 15 anos com IFI internadas no Centro Hospitalar Pereira Rossell entre 2010 e 2019. Metodologia: estudo retrospectivo, revisão de prontuários. Variáveis: idade, sexo, comorbidades, fatores de risco, sintomas, patógenos, tratamento e evolução. Resultados: foram registrados 26 casos de IFI em 23 crianças. Idade mediana 8 anos, sexo feminino 17, comorbidades 17, infecção por HIV 5, doença hemato-oncológica 4. Todos com fatores de risco. Suspeita clínica: febre 19, sintomas neurológicos 11, respiratórios 9, gastrointestinais 6, urinários 2, sepse/choque 3. Agentes identificados: Candida spp 14, Cryptococcus neoformans complexo 8 e Aspergillus fumigatus complexo 4. Tratamento: fluconazol 15, associado à anfotericina B 11. Todas as infecções por cândida foram sensíveis aos azóis. 7 morreram, idade média de 1 ano. Em 4 das crianças Cândida spp foi isolada, Aspergillus fumigatus complexo em 2 e Cryptococcus neoformans complexo em 1. Conclusões: IFIs são raras, afetando principalmente crianças imunocomprometidas, associadas a alta mortalidade. O diagnóstico requer alto índice de suspeita. Cândida spp e Cryptococcus spp são os agentes mais envolvidos. O tratamento precoce de acordo com a suscetibilidade disponível está associado a menor mortalidade.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Invasive Fungal Infections/drug therapy , Aspergillosis/diagnosis , Aspergillosis/drug therapy , Aspergillus fumigatus , Comorbidity , Fluconazole/therapeutic use , Child, Hospitalized , Amphotericin B/therapeutic use , Retrospective Studies , Risk Factors , Immunocompromised Host/immunology , Cryptococcosis/diagnosis , Cryptococcosis/drug therapy , Cryptococcus neoformans , Candidiasis, Invasive/diagnosis , Candidiasis, Invasive/drug therapy , Voriconazole/therapeutic use , Invasive Fungal Infections/diagnosis , Invasive Fungal Infections/mortality , Caspofungin/therapeutic use , Antifungal Agents/therapeutic useABSTRACT
BACKGROUND Esophageal necrosis is a rare entity characterized by the presence of extensive circumferential necrosis of the esophagus. It generally affects older adults who have associated chronic pathologies and has a reported mortality rate of approximately 32%. Most patients with esophageal necrosis have a complex clinical course. CASE REPORT We present the case of a 37-year-old man with idiopathic chronic renal failure who presented to the Emergency Department with sudden esophageal necrosis and mediastinitis, associated with invasive candidiasis. Diagnosis was challenging owing to the rarity of the condition. The patient required intensive care management and multiple surgical procedures. CONCLUSIONS Esophageal necrosis is an uncommon pathology that can be fatal because of associated complications. Its pathophysiology is unclear, and its treatment is based on the control of local injury and signs and symptoms. Acute esophageal necrosis associated with invasive Candida sp. infection is even more infrequent, with only a few cases reported in the literature.
Subject(s)
Candidiasis, Invasive , Mediastinitis , Adult , Candidiasis, Invasive/complications , Candidiasis, Invasive/diagnosis , Esophagus , Humans , Male , Mediastinitis/diagnosis , NecrosisABSTRACT
Resumen La candidemia es la micosis invasora más frecuente en los pacientes internados en hospitales de alta complejidad en el mundo. La infección fúngica en el sistema nervioso central constituye una complicación potencialmente mortal que agrava el pronóstico de los pacientes. El presente artículo aborda aspectos relevantes sobre las características clínicas de esta enfermedad, los mecanismos de invasión del hongo, la respuesta inmunitaria local frente a Candida albicans y el impacto de los defectos genéticos en receptores de la inmunidad innata, que aumentan la susceptibilidad a la neurocandidiasis.
Subject(s)
Humans , Central Nervous System Infections , Candidiasis, Invasive , Candida albicans , Candidiasis, Invasive/diagnosisABSTRACT
Candidemia is the most frequent invasive mycosis in hospitalized patients worldwide. Fungal infection in central nervous system is a life-threatening complication which aggravates patients' prognosis. This article summarizes relevant aspects on the clinical characteristics of this pathology, mechanisms of fungus invasion, local immune response to Candida albicans and the impact of genetic defects on innate immune receptors that increase susceptibility to the acquisition of this form of mycosis.
Subject(s)
Candidiasis, Invasive , Central Nervous System Infections , Candida albicans , Candidiasis, Invasive/diagnosis , HumansABSTRACT
As neutropenic patients with haematological cancer are not typically included in randomized controlled trials (RCTs) of candidaemia, there is low quality of evidence regarding the management of this common opportunistic mycosis in this patient population, which is at high risk for poor outcomes. Herein we identify the gaps in knowledge that are not addressed by the modern RCTs and candidaemia guidelines, and outline some considerations for the future clinical research agenda in candidaemia/invasive candidiasis in haematological patients.
Subject(s)
Candidemia , Candidiasis, Invasive , Hematologic Neoplasms , Opportunistic Infections , Antifungal Agents/therapeutic use , Candidemia/drug therapy , Candidiasis, Invasive/diagnosis , Candidiasis, Invasive/drug therapy , Hematologic Neoplasms/complications , Hematologic Neoplasms/drug therapy , Humans , Opportunistic Infections/drug therapyABSTRACT
Systemic infections due to Candida tropicalis are conditions which can frequently lead to death. The aim of this report is to describe the features of C. tropicalis biofilm in a patient with catheter-associated fungemia.
Subject(s)
Candida tropicalis/isolation & purification , Candidiasis, Invasive/diagnosis , Candidiasis, Invasive/pathology , Catheter-Related Infections/diagnosis , Catheter-Related Infections/pathology , Tongue Neoplasms/complications , Biofilms/growth & development , Candidiasis, Invasive/microbiology , Catheter-Related Infections/microbiology , Catheters/microbiology , Humans , Microscopy, Electron, ScanningABSTRACT
BACKGROUND: Pulmonary aspergillosis is a severe invasive infection that mainly affects immunocompromised patients, causing a great mortality. CLINICAL CASE: We present a male patient with chronic ethilism, diabetes mellitus, and work exposure of inhalated harmful chemicals, who had a fatal outcome, that even when not presenting typical risk factors, developed a clinical presentation compatible, and mycological evaluation that support the diagnosis of a probably invasive pulmonary aspergillosis. CONCLUSION: The effect of the combination of the described non-typical situations as predisposing factors for pulmonary aspergillosis requires further research, given that they are non-typical factors.
INTRODUCCIÓN: la aspergilosis pulmonar es una infección invasiva severa que afecta principalmente a pacientes inmunocomprometidos y representa una causa importante de mortalidad. CASO CLÍNICO: presentamos un paciente con antecedentes de etilismo crónico, diabetes mellitus y exposición laboral recurrente a sustancias químicas nocivas inhaladas, quien tuvo un desenlace fatal, y que, incluso al no presentar factores de riesgo típicos, desarrolló una presentación clínica compatible y tuvo estudios micológicos que apoyan el diagnóstico de una probable aspergilosis invasiva. CONCLUSIÓN: el efecto de la combinación de tales situaciones no típicas como factores predisponentes de aspergilosis pulmonar amerita mayor investigación, dado que se trata de factores de riesgo no típicos.
Subject(s)
Candidiasis, Invasive/diagnosis , Coinfection/diagnosis , Immunocompromised Host , Invasive Pulmonary Aspergillosis/diagnosis , Pseudomonas Infections/diagnosis , Alcoholism/complications , Aspergillus fumigatus/isolation & purification , Candida albicans/isolation & purification , Candidiasis, Invasive/microbiology , Coinfection/microbiology , Diabetes Mellitus, Type 2/complications , Environmental Pollutants/toxicity , Fatal Outcome , Humans , Invasive Pulmonary Aspergillosis/microbiology , Male , Middle Aged , Occupational Exposure/adverse effects , Pseudomonas Infections/microbiology , Pseudomonas aeruginosa/isolation & purification , Risk FactorsABSTRACT
In patients with invasive fungal infections, the accurate and rapid identification of the genus Candida is of utmost importance since antimycotic sensitivity is closely related to the species. The aim of the present study was to compare the identification results of species of the genus Candida obtained by BD PhoenixT (Becton Dickinson -#91;BD-#93;) and Maldi-TOF MS (Bruker Microflex LT Biotyper 3.1). A total of 192 isolates from the strain collection belonging to the Mycology Network of the Autonomous City of Buenos Aires, Argentina, were analyzed. The observed concordance was 95%. Only 10 strains (5%) were not correctly identified by the BD PhoenixT system. The average identification time with the Yeast ID panels was 8h 22 min. The BD PhoenixT system proved to be a simple, reliable and effective method for identifying the main species of the genus Candida.
En pacientes con infecciones fúngicas invasoras, la identificación certera y rápida de las especies del género Candida es de suma importancia, ya que la sensibilidad a los antifúngicos está íntimamente relacionada con la especie. El objetivo del presente estudio fue comparar los resultados de identificación de especies del género Candida obtenidos con el equipo comercial BD PhoenixT (Becton Dickinson -#91;BD-#93;) y con la técnica de Maldi-TOF MS (Bruker Microflex LT Biotyper 3.1.) Se analizaron 192 aislamientos provenientes del cepario perteneciente a la Red deMicología de la Ciudad Autónoma de Buenos Aires, Argentina. La concordancia observada fue del 95%. Solo 10 cepas (5%) no fueron identificadas correctamente por el sistema BD PhoenixT. El tiempo promedio de identificación con los paneles Yeast ID fue de 8 h 22 min. El sistema BD PhoenixT demostró ser un método simple, confiable y efectivo para la identificación de las principales especies del género Candida.
Subject(s)
Humans , Candida/isolation & purification , Candida/classification , Candidiasis/diagnosis , Candidiasis/microbiology , Mycological Typing Techniques , Candidiasis, Invasive/diagnosis , Candidiasis, Invasive/microbiologyABSTRACT
In patients with invasive fungal infections, the accurate and rapid identification of the genus Candida is of utmost importance since antimycotic sensitivity is closely related to the species. The aim of the present study was to compare the identification results of species of the genus Candida obtained by BD Phoenix™ (Becton Dickinson [BD]) and Maldi-TOF MS (Bruker Microflex LT Biotyper 3.1). A total of 192 isolates from the strain collection belonging to the Mycology Network of the Autonomous City of Buenos Aires, Argentina, were analyzed. The observed concordance was 95%. Only 10 strains (5%) were not correctly identified by the BD Phoenix™ system. The average identification time with the Yeast ID panels was 8h 22min. The BD Phoenix™ system proved to be a simple, reliable and effective method for identifying the main species of the genus Candida.
Subject(s)
Candida/classification , Candida/isolation & purification , Candidiasis/diagnosis , Candidiasis/microbiology , Candidiasis, Invasive/diagnosis , Candidiasis, Invasive/microbiology , Humans , Mycological Typing TechniquesABSTRACT
BACKGROUND: Invasive fungal infections are important causes of morbimortality in critical patients. Most of these infections are caused by Candida spp. which diagnosis has important limitations. AIM: Initial evaluation of the utility of 1,3-ß-D-glucan (BDG) as a diagnostic tool for invasive candida infections in critical patients. PATIENTS AND METHODS: Adult patients over 18 years old, hospitalized in intensive care units for more than five days, with fever > 38 °C of unclear origin and two or more risk factors for invasive Candida spp. infection were included. Samples for BDG were obtained on two consecutive days. The results were compared with definitive diagnosis of candidemia/invasive candidiasis (C/IC) confirmed by cultures. RESULTS: Median value of BDG in patients with C/IC was 224.3 ± 213.7 pg/ml and in patients without C/IC was 63.8 ± 76.7 pg/ml (p: 0.02). Sensitivity and specificity for the diagnosis of C/IC were 60 and 92%, respectively. Positive predictive value was 60% and negative predictive value was 92%. CONCLUSION: BDG could be considered as a complementary diagnostic tool for the diagnosis of C/IC in critical patients with risk factors.
Subject(s)
Candidiasis, Invasive/diagnosis , beta-Glucans/blood , Adult , Aged , Aged, 80 and over , Biomarkers/blood , Candidiasis, Invasive/blood , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Proteoglycans , Risk Factors , Sensitivity and Specificity , Young AdultABSTRACT
Resumen Introducción: La enfermedad fúngica invasora (EFI) se reconoce como causa importante de morbi-mortalidad en pacientes críticos. La mayoría de estas infecciones son provocadas por Candida spp. para cuyo diagnóstico existen importantes limitaciones. Objetivo: Realizar una evaluación inicial de la utilidad de la medición del 1,3-β-D- glucano (BDG) como herramienta diagnóstica de apoyo de las infecciones invasoras por Candida spp. en pacientes críticos. Pacientes y Método: Estudio prospectivo de pacientes mayores de 18 años hospitalizados en unidades de pacientes críticos por más de cinco días, con fiebre sin foco claro y dos o más factores de riesgo para EFI por Candida spp. Se obtuvieron muestras para BDG en dos días consecutivos. Los resultados se confrontaron con el diagnóstico definitivo de candidemia/candidiasis invasora (C/CI) demostrado según cultivos. Resultados: El valor promedio de BDG en los pacientes con diagnóstico de C/CI fue 224,3 ± 213,7 pg/ml y en aquellos sin C/CI 63,8 ± 76,7 pg/ml (p: 0,02). La sensibilidad y especificidad de BDG para diagnóstico de C/CI fue 60 y 92%, respectivamente. El valor predictor positivo fue 60% y el valor predictor negativo de 92%. Conclusión: BDG puede considerarse como un examen de apoyo en el diagnóstico de C/CI en pacientes críticos con factores de riesgo.
Background: Invasive fungal infections are important causes of morbimortality in critical patients. Most of these infections are caused by Candida spp. which diagnosis has important limitations. Aim: Initial evaluation of the utility of 1,3-β-D-glucan (BDG) as a diagnostic tool for invasive candida infections in critical patients. Patients and Methods: Adult patients over 18 years old, hospitalized in intensive care units for more than five days, with fever > 38 °C of unclear origin and two or more risk factors for invasive Candida spp. infection were included. Samples for BDG were obtained on two consecutive days. The results were compared with definitive diagnosis of candidemia/invasive candidiasis (C/IC) confirmed by cultures. Results: Median value of BDG in patients with C/IC was 224.3 ± 213.7 pg/ml and in patients without C/IC was 63.8 ± 76.7 pg/ml (p: 0.02). Sensitivity and specificity for the diagnosis of C/IC were 60 and 92%, respectively. Positive predictive value was 60% and negative predictive value was 92%. Conclusion: BDG could be considered as a complementary diagnostic tool for the diagnosis of C/IC in critical patients with risk factors.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , beta-Glucans/blood , Candidiasis, Invasive/diagnosis , Biomarkers/blood , Predictive Value of Tests , Prospective Studies , Risk Factors , Sensitivity and Specificity , Candidiasis, Invasive/bloodABSTRACT
Candida auris is an emerging multidrug-resistant fungus that causes a wide range of symptoms. We report finding 17 cases of C. auris infection that were originally misclassified but correctly identified 27.5 days later on average. Patients with a delayed diagnosis of C. auris had a 30-day mortality rate of 35.2%.
Subject(s)
Candida/pathogenicity , Candidiasis, Invasive/diagnosis , Drug Resistance, Multiple, Fungal , Fungemia/diagnosis , Adolescent , Adult , Aged , Antifungal Agents/therapeutic use , Candida/chemistry , Candida/drug effects , Candida/isolation & purification , Candidiasis, Invasive/drug therapy , Candidiasis, Invasive/microbiology , Candidiasis, Invasive/mortality , Child , Child, Preschool , Colombia , Delayed Diagnosis , Female , Fungemia/drug therapy , Fungemia/microbiology , Fungemia/mortality , Humans , Infant , Infant, Newborn , Male , Microbial Sensitivity Tests , Middle Aged , Survival AnalysisABSTRACT
Deep Candida infections commonly occur in immunosuppressed patients. A rare case of a multiple deep organ infection with Candida albicans and spinal tuberculosis was reported in a healthy young man. The 19-year-old man complained of month-long fever and lower back pain. He also had a history of scalded mouth syndrome. Coinfection with Mycobacterium tuberculosis and Candida albicans was diagnosed using the culture of aspirates from different regions. Symptoms improved considerably after antifungal and antituberculous therapy. This case illustrates that infection with tuberculosis might impair the host's immune system and increase the risk of invasive candidiasis in an immunocompetent patient.
Subject(s)
Candidiasis, Invasive/complications , Tuberculosis, Spinal/complications , Candidiasis, Invasive/diagnosis , Humans , Immunocompetence , Male , Tuberculosis, Spinal/diagnosis , Tuberculosis, Spinal/immunology , Young AdultABSTRACT
Deep Candida infections commonly occur in immunosuppressed patients. A rare case of a multiple deep organ infection with Candida albicans and spinal tuberculosis was reported in a healthy young man. The 19-year-old man complained of month-long fever and lower back pain. He also had a history of scalded mouth syndrome. Coinfection with Mycobacterium tuberculosis and Candida albicans was diagnosed using the culture of aspirates from different regions. Symptoms improved considerably after antifungal and antituberculous therapy. This case illustrates that infection with tuberculosis might impair the host's immune system and increase the risk of invasive candidiasis in an immunocompetent patient.
As infecções profundas por Candida ocorrem geralmente em pacientes imunossuprimidos. Relatamos caso raro de infecções profundas em múltiplos órgãos por Candida albicans e neuro tuberculose em homem jovem saudável. Um jovem de 19 anos de idade queixou-se de febre e lombalgia há um mês. Relatava ainda histórico de síndrome da boca escaldada. Foi diagnosticada co-infecção por Mycobacterium tuberculosis e Candida albicans em cultura do aspirado de diferentes regiões do organismo. Os sintomas melhoraram significativamente após a terapia antifúngica e antituberculosa. Este caso é apresentado para mostrar que a tuberculose pode prejudicar o sistema imune do hospedeiro e aumentar o risco de candidíase invasiva em paciente imunocompetente.
Subject(s)
Humans , Male , Young Adult , Candidiasis, Invasive/complications , Tuberculosis, Spinal/complications , Candidiasis, Invasive/diagnosis , Immunocompetence , Tuberculosis, Spinal/diagnosis , Tuberculosis, Spinal/immunologyABSTRACT
Candida lusitaniae es una levadura que ha sido descrita como un patógeno nosocomial emergente de baja frecuencia en infecciones profundas. La identificación oportuna de C. lusitaniae es importante porque puede desarrollar resistencia in vivo a la amfotericina B durante la terapia. Reportamos el aislamiento de C. lusitaniae como agente etiológico de infección de tracto respiratorio inferior en un paciente masculino. Los cultivos de orina y esputo fueron negativos para bacterias y positivos para esta levadura. Los aislamientos fueron identificados por métodos fenotípicos de rutina y confirmados por secuenciación y polimorfismos de longitud de fragmentos de restricción y PCR de la región espaciadora interna del DNA ribosómico.
The yeast Candida lusitaniae has been described as an emerging low frequency nosocomial pathogen in deep infections. Early identification of C. lusitaniae is important because it can readily develop in vivo resistance to amphotericin B during treatment. We report the isolation of C. lusitaniae as etiologic agent of a lower respiratory tract infection in a male patient. Urine and sputum cultures were negative for bacteria and positive for yeast. Isolates were identified by routine phenotypic methods and confirmed by ribosomal DNA internal spacer region restriction fragment length polymorphism PCR and sequencing.
Subject(s)
Humans , Male , Adult , Sequence Analysis, DNA/methods , Candida/isolation & purification , Candida/pathogenicity , Candidiasis, Invasive/diagnosis , Candidiasis, Invasive/etiology , Candidiasis, Invasive/drug therapy , Polymerase Chain Reaction , Polymorphism, Restriction Fragment Length , Antifungal Agents/administration & dosage , Cross Infection , Sputum/microbiology , Molecular Diagnostic Techniques , Respiratory System/microbiology , Respiratory System/pathologyABSTRACT
Invasive fungal infections have become an increasingly common problem in neonatal intensive care units (NICU). Invasive candidiasis (IC) is associated with substantial morbidity and mortality rates, especially in pre-term infants. The aim of this review is to suggest actions in monitoring, prevention, treatment and follow up of IC in the newborn infant.
Subject(s)
Candidiasis, Invasive , Antifungal Agents/therapeutic use , Candida/classification , Candida/drug effects , Candidiasis, Invasive/diagnosis , Candidiasis, Invasive/drug therapy , Candidiasis, Invasive/prevention & control , Child , Fluconazole/therapeutic use , Humans , Infant , Infant, Newborn , Infant, Premature , Risk FactorsABSTRACT
INTRODUCTION: We analyze how infectious disease physicians perceive and manage invasive candidosis in Brazil, in comparison to intensive care unit specialists. METHODS: A 38-question survey was administered to 56 participants. Questions involved clinicians' perceptions of the epidemiology, diagnosis, treatment and prophylaxis of invasive candidosis. P < 0.05 was considered statistically significant. RESULTS: The perception that candidemia not caused by Candida albicans occurs in less than 10% of patients is more commonly held by intensive care unit specialists (p=0.018). Infectious disease physicians almost always use antifungal drugs in the treatment of patients with candidemia, and antifungal drugs are not as frequently prescribed by intensive care unit specialists (p=0.006). Infectious disease physicians often do not use voriconazole when a patient's antifungal treatment has failed with fluconazole, which also differs from the behavior of intensive care unit specialists (p=0.019). Many intensive care unit specialists use fluconazole to treat candidemia in neutropenic patients previously exposed to fluconazole, in contrast to infectious disease physicians (p=0.024). Infectious disease physicians prefer echinocandins as a fi rst choice in the treatment of unstable neutropenic patients more frequently than intensive care unit specialists (p=0.013). When candidemia is diagnosed, most infectious disease physicians perform fundoscopy (p=0.015), whereas intensive care unit specialists usually perform echocardiograms on all patients (p=0.054). CONCLUSIONS: This study reveals a need to better educate physicians in Brazil regarding invasive candidosis. The appropriate management of this disease depends on more drug options being available in our country in addition to global coverage in private and public hospitals, thereby improving health care.
Subject(s)
Candidiasis, Invasive/diagnosis , Candidiasis, Invasive/therapy , Clinical Competence/statistics & numerical data , Critical Care , Infectious Disease Medicine , Practice Patterns, Physicians'/statistics & numerical data , Hospitalists , Humans , Surveys and QuestionnairesABSTRACT
Introduction We analyze how infectious disease physicians perceive and manage invasive candidosis in Brazil, in comparison to intensive care unit specialists. Methods A 38-question survey was administered to 56 participants. Questions involved clinicians' perceptions of the epidemiology, diagnosis, treatment and prophylaxis of invasive candidosis. P < 0.05 was considered statistically significant. Results The perception that candidemia not caused by Candida albicans occurs in less than 10% of patients is more commonly held by intensive care unit specialists (p=0.018). Infectious disease physicians almost always use antifungal drugs in the treatment of patients with candidemia, and antifungal drugs are not as frequently prescribed by intensive care unit specialists (p=0.006). Infectious disease physicians often do not use voriconazole when a patient's antifungal treatment has failed with fluconazole, which also differs from the behavior of intensive care unit specialists (p=0.019). Many intensive care unit specialists use fluconazole to treat candidemia in neutropenic patients previously exposed to fluconazole, in contrast to infectious disease physicians (p=0.024). Infectious disease physicians prefer echinocandins as a first choice in the treatment of unstable neutropenic patients more frequently than intensive care unit specialists (p=0.013). When candidemia is diagnosed, most infectious disease physicians perform fundoscopy (p=0.015), whereas intensive care unit specialists usually perform echocardiograms on all patients (p=0.054). Conclusions This study reveals a need to better educate physicians in Brazil regarding invasive candidosis. The appropriate management of this disease depends on more drug options being available in our country in addition to global coverage in private and public hospitals, thereby improving health care. .
Subject(s)
Humans , Critical Care , Candidiasis, Invasive/diagnosis , Candidiasis, Invasive/therapy , Clinical Competence/statistics & numerical data , Infectious Disease Medicine , Practice Patterns, Physicians'/statistics & numerical data , Hospitalists , Surveys and QuestionnairesABSTRACT
BACKGROUND: Candida parapsilosis is an important species in the genus Candida that plays a significant role in hospitalized patients with nosocomial infections. In patients with HIV infection or AIDS, central nervous system involvement by Candida species is exceptional. CASE REPORT: Here we report a case of an acute meningoencephalitis due to C. parapsilosis in an adult patient with AIDS. We describe the clinical manifestations, the diagnosis methods, antifungal therapy and outcome. CONCLUSIONS: C. parapsilosis is uncommonly reported as a cause of meningitis in AIDS patients. A higher index of suspicion and culture is necessary to confirm the diagnosis of candidal meningoencephalitis.
Subject(s)
AIDS-Related Opportunistic Infections/microbiology , Candida/isolation & purification , Candidiasis, Invasive/microbiology , Meningitis, Fungal/microbiology , Meningoencephalitis/microbiology , AIDS-Related Opportunistic Infections/cerebrospinal fluid , AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/drug therapy , Acute Disease , Adult , Anti-HIV Agents/therapeutic use , Antifungal Agents/therapeutic use , Candida/classification , Candida/growth & development , Candidiasis, Invasive/cerebrospinal fluid , Candidiasis, Invasive/diagnosis , Candidiasis, Invasive/drug therapy , Cerebrospinal Fluid/microbiology , Fluconazole/therapeutic use , Humans , Male , Meningitis, Fungal/cerebrospinal fluid , Meningitis, Fungal/diagnosis , Meningitis, Fungal/drug therapy , Meningoencephalitis/cerebrospinal fluid , Meningoencephalitis/diagnosis , Meningoencephalitis/drug therapy , Patient DropoutsABSTRACT
OBJECTIVE: To assess the impact of empiric antifungal therapy for invasive candidiasis on subsequent outcomes in premature infants. STUDY DESIGN: This was a cohort study of infants with a birth weight ≤ 1000 g receiving care at Neonatal Research Network sites. All infants had at least one positive culture for Candida. Empiric antifungal therapy was defined as receipt of a systemic antifungal on the day of or the day before the first positive culture for Candida was drawn. We created Cox proportional hazards and logistic regression models stratified on propensity score quartiles to determine the effect of empiric antifungal therapy on survival, time to clearance of infection, retinopathy of prematurity, bronchopulmonary dysplasia, end-organ damage, and neurodevelopmental impairment (NDI). RESULTS: A total of 136 infants developed invasive candidiasis. The incidence of death or NDI was lower in infants who received empiric antifungal therapy (19 of 38; 50%) compared with those who had not (55 of 86; 64%; OR, 0.27; 95% CI, 0.08-0.86). There was no significant difference between the groups for any single outcome or other combined outcomes. CONCLUSION: Empiric antifungal therapy was associated with increased survival without NDI. A prospective randomized trial of this strategy is warranted.