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1.
Pol J Microbiol ; 68(3): 303-308, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31880875

RESUMO

The data on susceptibility to antifungals of new species within Candida glabrata complex are limited. Our study was to enrich a global knowledge of yeast epidemiology and drug resistance. The study was focused on the identification of species within clinical isolates of the C. glabrata complex and on the determination of their resistance to antifungals. Four hundred forty-five clinical C. glabrata sensu lato strains were isolated from different clinical samples at routine mycological exams at the Infant Jesus Teaching Hospital in Warsaw. The identification of the most of tested isolates to species complex level was performed using the ID 32 C system. The identification of C. nivariensis and C. bracarensis species within the C. glabrata complex was performed by DNA sequencing. The MICs of amphotericin B, fluconazole, itraconazole, posaconazole, voriconazole, caspofungin, anidulafungin, and micafungin were determined by E-test. Twenty-four isolates did not have an ITS-1 region, characteristic of C. glabrata sensu stricto and their D1/D2 regions of the 26S rRNA were 99% homologous to C. nivariensis 26S rRNA. No strains of C. bracarensis were recovered. C. nivariensis strains were very susceptible to amphotericin B, anidulafungin, micafungin, and caspofungin. Ninety-two percent of C. nivariensis were resistant to itraconazole. The halves of the strains was resistant to posaconazole. Eighty-three percent of C. nivariensis were susceptible to voriconazole. None of the tested strains were susceptible to fluconazole. In the present study, none of the C. nivariensis strains were simultaneously resistant to azoles and echinocandins. C. nivariensis should be recognized as an emerging pathogen, resistant to azoles.The data on susceptibility to antifungals of new species within Candida glabrata complex are limited. Our study was to enrich a global knowledge of yeast epidemiology and drug resistance. The study was focused on the identification of species within clinical isolates of the C. glabrata complex and on the determination of their resistance to antifungals. Four hundred forty-five clinical C. glabrata sensu lato strains were isolated from different clinical samples at routine mycological exams at the Infant Jesus Teaching Hospital in Warsaw. The identification of the most of tested isolates to species complex level was performed using the ID 32 C system. The identification of C. nivariensis and C. bracarensis species within the C. glabrata complex was performed by DNA sequencing. The MICs of amphotericin B, fluconazole, itraconazole, posaconazole, voriconazole, caspofungin, anidulafungin, and micafungin were determined by E-test. Twenty-four isolates did not have an ITS-1 region, characteristic of C. glabrata sensu stricto and their D1/D2 regions of the 26S rRNA were 99% homologous to C. nivariensis 26S rRNA. No strains of C. bracarensis were recovered. C. nivariensis strains were very susceptible to amphotericin B, anidulafungin, micafungin, and caspofungin. Ninety-two percent of C. nivariensis were resistant to itraconazole. The halves of the strains was resistant to posaconazole. Eighty-three percent of C. nivariensis were susceptible to voriconazole. None of the tested strains were susceptible to fluconazole. In the present study, none of the C. nivariensis strains were simultaneously resistant to azoles and echinocandins. C. nivariensis should be recognized as an emerging pathogen, resistant to azoles.


Assuntos
Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Candidíase/microbiologia , Anfotericina B/farmacologia , Candida/classificação , Candida/genética , Candida/isolamento & purificação , Candidíase/epidemiologia , Farmacorresistência Fúngica , Fluconazol/farmacologia , Hospitais de Ensino/estatística & dados numéricos , Humanos , Testes de Sensibilidade Microbiana , Polônia/epidemiologia , Prevalência , Triazóis/farmacologia
2.
Pan Afr Med J ; 33: 198, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692732

RESUMO

Introduction: Epidemiology of these disorders, mainly caused by mycosis, is little known in the Ivory Coast. The aim of this study was to determine the different clinical aspects of intertrigos caused by fungal infections. Methods: We conducted a cross-sectional study in the Department of Clinical Dermatology at the University Hospital in Yopougon (Abidjan, Ivory Coast) from April to October 2012. The study involved the patients come to consultation with lesions in the folds suggesting a mycosis. Samples of serous fluid by swabbing or of scales by scrape cutting with the scalpel blade were performed at the level of the lesions. The fungal agents responsible for these lesions were identified after biological culture. Results: A total of 200 patients had lesions suggesting intertrigo caused by fungal infection. The average age of patients was 29.8 years (with a standard deviation of 11.1 years). Mycosis-related intertrigos accounted for 6.7% of reasons for consultation. A female predominance was observed (76.7%). Lesions mainly occurred in the groin area (40.8%) and in the intergluteal clefts (36.9%). The most observed symptoms were maceration (52.4%) followed by burning (18.4%). In 89.3% of cases, intertrigos were caused by yeasts, including Candida albicans (33%), and Candida parapsilosis(19.4%) which were predominant. Conclusion: Mycosis-related intertrigos mainly affect the young adults of female sex. Lesions mainly occur at the level of the inguinal folds and intergluteal clefts. The main etiological agents are yeasts (Candida).


Assuntos
Candidíase/epidemiologia , Intertrigo/epidemiologia , Micoses/epidemiologia , Adolescente , Adulto , Candida/isolamento & purificação , Candidíase/microbiologia , Criança , Pré-Escolar , Costa do Marfim , Estudos Transversais , Feminino , Hospitais Universitários , Humanos , Lactente , Intertrigo/microbiologia , Masculino , Pessoa de Meia-Idade , Micoses/microbiologia , Fatores Sexuais , Adulto Jovem
3.
BMC Infect Dis ; 19(1): 759, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31470800

RESUMO

BACKGROUND: Surveillance of current changes in the epidemiology of Invasive Fungal Diseases (IFDs) as an important component of the antifungal stewardship programs (ASP), requires careful regular monitoring, especially in high-risk settings such as oncology centers. This study aimed to examine Candida colonization status and corresponding current changes in children with malignancy during repeated admissions and also investigate the possible epidemiological shifts after the implementation of ASP. METHODS: In this prospective observational study, all eligible patients younger than 18 years were recruited during 2016-2017 at Amir Medical Oncology Center (AMOC) in Shiraz, Iran. Totally, 136 patients were enrolled and 482 samples were collected from different sites (oral/nasal discharges, urine and stool). Weekly regular sampling was carried out during hospitalization. Candida colonization status and epidemiological changes were monitored during repeated admissions. Samples were cultivated on Sabouraud Dextrose agar medium and identified by Polymerase Chain Reaction -Restriction Fragment Length Polymorphism (PCR-RFLP). RESULTS: Estimated Candida colonization incidence was 59.9% (82/136) in our patients. Candida colonization was found to be higher in oral cavity and rectum than that in nasal cavity. Among those long-term follow ups and repetitive hospitalizations, a significant number of patients exhibited changes in their colonization patterns (37.7%). Candida colonization did not reveal any significant relationship with age, sex, oncologic diseases and degree of neutropenia. C. albicans (72.0%) was found as the most common Candida species in colonized patients, followed by C. krusei, C. kefyr, C. glabrata and C. parapsilosis. CONCLUSION: Given the high incidence of Candida infections in children with cancers, close monitoring of epidemiologic changes is essential for judicious management, based on local surveillance data and improvement of overall quality of care in high risk patients.


Assuntos
Candida/classificação , Candida/isolamento & purificação , Infecção Hospitalar/microbiologia , Neoplasias Hematológicas/microbiologia , Readmissão do Paciente , Adolescente , Candida/genética , Candidíase/epidemiologia , Candidíase/microbiologia , Criança , Pré-Escolar , Infecção Hospitalar/epidemiologia , Feminino , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/epidemiologia , Neoplasias Hematológicas/terapia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Masculino , Boca/microbiologia , Nariz/microbiologia , Readmissão do Paciente/estatística & dados numéricos , Readmissão do Paciente/tendências , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de Restrição , Estudos Prospectivos , Reto/microbiologia , Recidiva
4.
Med Mycol J ; 60(3): 75-82, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31474694

RESUMO

We report here the results of the 2016 epidemiological survey of dermatomycosis in Japan. In total, 6,776 cases were analyzed as follows: dermatophytosis, 5,772 cases (85.2%); candidiasis, 757 cases (11.2%); Malassezia infection, 235 cases (3.5%); and other fungal infections, 11 cases (0.2%). In dermatophytosis, tinea pedis was the most frequent (3,314 cases: male, 1,705; female, 1,609), followed by tinea unguium (1,634 cases: male, 766; female, 868), tinea corporis (423 cases: male, 241; female, 182); tinea cruris (316 cases: male, 242; female, 74); tinea manuum (58 cases: male, 29; female, 29); tinea capitus, Celsus' kerion (26 cases: male, 19; female, 7); and tinea barbae (1 case: male, 1). The most frequent pathogen was Trichophyton rubrum. In candidiasis, candidal intertrigo was the most frequent (181 cases: male, 98; female, 83), followed by oral candidiasis (165 cases: male, 84; female, 81), genital candidiasis (119 cases: male, 45; female, 74), diaper candidiasis (113 cases: male, 49; female, 64), erosio interdigitalis (63 cases: male, 13; female, 50), onychomycosis (41 cases: male, 17; female, 24), onychia et paronychia (28 cases: male, 2; female, 26), and angular cheilitis (23 cases: male, 6; female, 17). Although the number of cases varied depending on the role of each cooperating medical institution in the area and on population composition, no significant differences in the frequencies of clinical types were observed.


Assuntos
Dermatomicoses/epidemiologia , Malassezia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Candidíase/epidemiologia , Criança , Pré-Escolar , Dermatomicoses/microbiologia , Feminino , Humanos , Lactente , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Onicomicose/epidemiologia , Onicomicose/microbiologia , Prevalência , Fatores Sexuais , Fatores de Tempo , Tinha/epidemiologia , Tinha/microbiologia , Tinha do Couro Cabeludo/epidemiologia , Tinha do Couro Cabeludo/microbiologia , Tinha dos Pés/epidemiologia , Tinha dos Pés/microbiologia , Trichophyton/patogenicidade , Adulto Jovem
5.
Future Microbiol ; 14: 1083-1085, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31512518

RESUMO

In this exclusive interview, Dimitrios P Kontoyiannis discusses current mycology hot topic, Candida auris. With a focus on the current knowns and unknowns for the pathogenesis, resistance and transmission of this emerging fungal pathogen, in addition to a look at therapeutics and future perspectives. This interview was conducted by Ellen Colvin, Commissioning Editor of Future Microbiology. Dimitrios P Kontoyiannis is the Texas 4000 distinguished endowed professor and deputy head in the Division of Internal Medicine at MD Anderson Cancer Center in Houston (TX, USA). Dr Kontoyiannis has authored over 550 peer-reviewed manuscripts and has given over 330 lectures in national and international conferences and academic institutions in the USA and abroad. He is considered a leading mycology expert world-wide with an H index of 101 and over 43,000 citations. His research group is credited for many and sustained contributions to clinical, translational and experimental mycology. He is the recipient of many national and international awards and is the past president elect of Immunocompromised Host Society (2016-2018).


Assuntos
Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Candida/isolamento & purificação , Candidíase/epidemiologia , Infecção Hospitalar/epidemiologia , Transmissão de Doença Infecciosa , Farmacorresistência Fúngica Múltipla , Antifúngicos/uso terapêutico , Candidíase/tratamento farmacológico , Candidíase/microbiologia , Candidíase/transmissão , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/microbiologia , Doenças Transmissíveis Emergentes/transmissão , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Infecção Hospitalar/transmissão , Gerenciamento Clínico , História do Século XX , História do Século XXI , Prevalência , Texas
6.
Acta Biochim Pol ; 66(3): 361-364, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31518088

RESUMO

PURPOSE: Candida spp. are ranked as one of the four major causative agents of fungal infections. The number of infections caused by Candida species resistant to fluconazole, which is applied as the first line drug in candidiasis treatment, increases every year. In such cases the application of echinocandin is necessary. Echinocandin susceptibility testing has become a routine laboratory practice in many countries due to the increasing frequency of clinical failures during treatment with these drugs. METHODS: We performed anidulafungin, micafungin and caspofungin susceptibility testing according to the microdilution broth method on 240 Candida isolates collected in Polish hospitals. RESULTS: We identified 12 isolates resistant to all echinocandins within 240 examined isolates. Moreover, 6 of the examined samples were identified as rare Candida species and among them we observed very high echinocandin MIC values. CONCLUSION: Our research proves that in Poland there is a problem of echinocandin resistance. Moreover, we identified two species of Candida which are rare causative agents of human infections, and there was no reported incidence of such infections in Poland until now.


Assuntos
Antifúngicos/uso terapêutico , Candida/efeitos dos fármacos , Candidíase/tratamento farmacológico , Candidíase/epidemiologia , Farmacorresistência Fúngica/efeitos dos fármacos , Equinocandinas/uso terapêutico , Anidulafungina/uso terapêutico , Candida/isolamento & purificação , Candidíase/microbiologia , Caspofungina/uso terapêutico , Equinocandinas/efeitos adversos , Humanos , Micafungina/uso terapêutico , Testes de Sensibilidade Microbiana , Polônia/epidemiologia
7.
J Pak Med Assoc ; 69(9): 1365-1368, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31511726

RESUMO

The oesophagus can be a site for a variety of lesions including inflammatory disorders, infections, mechanical conditions, toxic and physical injuries, vascular disorders and neoplastic conditions. hence the oesophageal diseases have a wide spectrum of pathological features. An understanding of histopathological details of oesophageal diseases is essential for their accurate diagnosis and management. The main objective of our study was to provide a comprehensive audit of oesophageal diseases in the province of Madinah in Saudi Arabia. From January 2006 to December 2017, were viewed the histopathological patterns of oesophageal lesions in patients at a tertiary care referral hospital who were diagnosed with oesophageal disease after upper gastroendoscopy. Of the 201 patients, 144 (71.6%) cases were found to be non-neoplastic and 57 (28.4%) cases were neoplastic. Our findings were comparable with earlier studies that helped establish a baseline of an oesophageal disease pattern, on the basis of histopathological examinations.


Assuntos
Doenças do Esôfago/epidemiologia , Adenocarcinoma/epidemiologia , Adenocarcinoma/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Esôfago de Barrett/epidemiologia , Esôfago de Barrett/patologia , Candidíase/epidemiologia , Candidíase/patologia , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia , Esofagite Eosinofílica/epidemiologia , Esofagite Eosinofílica/patologia , Doenças do Esôfago/patologia , Neoplasias Esofágicas/epidemiologia , Neoplasias Esofágicas/patologia , Esofagite Péptica/epidemiologia , Esofagite Péptica/patologia , Feminino , Humanos , Hiperplasia , Linfoma/epidemiologia , Linfoma/patologia , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/epidemiologia , Tumores Neuroendócrinos/patologia , Pólipos/epidemiologia , Pólipos/patologia , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Adulto Jovem
8.
Int J Antimicrob Agents ; 54(4): 400-406, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31419480

RESUMO

Candida auris (C. auris) is an emerging fungal pathogen causing invasive infections and outbreaks that have been difficult to control in healthcare facilities worldwide. There is a lack of current evidence for pragmatic infection prevention and control recommendations. The aim of this paper was to review the epidemiology of C. auris and identify best practices with a panel of experts, in order to provide guidance and recommendations for infection prevention and control measures based on available scientific evidence, existing guidelines and expert opinion. The Infection Prevention and Control working group of the International Society of Antimicrobial Chemotherapy organised an expert meeting with infection prevention and mycology experts to review recommendations for healthcare workers on infection prevention and control measures for C. auris at inpatient healthcare facilities. The most common interventions included: screening, standard precautions, cleaning and disinfection, inpatient transfer, outbreak management, decolonisation, and treatment.


Assuntos
Candida/isolamento & purificação , Candidíase/epidemiologia , Candidíase/prevenção & controle , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Controle de Infecções/métodos , Candidíase/microbiologia , Infecção Hospitalar/microbiologia , Instalações de Saúde , Humanos
9.
Emerg Infect Dis ; 25(9): 1698-1707, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31441749

RESUMO

Candida auris is an invasive healthcare-associated fungal pathogen. Cases of candidemia, defined as illness in patients with Candida cultured from blood, were detected through national laboratory-based surveillance in South Africa during 2016-2017. We identified viable isolates by using mass spectrometry and sequencing. Among 6,669 cases (5,876 with species identification) from 269 hospitals, 794 (14%) were caused by C. auris. The incidence risk for all candidemia at 133 hospitals was 83.8 (95% CI 81.2-86.4) cases/100,000 admissions. Prior systemic antifungal drug therapy was associated with a 40% increased adjusted odds of C. auris fungemia compared with bloodstream infection caused by other Candida species (adjusted odds ratio 1.4 [95% CI 0.8-2.3]). The crude in-hospital case-fatality ratio did not differ between Candida species and was 45% for C. auris candidemia, compared with 43% for non-C. auris candidemia. C. auris has caused a major epidemiologic shift in candidemia in South Africa.


Assuntos
Candida/isolamento & purificação , Candidíase/epidemiologia , Farmacorresistência Fúngica , Adolescente , Adulto , Idoso , Antifúngicos/uso terapêutico , Candidíase/tratamento farmacológico , Candidíase/microbiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Fatores de Risco , África do Sul/epidemiologia , Adulto Jovem
10.
BMC Infect Dis ; 19(1): 635, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31315582

RESUMO

BACKGROUND: The outcomes of deep-seated abscesses attributed to chronic disseminated candidiasis (CDC) in patients with hematological malignancies have rarely been reported in recent years. METHODS: We retrospectively reviewed and analyzed the data of patients with hematological malignancies who received a diagnosis of CDC at a medical center in Taiwan between 2008 and 2013. RESULTS: Sixty-one patients (32 men and 29 women) were diagnosed with CDC. The median age was 51 years (range: 18-83). The overall incidence of CDC was 1.53 per 100 patient-years in patients with hematological malignancies between 2008 and 2013. The highest incidence of CDC was 4.3 per 100 patient-years for acute lymphoblastic leukemia, followed by 3.6 for acute myeloid leukemia. We detected 3 (4.9%) proven, 13 (21.3%) probable, and 45 (73.8%) possible cases of CDC. A total of 13 patients had positive blood cultures for Candida species: C. tropicalis (8), C. albicans (2), C. glabrata (2), and C. famata (1). The median duration of antifungal treatment was 96 days (range: 7-796 days). Serial imaging studies revealed that the resolution rate of CDC was 30.0% at 3 months and 54.3% at 6 months. Five patients (8.2%) had residual lesions that persisted beyond one year. A multivariate analysis of the 90-day outcome revealed that shock was the only independent prognostic factor of 90-day survival in patients with CDC. CONCLUSION: The incidence of CDC did not decrease between 2008 and 2013. Patients with acute leukemia had a higher risk of CDC than those with other hematological malignancies. Imaging studies conducted at 6 months after diagnosis revealed that only half of the patients showed complete resolution. CDC requires prolonged treatment, and serial imaging at 6 months interval is suggested. Shock is the only independent prognostic factor of 90-day survival in patients with CDC.


Assuntos
Candidíase/etiologia , Neoplasias Hematológicas/complicações , Abscesso Hepático/microbiologia , Esplenopatias/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Candida/patogenicidade , Candidíase/diagnóstico por imagem , Candidíase/tratamento farmacológico , Candidíase/epidemiologia , Doença Crônica , Feminino , Neoplasias Hematológicas/microbiologia , Humanos , Abscesso Hepático/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esplenopatias/etiologia , Taxa de Sobrevida , Taiwan/epidemiologia
11.
J Infect Chemother ; 25(10): 743-749, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31257156

RESUMO

Candida auris is a multidrug-resistant and emergent pathogen that has caused healthcare-associated infection outbreaks. Recently, C. auris has spread worldwide; nevertheless, it was unexpectedly rare before 2009. Based on the molecular epidemiological analysis, C. auris may independently emerge at specific areas at first and recently may be transmitted to other continents. As C. auris cannot be detected using conventional methods, internally transcribed spacers, D1/D2 regions of the 26S rDNA sequencing, and/or matrix-assisted laser desorption ionization time-of-flight mass spectrometry method can be selected as comparatively accessible choices. Thus, detection of C. auris using the conventional method might be underestimated. In Japan, all C. auris strains were isolated from ear specimen and not from invasive mycoses. Japan strains were classified as an East Asian clade under a single clone. Although colonization, virulence, and infection pattern are almost the same as with other Candida species, its antifungal resistance is different. Fluconazole resistance is notably common, but resistance to all three classes of antifungals (azole, polyene, and echinocandin) rarely exists. Once C. auris is detected, screening, emphasis on hand hygiene adherence, use of single-patient room isolation, contact precaution, surveillance, and eradication from the environment and patients are appropriately required for infection control.


Assuntos
Antifúngicos/farmacologia , Candida/isolamento & purificação , Candidíase/tratamento farmacológico , Antifúngicos/uso terapêutico , Azóis/farmacologia , Azóis/uso terapêutico , Candida/efeitos dos fármacos , Candida/patogenicidade , Candidíase/epidemiologia , Candidíase/microbiologia , Farmacorresistência Fúngica Múltipla , Equinocandinas/farmacologia , Equinocandinas/uso terapêutico , Fluconazol/farmacologia , Fluconazol/uso terapêutico , Humanos , Japão/epidemiologia , Testes de Sensibilidade Microbiana , Polienos/farmacologia , Polienos/uso terapêutico , Prevalência
12.
Pak J Pharm Sci ; 32(3 (Supplementary)): 1185-1192, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31303589

RESUMO

Candida albicans was considered as the principal cause of opportunistic candidiasis but nowadays, neglected non-albicans Candida (NAC) species are evolving as more virulent and drug resistant strains. This research was intended to assess pervasiveness of candidiasis mainly caused by NAC species in Karachi city. A total of 562 clinical isolates of Candida spp. collected during the period of one year were identified by microscopic as well as morphological (germ tube formation, characteristics on CHROM agar and Corn meal agar) and Biochemical (sugar assimilation and fermentation) characteristics. Doubtful species were further identified by using Remel RapIDTM yeast plus kit. The results were statistically analyzed by SPSS 16.0 version software. Isolated strains of candida revealed slight predominance of C. albicans (54.5%) over non- albicans Candida species (45.5%). Among NAC species, C. tropicalis and C. glabrata were isolated as the predominant species. These clinical species were procured mainly from urine samples of females (73.7%) of age group 20-30 years. No significant correlations exist between Candida species and their months of isolation as well as their isolation from different districts of Karachi. Emergence of NAC species may predict an upcoming threat in health care facilities and hence, require prompt management and accurate identification to suggest empirical antifungal therapy.


Assuntos
Candida/isolamento & purificação , Candida/patogenicidade , Candidíase/epidemiologia , Candidíase/microbiologia , Adulto , Distribuição por Idade , Idoso , Candida albicans/isolamento & purificação , Candida albicans/patogenicidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Negligenciadas , Paquistão/epidemiologia , Estações do Ano , Urina/microbiologia , Adulto Jovem
15.
Emerg Infect Dis ; 25(7)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31211679

RESUMO

Candida auris is an emerging multidrug-resistant fungus that causes hospital-associated outbreaks of invasive infections with high death rates. During 2015-2016, health authorities in Colombia detected an outbreak of C. auris. We conducted an investigation to characterize the epidemiology, transmission mechanisms, and reservoirs of this organism. We investigated 4 hospitals with confirmed cases of C. auris candidemia in 3 cities in Colombia. We abstracted medical records and collected swabs from contemporaneously hospitalized patients to assess for skin colonization. We identified 40 cases; median patient age was 23 years (IQR 4 months-56 years). Twelve (30%) patients were <1 year of age, and 24 (60%) were male. The 30-day mortality was 43%. Cases clustered in time and location; axilla and groin were the most commonly colonized sites. Temporal and spatial clustering of cases and skin colonization suggest person-to-person transmission of C. auris. These cases highlight the importance of adherence to infection control recommendations.


Assuntos
Candida , Candidíase/epidemiologia , Candidíase/microbiologia , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/microbiologia , Infecção Hospitalar , Surtos de Doenças , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Candida/efeitos dos fármacos , Candidemia/epidemiologia , Candidemia/microbiologia , Candidíase/tratamento farmacológico , Candidíase/história , Criança , Pré-Escolar , Colômbia/epidemiologia , Doenças Transmissíveis Emergentes/história , Farmacorresistência Fúngica , Feminino , História do Século XXI , Humanos , Lactente , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Mortalidade , Avaliação de Resultados da Assistência ao Paciente , Vigilância em Saúde Pública , Estações do Ano , Adulto Jovem
16.
Emerg Infect Dis ; 25(9): 1763-1765, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31223105

RESUMO

The emerging yeast Candida auris has disseminated worldwide. We report on 7 cases identified in Germany during 2015-2017. In 6 of these cases, C. auris was isolated from patients previously hospitalized abroad. Whole-genome sequencing and epidemiologic analyses revealed that all patients in Germany were infected with different strains.


Assuntos
Antifúngicos/uso terapêutico , Candida/isolamento & purificação , Candidíase/epidemiologia , Antifúngicos/administração & dosagem , Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Candida/genética , Candidíase/microbiologia , Esquema de Medicação , Alemanha/epidemiologia , Humanos , Testes de Sensibilidade Microbiana , Viagem , Sequenciamento Completo do Genoma
17.
Rev. iberoam. micol ; 36(2): 55-60, abr.-jun. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-185476

RESUMO

Background: The number of fungal infections has increased in recent years in Rio Grande do Sul (RS), Brazil. Epidemiological studies are important for proper control of infections. Aims: To evaluate the etiology of fungal infections in patients in RS, from 2003 to 2015. Methods: This is a retrospective and longitudinal study carried out at Mycology Department of Central Laboratory of RS; 13,707 samples were evaluated. The variables sex, age, site of infection, and etiologic agent were analyzed. Susceptibility of Candida to fluconazole was tested in isolates from samples collected in 2015 from 51 outpatients. Results: Of the 13,707 samples, 840 cases (6.12%) of fungal infections were found and included in the analyses; female gender accounted for the 55.9% of the cases. The main fungus was Candida albicans (450 cases, 53.38%; p < 0.001). Onychomycosis was the most frequent infection in superficial mycoses. Systemic mycoses accounted for 54.05% of the cases, from which 68.8% occurred in males, mainly HIV-positive (33.11%), and the main etiologic agent in these cases was Cryptococcus neoformans (73.13%). Among 51 samples tested for susceptibility to fluconazole, 78.43% of Candida isolates were susceptible; 5.88% were susceptible in a dose-dependent manner, and 15.69% were resistant. Conclusions: C. albicans is a common cause of fungal infections in RS, accounting for half of the cases; resistance to antifungals was found in non-hospitalized patients. In addition, women seem to be more susceptible to fungal infections than men, however men show more systemic mycoses than women. The nails are the most common site of infection


Antecedentes: El número de casos de infecciones fúngicas ha aumentado en los últimos años en Rio Grande do Sul (RS), Brasil. Los estudios epidemiológicos son importantes para el control de estas infecciones. Objetivos: Evaluar la etiología de las infecciones fúngicas en pacientes de RS desde 2003 hasta 2015. Métodos: Este es un estudio retrospectivo y longitudinal realizado en el Departamento de Micología del Laboratorio Central de RS; se evaluaron 13.707 casos de infecciones. Se analizaron las variables sexo, edad, lugar de infección y agente etiológico. La sensibilidad de Candida al fluconazol se analizó en 51 aislamientos de muestras recogidas en el año 2015. Resultados: De las 13.707 muestras, 840 casos (6,12%) de infecciones fúngicas se incluyeron en el análisis; el 55,9% correspondieron a mujeres. El hongo predominante fue Candida albicans (450 casos, 53,38%; p < 0,001). La onicomicosis fue la infección más frecuente de las micosis superficiales. Las micosis sistémicas representaron el 54,05% de los casos; de estos, el 68,8% tuvieron lugar en hombres, principalmente VIH-positivos (33,11%), y el principal agente etiológico en estos casos fue Cryptococcus neoformans (73,13%). Entre las 51 muestras analizadas para determinar la sensibilidad al fluconazol, el 78,43% de los aislamientos de Candida fueron sensibles; el 5,88% fueron sensibles de forma dosis-dependiente y el 15,69% fueron resistentes. Conclusiones: C. albicans es una causa común de infecciones fúngicas en RS, pues representa la mitad de los casos; su resistencia a los antifúngicos se encontró entre pacientes ambulatorios. Además, parece que las mujeres son más susceptibles a las infecciones fúngicas que los hombres, mientras que los hombres presentan más micosis sistémicas que las mujeres; las uñas son el lugar más frecuente de infección


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Micoses/epidemiologia , Antifúngicos/uso terapêutico , Brasil/epidemiologia , Candida/efeitos dos fármacos , Candida/isolamento & purificação , Candida albicans/isolamento & purificação , Candidíase/epidemiologia , Candidíase/microbiologia , Criptococose/epidemiologia , Criptococose/microbiologia , Cryptococcus neoformans/isolamento & purificação , Fluconazol/uso terapêutico , Soronegatividade para HIV , Soropositividade para HIV/epidemiologia , Estudos Longitudinais , Testes de Sensibilidade Microbiana , Micoses/microbiologia , Onicomicose/epidemiologia , Onicomicose/microbiologia , Prevalência
18.
Int J Rheum Dis ; 22(7): 1239-1246, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31090187

RESUMO

AIM: To estimate incidence rate (IR) and risk factors for opportunistic infections (OI) in early rheumatoid arthritis (RA) patients. METHODS: Retrospective cohorts were identified in the Korean National Claims Database. Incident RA cases were recruited in 2010 (n = 14 081). Follow up was ended at the time of development of new OI or at the date of last visit within 12 months of diagnosis. The IR and standardized incidence ratio (SIR) of OI in early and overall RA (n = 226 838) over a year were calculated. A multivariable regression model was used to identify risk factors for OI in early RA. RESULTS: The IR of OI in early and overall RA were 3.81/100 and 3.67/100 person-years, respectively. The SIR for OI in early RA was 1.14 (95% CI, 1.05-1.23). Herpes zoster (SIR = 1.12, 95% CI, 1.03-1.22) and candidiasis (SIR = 2.40, 95% CI, 1.55-3.54) were common in early RA. Age (50 < age ≤ 60 [OR 1.74, 95% CI, 1.30-2.33], 60 < age ≤ 70 [OR 1.85, 95% CI, 1.36-2.52], age > 70 [OR 1.89, 95% CI, 1.34-2.68]), female sex (OR 1.40, 95% CI, 1.12-1.74), comorbidities (one comorbidity [OR 1.53, 95% CI, 1.24-1.89], ≥ two comorbidities [OR 1.84, 95% CI, 1.47-2.29]), and corticosteroid use of 5 mg/d or more (OR 1.38, 95% CI, 1.13-1.69) were significantly associated with increased risk of OI in early RA. CONCLUSION: Opportunistic infections, especially for herpes zoster and candidiasis, tend to occur more often in early RA than in overall RA. Age, female sex, comorbidities and corticosteroid use are related to increased OI in early RA patients.


Assuntos
Corticosteroides/efeitos adversos , Antirreumáticos/efeitos adversos , Artrite Reumatoide/tratamento farmacológico , Infecções Oportunistas/epidemiologia , Adulto , Fatores Etários , Idoso , Artrite Reumatoide/epidemiologia , Artrite Reumatoide/imunologia , Candidíase/epidemiologia , Candidíase/imunologia , Comorbidade , Bases de Dados Factuais , Feminino , Herpes Zoster/epidemiologia , Herpes Zoster/imunologia , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/imunologia , República da Coreia/epidemiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores de Tempo
19.
Isr Med Assoc J ; 5(21): 303-307, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31140219

RESUMO

BACKGROUND: With the widespread use of antifungal agents, the frequency of non-albicans Candida (NAC) blood-stream infections (BSI) is increasing. OBJECTIVES: To describe the epidemiology, clinical manifestations, and risk factors for NAC BSI, focusing on prior antifungal and immunosuppressive therapy. METHODS: The authors conducted an observational, retrospective cohort study among adult patients with candidemia at the Rambam Health Care Campus, a tertiary medical center in Israel, between 2009 and 2015. Comparisons between patients with Candidemia albicans and NAC candidemia were performed. Regression analysis, with NAC BSI as the dependent variable and significant risk factors for NAC as independent variables, was performed. RESULTS: A total of 308 episodes of candidemia were included. C. albicans was isolated in 30.8% of patients (95/308), while NAC spp. were isolated in the rest. Significant independent risk factors for NAC included immunosuppression therapy (odds ratio [OR] 0.38, 95% confidence interval [95%CI] 0.19-0.76) and previous azole use (OR 0.2, 95%CI 0.06-0.710). The interaction between prior azole and immunosuppression therapy in the model was not significant, and after its inclusion in the model only immunosuppression remained significantly associated with NAC. In the subgroup of patients who did not receive prior azoles, immunosuppression therapy, neutropenia, and bone marrow transplantation were significantly associated with NAC. CONCLUSIONS: Independent of previous azole treatment, immunosuppressive therapy was a significant risk factor for NAC in our cohort.


Assuntos
Antifúngicos , Candida albicans , Candida , Candidemia , Candidíase , Infecção Hospitalar , Idoso , Antifúngicos/classificação , Antifúngicos/uso terapêutico , Candida/classificação , Candida/isolamento & purificação , Candida albicans/efeitos dos fármacos , Candida albicans/isolamento & purificação , Candidemia/epidemiologia , Candidemia/microbiologia , Candidíase/diagnóstico , Candidíase/tratamento farmacológico , Candidíase/epidemiologia , Candidíase/microbiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Feminino , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Unidades de Terapia Intensiva/estatística & dados numéricos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
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