ABSTRACT Objective This study aimed to verify oral candidiasis, identify the causative species, and investigate the antifungal susceptibility of yeasts isolated from liver transplant patients. Methods A descriptive analysis of 97 patients who underwent liver transplantation was conducted at a hospital. Two clinical examinations (Collections A and B) of the oral cavity were performed. Oral material was collected from all patients, inoculated in Sabouraud Dextrose Agar, and incubated at 35℃ for 48 hours. Samples were identified by molecular sequencing of the internal trascribed space region of rDNA. Results An antifungal susceptibility test with fluconazole, amphotericin B, and micafungin was performed using the Clinical and Laboratory Standards Institute yeast broth microdilution method. Among the patients, 15 presented with oral candidiasis: eight in Collection A and seven in Collection B. The primary type of candidiasis was atrophic, followed by pseudomembranous candidiasis. The most prevalent species was Candida albicans (nine), followed by Candida glabrata (three), Candida tropicalis (two), and Candida dubliniensis (one). Regarding susceptibility to fluconazole, of the 15 samples, 11 were susceptible, three were susceptible in a dose-dependent manner, and one was resistant. Conclusion The most commonly identified type of candidiasis was atrophic, with C. albicans and C. glabrata being the most prevalent causative species. One fluconazole-resistant isolate each of C. tropicalis and C. albicans were identified. 9 hospital Collections B Agar 35 4 hours rDNA fluconazole method 1 atrophic nine, nine , (nine) three, (three) two, two (two) one. . (one) samples dosedependent dose dependent manner resistant C fluconazoleresistant 3 (nine (three (two (one

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.

Candidemia permance como a maior causa de morbidade e mortalidade em ambiente hospitalar. A epidemiologia de infecções por Candida vem se alterando, principalmente em relação ao número de episódios causados por espécies não-albicans. Este estudo teve como objetivo avaliar a frequência, em um período de quatro anos, de leveduras do gênero Candida isoladas de sangue de pacientes pediátricos internados em hospital público da cidade de São Paulo, Brasil. Neste período foram isoladas leveduras de sangue de 104 pacientes, e as espécies de Candida identificadas, por métodos fenotípicos e genotípicos, foram: C. albicans (39/104), C. tropicalis (25/104), C. parapsilosis (23/104), Pichia anomala (6/104), C. guilliermondii (5/104), C. krusei (3/104), C. glabrata (2/104) e C. pararugosa (1/104). Em todo período do estudo foi observada maior frequência de isolamento de C. não-albicans (63,55%) (p = 0,0286). Neste estudo verificou-se aumento das espécies não-albicans ao longo dos anos (principalmente em 2009 e 2010), assim, ressalta-se que correta identificação em nível de espécie é recomendável, para que isso acarrete diagnóstico rápido e tratamento eficaz.

Candidemia remains a major cause of morbidity and mortality in the health care environment. The epidemiology of Candida infection is changing, mainly in relation to the number of episodes caused by species C. non-albicans. The overall objective of this study was to evaluate the frequency of yeasts of the genus Candida, in a four-year period, isolated from blood of pediatric patients hospitalized in a public hospital of the city of São Paulo, Brazil. In this period, yeasts from blood of 104 patients were isolated and, the identified species of Candida by phenotypic and genotypic methods were: C. albicans (39/104), C. tropicalis (25/104), C. parapsilosis (23/104), Pichia anomala (6/104), C. guilliermondii (5/104), C. krusei (3/104), C. glabrata (2/104) and C. pararugosa (1/104). During the period of the study, a higher frequency of isolates of C. non-albicans (63.55%) (p = 0.0286) was verified. In this study we verified the increase of the non-albicans species throughout the years (mainly in 2009 and 2010). Thus, considering the peculiarities presented by Candida species, a correct identification of species is recommended to lead to a faster diagnosis and an efficient treatment.

A transição morfológica de levedura para hifa é essencial para a virulência de Candida albicans. Esta transição envolve a expressão de genes hifa-específicos que estão sob o controle de fatores transcricionais. Para descobrir genes hifa-específicos utilizamos um método de triagem diferencial, onde clones de biblioteca de DNA genômico foram hibridizados com sondas de cDNA de levedura e hifa. Dois clones com aumento de expressão em hifa foram selecionados. O sequenciamento dos insertos destes clones permitiu a identificação de dois genes metabólicos importantes: CaHXT7 (high-affinity hexose transporter) e CaYLL34 (da família AAA ATPase). As ORFs completas destes genes foram caracterizadas e a análise das proteínas hipotéticas revelou que: (1) CaHxt7p tem um domínio de transportador de hexose e (2) CaYll34 tem dois domínios AAA ATPase. Este é o primeiro estudo que demonstra aumento de expressão de genes metabólicos em hifas de C. albicans. Ainda, a associação dos produtos de CaHXT7 e CaYLL34 com a formação de hifas torna estas proteínas potenciais novos alvos para drogas antifúngicas.

The ability to switch from yeast to hyphal forms is essential for Candida albicans virulence. This morphological switch involves the expression of hyphal-specific genes under the control of transcriptional factors. To contribute to the discovery of hyphal-specific genes, we used a differential screening method where clones of a genomic DNA library were hybridized with yeast and hyphal cDNA probes. Two clones with increased expression in hyphae were selected for study. Sequencing these clones, we found that they encoded two important metabolic genes, CaHXT7 (high-affinity hexose transporter) and CaYLL34 (member of the AAA ATPase family). CaHXT7 and CaYLL34 ORFs were completely determined. Analyses of the putative proteins show that: (1) CaHxt7p has one hexose transporter domain and (2) CaYll34p has two AAA ATPase domains. These results show, for the first time, increased expression of metabolic genes in C. albicans hyphae. Also, because the proteins encoded by CaHXT7 and CaYLL34 may be necessary for the switching to hyphae, they could be new targets for antifungal drugs.