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Fioriti S, Brescini L, Pallotta F, Canovari B, Morroni G, Barchiesi F. Antifungal Combinations against Candida Species: From Bench to Bedside. J Fungi (Basel) 2022; 8:jof8101077. [PMID: 36294642 PMCID: PMC9605143 DOI: 10.3390/jof8101077] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
Candida spp. is the major causative agent of fungal infections in hospitalized patients and the fourth most common cause of nosocomial bloodstream infection (BSI). The availability of standardized methods for testing the in vitro activity of antifungals along with the expanding of antifungal armamentarium, the rising of drug-resistance and the persistence of a high mortality rate in systemic candidiasis have led to an increased interest in combination therapy. Therefore, we aimed to review the scientific literature concerning the antifungal combinations against Candida. A literature search performed in PubMed yielded 92 studies published from 2000 to 2021: 29 articles referring to in vitro studies, six articles referring to either in vitro and in vivo (i.e., animal models) studies and 57 clinical articles. Pre-clinical studies involved 735 isolates of Candida species and 12 unique types of antifungal combination approaches including azoles plus echinocandins (19%), polyenes plus echinocandins (16%), polyenes plus azoles (13%), polyenes plus 5-flucytosine ([5-FC], 13%), azoles plus 5-FC (11%) and other types of combinations (28%). Results varied greatly, often being species-, drug- and methodology-dependent. Some combinatorial regimens exerted a synergistic effect against difficult-to-treat Candida species (i.e., azoles plus echinocandins; polyenes plus 5-FC) or they were more effective than monotherapy in prevent or reducing biofilm formation and in speeding the clearance of infected tissues (i.e., polyenes plus echinocandins). In 283 patients with documented Candida infections (>90% systemic candidiasis/BSI), an antifungal combination approach could be evaluated. Combinations included: azoles plus echinocandins (36%), 5-FC-combination therapies (24%), polyenes plus azoles (18%), polyenes plus echinocandins (16%) and other types of combination therapy (6%). Case reports describing combination therapies yielded favorable response in most cases, including difficult-to-treat fungal infections (i.e., endocarditis, osteoarticular infections, CNS infections) or difficult-to-treat fungal pathogens. The only randomized trial comparing amphotericin-B deoxycholate (AMB) plus FLU vs. AMB alone for treatment of BSI in nonneutropenic patients showed that the combination trended toward improved success and more-rapid clearance from the bloodstream. In summary, antifungal combinations against Candida have produced great interest in the past two decades. To establish whether this approach can become a reliable treatment option, additional in vitro and clinical data are warranted.
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Affiliation(s)
- Simona Fioriti
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Lucia Brescini
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, 60126 Ancona, Italy
- Infectious Disease Clinic, Azienda Ospedaliero Universitaria “Ospedali Riuniti”, 60126 Ancona, Italy
| | - Francesco Pallotta
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, 60126 Ancona, Italy
- Infectious Disease Clinic, Azienda Ospedaliero Universitaria “Ospedali Riuniti”, 60126 Ancona, Italy
| | - Benedetta Canovari
- Infectious Diseases Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, 61121 Pesaro, Italy
| | - Gianluca Morroni
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, 60126 Ancona, Italy
- Correspondence: ; Tel.: +39-071-220-6298; Fax: +39-071-220-6297
| | - Francesco Barchiesi
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, 60126 Ancona, Italy
- Infectious Diseases Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, 61121 Pesaro, Italy
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Guo P, He Y, Fan R, Wu Z, Chen Y, Huang Y, Liao K, Chen P. A case series of medically managed Candida parapsilosis complex prosthetic valve endocarditis. Ann Clin Microbiol Antimicrob 2021; 20:1. [PMID: 33402178 PMCID: PMC7786486 DOI: 10.1186/s12941-020-00409-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022] Open
Abstract
Background In recent years, Candida parapsilosis is recognized as a species complex and is composed of Candida parapsilosis sensu stricto, Candida orthopsilosis and Candida metapsilosis. Candida parapsilosis complex prosthetic valve endocarditis (PVE) is rare and the survival rate is still low despite of optimal therapeutic strategies. In our report, it is novel to report cases as Candida parapsilosis complex PVE at species and identify Candida parapsilosis using MALDI-TOF MS. Case presentation A series of 4 cases of Candida parapsilosis complex PVE from our institution was reported. Three were infected by Candida parapsilosis sensu stricto and one was infected by Candida metapsilosis. The condition of two cases got better and the other died. Conclusions More attention should be paid to Candida parapsilosis complex PVE and early diagnosis and prompt antibiotic therapy may play a role in the treatment for Candida parapsilosis complex PVE. It is recommended to identify Candida parapsilosis complex at species level and MALDI-TOF MS as an easy, fast and efficient identification method is worth promoting in clinical microbiology
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Affiliation(s)
- Penghao Guo
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan road II, Guangzhou, Guangdong, China
| | - Yuting He
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan road II, Guangzhou, Guangdong, China
| | - Rui Fan
- Department of Ultrasound, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhongwen Wu
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan road II, Guangzhou, Guangdong, China
| | - Yili Chen
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan road II, Guangzhou, Guangdong, China
| | - Yuli Huang
- Clinical Medicine Research Center, Shunde Hospital, Southern Medical University, Foshan, People's Republic of China
| | - Kang Liao
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan road II, Guangzhou, Guangdong, China.
| | - Peisong Chen
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan road II, Guangzhou, Guangdong, China.
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Giuliano S, Guastalegname M, Russo A, Falcone M, Ravasio V, Rizzi M, Bassetti M, Viale P, Pasticci MB, Durante-Mangoni E, Venditti M. Candida endocarditis: systematic literature review from 1997 to 2014 and analysis of 29 cases from the Italian Study of Endocarditis. Expert Rev Anti Infect Ther 2017; 15:807-818. [PMID: 28903607 DOI: 10.1080/14787210.2017.1372749] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Candida Endocarditis (CE) is a deadly disease. It is of paramount importance to assess risk factors for acquisition of both Candida native (NVE) and prosthetic (PVE) valve endocarditis and relate clinical features and treatment strategies with the outcome of the disease. Areas covered: We searched the literature using the Pubmed database. Cases of CE from the Italian Study on Endocarditis (SEI) were also included. Overall, 140 cases of CE were analyzed. Patients with a history of abdominal surgery and antibiotic exposure had higher probability of developing NVE than PVE. In the PVE group, time to onset of CE was significantly lower for biological prosthesis compared to mechanical prosthesis. In the whole population, greater age and longer time to diagnosis were associated with increased likelihood of death. Patients with effective anti-biofilm treatment, patients who underwent cardiac surgery and patients who were administered chronic suppressive antifungal treatment showed increased survival. For PVE, moderate active anti-biofilm and highly active anti-biofilm treatment were associated with lower mortality. Expert commentary: Both NVE and PVE could be considered biofilm-related diseases, pathogenetically characterized by Candida intestinal translocation and initial transient candidemia. Cardiac surgery, EAB treatment and chronic suppressive therapy might be crucial in increasing patient survival.
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Affiliation(s)
- Simone Giuliano
- a Department of Public Health and Infectious Diseases , Policlinico Umberto I 'Sapienza' University of Rome , Rome , Italy
| | - Maurizio Guastalegname
- a Department of Public Health and Infectious Diseases , Policlinico Umberto I 'Sapienza' University of Rome , Rome , Italy
| | - Alessandro Russo
- a Department of Public Health and Infectious Diseases , Policlinico Umberto I 'Sapienza' University of Rome , Rome , Italy
| | - Marco Falcone
- a Department of Public Health and Infectious Diseases , Policlinico Umberto I 'Sapienza' University of Rome , Rome , Italy
| | - Veronica Ravasio
- b Infectious Diseases Unit , ASST Papa Giovanni XXIII , Bergamo , Italy
| | - Marco Rizzi
- b Infectious Diseases Unit , ASST Papa Giovanni XXIII , Bergamo , Italy
| | - Matteo Bassetti
- c Infectious Diseases Division , Santa Maria Misericordia University Hospital , Udine , Italy
| | - Pierluigi Viale
- d Infectious Diseases Unit, Department of Medical and Surgical Sciences , Alma Mater Studiorum University of Bologna , Bologna , Italy
| | | | - Emanuele Durante-Mangoni
- f Department of Clinical and Experimental Medicine , Università della Campania 'Luigi Vanvitelli', AORN dei Colli-Ospedale Monaldi , Naples , Italy
| | - Mario Venditti
- a Department of Public Health and Infectious Diseases , Policlinico Umberto I 'Sapienza' University of Rome , Rome , Italy
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Silva-Pinto A, Ferraz R, Casanova J, Sarmento A, Santos L. Candida parapsilosis prosthetic valve endocarditis. Med Mycol Case Rep 2015; 9:37-8. [PMID: 26288749 PMCID: PMC4539163 DOI: 10.1016/j.mmcr.2015.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 07/27/2015] [Accepted: 07/29/2015] [Indexed: 10/30/2022] Open
Abstract
Candida endocarditis is a rare infection associated with high mortality and morbidity. There are still some controversies about Candida endocarditis treatment, especially about the treatment duration. We report a case of a Candida parapsilosis endocarditis that presented as a lower limb ischemia. The patient was surgically treated with a cryopreserved homograft aortic replacement. We used intravenous fluconazole 800 mg as initial treatment, followed with 12 months of 400 mg fluconazole per os. The patient outcome was good.
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Affiliation(s)
- André Silva-Pinto
- Infectious Diseases Department, Centro Hospitalar São João, Alameda Professor Hernâni Monteiro, Porto 4200, Portugal ; Instituto de Inovação e Investigação em Saúde (I3S), Grupo de I&D em Nefrologia e Doenças Infecciosas, Instituto Nacional de Engenharia Biomédica (INEB), Portugal
| | - Rita Ferraz
- Infectious Diseases Department, Centro Hospitalar São João, Alameda Professor Hernâni Monteiro, Porto 4200, Portugal ; Instituto de Inovação e Investigação em Saúde (I3S), Grupo de I&D em Nefrologia e Doenças Infecciosas, Instituto Nacional de Engenharia Biomédica (INEB), Portugal
| | - Jorge Casanova
- Cardiac Surgery Department, Centro Hospitalar São João, Alameda Professor Hernâni Monteiro, Porto 4200, Portugal
| | - António Sarmento
- Infectious Diseases Department, Centro Hospitalar São João, Alameda Professor Hernâni Monteiro, Porto 4200, Portugal ; Instituto de Inovação e Investigação em Saúde (I3S), Grupo de I&D em Nefrologia e Doenças Infecciosas, Instituto Nacional de Engenharia Biomédica (INEB), Portugal
| | - Lurdes Santos
- Infectious Diseases Department, Centro Hospitalar São João, Alameda Professor Hernâni Monteiro, Porto 4200, Portugal ; Instituto de Inovação e Investigação em Saúde (I3S), Grupo de I&D em Nefrologia e Doenças Infecciosas, Instituto Nacional de Engenharia Biomédica (INEB), Portugal
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Jiang L, Yong X, Li R, Peng Y, Liu W, Qin Q, Zhang L, Liu Z, Liang H, Tao R. Dynamic analysis of oral Candida carriage, distribution, and antifungal susceptibility in HIV-infected patients during the first year of highly active antiretroviral therapy in Guangxi, China. J Oral Pathol Med 2014; 43:696-703. [PMID: 24931443 DOI: 10.1111/jop.12192] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Highly active antiretroviral therapy (HAART) as an effective therapy for immune reconstruction among patients with HIV/AIDS might have influence on oral Candida status. We investigated oral Candida carriage, distribution, and antifungal susceptibility dynamically during the first year of HAART among adult HIV-infected patients in Guangxi, China. METHODS Forty-five adult HIV-infected patients who received their first year HAART in the AIDS clinic of the Guangxi Center for Disease Control (CDC) and 31 healthy individuals were recruited. Clinical information and oral examinations were obtained. Oral rinses taken from patients at baseline, 3, 6, 12 months during HAART, respectively, were cultured, and Candida species were identified following standard microbiological techniques. In vitro antifungal susceptibilities were tested by the broth microdilution method. RESULTS The oral Candida load decreased gradually in the 45 patients with HIV/AIDS during the first year of HAART (P < 0.050). Among 176 Candida isolates, Candida albicans (114/176) was the predominant species, and Candida parapsilosis (23/62) was the most common non-albicans species. We found the frequency of resistance to fluconazole and itraconazole of Candida isolated from our samples increased (P < 0.05) after 12 months of HAART. In addition, the frequency of C. albicans isolates resistant to fluconazole and itraconazole was on the rise (P < 0.05). CONCLUSIONS The Candida load decreased with increased CD4(+) T cell counts, and C. albicans was still the prevailing species. Further, a trend toward more frequent in vitro resistance to fluconazole and itraconazole was observed. Our results provide reference for treatment and prevention of oral candidiasis among this population.
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Affiliation(s)
- Lanlan Jiang
- Department of Periodontics and Oral Medicine, College of Stomatology, Guangxi Medical University, Guangxi, China; Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Guangxi, China
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Shokohi T, Nouraei SM, Afsarian MH, Najafi N, Mehdipour S. Fungal Prosthetic Valve Endocarditis by Candida parapsilosis: A Case Report. Jundishapur J Microbiol 2014; 7:e9428. [PMID: 25147692 PMCID: PMC4138648 DOI: 10.5812/jjm.9428] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 01/27/2013] [Accepted: 03/03/2013] [Indexed: 11/16/2022] Open
Abstract
Introduction: Fungal prosthetic valve endocarditis (PVE) is rare but serious complication of valve replacement surgery. Candida species, particularly Candida albicans is the most common isolated pathogen in fungal PVE (1–6%of cases). Case Presentation: We describe a 35-year-old woman who underwent mechanical mitral valve replacement about 3 years ago. She was admitted with neurological symptoms and later with dyspnea and hypotension. Transesophageal echocardiography showed large and mobile prosthetic valve vegetation. She underwent mitral valve surgery. The explanted valve and vegetation revealed lots of budding yeasts and the isolated yeast was identified as C. parapsilosis. Amphotericin B and broad spectrum antibiotic were started immediately. Unfortunately, the patient died two days after surgery, due to sepsis probably related to the candidemia. Conclusions: Fungal endocarditis is uncommon infection, but it is a serious problem in patients with prosthetic valve. Fungal PVE can occur years after the surgery, thus long-term follow-up is essential.
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Affiliation(s)
- Tahereh Shokohi
- Department of Parasitology and Mycology, Mazandaran University of Medical Sciences, Sari, IR Iran
- Invasive Fungi Research center, Mazandaran University of Medical Sciences, Sari, IR Iran
- Corresponding author: Tahereh Shokohi, Department of Medical Mycology and Parasitology, Sari Medical School, Sari, IR Iran. Tel: +98-9111515741, Fax: +98-1513543248, E-mail:
| | | | - Mohammad Hosein Afsarian
- Department of Parasitology and Mycology, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Narges Najafi
- North Infectious Disease Research Center, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Shirin Mehdipour
- Mazandaran Heart Center, Mazandaran University of Medical Sciences, Sari, IR Iran
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