Disseminated cutaneous histoplasmosis in elderly patients. An uncommon presentation

Background: Human fungal infections have increased at an alarming rate in recent years, particularly in immunocompromised individuals. Cryptococcosis is the second most prevalent systemic fungal infection worldwide, and the most prevalent systemic infection in immunocompromised individuals, representing more than 70% of cases. The incidence of cryptococcosis is high in people with HIV/acquired immunodefi- ciency syndrome (AIDS), with recent estimates indicating that there are one million cases of cryptococcal meningitis globally per year in AIDS patients. Aims: The aim of this research was to develop a rapid flow cytometric antifungal susceptibility test and to compare the results with the standard methods. Methods: A reference strain and clinical isolates of Cryptococcus neoformans and Cryptococcus gattii were tested for susceptibility to amphotericin B by flow cytometry using propidium iodide as indicator of viability. Flow cytometry (FC) results were compared with the minimum inhibitory concentration (MIC) values determined by microdilution. Results: The antifungal activity of amphotericin B ranged from MICs of 0.06 to 2 g/ml for the 11 isolates studied. The same results were found by FC. Conclusions: The FC method allows same-day results, assisting in the selection of appropriate antifungal therapies. These results demonstrate an excellent correlation between FC and the classic methods of testing for susceptibility to antifungal agents. This rapid diagnosis method makes it possible to quickly administer effective therapeutic interventions, often saving lives.

Prospecção fitoquímica de ativos em extratos e frações originados de folhas de Azadirachta indica A. JUSS. visando atividade antimicrobiana

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Prospecção de substâncias anti histoplasma capsulatum nas formas planctônica e biofilme e análise proteômica

Pós-graduação em Biociências e Biotecnologia Aplicadas à Farmácia - FCFAR

Estudo de genes de Candida albicans com função desconhecida quanto à formação de biofilme, características biológicas e interação patógeno- hospedeiro

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Prospecção de protótipos antifúngicos contra biofilmes de Histoplasma capsulatum e Paracoccidioides brasiliensis

A paracoccidioidomicose é uma doença de grande impacto social, sendo a sétima causa de morte entre as doenças crônicas infecciosas no Brasil, que responde por mais de 80% dos casos relatados mundialmente. A histoplasmose é uma micose endêmica em determinadas regiões das Américas, onde causa surtos frequentes. Sabe-se que os dois fungos dimórficos causadores destas doenças, Paracoccioides brasiliensis (Pb) e Histoplasma capsulatum (Hc), respectivamente, são capazes de formar biofilme, uma forma de organização que os torna muito mais perigosos, difíceis de serem combatidos e que é essencial para o desenvolvimento de infecção. Além disso não existem muitas opções terapêuticas antifúngicas que não sejam tóxicas com o uso prolongado disponíveis no mercado atualmente. Estes fatos, deixam claro a necessidade de pesquisar novas formas de combater esses microrganismos, com o intuito de desenvolver fármacos menos tóxicos e mais eficientes. Uma nova possibilidade de opções terapêuticas com novas substância antifúngica são as chalconas, que foi o objeto de estudo desta pesquisa. Foi estudada a ação antifúngica de diversas moléculas de chalconas contra as formas planctônica e de biofilme dos dois fungos em questão. As chalconas que apresentaram menor valor de CIM90 durante os ensaios com a forma planctônica foram selecionadas para o teste contra biofilme fúngico, estas chalconas foram T3, T24, T19, J4 e A20. Foi observado que estas substâncias possuem atividade antifúngica capaz de inibir 90% do crescimento fúngico do biofilme de Pb. Em relação ao biofilme de Hc, não obtivemos uma inibição de 90% com nenhuma molécula, a chalcona T3 foi a que apresentou a maior inibição atingindo 70%. Também foi estudado a citotoxicidade destas chalconas e algumas delas apresentaram bons valores de seletividade para o Pb, como a T3, T24, T19 e A20 porém, em relação ao Hc, apenas a T3 apresentou um valor de seletividade...

Prospecção de protótipos antifúngicos contra biofilmes de Histoplasma capsulatum e Paracoccidioides brasiliensis

A paracoccidioidomicose é uma doença de grande impacto social, sendo a sétima causa de morte entre as doenças crônicas infecciosas no Brasil, que responde por mais de 80% dos casos relatados mundialmente. A histoplasmose é uma micose endêmica em determinadas regiões das Américas, onde causa surtos frequentes. Sabe-se que os dois fungos dimórficos causadores destas doenças, Paracoccioides brasiliensis (Pb) e Histoplasma capsulatum (Hc), respectivamente, são capazes de formar biofilme, uma forma de organização que os torna muito mais perigosos, difíceis de serem combatidos e que é essencial para o desenvolvimento de infecção. Além disso não existem muitas opções terapêuticas antifúngicas que não sejam tóxicas com o uso prolongado disponíveis no mercado atualmente. Estes fatos, deixam claro a necessidade de pesquisar novas formas de combater esses microrganismos, com o intuito de desenvolver fármacos menos tóxicos e mais eficientes. Uma nova possibilidade de opções terapêuticas com novas substância antifúngica são as chalconas, que foi o objeto de estudo desta pesquisa. Foi estudada a ação antifúngica de diversas moléculas de chalconas contra as formas planctônica e de biofilme dos dois fungos em questão. As chalconas que apresentaram menor valor de CIM90 durante os ensaios com a forma planctônica foram selecionadas para o teste contra biofilme fúngico, estas chalconas foram T3, T24, T19, J4 e A20. Foi observado que estas substâncias possuem atividade antifúngica capaz de inibir 90% do crescimento fúngico do biofilme de Pb. Em relação ao biofilme de Hc, não obtivemos uma inibição de 90% com nenhuma molécula, a chalcona T3 foi a que apresentou a maior inibição atingindo 70%. Também foi estudado a citotoxicidade destas chalconas e algumas delas apresentaram bons valores de seletividade para o Pb, como a T3, T24, T19 e A20 porém, em relação ao Hc, apenas a T3 apresentou um valor de seletividade...

Peptides of the Constant Region of Antibodies Display Fungicidal Activity

Synthetic peptides with sequences identical to fragments of the constant region of different classes (IgG, IgM, IgA) of antibodies (Fc-peptides) exerted a fungicidal activity in vitro against pathogenic yeasts, such as Candida albicans, Candida glabrata, Cryptococcus neoformans, and Malassezia furfur, including caspofungin and triazole resistant strains. Alanine-substituted derivatives of fungicidal Fc-peptides, tested to evaluate the critical role of each residue, displayed unaltered, increased or decreased candidacidal activity in vitro. An Fc-peptide, included in all human IgGs, displayed a therapeutic effect against experimental mucosal and systemic candidiasis in mouse models. It is intriguing to hypothesize that some Fc-peptides may influence the antifungal immune response and constitute the basis for devising new antifungal agents.

Epidemiology and predictors of a poor outcome in elderly patients with candidemia

Background: Candidemia affects patient populations from neonates to the elderly. Despite this, little information is available about the epidemiology of candidemia in elderly patients. Methods: We performed a retrospective analysis of 987 episodes of candidemia in adults (>14 years of age) from the databases of three laboratory-based surveys of candidemia performed at 14 tertiary care hospitals. Patients aged >= 60 years were considered elderly (group 1, n = 455, 46%) and were compared to younger patients (group 2, n = 532, 54%) regarding demographics, underlying diseases, comorbidities, exposure to medical procedures, species, treatment, and outcome. Results: The median APACHE II score was significantly higher in the elderly patients (19 vs. 15, p = 0.03). Variables that were observed significantly more frequently in elderly patients included admission to an intensive care unit, diabetes mellitus, renal failure, cardiac disease, lung disease, receipt of antibiotics or H2 blockers, insertion of a central venous catheter, mechanical ventilation, and candidemia due to Candida tropicalis. The 30-day mortality of elderly patients was significantly higher than that of younger patients (70% vs. 45%, p < 0.001). Factors associated with higher mortality by multivariate analysis included APACHE II score and being in group 1 (elderly). Factors associated with mortality in elderly patients were lung disease and the receipt of mechanical ventilation. Conclusions: Elderly patients account for a substantial proportion of patients with candidemia and have a higher mortality compared to younger patients. (C) 2012 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Candida spp. isolated from inpatients, the environment, and health practitioners in the Pediatric Unit at the Universitary Hospital of the Jundiai Medical College, State of Sao Paulo, Brazil

Introduction: This study aimed to isolate and identify Candida spp. from the environment, health practitioners, and patients with the presumptive diagnosis of candidiasis in the Pediatric Unit at the Universitary Hospital of the Jundiai Medical College, to verify the production of enzymes regarded as virulence factors, and to determine how susceptible the isolated samples from patients with candidiasis are to antifungal agents. Methods: Between March and November of 2008 a total of 283 samples were taken randomly from the environment and from the hands of health staff, and samples of all the suspected cases of Candida spp. hospital-acquired infection were collected and selected by the Infection Control Committee. The material was processed and the yeast genus Candida was isolated and identified by physiological, microscopic, and macroscopic attributes. Results: The incidence of Candida spp. in the environment and employees was 19.2%. The most frequent species were C. parapsilosis and C. tropicalis among the workers, C. guilliermondii and C. tropicalis in the air, C. lusitanae on the contact surfaces, and C. tropicalis and C. guilliermondii in the climate control equipment. The college hospital had 320 admissions, of which 13 (4%) presented Candida spp. infections; three of them died, two being victims of a C. tropicalis infection and the remaining one of C. albicans. All the Candida spp. in the isolates evidenced sensitivity to amphotericin B, nystatin, and fluconazole. Conclusions: The increase in the rate of hospital-acquired infections caused by Candida spp. indicates the need to take larger measures regarding recurrent control of the environment.

Candida spp. isolated from inpatients, the environment, and health practitioners in the pediatric unit at the Universitary Hospital of the Jundiaí Medical College, state of São Paulo, Brazil

INTRODUCTION: This study aimed to isolate and identify Candida spp. from the environment, health practitioners, and patients with the presumptive diagnosis of candidiasis in the Pediatric Unit at the Universitary Hospital of the Jundiaí Medical College, to verify the production of enzymes regarded as virulence factors, and to determine how susceptible the isolated samples from patients with candidiasis are to antifungal agents. METHODS: Between March and November of 2008 a total of 283 samples were taken randomly from the environment and from the hands of health staff, and samples of all the suspected cases of Candida spp. hospital-acquired infection were collected and selected by the Infection Control Committee. The material was processed and the yeast genus Candida was isolated and identified by physiological, microscopic, and macroscopic attributes. RESULTS: The incidence of Candida spp. in the environment and employees was 19.2%. The most frequent species were C. parapsilosis and C. tropicalis among the workers, C. guilliermondii and C. tropicalis in the air, C. lusitanae on the contact surfaces, and C. tropicalis and C. guilliermondii in the climate control equipment. The college hospital had 320 admissions, of which 13 (4%) presented Candida spp. infections; three of them died, two being victims of a C. tropicalis infection and the remaining one of C. albicans. All the Candida spp. in the isolates evidenced sensitivity to amphotericin B, nystatin, and fluconazole. CONCLUSIONS: The increase in the rate of hospital-acquired infections caused by Candida spp. indicates the need to take larger measures regarding recurrent control of the environment.

Amphotericin B nasal spray has no effect on nasal polyps

Nasal polyps and chronic rhinosinusitis are the products of an inflammatory process. Recently, fungal involvement has been thought to stimulate the development of polyps, and administration of antifungal agents was therefore considered a potential treatment. Several studies have been published indicating amphotericin B as an effective treatment for nasal polyps and chronic rhinosinusitis. The aim of our investigation was to evaluate the efficacy of intranasal applied amphotericin B on the growth of nasal polyps in a three-month, prospective, open trial. Our results show that nasal amphotericin B spray is not effective for nasal polyps and may even cause deterioration.

Candida parapsilosis endocarditis: a comparative review of the literature

Fungal endocarditis (FE) is an uncommon disease, and while accounting for only 1.3-6% of all cases of infectious endocarditis, it carries a high mortality risk. Although Candida albicans represents the main etiology of FE, C. parapsilosis is the most common non-albicans species. We report the case of a 32-year-old man with a history of prior intravenous drug (IVD) use hospitalized with endocarditis due to C. parapsilosis and review all 71 additional cases documented in the literature. A retrospective analysis of the 72 C. parapsilosis cases compared to 52 recently reviewed cases of C. albicans endocarditis was conducted to identify organism-specific clinical peculiarities. The most common predisposing factor for C. parapsilosis endocarditis (41/72; 57.4%) involved prosthetic valves followed by IVD use (12/72; 20%). Peripheral embolic and/or hemorrhagic events occurred in 28/64 (43.8%) patients, mostly in cerebral and lower limb territories. Overall mortality was 41.7%. Combined surgical and clinical treatment was associated with a lower mortality. Few patients received the newer antifungal agents, and it would appear that more experience is required for their use in the treatment of C. parapsilosis endocarditis.

Medicinal Chemistry of ureido derivatives as Antiinfectives

Ureides are compounds, which essentially incorporate urea as a substructural component either in open or cyclic form. Ureido derivatives are one of the oldest classes of bioactives, widely used as antiinfective agents. Several of these compounds, including aminoquinuride, aminocarbalide, imidurea, cloflucarban, nitrofurazone, urosulfan, viomycin are used in clinical situations. One of the ureides, the triclocarban is compulsorily used as antibacterial agent in cleansing and disinfecting solutions in hospital, household, cosmetics, toys, textile and plastics. It disables the activity of ENR, an enzyme vital for building the cell wall of the bacteria and fungus. Besides, the ureido-penicillins in clinical use there have been several ureido-lactam derivatives which have been reported to exhibit significant antibacterial activity. A urea containing dipeptide TAN-1057A isolated from Flexibacter spp. has potent bioactivity against MRSA. The metal complexes of sulphonyl ureido derivatives are effective antifungal agents by inhibiting the activity of phosphomannose isomerase, a key enzyme in the biosynthesis of yeast cell walls. There have been number of ureides including the cyclic ureas which are potent HIV protease inhibitors and display significant anti-HIV activity. The urea derivative, merimepodip that has been derived using structure based design, is potent inhibitor of IMPDH and is active against Hepatitis-C infection. This review will primarily focus on the significant work reported for this class of compounds including design, synthesis and biological activity.

Activity of anidulafungin in a murine model of Candida krusei infection: evaluation of mortality and disease burden by quantitative tissue cultures and measurement of serum (1,3)-beta-D-glucan levels.

Experience with anidulafungin against Candida krusei is limited. Immunosuppressed mice were injected with 1.3 x 10(7) to 1.5 x 10(7) CFU of C. krusei. Animals were treated with saline, 40 mg/kg fluconazole, 1 mg/kg amphotericin B, or 10 and 20 mg/kg anidulafungin for 5 days. Anidulafungin improved survival and significantly reduced the number of CFU/g in kidneys and serum beta-glucan levels.

Rationale for reading fluconazole MICs at 24 hours rather than 48 hours when testing Candida spp. by the CLSI M27-A2 standard method.

We investigated if CLSI M27-A2 Candida species breakpoints for fluconazole MIC are valid when read at 24 h. Analysis of a data set showed good correlation between 48- and 24-h MICs, as well as similar outcomes and pharmacodynamic efficacy parameters, except for isolates in the susceptible dose-dependent category, such as Candida glabrata.