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- ItemSomente MetadadadosDoenças fúngicas invasivas em pacientes oncohematológicos e receptores de transplante de células-tronco hematopoéticas: série histórica e aspectos evolutivos(Universidade Federal de São Paulo (UNIFESP), 2021) Bergamasco, Maria Daniela Di Dea [UNIFESP]; Colombo, Arnaldo Lopes [UNIFESP]; Universidade Federal de São PauloObjective: To describe the epidemiology of invasive fungal diseases (IFDs) in hematologic patients and hematopoietic cell transplant (HCT) recipients, managed with fluconazole prophylaxis and an antifungal diagnostic-driven approach for mold infection. Methods: This is a retrospective, single-center cohort study of all consecutive cases of proven or probable IFDs according to the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium (EORTC/MSGERC) diagnosed between 2009 and 2019 (11-year period), in adult hematologic patients and HCT recipients, managed with fluconazole prophylaxis and an antifungal diagnostic-driven approach for mold infection. Cases of possible IFDs and pneumocistosis were excluded from analysis. Results: During the study period, 94 cases of IFDs occurred among 664 hematologic patients and 316 HCT recipients. The frequency of IFDs among patients with allogeneic HCT, autologous HCT, acute leukemia and other hematologic malignancies was 8.9%, 1.6%, 17.3%, and 6.4%, respectively. Aspergillosis was the leading IFD (53.2%), followed by fusariosis (18.1%), candidiasis (10.6%), and cryptococcosis (8.5%).The overall 6-week mortality rate was 37.2%, and varied according to the host and the etiology ofIFD, from 28% in aspergillosis to 52.9% in fusariosis. Although IFDs occurred frequently in our cohort of patients managed with an antifungal diagnostic driven approach, mortality rates were comparable to other studies. In the face of challenges posed by the use of anti-mold prophylaxis, this strategy remains a reasonable alternative.
- ItemAcesso aberto (Open Access)Invasive fungal diseases in haematopoietic cell transplant recipients and in patients with acute myeloid leukaemia or myelodysplasia in Brazil(Wiley-Blackwell, 2013-08-01) Nucci, Marcio; Garnica, M.; Gloria, A. B.; Lehugeur, D. S.; Dias, V. C. H.; Palma, L. C.; Cappellano, P. [UNIFESP]; Fertrin, K. Y.; Carlesse, F. [UNIFESP]; Simoes, B.; Bergamasco, M. D. [UNIFESP]; Cunha, C. A.; Seber, Adriana [UNIFESP]; Ribeiro, M. P. D.; Queiroz-Telles, F.; Lee, Maria Lúcia de Martino [UNIFESP]; Chauffaille, M. L. [UNIFESP]; Silla, L.; Souza, C. A. de; Colombo, Arnaldo Lopes [UNIFESP]; Universidade Federal do Rio de Janeiro (UFRJ); Universidade Federal de Minas Gerais (UFMG); Univ Fed Rio Grande do Sul; Universidade Federal do Paraná (UFPR); Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Universidade Estadual de Campinas (UNICAMP)Invasive fungal disease (IFD) shows distinct regional incidence patterns and epidemiological features depending on the geographic region. We conducted a prospective survey in eight centres in Brazil from May 2007 to July 2009. All haematopoietic cell transplant (HCT) recipients and patients with acute myeloid leukaemia (AML) or myelodysplasia (MDS) were followed from admission until 1year (HCT) or end of consolidation therapy (AML/MDS). the 12-month cumulative incidence (CI) of proven or probable IFD was calculated, and curves were compared using the Grey test. Among 237 AML/MDS patients and 700 HCT recipients (378 allogeneic, 322 autologous), the 1-year CI of IFD in AML/MDS, allogeneic HCT and autologous HCT was 18.7%, 11.3% and 1.9% (p<0.001), respectively. Fusariosis (23 episodes), aspergillosis (20 episodes) and candidiasis (11 episodes) were the most frequent IFD. the 1-year CI of aspergillosis and fusariosis in AML/MDS, allogeneic HCT and autologous HCT were 13.4%, 2.3% and 0% (p<0.001), and 5.2%, 3.8% and 0.6% (p0.01), respectively. the 6-week probability of survival was 53%, and was lower in cases of fusariosis (41%). We observed a high burden of IFD and a high incidence and mortality for fusariosis in this first multicentre epidemiological study of IFD in haematological patients in Brazil.
- ItemSomente MetadadadosA prospective international Aspergillus terreus survey: an EFISG, ISHAM and ECMM joint study(Elsevier Sci Ltd, 2017) Risslegger, B.; Zoran, T.; Lackner, M.; Aigner, M.; Sanchez-Reus, F.; Rezusta, A.; Chowdhary, A.; Taj-Aldeen, S. J.; Arendrup, M. C.; Oliveri, S.; Kontoyiannis, D. P.; Alastruey-Izquierdo, A.; Lagrou, K.; Lo Cascio, G.; Meis, J. F.; Buzina, W.; Farina, C.; Drogari-Apiranthitou, M.; Grancini, A.; Tortorano, A. M.; Willinger, B.; Hamprecht, A.; Johnson, E.; Klingspor, L.; Arsic-Arsenijevic, V.; Cornely, O. A.; Meletiadis, J.; Prammer, W.; Tullio, V.; Vehreschild, J. -J.; Trovato, L.; Lewis, R. E.; Segal, E.; Rath, P. -M.; Hamal, P.; Rodriguez-Iglesias, M.; Roilides, E.; Arikan-Akdagli, S.; Chakrabarti, A.; Colombo, A. L. [UNIFESP]; Fernandez, M. S.; Martin-Gomez, M. T.; Badali, H.; Petrikkos, G.; Klimko, N.; Heimann, S. M.; Houbraken, J.; Uzun, O.; Edlinger, M.; de la Fuente, S.; Lass-Floerl, C.Objectives: A prospective international multicentre surveillance study was conducted to investigate the prevalence and amphotericin B susceptibility of Aspergillus terreus species complex infections. Methods: A total of 370 cases from 21 countries were evaluated. Results: The overall prevalence of A. terreus species complex among the investigated patients with mould-positive cultures was 5.2% (370/7116). Amphotericin B MICs ranged from 0.125 to 32 mg/L, (median 8 mg/L). Conclusions: Aspergillus terreus species complex infections cause a wide spectrum of aspergillosis and the majority of cryptic species display high amphotericin B MICs. (C) 2017 Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases.
- ItemAcesso aberto (Open Access)Surto de aspergilose pulmonar invasiva em enfermaria de transplante de medula óssea: achados tomográficos(Sociedade Brasileira de Pneumologia e Tisiologia, 2009-09-01) Freitas, Daniela Batista de Almeida [UNIFESP]; Piovesan, Ana Cláudia [UNIFESP]; Szarf, Gilberto [UNIFESP]; Jasinowodolinski, Dany [UNIFESP]; Meirelles, Gustavo de Souza Portes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To evaluate the main aspects on CT scans of six patients hospitalized in a bone marrow transplant ward, diagnosed with invasive pulmonary aspergillosis (IPA), during an in-hospital outbreak of the disease. METHODS: We reviewed 10 chest CT scans of six neutropenic or immunocompromised patients hospitalized in the hematology and bone marrow transplant ward of the Hospital São Paulo, in the city of São Paulo, Brazil, who were diagnosed with IPA between April of 2007 and October of 2007. The diagnosis of IPA was confirmed by anatomopathological findings (in 2 cases), culture (in 3 cases) or appropriate treatment response (in 1 case). RESULTS: We evaluated the CT scans of three male and three female patients, ranging from 22 to 58 years of age. The most common tomographic findings were nodules (5/6 cases) and areas of consolidation (2/6 cases). The nodules were more often multiple (3/5 cases), with irregular contours (4/5 cases) and accompanied by the halo sign (3/5 cases). One case presented multiple, centrally distributed areas of consolidation, and another presented an isolated, peripheral area of consolidation. Areas of ground-glass attenuation and septal thickening were found in three and two patients, respectively. Bilateral pleural effusion occurred in three cases. CONCLUSIONS: Consolidation, nodules, septal thickening, pleural effusion and ground-glass opacities were the principal tomographic findings in the six patients hospitalized in the abovementioned ward during the IPA outbreak. The nodules were often (in 67% of the cases) accompanied by the halo sign, a classically described finding in patients with IPA.
- ItemAcesso aberto (Open Access)The water supply system as a potential source of fungal infection in paediatric haematopoietic stem cell units(Biomed Central Ltd, 2013-06-26) Mesquita-Rocha, Sabrina [UNIFESP]; Godoy-Martinez, Patricio C.; Goncalves, Sarah S. [UNIFESP]; Daniel Urrutia, Milton; Carlesse, Fabianne [UNIFESP]; Seber, Adriana [UNIFESP]; Silva, Maria Aparecida Aguiar [UNIFESP]; Petrilli, Antonio Sergio [UNIFESP]; Colombo, Arnaldo Lopes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ Austral Chile; Univ AntofagastaBackground: We conducted a prospective study to investigate the presence of microfungal contamination in the water supply system of the Oncology Paediatric Institute, São Paulo - Brazil after the occurrence of one invasive Fusarium solani infection in a patient after Haematopoietic Stem Cell Transplantation (HSCT). During a twelve-month period, we investigated the water supply system of the HSCT unit by monitoring a total of fourteen different collection sites.Methods: One litre of water was collected in each location, filtered through a 0.45 mu m membrane and cultured on SDA to detect the presence of filamentous fungi. Physicochemical analyses of samples were performed to evaluate the temperature, turbidity, pH, and the concentration of free residual chlorine.Results: Over the 12 months of the study, 164 samples were collected from the water supply system of the HSCT unit, and 139 of the samples tested positive for filamentous fungi (84.8%), generating a total of 2,362 colonies. Cladosporium spp., Penicillium spp., Purpureocillium spp. and Aspergillus spp. were ranked as the most commonly found genera of mould in the collected samples. of note, Fusarium solani complex isolates were obtained from 14 out of the 106 samples that were collected from tap water (mean of 20 CFU/L). There was a positive correlation between the total number of fungal CFU obtained in all cultures and both water turbidity and temperature parameters. Our findings emphasise the need for the establishment of strict measures to limit the exposure of high-risk patients to waterborne fungal propagules.Conclusions: We were able to isolate a wide variety of filamentous fungi from the water of the HSCT unit where several immunocompromised patients are assisted.