C. auris is an emerging healthcare-associated pathogen associated with high mortality. Treatment options are limited, due to antifungal resistance. WGS analysis suggests nearly simultaneous, and recent, independent emergence of different clonal populations on 3 continents. Risk factors and transmission mechanisms need to be elucidated to guide control measures.

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Caspofungin is at least as effective as amphotericin B for the treatment of invasive candidiasis and, more specifically, candidemia.

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Paracoccidioidomycosis is a systemic fungal disease occurring in Latin America that is associated with rural environments and agricultural activities. However, the incidence and prevalence of paracoccidiodomycosis is underestimated because of the lack of compulsory notification. If paracoccidiodomycosis is not diagnosed and treated early and adequately, the endemic fungal infection could result in serious sequelae. While the Paracoccidioides brasiliensis (P. brasiliensis) complex has been known to be the causal agent of paracoccidiodomycosis, a new species, Paracoccidioides lutzii (P. lutzii), has been reported in Rondônia, where the disease has reached epidemic levels, and in the Central West and Pará. Accurate diagnoses and availability of antigens that are reactive with the patients' sera remain significant challenges. Therefore, the present guidelines aims to update the first Brazilian consensus on paracoccidioidomycosis by providing evidence-based recommendations for bedside patient management. This consensus summarizes etiological, ecoepidemiological, molecular epidemiological, and immunopathological data, with emphasis on clinical, microbiological, and serological diagnosis and management of clinical forms and sequelae, as well as in patients with comorbidities and immunosuppression. The consensus also includes discussion of outpatient treatments, severe disease forms, disease prevalence among special populations and resource-poor settings, a brief review of prevention and control measures, current challenges and recommendations.

SUMMARY Trichosporon spp. are basidiomycetous yeast-like fungi found widely in nature. Clinical isolates are generally related to superficial infections. However, this fungus has been recognized as an opportunistic agent of invasive infections, mostly in cancer patients and those exposed to invasive medical procedures. It is possible that the ability of Trichosporon strains to form biofilms on implanted devices, the presence of glucuronoxylomannan in their cell walls, and the ability to produce proteases and lipases are all factors likely related to the virulence of this genus and therefore may account for the progress of invasive trichosporonosis. Disseminated trichosporonosis has been increasingly reported worldwide and represents a challenge for both diagnosis and species identification. Phenotypic identification methods are useful for Trichosporon sp. screening, but only molecular methods, such as IGS region sequencing, allow the complete identification of Trichosporon isolates at the species level. Methods for the diagnosis of invasive trichosporonosis include PCR-based methods, Luminex xMAP technology, and, more recently, proteomics. Treating patients with trichosporonosis remains a challenge because of limited data on the in vitro and in vivo activities of antifungal drugs against clinically relevant species of the genus. Despite the mentioned limitations, the use of antifungal regimens containing triazoles appears to be the best therapeutic approach.

Candidemia studies have documented geographic differences in rates and epidemiology, underscoring the need for surveillance to monitor trends. We conducted prospective candidemia surveillance in Brazil to assess the incidence, species distribution, frequency of antifungal resistance, and risk factors for fluconazole-resistant Candida species. Prospective laboratory-based surveillance was conducted from March 2003 to December 2004 in 11 medical centers located in 9 major Brazilian cities. A case of candidemia was defined as the isolation of Candida spp. from a blood culture. Incidence rates were calculated per 1,000 admissions and 1,000 patientdays. Antifungal susceptibility tests were performed by using the broth microdilution assay, according to the Clinical and Laboratory Standards Institute guidelines. We detected 712 cases, for an overall incidence of 2.49 cases per 1,000 admissions and 0.37 cases per 1,000 patient-days. The 30-day crude mortality was 54%. C. albicans was the most common species (40.9%), followed by C. tropicalis (20.9%) and C. parapsilosis (20.5%). Overall, decreased susceptibility to fluconazole occurred in 33 (5%) of incident isolates, 6 (1%) of which were resistant. There was a linear correlation between fluconazole and voriconazole MICs (r ‫؍‬ 0.54 and P < 0.001 [Spearman's rho]). This is the largest multicenter candidemia study conducted in Latin America and shows the substantial morbidity and mortality of candidemia in Brazil. Antifungal resistance was rare, but correlation between fluconazole and voriconazole MICs suggests cross-resistance may occur.

INTRODUÇÃOMicose sistêmica endêmica de grande interesse para os países da América Latina, a paracoccidioidomicose (PCM) é causada pelo fungo termo-dimórfico Paracoccidioides brasiliensis. Apresenta distribuição heterogênea, havendo áreas de baixa e alta endemicidade. No adulto, a forma clínica predominante é a crônica, mas quando acomete crianças ou adolescentes apresenta-se na forma aguda ou subaguda. Quando não diagnosticada e tratada oportunamente, pode levar a formas disseminadas graves e letais, com rápido e progressivo envolvimento dos pulmões, tegumento, gânglios, baço, fígado e órgãos linfóides do tubo digestivo.De acordo com dados de inquéritos epidemiológicos realizados com paracoccidioidina no Brasil, Venezuela, Colômbia e Argentina, acredita-se que em torno de 50% dos habitantes de zonas endêmicas tenham sido expostos ao agente desta micose. Felizmente, apenas uma proporção muito pequena de indivíduos expostos a P. brasiliensis desenvolve alguma manifestação clínica da micose. Esta micose representa um importante problema de Saúde Pública devido ao seu alto potencial incapacitante e à quantidade de mortes prematuras que provoca, principalmente para segmentos sociais específicos, como os trabalhadores rurais, que além de tudo isso apresentam grandes deficiências de acesso e suporte da rede dos serviços de saúde favorecendo o diagnóstico tardio. A faixa etária mais acometida situa-se entre 30 e 50 anos de idade e mais de 90% dos casos são do sexo masculino. Os indivíduos acometidos pela micose, usualmente encontram-se na fase mais produtiva da vida, sendo que a doença leva a impacto social e econômico.Este documento tem como objetivo estabelecer as diretrizes para o consenso da abordagem clínica, diagnóstica e tratamento da PCM, visando subsidiar os profissionais da saúde no atendimento primário e secundário da doença. ECOEPIDEMIOLOGIANa natureza, P. brasiliensis apresenta-se como estruturas filamentosas contendo propágulos infectantes chamados conídios. Uma vez inalados, os propágulos dão origem a formas leveduriformes do fungo que constituirão sua forma parasitária nos tecidos do hospedeiro. Até recentemente, os humanos eram tidos como os únicos hospedeiros naturalmente infectados por este fungo. Atualmente, alguns animais foram encontrados portadores da infecção, como o tatu.Ao longo das últimas décadas, têm sido observadas notáveis alterações na freqüência, nas características demográficas da população atingida e na distribuição geográfica da PCM. Dependendo da região, a incidência se alterou, sem que se possam justificar totalmente as suas causas. É possível que o aumento da urbanização e melhoria do diagnóstico expliquem, em parte, estas alterações. Além disto, fatores ambientais decorrentes da abertura de novas fronteiras agrícolas, com a derrubada de florestas, sobretudo nas regiões Centro-Oeste e Norte, atingindo marcadamente a Amazônia, também contribuíram para o atual panorama da micose. Como é adquirida a infecção por P. brasiliensis?O grande fator de risco para aquisição da infecção são as...