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Sample translations submitted: 2
English to Spanish: Detection of antifungal resistance. Translation for LIFE (Leading International Fungal Education) General field: Medical Detailed field: Medical: Health Care
Source text - English Detection of antifungal resistance
Antifungal resistance is gradually rising. The reasons are multiple, including:
Emergence of new, resistant species such as Candida auris and Trichophyton indotineae
Replacement of susceptible species with resistant ones in patients on antifungal prophylaxis or therapy (ie Candida glabrata on fluconazole)
Emergence of resistance on therapy (ie Aspergillus fumigatus treated with itraconazole or voriconazole or Cryptococcus neoformans treated with fluconazole)
Emergence of azole resistant Aspergilli from the agricultural use of azole fungicides.
Some species of fungi are intrinsically resistant to certain or multiple antifungals. Commoner examples are Candida krusei and to fluconazole, Aspergillus terreus to amphotericin B, Aspergillus calidoustus to azoles, Fusarium spp. to fluconazole and Mucorales to voriconazole. In these cases, species identification is sufficient, and for the known resistance pattern, actually doing a susceptibility test to that antifungal is unnecessary (although sometimes done as part of a panel).
The vast majority of fungal susceptibility tests are done on positive cultures. In recent years, direct molecular (PCR) detection of some resistant markers have been commercially introduced.
Culture-based susceptibility testing
Reference systems for antifungal susceptibility testing
Academic efforts in the US (NCCLS, now CLSI) and in Europe (EUCAST) from the mid 1990’s lead to defined methods for identifying antifungal resistance, initially in common Candida species against fluconazole and Aspergillus spp. against itraconazole. These methods evolved over many years to embrace additional antifungals and fungi.
EUCAST AFST Committee provides a comprehensive reference method for antifungal susceptibility testing of Candida spp., Cryptococcus spp., Aspergillus spp., and more recently dermatophytes. The method is in microtitre plates, using RPMI with glucose medium and requires careful inoculum preparation, and care in endpoint reading. Yeast and dermatophyte MICs are read with a spectrophotometer, Aspergillus spp. by eye. Detailed methods are here: www.eucast.org/astoffungi/methodsinantifungalsusceptibilitytesting
Interpretation and reporting guidance is here: www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/AFST/Clinical_breakpoints/AFST_BP_v10.0_200204_updatd_links_200924.pdf
Clinical and Laboratory Standards Institute (CLSI) provides alternative microtitre methods for susceptibility testing of Candida spp., other yeasts and filamentous fungi, including Aspergillus spp. It utilises round bottom microtitre plates and visual endpoint reading. An earlier full version of the method for yeasts is here:
https://clsi.org/media/1461/m27a3_sample.pdf
The up-to-date 2022 version is here: https://clsi.org/standards/products/microbiology/documents/m27m44s/
An older version of the method for filamentous fungi is here: https://clsi.org/media/3682/m61ed2_sample.pdf and the up to date (2022) version is here: https://clsi.org/standards/products/microbiology/documents/m38m51s/
Interpretation guidance based on epidemiological cut-off values is here:
https://clsi.org/standards/products/microbiology/documents/m57s/
These systems have been used for defining resistance breakpoints, if possible based on correlative therapeutic outcome data. If not possible, because of data limitations, the alternative approach to defining resistance is based on epidemiological cut-off values (ECV) (ie outliers). Almost all endpoints describe inhibition; older assays also described fungicidal concentration, but these are much less frequently used in clinical practice.
Commercial systems for antifungal susceptibility testing
Several commercially available systems are available as part of complete solutions for laboratories including disks for disk diffusion assays and pre-filled microtitre plates for microbroth dilution testing. Some complete systems include eTest and several microtitre systems, some with colour change reagents to aid endpoint reading. Other systems integrate yeast identification with susceptibility testing.
Premade susceptibility microtitre plates for EUCAST Merlin Micronaut: https://www.merlin-diagnostika.de/en/products/susceptibility-testing-ast/index.html
Candida and other ascomycete yeasts
Candida spp. recovered from blood cultures or other deep tissue (normally sterile) samples should be tested for antifungal susceptibility as acquired resistance to azoles and echinocandins is an increasing concern. CLSI or EUCAST microbroth dilution protocols are the standard procedures. Commercial microbroth dilution kits (e.g. Sensititre YeastOneTM) or diffusion gradient (commonly known as Etests) are acceptable alternatives. Mass spectrometry can also provide susceptibility results and one such system is the Vitek 2. Clinical breakpoints (CBP) to define susceptibility or resistance have been assessed by EUCAST and CLSI for the most relevant pathogenic Candida spp. Among normally susceptible Candida spp. (e.g. C. albicans), fluconazole resistance is observed at variable frequency depending on the epidemiological context (only 2-5% in USA and Europe). C. glabrata is usually considered as ‘susceptible dose-dependent’ and exhibits variable susceptibility to azoles. C. krusei is intrinsically resistant to fluconazole, but not to voriconazole. For C. auris, there is no established CBP, but tentative breakpoints have been proposed by the Centers for Disease Control and Prevention (CDC, available at: www.cdc.gov/fungal/candida-auris/c-auris-antifungal.html). More than 90% of C. auris isolates have acquired resistance to fluconazole. Echinocandin resistance is rare (
Translation - Spanish Detección de resistencia antifúngica
La resistencia antifúngica está aumentando progresivamente. Las razones son múltiples e incluyen:
Emergencia de nuevas especies resistentes como Candida auris y Trichphyton indotineae
Reemplazo de especies sensibles por especies resistentes en pacientes bajo profilaxis o tratamiento antifúngico (tal es el caso de Candida glabrata bajo tratamiento con fluconazol)
Emergencia de resistencia bajo tratamiento (por ejemplo, Aspergillus fumigatus en tratamiento con itraconazol o voriconazol o Cryptococcus neoformans en tratamiento con fluconazol)
Emergencia de resistencia a azoles en Aspergillus a raíz del uso de azoles fungicidas en la agricultura.
Algunas especies de hongos son intrínsecamente resistentes a ciertos antifúngicos, a veces múltiples. Los ejemplos más comunes son Candida krusei a fluconazol, Aspergillus terreus a anfotericina B, Aspergillus calidoustus a azoles, Fusarium spp. a fluconazol y Mucorales a voriconazol. En estos casos, la identificación de la especie es suficiente y es innecesario realizar tests de susceptibilidad a los antifúngicos cuyo perfil de resistencia ya se conoce (aunque a veces se realiza como parte de un panel de varios antifúngicos).
La amplia mayoría de los tests de susceptiblidad antifúngica se realizan sobre cultivos positivos. En años recientes se ha introducido la detección molecular directa (por PCR) de algunos marcadores de resistencia.
Tests de susceptibilidad basados en cultivo
Sistemas de referencia para la determinación de la susceptibilidad antifúngica
Esfuerzos académicos en los Estados Unidos (NCCLS, actualmente CLSI) y en Europa (EUCAST) desde mediados de los años 90’ condujeron a la definición de métodos para identificar resistencia antifúngica, inicialmente en especies comunes de Candida a fluconazol y de Aspergillus spp. a itraconazol. Estos métodos evolucionaron a lo largo de muchos años para incluir antifúngicos y hongos adicionales.
El comité de EUCAST AFST provee de exhaustivos métodos de referencia para la determinación de susceptibilidad de Candida spp., Cryptococcus spp., Aspergillus spp. y, más recientemente, de dermatofitos. El método consiste en la utilización de microplacas con medio RPMI con glucosa y requiere de una preparación cuidadosa del inóculo y de precaución en la lectura del punto de corte. Las CIMs de levaduras y de dermatofitos se leen con espectrofotómetro, las de Aspergillus spp. al ojo desnudo. Los métodos detallados se encuentran en el siguiente link: https://www.eucast.org/astoffungi/methodsinantifungalsusceptibilitytesting y las guías para interpretación y reporte en: https://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/AFST/Clinical_breakpoints/AFST_BP_v10.0_200204_updatd_links_200924.pdf
El Instituto de Estándares Clínicos y de Laboratorio (CLSI por su sigla en inglés) provee de métodos de microtitulación alternativos para la determinación de susceptibilidad de Candida spp., otras levaduras y hongos filamentosos, incluyendo Aspergillus spp. Este método utiliza microplacas de fondo curvo y lectura visual. Una versión previa y completa de la metodología se encuentra en:
https://clsi.org/media/1461/m27a3_sample.pdf
y una versión actualizada de 2022 en: https://clsi.org/standards/products/microbiology/documents/m27m44s/
Una versión anterior del método para hongos filamentosos en: https://clsi.org/media/3682/m61ed2_sample.pdf y la actualización para 2022 en: https://clsi.org/standards/products/microbiology/documents/m38m51s/
La guía de interpretación basada en puntos de corte epidemiológicos se encuentra en el enlace:
Estos sistemas han sido usados para definir los puntos de corte de resistencia, siempre que fuera posible basándose en información correlativa de resultados terapéuticos. En caso contrario, debido a información limitada, el enfoque alternativo para definir resistencia se basa en valores de corte epidemiológicos (VCE) (es decir, valores atípicos). Casi todos los puntos de corte describen inhibición; ensayos previos también describían concentraciones fungicidas, pero estas son mucho menos usadas en la práctica clínica.
Sistemas comerciales para la determinación de susceptibilidad antifúngica
Varios sistemas comerciales se encuentran disponibles como parte de soluciones completas para los laboratorios, incluyendo discos para ensayos de disco-difusión y placas de microtitulación pre-llenadas para tests de microdilución en caldo. Algunos sistemas completos incluyen E-test® y varios sistemas de microtitulación, algunos de ellos con reactivos que cambian de color para ayudar a la lectura del punto final. Otros sistemas integran la identificación de levaduras con el estudio de susceptibilidad.
Tiras de difusión en agar por gradiente de antimicrobiano (elipsograma):
Los aislamientos de Candida spp. de hemocultivos u otros tejidos profundos (normalmente estériles) deben ser sometidos a tests de susceptibilidad antifúngica ya que la resistencia adquirida a los azoles y equinocandinas es un problema creciente. Los procedimientos estándar siguen los protocolos de microdilución en caldo de CLSI o EUCAST. Kits comerciales de microdiluación en caldo (Sensititre YeastOne®) o de tiras con gradiente de antimicrobianos por difusión en agar (comunmente conocidos como E-tests) son alternativas aceptables. La espectrometría de masas también puede proveer de resultados de susceptibilidad y uno de esos sistemas es Vitek MS®. Los puntos de corte clínicos para definir susceptibilidad o resistencia han sido evaluados por EUCAST y CLSI para las especies patógenas más relevantes de Candida. Entre las especies normalmente sensibles (por ej.: C.albicans), la resistencia a fluconazol se observa con frecuencia variable dependiendo del contexto epidemiológico (solamente 2-5% en EEUU y Europa). C.glabrata se considera habitualmente como “susceptible, dosis dependiente” y exhibe susceptibilidad variable a los azoles. C.krusei es intrínsecamente resistente a fluconazol pero no a voriconazol. No hay puntos de corte clínicos para C.auris pero el Centro para Control y Prevención de Enfermedades (CDC) ha propuesto puntos de corte tentativos (disponible en: https://www.cdc.gov/fungal/candida-auris/c-auris-antifungal.html). Más del 90% de los aislamientos de C.auris han adquirido resistencia fluconazol. La resistencia a equinocandinas es poco frecuente (
English to Spanish: Global Fungal Infection Forum 4: Developing a coalition roadmap for integration of fungal disease pathways and antimicrobial resistance solutions into health systems in Latin America General field: Medical Detailed field: Medical: Health Care
Source text - English chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://gaffiperu.s3.eu-west-2.amazonaws.com/Reports/GFIF+4+Report+EN+Final.pdf
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Bio
Medical doctor, microbiologist and specialist in public health, infection prevention and control, and infectious diseases, with extensive experience in scientific communication, research and specialized translation.
I work with English, French and Spanish, focusing on medical, microbiological, pharmaceutical and life sciences content. My scientific background allows me to understand complex concepts and terminology beyond the linguistic level, ensuring accuracy, consistency and subject-matter expertise.
I regularly translate educational materials for LIFE (Leading International Fungal Education) and have also translated content for the ECHO Antimicrobial Resistance (AMR) Curriculum of the American Society for Microbiology. My experience includes both voluntary and commissioned translation projects for international scientific audiences.
I lived in Paris for one year and in Geneva for four years, where I was involved in basic and clinical research and worked as a physician specializing in infectious diseases. This international experience strengthened my command of French and my familiarity with scientific and medical communication in multilingual environments. Several publications in Spanish, English and French.
In addition to my scientific career, I have advanced training in French and English. I am currently pursuing formal studies in Public translation. I am particularly interested in scientific, medical and literary translation.
I am committed to delivering accurate, well-researched and reader-focused translations tailored to the needs of each client.
Member since Mar '24
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