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Case report: Mycetoma caused by Gordonia soli
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França, João César Beenke

; Carneiro, Bruno Hassunuma

; Cognialli, Regielly Caroline Raimundo

; Queiroz-Telles, Flávio de

Revista da Sociedade Brasileira de Medicina Tropical

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2023, Volume 56 elocation e0326-2023

Abstract: En | Text: En | PDF: En

ABSTRACT Mycetoma is a neglected tropical disease caused by fungi (eumycetoma) or bacteria (actinomycetoma), with high morbidity. Gordonia spp. are gram-positive bacteria that have previously been reported to cause mycetoma. Here, we report a case of Gordonia soli (initially misidentified as Nocardia spp.) as the etiological agent of actinomycetoma in a 64-year-old patient. After a literature search in the Cochrane Library, LILACS, SciELO, MEDLINE, PubMed, and PubMed Central databases, we concluded that this is the first case report of mycetoma caused by Gordonia soli. The current case highlights the importance of microbiological diagnosis of mycetoma and the challenges in its management.

https://doi.org/10.1590/0037-8682-0326-2023

Clinical and epidemiological aspects of Candidemia in eight medical centers in the state of Parana, Brazil: Parana Candidemia Network
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Oliveira, Carla Sakuma de

; Colombo, Arnaldo Lopes

; Francisco, Elaine Cristina

; Lima, Bernardo de

; Gandra, Rinaldo F.

; Carvalho, Mariza Cristina Preifz de

; Carrilho, Cláudia Maria Dantas de Maia

; Petinelli, Renan

; Pelison, Marsilene

; Helbel, Cesar

; Czelusniak, Gerson

; Paz Morales, Hugo Manuel

; Perozin, Jamile Sardi

; Pinheiro, Rosangela Lameira

; Cognialli, Regielly

; Breda, Giovanni Luis

; Queiroz-Telles, Flávio

Brazilian Journal of Infectious Diseases

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2021, Volume 25 N. 1 elocation 101041

Abstract: En | Text: En | PDF: En

ABSTRACT Objectives: Candida spp. has been reported as one of the common agents of nosocomial bloodstream infections and is associated with a high mortality. Therefore, this study evaluated the clinical findings, local epidemiology, and microbiological aspects of candidemia in eight tertiary medical centers in the state of Parana, South of Brazil. Methods: In this study, we reported 100 episodes of candidemia in patients admitted to eight different hospitals in five cities of the state of Parana, Brazil, using data collected locally (2016 and 2017) and tabulated online. Results: The incidence was found to be 2.7 / 1000 patients / day and 1.2 / 1000 admissions. C. albicans was responsible for 49% of all candidemia episodes. Cancer and surgery were the two most common underlying conditions associated with candidemia. The mortality rate within 30 days was 48%, and removal of the central venous catheter (p = 0.029) as well as empirical or prophylactic exposure to antifungals were both related to improved survival (p = 0.033). Conclusions: This study highlights the high burden and mortality rates of candidemia in hospitals from Parana as well as the need to enhance antifungal stewardship program in the enrolled medical centers.

https://doi.org/10.1016/j.bjid.2020.11.006 198 downloads

Top 10 evidence-based recommendations from the Brazilian Society of Infectious Diseases for the Choosing Wisely Project
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Pasqualotto, Alessandro C.

; Almeida, Camila S.

; Kliemann, Dimas A.

; Barcellos, Guilherme B.

; Queiroz-Telles, Flávio

; Abdala, Edson

; Resende, Mariangela

; Batista, Filipe P.

; Vidal, José E.

; Rocha, Jaime

; Raboni, Sonia M.

; Cimerman, Sergio

; Gales, Ana C.

Brazilian Journal of Infectious Diseases

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oct 2019, Volume 23 N. 5 Pages 331 - 335

Abstract: En | Text: En | PDF: En

ABSTRACT The Choosing Wisely Initiative aims to collect statements from medical societies all over the world on medical interventions that result in no benefit to patients, with the potential to cause harm. In this article we present the views of the Diagnostic Laboratory Group at the Brazilian Society of Infectious Diseases (SBI). Ten experts from SBI were asked to list 10 diagnostic tests that were perceived as unnecessary in the field of infectious diseases. After voting for the more relevant topics, a questionnaire was sent to all SBI members, in order to select for the most important items. A total of 482 votes were obtained, and the top 10 results are shown in this manuscript. The Choosing Wisely statements of SBI should facilitate clinical practice by optimizing the use of diagnostic resources in the field of infectious diseases.

https://doi.org/10.1016/j.bjid.2019.08.004 372 downloads

Brazilian guidelines for the clinical management of paracoccidioidomycosis
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Shikanai-Yasuda, Maria Aparecida

; Mendes, Rinaldo Pôncio

; Colombo, Arnaldo Lopes

; Queiroz-Telles, Flávio de

; Kono, Adriana Satie Gonçalves

; Paniago, Anamaria M. M

; Nathan, André

; Valle, Antonio Carlos Francisconi do

; Bagagli, Eduardo

; Benard, Gil

; Ferreira, Marcelo Simão

; Teixeira, Marcus de Melo

; Silva-Vergara, Mario León

; Pereira, Ricardo Mendes

; Cavalcante, Ricardo de Souza

; Hahn, Rosane

; Durlacher, Rui Rafael

; Khoury, Zarifa

; Camargo, Zoilo Pires de

; Moretti, Maria Luiza

; Martinez, Roberto

Revista da Sociedade Brasileira de Medicina Tropical

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sep 2017, Volume 50 N. 5 Pages 715 - 740

Abstract: En | Text: En | PDF: En

Abstract 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.

https://doi.org/10.1590/0037-8682-0230-2017 10753 downloads

Clinical aspects and relevance of molecular diagnosis in late mucocutaneous leishmaniasis patients in Paraná, Brazil
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Thomaz-Soccol, Andréa

; Mocellin, Marcos

; Mulinari, Fabiane

; Castro, Edilene Alcântara de

; Queiroz-Telles, Flávio de

; Alcântara, Fernanda de Souza

; Bavaresco, Marcello Tortelli

; Hennig, Luciane

; Andraus, Anielo

; Luz, Ennio

; Thomaz-Soccol, Vanete

Brazilian Archives of Biology and Technology

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jun 2011, Volume 54 N. 3 Pages 487 - 494

Abstract: En | Text: En | PDF: En

The aim of the present work was to study the clinical aspects and relevance of molecular diagnosis in late mucocutaneous leishmaniasis patients in Parana, Brazil. Twenty one suspected cases of mucocutaneous leishmaniasis (MCL) in patients from the endemic areas of leishmaniasis were assessed. Different methods used in diagnosing the disease and the polymerase chain reaction (PCR) technique were compared in order to establish the sensitivity of each method. Out of the 21 patients analyzed, 14.3% presented other etiologies such as vasculitis, syphilis, and paracoccidioidomycosis, with all tests negative for leishmaniasis. Out of the remaining 15 patients, 6.7% cases were confirmed for leishmaniasis by direct examination; 46.67% were positive for culture, which allowed isolating and identifying the parasite and - with the PCR technique - it was possible to diagnose 100% MCL patients for all the three repetitions of exams. The PCR optimized for the present work proved to be an auxiliary method for diagnosing leishmaniasis applicable in the patients carrying MCL due to Leishmania (Viannia) braziliensis and did not need culture to be performed, resulting in a faster diagnosis.

2081 downloads Cited 1 time in SciELO

Análise das alterações radiográficas pulmonares durante a terapêutica da paracoccidioidomicose
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Moraes, Cristian Saievicz de

; Queiroz-Telles, Flávio

; Marchiori, Edson

; Escuissato, Dante Luiz

Radiologia Brasileira

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feb 2011, Volume 44 N. 1 Pages 20 - 28

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Foram analisadas as alterações radiográficas pulmonares em pacientes com paracoccidioidomicose crônica de modo evolutivo, verificando-se as diferenças entre os tratados com um novo agente antifúngico triazólico, o voriconazol, em relação aos que utilizaram a atual droga de escolha para o tratamento, o itraconazol. MATERIAIS E MÉTODOS: Realizou-se estudo comparativo, randomizado, com avaliação das radiografias do tórax obtidas antes, durante e após o tratamento de 39 pacientes, divididos em dois grupos: um recebendo o voriconazol e o outro, itraconazol. A avaliação das radiografias teve como parâmetro uma adaptação do método já estabelecido para a análise de outra doença pulmonar difusa, o esquema ILO (International Labour Office) de classificação das pneumoconioses, classificando-se as lesões em pequenas ou grandes opacidades. RESULTADOS: Os resultados obtidos coincidiram com as descrições prévias existentes em relação à apresentação das alterações radiográficas pulmonares, e a evolução destas ao longo do tratamento foi semelhante nos dois grupos. As pequenas opacidades regrediram parcialmente, ao passo que as grandes opacidades mostraram tendência à regressão completa. CONCLUSÃO: O uso da adaptação do modelo ILO de classificação das pneumoconioses revelou-se útil para o acompanhamento dos pacientes com paracoccidioidomicose crônica ao longo do tratamento, do ponto de vista radiográfico.

OBJECTIVE: Lung radiographic findings were reviewed to evaluate the differences in the progression of findings along the follow-up of patients with chronic paracoccidioidomycosis treated with a novel second-generation triazole antifungal agent (voriconazole) as compared with patients treated with the drug of choice for treatment of such disease (itraconazole). MATERIALS AND METHODS: A comparative, randomized study involved the review of chest radiographic images acquired before, during and after treatment of 39 patients divided into two groups: one receiving voriconazole and the other receiving itraconazole. The parameters adopted to describe and to measure lesions present on the radiographic images were based on an adaptation of the method used in cases of another diffuse pulmonary disease, the ILO (International Labour Office) classification of pneumoconioses, dividing the lesions into small and large opacities. RESULTS: The results coincided with previous descriptions regarding lung radiographic findings, and the progression of such findings along the treatment was similar for both groups. Partial regression was observed in the small opacities while large opacities showed a tendency towards complete regression. CONCLUSION: The adapted ILO classification demonstrated to be useful in the radiographic follow-up along treatment of patients with chronic paracoccidioidomycosis.

22633 downloads Cited 3 times in SciELO

Treatment of severe chromoblastomycosis with itraconazole and 5-flucytosine association
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Antonello, Vicente Sperb

; Silva, Marcelo Campos Appel da

; Cambruzzi, Eduardo

; Kliemann, Dimas Alexandre

; Santos, Breno Riegel

; Queiroz-Telles, Flávio

Revista do Instituto de Medicina Tropical de São Paulo

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dec 2010, Volume 52 N. 6 Pages 329 - 331

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Cromoblastomicose é uma infecção fúngica crônica do tecido subcutâneo causada pela inoculação traumática de um grupo específico de fungos através da pele, encontrados eventualmente em trabalhadores do campo descalços em países de clima tropical e subtropical. Relatamos aqui o caso de um paciente do sexo masculino com uma lesão dermatológica de crescimento lento e pruriginosa nos membros inferiores por 20 anos, diagnosticada e tratada com sucesso para cromoblastomicose. Apesar da prevalência desta doença em nossa região, o tratamento ainda é um desafio.

Chromoblastomycosis is a chronic human melanized fungi infection of the subcutaneous tissue caused by traumatic inoculation of a specific group of dematiaceous fungi through the skin, often found in barefooted agricultural workers, in tropical and subtropical climate countries. We report the case of a male patient presenting a slow-growing pruriginous lesion on the limbs for 20 years, mistreated over that time, which was diagnosed and successfully treated as chromoblastomycosis. Besides the prevalence of this disease, treatment is still a clinical challenge.

4341 downloads Cited 4 times in SciELO

HIV-1 genotypic resistance profile of patients failing antiretroviral therapy in Paraná, Brazil
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Toledo, Paula Virginia Michelon

; Carvalho, Denise Siqueira de

; Romagnoli, Luiza

; Marcinko, Gustavo

; Cunha, Clovis Arns da

; Souza, Margely Nunes de

; Brindeiro, Rodrigo

; Queiroz-Telles, Flávio de

Brazilian Journal of Infectious Diseases

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aug 2010, Volume 14 N. 4 Pages 360 - 371

Abstract: En | Text: En | PDF: En

Antiretroviral therapy (ART) has reduced morbidity and mortality related to human immunodeficiency virus (HIV) infection, but in spite of this advance, HIV mutations decrease antiretroviral susceptibility, thus contributing to treatment failure in patients. Genotyping HIV-1 allows the selection of new drugs after initial drug failure. This study evaluated the genotypic profile of HIV-1 isolates from treated (drug-experienced) patients in Paraná, Brazil. The prevalence of mutations in reverse transcriptase (RT) and protease (PR) genes were assessed. We analyzed 467 genotypes of patients with HIV-1 viral loads above 1,000 copies/mL. Mutations at HIV-1 RT and PR genes and previously used ART regimens were recorded. The most prevalent RT mutations were: 184V (68.31%), 215YF (51.6%), 103NS (46%), 41L (39.4%), 67N (38.54%), 210W (23.5%), 190ASE (23.2%), and 181C (17.4%). PR mutations were 90M (33.33%), 82ATFS (29%), 46I (26.8%) and 54V (22.2%). The prevalence of mutations was in line with previous national and international reports, except to nonnucleoside analogue reverse transcriptase inhibitors related mutations, which were more prevalent in this study. Previous exposure to antiretroviral drugs was associated with genotypic resistance to specific drugs, leading to treatment failure in HIV patients.

1921 downloads

Genetic diversity of human immunodeficiency virus-1 isolates in Paraná, Brazil
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Toledo, Paula Virginia Michelon

; Carvalho, Denise Siqueira de

; Rossi, Silvia Gomes de

; Brindeiro, Rodrigo

; Queiroz-Telles, Flávio de

Brazilian Journal of Infectious Diseases

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jun 2010, Volume 14 N. 3 Pages 230 - 236

Abstract: En | Text: En | PDF: En

OBJECTIVE: Because epidemiological data on circulating HIV subtypes among HIV-positive patients in the state of Paraná were not known until now, the aims of this study were to describe the genetic diversity profile of HIV-1 in treated patients in Paraná, Brazil, and report the differences in protease (PR) and reverse transcriptase (RT) mutations in HIV-1 subtypes. PATIENTS AND METHODS: A cross-sectional study was conducted from 2003 to 2006. Plasma viral RNA of 389 patients was extracted and PR and RT genes were polymerase chain reaction-amplified and sequenced. Sequences were subtyped and examined for antiretroviral resistance mutations. Data on gender of patient harboring the viruses and past history of antiretroviral treatment were also collected. RESULTS: Most viruses were either subtype B (61.44%) or subtype C (20.57%). Subtype C and F were more frequent in women (p < 0.00). The prevalence of subtypes was similar over the years studied. The most frequent RT mutations in all subtypes were M184V and mutations at codons 215, 41, 103, 67, 219, and 190. Mutations 41L, 210W, 215YF, and 74V were significantly more prevalent on subtype B, and the mutation 106M was significantly more prevalent on subtype C. The most frequent major PI mutations in all subtypes occurred at codons 46, 82, and 90. PR mutations 32I, 46I, and 84V were significantly more prevalent on subtype B. The minor PI mutations on codons 36, 93, and 63 were more prevalent on subtypes F, C, and B, respectively. CONCLUSION: We concluded that the predominant strain of HIV-1 in Paraná is subtype B, followed by subtype C. Some mutations at PR and TR had subtype predominance in accordance with other authors' report.

2024 downloads

10.

Invasive aspergillosis in hematopoietic stem cell transplant recipients: a retrospective analysis
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Carvalho-Dias, Viviane Maria Hessel

; Sola, Caroline Bonamin Santos

; Cunha, Clóvis Arns da

; Shimakura, Sílvia Emiko

; Pasquini, Ricardo

; Queiroz-Telles, Flávio de

Brazilian Journal of Infectious Diseases

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oct 2008, Volume 12 N. 5 Pages 385 - 389

Abstract: En | Text: En | PDF: En

Invasive aspergillosis (IA) currently is an important cause of mortality in subjects undergoing hematopoietic stem cell transplants (HSCT) and is also an important cause of opportunistic respiratory and disseminated infections in other types of immunocompromised patients. We examined the medical records of 24 cases of proven and probable invasive aspergillosis (IA) at the Hospital de Clinicas of the Federal University of Parana, Brazil, from January 1996 to October 2006. During this period occurred a mean of 2.2 cases per year or 3.0 cases per 100 HSTC transplants. There was a significant relationship between structural changes in the bone marrow transplant (BMT) Unit and the occurrence of IA cases (p=0.034, relative risk (RR) = 2.47). Approximately 83% of the patients died due to invasive fungal infection within 60 days of follow up. Some factors tended to be associated with mortality, but these associations were not significant. These included corticosteroid use, neutropenia (<100 cells/mm³) at diagnosis, patients that needed to change antifungal therapy because of toxicity of the initial first-line regimen and disseminated disease. These factors should be monitored in BMT units to help prevent IA. Physicians should be aware of the risk factors for developing invasive fungal infections and try to reduce or eliminate them. However, once this invasive disease begins, appropriate diagnostic and treatment measures must be implemented as soon as possible in order to prevent the high mortality rates associated with this condition.

3614 downloads

11.

Candidemia em um hospital terciário brasileiro: incidência, freqüência das diferentes espécies, fatores de risco e suscetibilidade aos antifúngicos
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França, João Cesar Beenke

; Ribeiro, Clea Elisa Lopes

; Queiroz-Telles, Flávio de

Revista da Sociedade Brasileira de Medicina Tropical

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feb 2008, Volume 41 N. 1 Pages 23 - 28

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

São apresentados os resultados de estudo transversal e observacional sobre candidemia realizado no Hospital de Clínicas da Universidade Federal do Paraná. No período de janeiro de 2001 a dezembro de 2004, foram analisados 100 episódios de candidemia. A incidência foi de 1,27 por 1.000 internações, sendo Candida spp o oitavo agente mais isolado nas infecções da corrente sanguínea. A idade variou de 5 dias a 89 anos com uma média de 32 anos, 60% dos casos ocorreram em adultos (66% > 50 anos) e 40% em crianças (52% < 1 ano). Cinqüenta e nove pacientes estavam internados em enfermarias e 41 em unidade de terapia intensiva. Candida albicans foi a espécie mais (59%) freqüente, seguida por Candida tropicalis (15%), Candida parapsilosis (9%). As condições associadas mais (97%) freqüentes foram uso de antibióticos, cateter venoso central (77%), bloqueador H2 (57%), nutrição parenteral total (49%) internamento em unidade de terapia intensiva (41%). Dos 51 isolados testados, 3 de Candida glabrata apresentaram suscetibilidade dose-dependente ao fluconazol e eram resistentes ao itraconazol. Uma amostra de Candida krusei apresentou suscetibilidade dose-dependente ao fluconazol, e uma de Candida pelliculosa suscetibilidade dose-dependente ao itraconazol. Na população de estudo, 68% receberam tratamento antifúngico, no entanto a mortalidade foi de 56%.

Results from a cross-sectional observational study on candidemia conducted at Hospital de Clínicas, Federal University of Paraná, are presented. From January 2001 to December 2004, one hundred candidemia cases were evaluated. The incidence was 1.27 episodes per 1,000 hospitalizations and Candida was the eighth most frequently isolated agent from bloodstream infections. The patients’ ages ranged from five days to 89 years, with a mean of 32 years. Sixty percent of the cases occurred in adults (66% > 50 years old) and 40% in children (52% < one year old). Fifty-nine percent had been admitted to medical wards and 41% to the intensive care unit. Candida albicans was the most (59%) frequent species followed by Candida tropicalis (15%) and Candida parapsilosis (9%). The most (97%) prevalent coexisting conditions were the use of antibacterial drugs, central venous catheter (77%), H2 blockers (57%), total parenteral nutrition (49%) and admission to the intensive care unit (41%). Out of the 51 isolates tested, three of Candida glabrata presented dose-dependent susceptibility to fluconazole and resistance to itraconazole. One sample of Candida krusei presented dose-dependent susceptibility to fluconazole and one of Candida pelliculosa presented dose-dependent susceptibility to itraconazole. Among the study population, 68% received antifungal therapy, but the mortality was 56%.

9364 downloads

12.

Disseminated cutaneous sporotrichosis in a patient with AIDS: report of a case
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Carvalho, Miriam Tomoko Mitsuno

; Castro, Adriana Pinheiro de

; Baby, Cristiane

; Werner, Betina

; Filus Neto, José

; Queiroz-Telles, Flávio

Revista da Sociedade Brasileira de Medicina Tropical

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dec 2002, Volume 35 N. 6 Pages 655 - 659

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Descrevemos um relato de caso de esporotricose cutânea disseminada como apresentação inicial de AIDS em um paciente masculino de 24 anos HIV positivo. Ele apresentava múltiplas lesões cutâneas ulceradas, distribuídas na face, tórax, pernas e braços. A biopsia de uma das lesões cutâneas foi sugestiva de esporotricose e a cultura revelou Sporothrix schenckii. Foi iniciado o tratamento com itraconazol e as lesões progressivamente involuiram depois de 15 dias de medicação. O paciente teve alta com tratamento ambulatorial, mas não retornou para seguimento. Ele morreu três meses depois em outro hospital. O tratamento da esporotricose em pacientes HIV positivos ainda não está estabelecido. Por sua boa penetração cutânea, o itraconazol é uma das melhores opções para formas disseminadas de esporotricose.

We describe a case report of disseminated cutaneous sporotrichosis as the initial presentation of AIDS in a 24-year-old HIV-positive male patient. He presented multiple ulcerated skin lesions distributed over the face, thorax, legs and arms. Biopsy of one of the cutaneous lesions was suggestive of sporotrichosis and culture isolated Sporothrix schenckii. Itraconazole was started and the lesions progressively resolved after 15 days of medication. The patient was discharged with this medication but he did not return for follow-up. He died three months later in another hospital. Therapy of sporotrichosis in HIV-infected patients remains unclear and the response to therapy is variable. Itraconazole is highly concentrated in the skin and is one of the options for treatment of disseminated sporotrichosis.

7664 downloads

13.

Multicenter Brazilian Study of Oral Candida Species Isolated from Aids Patients
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Sant'Ana, Priscilla de Laet

; Milan, Eveline Pípolo

; Martinez, Roberto

; Queiroz-Telles, Flávio

; Ferreira, Marcelo Simão

; Alcântara, Ana Paula

; Carvalho, Miriam T

; Colombo, Arnaldo Lopes

Memórias do Instituto Oswaldo Cruz

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mar 2002, Volume 97 N. 2 Pages 253 - 257

Abstract: En | Text: En | PDF: En

Oropharyngeal candidiasis continues to be considered the most common opportunistic disease in Aids patients. This study was designed to investigate species distribution, serotype and antifungal susceptibility profile among Candida spp. isolated from the oral cavity of Aids patients recruited from six Brazilian university centers. Oral swabs from 130 Aids patients were plated onto CHROMagar Candida medium and 142 isolates were recovered. Yeast isolates were identified by classical methods and serotyped using the Candida Check® system-Iatron. Antifungal susceptibility testing was performed according to the NCCLS microbroth assay. C. albicans was the most frequently isolated species (91%), and 70% of the isolates belonged to serotype A. We detected 12 episodes of co-infection (9%), including co-infection with both serotypes of C. albicans. Non-albicans species were isolated from 12 episodes, 50% of them exhibited DDS or resistance to azoles. Otherwise, only 8 out 130 isolates of C. albicans exhibited DDS or resistance to azoles. Brazilian Aids patients are infected mainly by C. albicans serotype A, most of them susceptible to all antifungal drugs.

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14.

Evaluation of efficacy and safety of itraconazole oral solution for the treatment of oropharyngeal candidiasis in AIDS patients
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Queiroz-Telles, Flávio

; Silva, Nanci

; Carvalho, Miriam M.

; Alcântara, Ana Paula

; Matta, Daniel da

; Barberino, Maria G.

; Bartczak, Sergio

; Colombo, Arnaldo Lopes

Brazilian Journal of Infectious Diseases

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- SciELO Analytics

apr 2001, Volume 5 N. 2 Pages 60 - 66

Abstract: En | Text: En | PDF: En

This study was a non-comparative multicenter clinical trial to evaluate the efficacy and tolerability of itraconazole oral solution 200 mg/day (100 mg twice a day in the fasting state) for the treatment of oropharyngeal candidiasis in AIDS patients. We included 50 patients who were treated and followed for up to 3 weeks after ending therapy in the analysis. Mycological cures at the end of therapy occurred in 20/50 patients (40%), but colonization by Candida sp. was recorded in 42/50 (84%) by the end of follow-up. A high rate of clinical response was observed in 46/50 (92%), and the response was sustained for up to 21 days after stopping therapy in 24/46 patients (52%). Clinical relapses were documented among 22 patients, but all causative fungal organisms associated with a relapse were susceptible to itraconazole. There were many patients with persistence or recurrence of Candida, but without mucositis. Relapse of Candida mucositis was significantly related to low levels of CD4 lymphocytes exhibited by symptomatic patients. The drug was well tolerated by all but 1 patient. We conclude that itraconazole oral solution (100 mg bid for 7-14 days) is a well tolerated and effective treatment for suppressing the symptoms of oropharyngeal candidiasis in AIDS patients. Patients with severe immunosuppression may relapse and require frequent cycles of treatment or longterm suppressive therapy.

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