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1.
Artigo em Inglês | MEDLINE | ID: mdl-32491141

RESUMO

This is a fatal case of fungaemia due to Cryptococcus albidus in an elderly woman with type 2 diabetes mellitus who presented pleural effusion as the only clinical presentation. Not only infections of the pleura are uncommon presentations of pulmonary cryptococcosis, but these infections due to non-C. neoformans species are extremely rare. This report places C. albidus on the growing number of disseminated mycosis-causing agents in diabetic patients.


Assuntos
Cryptococcus/isolamento & purificação , Diabetes Mellitus Tipo 2/microbiologia , Fungemia/microbiologia , Derrame Pleural/microbiologia , Idoso de 80 Anos ou mais , Evolução Fatal , Feminino , Humanos , Derrame Pleural/diagnóstico por imagem , Tomografia Computadorizada por Raios X
2.
J Med Microbiol ; 69(5): 712-720, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32368996

RESUMO

Introduction. Given the limited number of candidaemia studies in Iran, the profile of yeast species causing bloodstream infections (BSIs), especially in adults, remains limited. Although biochemical assays are widely used in developing countries, they produce erroneous results, especially for rare yeast species.Aim. We aimed to assess the profile of yeast species causing BSIs and to compare the accuracy of the Vitek 2 system and 21-plex PCR.Methodology. Yeast blood isolates were retrospectively collected from patients recruited from two tertiary care training hospitals in Tehran from 2015 to 2017. Relevant clinical data were mined. Identification was performed by automated Vitek 2, 21-plex PCR and sequencing of the internal transcribed spacer region (ITS1-5.8S-ITS2).Results. In total, 137 yeast isolates were recovered from 107 patients. The overall all-cause 30-day mortality rate was 47.7 %. Fluconazole was the most widely used systemic antifungal. Candida albicans (58/137, 42.3 %), Candida glabrata (30/137, 21.9 %), Candida parapsilosis sensu stricto (23/137, 16.8 %), Candida tropicalis (10/137, 7.3 %) and Pichia kudriavzevii (Candida krusei) (4/137, 2.9 %) constituted almost 90 % of the isolates and 10 % of the species detected were rare yeast species (12/137; 8.7 %). The 21-plex PCR method correctly identified 97.1 % of the isolates, a higher percentage than the Vitek 2 showed (87.6 %).Conclusion. C. albicans was the main cause of yeast-derived fungaemia in this study. Future prospective studies are warranted to closely monitor the epidemiological landscape of yeast species causing BSIs in Iran. The superiority of 21-plex PCR over automated Vitek 2 indicates its potential clinical utility as an alternative identification tool use in developing countries.


Assuntos
Fungemia/diagnóstico , Fungemia/epidemiologia , Fungemia/microbiologia , Reação em Cadeia da Polimerase Multiplex , Análise de Sequência de DNA , Leveduras/classificação , Leveduras/genética , Idoso , Idoso de 80 Anos ou mais , DNA Intergênico , Feminino , Fungemia/história , História do Século XXI , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase Multiplex/métodos , Reação em Cadeia da Polimerase Multiplex/normas , Análise de Sequência de DNA/métodos , Análise de Sequência de DNA/normas
3.
BMC Infect Dis ; 20(1): 377, 2020 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-32460728

RESUMO

BACKGROUND: Candida diddensiae, a yeast found in olive oil, is considered non-pathogenic to humans. Here, we describe the first case of fungemia caused by C. diddensiae in a hospitalized patient with underlying diseases. CASE PRESENTATION: A 62-year-old woman was admitted because of multiple contusions due to repeated falls and generalized weakness. She presented with chronic leukopenia due to systemic lupus erythematosus, and multiple cranial nerve neuropathies due to a recurring chordoma. She was given a lipid emulsion containing total parenteral nutrition (TPN) starting on the day of admission. Broad-spectrum antibiotics had been administered during her last hospital stay and from day 8 of this hospitalization. However, no central venous catheter was used during this hospital stay. Blood cultures obtained on hospital days 17, 23, and 24 yielded the same yeast, which was identified as C. diddensiae via sequence analyses of the internal transcribed spacer region and D1/D2 regions of the 26S ribosomal DNA of the rRNA gene. In vitro susceptibility testing showed that the minimum inhibitory concentration of fluconazole for all isolates was 8 µg/mL. On day 23, TPN was discontinued and fluconazole therapy was started. Blood cultures obtained on day 26 were negative. The fluconazole therapy was replaced with micafungin on day 26 and the patient exhibited improvements. CONCLUSION: The use of lipid TPN may potentially contribute to the occurrence of nosocomial fungemia by C. diddensiae, an unusual Candida species.


Assuntos
Infecção Hospitalar/microbiologia , Fungemia/microbiologia , Antibacterianos , Antifúngicos/administração & dosagem , Candida/efeitos dos fármacos , Candida/genética , Candida/isolamento & purificação , Candida/fisiologia , Cateteres Venosos Centrais , Infecção Hospitalar/tratamento farmacológico , DNA Ribossômico/genética , Feminino , Fluconazol/administração & dosagem , Fungemia/tratamento farmacológico , Hospitais , Humanos , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Nutrição Parenteral Total
5.
Microbiol Res ; 227: 126298, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31421716

RESUMO

An increasing number of infections originating from probiotic use are reported worldwide, with the majority of such cases caused by the yeast Saccharomyces 'boulardii', a subtype of S. cerevisiae. Reliably linking infectious cases to probiotic products requires unequivocal genotyping data, however, these techniques are often time-consuming and difficult to implement in routine diagnostics. This leads to a widespread lack of genetic data regarding the origin of Saccharomyces infections. We propose a quick and reliable PCR-based protocol for the identification of S. 'boulardii' based on a combined analysis of interdelta fingerprinting and microsatellite typing. By applying various typing methods and our proposed method to the clinical yeast collection of a Hungarian hospital we show that probiotic origin is common among clinical Saccharomyces, and that the new multiplex method enables rapid and unequivocal identification of probiotic yeast infections. This method can be applied for the identification of yeast infection sources, helping decisions on probiotic use.


Assuntos
Reação em Cadeia da Polimerase Multiplex/métodos , Técnicas de Tipagem Micológica/métodos , Probióticos , Saccharomyces/genética , Saccharomyces/isolamento & purificação , DNA Fúngico/isolamento & purificação , Fungemia/microbiologia , Técnicas de Genotipagem , Humanos , Repetições de Microssatélites , Micoses/microbiologia , Saccharomyces/classificação , Saccharomyces/patogenicidade , Saccharomyces cerevisiae/classificação , Saccharomyces cerevisiae/genética , Saccharomyces cerevisiae/isolamento & purificação
6.
J Med Microbiol ; 68(10): 1544-1551, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31436523

RESUMO

Introduction. Breakthrough bloodstream infections (BSIs) are rare among non-neutropenic patients.Aim. Our goal was to determine the risk factors associated with development of breakthrough BSIs among critically ill non-neutropenic patients and its role in mortality.Methodology. During a 24-month period (August 2016 to July 2018), all BSIs among non-neutropenic patients hospitalized at the University General Hospital of Patras, Greece, were included. Antimicrobial resistance of isolates was interpreted according to EUCAST guidelines. BSIs were considered as breakthrough when blood cultures yielded a pathogen in a patient who, for at least the previous 72 h, had been receiving at least one antibiotic to which the isolated microorganism was susceptible.Results. Among 217 episodes of BSI, 118 (54.4 %) developed a breakthrough infection. Primary BSIs predominated (101; 46.5 %), followed by catheter-related BSIs (56; 25.8 %). Gram-negative bacteria represented the most common pathogens isolated (157; 72.4 %), followed by Gram-positive bacteria (36; 16.6 %) and fungi (36; 16.6 %). Factors independently associated with the development of breakthrough BSIs were immunosuppressive therapy, obesity (body mass index ≥30 kg m- 2), infection by Gram-positive bacteria, noradrenaline dose during 24 h from BSI onset, prior use of colistin and antifungal treatment. Overall 14-day mortality was 23.0 % (50 patients). Multivariate analysis revealed noradrenaline dose during 24 h from BSI onset as an independent predictor of mortality, while appropriate empiric antimicrobial treatment and breakthrough BSI were identified as predictors of good prognosis.Conclusion. Breakthrough BSIs were common among critically ill non-neutropenic patients and these patients were associated with better survival because they were de facto receiving appropriate antibiotics.


Assuntos
Bacteriemia/microbiologia , Bacteriemia/mortalidade , Bactérias/isolamento & purificação , Estado Terminal/epidemiologia , Fungemia/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Bactérias/classificação , Bactérias/efeitos dos fármacos , Bactérias/genética , Estado Terminal/terapia , Feminino , Fungemia/epidemiologia , Fungemia/mortalidade , Fungos/classificação , Fungos/efeitos dos fármacos , Fungos/genética , Fungos/isolamento & purificação , Grécia/epidemiologia , Hospitais Universitários , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
Mycoses ; 62(12): 1100-1107, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31365161

RESUMO

Saprochaete clavata is a rare cause of fungaemia with deep organ involvement in patients with haematological malignancies with reported mortality rates of 60%-80%. We describe four cases of S clavata infection in a haematology unit over several months that were treated with voriconazole-based regimens. We also review the literature on factors that could contribute to earlier recognition and effective treatment of S clavata. We included all cases of culture-positive S clavata from sterile sites with associated signs of infection in patients undergoing treatment for a haematological malignancy. Isolates were identified by MALDI-TOF MS, and spectrum profiles were used to prepare clustering analysis of isolates. Susceptibility testing was performed using a commercial microtitre methods. Saprochaete clavata was isolated from the bloodstream in three cases and bronchial alveolar lavage (BAL) fluid in one case. Clustering analysis suggested strains of S clavata were clonal without evidence of divergence although a common source was not identified. Susceptibility testing yielded elevated MICs to fluconazole (8 mg/L) and echinocandins (>1-8 mg/L). All patients were treated with voriconazole-based regimens resulting in survival of 3/4 patients, who continued chemotherapy for their underlying malignancy without evidence of relapse. Saprochaete clavata is a rare but aggressive cause of breakthrough yeast infection in patients undergoing treatment for haematological malignancies, particularly patients with a prior history of echinocandin treatment. Timely initiation of appropriate treatment, aided by more rapid identification in microbiology laboratory, can reduce the risk of deep organ dissemination and patient death.


Assuntos
Fungemia/etiologia , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/microbiologia , Adulto , Idoso , Antifúngicos/uso terapêutico , Surtos de Doenças , Feminino , Fungemia/tratamento farmacológico , Fungemia/microbiologia , Neoplasias Hematológicas/tratamento farmacológico , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/microbiologia , Saccharomycetales/efeitos dos fármacos , Voriconazol/uso terapêutico
8.
PLoS One ; 14(7): e0219098, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31283786

RESUMO

BACKGROUND: We applied an in vitro model to evaluate the efficacy of a heparinized 40% ethanol-based lock solution in a wide variety of clinical isolates causing C-RBSI. METHODS: A total of 100 clinical strains were collected retrospectively from the blood of patients with C-RBSI. The reduction in biomass and metabolic activity of biofilms was measured using the crystal violet (CV) assay and XTT assay, respectively. Regrowth inhibition (RI) was measured within 24 hours and 72 hours of ethanol lock therapy. Percentage reduction of ≥ 85% in RI was considered to be successful. RESULTS: Ethanol lock was more effective in reducing metabolic activity than in reducing biomass (83% vs. 50%, respectively). Percentages of RI diminished as regrowth was prolonged (57% for 24 hours and 17% for 72 hours of regrowth). No statistically significant intraspecies differences were found in biofilm reduction or in RI (p>0.05). CONCLUSIONS: The use of heparinized 40% ethanol lock solution for 72 hours significantly reduced biomass and metabolic activity in clinical isolates from patients with C-RBSI. However, as biofilm has an important regrowth rate, 40% ethanol solution was not able to fully eradicate biofilm in vitro.


Assuntos
Anti-Infecciosos/administração & dosagem , Biofilmes/efeitos dos fármacos , Infecções Relacionadas a Cateter/prevenção & controle , Bacteriemia/microbiologia , Bacteriemia/prevenção & controle , Bactérias/efeitos dos fármacos , Bactérias/metabolismo , Biofilmes/crescimento & desenvolvimento , Biomassa , Infecções Relacionadas a Cateter/microbiologia , Etanol/administração & dosagem , Fungemia/microbiologia , Fungemia/prevenção & controle , Fungos/efeitos dos fármacos , Fungos/metabolismo , Heparina/administração & dosagem , Humanos , Técnicas In Vitro , Modelos Biológicos , Soluções
9.
BMC Infect Dis ; 19(1): 570, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262263

RESUMO

BACKGROUND: Kodamaea ohmeri is a yeast is frequently mistaken for Candida, which belongs to the same family. This micro-organism has been reported to cause life-threatening infections in humans. CASE PRESENTATION: A 81-year-old woman developed a severe fungemic pulmonary infection due to Kodamaea ohmeri that was identified from bronchoalveolar fluid and blood cultures, which is unusual in immunocompetent patients. Because K. ohmeri was first wrongly identified as Candida albicans, the patient inadequately received caspofungin, which was clinically ineffective, especially as the strain was resistant to echinocandins. Clinical cure was obtained after treatment was switched to voriconazole. CONCLUSIONS: An increasing number of serious infections due to K. ohmeri has been reported in the literature, but the correct identification of this micro-organism remains difficult.


Assuntos
Fungemia/tratamento farmacológico , Fungemia/microbiologia , Saccharomycetales/patogenicidade , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Candida albicans/patogenicidade , Erros de Diagnóstico , Farmacorresistência Fúngica/efeitos dos fármacos , Equinocandinas/uso terapêutico , Feminino , Humanos , Testes de Sensibilidade Microbiana , Saccharomycetales/efeitos dos fármacos , Voriconazol/uso terapêutico
10.
Am J Health Syst Pharm ; 76(7): 460-469, 2019 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-31361820

RESUMO

PURPOSE: Antimicrobial stewardship programs (ASPs) can be aided by using rapid diagnostics (RDT). However, there are limited data evaluating the impact of ASPs and RDT on sepsis outcomes in the setting of the new Sepsis-3 guidelines. This study evaluates the impact of a low-resource method for ASPs with RDT on sepsis outcomes. METHODS: This was a prospective, quasi-experimental study with a retrospective double pretest. Patients ≥ 18 years old with sepsis and concurrent bacteremia or fungemia were included; patients who were pregnant, had polymicrobial septicemia or who were transferred from an outside hospital were excluded. In the first pretest (O1), polymerase chain reaction was used to identify Staphylococcal species from positive blood cultures, and traditional laboratory techniques were used to identify other species. Matrix-assisted laser desorption ionization time-of-flight mass spectroscopy and FilmArray were implemented in the second pretest (O2), and twice daily blood culture review was implemented in the posttest (O3). RESULTS: A total of 394 patients (157 in O1, 176 in O2, 61 in O3) were enrolled. Clinical response was 73.2%, 83.5%, and 88.5% in O1, O2, and O3, respectively, p = 0.013. By Cox regression, the O3 was associated with improved time to clinical response (hazard ratio, 1.388; 95% confidence interval, 1.004-1.919) as compared with O1. Mortality, hospital length of stay, and intensive care unit length of stay were unchanged between groups. CONCLUSION: Twice-daily blood culture review may be useful for implementing rapid diagnostics within low-resource ASPs. Further research is needed to identify the optimal method of blood culture follow-up within low-resource settings.


Assuntos
Gestão de Antimicrobianos/métodos , Bacteriemia/tratamento farmacológico , Hemocultura/métodos , Procedimentos Clínicos , Fungemia/tratamento farmacológico , Idoso , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Gestão de Antimicrobianos/economia , Gestão de Antimicrobianos/normas , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Hemocultura/economia , Feminino , Fungemia/diagnóstico , Fungemia/microbiologia , Fungos/efeitos dos fármacos , Fungos/isolamento & purificação , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/economia , Fatores de Tempo
11.
Infez Med ; 27(2): 187-189, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31205044

RESUMO

Cryptococcosis is a systemic mycosis with a chronic or subacute progression caused by the inhalation of dehydrated yeasts or basidiospores. The causative agents are C. gattii and C. neoformans. The latter is more commonly associated with cellular immunodeficiency and is not rare in patients with Acquired Immunodeficiency Syndrome (AIDS). Cryptococcosis is common in pregnant women with AIDS; however, it is uncommon for the placenta to be affected, with few reported cases in the literature. We present the case of a pregnant woman with AIDS who had placental and pulmonary cryptococcosis associated with fungemia, with a satisfactory clinical outcome obtained after therapy.


Assuntos
Síndrome de Imunodeficiência Adquirida/microbiologia , Criptococose/microbiologia , Fungemia/microbiologia , Pneumopatias Fúngicas/microbiologia , Doenças Placentárias/microbiologia , Complicações Infecciosas na Gravidez/microbiologia , Feminino , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/virologia , Humanos , Recém-Nascido , Masculino , Sepse Neonatal/tratamento farmacológico , Doenças Placentárias/patologia , Gravidez , Complicações Infecciosas na Gravidez/patologia , Adulto Jovem
12.
Eur J Clin Microbiol Infect Dis ; 38(8): 1435-1441, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31065826

RESUMO

The diagnosis of bloodstream infection requires the optimum combination of media in an automated blood culture system for maximum recovery of pathogens with the earliest time to detection. In a previous work, we showed that for patients admitted to the Emergency Department of our hospital, the combination of BACTEC lytic anaerobic and BACTEC aerobic vials was more efficient than BACTEC anaerobic and BACTEC aerobic vial. In this study, we extended the work including a broader patient population, representative of all hospital. A total of 8629 cultures were collected during the pre-lytic phase, from 01 July 2013 to 30 June 2014 and 7940 cultures during the post-lytic phase, ranged from 01 July 2015 to 30 June 2016. The number of positive blood cultures was higher during the post-lytic phase (19.74%) than in the pre-lytic phase (17.52%), particularly for Escherichia coli, Staphylococcus spp., Enterococcus spp., and anaerobes. We also observed a significant decreased of the time to detection, with the mean and median in the post-lytic phase of 17.68 and 13.05 h compared with 19.49 and 14.47 h in the pre-lytic phase. Whereas the time to detection was the same for organisms recovered in the aerobic Plus bottles for both time periods, time to detection for the anaerobic lytic bottles was significantly faster than with the anaerobic Plus bottles. This study carried out on a long time observation reported that a simple modification of composition of blood culture set could lead to better results in bloodstream infection detection.


Assuntos
Bactérias/isolamento & purificação , Hemocultura/instrumentação , Técnicas Microbiológicas/instrumentação , Sepse/diagnóstico , Aerobiose , Idoso , Idoso de 80 Anos ou mais , Anaerobiose , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Feminino , Fungemia/diagnóstico , Fungemia/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
13.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 37(5): 335-340, mayo 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-189223

RESUMO

OBJETIVO: En esta revisión se pretende actualizar los nuevos procedimientos aplicables en el diagnóstico microbiológico de las bacteriemias y fungemias. MÉTODO: Revisión de la literatura científica. RESULTADOS Y CONCLUSIONES: Tras definir el proceso e indicar sus principios fundamentales, se revisan los principales biomarcadores utilizados en la práctica clínica. Posteriormente, se resaltan las particularidades de la fase preanalítica (recogida y transporte de las muestras) y se detallan los pasos a seguir para la identificación microbiológica por métodos clásicos, basados en el cultivo de las muestras de sangre. En el siguiente apartado, se revisan los métodos diagnósticos no basados en el cultivo, incluyendo los que detectan la presencia del genoma del microorganismo y los basados en el estudio del proteoma mediante espectrometría de masas. En el último apartado se describen los procedimientos a seguir para el estudio de la sensibilidad antibiótica, tanto por métodos fenotípicos como genotípicos


OBJETIVE: In this review we try to update the new procedures applicable in the microbiological diagnosis of bacteriemia and fungemias. METHOD: Review of scientific literature. RESULTS AND CONCLUSIONS: After defining the process and indicating its fundamental principles, the main biomarkers used in clinical practice are reviewed. Subsequently, the particularities of the pre-analytical phase (collection and transport of samples) are highlighted and the steps to follow for the microbiological identification by classical methods are detailed, based on the culture of the blood samples. In the following section, we review the diagnostic methods not culture based, including those that detect the presence of the genome of the microorganism and those based on the study of proteome by mass spectrometry. The last section describes the procedures more frecuently used for the study of antibiotic susceptibility, both by phenotypic and genotypic methods


Assuntos
Humanos , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Fungemia/diagnóstico , Fungemia/microbiologia , Hemocultura/métodos , Técnicas Microbiológicas/métodos , Biomarcadores , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz
14.
Diagn Microbiol Infect Dis ; 95(1): 77-79, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31005402

RESUMO

Eremothecium coryli is a dimorphic fungus of the Saccharomycetes class. While species within this class are known to cause human infection, Eremothecium species have previously only been known as phytopathogens and never been isolated from a human sample. Here, we report the first known case of human E. coryli infection.


Assuntos
Eremothecium/fisiologia , Fungemia/diagnóstico , Fungemia/tratamento farmacológico , Leucemia Mieloide Aguda/complicações , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Hemocultura , DNA Fúngico/genética , Eremothecium/citologia , Eremothecium/efeitos dos fármacos , Eremothecium/genética , Feminino , Fungemia/microbiologia , Fungemia/patologia , Humanos , Testes de Sensibilidade Microbiana , RNA Ribossômico 28S/genética , Análise de Sequência de DNA , Falha de Tratamento
15.
Mycopathologia ; 184(3): 457-458, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30955129

RESUMO

Pneumocystis jiroveci pneumonia in non-HIV patients is infrequent and characterized by atypical presentations and increased severity. Although hematogenous dissemination from the lungs can lead to extrapulmonary infections, isolation of oocysts from blood in human subjects has not been documented. We report a case of P. jiroveci pneumonia with persistent isolation of oocysts from blood and positivity of P. jiroveci polymerase chain reaction. The patient presented with bilateral diffuse pulmonary nodules and received prolonged treatment with trimethoprim/sulfamethoxazole.


Assuntos
Sangue/microbiologia , Fungemia/microbiologia , Pneumocystis carinii/isolamento & purificação , Pneumonia por Pneumocystis/complicações , Antifúngicos/administração & dosagem , Fungemia/tratamento farmacológico , Fungemia/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia por Pneumocystis/tratamento farmacológico , Pneumonia por Pneumocystis/patologia , Reação em Cadeia da Polimerase , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem
17.
J Infect Chemother ; 25(8): 635-638, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30910505

RESUMO

The introduction of the prophylactic use of antifungal drugs caused the increased occurrence of invasive fungal infections due to previously rare molds, such as fusariosis, after allogeneic hematopoietic stem cell transplantation. We herein report the case of a patient with diffuse large B-cell lymphoma who developed fungemia due to Fusarium solani during liposormal amphotericin B on day 25 after cord blood transplantation (CBT). Because Fusarium species might differ in virulence and drug susceptibility, the sequencing of the internal transcribed spacer region of the ribosomal RNA gene accurately identified Fusarium solani to be the cause of fungemia at the species level. This case highlights Fusarium solani as the cause of fungemia in a patient under liposormal amphotericin B treatment after CBT.


Assuntos
Anfotericina B/efeitos adversos , Fungemia/microbiologia , Fusarium/patogenicidade , Idoso , Antifúngicos/efeitos adversos , Transplante de Células-Tronco de Sangue do Cordão Umbilical , Fungemia/tratamento farmacológico , Humanos , Masculino
18.
Future Microbiol ; 14: 267-274, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30859860

RESUMO

AIM: Presenting the first clinical case of Wickerhamomyces myanmarensis. PATIENTS & METHODS: Yeast cells were isolated from blood and central venous catheter of a 5.5-year-old male subject. API 20C AUX, MALDI-TOF MS, ITS and LSU rDNA sequencing, and our qPCR assay were used for identification and the MIC values were determined by CLSI M27-A3. RESULTS: ITS and LSU rDNA sequencing identified both isolates as W. myanmarensis, while API 20C AUX and MALDI-TOF MS did not identify them correctly. Our qPCR specifically distinguished W. myanmarensis from W. anomalus. Isolate obtained from blood showed a higher MIC value for fluconazole, voriconazole and posaconazole. CONCLUSION: Utilization of reliable identification tools might reveal the genuine spectrum of opportunistic yeast species.


Assuntos
Antifúngicos/farmacologia , Fungemia/microbiologia , Saccharomycetales/efeitos dos fármacos , Saccharomycetales/isolamento & purificação , Criança , Farmacorresistência Fúngica , Fluconazol/farmacologia , Fungemia/tratamento farmacológico , Humanos , Masculino , Testes de Sensibilidade Microbiana , Reação em Cadeia da Polimerase em Tempo Real , Saccharomycetales/genética , Triazóis/farmacologia , Voriconazol/farmacologia
19.
Emerg Infect Dis ; 25(3): 601-602, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30789336

RESUMO

Candida auris is an emerging fungus that can cause invasive infections. It is associated with high mortality rates and resistance to multiple classes of antifungal drugs and is difficult to identify with standard laboratory methods. We describe the management and outcomes of 9 patients with C. auris fungemia in Brooklyn, New York, USA.


Assuntos
Candida , Candidíase/epidemiologia , Candidíase/microbiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Fungemia/microbiologia , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Candidíase/tratamento farmacológico , Candidíase/história , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/história , Gerenciamento Clínico , Farmacorresistência Fúngica , História do Século XXI , Hospitais Comunitários , Humanos , New York/epidemiologia , Vigilância em Saúde Pública
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