Onicomicose em pacientes imunocomprometidos: caracterização epidemiológica, fenotípica e molecular
Data
2022-06-23
Autores
Borba, Orion Sant´Anna Motter 
Orientadores
Tomimori, Jane
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
A onicomicomise é uma infecção fúngica comum entre os indivíduos
imunossuprimidos: os receptores de transplante renal (RTR) submetidos à
imunossupressão iatrogênica para a manutenção do órgão enxertado; os pacientes
com nefrite lúpica (NL), submetidos à corticoterapia; e os pacientes com diabetes
mellitus (DM) que apresentam imunossupressão intrínseca. O objetivo desse estudo
foi caracterizar e identificar as infecções fúngicas nas unhas (pés e mãos), em
pacientes imunocomprometidos: RTR, NL e DM, do ponto de vista epidemiológico,
clínico e micológico. O material clínico, escamas de unha (pé e/ou mão), foi coletado
de 47 RTR, 66 NL, 67 DM e 78 indivíduos imunocompetentes (grupo controle), dos
quais 63,6% eram do sexo feminino, com exceção do grupo de RTR. A média de idade
foi de 52 anos. O predomínio da onicomicose subungueal distal lateral (OSDL)
(75,2%), afetando principalmente a unha do hálux, foi ocorrência comum nos grupos
estudados. O acometimento maior das unhas dos pés por fungos dermatófitos e das
unhas das mãos pelas espécies de Candida foi estatisticamente significante,
confirmado por técnicas moleculares. Nos RTR, o período de tempo após o
transplante variou entre 1 ano e 19 anos, com média de 7,5 anos. A principal causa da
falência renal foi a associação da hipertensão arterial sistêmica (HAS) e DM.
Observou-se maior frequência de acometimento das unhas das mãos nos pacientes
com NL e DM, sendo que para a NL a diferença foi estatisticamente significante. Entre
os pacientes com DM, 76,0% não usavam insulina, este grupo mostrou idade mais
avançada entre os pacientes imunocomprometidos e as infecções por Candida spp
foram mais frequentes. 87,2% dos diagnósticos de onicomicose em cultura foram
confirmados por meio dos métodos moleculares, identificando os agentes fúngicos em
nível de espécie. Os dermatófitos, T. rubrum e T. interdigitale e as espécies de
Candida, C. parapsilosis e C. albicans, foram os agentes fúngicos mais frequentes nas
populações estudadas. As identificações por meio de técnicas moleculares como o
sequenciamento das regiões ITS do rDNA foram aplicadas. Entretanto não houve
diferença significante quanto a distribuição das espécies identificadas pelas técnicas
molecular e cultura com identificação fenotípica.
Onychomycosis is a common fungal disease among immunosuppressed individuals: renal transplant recipients (RTR) who underwent iatrogenic immunosuppression to maintain the grafted organ; patients with lupus nephritis (LN) that are submitted to corticosteroid therapy, and patients with diabetes mellitus (DM) who have intrinsic immunosuppression. The aim of this study was to characterize and identify fungal infections on the nails (feet and hands) in immunocompromised patients: RTR, LN and DM, analyzing epidemiological, clinical, and mycological characteristics. The clinical material, nail scales (foot and/or hand), was collected from 47 RTR, 66 NL, 67 DM, and 78 immunocompetent individuals (control group), of which (63.6%), were female, except for the RTR group. The average age was 52 years. The predominance of lateral distal subungual onychomycosis (OSDL) (75.2%), mainly affecting the hallux nail, was a common occurrence in the groups studied. The greater involvement of toenails by dermatophyte fungi and of fingernails by Candida species was statistically significant, that was confirmed by molecular techniques. In RTR, the period after transplantation ranged from 1 year to 19 years, with an average of 7.5 years. The main cause of kidney failure was the association of systemic arterial hypertension and DM. A higher frequency of fingernails in patients with LN and DM was observed, and for LN the difference was statistically significant. Among patients with DM, 76.0% did not use insulin, this group showed more advanced age among immunocompromised patients and infections by Candida spp were more frequent. 87.2% of onychomycosis diagnoses in culture were confirmed using molecular methods, identifying fungal agents at the species level. Dermatophytes, T. rubrum and T. interdigitale and the species of Candida, C. parapsilosis and C. albicans, were the most frequent fungal agents in the studied populations. Molecular techniques such as the sequencing of the ITS regions of the rDNA were performed. There was not any significant difference regarding the distribution of the species identified by the molecular technique and phenotypic identification. Keywords: kidney transplant, diabetes mellitus, lupus nephritis, onychomycosis.
Onychomycosis is a common fungal disease among immunosuppressed individuals: renal transplant recipients (RTR) who underwent iatrogenic immunosuppression to maintain the grafted organ; patients with lupus nephritis (LN) that are submitted to corticosteroid therapy, and patients with diabetes mellitus (DM) who have intrinsic immunosuppression. The aim of this study was to characterize and identify fungal infections on the nails (feet and hands) in immunocompromised patients: RTR, LN and DM, analyzing epidemiological, clinical, and mycological characteristics. The clinical material, nail scales (foot and/or hand), was collected from 47 RTR, 66 NL, 67 DM, and 78 immunocompetent individuals (control group), of which (63.6%), were female, except for the RTR group. The average age was 52 years. The predominance of lateral distal subungual onychomycosis (OSDL) (75.2%), mainly affecting the hallux nail, was a common occurrence in the groups studied. The greater involvement of toenails by dermatophyte fungi and of fingernails by Candida species was statistically significant, that was confirmed by molecular techniques. In RTR, the period after transplantation ranged from 1 year to 19 years, with an average of 7.5 years. The main cause of kidney failure was the association of systemic arterial hypertension and DM. A higher frequency of fingernails in patients with LN and DM was observed, and for LN the difference was statistically significant. Among patients with DM, 76.0% did not use insulin, this group showed more advanced age among immunocompromised patients and infections by Candida spp were more frequent. 87.2% of onychomycosis diagnoses in culture were confirmed using molecular methods, identifying fungal agents at the species level. Dermatophytes, T. rubrum and T. interdigitale and the species of Candida, C. parapsilosis and C. albicans, were the most frequent fungal agents in the studied populations. Molecular techniques such as the sequencing of the ITS regions of the rDNA were performed. There was not any significant difference regarding the distribution of the species identified by the molecular technique and phenotypic identification. Keywords: kidney transplant, diabetes mellitus, lupus nephritis, onychomycosis.