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1.
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
2.
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
3.
BMC Infect Dis ; 18(1): 385, 2018 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-30092780

RESUMO

BACKGROUNDS: Several studies have evaluated the impact of matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry (MS) combined with antimicrobial stewardship in patients with positive blood cultures; clinical outcomes improved. However, in many hospitals, antimicrobial stewardship is not available because of restricted medical resources. Thus, we investigated the impact of evaluation by MALDI-TOF MS on the clinical outcomes of patients with bacteremia and fungemia treated in a clinical setting lacking an antimicrobial stewardship program (ASP). METHODS: We designed a pre-post quasi experimental study and retrospectively reviewed the medical records of patients aged > 18 years old with bacteremia and fungemia during two periods: October-December 2012 and October-December 2013. Conventional methods were used to detect microbial pathogens in 2012, and MALDI-TOF MS was employed in 2013. Clinical outcomes compared between periods were the time to pathogen identification, time to effective therapy, 30-day all-cause mortality, time to microbiological clearance, length of ICU stay, and rate of recurrence of the same bloodstream infection (BSI). RESULTS: A total of 556 patients were enrolled; 302 patients in 2012, and 254 in 2013. The use of MALDI-TOF MS without an ASP reduced the time to pathogen identification (86.4 vs. 63.5 h, P < 0.001) but did not significantly reduce the time to effective therapy (27.4 vs. 23.2 h, P = 0.187). Also, none of the following differed significantly between the two periods: mortality (17.5 vs. 15.7%, P = 0.571), the time to microbiological clearance (3.6 vs. 3.7 days, P = 0.675), the length of ICU stay (16.8 vs. 14.7 days, P = 0.706), and the recurrence rate of the same BSI (5.0 vs. 2.8%, P = 0.183). CONCLUSIONS: The use of MALDI-TOF MS alone in a setting lacking an ASP did not afford clinical benefits. An ASP combined with MALDI-TOF MS is necessary to improve clinical outcomes.


Assuntos
Anti-Infecciosos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bactérias/química , Fungemia/tratamento farmacológico , Fungos/química , Idoso , Gestão de Antimicrobianos , Bacteriemia/microbiologia , Bacteriemia/patologia , Bactérias/isolamento & purificação , Feminino , Fungemia/microbiologia , Fungemia/patologia , Fungos/isolamento & purificação , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Recidiva , Estudos Retrospectivos , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Resultado do Tratamento
4.
J Infect Public Health ; 11(6): 896-897, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29731340

RESUMO

In the last few years, Cryptococcus laurentii infections have increased, particularly in immunocompromised patients. Here we report the first case of C. laurentii fungemia in low birth weight preterm infant from India. A preterm neonate was admitted for feeding intolerance and respiratory distress. Blood culture ascertained the causative organism as C. laurentii. The isolated strain was found susceptible to amphotericin B and the patient recovered following the administration of amphotericin B (5mg/kg body weight) for 8days.


Assuntos
Criptococose/diagnóstico , Criptococose/patologia , Cryptococcus/isolamento & purificação , Fungemia/diagnóstico , Fungemia/patologia , Recém-Nascido de Baixo Peso , Anfotericina B/administração & dosagem , Anfotericina B/farmacologia , Antifúngicos/administração & dosagem , Antifúngicos/farmacologia , Criptococose/tratamento farmacológico , Criptococose/microbiologia , Cryptococcus/classificação , Cryptococcus/efeitos dos fármacos , Fungemia/tratamento farmacológico , Fungemia/microbiologia , Humanos , Índia , Recém-Nascido , Masculino , Testes de Sensibilidade Microbiana , Resultado do Tratamento
5.
Rev Iberoam Micol ; 35(1): 56-58, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-29169813

RESUMO

A 48 year-old immunocompetent woman, who had a nodular lesion in the neck and a dense infiltrate at the lower lobe of the left lung, presented at the Mycology Unit of Muñiz Hospital of Buenos Aires City. The pulmonary infiltrate disappeared spontaneously 3 months later. The histopathological study of the nodular lesion showed capsulated yeasts (mucicarmin and alcian blue positive stains) compatible with Cryptococcus. The mycological study of a new sample, obtained by a nodular puncture, allowed the isolation of yeasts, identified as Cryptococcus gattii (VGII). Latex test for Cryptococcus capsular antigen in serum was positive (1/100). CSF cultures rendered negative results. Fluconazole at a daily dose of 800mg was given during 45 days with partial improvement; as cultures from a new clinical sample were positive for Cryptococcus, the antimycotic was changed to itraconazole 400mg/day for 5 months, with an excellent clinical response.


Assuntos
Criptococose/diagnóstico , Cryptococcus gattii/isolamento & purificação , Cistos/microbiologia , Fungemia/diagnóstico , Pneumopatias Fúngicas/diagnóstico , Doenças da Glândula Tireoide/microbiologia , Antifúngicos/uso terapêutico , Antígenos de Fungos/sangue , Criptococose/tratamento farmacológico , Criptococose/microbiologia , Criptococose/patologia , Cryptococcus gattii/imunologia , Feminino , Fluconazol/uso terapêutico , Fungemia/tratamento farmacológico , Fungemia/microbiologia , Fungemia/patologia , Humanos , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/microbiologia , Pneumopatias Fúngicas/patologia , Pessoa de Meia-Idade
6.
Rev Med Chil ; 145(8): 1067-1071, 2017 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-29189866

RESUMO

Saprochaete capitata (S. capitata) fungal sepsis is a severe condition with a clinical presentation that is similar to other yeast originated fungal sepsis. It is observed in patients with hematological malignancies such as acute myeloid leukemia and neutropenia. We report a 23 year old male presenting with cough, fever and malaise. A bone marrow biopsy led to the diagnosis of acute myeloid leukemia. During the first cycle of chemotherapy the patient presented fever: blood cultures were positive for Klebsiella pneumoniae. Despite antimicrobial treatment, fever persisted; a computed tomography showed a focal splenic lesion; a left exudative pleural effusion appeared. A Matrix Assisted Laser Desorption Ionization-Time of Flight mass spectrometry identified the presence of S. capitata. After multiple antifungal treatments and pleural cavity cleansing by means of videothoracoscopy and laparoscopic splenectomy, the infection resolved and the patient completed his chemotherapy.


Assuntos
Dipodascus/isolamento & purificação , Fungemia/cirurgia , Leucemia Mieloide Aguda/microbiologia , Antifúngicos/uso terapêutico , Drenagem/métodos , Fungemia/tratamento farmacológico , Fungemia/patologia , Humanos , Masculino , Pleurisia/microbiologia , Pleurisia/patologia , Esplenectomia/métodos , Esplenopatias/microbiologia , Esplenopatias/patologia , Esplenopatias/cirurgia , Resultado do Tratamento , Adulto Jovem
7.
Int J Infect Dis ; 61: 103-106, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28652216

RESUMO

Sporopachydermia cereana is a rare yeast found in necrotic cactus tissue, predominantly in the Americas. Infection in humans with clinical data has only been reported in four patients so far, all of whom died, either directly from the pathogen or from other complications of immunosuppression. Treatment of the yeast is complicated by difficulties in identification of the pathogen with conventional diagnostic techniques and by intrinsic resistance to echinocandins. The first patient to survive a disseminated infection with S. cereana is presented herein. The patient had acute myeloid leukemia and was treated successfully with antifungal therapy and subsequently underwent a successful allogeneic hematopoietic stem cell transplantation.


Assuntos
Fungemia/diagnóstico , Leucemia Mieloide Aguda/complicações , Linfonodos/patologia , Saccharomycetales , Antifúngicos/uso terapêutico , Feminino , Fungemia/complicações , Fungemia/tratamento farmacológico , Fungemia/patologia , Transplante de Células-Tronco Hematopoéticas , Humanos , Imunossupressão/efeitos adversos , Leucemia Mieloide Aguda/cirurgia , Linfonodos/microbiologia , Pessoa de Meia-Idade , Necrose
8.
Mycopathologia ; 182(7-8): 761-765, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28365835

RESUMO

Paecilomyces sp. are emerging pathogens in immunocompromised patients. We report here a case of Paecilomyces variotii fungemia, cured with amphotericin and anidulafungin, illustrating difficulties of early diagnosis and therapeutic choice in such rare fungal infection.


Assuntos
Fungemia/diagnóstico , Fungemia/patologia , Insuficiência Hepática/complicações , Transplante de Fígado , Linfoma/complicações , Paecilomyces/isolamento & purificação , Anfotericina B/uso terapêutico , Anidulafungina , Antifúngicos/uso terapêutico , Equinocandinas/uso terapêutico , Fungemia/tratamento farmacológico , Insuficiência Hepática/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
9.
J Mycol Med ; 27(2): 281-284, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28302347

RESUMO

The majority of invasive fungal infections observed in non-neutropenic patients hospitalized in an intensive care unit are caused by Candida spp and current guidelines recommend echinocandins as the first-line treatment. Fungemias caused by filamentous or arthrosporic fungi such as Saprochaete capitata (previously named Geotrichum capitatum) are extremely rare. In fact, invasive infections due to S. capitata have been reported almost exclusively in neutropenic oncohematological patients. In this report, we describe a case of fungemia caused by S. capitata in a non-neutropenic patient hospitalized in an intensive care unit after aortic valve replacement. The prompt identification of S. capitata is extremely important because of its intrinsic resistance to echinocandins.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Fungemia/microbiologia , Hospitalização , Unidades de Terapia Intensiva , Saccharomycetales/isolamento & purificação , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/reabilitação , Infecções Relacionadas a Cateter/microbiologia , Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/microbiologia , Farmacorresistência Fúngica , Equinocandinas/uso terapêutico , Fungemia/tratamento farmacológico , Fungemia/patologia , Humanos , Masculino , Testes de Sensibilidade Microbiana
10.
Mycopathologia ; 182(7-8): 751-754, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28349349

RESUMO

Talaromyces marneffei (also called Penicilliosis Marneffei or T. marneffei) is a rare fungal disease that is prevalent mainly in Southeast Asia and commonly seen in immunocompromised hosts. It was rarely observed in immunocompetent hosts. We report a case of acute disseminated T. marneffei in an immunocompetent patient in the non-prevalent region. This patient had never visited the endemic area. The patient experienced a persistent fever. Brain CT and magnetic resonance imaging (MRI) showed a mass in the right frontal with osteolytic damage. Excessive white blood cell (WBC) count and C-reactive protein content were observed. Antibiotics including meropenem and linezolid could not play an effect, and another two hard masses appeared in his right neck and front chest wall. The aspirates from the right frontal mass and bone marrow were cultured. The final diagnose of this infection was disseminated T. marneffei. After voriconazole treatment, all symptoms improved gradually. We present this case and aim to promote more clinicians and microbiologists in the non-endemic region to recognize this rare disease.


Assuntos
Fungemia/diagnóstico , Fungemia/patologia , Talaromyces/isolamento & purificação , Antifúngicos/uso terapêutico , Ásia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Proteína C-Reativa/análise , Fungemia/microbiologia , Humanos , Contagem de Leucócitos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pescoço/patologia , Parede Torácica/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Voriconazol/uso terapêutico
11.
Med Mycol ; 55(3): 278-284, 2017 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-27601609

RESUMO

Characteristics of cirrhosis-associated cryptococcosis first diagnosed after death are not fully known. In a multicenter study, data generated as standard of care was systematically collected in 113 consecutive patients with cirrhosis and cryptococcosis followed for 80 patient-years. The diagnosis of cryptococcosis was first established after death in 15.9% (18/113) of the patients. Compared to cases diagnosed while alive, these patients had higher MELD score (33 vs. 22, P = .029) and higher rate of cryptococcemia (75.0% vs. 41.9%, P = .027). Cases diagnosed after death, in comparison to those diagnosed during life were more likely to present with shock (OR 3.42, 95% CI 1.18-9.90, P = .023), require mechanical ventilation at admission (OR 8.5, 95% CI 2.74-26.38, P = .001), less likely to undergo testing for serum cryptococcal antigen (OR 0.07, 95% CI 0.02-0.21, P < .001) and have positive antigen when the test was performed (OR 0.07, 95% CI 0.01-0.60, P = .016). In a subset of cirrhotic patients with advanced liver disease cryptococcosis was first recognized after death. These patients had the characteristics of presenting with fulminant fungemia, were less likely to have positive serum cryptococcal antigen and posed a diagnostic challenge for care providers.


Assuntos
Criptococose/patologia , Fungemia/patologia , Cirrose Hepática/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Índice de Gravidade de Doença
12.
Lab Med ; 47(3): 255-8, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27406143

RESUMO

We report a case of Trichosporon loubieri (T. loubieri) fungemia with likely liver involvement in a 39-year-old Caucasian patient with relapsed B-cell acute lymphoblastic leukemia after an allogeneic hematopoietic cell transplant. This is the fifth published case of T. loubieri infection and only the third case of T. loubieri fungemia, to our knowledge. All 3 cases of T. loubieri infection with fungemia had liver involvement.


Assuntos
Fungemia/diagnóstico , Fungemia/patologia , Leucemia-Linfoma Linfoblástico de Células Precursoras B/complicações , Trichosporon/isolamento & purificação , Tricosporonose/diagnóstico , Tricosporonose/patologia , Adulto , Basidiomycota , Grupo com Ancestrais do Continente Europeu , Feminino , Fungemia/microbiologia , Humanos , Técnicas Microbiológicas , Microscopia , Transplante Homólogo/efeitos adversos , Tricosporonose/microbiologia
13.
Mycopathologia ; 181(11-12): 891-897, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27423433

RESUMO

Simultaneous infections with Cryptococcus neoformans and Histoplasma capsulatum are rare and typically occur in immunocompromised individuals, particularly AIDS patients. Because both of those fungi can spur the development of latent infections, it is generally unknown which organism was first present. The diagnosis of one fungus can hide the diagnosis of the other, leading to underdiagnoses and poor prognosis. We report a case of C. neoformans and H. capsulatum co-infection. We also performed a systematic review of the literature. Our patient, a 69-year-old HIV-negative man, presented with a 9-month history of a productive cough, dyspnea and wheezing. His history showed chronic obstructive pulmonary disease and type II diabetes mellitus (DM). Pulmonary lesions of unidentified etiology were noted. Cryptococcal involvement of the central nervous system was confirmed, and C. neoformans and H. capsulatum were also isolated from blood cultures. In the literature, we found ten cases of simultaneous histoplasmosis and cryptococcosis. Including our patient, all of the cases were located in North America and Latin America, except for two, one Indian and one African diagnosed in France. AIDS was the main predisposing factor, followed by DM and age >60 years. Several diagnostic methods were employed. A blood culture and bronchoalveolar lavage (BAL) culture resulted in the growth of C. neoformans in most of the cases. H. capsulatum was more often detected in BAL and bone marrow cultures. Although co-infection by these pathogens is severe, it can be cured if it is diagnosed and treated early. We emphasized the importance of clinical suspicion and differential diagnosis of systemic mycoses.


Assuntos
Coinfecção/diagnóstico , Criptococose/diagnóstico , Cryptococcus neoformans/isolamento & purificação , Fungemia/diagnóstico , Histoplasma/isolamento & purificação , Histoplasmose/diagnóstico , Idoso , Sangue/microbiologia , Coinfecção/patologia , Criptococose/complicações , Criptococose/patologia , Fungemia/patologia , Histoplasmose/complicações , Histoplasmose/patologia , Humanos , Masculino , Técnicas Microbiológicas , Microscopia , Neutrófilos/microbiologia
14.
Med Mycol ; 54(7): 669-76, 2016 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-27118805

RESUMO

Cryptococcosis is a classical systemic opportunistic mycosis, primarily occurring among patients with significant immunologic impairment. However, this disease could also affect patients without any recognized immunologic defects, that is, phenotypically normal patients. The medical records of 29 non-HIV/nontransplant patients with cryptococcal disease during the period 2007-2014 were retrospectively reviewed. The most common site of infection was the central nervous system (n = 25, 86.2%), followed by the pulmonary system (n = 11, 37.9%) and blood (n = 2, 6.8%). Thoracic- and brain-computed tomography demonstrated abnormalities of 81.2% (n = 13) and 62.5% (n = 15), respectively. In sum, 22% (n = 6) of the patients experienced a significant underlying condition. More than one therapeutic regimen was used in 77.8% (n = 21) of the patients. The isolates were identified as being Cryptococcus neoformans species complex (n = 4, 36.4%) and Cryptococcus gattii species complex (n = 7, 63.6%). The overall mortality was 20.7% (n = 6). Herein, we presented the first case series of cryptococcosis in this specific population in São Paulo City, Brazil. The incidence of cryptococcosis in our hospital has not increased in recent years, and 77.8% (n = 21) of cases had no obvious predisposing factor. However, this disease remains associated with high mortality.


Assuntos
Criptococose/patologia , Cryptococcus/isolamento & purificação , Adolescente , Adulto , Idoso , Encéfalo/diagnóstico por imagem , Brasil/epidemiologia , Infecções Fúngicas do Sistema Nervoso Central/epidemiologia , Infecções Fúngicas do Sistema Nervoso Central/patologia , Criança , Pré-Escolar , Criptococose/diagnóstico por imagem , Criptococose/epidemiologia , Criptococose/microbiologia , Cryptococcus/classificação , Feminino , Fungemia/epidemiologia , Fungemia/patologia , Humanos , Pneumopatias Fúngicas/epidemiologia , Pneumopatias Fúngicas/patologia , Masculino , Pessoa de Meia-Idade , Radiografia Torácica , Estudos Retrospectivos , Análise de Sobrevida , Tomografia Computadorizada por Raios X , Adulto Jovem
15.
Crit Care ; 20: 53, 2016 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-26956367

RESUMO

BACKGROUND: To characterize and identify prognostic factors for 28-day mortality among patients with hospital-acquired fungemia (HAF) in the Intensive Care Unit (ICU). METHODS: A sub-analysis of a prospective, multicenter non-representative cohort study conducted in 162 ICUs in 24 countries. RESULTS: Of the 1156 patients with hospital-acquired bloodstream infections (HA-BSI) included in the EUROBACT study, 96 patients had a HAF. Median time to its diagnosis was 20 days (IQR 10.5-30.5) and 9 days (IQR 3-15.5) after hospital and ICU admission, respectively. Median time to positivity of blood culture was longer in fungemia than in bacteremia (48.7 h vs. 38.1 h; p = 0.0004). Candida albicans was the most frequent fungus isolated (57.1%), followed by Candida glabrata (15.3%) and Candida parapsilosis (10.2%). No clear source of HAF was detected in 33.3% of the episodes and it was catheter-related in 21.9% of them. Compared to patients with bacteremia, HAF patients had a higher rate of septic shock (39.6% vs. 21.6%; p = 0.0003) and renal dysfunction (25% vs. 12.4%; p = 0.0023) on admission and a higher rate of renal failure (26% vs. 16.2%; p = 0.0273) at diagnosis. Adequate treatment started within 24 h after blood culture collection was less frequent in HAF patients (22.9% vs. 55.3%; p < 0.001). The 28-day all cause fatality was 40.6%. According to multivariate analysis, only liver failure (OR 14.35; 95% CI 1.17-175.6; p = 0.037), need for mechanical ventilation (OR 8.86; 95% CI 1.2-65.24; p = 0.032) and ICU admission for medical reason (OR 3.87; 95% CI 1.25-11.99; p = 0.020) were independent predictors of 28-day mortality in HAF patients. CONCLUSIONS: Fungi are an important cause of hospital-acquired BSI in the ICU. Patients with HAF present more frequently with septic shock and renal dysfunction on ICU admission and have a higher rate of renal failure at diagnosis. HAF are associated with a significant 28-day mortality rate (40%), but delayed adequate antifungal therapy was not an independent risk factor for death. Liver failure, need for mechanical ventilation and ICU admission for medical reason were the only independent predictors of 28-day mortality.


Assuntos
Fungemia/mortalidade , Fungemia/patologia , Mortalidade Hospitalar/tendências , Doença Iatrogênica , Idoso , Antifúngicos/uso terapêutico , Infecção Hospitalar/mortalidade , Feminino , Humanos , Incidência , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
16.
Jpn J Infect Dis ; 69(6): 520-522, 2016 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-26743142

RESUMO

Lodderomyces elongisporus infrequently causes bloodstream infections and has been isolated from Asia and Mexico. We encountered a catheter-related bloodstream infection, which involved some risk factors, due to L. elongisporus masquerading as Candida parapsilosis. A 39-year-old man who received a total arch and thoracoabdominal aortic replacement was admitted with a diagnosis of aorto-esophageal fistula. After thoracic drainage for the aorto-esophageal fistula, a catheter-related bloodstream infection was diagnosed. Micafungin (100 mg/day) was successfully administered to treat the catheter-related bloodstream infection for 42 days in total. The bloodstream and catheter tip yeast was grown on Candida agar medium and produced dark green colonies indicating Candida albicans. We performed sequencing analysis using a GenBank BLAST search. The sequence of the internal transcribed spacer region was 99.9% identical with that of the type strain L. elongisporus. This yeast organism has frequently been technically mistaken for non-albicans Candida spp. Furthermore, the prognosis and risk factors of L. elongisporus infection remain unclear owing to the scarcity of reported cases. Catheter-related bloodstream infection caused by this organism has not been described to date.


Assuntos
Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/etiologia , Fungemia/diagnóstico , Fungemia/microbiologia , Saccharomycetales/isolamento & purificação , Adulto , Antifúngicos/administração & dosagem , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/patologia , DNA Fúngico/química , DNA Fúngico/genética , DNA Espaçador Ribossômico/química , DNA Espaçador Ribossômico/genética , Equinocandinas/administração & dosagem , Fungemia/tratamento farmacológico , Fungemia/patologia , Humanos , Lipopeptídeos/administração & dosagem , Masculino , Micafungina , Técnicas Microbiológicas , Saccharomycetales/classificação , Saccharomycetales/genética , Análise de Sequência de DNA , Resultado do Tratamento
17.
Mycopathologia ; 181(1-2): 125-9, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26346377

RESUMO

Neutropenic patients are at risk of the development of hyalohyphomycosis and mucormycosis. Correct identification is essential for the initiation of the specific treatment, but concomitant mold infections are rarely reported. We report one unprecedented case of concomitant mucormycosis and fusariosis in a neutropenic patient with acute myeloid leukemia. The patient developed rhino-orbital infection by Rhizopus arrhizus and disseminated infection by Fusarium solani. The first culture from a sinus biopsy grew Rhizopus, which was consistent with the histopathology report of mucormycosis. A second sinus biopsy collected later during the patient's clinical deterioration was reported as hyalohyphomycosis, and the culture yielded F. solani. Due to the discordant reports, the second biopsy was reviewed and two hyphae types suggestive of both hyalohyphomycetes and mucormycetes were found. The dual mold infection was confirmed by PCR assays from paraffinized tissue sections. Increased awareness of the existence of dual mold infections in at-risk patients is necessary. PCR methods in tissue sections may increase the diagnosis of dual mold infections. In case of sequential biopsies showing discrepant results, mixed infections have to be suspected.


Assuntos
Fusariose/complicações , Fusariose/diagnóstico , Fusarium/isolamento & purificação , Mucormicose/complicações , Mucormicose/diagnóstico , Rhizopus/isolamento & purificação , Fungemia/complicações , Fungemia/diagnóstico , Fungemia/microbiologia , Fungemia/patologia , Fusariose/microbiologia , Fusariose/patologia , Fusarium/genética , Humanos , Hospedeiro Imunocomprometido , Leucemia Mieloide Aguda/complicações , Masculino , Pessoa de Meia-Idade , Mucormicose/microbiologia , Mucormicose/patologia , Neutropenia/complicações , Patologia Molecular , Reação em Cadeia da Polimerase , Rhizopus/genética , Sinusite/complicações , Sinusite/diagnóstico , Sinusite/microbiologia , Sinusite/patologia
18.
Mycopathologia ; 181(1-2): 145-9, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26369644

RESUMO

We report an atypical case of Rhodotorula mucilaginosa fungemia coexisting with pleural tuberculosis, in an immunocompetent host. The patient was an inhaled drug abuser and worked in a fruit market. The diagnosis of Rhodotorula mucilaginosa infection was established by the isolation of the yeast in two blood cultures followed by a good response to amphotericin B treatment. Persistent evening fever and pleural effusion led to the second diagnosis-pleural tuberculosis. In the last 5 years, this was the only case of Rhodotorula mucilaginosa fungemia in our hospital and the first case in the literature that documents Rhodotorula mucilaginosa fungemia associated with pleural tuberculosis.


Assuntos
Fungemia/complicações , Fungemia/diagnóstico , Rhodotorula/isolamento & purificação , Tuberculose Pleural/complicações , Tuberculose Pleural/diagnóstico , Adulto , Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Sangue/microbiologia , Fungemia/patologia , Humanos , Masculino , Resultado do Tratamento , Tuberculose Pleural/patologia
19.
Dermatol Online J ; 21(11)2015 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-26632935

RESUMO

Candida krusei (C. krusei) is a multidrug-resistant opportunistic fungal pathogen that may cause disseminated infections in immunocompromised hosts. However, its clinical and histologic features are not well-characterized. We present a unique case to contribute to the growing knowledge base associated with this organism. During hospitalization for neutropenic fever, a 19-year-old man with acute myeloid leukemia, who underwent hematopoietic stem cell transplantation, developed a generalized folliculocentric eruption following initiation of antifungal therapy for newly diagnosed C. krusei fungemia. Despite adequate antifungal coverage and negative blood cultures, the follicular-based erythematous papules persisted. Biopsies demonstrated yeast within ruptured follicles, without angiotropism or involvement of the interfollicular dermis, subcutaneous tissue, or stratum corneum. Concurrent skin tissue cultures confirmed C. krusei. The patient remained febrile despite aggressive antifungal therapy, with relapse of leukemia and subsequent death. Our case is unusual given the development of cutaneous lesions following clearance of fungemia, with yeast limited to ruptured follicular lumina, possibly indicating a primary cutaneous source or early transfollicular/transepidermal elimination. Given the limited available descriptions of cutaneous histopathology for C. krusei, we seek to add to the understanding of its pathophysiology and aid in the diagnosis and treatment of this often fatal infection.


Assuntos
Candidíase Cutânea/tratamento farmacológico , Candidíase Cutânea/patologia , Candidíase/tratamento farmacológico , Candidíase/patologia , Antifúngicos/uso terapêutico , Candidíase/imunologia , Candidíase Cutânea/imunologia , Evolução Fatal , Fungemia/tratamento farmacológico , Fungemia/imunologia , Fungemia/patologia , Humanos , Hospedeiro Imunocomprometido , Leucemia Mieloide Aguda/complicações , Masculino , Adulto Jovem
20.
Antimicrob Agents Chemother ; 59(12): 7249-54, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26369964

RESUMO

Coccidioidomycosis, or valley fever, is a growing health concern endemic to the southwestern United States. Safer, more effective, and more easily administered drugs are needed especially for severe, chronic, or unresponsive infections. The novel fungal CYP51 inhibitor VT-1161 demonstrated in vitro antifungal activity, with MIC50 and MIC90 values of 1 and 2 µg/ml, respectively, against 52 Coccidioides clinical isolates. In the initial animal study, oral doses of 10 and 50 mg/kg VT-1161 significantly reduced fungal burdens and increased survival time in a lethal respiratory model in comparison with treatment with a placebo (P < 0.001). Oral doses of 25 and 50 mg/kg VT-1161 were similarly efficacious in the murine central nervous system (CNS) model compared to placebo treatment (P < 0.001). All comparisons with the positive-control drug, fluconazole at 50 mg/kg per day, demonstrated either statistical equivalence or superiority of VT-1161. VT-1161 treatment also prevented dissemination of infection from the original inoculation site to a greater extent than fluconazole. Many of these in vivo results can be explained by the long half-life of VT-1161 leading to sustained high plasma levels. Thus, the efficacy and pharmacokinetics of VT-1161 are attractive characteristics for long-term treatment of this serious fungal infection.


Assuntos
Inibidores de 14-alfa Desmetilase/farmacologia , Antifúngicos/farmacologia , Coccidioides/efeitos dos fármacos , Coccidioidomicose/tratamento farmacológico , Fluconazol/farmacologia , Fungemia/prevenção & controle , Piridinas/farmacologia , Tetrazóis/farmacologia , Inibidores de 14-alfa Desmetilase/sangue , Inibidores de 14-alfa Desmetilase/farmacocinética , Animais , Antifúngicos/sangue , Antifúngicos/farmacocinética , Coccidioides/enzimologia , Coccidioides/crescimento & desenvolvimento , Coccidioidomicose/microbiologia , Coccidioidomicose/mortalidade , Coccidioidomicose/patologia , Modelos Animais de Doenças , Feminino , Fluconazol/sangue , Fluconazol/farmacocinética , Proteínas Fúngicas/antagonistas & inibidores , Proteínas Fúngicas/genética , Proteínas Fúngicas/metabolismo , Fungemia/microbiologia , Fungemia/mortalidade , Fungemia/patologia , Meia-Vida , Humanos , Camundongos , Testes de Sensibilidade Microbiana , Piridinas/sangue , Piridinas/farmacocinética , Esterol 14-Desmetilase/genética , Esterol 14-Desmetilase/metabolismo , Análise de Sobrevida , Tetrazóis/sangue , Tetrazóis/farmacocinética , Resultado do Tratamento
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