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Huang D, Qi M, Hu Y, Yu M, Liang Z. The impact of Candida spp airway colonization on clinical outcomes in patients with ventilator-associated pneumonia: A systematic review and meta-analysis. Am J Infect Control 2020; 48:695-701. [PMID: 31813630 DOI: 10.1016/j.ajic.2019.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/04/2019] [Accepted: 11/04/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Previous studies have drawn different conclusions about the impact of Candida airway colonization on clinical outcomes in patients with ventilator-associated pneumonia (VAP). METHODS We searched PubMed, the Cochrane Library, Embase (via OVID), and Web of Science database. We included both retrospective and prospective observational studies. The mean difference (MD) or risk ratio (RR) with 95% confidence intervals (CI) were applied to assess the association between Candida colonization and clinical outcomes. RESULTS A total of 8 studies with 1,661 patients were pooled in our final studies. Compared with patients with VAP without Candida colonization, patients with Candida colonization had significantly longer durations of mechanical ventilation (MD, 1.93; 95% CI, 0.53-3.33). The intensive care unit (ICU) length of stay seems to be longer among Candida colonized patients than noncolonized patients, although the results were not so significant (MD, 1.15; 95% CI, -1.04 to 3.34). Patients with colonization had higher 28-day mortality and ICU mortality than those without colonization (28-day mortality: RR, 1.64; 95% CI, 1.27-2.12; ICU mortality: RR, 1.57; 95% CI, 1.26-1.94). CONCLUSIONS The presence of Candida spp airway colonization is associated with longer durations of mechanical ventilation, higher 28-day mortality, higher ICU mortality, and probably longer ICU length of stay compared with the absence of colonization in patients with VAP.
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Lao M, Li C, Li J, Chen D, Ding M, Gong Y. Opportunistic invasive fungal disease in patients with type 2 diabetes mellitus from Southern China: Clinical features and associated factors. J Diabetes Investig 2020; 11:731-744. [PMID: 31758642 PMCID: PMC7232281 DOI: 10.1111/jdi.13183] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/05/2019] [Accepted: 11/19/2019] [Indexed: 12/25/2022] Open
Abstract
AIMS/INTRODUCTION A retrospective study was carried out to investigate the clinical characteristics and associated factors for invasive fungal disease in patients with type 2 diabetes mellitus. MATERIALS AND METHODS Demographic and clinical data were recorded. Associated factors were analyzed by logistic regression analysis. RESULTS Invasive fungal disease was diagnosed in 120 patients with type 2 diabetes mellitus (prevalence, 0.4%). Yeast infection (56/120, 46.7%), including candidiasis (31/56, 55.4%) and cryptococcosis (25/56, 44.6%), was the most common. The urinary tract was mainly involved in candidiasis (12/31, 38.7%). More than half of the cryptococcosis (16/25, 64.0%) presented as pneumonia. Mold infection accounted for 40.8% of the cases, and predominantly involved the lung (34/49, 69.4%). A total of 15 (12.5%) patients had mixed fungal infection. Candida albicans (24/111, 21.6%), Cryptococcus neoformans (19/111, 17.1%) and Aspergillus fumigatus (14/111, 12.6%) were the leading agents. Co-infection occurred in 58 (48.3%) patients, mainly presenting as pneumonia caused by Gram-negative bacteria. The inpatient mortality rate of invasive fungal disease was 23.3% (28/120). Glycated hemoglobin levels were higher in non-survivors than survivors (8.8 ± 2.5 vs 7.7 ± 2.1%, P = 0.02). Anemia (adjusted odds ratio, 3.50, 95% confidence interval 1.95-6.27, P < 0.001), hypoalbuminemia (adjusted odds ratio, 5.42, 95% confidence interval 3.14-9.36, P < 0.001) and elevated serum creatinine (adjusted odds ratio, 2.08, 95% confidence interval 1.07-4.04, P = 0.03) were associated with invasive fungal disease in type 2 diabetes mellitus patients. CONCLUSIONS Invasive fungal disease is a life-threatening complication in type 2 diabetes mellitus patients. C. a albicans, C. neoformans, and A. fumigatus are the leading agents. Prolonged hyperglycemia results in unfavorable outcomes. Correction of anemia and hypoalbuminemia might improve prognosis.
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Affiliation(s)
- Minxi Lao
- Department of GeriatricsThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Chen Li
- Department of GeriatricsThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Jin Li
- Department of GeriatricsThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
- Department of EndocrinologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Dubo Chen
- Department of Laboratory MedicineThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Meilin Ding
- Department of GeriatricsThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Yingying Gong
- Department of GeriatricsThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
- Department of EndocrinologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
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Ferreira EG, Yatsuda F, Pini M, Jarros IC, Veiga FF, de Oliveira AG, Negri M, Svidzinski TIE. Implications of the presence of yeasts in tracheobronchial secretions of critically ill intubated patients. EXCLI JOURNAL 2019; 18:801-811. [PMID: 31645841 PMCID: PMC6806203 DOI: 10.17179/excli2019-1631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 09/03/2019] [Indexed: 12/28/2022]
Abstract
The presence of some microorganisms in the respiratory tract is a known risk factor for the infection of air passages; however, it is not clear whether this holds true for Candida spp. Thus, our objective was to determine the frequency of yeast colonization in the tracheobronchial secretions of critically ill intubated patients and to assess the presence of these yeasts in the infra-cuff region of the endotracheal tube (ET). Patients aged 18 years or older who had been using an endotracheal tube for 48 hours were recruited. Tracheal secretions were collected; after extubation, the ETs were cut into two fragments in the infra-cuff region. One of these fragments was placed in a solution containing antibiotics and sent to the lab for culture and identification of yeasts. The remaining fragment was fixed and subjected to scanning electron microscopy (SEM). In total, 20 patients with an average age of 73.3 years (± 13.1) participated in this study. These patients remained under endotracheal intubation and invasive mechanical ventilation for an average of 6.4 (± 1.8) and 13.5 days (± 15), respectively. Of these patients, 45 % showed respiratory tract colonization by yeasts of the Candida genus, with C. albicans being the most frequently isolated species (66.7 %). Moreover, in almost 90 % of these patients, blastoconidia of the same yeast were found in the infra-cuff portion of the ET, as evidenced by SEM, strongly fixed on the ET surface. Yeasts isolated from both the infra-cuff region and the tracheobronchial secretions were susceptible to amphotericin B and fluconazole. In conclusion, our results show that the frequency of colonization by yeasts of the Candida genus in the tracheobronchial secretions of intubated patients within 48 hours is high, and that these species can also be found as a biofilm on the ET surface.
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Affiliation(s)
- Elenice Gomes Ferreira
- Graduate Programme in Health Sciences, Universidade Estadual de Maringá (UEM), Maringá, PR, Brazil.,Department of Physiotherapy UniCesumar, Maringá, PR, Brazil
| | - Fabrício Yatsuda
- Department of Physiotherapy UniCesumar, Maringá, PR, Brazil.,PIC/UniCesumar/ICETI (Instituto Cesumar de Ciência, Tecnologia e Inovação)
| | - Marcio Pini
- Department of Physiotherapy UniCesumar, Maringá, PR, Brazil.,PIC/UniCesumar/ICETI (Instituto Cesumar de Ciência, Tecnologia e Inovação)
| | - Isabele Carrilho Jarros
- Graduate Programme in Health Sciences, Universidade Estadual de Maringá (UEM), Maringá, PR, Brazil
| | - Flávia Franco Veiga
- Graduate Programme in Health Sciences, Universidade Estadual de Maringá (UEM), Maringá, PR, Brazil
| | | | - Melyssa Negri
- Division of Medical Mycology, Teaching and Research Laboratory in Clinical Analyses, Department of Clinical Analysis of State University of Maringa, Avenida Colombo 5790, 87020-900 Maringá, PR, Brazil
| | - Terezinha Inez Estivalet Svidzinski
- Division of Medical Mycology, Teaching and Research Laboratory in Clinical Analyses, Department of Clinical Analysis of State University of Maringa, Avenida Colombo 5790, 87020-900 Maringá, PR, Brazil
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The Inhalable Mycobiome of Sawmill Workers: Exposure Characterization and Diversity. Appl Environ Microbiol 2019; 85:AEM.01448-19. [PMID: 31420347 DOI: 10.1128/aem.01448-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 08/14/2019] [Indexed: 01/30/2023] Open
Abstract
Exposure to fungal spores has been associated with respiratory symptoms and allergic alveolitis among sawmill workers, but the complexity of sawmill workers' fungal exposure has been poorly studied. We characterized the fungal diversity in air samples from sawmill workers' breathing zones and identified differences in the richness, diversity, and taxonomic composition between companies, departments, wood types, and seasons. Full-shift personal inhalable dust samples (n = 86) collected from 11 industrial sawmill, sorting mill, and planer mill companies processing spruce and/or pine were subjected to DNA metabarcoding using the fungal internal transcribed spacer (ITS) region 2. The workers were exposed to a higher total number of operational taxonomic units (OTUs) in summer than in winter and when processing spruce than when processing pine. Workers in the saw department had the richest fungal exposure, followed by workers in the planing department and sorting of dry timber department. Sawmills explained 11% of the variation in the fungal community composition of the exposure, followed by season (5%) and department (3%). The fungal compositions of the exposures also differed between seasons, sawmills, wood types, and departments at the taxonomic level, ranging from the phylum to the species level. The differences in exposure diversity suggest that the potential health effects of fungal inhalation may also be different; hence, a risk assessment based on the fungal diversity differences should be performed. This study may serve as a basis for establishing a fungal profile of signature species that are specific for sawmills and that can be measured quantitatively in future risk assessments of sawmill workers.IMPORTANCE To gain more knowledge about exposure-response relationships, it is important to improve exposure characterization by comprehensively identifying the temporal and spatial fungal composition and diversity of inhalable dust at workplaces. The variation in the diverse fungal communities to which individuals are exposed in different seasons and sawmills suggests that variations in exposure-related health effects between seasons and companies can be expected. More importantly, the distinct fungal profiles between departments across companies indicate that workers in different job groups are differently exposed and that health risks can be department specific. DNA metabarcoding provides insight into a broad spectrum of airborne fungi that may serve as a basis for obtaining important knowledge about the fungi to which workers are exposed.
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Xu L, Chen B, Wang F, Wei C, Liu H, Liu J, Herth FJF, Luo F. A Higher Rate of Pulmonary Fungal Infection in Chronic Obstructive Pulmonary Disease Patients with Influenza in a Large Tertiary Hospital. Respiration 2019; 98:391-400. [PMID: 31330521 DOI: 10.1159/000501410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 06/08/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Influenza is considered a self-limiting disease. However, in patients with chronic obstructive pulmonary disease (COPD), it may result in serious outcomes during the flu season. OBJECTIVES The aims of this retrospective study were to explore the characteristics of hospitalized patients with COPD complicated by influenza and determine the factors affecting the prognosis of these patients. METHOD Demographic and clinical data were collected for 278 patients totally from the West China Hospital between January 1, 2016 and February 28, 2018. RESULTS Among the patients with influenza, the positive fungal culture rate, and the rates of antifungal drug and systemic corticosteroids use were higher for those with COPD than for those without COPD. Respiratory failure was more common in patients with influenza and COPD than in patients with influenza only, while the proportion of severe cases was higher among the former than among the latter. Among the patients with COPD, the positive fungal culture rate, particularly for Aspergillus, and the rate of systemic corticosteroids use were higher for those with influenza than for those without influenza. Multivariate analysis revealed that a COPD history of >20 years and smoking for >20 pack-years were independent factors for susceptibility of COPD patients to influenza. CONCLUSIONS Aspergillus infection seems to be more common in patients with influenza and COPD. In addition, COPD complicated by influenza during the seasonal outbreak can easily progress to a severe disease state. Heavy smokers and patients with a prolonged COPD history are more likely to be infected by influenza.
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Affiliation(s)
- Linrui Xu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Bojiang Chen
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Faping Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Chuanqi Wei
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Huan Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jia Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik University of Heidelberg, Heidelberg, Germany,
| | - Fengming Luo
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
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Fourie R, Pohl CH. Beyond Antagonism: The Interaction Between Candida Species and Pseudomonas aeruginosa. J Fungi (Basel) 2019; 5:jof5020034. [PMID: 31010211 PMCID: PMC6617365 DOI: 10.3390/jof5020034] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/18/2019] [Accepted: 04/18/2019] [Indexed: 12/11/2022] Open
Abstract
There are many examples of the interaction between prokaryotes and eukaryotes. One such example is the polymicrobial colonization/infection by the various opportunistic pathogenic yeasts belonging to the genus Candida and the ubiquitous bacterium, Pseudomonas aeruginosa. Although this interaction has simplistically been characterized as antagonistic to the yeast, this review highlights the complexity of the interaction with various factors influencing both microbes. The first section deals with the interactions in vitro, looking specifically at the role of cell wall components, quorum sensing molecules, phenazines, fatty acid metabolites and competition for iron in the interaction. The second part of this review places all these interactions in the context of various infection or colonization sites, i.e., lungs, wounds, and the gastrointestinal tract. Here we see that the role of the host, as well as the methodology used to establish co-infection, are important factors, influencing the outcome of the disease. Suggested future perspectives for the study of this interaction include determining the influence of newly identified participants of the QS network of P. aeruginosa, oxylipin production by both species, as well as the genetic and phenotypic plasticity of these microbes, on the interaction and outcome of co-infection.
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Affiliation(s)
- Ruan Fourie
- Department of Microbial, Biochemical and Food Biotechnology, University of the Free State, Bloemfontein 9301, South Africa.
| | - Carolina H Pohl
- Department of Microbial, Biochemical and Food Biotechnology, University of the Free State, Bloemfontein 9301, South Africa.
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Respiratory Tract Colonization by Candida species Portends Worse Outcomes in Immunocompromised Patients. ACTA ACUST UNITED AC 2018; 25:197-201. [PMID: 30911217 DOI: 10.1097/cpm.0000000000000279] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background The significance and clinical management of Candida colonization of the respiratory tract are ill-defined. We now report the frequency of Candida species from the lower respiratory tract in hematopoietic stem cell transplant recipients (HSCT) undergoing bronchoscopy with broncheoalveolar lavage (BAL) for pneumonitis post-HSCT. Methods The University of Michigan Clinical Microbiology Lab Database was queried for all respiratory cultures positive for Candida species between 2000-2012. We concurrently performed a retrospective analysis of 515 HSCT recipients with pneumonitis at our institution between 2001-2012. Results During this twelve-year period, there were 2524 unique Candida isolates (78% Candida albicans). Of the 515 HSCT patients with suspected pneumonitis,127 (24.7%) HSCT subjects were culture positive for a fungal pathogen, with Candida species identified in 27 cases (5.2%). When compared with other HSCT subjects, those cultures positive for Candida had significantly increased mortality (p=0.04). Conclusions Candida sp. are commonly cultured from the respiratory tract of HSCT recipients, with increased mortality in affected patients. While there is insufficient evidence for anti-fungal treatment of Candida species colonization, the presence of the yeast may be useful as a surrogate marker of disease severity.
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Essential oils and their components are a class of antifungals with potent vapour-phase-mediated anti-Candida activity. Sci Rep 2018; 8:3958. [PMID: 29500393 PMCID: PMC5834617 DOI: 10.1038/s41598-018-22395-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 02/22/2018] [Indexed: 12/17/2022] Open
Abstract
Multi-resistant microorganisms continue to challenge medicine and fuel the search for new antimicrobials. Here we show that essential oils and their components are a promising class of antifungals that can have specific anti-Candida activity via their vapour-phase. We quantify the vapour-phase-mediated antimicrobial activity (VMAA) of 175 essential oils and 37 essential oil components, representing more than a 1,000 unique molecules, against C. albicans and C. glabrata in a novel vapour-phase-mediated susceptibility assay. Approximately half of the tested essential oils and their components show growth-inhibitory VMAA. Moreover, an average greater activity was observed against the intrinsically more resistant C. glabrata, with essential oil component citronellal having a highly significant differential VMAA. In contrast, representatives of each class of antifungals currently used in clinical practice showed no VMAA. The vapour-phase-mediated susceptibility assay presented here thus allows for the simple detection of VMAA and can advance the search for novel (applications of existing) antimicrobials. This study represents the first comprehensive characterisation of essential oils and their components as a unique class of antifungals with antimicrobial properties that differentiate them from existing antifungal classes.
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Bergeron AC, Seman BG, Hammond JH, Archambault LS, Hogan DA, Wheeler RT. Candida albicans and Pseudomonas aeruginosa Interact To Enhance Virulence of Mucosal Infection in Transparent Zebrafish. Infect Immun 2017; 85:e00475-17. [PMID: 28847848 PMCID: PMC5649025 DOI: 10.1128/iai.00475-17] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 08/10/2017] [Indexed: 01/02/2023] Open
Abstract
Polymicrobial infections often include both fungi and bacteria and can complicate patient treatment and resolution of infection. Cross-kingdom interactions among bacteria, fungi, and/or the immune system during infection can enhance or block virulence mechanisms and influence disease progression. The fungus Candida albicans and the bacterium Pseudomonas aeruginosa are coisolated in the context of polymicrobial infection at a variety of sites throughout the body, including mucosal tissues such as the lung. In vitro, C. albicans and P. aeruginosa have a bidirectional and largely antagonistic relationship. Their interactions in vivo remain poorly understood, specifically regarding host responses in mediating infection. In this study, we examine trikingdom interactions using a transparent juvenile zebrafish to model mucosal lung infection and show that C. albicans and P. aeruginosa are synergistically virulent. We find that high C. albicans burden, fungal epithelial invasion, swimbladder edema, and epithelial extrusion events serve as predictive factors for mortality in our infection model. Longitudinal analyses of fungal, bacterial, and immune dynamics during coinfection suggest that enhanced morbidity is associated with exacerbated C. albicans pathogenesis and elevated inflammation. The P. aeruginosa quorum-sensing-deficient ΔlasR mutant also enhances C. albicans pathogenicity in coinfection and induces extrusion of the swimbladder. Together, these observations suggest that C. albicans-P. aeruginosa cross talk in vivo can benefit both organisms to the detriment of the host.
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Affiliation(s)
- Audrey C Bergeron
- Department of Molecular & Biomedical Sciences, University of Maine, Orono, Maine, USA
| | - Brittany G Seman
- Department of Molecular & Biomedical Sciences, University of Maine, Orono, Maine, USA
| | - John H Hammond
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Linda S Archambault
- Department of Molecular & Biomedical Sciences, University of Maine, Orono, Maine, USA
| | - Deborah A Hogan
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Robert T Wheeler
- Department of Molecular & Biomedical Sciences, University of Maine, Orono, Maine, USA
- Graduate School of Biomedical Sciences and Engineering, University of Maine, Orono, Maine, USA
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