Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.145
Filtrar
1.
BMC Infect Dis ; 20(1): 55, 2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-31952505

RESUMO

BACKGROUND: Candidaemia is the most common form of invasive candidiasis. Resistant Candida blood stream infection (BSI) is rising, with limitations on the development of broader-spectrum antifungal agents worldwide. Our study aimed to identify the occurrence of antifungal-resistant candidaemia and the distribution of these species, determine the risk factors associated with antifungal resistance and evaluate the association of antifungal-resistant candidaemia with the length of intensive care unit (ICU) and hospital stay and with 30-day mortality. METHODS: A retrospective cohort study was conducted at King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia. Adult patients diagnosed with candidaemia from January 2006 to December 2017 were included. RESULTS: A total of 196 BSIs were identified in 94 males (49.74%) and 95 females (50.26%). C. glabrata was the most commonly isolated Candida species, with 59 (30%), followed by C. albicans with 46 (23%). Susceptibility data were available for 122/189 patients, of whom 26/122 (21%) were resistant to one or more antifungals. C. parapsilosis with available sensitivity data were found in 30/122 isolates, of which 10/30 (33%) were resistant to fluconazole. Risk factors significantly associated with antifungal-resistant candidaemia included previous echinocandin exposure (odds ratio (OR) =1.38; 95% confidence interval (CI) (1.02-1.85); P = 0.006) and invasive ventilation (OR = 1.3; 95% CI (1.08-1.57); P = 0.005). The median length of ICU stay was 29 days [range 12-49 days] in the antifungal-resistant group and 18 days [range 6.7-37.5 days] in the antifungal-sensitive group (P = 0.28). The median length of hospital stay was 51 days [range 21-138 days] in the antifungal-resistant group and 35 days [range 17-77 days] in the antifungal-sensitive group (P = 0.09). Thirty-day mortality was 15 (57.7%) and 54 (56.25%) among the antifungal-resistant and antifungal-sensitive groups, respectively (OR = 1.01; 95% CI (0.84-1.21); P = 0.89). CONCLUSIONS: Our results indicate a high frequancy of non- C. albicans candidaemia. The rise in C. parapsilosis resistance to fluconazole is alarming. Further studies are required to confirm this finding.


Assuntos
Candidemia/diagnóstico , Farmacorresistência Fúngica , Adulto , Idoso , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Candida albicans/efeitos dos fármacos , Candida albicans/isolamento & purificação , Candida glabrata/efeitos dos fármacos , Candida glabrata/isolamento & purificação , Candidemia/tratamento farmacológico , Candidemia/microbiologia , Feminino , Fluconazol/farmacologia , Fluconazol/uso terapêutico , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Arábia Saudita
2.
Pan Afr Med J ; 33: 280, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692736

RESUMO

Esophageal intramural pseudo-diverticulosis is a rare disease of unknown etiology. It is characterized by multiple pseudodiverticula with segmental or diffuse involvement of the esophagus. We report, the case of a 78-year-old male who suffered from severe dysphagia. Diagnosis of esophageal intramural pseudo-diverticulosis was based on endoscopic and radiologic explorations. Histological analysis of esophageal mucosal biopsies has shown the presence of candida albicans. Antifungal treatment leads to spectacular improvement of dysphasia. Subsequently, the patient presented a cardio-respiratory failure and died despite adequate treatment.


Assuntos
Candida albicans/isolamento & purificação , Candidíase/diagnóstico , Transtornos de Deglutição/diagnóstico , Diverticulose Esofágica/diagnóstico , Idoso , Antifúngicos/administração & dosagem , Candidíase/tratamento farmacológico , Transtornos de Deglutição/tratamento farmacológico , Humanos , Masculino
3.
Turk J Ophthalmol ; 49(5): 294-296, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31650813

RESUMO

Endogenous endophthalmitis is a serious sight-threatening ocular emergency that usually occurs in patients with serious underlying risk factors. In this report, we describe a case of endogenous Candida endophthalmitis following trans-urethral lithotripsy in an immunocompetent woman. In our case, the retinal lesion regressed completely and vision was restored. We discuss diagnostic procedures and management strategies in this article.


Assuntos
Antifúngicos/uso terapêutico , Candida albicans/isolamento & purificação , Candidíase/terapia , Endoftalmite/terapia , Infecções Oculares Fúngicas/terapia , Litotripsia/efeitos adversos , Vitrectomia/métodos , Adulto , Candida albicans/genética , Candidíase/etiologia , Candidíase/microbiologia , DNA Fúngico/análise , Endoftalmite/etiologia , Endoftalmite/microbiologia , Infecções Oculares Fúngicas/etiologia , Infecções Oculares Fúngicas/microbiologia , Feminino , Humanos , Tomografia por Emissão de Pósitrons , Cálculos Ureterais/terapia , Acuidade Visual
4.
Nat Commun ; 10(1): 4566, 2019 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-31594939

RESUMO

Fungal dissemination into the bloodstream is a critical step leading to invasive fungal infections. Here, using intravital imaging, we show that Kupffer cells (KCs) in the liver have a prominent function in the capture of circulating Cryptococcus neoformans and Candida albicans, thereby reducing fungal dissemination to target organs. Complement C3 but not C5, and complement receptor CRIg but not CR3, are involved in capture of C. neoformans. Internalization of C. neoformans by KCs is subsequently mediated by multiple receptors, including CR3, CRIg, and scavenger receptors, which work synergistically along with C5aR signaling. Following phagocytosis, the growth of C. neoformans is inhibited by KCs in an IFN-γ independent manner. Thus, the liver filters disseminating fungi from circulation via KCs, providing a mechanistic explanation for the enhanced risk of cryptococcosis among individuals with liver diseases, and suggesting a therapeutic strategy to prevent fungal dissemination through enhancing KC functions.


Assuntos
Infecções Fúngicas Invasivas/imunologia , Macrófagos do Fígado/imunologia , Fígado/imunologia , Fagocitose , Animais , Candida albicans/imunologia , Candida albicans/isolamento & purificação , Candida albicans/patogenicidade , Complemento C3/genética , Complemento C3/imunologia , Complemento C3/metabolismo , Cryptococcus neoformans/imunologia , Cryptococcus neoformans/isolamento & purificação , Cryptococcus neoformans/patogenicidade , Modelos Animais de Doenças , Feminino , Humanos , Microscopia Intravital , Infecções Fúngicas Invasivas/sangue , Infecções Fúngicas Invasivas/microbiologia , Macrófagos do Fígado/metabolismo , Macrófagos do Fígado/microbiologia , Fígado/citologia , Fígado/diagnóstico por imagem , Masculino , Camundongos , Camundongos Knockout , Microscopia Confocal , Receptores de Complemento/genética , Receptores de Complemento/imunologia , Receptores de Complemento/metabolismo
5.
Middle East Afr J Ophthalmol ; 26(2): 110-113, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31543670

RESUMO

Postpartum endogenous fungal endophthalmitis in otherwise healthy females is extremely rare disease. We report a case of a 25-year-old female patient referred with a history of decreased vision in her right eye 1 month after uncomplicated vaginal delivery. She presented with multifocal chorioretinal infiltrates. The patient showed persistent inflammation in her right eye then after. Systemic workup was unremarkable apart from a history of vaginal discharge during peripartum period. Vaginal swap confirmed the presence of Candida albicans. Culture of the vitreous sample confirmed the growth of C. albicans. The patient was managed with intravitreal amphotericin B in addition to systemic antifungal treatment followed by pars plana vitrectomy. The patient achieved 20/40 vision with quiet eye after 6 months of follow-up.


Assuntos
Candida albicans/isolamento & purificação , Candidíase/microbiologia , Endoftalmite/microbiologia , Infecções Oculares Fúngicas/microbiologia , Período Pós-Parto , Complicações Infecciosas na Gravidez/microbiologia , Descarga Vaginal/microbiologia , Corpo Vítreo/microbiologia , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Candidíase/diagnóstico , Candidíase/tratamento farmacológico , Terapia Combinada , Endoftalmite/diagnóstico , Endoftalmite/tratamento farmacológico , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/tratamento farmacológico , Feminino , Humanos , Injeções Intravítreas , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Vitrectomia
6.
Zhonghua Shao Shang Za Zhi ; 35(8): 587-594, 2019 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-31474038

RESUMO

Objective: To explore the preliminary application effect of real-time fluorescence recombinase polymerase amplification (RPA) in the detection of Candida albicans. Methods: (1) Candida albicans standard strain and negative control bacteria of Pseudomonas aeruginosa, Staphylococcus aureus, Acinetobacter baumannii, Escherichia coli, Candida glabrata standard strains of respectively 1 mL were collected and their DNA were extracted by yeast/bacterial genomic kit. The specificity of polymerase chain reaction (PCR), real-time fluorescent quantitative PCR, and real-time fluorescence RPA in detecting Candida albicans were analyzed. (2) One Candida albicans standard strain and one negative control bacteria of Candida glabrata standard strain were collected, resuscitated, and counted. Candida albicans was diluted 10 times to 1×10(7) to 1×10(1) colony-forming unit (CFU)/mL. The DNA of the two bacteria were extracted as experiment (1). The sensitivity of PCR, real-time fluorescent quantitative PCR, and real-time fluorescence RPA in detecting Candida albicans were analyzed. The number of cycles for amplification curve to reach the threshold in real-time fluorescent quantitative PCR, and time of appearance of specific amplification curve in real-time fluorescence RPA were recorded and compared with the results in PCR. The detection limit and rate of the above-mentioned 3 methods in detecting Candida albicans were analyzed, and the correlation between concentration of Candida albicans in real-time fluorescence RPA and detection time was analyzed. (3) One standard strain of Candida albicans was collected, and the DNA was extracted as experiment (1) and detected by PCR, real-time fluorescent quantitative PCR, and real-time fluorescence RPA. The total detection time of the above-mentioned 3 methods was recorded, respectively. (4) The DNA of 31 clinical samples of suspected Candida albicans infection and 1 clinical sample of Candida albicans collected from cotton swab were extracted, PCR and real-time fluorescence RPA were carried out, and the positive detection rates of the above-mentioned methods were calculated. The DNA of the clinical samples with positive results in both PCR and real-time fluorescence RPA were extracted by yeast/bacterial genomic kit, chelex-100 boiling method, and repeatedly freeze-thawing with liquid nitrogen method, and real-time fluorescence RPA and PCR were carried out. The negative control bacteria was Candida glabrata in real-time fluorescence RPA, while negative control bacteria in PCR were the same as experiment (1). The positive results in PCR and real-time fluorescence RPA were observed and time for amplification curve to reach the fluorescence threshold in real-time fluorescence RPA was recorded, respectively. Data were processed with linear correlation analysis and t test. Results: (1) Three methods showed positive results in detecting standard strain of Candida albicans, and none of the 5 negative control bacteria showed positive results. (2) As the concentration of bacterial solution of Candida albicans decreased, the number of cycles for the amplification curve to reach the threshold increased in real-time fluorescent quantitative PCR, the time for appearance of specific amplification curve prolonged in real-time fluorescence RPA, and brightness of the gel strip weakened in PCR. None of the negative control bacteria in the above-mentioned 3 detection methods showed corresponding positive results. The detection limit of Candida albicans in real-time fluorescence RPA, PCR, and real-time fluorescent quantitative PCR was 1×10(1) CFU/mL. There was a significant negative correlation between the concentration of Candida albicans and the detection time in real-time fluorescence RPA (r=-0.95, P<0.01). The positive detection rates of PCR and real-time fluorescent quantitative PCR for Candida albicans of 1×10(1) to 1×10(7) CFU/mL were 100%. The positive detection rate of real-time fluorescence RPA for Candida albicans of 1×10(1) CFU/mL was 78%, and the positive detection rate of real-time fluorescence RPA for Candida albicans of 1×10(2) to 1×10(7) CFU/mL was 100%. (3) The total time of PCR, real-time fluorescent quantitative PCR, and real-time fluorescence RPA detection for Candida albicans was 133, 93, and 35 min, respectively. (4) The positive detection rate of real-time fluorescence RPA for 31 clinical samples of suspected Candida albicans infection was 32.26% (10/31), which was slightly lower than 35.48% (11/31) of PCR. Eleven clinical samples showed positive results both in real-time fluorescence RPA and PCR detection. No positive result was observed in the negative control bacteria detected both by real-time fluorescence RPA and PCR. The DNA was extracted by yeast/bacterial genomic extraction kit and chelex-100 boiling method for real-time fluorescence RPA detection. The time for the amplification curve to reach the threshold was (438±13) and (462±12) s, respectively, which was close (t=1.32, P>0.05). The DNA was extracted by repeatedly freeze-thawing with liquid nitrogen method for real-time fluorescence RPA, and the time for the amplification curve to reach the threshold in real-time fluorescence RPA was (584±15) s, which was significantly longer than that in the other 2 methods (t=7.55, 6.39, P<0.01). Conclusions: Real-time fluorescence RPA has advantages of rapid detection, simple operation, high sensitivity, and good specificity in detecting Candida albicans, which is worthy of clinical application.


Assuntos
Candida albicans/isolamento & purificação , Candidíase/diagnóstico , Reação em Cadeia da Polimerase , Humanos , Recombinases , Sensibilidade e Especificidade
7.
Int J Nanomedicine ; 14: 5323-5338, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31409990

RESUMO

Background: Candida albicans as an opportunistic fungus is one of the most important causes of late-onset morbidity and mortality in patients with major burns and severely impaired immune system. In recent years, the emergence of resistance to opportunistic fungi and toxicity of antimicrobial drugs make it necessary to develop new drugs. Methods: In the present study, we investigated anticandidal effects of indolicidin, as a representative of host defense peptide, conjugated with gold nanoparticles in fluconazole-resistant clinical isolates of C. albicans. After characterizing the conjugation of indolicidin using biophysical methodologies, the cytotoxicity and hemolytic activity of the nanocomplex were examined. In addition, the expression level of ERG11, responsible for antifungal resistance, and the immunomodulatory effect of peptide-nanomaterial conjugates were assessed. Results: Our data indicated that the nanocomplex was nontoxic for the fibroblast cells and erythrocytes. Treatment with the nanocomplex significantly reduced the expression levels of the ERG11 gene in fluconazole-resistant C. albicans isolates and the iNOS gene in macrophages. Conclusion: The study data provides a chance to develop innovative therapies for the treatment of C. albicans burn infections. However, further investigation is required to examine the efficiency of the nanocomplex.


Assuntos
Antifúngicos/farmacologia , Peptídeos Catiônicos Antimicrobianos/farmacologia , Queimaduras/microbiologia , Candida albicans/efeitos dos fármacos , Candida albicans/isolamento & purificação , Fluconazol/farmacologia , Ouro/farmacologia , Nanopartículas Metálicas/química , Animais , Peptídeos Catiônicos Antimicrobianos/química , Queimaduras/tratamento farmacológico , Candida albicans/genética , Morte Celular/efeitos dos fármacos , Farmacorresistência Fúngica/efeitos dos fármacos , Eritrócitos/efeitos dos fármacos , Eritrócitos/metabolismo , Fluconazol/química , Regulação Fúngica da Expressão Gênica/efeitos dos fármacos , Genes Fúngicos , Hemólise/efeitos dos fármacos , Humanos , Nanopartículas Metálicas/ultraestrutura , Camundongos , Camundongos Endogâmicos BALB C , Testes de Sensibilidade Microbiana , Células NIH 3T3 , Óxido Nítrico Sintase Tipo II/genética , Óxido Nítrico Sintase Tipo II/metabolismo
8.
J Pak Med Assoc ; 69(8): 1131-1135, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31431766

RESUMO

OBJECTIVE: To evaluate the occurrence and in vitro minimum inhibitory concentrations of different Candida species against nine antifungal agents in blood and urine. METHODS: The prospective descriptive study was conducted at The Children's Hospital, Lahore, Pakistan, from June 2015 to May 2016. Identification of the Candid aspecies was done by API (Analytical Profile Index) Candida (bioMerieux) and in vitro minimum inhibitory concentration break points were reported by using Sensititre Yeast One. Data was analysed using SPSS 20. RESULTS: Of the 87 samples, 68(78.2%) were isolated from blood and 19(21.8%) from urine specimens. Also, 66 (75.9%) samples were non-albicans Candida, 31(35.6%) Candida parapsilosis and 21(24.1%) were Candida albicans. Besides, 83(95.4%) strains exhibited excellent susceptibility pattern with the three echinocandins at minimum inhibitory concentration endpoint of ≤2µg/ml and all (100%) the strains inhibited by ≤1µg/ml of voriconazole. None (0%) of the C. albicans isolates was resistant to an antifungal agent. CONCLUSIONS: Excellent susceptibility pattern against antifungal agents was found with an increasing resistance trend towards non-albicans Candida species.


Assuntos
Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Candidemia/microbiologia , Candidíase/microbiologia , Farmacorresistência Fúngica , Infecções Urinárias/microbiologia , Adolescente , Candida/isolamento & purificação , Candida albicans/efeitos dos fármacos , Candida albicans/isolamento & purificação , Candida parapsilosis/efeitos dos fármacos , Candida parapsilosis/isolamento & purificação , Candidíase Invasiva/microbiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Testes de Sensibilidade Microbiana , Paquistão
9.
Res Microbiol ; 170(6-7): 272-279, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31449848

RESUMO

Candida albicans has the ability to switch reversibly between budding yeast, filamentous, pseudohypha, and hyphal forms, a process in which the transcription factor Flo8 plays an important role. This ability is important for the virulence and pathogenicity of C. albicans. To determine whether Flo8 plays a role in the regulation of drug sensitivity, we constructed a FLO8 null mutant flo8/flo8 from the parental strain SN152 and a Flo8-overexpressing strain, flo8/flo8::FLO8. The susceptibility of the isolates to antifungal agents was then evaluated using the agar dilution and broth microdilution methods. Expression of drug resistance-related genes by the isolates was investigated by real-time PCR. The flo8/flo8 mutation isolates exhibited increased resistance to fluconazole, voriconazole, and itraconazole compared with the wild-type and drug sensitivity was restored by FLO8 overexpression (flo8/flo8∷FLO8). Of seven drug resistance-related genes, the FLO8 null mutation resulted in increased CDR1 and CDR2 expression (1.60-fold and 5.27-fold, respectively) compared with SN152, while FLO8 overexpression resulted in decreased CDR1 expression (0.63-fold). These results suggest that Flo8 is involved in the susceptibility of C. albicans to antifungal azoles, with FLO8 deletion leading to constitutive overexpression of CDR1 and CDR2 and resistance to antifungal azoles.


Assuntos
Antifúngicos/farmacologia , Azóis/farmacologia , Candida albicans/genética , Farmacorresistência Fúngica/genética , Transativadores/genética , Candida albicans/efeitos dos fármacos , Candida albicans/isolamento & purificação , Proteínas Fúngicas/genética , Deleção de Genes , Proteínas de Membrana Transportadoras/genética , Testes de Sensibilidade Microbiana , Proteínas Serina-Treonina Quinases/genética
11.
Am J Case Rep ; 20: 975-979, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31281180

RESUMO

BACKGROUND Candida albicans is the principal human fungal opportunistic organism commonly detected in the gastrointestinal and genitourinary systems. Five species of candida (Glabrata, Tropicalis, Albicans, Parapsilosis, and Kruzei) are responsible for most cases of invasive candidiasis or candidemia, which is a growing public health concern due to the increasing complexity of patients, leading to a high fatality rate. CASE REPORT We report an extremely rare case of candida pericarditis due to esophagopericardial fistula in a young, heavy, alcoholic adult diagnosed by culture of the drained pericardial fluid, which showed a growth of Candida albicans. CONCLUSIONS We highlight the first case of candida pericarditis in immunocompetent adult successfully treated by pericardiocentesis and oral fluconazole.


Assuntos
Candida albicans/isolamento & purificação , Candidemia/microbiologia , Fístula Esofágica/complicações , Pericardite/microbiologia , Adulto , Antifúngicos/uso terapêutico , Candida albicans/efeitos dos fármacos , Candidemia/tratamento farmacológico , Candidemia/cirurgia , Dor no Peito , Fluconazol/uso terapêutico , Humanos , Hospedeiro Imunocomprometido , Masculino , Pericardiocentese , Pericardite/tratamento farmacológico , Pericardite/cirurgia
12.
Pak J Pharm Sci ; 32(3): 1103-1105, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31278726

RESUMO

Invasive fungal infections caused by Candida albicans constitute a prevalent worldwide health problem. Due to limited antifungal agents available, more efforts have been made towards searching the novel anti-candida drugs with low cytotoxicity. The present study was aimed to investigate the antifungal activities of baicalin and/or sodium bicarbonate (SB) against 29 C. albicans isolates including 27 clinical ones. By using broth microdilution method and checkerboard assay, it was observed that the minimum inhibitory concentrations (MICs) of baicalin and SB alone were > 2048 µg/mL, and those of baicalin and SB in combination decreased 16-32 folds with fractional inhibitory concentration index (FICI) in a range of 0.094-0.375. The results presented the strong synergism between SB and baicalin in 27 clinical C. albicans isolates and provided an alternative choice against C. albicans.


Assuntos
Antifúngicos/farmacologia , Candida albicans/efeitos dos fármacos , Flavonoides/farmacologia , Bicarbonato de Sódio/farmacologia , Candida albicans/isolamento & purificação , Candidíase/microbiologia , Sinergismo Farmacológico , Humanos , Testes de Sensibilidade Microbiana/métodos
13.
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
14.
Int J Infect Dis ; 85: 182-187, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31185293

RESUMO

OBJECTIVES: Candida auris emerged as a human pathogen in 2009 and has subsequently been identified around the world as a cause of invasive candidiasis. We did an analysis from a single institution in order to analyze risk factors and outcomes for C. auris candidemia. METHODS: Patients with candidemia were identified by the electronic medical record and reviewed for risk factors and outcome. Candida isolates were identified by Vitek2 as Candida haemulonii, but species determinations for 21 of the isolates using published molecular and proteomic methods identified all as C. auris. FINDINGS: From September 2010 to December 2016, C. auris accounted for 38% of 201 patients with candidemia, while C. albicans contributed 25%. C. auris patients had been hospitalized longer (mean 32 days vs. 13 days; p<0.001), were more likely to have central lines preceding candidemia than C. albicans patients (84% vs. 54%; p=<0.001) and had more commonly been treated with carbapenems (83% vs 61% for C. albicans [p=0.01]). The crude mortality was 29%, compared to 36% for C. albicans. CONCLUSIONS: These findings suggest an opportunistic pathogen that may be less virulent, but difficult to eradicate and that control efforts should focus on antimicrobial usage.


Assuntos
Candidemia/microbiologia , Adulto , Idoso , Antifúngicos/uso terapêutico , Candida/isolamento & purificação , Candida albicans/isolamento & purificação , Candidemia/tratamento farmacológico , Candidemia/mortalidade , Feminino , Humanos , Quênia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
15.
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
16.
Chemotherapy ; 64(1): 8-16, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31112957

RESUMO

BACKGROUND: Mounting worldwide resistance trends make the use of fluoroquinolone (FQ) antibacterial agents increasingly difficult. This is felt more acutely in the case of urogenital infections, which are mainly caused by Gram-negative pathogens. For years, levofloxacin and other FQs have been the first-line drugs for treating National Institutes of Health (NIH) category II chronic bacteria prostatitis (CBP). Eradication rates achieved by levofloxacin in the frame of randomized trials vary greatly, ranging between 71 and 86%. OBJECTIVES: This was a retrospective observational study to investigate the efficacy of levofloxacin against CBP in a real-life setting (urological outpatient wards). METHODS: A database including the clinical records of >2,500 CBP patients was reviewed. Patients were selected based on strict inclusion criteria. They were treated for 4 weeks with 500 mg levofloxacin per day, alone or combined with other antibacterials. Besides standard urological procedures including the 4-glass test for pathogen isolation, international symptom questionnaires (the NIH Chronic Prostatitis Symptom Index [NIH-CPSI] and International Prostate Symptom Score [IPSS]) were administered. RESULTS: Pathogen eradication was achieved in 79% of the cases treated with levofloxacin as a single agent and 87.8% of patients who received a combination of levofloxacin and azithromycin. The 11% increase in the eradication rate in the latter group is statistically significant. In addition, the levofloxacin-azithromycin combination caused a significant decrease in prostate volume and significantly increased the bladder-voided volume. IPSS and NIH-CPSI values and the urinary peak flow rate decreased to a similar extent in both treatment groups. No adverse effects were reported by patients belonging to either treatment group. CONCLUSION: Levofloxacin retained its therapeutic efficacy in patients assessed in a real-life setting, and high eradication rates were attained when it was administered as a single agent. A combination of an FQ with azithromycin induced a significant improvement of eradication rates. This strategy may be an interesting option in both first-referral and relapsing cases, although caution should be exercised when patients are at risk of developing arrhythmias, tendinitis, or other adverse effects.


Assuntos
Antibacterianos/uso terapêutico , Levofloxacino/uso terapêutico , Prostatite/tratamento farmacológico , Adulto , Idoso , Antibacterianos/farmacologia , Azitromicina/farmacologia , Azitromicina/uso terapêutico , Candida albicans/efeitos dos fármacos , Candida albicans/isolamento & purificação , Quimioterapia Combinada , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/efeitos dos fármacos , Bactérias Gram-Positivas/isolamento & purificação , Humanos , Levofloxacino/farmacologia , Masculino , Pessoa de Meia-Idade , National Institutes of Health (U.S.) , Próstata/fisiologia , Antígeno Prostático Específico/sangue , Prostatite/diagnóstico , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos , Adulto Jovem
17.
Artigo em Inglês | MEDLINE | ID: mdl-31058099

RESUMO

Candida albicans is an opportunistic pathogenic yeast that predominantly causes invasive candidiasis. The conventional diagnosis of C. albicans infection depends on time-consuming, culture-based gold-standard methods. Here, a multiple cross displacement amplification (MCDA) assay, combined with a gold nanoparticle-based lateral flow biosensor (LFB) visualization method, was developed for the rapid detection of C. albicans. The internal transcribed spacer II, a region between 5.8 and 28 S fungal ribosomal DNA, is a C. albicans species-specific sequence that was used as the MCDA assay target. As an isothermal amplification method, the MCDA reaction with optimized conditions could be completed within only 40 min at a constant temperature (64°C). Then, the amplification reaction products could be visibly detected by a LFB without special equipment. The developed MCDA-LFB assay for C. albicans detection was a specific and accurate method, and could distinguish C. albicans from other pathogens. Just 200 fg of genomic DNA template from pure cultures of C. albicans could be detected using the MCDA-LFB method. The limit of detection (LOD) of the new method was more sensitive than that of both qPCR and loop-mediated isothermal amplification (LAMP). Of 240 clinical sputum samples, all of the C. albicans-positive (87/240) samples identified by the gold-standard method were successfully detected by the MCDA-LFB assay. Moreover, the true positive rate of the newly developed assay was not only higher than that of qPCR (100 vs. 86.2%), but also higher than that of LAMP (100 vs. 94.3%). Thus, the MCDA-LFB assay might be a simple, specific, and sensitive method for the rapid diagnosis of C. albicans in clinical samples.


Assuntos
Técnicas Biossensoriais/métodos , Candida albicans/isolamento & purificação , Candidíase/diagnóstico , Cromatografia/métodos , Técnicas de Diagnóstico Molecular/métodos , Técnicas de Amplificação de Ácido Nucleico/métodos , DNA Fúngico/genética , DNA Espaçador Ribossômico/genética , Humanos , Sensibilidade e Especificidade , Temperatura Ambiente , Fatores de Tempo
18.
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
19.
Mycoses ; 62(8): 692-697, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31132175

RESUMO

Vulvovaginal candidiasis (VVC) is a common infection of the genital tract affecting millions of women worldwide. Data on epidemiological trends of VVC in Greece are scarce. This study was undertaken to evaluate the prevalence of VVC among symptomatic women in Crete, Greece, identify the Candida species involved and determine their susceptibility to antifungals. Over a 6-year period (2012-2017), 10 256 symptomatic women with vaginitis were evaluated. Isolation of yeasts was performed on Sabouraud dextrose agar with chloramphenicol, and the isolates were identified using the API 20 C AUX and/or the Vitek 2 YST card. Susceptibility of the isolates to amphotericin, fluconazole, voriconazole and flucytosine was determined by the Vitek 2 automated system. The results were interpreted according to Clinical and Laboratory Standards criteria. Vaginal swab cultures of 1217 (11.9%) women yielded Candida species. Recurrent VVC was documented in 62 (5.1%) of them. Candida albicans was the most frequently isolated species (75.6%), followed by Candida glabrata (13.6%). Overall, resistance rates to amphotericin B, fluconazole, voriconazole and flucytosine were 0.2%, 6.6%, 1.4% and 2.1%, respectively. Fluconazole resistance of C. albicans significantly increased in the second period of the study (2015-2017) (P = 0.031). This study demonstrated that VVC is a common infection among women in our region, with C. albicans being the predominant species involved. Although resistance to antifungals was infrequent, resistance to fluconazole among C. albicans isolates was found to significantly increase with time. Continued surveillance of changes in species distribution and susceptibility to antifungals are necessary to guide treatment.


Assuntos
Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Candidíase Vulvovaginal/epidemiologia , Vagina/microbiologia , Vaginite/microbiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Candida/isolamento & purificação , Candida albicans/efeitos dos fármacos , Candida albicans/isolamento & purificação , Candida glabrata/efeitos dos fármacos , Candida glabrata/isolamento & purificação , Candidíase Vulvovaginal/microbiologia , Farmacorresistência Fúngica , Feminino , Grécia/epidemiologia , Humanos , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Prevalência , Recidiva , Vaginite/epidemiologia , Adulto Jovem
20.
Acta Odontol Scand ; 77(7): 508-516, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31145647

RESUMO

Aims: Oral candidiasis is a major oral manifestation of uncontrolled diabetes mellitus, and a number of cofactors are associated with the pathogenesis of this infection. Here, we describe the prevalence of oral Candida in a Sri Lankan cohort of type 2 diabetes mellitus and risk factors that predispose them to this common fungal infection. Methods: A case-control study was conducted in 250 diabetics with type 2 diabetes and 81 nondiabetic controls. Clinical and demographic data were collected using an interviewer administered questionnaire, and patient records. Oral rinse samples were collected to determine the candidal carriage, and the resultant yeast growth was quantified and speciated using multiplex-PCR and phenotypic analyses. Chi-square test (χ2 test) and Fisher exact test were used for the determination of the significant relationships between risk factors and oral candidiasis. Results: The oral prevalence of Candida species among both groups was similar (81%) although a significantly higher proportion of diabetics (32.8%) yielded >2000 CFU/mL of yeasts compared with only 12.3% of the healthy controls (p < .05). Significant associations were noted between oral candidal carriage amongst diabetics, and (i) denture wearing, (ii) female gender and (iii) cigarette smoking (all, p < .05). Amongst both groups, C.albicans was the most common Candida species isolated followed by C. parapsilosis, C. tropicalis and C. glabrata. Conclusions: The oral infestation of Candida in our Sri Lankan cohort of diabetics is significantly higher than their healthy counterparts, and co-carriage of multiple yeast species is a common finding in the study population. As there are no previous such reports of the latter phenomenon particularly from the Asian region it is noteworthy, mainly in view of the recent data on the emergence of drug-resistant yeast species the world over.


Assuntos
Candida/isolamento & purificação , Candidíase Bucal/diagnóstico , Complicações do Diabetes , Diabetes Mellitus Tipo 2/diagnóstico , Adulto , Candida/classificação , Candida albicans/isolamento & purificação , Candidíase Bucal/epidemiologia , Candidíase Bucal/microbiologia , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/microbiologia , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Distribuição por Sexo , Sri Lanka/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA