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Etiologia das infeções fúngicas vaginais na região de Lubango-Huíla e a resistência aos fármacos antifúngicos
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A candidíase vulvovaginal é uma das infecções oportunistas mais comuns do tracto genital feminino. Candida albicans é o agente etiológico mais frequentemente isolado desta infecção, embora seja observado um aumento significativo da prevalência de infecções provocadas por outras espécies do género Candida. Mais recentemente a espécie Candida africana tem sido detectada em amostras biológicas desta origem a qual, vulgarmente, é identificada como sendo C. albicans. Esta pesquisa teve como objectivo principal a detecção e identificação rápida e específica de diferentes espécies de leveduras de interesse médico do género Candida presentes em amostras clínicas de exsudados vaginais e no estudo dos padrões de resistência aos fármacos antifúngicos. Foram estudadas 159 amostras de exsudados vaginais provenientes de doentes que acorreram às consultas de Ginecologia e Obstetrícia da Maternidade Irene Neto, Lubango, Huíla, Angola e somente 98 isolados clínicos foram estudados. O diagnóstico convencional de todos os isolados, permitiu a identificação de C. albicans pelo teste da Blastese. Os isolados clínicos que não filamentaram foram identificados por testes morfológicos, bioquímicos e moleculares. O meio Agar de Eosina e Azul Metileno utilizando a técnica de Dalmau permitiu a identificação a partir das estruturas micromorfológicas das leveduras. A identificação molecular por PCR Multiplex e por RFLP da região ITS do rDNA permitiu a identificação dos isolados de C. albicans que não filamentaram. Para a diferenciação de C. africana em relação aos isolados clínicos C.albicans, foi utilizado um método molecular baseado em PCR. Nesta pesquisa, a partir dos exsudados vaginais recolhidos de pacientes observadas nas consultas da Maternidade Irene Neto, Lubango, Huíla em Angola foram identificadas as espécies C. albicans, C. africana, C. parapsilosis, C. glabrata, C. guilliermondii, C. tropicalis C. lipolytica, C. pelliculosa, Saccharomyces cerevisiae e Trichosporon asahii. Foi estudada a sensibilidade in vitro de todos isolados clínicos aos antifúngicos fluconazol, voriconazol, caspofungina e posaconazol pelo método de Kirby-Bauer de acordo com a norma M44-A do CLSI. A aplicação de métodos moleculares no diagnóstico de candidíase vulvovaginal revelou ser mais sensível e específica, e apresentou resultados mais rigorosos que a convencional, para além de permitir a detecção da nova espécie C. africana. A aplicação da metodologia de difusão a partir de disco a todos os isolados clínicos africanos demonstrou a existência de uma elevada susceptibilidade aos antifúngicos estudados.
Vulvovaginal candidiasis is one of the most common opportunistic infections of the female genital tract. Candida albicans is the etiologic agent predominantly isolated, although a significant increase in the prevalence of infections caused by other species of Candida is observed. More recently, the species C. africana has been detected in biological samples from this origin which, commonly, is identified as C. albicans by conventional methods. The main goal of this research was the specific detection of different yeast species of the genus Candida isolated from vaginal samples from Gynecology and Obstetrics patients of Maternity Irene Neto, Lubango, Huíla, Angola and the study of resistance patterns to antifungal drugs. Were studied 159 samples of vaginal swabs and were isolated 98 clinical isolates for the study.Conventional diagnosis of all isolates included C. albicans identification by Blastesis test. Non filamentous isolates were identified by micro morphology in agar medium with eosin and methylene blue, and biochemical and molecular methodologies. Molecular identification by multiplex PCR and RFLP analysis of the rDNA ITS region allowed the identification of the isolates of most common Candida species. For differentiation between C. africana and C. albicans it was used a molecular method based on PCR. In this research, from the vaginal swabs collected from patients of Maternity Irene Neto, Lubango, Huila in Angola were identified the species C. albicans, C. africana, C. parapsilosis, C. glabrata, C. guilliermondii, C. tropicalis, C. lipolytica, C. pelliculosa, Saccharomyces cerevisiae and Trichosporon asahii. The in vitro studies for the sensitivity study of all clinical isolates to fluconazole, voriconazole, posaconazole, and caspofungin were done by the Kirby-Bauer method according to CLSI standard M44-A. The use of molecular methods for the diagnosis of vulvovaginal candidiasis has proved to be more specific, sensitive, and provided higher accuracy than the conventional techniques. The application of disk diffusion methodology in African clinical isolates showed the existence of a high susceptibility to the antifungal agents tested.
Vulvovaginal candidiasis is one of the most common opportunistic infections of the female genital tract. Candida albicans is the etiologic agent predominantly isolated, although a significant increase in the prevalence of infections caused by other species of Candida is observed. More recently, the species C. africana has been detected in biological samples from this origin which, commonly, is identified as C. albicans by conventional methods. The main goal of this research was the specific detection of different yeast species of the genus Candida isolated from vaginal samples from Gynecology and Obstetrics patients of Maternity Irene Neto, Lubango, Huíla, Angola and the study of resistance patterns to antifungal drugs. Were studied 159 samples of vaginal swabs and were isolated 98 clinical isolates for the study.Conventional diagnosis of all isolates included C. albicans identification by Blastesis test. Non filamentous isolates were identified by micro morphology in agar medium with eosin and methylene blue, and biochemical and molecular methodologies. Molecular identification by multiplex PCR and RFLP analysis of the rDNA ITS region allowed the identification of the isolates of most common Candida species. For differentiation between C. africana and C. albicans it was used a molecular method based on PCR. In this research, from the vaginal swabs collected from patients of Maternity Irene Neto, Lubango, Huila in Angola were identified the species C. albicans, C. africana, C. parapsilosis, C. glabrata, C. guilliermondii, C. tropicalis, C. lipolytica, C. pelliculosa, Saccharomyces cerevisiae and Trichosporon asahii. The in vitro studies for the sensitivity study of all clinical isolates to fluconazole, voriconazole, posaconazole, and caspofungin were done by the Kirby-Bauer method according to CLSI standard M44-A. The use of molecular methods for the diagnosis of vulvovaginal candidiasis has proved to be more specific, sensitive, and provided higher accuracy than the conventional techniques. The application of disk diffusion methodology in African clinical isolates showed the existence of a high susceptibility to the antifungal agents tested.
Descrição
Palavras-chave
Microbiologia médica Saúde pública Infeções Vagina Candidíase
Contexto Educativo
Citação
Editora
Instituto de Higiene e Medicina Tropical