A crossreactivity at the immunoglobulin E level of the cell wall mannoproteins of Candida albicans with other pathogenic Candida and airborne yeast species

Cutaneous yeast microflora in patients with atopic dermatitis

The skin of persons with atopic dermatitis (AD) is very susceptible to cutaneous infection, and some yeast species may also aggravate AD. The total yeast population of an AD patient’s skin and its relation with individual age and body part remains poorly characterized. The aim of this study was to clarify the differences in cutaneous yeast flora by age and body parts of AD patients.

By swabbing affected body parts (hands, legs, face, neck or trunk), 241 samples were collected from patients with AD (132 children and 109 adults), and as controls, 40 samples were taken from healthy individuals (20 children, 20 adults).

In all, 89 (36.9%) of samples were positive; the yeast isolated belonged to three genera: Candida (27.4%), Malassezia (6.6%), and Rhodotorula (2.9%). Cutaneous colonization with yeasts was two-fold higher in the adults than in children (P<0.0001). The distribution of the yeast species was dependent on the body part sampled: Malassezia predominated in the face, neck, and trunk regions (P=0.0047); Candida more frequently colonized hands and legs (P=0.0029).

Our study showed that cutaneous yeast flora and distribution of yeast species depends significantly on the age of the AD patient and the body part affected by atopic dermatitis.

Yeasts in the gut: from commensals to infectious agents

BACKGROUND

Controversy still surrounds the question whether yeasts found in the gut are causally related to disease, constitute a health hazard, or require treatment.

METHODS

The authors present the state of knowledge in this area on the basis of a selective review of articles retrieved by a PubMed search from 2005 onward. The therapeutic recommendations follow the current national and international guidelines.

RESULTS

Yeasts, mainly Candida species, are present in the gut of about 70% of healthy adults. Mucocutaneous Candida infections are due either to impaired host defenses or to altered gene expression in formerly commensal strains. The expression of virulence factors enables yeasts to form biofilms, destroy tissues, and escape the immunological attacks of the host. Yeast infections of the intestinal mucosa are of uncertain clinical significance, and their possible connection to irritable bowel syndrome, while plausible, remains unproved. Yeast colonization can trigger allergic reactions. Mucosal yeast infections are treated with topically active polyene antimycotic drugs. The adjuvant administration of probiotics is justified on the basis of positive results from controlled clinical trials.

CONCLUSION

The eradication of intestinal yeasts is advised only for certain clearly defined indications.

Cross-reactivity among fungal allergens: a clinically relevant phenomenon?

Atopic patients suffering from allergic asthma, allergic rhinitis, or atopic eczema often have detectable levels of serum IgE antibodies to fungi. Although the association between fungal sensitisation and different forms of allergic diseases, including allergic asthma and life-threatening allergic bronchopulmonary aspergillosis, is well established, the clinical relevance of cross-reactivity among different fungal species remains largely unknown. Recent progress in molecular cloning of fungal allergens and the availability of more than 40 completely sequenced fungal genomes facilitates characterisation, cloning, and production of highly pure recombinant allergens, identification of homologous and orthologous allergens widespread among the fungal kingdom, in silico prediction, and experimental in vitro and in vivo verification of cross-reactivity between homologous pan-allergens. These studies indicate that cross-reactivity is an important component of fungal sensitisation.

Reliability of antibodies to Candida methionine synthase for diagnosis, prognosis and risk stratification in systemic candidiasis: A generic strategy for the prototype development phase of proteomic markers

To be able to diagnose systemic candidiasis (SC) and to predict outcomes in SC patients are still challenging tasks for physicians. Previous proteomic studies suggest that anti-Candida methionine synthase (Met6p) IgG antibodies may be a candidate marker for SC. To evaluate their reliability for diagnosis, prognosis and risk stratification in SC, we developed a generic prototype strategy for their measurement in SC. Receiver-operating-characteristic curve analyses revealed a high diagnostic accuracy for this prototype format, which was slightly better to that for the widely used Western blot assays. Multivariate logistic-regression models showed a positive association between serum anti-Met6p IgG antibody levels and SC risk that was independent from established SC risk factors and other baseline variables. After adjusting for and stratifying according to known prognostic factors, a significant trend toward a lower two-month mortality risk with increasing levels was evidenced in SC patients at presentation. We conclude that these antibodies may be useful in discriminating SC from non-SC patients and determining risk stratification in SC. These may also confer protection against SC and be valuable for the design of future immunotherapies. Furthermore, our prototype format has the potential to make impact on other infectious diseases, cancers, allergies or autoimmune disorders.

Sensitization to fungi: epidemiology, comparative skin tests, and IgE reactivity of fungal extracts

BACKGROUND

Several fungal species are known to cause severe respiratory and cutaneous allergic diseases. Extracts from several allergenic fungi are used for in vivo and in vitro tests, as standard preparations are still not available.

OBJECTIVE

The aims are to define the pattern of in vivo and in vitro IgE reactivity to fungal species in an allergic population with respiratory symptoms; to determine the influence of different extract preparations on diagnostic results; and to evaluate whether there exists a relationship between the diagnostic pattern of reactivity and the pattern of specific IgE reactivity in immunoblots.

METHODS

Skin prick tests were applied to a cohort of 4962 respiratory subjects, aged 3-80 years. Fungal extracts from Alternaria, Aspergillus, Candida, Cladosporium, Penicillium, Saccharomyces, and Trichophyton were used, along with extracts from pollens, mites, and animal dander. Demographical and diagnostic data were recorded. IgE detection was carried out with the same allergenic extracts plus Malassezia. Comparative skin tests and IgE detection were carried out using extracts from three commercial suppliers. IgE immunoblots were carried out with the same panel of commercial fungal extracts and were compared with in-house extracts. Data analysis was carried out by grouping the population on the basis of their reactivity to a single, to two or to more than two, mould species.

RESULTS

Nineteen percent of the allergic population reacted to at least one fungal extract by means of the skin test. Alternaria and Candida accounted for the largest number of positive tests, and along with Trichophyton they were the main sensitizers in the subset of patients with an isolated sensitization. The prevalence of skin test reactivity increased for these three fungi in the subsets with two associated reactivities and, furthermore, in the subset showing reactivity to more than two mould species. In the latter group, a steady increase of the skin test reactivity was recorded for all the other fungal sources, suggesting a clustered reactivity. Comparative skin and IgE testing with different groups of subjects with a simple pattern of skin reactivity resulted in sensitivity differences between in vivo and in vitro tests, whereas discrepant results were recorded in the subsets of patients with multiple fungi sensitization. Although hampered by the limited reliability of fungal extracts, IgE immunoblots revealed differing patterns of reactivity when sera from the three subsets were used. This suggests a link between the diagnostic reactivity pattern and the IgE sensitization to extracts' components. Age and gender distribution differed among the Alternaria-, Candida-, and Trichophyton-sensitized subjects, but not in the subset with more than two fungi sensitizations.

CONCLUSIONS

The preliminary assessment of a new classification of the mould-sensitized population has been reached. The limiting quality of fungal extracts requires future studies using an allergenic molecule-based approach. The diagnostic process and the definition of the reactivity pattern would thus be easy, and it could lead to a novel specific immunotherapy approach.

Host's innate immune response to fungal and bacterial agents in vitro: up-regulation of interleukin-15 gene expression resulting in enhanced natural killer cell activity

Natural killer (NK) cells play an important role in the first line of defence against viral infections. We have shown earlier that exposure of human peripheral blood mononuclear cells (PBMC) to viruses results in rapid up-regulation of NK cell activity via interleukin-15 (IL-15) induction, and that this mechanism curtails viral infection in vitro. By using Candida albicans, Escherichia coli and Staphylococcus aureus, we now show here that exposure of PBMC to fungi and bacteria also results in an immediate increase of NK cytotoxicity. Reverse transcriptase-polymerase chain reaction and Western blot analyses as well as the use of antibodies against different cytokines revealed that IL-15 induction played a predominant role in this NK activation. These results indicate that IL-15 is also involved in the innate immune response against fungal and bacterial agents.