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R2291 HIV infection, HAART, and gynecomastia. Epidemiological, clinical, and potential pathogenetic correlates
S664 strain was SDD to itraconazole. C. guillermondii strain was resistant to caspofungin (MIC > 32 mg/L). None of the other strains of Candida spp. had MIC value greater than 1 mg/L to caspofungin, amphotericin B and voriconazole. Twenty four (77.4%) of the patients were in ICU, 6 (19.4%) of whom had burns. CVC were in place in 29 (93.5%) patients. Prior antibiotic usage was present in 30 (96.8%) patients. Fifteen (48.4%) patients were subject to total parenteral nutrition. As an underlying condition, 8 (25.8%) had prior abdominal surgery, 10 (32.3%) had malignancy, and 10 (32.3%) had chronic renal failure. Prior fluconazole usage within a month of the first positive blood culture for Candida spp. was present for 22 (71%) patients, two of whom had fluconazole-resistant or -SDD candidaemia. 11 episodes were treated with fluconazole and 18 with caspofungin. The overall mortality rate was 45.2%. Conclusion: C. albicans was found as the most common cause of candidaemia. Our study suggests that fluconazole resistance has not emerged among bloodstream isolates of C. albicans, although isolated from patients at high risk. Although number of non-albicans Candida strains is too low, fluconazole resistance was detected in one strain (14.3%). Present study shows that even for the patients at high risk, fluconazole still remains the drug of choice for C. albicans strains.
R2290 A four-year epidemiological study of aetiological agents of yeast infections and antifungal susceptibility profiles in the centre of Portugal C. Paulo, J. Marques, C. Mour˜ao, A. Meli¸co-Silvestre, A. Florindo, T. Gon¸calves (Coimbra, PT) Objectives: The objective of this study was to characterise the aetiological agents of yeast infections in the Portuguese population, together with the antifungal susceptibility profiles. Methods: Yeast isolates were collected from October 2002 to October 2006, from patients attending or hospitalised at the Centro Hospitalar de Coimbra. Species identification was primarily obtained using the commercial methods Bichro-latex Albicans Fumouze (Fumouze Diagnostics, France) and Api ID 32C (BioM´erieux, Portugal), and antifungal susceptibilities using the ATB Fungus 2 INT (BioM´erieux, Portugal) and the Fungitest (Sanofi Pasteur). Then, all the confirmed aetiological agents were subjected to re-identification by RFLP of the 5.8 S-ITS and/or by sequencing the contiguous D1/D2 fragment from the rRNA 26 S gene. All the isolates were deposited in a pathogenic yeast collection, the PYM collection. The following patient data was collected and registered in a database: age, gender, underlying disease, specimen collected. Results: A total of 727 yeast isolates were obtained, and confirmed as aetiological agents of yeast infections, during the four-year surveillance study. Half of the samples studied belong to patients older than 60 years. The most represented specimens in this survey were isolated from respiratory system infections (292), followed by urine (152), blood (48), catheters (49), gynaecological (47), intra-abdominal (20) and skin lesions (54). Among these, only 2% were not correctly identified using the commercial methods described above, when confirmed by the molecular biology techniques. As expected, the predominant pathogen is Candida albicans (60%), followed by C. tropicalis, C. parapsilosis and C. glabrata. Moreover, other species belonging to the Candida genus were also found as aetiological agents, together with Saccharomyces cerevisiae, Geotrichum capitatum, Cryptococcus neoformans. The isolated pathogens proved, in vitro, to be susceptible to the tested antifungals, included in the methods used. Infrequently, some isolates exhibited resistance to itraconazole (21 isolates). Conclusion: The data obtained during this study represents the first broad epidemiological study on yeast infections in the Portuguese population. As expected from similar studies in different countries the predominant pathogenic yeast is C. albicans. Albeit, these results showed that there are some regional specificities in what regards yeast infections aetiology.
17th ECCMID / 25th ICC, Abstracts accepted for publication only
AIDS and HIV infection R2291 HIV infection, HAART, and gynecomastia. Epidemiological, clinical, and potential pathogenetic correlates R. Manfredi, L. Calza (Bologna, IT) Introduction: Gynecomastia (G) is an emerging untoward event in patients treated with HAART. Patients and Methods: Through a cross-sectional study performed on around 1,000 HIV-infected patients (p) treated with antiretrovirals at our reference centre in Bologna (Italy), we identified all cases of G related to the administration of at least 12 consecutive months of HAART, to assess possible correlations of G with a spectrum of clinical, laboratory, and therapeutic variables (and including all adverse effects of HAART itself). All p with true G (as distinguished from lipomastia by an ultrasonography assay) were considered evaluable, while p with other predisposing conditions (endocrine disease, alcohol abuse, liver cirrhosis, and use of drug possibly predisposing to G), were carefully ruled out. Results: Twenty-one out of 616 evaluable HIV-infected male p (3.4% of our p population), developed a true G when aged 12−58 years. Seven p out of 21 never received protease inhibitor (PI)-containing therapies, while efavirenz-based regimens apparently prompted G in 7 p who were na¨ıve for PI, and worsened this disturbance in three further p who abandoned PI for efavirenz. Considering nucleoside analogues (NA), two p developed G during treatment conducted with dual isolated NA. Comparing the different administered NA, stavudine seemed to be the most commonly used compound, also taken for the longest time (p < 0.01). A complete hormonal workup did not detect significant abnormalities, save in one p, who had slight serum FHS, LH, and testosteron abnormalities (with normal prolactin levels). When considering the eventual correlation with the most common HAARTinduced disturbances, some forms of lipodystrophy was concurrent in all the 21 p with G, while hypertriglyceridaemia, hypercholesterolaemia, and hyperglycaemia were found in 15, 9, and 3 p, respectively. During the subsequent 12−36-month follow-up, a spontaneous ameliorement of G was never observed, notwithstanding eventual HAART modifications. Due to local hypersthesia, tenderness, and discomfort, two p resorted to surgery. Conclusions: G is probably an underestimated problem in the setting of HAART. The frequent association of G with other HAART-related dysmetabolism suggests a possible common pathogenetic causes. R2292 Aetiology of withdrawal lopinavir/ritonavir in a group of HIV-infected patients and evolution of subjects changed to other treatments in a simplification strategy V. Moreno, E. Valencia, I. Jim´enez-N´acher, J. Gonz´alez Lahoz (Madrid, ES) Objectives: (1) To analyse the aetiology of withdrawal Lopinavir/ritonavir (LOP/r) in a group of HIV infected patients with prolonged viral suppression and (2) to analyse the evolution of subjects changed to other treatments in a simplification strategy. Methods: We reviewed the clinical history of 101 HIV+ patients treated with LOP/r who were switched off to other treatment when they were with complete viral suppression. A data base was developed and the epidemiological, clinical, serological and laboratory characteristics were studied. All the simplification cases were separately analysed and the subjects with treatment failure were reviewed. Statistical study was done by SPSS 13.0. Results: Causes of LOP/r withdrawal were: toxicity in 7 cases, treatment interrupttion in 3 and simplification in 61 (65%). Two patients died, 10 were lost and in 8 was no possible to find the aetiology. Mean age in 61 patients who were simplified was 42 years (r: 27−59) and 52 (85.2%) were men. They had been receiving LOP/r for at least 12 months, 73.8% were heavily pre-treated and mean CD4+ cell was 613±343 mm3 (r: 108–1800). Twelve patients (19.7%) had AIDS and 24
R2290 A four-year epidemiological study of aetiological agents of yeast infections and antifungal susceptibility profiles in the centre of Portugal C. Paulo, J. Marques, C. Mour˜ao, A. Meli¸co-Silvestre, A. Florindo, T. Gon¸calves (Coimbra, PT) Objectives: The objective of this study was to characterise the aetiological agents of yeast infections in the Portuguese population, together with the antifungal susceptibility profiles. Methods: Yeast isolates were collected from October 2002 to October 2006, from patients attending or hospitalised at the Centro Hospitalar de Coimbra. Species identification was primarily obtained using the commercial methods Bichro-latex Albicans Fumouze (Fumouze Diagnostics, France) and Api ID 32C (BioM´erieux, Portugal), and antifungal susceptibilities using the ATB Fungus 2 INT (BioM´erieux, Portugal) and the Fungitest (Sanofi Pasteur). Then, all the confirmed aetiological agents were subjected to re-identification by RFLP of the 5.8 S-ITS and/or by sequencing the contiguous D1/D2 fragment from the rRNA 26 S gene. All the isolates were deposited in a pathogenic yeast collection, the PYM collection. The following patient data was collected and registered in a database: age, gender, underlying disease, specimen collected. Results: A total of 727 yeast isolates were obtained, and confirmed as aetiological agents of yeast infections, during the four-year surveillance study. Half of the samples studied belong to patients older than 60 years. The most represented specimens in this survey were isolated from respiratory system infections (292), followed by urine (152), blood (48), catheters (49), gynaecological (47), intra-abdominal (20) and skin lesions (54). Among these, only 2% were not correctly identified using the commercial methods described above, when confirmed by the molecular biology techniques. As expected, the predominant pathogen is Candida albicans (60%), followed by C. tropicalis, C. parapsilosis and C. glabrata. Moreover, other species belonging to the Candida genus were also found as aetiological agents, together with Saccharomyces cerevisiae, Geotrichum capitatum, Cryptococcus neoformans. The isolated pathogens proved, in vitro, to be susceptible to the tested antifungals, included in the methods used. Infrequently, some isolates exhibited resistance to itraconazole (21 isolates). Conclusion: The data obtained during this study represents the first broad epidemiological study on yeast infections in the Portuguese population. As expected from similar studies in different countries the predominant pathogenic yeast is C. albicans. Albeit, these results showed that there are some regional specificities in what regards yeast infections aetiology.
17th ECCMID / 25th ICC, Abstracts accepted for publication only
AIDS and HIV infection R2291 HIV infection, HAART, and gynecomastia. Epidemiological, clinical, and potential pathogenetic correlates R. Manfredi, L. Calza (Bologna, IT) Introduction: Gynecomastia (G) is an emerging untoward event in patients treated with HAART. Patients and Methods: Through a cross-sectional study performed on around 1,000 HIV-infected patients (p) treated with antiretrovirals at our reference centre in Bologna (Italy), we identified all cases of G related to the administration of at least 12 consecutive months of HAART, to assess possible correlations of G with a spectrum of clinical, laboratory, and therapeutic variables (and including all adverse effects of HAART itself). All p with true G (as distinguished from lipomastia by an ultrasonography assay) were considered evaluable, while p with other predisposing conditions (endocrine disease, alcohol abuse, liver cirrhosis, and use of drug possibly predisposing to G), were carefully ruled out. Results: Twenty-one out of 616 evaluable HIV-infected male p (3.4% of our p population), developed a true G when aged 12−58 years. Seven p out of 21 never received protease inhibitor (PI)-containing therapies, while efavirenz-based regimens apparently prompted G in 7 p who were na¨ıve for PI, and worsened this disturbance in three further p who abandoned PI for efavirenz. Considering nucleoside analogues (NA), two p developed G during treatment conducted with dual isolated NA. Comparing the different administered NA, stavudine seemed to be the most commonly used compound, also taken for the longest time (p < 0.01). A complete hormonal workup did not detect significant abnormalities, save in one p, who had slight serum FHS, LH, and testosteron abnormalities (with normal prolactin levels). When considering the eventual correlation with the most common HAARTinduced disturbances, some forms of lipodystrophy was concurrent in all the 21 p with G, while hypertriglyceridaemia, hypercholesterolaemia, and hyperglycaemia were found in 15, 9, and 3 p, respectively. During the subsequent 12−36-month follow-up, a spontaneous ameliorement of G was never observed, notwithstanding eventual HAART modifications. Due to local hypersthesia, tenderness, and discomfort, two p resorted to surgery. Conclusions: G is probably an underestimated problem in the setting of HAART. The frequent association of G with other HAART-related dysmetabolism suggests a possible common pathogenetic causes. R2292 Aetiology of withdrawal lopinavir/ritonavir in a group of HIV-infected patients and evolution of subjects changed to other treatments in a simplification strategy V. Moreno, E. Valencia, I. Jim´enez-N´acher, J. Gonz´alez Lahoz (Madrid, ES) Objectives: (1) To analyse the aetiology of withdrawal Lopinavir/ritonavir (LOP/r) in a group of HIV infected patients with prolonged viral suppression and (2) to analyse the evolution of subjects changed to other treatments in a simplification strategy. Methods: We reviewed the clinical history of 101 HIV+ patients treated with LOP/r who were switched off to other treatment when they were with complete viral suppression. A data base was developed and the epidemiological, clinical, serological and laboratory characteristics were studied. All the simplification cases were separately analysed and the subjects with treatment failure were reviewed. Statistical study was done by SPSS 13.0. Results: Causes of LOP/r withdrawal were: toxicity in 7 cases, treatment interrupttion in 3 and simplification in 61 (65%). Two patients died, 10 were lost and in 8 was no possible to find the aetiology. Mean age in 61 patients who were simplified was 42 years (r: 27−59) and 52 (85.2%) were men. They had been receiving LOP/r for at least 12 months, 73.8% were heavily pre-treated and mean CD4+ cell was 613±343 mm3 (r: 108–1800). Twelve patients (19.7%) had AIDS and 24