Cellular characterisation of Candida tropicalis presenting fluconazole-related trailing growth

Antimicrobial Mechanism of Salt/Acid Solution on Microorganisms Isolated from Trimmed Young Coconut

This study investigated the inhibitory activity of organic solutions containing 5, 10, 15, 20 and 30% (w/v) sodium chloride and citric acid solution and 15:10, 15:15, 15:20 and 15:30% (w/v) sodium chloride (NaCl) combined with citric acid (CA) solution (salt/acid solution) for 10 min against microorganisms isolated from trimmed young coconut: Bacillus cereus, B. subtilis, Staphylococcus aureus, S. epidermidis, Enterobacter aerogenes, Serratia marcescens, Candida tropicalis, Lodderromyces elongisporus, Aspergillus aculeatus and Penicillium citrinum. Commercial antimicrobial agents such as potassium metabisulfite and sodium hypochlorite (NaOCl) were used as the controls. Results showed that 30% (w/v) NaCl solution displayed antimicrobial properties against all microorganisms, with s reduction range of 0.00–1.49 log CFU/mL. Treatment of 30% (w/v) CA solution inhibited all microorganisms in the reduction range of 1.50–8.43 log CFU/mL, while 15:20% (w/v) salt/acid solution was the minimum concentration that showed a similar antimicrobial effect with NaOCl and strong antimicrobial effect against Gram-negative bacteria. The mode of action of this solution against selected strains including B. cereus, E. aerogenes and C. tropicalis was also determined by scanning electron microscopy and transmission electron microscopy. B. cereus and E. aerogenes revealed degradation and detachment of the outer layer of the cell wall and cytoplasm membrane, while cytoplasmic inclusion in treated C. tropicalis cells changed to larger vacuoles and rough cell walls. The results suggested that a 15:20% (w/v) salt/acid solution could be used as an alternative antimicrobial agent to eliminate microorganisms on fresh produce.

Adaptation of the emerging pathogenic yeast Candida auris to high caspofungin concentrations correlates with cell wall changes

Candida auris has emerged as a fungal pathogen that causes nosocomial outbreaks worldwide. Diseases caused by this fungus are of concern, due to its reduced susceptibility to several antifungals. C. auris exhibits paradoxical growth (PG; defined as growth at high, but not intermediate antifungal concentrations) in the presence of caspofungin (CPF). We have characterized the cellular changes associated with adaptation to CPF. Using EUCAST AFST protocols, all C. auris isolates tested showed PG to CPF, although in some isolates it was more prominent. Most isolates also showed a trailing effect (TE) to micafungin and anidulafungin. We identified two FKS genes in C. auris that encode the echinocandins target, namely β-1,3-glucan synthase. FKS1 contained the consensus hot-spot (HS) 1 and HS2 sequences. FKS2 only contained the HS1 region which had a change (F635Y), that has been shown to confer resistance to echinocandins in C. glabrata. PG has been characterized in other species, mainly C. albicans, where high CPF concentrations induced an increase in chitin, cell volume and aggregation. In C. auris CPF only induced a slight accumulation of chitin, and none of the other phenomena. RNAseq experiments demonstrated that CPF induced the expression of genes encoding several GPI-anchored cell wall proteins, membrane proteins required for the stability of the cell wall, chitin synthase and mitogen-activated protein kinases (MAPKs) involved in cell integrity, such as BCK2, HOG1 and MKC1 (SLT2). Our work highlights some of the processes induced in C. auris to adapt to echinocandins.

Evaluation of antifungal effect of iron‐oxide nanoparticles against different Candida species

Iron‐oxide nanoparticles (IONPs) have been widely favoured due to their biodegradable, low cytotoxic effects and having reactive surface which can be altered with biocompatible coatings. Considering various medical applications of IONPs, the authors were encouraged to study whether IONPs could be effective against fungal infections caused by Candida species. In this study, IONPs were characterised by scanning electron microscopy, X‐ray diffraction, Fourier transform infrared spectroscopy and vibrating sample magnetometer. The goal of this study was to evaluate the antifungal activity of IONPs against different Candida spp. compared with fluconazole (FLC). IONPs were spherical with the size of 30–40 nm. The minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) values of IONPs ranged from 62.5 to 500 µg/ml and 500 to 1000 μg/ml, respectively. The MIC and MFC of FLC were in range of 16–128 μg/ml and 64–512 μg/ml, respectively. The growth inhibition value indicated that Candida tropicalis , Candida albicans and Candida glabrata spp. were most susceptible to IONPs. The finding showed that the IONPs possessed antifungal potential against pathogenic Candida spp. and could inhibit the growth of all the tested Candida spp. Further studies, both in vitro and in vivo (including susceptibility, toxicity, Probability of kill (PK) and efficacy studies) are needed to determine whether IONPs are suitable for medicinal purposes.

Effect of serine protease KEX2 on Candida albicans virulence under halogenated methyl sulfones

Aim: The effect of KEX2 mutations on C. albicans virulence and resistance to halogenated methyl sulfones was assessed. Materials & methods: The mechanism of action of sulfones was studied using flow cytometry and microscopy. Expression of KEX2 and SAP5 was assessed using quantitative Real-Time-PCR. 2,3-Bis(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide and lactate dehydrogenase assays were elaborated to study, respectively, metabolism of Candida treated with sulfones and their cytotoxicity against tissues. Inflammatory response was detected by ELISA. Results: Lysosome permeabilization and dose-dependent programmed cell death under sulfones were noted. KEX2 induction depended on halogenomethylsulfonyl groups, which affected cell wall biosynthesis and adhesion. Conclusion: Sulfones treatment reduced Candida pathogenicity in Galleria mellonella. Sulfones are an alternative for antifungal therapies due to their safety profile and antibiofilm activity.

Evaluation of the possible influence of trailing and paradoxical effects on the clinical outcome of patients with candidemia

OBJECTIVE

Paradoxical growth (PG) and trailing effect (TE) are frequently observed during antifungal susceptibility testing (AFST). These two phenomena interfere with the determination of the minimal inhibitory concentration (MIC). The aim of this study was to assess the clinical impact of TE and PG.

METHODS

We analysed the frequency of TE and PG of 690 Candida isolates collected from a population-based study performed in Spain (CANDIPOP) and correlated the results with clinical outcome of the patients.

RESULTS

Around 70% (484/690) of the isolates exhibited TE to azoles. Candida tropicalis showed the highest presence of TE (39/53 isolates exhibited residual growth >25% of control). No TE was seen in most of the isolates from the psilosis complex. PG was mainly associated with echinocandins. In patients treated with fluconazole within the first 48 hours after blood sampling (n = 221), the presence of TE to azoles tended to be associated with lower 30-day mortality (odds ratio (OR) 0.55, 95% confidence interval (CI) 0.25-1.00) but not with clinical failure (OR 0.85, 95% CI 0.45-1.54). In the subgroup of 117 patients treated with echinocandins, the presence of PG was not associated with patient's response to antifungal treatment (OR for 30-day mortality 1.63, 95% CI 0.76-4.03; OR for clinical failure 1.17, 95% CI 0.53-2.70).

CONCLUSIONS

TE or PG are widely expressed among Candida spp., although they do not seem to influence clinical outcome.

Scope and frequency of fluconazole trailing assessed using EUCAST in invasive Candida spp. isolates

Trailing is a well-known phenomenon that is defined as reduced but persistent visible growth of Candida spp. at fluconazole concentrations above the MIC. Trailing is commonly detected using the CLSI M27-A3 method, although little is known about its frequency when investigated with EUCAST. We assessed the frequency and scope of fluconazole trailing after using EUCAST EDef 7.2. against a large number of Candida spp. isolates from patients with candidemia. We studied 639 fluconazole-susceptible non-krusei Candida spp. isolates from 570 patients admitted to Gregorio Marañón Hospital. Isolates were tested in vitro for fluconazole susceptibility according to the EUCAST EDef 7.2 procedure; trailing was defined as the presence of any residual growth in wells containing fluconazole concentrations above the MIC. According to the mean percentage of trailing observed, isolates were classified as residual trailers (0.1-5%), slight trailers (6%-10%), moderate trailers (11%-15%), and heavy trailers (>15%). The relationship between trailing and genotyping was assessed. The mean overall percentage of trailing was 6.8%, with C. albicans and C. tropicalis showing the highest percentages (9.75% and 9.29%, respectively; P < .001). C. albicans and C. tropicalis had the highest percentage of heavy trailers (>15%). Trailing was not genotype-specific. Fluconazole trailing was observed frequently when EUCAST was used for antifungal susceptibility testing, particularly in isolates of C. albicans and C. tropicalis The cut-off proposed enabled us to classify the isolates according to the degree of trailing and can be used as the basis for future studies to evaluate the clinical impact of this phenomenon.

A flow cytometry method for testing the susceptibility of Cryptococcus spp. to amphotericin B

BACKGROUND

Human fungal infections have increased at an alarming rate in recent years, particularly in immunocompromised individuals. Cryptococcosis is the second most prevalent systemic fungal infection worldwide, and the most prevalent systemic infection in immunocompromised individuals, representing more than 70% of cases. The incidence of cryptococcosis is high in people with HIV/acquired immunodeficiency syndrome (AIDS), with recent estimates indicating that there are one million cases of cryptococcal meningitis globally per year in AIDS patients.

AIMS

The aim of this research was to develop a rapid flow cytometric antifungal susceptibility test and to compare the results with the standard methods.

METHODS

A reference strain and clinical isolates of Cryptococcus neoformans and Cryptococcus gattii were tested for susceptibility to amphotericin B by flow cytometry using propidium iodide as indicator of viability. Flow cytometry (FC) results were compared with the minimum inhibitory concentration (MIC) values determined by microdilution.

RESULTS

The antifungal activity of amphotericin B ranged from MICs of 0.06 to 2μg/ml for the 11 isolates studied. The same results were found by FC.

CONCLUSIONS

The FC method allows same-day results, assisting in the selection of appropriate antifungal therapies. These results demonstrate an excellent correlation between FC and the classic methods of testing for susceptibility to antifungal agents. This rapid diagnosis method makes it possible to quickly administer effective therapeutic interventions, often saving lives.