Posts filed under ‘Antimicoticos’

Molecular Epidemiology of Candida auris in Colombia Reveals a Highly Related, Countrywide Colonization With Regional Patterns in Amphotericin B Resistance

Clinical Infectious Diseases, January 1, 2019 V.68  N.1 P.15–21

Patricia Escandón; Nancy A Chow; Diego H Caceres; Lalitha Gade; Elizabeth L Berkow …

Background

Candida auris is a multidrug-resistant yeast associated with hospital outbreaks worldwide. During 2015–2016, multiple outbreaks were reported in Colombia. We aimed to understand the extent of contamination in healthcare settings and to characterize the molecular epidemiology of C. auris in Colombia.

Methods

We sampled patients, patient contacts, healthcare workers, and the environment in 4 hospitals with recent C. auris outbreaks. Using standardized protocols, people were swabbed at different body sites. Patient and procedure rooms were sectioned into 4 zones and surfaces were swabbed. We performed whole-genome sequencing (WGS) and antifungal susceptibility testing (AFST) on all isolates.

Results

Seven of the 17 (41%) people swabbed were found to be colonized. Candida auris was isolated from 37 of 322 (11%) environmental samples. These were collected from a variety of items in all 4 zones. WGS and AFST revealed that although isolates were similar throughout the country, isolates from the northern region were genetically distinct and more resistant to amphotericin B (AmB) than the isolates from central Colombia. Four novel nonsynonymous mutations were found to be significantly associated with AmB resistance.

Conclusions

Our results show that extensive C. auris contamination can occur and highlight the importance of adherence to appropriate infection control practices and disinfection strategies. Observed genetic diversity supports healthcare transmission and a recent expansion of C. auris within Colombia with divergent AmB susceptibility.

FULL TEXT

https://academic.oup.com/cid/article/68/1/15/4996781

PDF (hacer CLIC en PDF)

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January 5, 2019 at 12:00 pm

Candida auris Sternal Osteomyelitis in a Man from Kenya Visiting Australia, 2015

Emerging Infectious Diseases January 2019 V.25  N.1

H. Heath et al.

In Australia in 2015, Candida auris sternal osteomyelitis was diagnosed in a 65-year-old man with a history of intensive care treatment in Kenya in 2012 and without a history of cardiac surgery.

The isolate was South Africa clade III.

Clinicians should note that C. auris can cause low-grade disease years after colonization.

PDF

https://wwwnc.cdc.gov/eid/article/25/1/pdfs/18-1321.pdf

December 26, 2018 at 3:48 pm

Radiological characteristics of pulmonary cryptococcosis in HIV-infected patients.

PLoS One. March 16, 2017 V.12 N.3 P.:e0173858.

Hu Z1, Chen J2, Wang J3, Xiong Q1, Zhong Y1, Yang Y1, Xu C4, Wei H1.

Abstract

BACKGROUND:

Current understanding of human immunodeficiency virus (HIV)-associated pulmonary cryptococcosis (PC) is largely based on studies performed about 2 decades ago which reported that the most common findings on chest radiograph were diffuse interstitial infiltrates. Few studies are available regarding the computed tomography (CT) findings. The aim of this study was to characterize chest CT features of HIV-associated PC.

METHODS:

HIV patients with cryptococccal infection and pulmonary abnormalities on Chest CT between September 2010 and May 2016 in the Second Affiliated Hospital of the Southeast University were retrospectively analyzed. Confirmed cases of tumors, mycobacterial infections and other fungal infections were excluded from the analysis.

RESULTS:

60 cases were identified. The median CD4 T-cell counts were 20 cells/μL (range, 0-205 cells/μL). Chest CT scans demonstrated nodular lesions in 93.3% of the studied patients. Those nodular lesions were usually cavitated and solitary nodule was the most common form. Pleural effusions and pneumonic infiltrates occurred in 11.6% and 31.7% of the cases respectively. Those lesions were usually had co-existing nodular lesions. Etiological analysis suggested that 76.8% of the nodular lesions could have a relationship with PC that 12.5% of the nodular lesions were “laboratory-confirmed” cases, 48.2% were “clinically confirmed” cases and 16.1% were “clinically probable” cases. 85.7% of the pleural effusions could be “clinically confirmed” cases of PC. At least, 38.5% of the diffuse pneumonic infiltrates may be clinically attributed to pneumocystis pneumonia.

CONCLUSIONS:

This study suggested that pulmonary nodules but not diffuse pneumonia are the most common radiological characteristics of HIV-associated PC. HIV-infected patients with pulmonary nodules on Chest CT should particularly be screened for cryptococcal infection

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5354418/pdf/pone.0173858.pdf

November 25, 2018 at 9:40 am

Pulmonary Cryptococcosis – Localized and Disseminated Infections in 27 Patients with AIDS.

Clinical Infectious Diseases September 1995 V.21 N.3 P.628–633

Marie-Caroline Meyohas; Patricia Roux; Diane Bollens; Christos Chouaid; Willy Rozenbaum …

We reviewed the records of 85 patients infected with both human immunodeficiency virus and Cryptococcus neoformans.

Twenty-seven patients (32%) had pulmonary cryptococcosis.

C. neoformans was cultured from bronchoalveolar lavage (BAL) or pleural fluid in 25 cases; the remaining two patients had cryptococcal antigen (CA) detected in BAL fluid and C. neoformans cultured from other sites.

All but one of the 27 patients had detectable CA in serum.

The CD4+ lymphocyte count was low in all cases (median, 24/mm3). Clinical manifestations of pulmonary cryptococcosis included fever (94%), cough (71%), dyspnea (7%), expectoration (4%), chest pain (2%), and hemoptysis (1%).

Diffuse interstitial opacities (70.5%), focal interstitial abnormalities, alveolar opacities, adenopathies, cavitary lesions, and pleural effusions were evident.

Outcome was poor (mean survival time, 23 weeks) despite treatment.

Patients with localized pulmonary cryptococcosis appeared to have a higher CD4+ lymphocyte count, an earlier diagnosis, lower serum CA titers, fewer previous or concomitant infections, and a better prognosis than patients with disseminated cryptococcosis.

abstract

https://academic.oup.com/cid/article-abstract/21/3/628/362645?redirectedFrom=fulltext

PDF

https://doi.org/10.1093/clinids/21.3.628

 

November 24, 2018 at 8:03 pm

Cryptococcus neoformans Pulmonary Infection in HIV-1-Infected Patients

Journal of Acquired Immune Deficiency Syndrome May 1990 V.3  N.5 P.480-484

Clark, Rebecca A.; Greer, Donald L.; Valainis, Gregory T…..

Cryptococcus neoformans (Cn) is a frequent pathogen in patients infected with the human immunodeficiency virus (HIV-1).

We review the initial presentation and clinical course of 18 HIV-1-infected (HIV +) patients with a Cn pulmonary infection. Simultaneous positive cerebrospinal fluid (CSF) cultures were found in 10 (63%) of 16 examined.

The most frequent presenting symptoms were fever (87%) and pulmonary complaints (60%).

Although the most common chest radiographic finding was bilateral diffuse interstitial infiltrates, nodules and cavitary lesions were also seen. Nine (50%) of the 18 patients died within 6 weeks of diagnosis.

Of six patients with an isolated Cn pulmonary infection, five have subsequently died.

Three of these five patients did not receive maintenance therapy and had confirmed or probable relapse.

Patients initially presenting with an isolated Cn pulmonary infection may later show disseminated disease, suggesting that such patients should receive both acute and maintenance therapy.

abstract

https://journals.lww.com/jaids/Abstract/1990/05000/Cryptococcus_neoformans_Pulmonary_Infection_in.3.aspx

PDF (CLIC en PDF)

November 24, 2018 at 8:01 pm

2017 GUIA ARGENTINA PARA USO de ANTIBIOTICOS en el 1er Nivel Asistencial – MSN 181 pags.

Guía de medicamentos esenciales para el PNA – Antimicrobianos 1ra edición – Ciudad Autónoma de Buenos Aires : Ministerio de Salud de la Nación. Cobertura Universal de Salud. Medicamentos, 2017

“Guía de Medicamentos Esenciales en el PNA – Grupo Antimicrobianos” describe las características farmacológicas y clínicas más relevantes de los Medicamentos Esenciales utilizados en el manejo de las enfermedades infecciosas prevalentes en el primer nivel de atención.

La misma se agrupa a su vez en: antibióticos, antimicóticos, antivirales, antiparasitarios y fármacos para el tratamiento de la Tuberculosis.

PDF

http://www.msal.gob.ar/images/stories/bes/graficos/0000001087cnt-medicamentos-esenciales-primer-nivel-atencion-antimicrobianos.pdf

November 3, 2018 at 5:44 pm

Periprosthetic fungal infection of a hip caused by Trichosporon inkin.

Arthroplast Today. July 28, 2017 V.4 N.1 P.24-26.

Burgo FJ1, Mengelle DE1, Abraham A1, Kremer G1, Autorino CM1.

Author information

1 Department of Orthopedic Surgery, Austral University Hospital, Adult Reconstruction Section, Buenos Aires, Argentina.

Abstract

An immunocompromised patient with a history of multiple hip implant revisions extended courses of empiric antibiotic treatment, and a retained metallic rod in the femoral medullary canal was transferred for diagnostic studies and treatment. A high suspicion of fungal infection and utilization of extended and specific fungal cultures were the diagnostic keys for infection with Trichosporon inkin. The treatment consisted in a debridement surgery with the use of a functional spacer with cement supplemented with voriconazole and vancomycin plus a 6-month systemic treatment with voriconazole. After 2 years of follow-up, the patient is free of symptoms.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5859464/pdf/main.pdf

August 28, 2018 at 11:58 am

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