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Endemic and opportunistic infections in Brazilian solid organ transplant recipients

BATISTA, M. V.; PIERROTTI, L. C.; ABDALA, E.; CLEMENTE, W. T.; GIRAO, E. S.; ROSA, D. R. T.; IANHEZ, L. E.; BONAZZI, P. R.; LIMA, A. S.; FERNANDES, P. F. C. B. C.; PADUA-NETO, M. V.; BACCHELLA, T.; OLIVEIRA, A. P. P.; VIANA, C. F. G.; FERREIRA, M. S.; SHI
Fonte: WILEY-BLACKWELL Publicador: WILEY-BLACKWELL
Tipo: Artigo de Revista Científica
ENG
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OBJECTIVE To evaluate the frequency and clinical features of endemic and other opportunistic infections in liver or kidney transplant recipients in four transplant centres in different geographical areas of Brazil. METHODS Retrospective analysis of medical and laboratory records of four transplant centres on endemic and other opportunistic infections in liver or kidney transplant recipients. Analyses were performed with spss statistical software. RESULTS From 2001 to 2006, 1046 kidney and 708 liver transplants were registered in all centres. The average age was 42 years. Among 82 (4.7%) cases with infections, the most frequent was tuberculosis (2.0%), followed by systemic protozoal infections (0.7%), toxoplasmosis (0.4%) and visceral leishmaniasis (0.3%). Systemic fungal infections occurred in 0.6%, of which 0.4% were cryptococcosis and 0.2% were histoplasmosis. Dengue was the only systemic viral infection and was registered in two cases (0.1%), of which one was classified as the classic form and the other as dengue haemorrhagic fever. Nocardiosis was described in one case (0.05%). The infectious agents most frequently associated with diarrhoea were Blastocystis sp., Schistosoma mansoni and Strongyloides stercoralis. CONCLUSIONS Opportunistic Infections in transplant patients have a wide spectrum and may vary from asymptomatic to severe infections with high mortality. A better understanding of the epidemiology of endemic pathogens and clinical manifestations can contribute to the establishment of an early diagnosis as well as correct treatment aimed at decreasing morbidity and mortality.

Expanding the Clinical and Genetic Spectrum of Human CD40L Deficiency: The Occurrence of Paracoccidioidomycosis and Other Unusual Infections in Brazilian Patients

Marques, Otávio Cabral; Schimke, Lena-Friederike; Pereira, Paulo Vítor Soeiro; Falcai, Angela; de Oliveira, Joao Bosco; Hackett, Mary J.; Errante, Paolo Ruggero; Weber, Cristina Worm; Ferreira, Janaira Fernandes; Kuntze, Gisele; Rosario-Filho, Nelson Au
Fonte: SPRINGER/PLENUM PUBLISHERS; NEW YORK Publicador: SPRINGER/PLENUM PUBLISHERS; NEW YORK
Tipo: Artigo de Revista Científica
ENG
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CD40 ligand (CD40L) deficiency or X-linked hyper-IgM syndrome (X-HIGM) is a well-described primary immunodeficiency in which Pneumocystis jiroveci pneumonia is a common clinical feature. We have identified an unusual high incidence of fungal infections and other not yet described infections in a cohort of 11 X-HIGM patients from nine unrelated Brazilian families. Among these, we describe the first case of paracoccidioidomycosis (PCM) in X-HIGM. The molecular genetic analysis of CD40L was performed by gene sequencing and evaluation of CD40L protein expression. Nine of these 11 patients (82%) had fungal infections. These included fungal species common to CD40L deficiency (P. jiroveci and Candida albicans) as well as Paracoccidioides brasiliensis. One patient presented with PCM at age 11 years and is now doing well at 18 years of age. Additionally, one patient presented with a simultaneous infection with Klebsiella and Acinetobacter, and one with condyloma caused by human papilloma virus. Molecular analysis revealed four previously described CD40L mutations, two novel missense mutations (c.433 T>G and c.476 G>C) resulting in the absence of CD40L protein expression by activated CD4(+) cells and one novel insertion (c.484_485insAA) within the TNFH domain leading to a frame shift and premature stop codon. These observations demonstrated that the susceptibility to fungal infections in X-HIGM extends beyond those typically associated with X-HIGM (P. jiroveci and C. albicans) and that these patients need to be monitored for those pathogens.; FAPESP [2008/06635-0...

Monitoramento terapêutico de fluconazol com suporte farmacocinético em pacientes grandes queimados com internação prolongada para controle das infecções fúngicas; Fluconazol therapeutic plasma monitoring for pharmacokinetics purpose for the control of fungal infections in longterm burn patients from the Intensive Care Unit

Bragatto, Michel Silveira
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 20/09/2011 PT
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A sepse é a maior causa de morbidade e mortalidade em pacientes queimados, uma vez que profundas alterações ocorrem na farmacocinética de agentes anti-infecciosos prescritos para o controle das infecções. Além disso, pacientes queimados podem apresentar quadro de infecção por germes da comunidade, numa fase precoce de internação na UTI, devendo receber antimicrobianos que diferem daqueles indicados na infecção sistêmica causada por germes hospitalares. Adicionalmente, na vigência de infecção fúngica, o quadro se torna ainda mais grave para os pacientes queimados de prolongada internação e imunocomprometimento. No presente trabalho deve como objetivo realizar o monitoramento plasmático de fluconazol prescrito aos pacientes com infecção sistêmica fúngica internados na UTI e investigar a farmacocinética para o ajuste do regime de dose no controle da infecção fúngica nos pacientes queimados. Investigaram-se 12 pacientes queimados internados na UTI/ Unidade de Queimados - Divisão de Cirurgia Plástica do HC FMUSP, portadores de infecção fúngica recebendo fluconazol através de infusão. Os pacientes receberam o antifúngico geralmente em associação a outros antimicrobianos para o controle das infecções seguindo a recomendação da CCIH do hospital relativa ao regime de dose empírica inicial do controle de infecção na UTI de Queimados. Realizou-se o monitoramento plasmático do fluconazol através da coleta de amostras sanguíneas de pico e vale. Complementarmente...

Fungal infections of the mucous membrane

Marques, Silvio Alencar
Fonte: Wiley-Blackwell Publicador: Wiley-Blackwell
Tipo: Artigo de Revista Científica Formato: 243-250
ENG
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A clinical review of three potentially severe fungal diseases, which are characterized in many cases by mucosal involvement, is presented. They are paracoccidioidomycosis, histoplasmosis, and mucormycosis. Mucosal involvement for paracoccidioidomycosis and rhinocerebral mucormycosis is frequent. Thus, oral involvement may provide early clue for diagnosis. In paracoccidioidomycosis, the mucosal lesion classically shows superficial ulcers with granular appearance and hemorrhagic points, usually on lips, palate, and jugal mucosa. In mucormycosis, necrosis of the palate followed for purulent discharge is a hallmark of rhinocerebral disease. Treatment with amphotericin B desoxycholate or the new second-generation triazoles is highly efficacious.

Management of fungal infections : diagnosis and human genetic susceptibility; Infecções fúngicas : diagnóstico e susceptibilidade genética humana

Carvalho, Agostinho Albérico Rodrigues de
Fonte: Universidade do Minho Publicador: Universidade do Minho
Tipo: Tese de Doutorado
Publicado em 29/07/2008 ENG
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Tese de Doutoramento Ciências da Saúde - Ciências Biológicas e Biomédicas; Invasive fungal infections represent nowadays a major public health problem with associated high mortality rates. The lack of adequate diagnostic methods, together with the fact that many emerging fungal species are resistant to the currently available antifungal agents, contributes to the profound impact of these diseases in the health care systems, especially when dealing with immunocompromised patients. Taking this into consideration, the development of novel diagnostic applications has been considered a critical issue in recent years. We described a multiplex PCR-based strategy allowing the identification of eight of the most clinically relevant Candida species. The strategy, based on the amplification of fragments from the internal transcribed spacer regions of the ribosomal RNA genes, was shown to present both high specificity and sensitivity, in addition to other attractive features, including the individual discrimination of species present in mixture and the direct identification from clinical specimens, characteristics reinforcing the potential clinical application of the method. In addition to the need of more satisfactory diagnostic methods...

DAMP signaling in fungal infections and diseases

Cunha, Cristina; Carvalho, Agostinho; Esposito, Antonella; Bistoni, Francesco; Romani, Luigina
Fonte: Frontiers Research Foundation Publicador: Frontiers Research Foundation
Tipo: Artigo de Revista Científica
Publicado em /09/2012 ENG
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Fungal infections and diseases predominantly affect patients with deregulated immunity. Compelling experimental and clinical evidence indicate that severe fungal diseases belong to the spectrum of fungus-related inflammatory diseases. Some degree of inflammation is required for protection during the transitional response occurring temporally between the rapid innate and slower adaptive response. However, progressive inflammation worsens disease and ultimately prevents pathogen eradication. The challenge now is to elucidate cellular and molecular pathways distinguishing protective vs. pathogenic inflammation to fungi. In addition to fungal ligands of pattern recognition receptors (pathogen-associated molecular patterns, PAMPs), several host-encoded proteins, the damage-associated molecular patterns (DAMPs), are released during tissue injury and activate innate recognition receptors. DAMPs have been shown to regulate inflammation in fungal diseases. The DAMP/receptor for advanced glycation end-products axis integrated with the PAMP/Toll-like receptors axis in the generation of the inflammatory response in experimental and clinical fungal pneumonia. These emerging themes better accommodate fungal pathogenesis in the face of high-level inflammation seen in several clinical settings and point to DAMP targeting as a novel immunomodulatory strategy in fungal diseases.; Supported by the Specific Targeted Research Project ALLFUN (FP7–HEALTH–2009 Contract number 260338) and the Italian Grant Application 2010 Fondazione per la Ricerca sulla Fibrosi Cistica (Research Project FFC#21/2010) with the contribution of funded Francesca Guadagnin...

Cracking the Toll-like receptor code in fungal infections

Cunha, Cristina; Romani, Luigina; Carvalho, Agostinho
Fonte: Informa Plc. Publicador: Informa Plc.
Tipo: Artigo de Revista Científica
Publicado em /10/2010 ENG
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Innate control of fungal infection requires the specific recognition of invariant fungal molecular structures by a variety of innate immune receptors, including Toll-like receptors. In addition to the role in inducing protective immune responses, Toll-like receptor engagement may paradoxically favor fungal infections, by inducing inflammatory pathology and impairing antifungal immunity. Although the dissection of complex genetic traits modulating susceptibility to fungal infections is complex, the contribution of host genetics may hold the key to elucidating new risk factors for these severe, often fatal diseases. Understanding host-pathogen interactions at the innate immune interface will eventually lead to the development of new therapeutics and genetic markers in fungal infections.

Fungal infections in neutropenic patients: a 8-year prospective study

Nucci,Marcio; Pulcheri,Wolmar; Spector,Nelson; Bueno,Ana Paula; Bacha,Paulo Cesar; Caiuby,Maria Julieta; Derossi,Andrea; Costa,Rosane; Morals,José Carlos; Oliveira,Halley Pacheco de
Fonte: Instituto de Medicina Tropical Publicador: Instituto de Medicina Tropical
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/1995 EN
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In this paper we report a eight-year prospective study designed to further characterize incidence, epidemiology, specific syndromes, treatment and prognosis associated with fungal infections in neutropenic patients. During the study period 30 fungal infections were diagnosed in 30 patients among 313 episodes of fever and neutropenia (10%). There were 15 cases of candidiasis, 5 pulmonary aspergillosis, 3 sinusitis by Aspergillus fumigatus, 5 infections by Fusarium sp., one infection by Trichosporon sp., and one infection due to Rhodotorula rubra. Blood cultures were positive in 18 cases (60%). The predisposing factors for fungal infection in multivariate analysis were the presence of central venous catheter (p<0.001), longer duration of profound (<100/mm³) neutropenia (p<0.001), the use of corticosteroids (p<0.001), gram-positive bacteremia (p=0.002) and younger age (p=0.03). In multivariate analysis only recovery of the neutropenia (p<0.001) was associated with good prognosis whereas the diagnosis of infection by Fusarium sp. (p=0.006) was strongly associated with a poor outcome. The death rate was 43%. There was no statistically significant difference in the death rate between patients who did receive (52%) or did not receive (50%) antifungal treatment. Identifying patients at risk...

Assessment of microbiological air quality in hemato-oncology units and its relationship with the occurrence of invasive fungal infections: an integrative review

Menegueti,Mayra Goncalves; Ferreira,Lecio Rodrigues; Silva,Magda Fabbri Isaac; Silva,Anderson Soares da; Bellissimo-Rodrigues,Fernando
Fonte: Sociedade Brasileira de Medicina Tropical - SBMT Publicador: Sociedade Brasileira de Medicina Tropical - SBMT
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/08/2013 EN
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Worldwide aging of the human population has promoted an increase in the incidence of neoplasia, including hematological cancers, which render patients particularly vulnerable to invasive fungal infections. For this reason, air filtration in hemato-oncology units has been recommended. However, scarce literature has assessed the impact of microbiological air quality on the occurrence of fungal infections in this population. We performed an integrative review of studies in the MEDLINE database that were published between January 1980 and October 2012, using the following combinations of keywords: air × quality × HEPA, air × quality × hematology, and airborne fungal infections. The search yielded only 13 articles, suggesting that high-efficiency filtering of the ambient air in hemato-oncology units can prevent the incidence of invasive fungal infections. However, no randomized clinical trial was found to confirm this suggestion. Currently, there is no consensus about the maximum allowable count of fungi in the air, which complicates filtration monitoring, including filter maintenance and replacement, and needs to be addressed in future studies.

Fungal infections in the immunocompromised host

Wanke,Bodo; Lazéra,Márcia dos Santos; Nucci,Marcio
Fonte: Instituto Oswaldo Cruz, Ministério da Saúde Publicador: Instituto Oswaldo Cruz, Ministério da Saúde
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2000 EN
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In recent years many remarkable changes occurred in our way of life, producing opportunities for microbes. All these changes are related to the recent emergence of previously unrecognized diseases, or the resurgence of diseases that, at least in developed countries, were thought to be under control. This concept is reviewed regarding fungal infections and their agents in the immunocompromised host. The changing pattern of these infections, the portals of entry of fungi into the human host, fungal pathogenicity and the main predisposing factors are analyzed. Opportunistic fungal infections in cancer, organ transplant and acquired immunodeficiency syndrome patients are reviewed, specially candidiasis and aspergillosis.

Epidemiology of fungal infections in liver transplant recipients: a six-year study of a large Brazilian liver transplantation centre

Zicker,Michelle; Colombo,Arnaldo Lopes; Ferraz-Neto,Ben-Hur; Camargo,Luis Fernando Aranha
Fonte: Instituto Oswaldo Cruz, Ministério da Saúde Publicador: Instituto Oswaldo Cruz, Ministério da Saúde
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/05/2011 EN
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Liver transplant seems to be an effective option to prolong survival in patients with end-stage liver disease, although it still can be followed by serious complications. Invasive fungal infections (ifi) are related to high rates of morbidity and mortality. The epidemiology of fungal infections in Brazilian liver transplant recipients is unknown. The aim of this observational and retrospective study was to determine the incidence and epidemiology of fungal infections in all patients who underwent liver transplantation at Albert Einstein Israeli Hospital between 2002-2007. A total of 596 liver transplants were performed in 540 patients. Overall, 77 fungal infections occurred in 68 (13%) patients. Among the 77 fungal infections, there were 40 IFI that occurred in 37 patients (7%). Candida and Aspergillus species were the most common etiologic agents. Candida species accounted for 82% of all fungal infections and for 67% of all IFI, while Aspergillus species accounted for 9% of all fungal infections and for 17% of all IFI. Non-albicans Candida species were the predominant Candida isolates. Invasive aspergillosis tended to occur earlier in the post-transplant period. These findings can contribute to improve antifungal prophylaxis and therapy practices in Brazilian centres.

Fungal infections in marrow transplant recipients under antifungal prophylaxis with fluconazole

Oliveira,J.S.R.; Kerbauy,F.R.; Colombo,A.L.; Bahia,D.M.M.; Pinheiro,G.S.; Silva,M.R.R.; Ribeiro,M.S.S.; Raineri,G.; Kerbauy,J.
Fonte: Associação Brasileira de Divulgação Científica Publicador: Associação Brasileira de Divulgação Científica
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/07/2002 EN
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Fungal infection is one of the most important causes of morbidity and mortality in bone marrow transplant (BMT) recipients. The growing incidence of these infections is related to several factors including prolonged granulocytopenia, use of broad-spectrum antibiotics, conditioning regimens, and use of immunosuppression to avoid graft-versus-host disease (GvHD). In the present series, we report five cases of invasive mold infections documented among 64 BMT recipients undergoing fluconazole antifungal prophylaxis: 1) A strain of Scedosporium prolificans was isolated from a skin lesion that developed on day +72 after BMT in a chronic myeloid leukemic patient. 2) Invasive pulmonary aspergillosis (Aspergillus fumigatus) was diagnosed on day +29 in a patient with a long period of hospitalization before being transplanted for severe aplastic anemia. 3) A tumoral lung lesion due to Rhizopus arrhizus (zygomycosis) was observed in a transplanted patient who presented severe chronic GvHD. 4) A tumoral lesion due to Aspergillus spp involving the 7th, 8th and 9th right ribs and local soft tissue was diagnosed in a BMT patient on day +110. 5) A patient with a history of Ph1-positive acute lymphocytic leukemia exhibited a cerebral lesion on day +477 after receiving a BMT during an episode of severe chronic GvHD. At that time...

Serum Glucan Levels Are Not Specific for Presence of Fungal Infections in Intensive Care Unit Patients

Digby, Justin; Kalbfleisch, John; Glenn, Andy; Larsen, Angie; Browder, William; Williams, David
Fonte: American Society for Microbiology Publicador: American Society for Microbiology
Tipo: Artigo de Revista Científica
Publicado em /09/2003 EN
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Fungal infections in the critically ill patient are difficult to diagnose and are associated with a high mortality rate. A major obstacle to managing fungal infection is the lack of a reliable clinical assay that will rapidly identify patients with fungal sepsis. Glucans are polymers of glucose that are found in the cell wall of fungi and certain bacteria. Glucans are also released from the fungal cell wall into the extracellular milieu. Several studies have reported that detection of fungal glucan in serum or plasma is useful in the diagnosis of mycoses. However, recent studies have questioned the clinical utility of this assay. In this study, we examined serum glucan levels in intensive care unit (ICU) patients and attempt to correlate serum glucan levels with the presence of fungal infection. Following attainment of informed consent, serum was harvested from 46 ICU patients with confirmed fungal infections, confirmed bacterial infections, or no evidence of infection. Sera from eight healthy volunteers served as control. Serum glucan was assayed with a glucan-specific Limulus assay. Serum glucan levels were increased (69.6 ± 17 pg/ml; P < 0.001) in ICU patients versus the normal (11.5 ± 1.3 pg/ml) and noninfected ICU (27.4 ± 17 pg/ml) controls. However...

Emerging fungal infections among children: A review on its clinical manifestations, diagnosis, and prevention

Jain, Akansha; Jain, Shubham; Rawat, Swati
Fonte: Medknow Publications Publicador: Medknow Publications
Tipo: Artigo de Revista Científica
Publicado em //2010 EN
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The incidence of fungal infections is increasing at an alarming rate, presenting an enormous challenge to healthcare professionals. This increase is directly related to the growing population of immunocompromised individuals especially children resulting from changes in medical practice such as the use of intensive chemotherapy and immunosuppressive drugs. Although healthy children have strong natural immunity against fungal infections, then also fungal infection among children are increasing very fast. Virtually not all fungi are pathogenic and their infection is opportunistic. Fungi can occur in the form of yeast, mould, and dimorph. In children fungi can cause superficial infection, i.e., on skin, nails, and hair like oral thrush, candida diaper rash, tinea infections, etc., are various types of superficial fungal infections, subcutaneous fungal infection in tissues under the skin and lastly it causes systemic infection in deeper tissues. Most superficial and subcutaneous fungal infections are easily diagnosed and readily amenable to treatment. Opportunistic fungal infections are those that cause diseases exclusively in immunocompromised individuals, e.g., aspergillosis, zygomycosis, etc. Systemic infections can be life-threatening and are associated with high morbidity and mortality. Because diagnosis is difficult and the causative agent is often confirmed only at autopsy...

Epidemiology of Invasive Fungal Infections in Latin America

Sifuentes-Osornio, Jose; Corzo-León, Dora E.; Ponce-de-León, L. Alfredo
Fonte: Current Science Inc. Publicador: Current Science Inc.
Tipo: Artigo de Revista Científica
EN
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The pathogenic role of invasive fungal infections (IFIs) has increased during the past two decades in Latin America and worldwide, and the number of patients at risk has risen dramatically. Working habits and leisure activities have also been a focus of attention by public health officials, as endemic mycoses have provoked a number of outbreaks. An extensive search of medical literature from Latin America suggests that the incidence of IFIs from both endemic and opportunistic fungi has increased. The increase in endemic mycoses is probably related to population changes (migration, tourism, and increased population growth), whereas the increase in opportunistic mycoses may be associated with the greater number of people at risk. In both cases, the early and appropriate use of diagnostic procedures has improved diagnosis and outcome.

Advancing the Field: Evidence for New Management Strategies in Invasive Fungal Infections

Morrissey, C. Orla
Fonte: Current Science Inc. Publicador: Current Science Inc.
Tipo: Artigo de Revista Científica
EN
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Invasive fungal infections (IFI) are a significant cause of morbidity and mortality in the immunocompromised. The traditional diagnostic methods of culture and histological examination lack sensitivity and often only make a diagnosis late when the fungal burden is high, reducing the chances of cure even with the availability of new more potent and less toxic antifungal agents. New non-culture-based serological and PCR assays have been developed. These appear more sensitive and are able to make an earlier diagnosis as compared with traditional diagnostic methods. Early diagnosis is central to reducing IFI-related morbidity and mortality. This review describes the diagnostic potential of the new serological and PCR assays and outlines how these assays have been incorporated into algorithms to improve the management of IFI.

Recommendations for the treatment of established fungal infections

Thursky, K.; Playford, E.; Seymour, J.; Sorrell, T.; Ellis, D.; Guy, S.; Gilroy, N.; Chu, J.; Shaw, D.
Fonte: Blackwell Publishing Asia Publicador: Blackwell Publishing Asia
Tipo: Artigo de Revista Científica
Publicado em //2008 EN
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Evidence-based guidelines for the treatment of established fungal infections in the adult haematology/oncology setting were developed by a national consensus working group representing clinicians, pharmacists and microbiologists. These updated guidelines replace the previous guidelines published in the Internal Medicine Journal by Slavin et al. in 2004. The guidelines are pathogen-specific and cover the treatment of the most common fungal infections including candidiasis, aspergillosis, cryptococcosis, zygomycosis, fusariosis, scedosporiosis, and dermatophytosis. Recommendations are provided for management of refractory disease or salvage therapies, and special sites of infections such as the cerebral nervous system and the eye. Because of the widespread use newer broad-spectrum triazoles in prophylaxis and empiric therapy, these guidelines should be implemented in concert with the updated prophylaxis and empiric therapy guidelines published by this group.; K. A. Thursky, E. G. Playford, J. F. Seymour, T. C. Sorrell, D. H. Ellis, S. D. Guy, N. Gilroy, J. Chu and D. R. Shaw; © 2008 The Authors Journal compilation. Copyright © 2008 John Wiley & Sons, Inc

β-d-Glucan Testing Is Important for Diagnosis of Invasive Fungal Infections

Theel, Elitza S.; Doern, Christopher D.
Fonte: American Society for Microbiology Publicador: American Society for Microbiology
Tipo: Artigo de Revista Científica
Publicado em /11/2013 EN
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Invasive fungal infections are a significant cause of morbidity and mortality in patients who receive immunosuppressive therapy, such as solid organ and hematopoietic stem cell transplant (HSCT) recipients. Many of the fungi associated with these infections are angioinvasive and are best diagnosed by visualizing the organism in or culturing the organism from deep tissue. However, obtaining such tissue often requires an invasive procedure. Many HSCT recipients are thrombocytopenic, making such procedure too risky because of potential bleeding complications. Additionally, positive blood cultures are rare for patients with angioinvasive fungal infections, making this diagnostic strategy of little value. Undiagnosed fungal infections in these patient populations are a significant cause of mortality. Prophylactic use of antifungal agents, such as the echinocandins, during periods of neutropenia or graft-versus-host disease may prevent some fungal infections but increase the risk for others. Detection of fungal antigens in body fluids, including cryptococcus capsular polysaccharide, histoplasma antigen, galactomannan, and β-d-glucan, is viewed as being clinically useful for at least the presumptive diagnosis of invasive fungal infections. β-d-Glucan is an attractive antigen in that it is found in a broad range of fungal agents...

Invasive fungal infections in Chile: a multicenter study of fungal prevalence and susceptibility during a 1-year period

Chilean Invasive Fungal Infections Group; Díaz, María Cristina; Febré V., Naldy; Silva, Víctor
Fonte: TAYLOR & FRANCIS LTD Publicador: TAYLOR & FRANCIS LTD
Tipo: Artículo de revista
EN
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During the first year of an ongoing surveillance program of invasive fungal infections (IFI) a total of 130 patients (56% male) with fungal strains isolated from blood and other sterile sites were reported from 13 hospitals in Chile. Significant yeast isolates were obtained from 118 patients, and molds affected 12 patients. The main patient groups affected were neonates, children less than 1 year old and adults aged 50-79 years. All fungal bloodstream infections (BSI) were due to yeasts; 79 patients (61%) were affected. The main risk factors recorded were antibiotic therapy (76%), stay in the intensive care unit (ICU) (70%) and presence of a central venous catheter (65%). Nosocomial infections were represented in 83.5% of BSI. Overall, Candida albicans (40.8%), C parapsilosis (13.1%), C. tropicalis (10%) and Cryptococcus neoformans (10%) were the most common species. Aspergillus fumigatus (3.1%) was the most frequent mold. C. albicans (48.1%) and C parapsilosis (17.7%), were the most frequent agents recovered from blood. Saccharomyces cerevisiae and Trichosporon mucoides, two emerging pathogens, were also isolated. All yeasts tested were susceptible to amphotericin B with minimal inhibitory concentration (MIC) less than or equal to 1 mug/ml. Resistance to itraconazole (MIC greater than or equal to 1 mug/ml) and fluconazole (MIC greater than or equal to 64 mug/ml) was observed in 4 and 6% of cases...

Infecções fúngicas em pacientes neutropênicos: estudo prospectivo de 8 anos; Fungal infections in neutropenic patients: a 8-year prospective study

Nucci, Marcio; Pulcheri, Wolmar; Spector, Nelson; Bueno, Ana Paula; Bacha, Paulo Cesar; Caiuby, Maria Julieta; Derossi, Andrea; Costa, Rosane; Morals, José Carlos; Oliveira, Halley Pacheco de
Fonte: Universidade de São Paulo. Instituto de Medicina Tropical de São Paulo Publicador: Universidade de São Paulo. Instituto de Medicina Tropical de São Paulo
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; ; ; ; ; Formato: application/pdf
Publicado em 01/10/1995 ENG
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Com o objetivo de melhor caracterizar incidência, epidemiologia, síndromes específicas, tratamento e prognóstico associado com infecções fúngicas sistêmicas em pacientes neutropênicos foi feito um estudo prospectivo de 8 anos. Durante este período foram diagnosticadas 30 infecções fúngicas em 30 pacientes neutropênicos febris (10%). Houve 15 casos de candidíase, 5 aspergiloses pulmonares, 3 sinusites por Aspergillus fumigatus, 5 infecções por Fusarium sp., uma infecção por Trichosporon sp., e uma infecção por Rhodotorula rubra. As hemoculturas foram positivas em 18 casos (60%). Os fatores de risco para infecção fúngica em análise multivariada foram: presença de cateter venoso central (p; In this paper we report a eight-year prospective study designed to further characterize incidence, epidemiology, specific syndromes, treatment and prognosis associated with fungal infections in neutropenic patients. During the study period 30 fungal infections were diagnosed in 30 patients among 313 episodes of fever and neutropenia (10%). There were 15 cases of candidiasis, 5 pulmonary aspergillosis, 3 sinusitis by Aspergillus fumigatus, 5 infections by Fusarium sp., one infection by Trichosporon sp., and one infection due to Rhodotorula rubra. Blood cultures were positive in 18 cases (60%). The predisposing factors for fungal infection in multivariate analysis were the presence of central venous catheter (p