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Most evidence on ventilator-associated pneumonia (VAP)-related and ventilator-associated tracheobronchitis (VAT)-related mortality comes from general ICU settings, with limited data on critically ill cancer patients. This study aimed to characterize the microbiological profile and resistance patterns in an oncology hospital and evaluate their impact on 14-day mortality. We conducted a retrospective analysis of VAP and VAT cases in an oncology ICU in Brazil (Jan-Dec 2024), assessing bacterial frequency, multidrug-resistant organisms (MDRO), and mortality. Multivariate analysis was used to identify the variables significantly associated with mortality. Among 85 ICU patients, tracheobronchitis was more frequent (59%) than pneumonia (41%). Most were male (61%) with a median age of 62 years and had solid tumors (85%), mainly in the lungs and neck. Of 109 samples, (27%), (20%), and (17%) were the most common pathogens. MDRO was particularly high in (82%). Overall, 14-day mortality was 55%. MDR was not associated with mortality ( = 0.3), but VAP (OR 4.20, = 0.004) and infections with positive blood culture (OR 5.38, = 0.023) were independently associated with mortality. This study provides valuable insights into the microbiological profile of patients with VAP and VAT in an oncological ICU and its impact on mortality. Mortality was not associated with MDR, possibly reflecting the high baseline risk from underlying conditions. However, patients with positive blood cultures had significantly higher mortality, suggesting a more invasive disease.

Paracoccidioidomycosis is a systemic fungal disease occurring in Latin America that is associated with rural environments and agricultural activities. However, the incidence and prevalence of paracoccidiodomycosis is underestimated because of the lack of compulsory notification. If paracoccidiodomycosis is not diagnosed and treated early and adequately, the endemic fungal infection could result in serious sequelae. While the Paracoccidioides brasiliensis ( P. brasiliensis ) complex has been known to be the causal agent of paracoccidiodomycosis, a new species, Paracoccidioides lutzii ( P. lutzii ), has been reported in Rondônia, where the disease has reached epidemic levels, and in the Central West and Pará. Accurate diagnoses and availability of antigens that are reactive with the patients' sera remain significant challenges. Therefore, the present guidelines aims to update the first Brazilian consensus on paracoccidioidomycosis by providing evidence-based recommendations for bedside patient management. This consensus summarizes etiological, ecoepidemiological, molecular epidemiological, and immunopathological data, with emphasis on clinical, microbiological, and serological diagnosis and management of clinical forms and sequelae, as well as in patients with comorbidities and immunosuppression. The consensus also includes discussion of outpatient treatments, severe disease forms, disease prevalence among special populations and resource-poor settings, a brief review of prevention and control measures, current challenges and recommendations.

Paracoccidioidomycosis (PCM) is an important endemic, systemic disease in Latin America caused by spp. This mycosis has been associated with high morbidity and sequels, and its clinical manifestations depend on the virulence of the infecting strain, the degree and type of immune response, infected tissues, and intrinsic characteristics of the host. The T helper(Th)1 and Th17/Th22 cells are related to resistance and control of infection, and a Th2/Th9 response is associated with disease susceptibility. In this study, we focused on interleukin(IL)-12p35 ( ), IL-18 ( ), and IFN-γ receptor 1 ( ) genetic polymorphisms because their respective roles have been described in human PCM. Real-time PCR was employed to analyze -504 G/T (rs2243115), -607 C/A (rs1946518), and -611 A/G (rs1327474) single nucleotide polymorphisms (SNP). One hundred forty-nine patients with the acute form (AF), multifocal chronic (MC), or unifocal chronic (UC) forms of PCM and 110 non-PCM individuals as a control group were included. In the unconditional logistic regression analysis adjusted by ethnicity and sex, we observed a high risk of the -607 -allele for both AF [ = 0.015; OR = 3.10 (95% CI: 1.24-7.77)] and MC groups [ = 0.023; OR = 2.61 (95% CI: 1.14-5.96)] when compared with UC. The -607 -allele associated risk for the AF and MC groups as well as the protective role of the -allele in UC are possibly linked to higher levels of IL-18 at different periods of the course of the disease. Therefore, a novel role of -607 C/A SNP is shown in the present study, highlighting its importance in the outcome of PCM.

Chronic pulmonary aspergillosis (CPA) is a progressive fungal disease that primarily affects individuals with preexisting lung conditions. The clinical presentation, radiological characteristics, and outcomes of CPA in people living with HIV (PLHIV) remain poorly understood. We conducted a retrospective study at Hospital das Clínicas, University of São Paulo, Brazil, reviewing medical records of CPA patients from January 2010 to November 2024. HIV-infected and HIV-negative CPA patients were compared in terms of clinical features, diagnostic findings, treatment strategies, and outcomes. CPA diagnosis was based on European Society for Clinical Microbiology and Infectious Diseases and European Respiratory Society criteria. A total of 96 CPA patients were included, of whom 8 (8%) were PLHIV. Compared to HIV-negative patients, PLHIV were younger (median age: 44 vs. 52 years, p  = 0.13) and more likely to have active pulmonary TB (38% vs. 4.5%, p  = 0.013). Itraconazole was the most used antifungal in both groups (57% vs. 79%, p  = 0.2). One-year mortality also did not differ significantly between PLHIV and HIV-negative patients (13% vs. 4%, p  = 0.3). Notably, 50% of PLHIV experienced clinical failure despite prolonged antifungal therapy and/or surgery. In conclusion, CPA in PLHIV is frequently associated with active TB and presents with a high rate of clinical failure despite treatment. Our findings highlight the need for optimized diagnostic and therapeutic strategies for CPA in this under-recognized population. Further prospective studies are warranted to better define prognostic factors and improve management approaches.

Naganishia albida (Cryptococcus albidus) is considered saprophytic fungi, and is rarely reported as a human pathogen. Cutaneous infections caused by non-neoformans cryptococcus are rare. We describe a case of an immunocompetent older male with cutaneous cryptococcosis caused by Naganishia albida following skin trauma, and conduct a literature review in PubMed, Lilacs, and Embase. Only six previous similar reports were found. The seven cases (including ours) were widely distributed geographically (Brazil, the US, the UK, Hungary, South Korea, and Iran), all males, and their ages varied, ranging from 14 to 86 years. Four individuals had underlying skin diseases (Sezary Syndrome, psoriasis, and skin rash without etiology) plus potentially immunosuppressive underlying conditions (diabetes mellitus, kidney transplantation, and the use of etanercept, adalimumab, and methylprednisolone). Cutaneous presentation was polymorphic, with lesions characterized as warts, ulcers, plaques, and even macules. Two patients presented disseminated disease. Serum cryptococcal antigen was negative in six patients, and diagnosis was made by fungal culture in all. There is a lack of data on optimal antifungal treatment and outcomes.

Background In regions where there is only itraconazole capsule as a therapeutic option for treatment of chronic pulmonary aspergillosis (CPA), measuring the serum concentrations becomes even more important for therapeutic success. Objective Evaluate the initial itraconazole serum trough concentrations after the administration of oral capsule of itraconazole for the treatment of CPA. Methods The measurement was performed at least 7-days after initiation of therapy. The standard treatment at our institution was a 200 mg capsule every 12 h. We defined that an adequate serum trough concentration of itraconazole during treatment was 1–4 mg/L. Results This study recruited 28 patients. The median value was 0.30 mg/L (IQR 0.01–0.70). Only 11% (n = 3) had adequate serum concentrations based on guideline recommendation. All patients with clinical deterioration had itraconazole serum levels ≤ 0.8 mg/L. Conclusion The initial serum concentrations of itraconazole after capsule formulation administration were low. Increasing the dose should be considered when the itraconazole concentration is low, especially if it is ≤ 0.8 mg/L, and the patient presents with clinical deterioration. Larger studies are needed to evaluate the adequate concentrations recommended for CPA.

Objectives Chronic pulmonary aspergillosis (CPA) is a research priority in fungal diseases with a need for new studies to reduce misdiagnosis with more common diseases, discuss improvement in diagnostic methods and better characterize gaps in antifungal and surgical treatments to improve clinical outcomes. Methods In this retrospective study, we reviewed medical records of patients diagnosed with CPA from January 2010 to June 2021 at University of São Paulo, São Paulo, Brazil. We evaluated clinical characteristics, radiological findings, serology, treatment, and outcomes. Results The study included 91 participants, with 43 (47.3%) patients who underwent surgery and 69 (75.8%) received antifungal therapy. We found a predominance of middle-aged adults (median 51 years), males (n = 58, 64%) with lower BMI (median 21.3 kg/m 2 ). The most common underlying lung disease was pulmonary tuberculosis (n = 70, 76.9%). The commonest symptoms were cough (n = 67, 74%), haemoptysis, and dyspnea (n = 63, 70%). The most common chest computerized tomography abnormalities were cavity (n = 86, 94.5%), with a predominance of mycetomas (n = 78, 91%). The serology was positive in 81% (61/75). The one-year mortality was low (3.3%). Clinical improvement and stability occurred in 89% of participants for constitucional symptoms and 86% for pulmonary symptoms. While serological improvement and stability occurred in 71%. Radiological improvement and stability occurred in 75%. Conclusion We observed a good outcome after 1-year follow-up, in which the majority had improvement or stability of pulmonary and constitutional symptoms, decrease in CIE titers and low mortality.

Fingolimod is a sphingosine-1-phosphate receptor modulator used to treat multiple sclerosis. While fingolimod has been associated with an increased risk of cryptococcal meningitis, its correlation with other deep mycoses remains unclear. In this study, we conducted a scoping review of fingolimod associated with histoplasmosis, based on a case report, a literature review, and data from the FDA Adverse Events Reporting System (FAERS) as of January 24th, 2023. A 30-year-old Brazilian woman diagnosed with relapsing-remitting multiple sclerosis, receiving a daily dose of 0.5 mg of fingolimod, presented with a two-month history of fever and unintended weight loss, accompanied by lymphadenopathy, splenomegaly, and lung involvement was investigated. Biopsy of a lung nodule revealed fungal structures suggestive of Histoplasma sp. Additionally, serological testing yielded positive for Histoplasma capsulatum. Disseminated histoplasmosis should be considered in the differential diagnosis of febrile syndromes in patients undergoing fingolimod therapy for multiple sclerosis, particularly in the Americas, where this mycosis is endemic. Treatment with itraconazole and modification of immunotherapy can achieve excellent clinical outcomes.

ABSTRACT Mycobacterium kansasii comprises one of the most common and most pathogenic nontuberculous mycobacteria, particularly in immunocompromised individuals. This retrospective observational study aimed to describe the epidemiology, clinical characteristics, and outcomes of M. kansasii infections in 13 cancer patients from Instituto do Cancer do Estado de Sao Paulo, Brazil, from January 2011 to September 2023. Of the 19 initial positive cultures, 13 fully met diagnostic criteria for M. kansasii infections. Solid tumors occurred the most (69.2%), and only 38.4% of patients were undergoing chemotherapy at diagnosis. Smoking was the most frequent previous characteristic in these cases (76.9%). Fever (53.4%), cough (46.1%) and dyspnea (30.7%) were the most common symptoms. Multiple nodules (46.1%) and cavities (46.1%) were the most common radiological findings. Overall, seven patients (53.8%) received at least 12 months of therapy. One-year overall mortality totaled 38.4-22.2% in patients with solid tumors and 75% in patients with hematologic malignancies. In conclusion, M. kansasii infections were predominantly pulmonary in this series of cancer patients, which showed a high frequency of other respiratory comorbidities, especially smoking. Mortality occurred in several patients, particularly among those with hematological malignancies.

ABSTRACT Invasive candidiasis is associated with high morbidity and mortality, and the rising of antifungal resistance underscores the need for new therapies. Rezafungin, a second-generation echinocandin, enables once-weekly dosing, achieves high plasma concentrations, and shows potent in vitro activity. We report two Brazilian cases showing its clinical utility: (i) fluconazole-resistant Candida tropicalis bloodstream infection in a patient with colorectal cancer and chronic kidney disease and (ii) azole-refractory C. albicans esophagitis in a patient with autoimmune polyglandular syndrome type 1. Both achieved rapid clinical response and microbiological clearance. These are the first documented cases of rezafungin use for invasive candidiasis in Brazil.