Revista Do Instituto De Medicina Tropical De Sao Paulo最新文献

{"title":"The potential of essential oils as mosquito (Diptera: Culicidae) bio-repellents: a systematic review.","authors":"Adeilson Pimentel Rabelo, Rodrigo Alves Soares Cruz, Everson Dos Santos David, Erique da Costa Fonseca, Karen Carmo Dos Santos, Raimundo Nonato Picanço Souto","doi":"10.1590/S1678-9946202668039","DOIUrl":"10.1590/S1678-9946202668039","url":null,"abstract":"<p><p>Controlling culicid-borne diseases remains a global public health challenge. While public health actions are vital, individual protection via repellents is essential. Concerns regarding synthetic compounds such as DEET have intensified the search for sustainable plant-derived alternatives. This systematic review analyzed 33 experimental studies that were published from 2020 to 2024. A comprehensive search was performed on SciELO, PubMed, Scopus, Web of Science, ScienceDirect, and LILACS using the keywords \"Repellency,\" \"Essential Oils,\" and \"Mosquitoes.\" Data were independently selected and extracted to evaluate protection time and repellency percentages. The included studies showed low risk of methodological bias according to SYRCLE. Results showed that most of the tested essential oils possess high protective potential. Species such as Perilla frutescens, Leucas stachydiformis, Cymbopogon nardus, and Eucalyptus camaldulensis achieved up to 100% repellency, with protection exceeding eight hours. The cage test was the predominant laboratory method. Essential oils are promising, effective alternatives to synthetic repellents, offering reduced environmental and toxicological impacts. However, this evidence is based on controlled laboratory conditions rather than field trials. This limitation may affect real-world effectiveness, and further research in natural environments is recommended to validate these results for commercial application.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"68 ","pages":"e39"},"PeriodicalIF":1.3,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-treatment paradoxical reaction in tuberculous flexor tenosynovitis with rice bodies after a cat bite.","authors":"Zehra Çağla Karakoç, Sait Ada, Önder Pekel, Arzu Avcı, Kubilay Erol, Mahir Kapmaz, Ali Mert","doi":"10.1590/S1678-9946202668042","DOIUrl":"10.1590/S1678-9946202668042","url":null,"abstract":"<p><p>Tuberculous tenosynovitis is a rare form of extrapulmonary tuberculosis characterized by an indolent course and nonspecific clinical findings, frequently leading to delayed diagnosis. Paradoxical inflammatory reactions during or after anti-tuberculosis therapy may further complicate clinical management and mimic disease relapse. This is a case study regarding a 54-year-old female veterinarian presented with a four-year history of progressive swelling and induration of the right index finger extending to the palm, accompanied by gradually worsening limitation of finger flexion and hand grasp. Magnetic resonance imaging demonstrated extensive flexor tenosynovitis with synovial proliferation. Tenosynovectomy revealed multiple rice bodies surrounding the flexor tendon. Histopathology showed well-formed granulomas without central necrosis, accompanied by focal stromal coagulative necrosis, while microbiological tests were negative. Tuberculous tenosynovitis was diagnosed based on clinical, radiological, and histopathological findings, and anti-tuberculosis therapy was initiated. The patient showed gradual clinical improvement over the nine-month course of treatment. However, one month after therapy completion, recurrent finger swelling with axillary and new epitrochlear lymphadenopathy developed. In the absence of evidence of relapse, a post-treatment paradoxical inflammatory reaction was suspected. Corticosteroid therapy resulted in rapid clinical improvement. This case highlights the diagnostic challenges of tuberculous tenosynovitis, particularly in patients with delayed presentation and negative microbiological findings, and underscores that paradoxical inflammatory reactions may occur even after completion of anti-tuberculosis therapy, potentially mimicking disease relapse.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"68 ","pages":"e42"},"PeriodicalIF":1.3,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Between insects and birds: molecular evidence of Bartonella henselae DNA in Rhodnius prolixus (Stål, 1859) from an insectary and Cairina moschata (Linnaeus, 1758) ducks used as triatomine blood meal source.","authors":"Luciene Silva Dos Santos, Paulo Eduardo Neves Ferreira Velho, Jader de Oliveira, João Aristeu da Rosa, Osvaldo Campos Dos Santos Nonato, Francine Ramos Scheffer, Marina Rovani Drummond","doi":"10.1590/S1678-9946202668036","DOIUrl":"10.1590/S1678-9946202668036","url":null,"abstract":"<p><p>Bartonella henselae is the primary human pathogen species of this Gram-negative bacterial genus, associated with several clinical manifestations including cat scratch disease, bacillary angiomatosis, endocarditis, and myocarditis. This pathogen was recently detected in Triatoma sordida, a vector of Chagas disease in Brazil. Here, we investigated the presence of B. henselae DNA in Rhodnius prolixus, another triatomine vector of Trypanosoma cruzi maintained in an insectary and in ducks (Cairina moschata) used as a blood source for their colony. A total of 84 triatomines and blood samples from 10 ducks were analyzed by nested PCR targeting the ftsZ gene of B. henselae. Bacterial DNA was detected in four (4.76%) triatomines and in nine (90%) ducks. Sequencing of amplicons from three triatomines and two ducks revealed 100% identity, full query coverage, and highly significant E-values, indicating complete sequence identity to Bartonella henselae strain Houston-1. To the best of the authors' knowledge, this study provides novel evidence of B. henselae DNA in R. prolixus and C. moschata. However, the vector competence of triatomines for transmitting this bacterium to humans and/or ducks remains unclear.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"68 ","pages":"e36"},"PeriodicalIF":1.3,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strain-dependent duodenal structural alterations in hamsters infected with Leishmania (Viannia) braziliensis.","authors":"Maria Gabriela Lima da Silva-Zussa, Amanda Gubert Alves Dos Santos, Thaís Gomes Verzignassi Silveira, Andrea Claudia Bekner Silva Fernandes, Lainy Leiny de Lima, Roberto Keiji Nakamura Cuman, Débora de Mello Gonçales Sant'Ana, Gessilda de Alcantara Nogueira-Melo","doi":"10.1590/S1678-9946202668038","DOIUrl":"10.1590/S1678-9946202668038","url":null,"abstract":"<p><p>Leishmania (Viannia) braziliensis (LVB), the main etiological agent of cutaneous and mucocutaneous leishmaniasis, may cause atypical manifestations in immunosuppressed hosts, affecting organs beyond the skin, including the intestine. This study investigated whether the duodenum is involved during experimental LVB infection in hamsters. Overall, 48 female golden hamsters were divided into a control and infected group with five LVB strains. They were euthanized after 90 or 120 days of infection. Duodenal samples were subjected to histological and morphometric analyses, including evaluation of the duodenal wall, villi dimensions, intraepithelial lymphocytes, goblet cells, mast cells, collagen fiber composition (types I and III), and myenteric ganglia. Biochemical assays were performed to assess myeloperoxidase activity and nitrite levels. LVB infection reduced Alcian Blue pH 1.0-positive goblet cells and myenteric ganglia area at 90 days and increased type III collagen fibers at 120 days. Infected animals showed increased villus width at 90 days and greater villus height at 120 days. Overall, LVB infection induces significant and time-dependent alterations in the duodenal histoarchitecture, including epithelial, neuronal, and extracellular matrix changes, indicating that the duodenum undergoes dynamic structural remodeling during the infection.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"68 ","pages":"e38"},"PeriodicalIF":1.3,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infective endocarditis in the real world: Diagnostic challenges and predictors of in-hospital mortality in a 10-year retrospective cohort from a Brazilian tertiary center.","authors":"Raquel Couto E Silva, Danilo Bortolotto Gurian, Guilherme Barbosa Pinto, Murilo Freua Sequeira, Erika Yukie Ishigaki, Eloisa Basile Siqueira Ayub, Nicoly Caroline de Andrade Delmondes, Gabriel Fialkovitz, Rinaldo Focaccia Siciliano, Olavo Henrique Munhoz Leite, Marcello Mihailenko Chaves Magri","doi":"10.1590/S1678-9946202668037","DOIUrl":"10.1590/S1678-9946202668037","url":null,"abstract":"<p><p>Infective endocarditis (IE) remains a life-threatening condition with high mortality, particularly in middle-income countries where access to advanced diagnostics and timely surgery is unequal. Real-world data from such settings remain limited. This study describes the clinical and microbiological characteristics of patients with suspected IE and identifies independent predictors of in-hospital mortality at a Brazilian tertiary referral center. We conducted a retrospective cohort including adults hospitalized with suspected IE between 2012 and 2022. Cases were classified according to modified Duke criteria. Demographic, clinical, laboratory, microbiological, and echocardiographic data were collected, and independent predictors of in-hospital mortality were identified using multivariable logistic regression. Of the 112 patients evaluated, 66 met the criteria for definite or possible IE. Median age was 55 years, 59.1% were male, and 34.8% were ≥60 years. Structural heart disease was present in 87.8%, predominantly involving the mitral valve. Blood cultures were positive in 57.1%, with Staphylococcus aureus as the leading pathogen (25%), whereas 42.9% were culture-negative. Echocardiographic evidence of IE was documented in 80.9%, and valve surgery was performed in 51.5%. In-hospital mortality was 36.6%. Independent predictors of death included age ≥60 years (OR 7.0), hypertension (OR 3.9), new valvular regurgitation (OR 6.3), thrombocytopenia ≤150×10³/mm³ (OR 3.5), total bilirubin ≥1.2 mg/dL (OR 15.4), and arterial lactate >1.6 mmol/L (OR 5.2). In this real-world cohort, IE was characterized by diagnostic limitations, a high proportion of culture-negative cases, and high in-hospital mortality. Readily available clinical and laboratory parameters showed prognostic value and may support early risk stratification in resource-limited settings.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"68 ","pages":"e37"},"PeriodicalIF":1.3,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The diagnostic value of fine-needle aspiration cytology in the early diagnosis of pulmonary cryptococcosis.","authors":"Dongxia Wang, Ning Wang, Jiejing Liu, Chengyan Zhao, Xue Xing","doi":"10.1590/S1678-9946202668033","DOIUrl":"10.1590/S1678-9946202668033","url":null,"abstract":"<p><p>Pulmonary cryptococcosis, an invasive fungal infection caused by Cryptococcus spp., is often misdiagnosed as tuberculosis or lung cancer due to overlapping clinical and radiological features, leading to treatment delays. In this descriptive study, we aim to characterize the diagnostic findings and clinical utility of fine-needle aspiration cytology (FNAC) in a series of patients with pulmonary cryptococcosis, within the context of other available diagnostic modalities. We retrospectively analyzed 10 patients with pulmonary cryptococcosis who underwent imaging-guided percutaneous lung aspiration. Wright-Giemsa-stained cytology smears were examined under oil immersion, enabling clear visualization of the characteristic morphological features of Cryptococcus. In this case series, FNAC provided a rapid cytological diagnosis within two hours in all 10 cases, consistent with the results obtained by metagenomic next-generation sequencing (mNGS) and serological testing. In contrast, conventional smear microscopy showed lower detection rates, and histopathology required longer processing times. The use of FNAC facilitated early diagnosis, enabling timely initiation of antifungal therapy and helping to avoid unnecessary surgical interventions. Our findings suggest that cytomorphological evaluation by FNAC is a rapid and valuable diagnostic tool in the early clinical management of pulmonary cryptococcosis, effectively complementing existing diagnostic methods.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"68 ","pages":"e33"},"PeriodicalIF":1.3,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13185523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clostridioides difficile infections in seven Brazilian hospitals during the COVID-19 pandemic: hand hygiene and antimicrobial consumption.","authors":"Luiza Arcas Gonçalves, Ivan Lira Dos Santos, Ana Paula Matos Porto, Antônio Brazil Viana Junior, Julia Herkenhoff Carijo, Claudia Dantas de Maio Carillho, Brunno Cesar Batista Cocentino, Luciana Neves Passos, Glaucia Fernanda Varkulja, Thais Guimarães, Silvia Figueiredo Costa","doi":"10.1590/S1678-9946202668031","DOIUrl":"10.1590/S1678-9946202668031","url":null,"abstract":"<p><p>This study aimed to evaluate the incidence density of Clostridioides difficile infections (CDIs), hand hygiene adherence, and antimicrobial consumption across Brazilian hospitals during the COVID-19 pandemic. An ecological study was conducted in seven Brazilian hospitals from June 2018 to December 2019 (pre-pandemic) and from June 2020 to December 2021(pandemic). Data on CDI incidence density, hand hygiene adherence, and antimicrobial consumption were collected. CDI incidence was assessed based on the number of monthly cases and the incidence density rate per 10,000 patient-days. This study involved hospitals from four states and included three public and four private institutions. Statistical analyses were performed using the Mann-Whitney U test in R (p < 0.05). Time series analysis used joinpoint regression to determine monthly percent change, average monthly percent change, and 95% confidence intervals. Although statistically insignificant, an upward trend occurred in CDI incidence (p = 0.081) from the pre-pandemic to the pandemic periods. Consumption of azithromycin (p < 0.01) and levofloxacin (p < 0.01) increased significantly, whereas ceftriaxone use decreased (p = 0.0038). The joinpoint regression analysis of antimicrobial consumption trends during the pandemic showed trend changes for vancomycin and meropenem defined daily dose, with higher consumption during the second wave of COVID-19 in Brazil. Hand hygiene adherence failed to differ significantly but showed a downward trend in 2020 and 2021. The dynamics of the COVID-19 pandemic and changes in protective measures may have influenced CDI incidence and antimicrobial consumption patterns across the study period.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"68 ","pages":"e31"},"PeriodicalIF":1.3,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13185524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular biomarkers associated with ATLL and HAM progression in HTLV-1 infection: a systematic review.","authors":"Theo Leite, Marcos Eduardo Souza Abreu, Alex Ap Rosini Silva, Rubens de Assis Santos Sebastião, Lucas Araujo Romão, Jorge Casseb, Tatiane Assone, Fabio Eudes Leal, Sheila de Oliveira Garcia Mateos","doi":"10.1590/S1678-9946202668030","DOIUrl":"10.1590/S1678-9946202668030","url":null,"abstract":"<p><p>Human T-lymphotropic virus type 1 (HTLV-1) infects approximately five to 10 million individuals worldwide, although only a minority develop severe outcomes such as adult T-cell leukemia/lymphoma (ATLL) or HTLV-1-associated myelopathy (HAM). Proviral load (PVL), while widely used, shows limited sensitivity and specificity, reinforcing the need for complementary biomarkers. Omics-based approaches have emerged as promising tools to improve risk prediction. We conducted a systematic review following PRISMA guidelines, searching PubMed, Web of Science, Virtual Health Library (BVS), and CAPES Periodicals databases for studies published between May 2020 and May 2025. Eligible studies included original observational designs investigating genomic, proteomic, and metabolic biomarkers associated with progression to ATLL or HAM. Methodological quality was assessed using tools from the National Heart, Lung, and Blood Institute (NHLBI). In total, 35 studies met the inclusion criteria, most conducted in Brazil, Japan, and Iran. A total of 67 biomarkers were identified: 37 genomic, 27 proteomic, and three metabolic with potential clinical applications in risk stratification, prognosis, and therapeutic monitoring of HTLV-1 infection. PVL remained the most frequently investigated marker but lacked predictive power in isolation. Additional candidates with strong potential included IFN-γ, CXCL10, Neopterin, AnxA1, and sTNFR2. This review highlights the potential of integrated multiparametric panels-combining PVL with omics-derived biomarkers-as a promising strategy to improve risk stratification, prognosis, and therapeutic monitoring in people living with HTLV-1 (PLHTLV-1). However, further longitudinal and clinically validated studies are needed to confirm their applicability and support their translation into early intervention strategies, particularly during the asymptomatic phase.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"68 ","pages":"e30"},"PeriodicalIF":1.3,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13185522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of brucellosis in pregnant women: a systematic review and analysis of current gaps and future perspectives.","authors":"Endi Lanza Galvão, Diêgo Mendes Xavier, Glaciele Maria de Souza, Gláucia Cota, Sarah Nascimento Silva","doi":"10.1590/S1678-9946202668032","DOIUrl":"10.1590/S1678-9946202668032","url":null,"abstract":"<p><p>Human brucellosis is a globally prevalent bacterial disease with significant implications during pregnancy due to obstetric complications. Despite the importance of early diagnosis and treatment, the lack of therapeutic consensus and robust evidence underscores the need for systematic evaluation to guide clinical practice. This study systematically reviewed the literature to identify and summarize available drug therapy options for brucellosis in pregnant women, focusing on efficacy, safety, and obstetric outcomes. The review followed PRISMA and Cochrane Handbook guidelines. Searches were conducted in MEDLINE, Embase, Cochrane Library, LILACS, and gray literature for references indexed up to September 15, 2025. Eligible studies reported therapeutic interventions in pregnant women with brucellosis. Risk of bias was assessed using the JBI Critical Appraisal tool, and data on participants, interventions, and outcomes were extracted. Of 737 records screened, six studies met the inclusion criteria, comprising retrospective and prospective reports published between 1991 and 2020, totaling 403 pregnant women. Therapeutic regimens varied, with sulfamethoxazole-trimethoprim (SMX-TMP) plus rifampicin being the most frequently used combination. Adverse obstetric outcomes associated with this regimen occurred in 16% (95%CI: 8%-30%) of cases. Overall, abortion occurred in 94 (23.3%) women, 20 preterm births were reported, and 10 newborns had low birth weight. Recurrence was observed in only 3% of cases. Heterogeneity in outcomes and definitions limited comparability. In conclusion, there is no standardized treatment for brucellosis during pregnancy. Adverse obstetric outcomes remain frequent, highlighting the need for controlled studies to establish safe and effective therapeutic protocols.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"68 ","pages":"e32"},"PeriodicalIF":1.3,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13185525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare fungal bloodstream infections in pediatric patients: a case series.","authors":"Nicole Feitosa Ximenes Ferreira, Giovana Fernandes Zorzan, André Ricardo Araújo da Silva","doi":"10.1590/S1678-9946202668034","DOIUrl":"10.1590/S1678-9946202668034","url":null,"abstract":"<p><p>Fungemia caused by rare fungal species has been increasingly recognized in both immunocompromised and immunocompetent children. Our aim is to characterize the clinical and microbiological features of rare fungal bloodstream infections in hospitalized pediatric patients. A retrospective, descriptive study was conducted including all cases of fungemia due to rare yeasts in patients admitted to two tertiary pediatric hospitals between 2021 and 2025. Fungal species identification, anatomical sites of infection, antifungal therapeutic regimens, and clinical outcomes were systematically analyzed. In total, 13 cases of rare fungal bloodstream infections were identified among 13 patients from 2,555 blood cultures obtained during the study period, representing an incidence of 0.5%. The predominant species isolated were Saccharomyces cerevisiae (n=5), Wickerhamomyces anomalus (n=3), Candid orthopsilosis (n=2), Yarrowia lipolytica (n=1), Meyerozyma guilliermondii (n=1), and Trichosporon asahii (n=1). The median age at infection was 31 months (range: 0-178 months), with 92.3% (12/13) of patients presenting underlying medical conditions. The median interval from hospital admission to fungemia onset was 19 days (range: 0-73 days). Amphotericin B deoxycholate was the most frequently employed initial antifungal agent (n=5), followed by liposomal amphotericin B (n=4). Modification of antifungal therapy was required in five cases (38.5%). Microbiological clearance was achieved in all patients on subsequent blood cultures. The 30-day all-cause mortality rate was 15.4% (2/13). We concluded that rare fungal bloodstream infections occurred predominantly in patients with underlying comorbidities and prolonged hospital stays; nevertheless, the majority showed favorable clinical responses with appropriate antifungal therapy and achieved fungal eradication from the bloodstream.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"68 ","pages":"e34"},"PeriodicalIF":1.3,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13183347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}