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Abstract Candidemia is the predominant form of invasive candidiasis and the most frequently occurring serious fungal infection in critically ill patients in Intensive Care Units (ICU). Studies carried out in Latin America reveal a higher incidence of candidemia and higher mortality rates when compared to North America or Europe. This highlights the need to develop guidelines for correctly diagnosing and treating candidemia in critically ill patients in the ICU. These guidelines are part of the efforts to implement antifungal optimization programs in the region to obtain better clinical outcomes and promote rational antifungal use. This evidence-based clinical standard, established through expert consensus for the Latin American context, contains recommendations and algorithms for diagnosing and treating candidemia in critically ill ICU patients.

https://doi.org/10.1016/j.bjid.2024.104495

Diretriz Brasileira de Ergometria em População Adulta – 2024
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Carvalho, Tales de

; Freitas, Odilon Gariglio Alvarenga de

; Chalela, William Azem

; Hossri, Carlos Alberto Cordeiro

; Milani, Mauricio

; Buglia, Susimeire

; Precoma, Dalton Bertolim

; Falcão, Andréa Maria Gomes Marinho

; Mastrocola, Luiz Eduardo

; Castro, Iran

; Albuquerque, Pedro Ferreira de

; Coutinho, Ricardo Quental

; Brito, Fabio Sandoli de

; Alves, Josmar de Castro

; Serra, Salvador Manoel

; Santos, Mauro Augusto dos

; Colombo, Clea Simone Sabino de Souza

; Stein, Ricardo

; Herdy, Artur Haddad

; Silveira, Anderson Donelli da

; Castro, Claudia Lucia Barros de

; Silva, Miguel Morita Fernandes da

; Meneghello, Romeu Sergio

; Ritt, Luiz Eduardo Fonteles

; Malafaia, Felipe Lopes

; Marinucci, Leonardo Filipe Benedeti

; Pena, José Luiz Barros

; Almeida, Antônio Eduardo Monteiro de

; Vieira, Marcelo Luiz Campos Stier Júnior, Arnaldo Laffitte

Arquivos Brasileiros de Cardiologia

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2024, Volume 121 N. 3 elocation e20240110

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

https://doi.org/10.36660/abc.20240110

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

A consensus document for the clinical management of invasive fungal diseases in pediatric patients with hematologic cancer and/or undergoing hematopoietic stem cell transplantation in Brazilian medical centers
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Carlesse, Fabianne

; Daudt, Liane Esteves Seber, Adriana Dutra, Álvaro Pimenta Melo, Analy Salles de Azevedo Simões, Belinda Macedo, Carla Renata Donato Bonfim, Carmem Benites, Eliana Gregianin, Lauro Batista, Marjorie Vieira Abramczyk, Marcelo Tostes, Vivian Lederman, Henrique Manoel Lee, Maria Lúcia de Martino Loggetto, Sandra Castro Junior, Cláudio Galvão de Colombo, Arnaldo Lopes

Brazilian Journal of Infectious Diseases

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dec 2019, Volume 23 N. 6 Pages 395 - 409

Abstract: En | Text: En | PDF: En

ABSTRACT In the present paper we summarize the suggestions of a multidisciplinary group including experts in pediatric oncology and infectious diseases who reviewed the medical literature to elaborate a consensus document (CD) for the diagnosis and clinical management of invasive fungal diseases (IFDs) in children with hematologic cancer and those who underwent hematopoietic stem-cell transplantation. All major multicenter studies designed to characterize the epidemiology of IFDs in children with cancer, as well as all randomized clinical trials addressing empirical and targeted antifungal therapy were reviewed. In the absence of randomized clinical trials, the best evidence available to support the recommendations were selected. Algorithms for early diagnosis and best clinical management of IFDs are also presented. This document summarizes practical recommendations that will certainly help pediatricians to best treat their patients suffering of invasive fungal diseases.

https://doi.org/10.1016/j.bjid.2019.09.005 894 downloads

II Consenso Brasileiro em Paracoccidioidomicose - 2017
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Shikanai-Yasuda, Maria Aparecida

; Mendes, Rinaldo Pôncio Colombo, Arnaldo Lopes Telles, Flávio de Queiroz Kono, Adriana Paniago, Anamaria Mello Miranda Nathan, André Valle, Antonio Carlos Francisconi do Bagagli, Eduardo Benard, Gil Ferreira, Marcelo Simão Teixeira, Marcus de Melo Vergara, Mario Leon Silva Pereira, Ricardo Mendes Cavalcante, Ricardo de Souza Hahn, Rosane Durlacher, Rui Rafael Khoury, Zarifa Camargo, Zoilo Pires de Moretti, Maria Luiza Martinez, Roberto

Epidemiologia e Serviços de Saúde

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2018, Volume 27 N. spe elocation e0500001

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

Resumo A paracoccidioidomicose (PCM) é uma micose sistêmica, relacionada às atividades agrícolas, com incidência e prevalência subestimadas, pela ausência de notificação em várias Unidades da Federação (UFs). A evolução insidiosa do quadro clínico pode ter como consequência sequelas graves se o diagnóstico e o tratamento não forem instituídos precoce e adequadamente. Ao lado do complexo Paracoccidioides brasiliensis (P. brasiliensis), a descrição de nova espécie, Paracoccidioides lutzii (P. lutzii), em Rondônia, onde a doença alcançou níveis epidêmicos, bem como na região Centro-Oeste e no Pará, constituem-se em desafios para a instituição do diagnóstico e a urgente disponibilização de antígenos que tenham reatividade com os soros dos pacientes. Este consenso visa atualizar o primeiro consenso brasileiro em PCM, estabelecendo recomendações para o manejo clínico do paciente, com base nas evidências conhecidas. São apresentados dados de etiologia, epidemiologia, imunopatogenia, diagnóstico, terapêutica e sequelas, enfatizando-se o diagnóstico e a terapêutica, bem como recomendações e desafios atuais nessa área do conhecimento.

Abstract Paracoccidioidomycosis is a systemic fungal disease associated with agricultural activities. Its incidence and prevalence are underestimated because of the lack of reporting in several Brazilian states. If paracoccidiodomycosis is not diagnosed and treated early and adequately, endemic fungal infection may result in serious sequelae. In addition to the Paracoccidioides brasiliensis (P. brasiliensis) complex, the appearance of a new species, Paracoccidioides lutzii (P. lutzii), in Rondônia state, where the disease has reached epidemic levels, and in the country’s Midwest region and Pará state, are challenges to diagnosis and to the urgent availability of antigens that are reactive with patients’ sera. These guidelines aim to update the first Brazilian consensus on paracoccidioidomycosis by providing evidence-based recommendations for bedside patient management. The guidelines provide data on etiology, epidemiology, immunopathogenesis, diagnosis, treatment and sequelae, with emphasis on diagnosis and treatment, as well as current recommendations and challenges in this field of knowledge.

Resumen La paracoccidioidomicosis es una micosis sistémica, relacionada con las actividades agrícolas, con incidencia y prevalencia subestimadas por la ausencia de notificación en varios estados. La evolución insidiosa del cuadro clínico puede tener como consecuencia secuelas graves si el diagnóstico y el tratamiento no se establecen precoz y adecuadamente. Al lado del complejo Paracoccidioides brasiliensis (P. brasiliensis), la descripción de nueva especie, Paracoccidioides lutzii (P. lutzii) en Rondonia, donde la enfermedad alcanzó niveles epidémicos, y en la región Centro Oeste y en Pará, se constituyen en desafíos para la institución del diagnóstico y la urgente puesta a disposición de antígenos que tengan reactividad con los sueros de los pacientes. El presente consenso tiene por objeto actualizar el primer consenso brasileño en paracoccidioidomicosis, estableciendo recomendaciones para el manejo del paciente al borde del lecho, con base en las evidencias conocidas. Se presentan datos de etiología, epidemiología, inmunopatogenia, diagnóstico, terapéutica y secuelas, enfatizando el diagnóstico y terapéutica, así como recomendaciones desafíos y actuales en esta área del conocimiento.

https://doi.org/10.5123/s1679-49742018000500001 42486 downloads

II Consenso Brasileiro em Paracoccidioidomicose - 2017
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Shikanai-Yasuda, Maria Aparecida

Epidemiologia e Serviços de Saúde

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2018, Volume 27 N. spe elocation e0500001

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

https://doi.org/10.5123/s1679-49742018000500001

Emergence of Trichosporon mycotoxinivorans (Apiotrichum mycotoxinivorans) invasive infections in Latin America
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Almeida Jr, João Nobrega de Francisco, Elaine Cristina Barberino, Maria Goreth M de Andrade Silva Filho, Luiz Vicente Ribeiro F da Brandão, Oriana M Colombo, Arnaldo Lopes Padovan, Ana Carolina Barbosa

Memórias do Instituto Oswaldo Cruz

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oct 2017, Volume 112 N. 10 Pages 719 - 722

Abstract: En | Text: En | PDF: En

We report the first two cases of Trichosporon mycotoxinivorans infections in Latin America. We also conducted a literature review and a microbiological investigation, including that of clinical and environmental isolates. A 30-year-old man with chronic renal failure had disseminated infection after dialysis and a 15-year-old boy with cystic fibrosis (CF) had pulmonary exacerbations with positive respiratory samples. A review of the relevant literature revealed that deep-seated infections were related to immunosuppression or invasive devices, while most of the CF patients showed a decline in lung function after positive cultures. Phylogenetic analyses revealed three distinct circulating genotypes. MALDI-TOF mass spectrometry analysis showed similar spectral profiles and correctly identified all strains/isolates. Biofilm production was documented in a bloodstream isolate and biofilm-producing cells showed high minimum inhibitory concentrations against antifungals.

https://doi.org/10.1590/0074-02760170011 1164 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

Invasive candidosis: contrasting the perceptions of infectious disease physicians and intensive care physicians
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Schultz, Vanessa Colombo, Arnaldo Lopes Pasqualotto, Alessandro Comaru

Revista da Sociedade Brasileira de Medicina Tropical

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jul 2013, Volume 46 N. 4 Pages 466 - 471

Abstract: En | Text: En | PDF: En

Introduction We analyze how infectious disease physicians perceive and manage invasive candidosis in Brazil, in comparison to intensive care unit specialists. Methods A 38-question survey was administered to 56 participants. Questions involved clinicians' perceptions of the epidemiology, diagnosis, treatment and prophylaxis of invasive candidosis. P < 0.05 was considered statistically significant. Results The perception that candidemia not caused by Candida albicans occurs in less than 10% of patients is more commonly held by intensive care unit specialists (p=0.018). Infectious disease physicians almost always use antifungal drugs in the treatment of patients with candidemia, and antifungal drugs are not as frequently prescribed by intensive care unit specialists (p=0.006). Infectious disease physicians often do not use voriconazole when a patient's antifungal treatment has failed with fluconazole, which also differs from the behavior of intensive care unit specialists (p=0.019). Many intensive care unit specialists use fluconazole to treat candidemia in neutropenic patients previously exposed to fluconazole, in contrast to infectious disease physicians (p=0.024). Infectious disease physicians prefer echinocandins as a first choice in the treatment of unstable neutropenic patients more frequently than intensive care unit specialists (p=0.013). When candidemia is diagnosed, most infectious disease physicians perform fundoscopy (p=0.015), whereas intensive care unit specialists usually perform echocardiograms on all patients (p=0.054). Conclusions This study reveals a need to better educate physicians in Brazil regarding invasive candidosis. The appropriate management of this disease depends on more drug options being available in our country in addition to global coverage in private and public hospitals, thereby improving health care.

https://doi.org/10.1590/0037-8682-0057-2013 1667 downloads

10.

Brazilian guidelines for the management of candidiasis - a joint meeting report of three medical societies: Sociedade Brasileira de Infectologia, Sociedade Paulista de Infectologia and Sociedade Brasileira de Medicina Tropical
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Colombo, Arnaldo Lopes Guimarães, Thaís Camargo, Luis Fernando Aranha Richtmann, Rosana Queiroz-Telles, Flavio de Salles, Mauro José Costa Cunha, Clóvis Arns da Yasuda, Maria Aparecida Shikanai Moretti, Maria Luiza Nucci, Marcio

Brazilian Journal of Infectious Diseases

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jun 2013, Volume 17 N. 3 Pages 283 - 312

Abstract: En | Text: En | PDF: En

Candida infections account for 80% of all fungal infections in the hospital environment, including bloodstream, urinary tract and surgical site infections. Bloodstream infections are now a major challenge for tertiary hospitals worldwide due to their high prevalence and mortality rates. The incidence of candidemia in tertiary public hospitals in Brazil is approximately 2.5 cases per 1000 hospital admissions. Due to the importance of this infection, the authors provide a review of the diversity of the genus Candida and its clinical relevance, the therapeutic options and discuss the treatment of major infections caused by Candida. Each topography is discussed with regard to epidemiological, clinical and laboratory diagnostic and therapeutic recommendations based on levels of evidence.

https://doi.org/10.1016/j.bjid.2013.02.001 11729 downloads Cited 11 times in SciELO

11.

Historical trends in the epidemiology of candidaemia: analysis of an 11-year period in a tertiary care hospital in Brazil
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Wille, Marcos Paulo Guimaraes, Thais Furtado, Guilherme Henrique Campos Colombo, Arnaldo Lopes

Memórias do Instituto Oswaldo Cruz

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may 2013, Volume 108 N. 3 Pages 288 - 292

Abstract: En | Text: En | PDF: En

Candida species are an important cause of bloodstream infections (BSI). To evaluate the epidemiological, clinical and microbiological aspects of two cohorts {1994-1999 [period 1 (P1) ]; 2000-2004 [period 2 (P2) ]} of candidaemic patients, we performed a retrospective analysis from a laboratory-based survey. A total of 388 candidaemias were identified, with an incidence of 0.20/1,000 patient-days and a significant increase in P2 vs. P1 (0.25 vs. 0.15, p = 0.04). Cancer and prior antibiotic use were frequent and Candida albicans was the most prevalent species found (42.4%). Resistance to fluconazole was found in 2.47% of the strains. No differences were observed in the species distribution of Candida during the study periods. In the P2 cohort, there were higher prevalence of elderly individuals, cardiac, pulmonary and liver diseases, renal failure, central venous catheters and antibiotic therapy. In P1, there were higher prevalence of neurological diseases and chemotherapy. The crude mortality was 55.4%. In conclusion, our incidence rates remained high. Furthermore, the distribution pattern of Candida species and the fluconazole resistance profile remained unchanged. Moreover, we found a clear trend of higher prevalence of candidaemia among the elderly and among patients with comorbidities. Finally, it is necessary to discuss strategies for the prevention and control of Candida BSI in Brazil.

https://doi.org/10.1590/S0074-02762013000300005 2607 downloads Cited 5 times in SciELO

12.

The persistence of multifocal colonisation by a single ABC genotype of Candida albicans may predict the transition from commensalism to infection
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Chaves, Guilherme Maranhão Santos, Fernanda Pahim Colombo, Arnaldo Lopes

Memórias do Instituto Oswaldo Cruz

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mar 2012, Volume 107 N. 2 Pages 198 - 204

Abstract: En | Text: En | PDF: En

Candida albicans is a common member of the human microbiota and may cause invasive disease in susceptible populations. Several risk factors have been proposed for candidaemia acquisition. Previous Candida multifocal colonisation among hospitalised patients may be crucial for the successful establishment of candidaemia. Nevertheless, it is still not clear whether the persistence or replacement of a single clone of C. albicans in multiple anatomical sites of the organism may represent an additional risk for candidaemia acquisition. Therefore, we prospectively evaluated the dynamics of the colonising strains of C. albicans for two groups of seven critically ill patients: group I included patients colonised by C. albicans in multiple sites who did not develop candidaemia and group II included patients who were colonised and who developed candidaemia. ABC and microsatellite genotyping of 51 strains of C. albicans revealed that patients who did not develop candidaemia were multiply colonised by at least two ABC genotypes of C. albicans, whereas candidaemic patients had highly related microsatellites and the same ABC genotype in colonising and bloodstream isolates that were probably present in different body sites before the onset of candidaemia.

2571 downloads Cited 2 times in SciELO

13.

Epidemiology of fungal infections in liver transplant recipients: a six-year study of a large Brazilian liver transplantation centre
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Zicker, Michelle Colombo, Arnaldo Lopes Ferraz-Neto, Ben-Hur Camargo, Luis Fernando Aranha

Memórias do Instituto Oswaldo Cruz

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may 2011, Volume 106 N. 3 Pages 339 - 345

Abstract: En | Text: En | PDF: En

Liver transplant seems to be an effective option to prolong survival in patients with end-stage liver disease, although it still can be followed by serious complications. Invasive fungal infections (ifi) are related to high rates of morbidity and mortality. The epidemiology of fungal infections in Brazilian liver transplant recipients is unknown. The aim of this observational and retrospective study was to determine the incidence and epidemiology of fungal infections in all patients who underwent liver transplantation at Albert Einstein Israeli Hospital between 2002-2007. A total of 596 liver transplants were performed in 540 patients. Overall, 77 fungal infections occurred in 68 (13%) patients. Among the 77 fungal infections, there were 40 IFI that occurred in 37 patients (7%). Candida and Aspergillus species were the most common etiologic agents. Candida species accounted for 82% of all fungal infections and for 67% of all IFI, while Aspergillus species accounted for 9% of all fungal infections and for 17% of all IFI. Non-albicans Candida species were the predominant Candida isolates. Invasive aspergillosis tended to occur earlier in the post-transplant period. These findings can contribute to improve antifungal prophylaxis and therapy practices in Brazilian centres.

3875 downloads

14.

Candidemia em hospital terciário do nordeste do Brasil
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Hinrichsen, Sylvia Lemos Falcão, Érika Vilella, Tatiana Aguiar Santos Colombo, Arnaldo Lopes Nucci, Márcio Moura, Líbia Rêgo, Leandro Lira, Conceição Almeida, Luciano

Revista da Sociedade Brasileira de Medicina Tropical

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aug 2008, Volume 41 N. 4 Pages 394 - 398

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

Realizou-se um estudo observacional, prospectivo, de base laboratorial, para investigar a incidência de candidemia, distribuição de espécies e condições clínicas entre setembro 2003 e março 2004, em um hospital privado terciário em Recife, Nordeste do Brasil. Um caso de candidemia foi definido como isolamento de Candida spp de hemocultura. A taxa de incidência foi calculada por 1.000 admissões. Um total de 5.532 pacientes foram admitidos no hospital durante o período de estudo, e 1.745 culturas de sangue foram processadas. Foram observados 21 episódios de candidemia em 18 pacientes. A taxa de incidência de candidemia foi de 3,9 episódios por 1.000 admissões. Espécies não-albicans representaram mais de 50% dos casos, predominando Candida parapsilosis (33%) e Candida tropicalis (24%). Onze (61%) pacientes morreram. A incidência de candidemia foi mais alta que aquela observada em estudo multicêntrico brasileiro. Candidemia foi predominantemente causada por espécies não-albicans.

We conducted a prospective, observational, laboratory-based study on candidemia to investigate the incidence of candidemia, species distribution and clinical conditions between September 2003 and March 2004 in a private tertiary hospital in Recife, northeastern Brazil. Cases of candidemia were defined as occurrences of isolation of Candida spp from blood cultures. The incidence rate was calculated per 1,000 admissions. A total of 5,532 patients were admitted to the hospital during the study period, and 1,745 blood cultures were processed. Twenty-one episodes of candidemia were observed in 18 patients. The incidence rate of candidemia was 3.9 episodes per 1,000 admissions. Non-albicans species accounted for more than 50% of the cases, and Candida parapsilosis (33%) and Candida tropicalis (24%) predominated. Eleven (61%) patients died. The incidence of candidemia was higher than that observed in a Brazilian multicenter study. Candidemia was caused predominantly by non-albicans species.

6648 downloads Cited 3 times in SciELO

15.

Paracoccidioidomycosis: advances and unmet needs 100 years after its initial description by Lutz
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Colombo, Arnaldo Lopes

Journal of Venomous Animals and Toxins including Tropical Diseases

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2008, Volume 14 N. 3 Pages 387 - 392

Abstract: En | Text: En | PDF: En

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