Posts filed under ‘Antimicoticos’

Histoplasmosis-related healthcare use, diagnosis, and treatment in a commercially insured population, United States.

Clinical Infectious Diseases April 30, 2019  

Benedict K1, Beer KD1, Jackson BR1.

Abstract

BACKGROUND:

Infections with Histoplasma can range from asymptomatic to life-threatening acute pulmonary or disseminated disease. Histoplasmosis can be challenging to diagnose and is widely under-recognized. We analyzed insurance claims data to better characterize histoplasmosis testing and treatment practices and its burden on patients.

METHODS:

We used the IBM® MarketScan® Research Databases to identify patients with histoplasmosis (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 115.00-115.99) during 2012-2014. We analyzed claims in the 3 months before to the 1 year after diagnosis and examined differences between probable (hospitalized or >1 outpatient visit) and suspect (1 outpatient visit) patients.

RESULTS:

Among 1,935 patients (943 probable, 922 suspect), 54% had codes for symptoms or findings consistent with histoplasmosis and 35% had ≥2 healthcare visits in the 3 months before diagnosis. Overall, 646 (33%) had any fungal-specific laboratory test: histoplasmosis antibody test (n= 349, 18%), Histoplasma antigen test (n=349, 18%), fungal smear (n=294, 15%), or fungal culture (n=223, 12%); 464 (24%) had a biopsy. Forty-nine percent of probable patients and 10% of suspect patients were prescribed antifungal medication in the outpatient setting. Total, 19% were hospitalized. Patients’ last histoplasmosis-associated healthcare visits occurred a median of 6 months after diagnosis.

CONCLUSIONS:

Some histoplasmosis patients experienced severe disease, apparent diagnostic delays, and prolonged illness, whereas other patients lacked symptoms and were likely diagnosed incidentally (e.g., via biopsy). Low rates of histoplasmosis-specific testing also suggest incidental diagnoses and low provider suspicion, highlighting the need for improved awareness about this disease.

abstract

https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciz324/5481778

PDF (CLIC en PDF)

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May 23, 2019 at 8:16 am

Mortality due to Cryptococcus neoformans and Cryptococcus gattiiin low-income settings: an autopsy study

Scientific Reports May 2019       

Cryptococcosis is a major opportunistic infection and is one of the leading causes of death in adults living with HIV in sub-Saharan Africa. Recent estimates indicate that more than 130,000 people may die annually of cryptococcal meningitis in this region.

Although complete diagnostic autopsy (CDA) is considered the gold standard for determining the cause of death, it is seldom performed in low income settings.

In this study, a CDA was performed in 284 deceased patients from Mozambique (n = 223) and Brazil (n = 61). In depth histopathological and microbiological analyses were carried out in all cases dying of cryptococcosis. We determined the cryptococcal species, the molecular and sero-mating types and antifungal susceptibility.

We also described the organs affected and reviewed the clinical presentation and patient management. Among the 284 cases included, 17 fatal cryptococcal infections were diagnosed. Cryptococcus was responsible for 16 deaths among the 163 HIV-positive patients (10%; 95%CI: 6–15%), including four maternal deaths.

One third of the cases corresponded to C. gattii (VGI and VGIV molecular types, Bα and Cα strains) and the remaining infections typed were caused by C. neoformans var. Grubii (all VNI and Aα strains). The level of pre-mortem clinical suspicion was low (7/17, 41%), and 7/17 patients (41%) died within the first 72 hours of admission.

Cryptococcosis was responsible for a significant proportion of AIDS-related mortality. The clinical diagnosis and patient management were inadequate, supporting the need for cryptococcal screening for early detection of the disease.

This is the first report of the presence of C. gattii infection in Mozambique…

FULL TEXT

https://www.nature.com/articles/s41598-019-43941-w.epdf

May 22, 2019 at 7:53 am

Liposomal Amphotericin B: Two Decades of Preclinical and Clinical Advances for Treatment of Invasive Fungal Infections

Clinical Infectious Diseases May 15, 2019 V.68 SUPPL. 4

Pharmacology of Liposomal Amphotericin B: An Introduction to Preclinical and Clinical Advances for

Treatment of Life-threatening Invasive Fungal Infections

Preclinical Safety, Tolerability, Pharmacokinetics, Pharmacodynamics, and Antifungal Activity of Liposomal Amphotericin B

Clinical Pharmacokinetics, Pharmacodynamics, Safety and Efficacy of Liposomal Amphotericin B

https://academic.oup.com/cid/issue/68/Supplement_4

 

May 5, 2019 at 12:31 pm

Chile: Primer reporte de colonización por Candida auris uris en un paciente procedente de India

Sociedad Chilena de Infectología

Microbiólogos e infectólogos del Hospital del Salvador, de Santiago, reportaron el 1er aislamiento en Chile de Candida auris en un paciente de nacionalidad india y radicado en Chile hace 30 años. El paciente es diabético tipo II de larga data.

En agosto 2018 evolucionó con signos de isquemia y posteriormente necrosis del 4to dedo izquierdo asociado a celulitis del mismo pie.

Sus familiares decidieron el traslado a Mumbay (India), para su tratamiento.

Fue amputado en un hospital en Mumbay el 20/agosto/2018. Completó 24 días de hospitalización por dificultad en el manejo de su diabetes mellitus, y posteriormente continuó con curaciones ambulatorias en el mismo centro.

Una semana antes de volver a Chile, en octubre 2018, notó signos compatibles con necrosis en la falange distal del 3er dedo ipsilateral.

Consultó a su regreso a Chile en el Servicio de Urgencia de un centro privado. Fue derivado al Hospital del Salvador, donde se estudió y derivó a cirugía vascular para amputación del 3er y 5to dedos  izquierdos con diagnóstico de pie diabético con complicaciones vasculares, sin signos de infección.

El 26/diciembre/2018 ingresó a pabellón, donde se tomaron cultivos de tejido del lecho de amputación y de una úlcera plantar en relación a la base del 5to dedo.

Luego de 48 hs de incubación no hubo crecimiento de colonias en el cultivo corriente, por lo que se realizó un traspaso final desde el caldo tioglicolato a un agar sangre.

El 31/12/2018 se estudió una colonia blanca pequeña, la que es identificada como Kokuria kristinae (98% de concordancia). Se realizó tinción de Gram de dicha colonia, observándose levaduras.

El 2/enero/2019 se procesó nuevamente, dando como resultado C. auris con 99% de concordancia.

En función de los resultados obtenidos, se envió la cepa al Instituto de Salud Pública (ISP), quien el 17/enero/2019 confirmó la identificación.

El paciente no fue tratado con antifúngicos debido a que este hallazgo fue interpretado como una colonización, al no existir síntomas ni signos inflamatorios en el sitio quirúrgico.

En controles posteriores, un mes después de la amputación, se evidenciaron elementos compatibles con infección del sitio quirúrgico (ISQ) realizándose toilette de la zona en la cual se aislaron Klebsiella pneumoniae (en tejido óseo y partes blandas) y Staphylococcus aureus (partes blandas), pero no se ha vuelto a aislar C. auris en muestras de tejido y hueso del paciente.

Producto del patrón de susceptibilidad de los agentes identificados, se hospitalizó para tratamiento ATB IV, siendo sometido finalmente a una amputación trans-metatarsiana el 19/febrero/2019.

En dicho procedimiento se tomaron cultivos óseos y de tejidos blandos adyacentes con resultados negativos.

Durante esta hospitalización, se obtuvieron hisopados nasal, orofaríngeo, axilar e inguinorrectal para estudio de portación de C. auris, con resultados negativos.

Para los procesos de atención clínica, el paciente fue manejado con precauciones de contacto (unidad individual, uso de elementos de protección personal, aseo de unidad supervisado de acuerdo a protocolo interno).

Candida auris es un hongo emergente considerado una seria amenaza para la salud pública. La preocupación mundial por C. auris se debe principalmente a tres razones:

1) la resistencia que presenta a múltiples antifúngicos comúnmente utilizados para tratar las infecciones por Candida;

2) los errores en la identificación con los métodos de laboratorio estándar;

3) ser causa de brotes intrahospitalarios en los cinco continentes.

Por esta razón, es importante identificar rápidamente la presencia de C. auris en un paciente hospitalizado, para que se puedan tomar las precauciones especiales para detener su propagación. Dado el gran potencial de diseminación de esta Candida, es muy importante reforzar las medidas de control para reducir el riesgo de transmisión.

Fuente:

Primer reporte en Chile de colonización por Candida auris en un paciente procedente de India.

Sociedad Chilena de Infectología (Chile)

PDF

http://www.sochinf.cl/portal/templates/sochinf2008/documentos/2019/Primer_reporte_Chile_colonizacion_Candida_auris_India.pdf

April 15, 2019 at 8:35 am

Review – Candida auris – Review of the Literature

Clinical Microbiology Reviews January 2018 V.31 N.1

Anna Jeffery-Smith, Surabhi K. Taori, Silke Schelenz, Katie Jeffery, Elizabeth M. Johnson, Andrew Borman, Candida auris Incident Management Team, Rohini Manuel, Colin S. Brown

The emerging pathogen Candida auris has been associated with nosocomial outbreaks on five continents. Genetic analysis indicates the simultaneous emergence of separate clades of this organism in different geographical locations.

Invasive infection and colonization have been detected predominantly in patients in high-dependency settings and have garnered attention due to variable antifungal resistance profiles and transmission within units instituting a range of infection prevention and control measures. Issues with the identification of C. auris using both phenotypic and molecular techniques have raised concerns about detecting the true scale of the problem.

This review considers the literature available on C. auris and highlights the key unknowns, which will provide direction for further work in this field.

FULL TEXT

https://cmr.asm.org/content/31/1/e00029-17

PDF

https://cmr.asm.org/content/cmr/31/1/e00029-17.full.pdf

 

– – –

April 11, 2019 at 8:15 am

Candida auris Clinical Isolates from South Korea: Identification, Antifungal Susceptibility, and Genotyping

Journal of Clinical Microbioliology March 2019 57:e01624-18

Yong Jun Kwon, Jong Hee Shin, Seung A Byun, Min Ji Choi, Eun Jeong Won, Dain Lee, Seung Yeob Lee, Sejong Chun, Jun Hyung Lee, Hyun Jung Choi, Seung Jung Kee, Soo Hyun Kim and Myung Geun Shin

Candida auris is an emerging worldwide fungal pathogen. Over the past 20 years, 61 patient isolates of C. auris (4 blood and 57 ear) have been obtained from 13 hospitals in Korea.

abstract

https://jcm.asm.org/content/57/4/e01624-18.abstract?etoc

PDF

https://jcm.asm.org/content/jcm/57/4/e01624-18.full.pdf

 

March 31, 2019 at 6:54 pm

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)

January 5, 2019 at 12:00 pm

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