1
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Mitchell CM. Assessment and Treatment of Vaginitis. Obstet Gynecol 2024:00006250-990000000-01111. [PMID: 38991218 DOI: 10.1097/aog.0000000000005673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/11/2024] [Indexed: 07/13/2024]
Abstract
Vaginitis is the presenting symptom at millions of office visits each year in the United States. Although treatment of sporadic cases is often straightforward, recurrent cases present both diagnostic and treatment challenges. Molecular diagnostic tests are likely superior to in-office microscopy for most clinicians and most cases. In both recurrent bacterial vaginosis and recurrent vulvovaginal candidiasis, national treatment guidelines recommend an extended treatment duration with one of the first-line agents. In cases in which such treatment is not successful, vaginal boric acid is likely the cheapest and easiest alternative option. New antifungal medications offer additional but limited treatment options. Probiotics are not recommended for prevention of vulvovaginal candidiasis; however, vaginal products containing Lactobacillus crispatus may have promise for recurrent bacterial vaginosis. Trichomoniasis should be treated with a 1-week course of metronidazole; this is the only sexually transmitted infection for which treatment recommendations vary by sex. In cases in which patients do not respond to initial treatment, the diagnosis should be reconsidered, and other potential causes such as desquamative inflammatory vaginitis, genitourinary syndrome of menopause, or vulvodynia should be considered.
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Affiliation(s)
- Caroline M Mitchell
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, and the Vulvovaginal Disorders Program, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
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2
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Mira NP, Marshall R, Pinheiro MJF, Dieckmann R, Dahouk SA, Skroza N, Rudnicka K, Lund PA, De Biase D. On the potential role of naturally occurring carboxylic organic acids as anti-infective agents: opportunities and challenges. Int J Infect Dis 2024; 140:119-123. [PMID: 38325748 DOI: 10.1016/j.ijid.2024.01.011] [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: 10/26/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 02/09/2024] Open
Abstract
Carboxylic organic acids are intermediates of central carbon metabolic pathways (e.g. acetic, propionic, citric, and lactic acid) long known to have potent antimicrobial potential, mainly at acidic pHs. The food industry has been leveraging those properties for years, using many of these acids as preservatives to inhibit the growth of pathogenic and/or spoilage fungal and bacterial species. A few of these molecules (the most prominent being acetic acid) have been used as antiseptics since Hippocratic medicine, mainly to treat infected wounds in patients with burns. With the growth of antibiotic therapy, the use of carboxylic acids (and other chemical antiseptics) in clinical settings lost relevance; however, with the continuous emergence of multi-antibiotic/antifungal resistant strains, the search for alternatives has intensified. This prospective article raises awareness of the potential of carboxylic acids to control infections in clinical settings, considering not only their previous exploitation in this context (which we overview) but also the positive experience of their safe use in food preservation. At a time of great concern with antimicrobial resistance and the slow arrival of new antimicrobial therapeutics to the market, further exploration of organic acids as anti-infective molecules may pave the way to more sustainable prophylactic and therapeutic approaches.
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Affiliation(s)
- Nuno Pereira Mira
- iBB, Institute for Bioengineering and Biosciences, Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal; Associate Laboratory i4HB-Institute for Health and Bioeconomy at Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal.
| | - Robert Marshall
- Institute of Microbiology and Infection, School of Biosciences, University of Birmingham, Birmingham, United Kingdom
| | - Maria Joana F Pinheiro
- iBB, Institute for Bioengineering and Biosciences, Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal; Associate Laboratory i4HB-Institute for Health and Bioeconomy at Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Ralf Dieckmann
- German Federal Institute for Risk Assessment, Department of Biological Safety, Berlin, Germany
| | - Sascha Al Dahouk
- German Federal Institute for Risk Assessment, Department of Biological Safety, Berlin, Germany
| | - Nevena Skroza
- Unit of Dermatology, Department of Medico-Surgical Science and Biotechnologies, Sapienza University of Rome, A. Fiorini Hospital, Latina, Italy
| | - Karolina Rudnicka
- Department of Immunology and Infectious Biology, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
| | - Peter A Lund
- Associate Laboratory i4HB-Institute for Health and Bioeconomy at Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Daniela De Biase
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
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3
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Bellavita R, Falanga A, Merlino F, D'Auria G, Molfetta N, Saviano A, Maione F, Galdiero U, Catania MR, Galdiero S, Grieco P, Roscetto E, Falcigno L, Buommino E. Unveiling the mechanism of action of acylated temporin L analogues against multidrug-resistant Candida albicans. J Enzyme Inhib Med Chem 2023; 38:36-50. [PMID: 36305289 PMCID: PMC9621209 DOI: 10.1080/14756366.2022.2134359] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The increasing resistance of fungi to conventional antifungal drugs has prompted worldwide the search for new compounds. In this work, we investigated the antifungal properties of acylated Temporin L derivatives, Pent-1B and Dec-1B, against Candida albicans, including the multidrug-resistant strains. Acylated peptides resulted to be active both on reference and clinical strains with MIC values ranging from 6.5 to 26 µM, and they did not show cytotoxicity on human keratinocytes. In addition, we also observed a synergistic or additive effect with voriconazole for peptides Dec-1B and Pent-1B through the checkerboard assay on voriconazole-resistant Candida strains. Moreover, fluorescence-based assays, NMR spectroscopy, and confocal microscopy elucidated a potential membrane-active mechanism, consisting of an initial electrostatic interaction of acylated peptides with fungal membrane, followed by aggregation and insertion into the lipid bilayer and causing membrane perturbation probably through a carpeting effect.
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Affiliation(s)
- Rosa Bellavita
- Department of Pharmacy, University of Naples "Federico II", Naples, Italy
| | - Annarita Falanga
- Department of Agricultural Science, University of Naples "Federico II", Portici, Italy
| | - Francesco Merlino
- Department of Pharmacy, University of Naples "Federico II", Naples, Italy
| | - Gabriella D'Auria
- Department of Pharmacy, University of Naples "Federico II", Naples, Italy
| | - Nicola Molfetta
- Department of Pharmacy, University of Naples "Federico II", Naples, Italy
| | - Anella Saviano
- Department of Pharmacy, University of Naples "Federico II", Naples, Italy
| | - Francesco Maione
- Department of Pharmacy, University of Naples "Federico II", Naples, Italy
| | - Umberto Galdiero
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy
| | - Maria Rosaria Catania
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy
| | - Stefania Galdiero
- Department of Pharmacy, University of Naples "Federico II", Naples, Italy
| | - Paolo Grieco
- Department of Pharmacy, University of Naples "Federico II", Naples, Italy
| | - Emanuela Roscetto
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy
| | - Lucia Falcigno
- Department of Pharmacy, University of Naples "Federico II", Naples, Italy
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4
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Vandecruys P, Baldewijns S, Sillen M, Van Genechten W, Van Dijck P. Oteseconazole: a long-awaited diversification of the antifungal arsenal to manage recurrent vulvovaginal candidiasis (RVVC). Expert Rev Anti Infect Ther 2023; 21:799-812. [PMID: 37449774 DOI: 10.1080/14787210.2023.2233696] [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: 04/18/2023] [Revised: 06/06/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Recurrent vulvovaginal candidiasis (RVVC) affects women worldwide and has far-reaching implications for a patient's quality of life. For decades, maintenance treatment using the azole antifungal fluconazole was the preferred treatment. Although efficient in controlling the symptoms, the development of azole resistance and high rates of recurrence after therapy cessation have emerged as significant limitations. Nevertheless, persistent efforts have delivered novel treatment options. Oteseconazole (VT-1161), marketed as VIVJOA, is an oral, tetrazole antifungal with unprecedented specificity toward the fungal lanosterol 14α-demethylase. AREAS COVERED We reviewed literature data on oteseconazole with a focus on the management of RVVC. EXPERT OPINION Therapeutic options for RVVC are limited, and novel, innovative approaches are needed to treat this debilitating condition. These therapies need to be well-tolerated and prevent RVVC recurrence. The available clinical data show excellent safety and efficacy, with an unprecedentedly low recurrence rate. However, we believe health-care providers should be mindful to monitor for the development of resistance, as this may result in treatment failure. Further, the availability and cost may, like for most novel drugs, affect the widespread clinical implementation of VIVJOA. Altogether, we are convinced that VIVJOA is a significant advance in RVVC management.
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Affiliation(s)
- Paul Vandecruys
- Laboratory of Molecular Cell Biology, Department of Biology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Silke Baldewijns
- Laboratory of Molecular Cell Biology, Department of Biology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Mart Sillen
- Laboratory of Molecular Cell Biology, Department of Biology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Wouter Van Genechten
- Laboratory of Molecular Cell Biology, Department of Biology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Patrick Van Dijck
- Laboratory of Molecular Cell Biology, Department of Biology, Katholieke Universiteit Leuven, Leuven, Belgium
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Sobel JD. Resistance to Fluconazole of Candida albicans in Vaginal Isolates: a 10-Year Study in a Clinical Referral Center. Antimicrob Agents Chemother 2023; 67:e0018123. [PMID: 37093005 PMCID: PMC10190554 DOI: 10.1128/aac.00181-23] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/23/2023] [Indexed: 04/25/2023] Open
Abstract
Review of vaginal isolates of Candida albicans that caused clinical failure in a 10-year collection of vaginal C. albicans specimens obtained in a university vaginitis referral clinic indicated an increase in fluconazole resistance. Factors contributing to azole resistance are discussed, including treatment choice associated with fluconazole-resistant C. albicans vaginal infection.
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Affiliation(s)
- J. D. Sobel
- Department of Internal Medicine, Wayne State University, Detroit, Michigan, USA
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6
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Sobel JD, Sebastian S, Boikov DA. A longitudinal study on fluconazole resistance in Candida albicans vaginal isolates. Mycoses 2023. [PMID: 36866967 DOI: 10.1111/myc.13582] [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: 11/12/2022] [Revised: 02/13/2023] [Accepted: 02/23/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Recurrent vulvovaginal candidiasis (RVVC), despite its worldwide prevalence, has limited treatment options; and a long-term prophylactic regimen utilising fluconazole is the dominant choice. OBJECTIVES An increase in fluconazole resistance is reported, and little information is available about the reversibility of resistance status following the withdrawal of fluconazole. METHODS Repeated antifungal susceptibility tests (ASTs) for fluconazole at a median interval of 3 months between them were evaluated in women with refractory or recurrent VVC patients at the Vaginitis clinic from 2012 to 2021 (10 years) and performed at pH 7 and pH 4.5 using the broth microdilution tests based on the CLSI M27-A4 reference method. RESULTS Of 38 patients with long-term follow-up with repeat ASTs, 13 patients (13/38, 34.2%) tested at pH 7.0 remained susceptible to fluconazole with MIC ≤2 μg/mL. Nineteen patients (19/38, 50%) remained resistant to fluconazole with MIC ≥8 μg/mL, whereas four (4/38, 10.5%) changed from susceptible to resistant and two (2/38, 5.2%) changed from resistant to susceptible over time. At pH 4.5, among the 37 patients with repeated MIC values, nine (9/37, 24.3%) remained susceptible to fluconazole and 22 (22/37, 59.5%) remained resistant. Three isolates (3/37, 8.1%) changed from susceptible to resistant, while 3 (3/37, 8.1%) changed from resistant to susceptible over time. CONCLUSION Fluconazole susceptibility in Candida albicans vaginal isolates obtained longitudinally in women with RVVC remains stable with rare reversal of resistance despite azole avoidance.
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Affiliation(s)
- Jack D Sobel
- Division of Infectious Diseases, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Sreya Sebastian
- Division of Infectious Diseases, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Dina A Boikov
- Division of Infectious Diseases, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
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7
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Yang J, Park S, Kim HJ, Lee SJ, Jung WH. The Interkingdom Interaction with Staphylococcus Influences the Antifungal Susceptibility of the Cutaneous Fungus Malassezia. J Microbiol Biotechnol 2023; 33:180-187. [PMID: 36575858 PMCID: PMC9998211 DOI: 10.4014/jmb.2210.10039] [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: 10/24/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 12/29/2022]
Abstract
The skin is a dynamic ecosystem on which diverse microbes reside. The interkingdom interaction between microbial species in the skin microbiota is thought to influence the health and disease of the skin although the roles of the intra- and interkingdom interactions remain to be elucidated. In this context, the interactions between Malassezia and Staphylococcus, the most dominant microorganisms in the skin microbiota, have gained attention. This study investigated how the interaction between Malassezia and Staphylococcus affected the antifungal susceptibility of the fungus to the azole antifungal drug ketoconazole. The susceptibility was significantly decreased when Malassezia was co-cultured with Staphylococcus. We found that acidification of the environment by organic acids produced by Staphylococcus influenced the decrease of the ketoconazole susceptibility of M. restricta in the co-culturing condition. Furthermore, our data demonstrated that the significant increased ergosterol content and cell membrane and wall thickness of the M. restricta cells grown in the acidic environment may be the main cause of the altered azole susceptibility of the fungus. Overall, our study suggests that the interaction between Malassezia and Staphylococcus influences the antifungal susceptibility of the fungus and that pH has a critical role in the polymicrobial interaction in the skin environment.
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Affiliation(s)
- Juan Yang
- Department of Systems Biotechnology and Institute of Microbiomics, Chung-Ang University, Anseong 17546, Republic of Korea
| | - Sungmin Park
- Department of Systems Biotechnology and Institute of Microbiomics, Chung-Ang University, Anseong 17546, Republic of Korea
| | - Hyun Ju Kim
- Department of Systems Biotechnology and Institute of Microbiomics, Chung-Ang University, Anseong 17546, Republic of Korea
| | - Sang Jun Lee
- Department of Systems Biotechnology and Institute of Microbiomics, Chung-Ang University, Anseong 17546, Republic of Korea
| | - Won Hee Jung
- Department of Systems Biotechnology and Institute of Microbiomics, Chung-Ang University, Anseong 17546, Republic of Korea
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8
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Sobel JD. Role of Antifungal Susceptibility Tests in the Treatment of Vulvovaginal Candidiasis. Curr Infect Dis Rep 2023. [DOI: 10.1007/s11908-023-00797-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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9
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Agrawal P, Yazdy G, Ghanem KG, Handa VL, Schumacher CM, Sobel JD, Zhang SX, Tuddenham S. Vaginal Candida albicans: High Frequency of in Vitro Fluconazole Resistance in a Select Population-A Brief Note. Sex Transm Dis 2023; 50:121-123. [PMID: 36630418 DOI: 10.1097/olq.0000000000001730] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Abstract
In this select population, we found a high frequency of in vitro fluconazole resistance in vaginal Candida albicans. Resistance did not reliably predict future susceptibility.
Among clinician-ordered vaginal cultures positive for Candida albicans, 30% exhibited fluconazole resistance. Resistance did not reliably predict future susceptibility. Prospective studies to verify associations with demographic and clinical factors as well as to correlate in vitro resistance with treatment response and longitudinal resistance patterns are needed.
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Affiliation(s)
| | | | | | | | - Christina M Schumacher
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jack D Sobel
- Division of Infectious Disease, Wayne State University, Detroit, MI
| | - Sean X Zhang
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
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10
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Morris GC, Dean G, Soni S, Sundaram S, Fearnley N, Wilson JD. Outcomes and experiences of using oral voriconazole with or without concomitant topical agents to treat refractory vulvovaginal yeast infections. Int J STD AIDS 2022; 33:1134-1141. [PMID: 36214529 DOI: 10.1177/09564624221127356] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND We describe 11 cases of refractory vulvovaginal yeast infections (RVVYI) treated using oral voriconazole with or without concomitant topical agents. METHODS Retrospective case-note review of all women prescribed oral voriconazole to treat RVVYI in five Sexual Health Clinics from Jan 2010-March 2020. Demographic details, clinical features, diagnostic results and treatment outcomes were collected. RESULTS 11 women with vulvovaginal symptoms for a median of 1 year were treated with voriconazole. RVVYI was diagnosed clinically and confirmed on microscopy and culture with speciation. 10/11 isolates were fluconazole resistant, 1 intermediately sensitive, 10/11 were either fully or intermediately sensitive to voriconazole. All had received prior fluconazole and clotrimazole and 10/11 had used at least 2-weeks of one or more second-line antifungals with non-clearance of the yeast. Oral voriconazole 400 mg BD day-1, then 200 mg BD 13-days was prescribed and 10/11 women completed the course. Concomitant topical treatment was used by 6/11. Liver and renal function were monitored at 0, 7, 14 days. One woman stopped voriconazole after 5-days due to perioral tingling. Other transient side-effects were nausea (n = 2), photosensitivity, muscle aches, hair thinning (all n = 1), peripheral visual disturbance (n = 2). 8/11 experienced both symptom reduction and yeast clearance. Two women had an initial partial response but experienced resolution of symptoms following a second course of voriconazole. CONCLUSIONS Our observational data adds to the limited evidence to support voriconazole treatment for RVVYI. A 2-week course of voriconazole was tolerated and completed by 10/11 women. Eight women, five using concomitant topical agents, achieved mycological cure.
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Affiliation(s)
- Georgina Claire Morris
- Wiltshire Sexual Health Service, 7053Salisbury NHS Foundation Trust, Salisbury, Wiltshire, United Kingdom of Great Britain and Northern Ireland
| | - Gillian Dean
- Claude Nicol Centre, 1949University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom of Great Britain and Northern Ireland
| | - Suneeta Soni
- Claude Nicol Centre, 1949University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom of Great Britain and Northern Ireland
| | - Sangeetha Sundaram
- Southampton Sexual Health Services, 232267Solent NHS Trust, Southampton, United Kingdom of Great Britain and Northern Ireland
| | - Nicola Fearnley
- Locala Sexual Health, Bradford, United Kingdom of Great Britain and Northern Ireland
| | - Janet Diane Wilson
- Leeds Sexual Health, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom of Great Britain and Northern Ireland
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11
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Tasleem, Shanthi N, Mahato AK, Bahuguna R. Oral delivery of butoconazole nitrate nanoparticles for systemic treatment of chronic paracoccidioidomycosis: A future aspect. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103808] [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]
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12
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Jarungsirawat R, Kajthunyakarn W, Siriwachirachai C, Pongjanyakul T. Formulation Development of Fluconazole-Loaded Lactose Agglomerate Tablets as a Disinfectant for Candida-Associated Dentures. Pharmaceutics 2022; 14:pharmaceutics14081723. [PMID: 36015349 PMCID: PMC9414907 DOI: 10.3390/pharmaceutics14081723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/13/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
Denture stomatitis is induced by irritation or an inflammatory response when wearing a denture for a long time. Candida species are the leading cause of biofilm formation on the surfaces and fissures of dentures. Thus, this study aimed to formulate and evaluate fluconazole tablets for use in preparing a disinfectant mixture with anticandidal activity. For size enlargement of lactose, a tablet diluent, using polyvinylpyrrolidone (PVP) as an agglomerating agent, was developed to enhance the flowability and compactability of the tablet preparation using direct compression. Lactose agglomerates with 6% PVP were used as a diluent for the fluconazole tablets. Furthermore, other excipients were used, such as a buffering agent, disintegrant, surfactant, and lubricant. The fluconazole tablets obtained could be dispersed and dissolved within 10 min in distilled water to achieve a clear mixture, providing a neutral pH and 96% transmittance. Furthermore, the fluconazole mixtures displayed anticandidal efficiency against C. albicans with a similar effect to the standard fluconazole solution. These findings suggest that the fluconazole-loaded lactose agglomerate tablets show strong potential when prepared using direct compression. The fluconazole mixtures made by dispersing the tablets can be used as a disinfectant for Candida-associated dentures, particularly in patients with oral candidiasis.
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Affiliation(s)
- Rapee Jarungsirawat
- Division of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Wanassnant Kajthunyakarn
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Srinakharinwirot University, Nakhon Nayok 26120, Thailand
| | - Chaipat Siriwachirachai
- Division of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Thaned Pongjanyakul
- Division of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
- Correspondence: ; Tel.: +66-850-113-176
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Wiederhold NP. Pharmacodynamics, Mechanisms of Action and Resistance, and Spectrum of Activity of New Antifungal Agents. J Fungi (Basel) 2022; 8:jof8080857. [PMID: 36012845 PMCID: PMC9410397 DOI: 10.3390/jof8080857] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/07/2022] [Accepted: 08/14/2022] [Indexed: 12/21/2022] Open
Abstract
Several new antifungals are currently in late-stage development, including those with novel pharmacodynamics/mechanisms of action that represent new antifungal classes (manogepix, olorofim, ATI-2307, GR-2397). Others include new agents within established classes or with mechanisms of action similar to clinically available antifungals (ibrexafungerp, rezafungin, oteseconazole, opelconazole, MAT2203) that have been modified in order to improve certain characteristics, including enhanced pharmacokinetics and greater specificity for fungal targets. Many of the antifungals under development also have activity against Candida and Aspergillus strains that have reduced susceptibility or acquired resistance to azoles and echinocandins, whereas others demonstrate activity against species that are intrinsically resistant to most clinically available antifungals. The tolerability and drug–drug interaction profiles of these new agents also appear to be promising, although the number of human subjects that have been exposed to many of these agents remains relatively small. Overall, these agents have the potential for expanding our antifungal armamentarium and improving clinical outcomes in patients with invasive mycoses.
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Affiliation(s)
- Nathan P Wiederhold
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
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14
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Kiasat N, Takesh A, Fatahinia M. Identification and genetic diversity of Alternaria species recovered from the air of Ahvaz city, the Southwestern part of Iran. INTERNATIONAL JOURNAL OF MOLECULAR EPIDEMIOLOGY AND GENETICS 2022; 13:24-31. [PMID: 36189195 PMCID: PMC9520247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/03/2022] [Indexed: 06/16/2023]
Abstract
The Alternaria genus has pathogenic, endophytic, and saprobic characteristics. Alternaria genus causes respiratory diseases, fungal allergenicity and the production of mycotoxin in food. Ahvaz city is one of the areas where the presence of dust and high humidity cause the growth and spread of fungal species in the air. Identification of Alternaria species is difficult based on morphology solely. For the first time in Ahvaz, the classification of this fungus was performed using ITS region, alta1 gene, and morphology. For the identification of Alternaria isolates in the Ahvaz city air using morphological and molecular characteristics, potato dextrose agar (PDA) media were used to culture 40 Alternaria isolates recovered from the Ahvaz city air. Afterward, the appearance of the colonies was examined. The DNAs of the isolates were extracted and amplified using the specific primers of the ITS and, Alt a1 regions. The amplified DNA products were sequenced. Then, they were compared with the sequences in the NCBI GeneBank. Based on the morphological results, the isolates included four different species and A. alternata had the highest frequency. Alt a1 gene was present in all the isolates of Alternaria species recovered in our research. Finally, identifying the varieties of Alternaria species based on morphological characteristics as well as ITS or Alt a1 regions is useful but difficult.
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Affiliation(s)
- Neda Kiasat
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran
| | - Ameneh Takesh
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran
| | - Mahnaz Fatahinia
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran
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15
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Ge G, Yang Z, Li D, Zhang N, Chen B, Shi D. Distinct host immune responses in recurrent vulvovaginal candidiasis and vulvovaginal candidiasis. Front Immunol 2022; 13:959740. [PMID: 35967437 PMCID: PMC9366074 DOI: 10.3389/fimmu.2022.959740] [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: 06/07/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Recurrent vulvovaginal candidiasis (RVVC) and vulvovaginal candidiasis (RVVC) are one of the most common gynecological infections, primarily caused by Candida species. Although risk factors of RVVC and VVC have been identified in many studies, antifungal immunological mechanisms are still not fully understood. We performed a 1-year prospective study in a local hospital to monitor 98 patients clinically diagnosed with gynecological Candida infection. The results showed that 20.41% (20/98) are with RVVC, and 79.59% (78/98) patients have VVC. C. albicans accounts for 90% and 96.1% of all strains isolated collected from RVVC and VVC patients, respectively. Antifungal susceptibility testing showed no significant difference in Candida species between RVVC and VVC patients. However, the serum levels of IFN-γ, TNF-α, and IL-17F in the RVVC group were significantly lower than those of the VVC group, while IL-4, IL-6, and IL-10 were higher in the RVVC patients than VVC patients. IL-17A and IL-2 levels were comparable between the two groups. Taken together, our results suggest that the host-immune responses, especially Th1/2 immunity, may play important roles in prognosis of RVVC and VVC.
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Affiliation(s)
- Gai Ge
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Zhiya Yang
- Laboratory of Medical Mycology, Jining No.1 People’s Hospital, Jining, China
| | - Dongmei Li
- Department of Microbiology & Immunology, Georgetown University Medical Center, Washington DC, United States
| | - Ning Zhang
- Laboratory of Medical Mycology, Jining No.1 People’s Hospital, Jining, China
| | - Biao Chen
- Laboratory of Medical Mycology, Jining No.1 People’s Hospital, Jining, China
| | - Dongmei Shi
- Laboratory of Medical Mycology, Jining No.1 People’s Hospital, Jining, China
- Department of Dermatology, Jining No.1 People’s Hospital, Jining, China
- *Correspondence: Dongmei Shi,
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16
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Abstract
Antifungal drug susceptibility tests (AST) for Candida albicans are increasingly demanded for women with refractory or recurrent Candida vaginitis due to fluconazole resistance. Given reduced activity of azole drugs at pH levels found in women with Candida vaginitis, it is proposed that AST be performed at pH 4.5, since testing at only the recommended pH 7.0 is likely to miss a significant number of clinically relevant azole-resistant C. albicans vaginal isolates.
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17
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Nyirjesy P, Brookhart C, Lazenby G, Schwebke J, Sobel JD. Vulvovaginal Candidiasis: A Review of the Evidence for the 2021 Centers for Disease Control and Prevention of Sexually Transmitted Infections Treatment Guidelines. Clin Infect Dis 2022; 74:S162-S168. [PMID: 35416967 DOI: 10.1093/cid/ciab1057] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Vulvovaginal candidiasis (VVC) is a common cause of vulvovaginal itching and discharge. This article discusses the latest CDC STI Treatment Guidelines for VVC. METHODS A literature search of relevant topics was performed, and a team of experts was convened to discuss (1) diagnosis/testing modalities; treatment of (2) uncomplicated VVC , (3) complicated VVC, and (4) VVC caused by non-albicans yeast; (5) alternative treatment regimens; (6) susceptibility testing of yeast; Special Populations: (7) pregnancy and (8) HIV and VVC. RESULTS Yeast culture remains the gold standard for diagnoses. Newer molecular assays have been developed for the diagnosis of VVC and perform well. Azole antifungals remain the treatment of choice for uncomplicated VVC. Two new drugs, TOL-463 and recently FDA-approved ibrexafungerp, appeared promising in clinical trials. For recurrent VVC, oteseconazole, not yet commercially available, may represent a new option. For non-albicans yeast infections in symptomatic patients, boric acid appears useful. No evidence supports the use of alternative treatments, including probiotics. Fluconazole during pregnancy may be associated with spontaneous abortion and craniofacial and heart defects. In women with HIV infection, lower CD4+ T-cell counts are associated with increased rates of VVC, and VVC is associated with increased viral shedding. Treatment measures in women with HIV infection are identical to those women without HIV infection. CONCLUSIONS There has been significant new knowledge generated about VVC since the 2015 CDC Guidelines which have led to changing recommendations.
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Affiliation(s)
- Paul Nyirjesy
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Carolyn Brookhart
- Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Gweneth Lazenby
- Division of Infectious Diseases, Department of Obstetrics and Gynecology and Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jane Schwebke
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jack D Sobel
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
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18
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Chayachinda C, Thamkhantho M, Ngamsakulrungroj P, Leeyaphan C, Tulyaprawat O. Effect of intravaginal gentian violet for acute vaginal candidiasis treated with a single dose oral fluconazole: a randomised controlled trial. J OBSTET GYNAECOL 2022; 42:2190-2196. [DOI: 10.1080/01443615.2022.2035336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Chenchit Chayachinda
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Manopchai Thamkhantho
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Popchai Ngamsakulrungroj
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Charussri Leeyaphan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Orwan Tulyaprawat
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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19
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Hong N, Lei Y, Chen H, Chen X, Tsui KM, Hu D, Liao W, Yan L, Zhang H, Zhao R, Wu G, Yu N, Deng S. Genotyping and Drug Resistance Profile of Clinical Isolates of Candida albicans from Vulvovaginal Candidiasis in the Eastern China. Mycopathologia 2022; 187:217-224. [PMID: 35072854 PMCID: PMC9124162 DOI: 10.1007/s11046-022-00616-x] [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: 10/09/2021] [Accepted: 01/01/2022] [Indexed: 11/23/2022]
Abstract
A total of 244 Candida albicans isolates recovered from vulvovaginal candidiasis (VVC) patients in Suzhou, Eastern China, were investigated. According to CLSI documents M27-A4 and M59-3ed/M60-2ed, the MIC geometric means of nine antifungals in increasing order were micafungin (0.048 mg/L), anidulafungin (0.132 mg/L), caspofungin (0.19 mg/L), itraconazole (0.23 mg/L), posaconazole (0.25 mg/L), voriconazole (0.28 mg/L), 5-flucytosine (0.44 mg/L), amphotericin B (0.49 mg/L) and fluconazole (2.01 mg/L) respectively. Of note, 6.5% (16/244) C. albicans isolates showed resistance mainly to anidulafungin (mono-echinocandin resistance), while voriconazole had the lowest susceptibility rate of 34.8% (85/244), followed by fluconazole 59.4% (145/244), respectively. All isolates were genotyped by allelic combination of 3 microsatellite markers (CEF3, CAIII and LOC4). A total of 129 different allelic genotypes were identified, in which seven different clades were recognized with a discriminatory power of 0.96. Genotypes A-D were present in 35% of the isolates. In conclusion, decrease in antifungal drug susceptibility to C. albicans isolates from VVC is alarming. Our findings revealed the genetic diversity of C. albicans isolates among VVC patients and provided insights into the molecular epidemiology of Candida infections in China.
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Affiliation(s)
- Nan Hong
- Department of Dermatology, South China Hospital, Health Science Center, Shenzhen University, Shenzhen, China.,Department of Dermatology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Yan Lei
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huan Chen
- Department of Dermatology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xiaofei Chen
- Department of Medical Microbiology, The People's Hospital of Suzhou New District, Suzhou, Jiangsu, China
| | - Kin Ming Tsui
- Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Department of Pathology, Sidra Medicine, Doha, Qatar
| | - Danyang Hu
- Department of Medical Microbiology, The People's Hospital of Suzhou New District, Suzhou, Jiangsu, China
| | - Wanqing Liao
- Shanghai Key Laboratory of Medical Molecular Mycology, Department of Dermatology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Liang Yan
- Department of Dermatology, PLA General Hospital of Central Theater Command, Wuhan, China
| | - Hong Zhang
- Department of Medical Microbiology, The People's Hospital of Suzhou New District, Suzhou, Jiangsu, China
| | - Rongfen Zhao
- Department of Medical Microbiology, The People's Hospital of Suzhou New District, Suzhou, Jiangsu, China
| | - Gang Wu
- Nanjing Chia Tai Tianqing Pharmaceutical Co., Ltd, Nanjing, China
| | - Nong Yu
- Department of Medical Microbiology, The People's Hospital of Suzhou New District, Suzhou, Jiangsu, China
| | - Shuwen Deng
- Department of Medical Microbiology, The People's Hospital of Suzhou New District, Suzhou, Jiangsu, China.
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20
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Lang Y, Wang Y, Zhou R, Zeng X, Zhao H, Wu P. Polythiophene for Near Full pH Photo-antimicrobial. J Mater Chem B 2022; 10:4944-4951. [PMID: 35723511 DOI: 10.1039/d2tb00727d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Microbial infections are currently one of the world’s major public health cares, the evolution of which has resulted in the development of multiple tolerances (not just the drug or antibiotic...
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Affiliation(s)
- Yunhe Lang
- Analytical & Testing Centre, State Key Laboratory of Hydraulics and Mountain River Engineering, Sichuan University, Chengdu 610041, China.
| | - Ying Wang
- Analytical & Testing Centre, State Key Laboratory of Hydraulics and Mountain River Engineering, Sichuan University, Chengdu 610041, China.
| | - Ronghui Zhou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Xin Zeng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Hang Zhao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Peng Wu
- Analytical & Testing Centre, State Key Laboratory of Hydraulics and Mountain River Engineering, Sichuan University, Chengdu 610041, China.
- School of Chemistry and Chemical Engineering, Henan Normal University, Xinxiang, 453007, China
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21
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Phillips NA, Bachmann G, Haefner H, Martens M, Stockdale C. Topical Treatment of Recurrent Vulvovaginal Candidiasis: An Expert Consensus. WOMEN'S HEALTH REPORTS 2022; 3:38-42. [PMID: 35136875 PMCID: PMC8812501 DOI: 10.1089/whr.2021.0065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 11/13/2022]
Abstract
Background: Recurrent vulvovaginal candidiasis (RVVC), defined as three or more confirmed infections over 1 year, occurs in up to 10% of women. In these women, the objective is often symptomatic control rather than mycologic cure. Current Centers for Disease Control and Prevention (CDC) guidelines recommend oral fluconazole as first-line maintenance, but state if this oral regimen is not feasible, intermittent topical treatments can be considered. No specific recommendations for type or frequency of topical applications are provided by the CDC. Methods: A panel of vulvovaginal experts convened to develop a consensus recommendation for topical maintenance dosing for RVVC. Results: Data suggest that clotrimazole, miconazole, terconazole, and intravaginal boric acid are suggested recommendations for recurrent vulvovaginitis caused by both Candida albicans and nonalbicans species. Nystatin ovules may not be as effective as azoles. Identification of species will influence treatment decisions. In addition, treatment may be modified based on prior response to a specific agent, especially in nonalbicans species. Fluconazole, ibrexafungerp, and intravaginal boric acid should be avoided during pregnancy. Conclusions: The expert consensus for women with RVVC is an initial full course of treatment followed by topical maintenance beginning at one to three times weekly, based on chosen agent. Twice a week dosing was the regimen most often utilized. In some women, episodic treatment may be used, but maintenance should remain an option for this population.
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Affiliation(s)
- Nancy A. Phillips
- Department Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Gloria Bachmann
- Department Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Hope Haefner
- Department Obstetrics and Gynecology, University of Michigan University Hospital, Ann Arbor, Michigan, USA
| | - Mark Martens
- Department Obstetrics and Gynecology, Tower Health, West Reading, Pennsylvania, USA
| | - Colleen Stockdale
- Department Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa, USA
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22
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Gamal A, Kadry A, Elshaer M, Ghannoum MA. Novel Antifungals for the Treatment of Vulvovaginal Candidiasis: Where Are We? Infect Dis (Lond) 2022. [DOI: 10.17925/id.2022.1.1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Vulvovaginal candidiasis (VVC) is a common health-related issue and the second most common cause of vaginitis. Previously, azole antifungals were the mainstay of VVC treatment. Additionally, boric acid and nystatin have been used topically for management of VVC. Despite being effective and well tolerated by most patients, the use of azoles may be limited in some cases. Currently, two new antifungal agents have received US Food and Drug Administration approval for use in the management of VVC. In this article, we briefly review treatment regimens used for the management of VVC over the past decade, the newly approved agents and their possible clinical application, and future treatment considerations.
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23
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Wiederhold NP. Antifungal Susceptibility Testing: A Primer for Clinicians. Open Forum Infect Dis 2021; 8:ofab444. [PMID: 34778489 PMCID: PMC8579947 DOI: 10.1093/ofid/ofab444] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/26/2021] [Indexed: 12/13/2022] Open
Abstract
Clinicians treating patients with fungal infections may turn to susceptibility testing to obtain information regarding the activity of different antifungals against a specific fungus that has been cultured. These results may then be used to make decisions regarding a patient's therapy. However, for many fungal species that are capable of causing invasive infections, clinical breakpoints have not been established. Thus, interpretations of susceptible or resistant cannot be provided by clinical laboratories, and this is especially true for many molds capable of causing severe mycoses. The purpose of this review is to provide an overview of susceptibility testing for clinicians, including the methods used to perform these assays, their limitations, how clinical breakpoints are established, and how the results may be put into context in the absence of interpretive criteria. Examples of when susceptibility testing is not warranted are also provided.
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Affiliation(s)
- Nathan P Wiederhold
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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24
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Sobel R, Nyirjesy P, Ghannoum MA, Delchev DA, Azie NE, Angulo D, Harriott IA, Borroto-Esoda K, Sobel JD. Efficacy and safety of oral ibrexafungerp for the treatment of acute vulvovaginal candidiasis: a global phase 3, randomised, placebo-controlled superiority study (VANISH 306). BJOG 2021; 129:412-420. [PMID: 34676663 PMCID: PMC9299454 DOI: 10.1111/1471-0528.16972] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/30/2021] [Accepted: 09/08/2021] [Indexed: 01/25/2023]
Abstract
Objective To evaluate the efficacy and safety of ibrexafungerp versus placebo for acute vulvovaginal candidiasis (VVC) treatment. Design Global phase 3, randomised, placebo‐controlled superiority study. Setting Study sites in the USA (n = 19) and Bulgaria (n = 18). Population Female patients aged ≥12 years with acute VVC and a vulvovaginal signs and symptoms (VSS) score ≥4 at baseline. Methods Patients were randomly assigned 2:1 to ibrexafungerp (300 mg twice for 1 day) or placebo. Main outcome measures The primary endpoint was the percentage of patients with a clinical cure (VSS = 0) at the test‐of‐cure visit (day 11 ± 3). Secondary endpoints included percentages of patients with mycological eradication, clinical cure and mycological eradication (overall success), clinical improvement (VSS ≤1) at test‐of‐cure visit, and complete resolution of symptoms at follow‐up visit (day 25 ± 4). Results At the test‐of‐cure visit, patients receiving ibrexafungerp had significantly higher rates of clinical cure (63.3% [119/188] versus 44.0% [37/84]; P = 0.007), mycological eradication (58.5% [110/188] versus 29.8% [25/84]; P < 0.001), overall success (46.1% [82/188] versus 28.4% [23/84]; P = 0.022) and clinical improvement (72.3% [136/188] versus 54.8% [46/84]; P = 0.01) versus those receiving placebo. Symptom resolution was sustained and further increased with ibrexafungerp (73.9%) versus placebo (52.4%) at follow‐up (P = 0.001). Ibrexafungerp was generally well tolerated. Adverse events were primarily gastrointestinal and were mild to moderate in severity. Conclusions Ibrexafungerp demonstrated statistical superiority over placebo for the primary and secondary endpoints. Ibrexafungerp is a promising novel, well‐tolerated and effective oral 1‐day treatment for acute VVC. Tweetable abstract Ibrexafungerp is statistically superior to placebo for the treatment of vulvovaginal candidiasis. Ibrexafungerp is statistically superior to placebo for the treatment of vulvovaginal candidiasis. Linked article This article is commented on by KSJ Olah, p. 421–422 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.17000.
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Affiliation(s)
- R Sobel
- Department of Obstetrics and Gynecology, Jefferson Vulvovaginal Health Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - P Nyirjesy
- Department of Obstetrics and Gynecology, Jefferson Vulvovaginal Health Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - M A Ghannoum
- Department of Dermatology, Center for Medical Mycology, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - D A Delchev
- Department of Gynaecology, MHAT Dr. Bratan Shukerov AD, Smolyan, Bulgaria
| | - N E Azie
- Departments of Clinical Development and Medical Affairs, SCYNEXIS, Inc., Jersey City, NJ, USA
| | - D Angulo
- Department of Clinical Research, SCYNEXIS, Inc., Jersey City, NJ, USA
| | - I A Harriott
- Department of Medical Affairs, SCYNEXIS, Inc., Jersey City, NJ, USA
| | | | - J D Sobel
- Infectious Diseases, Department of Internal Medicine, Wayne State University, Detroit, MI, USA
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25
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Faria-Gonçalves P, Rolo J, Gaspar C, Palmeira-de-Oliveira R, Martinez-de-Oliveira J, Palmeira-de-Oliveira A. Virulence Factors as Promoters of Chronic Vulvovaginal Candidosis: A Review. Mycopathologia 2021; 186:755-773. [PMID: 34613569 DOI: 10.1007/s11046-021-00592-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/09/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The vast majority of the species of the genus Candida spp. is commensal in humans; however, some are opportunistic pathogens that can cause infection, called candidosis. Among the different types of candidosis, we highlight the vulvovaginal (VVC) which can occur in two main clinical variants: chronic (cVVC) and episodic or sporadic. The incidence of cVVC has been worrying the scientific community, promoting the research on genotypic and phenotypic causes of its occurrence. We summarize important findings on factors that favor chronic vulvovaginal candidosis with respect to molecular epidemiology and the expression of various virulence factors, while clarifying the terminology involving these infections. AIM AND METHODOLOGY The aim of this review was to gather research that linked virulence factors to VVC and its persistence and recurrence, using two databases (Pubmed and Google Scholar). Predisposing factors in women for the occurrence of cVVC and some studies that refer new preventive and alternative therapies were also included, where appropriate. RESULTS AND DISCUSSION Several studies have been shedding light on the increasing number of persistence and recurrences of VVC. The expression of virulence factors has been related to both chronic forms of VVC and antifungal resistance. Other studies report mutations occurring in the genome of Candida spp. during the infection phase which may be important indications for new therapies. The introduction of preventive therapies and new therapies has revealed great importance and is also highlighted here.
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Affiliation(s)
- Paula Faria-Gonçalves
- Health Sciences Research Center, University of Beira Interior, Av. Infante D. Henrique, 6200-506, Covilhã, Portugal.,Faculty of Medicine, University Mandume Ya Ndemufayo, Lubango, Angola.,Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Joana Rolo
- Health Sciences Research Center, University of Beira Interior, Av. Infante D. Henrique, 6200-506, Covilhã, Portugal.
| | - Carlos Gaspar
- Health Sciences Research Center, University of Beira Interior, Av. Infante D. Henrique, 6200-506, Covilhã, Portugal.,Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.,Health Products Research and Development Lda, Covilhã, Portugal
| | - Rita Palmeira-de-Oliveira
- Health Sciences Research Center, University of Beira Interior, Av. Infante D. Henrique, 6200-506, Covilhã, Portugal.,Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.,Health Products Research and Development Lda, Covilhã, Portugal.,Center for Neuroscience and Cell Biology, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
| | - José Martinez-de-Oliveira
- Health Sciences Research Center, University of Beira Interior, Av. Infante D. Henrique, 6200-506, Covilhã, Portugal
| | - Ana Palmeira-de-Oliveira
- Health Sciences Research Center, University of Beira Interior, Av. Infante D. Henrique, 6200-506, Covilhã, Portugal.,Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.,Health Products Research and Development Lda, Covilhã, Portugal
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26
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Faria-Gonçalves P, Gaspar C, Oliveira AS, Palmeira-de-Oliveira R, Gonçalves T, Martinez-de-Oliveira J, Palmeira-de-Oliveira A, Rolo J. Evaluation of overtime phenotypic variation of yeasts in chronic vulvovaginal candidosis cases. Med Mycol 2021; 59:1166-1173. [PMID: 34427667 DOI: 10.1093/mmy/myab048] [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: 04/23/2021] [Revised: 07/22/2021] [Accepted: 08/20/2021] [Indexed: 11/13/2022] Open
Abstract
Chronic vulvovaginal candidosis results either from reinfection or from the ability of Candida spp. to persist in the vulva and/or vagina. Persistence is usually associated with increased antifungal (mainly azoles) resistance rates, which can explain treatment failure, and/or increased expression of virulence factors by Candida spp. The aim of this study was to assess the mechanisms leading to Candida spp persistence, by studying sequential isolates from women with chronic vulvovaginal candidosis, focusing on strains genotypes, azole resistance and ability to form biofilms along the period of clinical evaluation.The strains were identified at species level by automated analysis of biochemical profiles and molecular typing evaluated by polymorphic DNA analysis. The capacity to form biofilm was assessed with a microtiter plate assay. Fluconazole susceptibility was determined by the microdilution broth assay at both pH 7 (following the recommended guideline) and pH 4.5 (as representative of vaginal pH).We studied samples from 17 clinically recurrent cases. In 53% of the chronic cases there were two or more isolates that had a phylogenetic relationship while the remaining (47%) were caused by different species. In those cases where related strains were involved in recurrence, we verified an increase in MIC at pH 7 and also an increased capacity to form biofilms over time. Significant correlation between these two parameters was observed only in cases caused by C. glabrata, evidencing the importance of these two factors to enhance persistence in the vaginal mucosa for this particular species. LAY ABSTRACT Chronic vulvovaginal candidosis (VVC) affects millions of women worldwide. We found that persistence of the same Candida strain on the vaginal mucosa does not account for the great majority of VVC cases. Moreover, modulation of biofilm formation and azole resistance overtime was investigated.
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Affiliation(s)
- Paula Faria-Gonçalves
- CICS-UBI: Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.,Faculdade de Ciências da Saúde, University of Beira Interior, Covilhã, Portugal.,FMUMN: Faculty of Medicine, University Mandume ya Ndemufayo, Angola
| | - Carlos Gaspar
- CICS-UBI: Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.,Faculdade de Ciências da Saúde, University of Beira Interior, Covilhã, Portugal.,Labfit-HPRD:Health Products Research and Development Lda, Covilhã, Portugal
| | - Ana Sofia Oliveira
- CICS-UBI: Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.,Faculdade de Ciências da Saúde, University of Beira Interior, Covilhã, Portugal
| | - Rita Palmeira-de-Oliveira
- CICS-UBI: Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.,Faculdade de Ciências da Saúde, University of Beira Interior, Covilhã, Portugal.,Labfit-HPRD:Health Products Research and Development Lda, Covilhã, Portugal.,CNC - Center for Neurosciences and Cell Biology, Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
| | - Teresa Gonçalves
- CNC - Center for Neurosciences and Cell Biology, Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal.,FMUC - Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - José Martinez-de-Oliveira
- CICS-UBI: Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Ana Palmeira-de-Oliveira
- CICS-UBI: Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.,Faculdade de Ciências da Saúde, University of Beira Interior, Covilhã, Portugal.,Labfit-HPRD:Health Products Research and Development Lda, Covilhã, Portugal
| | - Joana Rolo
- CICS-UBI: Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
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27
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In Vitro pH Activity of Ibrexafungerp against Fluconazole-Susceptible and -Resistant Candida Isolates from Women with Vulvovaginal Candidiasis. Antimicrob Agents Chemother 2021; 65:e0056221. [PMID: 34001513 PMCID: PMC8284466 DOI: 10.1128/aac.00562-21] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The vaginal environment with candidiasis has a pH of 3.8 to 4.5 and this has a negative effect on the activity of antifungals. Ibrexafungerp was evaluated against 187 Candida isolates, including fluconazole-sensitive and -resistant Candida albicans, Candida glabrata, Candida krusei, Candida parapsilosis, and Candida tropicalis with the media adjusted to pH 7.0 and pH 4.5. Ibrexafungerp MIC values were not adversely affected when tested at pH 4.5. Ibrexafungerp exhibited significant activity against all isolates at pH 4.5.
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28
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Exogenous Reproductive Hormones nor Candida albicans Colonization Alter the Near Neutral Mouse Vaginal pH. Infect Immun 2021; 89:IAI.00550-20. [PMID: 33106292 DOI: 10.1128/iai.00550-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/16/2020] [Indexed: 12/15/2022] Open
Abstract
While human vaginal pH in childbearing-age women is conclusively acidic, the mouse vaginal pH is reported as being near neutral. However, this information appears to be somewhat anecdotal with respect to vulvovaginal candidiasis, as such claims in the literature frequently lack citations of studies that specifically address this physiological factor. Given the disparate pH between mice and humans, the role of exogenous hormones and colonization by the fungal pathogen Candida albicans in shaping vaginal pH was assessed. Use of a convenient modified vaginal lavage technique with the pH indicator dye phenol red demonstrated that indeed vaginal pH was near neutral (7.2 ± 0.24) and was not altered by delivery of progesterone or estrogen in C57BL/6 mice. These trends were conserved in DBA/2 and CD-1 mouse backgrounds, commonly used in the mouse model of vaginitis. It was also determined that vaginal colonization with C. albicans did not alter the globally neutral vaginal pH over the course of one week. Construction and validation of a C. albicans reporter strain expressing GFPy, driven by the pH-responsive PHR1 promoter, confirmed the murine vaginal pH to be at least ≥6.0. Collectively, our data convincingly demonstrate a stable and conserved near neutrality of the mouse vaginal pH during vulvovaginal candidiasis and should serve as a definitive source for future reference. Implications and rationale for disparate pH in this model system are also discussed.
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29
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Lund PA, De Biase D, Liran O, Scheler O, Mira NP, Cetecioglu Z, Fernández EN, Bover-Cid S, Hall R, Sauer M, O'Byrne C. Understanding How Microorganisms Respond to Acid pH Is Central to Their Control and Successful Exploitation. Front Microbiol 2020; 11:556140. [PMID: 33117305 PMCID: PMC7553086 DOI: 10.3389/fmicb.2020.556140] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/21/2020] [Indexed: 12/20/2022] Open
Abstract
Microbes from the three domains of life, Bacteria, Archaea, and Eukarya, share the need to sense and respond to changes in the external and internal concentrations of protons. When the proton concentration is high, acidic conditions prevail and cells must respond appropriately to ensure that macromolecules and metabolic processes are sufficiently protected to sustain life. While, we have learned much in recent decades about the mechanisms that microbes use to cope with acid, including the unique challenges presented by organic acids, there is still much to be gained from developing a deeper understanding of the effects and responses to acid in microbes. In this perspective article, we survey the key molecular mechanisms known to be important for microbial survival during acid stress and discuss how this knowledge might be relevant to microbe-based applications and processes that are consequential for humans. We discuss the research approaches that have been taken to investigate the problem and highlight promising new avenues. We discuss the influence of acid on pathogens during the course of infections and highlight the potential of using organic acids in treatments for some types of infection. We explore the influence of acid stress on photosynthetic microbes, and on biotechnological and industrial processes, including those needed to produce organic acids. We highlight the importance of understanding acid stress in controlling spoilage and pathogenic microbes in the food chain. Finally, we invite colleagues with an interest in microbial responses to low pH to participate in the EU-funded COST Action network called EuroMicropH and contribute to a comprehensive database of literature on this topic that we are making publicly available.
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Affiliation(s)
- Peter A Lund
- Institute of Microbiology and Infection, School of Biosciences, University of Birmingham, Birmingham, United Kingdom
| | - Daniela De Biase
- Department of Medico-Surgical Sciences and Biotechnologies, Laboratory affiliated to the Istituto Pasteur Italia - Fondazione Cenci Bolognetti, Sapienza University of Rome, Latina, Italy
| | - Oded Liran
- Department of Plant Sciences, MIGAL - Galilee Research Institute, Kiryat-Shemona, Israel
| | - Ott Scheler
- Department of Chemistry and Biotechnology, Tallinn University of Technology, Tallinn, Estonia
| | - Nuno Pereira Mira
- Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Zeynep Cetecioglu
- Department of Chemical Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
| | | | - Sara Bover-Cid
- IRTA, Food Safety Programme, Finca Camps i Armet, Monells, Spain
| | - Rebecca Hall
- School of Biosciences, Kent Fungal Group, University of Kent, Canterbury, United Kingdom
| | - Michael Sauer
- Department of Biotechnology, University of Natural Resources and Life Sciences (BOKU), Vienna, Austria
| | - Conor O'Byrne
- Bacterial Stress Response Group, Microbiology, School of Natural Sciences, NUI Galway, Galway, Ireland
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30
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Saxon Lead Author GDGC, Edwards A, Rautemaa-Richardson R, Owen C, Nathan B, Palmer B, Wood C, Ahmed H, Ahmad Patient Representatives S, FitzGerald Ceg Editor M. British Association for Sexual Health and HIV national guideline for the management of vulvovaginal candidiasis (2019). Int J STD AIDS 2020; 31:1124-1144. [PMID: 32883171 DOI: 10.1177/0956462420943034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Guideline Development Group Cara Saxon Lead Author
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Anne Edwards
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Riina Rautemaa-Richardson
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Caroline Owen
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Bavithra Nathan
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Bret Palmer
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Clare Wood
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Humera Ahmed
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Sameena Ahmad Patient Representatives
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Mark FitzGerald Ceg Editor
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
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31
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Azie N, Angulo D, Dehn B, Sobel JD. Oral Ibrexafungerp: an investigational agent for the treatment of vulvovaginal candidiasis. Expert Opin Investig Drugs 2020; 29:893-900. [PMID: 32746636 DOI: 10.1080/13543784.2020.1791820] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Vulvovaginal candidiasis (VVC) is a common fungal infection caused by predominantly Candida albicans, and is diagnosed in up to 40% of women with vaginal complaints in the primary care setting. Approximately 75% of women experience at least one episode during their reproductive years. AREAS COVERED Ibrexafungerp is an orally active, semi-synthetic triterpenoid glucan synthase inhibitor under development for treatment and prevention of VVC. We present the chemistry, mechanism of action, pharmacology, microbiology, and results from clinical studies with ibrexafungerp in women with VVC. EXPERT OPINION Ibrexafungerp addresses several unmet needs with existing antifungal drugs as a first in a new class of antifungal agents with a novel mechanism of action demonstrating no antifungal cross resistance with azoles, and fungicidal activity against Candida spp., including fluconazole-resistant species. Some of the key attributes of ibrexafungerp related to VVC include oral one-day dosing, high tissue penetration, enhanced activity at low pH seen in the vagina, low risk for clinically significant drug-drug interactions, and a low risk of adverse events. If approved, ibrexafungerp will be the first new antifungal agent available for the treatment of VVC in more than 20 years and the only oral, non-azole antifungal approved for women suffering from VVC.
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Affiliation(s)
- Nkechi Azie
- Clinical Development, SCYNEXIS Inc , Jersey City, NJ, USA
| | - David Angulo
- Clinical Development, SCYNEXIS Inc , Jersey City, NJ, USA
| | - Barbara Dehn
- Clinical Development, El Camino Medical Group , Mountain View, CA, USA
| | - Jack D Sobel
- School of Medicine, Wayne State University , Detroit, MI, USA
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32
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Song J, Liu X, Li R. Sphingolipids: Regulators of azole drug resistance and fungal pathogenicity. Mol Microbiol 2020; 114:891-905. [PMID: 32767804 DOI: 10.1111/mmi.14586] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/29/2020] [Accepted: 08/02/2020] [Indexed: 12/14/2022]
Abstract
In recent years, the role of sphingolipids in pathogenic fungi, in terms of pathogenicity and resistance to azole drugs, has been a rapidly growing field. This review describes evidence about the roles of sphingolipids in azole resistance and fungal virulence. Sphingolipids can serve as signaling molecules that contribute to azole resistance through modulation of the expression of drug efflux pumps. They also contribute to azole resistance by participating in various microbial pathways such as the unfolded protein response (UPR), pH-responsive Rim pathway, and pleiotropic drug resistance (PDR) pathway. In addition, sphingolipid signaling and eisosomes also coordinately regulate sphingolipid biosynthesis in response to azole-induced membrane stress. Sphingolipids are important for fungal virulence, playing roles during growth in hosts under stressful conditions, maintenance of cell wall integrity, biofilm formation, and production of various virulence factors. Finally, we discuss the possibility of exploiting fungal sphingolipids for the development of new therapeutic strategies to treat infections caused by pathogenic fungi.
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Affiliation(s)
- Jinxing Song
- The Key Laboratory of Biotechnology for Medicinal Plants of Jiangsu Province and School of Life Science, Jiangsu Normal University, Xuzhou, PR China
| | - Xiao Liu
- The Key Laboratory of Biotechnology for Medicinal Plants of Jiangsu Province and School of Life Science, Jiangsu Normal University, Xuzhou, PR China
| | - Rongpeng Li
- The Key Laboratory of Biotechnology for Medicinal Plants of Jiangsu Province and School of Life Science, Jiangsu Normal University, Xuzhou, PR China
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33
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Hauzer M, Cohen MJ, Polacheck I, Moses A, Korem M. The prevalence and clinical significance of microcolonies when tested according to contemporary interpretive breakpoints for fluconazole against Candida species using E-test. Med Mycol 2020; 57:718-723. [PMID: 30576514 DOI: 10.1093/mmy/myy130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/28/2018] [Accepted: 11/06/2018] [Indexed: 12/21/2022] Open
Abstract
Changes in the interpretive-breakpoints for antifungals against various Candida species have raised the need to examine the significance of the phenomenon of the growth of microcolonies in agar diffusion inhibition zones, which has generally been considered negligible. The objective was to determine the incidence of cases in which microcolonies demonstrate fluconazole resistance according to current interpretive-breakpoints and whether their growth is associated with therapeutic failure. The fluconazole minimum inhibitory concentrations (MICs) of 100 blood culture isolates of Candida were performed by E-test on Roswell Park Memorial Institute (RPMI) agar and examined for the appearance of microcolonies. Fluconazole MICs of microcolonies were then determined over three generations. The significance of the phenomenon of microcolonies was determined according to clinical data retrieved from electronic files. Microcolonies were a common phenomenon among Candida isolates following incubation on RPMI agar, with a higher frequency among C. albicans isolates as compared to non-albicans Candida across generations (57-93% vs 31-93%, respectively) and a similar fluconazole susceptibility rate over three generations. The rate of microcolonies was similar in both patients with successful and unsuccessful outcome (41% vs 42%, respectively). Microcolonies are a common phenomenon. No increase in MIC was demonstrated throughout three generations of microcolony inoculation on RPMI, and no difference in clinical outcome was observed.
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Affiliation(s)
- Michael Hauzer
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Itzhack Polacheck
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Allon Moses
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Maya Korem
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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34
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Leu SJ, Lee YC, Lee CH, Liao PY, Chiang CW, Yang CM, Su CH, Ou TY, Liu KJ, Lo HJ, Tsai BY, Yang YY. Generation and Characterization of Single Chain Variable Fragment against Alpha-Enolase of Candida albicans. Int J Mol Sci 2020; 21:ijms21082903. [PMID: 32326294 PMCID: PMC7215377 DOI: 10.3390/ijms21082903] [Citation(s) in RCA: 14] [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: 04/06/2020] [Revised: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 11/16/2022] Open
Abstract
Candida albicans (C. albicans) is an opportunistic human pathogen responsible for approximately a half of clinical candidemia. The emerging Candida spp. with resistance to azoles is a major challenge in clinic, suggesting an urgent demand for new drugs and therapeutic strategies. Alpha–enolase (Eno1) is a multifunctional protein and represents an important marker for invasive candidiasis. Thus, C. albicans Eno1 (CaEno1) is believed to be an important target for the development of therapeutic agents and antibody drugs. Recombinant CaEno1 (rCaEno1) was first used to immunize chickens. Subsequently, we used phage display technology to construct two single chain variable fragment (scFv) antibody libraries. A novel biopanning procedure was carried out to screen anti-rCaEno1 scFv antibodies, whose specificities were further characterized. The polyclonal IgY antibodies showed binding to rCaEno1 and native CaEno1. A dominant scFv (CaS1) and its properties were further characterized. CaS1 attenuated the growth of C. albicans and inhibited the binding of CaEno1 to plasminogen. Animal studies showed that CaS1 prolonged the survival rate of mice and zebrafish with candidiasis. The fungal burden in kidney and spleen, as well as level of inflammatory cytokines were significantly reduced in CaS1-treated mice. These results suggest CaS1 has potential of being immunotherapeutic drug against C. albicans infections.
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Affiliation(s)
- Sy-Jye Leu
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (S.-J.-L.); (C.-H.S.)
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (P.-Y.L.); (C.-W.C.); (C.-M.Y.)
- Center for Reproductive Medicine and Sciences, Taipei Medical University, Taipei 11031, Taiwan
| | - Yu-Ching Lee
- The Center of Translational Medicine, Taipei Medical University, Taipei 11031, Taiwan;
| | - Chi-Hsin Lee
- School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan; (C.-H.L.); (K.-J.L.)
| | - Po-Yen Liao
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (P.-Y.L.); (C.-W.C.); (C.-M.Y.)
| | - Chen-Wei Chiang
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (P.-Y.L.); (C.-W.C.); (C.-M.Y.)
| | - Chieh-Ming Yang
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (P.-Y.L.); (C.-W.C.); (C.-M.Y.)
| | - Ching-Hua Su
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (S.-J.-L.); (C.-H.S.)
| | - Tsong-Yih Ou
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, College of Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan;
| | - Ko-Jiunn Liu
- School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan; (C.-H.L.); (K.-J.L.)
- National Institute of Cancer Research, National Health Research Institutes, Tainan 70456, Taiwan
| | - Hsiu-Jung Lo
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Tainan 70456, Taiwan;
- School of Dentistry, China Medical University, Taichung 40402, Taiwan
| | - Bor-Yu Tsai
- Navi Bio-Therapeutics Inc., Taipei 10351, Taiwan;
| | - Yi-Yuan Yang
- School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan; (C.-H.L.); (K.-J.L.)
- Core Laboratory of Antibody Generation and Research, Taipei Medical University, Taipei 11031, Taiwan
- Ph.D. Program in Medical Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan
- Correspondence: ; Tel.: +886-2-27361661 (ext. 3325); Fax: +886-2-27324510
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Candida africana vulvovaginitis: Prevalence and geographical distribution. J Mycol Med 2020; 30:100966. [PMID: 32317216 DOI: 10.1016/j.mycmed.2020.100966] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/26/2019] [Accepted: 03/29/2020] [Indexed: 02/07/2023]
Abstract
Candida africana has been recovered principally as a causative agent of vulvovaginal candidiasis (VVC) from different countries, which is likely to be misidentified as the typical Candida albicans or Candida dubliniensis. The current study aimed to characterize C. albicans species complex obtained from VVC based on conventional and molecular assays. Furthermore, in vitro antifungal susceptibility testing was performed based on CLSI documents. Additionally, due to low knowledge concerning C. africana infections, we reviewed all published papers from 1991 to 2019. One hundred forty-four out of 287 patients were identified with Candida infection, among whom 151 isolates of Candida were obtained. Candida albicans 109 (72.1%), Candida glabrata 21 (13.9%), Candida krusei 8 (5.2%), Candida tropicalis 5 (3.3%), Candida africana 3 (1.9%), Candida parapsilosis 3 (1.9%) and C. dubliniensis 2 (1.3%) were isolated from patients. MIC results showed that C. africana isolates were susceptible to all tested antifungal drugs. Candida africana infections were more prevalent in Africa. One hundred fifteen (40.6%) of patients with C. africana candidiasis were from seven African countries, and Madagascar and Angola had the majority of cases. The epidemiological data, phenotypic, clinical features, ecologic similarity, and antifungal susceptibility profiles for better understanding of the pathogenic mechanisms and optimal treatment underlying non-CandidaalbicansCandida vulvovaginitis are highly recommended.
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Donders GG, Grinceviciene S, Ruban K, Bellen G. Vaginal pH and microbiota during fluconazole maintenance treatment for recurrent vulvovaginal candidosis (RVVC). Diagn Microbiol Infect Dis 2020; 97:115024. [PMID: 32253071 DOI: 10.1016/j.diagmicrobio.2020.115024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/11/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND It is commonly stated that Candida in the vagina prefers a low pH to develop infection. However, mixed infections of Candida with bacterial vaginosis (BV) and aerobic vaginitis (AV) are rather common and may challenge the rule that Candida should only be looked for in low vaginal pH settings. In this study we tested whether the vaginal pH in acute vaginal candidosis is lower than in women successfully treated to prevent Candida recurrences. METHODS Vaginal pH and microscopy findings of vaginal microbiota were recorded during 12 visits over 1.5 years in 117 patients medically monitored during a degressive fluconazole maintenance regimen for proven recurrent vulvovaginal candidosis (ReCiDiF trial). The fluctuation of the mean pH of and microscopic findings of the vaginal smears were studied before, during and after the treatment. RESULTS The mean vaginal pH of women with acute infection before or after ending maintenance treatment was (4.7±0.8 and 4.8 ±1.0, respectively, p>0.05). During maintenance treatment with fluconazole, the pH dropped significantly to 4.5±0.8 (p=0.01). Depression of Lactobacilli spp. (increased lactobacillary grades) was more frequent during the acute, pre-treatment period (30.0%) than during the treatment period (23.1%, p=0.03). Aerobic vaginitis type flora was also more prevalent pre-treatment than during treatment (30.0% vs 22.2%, OR=0.7 (95%CI 0.5-0.9), p=0.01). DISCUSSION In women with RVVC, acute vaginal Candida infection is associated with an increased pH, and disturbed vaginal bacterial microbiota. During fluconazole maintenance treatment, the pH drops to normal levels and the lactobacillary grade improves. CONDENSATION Acute Candida vulvovaginitis can be associated with a disturbance of the vaginal microbiota. In patients with recurrent vulvovaginal candidosis, decrease of pH, and increase of Lactobacilli spp. were observed during fluconazole maintenance treatment. This pH drop was seen in all response groups. This contradicts the common belief that active vaginal Candida infection is related to low pH.
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Affiliation(s)
- Gilbert Gg Donders
- Femicare Clinical Research for Women, Tienen, Belgium; Regional Hospital H Hart, Tienen, Belgium; University Hospital Antwerp, Antwerpen, Belgium.
| | - Svitrigaile Grinceviciene
- Femicare Clinical Research for Women, Tienen, Belgium; Department of Biothermodynamics and Drug Design, Institute of Biotechnology, Vilnius University, Vilnius, Lithuania
| | | | - Gert Bellen
- Femicare Clinical Research for Women, Tienen, Belgium
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Jansook P, Prajapati M, Pruksakorn P, Loftsson T. Antifungal activity of econazole nitrate/cyclodextrin complex: Effect of pH and formation of complex aggregates. Int J Pharm 2020; 574:118896. [DOI: 10.1016/j.ijpharm.2019.118896] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/16/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
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CD101 Topical Compared With Oral Fluconazole for Acute Vulvovaginal Candidiasis: A Randomized Controlled Trial. J Low Genit Tract Dis 2019; 23:226-229. [PMID: 30893271 DOI: 10.1097/lgt.0000000000000473] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Vulvovaginal candidiasis (VVC) is an infection of the vagina's mucous membranes, caused by Candida albicans in more than 90% of acute VVC. Several topical and oral azole agents are available in a variety of formulations, and all seem to have similar effectiveness. Azoles are fungistatic, meaning that the fungi are inhibited from growth or replication but are not eradicated. Recurrent infection and developing azole resistance demonstrate a significant need for alternative treatments. MATERIALS AND METHODS One hundred twenty-six women were randomized to 1 of the following 3 treatment cohorts: CD101 3% gel (n = 50) applied intravaginally on days 1 and 2, CD101 6% ointment (n = 50) applied intravaginally on day 1, or oral fluconazole 150 mg (n = 26) on day 1. Primary outcomes of clinical and mycological cure, as demonstrated by changes in the vaginal scores and mycological culture, were assessed on day 7 (±2 days), day 14 (±2 days), and day 28 (±7 days). Safety assessments included treatment-emergent adverse events. RESULTS Ninety-nine women with positive Candida culture remained in the modified intent-to-treat population with 40 in each CD101 arm and 19 in the fluconazole arm. In the CD101 gel, CD101 ointment, and oral fluconazole groups, 35%, 30%, and 52.6% demonstrated clinical cure and 45%, 40%, and 57.9% had mycological cure at day 28, respectively. CONCLUSIONS CD101 3% gel and CD101 6% ointment were well tolerated and produced similar rates of clinical and mycological cure in patients with an acute, moderate-to-severe episode of VVC. However, cure rates for these 2 formulations and regimens of CD101 were lower than those in patients treated with fluconazole.
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Antypenko L, Sadykova Z, Shabelnyk K, Meyer F, Kovalenko S, Meyer V, Garbe LA, Steffens K. Synthesis and mode of action studies of novel {2-(3-R-1H-1,2,4-triazol-5-yl)phenyl}amines to combat pathogenic fungi. Arch Pharm (Weinheim) 2019; 352:e1900092. [PMID: 31463959 DOI: 10.1002/ardp.201900092] [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: 03/21/2019] [Revised: 07/10/2019] [Accepted: 07/17/2019] [Indexed: 11/09/2022]
Abstract
Due to their high specificity and efficacy, triazoles have become versatile antifungals to treat fungal infections in human healthcare and to control phytopathogenic fungi in agriculture. However, azole resistance is an emerging problem affecting human health as well as food security. Here we describe the synthesis of 10 novel {2-(3-R-1H-1,2,4-triazol-5-yl)phenyl}amines. Their structure was ascertained by liquid chromatography-mass spectrometry, 1 H and 13 C NMR, and elemental analysis data. Applying an in vitro growth assay, these triazoles show moderate to significant antifungal activity against the opportunistic pathogen Aspergillus niger, 12 fungi (Fusarium oxysporum, Fusarium fujikuroi, Colletotrichum higginsianum, Gaeumannomyces graminis, Colletotrichum coccodes, Claviceps purpurea, Alternaria alternata, Mucor indicus, Fusarium graminearum, Verticillium lecanii, Botrytis cinerea, Penicillium digitatum) and three oomycetes (Phytophtora infestans GL-1, P. infestans 4/91; R+ and 4/91; R-) in the concentration range from 1 to 50 µg/ml (0.003-2.1 μM). Frontier molecular orbital energies were determined to predict their genotoxic potential. Molecular docking calculations taking into account six common fungal enzymes point to 14α-demethylase (CYP51) and N-myristoyltransferase as the most probable fungal targets. With respect to effectiveness, structure-activity calculations revealed the strong enhancing impact of adamantyl residues. The shown nonmutagenicity in the Salmonella reverse-mutagenicity assay and no violations of drug-likeness parameters suggest the good bioavailability and attractive ecotoxicological profile of the studied triazoles.
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Affiliation(s)
- Lyudmyla Antypenko
- Department of Food and Bioproduct Technology, Neubrandenburg University, Neubrandenburg, Germany
| | - Zhanar Sadykova
- Department of Food and Bioproduct Technology, Neubrandenburg University, Neubrandenburg, Germany
| | - Kostiantyn Shabelnyk
- Departments of Pharmaceutical Chemistry, Organic and Bioorganic Chemistry, Zaporizhzhya State Medical University, Zaporizhzhya, Ukraine
| | - Fatuma Meyer
- Department of Food and Bioproduct Technology, Neubrandenburg University, Neubrandenburg, Germany
| | - Sergiy Kovalenko
- Departments of Pharmaceutical Chemistry, Organic and Bioorganic Chemistry, Zaporizhzhya State Medical University, Zaporizhzhya, Ukraine
| | - Vera Meyer
- Department of Applied and Molecular Microbiology, Institute of Biotechnology, Technische Universität Berlin, Berlin, Germany
| | - Leif-Alexander Garbe
- Department of Food and Bioproduct Technology, Neubrandenburg University, Neubrandenburg, Germany
| | - Karl Steffens
- Department of Food and Bioproduct Technology, Neubrandenburg University, Neubrandenburg, Germany
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Gonçalves B, Azevedo NM, Henriques M, Silva S. Hormones modulate Candida vaginal isolates biofilm formation and decrease their susceptibility to azoles and hydrogen peroxide. Med Mycol 2019; 58:341-350. [DOI: 10.1093/mmy/myz070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/25/2019] [Accepted: 06/05/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Vulvovaginal candidiasis (VVC) is an infection usually caused by Candida albicans and increasingly by Candida glabrata, which has an intrinsically high resistance to commonly used antifungals. Candida species possess virulence factors that contribute to VVC development, as the ability to form biofilms in vaginal walls and intrauterine devices. It is known that VVC is promoted by conditions that increase the hormones levels, during pregnancy, however, the effects of hormones on Candida cells are poorly studied, especially in C. glabrata. Thus, the influence of progesterone and β-estradiol, at normal cycle and pregnancy concentrations, on biofilm formation and resistance of C. albicans and C. glabrata vaginal isolates, was analyzed using acidic conditions (pH 4). Biofilms of C. albicans developed in the presence of hormones presented reduced biomass (up to 65%) and impaired cells ability to produce filamentous forms. On the other hand, C. glabrata presented high adaptation to the presence of hormones, which did not affect its biofilm formation. Additionally, hormones impaired the susceptibility of C. albicans and C. glabrata cells to azoles, with potential clinical significance in the presence of pregnancy hormone levels. A similar result was obtained for the susceptibility to hydrogen peroxide, a biological vaginal barrier against Candida growth. Overall, the results of this study suggest that hormones may act as environmental cues promoting Candida protection from vaginal defenses and harmful conditions, what may have implications in Candida vaginal pathogenicity and treatment of VVC, especially in C. glabrata infections due to its high adaptability to vaginal conditions.
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Affiliation(s)
- Bruna Gonçalves
- CEB, Center of Biological Engineering, LIBRO – “Laboratório de Investigação em Biofilmes Rosário Oliveira”, University of Minho, Gualtar Campus, 4715-057 Braga, Portugal
| | - Nuno Miguel Azevedo
- CEB, Center of Biological Engineering, LIBRO – “Laboratório de Investigação em Biofilmes Rosário Oliveira”, University of Minho, Gualtar Campus, 4715-057 Braga, Portugal
| | - Mariana Henriques
- CEB, Center of Biological Engineering, LIBRO – “Laboratório de Investigação em Biofilmes Rosário Oliveira”, University of Minho, Gualtar Campus, 4715-057 Braga, Portugal
| | - Sónia Silva
- CEB, Center of Biological Engineering, LIBRO – “Laboratório de Investigação em Biofilmes Rosário Oliveira”, University of Minho, Gualtar Campus, 4715-057 Braga, Portugal
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A Novel 1,3-Beta-d-Glucan Inhibitor, Ibrexafungerp (Formerly SCY-078), Shows Potent Activity in the Lower pH Environment of Vulvovaginitis. Antimicrob Agents Chemother 2019; 63:AAC.02611-18. [PMID: 30885896 DOI: 10.1128/aac.02611-18] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/10/2019] [Indexed: 01/31/2023] Open
Abstract
Ibrexafungerp (IBX) (formerly SCY-078) is a novel glucan synthase inhibitor whose oral availability is being evaluated for efficacy against vulvovaginal candidiasis (VVC). Bioavailability and in vitro activity are important efficacy indicators, but accepted susceptibility methods do not always accurately predict activity in an acidic environment, such as the vagina. Studies were 3-fold, as follows: (i) pharmacokinetic study following oral administration in a murine model; (ii) susceptibility testing of isolates from a phase 2 VVC clinical trial by CLSI M27-A4 methodology; and (iii) susceptibility testing of Candida albicans and Candida glabrata isolates obtained from this trial group in RPMI 1640 adjusted to 3 different pH values, 7.0, 5.72, and 4.5, compared to susceptibility testing for micafungin and fluconazole. IBX readily accumulated in vaginal tissues and secretions following oral administration. Potent in vitro activity was demonstrated against Candida strains obtained at baseline and end of study visits. Moreover, the geometric mean (GM) values for IBX at pH 4.5 were dramatically lower than those at pH 7.0 and 5.72. The MIC90 values of micafungin remained the same regardless of pH value, while those of fluconazole tended to increase with lower pH values. IBX is able to reach target tissues following oral administration at pharmacologically meaningful levels. IBX demonstrated potent in vitro activity, with no development of resistance, following repeated exposure over the course of the clinical trial. Importantly, activity of IBX in an acidic medium suggests a therapeutic advantage of this novel antifungal in the treatment of vaginal Candida infections.
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Antifungal Susceptibility Profile of Candida Albicans Isolated from Vulvovaginal Candidiasis in Xinjiang Province of China. Mycopathologia 2019; 184:413-422. [PMID: 30968320 DOI: 10.1007/s11046-018-0305-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 10/30/2018] [Indexed: 12/12/2022]
Abstract
We investigated the antifungal susceptibility profiles of 207 independent Candida albicans strains isolated from patients with vulvovaginal candidiasis (VVC) in Xinjiang Province of China. Using CLSI M27-A3 and M27-S4 guidelines, anidulafungin and micafungin were the most active drugs against C. albicans showing an MIC50/MIC90 corresponding to 0.016/0.0313 µg/mL, followed by caspofungin (0.25/0.25 µg/mL), posaconazole (0.125/0.5 µg/mL), ravuconazole (0.063/1 µg/mL), itraconazole (0.125/1 µg/mL), amphotericine B (0.5/1 µg/mL), isavuconazole (0.063/2 µg/mL), 5-flucytosine (1/2 µg/mL), voriconazole (0.125/4 µg/mL), and fluconazole (0.5/4 µg/mL). 96.1% (199)-100.0% (207) isolates were sensitive to the three echinocandins tested, amphotericine B and 5-flucytosine. The in vitro activity of triazoles against all isolates tested was variable; itraconazole and voriconazole had reduced the activity to almost half of the isolates (55.1% (114) and 51.2% (106) susceptible, respectively). Fluconazole was active against 76.3% (158) isolates tested. The new triazoles ravuconazole, isavuconazole and posaconazole showed good in vitro potency against 89.9% (186)-95.2% (197) of isolates with the geometric mean MIC (µg/mL) of 0.10, 0.12 and 0.14 µg/mL, respectively. In conclusion, our study indicates that for effective management of systemic candidiasis in Xinjiang Province of China, it is important to determine the susceptibility profiles of isolated C. albicans from patients with VVC.
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Pic E, Burgain A, Sellam A. Repurposing the anthelminthic salicylanilide oxyclozanide against susceptible and clinical resistant Candida albicans strains. Med Mycol 2019; 57:387-390. [PMID: 29762783 DOI: 10.1093/mmy/myy027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 03/14/2018] [Accepted: 04/05/2018] [Indexed: 12/16/2022] Open
Abstract
Current antifungal drugs suffer from limitations including toxicity, adverse interactions with other commonly prescribed drugs, and the emergence of resistant strains. Here, we repurposed the anthelmintic oxyclozanide as a potent antifungal agent against both sensitive and resistant clinical isolates of Candida albicans, as well as other human opportunistic fungi. Antifungal activity of oxyclozanide was enhanced when C. albicans grew in nonfermentable carbon sources. Our data support a mechanism of action where oxyclozanide uncoupled the mitochondrial electron transport from oxidative phosphorylation and perturbed the mitochondrial membrane potential.
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Affiliation(s)
- Emilie Pic
- Infectious Diseases Research Centre-CRI, CHU de Québec Research Center (CHUQ), Université Laval, Quebec City, QC, Canada
| | - Anaïs Burgain
- Infectious Diseases Research Centre-CRI, CHU de Québec Research Center (CHUQ), Université Laval, Quebec City, QC, Canada
| | - Adnane Sellam
- Infectious Diseases Research Centre-CRI, CHU de Québec Research Center (CHUQ), Université Laval, Quebec City, QC, Canada.,Department of Microbiology, Infectious Disease and Immunology, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
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Song Y, Zhu P, Wu Y, Tan L, Wei W, Liu S, Huang Q, Chen J. Epsilon-poly-l-lysine decorated ordered mesoporous silica contributes to the synergistic antifungal effect and enhanced solubility of a lipophilic drug. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 99:231-240. [PMID: 30889695 DOI: 10.1016/j.msec.2019.01.077] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/21/2018] [Accepted: 01/18/2019] [Indexed: 11/18/2022]
Abstract
The emergence of drug-resistant fungal strains remains a severe threat for the public health, which prompts strict restrictions on the uses of antifungal drugs. However, the majority of lipophilic fungistatic agents are poorly water soluble with a low oral adsorption characteristic posing challenges for the precise prescriptions. In this study, a natural antimicrobial cationic peptide of epsilon-poly-l-lysine (EPL) decorated ordered mesoporous silica (SBA-15) was facilely prepared for the efficient loading of antifungal itraconazole (ITZ) drugs. The characterized mesoporous SBA-15/EPL/ITZ composite exhibited remarkable antifungal performance against Aspergillus fumigatus as a model mold, which was attributed to synergistic antifungal activities of ITZ and EPL in the mesopores. Moreover, the in vitro release behaviors of ITZ in the composite nanoexcipients both in simulated gastric fluid and fasted state simulated intestinal fluid were studied. The observed release kinetics of ITZ demonstrated a contributing role of SBA-15/EPL to enhance the solubility of ITZ and thereby may promote its flux across the gastrointestinal epithelium, which is beneficial for the absorption of drugs. Additionally, SBA-15/EPL/ITZ composites showed desirable biocompatibility toward mammalian red blood cells, human cervical cancer cells (Hela) and human embryonic kidney cells (HEK-293T). Furthermore, the pharmacokinetic profiles of obtained nano-formulations were assessed in rats, among which the improved adsorption of SBA-15/EPL/ITZ composites (AUC0-24h sum: 8381.7 nM·h) was identified compared with that of pure ITZ (525.1 nM·h) and the commercial drug of Sporanox (7516.6 nM·h). Collectively, the prepared SBA-15/EPL/ITZ provides an ecofriendly and integrated nanocomposite with enhanced solubility of lipophilic drugs to combat proliferations of infectious fungi.
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Affiliation(s)
- Yiyan Song
- School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Ping Zhu
- School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Yuan Wu
- Department of Medical Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China
| | - Li Tan
- Jiangsu Institute for Food and Drug Control, Nanjing 210009, China
| | - Wei Wei
- Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, Jiangsu Province Hi-Tech Key Laboratory for Bio-medical Research, School of Chemistry and Chemical Engineering, Southeast University, Nanjing 211189, China
| | - Songqin Liu
- Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, Jiangsu Province Hi-Tech Key Laboratory for Bio-medical Research, School of Chemistry and Chemical Engineering, Southeast University, Nanjing 211189, China
| | - Qing Huang
- Jiangsu Institute for Food and Drug Control, Nanjing 210009, China
| | - Jin Chen
- School of Public Health, Nanjing Medical University, Nanjing 211166, China; The Key Laboratory of Modern Toxicology, Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu, China; Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu, China.
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Ganan M, Lorentzen SB, Agger JW, Heyward CA, Bakke O, Knutsen SH, Aam BB, Eijsink VGH, Gaustad P, Sørlie M. Antifungal activity of well-defined chito-oligosaccharide preparations against medically relevant yeasts. PLoS One 2019; 14:e0210208. [PMID: 30620751 PMCID: PMC6324834 DOI: 10.1371/journal.pone.0210208] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 12/18/2018] [Indexed: 11/19/2022] Open
Abstract
Due to their antifungal activity, chitosan and its derivatives have potential to be used for treating yeast infections in humans. However, to be considered for use in human medicine, it is necessary to control and know the chemical composition of the compound, which is not always the case for polymeric chitosans. Here, we analyze the antifungal activity of a soluble and well-defined chito-oligosaccharide (CHOS) with an average polymerization degree (DPn) of 32 and fraction of acetylation (FA) of 0.15 (C32) on 52 medically relevant yeast strains. Minimal inhibitory concentrations (MIC) varied widely among yeast species, strains and isolates (from > 5000 to < 9.77 μg mL-1) and inhibition patterns showed a time- and dose-dependencies. The antifungal activity was predominantly fungicidal and was inversely proportional to the pH, being maximal at pH 4.5, the lowest tested pH. Furthermore, antifungal effects of CHOS fractions with varying average molecular weight indicated that those fractions with an intermediate degree of polymerization, i.e. DP 31 and 54, had the strongest inhibitory effects. Confocal imaging showed that C32 adsorbs to the cell surface, with subsequent cell disruption and accumulation of C32 in the cytoplasm. Thus, C32 has potential to be used as a therapy for fungal infections.
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Affiliation(s)
- Monica Ganan
- Department of Chemistry, Biotechnology, and Food Science, Norwegian University of Life Sciences, Aas, Norway
- Institute of Clinical Medicine, Department of Microbiology, University of Oslo, Blindern, Oslo, Norway
| | - Silje B. Lorentzen
- Department of Chemistry, Biotechnology, and Food Science, Norwegian University of Life Sciences, Aas, Norway
| | - Jane W. Agger
- Department of Chemistry, Biotechnology, and Food Science, Norwegian University of Life Sciences, Aas, Norway
| | | | - Oddmund Bakke
- Department of Biosciences, University of Oslo, Blindern, Oslo, Norway
| | - Svein H. Knutsen
- Nofima, Norwegian Institute of Food Fisheries & Aquaculture Research, Aas, Norway
| | - Berit B. Aam
- Department of Chemistry, Biotechnology, and Food Science, Norwegian University of Life Sciences, Aas, Norway
| | - Vincent G. H. Eijsink
- Department of Chemistry, Biotechnology, and Food Science, Norwegian University of Life Sciences, Aas, Norway
| | - Peter Gaustad
- Institute of Clinical Medicine, Department of Microbiology, University of Oslo, Blindern, Oslo, Norway
| | - Morten Sørlie
- Department of Chemistry, Biotechnology, and Food Science, Norwegian University of Life Sciences, Aas, Norway
- * E-mail:
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46
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Lourenço A, Pedro NA, Salazar SB, Mira NP. Effect of Acetic Acid and Lactic Acid at Low pH in Growth and Azole Resistance of Candida albicans and Candida glabrata. Front Microbiol 2019; 9:3265. [PMID: 30671051 PMCID: PMC6331520 DOI: 10.3389/fmicb.2018.03265] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/14/2018] [Indexed: 01/20/2023] Open
Abstract
Successful colonization of the acidic vaginal niche by C. glabrata and C. albicans depends on their ability to cope with the presence of lactic and acetic acids produced by commensal microbiota. As such, the inhibitory effect of these acids at a low pH in growth of C. glabrata and C. albicans was investigated. The effect of the presence of these organic acids in tolerance of the two Candida species to azoles used in treatment of vaginal infections was also investigated including eventual synergistic effects. Under the different experimental conditions tested lactic acid exerted no significant inhibitory effect against C. albicans or C. glabrata, contrasting with the generalized impression that the production of this acid is on the basis of the protective effect exerted by vaginal lactobacilii. Differently, C. glabrata and C. albicans exhibited susceptibility to acetic acid, more prominent at lower pHs and stronger for the latter species. Synergism between acetic acid and azoles was observed both for C. albicans and C. glabrata, while lactic acid-azole synergism was only efficient against C. albicans. Altogether our in vitro results indicate that tolerance to acetic acid at a low pH may play a more relevant role than tolerance to lactic acid in determining competitiveness in the vaginal tract of C. albicans and C. glabrata including under azole stress. Treatment of vaginal candidiasis with azoles may depend on the level of acetic and lactic acids present and improvements could be achieved synergizing the azole with these acids.
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Affiliation(s)
- Andreia Lourenço
- Department of Bioengineering, Institute for Bioengineering and Biosciences, Instituto Superior Técnico, University of Lisbon, Lisbon, Portugal
| | - Nuno Alexandre Pedro
- Department of Bioengineering, Institute for Bioengineering and Biosciences, Instituto Superior Técnico, University of Lisbon, Lisbon, Portugal
| | - Sara Barbosa Salazar
- Department of Bioengineering, Institute for Bioengineering and Biosciences, Instituto Superior Técnico, University of Lisbon, Lisbon, Portugal
| | - Nuno Pereira Mira
- Department of Bioengineering, Institute for Bioengineering and Biosciences, Instituto Superior Técnico, University of Lisbon, Lisbon, Portugal
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Schneider J, Mateo E, Marcos-Arias C, Eiró N, Vizoso F, Pérez-Fernández R, Eraso E, Quindós G. Antifungal Activity of the Human Uterine Cervical Stem Cells Conditioned Medium (hUCESC-CM) Against Candida albicans and Other Medically Relevant Species of Candida. Front Microbiol 2018; 9:2818. [PMID: 30519227 PMCID: PMC6258777 DOI: 10.3389/fmicb.2018.02818] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 11/02/2018] [Indexed: 12/12/2022] Open
Abstract
Background: Candidiasis is a major cause of human morbidity and mortality. Human uterine cervical stem cells conditioned medium (hUCESC-CM) is obtained from stromal stem cells of the cervical transformation zone, which are in permanent contact with a wide array of potential vaginal pathogens. In previous reports we have found that hUCESC-CM has antitumor and antibacterial potential. Since Candida is the most prevalent yeast in the human vagina, it seems plausible that hUCESC-CM might also show activity against it. Methods: In a preliminary step, to evaluate if hUCESC-CM showed any activity at all on Candida growth, in vitro activities of hUCESC-CM against fluconazole-susceptible reference strains of Candida albicans, Candida glabrata, Candida krusei, and Candida parapsilosis were studied with a microdilution method on RPMI 1640, using the BioScreen C microbiological incubator. Each measurement was repeated five times. The same methodology was used subsequently on fluconazole-susceptible and fluconazole-resistant Candida isolates from blood and vagina of those species corresponding to the reference strains of Candida against which activity had been detected in the previous study. Moreover, two fluconazole-resistant clinical isolates of Candida auris from blood and urine were also included. Findings: In vitro inhibitory activity of hUCESC-CM ranged from 57.5 to 96.6% growth-reduction against fluconazole-susceptible reference strains of Candida albicans, Candida glabrata, and Candida parapsilosis. hUCESC-CM also reduced the growth of all fluconazole-susceptible tested vaginal isolates by more than 50%. For fluconazole-resistant isolates, growth-reduction was higher than 67% for Candida albicans, regardless of its origin (vagina or blood). The isolate of Candida auris from urine with a MIC > 128 μ/ml for fluconazole was also significantly inhibited. However, hUCESC-CM was almost inactive against any of the fluconazole-resistant blood isolates of Candida glabrata, Candida parapsilosis, and Candida auris tested. Interpretation: This is the first report about the growth-inhibiting properties of conditioned medium from human stromal stem cells against different species of Candida. Antifungal activity of stromal stem cells depends on their site of origin, being most effective against Candida species most prevalent at that particular location. If confirmed in further studies, these findings might result in a completely new therapeutic approach against superficial and invasive candidiasis.
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Affiliation(s)
- José Schneider
- Fundación para la Investigación con Células Madre Uterinas, Gijón, Spain
- Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
| | - Estibaliz Mateo
- Laboratorio de Micología Médica, UFI 11/25, Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU), Bilbao, Spain
| | - Cristina Marcos-Arias
- Laboratorio de Micología Médica, UFI 11/25, Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU), Bilbao, Spain
| | - Noemi Eiró
- Fundación para la Investigación con Células Madre Uterinas, Gijón, Spain
- Unidad de Investigación, Fundación Hospital de Jove, Gijón, Spain
| | - Francisco Vizoso
- Fundación para la Investigación con Células Madre Uterinas, Gijón, Spain
- Unidad de Investigación, Fundación Hospital de Jove, Gijón, Spain
| | - Román Pérez-Fernández
- Fundación para la Investigación con Células Madre Uterinas, Gijón, Spain
- Departamento de Fisiología-CIMUS, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Elena Eraso
- Laboratorio de Micología Médica, UFI 11/25, Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU), Bilbao, Spain
| | - Guillermo Quindós
- Laboratorio de Micología Médica, UFI 11/25, Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU), Bilbao, Spain
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48
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Makanjuola O, Bongomin F, Fayemiwo SA. An Update on the Roles of Non- albicans Candida Species in Vulvovaginitis. J Fungi (Basel) 2018; 4:E121. [PMID: 30384449 PMCID: PMC6309050 DOI: 10.3390/jof4040121] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/16/2018] [Accepted: 10/16/2018] [Indexed: 02/08/2023] Open
Abstract
Candida species are one of the commonest causes of vaginitis in healthy women of reproductive age. Vulvovaginal candidiasis (VVC) is characterized by vulvovaginal itching, redness and discharge. Candida albicans, which is a common genito-urinary tract commensal, has been the prominent species and remains the most common fungal agent isolated from clinical samples of patients diagnosed with VVC. In recent times, however, there has been a notable shift in the etiology of candidiasis with non-albicans Candida (NAC) species gaining prominence. The NAC species now account for approximately 10% to as high as 45% of VVC cases in some studies. This is associated with treatment challenges and a slightly different clinical picture. NAC species vaginitis is milder in presentation, often occur in patients with underlying chronic medical conditions and symptoms tend to be more recurrent or chronic compared with C. albicans vaginitis. C. glabrata is the most common cause of NAC-VVC. C. tropicalis, C. krusei, C. parapsilosis, and C. guilliermondii are the other commonly implicated species. Treatment failure is common in NAC-VVC, since some of these species are intrinsically resistant or show low susceptibilities to commonly used antifungal agents. This article reviews the etiology, pathogenesis, clinical features, diagnosis, and management of NAC vulvovaginitis.
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Affiliation(s)
- Olufunmilola Makanjuola
- Department of Medical Microbiology and Parasitology, University of Ibadan, Ibadan 200284, Nigeria.
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Gulu University, Gulu P.O. Box 166, Uganda.
| | - Samuel A Fayemiwo
- Department of Medical Microbiology and Parasitology, University of Ibadan, Ibadan 200284, Nigeria.
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK.
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49
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Reduced Antifungal Susceptibility of Vulvovaginal Candida Species at Normal Vaginal pH Levels: Clinical Implications. J Low Genit Tract Dis 2018; 22:152-158. [PMID: 29474241 DOI: 10.1097/lgt.0000000000000383] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of the study were to assess for differences in antifungal in vitro potency at pH 7 and pH 4 and to discuss any potential clinical implications of that difference. MATERIALS AND METHODS A retrospective analysis of 217 first positive yeast cultures from 217 patients. Yeast isolates underwent antifungal susceptibility testing, with minimum inhibitory concentrations (MICs) (microgram per milliliter) measured at pH 7 and pH 4 for fluconazole, itraconazole, miconazole, clotrimazole, terconazole, and nystatin. Only the first isolates collected from each patient were included in the analysis. RESULTS Yeast first isolates included 173 Candida albicans, 15 Candida glabrata, and 29 isolates from 8 other species. Geometric mean (GM) MIC values for all antifungals were significantly higher when tested at pH 4 (p < .001 for all comparisons). For C. albicans, the largest GM MIC differences were observed for terconazole (0.17 pH 7 vs 6.17 pH 4) and clotrimazole (0.04 vs 0.24). For terconazole, 97.7% of the isolates had a MIC of 1 or less at pH 7 but 83.2% had a MIC of 4 or higher at pH 4. For C. glabrata, terconazole (GM MIC = 0.26 pH 7 vs >64 pH 4), clotrimazole (0.13 vs 6.96), miconazole (0.06 vs 0.76), and fluconazole (3.17 vs 26.6) were most affected. All C. glabrata isolates had a MIC of 1 or less for terconazole at pH 7 and one had a MIC of 8 at pH 4, whereas all the rest were highly resistant (MIC > 64). CONCLUSIONS Antifungals have reduced in vitro potency when tested at lower pH. Candida glabrata is more affected than C. albicans. The impact may be greatest for the antifungal terconazole and against C. glabrata isolates.
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Asghar F, Yan H, Jiang L. The putative transcription factor CaMaf1 controls the sensitivity to lithium and rapamycin and represses RNA polymerase III transcription in Candida albicans. FEMS Yeast Res 2018; 18:5047891. [PMID: 29982370 DOI: 10.1093/femsyr/foy068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 06/23/2018] [Indexed: 12/19/2022] Open
Abstract
Maf1 is a repressor of RNA polymerase (Pol) III transcription for tRNA. Nutrient deprivation and environmental stress repress Pol III transcription through Maf1 in Saccharomyces cerevisiae. The sole Candida albicans homolog CaMaf1 is a protein of 380 amino acids with conserved domains and motifs of the eukaryotic Maf1 family. Here, we show that C. albicans cells lacking CaMAF1 show elevated levels of tRNA. Deletion of CaMAF1 increases the sensitivity of C. albicans cells to lithium cation and SDS as well as tolerance to rapamycin and azole. In addition, deletion of CaMAF1 reduces the level of filamentation and alters the surface morphology of colonies. CaMaf1 is localized in the nucleus of log-phase growing cells. However, a dynamic change of subcellular localization of CaMaf1 exists during serum-induced morphological transition, with CaMaf1 being localized in the nuclei of cells with germ tubes and short filaments but outside of the nuclei of cells with long filaments. In addition, CaMaf1 is required for rapamycin-induced repression of CaERG20, encoding the farnesyl pyrophosphate synthetase involved in ergosterol biosynthesis. Therefore, CaMaf1 plays a role as a general repressor of Pol III transcription in C. albicans.
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Affiliation(s)
- Faiza Asghar
- Laboratory for Yeast Molecular and Cell Biology, the Research Center of Fermentation Technology, School of Agricultural Engineering and Food Science, Shandong University of Technology, 266 XiCunXi Road, Zibo 255000, China
| | - Hongbo Yan
- Laboratory for Yeast Molecular and Cell Biology, the Research Center of Fermentation Technology, School of Agricultural Engineering and Food Science, Shandong University of Technology, 266 XiCunXi Road, Zibo 255000, China
| | - Linghuo Jiang
- Laboratory for Yeast Molecular and Cell Biology, the Research Center of Fermentation Technology, School of Agricultural Engineering and Food Science, Shandong University of Technology, 266 XiCunXi Road, Zibo 255000, China
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