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Shantal CJN, Juan CC, Lizbeth BUS, Carlos HGJ, Estela GPB. Candida glabrata is a successful pathogen: an artist manipulating the immune response. Microbiol Res 2022; 260:127038. [DOI: 10.1016/j.micres.2022.127038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 04/02/2022] [Accepted: 04/07/2022] [Indexed: 02/07/2023]
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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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Dewan E, Biswas D, Kakati B, Verma SK, Kotwal A, Oberoi A. Epidemiological and mycological characteristics of candidemia in patients with hematological malignancies attending a tertiary-care center in India. Hematol Oncol Stem Cell Ther 2015; 8:99-105. [PMID: 26173033 DOI: 10.1016/j.hemonc.2015.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 05/21/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We undertook the present study to ascertain the contributing risk factors and explore the epidemiological and mycological characteristics of opportunistic candidemia among patients with hematological malignancies. DESIGN AND SETTINGS Observational cross-sectional study in a tertiary care center. PATIENTS AND METHODS Consecutive patients with hematological malignancies reporting to the collaborating medical and pediatric units with a febrile episode were recruited and screened for candidemia by blood culture. Recovered Candida isolates were speciated and antifungal susceptibility testing was performed as per Clinical and Laboratory Standards Institute guideline (CLSI) guidelines M44-A. Further analysis was done for potential risk factors and compared between culture positive and negative patients. RESULTS Of 150 patients recruited, the majority (n=27) were between 51 and 60 years and the male to female ratio was 1.63:1. Fifteen patients (10%) were culture positive. The culture positivity was significantly higher in acute lymphocytic leukemia (ALL) than in non-ALL patients (p=0.03). There was significant association of candidaemia with leucopenia, chemotherapeutic drugs, corticosteroids and presence of indwelling devices. Duration of disease (p=0.032) and duration of hospitalization (p=0.003) were significantly prolonged in culture positive patients. C. tropicalis was the commonest isolate (46.67%), with non- Candida albicans outnumbering C. albicans in all categories of hematological malignancies (2.75:1). All isolates of C. albicans were uniformly sensitive to all the azoles, but only 50% were sensitive to amphotericin B and none to nystatin and flucytosine. CONCLUSIONS This observational study identifies ALL and chronic lymphocytic leukemia (CLL) as the forms of hematological malignancy predominantly associated with candidemia; specifies risk factors and chemotherapeutic agents predisposing patients towards its occurrence; reports a preponderance of C. tropicalis among the causative agents and finds voriconazole to be the most effective antifungal agent against the recovered isolates. This information could assist in tailoring prophylactic and therapeutic antifungal practices for this infection, according to local epidemiological and mycological characteristics.
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Affiliation(s)
- Eshani Dewan
- Department of Microbiology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India; Department of Microbiology, Christian Medical College and Hospital, Ludhiana, Punjab, India.
| | - Debasis Biswas
- Department of Microbiology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India; Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Barnali Kakati
- Department of Microbiology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - S K Verma
- Department of Medicine, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Aarti Kotwal
- Department of Microbiology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Aroma Oberoi
- Department of Microbiology, Christian Medical College and Hospital, Ludhiana, Punjab, India
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Abstract
Although major advances in the care of cancer patients over the past several decades have resulted in improved survival, infectious complications remain a significant cause of morbidity and mortality. To successfully identify, treat, and prevent infections, a comprehensive understanding of risk factors that predispose to infection and of commonly encountered pathogens is necessary. In addition, clinicians must keep abreast of the changing epidemiology of infections in this population. As therapeutic modalities continue to evolve, as established pathogens become increasingly drug resistant, and as new pathogens are discovered, successful management of infections will continue to present challenges in the years to come.
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Affiliation(s)
- Valentina Stosor
- Div. Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois USA
| | - Teresa R. Zembower
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois USA
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Kotwal A, Biswas D, Sharma JP, Gupta A, Jindal P. An observational study on the epidemiological and mycological profile of Candidemia in ICU patients. Med Sci Monit 2012; 17:CR663-668. [PMID: 22037747 PMCID: PMC3539502 DOI: 10.12659/msm.882053] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background This study aimed to analyze the epidemiological and mycological profile of candidemia in intensive care unit (ICU) patients attending a tertiary care teaching hospital in the Himalayan region of northern India. Material/Methods A 15-bed medico-surgical ICU and a 5-bed pediatric ICU. Ninety-one consecutively admitted ICU patients were screened for the presence of candidemia by performing blood cultures at periodic intervals. Results The recovered Candida isolates were speciated and subjected to antifungal susceptibility testing using standard procedures. Forty-one of the recruited patients (45%) were found to be candidemic, with the majority of patients being in the extremes of age (13 neonates and 15 >65 years of age). Four risk factors were found to be significantly associated with the occurrence of candidemia in our patients – a period of hospitalization exceeding 7 days (p=0.0008), previous use of antibiotics (p=0.001), presence of chronic renal failure (p=0.003), and ongoing cancer chemotherapy (p= 0.041). Ninety-six Candida isolates were recovered from the 41 culture-positive patients, with Candida albicans being the commonest isolate recovered (n=75, 78.1%), followed by Candida tropicalis (n=15, 16%), and Candida glabrata (n=6, 6.5%). Fluconazole resistance was observed among 26% of all Candida isolates and 17.3% of C. albicans isolates. Conclusions Contrary to the majority of recent reports, species shift towards non-albicans candidemia has not been observed in our center, though the prevalence of azole resistance is alarmingly high even among the C. albicans isolates.
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Affiliation(s)
- Aarti Kotwal
- Department of Microbiology, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Jolly Grant, Dehradun, India
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Odds FC. Epidemiological shifts in opportunistic and nosocomial Candida infections: mycological aspects. Int J Antimicrob Agents 2010; 6:141-4. [PMID: 18611700 DOI: 10.1016/0924-8579(95)00049-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/1995] [Indexed: 11/28/2022]
Abstract
Increases in the prevalence of yeast species other than C. albicans as agents of disseminated mycoses in immunosuppressed patients and of fluconazole-resistant C. albicans isolates from patients infected with HIV indicate changes in the epidemiology of Candida infections. The precise reasons for alterations in prevalence of various agents are difficult to pinpoint but changes in the types of host populations at risk of Candida infection and selection of resistant yeast populations by widescale usage of certain antifungal agents seem to be factors involved in the process. Greater attention to speciation of clinical yeasts and standardized susceptibility test methods are needed for future epidemiological surveillance.
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Affiliation(s)
- F C Odds
- Department of Bacteriology and Mycology, Janssen Research Foundation, B-2340 Beerse, Belgium
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Acute Myelogenous Leukemia and Febrile Neutropenia. MANAGING INFECTIONS IN PATIENTS WITH HEMATOLOGICAL MALIGNANCIES 2009. [PMCID: PMC7121946 DOI: 10.1007/978-1-59745-415-5_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Aggressive chemotherapy has a deleterious effect on all components of the defense system of the human body. The resulting neutropenia as well as injury to the pulmonary and gastrointestinal mucosa allow pathogenic micro-organisms easy access to the body. The symptoms of an incipient infection are usually subtle and limited to unexplained fever due to the absence of granulocytes. This is the reason why prompt administration of antimicrobial agents while waiting for the results of the blood cultures, the so-called empirical approach, became an undisputed standard of care. Gram-negative pathogens remain the principal concern because their virulence accounts for serious morbidity and a high early mortality rate. Three basic intravenous antibiotic regimens have evolved: initial therapy with a single antipseudomonal β-lactam, the so-called monotherapy; a combination of two drugs: a β-lactam with an aminoglycoside, a second β-lactam or a quinolone; and, thirdly, a glycopeptide in addition to β-lactam monotherapy or combination. As there is no single consistently superior empirical regimen, one should consider the local antibiotic susceptibility of bacterial isolates in the selection of the initial antibiotic regimen. Not all febrile neutropenic patients carry the same risk as those with fever only generally respond rapidly, whereas those with a clinically or microbiologically documented infection show a much slower reaction and less favorable response rate. Once an empirical antibiotic therapy has been started, the patient must be monitored continuously for nonresponse, emergence of secondary infections, adverse effects, and the development of drug-resistant organisms. The averageduration of fever in serious infections in eventually successfully treated neutropenic patients is 4–5 days. Adaptations of an antibiotic regimen in a patient who is clearly not responding is relatively straightforward when a micro-organism has been isolated; the results of the cultures, supplemented by susceptibility testing, will assist in selecting the proper antibiotics. The management of febrile patients with pulmonary infiltrates is complex. Bronchoscopy and a high resolution computer-assisted tomographic scan represent the cornerstones of all diagnostic procedures, supplemented by serological tests for relevant viral pathogens and for aspergillosis. Fungi have been found to be responsible for two thirds of all superinfections that may surface during broad-spectrum antibiotic treatment of neutropenic patients. Antibiotic treatment is usually continued for a minimum of 7 days or until culture results indicate that the causative organism has been eradicated and the patient is free of major signs and symptoms. If a persistently neutropenic patient has no complaints and displays no evidence of infection, early watchful cessation of antibiotic therapy or a change to the oral regimen should be considered.
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Worth LJ, Slavin MA. Bloodstream infections in haematology: risks and new challenges for prevention. Blood Rev 2008; 23:113-22. [PMID: 19046796 DOI: 10.1016/j.blre.2008.10.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Bloodstream infections are an important cause of morbidity and mortality in the haematology population, and may contribute to delayed administration of chemotherapy, increased length of hospitalisation, and increased healthcare expenditure. For gram-positive, gram-negative, anaerobic and fungal infections, specific risk factors are recognised. Unique host and environmental factors contributing to pathogenesis are acknowledged in this population. Trends in spectrum and antimicrobial susceptibility of pathogens are examined, and potential contributing factors are discussed. These include the widespread use of empiric antimicrobial therapy, increasingly intensive chemotherapeutic regimens, frequent use of central venous catheters, and local infection control practices. In addition, the risks and benefits of prophylaxis, and spectrum of endemic flora are identified as relevant factors within individual centres. Finally, challenges are presented regarding prevention, early detection, surveillance and prophylaxis. To reduce the rate and impact of bloodstream infections multifaceted and customised strategies are required within individual haematology units.
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Affiliation(s)
- Leon J Worth
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victoria, Australia.
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Infection in the Hematopoietic Stem Cell Transplant Recipient. HEMATOPOIETIC STEM CELL TRANSPLANTATION 2008. [PMCID: PMC7120030 DOI: 10.1007/978-1-59745-438-4_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Agirbasli H, Otlu B, Bilgen H, Durmaz R, Gedikoglu G. Epidemiological characteristics of fatal Candida krusei fungemia in immunocompromised febrile neutropenic children. Infection 2007; 36:88-91. [PMID: 18084719 DOI: 10.1007/s15010-007-6246-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Accepted: 08/07/2007] [Indexed: 10/22/2022]
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Perlroth J, Choi B, Spellberg B. Nosocomial fungal infections: epidemiology, diagnosis, and treatment. Med Mycol 2007; 45:321-46. [PMID: 17510856 DOI: 10.1080/13693780701218689] [Citation(s) in RCA: 478] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Invasive fungal infections are increasingly common in the nosocomial setting. Furthermore, because risk factors for these infections continue to increase in frequency, it is likely that nosocomial fungal infections will continue to increase in frequency in the coming decades. The predominant nosocomial fungal pathogens include Candida spp., Aspergillus spp., Mucorales, Fusarium spp., and other molds, including Scedosporium spp. These infections are difficult to diagnose and cause high morbidity and mortality despite antifungal therapy. Early initiation of effective antifungal therapy and reversal of underlying host defects remain the cornerstones of treatment for nosocomial fungal infections. In recent years, new antifungal agents have become available, resulting in a change in standard of care for many of these infections. Nevertheless, the mortality of nosocomial fungal infections remains high, and new therapeutic and preventative strategies are needed.
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Affiliation(s)
- Joshua Perlroth
- Division of Infectious Diseases, Harbor-University of California Los Angeles (UCLA) Medical Center, California 90502, USA
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Jacobsen MD, Gow NAR, Maiden MCJ, Shaw DJ, Odds FC. Strain typing and determination of population structure of Candida krusei by multilocus sequence typing. J Clin Microbiol 2006; 45:317-23. [PMID: 17122025 PMCID: PMC1829042 DOI: 10.1128/jcm.01549-06] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A multilocus sequence typing (MLST) scheme for Candida krusei was devised, based on sequencing of six gene fragments of the species. The existence of heterozygous results for each of the six fragments sequenced confirms that C. krusei is diploid for at least part of its genome. The C. krusei MLST scheme had a discriminatory index of 0.998, making this system ideal for strain typing of C. krusei clinical isolates. MLST data for 122 independent C. krusei isolates from a range of geographical sources were analyzed by eBURST, structure, and the unweighted-pair group method using average linkages to derive a population structure comprising four subtype strain clusters. There was no evidence of geographical associations with particular subtypes. Data for pairs of isolates from seven patients showed that each patient was colonized and/or infected with strain types that were indistinguishable by MLST. The C. krusei MLST database can be accessed online at http://pubmlst.org/ckrusei/.
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Affiliation(s)
- Mette D Jacobsen
- Institute of Medical Sciences, University of Aberdeen, Aberdeen AB25 2ZD, United Kingdom
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Hsiao HH, Tsai HJ, Liu YC, Tseng YT, Lu PL, Yang WC, Liu TC, Lin SF. Invasive Fungal Infections in Patients with Acute Leukemia. Kaohsiung J Med Sci 2006; 22:217-22. [PMID: 16793556 DOI: 10.1016/s1607-551x(09)70239-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Invasive fungal infections, a serious problem among cancer patients, are increasing in incidence, and can cause morbidity and mortality. Such infections may hinder additional treatment, especially for patients with leukemia. We report here our experiences in the management of invasive fungal infection in patients with acute leukemia. A total of 18 patients were enrolled in the study: 12 had microabscesses of the liver and/or spleen and/or kidneys; four had sinonasal infections; and two had pulmonary infections. Most of the patients (88.9%) received amphotericin B during treatment for fungal infection. Thirteen patients achieved complete response without evidence of fungal infection in follow-up. In the study, there were 11 mortalities, including five patients who died during therapy and six who later died as a result of relapse or refractoriness of the leukemia. We suggest that many patients may have a good response to antifungal therapy, and that fungal infection does not have to preclude additional chemotherapy after proper management. The state of the underlying disease has a strong impact on outcome.
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Affiliation(s)
- Hui-Hua Hsiao
- Division of Hematology-Oncology, Kaohsiung Medical University Chun-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Arancia S, Carattoli A, La Valle R, Cassone A, De Bernardis F. Use of 65 kDa mannoprotein gene primers in Real Time PCR identification of Candida albicans in biological samples. Mol Cell Probes 2006; 20:263-8. [PMID: 16616453 DOI: 10.1016/j.mcp.2006.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2005] [Accepted: 01/31/2006] [Indexed: 10/25/2022]
Abstract
A method for the detection and quantification of Candida albicans in biological samples (blood, urine and serum) was developed with the use of Real-Time PCR utilizing CaMP65-specific primers. Two different systems were used for the detection in the LightCycler platform (Roche): the SYBR green fluorescent dye with melting peak analysis and the 5'nuclease fluorescent-probe detection. The amplification was highly specific for C. albicans, providing no cross-reaction on genomic DNA extracted from other Candida species or Aspergillus. The sensitivity in simulated biological samples was especially high (1 genome) when applied to sera and urine, and in blood samples the limit of detection was higher by ten-fold. Finally, the real-time PCR was employed in order to detect and quantify C. albicans in the sera from patients with invasive candidiasis.
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Affiliation(s)
- Silvia Arancia
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
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Ribeiro P, Costa F, Monteiro A, Caldas J, Silva M, Ferreira G, Veiga J, Sousa MO, Viegas MP, Santos E, Gonçalves AJ, Sousa AB. Polymerase chain reaction screening for fungemia and/or invasive fungal infections in patients with hematologic malignancies. Support Care Cancer 2006; 14:469-74. [PMID: 16435098 DOI: 10.1007/s00520-005-0903-7] [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] [Received: 08/04/2005] [Accepted: 10/20/2005] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Invasive fungal infections (IFIs) are a life-threatening complication in patients with hematologic malignancies, mainly in acute leukemia patients, following chemotherapy. IFI incidence is increasing, and associated mortality remains high due to unreliable diagnosis. Antifungal drugs are often limited by inadequate antimicrobial spectrum and side effects. Thus, the detection of circulating fungal DNA has been advocated as a rapid, more sensitive diagnostic tool. PATIENTS AND METHODS Between June 01 and January 03, weekly blood samples (1,311) were screened from 193 patients undergoing intensive myelosuppressive or immunosuppressive therapy. IFI cases were classified according to European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. Fungal DNA was extracted from whole blood and amplified using polymerase chain reaction (PCR) published primers that bind to the conserved regions of the fungal 18S rRNA gene sequence. In our study, two or more consecutive positive samples were always associated with fungal disease. RESULTS PCR screening predicted the development of IFI to be 17 days (median). This test had a specificity of 91.1% and a sensitivity of 75%. IFI incidence was 7.8%. DISCUSSION Therefore, our results confirm the potential usefulness of PCR serial screening and the clinical applicability in everyday routine. PCR screening offers a noninvasive repeatable aid to the diagnosis of IFI.
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Affiliation(s)
- Patrícia Ribeiro
- Department of Hematology, Hospital dos Capuchos, Lisbon, Portugal.
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Abelson JA, Moore T, Bruckner D, Deville J, Nielsen K. Frequency of fungemia in hospitalized pediatric inpatients over 11 years at a tertiary care institution. Pediatrics 2005; 116:61-7. [PMID: 15995032 DOI: 10.1542/peds.2004-1605] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine the frequency of bloodstream fungal infections in children who were admitted to our tertiary institution over an 11-year period. METHODS We conducted a retrospective cohort study of patients who were aged 0 to 21 years, had bloodstream fungal infections, and were admitted to the University of California, Los Angeles from 1991 through 2001. Patients were identified through the microbiology laboratory database. All positive fungal cultures for pediatric inpatients were reviewed. For each fungemic patient, a review of clinical course, cause, and outcome was performed. RESULTS Over 11 years, 1124 pediatric inpatients with 3633 positive cultures had evidence of fungal colonization or infection. The mean incidence of positive fungal cultures increased from 105 between 1991 and 1996 to 129 patients per year between 1997 and 2001. Fungal isolates were mainly Candida species (85%) obtained primarily from respiratory (41%) and urine (27%) cultures. Only 7.5% of positive fungal cultures were from blood, although 24490 pediatric admissions prompted 72960 bacterial and fungal blood cultures, at charges of 2.52 million dollars. Of 14592 fungal blood cultures, <2% (n = 272) were positive, involving <1% (n = 97) of patients. The mean rise in number of children with fungemia was significant, from 6.8 between 1991 and 1996 to 13.0 patients per year between 1997 and 2001. Fungemia was associated with a high all-cause mortality rate (46%), particularly in immunocompromised patients (57%). Organisms recovered were primarily Candida species (91%). There was a decline in C albicans and C glabrata fungemia and an increase in C parapsilosis organisms. In 84% of patients, fungal organisms were isolated from both bacterial and fungal blood cultures, and in 74%, the same organism was isolated from additional body sites. CONCLUSIONS Episodes of fungemia increased significantly over 11 years as compared with a moderate increase in positive fungal cultures and were associated with high all-cause mortality rates. More sensitive assays for early identification of fungal bloodstream infections are warranted.
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Abstract
The development of a useful Candida vaccine is a distinct possibility despite the fact that individuals with a lifetime of commensal sensitization do not develop sterile immunity to the organism. An effective Candida vaccine would be invaluable in preventing hematogenously disseminated candidiasis, as well as mucocutaneous disease. This review is a discussion of our current understanding of the interplay between commensal and pathogenic forms of Candida albicans and approaches toward active and passive immunoprevention against candidiasis.
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Affiliation(s)
- A Brian Mochon
- Department of Microbiology and Immunology, Tulane University Health Sciences Center, New Orleans, Louisiana, USA.
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Arancia S, Sandini S, Cassone A, De Bernardis F, La Valle R. Construction and use of PCR primers from a 65 kDa mannoprotein gene for identification of C. albicans. Mol Cell Probes 2004; 18:171-5. [PMID: 15135451 DOI: 10.1016/j.mcp.2003.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2003] [Accepted: 11/24/2003] [Indexed: 10/26/2022]
Abstract
A method for detection of Candida albicans in biological samples (blood, serum, urine) was developed by the use of polymerase chain reaction (PCR) amplification of a DNA fragment of a gene coding for a 65 kDa mannoprotein of C. albicans (CaMP65). The PCR amplifies a 220 bp fragments whose specificity for C. albicans was demonstrated by Southern blot with a non-radioactive probe, leading to the differentiation from all other yeast species or human and bacterial DNA. The sensitivity of this assay was 5-10 C. albicans cells per milliliter of biological sample.
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Affiliation(s)
- S Arancia
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy.
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Ibàñez-Nolla J, Nolla-Salas M, León MA, García F, Marrugat J, Soria G, Díaz RM, Torres-Rodríguez JM. Early diagnosis of candidiasis in non-neutropenic critically ill patients. J Infect 2004; 48:181-92. [PMID: 14720495 DOI: 10.1016/s0163-4453(03)00120-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine a method for the early diagnosis of candidiasis in non-neutropenic critically ill patients in order to reduce mortality. METHODS A prospective study in non-neutropenic critically patients in whom Candida spp. were detected, was made in an intensive care unit (ICU) during an 8-year period from 3389 patients admitted. A diagnostic and therapeutic protocol was designed. Invasive candidiasis was defined according to dissemination and multifocality. RESULTS Candida spp. were found in 145 cases (4.3%): 120 (83%) were considered as invasive candidiasis and 25 as colonisation (17%). The hospital mortality was 46% (67/145). A post-mortem study was carried out in 54% (36/67) of hospital deaths. Candida albicans was the most frequently isolated species (87%), followed by Candida glabrata (18%). There were 24 candidemias and three cases of endophtalmitis. Digestive and respiratory samples and non-C. albicans yeasts were risk factors for invasive candidiasis. The mortality rate was related statistically to invasive candidiasis and inversely to the appropriate antifungal treatment. CONCLUSIONS Invasive candidiasis is related to digestive and respiratory samples and to the presence of non-C. albicans species. A simpler definition of invasive candidiasis in non-neutropenic critically ill patients will permit more rapid and accurate specific antifungal therapy.
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Affiliation(s)
- J Ibàñez-Nolla
- Intensive Care Unit, Hospital General de Catalunya, C/Gomera s/n, Sant Cugat del Vallés, Barcelona 08190, Spain.
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Hourez R, Gillard PH, Mariat P, Aoun M. Disseminated fungemia due to Candida krusei with cutaneous lesions and successful treatment by amphotericin B lipid complex and catheter removal: a case report. Int J Infect Dis 2002; 6:326-8. [PMID: 12725216 DOI: 10.1016/s1201-9712(02)90172-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Biasoli MS, Tosello ME, Magaró HM. Adherence of Candida strains isolated from the human gastrointestinal tract. Mycoses 2002; 45:465-9. [PMID: 12472722 DOI: 10.1046/j.1439-0507.2002.00793.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The adherence of different Candida strains isolated from the human gastrointestinal tract was studied. The 23 Candida strains isolated from faeces were C. albicans (12), C. glabrata (2), C. krusei (2), C. parapsilosis (2), C. tropicalis (2), C. colliculosa (1), C. kefyr (1) and C. lusitaniae (1). Buccal epithelial cells from different healthy donors were used. Adherence values were maximal for C. albicans and minimal for C. krusei. A relation exists between yeast adherence capacity and the ability to colonize mucosal surfaces.
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Affiliation(s)
- M Susana Biasoli
- CEREMIC (Centro de Referencia de Micología), and Area Parasitología, Dpto. de Microbiología, Facultad de Ciencias, Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Suipacha, Rosario, Argentina
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24
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Abstract
Demographic information, risk factors, therapy, and outcome for all patients who had candidemia at King Fahad teaching hospital Al-khobar, between January 1995 and January 2000 were retrospectively reviewed. Thirty-two candidemic patients were identified. Candida parapsilosis was the most frequently isolated species (44%), followed by Candida tropicalis (25%), Candida albicans (19%), Candida krusei (6%), Candida glabrata (3%), and Candida guilliermondi (3%). Risk factors included recent broad-spectrum antibiotics use (100%), ICU residency (71%), central venous catheters (66%), recent surgery (56%), total parenteral nutrition (43%), and immunosuppressive therapy (31%). Fluconazole was used before the onset of candidemia in only two patients. The overall mortality rate was 44%. Eight (25%) episodes of candidemia were not diagnosed and treated before the patient's demise. In view of the high mortality rate associated with hematogenous candidiasis, and lack of sensitive and specific laboratory tests necessary for the premortem diagnosis of infection, empirical antifungal therapy is recommended for high-risk patients.
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Affiliation(s)
- H A Bukharie
- King Fahad Hospital of the University Al-khobar, Saudi Arabia.
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25
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Garbino J, Kolarova L, Rohner P, Lew D, Pichna P, Pittet D. Secular trends of candidemia over 12 years in adult patients at a tertiary care hospital. Medicine (Baltimore) 2002; 81:425-33. [PMID: 12441899 DOI: 10.1097/00005792-200211000-00003] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The incidence of fungal infections has been increasing for the last 3 decades, especially among neutropenic, cancer, and critically ill patients. These infections are associated with high mortality rates. We retrospectively reviewed medical charts of adult patients with fungemia from 1989 to 2000 at our institution. The characteristics of the population groups served by the hospital were described. Of 328 patients with fungemia, we reviewed 315 (96%) medical records, and focused on those with candidemia (n = 294). The species distribution in patients with candidemia showed that the most commonly identified species were Candida albicans (66%), followed by C. glabrata (17%), and C. parapsilosis (6%). The incidence of candidemia ranged from 0.2 to 0.46 per 10,000 patient-days with the highest incidence in 1993 and the lowest in 1997. Although most studies show an increased incidence of candidemia, we observed a reduction over the study period. Furthermore, we observed no shift from C. albicans to non-albicans Candida species despite a significant increase in the use of fluconazole. The overall mortality among patients with candidemia was 44%, with the highest rate in patients over 65 years (52%). Factors independently associated with higher mortality were patient age greater than 65 years, intensive care unit admission, and underlying cancer.
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Affiliation(s)
- Jorge Garbino
- Department of Internal Medicine, University of Geneva Hospital, Switzerland
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26
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Sandini S, Melchionna R, Bromuro C, La Valle R. Gene expression of 70 kDa heat shock protein of Candida albicans: transcriptional activation and response to heat shock. Med Mycol 2002; 40:471-8. [PMID: 12462526 DOI: 10.1080/mmy.40.5.471.478] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
CaHSP70 (70 kDa heat shock protein) is a highly immunogenic protein of Candida albicans. We have studied heat shock-induced expression of the CaHSP70 gene under germ tube-inductive and non-inductive conditions. The CaHSP70 upstream regulatory region was cloned and sequenced. It contains at least three heat shock elements (HSEs), specific DNA sequences that are bound by the heat shock transcription factor (HSF), and one stress response element (STRE), which is an upstream activator sequence (UAS) that causes transcription activation under stress. The binding of HSF to HSE in the CaHSP70 promoter region is constitutive, although the mobility of protein/DNA complexes is altered after heat shock. The CaHSP70 promoter was cloned into a lacZ reporter plasmid, and was able to respond to heat shock in C. albicans as well as in Saccharomyces cerevisiae.
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Affiliation(s)
- S Sandini
- Laboratory of Bacteriology and Medical Mycology, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy
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27
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Masiá Canuto M, Gutiérrez Rodero F. Antifungal drug resistance to azoles and polyenes. THE LANCET. INFECTIOUS DISEASES 2002; 2:550-63. [PMID: 12206971 DOI: 10.1016/s1473-3099(02)00371-7] [Citation(s) in RCA: 217] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is an increased awareness of the morbidity and mortality associated with fungal infections caused by resistant fungi in various groups of patients. Epidemiological studies have identified risk factors associated with antifungal drug resistance. Selection pressure due to the continuous exposure to azoles seems to have an essential role in developing resistance to fluconazole in Candida species. Haematological malignancies, especially acute leukaemia with severe and prolonged neutropenia, seem to be the main risk factors for acquiring deep-seated mycosis caused by resistant filamentous fungi, such us Fusarium species, Scedosporium prolificans, and Aspergillus terreus. The still unacceptably high mortality rate associated with some resistant mycosis indicates that alternatives to existing therapeutic options are needed. Potential measures to overcome antifungal resistance ranges from the development of new drugs with better antifungal activity to improving current therapeutic strategies with the present antifungal agents. Among the new antifungal drugs, inhibitors of beta glucan synthesis and second-generation azole and triazole derivatives have characteristics that render them potentially suitable agents against some resistant fungi. Other strategies including the use of high doses of lipid formulations of amphotericin B, combination therapy, and adjunctive immune therapy with cytokines are under investigation. In addition, antifungal control programmes to prevent extensive and inappropriate use of antifungals may be needed.
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Affiliation(s)
- Mar Masiá Canuto
- Infectious Diseases Unit, Elche University General Hospital, Alicante, Spain
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28
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Donowitz GR, Maki DG, Crnich CJ, Pappas PG, Rolston KV. Infections in the neutropenic patient--new views of an old problem. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2002:113-39. [PMID: 11722981 DOI: 10.1182/asheducation-2001.1.113] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Infection in the neutropenic patient has remained a major clinical challenge for over three decades. While diagnostic and therapeutic interventions have improved greatly during this period, increases in the number of patients with neutropenia, changes in the etiologic agents involved, and growing antibiotic resistance have continued to be problematic. The evolving etiology of infections in this patient population is reviewed by Dr. Donowitz. Presently accepted antibiotic regimens and practices are discussed, along with ongoing controversies. In Section II, Drs. Maki and Crnich discuss line-related infection, which is a major infectious source in the neutropenic. Defining true line-related bloodstream infection remains a challenge despite the fact that various methods to do so exist. Means of prevention of line related infection, diagnosis, and therapy are reviewed. Fungal infection continues to perplex the infectious disease clinician and hematologist/oncologist. Diagnosis is difficult, and many fungal infections will lead to increased mortality even with rapid diagnosis and therapy. In Section III, Dr. Pappas reviews the major fungal etiologies of infection in the neutropenic patient and the new anti-fungals that are available to treat them. Finally, Dr. Rolston reviews the possibility of outpatient management of neutropenic fever. Recognizing that neutropenics represent a heterogeneous group of patients, identification of who can be treated as an outpatient and with what antibiotics are discussed.
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Affiliation(s)
- G R Donowitz
- University of Virginia Health System, Charlottesville 22908-1343, USA
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29
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Stradomska TJ, Mielniczuk Z. Gas chromatographic determination of D-/L-arabinitol ratio in healthy Polish children. J Chromatogr B Analyt Technol Biomed Life Sci 2002; 773:175-81. [PMID: 12031844 DOI: 10.1016/s1570-0232(02)00180-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The D-/L-arabinitol enantiomers ratio (a marker of disseminated candidiasis of Candida species) in urine was determined by gas chromatography (GC) in 198 healthy Polish children ranging in age from 0 to 18 years. The urine samples were dry and trifluoroacetic anhydride (TFAA)-treated. Enantiomers derivatives were separated on a chiral column (beta-Dex 120, 60 m x 0.25 mm I.D.). A glass "solid-phase" injector and electron capture detector (ECD) were used. The ECD response was linear with correlation coefficients 0.999. The limit of detection was 0.02 micromol/l. Good results in terms of reproducibility, accuracy (RSD<10%, bias<6%), and linearity were obtained from real urine samples containing up to 400 micromol/l D-arabinitol. TFA-arabinitol derivatives in biological samples were stable from 1 to 5 days (depending on the arabinitol contents), while TFA-arabinitol standard derivatives were stable for 2 weeks. The identity of D- and L-arabinitol were confirmed by GC-MS analysis. The mean D-/L-arabinitol ratios ranged from 2.48 to 1.65 in the examined groups. The D-/L-arabinitol ratio was found to be exponentially regressive with age. A few cases of diagnosis of disseminated candidiasis by the GC method and confirmed by blood culture are described. The described GC method was also used for monitoring antifungal treatment of patients with disseminated candidiasis.
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Affiliation(s)
- Teresa J Stradomska
- Department of Laboratory Diagnostics, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-736 Warsaw, Poland
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30
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Bodey GP, Mardani M, Hanna HA, Boktour M, Abbas J, Girgawy E, Hachem RY, Kontoyiannis DP, Raad II. The epidemiology of Candida glabrata and Candida albicans fungemia in immunocompromised patients with cancer. Am J Med 2002; 112:380-5. [PMID: 11904112 DOI: 10.1016/s0002-9343(01)01130-5] [Citation(s) in RCA: 166] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE Candida glabrata is an increasing cause of candidemia, especially at cancer and bone marrow transplant centers where fluconazole is used for antifungal prophylaxis. This yeast is less susceptible to fluconazole in vitro than is Candida albicans. We compared the characteristics of patients who had C. glabrata and C. albicans candidemia at a large cancer center. SUBJECTS AND METHODS We searched the microbiological laboratory reports and identified 116 cases of C. glabrata candidemia between 1993 and 1999. The 116 cases of C. albicans candidemia that occurred most closely in time (before or after each case of C. glabrata candidemia) served as the control group. Data were collected from patients' medical records. RESULTS When compared with patients who had C. albicans infection, patients with C. glabrata candidemia more often had an underlying hematologic malignancy (68 [59%] vs. 26 [22%], P = 0.0001), had an Acute Physiology and Chronic Health Evaluation (APACHE) II score > or =16 (55 [48%] vs. 28 [25%], P = 0.0002), and received fluconazole prophylaxis (57 [49%] vs. 8 [7%], P = 0.0001). Patients with C. albicans candidemia more often had concomitant infections (101 [87%] vs. 78 [67%], P = 0.0003) and septic thrombophlebitis (11 [10%] vs. 2 [2%], P = 0.01). Among patients treated with antifungal therapy, those with C. albicans candidemia had a significantly greater overall response to therapy (83/104 [80%] vs. 60/97 [62%], P = 0.005) and to primary therapy (74/104 [71%] vs. 45/97 [46%], P = 0.0003). Amphotericin B preparations were not more effective than fluconazole (19/45 [42%] vs. 20/38 [53%], P = 0.5) in patients with C. glabrata candidemia. Fluconazole was less effective against C. glabrata than against C. albicans (20/38 [53%] vs. 57/74 [77%], P = 0.008). CONCLUSION C. glabrata has emerged as an important cause of candidemia, especially among neutropenic patients who receive fluconazole prophylaxis.
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Affiliation(s)
- Gerald P Bodey
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
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31
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Shin JH, Kee SJ, Shin MG, Kim SH, Shin DH, Lee SK, Suh SP, Ryang DW. Biofilm production by isolates of Candida species recovered from nonneutropenic patients: comparison of bloodstream isolates with isolates from other sources. J Clin Microbiol 2002; 40:1244-8. [PMID: 11923339 PMCID: PMC140345 DOI: 10.1128/jcm.40.4.1244-1248.2002] [Citation(s) in RCA: 271] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Biofilm production has been implicated as a potential virulence factor of some Candida species responsible for catheter-related fungemia in patients receiving parenteral nutrition. We therefore compared clinical bloodstream isolates representing seven different Candida species to each other and to those from other anatomical sites for the capacity to form biofilms in glucose-containing medium. Potential associations between the capacity to form biofilms and the clinical characteristics of fungemia were also analyzed. Isolates included the following from nonneutropenic patients: 101 bloodstream isolates (35 C. parapsilosis, 30 C. albicans, 18 C. tropicalis, 8 C. glabrata, and 10 other Candida species isolates) and 259 clinical isolates from other body sites (116 C. albicans, 53 C. glabrata, 43 C. tropicalis, 17 C. parapsilosis, and 30 other Candida species isolates). Organisms were grown in Sabouraud dextrose broth (SDB) containing a final concentration of 8% glucose to induce biofilm formation, as published previously. Biofilm production was determined by both visual and spectrophotometric methods. In this medium, biofilm production by C. albicans isolates was significantly less frequent (8%) than that by non-C. albicans Candida species (61%; P < 0.0001). The overall proportion of non-C. albicans Candida species isolates from the blood that produced biofilms was significantly higher than that of non-C. albicans Candida isolates obtained from other sites (79% versus 52%; P = 0.0001). Bloodstream isolates of C. parapsilosis alone were significantly more likely to be biofilm positive than were C. parapsilosis isolates from other sites (86% versus 47%; P = 0.0032). Non-C. albicans Candida species, including C. parapsilosis, were more likely to be biofilm positive if isolates were derived from patients whose candidemia was central venous catheter (CVC) related (95%; P < 0.0001) and was associated with the use of total parenteral nutrition (TPN) (94%; P < 0.005). These data suggest that the capacity of Candida species isolates to produce biofilms in vitro in glucose-containing SDB may be a reflection of the pathogenic potential of these isolates to cause CVC-related fungemia in patients receiving TPN.
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Affiliation(s)
- Jong Hee Shin
- Department of Clinical Pathology, Chonnam National University Medical School, Gwangju, South Korea.
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32
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Sanglard D, Odds FC. Resistance of Candida species to antifungal agents: molecular mechanisms and clinical consequences. THE LANCET. INFECTIOUS DISEASES 2002; 2:73-85. [PMID: 11901654 DOI: 10.1016/s1473-3099(02)00181-0] [Citation(s) in RCA: 513] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Candida albicans and related species pathogenic for man become resistant to antifungal agents, in particular triazole compounds, by expression of efflux pumps that reduce drug accumulation, alteration of the structure or concentration of antifungal target proteins, and alteration of membrane sterol composition. The clinical consequences of antifungal resistance can be seen in treatment failures in patients and in changes in the prevalences of Candida species causing disease. These effects were seen unequivocally in HIV-infected patients with oropharyngeal candida infections, but their incidence has decreased dramatically with the introduction of highly active antiretroviral therapy. The evidence for similar emergence of antifungal-resistant yeast strains and species in other types of candida infections is confounded by non-standardised susceptibility testing methods and definitions of a resistant fungal isolate. Recent large-scale surveys of yeasts isolated from blood cultures, based on standardised methodology and resistance definitions, do not support the view that antifungal resistance in pathogenic yeasts constitutes a significant or growing therapeutic problem.
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Affiliation(s)
- Dominique Sanglard
- Institute of Microbiology, University Hospital Lausanne, Lausanne, Switzerland
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33
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Gómez J, Baños V, Simarro E, Ruiz J, Requena L, Pérez J, Canteras M, Valdés M. [Nosocomial fungemias in a general hospital. Epidemiology and prognostic factors. Prospective study 1993-1998]. Enferm Infecc Microbiol Clin 2001; 19:304-7. [PMID: 11747788 DOI: 10.1016/s0213-005x(01)72650-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nosocomial fungemias are infections with a high mortality rate. In last years the incidence of these infections has increased probably because of the growing population of immunocompromised patients who undergo aggressive diagnostic and therapeutic techniques. OBJECTIVE To know the epidemiologic characteristics, risk factors, clinical features and prognosis of fungemia. PATIENTS AND METHODS We prospectively evaluated all the patients with proven fungemia in our center during a 5 year-period. After finishing antifungal treatment a minimum follow-up of 1 month was carried out. Fungal isolation and identification were performed by standard tests. RESULTS During the period of study we evaluated 81 patients with an episode of nosocomial fungemia. Global incidence was 0,9 episodes per thousand admitted patients. Candida albicans was the more frequently isolated species (n=53), followed by C. parapsilosis (n=11), C. tropicalis (n=6) and C. glabrata (n=5). Most of the patients had a central intravenous line and were on parenteral nutrition therapy. All of them previously received at least one course of broad-spectrum antibiotics. Overall mortality was 49,6%. A worst prognosis was significantly associated with: age over 65 years, surgical procedures during present admission, leucocytosis, shock, and delay in antifungal treatment. CONCLUSIONS Fungal bloodstream infection incidence is high in our environment. It is associated with a high mortality rate, specially in patients in whom the beginning of antifungal treatment was delayed. A higher clinical suspicion index may improve the poor outcome in these patients.
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Affiliation(s)
- J Gómez
- Infecciosas, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
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34
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Poikonen E, Vuopio-Varkila J, Kaukoranta-Tolvanen SS, Sivonen A, Siren E, Ruutu P. Epidemiological typing of Candida albicans from bloodstream infections by restriction enzyme analysis. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2001; 33:140-4. [PMID: 11233851 DOI: 10.1080/003655401750065553] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Candida albicans blood culture isolates (n = 142) from 130 patients treated in 7 acute care hospitals in Southern Finland between 1986 and 1995 were typed by restriction enzyme analysis (REA) with EcoRI and MspI. REA revealed 118 distinct DNA types: 13 were detected in > 1 patient and 105 DNA types were unique. Patients with identical DNA types were not temporally or geographically clustered. Among 11 patients with more than 1 C. albicans isolate during 1 episode of fungemia the DNA type remained the same, except in 1 patient. These results indicate that REA is a powerful tool for the epidemiological typing of C. albicans infections.
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Affiliation(s)
- E Poikonen
- Helsinki University Hospital, Internal Medicine Clinic, Finland
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35
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García-Ruiz JC, Pontón J. [Invasive fungal infections in patients with hematological malignancies: a clinical approach]. Med Clin (Barc) 2000; 115:305-12. [PMID: 11093887 DOI: 10.1016/s0025-7753(00)71542-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J C García-Ruiz
- Servicio de Hematología. Hospital de Cruces. Baracaldo. Vizcaya.
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36
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Salonen JH, Richardson MD, Gallacher K, Issakainen J, Helenius H, Lehtonen OP, Nikoskelainen J. Fungal colonization of haematological patients receiving cytotoxic chemotherapy: emergence of azole-resistant Saccharomyces cerevisiae. J Hosp Infect 2000; 45:293-301. [PMID: 10973747 DOI: 10.1053/jhin.1999.0718] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fungal colonization during cytotoxic chemotherapy was studied in 42 patients with a recent diagnosis of a haematological malignancy. In total, 2759 surveillance cultures were taken from the nostrils, throat, urine, stool and perineal region. Seven hundred and ninety-six positive surveillance cultures (28.9%) yielded 968 fungal isolates. The rate of fungal colonization did not differ between patients with acute leukaemia, patients with other haematological malignancies and control patients in the same ward at admission (71% vs. 67% vs. 80%). Patients with acute leukaemia were colonized at a significantly lower rate in samples from the throat (32%), urine (10%), stool (45%) and perineum (29%) taken during hospitalization when compared with other haematological patients (respective values 58%, 21%, 67% and 45%; P-values 0.001). This could be attributed to differences in the use of antifungal drugs. Although 21/42 (50%) of our patients had multiple-site fungal colonization at the end of follow-up, only one systemic Candida infection was diagnosed. Extensive use of antifungal treatment may have influenced the low incidence of systemic fungal infections during the follow-up. In addition to Candida species, Malassezia furfur, Geotrichum candidum and Saccharomyces cerevisiae were frequently isolated. The rate of S. cerevisiae isolation increased significantly over time after admission (1%, vs. 18% of isolates, P<0.001), suggesting hospital-acquired transmission. These isolates were highly resistant to azole antifungals (MIC90 128 microg/mL for fluconazole and 16 microg/ml, for itraconazole), and caused persistent multiple site colonization in 12 patients. Extensive use of antifungal agents in a haematological ward may keep the incidence of invasive fungal infections low in spite of heavy fungal colonization. However, there may be a risk of emergence of resistant fungal strains.
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Affiliation(s)
- J H Salonen
- Department of Medicine, Turku University Central Hospital, Finland.
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37
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Mardani M, Hanna HA, Girgawy E, Raad I. Nosocomial Candida guilliermondii fungemia in cancer patients. Infect Control Hosp Epidemiol 2000; 21:336-7. [PMID: 10823569 DOI: 10.1086/501768] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
From 1988 to 1998, we identified nine patients with Candida guilliermondii fungemia. Four of the five patients with nosocomial infection died, while all of the non-nosocomial cases survived, even though one half of them (2/4) did not receive any treatment Nosocomial C guilliermondii fungemia is often associated with poor outcome despite aggressive antifungal therapy.
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Affiliation(s)
- M Mardani
- University of Texas M.D. Anderson Cancer Center, Department of Medical Specialties, Houston 77030, USA
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38
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Costa SF, Marinho I, Araújo EA, Manrique AE, Medeiros EA, Levin AS. Nosocomial fungaemia: a 2-year prospective study. J Hosp Infect 2000; 45:69-72. [PMID: 10917780 DOI: 10.1053/jhin.1999.0670] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Eighty-six consecutive patients with fungaemia were studied during a period of 2 years, 81% had two or more positive blood cultures. Gastrointestinal tract (28%) and haematological diseases (17%) were the most common underlying conditions. The majority of cases had received vancomycin and/or imipenem (87%) and a central venous catheter (78%). Candida albicans (50%) and Candida parapsilosis (17%) were the most frequent isolates. Overall mortality was 41%, and for patients with Candida tropicalis was 71%. There was not significant difference in survival with gender, age and days of treatment with antifungal drugs. Haematological diseases, neutropenia and a higher number of positive blood cultures were associated with poor outcome.
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Affiliation(s)
- S F Costa
- Nosocomial Infection Control Group of Hospital das Clinicas of University of São Paulo, Brazil
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39
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Ivanovska N, Hristova M, Philipov S. IMMUNOSUPPRESSION AND RECOVERY OF DRUG-IMPAIRED HOST RESISTANCE AGAINST CANDIDA ALBICANS INFECTION BY OXOGLAUCINE. Pharmacol Res 2000; 41:99-105. [PMID: 10712834 DOI: 10.1006/phrs.1999.0567] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The immunosuppressive action of aporphinoid alkaloid oxoglaucine was studied in experimental Candida albicans (C. albicans) infection in mice. The alkaloid augmented host resistance to pathogen applied to mice (6-8 weeks of age) at a low dose of 2 mg kg(-1)in 3 days and impaired it at a high dose of 10 mg kg(-1). The suppressive activity observed under the latter schedule correlated with the inhibited proliferative response of splenic cells to mitogens and with decreased popliteal lymph node (PLN) reaction to C. albicans. Treatment of mice with oxoglaucine (at the age of 5 days) at a dose of 5 mg kg(-1)in 3 consecutive days increased the susceptibility to Candida inoculation at the age of 6 weeks. Delayed type hypersensitivity (DTH) response to C. albicans was enhanced after pretreatment of adult mice and was suppressed after administration to newborn mice. Long-time treatment (10 days) with oxoglaucine, cyclophoshamide or prednisolone at a dose of 10 mg kg(-1)increased the rate of mortality of Candida -infected mice. Combined pretreatment of mice with cyclophosphamide or prednisolone (5 days at a dose of 5 mg kg(-1)) followed by oxoglaucine (5 days at a dose of 5 mg kg(-1)), prolonged the survival of infected mice. 2000 Academic Press@p$hr Copyright 2000 Academic Press.
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Affiliation(s)
- N Ivanovska
- Department of Immunology, Institute of Microbiology, Bulgarian Academy of Sciences, 1113
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40
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Linden P, Lee L, Walsh TJ. Retrospective analysis of the dosage of amphotericin B lipid complex for the treatment of invasive fungal infections. Pharmacotherapy 1999; 19:1261-8. [PMID: 10555932 DOI: 10.1592/phco.19.16.1261.30870] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To understand the relationship between dosage and therapeutic response of amphotericin B lipid complex (ABLC) by analyzing underlying diseases, types of infections, and therapeutic outcomes with different dosages as second-line antifungal therapy. DESIGN Retrospective analysis of low-dose (initial dose < or = 3 mg/kg) ABLC from three open-label, clinical, second-line treatment studies. SETTING Centers in the United States (204), Canada (3), Australia (1), Mexico (1), and The Netherlands (1). PATIENTS Five hundred fifty-one patients (5 enrolled twice) with invasive fungal infections, of whom 289 failed and 267 were intolerant to conventional antifungal therapy. INTERVENTIONS Patients were to receive the recommended dosage of ABLC 5 mg/kg/day, with dosage reduction for markedly increased serum creatinine. The duration of treatment was 4 weeks; therapy could be extended if the investigator considered additional treatment necessary. MEASUREMENTS AND MAIN RESULTS Seventy-three patients (13%) received ABLC 3 mg/kg/day (low dosage) instead of the protocol-recommended 5 mg/kg/day Response was 65% and 56%, respectively. Logistic regression analysis revealed that the following patients are most likely to start therapy at the lower dosage: those with candidiasis and other yeast infections, patients with nephrotoxicity due to prior amphotericin B, and those with underlying conditions other than hematologic malignancy. CONCLUSION These results suggest that ABLC 3 mg/kg/day may be effective in treating patients with candidiasis who do not have hematologic malignancy.
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Affiliation(s)
- P Linden
- Division of Critical Care Medicine, University of Pittsburgh Medical Center, Pennsylvania 15213-2582, USA
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41
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Wise GJ, Talluri GS, Marella VK. Fungal infections of the genitourinary system: manifestations, diagnosis, and treatment. Urol Clin North Am 1999; 26:701-18, vii. [PMID: 10584612 DOI: 10.1016/s0094-0143(05)70212-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
There is an increasing pool of immunocompromised patients who are at an increased risk to fungi infections, which now cause 8% of nosocomial infections. Premature infants and elderly, transplant, and HIV patients are prime candidates for invasive fungal infections. The genitourinary system can be a source or target of disseminated fungal infection. Although candidal species are the most frequent pathogen, other species such as aspergila, cryptoccoccus have become major pathogens. "Environmental fungi," which include blastomyces, coccidioides and histoplasma, have become more aggressive in the vulnerable patient.
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Affiliation(s)
- G J Wise
- Division of Urology, Maimonides Medical Center, Brooklyn, New York, USA.
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42
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Groll AH, Petraitis V, Petraitiene R, Field-Ridley A, Calendario M, Bacher J, Piscitelli SC, Walsh TJ. Safety and efficacy of multilamellar liposomal nystatin against disseminated candidiasis in persistently neutropenic rabbits. Antimicrob Agents Chemother 1999; 43:2463-7. [PMID: 10508025 PMCID: PMC89501 DOI: 10.1128/aac.43.10.2463] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The activity of liposomal nystatin (L-Nys) against subacute disseminated candidiasis was investigated in persistently neutropenic rabbits. Antifungal therapy was administered for 10 days starting 24 h after intravenous inoculation of 10(3) blastoconidia of Candida albicans. Responses to treatment were assessed by the quantitative clearance of the organism from blood and tissues. Treatments consisted of L-Nys at dosages of 2 and 4 mg/kg of body weight/day (L-Nys2 and L-Nys4, respectively) amphotericin B deoxycholate at 1 mg/kg/day (D-AmB), and fluconazole at 10 mg/kg/day (Flu). All treatments were given intravenously once daily. Compared to the results for untreated but infected control animals, treatment with L-Nys2, L-Nys4, D-AmB, and Flu resulted in a significant clearance of the residual burden of C. albicans from the kidney, liver, spleen, lung, and brain (P < 0.0001 by analysis of variance). When the proportion of animals infected at at least one of the five tissue sites studied was evaluated, a dose-dependent response to treatment with L-Nys was found (P < 0.05). Compared to D-AmB-treated rabbits, mean serum creatinine and blood urea nitrogen levels at the end of therapy were significantly lower in animals treated with L-Nys2 (P < 0.001) and L-Nys4 (P < 0.001 and P < 0.01, respectively). L-Nys was less nephrotoxic than conventional amphotericin B and had dose-dependent activity comparable to that of amphotericin B for the early treatment of subacute disseminated candidiasis in persistently neutropenic rabbits.
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Affiliation(s)
- A H Groll
- Immunocompromised Host Section, Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
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Pagano L, Antinori A, Ammassari A, Mele L, Nosari A, Melillo L, Martino B, Sanguinetti M, Equitani F, Nobile F, Carotenuto M, Morra E, Morace G, Leone G. Retrospective study of candidemia in patients with hematological malignancies. Clinical features, risk factors and outcome of 76 episodes. Eur J Haematol 1999; 63:77-85. [PMID: 10480286 DOI: 10.1111/j.1600-0609.1999.tb01120.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A retrospective study of 76 episodes of candidemia in 73 patients with underlying hematological malignancy, from 1988 until 1997, has been conducted to evaluate the clinical characteristics and to ascertain the variables related to the onset and the outcome of candidemia. The most frequent malignancy was acute myeloid leukemia (29 episodes). Candidemia developed mainly during aplasia in patients refractory to chemotherapy (42%). In 65 episodes (86%) the patients were neutropenic (ANC <1 x 10(9)/l) before the candidemia diagnosis for a median time of 13 d, and in 53 episodes (70%) at microbiological diagnosis of candidemia ANC was <1 x 10(9)/l. Candida albicans was the most frequently isolated etiologic agent (31 episodes), but C. non-albicans species sustained the majority of candidemia. Seventeen candidemias developed during azoles prophylaxis. One month after the diagnosis of candidemia, 26 patients died. In 19 cases, death was attributable to candidemia. The case-control study demonstrated, at univariate analysis, that the colonization with Candida. spp. (p=0.004), antimycotic prophylaxis (p=0.01), presence of central venous catheter (p=0.01), neutropenia (p=0.002), and the use of glycopeptide (p=0.0001) increased the risk of candidemia. Using multivariate regression analysis only colonization with Candida spp. and the previous therapy with glycopeptide were associated with a significantly increased risk. Acute mortality, expressed by a cumulative probability of survival at 30 d from diagnosis of candidemia, was 0.67 (95% C.I. 0.55-0.77) and was significantly reduced in patients with neutrophils <1 x 10(9)/l when compared to those with neutrophils >1 x 10(9)/l (p at Mantel-Cox=0.029). Overall cumulative probability of survival at 1 yr was 0.38 (95% C.I. 0.27-0.49) and only the treatment with Amfotericin B significantly reduced the risk of death.
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Affiliation(s)
- L Pagano
- Istituto di Semeiotica Medica, Università Cattolica Sacro Cuore, Rome, Italy
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Olicio R, Almeida CA, Seuánez HN. A rapid method for detecting and distinguishing clinically important yeasts by heteroduplex mobility assays (HMAs). Mol Cell Probes 1999; 13:251-5. [PMID: 10441196 DOI: 10.1006/mcpr.1999.0245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Heteroduplex Mobility Assays (HMAs) of 700 bp amplified products of a 17S rDNA region were used to identify and differentiate seven yeast species of clinical importance Candida albicans, Torulopsis (Candida) glabrata, Candida tropicalis, Candida parapsilosis, Candida (Pichia) guilliermondii and Hansenula (Pichia) anomala. Distance of heteroduplex migration (dHE) was found to be negatively correlated to the number of nucleotide differences between amplified DNA sequences.
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Affiliation(s)
- R Olicio
- Genetics Section, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
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45
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De Pauw B. Fungal Infections. Support Care Cancer 1999. [DOI: 10.3109/9780203909799-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ziegelbauer K, Grusdat G, Schade A, Paffhausen W. High throughput assay to detect compounds that enhance the proton permeability of Candida albicans membranes. Biosci Biotechnol Biochem 1999; 63:1246-52. [PMID: 10478452 DOI: 10.1271/bbb.63.1246] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We describe a 96-well microtiter plate format assay to detect changes in proton permeability in membranes of the pathogenic yeast, Candida albicans. Candida albicans cells were incubated with the lipophilic ester of 2',7'-bis-(2-carboxyethyl)-5-(and-6)-carboxyfluorescein (BCECF), a pH-sensitive fluorescein derivative. Inside the cells, BCECF was released and trapped in the vacuole. Compounds that destroyed membrane integrity increased the pH value of the vacuole due to proton leakage into the cytoplasm. This was paralleled by an increase in BCECF fluorescence intensity, which could be quantified. The test assay was validated with amphotericin B, as well as with other membrane-active compounds known to increase membrane permeability. Possible applications and limitations of this assay in the field of antifungal drug discovery are discussed.
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Affiliation(s)
- K Ziegelbauer
- Institute for Antiinfective Research, Bayer AG, Wuppertal, Germany.
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Colović M, Lazarević V, Colović R, Janković G, Suvajdzić N, Bogdanović A, Bila J. Hepatosplenic candidiasis after neutropenic phase of acute leukaemia. Cancer Immunol Immunother 1999; 16:139-42. [PMID: 10456663 DOI: 10.1007/bf02785848] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Hepatosplenic candidiasis following granulocytopenic periods is a relatively recently recognised problem in immunocompromised patients, particularly in those with acute leukaemia. We present three patients in whom diagnosis of hepatosplenic candidiasis was suspected on the basis of ultrasonographic (US), computed tomographic (CT) findings and confirmed by laparoscopy and biopsy of liver lesions. All three patients were successfully treated briefly with amphotericin B, followed by a longer period of fluconazole. In one patient laparotomy and surgical evacuation of abscesses was performed. This condition could be more often recognised by careful follow-up of liver function test, C-reactive protein level, ultrasonography, CT and MRI after recovery from chemotherapy-induced neutropenia.
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MESH Headings
- Adult
- Amphotericin B/therapeutic use
- Antifungal Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Candidiasis/complications
- Candidiasis/diagnosis
- Candidiasis/drug therapy
- Female
- Fluconazole/therapeutic use
- Humans
- Leukemia, Monocytic, Acute/complications
- Leukemia, Monocytic, Acute/drug therapy
- Leukemia, Monocytic, Acute/immunology
- Leukemia, Myeloid, Acute/complications
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/immunology
- Leukemia-Lymphoma, Adult T-Cell/complications
- Leukemia-Lymphoma, Adult T-Cell/drug therapy
- Leukemia-Lymphoma, Adult T-Cell/immunology
- Liver Diseases/complications
- Liver Diseases/diagnosis
- Liver Diseases/drug therapy
- Male
- Middle Aged
- Neutropenia/chemically induced
- Neutropenia/immunology
- Opportunistic Infections/complications
- Opportunistic Infections/diagnosis
- Opportunistic Infections/drug therapy
- Splenic Diseases/complications
- Splenic Diseases/diagnosis
- Splenic Diseases/drug therapy
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Affiliation(s)
- M Colović
- Institute of Hematology, Clinical Center of Sebia, Faculty of Medicine, Belgrade, Yugloslavia
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Morace G, Pagano L, Sanguinetti M, Posteraro B, Mele L, Equitani F, D'Amore G, Leone G, Fadda G. PCR-restriction enzyme analysis for detection of Candida DNA in blood from febrile patients with hematological malignancies. J Clin Microbiol 1999; 37:1871-5. [PMID: 10325339 PMCID: PMC84973 DOI: 10.1128/jcm.37.6.1871-1875.1999] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Blood samples were drawn daily from 72 patients who had hematological malignancies, neutropenia, and fever and who had failed to respond to broad-spectrum antibiotics. Each sample was used for conventional fungal blood cultures and for detection and identification of Candida DNA by a PCR method with subsequent restriction enzyme analysis (REA) recently developed in our laboratory. The PCR method was able to detect five CFU of Candida spp. per ml of blood, and subsequent REA of the amplicons allowed the identification of the Candida species most commonly implicated in cases of candidiasis. Thirty-one patients were PCR-REA positive, and four of these patients were also culture positive. The ultimate diagnosis for 13 of these patients and 1 patient who was PCR-REA negative was disseminated candidiasis (confirmed by clinical data, multiple cultures, histology, autopsy, and/or ultrasonographic evidence of hepatosplenic candidiasis). The molecular method is significantly more sensitive than conventional fungal blood cultures and has a high negative predictive value (97.5%) for the development of disseminated candidiasis in neutropenic patients.
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Affiliation(s)
- G Morace
- Institutes of Microbiologia, Facoltà di Medicina e Chirurgia "A. Gemelli," Università Cattolica del Sacro Cuore, 1-00168 Rome, Italy.
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Gözdaşoĝlu S, Ertem M, Büyükkeçeci Z, Yavuzdemir S, Bengisun S, Ozenci H, Taçyildiz N, Unal E, Yavuz G, Deda G, Aysev D. Fungal colonization and infection in children with acute leukemia and lymphoma during induction therapy. MEDICAL AND PEDIATRIC ONCOLOGY 1999; 32:344-8. [PMID: 10219335 DOI: 10.1002/(sici)1096-911x(199905)32:5<344::aid-mpo6>3.0.co;2-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Fungal infection represents a growing problem in children with hematologic malignancies. During chemotherapy induced neutropenia, colonization with fungi is considered a major risk factor for subsequent fungal infection. The rates and risk factors for mycotic infections in pediatric oncology patients is undetermined, particularly for centers in developing countries. The aim of this study was to evaluate the rates and risk factors of fungal colonization in children with acute leukemia and lymphoma at one of the major pediatric hematology/oncology centers in Turkey. PROCEDURE Fifty-two consecutive children newly diagnosed with acute leukemia and lymphoma during intensive remission induction therapy were evaluated for the occurrence of fungal colonization (defined as at least one positive surveillance culture) and infection. RESULTS Thirty-six of the 52 patients (69.2%) were colonized by Candida albicans which was the only fungus isolated from surveillance cultures. There were three (5.8%) proven systemic fungal infections: two cases of candidemia and one case of brain abscess with Aspergillus spp. isolated from tissue. All patients with fungal colonization were receiving prophylactic or curative antibiotics. No significant association was found between type of disease and fungal colonization, but there was a significant association with neutropenia. CONCLUSIONS Our findings suggest that there is a high rate of fungal colonization in children receiving remission induction therapy for acute leukemia and lymphoma. Limiting the use of antibiotics and instituting antifungal chemoprophylaxis may decrease the rate, while the early initiation of empiric antifungal therapy in patients with fever and suspected mycotic colonization may increase survival in these patients.
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Affiliation(s)
- S Gözdaşoĝlu
- Pediatric Hematology-Oncology Research Center, Ankara University School of Medicine, Dikimevi, Turkey
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