Perfil de infecções fúngicas e colonização por leveduras do gênero Candida em Juiz de Fora, Minas Gerais: etiologia, epidemiologia, fatores de virulência e perfil de susceptibilidade aos antifúngicos

Abstract

Candida is the fungal genus most implicated in the clinical setting. Some species are successful colonizers of the human host, but under certain circumstances they can cause infections ranging from superficial candidiasis to life-threatening disseminated candidiasis. The present study aimed to evaluate the etiology of these infections, of community and hospital origin, the virulence factors, as well as the susceptibility profile to antifungals of medical interest, and to determine the epidemiological aspects of the individuals affected by these infectious processes, in order to provide data on the epidemiology, aiming to contribute to prevention, control and propagation strategies of these microorganisms. Two research follow-ups were carried out, a 2020 retrospective analysis and a 2021 prospective analysis of electronic medical records of hospitalized and community-based individuals, assisted by a clinical microbiology service, in Juiz de Fora, Minas Gerais. In 2020, yeasts were isolated from 126 hospitalized individuals and 57 from community individuals. In community members, females (n=47; 82.4%) were predominant. Nonalbicans Candida spp. were the most frequently retrieved (n=36; 63.2%), with urine (n=19; 33.5) being the most frequent clinical specimen. Among hospitalized individuals, females were also more frequent (n=69; 54.7%), with a predominance of those over 61 years old (n=94; 74.8%). Non-albicans Candida spp. were the most common strains (n=79; 62.7%). Antifungal therapy was prescribed for only (n=67; 53.2%) subjects after diagnosis. The outcome of in-hospital death was observed in (n=70; 55.6%). In 2021, yeasts were isolated from 63 hospitalized individuals and 39 community individuals. Among community individuals, females (n=26; 66.7%) were predominant. Candida albicans was the most frequently recovered (n=20; 51.3%) among community and hospitalized individuals (n=39; 61.9%). Among those hospitalized, females were also more frequent (n=32; 50.8%), with a predominance of those over 61 years of age (n=48; 76.2%). Antifungal therapy was prescribed for only (n=16; 25.4%) of the individuals after diagnosis. The outcome of inhospital death was observed (n=44; 69.8%). Of the yeasts in the prospective study, hemolytic activity by C. albicans (n=33; 55.9%) and by non-albicans Candida spp. (n=25; 58.1%) was the most common virulence factor. Fluconazole and voriconazole were the antifungals with the highest resistance index: (n= 47; 79.7%) for C. albicans and (n=23; 53.5%) for non-albicans Candida spp. These data on the epidemiology of candidiasis contribute to strategies for the prevention, control and spread of these microorganisms.