Portal de Periódicos da CAPES

Candida and hands

1986; Elsevier BV; Volume: 8; Issue: 1 Linguagem: Inglês

10.1016/0195-6701(86)90099-x

1532-2939

J. Burnie,

Antifungal resistance and susceptibility

Systemic candidosis is a disease of increasing incidence with a high mortality and no typical clinical picture (Gold, 1984). The mainstay of treatment is amphotericin B which has been associated with nephrotoxicity (de Repentigny & Reiss, 1984). Difficulties in diagnosis and treatment have led to the use of numerous different oral antifungal agents as chemoprophylaxis, but since no regime has proved completely successful (Donnelly et al., 1984), treatment with parenteral amphotericin B is often given to immunocompromised patients whose pyrexia fails to resolve after antibacterial therapy (Holleran, Wilbur & De Gregorio, 1985). Infection has usually been attributed to autoinfection by yeasts colonizing the patient’s bowel or iv catheters (Krause, Matheis & Wulf, 1969; Stone, 1974). However, the recent report (Burnie et al., 1985~) of an outbreak of systemic candidosis in the intensive care unit at the London Hospital marks a new approach to the control of this infection. Thirteen patients on the unit developed systemic candidosis (due to an epidemic strain) as defined by either cultural and histological evidence from a deep organ biopsy or by positive blood cultures obtained from different iv sites at least 24 h apart. The outbreak isolates typed as serotype A (Hasenclever & Mitchell, 1961), morphotype Al (Brown-Thomson, 1968) and biotype o/i/5/5/, (Odds & Abbott, 1980). The same type also caused 44% of the superficial candidal infections in the unit compared with 17% of the candidal infections in other parts of the same hospital. No environmental source was identified during this outbreak but the strain was isolated from the mouths of four of 65 nurses and the hands/of one of these individuals. Two of 17 nurses acquired the strain on their hands immediately after nursing patients with systemic candidosis. A further nurse developed vaginal candidosis due to an outbreak isolate. There appeared to be a cycle of infection between patients and staff in the unit, with hands acting as the major route of transmission. Since Candidu ulbicuns is rarely demonstrable in the atmosphere (Midgley & Clayton, 1972) even near infants with oral thrush (Kozinn et al., 1959) the suspected cycle of infection demonstrated in the unit was not surprising. Two previous outbreaks of cutaneous candidal infection have been documented and in both of these the source was shown to be contaminated fomites (Cremer & De Groot, 1967; Malamatinis, Mattmiller & Westfall, 1968). An outbreak of Cund. purupsilosis septicaemia due to contaminated iv feeds (Solomon et al., 1984) has also been reported.