RESUMO
Abstract The yeast Saccharomyces cerevisiae var. boulardii is a biotherapeutic agent used for the prevention and treatment of several gastrointestinal diseases. We report a case of fungemia in a patient suffering from Clostridium difficile-associated diarrhea and treated with metronidazole and a probiotic containing S. cerevisiae var. boulardii. The yeasts isolated from the blood culture and capsules were identified by MALDI-TOF MS and API ID 32 C as S. cerevisiae, and showed the same appearance and color on CHROMAgar Candida. Treatment with fluconazole 400mg/day was initiated and the probiotic was stopped. The patient was discharged from hospital in good condition and was referred to a rehabilitation center. We suggest that the potential benefit of S. cerevisiae var. boulardii should be accurately evaluated, especially in elderly patients. Moreover, all physicians should be trained in the use of probiotic agents and enquire whether the use probiotics was included in the patients'medical histories. © 2019 Asociación Argentina de Microbiología. Published by Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Resumen Saccharomyces cerevisiae var. boulardii es un agente bioterapéutico usado en la prevención y el tratamiento de varias enfermedades gastrointestinales. Informamos de un caso de fungemia en una paciente con diarrea asociada a Clostridium difficile, y tratada con metron-idazol y un probiótico que contenía S. cerevisiae var. boulardii. Las levaduras aisladas a partir del hemocultivo y del contenido de las cápsulas tomadas por la paciente se identificaron como S. cerevisiae mediante MALDI-TOF MS y API® ID 32C, las colonias mostraron el mismo color y aspecto en el medio CHROMAgar™ Candida. Se instauró un tratamiento con fluconazol 400mg/día y se suspendió el probiótico. La paciente fue dada de alta del hospital en buenas condiciones, y remitida a un centro de rehabilitación. Sugerimos que el beneficio potencial del uso de S. cerevisiae var. boulardii debe ser evaluado en cada paciente, especialmente en personas añosas. El uso de probióticos debería incluirse en los interrogatorios orientados al diagnóstico y formar parte de la historia clínica. © 2019 Asociación Argentina de Microbiología. Publicado por Elsevier España, S.L.U. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Assuntos
Idoso de 80 Anos ou mais , Feminino , Humanos , Saccharomyces cerevisiae/isolamento & purificação , Fungemia/etiologia , Probióticos/efeitos adversos , Saccharomyces boulardii , Micoses/etiologiaRESUMO
The yeast Saccharomyces cerevisiae var. boulardii is a biotherapeutic agent used for the prevention and treatment of several gastrointestinal diseases. We report a case of fungemia in a patient suffering from Clostridiumdifficile-associated diarrhea and treated with metronidazole and a probiotic containing S. cerevisiae var. boulardii. The yeasts isolated from the blood culture and capsules were identified by MALDI-TOF MS and API ID 32 C as S. cerevisiae, and showed the same appearance and color on CHROMAgar Candida. Treatment with fluconazole 400mg/day was initiated and the probiotic was stopped. The patient was discharged from hospital in good condition and was referred to a rehabilitation center. We suggest that the potential benefit of S. cerevisiae var. boulardii should be accurately evaluated, especially in elderly patients. Moreover, all physicians should be trained in the use of probiotic agents and enquire whether the use probiotics was included in the patients'medical histories.
Assuntos
Fungemia/etiologia , Micoses/etiologia , Probióticos/efeitos adversos , Saccharomyces boulardii , Saccharomyces cerevisiae/isolamento & purificação , Idoso de 80 Anos ou mais , Feminino , HumanosRESUMO
Introducción: Rhodotorula es considerada un microorganismo contaminante no virulento. Forma parte de la microbiota de la piel, las uñas y las mucosas. Se aísla con frecuencia del ambiente humanizado. Estas levaduras han surgido como patógenos oportunistas en pacientes con inmunodeficiencias, portadores de catéteres intravenosos de larga duración y otros. Objetivo: Informar a la comunidad pediátrica un nuevo caso de fungemia causada por Rhodotorula. Presentación del caso: lactante de 2 meses de edad, pretérmino de 32,1 semanas, con un peso al nacer de 1 800 gramos, que ingresa en la sala de cuidados intensivos del Hospital Pediátrico Provincial, Cienguegos, con el diagnóstico de una sepsis sin un foco primario definido. Después de 5 días de tratamiento con meropenem y vancomicina la fiebre cede y reaparece nuevamente pasados otros 5 días. En el momento en que la fiebre se reanuda tenía un catéter centrovenoso de ocho días de duración. En los hemocultivos realizados en esa fecha se aisló una Rhodotorula sp. Conclusiones: A pesar de que Rhodotorula es un microorganismo de baja virulencia, debe considerarse un potencial patógeno en pacientes con inmunosupresión y catéteres venosos centrales. Las especies de Rhodotorula se consideran intrínsecamente resistentes a los azoles y las equinocandinas, pero susceptibles a anfotericina B y flucitosina. En consecuencia, el tratamiento de elección preferido es con cualquier tipo de preparación de anfotericina B. El resultado alcanzado constituye un llamado de atención para la comunidad pediátrica nacional y foránea(AU)
ABSTRACT Introduction: Rhodotorula is considered a contaminating, non-virulent microorganism. It is part of the microbiota of the skin, nails and mucous membranes. It is often isolated from the humanized environment. These yeasts have emerged as opportunistic pathogens in patients with immunodeficiencies carrying long-term intravenous catheters. Objective: To inform to the pediatricians´ community a new case of fungemia due to Rhodotorula. Case presentation: 2-month-old, preterm infant of 32.1 weeks, with a birth weight of 1800 grams, who was admitted to Intensive Care service in Provincial Pediatric Hospital of Cienfuegos province with a diagnosis of sepsis without a defined primary focus. After 5 days of treatment with meropenem and vancomycin, the fever subsides and reappears again after another 5 days. By the time the fever reappears he had an 8-day central venous catheter. In the blood cultures carried out on that date a Rhodotorulasp was isolated. Conclusions: Although Rhodotorula is a low virulence microorganism, it should be considered as a potential pathogen in patients with immunosuppression and central venous catheters. Rhodotorula species are considered intrinsically resistant to azoles and echinocandins, but sensitive to amphotericin B and flucytosine. Consequently, the preferred treatment of choice is with any type of amphotericin B preparations. The results achieved constitute a call of attention to the national and foreign pediatrics´ community(AU)
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Humanos , Masculino , Lactente , Fungemia/complicações , Fungemia/etiologia , Infecções Relacionadas a Cateter/complicações , Relatos de CasosRESUMO
We used whole-genome sequence typing (WGST) to investigate an outbreak of Sarocladium kiliense bloodstream infections (BSI) associated with receipt of contaminated antinausea medication among oncology patients in Colombia and Chile during 2013-2014. Twenty-five outbreak isolates (18 from patients and 7 from medication vials) and 11 control isolates unrelated to this outbreak were subjected to WGST to elucidate a source of infection. All outbreak isolates were nearly indistinguishable (<5 single-nucleotide polymorphisms), and >21,000 single-nucleotide polymorphisms were identified from unrelated control isolates, suggesting a point source for this outbreak. S. kiliense has been previously implicated in healthcare-related infections; however, the lack of available typing methods has precluded the ability to substantiate point sources. WGST for outbreak investigation caused by eukaryotic pathogens without reference genomes or existing genotyping methods enables accurate source identification to guide implementation of appropriate control and prevention measures.
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Antieméticos/efeitos adversos , Surtos de Doenças , Contaminação de Medicamentos , Fungemia/etiologia , Hypocreales , Chile , Colômbia , DNA Fúngico , Fungemia/diagnóstico , Fungemia/microbiologia , Humanos , Hypocreales/genética , Hypocreales/isolamento & purificação , Polimorfismo de Nucleotídeo Único , Análise de Sequência de DNARESUMO
BACKGROUND: Mucormycosis is a rare fungal infection of the mucorales order, which affects mostly immunocompromised patients. The association with emphysematous gastritis is rare and often fatal produced by gas -forming bacteria. We report the case of a trauma patient with type 1 diabetes mellitus, and diabetic ketoacidosis complicated with gastric mucormycosis associated with emphysematous gastritis. CLINICAL CASE: A male aged 32 who is involved in a car accident, who suffered head trauma, is admitted to the Intensive Care Unit, presenting diabetic ketoacidosis and upper gastrointestinal bleeding. An endoscopy was performed and an erosive esophagitis Class C, ischemia and gastric necrosis was found. A computed tomography scan showed emphysematous gastritis and gastric necrosis. He underwent total gastrectomy with a histopathology report of gastric mucormycosis. After the surgical procedure the patient died because of sepsis secondary to pulmonary mucormycosis DISCUSSION: Mucormycosis is a rare fungical disease which infrequently affects the gastrointestinal tract, being the stomach the most affected site. The mortality is high if the diagnosis is not done promptly and appropriate treatment is given. CONCLUSION: Suspecting its existence is necessary in patients with immunocompromised status to diagnose and provide timely treatment to increase survival, because of its high mortality.
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Enfisema/etiologia , Gastrite/complicações , Mucormicose/complicações , Acidentes de Trânsito , Adulto , Lesões Encefálicas/complicações , Diabetes Mellitus Tipo 1/complicações , Cetoacidose Diabética/complicações , Esofagite/complicações , Evolução Fatal , Fungemia/etiologia , Gastrectomia , Gastrite/microbiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Hospedeiro Imunocomprometido , Pneumopatias Fúngicas/etiologia , Masculino , Úlcera Gástrica/etiologiaRESUMO
Nosocomial neonatal candidiasis is a major problem in infants, which require intensive therapy. The subjects of the present study were three preterm infants admitted to the neonatal intensive care unit of the General Hospital "Dr. Manuel Gea Gonzalez". The infants developed Candida parapsilosis infection on the mean age of 13.6 day of life. Prior to fungemia, infants had received assisted ventilation and hyperalimentation through central venous catheter. Sequence analysis of the internal transcribed spacer gene ruled out other Candida species and revealed that the eight isolates were C. parapsilosis. The isolates were examined based on their molecular relation by random amplified polymorphic DNA analysis. The profiles allowed the identification of two main genotypes of C. parapsilosis as the outbreak cause and as a result of the cross-infection with health care workers' hands. We conclude that C. parapsilosis commonly colonize through horizontal transmission due to the staff's noncompliance of hand hygiene procedures.
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Candidíase/etiologia , Infecções Relacionadas a Cateter/etiologia , Infecção Hospitalar/etiologia , Surtos de Doenças , Doenças em Gêmeos/etiologia , Contaminação de Equipamentos/prevenção & controle , Fungemia/etiologia , Desinfecção das Mãos , Recém-Nascido Prematuro , Candidíase/diagnóstico , Candidíase/epidemiologia , Candidíase/prevenção & controle , Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Doenças em Gêmeos/diagnóstico , Doenças em Gêmeos/epidemiologia , Doenças em Gêmeos/prevenção & controle , Fungemia/diagnóstico , Fungemia/epidemiologia , Fungemia/prevenção & controle , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , México/epidemiologia , Testes de Sensibilidade Microbiana , Técnica de Amplificação ao Acaso de DNA PolimórficoRESUMO
Candida spp. are important healthcare-associated pathogens. Identifying the source of infection is important for prevention and control strategies. The objective of this study was to evaluate candida colonisation sites as potential sources for candidaemia. Sixty-three consecutive patients with a positive blood culture for candida were included. Surveillance cultures were collected from urine, rectum, oropharynx, skin, intravascular catheter tip and skin around catheter. Molecular typing was performed when the same species of candida was isolated from blood and surveillance sites of a patient. C. albicans was associated with 42% of candidaemias, C. parapsilosis 33%, C. tropicalis 16% and C. guilliermondii, C. krusei, C. glabrata, C. holmii and C. metapsilosis were all 2% each. Six of 10 C. parapsilosis catheter tip isolates were indistinguishable from corresponding blood isolates (all in neonates). C. albicans isolates from blood were indistinguishable from corresponding gastrointestinal tract isolates in 13 of 26 patients and from catheter tip isolates in two patients. In conclusion, the results suggest that gastrointestinal colonisation is the probable source of C. albicans candidaemia and C. parapsilosis is exogenous.
Assuntos
Candida/isolamento & purificação , Candidíase/microbiologia , Fungemia/etiologia , Fungemia/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Candida/classificação , Candida/genética , Criança , Pré-Escolar , Impressões Digitais de DNA , DNA Fúngico/genética , Feminino , Trato Gastrointestinal/microbiologia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Técnicas de Tipagem Micológica , Adulto JovemRESUMO
In order to characterize the epidemiology, microbiology and outcome of candidemia due to Candida parapsilosis, we examined a database of 282 episodes of candidemia prospectively collected from four tertiary care hospitals in São Paulo, Brazil between March 2002 and February 2003, and compared the characteristics of patients with candidemia due to C. parapsilosis (n=64) with those caused by Candida albicans (n=107). C. parapsilosis candidemia was associated with neutropenia (p=0.005), tunneled central venous catheter (p=0.005) and cancer chemotherapy (p=0.03). By multivariate analysis, candidemia due to C. parapsilosis was associated with the presence of a tunneled central venous catheter (relative risk 3.71, 95% confidence interval 1.28-10.70). Except for a single isolate of C. parapsilosis that exhibited MIC >1 microg/ml to amphotericin B, no resistance was observed in 166 isolates tested against fluconazole, itraconazole, 5-flucytosine and amphotericin B. The caspofungin MIC values of C. parapsilosis isolates were significantly higher than those exhibited by C. albicans isolates (p<0.001). The overall mortality of patients with candidemia due to C. parapsilosis was significantly lower (45% vs. 62%, p=0.03). The association between C. parapsilosis candidemia and a tunneled central venous catheter supports the idea that the main mode of acquisition of C. parapsilosis is from an external source.
Assuntos
Candidíase/microbiologia , Fungemia/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Candida/efeitos dos fármacos , Candidíase/etiologia , Criança , Pré-Escolar , Feminino , Fungemia/etiologia , Humanos , Lactente , Recém-Nascido , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Rhodotorula sp. are commensal yeasts that may cause opportunistic infections. There have been only a few case reports of Rhodotorula fungemia in children with cancer, and in all of them the patients had a central venous catheter inserted. The authors report three nonfatal cases of fungemia by Rhodotorula in patients with post-chemotherapy neutropenia. Two of three patients required catheter removal, and a response was achieved with systemic antifungal therapy. Aggressive therapy may be required for selected high-risk patients.
Assuntos
Antifúngicos/uso terapêutico , Fungemia/etiologia , Rhodotorula/isolamento & purificação , Adolescente , Antineoplásicos/uso terapêutico , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/microbiologia , Criança , Feminino , Fungemia/tratamento farmacológico , Humanos , Leucemia Promielocítica Aguda/complicações , Leucemia Promielocítica Aguda/tratamento farmacológico , Leucemia Promielocítica Aguda/microbiologia , Linfoma de Células T/complicações , Linfoma de Células T/tratamento farmacológico , Linfoma de Células T/microbiologia , Sarcoma de Ewing/complicações , Sarcoma de Ewing/tratamento farmacológico , Sarcoma de Ewing/microbiologiaRESUMO
Clinical protocols of 28 cases of cryptococcemia studied between April 1995 and November 2002 were reviewed. The varieties of Cryptococcus neorformans, the underlying disease, and the severity and outcome of the disease were emphasized. Most patients were immunossupressed (89.3% with AIDS) and Cryptococcus neoformans var. grubii was the main recovered variety (92.8%). Regardless of antifungal treatment, in-hospital mortality was 41% strongly associated with APACHE II score, >14 (p<0.01).