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Diagnóstico laboratorial de micoses humanas métodos convencionais vs. métodos moleculares
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Ao longo do último século, os métodos de diagnóstico e terapêutica têm contribuído para alterar a história natural das doenças infecciosas, nomeadamente as de origem fúngica. Para tal, muito tem contribuído um melhor diagnóstico laboratorial, permitindo identificar a espécie
responsável pela infecção e orientar para o tratamento mais eficaz na sua cura.
O objectivo principal deste trabalho foi a aquisição de conhecimentos sobre as técnicas laboratoriais mais adequadas para um correcto diagnóstico micológico, principalmente na identificação e caracterização de leveduras do género Candida e de dermatofitoses. Para tal, ao
longo de um ano, foram analisadas amostras provenientes de indivíduos com diagnóstico clínico de micose.
Relativamente às micoses oportunistas induzidas por leveduras do género Candida, foi feito o diagnóstico laboratorial de um elevado número de casos de candidose usando métodos tradicionais e métodos moleculares. Os resultados obtidos por ambos os métodos foram
comparados, tendo-se concluído que os segundos são mais rápidos e igualmente seguros na correcta identificação das espécies. Contudo, apresentam mais especificidades ao nível do esquipamento e
material de laboratório necessário.
Para as leveduras do género Candida, foi ainda efectuado um teste de sensibilidade aos antifúngicos fluconazol e voriconazol, tendo-se verificado elevada sensibilidade dos isolados para ambos os fármacos. Verificou-se ainda que os isolados resistentes in vitro ao fluconazol foram sensíveis ao voriconazol.
Foi ainda realizado um estudo epidemiológico de onicomicoses e Tinea Pedis em agentes do Corpo de Intervenção da Polícia de Segurança Pública, tendo-se aferido que estas infecções podem agravar um problema de saúde pública pelo seu elevado poder contagioso, principalmente em áreas de fácil dispersão de fungo, como são os balneários ou os dormitórios frequentados diariamente por várias centenas de indivíduos.
Com este trabalho concluiu-se que a identificação laboratorial do fungo responsável pela infecção é um passo fundamental para o adequado diagnóstico clínico e consequente esquema terapêutico. Assim e apesar da tendência dos últimos anos indiciar a orientação para o uso mais intensivo de técnicas moleculares no diagnóstico micológico, estas não deverão ser usadas isoladamente dos métodos tradicionais, mas sim como técnicas complementares de diagnóstico, pois onde umas podem falhar, as outras podem responder adequadamente.
Along the last century, the methods of diagnosis and therapeutics have been contributing to modify the natural history of the infectious diseases, namely fungic infections. Much has been contributing to a better diagnostic, allowing to identify the sort responsible for the infection and to orientate for the most efficient treatment in his cure. The principal goal of this work was the acquisition of knowledges on the laboratorial techniques, more adapted for a correct diagnosis in miology, in the identification and characterization of yeasts of the type Candida and dermatofitosys. Along one year, samples originating from individuals were analysed with clinical diagnosis of mycosis. Face to the mycosis induced by yeasts of the type Candida, was done the laboratorial diagnosis from a number of cases of candidose using traditional methods and molecular methods. The results obtained by both methods were compared, when it ended that the second ones are quicker and equally insurances in the correct identification of the sorts. For the yeasts of the type Candida, was still effectuated a test of sensibility to the fluconazol and voriconazol, when elevated sensibility of the isolated ones happened for both drugs. One checked still that the isolated resistant in vitro to fluconazol were sensitive to voriconazol. A epidemiologic study was fulfilled on onicomicoses and Tinea Pedis in agents of the Body of Intervention of the Police officer of Public Security, when it checked that these infections can aggravate a problem of public health for his elevated contagious power, principally in areas of easy dispersal of fungus, since they are the bathing resorts or the bedrooms frequented daily by several hundreds of individuals. With this work it was still possible to end that the laboratorial identification of the fungus responsible for the infection is a basic step for the appropriate clinical diagnosis. In spite of the tendency of the last years to use more intensive of molecular techniques in the diagnosis, these will not have to be used separately of the traditional techniques, but yes like complementary techniques of diagnosis, so it happened what, where a few can fail, others can answer appropriately.
Along the last century, the methods of diagnosis and therapeutics have been contributing to modify the natural history of the infectious diseases, namely fungic infections. Much has been contributing to a better diagnostic, allowing to identify the sort responsible for the infection and to orientate for the most efficient treatment in his cure. The principal goal of this work was the acquisition of knowledges on the laboratorial techniques, more adapted for a correct diagnosis in miology, in the identification and characterization of yeasts of the type Candida and dermatofitosys. Along one year, samples originating from individuals were analysed with clinical diagnosis of mycosis. Face to the mycosis induced by yeasts of the type Candida, was done the laboratorial diagnosis from a number of cases of candidose using traditional methods and molecular methods. The results obtained by both methods were compared, when it ended that the second ones are quicker and equally insurances in the correct identification of the sorts. For the yeasts of the type Candida, was still effectuated a test of sensibility to the fluconazol and voriconazol, when elevated sensibility of the isolated ones happened for both drugs. One checked still that the isolated resistant in vitro to fluconazol were sensitive to voriconazol. A epidemiologic study was fulfilled on onicomicoses and Tinea Pedis in agents of the Body of Intervention of the Police officer of Public Security, when it checked that these infections can aggravate a problem of public health for his elevated contagious power, principally in areas of easy dispersal of fungus, since they are the bathing resorts or the bedrooms frequented daily by several hundreds of individuals. With this work it was still possible to end that the laboratorial identification of the fungus responsible for the infection is a basic step for the appropriate clinical diagnosis. In spite of the tendency of the last years to use more intensive of molecular techniques in the diagnosis, these will not have to be used separately of the traditional techniques, but yes like complementary techniques of diagnosis, so it happened what, where a few can fail, others can answer appropriately.
Descrição
Palavras-chave
Ciências biomédicas Biologia molecular Micologia Micoses Diagnóstico laboratorial Fungos
Contexto Educativo
Citação
Editora
Instituto de Higiene e Medicina Tropical