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Virulence Factors of Candida spp. and Host Immune Response Important in the Pathogenesis of Vulvovaginal Candidiasis. Int J Mol Sci 2022; 23:ijms23115895. [PMID: 35682581 PMCID: PMC9179972 DOI: 10.3390/ijms23115895] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/13/2022] [Accepted: 05/23/2022] [Indexed: 12/28/2022] Open
Abstract
Vulvovaginal candidiasis (VVC) is one of the most common types of vaginal infections in women around the world and is often underestimated by both patients and doctors. Research on the pathogenesis of fungal vaginal infections over the last 20 years has resulted in a closer understanding of the virulence factors involved in Candida epithelial invasion and their mechanisms of action. Recently, attention was drawn to the enormous complexity of the interaction between yeast-like fungi and host cells, as well as the level of complexity of the host's response to infection and their impact on the course and treatment of VVC. Our work provides a broad description of already known and some new reports on Candida virulence factors (such as phenotypic switching or biofilm formation capacity) and their importance for tissue invasion in VVC. At the same time, we also focus on interactions with host cells and local innate immune mechanisms involved in the response to vaginal fungal invasion that are now considered equally important in this case. The presented review describes the most important aspects of the still unknown pathogenicity of Candida associated with vaginal infections.
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Verma R, Pradhan D, Hasan Z, Singh H, Jain AK, Khan LA. A systematic review on distribution and antifungal resistance pattern of Candida species in the Indian population. Med Mycol 2021; 59:1145-1165. [PMID: 34625811 DOI: 10.1093/mmy/myab058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/16/2021] [Accepted: 09/28/2021] [Indexed: 12/16/2022] Open
Abstract
The emergence of antifungal drug resistance in Candida species has led to increased morbidity and mortality in immunocompromised patients. Understanding species distribution and antifungal drug resistance patterns is an essential step for novel drug development. A systematic review was performed addressing this challenge in India with keywords inclusive of 'Candida', 'Antifungal Drug Resistance', 'Candidemia', 'Candidiasis' and 'India'. A total of 106 studies (January 1978-March 2020) from 20 Indian states were included. Of over 11,429 isolates, Candida albicans was the major species accounting for 37.95% of total isolates followed by C. tropicalis (29.40%), C. glabrata (11.68%) and C. parapsilosis (8.36%). Rates of antifungal resistance were highest in non-albicans Candida (NAC) species - C. haemuloni (47.16%), C. krusei (28.99%), C. lipolytica (28.89%) and C. glabrata (20.69%). Approximately 10.34% isolates of C. albicans were observed to be drug-resistant. Candida species were frequently resistant to certain azoles (ketoconazole-22.2%, miconazole-22.1% and fluconazole-21.8%). In conclusion, the present systematic review illustrates the overall distribution and antifungal resistance pattern of Candida species among the Indian population that could be helpful in the future for the formation of treatment recommendations for the region but also elsewhere.
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Affiliation(s)
- Rashi Verma
- Department of Biosciences, Jamia Millia Islamia, New Delhi, India.,Biomedical Informatics Centre, ICMR-National Institute of Pathology, New Delhi, India
| | - Dibyabhaba Pradhan
- Indian Council of Medical Research - Computational Genomics Centre, All India Institute of Medical Research, New Delhi, India
| | - Ziaul Hasan
- Department of Biosciences, Jamia Millia Islamia, New Delhi, India
| | - Harpreet Singh
- Indian Council of Medical Research - Computational Genomics Centre, All India Institute of Medical Research, New Delhi, India
| | - Arun Kumar Jain
- Biomedical Informatics Centre, ICMR-National Institute of Pathology, New Delhi, India
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Frías-De-León MG, Hernández-Castro R, Conde-Cuevas E, García-Coronel IH, Vázquez-Aceituno VA, Soriano-Ursúa MA, Farfán-García ED, Ocharán-Hernández E, Rodríguez-Cerdeira C, Arenas R, Robledo-Cayetano M, Ramírez-Lozada T, Meza-Meneses P, Pinto-Almazán R, Martínez-Herrera E. Candida glabrata Antifungal Resistance and Virulence Factors, a Perfect Pathogenic Combination. Pharmaceutics 2021; 13:pharmaceutics13101529. [PMID: 34683822 PMCID: PMC8538829 DOI: 10.3390/pharmaceutics13101529] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/03/2021] [Accepted: 09/14/2021] [Indexed: 02/07/2023] Open
Abstract
In recent years, a progressive increase in the incidence of invasive fungal infections (IFIs) caused by Candida glabrata has been observed. The objective of this literature review was to study the epidemiology, drug resistance, and virulence factors associated with the C. glabrata complex. For this purpose, a systematic review (January 2001-February 2021) was conducted on the PubMed, Scielo, and Cochrane search engines with the following terms: "C. glabrata complex (C. glabrata sensu stricto, C. nivariensis, C. bracarensis)" associated with "pathogenicity" or "epidemiology" or "antibiotics resistance" or "virulence factors" with language restrictions of English and Spanish. One hundred and ninety-nine articles were found during the search. Various mechanisms of drug resistance to azoles, polyenes, and echinocandins were found for the C. glabrata complex, depending on the geographical region. Among the mechanisms found are the overexpression of drug transporters, gene mutations that alter thermotolerance, the generation of hypervirulence due to increased adhesion factors, and modifications in vital enzymes that produce cell wall proteins that prevent the activity of drugs designed for its inhibition. In addition, it was observed that the C. glabrata complex has virulence factors such as the production of proteases, phospholipases, and hemolysins, and the formation of biofilms that allows the complex to evade the host immune response and generate fungal resistance. Because of this, the C. glabrata complex possesses a perfect pathogenetic combination for the invasion of the immunocompromised host.
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Affiliation(s)
- María Guadalupe Frías-De-León
- Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca 56530, Mexico; (M.G.F.-D.-L.); (M.R.-C.)
| | - Rigoberto Hernández-Castro
- Departamento de Ecología de Agentes Patógenos, Hospital General “Dr. Manuel Gea González”, Ciudad de México 14080, Mexico; (R.H.-C.); (V.A.V.-A.)
| | - Esther Conde-Cuevas
- Maestría en Ciencias de la Salud, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Ciudad de México 11340, Mexico; (E.C.-C.); (I.H.G.-C.); (P.M.-M.)
| | - Itzel H. García-Coronel
- Maestría en Ciencias de la Salud, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Ciudad de México 11340, Mexico; (E.C.-C.); (I.H.G.-C.); (P.M.-M.)
| | - Víctor Alfonso Vázquez-Aceituno
- Departamento de Ecología de Agentes Patógenos, Hospital General “Dr. Manuel Gea González”, Ciudad de México 14080, Mexico; (R.H.-C.); (V.A.V.-A.)
| | - Marvin A. Soriano-Ursúa
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Ciudad de México 11340, Mexico; (M.A.S.-U.); (E.D.F.-G.); (E.O.-H.)
| | - Eunice D. Farfán-García
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Ciudad de México 11340, Mexico; (M.A.S.-U.); (E.D.F.-G.); (E.O.-H.)
| | - Esther Ocharán-Hernández
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Ciudad de México 11340, Mexico; (M.A.S.-U.); (E.D.F.-G.); (E.O.-H.)
| | - Carmen Rodríguez-Cerdeira
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Vigo, Spain; (C.R.-C.); (R.A.)
- Dermatology Department, Hospital Vithas Ntra. Sra. de Fátima and University of Vigo, 36206 Vigo, Spain
- Campus Universitario, University of Vigo, 36310 Vigo, Spain
| | - Roberto Arenas
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Vigo, Spain; (C.R.-C.); (R.A.)
- Sección de Micología, Hospital General “Dr. Manuel Gea González”, Tlalpan, Ciudad de México 14080, Mexico
| | - Maura Robledo-Cayetano
- Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca 56530, Mexico; (M.G.F.-D.-L.); (M.R.-C.)
| | - Tito Ramírez-Lozada
- Servicio de Ginecología y Obstetricia, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca 56530, Mexico;
| | - Patricia Meza-Meneses
- Maestría en Ciencias de la Salud, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Ciudad de México 11340, Mexico; (E.C.-C.); (I.H.G.-C.); (P.M.-M.)
- Servicio de Infectología, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca 56530, Mexico
| | - Rodolfo Pinto-Almazán
- Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca 56530, Mexico; (M.G.F.-D.-L.); (M.R.-C.)
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Ciudad de México 11340, Mexico; (M.A.S.-U.); (E.D.F.-G.); (E.O.-H.)
- Correspondence: (R.P.-A.); (E.M.-H.); Tel.: +52-555-972-9800 (R.P.-A. or E.M.-H.)
| | - Erick Martínez-Herrera
- Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca 56530, Mexico; (M.G.F.-D.-L.); (M.R.-C.)
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Ciudad de México 11340, Mexico; (M.A.S.-U.); (E.D.F.-G.); (E.O.-H.)
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Vigo, Spain; (C.R.-C.); (R.A.)
- Correspondence: (R.P.-A.); (E.M.-H.); Tel.: +52-555-972-9800 (R.P.-A. or E.M.-H.)
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Sasani E, Yadegari MH, Khodavaisy S, Rezaie S, Salehi M, Getso MI. Virulence Factors and Azole-Resistant Mechanism of Candida Tropicalis Isolated from Candidemia. Mycopathologia 2021; 186:847-856. [PMID: 34410566 DOI: 10.1007/s11046-021-00580-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/14/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND Limited knowledge exists on the virulence factors of Candida tropicalis and the mechanisms of azole resistance that lead to an intensified pathogenicity and treatment failure. We aimed to evaluate the virulence factors and molecular mechanisms of azole resistance among C. tropicalis isolated from patients with candidemia. MATERIALS AND METHODS Several virulence factors, including extracellular enzymatic activities, cell surface hydrophobicity (CSH), and biofilm formation, were evaluated. Antifungal susceptibility pattern and expression level of ERG11, UPC2, MDR1, and CDR1 genes of eight (4 fluconazole resistance and 4 fluconazole susceptible) clinical C. tropicalis isolates were assessed. The correlation between the virulence factors and antifungal susceptibility patterns was analyzed. RESULTS During a 4 year study, forty-five C. tropicalis isolates were recovered from candidemia patients. The isolates expressed different frequencies of virulence determinants as follows: coagulase 4 (8.9%), phospholipase 5 (11.1%), proteinase 31 (68.9%), esterase 43 (95.6%), hemolysin 44 (97.8%), biofilm formation 45 (100%) and CSH 45(100%). All the isolates were susceptible to amphotericin B and showed the highest resistance to voriconazole. There was a significant positive correlation between micafungin minimum inhibitory concentrations (MICs) and hemolysin production (rs = 0.316). However, we found a negative correlation between fluconazole MICs and esterase production (rs = -0.383). We observed the high expression of ERG11 and UPC2 genes in fluconazole-resistant C. tropicalis isolates. CONCLUSION C. tropicalis isolated from candidemia patients extensively displayed capacities for biofilm formation, hemolysis, esterase activity, and hydrophobicity. In addition, the overexpression of ERG11 and UPC2 genes was considered one of the possible mechanisms of azole resistance.
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Affiliation(s)
- Elahe Sasani
- Department of Medical Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Hossein Yadegari
- Department of Medical Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Sadegh Khodavaisy
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sassan Rezaie
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Salehi
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Muhammad Ibrahim Getso
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Department of Medical Microbiology and Parasitology, College of Health Sciences, Bayero University, Kano, Nigeria
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Żyrek D, Wajda A, Czechowicz P, Nowicka J, Jaśkiewicz M, Neubauer D, Kamysz W. The Antimicrobial Activity of Omiganan Alone and In Combination against Candida Isolated from Vulvovaginal Candidiasis and Bloodstream Infections. Antibiotics (Basel) 2021; 10:antibiotics10081001. [PMID: 34439051 PMCID: PMC8389017 DOI: 10.3390/antibiotics10081001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/15/2021] [Accepted: 08/17/2021] [Indexed: 12/25/2022] Open
Abstract
Fungi from the Candida genus are widespread commensals and, at the same time, are the leading cause of fungal infections worldwide. For instance, vulvovaginal candidiasis (VVC) affects approximately 75% of women at least once in their lifetime, remaining the second most common gynecological infection. On the contrary, hospital-acquired fungal bloodstream infections (BSIs), although less frequent, are characterized by a high mortality rate. Undoubtedly, the main reason for this situation are virulence factors that these yeast-like fungi can produce, and the ability to form a biofilm is one of the most important of them. Due to the low effectiveness of classic antimycotics against Candida biofilms, an intense search for new drugs capable of eradicating this structure is highly demanded. One of the most promising groups of compounds exhibiting such properties are antimicrobial peptides (AMPs). This study focuses on a comparison of the efficacy of Omiganan and fluconazole alone and in combination against Candida strains isolated from BSIs. The obtained results are consistent with our previous reports on the effectiveness of Omiganan against clinical strains isolated from VVC. This is also the first report on the combinatory application of Omiganan in the context of fungal BSI. The majority of combinations with fluconazole showed an additive effect, as well as a synergistic effect in the range of certain concentrations. Importantly, such effects are visible at concentrations much lower than for those compounds used individually. Potentially, this entails the possibility of limiting the adverse effects (e.g., toxicity) of Omiganan and fluconazole applied in vivo, thus improving the safety profile of this particular antifungal therapy.
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Affiliation(s)
- Dawid Żyrek
- Department of Microbiology, Faculty of Medicine, Wrocław Medical University, 50-367 Wrocław, Poland; (D.Ż.); (A.W.)
| | - Andrzej Wajda
- Department of Microbiology, Faculty of Medicine, Wrocław Medical University, 50-367 Wrocław, Poland; (D.Ż.); (A.W.)
| | - Paulina Czechowicz
- Department of Microbiology, Faculty of Medicine, Wrocław Medical University, 50-367 Wrocław, Poland; (D.Ż.); (A.W.)
- Correspondence: (P.C.); (J.N.)
| | - Joanna Nowicka
- Department of Microbiology, Faculty of Medicine, Wrocław Medical University, 50-367 Wrocław, Poland; (D.Ż.); (A.W.)
- Correspondence: (P.C.); (J.N.)
| | - Maciej Jaśkiewicz
- Department of Inorganic Chemistry, Faculty of Pharmacy, Medical University of Gdańsk, 80-416 Gdańsk, Poland; (M.J.); (D.N.); (W.K.)
| | - Damian Neubauer
- Department of Inorganic Chemistry, Faculty of Pharmacy, Medical University of Gdańsk, 80-416 Gdańsk, Poland; (M.J.); (D.N.); (W.K.)
| | - Wojciech Kamysz
- Department of Inorganic Chemistry, Faculty of Pharmacy, Medical University of Gdańsk, 80-416 Gdańsk, Poland; (M.J.); (D.N.); (W.K.)
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Czechowicz P, Jaśkiewicz M, Neubauer D, Gościniak G, Kamysz W. Anticandidal Activity of Omiganan and Its Retro Analog Alone and in Combination with Fluconazole. Probiotics Antimicrob Proteins 2021; 13:1173-1182. [PMID: 33655458 PMCID: PMC8342346 DOI: 10.1007/s12602-021-09757-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2021] [Indexed: 01/10/2023]
Abstract
Vulvovaginal candidiasis (VVC) is a vaginal infection that manifests itself as several symptoms which can lead to various life-threatening complications. The majority of VVC is caused by Candida albicans strains, and it is estimated that approximately 75% of women worldwide would suffer from this condition at least once during their lifetime. Surprisingly, the detailed pathomechanism of yeast-like fungi invasions in vagina is not yet fully understood. However, the ability to form biofilm on vaginal mucosa is considered as one of the critical factors associated with failure of the therapy and recurrences of the disease. Antimicrobial peptides (AMPs) are a promising class of compounds that are receiving a growing interest owing to their antibacterial, antifungal, and antibiofilm properties. Omiganan is a synthetic analog of Indolicidin that is characterized by wide spectrum of antimicrobial and antibiofilm activities. Recent reports suggest improved activity of analogs with a reversed sequence (retro-analog concept). Therefore, Omiganan and its retro analog were tested against planktonic forms and biofilm of 18 Candida strains isolated from VVC. Moreover, the synergy between the AMPs and fluconazole was studied as well. The AMPs appeared to be effective against C. albicans biofilm, and the reversion of the sequence generally led to an improved antimicrobial activity. Furthermore, confocal and scanning electron microscopic visualizations revealed the effectiveness of AMPs-fluconazole combinations also against fluconazole-resistant strains.
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Affiliation(s)
- Paulina Czechowicz
- Department of Microbiology, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland.
| | - Maciej Jaśkiewicz
- Department of Inorganic Chemistry, Faculty of Pharmacy, Medical University of Gdańsk, Gdansk, Poland
| | - Damian Neubauer
- Department of Inorganic Chemistry, Faculty of Pharmacy, Medical University of Gdańsk, Gdansk, Poland
| | - Grażyna Gościniak
- Department of Microbiology, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Wojciech Kamysz
- Department of Inorganic Chemistry, Faculty of Pharmacy, Medical University of Gdańsk, Gdansk, Poland
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Pereira LC, Correia AF, da Silva ZDL, de Resende CN, Brandão F, Almeida RM, de Medeiros Nóbrega YK. Vulvovaginal candidiasis and current perspectives: new risk factors and laboratory diagnosis by using MALDI TOF for identifying species in primary infection and recurrence. Eur J Clin Microbiol Infect Dis 2021; 40:1681-1693. [PMID: 33713006 PMCID: PMC8295079 DOI: 10.1007/s10096-021-04199-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/16/2021] [Indexed: 01/12/2023]
Abstract
Vulvovaginal candidiasis (VVC), considered the second cause of genital infection among women, has pathogenic mechanisms still to be elucidated and unknown risk factors. Prevalence studies with laboratory diagnosis (at first diagnosis and recurrence) are uncommon, especially using MALDI TOF, used in this clinical, epidemiological, and laboratory study for evaluating candidiasis, and identifying unknown risk factors. To obtain clinical and epidemiological data, patients were questioned, and there was material collection. Samples collected were identified by using phenotypic and presumptive methods and confirmed by MALDI TOF. This study analyzed 278 patients, divided into symptomatic (n = 173) and asymptomatic (n = 105) groups. Regarding the main candidiasis symptoms (discharge, itching, and burning), only 50.3% of patients described these concomitant symptoms, showing a positive predictive value of 67.8%. Regarding the risk factors investigated, there was a statistical correlation between candidiasis and dairy products, gut transit, contraceptive use, respiratory allergy, and panty liners, describing new risk factors related to intestinal and vaginal dysbiosis. After Candida species analysis and confirmation, the primary prevalence was 80.9% (Candida albicans), 15.2% (non-albicans), 1% (Rhodotorula mucilaginosa), and 1.9% (unidentified species). In recurrence, the prevalence was 66.7% (C. albicans) and 33.3% (non-albicans). The presence of symptoms has low positive predictive value for the diagnosis of candidiasis, even when considering the classic triad of symptoms. Laboratory identification of yeast species is essential for correct treatment, preventing the resistance to antifungals and the high recurrence. In addition, dairy products and bowel habits, both related to intestinal and vaginal dysbiosis, may be associated with VVC.
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Affiliation(s)
- Lívia Custódio Pereira
- Vulvar Pathology Clinic, Department of Gynecology, Brasilia University Hospital, University of Brasilia, Brasília, DF, Brazil
- Microbiology and Immunology Clinical Laboratory, Department of Pharmacy, Faculty of Health Sciences, University of Brasilia, Darcy Ribeiro Campus, Brasília, DF, 70900-910, Brazil
| | - Amabel Fernandes Correia
- Medical Biology Management, Center of Parasitology and Mycology, Central Public Health Laboratory of the District Federal (LACEN-DF), Brasília, DF, Brazil
| | - Zita Dinis Lopes da Silva
- Microbiology and Immunology Clinical Laboratory, Department of Pharmacy, Faculty of Health Sciences, University of Brasilia, Darcy Ribeiro Campus, Brasília, DF, 70900-910, Brazil
| | - Ceres Nunes de Resende
- Vulvar Pathology Clinic, Department of Gynecology, Brasilia University Hospital, University of Brasilia, Brasília, DF, Brazil
| | - Fabiana Brandão
- Microbiology and Immunology Clinical Laboratory, Department of Pharmacy, Faculty of Health Sciences, University of Brasilia, Darcy Ribeiro Campus, Brasília, DF, 70900-910, Brazil
| | - Rosane Mansan Almeida
- Microbiology and Immunology Clinical Laboratory, Department of Pharmacy, Faculty of Health Sciences, University of Brasilia, Darcy Ribeiro Campus, Brasília, DF, 70900-910, Brazil
| | - Yanna Karla de Medeiros Nóbrega
- Microbiology and Immunology Clinical Laboratory, Department of Pharmacy, Faculty of Health Sciences, University of Brasilia, Darcy Ribeiro Campus, Brasília, DF, 70900-910, Brazil.
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8
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Hacioglu M, Oyardi O, Kirinti A. Oregano essential oil inhibits Candida spp. biofilms. ACTA ACUST UNITED AC 2021; 76:443-450. [PMID: 33915040 DOI: 10.1515/znc-2021-0002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 04/06/2021] [Indexed: 11/15/2022]
Abstract
Candida spp. can form biofilms on mucosal surfaces and epithelial cells as well as on devices implanted in the body such as catheters and dentures, which are thought to underlie the most recalcitrant infections. It was aimed to show antifungal and antibiofilm activities of oregano oil (Origanum onites). The antifungal activities of some essential oils were investigated against C. spp. and among them, oregano oil was found to be the most effective oil and further biofilm studies were conducted with it. Oregano oil inhibited biofilm adhesion and formation of C. spp. and mature biofilms and also displayed the ability to reduce biofilm formation when they were allowed to form on surfaces previously coated with oil (up to 50% inhibition rates). In addition, oregano oil was found to be effective against dual biofilms of Candida albicans + Staphyloccocus aureus at different concentrations. This study suggests that O. onites essential oil has useful antibiofilm effects against C. spp. The inhibitory effects of O. onites essential oil, against C. spp., were demonstrated for the first time. It also had antifungal effect on biofilm formation and established biofilm even at MIC level.
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Affiliation(s)
- Mayram Hacioglu
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Istanbul University, Beyazit, Istanbul, 34116, Turkey
| | - Ozlem Oyardi
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Istanbul University, Beyazit, Istanbul, 34116, Turkey
| | - Alpcan Kirinti
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Istanbul University, Beyazit, Istanbul, 34116, Turkey
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El-Kholy MA, Helaly GF, El Ghazzawi EF, El-Sawaf G, Shawky SM. Virulence Factors and Antifungal Susceptibility Profile of C. tropicalis Isolated from Various Clinical Specimens in Alexandria, Egypt. J Fungi (Basel) 2021; 7:jof7050351. [PMID: 33947158 PMCID: PMC8146935 DOI: 10.3390/jof7050351] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The incidence of candidiasis caused by non-albicans Candida (NAC) species is increasing. Candida tropicalis has emerged as one of the most important NAC species. This study aims to examine the antifungal susceptibility profile and some virulence factors of C. tropicalis isolated from various clinical specimens. METHODS A total of 71 C. tropicalis isolates from various clinical specimens (69.01%, 18.31%, 9.86%, and 2.82% of isolates were collected from urine, respiratory samples, blood, and skin and soft tissue infections, respectively) from ICU patients in Alexandria, Egypt. The isolates were identified at species level by CHROMagar Candida and VITEK 2 compact system. Furthermore, the antifungal susceptibility was determined using the VITEK 2 system AST-YS07 card containing different antifungals. Hemolysin, phospholipase, and proteinase activity and biofilm formation were also tested as virulence factors. RESULTS Only 30 isolates (42.25%) were non-susceptible (MIC ≥ 4 µg/mL) to fluconazole, of which 28 isolates showed non-susceptibility (MIC ≥ 0.25 µg/mL) to voriconazole. All isolates showed both hemolysin and proteinase activities, while only 9 isolates (12.68%) showed phospholipase production and 70 isolates (98.59%) demonstrated biofilm formation. Strong biofilm production was observed among the blood culture isolates (85.71%), followed by the respiratory and urinary isolates (61.54% and 46.94%, respectively). CONCLUSIONS This study sought to provide useful data on the antifungal susceptibility of C. tropicalis isolates from ICU patients suffering from invasive infections with an increased trend towards elevated MICs levels of both fluconazole and voriconazole. Due to the high incidence of systemic candidiasis and antifungal resistance, C. tropicalis is emerging as a serious root of infections. Therefore, early and accurate identification of Candida species along with susceptibility testing is of utmost importance.
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Affiliation(s)
- Mohammed A. El-Kholy
- Department of Microbiology and Biotechnology, Clinical and Biological Sciences Division, College of Pharmacy, Arab Academy for Science, Technology and Maritime Transport (AASTMT), P.O. Box 1029, Alexandria, Egypt
- Correspondence:
| | - Ghada F. Helaly
- Department of Microbiology, Medical Research Institute, Alexandria University, P.O. Box 1029, Alexandria, Egypt; (G.F.H.); (E.F.E.G.); (G.E.-S.); (S.M.S.)
| | - Ebtisam F. El Ghazzawi
- Department of Microbiology, Medical Research Institute, Alexandria University, P.O. Box 1029, Alexandria, Egypt; (G.F.H.); (E.F.E.G.); (G.E.-S.); (S.M.S.)
| | - Gamal El-Sawaf
- Department of Microbiology, Medical Research Institute, Alexandria University, P.O. Box 1029, Alexandria, Egypt; (G.F.H.); (E.F.E.G.); (G.E.-S.); (S.M.S.)
| | - Sherine M. Shawky
- Department of Microbiology, Medical Research Institute, Alexandria University, P.O. Box 1029, Alexandria, Egypt; (G.F.H.); (E.F.E.G.); (G.E.-S.); (S.M.S.)
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Ganeshkumar A, Nagarajan P, Mahalingam P, Balasubramanian S, Archunan PA, Govindaraju A, Rajaram R. Antifungal susceptibility and virulence profile of candida isolates from abnormal vaginal discharge of women from southern India. Eur J Obstet Gynecol Reprod Biol 2020; 254:153-158. [PMID: 32971434 DOI: 10.1016/j.ejogrb.2020.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Vaginal candidiasis is the most common opportunistic fungal infection, largely associated with a woman's psychological and economic status. Recently, the rate of disease progression has increased extensively; however, region-specific studies are very limited. This study aimed to understand variation in hydrolytic activities and antifungal susceptibility of Candida isolates from vaginal discharge. STUDY DESIGN The present study was aimed to understand the variation of hydrolytic activities and antifungal susceptibility of Candida isolates from vaginal discharge. RESULTS In total, 34 different Candida isolates were collected: C. albicans (n = 17; 50 %), C. glabrata (n = 6; 17.64 %), C. tropicalis (n = 4; 11.76 %) and C. parapsilosis (n = 7; 20.58 %). All isolates were primarily identified and confirmed by basic microbiological methods followed by the VITEK-2 system. Antifungal susceptibility of the isolates were evaluated using yeast antifungal susceptibility testing cards. The isolates of C. albicans, C. glabrata, C. tropicalis and C. parapsilosis were 100 % susceptible to amphotericin B. The non-albicans isolates presented 100 % of proteolytic and lipolytic activity compared with C. albicans. Eight (47.06 %) C. albicans isolates showed positive esterase activity (Pz<1), whereas nine (52.94 %) were negative to esterase (Pz = 1). Of the 34 Candida isolates, 28 (82.35 %) were found to be moderate-to-strong biofilm producers: 14 C. albicans, three C. glabrata, six C. parapsilosis and five C. tropicalis. CONCLUSION This study clarified the antifungal susceptibility and virulence behaviour of Candida isolates; this will be of use in the selection of antifungal agents for Candida prophylaxis.
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Affiliation(s)
- Arumugam Ganeshkumar
- DNA Barcoding and Marine Genomics Laboratory, Department of Marine Sciences, Bharathidasan University, Tiruchirapalli, India; Department of Microbiology, Trichy SRM Medical College Hospital and Research Centre, Tiruchirapalli, India
| | - Prabhusaran Nagarajan
- Department of Microbiology, Trichy SRM Medical College Hospital and Research Centre, Tiruchirapalli, India
| | - Pramila Mahalingam
- Department of Microbiology, Trichy SRM Medical College Hospital and Research Centre, Tiruchirapalli, India; Department of Biotechnology, Nehru Memorial College, Tiruchirapalli, India
| | - Saranya Balasubramanian
- Department of Obstetrics and Gynaecology, Trichy SRM Medical College Hospital and Research Centre, Tiruchirapalli, India
| | | | - Archunan Govindaraju
- Centre for Pheromone Technology, Department of Animal Sciences, Bharathidasan University, Tiruchirapalli, India
| | - Rajendran Rajaram
- DNA Barcoding and Marine Genomics Laboratory, Department of Marine Sciences, Bharathidasan University, Tiruchirapalli, India.
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Reinhardt LC, Nascente PS, Ribeiro JS, Guimarães VBS, Etges A, Lund RG. Sensitivity to antifungals by Candida spp samples isolated from cases of chronic atrophic candidiasis (CAC). BRAZ J BIOL 2020; 80:266-272. [PMID: 31291399 DOI: 10.1590/1519-6984.190454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 09/10/2018] [Indexed: 01/23/2023] Open
Abstract
The treatment of choice for chronic atrophic candidiasis (CAC), also known as denture stomatitis, is topical antifungal therapy. This study aimed to isolate, identify, and assess the antifungal susceptibility of Candida species from mucosal sites in denture wearers with a diagnosis of CAC and determine the prevalence of associated variables. The sample consisted of 44 patients wearing complete or partial dentures who had a clinical diagnosis of CAC. Using sterile cotton swabs, specimens were collected from the oral mucosa of all patients and grown at 30ºC for 48 h in CHROMagar Candida, as a means of isolating and screening the species. The complementary identification of the species was performed using the VITEK 2 automated system (BioMérieux), as well as the determination of their susceptibility to antifungal agents. Data were analyzed using the chi-square test. STATA 13.1 was used for statistical analysis (α = 5%). Of 44 patients with CAC, 33 (75%) had lesions classified as Newton type II. Yeasts were isolated in 38 cases. The most prevalent species was Candida albicans. None of the isolates were resistant to the antifungals tested. Our findings suggest that current indications for antifungal agents are appropriate. Also, antifungal susceptibility testing and proper fungal identification can help dentists to determine the optimal course of treatment for CAC.
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Affiliation(s)
- L C Reinhardt
- Programa de Pós-graduação em Odontologia - PPGO, Laboratório de Microbiologia Oral, Faculdade de Odontologia, Universidade Federal de Pelotas - UFPel, Rua Gonçalves Chaves, 457, Sala 702/3, CEP , Pelotas, RS, Brasil
| | - P S Nascente
- Programa de Pós-graduação em Bioquímica e Bioprospecção - PPGBBio, Departamento de Microbiologia e Parasitologia, Laboratório de Micologia, Universidade Federal de Pelotas - UFPel, Campus Universitário Capão do Leão, s/n, , Capão do Leão, RS, Brasil
| | - J S Ribeiro
- Programa de Pós-graduação em Odontologia - PPGO, Laboratório de Microbiologia Oral, Faculdade de Odontologia, Universidade Federal de Pelotas - UFPel, Rua Gonçalves Chaves, 457, Sala 702/3, CEP , Pelotas, RS, Brasil
| | - V B S Guimarães
- Programa de Pós-graduação em Odontologia - PPGO, Laboratório de Microbiologia Oral, Faculdade de Odontologia, Universidade Federal de Pelotas - UFPel, Rua Gonçalves Chaves, 457, Sala 702/3, CEP , Pelotas, RS, Brasil
| | - A Etges
- Centro de Diagnóstico e Doenças da Boca - CDDB, Faculdade de Odontologia, Universidade Federal de Pelotas - UFPel, Rua Gonçalves Chaves, 457, Sala 607, CEP , Pelotas, RS, Brasil
| | - R G Lund
- Programa de Pós-graduação em Odontologia - PPGO, Laboratório de Microbiologia Oral, Faculdade de Odontologia, Universidade Federal de Pelotas - UFPel, Rua Gonçalves Chaves, 457, Sala 702/3, CEP , Pelotas, RS, Brasil.,Programa de Pós-graduação em Bioquímica e Bioprospecção - PPGBBio, Departamento de Microbiologia e Parasitologia, Laboratório de Micologia, Universidade Federal de Pelotas - UFPel, Campus Universitário Capão do Leão, s/n, , Capão do Leão, RS, Brasil
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Edward EA, Mohamed NM, Zakaria AS. Resensitization of Fluconazole-Resistant Urinary Candida spp. Isolates by Amikacin through Downregulation of Efflux Pump Genes. Pol J Microbiol 2020; 69:73-84. [PMID: 32189482 PMCID: PMC7256858 DOI: 10.33073/pjm-2020-010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/11/2020] [Accepted: 02/06/2020] [Indexed: 10/26/2022] Open
Abstract
The contribution of fluconazole-resistant Candida spp. isolates to urinary tract infections in Egypt has become a nationwide problem. A recent approach to overcome such disaster is combining conventional antifungals with non-antifungals. This study investigated the interaction of amikacin with fluconazole against resistant Candida strains isolated from the urine culture of patients admitted to Alexandria Main University Hospital. Among the collected Candida spp. isolates, 42.9% were resistant to fluconazole with MICs ranging between 128 and 1,024 μg/ml. The resistance-modifying activity of amikacin (4,000 μg/ml) was studied against fluconazole-resistant isolates where amikacin sensitized 91.7 % of resistant Candida spp. isolates to fluconazole with a modulation factor ranging between 32 and 256. The rhodamine efflux assay was performed to examine the impact of amikacin on efflux pump activity. After 120 minutes of treatment, amikacin affected the efflux pump activity of the isolates tested with a percentage of reduction in the fluorescence intensity of 8.9%. Quantitative real-time PCR was applied to assess the amikacin effect on the expression of the efflux pump genes MDR1, CDR1, and CDR2. The downregulatory effect of amikacin on the expression of the studied genes caused a percentage of reduction in the expression level ranging between 42.1 and 94%. In conclusion, amikacin resensitized resistant Candida spp. isolates to fluconazole and could be used in combination in the management of candiduria with a higher efficiency or at lower administration doses. To the best of our knowledge, this is the first study evaluating the enhancement of fluconazole activity in combination with amikacin against Candida spp. The contribution of fluconazole-resistant Candida spp. isolates to urinary tract infections in Egypt has become a nationwide problem. A recent approach to overcome such disaster is combining conventional antifungals with non-antifungals. This study investigated the interaction of amikacin with fluconazole against resistant Candida strains isolated from the urine culture of patients admitted to Alexandria Main University Hospital. Among the collected Candida spp. isolates, 42.9% were resistant to fluconazole with MICs ranging between 128 and 1,024 μg/ml. The resistance-modifying activity of amikacin (4,000 μg/ml) was studied against fluconazole-resistant isolates where amikacin sensitized 91.7 % of resistant Candida spp. isolates to fluconazole with a modulation factor ranging between 32 and 256. The rhodamine efflux assay was performed to examine the impact of amikacin on efflux pump activity. After 120 minutes of treatment, amikacin affected the efflux pump activity of the isolates tested with a percentage of reduction in the fluorescence intensity of 8.9%. Quantitative real-time PCR was applied to assess the amikacin effect on the expression of the efflux pump genes MDR1, CDR1, and CDR2. The downregulatory effect of amikacin on the expression of the studied genes caused a percentage of reduction in the expression level ranging between 42.1 and 94%. In conclusion, amikacin resensitized resistant Candida spp. isolates to fluconazole and could be used in combination in the management of candiduria with a higher efficiency or at lower administration doses. To the best of our knowledge, this is the first study evaluating the enhancement of fluconazole activity in combination with amikacin against Candida spp.
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Affiliation(s)
- Eva A Edward
- Department of Microbiology and Immunology, Faculty of Pharmacy, Alexandria University , Egypt
| | - Nelly M Mohamed
- Department of Microbiology and Immunology, Faculty of Pharmacy, Alexandria University , Egypt
| | - Azza S Zakaria
- Department of Microbiology and Immunology, Faculty of Pharmacy, Alexandria University , Egypt
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Pandey N, Gupta MK, Tilak R. Extracellular hydrolytic enzyme activities of the different Candida spp. isolated from the blood of the Intensive Care Unit-admitted patients. J Lab Physicians 2020; 10:392-396. [PMID: 30498309 PMCID: PMC6210849 DOI: 10.4103/jlp.jlp_81_18] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Candida spp. secretes various extracellular hydrolytic enzymes. These enzymes are the important virulence factor for the pathogenesis of Candida. We assessed four different enzymatic activities of Candida isolates obtained from bloodstream infections. MATERIALS AND METHODS We isolated 79 strains of different Candida species from the blood of the Intensive Care Unit-admitted patients. Species were identified by conventional methods including culture characteristic, germ tube, sugar assimilation, and Dalmau's culture technique. Phospholipase, proteinase, hemolysin, and esterase enzymatic activities were determined by the Plate method. RESULTS Non albicans candida were the most common isolates from the blood of the ICU admitted patient with a predominance of Candida tropicalis. Hemolytic activity was the most prominent enzyme activity followed by the proteinase activity. Candida albicans (89.86%) was the major proteinase producer, while 95.8% of C. tropicalis produced hemolysin. No esterase activity was shown by the Candida glabrata and Candida krusei. CONCLUSION No significant difference was observed between the two most common causative agents of candidemia: C. albicans and C. tropicalis.
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Affiliation(s)
- Nidhi Pandey
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Munesh Kumar Gupta
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ragini Tilak
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Upregulation of secreted aspartyl proteinase genes of fluconazole-sensitive Candida albicans isolates. Mol Biol Rep 2019; 46:6147-6154. [PMID: 31602591 DOI: 10.1007/s11033-019-05049-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 08/28/2019] [Indexed: 01/20/2023]
Abstract
Candida albicans infection development depends on several factors associated with this etiological agent, including secreted aspartyl protease (Sap) production. Sap expression commonly occurs under selective pressure caused by the presence of antifungals. Fluconazole is the main antifungal drug used for treatment or prophylaxis. This study investigated the influence of inhibitory and sub-inhibitory fluconazole concentrations on Sap activity and their gene transcription for three clinical C. albicans isolates. Two isolates presented significant increases in Sap activity and transcription of SAP 1-8 genes in the presence of 1 MIC80 of fluconazole compared to the absence of the antifungal agent. The results suggest that the increase in Sap activity occurs due to an upregulation of the SAP gene transcription influenced by fluconazole. This suggests the importance of all SAP genes in the progression of bloodstream infections compared to primary tissue infection. However, this phenomenon does not occur everywhere, and it is multifactorial. This may be related to the selective pressure effect on transcription modulators. Although preliminary, these results open a new perspective for the study of virulence factors.
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15
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Khan Z, Bhargava A, Mittal P, Bharti R, Puri P, Khunger N, Bala M. Evaluation of reliability of self-collected vaginal swabs over physician-collected samples for diagnosis of bacterial vaginosis, candidiasis and trichomoniasis, in a resource-limited setting: a cross-sectional study in India. BMJ Open 2019; 9:e025013. [PMID: 31462459 PMCID: PMC6719764 DOI: 10.1136/bmjopen-2018-025013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Self-collected vaginal swabs can facilitate diagnosis of vaginal discharge (VD) in resource-limited settings, provided reliability of the method is established. The aim of this study was to evaluate the concordance between self-collected and physician-collected vaginal swabs for aetiological diagnosis of VD and to determine the prevalence of bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and trichomonas vaginitis (TV). METHODS A total of 550 females (median age: 32 years; range: 18-45 years) attending two sexually transmitted infection/reproductive tract infection (STI/RTI) clinics with VD from January 2015 to May 2016 were included in the study after obtaining written informed consent. Swabs were self-collected by patients after instructions and subsequently by a physician under speculum examination. Samples were processed for standard bedside tests, Gram staining, wet mount and culture (gold standard) according to the national guidelines. Concordance between the two methods was determined by the Cohen's kappa value. RESULTS BV, VVC and TV were diagnosed in 79 (14.4%), 144 (26.2%) and 3 (0.5%) patients, respectively. VVC coexisted with BV in 58 (10.5%) patients. There was no coinfection of TV with BV or VVC. Candida albicans was isolated in 84 (58.3%) VVC cases. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of self-collected swabs for diagnosing BV was 91.1%, 100%, 100% and 98.5%, respectively, while for the C. albicans VVC and TV, sensitivity, specificity, PPV and NPV all were 100% as compared with physician-collected swabs. Highly concordant results were obtained between two methods by the Kappa values of 0.95 (BV), 0.99 (VVC) and 1.0 (TV). CONCLUSION The comparative performance of self-collected and physician-collected vaginal swabs establishes self-collection of samples for BV, VVC and TV as a viable alternative tool in the management of STIs/RTIs, especially in peripheral and resource-constrained settings. This would be effective in implementing the diagnostic approaches for STIs/RTIs in community-based surveillance studies at national or regional level and therefore strengthening the National STI/RTI Control Programme.
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Affiliation(s)
- Zarine Khan
- Department of Microbiology, VMMC & Safdarjung Hospital, New Delhi, India
| | - Aradhana Bhargava
- Apex Regional STI Training, Research & Reference Laboratory, VMMC and Safdarjung Hospital, New Delhi, India
| | - Pratima Mittal
- Department of Obstetrics & Gynaecology, VMMC & Safdarjung Hospital, New Delhi, India
| | - Rekha Bharti
- Department of Obstetrics & Gynaecology, VMMC & Safdarjung Hospital, New Delhi, India
| | - Poonam Puri
- Department of Dermatology & STD, VMMC and Safdarjung Hospital, New Delhi, India
| | - Niti Khunger
- Department of Dermatology & STD, VMMC and Safdarjung Hospital, New Delhi, India
| | - Manju Bala
- Apex Regional STI Training, Research & Reference Laboratory, VMMC and Safdarjung Hospital, New Delhi, India
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In Vitro Determination of Hydrolytic Enzymes and Echinocandin Susceptibility in Mexican Clinical Isolates of Candida glabrata Sensu Stricto. Jundishapur J Microbiol 2019. [DOI: 10.5812/jjm.85092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Hacioglu M, Guzel CB, Savage PB, Tan ASB. Antifungal susceptibilities, in vitro production of virulence factors and activities of ceragenins against Candida spp. isolated from vulvovaginal candidiasis. Med Mycol 2019; 57:291-299. [PMID: 29846682 DOI: 10.1093/mmy/myy023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 03/01/2018] [Accepted: 04/04/2018] [Indexed: 12/12/2022] Open
Abstract
Vulvovaginal candidiasis (VVC) is the second most common cause of vaginitis after bacterial vaginosis, affecting millions of women worldwide every year. Candida albicans is the most frequent agent of VVC followed by other species of Candida such as C. glabrata and C. parapsilosis. Out of a total of 100 clinical isolates of Candida spp. obtained from patients diagnosed with VVC, 84 were identified as C. albicans, while the remaining isolates were identified as non--albicans Candida strains. Phospholipases and proteinases were produced by a majority of the C. albicans strains and esterases and hemolysins a minority of these strains. Among the non-C. albicans strains, only a few of the strains produced these proteins. Nearly all of the isolates formed biofilms. Our results showed that the butoconazole, clotrimazole, and fluconazole were active against C. albicans and less so against the non-albicans Candida strains. The MIC90 of amphotericin B and nystatins were 2 and 4 μg/ml, respectively, against either C. albicans or non-albicans Candida spp. Representative ceragenins (CSA-13, CSA-131, and CSA-138), developed as mimics of endogenous antimicrobial peptides, were active against fluconazole-resistant strains, both alone and in combination with fluconazole. These results suggest the potential use of ceragenins in treating VVC, including infections caused by fluconazole-resistant isolates.
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Affiliation(s)
- Mayram Hacioglu
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Istanbul University, Beyazit, Istanbul, 34116, Turkey
| | - Cagla Bozkurt Guzel
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Istanbul University, Beyazit, Istanbul, 34116, Turkey
| | - Paul B Savage
- Department of Chemistry and Biochemistry, Brigham Young University, Provo, Utah, 84602, USA
| | - A Seher Birteksoz Tan
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Istanbul University, Beyazit, Istanbul, 34116, Turkey
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Tulasidas S, Rao P, Bhat S, Manipura R. A study on biofilm production and antifungal drug resistance among Candida species from vulvovaginal and bloodstream infections. Infect Drug Resist 2018; 11:2443-2448. [PMID: 30538510 PMCID: PMC6260174 DOI: 10.2147/idr.s179462] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction Candida species, one among the opportunistic fungi, has become a common pathogen causing vaginal thrush and nosocomial bloodstream infections (BSIs). This study aims to evaluate the prevalence and antifungal susceptibility of various Candida species and slime production by Candida species in BSIs and vulvovaginal candidiasis (VVC). Materials and methods A total of 176 samples were collected for a period of 1 year. Anti-fungal susceptibility testing and biofilm production testing were performed by the Kirby-Bauer method and crystal violet assay, respectively. Results Out of 176 samples, 74 (42%) were from BSIs and 102 (58%) were from VVC. The biofilm production was comparatively high in blood isolates, 55 (74%), than cervical isolates, 45 (44%). Increase in the trends of non-albicans Candida (NAC) species was seen in our setup. Good susceptibility rates were seen among Candida species, 82.38% to voriconazole and an increasing resistance pattern of 26.13% to fluconazole. Conclusion Speciation of Candida becomes important as the prevalence of NAC is increasing. Antifungal susceptibility testing by the disk diffusion method is cost effective and should be adopted in routine testing as there is an increasing azole resistance, especially in invasive NAC infections. In this study, there was no correlation of antifungal drugs with the biofilm production.
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Affiliation(s)
- Sanyuktha Tulasidas
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Manipal, India
| | - Pooja Rao
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal McGill Center for Infectious Diseases, Mangalore, Manipal, India,
| | - Sevitha Bhat
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal McGill Center for Infectious Diseases, Mangalore, Manipal, India,
| | - Radhakrishna Manipura
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Manipal, India
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Rodríguez-Cerdeira C, Gregorio MC, Molares-Vila A, López-Barcenas A, Fabbrocini G, Bardhi B, Sinani A, Sánchez-Blanco E, Arenas-Guzmán R, Hernandez-Castro R. Biofilms and vulvovaginal candidiasis. Colloids Surf B Biointerfaces 2018; 174:110-125. [PMID: 30447520 DOI: 10.1016/j.colsurfb.2018.11.011] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 11/04/2018] [Accepted: 11/05/2018] [Indexed: 01/18/2023]
Abstract
Candida species, including C. albicans, are part of the mucosal flora of most healthy women, and inhabit the gastrointestinal and genitourinary tracts. Under favourable conditions, they can colonize the vulvovaginal mucosa, giving rise to symptomatic vulvovaginal candidiasis (VVC). The mechanism by which Candida spp. produces inflammation is unknown. Both, the blastoconidia and the pseudohyphae are capable of destroying the vaginal epithelium by direct invasion. Although the symptoms are not always related to the fungal burden, in general, VVC is associated with a greater number of yeasts and pseudohyphae. Some years ago, C. albicans was the species most frequently involved in the different forms of VVC. However, infections by different species have emerged during the last two decades producing an increase in causative species of VVC such as C. glabrata, C. parapsilosis, C. krusei and C. tropicalis. Candida species are pathogenic organisms that have two forms of development: planktonic and biofilm. A biofilm is defined as a community of microorganisms attached to a surface and encompassed by an extracellular matrix. This form of presentation gives microorganisms greater resistance to antifungal agents. This review, about Candia spp. with a special emphasis on Candida albicans discusses specific areas such as biofilm structure and development, cell morphology and biofilm formation, biofilm-associated gene expression, the cell surface and adherence, the extracellular matrix, biofilm metabolism, and biofilm drug resistance in vulvovaginitis biofilms as an important virulence factor in fungi.
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Affiliation(s)
- Carmen Rodríguez-Cerdeira
- Efficiency, Quality and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Spain; Dermatology Department, Hospital do Meixoeiro and University of Vigo, Vigo, Spain; European Women's Dermatologic and Venereologic Society (EWDVS), Vigo, Spain.
| | - Miguel Carnero Gregorio
- Efficiency, Quality and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Spain; Department of Biochemistry, Genetics and Immunology, University of Vigo, Vigo, Spain
| | - Alberto Molares-Vila
- Efficiency, Quality and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Spain; Department of Department of Analytical & Food Chemistry, Universidade de Vigo (UVIGO), Spain
| | - Adriana López-Barcenas
- Efficiency, Quality and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Spain; Mycology Service, Hospital Manuel Gea González, Mexico City, Mexico
| | | | | | - Ardiana Sinani
- Dermatology Service, Military Medical Unit, University Trauma Hospital, Tirana, Albania
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Reinhardt LC, Nascente PDS, Ribeiro JS, Etges A, Lund RG. A single-center 18-year experience with oral candidiasis in Brazil: a retrospective study of 1,534 cases. Braz Oral Res 2018; 32:e92. [PMID: 30231172 DOI: 10.1590/1807-3107bor-2018.vol32.0092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 07/25/2018] [Indexed: 11/22/2022] Open
Abstract
Despite the large number of published studies about oral candidiasis and associated risk factors, reports of large single-center retrospective studies on the prevalence of oral candidiasis, risk factors, and the oral candidiasis types diagnosed more frequently in oral diagnostic reference centers are scarce. The objective of the present study was to retrospectively survey the demographic and clinical profiles of 1,534 patients diagnosed with candidiasis and treated at the Center for Diagnosis of Oral Diseases (CDOD), Pelotas Dental School, Federal University of Pelotas between 1997 and 2014. Using a retrospective, cross-sectional, epidemiological design, data on race, gender, age, systemic diseases, oral candidiasis type and location, symptoms, and harmful habits such as smoking and alcohol consumption were collected. The statistical analysis was performed using STATA version 13.1. Risk factors for chronic atrophic candidiasis (CAC) were evaluated using Poisson regression with robust variance (p ≤ 0.05). The majority of patients with oral candidiasis seen at the CDOD over the 18-year period of analysis were Caucasian women, aged 51-60 years, nonsmokers, and nondrinkers, with no systemic disease, and who wore some form of dental prostheses. CAC was the single most common clinical type of candidiasis detected, and the most frequently affected oral site was the palate. These data from a large single-center in Brazil agree with previous evidence about the clinical and demographic profiles of patients with oral candidiasis.
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Affiliation(s)
- Leandro Calcagno Reinhardt
- Post-Graduate Program in Dentistry, School of Dentistry, Universidade Federal de Pelotas - UFPel, Pelotas, RS, Brazil
| | - Patricia da Silva Nascente
- Department of Microbiology and Parasitology, Institute of Biology, Universidade Federal de Pelotas - UFPel, Capão do Leão, RS, Brazil
| | - Juliana Silva Ribeiro
- Post-Graduate Program in Dentistry, School of Dentistry, Universidade Federal de Pelotas - UFPel, Pelotas, RS, Brazil
| | - Adriana Etges
- Post-Graduate Program in Dentistry, School of Dentistry, Universidade Federal de Pelotas - UFPel, Pelotas, RS, Brazil
| | - Rafael Guerra Lund
- Post-Graduate Program in Dentistry, School of Dentistry, Universidade Federal de Pelotas - UFPel, Pelotas, RS, Brazil
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21
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Treviño-Rangel RDJ, Bodden-Mendoza BA, Montoya AM, Villanueva-Lozano H, Elizondo-Zertuche M, Robledo-Leal E, González GM. Phenotypical characterization and molecular identification of clinical isolates of Candida tropicalis. Rev Iberoam Micol 2017; 35:17-21. [PMID: 29287631 DOI: 10.1016/j.riam.2017.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/24/2017] [Accepted: 05/18/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Candida tropicalis is an increasingly important human pathogen which usually affects neutropenic oncology patients with common hematogenous seeding to peripheral organs and high mortality rates. Candida pathogenicity is facilitated by several virulence attributes, including secretion of hydrolytic enzymes; however, little is known regarding the C. tropicalis ability to secrete them and their role in the disease. AIMS To confirm by molecular means the identification of 187 clinical isolates (127 from blood, 52 from urine, and 8 from diverse clinical origins) phenotypically identified as C. tropicalis, and to investigate their in vitro aspartyl proteinase, phospholipase, esterase, hemolysin, DNase and coagulase activities. METHODS The molecular confirmation was performed by ITS sequencing, and the enzymatic determinations were conducted using plate assays with specific substrates, with the exception of coagulase, which was determined by the classical tube test. RESULTS The majority of the strains exhibited a very strong or strong activity of aspartyl proteinase, phospholipase and esterase. A 4.7% of the bloodstream isolates were hemolysin producers, and all were negative for the coagulase and DNase assays. CONCLUSIONS Very strong activities of aspartyl proteinase, phospholipase and esterase profiles were detected, and a statistical association between phospholipase production and blood and urine isolates was found.
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Affiliation(s)
- Rogelio de J Treviño-Rangel
- Department of Microbiology, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Byron A Bodden-Mendoza
- Department of Microbiology, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Alexandra M Montoya
- Department of Microbiology, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Hiram Villanueva-Lozano
- Department of Microbiology, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Mariana Elizondo-Zertuche
- Department of Microbiology, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Efrén Robledo-Leal
- Department of Microbiology and Immunology, School of Biological Sciences, Universidad Autónoma de Nuevo León, San Nicolás de los Garza, Nuevo León, Mexico
| | - Gloria M González
- Department of Microbiology, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico.
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22
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Subramanya SH, Baral BP, Sharan NK, Nayak N, Metok Y, Sathian B, Bairy I, Gokhale S. Antifungal susceptibility and phenotypic virulence markers of Candida species isolated from Nepal. BMC Res Notes 2017; 10:543. [PMID: 29096684 PMCID: PMC5669004 DOI: 10.1186/s13104-017-2852-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 10/23/2017] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Candida species are part of the commensal microflora in many anatomical sites of the human body; however, breach in the integrity of the body part and impaired immunity of the host can lead to invasive candidiasis. A number of virulence determinants could contribute towards its pathogenicity. Thus we attempted to evaluate the in vitro expression of different virulence factors among clinical isolates of Candida species and assayed their susceptibility patterns against a range of antifungal agents. RESULT Of the total of 71 isolates we obtained, 48 (67.6%) were Candida albicans, 11 (15.49%) Candida tropicalis, 09 (12.67%) Candida glabrata and 03 (4.22%) were Candida krusei. Proteinase, phospholipase and esterase production could be revealed amongst 43 (60.56%), 44 (61.97%) and 49 (69.01%) isolates respectively. None of the isolates showed DNAase activity. Fifty-five (77.39%) isolates were biofilm producers, and 53 (74.6%) exhibited high cell surface hydrophobicity.
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Affiliation(s)
| | | | | | | | - Yang Metok
- Manipal College of Medical Sciences, Pokhara, Nepal
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23
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Canela HMS, Cardoso B, Vitali LH, Coelho HC, Martinez R, Ferreira MEDS. Prevalence, virulence factors and antifungal susceptibility of Candida spp. isolated from bloodstream infections in a tertiary care hospital in Brazil. Mycoses 2017; 61:11-21. [PMID: 28940753 DOI: 10.1111/myc.12695] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/20/2017] [Accepted: 08/22/2017] [Indexed: 12/13/2022]
Abstract
Candida spp. are responsible for 80% of all systemic fungal infections and are associated with high mortality rates. This study characterised 79 bloodstream isolates of C. albicans, C. glabrata, C. orthopsilosis, C. parapsilosis and C. tropicalis from patients in a Brazilian hospital. The susceptibility to amphotericin B, caspofungin, fluconazole and voriconazole was determined; virulence factor production was assessed based on haemolysin, phospholipase and proteinase activities, and the patients' clinical characteristics were analysed. C. albicans was the predominant species (44%), followed by C. glabrata (19%), C. tropicalis (19%), C. parapsilosis (14%) and C. orthopsilosis (4%). The candidemia incidence was 1.52 per 1000 admissions, and the crude mortality rate was 52%. One C. albicans isolate was resistant to fluconazole and voriconazole. Moreover, 20.2%, 2.5% and 3.8% of the isolates exhibited dose-dependent susceptibility to fluconazole, voriconazole and caspofungin, respectively. In conclusion, although the C. glabrata incidence was higher than that usually described in Brazil, its increase was previously observed in studies conducted worldwide. Furthermore, the azole resistance of the C. albicans isolate could be due to previous exposure to these antifungals. These results highlight the importance of epidemiological studies and will facilitate an improved understanding of candidemia in the studied hospital.
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Affiliation(s)
- Heliara Maria Spina Canela
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto-Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Bárbara Cardoso
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto-Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Lucia Helena Vitali
- Faculdade de Medicina de Ribeirão Preto-Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Harnoldo Colares Coelho
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto-Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Roberto Martinez
- Faculdade de Medicina de Ribeirão Preto-Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
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Sharma Y, Chumber SK, Kaur M. Studying the Prevalence, Species Distribution, and Detection of In vitro Production of Phospholipase from Candida Isolated from Cases of Invasive Candidiasis. J Glob Infect Dis 2017; 9:8-11. [PMID: 28250619 PMCID: PMC5330047 DOI: 10.4103/0974-777x.199995] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIM Candida spp. have emerged as successful pathogens both in invasive and mucosal infections. C. albicans is the sixth cause of most common nosocomial infections according to studies by the Centers for Disease Control and Prevention. A shift toward non-albicans species has been reported. There is a dearth of knowledge regarding the virulence factors of Candida, especially from this part of India. The aim was to study the prevalence of Candida, speciate, and determine antifungal sensitivity along with the detection of in vitro production of phospholipases in 100 Candida isolates. MATERIALS AND METHODS A total of 100 Candida isolates from various clinical specimens were studied (February 1, 2015-May 31, 2015; 4 months). Speciation was done by conventional methods and antifungal drugs fluconazole and voriconazole tested. Phospholipase activity (Pz value) was determined. RESULTS Of the 100 Candida spp., 35% were C. albicans and 65% were nonalbicans Candida (NAC). Species spectrum was of the 100 isolates as follows: 35 were C. albicans, 17 Candida tropicalis, 6 Candida glabrata, 8 Candida guilliermondi, 1 Candida kefyr, 6 Candida krusei, 14 Candida parapsilosis, 2 Candida lusitaniae, and 1 Trichosporon and 10 Candida spp. (not speciated). Phospholipase production was seen in 81 (81%) of the total isolates. The majority (63%) of phospholipase producers were NAC. Among NAC spp., the maximum phospholipase activity was seen in C. tropicalis (30%) and C. parapsilosis (24%). Of these, 60% of Candida was from patients admitted to the hospital. Sensitivity rates of C. albicans for fluconazole and voriconazole were 89.5% and 90.5%, respectively. CONCLUSION Increasing usage of devices, total parenteral nutrition, broad-spectrum antibiotics, chemotherapies, and transplantation are factors contributing to the increase of candidal infections. Recent studies underline the increasing frequency of infections by NAC. The present study showcases the increased prevalence as well as virulence of NAC. In addition, early detection of virulence factors by Candida is useful in clinical decision-making.
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Affiliation(s)
- Yukti Sharma
- Department of Microbiology, Laboratory Diagnostic Services, St. Stephen's Hospital, New Delhi, India
| | - Susheel Kumar Chumber
- Department of Microbiology, Laboratory Diagnostic Services, St. Stephen's Hospital, New Delhi, India
| | - Mandeep Kaur
- Department of Hematology, Laboratory Diagnostic Services, St. Stephen's Hospital, New Delhi, India
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Wang H, Xu YC, Hsueh PR. Epidemiology of candidemia and antifungal susceptibility in invasive Candida species in the Asia-Pacific region. Future Microbiol 2016; 11:1461-1477. [PMID: 27750452 DOI: 10.2217/fmb-2016-0099] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In the Asia-Pacific region, Candida albicans is the predominant Candida species causing invasive candidiasis/candidemia in Australia, Japan, Korea, Hong Kong, Malaysia, Singapore and Thailand whereas C. tropicalis is the most frequently encountered Candida species in Pakistan and India. Invasive isolates of C. albicans, C. parapsilosis complex and C. tropicalis remain highly susceptible to fluconazole (>90% susceptible). Fluconazole resistance (6.8-15%), isolates with the non-wild-type phenotype for itraconazole susceptibility (3.9-10%) and voriconazole (5-17.8%), and echinocandin resistance (2.1-2.2% in anidulafungin and 2.2% in micafungin) among invasive C. glabrata complex isolates are increasing in prevalence. Moreover, not all isolates of C. tropicalis have been shown to be susceptible to fluconazole (nonsusceptible rate, 5.7-11.6% in China) or voriconazole (nonsusceptible rate, 5.7-9.6% in China).
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Affiliation(s)
- He Wang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ying-Chun Xu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Po-Ren Hsueh
- Departments of Laboratory Medicine & Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Seneviratne CJ, Rajan S, Wong SSW, Tsang DNC, Lai CKC, Samaranayake LP, Jin L. Antifungal Susceptibility in Serum and Virulence Determinants of Candida Bloodstream Isolates from Hong Kong. Front Microbiol 2016; 7:216. [PMID: 26955369 PMCID: PMC4767892 DOI: 10.3389/fmicb.2016.00216] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 02/10/2016] [Indexed: 01/12/2023] Open
Abstract
Candida bloodstream infections (CBI) are one of the most common nosocomial infections globally, and they account for a high mortality rate. The increasing global prevalence of drug-resistant Candida strains has also been posing a challenge to clinicians. In this study, we comprehensively evaluated the biofilm formation and production of hemolysin and proteinase of 63 CBI isolates derived from a hospital setting in Hong Kong as well as their antifungal susceptibility both in the presence and in the absence of human serum, using standard methodology. Candida albicans was the predominant species among the 63 CBI isolates collected, and non-albicans Candida species accounted for approximately one third of the isolates (36.5%). Of them, Candida tropicalis was the most common non-albicans Candida species. A high proportion (31.7%) of the CBI isolates (40% of C. albicans isolates, 10% of C. tropicalis isolates, 11% of C. parapsilosis isolates, and 100% of C. glabrata isolates) were found to be resistant to fluconazole. One of the isolates (C. tropicalis) was resistant to amphotericin B. A rising prevalence of drug-resistance CBI isolates in Hong Kong was observed with reference to a previous study. Notably, all non-albicans Candida species, showed increased hemolytic activity relative to C. albicans, whilst C. albicans, C. tropicalis, and C. parapsilosis exhibited proteinase activities. Majority of the isolates were capable of forming mature biofilms. Interestingly, the presence of serum distorted the yeast sensitivity to fluconazole, but not amphotericin B. Taken together, our findings demonstrate that CBI isolates of Candida have the potential to express to varying extent their virulence attributes (e.g., biofilm formation, hemolysin production, and proteinase activity) and these, together with perturbations in their antifungal sensitivity in the presence of serum, may contribute to treatment complication in candidemia. The effect of serum on antifungal activity warrants further investigations, as it has direct clinical relevance to the treatment outcome in subjects with candidemia.
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Affiliation(s)
- Chaminda J Seneviratne
- Oral Sciences, Faculty of Dentistry, National University of SingaporeSingapore; Faculty of Dentistry, The University of Hong KongHong Kong, China
| | - Suhasini Rajan
- Faculty of Dentistry, The University of Hong Kong Hong Kong, China
| | - Sarah S W Wong
- Faculty of Dentistry, The University of Hong Kong Hong Kong, China
| | | | | | - Lakshman P Samaranayake
- Faculty of Dentistry, The University of Hong KongHong Kong, China; School of Dentistry, University of QueenslandBrisbane, QLD, Australia
| | - Lijian Jin
- Faculty of Dentistry, The University of Hong Kong Hong Kong, China
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Scarsini M, Tomasinsig L, Arzese A, D'Este F, Oro D, Skerlavaj B. Antifungal activity of cathelicidin peptides against planktonic and biofilm cultures of Candida species isolated from vaginal infections. Peptides 2015; 71:211-21. [PMID: 26238597 DOI: 10.1016/j.peptides.2015.07.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 07/23/2015] [Accepted: 07/24/2015] [Indexed: 01/13/2023]
Abstract
Vulvovaginal candidiasis (VVC) is a frequent gynecological condition caused by Candida albicans and a few non-albicans Candida spp. It has a significant impact on the quality of life of the affected women also due to a considerable incidence of recurrent infections that are difficult to treat. The formation of fungal biofilm may contribute to the problematic management of recurrent VVC due to the intrinsic resistance of sessile cells to the currently available antifungals. Thus, alternative approaches for the prevention and control of biofilm-related infections are urgently needed. In this regard, the cationic antimicrobial peptides (AMPs) of the innate immunity are potential candidates for the development of novel antimicrobials as many of them display activity against biofilm formed by various microbial species. In the present study, we investigated the in vitro antifungal activities of the cathelicidin peptides LL-37 and BMAP-28 against pathogenic Candida spp. also including C. albicans, isolated from vaginal infections, and against C. albicans SC5314 as a reference strain. The antimicrobial activity was evaluated against planktonic and biofilm-grown Candida cells by using microdilution susceptibility and XTT [2,3-bis(2-methoxy-4-nitro-5-sulfo-phenyl)-2H-tetrazolium-5-carboxanilide] reduction assays and, in the case of established biofilms, also by CFU enumeration and fluorescence microscopy. BMAP-28 was effective against planktonically grown yeasts in standard medium (MIC range, 2-32μM), and against isolates of C. albicans and Candida krusei in synthetic vaginal simulated fluid (MIC range 8-32μM, depending on the pH of the medium). Established 48-h old biofilms formed by C. albicans SC5314 and C. albicans and C. krusei isolates were 70-90% inhibited within 24h incubation with 16μM BMAP-28. As shown by propidium dye uptake and CFU enumeration, BMAP-28 at 32μM killed sessile C. albicans SC5314 by membrane permeabilization with a faster killing kinetics compared to 32μM miconazole (80-85% reduced biofilm viability in 90min vs 48h). In addition, BMAP-28 at 16μM prevented Candida biofilm formation on polystyrene and medical grade silicone surfaces by causing a >90% reduction in the viability of planktonic cells in 30min. LL-37 was overall less effective than BMAP-28 against planktonic Candida spp. (MIC range 4-≥64μM), and was ineffective against established Candida biofilms. However, LL-37 at 64μM prevented Candida biofilm development by inhibiting cell adhesion to polystyrene and silicone surfaces. Finally, Candida adhesion was strongly inhibited when silicone was pre-coated with a layer of BMAP-28 or LL-37, encouraging further studies for the development of peptide-based antimicrobial coatings.
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Affiliation(s)
- Michele Scarsini
- Department of Medical and Biological Sciences, University of Udine, Piazzale Kolbe 4, 33100 Udine, Italy
| | - Linda Tomasinsig
- Department of Medical and Biological Sciences, University of Udine, Piazzale Kolbe 4, 33100 Udine, Italy
| | - Alessandra Arzese
- Department of Experimental and Clinical Sciences, University of Udine, Piazzale Kolbe 4, 33100 Udine, Italy
| | - Francesca D'Este
- Department of Medical and Biological Sciences, University of Udine, Piazzale Kolbe 4, 33100 Udine, Italy
| | - Debora Oro
- Department of Medical and Biological Sciences, University of Udine, Piazzale Kolbe 4, 33100 Udine, Italy
| | - Barbara Skerlavaj
- Department of Medical and Biological Sciences, University of Udine, Piazzale Kolbe 4, 33100 Udine, Italy.
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28
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Kali A, Seetha KS, Srirangaraj S. Antifungal Breakpoints of Non-albicans Candida Clinical Isolates in Vitek-2 Compact. J Clin Diagn Res 2015; 9:DL01. [PMID: 26266123 DOI: 10.7860/jcdr/2015/14211.6043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 05/09/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Arunava Kali
- Assistant Professor, Department of Microbiology, Mahatma Gandhi Medical College & Research Institute , Pondicherry, India
| | - Kunigal Srinivasaiah Seetha
- Professor and HOD, Department of Microbiology, Mahatma Gandhi Medical College & Research Institute , Pondicherry, India
| | - Sreenivasan Srirangaraj
- Professor and HOD, Department of Microbiology, Mahatma Gandhi Medical College & Research Institute , Pondicherry, India
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