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Jauregizar N, Quindós G, Gil-Alonso S, Suárez E, Sevillano E, Eraso E. Postantifungal Effect of Antifungal Drugs against Candida: What Do We Know and How Can We Apply This Knowledge in the Clinical Setting? J Fungi (Basel) 2022; 8:jof8070727. [PMID: 35887482 PMCID: PMC9317160 DOI: 10.3390/jof8070727] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/29/2022] [Accepted: 07/06/2022] [Indexed: 02/07/2023] Open
Abstract
The study of the pharmacological properties of an antifungal agent integrates the drug pharmacokinetics, the fungal growth inhibition, the fungicidal effect and the postantifungal activity, laying the basis to guide optimal dosing regimen selection. The current manuscript reviews concepts regarding the postantifungal effect (PAFE) of the main classes of drugs used to treat Candida infections or candidiasis. The existence of PAFE and its magnitude are highly dependent on both the fungal species and the class of the antifungal agent. Therefore, the aim of this article was to compile the information described in the literature concerning the PAFE of polyenes, azoles and echinocandins against the Candida species of medical interest. In addition, the mechanisms involved in these phenomena, methods of study, and finally, the clinical applicability of these studies relating to the design of dosing regimens were reviewed and discussed. Additionally, different factors that could determine the variability in the PAFE were described. Most PAFE studies were conducted in vitro, and a scarcity of PAFE studies in animal models was observed. It can be stated that the echinocandins cause the most prolonged PAFE, followed by polyenes and azoles. In the case of the triazoles, it is worth noting the inconsistency found between in vitro and in vivo studies.
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Affiliation(s)
- Nerea Jauregizar
- Department of Pharmacology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), 48940 Bilbao, Spain;
- Correspondence:
| | - Guillermo Quindós
- Department of Immunology, Microbiology and Parasitology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), 48940 Bilbao, Spain; (G.Q.); (S.G.-A.); (E.S.); (E.E.)
| | - Sandra Gil-Alonso
- Department of Immunology, Microbiology and Parasitology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), 48940 Bilbao, Spain; (G.Q.); (S.G.-A.); (E.S.); (E.E.)
| | - Elena Suárez
- Department of Pharmacology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), 48940 Bilbao, Spain;
| | - Elena Sevillano
- Department of Immunology, Microbiology and Parasitology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), 48940 Bilbao, Spain; (G.Q.); (S.G.-A.); (E.S.); (E.E.)
| | - Elena Eraso
- Department of Immunology, Microbiology and Parasitology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), 48940 Bilbao, Spain; (G.Q.); (S.G.-A.); (E.S.); (E.E.)
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Prevalence of different fungal species in Saliva and Swab samples of patients undergoing Radiotherapy for Oral Cancer. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2021. [DOI: 10.22207/jpam.15.3.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Oral cancer is one of the leading causes of morbidity and mortality globally. There is a lack of studies on the growth of different Candida species in swab pre and post-radiotherapy. Hence, this study aimed to determine different Candida species in the oral cavity of patients who undergo radiotherapy. The study included 50 patients with oral cancer scheduled to undergo radiotherapy. Both saliva and swab samples were collected from all the patients before and after two- and six weeks of starting the radiotherapy. Similar inoculation was performed using the salivary swabs and incubated aerobically at 37°C for 48h. After 48h, culture plates were removed from the incubator and observed for the growth of different fungal species based on the color of the colonies. The culture of samples from patients with oral cancer resulted in the growth of 68% of Candida species in saliva and 44% in swab before initiating radiation. Unlike baseline findings, Candida albicans were identified in a higher number in swab samples (44%) than saliva (24%) post two weeks of radiotherapy. All saliva samples were positive to candida species, in which Candida albicans shows high prevalence (24%). After six weeks of radiotherapy, in the swab, 30% of samples were positive for Candida albicans, and 18% of samples were positive for non-albicans species. Before radiotherapy, at two weeks and six weeks of radiotherapy, saliva samples showed a higher prevalence of Candidal species compared to swab samples. The combination of other Candida species was also higher in saliva samples compared to swab samples during radiotherapy.
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Martínez Medina JJ, Torres CA, Alegre WS, Franca CA, López Tévez LL, Ferrer EG, Okulik NB, Williams PA. DFT vibrational assignments, in vitro antifungal activity, genotoxic and acute toxicity determinations of the [Zn(phen)2(cnge)(H2O)](NO3)2·H2O complex. J Mol Struct 2015. [DOI: 10.1016/j.molstruc.2015.07.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Effect of Eugenol on Cell Surface Hydrophobicity, Adhesion, and Biofilm of Candida tropicalis and Candida dubliniensis Isolated from Oral Cavity of HIV-Infected Patients. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:505204. [PMID: 24799938 PMCID: PMC3996878 DOI: 10.1155/2014/505204] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 02/21/2014] [Indexed: 11/17/2022]
Abstract
Most Candida spp. infections are associated with biofilm formation on host surfaces. Cells within these communities display a phenotype resistant to antimicrobials and host defenses, so biofilm-associated infections are difficult to treat, representing a source of reinfections. The present study evaluated the effect of eugenol on the adherence properties and biofilm formation capacity of Candida dubliniensis and Candida tropicalis isolated from the oral cavity of HIV-infected patients. All isolates were able to form biofilms on different substrate surfaces. Eugenol showed inhibitory activity against planktonic and sessile cells of Candida spp. No metabolic activity in biofilm was detected after 24 h of treatment. Scanning electron microscopy demonstrated that eugenol drastically reduced the number of sessile cells on denture material surfaces. Most Candida species showed hydrophobic behavior and a significant difference in cell surface hydrophobicity was observed after exposure of planktonic cells to eugenol for 1 h. Eugenol also caused a significant reduction in adhesion of most Candida spp. to HEp-2 cells and to polystyrene. These findings corroborate the effectiveness of eugenol against Candida species other than C. albicans, reinforcing its potential as an antifungal applied to limit both the growth of planktonic cells and biofilm formation on different surfaces.
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Copper(II) complexes with cyanoguanidine and o-phenanthroline: Theoretical studies, in vitro antimicrobial activity and alkaline phosphatase inhibitory effect. J Mol Struct 2014. [DOI: 10.1016/j.molstruc.2013.11.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ellepola ANB. Amphotericin B-induced in vitro postantifungal effect on Candida species of oral origin. Med Princ Pract 2012; 21:442-6. [PMID: 22678101 DOI: 10.1159/000339080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 04/04/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this investigation was to measure the postantifungal effect (PAFE) of 6 different oral Candida species following exposure to amphotericin B. MATERIALS AND METHODS Five oral isolates each of Candida albicans, Candida tropicalis, Candida krusei, Candida parapsilosis, Candida glabrata and Candida guilliermondii (total of 30 isolates) were examined for the presence of PAFE after 1 h of exposure to the minimum inhibitory concentration of amphotericin B. The PAFE was determined as the difference in time (hours) required for the growth of the drug-free control and the drug-exposed test cultures to increase to 0.05 absorbance level following removal of amphotericin B. RESULTS The mean duration of amphotericin B-induced PAFE was lowest for C. albicans (5.91 ± 0.31 h) and greatest for C. parapsilosis (12.72 ± 0.11 h), while C. guilliermondii (8.32 ± 0.33 h), C. glabrata (8.43 ± 0.21 h), C. krusei (9.68 ± 0.23 h) and C. tropicalis (10.98 ± 0.18 h) elicited intermediate values. CONCLUSION Even a limited exposure to sublethal concentrations of amphotericin B suppressed growth of Candida species of oral origin. The significant variation in amphotericin B-induced PAFE amongst different Candida species may have clinical implications in terms of amphotericin B regimens used in the management of oral candidiasis.
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Affiliation(s)
- A N B Ellepola
- Department of Bioclinical Sciences, Faculty of Dentistry, Health Sciences Center, Kuwait University, Jabriya, Kuwait.
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Lima-Neto RG, Beltrão EIC, Oliveira PC, Neves RP. Adherence of Candida albicans and Candida parapsilosis to epithelial cells correlates with fungal cell surface carbohydrates. Mycoses 2011; 54:23-9. [PMID: 19735440 DOI: 10.1111/j.1439-0507.2009.01757.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Many studies have described the adherence of Candida albicans to epithelial cells but little is known about Candida parapsilosis adhesion and its role in host cell surface recognition. This study was designed to evaluate the correlation between the adherence of 20 C. albicans and 12 C. parapsilosis strains to human buccal epithelial cells and the expression of fungal cell surface carbohydrates using lectin histochemistry. Adherence assays were carried out by incubating epithelial cells in yeast suspensions (10(7) cells ml(-1) ) and peroxidase conjugated lectins (Con A, WGA, UEA I and PNA at 25 μg ml(-1) ) were used for lectin histochemistry. The results showed that adherence was overall greater for C. albicans than for C. parapsilosis (P < 0.01) and that the individual strain differences correlated with a high content of cell surface α-l-fucose residues as indicated by the UEA I staining pattern. Based on the saccharide specificity of the lectins used, these results suggest that l-fucose residues on cell surface glycoconjugates may represent recognition molecules for interactions between the yeast strain studied and the host (r = 0.6985, P = 0.0045). In addition, our results indicated the presence of α-d-glucose/α-d-mannose, N-acetyl-D-glucosamine/N-acetylneuraminic acid and D-galactose/N-acetyl-D-galactosamine in fungal cell wall.
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Affiliation(s)
- Reginaldo G Lima-Neto
- Laboratório de Micologia Médica, Centro de Ciências Biológicas (CCB), Universidade Federal de Pernambuco (UFPE), Cidade universitária, Av. Morais Rego s/n, 50670-910, Recife, Brazil.
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Azizi A, Rezaei M. Prevalence of Candida species in the oral cavity of patients undergoing head and neck radiotherapy. J Dent Res Dent Clin Dent Prospects 2009; 3:78-81. [PMID: 23230489 PMCID: PMC3517277 DOI: 10.5681/joddd.2009.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2009] [Accepted: 07/11/2009] [Indexed: 11/30/2022] Open
Abstract
Background and aims
Candidiasis is a common opportunistic infection in immunocompromised patients. Radiation to the head and neck affects the oral mucous membrane and produces xerostomia. Xerostomia alters the oral mucosa and predisposes them to colonization by Candida species. The aim of this study was evaluation of Candida species before and after radiotherapy.
Materials and methods
Twenty patients undergoing radiation therapy were selected. None of the patients had taken any antibiotics and antifungals during the 3-month period prior to the study and did not take any during the study; in addition, they did not have any systemic conditions predisposing them to Candida infections. Swabs were collected from all the patients for Candida species culturing procedures 3±1 days before treatment and 2 and 4 weeks after radiotherapy. Swabs were inoculated on 2% Sabouraud’s dextrose agar. Different types of Candida species are specified by colony color. Analysis of variance was used to assess the difference between the periods before and after treatment.
Results
Mean age of the patients were 59.4 years. Ten patients were Candida-positive before the initiation of radiotherapy. Eighteen and 20 patients were Candida-positive after two and four weeks of radiotherapy, respectively. The most frequent type of Candida in this study was Candida albicans both before and after radiotherapy.
Conclusion
The present study suggests that patients undergoing head and neck radiotherapy should take antifungal agents, especially sugar-free agents, topical fluoride and salivary substitutes. The most commonly found Candida in this study was Candida albicans, which might be attributed to its high pathogenecity.
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Affiliation(s)
- Arash Azizi
- Associate professor, Department of Oral Medicine, Faculty of Dentistry, Ahwaz Jundi Shapoor University of Medical Sciences, Ahvaz, Iran
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Ellepola ANB, Samaranayake LP. Investigative Methods for Studying the Adhesion and Cell Surface Hydrophobicity ofCandidaSpecies: An Overview. MICROBIAL ECOLOGY IN HEALTH AND DISEASE 2009. [DOI: 10.1080/089106001750071708] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Arjuna N. B. Ellepola
- Oral Biosciences, Faculty of Dentistry, The Prince Philip Dental Hospital, University of Hong Kong, Hong Kong SAR; Division of Pharmacology, Department of Oral Medicine, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka
| | - Lakshman P. Samaranayake
- Oral Biosciences, Faculty of Dentistry, The Prince Philip Dental Hospital, University of Hong Kong, Hong Kong SAR; Division of Pharmacology, Department of Oral Medicine, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka
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Ellepola ANB, Samaranayake LP. Impact of Brief, Sequential Exposure to Fluconazole and Amphotericin B on the Cell Surface Hydrophobicity of oral Candida albicans Isolates Obtained from HIV Infected Patients. MICROBIAL ECOLOGY IN HEALTH AND DISEASE 2009. [DOI: 10.1080/089106002320644339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Arjuna N. B. Ellepola
- Oral Biosciences, Faculty of Dentistry, University of Hong Kong, Hong Kong
- Division of Pharmacology, Department of Oral Medicine, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka
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Ellepola ANB. In vitro post-antifungal effect (PAFE) elicited by chlorhexidine gluconate on oral isolates of Candida albicans. MICROBIAL ECOLOGY IN HEALTH AND DISEASE 2009. [DOI: 10.1080/089106099435718] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Arjuna N. B. Ellepola
- Faculty of Dentistry, The Prince Philip Dental Hospital, 34 Hospital Road, Hong Kong
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12
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Synergistic activity of lysozyme and antifungal agents against Candida albicans biofilms on denture acrylic surfaces. Arch Oral Biol 2009; 54:115-26. [DOI: 10.1016/j.archoralbio.2008.09.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Revised: 09/22/2008] [Accepted: 09/24/2008] [Indexed: 02/07/2023]
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Boucherit Z, Seksek O, Bolard J. Dormancy of Candida albicans cells in the presence of the polyene antibiotic amphotericin B: simple demonstration by flow cytometry. Med Mycol 2007; 45:525-33. [PMID: 17710622 DOI: 10.1080/13693780701487821] [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] [Indexed: 01/17/2023] Open
Abstract
Flow cytometry light scattering was used to monitor size increase of Candida albicans (isolate ATCC 10231) cells in the presence or absence of the antifungal drug amphotericin B (AmB). This non-invasive and descriptive method allowed for the differentiation of dead and dormant sub-populations of cells. When inoculated into a growth medium without AmB, a progressive increase in light scattering was observed over a period of approximately 4 h, but without proliferation of the yeast. After this period, the light scattering distribution regressed to baseline level, whereas cell proliferation started. In the presence of AmB, all the cells shrank in size within approximately 4 h and proliferation was temporarily halted. However, in the presence of 0.4 microM AmB, a progressive increase of light scattering occurred after 21 h which was similar to that observed within the first 4 h in the absence of the antifungal. After approximately 24 h of incubation at this concentration of AmB, proliferation resumed. These observations indicate that this renewed cell proliferation was due to the reawakening of dormant cells in the presence of AmB (45% in the presence of 0.4 microM AmB) rather than the result of the development of viable cells that had escaped detection. This simple descriptive approach could be extended to other fungal strains or species, to other antifungal drugs and possibly to bacteria.
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Affiliation(s)
- Zahia Boucherit
- BIOMOCETI, UMR CNRS 7033, Université Pierre et Marie Curie, France
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Vitale RG, Afeltra J, Meis JFGM, Verweij PE. Activity and post antifungal effect of chlorpromazine and trifluopherazine against Aspergillus, Scedosporium and zygomycetes. Mycoses 2007; 50:270-6. [PMID: 17576318 DOI: 10.1111/j.1439-0507.2007.01371.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The phenothiazine compounds chlorpromazine and trifluopherazine are antipsychotic agents that exhibit antimicrobial activity against bacteria, some protozoa and yeasts. Data of activity against filamentous fungi are lacking. The in vitro activity and postantifungal effect (PAFE) of chlorpromazine and trifluopherazine was determined against Aspergillus species, zygomycetes and Scedosporium species. In vitro susceptibility testing was performed with CLSI M38A and the PAFE was determined with previously established methods. Both drugs inhibited the growth of all fungi tested at concentrations of 16 to 64 microg ml(-1). For Aspergillus species the mean PAFE was 3.7 and 4.7 h; for zygomycetes, 3.1 and 3.4 h; for Scedosporium, 4.3 and 5.3 h for chlorpromazine and trifluoroperazine respectively. These are the first drugs shown to induce PAFE against Scedosporium. We show that phenothiazine compounds have in vitro antifungal activity and exhibit PAFE against a broad range of filamentous fungal pathogens. Although the exact mechanism of action is unknown, further studies are needed to explore the clinical usefulness of phenothiazine compounds.
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Affiliation(s)
- Roxana G Vitale
- Department of Medical Microbiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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Chryssanthou E, Cars O, Sjölin J. New automated method for determining postantifungal effect of amphotericin B against Candida species: effects of concentration, exposure time, and area under the curve. Antimicrob Agents Chemother 2002; 46:4016-8. [PMID: 12435715 PMCID: PMC132789 DOI: 10.1128/aac.46.12.4016-4018.2002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The postantifungal effect (PAFE) of amphotericin B was determined with a BacT/Alert automated system, which is based on the colorimetric detection of CO(2). The levels of accuracy and precision of the automated method were high. Longer PAFEs were obtained for Candida albicans (P < 0.001), C. glabrata (P < 0.01), and C. krusei (P < 0.01) at increasing amphotericin B concentrations and exposure times.
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Affiliation(s)
- Erja Chryssanthou
- Department of Clinical Microbiology, Karolinska Hospital, Stockholm, Sweden.
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Maza JL, Elguezabal N, Prado C, Ellacuría J, Soler I, Pontón J. Candida albicans adherence to resin-composite restorative dental material: influence of whole human saliva. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 94:589-92. [PMID: 12424453 DOI: 10.1067/moe.2002.126024] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Attachment of Candida albicans to oral surfaces is believed to be a critical event in the colonization of the oral cavity and in the development of oral diseases such as Candida-associated denture stomatitis. Although there is considerable information about the adhesion of C albicans to buccal epithelial cells and prosthetic materials, there is very little information about the adhesion of C albicans to composite restorative materials. The purpose of this study was to investigate the degree of adhesion of C albicans to a resin-composite restorative material (Herculite). METHODS The adhesion of 2 strains of C albicans, a germinative and a germ tube-deficient mutant, was studied by a visual method after incubating the fungus and the resin with and without human whole saliva. RESULTS In absence of saliva, the adhesion of the C albicans germinative isolate to the resin showed an increase in parallel with the germination, reaching a maximum at the end of the experiment (120 minutes). However, no significant differences were observed in the adhesion of the agerminative mutant during the period of time studied. In the presence of saliva, the adhesion of both isolates to the resin was significantly lowered. CONCLUSION Germination and the presence of human whole saliva are important factors in the adhesion of C albicans to the resin-composite restorative material Herculite.
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Affiliation(s)
- José Luis Maza
- Department of Estomatología, Facultad de Medicina y Odontología, Universidad del País Vasco, Vizcaya, Spain.
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Ellepola AN, Samaranayake LP. Oral candidal infections and antimycotics. CRITICAL REVIEWS IN ORAL BIOLOGY AND MEDICINE : AN OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION OF ORAL BIOLOGISTS 2002; 11:172-98. [PMID: 12002814 DOI: 10.1177/10454411000110020301] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The advent of the human immunodeficiency virus infection and the increasing prevalence of compromised individuals in the community due to modern therapeutic advances have resulted in a resurgence of opportunistic infections, including oral candidoses. One form of the latter presents classically as a white lesion of "thrush" and is usually easily diagnosed and cured. Nonetheless, a minority of these lesions appears in new guises such as erythematous candidosis, thereby confounding the unwary clinician and complicating its management. Despite the availability of several effective antimycotics for the treatment of oral candidoses, failure of therapy is not uncommon due to the unique environment of the oral cavity, where the flushing effect of saliva and the cleansing action of the oral musculature tend to reduce the drug concentration to sub-therapeutic levels. This problem has been partly circumvented by the introduction of the triazole agents, which initially appeared to be highly effective. However, an alarming increase of organisms resistant to the triazoles has been reported recently. In this review, an overview of clinical manifestations of oral candidoses and recent advances in antimycotic therapy is given, together with newer concepts, such as the post-antifungal effect (PAFE) and its possible therapeutic implications.
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Affiliation(s)
- A N Ellepola
- Division of Oral Bio-sciences, Faculty of Dentistry, University of Hong Kong, Prince Philip Dental Hospital, Hong Kong
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Shu M, Ellepola AN, Samaranayake LP. Effects of two different growth media on the postantifungal effect induced by polyenes on Candida species. J Clin Microbiol 2001; 39:2732-5. [PMID: 11427609 PMCID: PMC88225 DOI: 10.1128/jcm.39.7.2732-2735.2001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
There are no data on the effects of different growth media on polyene-induced postantifungal effect (PAFE) in Candida species. Hence, the nystatin- and amphotericin B-induced PAFEs in six Candida species (26 isolates) grown in Sabouraud's dextrose broth (SAB) and RPMI broth were evaluated, following limited exposure to the MICs of the two polyenes, using an automated turbidometric method. For nystatin, PAFE varied between 1.88 and 4.87 h in SAB and 0.66 and 6.89 h in RPMI, and for amphotericin B, the equivalent values were 3.13 to 10.98 h in SAB and 0.97 to 7.01 h in RPMI. These highly significant (P < 0.001) variations in the PAFE with both drugs, noted with most Candida strains grown in different media, call for standardization of intralaboratory methodology in measuring this parameter in order to obtain universally comparable data.
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Affiliation(s)
- M Shu
- Conservative Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong, People's Republic of China
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Dodds ES, Drew RH, Perfect JR. Antifungal pharmacodynamics: review of the literature and clinical applications. Pharmacotherapy 2000; 20:1335-55. [PMID: 11079283 DOI: 10.1592/phco.20.17.1335.34901] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Invasive fungal infections are seen with growing frequency, likely due to increases in numbers of patients at risk of infection. Optimal selection and dosing of antifungal agents are important, as these infections are often refractory to available therapy. In contrast to antibacterials, studies examining the pharmacodynamic properties of antifungals and their application in treating invasive disease often are lacking. Agents administered for invasive infections are amphotericin B, flucytosine, and azole antifungals. Several drugs are under investigation, such as posiconazole, voriconazole, and the echinocandins, and preliminary pharmacodynamic data likely will help shape dosing regimens. Clinical trials that investigated dosage and administration, as well as the potential benefits of combination and sequential therapy, are addressed. In addition, antifungal susceptibility and animal models of infection are discussed.
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Affiliation(s)
- E S Dodds
- Campbell University School of Pharmacy, Buies Creek, North Carolina, USA
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Ellepola AN, Samaranayake LP. The effect of brief exposure to sub-therapeutic concentrations of chlorhexidine gluconate on the germ tube formation of oral Candida albicans and its relationship to post-antifungal effect. Oral Dis 2000; 6:166-71. [PMID: 10822360 DOI: 10.1111/j.1601-0825.2000.tb00328.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Adherence of Candida albicans has been implicated as the first step in the pathogenesis of oral candidosis, and germ tube formation a contributory attribute. Recently, these organisms have also been implicated in persistent apical periodontitis. Chlorhexidine gluconate is by far the commonest antiseptic mouth wash prescribe in dentistry. As the intraoral concentrations of this antiseptic fluctuate considerably due to the dynamics of the oral cavity, the main objective of this study was to investigate the effect of brief exposure to three different sub-therapeutic concentrations of chlorhexidine gluconate (0.005%, 0.0025% and 0.00125%) on the germ tube formation of C. albicans. These findings were then correlated with the chlorhexidine-induced post-antifungal effect (PAFE) values we obtained in a study using the identical organisms and experimental conditions. DESIGN Ten oral isolates of C. albicans were exposed to three different concentrations of chlorhexidine gluconate for 30 min, the antiseptic removed, and the germ tube formation of these isolates quantified following subsequent incubation in a germ tube inducing medium. The PAFE was evaluated by turbidometric measurement of growth. RESULTS When compared with the controls, exposure to 0.005%, 0.0025% and 0.00125% chlorhexidine gluconate suppressed the ability to form germ tubes by 81.23% (P < 0.01), 42.74% (P < 0.01) and 9.13% (P > 0.05), respectively, while eliciting a mean PAFE of 9.91 h, 1.65 h and 0.67 h respectively. On regression analysis a significant positive correlation was observed between these two parameters (P < 0.0001; r = 0.7325). CONCLUSIONS Taken together, these findings imply that short exposure to sub-therapeutic levels of chlorhexidine gluconate may modulate candidal germ tube formation as well as its growth, thereby suppressing its pathogencity in vivo.
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Affiliation(s)
- A N Ellepola
- Prince Philip Dental Hospital, Faculty of Dentistry, University of Hong Kong, Hong Kong SAR
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