Vigilância de colonização por fungos filamentosos em cavidade nasal de pacientes oncológicos pediátricos durante episódios de neutropenia
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Data
1997
Autores
Oliveira, Neuza Maria Cavalcante [UNIFESP]
Orientadores
Colombo, Arnaldo Lopes [UNIFESP]
Tipo
Dissertação de mestrado
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The incidence of fungal infection seems to be on the increase in recent years among cancer patients, especially in leukemia patients. The most common fungi responsible for infection in the neutropenic host are Candida spp, Aspergillus spp and Mucor spp. Other fungi that are being recovered with increasing frequence include Fusarium spp, Pseudallescheria boydii and dematiaceous fungi. Infections of the respiratory tract are among the most common complications in the immunosupressed cancer patient. Fungal sinusitis by Aspergillus spp or less often Mucor spp is potentially devastating because it can quickly extend into the brain or be aspirated into the lungs, resulting in fungal pneumonia. Infections of the lung present special diagnostic problems because the differential diagnosis must include not only fungal organisms but also bacteria, viruses and protozoa. Of the fungal organisms, Aspergillus spp is the major cause of pneumonia in cancer patients. Control of the pneumonia and sinusitis requires an early diagnosis and prompt intervention. Diagnosis of fungal infection generally requires the histopathologic demonstration of the organism invading tissues, as well as a positive culture result. However, it may be dangerous and even contraindicate to biopsy patients with severe trombocytopenia and coagulation factor abnormalities. Cultures of the anterior nares may be helpful in identifying patients at increased risk foi inavsive pulmonary disease due to Aspergillus spp, but such procedures are not universally accepted. Several groups have investigated the use of serologic and fungal antigen detection techniques, but their serologic test may detect circulating antobodies and antigens, but are unreliable because of lack of specicity and the inability of many patients immunocompromised to produce antibody. Their use cannot be recommended routinely at this time. The main objectives of this study were to analyze the incidence of mould nasal colonization, involved genera and the correlation between positive surveillance nasal cultures with sinusitis, pneumonia, amphotericin B use and mortality rate. In was perfomed a cohort prospective study from july/95 to june/96 to analise the incidence of nasal mould coloniaztion among pediatric patients during febril neutropenic episodes. It a included a total of 113 episodes of neutropenic documented in 70 children, 43 males and 27 females. The patient’s age varied from 2 to 18 years old. The incidence of nose colonization by mould as 21%, including the following genera: Aspergillus spp (7), Penicillium spp (5), Cladosporium spp (4), Rhizopus spp (3), Fusarium spp (2), Scopulariopsis spp (2) and Acremonium spp (1). Colonized and non colonized patients exhibited the same demograph e and clinical characterisitcs includings: sex, age, underlying disease, phase of disease, neutropenia duration time, antibiotic use, fever, sinusitis, pneumonia, antimicotic use and death. In the period between july/95 and june/96, nasal cultures from 70 neutropenic pediatric patients were obtained by swabbing the anterior nares.
Despite a significant rate of mould nasal colonization (21%) found in our pediatric oncological patients, colonization episodes was not associated with increased morbidity or mortality.
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OLIVEIRA, Neuza Maria Cavalcante. Vigilância de colonização por fungos filamentosos em cavidade nasal de pacientes oncológicos pediátricos durante episódios de neutropenia. Dissertação (Mestrado em Ciências) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 1997.