Antigens of Coccidioides posadasii as an important tool for the immunodiagnosis of coccidioidomycosis.

Serologic diagnosis has been presented as a safe alternative for coccidioidomycosis. However, commercial kits based on coccidioidal antibodies available in the USA are considered too expensive for laboratories outside that country. In this study, we describe the preparation of antigens for detection of human coccidioidal antibodies by the immunodiffusion test (ID) and enzyme immunoassay (EIA). Antigens were tested against serum samples from patients with coccidioidomycosis, histoplasmosis and paracoccidioidomycosis, as well as healthy individuals. The highest reactivity in the ID tests was seen in the F0-90 antigen. In the EIAs, the best results were obtained with the F60-90 antigen. None of the serum samples from healthy individuals were recognized by any of the antigen extracts tested by ID or EIA. In conclusion, the F0-90 and F60-90 antigens have the potential to be commercially employed in presumptive diagnosis of coccidioidomycosis by ID or EIA, respectively. The tests could improve serological diagnosis of coccidioidomycosis in South America.

Candidemia in a Brazilian hospital: the importance of Candida parapsilosis.

The aim of this study was to perform a retrospective analysis of cases of candidemia in a Brazilian hospital in the city of Fortaleza, Ceará. A total of 50 blood cultures were analyzed from 40 candidemic patients. The mycological diagnosis was based on the phenotypical analysis and the patients' data were recorded in appropriate files. The most frequent species were Candida parapsilosis (n = 18), followed by C. albicans (n = 14), C. tropicalis (n = 8), C. guillermondii (n = 6), C. glabrata (n = 2), and Candida spp. (n = 2). A detailed descriptive study was undertaken with 21 patients whose medical records were complete. The candidemia episodes occurred in eight male patients and 13 female patients. The most representative risk factors implicated in candidemia were prior antibiotic therapy, central venous catheters, parenteral nutrition, gastric probes and mechanical ventilation. Death occurred in 13 of the 21-candidemic patients. This study demonstrated the emergence of candidemia caused by C. parapsilosis in a Brazilian hospital in the city of Fortaleza, Ceará.

In vitro synergistic effects of antituberculous drugs plus antifungals against Coccidioides posadasii.

The aim of the present study was to evaluate the in vitro interactions of antituberculous drugs (ATDs) with antifungals against Coccidioides posadasii. Eighteen drug combinations, formed by an ATD (isoniazid, pyrazinamide or ethambutol) plus an antifungal (amphotericin B, ketoconazole, itraconazole, fluconazole, voriconazole or caspofungin), were tested using the checkerboard method. All the antimicrobial combinations inhibited C. posadasii strains and synergistic interactions were observed for 10 combinations. Antagonism between the tested drugs was not observed. Stronger synergistic interactions were seen in the combinations formed by triazoles plus ethambutol as well as itraconazole plus pyrazinamide. Further studies in animal models are needed to confirm the usefulness of these combinations.

Candidemia in a Brazilian hospital: the importance of Candida parapsilosis

O presente estudo objetivou desenvolver uma análise retrospectiva de casos de candidemia em hospital brasileiro na cidade de Fortaleza, Ceará. Um total de 50 hemoculturas foram analisadas de 40 pacientes com quadros de candidemia. O diagnóstico micológico foi baseado na análise morfológica e bioquímica e os dados dos pacientes foram coletados das histórias clínicas. As espécies mais freqüentes foram Candida parapsilosis (n = 18), seguida por C. albicans (n = 14), C. tropicalis (n = 8), C. guillermondii (n = 6), C. glabrata (n = 2) e Candida spp. (n = 2). Um estudo descritivo foi realizado com apenas 21 pacientes os quais possuíam dados clínicos completos. Os episódios de candidemia aconteceram em oito pacientes do sexo masculino e 13 do feminino. Os fatores de risco implicados em candidemia foram antibioticoterapia prévia, uso de cateter venoso central, nutrição parenteral, sondagem gástrica e ventilação mecânica. A morte aconteceu em 13 dos 21 pacientes com candidemia. Este estudo demonstrou a emergência de candidemia causada por C. parapsilosis em um hospital brasileiro na cidade de Fortaleza, Ceará.

Perfil de sensibilidade de cepas de Coccidioides posadasii a associação de drogas antimicrobianas [manuscrito] / Sensitivity profile of Coccidioides strains posadasii the combination of antimicrobial drugs [manuscript]

A coccidioidomicose é uma infecção sistêmica, predominantemente pulmonar, causada pelos fungos dimórficas Coccidioides immitis e C. posadasii. O Brasil está na relação de países com áreas endêmicas da coccidioidomicose (RESTREPO, 2006), circunscritas as zonas do semiárido da região do Nordeste (COX & MAGEE, 2004). Esse cenário leva a uma investigação mair para novas estratégias inibitórias contra Coccidioides posadasii. Baseando-se neste contexto, buscou-se estudar novas estratégias, como avaliar a interação in vitro dos principais antifúngicos utilizados no tratamento da coccidioidomicose, analisar o efeito inibitório in vitro de drogas antimicrobianas, como o sulfametoxazol com trimetoprim (SMX/TMP) associado ou não com anfotericina B (AMB), bem como avaliar a interação in vitro das drogas antituberculose com drogas antifúngicas frente a cepas de C. posadasii isoladas no Nordeste brasileiro. O estudo foi conduzido em ensaio de macrodiluição, de acordo com o protocolo descrito no documento M-38A, padronizado pelo Clinical Laboratory Checkerboard...