1
|
Marques MJAM, Alves F, Sousa MHS, Guimarães FEG, Kurachi C. Morphological aspects and the effectiveness of photodynamic inactivation against Rhizopus oryzae in different life cycles. Photochem Photobiol Sci 2024; 23:1323-1339. [PMID: 38806860 DOI: 10.1007/s43630-024-00597-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 05/18/2024] [Indexed: 05/30/2024]
Abstract
Mucormycosis is an extremely aggressive fungal disease with a high mortality rate, especially in people with compromised immune systems. Most cases of mucormycosis are caused by the fungus Rhizopus oryzae. The treatments used are based on high doses of antifungals, associated with surgical resections, when it is possible. However, even with this aggressive treatment, the estimated attributable mortality rate is high. There is therefore a need to develop adjuvant treatments. Photodynamic Inactivation (PDI) may be an auxiliary therapeutic option for mucormycosis. Due to the lack of reports in the literature on the morphology and photodynamic inactivation of R. oryzae, characterization of the fungus using Confocal Microscopy and Transmission Electron Microscopy, and different protocols using Photodithazine® (PDZ), a chlorin e6 compound, as a photosensitizer, were performed. The fungus growth rate under different concentrations and incubation times of the photosensitizer and its association with the surfactant Sodium Dodecyl Sulphate (SDS) was evaluated. For the hyphae, both in the light and dark phases, in the protocols using only PDZ, no effective photodynamic response was observed. Meanwhile with the combination of SDS 0.05% and PDZ, inhibition growth rates of 98% and 72% were achieved for the white and black phase, respectively. In the conidia phase, only a 1.7 log10 reduction of the infective spores was observed. High concentration of melanin and the complex and resistant structures, especially at the black phase, results in a high limitation of the PDI inactivation response. The combined use of the SDS resulted in an improved response, when compared to the one obtained with the amphotericin B treatment.
Collapse
Affiliation(s)
- M J A M Marques
- São Carlos Institute of Physics, University of São Paulo, São Carlos, Brazil
| | - F Alves
- São Carlos Institute of Physics, University of São Paulo, São Carlos, Brazil
| | - M H S Sousa
- São Carlos Institute of Physics, University of São Paulo, São Carlos, Brazil
| | - F E G Guimarães
- São Carlos Institute of Physics, University of São Paulo, São Carlos, Brazil
| | - C Kurachi
- São Carlos Institute of Physics, University of São Paulo, São Carlos, Brazil.
| |
Collapse
|
2
|
Loreto ES, Tondolo JSM, Zanette RA. Treating Pythiosis with Antibacterial Drugs Targeting Protein Synthesis: An Overview. J Fungi (Basel) 2024; 10:234. [PMID: 38667905 PMCID: PMC11051233 DOI: 10.3390/jof10040234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/08/2024] [Accepted: 03/18/2024] [Indexed: 04/28/2024] Open
Abstract
This review article explores the effectiveness of antibacterial drugs that inhibit protein synthesis in treating pythiosis, a difficult-to-treat infection caused by Pythium insidiosum. The article highlights the susceptibility of P. insidiosum to antibacterial drugs, such as macrolides, oxazolidinones, and tetracyclines. We examine various studies, including in vitro tests, experimental infection models, and clinical case reports. Based on our synthesis of these findings, we highlight the potential of these drugs in managing pythiosis, primarily when combined with surgical interventions. The review emphasizes the need for personalized treatment strategies and further research to establish standardized testing protocols and optimize therapeutic approaches.
Collapse
Affiliation(s)
- Erico S. Loreto
- Sobresp Faculty of Health Sciences, 520 Appel Street, Santa Maria 97015-030, RS, Brazil;
| | - Juliana S. M. Tondolo
- Sobresp Faculty of Health Sciences, 520 Appel Street, Santa Maria 97015-030, RS, Brazil;
| | - Régis A. Zanette
- Department of Pharmacology, Basic Health Sciences Institute, Federal University of Rio Grande do Sul, 2600 Ramiro Barcelos Street, Porto Alegre 90035-003, RS, Brazil;
| |
Collapse
|
3
|
Souza BMN, Miñán AG, Brambilla IR, Pinto JG, Garcia MT, Junqueira JC, Ferreira-Strixino J. Effects of antimicrobial photodynamic therapy with photodithazine® on methicillin-resistant Staphylococcus aureus (MRSA): Studies in biofilms and experimental model with Galleria mellonella. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 2024; 252:112860. [PMID: 38330692 DOI: 10.1016/j.jphotobiol.2024.112860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/15/2024] [Accepted: 02/01/2024] [Indexed: 02/10/2024]
Abstract
Staphylococcus aureus infections are a severe health problem due to the high mortality rate. Conventional treatment of these infections is via the administration of antibiotics. However, its indiscriminate use can select resistant microorganisms. Thus, it is necessary to develop alternatives for antibiotic therapy. Antimicrobial Photodynamic Therapy (aPDT), a therapeutic method that associates a photosensitizer (PS), a light source with adequate wavelength to the PS, interacts with molecular oxygen generating reactive oxygen species responsible for cell inactivation, is a viable alternative. This work aimed to analyze, in vitro and in vivo, the action of aPDT with PS Photodithazine® (PDZ) on the methicillin-resistant S. aureus (MRSA) strain. In the in vitro method, the S. aureus biofilm was incubated with PDZ at 50 and 75 μg.mL-1 for 15 min, adopting the light dose of 25, 50, and 100 J/cm2. In addition, PS interaction, formation of reactive oxygen species (ROS), bacterial metabolism, adhesion, bacterial viability, and biofilm structure were evaluated by scanning electron microscopy. Subsequently, the strain was inoculated into models of Galleria mellonella, and the survival curve, health scale, blood cell analysis, and CFU/mL of S. aureus in the hemolymph were analyzed after aPDT. In the in vitro results, bacterial reduction was observed in the different PDZ concentrations, highlighting the parameters of 75 μg.mL-1 of PDZ and 100 J/cm2. As for in vivo results, aPDT increased survival and stimulated the immune system of G. mellonella infected by S. aureus. aPDT proved effective in both models, demonstrating its potential as an alternative therapy in treating MRSA bacterial infections.
Collapse
Affiliation(s)
- Beatriz Müller N Souza
- Photobiology Applied to Health (PhotoBioS Lab), Universidade do Vale do Paraíba (UNIVAP), São José dos Campos, São Paulo, Brazil
| | - Alejandro Guillermo Miñán
- Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata 1900, Argentina.
| | - Isabelle Ribeiro Brambilla
- Photobiology Applied to Health (PhotoBioS Lab), Universidade do Vale do Paraíba (UNIVAP), São José dos Campos, São Paulo, Brazil
| | - Juliana Guerra Pinto
- Photobiology Applied to Health (PhotoBioS Lab), Universidade do Vale do Paraíba (UNIVAP), São José dos Campos, São Paulo, Brazil.
| | - Maíra Terra Garcia
- Department of Biosciences and Oral Diagnosis, Universidade Estadual Paulista (Unesp), Institute of Science and Technology (ICT), São José dos Campos, São Paulo, Brazil
| | - Juliana Campos Junqueira
- Department of Biosciences and Oral Diagnosis, Universidade Estadual Paulista (Unesp), Institute of Science and Technology (ICT), São José dos Campos, São Paulo, Brazil.
| | - Juliana Ferreira-Strixino
- Photobiology Applied to Health (PhotoBioS Lab), Universidade do Vale do Paraíba (UNIVAP), São José dos Campos, São Paulo, Brazil.
| |
Collapse
|
4
|
Rodrigues VS, Trevisan LAC, Cintra BS, Pires RH, Ribeiro AB, Tavares DC, Oberhaus E, Ferreira JC. Effectiveness of photo-ozone therapy against equine Pythium insidiosum. J Equine Vet Sci 2024; 134:105030. [PMID: 38342358 DOI: 10.1016/j.jevs.2024.105030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/18/2024] [Accepted: 02/06/2024] [Indexed: 02/13/2024]
Abstract
Cutaneous pythiosis is a life-threatening infectious disease. Low-level laser therapy (LLLT) and ozone (O3) have been used individually in the treatment of infected wounds. The goals of the study were a) to characterize the antimicrobial action of the photo-ozone therapy (LLLT-O3) against equine Pythium insidiosum, and b) to assess the cytotoxic potential of the LLLT-O3 in keratinocytes. Specimens of pathogen were isolated from 10 horses. After culturing, 120 hyphae plugs were distributed among four groups (n=30 hyphae plugs/group): LLLT (laser irradiation for 160 sec;), O3 (exposition to O3 for 15 min;), LLLT-O3 (LLLT and O3 treatments in sequence) and control (untreated plugs). The hyphae growth was measured during the first 14 days post-treatment. Where there was an absence of hyphae growth, the plug was recultured for an additional 7 days. The cytotoxic potential of the treatments against HaCaT keratinocytes was assessed by colorimetric assays. The LLLT-O3 and O3 treatments inactivated, respectively, 92.3% (28/30) and 30% (9/30) of the samples. No growth was detected after 7 days reculture of inactivated hyphae plugs on new media. Hyphae growth was visualized in 100% of the control and LLLT hyphae plugs. The viability of HaCaT cells was not affected by the isolated treatments (LLLT and O3), while the LLLT-O3 showed slight cytotoxic effect (20%) when compared to the control group (P<0.05). Photo-ozone therapy inactivated equine P. insidiosum hyphae with minimal cytotoxicity in skin cells in vitro.
Collapse
Affiliation(s)
- V S Rodrigues
- Post-graduation Program in Animal Sciences, University of Franca, 201 Dr. Armando de Sáles Oliveira, Franca, SP, Brazil, 14404-600
| | - L A C Trevisan
- Post-graduation Program in Animal Sciences, University of Franca, 201 Dr. Armando de Sáles Oliveira, Franca, SP, Brazil, 14404-600
| | - B S Cintra
- Post-graduation Program in Animal Sciences, University of Franca, 201 Dr. Armando de Sáles Oliveira, Franca, SP, Brazil, 14404-600
| | - R H Pires
- Post-graduation Program in Animal Sciences, University of Franca, 201 Dr. Armando de Sáles Oliveira, Franca, SP, Brazil, 14404-600
| | - A B Ribeiro
- Post-graduation Program in Animal Sciences, University of Franca, 201 Dr. Armando de Sáles Oliveira, Franca, SP, Brazil, 14404-600
| | - D C Tavares
- Post-graduation Program in Animal Sciences, University of Franca, 201 Dr. Armando de Sáles Oliveira, Franca, SP, Brazil, 14404-600
| | - E Oberhaus
- School of Animal Sciences, Louisiana State University, 201D Animal & Food Sciences Lab Bldg., Baton Rouge, LA, USA, 70803
| | - J C Ferreira
- Post-graduation Program in Animal Sciences, University of Franca, 201 Dr. Armando de Sáles Oliveira, Franca, SP, Brazil, 14404-600.
| |
Collapse
|
5
|
Yolanda H, Jearawuttanakul K, Wannalo W, Kanjanasirirat P, Borwornpinyo S, Rujirawat T, Payattikul P, Kittichotirat W, Wichadakul D, Krajaejun T. Potential anti- Pythium insidiosum therapeutics identified through screening of agricultural fungicides. Microbiol Spectr 2024; 12:e0162023. [PMID: 38179943 PMCID: PMC10846074 DOI: 10.1128/spectrum.01620-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/07/2023] [Indexed: 01/06/2024] Open
Abstract
Pythiosis is a life-threatening infectious disease caused by the oomycete Pythium insidiosum. Clinical manifestations of pythiosis include an eye, blood vessel, skin, or gastrointestinal tract infection. Pythiosis has been increasingly reported worldwide, with an overall mortality rate of 28%. Radical surgery is required to save patients' lives due to the limited efficacy of antimicrobial drugs. Effective medical treatments are urgently needed for pythiosis. This study aims to find anti-P. insidiosum agents by screening 17 agricultural fungicides that inhibit plant-pathogenic oomycetes and validating their efficacy and safety. Cyazofamid outperformed other fungicides as it can potently inhibit genetically diverse P. insidiosum isolates while exhibiting minimal cellular toxicities. The calculated therapeutic scores determined that the concentration of cyazofamid causing significant cellular toxicities was eight times greater than the concentration of the drug effectively inhibiting P. insidiosum. Furthermore, other studies showed that cyazofamid exhibits low-to-moderate toxicities in animals. The mechanism of cyazofamid action is likely the inhibition of cytochrome b, an essential component in ATP synthesis. Molecular docking and dynamic analyses depicted a stable binding of cyazofamid to the Qi site of the P. insidiosum's cytochrome b orthologous protein. In conclusion, our search for an effective anti-P. insidiosum drug indicated that cyazofamid is a promising candidate for treating pythiosis. With its high efficacy and low toxicity, cyazofamid is a potential chemical for treating pythiosis, reducing the need for radical surgeries, and improving recovery rates. Our findings could pave the way for the development of new and effective treatments for pythiosis.IMPORTANCEPythiosis is a severe infection caused by Pythium insidiosum. The disease is prevalent in tropical/subtropical regions. This infectious condition is challenging to treat with antifungal drugs and often requires surgical removal of the infected tissue. Pythiosis can be fatal if not treated promptly. There is a need for a new treatment that effectively inhibits P. insidiosum. This study screened 17 agricultural fungicides that target plant-pathogenic oomycetes and found that cyazofamid was the most potent in inhibiting P. insidiosum. Cyazofamid showed low toxicity to mammalian cells and high affinity to the P. insidiosum's cytochrome b, which is involved in energy production. Cyazofamid could be a promising candidate for the treatment of pythiosis, as it could reduce the need for surgery and improve the survival rate of patients. This study provides valuable insights into the biology and drug susceptibility of P. insidiosum and opens new avenues for developing effective therapies for pythiosis.
Collapse
Affiliation(s)
- Hanna Yolanda
- Program in Translational Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Department of Parasitology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Kedchin Jearawuttanakul
- Excellent Center for Drug Discovery, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Warawuth Wannalo
- Excellent Center for Drug Discovery, Faculty of Science, Mahidol University, Bangkok, Thailand
| | | | - Suparerk Borwornpinyo
- Excellent Center for Drug Discovery, Faculty of Science, Mahidol University, Bangkok, Thailand
- Department of Biotechnology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Thidarat Rujirawat
- Research Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Penpan Payattikul
- Research Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Weerayuth Kittichotirat
- Bioinformatics and Systems Biology Program, School of Bioresources and Technology and School of Information Technology, King Mongkut’s University of Technology Thonburi, Bangkhuntien, Bangkok, Thailand
- Systems Biology and Bioinformatics Research Group, Pilot Plant Development and Training Institute, King Mongkut’s University of Technology Thonburi, Bangkhuntien, Bangkok, Thailand
| | - Duangdao Wichadakul
- Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Systems Biology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Theerapong Krajaejun
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
6
|
Billings P, Walton S, Shmalberg J, Santoro D. The Use of Mefenoxam to Treat Cutaneous and Gastrointestinal Pythiosis in Dogs: A Retrospective Study. Microorganisms 2023; 11:1726. [PMID: 37512898 PMCID: PMC10385059 DOI: 10.3390/microorganisms11071726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/24/2023] [Accepted: 05/28/2023] [Indexed: 07/30/2023] Open
Abstract
Pythium insidiosum, an aquatic oomycete with pathogenic potential in mammals, causes gastrointestinal and cutaneous disease in dogs. Mefenoxam, an agricultural anti-oomycotic compound, has a demonstrated the ability to inhibit P. insidiosum growth in vitro and has been associated with efficacy in treating gastrointestinal pythiosis in several case reports. Electronic medical records of dogs seen at University of Florida Small Animal Hospital and treated with mefenoxam between 2013 and 2020 were searched. Dogs were included in this study upon previous definitive diagnosis with either organism identification using culture, PCR, or antibody ELISA, or a combination of these tests with or without supportive histopathological analysis. Since 2013, mefenoxam had been administered to 25 dogs with cutaneous pythiosis and 16 dogs with gastrointestinal pythiosis. In both gastrointestinal and cutaneous pythiosis groups, the administration of mefenoxam was associated with a survivability rate of approximately 51%. There was a statistically significant difference in the time to death between cutaneous (245 days (52-530)) and gastrointestinal (90 days (21-203)) groups; dogs infected with cutaneous pythiosis survived significantly longer after being diagnosed with the disease (p = 0.035). The dogs in this study experienced increased survival rates and time to death, in the absence of side effects due to mefenoxam, compared with previously published literature. The results of this retrospective study, with some limitations, are promising and should prompt further investigation into the use of mefenoxam in the treatment of both gastrointestinal and cutaneous pythiosis.
Collapse
Affiliation(s)
- Phillip Billings
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, 2015 SW 16th Avenue, Gainesville, FL 32610, USA
| | - Stuart Walton
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, 2015 SW 16th Avenue, Gainesville, FL 32610, USA
| | - Justin Shmalberg
- Department of Comparative, Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Domenico Santoro
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, 2015 SW 16th Avenue, Gainesville, FL 32610, USA
| |
Collapse
|
7
|
Piksa M, Lian C, Samuel IC, Pawlik KJ, Samuel IDW, Matczyszyn K. The role of the light source in antimicrobial photodynamic therapy. Chem Soc Rev 2023; 52:1697-1722. [PMID: 36779328 DOI: 10.1039/d0cs01051k] [Citation(s) in RCA: 66] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Antimicrobial photodynamic therapy (APDT) is a promising approach to fight the growing problem of antimicrobial resistance that threatens health care, food security and agriculture. APDT uses light to excite a light-activated chemical (photosensitiser), leading to the generation of reactive oxygen species (ROS). Many APDT studies confirm its efficacy in vitro and in vivo against bacteria, fungi, viruses and parasites. However, the development of the field is focused on exploring potential targets and developing new photosensitisers. The role of light, a crucial element for ROS production, has been neglected. What are the main parameters essential for effective photosensitiser activation? Does an optimal light radiant exposure exist? And finally, which light source is best? Many reports have described the promising antibacterial effects of APDT in vitro, however, its application in vivo, especially in clinical settings remains very limited. The restricted availability may partially be due to a lack of standard conditions or protocols, arising from the diversity of selected photosensitising agents (PS), variable testing conditions including light sources used for PS activation and methods of measuring anti-bacterial activity and their effectiveness in treating bacterial infections. We thus sought to systematically review and examine the evidence from existing studies on APDT associated with the light source used. We show how the reduction of pathogens depends on the light source applied, radiant exposure and irradiance of light used, and type of pathogen, and so critically appraise the current state of development of APDT and areas to be addressed in future studies. We anticipate that further standardisation of the experimental conditions will help the field advance, and suggest key optical and biological parameters that should be reported in all APDT studies. More in vivo and clinical studies are needed and are expected to be facilitated by advances in light sources, leading to APDT becoming a sustainable, alternative therapeutic option for bacterial and other microbial infections in the future.
Collapse
Affiliation(s)
- Marta Piksa
- Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Science, Weigla 12, 53-114, Wroclaw, Poland
| | - Cheng Lian
- Organic Semiconductor Centre, SUPA, School of Physics and Astronomy, University of St Andrews, Fife, KY16 9SS, UK.
| | - Imogen C Samuel
- School of Medicine, University of Manchester, Manchester, M13 9PL, UK
| | - Krzysztof J Pawlik
- Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Science, Weigla 12, 53-114, Wroclaw, Poland
| | - Ifor D W Samuel
- Organic Semiconductor Centre, SUPA, School of Physics and Astronomy, University of St Andrews, Fife, KY16 9SS, UK.
| | - Katarzyna Matczyszyn
- Institute of Advanced Materials, Faculty of Chemistry, Wroclaw University of Science and Technology, Wyb. Wyspianskiego 27, 50-370 Wroclaw, Poland.
| |
Collapse
|
8
|
Sierra-Garcia IN, Cunha Â, Lourenço LM. In vitro photodynamic treatment of Fusarium oxysporum conidia through the action of thiopyridinium and methoxypyridinium chlorins. J Photochem Photobiol A Chem 2022. [DOI: 10.1016/j.jphotochem.2022.114081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
9
|
Gurnani B, Kaur K, Agarwal S, Lalgudi VG, Shekhawat NS, Venugopal A, Tripathy K, Srinivasan B, Iyer G, Gubert J. Pythium insidiosum Keratitis: Past, Present, and Future. Ophthalmol Ther 2022; 11:1629-1653. [PMID: 35788551 PMCID: PMC9255487 DOI: 10.1007/s40123-022-00542-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022] Open
Abstract
Pythium insidiosum (PI) is an oomycete, a protist belonging to the clade Stramenopila. PI causes vision-threatening keratitis closely mimicking fungal keratitis (FK), hence it is also labeled as "parafungus". PI keratitis was initially confined to Thailand, USA, China, and Australia, but with growing clinical awareness and improvement in diagnostic modalities, the last decade saw a massive upsurge in numbers with the majority of reports coming from India. In the early 1990s, pythiosis was classified as vascular, cutaneous, gastrointestinal, systemic, and ocular. Clinically, morphologically, and microbiologically, PI keratitis closely resembles severe FK and requires a high index of clinical suspicion for diagnosis. The clinical features such as reticular dot infiltrate, tentacular projections, peripheral thinning with guttering, and rapid limbal spread distinguish it from other microorganisms. Routine smearing with Gram and KOH stain reveals perpendicular septate/aseptate hyphae, which closely mimic fungi and make the diagnosis cumbersome. The definitive diagnosis is the presence of dull grey/brown refractile colonies along with zoospore formation upon culture by leaf induction method. However, culture is time-consuming, and currently polymerase chain reaction (PCR) method is the gold standard. The value of other diagnostic modalities such as confocal microscopy and immunohistopathological assays is limited due to cost, non-availability, and limited diagnostic accuracy. PI keratitis is a relatively rare disease without established treatment protocols. Because of its resemblance to fungus, it was earlier treated with antifungals but with an improved understanding of its cell wall structure and absence of ergosterol, this is no longer recommended. Currently, antibacterials have shown promising results. Therapeutic keratoplasty with good margin (1 mm) is mandated for non-resolving cases and corneal perforation. In this review, we have deliberated on the evolution of PI keratitis, covered all the recently available literature, described our current understanding of the diagnosis and treatment, and the potential future diagnostic and management options for PI keratitis.
Collapse
Affiliation(s)
- Bharat Gurnani
- Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, 605007, India.
| | - Kirandeep Kaur
- Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, 605007 India
| | - Shweta Agarwal
- Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, CJ Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu 600006 India
| | | | - Nakul S. Shekhawat
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Anitha Venugopal
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu India
| | | | - Bhaskar Srinivasan
- Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, CJ Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu 600006 India
| | - Geetha Iyer
- Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, CJ Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu 600006 India
| | - Joseph Gubert
- Department of Microbiology, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, 605007 India
| |
Collapse
|
10
|
Medhasi S, Chindamporn A, Worasilchai N. A Review: Antimicrobial Therapy for Human Pythiosis. Antibiotics (Basel) 2022; 11:antibiotics11040450. [PMID: 35453202 PMCID: PMC9029071 DOI: 10.3390/antibiotics11040450] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 01/14/2023] Open
Abstract
Human pythiosis is associated with poor prognosis with significant mortality caused by Pythium insidiosum. Antimicrobials’ in vitro and in vivo results against P. insidiosum are inconsistent. Although antimicrobials are clinically useful, they are not likely to achieve therapeutic success alone without surgery and immunotherapy. New therapeutic options are therefore needed. This non-exhaustive review discusses the rationale antimicrobial therapy, minimum inhibitory concentrations, and efficacy of antibacterial and antifungal agents against P. insidiosum. This review further provides insight into the immunomodulating effects of antimicrobials that can enhance the immune response to infections. Current data support using antimicrobial combination therapy for the pharmacotherapeutic management of human pythiosis. Also, the success or failure of antimicrobial treatment in human pythiosis might depend on the immunomodulatory effects of drugs. The repurposing of existing drugs is a safe strategy for anti-P. insidiosum drug discovery. To improve patient outcomes in pythiosis, we suggest further research and a deeper understanding of P. insidiosum virulence factors, host immune response, and host immune system modification by antimicrobials.
Collapse
Affiliation(s)
- Sadeep Medhasi
- Department of Transfusion Medicine and Clinical Microbiology, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok 10330, Thailand;
| | - Ariya Chindamporn
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand;
| | - Navaporn Worasilchai
- Department of Transfusion Medicine and Clinical Microbiology, Faculty of Allied Health Sciences, Immunomodulation of Natural Products Research Group, Chulalongkorn University, Bangkok 10330, Thailand
- Correspondence: ; Tel.: +66-2218-1065
| |
Collapse
|
11
|
Sadraeian M, Junior FFP, Miranda M, Galinskas J, Fernandes RS, da Cruz EF, Fu L, Zhang L, Diaz RS, Cabral-Miranda G, Guimarães FEG. Study of Viral Photoinactivation by UV-C Light and Photosensitizer Using a Pseudotyped Model. Pharmaceutics 2022; 14:pharmaceutics14030683. [PMID: 35336059 PMCID: PMC8955308 DOI: 10.3390/pharmaceutics14030683] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 01/27/2023] Open
Abstract
Different light-based strategies have been investigated to inactivate viruses. Herein, we developed an HIV-based pseudotyped model of SARS-CoV-2 (SC2) to study the mechanisms of virus inactivation by using two different strategies; photoinactivation (PI) by UV-C light and photodynamic inactivation (PDI) by Photodithazine photosensitizer (PDZ). We used two pseudoviral particles harboring the Luciferase-IRES-ZsGreen reporter gene with either a SC2 spike on the membrane or without a spike as a naked control pseudovirus. The mechanism of viral inactivation by UV-C and PDZ-based PDI were studied via biochemical characterizations and quantitative PCR on four levels; free-cell viral damage; viral cell entry; DNA integration; and expression of reporter genes. Both UV-C and PDZ treatments could destroy single stranded RNA (ssRNA) and the spike protein of the virus, with different ratios. However, the virus was still capable of binding and entering into the HEK 293T cells expressing angiotensin-converting enzyme 2 (ACE-2). A dose-dependent manner of UV-C irradiation mostly damages the ssRNA, while PDZ-based PDI mostly destroys the spike and viral membrane in concentration and dose-dependent manners. We observed that the cells infected by the virus and treated with either UV-C or PDZ-based PDI could not express the luciferase reporter gene, signifying the viral inactivation, despite the presence of RNA and DNA intact genes.
Collapse
Affiliation(s)
- Mohammad Sadraeian
- Instituto de Física de São Carlos, Universidade de São Paulo, Caixa Postal 369, São Carlos 13560-970, SP, Brazil; (F.F.P.J.); (M.M.); (R.S.F.)
- Institute for Biomedical Materials and Devices (IBMD), Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia; (L.F.); (L.Z.)
- Correspondence: (M.S.); (F.E.G.G.); Tel.: +55-(16)-33739792 (F.E.G.G.)
| | - Fabio Francisco Pinto Junior
- Instituto de Física de São Carlos, Universidade de São Paulo, Caixa Postal 369, São Carlos 13560-970, SP, Brazil; (F.F.P.J.); (M.M.); (R.S.F.)
| | - Marcela Miranda
- Instituto de Física de São Carlos, Universidade de São Paulo, Caixa Postal 369, São Carlos 13560-970, SP, Brazil; (F.F.P.J.); (M.M.); (R.S.F.)
| | - Juliana Galinskas
- Laboratório de Retrovirologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04039-032, SP, Brazil; (J.G.); (E.F.d.C.); (R.S.D.)
| | - Rafaela Sachetto Fernandes
- Instituto de Física de São Carlos, Universidade de São Paulo, Caixa Postal 369, São Carlos 13560-970, SP, Brazil; (F.F.P.J.); (M.M.); (R.S.F.)
| | - Edgar Ferreira da Cruz
- Laboratório de Retrovirologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04039-032, SP, Brazil; (J.G.); (E.F.d.C.); (R.S.D.)
| | - Libing Fu
- Institute for Biomedical Materials and Devices (IBMD), Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia; (L.F.); (L.Z.)
| | - Le Zhang
- Institute for Biomedical Materials and Devices (IBMD), Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia; (L.F.); (L.Z.)
| | - Ricardo Sobhie Diaz
- Laboratório de Retrovirologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04039-032, SP, Brazil; (J.G.); (E.F.d.C.); (R.S.D.)
| | - Gustavo Cabral-Miranda
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo (ICB/USP), São Paulo 05508-000, SP, Brazil;
- Institute of Research and Education in Child Health (PENSI), São Paulo 01228-200, SP, Brazil
| | - Francisco Eduardo Gontijo Guimarães
- Instituto de Física de São Carlos, Universidade de São Paulo, Caixa Postal 369, São Carlos 13560-970, SP, Brazil; (F.F.P.J.); (M.M.); (R.S.F.)
- Correspondence: (M.S.); (F.E.G.G.); Tel.: +55-(16)-33739792 (F.E.G.G.)
| |
Collapse
|
12
|
History and Perspective of Immunotherapy for Pythiosis. Vaccines (Basel) 2021; 9:vaccines9101080. [PMID: 34696188 PMCID: PMC8539095 DOI: 10.3390/vaccines9101080] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/27/2021] [Accepted: 09/08/2021] [Indexed: 12/24/2022] Open
Abstract
The fungus-like microorganism Pythium insidiosum causes pythiosis, a life-threatening infectious disease increasingly reported worldwide. Antimicrobial drugs are ineffective. Radical surgery is an essential treatment. Pythiosis can resume post-surgically. Immunotherapy using P. insidiosum antigens (PIA) has emerged as an alternative treatment. This review aims at providing up-to-date information of the immunotherapeutic PIA, with the focus on its history, preparation, clinical application, outcome, mechanism, and recent advances, in order to promote the proper use and future development of this treatment modality. P. insidiosum crude extract is the primary source of immunotherapeutic antigens. Based on 967 documented human and animal (mainly horses) pythiosis cases, PIA immunotherapy reduced disease morbidity and mortality. Concerning clinical outcomes, 19.4% of PIA-immunized human patients succumbed to vascular pythiosis instead of 41.0% in unimmunized cases. PIA immunotherapy may not provide an advantage in a local P. insidiosum infection of the eye. Both PIA-immunized and unimmunized horses with pythiosis showed a similar survival rate of ~70%; however, demands for surgical intervention were much lesser in the immunized cases (22.8% vs. 75.2%). The proposed PIA action involves switching the non-protective T-helper-2 to protective T-helper-1 mediated immunity. By exploring the available P. insidiosum genome data, synthetic peptides, recombinant proteins, and nucleic acids are potential sources of the immunotherapeutic antigens worth investigating. The PIA therapeutic property needs improvement for a better prognosis of pythiosis patients.
Collapse
|
13
|
Consecutive treatments with photodynamic therapy and nystatin altered the expression of virulence and ergosterol biosynthesis genes of a fluconazole-resistant Candida albicans in vivo. Photodiagnosis Photodyn Ther 2021; 33:102155. [PMID: 33444787 DOI: 10.1016/j.pdpdt.2020.102155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/02/2020] [Accepted: 12/11/2020] [Indexed: 12/15/2022]
Abstract
This investigation assessed the effect of five consecutive daily topical treatments of antimicrobial photodynamic therapy (aPDT), nystatin (NYS), and an association of treatments on a fluconazole-resistant strain of Candida albicans colonizing the tongues of mice. After the last treatments application, colonies of C. albicans were recovered from the tongues and used to determine their fluconazole susceptibility. After 24 hours of the last treatment, the mice tongues were processed to evaluate the expression of C. albicans genes related to the virulence and ergosterol production. The fluconazole susceptibility test yielded a resistance profile similar for all treatment groups and the control group (no treatment). The treatments aPDT, NYS, NYS+aPDT, and aPDT+NYS promoted a reduction in ALS1, EFG1, CAP1, SOD1, SAP1, and LIP3 expression. The expression of HWP1 was higher in the three groups containing nystatin. In contrast, the treatments produced a significative increase in CAT1 gene expression, mainly in the groups in which aPDT was performed. The expression of genes related to ergosterol production was significantly reduced by the treatments evaluated (aPDT, NYS, NYS+aPDT, and aPDT+NYS). Thus, the consecutive topical treatments performed on mice tongues promoted a reduction in the expression of virulence and ergosterol biosynthesis genes of a fluconazole-resistant C. albicans.
Collapse
|
14
|
Ferreira JC, Pires RH, Costa GBD, Carrijo BN, Guiotto FG, Rodrigues VS. The In Vitro Effect of Ozone Therapy Against Equine Pythium insidiosum. J Equine Vet Sci 2020; 98:103305. [PMID: 33663716 DOI: 10.1016/j.jevs.2020.103305] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/07/2020] [Accepted: 10/14/2020] [Indexed: 12/31/2022]
Abstract
The goal of the present study was to characterize the antimicrobial action of different ozone (O3) presentations against Pythium insidiosum isolated from horses. In experiment 1, P. insidiosum was treated with ozonated distilled water, ozonated sunflower oils with distinct peroxide indexes or O3 gas (72 μg O3 mL-1). In experiment 2, samples were exposed one or three times to oxygen (O2) or O3 gas (72 μg O3 mL-1; 30 min/day). In experiment 3, P. insidiosum was treated with different concentrations of O3 gas (Ø, 32, 52, or 72 μg O3 mL-1) for three days (30 min/day). In experiment 4, samples were exposed to O2 or O3 gas (72 μg O3 mL-1) for 05, 15, or 30 minutes during three days. Posteriorly, all samples were cultured for two weeks, and the pathogen growth area was measured until D14. Samples with absence of growth on D14 were recultured to assess the germicidal or germistatic action of the treatment. In experiment 1, only ozonized sunflower oil with a high peroxide index had germicidal action against the pathogen. In experiment 2, samples exposed three times to O3 gas were inactivated. In experiment 3, the O3 therapy had germicidal action against P. insidiosum independently of the gas concentration (P > .1). In experiment 4, O3 treatments ≥15 minutes suppressed the pathogen development, whereas samples exposed to O3 gas for 5 minutes had progressive growth (P < .01). In conclusion, ozonated sunflower oil with a high peroxide index and multiple exposures to O3 gas mixtures were able to inactivate P. insidiosum isolated from horses.
Collapse
|
15
|
Antimicrobial photodynamic therapy reduces gene expression of Candida albicans in biofilms. Photodiagnosis Photodyn Ther 2020; 31:101825. [PMID: 32445962 DOI: 10.1016/j.pdpdt.2020.101825] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 02/08/2023]
Abstract
The present study evaluated whether the oxidative stress caused by antimicrobial photodynamic therapy (aPDT) affects the expression of C. albicans genes related to adhesion and biofilm formation (ALS1 and HPW1) and oxidative stress response (CAP1, CAT1, and SOD1). The aPDT was mediated by two photosensitizing agents (PSs) Photodithazine® (PDZ at 100 and 200 mg/L) or Curcumin (CUR at 40 and 80 μM) and LED (37.5 J/cm2 or 50 J/cm2). The quantification of the expression was performed by Reverse Transcription-Quantitative Polymerase Chain Reaction (RT-qPCR) using specific primers for the target genes. The data were analyzed by Analysis of Variance (α = 0.05), followed by Tukey's post-test. It was observed reduction in the expression of ALS1, HWP1, CAP1, CAT1, and SOD1 when aPDT was performed using 200 mg/L PDZ and 80 μM CUR associated to LED (37.7 and 50 J/cm2, respectively) and using 100 mg/L PDZ and 40 μM CUR with LED of 50 J/cm2 (versus control). Also, the expression of CAP1 and SOD1 genes was reduced after aPDT using 100 mg/L PDZ and LED of 37.5 J/cm2. There was a significant reduction in the expression of genes HWP1, CAP1, and SOD1 after aPDT using 40 μM CUR and 37.5 J/cm2 (versus the control group). The application of LED only at 37.5 and 50 J/cm2 promoted down-regulation of ALS1, CAP1, CAT1, and SOD1 genes (versus the control group). Therefore, aPDT mediated by LED -associated PSs PDZ and CUR promoted a reduction in the expression of the five C. albicans genes evaluated.
Collapse
|
16
|
Gubarkova EV, Feldchtein FI, Zagaynova EV, Gamayunov SV, Sirotkina MA, Sedova ES, Kuznetsov SS, Moiseev AA, Matveev LA, Zaitsev VY, Karashtin DA, Gelikonov GV, Pires L, Vitkin A, Gladkova ND. Optical coherence angiography for pre-treatment assessment and treatment monitoring following photodynamic therapy: a basal cell carcinoma patient study. Sci Rep 2019; 9:18670. [PMID: 31822752 PMCID: PMC6904495 DOI: 10.1038/s41598-019-55215-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/26/2019] [Indexed: 01/10/2023] Open
Abstract
Microvascular networks of human basal cell carcinomas (BCC) and surrounding skin were assessed with optical coherence angiography (OCA) in conjunction with photodynamic therapy (PDT). OCA images were collected and analyzed in 31 lesions pre-treatment, and immediately/24 hours/3-12 months post-treatment. Pre-treatment OCA enabled differentiation between prevalent subtypes of BCC (nodular and superficial) and nodular-with-necrotic-core BCC subtypes with a diagnostic accuracy of 78%; this can facilitate more accurate biopsy reducing sampling error and better therapy regimen selection. Post-treatment OCA images at 24 hours were 98% predictive of eventual outcome. Additional findings highlight the importance of pre-treatment necrotic core, vascular metrics associated with hypertrophic scar formation, and early microvascular changes necessary in both tumorous and peri-tumorous regions to ensure treatment success.
Collapse
Affiliation(s)
- E V Gubarkova
- Privolzhsky Research Medical University, Minina Square 10/1, 603005, Nizhny Novgorod, Russia.
| | - F I Feldchtein
- Privolzhsky Research Medical University, Minina Square 10/1, 603005, Nizhny Novgorod, Russia
| | - E V Zagaynova
- Privolzhsky Research Medical University, Minina Square 10/1, 603005, Nizhny Novgorod, Russia
| | - S V Gamayunov
- A. Tsyb Medical Radiological Research Center, Korolev Street 4, Obninsk, 249036, Kaluga region, Russia
| | - M A Sirotkina
- Privolzhsky Research Medical University, Minina Square 10/1, 603005, Nizhny Novgorod, Russia
| | - E S Sedova
- Privolzhsky Research Medical University, Minina Square 10/1, 603005, Nizhny Novgorod, Russia
| | - S S Kuznetsov
- N.A. Semashko Nizhny Novgorod Regional Clinical Hospital, Rodionova Street 190, 603093, Nizhny Novgorod, Russia
| | - A A Moiseev
- Institute of Applied Physics Russian Academy of Science, Ulyanova Street 46, 603950, Nizhny Novgorod, Russia
| | - L A Matveev
- Institute of Applied Physics Russian Academy of Science, Ulyanova Street 46, 603950, Nizhny Novgorod, Russia
| | - V Y Zaitsev
- Institute of Applied Physics Russian Academy of Science, Ulyanova Street 46, 603950, Nizhny Novgorod, Russia
| | - D A Karashtin
- Institute of Applied Physics Russian Academy of Science, Ulyanova Street 46, 603950, Nizhny Novgorod, Russia
| | - G V Gelikonov
- Institute of Applied Physics Russian Academy of Science, Ulyanova Street 46, 603950, Nizhny Novgorod, Russia
| | - L Pires
- University of Toronto and University Health Network, 610 University Ave., Toronto, Ontario, M5G 2M9, Canada
| | - A Vitkin
- University of Toronto and University Health Network, 610 University Ave., Toronto, Ontario, M5G 2M9, Canada
| | - N D Gladkova
- Privolzhsky Research Medical University, Minina Square 10/1, 603005, Nizhny Novgorod, Russia
| |
Collapse
|
17
|
Tan J, Liu Z, Sun Y, Yang L, Gao L. Inhibitory Effects of Photodynamic Inactivation on Planktonic Cells and Biofilms of Candida auris. Mycopathologia 2019; 184:525-531. [PMID: 31230199 DOI: 10.1007/s11046-019-00352-9] [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: 01/10/2019] [Accepted: 06/13/2019] [Indexed: 11/29/2022]
Abstract
Candida auris is an emerging pathogen that has caused numerous severe infections in recent years, and has therefore become a global concern for public health agencies. Most conventional antifungal agents, especially fluconazole, have shown limited effects on this pathogen. New methods to restrict this pathogen are in urgent demand. Antimicrobial photodynamic therapy (aPDT) has been shown to be a promising technique against multiple pathogenic fungi. This study sought to determine the in vitro effect of aPDT using methylene blue (MB) combined with light-emitting diode (LED) on the viability of planktonic cells and biofilms of five clinical strains of C. auris. MB (8, 16 and 32 μg/ml) was applied as the photosensitizer, and a LED (635 nm, 12 and 24 J/cm2) device was used as light source to activate the photosensitizer. The results showed that there was no growth of tested C. auris strains following aPDT on planktonic cultures. In addition, aPDT exhibited colony-forming unit reduction of up to 7.20 log10 against C. auris biofilms. These data demonstrate that in vitro aPDT with MB and LED offers promising potential for the treatment of C. auris infections.
Collapse
Affiliation(s)
- Jingwen Tan
- Department of Medical Mycology, Shanghai Dermatology Hospital, Shanghai, 200443, China
| | - Zhaoyang Liu
- Department of Stomatology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, 434100, China
| | - Yi Sun
- Department of Dermatology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, 434100, China
| | - Lianjuan Yang
- Department of Medical Mycology, Shanghai Dermatology Hospital, Shanghai, 200443, China.
| | - Lujuan Gao
- Department of Dermatology, Zhongshan Hospital Fudan University, Shanghai, 200032, China.
| |
Collapse
|
18
|
Ros Castellar F, Sobrino Jiménez C, del Hierro Zarzuelo A, Herrero Ambrosio A, Boto de Los Bueis A. Intraocular minocycline for the treatment of ocular pythiosis. Am J Health Syst Pharm 2019; 74:821-825. [PMID: 28546303 DOI: 10.2146/ajhp160248] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE A case of ocular pythiosis successfully treated with surgery and intraocular and oral minocycline is reported. SUMMARY A 30-year-old man who wore corrective contact lenses traveled to Brazil and Colombia where he swam in salt and fresh waters while wearing contact lenses. He sought treatment at an emergency department after 2 weeks of suffering with a painful corneal ulcer, redness, and loss of vision in his right eye that had been treated at other centers with ophthalmic moxifloxacin for 10 days and with fortified topical antibiotics (amikacin and vancomycin) for 2 days. Examination using a slit lamp revealed a deep central corneal ulcer with surrounding white infiltrate, endothelial plaque, and hypopyon. Due to infection severity, the patient was admitted and received empirical antibiotic therapy and i.v. and topical antifungals. During the first corneal transplantation, the patient's original infection relapsed and was treated with voriconazole and liposomal amphotericin B intraocular injections. A subsequent infection developed, and a second keratoplasty was performed. One month after hospital admission, the patient was diagnosed with ocular pythiosis and therapy with oral minocycline was initiated. After severe infection relapse in the anterior chamber, the patient underwent a third penetrating keratoplasty, where minocycline intraocular injection was administered. After this intervention, complete infection control was achieved, and the patient was discharged 45 days after admission with oral minocycline and 1% cyclosporine and 0.3% ofloxacin eye drops. CONCLUSION A patient with ocular pythiosis was successfully treated with penetrating keratoplasty and 2 months of treatment with intracameral and oral minocycline.
Collapse
|
19
|
Carmello JC, Alves F, G. Basso F, de Souza Costa CA, Bagnato VS, Mima EGDO, Pavarina AC. Treatment of Oral Candidiasis Using Photodithazine®- Mediated Photodynamic Therapy In Vivo. PLoS One 2016; 11:e0156947. [PMID: 27253525 PMCID: PMC4890797 DOI: 10.1371/journal.pone.0156947] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/23/2016] [Indexed: 11/19/2022] Open
Abstract
This study evaluated the effectiveness of antimicrobial photodynamic therapy (aPDT) in the treatment of oral candidiasis in a murine model using Photodithazine® (PDZ). This model of oral candidiasis was developed to allow the monitoring of the infection and the establishment of the aPDT treatment. Six-week-old female mice were immunosuppressed and inoculated with C. albicans to induce oral candidiasis. PDZ-mediated aPDT and nystatin treatment were carried out for 5 consecutive days with one application per day. The macroscopic evaluation of oral lesions was performed. After each treatment, the tongue was swabbed to recover C. albicans cells. Viable colonies were quantified and the number of CFU/ml determined. The animals were sacrificed 24 hours and 7 days after treatment and the tongues were surgically removed for histological analysis and analysis of inflammatory cytokines expression (IL-1, TNF-α and IL-6) by RT-qPCR. Data were analyzed by two-way ANOVA. PDZ-mediated aPDT was as effective as Nystatin (NYS group) in the inactivation of C. albicans, reducing 3 and 3.2 logs10 respectively, 24 h after treatment (p<0.05). Animals underwent PDZ-mediated aPDT showed complete remission of oral lesions, while animals treated with NYS presented partial remission of oral lesions in both periods assessed. Histological evaluation revealed mild inflammatory infiltrate in the groups treated with aPDT and NYS in both periods assessed. The aPDT induced the TNF-α expression when compared with the control (P-L-) (p<0.05), 24 h and 7 days after treatment. In summary, the murine model developed here was able to mimic the infection and PDZ-mediated aPDT was effective to treat mice with oral candidiasis.
Collapse
Affiliation(s)
- Juliana Cabrini Carmello
- Department of Dental Materials and Prosthodontics, Araraquara Dental School, UNESP- Univ Estadual Paulista, Araraquara, SP, Brazil
| | - Fernanda Alves
- Department of Dental Materials and Prosthodontics, Araraquara Dental School, UNESP- Univ Estadual Paulista, Araraquara, SP, Brazil
| | - Fernanda G. Basso
- Department of Physiology and Pathology, Araraquara Dental School, UNESP- Univ Estadual Paulista, Araraquara, SP, Brazil
| | - Carlos Alberto de Souza Costa
- Department of Physiology and Pathology, Araraquara Dental School, UNESP- Univ Estadual Paulista, Araraquara, SP, Brazil
| | | | - Ewerton Garcia de Oliveira Mima
- Department of Dental Materials and Prosthodontics, Araraquara Dental School, UNESP- Univ Estadual Paulista, Araraquara, SP, Brazil
| | - Ana Cláudia Pavarina
- Department of Dental Materials and Prosthodontics, Araraquara Dental School, UNESP- Univ Estadual Paulista, Araraquara, SP, Brazil
| |
Collapse
|
20
|
Gao L, Jiang S, Sun Y, Deng M, Wu Q, Li M, Zeng T. Evaluation of the Effects of Photodynamic Therapy Alone and Combined with Standard Antifungal Therapy on Planktonic Cells and Biofilms of Fusarium spp. and Exophiala spp. Front Microbiol 2016; 7:617. [PMID: 27199946 PMCID: PMC4847004 DOI: 10.3389/fmicb.2016.00617] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 04/14/2016] [Indexed: 12/02/2022] Open
Abstract
Infections of Fusarium spp. and Exophiala spp. are often chronic, recalcitrant, resulting in significant morbidity, causing discomfort, disfigurement, social isolation. Systemic disseminations happen in compromised patients, which are often refractory to available antifungal therapies and thereby lead to death. The antimicrobial photodynamic therapy (aPDT) has been demonstrated to effectively inactivate multiple pathogenic fungi and is considered as a promising alternative treatment for mycoses. In the present study, we applied methylene blue (8, 16, and 32 μg/ml) as a photosensitizing agent and light emitting diode (635 ± 10 nm, 12 and 24 J/cm2), and evaluated the effects of photodynamic inactivation on five strains of Fusarium spp. and five strains of Exophiala spp., as well as photodynamic effects on in vitro susceptibility to itraconazole, voriconazole, posaconazole and amphotericin B, both planktonic and biofilm forms. Photodynamic therapy was efficient in reducing the growth of all strains tested, exhibiting colony forming unit-reductions of up to 6.4 log10 and 5.6 log10 against planktonic cultures and biofilms, respectively. However, biofilms were less sensitive since the irradiation time was twice longer than that of planktonic cultures. Notably, the photodynamic effects against Fusarium strains with high minimal inhibitory concentration (MIC) values of ≥16, 4-8, 4-8, and 2-4 μg/ml for itraconazole, voriconazole, posaconazole and amphotericin B, respectively, were comparable or even superior to Exophiala spp., despite Exophiala spp. showed relatively better antifungal susceptibility profile. MIC ranges against planktonic cells of both species were up to 64 times lower after aPDT treatment. Biofilms of both species showed high sessile MIC50 (SMIC50) and SMIC80 of ≥16 μg/ml for all azoles tested and variable susceptibilities to amphotericin B, with SMIC ranging between 1 and 16 μg/ml. Biofilms subjected to aPDT exhibited a distinct reduction in SMIC50 and SMIC80 compared to untreated groups for both species, except SMIC80 of itraconazole against Fusarium biofilms. In conclusion, in vitro photodynamic therapy was efficient in inactivation of Fusarium spp. and Exophiala spp., both planktonic cultures and biofilms. In addition, the combination of aPDT and antifungal drugs represents an attractive alternative to the current antifungal strategies. However, further investigations are warranted for the reliable and safe application in clinical practice.
Collapse
Affiliation(s)
- Lujuan Gao
- Department of Dermatology, Zhongshan Hospital Fudan University Shanghai, China
| | - Shaojie Jiang
- Department of Gastroenterology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University Jingzhou, China
| | - Yi Sun
- Department of Dermatology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University Jingzhou, China
| | - Meiqi Deng
- The Second Clinical Medical College, Yangtze University Jingzhou, China
| | - Qingzhi Wu
- Department of Dermatology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University Jingzhou, China
| | - Ming Li
- Department of Dermatology, Zhongshan Hospital Fudan University Shanghai, China
| | - Tongxiang Zeng
- Department of Dermatology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University Jingzhou, China
| |
Collapse
|
21
|
Bernal C, Ribeiro AO, Andrade GP, Perussi JR. Photodynamic efficiency of hypericin compared with chlorin and hematoporphyrin derivatives in HEp-2 and Vero epithelial cell lines. Photodiagnosis Photodyn Ther 2015; 12:176-85. [DOI: 10.1016/j.pdpdt.2015.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 04/08/2015] [Accepted: 04/10/2015] [Indexed: 01/10/2023]
|
22
|
Zanette RA, Bitencourt PER, Kontoyiannis DP, Fighera RA, Flores MM, Kommers GD, Silva PS, Ludwig A, Moretto MB, Alves SH, Santurio JM. Complex interaction of deferasirox and Pythium insidiosum: iron-dependent attenuation of growth in vitro and immunotherapy-like enhancement of immune responses in vivo. PLoS One 2015; 10:e0118932. [PMID: 25738758 PMCID: PMC4349436 DOI: 10.1371/journal.pone.0118932] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 01/07/2015] [Indexed: 12/22/2022] Open
Abstract
Pythium insidiosum iron acquisition mechanisms are unknown. We previously showed that the iron chelator deferasirox had weak activity in vitro and in rabbits with experimental pythiosis. Here we show that deferasirox causes damage to P. insidiosum hyphae in vitro, but that activity is diminished in the presence of exogenous iron. The tissue activity of the proinflammatory enzyme adenosine deaminase and the histological pattern observed in pythiosis lesions of rabbits treated with deferasirox were similar to the ones in animals treated with immunotherapy.
Collapse
Affiliation(s)
- Régis A. Zanette
- Graduate Program in Pharmacology, Health Science Center, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Paula E. R. Bitencourt
- Graduate Program in Pharmaceutical Sciences, Health Science Center, UFSM, Santa Maria, RS, Brazil
| | - Dimitrios P. Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, United States of America
| | - Rafael A. Fighera
- Graduate Program in Veterinary Medicine, Health Science Center, UFSM, Santa Maria, RS, Brazil
| | - Mariana M. Flores
- Graduate Program in Veterinary Medicine, Health Science Center, UFSM, Santa Maria, RS, Brazil
| | - Glaucia D. Kommers
- Graduate Program in Veterinary Medicine, Health Science Center, UFSM, Santa Maria, RS, Brazil
| | - Priscila S. Silva
- Graduate Program in Pharmaceutical Sciences, Health Science Center, UFSM, Santa Maria, RS, Brazil
| | - Aline Ludwig
- Graduate Program in Pharmacology, Health Science Center, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Maria B. Moretto
- Graduate Program in Pharmaceutical Sciences, Health Science Center, UFSM, Santa Maria, RS, Brazil
| | - Sydney H. Alves
- Graduate Program in Pharmacology, Health Science Center, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil
- Graduate Program in Pharmaceutical Sciences, Health Science Center, UFSM, Santa Maria, RS, Brazil
| | - Janio M. Santurio
- Graduate Program in Pharmacology, Health Science Center, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil
- * E-mail:
| |
Collapse
|