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Pinho S, Miranda IM, Costa-de-Oliveira S. Global Epidemiology of Invasive Infections by Uncommon Candida Species: A Systematic Review. J Fungi (Basel) 2024; 10:558. [PMID: 39194884 DOI: 10.3390/jof10080558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/29/2024] [Accepted: 08/01/2024] [Indexed: 08/29/2024] Open
Abstract
Emerging and uncommon Candida species have been reported as an increasing cause of invasive Candida infections (ICI). We aim to systematize the global epidemiology associated with emergent uncommon Candida species responsible for invasive infections in adult patients. A systematic review (from 1 January 2001 to 28 February 2023) regarding epidemiological, clinical, and microbiological data associated to invasive Candida infections by uncommon Candida spp. were collected. In total, 1567 publications were identified, and 36 were selected according to inclusion criteria (45 cases). The chosen studies covered: C. auris (n = 21), C. haemulonii (n = 6), C. fermentati (n = 4), C. kefyr (n = 4), C. norvegensis (n = 3), C. nivariensis (n = 3), C. bracarensis (n = 1), C. duobushaemulonii (n = 1), C. blankii (n = 1), and C. khanbhai (n = 1). Over the recent years, there has been an increase in the number of invasive infections caused by uncommon Candida spp. Asia and Europe are the continents with the most reported cases. The challenges in strain identification and antifungal susceptibility interpretation were significant. The absence of clinical breakpoints for the susceptibility profile determination for uncommon Candida spp. makes interpretation and treatment options a clinical challenge. It is crucial that we focus on new and accessible microbiology techniques to make fast and accurate diagnostics and treatments.
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Affiliation(s)
- Sandra Pinho
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Isabel M Miranda
- Cardiovascular R&D Centre UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Sofia Costa-de-Oliveira
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Center for Health Technology and Services Research-CINTESIS@RISE, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
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Bregón-Villahoz M, Menéndez-Manjón P, Carrano G, Díez-Villalba A, Arrieta-Aguirre I, Fernandez-de-Larrinoa I, Moragues MD. Candida albicans cDNA library screening reveals novel potential diagnostic targets for invasive candidiasis. Diagn Microbiol Infect Dis 2024; 109:116311. [PMID: 38657353 DOI: 10.1016/j.diagmicrobio.2024.116311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 04/04/2024] [Accepted: 04/17/2024] [Indexed: 04/26/2024]
Abstract
The detection of patterns associated with the invasive form of Candida albicans, such as Candida albicans germ tube antibodies (CAGTA), is a useful complement to blood culture for Invasive Candidiasis (IC) diagnosis. As CAGTA are detected by a non-standardisable and non-automatable technique, a Candida albicans cDNA expression library was screened with CAGTA isolated from serum of an animal model of invasive candidiasis, and five protein targets were identified: hyphally regulated cell wall protein 1 (Hyr1), enolase 1 (Eno1), coatomer subunit gamma (Sec21), a metallo-aminopeptidase (Ape2) and cystathionine gamma-lyase (Cys3). Homology with proteins from other organisms rules out Cys3 as a good biomarker while Sec21 results suggest that it is not in the germ tubes surface but secreted to the external environment. Our analysis propose Ape2, Sec21 and a region of Hyr1 different from the one currently being studied for immunoprotection as potential biomarker candidates for the diagnosis of IC.
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Affiliation(s)
- Marta Bregón-Villahoz
- Department of Nursing I, University of the Basque Country UPV/EHU, Spain; Department of Immunology, Microbiology and Parasitology, University of the Basque Country UPV/EHU, Spain
| | - Pilar Menéndez-Manjón
- Department of Nursing I, University of the Basque Country UPV/EHU, Spain; Department of Immunology, Microbiology and Parasitology, University of the Basque Country UPV/EHU, Spain
| | - Giulia Carrano
- Department of Immunology, Microbiology and Parasitology, University of the Basque Country UPV/EHU, Spain
| | - Ander Díez-Villalba
- Department of Nursing I, University of the Basque Country UPV/EHU, Spain; Department of Immunology, Microbiology and Parasitology, University of the Basque Country UPV/EHU, Spain
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Parambath S, Dao A, Kim HY, Zawahir S, Alastruey Izquierdo A, Tacconelli E, Govender N, Oladele R, Colombo A, Sorrell T, Ramon-Pardo P, Fusire T, Gigante V, Sati H, Morrissey CO, Alffenaar JW, Beardsley J. Candida albicans-A systematic review to inform the World Health Organization Fungal Priority Pathogens List. Med Mycol 2024; 62:myae045. [PMID: 38935906 PMCID: PMC11210619 DOI: 10.1093/mmy/myae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/20/2023] [Accepted: 04/27/2024] [Indexed: 06/29/2024] Open
Abstract
Candida albicans is a common fungal pathogen and amongst the leading causes of invasive candidiasis globally. This systematic review examines the characteristics and global impact of invasive infections caused by C. albicans. We searched on PubMed and Web of Science for studies reporting on criteria such as mortality, morbidity, drug resistance, preventability, yearly incidence, and distribution/emergence during the period from 2016 to 2021. Our findings indicate that C. albicans is the most common Candida species causing invasive disease and that standard infection control measures are the primary means of prevention. However, we found high rates of mortality associated with infections caused by C. albicans. Furthermore, there is a lack of data on complications and sequelae. Resistance to commonly used antifungals remains rare. Although, whilst generally susceptible to azoles, we found some evidence of increasing resistance, particularly in middle-income settings-notably, data from low-income settings were limited. Candida albicans remains susceptible to echinocandins, amphotericin B, and flucytosine. We observed evidence of a decreasing proportion of infections caused by C. albicans relative to other Candida species, although detailed epidemiological studies are needed to confirm this trend. More robust data on attributable mortality, complications, and sequelae are needed to understand the full extent of the impact of invasive C. albicans infections.
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Affiliation(s)
- Sarika Parambath
- Sydney Infectious Diseases Institute, The University of Sydney, Sydney, NSW, Australia
| | - Aiken Dao
- Sydney Infectious Diseases Institute, The University of Sydney, Sydney, NSW, Australia
- Westmead Institute for Medical Research, Westmead, NSW, Australia
- Westmead Hospital, Westmead, NSW, Australia
| | - Hannah Yejin Kim
- Sydney Infectious Diseases Institute, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
- Westmead Hospital, Department of Pharmacy, Westmead, NSW, Australia
| | - Shukry Zawahir
- Sydney Infectious Diseases Institute, The University of Sydney, Sydney, NSW, Australia
- Central Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney NSW, Australia
| | - Ana Alastruey Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Evelina Tacconelli
- Department of Diagnostics and Public Health, Verona University, Verona, Italy
| | - Nelesh Govender
- National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Institute of Infection and Immunity, St George's University of London, London, UK
- MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Rita Oladele
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - Tania Sorrell
- Sydney Infectious Diseases Institute, The University of Sydney, Sydney, NSW, Australia
- Westmead Institute for Medical Research, Westmead, NSW, Australia
- Westmead Hospital, Westmead, NSW, Australia
| | - Pilar Ramon-Pardo
- Antimicrobial Research Division, World Health Organization, Geneva, Switzerland
| | - Terence Fusire
- Antimicrobial Research Division, World Health Organization, Geneva, Switzerland
| | - Valeria Gigante
- Antimicrobial Research Division, World Health Organization, Geneva, Switzerland
| | - Hatim Sati
- Antimicrobial Research Division, World Health Organization, Geneva, Switzerland
| | - C Orla Morrissey
- Department of Infectious Diseases, Alfred Health, VIC, Australia
- Monash University, Department of Infectious Diseases, Melbourne, VIC, Australia
| | - Jan-Willem Alffenaar
- Sydney Infectious Diseases Institute, The University of Sydney, Sydney, NSW, Australia
- Westmead Hospital, Westmead, NSW, Australia
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Justin Beardsley
- Sydney Infectious Diseases Institute, The University of Sydney, Sydney, NSW, Australia
- Westmead Institute for Medical Research, Westmead, NSW, Australia
- Westmead Hospital, Westmead, NSW, Australia
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Branda Dos Reis C, Otenio MH, Júnior AMDM, Maia Dornelas JC, Fonseca do Carmo PH, Viana RO, Santos Ricoy AC, de Souza Alves V. Virulence profile of Candida spp. isolated from an anaerobic biodigester supplied with dairy cattle waste. Microb Pathog 2024; 187:106516. [PMID: 38176462 DOI: 10.1016/j.micpath.2023.106516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024]
Abstract
Anaerobic biodigesters play a crucial role in enhancing animal waste management. However, the presence of pathogens in the biodigestion process poses a significant concern. Candida spp., a widespread fungus known for its opportunistic nature and adaptability to diverse environmental conditions, including reciprocal transmission between humans and animals, is one such pathogen of concern. Therefore, it is imperative to assess the virulence profile of Candida spp. originating from anaerobic biodigestion processes. Here we demonstrate that strains isolated from the biodigestion process of dairy cattle waste exhibit noteworthy virulence mechanisms, surpassing the virulence of clinical control strains. After we identified strains from affluent, effluent, and biofertilizer, we observed that all analyzed isolates produced biofilm. Additionally, a substantial proportion of these isolates demonstrated phospholipase production, while only a few strains exhibited protease production. Furthermore, all strains exhibited resistance or dose-dependent responses to amphotericin B and itraconazole, with the majority displaying resistance to fluconazole. In the in vivo test, we observed a significant correlation (p < 0.05) between the LT50 and biofilm formation as well as hyphae/pseudohyphae production. Additionally, some isolates demonstrated a quicker nematode-killing capacity compared to clinical controls. Our findings underscore the considerable pathogenic potential of certain Candida species present in the dynamics of anaerobic biodigestion. Importantly, the anaerobic biodigester system did not eliminate Candida strains from dairy cattle waste, highlighting the need for caution in utilizing biodigester products. We advocate for further studies to explore the virulence of other microorganisms in various animal production contexts. Furthermore, our results emphasize the urgency of enhancing waste treatment methods to effectively eliminate pathogens and curb their potential dissemination.
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Affiliation(s)
- Camila Branda Dos Reis
- Laboratory of Microorganism Cell Biology, Microbiology Department, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, 31270-901, Brazil.
| | - Marcelo Henrique Otenio
- Laboratory of Livestock Waste Management, Brazilian Agricultural Research Corporation - Dairy Cattle, Juiz de Fora, Minas Gerais, 36038-330, Brazil.
| | | | - João Carlos Maia Dornelas
- Laboratory of Mycology, Microbiology Department, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, 31270-901, Brazil.
| | - Paulo Henrique Fonseca do Carmo
- Laboratory of Mycology, Microbiology Department, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, 31270-901, Brazil.
| | - Roberta Oliveira Viana
- Laboratory of Microorganism Cell Biology, Microbiology Department, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, 31270-901, Brazil.
| | - Ana Carolina Santos Ricoy
- Laboratory of Microorganism Cell Biology, Microbiology Department, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, 31270-901, Brazil.
| | - Viviane de Souza Alves
- Microbiology Department, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, 31270-901, Brazil.
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Rajeshwari R, Vyasam S, Chandran J, Porwal S, Ebenezer K, Thokchom M, James EJ, Karuppusami R. Risk Factors for Candida Infection among Children Admitted to a Pediatric Intensive Care Unit in a Tertiary Care Centre in Southern India. Indian J Crit Care Med 2022; 26:717-722. [PMID: 35836644 PMCID: PMC9237143 DOI: 10.5005/jp-journals-10071-24203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background To describe the clinical profile, risk factors, and outcomes that are associated with candida infection among critically ill children. Patients and methods A retrospective case-control study wherein 109 children admitted to the pediatric intensive care unit (PICU) in the years between 2015 and 2017 with the growth of candida from blood, urine, endotracheal (ET) aspirate, and pus swabs were included and compared to 97 age and sex-matched controls chosen from the same time period. Results Of the 124 candida isolates from 109 children, 37% were from blood, 24% from urine, and 14% in pus; 40% of the isolates were from ET aspirate. Candida non-albicans types (70%) predominated with Candida tropicalis causing 50% of the infections. Risk factors for candida infection were neutropenia [OR 20.01, 95% CI (0.94–422.32)], mechanical ventilation [OR 5.97, 95% CI (2.44–14.62)], peritoneal dialysis [OR 5.81, 95% CI (1.27–26.50)], institution of amino acids [OR 5.41, 95% CI (0.85–34.13)], presence of central venous catheter [OR 3.83, 95% CI (1.59–9.19)], antibiotic use >5 days [OR 3.58, 95% CI (1.38–9.29)]. Candida Cases (95.4%) had a septic shock with acute kidney injury in 34% and had significantly lower survival than controls [72 (66%) of 109 vs. 74 (80%) of 92] (p = 0.023). Conclusions The rate of candida infection in our PICU was 4.2% of PICU admissions. The most common species was C. tropicalis. The independent risk factors for candida infection were neutropenia, antibiotic duration >5 days, peritoneal dialysis, amino acid administration, mechanical ventilation, and presence of a central venous catheter (CVC). How to cite this article Rajeshwari R, Vyasam S, Chandran J, Porwal S, Ebenezer K, Thokchom M, et al. Risk Factors for Candida Infection among Children Admitted to a Pediatric Intensive Care Unit in a Tertiary Care Centre in Southern India. Indian J Crit Care Med 2022;26(6):717–722.
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Affiliation(s)
- Raja Rajeshwari
- Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Siva Vyasam
- Department of PICU, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Jolly Chandran
- Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Sanketh Porwal
- Department of PICU, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Kala Ebenezer
- Christian Medical College and Hospital, Vellore, Tamil Nadu, India
- Kala Ebenezer, Christian Medical College and Hospital, Vellore, Tamil Nadu, India, Phone: +91 9994615365, e-mail:
| | - Muniya Thokchom
- Department of PICU, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Ebor J James
- Department of PICU, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Reka Karuppusami
- Department of Biostatisitics, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Epidemiology of Fungal Colonization in Children Treated at the Department of Oncology and Hematology: Single-Center Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042485. [PMID: 35206670 PMCID: PMC8872470 DOI: 10.3390/ijerph19042485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 12/07/2022]
Abstract
Oncological patients are especially predisposed to fungal infections due to multiple risk factors and immunocompromising treatment. Epidemiological research regarding pediatric oncologic patients is still insufficient, and existing data are difficult to generalize on different populations. Therefore, we aimed to analyze fungal infections and fungal epidemiology in the Department of Oncology and Hematology of the University Children’s Hospital in Krakow with help from the Clinical Microbiology Department. During the chosen period of 2005 and 2015–2020, 2342 tests were performed in our ward on 847 patients. Analyzed samples were divided into five source groups. The amount of patients with positive test results was 62.5%. The year with the highest detection level was 2005. The most frequent pathogen was Candida albicans, with a significant decrease in tendency. An increase in non-albicans species was observed. Candida parapsilosis was not frequently observed compared to similar studies. We noticed an increase in positive results from the urinary tract material. Our results confirmed that fungal infections are still an issue, and they may indicate the efficacy of prophylaxis. The majority of our results are consistent with the literature, yet we managed to emphasize data unique to our patients’ population. Our findings are helpful in clinical work and for further studies in our center.
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Invasive Candida Infections in Neonates after Major Surgery: Current Evidence and New Directions. Pathogens 2021; 10:pathogens10030319. [PMID: 33803104 PMCID: PMC7999498 DOI: 10.3390/pathogens10030319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 02/07/2023] Open
Abstract
Infections represent a serious health problem in neonates. Invasive Candida infections (ICIs) are still a leading cause of mortality and morbidity in neonatal intensive care units (NICUs). Infants hospitalized in NICUs are at high risk of ICIs, because of several risk factors: broad spectrum antibiotic treatments, central catheters and other invasive devices, fungal colonization, and impaired immune responses. In this review we summarize 19 published studies which provide the prevalence of previous surgery in neonates with invasive Candida infections. We also provide an overview of risk factors for ICIs after major surgery, fungal colonization, and innate defense mechanisms against fungi, as well as the roles of different Candida spp., the epidemiology and costs of ICIs, diagnosis of ICIs, and antifungal prophylaxis and treatment.
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Candidemia in Children with Malignancies: Report from the Infection Working Group of the Hellenic Society of Pediatric Hematology-Oncology. J Fungi (Basel) 2020; 6:jof6040276. [PMID: 33182837 PMCID: PMC7712277 DOI: 10.3390/jof6040276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 01/22/2023] Open
Abstract
Candidemia is an important cause of morbidity and mortality especially in immunocompromised and hospitalized patients. We retrospectively collected data of candidemia cases that occurred in the seven Hematology-Oncology Departments/Units of Greece and the Stem Cell Transplant Unit between 2015 and 2019. In total, 19 episodes of candidemia in 19 patients were recorded. The majority of the patients (78.9%) had at least one risk factor for candidemia. The most frequent risk factors associated with candidemia observed in our patients were prolonged duration of hospitalization (30 days, range 1–141), presence of a central venous catheter at diagnosis of candidemia (73.7%) and antibiotics use during the last two weeks (84.2%). Candida parapsilosis was the most common species isolated accounting for 42.1%, followed by C. albicans (26.3%) and C. famata (15.8%). Nearly all of the patients (84.2%) received antifungal monotherapy with liposomal amphotericin B or echinocandins. The central venous catheter was removed in 78.6% of patients and the median time between the first positive blood culture and catheter removal was 3 days (range 1–9). Mortality at 28 days was 26.3%. In conclusion, a predominance of non-albicans species was observed in our study in conformity with the global trend.
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Zeng Z, Tian G, Ding Y, Yang K, Deng J, Liu J. Epidemiology, antifungal susceptibility, risk factors and mortality of invasive candidiasis in neonates and children in a tertiary teaching hospital in Southwest China. Mycoses 2020; 63:1164-1174. [PMID: 32687642 DOI: 10.1111/myc.13146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 07/11/2020] [Accepted: 07/13/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Invasive candidiasis (IC) is a major cause of morbidity and mortality in neonates and children; however, little information on the epidemiology of IC in paediatric patients in China is available. METHODS A 7-year retrospective study was conducted to analyse the prevalence, species distributions, antifungal susceptibility, risk factors and mortality among paediatric inpatients with IC in a regional tertiary teaching hospital in Southwest China. RESULTS A total of 86 paediatric inpatients with IC during the seven-year study period were identified, with a mean annual incidence of 1.04 cases per 1000 admissions and a neonatal incidence of 2.72 cases per 1000 admissions. The species distributions of Candida albicans and non-albicans Candida were 48.8% and 51.2%, respectively. The total resistance rates to fluconazole (FCA), itraconazole (ITR) and voriconazole (VRC) were 8.1%, 26.7% and 14.0%, respectively. Age, length of hospital stay, respiratory dysfunction, hospitalisation duration > 30 days and IC due to C albicans and Candida glabrata were associated with neonatal mortality (P < 0.05) according to univariate analyses. Respiratory dysfunction [odds ratio (OR), 50.03; 95% confidence interval (CI), 3.47-721.44; P = 0.004] was the only independent predictor of neonatal mortality. The overall mortality rate was 8.1%, and only neonatal IC patients died, with a neonatal mortality rate of 13.0%. CONCLUSIONS This report shows that the incidence and mortality of IC among neonatal patients warrants increased attention in Southwest China. Clinical interventions should be actively applied to reduce the incidence and mortality of neonatal infection. Fluconazole was a reasonable choice for the treatment of IC prior to species identification.
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Affiliation(s)
- Zhangrui Zeng
- Department of Laboratory Medicine, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Gang Tian
- Department of Laboratory Medicine, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yinhuan Ding
- Department of Laboratory Medicine, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Kui Yang
- Department of Laboratory Medicine, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jian Deng
- Department of Laboratory Medicine, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jinbo Liu
- Department of Laboratory Medicine, Affiliated Hospital of Southwest Medical University, Luzhou, China
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Pakshir K, Badali H, Nami S, Mirzaei H, Ebrahimzadeh V, Morovati H. Interactions between immune response to fungal infection and microRNAs: The pioneer tuners. Mycoses 2019; 63:4-20. [PMID: 31597205 DOI: 10.1111/myc.13017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 12/12/2022]
Abstract
Due to their physiological and biological characteristics, numerous fungi are potentially emerging pathogens. Active dynamicity of fungal pathogens causes life-threatening infections annually impose high costs to the health systems. Although immune responses play crucial roles in controlling the fate of fungal infections, immunocompromised patients are at high risk with high mortality. Tuning the immune response against fungal infections might be an effective strategy for controlling and reducing the pathological damages. MicroRNAs (miRNAs) are known as the master regulators of immune response. These single-stranded tuners (18-23 bp non-coding RNAs) are endogenously expressed by all metazoan eukaryotes and have emerged as the master gene expression controllers of at least 30% human genes. In this review article, following the review of biology and physiology (biogenesis and mechanism of actions) of miRNAs and immune response against fungal infections, the interactions between them were scrutinised. In conclusion, miRNAs might be considered as one of the potential goals in immunotherapy for fungal infections. Undoubtedly, advanced studies in this field, further identifying of miRNA roles in governing the immune response, pave the way for inclusion of miRNA-related immunotherapeutic in the treatment of life-threatening fungal infections.
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Affiliation(s)
- Keyvan Pakshir
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Badali
- Invasive Fungi Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.,Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Sanam Nami
- Department of Medical Mycology and Parasitology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamed Mirzaei
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Veghar Ebrahimzadeh
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Morovati
- Department of Medical Mycology and Parasitology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.,Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Aslan N, Yildizdas D, Alabaz D, Horoz OO, Yontem A, Kocabas E. Invasive Candida Infections in a Pediatric Intensive Care Unit in Turkey: Evaluation of an 11-Year Period. J Pediatr Intensive Care 2019; 9:21-26. [PMID: 31984153 DOI: 10.1055/s-0039-1695061] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/13/2019] [Indexed: 12/27/2022] Open
Abstract
The aim of this study was to evaluate the Candida species, predisposing factors, antifungal treatment approaches, and clinical outcomes of invasive Candida infections (ICIs) in a tertiary pediatric intensive care unit (PICU). A retrospective study was performed from January 2008 to January 2019 including 102 children with ICIs who were admitted to a university hospital in southeastern Turkey. Positive blood cultures were detected in 43 (42.1%) patients, and positive urine cultures were detected in 59 (57.8%). According to our results, Candida albicans (42.2%) was the most common species for all isolates followed by C. parapsilosis (17.6%). In our patient population, non- albicans Candida species were dominant (57.8%) in all isolates. The most common facilitating factor in our study was the use of mechanical ventilator support (87.3%). The mortality rate of our patients with ICIs was 13.7%. Candida albicans was found to have the highest mortality rate among all Candida species (30.7%). When we compared patients with C. albicans and those with non- albicans Candida species in terms of risk factors, we detected a significant difference between the two groups for total parenteral nutrition use ( p = 0.027). Fluconazole was the most preferred (58.8%) treatment option in our PICU for ICIs. Our results showed an increased trend in micafungin use in recent years. ICIs are a significant problem due to the high mortality and morbidity rates in critically ill pediatric patients in PICUs. In recent years, an increase in Candida infections caused by non- albicans Candida species has been reported. Multicenter prospective studies are needed to determine the risk factors for ICIs.
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Affiliation(s)
- Nagehan Aslan
- Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Dincer Yildizdas
- Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Derya Alabaz
- Department of Pediatric Infectious Disease, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Ozden Ozgur Horoz
- Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Ahmet Yontem
- Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Emine Kocabas
- Department of Pediatric Infectious Disease, Cukurova University Faculty of Medicine, Adana, Turkey
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Noni M, Stathi A, Vaki I, Velegraki A, Zachariadou L, Michos A. Changing Epidemiology of Invasive Candidiasis in Children during a 10-Year Period. J Fungi (Basel) 2019; 5:jof5010019. [PMID: 30813283 PMCID: PMC6462917 DOI: 10.3390/jof5010019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 02/15/2019] [Accepted: 02/21/2019] [Indexed: 11/16/2022] Open
Abstract
Candida species are a common cause of invasive infection in neonates and children. The aim of our study was to evaluate the epidemiology and microbiology of invasive candidiasis (IC) in the largest tertiary Greek pediatric hospital during a 10-year period. A retrospective cohort study was performed from January 2008 to December 2017. Identification of species and antifungal susceptibility testing was performed according to the Clinical and Laboratory Standards Institute (CLSI) methodology. During the study period, 178 cases of IC were recorded. The tissue distribution included blood (87.1%), cerebrospinal (7.9%), peritoneal (3.9%) and pleural fluids (1.1%). Candida albicans and Candida parapsilosis (sensu lato) were the most frequently isolated species (47.8% and 28.7% respectively). From period 2008⁻2012 to period 2013⁻2017, a significant decrease in IC rates was detected (0.21 cases/1000 hospitalization days VS 0.11 cases/1000 hospitalization days, P = 0.040), while median minimum inhibitory concentrations (MICs) of amphotericin B were significantly increased for both C. albicans and C. parapsilosis (sl) (P = 0.037 and P = 0.004 respectively). The decrease in IC rates may reflect the increased awareness as well as the effective infection control initiatives and antifungal interventions. However, the significant increase in the MICs for amphotericin B and echinocandins such as caspofungin, raises concerns about their common use as first-line treatment. Epidemiologic monitoring is, therefore, critically important in order to evaluate and optimize therapeutic protocols for IC in pediatric populations.
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Affiliation(s)
- Maria Noni
- First Department of Pediatrics, Division of Infectious Diseases, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, 115 27 Athens, Greece.
| | - Angeliki Stathi
- Department of Microbiology, "Aghia Sophia" Children's Hospital, 115 27 Athens, Greece.
| | - Ilia Vaki
- First Department of Pediatrics, Division of Infectious Diseases, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, 115 27 Athens, Greece.
| | - Aristea Velegraki
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece.
| | - Levantia Zachariadou
- Department of Microbiology, "Aghia Sophia" Children's Hospital, 115 27 Athens, Greece.
| | - Athanasios Michos
- First Department of Pediatrics, Division of Infectious Diseases, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, 115 27 Athens, Greece.
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13
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The Role of Antifungals in Pediatric Critical Care Invasive Fungal Infections. Crit Care Res Pract 2018; 2018:8469585. [PMID: 30595916 PMCID: PMC6282141 DOI: 10.1155/2018/8469585] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/20/2018] [Accepted: 10/30/2018] [Indexed: 12/11/2022] Open
Abstract
Invasive fungal infections (IFIs) have seen considerable increase in pediatric intensive care units over the past several decades. IFIs are predominantly caused by Candida species, and candidemia is the third most common cause of healthcare-associated bloodstream infections (BSIs) in children. IFIs are opportunistic infections that affect pediatric patients in critical care resulting in significant morbidity and mortality especially in those with a compromised immune system. IFIs are the leading cause of death in children with comorbidities such as immunosuppression, and pediatric ICU admission has been shown to be an independent risk factor for mortality. Management of IFI and fungal sepsis is broad and encompasses several key components that include prompt initiation of therapy and rapid source identification and control. This study reviews important antifungals in the pediatric critical care setting including the pharmacologic properties, antifungal spectrum, adverse effects, and clinical uses of agents belonging to the four major classes of antifungals—the polyenes, azoles, echinocandins, and pyrimidine analogue flucytosine. The polyenes and azoles are the most often used classes of antifungals. The echinocandins are a relatively newer class of antifungal agents that offer excellent Candida activity and are currently recommended as the first-line therapy for invasive candidiasis.
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14
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Abstract
Considerable progress has been made in the prevention, diagnosis, and management of pediatric patients with invasive fungal disease (IFD). The reported decreasing trend in the incidence of invasive candidiasis (IC) over the past 15 years in both neonates and children has been encouraging. Nevertheless, due to the growing number of immunocompromised children at risk for IFD, this disease continues to be associated with significant morbidity and death and with increased financial burden to the health care system. Therefore, it is important to understand the contemporary epidemiology of IFD. Incidence rates of IFD in children are affected by geographical, population, and time variability. There is an ongoing effort to constantly document and update the incidence of IFD and species distribution among different pediatric populations as a means to direct preventative, diagnostic, and therapeutic resources to the most appropriate subset of patients. Children with a hematologic malignancy or a primary or secondary immunodeficiency, those undergoing solid organ or hematopoietic stem cell transplantation, and premature neonates are the major subsets of pediatric patients at risk of developing IFD. In this review, we focus on fungal disease epidemiology with a specific emphasis on the 2 most common pediatric IFDs, IC and invasive aspergillosis (IA).
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Affiliation(s)
- Zoi Dorothea Pana
- Hospital Epidemiology and Infection Control Department (HEIC), Division of Infectious Diseases, Johns Hopkins Hospital, Baltimore, Maryland
- Third Department of Paediatrics, Infectious Diseases Unit, Aristotle University School of Medicine, Hippokration General Hospital, Thessaloniki, Greece
| | - Emmanuel Roilides
- Third Department of Paediatrics, Infectious Diseases Unit, Aristotle University School of Medicine, Hippokration General Hospital, Thessaloniki, Greece
| | - Adilia Warris
- Aberdeen Fungal Group, MRC Centre for Medical Mycology, Institute of Medical Sciences and the Royal Aberdeen Children’s Hospital, University of Aberdeen, United Kingdom
| | - Andreas H Groll
- Center for Bone Marrow Transplantation and Department of Paediatric Hematology and Oncology, Infectious Disease Research Program, University Children’s Hospital, Muenster, Germany
| | - Theoklis Zaoutis
- Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness Research, Children’s Hospital of Philadelphia, Pennsylvania; and
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia
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15
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King J, Pana ZD, Lehrnbecher T, Steinbach WJ, Warris A. Recognition and Clinical Presentation of Invasive Fungal Disease in Neonates and Children. J Pediatric Infect Dis Soc 2017; 6:S12-S21. [PMID: 28927201 PMCID: PMC5907856 DOI: 10.1093/jpids/pix053] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Invasive fungal diseases (IFDs) are devastating opportunistic infections that result in significant morbidity and death in a broad range of pediatric patients, particularly those with a compromised immune system. Recognizing them can be difficult, because nonspecific clinical signs and symptoms or isolated fever are frequently the only presenting features. Therefore, a high index of clinical suspicion is necessary in patients at increased risk of IFD, which requires knowledge of the pediatric patient population at risk, additional predisposing factors within this population, and the clinical signs and symptoms of IFD. With this review, we aim to summarize current knowledge regarding the recognition and clinical presentation of IFD in neonates and children.
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Affiliation(s)
- Jill King
- Aberdeen Fungal Group, Medical Research Council Centre for Medical Mycology, Institute of Medical Sciences, University of Aberdeen, and the Royal Aberdeen Children’s Hospital, United Kingdom
| | - Zoi-Dorothea Pana
- Hospital Epidemiology and Infection Control, Division of Infectious Diseases, Johns Hopkins Hospital, Baltimore, Maryland
| | - Thomas Lehrnbecher
- Division of Paediatric Haematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany; and
| | - William J Steinbach
- Division of Pediatric Infectious Diseases, Department of Pediatrics, and Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, North Carolina
| | - Adilia Warris
- Aberdeen Fungal Group, Medical Research Council Centre for Medical Mycology, Institute of Medical Sciences, University of Aberdeen, and the Royal Aberdeen Children’s Hospital, United Kingdom
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Szmigielska A, Krzemień G. [Sterile leukocyturia - difficult diagnostic problem in children]. DEVELOPMENTAL PERIOD MEDICINE 2017; 21. [PMID: 28796985 PMCID: PMC8522970 DOI: 10.34763/devperiodmed.20172102.139143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Sterile leukocyturia is an important and difficult clinical problem in children. In this paper, we described the most common nephrologic causes of sterile leukocyturia, including infectious, non-infectious and extrarenal etiology. We stressed an the importance of appropriate urine collection for urinalysis. There is a need for treatment of inflammation and also for diagnosis of potential anomalies of urethral orifice as causes of sterile leukocyturia in children.
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Affiliation(s)
- Agnieszka Szmigielska
- Katedra i Klinika Pediatrii i Nefrologii, Warszawski UniwersytetMedyczny, Polska,Agnieszka Szmigielska Katedra i Klinika Pediatrii i Nefrologii, Warszawski Uniwersytet Medyczny ul. Żwirki i Wigury 63a Warsaw, Poland tel. (22) 317-96-56 fax (22) 317-99-54
| | - Grażyna Krzemień
- Katedra i Klinika Pediatrii i Nefrologii, Warszawski UniwersytetMedyczny, Polska
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