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Ramage G, Borghi E, Rodrigues CF, Kean R, Williams C, Lopez-Ribot J. Our current clinical understanding of Candida biofilms: where are we two decades on? APMIS 2023; 131:636-653. [PMID: 36932821 DOI: 10.1111/apm.13310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/12/2023] [Indexed: 03/19/2023]
Abstract
Clinically we have been aware of the concept of Candida biofilms for many decades, though perhaps without the formal designation. Just over 20 years ago the subject emerged on the back of progress made from the bacterial biofilms, and academic progress pace has continued to mirror the bacterial biofilm community, albeit at a decreased volume. It is apparent that Candida species have a considerable capacity to colonize surfaces and interfaces and form tenacious biofilm structures, either alone or in mixed species communities. From the oral cavity, to the respiratory and genitourinary tracts, wounds, or in and around a plethora of biomedical devices, the scope of these infections is vast. These are highly tolerant to antifungal therapies that has a measurable impact on clinical management. This review aims to provide a comprehensive overight of our current clinical understanding of where these biofilms cause infections, and we discuss existing and emerging antifungal therapies and strategies.
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Affiliation(s)
- Gordon Ramage
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
- Study Group for Biofilms (ESGB), European Society for Clinical Microbiology and Infectious Disease, Basel, Switzerland
| | - Elisa Borghi
- Study Group for Biofilms (ESGB), European Society for Clinical Microbiology and Infectious Disease, Basel, Switzerland
- Department of Health Sciences, San Paolo Medical School, Università Degli Studi di Milano, Milan, Italy
| | - Célia Fortuna Rodrigues
- Study Group for Biofilms (ESGB), European Society for Clinical Microbiology and Infectious Disease, Basel, Switzerland
- LEPABE-Department of Chemical Engineering, Faculty of Engineering, Cooperativa de Ensino Superior Politécnico e Universitário-CESPU, Gandra, Portugal
- ALiCE-Associate Laboratory in Chemical Engineering, Faculty of Engineering, Cooperativa de Ensino Superior Politécnico e Universitário-CESPU, Gandra, Portugal
- TOXRUN-Toxicology Research Unit, Cooperativa de Ensino Superior Politécnico e Universitário-CESPU, Gandra, Portugal
| | - Ryan Kean
- Study Group for Biofilms (ESGB), European Society for Clinical Microbiology and Infectious Disease, Basel, Switzerland
- Department of Biological Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Craig Williams
- Study Group for Biofilms (ESGB), European Society for Clinical Microbiology and Infectious Disease, Basel, Switzerland
- Microbiology Department, Morecambe Bay NHS Trust, Lancaster, UK
| | - Jose Lopez-Ribot
- Department of Biology and the South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, Texas, USA
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Gamaletsou MN, Rammaert B, Brause B, Bueno MA, Dadwal SS, Henry MW, Katragkou A, Kontoyiannis DP, McCarthy MW, Miller AO, Moriyama B, Pana ZD, Petraitiene R, Petraitis V, Roilides E, Sarkis JP, Simitsopoulou M, Sipsas NV, Taj-Aldeen SJ, Zeller V, Lortholary O, Walsh TJ. Osteoarticular Mycoses. Clin Microbiol Rev 2022; 35:e0008619. [PMID: 36448782 PMCID: PMC9769674 DOI: 10.1128/cmr.00086-19] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Osteoarticular mycoses are chronic debilitating infections that require extended courses of antifungal therapy and may warrant expert surgical intervention. As there has been no comprehensive review of these diseases, the International Consortium for Osteoarticular Mycoses prepared a definitive treatise for this important class of infections. Among the etiologies of osteoarticular mycoses are Candida spp., Aspergillus spp., Mucorales, dematiaceous fungi, non-Aspergillus hyaline molds, and endemic mycoses, including those caused by Histoplasma capsulatum, Blastomyces dermatitidis, and Coccidioides species. This review analyzes the history, epidemiology, pathogenesis, clinical manifestations, diagnostic approaches, inflammatory biomarkers, diagnostic imaging modalities, treatments, and outcomes of osteomyelitis and septic arthritis caused by these organisms. Candida osteomyelitis and Candida arthritis are associated with greater events of hematogenous dissemination than those of most other osteoarticular mycoses. Traumatic inoculation is more commonly associated with osteoarticular mycoses caused by Aspergillus and non-Aspergillus molds. Synovial fluid cultures are highly sensitive in the detection of Candida and Aspergillus arthritis. Relapsed infection, particularly in Candida arthritis, may develop in relation to an inadequate duration of therapy. Overall mortality reflects survival from disseminated infection and underlying host factors.
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Affiliation(s)
- Maria N. Gamaletsou
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Blandine Rammaert
- Université de Poitiers, Faculté de médecine, CHU de Poitiers, INSERM U1070, Poitiers, France
| | - Barry Brause
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Marimelle A. Bueno
- Far Eastern University-Dr. Nicanor Reyes Medical Foundation, Manilla, Philippines
| | | | - Michael W. Henry
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Aspasia Katragkou
- Nationwide Children’s Hospital, Columbus, Ohio, USA
- The Ohio State University School of Medicine, Columbus, Ohio, USA
| | | | - Matthew W. McCarthy
- Weill Cornell Medicine of Cornell University, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
| | - Andy O. Miller
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - Zoi Dorothea Pana
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Ruta Petraitiene
- Weill Cornell Medicine of Cornell University, New York, New York, USA
| | | | - Emmanuel Roilides
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | | | - Maria Simitsopoulou
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Nikolaos V. Sipsas
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Valérie Zeller
- Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | - Olivier Lortholary
- Université de Paris, Faculté de Médecine, APHP, Hôpital Necker-Enfants Malades, Paris, France
- Institut Pasteur, Unité de Mycologie Moléculaire, CNRS UMR 2000, Paris, France
| | - Thomas J. Walsh
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
- Weill Cornell Medicine of Cornell University, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
- Center for Innovative Therapeutics and Diagnostics, Richmond, Virginia, USA
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Escobar IE, Possamai Rossatto FC, Kim SM, Kang MH, Kim W, Mylonakis E. Repurposing Kinase Inhibitor Bay 11-7085 to Combat Staphylococcus aureus and Candida albicans Biofilms. Front Pharmacol 2021; 12:675300. [PMID: 34025434 PMCID: PMC8133364 DOI: 10.3389/fphar.2021.675300] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/19/2021] [Indexed: 12/03/2022] Open
Abstract
Staphylococcus aureus and Candida spp. are commonly linked with topical biofilm-associated infections such as those found on chronic wounds. These biofilms are notoriously difficult to treat, highlighting the grave need to discover and study new broad-spectrum agents to combat associated infections. Here we report that the kinase inhibitor Bay 11-7085 exhibited bactericidal activity against multidrug-resistant S. aureus with a minimum inhibitory concentration (MIC) of 4 μg/ml. In addition, S. aureus strain MW2 did not acquire resistance to antibiotic pressure. Furthermore, Bay 11-7085 exhibited potency against Candida albicans and the emerging pathogen Candida auris with a MIC of 0.5–1 μg/ml. Bay 11-7085 partially inhibited and eradicated biofilm formation of various pathogens, such as VRSA (vancomycin-resistant S. aureus), as well as antifungal-resistant Candida spp. isolates. Notably, Bay 11-7085 partially inhibited initial cell attachment and formation of a VRSA-C. albicans polymicrobial biofilm in vitro. In contrast to C. albicans, inhibition of VRSA biofilm was linked to initial cell attachment independent of its bactericidal activity. Finally, Bay 11-7085 was effective in vivo at increasing the lifespan of C. elegans during an S. aureus and a C. albicans infection. Our work proposes kinase inhibitor Bay 11-7085 as a potential compound capable of combating biofilms associated with primary multidrug-resistant bacteria and yeast pathogens associated with wound infections.
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Affiliation(s)
- Iliana E Escobar
- Infectious Diseases Division, Department of Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, United States
| | - Fernanda Cristina Possamai Rossatto
- Infectious Diseases Division, Department of Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, United States.,Laboratory of Biofilms and Alternative Models, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Soo Min Kim
- College of Pharmacy, Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
| | - Min Hee Kang
- College of Pharmacy, Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
| | - Wooseong Kim
- College of Pharmacy, Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
| | - Eleftherios Mylonakis
- Infectious Diseases Division, Department of Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, United States
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Candida albicans skin infection in patients with type 2 diabetes: a systematic review and meta-analysis. J Diabetes Metab Disord 2021; 20:665-672. [PMID: 34222084 DOI: 10.1007/s40200-021-00797-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
Background Fungal infections including Candida albicans is one of the most important health concerns among type 2 diabetic patients. Therefore, this study aimed to determine the prevalence of C. albicans skin infection in patients with type 2 diabetes in a systematic review and meta-analysis. Methods In this review study, data were extracted from national and international databases of SID, MagIran, IranMedex, IranDoc, Google Scholar, Cochrane, Embase, ScienceDirect, Scopus, PubMed, and Web of Science (WoS) with no time limit until January 2021. The random effects model was used for doing analysis and the I2 index was used for assessing the heterogeneity of studies. Data were analyzed using Comprehensive Meta-Analysis (Version 2). Results The prevalence of C. albicans skin infection in patients with type 2 diabetes was 11.4% (95% CI: 8.9%-14.4%) in 13 reviewed articles with a sample size of 1348. Regarding the heterogeneity based on meta-regression, there was a significant difference between the effect of sample size (P < 0.05) and the prevalence of C. albicans skin infection in patients with type 2 diabetes. Conclusion The results of this study showed that C. albicans skin infection was high in type 2 diabetic patients in Iran. Therefore, to improve the aforementioned situation and to troubleshoot and monitor at all levels, appropriate policies should be adopted.
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Rewak-Soroczynska J, Sobierajska P, Targonska S, Piecuch A, Grosman L, Rachuna J, Wasik S, Arabski M, Ogorek R, Wiglusz RJ. New Approach to Antifungal Activity of Fluconazole Incorporated into the Porous 6-Anhydro-α-l-Galacto-β-d-Galactan Structures Modified with Nanohydroxyapatite for Chronic-Wound Treatments-In Vitro Evaluation. Int J Mol Sci 2021; 22:3112. [PMID: 33803717 PMCID: PMC8003069 DOI: 10.3390/ijms22063112] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/05/2021] [Accepted: 03/15/2021] [Indexed: 12/22/2022] Open
Abstract
New fluconazole-loaded, 6-Anhydro-α-l-Galacto-β-d-Galactan hydrogels incorporated with nanohydroxyapatite were prepared and their physicochemical features (XRD, X-ray Diffraction; SEM-EDS, Scanning Electron Microscopy-Energy Dispersive X-ray Spectroscopy; ATR-FTIR, Attenuated Total Reflectance-Fourier Transform Infrared Spectroscopy), fluconazole release profiles and enzymatic degradation were determined. Antifungal activity of pure fluconazole was tested using Candida species (C. albicans, C. tropicalis, C. glabarata), Cryptococcus species (C. neoformans, C. gatti) and Rhodotorula species (R. mucilaginosa, R. rubra) reference strains and clinical isolates. Standard microdilution method was applied, and fluconazole concentrations of 2-250 µg/mL were tested. Moreover, biofilm production ability of tested isolates was tested on the polystyrene surface at 28 and 37 ± 0.5 °C and measured after crystal violet staining. Strains with the highest biofilm production ability were chosen for further analysis. Confocal microscopy photographs were taken after live/dead staining of fungal suspensions incubated with tested hydrogels (with and without fluconazole). Performed analyses confirmed that polymeric hydrogels are excellent drug carriers and, when fluconazole-loaded, they may be applied as the prevention of chronic wounds fungal infection.
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Affiliation(s)
- Justyna Rewak-Soroczynska
- Institute of Low Temperature and Structure Research, Polish Academy of Sciences, Okolna 2, 50-422 Wroclaw, Poland; (J.R.-S.); (P.S.); (S.T.); (L.G.)
| | - Paulina Sobierajska
- Institute of Low Temperature and Structure Research, Polish Academy of Sciences, Okolna 2, 50-422 Wroclaw, Poland; (J.R.-S.); (P.S.); (S.T.); (L.G.)
| | - Sara Targonska
- Institute of Low Temperature and Structure Research, Polish Academy of Sciences, Okolna 2, 50-422 Wroclaw, Poland; (J.R.-S.); (P.S.); (S.T.); (L.G.)
| | - Agata Piecuch
- Department of Mycology and Genetics, University of Wroclaw, Przybyszewskiego 63, 51-148 Wroclaw, Poland; (A.P.); (R.O.)
| | - Lukasz Grosman
- Institute of Low Temperature and Structure Research, Polish Academy of Sciences, Okolna 2, 50-422 Wroclaw, Poland; (J.R.-S.); (P.S.); (S.T.); (L.G.)
| | - Jaroslaw Rachuna
- Institute of Biology, Jan Kochanowski University, Uniwersytecka 7, 25-406 Kielce, Poland; (J.R.); (M.A.)
| | - Slawomir Wasik
- Institute of Physics, Jan Kochanowski University, Swietokrzyska 15, 25-406 Kielce, Poland;
| | - Michal Arabski
- Institute of Biology, Jan Kochanowski University, Uniwersytecka 7, 25-406 Kielce, Poland; (J.R.); (M.A.)
| | - Rafal Ogorek
- Department of Mycology and Genetics, University of Wroclaw, Przybyszewskiego 63, 51-148 Wroclaw, Poland; (A.P.); (R.O.)
| | - Rafal J. Wiglusz
- Institute of Low Temperature and Structure Research, Polish Academy of Sciences, Okolna 2, 50-422 Wroclaw, Poland; (J.R.-S.); (P.S.); (S.T.); (L.G.)
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6
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Hot topics in diabetic foot infection. Int J Antimicrob Agents 2020; 55:105942. [PMID: 32194153 DOI: 10.1016/j.ijantimicag.2020.105942] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 01/12/2023]
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Osmanov A, Wise A, Denning DW. In vitro and in vivo efficacy of miramistin against drug-resistant fungi. J Med Microbiol 2019; 68:1047-1052. [PMID: 31169488 DOI: 10.1099/jmm.0.001007] [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] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Miramistin is a topical antiseptic with broad antimicrobial activity that was developed in the Soviet Union during the Cold War. AIM To investigate the antifungal activity of miramistin against clinically relevant drug-resistant fungi. METHODOLOGY The in vitro activity of miramistin was determined following Clinical and Laboratory Standards Institute (CLSI) guidelines. Mammalian cell toxicity was tested using a McCoy cell line and topical and systemic tolerability, and in vivo efficacy was tested using Galleria mellonella models. RESULTS The minimal inhibitory concentration (MIC) range against fungi was 1.56-25 mg l-1 (GM 3.13 mg l-1 ). In the G. mellonella model, miramistin provided potent survival benefits for Candida albicans and Aspergillus fumigatus infection. Miramistin was tolerated by McCoy cell lines at concentrations up to 1000 mg l-1 and was systemically safe in G. mellonella at 2000 mg kg-1. Topical administration at 32 000 mg l-1 was well tolerated with no adverse effects. CONCLUSION These findings support further investigation of miramistin and suggest its possible use for treatment of superficial fungal infections.
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Affiliation(s)
- Ali Osmanov
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Andrew Wise
- Evotec UK Ltd, Block 23 Alderley Park, Macclesfield SK10 4TG, UK
| | - David W Denning
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Southmoor Road, Manchester M23 9LT, UK
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ÖZTÜRK AM, TAŞBAKAN MI, METIN DY, YENER C, UYSAL S, YILDIRIM ŞIMŞIR I, ERTAM İ, PULLUKÇU H, ARDA B, ÇETINKALP S. A neglected causative agent in diabetic foot infection: a retrospective evaluation of 13 patients with fungal etiology. Turk J Med Sci 2019; 49:81-86. [PMID: 30761877 PMCID: PMC7350845 DOI: 10.3906/sag-1809-74] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background/aim Clinicians often neglect fungal infections and do not routinely investigate deep tissue from the wound for fungal culture and sensitivity due to insufficient information in the literature. In this study, we aimed to evaluate fungal etiology of invasive fungal diabetic foot which is rarely reported in the literature. Materials and methods The patients who were unresponsive to antibiotic therapy and those with positive fungal in bone or deep tissue culture were enrolled in the study. Detailed hospital records were retrieved for demographics and clinical features. Results A total of 13 patients who were diagnosed with invasive fungal diabetic foot (ten females, three males, mean age 59.8 ± 9 years) were included. All of the patients had type-2 diabetes mellitus. Eleven (84.6%) patients had mixed infection. The most common cause of fungal infections of diabetic foot ulcers was the Candida species. Ten (76.9%) patients underwent amputation, two (15.4%) patients refused amputation, and one patient died before surgery. Conclusion Invasive fungal infections may also be a causative pathogen in deep tissue infections. Therefore, fungal pathogens should be considered in patients unresponsive to long-term antibiotic therapy. Early detection of fungal infections in high-risk individuals is critical for the prevention of severe consequences such as foot amputation.
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Affiliation(s)
- Anıl Murat ÖZTÜRK
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ege University, İzmirTurkey
| | - Meltem Işıkgöz TAŞBAKAN
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Ege University, İzmirTurkey
- * To whom correspondence should be addressed. E-mail:
| | - Dilek Yeşim METIN
- Department of Clinical Microbiology, Faculty of Medicine, Ege University, İzmirTurkey
| | - Can YENER
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ege University, İzmirTurkey
| | - Serhat UYSAL
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Ege University, İzmirTurkey
- Department of Clinical Microbiology and Infectious Diseases, Kanuni Training and Research Hospital, TrabzonTurkey
| | - Ilgın YILDIRIM ŞIMŞIR
- Division of Endocrinology, Department of Internal Diseases, Faculty of Medicine, Ege University, İzmirTurkey
| | - İlgen ERTAM
- Department of Dermatology, Faculty of Medicine, Ege University, İzmirTurkey
| | - Hüsnü PULLUKÇU
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Ege University, İzmirTurkey
| | - Bilgin ARDA
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Ege University, İzmirTurkey
| | - Sevki ÇETINKALP
- Division of Endocrinology, Department of Internal Diseases, Faculty of Medicine, Ege University, İzmirTurkey
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Vas PRJ, Panagopoulos P, Papanas N. Diabetic Foot Fungal Osteomyelitis: No Longer Unknown and Hidden? INT J LOW EXTR WOUND 2018; 17:142-143. [DOI: 10.1177/1534734618794575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Torrence GM, Schmidt BM. Fungal Osteomyelitis in Diabetic Foot Infections: A Case Series and Comparative Analysis. INT J LOW EXTR WOUND 2018; 17:184-189. [PMID: 30092692 DOI: 10.1177/1534734618791607] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Fungal osteomyelitis (OM) is relatively rare. There is scarce literature discussing fungal OM in diabetic foot infections (DFIs). This case series explores the clinical characteristics of patients treated at a large tertiary academic center for DFI and found to have a causative agent of fungal origin in their bone on surgical intervention. Between July 2017 and March 2018, a prospective longitudinal analysis was performed of patients with diabetes admitted to our institution who underwent operative management of OM. Demographic, clinical, radiographic, and laboratory data were collected for all patients. Data between bacterial and fungal OM cohorts was analyzed for differences and similarities in patient characteristics and outcomes. All patients were followed 20 weeks postoperatively. Five patients with fungal OM were identified from the 35 cases where OM was confirmed through podiatric surgical intervention. In each fungal case, a Candida species was isolated from operative bone culture which included subspecies Candida albicans, C parapsilosis, and C glabrata. A P value ⩾.05 was found in clinical characteristics between our cohorts. Wound healing was achieved in 40% of patients with fungal OM, and oral fluconazole successfully treated Candida OM in the cases that achieved healing. Diabetes can increase the risk of Candida OM. In DFIs, fungus can impede wound healing if not recognized and treated. Because Candida OM is typically indolent in nature, bone biopsy and mycological culture is recommended for definitive diagnosis and treatment.
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Affiliation(s)
| | - Brian M Schmidt
- 1 University of Michigan Hospital and Health Systems, Ann Arbor, MI, USA
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Prevalence of yeast in diabetic foot infections. Int J Diabetes Dev Ctries 2017. [DOI: 10.1007/s13410-016-0491-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Wijesuriya TM, Weerasekera MM, Kottahachchi J, Ranasinghe KNP, Dissanayake MSS, Prathapan S, Gunasekara TDCP, Nagahawatte A, Guruge LD, Bulugahapitiya U, Fernando SSN. Proportion of lower limb fungal foot infections in patients with type 2 diabetes at a tertiary care hospital in Sri Lanka. Indian J Endocrinol Metab 2014; 18:63-69. [PMID: 24701432 PMCID: PMC3968735 DOI: 10.4103/2230-8210.126556] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Superficial fungal foot infection (SFFI) in diabetic patients increases the risk of developing diabetic foot syndrome. Sixteen percent of urban population is suffering from diabetes in Sri Lanka. As the diabetes patients are more prone to get fungal foot infections, early intervention is advisable owing to the progressive nature of the infection. There is no data on the prevalence of SFFIs in diabetic patients in Sri Lanka. OBJECTIVE To determine the etiological agents causing SFFI in patients with type 2 diabetes. MATERIALS AND METHODS Three hundred eighty five diabetic patients were included. Nail clippings and swabs were collected from the infected sites using the standard protocol. Laboratory identification was done and pathogens were identified to the species level by morpho physiological methods. RESULTS Clinically 295 patients showed SFFI, of which 255 (86%) were mycologically confirmed for infection. Out of 236 direct microscopy (KOH) positives, 227 (96%) were culture positive. Two hundred and fifty one patients (98%) with SFFI had diabetes for more than 10 years. Of the patients with SFFIs 92% had >100 mg/dl FBS and 81% had >140 mg/dl PPBS levels and 80% had both elevated FBS and PPBS. Non-dermatophyte fungal species were the commonest pathogens followed by yeast and dermatophytes. CONCLUSION Aspergillus niger was the commonest pathogen followed by Candida albicans. SFFIs were seen significantly with the increasing age, gender, duration of diabetes and with less controlled glycaemic level.
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Affiliation(s)
- T. M. Wijesuriya
- Department of Microbiology, University of Sri Jayewardenepura, Sri Lanka
| | - M. M. Weerasekera
- Department of Microbiology, University of Sri Jayewardenepura, Sri Lanka
| | - J. Kottahachchi
- Department of Microbiology, University of Sri Jayewardenepura, Sri Lanka
| | | | | | - S. Prathapan
- Department of Community Medicine, University of Sri Jayewardenepura, Sri Lanka
| | | | - A. Nagahawatte
- Department of Microbiology, University of Sri Jayewardenepura, Sri Lanka
| | - L. D. Guruge
- Department of Microbiology, University of Sri Jayewardenepura, Sri Lanka
| | - U. Bulugahapitiya
- Diabetic Clinic, Colombo South Teaching Hospital, Kalubowila, Sri Lanka
| | - S. S. N. Fernando
- Department of Microbiology, University of Sri Jayewardenepura, Sri Lanka
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Fusarium falciforme Infection of Foot in a Patient with Type 2 Diabetes Mellitus: A Case Report and Review of the Literature. Mycopathologia 2013; 176:225-32. [DOI: 10.1007/s11046-013-9646-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 04/02/2013] [Indexed: 10/26/2022]
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Gamaletsou MN, Kontoyiannis DP, Sipsas NV, Moriyama B, Alexander E, Roilides E, Brause B, Walsh TJ. Candida osteomyelitis: analysis of 207 pediatric and adult cases (1970-2011). Clin Infect Dis 2012; 55:1338-51. [PMID: 22911646 DOI: 10.1093/cid/cis660] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The epidemiology, pathogenesis, clinical manifestations, management, and outcome of Candida osteomyelitis are not well understood. METHODS Cases of Candida osteomyelitis from 1970 through 2011 were reviewed. Underlying conditions, microbiology, mechanisms of infection, clinical manifestations, antifungal therapy, and outcome were studied in 207 evaluable cases. RESULTS Median age was 30 years (range, ≤ 1 month to 88 years) with a >2:1 male:female ratio. Most patients (90%) were not neutropenic. Localizing pain, tenderness, and/or edema were present in 90% of patients. Mechanisms of bone infection followed a pattern of hematogenous dissemination (67%), direct inoculation (25%), and contiguous infection (9%). Coinciding with hematogenous infection, most patients had ≥2 infected bones. When analyzed by age, the most common distribution of infected sites for adults was vertebra (odds ratio [OR], 0.09; 95% confidence interval [CI], .04-.25), rib, and sternum; for pediatric patients (≤18 years) the pattern was femur (OR, 20.6; 95% CI, 8.4-48.1), humerus, then vertebra/ribs. Non-albicans Candida species caused 35% of cases. Bacteria were recovered concomitantly from 12% of cases, underscoring the need for biopsy and/or culture. Candida septic arthritis occurred concomitantly in 21%. Combined surgery and antifungal therapy were used in 48% of cases. The overall complete response rate of Candida osteomyelitis of 32% reflects the difficulty in treating this infection. Relapsed infection, possibly related to inadequate duration of therapy, occurred among 32% who ultimately achieved complete response. CONCLUSIONS Candida osteomyelitis is being reported with increasing frequency. Localizing symptoms are usually present. Vertebrae are the most common sites in adults vs femora in children. Timely diagnosis of Candida osteomyelitis with extended courses of 6-12 months of antifungal therapy, and surgical intervention, when indicated, may improve outcome.
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Affiliation(s)
- Maria N Gamaletsou
- Division of Infectious Diseases, Weill Cornell Medical Center of Cornell University, New York, NY 10065, USA
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Bilateral polymicrobial osteomyelitis with Candida tropicalis and Candida krusei: a case report and an updated literature review. Int J Infect Dis 2012; 16:e16-22. [DOI: 10.1016/j.ijid.2011.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 06/20/2011] [Accepted: 10/03/2011] [Indexed: 11/21/2022] Open
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Orthopaedic device associated Candidal infection – A retrospective review of patient characteristics and outcome. J Infect 2011; 63:167-71. [DOI: 10.1016/j.jinf.2011.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 05/28/2011] [Indexed: 11/21/2022]
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Dowd SE, Delton Hanson J, Rees E, Wolcott RD, Zischau AM, Sun Y, White J, Smith DM, Kennedy J, Jones CE. Survey of fungi and yeast in polymicrobial infections in chronic wounds. J Wound Care 2011; 20:40-7. [PMID: 21278640 DOI: 10.12968/jowc.2011.20.1.40] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To assess the incidence, abundance and species diversity of fungi in chronic wounds, as well as to describe the associations of major fungi populations. METHOD Comprehensive molecular diagnostic reports were evaluated from a total of 915 chronic wounds in a retrospective study. RESULTS Of the 915 clinical specimens, 208 (23%) were positive for fungal species. These samples were further compared in a compiled dataset, and sub-classified among the four major chronic wound types (decubitus ulcer, diabetic foot ulcer, non-healing surgical wound, and venous leg ulcer). The most abundant fungi were yeasts in the genus Candida; however, Curvularia, Malessezia, Aureobasidium, Cladosporium, Ulocladium, Engodontium and Trichtophyton were also found to be prevalent components of these polymicrobial infections. A notable bacterial/fungal negative correlation was found to be apparent between Staphylococcus and Candida. There were also significant relationships between both bacterial and fungal genera and patient metadata including gender, diabetes status and cardiovascular comorbidities. CONCLUSION This microbial survey shows that fungi are more important wound pathogens and opportunistic pathogens than previously reported, exemplifying the impact of these under-reported pathogens. With the application of modern cost-effective and comprehensive molecular diagnostics, clinicians can now identify and address this significant component of chronic wound bioburden with targeted therapies, thereby improving healing trajectories.
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Affiliation(s)
- S E Dowd
- Research and testing Laboratory, Lubbock, TX, USA.
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Spectrum and prevalence of fungi infecting deep tissues of lower-limb wounds in patients with type 2 diabetes. J Clin Microbiol 2010; 48:2097-102. [PMID: 20410345 DOI: 10.1128/jcm.02035-09] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The prevalence rate and spectrum of fungi infecting deep tissues of diabetic lower-limb wounds (DLWs) have not been previously studied. Five hundred eighteen (382 male and 136 female) consecutive patients with type 2 diabetes hospitalized due to infected lower-limb wounds were enlisted in this study. Deep tissue (approximately 0.5- x 0.5-cm size) taken perioperatively from the wound bed was cultured for fungi. Fungi was found in 27.2% (141/518) of the study population. Candida parapsilosis (25.5%), Candida tropicalis (22.7%), Trichosporon asahii (12.8%), Candida albicans (10.6%), and Aspergillus species (5.0%) were the most predominant fungal isolates. Of the fungal isolates, 17.7% were resistant to itraconazole, 6.9% were resistant to amphotericin B, 6.9% were resistant to voriconazole, 3.9% were resistant to fluconazole, and 1.5% were resistant to flucytosine. Of the population, 79.7% (413/518) had bacterial infection in deep tissue. The predominant isolates were Enterococcus faecalis (14.1%), Staphylococcus aureus (12.2%), and Pseudomonas aeruginosa (10.8%). Mixed fungal and bacterial infections were seen in 21.4% of patients, while 5.8% had only fungal infection and 58.3% had only bacterial infections. Another 14.5% had neither bacteria nor fungi in the deep tissue. Patients with higher glycosylated hemoglobin levels had significantly more fungal infections. Our study reveals that deep-seated fungal infections are high in DLWs. In the context of delayed wound healing and amputation rates due to DLWs, it is important to study the pathogenicity of fungi in deep tissues of DLWs and their possible contribution to delayed wound healing. The role of antifungal agents in wound management needs to be evaluated further.
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Yener S, Topcu A, Manisali M, Comlekci A, Yesil S. Candida albicans osteomyelitis in a diabetic foot ulcer. J Diabetes Complications 2009; 23:137-8. [PMID: 18413156 DOI: 10.1016/j.jdiacomp.2007.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Revised: 08/31/2007] [Accepted: 10/23/2007] [Indexed: 11/21/2022]
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Taj-Aldeen SJ, Gene J, Al Bozom I, Buzina W, Cano JF, Guarro J. Gangrenous necrosis of the diabetic foot caused byFusarium acutatum. Med Mycol 2006; 44:547-52. [PMID: 16966172 DOI: 10.1080/13693780500543246] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Foot infections are common and serious complications of diabetic patients. We report the case of a 68-year-old patient with a diabetic foot infection that developed into a gangrenous necrosis. Fusarium spp. was isolated on two successive occasions with no other associated microorganisms. Histopathology demonstrated invasion of the fungus into the tisssue. These findings suggested an infection rather than colonization. A detailed morphological study showed that the isolate was Fusarium acutatum, which was confirmed by rDNA sequencing. This fungus is found only in Asia and has not been previously reported as a human pathogen.
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Affiliation(s)
- Saad J Taj-Aldeen
- Microbiology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar.
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Mlinaric Missoni E, Vukelic M, de Soy D, Belicza M, Vazic Babic V, Missoni E. Fungal infection in diabetic foot ulcers. Diabet Med 2005; 22:1124-5. [PMID: 16026387 DOI: 10.1111/j.1464-5491.2005.01611.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Missoni EM, Rade D, Nederal S, Kalenic S, Kern J, Babic VV. Differentiation between Candida species isolated from diabetic foot by fatty acid methyl ester analysis using gas chromatography. J Chromatogr B Analyt Technol Biomed Life Sci 2005; 822:118-23. [PMID: 15993665 DOI: 10.1016/j.jchromb.2005.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Revised: 05/06/2005] [Accepted: 06/01/2005] [Indexed: 11/29/2022]
Abstract
Gas chromatography (GC) was used to differentiate 100 isolates of Candida species (Candida parapsilosis, Candida albicans, Candida tropicalis, Candida famata and Candida glabrata) from 22 of 509 diabetic patients in whom the same species had been isolated from ulcer and interdigital spaces of the same and/or the other foot. All clinical isolates were identified by quantitative differences in the composition of six cell fatty acids (CFA). The values of the coefficients of variability (CV) of CFA show that the isolates from foot ulcers and interdigital spaces of the same diabetic patient probably belong to different chemotypes of the same Candida species.
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Affiliation(s)
- Emilija Mlinaric Missoni
- Clinical Mycology Department, Croatian National Institute of Public Health, Rockefellerova 2, Croatia.
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Arias F, Mata-Essayag S, Landaeta ME, Capriles CHD, Pérez C, Núñez MJ, Carvajal A, Silva M. Candida albicans osteomyelitis: case report and literature review. Int J Infect Dis 2004; 8:307-14. [PMID: 15325600 DOI: 10.1016/j.ijid.2003.12.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2003] [Revised: 10/11/2003] [Accepted: 12/28/2003] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Osteomyelitis due to Candida species is an unusual but recognized entity. However, with the increasing occurrence of factors predisposing to candidemia and invasive candidiasis, candidal osteomyelitis is being diagnosed more frequently. An unusual case of Candida albicans osteomyelitis is reported here, along with a review of the published literature on previously reported cases of this disease. METHODS Report of the case and literature review. RESULTS In this case, Candida albicans was isolated from the talus; however, the diagnosis was made after several cultures were performed. Only one other case of Candida osteomyelitis located in foot bones was found in the review. CONCLUSIONS It is thought that this is the first case reported in Venezuela, and only the second in international literature.
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Affiliation(s)
- Félix Arias
- Servicio de Enfermedades Infecciosas del Adulto, Hospital Universitario de Caracas, Venezuela
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Abstract
Approximately 30% of patients with diabetes mellitus will have disease-related dermatological problems. Dry skin can be associated with autonomic neuropathy and may be fragile, promoting bacterial invasion. Any potentially infected 'diabetic foot' must be taken seriously, and non-painful deep sepsis suspected if there is evidence of sensory loss. Consideration should be given to eliminating nasal carriage of staphylococci if recurrent superficial sepsis occurs in the presence of poor diabetic control. Fungal infections, both of skin and nails, are common but usually not serious in the absence of immunosuppression. Treatment with topical antifungals may need to be combined with systemic therapy for successful eradication. Systemic antifungal therapy should be carefully considered as treatment needs to be prolonged and is potentially toxic, particularly in individuals with diabetes mellitus who often have co-morbidities. Varicose eczema should be treated by physical therapies intended to improve venous return and prevent peripheral edema and tissue injury. Allergic dermatitis is commonly associated with topical treatments and other sensitizers. Many reactions are not apparent from history, and patch testing for sensitivity is recommended. There are several diabetes mellitus-specific conditions that dermatologists must be aware of, including, necrobiosis lipoidica diabeticorum, granuloma annulare, diabetic dermopathy (spotted leg syndrome or shin spots), diabetic bullae (bullosis diabeticorum), and limited joint mobility and waxy skin syndrome. Ulceration, due to varying combinations of peripheral vascular disease and sensory neuropathy, is the province of the specialist team dealing with the diabetic foot and should ideally be referred to an appropriate multidisciplinary team.
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Affiliation(s)
- Mo Aye
- Department of Medicine, University of Hull, Hull, UK
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