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Erami M, Aboutalebian S, Hezaveh SJH, Ghazvini RD, Momen-Heravi M, Jafari Y, Ahsaniarani AH, Basirpour B, Matini AH, Mirhendi H. Microbial and clinical epidemiology of invasive fungal rhinosinusitis in hospitalized COVID-19 patients, the divergent causative agents. Med Mycol 2023; 61:myad020. [PMID: 36906282 DOI: 10.1093/mmy/myad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/19/2023] [Accepted: 03/10/2023] [Indexed: 03/13/2023] Open
Abstract
Since COVID-19 spread worldwide, invasive fungal rhinosinusitis (IFRS) has emerged in immunocompromised patients as a new clinical challenge. In this study, clinical specimens of 89 COVID-19 patients who presented clinical and radiological evidence suggestive of IFRS were examined by direct microscopy, histopathology, and culture, and the isolated colonies were identified through DNA sequence analysis. Fungal elements were microscopically observed in 84.27% of the patients. Males (53.9%) and patients over 40 (95.5%) were more commonly affected than others. Headache (94.4%) and retro-orbital pain (87.6%) were the most common symptoms, followed by ptosis/proptosis/eyelid swelling (52.8%), and 74 patients underwent surgery and debridement. The most common predisposing factors were steroid therapy (n = 83, 93.3%), diabetes mellitus (n = 63, 70.8%), and hypertension (n = 42, 47.2%). The culture was positive for 60.67% of the confirmed cases, and Mucorales were the most prevalent (48.14%) causative fungal agents. Different species of Aspergillus (29.63%) and Fusarium (3.7%) and a mix of two filamentous fungi (16.67%) were other causative agents. For 21 patients, no growth was seen in culture despite a positive result on microscopic examinations. In PCR-sequencing of 53 isolates, divergent fungal taxons, including 8 genera and 17 species, were identified as followed: Rhizopus oryzae (n = 22), Aspergillus flavus (n = 10), A. fumigatus (n = 4), A. niger (n = 3), R. microsporus (n = 2), Mucor circinelloides, Lichtheimia ramosa, Apophysomyces variabilis, A. tubingensis, A. alliaceus, A. nidulans, A. calidoustus, Fusarium fujikuroi/proliferatum, F. oxysporum, F. solani, Lomentospora prolificans, and Candida albicans (each n = 1). In conclusion, a diverse set of species involved in COVID-19-associated IFRS was observed in this study. Our data encourage specialist physicians to consider the possibility of involving various species in IFRS in immunocompromised and COVID-19 patients. In light of utilizing molecular identification approaches, the current knowledge of microbial epidemiology of invasive fungal infections, especially IFRS, may change dramatically.
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Affiliation(s)
- Mahzad Erami
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Infectious Disease, School of Medicine, infectious diseases research center, Kashan University of Medical Sciences, Kashan, Iran
| | - Shima Aboutalebian
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Mycology Reference Laboratory, Research Core Facilities Laboratory, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed Jamal Hashemi Hezaveh
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Roshanak Daie Ghazvini
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansooreh Momen-Heravi
- Department of Infectious Disease, School of Medicine, infectious diseases research center, Kashan University of Medical Sciences, Kashan, Iran
| | - Yazdan Jafari
- Department of Internal Medicine, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Amir Hossein Ahsaniarani
- Department of Otorhinolaryngology, School of Medicine, Matini Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Bahare Basirpour
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Hassan Matini
- Department of Pathology and Histology, School of Medicine, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Mirhendi
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Mycology Reference Laboratory, Research Core Facilities Laboratory, Isfahan University of Medical Sciences, Isfahan, Iran
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Preparation and evaluation of 99mTc-anidulafungin: a potential radiotracer for fungal infection. J Radioanal Nucl Chem 2020. [DOI: 10.1007/s10967-020-07274-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Horká M, Šalplachta J, Růžička F, Šlais K. Preparative and capillary isoelectric focusing for detection and identification of Aspergillus conidia in complex sample matrices. J Sep Sci 2018; 41:4203-4211. [PMID: 30194717 DOI: 10.1002/jssc.201800547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 02/06/2023]
Abstract
This study describes a new method for fast identification of highly hydrophobic conidia of Aspergillus species from both simple and complex matrices. The method is based on recently developed preparative isoelectric focusing in a cellulose-based separation medium which had to be modified with respect to the highly hydrophobic surface of the conidia. Although Aspergillus conidia are colored, their zones in the cellulose bed were indicated by colored isoelectric point markers. The isoelectric point values of Aspergillus conidia were determined by capillary isoelectric focusing. Preparative isoelectric focusing was successfully used for preconcentration of individual conidia of cultivated strains of Aspergillus niger, Aspergillus fumigatus, Aspergillus flavus, and Aspergillus parasiticus, and also for separation of the conidia in a mixture. Subsequently, red pepper powder and peanuts spiked with Aspergillus niger and Aspergillus flavus conidia, respectively, were used as complex matrices. The detection limit for identification of the conidia in these complex matrices is 104 conidia mL-1 . The presence of conidia in the focused zones was confirmed by their subsequent analysis by capillary isoelectric focusing. Their viability was confirmed by a cultivation of the conidia extracted from the collected fractions after preparative isoelectric focusing.
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Affiliation(s)
- Marie Horká
- Institute of Analytical Chemistry of the CAS, Brno, Czech Republic
| | - Jiří Šalplachta
- Institute of Analytical Chemistry of the CAS, Brno, Czech Republic
| | - Filip Růžička
- The Department of Microbiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Karel Šlais
- Institute of Analytical Chemistry of the CAS, Brno, Czech Republic
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Agha Kuchak Afshari S, Rahimi H, Hashemi SJ, Daie Ghazvini R, Badali H, Aghaei Gharehbolagh S, Rezaie S. Evaluation of PCR-reverse line blot hybridization assay for simultaneous identification of medically important saprophytic fungi. J Mycol Med 2017; 28:173-179. [PMID: 29100947 DOI: 10.1016/j.mycmed.2017.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 09/05/2017] [Accepted: 09/11/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND In immunocompromised patients suffering from invasive fungal infections, rapid identification of fungal species is important since the appropriate treatment is usually related to the responsible species. We describe here, an assay based on combination of PCR and reverse line blot hybridization (PCR/RLB) for differentiation causative agent of fungal infections. MATERIALS AND METHODS We performed PCR/RLB assay on 10 reference strains, which include Aspergillus species (A. fumigatus, A. flavus, A. niger, A. terreus, and A. clavatus), Mucor circnelloides, Rhizopus oryzae, Alternaria alternata, Cladosporium herbarum, and Fusarium solani. Besides, twenty-two clinical specimens from patients with proven fungal infections were analyzed for the identification of species. The obtained results were then compared with the results of culture and sequence analysis. RESULTS The fungal species-specific oligonucleotide probes were able to distinguish between all species represented in this study with the exception of cross-reactivity between A. niger and A. fumigatus species. Two specimens, which were represented as mixed fungi in culture, were identified properly by this method. Results of the RLB assay were concordant with the culture and ITS sequencing results. CONCLUSION Our result demonstrate that the RLB assay potentially is suitable for rapid and simultaneous identification of variety fungal pathogens directly from culture as well as from clinical specimens.
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Affiliation(s)
- S Agha Kuchak Afshari
- Department of Medical Mycology and Parasitology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - H Rahimi
- Molecular Medicine Department, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - S J Hashemi
- Department of Medical Mycology and Parasitology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - R Daie Ghazvini
- Department of Medical Mycology and Parasitology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - H Badali
- Department of Medical Mycology and Parasitology, Antimicrobial Resistance Research Center (ARRC), Mazandaran University of Medical Science, Sari, Iran
| | - S Aghaei Gharehbolagh
- Department of Medical Mycology and Parasitology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - S Rezaie
- Department of Medical Mycology and Parasitology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Rezazadeh E, Moazeni M, Sabokbar A. Use of cost effective and rapid molecular tools for identification of Candida species, opportunistic pathogens. Curr Med Mycol 2016; 2:1-4. [PMID: 28681021 PMCID: PMC5490282 DOI: 10.18869/acadpub.cmm.2.3.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background and Purpose : Candidiasis is a widespread fungal infection caused by different Candida species. Rapid identification of Candida species in clinical laboratory is becoming increasingly important since the identification and discrimination of ethological agents for early treatment. We aimed at molecular identification of commonly Candida species isolated from clinical samples by using both PCR-RFLP assay and amplification of hwp1 gene. Materials and Methods: Clinical samples comprising of vaginal specimens ,cutaneous, sputum, bronchoalveolar lavage(BAL,( and blood cultures were recovered from suspected patients. Candida isolates were initially identified phenotypically and confirmed by molecular approaches based on restriction fragment length polymorphism (PCR-RFLP (with MspI restriction enzyme. Amplification of hwp1 gene was performed for discrimination of C. albicans from C. dubliniensis and C.africana. Results: The most abundant species were C. albicans (n=67; 44.6 %), C. glabrata (n=10; 20 %), C. tropicalis (n=20; 13.3 %), C. krusei (n=12; 8 %), C. parapsilosis (n=11; 7.3 %). Out of 67 C. albicans species, 6 species identified as C. dubliniensis and 4 species identified as C. africana. Conclusion: High frequency of non-albicansCandida species and differences in levels of susceptibility to the antifungal agents are important issues in medicine .Therefore, to manage the Candida-related infections properly, molecular diagnostic methods would be fast, reliable and even cost-effective approaches for identification of Candida species.
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Affiliation(s)
- E Rezazadeh
- Department of Microbiology, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - M Moazeni
- Invasive Fungi Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - A Sabokbar
- Department of Microbiology, Karaj Branch, Islamic Azad University, Karaj, Iran
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Hankovszky P, Társy D, Öveges N, Molnár Z. Invasive Candida Infections in the ICU: Diagnosis and Therapy. ACTA ACUST UNITED AC 2015; 1:129-139. [PMID: 29967821 DOI: 10.1515/jccm-2015-0025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/15/2015] [Indexed: 11/15/2022]
Abstract
Invasive fungal infections have become a serious problem in the critically ill. One of the main reasons is the development of an immunocompromised condition. The most frequently found pathogens are Candida species. In order to provide adequate treatment, understanding this potentially life-threatening infection is mandatory. The aim of this summary is to view Candida infections from a different perspective and to give an overview on epidemiology, the range of pathophysiology from colonization to the invasive infections, and its impact on mortality. New therapeutic options will also be discussed and how these relate to current guidelines. Finally, the key issue of the choice of anti-fungal agents will be evaluated.
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Affiliation(s)
- Péter Hankovszky
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Albert Szent-Györgyi Health Center, Szeged, Hungary
| | - Domokos Társy
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Albert Szent-Györgyi Health Center, Szeged, Hungary
| | - Nándor Öveges
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Albert Szent-Györgyi Health Center, Szeged, Hungary
| | - Zsolt Molnár
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Albert Szent-Györgyi Health Center, Szeged, Hungary
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Olczak-Kowalczyk D, Pyrżak B, Dąbkowska M, Pańczyk-Tomaszewska M, Miszkurka G, Rogozińska I, Swoboda-Kopeć E, Gozdowski D, Kalińska A, Piróg A, Mizerska-Wasiak M, Roszkowska-Blaim M. Candida spp. and gingivitis in children with nephrotic syndrome or type 1 diabetes. BMC Oral Health 2015; 15:57. [PMID: 25952029 PMCID: PMC4425863 DOI: 10.1186/s12903-015-0042-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 04/28/2015] [Indexed: 01/12/2023] Open
Abstract
Background Diabetes and Nephrotic syndrome (NS) promote plaque-related gingivitis and yeast-like fungal infections. The study assesses the impact of Candida spp. and general disease- or treatment-related factors on plaque-related gingivitis severity in children and adolescents with Nephrotic syndrome /diabetes. Methods Body mass index (BMI), BMI standard deviation score, and oral cavity (Plaque Index – PLI, Gingival Index – GI, mucosa status, presence and Candida enzymatic activity) were assessed in 96 patients (32 with NS: 30- immunosuppressive treatment, 35 - type 1 diabetes, and 29 generally healthy), aged; 3–18 years. Laboratory included cholesterol and triglyceride measurements; in diabetic subjects– glycated haemoglobin, in NS: total protein, albumin, creatinine, haemoglobin, haematocrit, white cell count, urinary protein excretion. Medical records supplied information on disease duration and treatment. A statistical analysis was performed; Kendall Tau coefficient, chi-square test, t-test, and multiple regression analysis ( P < 0.05). Results Candida spp. often occurred in healthy patients, but oral candidiasis was found only in the NS and diabetes groups (9.37% and 11.43%). Gingivitis occurred more frequently in patients with NS/diabetes. Gingivitis severity was correlated with PLI, age, and yeast enzyme activity in NS – to with immunosuppressive treatment with >1 drug, drug doses, treatment duration, lipid disorders, and BMI; in diabetes, with blood glucose and glycated haemoglobin >8%. Conclusion Poor hygiene control is the main cause of gingivitis. Gingivitis severity is most likely related to age, lipid disorders and increase in body mass. Candida spp., in uncompensated diabetes and in those using immunosuppressive treatment, might intensify plaque-related gingivitis.
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Affiliation(s)
- Dorota Olczak-Kowalczyk
- Department of Paediatric Dentistry, Medical University of Warsaw, 18 Miodowa St, 00-246, Warszawa, Poland.
| | - Beata Pyrżak
- Department of Paediatric Endocrinology, Medical University of Warsaw, Warszawa, Poland.
| | - Maria Dąbkowska
- Department of Dental Medical Microbiology, Medical University of Warsaw, Warszawa, Poland.
| | | | - Grażyna Miszkurka
- Department of Paediatric Endocrinology, Medical University of Warsaw, Warszawa, Poland.
| | - Izabela Rogozińska
- Department of Paediatric Endocrinology, Medical University of Warsaw, Warszawa, Poland.
| | - Ewa Swoboda-Kopeć
- Department of Dental Medical Microbiology, Medical University of Warsaw, Warszawa, Poland.
| | - Dariusz Gozdowski
- Department of Experimental Statistics and Bioinformatics, Warsaw University of Life Sciences, Warsaw, Poland.
| | - Angelika Kalińska
- Department of Paediatric Dentistry, Medical University of Warsaw, 18 Miodowa St, 00-246, Warszawa, Poland.
| | - Anna Piróg
- Department of Paediatric Dentistry, Medical University of Warsaw, 18 Miodowa St, 00-246, Warszawa, Poland.
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Abstract
AbstractOver the past decade, the incidence of hospital-acquired bloodstream infections caused byCandidastrains has risen, while the implicated species have changed.Candida tropicalis, Candida parapsilosis, andCandida glabrataall have increased in incidence. Data from the Centers for Disease Control and Prevention reveal that, between 1980 and 1990,Candidaemerged as the sixth most common nosocomial pathogen (7.2.%) and was the fourth most common pathogen in nosocomial bloodstream infections, surpassed only by coagulase-negative staphylococci,Staphylococcus aureus, and enterococci. The incidence of candidemia is dramatically higher in high-risk critical-care units: 25% of cases occur in surgical intensive-care units (ICUs) versus 25% in bone marrow transplantation units, 20% in medical ICUs, 20% in general medical wards, and 10% in oncology-hematology units. Burns and gastrointestinal surgery predispose to nosocomial candidemia. Independent risk factors include prior therapy with multiple antibiotics, isolation ofCandidafrom sites other than blood, and prior hemodialysis. Crude mortality exceeds 55% and is associated with older age and concomitant renal failure, hepatic failure, acute respiratory diseases, or postoperative shock. In addition to extreme vigilance for early recognition ofCandidasepsis in critically ill surgical patients, the high risk for candidemia probably necessitates fungal surveillance cultures and initiation of preemptive antifungal therapy in high-risk surgical patients.
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Dou YH, Du JK, Liu HL, Shong XD. The role of procalcitonin in the identification of invasive fungal infection-a systemic review and meta-analysis. Diagn Microbiol Infect Dis 2013; 76:464-9. [PMID: 23711529 DOI: 10.1016/j.diagmicrobio.2013.04.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 04/19/2013] [Indexed: 11/24/2022]
Abstract
We aimed to summarize evidence on the accuracy of procalcitonin (PCT) test in differentiating fungal infection from other causes of infection. We searched electronic database for original researches that reported diagnostic performance of PCT alone or compare with other biomarkers to diagnose invasive fungal infection (IFI). We included 8 qualifying studies studying 474 episodes of suspected fungal infection with 155 (32.7%) probable or proven IFIs. Four studies compared IFI to bacterial sepsis, in which the pooled positive likelihood ratios and negative likelihood ratios were 4.65 (95% confidence interval [CI], 2.46-8.79) and 0.15 (95% CI, 0.05-0.41), respectively. Another 4 studies compared IFI to uninfected individuals, in which the pooled positive likelihood ratios and negative likelihood ratios were 4.01 (95% CI, 2.04-7.88) and 0.23 (0.07-0.77), respectively. The existing literature suggests good diagnostic accuracy for the PCT test for discrimination between IFIs and bacterial infection or noninfectious conditions. Given the high heterogeneity, medical decisions should be based on both PCT test results and clinical findings.
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Affiliation(s)
- Yu-Hong Dou
- Clinical Laboratory, Shenzhen Shajing Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Mikulska M, Furfaro E, Viscoli C. Biomarkers for Diagnosis and Follow-Up of Invasive Candidiasis: A Brief Review of the ECIL Recommendations. CURRENT FUNGAL INFECTION REPORTS 2012. [DOI: 10.1007/s12281-012-0101-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Del Chierico F, Masotti A, Onori M, Fiscarelli E, Mancinelli L, Ricciotti G, Alghisi F, Dimiziani L, Manetti C, Urbani A, Muraca M, Putignani L. MALDI-TOF MS proteomic phenotyping of filamentous and other fungi from clinical origin. J Proteomics 2012; 75:3314-30. [PMID: 22504628 DOI: 10.1016/j.jprot.2012.03.048] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Revised: 03/01/2012] [Accepted: 03/26/2012] [Indexed: 10/28/2022]
Abstract
Major changes in medical, intensive care and organ transplantation practices are drastically increasing the risk of fungal opportunistic infections. We designed and set-up a MALDI-TOF MS-based assay to identify the most isolated and emerging therapy-refractory/uncommon fungi from cystic fibrosis (CF) and immunocompromised patients. Two-hundred and thirty isolates from 10 different genera (Aspergillus, Emericella, Fusarium, Geosmithia, Neosartorya, Penicillium, Pseudallescheria, Scedosporium, Talaromyces, Fomitopsis), investigated during routine diagnostic efforts, were correlated to 22 laboratory-adapted reference MALDI-TOF MS "proteomic phenotypes". A growth time-course at 30°C on Sabouraud agar medium was performed for the 22 "phenotypes" at 48, 72, 96 and 120h points. The best peptide extraction conditions for full recovery of conidia- or asci-producing multihyphal morph structures and the highest intra- and inter-class profiling correlation were identified for the 120h point spectra dataset, from which an engineered library derived (pre-analytical phase). Fingerprinting classifiers, selected by Wilcoxon/Kruskal-Wallis algorithm, were computed by Genetic Algorithm, Support Vector Machine, Supervised Neuronal Network and Quick Classifier model construction. MS identification (ID) of clinical isolates was referred to genotyping (GT) and, retrospectively, compared to routine morphotyping (MT) IDs (analytical phase). Proteomic phenotyping is revolutionizing diagnostic mycology as fully reflecting species/morph varieties but often overcoming taxonomic hindrance.
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Affiliation(s)
- Federica Del Chierico
- Parasitology Unit, Department of Laboratory Medicine, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
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Arendrup MC, Bille J, Dannaoui E, Ruhnke M, Heussel CP, Kibbler C. ECIL-3 classical diagnostic procedures for the diagnosis of invasive fungal diseases in patients with leukaemia. Bone Marrow Transplant 2012; 47:1030-45. [DOI: 10.1038/bmt.2011.246] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Detection of invasive Candida albicans infection using a specific 99mTc-labeled monoclonal antibody for the C. albicans germ tube. Appl Microbiol Biotechnol 2011; 93:2099-108. [DOI: 10.1007/s00253-011-3533-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 07/25/2011] [Accepted: 08/04/2011] [Indexed: 10/17/2022]
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Hsu JL, Ruoss SJ, Bower ND, Lin M, Holodniy M, Stevens DA. Diagnosing invasive fungal disease in critically ill patients. Crit Rev Microbiol 2011; 37:277-312. [PMID: 21749278 DOI: 10.3109/1040841x.2011.581223] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Fungal infections are increasing, with a changing landscape of pathogens and emergence of new groups at risk for invasive disease. We review current diagnostic techniques, focusing on studies in critically ill patients. Microbiological cultures, the current "gold standard", demonstrate poor sensitivity, thus diagnosis of invasive disease in the critically ill is difficult. This diagnostic dilemma results in under- or over-treatment of patients, potentially contributing to poor outcomes and antifungal resistance. While other current diagnostic tests perform moderately well, many lack timeliness, efficacy, and are negatively affected by treatments common to critically ill patients. New nucleic acid-based research is promising.
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Affiliation(s)
- Joe L Hsu
- Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Simultaneous detection and identification of Aspergillus and mucorales species in tissues collected from patients with fungal rhinosinusitis. J Clin Microbiol 2011; 49:1501-7. [PMID: 21325541 DOI: 10.1128/jcm.02262-10] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Rapid detection and differentiation of Aspergillus and Mucorales species in fungal rhinosinusitis diagnosis are desirable, since the clinical management and prognosis associated with the two taxa are fundamentally different. We describe an assay based on a combination of broad-range PCR amplification and reverse line blot hybridization (PCR/RLB) to detect and differentiate the pathogens causing fungal rhinosinusitis, which include five Aspergillus species (A. fumigatus, A. flavus, A. niger, A. terreus, and A. nidulans) and seven Mucorales species (Mucor heimalis, Mucor racemosus, Mucor cercinelloidea, Rhizopus arrhizus, Rhizopus microsporus, Rhizomucor pusillus, and Absidia corymbifera). The assay was validated with 98 well-characterized clinical isolates and 41 clinical tissue specimens. PCR/RLB showed high sensitivity and specificity, with 100% correct identifications of 98 clinical isolates and no cross-hybridization between the species-specific probes. Results for five control isolates, Candida albicans, Fusarium solani, Scedosporium apiospermum, Penicillium marneffei, and Exophiala verrucosa, were negative as judged by PCR/RLB. The analytical sensitivity of PCR/RLB was found to be 1.8 × 10(-3) ng/μl by 10-fold serial dilution of Aspergillus genomic DNA. The assay identified 35 of 41 (85.4%) clinical specimens, exhibiting a higher sensitivity than fungal culture (22 of 41; 53.7%) and direct sequencing (18 of 41; 43.9%). PCR/RLB similarly showed high specificity, with correct identification 16 of 18 specimens detected by internal transcribed spacer (ITS) sequencing and 16 of 22 detected by fungal culture, but it also has the additional advantage of being able to detect mixed infection in a single clinical specimen. The PCR/RLB assay thus provides a rapid and reliable option for laboratory diagnosis of fungal rhinosinusitis.
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Mikulska M, Calandra T, Sanguinetti M, Poulain D, Viscoli C. The use of mannan antigen and anti-mannan antibodies in the diagnosis of invasive candidiasis: recommendations from the Third European Conference on Infections in Leukemia. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:R222. [PMID: 21143834 PMCID: PMC3219989 DOI: 10.1186/cc9365] [Citation(s) in RCA: 216] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 11/02/2010] [Accepted: 12/08/2010] [Indexed: 12/16/2022]
Abstract
Introduction Timely diagnosis of invasive candidiasis (IC) remains difficult as the clinical presentation is not specific and blood cultures lack sensitivity and need a long incubation time. Thus, non-culture-based methods for diagnosing IC have been developed. Mannan antigen (Mn) and anti-mannan antibodies (A-Mn) are present in patients with IC. On behalf of the Third European Conference on Infections in Leukemia, the performance of these tests was analysed and reviewed. Methods The literature was searched for studies using the commercially available sandwich enzyme-linked immunosorbent assays (Platelia™, Bio-Rad Laboratories, Marnes-la-Coquette, France) for detecting Mn and A-Mn in serum. The target condition of this review was IC defined according to 2008 European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. Sensitivity, specificity and diagnostic odds ratios (DOR) were calculated for Mn, A-Mn and combined Mn/A-Mn testing. Results Overall, 14 studies that comprised 453 patients and 767 controls were reviewed. The patient populations included in the studies were mainly haematological and cancer cases in seven studies and mainly intensive care unit and surgery cases in the other seven studies. All studies but one were retrospective in design. Mn sensitivity was 58% (95% confidence interval [CI], 53-62); specificity, 93% (95% CI, 91-94) and DOR, 18 (95% CI 12-28). A-Mn sensitivity was 59% (95% CI, 54-65); specificity, 83% (95% CI, 79-97) and DOR, 12 (95% CI 7-21). Combined Mn/A-Mn sensitivity was 83% (95% CI, 79-87); specificity, 86% (95% CI, 82-90) and DOR, 58 (95% CI 27-122). Significant heterogeneity of the studies was detected. The sensitivity of both Mn and A-Mn varied for different Candida species, and it was the highest for C. albicans, followed by C. glabrata and C. tropicalis. In 73% of 45 patients with candidemia, at least one of the serological tests was positive before the culture results, with mean time advantage being 6 days for Mn and 7 days for A-Mn. In 21 patients with hepatosplenic IC, 18 (86%) had Mn or A-Mn positive test results at a median of 16 days before radiological detection of liver or spleen lesions. Conclusions Mn and A-Mn are useful for diagnosis of IC. The performance of combined Mn/A-Mn testing is superior to either Mn or A-Mn testing.
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Affiliation(s)
- Malgorzata Mikulska
- Division of Infectious Diseases, San Martino University Hospital, L,go R, Benzi, 10, Genoa, Italy.
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Ostrosky-Zeichner L, Kullberg BJ, Bow EJ, Hadley S, León C, Nucci M, Patterson TF, Perfect JR. Early treatment of candidemia in adults: a review. Med Mycol 2010; 49:113-20. [PMID: 20818922 DOI: 10.3109/13693786.2010.512300] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Invasive candidiasis is associated with high mortality, particularly in adults. Retrospective studies show that shorter times to treatment are correlated with a lower risk of death. A number of factors can be used to predict which patients would benefit from antifungal prophylaxis or early (pre-emptive or empirical) therapy. Detection of the fungal cell wall component (1→3)-β-D-glucan (BDG) shows promise as an early biomarker of invasive fungal infection and may be useful in identifying patients who would benefit from early antifungal treatment. To date, no consistent early treatment strategy has evolved. Proof-of-concept studies are needed to assess the role of pre-emptive and empirical therapy in ICU patients and the relevance of BDG as an early marker of infection.
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Krishnan S, Ostrosky-Zeichner L. Invasive candidiasis in the intensive care unit. Hosp Pract (1995) 2010; 38:82-91. [PMID: 20469617 DOI: 10.3810/hp.2010.04.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Invasive fungal disease by Candida spp. is on the rise in the modem era of prolonged patient survival by virtue of improved critical care measures, novel chemotherapy regimens, and increasing immunosuppression following organ transplants. Invasive candidiasis (IC) in the setting of an intensive care unit results in prolonged hospital stay and increased morbidity. Clinical suspicion plays a major role in the diagnosis of IC, as current laboratory methods are not very sensitive. Various serum markers and molecular techniques are under development to improve diagnostic strategies. Treatment options involve an expanding spectrum of antifungals. Knowledge of local epidemiology and the risk factors that predispose patients to this disease are essential for effective patient care in an intensive care setting.
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Affiliation(s)
- Sujatha Krishnan
- Division of Infectious Diseases, University of Texas Medical School at Houston, Houston, TX, USA.
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Zilberberg MD, Kollef MH, Arnold H, Labelle A, Micek ST, Kothari S, Shorr AF. Inappropriate empiric antifungal therapy for candidemia in the ICU and hospital resource utilization: a retrospective cohort study. BMC Infect Dis 2010; 10:150. [PMID: 20525301 PMCID: PMC2890008 DOI: 10.1186/1471-2334-10-150] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Accepted: 06/03/2010] [Indexed: 11/15/2022] Open
Abstract
Background Candida represents the most common cause of invasive fungal disease, and candidal blood stream infections (CBSI) are prevalent in the ICU. Inappropriate antifungal therapy (IAT) is known to increase a patient's risk for death. We hypothesized that in an ICU cohort it would also adversely affect resource utilization. Methods We retrospectively identified all patients with candidemia on or before hospital day 14 and requiring an ICU stay at Barnes-Jewish Hospital between 2004 and 2007. Hospital length of stay following culture-proven onset of CBSI (post-CBSI HLOS) was primary and hospital costs secondary endpoints. IAT was defined as treatment delay of ≥24 hours from candidemia onset or inadequate dose of antifungal agent active against the pathogen. We developed generalized linear models (GLM) to assess independent impact of inappropriate therapy on LOS and costs. Results Ninety patients met inclusion criteria. IAT was frequent (88.9%). In the IAT group antifungal delay ≥24 hours occurred in 95.0% and inappropriate dosage in 26.3%. Unadjusted hospital mortality was greater among IAT (28.8%) than non-IAT (0%) patients, p = 0.059. Both crude post-CBSI HLOS (18.4 ± 17.0 vs. 10.7 ± 9.4, p = 0.062) and total costs ($66,584 ± $49,120 vs. $33,526 ± $27,244, p = 0.006) were higher in IAT than in non-IAT. In GLMs adjusting for confounders IAT-attributable excess post-CBSI HLOS was 7.7 days (95% CI 0.6-13.5) and attributable total costs were $13,398 (95% CI $1,060-$26,736). Conclusions IAT of CBSI, such as delays and incorrect dosing, occurs commonly. In addition to its adverse impact on clinical outcomes, IAT results in substantial prolongation of hospital LOS and increase in hospital costs. Efforts to enhance rates of appropriate therapy for candidemia may improve resource use.
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Ha JF, Italiano CM, Heath CH, Shih S, Rea S, Wood FM. Candidemia and invasive candidiasis: a review of the literature for the burns surgeon. Burns 2010; 37:181-95. [PMID: 20395056 DOI: 10.1016/j.burns.2010.01.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Revised: 12/05/2009] [Accepted: 01/06/2010] [Indexed: 10/19/2022]
Abstract
Advances in critical care, operative techniques, early fluid resuscitation, antimicrobials to control bacterial infections, nutritional support to manage the hypermetabolic response and early wound excision and coverage has improved survival rates in major burns patients. These advances in management have been associated with increased recognition of invasive infections caused by Candida species in critically ill burns patients. Candida albicans is the most common species to cause invasive Candida infections, however, non-albicans Candida species appear to becoming more frequent. These later species may be less fluconazole susceptible than Candida albicans. High crude and attributable mortality rates from invasive Candida sepsis are multi-factorial. Diagnosis of invasive candidiasis and candidemia remains difficult. Prophylactic and pre-emptive therapies appear promising strategies, but there is no specific approach which is well-studied and clearly efficacious in high-risk burns patients. Treatment options for invasive candidiasis include several amphotericin B formulations and newer less toxic antifungal agents, such as azoles and echinocandins. We review the currently available data on diagnostic and management strategies for invasive candidiasis and candidemia; whenever possible providing reference to the high-risk burn patients. We also present an algorithm for the management of candidemia and invasive candidiasis in burn patients.
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Affiliation(s)
- Jennifer F Ha
- Telstra Burns Unit, Department of Plastic Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
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Abstract
Invasive candidiasis has emerged as an important cause of morbidity and mortality in intensive care unit patients. This short review focuses on many aspects of Candida infection in critically ill patients including epidemiology, impact on mortality, problems related to diagnosis, strategies to identify patients at risk of developing fungal infections, role of prophylaxis and pre-emptive strategies, empiric treatment and the role of different classes of antifungal drugs. New antifungal agents, specifically new azoles and echinocandins are discussed.
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Affiliation(s)
- Mariano Pennisi
- Institute of Intensive Care and Anaesthesiology, University A. Gemelli General Hospital, Rome, Italy
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Abstract
PURPOSE OF REVIEW Antifungal drug resistance is a confounding factor that negatively impacts clinical outcome for patients with serious mycoses. Early detection of fungi in blood or other specimens with a rapid assessment of drug susceptibility could improve the survival of patients with invasive disease by accelerating the initiation of appropriate antifungal treatment. Recent years have seen the growth of molecular technology that is ideally suited for fungal identification and assessment of drug resistance mechanisms. RECENT FINDINGS Elucidation of the genetic mechanisms responsible for triazole and echinocandin resistance in prominent Candida spp. and Aspergillus spp. provides an opportunity to develop molecular diagnostic platforms suitable for rapid detection of primary and secondary drug resistance. Several highly dynamic and robust amplification/detection methodologies are now available that can provide simultaneous species identification and high fidelity discrimination of resistance alleles. SUMMARY Molecular diagnostic platforms are ideal for rapid detection of fungal pathogens and they provide an opportunity to develop in parallel molecular assays that can evaluate antifungal drug resistance.
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Ellis M, Al-Ramadi B, Bernsen R, Kristensen J, Alizadeh H, Hedstrom U. Prospective evaluation of mannan and anti-mannan antibodies for diagnosis of invasive Candida infections in patients with neutropenic fever. J Med Microbiol 2009; 58:606-615. [PMID: 19369522 DOI: 10.1099/jmm.0.006452-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The diagnostic performance and usefulness of the Platelia antigen and antibody test (Bio-Rad) was investigated in a prospective study of haematological patients at risk for invasive Candida infections. Among 100 patients, 86 were eligible, of whom invasive candidiasis (IC) occurred in 12 (14%), according to the criteria of the European Organization for Research and Treatment of Cancer/Mycoses Study Group. These included candidaemia due to Candida albicans (one patient) or Candida tropicalis (four patients), and hepatosplenic candidiasis (seven patients). The comparator group of 74 patients included 50 with febrile neutropenia alone and 24 with mould infections. A strategy was developed to determine diagnostic cut-offs from receiver operating characteristic curves with maximal sensitivity and, given this sensitivity, maximal specificity, both being greater than 0. In this patient population, these values were 0.25 ng ml(-1) for mannan (M) and 2.6 arbitrary units ml(-1) for anti-mannan (AM), which are lower than those recommended by the manufacturer. All patients developed at least one positive diagnostic M or AM result during the 10 days of persistent febrile neutropenia (PFN). The optimal overall performance was found when two consecutive positive tests for both M and AM were used [sensitivity, specificity, positive predictive value and negative predictive value (NPV) (95 % confidence intervals) of 0.73 (0.39-0.94), 0.80 (0.69-0.89), 0.36 (0.17-0.59) and 0.95 (0.86-0.99), respectively]. There was a positive correlation of M with beta-D-glucan (r=0.28, P=0.01). The first positive M test was found up to a mean+/-sd of 8.8+/-8.5 (range 2-23) days prior to a clinical/mycological diagnosis of IC. Day-to-day variation in quantitative M levels was high. High-level AM responses were delayed until leucopenia resolved. The low specificities of the test performance may have been due to some of the comparator patients having subclinical Candida infections as evidenced by the high incidence of colonization among them (60% had a colonization index of >or=0.5). The high NPVs suggest that the tests may be particularly useful in excluding IC. It is feasible to explore the use of serial measurements of M and AM as part of a broader diagnostic strategy for selecting PFN patients to receive antifungal drug therapy.
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Affiliation(s)
- Michael Ellis
- Department of Medicine, Faculty of Medicine and Health Sciences, UAE University, Al-Ain, UAE
| | - Basel Al-Ramadi
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, UAE University, Al-Ain, UAE
| | - Roos Bernsen
- Department of Community Medicine, Faculty of Medicine and Health Sciences, UAE University, Al-Ain, UAE
| | | | | | - Ulla Hedstrom
- Department of Medicine, Al-Ain Hospital, Al-Ain, UAE
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Arancia S, Sandini S, Cassone A, De Bernardis F. Use of 65-kDa mannoprotein gene primers for real-time identification of Candida albicans. CURRENT FUNGAL INFECTION REPORTS 2008. [DOI: 10.1007/s12281-008-0031-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Miyasaka NRS, Unterkircher CS, Shimizu MT. Catalase activity of different Candida species after exposition to specific antiserum. Braz J Microbiol 2008; 39:35-9. [PMID: 24031174 PMCID: PMC3768363 DOI: 10.1590/s1517-83822008000100009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Revised: 09/22/2007] [Accepted: 01/23/2008] [Indexed: 11/22/2022] Open
Abstract
Antisera were developed in rabbits after challenge with intracellular antigens of Candida albicans, C. tropicalis and C. parapsilosis. Microorganism catalase has been correlated with virulence, resistance to drugs and immunogenicity. The intracellular catalase is consistently present in strains of Candida and in this paper, the enzyme activity was analysed by PAGE after exposition to antisera. The catalases of C. albicans, C. parapsilosis and C. tropicalis were immunogenic and differed in their binding to specific antibodies raised in rabbits. Tests of cross-reactivity between different Candida species showed that when antiserum from C. albicans immunized rabbit was incubated with intracellular extracts of these three Candida species, the catalases activities were abolished. However, the antisera from C. parapsilosis or C. tropicalis immunized rabbits did not affect the catalase activity of C. albicans; the enzyme of C. albicans was inactivated only by the antiserum to the catalase of own C. albicans. The antiserum to the catalase of C. tropicalis was species-specific and did not cross-react with catalases of C. albicans and C. parapsilosis. The activities of Aspergillus niger and bovine catalases were not affected by the antiserum from any Candida immunized rabbits. This report is a preliminary study of specific antisera that react against intracellular catalase of Candida sp. and neutralize the enzymatic activity. Further study is necessary to develop species-specific antibody once differences in the susceptibility of the Candida species to commonly used antifungal drugs make identification to the species level important.
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Affiliation(s)
- Natália R S Miyasaka
- Instituto de Ciências Biomédicas, Universidade de São Paulo, Departamento de Microbiologia , São Paulo, SP , Brasil ; Universidade São Francisco, Departamento de Microbiologia e Imunologia , Bragança Paulista, SP , Brasil
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Méan M, Marchetti O, Calandra T. Bench-to-bedside review: Candida infections in the intensive care unit. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 12:204. [PMID: 18279532 PMCID: PMC2374590 DOI: 10.1186/cc6212] [Citation(s) in RCA: 153] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Invasive mycoses are life-threatening opportunistic infections and have emerged as a major cause of morbidity and mortality in critically ill patients. This review focuses on recent advances in our understanding of the epidemiology, diagnosis and management of invasive candidiasis, which is the predominant fungal infection in the intensive care unit setting. Candida spp. are the fourth most common cause of bloodstream infections in the USA, but they are a much less common cause of bloodstream infections in Europe. About one-third of episodes of candidaemia occur in the intensive care unit. Until recently, Candida albicans was by far the predominant species, causing up to two-thirds of all cases of invasive candidiasis. However, a shift toward non-albicans Candida spp., such as C. glabrata and C. krusei, with reduced susceptibility to commonly used antifungal agents, was recently observed. Unfortunately, risk factors and clinical manifestations of candidiasis are not specific, and conventional culture methods such as blood culture systems lack sensitivity. Recent studies have shown that detection of circulating β-glucan, mannan and antimannan antibodies may contribute to diagnosis of invasive candidiasis. Early initiation of appropriate antifungal therapy is essential for reducing the morbidity and mortality of invasive fungal infections. For decades, amphotericin B deoxycholate has been the standard therapy, but it is often poorly tolerated and associated with infusion-related acute reactions and nephrotoxicity. Azoles such as fluconazole and itraconazole provided the first treatment alternatives to amphotericin B for candidiasis. In recent years, several new antifungal agents have become available, offering additional therapeutic options for the management of Candida infections. These include lipid formulations of amphotericin B, new azoles (voriconazole and posaconazole) and echinocandins (caspofungin, micafungin and anidulafungin).
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Affiliation(s)
- Marie Méan
- Infectious Diseases Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
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Fungal infection in patients with serpiginous choroiditis or acute zonal occult outer retinopathy. J Clin Microbiol 2007; 46:130-5. [PMID: 18003800 DOI: 10.1128/jcm.02605-06] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The etiologies of a number of retinopathies, including serpiginous choroiditis and acute zonal occult outer retinopathy (AZOOR), remain uncertain. Recently, we provided evidence that AZOOR is caused by Candida famata infection. The purpose of this article was to investigate the presence of fungal infection in five patients affected with serpiginous choroiditis and five patients with diagnosis of AZOOR. To assess the presence of fungal infection the presence of antibodies in human serum samples against C. famata, C. albicans, C. parapsilosis, C. glabrata and C. krusei was analyzed. In addition, quantitative PCR was carried out to detect fungal genomes in whole blood. Finally, the presence of fungal antigens in the serum samples of patients was investigated. Three AZOOR patients presented high antibody titers against Candida spp., while antibodies against Candida spp. were observed in serum samples from four patients with serpiginous choroiditis. Fungal genomes in peripheral blood were evidenced in serum samples from one AZOOR and four serpiginous choroiditis patients. Fungal antigens were also apparent in the serum of different patients. Our findings indicate that there was evidence of disseminated fungal infection in most patients examined.
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Hata DJ, Hall L, Fothergill AW, Larone DH, Wengenack NL. Multicenter evaluation of the new VITEK 2 advanced colorimetric yeast identification card. J Clin Microbiol 2007; 45:1087-92. [PMID: 17267631 PMCID: PMC1865816 DOI: 10.1128/jcm.01754-06] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The performance of the new VITEK 2 Advanced Colorimetry yeast identification (YST) card for use with the VITEK 2 system (bioMérieux, Inc., Hazelwood, MO) was compared to that of the API 20C AUX (API) system (bioMérieux SA, Marcy-l'Etoile, France) in a multicenter evaluation. A total of 12 quality control, 64 challenge, and 623 clinical yeast isolates were used in the study. Comparisons of species identification, platform reliability, and substrate reproducibility were made between YST and API, with API considered the reference standard. Quality control testing to assess system and substrate reproducibility matched expected results >/=95% of the time. The YST card correctly identified 100% of the challenge strains, which covered the species range of the manufacturer's performance claims. Using clinical isolates, the YST card correctly identified 98.5%, with 1.0% of isolates incorrectly identified and 0.5% unidentified. Among clinical isolates, the YST card generated fewer low-discrimination results (18.9%) than did API (30.0%). The time to identification with YST was 18 h, compared to 48 to 72 h with API. The colorimetric YST card used with the VITEK 2 provides a highly automated, objective yeast identification method with excellent performance and reproducibility. We found this system useful for timely and accurate identification of significant yeast species in the clinical microbiology laboratory.
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Affiliation(s)
- D Jane Hata
- Division of Clinical Microbiology, Mayo Clinic, 200 1st St., S.W., Rochester, MN 55905, USA.
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Uno K, Sugiura S, Konishi M, Yasuda Y, Mikasa K, Kita E. Evaluation of diagnostic methods for Candida albicans translocation in a mouse model: seminested polymerase chain reaction, blood culture, and serological assays. J Infect Chemother 2007; 13:196-203. [PMID: 17721680 DOI: 10.1007/s10156-007-0536-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2007] [Accepted: 05/14/2007] [Indexed: 10/22/2022]
Abstract
For the rapid diagnosis of systemic Candida infection, we compared the performance of an established seminested polymerase chain reaction (snPCR), serological tests for (1 --> 3)-beta-D-glucan assay and Candida mannan antigen assay, and blood culture in our murine model for Candida albicans translocation. In this mouse model, C. albicans disseminated to the liver from the intestine after day 6.5; the snPCR and blood culture results became positive from days 8 to 8.5 in about 60% of infected mice with culture-proven translocation, and in 100% on day 9. Both (1 --> 3)-beta-D-glucan and Candida mannan antigen were elevated in the serum as early as day 6.5 of infection, though they did not identify Candida species. Because the established snPCR can differentiate four clinically important Candida species and conventional microbiological methods require at least 48 h to identify Candida species in blood samples, the snPCR assay is advantageous for rapidly identifying Candida species in the blood. Therefore, the combination of the serological assays and the snPCR seems to be valuable for the early diagnosis of systemic C. albicans infection.
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Affiliation(s)
- Kenji Uno
- Center for Infectious Diseases, Nara Medical University School of Medicine, Kashihara, Nara 634-8521, Japan.
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Playford EG, Kong F, Sun Y, Wang H, Halliday C, Sorrell TC. Simultaneous detection and identification of Candida, Aspergillus, and Cryptococcus species by reverse line blot hybridization. J Clin Microbiol 2006; 44:876-80. [PMID: 16517870 PMCID: PMC1393088 DOI: 10.1128/jcm.44.3.876-880.2006] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report on a reverse line blot (RLB) assay, utilizing fungal species-specific oligonucleotide probes to hybridize with internal transcribed spacer 2 region sequences amplified using a nested panfungal PCR. Reference and clinical strains of 16 Candida species (116 strains), Cryptococcus neoformans (five strains of Cryptococcus neoformans var. neoformans, five strains of Cryptococcus neoformans var. grubii, and six strains of Cryptococcus gatti), and five Aspergillus species (68 strains) were all correctly identified by the RLB assay. Additional fungal species (16 species and 26 strains) not represented on the assay did not exhibit cross-hybridization with the oligonucleotide probes. In simulated clinical specimens, the sensitivity of the assay for Candida spp. and Aspergillus spp. was 10(0.5) cells/ml and 10(2) conidia/ml, respectively. This assay allows sensitive and specific simultaneous detection and identification of a broad range of fungal pathogens.
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Affiliation(s)
- E Geoffrey Playford
- Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, New South Wales, Australia.
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Arancia S, Carattoli A, La Valle R, Cassone A, De Bernardis F. Use of 65 kDa mannoprotein gene primers in Real Time PCR identification of Candida albicans in biological samples. Mol Cell Probes 2006; 20:263-8. [PMID: 16616453 DOI: 10.1016/j.mcp.2006.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2005] [Accepted: 01/31/2006] [Indexed: 10/25/2022]
Abstract
A method for the detection and quantification of Candida albicans in biological samples (blood, urine and serum) was developed with the use of Real-Time PCR utilizing CaMP65-specific primers. Two different systems were used for the detection in the LightCycler platform (Roche): the SYBR green fluorescent dye with melting peak analysis and the 5'nuclease fluorescent-probe detection. The amplification was highly specific for C. albicans, providing no cross-reaction on genomic DNA extracted from other Candida species or Aspergillus. The sensitivity in simulated biological samples was especially high (1 genome) when applied to sera and urine, and in blood samples the limit of detection was higher by ten-fold. Finally, the real-time PCR was employed in order to detect and quantify C. albicans in the sera from patients with invasive candidiasis.
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Affiliation(s)
- Silvia Arancia
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
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Pitarch A, Jiménez A, Nombela C, Gil C. Decoding Serological Response to Candida Cell Wall Immunome into Novel Diagnostic, Prognostic, and Therapeutic Candidates for Systemic Candidiasis by Proteomic and Bioinformatic Analyses. Mol Cell Proteomics 2006; 5:79-96. [PMID: 16195222 DOI: 10.1074/mcp.m500243-mcp200] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
In an effort to bring novel diagnostic and prognostic biomarkers or even potential targets for vaccine design for systemic candidiasis (SC) into the open, a systematic proteomic approach coupled with bioinformatic analysis was used to decode the serological response to Candida wall immunome in SC patients. Serum levels of IgG antibodies against Candida wall-associated proteins (proteins secreted from protoplasts in active wall regeneration, separated by two-dimensional gel electrophoresis, and identified by mass spectrometry) were measured in 45 SC patients, 57 non-SC patients, and 61 healthy subjects by Western blotting. Two-way hierarchical clustering and principal component analysis of their serum anti-Candida wall antibody expression patterns discriminated SC patients from controls and highlighted the heterogeneity of their expression profiles. Multivariate logistic regression models demonstrated that high levels of antibodies against glucan 1,3-beta-glucosidase (Bgl2p) and the anti-wall phosphoglycerate kinase antibody seropositivity were the only independent predictors of SC. Receiver operating characteristic curve analysis revealed no difference between their combined evaluation and measurement of anti-Bgl2p antibodies alone. In a logistic regression model adjusted for known prognostic factors for mortality, SC patients with high anti-Bgl2p antibody levels or a positive anti-wall enolase antibody status, which correlated with each other, had a reduced 2-month risk of death. After controlling for each other, only the seropositivity for anti-wall enolase antibodies was an independent predictor of a lower risk of fatality, supporting that these mediated the protective effect. No association between serum anti-cytoplasmic enolase antibody levels and outcomes was established, suggesting a specific mechanism of enolase processing during wall biogenesis. We conclude that serum anti-Bgl2p antibodies are a novel accurate diagnostic biomarker for SC and that, at high levels, they may provide protection by modulating the anti-wall enolase antibody response. Furthermore serum anti-wall enolase antibodies are a new prognostic indicator for SC and confer protection against it. Bgl2p and wall-associated enolase could be valuable candidates for future vaccine development.
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MESH Headings
- Aged
- Antibodies, Fungal/blood
- Antigens, Fungal/immunology
- Candida albicans/immunology
- Candidiasis/immunology
- Candidiasis/therapy
- Case-Control Studies
- Cell Wall/immunology
- Computational Biology
- Databases, Protein
- Electrophoresis, Gel, Two-Dimensional
- Female
- Fungal Proteins/immunology
- Glucan 1,3-beta-Glucosidase/immunology
- Humans
- Immunoglobulin G/blood
- Male
- Phosphopyruvate Hydratase/immunology
- Proteomics
- Sensitivity and Specificity
- Spectrometry, Mass, Electrospray Ionization
- Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization
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Affiliation(s)
- Aida Pitarch
- Department of Microbiology II, Faculty of Pharmacy, Complutense University of Madrid, 28040 Madrid, Spain
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35
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Brown MR, Thompson CA, Mohamed FM. Systemic candidiasis in an apparently immunocompetent dog. J Vet Diagn Invest 2005; 17:272-6. [PMID: 15945387 DOI: 10.1177/104063870501700312] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Members of the family Candida spp. are ubiquitous dimorphic fungi that normally inhabit the alimentary, upper respiratory, and genital mucosae of mammals. Cell-mediated immunity appears to be an important limitation to the pathologic spread of these fungi. Prolonged immunosuppression, cytotoxic chemotherapy causing neutropenia, diabetes mellitus, long-term glucocorticoid therapy, and prolonged antimicrobial therapy have resulted in an increased incidence of both localized and disseminated candidiasis. This report describes a systemic Candida spp. infection in a dog with no obvious underlying deficiency in host resistance. Cytopathology, histopathology, transmission electron microscopy, and immunohistochemical staining were used to determine the etiology of the causative agent.
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Affiliation(s)
- M Raquel Brown
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, Texas A&M University, College Station, TX 77843-4474, USA
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36
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Arancia S, Sandini S, Cassone A, De Bernardis F, La Valle R. Construction and use of PCR primers from a 65 kDa mannoprotein gene for identification of C. albicans. Mol Cell Probes 2004; 18:171-5. [PMID: 15135451 DOI: 10.1016/j.mcp.2003.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2003] [Accepted: 11/24/2003] [Indexed: 10/26/2022]
Abstract
A method for detection of Candida albicans in biological samples (blood, serum, urine) was developed by the use of polymerase chain reaction (PCR) amplification of a DNA fragment of a gene coding for a 65 kDa mannoprotein of C. albicans (CaMP65). The PCR amplifies a 220 bp fragments whose specificity for C. albicans was demonstrated by Southern blot with a non-radioactive probe, leading to the differentiation from all other yeast species or human and bacterial DNA. The sensitivity of this assay was 5-10 C. albicans cells per milliliter of biological sample.
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Affiliation(s)
- S Arancia
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy.
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37
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López-Ribot JL, Casanova M, Murgui A, Martínez JP. Antibody response toCandida albicanscell wall antigens. ACTA ACUST UNITED AC 2004; 41:187-96. [PMID: 15196567 DOI: 10.1016/j.femsim.2004.03.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2003] [Revised: 03/25/2004] [Accepted: 03/25/2004] [Indexed: 11/22/2022]
Abstract
The cell wall of Candida albicans is not only the structure where many essential biological functions reside but is also a significant source of candidal antigens. The major cell wall components that elicit a response from the host immune system are proteins and glycoproteins, the latter being predominantly mannoproteins. Both carbohydrate and protein moieties are able to trigger immune responses. Proteins and glycoproteins exposed at the most external layers of the wall structure are involved in several types of interactions of fungal cells with the exocellular environment. Thus, coating of fungal cells with host antibodies has the potential to profoundly influence the host-parasite interaction by affecting antibody-mediated functions such as opsonin-enhanced phagocytosis and blocking the binding activity of fungal adhesins to host ligands. In this review we examine various members of the protein and glycoprotein fraction of the C. albicans cell wall that elicit an antibody response in vivo. Some of the studies demonstrate that certain cell wall antigens and anti-cell wall antibodies may be the basis for developing specific and sensitive serologic tests for the diagnosis of candidiasis, particularly the disseminated form. In addition, recent studies have focused on the potential of antibodies against the cell wall protein determinants in protecting the host against infection. Hence, a better understanding of the humoral response triggered by the cell wall antigens of C. albicans may provide the basis for the development of (i) effective procedures for the serodiagnosis of disseminated candidiasis, and (ii) novel prophylactic (vaccination) and therapeutic strategies to control this type of infections.
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Affiliation(s)
- José L López-Ribot
- Department of Medicine, Division of Infectious Diseases, The University of Texas Health Sciences Center, San Antonio, USA
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38
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Girmenia C, Martino P, De Bernardis F, Boccanera M, Cassone A. Lack of circulating Candida mannoprotein antigen in patients with focal hepatosplenic candidiasis. J Med Microbiol 2004; 53:103-106. [PMID: 14729929 DOI: 10.1099/jmm.0.05297-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The significance of Candida mannoprotein serum detection in 15 patients with haematological malignancies and proven (six cases) or probable (nine cases) hepatosplenic candidiasis was retrospectively evaluated. Circulating mannoprotein antigen was detected in three of six and in one of two serum samples from two patients with probable infection. The antigen was not detected in 38 serum samples of 13 (87 %) patients. Thus, in contrast to other deep-seated Candida infections, mannoprotein is infrequently detectable during focal hepatosplenic candidiasis and does not appear to be of diagnostic value.
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Affiliation(s)
- Corrado Girmenia
- Dipartimento di Biotecnologie Cellulari ed Ematologia, University 'La Sapienza', Via Benevento 6, 00161 Rome, Italy 2Dipartimento di Batteriologia e Micologia Medica, Istituto Superiore di Sanita, Viale Regina Elena 299, 00161 Rome, Italy
| | - Pietro Martino
- Dipartimento di Biotecnologie Cellulari ed Ematologia, University 'La Sapienza', Via Benevento 6, 00161 Rome, Italy 2Dipartimento di Batteriologia e Micologia Medica, Istituto Superiore di Sanita, Viale Regina Elena 299, 00161 Rome, Italy
| | - Flavia De Bernardis
- Dipartimento di Biotecnologie Cellulari ed Ematologia, University 'La Sapienza', Via Benevento 6, 00161 Rome, Italy 2Dipartimento di Batteriologia e Micologia Medica, Istituto Superiore di Sanita, Viale Regina Elena 299, 00161 Rome, Italy
| | - Maria Boccanera
- Dipartimento di Biotecnologie Cellulari ed Ematologia, University 'La Sapienza', Via Benevento 6, 00161 Rome, Italy 2Dipartimento di Batteriologia e Micologia Medica, Istituto Superiore di Sanita, Viale Regina Elena 299, 00161 Rome, Italy
| | - Antonio Cassone
- Dipartimento di Biotecnologie Cellulari ed Ematologia, University 'La Sapienza', Via Benevento 6, 00161 Rome, Italy 2Dipartimento di Batteriologia e Micologia Medica, Istituto Superiore di Sanita, Viale Regina Elena 299, 00161 Rome, Italy
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39
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Morrison CJ, Hurst SF, Reiss E. Competitive binding inhibition enzyme-linked immunosorbent assay that uses the secreted aspartyl proteinase of Candida albicans as an antigenic marker for diagnosis of disseminated candidiasis. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 2003; 10:835-48. [PMID: 12965914 PMCID: PMC193877 DOI: 10.1128/cdli.10.5.835-848.2003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2003] [Revised: 03/18/2003] [Accepted: 06/23/2003] [Indexed: 11/20/2022]
Abstract
The secreted aspartyl proteinases (Saps) of Candida albicans have been implicated as virulence factors associated with adherence and tissue invasion. The potential use of proteinases as markers of invasive candidiasis led us to develop a competitive binding inhibition enzyme-linked immunosorbent assay (ELISA) to detect Sap in clinical specimens. Daily serum and urine specimens were collected from rabbits that had been immunosuppressed with cyclophosphamide and cortisone acetate and infected intravenously with 10(7) C. albicans blastoconidia. Disseminated infection was confirmed by organ culture and histopathology. Although ELISA inhibition was observed when serum specimens from these rabbits were used, more significant inhibition, which correlated with disease progression, occurred when urine specimens were used. Urine collected as early as 1 day after infection resulted in significant ELISA inhibition (mean inhibition +/- standard error [SE] compared with preinfection control urine, 15.7% +/- 2.7% [P < 0.01]), and inhibition increased on days 2 through 5 (29.4% +/- 4.8% to 44.5% +/- 3.5% [P < 0.001]). Urine specimens from immunosuppressed rabbits infected intravenously with Candida tropicalis, Candida parapsilosis, Candida krusei, Cryptococcus neoformans, Aspergillus fumigatus, or Staphylococcus aureus were negative in the assay despite culture-proven dissemination. Nonimmunosuppressed rabbits receiving oral tetracycline and gentamicin treatment were given 2 x 10(8) C. albicans blastoconidia orally or intraurethrally to establish colonization of the gastrointestinal tract or bladder, respectively, without systemic dissemination; urine specimens from these rabbits also gave negative ELISA results. Dissemination to the kidney and spleen occurred in one rabbit challenged by intragastric inoculation, and urine from this rabbit demonstrated significant inhibition in the ELISA (mean inhibition +/- SE by day 3 after infection, 32.9% +/- 2.7% [P < 0.001]). The overall test sensitivity was 83%, the specificity was 92%, the positive predictive value was 84%, the negative predictive value was 91%, and the efficiency was 89% (166 urine samples from 33 rabbits tested). The specificity, positive predictive value, and efficiency could be increased to 97, 95, and 92%, respectively, if at least two positive test results were required for a true positive designation. The ELISA was sensitive and specific for the detection of Sap in urine specimens from rabbits with disseminated C. albicans infection, discriminated between colonization and invasive disease, reflected disease progression and severity, and has the potential to be a noninvasive means to diagnose disseminated candidiasis.
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Affiliation(s)
- Christine J Morrison
- Mycotic Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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40
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41
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Rimek D, Singh J, Kappe R. Cross-reactivity of the PLATELIA CANDIDA antigen detection enzyme immunoassay with fungal antigen extracts. J Clin Microbiol 2003; 41:3395-8. [PMID: 12843102 PMCID: PMC165363 DOI: 10.1128/jcm.41.7.3395-3398.2003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We studied the specificity of the PLATELIA CANDIDA Ag enzyme immunoassay by using 130 isolates of 63 clinically relevant fungal species. Antigen extracts of seven Candida spp. (Candida albicans, C. dubliniensis, C. famata, C. glabrata, C. guilliermondii, C. lusitaniae, and C. tropicalis) repeatedly yielded positive reactions (>0.5 ng/ml). Geotrichum candidum and Fusarium verticillioides were found to yield borderline-positive reactions (0.25 to 0.50 ng/ml). Antigen preparations from the other 54 fungal species, including yeasts, molds, dermatophytes, and dimorphic fungi, did not cross-react in the assay.
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Affiliation(s)
- Dagmar Rimek
- Department of Medical Microbiology and Hospital Hygiene, University Hospital, D-18057 Rostock, Germany.
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42
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Nichterlein T, Buchheidt D, Hein A, Becker KP, Mosbach K, Kretschmar M. Comparison of glucan detection and galactomannan enzyme immunoassay in gastrointestinal and systemic murine candidiasis. Diagn Microbiol Infect Dis 2003; 46:103-8. [PMID: 12854511 DOI: 10.1016/s0732-8893(03)00038-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Mouse models of systemic and gastrointestinal infection with the yeast Candida albicans were used to investigate the ability of a commercial mannan antigen enzyme immunoassay and a commercial (1-->3) beta-D-glucan limulus assay to detect systemic infection and to differentiate between colonization and infection. Both assays were positive in all i.v. infected mice and negative in all uninfected control mice. In gastrointestinal infection both tests were positive whenever organ cultures were positive. In colonized mice with no detectable dissemination, there were mostly negative results with the glucan assay whereas the mannan assay was positive or intermediate in all colonized mice. Therefore, in the mouse model used, glucan detection appeared to be superior for differentiation between colonization and dissemination.
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Affiliation(s)
- Thomas Nichterlein
- Institut für Medizinische Mikrobiologie und Hygiene, Klinikum Mannheim, D-68167 Mannheim, Germany
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43
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White PL, Shetty A, Barnes RA. Detection of seven Candida species using the Light-Cycler system. J Med Microbiol 2003; 52:229-238. [PMID: 12621088 DOI: 10.1099/jmm.0.05049-0] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Due to the limitations of classical methods for the detection of systemic fungal infections and the high mortality rates associated with these infections, it has become essential to develop a quick, sensitive and specific detection assay. By using the Idaho Technologies Light-Cycler system, a qualitative real-time PCR system has been developed for the detection of the leading causes of systemic infection within the genus Candida. The sensitivity of the assay was comparable to previously described PCR methods (1-5 c.f.u. ml(-1)) and, by the use of a single Candida probe, it was able to detect, but not differentiate between, seven species of Candida (Candida albicans, Candida dubliniensis, Candida glabrata, Candida kefyr, Candida krusei, Candida parapsilosis and Candida tropicalis). Single-round amplification on the Light-Cycler allowed rapid turn-around of clinical samples (within one working day) and it was shown to be more sensitive than classical procedures, exposing 39 possible systemic infections that were not detected by blood culture.
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Affiliation(s)
- P Lewis White
- Department of Medical Microbiology and PHLS, University Hospital Wales, Heath Park, Cardiff CF14 4XN, UK
| | - Anjali Shetty
- Department of Medical Microbiology and PHLS, University Hospital Wales, Heath Park, Cardiff CF14 4XN, UK
| | - Rosemary A Barnes
- Department of Medical Microbiology and PHLS, University Hospital Wales, Heath Park, Cardiff CF14 4XN, UK
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44
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Development and evaluation of the nuclisens basic kit NASBA for the detection of RNA from Candida species frequently resistant to antifungal drugs. Diagn Microbiol Infect Dis 2003; 45:217-20. [PMID: 12663165 DOI: 10.1016/s0732-8893(02)00510-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We describe a Nucleic Acid Sequence Based Amplification (NASBA) protocol to detect 6 different Candida species (Candida krusei, Candida glabrata, Candida inconspicua, Candida dubliniensis, Candida norvegensis, Candida lusitaniae) and compare it to a PCR assay. NASBA showed a sensitivity of 1 Colony Forming Unit and detected RNA from all 6 Candida species within 1 working day. All 5 patients with documented candidiasis showed identical results by both methods. This assay offers a sensitive, specific and fast possibility to detect yeast RNA.
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45
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Meletiadis J, Melchers WJG, Meis JFGM, Van Den Hurk P, Jannes G, Verweij PE. Evaluation of a polymerase chain reaction reverse hybridization line probe assay for the detection and identification of medically important fungi in bronchoalveolar lavage fluids. Med Mycol 2003; 41:65-74. [PMID: 12627806 DOI: 10.1080/mmy.41.1.65.74] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
An assay system in which polymerase chain reaction (PCR) amplification of the ITS-1 region of ribosomal DNA (rDNA) is combined with a reverse-hybridization line probe assay (LiPA) was used for the identification of six Candida species and four Aspergillus species in pure cultures of clinical isolates, as well as in bronchoalveolar lavage (BAL) fluid samples from 42 patients with various underlying diseases. The results were compared with the results obtained with conventional routine identification methods as well as with a commercial enzyme-linked immunosorbent assay (ELISA) galactomannan detection assay and an Aspergillus-specific PCR. No discrepancies between the PCR-LiPA system and routine methods were found for pure cultures of Candida and Aspergillus species except in the case of Aspergillus versicolor. In BAL fluid samples in which Candida species were cultured, the PCR-LiPA system identified more species than did the routine methods. When routine analyses of patient samples were supplemented by adding data obtained by repurifying and re-identifying cultures and by taking isolates obtained from other body sites into account, the results agreed with PCR-LiPA system results in 81% of the cases (34/42). Most of the remaining discrepancies (6/8) involved cases in which such supplementary data were not available. In BAL fluid samples from which A. fumigatus was cultured, the agreement between the PCR-LiPA system and the routine methods was low. Only 2 of 11 BAL samples shown to contain A. fumigatus in ELISA and genus-specific PCR assays were positive in PCR-LiPA system. The PCR-LiPA system enables the simultaneous detection and identification of different fungal species present in pure or mixed populations within 6 h in a single assay. Optimization is required, however, before it is useful as a diagnostic tool in the clinical microbiology laboratory.
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Affiliation(s)
- J Meletiadis
- Department of Medical Microbiology, University Medical Center Nijmegen, Nijmegen, The Netherlands.
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46
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Posteraro B, Valentini P, Delogu A, De RG, Boccacci S, Sanguinetti M, Nacci A, Sopo SM, Ranno O, Morace G, Fadda G. Candida albicans endocarditis diagnosed by PCR-based molecular assay in a critically ill pediatric patient. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2002; 34:145-7. [PMID: 11928853 DOI: 10.1080/00365540110077173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
A young Down's syndrome patient developed tricuspid valve endocarditis several years after undergoing surgical closure of a congenital ventricular septal defect. Fungal etiology was established by PCR amplification of the Candida albicans ERG11 gene. Although antifungal therapy was administered, surgical replacement of the infected valve was required to eliminate the infection.
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Affiliation(s)
- Brunella Posteraro
- Institutes of Microbiology, Catholic University of the Sacred Heart, Rome, Italy.
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47
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Yeo SF, Wong B. Current status of nonculture methods for diagnosis of invasive fungal infections. Clin Microbiol Rev 2002; 15:465-84. [PMID: 12097252 PMCID: PMC118074 DOI: 10.1128/cmr.15.3.465-484.2002] [Citation(s) in RCA: 195] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The incidence of invasive fungal infections has increased dramatically in recent decades, especially among immunocompromised patients. However, the diagnosis of these infections in a timely fashion is often very difficult. Conventional microbiologic and histopathologic approaches generally are neither sensitive nor specific, and they often do not detect invasive fungal infection until late in the course of disease. Since early diagnosis may guide appropriate treatment and prevent mortality, there has been considerable interest in developing nonculture approaches to diagnosing fungal infections. These approaches include detection of specific host immune responses to fungal antigens, detection of specific macromolecular antigens using immunologic reagents, amplification and detection of specific fungal nucleic acid sequences, and detection and quantitation of specific fungal metabolite products. This work reviews the current status and recent developments as well as problems in the design of nonculture diagnostic methods for invasive fungal infections.
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Affiliation(s)
- Siew Fah Yeo
- Infectious Disease Section, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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48
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Ahmad S, Khan Z, Mustafa AS, Khan ZU. Seminested PCR for diagnosis of candidemia: comparison with culture, antigen detection, and biochemical methods for species identification. J Clin Microbiol 2002; 40:2483-9. [PMID: 12089267 PMCID: PMC120535 DOI: 10.1128/jcm.40.7.2483-2489.2002] [Citation(s) in RCA: 153] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The rapid detection and identification of Candida species in clinical laboratories are extremely important for the management of patients with hematogenous candidiasis. The presently available culture and biochemical methods for detection and species identification of Candida are time-consuming and lack the required sensitivity and specificity. In this study, we have established a seminested PCR (snPCR) using universal and species-specific primers for detection of Candida species in serum specimens. The universal outer primers amplified the 3' end of 5.8S ribosomal DNA (rDNA) and the 5' end of 28S rDNA, including the internally transcribed spacer 2 (ITS2), generating 350- to 410-bp fragments from the four commonly encountered Candida species, viz., C. albicans, C. tropicalis, C. glabrata, and C. parapsilosis. The species-specific primers, complementary to unique sequences within the ITS2 of each test species, amplified species-specific DNA in the reamplification step of the snPCR. The sensitivity of Candida detection by snPCR in spiked serum specimens was close to 1 organism/ml. Evaluation of snPCR for specific identification of Candida species with 76 clinical Candida isolates showed 99% concordant results with the Vitek and/or ID32C yeast identification system. Further evaluation of snPCR for detection of Candida species in sera from culture-proven (n = 12), suspected (n = 16), and superficially colonized (n = 10) patients and healthy subjects (n = 12) showed that snPCR results were consistently negative with sera from healthy individuals and colonized patients. In culture-proven candidemia patients, the snPCR results were in full agreement with blood culture results with respect to both positivity and species identity. In addition, snPCR detected candidemia due to two Candida species in five patients, compared to three by blood culture. In the category of suspected candidemia with negative blood cultures for Candida, nine patients (56%) were positive by snPCR; two of them had dual infection with C. albicans and either C. tropicalis or C. glabrata. In conclusion, the snPCR developed in this study is specific and more sensitive than culture for the detection of Candida species in serum specimens. Moreover, the improved detection of cases of candidemia caused by more than one Candida species is an additional advantage.
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MESH Headings
- Antigens, Fungal/analysis
- Base Sequence
- Candidiasis/diagnosis
- Candidiasis/microbiology
- DNA Primers/genetics
- DNA, Fungal/blood
- DNA, Fungal/genetics
- DNA, Ribosomal/blood
- DNA, Ribosomal/genetics
- Fungemia/diagnosis
- Fungemia/microbiology
- Humans
- Mycology/methods
- Mycology/standards
- Mycology/statistics & numerical data
- Polymerase Chain Reaction/methods
- Polymerase Chain Reaction/standards
- Polymerase Chain Reaction/statistics & numerical data
- RNA, Fungal/genetics
- RNA, Ribosomal, 28S/genetics
- RNA, Ribosomal, 5.8S/genetics
- Sensitivity and Specificity
- Species Specificity
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Affiliation(s)
- Suhail Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat-13110, Kuwait
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49
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Bär W, Hecker H. Diagnosis of systemic Candida infections in patients of the intensive care unit. Significance of serum antigens and antibodies. Mycoses 2002; 45:22-8. [PMID: 11856433 DOI: 10.1046/j.1439-0507.2002.00709.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The combined detection of Candida antigen and antibody for the determination of systemic Candida infections (SCI) was investigated. One hundred and four patients from the intensive care unit (ICU) were analysed. Seventeen of the patients were suspected of having SCI, based on clinical and laboratory criteria. In these patients, Candida antigens and antibodies were analysed extensively. Ten patients had a positive Candida antigen (titre >1:16) determined by the latex agglutination assay Cand-Tec(R) and their median antibody titre was 1:160 in the indirect haemagglutination test (HAT). Seven antigen-negative patients had a median titre of 1:1280 (HAT). Forty-one of 42 colonized control patients had negative antigen titres and a median antibody titre of 1:160. The sensitivities and specificities were 58.8% and 97.6% for antigenemia, and 52.9% and 85.7% for antibody detection. These values reached 100.0% and 83.3%, respectively, when the results of both tests were combined. This indicates a high degree of concordance between serological results (Candida antigen and/or antibodies) and clinical presentation. We conclude, that the combined investigation of antigen and antibody titres might be a helpful tool in the characterization of SCI in ICU patients, if antigen titres are >or=1:16 or antibody titres (HAT) are >or=1:640.
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Affiliation(s)
- W Bär
- Institute of Medical Microbiology, Carl-Thiem-Klinikum, Cottbus, Germany.
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50
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Abstract
Incidences of infections due to Candida have increased over the last 15-20 y. This increase in the incidence and the high associated mortality rate despite therapy has focused the attention on this disease and prompted investigators to undertake research aimed at understanding the pathogenesis of this disease as well as methods to treat it. This paper discusses recent developments in the Candida field and the impact they have on patient management.
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Affiliation(s)
- M A Ghannoum
- Center for Medical Mycology, University Hospitals of Cleveland, Case Western Reserve University, Ohio 44106-5028, USA.
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