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Marcio Nucci

Publications and source records attributed to Marcio Nucci.

At least 19 recordsLinked to original sources
PubMed2007

Evidence for a pseudo-outbreak of Candida guilliermondii fungemia in a university hospital in Brazil.

Fungal infections due to Candida species represent an important cause of nosocomial bloodstream infections. We report a large pseudo-outbreak of Candida guilliermondii fungemia that occurred in a university hospital in Brazil. C. guilliermondii was identified in 64 (43%) of the 149 blood samples drawn between June 2003 and July 2004. The samples were from patients in different wards of the hospital but concentrated in pediatric units. None of the patients had clinical signs of fungemia, and observational analysis revealed errors in the collection of blood samples. During the investigation of the pseudo-outbreak, C. guilliermondii was isolated from environmental surfaces and from the skin and nails of members of the nursing team. Through a subtyping analysis it was found that some of the nonpatient isolates were highly related to the patient isolates, and all the patient isolates were highly related. This is consistent with the hypothesis that the pseudo-outbreak was from a limited number of common sources. 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.

Blood↗
PubMed2006

Variations of salivary flow rates in Brazilian school children.

The salivary flow rate (SFR) in healthy individuals may vary according to different factors. There is a scarcity of studies from different geographical areas that analyze SFR variations in children. The aim of this study was to verify stimulated salivary flow rate (SFR) variations in 6 to 12-year-old children, from four different public schools of Rio de Janeiro and correlate these data to gender, age, type of dentition, and health status. Clinical data were taken from the children's medical records that were kept at those schools. Oral examination and sialometry were performed in every child. Salivary flow rate was obtained by chewing-stimulated whole saliva under standard conditions. There were significant differences in SFR according to age (p = 0.0003). Six and 12-year-old children showed the lowest SFR, and when they were excluded from the analysis, no significant differences were found (p = 0.21). There were also significant differences in SFR among children from different public schools (p = 0.0009). The gender did not show any correlation to SFR, even when children were stratified by age (p = 0.36). 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.

Age Distribution↗
PubMed2006

Emerging fungi.

The hyalohyphomycetes (especially Fusarium spp) have emerged as significant pathogens in severely immunocompromised patients. Human infections by Fusarium spp can be superficial or limited to single organs in otherwise healthy patients. Such infections are rare and tend to respond well to therapy. By contrast, disseminated fusarial hyalohyphomycosis affects the immunocompromised host and frequently is fatal. Successful outcome is determined by the degree of immunosuppression and the extent of the infection. These infections may be suspected clinically on the basis of a constellation of clinical and laboratory findings, which should lead to prompt therapy.

Communicable Diseases, Emerging↗
PubMed2006

Clinical and microbiological aspects of candidemia due to Candida parapsilosis in Brazilian tertiary care hospitals.

In order to characterize the epidemiology, microbiology and outcome of candidemia due to Candida parapsilosis, we examined a database of 282 episodes of candidemia prospectively collected from four tertiary care hospitals in São Paulo, Brazil between March 2002 and February 2003, and compared the characteristics of patients with candidemia due to C. parapsilosis (n=64) with those caused by Candida albicans (n=107). C. parapsilosis candidemia was associated with neutropenia (p=0.005), tunneled central venous catheter (p=0.005) and cancer chemotherapy (p=0.03). By multivariate analysis, candidemia due to C. parapsilosis was associated with the presence of a tunneled central venous catheter (relative risk 3.71, 95% confidence interval 1.28-10.70). Except for a single isolate of C. parapsilosis that exhibited MIC >1 microg/ml to amphotericin B, no resistance was observed in 166 isolates tested against fluconazole, itraconazole, 5-flucytosine and amphotericin B. The caspofungin MIC values of C. parapsilosis isolates were significantly higher than those exhibited by C. albicans isolates (p<0.001). The overall mortality of patients with candidemia due to C. parapsilosis was significantly lower (45% vs. 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.

Adolescent↗
PubMed2006

Epidemiology of candidemia in Brazil: a nationwide sentinel surveillance of candidemia in eleven medical centers.

Candidemia studies have documented geographic differences in rates and epidemiology, underscoring the need for surveillance to monitor trends. We conducted prospective candidemia surveillance in Brazil to assess the incidence, species distribution, frequency of antifungal resistance, and risk factors for fluconazole-resistant Candida species. Prospective laboratory-based surveillance was conducted from March 2003 to December 2004 in 11 medical centers located in 9 major Brazilian cities. A case of candidemia was defined as the isolation of Candida spp. from a blood culture. Incidence rates were calculated per 1,000 admissions and 1,000 patient-days. Antifungal susceptibility tests were performed by using the broth microdilution assay, according to the Clinical and Laboratory Standards Institute guidelines. We detected 712 cases, for an overall incidence of 2.49 cases per 1,000 admissions and 0.37 cases per 1,000 patient-days. The 30-day crude mortality was 54%. C. albicans was the most common species (40.9%), followed by C. tropicalis (20.9%) and C. parapsilosis (20.5%). Overall, decreased susceptibility to fluconazole occurred in 33 (5%) of incident isolates, 6 (1%) of which were resistant. There was a linear correlation between fluconazole and voriconazole MICs (r = 0.54 and P < 0.001 [Spearman's rho]). This is the largest multicenter candidemia study conducted in Latin America and shows the substantial morbidity and mortality of candidemia in Brazil. Antifungal resistance was rare, but correlation between fluconazole and voriconazole MICs suggests cross-resistance may occur.

Adolescent↗
PubMed2005

A non-randomized comparative study using different doses of acyclovir to prevent herpes simplex reactivation in patients submitted to autologous stem cell transplantation.

The reactivation of Herpes Simplex virus (HSV) occurs in 70% to 80% of patients submitted to autologous stem cell transplantation (ASCT); it increases the severity of chemotherapy-induced mucositis. Therefore, the use of acyclovir in ASCT patients is considered standard practice. However, the minimum dose needed to prevent reactivation is a matter of debate. We compared two doses of acyclovir in a non-randomized fashion in 59 patients submitted to ASCT: 32 patients received a dose of 125 mg/m(2) IV every six hours and the subsequent 27 patients received a dose of 60 mg/m(2) IV every six hours. Viral excretion was evaluated through weekly viral culture of oral swabs. Grade 4 mucositis was more frequent in Group 1 (p= 0.03). The reactivation rates in Groups 1 and 2 were 9% and 4%, respectively (p= 0.62, 95% confidence interval -7 - 18). 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.

Acyclovir↗
PubMed2005

Emerging fungal diseases.

The epidemiology of invasive fungal infection is evolving. Yeasts other than Candida albicans and molds other than Aspergillus fumigatus have emerged as significant causes of invasive mycoses in severely immunocompromised patients. Although, in some instances, these changes may be related to medical interventions, such as the use of antifungal agents in prophylaxis, in the majority of cases, they seem to be a consequence of changes in the host, such as more-severe immunosuppression or different types of immunosuppression impacting both risk periods and the infections that occur. These factors have altered the epidemiology of infection in organ transplant recipients, premature newborns, and critically ill patients. This review discusses the epidemiology of some fungal infections that have emerged in the past few years, with an emphasis on the potential factors associated with their emergence and on practical implications of these epidemiological changes.

Communicable Diseases, Emerging↗
PubMed2005

Risk factors for acquisition of multidrug-resistant Pseudomonas aeruginosa producing SPM metallo-beta-lactamase.

To evaluate risk factors for colonization or infection due to multidrug-resistant Pseudomonas aeruginosa (MDRPa) carrying the bla(SPM) gene (SPM-MRDPa) among hospitalized patients, we undertook a case control study at a 480-bed, tertiary-care university hospital. Two different case definitions were used. In the first definition, a case patient (SPM case patient) was defined as a patient who had at least one isolate of SPM-MDRPa (14 patients). In the second, a case patient (non-SPM case patient) was defined as a patient who had at least one isolate of non-SPM-MDRPa (18 patients). For each case patient, we selected two controls, defined as a patient colonized and/or infected by a non-MDRPa isolate during the same study period and with the closest duration of hospitalization until the isolation of P. aeruginosa as cases. The use of quinolones was the single independent predictor of colonization and/or infection by bla(SPM) MDRPa (odds ratio [OR] = 14.70, 95% confidence interval [95% CI] = 1.70 to 127.34, P = 0.01), whereas the use of cefepime was the single predictor of colonization and/or infection by non-bla(SPM) MDRPa (OR = 8.50, 95% CI = 1.51 to 47.96, P = 0.01). The main risk factor for MDRPa was a history of antibiotics usage. Stratification of risk factor analysis by a precise mechanism of resistance led us to identify a specific antibiotic, a quinolone, as a predictor for SPM-MDRPa.

Adolescent↗
PubMed2005

Risk factors for and attributable mortality from tuberculosis in patients with hematologic malignances.

BACKGROUND AND OBJECTIVES: Patients with hematologic malignancies are at increased risk of developing tuberculosis because of the T-cell immunodeficiency associated with the disease and/or its treatment. The objective of this study was to evaluate risk factors, clinical findings and the attributable mortality associated with tuberculosis in patients with hhematologic malignancies. DESIGN AND METHODS: We performed a retrospective review of the clinical records of 917 patients observed between 1990 and 2000. A risk classification for tuberculosis (low vs. high risk) was developed based on the underlying disease and previous exposure to agents that deplete T-cell mediated immunity. Patients with and without tuberculosis were compared by univariate and multivariate analyses with regard to demographic and clinical characteristics, underlying diseases and their treatment. The attributable mortality was assessed by matching cases and controls using the independent variables identified as risk factors as the matching parameters, and was estimated by subtracting the crude mortality of the controls from the crude mortality of the cases. RESULTS: We found 24 cases of tuberculosis (2.6%). Risk factors by multivariate analysis were malnutrition (OR 55.66, 95% CI 2.47--1254.82), use of fludarabine (OR 6.08, 95% CI 1.22--30.25), use of corticosteroids (OR 5.32, 95% CI 1.15--24.39) and belonging to the high-risk group (OR 3.73, 95% CI 1.09--12.76). The crude mortality of patients with tuberculosis was 75%, and the attributable mortality was 62.5% (risk ratio 6.0, 95% CI 2.03--17.70). INTERPRETATION AND CONCLUSIONS: The mortality attributable to tuberculosis is high in patients with hematologic malignancies. The identification of risk factors may be useful for evaluating strategies to be applied in high-risk patients.

Adolescent↗
PubMed2004

Fusarium infection in hematopoietic stem cell transplant recipients.

To characterize the epidemiology and prognostic factors of invasive fusariosis in hematopoietic stem cell transplant (HSCT) recipients, the records of HSCT recipients from 9 hospitals (7 in Brazil and 2 in the United States) were retrospectively reviewed. Sixty-one cases were identified: 54 in allogeneic HSCT recipients and 7 in autologous HSCT recipients. The incidence of fusariosis among allogeneic HSCT recipients varied between a range of 4.21-5.0 cases per 1000 in human leukocyte antigen (HLA)--matched related transplant recipients to 20.19 cases per 1000 in HLA-mismatched transplant recipients. The median time period between transplantation and diagnosis of fusariosis was 48 days. Among allogeneic HSCT recipients, a trimodal distribution was observed: a first peak before engraftment, a second peak at a median of 62 days after transplantation, and a third peak >1 year after transplantation. The actuarial survival was 13% (median, 13 days). Persistent neutropenia was the single prognostic factor for death identified by multivariate analysis.

Adolescent↗
PubMed2003

Outcome predictors of 84 patients with hematologic malignancies and Fusarium infection.

BACKGROUND: Invasive infection by Fusarium sp. is associated with high mortality in patients with hematologic cancer. Yet to the authors' knowledge, little is known regarding predictors of adverse outcome. METHODS: The authors conducted a retrospective review of the records of patients with hematologic carcinoma and invasive fusariosis who were treated at one institution in the U.S. and at 11 centers in Brazil. RESULTS: The records of 84 patients were evaluated. Neutropenia was present in 83% and 33 patients had undergone stem cell transplantation. Only 18 patients (21%) were alive 90 days after the diagnosis of fusariosis. Multivariate predictors of poor outcome were persistent neutropenia (hazard ratio [HR] of 5.43; 95% confidence interval [95% CI], 2.64-11.11) and use of corticosteroids (HR of 2.18; 95% CI, 1.98-3.96). The actuarial survival rate of patients without any of these factors was 67% compared with 30% for patients who recovered from neutropenia but were receiving corticosteroids and 4% for patients with persistent neutropenia only. None of the patients with both risk factors survived (P<0.0001). 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.

Adolescent↗
PubMed2003

Emergence of resistant Candida in neutropenic patients.

Problems with resistance to antifungal drugs have emerged due to an increase in the incidence of systemic fungal infections and widespread use of antifungal agents. Accordingly, efforts have been made to develop adequate fungal susceptibility tests. The ideal test should have high intra and inter-laboratory reproducibility, good correlation with the clinical outcome, and should be easy to perform. While no such test has yet been developed, advances have been made. Over the past decade, many reports of fungal resistance have been published, most of them in AIDS patients. 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.

Antifungal Agents↗
PubMed2003

Emerging moulds: Fusarium, Scedosporium and Zygomycetes in transplant recipients.

PURPOSE OF REVIEW: The incidence of non-Aspergillus mould infections in transplant recipients has increased over the past decade. 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. RECENT FINDINGS: Although the reasons for the increased incidence of non-Aspergillus mould infections in transplant recipients are not very clear, changes in transplant procedures, resulting in more severe immunosuppression, seem to play a major role, as suggested by recent epidemiologic data. Infections caused by these fungi have a tendency to be disseminated, and the prognosis is usually poor because the fungi are resistant to most of the available antifungal agents. New drugs, particularly the new azoles, may have a role in the treatment and prophylaxis of these infections, but the available data are still scant. SUMMARY: The understanding of the changing epidemiology of fungal infections and their implications for the prognosis of transplant recipients are important to better evaluate the impact of new transplant procedures.

Fusarium↗
PubMed2002

Cutaneous infection by Fusarium species in healthy and immunocompromised hosts: implications for diagnosis and management.

Infections by Fusarium species frequently involve the skin, either as the primary or the metastatic site. To better understand the pathophysiology of these infections, 43 new patients with fusariosis were evaluated, and the literature was reviewed. A total of 259 patients (232 immunocompromised and 27 immunocompetent) were identified. Skin involvement was present in 70% of patients, particularly in immunocompromised patients (72% vs. 52%; P=.03). In immunocompetent patients, cutaneous infections were characterized by preceding skin breakdown, localized involvement, slow pace of progression, and good response to therapy. In contrast, skin involvement in immunocompromised patients was only occasionally preceded by skin breakdown and typically was presented as rapidly progressive disseminated lesions at various stages of evolution. Metastatic skin lesions were associated with fungemia, neutropenia, and death. 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.

Fusarium↗
PubMed2002

Nosocomial outbreak of Exophiala jeanselmei fungemia associated with contamination of hospital water.

From December 1996 through September 1997, we diagnosed 19 cases of fungemia due to Exophiala jeanselmei. We conducted a matched case-control study in which we cultured specimens of blood products, intravenous solutions, and water from a hospital water system. Isolates from environmental cultures were compared to those recovered from patients by random amplification of polymorphic DNA (RAPD). Multivariate analysis showed that neutropenia, longer duration of hospitalization, and use of corticosteroids were risk factors for infection. Environmental cultures yielded E. jeanselmei from 3 of 85 sources: deionized water from the hospital pharmacy, 1 water tank, and water from a sink in a non-patient care area. Use of deionized pharmacy water to prepare antiseptic solutions was discontinued, and no additional cases of infection occurred. 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.

Adolescent↗