Abstract
Aspergillus and Fusarium cause a broad spectrum of infections in humans, mainly in immunocompromised patients. Among these, patients undergoing hemodialysis are highly susceptible to infections, requiring a constant and adequate environmental disinfection program. Nevertheless, monitoring the residual disinfectants can contribute to the morbidity and mortality reduction in these patients. Here, we evaluated the susceptibility of Aspergillus spp. (n=19) and Fusarium spp. (n=13) environmental isolates against disinfectants (acetic acid, citric acid, peracetic acid, sodium hypochlorite, and sodium metabisulphite) at different concentrations and time exposures. Also, we investigated the in vivo toxicity of the peracetic acid residual concentration in mice. Fusarium isolates were identified by F. equiseti, F. oxysporum and F. solani while Aspergillus presented clinically relevant species (A. fumigatus, A. niger and A. terreus) and environmental ones. Against planktonic cells, only two disinfectants (acetic acid and sodium hypochlorite) showed a fungicidal effect on Fusarium spp., while only one (sodium hypochlorite) was effective against Aspergillus spp. Both fungi formed robust in vitro biofilms with large amounts of the extracellular matrix, as evidenced by electron micrographs. Exposure of fungal biofilms to disinfectants showed sensitivity to three (acetic, citric, and peracetic acids), although the concentrations and times of exposure varied according to the fungal genus. Mice exposure to the residual dose of peracetic acid during 60 weeks showed anatomopathological, hematological, and biochemical changes. The implementation of news control measures and those that already exist can help reduce infections, the second cause of death and morbidity in these patients, besides providing safety and well-being to them, a priority of any quality health program.
Highlights
Chronic renal patients, due to abnormalities in their immune systems, such as T cell deficiency, accumulation of proinflammatory cytokines, oxidative stress, among others, are more susceptible to infections, which are the second most common cause of morbidity and mortality in these patients (Kato et al, 2008; Chang et al, 2020)
DNA sequencing of 13 strains of Fusarium was identified as F. oxysporum species complex (FOSC) - Fusarium oxysporum species complex (46,1%), FSSC Fusarium solani species complex (46,1%) and FIESC - Fusarium incarnatum-equiseti species complex (7,7%)
The results showed that despite the variety of disinfectants used in the hemodialysis setting, few of them were shown to be effective against the microorganisms and life forms studied
Summary
Due to abnormalities in their immune systems, such as T cell deficiency, accumulation of proinflammatory cytokines, oxidative stress, among others, are more susceptible to infections, which are the second most common cause of morbidity and mortality in these patients (Kato et al, 2008; Chang et al, 2020). Aspergillus, a filamentous fungus, are saprobic organisms found in the environment and were considered an important opportunistic agent in clinical practice (Hsieh et al, 2017). Factors such as i) reduced conidia size, which facilitates inhalation of conidial forms; ii) temperature found in the upper airways is practically the same as the fungus develops in nature; iii) great adherence capacity and biofilm formation, contribute to the development of pathologies associated with Aspergillus in immunocompromised patients (Müller et al, 2011; Lass-Flörl et al, 2013; Beauvais and Latgé, 2015)
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