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Polychromatic luminescence and improved antifungal performance of succinic acid in the lattice of L-Lysine monohydrochloride. Saudi J Biol Sci 2021; 28:395-399. [PMID: 33424322 PMCID: PMC7783679 DOI: 10.1016/j.sjbs.2020.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 11/22/2022] Open
Abstract
The incorporation of succinic acid (SA) in the lattice of L-Lysine monohydrochloride (LM) has opened the new avenue in the field of production and application of scintillator materials such as LED and antifungal drug. Crystalline trait and monoclinic structure were scanned by XRD. The existence of carbonyl, carboxylate and protonated amine group were confirmed through FTIR and UV spectra predicted the transmittance of SA: LM crystal. Polychromatic luminescence behaviour had achieved through the incorporation of SA instead of blue luminescence, which is a new result. Also SA: LM exhibited good response towards pathogenic fungi which causes numerous types of infections and diseases in both humans and animals. The high inhibitory zone at 16 mm was formed by the grown SA: LM crystal against the life threatening fungi like Candida albicans. Also fungal inhibition against candida parapsilosis and Aspergillus flaves, respectively, were tuned by the inclusion of succinic acid.
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Matsui H, Higashide M, Hanaki H. Evaluation of a rapid immunochromatographic test for the detection of Candida species from oropharyngeal samples. J Microbiol Methods 2020; 179:106090. [PMID: 33129918 DOI: 10.1016/j.mimet.2020.106090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 01/04/2023]
Abstract
Oropharyngeal candidiasis is the most common opportunistic fungal infectious disease. Culture methods and microscopy are used to detect the presence of Candida species in clinical specimens. We have previously developed an immunochromatographic test (ICT) to enable the simple and rapid diagnosis of candidiasis. In this study, we evaluated the performance of the ICT for the detection of Candida species from pharyngeal swabs and compared the results with those of the culture method. The isolated Candida species were identified using polymerase chain reaction-restriction fragment length polymorphism, and viable cell counts were determined using selective chromogenic agar. The detection rate of C. albicans was 63.3% and 0% among ≤102 and ≥ 106 colony-forming units (CFU)/mL of viable Candida cells from pharyngeal swabs, respectively. The detection rate of nonC. albicans Candida species, especially C. glabrata, increased commensurately from 16.7% at ≤102 CFU/mL to 75.0% at ≥106 CFU/mL. Among the 300 pharyngeal swabs analyzed, 59 cultures detected Candida species at a count of >103 CFU/mL (53 were ICT-positive). Of the remaining 241 culture-negative specimens, 219 were ICT-negative. The sensitivity, specificity, and accuracy of the ICT were 89.8%, 90.9%, and 90.7%, respectively. Taken together, the ICT evaluated can be made readily available for clinical use in detecting Candida.
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Affiliation(s)
- Hidehito Matsui
- Ōmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane, Minato-Ku, Tokyo 108-8641, Japan
| | - Masato Higashide
- Kotobiken Medical Laboratories, Inc., 445-1, Kamiyokoba, Ibaraki 305-0854, Japan
| | - Hideaki Hanaki
- Ōmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane, Minato-Ku, Tokyo 108-8641, Japan.
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Orlandini RK, Bepu DAN, Saraiva MDCP, Bollela VR, Motta ACF, Lourenço AG. Are Candida albicans isolates from the oral cavity of HIV-infected patients more virulent than from non-HIV-infected patients? Systematic review and meta-analysis. Microb Pathog 2020; 149:104477. [PMID: 32920148 DOI: 10.1016/j.micpath.2020.104477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/05/2020] [Accepted: 09/03/2020] [Indexed: 01/24/2023]
Abstract
Candida albicans is the main causative agent of oral lesions in HIV-infected patients and its oral colonization is a potential source of systemic dissemination. Although the high prevalence of lesions in HIV patients can be explained by the immunosuppressive condition, several studies have reported that natural selection can make C. albicans more virulent in this group of patients. Comparisons of the activity of exoenzymes (phospholipase, proteinase and hemolysin) in C. albicans isolated from HIV-infected and uninfected patients have yielded conflicting results. This study aimed, through a systematic review and meta-analysis, to answer the question: "Is the hydrolytic enzymatic activity of C. albicans, isolated from the oral cavity, different in individuals infected and not infected with HIV?" The question was addressed using the PECO framework: P (Population): children and adults, E (Exposure): HIV infection, C (Comparator): non-HIV-infected patients; O (Outcomes): exoenzymes activity i.e. phospholipase, proteinase and hemolysin. We conducted a systematic search on Pubmed, Embase, Scopus, Livivo, Lilacs, Web of Science, and Science Direct databases, and Google Scholar. The MAStARI tool was used to evaluate the risk of bias in the selected studies. From 2259 studies, 19 were included in this review and 11 comprised the meta-analysis. The activity of phospholipase (M-H = 0.15; Z = 2,76; p = 0.0006) and hemolysin exoenzymes (M-H = 0.07; z = 1,94; p = 0.05) was higher in C. albicans isolated from the oral cavity of HIV-infected patients, whereas the levels of protease activity were not different compared with non-HIV-infected individuals. This study showed a higher phospholipase and hemolysin activity in C. albicans isolates from the oral cavity of HIV-infected patients.
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Affiliation(s)
- Renata Klemp Orlandini
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, Brazil
| | - Davi Ariel Nobuo Bepu
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, Brazil
| | | | - Valdes Roberto Bollela
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto, São Paulo, Brazil
| | - Ana Carolina Fragoso Motta
- Department of Stomatology, Public Oral Health and Forensic Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Brazil
| | - Alan Grupioni Lourenço
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, Brazil.
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Sah P, Patel P, Chandrashekar C, Martena S, Ballal M, Hegde M, Guddattu V, Murdoch C, Sharma M, Radhakrishnan R. Oral candidal carriage correlates with CD4 + cell count but not with HIV and highly active antiretroviral therapy status. ACTA ACUST UNITED AC 2019; 10:e12438. [PMID: 31313889 DOI: 10.1111/jicd.12438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 05/28/2019] [Accepted: 06/13/2019] [Indexed: 01/03/2023]
Abstract
AIM The occurrence of oropharyngeal candidiasis (OPC) may be influenced by oral candidal carriage (OCC). Although OPC is strongly associated with low CD4+ cell count (400-700 cells/mm3 ) and a lack of highly active antiretroviral therapy (HAART), the effect of these two parameters on OCC is debatable. We investigated the oral candidal carriage, species diversity, antifungal susceptibility and the association of OCC with CD4+ cell count and HAART. METHODS Oral candidal isolates from 120 HIV+ patients (60 receiving and 60 not receiving HAART) and 60 healthy controls were quantified, and their species determined using standard culture and biochemical methods, followed by antifungal susceptibility testing using the agar dilution method. RESULTS The OCC was significantly higher in HIV+ patients; Candida albicans was the most frequently isolated species in both groups, followed by Candida tropicalis. Candidal density carriage correlated significantly with CD4+ cell count, but not with HIV and HAART status. Among the isolates from HIV+ patients, 35.4% showed reduced susceptibility to fluconazole. CONCLUSION HIV status results in significantly elevated rates of OCC C albicans remains the predominant pathogen, although other species are emerging rapidly. Resistance to fluconazole is on the rise, and more efficient treatment strategies need to be implemented.
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Affiliation(s)
| | - Pratik Patel
- Clinical Oral Pathologist, Oroscan Diagnostics, Surat, Gujarat, India
| | - Chetana Chandrashekar
- Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Suganthi Martena
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Mamatha Ballal
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Manjayya Hegde
- Antiretroviral Treatment Centre, Government District Hospital, Udupi, India
| | - Vasudeva Guddattu
- Department of Statistics, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Craig Murdoch
- Unit of Oral and Maxillofacial Medicine and Surgery, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Mohit Sharma
- Department of Oral Pathology, Sudha Rustagi College of Dental Sciences and Research, Faridabad, India
| | - Raghu Radhakrishnan
- Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
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Alrayyes SF, Alruwaili HM, Taher IA, Elrahawy KM, Almaeen AH, Ashekhi AO, Alam MK. Oral Candidal carriage and associated risk indicators among adults in Sakaka, Saudi Arabia. BMC Oral Health 2019; 19:86. [PMID: 31117990 PMCID: PMC6530046 DOI: 10.1186/s12903-019-0775-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 04/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Candida is a ubiquitous organism in nature which inhabits the oral cavity as part of the normal microbial flora. The oral carriage of Candida is perpetuated by several predisposing factors. METHODS This cross-sectional study was designed to investigate the carriage rate of Candida among 104 voluntary adults at the college of medicine - Jouf University. The concentrated oral rinse technique using Sabouraud Dextrose agar medium supplemented with 0.05% Chloramphenicol was used to isolate Candida. The relative factors affecting the colonization of Candida and the concentration of each type were also determined. RESULTS Candida species were isolated from the oral cavity of 45 (43.4%) subjects. Of these 55.6% were identifies as C. albicans as determined by the Vitek 2 compact system. Other Candida species were represented by C. glabrata (11.1%), C. krusei (11.1%), C. dubliniensis (8.9%), C. parapsilosis (6.7%), C. tropicalis (4.4%), and C. famata (2.2%). Subjects with very poor plaque status, severe gingivitis and diabetes had significantly (P = 0.001) high concentration of Candida spp. CONCLUSION Plague, severe gingivitis, and diabetes were found to be significantly associated with higher Candida colonization.
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Affiliation(s)
- Saad F. Alrayyes
- Department of Pathology, College of medicine-Jouf University, Aljouf, KSA, Saudi Arabia
| | - Hammad M. Alruwaili
- Department of Pathology, College of medicine-Jouf University, Aljouf, KSA, Saudi Arabia
| | - Ibrahim A. Taher
- Department of Pathology, College of medicine-Jouf University, Aljouf, KSA, Saudi Arabia
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Respiratory Tract Colonization by Candida species Portends Worse Outcomes in Immunocompromised Patients. ACTA ACUST UNITED AC 2018; 25:197-201. [PMID: 30911217 DOI: 10.1097/cpm.0000000000000279] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background The significance and clinical management of Candida colonization of the respiratory tract are ill-defined. We now report the frequency of Candida species from the lower respiratory tract in hematopoietic stem cell transplant recipients (HSCT) undergoing bronchoscopy with broncheoalveolar lavage (BAL) for pneumonitis post-HSCT. Methods The University of Michigan Clinical Microbiology Lab Database was queried for all respiratory cultures positive for Candida species between 2000-2012. We concurrently performed a retrospective analysis of 515 HSCT recipients with pneumonitis at our institution between 2001-2012. Results During this twelve-year period, there were 2524 unique Candida isolates (78% Candida albicans). Of the 515 HSCT patients with suspected pneumonitis,127 (24.7%) HSCT subjects were culture positive for a fungal pathogen, with Candida species identified in 27 cases (5.2%). When compared with other HSCT subjects, those cultures positive for Candida had significantly increased mortality (p=0.04). Conclusions Candida sp. are commonly cultured from the respiratory tract of HSCT recipients, with increased mortality in affected patients. While there is insufficient evidence for anti-fungal treatment of Candida species colonization, the presence of the yeast may be useful as a surrogate marker of disease severity.
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Phenotypic and genotypic variations in Candida albicans isolates from Romanian patients. REV ROMANA MED LAB 2018. [DOI: 10.2478/rrlm-2018-0023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Background: During the last two decades a major increase in the proportion of severe fungal infections has been noted due to the excessive use of broad-spectrum antibiotics, catheters, and a growing number of immunocompromised patients.
Objectives: This is the first investigation providing complete data regarding the phenotypic and genotypic profiles of Candida albicans (C. albicans) isolates in Romanian patients.
Methods: We investigated 301 isolates in terms of genotype determination (G), resistogram (R), phospholipase activity (Pl), haemolysis (Hl), proteinase activity (Pt), and biofilm formation (BF).
Results: The analyzed isolates of C. albicans showed low values for Pt (61.73%), Hl (95.49%), and BF (60.71%), and did not present any Pl activity (92.23%). More than half of the investigated samples were genotype A with 450 bp (52.92%) and the majority (86.19%) were resistant to sodium selenite (A), boric acid (B), sodium periodate (D) and silver nitrate (E), but sensitive to cetrimide (-). One-way ANOVA analysis revealed significant effects of the infection site on biofilm formation (p = 0.0137) and no significant correlation was found between the genotype (A, B, C) and the infection site (p =0.449).
Conclusions: Based on the obtained results it can be concluded that C. albicans isolates in Romanian patients exhibit different genotypic and phenotypic patterns, and no significant correlations between genotype and infection site could be observed.
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Liu Z, Yong X, Jiang L, Zhang L, Lin X, Liu W, Peng Y, Tao R. Salivary human beta-defensins affected by oral Candida status in Chinese HIV/AIDS patients undergoing ART. Oral Dis 2018; 24:964-971. [PMID: 29498794 DOI: 10.1111/odi.12847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 02/08/2018] [Accepted: 02/18/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To observe relationships between oral Candida status and salivary human beta-defensin 2 and 3 (hBD-2 and hBD-3) levels in HIV/AIDS patients of Guangxi, China during the first year of antiretroviral therapy (ART) dynamically, and to understand the influence of ART on oral Candida status and salivary hBDs expressions. METHODS A prospective self-controlled study was carried to observe the dynamic changes of CD4+ T cell counts, oral Candida carriages and salivary hBD-2,3 expressions in HIV/AIDS patients during the first year of ART. A total of 90 HIV/AIDS patients were enrolled and were examined at the baseline, 3rd, 6th, 12th month of ART. Thirty healthy individuals were enrolled as control. Peripheral blood, oral rinse sample, and unstimulated whole saliva were collected to test CD4+ T cell counts, oral Candida carriages, and hBD-2,3 expressions. RESULTS In the first year of ART, CD4+ T cell counts increased significantly. However, oral Candida carriages and oral candidiasis decreased significantly, and salivary hBD-2 expressions in HIV/AIDS patients decreased gradually, salivary hBD-3 levels were highly variable. Salivary hBD-2 concentrations were positively related to oral Candida carriages. CONCLUSIONS The incidence of oral candidiasis among HIV/AIDS patients gradually decreased due to the immune reconstruction of ART. Salivary defensins might play an important role in Candida-host interaction in HIV/AIDS patients.
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Affiliation(s)
- Z Liu
- Department of Periodontics and Oral Medicine, College of Stomatology, Guangxi Medical University, Nanning, Guangxi, China.,Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Guangxi, China
| | - X Yong
- Department of Periodontics and Oral Medicine, College of Stomatology, Guangxi Medical University, Nanning, Guangxi, China
| | - L Jiang
- Department of Periodontics and Oral Medicine, College of Stomatology, Guangxi Medical University, Nanning, Guangxi, China
| | - L Zhang
- Department of Periodontics and Oral Medicine, College of Stomatology, Guangxi Medical University, Nanning, Guangxi, China
| | - X Lin
- Department of Periodontics and Oral Medicine, College of Stomatology, Guangxi Medical University, Nanning, Guangxi, China
| | - W Liu
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention (CDC), Guangxi, China
| | - Y Peng
- Department of Periodontics and Oral Medicine, College of Stomatology, Guangxi Medical University, Nanning, Guangxi, China
| | - R Tao
- Department of Periodontics and Oral Medicine, College of Stomatology, Guangxi Medical University, Nanning, Guangxi, China.,Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Guangxi, China
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Rapid Phenotypic and Genotypic Diversification After Exposure to the Oral Host Niche in Candida albicans. Genetics 2018; 209:725-741. [PMID: 29724862 DOI: 10.1534/genetics.118.301019] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/21/2018] [Indexed: 12/15/2022] Open
Abstract
In vitro studies suggest that stress may generate random standing variation and that different cellular and ploidy states may evolve more rapidly under stress. Yet this idea has not been tested with pathogenic fungi growing within their host niche in vivo Here, we analyzed the generation of both genotypic and phenotypic diversity during exposure of Candida albicans to the mouse oral cavity. Ploidy, aneuploidy, loss of heterozygosity (LOH), and recombination were determined using flow cytometry and double digest restriction site-associated DNA sequencing. Colony phenotypic changes in size and filamentous growth were evident without selection and were enriched among colonies selected for LOH of the GAL1 marker. Aneuploidy and LOH occurred on all chromosomes (Chrs), with aneuploidy more frequent for smaller Chrs and whole Chr LOH more frequent for larger Chrs. Large genome shifts in ploidy to haploidy often maintained one or more heterozygous disomic Chrs, consistent with random Chr missegregation events. Most isolates displayed several different types of genomic changes, suggesting that the oral environment rapidly generates diversity de novo In sharp contrast, following in vitro propagation, isolates were not enriched for multiple LOH events, except in those that underwent haploidization and/or had high levels of Chr loss. The frequency of events was overall 100 times higher for C. albicans populations following in vivo passage compared with in vitro These hyper-diverse in vivo isolates likely provide C. albicans with the ability to adapt rapidly to the diversity of stress environments it encounters inside the host.
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Clark-Ordóñez I, Callejas-Negrete OA, Aréchiga-Carvajal ET, Mouriño-Pérez RR. Candida species diversity and antifungal susceptibility patterns in oral samples of HIV/AIDS patients in Baja California, Mexico. Med Mycol 2017; 55:285-294. [PMID: 27630251 DOI: 10.1093/mmy/myw069] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 08/01/2016] [Indexed: 12/11/2022] Open
Abstract
Candidiasis is the most common opportunistic fungal infection in HIV patients. The aims of this study were to identify the prevalence of carriers of Candida, Candida species diversity, and in vitro susceptibility to antifungal drugs. In 297 HIV/AIDS patients in Baja California, Mexico, Candida strains were identified by molecular methods (PCR-RFLP) from isolates of oral rinses of patients in Tijuana, Mexicali, and Ensenada. 56.3% of patients were colonized or infected with Candida. In Tijuana, there was a significantly higher percentage of carriers (75.5%). Out of the 181 strains that were isolated, 71.8% were Candida albicans and 28.2% were non-albicans species. The most common non-albicans species was Candida tropicalis (12.2%), followed by Candida glabrata (8.3%), Candida parapsilosis (2.2%), Candida krusei (1.7%), and Candida guilliermondii (1.1%). Candida dubliniensis was not isolated. Two associated species were found in 11 patients. In Mexicali and Ensenada, there was a lower proportion of Candida carriers compared to other regions in Mexico and worldwide, however, in Tijuana, a border town with many peculiarities, a higher carrier rate was found. In this population, only a high viral load was associated with oral Candida carriers. Other factors such as gender, use of antiretroviral therapy, CD4+ T-lymphocyte levels, time since diagnosis, and alcohol/ tobacco consumption, were not associated with Candida carriers.
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Affiliation(s)
- Isadora Clark-Ordóñez
- Departamento de Microbiología. Centro de Investigación Científica y de Educación Superior de Ensenada. Ensenada B. C.,Facultad de Medicina. Universidad Autónoma de Baja California. Mexicali, B. C
| | - Olga A Callejas-Negrete
- Departamento de Microbiología. Centro de Investigación Científica y de Educación Superior de Ensenada. Ensenada B. C
| | - Elva T Aréchiga-Carvajal
- Departamento de Microbiología e Inmunología. Facultad de Ciencias Biológicas. Universidad Autónoma de Nuevo León. Monterrey, N. L
| | - Rosa R Mouriño-Pérez
- Departamento de Microbiología. Centro de Investigación Científica y de Educación Superior de Ensenada. Ensenada B. C
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Mushi MF, Bader O, Taverne-Ghadwal L, Bii C, Groß U, Mshana SE. Oral candidiasis among African human immunodeficiency virus-infected individuals: 10 years of systematic review and meta-analysis from sub-Saharan Africa. J Oral Microbiol 2017; 9:1317579. [PMID: 28748027 PMCID: PMC5508360 DOI: 10.1080/20002297.2017.1317579] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/04/2017] [Indexed: 11/18/2022] Open
Abstract
Oral candidiasis (OC) is the most common opportunistic fungal infection among immunocompromised individuals. This systematic review and meta-analysis reports on the contribution of non-albicans Candida species in causing OC among human immunodeficiency virus (HIV)-infected individuals in sub-Saharan Africa between 2005 and 2015. Thirteen original research articles on oral Candida infection/colonization among HIV-infected African populations were reviewed. The prevalence of OC ranged from 7.6% to 75.3%. Pseudomembranous candidiasis was found to range from 12.1% to 66.7%. The prevalence of non-albicans Candida species causing OC was 33.5% [95% confidence interval (CI) 30.9–36.39%]. Of 458 non-albicans Candida species detected, C. glabrata (23.8%; 109/458) was the most common, followed by C. tropicalis (22%; 101/458) and C. krusei (10.7%; 49/458). The overall fluconazole resistance was 39.3% (95% CI 34.4–44.1%). Candida albicans was significantly more resistant than non-albicans Candida species to fluconazole (44.7% vs 21.9%; p < 0.001). One-quarter of the cases of OC among HIV-infected individuals in sub-Saharan Africa were due to non-albicans Candida species. Candida albicans isolates were more resistant than the non-albicans Candida species to fluconazole and voriconazole. Strengthening the capacity for fungal diagnosis and antifungal susceptibility testing in sub-Saharan Africa is mandatory in order to track the azole resistance trend.
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Affiliation(s)
- Martha F Mushi
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Heath and Allied Sciences, Mwanza, Tanzania
| | - Oliver Bader
- Institute of Medical Microbiology, University Medical Center, Göttingen, Germany
| | | | - Christine Bii
- Kenya Medical Research Institute, Center for Microbiology Research, Nairobi, Kenya
| | - Uwe Groß
- Institute of Medical Microbiology, University Medical Center, Göttingen, Germany
| | - Stephen E Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Heath and Allied Sciences, Mwanza, Tanzania
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Lourenço AG, Ribeiro AERA, Nakao C, Motta ACF, Antonio LGL, Machado AA, Komesu MC. Oral Candida spp carriage and periodontal diseases in HIV-infected patients in Ribeirão Preto, Brazil. Rev Inst Med Trop Sao Paulo 2017; 59:e29. [PMID: 28591257 PMCID: PMC5459536 DOI: 10.1590/s1678-9946201759029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 03/31/2017] [Indexed: 11/21/2022] Open
Abstract
The majority of HIV-infected patients develop Candida spp-associated clinical oral lesions. Studies have shown that asymptomatic oral colonization of Candida spp may lead to oral lesions or become a source of disseminated infections. The aim of this study was to verify the effects of periodontal conditions on Candida spp prevalence and Candida spp carriage in the oral cavity of HIV-infected patients compared to non-infected patients. Twenty-five patients not infected with HIV and 48 HIV-infected patients were classified according to periodontal conditions as being periodontal healthy or with periodontal disease. Candida spp carriage and classification were performed in oral rinse samples. Viral load and CD4+ T lymphocyte (CD4+L) counts were performed in blood samples from HIV-infected patients. No differences in Candida spp prevalence related to HIV status or periodontal condition were detected. However, Candida spp carriage was increased in periodontally affected HIV-infected patients when compared to periodontally healthy HIV-infected patients (p= 0.04). Periodontally healthy HIV-infected patients presented Candida spp carriage in similar levels as healthy or periodontally affected non-HIV-infected patients. Candida spp carriage was correlated with CD4+L counting in HIV-infected patients. We concluded that periodontal disease is associated with increased Candida spp carriage in HIV-infected patients and may be a predisposing factor to clinical manifestations of candidiasis.
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Affiliation(s)
- Alan Grupioni Lourenço
- Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, Departamento de Morfologia, Fisiologia e Patologia Básica, Ribeirão Preto, São Paulo, Brazil
| | - Ana Elisa Rodrigues Alves Ribeiro
- Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, Departamento de Morfologia, Fisiologia e Patologia Básica, Ribeirão Preto, São Paulo, Brazil
| | - Cristiano Nakao
- Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, Departamento de Morfologia, Fisiologia e Patologia Básica, Ribeirão Preto, São Paulo, Brazil
| | - Ana Carolina Fragoso Motta
- Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, Departamento de Estomatologia, Saúde Coletiva e Odontologia Legal, Ribeirão Preto, São Paulo, Brazil
| | - Luana Grupioni Lourenço Antonio
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Medicina Interna, Ribeirão Preto, São Paulo, Brazil
| | - Alcyone Artioli Machado
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Medicina Interna, Ribeirão Preto, São Paulo, Brazil
| | - Marilena Chinali Komesu
- Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, Departamento de Morfologia, Fisiologia e Patologia Básica, Ribeirão Preto, São Paulo, Brazil
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Wu CJ, Ko WC, Ho MW, Lin HH, Yang YL, Lin JN, Huang IW, Wang HY, Lai JF, Shiau YR, Hsieh LY, Chen HT, Lin CC, Chu WL, Lo HJ, Lauderdale TL. Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus colonization among human immunodeficient virus-infected outpatients in Taiwan: oral Candida colonization as a comparator. J Oral Microbiol 2017; 9:1322446. [PMID: 28748029 PMCID: PMC5508359 DOI: 10.1080/20002297.2017.1322446] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 04/17/2017] [Indexed: 12/30/2022] Open
Abstract
Human immuodeficency virus (HIV)-infected patients receiving highly active antiretroviral therapy (HAART) and community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) have increased in recent years in Taiwan. This study was undertaken to determine the prevalence of and risk factors for nasal and oral S. aureus and MRSA colonization among contemporary HIV-infected populations. Clinical variables for S. aureus and MRSA colonization among HIV-infected outpatients from three hospitals were analyzed and compared with those for oral Candida colonization. Genetic characteristics of MRSA isolates were analyzed. A total of 714 patients were screened for nasal S. aureus colonization, and a subset of 457 patients were also screened for oral S. aureus colonization. Of all patients, 79.4% were receiving HAART, and their mean CD4 count was 472 cells/mm3. The colonization rates in the oral cavity, nasal cavity, and at either site were 18.8%, 31.7%, and 36.8%, respectively, for S. aureus, and 3.1%, 4.4%, and 5.5%, respectively, for MRSA. These rates were all much lower than the previously reported rate of oral Candida colonization (52.4%). By multivariate analysis, a suppressed viral load (<200 copies/mL) protected against oral S. aureus, MRSA, and Candida colonization, and recent use of antibacterial agents protected against oral and nasal S. aureus colonization. Recent incarceration increased the risk of nasal MRSA colonization, while recent hospitalization, tuberculosis, older age, and intravenous drug use increased the risk of oral Candida colonization. Candida spp. did not augment S. aureus or MRSA colonization in the oral cavity. Most of the 41 MRSA isolates recovered belonged to the SCCmec IV/pvl-negative (51.2%) and VT/pvl-positive (26.8%) ST59 local prevalent CA-MRSA clones. Distinct carriage rates demonstrated here suggested that mucosal immunity against colonization might differ in terms of microbes and sites. A decreased risk in oral carriage of MRSA and Candida might be a benefit of HAART.
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Affiliation(s)
- Chi-Jung Wu
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan.,Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Mao-Wang Ho
- Section of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hsi-Hsun Lin
- Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Yun-Liang Yang
- Institute of Molecular Medicine and Bioengineering, National Chiao Tung University, Hsinchu, Taiwan.,Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Jiun-Nong Lin
- Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - I-Wen Huang
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Hui-Ying Wang
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Jui-Fen Lai
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Yih-Ru Shiau
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Li-Yun Hsieh
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Hui-Ting Chen
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan.,Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Chih-Chao Lin
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Wen-Li Chu
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Hsiu-Jung Lo
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan.,School of Dentistry, China Medical University, Taichung, Taiwan
| | - Tsai-Ling Lauderdale
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
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Cartagena AF, Esmerino LA, Polak-Junior R, Olivieri Parreiras S, Domingos Michél M, Farago PV, Campanha NH. New denture adhesive containing miconazole nitrate polymeric microparticles: Antifungal, adhesive force and toxicity properties. Dent Mater 2017; 33:e53-e61. [DOI: 10.1016/j.dental.2016.09.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 09/14/2016] [Accepted: 09/27/2016] [Indexed: 12/16/2022]
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Sato T, Kishi M, Suda M, Sakata K, Shimoda H, Miura H, Ogawa A, Kobayashi S. Prevalence of Candida albicans and non-albicans on the tongue dorsa of elderly people living in a post-disaster area: a cross-sectional survey. BMC Oral Health 2017; 17:51. [PMID: 28148273 PMCID: PMC5288978 DOI: 10.1186/s12903-017-0342-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 01/26/2017] [Indexed: 11/17/2022] Open
Abstract
Background Candida species are normal commensal organisms of the mouth. However, they can cause oral mucosal and severe systemic infections in persons with reduced immune function, which is common in the very elderly. In post-disaster areas, the number of elderly residents rapidly increases due to the outflow of younger generations. Hence, we examined the prevalence of Candida albicans and non-albicans in association with oral and systemic conditions, life style, medications, and living conditions. Methods This study was performed in 2014. Participants of this study were 266 community dwellers aged 60 years or older in Otsuchi town, which was severely damaged by the Great East Japan Earthquake and Tsunami in 2011. Oral specimens were collected from tongue dorsa by swabbing. After 48 h incubation on CHROMagar™ medium, C. albicans and non-albicans were identified by the morphology and pigmentation of the colonies. Oral and systemic health check-ups were performed to assess the following: number of remaining teeth and periodontal status, oral hygiene, use of dentures, obesity, hypertension, hyperlipidemia, and hyperglycemia. A questionnaire addressed lifestyle, medications, and living conditions. Using the variables above, the relative factors involved in the colonization and the amounts of each type of Candida were determined. Results C. albicans and non-albicans were detected in 142 (53.4%) and 63 (23.7%) participants, respectively. Multinomial logistic regression analyses revealed that the significant factors of colonization by C. albicans were “having decayed teeth” and “relocation from home”. Factors related to non-albicans colonization were “age over 80 years”, “number of remaining teeth”, “use of dentures”, and “obesity”. On the contrary, none of the parameters were related to the amount of non-albicans in the carrier, and the amount of C. albicans was significantly associated with “number of teeth” and “hypertension”. Conclusions Prevalence-related factors differed between C. albicans and non-albicans colonization. In addition, other than oral status, systemic and living conditions affected the prevalence of both C. albicans and non-albicans in elderly people living in a post-disaster area. Electronic supplementary material The online version of this article (doi:10.1186/s12903-017-0342-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Toshiro Sato
- Division of Preventive Dentistry, Department of Oral Medicine, School of Dentistry Iwate Medical University, 1-3-27 Chuo-dori, Morioka, Iwate, 020-8505, Japan
| | - Mitsuo Kishi
- Division of Preventive Dentistry, Department of Oral Medicine, School of Dentistry Iwate Medical University, 1-3-27 Chuo-dori, Morioka, Iwate, 020-8505, Japan.
| | - Miki Suda
- Division of Preventive Dentistry, Department of Oral Medicine, School of Dentistry Iwate Medical University, 1-3-27 Chuo-dori, Morioka, Iwate, 020-8505, Japan
| | - Kiyomi Sakata
- Department of Hygiene and Preventive Medicine, Iwate Medical University, School of Medicine, 2-1-1 Nishitokuta, Yahaba, Iwate, 028-3694, Japan
| | - Haruki Shimoda
- Department of Hygiene and Preventive Medicine, Iwate Medical University, School of Medicine, 2-1-1 Nishitokuta, Yahaba, Iwate, 028-3694, Japan
| | - Hiroyuki Miura
- Division of Dental Education, Department of Oral Medicine, School of Dentistry Iwate Medical University, 1-3-27 Chuo-dori, Morioka, Iwate, 020-8505, Japan
| | - Akira Ogawa
- Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
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Minea B, Nastasa V, Kolecka A, Mares M, Marangoci N, Rosca I, Pinteala M, Hancianu M, Mares M. Etiologic Agents and Antifungal Susceptibility of Oral Candidosis from Romanian patients with HIV-infection or type 1 diabetes mellitus. Pol J Microbiol 2016; 65:123-9. [PMID: 27282005 DOI: 10.5604/17331331.1197327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This is the first Romanian investigation of oral candidosis in patients suffering of HIV-infection or type 1 diabetes mellitus (T1DM). Candida albicans was the dominant species in both types of isolates: n = 14 (46.7%) in T1DM, n = 60 (69.8%) in HIV. The most frequent non-albicans Candida spp. were Candida kefyr (n = 6; 20%) in T1DM and Candida dubliniensis (n = 8; 9.3%) in HIV. Resistance to fluconazole was detected only in the HIV non-albicans Candida group (n = 8; 9.3%). All isolates were susceptible to VOR. The experimental drug MXP had MIC values equal or close to the ones of VOR. Echinocandin resistance was more frequent than azole resistance.
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Menezes RDP, Borges AS, Araujo LBD, Pedroso RDS, Röder DVDDB. RELATED FACTORS FOR COLONIZATION BY Candida SPECIES IN THE ORAL CAVITY OF HIV-INFECTED INDIVIDUALS. Rev Inst Med Trop Sao Paulo 2016; 57:413-9. [PMID: 26603229 PMCID: PMC4660451 DOI: 10.1590/s0036-46652015000500008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 02/03/2015] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED The colonization of the oral cavity is a prerequisite to the development of oropharyngeal candidiasis. AIMS The aims of this study were: to evaluate colonization and quantify Candida spp. in the oral cavity; to determine the predisposing factors for colonization; and to correlate the levels of CD4+ cells and viral load with the yeast count of colony forming units per milliliter (CFU/mL) in HIV-positive individuals treated at a University Hospital. Saliva samples were collected from 147 HIV patients and were plated on Sabouraud Dextrose Agar (SDA) and chromogenic agar, and incubated at 30 ºC for 72 h. Colonies with similar morphology in both media were counted and the result expressed in CFU/mL. RESULTS Of the 147 HIV patients, 89 had positive cultures for Candida spp., with a total of 111 isolates, of which C. albicans was the most frequent species (67.6%), and the mean of colonies counted was 8.8 × 10³ CFU/mL. The main predisposing factors for oral colonization by Candida spp. were the use of antibiotics and oral prostheses. The use of reverse transcriptase inhibitors appears to have a greater protective effect for colonization. A low CD4+ T lymphocyte count is associated with a higher density of yeast in the saliva of HIV patients.
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Ho MW, Yang YL, Lin CC, Chi CY, Chen HT, Lin PC, Hsieh LY, Chou CH, Chu WL, Wu CP, Lauderdale TL, Lo HJ. Yeast oropharyngeal colonization in human immunodeficiency virus-infected patients in central taiwan. Mycopathologia 2014; 177:309-17. [PMID: 24804977 DOI: 10.1007/s11046-014-9753-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 04/27/2014] [Indexed: 10/25/2022]
Abstract
A prospective, cross-sectional study was conducted at a medical center in central Taiwan to understand the prevalence, associated factors, and microbiologic features for oropharyngeal yeast colonization in human immunodeficiency virus-infected outpatients. Oral yeast colonization was detected in 127 (45 %) patients, including 21 (16.5 %) colonized by more than one species. Of the 154 isolates, Candida albicans was the most common species (114, 74 %), followed by Candida dubliniensis (10, 6.5 %), Candida glabrata (10, 6.5 %), Candida tropicalis (7, 4.5 %), and 13 others. We found that receiving antituberculous drug (p = 0.046) or atazanavir (p = 0.045) was two predictors for patients colonized by non-C. albicans species (p = 0.005) and risking mixed yeast colonization (p = 0.009). Even though our data showed that clinical antifungal drugs remained effective in vitro against the colonizing yeasts, the increased mixed yeast colonization indicates a potential issue for controlling mixed infections in hospital settings.
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Affiliation(s)
- Mao-Wang Ho
- Section of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
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Importance of Diversity in the Oral Microbiota including Candida Species Revealed by High-Throughput Technologies. Int J Dent 2014; 2014:454391. [PMID: 24864144 PMCID: PMC4016938 DOI: 10.1155/2014/454391] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 04/01/2014] [Indexed: 01/27/2023] Open
Abstract
Taking advantage of high-throughput technologies, deep sequencing of the human microbiome has revealed commensal bacteria independent of the ability to culture them. The composition of the commensal microbiome is dependent on bacterial diversity and the state of the host regulated by the immune system. Candida species are well known as components of the commensal oral microbiota. Candida species frequently colonize and develop biofilms on medical devices like dentures and catheters. Therefore, Candida biofilm on dentures leads to a decrease in the bacterial diversity and then to a change in the composition of the oral microbiota. A disturbance in the balance between commensal bacteria and the host immune system results in a switch from a healthy state to a diseased state even in the limited oral niche.
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21
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Premkumar J, Ramani P, Chandrasekar T, Natesan A, Premkumar P. Detection of species diversity in oral candida colonization and anti-fungal susceptibility among non-oral habit adult diabetic patients. J Nat Sci Biol Med 2014; 5:148-54. [PMID: 24678215 PMCID: PMC3961921 DOI: 10.4103/0976-9668.127315] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives: Patients with diabetes mellitus are prone to secondary infections. In this study we aim to determine the prevalence of one such secondary infection (oral Candida colonization) and evaluate the influence of local and systemic factors on the oral candidal colonization in patients with diabetes mellitus. Materials and Methods: Forty non-insulin-dependent diabetic patients and 40 healthy individuals were included in this study. Samples were collected by using the oral rinse method. The candidal species were isolated and identified through phenotypic methods. An in vitro antifungal susceptibility profile was evaluated. Glycemic control, as determined by the glycosylated hemoglobin concentrations (HbA1c) of the study subjects, was correlated with the candidal colonization. Results: Patients with diabetes showed a significantly higher prevalence of candidal colonization. The rate of carriage and density (P = 0.001) was higher. Candida albicans was the most predominantly isolated species, however, C. dubliniensis, C. tropicalis, and C. parapsilosis were also observed. Variable resistance toward the antifungal drugs (amphotericin B and fluconazole) was observed in the Candida isolated from diabetics, but not from healthy patients. Interestingly, a positive correlation was observed between glycemic control and candidal colonization. Conclusion: Diabetic patients had a higher candidal carriage rate, with a variety of candidal strains, which significantly varied in their resistance to routinely used anti-fungal agents. Interestingly the higher oral candidal colonization in diabetic patients is related to local and systemic factors, independent of their oral habits.
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Affiliation(s)
- Jeyanthi Premkumar
- Department of Oral and Maxillofacial Pathology, College of Dental Sciences and Hospital, Rau, Indore, India
| | - Pratibha Ramani
- Department of Oral and Maxillofacial Pathology, Saveetha Dental College, Chennai, India
| | | | - Anuja Natesan
- Department of Oral and Maxillofacial Pathology, Saveetha Dental College, Chennai, India
| | - Priya Premkumar
- Department of Oral and Maxillofacial Pathology, Saveetha Dental College, Chennai, India
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22
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Fangtham M, Magder LS, Petri MA. Oral candidiasis in systemic lupus erythematosus. Lupus 2014; 23:684-90. [PMID: 24598219 DOI: 10.1177/0961203314525247] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 01/27/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We assessed the frequency of oral candidiasis and the association between demographic variables, disease-related variables, corticosteroid treatment, other treatments and the occurrence of oral candidiasis in the Hopkins Lupus Cohort. METHODS In this large prospective cohort study of 2258 patients with systemic lupus erythematosus (SLE), demographic and clinical associates of oral candidiasis were estimated by univariate, multivariate and within-person regression models. RESULTS There were 53,548 cohort visits. Oral candidiasis was diagnosed at 675 visits (1.25%) in 325 (14%) of the patients. In the multivariate analyses, oral candidiasis was associated with African-American ethnicity, SELENA-SLEDAI disease activity, high white blood cell count, a history of bacterial infection, prednisone use and immunosuppressive use. The urine protein by urine dip stick was higher in SLE patients with oral candidiasis. Considering only patients who had candidiasis at some visits in a 'within-person' analysis, candidiasis was more frequent in visits with higher SELENA-SLEDAI disease activity, high white blood cell count, proteinuria by urine dip stick, a history of bacterial infection and prednisone use. The use of hydroxychloroquine was associated with a lower risk of oral candidiasis, but was not statistically significant (p = 0.50) in the within-person analysis models. CONCLUSION This study identified multiple risk factors for oral candidiasis in SLE. Inspection of the oral cavity for signs of oral candidiasis is recommended especially in SLE patients with active disease, proteinuria, high white blood cell count, taking prednisone, immunosuppressive drugs or antibiotics.
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Affiliation(s)
- M Fangtham
- Johns Hopkins University, School of Medicine Division of Rheumatology, Baltimore, MD, USA
| | - L S Magder
- University of Maryland Department of Epidemiology and Public Health, Baltimore, MD, USA
| | - M A Petri
- Johns Hopkins University, School of Medicine Division of Rheumatology, Baltimore, MD, USA
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Thanyasrisung P, Kesakomol P, Pipattanagovit P, Youngnak-Piboonratanakit P, Pitiphat W, Matangkasombut O. Oral Candida carriage and immune status in Thai human immunodeficiency virus-infected individuals. J Med Microbiol 2014; 63:753-759. [PMID: 24591706 DOI: 10.1099/jmm.0.069773-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Oral candidiasis is a common opportunistic infection among human immunodeficiency virus (HIV)-infected individuals, with growing concerns about the emergence of non-albicans species with resistance to antifungal agents. This cross-sectional study determined the prevalence of oral Candida species in Thai HIV-infected adults and factors affecting their colonization. Candida species were identified from oral rinse samples of 60 HIV-infected participants of the MTCT-Plus initiative and 49 healthy controls by culture-based and molecular assays. The prevalence of oral Candida carriage was similar in HIV-infected patients (56.6 %) and in controls (55.1 %, P = 0.87). Candida albicans was the most predominant species in both groups (94.1 % of Candida carriers in HIV, 88.9 % in control). Interestingly, Candida dubliniensis was the second most common species in controls (29.6 %) and the third in HIV-infected patients (11.8 %, P = 0.08). Multivariate analysis showed that, amongst HIV-infected individuals, CD4 count <200 cells mm(-3) was associated with increased prevalence of oral carriage of both C. albicans (P = 0.03) and non-albicans species (P = 0.03). Moreover, patients with tuberculosis infection had a higher prevalence of the non-albicans species than those without (P = 0.03). Intriguingly, contraceptive use was also associated positively with non-albicans and multi-species carriage (P = 0.04 for both). However, use of antiretroviral drugs protected the patients from Candida carriage (P = 0.03), especially from C. albicans (P = 0.02). In conclusion, while HIV-infected individuals had a similar prevalence of oral Candida carriage to that of the control group, host immune status, tuberculosis infection, and contraceptive use may influence oral colonization of Candida, especially of the non-albicans species.
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Affiliation(s)
- Panida Thanyasrisung
- Department of Microbiology and DRU on Oral Microbiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Piyanate Kesakomol
- Interdepartmental Program in Medical Microbiology, Graduate School, Chulalongkorn University, Bangkok, Thailand
| | - Patchara Pipattanagovit
- Department of Microbiology and DRU on Oral Microbiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | | | - Waranuch Pitiphat
- Department of Community Dentistry, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Oranart Matangkasombut
- Department of Microbiology and DRU on Oral Microbiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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Tsai PW, Chen YT, Hsu PC, Lan CY. Study of Candida albicans and its interactions with the host: A mini review. Biomedicine (Taipei) 2013. [DOI: 10.1016/j.biomed.2012.12.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Cavaleiro I, Proença L, Félix S, Salema-Oom M. Prevalence of Yeast Other than Candida albicans
in Denture Wearers. J Prosthodont 2013; 22:351-7. [DOI: 10.1111/jopr.12005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2012] [Indexed: 11/26/2022] Open
Affiliation(s)
- Inês Cavaleiro
- Instituto Superior Ciências da Saúde Egas Moniz; Centro de Investigação Interdisciplinar Egas Moniz (CiiEM); Caparica Portugal
| | - Luis Proença
- Instituto Superior Ciências da Saúde Egas Moniz; Centro de Investigação Interdisciplinar Egas Moniz (CiiEM); Caparica Portugal
- Faculdade de Ciências da Universidade de Lisboa; Centro de Ciências Moleculares e Materiais (CCMM); Lisboa Portugal
| | - Sérgio Félix
- Instituto Superior Ciências da Saúde Egas Moniz; Centro de Investigação Interdisciplinar Egas Moniz (CiiEM); Caparica Portugal
| | - Madalena Salema-Oom
- Instituto Superior Ciências da Saúde Egas Moniz; Centro de Investigação Interdisciplinar Egas Moniz (CiiEM); Caparica Portugal
- Faculdade de Ciência e Tecnologia da Universidade Nova de Lisboa; Centro de Recursos Microbiológicos (CREM); Caparica Portugal
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Li X, Lei L, Tan D, Jiang L, Zeng X, Dan H, Liao G, Chen Q. Oropharyngeal Candida colonization in human immunodeficiency virus infected patients. APMIS 2012; 121:375-402. [PMID: 23030258 DOI: 10.1111/apm.12006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 08/26/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Xiaoxu Li
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu; China
| | - Lei Lei
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu; China
| | - Dan Tan
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu; China
| | - Lu Jiang
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu; China
| | - Xin Zeng
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu; China
| | - Hongxia Dan
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu; China
| | - Ga Liao
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu; China
| | - Qianming Chen
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu; China
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27
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Owotade FJ, Patel M, Ralephenya TRMD, Vergotine G. Oral Candida colonization in HIV-positive women: associated factors and changes following antiretroviral therapy. J Med Microbiol 2012; 62:126-132. [PMID: 23002070 DOI: 10.1099/jmm.0.047522-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
There is a paucity of information about the factors associated with oral colonization with Candida species and the changes associated with antiretroviral (ARV) therapy. This study investigated the role of ARV therapy and other factors in a study population. Relevant clinical and laboratory information was obtained and oral rinse specimens were tested for yeast identification. The findings were compared with previous data from the same clinic before ARV therapy was available. Of 197 patients, 117 (59.4 %) were colonized. Candida albicans was the dominant species (71 %) and Candida dubliniensis was the most frequent non-albicans Candida. The colonized group had a higher rate of concurrent tuberculosis (TB) infection (77.4 % compared with 56 % in the non-colonized patients, P = 0.03) and a lower median CD4(+) count (346.5 cells mm(-3)) compared with the non-colonized group (418 cells mm(-3)). Participants not on ARV therapy and those having oral prosthesis were all colonized (P = 0.003 and P = 0.022, respectively). The oral Candida count was negatively correlated with the CD4(+) count in participants on ARV therapy (P = 0.006). Associated factors using logistic regression were dental caries (odds ratio = 1.30; 95 % confidence interval = 1.07-1.60] and diabetes mellitus (odds ratio = 5.52; 95 % confidence interval = 1.68-18.12). The colonization rate was higher (81.3 %) as well as the yeast count before ARV therapy was available, while the prevalence of C. dubliniensis was found to have increased from 6.3 to 11 %. Dental caries, diabetes mellitus, oral prostheses and TB infection were associated with oral colonization. The colonization rate, variety and yeast counts declined with ARV therapy.
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Affiliation(s)
- Foluso J Owotade
- Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria
- Division of Oral Microbiology, Clinical Microbiology and Infectious Diseases, School of Pathology, National Health Laboratory Services and Faculty of Health Sciences, University of The Witwatersrand, Johannesburg, South Africa
| | - Mrudula Patel
- Division of Oral Microbiology, Clinical Microbiology and Infectious Diseases, School of Pathology, National Health Laboratory Services and Faculty of Health Sciences, University of The Witwatersrand, Johannesburg, South Africa
| | - Tshakane R M D Ralephenya
- School of Oral Health Sciences, Faculty of Health Sciences, University of The Witwatersrand, Johannesburg, South Africa
| | - Glynnis Vergotine
- School of Oral Health Sciences, Faculty of Health Sciences, University of The Witwatersrand, Johannesburg, South Africa
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Moris DV, Melhem MSC, Martins MA, Souza LR, Kacew S, Szeszs MW, Carvalho LR, Pimenta-Rodrigues MV, Berghs HAM, Mendes RP. Prevalence and antifungal susceptibility of Candida parapsilosis complex isolates collected from oral cavities of HIV-infected individuals. J Med Microbiol 2012; 61:1758-1765. [PMID: 22956748 DOI: 10.1099/jmm.0.045112-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
At present, few data are available on the prevalence and antifungal susceptibility of Candida parapsilosis complex isolates from HIV-infected individuals. The C. parapsilosis complex comprises three species, C. parapsilosis sensu stricto, C. metapsilosis and C. orthopsilosis. Fifteen of 318 Candida isolates were identified as members of the C. parapsilosis complex by PCR and restriction fragment length polymorphism (RFLP). The prevalence of C. parapsilosis complex isolates was 4.7 %, 2.2 % being identified as C. parapsilosis sensu stricto and 2.5 % as C. metapsilosis, while no C. orthopsilosis was isolated. This is believed to be the first study that has identified isolates of C. metapsilosis obtained from the oral cavity of HIV-infected individuals. Antifungal susceptibility tests indicated that all the isolates were susceptible to amphotericin B (AMB), fluconazole (FLC), ketoconazole (KTC), itraconazole (ITC), voriconazole (VRC) and caspofungin (CASPO). Although isolates of C. parapsilosis sensu stricto and C. metapsilosis were susceptible to FLC, isolates of C. metapsilosis showed a tendency for higher MICs (≥1.0 µg ml(-1)). Based upon the frequency of candidiasis and the fact that certain isolates of the C. parapsilosis complex respond differently to FLC therapy, our data may be of therapeutic relevance with respect to susceptibility and potential resistance to specific antifungal agents. Our data suggest that C. metapsilosis can be a human commensal; its importance as a pathogen has yet to be confirmed.
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Affiliation(s)
- D V Moris
- Departamento de Doenças Tropicais e Diagnóstico por Imagem, Faculdade de Medicina de Botucatu, UNESP, Botucatu, São Paulo State, Brazil
| | | | | | - L R Souza
- Departamento de Doenças Tropicais e Diagnóstico por Imagem, Faculdade de Medicina de Botucatu, UNESP, Botucatu, São Paulo State, Brazil
| | - S Kacew
- Institute for Population Health, University of Ottawa, Ontario, Canada
| | - M W Szeszs
- Instituto Adolfo Lutz, São Paulo, Brazil
| | - L R Carvalho
- Departamento de Bioestatística, Instituto de Biociências, UNESP, Botucatu, São Paulo State, Brazil
| | - M V Pimenta-Rodrigues
- Departamento de Doenças Tropicais e Diagnóstico por Imagem, Faculdade de Medicina de Botucatu, UNESP, Botucatu, São Paulo State, Brazil
| | | | - R P Mendes
- Departamento de Doenças Tropicais e Diagnóstico por Imagem, Faculdade de Medicina de Botucatu, UNESP, Botucatu, São Paulo State, Brazil
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Candida and candidiasis in HIV-infected patients: where commensalism, opportunistic behavior and frank pathogenicity lose their borders. AIDS 2012; 26:1457-72. [PMID: 22472853 DOI: 10.1097/qad.0b013e3283536ba8] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In this era of efficacious antiretroviral therapy and consequent immune reconstitution, oropharyngeal and esophageal candidiasis (OPC and OEC) still remain two clinically relevant presentations in the global HIV setting. Both diseases are predominantly caused by Candida albicans, a polymorphic fungus which is a commensal microbe in the healthy individual but can become an aggressive pathogen in a debilitated host. Actually, C. albicans commensalism is not the result of a benign behavior of one of the many components of human microbiota, but rather the result of host's potent innate and adaptive immune responses that restrict the growth of a potentially dangerous microrganism on the epithelia. An important asset guarding against the fungus is the Th17 functional subset of T helper cells. The selective loss of these cells with the progression of HIV infection causes the decay of fungal containment on the oral epithelium and allows C. albicans to express its pathogenic potential. An important part of this potential is represented by mechanisms to evade host immunity and enhance inflammation and immunoactivation. In C. albicans, these mechanisms are mostly incorporated into and expressed by characteristic morphogenic transitions such as the yeast-to-hyphal growth and the white-to-opaque switch. In addition, HIV infection generates an 'environment' selecting for overexpression of the virulence potential by the fungus, particularly concerning the secreted aspartyl proteinases (Saps). These enzymes can degrade critical host defense components such as complement and epithelial defensive proteins such as histatin-5 and E-cadherin. It appears that part of this enhanced Candida virulence could be induced by the binding of the fungus to HIV and/or induced by HIV proteins such as GP160 and tat. Both OPC and OEC can be controlled by old and new antimycotics, but in the absence of host collaboration, anticandidal therapy may become ineffective in the long run. For these reasons, new therapeutics targeting virulence factors and specific immune interventions are being addressed. Among these new approaches, vaccination is a promising one. Two subunit vaccines based on antigens dominantly expressed by C. albicans in vivo, that is the Als3 adhesin and Sap2, have recently undergone phase 1 clinical trials. Overall, studies of Candida and candidiasis in the HIV-positive patient while certainly contributing to a more effective control of the microorganism may also provide useful information on HIV-host relationship itself that can assist the fight against the virus.
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Sidrim JJC, Perdigão-Neto LV, Cordeiro RA, Brilhante RSN, Leite JJG, Teixeira CEC, Monteiro AJ, Freitas RMF, Ribeiro JF, Mesquita JRL, Gonçalves MVF, Rocha MFG. Viral protease inhibitors affect the production of virulence factors in Cryptococcus neoformans. Can J Microbiol 2012; 58:932-6. [PMID: 22716223 DOI: 10.1139/w2012-075] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The effects of the protease inhibitors saquinavir, darunavir, ritonavir, and indinavir on growth inhibition, protease and phospholipase activities, as well as capsule thickness of Cryptococcus neoformans were investigated. Viral protease inhibitors did not reduce fungal growth when tested in concentrations ranging from 0.001 to 1.000 mg/L. A tendency toward increasing phospholipase activity was observed with the highest tested drug concentration in a strain-specific pattern. However, these drugs reduced protease activity as well as capsule production. Our results confirm a previous finding that antiretroviral drugs affect the production of important virulence factors of C. neoformans.
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Affiliation(s)
- J J C Sidrim
- Department of Pathology and Legal Medicine, School of Medicine, Specialized Medical Mycology Center, Postgraduate Program in Medical Microbiology, Federal University of Ceará, Campus do Porangabussu, Fortaleza-CE, Brazil
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31
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Wu CJ, Lee HC, Yang YL, Chang CM, Chen HT, Lin CC, Lee NY, Chu WL, Hsieh LY, Wang YL, Lauderale TL, Tseng FC, Ko NY, Ko WC, Lo HJ. Oropharyngeal yeast colonization in HIV-infected outpatients in southern Taiwan: CD4 count, efavirenz therapy and intravenous drug use matter. Clin Microbiol Infect 2011; 18:485-90. [PMID: 21939471 DOI: 10.1111/j.1469-0691.2011.03655.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To understand the status of oropharyngeal yeast colonization in human immunodeficiency virus (HIV) -infected outpatients in the era of highly active antiretroviral therapy (HAART), we conducted a prospective, cross-sectional study from October 2009 to January 2010 at a medical centre in southern Taiwan. Fungal cultures of the oropharyngeal swabs were performed on 327 enrolled patients. At enrolment, 258 (79%) patients had been receiving HAART, and 42 (12.8%), 73 (22.3%) and 212 (64.8%) patients had CD4 cell counts ≤200, 201-350, and >350 cells/mm(3) , respectively. Oral yeast colonization was detected in 193 (59%) patients, among whom 157 (81.3%), 25 (13.0%), and 11 (5.7%) were colonized by a single, two and more than two species, respectively. Multivariate analysis showed that receipt of efavirenz-containing regiments and CD4 cell counts >200 cells/mm(3) were associated with lower risks of oral yeast colonization, while intravenous drug users were at a higher risk. Among the 241 isolates recovered, Candida albicans accounted for 69.7%, followed by C. dubliniensis (9.5%), C. glabrata (8.3%), C. tropicalis (3.3%), C. intermedia (2.1%), C. parapsilosis (1.7%), and 11 other species (5.4%). Overall, 230 (95.4%), 236 (97.9%) and 240 (99.6%) isolates were susceptible to fluconazole, voriconazole and amphotericin B, respectively. In conclusion, colonization by C. dubliniensis has emerged in recent years. In addition to a CD4 cell count ≤200 cells/mm(3) , which is a known risk factor for oropharyngeal yeast colonization in HIV-infected patients that was identified in our previous studies, two risk factors, non-receipt of efavirenz-based combinations and intravenous drug use, were first identified in the present study. Fluconazole remained effective in vitro against the yeasts colonizing the oropharynx in this population.
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Affiliation(s)
- C-J Wu
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, Taiwan
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Sardi JCO, Almeida AMF, Mendes Giannini MJS. New antimicrobial therapies used against fungi present in subgingival sites--a brief review. Arch Oral Biol 2011; 56:951-9. [PMID: 21676377 DOI: 10.1016/j.archoralbio.2011.03.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 03/16/2011] [Accepted: 03/17/2011] [Indexed: 01/14/2023]
Abstract
Although the main reservoir of Candida spp. is believed to be the buccal mucosa, these microorganisms can coaggregate with bacteria in subgingival biofilm and adhere to epithelial cells. The treatment of periodontal disease includes scaling and root planning (SRP) associated with proper oral hygiene. However, some patients may have negative responses to different therapeutic procedures, with a continuous loss of insertion, so the use of antimicrobials is needed as an adjuvant to SRP treatment. The use of a broad-spectrum antibiotic, such as tetracycline and metronidazole, as an aid in periodontal treatment has also been a factor for the development of superinfections by resistant bacteria and Candida species, even in patients with HIV. In the dental practice, the most commonly used antifungals are nystatin and fluconazole. However, the introduction of new drugs like the next generation of azoles is essential before the onset of emergent species in periodontal disease. Plants are good options for obtaining a wide variety of drugs. This alternative could benefit a large population that uses plants as a first treatment option. Plants have been used in medicine for a long time and are extensively used in folk medicine, because they represent an economic alternative, are easily accessible and are applicable to various diseases. Herein, we briefly review the literature pertaining the presence of Candida sp. in periodontal pockets, the conventional antifungal resistance and new therapies that include natural antifungal agents are reviewed.
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Affiliation(s)
- Janaina Cássia Orlandi Sardi
- Faculty of Pharmaceutical Sciences of Araraquara, Department of Clinical Analysis, Laboratory of Clinical Mycology, Univ Estadual Paulista, UNESP, Araraquara, SP, Brazil
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Portela MB, Souza IP, Abreu CM, Bertolini M, Holandino C, Alviano CS, Santos AL, Soares RM. Effect of serine-type protease of Candida spp. isolated from linear gingival erythema of HIV-positive children: critical factors in the colonization. J Oral Pathol Med 2010; 39:753-60. [DOI: 10.1111/j.1600-0714.2010.00906.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Genetic variation of innate immune genes in HIV-infected african patients with or without oropharyngeal candidiasis. J Acquir Immune Defic Syndr 2010; 55:87-94. [PMID: 20577092 DOI: 10.1097/qai.0b013e3181e53c64] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The occurrence of oropharyngeal candidiasis (OPC) in combination with HIV disease progression is a very common phenomenon. However, not all HIV-infected patients develop OPC, even when they progress to low CD4 T-cell counts. Because T-cell immunity is defective in AIDS, the innate defence mechanisms are likely to have a central role in antifungal immunity in these patients. We investigated whether genetic variations in the innate immune genes DECTIN-1, TLR2, TLR4, TIRAP, and CASPASE-12 are associated with the presence of OPC in HIV-infected subjects from East Africa. METHODS A total of 225 HIV patients were genotyped for several single nucleotide polymorphisms (SNPs), and this was correlated with the occurrence of OPC in these patients. In addition, primary immune cells obtained from individuals with different genotypes were stimulated with Candida albicans, and cytokine production was measured. RESULTS The analysis revealed that no significant differences in the polymorphism frequencies could be observed, although a tendency toward a protective effect on OPC of the DECTIN-1 I223S SNP was apparent. Furthermore, interferon gamma production capacity was markedly lower in cells bearing the DECTIN-1 SNP I223S. It could also be demonstrated that the 223S mutated form of the DECTIN-1 gene exhibits a lower capacity to bind zymosan. CONCLUSIONS These data demonstrate that common polymorphisms of TLR2, TLR4, TIRAP, and CASPASE-12 do not influence susceptibility to OPC in HIV-infected patients in East Africa but suggest an immunomodulatory effect of the I223S SNP on dectin-1 function and possibly the susceptibility to OPC in HIV patients.
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Oropharyngeal colonization of HIV-infected outpatients in Taiwan by yeast pathogens. J Clin Microbiol 2010; 48:2609-12. [PMID: 20444970 DOI: 10.1128/jcm.00500-10] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Among 234 isolates comprising 26 different Candida species colonizing the oropharynx of 181 (54.3% of 399 surveyed) HIV-infected outpatients, 27 (11.7%) were fluconazole resistant. Antibacterial treatment was associated with increased rates of yeast colonization, while antiretroviral therapy and pneumococcal vaccination protected patients from yeast colonization.
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36
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Pupulin ART, Carvalho PG, Nishi L, Nakamura CV, Guilherme ALF. [Enteropathogens relating to diarrhea in HIV patients on antiretroviral therapy]. Rev Soc Bras Med Trop 2010; 42:551-5. [PMID: 19967238 DOI: 10.1590/s0037-86822009000500013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 08/28/2009] [Indexed: 11/21/2022] Open
Abstract
The etiology of the diarrheic process in AIDS may be caused by viruses, bacteria, fungi, protozoa or helminths, as well as HIV itself. This study evaluated enteropathogens relating to diarrhea in HIV patients who were on antiretroviral therapy. The parasitological methods used were Faust, Hoffmann and Kinyoun. Isolation and culturing of fungi were carried out in accordance with the methodology recommended by the NCCLS M27-A standard. The yeast species were identified using the polymerase chain reaction (PCR). Bacteria were isolated on MacConkey and SS agar and the species were identified using Enterokit B (Probac do Brasil) and biochemical methods. Forty-nine patients were evaluated: 44.89% presented enteroparasites and 48.1% presented Candida sp, of which 61.5% were Candida albicans, 7.6% were Candida sp and 30.7% were Candida non-albicans. Bacteria were isolated from 72% of the patients, of which 49% were Escherichia coli, 13% Salmonella parathyphi, Klebsiella sp or Proteus and 6% Citrobacter freundii or Yersinia sp. There was high prevalence of Candida sp in HIV patients with diarrhea and non-albicans species were isolated. Their presence could be taken to mean that they were accomplices in or causes of the infection.
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37
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Loreto ES, Scheid LA, Nogueira CW, Zeni G, Santurio JM, Alves SH. Candida dubliniensis: Epidemiology and Phenotypic Methods for Identification. Mycopathologia 2010; 169:431-43. [PMID: 20490751 DOI: 10.1007/s11046-010-9286-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 02/04/2010] [Indexed: 11/26/2022]
Affiliation(s)
- Erico Silva Loreto
- Departamento de Química, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
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Witzel AL, Silveira FRXD, Pires MDFC, Lotufo MA. Oral candidiasis in HIV+ patients under treatment with protease inhibitors. Braz Oral Res 2009; 22:371-7. [PMID: 19148395 DOI: 10.1590/s1806-83242008000400015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Accepted: 10/12/2007] [Indexed: 11/22/2022] Open
Abstract
The purpose of this work was to evaluate the influence of Protease Inhibitors (PI) on the occurrence of oral candidiasis in 111 HIV+ patients under PI therapy (Group A). The controls consisted of 56 patients that were not using PI drugs (Group B) and 26 patients that were not using any drugs for HIV therapy (Group C). The patient's cd4 cell counts were taken in account for the correlations. One hundred and ninety three patients were evaluated. The PI did not affect the prevalence of oral candidiasis (p = 0.158) or the frequency of C. albicans isolates (p = 0.133). Patients with lower cd4 cell counts showed a higher frequency of C. albicans isolates (p = 0.046) and a greater occurrence of oral candidiasis (p = 0.036).
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Dongari-Bagtzoglou A, Dwivedi P, Ioannidou E, Shaqman M, Hull D, Burleson J. Oral Candida infection and colonization in solid organ transplant recipients. ACTA ACUST UNITED AC 2009; 24:249-54. [PMID: 19416456 DOI: 10.1111/j.1399-302x.2009.00505.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Oral Candida carriage and infection have been reported to be associated with a greater risk for systemic infection in transplant recipients; however, a systematic analysis of the oral Candida titers and species has not been previously conducted. The objectives of this study were to determine the prevalence of oropharyngeal candidiasis, the oral carrier status, Candida titers and species in this population. METHODS Ninety kidney and heart transplant subjects and 72 age-matched healthy controls were included. Swabs from the oral mucosa and a standardized amount of unstimulated saliva were plated on Chromagar Candida, and colony-forming units per millilitre were calculated. Initial speciation was based on colony color and was confirmed by standard germ tube, biotyping, or polymerase chain reaction assays. RESULTS Infection with C. albicans was detected in seven transplant subjects and none of the controls. The transplant group had significantly higher oral Candida titers than the control group. There were no statistically significant relationships between the dose or type of immunosuppressants and oral Candida titers or infection. A significantly higher percentage of transplant subjects were colonized by more than one species, compared with control subjects. The most frequent species combination in transplant subjects was C. albicans and C. glabrata. C. glabrata was isolated from 13.5% of transplant carriers and none of the controls. CONCLUSIONS Increased oral Candida infection and carriage titers were found in the transplant population. Although the majority of transplant patients were colonized by C. albicans, C. glabrata appears to emerge as the second most prevalent species.
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Affiliation(s)
- A Dongari-Bagtzoglou
- Department of Oral Health and Diagnostic Sciences, Division of Periodontology, School of Dental Medicine, University of Connecticut Health Center, Farmington, CT 06030-1710, USA.
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Delgado A, de Jesus Pedro R, Aoki F, Resende M, Trabasso P, Colombo A, de Oliveira M, Mikami Y, Moretti M. Clinical and microbiological assessment of patients with a long-term diagnosis of human immunodeficiency virus infection and Candida oral colonization. Clin Microbiol Infect 2009; 15:364-71. [DOI: 10.1111/j.1469-0691.2009.02707.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Girish Kumar CP, Menon T, Rajasekaran S, Sekar B, Prabu D. Carriage of Candida species in oral cavities of HIV infected patients in South India. Mycoses 2008; 52:44-8. [PMID: 18522700 DOI: 10.1111/j.1439-0507.2008.01534.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Fifty-four patients with human immunodeficiency virus (HIV) infection were studied to assess the load of oral carriage of Candida spp. The mean oral Candida carriage density (30,305.93 +/- 56,643.93 CFU ml(-1)) in HIV patients was significantly higher than that seen in the control population (93.48 +/- 358.48 CFU ml(-1); P = 0.000). The mean Candida load in HIV patients with oral thrush (46,591.43 +/- 65,002.57 CFU ml(-1)) was significantly higher than in the HIV subjects without oral thrush (306.32 +/- 699.50 CFU ml(-1); P = 0.000). Non-C. albicans Candida species (56%) were more predominant than the C. albicans (44%) isolates. 25S rDNA PCR analysis of C. albicans revealed preponderance of genotype A strains. Interestingly, 42.6% of rinse specimens grew multiple Candida species, with the combination of C. albicans and C. krusei (39.1%) being the most frequent.
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Affiliation(s)
- C P Girish Kumar
- Department of Microbiology, Dr A. L. Mudaliar Post Graduate Institute of Basic Medical Sciences, University of Madras, Taramani, Chennai, Tamil Nadu, India
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Ranganathan K, Narasimhan P, Vidya KM, Gunaseelan R, Kumarasamy N, Solomon S, Samaranayake LP. Oral Candida species in healthy and HIV-infected subjects in Chennai, South India. Trop Med Health 2008. [DOI: 10.2149/tmh.2007-28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Erköse G, Erturan Z. Oral Candida colonization of human immunodeficiency virus infected subjects in Turkey and its relation with viral load and CD4+T-lymphocyte count. Mycoses 2007; 50:485-90. [PMID: 17944711 DOI: 10.1111/j.1439-0507.2007.01393.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Gonca Erköse
- Department of Microbiology and Clinical Microbiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Duran N, Öztürk F, Açık L, Aslantaş Ö, Aslan G. NUMERICAL ANALYSIS OF CANDIDA SPECIES FROM URINER SYSTEM INFECTIONS BASED ON SDS-PAGE AND DETECTION OF ANTIFUNGAL RESISTANCE. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2007. [DOI: 10.29333/ejgm/82501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Candida in oral lichen planus patients undergoing topical steroid therapy. ACTA ACUST UNITED AC 2007; 104:61-6. [PMID: 17261374 DOI: 10.1016/j.tripleo.2006.10.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2006] [Revised: 09/01/2006] [Accepted: 10/23/2006] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the incidence, intensity, and species of Candida in the oral cavity of oral lichen planus (OLP) patients who were being treated with a topical steroid. STUDY DESIGN The incidence and intensity of oral Candida carriage were assessed by salivary and imprint cultures. Cytological smears were used to investigate the presence of Candida spores and hyphae in the OLP lesions. Candida species were identified by a chlamydospore formation test and the API 20C system. RESULTS The salivary cultures were positive in 76.7% of the OLP patients and 43.3% of the controls (P = .008), whereas the imprint cultures were positive in 76.7% of the OLP patients and 40% of the controls (P = .004). A high-level Candida count in saliva was more frequently found in the OLP patients than in the controls (73.9% vs. 38.5%; P = .004). The mean scores of Candida growth from imprint cultures were higher in OLP patients than in the controls (P = .002). The mean scores of Candida growth were also higher in OLP patients who were taking xerogenic or immunosuppressive drugs (P = .038) and in OLP denture wearers (P = .022). Spores and hyphae were detected in 83.3% of the OLP lesions. Candida albicans, the most frequently isolated yeast, was found in 76.7% OLP patients and 40% of the controls. CONCLUSIONS The results of this study indicate that topical steroids induce Candida growth and the associated risk factors are age, medication use, and the wearing of dentures.
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Perlroth J, Choi B, Spellberg B. Nosocomial fungal infections: epidemiology, diagnosis, and treatment. Med Mycol 2007; 45:321-46. [PMID: 17510856 DOI: 10.1080/13693780701218689] [Citation(s) in RCA: 487] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Invasive fungal infections are increasingly common in the nosocomial setting. Furthermore, because risk factors for these infections continue to increase in frequency, it is likely that nosocomial fungal infections will continue to increase in frequency in the coming decades. The predominant nosocomial fungal pathogens include Candida spp., Aspergillus spp., Mucorales, Fusarium spp., and other molds, including Scedosporium spp. These infections are difficult to diagnose and cause high morbidity and mortality despite antifungal therapy. Early initiation of effective antifungal therapy and reversal of underlying host defects remain the cornerstones of treatment for nosocomial fungal infections. In recent years, new antifungal agents have become available, resulting in a change in standard of care for many of these infections. Nevertheless, the mortality of nosocomial fungal infections remains high, and new therapeutic and preventative strategies are needed.
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Affiliation(s)
- Joshua Perlroth
- Division of Infectious Diseases, Harbor-University of California Los Angeles (UCLA) Medical Center, California 90502, USA
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Odds FC, Davidson AD, Jacobsen MD, Tavanti A, Whyte JA, Kibbler CC, Ellis DH, Maiden MCJ, Shaw DJ, Gow NAR. Candida albicans strain maintenance, replacement, and microvariation demonstrated by multilocus sequence typing. J Clin Microbiol 2006; 44:3647-58. [PMID: 17021093 PMCID: PMC1594753 DOI: 10.1128/jcm.00934-06] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2006] [Revised: 05/18/2006] [Accepted: 07/24/2006] [Indexed: 11/20/2022] Open
Abstract
We typed 165 Candida albicans isolates from 44 different sources by multilocus sequence typing (MLST) and ABC typing of rRNA genes and determined their homozygosity or heterozygosity at the mating-type-like locus (MTL). The isolates represented pairs or larger sets from individual sources, which allowed the determination of strain diversity within patients. A comparison of replicate sequence data determined a reproducibility threshold for regarding isolates as MLST indistinguishable. For 36 isolate sets, MLST and ABC typing showed indistinguishable or highly related strain types among isolates from different sites or from the same site at different times from each patient. This observation included 11 sets with at least one isolate from a blood culture and a nonsterile site from the same patient. For one patient, strain replacement was evidenced in the form of two sets of isolates from different hospital admissions where the strain types within each set were nearly identical but where the two sets differed both by MLST and ABC typing. MLST therefore confirms the existing view of C. albicans strain carriage. Microvariation, evidenced as small differences between MLST types, resulted in most instances from a loss of heterozygosity at one or more of the sequenced loci. Among isolate sets that showed major strain type differences, some isolates could be excluded as likely examples of handling errors during storage. However, for a minority of isolates, intermittent differences in ABC type for tightly clustered MLST types and intermittent appearances of MTL homozygosity lead us to propose that some C. albicans isolates, or all isolates under yet-to-be-determined conditions, maintain a high level of genetic diversity by mechanisms such as recombination, gene conversion, or chromosomal ploidy change.
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Affiliation(s)
- F C Odds
- Aberdeen Fungal Group, Institute of Medical Sciences, Aberdeen AB25 2ZD, United Kingdom.
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Heggelund L, Mollnes TE, Espevik T, Müller F, Kristiansen KI, Aukrust P, Frøland SS. Modulatory effect of mannose-binding lectin on cytokine responses: possible roles in HIV infection. Eur J Clin Invest 2005; 35:765-70. [PMID: 16313253 DOI: 10.1111/j.1365-2362.2005.01579.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mannose-binding lectin (MBL) is a soluble receptor of the innate immune system, probably contributing to antimicrobial defence. The possible role of MBL in HIV infection is unclear. MATERIALS AND METHODS Peripheral blood mononuclear cells (PBMCs) from 28 HIV-infected patients and 13 healthy controls were stimulated with MBL and costimulated with HIV-1 gp120 or mannan from Saccharomyces cerevisiae before inflammatory responses in PBMC cultures were examined by enzyme-linked immunosorbent assay (ELISA) and flow cytometry. HIV-1 RNA replication in vitro was assessed by quantitative reverse transcription polymerase chain reaction (RT-PCR) in supernatants from patients with measurable HIV-1 RNA levels. RESULTS (i) Enhanced TNF-alpha responses were observed when PBMCs from healthy controls and HIV-infected patients were stimulated with MBL and costimulated with HIV-1 gp120 or mannan. (ii) MBL stimulation induced increased HIV RNA replication in culture supernatants when costimulated with mannan. CONCLUSIONS The present study suggests a modulatory role of MBL on cytokine responses, and HIV replication after stimulation with microbial products. These effects of MBL on inflammatory responses and viral replication may be clinically relevant for HIV infection.
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Affiliation(s)
- L Heggelund
- Section of Clinical Immunology and Infectious Diseases, Medical Department, Research Institute for Internal Medicine, Rikshospitalet University Hospital, University of Oslo, Oslo, Norway.
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Abstract
Candida dubliniensis is a recently described species of pathogenic yeast that shares many phenotypic features with Candida albicans. It is primarily associated with oral colonization and infection in HIV-infected individuals. Isolates of C. dubliniensis are generally susceptible to commonly used azole antifungal agents; however, resistance has been observed in clinical isolates and can be induced by in vitro exposure. Molecular mechanisms of azole resistance in C. dubliniensis include increased drug efflux, modifications of the target enzyme and alterations in the ergosterol biosynthetic pathway.
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Sánchez-Vargas LO, Ortiz-López NG, Villar M, Moragues MD, Aguirre JM, Cashat-Cruz M, Lopez-Ribot JL, Gaitán-Cepeda LA, Quindós G. Oral Candida isolates colonizing or infecting human immunodeficiency virus-infected and healthy persons in Mexico. J Clin Microbiol 2005; 43:4159-62. [PMID: 16081965 PMCID: PMC1233912 DOI: 10.1128/jcm.43.8.4159-4162.2005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Oral yeast carriage was studied in 312 Mexican subjects. Candida albicans was the most frequent species, but other Candida spp. were isolated from 16.5 to 38.5% of patients. Colonization did not correlate with CD4+ number or viral load, but highly active antiretroviral therapy reduced the frequency of candidiasis. Most isolates were susceptible to fluconazole, but 10.8% were resistant to one or more azoles.
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Affiliation(s)
- Luis Octavio Sánchez-Vargas
- Laboratorio de Micología Médica, Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Odontología, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain, Facultad de Odontología, Universidad Nacional Autónoma de México, México DF, México, Laboratorio de Micología Médica, Departamento de Enfermería I, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain, Cátedra de Medicina Bucal, Departamento de Estomatología, Facultad de Medicina y Odontología, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain, Departamento de Epidemiología, Hospital Infantil de México Dr. Federico Gómez, México DF, Mexico, Department of Medicine, Division of Infectious Diseases, South Texas Centers for Biology in Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Natalia Guadalupe Ortiz-López
- Laboratorio de Micología Médica, Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Odontología, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain, Facultad de Odontología, Universidad Nacional Autónoma de México, México DF, México, Laboratorio de Micología Médica, Departamento de Enfermería I, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain, Cátedra de Medicina Bucal, Departamento de Estomatología, Facultad de Medicina y Odontología, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain, Departamento de Epidemiología, Hospital Infantil de México Dr. Federico Gómez, México DF, Mexico, Department of Medicine, Division of Infectious Diseases, South Texas Centers for Biology in Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - María Villar
- Laboratorio de Micología Médica, Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Odontología, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain, Facultad de Odontología, Universidad Nacional Autónoma de México, México DF, México, Laboratorio de Micología Médica, Departamento de Enfermería I, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain, Cátedra de Medicina Bucal, Departamento de Estomatología, Facultad de Medicina y Odontología, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain, Departamento de Epidemiología, Hospital Infantil de México Dr. Federico Gómez, México DF, Mexico, Department of Medicine, Division of Infectious Diseases, South Texas Centers for Biology in Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - María Dolores Moragues
- Laboratorio de Micología Médica, Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Odontología, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain, Facultad de Odontología, Universidad Nacional Autónoma de México, México DF, México, Laboratorio de Micología Médica, Departamento de Enfermería I, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain, Cátedra de Medicina Bucal, Departamento de Estomatología, Facultad de Medicina y Odontología, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain, Departamento de Epidemiología, Hospital Infantil de México Dr. Federico Gómez, México DF, Mexico, Department of Medicine, Division of Infectious Diseases, South Texas Centers for Biology in Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - José Manuel Aguirre
- Laboratorio de Micología Médica, Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Odontología, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain, Facultad de Odontología, Universidad Nacional Autónoma de México, México DF, México, Laboratorio de Micología Médica, Departamento de Enfermería I, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain, Cátedra de Medicina Bucal, Departamento de Estomatología, Facultad de Medicina y Odontología, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain, Departamento de Epidemiología, Hospital Infantil de México Dr. Federico Gómez, México DF, Mexico, Department of Medicine, Division of Infectious Diseases, South Texas Centers for Biology in Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Miguel Cashat-Cruz
- Laboratorio de Micología Médica, Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Odontología, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain, Facultad de Odontología, Universidad Nacional Autónoma de México, México DF, México, Laboratorio de Micología Médica, Departamento de Enfermería I, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain, Cátedra de Medicina Bucal, Departamento de Estomatología, Facultad de Medicina y Odontología, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain, Departamento de Epidemiología, Hospital Infantil de México Dr. Federico Gómez, México DF, Mexico, Department of Medicine, Division of Infectious Diseases, South Texas Centers for Biology in Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Jose Luis Lopez-Ribot
- Laboratorio de Micología Médica, Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Odontología, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain, Facultad de Odontología, Universidad Nacional Autónoma de México, México DF, México, Laboratorio de Micología Médica, Departamento de Enfermería I, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain, Cátedra de Medicina Bucal, Departamento de Estomatología, Facultad de Medicina y Odontología, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain, Departamento de Epidemiología, Hospital Infantil de México Dr. Federico Gómez, México DF, Mexico, Department of Medicine, Division of Infectious Diseases, South Texas Centers for Biology in Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Luis Alberto Gaitán-Cepeda
- Laboratorio de Micología Médica, Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Odontología, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain, Facultad de Odontología, Universidad Nacional Autónoma de México, México DF, México, Laboratorio de Micología Médica, Departamento de Enfermería I, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain, Cátedra de Medicina Bucal, Departamento de Estomatología, Facultad de Medicina y Odontología, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain, Departamento de Epidemiología, Hospital Infantil de México Dr. Federico Gómez, México DF, Mexico, Department of Medicine, Division of Infectious Diseases, South Texas Centers for Biology in Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Guillermo Quindós
- Laboratorio de Micología Médica, Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Odontología, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain, Facultad de Odontología, Universidad Nacional Autónoma de México, México DF, México, Laboratorio de Micología Médica, Departamento de Enfermería I, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain, Cátedra de Medicina Bucal, Departamento de Estomatología, Facultad de Medicina y Odontología, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain, Departamento de Epidemiología, Hospital Infantil de México Dr. Federico Gómez, México DF, Mexico, Department of Medicine, Division of Infectious Diseases, South Texas Centers for Biology in Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Corresponding author. Mailing address: Laboratorio de Micología Médica, Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Odontología, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain. Phone: 34946012854. Fax:34946013400. E-mail:
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