Browsing by Author "Batista, Judite"
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- COVID-19-Associated Invasive Pulmonary Aspergillosis in the Intensive Care Unit: A Case Series in a Portuguese HospitalPublication . Ranhel, David; Ribeiro, Ana; Batista, Judite; Pessanha, Maria; Cristovam, Elisabete; Duarte, Ana; Dias, Ana; Coelho, Luís; Monteiro, Filipa; Freire, Pedro; Veríssimo, Cristina; Sabino, Raquel; Toscano, CristinaInvasive pulmonary aspergillosis (IPA) has become a recognizable complication in coronavirus disease 2019 (COVID-19) patients admitted to intensive care units (ICUs). Alveolar damage in the context of acute respiratory distress syndrome (ARDS) appears to be the culprit in facilitating fungal invasion in COVID-19 patients, leading to a COVID-19-associated pulmonary aspergillosis (CAPA) phenomenon. From November 2020 to 15 February 2021, 248 COVID-19 patients were admitted to our ICUs, of whom ten patients (4% incidence) were classified as either probable (six) or possible (four) CAPA cases. Seven patients had positive cultural results: Aspergillus fumigatus sensu stricto (five), A. terreus sensu stricto (one), and A. welwitschiae (one). Five patients had positive bronchoalveolar lavage (BAL) and galactomannan (GM), and two patients had both positive cultural and GM criteria. All but two patients received voriconazole. Mortality rate was 30%. Strict interpretation of classic IPA definition would have resulted in eight overlooked CAPA cases. Broader diagnostic criteria are essential in this context, even though differentiation between Aspergillus colonization and invasive disease might be more challenging. Herein, we aim to raise awareness of CAPA in view of its potential detrimental outcome, emphasizing the relevance of a low threshold for screening and early antifungal treatment in ARDS patients.
- Epidemiologia das Infeções Fúngicas Superficiais em Portugal: revisão de 3 anos (2014-2016)Publication . Rato, Margarida; Costin, Adelina; Furtado, Constança; Sousa, Cristina; Toscano, Cristina; Veríssimo, Cristina; Trindade, Felicidade; Tavares Almeida, Filipa; da Cunha Velho, Glória; Catorze, Goreti; Raposo, Inês; Selada, Joana; Ferreira, João A.; Batista, Judite; Santos, Luís; Sereijo, Manuel; Silva, Manuela; Apetato, Margarida; Sanches, Maria; Costa-Silva, Miguel; Filipe, Paulo L.; Santos, Paulo; Fonseca, Pedro D.; Mascarenhas, Rosa; Bajanca, Rui; Lopes, Virgínia; Lewis, Viviana; Duarte, Maria da Luz; Galhardas, Célia; Anes, MargaridaIntrodução: As infeções fúngicas superficiais são as dermatoses infeciosas mais frequentes e a sua incidência continua a aumentar. Os dermatófitos são os principais agentes causais apresentando, contudo, uma distribuição geográfica variável. Material e Métodos: O presente estudo teve como objetivo a caracterização epidemiológica das infeções fúngicas superficiais diagnosticadas nos Serviços/Unidades de Dermatologia pertencentes ao Serviço Nacional de Saúde Português entre janeiro de 2014 e dezembro 2016 através da análise retrospetiva dos resultados das culturas realizadas durante esse período. Resultados: Foram estudados 2375 isolamentos, pertencentes a 2319 doentes. O dermatófito mais frequentemente isolado foi o Trichophyton rubrum (53,6%), tendo sido o principal agente causal da tinha da pele glabra (52,4%) e das onicomicoses (51,1%). Relativamente às tinhas do couro cabeludo, globalmente o Microsporum audouinii foi o agente mais prevalente (42,6%), seguido do Trichophyton soudanense (22,1%). Enquanto na área metropolitana de Lisboa estes dermatófitos foram os principais agentes de tinha do couro cabeludo, nas regiões Norte e Centro o agente mais frequente foi o Microsporum canis (58,5%). Os fungos leveduriformes foram os principais responsáveis pelas onicomicoses das mãos (76,7%). Conclusão: Os resultados deste estudo estão globalmente concordantes com a literatura científica. O Trichophyton rubrum apresenta-se como o dermatófito mais frequentemente isolado em cultura. Na tinha do couro cabeludo, na área metropolitana de Lisboa, as espécies antropofílicas de importação assumem particular destaque.
- Rhino-orbital-cerebral mucormycosis in a diabetic ketoacidotic patient – case reportPublication . Correia, Filipe; Pereira, Sílvia; Toscano, Cristina; Batista, Judite; Sabino, Raquel; Veríssimo, Cristina; Lameiras, Ana Rita; Donato, Mariana; Escada, PedroMucormycosis is a rare but life threatening invasive mycosis caused by members of the Mucorales order. It usually develops in an immunocompromised host, mainly diabetics, but also in hematologic malignancies or transplanted patients. The usual clinical presentation of this fungal sinusitis is a combined rhino-orbital-cerebral infection and, despite the advances in combining antifungal and surgical treatment, it remains a fatal human infection in most cases. Materials and Methods: Case report of a patient presenting with prostration and left eye exophthalmia and cellulitis, as a result of mucormycosis. We highlight the particularities of the surgical endoscopic debridement, microbiology and histologic results. Results: 68 years-old male, with no prior relevant history, presented with a 2-day history of polydipsia, polyuria, prostration, fever and dyspnea. Findings included left eye exophthalmia, chemosis and limitation on ocular movements. Laboratory results were compatible with an inaugural diabetic ketoacidosis and sinus and orbital- CT-scans showed a left side ethmoidalsinusitis, with postseptal cellulitis. Despite the metabolic correction and broad-spectrum antibiotic coverage, the neurologic status didn’t improve and brain scans showed a diffuse hypointense frontobasal area compatible with an ischemic stroke and intracranial extension of the inflammatory process. Urgent endoscopic surgical debridement of the sinus infection was accomplished through an endoscopic total ethmoidectomy, maxillary, sphenoidal and frontal sinusotomy. Intraoperatory findings included a scarce purulent discharge and a diffuse necrotic sinus mucosa. The histologic and microbiologic results were compatible with an invasive sinus mucormycosis: broad non-septate hyphae were observed on direct examination of sinus biopsy. On culture, macro and micro characteristics were compatible with Rhizopus arrhizus and amphotericin B was started in high doses. Identification confirmed by sequencing of genomic DNA fragments proved to be a Rhizopus microsporus. The initial post-operative period was favorable, with improvement on the left eye and sinus inflammatory signs but the neurologic status declined on the 4th day, with a huge hemorrhagic transformation of the frontal necrotic parenchyma ending in a fatal result. We present surgical images and video recording of the endonasal procedure, microbiology and histology pictures. Conclusions: Despite the aggressive therapy, the fatal closure is, unfortunately, a common result of mucormycosis. The angioinvasive feature of Mucormycetes, enhanced by the ketoacidic pro-growth environment, causes a purulent arteritis and thrombosis with resultant ischemia and infarction of tissues. Intracerebral hemorrhage probably resulted from mycotic aneurysms rupture. Early diagnosis, combined treatment and reversal of the immunosuppressive status remain the key points to a successful result.