Para determinar la susceptibilidad de cepas de Candida aisladas de hemocultivos en nuestro medio, se estudiaron 78 cepas obtenidas de pacientes hospitalizados en diferentes servicios del Servicio Autónomo Hospital Universitario de Maracaibo (SAHUM), Venezuela. Para la identificación de especies se usó el medio cromogénico Brilliance Candida Agar y Vitek-YBC. Adicionalmente, los cultivos fueron identificados por el método tradicional. La susceptibilidad fue determinada por el método de difusión con discos de fluconazol y voriconazol según la metodología M44-A2 del Clinical Laboratory Standard Institute. La frecuencia de las especies de Candida fue: C. parapsilosis 51,28%, C. tropicalis 15,38%, C. guilliermondii 11,54%, C. albicans 10,26% C. famata 6,41%, C. glabrata 3,85% y C. krusei 1,28%. La susceptibilidad fue de 96,15% y 100% para fluconazol y voriconazol, respectivamente. Tres de las 78 cepas, identificadas como C. albicans, C. guilliermondii y C. krusei fueron resistentes a fluconazol. Estos resultados sugieren que fluconazol y voriconazol pueden ser utilizados en el tratamiento de pacientes con candidemia en SAHUM, sin embargo, la vigilancia epidemiológica y la determinación de la susceptibilidad de Candida deben mantenerse.

To determine the susceptibility of Candida strains isolated from blood cultures in Maracaibo, Venezuela, 78 strains obtained from hospitalized patients in different services of the autonomous Maracaibo University Hospital, Venezuela, were studied. Chromogenic Medium Brilliance Candida Agar and Vitek-YBC were used for species identification. In addition, cultures were assessed using the traditional identification method. Susceptibility was determined by the diffusion method with fluconazole and voriconazole disks, according to the Clinical and Laboratory Standard Institute, Document M44-A2. Frequency of the Candida species was: C. parapsilosis 51.28%, C. tropicalis 15.38%, C. guilliermondii 11.54%, C. albicans 10.26% C. famata 6.41%, C. glabrata 3.85% and C. krusei 1.28%. Susceptibility was 96.15% and 100% for fluconazole and voriconazole, respectively. Three isolates identified as C. albicans, C. guilliermondii and C. krusei were resistant to fluconazole. These results suggest that fluconazole and voriconazole can be useful in the treatment of patients with candidemia; however, epidemiological surveillance and susceptibility pattern determination of Candida must be maintained.

Se estudió la epidemiología de Candidemias en el Servicio Autónomo Hospital Universitario de Maracaibo (SAHUM), analizándose 78 episodios de Candidemia entre Enero 2007 y Marzo 2010, procedentes de 70 pacientes de ambos sexos y edades entre 15 días y 88 años, hospitalizados en diferentes servicios de SAHUM, de cuyos hemocultivos se aisló Candida sp en el Centro de Referéncia Bacteriológica (CRB) de esa institución. Para la identificación de especies se usó el medio cromogénico Brilliance Candida Agar y Vitek-YBC en el CRB. Adicionalmente, los cultivos fueron evaluados por el método tradicional en el Laboratorio de Micología de la Universidad del Zulia. Las características de los pacientes se tomaron de fichas del CRB. La mediana de la edad de los pacientes fue 17 años. Hubo 8 aislamientos secuenciales. La frecuencia de las especies de Candida fue: C. parapsilosis 51,28%, C. tropicalis 15,38%, C. guilliermondii 11,54%, C. albicans 10,26% C. famata 6,41%, C. glabrata 3,85% y C. krusei 1,28%. El Chi cuadrado indicó que los niños en los servicios no UCI tienen mayor probabilidad de adquirir Candidemias. Se observó un cambio en la frecuencia de especies, por lo tanto se requiere una vigilancia epidemiológica permanente en SAHUM.

The epidemiology of candidemia in the Servicio Autónomo Hospital Universitario de Maracaibov(SAHUM) was studied. From January 2008 to March 2010, 78 candidemia episodes from 70 patients were analyzed. Ages ranged from 15 days to 80 years old. Patients were hospitalized in different wards at SAHUM. Candida spp was isolated in blood cultures processed at the Bacteriology Reference Center (CRB). For species identification, chromogenic Brilliance Candida Agar and Vitek-YBC were used. Additionally, the cultures were evaluated by traditional methods at the Mycology Laboratory, University of Zulia. Patients’ characteristics were obtained from the CRB register. The median patients’ age was 17 years old. Eight sequential isolates were obtained. The following Candida species were found:, C. parapsilosis 51.28%, C. tropicalis 15.38%, C. guilliermondii 11.54%, C. albicans 10.26%, C. famata 6.41%, C. glabrata 3.85% and Candida krusei 1.28%. X² showed that children in non-ICU wards were more likely to have candidemia. A change in the frequency of the species isolated was observed; for this reason, a permanent surveillance system is required.

En el niño recién nacido la colonización por especies de levaduras puede ser el precursor de una infección clínica. En esta investigación se evaluó la colonización por levaduras en piel de neonatos nacidos a término en las primeras 48 horas del nacimiento. Las muestras de piel, de 100 niños, se tomaron de diferentes regiones anatómicas. Se empleó el método de la impronta con cinta plástica transparente. Se realizó un examen directo con azul de metileno (0,25%) y se cultivó en los medios Sabouraud Dextrosa Agar y Dixon con antibióticos. La identificación de los aislados se hizo según metodología clásica. Los resultados indican que los neonatos presentaron una colonización por levaduras en un 45%. Se observó una colonización baja por Malassezia furfur (5%) y el predominio de Candida parapsilosis (87,9%). Esta especie de Candida fue aislada en un 54,2% cuando el nacimiento fue por cesárea y, 33,7% cuando fue por parto. El alto porcentaje de colonización por C. parapsilosis tanto en los niños nacidos por parto como por cesárea podría deberse a la trasmisión horizontal a partir de las manos del personal de salud que los atiende.

In the newborn, colonization by yeast species may be the precursor for a clinical infection. This study assessed yeast colonization on the skin of term infants during the first 48 hours after birth. Skin samples of 100 children were taken from different anatomical regions. The stamp method with transparent plastic tape was used. A direct test with methylene blue (0.25%) was made and cultured in Sabouraud dextrose agar and Dixon media with antibiotics. Isolates were identified according to classic methodology. Results indicate that 45% of the newborns had yeast colonies. Low colonization by Malassezia furfur (5%) and the predominance of Candida parapsilosis (87.9%) were observed. This species of Candida was isolated in 54.2% of births by caesarean section and 33.7% of natural births. The high rate of colonization by C. parapsilosis in children born by caesarean as well as normal delivery could be due to horizontal transmission from the hands of health workers taking care of them.

Con el fin de estudiar los factores que predisponen al paciente para la adquisición de Candida albicans en el tracto urinario, se realizó una investigación de tipo retrospectiva en el Hospital Universitario de Maracaibo durante el período 1999-2001. Para tal fin se tomó una muestra de 53 pacientes: 28 que mostraron la presencia de Candida albicans (Ca+) y 25 que no la mostraron (control), con una edad promedio de 42 años. Las variables estudiadas fueron sexo, tiempo de hospitalización (TH), ingreso a UCI (IU), uso de sonda vesical (SV), tiempo de colocación de sonda vesical (TCSV), uso de antibióticos (UA), tiempo de uso de antibióticos (TUAB) y número de antibióticos (NAB). Los datos se registraron en un instrumento tipo cuestionario. Los análisis estadísticos de los resultados mostraron que en los pacientes Ca+ las variables: TH, TCSV, TUAB, NAB, IU y sexo femenino fueron más frecuentes. El análisis discriminante de las variables estudiadas permitió establecer relación estadísticamente significativa con las variables TCSV, TUAB y NAB, aunque esta última variable no tiene influencia en el modelo al analizar la ecuación discriminante. La prueba de Ji-Cuadrada indicó que hubo dependencia entre el sexo femenino, TCSV mayor a 10 días, NAB mayor o igual a 2, TUAB mayor a 14 días. La remoción temprana de la sonda vesical y el adecuado uso de antibióticos durante la hospitalización, como medidas de prevención podrían evitar la adquisición de C. albicans en la orina de pacientes hospitalizados.

For the purpose of studying the predisposition factors in patients in the acquisition of Candida albicans in the urinary tract, retrospective research was undertaken in the University Hospital in Maracaibo from 1999-2001. For such a purpose a sample of 53 patients was taken: 28 showing the presence of Candida albicans (Ca+) and 25 that did not show it (control), with an average overall age of 42. The variables studied were sex, time of hospitalization (TH), permanence in an intensive care unit -UCI- (IU), use of bladder catheter (SV), bladder catheter usage time (TCSV), use of antibiotics (UA), duration of the use of antibiotics (TUAB) and number of antibiotics used (NAB). The data was registered in a questionnaire type instrument. The statistical analyses of the results showed that in Ca+ patients, the variables: TH, TCSV, TUAB, NAB, IU and female (sex), were more frequent than the averages of each one of these variables in the Ca- group. The discriminative analysis for the same variables allowed for the establishment of statistically significant relation with variables TCSV, TUAB and NAB; although the last variable did not have any influence in the model when the discriminative equation was analyzed. The Ji-Square test indicated that there was dependence for the feminine sex, TCSV was greater at 10 days, NAB was greater or equal to 2, TUAB was greater at 14 days. Early removal of the bladder catheter and the adequate use of antibiotics during hospitalization, are practices that help to prevent the acquisition of C. albicans in hospitalized patients.

From March 1999 to March 2000, we conducted a prospective multicenter study of candidemia involving five tertiary care hospitals from four countries in Latin America. Yeast isolates were identified by classical methods and the antifungal susceptibility profile was determined according to the National Committee for Clinical Laboratory Standards microbroth assay method. During a 12 month-period we were able to collect a total of 103 bloodstream isolates of Candida spp. C. albicans was the most frequently isolated species accounting for 42% of all isolates. Non-albicans Candida species strains accounted for 58% of all episodes of candidemia and were mostly represented by C. tropicalis (24.2%) and C. parapsilosis (21.3%). It is noteworthy that we were able to identify two cases of C. lusitaniae from different institutions. In our casuistic, non-albicans Candida species isolates related to candidemic episodes were susceptible to fluconazole. Continuously surveillance programs are needed in order to identify possible changes in the species distribution and antifungal susceptibility patterns of yeasts that may occurs after increasing the use of azoles in Latin American hospitals.

Até a década de 80, antes do surgimento da AIDS, a criptococose era relativamente rara. Verificou-se que esta doença afeta muito frequentemente os pacientes com AIDS e pode ser a primeira manifestação desta síndrome. O objetivo deste trabalho é o de comparar o resultado dos exames das amostras do LCR inicial na meningencefalite por criptococo entre pacientes com e sem AIDS. Este trabalho é baseado no estudo de 41 pacientes com neurocriptococose sem AIDS e de 23 pacientes com neurocriptococose e AIDS. Este estudo permitiu verificar que a reação inflamatória, no sistema nervoso, quando presente, foi de menor intensidade nos pacientes com AIDS; a reação inflamatória esteve presente em todos os pacientes sem AIDS e ausente em 21,7% dos pacientes com AIDS; o quadro inflamatório crônico, semelhante ao da meningencefalite tuberculosa, clássico nas meningencefalites por criptococo, ocorreu raramente nos pacientes com AIDS; em média, o número de criptococos no LCR foi maior nos pacientes com AIDS; pode ser feito diagnóstico presuntivo da AIDS quando o criptococo estiver presente no LCR que não apresenta alterações citológicas e bioquímicas.

Neurocryptococcosis was a rare nervous system infection. With the rising number of patients with AIDS it became a very frequent disease. This infection is supposed to infect patients with some kind of immunodeficiency and the CSF alterations often simulate tuberculous meningitis. The purpose of this research was to compare the CSF changes in AIDS and non-AIDS patients with meningoencephalitis caused by Cr. neoformans. There were analysed 41 CSF samples from non-AIDS patients with neurocryptococcosis and 23 CSF samples from AIDS patients with neurocryptococcosis. The results of this research allowed to conclude that the inflammatory changes in the CSF from AIDS patients showed a lower intensity compared to those non-AIDS patients. These results showed as well, that the CSF samples from non-AIDS patients always revealed some changes besides the yeast cells. In some samples of AIDS patients, however the unique change was the presence of the yeast. It was demonstrated also, that the presence of Cr. neoformans in CSF, not accompanied by any other change, may suggest that is a patient with AIDS. In non-AIDS patients CSF alterations often simulates tuberculous meningitis. However these alterations were rare in AIDS patients. The yeast cells were more numerous in CSF samples from AIDS patients than in those from non-AIDS patients