1
|
De Gaetano S, Midiri A, Mancuso G, Avola MG, Biondo C. Candida auris Outbreaks: Current Status and Future Perspectives. Microorganisms 2024; 12:927. [PMID: 38792757 PMCID: PMC11123812 DOI: 10.3390/microorganisms12050927] [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: 04/02/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024] Open
Abstract
Candida auris has been identified by the World Health Organization (WHO) as a critical priority pathogen on its latest list of fungi. C. auris infections are reported in the bloodstream and less commonly in the cerebrospinal fluid and abdomen, with mortality rates that range between 30% and 72%. However, no large-scale epidemiology studies have been reported until now. The diagnosis of C. auris infections can be challenging, particularly when employing conventional techniques. This can impede the early detection of outbreaks and the implementation of appropriate control measures. The yeast can easily spread between patients and in healthcare settings through contaminated environments or equipment, where it can survive for extended periods. Therefore, it would be desirable to screen patients for C. auris colonisation. This would allow facilities to identify patients with the disease and take appropriate prevention and control measures. It is frequently unsusceptible to drugs, with varying patterns of resistance observed among clades and geographical regions. This review provides updates on C. auris, including epidemiology, clinical characteristics, genomic analysis, evolution, colonisation, infection, identification, resistance profiles, therapeutic options, prevention, and control.
Collapse
Affiliation(s)
| | | | | | | | - Carmelo Biondo
- Mycology Laboratory, Department of Human Pathology, University of Messina, 98125 Messina, Italy; (S.D.G.); (A.M.); (G.M.); (M.G.A.)
| |
Collapse
|
2
|
Melinte V, Tudor AD, Bujoi AG, Radu MA, Văcăriou MC, Cismaru IM, Holban TS, Mîrzan CL, Popescu R, Ciupan RC, Baciu A, Moraru OE, Popa-Cherecheanu M, Gheorghiță V. Candida auris Outbreak in a Multidisciplinary Hospital in Romania during the Post-Pandemic Era: Potential Solutions and Challenges in Surveillance and Epidemiological Control. Antibiotics (Basel) 2024; 13:325. [PMID: 38667001 PMCID: PMC11047361 DOI: 10.3390/antibiotics13040325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/29/2024] Open
Abstract
Candida auris is a newly emerging yeast, which is raising public health concerns due to its outbreak potential, lack of protocols for decontamination and isolation of patients or contacts, increased resistance to common antifungals, and associated high mortality. This research aimed to describe the challenges related to identifying the outbreak, limiting further contamination, and treating affected individuals. We retrospectively analyzed all cases of C. auris detected between October 2022 and August 2023, but our investigation focused on a three-month-long outbreak in the department of cardio-vascular surgery and the related intensive care unit. Along with isolated cases in different wards, we identified 13 patients who became infected or colonized in the same area and time, even though the epidemiological link could only be traced in 10 patients, according to the epidemiologic investigation. In conclusion, our study emphasizes the substantial challenge encountered in clinical practice when attempting to diagnose and limit the spread of an outbreak. Therefore, it is crucial to promptly apply contact precaution measures and appropriate environmental cleaning, from the first positive case detected.
Collapse
Affiliation(s)
- Violeta Melinte
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.-A.R.); (O.E.M.); (M.P.-C.); (V.G.)
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
| | - Alexandra Daniela Tudor
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
| | - Adrian Georgian Bujoi
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
| | - Maria-Adelina Radu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.-A.R.); (O.E.M.); (M.P.-C.); (V.G.)
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
| | - Maria Cristina Văcăriou
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
| | - Ioana Miriana Cismaru
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
| | - Tiberiu Sebastian Holban
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
| | - Carmen Luminița Mîrzan
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
| | - Ruxandra Popescu
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
| | - Robert Cătălin Ciupan
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
| | - Alin Baciu
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
| | - Oriana Elena Moraru
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.-A.R.); (O.E.M.); (M.P.-C.); (V.G.)
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
| | - Matei Popa-Cherecheanu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.-A.R.); (O.E.M.); (M.P.-C.); (V.G.)
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
| | - Valeriu Gheorghiță
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.-A.R.); (O.E.M.); (M.P.-C.); (V.G.)
- “Agrippa Ionescu” Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.D.T.); (A.G.B.); (M.C.V.); (I.M.C.); (T.S.H.); (C.L.M.); (R.P.); (R.C.C.); (A.B.)
| |
Collapse
|
3
|
Santana DJ, Zhao G, O’Meara TR. The many faces of Candida auris: Phenotypic and strain variation in an emerging pathogen. PLoS Pathog 2024; 20:e1012011. [PMID: 38427609 PMCID: PMC10906884 DOI: 10.1371/journal.ppat.1012011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024] Open
Abstract
Candida auris is an emerging fungal pathogen with unusual evolutionary history-there are multiple distinct phylogeographic clades showing a near simultaneous transition from a currently unknown reservoir to nosocomial pathogen. Each of these clades has experienced different selective pressures over time, likely resulting in selection for genotypes with differential fitness or phenotypic consequences when introduced to new environments. We also observe diversification within clades, providing additional opportunities for phenotypic differences. These differences can have large impacts on pathogenic potential, drug resistance profile, evolutionary trajectory, and transmissibility. In recent years, there have been significant advances in our understanding of strain-specific behavior in other microbes, including bacterial and fungal pathogens, and we have an opportunity to take this strain variation into account when describing aspects of C. auris biology. Here, we critically review the literature to gain insight into differences at both the strain and clade levels in C. auris, focusing on phenotypes associated with clinical disease or transmission. Our goal is to integrate clinical and epidemiological perspectives with molecular perspectives in a way that would be valuable for both audiences. Identifying differences between strains and understanding which phenotypes are strain specific will be crucial for understanding this emerging pathogen, and an important caveat when describing the analysis of a singular isolate.
Collapse
Affiliation(s)
- Darian J. Santana
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
| | - Guolei Zhao
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Teresa R. O’Meara
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| |
Collapse
|
4
|
Ma Z, Ensley HE, Graves B, Kruppa MD, Rice PJ, Lowman DW, Williams DL. Synthesis of a unique mannose α-1-phosphate side chain moiety found in Candida auris cell wall mannan. Carbohydr Res 2024; 537:109059. [PMID: 38408423 PMCID: PMC10957239 DOI: 10.1016/j.carres.2024.109059] [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: 12/29/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/28/2024]
Abstract
Candida auris is an emerging fungal pathogen that has become a world-wide public health threat. While there have been numerous studies into the nature, composition and structure of the cell wall of Candida albicans and other Candida species, much less is known about the C. auris cell wall. We have shown that C. auris cell wall mannan contains a unique phosphomannan structure which distinguishes C. auris mannan from the mannans found in other fungal species. Specifically, C. auris exhibits two unique acid-labile mannose α-1-phosphate (Manα1PO4) sidechains that are absent in other fungal mannans and fungal pathogens. This unique mannan structural feature presents an opportunity for the development of vaccines, therapeutics, diagnostic tools and/or research reagents that target C. auris. Herein, we describe the successful synthesis and structural characterization of a Manα1PO4-containing disaccharide moiety that mimics the phosphomannan found in C. auris. Additionally, we present evidence that the synthetic Manα1PO4 glycomimetic is specifically recognized and bound by cell surface pattern recognition receptors, i.e. rhDectin-2, rhMannose receptor and rhMincle, that are known to play important roles in the innate immune response to C. auris as well as other fungal pathogens. The synthesis of the Manα1PO4 glycomimetic may represent an important starting point in the development of vaccines, therapeutics, diagnostics and research reagents which target a number of C. auris clinical strains. In addition, these data provide new insights and understanding into the structural biology of this unique fungal pathogen.
Collapse
Affiliation(s)
- Zuchao Ma
- Departments of Surgery, East Tennessee State University, Johnson City, TN, USA; Drug Discovery and Synthesis Core, East Tennessee State University, Johnson City, TN, USA; Center for Inflammation, Infectious Disease and Immunity, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA.
| | - Harry E Ensley
- Departments of Surgery, East Tennessee State University, Johnson City, TN, USA; Drug Discovery and Synthesis Core, East Tennessee State University, Johnson City, TN, USA; Center for Inflammation, Infectious Disease and Immunity, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Bridget Graves
- Departments of Surgery, East Tennessee State University, Johnson City, TN, USA; Center for Inflammation, Infectious Disease and Immunity, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Michael D Kruppa
- Biomedical Sciences, East Tennessee State University, Johnson City, TN, USA; Center for Inflammation, Infectious Disease and Immunity, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Peter J Rice
- Center for Inflammation, Infectious Disease and Immunity, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA; Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - Douglas W Lowman
- Departments of Surgery, East Tennessee State University, Johnson City, TN, USA; Drug Discovery and Synthesis Core, East Tennessee State University, Johnson City, TN, USA; Center for Inflammation, Infectious Disease and Immunity, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - David L Williams
- Departments of Surgery, East Tennessee State University, Johnson City, TN, USA; Drug Discovery and Synthesis Core, East Tennessee State University, Johnson City, TN, USA; Center for Inflammation, Infectious Disease and Immunity, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| |
Collapse
|
5
|
Omardien S, Teska P. Skin and hard surface disinfection against Candida auris - What we know today. Front Med (Lausanne) 2024; 11:1312929. [PMID: 38384416 PMCID: PMC10879571 DOI: 10.3389/fmed.2024.1312929] [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: 10/12/2023] [Accepted: 01/05/2024] [Indexed: 02/23/2024] Open
Abstract
Candida auris has emerged as a global healthcare threat, displaying resistance to important healthcare antifungal therapies. Infection prevention and control protocols have become paramount in reducing transmission of C. auris in healthcare, of which cleaning and disinfection plays an important role. Candida albicans is used as a surrogate yeast for yeasticidal claims of disinfection products, but reports have been made that sensitivity to disinfectants by C. auris differs from its surrogate. In this review, we aimed to compile the information reported for products used for skin and hard surface disinfection against C. auris in its planktonic or biofilm form. A comparison was made with other Candida species, and information were gathered from laboratory studies and observations made in healthcare settings.
Collapse
Affiliation(s)
| | - Peter Teska
- Diversey Holdings Ltd., Fort Mill, SC, United States
| |
Collapse
|
6
|
Elgammal Y, Salama EA, Seleem MN. Enhanced antifungal activity of posaconazole against Candida auris by HIV protease inhibitors, atazanavir and saquinavir. Sci Rep 2024; 14:1571. [PMID: 38238403 PMCID: PMC10796399 DOI: 10.1038/s41598-024-52012-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/12/2024] [Indexed: 01/22/2024] Open
Abstract
The increasing incidence and dissemination of multidrug-resistant Candida auris represents a serious global threat. The emergence of pan-resistant C. auris exhibiting resistance to all three classes of antifungals magnifies the need for novel therapeutic interventions. We identified that two HIV protease inhibitors, atazanavir and saquinavir, in combination with posaconazole exhibited potent activity against C. auris in vitro and in vivo. Both atazanavir and saquinavir exhibited a remarkable synergistic activity with posaconazole against all tested C. auris isolates and other medically important Candida species. In a time-kill assay, both drugs restored the fungistatic activity of posaconazole, resulting in reduction of 5 and 5.6 log10, respectively. Furthermore, in contrast to the individual drugs, the two combinations effectively inhibited the biofilm formation of C. auris by 66.2 and 81.2%, respectively. Finally, the efficacy of the two combinations were tested in a mouse model of C. auris infection. The atazanavir/posaconazole and saquinavir/posaconazole combinations significantly reduced the C. auris burden in mice kidneys by 2.04- (99.1%) and 1.44-log10 (96.4%) colony forming unit, respectively. Altogether, these results suggest that the combination of posaconazole with the HIV protease inhibitors warrants further investigation as a new therapeutic regimen for the treatment of C. auris infections.
Collapse
Affiliation(s)
- Yehia Elgammal
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, 1410 Prices Fork Rd, Blacksburg, VA, 24061, USA
- Center for One Health Research, Virginia Polytechnic Institute and State University, Blacksburg, VA, 24061, USA
| | - Ehab A Salama
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, 1410 Prices Fork Rd, Blacksburg, VA, 24061, USA
- Center for One Health Research, Virginia Polytechnic Institute and State University, Blacksburg, VA, 24061, USA
| | - Mohamed N Seleem
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, 1410 Prices Fork Rd, Blacksburg, VA, 24061, USA.
- Center for One Health Research, Virginia Polytechnic Institute and State University, Blacksburg, VA, 24061, USA.
| |
Collapse
|
7
|
Lee EH, Choi MH, Lee KH, Kim D, Jeong SH, Song YG, Han SH. Intrahospital transmission and infection control of Candida auris originating from a severely infected COVID-19 patient transferred abroad. J Hosp Infect 2024; 143:140-149. [PMID: 37939883 DOI: 10.1016/j.jhin.2023.10.017] [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: 08/04/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Intrahospital spread of Candida auris, which survives tenaciously in many environments, can cause sustained colonization and infection. A large outbreak of C. auris was experienced in the intensive care units (ICUs) at the study hospital during the coronavirus disease 2019 (COVID-19) pandemic. METHODS The index patient with severe COVID-19, who was transferred from Vietnam in January 2022, developed C. auris candidaemia 10 days after hospitalization. From mid-June 2022 to January 2023, strengthened infection prevention and control (IPC) measures were implemented in three ICUs: (1) contact precautions and isolation (CPI) for C. auris-positive cases; (2) surveillance cultures including point-prevalence (N=718) for patients or close contacts or ICU-resident healthcare workers (HCWs); (3) intensive environmental disinfection with 10-fold diluted bleach; and (4) 2% chlorhexidine bathing for all ICU patients. Environmental cultures (ECx) on surfaces and shared objects (N=276) were conducted until early September 2022, when all ECx were negative. RESULTS Among 53 C. auris-positive patients between February 2022 and January 2023, invasive infections resulted in seven cases of candidaemia and one case of pneumonia. C. auris was isolated from reusable tympanic thermometers (TTMs) contaminated with earwax. The isolation rate of C. auris in ECx decreased from 6.8% in June 2022 to 2.0% in August 2022, and was no longer detected in TTMs. Colonization in HCWs was remarkably rare (0.5%). The number of C. auris-positive patients peaked in July (N=10) then decreased gradually. By January 2023, no C. auris were isolated in the ICU. CONCLUSION Aggressive IPC measures with CPI, ECx and surveillance, decontamination of TTMs, and bathing were effective in successfully controlling this C. auris outbreak.
Collapse
Affiliation(s)
- E H Lee
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - M H Choi
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - K H Lee
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - D Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - S H Jeong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Y G Song
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - S H Han
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
8
|
Erturk Sengel B, Ekren BY, Sayin E, Tukenmez Tigen E, Seydaliyeva A, Cerikcioglu N, Cinel I, Korten V, Sezerman U, Odabasi Z. Nosocomial infection of C. auris in COVID-19 Intensive Care Unit in Türkiye and Phylogenetic Analysis of Isolates. Mycopathologia 2023; 188:765-773. [PMID: 37542203 DOI: 10.1007/s11046-023-00782-6] [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: 05/05/2023] [Accepted: 07/25/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND The difficulties in the identification of C. auris and the delays in the implementation of infection control precautions contribute to outbreaks. This study analyzed 10 patients with COVID-19 and C. auris candidemia, their characteristic and clinical features and phylogenetic features, and the antifungal susceptibilities of the isolates. METHOD C. auris were detected in the COVID-19 ICU of a university hospital between January and August 2021. Identification to species level was performed using MALDI-TOF MS. Antifungal susceptibilities were determined by the Sensititre YeastOne YO10 panel. The isolates were whole genome sequenced to assess genetic relatedness and a phylogenetic tree was drawn including various C. auris clades. RESULTS The mean growth time in blood cultures was 38.8 h. C. auris candidemia developed on the average 27th day of ICU admission. All were susceptible to anidulafungin and micafungin, while they were resistant to fluconazole and amphotericin B. Only three isolates were found to be resistant to caspofungin. All patients died. With the WGS method, all isolates were found in a close resemblance to each other in terms of total nucleotide similarity (with a minimum of 96% pairwise alignment). Our isolates showed the closest similarity to South Asian clade (Clade I). CONCLUSIONS This study is the first to evaluate the phylogenetic characteristics of C. auris using WGS and to determine antifungal susceptibilities in Türkiye on COVID-19 patients. The mortality rate was very high in patients who have both COVID-19 and C. auris candidemia.
Collapse
Affiliation(s)
- Buket Erturk Sengel
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Berkay Yekta Ekren
- Institute of Health Sciences, Department of Biostatistics and Bioinformatics, Acibadem University, Istanbul, Turkey
| | - Elvan Sayin
- Department of Medical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Elif Tukenmez Tigen
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Aytan Seydaliyeva
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Nilgun Cerikcioglu
- Department of Medical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ismail Cinel
- Department of Anesthesiology and Reanimation, Critical Care, Marmara University School of Medicine, Istanbul, Turkey
| | - Volkan Korten
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ugur Sezerman
- Institute of Health Sciences, Department of Biostatistics and Bioinformatics, Acibadem University, Istanbul, Turkey
| | - Zekaver Odabasi
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| |
Collapse
|
9
|
Grimmeisen M, Jessen-Trefzer C. Increasing the Selectivity of Light-Active Antimicrobial Agents - Or How To Get a Photosensitizer to the Desired Target. Chembiochem 2023; 24:e202300177. [PMID: 37132365 DOI: 10.1002/cbic.202300177] [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: 03/03/2023] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 05/04/2023]
Abstract
Photosensitizers combine the inherent reactivity of reactive oxygen species with the sophisticated reaction control of light. Through selective targeting, these light-active molecules have the potential to overcome certain limitations in drug discovery. Ongoing advances in the synthesis and evaluation of photosensitizer conjugates with biomolecules such as antibodies, peptides, or small-molecule drugs are leading to increasingly powerful agents for the eradication of a growing number of microbial species. This review article, therefore, summarizes challenges and opportunities in the development of selective photosensitizers and their conjugates described in recent literature. This provides adequate insight for newcomers and those interested in this field.
Collapse
Affiliation(s)
- Michael Grimmeisen
- University of Freiburg, Faculty of Chemistry and Pharmacy, Institute of Organic Chemistry, Albertstraße 21, 79104, Freiburg im Breisgau, Germany
| | - Claudia Jessen-Trefzer
- University of Freiburg, Faculty of Chemistry and Pharmacy, Institute of Organic Chemistry, Albertstraße 21, 79104, Freiburg im Breisgau, Germany
| |
Collapse
|
10
|
Kaki R. Risk factors and mortality of the newly emerging Candida auris in a university hospital in Saudi Arabia. Mycology 2023; 14:256-263. [PMID: 37583454 PMCID: PMC10424598 DOI: 10.1080/21501203.2023.2227218] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/14/2023] [Indexed: 08/17/2023] Open
Abstract
Candida auris presents a global health threat. We investigated risk factors and mortality of Candida auris infections in a retrospective study in Saudi Arabia. We included 27 patients ≥14 with invasive Candida auris from 2015-2022, with median age 58, and 66.7% males. All patients had indwelling devices. The most common infection sources were central line-associated bloodstream infection in 17 (63.0%), and urinary tract infections in four (12%). Fever and shock were observed in nine patients (33.3%) each, and 22 (81%) were admitted to the intensive care unit. Common comorbidities were diabetes and heart disease in 13 (48.1%) patients each. The median hospital stay was 78 days, and the median Charlson index was 4. The C. auris cultures were 100% susceptible to voriconazole, caspofungin, and amphotericin, while three were fully susceptible to fluconazole (11.1%). Despite treatment, 18 (66.7%) patients died. In conclusion, invasive C. auris infection had varied presentations. All patients had indwelling devices, and many had lengthy hospital stays. All isolates were susceptible to amphotericin and echinocandins, while few were fully susceptible to fluconazole.
Collapse
Affiliation(s)
- Reham Kaki
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Infectious Disease & Infection Control and Environmental Health, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| |
Collapse
|
11
|
Ortiz-Roa C, Valderrama-Rios MC, Sierra-Umaña SF, Rodríguez JY, Muñetón-López GA, Solórzano-Ramos CA, Escandón P, Alvarez-Moreno CA, Cortés JA. Mortality Caused by Candida auris Bloodstream Infections in Comparison with Other Candida Species, a Multicentre Retrospective Cohort. J Fungi (Basel) 2023; 9:715. [PMID: 37504704 PMCID: PMC10381160 DOI: 10.3390/jof9070715] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/29/2023] Open
Abstract
Candida auris is an emerging pathogen considered to be critical in the World Health Organization fungal organisms list. The study aims to determine the mortality and hospital stays attributed to Candida auris (C. auris) compared to other Candida species in adult patients with candidemia. A retrospective cohort of adults with candidemia was examined from seven centres in Colombia between 2016 and 2021. The primary outcome was 30-day mortality, and the secondary outcome was the length of hospital stay among survivors. Adjustment of the confounding variables was performed using inverse probability weights of exposure propensity score (candidemia by C. auris), survival regression models (Weibull distribution), and a counting model (negative binomial distribution). A value of 244 (47.6%) of the 512 patients with candidemia died within the first 30 days. The crude mortality in C. auris was 38.1% vs. 51.1% in Candida non-auris (CNA). In the Weibull model, mortality in the C. auris group was lower (adjusted HR: aHR- 0.69, 95% CI: 0.53-0.90). Antifungal treatment also decreased mortality, with an aHR of 0.36 (95% CI 0.27-0.47), while the presence of septic shock on patient progression increased it, with an aHR of 1.73 (95% CI 1.41-2.13). Among the patients who survived, no differences in the length of hospital stay were observed between the C. auris and the CNA groups, with an incidence rate ratio of 0.92 (95% CI: 0.68-1.22). Mortality in patients with C. auris bloodstream infections appears lower when adjusted for numerous confounding variables regarding treatment and the presence of septic shock in patient progression. We identified no significant effect of C. auris on the length of hospital stay in surviving patients.
Collapse
Affiliation(s)
- Cynthia Ortiz-Roa
- Department of Internal Medicine, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá 111321, Colombia
| | | | | | - José Yesid Rodríguez
- Clínica Integral de Emergencias Laura Daniela, Instituto Cardiovascular del Cesar, Centro de Investigaciones Microbiológicas del Cesar (CIMCE), Valledupar 200001, Colombia
| | | | | | - Patricia Escandón
- Grupo de Microbiología, Instituto Nacional de Salud, Bogotá 111321, Colombia
| | | | - Jorge Alberto Cortés
- Department of Internal Medicine, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá 111321, Colombia
- Infectious Diseases Unit, Hospital Universitario Nacional, Bgootá 111321, Colombia
| |
Collapse
|
12
|
Xu Z, Zhang L, Han R, Ding C, Shou H, Duan X, Zhang S. A Candidemia Case Caused by a Novel Drug-Resistant Candida auris with the Y132F Mutation in Erg11 in Mainland China. Infect Drug Resist 2023; 16:3065-3072. [PMID: 37222986 PMCID: PMC10202200 DOI: 10.2147/idr.s409708] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/10/2023] [Indexed: 05/25/2023] Open
Abstract
Background Candida auris is a pathogen first found in external ear canal, becoming a major threat to global health. Here, we describe a candidemia case caused by a novel drug-resistant Candida auris strain. Case Presentation An 80-year-old patient, with multiple serious medical conditions, was suffered from candidemia caused by Candida auris, died 9 days after admission in our hospital. Phylogenetic analysis indicates that this C. auris isolate (designated BJCA003) belongs to the South Asian clade, carries the Y132F mutation in the protein Erg11. And antibiotic susceptibility test indicated that BJCA003 is resistant to fluconazole and amphotericin B, not susceptible to caspofungin. In addition, this strain has multiple colony and cellular morphologies under different culture conditions. Conclusion Strain BJCA003 is a novel drug resistant C. auris strain in mainland China, the Y132F mutation in Erg11 may attribute to fluconazole-resistance, alarming that we still face more challenges about C. auris.
Collapse
Affiliation(s)
- Zhaoxia Xu
- Department of Clinical Laboratory, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Lei Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing, People’s Republic of China
| | - Ran Han
- Department of Clinical Laboratory, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Chengwei Ding
- Department of Clinical Laboratory, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Haochang Shou
- Department of Clinical Laboratory, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Xueguang Duan
- Department of Clinical Laboratory, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Shengwei Zhang
- Department of Clinical Laboratory, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| |
Collapse
|
13
|
D'Ambrosio F. Oral Mycobiome and COVID-19. Microorganisms 2023; 11:microorganisms11040982. [PMID: 37110405 PMCID: PMC10142434 DOI: 10.3390/microorganisms11040982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
The most common signs and symptoms of COVID-19 include fever, cough, dyspnea, conjunctivitis, diarrhea, and olfactory and gustatory disturbances [...].
Collapse
Affiliation(s)
- Francesco D'Ambrosio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| |
Collapse
|
14
|
Kley D. Reducing the Risk of Perioperative Transmission of Candida auris. AORN J 2023; 117:243-247. [PMID: 36971538 DOI: 10.1002/aorn.13900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 03/29/2023]
|
15
|
Di Vito M, Garzoli S, Rosato R, Mariotti M, Gervasoni J, Santucci L, Ovidi E, Cacaci M, Lombarini G, Torelli R, Urbani A, Sanguinetti M, Bugli F. A New Potential Resource in the Fight against Candida auris: the Cinnamomum zeylanicum Essential Oil in Synergy with Antifungal Drug. Microbiol Spectr 2023; 11:e0438522. [PMID: 36975835 PMCID: PMC10101117 DOI: 10.1128/spectrum.04385-22] [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: 10/27/2022] [Accepted: 03/10/2023] [Indexed: 03/29/2023] Open
Abstract
Candida auris is a multidrug-resistant fungus known to be a global public health problem. The skin-based transmission, together with the marked resistance to drugs, resulted in its rapid spread to all continents. The aim of this study was to identify an essential oil (EO) active in the fight against C. auris. A total of 15 EOs were tested against 10 clinical strains of C. auris. Cinnamomum zeylanicum EO (CZ-EO) was the most effective (MIC90 and MFC90 equal to 0.06% vol/vol). Three fractions obtained from CZ-EO, and the cinnamaldehyde (CIN), the major chemical compound, were tested to identify the principal compound effectives against C. auris. All CIN-containing samples showed anti-fungal activity. To study the synergy with fluconazole, CZ-EO, its active fraction (FR2), and CIN were tested in checkerboard tests. Results show that CZ-EO and FR2, but not CIN, synergize with fluconazole. Furthermore, only the copresence of CZ-EO or FR2 synergize with fluconazole at therapeutic concentrations of the drug (0.45 ± 0.32 μg/mL and 0.64 ± 0.67 μg/mL, respectively), while CIN only shows additive activity. In vivo studies conducted on Galleria mellonella larvae show the absence of toxicity of CZ-EO up to concentrations of 16% vol/vol, and the ability of CZ-EO to reactivate the efficacy of fluconazole when formulated at synergic concentrations. Finally, biochemical tests were made to study the mechanism of action of CZ-EO. These studies show that in the presence of both fluconazole and CZ-EO, the activity of fungal ATPases decreases and, at the same time, the amount of intracellular drug increases. IMPORTANCE This study highlights how small doses of CZ-EO are able to inhibit the secretion of fluconazole and promote its accumulation in the fungal cell. In this manner, the drug is able to exert its pharmacological effects bypassing the resistance of the yeast. If further studies will confirm this synergy, it will be possible to develop new therapeutic formulations active in the fight against C. auris resistances.
Collapse
Affiliation(s)
- M. Di Vito
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S. Garzoli
- Dipartimento di Chimica e Tecnologie del Farmaco, Università di Roma Sapienza, Rome, Italy
| | - R. Rosato
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M. Mariotti
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - J. Gervasoni
- UOC Chimica, Biochimica e Biologia Molecolare Clinica, Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - L. Santucci
- UOC Chimica, Biochimica e Biologia Molecolare Clinica, Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - E. Ovidi
- Department for Innovation in Biological, Agro-Food and Forest Systems DIBAF—University of Tuscia, Viterbo, Italy
| | - M. Cacaci
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G. Lombarini
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - R. Torelli
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A. Urbani
- UOC Chimica, Biochimica e Biologia Molecolare Clinica, Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - M. Sanguinetti
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - F. Bugli
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| |
Collapse
|
16
|
Codreanu SI, Ciurea CN. Candida spp. DNA Extraction in the Age of Molecular Diagnosis. Microorganisms 2023; 11:microorganisms11040818. [PMID: 37110241 PMCID: PMC10143247 DOI: 10.3390/microorganisms11040818] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
The standard procedure for the detection of candidemia is blood culture, a method that might require 3-5 days for a positive result. Compared with culturing, molecular diagnosis techniques can provide faster diagnosis. The current paper aimed to present the main strengths and constraints of current molecular techniques for Candida spp. DNA extraction, analyzing their efficiency from a time, price, and ease of usage point of view. A comprehensive search was conducted using the PubMed NIH database for peer-reviewed full-text articles published before October 2022. The studies provided adequate data on the diagnosis of the infection with the Candida spp. DNA extraction is a relevant step in yielding pure qualitative DNA to be amplified in molecular diagnostic techniques. The most used fungal DNA extraction strategies are: mechanical (bead beating, ultrasonication, steel-bullet beating), enzymatic (proteinase K, lysozyme, lyticase), and chemical extraction (formic acid, liquid nitrogen, ammonium chloride). More clinical studies are needed to formulate adequate guidelines for fungal DNA extraction as the current paper highlighted discrepancies in the reported outcome.
Collapse
Affiliation(s)
- Smaranda Ioana Codreanu
- Faculty of Medicine, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology of Târgu Mures, 38 Gheorghe Marinescu Street, 540139 Târgu Mures, Romania
| | - Cristina Nicoleta Ciurea
- Department of Microbiology, Faculty of Medicine, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology of Târgu Mures, 38 Gheorghe Marinescu Street, 540139 Târgu Mures, Romania
| |
Collapse
|
17
|
Marena GD, Carvalho GC, Dos Santos Ramos MA, Chorilli M, Bauab TM. Anti-Candida auris activity in vitro and in vivo of micafungin loaded nanoemulsions. Med Mycol 2023; 61:6847217. [PMID: 36427066 DOI: 10.1093/mmy/myac090] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/06/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022] Open
Abstract
Fungi are becoming increasingly resistant, especially the new strains. Therefore, this work developed nanoemulsions (NE) containing micafungin (MICA), in order to improve its action against infections caused by Candida auris. The NEs were composed of the surfactants polyoxyethylene (20) cetyl ether (Brij 58®)/soy phosphatidylcholine at 10%, sunflower oil/cholesterol at 10%, and 80% PBS. The NEs were characterized by Dynamic Light Scattering (DLS). For the microbiological in vitro evaluation the determination of the minimum inhibitory concentration (MIC), ergosterol/sorbitol, time kill and biofilms tests were performed. Additionally, the antifungal activity was also evaluated in a Galleria mellonella model. The same model was used in order to evaluate acute toxicity. The NE showed a size of ∼ 42.12 nm, a polydispersion index (PDI) of 0.289, and a zeta potential (ZP) of -3.86 mV. NEM had an average size of 41.29 nm, a PDI of 0.259, and a ZP of -4.71 mV. Finally, both nanoemulsions showed good stability in a storage period of 3 months. Although NEM did not show activity in planktonic cells, it exhibited action against biofilm and in the in vivo infection model. In the alternative in vivo model assay, it was possible to observe that both, NEM and free MICA at 0.2 mg/l, was effective against the infection, being that NEM presented a better action. Finally, NEM and free MICA showed no acute toxicity up to 4 mg/l. NEM showed the best activities in in vitro in mature antibiofilm and in alternative in vivo models in G. mellonella. Although, NEs showed to be attractive for MICA transport in the treatment of infections caused by C. auris in vitro and in vivo studies with G. mellonella, further studies should be carried out, in mice, for example.
Collapse
Affiliation(s)
- Gabriel Davi Marena
- São Paulo State University (UNESP), Department of Drugs and Medicines, School of Pharmaceutical Sciences, Campus Araraquara, Araraquara, São Paulo State, Brazil.,São Paulo State University (UNESP), Department of Biological Sciences, School of Pharmaceutical Sciences, Campus Araraquara, Araraquara, São Paulo State, Brazil
| | - Gabriela Corrêa Carvalho
- São Paulo State University (UNESP), Department of Drugs and Medicines, School of Pharmaceutical Sciences, Campus Araraquara, Araraquara, São Paulo State, Brazil.,São Paulo State University (UNESP), Department of Biological Sciences, School of Pharmaceutical Sciences, Campus Araraquara, Araraquara, São Paulo State, Brazil
| | - Matheus Aparecido Dos Santos Ramos
- São Paulo State University (UNESP), Department of Drugs and Medicines, School of Pharmaceutical Sciences, Campus Araraquara, Araraquara, São Paulo State, Brazil
| | - Marlus Chorilli
- São Paulo State University (UNESP), Department of Drugs and Medicines, School of Pharmaceutical Sciences, Campus Araraquara, Araraquara, São Paulo State, Brazil
| | - Tais Maria Bauab
- São Paulo State University (UNESP), Department of Biological Sciences, School of Pharmaceutical Sciences, Campus Araraquara, Araraquara, São Paulo State, Brazil
| |
Collapse
|
18
|
Dangarembizi R, Wasserman S, Hoving JC. Emerging and re-emerging fungal threats in Africa. Parasite Immunol 2023; 45:e12953. [PMID: 36175380 PMCID: PMC9892204 DOI: 10.1111/pim.12953] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 02/04/2023]
Abstract
The emergence of deadly fungal infections in Africa is primarily driven by a disproportionately high burden of human immunodeficiency virus (HIV) infections, lack of access to quality health care, and the unavailability of effective antifungal drugs. Immunocompromised people in Africa are therefore at high risk of infection from opportunistic fungal pathogens such as Cryptococcus neoformans and Pneumocystis jirovecii, which are associated with high morbidity, mortality, and related socioeconomic impacts. Other emerging fungal threats include Emergomyces spp., Histoplasma spp., Blastomyces spp., and healthcare-associated multi-drug resistant Candida auris. Socioeconomic development and the Covid-19 pandemic may influence shifts in epidemiology of invasive fungal diseases on the continent. This review discusses the epidemiology, clinical manifestations, and current management strategies available for these emerging fungal diseases in Africa. We also discuss gaps in knowledge, policy, and research to inform future efforts at managing these fungal threats.
Collapse
Affiliation(s)
- Rachael Dangarembizi
- Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa,Neuroscience Institute, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa,CMM AFRICA Medical Mycology Research Unit, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa,Contact information of corresponding author Dr Rachael Dangarembizi, Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa, Neuroscience Institute, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa, CMM AFRICA Medical Mycology Research Unit, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa,
| | - Sean Wasserman
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa,Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Jennifer Claire Hoving
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa,Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa,CMM AFRICA Medical Mycology Research Unit, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
19
|
Rabaan AA, Eljaaly K, Alfouzan WA, Mutair AA, Alhumaid S, Alfaraj AH, Aldawood Y, Alsaleh AA, Albayat H, Azmi RA, AlKaabi N, Alzahrani SJ, AlBahrani S, Sulaiman T, Alshukairi AN, Abuzaid AA, Garout M, Ahmad R, Muhammad J. Psychogenetic, genetic and epigenetic mechanisms in Candida auris: Role in drug resistance. J Infect Public Health 2023; 16:257-263. [PMID: 36608452 DOI: 10.1016/j.jiph.2022.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/28/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
In recent years, we are facing the challenge of drug resistance emergence in fungi. The availability of limited antifungals and development of multi-drug resistance in fungal pathogens has become a serious concern in the past years in the health sector. Although several cellular, molecular, and genetic mechanisms have been proposed to explain the drug resistance mechanism in fungi, but a complete understanding of the molecular and genetic mechanisms is still lacking. Besides the genetic mechanism, epigenetic mechanisms are pivotal in the fungal lifecycle and disease biology. However, very little is understood about the role of epigenetic mechanisms in the emergence of multi-drug resistance in fungi, especially in Candida auris (C. auris). The current narrative review summaries the clinical characteristics, genomic organization, and molecular/genetic/epigenetic mechanisms underlying the emergence of drug resistance in C. auris. A very few studies have attempted to evaluate the role of epigenetic mechanisms in C. auris. Furthermore, advanced genetic tools such as the CRISP-Cas9 system can be utilized to elucidate the epigenetic mechanisms and their role in the emergence of multi-drug resistance in C. auris.
Collapse
Affiliation(s)
- Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia; Department of Public Health and Nutrition, The University of Haripur, Haripur 22610, Pakistan.
| | - Khalid Eljaaly
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia; Pharmacy Practice and Science Department, College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Wadha A Alfouzan
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat 13110, Kuwait; Microbiology Unit, Department of Laboratories, Farwania Hospital, Farwania 85000, Kuwait
| | - Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, Al-Ahsa 36342, Saudi Arabia; College of Nursing, Princess Norah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia; School of Nursing, Wollongong University, Wollongong, NSW 2522, Australia; Nursing Department, Prince Sultan Military College of Health Sciences, Dhahran 33048, Saudi Arabia
| | - Saad Alhumaid
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa 31982, Saudi Arabia
| | - Amal H Alfaraj
- Pediatric Department, Abqaiq General Hospital, First Eastern Health Cluster, Abqaiq 33261, Saudi Arabia
| | - Yahya Aldawood
- Clinical Laboratory Science Department, Mohammed Al-Mana College for Medical Sciences, Dammam 34222, Saudi Arabia
| | - Abdulmonem A Alsaleh
- Clinical Laboratory Science Department, Mohammed Al-Mana College for Medical Sciences, Dammam 34222, Saudi Arabia
| | - Hawra Albayat
- Infectious Disease Department, King Saud Medical City, Riyadh 7790, Saudi Arabia
| | - Reyouf Al Azmi
- Infection Prevention and Control, Eastern Health Cluster, Dammam 32253, Saudi Arabia
| | - Nawal AlKaabi
- Sheikh Khalifa Medical City, Abu Dhabi Health Services Company (SEHA), Abu Dhabi, 51900, United Arab Emirates; College of Medicine and Health Science, Khalifa University, Abu Dhabi, 127788, United Arab Emirates
| | - Samira J Alzahrani
- Molecular Diagnostic Laboratory, King Fahd Military Medical Complex, Dhahran 31932, Saudi Arabia
| | - Salma AlBahrani
- Infectious Disease Unit, Specialty Internal Medicine, King Fahd Military Medical Complex, Dhahran 31932, Saudi Arabia
| | - Tarek Sulaiman
- Infectious Diseases Section, Medical Specialties Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abeer N Alshukairi
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia; Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Abdulmonem A Abuzaid
- Medical Microbiology Department, Security Forces Hospital Programme, Dammam 32314, Saudi Arabia
| | - Mohammed Garout
- Department of Community Medicine and Health Care for Pilgrims, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Rafiq Ahmad
- Department of Microbiology, The University of Haripur, Haripur 22610, Pakistan
| | - Javed Muhammad
- Department of Microbiology, The University of Haripur, Haripur 22610, Pakistan.
| |
Collapse
|
20
|
Rezai MS, Ahangarkani F. Guidelines adherence as a major protective aspect to increase survival rate in patients with candidaemia in Europe. THE LANCET INFECTIOUS DISEASES 2023; 23:647-648. [DOI: 10.1016/s1473-3099(23)00046-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 02/17/2023]
|
21
|
Vashistha A, Kumar S, Kirar S, Sharma N, Das B, Banerjee UC, Pawar SV, Kumar R, Yadav AK. Synthesis, biological evaluation and in silico studies of 2-aminoquinolines and 1-aminoisoquinolines as antimicrobial agents. Comput Biol Chem 2023; 102:107807. [PMID: 36587565 DOI: 10.1016/j.compbiolchem.2022.107807] [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: 11/19/2022] [Revised: 12/22/2022] [Accepted: 12/25/2022] [Indexed: 12/29/2022]
Abstract
The current study reports synthesis of 2-aminoquinolines and 1-aminoisoquinolines derivatives and their characterization. Further, in vitro studies were conducted to determine antimicrobial activities. Compound 3 h showed maximum activity against B. subtilis (IC50: 0.10±0.02 µM) and E. coli (IC50: 0.13±0.01 µM) whereas compound 3i showed higher antimicrobial activity against E. coli (IC50: 0.11±0.01) and C. viswanathii (IC50: 0.10±0.05 µM). Safety profiles of the most potent derivatives were evaluated utilizing cell viability assay using RAW 264.7 and HeLa cell lines and in vitro hemolytic assay was carried out freshly isolated RBC from healthy rat. Furthermore, in silico studies, like molecular docking, binding free energy calculations and ADME predictions were done to get the best lead candidates. Additionally, molecular dynamic simulation for 100 ns was performed to know stability of protein and ligand complex. The active compounds were found to be non-toxic and non-hemolytic and hold great promise to become newer antimicrobial agents.
Collapse
Affiliation(s)
- Aditi Vashistha
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India
| | - Sunil Kumar
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India
| | - Seema Kirar
- Department of Biotechnology, National Institute of Pharmaceutical Education and Research (NIPER), Sector-67, S.A.S. Nagar 160062, Punjab, India
| | - Nikhil Sharma
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India
| | - Bhanuranjan Das
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (BHU), India
| | | | - Sandip V Pawar
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India
| | - Rajnish Kumar
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (BHU), India
| | - Ashok Kumar Yadav
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India.
| |
Collapse
|
22
|
de Melo CC, de Sousa BR, da Costa GL, Oliveira MME, de Lima-Neto RG. Colonized patients by Candida auris: Third and largest outbreak in Brazil and impact of biofilm formation. Front Cell Infect Microbiol 2023; 13:1033707. [PMID: 36756619 PMCID: PMC9900136 DOI: 10.3389/fcimb.2023.1033707] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/03/2023] [Indexed: 01/24/2023] Open
Abstract
Objective To describe the clinical-epidemiological features of patients colonized by Candida auris in the largest outbreak in Brazil and to show the biofilm formation capacity of yeast strains. Methods Clinical yeasts suspected of C. auris isolated from urine and surveillance samples were seeded on chromogenic media at 30°C and Sabouraud agar at 42°C. matrix-assisted laser desorption/ionization-time of flight mass spectometry was used for reliable identification. After proteomic confirmation, the genomic approach and culture on Chromagar Candida Plus media were carried out. Biofilm formation was investigated based on metabolic activity, and the clinical-epidemiological profile of patients was described. Results A total of 11 C. auris clinical yeasts from nine patients were identified between the end of December 2021 and March 2022. Two clinical yeasts were isolates from urine and nine clinical yeasts were isolates from axillary and inguinal surveillance swabs. No case is related to previous Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, all the yeasts showed a high ability of biofilm formation. Conclusion C. auris requires great vigilance as its high capacity to colonize and form biofilms contributes to its dissemination. The rapid and precise identification of this species is essential for the management, control, and prevention of infections.
Collapse
Affiliation(s)
- Camylla Carvalho de Melo
- Hospital da Restauração, Department of Health, State of Pernambuco, Recife, Brazil,Post-Graduate Program in Tropical Medicine, Center for Medical Sciences, Federal University of Pernambuco (UFPE), Recife, PE, Brazil
| | | | | | - Manoel Marques Evangelista Oliveira
- Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, RJ, Brazil,*Correspondence: Reginaldo Gonçalves de Lima-Neto, ; Manoel Marques Evangelista Oliveira,
| | - Reginaldo Gonçalves de Lima-Neto
- Post-Graduate Program in Tropical Medicine, Center for Medical Sciences, Federal University of Pernambuco (UFPE), Recife, PE, Brazil,Post-Graduate Program in Fungal Biology, University of Pernambuco (UFPE), Recife, Brazil,*Correspondence: Reginaldo Gonçalves de Lima-Neto, ; Manoel Marques Evangelista Oliveira,
| |
Collapse
|
23
|
Rosato R, Napoli E, Granata G, Di Vito M, Garzoli S, Geraci C, Rizzo S, Torelli R, Sanguinetti M, Bugli F. Study of the Chemical Profile and Anti-Fungal Activity against Candida auris of Cinnamomum cassia Essential Oil and of Its Nano-Formulations Based on Polycaprolactone. PLANTS (BASEL, SWITZERLAND) 2023; 12:358. [PMID: 36679069 PMCID: PMC9860731 DOI: 10.3390/plants12020358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Candida auris represents an emerging pathogen that results in nosocomial infections and is considered a serious global health problem. The aim of this work was to evaluate the in vitro antifungal efficacy of Cinnamomum cassia essential oil (CC-EO) pure or formulated in polycaprolactone (PCL) nanoparticles against ten clinical strains of C. auris. METHODS nanoparticles of PCL were produced using CC-EO (nano-CC-EO) and cinnamaldehyde (CIN) through the nanoprecipitation method. The chemical profile of both CC-EO and nano-CC-EO was evaluated using SPME sampling followed by GC-MS analysis. Micro-broth dilution tests were performed to evaluate both fungistatic and fungicidal effectiveness of CC-EO and CIN, pure and nano-formulated. Furthermore, checkerboard tests to evaluate the synergistic action of CC-EO or nano-CC-EO with micafungin or fluconazole were conducted. Finally, the biofilm disrupting activity of both formulations was evaluated. RESULTS GC-MS analysis shows a different composition between CC-EO and nano-CC-EO. Moreover, the microbiological analyses do not show any variation in antifungal effectiveness either towards the planktonic form (MICCC-EO = 0.01 ± 0.01 and MICnano-CC-EO = 0.02 ± 0.01) or the biofilm form. No synergistic activity with the antifungal drugs tested was found. CONCLUSIONS both CC-EO and nano-CC-EO show the same antimicrobial effectiveness and are potential assets in the fight against C. auris.
Collapse
Affiliation(s)
- Roberto Rosato
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00167 Rome, Italy
| | - Edoardo Napoli
- Istituto di Chimica Biomolecolare—Consiglio Nazionale delle Ricerche, 95126 Catania, Italy
| | - Giuseppe Granata
- Istituto di Chimica Biomolecolare—Consiglio Nazionale delle Ricerche, 95126 Catania, Italy
| | - Maura Di Vito
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00167 Rome, Italy
| | - Stefania Garzoli
- Dipartimento di Chimica e Tecnologie del Farmaco, Università di Roma Sapienza, Piazzale Aldo Moro 5, 00100 Rome, Italy
| | - Corrada Geraci
- Istituto di Chimica Biomolecolare—Consiglio Nazionale delle Ricerche, 95126 Catania, Italy
| | - Silvia Rizzo
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00167 Rome, Italy
| | - Riccardo Torelli
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Maurizio Sanguinetti
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00167 Rome, Italy
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Francesca Bugli
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00167 Rome, Italy
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| |
Collapse
|
24
|
Pedraza-Sánchez S, Cruz-González A, Palmeros-Rojas O, Gálvez-Romero JL, Bellanti JA, Torres M. Polyvalent human immunoglobulin for infectious diseases: Potential to circumvent antimicrobial resistance. Front Immunol 2023; 13:987231. [PMID: 36713426 PMCID: PMC9880058 DOI: 10.3389/fimmu.2022.987231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/05/2022] [Indexed: 01/11/2023] Open
Abstract
Antimicrobial resistance (AMR) is a global health problem that causes more than 1.27 million deaths annually; therefore, it is urgent to focus efforts on solving or reducing this problem. The major causes of AMR are the misuse of antibiotics and antimicrobials in agriculture, veterinary medicine, and human medicine, which favors the selection of drug-resistant microbes. One of the strategies proposed to overcome the problem of AMR is to use polyvalent human immunoglobulin or IVIG. The main advantage of this classic form of passive immunization is its capacity to enhance natural immunity mechanisms to eliminate bacteria, viruses, or fungi safely and physiologically. Experimental data suggest that, for some infections, local administration of IVIG may produce better results with a lower dose than intravenous application. This review presents evidence supporting the use of polyvalent human immunoglobulin in AMR, and the potential and challenges associated with its proposed usage.
Collapse
Affiliation(s)
- Sigifredo Pedraza-Sánchez
- Unidad de Bioquímica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico,*Correspondence: Martha Torres, ; Sigifredo Pedraza-Sánchez,
| | - Adrián Cruz-González
- Facultad de Ciencias, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Oscar Palmeros-Rojas
- Área de matemáticas, preparatoria agrícola, Universidad Autónoma Chapingo, Texcoco, Mexico
| | | | | | - Martha Torres
- Subdirección de Investigación Biomédica, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico,*Correspondence: Martha Torres, ; Sigifredo Pedraza-Sánchez,
| |
Collapse
|
25
|
Yune PS, Coe J, Rao M, Lin MY. Candida auris in skilled nursing facilities. Ther Adv Infect Dis 2023; 10:20499361231189958. [PMID: 37529375 PMCID: PMC10387771 DOI: 10.1177/20499361231189958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/08/2023] [Indexed: 08/03/2023] Open
Abstract
Candida auris is a fungal organism resistant to several classes of antifungals. Since its identification in 2009, it has gained worldwide attention in healthcare for its virulence and resistance to commonly used antifungal therapeutics. Although its origin and mechanisms of transmission are not fully elucidated, it is widely recognized as a high priority healthcare-associated pathogen. Infection control efforts in skilled nursing facilities have been very challenging due to the tendency of C. auris to persist in the environment and colonize residents. In this narrative review, we discuss the epidemiology and infection prevention of C. auris in skilled nursing facilities. We also identify challenges in the diagnosis and management of both symptomatic infections and asymptomatic colonization.
Collapse
Affiliation(s)
- Philip S. Yune
- Division of Infectious Disease, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jared Coe
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Michael Y. Lin
- Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
26
|
Russo E, Di Bari S, Agnoletti V. Benefits of patient risk stratification and targeted interventions on multidrug resistant pathogens prevention and control. DISCOVER HEALTH SYSTEMS 2022; 1:6. [PMID: 37521116 PMCID: PMC9664758 DOI: 10.1007/s44250-022-00006-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Emanuele Russo
- Anesthesia and Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy
| | - Silvia Di Bari
- Anesthesia and Intensive Care Department, Alma Mater Studiorum - Università di Bologna, Azienda Ospedaliero-Universitaria di Bologna IRCCS, via Giuseppe Massarenti 9, 40138 Bologna, Italy
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy
| |
Collapse
|
27
|
Bassetti M, Giacobbe DR, Vena A, Esposito S. An overview of micafungin as a treatment option for invasive candidiasis in pediatric patients younger than 4 months old. Expert Opin Pharmacother 2022; 23:1987-1993. [DOI: 10.1080/14656566.2022.2147824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Antonio Vena
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
| |
Collapse
|
28
|
Clinical Challenges of Emerging and Re-Emerging Yeast Infections in the Context of the COVID-19 Pandemic. Microorganisms 2022; 10:microorganisms10112223. [PMID: 36363816 PMCID: PMC9695014 DOI: 10.3390/microorganisms10112223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 11/12/2022] Open
Abstract
During the geological eras, some fungi, through adaptation and/or environmental/ecological pressure, interacted directly and indirectly with humans, through occasionally harmful interaction interdependent on the individual’s immunological condition. Infections caused by yeasts are underreported, subjugated, and underdiagnosed, and treatment is restricted to a few drugs, even after the significant progress of medicine and pharmacology. In the last centuries, antagonistically, there has been an exponential increase of immunocompromised individuals due to the use of immunosuppressive drugs such as corticosteroids, increased cases of transplants, chemotherapeutics, autoimmune diseases, neoplasms, and, more recently, coronavirus disease 2019 (COVID-19). This review aims to survey emerging and re-emerging yeast infections in the current clinical context. Currently, there is an immense clinical challenge for the rapid and correct diagnosis and treatment of systemic mycoses caused by yeasts due to the terrible increase in cases in the current context of COVID-19.
Collapse
|
29
|
Gupta SK, Osmanoglu Ö, Minocha R, Bandi SR, Bencurova E, Srivastava M, Dandekar T. Genome-wide scan for potential CD4+ T-cell vaccine candidates in Candida auris by exploiting reverse vaccinology and evolutionary information. Front Med (Lausanne) 2022; 9:1008527. [PMID: 36405591 PMCID: PMC9669072 DOI: 10.3389/fmed.2022.1008527] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2023] Open
Abstract
Candida auris is a globally emerging fungal pathogen responsible for causing nosocomial outbreaks in healthcare associated settings. It is known to cause infection in all age groups and exhibits multi-drug resistance with high potential for horizontal transmission. Because of this reason combined with limited therapeutic choices available, C. auris infection has been acknowledged as a potential risk for causing a future pandemic, and thus seeking a promising strategy for its treatment is imperative. Here, we combined evolutionary information with reverse vaccinology approach to identify novel epitopes for vaccine design that could elicit CD4+ T-cell responses against C. auris. To this end, we extensively scanned the family of proteins encoded by C. auris genome. In addition, a pathogen may acquire substitutions in epitopes over a period of time which could cause its escape from the immune response thus rendering the vaccine ineffective. To lower this possibility in our design, we eliminated all rapidly evolving genes of C. auris with positive selection. We further employed highly conserved regions of multiple C. auris strains and identified two immunogenic and antigenic T-cell epitopes that could generate the most effective immune response against C. auris. The antigenicity scores of our predicted vaccine candidates were calculated as 0.85 and 1.88 where 0.5 is the threshold for prediction of fungal antigenic sequences. Based on our results, we conclude that our vaccine candidates have the potential to be successfully employed for the treatment of C. auris infection. However, in vivo experiments are imperative to further demonstrate the efficacy of our design.
Collapse
Affiliation(s)
- Shishir K. Gupta
- Department of Bioinformatics, Biocenter, Functional Genomics and Systems Biology Group, University of Würzburg, Würzburg, Germany
- Evolutionary Genomics Group, Center for Computational and Theoretical Biology, University of Würzburg, Würzburg, Germany
| | - Özge Osmanoglu
- Department of Bioinformatics, Biocenter, Functional Genomics and Systems Biology Group, University of Würzburg, Würzburg, Germany
| | - Rashmi Minocha
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Sourish Reddy Bandi
- Department of Bioinformatics, Biocenter, Functional Genomics and Systems Biology Group, University of Würzburg, Würzburg, Germany
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany
| | - Elena Bencurova
- Department of Bioinformatics, Biocenter, Functional Genomics and Systems Biology Group, University of Würzburg, Würzburg, Germany
| | - Mugdha Srivastava
- Department of Bioinformatics, Biocenter, Functional Genomics and Systems Biology Group, University of Würzburg, Würzburg, Germany
- Core Unit Systems Medicine, University of Würzburg, Würzburg, Germany
| | - Thomas Dandekar
- Department of Bioinformatics, Biocenter, Functional Genomics and Systems Biology Group, University of Würzburg, Würzburg, Germany
- BioComputing Unit, European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
| |
Collapse
|
30
|
Fungicidal activity of human antimicrobial peptides and their synergistic interaction with common antifungals against multidrug-resistant Candida auris. Int Microbiol 2022; 26:165-177. [PMID: 36329309 DOI: 10.1007/s10123-022-00290-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/12/2022] [Accepted: 10/25/2022] [Indexed: 11/05/2022]
Abstract
Emergence of Candida auris, a multidrug-resistant yeast, demonstrates the urgent need for novel antifungal agents. Human antimicrobial peptides (AMPs) are naturally occurring molecules with wide spectrum antimicrobial activity, particularly against a variety of fungi. Therefore, this study examined the antifungal activity of seven different human AMPs against C. auris following the CLSI guidelines. The antifungal activity was further assessed using time kill curve and cell viability assays. For combination interaction, effectiveness of these peptides with three antifungals, fluconazole, amphotericin B, and caspofungin was done following standard protocols. To elucidate the antifungal mechanism, the effects of peptides on membrane permeability were investigated using propidium iodide staining method and confocal imaging. Antifungal susceptibility results showed that all the examined peptides possessed fungicidal effect against C. auris at different levels, with human β-defensin-3 being the most potent antifungal with MIC values ranging from 3.125 to 12.5 µg/ml. Time kill curves further confirmed the killing effect of all the tested peptides. Viability assay showed a significant decrease in the percentage of viable cells exposed to different inhibitory and fungicidal concentrations of each peptide (p < 0.01). Furthermore, peptides showed mostly synergistic interaction when combined with conventional antifungal drugs, with caspofungin showing 100% synergy when combined with different AMPs. As antifungal mechanism, peptides disrupted the membrane permeability at concentrations that correlated with the inhibition of growth. Overall, the findings of this study point towards the application of the tested peptides as a monotherapy or as a combination therapy with antifungal drugs to treat multidrug-resistant C. auris infections.
Collapse
|
31
|
Di Mambro T, Vanzolini T, Bianchi M, Crinelli R, Canonico B, Tasini F, Menotta M, Magnani M. Development and in vitro characterization of a humanized scFv against fungal infections. PLoS One 2022; 17:e0276786. [PMID: 36315567 PMCID: PMC9621433 DOI: 10.1371/journal.pone.0276786] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/14/2022] [Indexed: 01/24/2023] Open
Abstract
The resistance and the birth of new intrinsic and multidrug-resistant pathogenic species like C. auris is creating great concern in the antifungal world. Given the limited drug arsenal and the lack of effectiveness of the available compounds, there is an urgent need for innovative approaches. The murine mAb 2G8 was humanized and engineered in silico to develop a single-chain fragment variable (hscFv) antibody against β-1,3-glucans which was then expressed in E. coli. Among the recombinant proteins developed, a soluble candidate with high stability and affinity was obtained. This selected protein is VL-linker-VH oriented, and it is characterized by the presence of two ubiquitin monomers at the N-terminus and a His tag at the C-terminus. This construct, Ub2-hscFv-His, guaranteed stability, solubility, efficient purification and satisfactory recovery of the recombinant product. HscFv can bind β-1,3-glucans both as coated antigens and on C. auris and C. albicans cells similarly to its murine parental and showed long stability and retention of binding ability when stored at 4°, -20° and -80° C. Furthermore, it was efficient in enhancing the antifungal activity of drugs caspofungin and amphotericin B against C. auris. The use of biological drugs as antifungals is limited; here we present a promising hscFv which has the potential to be useful in combination with currently available antifungal drugs.
Collapse
Affiliation(s)
| | - Tania Vanzolini
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
- * E-mail:
| | - Marzia Bianchi
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Rita Crinelli
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Barbara Canonico
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Filippo Tasini
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Michele Menotta
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Mauro Magnani
- Diatheva s.r.l., Cartoceto, Italy
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
| |
Collapse
|
32
|
Thatchanamoorthy N, Rukumani Devi V, Chandramathi S, Tay ST. Candida auris: A Mini Review on Epidemiology in Healthcare Facilities in Asia. J Fungi (Basel) 2022; 8:1126. [PMID: 36354893 PMCID: PMC9696804 DOI: 10.3390/jof8111126] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 07/28/2023] Open
Abstract
Candida auris, a newly emerging healthcare-associated yeast pathogen from the Metschnikowiaceae family, was first described in the ear canal of an elderly Japanese patient in 2009. The yeast is one of the causative agents of candidemia, which has been linked with nosocomial outbreaks and high mortality rates in healthcare facilities worldwide. Since its first isolation, the occurrence of C. auris in six continents has becomes a grave concern for the healthcare professionals and scientific community. Recent reports showed the identification of five geographically distinct clades and high rates of antifungal resistance associated with C. auris. Till date, there are no effective treatment options, and standardized measures for prevention and control of C. auris infection in healthcare facilities. This leads to frequent therapeutic failures and complicates the eradication of C. auris infection in healthcare facilities. Thus, this review focuses on the recent understanding of the epidemiology, risk factors, diagnosis, transmission and prevention and control strategies of C. auris infection in healthcare facilities in Asia.
Collapse
Affiliation(s)
- Nishanthinie Thatchanamoorthy
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Jalan Profesor Diraja Ungku Aziz, Kuala Lumpur 50603, Wilayah Persekutuan, Malaysia
| | - Velayuthan Rukumani Devi
- Department of Medical Microbiology, University Malaya Medical Centre, Jalan Profesor Diraja Ungku Aziz, Kuala Lumpur 59100, Wilayah Persekutuan, Malaysia
| | - Samudi Chandramathi
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Jalan Profesor Diraja Ungku Aziz, Kuala Lumpur 50603, Wilayah Persekutuan, Malaysia
| | - Sun Tee Tay
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Jalan Profesor Diraja Ungku Aziz, Kuala Lumpur 50603, Wilayah Persekutuan, Malaysia
| |
Collapse
|
33
|
de Groot T, Spruijtenburg B, Parnell LA, Chow NA, Meis JF. Optimization and Validation of Candida auris Short Tandem Repeat Analysis. Microbiol Spectr 2022; 10:e0264522. [PMID: 36190407 PMCID: PMC9603409 DOI: 10.1128/spectrum.02645-22] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/06/2022] [Indexed: 01/04/2023] Open
Abstract
Candida auris is an easily transmissible yeast with resistance to different antifungal compounds. Outbreaks of C. auris are mostly observed in intensive care units. To take adequate measures during an outbreak, it is essential to understand the transmission route, which requires isolate genotyping. In 2019, a short tandem repeat (STR) genotyping analysis was developed for C. auris. To determine the discriminatory power of this method, we performed STR analysis of 171 isolates with known whole-genome sequencing (WGS) data using Illumina reads, and we compared their resolutions. We found that STR analysis separated the 171 isolates into four clades (clades I to IV), as was also seen with WGS analysis. Then, to improve the separation of isolates in clade IV, the STR assay was optimized by the addition of 2 STR markers. With this improved STR assay, a total of 32 different genotypes were identified, while all isolates with differences of >50 single-nucleotide polymorphisms (SNPs) were separated by at least 1 STR marker. Altogether, we optimized and validated the C. auris STR panel for clades I to IV and established its discriminatory power, compared to WGS SNP analysis using Illumina reads. IMPORTANCE The emerging fungal pathogen Candida auris poses a threat to public health, mainly causing outbreaks in intensive care units. Genotyping is essential for investigating potential outbreaks and preventing further spread. Previously, we developed a STR genotyping scheme for rapid and high-resolution genotyping, and WGS SNP outcomes for some isolates were compared to STR data. Here, we compared WGS SNP and STR outcomes for a larger sample cohort. Also, we optimized the resolution of this typing scheme with the addition of 2 STR markers. Altogether, we validated and optimized this rapid, reliable, and high-resolution typing scheme for C. auris.
Collapse
Affiliation(s)
- Theun de Groot
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Centre of Expertise in Mycology, Radboud University Medical Center/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Bram Spruijtenburg
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Centre of Expertise in Mycology, Radboud University Medical Center/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Lindsay A. Parnell
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nancy A. Chow
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jacques F. Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Centre of Expertise in Mycology, Radboud University Medical Center/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| |
Collapse
|
34
|
Wang H, Zhang R, Ma B, Wang W, Yu C, Han J, Zhu L, Zhang X, Dai H, Liu H, Chen B. Japonamides A and B, Two New Cyclohexadepsipeptides from the Marine-Sponge-Derived Fungus Aspergillus japonicus and Their Synergistic Antifungal Activities. J Fungi (Basel) 2022; 8:jof8101058. [PMID: 36294623 PMCID: PMC9605600 DOI: 10.3390/jof8101058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/28/2022] [Accepted: 10/06/2022] [Indexed: 11/09/2022] Open
Abstract
Two new cyclohexadepsipeptides japonamides A (1) and B (2) were isolated from the ethyl acetate extract of a marine-sponge-derived fungus Aspergillus japonicus based on molecular networking. Their structures were elucidated by comprehensive spectral analysis and their absolute configurations were confirmed by Marfey's method. Compounds 1 and 2 showed no antifungal activities against Candida albicans SC5314 measured by the broth microdilution method but exhibited prominent synergistic antifungal activities in combination with fluconazole, ketoconazole, or rapamycin. The Minimum inhibitory concentrations (MICs) of rapamycin, fluconazole, and ketoconazole were significantly decreased from 0.5 to 0.002 μM, from 0.25 to 0.063 μM, and from 0.016 to 0.002 μM, in the presence of compounds 1 or 2 at 3.125 μM, 12.5 μM, and 6.25 μM, respectively. Surprisingly, the combination of compounds 1 or 2 with rapamycin showed a strong synergistic effect, with fractional inhibitory concentration index (FICI) values of 0.03.
Collapse
Affiliation(s)
- Haifeng Wang
- School of Traditional Chinese Materia Medica, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Rui Zhang
- School of Traditional Chinese Materia Medica, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Ben Ma
- School of Traditional Chinese Materia Medica, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Wenzhao Wang
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, Beijing 100190, China
| | - Chong Yu
- School of Traditional Chinese Materia Medica, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Junjie Han
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, Beijing 100190, China
| | - Lingjuan Zhu
- School of Traditional Chinese Materia Medica, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Xue Zhang
- School of Traditional Chinese Materia Medica, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Huanqin Dai
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, Beijing 100190, China
| | - Hongwei Liu
- School of Traditional Chinese Materia Medica, Shenyang Pharmaceutical University, Shenyang 110016, China
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, Beijing 100190, China
- Correspondence: (H.L.); (B.C.)
| | - Baosong Chen
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, Beijing 100190, China
- Correspondence: (H.L.); (B.C.)
| |
Collapse
|
35
|
Cui X, Wang L, Lü Y, Yue C. Development and research progress of anti-drug resistant fungal drugs. J Infect Public Health 2022; 15:986-1000. [PMID: 35981408 DOI: 10.1016/j.jiph.2022.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/24/2022] Open
Abstract
With the widespread use of immunosuppressive agents and the increase in patients with severe infections, the incidence of fungal infections worldwide has increased year by year. The fungal pathogens Candida albicans, Cryptococcus neoformans and Aspergillus fumigatus cause a total of more than 1 million deaths each year. Long-term use of antifungal drugs can easily lead to fungal resistance, and the prevalence of drug-resistant fungi is a major global health challenge. In order to effectively control global fungal infections, there is an urgent need for new drugs that can exert effective antifungal activity and overcome drug resistance. We must promote the discovery of new antifungal targets and drugs, and find effective ways to control drug-resistant fungi through different ways, so as to reduce the threat of drug-resistant fungi to human life, health and safety. In the past few years, certain progress has been made in the research and development of antifungal drugs. In addition to summarizing some of the antifungal drugs currently approved by the FDA, this review also focuses on potential antifungal drugs, the repositioned drugs, and drugs that can treat drug-resistant bacteria and fungal infections, and provide new ideas for the development of antifungal drugs in the future.
Collapse
Affiliation(s)
- Xiangyi Cui
- Key Laboratory of Microbial Drugs Innovation and Transformation of Yan'an, School of Basic Medicine, Yan'an University, Yan'an 716000, Shaanxi, China; Shaanxi Engineering & Technological Research Center for Conversation & Utilization of Regional Biological Resources,Yan'an University, NO.580 Shengdi Road, Baota District, Yan'an 716000, Shaanxi, China.
| | - Lanlin Wang
- Key Laboratory of Microbial Drugs Innovation and Transformation of Yan'an, School of Basic Medicine, Yan'an University, Yan'an 716000, Shaanxi, China; Shaanxi Engineering & Technological Research Center for Conversation & Utilization of Regional Biological Resources,Yan'an University, NO.580 Shengdi Road, Baota District, Yan'an 716000, Shaanxi, China.
| | - Yuhong Lü
- Key Laboratory of Microbial Drugs Innovation and Transformation of Yan'an, School of Basic Medicine, Yan'an University, Yan'an 716000, Shaanxi, China; Shaanxi Engineering & Technological Research Center for Conversation & Utilization of Regional Biological Resources,Yan'an University, NO.580 Shengdi Road, Baota District, Yan'an 716000, Shaanxi, China.
| | - Changwu Yue
- Key Laboratory of Microbial Drugs Innovation and Transformation of Yan'an, School of Basic Medicine, Yan'an University, Yan'an 716000, Shaanxi, China; Shaanxi Engineering & Technological Research Center for Conversation & Utilization of Regional Biological Resources,Yan'an University, NO.580 Shengdi Road, Baota District, Yan'an 716000, Shaanxi, China.
| |
Collapse
|
36
|
Liang C, Lian N, Li M. The emerging role of neutrophil extracellular traps in fungal infection. Front Cell Infect Microbiol 2022; 12:900895. [PMID: 36034717 PMCID: PMC9411525 DOI: 10.3389/fcimb.2022.900895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Fungal infections are global public health problems and can lead to substantial human morbidity and mortality. Current antifungal therapy is not satisfactory, especially for invasive, life-threatening fungal infections. Modulating the antifungal capacity of the host immune system is a feasible way to combat fungal infections. Neutrophils are key components of the innate immune system that resist fungal pathogens by releasing reticular extracellular structures called neutrophil extracellular traps (NETs). When compared with phagocytosis and oxidative burst, NETs show better capability in terms of trapping large pathogens, such as fungi. This review will summarize interactions between fungal pathogens and NETs. Molecular mechanisms of fungi-induced NETs formation and defensive strategies used by fungi are also discussed.
Collapse
Affiliation(s)
- Chuting Liang
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (STIs), Chinese Academy of Medical Sciences and Peking Union Medical College, Institute of Dermatology, Nanjing, China
| | - Ni Lian
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (STIs), Chinese Academy of Medical Sciences and Peking Union Medical College, Institute of Dermatology, Nanjing, China
| | - Min Li
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (STIs), Chinese Academy of Medical Sciences and Peking Union Medical College, Institute of Dermatology, Nanjing, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- *Correspondence: Min Li,
| |
Collapse
|
37
|
Dekkerová J, Černáková L, Kendra S, Borghi E, Ottaviano E, Willinger B, Bujdáková H. Farnesol Boosts the Antifungal Effect of Fluconazole and Modulates Resistance in Candida auris through Regulation of the CDR1 and ERG11 Genes. J Fungi (Basel) 2022; 8:jof8080783. [PMID: 35893151 PMCID: PMC9332773 DOI: 10.3390/jof8080783] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022] Open
Abstract
Candida auris is considered a serious fungal pathogen frequently exhibiting a high resistance to a wide range of antifungals. In this study, a combination of the quorum-sensing molecule farnesol (FAR) and fluconazole (FLU) was tested on FLU-resistant C. auris isolates (C. auris S and C. auris R) compared to the susceptible C. auris H261. The aim was to assess the possible synergy between FAR and FLU, by reducing the FLU minimal inhibitory concentration, and to determine the mechanism underlying the conjunct effect. The results confirmed a synergic effect between FAR and FLU with a calculated FIC index of 0.75 and 0.4 for C. auris S and C. auris R, respectively. FAR modulates genes involved in azole resistance. When FAR was added to the cells in combination with FLU, a significant decrease in the expression of the CDR1 gene was observed in the resistant C. auris isolates. FAR seems to block the Cdr1 efflux pump triggering a restoration of the intracellular content of FLU. These results were supported by observed increasing accumulation of rhodamine 6G by C. auris cells. Moreover, C. auris treated with FAR showed an ERG11 gene down-regulation. Overall, these results suggest that FAR is an effective modulator of the Cdr1 efflux pump in C. auris and, in combination with FLU, enhances the activity of this azole, which might be a promising strategy to control infections caused by azole-resistant C. auris.
Collapse
Affiliation(s)
- Jaroslava Dekkerová
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, Ilkovicova 6, 84215 Bratislava, Slovakia; (J.D.); (L.Č.); (S.K.)
| | - Lucia Černáková
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, Ilkovicova 6, 84215 Bratislava, Slovakia; (J.D.); (L.Č.); (S.K.)
| | - Samuel Kendra
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, Ilkovicova 6, 84215 Bratislava, Slovakia; (J.D.); (L.Č.); (S.K.)
| | - Elisa Borghi
- Department of Health Sciences, San Paolo Medical School, Università Degli Studi di Milano, Via A. di Rudini 8, 20142 Milan, Italy; (E.B.); (E.O.)
| | - Emerenziana Ottaviano
- Department of Health Sciences, San Paolo Medical School, Università Degli Studi di Milano, Via A. di Rudini 8, 20142 Milan, Italy; (E.B.); (E.O.)
| | - Birgit Willinger
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, 1090 Vienna, Austria;
| | - Helena Bujdáková
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, Ilkovicova 6, 84215 Bratislava, Slovakia; (J.D.); (L.Č.); (S.K.)
- Correspondence: ; Tel.: +421-2-9014-9436
| |
Collapse
|
38
|
Safari F, Madani M, Kheirollahi M, Mirhendi H. Development and Validation of Specific Conventional PCR and Real-Time PCR Assays for Rapid Detection/Identification of C. auris from Yeast Isolates and Clinical Specimens. Mycoses 2022; 65:1137-1145. [PMID: 35860950 DOI: 10.1111/myc.13504] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/10/2022] [Accepted: 07/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The accurate occurrence rate of C. auris infections is still not clear, mainly due to defects in detection and identification tools routinely used. In this study, we used conventional PCR and real-time PCR assays for sensitive and specific detection/identification of C. auris from either yeast isolates or clinical specimens collected from various patients in different parts of Iran. Our survey is the first large scale study rating the incidence of C. auris infections in Iran. METHODS A total of 439 yeast isolates and 590 clinical specimens were screened by specific C. auris-PCR, targeting the ITS region. The validity of positive samples was assessed by sequencing. RESULTS Four out of 590 clinical specimens (0.68%) were positive by conventional PCR, while in real-time PCR performed on 100 clinical samples, including those four samples positive in conventional samples, 6 samples were positive. A complete agreement of the identification of positive cases with sequencing results was documented. Among 439 culture isolate, none was positive for C. auris. After following up and resampling of the patients with positive PCR, only one specimen showed positive culture for C. auris, which was confirmed by sequencing. CONCLUSION C. auris is not a common cause of systemic or superficial fungal infections in Iran, and a few detected positive cases can be considered as a commensal, colonizer, or infecting yeast which may potentially emerge in some clinical and therapeutical conditions. Mycological and phenotypical assays are not sensitive approaches for isolation/identification of C. auris, unless a specific and sensitive molecular-based method is applied.
Collapse
Affiliation(s)
- Fatemeh Safari
- Department of Microbiology, Falavarjan Branch, Islamic Azad University, Isfahan, Iran
| | - Mahboobeh Madani
- Department of Microbiology, Falavarjan Branch, Islamic Azad University, Isfahan, Iran
| | - Majid Kheirollahi
- Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Mirhendi
- Department of Parasitology and Mycology, School of Medicine; & Research Core Facilities Laboratory, Mycology Reference Laboratory, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
39
|
Nazari T, Sadeghi F, Izadi A, Sameni S, Mahmoudi S. COVID-19-associated fungal infections in Iran: A systematic review. PLoS One 2022; 17:e0271333. [PMID: 35816494 PMCID: PMC9273100 DOI: 10.1371/journal.pone.0271333] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/29/2022] [Indexed: 12/17/2022] Open
Abstract
Objectives
This systematic review aims to summarize the mycological and clinical features of COVID-19-associated fungal infections (CAFIs) in Iran.
Methods
PubMed, Web of Science, Scopus, Cochrane Library, SID, Magiran, IranDoc, and Google Scholar were searched for Persian and English articles published from January 1, 2020, to November 5, 2021, using a systematic search strategy. Studies on Iranian patients suffering from CAFIs were included in the review.
Results
Twenty-two studies comprising 169 patients were retrieved. Reported CAFIs included candidiasis (85, 50.30%), mucormycosis (35, 20.71%), aspergillosis (29, 17.16%), fusariosis (6, 3.55%), three cases caused by rare pathogens (Rhodotorula mucilaginosa, Diaporthe foeniculina, and Sarocladium kiliense) and 11 (6.51%) uncharacterized mold infections. The most common underlying diseases were diabetes (67/168, 39.88%), cardiovascular diseases (55/168, 32.74%), and hypertension (43/168, 25.59%). The use of antibiotics (111/124, 89.52%), corticosteroids (93/132, 70.44%), and mechanical ventilation (66, 51.16%) were the most common predisposing factors. Totally, 72 (50.35%) of 143 patients with CAFIs died (data were not available for 26 patients).
Conclusion
Fungal infections are evident to be a complication of COVID-19 in Iran; thus, clinicians should consider them as a differential diagnosis, especially in patients with comorbidities and previous antibiotic or corticosteroid use.
Collapse
Affiliation(s)
- Tina Nazari
- Department of Medical Geriatrics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sadeghi
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Izadi
- Department of Medical Parasitology and Mycology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
- Medical Mycology and Bacteriology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Setayesh Sameni
- Department of Medical Sciences, Shahrood Branch, Islamic Azad University, Shahrood, Iran
| | - Shahram Mahmoudi
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- * E-mail: ,
| |
Collapse
|
40
|
Abduljalil H, Bakri A, Albashaireh K, Alshanta OA, Brown JL, Sherry L, Kean R, Nile C, McLean W, Ramage G. Screening the Tocriscreen™ bioactive compound library in search for inhibitors of
Candida
biofilm formation. APMIS 2022; 130:568-577. [PMID: 35791082 PMCID: PMC9541805 DOI: 10.1111/apm.13260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/29/2022] [Indexed: 11/28/2022]
Abstract
Biofilms formed by Candida species present a significant clinical problem due to the ineffectiveness of many conventional antifungal agents, in particular the azole class. We urgently require new and clinically approved antifungal agents quickly for treatment of critically ill patients. To improve efficiency in antifungal drug development, we utilized a library of 1280 biologically active molecules within the Tocriscreen 2.0 Micro library. Candida aurisNCPF 8973 and Candida albicansSC5314 were initially screened for biofilm inhibitory activity using metabolic and biomass quantitative assessment methods, followed up by targeted evaluation of five selected hits. The initial screening (80% metabolic inhibition rate) revealed that there was 90 and 87 hits (approx. 7%) for C. albicans and C. auris, respectively. Additionally, all five compounds selected from the initial hits exhibited a biofilm inhibition effect against several key Candida species tested, including C. glabrata and C. krusei. Toyocamycin displayed the most potent activity at concentrations as low as 0.5 μg/mL, though was limited to inhibition. Darapladib demonstrated an efficacy for biofilm inhibition and treatment at a concentration range from 8 to 32 μg/mL and from 16 to 256 μg/mL, respectively. Combinational testing with conventional antifungals against C. albicans strains demonstrated a range of synergies for planktonic cells, and notably an anti‐biofilm synergy for darapladib and caspofungin. Together, these data provide new insights into antifungal management possibilities for Candida biofilms.
Collapse
Affiliation(s)
- Hafsa Abduljalil
- Glasgow Biofilm Research Group School of Medicine Dentistry and Nursing College of Medical, Veterinary and Life Sciences University of Glasgow Glasgow UK
| | - Ahmed Bakri
- Glasgow Biofilm Research Group School of Medicine Dentistry and Nursing College of Medical, Veterinary and Life Sciences University of Glasgow Glasgow UK
| | - Khawlah Albashaireh
- Glasgow Biofilm Research Group School of Medicine Dentistry and Nursing College of Medical, Veterinary and Life Sciences University of Glasgow Glasgow UK
| | - Om Alkhir Alshanta
- Glasgow Biofilm Research Group School of Medicine Dentistry and Nursing College of Medical, Veterinary and Life Sciences University of Glasgow Glasgow UK
| | - Jason L. Brown
- Glasgow Biofilm Research Group School of Medicine Dentistry and Nursing College of Medical, Veterinary and Life Sciences University of Glasgow Glasgow UK
| | - Leighann Sherry
- Glasgow Biofilm Research Group School of Medicine Dentistry and Nursing College of Medical, Veterinary and Life Sciences University of Glasgow Glasgow UK
| | - Ryan Kean
- Department of Biological and Biomedical Sciences Glasgow Caledonian University
| | | | - William McLean
- Glasgow Biofilm Research Group School of Medicine Dentistry and Nursing College of Medical, Veterinary and Life Sciences University of Glasgow Glasgow UK
| | - Gordon Ramage
- Glasgow Biofilm Research Group School of Medicine Dentistry and Nursing College of Medical, Veterinary and Life Sciences University of Glasgow Glasgow UK
| |
Collapse
|
41
|
Hillock NT, Merlin TL, Turnidge J, Karnon J. Modelling the Future Clinical and Economic Burden of Antimicrobial Resistance: The Feasibility and Value of Models to Inform Policy. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:479-486. [PMID: 35368230 PMCID: PMC8977126 DOI: 10.1007/s40258-022-00728-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 05/31/2023]
Abstract
Due to the increasing threat to public health and the economy, governments internationally are interested in models to estimate the future clinical and economic burden of antimicrobial resistance (AMR) and to evaluate the cost-effectiveness of interventions to prevent or control resistance and to inform resource-allocation decision making. A widely cited UK report estimated that 10 million additional deaths will occur globally per annum due to AMR by 2050; however, the utility and accuracy of this prediction has been challenged. The precision of models predicting the future economic burden of AMR is dependent upon the accuracy of predicting future resistance rates. This paper reviews the feasibility and value of modelling to inform policy and resource allocation to manage and curb AMR. Here we describe methods used to estimate future resistance in published burden-of-disease models; the sources of uncertainty are highlighted, which could potentially mislead policy decision-making. While broad assumptions can be made regarding some predictable factors contributing to future resistance rates, the unexpected emergence, establishment and spread of new resistance genes introduces substantial uncertainty into estimates of future economic burden, and in models evaluating the effectiveness of interventions or policies to address AMR. Existing reporting standards for best practice in modelling should be adapted to guide the reporting of AMR economic models, to ensure model transparency and validation for interpretation by policymakers.
Collapse
Affiliation(s)
- Nadine T. Hillock
- School of Public Health, University of Adelaide, North Terrace, Adelaide, SA 5000 Australia
| | - Tracy L. Merlin
- School of Public Health, University of Adelaide, North Terrace, Adelaide, SA 5000 Australia
| | - John Turnidge
- University of Adelaide, North Terrace, Adelaide, SA 5000 Australia
| | - Jonathan Karnon
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042 Australia
| |
Collapse
|
42
|
Oh KH, Lee SH. COVID-19 and Fungal Diseases. Antibiotics (Basel) 2022; 11:antibiotics11060803. [PMID: 35740209 PMCID: PMC9219667 DOI: 10.3390/antibiotics11060803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 01/08/2023] Open
Abstract
Coronavirus Disease-2019 (COVID-19) can cause secondary bacterial and fungal infections by affecting the expression of pro-inflammatory markers, such as tumor necrosis alpha and certain cytokines, as well as the numbers of CD4 and CD8 cells. In particular, in the head and neck, various fungal species are naturally present, making it the main route of secondary infection. It is difficult to clearly distinguish whether secondary infection is caused by COVID-19 directly or indirectly as a result of the immunocompromised state induced by drugs used to treat the disease. However, the risk of fungal infection is high in patients with severe COVID-19, and lymphopenia is observed in most patients with the disease. Patients with COVID-19 who are immunosuppressed or have other pre-existing comorbidities are at a significantly higher risk of acquiring invasive fungal infections. In order to reduce morbidity and mortality in these patients, early diagnosis is required, and treatment with systemic antifungal drugs or surgical necrotic tissue resection is essential. Therefore, this review aimed to examine the risk of fungal infection in the head and neck of patients with COVID-19 and provide information that could reduce the risk of mortality.
Collapse
|
43
|
Barantsevich N, Barantsevich E. Diagnosis and Treatment of Invasive Candidiasis. Antibiotics (Basel) 2022; 11:antibiotics11060718. [PMID: 35740125 PMCID: PMC9219674 DOI: 10.3390/antibiotics11060718] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/14/2022] [Accepted: 05/18/2022] [Indexed: 02/06/2023] Open
Abstract
Candida species, belonging to commensal microbial communities in humans, cause opportunistic infections in individuals with impaired immunity. Pathogens encountered in more than 90% cases of invasive candidiasis include C. albicans, C. glabrata, C. krusei, C. tropicalis, and C. parapsilosis. The most frequently diagnosed invasive infection is candidemia. About 50% of candidemia cases result in deep-seated infection due to hematogenous spread. The sensitivity of blood cultures in autopsy-proven invasive candidiasis ranges from 21% to 71%. Non-cultural methods (beta-D-glucan, T2Candida assays), especially beta-D-glucan in combination with procalcitonin, appear promising in the exclusion of invasive candidiasis with high sensitivity (98%) and negative predictive value (95%). There is currently a clear deficiency in approved sensitive and precise diagnostic techniques. Omics technologies seem promising, though require further development and study. Therapeutic options for invasive candidiasis are generally limited to four classes of systemic antifungals (polyenes, antimetabolite 5-fluorocytosine, azoles, echinocandins) with the two latter being highly effective and well-tolerated and hence the most widely used. Principles and methods of treatment are discussed in this review. The emergence of pan-drug-resistant C. auris strains indicates an insufficient choice of available medications. Further surveillance, alongside the development of diagnostic and therapeutic methods, is essential.
Collapse
|
44
|
Vaseghi N, Sharifisooraki J, Khodadadi H, Nami S, Safari F, Ahangarkani F, Meis JF, Badali H, Morovati H. Global Prevalence and Subgroup Analyses of Coronavirus Disease (COVID-19) Associated Candida auris infections (CACa): A Systematic Review and Meta-Analysis. Mycoses 2022; 65:683-703. [PMID: 35555921 PMCID: PMC9347948 DOI: 10.1111/myc.13471] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/02/2022] [Accepted: 05/10/2022] [Indexed: 11/30/2022]
Abstract
Background Increased hospitalisation rates in the Coronavirus disease 19 (COVID‐19) era lead to a new wave of hospital‐acquired infections such as emerging multidrug‐resistant Candida auris. We aimed to evaluate and estimate the global prevalence of coronavirus‐associated C. auris infection (CACa). Methods We searched related databases between December 2019 and April 2022 for studies that reported data about CACa. Meta‐analysis was performed using MedCalc software version 20.104 according to the DerSimonian and Laird method applying the random‐effects model. We evaluated heterogeneity using the χ2‐based Q statistic (significant for p‐value < .1) and the I2 statistic (>75% indicative of ‘notable’ heterogeneity). Moreover, if possible, an odds ratio (OR) analysis was performed for eligible data. Results Our meta‐analysis includes ten eligible studies, including 1942 patients hospitalised with COVID‐19; 129 were C. auris cases. The overall pooled prevalence of CACa was estimated at 5.7%. The mortality rate of CACa was estimated at 67.849%. Hypertension was the most prevalent comorbidity (59.374%), followed by diabetes mellitus (52.898%) and cardiovascular diseases (31.392%). Men with a prevalence rate of 80.012% were 3.27 (OR) times more prone to getting infected by C. auris. Conclusion We concluded that the prevalence of C. auris infections decreased during the COVID‐19 pandemic and the prevalence gradient changed from Asia to America. Unfortunately, there are many descriptive studies with duplicate content in the field of epidemiology of C. auris infections which are increasing every day. We suggest further non‐descriptive studies to accurately establish the cause‐and‐effect relationships between C. auris and COVID‐19 infections.
Collapse
Affiliation(s)
- Narges Vaseghi
- Department of Pathobiology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Joobin Sharifisooraki
- Health Reproductive Research Center, Islamic Azad University, Sari, Mazandaran, Iran
| | - Hossein Khodadadi
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sanam Nami
- Department of Medical Mycology and Parasitology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Safari
- Department of Microbiology, Falavarjan Branch, Islamic Azad University, Isfahan, Iran
| | - Fatemeh Ahangarkani
- Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.,Excellence Center for Medical Mycology, Centre of Expertise, Mycology Radboudumc/Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.,Bioprocess Engineering and Biotechnology Graduate Program, Federal University of Paraná, Curitiba, Brazil
| | - Hamid Badali
- Department of Molecular Microbiology & Immunology/South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, Texas
| | - Hamid Morovati
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
45
|
COVID-19 and C. auris: A Case-Control Study from a Tertiary Care Center in Lebanon. Microorganisms 2022; 10:microorganisms10051011. [PMID: 35630454 PMCID: PMC9145281 DOI: 10.3390/microorganisms10051011] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 02/04/2023] Open
Abstract
Many healthcare centers around the world have reported the surge of Candida auris (C. auris) outbreaks during the COVID-19 pandemic, especially among intensive care unit (ICU) patients. This is a retrospective study conducted at the American University of Beirut Medical Center (AUBMC) between 1 October 2020 and 15 June 2021, to identify risk factors for acquiring C. auris in patients with severe COVID-19 infection and to evaluate the impact of C. auris on mortality in patients admitted to the ICU during that period. Twenty-four non-COVID-19 (COV−) patients were admitted to ICUs at AUBMC during that period and acquired C. auris (C. auris+/COV−). Thirty-two patients admitted with severe COVID-19 (COV+) acquired C. auris (C. auris+/COV+), and 130 patients had severe COVID-19 without C. auris (C. auris−/COV+). Bivariable analysis between the groups of (C. auris+/COV+) and (C. auris−/COV+) showed that higher quick sequential organ failure assessment (qSOFA) score (p < 0.001), prolonged length of stay (LOS) (p = 0.02), and the presence of a urinary catheter (p = 0.015) or of a central venous catheter (CVC) (p = 0.01) were associated with positive culture for C. auris in patients with severe COVID-19. The multivariable analysis showed that prolonged LOS (p = 0.008) and a high qSOFA score (p < 0.001) were the only risk factors independently associated with positive culture for C. auris. Increased LOS (p = 0.02), high “Candida score” (p = 0.01), and septic shock (p < 0.001) were associated with increased mortality within 30 days of positive culture for C. auris. Antifungal therapy for at least 7 days (p = 0.03) appeared to decrease mortality within 30 days of positive culture for C. auris. Only septic shock was associated with increased mortality in patients with C. auris (p = 0.006) in the multivariable analysis. C. auris is an emerging pathogen that constitutes a threat to the healthcare sector.
Collapse
|
46
|
Candida auris Candidemia in Critically Ill, Colonized Patients: Cumulative Incidence and Risk Factors. Infect Dis Ther 2022; 11:1149-1160. [PMID: 35404010 PMCID: PMC8995918 DOI: 10.1007/s40121-022-00625-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/14/2022] [Indexed: 01/10/2023] Open
Abstract
Introduction Candida auris (C. auris) is an emerging nosocomial pathogen, and a sharp rise in cases of colonization and infection has been registered in intensive care units (ICUs) during the ongoing coronavirus disease 2019 (COVID-19) pandemic. The unfavorable resistance profile of C. auris and the potential high mortality of C. auris infections represent an important challenge for physicians. Methods We conducted a single-center retrospective study including all patients admitted to ICUs with isolation of C. auris in any non-sterile body site between February 20, 2020, and May 31, 2021. The primary aim of the study was to assess the cumulative incidence of C. auris candidemia in colonized patients. The secondary aim was to identify predictors of C. auris candidemia in the study population. Results During the study period, 157 patients admitted to ICUs in our hospital became colonized with C. auris; 59% of them were affected by COVID-19. Overall, 27 patients (17%) developed C. auris candidemia. The cumulative risk of developing C. auris candidemia was > 25% at 60 days after first detection of C. auris colonization. Seven patients with C. auris candidemia (26%) also developed a late recurrent episode. All C. auris blood isolates during the first occurring episode were resistant to fluconazole and susceptible to echinocandins, while 15 (56%) were resistant to amphotericin B. During late recurrent episodes, emergent resistance to caspofungin and amphotericin B occurred in one case each. In the final multivariable model, only multisite colonization retained an independent association with the development of C. auris candidemia. Conclusion Candida auris candidemia may occur in up to one fourth of colonized critically ill patients, and multisite colonization is an independent risk factor for the development of candidemia. Implementing adequate infection control measures remains crucial to prevent colonization with C. auris and indirectly the subsequent development of infection.
Collapse
|
47
|
Wang Y, Xu H, Chen N, Yang J, Zhou H. LncRNA: A Potential Target for Host-Directed Therapy of Candida Infection. Pharmaceutics 2022; 14:pharmaceutics14030621. [PMID: 35335994 PMCID: PMC8954347 DOI: 10.3390/pharmaceutics14030621] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/25/2022] [Accepted: 03/09/2022] [Indexed: 02/01/2023] Open
Abstract
Despite various drugs work against Candida, candidiasis represents clinical management challenges worldwide due to the rising incidence and recurrence rate, as well as epidemics, of new drug-resistant pathogens. Recent insights into interactions between Candida and hosts contribute to exploring novel therapeutic strategies, termed host-directed therapies (HDTs). HDTs are viable adjuncts with good efficacy for the existing standard antifungal regimens. However, HDTs induce other response unintendedly, thus requiring molecular targets with highly specificity. Long noncoding RNAs (lncRNAs) with highly specific expression patterns could affect biological processes, including the immune response. Herein, this review will summarize recent advances of HDTs based on the Candida–host interaction. Especially, the findings and application strategies of lncRNAs related to the host response are emphasized. We propose it is feasible to target lncRNAs to modulate the host defense during Candida infection, which provides a new perspective in identifying options of HDTs for candidiasis.
Collapse
|
48
|
Mariita RM, Davis JH, Lottridge MM, Randive RV. Shining light on multi-drug resistant Candida auris: Ultraviolet-C disinfection, wavelength sensitivity, and prevention of biofilm formation of an emerging yeast pathogen. Microbiologyopen 2022; 11:e1261. [PMID: 35212481 PMCID: PMC8767514 DOI: 10.1002/mbo3.1261] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/13/2021] [Indexed: 12/22/2022] Open
Abstract
Candida auris is an emerging fungal superbug of worldwide interest. It is associated with high mortality rates and exhibits increased resistance to antifungals. Ultraviolet subtype C (UVC) light can be used to disinfect surfaces to mitigate its spread. The objectives of this study were (1) To investigate UVC disinfection performances and wavelength sensitivity of C. auris. (2) To evaluate the UVC dose required for the prevention of biofilm formation on stainless-steel, plastic (polystyrene), and poly-cotton fabric surfaces. C. auris was grown following standard procedures. The study utilized six different UVC LED arrays with wavelengths between 252 and 280 nm. Arrays were set at similar intensities, to obtain doses of 5-40 mJ cm-2 and similar irradiation time. Disinfection performance for each array was determined using log reduction value (LRV) and percentage reduction by comparing the controls against the irradiated treatments. Evaluation of the ability of 267 nm UVC LEDs to prevent C. auris biofilm formation was investigated using stainless-steel, plastic coupons, and poly-cotton fabric. Peak sensitivity to UVC disinfection was between 267 and 270 nm. With 20 mJ cm-2 , the study obtained ≥LRV3. On stainless-steel coupons, 30 mJ cm-2 was sufficient to prevent biofilm formation, while on plastic, this required 10 mJ cm-2 . A dose of 60 mJ cm-2 reduced biofilms on poly-cotton fabric significantly (R2 = 0.9750, p = 0.0002). The study may allow for the design and implementation of disinfection systems.
Collapse
Affiliation(s)
- Richard M. Mariita
- Product Engineering DepartmentCrystal IS Inc., an Asahi Kasei CompanyGreen IslandNew YorkUSA
| | - James H. Davis
- Product Engineering DepartmentCrystal IS Inc., an Asahi Kasei CompanyGreen IslandNew YorkUSA
| | - Michelle M. Lottridge
- Product Engineering DepartmentCrystal IS Inc., an Asahi Kasei CompanyGreen IslandNew YorkUSA
| | - Rajul V. Randive
- Product Engineering DepartmentCrystal IS Inc., an Asahi Kasei CompanyGreen IslandNew YorkUSA
| |
Collapse
|
49
|
Antimicrobials and Resistance Part II: Antifungals, Antivirals, and Antiparasitics. J Am Acad Dermatol 2022; 86:1207-1226. [DOI: 10.1016/j.jaad.2021.11.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 11/18/2022]
|
50
|
Baldim I, Paziani MH, Grizante Barião PH, Kress MRVZ, Oliveira WP. Nanostructured Lipid Carriers Loaded with Lippia sidoides Essential Oil as a Strategy to Combat the Multidrug-Resistant Candida auris. Pharmaceutics 2022; 14:pharmaceutics14010180. [PMID: 35057078 PMCID: PMC8781248 DOI: 10.3390/pharmaceutics14010180] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 12/12/2022] Open
Abstract
The emerging pathogen Candida auris is an emerging fungal pathogen that was associated with nosocomial infectious outbreaks. Its worldwide incidence and the emerging multidrug-resistant strains highlight the urgency for novel and effective antifungal treatment strategies. Lippia sidoides essential oil (LSEO) proved antifungal activity, including anti-Candida. However, it may undergo irreversible changes when in contact with external agents without adequate protection. Herein, we encapsulated LSEO in nanostructured lipid carriers (NLC) through the hot emulsification method followed by sonication. NLC matrix was based on oleic acid and Compritol® 888, or a combination of carnauba wax and beeswax, stabilized by sodium dodecyl sulfate. Eight formulations were produced and characterized by the determination of the particle size (213.1 to 445.5 nm), polydispersity index (around 0.3), and ζ-potential (−93.1 to −63.8 mV). The antifungal activity of nanoparticles and LSEO against C. auris and the in vivo toxicity in Galleria mellonella model were also evaluated. Both NLC and LSEO exhibited potent activity against the yeast, with Minimum Inhibitory Concentration between 281 and 563 µg/mL, and did not evidence toxicity in the in vivo model. Therefore, this study confirms the viability of NLCs loaded with LSEO in combating drug-resistant pathogens as a potential new therapeutic strategy for managing of candidemia.
Collapse
|