RESUMO
OBJECTIVE: To report the species identified in candidemia isolated in hospitals in Paraguay, their distribution by age groups, and their susceptibility to fluconazole, voriconazole, and amphotericin B. METHODS: Retrospective study of candidemia reported to the Central Health Public Laboratory by seven hospitals between 2010 and 2018. Identification and susceptibility testing were performed using the automated Vitek 2® system. RESULTS: 520 cases of candidiasis were reported. The prevalent species were Candida albicans (34.4%), C. parapsilosis (30.4%), C. tropical (25.4%), C. glabrata (4.8%), and C. krusei (2.1%). Less frequent species were: C. lusitaniae (1.2%), C. guilliermondii (1%), C. famata (0.3%), C. rugous (0.2%), and C. kefyr (0.2%). Candidiasis was most prevalent in the elderly (48.5%) and adults (29.9%). C. parapsilosis was most frequent in newborns and infants, and C. tropical in pediatric patients; 2.8% and 0.6% of C. albicans and 4.4% and 2.5% of C. parapsilosis were resistant, respectively, to fluconazole and voriconazole; 8% of C. glabrata were resistant to fluconazole and two isolations showed a minimum inhibitory concentration for voriconazole greater than 0.25 mg/L. CONCLUSIONS: This is the first report on candidemias in hospitals of Paraguay. Together with other studies, it will improve knowledge about this infection in the country.
OBJETIVO: Relatar as espécies identificadas em candidemias isoladas em hospitais do país, apresentar a sua distribuição por faixa etária e determinar a sua sensibilidade ao fluconazol, voriconazol e anfotericina B. MÉTODOS: Estudo retrospectivo de candidemias notificadas por sete hospitais ao Laboratório Central de Saúde Pública no período de 2010 a 2018. A identificação e o antifungigrama foram realizados pelo sistema automatizado Vitek®2. RESULTADOS: Foram notificados 520 casos de candidemia. As espécies predominantes foram Candida albicans (34,4%), C. parapsilosis (30,4%), C. tropicalis (25,4%), C. glabrata (4,8%) e C. krusei (2,1%). Outras espécies menos frequentes foram: C. lusitaniae (1,2%), C. guilliermondii (1%), C. famata (0,3%), C. rugosa (0,2%) e C. kefyr (0,2%). As candidemias em pacientes idosos (48,5%) e adultos (29,9%) foram as mais prevalentes. C. parapsilosis foi a espécie mais frequente em recém-nascidos e lactentes, e C. tropicalis predominou em pacientes pediátricos. Ao todo, 2,8% e 0,6% dos casos de C. albicans e 4,4% e 2,5% dos de C. parapsilosis foram resistentes a fluconazol e voriconazol, respectivamente. Além disso, 8% dos casos de C. glabrata foram resistentes ao fluconazol, e duas amostras isoladas apresentaram uma concentração inibitória mínima para voriconazol acima de 0,25 mg/L. CONCLUSÕES: Este é o primeiro estudo sobre candidemias em hospitais do Paraguai, o que, juntamente com outros estudos, permitirá conhecer melhor esta infecção no país.
RESUMO
La mucormicosis es una infección con una alta mortalidad, el pronóstico está en relación con el diagnóstico precoz, el tratamiento quirúrgico y antimicótico. Se presenta un varón de 65 años de edad, hipertenso conocido, tratado con losartan, ingresa con una historia de 15 días de evolución con astenia, anorexia, pérdida de peso y cefalea holocraneana, y ptosis palpebral de una semana de evolución. Al examen físico se constata una protrusión ocular y parálisis del tercer par del ojo derecho. Presentó hiperglicemia que fue revertida con insulina. La resonancia magnética de órbita y senos paranasales mostró un engrosamiento del nervio óptico derecho, ocupación de los senos paranasales. El paciente fue sometido a un tratamiento quirúrgico de la lesión retrocular, la biopsia de la lesión mostró al examen directo hifas hialinas compatible con mucorales. Se inició tratamiento con amfotericina B.
Mucormycosis is an infection with high mortality, the prognosis is related to early diagnosis, surgical and antifungal treatment. We present a 65-year-old male, known hypertensive, under treatment with losartan, admitted with a 15-day history of asthenia, anorexia, weight loss and holocranial headache, and palpebral ptosis of one week's evolution. Physical examination revealed ocular protrusion and paralysis of the third pair of the right eye. The patient presented hyperglycemia that was reversed with insulin. Magnetic resonance imaging of the orbit and paranasal sinuses showed thickening of the right optic nerve, occupation of the paranasal sinuses. The patient underwent surgical treatment of the retrocular lesion, biopsy of the lesion showed hyaline hyphae compatible with mucorales on direct examination. Treatment with amphotericin B was started.
RESUMO
La Mucormicosis es una infección poco frecuente, de elevada morbi-mortalidad producida por hongos oportunistas del orden Mucorales, pertenecientes a varias familias y especies. Presenta varias formas clínicas, siendo la más frecuente la rinocerebral y, los factores predisponentes son muchos, pero los principales son la diabetes mellitus descompensada y la leucemia. Se reporta 4 casos de mucormicosis de la forma rinocerebral, relacionados con diabetes mellitus, 3 de ellos con evolución fatal. En todos los casos se observaron en el estudio micológico y, en la anatomía patológica las características hifas hialinas cenocíticas con ramificaciones en ángulo recto y en 2 de los casos, el cultivo identificó al Rhizopus spp y al Mycoclades spp como los responsables.
The mucormycosis is a rare infection, with high morbidity and mortality; produced by opportunistic fungi of the order Mucorales belonging to several families and species. This infection presents several clinical forms. The most common is the rhino-cerebral. Predisposing factors are many but the principals are decompensated diabetes mellitus and leukemia. We report four cases of rhinocerebral mucormycosis related to diabetes mellitus; three of them with fatal evolution. In all cases, we found both in the mycological study and in the pathological anatomy the characteristics of hyaline hyphae with right-angled branches. Particularly, in two cases, the culture identified Rhizopus spp and Mycoclades spp as responsible.
RESUMO
RESUMEN Introducción: la cromomicosis es una micosis profunda provocada por la inoculación traumática percutánea, de hongos dematiáceos que habitan el suelo y restos vegetales. Es una micosis de difícil manejo, con importante morbilidad, que afecta una población generalmente de precarias condiciones socioeconómicas, en una etapa productiva de la vida. Objetivos: determinar la frecuencia y características clínicas de la cromomicosis en el Servicio de Dermatología del Hospital Nacional (Itauguá, Paraguay) en el periodo de 24 años (1991- 2015). Metodología: estudio observacional descriptivo de 25 casos de cromomicosis con confirmación micológica y/o anatomopatológica. Resultados: la micosis fue más frecuente en varones adultos, procedentes de áreas rurales, dedicados a labores agrícolas. Predominaron las lesiones ubicadas en miembros inferiores. El agente causal más frecuente fue el Fonsecae sp. El itraconazol fue el tratamiento más utilizado. Conclusiones: la cromomicosis afectó de preferencia a varones adultos del área rural, aislándose con mayor frecuencia Fonsecae sp.
ABSTRACT Introduction: Chromomycosis is a deep mycosis caused by the percutaneous traumatic inoculation of dematiaceous fungi that inhabit soil and vegetal debris. It is a mycosis of difficult management, with important morbidity, that affects a population generally of precarious socio-economic conditions in a productive stage of life. Objectives: To determine the frequency and clinical characteristics of chromomycosis in the Dermatology Service of the National Hospital (Itauguá, Paraguay) over a 24-year period (1991- 2015). Methodology: Observational descriptive study of 25 cases of chromomycosis with mycological and/or anatomopathological confirmation. Results: Mycosis was more frequent in adult men from rural areas, engaged in agricultural work. Lesions in lower limbs prevailed. The most frequent causative agent was Fonsecae sp. Itraconazole was the most commonly used treatment. Conclusions: Chromomycosis affected preferentially adult men from rural areas, and Fonsecae sp. was the most frequently isolated fungus.