Marcio Nucci

..Patients with candidemia frequently have a central venous catheter (CVC) in place, and its early removal is considered the standard of care...

..Neither the susceptibility of the isolates nor the presence of a catheter was found to be a risk factor. These data suggest that gastrointestinal colonization plays a major role in the development of breakthrough candidemia...

..Though the frequency of resistant strains is still low in neutropenic cancer patients, and is mostly limited to Candida glabrata and Candida krusei, resistance to Candida albicans has also been reported...

..The actuarial survival was 13% (median, 13 days). Persistent neutropenia was the single prognostic factor for death identified by multivariate analysis...

..RAPD typing showed that isolates from case patients and isolates from the pharmacy water were highly related, whereas the patterns of isolates recovered from the 2 other sources of water were distinct...

..tropicalis and C. albicans candidemia was a higher proportion of neutropenic patients in C. tropicalis candidemia. C. tropicalis is a leading cause of candidemia in Brazil, and its epidemiology is similar to that of C. albicans...

..This paper will review recent data regarding the epidemiology, clinical manifestations, treatment and the outcome of infections caused by Fusarium spp., Scedosporium spp. and the Zygomycetes in transplant recipients...

..In this review, we discuss the differential diagnosis and management of antifungal therapy failure in invasive mycoses, to help clinicians appreciate the meaning of primary antifungal therapy failure...

..E. jeanselmei and Rhinocladiella species are potential causes of nosocomial fungemia and may be associated with systemic infection...

..Species distribution also differs: in Latin America, the most common Candida species (other than Candida albicans) causing bloodstream infections are Candida parapsilosis or Candida tropicalis, rather than Candida glabrata...

..0001). CONCLUSIONS: Measures to reduce the duration of neutropenia, as well as the judicious use of corticosteroids, may reduce the high mortality rate of fusariosis in patients with hematologic cancer...

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..Treatment options include the lipid formulations of amphotericin B, voriconazole, and posaconazole. Prevention of fusarial infection among high-risk patients should be considered...

..Management of infections in MM patients must include recognition of the likely pathogens. Specific strategies of diagnosis, prophylaxis, and empirical and specific therapy are based on host factors and probable pathogens...

..These infections may be suspected clinically on the basis of a constellation of clinical and laboratory findings, which should lead to prompt therapy...

..This article will review recent data regarding the epidemiology and treatment of these infections...

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..We developed an index (D-index) that combines duration and severity of neutropenia. The aim of this study was to test the D-index as a predictor of IMI...

..An emphasis is given to invasive aspergillosis...

..The higher overall survival rate in patients treated every 21 days suggests that this intensified schedule might be more effective. The placement of a Port catheter is recommended, due to the high incidence of phlebitis...

..The use of chlorhexidine mouth rinses dramatically reduced Candida cfu counts, but when patients discontinued treatment, intensity of colonization rose again...

..This study investigates the association between cerebral vein thrombosis (CVT) and the mutations FV 1691A (factor V Leiden), PT 20210A and MTHFR 677TT and acquired factors including oral contraceptive (OC) use...

..19%; P=.04). For patients with profound and prolonged neutropenia, itraconazole capsules at the dosage of 100 mg every 12 h reduce the frequency of systemic fungal infections and the use of empirical amphotericin B...

..If treatment is considered, fluconazole is the drug of choice, provided the agent is not Candida krusei or Candida glabrata...

..Although it is possible that removal of CVCs may reduce the rate of complications due to candidemia, including death, the findings of this literature review do not substantiate this consensus recommendation...

..The results suggest the need for prospective studies addressing the use of iron chelation in the pretransplantation period...

..We hypothesize that giving lower weight to the prespecified radiologic findings in patients with a positive serum galactomannan index test result will improve the definition's diagnostic sensitivity...

..01, respectively. Our data suggest that DAPK and RAR beta hypermethylation are adverse prognostic factors in MM. The relevance of these findings as poor prognosis indicators requires confirmation in a larger sample with longer follow-ups...

..Skin was the single source of diagnosis for the majority of immunocompromised and immunocompetent patients. Recommendations for the prevention of fatal fusariosis originating from skin are presented...

..There was a clear predominance of non-albicans species, regardless of the underlying disease, antifungal prophylaxis or the presence of neutropenia...

..Prophylaxis with reduced doses of intravenous acyclovir seems to be as effective as a higher dose in inhibiting HSV reactivation, with a significant reduction in cost. Prospective randomized studies are needed to confirm our conclusions...

..This study evaluated the relationship between salivary flow and Candida colony counts in the saliva of patients with xerostomia...

..47, 95% CI 2.60-34.40) were associated with infection due to MDR Gram-negative isolates. These findings may have important clinical implications in the decision of giving prophylaxis and selecting the empiric antibiotic regimen...

..host disease in which low-level laser therapy applied to the oral mucosa, in addition to standard systemic immunosuppressive treatment, resulted in quick healing and symptomatic relief...

..To analyze possible risk factors for death among patients with nosocomial candidemia. To identify risk factors for death in patients with candidemia, we analyzed demographic, clinical, and microbiological data...

..9). Amphotericin B diluted in a lipid emulsion seems to be associated with a smaller number of acute adverse events and fewer cases of hypokalemia than amphotericin B diluted in 5% dextrose...

..Forty-five prior episodes of febrile neutropenia were compared to 97 episodes seen after application of the guidelines. Glycopeptide use was reduced from 73% to 43% of episodes (P=.0008), without changes in outcome...

..An immediate change in the antibiotic regimen in such circumstances may improve the prognosis of these patients...

..Oral candidiasis, antibiotic exposure and dental prosthesis wearing were associated with relatively high Candida counts in saliva. Low salivary flow rates predisposed to intense colonization by C. albicans and C. parapsilosis...

..Multivariate analysis identified the use of steroids as the most significant variable associated with infectious episodes. PBSCT was associated with more infections in the post-engraftment period...

..Starting G-CSF on day +1 does not result in faster neutrophil engraftment but in later onset and consequently, slightly shorter duration of neutropenia in patients who receive melphalan 200 mg/m(2) and CD34(+) cell doses >3.0 x 10(6)/kg...

..05%. Patients without these clinical factors should probably not be submitted to a bone marrow biopsy as part of the staging procedures performed in Hodgkin's disease...

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..62%, p=0.03). The association between C. parapsilosis candidemia and a tunneled central venous catheter supports the idea that the main mode of acquisition of C. parapsilosis is from an external source...

..36). Correlation between SFR and deciduous, mixed or permanent dentition was not found as well. These results show that the analyzed clinical variables did not seem to influence SFR in this children population...

..The echinocandins have potent fungicidal activity against most Candida species, but there are few data comparing the safety and efficacy of echinocandins in the treatment of invasive candidiasis...

..Antifungal resistance was rare, but correlation between fluconazole and voriconazole MICs suggests cross-resistance may occur...

..Invasive candidosis is increasingly prevalent in seriously ill patients. Our aim was to compare micafungin with liposomal amphotericin B for the treatment of adult patients with candidaemia or invasive candidosis...

..The adoption of intervention measures was effective in resolving the outbreak, supporting the hypothesis that the outbreak was due to poor techniques of drawing blood samples for culture...