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Tian S, Wu Y, Li H, Rong C, Wu N, Chu Y, Jiang N, Zhang J, Shang H. Evolutionary accumulation of FKS1 mutations from clinical echinocandin-resistant Candida auris. Emerg Microbes Infect 2024; 13:2377584. [PMID: 38989545 PMCID: PMC11265302 DOI: 10.1080/22221751.2024.2377584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 07/04/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Drug resistance to echinocandins, first-line drugs used to treat Candida auris infection, is rapidly emerging. However, the accumulation of mutations in genes other than FKS1 (before an isolate develops to resistance via FKS1 mutations), remains poorly understood. Methods: Four clinical cases and 29 isolates associated with the incremental process of echinocandin resistance were collected and analyzed using antifungal drug susceptibility testing and genome sequencing to assess the evolution of echinocandin resistance. FINDINGS Six echinocandin minimum inhibitory concentration (MIC)-elevated C. auris strains and seven resistant strains were isolated from the urinary system of patients receiving echinocandin treatment. Meanwhile, phylogenetic analyses illustrated that the echinocandin-resistant strains were closely related to other strains in the same patient. Genomic data revealed that the echinocandin-resistant strains had FKS1 mutations. Furthermore, three categories (ECN-S/E/R) of non-synonymous mutant SNP genes (such as RBR3, IFF6, MKC1, MPH1, RAD2, and MYO1) in C. auris appeared to be associated with the three-stage-evolutionary model of echinocandin resistance in C. glabrata: cell wall stress, drug adaptation, and genetic escape (FKS mutation). INTERPRETATION Echinocandin-resistant C. auris undergoes spatial and temporal phase changes closely related to echinocandin exposure, particularly in the urinary system. These findings suggest that FKS1 mutations mediate an evolutionary accumulation of echinocandin resistance followed by modulation of chromosome remodelling and DNA repair processes that ultimately lead to FKS1 hot spot mutations and the development of drug resistance. This study provides an in-depth exploration of the molecular pathways involved in the evolution of Candida auris echinocandin resistance.
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Affiliation(s)
- Sufei Tian
- National Clinical Research Center for Laboratory Medicine, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Department of Laboratory Medicine, the First Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Yusheng Wu
- National Clinical Research Center for Laboratory Medicine, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Department of Laboratory Medicine, the First Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Hailong Li
- National Clinical Research Center for Laboratory Medicine, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Department of Laboratory Medicine, the First Hospital of China Medical University, Shenyang, People’s Republic of China
- NHC Key Laboratory of AIDS Prevention and Treatment, The First Hospital of China Medical University, China Medical University, Shenyang, People’s Republic of China
| | - Chen Rong
- National Clinical Research Center for Laboratory Medicine, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Department of Laboratory Medicine, the First Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Na Wu
- Department of Infectious Diseases, the First Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Yunzhuo Chu
- National Clinical Research Center for Laboratory Medicine, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Department of Laboratory Medicine, the First Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Ning Jiang
- National Clinical Research Center for Laboratory Medicine, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Department of Laboratory Medicine, the First Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Jingping Zhang
- Department of Infectious Diseases, the First Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Hong Shang
- National Clinical Research Center for Laboratory Medicine, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Department of Laboratory Medicine, the First Hospital of China Medical University, Shenyang, People’s Republic of China
- NHC Key Laboratory of AIDS Prevention and Treatment, The First Hospital of China Medical University, China Medical University, Shenyang, People’s Republic of China
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Long B, Lacy AJ, Koyfman A, Liang SY. Candida auris: A focused review for emergency clinicians. Am J Emerg Med 2024; 84:162-167. [PMID: 39137491 DOI: 10.1016/j.ajem.2024.07.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 07/25/2024] [Accepted: 07/28/2024] [Indexed: 08/15/2024] Open
Abstract
INTRODUCTION Candida auris is an emerging pathogen and human health threat. However, diagnosis and treatment of fungal infection due to C. auris are challenging. OBJECTIVE This narrative review provides a focused overview of C. auris for the emergency clinician. DISCUSSION C. auris was first identified in 2009 and is currently present on all continents except Antarctica. C. auris possesses multiple genetic factors resulting in antimicrobial resistance, increased virulence and survival within the host, and environmental adaptation. It is readily transmitted from person to person and from the environment to a person, resulting in colonization. Infection may develop days to months following colonization, most commonly in those with immunocompromised state, significant comorbidities or other underlying conditions, healthcare exposure, and recent antimicrobial therapy. Candidemia, device infection (e.g., central venous catheter), soft tissue or wound infection, burn infection, osteomyelitis, myocarditis, meningitis, and urinary tract infection have been associated with C. auris. Samples should be obtained from the suspected site of infection for microbiological culture. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) with reference databases to differentiate C. auris from other species is optimal for diagnosis, though other molecular testing methods are available. Treatment is challenging due to antifungal resistance, with over 90% resistant to fluconazole. Echinocandins are most commonly used as the first line therapy. Prevention of colonization and infection are vital and include screening in high-risk populations and strict adherence to infection prevention practices with contact precautions and hand hygiene, as well as appropriate decontamination of patient areas. CONCLUSION An understanding of C. auris can assist emergency clinicians in the care of infected or colonized patients.
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Affiliation(s)
- Brit Long
- SAUSHEC, Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, United States.
| | - Aaron J Lacy
- Division of Emergency Medicine Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, United States
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwester, Dallas, TX, United States
| | - Stephen Y Liang
- Divisions of Emergency Medicine and Infectious Diseases, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, United States.
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Castanheira M, Deshpande LM, Rhomberg PR, Carvalhaes CG. Recent increase in Candida auris frequency in the SENTRY surveillance program: antifungal activity and genotypic characterization. Antimicrob Agents Chemother 2024:e0057024. [PMID: 39264189 DOI: 10.1128/aac.00570-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 08/08/2024] [Indexed: 09/13/2024] Open
Abstract
We observed an increase in the frequency of Candida auris among invasive candidiasis isolates in the 2022 SENTRY Antifungal Surveillance Program compared to prior years: ≤0.1% before 2018, 0.4%-0.6% from 2018 to 2021, and 1.6% in 2022. C. auris isolates were collected in seven countries, but 28 (35.9%) isolates were recovered in the USA (five states; more common in New York, Texas, and New Jersey) and 26 (33.3%) in Panama. Greece and Turkey had 12 and 9 isolates, respectively. Overall, 82.1% of the isolates were resistant to fluconazole; 17.9% were resistant to amphotericin B; and 1.3% were resistant to caspofungin, anidulafungin, or micafungin (Centers for Disease Control and Prevention tentative resistance breakpoints). Rezafungin inhibited 96.2% of the isolates (Clinical and Laboratory Standards Institute susceptibility breakpoint). Pandrug resistance was not observed, but 17.9% of the isolates were resistant to fluconazole and amphotericin B. South Asian (Clade I) isolates were most common (n = 40, 51.3%); of these, 97.5% were resistant to fluconazole and 30.0% were resistant to amphotericin B. Thirty (38.5%) isolates belonged to the South American region (Clade IV), and 56.7% of those were resistant to fluconazole and 6.7% to amphotericin B. Seven isolates belonged to the South African Clade III and one to East Asian Clade II. Erg11 (Y132F, K143R, and F126L) and MRR1 (N647T) alterations were detected. One isolate that was resistant to all echinocandins carried an FKS R1354G alteration. Two isolates displayed elevated rezafungin minimum inhibitory concentration (MIC) values but low MIC values against other echinocandins and no FKS alterations. As C. auris is spreading globally, monitoring this species is prudent.
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Affiliation(s)
| | | | - Paul R Rhomberg
- Element Iowa City (JMI Laboratories), North Liberty, Iowa, USA
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Forrest GN. Clinical Microbiology Reviews: a 21st century vision. Clin Microbiol Rev 2024; 37:e0009524. [PMID: 38899878 PMCID: PMC11391689 DOI: 10.1128/cmr.00095-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
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Ramli AH, Jayathilaka EHTT, Dias MKHM, Abdul Malek E, Jain N, An J, Churchill DG, Rukayadi Y, Swain P, Kim CH, de Zoysa M, Mohd Faudzi SM. Antifungal activity of synthetic xanthenone against fluconazole-resistant Candida auris and its mechanism of action. Microb Pathog 2024; 194:106797. [PMID: 39029597 DOI: 10.1016/j.micpath.2024.106797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 06/06/2024] [Accepted: 07/15/2024] [Indexed: 07/21/2024]
Abstract
Candida auris, an emerging multidrug-resistant fungal pathogen discovered in Japan in 2009, poses a significant global health threat, with infections reported in about 25 countries. The escalation of drug-resistant strains underscores the urgent need for new treatment options. This study aimed to investigate the antifungal potential of 2,3,4,4a-tetrahydro-1H-xanthen-1-one (XA1) against C. auris, as well as its mechanism of action and toxic profile. The antifungal activity of XA1 was first evaluated by determining the minimum inhibitory concentration (MIC), time-kill kinetics and biofilm inhibition. In addition, structural changes, membrane permeability, reactive oxygen species (ROS) production, and in vitro and in vivo toxicity of C. auris after exposure to XA1 were investigated. The results indicated that XA1 exhibited an MIC of 50 μg/mL against C. auris, with time-kill kinetics highlighting its efficacy. Field emission scanning electron microscopy (FE-SEM) showed structural damage in XA1-treated cells, supported by increased membrane permeability leading to cell death. Furthermore, XA1 induced ROS production and significantly inhibited biofilm formation. Importantly, XA1 exhibited low cytotoxicity in human epidermal keratinocytes (HaCaT), with a cell viability of over 90 % at 6.25 μg/mL. In addition, an LD50 of 17.68 μg/mL was determined in zebrafish embryos 24 h post fertilization (hpf), with developmental delay observed at prolonged exposure at 6.25 μg/mL (48-96 hpf). These findings position XA1 as a promising candidate for further research and development of an effective antifungal agent.
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Affiliation(s)
- Amirah Hani Ramli
- Natural Medicines and Product Research Laboratory, Institute of Bioscience, Universiti Putra Malaysia, Serdang, 43400, Selangor, Malaysia
| | - E H T Thulshan Jayathilaka
- College of Veterinary Medicine and Research Institute of Veterinary Medicine, Chungnam National University, Yuseong-gu, Daejeon, 34134, Republic of Korea
| | | | - Emilia Abdul Malek
- Department of Chemistry, Faculty of Science, Universiti Putra Malaysia, 43400, UPM, Serdang, Selangor, Malaysia
| | - Neha Jain
- Department of Chemistry, Molecular Logic Gate Laboratory, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea
| | - Jongkeol An
- Department of Chemistry, Molecular Logic Gate Laboratory, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea
| | - David G Churchill
- Department of Chemistry, Molecular Logic Gate Laboratory, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea
| | - Yaya Rukayadi
- Natural Medicines and Product Research Laboratory, Institute of Bioscience, Universiti Putra Malaysia, Serdang, 43400, Selangor, Malaysia; Department of Food Science, Faculty of Food Science and Technology, Universiti Putra Malaysia, 43400, UPM, Serdang, Selangor, Malaysia
| | - Puspanjali Swain
- Department of Biology, Chungnam National University, Yuseong-gu, Daejeon, 34134, Republic of Korea
| | - Cheol-Hee Kim
- Department of Biology, Chungnam National University, Yuseong-gu, Daejeon, 34134, Republic of Korea
| | - Mahanama de Zoysa
- College of Veterinary Medicine and Research Institute of Veterinary Medicine, Chungnam National University, Yuseong-gu, Daejeon, 34134, Republic of Korea.
| | - Siti Munirah Mohd Faudzi
- Natural Medicines and Product Research Laboratory, Institute of Bioscience, Universiti Putra Malaysia, Serdang, 43400, Selangor, Malaysia; Department of Chemistry, Faculty of Science, Universiti Putra Malaysia, 43400, UPM, Serdang, Selangor, Malaysia.
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Yue H, Xu X, Peng B, Wang X, Zhang S, Tian J, Wang S, Song M, Liu Q. Antifungal Activity of the Dichloromethane Extract of CaoHuangGuiXiang Formula Against Candida auris by in vitro and in vivo Evaluation. Infect Drug Resist 2024; 17:3547-3559. [PMID: 39161467 PMCID: PMC11330856 DOI: 10.2147/idr.s467418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 08/02/2024] [Indexed: 08/21/2024] Open
Abstract
Purpose CaoHuangGuiXiang (CHGX) formula is a traditional Chinese medicine for the treatment of Candida-related infection. However, its antifungal mechanisms against the emerging fungal pathogen Candida auris remain unclear. This study aimed to evaluate the antifungal activity of the dichloromethane extract of CHGX (CHGX-DME) and clarified its antifungal mechanims against C. auris. Methods The major components of CHGX-DME were identified by ultra-performance liquid chromatography tandem mass spectrometry. Then, the minimal inhibitory concentration (MIC) assay and the time-kill kinetic assay were performed to investigate the in vitro antifungal activity of CHGX-DME against C. auris, including 8 isolates of 4 discrete clades and 2 special phenotypes (filamentous and aggregative). Furthermore, the effect of CHGX-DME on biofilm development was examined. In addition, the in vivo toxicity and efficacy of CHGX-DME were evaluated in a Galleria mellonella infection model. Results First, 20 major compounds in CHGX-DME were detected and characterized. The MIC50% and MIC90% of CHGX-DME against C. auris isolates ranged from 50-200 mg/L and 100-400 mg/L, respectively. At 400 mg/L, CHGX-DME was able to efficiently kill more than 70% and 90% of C. auris cells after 3 hours and 6 hours of treatment, respectively. This notable antifungal activity exhibited a dosage- and time-dependent manner. Moreover, CHGX-DME not only played a critical role in inhibiting the proliferation of filamentous and aggregative cells, but also showed restricting effect on biofilm development in C. auris. Importantly, it significantly improved the survival rate and reduced the fungal burden in G. mellonella infection models, suggesting a remarkable treatment effect against C. auris infection. Conclusion CHGX-DME exhibited potent antifungal activity against C. auris and significantly ameliorated this fungal infection in the G. mellonella model, confirming that it would be a promising antifungal drug for the troublesome and emerging fungal pathogen C. auris.
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Affiliation(s)
- Huizhen Yue
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China
- Beijing Institute of Chinese Medicine, Beijing, People’s Republic of China
- Beijing Key Laboratory of Basic Research with Traditional Chinese Medicine on Infectious Diseases, Beijing, People’s Republic of China
| | - Xiaolong Xu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China
- Beijing Institute of Chinese Medicine, Beijing, People’s Republic of China
- Beijing Key Laboratory of Basic Research with Traditional Chinese Medicine on Infectious Diseases, Beijing, People’s Republic of China
| | - Bing Peng
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China
- Beijing Institute of Chinese Medicine, Beijing, People’s Republic of China
- Beijing Key Laboratory of Basic Research with Traditional Chinese Medicine on Infectious Diseases, Beijing, People’s Republic of China
| | - Xuanyu Wang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China
| | - Shengnan Zhang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China
| | - Jinhao Tian
- Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Shuo Wang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China
| | - Maifen Song
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China
| | - Qingquan Liu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China
- Beijing Institute of Chinese Medicine, Beijing, People’s Republic of China
- Beijing Key Laboratory of Basic Research with Traditional Chinese Medicine on Infectious Diseases, Beijing, People’s Republic of China
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Kim JS, Cha H, Bahn YS. Comprehensive Overview of Candida auris: An Emerging Multidrug-Resistant Fungal Pathogen. J Microbiol Biotechnol 2024; 34:1365-1375. [PMID: 38881183 PMCID: PMC11294645 DOI: 10.4014/jmb.2404.04040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/18/2024]
Abstract
The rise of Candida auris, a multidrug-resistant fungal pathogen, across more than 40 countries, has signaled an alarming threat to global health due to its significant resistance to existing antifungal therapies. Characterized by its rapid spread and robust drug resistance, C. auris presents a critical challenge in managing infections, particularly in healthcare settings. With research on its biological traits and genetic basis of virulence and resistance still in the early stages, there is a pressing need for a concerted effort to understand and counteract this pathogen. This review synthesizes current knowledge on the epidemiology, biology, genetic manipulation, pathogenicity, diagnostics, and resistance mechanisms of C. auris, and discusses future directions in research and therapeutic development. By exploring the complexities surrounding C. auris, we aim to underscore the importance of advancing research to devise effective control and treatment strategies.
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Affiliation(s)
- Ji-Seok Kim
- Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, Seoul 03722, Republic of Korea
| | - Hyunjin Cha
- Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, Seoul 03722, Republic of Korea
| | - Yong-Sun Bahn
- Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, Seoul 03722, Republic of Korea
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Determann B, Fu J, Wickes BL. Development of a Shuttle Vector That Transforms at High Frequency for the Emerging Human Fungal Pathogen: Candida auris. J Fungi (Basel) 2024; 10:477. [PMID: 39057362 PMCID: PMC11278357 DOI: 10.3390/jof10070477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Routine molecular manipulation of any organism is inefficient and difficult without the existence of a plasmid. Although transformation is possible in C. auris, no plasmids are available that can serve as cloning or shuttle vectors. C. auris centromeres have been well characterized but have not been explored further as molecular tools. We tested C. auris centromeric sequences to identify which, if any, could be used to create a plasmid that was stably maintained after transformation. We cloned all seven C. auris centromeric sequences and tested them for transformation frequency and stability. Transformation frequency varied significantly; however, one was found to transform at a very high frequency. A 1.7 Kb subclone of this sequence was used to construct a shuttle vector. The vector was stable with selection and maintained at ~1 copy per cell but could be easily lost when selection was removed, which suggested that the properties of the centromeric sequence were more Autonomously Replicating Sequence (ARS)-like than centromere-like when part of a plasmid. Rescue of this plasmid from transformed C. auris cells into E. coli revealed that it remained intact after the initial C. auris transformation, even when carrying large inserts. The plasmid was found to be able to transform all four clades of C. auris, with varying frequencies. This plasmid is an important new reagent in the C. auris molecular toolbox, which will enhance the investigation of this human fungal pathogen.
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Affiliation(s)
| | | | - Brian L. Wickes
- The Department of Microbiology, Immunology, and Molecular Genetics, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA (J.F.)
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Chalin A, Arvor A, Hervault AS, Plaisance M, Niol L, Simon S, Volland H. A lateral flow immunoassay for the rapid identification of Candida auris from isolates or directly from surveillance enrichment broths. Front Microbiol 2024; 15:1439273. [PMID: 39021636 PMCID: PMC11252032 DOI: 10.3389/fmicb.2024.1439273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Candida auris is a recently discovered yeast with a multi-drug resistant profile associated with high mortality rates. The rapid identification of Candida auris in hospital settings is crucial to allow appropriate therapeutic and rapid implementation of infection management measures. The aim of this study was to develop a lateral flow immunoassay (LFIA) for the rapid identification of Candida auris. Methods Highly specific monoclonal antibodies were obtained by immunizing mice with membrane proteins from Candida auris which were then used to develop a LFIA whose performance was assessed by testing 12 strains of Candida auris and 37 strains of other Candida species. Isolates were grown on either Sabouraud dextrose, CHROMagarTM Candida Plus or HardyCHROMTM Candida + auris agar plates. The strains were also cultured on salt sabouraud-dextrose with chloramphenicol or a commercially available Salt-Sabouraud Dulcitol Broth with chloramphenicol and gentamicin, and processed using a simple centrifugation protocol to recover a pellet. Finally, the colonies or yeast extract were transferred to the LFIA to determine the specificity and sensitivity of the assay. Results The LFIA reached 100% specificity and sensitivity from solid agar plates. For both enrichment broths, some Candida non-auris species were able to grow, but the LFIA remained 100% specific. The use of a dextrose-based sabouraud broth resulted in earlier identification with the LFIA, with most of the Candida auris strains detected at 24 h. Conclusion The developed LFIA prototype represents a powerful tool to fight the emerging threat of Candida auris. Clinical validation represents the next step.
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Affiliation(s)
- Arnaud Chalin
- NG Biotech – Research and Development Department, Guipry-Messac, France
| | - Antoine Arvor
- Université Paris-Saclay, Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement (INRAE), Médicaments et Technologies pour la Santé (MTS), Service de Pharmacologie et d'Immunoanalyse (SPI), Laboratoire d'Etudes et de Recherches en Immunoanalyse (LERI), Gif-sur-Yvette, France
| | | | - Marc Plaisance
- Université Paris-Saclay, Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement (INRAE), Médicaments et Technologies pour la Santé (MTS), Service de Pharmacologie et d'Immunoanalyse (SPI), Laboratoire d'Etudes et de Recherches en Immunoanalyse (LERI), Gif-sur-Yvette, France
| | - Léa Niol
- NG Biotech – Research and Development Department, Guipry-Messac, France
| | - Stéphanie Simon
- Université Paris-Saclay, Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement (INRAE), Médicaments et Technologies pour la Santé (MTS), Service de Pharmacologie et d'Immunoanalyse (SPI), Laboratoire d'Etudes et de Recherches en Immunoanalyse (LERI), Gif-sur-Yvette, France
| | - Hervé Volland
- Université Paris-Saclay, Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement (INRAE), Médicaments et Technologies pour la Santé (MTS), Service de Pharmacologie et d'Immunoanalyse (SPI), Laboratoire d'Etudes et de Recherches en Immunoanalyse (LERI), Gif-sur-Yvette, France
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Meawed TE, AlNakeera AM, Attia O, Hassan NAM, Anis RH. Candida auris central line-associated blood stream infection in critically ill patients: the worst end of a bad scenario. Int Microbiol 2024:10.1007/s10123-024-00545-3. [PMID: 38940863 DOI: 10.1007/s10123-024-00545-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/29/2024] [Accepted: 06/04/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Candida auris (C. auris) is an emerging aggressive pathogen that causes severe infections in critically ill patients. Therefore, the assessment of this pathogen, characterized by inclination for biofilm formation, elevated colonization rate, and resistance to multiple drugs, holds a paramount importance. There is no data regarding the isolation of C. auris in our tertiary care hospitals' intensive care units (ICUs). The current case study was arranged to assess the incidence of C. auris central line-associated bloodstream infection (CLABSI) problem in our (ICUs). METHODS Specimens of central venous catheter blood, peripheral blood, and catheter tips were collected from 301 critically ill patients with suspected (CLABSI). Microbiological cultures were utilized to diagnose bacterial and fungal superinfections. The fungal species identification and antifungal susceptibility testing were conducted using the Brilliance Chrome agar, VITEK® 2 compact system, and MALDI-TOF MS. RESULTS All included specimens (100%) yielded significant growth. Only 14 specimens (4.7%) showed fungal growth in the form of different Candida species. When comparing the identification of C. auris, MALDI-TOF MS is considered the most reliable method. Brilliance CHROMagar demonstrated a sensitivity of 100%, whereas VITEK only showed a sensitivity of approximately 33%. All recovered isolates of C. auris were fluconazole resistant. CONCLUSION C. auris is a highly resistant emerging pathogen in our ICUs that is often overlooked in identification using conventional methods.
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Affiliation(s)
- Takwa E Meawed
- Medical Microbiology and Immunology Department, Zagazig University, Zagazig, Egypt.
| | | | - Osama Attia
- Internal Medicine Department, Zagazig University, Zagazig, Egypt
| | | | - Reham H Anis
- Medical Microbiology and Immunology Department, Zagazig University, Zagazig, Egypt
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Pham D, Sivalingam V, Tang HM, Montgomery JM, Chen SCA, Halliday CL. Molecular Diagnostics for Invasive Fungal Diseases: Current and Future Approaches. J Fungi (Basel) 2024; 10:447. [PMID: 39057332 PMCID: PMC11278267 DOI: 10.3390/jof10070447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/21/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
Invasive fungal diseases (IFDs) comprise a growing healthcare burden, especially given the expanding population of immunocompromised hosts. Early diagnosis of IFDs is required to optimise therapy with antifungals, especially in the setting of rising rates of antifungal resistance. Molecular techniques including nucleic acid amplification tests and whole genome sequencing have potential to offer utility in overcoming limitations with traditional phenotypic testing. However, standardisation of methodology and interpretations of these assays is an ongoing undertaking. The utility of targeted Aspergillus detection has been well-defined, with progress in investigations into the role of targeted assays for Candida, Pneumocystis, Cryptococcus, the Mucorales and endemic mycoses. Likewise, whilst broad-range polymerase chain reaction assays have been in use for some time, pathology stewardship and optimising diagnostic yield is a continuing exercise. As costs decrease, there is also now increased access and experience with whole genome sequencing, including metagenomic sequencing, which offers unparalleled resolution especially in the investigations of potential outbreaks. However, their role in routine diagnostic use remains uncommon and standardisation of techniques and workflow are required for wider implementation.
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Affiliation(s)
- David Pham
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital, Westmead, NSW 2145, Australia; (D.P.)
| | - Varsha Sivalingam
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital, Westmead, NSW 2145, Australia; (D.P.)
| | - Helen M. Tang
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital, Westmead, NSW 2145, Australia; (D.P.)
| | - James M. Montgomery
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital, Westmead, NSW 2145, Australia; (D.P.)
| | - Sharon C.-A. Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital, Westmead, NSW 2145, Australia; (D.P.)
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
- Sydney Infectious Diseases Institute, The University of Sydney, Westmead, NSW 2145, Australia
| | - Catriona L. Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital, Westmead, NSW 2145, Australia; (D.P.)
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12
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Khanum N, Alfaraj SH, Alboqmy KN, Alshakrah F, Dar NG, Abdallah H, Kumar D, Alsalam M, Abu-Salah AHM, Alsunaid AA, Alhamed RAR, Cherian PK, Alharbi OM, Alhemaid NY, Mamayabay MAM, Memish ZA. Implementation of effective strategies to prevent Candida auris transmission in a Quaternary Care Center, Riyadh, Saudi Arabia. J Chemother 2024:1-16. [PMID: 38915243 DOI: 10.1080/1120009x.2024.2370207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/14/2024] [Indexed: 06/26/2024]
Abstract
This study outlines the results of an investigation of a large C. auris outbreak at King Saud Medical City (KSMC), a quaternary hospital in Saudi Arabia. We identified 122 cases of C. auris (colonization, 74; infection, 48) from June 2021 to June 2022. The mean patient age was 48.4 years, and the median duration of stay before diagnosis was 32.7 days. A significant proportion of patients (87.70%) were diagnosed with C. auris more than 3 days after admission to KSMC. The source of exposure was either nosocomial (from KSMC, 28.68%; from other hospitals, 16.39%) or unknown (54.91%). The hospitalization mortality rate was 45.90%. This report highlights the challenges in investigating and managing C. auris outbreaks, emphasizing the need for a comprehensive approach incorporating strategies for screening and early identification, effective environmental cleaning, and the implementation of stringent infection control measures such as hand hygiene, isolation of patient, standard and contact precaution and decolonization.
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Affiliation(s)
- Nazia Khanum
- Prevention and Control of Infection Administration, King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Sarah H Alfaraj
- Prevention and Control of Infection Administration, King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Khulood Naser Alboqmy
- Prevention and Control of Infection Administration, King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Faleh Alshakrah
- Prevention and Control of Infection Administration, King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Nadeem Gul Dar
- Prevention and Control of Infection Administration, King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Hassan Abdallah
- Prevention and Control of Infection Administration, King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Deva Kumar
- Prevention and Control of Infection Administration, King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Mona Alsalam
- Prevention and Control of Infection Administration, King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | | | - Antisar Abdulrahman Alsunaid
- Prevention and Control of Infection Administration, King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Rashed Abdulaziz Rashed Alhamed
- Prevention and Control of Infection Administration, King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Prince Kochummen Cherian
- Prevention and Control of Infection Administration, King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Ohoud Mohammed Alharbi
- Prevention and Control of Infection Administration, King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Nada Yousef Alhemaid
- Prevention and Control of Infection Administration, King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Mary Ann M Mamayabay
- Prevention and Control of Infection Administration, King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Ziad A Memish
- Research and Innovation Center, King Saud Medical City, Ministry of Health & College of Medicine, Al Faisal University, Riyadh, Kingdom of Saudi Arabia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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13
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Griffith EM, Marsalisi C, Verdecia J, Buchanan SR, Goulart MA. Recurrent Fungemia Due to Candida auris. Cureus 2024; 16:e62478. [PMID: 39022480 PMCID: PMC11251896 DOI: 10.7759/cureus.62478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 06/16/2024] [Indexed: 07/20/2024] Open
Abstract
We present a case of recurrent multidrug-resistant Candida auris (C. auris) in a patient who required multiple hospitalizations. The patient's case was complicated by interval admissions to the intensive care unit for septic and hypovolemic shock for 12 months to manage C. auris fungemia. Despite adequate isolation precautions and appropriate antifungal treatment, this case demonstrates the profound implications of this emerging pathogen, specifically regarding invasive infections. Moreover, C. auris is rapidly becoming known as a multidrug-resistant organism, which limits treatment options and thus contributes to high mortality.
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Affiliation(s)
- Emma M Griffith
- Internal Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, USA
| | - Christopher Marsalisi
- Internal Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, USA
| | - Jorge Verdecia
- Infectious Diseases, University of Florida College of Medicine-Jacksonville, Jacksonville, USA
| | | | - Michael A Goulart
- Infection Prevention, University of Florida Health, Jacksonville, USA
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14
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Zöngür A. Antimicrobial, Antioxidant and Cytotoxic Effects of Essential Oil, Fatty Acids and Bioactive Compounds of Beta vulgaris var. crassa (Fodder Beet). Indian J Microbiol 2024; 64:719-731. [PMID: 39010984 PMCID: PMC11246347 DOI: 10.1007/s12088-024-01269-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 03/24/2024] [Indexed: 07/17/2024] Open
Abstract
Beta vulgaris var. crassa is undoubtedly a very important plant that is not used enough in the world. In this study, it was aimed to determine the cytotoxic activities of the components (essential oils, fatty acids, total phenol and flavonoid) found in the leaf parts of Beta vulgaris var. crassa against PC-3, MCF-7 and HeLa cancer cell lines. In addition, the effectiveness of these ingredients against bacteria and fungi that can cause serious health problems in humans was tested. In experiments, three tumor cell lines were exposed to various plant extract concentrations (31.25, 62.5, 125, 250, 500 and 1000 µg/mL) for 72 h. It was found that plant extracts showed high (SI: 2.14 > 2) cytotoxicity to PC-3 cells, moderate (SI: 1.62 < 2) to HeLa cells, and low (SI: 0.93 < 2) cytotoxicity to MCF-7 cells. Also, different plant extract concentrations were found to cause an inhibition rate of 16.3-22.3% in Staphylococcus aureus, 16.8-23.5% in Streptococcus pyogenes and 12-16.2% in Cutibacterium acnes. Similarly, inhibition rates were determined between 9.5-20.7% for Candida albicans, 3.5-7.7% for Candida auris, and 5.5-15.1% for Candida glabrata. The results showed that the plant extract exhibited a concentration-dependent cytotoxic and antimicrobial effect against both cancer cell lines and microbial pathogens. Graphical Abstract Supplementary Information The online version contains supplementary material available at 10.1007/s12088-024-01269-8.
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15
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Izadi A, Paknia F, Roostaee M, Mousavi SAA, Barani M. Advancements in nanoparticle-based therapies for multidrug-resistant candidiasis infections: a comprehensive review. NANOTECHNOLOGY 2024; 35:332001. [PMID: 38749415 DOI: 10.1088/1361-6528/ad4bed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 05/15/2024] [Indexed: 05/31/2024]
Abstract
Candida auris, a rapidly emerging multidrug-resistant fungal pathogen, poses a global health threat, with cases reported in over 47 countries. Conventional detection methods struggle, and the increasing resistance ofC. auristo antifungal agents has limited treatment options. Nanoparticle-based therapies, utilizing materials like silver, carbon, zinc oxide, titanium dioxide, polymer, and gold, show promise in effectively treating cutaneous candidiasis. This review explores recent advancements in nanoparticle-based therapies, emphasizing their potential to revolutionize antifungal therapy, particularly in combatingC. aurisinfections. The discussion delves into mechanisms of action, combinations of nanomaterials, and their application against multidrug-resistant fungal pathogens, offering exciting prospects for improved clinical outcomes and reduced mortality rates. The aim is to inspire further research, ushering in a new era in the fight against multidrug-resistant fungal infections, paving the way for more effective and targeted therapeutic interventions.
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Affiliation(s)
- Alireza Izadi
- Department of Medical Parasitology and Mycology, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
- Medical Mycology and Bacteriology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Paknia
- Department of Nanobiotechnology, Faculty of Biological Sciences, Tarbiat Modares University, Tehran 14115-154, Iran
| | - Maryam Roostaee
- Department of Chemistry, Faculty of Sciences, Vali-e-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Seyed Amin Ayatollahi Mousavi
- Department of Medical Parasitology and Mycology, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
- Medical Mycology and Bacteriology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahmood Barani
- Department of Chemistry, Faculty of Nano and Bio Science and Technology, Persian Gulf University, Bushehr 75168, Iran
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16
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Hleba L, Hlebová M, Charousová I. In Vitro Evaluation of Synergistic Essential Oils Combination for Enhanced Antifungal Activity against Candida spp. Life (Basel) 2024; 14:693. [PMID: 38929677 PMCID: PMC11204509 DOI: 10.3390/life14060693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
In recent years, a significant number of infections have been attributed to non-albicidal Candida species (NAC), mainly due to the increasing resistance of NAC to antifungal agents. As only a few antifungal agents are available (azoles, echinocandins, polyenes, allylamines and nucleoside analogues), it is very important to look for possible alternatives to inhibit resistant fungi. One possibility could be essential oils (EOs), which have been shown to have significant antifungal and antibacterial activity. Therefore, in this study, the efficacy of 12 EOs and their combinations was evaluated against four yeasts of the genus Candida (C. albicas, C. glabrata, C. tropicalis and C. parapsilosis). GC-MS and GC-MS FID techniques were used for the chemical analysis of all EOs. VITEK-2XL was used to determine the antifungal susceptibility of the tested Candida spp. strains. The agar disc diffusion method was used for primary screening of the efficacy of the tested EOs. The broth dilution method was used to determine the minimum inhibitory concentrations (MICs) of the most potent EOs. After MIC cultivation, the minimum fungicidal concentration (MFC) was determined on Petri dishes (60 mm). The synergistic effect of combined EOs was evaluated using the checkerboard method and expressed as a fractional inhibitory concentration index (FICI). The results showed that ginger > ho-sho > absinth > dill > fennel > star anise > and cardamom were the most effective EOs. For all Candida species tested, the synergy was mainly observed in these combinations: ginger/fennel for C. albicans FICI 0.25 and C. glabrata, C. tropicalis and C. parapsilosis FICI 0.5 and absinth/fennel for C. albicans FICI 0.3125, C. tropicalis FICI 0.3125 and C. parapsilosis FICI 0.375. Our results suggest that the resistance of fungal pathogens to available antifungals could be reduced by combining appropriate EOs.
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Affiliation(s)
- Lukáš Hleba
- Institute of Biotechnology, Faculty of Biotechnology and Food Sciences, Slovak University of Agriculture in Nitra, Tr. A. Hlinku 2, 94976 Nitra, Slovakia
| | - Miroslava Hlebová
- Institute of Biology and Biotechnology, Faculty of Natural Sciences, University of SS. Cyril and Methodius, Nám. J. Herdu 2, SK-91701 Trnava, Slovakia
| | - Ivana Charousová
- Clinical Microbiology Laboratory, Unilabs Slovensko, s.r.o., J. Bellu 66, SK-03495 Likavka, Slovakia
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17
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Al Ajmi JA, B. Malik A, Nafady-Hego H, Hanana F, Abraham J, G. Garcell H, Hudaib G, Al-Wali W, Eltayeb F, Shams S, G. Thomas A, Saleem S, Abou-Samra AB, Butt AA. Spectrum of infection and outcomes in individuals with Candida auris infection in Qatar. PLoS One 2024; 19:e0302629. [PMID: 38781160 PMCID: PMC11115301 DOI: 10.1371/journal.pone.0302629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 04/05/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND We investigated the spectrum of infection and risk factors for invasive fungal disease due to Candida auris (CA) in Qatar. METHODS We performed structured chart reviews on individuals with any positive CA culture between May 2019 and December 2022 at three tertiary care hospitals in Qatar. Invasive CA disease (ICAD) was defined as a positive sterile site culture, or any positive culture for CA with appropriate antifungal prescription. Main outcomes included proportion of individuals who developed ICAD among those with positive cultures, and 30-day/in-hospital mortality. RESULTS Among 331 eligible individuals, median age was 56 years, 83.1% were male, 70.7% were non-Qataris, and 37.5% had ≥ 3 comorbidities at baseline. Overall, 86.4% were deemed to have colonization and 13.6% developed ICAD. Those with ICAD were more likely to have invasive central venous or urinary catheterization and mechanical ventilation. Individuals with ICAD had longer prior ICU stay (16 vs 26 days, P = 0.002), and longer hospital length of stay (63 vs. 43 days; P = 0.003), and higher 30-day mortality (38% vs. 14%; P<0.001). In multivariable regression analysis, only mechanical ventilation was associated with a higher risk of ICAD (OR 3.33, 95% CI 1.09-10.17). CONCLUSION Invasive Candida auris Disease is associated with longer hospital stay and higher mortality. Severely ill persons on mechanical ventilation should be especially monitored for development of ICAD.
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Affiliation(s)
- Jameela A. Al Ajmi
- Corporate Quality and Patient Safety Department, Hamad Medical Corporation, Doha, Qatar
| | - Aimon B. Malik
- Corporate Quality and Patient Safety Department, Hamad Medical Corporation, Doha, Qatar
| | - Hanaa Nafady-Hego
- Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Fathima Hanana
- Corporate Quality and Patient Safety Department, Hamad Medical Corporation, Doha, Qatar
| | - Joji Abraham
- Corporate Quality and Patient Safety Department, Hamad Medical Corporation, Doha, Qatar
| | - Humberto G. Garcell
- Infection Prevention and Control Department, The Cuban Hospital, Dukhan, Qatar
| | - Ghada Hudaib
- Corporate Quality and Patient Safety Department, Hamad Medical Corporation, Doha, Qatar
| | - Walid Al-Wali
- Department of Microbiology and Laboratory Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Faiha Eltayeb
- Department of Microbiology and Laboratory Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Sherin Shams
- Corporate Quality and Patient Safety Department, Hamad Medical Corporation, Doha, Qatar
| | - Anil G. Thomas
- Corporate Quality and Patient Safety Department, Hamad Medical Corporation, Doha, Qatar
| | - Samah Saleem
- Corporate Quality and Patient Safety Department, Hamad Medical Corporation, Doha, Qatar
| | - Abdul-Badi Abou-Samra
- Corporate Quality and Patient Safety Department, Hamad Medical Corporation, Doha, Qatar
| | - Adeel A. Butt
- Corporate Quality and Patient Safety Department, Hamad Medical Corporation, Doha, Qatar
- Department of Medicine and Population Health Sciences, Weill Cornell Medicine, New York, NY, United States of America
- Department of Medicine and Population Health Sciences, Weill Cornell Medicine, Education City, Qatar
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18
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Silva I, Miranda IM, Costa-de-Oliveira S. Potential Environmental Reservoirs of Candida auris: A Systematic Review. J Fungi (Basel) 2024; 10:336. [PMID: 38786691 PMCID: PMC11122228 DOI: 10.3390/jof10050336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/28/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024] Open
Abstract
Candida auris, a multidrug-resistant yeast, poses significant challenges in healthcare settings worldwide. Understanding its environmental reservoirs is crucial for effective control strategies. This systematic review aimed to review the literature regarding the natural and environmental reservoirs of C. auris. Following the PRISMA guidelines, published studies until October 2023 were searched in three databases: PubMed, Web of Science, and Scopus. Information regarding the origin, sampling procedure, methods for laboratory identification, and antifungal susceptibility was collected and analyzed. Thirty-three studies published between 2016 and 2023 in 15 countries were included and analyzed. C. auris was detected in various environments, including wastewater treatment plants, hospital patient care surfaces, and natural environments such as salt marshes, sand, seawater, estuaries, apples, and dogs. Detection methods varied, with molecular techniques often used alongside culture. Susceptibility profiles revealed resistance patterns. Phylogenetic studies highlight the potential of environmental strains to influence clinical infections. Despite methodological heterogeneity, this review provides valuable information for future research and highlights the need for standardized sampling and detection protocols to mitigate C. auris transmission.
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Affiliation(s)
- Isabel Silva
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - Isabel M. Miranda
- Cardiovascular R&D Centre UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - Sofia Costa-de-Oliveira
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Center for Health Technology and Services Research—CINTESIS@RISE, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
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19
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Jones CR, Neill C, Borman AM, Budd EL, Cummins M, Fry C, Guy RL, Jeffery K, Johnson EM, Manuel R, Mirfenderesky M, Moore G, Patel B, Schelenz S, Staniforth K, Taori SK, Brown CS. The laboratory investigation, management, and infection prevention and control of Candida auris: a narrative review to inform the 2024 national guidance update in England. J Med Microbiol 2024; 73:001820. [PMID: 38771623 PMCID: PMC11165919 DOI: 10.1099/jmm.0.001820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/11/2024] [Indexed: 05/22/2024] Open
Abstract
The emergent fungal pathogen Candida auris is increasingly recognised as an important cause of healthcare-associated infections globally. It is highly transmissible, adaptable, and persistent, resulting in an organism with significant outbreak potential that risks devastating consequences. Progress in the ability to identify C. auris in clinical specimens is encouraging, but laboratory diagnostic capacity and surveillance systems are lacking in many countries. Intrinsic resistance to commonly used antifungals, combined with the ability to rapidly acquire resistance to therapy, substantially restricts treatment options and novel agents are desperately needed. Despite this, outbreaks can be interrupted, and mortality avoided or minimised, through the application of rigorous infection prevention and control measures with an increasing evidence base. This review provides an update on epidemiology, the impact of the COVID-19 pandemic, risk factors, identification and typing, resistance profiles, treatment, detection of colonisation, and infection prevention and control measures for C. auris. This review has informed a planned 2024 update to the United Kingdom Health Security Agency (UKHSA) guidance on the laboratory investigation, management, and infection prevention and control of Candida auris. A multidisciplinary response is needed to control C. auris transmission in a healthcare setting and should emphasise outbreak preparedness and response, rapid contact tracing and isolation or cohorting of patients and staff, strict hand hygiene and other infection prevention and control measures, dedicated or single-use equipment, appropriate disinfection, and effective communication concerning patient transfers and discharge.
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Affiliation(s)
- Christopher R. Jones
- HCAI, Fungal, AMR, AMU, and Sepsis Division, UK Health Security Agency, London, UK
| | - Claire Neill
- HCAI, Fungal, AMR, AMU, and Sepsis Division, UK Health Security Agency, London, UK
| | - Andrew M. Borman
- UKHSA Mycology Reference Laboratory, National Infection Services, UKHSA South West Laboratory, Science Quarter, Southmead Hospital, Bristol, UK
- MRC Centre for Medical Mycology, University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter, UK
| | - Emma L. Budd
- HCAI, Fungal, AMR, AMU, and Sepsis Division, UK Health Security Agency, London, UK
| | - Martina Cummins
- Department of Microbiology and Infection Control, Barts Health NHS Trust, London, UK
| | - Carole Fry
- HCAI, Fungal, AMR, AMU, and Sepsis Division, UK Health Security Agency, London, UK
| | - Rebecca L. Guy
- HCAI, Fungal, AMR, AMU, and Sepsis Division, UK Health Security Agency, London, UK
| | - Katie Jeffery
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Elizabeth M. Johnson
- UKHSA Mycology Reference Laboratory, National Infection Services, UKHSA South West Laboratory, Science Quarter, Southmead Hospital, Bristol, UK
- MRC Centre for Medical Mycology, University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter, UK
| | - Rohini Manuel
- Public Health Laboratory London, Science Group, UK Health Security Agency, London, UK
| | | | - Ginny Moore
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - Bharat Patel
- Public Health Laboratory London, Science Group, UK Health Security Agency, London, UK
| | - Silke Schelenz
- Department of Microbiology, King’s College Hospital NHS Foundation Trust, London, UK
| | - Karren Staniforth
- HCAI, Fungal, AMR, AMU, and Sepsis Division, UK Health Security Agency, London, UK
| | | | - Colin S. Brown
- HCAI, Fungal, AMR, AMU, and Sepsis Division, UK Health Security Agency, London, UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
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20
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De Gaetano S, Midiri A, Mancuso G, Avola MG, Biondo C. Candida auris Outbreaks: Current Status and Future Perspectives. Microorganisms 2024; 12:927. [PMID: 38792757 PMCID: PMC11123812 DOI: 10.3390/microorganisms12050927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024] Open
Abstract
Candida auris has been identified by the World Health Organization (WHO) as a critical priority pathogen on its latest list of fungi. C. auris infections are reported in the bloodstream and less commonly in the cerebrospinal fluid and abdomen, with mortality rates that range between 30% and 72%. However, no large-scale epidemiology studies have been reported until now. The diagnosis of C. auris infections can be challenging, particularly when employing conventional techniques. This can impede the early detection of outbreaks and the implementation of appropriate control measures. The yeast can easily spread between patients and in healthcare settings through contaminated environments or equipment, where it can survive for extended periods. Therefore, it would be desirable to screen patients for C. auris colonisation. This would allow facilities to identify patients with the disease and take appropriate prevention and control measures. It is frequently unsusceptible to drugs, with varying patterns of resistance observed among clades and geographical regions. This review provides updates on C. auris, including epidemiology, clinical characteristics, genomic analysis, evolution, colonisation, infection, identification, resistance profiles, therapeutic options, prevention, and control.
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Affiliation(s)
| | | | | | | | - Carmelo Biondo
- Mycology Laboratory, Department of Human Pathology, University of Messina, 98125 Messina, Italy; (S.D.G.); (A.M.); (G.M.); (M.G.A.)
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21
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Acosta-Mosquera Y, Tapia JC, Armas-González R, Cáceres-Valdiviezo MJ, Fernández-Cadena JC, Andrade-Molina D. Prevalence and Species Distribution of Candida Clinical Isolates in a Tertiary Care Hospital in Ecuador Tested from January 2019 to February 2020. J Fungi (Basel) 2024; 10:304. [PMID: 38786659 PMCID: PMC11122525 DOI: 10.3390/jof10050304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/03/2024] [Accepted: 04/09/2024] [Indexed: 05/25/2024] Open
Abstract
The incidence of candidemia in healthcare centers is associated with high morbidity and mortality. Frequency varies significantly among regions, with some species being more prevalent than others in Latin America. In this study, 191 clinical Candida isolates were collected from a major hospital in Ecuador from January 2019 to February 2020 aiming to assess their prevalence and distribution. After data processing, 168 isolates characterized by the VITEK 2 system were subsequently identified by ITS sequencing. Results showed diverse Candida species distributions, with C. albicans and C. tropicalis being the most prevalent across different clinical sources. In hospitalized individuals, C. tropicalis (38%) and C. albicans (37%) were the most prevalent, followed by, C. parapsilosis (16%), C. glabrata (5%), and other non-Candida albicans (NCA) species (6%). Conversely, C. parapsilosis (48%), C. albicans (20%), and C. glabrata (14%), associated with candidemia, were the most common in blood and CSF. Additionally, uncommon NCA species such as C. haemulonii, C. kefyr, and C. pelliculosa were identified in Ecuador for the first time. Discrepancies in species identification were observed between the VITEK 2 system and ITS sequencing, coinciding at 85%. This highlights the need for ongoing surveillance and identification efforts in Ecuador's clinical and epidemiological settings.
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Affiliation(s)
| | - Juan Carlos Tapia
- Omics Science Laboratory, Faculty of Health Science, Universidad Espíritu Santo, Samborondon 092301, Ecuador; (J.C.T.); (M.J.C.-V.)
| | - Rubén Armas-González
- Instituto Interamericano de Cooperación para la Agricultura (IICA), Representación Ecuador-Proyecto-5CN-1RBT, Quito 170518, Ecuador;
- Faculty of Health Science, Universidad Espíritu Santo, Samborondon 092301, Ecuador
| | - María José Cáceres-Valdiviezo
- Omics Science Laboratory, Faculty of Health Science, Universidad Espíritu Santo, Samborondon 092301, Ecuador; (J.C.T.); (M.J.C.-V.)
| | - Juan Carlos Fernández-Cadena
- African Genome Center, University Mohammed VI Polytechnic (UM6P), Lot 660, Hay Moulay Rachid, Ben Guerir 43150, Morocco
| | - Derly Andrade-Molina
- Omics Science Laboratory, Faculty of Health Science, Universidad Espíritu Santo, Samborondon 092301, Ecuador; (J.C.T.); (M.J.C.-V.)
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22
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Jafarlou M. Unveiling the menace: a thorough review of potential pandemic fungal disease. FRONTIERS IN FUNGAL BIOLOGY 2024; 5:1338726. [PMID: 38711422 PMCID: PMC11071163 DOI: 10.3389/ffunb.2024.1338726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/04/2024] [Indexed: 05/08/2024]
Abstract
Fungal diseases have emerged as a significant global health threat, with the potential to cause widespread outbreaks and significant morbidity and mortality. Anticipating future pandemic fungal diseases is essential for effective preparedness and response strategies. This comprehensive literature review aims to provide a comprehensive analysis of the existing research on this topic. Through an extensive examination of scholarly articles, this review identifies potential fungal pathogens that have the potential to become pandemics in the future. It explores the factors contributing to the emergence and spread of these fungal diseases, including climate change, globalization, and antimicrobial resistance. The review also discusses the challenges in diagnosing and treating these diseases, including limited access to diagnostic tools and antifungal therapies. Furthermore, it examines the strategies and interventions that can be employed to mitigate the impact of future pandemic fungal diseases, such as improved surveillance systems, public health education, and research advancements. The findings of this literature review contribute to our understanding of the potential risks posed by fungal diseases and provide valuable insights for public health professionals and policymakers in effectively preparing for and responding to future pandemic outbreaks. Overall, this review emphasizes the importance of proactive measures and collaborative efforts to anticipate and mitigate the impact of future pandemic fungal diseases.
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23
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Melinte V, Tudor AD, Bujoi AG, Radu MA, Văcăriou MC, Cismaru IM, Holban TS, Mîrzan CL, Popescu R, Ciupan RC, Baciu A, Moraru OE, Popa-Cherecheanu M, Gheorghiță V. Candida auris Outbreak in a Multidisciplinary Hospital in Romania during the Post-Pandemic Era: Potential Solutions and Challenges in Surveillance and Epidemiological Control. Antibiotics (Basel) 2024; 13:325. [PMID: 38667001 PMCID: PMC11047361 DOI: 10.3390/antibiotics13040325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/29/2024] Open
Abstract
Candida auris is a newly emerging yeast, which is raising public health concerns due to its outbreak potential, lack of protocols for decontamination and isolation of patients or contacts, increased resistance to common antifungals, and associated high mortality. This research aimed to describe the challenges related to identifying the outbreak, limiting further contamination, and treating affected individuals. We retrospectively analyzed all cases of C. auris detected between October 2022 and August 2023, but our investigation focused on a three-month-long outbreak in the department of cardio-vascular surgery and the related intensive care unit. Along with isolated cases in different wards, we identified 13 patients who became infected or colonized in the same area and time, even though the epidemiological link could only be traced in 10 patients, according to the epidemiologic investigation. In conclusion, our study emphasizes the substantial challenge encountered in clinical practice when attempting to diagnose and limit the spread of an outbreak. Therefore, it is crucial to promptly apply contact precaution measures and appropriate environmental cleaning, from the first positive case detected.
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Affiliation(s)
- Violeta Melinte
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.-A.R.); (O.E.M.); (M.P.-C.); (V.G.)
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
| | - Alexandra Daniela Tudor
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
| | - Adrian Georgian Bujoi
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
| | - Maria-Adelina Radu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.-A.R.); (O.E.M.); (M.P.-C.); (V.G.)
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
| | - Maria Cristina Văcăriou
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
| | - Ioana Miriana Cismaru
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
| | - Tiberiu Sebastian Holban
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
| | - Carmen Luminița Mîrzan
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
| | - Ruxandra Popescu
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
| | - Robert Cătălin Ciupan
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
| | - Alin Baciu
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
| | - Oriana Elena Moraru
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.-A.R.); (O.E.M.); (M.P.-C.); (V.G.)
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
| | - Matei Popa-Cherecheanu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.-A.R.); (O.E.M.); (M.P.-C.); (V.G.)
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
| | - Valeriu Gheorghiță
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.-A.R.); (O.E.M.); (M.P.-C.); (V.G.)
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
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Marena GD, Carvalho GC, Ruiz-Gaitán A, Onisto GS, Bugalho BCM, Genezini LMV, Santos MOD, Blanco AL, Chorilli M, Bauab TM. Potential Activity of Micafungin and Amphotericin B Co-Encapsulated in Nanoemulsion against Systemic Candida auris Infection in a Mice Model. J Fungi (Basel) 2024; 10:253. [PMID: 38667924 PMCID: PMC11051191 DOI: 10.3390/jof10040253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
The Candida auris species is a multidrug-resistant yeast capable of causing systemic and lethal infections. Its virulence and increase in outbreaks are a global concern, especially in hospitals where outbreaks are more recurrent. In many cases, monotherapy is not effective, and drug combinations are opted for. However, resistance to antifungals has increased over the years. In view of this, nanoemulsions (NEs) may represent a nanotechnology strategy in the development of new therapeutic alternatives. Therefore, this study developed a co-encapsulated nanoemulsion with amphotericin B (AmB) and micafungin (MICA) (NEMA) for the control of infections caused by C. auris. NEs were developed in previous studies. Briefly, the NEs were composed of a mixture of 10% sunflower oil and cholesterol as the oil phase (5:1), 10% Polyoxyethylene (20) cetyl ether (Brij® 58) and soy phosphatidylcholine as surfactant/co-surfactant (2:1), and 80% PBS as the aqueous phase. The in vivo assay used BALB/c mice weighing between 25 and 28 g that were immunosuppressed (CEUA/FCF/CAr n° 29/2021) and infected with Candida auris CDC B11903. The in vivo results show the surprising potentiate of the antifungal activity of the co-encapsulated drugs in NE, preventing yeast from causing infection in the lung and thymus. Biochemical assays showed a higher concentration of liver and kidney enzymes under treatment with AmB and MICAmB. In conclusion, this combination of drugs to combat the infection caused by C. auris can be considered an efficient therapeutic option, and nanoemulsions contribute to therapeutic potentiate, proving to be a promising new alternative.
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Affiliation(s)
- Gabriel Davi Marena
- Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, Brazil; (G.D.M.); (G.C.C.); (G.S.O.); (B.C.M.B.); (L.M.V.G.); (M.O.D.S.); (A.L.B.)
- Department of Drug and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, Brazil;
| | - Gabriela Corrêa Carvalho
- Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, Brazil; (G.D.M.); (G.C.C.); (G.S.O.); (B.C.M.B.); (L.M.V.G.); (M.O.D.S.); (A.L.B.)
- Department of Drug and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, Brazil;
| | - Alba Ruiz-Gaitán
- Severe Infection Research Group, Health Research Institute La Fe, 46026 Valencia, Spain
- Department of Medical Microbiology, University and Polytechnic La Fe Hospital, 46026 Valencia, Spain
| | - Giovana Scaramal Onisto
- Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, Brazil; (G.D.M.); (G.C.C.); (G.S.O.); (B.C.M.B.); (L.M.V.G.); (M.O.D.S.); (A.L.B.)
| | - Beatriz Chiari Manzini Bugalho
- Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, Brazil; (G.D.M.); (G.C.C.); (G.S.O.); (B.C.M.B.); (L.M.V.G.); (M.O.D.S.); (A.L.B.)
| | - Letícia Maria Valente Genezini
- Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, Brazil; (G.D.M.); (G.C.C.); (G.S.O.); (B.C.M.B.); (L.M.V.G.); (M.O.D.S.); (A.L.B.)
| | - Maíra Oliveira Dos Santos
- Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, Brazil; (G.D.M.); (G.C.C.); (G.S.O.); (B.C.M.B.); (L.M.V.G.); (M.O.D.S.); (A.L.B.)
| | - Ana Lígia Blanco
- Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, Brazil; (G.D.M.); (G.C.C.); (G.S.O.); (B.C.M.B.); (L.M.V.G.); (M.O.D.S.); (A.L.B.)
| | - Marlus Chorilli
- Department of Drug and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, Brazil;
| | - Tais Maria Bauab
- Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, Brazil; (G.D.M.); (G.C.C.); (G.S.O.); (B.C.M.B.); (L.M.V.G.); (M.O.D.S.); (A.L.B.)
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25
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Vélez N, Argel A, Kissmann AK, Alpízar-Pedraza D, Escandón P, Rosenau F, Ständker L, Firacative C. Pore-forming peptide C14R exhibits potent antifungal activity against clinical isolates of Candida albicans and Candida auris. Front Cell Infect Microbiol 2024; 14:1389020. [PMID: 38601736 PMCID: PMC11004338 DOI: 10.3389/fcimb.2024.1389020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/18/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction Invasive candidiasis is a global public health problem as it poses a significant threat in hospital-settings. The aim of this study was to evaluate C14R, an analog derived from peptide BP100, as a potential antimicrobial peptide against the prevalent opportunistic yeast Candida albicans and the emergent multidrug-resistant yeast Candida auris. Methods Antifungal susceptibility testing of C14R against 99 C. albicans and 105 C. auris clinical isolates from Colombia, was determined by broth microdilution. Fluconazole was used as a control antifungal. The synergy between C14R and fluconazole was assessed in resistant isolates. Assays against fungal biofilm and growth curves were also carried out. Morphological alterations of yeast cell surface were evaluated by scanning electron microscopy. A permeability assay verified the pore-forming ability of C14R. Results C. albicans and C. auris isolates had a geometric mean MIC against C14R of 4.42 µg/ml and 5.34 µg/ml, respectively. Notably, none of the isolates of any species exhibited growth at the highest evaluated peptide concentration (200 µg/ml). Synergistic effects were observed when combining the peptide and fluconazole. C14R affects biofilm and growth of C. albicans and C. auris. Cell membrane disruptions were observed in both species after treatment with the peptide. It was confirmed that C14R form pores in C. albicans' membrane. Discussion C14R has a potent antifungal activity against a large set of clinical isolates of both C. albicans and C. auris, showing its capacity to disrupt Candida membranes. This antifungal activity remains consistent across isolates regardless of their clinical source. Furthermore, the absence of correlation between MICs to C14R and resistance to fluconazole indicates the peptide's potential effectiveness against fluconazole-resistant strains. Our results suggest the potential of C14R, a pore-forming peptide, as a treatment option for fungal infections, such as invasive candidiasis, including fluconazole and amphotericin B -resistant strains.
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Affiliation(s)
- Norida Vélez
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Andreys Argel
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | | | - Daniel Alpízar-Pedraza
- Institute of Pharmaceutical Biotechnology, Ulm University, Ulm, Germany
- Biochemistry and Molecular Biology Department, Center for Pharmaceutical Research and Development, Ciudad de La Habana, Cuba
| | | | - Frank Rosenau
- Institute of Pharmaceutical Biotechnology, Ulm University, Ulm, Germany
| | - Ludger Ständker
- Core Facility for Functional Peptidomics, Faculty of Medicine, Ulm University, Ulm, Germany
| | - Carolina Firacative
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
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26
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Hsu AJ, Hanisch BR, Fisher BT, Huppler AR. Pipeline of Novel Antifungals for Invasive Fungal Disease in Transplant Recipients: A Pediatric Perspective. J Pediatric Infect Dis Soc 2024; 13:S68-S79. [PMID: 38417087 DOI: 10.1093/jpids/piad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/04/2024] [Indexed: 03/01/2024]
Abstract
Invasive fungal disease (IFD) remains a significant cause of morbidity and mortality in children undergoing transplantation. There is a growing armamentarium of novel antifungal agents recently approved for use or in late stages of clinical development. The overarching goal of this review is to discuss the mechanisms of action, spectrum of activity, stage of development, and pediatric-specific data for the following agents: encochleated amphotericin B deoxycholate, fosmanogepix, ibrexafungerp, isavuconazole, olorofim, opelconazole, oteseconazole, and rezafungin. Additionally, key drug attributes of these novel agents and their potential future therapeutic roles in pediatric transplant recipients are discussed.
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Affiliation(s)
- Alice Jenh Hsu
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Benjamin R Hanisch
- Department of Pediatric Infectious Diseases, Children's National, Washington, District of Columbia, USA
| | - Brian T Fisher
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anna R Huppler
- Division of Pediatric Infectious Diseases, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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27
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Kumar SAS, Krishnan D, Jothipandiyan S, Durai R, Hari BNV, Nithyanand P. Cell-free supernatants of probiotic consortia impede hyphal formation and disperse biofilms of vulvovaginal candidiasis causing Candida in an ex-vivo model. Antonie Van Leeuwenhoek 2024; 117:37. [PMID: 38367023 DOI: 10.1007/s10482-024-01929-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/13/2024] [Indexed: 02/19/2024]
Abstract
Vulvovaginal candidiasis is the second most common vaginal infection caused by drug-resistant Candida species that affects about 70-75% of reproductive age group women across the globe. As current-day antifungal drugs are ineffective against the biofilms formed by the drug-resistant Candida strains, several natural compounds and antagonistic microbes are being explored as alternative antifungal agents. In the present study, we investigated the anti-biofilm activity of Cell-Free Supernatant (CFS) extracted from the commercially available probiotics VSL-3 against the biofilms of Candida species and also evaluated their efficacy in curbing the yeast-to-hyphal transition. Various methodologies like crystal violet staining and scanning electron microscopy were used to study the effect of CFS against the biofilms formed by the species. The ability of CFS to interfere with yeast to hyphal transition in Candida was studied by colony morphology assay and visually confirmed with phase contrast microscopy. The potential of the CFS of the probiotics was also evaluated using goat buccal tissue, a novel ex-vivo model that mimics the vaginal environment. Moreover, the supernatant extracted from VSL-3 had the ability to down-regulate the expression of virulence genes of Candida from the biofilm formed over the ex-vivo model. These results emphasize the anti-fungal and anti-infective properties of the CFS of VSL-3 against drug-resistant Candida strains causing vulvovaginal candidiasis.
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Affiliation(s)
- Sudaarsan Aruna Senthil Kumar
- Biofilm Biology Laboratory, Centre for Research On Infectious Diseases (CRID), School of Chemical and Biotechnology, SASTRA Deemed University, Tirumalaisamudram, Thanjavur, Tamil Nadu, 613 401, India
| | - Dhesiga Krishnan
- Biofilm Biology Laboratory, Centre for Research On Infectious Diseases (CRID), School of Chemical and Biotechnology, SASTRA Deemed University, Tirumalaisamudram, Thanjavur, Tamil Nadu, 613 401, India
| | - Sowndarya Jothipandiyan
- Biofilm Biology Laboratory, Centre for Research On Infectious Diseases (CRID), School of Chemical and Biotechnology, SASTRA Deemed University, Tirumalaisamudram, Thanjavur, Tamil Nadu, 613 401, India
| | - Ramyadevi Durai
- Department of Pharmacy, School of Chemical and Biotechnology, SASTRA Deemed University, Thanjavur, Tamil Nadu, 613 401, India
| | - B Narayanan Vedha Hari
- Department of Pharmacy, School of Chemical and Biotechnology, SASTRA Deemed University, Thanjavur, Tamil Nadu, 613 401, India
| | - Paramasivam Nithyanand
- Biofilm Biology Laboratory, Centre for Research On Infectious Diseases (CRID), School of Chemical and Biotechnology, SASTRA Deemed University, Tirumalaisamudram, Thanjavur, Tamil Nadu, 613 401, India.
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Maniah K. Anticandidal effectiveness of greenly synthesized zinc oxide nanoparticles against candidal pathogens. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART A, TOXIC/HAZARDOUS SUBSTANCES & ENVIRONMENTAL ENGINEERING 2024; 58:1097-1110. [PMID: 38351615 DOI: 10.1080/10934529.2024.2315922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/01/2024] [Indexed: 03/08/2024]
Abstract
Drug resistance of pathogenic candidal strains to conventional antifungal agents represents a significant health issue contributing to high morbidity worldwide. Hence, the aim of the current study focused on evaluating the antifungal and synergistic activities of the green synthesized zinc oxide nanoparticles formulated using Laurus nobilis leaf extract. The biogenic ZnONPs were hexagonal in shape with average particle size diameter of 37.98 nm and pure crystalline structure as detected by XRD data. The highest antifungal activity of biogenic ZnONPs was detected against Candida parapsilosis strain demonstrating relative inhibitory zone diameters of 17.13 ± 0.74 and 25.78 ± 0.47 mm, at the concentrations of 100 and 200 µg/disk, respectively. Moreover, the biogenic ZnONPs demonstrated the highest synergistic activity with clotrimazole antifungal agent against Candida glabrata followed by Candida auris strains. MTT assay revealed that the biogenic ZnONPs showed low toxicity demonstrating relative IC50 value of 774.45 µg/mL against normal lung fibroblast cells which further affirmed their biosafety for application. In conclusion, the bioinspired ZnONPs could be utilized for the formulation of effective antifungal agents against drug resistant candidal strains and also could be combined with antifungal agents to boost their antifungal efficiency.
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Affiliation(s)
- Khalid Maniah
- Department of Biology, King Khalid Military Academy, Riyadh, Saudi Arabia
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29
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Thomsen J, Abdulrazzaq NM, Oulhaj A, Nyasulu PS, Alatoom A, Denning DW, Al Dhaheri F, Menezes GA, Moubareck CA, Senok A, Everett DB. Emergence of highly resistant Candida auris in the United Arab Emirates: a retrospective analysis of evolving national trends. Front Public Health 2024; 11:1244358. [PMID: 38292390 PMCID: PMC10826512 DOI: 10.3389/fpubh.2023.1244358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/08/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction The Centers for Disease Prevention and Control lists Candida auris, given its global emergence, multidrug resistance, high mortality, and persistent transmissions in health care settings as one of five urgent threats. As a new threat, the need for surveillance of C. auris is critical. This is particularly important for a cosmopolitan setting and global hub such as the United Arab Emirates (UAE) where continued introduction and emergence of resistant variant strains is a major concern. Methods The United Arab Emirates has carried out a 12 years of antimicrobial resistance surveillance (2010-2021) across the country, spanning all seven Emirates. A retrospective analysis of C. auris emergence from 2018-2021 was undertaken, utilising the demographic and microbiological data collected via a unified WHONET platform for AMR surveillance. Results Nine hundred eight non-duplicate C. auris isolates were reported from 2018-2021. An exponential upward trend of cases was found. Most isolates were isolated from urine, blood, skin and soft tissue, and the respiratory tract. UAE nationals nationals comprised 29% (n = 186 of 632) of all patients; the remainder were from 34 other nations. Almost all isolates were from inpatient settings (89.0%, n = 809). The cases show widespread distribution across all reporting sites in the country. C. auris resistance levels remained consistently high across all classes of antifungals used. C. auris in this population remains highly resistant to azoles (fluconazole, 72.6% in 2021) and amphotericin. Echinocandin resistance has now emerged and is increasing annually. There was no statistically significant difference in mortality between Candida auris and Candida spp. (non-auris) patients (p-value: 0.8179), however Candida auris patients had a higher intensive care unit (ICU) admission rate (p-value <0.0001) and longer hospital stay (p < 0.0001) compared to Candida spp. (non-auris) patients. Conclusion The increasing trend of C. auris detection and associated multidrug resistant phenotypes in the UAE is alarming. Continued C. auris circulation in hospitals requires enhanced infection control measures to prevent continued dissemination.
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Affiliation(s)
- Jens Thomsen
- Department of Environmental and Occupational Health and Safey, Abu Dhabi Publich Health Center, Abu Dhabi, United Arab Emirates
- Department of Pathology and Infectious Diseases, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Najiba M. Abdulrazzaq
- Al Kuwait Hospital Dubai, Emirates Health Services Establishment (EHS), Dubai, United Arab Emirates
| | - Abderrahim Oulhaj
- Department of Epidemiology and Public Health, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Peter S. Nyasulu
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Adnan Alatoom
- Department of Pathology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - David W. Denning
- Manchester Fungal Infection Group, The University of Manchester, Manchester, United Kingdom
| | - Fatima Al Dhaheri
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | - Godfred Antony Menezes
- Department of Medical Microbiology and Immunology, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
| | | | - Abiola Senok
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- School of Dentistry, Cardiff University, Cardiff, United Kingdom
| | - Dean B. Everett
- Department of Pathology and Infectious Diseases, Khalifa University, Abu Dhabi, United Arab Emirates
- Biotechnology Research Center, Khalifa University, Abu Dhabi, United Arab Emirates
- Infection Research Unit, Khalifa University, Abu Dhabi, United Arab Emirates
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Gill GK, Gill JK, Thakur S, Galwankar S, Gill HS. Candida auris - A Brief Overview. J Glob Infect Dis 2024; 16:3-4. [PMID: 38680752 PMCID: PMC11045153 DOI: 10.4103/jgid.jgid_52_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 02/23/2024] [Accepted: 02/25/2024] [Indexed: 05/01/2024] Open
Affiliation(s)
- Gurmat Kaur Gill
- Department of Infectious Disease and Internal Medicine, Division of Infectious Disease, University at Buffalo, Buffalo, New York, NY, USA
| | - Jaskirat Kaur Gill
- Department of Emergency Medicine, Institute of Critical Care Medicine, Mount Sinai Health System, New York, NY, USA
| | - Suman Thakur
- Department of Microbiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Sagar Galwankar
- Department of Emergency Medicine, University of Florida, Jacksonville, Florida, USA
| | - Harman Singh Gill
- Department of Emergency Medicine and Medicine, South Brooklyn Health, NYC Health and Hospitals, New York, NY, USA
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Naeimi B, Safari F, Ahmadikia K, Ahmadipour MJ, Sadeghzadeh F, Kondori N, Ahmadi B. Screening Candida auris through a multiplex stepwise PCR algorithm directly from clinical samples of patients suspected of otomycosis in south of Iran; Detection of five cases. Mycoses 2024; 67:e13686. [PMID: 38214363 DOI: 10.1111/myc.13686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Otomycosis is an infection of the external auditory canal caused by molds and yeasts with descending frequency. Laboratory diagnosis is usually confirmed by microscopy and culture. However, they are not specific enough to reliably differentiate the causative agents, especially for rare pathogens such as Candida auris. The purpose of the current study was to the molecular screening of C. auris species from direct clinical samples of patients with suspected otomycosis in Southern of Iran. MATERIALS AND METHODS A total of 221 ear aspirates collected from 221 patients with suspected otomycosis over a four-year period. All the ear aspirations were examined with pan-fungal primers, then those with a positive result was included in two separate reaction mixtures simultaneously to identify the most clinically relevant Aspergillus and Candida species. The validity of positive samples for C. auris was assessed by sequencing. RESULTS Of the 189 pan-fungal positive PCRs, 78 and 39 specimens contained Aspergillus spp. and Candida spp., respectively. Furthermore, 65 specimens showed simultaneous positive bands in both Candida and Aspergillus species-specific multiplex PCR including five samples/patients with positive result for C. auris (5/189; 2.6%). Four out of five cases with C. auris species-specific PCR were reconfirmed by sequencing, while none were positive for C. auris in culture. CONCLUSION Unfortunately, due to high treatment failure rates of antifungal classes against C. auris species, rapid and accurate identification of patients colonised with C. auris is critical to overcome the challenge of preventing transmission. This PCR assay can be successfully applied for rapid and accurate detection of C. auris directly in patient samples and is able to differentiate C. auris from closely related Candida species.
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Affiliation(s)
- Behrouz Naeimi
- Department of Medical Laboratory Sciences, Faculty of Paramedical, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Fatemeh Safari
- Department of Microbiology, Falavarjan Branch, Islamic Azad University, Isfahan, Iran
| | - Kazem Ahmadikia
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Farzaneh Sadeghzadeh
- Department of Medical Laboratory Sciences, Faculty of Paramedical, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Nahid Kondori
- Department of Infectious Diseases, Institution of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bahram Ahmadi
- Department of Medical Laboratory Sciences, Faculty of Paramedical, Bushehr University of Medical Sciences, Bushehr, Iran
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Borman AM, Johnson EM. Changes in fungal taxonomy: mycological rationale and clinical implications. Clin Microbiol Rev 2023; 36:e0009922. [PMID: 37930182 PMCID: PMC10732072 DOI: 10.1128/cmr.00099-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/13/2023] [Indexed: 11/07/2023] Open
Abstract
Numerous fungal species of medical importance have been recently subjected to and will likely continue to undergo nomenclatural changes as a result of the application of molecular approaches to fungal classification together with abandonment of dual nomenclature. Here, we summarize those changes affecting key groups of fungi of medical importance, explaining the mycological (taxonomic) rationale that underpinned the changes and the clinical relevance/importance (where such exists) of the key nomenclatural revisions. Potential mechanisms to mitigate unnecessary taxonomic instability are suggested, together with approaches to raise awareness of important changes to minimize potential clinical confusion.
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Affiliation(s)
- Andrew M. Borman
- UK HSA National Mycology Reference Laboratory, Science Quarter, Southmead Hospital, Bristol, United Kingdom
- Medical Research Council Centre for Medical Mycology (MRC CMM), University of Exeter, Exeter, United Kingdom
| | - Elizabeth M. Johnson
- UK HSA National Mycology Reference Laboratory, Science Quarter, Southmead Hospital, Bristol, United Kingdom
- Medical Research Council Centre for Medical Mycology (MRC CMM), University of Exeter, Exeter, United Kingdom
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Amer HA, AlFaraj S, Alboqami K, Alshakarh F, Alsalam M, Kumar D, Altayieb J, Alsunid A, Khanum N, Dar NG, Badawi M, Abdallah H, Memish ZA. Characteristics and Mitigation Measures of Candida auris Infection: Descriptive Analysis from a Quaternary Care Hospital in Saudi Arabia, 2021-2022. J Epidemiol Glob Health 2023; 13:825-830. [PMID: 37870721 PMCID: PMC10686928 DOI: 10.1007/s44197-023-00154-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/12/2023] [Indexed: 10/24/2023] Open
Abstract
OBJECTIVE To analyze the characteristics of C. auris cases, and to describe the interventions applied for improving the diagnosis and controlling the transmission. METHOD Medical records of C. auris cases reported between January 2021 until June 2022 at King Saud Medical City (KSMC), Riyadh, Kingdom of Saudi Arabia have been reviewed. We analyzed the demographic and clinical characteristics of the cases to illustrate the possible contributing factors with C. auris infection. A multidisciplinary committee has been formulated to investigate the potential source of the outbreak among clusters of cases in the intensive care units (ICU). A bundle of mitigation measures has been applied which was successful to contain the outbreak. RESULTS During the study period, a total of 129 cases of C. auris were identified, their mean age is 47 ± 22.3 SD, and 72.1% are males. 57% of cases were colonized, all of them were identified through active screening. A number of comorbidities were present including 27.9% were having hypertension, 27.1% with diabetes, 22.5% with COVID-19 and 20.2% with respiratory diseases. The average length of stay before reported positive was 36.23 days. 78.3% of those patients were in the critical care unit, 73.6% with vascular catheter, 88% with urinary catheters and 66.7% with mechanical ventilation. The vast majority of patients were using multiple antibiotics (86%). As per the univariate logistic model, risk factors significantly associated with mortality were (Age, Trauma RTA, ICU, Vascular Access, Foley Catheters, Mechanical Ventilation, Tracheostomy and Endotracheal Tubes) with p values (0.0038, 0.0159, 0.0108, 0.0122, 0.0071, <.0001, 0.0148 and 0.0107), respectively. Multivariate logistic regression showed that having a Foley Catheter was the only statistically significant factor associated with mortality. CONCLUSION This retrospective analysis highlights the main characteristics associated with C. auris-infected patients. In addition, it highlights the effectiveness of the bundle of mitigation strategies applied to limit the spread of C. auris in healthcare facilities.
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Affiliation(s)
- Hala A Amer
- Prevention and Control of Infection Administration, King Saud Medical City, Riyadh, Saudi Arabia.
- Community Medicine Research Department, National Research Center, Cairo, Egypt.
| | - Sarah AlFaraj
- Prevention and Control of Infection Administration, King Saud Medical City, Riyadh, Saudi Arabia
| | - Kholoud Alboqami
- Prevention and Control of Infection Administration, King Saud Medical City, Riyadh, Saudi Arabia
| | - Faleh Alshakarh
- Prevention and Control of Infection Administration, King Saud Medical City, Riyadh, Saudi Arabia
| | - Mona Alsalam
- Prevention and Control of Infection Administration, King Saud Medical City, Riyadh, Saudi Arabia
| | - Deva Kumar
- Prevention and Control of Infection Administration, King Saud Medical City, Riyadh, Saudi Arabia
| | - Juhaina Altayieb
- Prevention and Control of Infection Administration, King Saud Medical City, Riyadh, Saudi Arabia
| | - Antisar Alsunid
- Prevention and Control of Infection Administration, King Saud Medical City, Riyadh, Saudi Arabia
| | - Nazia Khanum
- Prevention and Control of Infection Administration, King Saud Medical City, Riyadh, Saudi Arabia
| | - Nadeem Gul Dar
- Prevention and Control of Infection Administration, King Saud Medical City, Riyadh, Saudi Arabia
| | - Muhammad Badawi
- Prevention and Control of Infection Administration, King Saud Medical City, Riyadh, Saudi Arabia
| | - Hassan Abdallah
- Prevention and Control of Infection Administration, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ziad A Memish
- Research and Innovation Center, King Saud Medical City, Riyadh, Saudi Arabia
- College of Medicine, AlFaisal University, Riyadh, Saudi Arabia
- Hubert Department of Global Health, Rollins School of Public Health, Emory, University, Atlanta, USA
- Division of Infectious Diseases, Kyung Hee University, Seoul, Korea
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Micelly-Moreno J, Barreto-Santamaría A, Arévalo-Pinzón G, Firacative C, Gómez BL, Escandón P, Patarroyo MA, Muñoz JE. Therapeutic Use of the Antimicrobial Peptide PNR20 to Resolve Disseminated Candidiasis in a Murine Model. J Fungi (Basel) 2023; 9:1149. [PMID: 38132750 PMCID: PMC10744665 DOI: 10.3390/jof9121149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023] Open
Abstract
Invasive fungal infections (IFIs) caused by Candida species are an emerging threat globally, given that patients at-risk and antifungal resistance are increasing. Antimicrobial peptides (AMPs) have shown good therapeutic capacity against different multidrug-resistant (MDR) microorganisms. This study evaluated the activity of the synthetic peptide, PNR20, against Candida albicans ATCC 10231 and a MDR Colombian clinical isolate of Candida auris. Perturbation of yeast cell surface was evaluated using scanning electron microscopy. Cell viability of Vero cells was determined to assess peptide toxicity. Additionally, survival, fungal burden, and histopathology of BALB/c mice infected intravenously with each Candida species and treated with PNR20 were analyzed. Morphological alterations were identified in both species, demonstrating the antifungal effect of PNR20. In vitro, Vero cells' viability was not affected by PNR20. All mice infected with either C. albicans or C. auris and treated with PNR20 survived and had a significant reduction in the fungal burden in the kidney compared to the control group. The histopathological analysis in mice infected and treated with PNR20 showed more preserved tissues, without the presence of yeast, compared to the control groups. This work shows that the utilization of PNR20 is a promising therapeutic alternative against disseminated candidiasis.
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Affiliation(s)
- Jeisson Micelly-Moreno
- Faculty of Health Sciences, Universidad Colegio Mayor de Cundinamarca, Bogota 110311, Colombia;
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad de Rosario, Bogota 111221, Colombia; (C.F.); (B.L.G.)
| | - Adriana Barreto-Santamaría
- Receptor-Ligand Department, Fundación Instituto de Inmunología de Colombia (FIDIC), Bogota 111321, Colombia;
| | - Gabriela Arévalo-Pinzón
- Microbiology Department, Faculty of Sciences, Pontificia Universidad Javeriana, Carrera 7 #40–62, Bogota 110231, Colombia;
| | - Carolina Firacative
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad de Rosario, Bogota 111221, Colombia; (C.F.); (B.L.G.)
| | - Beatriz L. Gómez
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad de Rosario, Bogota 111221, Colombia; (C.F.); (B.L.G.)
| | - Patricia Escandón
- Microbiology Group, Instituto Nacional de Salud, Bogota 111321, Colombia;
| | - Manuel A. Patarroyo
- Molecular Biology and Immunology Department, Fundación Instituto de Inmunología de Colombia (FIDIC), Bogota 111321, Colombia;
- Microbiology Department, Faculty of Medicine, Universidad Nacional de Colombia, Bogota 111321, Colombia
| | - Julián E. Muñoz
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad de Rosario, Bogota 111221, Colombia; (C.F.); (B.L.G.)
- Public Health Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota 111221, Colombia
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Bohner F, Papp C, Takacs T, Varga M, Szekeres A, Nosanchuk JD, Vágvölgyi C, Tóth R, Gacser A. Acquired Triazole Resistance Alters Pathogenicity-Associated Features in Candida auris in an Isolate-Dependent Manner. J Fungi (Basel) 2023; 9:1148. [PMID: 38132749 PMCID: PMC10744493 DOI: 10.3390/jof9121148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
Fluconazole resistance is commonly encountered in Candida auris, and the yeast frequently displays resistance to other standard drugs, which severely limits the number of effective therapeutic agents against this emerging pathogen. In this study, we aimed to investigate the effect of acquired azole resistance on the viability, stress response, and virulence of this species. Fluconazole-, posaconazole-, and voriconazole- resistant strains were generated from two susceptible C. auris clinical isolates (0381, 0387) and compared under various conditions. Several evolved strains became pan-azole-resistant, as well as echinocandin-cross-resistant. While being pan-azole-resistant, the 0381-derived posaconazole-evolved strain colonized brain tissue more efficiently than any other strain, suggesting that fitness cost is not necessarily a consequence of resistance development in C. auris. All 0387-derived evolved strains carried a loss of function mutation (R160S) in BCY1, an inhibitor of the PKA pathway. Sequencing data also revealed that posaconazole treatment can result in ERG3 mutation in C. auris. Despite using the same mechanisms to generate the evolved strains, both genotype and phenotype analysis highlighted that the development of resistance was unique for each strain. Our data suggest that C. auris triazole resistance development is a highly complex process, initiated by several pleiotropic factors.
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Affiliation(s)
- Flora Bohner
- Department of Microbiology, University of Szeged, 6726 Szeged, Hungary; (F.B.); (C.P.); (T.T.); (M.V.); (A.S.); (C.V.)
| | - Csaba Papp
- Department of Microbiology, University of Szeged, 6726 Szeged, Hungary; (F.B.); (C.P.); (T.T.); (M.V.); (A.S.); (C.V.)
| | - Tamas Takacs
- Department of Microbiology, University of Szeged, 6726 Szeged, Hungary; (F.B.); (C.P.); (T.T.); (M.V.); (A.S.); (C.V.)
| | - Mónika Varga
- Department of Microbiology, University of Szeged, 6726 Szeged, Hungary; (F.B.); (C.P.); (T.T.); (M.V.); (A.S.); (C.V.)
| | - András Szekeres
- Department of Microbiology, University of Szeged, 6726 Szeged, Hungary; (F.B.); (C.P.); (T.T.); (M.V.); (A.S.); (C.V.)
| | - Joshua D. Nosanchuk
- Department of Medicine (Infectious Diseases), Albert Einstein College of Medicine, Bronx, New York, NY 10461, USA;
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, NY 10461, USA
| | - Csaba Vágvölgyi
- Department of Microbiology, University of Szeged, 6726 Szeged, Hungary; (F.B.); (C.P.); (T.T.); (M.V.); (A.S.); (C.V.)
| | - Renáta Tóth
- Department of Microbiology, University of Szeged, 6726 Szeged, Hungary; (F.B.); (C.P.); (T.T.); (M.V.); (A.S.); (C.V.)
| | - Attila Gacser
- Department of Microbiology, University of Szeged, 6726 Szeged, Hungary; (F.B.); (C.P.); (T.T.); (M.V.); (A.S.); (C.V.)
- HCEMM-USZ Fungal Pathogens Research Group, Department of Microbiology, University of Szeged, 6726 Szeged, Hungary
- HUN-REN-USZ Pathomechanisms of Fungal Infections Research Group, University of Szeged, 6726 Szeged, Hungary
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Ajetunmobi OH, Chaturvedi AK, Badali H, Vaccaro A, Najvar L, Wormley FL, Wiederhold NP, Patterson TF, Lopez-Ribot JL. Screening the medicine for malaria venture's Pandemic Response Box to identify novel inhibitors of Candida albicans and Candida auris biofilm formation. APMIS 2023; 131:613-625. [PMID: 37337909 PMCID: PMC10592529 DOI: 10.1111/apm.13342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/21/2023]
Abstract
Candida spp. are opportunistic yeasts capable of forming biofilms, which contribute to resistance, increasing the urgency for new effective antifungal therapies. Repurposing existing drugs could significantly accelerate the development of novel therapies against candidiasis. We screened the Pandemic Response Box containing 400 diverse drug-like molecules active against bacteria, viruses or fungi, for inhibitors of Candida albicans and Candida auris biofilm formation. Initial hits were identified based on the demonstration of >70% inhibitory activity. Dose-response assays were used to confirm the antifungal activity of initial hits and establish their potency. The spectrum of antifungal activity of the leading compounds was determined against a panel of medically important fungi, and the in vivo activity of the leading repositionable agent was evaluated in murine models of C. albicans and C. auris systemic candidiasis. The primary screening identified 20 hit compounds, and their antifungal activity and potency against C. albicans and C. auris were validated using dose-response measurements. From these experiments, the rapalog everolimus, emerged as the leading repositionable candidate. Everolimus displayed potent antifungal activity against different Candida spp., but more moderate levels of activity against filamentous fungi. Treatment with everolimus increased survival of mice infected with C. albicans, but not those with C. auris. The screening of the Pandemic Response Box resulted in the identification of several drugs with novel antifungal activity, with everolimus emerging as the main repositionable candidate. Further in vitro and in vivo studies are needed to confirm its potential therapeutic use.
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Affiliation(s)
- Olabayo H. Ajetunmobi
- Department of Molecular Microbiology & Immunology, and South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Ashok K. Chaturvedi
- Department of Molecular Microbiology & Immunology, and South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Hamid Badali
- Department of Molecular Microbiology & Immunology, and South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Alessandra Vaccaro
- Department of Molecular Microbiology & Immunology, and South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Laura Najvar
- Department of Medicine, Division of Infectious Diseases, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Floyd L. Wormley
- Department of Biology, Texas Christian University, Fort Worth, Texas, USA
| | - Nathan P. Wiederhold
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Thomas F. Patterson
- Department of Medicine, Division of Infectious Diseases, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Jose L. Lopez-Ribot
- Department of Molecular Microbiology & Immunology, and South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, Texas, USA
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Huma ZE, Saleem S, Imran M, Jabeen K, Arshad F, Amar A. Screening of C. auris among Candida isolates from various tertiary care institutions in Lahore by VITEK 2 and real time PCR based molecular technique. PLoS One 2023; 18:e0293390. [PMID: 37874842 PMCID: PMC10597507 DOI: 10.1371/journal.pone.0293390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/20/2023] [Indexed: 10/26/2023] Open
Abstract
Candida auris is a multidrug-resistant pathogen, that is a well-known cause of nosocomial infections. This pathogen is being identified using advanced diagnostic approaches and epidemiological typing procedures. In underdeveloped nations, several researchers developed and validated a low-cost approach for reliably identifying Candida auris. The goal of this study was to assess the burden of Candida auris in different teaching hospitals of Lahore and to limit its spread to minimize hospital-related illnesses. Candida isolates were obtained from various tertiary care institutions in Lahore in the form of culture on various culture plates. Sabouraud agar culture plates were used to culture the Candida spp. Fluconazole-resistant Candida species were chosen for further identification using VITEK 2 Compact ID and molecular identification using species-specific PCR assay. The current study obtained 636 Candida samples from several tertiary care institutions in Lahore. Fluconazole resistance was found in 248 (38.9%) of 636 Candida samples. No isolate was identified as Candida auris by VITEK 2 Compact ID and real-time PCR-based molecular identification. Thus with limited resources, these two methods may serve as useful screens for Candida auris. However, it should be screened all over the country to limit its spread to break the chain of nosocomial infections.
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Affiliation(s)
- Zill-e- Huma
- Department of Microbiology, University of Health Sciences, Lahore, Pakistan
| | - Sidrah Saleem
- Department of Microbiology, University of Health Sciences, Lahore, Pakistan
| | - Muhammad Imran
- Department of Microbiology, University of Health Sciences, Lahore, Pakistan
| | - Kokab Jabeen
- Department of Microbiology, University of Health Sciences, Lahore, Pakistan
| | - Faiqa Arshad
- Department of Microbiology, University of Health Sciences, Lahore, Pakistan
| | - Ali Amar
- Department of Human Genetics and Molecular Biology, University of Health Sciences, Lahore, Pakistan
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Erturk Sengel B, Ekren BY, Sayin E, Tukenmez Tigen E, Seydaliyeva A, Cerikcioglu N, Cinel I, Korten V, Sezerman U, Odabasi Z. Nosocomial infection of C. auris in COVID-19 Intensive Care Unit in Türkiye and Phylogenetic Analysis of Isolates. Mycopathologia 2023; 188:765-773. [PMID: 37542203 DOI: 10.1007/s11046-023-00782-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/25/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND The difficulties in the identification of C. auris and the delays in the implementation of infection control precautions contribute to outbreaks. This study analyzed 10 patients with COVID-19 and C. auris candidemia, their characteristic and clinical features and phylogenetic features, and the antifungal susceptibilities of the isolates. METHOD C. auris were detected in the COVID-19 ICU of a university hospital between January and August 2021. Identification to species level was performed using MALDI-TOF MS. Antifungal susceptibilities were determined by the Sensititre YeastOne YO10 panel. The isolates were whole genome sequenced to assess genetic relatedness and a phylogenetic tree was drawn including various C. auris clades. RESULTS The mean growth time in blood cultures was 38.8 h. C. auris candidemia developed on the average 27th day of ICU admission. All were susceptible to anidulafungin and micafungin, while they were resistant to fluconazole and amphotericin B. Only three isolates were found to be resistant to caspofungin. All patients died. With the WGS method, all isolates were found in a close resemblance to each other in terms of total nucleotide similarity (with a minimum of 96% pairwise alignment). Our isolates showed the closest similarity to South Asian clade (Clade I). CONCLUSIONS This study is the first to evaluate the phylogenetic characteristics of C. auris using WGS and to determine antifungal susceptibilities in Türkiye on COVID-19 patients. The mortality rate was very high in patients who have both COVID-19 and C. auris candidemia.
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Affiliation(s)
- Buket Erturk Sengel
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Berkay Yekta Ekren
- Institute of Health Sciences, Department of Biostatistics and Bioinformatics, Acibadem University, Istanbul, Turkey
| | - Elvan Sayin
- Department of Medical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Elif Tukenmez Tigen
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Aytan Seydaliyeva
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Nilgun Cerikcioglu
- Department of Medical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ismail Cinel
- Department of Anesthesiology and Reanimation, Critical Care, Marmara University School of Medicine, Istanbul, Turkey
| | - Volkan Korten
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ugur Sezerman
- Institute of Health Sciences, Department of Biostatistics and Bioinformatics, Acibadem University, Istanbul, Turkey
| | - Zekaver Odabasi
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
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McCarty Walsh E, Hanson MB. Fungal Infections of the External Auditory Canal and Emerging Pathogens. Otolaryngol Clin North Am 2023; 56:909-918. [PMID: 37553272 DOI: 10.1016/j.otc.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Fungal infections of the external auditory canal can range from common (otomycosis) to life threatening (necrotizing otitis externa). Proper identification of fungal pathogens is necessary to guide appropriate therapy, and a high index of suspicion for fungal causes of ear canal disease is critical. Fungal pathogens may be an especially important cause of ear canal disease in certain populations, including patients with diabetes, patients recently treated with antibiotics, and immunosuppressed patients. Opportunistic fungal infections of the ear canal are an emerging concern.
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Affiliation(s)
- Erika McCarty Walsh
- Department of Otolaryngology, Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Matthew B Hanson
- Department of Otolaryngology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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Abstract
Candida auris is a multidrug-resistant fungal pathogen that presents a serious threat to global human health. Since the first reported case in 2009 in Japan, C. auris infections have been reported in more than 40 countries, with mortality rates between 30% and 60%. In addition, C. auris has the potential to cause outbreaks in health care settings, especially in nursing homes for elderly patients, owing to its efficient transmission via skin-to-skin contact. Most importantly, C. auris is the first fungal pathogen to show pronounced and sometimes untreatable clinical drug resistance to all known antifungal classes, including azoles, amphotericin B, and echinocandins. In this review, we explore the causes of the rapid spread of C. auris. We also highlight its genome organization and drug resistance mechanisms and propose future research directions that should be undertaken to curb the spread of this multidrug-resistant pathogen.
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Affiliation(s)
- Anuradha Chowdhary
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India;
- National Reference Laboratory for Antimicrobial Resistance in Fungal Pathogens, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Kusum Jain
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India;
| | - Neeraj Chauhan
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA
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Cobrado L, Ricardo E, Ramalho P, Fernandes AR, Rodrigues AG. Does repeated exposure to hydrogen peroxide induce Candida auris resistance? Antimicrob Resist Infect Control 2023; 12:92. [PMID: 37674229 PMCID: PMC10483791 DOI: 10.1186/s13756-023-01281-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 07/27/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND To minimize environmental colonization by microorganisms that may persist and thrive in healthcare settings, thus reducing healthcare-associated infections (HAIs), new insights over already known biocides are certainly of relevance. Although the efficacy of hydrogen peroxide (H2O2) against the emergent yeast Candida auris is moderately documented, concerns over the potential induction of resistance after repeated exposure do persist. The main objective of the present study was to evaluate the hypothetical induction of Candida auris resistance following 30 days of consecutive exposure to lethal and sublethal concentrations of H2O2. Furthermore, the authors aimed to elucidate about the rank of efficacy of H2O2 against C. auris comparing to other Candida species and whether different strains of C. auris may display different susceptibilities to H2O2. METHODS During the induction of resistance assays, both type strains and clinical isolates of Candida auris, Candida albicans and Candida parapsilosis were exposed repeatedly to defined concentrations of H2O2, for 30 days. RESULTS After that period, no significant differences were found when comparing the minimal inhibitory concentration values of H2O2 in case of the induced strains versus each respective positive control. Moreover, H2O2 displayed similar effectiveness against all the tested Candida species and no differences were demonstrated among the distinct strains of C. auris. CONCLUSIONS The adoption of H2O2 solutions in routine protocols in order to promote disinfection standards against Candida auris, improving patient safety and reducing healthcare costs, is certainly welcomed.
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Affiliation(s)
- Luis Cobrado
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, Porto, 4200 - 319, Portugal.
- Center for Health Technology and Services Research / Rede de Investigação em Saúde, CINTESIS / RISE, University of Porto, Porto, Portugal.
- Burn Unit, Department of Plastic and Reconstructive Surgery, University Hospital Center of São João, Porto, Portugal.
| | - Elisabete Ricardo
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, Porto, 4200 - 319, Portugal
- Center for Health Technology and Services Research / Rede de Investigação em Saúde, CINTESIS / RISE, University of Porto, Porto, Portugal
| | - Patricia Ramalho
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, Porto, 4200 - 319, Portugal
- Center for Health Technology and Services Research / Rede de Investigação em Saúde, CINTESIS / RISE, University of Porto, Porto, Portugal
| | - Angela Rita Fernandes
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, Porto, 4200 - 319, Portugal
| | - Acacio Goncalves Rodrigues
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, Porto, 4200 - 319, Portugal
- Center for Health Technology and Services Research / Rede de Investigação em Saúde, CINTESIS / RISE, University of Porto, Porto, Portugal
- Burn Unit, Department of Plastic and Reconstructive Surgery, University Hospital Center of São João, Porto, Portugal
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Caliman Sato M, Izu Nakamura Pietro EC, Marques da Costa Alves L, Kramer A, da Silva Santos PS. Candida auris: a novel emerging nosocomial pathogen - properties, epidemiological situation and infection control. GMS HYGIENE AND INFECTION CONTROL 2023; 18:Doc18. [PMID: 37693850 PMCID: PMC10486814 DOI: 10.3205/dgkh000444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Immunosuppression and critical illnesses in combination with ecological imbalance open the door for novel opportunistic fungal infections, as in case of Candida (C). auris. C. auris has emerged globally as a multidrug-resistant yeast, causing infections and outbreaks in health care facilities. This narrative review discusses the properties of the yeast, the development of the epidemiological situation, the nosocomial spread and causes for nosocomial outbreaks triggered by C. auris in the hospital environment, and summarizes international recommendations for infection control, supplemented by suggestions on diagnostic, screening and antibiotic stewardship.
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Affiliation(s)
- Marcelo Caliman Sato
- Center for Lasers and Applications, Instituto de Pesquisas Energéticas e Nucleares (IPEN-CNEN), São Paulo, Brazil
| | | | | | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
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Henriques J, Mixão V, Cabrita J, Duarte TI, Sequeira T, Cardoso S, Germano N, Dias L, Bento L, Duarte S, Veríssimo C, Gomes JP, Sabino R. Candida auris in Intensive Care Setting: The First Case Reported in Portugal. J Fungi (Basel) 2023; 9:837. [PMID: 37623608 PMCID: PMC10455255 DOI: 10.3390/jof9080837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 07/31/2023] [Accepted: 08/05/2023] [Indexed: 08/26/2023] Open
Abstract
Candida auris is an opportunistic human pathogen that has rapidly spread to multiple countries and continents and has been associated with a high number of nosocomial outbreaks. Herein, we report the first case of C. auris in Portugal, which was associated with a patient transferred from Angola to an ICU in Portugal for liver transplantation after a SARS-CoV-2 infection. C. auris was isolated during the course of bronchoalveolar lavage, and it was subjected to antifungal susceptibility testing and whole-genome sequence analysis. This isolate presents low susceptibility to azoles and belongs to the genetic clade III with a phylogenetic placement close to African isolates. Although clade III has already been reported in Europe, taking into account the patient's clinical history, we cannot discard the possibility that the patient's colonization/infection occurred in Angola, prior to admission in the Portuguese hospital. Considering that C. auris is a fungal pathogen referenced by WHO as a critical priority, this case reinforces the need for continuous surveillance in a hospital setting.
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Affiliation(s)
- João Henriques
- Intensive Care Medicine Department, Centro Hospitalar Universitário Lisboa Central, 1150-199 Lisbon, Portugal; (J.H.); (J.C.); (T.I.D.); (T.S.); (S.C.); (N.G.); (L.B.)
| | - Verónica Mixão
- Genomics and Bioinformatics Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge (INSA), Av. Padre Cruz, 1649-016 Lisbon, Portugal;
| | - Joana Cabrita
- Intensive Care Medicine Department, Centro Hospitalar Universitário Lisboa Central, 1150-199 Lisbon, Portugal; (J.H.); (J.C.); (T.I.D.); (T.S.); (S.C.); (N.G.); (L.B.)
| | - Tiago Isidoro Duarte
- Intensive Care Medicine Department, Centro Hospitalar Universitário Lisboa Central, 1150-199 Lisbon, Portugal; (J.H.); (J.C.); (T.I.D.); (T.S.); (S.C.); (N.G.); (L.B.)
| | - Tânia Sequeira
- Intensive Care Medicine Department, Centro Hospitalar Universitário Lisboa Central, 1150-199 Lisbon, Portugal; (J.H.); (J.C.); (T.I.D.); (T.S.); (S.C.); (N.G.); (L.B.)
| | - Sofia Cardoso
- Intensive Care Medicine Department, Centro Hospitalar Universitário Lisboa Central, 1150-199 Lisbon, Portugal; (J.H.); (J.C.); (T.I.D.); (T.S.); (S.C.); (N.G.); (L.B.)
| | - Nuno Germano
- Intensive Care Medicine Department, Centro Hospitalar Universitário Lisboa Central, 1150-199 Lisbon, Portugal; (J.H.); (J.C.); (T.I.D.); (T.S.); (S.C.); (N.G.); (L.B.)
| | - Liliana Dias
- Infection Prevention and Control and Antimicrobial Stewardship, Centro Hospitalar Universitário Lisboa Central, 1150-199 Lisbon, Portugal;
| | - Luís Bento
- Intensive Care Medicine Department, Centro Hospitalar Universitário Lisboa Central, 1150-199 Lisbon, Portugal; (J.H.); (J.C.); (T.I.D.); (T.S.); (S.C.); (N.G.); (L.B.)
| | - Sílvia Duarte
- Innovation and Technology Unit, Department of Human Genetics, National Institute of Health Doutor Ricardo Jorge (INSA), Av. Padre Cruz, 1649-016 Lisbon, Portugal;
| | - Cristina Veríssimo
- Reference Unit for Parasitic and Fungal Infections, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge (INSA), Av. Padre Cruz, 1649-016 Lisbon, Portugal;
| | - João Paulo Gomes
- Genomics and Bioinformatics Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge (INSA), Av. Padre Cruz, 1649-016 Lisbon, Portugal;
- Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477 Lisbon, Portugal
| | - Raquel Sabino
- Reference Unit for Parasitic and Fungal Infections, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge (INSA), Av. Padre Cruz, 1649-016 Lisbon, Portugal;
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal
- Laboratório Associado TERRA–Laboratório para o Uso Sustentável da Terra e dos Serviços dos Ecossistemas, Instituto Superior de Agronomia, Tapada da Ajuda, 1349-017 Lisbon, Portugal
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Koleri J, Petkar HM, Rahman S Al Soub HA, Rahman S AlMaslamani MA. Candida auris Blood stream infection- a descriptive study from Qatar. BMC Infect Dis 2023; 23:513. [PMID: 37544995 PMCID: PMC10405369 DOI: 10.1186/s12879-023-08477-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/21/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Candida auris is an emerging yeast pathogen that can cause invasive infections, particularly candidemia, in healthcare settings. Candida auris is characterized by resistance to multiple classes of antifungal drugs and high mortality. OBJECTIVE To describe the risk factors, clinical characteristics, antifungal susceptibility pattern and outcomes of Candida auris blood stream infection. METHODS We conducted a retrospective review of electronic medical records of C. auris fungemia cases in the facilities under Hamad Medical corporation, Qatar from 1/11/2018 to 31/7/2021. Demographic data, risk factors, antibiogram and 30-day outcome are described. RESULTS We identified 36 patients with C. auris fungemia. Most of the patients were in intensive care unit following severe COVID-19 pneumonia and had received steroids and broad-spectrum antibiotics. Most cases were central line related. Over 90% of isolates were non-susceptible to fluconazole, while amphotericin B resistance reached 85%. Factors associated with high mortality included initial SOFA score of 9 or above and absence of source control. CONCLUSION Our study reveals a concerning 41.6% mortality rate within 30 days of C. auris candidemia. Furthermore, the prevalence of amphotericin B resistance in Qatar exceeds what has been reported in the literature necessitating further exploration. Echinocandins retains nearly 100% susceptibility and should be prioritized as the treatment of choice. These findings emphasize the need for vigilant monitoring and appropriate management strategies to combat C. auris infections and improve patient outcomes.
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Affiliation(s)
- Junais Koleri
- Division of Infectious Diseases, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
| | - Hawabibee Mahir Petkar
- Division of Infectious Diseases, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
- Department of Microbiology, Hamad Medical Corporation, Doha, Qatar
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Fayed B, Lazreg IK, AlHumaidi RB, Qasem MAAA, Alajmy BMGN, Bojbarah FMAM, Senok A, Husseiny MI, Soliman SSM. Intra-clade Heterogeneity in Candida auris: Risk of Management. Curr Microbiol 2023; 80:295. [PMID: 37486431 DOI: 10.1007/s00284-023-03416-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/12/2023] [Indexed: 07/25/2023]
Abstract
Candida auris has emerged as a significant nosocomial fungal pathogen with a high risk of pathogenicity. Since the initial detection of C. auris in 2009, it gained lots of attention with a recent alert by the Centers for Disease Control and Prevention (CDC) due to its high infectivity and drug resistance. Several studies showed the capability of C. auris to secrete lytic enzymes, germinate, and form a biofilm that eventually results in interactions with the host cells, leading to serious infections. Other studies demonstrated a decrease in susceptibility of C. auris strains to available antifungals, which may be caused by mutations within the target genes, or the drug efflux pumps. However, the contribution of C. auris heterogeneity in pathogenicity and drug resistance is not well studied. Here, we shed light on the factors contributing to the development of heterogeneity in C. auris. These include phenotypic changes, biofilm formation, mechanisms of drug resistance, host invasion, mode of transmission, and expression of virulence factors. C. auris exhibits different phenotypes, particularly aggregative, and non-aggregative forms that play an important role in fungal heterogeneity, which significantly affects drug resistance and pathogenicity. Collectively, heterogeneity in C. auris significantly contributes to ineffective treatment, which in turn affects the fungal pathogenicity and drug resistance. Therefore, understanding the underlying reasons for C. auris heterogeneity and applying effective antifungal stewardship could play a major role in controlling this pathogen.
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Affiliation(s)
- Bahgat Fayed
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, UAE
- Chemistry of Natural and Microbial Products, National Research Centre, Cairo, Egypt
| | - Imene K Lazreg
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, UAE
| | - Razan B AlHumaidi
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, UAE
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, UAE
| | - Maryam A A A Qasem
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, UAE
| | - Bashayir M Gh N Alajmy
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, UAE
| | - Fatemh M A M Bojbarah
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, UAE
| | - Abiola Senok
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14 Dubai Healthcare City, P.O.Box 505055, Dubai, UAE
| | - Mohamed I Husseiny
- Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
- Department of Translational Research & Cellular Therapeutics, Arthur Riggs Diabetes & Metabolism Research Institute, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - Sameh S M Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, UAE.
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, UAE.
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Du H, Bing J, Xu X, Zheng Q, Hu T, Hao Y, Li S, Nobile CJ, Zhan P, Huang G. Candida vulturna Outbreak Caused by Cluster of Multidrug-Resistant Strains, China. Emerg Infect Dis 2023; 29:1425-1428. [PMID: 37347816 PMCID: PMC10310381 DOI: 10.3201/eid2907.230254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
Candida vulturna belongs to the Candida haemulonii species complex and is phylogenetically related to C. auris. We report a C. vulturna outbreak among persons in Shanxi Province, China, during 2019-2022. Isolates were resistant to multiple antifungal drugs and exhibited enhanced adhesion and biofilm formation properties.
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Affiliation(s)
| | | | | | - Qiushi Zheng
- Huashan Hospital, Fudan University, Shanghai, China (H. Du, J. Bing, Q. Zheng, T. Hu, G. Huang)
- Sinopharm Tongmei General Hospital, Datong, China (X. Xu, Y. Hao, S. Li)
- University of California, Merced, California, USA (C.J. Nobile)
- Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang, China (P. Zhan)
| | - Tianren Hu
- Huashan Hospital, Fudan University, Shanghai, China (H. Du, J. Bing, Q. Zheng, T. Hu, G. Huang)
- Sinopharm Tongmei General Hospital, Datong, China (X. Xu, Y. Hao, S. Li)
- University of California, Merced, California, USA (C.J. Nobile)
- Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang, China (P. Zhan)
| | - Yajuan Hao
- Huashan Hospital, Fudan University, Shanghai, China (H. Du, J. Bing, Q. Zheng, T. Hu, G. Huang)
- Sinopharm Tongmei General Hospital, Datong, China (X. Xu, Y. Hao, S. Li)
- University of California, Merced, California, USA (C.J. Nobile)
- Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang, China (P. Zhan)
| | - Shuping Li
- Huashan Hospital, Fudan University, Shanghai, China (H. Du, J. Bing, Q. Zheng, T. Hu, G. Huang)
- Sinopharm Tongmei General Hospital, Datong, China (X. Xu, Y. Hao, S. Li)
- University of California, Merced, California, USA (C.J. Nobile)
- Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang, China (P. Zhan)
| | - Clarissa J. Nobile
- Huashan Hospital, Fudan University, Shanghai, China (H. Du, J. Bing, Q. Zheng, T. Hu, G. Huang)
- Sinopharm Tongmei General Hospital, Datong, China (X. Xu, Y. Hao, S. Li)
- University of California, Merced, California, USA (C.J. Nobile)
- Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang, China (P. Zhan)
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Pechacek J, Lionakis MS. Host defense mechanisms against Candida auris. Expert Rev Anti Infect Ther 2023; 21:1087-1096. [PMID: 37753840 DOI: 10.1080/14787210.2023.2264500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 09/25/2023] [Indexed: 09/28/2023]
Abstract
INTRODUCTION Candida auris is a pathogen of growing public health concern given its rapid spread across the globe, its propensity for long-term skin colonization and healthcare-related outbreaks, its resistance to a variety of antifungal medications, and the high morbidity and mortality associated with invasive disease. Despite that, the host immune response mechanisms that operate during C. auris skin colonization and invasive infection remains poorly understood. AREAS COVERED In this manuscript, we review the available literature in the growing research field pertaining to C. auris host defenses and we discuss what is known about the ability of C. auris to thrive on mammalian skin, the role of lymphoid cell-mediated, IL-17-dependent defenses in controlling cutaneous colonization, and the contribution of myeloid phagocytes in curtailing systemic infection. EXPERT OPINION Understanding the mechanisms by which the host immune system responds to and controls colonization and infection with C. auris and developing a deeper knowledge of tissue-specific host-C. auris interactions and of C. auris immune-evading mechanisms may help devise improved strategies for decolonization, prognostication, prevention, vaccination, and/or directed antifungal treatment in vulnerable patient populations.
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Affiliation(s)
- Joseph Pechacek
- From the Fungal Pathogenesis Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Michail S Lionakis
- From the Fungal Pathogenesis Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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de St. Maurice A, Parti U, Anikst VE, Harper T, Mirasol R, Dayo AJ, Garner OB, Prabaker KK, Yang S. Clinical, microbiological, and genomic characteristics of clade-III Candida auris colonization and infection in southern California, 2019-2022. Infect Control Hosp Epidemiol 2023; 44:1093-1101. [PMID: 36052507 PMCID: PMC10369217 DOI: 10.1017/ice.2022.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/11/2022] [Accepted: 07/16/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Candida auris is an emerging fungal pathogen causing outbreaks in healthcare facilities. Five distinctive genomic clades exhibit clade-unique characteristics, highlighting the importance of real-time genomic surveillance and incorporating genotypic information to inform infection prevention practices and treatment algorithms. METHODS Both active and passive surveillance were used to screen hospitalized patients. C. auris polymerase chain reaction (PCR) assay on inguinal-axillary swabs was performed on high-risk patients upon admission. All clinical yeast isolates were identified to the species level. C. auris isolates were characterized by both phenotypic antifungal susceptibility tests and whole-genome sequencing. RESULTS From late 2019 to early 2022, we identified 45 patients with C. auris. Most had a tracheostomy or were from a facility with a known outbreak. Moreover, 7 patients (15%) were only identified through passive surveillance. Also, 8 (18%) of the patients had a history of severe COVID-19. The overall mortality was 18%. Invasive C. auris infections were identified in 13 patients (29%), 9 (69%) of whom had bloodstream infections. Patients with invasive infection were more likely to have a central line. All C. auris isolates were resistant to fluconazole but susceptible to echinocandins. Genomic analysis showed that 1 dominant clade-III lineage is circulating in Los Angeles, with very limited intrahost and interhost genetic diversity. CONCLUSIONS We have demonstrated that a robust C. auris surveillance program can be established using both active and passive surveillance, with multidisciplinary efforts involving the microbiology laboratory and the hospital epidemiology team. In Los Angeles County, C. auris strains are highly related and echinocandins should be used for empiric therapy.
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Affiliation(s)
| | - Urvashi Parti
- Department of Clinical Epidemiology and Infection Prevention, Los Angeles, California
| | - Victoria E. Anikst
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Thomas Harper
- Department of Clinical Epidemiology and Infection Prevention, Los Angeles, California
| | - Ruel Mirasol
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Ayrton J. Dayo
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Omai B. Garner
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Kavitha K. Prabaker
- Department of Clinical Epidemiology and Infection Prevention, Los Angeles, California
| | - Shangxin Yang
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
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49
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Kaki R. Risk factors and mortality of the newly emerging Candida auris in a university hospital in Saudi Arabia. Mycology 2023; 14:256-263. [PMID: 37583454 PMCID: PMC10424598 DOI: 10.1080/21501203.2023.2227218] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/14/2023] [Indexed: 08/17/2023] Open
Abstract
Candida auris presents a global health threat. We investigated risk factors and mortality of Candida auris infections in a retrospective study in Saudi Arabia. We included 27 patients ≥14 with invasive Candida auris from 2015-2022, with median age 58, and 66.7% males. All patients had indwelling devices. The most common infection sources were central line-associated bloodstream infection in 17 (63.0%), and urinary tract infections in four (12%). Fever and shock were observed in nine patients (33.3%) each, and 22 (81%) were admitted to the intensive care unit. Common comorbidities were diabetes and heart disease in 13 (48.1%) patients each. The median hospital stay was 78 days, and the median Charlson index was 4. The C. auris cultures were 100% susceptible to voriconazole, caspofungin, and amphotericin, while three were fully susceptible to fluconazole (11.1%). Despite treatment, 18 (66.7%) patients died. In conclusion, invasive C. auris infection had varied presentations. All patients had indwelling devices, and many had lengthy hospital stays. All isolates were susceptible to amphotericin and echinocandins, while few were fully susceptible to fluconazole.
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Affiliation(s)
- Reham Kaki
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Infectious Disease & Infection Control and Environmental Health, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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50
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Li Y, Chen C, Cong L, Mao S, Shan M, Han Z, Mao J, Xie Z, Zhu Z. Inhibitory Effects of a Maleimide Compound on the Virulence Factors of Candida albicans. Virulence 2023:2230009. [PMID: 37367101 DOI: 10.1080/21505594.2023.2230009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/26/2023] [Accepted: 06/21/2023] [Indexed: 06/28/2023] Open
Abstract
Candidiasis caused by Candida albicans infection has long been a serious human health problem. The pathogenicity of C. albicans is mainly due to its virulence factors, which are the novel targets of antifungal drugs for low risk of resistance development. In this study, we identified a maleimide compound [1-(4-methoxyphenyl)-1hydro-pyrrole-2,5-dione, MPD] that exerts effective anti-virulence activity. It could inhibit the process of adhesion, filamentation, and biofilm formation in C. albicans. In addition, it exhibited low cytotoxicity, hemolytic activity and drug resistance development. Moreover, in Galleria mellonella-C. albicans (in vivo) infection model, the survival time of infected larvae was significantly prolonged under the treatment of MPD. Further, mechanism research revealed that MPD increased farnesol secretion by upregulating the expression of Dpp3. The increased farnesol inhibited the activity of Cdc35, which then decreased the intracellular cAMP content resulting in the inhibition of virulence factors via the Ras1-cAMP-Efg1 pathway. In all, this study evaluated the inhibitory effect of MPD on various virulence factors of C. albicans and identified the underlying mechanisms. This suggests a potential application of MPD to overcome fungal infections in clinic.
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Affiliation(s)
- Ying Li
- School of Medical Technology, Xuzhou Medical University, Xuzhou, China
| | - Chaoqun Chen
- School of Medical Technology, Xuzhou Medical University, Xuzhou, China
| | - Liu Cong
- School of Medical Technology, Xuzhou Medical University, Xuzhou, China
| | - Shanshan Mao
- School of Medical Technology, Xuzhou Medical University, Xuzhou, China
| | - Mingzhu Shan
- School of Medical Technology, Xuzhou Medical University, Xuzhou, China
- Clinical laboratory, The Central Hospital of Xuzhou City, Xuzhou, China
| | - Zibing Han
- Department of Genetics, Xuzhou Medical University, Xuzhou, China
| | - Jiayi Mao
- Department of Genetics, Xuzhou Medical University, Xuzhou, China
| | - Zhiyu Xie
- Key Laboratory of Micro-Nano Materials for Energy Storage and Conversion of Henan Province, Institute of Surface Micro and Nano Materials, College of Chemical and Materials Engineering, Xuchang University, Xuchang, China
| | - Zuobin Zhu
- Department of Genetics, Xuzhou Medical University, Xuzhou, China
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