Professional Documents
Culture Documents
OPORTUNISTAS
DR. JOHNNY A. GORDILLO CARBONEL
HISTOPLAMA
Sinonimia
Enfermedad de Darling
Histoplasmosis americana
Citomicosis
Retculoendoteliosis
HISTOPLASMOSIS
Definicin
DISTRIBUCIN:
Cosmopolita
Climas clidos
Per: Hunuco, San Martn
Rupa Rupa San Martn
cueva de las Lechuzas
Hbitat
T: 22 29 oC,
Humedad: 67 87 % 8.
Verano: mayor produccin
Temporada seca: primoinfecciones,
Fuente de
infeccin
ETIOLOGA
El Histoplasma capsulatum,
fase saproftica
Tambiente, produciendo micelio, macroconidias
tuberculadas y microconidias (elemento infectante).
fase parasitaria
Levadura a T 37 O C, forma Parasitaria, Intracelular,
presenta Halo
Patogenia
Histoplasmosis Diseminada
Diagnstico de Laboratorio
Examen directo
Cultivo
PARACOCCIDIOIDOMICOSIS
Sinonmia:
Blastomicosis sudamericana
Blastomicosis brasilea
Granuloma paracoccidioides
Enfermedad de Lutz-Splendore
Almeida
Epidemiologa
Puerta de entrada:
En un hongo imperfecto
Factores de riego
Cultivos
Biopsia: PA
morfologa
Patterson TF: Advances and challenges in management of invasive mycoses. Lancet 2005;366:1013-1025.
Rodriguez D, Almirante B, Park BJ, et al: Candidemia in neonatal intensive care units, Barcelona, Spain. Pediatr Infect Dis J 2006;25:224-229.
Tipificacin
C. albicans
C. parapsilosis,
C. tropicalis,
C. krusei,
C. lusitaniae,
C. glabrata,
C. dubliniensis
Maxwell MJ, Messer SA, Hollis RJ, et al: Evaluation of E test method for determining fluconazole and voriconazole MICs for 279 clinical isolates
of Candida species infrequently isolated from blood. J Clin Microbiol 2003;41:1087-1090.
Medical Letter: Anidulafungin (eraxis) for candida infections. Med Lett 2006;48:43-44.
Palma-Carlos AG, Palma-Carlos ML: Chronic mucocutaneous candidiasis revisited. Allerg Immunol 2001;33:229-232.
Noyola DE, Fernandez M, Moylett EH: Ophthalmologic, visceral and cardiac involvement in neonates with candidemia. Clin Infect Dis 2001;32: 1018-1023.
Infecciones neonatales
Candidiasis diseminada
Candidiemia
UCIN
Consideraciones neonatales
Kaufman D, Boyle R, Hazen KC, et al: Twice weekly fluconazole prophylaxis for prevention of invasive candida
infection in high-risk infants of <1000 grams birth weight.J Pediatr2005;147:172-179.
Feja KN, Wu F, Roberts K, et al: Risk factors for candidemia in critically ill infants: A matched case-control
study.J Pediatr2005;147:156-161.
Infeccin diseminada:
Riones--------------------------- USG
Tracto gastrointestinal?..
Kullberh BJ, Sobel JD, Ruhnke M, et al: Voriconazole versus a regimen of amphotericin B followed by
fluconazole for candidemia in non-neutropenic patients: A randomized non-inferiority
Candidiasis oral:
del 1 ao de vida
ANTIBIOTICOS
VIH
DIABETES
Manejo:
Clotrimazol crema 1%
Miconazol crema 2%
Anfotericina crema
Saiman L, Ludington E, Dawson JD, et al: Risk factors for Candida species colonization of neonatal intensive
care unit patients.Pediatr Infect Dis J2001;20(12):1119-1124.
Paroniquia
vulvovaginitis
Embarazo/Anticonceptivos/higiene/Antibiticos
Prurito/disuria/eritema/Exudado blanquecino
Infecciones en inmunocomprometidos
35% C. albicans
Walsh TJ, Pappas P, Winston DJ, et al: Voriconazole compared with liposomal amphotericin B for empirical
antifungal therapy in patients with neutropenia and persistent fever.N Engl J Med2002;346:225-234.
VIH
3 formas clnicas:
Centers for Disease Control: Guidelines for prevention and treatment of opportunistic
infections in HIV-infected adults and adolescents. MMWR 2009;March 24 / 58 (Early
Release); 1-198.
Cncer y trasplantes
Neutropenicos
Walsh TJ, Teppler H, Donowitz GR, et al: Caspofungin versus liposomal amphotericin B for empirical antifungal
therapy in patients with persistent fever and neutropenia.N Engl J Med2004;351(14):1391-1402.
Endocrinopatas
Tratamiento
frmaco
espectro
Anfotericina B
5-fluoro
citosina
Fluconazol
Itraconazol
Voriconazol
caspofungina
Candida, Aspergillus
NO: C. neoformans, Fusarium,Zygomycetes
GRACIAS