Mestrado em Doenças Infecciosas

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Navegando Mestrado em Doenças Infecciosas por Autor "Araujo, Mariceli Lamas"

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    Aspectos epidemiológicos e clínicos da paracoccidioidomicose no Estado do Espírito Santo
    (Universidade Federal do Espírito Santo, 2012-08-31) Peçanha, Paulo Mendes; Falqueto, Aloísio; Araujo, Mariceli Lamas; Miranda, Angelica Espinosa Barbosa; Wanke, Bodo
    In a serie of cases of paracoccidioidomycosis we retrospectively reviewed the records of 546 patients treated at the Hospital Universitario Cassiano Antonio Moraes (HUCAM), Federal University of Espírito Santo - UFES, from 1978 to 2012. The patients ages ranged from 7 to 83 years, with 512 males and 34 females in a ratio of 15:1. Most of the patients( 81,34%) were from the state of Espírito Santo (ES), 18,66% came from other states, mainly from rural areas and 77,6% of them were farmers. The map of geographical distribution in ES showed higher concentration of cases in counties in the western border, along Minas Gerais state.Looking at the clinical features 60 (10.99%) patients presented the acute / subacute form of the disease, 485 (88.83%) the chronic form and one patient the subclinical form. The organs most often affected were the lungs, oropharyngeal mucosa, lymph nodes, skin and larynx. Several other organs were also affected less frequently. The diagnosis was established by histopathology in 252 (46.15%), direct examination in 168 (30.77%), direct examination and histopathology in 111 (20.33%) and serology in 15 (2.75%) patients. The infectious diseases more frequently associated were tuberculosis, AIDS, leishmaniasis and intestinal parasites. Patients were treated with sulfonamides, or azole in mild to moderate forms and amphotericin B in severe forms. The length of the treatment was analysed in 366 patients. Only 146 (40%) completed the minimum of 18 months needed when taking sulphonamides. The most common sequelae were residual pulmonary lesions and scars on skin and mucous membranes. The number of cases in this serie highlights the state of Espírito Santo as important endemic area of paracoccidioidomycosis in Brazil and the results follow the clinical and epidemiological patterns demonstrated in other series.
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    Diagnóstico sorológico da paracoccidioidomicose : comparação entre os testes de Imunodifusão Dupla (IDD) e Ensaio Imunoenzimático (ELISA)
    (Universidade Federal do Espírito Santo, 2012-03-30) Pereira, Aline Lyra; Velloso, Tânia Regina Grão; Araujo, Mariceli Lamas; Falqueto, Aloísio; Malaquias, Luiz Cosme Cotta
    Paracoccidioidomycosis (PCM) is a systemic mycosis caused by the dimorphic fungus Paracoccidioides brasiliensis. It is among the most common fungal infections in Latin America, with Brazil being the country of highest endemicity, mainly in the Southeast part. The diagnosis considered by many authors as gold standard for the PCM is the finding of suggestive yeast cells of Paracoccidioides brasiliensis in the Direct Microscopic Examination of sputum or other clinical specimens, such as scraping the lesion, lymph node aspirate, biopsy, etc. The serological tests are of great importance, since they complement or replace the mycological examination in the diagnosis / prognosis of the disease. The aim of this study was to compare two serological tests for PCM: a double immunodiffusion (IDD) and Enzyme-Linked Immunoabsorbent Assay (ELISA). The methodology was established by comparing antibody titers obtained from three groups of patients: 145 serum samples from 83 patients with PCM (Group I), 49 healthy blood donors (Group II) and 13 patients with IDD positive for other pulmonary mycoses: 11 with histoplasmosis and 2 with aspergillosis (Group III). Our results showed that eight (9.6%) and 5 (6.0%) of patients with PCM were false negative to the IDD and ELISA tests, respectively. In the group of healthy patients, no cases of false positive in IDD were observed; however, 5 (10.2%) of samples were positive with low titers in ELISA. Among the 13 patients with other mycoses, the ELISA showed that 10 (77.0%) were positive while the IDD tests did not show any case of cross-reaction. The sensitivity of the ELISA (93.9%) was slightly higher than the IDD (90.3%). The specificity of the ELISA calculated basing on the healthy control and patients with other mycoses was 89.7% and 23.1%, respectively. IDD showed 100% of specificity for both cases. The positive predictive and negative predictive values were 100% and 83.8% for IDD and 88.5% and 90.3% for ELISA, respectively. The accuracy of the tests was also calculated: the IDD was 94.4% while ELISA was 86.2%.
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    Frequência de dermatoses infecciosas e perfil etiológico das micoses cutâneas em pacientes infectados pelo HIV atendidos em hospital de Vitória-ES
    (Universidade Federal do Espírito Santo, 2013-08-12) Brezinscki, Marisa Simon; Araujo, Mariceli Lamas; Pinto Neto, Lauro Ferreira da Silva; Falqueto, Aloísio
    Introduction: Skin infectious diseases of fungal, bacterial and viral etiology are frequent in HIV-infected patients. HIV infection may change the epidemiology of infectious diseases, leading to atypical manifestations Objectives: 1 Determine the etiologic agents and the more frequent clinical forms of mycoses in HIV infected patients. 2 - Correlate the occurrence of mycoses with CD4 s levels and viral load. 3-Evaluate the frequency of bacterial and viral skin diseases. Methods: A descriptive cross sectional study, which evaluated 86 patients with HIV infection. Sociodemographic and laboratory data collection, dermatological examination were performed and when necessary, scraping the lesion for direct microscopy and fungal culture, if necessary. Results: The mean age was 44.02 (± 12.17) years, 66.3% were men, and the gender ratio 1.97 men: 1 woman. The average time of diagnosis of HIV infection o was 5.59 years. Injuries caused by fungi, bacteria or viruses in keratinized tissues were observed in 58,14% of the patients (39.53% fungal, 18.6% bacterial and 10.46% viral). Onychomycosis was the most common mycoses, and Candida spp. the most frequent agent in these cases. Trichophyton rubrum was the most frequently isolated agent in the whole sample. Patients with CD4 levels less than 50 cells / uL and viral load greater than 50,000 copies / mL had more mycoses. Viral wart was the most frequent viral skin disease and folliculitis was the most frequent bacterial disease. Conclusions: The etiology of superficial mycoses in HIV patients did not differ from those found in the population immunocompetent. However, in some cases, fungal infections manifested in subtle form, with little inflammatory reaction or with more severe and extensive clinical aspects than those usually observed. The higher frequency of cutaneous mycosis was observed in patients with more advanced degrees of immunosuppression
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    Ocorrência de infecção nosocomial por Candida spp. no Hospital Universitário Cassiano Antonio de Moraes (HUCAM) e avaliação da anfotericina B e voriconazol na inibição de formação de biofilme pelas espécies isoladas
    (Universidade Federal do Espírito Santo, 2013-08-09) Ribeiro, Aline Dias; Araujo, Mariceli Lamas; Velloso, Tânia Regina Grão; Pereira, Fausto Edmundo Lima
    INTRODUCTION: Bloodstream fungi infections have highlighted mainly by the growing number of cases of candidemia (infections by Candida spp this site). Currently, this fungus figure as one of seven most common pathogens in nosocomial infections, presenting mortality rates gross between 40 and 70%, and attributed of 50%. Biofilm formation is often associated with the persistent Candida spp. infection and it complicates the treatment due to high resistence that fungal cells acquire to antifungal drugs, in these circumstances. OBJECTIVES: Estabilish the candidemias incidence in University Hospital Cassiano Antônio de Moraes (HUCAM), between 1 º of March 2011 to December 30 2012; estabilish prevalence rates of Candida spp. species e test the potential drug activity of amphotericin B and voriconazole in the inhibition of biofilm formation by the species isolated. MATERIALS AND METHODS: Information on the total number of admissions and patient-days in the ICU and NICU s HUCAM were provided by statistics sector and 32 Candida spp. strains obtained from blood, urine and catheter tip were isolated in Laboratory of Clinical Analysis of the hospital. Inhibition of biofilm formation tests were analized using statistical of Wilcoxon, of Signs and of Mann-Whitney. RESULTS: HUCAM s sector with greater incidence of candidemia was the NICU (8.6 / 10,000 patients-day and 14,2 / 1,000 hospitalizations). Candida spp was the fifth most isolated microorganism of BSI, with predominance of non-albicans species (81%), being C. parapsilosis the species most frequent. In NICU, the frequency of candidemia by C. albicans was 67% and the only non-albicans specie isolated was Candida parapsilosis. In the evaluation of biofilm formation inhibition was evidenced that the concentrations of amphotericin B statistically significant were: 128 μg / mL for the species C. albicans studied, C. parapsilosis and C. tropicalis and 64 μg / mL for the species grouped into "others". Voriconazole was able to inhibit biofilm formation only for isolates of the species C. albicans and at the highest concentration tested (64 μg / ml). CONCLUSIONS: The highest incidence of candidemia in HUCAM was found for neonates interned in NICU. The distribution of Candida species ranged according with sectors the hospital, but suffered little alteration in relation to period studied. Overall, amphotericin B was more effective than voriconazole in the inhibition of biofilm formation by Candida species
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    Prevalência das infecções cutâneas fúngicas em transplantados renais atendidos em hospital da Grande Vitória, ES
    (Universidade Federal do Espírito Santo, 2013-08-14) Ferreira, Priscila Ventorim Lisboa; Araujo, Mariceli Lamas; Falqueto, Aloísio; Vasconcellos Filho, Lauro Monteiro
    Introduction: Several cutaneous changes have been reported in renal transplant recipients, most of them due to immunosuppressive effects or side effects of the drugs and can be grouped into viral, bacterial and fungal infections, pre-neoplastic and neoplastic, and iatrogenic. Objectives: 1 - Determine the etiologic agents and clinical forms of mycoses observed in renal transplant recipients studied. 2 - Correlate the occurrence of fungal infection with immunosuppressive regimen and time of transplantation. 3 - Evaluate the frequency of bacterial and viral skin diseases. Materials and Methods: Descriptive cross-sectional study with convenience sampling, which evaluated 82 renal transplant recipients under immunosuppressive medications, treated at a hospital in Vitória (ES) in the years 2011 and 2012. After dermatological examination, skin scrapings were performed by light microscopy and mycological culture. Results: The sample consisted mostly of males and a mean age of 49.2 years. The most frequent regimen was the combination of Prednisone + Tacrolimus + Mycophenolate sodium (46.3%) and it was the most related to dermatomycoses. The frequency of dermatomycoses was 28%, with 19.5% of onychomycosis, 6.1% of pitiryasis versicolor and 2.4% of Tineas. We also found 7.3% of common warts, 2.4% of herpes simplex and the same percentage of 1.22% for molluscum contagiosum, erysipelas and furunculosis. The group of patients with late transplant (between 3 and 5 years) showed the highest frequency of dermatomycoses. Conclusions: The clinical aspects of dermatomycoses was similar but it was more frequent than that observed in the general population. The percentage of cutaneous infections was similar to that of immunocompetent population.
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    Transmissão de cepas de Candida spp entre pacientes HIV positivos e seus contatos domiciliares
    (Universidade Federal do Espírito Santo, 2011-12-13) Antunes, Fabíola Assad; Dietze, Reynaldo; Araujo, Mariceli Lamas; Corbett, Carlos Eduardo Pereira
    Household transmission of Candida spp isolates is a little discussed topic in the medical literature, though transmission in the nosocomial enviroment and between sexual partners is already well stablished. The subjects in our study were divided into the following groups: HIV-positive patients with oral candidiasis (Group 1), HIV-positive patients colonized by isolates of Candida spp in the oral cavity (Group 2) and a control group, comprised of HIVnegative blood donors (Group 3) and their respective household contacts, in a total of 343 subjects. Data were obtained regarding age, sex, previous exposure to azoles, previous history of oral candidiasis, HIV sorology, HIV viral load, CD4 cell count, tabagism, denture use, sexual partner status and other imunossupressive underlying conditions from the subjects; the recovered isolates were phenotipically tested for species differentiation and were submitted to antifungal drugs susceptibility tests. Among the HIV-positive patients, assymptomatic oral Candida spp. carriage rate was 34,3%, and among the HIV-negative subjects the rate was 19,3%; there was no statistical difference between the two groups. Using multivariate analysis, HIV infection was the only risk factor associated with assymptomatic oral Candida spp cariage. Multivariate analysis was also employed to evaluate risk factors associated with oral candidiasis; age was the only identified risk factor. Among the HIV-positive patients, though, CD4 count below 200 was also associated with oral candidiasis; the same did not occur with high HIV viral load. The most prevalent species was Candida albicans (77,98%), and 14,7% of the isolates were azole-resistant or DDS. Most of the resistant isolates belonged to Group 1. The simultaneous isolation of 46 strains of Candida albicans, wich belonged to 22 households, were submitted to RAPD, using the primers M2 and RP-2. The RAPD results did not show any correlations between the same household strains, but showed a relationship between strains obtained from subjects who lived within no geographical proximity, showing that the technique employed had no discriminatory power for genotyping the involved strains.