Una experiencia de siete años en el laboratorio de Micología del Hospital de Pediatría Juan P. Garrahan / A seven-year experience in the Mycology Laboratory of Hospital de Pediatría Juan P. Garrahan

En noviembre del año 2015 nos incorporamos al Laboratorio de Micología del Servicio de Microbiología del Hospital Garrahan. En este breve resumen queremos compartir los avances logrados a través de nuestra experiencia durante siete años de trabajo profesional. Debido a los diagnósticos realizados y su complejidad, consideramos que el Hospital Garrahan, sus pacientes y la comunidad toda necesitan contar con un laboratorio de Micología que responda a sus necesidades. Creemos haber iniciado un camino que esperamos continúe y culmine con la creación de la Unidad de Micología (AU)

In November 2015 we joined the Mycology Laboratory of the Microbiology Service of the Hospital Garrahan. In this brief summary we want to share the advances achieved through our experience during seven years of professional work. Due to the diagnosis made and their complexity, we believe that the Hospital Garrahan, its patients and the entire community, need to have a Mycology laboratory that responds to their requirements. We believe we have started a path that we hope will continue and culminate with the creation of the Mycology Unit (AU)

Osteomielitis fúngica en niños quemados / Fungal osteomyelitis in burned children

Introducción: En pacientes pediátricos quemados la osteomielitis fúngica es una complicación infrecuente que conduce a una significativa morbilidad. La información en la literatura está limitada a unos escasos reportes de casos. Objetivo: Describir las características clínicas, epidemiológicas y de evolución de niños quemados con osteomielitis fúngica. Métodos: Se llevo a cabo un estudio retrospectivo y descriptivo de pacientes mayores de 1 mes y menores de 18 años quemados con osteomielitis fúngica internados en el hospital Juan P. Garrahan, un hospital terciario en Buenos Aires, Argentina. Resultados: entre enero del 2007 y enero del 2017, de 600 niños quemados, 9 pacientes presentaron diagnóstico confirmado de osteomielitis fúngica. La mediana de edad fue de 42.5 meses (RIC, 27-118 meses) y la mediana de superficie quemada fue de 33.5% (RIC, 18.5-58%). La osteomielitis fue diagnosticada con una mediana de 30 días luego de la quemadura. Las localizaciones más frecuentes de osteomielitis fueron los miembros superiores y a nivel de calota. Los microorganismos aislados a partir del cultivo de hueso fueron: Fusarium spp. en tres pacientes, Mucor spp. en un paciente; Trichosporon asahii en un paciente; Cándida albicans en dos pacientes y Candida parapsilosis en dos pacientes. En dos casos la infección fúngica fue asociada con aislamientos bacteriano concomitante. Todos los pacientes presentaron hallazgos histopatológicos compatibles con osteomielitis. La mediana de tiempo de tratamiento fue de 44.5 días (RIC, 34.5- 65.5 días). Seis pacientes (67%) presentaron secuela motora. Conclusión: La osteomielitis fúngica fue infrecuente Candida spp. y Fusarium spp. fueron los hongos más comúnmente identificados. La secuela funcional fue frecuente (AU)

Introduction: In pediatric burn patients fungal osteomyelitis is a rare complication that leads to significant morbidity. Data in the literature are limited to sporadic case reports. Objective: To describe the clinical and epidemiological features and outcome in burned children with fungal osteomyelitis. Methods: A retrospective descriptive study was conducted in burn patients older than 1 month and younger than 18 years admitted to Hospital Juan P. Garrahan, a tertiary hospital in Buenos Aires, Argentina. Results: Between January 2007 and January 2017, of 600 burned children, nine had a confirmed diagnosis of fungal osteomyelitis. Median age was 42.5 months (IQR, 27-118 months) and median burn surface was 33.5% (IQR, 18.5-58%). Osteomyelitis was diagnosed at a median of 30 days after the burn. The most common location of osteomyelitis were the upper limbs and skull. The microorganisms isolated form bone cultures were Fusarium spp. in three patients, Mucor spp. in one patient; Trichosporon asahii in one patient; Candida albicans in two patients; and Candida parapsilosis in two patients. In two cases the funal infection was associated with concomitant bacterial isolation. In all patients, the histopathological findings were compatible with osteomyelitis. Median duration of treatment was 44.5 days (IQR, 34.5-65.5 days). Six patients (67%) had motor sequelae. Conclusion: Fungal osteomyelitis is a rare disease. Candida spp. and Fusarium spp. were most frequently identified fungi. Functional sequelae were common (AU)

Candidemia en un hospital pediátrico de alta complejidad / Candidemia in a tertiary-care pediatric hospital

Introducción: La frecuencia de las candidemias ha aumentado en los últimos años asociada principalmente a internación prolongada, antibióticos de amplio espectro y enfermedades de base. Se produjo también un cambio en la distribución y un aumento en la resistencia a los antifúngicos de las distintas especies de Candida spp., todo esto asociado a una elevada morbimortalidad. En este trabajo realizado durante un año en un hospital de alta complejidad, se incluyeron 33 pacientes con candidemia. La mediana de la edad fue de 22 meses y un 60% de los afectados fueron varones. El 97% de los niños tenían enfermedad de base con predominio de la patología oncohematológica. Un 88% presentó algún procedimiento o condición predisponente para la infección, principalmente portación de catéter venoso central y cirugía previa. En un 59% de los aislamientos predominaron especies de Candida diferentes de Candida albicans. Anfotericina B desoxicolato fue el tratamiento empírico de elección. La mediana de tratamiento fue de 21 días y la de internación de 66 días. La mortalidad fue del 12% y se asoció a ingreso a UCI, presencia de fiebre al momento del diagnóstico y requerimiento de ARM (AU)

The incidence of candidemia has increased over the past years mainly associated with prolonged hospital stay, wide-spectrum antibiotics, and underlying diseases. At the same time there has been a change in the distribution and an increase in the resistance to antifungals in different Candida spp, associated with a high morbidity and mortality. In this study, conducted during one year at a tertiary hospital, 33 patients with candidemia were included. Median age was 22 months and 60% of the patients were boys. Overall, 97% of the children had an underlying hematology-oncology disease. Of the patients, 88% underwent a procedure or had a condition that predisposed to infection, mainly the placement of a central venous catheter and previous surgery. In 59% the isolated Candida species were Candida albicans. Amphotericin B deoxycholate was the empirical treatment of choice. Median time of treatment was 21 days and median hospital stay was 66 days. Mortality was 12% and was associated with ICU admission, presence of fever at the time of diagnosis, and requirement of mechanical ventilation (AU)

Anidulafungina en niños: Experiencia en niños con trasplante de médula ósea / Anidulafungin in children: experience in children undergoing bone marrow transplantation

Introducción: Las infecciones fúngicas invasoras (IFI) son un problema de salud cada vez mayor, y se asocian con una alta morbilidad y mortalidad. Las nuevas opciones terapéuticas, tales como las equinocandinas y entre estos anidulafungina, se han utilizado en la población adulta, pero en pacientes pediátricos con trasplante de médula ósea la experiencia es escasa. Objetivo: El objetivo de este estudio descriptivo es presentar nuestra experiencia con el uso de la anidulafungina como profilaxis o tratamiento en pacientes con trasplante de médula ósea. Material y métodos: Entre enero hasta junio 2016, 29 pacientes trasplantados de médula ósea recibieron anidulafungina como profilaxis o tratamiento de infecciones fúngicas invasivas (IFI) probadas, probables o posibles. En todos los casos se monitorizó el valor de transaminasas, bilirrubina, creatinina y el recuento de glóbulos blancos al inicio y al final del tratamiento. Resultados: La anidulafungina se administró por vía intravenosa en una dosis de carga de 3 mg/kg/día, seguida de 1,5 mg/kg/día durante una mediana (Md) de 16 días (intervalo intercuartílico: 2-65 d). La Md de la edad de los pacientes fue de 97 meses (rango: 6-211m). La anidulafungina fue indicada como tratamiento en 7 casos (24%) y como profilaxis primaria o secundaria,en 22 (76%). En un paciente se confirmó microbiológicamente una IFI, por Candida albicans. Las Md de los parámetros bioquímicos en el inicio del tratamiento y al final, fueron: transaminasas GOT 29,5 U/l y 32 U/l (p 0,44); bilirrubina 0,35 y 0,30 mg/dL (p: 0,20); creatinina, 0,52 y 0,60 mg/dl (p:0,67). El recuento de glóbulos blancos mostró una gran variabilidad debido a la enfermedad subyacente, pero la diferencia de su valor entre el inicio y al final de la administración del fármaco, no fue significativo: Md 2810 células/mm3 y 5160 células/mm3, respectivamente (p: 0,07). Ninguno de los pacientes tuvo eventos adversos o murieron por causas relacionadas con anidulafungina. En el seguimiento a 30 días no se registró recaída de la infección o mortalidad relacionada a la droga. Conclusiones: Los resultados de nuestra serie sugieren que la anidulafungina podría ser una opción para la profilaxis o el tratamiento de las IFI en los niños con trasplante de médula ósea. Se requieren más estudios para confirmar estas observaciones (AU)

Introduction: Invasive fungal infections (IFI) are an increasing health problem associated with high morbidity and mortality. New treatment options, such as echinocandins and among these anidulafungin, have been used in the adult population, but experience in children undergoing bone marrow transplantation is scarce. Aim: The aim of this descriptive study is to present our experience with the use of anidulafungine as prophylaxis or treatment in patients undergoing bone marrow transplantation. Material and methods: Between January and June 2016, 29 patients who underwent bone marrow transplantation received anidulafungin as prophylaxis against or treatment for confirmed, probable, or possible (IFI). In all cases transaminase, bilirubin, and creatinine levels as well as total white blood cell count were monitored at treatment initiation and completion. Results: Anidulafungine is administered intravenously in a loading dose of 3 mg/kg/day, followed by 1.5 mg/kg/day for a mean of 16 days (interquartile range: 2-65 d). Mean age of the patients was 97 months (range: 6-211m). Anidulafungine was used as treatment in 7 cases (24%) and as primary or secondary prophylaxis in 22 (76%). IFI was microbiologically confirmed to be Candida albicans in one patient. Mean biochemical parameters at treatment onset and completion were: transaminases AST 29.5 U/l and 32 U/l (p 0.44); bilirubin 0.35 and 0.30 mg/dL (p 0.20); creatinine, 0.52 and 0.60 mg/dl (p : 0.67). White blood cell count was highly variable due to the underlying disease; however, the difference between values at treatment initiation and completion were not significant: Mean 2810 cells/mm3 and 5160 cells/mm3, respectively (p: 0.07). None of the patients had adverse effects or died because of anidulafungin-related causes. At 30 days of follow-up no relapse of infection or drug-related mortality was observed. Conclusions: The results in our series suggest that anidulafungin is an option for the prophylaxis against or treatment of IFI in children undergoing bone marrow transplantation. Further studies are necessary to confirm these findings (AU)

Genotypic study of strains belonging to the genus Trichosporon.

Trichosporon asahii is an opportunistic fungus considered the leading etiologic agent of trichospornosis, a disease that causes great morbidity/mortality among affected patients. The identification of the etiologic agent is generally obtained through physiological and morphological studies. Molecular investigations, such as species-specific primers (PCR), have recently been developed with the aim of applying a more simple, specific, and faster technology for mycological diagnosis. The genetic material amplification technique using ad-random primers (RAPD: random amplified polymorphic DNA) is an epidemiological tool which enables research on infection by and transmission of suspected agents. In this study, the amplified polymorphic DNA technique was used to determine the intraspecific diversity of 10 Trichosporon asahii strains. Primers OPAO-15 and 1821 were used and these allowed association to 5 and 3 electrophoretic patterns, respectively. The T. asahii molecular identification, which had been previously analyzed by conventional methods, was performed by means of primers TAAF and pITS4. Our results support the use of these techniques for clonality studies of the strains of this fungus as well as for the fast and specific identification of its members in clinical cases.

Susceptibility of Candida species to fluconazole assayed by a disk diffusion method with automated reading versus a microdilution method.

In vitro susceptibilities of 290 isolates of Candida spp to fluconazole were evaluated by a new NCCLS M44-P agar disk diffusion method that was read and interpreted automatically by the BIOMIC image-analysis plate reader system. Disk test results were compared to results obtained by a modified NCCLS M27-A broth microdilution method using RPMI-1640 supplemented with 2% dextrose. Overall agreement between both methods was 90.0%. Category agreement between the broth and disk test results for susceptible, susceptible dose-dependent and resistant disk results were 99.6%, 19.05% and 52.17%, respectively. No very major discrepancies, 1.03% major discrepancies, and 8.97% minor discrepancies were observed between results of the two test methods. This analysis suggests that results from both methods correlate highly for Candida strains susceptible to fluconazole. The lower agreement between the two methods for resistant and susceptible dose-dependent isolates was due to strains near or on that breakpoint, different media (Mueller-Hinton vs RPMI), agar vs broth, 80% vs 50% endpoints, and trailing growth near the endpoints.

Susceptibility of Candida species to fluconazole assayed by a disk diffusion method with automated reading versus a microdilution method.

In vitro susceptibilities of 290 isolates of Candida spp to fluconazole were evaluated by a new NCCLS M44-P agar disk diffusion method that was read and interpreted automatically by the BIOMIC image-analysis plate reader system. Disk test results were compared to results obtained by a modified NCCLS M27-A broth microdilution method using RPMI-1640 supplemented with 2

dextrose. Overall agreement between both methods was 90.0

. Category agreement between the broth and disk test results for susceptible, susceptible dose-dependent and resistant disk results were 99.6

, 19.05

and 52.17

, respectively. No very major discrepancies, 1.03

major discrepancies, and 8.97

minor discrepancies were observed between results of the two test methods. This analysis suggests that results from both methods correlate highly for Candida strains susceptible to fluconazole. The lower agreement between the two methods for resistant and susceptible dose-dependent isolates was due to strains near or on that breakpoint, different media (Mueller-Hinton vs RPMI), agar vs broth, 80

vs 50

endpoints, and trailing growth near the endpoints.

Susceptibility of Candida species to fluconazole assayed by a disk diffusion method with automated reading versus a microdilution method

In vitro susceptibilities of 290 isolates of Candida spp to fluconazole were evaluated by a new NCCLS M44-P agar disk diffusion method that was read and interpreted automatically by the BIOMIC image-analysis plate reader system. Disk test results were compared to results obtained by a modified NCCLS M27-A broth microdilution method using RPMI-1640 supplemented with 2

. Category agreement between the broth and disk test results for susceptible, susceptible dose-dependent and resistant disk results were 99.6

major discrepancies, and 8.97

minor discrepancies were observed between results of the two test methods. This analysis suggests that results from both methods correlate highly for Candida strains susceptible to fluconazole. The lower agreement between the two methods for resistant and susceptible dose-dependent isolates was due to strains near or on that breakpoint, different media (Mueller-Hinton vs RPMI), agar vs broth, 80

endpoints, and trailing growth near the endpoints.

[Comparative study of the Candida albicans genotypes isolated from immunocompromised patients and health carriers]. / Estudio comparativo de los genotipos de Candida albicans aislados de pacientes inmunocomprometidos y portadores sanos.

The aim of this study is to compare Candida albicans strain genotype isolates from oral cavity of immunocompromised patients due to different immunologic impairments with apparently normal carriers. Four populations were studied: 1) HIV positive hospitalized patients, 2) HIV negative immunocompromised patients (leukemia, lymphoma, organ transplant recipients), 3) drug addicts prior to AIDS pandemia in Argentina, 4) apparently normal carriers. DNA extracted was digested with the enzyme Eco RI, electrophoresed, transferred to nitrocellulose membrane and hybridized with the 27A probe labelled with 32P. The comparison between the profiles obtained permitted the differentiation of 16 genotypes. The distribution of the strains led to the conclusion that: a) all the isolated strains from AIDS patients were closely related and distributed in only three genotypes (1, 3, 11); b) a major genetic relationship between the isolates from AIDS patients and HIV negative immunocompromised patients was observed; c) strains from carriers showed a minor genetic similarity with those obtained from AIDS patients; d) characteristic profiles belonging to any of the studied groups were not found; e) significant genomic changes have not been observed during the last twenty years.

Estudio comparativo de los genotipos de Candida albicans aislados de pacientes inmunocomprometidos y portadores sanos. / [Comparative study of the Candida albicans genotypes isolated from immunocompromised patients and health carriers]

The aim of this study is to compare Candida albicans strain genotype isolates from oral cavity of immunocompromised patients due to different immunologic impairments with apparently normal carriers. Four populations were studied: 1) HIV positive hospitalized patients, 2) HIV negative immunocompromised patients (leukemia, lymphoma, organ transplant recipients), 3) drug addicts prior to AIDS pandemia in Argentina, 4) apparently normal carriers. DNA extracted was digested with the enzyme Eco RI, electrophoresed, transferred to nitrocellulose membrane and hybridized with the 27A probe labelled with 32P. The comparison between the profiles obtained permitted the differentiation of 16 genotypes. The distribution of the strains led to the conclusion that: a) all the isolated strains from AIDS patients were closely related and distributed in only three genotypes (1, 3, 11); b) a major genetic relationship between the isolates from AIDS patients and HIV negative immunocompromised patients was observed; c) strains from carriers showed a minor genetic similarity with those obtained from AIDS patients; d) characteristic profiles belonging to any of the studied groups were not found; e) significant genomic changes have not been observed during the last twenty years.

Estudio comparativo de los genotipos de Candida albicans aislados de pacientes inmunocomprometidos y portadores sanos / [Comparative study of the Candida albicans genotypes isolated from immunocompromised patients and health carriers]

The aim of this study is to compare Candida albicans strain genotype isolates from oral cavity of immunocompromised patients due to different immunologic impairments with apparently normal carriers. Four populations were studied: 1) HIV positive hospitalized patients, 2) HIV negative immunocompromised patients (leukemia, lymphoma, organ transplant recipients), 3) drug addicts prior to AIDS pandemia in Argentina, 4) apparently normal carriers. DNA extracted was digested with the enzyme Eco RI, electrophoresed, transferred to nitrocellulose membrane and hybridized with the 27A probe labelled with 32P. The comparison between the profiles obtained permitted the differentiation of 16 genotypes. The distribution of the strains led to the conclusion that: a) all the isolated strains from AIDS patients were closely related and distributed in only three genotypes (1, 3, 11); b) a major genetic relationship between the isolates from AIDS patients and HIV negative immunocompromised patients was observed; c) strains from carriers showed a minor genetic similarity with those obtained from AIDS patients; d) characteristic profiles belonging to any of the studied groups were not found; e) significant genomic changes have not been observed during the last twenty years.

Oropharyngeal candidosis in AIDS patients: an epidemiological study using restriction analysis of Candida albicans total genomic DNA.

This study investigates the epidemiology of Candida albicans strains isolated from oral and rectal swabs obtained before and after treatment with antifungal drugs in hospitalized AIDS patients. Twenty-one health care workers from the hospital unit were also studied. Samples were obtained from the oral cavity and hands. The molecular fingerprinting restriction endonuclease-digested genomic DNA technique was used. A total of 94 C. albicans strains were isolated: 76 from patients and 18 from the health care workers. Each sample was digested independently with EcoRI and HinfI restriction enzymes, electrophoresed on 0.8% agarose gels and stained with ethidium bromide. The strains were sorted into groups according to patterns. Analysis of the different restriction patterns suggests that most of the infective strains had an endogenous source, whereas the recurrences of candidosis, after antifungal therapy, could be considered as persistence or reinfection by a different strain. Our data show that horizontal transmission by strains carried by health care workers does not play an important role in the overall epidemiology of candidosis.

[Preparation and study of an exoantigen of Histoplasma capsulatum for serological reactions.]. / Preparación y estudio de un exoantigeno de la fase levaduriforme de Histoplasma capsulatum para reacciones serológicas.

The aim of this study was to determine the usefulness of a yeast-phase exo-antigen of Histoplasma capsulatum in standard serologic reactions. Three native strains of H.capsulatum which belong to Mycology Center collection were employed. They were maintained in their yeast-phase by weekly subcultures in 2% dextrose broth agar at 37 degrees C. After one week incubation yeast cells were suspended in distilled water containing thimerosal and phenylmethyl sulfonyl fluoride at a concentration of 1:5000. This suspension was left at room temperature for 72 h, then the supernatant was separated by centrifugation and it was lyophilized. Proteins and polysaccharides concentrations were determined. Immunodiffusion (ID) tests were carried out with an antigenic dilution containing 1.4 mg/ml of proteins. This exo-antigen was submitted to SDS-PAGE. Seven protein fractions were detected but only two of them showed antigenic activity against a pool of positive human sera; the molecular weights of these two proteins were 97 kDa and 66 kDa respectively. A metabolic antigen from the mycelial phase of H. capsulatum was used as control. A rabbit gammaglobulin anti-H. capsulatum was prepared and employed as positive control in serologic reactions. The antigenic capacity of ten batches of this exo-antigen was studied by ID and counterimmunoelectrophoresis (CIE) tests using serum samples of 20 hamsters experimentally infected by intracardiac inoculation of the yeast-phase of H. capsulatum. All tests presented positive results after three weeks of the infection. Fifty sera from patients suffering progressive histopasmosis were analyzed: ID, CIE and complement fixation (CF) tests were performed in all cases. HIV negative patients presented 7/7 (100%) positive reactions with the yeast-phase exoantigen and 5/7 (71.4%) with histoplasmin. In HIV positive patients CIE and CF were the most sensitive serologic tests, they gave positive results in 15/43 cases (34.8%) with the yeast-phase exo-antigen and in 7/43 cases (13.9%) with histoplasmin. Sera from 10 patients with paracoccidioidomycosis, aspergillosis and candidiasis respectively were studied by ID with the aim of detecting serologic cross reactions. No cross reaction was detected in these serum samples. This yeast-phase exo-antigen of H. capsulatum is more sensitive than and equally as specific as control histoplasmin.

Tratamiento de la coccidioidomicosis experimental en ratas Wistar / Experimental treatment of coccidioidomycosis in Wistar rats

Se realizó un estudio comparativo entre Itraconazol (I) y Fluconazol (F) en el tratamiento de la coccidioidomicosis experimental en ratas Wistar. Treinta animales de 250 g de peso fueron inoculados con 200 artroconidias de Coccidioides immitis por vía intercardíaca. Ambas drogas fueron administradas por gastroclisis a razón de 200 mg//kg/día durante 5 semanas a partir del 7 día post-inoculación. El grupo control recibió el solvente de las drogas. Los animales que sobrevivieron 2 semanas después de concluído el tratamiento fueron sacrificados y se le realizaron los siguientes estudios: 1) examen macroscópico (presencia de granulomas) y microscópico (presencia de esporangios) en los pulmones; 2) unidades formadoras de colonias en homogeneizado de pulmones; 3) estudio histopatológico de pulmones con H & E realizando una evaluación semi-cuantitativa contando: a) número de granulomas por campo de 50x; b) número de esporangios con esporangiosporos en cada granuloma y c) número de esporangios vacíos. Los resultados obtenidos mostraron que el itraconazol fue más eficaz que el fluconazol en el tratamiento de este modelo experimental, en la evaluación efectuada a través de varios de los parámetros considerados: 1) se comprobaron menor cantidad de cultivos pulmonares positivos, (30 por ciento vs 100 por ciento); 2) menor número de UFC/g de pulmón (<1x10 vs 1.7x10 ); 3) menos cantidad de granulomas pulmonares en el estudio histopatológico (1/14 campos vs 1/4 campos); 4) menor cantidad de esporangios por granuloma (0 vs 33) y 5) mayor número de esporangios vacíos o alterados. Cabe señalar, sin embargo, que el fluconazol fue capaz de reducir el número de UFC/g pulmón,comparando con el grupo control

Tratamiento de la coccidioidomicosis experimental en ratas Wistar / Experimental treatment of coccidioidomycosis in Wistar rats

Se realizó un estudio comparativo entre Itraconazol (I) y Fluconazol (F) en el tratamiento de la coccidioidomicosis experimental en ratas Wistar. Treinta animales de 250 g de peso fueron inoculados con 200 artroconidias de Coccidioides immitis por vía intercardíaca. Ambas drogas fueron administradas por gastroclisis a razón de 200 mg//kg/día durante 5 semanas a partir del 7 día post-inoculación. El grupo control recibió el solvente de las drogas. Los animales que sobrevivieron 2 semanas después de concluído el tratamiento fueron sacrificados y se le realizaron los siguientes estudios: 1) examen macroscópico (presencia de granulomas) y microscópico (presencia de esporangios) en los pulmones; 2) unidades formadoras de colonias en homogeneizado de pulmones; 3) estudio histopatológico de pulmones con H & E realizando una evaluación semi-cuantitativa contando: a) número de granulomas por campo de 50x; b) número de esporangios con esporangiosporos en cada granuloma y c) número de esporangios vacíos. Los resultados obtenidos mostraron que el itraconazol fue más eficaz que el fluconazol en el tratamiento de este modelo experimental, en la evaluación efectuada a través de varios de los parámetros considerados: 1) se comprobaron menor cantidad de cultivos pulmonares positivos, (30 por ciento vs 100 por ciento); 2) menor número de UFC/g de pulmón (<1x10 vs 1.7x10 ); 3) menos cantidad de granulomas pulmonares en el estudio histopatológico (1/14 campos vs 1/4 campos); 4) menor cantidad de esporangios por granuloma (0 vs 33) y 5) mayor número de esporangios vacíos o alterados. Cabe señalar, sin embargo, que el fluconazol fue capaz de reducir el número de UFC/g pulmón,comparando con el grupo control

Características epidemiológicas de 71 casos de criptococosis diagnosticados en diferentes centros asistenciales de la ciudad de Buenos Aires y sus alrededores, durante 1991 / Epidemiological characteristics of 71 cases of cryptococcosis diagnosed in different medical centers of the city of Buenos Aires and its suburbs, in 1991

Se estudiaron algunas características epidemiológicas de 71 casos de criptococosis diagnosticados en 8 centros asistenciales de la ciudad de Buenos Aires y el Gran Buenos Aires, durante 1991. Los hospitales Muñiz y Fernández, comunicaron cerca del 85 por ciento de los casos. El 89 por ciento de los pacientes era de sexo masculino. Las causas predisponentes fueron SIDA (66 casos), transplante renal (2 casos), hepatopatía autoinmune tratada con corticoides, diabetes descompensada y embarazo/puerperio. La mediana de la edad fue de 27 años en la población total (rango 19-62), de 27 años en los casos asociados al SIDA (rango 19-50) y de 50 años en los no asociados a esa enfermedad (rango 24-62). El 56 por ciento de los pacientes se ubicó en el grupo etario de 20-29 años de edad. Una estimación indirecta permite suponer que el porcentaje de pacientes con SIDA que padecieron criptococosis durante 1991 en el área en estudio fue de 25,88 por ciento. El 100 por ciento de 32 casos de Cryptococcus neoformans aisladas de los pacientes fueron identificadas como variedad neoformans. La criptococosis aumenta año a año su incidencia en nuestro medio, paralelamente con su causa predisponente más importante, el SIDA. Su transformación potencial en un problema sanitario, debe alertar a la autoridades competentes

Características epidemiológicas de 71 casos de criptococosis diagnosticados en diferentes centros asistenciales de la ciudad de Buenos Aires y sus alrededores, durante 1991 / Epidemiological characteristics of 71 cases of cryptococcosis diagnosed in different medical centers of the city of Buenos Aires and its suburbs, in 1991

Se estudiaron algunas características epidemiológicas de 71 casos de criptococosis diagnosticados en 8 centros asistenciales de la ciudad de Buenos Aires y el Gran Buenos Aires, durante 1991. Los hospitales Muñiz y Fernández, comunicaron cerca del 85 por ciento de los casos. El 89 por ciento de los pacientes era de sexo masculino. Las causas predisponentes fueron SIDA (66 casos), transplante renal (2 casos), hepatopatía autoinmune tratada con corticoides, diabetes descompensada y embarazo/puerperio. La mediana de la edad fue de 27 años en la población total (rango 19-62), de 27 años en los casos asociados al SIDA (rango 19-50) y de 50 años en los no asociados a esa enfermedad (rango 24-62). El 56 por ciento de los pacientes se ubicó en el grupo etario de 20-29 años de edad. Una estimación indirecta permite suponer que el porcentaje de pacientes con SIDA que padecieron criptococosis durante 1991 en el área en estudio fue de 25,88 por ciento. El 100 por ciento de 32 casos de Cryptococcus neoformans aisladas de los pacientes fueron identificadas como variedad neoformans. La criptococosis aumenta año a año su incidencia en nuestro medio, paralelamente con su causa predisponente más importante, el SIDA. Su transformación potencial en un problema sanitario, debe alertar a la autoridades competentes (AU)