25º Congresso Brasileiro de Microbiologia

25º Congresso Brasileiro de Microbiologia

ResumoID:382-1

Área: Micologia Médica ( Divisão B )

URINARY TRACT INFECTION BY TRICHOSPORON OVOIDES:&NBSP;CASE REPORT

Vanessa Karina Alves da Silva (UFPE); Ruy de Lima Cavalcanti Neto (HCPE); Reginaldo Gonçalves Lima Neto (UFPE); Danielle Patrícia Cerqueira Macêdo (UFPE); Aline Mary de Almeida Farias (UFPE); Rejane Pereira Neves (UFPE)

Resumo

Trichosporon ovoides integrates normal flora of the human skin and gastrointestinal tract and may cause various localized or disseminated infections in immunodeficient hosts. Urinary tract infection (UTI) caused by T. ovoides is rare and this species has emerged as an important opportunistic pathogen in this group of patients, specially the renal transplant recipients. A 61 years old man underwent renal transplantation in August 2008 and received immunossupressive medications such as cyclosporine, azathioprine and prednisone, making use of urinary catheters. After two months, the patient was diagnosed with benign prostatic hyperplasia and surgery was performed. However, after this procedure he developed clinical signs of severe infection. Urine samples were cultured on Sabouraud dextrose agar with chloramphenicol (50mg/L) and incubated both at 37ºC and 30ºC for 72 hours. Direct observation of the urinary precipitate revealed septate hyaline hyphae with arthrospores and budding yeast cells. At both temperatures numerous tiny, creamy to white, dry and wrinkled colonies were obtained. The yeast was identified through morphology, hydrolysis of urea, carbohydrate fermentation and assimilation patterns and nitrate assimilation tests. Based on morphophysiological characteristics, the isolate was identified as T. ovoides. The strain has been maintained under mineral oil (number URM5975) at the internationally recognized URM Culture Collection of Department of Mycology, Federal University of Pernambuco, Brazil. The minimum inhibitory concentrations (MICs) were determined using the reference broth microdillution method and were interpreted by following the guidelines established in Clinical and Laboratoty Standards Institute document M27A2. The tested concentrations of antifungal agents ranged from 0.125 µg/mL to fluconazole and 0.0313 µg/mL to anphotericin B. The microdillutin plates were incubated at 35ºC and observed for the presence or absence of visible growth at 24-48h. Fluconazole MIC of the isolate corresponded to 0.25 µg/mL and the amphotericin B was 1µg/mL. The patient received amphotericin B (1mg/Kg) therapy however it was not effective leading to a fatal outcome. Autopsy analyses revealed sepsis. Trichosporonosis is usually an insidious disease although it may occur as an acute opportunistic infection in susceptible patients. Urinary catheters have been held responsible as a cause of 80% of hospital urinary tract infections. Although significant advances have been made in surgical techniques and immunosuppressant for renal transplantation, UTIs continue to be a major problem. Prevention of these infections as well as prompt diagnosis and appropriate treatment are crucial in posttransplant because of their influence on patient and graft outcomes.

Palavras-chave: Trichosporon ovoides, renal transplant, sepsis

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