Disseminated fusariosis is an uncommon clinical condition in immunocompromised patients. We report a fatal case of disseminated fusariosis secondary to neuroblastoma in a male patient, 15 years old, who underwent a bone marrow transplant. The patient was admitted to the pediatric intensive care unit (PICU) of a public hospital in Recife-PE, Brazil, presenting bone marrow aplasia, severe leukopenia, and thrombocytopenia. After 15 days, the patient developed right knee effusion. Synovial fluid and blood samples were analyzed at the Medical Mycology Laboratory of the Federal University of Pernambuco. Mycological diagnosis was based on the presence of hyaline septate hyphae on direct examination and the isolation of Fusarium oxysporum in culture, confirming the case of disseminated fusariosis. In vitro, the isolate showed fluconazole resistance and sensitivity to amphotericin B, anidulafungin, and voriconazole. Therapy with voriconazole in combination with liposomal amphotericin B led to an improved clinical response; however, due to underlying disease complications, the patient progressed to death.
In the present study we report a case of candidemia in an infant with cystic fibrosis admitted to a Pediatric Intensive Care Unit (PICU) with a fatal course. Six-month-old male patient with a history of productive cough and persistent fever. He was admitted to the PICU of a public hospital in the city of Recife, PE, Brazil, with a diagnosis of dyspnea and cystic fibrosis, with a respiratory infection. Antibiotics were administered, however without success, peripheral blood and transcatheter blood cultures were requested, the isolated agents were Staphylococcus epidermidis and Pseudomonas aeruginosa, respectively. After seven days, the patient presented lesions on the genitalia and persistent fever. Blood and genital lesions were collected, the samples were identified as Candida albicans through the classical taxonomy and the VITEK 120 automated system. The antifungal sensitivity test followed the protocol by the broth microdilution method (CLSI- Clinical and Laboratory Standard Institute, 2008b). The isolates from blood samples were sensitive to amphotericin B with a Minimal Inhibitory Concentration (MIC) of 0.03 µg/mL, 0.12 µg/mL for anidulafungin and 0.25 µg/mL for voriconazole, exhibiting resistance to fluconazole with MIC of 64 µg/mL. C. albicans isolated from the genitalia lesion was sensitive to all the drugs used. The patient was administered nystatin 4 times a day and amphotericin B. The patient improved from the genital lesion and fever. However, after three days, the patient presented cardiac and respiratory deficit that led to cardiac arrest, leading to death.
Background Opportunistic infections are frequent in people living with the human immunodeficiency virus who either do not have access to antiretroviral therapy (ART) or use it irregularly. Tuberculosis is the most frequent infectious disease in PLHIV and can predispose patients to severe fungal infections with dire consequences. Case presentation We describe the case of a 35-year-old Brazilian man living with human immunodeficiency virus (HIV) for 10 years. He reported no adherence to ART and a history of histoplasmosis with hospitalization for 1 month in a public hospital in Natal, Brazil. The diagnosis was disseminated Mycobacterium tuberculosis infection. He was transferred to the health service in Recife, Brazil, with a worsening condition characterized by daily fevers, dyspnea, pain in the upper and lower limbs, cough, dysphagia, and painful oral lesions suggestive of candidiasis. Lymphocytopenia and high viral loads were found. After screening for infections, the patient was diagnosed with tuberculous pericarditis and esophageal candidiasis caused by Candida tropicalis. The isolated yeasts were identified using the VITEK 2 automated system and matrix-assisted laser desorption/ionization time-of-flight–mass spectrometry. Antifungal microdilution broth tests showed sensitivity to fluconazole, voriconazole, anidulafungin, caspofungin, micafungin, and amphotericin B, with resistance to fluconazole and voriconazole. The patient was treated with COXCIP-4 and amphotericin deoxycholate. At 12 days after admission, the patient developed sepsis of a pulmonary focus with worsening of his respiratory status. Combined therapy with meropenem, vancomycin, and itraconazole was started, with fever recurrence, and he changed to ART and tuberculostatic therapy. The patient remained clinically stable and was discharged with clinical improvement after 30 days of hospitalization. Conclusion Fungal infections should be considered in patients with acquired immunodeficiency syndrome as they contribute to worsening health status. When mycoses are diagnosed early and treated with the appropriate drugs, favorable therapeutic outcomes can be achieved.
Os aparelhos celulares correspondem a uma ferramenta social importante no cotidiano, pois facilitam os processos de comunicação e permitem a aproximação de pessoas de forma rápida e eficiente. Seu uso indiscriminado em ambientes clínicos por profissionais de saúde pode contribuir com o fenômeno da resistência bacteriana, uma vez que o mesmo serve como carreador de diversos microrganismos, e entre eles podem conter alguns com elevada patogenicidade e que apresentam mecanismos de virulência intrínsecos, como formação de Biofilmes. Diante disso, o objetivo do presente estudo foi analisar o perfil de isolados bacterianos oriundos de aparelhos celulares de profissionais de saúde de diferentes setores em um hospital do Recife, Pernambuco-Brasil, levando-se em consideração seu perfil de resistência e seu fator de virulência, como formação de biofilme. Foram investigados dados microbiológicos provenientes de 10 isolados de aparelhos celulares de profissionais de saúde. Os isolados foram semeados em meios de cultura específicos e avaliado o potencial de formação de biofilme em meio ágar vermelho congo e os isolados caracterizados quanto o seu perfil de resistência á antimicrobianos. Como resultados, obteve-se um perfil de contaminação de aparelhos celulares por microrganismos resistentes e produtores de biofilme, bem como dados alarmantes da propagação da resistencia bacteriana. Diante dos resultados encontrados, conclui-se que os aparelhos celulares são fontes importantes da propagação da resistência bacteriana, sendo necessário melhores processos de higienização para o seu uso no ambiente clínico e terapêutico, para que o mesmo não ponha em risco os pacientes nos leitos de UTI’s.
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