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Khosravi AR, Mansouri P, Saffarian Z, Vahedi G, Nikaein D. Chronic mucocutaneous candidiasis, a case study and literature review. J Mycol Med 2018; 28:206-210. [PMID: 29500032 DOI: 10.1016/j.mycmed.2018.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 01/23/2018] [Accepted: 02/05/2018] [Indexed: 10/17/2022]
Abstract
Chronic mucocutaneous candidiasis (CMC) is a clinically heterogeneous disease. Some immunologic and hormonal abnormalities have been associated with CMC. The factors that predispose host to CMC infection could be autosomal or acquisitive. The disease usually occurs in childhood. Here, we reviewed the published literature on chronic mucocutaneous candidiasis and a four years old girl is presented with CMC. She had a history of recurrent thrush and otomycosis since the age of one. Candida albicans was detected in skin scraping and biopsy samples. Serum iron was low. TSH hormone level was high and T4 level was low. Giardia cysts were found in stool sample. Mucocutaneous and nail manifestations of the disease were disappeared after a period of Itraconazole therapy.
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Affiliation(s)
- A R Khosravi
- Mycology Research Center, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran.
| | - P Mansouri
- Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Z Saffarian
- Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran
| | - G Vahedi
- Mycology Research Center, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - D Nikaein
- Mycology Research Center, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
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2
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Abstract
Many diseases that were considered major affliction of mankind in the past have been successfully eradicated with introduction of appropriate vaccine strategies. In order to expedite new challenges coming up to deal with various infectious diseases, nano-particulate-based subunit vaccines seem to be the demand of ordeal. The nano-vaccines can find better scope for the diseases that were not rampant in the semi-advanced world few years back. For example in present-day circumstances that corroborate with advancement in the field of medical sciences in terms of cancer chemotherapy, organ transplantation, therapy of autoimmune diseases, etc.; along with prevalence of altogether unheard diseases such as HIV infection, people are at risk of infliction with many more pathogens. In this regard, development of an effective prophylactic strategy against many opportunistic infections primarily caused by fungal pathogens needs better understanding of host pathogen relation and role of active immunity against pathogenic fungi. In the present study, we have tried to decipher effectiveness of a nano-sized vaccine delivery system in imparting protection against fungal pathogens.
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Affiliation(s)
- Swaleha Zubair
- Women's College, Aligarh Muslim University (AMU), Aligarh, Uttar Pradesh, 202002, India
| | - Asim Azhar
- Interdisciplinary Biotechnology Unit, Aligarh Muslim University (AMU), Aligarh, Uttar Pradesh, 202002, India
| | - Nazoora Khan
- Interdisciplinary Biotechnology Unit, Aligarh Muslim University (AMU), Aligarh, Uttar Pradesh, 202002, India
| | - Ejaj Ahmad
- Interdisciplinary Biotechnology Unit, Aligarh Muslim University (AMU), Aligarh, Uttar Pradesh, 202002, India
| | - Mohd Ajmal
- Department of Anatomy, JNMC, Aligarh Muslim University (AMU), Aligarh, India
| | - Mohammad Owais
- Interdisciplinary Biotechnology Unit, Aligarh Muslim University (AMU), Aligarh, Uttar Pradesh, 202002, India.
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Rani M, Das S, Ramachandran VG, Dar SA, Ranga GS, Tripathi AK. Interleukin-10 as an indicator of chronic course of oral candidiasis in diabetics: an in vitro study. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-015-0455-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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4
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C-type lectin receptors and cytokines in fungal immunity. Cytokine 2012; 58:89-99. [DOI: 10.1016/j.cyto.2011.08.031] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 08/20/2011] [Indexed: 12/29/2022]
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Engelhardt KR, Grimbacher B. Mendelian traits causing susceptibility to mucocutaneous fungal infections in human subjects. J Allergy Clin Immunol 2012; 129:294-305; quiz 306-7. [DOI: 10.1016/j.jaci.2011.12.966] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 12/13/2011] [Accepted: 12/16/2011] [Indexed: 01/08/2023]
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6
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MacCallum DM. Hosting infection: experimental models to assay Candida virulence. Int J Microbiol 2011; 2012:363764. [PMID: 22235206 PMCID: PMC3253448 DOI: 10.1155/2012/363764] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 10/13/2011] [Indexed: 02/01/2023] Open
Abstract
Although normally commensals in humans, Candida albicans, Candida tropicalis, Candida parapsilosis, Candida glabrata, and Candida krusei are capable of causing opportunistic infections in individuals with altered physiological and/or immunological responses. These fungal species are linked with a variety of infections, including oral, vaginal, gastrointestinal, and systemic infections, with C. albicans the major cause of infection. To assess the ability of different Candida species and strains to cause infection and disease requires the use of experimental infection models. This paper discusses the mucosal and systemic models of infection available to assay Candida virulence and gives examples of some of the knowledge that has been gained to date from these models.
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Affiliation(s)
- Donna M. MacCallum
- Aberdeen Fungal Group, School of Medical Sciences, Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
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7
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Chronic mucocutaneous candidiasis and congenital susceptibility to Candida. Curr Opin Allergy Clin Immunol 2011; 10:542-50. [PMID: 20859203 DOI: 10.1097/aci.0b013e32833fd74f] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW To give an overview on the clinical spectrum and the molecular background of host defence against Candida. RECENT FINDINGS For many decades the molecular causes and the pathogenesis for an increased susceptibility to Candida - and fungal infections in general - have been elusive. In 2009 and 2010 interesting reports on the genetic background and the pathomechanisms involved in chronic mucocutaneous candidiasis (CMC) have been published. SUMMARY The susceptibility to recurrent Candida infections can be a monogenetic Mendelian trait. The sensing of Candida cell wall components and the consecutive intracellular signalling in myeloid cells via CARD9, but also the role of Th17 cells and their cytokines take centre stage in the human host defence against Candida.
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Passantino L, Ostillio A, Cianciotta A, Russo C, Carrassi M, Patruno R, Dhaskali L, Passantino GF, Passantino A. Apoptosis of gut-associated lymphoid tissue in rainbow trout Oncorhynchus mykiss after incubation with Candida albicans and bacterial lipopolysaccharide. Immunopharmacol Immunotoxicol 2010; 33:347-50. [PMID: 20843276 DOI: 10.3109/08923973.2010.512920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Until now a few studies have been carried out on the gut lymphoid system in fish despite its protective role in the host. Here, we have evaluated the effects of Candida albicans (Ca) and lipopolysaccaride (LPS) on the pyloric and terminal segments of gut in the rainbow trout Oncorhynchus mykiss. In particular, data show that both Ca and LPS are able to cause apoptosis of intestinal lymphoid cells as detected by the terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) procedure. These findings suggest a further modality of gut response in fish to environmental antigens.
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Affiliation(s)
- L Passantino
- Department of Animal Health and Welfare, Faculty of Veterinary Medicine, University of Bari, Bari, Italy.
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Kothavade RJ, Kura MM, Valand AG, Panthaki MH. Candida tropicalis: its prevalence, pathogenicity and increasing resistance to fluconazole. J Med Microbiol 2010; 59:873-880. [PMID: 20413622 DOI: 10.1099/jmm.0.013227-0] [Citation(s) in RCA: 189] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Candida tropicalis has been identified as the most prevalent pathogenic yeast species of the Candida-non-albicans group. Historically, Candida albicans has been the major species responsible for causing candidiasis in immunocompromised and immunocompetent patients. However, infections (candidiasis) due to C. tropicalis have increased dramatically on a global scale thus proclaiming this organism to be an emerging pathogenic yeast. The reasons for this organism's dominance and its resistance to fluconazole have been difficult to elucidate. In addition, the mechanism of this organism's pathogenicity and the consequent immune response remain to be clarified. This paper describes certain predisposing factors potentially responsible for these characteristics and presents a 'root cause analysis' to explain the increasing prevalence of C. tropicalis in developed and undeveloped countries, as well as the organism's acquired drug resistance. Control measures against fluconazole resistance in clinical management have also been discussed.
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Affiliation(s)
- Rajendra J Kothavade
- Microbiology Section, WQA Laboratory, EPCOR, 9469 Rossdale Rd NW, Edmonton, AB T5K 0S5, Canada
| | - M M Kura
- Department of Dermatology, Grant Medical College and Sir J. J. Group of Hospitals, Mumbai 400 008, India
| | - Arvind G Valand
- Department of Pathology, Grant Medical College and Sir J. J. Group of Hospitals, Mumbai 400 008, India
| | - M H Panthaki
- Department of Immunocytobiology and Pathology, Sir H. N. Hospital and Medical Research Centre, Mumbai 400 004, India
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Abstract
The increased incidence of invasive candidosis in numerous categories of patients, including neonates, cancer patients, AIDS patients and patients who have undergone organ transplantation, is of great concern for the physicians involved. The manifestations of candidosis are numerous, and various clinical entities such as localized and disseminated infection have to be considered separately. All types of localized candidosis per se are usually not the main cause of disseminated disease. However, spreading of the mycotic pathogens in the gastrointestinal tract could induce disseminated candidosis. Prophylactic measurements in risk patients and consequent local and, if necessary, systemic treatment is recommended in these clinical entities.
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Jobst D, Kraft K. Candida species in stool, symptoms and complaints in general practice ? a cross-sectional study of 308 outpatients. Mycoses 2006; 49:415-20. [PMID: 16922795 DOI: 10.1111/j.1439-0507.2006.01244.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Patients with unspecific symptoms were sometimes tested for Candida. In case of findings of this yeast-like fungus in their stools they often were labelled with the diagnosis of a "Candida-syndrome". This comprises headache, weakness, flatulence, ravenous appetite for sweets, itching skin and several more unspecific symptoms. All 500 randomly sampled patients in 12 mainly naturopathic practices were asked to take part. In case of participation, they received stool-tubes and questionnaires to be answered during the waiting-time by the patients themselves. We asked for details of lifestyle, diseases and a number of unspecific symptoms. The stool-tubes were sent to a microbiological lab within 24 h after being filled. About one-third of all 308 participants carried Candida albicans in their stools. This finding is regarded as normal. Smoking habits were highly associated to Candida: 45 of the 78 smokers (58%), but only 68 of the 230 (29%) non-smokers were Candida positive, P < 0.0001. Three more results were associated with Candida-positive stools: Candida-vaginitis, allergies against food and allergies in general. Hints of a Candida-syndrome could not be found. The relation with smoking cigarettes is a new result. Associations to Candida-vaginitis and allergies were described before.
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Affiliation(s)
- Detmar Jobst
- Lehrbeauftragter für Allgemeinmedizin und Naturheilverfahren, Rheinische Friedrich-Wilhelms-Universität Bonn und Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany.
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12
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Schaller M. [Candida albicans--interactions with the mucosa and the immune system]. J Dtsch Dermatol Ges 2006; 4:328-36; quiz 337-8. [PMID: 16638063 DOI: 10.1111/j.1610-0387.2006.05935.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Martin Schaller
- Department of Dermatology, Eberhard Karls University, Tübingen.
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Neves NA, Carvalho LP, Lopes ACV, Cruz A, Carvalho EM. Successful treatment of refractory recurrent vaginal candidiasis with cetirizine plus fluconazole. J Low Genit Tract Dis 2005; 9:167-70. [PMID: 16044057 DOI: 10.1097/01.lgt.0000171664.63976.fb] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the prevalence of allergy in patients with recurrent vaginal candidiasis (RVC) and the efficacy of fluconazole in combination with an antihistamine drug in RVC patients who do not respond to fluconazole alone. MATERIALS AND METHODS Participants in the study included 24 women with RVC. All subjects filled out an International Study of Asthma and Allergies in Childhood questionnaire and 23 performed skin prick tests for immediate type 1 hypersensitivity as part of atopy assessment. All subjects were treated with fluconazole 150 mg weekly and were followed every 2 months for 6 months. Those who did not respond to fluconazole alone received cetirizine 10 mg daily in addition to the antifungal medication and were followed up for 6 months. RESULTS The majority of women had a history of allergy (60%) and 10 of them (43%) had at least 1 positive result of a skin prick test to aeroallergens. Nineteen patients (79%) responded to fluconazole alone. The 5 patients who remained with symptoms had a medical history of allergy and obtained remission when cetirizine was associated with fluconazole. CONCLUSIONS Patients with RVC refractory to standard antifungal therapy and a history of allergy may respond to the combination of antihistamine and antifungal therapy.
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Affiliation(s)
- Nilma A Neves
- Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Rua João das Botas s/n, Canela 40110-160, Salvador, Bahia, Brazil
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Myhre AG, Stray-Pedersen A, Spangen S, Eide E, Veimo D, Knappskog PM, Abrahamsen TG, Husebye ES. Chronic mucocutaneous candidiasis and primary hypothyroidism in two families. Eur J Pediatr 2004; 163:604-11. [PMID: 15290270 DOI: 10.1007/s00431-004-1516-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
UNLABELLED We describe the clinical and immunological features of two families with chronic mucocutaneous candidiasis (CMC) and primary hypothyroidism. Family A includes three siblings with both candidiasis and hypothyroidism and four individuals with hypothyroidism only. Family B includes four members with candidiasis, of whom one (a male child) also had hypothyroidism. All individuals affected with CMC had suffered from oral candidiasis and onychomycosis since infancy. Facial seborrhoic dermatitis, general folliculitis and scaling blepharitis were main manifestations. Hypothyroidism became evident during childhood. No thyroid antibodies were present in the affected siblings in family A, while the male in family B with hypothyroidism had antibodies against thyroid peroxidase at diagnosis. Immunological evaluation revealed intra-individual variations in serum immunoglobulin levels, lymphocyte subsets and proliferative responses, but there were no consistent abnormalities. Vaccine responses were normal. AIRE gene region microsatellite markers did not segregate with disease nor were autoantibodies typical for autoimmune polyendocrine syndrome type 1 detected in the families. CONCLUSION The link between hypothyroidism and chronic mucocutaneous candidiasis remains to be identified.
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Affiliation(s)
- Anne Grethe Myhre
- Department of Paediatrics, Akershus University Hospital, Nordbyhagen, Norway.
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Abstract
Candida species are commensal fungal organisms as well as opportunistic pathogens of mucosal tissues. From the commensal relationship, most healthy individuals have demonstrable Candida-specific immunity. In immunocompromised persons, however, fungal infections caused primarily by C. albicans often occur. In HIV disease, up to 90% of HIV+ persons will have a symptomatic episode of oropharyngeal candidiasis (OPC) sometime during progression to AIDS, many of which become recurrent. In contrast, vulvovaginal candidiasis (VVC) and systemic Candida infections (candidaemia) are much less common during HIV disease, indicating the diversity and compartmentalization of the host response to Candida. Both innate resistance and acquired immunity play some role in maintaining C. albicans in the commensal state and protecting the systemic circulation. Polymorphonuclear leukocytes (PMNL) are critical for protection against systemic infections, whereas cell-mediated immunity (CMI) by Th1-type CD4+ T-cells is important for protection against mucosal infections. However, there is a discordant role for CMI at the vaginal versus oral mucosa, whereas little to no role for local or systemic CMI is evident at the vaginal mucosa. In contrast, there is a strong correlation between reduced blood CD4+ cells and the incidence of OPC, but it remains unclear whether systemic or local CMI is more important. Evaluation of systemic CMI in a cohort of HIV+ individuals with and without mucosal candidiasis revealed that Candida-specific CMI is not different between HIV+ persons with OPC or VVC and HIV- persons. Thus, the correlation of reduced CD4+ cell numbers to OPC may be explained by the requirement for a threshold number of systemic CD4+ cells to protect the oral mucosa together with the status of local immunity. Indeed, HIV+ persons with and without OPC had a Th2-type salivary cytokine profile suggestive of susceptibility to Candida infection compared with a protective Th0/Th1-type profile in HIV- persons. Candida-specific antibodies, although present, are controversial relative to a role in protection or eradication of infection. While studies of mucosal innate resistance are limited, we recently found that epithelial cells from saliva and vaginal lavages of healthy individuals inhibit the growth of Candida in vitro. This epithelial cell anti-Candida activity requires cell contact by viable cells with no role for soluble factors, including saliva. Interestingly, oral epithelial cells from HIV+ persons with OPC had significantly reduced activity, indicating some protective role for the epithelial cells. Taken together, these data suggest that immunity to Candida is site-specific, compartmentalized and involves innate and/or acquired mechanisms from systemic and/or local sources.
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Affiliation(s)
- P L Fidel
- Department of Microbiology, Immunology, and Parasitology, Louisiana State University Health Sciences Center, New Orleans, USA.
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Fidel PL. The protective immune response against vaginal candidiasis: lessons learned from clinical studies and animal models. Int Rev Immunol 2002; 21:515-48. [PMID: 12650240 DOI: 10.1080/08830180215015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Recurrent vulvovaginal candidiasis (RVVC) is a significant problem in women of childbearing ages and is caused by Candida albicans, a commensal organism of the intestinal and reproductive tracts. As a result of this commensalism, most healthy individuals have demonstrable Candida-specific adaptive immunity that is considered protective. In women with RVVC, a deficiency/dysfunction of this protective immunity is postulated to affect susceptibility to infection. Although cell-mediated immunity (CMI) is considered important for protection against mucosal candidal infections, little is understood about specific host defenses that are important at the vaginal mucosa. Studies to date suggest that a compartmentalized local, rather than systemic, immunity is important for defense against vaginitis. This review will summarize the current state of knowledge regarding protective host defense mechanisms against vaginal C. albicans infections both from clinical studies and animal models. From these data, hypotheses are presented for what host defense mechanisms appear important for resistance/susceptibility to vaginal infection.
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Affiliation(s)
- Paul L Fidel
- Department of Microbiology, Immunology, and Parasitology, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112, USA.
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Carvalho LP, Bacellar O, Neves N, de Jesus AR, Carvalho EM. Downregulation of IFN-gamma production in patients with recurrent vaginal candidiasis. J Allergy Clin Immunol 2002; 109:102-5. [PMID: 11799373 DOI: 10.1067/mai.2002.120555] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Recurrent vaginal candidiasis (RVC) is an important health problem with unknown pathogenesis. Although impairment of the T-cell response is associated with persistent or recurrent candidiasis, data on immunologic responses in patients with RVC are controversial. OBJECTIVES To evaluate the T-cell response in patients with RVC and the ability of cytokines and cytokine antagonists to modulate IFN-gamma production in cultures stimulated with Candida albicans antigens. METHODS Participants in the study included 13 patients with RVC and 7 control women with sporadic candidiasis. Cytokines were determined by ELISA in supernatants of mononuclear cells with C albicans, purified protein derivative, or tetanus toxoid antigen. RESULTS IFN-gamma production was absent or low in 11 of 13 women (84.6%) with RVC. Absent or low IFN-gamma production was specific to C albicans antigens (189 +/- 389 pg/mL), because high IFN-gamma levels were found in cultures stimulated with purified protein derivative (739 +/- 774 pg/mL) or tetanus toxoid antigens (1085 +/- 546 pg/mL). Monoclonal antibody anti-IL-10 enhanced IFN-gamma levels (750 +/- 753 pg/mL), and IL-10 suppressed this cytokine production in patients with sporadic candidiasis. CONCLUSIONS Mononuclear cells from patients with RVC stimulated with C albicans antigen have low or absent IFN-gamma production. IL-10 plays an important role in downregulation of the T-cell response in these patients.
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Affiliation(s)
- Lucas P Carvalho
- Serviço de Imunologia do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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Starzyk J, Kumorowicz-Kopiec M, Kowalczyk M, Starzyk B, Rybakowa M, Dziatkowiak H. Natural history of asplenism in APECED--patient report. J Pediatr Endocrinol Metab 2001; 14:443-9. [PMID: 11327379 DOI: 10.1515/jpem.2001.14.4.443] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Only a few reports on patients with hypo/ asplenism associated with APECED have been published, yet hyposplenism has been found in approximately half of the studied patients. The 7-year follow-up in our only patient with APECED revealed a decrease of spleen size from normal to half-size by ultrasound and CT examinations. Scintigraphy of the liver and spleen demonstrated a progressively diminishing splenic uptake of the tracer from low to complete absence. Peripheral blood smears revealed permanent thrombocytosis with the presence of Howell-Jolly bodies when functional asplenism was reached. The cause of autoimmunization and hyposplenism in APECED is unknown. We hypothesize that hyposplenism depends primarily on local AIRE gene dysfunction in the spleen, and secondarily on an AIRE gene-mediated autoagressive process. In our opinion, hypo/asplenism in APECED disease might not be noticed in patients with APECED if not directly examined. Thus we emphasize the necessity of searching for hyposplenism in all patients with APECED, and recommend scintigraphy.
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Affiliation(s)
- J Starzyk
- Department of Children and Adolescent Endocrinology, Polish-American Children's Hospital, Faculty of Medicine, Jagiellonian University, Krakow, Poland.
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Rex JH, Walsh TJ, Sobel JD, Filler SG, Pappas PG, Dismukes WE, Edwards JE. Practice guidelines for the treatment of candidiasis. Infectious Diseases Society of America. Clin Infect Dis 2000; 30:662-78. [PMID: 10770728 DOI: 10.1086/313749] [Citation(s) in RCA: 534] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/1999] [Revised: 06/10/1999] [Indexed: 11/03/2022] Open
Abstract
Infections due to Candida species are the most common of the fungal infections. Candida species produce a broad range of infections, ranging from nonlife-threatening mucocutaneous illnesses to invasive process that may involve virtually any organ. Such a broad range of infections requires an equally broad range of diagnostic and therapeutic strategies. This document summarizes current knowledge about treatment of multiple forms of candidiasis and is the guideline of the Infectious Diseases Society of America (IDSA) for the treatment of candidiasis. Throughout this document, treatment recommendations are scored according to the standard scoring scheme used in other IDSA guidelines to illustrate the strength of the underlying data. The document covers 4 major topical areas. The role of the microbiology laboratory. To a greater extent than for other fungi, treatment of candidiasis can now be guided by in vitro susceptibility testing. The guidelines review the available information supporting current testing procedures and interpretive breakpoints and place these data into clinical context. Susceptibility testing is most helpful in dealing with infection due to non-albicans species of Candida. In this setting, especially if the patient has been treated previously with an azole antifungal agent, the possibility of microbiological resistance must be considered. Treatment of invasive candidiasis. In addition to acute hematogenous candidiasis, the guidelines review strategies for treatment of 15 other forms of invasive candidiasis. Extensive data from randomized trials are really available only for therapy of acute hematogenous candidiasis in the nonneutropenic adult. Choice of therapy for other forms of candidiasis is based on case series and anecdotal reports. In general, both amphotericin B and the azoles have a role to play in treatment. Choice of therapy is guided by weighing the greater activity of amphotericin B for some non-albicans species (e.g., Candida krusei) against the lesser toxicity and ease of administration of the azole antifungal agents. Flucytosine has activity against many isolates of Candida but is not often used. Treatment of mucocutaneous candidiasis. Therapy for mucosal infections is dominated by the azole antifungal agents. These drugs may be used topically or systemically and have been proven safe and efficacious. A significant problem with mucosal disease is the propensity for a small proportion of patients to suffer repeated relapses. In some situations, the explanation for such a relapse is obvious (e.g., relapsing oropharyngeal candidiasis in an individual with advanced and uncontrolled HIV infection), but in other patients the cause is cryptic (e.g., relapsing vaginitis in a healthy woman). Rational strategies for these situations are discussed in the guidelines and must consider the possibility of induction of resistance over time. Prevention of invasive candidiasis. Prophylactic strategies are useful if the risk of a target disease is sharply elevated in a readily identified group of patients. Selected patient groups undergoing therapy that produces prolonged neutropenia (e.g., some bone-marrow transplant recipients) or who receive a solid-organ transplant (e.g., some liver transplant recipients) have a sufficient risk of invasive candidiasis to warrant prophylaxis.
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Affiliation(s)
- J H Rex
- Dept. of Internal Medicine, Center for the Study of Emerging and Re-emerging Pathogens, University of Texas Medical School, Houston, TX 77030, USA.
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STEELE C, OZENCI H, LUO W, SCOTT M, JR PLFIDEL. Growth inhibition ofCandida albicansby vaginal cells from naïve mice. Med Mycol 1999. [DOI: 10.1080/j.1365-280x.1999.00228.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Fidel PL, Vazquez JA, Sobel JD. Candida glabrata: review of epidemiology, pathogenesis, and clinical disease with comparison to C. albicans. Clin Microbiol Rev 1999; 12:80-96. [PMID: 9880475 PMCID: PMC88907 DOI: 10.1128/cmr.12.1.80] [Citation(s) in RCA: 615] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Until recently, Candida glabrata was considered a relatively nonpathogenic commensal fungal organism of human mucosal tissues. However, with the increased use of immunosuppressive agents, mucosal and systemic infections caused by C. glabrata have increased significantly, especially in the human immunodeficiency virus-infected population. A major obstacle in C. glabrata infections is their innate resistance to azole antimycotic therapy, which is very effective in treating infections caused by other Candida species. Candida glabrata, formerly known as Torulopsis glabrata, contrasts with other Candida species in its nondimorphic blastoconidial morphology and haploid genome. C. glabrata currently ranks second or third as the causative agent of superficial (oral, esophageal, vaginal, or urinary) or systemic candidal infections, which are often nosocomial. Currently, however, there are few recognized virulence factors of C. glabrata and little is known about the host defense mechanisms that protect against infection. Two established animal models (systemic and vaginal) have been established to study treatment, pathogenesis, and immunity. Treatment of C. glabrata infections can include azoles but often requires amphotericin B or flucytosine. This review summarizes all known clinical and experimental information about C. glabrata infections with comparisons to C. albicans as a means of contrasting the two species commonly observed and emphasizing the many recognized differences.
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Affiliation(s)
- P L Fidel
- Department of Microbiology, Immunology, and Parasitology, Louisiana State University Medical Center, New Orleans, Louisiana 70112, USA.
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Abstract
Chronic mucocutaneous candidiasis is a heterogenous group of disorders, associated with a variety of autoimmune disorders and a broad spectrum of immune aberrations. We describe 2 patients with chronic mucocutaneous candidiasis who had cerebrovascular disease with severe neurologic sequelae. Results of angiography of cerebral vessels and brain biopsy in one were consistent with the diagnosis of cerebral vasculitis.
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Affiliation(s)
- M Grouhi
- University of Toronto, Ontario, Canada
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Gaspari AA, Burns R, Nasir A, Ramirez D, Barth RK, Haidaris CG. CD86 (B7-2), but not CD80 (B7-1), expression in the epidermis of transgenic mice enhances the immunogenicity of primary cutaneous Candida albicans infections. Infect Immun 1998; 66:4440-9. [PMID: 9712799 PMCID: PMC108537 DOI: 10.1128/iai.66.9.4440-4449.1998] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/1998] [Accepted: 06/24/1998] [Indexed: 11/20/2022] Open
Abstract
Transgenic (Tg) mice whose epidermal keratinocytes constitutively overexpress either B7-1 (CD80) or B7-2 (CD86) exhibited exaggerated cutaneous delayed type hypersensitivity (DTH) to haptens compared to non-Tg mice. To determine whether enhanced DTH in these Tg mice is seen in response to cutaneous fungal infections, a primary infection with Candida albicans was established by inoculating this organism on the occluded skin of Tg and non-Tg mice. These infections resolved 7 days after removal of occlusive dressing in all three groups of mice, without evidence of exaggerated inflammation in either the Tg or non-Tg mice. Only B7-2 Tg mice developed enhanced Th1-lymphocyte-mediated immune responses to C. albicans antigens after resolving this infection: enhanced footpad swelling in response to intradermal C. albicans antigens, enhanced production of mRNA encoding Th1 lymphokines in draining lymph nodes, and increased gamma interferon secreted into culture supernatants by lymph node T lymphocytes stimulated with Candida antigens in vitro. Lastly, Western blotting of sera from mice that had resolved this fungal infection indicated that only B7-2 Tg mice recognized a wide range of Candida-associated antigens. These data suggest that these two costimulatory molecules, when expressed by keratinocytes, do not deliver identical signals to C. albicans antigen-reactive Th1 lymphocytes. The enhanced immune response in B7-2 Tg mice to a cutaneous C. albicans infection demonstrates the importance of antigen presentation and costimulation in immune reactivity to fungi. Furthermore, B7-2 Tg mice may be useful in identification of protective Candida antigens.
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Affiliation(s)
- A A Gaspari
- Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA.
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25
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Abstract
Vulvovaginal candidiasis is a common mucosal fungal infection in women of child-bearing ages. Despite the role for cell-mediated immunity and T cells in host protection against the majority of mucosal Candida albicans infections, there is controversy as to whether immunosuppression by HIV infection enhances susceptibility to vaginal candidiasis. To date, host defense against C. albicans vaginitis has been studied in women with recurrent vaginitis, in HIV-infected women, and in animal models of experimental vaginitis. Together, data suggest that local immunity is more important than that in the systemic circulation for host defense against vaginitis. Thus, current investigations have been focused specifically on innate and acquired immune responses against C. albicans at the vaginal mucosa. This review will discuss the current knowledge of host defenses against C. albicans vaginitis, both systemically and locally, and try to shed some light on several issues surrounding the efficiency of this seemingly compartmentalized immune response.
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Affiliation(s)
- P L Fidel
- Department of Microbiology, Immunology, and Parasitology, Louisiana State University Medical Center, New Orleans, USA
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Fidel PL, Sobel JD. Protective immunity in experimental Candida vaginitis. RESEARCH IN IMMUNOLOGY 1998; 149:361-73; discussion 510-2. [PMID: 9720954 DOI: 10.1016/s0923-2494(98)80760-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- P L Fidel
- Department of Microbiology, Immunology, and Parasitology, Louisiana State University Medical Center, New Orleans 70112, USA
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27
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Kobrynski LJ, Tanimune L, Kilpatrick L, Campbell DE, Douglas SD. Production of T-helper cell subsets and cytokines by lymphocytes from patients with chronic mucocutaneous candidiasis. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 1996; 3:740-5. [PMID: 8914768 PMCID: PMC170440 DOI: 10.1128/cdli.3.6.740-745.1996] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Chronic mucocutaneous candidiasis (CMC) is a heterogeneous group of disorders characterized by recurrent and persistent superficial candidal infections. Cytokine-induced dysregulation of T-helper cell function has been described in other immune-deficient states but has not been studied in CMC patients. We studied T-helper cell subsets by flow cytometry and cytokine production by stimulated lymphocytes in six CMC patients, two healthy pediatric controls, and five healthy adult controls. Peripheral blood lymphocytes were stimulated in vitro with phytohemagglutinin or Candida albicans extract, and the production of interleukin-2R (IL-2R), IL-4, IL-10, and gamma interferon in the supernatants was measured by enzyme-linked immunosorbent assay. CMC patients had a decrease in the CD29+/CD29+ cell population compared with the numbers in controls (P < 0.02). The percentage of CD4+/CD45RA+ cells was greater in patients than in controls, but the difference was not significant. There was no difference in the production of IL-10 or gamma interferon by the patient lymphocytes. CMC patients produced more IL-4 than the controls (P < 0.001), whereas the controls tended to produce more IL-2R than the patients (P = 0.19). These findings support the concept that a decrease in CD4+/CD29+ T-helper inducer cells along with T-helper cell dysregulation may lead to defective memory responses to antigens in CMC patients and a decrease in cell-mediated immunity due to inhibition of TH1 cells by increased levels of IL-4.
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Affiliation(s)
- L J Kobrynski
- Division of Allergy, Immunology, and Infectious Diseases, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine 19104, USA
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Abstract
Recurrent vulvovaginal candidiasis (RVVC) is a prevalent opportunistic mucosal infection, caused predominantly by Candida albicans, which affects a significant number of otherwise healthy women of childbearing age. Since there are no known exogenous predisposing factors to explain the incidence of symptomatic vaginitis in most women with idiopathic RVVC, it has been postulated that these particular women suffer from an immunological abnormality that prediposes them to RVVC. Because of the increased incidence of mucosal candidiasis in individuals with depressed cell-mediated immunity (CMI), defects in CMI are viewed as a possible explanation for RVVC. In this review, we attempt to place into perspective the accumulated information regarding the immunopathogenesis of RVVC, as well as to provide new immunological perspectives and hypotheses regarding potential immunological deficiencies that may predispose to RVVC and potentially other mucosal infections by the same organism. The results of both clinical studies and studies in an animal model of experimental vaginitis suggest that systemic CMI may not be the predominant host defense mechanism against C. albicans vaginal infections. Rather, locally acquired mucosal immunity, distinct from that in the peripheral circulation, is now under consideration as an important host defense at the vaginal mucosa, as well as the notion that changes in local CMI mechanism(s) may predispose to RVVC.
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Affiliation(s)
- P L Fidel
- Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
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Peterson P, Perheentupa J, Krohn KJ. Detection of candidal antigens in autoimmune polyglandular syndrome type I. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 1996; 3:290-4. [PMID: 8705671 PMCID: PMC170334 DOI: 10.1128/cdli.3.3.290-294.1996] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Autoimmune polyglandular syndrome type I (APS I) is associated with chronic mucocutaneous candidiasis. To characterize the antibody responses in this subgroup of Candida albicans infections, we screened a candidal cDNA expression library with patient sera and found four cDNA clones encoding the immunopositive proteins enolase, heat shock protein 90, pyruvate kinase, and alcohol dehydrogenase. The reactivity to these antigens was studied further by immunoprecipitation assays with in vitro-transcribed and -translated proteins. Analysis of sera from 44 APS I patients showed that the highest antibody reactivity was found with enolase (80% of patients reactive), but significant serological responses were also found with heat shock protein 90 (67%), pyruvate kinase (62.5%), and alcohol dehydrogenase (64%). Overall, 95.5% of patients had detectable antibodies to at least one of these proteins. The cDNAs of enolase and heat shock protein 90 were also expressed in Escherichia coli and studied by immunoblotting. Again, 84% of sera reacted with enolase, whereas 44% of sera reacted with heat shock protein 90. A good correlation between the two methods was found for both enolase (r = 0.86; n = 58; P < 0.001) and heat shock protein 90 (r = 0.71; n = 56; P < 0.001). Our results indicate that the four abundant candidal proteins are the major antigens and can be used as accurate markers of candidiasis in APS I patients. The immunoprecipitation assay described here is particularly useful for the rapid analysis of a large number of samples.
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Affiliation(s)
- P Peterson
- Institute of Medical Technology, University of Tampere, Finland
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Ashman RB, Papadimitriou JM. Production and function of cytokines in natural and acquired immunity to Candida albicans infection. Microbiol Rev 1995; 59:646-72. [PMID: 8531890 PMCID: PMC239393 DOI: 10.1128/mr.59.4.646-672.1995] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Host resistance against infections caused by the yeast Candida albicans is mediated predominantly by polymorphonuclear leukocytes and macrophages. Antigens of Candida stimulate lymphocyte proliferation and cytokine synthesis, and in both humans and mice, these cytokines enhance the candidacidal functions of the phagocytic cells. In systemic candidiasis in mice, cytokine production has been found to be a function of the CD4+ T helper (Th) cells. The Th1 subset of these cells, characterized by the production of gamma interferon and interleukin-2, is associated with macrophage activation and enhanced resistance against reinfection, whereas the Th2 subset, which produces interleukins-4, -6, and -10, is linked to the development of chronic disease. However, other models have generated divergent data. Mucosal infection generally elicits Th1-type cytokine responses and protection from systemic challenge, and identification of cytokine mRNA present in infected tissues of mice that develop mild or severe lesions does not show pure Th1- or Th2-type responses. Furthermore, antigens of C. albicans, mannan in particular, can induce suppressor cells that modulate both specific and nonspecific cellular and humoral immune responses, and there is an emerging body of evidence that molecular mimicry may affect the efficiency of anti-Candida responses within defined genetic contexts.
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Affiliation(s)
- R B Ashman
- Department of Pathology, University of Western Australia, Nedlands, Australia
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Rosenberg EW, Noah PW, Skinner RB. Psoriasis is a visible manifestation of the skin's defense against micro-organisms. J Dermatol 1994; 21:375-81. [PMID: 8063999 DOI: 10.1111/j.1346-8138.1994.tb01758.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The recent discovery that human epidermal cells themselves make and secrete the components necessary for activation of the alternative complement pathway appears to provide an explanation for how human skin is ordinarily able to avoid colonization by molds and other organisms. It also helps clarify the mechanisms underlying clinical and laboratory findings seen in chronic mucocutaneous candidiasis, dandruff, and psoriasis. Psoriasis seems best explainable as a visible, late stage of the inflammatory sequelae of activation of the alternative complement pathway in the epidermis.
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Affiliation(s)
- E W Rosenberg
- Department of Medicine (Dermatology), University of Tennessee College of Medicine, Memphis
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Germain M, Gourdeau M, Hébert J. Case report: familial chronic mucocutaneous candidiasis complicated by deep candida infection. Am J Med Sci 1994; 307:282-3. [PMID: 8160723 DOI: 10.1097/00000441-199404000-00008] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Chronic mucocutaneous candidiasis (CMC) is usually characterized by onset in childhood and is almost never complicated by deep fungal infection. The authors report two cases of fatal candida meningitis in patients who suffered from mild, adult-onset CMC. The pedigrees suggest an autosomal recessive disorder. In the index cases and in a symptomatic sibling, the immunologic work-up showed a specific cellular deficit as opposed to Candida albicans, as is typical of other forms of CMC. Both families were of French Canadian descent and originated from eastern Quebec. Three other cases of primary candida meningitis in patients of the same ethnic origin are also reported and reviewed. It is suggested that these cases may represent a variant of familial adult-onset CMC, in which there is a striking predisposition to deep infection.
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Affiliation(s)
- M Germain
- School of Public Health and Community Medicine, Department of Epidemiology, University of Washington, Seattle 98195
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Oyefara BI, Kim HC, Danziger RN, Carroll M, Greene JM, Douglas SD. Autoimmune hemolytic anemia in chronic mucocutaneous candidiasis. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 1994; 1:38-43. [PMID: 7496919 PMCID: PMC368193 DOI: 10.1128/cdli.1.1.38-43.1994] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Chronic mucocutaneous candidiasis is an immunodeficiency disease characterized by T-cell dysregulation and chronic superficial candidal infections. We report on three patients with chronic mucocutaneous candidiasis who developed autoantibodies to erythrocytes. Our first patient, a 19-year-old female, developed autoimmune hemolytic anemia (AIHA) that required multiple courses of treatment, including corticosteroids, intravenous immunoglobulin, and danazol. During the last exacerbation of AIHA, intensive treatment with corticosteroids and intravenous immunoglobulin failed and yet the patient responded to plasmapheresis. Our second patient, a 21-year-old male, developed AIHA which responded to oral corticosteroid therapy. Our third patient, a 6-year-old female without evidence of hemolysis, was found to have erythrocyte autoantibodies on routine screening. These three patients had positive direct antiglobulin tests, and the first patient had both immunoglobulin G (IgG) and IgM erythrocyte autoantibodies, while the remaining two patients had only IgG autoantibody. This is the first report of the association of AIHA with chronic mucocutaneous candidiasis. We suggest that all patients with chronic mucocutaneous candidiasis be screened periodically for erythrocyte autoantibodies. Plasmapheresis, a safe ancillary procedure in the management of AIHA, may be life-saving in some cases. The occurrence of erythrocyte autoantibodies in mucocutaneous candidiasis may be related to immunoregulatory disorders in this disease.
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Affiliation(s)
- B I Oyefara
- Division of Allergy, Immunology and Infectious Disease, Children's Hospital of Philadelphia, PA 19104, USA
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Mateev G, Kantardjiev T, Vassileva S, Tsankov N. Chronic mucocutaneous candidosis with osteolysis of the frontal bone. Int J Dermatol 1993; 32:888-9. [PMID: 8125693 DOI: 10.1111/j.1365-4362.1993.tb01408.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- G Mateev
- Department of Dermatology, Sofia Faculty of Medicine, Bulgaria
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Abstract
Chronic mucocutaneous candidosis has been described in patients with impaired cell-mediated immunity. We describe a female patient with sarcoidosis who developed a Candida granuloma on her upper lip. Moderate impairment of the cell-mediated immunity was detected. Three months' treatment with ketoconazole was successful, but the lesion recurred at the same place after treatment was stopped.
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Affiliation(s)
- G Mateev
- Institute of Dermatology, Sofia, Bulgaria
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Friedman TC, Thomas PM, Fleisher TA, Feuillan P, Parker RI, Cassorla F, Chrousos GP. Frequent occurrence of asplenism and cholelithiasis in patients with autoimmune polyglandular disease type I. Am J Med 1991; 91:625-30. [PMID: 1750432 DOI: 10.1016/0002-9343(91)90215-j] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE This study assesses the occurrence of asplenism and gallstones in patients with autoimmune polyglandular disease type I (APG I). PATIENTS AND METHODS Nine patients with APG I (ages 14 to 48) were studied at the National Institutes of Health. Each patient received endocrine testing, a careful examination of his or her peripheral blood smear, lymphocyte immunophenotyping, a liver-spleen scan, and either an upper abdominal ultrasound or a computer-assisted tomogram to evaluate the spleen and gallbladder. RESULTS We documented asplenism in four patients and cholelithiasis in four patients, with two patients having both conditions. The patients with asplenism had Howell-Jolly bodies on peripheral blood smears, lack of splenic uptake by liver-spleen scan, and absent spleens by abdominal computed tomographic scan or ultrasound evaluation. The clinical presentation of the patients with cholelithiasis ranged from acute symptoms requiring surgery to asymptomatic gallstones. Lymphocyte immunophenotyping did not reveal consistent changes in either B- or T-cell subpopulations in the patients studied. CONCLUSION Asplenism and gallstones occur frequently in patients with APG I. In addition to careful examination of the peripheral blood smear for Howell-Jolly bodies to screen for asplenism, we recommend an abdominal ultrasound to detect asplenism and/or gallstones in all patients with APG I. Appropriate immunizations and antibiotic coverage may be helpful in those patients with absent spleens.
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Affiliation(s)
- T C Friedman
- Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892
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Romani L, Mocci S, Cenci E, Rossi R, Puccetti P, Bistoni F. Candida albicans-specific Ly-2+ lymphocytes with cytolytic activity. Eur J Immunol 1991; 21:1567-70. [PMID: 1828430 DOI: 10.1002/eji.1830210636] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
To determine whether antigen (Ag)-specific cytotoxic T lymphocytes are generated during experimental Candida albicans infection, purified L3T4+ and Ly-2+ lymphocytes from immunized mice were cultured in the presence of syngeneic accessory cells, C. albicans Ag, and interleukin 2. Yeast-infected bone marrow macrophages were used as target cells in a standard 51Cr-release assay. Freshly isolated L3T4+ and Ly-2+ lymphocytes failed to lyse either target cell type. However, Ag-specific, major histocompatibility complex (MHC)-unrestricted lysis of infected macrophages was evident with immune Ly-2+ cells after 7-10 days in culture. The cultured cells were greater than 98% Thy-1+, CD3+, L3T4-, Ly-2+, T cell receptor alpha/beta + T cells, and their lytic activity was potentiated by the addition of anti-CD3 monoclonal antibodies. At limiting effector cell numbers, Ag-specific MHC-restricted lymphocytes with cytotoxic activity against infected macrophages could be identified. We suggest that C. albicans infection stimulates multiple cytotoxic cell precursors with varying recognition stringency, which include MHC class I-restricted, Ag-specific cytotoxic T lymphocytes.
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Affiliation(s)
- L Romani
- Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Italy
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Nelson RD, Shibata N, Podzorski RP, Herron MJ. Candida mannan: chemistry, suppression of cell-mediated immunity, and possible mechanisms of action. Clin Microbiol Rev 1991; 4:1-19. [PMID: 2004345 PMCID: PMC358175 DOI: 10.1128/cmr.4.1.1] [Citation(s) in RCA: 114] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The ability of Candida albicans to establish an infection involves multiple components of this fungal pathogen, but its ability to persist in host tissue may involve primarily the immunosuppressive property of a major cell wall glycoprotein, mannan. Mannan and oligosaccharide fragments of mannan are potent inhibitors of cell-mediated immunity and appear to reproduce the immune deficit of patients with the mucocutaneous form of candidiasis. However, neither the exact structures of these inhibitory species nor their mechanisms of action have yet been clearly defined. Different investigators have proposed that mannan or mannan catabolites act upon monocytes or suppressor T lymphocytes, but research from unrelated areas has provided still other possibilities for consideration. These include interference with cytokine activities, lymphocyte-monocyte interactions, and leukocyte homing. To stimulate further research of the immunosuppressive property of C. albicans mannan, we have reviewed (i) the relationship of mannan to other antigens and virulence factors of the fungus; (ii) the chemistry of mannan, together with methods for preparation of mannan and mannan fragments; and (iii) the historical evidence for immunosuppression by Candida mannan and the mechanisms currently proposed for this property; and (iv) we have speculated upon still other mechanisms by which mannan might influence host defense functions. It is possible that understanding the immunosuppressive effects of mannan will provide clues to novel therapies for candidiasis that will enhance the efficacy of both available and future anti-Candida agents.
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Affiliation(s)
- R D Nelson
- Department of Dermatology, University of Minnesota Medical School, Minneapolis 55455
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41
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Affiliation(s)
- C H Kirkpatrick
- Conrad D. Stephenson Laboratory for Research in Immunology, Department of Medicine, National Jewish Center for Immunology and Respiratory Medicine, Denver, Colorado 80206
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