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Villanueva-Cotrina F, Bejar V, Guevara J, Cajamarca I, Medina C, Mujica L, Lescano AG. Biofilm formation and increased mortality among cancer patients with candidemia in a Peruvian reference center. BMC Infect Dis 2024; 24:1145. [PMID: 39395965 PMCID: PMC11470705 DOI: 10.1186/s12879-024-10044-5] [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: 01/30/2024] [Accepted: 10/02/2024] [Indexed: 10/14/2024] Open
Abstract
BACKGROUND Candidemia is an invasive mycosis with an increasing global incidence and high mortality rates in cancer patients. The production of biofilms by some strains of Candida constitutes a mechanism that limits the action of antifungal agents; however, there is limited and conflicting evidence about its role in the risk of death. This study aimed to determine whether biofilm formation is associated with mortality in cancer patients with candidemia. METHODS This retrospective cohort study included patients treated at Peru's oncologic reference center between June 2015 and October 2017. Data were collected by monitoring patients for 30 days from the diagnosis of candidemia until the date of death or hospital discharge. Statistical analyses evaluated the association between biofilm production determined by XTT reduction and mortality, adjusting for demographic, clinical, and microbiological factors assessed by the hospital routinary activities. Survival analysis and bivariate and multivariate Cox regression were used, estimating the hazard ratio (HR) as a measure of association with a significance level of p < 0.05. RESULTS A total of 140 patients with candidemia were included in the study. The high mortality observed on the first day of post-diagnosis follow-up (81.0%) among 21 patients who were not treated with either antifungal or antimicrobial drugs led to stratification of the analyses according to whether they received treatment. In untreated patients, there was a mortality gradient in patients infected with non-biofilm-forming strains vs. low/medium and high-level biofilm-forming strains (25.0%, 66.7% and 82.3%, respectively, p = 0.049). In treated patients, a high level of biofilm formation was associated with increased mortality (HR, 3.92; 95% p = 0.022), and this association persisted after adjusting for age, comorbidities, and hospital emergency admission (HR, 6.59; CI: 1.87-23.24, p = 0.003). CONCLUSIONS The association between candidemia with in vitro biofilm formation and an increased risk of death consistently observed both in patients with and without treatment, provides another level of evidence for a possible causal association. The presence of comorbidities and the origin of the hospital emergency, which reflect the fragile clinical condition of the patients, and increasing age above 15 years were associated with a higher risk of death.
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Affiliation(s)
- Freddy Villanueva-Cotrina
- Department of Pathology, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru.
- Mycology Laboratory, Instituto de Medicina Tropical Daniel Alcides Carrion - Universidad Nacional Mayor de San Marcos, Lima, Peru.
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.
- Instituto de Medicina Regional - Universidad Nacional del Nordeste. CONICET, Chaco, Argentina.
| | - Vilma Bejar
- Mycology Laboratory, Instituto de Medicina Tropical Daniel Alcides Carrion - Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - José Guevara
- Mycology Laboratory, Instituto de Medicina Tropical Daniel Alcides Carrion - Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Ines Cajamarca
- Department of Pathology, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Cyntia Medina
- Mycology Laboratory, Instituto de Medicina Tropical Daniel Alcides Carrion - Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Luis Mujica
- Mycology Laboratory, Instituto de Medicina Tropical Daniel Alcides Carrion - Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Andres G Lescano
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
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Farah N, Lim CW, Chin VK, Chong PP, Basir R, Yeo WWY, Tay ST, Choo S, Lee TY. Photoactivated riboflavin inhibits planktonic and biofilm growth of Candida albicans and non-albicans Candida species. Microb Pathog 2024; 191:106665. [PMID: 38685359 DOI: 10.1016/j.micpath.2024.106665] [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: 03/22/2024] [Revised: 04/23/2024] [Accepted: 04/26/2024] [Indexed: 05/02/2024]
Abstract
Fungal infections caused by Candida species pose a serious threat to humankind. Antibiotics abuse and the ability of Candida species to form biofilm have escalated the emergence of drug resistance in clinical settings and hence, rendered it more difficult to treat Candida-related diseases. Lethal effects of Candida infection are often due to inefficacy of antimicrobial treatments and failure of host immune response to clear infections. Previous studies have shown that a combination of riboflavin with UVA (riboflavin/UVA) light demonstrate candidacidal activity albeit its mechanism of actions remain elusive. Thus, this study sought to investigate antifungal and antibiofilm properties by combining riboflavin with UVA against Candida albicans and non-albicans Candida species. The MIC20 for the fluconazole and riboflavin/UVA against the Candida species tested was within the range of 0.125-2 μg/mL while the SMIC50 was 32 μg/mL. Present findings indicate that the inhibitory activities exerted by riboflavin/UVA towards planktonic cells are slightly less effective as compared to controls. However, the efficacy of the combination towards Candida species biofilms showed otherwise. Inhibitory effects exerted by riboflavin/UVA towards most of the tested Candida species biofilms points towards a variation in mode of action that could make it an ideal alternative therapeutic for biofilm-related infections.
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Affiliation(s)
- Nuratiqah Farah
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, UPM Serdang, Selangor, Malaysia
| | - Chee Woei Lim
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, UPM Serdang, Selangor, Malaysia
| | - Voon Kin Chin
- Faculty of Medicine, Nursing, and Health Sciences, SEGi University, Kota Damansara, 47810, Petaling Jaya, Selangor, Malaysia
| | - Pei Pei Chong
- School of Biosciences, Taylor's University, No 1, Jalan Taylor's, 47500, Subang Jaya, Selangor, Malaysia
| | - Rusliza Basir
- Department of Human Anatomy, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, 43400, UPM Serdang, Selangor, Malaysia
| | - Wendy Wai Yeng Yeo
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor Darul Ehsan, Malaysia
| | - Sun Tee Tay
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Sulin Choo
- School of Biosciences, Taylor's University, No 1, Jalan Taylor's, 47500, Subang Jaya, Selangor, Malaysia
| | - Tze Yan Lee
- Perdana University School of Liberal Arts, Science and Technology (PUScLST), Suite 9.2, 9th Floor, Wisma Chase Perdana, Changkat Semantan, Damansara Heights, 50490, Kuala Lumpur, Malaysia.
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3
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Day AW, Kumamoto CA. Selection of ethanol tolerant strains of Candida albicans by repeated ethanol exposure results in strains with reduced susceptibility to fluconazole. PLoS One 2024; 19:e0298724. [PMID: 38377103 PMCID: PMC10878505 DOI: 10.1371/journal.pone.0298724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/23/2024] [Indexed: 02/22/2024] Open
Abstract
Candida albicans is a commensal yeast that has important impacts on host metabolism and immune function, and can establish life-threatening infections in immunocompromised individuals. Previously, C. albicans colonization has been shown to contribute to the progression and severity of alcoholic liver disease. However, relatively little is known about how C. albicans responds to changing environmental conditions in the GI tract of individuals with alcohol use disorder, namely repeated exposure to ethanol. In this study, we repeatedly exposed C. albicans to high concentrations (10% vol/vol) of ethanol-a concentration that can be observed in the upper GI tract of humans following consumption of alcohol. Following this repeated exposure protocol, ethanol small colony (Esc) variants of C. albicans isolated from these populations exhibited increased ethanol tolerance, altered transcriptional responses to ethanol, and cross-resistance/tolerance to the frontline antifungal fluconazole. These Esc strains exhibited chromosomal copy number variations and carried polymorphisms in genes previously associated with the acquisition of fluconazole resistance during human infection. This study identifies a selective pressure that can result in evolution of fluconazole tolerance and resistance without previous exposure to the drug.
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Affiliation(s)
- Andrew W. Day
- Graduate School of Biomedical Sciences, Tufts University, Boston, Massachusetts, United States of America
- Department of Molecular Biology and Microbiology, Tufts University, Boston, Massachusetts, United States of America
| | - Carol A. Kumamoto
- Department of Molecular Biology and Microbiology, Tufts University, Boston, Massachusetts, United States of America
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4
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Jeon S, Shin JH, Lim HJ, Choi MJ, Byun SA, Lee D, Lee SY, Won EJ, Kim SH, Shin MG. Disk Diffusion Susceptibility Testing for the Rapid Detection of Fluconazole Resistance in Candida Isolates. Ann Lab Med 2021; 41:559-567. [PMID: 34108283 PMCID: PMC8203430 DOI: 10.3343/alm.2021.41.6.559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/28/2020] [Accepted: 05/20/2021] [Indexed: 11/19/2022] Open
Abstract
Background Given the increased fluconazole resistance (FR) among Candida isolates, we assessed the suitability of disk diffusion susceptibility testing (DDT) for the early detection of FR using well-characterized Candida isolates. Methods In total, 188 Candida isolates, including 66 C. albicans (seven Erg11 mutants), 69 C. glabrata (33 Pdr1 mutants), 29 C. parapsilosis (15 Erg11 mutants), and 24 C. tropicalis (eight Erg11 mutants) isolates, were tested in this study. FR was assessed using DDT according to the standard CLSI M44-ED3 method, except that two cell suspensions, McFarland 0.5 (standard inoculum) and 2.5 (large inoculum), were used, and the inhibition zones were read at 2-hour intervals from 10 hours to 24 hours. Results DDT results for the standard inoculum were readable after 14 hours (C. albicans, C. glabrata, and C. tropicalis) and 20 hours (C. parapsilosis) for >95% of the isolates, whereas the results for the large inoculum were readable after 12 hours (C. glabrata and C. tropicalis), 14 hours (C. albicans), and 16 hours (C. parapsilosis) for >95% of the isolates. Compared with the results produced using the CLSI M27-ED4 broth microdilution method, the first readable results from the DDT method for each isolate exhibited an agreement of 97.0%, 98.6%, 72.4%, and 91.7% for the standard inoculum and 100%, 98.6%, 96.6%, and 95.8% for the large inoculum for C. albicans, C. glabrata, C. parapsilosis, and C. tropicalis, respectively. Conclusions DDT using large inoculum may detect FR rapidly and reliably in the four most common Candida species.
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Affiliation(s)
- Suhak Jeon
- Department of Laboratory Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea
| | - Jong Hee Shin
- Department of Laboratory Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea
| | - Ha Jin Lim
- Department of Laboratory Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea
| | - Min Ji Choi
- Department of Laboratory Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea
| | - Seung A Byun
- Department of Laboratory Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea
| | - Dain Lee
- Department of Laboratory Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea
| | - Seung Yeob Lee
- Department of Laboratory Medicine, Jeonbuk National University Medical School and Jeonbuk National University Hospital, Jeonju, Korea
| | - Eun Jeong Won
- Department of Parasitology and Tropical Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Soo Hyun Kim
- Department of Laboratory Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea.,Department of Microbiology and Laboratory Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Myung Geun Shin
- Department of Laboratory Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea
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Kermani F, Sadeghian M, Shokohi T, Hashemi S, Moslemi D, Davodian S, Abastabar M, Bandalizadeh Z, Faeli L, Seifi Z, Fami Zaghrami M, Haghani I. Molecular identification and antifungal susceptibility testing of Candida species isolated from oral lesions in patients with head and neck cancer undergoing radiotherapy. Curr Med Mycol 2021; 7:44-50. [PMID: 34553097 PMCID: PMC8443873 DOI: 10.18502/cmm.7.1.6242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/14/2021] [Accepted: 05/02/2021] [Indexed: 12/02/2022] Open
Abstract
Background and Purpose: Radiation therapy in patients with head and neck malignancies predisposes them to oral Candida colonization and infection due to damage of oral mucosa and
destruction of the salivary gland. This study aimed to determine the prevalence of oropharyngeal candidiasis (OPC) in patients with head and neck cancer (HNC) undergoing radiotherapy (RT),
identify the yeasts isolated from them, and determine their antifungal susceptibility. Materials and Methods: This cross-sectional study was conducted from December 2018 to June 2019 at two referral radiotherapy centers in northern Iran.
Yeast strains that were isolated from patients with HNC were identified using conventional and molecular methods. The in vitro activities of eight common antifungal
drugs against 55 isolates were investigated according to the guidelines of the Clinical and Laboratory Standard Institute (M27-A3 and M27-S4) broth microdilution document. Results: Among 59 patients receiving RT, the prevalence of OPC was 21 (35.59%) and 15 (25.42%) patients were diagnosed with colonization. The mean age of the patients was
55.32±13.3 years (within the range of 27-87 years). In this study, the pseudomembranous form was reported as the most clinical type of OPC. Candida albicans with the
frequency of 60% was the most common type of Candida spp. that was observed in this study, although non-albicansCandida spp.,
such as C. glabrata (27.27%), C. tropicalis (5.45%), C. parapsilosis (3.63%), C. krusei (1.83%), and C. kefyr (1.83%) were also isolated.
Considering the low minimum inhibitory concentration range of amphotericin B, compared to fluconazole, administration of this agent is a more suitable antifungal
drug for extensive oral candidiasis in these patients. Among azoles, clotrimazole had low efficacy and several studied isolates (65.5%) showed resistance. Conclusion: Correct diagnosis as well as determining drug sensitivity and risk factors are the effective steps in reducing the complications related to oral candidiasis in people undergoing RT.
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Affiliation(s)
- Firoozeh Kermani
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohaddese Sadeghian
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tahereh Shokohi
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyedebrahim Hashemi
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Dariush Moslemi
- Department of Radiology and Radiation Therapy, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Saeed Davodian
- Department of Radiation Oncology, School of Medicine, Imam Khomeini Hospital, Mazandaran University of Medical Science, Sari, Iran
| | - Mahdi Abastabar
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zainab Bandalizadeh
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Leyla Faeli
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zahra Seifi
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmoud Fami Zaghrami
- Department of Microbiology, School of Veterinary Medicine, Islamic Azad University, Babol, Iran
| | - Iman Haghani
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
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Wang Y, Fan X, Wang H, Kudinha T, Mei YN, Ni F, Pan YH, Gao LM, Xu H, Kong HS, Yang Q, Wang WP, Xi HY, Luo YP, Ye LY, Xiao M. Continual Decline in Azole Susceptibility Rates in Candida tropicalis Over a 9-Year Period in China. Front Microbiol 2021; 12:702839. [PMID: 34305872 PMCID: PMC8299486 DOI: 10.3389/fmicb.2021.702839] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background There have been reports of increasing azole resistance in Candida tropicalis, especially in the Asia-Pacific region. Here we report on the epidemiology and antifungal susceptibility of C. tropicalis causing invasive candidiasis in China, from a 9-year surveillance study. Methods From August 2009 to July 2018, C. tropicalis isolates (n = 3702) were collected from 87 hospitals across China. Species identification was carried out by mass spectrometry or rDNA sequencing. Antifungal susceptibility was determined by Clinical and Laboratory Standards Institute disk diffusion (CHIF-NET10-14, n = 1510) or Sensititre YeastOne (CHIF-NET15-18, n = 2192) methods. Results Overall, 22.2% (823/3702) of the isolates were resistant to fluconazole, with 90.4% (744/823) being cross-resistant to voriconazole. In addition, 16.9 (370/2192) and 71.7% (1572/2192) of the isolates were of non-wild-type phenotype to itraconazole and posaconazole, respectively. Over the 9 years of surveillance, the fluconazole resistance rate continued to increase, rising from 5.7 (7/122) to 31.8% (236/741), while that for voriconazole was almost the same, rising from 5.7 (7/122) to 29.1% (216/741), with no significant statistical differences across the geographic regions. However, significant difference in fluconazole resistance rate was noted between isolates cultured from blood (27.2%, 489/1799) and those from non-blood (17.6%, 334/1903) specimens (P-value < 0.05), and amongst isolates collected from medical wards (28.1%, 312/1110) versus intensive care units (19.6%, 214/1092) and surgical wards (17.9%, 194/1086) (Bonferroni adjusted P-value < 0.05). Although echinocandin resistance remained low (0.8%, 18/2192) during the surveillance period, it was observed in most administrative regions, and one-third (6/18) of these isolates were simultaneously resistant to fluconazole. Conclusion The continual decrease in the rate of azole susceptibility among C. tropicalis strains has become a nationwide challenge in China, and the emergence of multi-drug resistance could pose further threats. These phenomena call for effective efforts in future interventions.
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Affiliation(s)
- Yao Wang
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xin Fan
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - He Wang
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Timothy Kudinha
- School of Biomedical Sciences, Charles Sturt University, Orange, NSW, Australia.,New South Wales Health Pathology, Regional and Rural, Orange Hospital, Orange, NSW, Australia
| | - Ya-Ning Mei
- Department of Clinical Laboratory, Jiangsu Province Hospital, Nanjing, Jiangsu, China
| | - Fang Ni
- Department of Clinical Laboratory, Jiangsu Province Hospital, Nanjing, Jiangsu, China
| | - Yu-Hong Pan
- Department of Clinical Laboratory, Fujian Medical University Union Hospital, Fuzhou, China
| | - Lan-Mei Gao
- Department of Clinical Laboratory, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hui Xu
- Department of Clinical Laboratory, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hai-Shen Kong
- Department of Laboratory Medicine, First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Qing Yang
- Department of Laboratory Medicine, First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Wei-Ping Wang
- Institute of Laboratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Hai-Yan Xi
- Institute of Laboratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Yan-Ping Luo
- Medical Laboratory Center, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Li-Yan Ye
- Medical Laboratory Center, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Meng Xiao
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Silver nanoparticles offer a synergistic effect with fluconazole against fluconazole-resistant Candida albicans by abrogating drug efflux pumps and increasing endogenous ROS. INFECTION GENETICS AND EVOLUTION 2021; 93:104937. [PMID: 34029724 DOI: 10.1016/j.meegid.2021.104937] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 04/23/2021] [Accepted: 05/19/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES A frequent emergence of drug resistance has been observed and posed great threat to global public health recently. This work aimed to investigate the potential synergistic effect and the underlying mechanisms of AgNPs-fluconazole combination more extensively through 2 clinically isolated fluconazole-resistant Candida albicans (C. albicans) strains. METHODS Antifungal properties of AgNPs and fluconazole alone or together against planktonic cells and biofilms were tested. Cellular and molecular targets associated with fluconazole resistance were monitored after AgNPs treatment. Antifungal potential of AgNPs-fluconazole combination was also explored in vivo using a mouse model of disseminated candidiasis. Tissue burden and survival rate were analyzed. RESULTS The results indicated that AgNPs worked synergistically with fluconazole against both planktonic cells of fluconazole-resistant C. albicans and biofilms formed <12 h. AgNPs treatment down-regulated ERG1, ERG11, ERG25, and CDR2, decreased membrane ergosterol levels and membrane fluidity, reduced membrane content of Cdr1p, Cdr2p, and thus efflux bump activity. The elevated ROS production was also a likely cause of the synergistic effect. In vivo, AgNPs and fluconazole combination significantly decreased the fungal burden and improved the survival rate of infected mice. CONCLUSION In conclusion, these results further confirm that AgNPs-fluconazole combination is a hopeful strategy for the treatment of fluconazole-resistant fungal infections.
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8
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Vinche ADL, de- la-Cruz-Chacón I, González-Esquinca AR, da Silva JDF, Ferreira G, dos Santos DC, Garces HG, de Oliveira DVM, Marçon C, Cavalcante RDS, Mendes RP. Antifungal activity of liriodenine on agents of systemic mycoses, with emphasis on the genus Paracoccidioides. J Venom Anim Toxins Incl Trop Dis 2020; 26:e20200023. [PMID: 33193751 PMCID: PMC7595607 DOI: 10.1590/1678-9199-jvatitd-2020-0023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 10/06/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Endemic systemic mycoses remain a health challenge, since these opportunistic diseases are increasingly infecting immunosuppressed patients. The simultaneous use of antifungal compounds and other drugs to treat infectious or non-infectious diseases has led to several interactions and undesirable effects. Thus, new antifungal compounds should be investigated. The present study aimed to evaluate the activity of liriodenine extracted from Annona macroprophyllata on agents of systemic mycoses, with emphasis on the genus Paracoccidioides. METHODS The minimum inhibitory concentration (MIC) and minimum fungicide concentration (MFC) were determined by the microdilution method. The cellular alterations caused by liriodenine on a standard P. brasiliensis (Pb18) strain were evaluated by transmission and scanning electron microscopy. RESULTS Liriodenine was effective only in 3 of the 8 strains of the genus Paracoccidioides and in the Histoplasma capsulatum strain, in a very low concentration (MIC of 1.95 μg.mL-1); on yeasts of Candida spp. (MIC of 125 to 250 μg.mL-1), including C. krusei (250 μg.mL-1), which has intrinsic resistance to fluconazole; and in Cryptococcus neoformans and Cryptococcus gattii (MIC of 62.5 μg.mL-1). However, liriodenine was not effective against Aspergillus fumigatus at the studied concentrations. Liriodenine exhibited fungicidal activity against all standard strains and clinical isolates that showed to be susceptible by in vitro tests. Electron microscopy revealed cytoplasmic alterations and damage to the cell wall of P. brasiliensis (Pb18). CONCLUSION Our results indicate that liriodenine is a promising fungicidal compound that should undergo further investigation with some chemical modifications.
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Affiliation(s)
- Adriele Dandara Levorato Vinche
- Department of Tropical Disease and Imaging Diagnosis, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | | | | | - Julhiany de Fátima da Silva
- Department of Tropical Disease and Imaging Diagnosis, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Gisela Ferreira
- Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | | | - Hans Garcia Garces
- Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | | | - Camila Marçon
- Department of Tropical Disease and Imaging Diagnosis, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Ricardo de Souza Cavalcante
- Department of Tropical Disease and Imaging Diagnosis, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Rinaldo Poncio Mendes
- Department of Tropical Disease and Imaging Diagnosis, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil
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9
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Abstract
Although not as ubiquitous as antibacterial susceptibility testing, antifungal susceptibility testing (AFST) is a tool of increasing importance in clinical microbiology laboratories. The goal of AFST is to reliably produce MIC values that may be used to guide patient therapy, inform epidemiological studies, and track rates of antifungal drug resistance. There are three methods that have been standardized by standards development organizations: broth dilution, disk diffusion, and azole agar screening for Aspergillus Other commonly used methods include gradient diffusion and the use of rapid automated instruments. Novel methodologies for susceptibility testing are in development. It is important for laboratories to consider not only the method of testing but also the interpretation (or lack thereof) of in vitro data.
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10
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Seyoum E, Bitew A, Mihret A. Distribution of Candida albicans and non-albicans Candida species isolated in different clinical samples and their in vitro antifungal suscetibity profile in Ethiopia. BMC Infect Dis 2020; 20:231. [PMID: 32188422 PMCID: PMC7081544 DOI: 10.1186/s12879-020-4883-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/12/2020] [Indexed: 12/30/2022] Open
Abstract
Background The spectrum of yeasts and their antifungal susceptibility profile are poorly known and treatment of fungal disease has remained empirical. The aim of this study is to determine the spectrum and antifungal susceptibility profile of yeasts particularly of Candida species. Methods A descriptive study on the composition of Candida species and antifungal susceptibility profile were conducted from January 2018 to September 2018. Clinical samples collected from different sites were cultured on Sabouraud dextrose agar and incubated for an appropriate time. Identification of yeast isolates and their antifungal susceptibility profile were determined by the VITEK 2 compact system. Descriptive statistics such as frequency and percentage of Candida species were calculated using SPSS version 20. Results Of 209 yeasts recovered, 104(49.8%), 90 (43.1%), 15(7.2%) were C. albicans, non albicans Candida species, and other yeasts, respectively. Among non albicans Candida species, Candida krusei was the commonest isolate. Of other yeast groups, 66.7% was represented by Cryptococcus laurentii. Regardless of Candida species identified, 85.6, 3.9, and 10.5% of the isolates were susceptible, intermediate, and resistant to fluconazole, respectively. C krusei was 100% resistant to the drug. Voriconazole demonstrated the greatest antifungal activity against Candida isolates in which 99.4% of Candida isolates were susceptible. The susceptibility and the resistance rate of Candida isolate to both caspofungin and micafungin were the same being 96 and 4% respectively. However, micafungin was more potent than caspofungin. The susceptibility, resistant, and intermediate rates of yeasts against flucytosine were, 86.2, 6.6, and 7.2%, respectively. Conclusions The present study demonstrated the distribution of Candida species in different clinical specimens where the isolation rate of non-albicans Candida species was comparable to Candida albicans. The high resistance rate of C. krusei to fluconazole and flucytosine may demonstrate that the treatment of candidiasis empirically is questionable.
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Affiliation(s)
- Elias Seyoum
- Ethiopian Public Health Institute, Clinical Bacteriology and Mycology Research Case Team, Addis Ababa, Ethiopia.
| | - Adane Bitew
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Amete Mihret
- Ethiopian Public Health Institute, Clinical Bacteriology and Mycology Research Case Team, Addis Ababa, Ethiopia
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Macroalgal activity against fungal urinary tract infections: in vitro screening and evaluation study. RENDICONTI LINCEI. SCIENZE FISICHE E NATURALI 2020. [DOI: 10.1007/s12210-019-00856-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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12
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Sayed FN, Mahmoud WH, Omar M, Mohamed GG. Theoretical studies of new Schiff base ligand derived from 1,3‐diaminopropane and 2‐acetyl ferrocene and studying some applications of its metal complexes. Appl Organomet Chem 2019. [DOI: 10.1002/aoc.5143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Fatma N. Sayed
- Chemistry Department, Faculty of ScienceCairo University Giza 12613 Egypt
| | - Walaa H. Mahmoud
- Chemistry Department, Faculty of ScienceCairo University Giza 12613 Egypt
| | - M.M. Omar
- Chemistry Department, Faculty of ScienceCairo University Giza 12613 Egypt
| | - Gehad G. Mohamed
- Chemistry Department, Faculty of ScienceCairo University Giza 12613 Egypt
- Egypt Nanotechnology CenterCairo University El‐Sheikh Zayed, 6th October City Giza 12588 Egypt
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Gonçalves B, Azevedo NM, Henriques M, Silva S. Hormones modulate Candida vaginal isolates biofilm formation and decrease their susceptibility to azoles and hydrogen peroxide. Med Mycol 2019; 58:341-350. [DOI: 10.1093/mmy/myz070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/25/2019] [Accepted: 06/05/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Vulvovaginal candidiasis (VVC) is an infection usually caused by Candida albicans and increasingly by Candida glabrata, which has an intrinsically high resistance to commonly used antifungals. Candida species possess virulence factors that contribute to VVC development, as the ability to form biofilms in vaginal walls and intrauterine devices. It is known that VVC is promoted by conditions that increase the hormones levels, during pregnancy, however, the effects of hormones on Candida cells are poorly studied, especially in C. glabrata. Thus, the influence of progesterone and β-estradiol, at normal cycle and pregnancy concentrations, on biofilm formation and resistance of C. albicans and C. glabrata vaginal isolates, was analyzed using acidic conditions (pH 4). Biofilms of C. albicans developed in the presence of hormones presented reduced biomass (up to 65%) and impaired cells ability to produce filamentous forms. On the other hand, C. glabrata presented high adaptation to the presence of hormones, which did not affect its biofilm formation. Additionally, hormones impaired the susceptibility of C. albicans and C. glabrata cells to azoles, with potential clinical significance in the presence of pregnancy hormone levels. A similar result was obtained for the susceptibility to hydrogen peroxide, a biological vaginal barrier against Candida growth. Overall, the results of this study suggest that hormones may act as environmental cues promoting Candida protection from vaginal defenses and harmful conditions, what may have implications in Candida vaginal pathogenicity and treatment of VVC, especially in C. glabrata infections due to its high adaptability to vaginal conditions.
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Affiliation(s)
- Bruna Gonçalves
- CEB, Center of Biological Engineering, LIBRO – “Laboratório de Investigação em Biofilmes Rosário Oliveira”, University of Minho, Gualtar Campus, 4715-057 Braga, Portugal
| | - Nuno Miguel Azevedo
- CEB, Center of Biological Engineering, LIBRO – “Laboratório de Investigação em Biofilmes Rosário Oliveira”, University of Minho, Gualtar Campus, 4715-057 Braga, Portugal
| | - Mariana Henriques
- CEB, Center of Biological Engineering, LIBRO – “Laboratório de Investigação em Biofilmes Rosário Oliveira”, University of Minho, Gualtar Campus, 4715-057 Braga, Portugal
| | - Sónia Silva
- CEB, Center of Biological Engineering, LIBRO – “Laboratório de Investigação em Biofilmes Rosário Oliveira”, University of Minho, Gualtar Campus, 4715-057 Braga, Portugal
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Abstract
Patients with suppressed immunity are at the highest risk for hospital-acquired infections. Among these, invasive candidiasis is the most prevalent systemic fungal nosocomial infection. Over recent decades, the combined prevalence of non-albicans Candida species outranked Candida albicans infections in several geographical regions worldwide, highlighting the need to understand their pathobiology in order to develop effective treatment and to prevent future outbreaks. Candida parapsilosis is the second or third most frequently isolated Candida species from patients. Besides being highly prevalent, its biology differs markedly from that of C. albicans, which may be associated with C. parapsilosis' increased incidence. Differences in virulence, regulatory and antifungal drug resistance mechanisms, and the patient groups at risk indicate that conclusions drawn from C. albicans pathobiology cannot be simply extrapolated to C. parapsilosis Such species-specific characteristics may also influence their recognition and elimination by the host and the efficacy of antifungal drugs. Due to the availability of high-throughput, state-of-the-art experimental tools and molecular genetic methods adapted to C. parapsilosis, genome and transcriptome studies are now available that greatly contribute to our understanding of what makes this species a threat. In this review, we summarize 10 years of findings on C. parapsilosis pathogenesis, including the species' genetic properties, transcriptome studies, host responses, and molecular mechanisms of virulence. Antifungal susceptibility studies and clinician perspectives are discussed. We also present regional incidence reports in order to provide an updated worldwide epidemiology summary.
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Makanjuola O, Bongomin F, Fayemiwo SA. An Update on the Roles of Non- albicans Candida Species in Vulvovaginitis. J Fungi (Basel) 2018; 4:E121. [PMID: 30384449 PMCID: PMC6309050 DOI: 10.3390/jof4040121] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/16/2018] [Accepted: 10/16/2018] [Indexed: 02/08/2023] Open
Abstract
Candida species are one of the commonest causes of vaginitis in healthy women of reproductive age. Vulvovaginal candidiasis (VVC) is characterized by vulvovaginal itching, redness and discharge. Candida albicans, which is a common genito-urinary tract commensal, has been the prominent species and remains the most common fungal agent isolated from clinical samples of patients diagnosed with VVC. In recent times, however, there has been a notable shift in the etiology of candidiasis with non-albicans Candida (NAC) species gaining prominence. The NAC species now account for approximately 10% to as high as 45% of VVC cases in some studies. This is associated with treatment challenges and a slightly different clinical picture. NAC species vaginitis is milder in presentation, often occur in patients with underlying chronic medical conditions and symptoms tend to be more recurrent or chronic compared with C. albicans vaginitis. C. glabrata is the most common cause of NAC-VVC. C. tropicalis, C. krusei, C. parapsilosis, and C. guilliermondii are the other commonly implicated species. Treatment failure is common in NAC-VVC, since some of these species are intrinsically resistant or show low susceptibilities to commonly used antifungal agents. This article reviews the etiology, pathogenesis, clinical features, diagnosis, and management of NAC vulvovaginitis.
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Affiliation(s)
- Olufunmilola Makanjuola
- Department of Medical Microbiology and Parasitology, University of Ibadan, Ibadan 200284, Nigeria.
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Gulu University, Gulu P.O. Box 166, Uganda.
| | - Samuel A Fayemiwo
- Department of Medical Microbiology and Parasitology, University of Ibadan, Ibadan 200284, Nigeria.
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK.
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Osaigbovo II, Lofor PV, Oladele RO. Fluconazole Resistance among Oral Candida Isolates from People Living with HIV/AIDS in a Nigerian Tertiary Hospital. J Fungi (Basel) 2017; 3:jof3040069. [PMID: 29371583 PMCID: PMC5753171 DOI: 10.3390/jof3040069] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 11/29/2017] [Accepted: 12/07/2017] [Indexed: 12/19/2022] Open
Abstract
Oropharyngeal candidiasis, a common fungal infection in people living with HIV/AIDS (PLWHA), arises from Candida species colonizing the oral cavity. Fluconazole is the preferred treatment and is often used empirically. Few studies have investigated the prevalence of fluconazole resistance in Nigeria. This study aimed at determining the burden of fluconazole resistance among Candida species in the oral cavities of PLWHA. We sampled the oral cavities of 350 HIV-infected adults and an equal number of HIV-negative controls. Candida isolates were identified using germ tube tests, CHROMagar Candida (CHROMagar, Paris, France), and API Candida yeast identification system (BioMérieux, Marcy-l’Étoile, France). Fluconazole susceptibility was determined using the Clinical and Laboratory Standards Institute disc diffusion method. Data were analysed using SPSS version 21 (IBM, New York, NY, USA). The significance level was set at p ≤ 0.05. The isolation rates for Candida amongst HIV-infected subjects and controls were 20.6% and 3.4%, respectively (p < 0.001). In PLWHA, Candida albicans was most frequently isolated (81.3%) and fluconazole resistance was present in 18 (24%) of the 75 Candida isolates. Resistance to fluconazole was present in half of the non-albicans Candida isolates. Fluconazole resistance is prevalent among oral Candida isolates in PLWHA in the study area with a significantly higher rate among non-albicans Candida spp.
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Affiliation(s)
- Iriagbonse I Osaigbovo
- Department of Medical Microbiology, School of Medicine, University of Benin, Benin City PMB 1154, Nigeria.
- Department of Medical Microbiology, University of Benin Teaching Hospital, Benin City PMB 1111, Nigeria.
| | - Patrick V Lofor
- Department of Medical Microbiology, School of Medicine, University of Benin, Benin City PMB 1154, Nigeria.
- Department of Medical Microbiology, University of Benin Teaching Hospital, Benin City PMB 1111, Nigeria.
| | - Rita O Oladele
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M139PL, UK.
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Whole Genome Sequence of the Heterozygous Clinical Isolate Candida krusei 81-B-5. G3-GENES GENOMES GENETICS 2017; 7:2883-2889. [PMID: 28696923 PMCID: PMC5592916 DOI: 10.1534/g3.117.043547] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Candida krusei is a diploid, heterozygous yeast that is an opportunistic fungal pathogen in immunocompromised patients. This species also is utilized for fermenting cocoa beans during chocolate production. One major concern in the clinical setting is the innate resistance of this species to the most commonly used antifungal drug fluconazole. Here, we report a high-quality genome sequence and assembly for the first clinical isolate of C. krusei, strain 81-B-5, into 11 scaffolds generated with PacBio sequencing technology. Gene annotation and comparative analysis revealed a unique profile of transporters that could play a role in drug resistance or adaptation to different environments. In addition, we show that, while 82% of the genome is highly heterozygous, a 2.0 Mb region of the largest scaffold has undergone loss of heterozygosity. This genome will serve as a reference for further genetic studies of this pathogen.
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Moreno X, Reviakina V, Panizo MM, Ferrara G, García N, Alarcón V, Garcés MF, Dolande M. [Molecular identification and in vitro antifungal susceptibility of blood isolates of the Candida parapsilosis species complex in Venezuela]. Rev Iberoam Micol 2017; 34:165-170. [PMID: 28457646 DOI: 10.1016/j.riam.2016.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 10/30/2016] [Accepted: 11/17/2016] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Candida parapsilosis is a species complex consisting of Candida parapsilosis sensu stricto, Candida orthopsilosis, and Candida metapsilosis. Studies worldwide have described its epidemiology and susceptibility to antifungal agents. AIMS The aims of this study were to carry out the molecular identification of blood isolates belonging to the Candida parapsilosis species complex, and to determine their in vitro susceptibility to antifungals of systemic use. METHODS A study of 86 strains of C. parapsilosis species complex collected in 2008-2011 and obtained from the Candidaemia Surveillance Network of Mycology Department of the Rafael Rangel National Institute of Hygiene, was made. Secondary alcohol-dehydrogenase gene amplification was performed using polymerase chain reaction, and the products were analysed by restriction fragments length polymorphisms using the enzyme BanI. Susceptibility tests were performed using Etest®, following the manufacturer's instructions with modifications. RESULTS Of the 86 isolates studied, 81 (94.2%) were C. parapsilosis sensu stricto, 4 (4.6%) C. orthopsilosis, and one (1.2%) C. metapsilosis. C. parapsilosis isolates were susceptible to amphotericin B and caspofungin, showing low rates of resistance to fluconazole and voriconazole. C. orthopsilosis and C. metapsilosis were susceptible to all the antifungals tested. CONCLUSIONS The results obtained in Venezuela provide for the first time important information about the distribution of C. parapsilosis species complex in cases of candidaemia, and support the need for continuing surveillance programs, including molecular discrimination of species and antifungal susceptibility tests, which may guide specific therapy.
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Affiliation(s)
- Xiomara Moreno
- Departamento de Microbiología, Instituto Médico La Floresta, Caracas, Venezuela.
| | - Vera Reviakina
- Departamento de Micología, Instituto Nacional de Higiene Rafael Rangel, Caracas, Venezuela
| | - María M Panizo
- Departamento de Micología, Instituto Nacional de Higiene Rafael Rangel, Caracas, Venezuela
| | - Giusseppe Ferrara
- Departamento de Micología, Instituto Nacional de Higiene Rafael Rangel, Caracas, Venezuela
| | - Nataly García
- Departamento de Micología, Instituto Nacional de Higiene Rafael Rangel, Caracas, Venezuela
| | - Víctor Alarcón
- Departamento de Micología, Instituto Nacional de Higiene Rafael Rangel, Caracas, Venezuela
| | - María F Garcés
- Laboratorio de Investigaciones Básicas y Aplicadas, Escuela de Bioanálisis, Universidad Central de Venezuela, Caracas, Venezuela
| | - Maribel Dolande
- Departamento de Micología, Instituto Nacional de Higiene Rafael Rangel, Caracas, Venezuela
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Motoa G, Muñoz JS, Oñate J, Pallares CJ, Hernández C, Villegas MV. Epidemiology of Candida isolates from Intensive Care Units in Colombia from 2010 to 2013. Rev Iberoam Micol 2016; 34:17-22. [PMID: 27810262 DOI: 10.1016/j.riam.2016.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 11/25/2015] [Accepted: 02/12/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The frequency of Candida isolates as a cause of hospital infections has risen in recent years, leading to high rates of morbidity and mortality. The knowledge of the epidemiology of those hospital acquired fungal infections is essential to implement an adequate antifungal therapy. AIMS To describe the epidemiology of Candida infections in Intensive Care Units (ICUs) from a surveillance network in Colombia. METHODS Information was collected from the microbiology laboratories of 20 tertiary healthcare institutions from 10 Colombian cities using the Whonet® software version 5.6. A general descriptive analysis of Candida species and susceptibility profiles focusing on fluconazole and voriconazole was completed between 2010 and 2013, including a sub-analysis of healthcare associated infections (HAIs) during the last year. RESULTS Candida isolates made up 94.5% of the 2680 fungal isolates considered, with similar proportions for Candida albicans and non-C. albicans Candida species (48.3% and 51.7%, respectively). Among the latter, Candida tropicalis (38.6%) and Candida parapsilosis (28.5%) were the most frequent species. Of note, among the blood isolates C. albicans was not the main species. Most of the species isolated were susceptible to fluconazole and voriconazole. From the HAIs reported, 25.5% were caused by Candida; central line-associated bloodstream infection was the most common HAI (58.8%). There were no statistically significant differences regarding length of hospital stay and device days among HAIs. CONCLUSIONS In ICUs of Colombia, non-C. albicans Candida species are as frequent as C. albicans, except in blood samples where non-C. albicans Candida isolates predominate. Further studies are needed to evaluate Candida associated risk factors and to determine its clinical impact.
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Affiliation(s)
- Gabriel Motoa
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
| | - Juan Sebastián Muñoz
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
| | - José Oñate
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia; Department of Internal Medicine, School of Medicine, Universidad del Valle, Cali, Colombia; Centro Medico Imbanaco, Cali, Colombia
| | | | - Cristhian Hernández
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
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Epidemiology, microbiology, clinical characteristics, and outcomes of candidemia in internal medicine wards-a retrospective study. Int J Infect Dis 2016; 52:49-54. [PMID: 27663909 DOI: 10.1016/j.ijid.2016.09.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/13/2016] [Accepted: 09/15/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The clinical characteristics of internal medicine ward (IMW) patients with candidemia are unclear. The aim of this study was to define the clinical characteristics of candidemic IMW patients and to study the incidence, species distribution, and outcomes of these patients compared to surgical and intensive care unit (ICU) candidemic patients. METHODS A retrospective cohort of candidemic patients in IMWs, general surgery wards, and an ICU at Beilinson Hospital during the period 2007-2014 was analyzed. RESULTS A total of 118 patients with candidemia were identified in six IMWs, two general surgery wards, and one ICU in the hospital. Candida albicans was the leading causative agent (41.1%). Higher proportions of Candida parapsilosis and Candida tropicalis isolates were observed in the IMW patients. IMW patients were significantly older, with poorer functional capacity, and had more frequently been exposed to antibiotic therapy within 90 days, in particular β-lactam-β-lactamase inhibitor combinations and cephalosporins. At onset of candidemia, a significantly lower number of IMW patients were mechanically ventilated (p<0.01); these patients did not have central line catheters comparable to ICU and surgical patients (p<0.001). They were less likely to receive adequate antifungal therapy within 48h, and this was the only significant predictor of survival in these patients (p=0.028): hazard ratio 3.7 (95% confidence interval 1.14-12.5) for therapy delayed to >48h. CONCLUSIONS IMW candidemic patients account for a substantial proportion of candidemia cases and have unique characteristics and high mortality rates.
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Rezazadeh E, Sabokbar A, Moazeni M, Rezai MS, Badali H. Microdilution in vitro Antifungal Susceptibility Patterns of Candida Species, From Mild Cutaneous to Bloodstream Infections. Jundishapur J Microbiol 2016; 9:e34151. [PMID: 27679703 PMCID: PMC5035436 DOI: 10.5812/jjm.34151] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 06/11/2016] [Accepted: 06/25/2016] [Indexed: 11/24/2022] Open
Abstract
Background Candida species, as opportunistic organisms, can cause various clinical manifestations, ranging from mild cutaneous infections to systemic candidiasis in otherwise healthy individuals. Remarkably, the incidence and mortality rates of candidemia have significantly increased worldwide, even after advances in medical interventions and the development of novel antifungal drugs. Objectives Given the possible resistance to antifungal agents, susceptibility testing can be useful in defining the activity spectrum of antifungals and determining the appropriate treatment regime. Materials and Methods The in vitro susceptibilities of molecularly identified Candida strains (n = 150) belonging to seven species recovered from clinical specimens, including vaginal, cutaneous, sputum, bronchoalveolar lavage (BAL), and blood samples, were determined for six antifungal drugs (amphotericin B, fluconazole, itraconazole, voriconazole, posaconazole, and caspofungin), based on the clinical and laboratory standards institute’s M27-A3 and M27-S4 documents. Results Candida albicans was the most frequently isolated species (44.66%), followed by non-albicans Candida, including C. glabrata (20%), C. parapsilosis (13.33%), C. krusei (8%), C. tropicalis (7.3%), C. dubliniensis (4%), and C. africana (3.33%). Posaconazole had the lowest geometric mean minimum inhibitory concentration (MIC) (0.0122 µg/ml), followed by amphotericin B (0.0217 µg/mL), voriconazole (0.1022 µg/mL), itraconazole (0.1612 µg/mL), caspofungin (0.2525 µg/mL), and fluconazole (0.4874 µg/mL) against all isolated Candida species. Candida africana and C. parapsilosis were significantly more susceptible to fluconazole, compared to C. albicans and other Candida species (P < 0.001). However, their clinical effectiveness in the treatment of Candida infections remains to be determined. Conclusions These findings highlight the importance of precise and correct species identification of clinical yeast isolates via molecular approaches, and of monitoring the antifungal susceptibility of Candida species recovered from clinical sources. Laboratories should consider routine MIC testing of C. glabrata isolates collected from sterile sites. Surveillance studies of Candida species and new analyses of antifungal treatment outcomes will allow more informed determinations of the value of these drugs in the antifungal armamentarium.
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Affiliation(s)
- Elham Rezazadeh
- Department of Microbiology, Karaj Branch, Islamic Azad University, Karaj, IR Iran
| | - Azar Sabokbar
- Department of Microbiology, Karaj Branch, Islamic Azad University, Karaj, IR Iran
| | - Maryam Moazeni
- Department of Medical Mycology and Parasitology, Invasive Fungi Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Mohammad Sadegh Rezai
- Infection Diseases Research Center with Focus on Nosocomial Infection, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Hamid Badali
- Department of Medical Mycology and Parasitology, Infection Diseases Research Center with Focus on Nosocomial Infection, Mazandaran University of Medical Sciences, Sari, IR Iran
- Corresponding author: Hamid Badali, Department of Medical Mycology and Parasitology, Infection Diseases Research Center with Focus on Nosocomial Infection, Mazandaran University of Medical Sciences, Sari, IR Iran. Tel: +98-9128413720, E-mail:
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Shokohi T, Badali H, Amirrajab N, Ataollahi MR, Kouhpayeh SA, Afsarian MH. In vitro activity of five antifungal agents against Candida albicans isolates, Sari, Iran. Curr Med Mycol 2016; 2:34-39. [PMID: 28681018 PMCID: PMC5490303 DOI: 10.18869/acadpub.cmm.2.2.8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background and Purpose: Candidaalbicans is the most common causative agent of candidiasis. Candidiasis management is dependent on the immune status of the host, severity of disease, and the choice of antifungal drug. Antifungals, specifically triazoles, are widely administered for the treatment of invasive fungal infections. Herein, we aimed to evaluate the invitro susceptibility of C. albicans isolates to fluconazole (FLZ), itraconazole (ITZ), voriconazole (VRZ), amphotericin B (AMB), and Caspofungin (CAS). Materials and Methods: A total of 44 clinical strains of C. albicans were collected from 36 patients admitted to four hospitals in Mazandaran Province, Iran. The invitro antifungal susceptibility testing was performed based on the Clinical and Laboratory Standards Institute methods. Results : Generally, 34 isolates were susceptible to all the five antifungal drugs, while four isolates were susceptible or susceptible dose-dependent (SDD) and six isolates were SDD or resistant to these antifungals. The lowest minimum inhibitory concentration (MIC; 0.016 µg/ml) belonged to AMB and the highest MIC was for FLZ )16 µg/ml). The lowest MIC (50 0.063 µg/ml) was related to ITZ and the lowest MIC (90 0.25 µg/ml) pertained to CAS, in addition , the highest MIC (50 1 µg/ml) and MIC (90 4 µg/ml) were for FLZ. Four of the isolates showed resistance to both FLZ and VRZ, separately, and five isolates were resistant to ITZ. Caspofungin showed potent activity against more than %95 of the C. albicans isolates. Conclusion: Overall, we reported %9.1 resistance to FLZ and VRZ ,%11.3 resistance to ITZ and AMB, and %4.6 resistance to caspofungin .Our finding is in agreement with previous observations proposing that C. albicans isolates develop resistance to some antifungal drugs such as FLZ since they are widely used as prophylaxis.
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Affiliation(s)
- T Shokohi
- Invasive Fungal Research Center, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - H Badali
- Invasive Fungal Research Center, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - N Amirrajab
- Department of Medical Laboratory Sciences, School of Paramedicine/Infectious & Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - M R Ataollahi
- Department of Medical Microbiology, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - S A Kouhpayeh
- Department of Pharmacology, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - M H Afsarian
- Department of Medical Microbiology, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran
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Neufeld PM, Melhem MDSC, Szeszs MW, Ribeiro MD, Amorim EDLT, da Silva M, Lazéra MDS. Nosocomial candidiasis in Rio de Janeiro State: Distribution and fluconazole susceptibility profile. Braz J Microbiol 2015; 46:477-84. [PMID: 26273262 PMCID: PMC4507539 DOI: 10.1590/s1517-838246220120023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 12/08/2014] [Indexed: 12/16/2022] Open
Abstract
One hundred and forty-one Candida species isolated from clinical specimens of hospitalized patients in Rio de Janeiro, Brazil, during 2002 to 2007, were analized in order to evaluate the distribution and susceptibility of these species to fluconazole. Candida albicans was the most frequent species (45.4%), followed by C. parapsilosis sensu lato (28.4%), C. tropicalis (14.2%), C. guilliermondii (6.4%), C. famata (2.8%), C. glabrata (1.4%), C. krusei (0.7%) and C. lambica (0.7%). The sources of fungal isolates were blood (47.5%), respiratory tract (17.7%), urinary tract (16.3%), skin and mucous membrane (7.1%), catheter (5.6%), feces (2.1%) and mitral valve tissue (0.7%). The susceptibility test was performed using the methodology of disk-diffusion in agar as recommended in the M44-A2 Document of the Clinical and Laboratory Standards Institute (CLSI). The majority of the clinical isolates (97.2%) was susceptible (S) to fluconazole, although three isolates (2.1%) were susceptible-dose dependent (S-DD) and one of them (0.7%) was resistant (R). The S-DD isolates were C. albicans, C. parapsilosis sensu lato and C. tropicalis. One isolate of C. krusei was resistant to fluconazole. This work documents the high susceptibility to fluconazole by Candida species isolated in Rio de Janeiro, Brazil.
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Affiliation(s)
- Paulo Murillo Neufeld
- Universidade Federal do Rio de
Janeiro, Departamento de Análises Clínicas e
Toxicológicas, Universidade Federal do Rio de
Janeiro, Rio de Janeiro, RJ, Brasil, Departamento de Análises Clínicas e
Toxicológicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ,
Brazil
- Fundação Oswaldo Cruz, Instituto Nacional de Controle de Qualidade em
Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil, Instituto Nacional de Controle de Qualidade em
Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Marcia de Souza Carvalho Melhem
- Instituto Adolfo Lutz, Serviço de Parasitologia, Instituto Adolfo Lutz, São Paulo, SP, Brasil, Serviço de Parasitologia, Instituto Adolfo
Lutz, São Paulo, SP, Brazil
| | - Maria Walderez Szeszs
- Instituto Adolfo Lutz, Serviço de Parasitologia, Instituto Adolfo Lutz, São Paulo, SP, Brasil, Serviço de Parasitologia, Instituto Adolfo
Lutz, São Paulo, SP, Brazil
| | - Marcos Dornelas Ribeiro
- Serviço de Patologia Clínica, Instituto Estadual de Hematologia Arthur da
Siqueira Cavalcante, Rio de Janeiro, RJ, Brasil, Serviço de Patologia Clínica, Instituto
Estadual de Hematologia Arthur da Siqueira Cavalcante, Rio de Janeiro, RJ,
Brazil
| | - Efigênia de Lourdes Teixeira Amorim
- Setor de Microbiologia e Urinálise, Laboratório Sérgio Franco, Rio de Janeiro, RJ, Brasil, Setor de Microbiologia e Urinálise, Laboratório
Sérgio Franco, Rio de Janeiro, RJ, Brazil
| | - Manuela da Silva
- Fundação Oswaldo Cruz, Instituto Nacional de Controle de Qualidade em
Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil, Instituto Nacional de Controle de Qualidade em
Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Marcia dos Santos Lazéra
- Fundação Oswaldo Cruz, Laboratório de Micologia, Instituto de Pesquisa Clínica Hospital Evandro
Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil, Laboratório de Micologia, Instituto de Pesquisa
Clínica Hospital Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ,
Brazil
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El-Azizi M, Farag N, Khardori N. Antifungal activity of amphotericin B and voriconazole against the biofilms and biofilm-dispersed cells of Candida albicans employing a newly developed in vitro pharmacokinetic model. Ann Clin Microbiol Antimicrob 2015; 14:21. [PMID: 25885806 PMCID: PMC4389768 DOI: 10.1186/s12941-015-0083-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 03/23/2015] [Indexed: 11/16/2022] Open
Abstract
Background Candida albicans is a common cause of a variety of superficial and invasive disseminated infections the majority of which are associated with biofilm growth on implanted devices. The aim of the study is to evaluate the activity of amphotericin B and voriconazole against the biofilm and the biofilm-dispersed cells of Candida albicans using a newly developed in vitro pharmacokinetic model which simulates the clinical situation when the antifungal agents are administered intermittently. Methods RPMI medium containing 1–5 X 106 CFU/ml of C. albicans was continuously delivered to the device at 30 ml/h for 2 hours. The planktonic cells were removed and biofilms on the catheter were kept under continuous flow of RPMI medium at 10 ml/h. Five doses of amphotericin B or voriconazole were delivered to 2, 5 and 10 day-old biofilms at initial concentrations (2 and 3 μg/ml respectively) that were exponentially diluted. Dispersed cells in effluents from the device were counted and the adherent cells on the catheter were evaluated after 48 h of the last dose. Results The minimum inhibitory concentration of voriconazole and amphotericin B against the tested isolate was 0.0325 and 0.25 μg/ml respectively. Amphotericin B significantly reduced the dispersion of C. albicans cells from the biofilm. The log10 reduction in the dispersed cells was 2.54-3.54, 2.30-3.55, and 1.94-2.50 following addition of 5 doses of amphotericin B to 2-, 5- and 10-day old biofilms respectively. The number of the viable cells within the biofilm was reduced by 18 (±7.63), 5 and 4% following addition of the 5 doses of amphotericin B to the biofilms respectively. Voriconazole showed no significant effect on the viability of C. albicans within the biofilm. Conclusion Both antifungal agents failed to eradicate C. albicans biofilm or stop cell dispersion from them and the resistance progressed with maturation of the biofilm. These findings go along with the need for removal of devices in spite of antifungal therapy in patients with device-related infection. This is the first study which investigates the effects of antifungal agents on the biofilm and biofilm-dispersion of C. albicans in an in vitro pharmacokinetic biofilm model.
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Affiliation(s)
- Mohamed El-Azizi
- German University in Cairo, GUC, Faculty of Pharmacy and Biotechnology, Department of Microbiology, Immunology and Biotechnology, Al-Tagmoa Al-Khamis, New Cairo City, Egypt.
| | - Noha Farag
- German University in Cairo, GUC, Faculty of Pharmacy and Biotechnology, Department of Microbiology, Immunology and Biotechnology, Al-Tagmoa Al-Khamis, New Cairo City, Egypt.
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25
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Dalwai S, Rodrigues SJ, Baliga S, Shenoy VK, Shetty TB, Pai UY, Saldanha S. Comparative evaluation of antifungal action of tea tree oil, chlorhexidine gluconate and fluconazole on heat polymerized acrylic denture base resin - anin vitrostudy. Gerodontology 2014; 33:402-9. [DOI: 10.1111/ger.12176] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Sameen Dalwai
- Department of Prosthodontics; Manipal College of Dental Sciences; Mangalore India
| | - Shobha J. Rodrigues
- Department of Prosthodontics; Manipal College of Dental Sciences; Mangalore India
| | - Shrikala Baliga
- Department of Microbiology; Kasturba Medical College; Mangalore India
| | - Vidya K. Shenoy
- Department Of Prosthodontics; A J Institute of Dental Sciences; Mangalore India
| | - Thilak B. Shetty
- Department of Prosthodontics; Manipal College of Dental Sciences; Mangalore India
| | - Umesh Y. Pai
- Department of Prosthodontics; Manipal College of Dental Sciences; Mangalore India
| | - Sharon Saldanha
- Department of Prosthodontics; Manipal College of Dental Sciences; Mangalore India
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26
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Devrim I, Yaman Y, Demirağ B, Oymak Y, Cartı Ö, Özek G, Tulumoğlu S, Erdem T, Gamze G, Gözmen S, Güneş BT, Bayram N, Vergin C. A single center's experience with Candida parapsilosis related long-term central venous access device infections: the port removal decision and its outcomes. Pediatr Hematol Oncol 2014; 31:435-41. [PMID: 24383767 DOI: 10.3109/08880018.2013.862587] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pediatric cancer patients have an increased risk of potentially life-threatening fungal infections such as Candida parapsilosis, associated with long-term CVADs. The Infectious Diseases Society of America (IDSA) guidelines on Candida catheter-related bloodstream infections recommend systemic antifungal therapy and catheter removal. In this study, we focused on our experience with antifungal failure due to totally implanted catheter-associated C. parapsilosis bloodstream infections. We investigated cases leading to port removal in pediatric malignancy patients and the associated patient outcomes. In the first phase of the study, a retrospective chart review was performed to collect patient information, including primary disease; time from hospitalization to port-related candidemia; antifungal drug choice; and the time at which port removal occurred. During the second phase, antifungal susceptibility tests for C. parapsilosis were performed in our microbiology laboratory. All patients had fevers and were neutropenic at the time of candidemia diagnosis. The mean duration between the first isolation of Candida parapsilosis from the port samples to the port removal was 9.75 ± 5.29 days for 11 patients. Patient fevers lasted for a mean time of 16.22 ± 6.51 days. The median recovery duration from fever after CVC removal was four days (range 2-12 days). The median duration for achieving negative blood cultures, following antifungal treatment was 18 days (range 10-27 days). Our data favored the removal of catheters in the presence of ongoing fever, as suggested by the guidelines, independent of the chosen antifungal treatment. Future studies with large samples are needed to evaluate the effects of catheter removal on mortality rates and patient outcomes.
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Affiliation(s)
- Ilker Devrim
- 1Division of Pediatric Infectious Disease, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
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27
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Strasfeld L, Weinstock DM. Antifungal prophylaxis among allogeneic hematopoietic stem cell transplant recipients: current issues and new agents. Expert Rev Anti Infect Ther 2014; 4:457-68. [PMID: 16771622 DOI: 10.1586/14787210.4.3.457] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Invasive candidiasis and invasive mold infections cause significant morbidity and mortality in the hematopoietic stem cell transplant population, in particular in recipients of allografts. The introduction of a variety of new antifungal compounds over the past decade has focused attention on prophylactic strategies as a means to decrease the burden of invasive fungal infections (IFIs). Until recently, fluconazole has been the standard agent for prophylaxis before and after engraftment. In 2005, the echinocandin micafungin received US FDA approval for prophylaxis against IFIs in stem cell transplant recipients during the neutropenic period prior to engraftment. In patients with substantial risk for invasive mold infection, many centers now use a mold-active antifungal agent (e.g., a triazole such as itraconazole, voriconazole or posaconazole, or an echinocandin) as prophylaxis after engraftment. Several recent studies have highlighted the efficacy of these newer agents in preventing IFIs in these highly immunocompromised patients. This review will discuss current issues in IFI and new agents available for prophylaxis in allogeneic hematopoietic stem cell transplant recipients.
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Affiliation(s)
- Lynne Strasfeld
- Weill Medical College of Cornell University, Department of Medicine, Division of International Medicine and Infectious Diseases, 1300 York Avenue, A-421, New York, NY 10021, USA.
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Yeast identification algorithm based on use of the Vitek MS system selectively supplemented with ribosomal DNA sequencing: proposal of a reference assay for invasive fungal surveillance programs in China. J Clin Microbiol 2013; 52:572-7. [PMID: 24478490 DOI: 10.1128/jcm.02543-13] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Sequence analysis of the internal transcribed spacer (ITS) region was employed as the gold standard method for yeast identification in the China Hospital Invasive Fungal Surveillance Net (CHIF-NET). It has subsequently been found that matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) is potentially a more practical approach for this purpose. In the present study, the performance of the Vitek MS v2.0 system for the identification of yeast isolates collected from patients with invasive fungal infections in the 2011 CHIF-NET was evaluated. A total of 1,243 isolates representing 31 yeast species were analyzed, and the identification results by the Vitek MS v2.0 system were compared to those obtained by ITS sequence analysis. By the Vitek MS v2.0 system, 96.7% (n = 1,202) of the isolates were correctly assigned to the species level and 0.2% (n = 2) of the isolates were identified to the genus level, while 2.4% (n = 30) and 0.7% (n = 9) of the isolates were unidentified and misidentified, respectively. After retesting of the unidentified and misidentified strains, 97.3% (n = 1,209) of the isolates were correctly identified to the species level. Based on these results, a testing algorithm that combines the use of the Vitek MS system with selected supplementary ribosomal DNA (rDNA) sequencing was developed and validated for yeast identification purposes. By employing this algorithm, 99.7% (1,240/1,243) of the study isolates were accurately identified with the exception of two isolates of Candida fermentati and one isolate of Cryptococcus gattii. In conclusion, the proposed identification algorithm could be practically implemented in strategic programs of fungal infection surveillance.
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Carvalho C, Yang J, Vogan A, Maganti H, Yamamura D, Xu J. Clinical and tree hollow populations of human pathogenic yeast in Hamilton, Ontario, Canada are different. Mycoses 2013; 57:271-83. [PMID: 24283796 DOI: 10.1111/myc.12156] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/22/2013] [Accepted: 10/22/2013] [Indexed: 11/29/2022]
Abstract
Yeast are among the most frequent pathogens in humans. The dominant yeast causing human infections belong to the genus Candida and Candida albicans is the most frequently isolated species. However, several non-C. albicans species are becoming increasingly common in patients worldwide. The relationships between yeast in humans and the natural environments remain poorly understood. Furthermore, it is often difficult to identify or exclude the origins of disease-causing yeast from specific environmental reservoirs. In this study, we compared the yeast isolates from tree hollows and from clinics in Hamilton, Ontario, Canada. Our surveys and analyses showed significant differences in yeast species composition, in their temporal dynamics, and in yeast genotypes between isolates from tree hollows and hospitals. Our results are inconsistent with the hypothesis that yeast from trees constitute a significant source of pathogenic yeast in humans in this region. Similarly, the yeast in humans and clinics do not appear to contribute to yeast in tree hollows.
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Affiliation(s)
- Chris Carvalho
- Department of Biology, McMaster University, Hamilton, ON, Canada
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30
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R. Y, M.P. S, U.A. B, R. R, K.B. A. Candiduria: prevalence and trends in antifungal susceptibility in a tertiary care hospital of mangalore. J Clin Diagn Res 2013; 7:2459-61. [PMID: 24392372 PMCID: PMC3879894 DOI: 10.7860/jcdr/2013/6298.3578] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 10/24/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The incidence of Candida has been on rise worldwide. Urinary tract infections (UTIs) as a result of Candida species are becoming, common in hospitalised patients. Clinicians face dilemma in differentiating colonization from true candiduria. The species identification of Candida is important, as non albicans Candida species are increasing in number and more resistant to antifungal drugs. The aim of the study was to find out the frequency of Candida among uropathogens, their speciation and to determine the susceptibilities to antifungal drugs of Candida species isolated from candiduria. MATERIAL AND METHODS A total of 2900 urine samples were analysed in a tertiary care hospital. Candida species isolated from urine samples were subjected to speciation using CHROM agar and standard yeast identification protocol. Antifungal susceptibility testing for fluconazole, voriconazole, flucytosine, amphotericin B was carried out using VITEK-2 compact system of Biomerieux. RESULT A total of 66(2.27%) Candida species were isolated from 2900 urine samples. Among them non albicans Candida species were predominant (69.7%) compared to Candida albicans (30.3%). The Candida isolated were more susceptible to amphotericin B (91%) and flucytosine (82%) compared to voriconazole (72.72%) and fluconazole (66.66%). CONCLUSION The present study reiterates the prevalence of Candida species among UTIs and their antifungal susceptibility pattern. Prevalence of non albicans Candida was more than Candida albicans. Non albicans Candida species are more resistant to antifungal drugs compared to C.albicans. Therefore, the species identification of Candida isolates along with their antifungal susceptibility pattern can help the clinicians in better treating the patients with candiduria.
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Affiliation(s)
- Yashavanth R.
- Associate Professor, Department of Microbiology, AJ Institute of Medical Sciences, Mangalore, India
| | - Shiju M.P.
- Microbiologist, Columbia Asia, Referral Hospital, Bangalore, India
| | - Bhaskar U.A.
- Post-Graduate Student, Department of Microbiology, AJ Institute of Medical Sciences, Mangalore, India
| | - Ronald R.
- Professor & Head, Department of Microbiology, AJ Institute of Medical Sciences, Mangalore, India
| | - Anita K.B.
- Professor, Department of Microbiology, AJ Institute of Medical Sciences, Mangalore, India
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31
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Nelson M, Wanjiru W, Margaret M. Identification and Susceptibility Profile of Vaginal Candida Species to Antifungal Agents among Pregnant Women Attending the Antenatal Clinic of Thika District Hospital, Kenya. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojmm.2013.34036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Canadian clinical practice guidelines for invasive candidiasis in adults. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2012; 21:e122-50. [PMID: 22132006 DOI: 10.1155/2010/357076] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Candidemia and invasive candidiasis (C/IC) are life-threatening opportunistic infections that add excess morbidity, mortality and cost to the management of patients with a range of potentially curable underlying conditions. The Association of Medical Microbiology and Infectious Disease Canada developed evidence-based guidelines for the approach to the diagnosis and management of these infections in the ever-increasing population of at-risk adult patients in the health care system. Over the past few years, a new and broader understanding of the epidemiology and pathogenesis of C/IC has emerged and has been coupled with the availability of new antifungal agents and defined strategies for targeting groups at risk including, but not limited to, acute leukemia patients, hematopoietic stem cell transplants and solid organ transplants, and critical care unit patients. Accordingly, these guidelines have focused on patients at risk for C/IC, and on approaches of prevention, early therapy for suspected but unproven infection, and targeted therapy for probable and proven infection.
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Pires RH, Santos JMD, Zaia JE, Martins CHG, Mendes-Giannini MJS. Candida parapsilosis complex water isolates from a haemodialysis unit: biofilm production and in vitro evaluation of the use of clinical antifungals. Mem Inst Oswaldo Cruz 2012; 106:646-54. [PMID: 22012217 DOI: 10.1590/s0074-02762011000600002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Accepted: 08/16/2011] [Indexed: 11/22/2022] Open
Abstract
Candida parapsilosis, currently divided into three distinct species, proliferates in glucose-rich solutions and has been associated with infections resulting from the use of medical devices made of plastic, an environment common in dialysis centres. The aims of this study were (i) to screen for Candida orthopsilosis and Candida metapsilosis (100 environmental isolates previously identified as C. parapsilosis), (ii) to test the ability of these isolates to form biofilm and (iii) to investigate the in vitro susceptibility of Candida spp biofilms to the antifungal agents, fluconazole (FLC) and amphotericin B (AMB). Isolates were obtained from a hydraulic circuit collected from a haemodialysis unit. Based on molecular criteria, 47 strains were re-identified as C. orthopsilosis and 53 as C. parapsilosis. Analyses using a formazan salt reduction assay and total viable count, together with microscopy studies, revealed that 72 strains were able to form biofilm that was structurally similar, but with minor differences in morphology. A microtitre-based colorimetric assay used to test the susceptibility of fungal biofilms to AMB and FLC demonstrated that the C. parapsilosis complex displayed an increased resistance to these antifungal agents. The results from these analyses may provide a basis for implementing quality controls and monitoring to ensure the microbiological purity of dialysis water, including the presence of yeast.
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Affiliation(s)
- Regina Helena Pires
- Departamento de Análises Clínicas, Faculdade de Ciências Farmacêuticas, Universidade Estadual Paulista, Araraquara, SP, Brasil.
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Iatta R, Caggiano G, Cuna T, Montagna MT. Antifungal susceptibility testing of a 10-year collection of Candida spp. isolated from patients with candidemia. J Chemother 2012; 23:92-6. [PMID: 21571625 DOI: 10.1179/joc.2011.23.2.92] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Nosocomial yeast infections have increased significantly worldwide and especially in surgical and intensive care unit (ICU) patients. Although Candida species have various degrees of susceptibility to frequently used drugs, antifungal resistance is rare. A ten-year retrospective surveillance of candidemia was carried out in a University Hospital of Southern Italy. The aim of this study was the determination of Candida bloodstream infections (BSI) and central venous catheter (CVC)- related episodes, prevalence and in vitro susceptibility. 320 candidemia episodes were registered and 374 yeasts collected. Etest and Sensititre methods were used to test the isolates' susceptibility to amphotericin B, anidulafungin, caspofungin, fluconazole, itraconazole, posaconazole and voriconazole. The results were compared with those of CLSI reference broth microdilution method. Most yeasts were susceptible to all antifungal drugs, with the exception of C. Glabrata susceptibility to triazoles and C. tropicalis to fluconazole and voriconazole. As expected, C. parapsilosis isolates were generally associated with higher echinocandin minimum inhibitory concentrations (miCs) than the other Candida species. This study confirms the different antifungal susceptibility patterns among species, and underlines the need to perform antifungal susceptibility testing of clinically relevant yeasts.
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Affiliation(s)
- R Iatta
- Department of Biomedical Science and Human Oncology, Section of Hygiene - Aldo Moro, University of Bari, Italy.
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35
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Hossein M, Mirhendi SH, Brandão J, Mirdashti R, Rosado L. Comparison of Enzymatic Method Rapid Yeast Plus System with RFLP-PCR for Identification of Isolated Yeast from Vulvovaginal Candidiasis. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2011; 14:443-50. [PMID: 23493663 PMCID: PMC3586841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 04/06/2011] [Indexed: 12/02/2022]
Abstract
OBJECTIVES To compare two identification methods, i.e., restriction fragment length polymorphism (RFLP)-PCR analysis and enzymatic method Rapid TM Yeast Plus System to identify different species causing vulvovaginal candidiasis (VVC). MATERIALS AND METHODS Vaginal discharges of women who had attended the gynecology outpatient clinic of Mobini Hospital in Sabzevar, Iran were collected using cotton swabs and were cultured on Sabouraud dextrose agar. Isolated yeasts were identified by germ-tube testing and Rapid TM Yeast Plus System (Remel USA). For molecular identification, the isolated DNA was amplified with ITS1 and ITS4 universal primers and PCR products digested with the enzyme HpaІІ followed by agarose gel electrophoresis. Epidemiological and clinical features of women with respect to identified species were also evaluated. RESULTS Out of 231 subjects enrolled, 62 VVC cases were detected. The isolated species were identified as follows: Candida albicans, 24 (38.7%), C. glabrata, 15 (24.2%), C. kefyr, 13 (21.0%) C. krusei, 9 (14.5%), and Saccharomyces cerevisiae, 1 (1.6%) by RFLP-PCR method; whereas findings by Rapid TM Yeast Plus System were C. albicans, 24 (38.7%), C. glabrata, 5 (8%), C. kefyr, 11 (17.7%) C. krusei, 2 (3.2%), S. cerevisiae, 9 (14.5%), and C. tropicalis, 6 (9.6%) as well as other nonpathogenic yeasts, 4 (6.9%). CONCLUSION Statistical comparison showed that there is no significant difference in identification of C. albicans by the two methods; although, in this study, it was not true about other species of yeasts. A correlation between clinical and laboratory findings is important as it enables us to administer an appropriate treatment on time.
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Affiliation(s)
- Moallaei Hossein
- Department of Medical Microbiology, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Seied Hossein Mirhendi
- Departmentof Medical Parasitology and Mycology, School of Public Health and National Institute of Health Researches, Tehran University of Medical Sciences, Tehran, Iran
| | - João Brandão
- Department of Infectious Diseases, National Iinstitute of Health Dr. Ricardo Jorge, Av. Padre Cruz 1649-016 Lisbon, Portugal
| | - Reza Mirdashti
- Central Labs of Medical Basic Sciences, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Laura Rosado
- Department of Infectious Diseases, National Iinstitute of Health Dr. Ricardo Jorge, Av. Padre Cruz 1649-016 Lisbon, Portugal
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Capoor MR, Sarabahi S, Tiwari VK, Narayanan RP. Fungal infections in burns: Diagnosis and management. Indian J Plast Surg 2011; 43:S37-42. [PMID: 21321655 PMCID: PMC3038393 DOI: 10.4103/0970-0358.70718] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Burn wound infection (BWI) is a major public health problem and the most devastating form of trauma worldwide. Fungi cause BWI as part of monomicrobial or polymicrobial infection, fungaemia, rare aggressive soft tissue infection and as opportunistic infections. The risk factors for acquiring fungal infection in burns include age of burns, total burn size, body surface area (BSA) (30-60%), full thickness burns, inhalational injury, prolonged hospital stay, late surgical excision, open dressing, artificial dermis, central venous catheters, antibiotics, steroid treatment, long-term artificial ventilation, fungal wound colonisation (FWC), hyperglycaemic episodes and other immunosuppressive disorders. Most of the fungal infections are missed owing to lack of clinical awareness and similar presentation as bacterial infection coupled with paucity of mycology laboratories. Expedient diagnosis and treatment of these mycoses can be life-saving as the mortality is otherwise very high. Emergence of resistance in non-albicans Candida spp., unusual yeasts and moulds in fungal BWI, leaves very few fungi susceptible to antifungal drugs, leaving many patients susceptible. There is a need to speciate fungi as far as the topical and systemic antifungal is concerned. Deep tissue biopsy and other relevant samples are processed by standard mycological procedures using direct microscopy, culture and histopathological examination. Patients with FWC should be treated by aggressive surgical debridement and, in the case of fungal wound infection (FWI), in addition to surgical debridement, an intravenous antifungal drug, most commonly amphotericin B or caspofungin, is prescribed followed by de-escalating with voriconazole or itraconazole, or fluconazole depending upon the species or antifungal susceptibility, if available. The propensity for fungal infection increases, the longer the wound is present. Therefore, the development of products to close the wound more rapidly, improvement in topical antifungal therapy with mould activity and implementation of appropriate systemic antifungal therapy guided by antifungal susceptibility may improve the outcome for severely injured burn victims.
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Affiliation(s)
- Malini R Capoor
- Department of Micrbiology Vardhman Mahaveer Medical College & Safdarjung Hospital, Delhi - 110 029, India
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Capoor MR, Gupta S, Sarabahi S, Mishra A, Tiwari VK, Aggarwal P. Epidemiological and clinico-mycological profile of fungal wound infection from largest burn centre in Asia. Mycoses 2011; 55:181-8. [PMID: 21740469 DOI: 10.1111/j.1439-0507.2011.02065.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The current study was conducted to know the incidence, predisposing factors, spectrum, clinical profile and antifungal susceptibility (AFS) of fungal wound infection (FWI) in burn patients. Of a total of 71 patients, 20 (28.2%) emerged with the diagnosis of FWI. Fungal pathogens in this study were Candida tropicalis (14%), Candida parapsilosis (5.6%), Aspergillus niger (2.8%) and one each of Candida albicans (1.4%), Candida glabrata (1.4%), Syncephalestrum (1.4%) and Fusarium solani (1.4%). All patients with mould infections expired before the mycological culture results could be conveyed to clinicians. Of the yeasts isolated in the study, one each of C. tropicalis and C. albicans showed cross-resistance to azoles. All the moulds were susceptible to amphotericin B. This study depicted that fungal invasion is associated with a high mortality, burn size 30-60% and high incidence of inhalational injury. Fungal invasion was detected on an average of 14 days after injury. Association of use of four classes of drugs - aminoglycosides, imipenem, vancomycin and third generation cephalosporins and use of total parenteral nutrition was observed. Expedient laboratory diagnosis of FWI and appropriate systemic antifungal therapy guided by AFS may improve outcome for severely injured burn victims.
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Affiliation(s)
- Malini R Capoor
- Department of Microbiology, Vardhman Mahaveer Medical College & Safdarjung Hospital, New Delhi, India.
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Metin DY, Hilmioglu-Polat S, Samlioglu P, Doganay-Oflazoglu B, Inci R, Tumbay E. Evaluation of antifungal susceptibility testing with microdilution and Etest methods of Candida blood isolates. Mycopathologia 2011; 172:187-99. [PMID: 21424603 DOI: 10.1007/s11046-011-9413-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 03/06/2011] [Indexed: 10/18/2022]
Abstract
Candida species that show an increasing number of clinical and/or microbiological resistance to several antifungals and are the most common agents of invasive fungal infections. The aim of this study was to investigate the in vitro susceptibility of Candida blood isolates to antifungal agents (amphotericin B, fluconazole, itraconazole, and voriconazole) by comparative use of the CLSI reference microdilution method and Etest. Four hundred Candida blood isolates (215 Candida albicans, 185 non-albicans Candida strains) were included in the study. The broth microdilution test was performed according to the CLSI M27 A2 document. Etest was carried out according to the manufacturer's instructions. The MIC results obtained with reference microdilution were compared with those obtained with the Etest by using percent and categorical agreements. According to MIK(90) values, voriconazole was the most active and itraconazole was the least active drug in vitro against all Candida species. Other than voriconazole, statistically significant differences were found when the susceptibility of Candida albicans and non-albicans Candida spp. to amphotericin B, fluconazole, and itraconazole were compared. These antifungal agents were found to be more active to C. albicans. Among the non-albicans Candida species, the lowest MIC values were obtained for Candida parapsilosis isolates. When the standard method was compared with Etest, the total agreement was higher for C. albicans than for non-albicans species, especially for fluconazole and voriconazole. In view of the findings, it was concluded that itraconazole showed the lowest activity against all Candida species. Etest could be an alternative method in assessing the in vitro antifungal susceptibility of Candida spp., but it is more convenient to use the microdilution method for studying in vitro susceptibility of non-albicans species, in particular for those possessing high MIC values against azoles.
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Affiliation(s)
- Dilek Yesim Metin
- Department of Medical Microbiology, Ege University Faculty of Medicine, Bornova, Izmir, Turkey.
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Dota KFD, Freitas AR, Consolaro MEL, Svidzinski TIE. A Challenge for Clinical Laboratories: Detection of Antifungal Resistance inCandidaSpecies Causing Vulvovaginal Candidiasis. Lab Med 2011. [DOI: 10.1309/lmdfca8yez0mqula] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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San-Blas G, Burger E. Experimental medical mycological research in Latin America - a 2000-2009 overview. Rev Iberoam Micol 2010; 28:1-25. [PMID: 21167301 DOI: 10.1016/j.riam.2010.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 11/24/2010] [Accepted: 11/24/2010] [Indexed: 11/26/2022] Open
Abstract
An overview of current trends in Latin American Experimental Medical Mycological research since the beginning of the 21(st) century is done (search from January 2000 to December 2009). Using the PubMed and LILACS databases, the authors have chosen publications on medically important fungi which, according to our opinion, are the most relevant because of their novelty, interest, and international impact, based on research made entirely in the Latin American region or as part of collaborative efforts with laboratories elsewhere. In this way, the following areas are discussed: 1) molecular identification of fungal pathogens; 2) molecular and clinical epidemiology on fungal pathogens of prevalence in the region; 3) cell biology; 4) transcriptome, genome, molecular taxonomy and phylogeny; 5) immunology; 6) vaccines; 7) new and experimental antifungals.
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Affiliation(s)
- Gioconda San-Blas
- Instituto Venezolano de Investigaciones Científicas, Caracas, Venezuela.
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Yang YL, Cheng MF, Wang CW, Wang AH, Cheng WT, Lo HJ, Hospitals T. The distribution of species and susceptibility of amphotericin B and fluconazole of yeast pathogens isolated from sterile sites in Taiwan. Med Mycol 2010; 48:328-34. [PMID: 20141372 DOI: 10.3109/13693780903154070] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To study the demographic changes of yeasts causing invasive infections in Taiwan, especially with respect to species distribution and antifungal susceptibility, we analyzed isolates obtained from four sterile sites of patients in 19 hospitals in 2002 (155 strains) and again from the same hospitals in 2006 (208 strains). Blood was the most common source of the yeasts, accounting for 73.8% of the total isolates, followed by ascites (21.5%), cerebrospinal fluid (3%), and synovia (1.7%). Candida albicans was the most frequently recovered species (50.1% of the total), followed by Candida tropicalis (20.7%), Candida glabrata (11.6%), Candida parapsilosis (8.5%), Cryptococcus neoformans (3.9%), Candida krusei (0.8%), and nine other species (4.3%). There were one (0.3%) and seven (1.9%) isolates with minimum inhibitory concentrations (MICs) of amphotericin B > or =2 mg/l after 24 h and 48 h incubation, respectively. In addition, there were 15 (4.3%) and 31 (8.6%) isolates with MICs of fluconazole > or =64 mg/l under the same conditions. The MIC(90) value of amphotericin B was 1 mg/l. The MIC(90) values of fluconazole were 4 mg/l after 24 h incubation and 32 mg/l after 48 h incubation. Interestingly, MICs for fluconazole > or =64 mg/l after 24 h were significantly higher for isolates obtained in 2006 than those in 2002 after 24 h (7.1% vs. 0.7%, p =0.009) and 48 h (13.5% vs. 2%, p =0.0003) incubations. The demographic difference between these two surveys is mainly due to one species, C. tropicalis.
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Affiliation(s)
- Y L Yang
- Department of Biological Science and Technology, Institute of Molecular Medicine and Bioengineering, National Chiao Tung University, Hsinchu, Taiwan
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Krishnan S, Ostrosky-Zeichner L. Invasive candidiasis in the intensive care unit. Hosp Pract (1995) 2010; 38:82-91. [PMID: 20469617 DOI: 10.3810/hp.2010.04.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Invasive fungal disease by Candida spp. is on the rise in the modem era of prolonged patient survival by virtue of improved critical care measures, novel chemotherapy regimens, and increasing immunosuppression following organ transplants. Invasive candidiasis (IC) in the setting of an intensive care unit results in prolonged hospital stay and increased morbidity. Clinical suspicion plays a major role in the diagnosis of IC, as current laboratory methods are not very sensitive. Various serum markers and molecular techniques are under development to improve diagnostic strategies. Treatment options involve an expanding spectrum of antifungals. Knowledge of local epidemiology and the risk factors that predispose patients to this disease are essential for effective patient care in an intensive care setting.
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Affiliation(s)
- Sujatha Krishnan
- Division of Infectious Diseases, University of Texas Medical School at Houston, Houston, TX, USA.
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Agar-based disk diffusion assay for susceptibility testing of dermatophytes. J Clin Microbiol 2010; 48:3750-2. [PMID: 20668120 DOI: 10.1128/jcm.01357-10] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Currently, no agar-based susceptibility testing method has been standardized for testing dermatophytes. We describe a newly developed agar-based method employing disk diffusion assay to test the susceptibility of 47 isolates of dermatophytes against 8 antifungals. Our results show that the method is reproducible, is simple, and could be used to determine the antifungal susceptibility of dermatophytes.
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Kernt M, Kampik A. Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives. Clin Ophthalmol 2010; 4:121-35. [PMID: 20390032 PMCID: PMC2850824 DOI: 10.2147/opth.s6461] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Indexed: 12/07/2022] Open
Abstract
Endophthalmitis is a rare but sight-threatening complication that can occur after ocular surgery or trauma or as a consequence of systemic infection. To optimize visual outcome, early diagnosis and treatment are essential. Over recent decades, advances in hygienic standards, improved microbiologic and surgical techniques, development of powerful antimicrobial drugs, and the introduction of intravitreal antibiotic therapy have led to a decreased incidence and improved management of endophthalmitis. However, endophthalmitis still represents a serious clinical problem. This review focuses on current principles and techniques for evaluation and treatment of endophthalmitis. In addition, it addresses recent developments regarding antimicrobial treatment and prophylaxis of infectious endophthalmitis.
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Affiliation(s)
- M Kernt
- Department of Ophthalmology, Ludwig Maximilian University, Munich, Germany
| | - A Kampik
- Department of Ophthalmology, Ludwig Maximilian University, Munich, Germany
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Abegg MA, Alabarse PVG, Casanova A, Hoscheid J, Salomon TB, Hackenhaar FS, Medeiros TM, Benfato MS. Response to oxidative stress in eight pathogenic yeast species of the genus Candida. Mycopathologia 2010; 170:11-20. [PMID: 20229037 DOI: 10.1007/s11046-010-9294-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 03/02/2010] [Indexed: 01/24/2023]
Abstract
In the course of an infection, the formation of reactive oxygen species by phagocytes and the antioxidant defense mechanisms of microorganisms play a crucial role in pathogenesis. In this study, isolates representing 8 pathogenic Candida species-Candida albicans, Candida dubliniensis, Candida famata, Candida glabrata, Candida guilliermondii, Candida krusei, Candida parapsilosis and Candida tropicalis-were compared with regard to their resistance to oxidative stress in vitro. We evaluated degree of resistance, induction of oxidative damage, capacity to adapt, and induction of antioxidant enzymes. The species showed variable sensitivity to oxidative attack. C. albicans, C. glabrata, and C. krusei were more resistant to oxidative stress under the conditions tested; C. parapsilosis and C. tropicalis presented medium resistance; and C. dubliniensis, C. famata, and C. guilliermondii were more sensitive. The overall greater resistance to oxidative stress of C. albicans and C. glabrata may provide an advantage to these species, which are the major causative agents of candidiasis.
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Affiliation(s)
- Maxwel Adriano Abegg
- Programa de Pós-Graduação em Biologia Celular e Molecular (PPGBCM), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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Early prediction of Candida glabrata fungemia in nonneutropenic critically ill patients*. Crit Care Med 2010; 38:826-30. [DOI: 10.1097/ccm.0b013e3181cc4734] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Negri M, Henriques M, Svidzinski TIE, Paula CR, Oliveira R. Correlation between Etest, disk diffusion, and microdilution methods for antifungal susceptibility testing of Candida species from infection and colonization. J Clin Lab Anal 2010; 23:324-30. [PMID: 19785043 DOI: 10.1002/jcla.20337] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The correlation between the microdilution (MD), Etest (ET), and disk diffusion (DD) methods was determined for amphotericin B, itraconazole and fluconazole. The minimal inhibitory concentration (MIC) of those antifungal agents was established for a total of 70 Candida spp. isolates from colonization and infection. The species distribution was: Candida albicans (n=27), C. tropicalis (n=17), C. glabrata (n=16), C. parapsilosis (n=8), and C. lusitaniae (n=2). Non-Candida albicans Candida species showed higher MICs for the three antifungal agents when compared with C. albicans isolates. The overall concordance (based on the MIC value obtained within two dilutions) between the ET and the MD method was 83% for amphotericin B, 63% for itraconazole, and 64% for fluconazole. Considering the breakpoint, the agreement between the DD and MD methods was 71% for itraconazole and 67% for fluconazole. The DD zone diameters are highly reproducible and correlate well with the MD method, making agar-based methods a viable alternative to MD for susceptibility testing. However, data on agar-based tests for itraconazole and amphotericin B are yet scarce. Thus, further research must still be carried out to ensure the standardization to other antifungal agents.
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Affiliation(s)
- Melyssa Negri
- Centre of Biological Engineering, Institute for Biotechnology and Bioengineering, Universidade do Minho, Braga, Portugal
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Bruder-Nascimento A, Camargo CH, Sugizaki MF, Sadatsune T, Montelli AC, Mondelli AL, Bagagli E. Species distribution and susceptibility profile of Candida species in a Brazilian public tertiary hospital. BMC Res Notes 2010; 3:1. [PMID: 20044935 PMCID: PMC2830941 DOI: 10.1186/1756-0500-3-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Accepted: 01/03/2010] [Indexed: 11/21/2022] Open
Abstract
Background Species identification and antifungal susceptibility tests were carried out on 212 Candida isolates obtained from bloodstream infections, urinary tract infections and dialysis-associated peritonitis, from cases attended at a Brazilian public tertiary hospital from January 1998 to January 2005. Findings Candida albicans represented 33% of the isolates, Candida parapsilosis 31.1%, Candida tropicalis 17.9%,Candida glabrata 11.8%, and others species 6.2%. In blood culture, C. parapsilosis was the most frequently encountered species (48%). The resistance levels to the antifungal azoles were relatively low for the several species, except for C. tropicalis and C. glabrata. Amphotericin B resistance was observed in 1 isolate of C. parapsilosis. Conclusions The species distribution and antifungal susceptibility herein observed presented several epidemiological features common to other tertiary hospitals in Latin American countries. It also exhibited some peculiarity, such as a very high frequency of C. parapsilosis both in bloodstream infections and dialysis-associated peritonitis. C. albicans also occurred in an important number of case infections, in all evaluated clinical sources. C. glabrata presented a high proportion of resistant isolates. The data emphasize the necessity to carry out the correct species identification accompanied by the susceptibility tests in all tertiary hospitals.
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