Bloodstream infection in patients with end-stage renal disease in a teaching hospital in central-western Brazil

Introduction Vascular access in patients undergoing hemodialysis is considered a critical determinant of bloodstream infection (BSI) and is associated with high morbidity and mortality. The purpose of this study was to investigate the occurrence of BSI in patients with end-stage renal disease using central venous catheters for hemodialysis. Methods A cohort study was conducted in a public teaching hospital in central-western Brazil from April 2010 to December 2011. For every patient, we noted the presence of hyperemia/exudation upon catheter insertion, as well as fever, shivering, and chills during hemodialysis. Results Fifty-nine patients were evaluated. Thirty-five (59.3%) patients started dialysis due to urgency, 37 (62.7%) had BSI, and 12 (20%) died. Hyperemia at the catheter insertion site (64.9%) was a significant clinical manifestation in patients with BSI. Statistical analysis revealed 1.7 times more cases of BSI in patients with hypoalbuminemia compared with patients with normal albumin levels. The principal infective agents identified in blood cultures and catheter-tip cultures were Staphylococcus species (24 cases), non-fermentative Gram-negative bacilli (7 cases of Stenotrophomonas maltophilia and 5 cases of Chryseobacterium indologenes), and Candida species (6). Among the Staphylococci identified, 77.7% were methicillin-resistant, coagulase-negative Staphylococci. Of the bacteria isolated, the most resistant were Chryseobacterium indologenes and Acinetobacter baumannii. Conclusions Blood culture was demonstrated to be an important diagnostic test and identified over 50% of positive BSI cases. The high frequency of BSI and the isolation of multiresistant bacteria were disturbing findings. Staphylococcus aureus was the most frequently isolated microorganism, although Gram-negative bacteria predominated overall. These results highlight the importance of infection prevention and control measures in dialysis units.

The performance of an in-house nested-PCR technique for pleural tuberculosis diagnoses

Introduction This study evaluated the performance of an in-house nested-PCR system for the detection of the Mycobacterium tuberculosis complex in pleural fluid, blood and urine samples from pleural effusion tuberculosis patients by health services physicians in Pernambuco, Brazil. Methods A prospective double-blind study with 37 hospitalized patients of both sexes, aged over 15, was used to investigate the diagnosis of pleural effusion. The criteria used to define the cases included the demonstration of bacillus in biological samples by smear or culture or by a granulomatous finding in the histopathological examination, associated with an evident response to specific treatments to each clinical situation. Pleural fluid, blood and urine samples were collected and subjected to routine tests and the nested PCR technique to assess for M. tuberculosis amplification. Results In total, 37 pleural effusion patients took part in the study, of whom 19 (51.3%) had tubercular etiologies and 18 (48.7%) had etiologies from other causes. When the pleural fluid, blood and/or urine sample in-house nested-PCR sensitivities were evaluated simultaneously, the results were positive regardless of the biological specimen (the sensitivity was 84.2%); however, when the blood and/or urine samples were analyzed together, the sensitivity was 72.2%. When the pleural fluid samples were evaluated alone, the sensitivity was only 33.3%. Conclusions The performance of the diagnostic pleural tuberculosis nested-PCR was directly related to the diversity of the samples collected from the same patient. Additionally, this study may identify a need to prioritize non-invasive blood and urine collection for this diagnosis.

In vitro antimalarial activity of tigecycline against Plasmodium falciparum culture-adapted reference strains and clinical isolates from the Brazilian Amazon

Introduction: We evaluated the in vitro antimalarial activity of tigecycline as an alternative drug for the treatment of severe malaria. Methods: A chloroquine-sensitive Plasmodium falciparum reference strain, a chloroquine-resistant reference strain, and three clinical isolates were tested for in vitro susceptibility to tigecycline. A histidine-rich protein in vitro assay was used to evaluate antimalarial activity. Results: The geometric-mean 50% effective concentration (EC50%) of tigecycline was 535.5 nM (confidence interval (CI): 344.3-726.8). No significant correlation was found between the EC50% of tigecycline and that of any other tested antimalarial drug. Conclusions: Tigecycline may represent an alternative drug for the treatment of patients with severe malaria.

A infecção por Helicobacter pylori em populações de Angola

RESUMO: A infecção por H. pylori, enquadra-se nas doenças infecciosas gastroduodenais e estima-se que mais de 50% da população mundial esteja infectada. A história natural da infecção por H. pylori, sofre interferências relacionadas com a genética do hospedeiro, a estirpe e as características da toxicidade da bactéria. Associam-se a estes factores, o tempo de exposição à infecção, assim como as condições sociais e higiéno-sanitárias. Paralelamente, o H. pylori é considerado o principal agente patogénico das doenças gastroduodenais. Este estudo teve como objectivo principal caracterizar a infecção por H. pylori em populações de Angola e sua avaliação como problema de Saúde Pública. Trata-se de um estudo prospectivo dirigido a dois grupos populacionais, um constituído por indivíduos aparentemente saudáveis, sem queixas gástricas específicas, em ambiente de comunidade, Grupo I, e outro, Grupo II, constituído por doentes que acorreram ao serviço de Gastrenterologia do Hospital Militar Principal de Luanda (HMP). No que diz respeito ao estudo na comunidade a pesquisa de H. pylori foi realizada pelo método ELISA de pesquisa de antigénios nas fezes. Por sua vez, a nível hospitalar, os métodos de diagnóstico da infecção por H. pylori foram: a endoscopia digestiva alta para a colheita de biópsias da mucosa gástrica destinadas ao exame anatomopatológico, ao exame citobacteriológico e aos métodos moleculares. Como método não invasivos foi utilizado o teste respiratório com ureia marcada. Grupo I: o diagnóstico da infecção por H. pylori, realizado pela pesquisa de antigénios deste microrganismo nas fezes, revelou uma frequência de 69,6% na população em estudo. Considerando em cada região, verificou-se que a região do Sambizanga possuía o valor mais elevado de frequência, 81,2%, seguida do Dinge com 79,5%, estatisticamente significativas (p 0,001). A avaliação da distribuição da frequência da infecção por grupo etário, revelou que os indivíduos com idade inferior a 15 anos, possuíam uma frequência de infecção de 63,5% e sendo de 76% nos indivíduos com idade superior a 15 anos. Este estudo permitiu concluir que a frequência da infecção por H. pylori nas regiões estudadas, é de 70% à excepção do Capulo, zona litoral em que não obstante as precárias condições de saneamento, a frequência da infecção por H. pylori é baixa. Grupo II: dos 309 doentes avaliados, verificou-se que 22 (7%), apresentavam uma mucosa normal e 287 (93%) uma mucosa alterada. A avaliação histológica das biópsias do antro, em 270 amostras de acordo com o Sistema de Sidney, em 235 (87,0%), revelou a presença de gastrite, 13 (4,8%) a presença de úlcera e em 9 (3,3%), uma lesão tumoral. A avaliação histológica da actividade nas 226 amostras do antro gástrico, verificou-se que 129 (57%) possuíam actividade e 97 (43%) não possuíam. O estudo das 255 biópsias do corpo, revelou em 212 (83,1%), a presença de lesões de gastrite, em 7 (2,7%), observaram-se lesões tumorais e 2 (0.8%) apresentaram úlcera. Dos 263 doentes avaliados histologicamente para pesquisa do H. pylori, 148 (58,2%) revelaram a presença positiva desta bactéria e 106 (41,7%) foram negativas. No que diz respeito à susceptibilidade aos macrólidos, do universo de 158 doentes com H. pylori positivo, 125 (79,1%) doentes apresentaram estirpes sensíveis aos macrólidos e 33 (20,9%) estirpes resistentes. Em relação aos factores de virulência, na avaliação conjunta dos dois factores de virulência estudados (cagA e vacA), em relação ao tipo de lesões encontradas na mucosa gástrica, verificou-se que dos 11 doentes com úlcera, 7 (63,6%), apresentavam uma estirpe cagA negativa, sendo 6 vacA s1 (85,7%), uma s2 e 4 (36,3%) com uma estirpe cagA positiva e vacA s1. Por sua vez dos 2 doentes com tumor, ambas as estirpes eram cagA negativas, sendo uma vacA s1 e outra vacA s2. Em relação aos factores de virulência nos doentes aos quais se diagnosticou úlcera e tumor apresentavam estirpe cagA negativa, vacAs1. Em relação ás lesões gástricas inflamatórias, os doentes com gastrite apresentavam cagA positivo. Do presente trabalho, em atenção aos resultados obtidos no que concerne a prevalência em populações sem queixas gastrenterológicas, recomenda-se que o mesmo se possa vir a replicar numa abrangência maior, realizando-se, por exemplo, estudos comparativos de prevalência entre as populações residentes no litoral (beira-mar) e as do interior. Pelas características genotípicas de H. pylori, em correspondência com as lesões encontradas, após novos estudos mais abrangentes, recomenda-se a avaliação de uma terapêutica mais acessível para o doente e que seja de maior eficácia. Face à escassez de médicos especialistas em gastrenterologia em Angola e de meios de diagnóstico, recomenda-se um estudo mais alargado da eficácia do seguimento do doente dispéptico, conforme protocolo avaliado pelo Colégio da Especialidade de Gastrenterologia da Ordem dos Médicos de Angola e já em prática em algumas instituições de saúde.--------------------------- ABSTRACT: H.pylori infection, is part of the gastroduodenal infectious diseases and it is estimated that over 50% of the world population is infected. The natural history of H.pylori infection, is influenced by host genetic, strain type, of bacterial virulence factors, time of exposure to the infection, as well as social and hygienic-sanitary conditions. In parallel, H.pylori is considered the main pathogen of gastroduodenal diseases. This study's main objective was to characterize H.pylori infection in populations of Angola and its evaluation as a public health problem. This is a prospective study conducted in two population groups, one in community environment composed by healthy individuals without specific gastric complaints - Group I, and Group II consisting of patients who went to the Gastroenterology Service of the Hospital Military of Luanda (HMP). As regards to the study in the community detection of H.pylori was carried out by antigen search in faeces using ELISA method. At hospital level H.pylori infection diagnostic methods were: upper gastrointestinal endoscopy to obtain gastric mucosal biopsies for histology, culture and molecular methods. As a non-invasive breath test with labelled urea was used. Group I: the diagnosis of H.pylori infection, by antigens detection in faeces, revealed a frequency of 69.6% in the study population. Whereas in each region, it was found that the Sambizanga region had the highest frequency of positive cases, 81.2% , followed by Dinge with 79.5%, Funda with 78.7 and Capulo with 39.8% being differences statistically significant (p=0.001). The evaluation of the distribution of the infection frequency by age group, revealed that individuals younger than 15 years had a frequency of 63.5% and in individuals older than 15 years, 76%. This study showed that the frequency of H.pylori infection in the regions studied was 70% exception due to Capulo, a coastal zone where despite the poor sanitation conditions; the frequency of H.pylori infection is lower. Group II: from the 309 patients evaluated, it was found that 22 (7%) had a normal mucosa and 287 (93%) a modified mucosa. Histological evaluation of antrum biopsies in 270 samples according to the Sydney System revealed the presence of gastritis in 235 (87.0%), the presence of ulcers in 13 (4.8%) and a tumour in 9 (3 3%). Histological assessment of activity in the gastric antrum of 226 samples, revealed that 129 (57%) had activity and 97 (43%) did not. The evaluation of the 255 corpus biopsies showed in 212 (83.1%), the presence of lesions of gastritis, in 7 (2.7%) tumour lesions and in 2 (0.8%) an ulcer. Of the 263 patients histological evaluated for H.pylori, 148 (58.2%) revealed the presence of this bacteria and 106 (41.7%) were negative. As regards susceptibility to macrolides from the universe of 158 patients with H.pylori, 125 (79.1%) patients had macrolides susceptible strains and 33 (20.9%) resistant strains. Regarding virulence factors (vacA and cagA), it was found that from the 11 patients with ulcers, 7 (63.6%), had a cagA negative strain, being 6 vacA s1, (85.7%) one vacA s2 and 4 (36.3%) with a cagA positive strain vacA s1. Concerning the 2 patients with tumour, both strains were cagA negative, one vacA s1 and other vacA s2. Patients with ulcer and tumour had cagA negative strains vacAs1. From this work, considering the prevalence of H.pylori obtained in health population, it is recommended that the same study should be performed in larger scale to confirm these results. The results of H.pylori genotyping suggest that more comprehensive studies are needed. Given the reduce number gastroenterology specialist in Angola and the lack of diagnostics methods, we recommend a larger study of the effectiveness of follow-up the patient dyspeptic, according to the protocol assessed by the College of Gastroenterology Specialty of the Order of Doctors and Angola already in place in some health institutions.

Serological evidence for Saint Louis encephalitis virus in free-ranging New World monkeys and horses within the upper Paraná River basin region, Southern Brazil

Introduction Saint Louis encephalitis virus (SLEV) primarily occurs in the Americas and produces disease predominantly in humans. This study investigated the serological presence of SLEV in nonhuman primates and horses from southern Brazil. Methods From June 2004 to December 2005, sera from 133 monkeys (Alouatta caraya, n=43; Sapajus nigritus, n=64; Sapajus cay, n=26) trap-captured at the Paraná River basin region and 23 blood samples from farm horses were obtained and used for the serological detection of a panel of 19 arboviruses. All samples were analyzed in a hemagglutination inhibition (HI) assay; positive monkey samples were confirmed in a mouse neutralization test (MNT). Additionally, all blood samples were inoculated into C6/36 cell culture for viral isolation. Results Positive seroreactivity was only observed for SLEV. A prevalence of SLEV antibodies in sera was detected in Alouatta caraya (11.6%; 5/43), Sapajus nigritus (12.5%; 8/64), and S. cay (30.8%; 8/26) monkeys with the HI assay. Of the monkeys, 2.3% (1/42) of A. caraya, 6.3% 94/64) of S. nigritus, and 15.4% (4/26) of S. cay were positive for SLEV in the MNT. Additionally, SLEV antibodies were detected by HI in 39.1% (9/23) of the horses evaluated in this study. Arboviruses were not isolated from any blood sample. Conclusions These results confirmed the presence of SLEV in nonhuman primates and horses from southern Brazil. These findings most likely represent the first detection of this virus in nonhuman primates beyond the Amazon region. The detection of SLEV in animals within a geographical region distant from the Amazon basin suggests that there may be widespread and undiagnosed dissemination of this disease in Brazil.

Evolutionary dynamics of Chlamydia trachomatis genome and identification of molecular patterns of hypothetical protein coding genes

The obligate intracellular bacterium Chlamydia trachomatis is a human pathogen of major public health significance. Strains can be classified into 15 main serovars (A to L3) that preferentially cause ocular infections (A-C), genital infections (D-K) or lymphogranuloma venereum (LGV) (L1-L3), but the molecular basis behind their distinct tropism, ecological success and pathogenicity is not welldefined. Most chlamydial research demands culture in eukaryotic cell lines, but it is not known if stains become laboratory adapted. By essentially using genomics and transcriptomics, we aimed to investigate the evolutionary patterns underlying the adaptation of C. trachomatis to the different human tissues, given emphasis to the identification of molecular patterns of genes encoding hypothetical proteins, and to understand the adaptive process behind the C. trachomatis in vivo to in vitro transition. Our results highlight a positive selection-driven evolution of C. trachomatis towards nichespecific adaptation, essentially targeting host-interacting proteins, namely effectors and inclusion membrane proteins, where some of them also displayed niche-specific expression patterns. We also identified potential "ocular-specific" pseudogenes, and pointed out the major gene targets of adaptive mutations associated with LGV infections. We further observed that the in vivo-derived genetic makeup of C. trachomatis is not significantly compromised by its long-term laboratory propagation. In opposition, its introduction in vitro has the potential to affect the phenotype, likely yielding virulence attenuation. In fact, we observed a "genital-specific" rampant inactivation of the virulence gene CT135, which may impact the interpretation of data derived from studies requiring culture. Globally, the findings presented in this Ph.D. thesis contribute for the understanding of C.trachomatis adaptive evolution and provides new insights into the biological role of C. trachomatishypothetical proteins. They also launch research questions for future functional studies aiming toclarify the determinants of tissue tropism, virulence or pathogenic dissimilarities among C. trachomatisstrains.

Performance of the Vitek 2 system software version 5.03 in the bacterial identification and antimicrobial susceptibility test: evaluation study of clinical and reference strains of Gram-positive cocci

Introduction. The genera Enterococcus, Staphylococcus and Streptococcus are recognized as important Gram-positive human pathogens. The aim of this study was to evaluate the performance of Vitek 2 in identifying Gram-positive cocci and their antimicrobial susceptibilities. Methods. One hundred four isolates were analyzed to determine the accuracy of the automated system for identifying the bacteria and their susceptibility to oxacillin and vancomycin. Results. The system correctly identified 77.9% and 97.1% of the isolates at the species and genus levels, respectively. Additionally, 81.8% of the Vitek 2 results agreed with the known antimicrobial susceptibility profiles. Conclusion. Vitek 2 correctly identified the commonly isolated strains; however, the limitations of the method may lead to ambiguous findings.

Osteoarticular tuberculosis in an HIV-positive patient: a case report

The authors report a case of a 38-year-old HIV-positive woman, with subcutaneous nodules on the thoracic region with 3 months of evolution. Clinical, laboratory, and epidemiological features were evaluated and associated with apparent damage to the T11-T12 vertebrae, identification by imaging tests, positivity in a polymerase chain reaction-based test, and reactivity to the Mantoux tuberculin skin test (PPD-RT 23). The patient was diagnosed with osteoarticular tuberculosis and received treatment for a year, and clinical cure was achieved.

Evaluation of three enzyme immunoassays and a nucleic acid amplification test for the diagnosis of Clostridium difficile-associated diarrhea at a university hospital in Brazil

Introduction Despite the known importance of Clostridium difficile as a nosocomial pathogen, few studies regarding Clostridium difficile infection (CDI) in Brazil have been conducted. To date, the diagnostic tests that are available on the Brazilian market for the diagnosis of CDI have not been evaluated. The aim of this study was to compare the performances of four commercial methods for the diagnosis of CDI in patients from a university hospital in Brazil. Methods Three enzyme immunoassays (EIAs) and one nucleic acid amplification test (NAAT) were evaluated against a cytotoxicity assay (CTA) and toxigenic culture (TC). Stool samples from 92 patients with suspected CDI were used in this study. Results Twenty-five (27.2%) of 92 samples were positive according to the CTA, and 23 (25%) were positive according to the TC. All EIAs and the NAAT test demonstrated sensitivities between 59 and 68% and specificities greater than 91%. Conclusions All four methods exhibited low sensitivities for the diagnosis of CDI, which could lead to a large number of false-negative results, an increased risk of cross-infection to other patients, and overtreatment with empirical antibiotics.

Colistin and anti-Gram-positive bacterial agents against Acinetobacter baumannii

Introduction Acinetobacter baumannii has attained an alarming level of resistance to antibacterial drugs. Clinicians are now considering the use of older agents or unorthodox combinations of licensed drugs against multidrug-resistant strains to bridge the current treatment gap. We investigated the in vitro activities of combination treatments that included colistin with vancomycin, norvancomycin or linezolid against multidrug-resistant Acinetobacter baumannii. Methods The fractional inhibitory concentration index and time-kill assays were used to explore the combined effects of colistin with vancomycin, norvancomycin or linezolid against 40 clinical isolates of multidrug-resistant Acinetobacter baumannii. Transmission electron microscopy was performed to evaluate the interactions in response to the combination of colistin and vancomycin. Results The minimum inhibitory concentrations (MICs) of vancomycin and norvancomycin for half of the isolates decreased below the susceptibility break point, and the MIC of linezolid for one isolate was decreased to the blood and epithelial lining fluid concentration using the current dosing regimen. When vancomycin or norvancomycin was combined with subinhibitory doses of colistin, the multidrug-resistant Acinetobacter baumannii test samples were eradicated. Transmission electron microscopy revealed that subinhibitory doses of colistin were able to disrupt the outer membrane, facilitating a disruption of the cell wall and leading to cell lysis. Conclusions Subinhibitory doses of colistin significantly enhanced the antibacterial activity of vancomycin, norvancomycin, and linezolid against multidrug-resistant Acinetobacter baumannii.

Ideação suicida : A influência da vinculação e do bem-estar psicológico

Dissertação de Mestrado apresentada ao ISPA - Instituto Universitário

Comparison of recombinant A2-ELISA with rKE16 dipstick and direct agglutination tests for diagnosis of visceral leishmaniasis in dogs in Northwestern Iran

INTRODUCTION: Various methods are used for the diagnosis of visceral leishmaniasis (VL), such as microscopic examination, culture and inoculation of laboratory animals; however, serological assays are commonly used for the detection of antibodies in serum samples with a wide range of specificity and sensitivity. METHODS: The purpose of this study was to compare three serological methods, including rA2-ELISA, the recombinant KE16 (rKE16) dipstick test and the direct agglutination test (DAT), for the detection of antibodies against VL antigens. The assays utilized 350 statistically based random serum samples from domestic dogs with clinical symptoms as well as samples from asymptomatic and healthy dogs from rural and urban areas of the Meshkinshahr district, northwestern Iran. RESULTS: Samples were assessed, and the following positive rates were obtained: 11.5% by rKE16, 26.9% by DAT and 49.8% by ELISA. The sensitivity among symptomatic dogs was 32.4% with rKE16, 100% with DAT and 52.9% with ELISA. Conversely, rA2-ELISA was less specific for asymptomatic dogs, at 46.5%, compared with DAT, at 88.9%. CONCLUSIONS : This study recommends rA2-ELISA as a parallel assay combined with DAT to detect VL infection among dogs. Further evaluations should be performed to develop an inexpensive and reliable serologic test for the detection of Leishmania infantum among infected dogs.

Leptospirosis in animals and human contacts in Egypt: broad range surveillance

INTRODUCTION: Leptospirosis is a re-emerging zoonotic disease of humans and animals worldwide. The disease is caused by pathogenic species of the genus Leptospira. These organisms are maintained in nature via chronic renal infection of carrier animals, which excrete the organisms in their urine. Humans become infected through direct or indirect exposure to infected animals and their urine or through contact with contaminated water and soil. This study was conducted to investigate Leptospira infections as a re-emerging zoonosis that has been neglected in Egypt. METHODS: Samples from 1,250 animals (270 rats, 168 dogs, 625 cows, 26 buffaloes, 99 sheep, 14 horses, 26 donkeys and 22 camels), 175 human contacts and 45 water sources were collected from different governorates in Egypt. The samples were collected from different body sites and prepared for culture, PCR and the microscopic agglutination test (MAT). RESULTS: The isolation rates of Leptospira serovars were 6.9%, 11.3% and 1.1% for rats, dogs and cows, respectively, whereas the PCR results revealed respective detection rates of 24%, 11.3% and 1.1% for rats, dogs and cows. Neither the other examined animal species nor humans yielded positive results via these two techniques. Only six Leptospira serovars (Icterohaemorrhagiae, Pomona, Canicola, Grippotyphosa, Celledoni and Pyrogenes) could be isolated from rats, dogs and cows. Moreover, the seroprevalence of leptospiral antibodies among the examined humans determined using MAT was 49.7%. CONCLUSIONS: The obtained results revealed that rats, dogs and cows were the most important animal reservoirs for leptospirosis in Egypt, and the high seroprevalence among human contacts highlights the public health implications of this neglected zoonosis.

Study of the risk factors related to acquisition of urinary tract infections in patients submitted to renal transplant

INTRODUCTION: Urinary tract infections (UTI) among transplant recipients are usually caused by gram-negative microorganisms and can provoke a high incidence of morbidity and mortality. The aim of this study was to evaluate the risk factors associated with the acquisition of UTIs during the first year after renal transplantation. METHODS: Here, we report a single-center retrospective cohort study of 99 renal transplant patients followed for the first year after surgery. The definition of a UTI episode was a urine culture showing bacterial growth and leucocyturia when patients presented with urinary symptoms. The absence of infection (asymptomatic bacteriuria) was defined as an absence of symptoms with negative urine culture or bacterial growth with any number of colonies. RESULTS: Ninety-nine patients were included in the study. During the study, 1,847 urine cultures were collected, and 320 (17.3%) tested positive for bacterial growth. Twenty-six (26.2%) patients developed a UTI. The most frequent microorganisms isolated from patients with UTIs were Klebsiella pneumoniae (36%), with 33% of the strains resistant to carbapenems, followed by Escherichia coli (20%). There were no deaths or graft losses associated with UTI episodes. CONCLUSIONS: Among the UTI risk factors studied, the only one that was associated with a higher incidence of infection was female sex. Moreover, the identification of drug-resistant strains is worrisome, as these infections have become widespread globally and represent a challenge in the control and management of infections, especially in solid organ transplantation.

Molecular identification and antifungal susceptibility profiles of Candida parapsilosis complex species isolated from culture collection of clinical samples

AbstractINTRODUCTION:Candida parapsilosis is a common yeast species found in cases of onychomycosis and candidemia associated with infected intravascular devices. In this study, we differentiated Candida parapsilosis sensu stricto, Candida orthopsilosis , and Candida metapsilosis from a culture collection containing blood and subungual scraping samples. Furthermore, we assessed the in vitro antifungal susceptibility of these species to fluconazole, itraconazole, voriconazole, posaconazole, amphotericin B, and caspofungin.METHODS:Differentiation of C. parapsilosis complex species was performed by amplification of the secondary alcohol dehydrogenase (SADH) gene and digestion by the restriction enzyme Ban I. All isolates were evaluated for the determination of minimal inhibitory concentrations using Etest, a method for antifungal susceptibility testing.RESULTS:Among the 87 isolates, 78 (89.7%) were identified as C. parapsilosis sensu stricto , five (5.7%) were identified as C. orthopsilosis , and four (4.6%) were identified as C. metapsilosis . Analysis of antifungal susceptibility showed that C. parapsilosis sensu strictoisolates were less susceptible to amphotericin B and itraconazole. One C. parapsilosis sensu stricto isolate was resistant to amphotericin B and itraconazole. Moreover, 10.2% of C. parapsilosis sensu stricto isolates were resistant to caspofungin. Two C. parapsilosis sensu strictoisolates and one C. metapsilosis isolate were susceptible to fluconazole in a dose-dependent manner.CONCLUSIONS:We reported the first molecular identification of C. parapsilosiscomplex species in State of Goiás, Brazil. Additionally, we showed that although the three species exhibited differences in antifungal susceptibility profiles, the primary susceptibility of this species was to caspofungin.