Charaterization of Candida oral colonization in Hematopoietic Stem Cell transplant (HSCT) patientes of the UNICAMP / Caracterização do perfil de colonização oral por Candida spp. em pacientes submetidos a transplante de celulas progenitoras hematopoieticas no Hospital de Clinicas da UNICAMP

AUTOR(ES)
DATA DE PUBLICAÇÃO

2006

RESUMO

Superficial and systemic Candida infections are usually responsible for morbidity and mortality in hematopoietic stem cell transplant (HSCT) recipients. Previous colonization is an important risk factor and seems to be a pre-requisite for infection and the oral cavity may be a reservoir for these microorganisms. The aim of this study was to ana1yze, prospectively, the unstimulated salivary flow rate and the fluconazole prophylactic regimen effects (200mg/day) in the number of Candida colonized patients and in the colonyforming unit (CFU) count of the Candida species identified in the saliva of HSCT recipients. The objective was also performed antifungal susceptibility tests in clinical isolates, determine the electrophoretic karyotype by pulsed-field gel electrophoresis (pFGE) in the Candida albicans isolates and verify the similarity between colonization and infection strains. Thirty-five patients were enrolled, 21 Allogeneic and 14 Autologous HSCT recipients. The median age was 44 years old (range 21-71). Twenty-two (63%) were male and 13 (37%) were female. The salivary flow rate varied in the Allogeneic (p=0,0003) and in the Autologous groups (p=0,009). Candida colonization was found in 57% of the patients. There was a 60% reduction of the number of colonized in patients under prophylactic fluconazole regimen. In this same time, there also was a reduction of the median CFU/ml count followed by an important increase of the sequential samples, reaching values higher than the count found in the initial collection. There was a significant inverse relationship between salivary flow and Candida CFU/rnl count (p=0,005). It was not possible to correlate the CFU/rnl count and oral candidosis. Candida albicans was the most frequent specie identified (63%) followed by Candida parapsilosis. Antifungal resistance was found in 6 clinical isolates of non-albicans species of Candida, 2 Candida parapsilosis,2 Candida guilliermondii, 1 Candida krusei and 1 Candida sp. We found 9 pattems of Candida albicans electrophoretic karyotyping. In 6 patients the initial colonization strain was found during the following study. Four patients (11,4%) developed oral candidosis by Candida albicans in the post engraftment period. AlI patients were initially colonized by the same specie. In 3 of these patients the same colonization strain was identified in the infection period. The major occurrence of oral candidosis in the post engraftment period may be related with inherent host factors. The persistence of the same strain suggests that the fluconazole prophylaxis does not eradicate the colonization strain. The previous colonization appears be a pre-requisite for de infection development

ASSUNTO(S)

saliva cariotipagem antimicoticos saliva antifugal agents karyotyping

ACESSO AO ARTIGO

Documentos Relacionados