newsletter | contact Share | Yeast Infection (Candidiasis) Information for adults A A A This is a candida (yeast) infection of the skin folds of the abdomen. Overview Candidiasis, commonly known as a yeast infection, is an infection with the common yeast ( ...
The oropharyngeal candidiasis is a common condition in cancer patients treated by irradiation, during and after their treatment. For example, almost 70% of patients treated with chemo-radiation for head and neck cancer are colonized, and 40% of symptomatic patients have an oropharyngeal candidiasis. Furthermore, we noticed an increase in non-albicans Candida strains, which are present in almost 50% of samples. Cancer treatments, especially radiation therapy, and co-morbidities are risk factors of oropharyngeal candidiasis. Oropharyngeal candidiasis has substantial effects on quality of life, and may limit treatment. Epidemiologic data, physiopathology, clinical diagnosis criteria, consequences and treatment of oropharyngeal candidiasis will be discussed in this article. (authors)
The growing problem of candidemia and systemic candidiasis reflects the enormous increase in the pool of patients at risk as well as the increased opportunity that exists for Candida sp to invade tissues normally resistant to invasion. Candida sp, as truly opportunistic pathogens, exploit recent technological advances to gain access to the circulation and deep tissues. The increased prevalence of local and systemic disease caused by Candida organisms has resulted in new clinical syndromes, the expression of which depends upon the immune status of the host. These new syndromes include the focal hepatosplenic candidiasis, Candida peritonitis and systemic candidiasis. Management of serious and life-threatening invasive candidiasis remains severely hampered by the lack of reliable diagnostic methods that would allow early detection of both fungemia and tissue invasion by Candida organisms. Amphotericin B remains the cornerstone of effective antifungal therapy in systemic candidiasis. Over the last decade, new principles have emerged, including shorter and lower dosage regimens for catheter-related candidemia. The newer oral azoles may play a useful role in the management of invasive candidiasis. PMID:2247707
Sobel, J D; Vazquez, J
Candidiasis remains the most frequently encountered fungal infection in patients with profound granulocytopenia and appears to be increasing in frequency. In addition, Candida infections are occurring earlier during remission induction chemotherapy and can be caused by a variety of species such as C. albicans, C. tropicalis, and C. krusei. The most frequent source of disseminated infection is the gastrointestinal tract, as the integrity of the epithelium is disrupted by chemotherapeutic agents. The spectrum of disseminated candidiasis comprises both an acute and a chronic presentation (also known in the literature as hepatosplenic candidiasis). The management of disseminated infection consists of early empiric antifungal therapy with a standard agent, amphotericin B. Unfortunately, responses in the setting of profound granulocytopenia appear to be poor. Other agents that appear to be useful in the management of disseminated candidiasis include 5-flucytosine and fluconazole. Based on animal experimentation, it appears that the combination of these three classes of agents might produce superior results compared with amphotericin B alone. Removal of the central venous catheter does not appear warranted in the setting of profound granulocytopenia, and the role of colony stimulating factors needs to be defined. Given the severity and high mortality associated with disseminated candidiasis in patients with hematologic malignancies, antifungal prophylaxis appears warranted. PMID:8265854
Anaissie, E; Pinczowski, H
Oropharyngeal candidiasis is a frequent cause of morbidity in patients with defects in cell-mediated immunity or saliva production. Animal models of this infection are important for studying disease pathogenesis and evaluating vaccines and antifungal therapies. Here we describe a simple murine model of oropharyngeal candidiasis. Mice are rendered susceptible to oral infection by injection with cortisone acetate and then inoculated by placing a swab saturated with Candida albicans sublingually. This process results in a reproducible level of infection, the histopathology of which mimics that of pseudomembranous oropharyngeal candidiasis in patients. Using this model, data are obtained after 5–9 days of work.
Solis, Norma V.; Filler, Scott G.
Eight immunocompromised cancer patients with tissue-proved candidiasis underwent serial abdominal ultrasound (US) and computed tomography (CT). At US, four patterns of hepatic and splenic candidiasis were recognized, one of which the authors call a "wheels-within-wheels" pattern. In addition, periportal linear areas of increased attenuation, possibly calcified, were identified at follow-up, nonenhanced CT. Some abscesses were better seen on nonenhanced CT scans, while others became visible only with enhancement. Although lesions not seen at US were often seen at CT, the opposite was also true. In two cases, pathologic proof of candidiasis was established even when all imaging studies were normal. For maximum imaging sensitivity, patients should be studied with US and nonenhanced and enhanced CT. Even when both US and CT scans are negative, if there is a strong clinical suggestion of candidiasis, open biopsy is recommended. PMID:3275982
Pastakia, B; Shawker, T H; Thaler, M; O'Leary, T; Pizzo, P A
Although mucocutaneous candidiasis is a common infection in renal transplant recipients, disseminated candidiasis is rare. Candida pnemonia causing miliary mottling on X-ray chest with the central nervous system involvement is still rarer. We report an unusual case with disseminated candidiasis that presented 18 years after renal transplantation and improved on conventional antifungal therapy; the relevant literature is reviewed. PMID:23439779
Bismay, K; Mathew, A; Rajesh, R; Kurian, G; Unni, V N; Kavita, R D; Sreehari, S
Although mucocutaneous candidiasis is a common infection in renal transplant recipients, disseminated candidiasis is rare. Candida pnemonia causing miliary mottling on X-ray chest with the central nervous system involvement is still rarer. We report an unusual case with disseminated candidiasis that presented 18 years after renal transplantation and improved on conventional antifungal therapy; the relevant literature is reviewed.
Full Text Available Oral candidiasis is an opportunistic infection of the oral cavity. It is common and underdiagnosed among the elderly, particularly in those who wear dentures and in many cases is avoidable with a good mouth care regimen. It can also be a mark of systemic disease, such as diabetes mellitus and is a common problem among the immunocompromised. Oral candidiasis is caused by an overgrowth or infection of the oral cavity by a yeast-like fungus, candida.The important ones are C albicans, C tropicalis, C glabrata , C pseudotropicalis, C guillierimondii, C krusei, C lusitaniae, C parapsilosis and C stellatoidea. C albicans, C glabrata and C tropicalis represent more than 80% of isolates from clinical infection. Oral candidiasis is the most common human fungal infection especially in early and later life. The incidence varies depending on age and certain predisposing factors. There are three broad groupings consisting of acute candidiasis, chronic candidiasis and angular cheilitis. Chronic hyperplastic candidosis/candidiasis (CHC; syn. candidal leukoplakia is a variant of oral candidosis that typically presents as a white patch on the commissures of the oral mucosa. Risk factors include impaired salivary gland function, drugs, dentures, high carbohydrate diet, smoking, diabetes mellitus, Cushing`s syndrome, malignancies and immunosuppressive conditions. The aim of the research is to describe the clinical manifestations of the disease.
We report on two patients with acute leukemia and prolonged granulocytopenia after cytotoxic therapy in whom the diagnosis hepatosplenic candidiasis was made. Both patients developed upper abdominal discomfort with elevated alkaline phosphatase after resolution of granulocytopenia. The diagnosis was established by demonstration of multiple abscesses in liver and spleen on ultrasound and computed tomography. Both patients were initially treated with amphotericin B i.v., one of them received liposomal amphotericin B (cumulative dose of 2,530 mg and 570 mg, respectively). Thereafter, therapy was continued for months with oral fluconazole. The treatment of hepatosplenic candidiasis was successful, however, the patients died from relapse and progression of leukemia. PMID:1293053
Loeliger, A; van Leeuwen, M; Rozenberg-Arska, M; Dekker, A W
Hepatosplenic candidiasis is a severe complication encountered in immuno-compromised patients. Different imaging techniques can establish the diagnosis. After an introduction to the pathophysiological and clinical principles, the role of plain radiography, radionuclide scans, ultrasound, computed tomography and magnetic resonance imaging is discussed. PMID:10420910
Müller, D; Kopka, L; Grabbe, E
Much progress has been made over the last decade in diagnosing and treating CDC, a chronic and debilitating infection that interferes with the delivery of intensive cytotoxic chemotherapy in patients with leukemia. The use of fluconazole prophylaxis in these patients has decreased the incidence of CDC dramatically. The greatest future challenges are gaining a better understanding of its pathophysiology, and the continued development of effective diagnostic and therapeutic strategies to treat this unusual manifestation of systemic candidiasis. PMID:10987117
Kontoyiannis, D P; Luna, M A; Samuels, B I; Bodey, G P
Vulvovaginitis is the most common gynecologic condition seen by practitioners rendering primary care to women. Vulvovaginitis Candidiasis (VVC) is the most common type of vaginitis and this study aimed at specifying VVC recurrence during pregnancy. In this prospective study, 150 pregnant women suffering from vaginal excretion, morsus and itching were studied. Initially, the patients were treated using clotrimazole local cream (5 g) for 7 successive days. After initial treatment, the pat...
Fardiazar, Z.; Ronaci, F.; Torab, R.; Goldust, M.
Chronic diseminated candidiasis--mainly its hepatosplenic form- is one of the most characteristic invasive infection due to Candida in haematological patients. A case is presented of a 31 year old man admitted to the Clinical Department with acute mieloid leukosis M2, showing febrile neutropenia after induction and consolidation chemotherapy. Hepatoesplenic candidiasis was diagnosed and confirmed by computered axial tomography (CAT) and hepatic biopsy; amphotericin B followed by liposome encapsuled amphotericin B up to complete a total dose of 4 g was used for treatment. The patient was discharged waiting for bone marrow transplantation. Early suspicion of hepatosplenic candidiasis helps to select a rapid diagnosis method and an effective treatment. PMID:15176375
Larregina, A; Bartoletti, B; Romano, H; Paniccia, L; Polini, N N
Systemic fungal infections have long been recognized in terminally ill patients with cancer. Systemic candidiasis is the most common, the incidence having increased in the last few years. Eight children diagnosed as having systemic candidiasis during a two-year period (1987-1988) are presented. Three had an isolated fungal pneumonitis, two an hepatosplenic candidiasis, one a multisystemic involvement (hepatosplenic, pulmonary and nodular skin lesions) and the remaining two patients had a Candida sepsis with no visceral lesions having been documented. All patients had neutropenia and prolonged fever no responsive to broad spectrum antibiotics. We would like to underline the importance of an early and prolonged antifungal therapy, especially in hepatosplenic candidiasis, in order to obtain the cure. PMID:2619132
Fernández Navarro, J M; Verdeguer Miralles, A; Ruiz Soler, J G; Ferris Tortajada, J; Esquembre Menor, C; Castel Sánchez, V
INTRODUCTION Hepatosplenic candidiasis is a disseminated invasive fungal infection that may affects patients with acute leukemia. The main clinical manifestation is a persistent fever in patients recovered from prolonged neutropenia after recent chemotherapy. CASE OUTLINE The authors present three patients, two women and one men, aged 23, 26 and 33 years, with acute leukemia; one with acute myeloblastic and two with acute lymphoblastic leukemia who developed hepatosplenic candidiasis. The dia...
Raji? Zoran; ?olovi? Nataša; Sretenovi? Mirjana; Ple?i? Mira; Jankovi? Snežana; Bakra? Milena; ?olovi? Milica
Here we describe a patient who developed lung abscess caused by Candida albicans. There was no evidence of disseminated/ extrapulmonary candidiasis or any immunodeficiency. However, he was taking high doses of inhaled corticosteroid for chronic airflow obstruction. CT guided percutaneous needle aspiration provided the specimen which confirmed the diagnosis of pulmonary candidiasis. His sputum culture was also positive for Candida albicans. The patient achieved favourable out-come with a 4 wee...
Gupta Prem; Agarwal Dipti; Yadav R
The disproportionate increase in oropharyngeal candidiasis (OPC) compared with systemic and vaginal candidiasis in female patients with AIDS has been a paradox for almost three decades. New data now show that severe OPC develops in Th17-deficient mice, but not Th1-deficient mice, implicating Th17-induced effector molecules in resistance to oral disease. These findings clarify and extend our current thinking about how CD4 T cell deficiency influences susceptibility to OPC.
Pirofski, Liise-anne; Casadevall, Arturo
Full Text Available Background and Objective: Candidiasis is a common opportunistic infection in HIV-infected patients. The spectrum of Candida infection is diverse, starting from asymptomatic colonization to pathogenicforms. The low absolute CD4+ T-lymphocyte count has traditionally been cited as the greatest risk factor for the development of Oropharyngeal Candidiasis and current guidelines suggest increased risk once CD4+ T lymphocyte counts fall below 200 cells/?L. Gradual emergence of non-albicans Candida species as a cause of refractory mucosal and invasive Candidiasis, particularly in patients with advanced immunosuppression and problem of resistance to azoles and other antifungal agents in the Candida species is a point of concern.Materials and Methods: A prospective study was carried out over a period of 2 years (2010-2011 on patients suffering from AIDS for the presence of Candida infection. After thorough clinical examination relevant specimens were collected and processed specifically to ascertain Candida infection. Speciation of Candida isolates and antifungal sensitivity testing was also done. The CD4 cell counts of all the patients were estimated and correlated with the presence (or absence of candidiasis.Results: Out of a total of 165 HIV positive patients, a definitive diagnosis of candidiasis was made in 80 patients. Candida albicans was the most common yeast isolated. Patients with candidiasis had CD4 counts less than 200 cells/mm3. Maximum resistance was seen with fluconazole while no resistance was seen with voriconazole.Conclusion: The most common opportunistic fungal infection in HIV positive patients is candidiasis, affecting the mucocutaneous system mainly but the invasive form is also common. Resistance to azoles and other antifungal agents in the Candida species is a point of concern.
Parvaz Anwar Khan
Full Text Available Background/Aim. Recurrent vulvovaginal candidiasis is relatively frequent condition, and may have serious health consequences, like chronic vulvovaginal pain syndrome. The aim of our study was to determine possible risk factors for recurrent vulvovaginal candidiasis in non-pregnant females within the reproductive age. Methods. The design of our study was of a case-control type. Case and control patients were selected from the gynecological patients at six primary care facilities in Serbia and in Montenegro. The data on the patients' health condition, concomitant therapy and diseases were taken from their records, and the data on habits were obtained by unstructured interview. For potential risk factors crude odds ratios were calculated, and then adjusted by logistic regression. Results. A total of fifty-one patients had four or more episodes of vulvovaginal candidiasis during the last year (cases, and 132 patients with one to three episodes of vulvovaginal candidiasis were sampled as controls, matched by age. The only two significant associations were found between recurrent vulvovaginal candidiasis and continual wearing of panty liners during the last year (Odds ratio - ORadjusted: 3.97; confidence interval - CI: 1.57-10.02; p = 0.004, and between recurrent vulvovaginal candidiasis and predominant use of vaginal tampons during menstruation in the last year (ORadjusted: 4.25; CI: 1.11-16.27; p = 0.035. The synergistic effect was observed for the concurrent continual wearing of panty liners during the last year and selfmedication with antimycotics. Conclusions. Local factors, like wearing of panty liners or use of tampons during menstruation, may promote recurrence of vulvovaginal candidiasis, especially in patients who practice selfmedication with antimycotics.
Vulvovaginitis is the most common gynecologic condition seen by practitioners rendering primary care to women. Vulvovaginitis Candidiasis (VVC) is the most common type of vaginitis and this study aimed at specifying VVC recurrence during pregnancy. In this prospective study, 150 pregnant women suffering from vaginal excretion, morsus and itching were studied. Initially, the patients were treated using clotrimazole local cream (5 g) for 7 successive days. After initial treatment, the patients were freely visited once a month until delivery considering vaginitis symptoms and VVC recurrence was examined during pregnancy. Mean age of the understudy mothers was 27.26 +/- 3.76. Mean of recurrence number was 0.17 +/- 0.48 during the first trimester. Mean of recurrence number was 0.92 +/- 0.76 during the second trimester. Mean of recurrence number was 2.16 +/- 0.63 during the third trimester. Statistically significant difference was between recurrences during three trimesters of pregnancy (p < 0.001). There is statistically significant difference between mean number of recurrences during three trimesters of pregnancy. PMID:24199471
Fardiazar, Z; Ronaci, F; Torab, R; Goldust, M
Full Text Available Vulvovaginitis is the most common gynecologic condition seen by practitioners rendering primary care to women. Vulvovaginitis Candidiasis (VVC is the most common type of vaginitis and this study aimed at specifying VVC recurrence during pregnancy. In this prospective study, 150 pregnant women suffering from vaginal excretion, morsus and itching were studied. Initially, the patients were treated using clotrimazole local cream (5 g for 7 successive days. After initial treatment, the patients were freely visited once a month until delivery considering vaginitis symptoms and VVC recurrence was examined during pregnancy. Mean age of the understudy mothers was 27.26±3.76. Mean of recurrence number was 0.17±0.48 during the first trimester. Mean of recurrence number was 0.92±0.76 during the second trimester. Mean of recurrence number was 2.16±0.63 during the third trimester. Statistically significant difference was between recurrences during three trimesters of pregnancy (p<0.001. There is statistically significant difference between mean number of recurrences during three trimesters of pregnancy.
Full Text Available La candidiasis diseminada crónica, principalmente en su variedad hepatoesplénica, es una de las formas clínicas más características de infección invasora por Candida en pacientes hematológicos. Se presenta el caso clínico de un varón de 31 años, con leucemia mieloide aguda (LMA M2, internado en el Servicio de Clínica Médica del hospital, que luego del tratamiento quimioterápico de inducción y consolidación presentó neutropenia febril leve. La candidiasis hepatoesplénica fue diagnosticada por tomografía axial computada (TAC y biopsia hepática. El enfermo fue tratado con anfotericina B, seguida de la forma liposomal hasta completar los 4 g. Se le dió el alta en espera de transplante de médula ósea. En este paciente se demostró que la sospecha temprana de candidiasis hepatoesplénica ayudó en la elección de un método de diagnóstico precoz y a su correcto tratamiento.Chronic diseminated candidiasis - mainly its hepatosplenic form- is one of the most characteristic invasive infection due to Candida in haematological patients. A case is presented of a 31 year old man admitted to the Clinical Department with acute mieloid leukosis M2, showing febrile neutropenia after induction and consolidation chemotherapy. Hepatoesplenic candidiasis was diagnosed and confirmed by computered axial tomography (CAT and hepatic biopsy; amphotericin B followed by liposome encapsuled amphotericin B up to complete a total dose of 4 g was used for treatment. The patient was discharged waiting for bone marrow transplantation. Early suspicion of hepatosplenic candidiasis helps to select a rapid diagnosis method and an effective treatment.
... treatment with amphotericin B may be necessary. For healthcare providers: the most up-to-date clinical practice guidelines for the treatment of oropharyngeal / esophageal candidiasis are available at the Infectious Diseases Society of America. Print page Get email updates Contact Us: Centers ...
Full Text Available Fundamento: Cuando la candidiasis se asocia con la prótesis removible puede inducir a la formación de estomatitis subprótesis, esencialmente en aparatos desajustados y con muchos años de uso. Objetivo: Determinar la prevalencia de la candidiasis en pacientes con estomatitis subprótesis. Método: Se realizó un estudio observacional, descriptivo y transversal en la Clínica Estomatológica Docente de La Vigía desde enero a marzo de 2008 en 30 pacientes mayores de 20 años y de ambos sexos con estomatitis subprótesis (10 en cada grado clínico de la lesión, portadores de prótesis removibles. Resultados: El comportamiento microbiológico de los pacientes con estomatitis subprótesis afloró que no todos los pacientes afectados presentaron candidiasis, solo se evidenció la presencia de la misma en 21 para un 70 % de la muestra. Según el grado de la lesión esta afección se presentó en cuatro pacientes de grado I para un 19,04 %, 7 del grado II para un 33,33 % y en el 100 % del grado III con diferencia significativa entre la proporción de pacientes con cándida de los grados I y II con respecto al grado III (p<005. En el estudio predominaron los pacientes con afecciones de grado III. Conclusiones: No todos los pacientes con estomatitis subprótesis presentaron cándida albicans. Se incrementó la candidiasis en los grados avanzados de la estomatitis subprótesis. La totalidad de las prótesis en pacientes con lesiones grado II y III presentaron cándida albicans.
Isidro de Jesu00FAs Nu00E1poles Gonzu00E1lez
Full Text Available SciELO Colombia | Language: Spanish Abstract in spanish Introducción. La candidiasis cutánea es una enfermedad que afecta tanto a población infantil como adulta. Las forma de presentación puede ser localizada o sistémica y el agente etiológico múltiple, siendo las especies infecciosas de Candida albicans más prevalentes en niños. Objetivo. Presentar un c [...] aso de candidiasis cutánea congénita cuya causa aparente fue la transmisión vertical durante el parto. Material y metodología. Se describe el caso de un recién nacido a término expuesto a una candidiasis vaginal subclínica, que desarrolló una candidiasis cutánea congénita por C. albicans asociada a sepsis y dificultad respiratoria en las primeras 24 horas de vida. Se practicaron hemocultivos, biopsia cutánea de las lesiones pápulopústulo-vesiculosas, análisis de sangre y punción lumbar. Resultados. En la bioquímica y el hemograma se encontró una proteína C reactiva de 5,7 mg/dl, leucocitosis con desviación a la izquierda y anemia leve. A las 24 horas, en el control se encontró una proteína C reactiva (7,82 mg/dl) que fue en aumento progresivo durante tres días, por lo que se practicó punción lumbar. El hemocultivo fue positivo para Staphylococcus aureus. La biopsia cutánea dio como resultado histológico la candidiasis cutánea. Conclusiones. El diagnóstico precoz es fundamental para prevenir complicaciones derivadas del cuadro producido por C. albicans en neonatos. Abstract in english Introduction. Cutaneous candidiasis is a disease that affects children as well as adults. The presentation may be localized or systemic, and with multiple etiological agents. The most prevalent infecting species in children differs from that of the adult. Objective. A case is presented where a conge [...] nital cutaneous candidiasis was transmitted to the child during birth. Materials and methods. A full term newborn was exposed to a subclinical vaginal candidiasis infection, and 24 hr after birth, developed congenital cutaneous candidiasis. The etiological agent was Candida albicans, and was associated with sepsis and respiratory distress. Blood cultures, cutaneous biopsy of vesicular lesions, blood tests and lumbar puncture were performed. Results. Biochemistry and blood count showed a CRP of 5.7 mg/dl, leukocytosis with left shift and mild anemia. After 24 hr, the blood analyses showed an increase in a CRP (7.8 mg/dl) and increased progressively for three days; consequently, a lumbar puncture was performed. Blood culture was positive for Staphylococcus aureus. Cutaneous biopsy confirmed the cutaneous candidiasis. Conclusions. The early diagnosis is essential to prevent complications derived by the Candida albicans in newborns.
El Ahmed, Husein Husein; Cañadas-De la Fuente; Fernández-Castillo, Rafael; González-Jiménez, Emilio; Cantero-Hinojosa, Jesús; Lardón-Fernández, Marita.
OBJECTIVES: To document the microscopic features of vaginal candidiasis and to examine the relation between yeast morphology and patient symptomatology. METHOD: The study population comprised women undergoing screening for genital infection at a department of genitourinary medicine. RESULTS/CONCLUSION: Data were collected on 267 women of whom 234 were found to have vaginal candidiasis by vaginal culture. The remaining 33 patients had microscopic features of candidiasis (spores and/or hy...
Sonnex, C.; Lefort, W.
Hepatosplenic candidiasis has increased in frequency among immunocompromised hosts. Risk factors include hematologic malignancy, intensive chemotherapy, prolonged neutropenia, and treatment with broad-spectrum antibiotics. Patients most commonly present with abdominal pain, persistent fevers despite antibiotic therapy, and an elevated alkaline phosphatase level that is out of proportion to other hepatic enzyme levels. Gastrointestinal mucosal damage secondary to intensive chemotherapy may allow colonization with Candida species and subsequent seeding of the portal vein. Treatment has consisted of prolonged courses of amphotericin B, with mortality rates approaching 50%. We report a case of hepatosplenic candidiasis in a patient with acute myelogenous leukemia who had clinical and radiographic improvement during fluconazole therapy. Fluconazole may be an efficacious and less toxic alternative to amphotericin B. PMID:1739374
Flannery, M T; Simmons, D B; Saba, H; Altus, P; Wallach, P M; Adelman, H M
Full Text Available This is a retrospective study of 59 patients endoscoped over a period of six years at a private clinic and were found to have esophageal candidiasis. The median age was 46.38 years. Thirty (51 % patients had no precipitating factors. Only 18 (30% patients had typical symptoms. The distal part of the esophagus was more often involved. The thrush was scattered in 57 (97% patients. The endoscopic finding was confirmed by cytology in all patients included. Symptoms improved on oral nystatin treatment and simultaneous treatment of associated conditions in all 46 patients followed up. In conclusion, esophageal candidiasis appear to be not uncommon among dyspeptic population. It presents more frequently with atypical symptoms and responds well to oral nystatin treatment.
Al Mofleh Ibrahim
For Candida species, a bimodal wild-type MIC distribution for echinocandins exists, but resistance to echinocandins is rare. We characterized isolates from patients with invasive candidiasis (IC) breaking through ?3 doses of micafungin therapy during the first 28 months of its use at our center: MICs were determined and hot-spot regions within FKS genes were sequenced. Eleven of 12 breakthrough IC cases identified were in transplant recipients. The median duration of micafungin exposure pri...
Pfeiffer, Christopher D.; Garcia-effron, Guillermo; Zaas, Aimee K.; Perfect, John R.; Perlin, David S.; Alexander, Barbara D.
The caspofungin clinical trial database offers an opportunity to assess susceptibility results for Candida pathogens obtained from patients with candidiasis and allows for correlations between efficacy outcomes and MICs. Candida isolates have been identified from patients enrolled in four studies of esophageal candidiasis and two studies of invasive candidiasis. The MICs of caspofungin for all baseline isolates were measured at a central laboratory using NCCLS criteria (document M-27A); MICs ...
Kartsonis, Nicholas; Killar, John; Mixson, Lori; Hoe, Chao-min; Sable, Carole; Bartizal, Kenneth; Motyl, Mary
Full Text Available INTRODUCTION Hepatosplenic candidiasis is a disseminated invasive fungal infection that may affects patients with acute leukemia. The main clinical manifestation is a persistent fever in patients recovered from prolonged neutropenia after recent chemotherapy. CASE OUTLINE The authors present three patients, two women and one men, aged 23, 26 and 33 years, with acute leukemia; one with acute myeloblastic and two with acute lymphoblastic leukemia who developed hepatosplenic candidiasis. The diagnosis was based on prolonged fever, elevated serum bilirubin and alkaline phosphatase, as well as characteristic lesions on computed tomography, nuclear magnetic resonance and ultrasonographic findings and positive blood culture in one patient. The antifungal treatment was successful in one patient only. Two patients died due to progression of leukemia. CONCLUSION If leukemia patient in remission after chemotherapy develops a prolonged fever of unknown origin, hepatosplenic candidiasis has to be considered and all efforts should be done to diagnose it. The diagnosis is based on clinical presentation and imaging techniques. The positive cultures of fungi are not usually possible and are not mandatory. The antifungal treatment may be prolonged, sometimes 2 to 3 months or even more.
Full Text Available SciELO Argentina | Language: Spanish Abstract in spanish La candidiasis diseminada crónica, principalmente en su variedad hepatoesplénica, es una de las formas clínicas más características de infección invasora por Candida en pacientes hematológicos. Se presenta el caso clínico de un varón de 31 años, con leucemia mieloide aguda (LMA) M2, internado en el [...] Servicio de Clínica Médica del hospital, que luego del tratamiento quimioterápico de inducción y consolidación presentó neutropenia febril leve. La candidiasis hepatoesplénica fue diagnosticada por tomografía axial computada (TAC) y biopsia hepática. El enfermo fue tratado con anfotericina B, seguida de la forma liposomal hasta completar los 4 g. Se le dió el alta en espera de transplante de médula ósea. En este paciente se demostró que la sospecha temprana de candidiasis hepatoesplénica ayudó en la elección de un método de diagnóstico precoz y a su correcto tratamiento. Abstract in english Chronic diseminated candidiasis - mainly its hepatosplenic form- is one of the most characteristic invasive infection due to Candida in haematological patients. A case is presented of a 31 year old man admitted to the Clinical Department with acute mieloid leukosis M2, showing febrile neutropenia af [...] ter induction and consolidation chemotherapy. Hepatoesplenic candidiasis was diagnosed and confirmed by computered axial tomography (CAT) and hepatic biopsy; amphotericin B followed by liposome encapsuled amphotericin B up to complete a total dose of 4 g was used for treatment. The patient was discharged waiting for bone marrow transplantation. Early suspicion of hepatosplenic candidiasis helps to select a rapid diagnosis method and an effective treatment.
A., Larregina; B., Bartoletti; H., Romano; L., Paniccia; N. N., Polini.
The presence of fungus balls within the collecting system is an important clue to the radiological diagnosis of genitourinary candidiasis. In this report, an 8-month-old infant with this opportunistic infection is described. Emphasis is placed on the radiological findings of renal candidiasis, including previously unreported MR appearances. Sonographic and Doppler findings of accompanying Candida epididymitis are also described. (orig.)
This document summarizes current knowledge about diagnosis and treatment of candidiasis affecting the skin and oral mucosa. Several clinical forms of mucocutaneous candidiasis are distinguished depending on a patient's age and infected site, e.g. Candida intertrigo, erythema mycoticum infantile, erosio interdigitalis blastomycetica, candidal paronychia and onychia, Candida onychomycosis, and oral candidiasis. The diagnosis of candidiasis is confirmed by observation of mycelial forms on microscopic examination. Since Candida yeasts (especially C. albicans) are normal inhabitants of the skin and oral mucosa, it must always be noted that positive culture does not always indicate the presence of candidal infection. The pathogenicity of Candida species is relatively low, and some special conditions are required for tissue invasion by the fungus. Predisposing factors, such as disturbances of the cutaneous and mucosal microenvironment and systemic or local immunosuppression, should be checked in patients with recurrent infection. Therapy for cutaneous candidiasis is dominated by topical antifungal agents. Azole antifungal cream (e.g., bifonazole, ketoconazole, neticonazole hydrochloride, lanoconazole and luliconazole) is most effective. Terbinafine hydrochloride and amorolfine hydrochloride are also useful. Cutaneous candidiasis usually requires a shorter duration of topical treatment (1-2 weeks) than superficial dermatophyte infections. For candidal paronychia and onychomycosis, oral therapy with itraconazole is recommended. The daily dose of itraconazole should be taken for several months, while its pulse therapy for candidiasis is not approved in Japan. Itraconazole oral solution is commonly used for oral candidiasis, and miconazole gel is also effective. PMID:19942790
Full Text Available Chronic mucocutaneous candidiasis(CMC is a rare group of overlapping syndromes that have in common a clinical pattern of persistent and diffuse cutaneous or mucosal candidal infections. It is usually associated with multiple endocrine dysfunctions and autoimmune disorders therefore patients needs a complete systemic evaluation. Patients of CMC are also susceptible to other fungal and viral infections due to impaired cell mediated immunity. We report a case of CMC wherein the cutaneous and mucosal lesions were not associated with any systemic disorder. The patient responded to topical clotrimazole.
Chronic mucocutaneous candidiasis (CMC) is characterized by Candida infection of the mucous membrane, scalp, skin and nails. We present a case of a 42-year-old man who was treated twice in the Dermatological Department. He was admitted the first time as a 7-year-old boy because of skin and mucosal lesions and then the diagnosis of granuloma candidamyceticum was established. Thirty-one years later he was admitted again with a history of facial skin lesions and blepharitis. For a couple of years he had suffered from diabetes and hypothyroidism. The diagnosis of CMC with endocrinopathy was established in our patient.
Erkiert-Polguj, Anna; Dziankowska-Bartkowiak, Bozena; Sysa-Jedrzejowska, Anna; Narbutt, Joanna
Chronic mucocutaneous candidiasis (CMC) is characterized by Candida infection of the mucous membrane, scalp, skin and nails. We present a case of a 42-year-old man who was treated twice in the Dermatological Department. He was admitted the first time as a 7-year-old boy because of skin and mucosal lesions and then the diagnosis of granuloma candidamyceticum was established. Thirty-one years later he was admitted again with a history of facial skin lesions and blepharitis. For a couple of year...
Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish Fundamento: Cuando la candidiasis se asocia con la prótesis removible puede inducir a la formación de estomatitis subprótesis, esencialmente en aparatos desajustados y con muchos años de uso. Objetivo: Determinar la prevalencia de la candidiasis en pacientes con estomatitis subprótesis. Método: Se r [...] ealizó un estudio observacional, descriptivo y transversal en la Clínica Estomatológica Docente de La Vigía desde enero a marzo de 2008 en 30 pacientes mayores de 20 años y de ambos sexos con estomatitis subprótesis (10 en cada grado clínico de la lesión), portadores de prótesis removibles. Resultados: El comportamiento microbiológico de los pacientes con estomatitis subprótesis afloró que no todos los pacientes afectados presentaron candidiasis, solo se evidenció la presencia de la misma en 21 para un 70 % de la muestra. Según el grado de la lesión esta afección se presentó en cuatro pacientes de grado I para un 19,04 %, 7 del grado II para un 33,33 % y en el 100 % del grado III con diferencia significativa entre la proporción de pacientes con cándida de los grados I y II con respecto al grado III (p Abstract in english Background: When candidiasis is associated with removable prosthesis may induced to the formation of stomatitis sub-prothesis, essentially in non-adjusted appliance and with many years of use. Objective: To determine the prevalence of candidiasis in patients with stomatitis sub-prosthesis. Method: A [...] n observational, descriptive and cross-sectional study at " La Vigía" Teaching Odontology Clinic from January to March 2008 was conducted in 30 patients older than 20 years and from both sexes with stomatitis sub-prosthesis (10 in each clinical degree of the lesion), carriers of removable prosthesis. Results: The microbiological behavior of patients with stomatitis sub-prosthesis showed that not all the affected patients presented candidiasis, only showed its presence in 21 for a 70% of the sample. According to the degree of the lesion this affection was presented in four patients of I degree for a 19.04%, 7 of II degree for a 33.33% and in the 100% of III degree with significant difference among the proportion of patients with Candida of I and II degrees regarding to III degree (p
Isidro de Jesús, Nápoles González; Silvia María, Díaz Gómez; Elizabeth, Puig Capote; Nelia, Espeso Nápoles.
Full Text Available Se presenta una revisión de la literatura actualizada de una de las enfermedades más frecuentes de la mucosa bucal y la afección micótica más común en esta localización: la candidiasis de la mucosa bucal. Se detallan los factores predisponentes generales y locales que favorecen la aparición de esta alteración patológica como son los tratamientos prolongados con antibióticos, la diabetes, la anemia, la radioterapia y quimioterapia antineoplásicas, las drogas inmunosupresoras y el SIDA, entre otros. Se exponen las diferentes clasificaciones clínicas, según el criterio de distintos autores y el cuadro clínico de la enfermedad. Finalmente se presentan alternativas terapéuticas tanto en el campo de la medicina convencional como en el de la medicina tradicional y natural.This paper presents an updated literature review of one of the most frequent diseases in the oral mucosa and the most common mycotic affection in this site, i.e, oral mucosal candidiasis. The general and local predisposing factors that favor the occurrence of this pathological disorder such as extended antibiotic treatments, diabetes, anemia, anti-neoplastic radiotherapy and chemotherapy, immunosuppresive drugs, AIDS, among others. Different clinical classifications, according to several authors´ criteria and the clinical picture of the disease, are stated. Finally, therapeutical options in the fields of conventional medicine and traditional and natural medicine are presented.
Judy Rodríguez Ortega
A case had recurrent and chronic mucocutaneous candidiasis . The main immunological feature were gross T cell deficiency, anergy to common recall antigens but normal serum immunoglobulins, complement and phagocytosis. Ultimately, the multiple candida infections led to a fatal outcome.
Karnik A; Vijayvargiya R; Chitnis D; Sethi N
We present the case of a preterm neonate who was born with respiratory distress and a papulovesicular rash that was diagnosed as congenital candidiasis (CC). The mother was asymptomatic. The cutaneous eruption and respiratory distress improved following treatment with systemic antifungals. Congenital candidiasis ranges in presentation from isolated cutaneous involvement to severe multisystem disease. Given its rarity among neonatal skin eruptions, heightened suspicion is required for prompt diagnosis and treatment. PMID:24897134
Siriratsivawong, Rick; Pavlis, Michelle; Hymes, Saul R; Mintzer, Jonathan P
Recurrent vulvovaginal candidiasis, caused by Candida albicans, is a significant problem in women of childbearing age. Although cell-mediated immunity (CMI) due to T cells and cytokines is the predominant host defense mechanism against C. albicans at mucosal tissue sites, host defense mechanisms against C. albicans at the vaginal mucosa are poorly understood. Based on an estrogen-dependent murine model of vaginal candidiasis, our data suggest that systemic CMI is ineffective against C. albica...
Saavedra, Michael; Taylor, Brad; Lukacs, Nicholas; Fidel, Paul L.
Protective host defense mechanisms against vaginal Candida albicans infections are poorly understood. Although cell-mediated immunity (CMI) is the predominant host defense mechanism against most mucosal Candida infections, the role of CMI against vaginal candidiasis is uncertain, both in humans and in an experimental mouse model. The role of humoral immunity is equally unclear. While clinical observations suggest a minimal role for antibodies against vaginal candidiasis, an experimental rat m...
Wozniak, Karen L.; Wormley, Floyd L.; Fidel, Paul L.
Seven young men developed disseminated candidiasis within 10 days of a single episode of intravenous heroin abuse. Sequential development of eye and skin lesions was noted in all cases. The bone or costal cartilage was involved in five. Ocular manifestations of candidiasis included episcleritis, chorioretinitis, and endophthalmitis. A presumptive diagnosis of candida chorioretinitis was established rapidly by culture of Candida albicans from involved skin and costal cartilage. Systemic therap...
Sorrell, T. C.; Dunlop, C.; Collignon, P. J.; Harding, J. A.
Using gas-liquid chromatography, we measured five mannose in the serum of six nondiabetic patients with autopsy-proven invasive candidiasis. In all patients serum mannose concentrations were higher than mannose levels found in serum from normal adults and children or from patients with catheter-associated candidemia, mucosal candidiasis, and other mycoses. Spinal fluid from two patients with Candida meningitis showed increased free mannose as compared to seven non-inflammatory spinal fluid sa...
Monson, T. P.; Wilkinson, K. P.
Three children with acute lymphoblastic leukemia developed disseminated fungal disease predominantly involving the liver and spleen. The three patients were undergoing induction chemotherapy and had neutropenia when they presented prolonged fever not responsive to antibiotics. Once neutropenia was recovered, hepatosplenomegaly leukocytosis, elevated serum alkaline phosphatase, and hypoechoic areas in the spleen and liver ultrasound were observed. All fungal blood cultures were negative, with the diagnosis being confirmed by histologic study. One of the patients died without achieving control of the candidiasis. The other two patients received prolonged antifungal treatment concurrently with chemotherapy and both are alive, one of them cured and in complete remission. The increasing frequency of this infection in recent years and the importance of a prompt and prolonged administration of antifungal therapy to obtain the cure are discussed. PMID:2297657
Verdeguer, A; Fernández, J M; Esquembre, C; Ferris, J; Ruiz, J G; Castel, V
Full Text Available Candidiasis of the oral mucosa arises chiefly as a re- sult of infection with Candida albicans. Many clinico- pathological analyses of macroscopic findings have been described, although the clinical findings of oral candidiasis vary considerably and the conditions are complex. The present study analyzes the distribution, clinical, cytological and histological diagnoses of oral candidiasis, associated complex diseases and the di-agnostic value of cytology. The ratio of Candida in-fection was 28.9% among 1551 study participants. Females were infected significantly more often than men (p < 0.01 and the affected age range was 60 - 79 years (61.0%, p < 0.01. The predominantly affected areas were the tongue (48.3%, p < 0.01 and gingiva (20.0%, p < 0.01, and occurrence at multiple loci was seen in 43 (9.6% patients. The typical clinical find- ings of oral candidiasis were ulcerative/erythematous lesions (33.2%, p < 0.01 and pseudomembranous candidiasis (31.6%, p < 0.01. A histopathological dia- gnosis of candidiasis based on biopsy specimens from 26 lesions in patients with Candida infection indicated by cytology was confirmed from cultures. The break- down of a cytological to a definite diagnosis was 6 positive (SCC 4, verrucous carcinoma 1, moderate to severe dysplasia 1, 6 suspected positive (mild dyspla- sia, 2; moderate to severe dysplasia, 2; papilloma, 1 and SCC, 1 and 14 negative (epulis, 3; papilloma, 3; granulation tissue, 2; fibrosis, 2 and others, 4. Exfo-liative cytology can easily judge the presence of Can-dida species, although experience is necessary for the presumptive diagnosis of an oral mucosal disease. The application of exfoliative cytology using the Pe- riodic acid-Schiff reaction is helpful for the earlier detection of oral candidiasis with various macrosco- pic findings.
Invasive candidiasis is the 4th leading cause of nosocomial bloodstream infection in the US with mortality that exceeds 40% despite administration of antifungal therapy; neutropenia is a major risk factor for poor outcome after invasive candidiasis. In a fatal mouse model of invasive candidiasis that mimics human bloodstream-derived invasive candidiasis, the most highly infected organ is the kidney and neutrophils are the major cellular mediators of host defense; however, factors regulating n...
In the absence of any demonstrable T- or B-cell responses, gnotobiotic CB-17 SCID (severe combined immunodeficient) mice not only show innate resistance to acute systemic (intravenous challenge) candidiasis but also manifest innate resistance to systemic candidiasis of endogenous (gastrointestinal tract) origin. Poly(I. C), a potent inducer of interferons (IFNs) in vivo, enhanced the susceptibility of CB-17 SCID mice to acute systemic candidiasis and to systemic candidiasis of endogenous orig...
Jensen, J.; Vazquez-torres, A.; Balish, E.
Gastrointestinal endoscopy was performed in two bronchial asthma patients using inhaled corticosteroid who complained of odynophagia. The endoscopic finding was high grade with white moss (Grade III) in both patients. Esophageal candidiasis is often recognized in bronchial asthmatic patients receiving long-term fluticasone propionate (FP) dry powder (Diskhaler) inhalation. We therefore examined the complicated context of esophageal candidiasis in patients with long-term FP inhalation. Out of 20 bronchial asthmatic patients who had been using FP inhalation long-term, seven showed signs of esophageal candidiasis. Three patients had mild grade (Grade I), one middle grade (Grade II) and three high grade (Grade III) candidiasis, with a frequency of 35%. This rate is higher than the usual spontaneous occurrence rate of esophageal candidiasis, and it is suggested that inhalation of corticosteroid medication can penetrate into the esophagus after deep inhalation. We tested this hypothesis in two studies. 1) To measure the esophageal concentration of FP, four healthy adults inhaled 200 microg FP once. Right after inhalation, FP concentration in the esophageal washing fluid was 3.3 microg. On another day, 30 minutes after the same dose of inhaled FP, one FP concentration in the esophageal washing fluid was 0.67 microg (immediately laydown), and another was 0.11 microg (remained standing). This indicates that even though FP dissipates quickly, it remains in the esophagus 30 minutes after inhalation. 2) We observed the process in one patient with high grade (Grade III) esophageal candidiasis. The time of inhalation was changed from just after getting up and just before going to bed to before breakfast and before dinner. Under this regimen, the signs of esophageal candidiasis improved from high to middle grade. Conclusion: If asthmatic patients do not go to sleep immediately after FP inhalation, the remaining FP in the esophagus decreases rapidly, thereby decreasing the risk of esophageal candidiasis. In addition, by changing the FP inhalation times to before breakfast and dinner, the remaining FP in the esophagus is washed away and does not remain in the esophagus. Therefore, this study, which avoided inhalation before going to bed, provides useful information for the prevention and improvement of esophageal candidiasis. PMID:14685037
Shuto, Hiroshi; Nagata, Makoto; Terashi, Yoshinori; Yamaguchi, Michiya; Takizawa, Takao; Shuto, Chizuru; Watanabe, Kensuke; Tosaka, Kaoru; Okano, Masahiko; Noguchi, Hisashi
Full Text Available SciELO Chile | Language: Spanish Abstract in spanish [...] Abstract in english Background: Esophageal candidiasis is associated with conditions that cause an immune depression. It is a defining disease for AIDS, is observed in poorly controlled diabetics, in patients with renal or hepatic failure, in patients with cancer and in subjects using medications causing immunosuppress [...] ion or broad spectrum antimicrobials. Aim: To report the features of 10 immunocompetent patients with esophageal candidiasis. Patients and methods: Six males and four females aged between 48 and 82 years, without conditions associated with immunosuppression, in whom an esophageal candidiasis was found on an upper gastrointestinal endoscopy. Delayed skin hypersensitivity to eight antigens, Iymphocyte subpopulations, yeast phagocytosis and neutrophil chemotaxis were measured. Results: Six patients had a low CD4 Iymphocyte count and seven had a low CD8 count. Seven patients were anergic on skin hypersensitivity challenge. Yeast phagocytosis was abnormal in one patient and neutrophil chemotaxis was abnormal in two. Humoral immunity was normal in all subjects. All patients were treated with oral fluconazole in doses of 150 mg/day for 14 days, with complete resolution of candidiasis in all. Conclusions: Patients with esophageal candidiasis, have frequent alterations of cellular immunity, that must be diagnosed and treated
Claudia, Cortés M; Danny, Oksenberg R; Alejandro, Afani S; Carlos, Defilippi C; Ana María, Madrid S.
Full Text Available Background: Esophageal candidiasis is associated with conditions that cause an immune depression. It is a defining disease for AIDS, is observed in poorly controlled diabetics, in patients with renal or hepatic failure, in patients with cancer and in subjects using medications causing immunosuppression or broad spectrum antimicrobials. Aim: To report the features of 10 immunocompetent patients with esophageal candidiasis. Patients and methods: Six males and four females aged between 48 and 82 years, without conditions associated with immunosuppression, in whom an esophageal candidiasis was found on an upper gastrointestinal endoscopy. Delayed skin hypersensitivity to eight antigens, Iymphocyte subpopulations, yeast phagocytosis and neutrophil chemotaxis were measured. Results: Six patients had a low CD4 Iymphocyte count and seven had a low CD8 count. Seven patients were anergic on skin hypersensitivity challenge. Yeast phagocytosis was abnormal in one patient and neutrophil chemotaxis was abnormal in two. Humoral immunity was normal in all subjects. All patients were treated with oral fluconazole in doses of 150 mg/day for 14 days, with complete resolution of candidiasis in all. Conclusions: Patients with esophageal candidiasis, have frequent alterations of cellular immunity, that must be diagnosed and treated
Claudia Cortés M
Candidiasis is the most common opportunistic yeast infection. Candida species and other microorganisms are involved in this complicated fungal infection, but Candida albicans continues to be the most prevalent. In the past two decades, it has been observed an abnormal overgrowth in the gastrointestinal, urinary and respiratory tracts, not only in immunocompromised patients, but also related to nosocomial infections and even in healthy individuals. There is a widely variety of causal factors that contribute to yeast infection which means that candidiasis is a good example of a multifactorial syndrome. Due to rapid increase in the incidence in these infections, this is the subject of numerous studies. Recently, the focus of attention is the treatment and, above all, the prevention of those complications. The diagnosis of candidiasis could become quite complicated. Prevention is the most effective "treatment," much more than eradication of the yeast with antifungal agents. There are several aspects to consider in the daily routine that can provide a strength protection. However, a therapeutic approach is necessary when the infection is established, and therefore, other alternatives should be explored. This review provides an overview on predisposition factors, prevention and diagnosis of candidiasis, highlighting alternative approaches for candidiasis treatment. PMID:24789109
Martins, Natália; Ferreira, Isabel C F R; Barros, Lillian; Silva, Sónia; Henriques, Mariana
Full Text Available SciELO Chile | Language: Spanish Abstract in spanish Las infeccciones por hongos, particularmente candida, han emergido como una causa importante de infecciones nosocomiales en recién nacidos de muy bajo peso. Las infecciones a candida pueden ser diseminadas, por colonización de un acceso venoso central o congénitas. La candidiasis congénita es una co [...] ndición inhabitual producida por la infección a candida adquirida in utero. Reportamos el curso clínico de un recién nacido prematuro de muy bajo peso (peso 630 g, edad gestacional 24 semanas) con una candidiasis congénita. Por otro lado, se revisan los factores de riesgo, presentación clínica, hallazgos de laboratorio, tratamiento y pronóstico de esta patología, basado en una revisión de los casos reportados en la literatura Abstract in english Systemic candidiasis has become an important cause of nosocomial infections in very low birth weight infants (VLBW). In this vulnerable population candidal infection may be disseminated, be congenital or related to intravenous lines. Congenital candidiasis is a rare disorder acquired in utero. In th [...] is report we describe a VLBW infant (24 weeks of gestational age and birth weight of 630gm) with congenital candidiasis, and discuss the risk factors, clinical and laboratory findings, treatment and the outcome of this condition based on a review of reported cases in the literature
Raúl, Bustos B.; Daniel, Copaja L.; Aldo, Bancalari M..
Full Text Available Las infeccciones por hongos, particularmente candida, han emergido como una causa importante de infecciones nosocomiales en recién nacidos de muy bajo peso. Las infecciones a candida pueden ser diseminadas, por colonización de un acceso venoso central o congénitas. La candidiasis congénita es una condición inhabitual producida por la infección a candida adquirida in utero. Reportamos el curso clínico de un recién nacido prematuro de muy bajo peso (peso 630 g, edad gestacional 24 semanas con una candidiasis congénita. Por otro lado, se revisan los factores de riesgo, presentación clínica, hallazgos de laboratorio, tratamiento y pronóstico de esta patología, basado en una revisión de los casos reportados en la literaturaSystemic candidiasis has become an important cause of nosocomial infections in very low birth weight infants (VLBW. In this vulnerable population candidal infection may be disseminated, be congenital or related to intravenous lines. Congenital candidiasis is a rare disorder acquired in utero. In this report we describe a VLBW infant (24 weeks of gestational age and birth weight of 630gm with congenital candidiasis, and discuss the risk factors, clinical and laboratory findings, treatment and the outcome of this condition based on a review of reported cases in the literature
Raúl Bustos B.
Hepatosplenic candidiasis following granulocytopenic periods is a relatively recently recognised problem in immunocompromised patients, particularly in those with acute leukaemia. We present three patients in whom diagnosis of hepatosplenic candidiasis was suspected on the basis of ultrasonographic (US), computed tomographic (CT) findings and confirmed by laparoscopy and biopsy of liver lesions. All three patients were successfully treated briefly with amphotericin B, followed by a longer period of fluconazole. In one patient laparotomy and surgical evacuation of abscesses was performed. This condition could be more often recognised by careful follow-up of liver function test, C-reactive protein level, ultrasonography, CT and MRI after recovery from chemotherapy-induced neutropenia. PMID:10456663
Colovi?, M; Lazarevi?, V; Colovi?, R; Jankovi?, G; Suvajdzi?, N; Bogdanovi?, A; Bila, J
Hepatosplenic candidiasis is increasingly observed in patients with a haematological malignancy who have received chemotherapy. A case history is described of a male aged 45 who developed symptoms of hepatosplenic candidiasis caused by Candida tropicalis after treatment for acute myeloid leukaemia. The disease is characterized by persistent fever after recovery of the leukopenia induced by the chemotherapy. Echographic and computer-tomographic examination may reveal abscess patterns specific of Candida in the liver. Treatment consists of amphotericin B intravenously or fluconazole orally. Protracted treatment is frequently required. PMID:8289957
Zweegman, S; Sibinga, L; Huijgens, P C
The authors report two cases of splenic and hepatosplenic candidiasis occurring during a protracted neutropenia induced by chemotherapy for acute leukemia (lymphoblastic and myeloblastic respectively). Fungal infection was revealed by persistent or recurrent fever after correction of neutropenia. Diagnosis was suggested by findings at abdominal ultrasonography. It was confirmed by histological analysis which, in the first case, required open liver biopsy. In both cases, lack of improvement of splenic lesions despite treatment with Amphotericin B followed by fluconazole led to splenectomy. Both patients received postoperative anti fungal therapy with Ampho B and at one year's follow up, the patient who had the hepatosplenic candidiasis seems to have recovered. PMID:2369269
Levine, M; Bader-Meunier, B; Tassin, E; Dupont, B; Courtecuisse, V; Tchernia, G
Shorter courses of therapy have been developed for most antifungal agents used for the treatment of vaginal candidiasis, including clotrimazole, econazole, isoconazole, miconazole, terconazole and fluconazole. A search of the medical literature identified 14 studies that compared single-dose therapy for vaginal candidiasis in nonpregnant women. These studies, conducted according to similar study designs, provided sufficient information to evaluate clinical and mycologic cure rates. There were few significant differences in either the clinical or mycologic cure rates of single-dose therapy, and no one therapy was consistently better than any other. Until further information is available, the choice of therapy will continue to be based on individual clinician preference. PMID:10394549
Edelman, D A; Grant, S
A retrospective study of 23 patients with acute leukaemia and hepatosplenic candidiasis (HSC) was conducted to evaluate clinical treatment characteristics in terms of amount and duration of antifungal agents and to assess treatment outcome. Patients were admitted to two major tertiary care centres between 1990 and 1998. The diagnosis of HSC was based on clinical, blood cultures, histologic and imaging studies. Patients were treated with amphotericin B without interruption of the planned chemotherapy regimens. Serial magnetic resonance imaging (MRI) studies were the main tool for following patients' response and activity of the fungal lesions in conjunction with clinical and laboratory parameters. Treatment with amphotericin B was continued until resolution of all clinical symptoms and signs attributable to HSC, obtaining negative blood cultures and the appearance of at least healed lesions on MRI. Amphotericin B was discontinued in four patients because of severe nephrotoxicity (two patients), or continuous fever and persistent fungal lesions on MRI (two patients). Amphotericin B lipid complex (ABELCET) was successfully used as salvage therapy for these refractory patients. Four patients died with evidence of HSC despite treatment and supportive measures. The response rate for treatment of HSC was 82%. The mean total dose of amphotericin B including empirical treatment was 4 g and the median duration of treatment for responding patients was 112 d. The median number of days of anti- fungal treatment before the disappearance of fever was 19 d. Our results confirmed the need for protracted courses of antifungal agents for the successful eradication of HSC. Chemotherapy for the underlying disorder should not be interrupted or delayed in order to treat HSC. PMID:10468858
Sallah, S; Semelka, R C; Wehbie, R; Sallah, W; Nguyen, N P; Vos, P
Full Text Available Las infecciones invasoras por Candida spp, representan una patología relevante en los pacientes críticos. Para su oportuno diagnóstico es necesaria una elevada sospecha clinica, tomando en consideración el cuadro clinico y la presencia de factores de riesgo. Pese a la incorporación de nuevos fármacos al arsenal terapéutico durante la última década, mantiene una elevada mortalidad. Las claves para mejorar los desenlaces clínicos en estos pacientes son el empleo de una terapia precoz, eficaz y que permita la cobertura de distintas especies de Candida: C albicans y no albicans. Recientes guías internacionales sugieren la terapia empírica con equinocandinas ante la sospecha de candidiasis invasora en esta población de pacientes. Este grupo de fármacos ha documentado adecuada eficacia clínica y seguridad en estos pacientes. Se espera que la incorporación de nuevas equinocandinas al mercado aminore sus costos y mejore el acceso a este grupo de fármacos.Invasive infections by Candida strains are a relevant pathology in critically ill patients. Candida should be considered where a high risk of infection is present for a critical early diagnosis. Despite the incorporation of new drugs in the therapeutic armamentarium over the last decade, mortality remains high. The key in improving clinical outcomes of these patients are the use of early effective therapies that offer coverage against different strains of Candida: C. albicans and non-albicans. Recent international guidelines suggest empiric therapy with echinocandins in suspected invasive candidiasis in this patient population. This group of drugs adequately documented clinical efficacy and safe use in these patients. The emergence of new echinocandins could improve access to these drugs by reducing their cost.
Eduardo Tobar A
Full Text Available A case had recurrent and chronic mucocutaneous candidiasis . The main immunological feature were gross T cell deficiency, anergy to common recall antigens but normal serum immunoglobulins, complement and phagocytosis. Ultimately, the multiple candida infections led to a fatal outcome.
To determine whether a prior history of hepatosplenic candidiasis resulted in increased Candida-associated morbidity and mortality after marrow transplant, 15 consecutive patients with biopsy-proven hepatosplenic candidiasis were observed prospectively. All patients received amphotericin B before transplant. Amphotericin B was continued at a dose of 0.5 mg/kg/day from conditioning through marrow engraftment, at which time it was discontinued if computerized tomography (CT) evidence of disease was stable or improved. Patients were observed for progression of candidiasis for the first 100 days after transplant. The amount and duration of antifungal therapy received before transplant varied widely. The majority of patients (73%) had persistently abnormal CT scans before transplant. After transplant, 3 of 15 died (20%) with evidence of fungal disease, although fungal species differed from those diagnosed pretransplant, compared with a historical mortality rate of 90% in posttransplant patients with documented hepatosplenic candida. Comparison CT scans obtained before and after transplant showed improvement in 9 of 15 (60%), complete resolution in 2 of 15 (13%), and none showed progression. We conclude that hepatosplenic candidiasis is not an absolute contraindication to marrow transplant when patients receive amphotericin B therapy before transplant and continue therapy until engraftment is established. PMID:7919390
Bjerke, J W; Meyers, J D; Bowden, R A
Candida infections are the most frequent infections in neutropenic patients. Hepatosplenic candidiasis (HSC) is a part of disseminated Candida infection that occurs most commonly in patients with hematologic malignancies treated with chemotherapy and requires protracted antifungal therapy. During invasive mycosis with rapid resolution of immunosuppression, immune reconstitution inflammatory syndrome (IRIS) which mimics treatment failure, drug toxicity or breakthrough infections may occur. Man...
Bayram, Cengiz; Fettah, Ali; Yarali, Nese; Kara, Abdurrahman; Azik, Fatih Mehmet; Tavil, Betul; Tunc, Bahattin
Verrucous carcinoma has a special propensity to mimic benign lesions of the oral cavity. A case of the oral verrucous carcinoma in maxillary alveolar ridge, extending to buccal vestibule, cheek, and labial mucosa, which was diagnosed and initially treated as chronic candidiasis, is presented. Clinical, histopathological, and therapeutic considerations related to diagnosis of the verrucous carcinoma in the oral cavity are discussed. PMID:22720181
Garcia, Natália Galvão; Oliveira, Denise Tostes; Hanemann, João Adolfo Costa; Pereira, Alessandro Antônio Costa
Full Text Available SciELO Venezuela | Language: Spanish Abstract in spanish La candidiasis orofaríngea constituye una patología frecuente en la población pediátrica. Con la finalidad de ofrecer una alternativa terapéutica segura y eficaz, se realizó un estudio multicéntrico, prospectivo, comparativo, simple ciego y de asignación aleatoria, donde se incluyeron 181 pacientes [...] con diagnóstico clínico y micológico de candidiasis orofaríngea; fueron asignados al azar para recibir Fluconazol suspensión a 5 mgrs/Kg dosis única diaria o Nistatina suspensión 50.000 unidades/Kg cada 6 horas. Se obtuvo una respuesta clínica satisfactoria al final del tratamiento con una diferencia estadística altamente significativa (p Abstract in english The Oropharyngeal Candidiasis constitute a frecuent pathology in the pediatric population. In order to offer a safe and efficient therapeutic alternative, an multicentric, prospective, single blind and randomized study was performed 181 patients which included clinic and micologic diagnostic of Orof [...] aringeal Candidiasis; they were asigned in a randomized way to received fluconazole suspensión containing 5 mgrs/Kg once daily or Nystatin suspensión 50.000 units/Kg every six hours. Satisfactory clinic response was obtained at the end of the treatment with a very significant statistic difference (p
B, Del Nogal; M, Carrabs; JA, Suárez; N, SandovaI; L, Escalona; O, Febres; A, González; A, Martin; Y, Izaguirre; G, Espinoza.
Full Text Available
Candida is one of the most frequent pathogens isolated in bloodstream infections, and is associated with significant morbidity and mortality. In addition to haematological patients, there are several other populations with a substantial risk of developing invasive candidiasis (IC. These include patients undergoing prolonged hospitalisation with the use of broad-spectrum antibiotics, those fitted with intravascular catheters, admitted to both adult and neonate intensive care units (ICU or gastrointestinal surgery wards and subjects with solid tumours undergoing cytotoxic chemotherapy. As a general rule, every immunocompromised patient might be at risk of Candida infection, including, for example, diabetic patients.
The epidemiology of species responsible for IC has been changing, both at local and worldwide level, shifting from C. albicans to non-albicans species, that can be intrinsically resistant to fluconazole (C. krusei and, to some extent, C. glabrata, difficult to eradicate because of biofilm production (C. parapsilosis or than might acquire resistance to azole during therapy.
Delaying the specific therapy has been shown to increase morbidity and mortality, but traditional microbiological diagnosis is poorly sensitive and slow. Thus, culture-based treatment may result in therapy started too late. In order to reduce the mortality in IC, several management strategies have been developed: prophylaxis, empirical and pre-emptive therapy. Compared to prophylaxis, the latter approaches allow to reduce the use of antifungals by targeting only patients at very high risk of IC. Non-invasive serological markers and scores based on clinical prediction rules such as the presence of risk factors or Candida colonisation, have been developed with the aim of allowing prompt initiation of treatment. Although the use of these diagnostic tools in pre-emptive strategies is promising, the performance and cost-effectiveness should be tested in large trials.
Agents recommended for initial treatment of candidemia in severely ill patients include echinocandins and lipid formulations of amphotericin B, while stable patients without risk factors for azole-resistance might be treated with fluconazole.
Opportunistic fungal infections are significant problems for neutropenic patients who are undergoing cytotoxic therapy for acute leukemia. Systemic and hepatosplenic candidiasis have been reported in acute leukemic patients who are on chemotherapy. Gastrointestinal tract involvement is a rare phenomenon in disseminated candidiasis, especially in acute leukemia. We report one such rare case of acute myeloid leukemia in an infant who died of disseminated candidiasis with gastrointestinal tract involvement prior to the institution of chemotherapy. PMID:17696044
Goyal, Richa; Vaiphei, Kim; Vankalakunti, Mahesh; Marwaha, Ram Kumar
Mucocutaneous candidiasis (MC) is one of the first signs of human immunodeficiency virus (HIV) infection. Over 90% of patients with AIDS will eventually develop oropharyngeal candidiasis (OPC) at some time during their illness, and an additional 10% will develop esophageal candidiasis (EC). Although numerous antifungal agents are available, azoles, both topical (clotrimazole) and systemic (fluconazole, itraconazole), have replaced older topical antifungals (gentian violet and nystatin) in the...
Vazquez, Jose A.
A randomized cross-over clinical and endoscopic evaluation of 85 Ugandan patients showed that esophageal candidiasis in AIDS patients with oral candidiasis could be managed without endoscopy and biopsies. Oral lesions, especially when accompanied by esophageal symptoms, were sufficient for diagnosis. Miconazole was more effective than nystatin in treating esophageal candidiasis and could be a valid alternative to more expensive azolic drugs in developing countries.
Ravera, M.; Reggiori, A.; Agliata, A. M.; Rocco, R. P.
Hepatosplenic candidiasis is also called chronic disseminated candidiasis and usually seen in patients with hematologic malignancies who have just recovered from an episode of neutropenia. Gastric candidiasis most commonly present as a mucosal lesion such as an ulcer or erosions, but other gastric lesion is very rare. We experienced a case of gastric candidiasis which presented as gastric subepithelial mass in a 60-year old woman who had undergone the 2nd consolidation chemotherapy due to acute myeloid leukemia. The pathologic diagnosis was confirmed by fine needle aspiration of the gastric subepithelial mass under the guidance of endoscopic ultrasonography. PMID:19158470
Kim, Su Hyun; Kim, Sang Gyun; Kang, Seung Joo; Kim, Mi Na; Park, Jin Myung; Jo, Hyun Jin; Choi, Moon Sun; Song, In Sung
Full Text Available Oral candidiasis is an opportunistic infection caused primarily by Candida albicans. However, in recent years, species of non-albicans Candida have been implicated more frequently in mucosal infection. Candida species usually reside as commensal organisms and are part of normal oral microflora. Determining exactly how transformation from commensal to pathogen takes place and how it can be prevented is continuous challenge for clinical doctors. Candidal adherence to mucosal surfaces is considered as a critical initial step in the pathogenesis of oral candidiasis. Acrylic dentures, acting as reservoirs, play an important role in increasing the risk from Candida colonisation. Thus, this review discusses what is currently known about the adhesion of non-albicans Candida species of oral origin to buccal epithelial cells and denture acrylics.
Bokor-Brati? Marija B.
Our research on pathogenesis of disseminated candidiasis led to the discovery that antibodies specific for Candida albicans cell surface ?-1, 2–mannotriose [?-(Man)3] protect mice. A 14 mer peptide Fba, which derived from the N-terminal portion of the C. albicans cytosolic/cell surface protein fructose-bisphosphate aldolase, was used as the glycan carrier and resulted in a novel synthetic glycopeptide vaccine ?-(Man)3-Fba. By a dendritic cell-based immunization approach, this conjugate i...
Xin, Hong; Cartmell, Jonathan; Bailey, Justin J.; Dziadek, Sebastian; Bundle, David R.; Cutler, Jim E.
Studies with an estrogen-dependent murine model of vaginal candidiasis suggest that local cell-mediated immunity (CMI) is more important than systemic CMI for protection against vaginitis. The present study, however, showed that, compared to uninfected mice, little to no change in the percentage or types of vaginal T cells occurred during a primary vaginal infection or during a secondary vaginal infection where partial protection was observed. Furthermore, depletion of polymorphonuclear leuko...
Fidel, Paul L.; Luo, Wei; Steele, Chad; Chabain, Joseph; Baker, Marc; Wormley, Floyd
Vulvovaginal candidiasis (VVC) is an opportunistic mucosal infection caused by Candida albicans that affects large numbers of otherwise healthy women of childbearing age. Acute episodes of VVC often occur during pregnancy and during the luteal phase of the menstrual cycle, when levels of progesterone and estrogen are elevated. Although estrogen-dependent experimental rodent models of C. albicans vaginal infection are used for many applications, the role of reproductive hormones and/or their l...
Fidel, Paul L.; Cutright, Jessica; Steele, Chad
Oral candidiasis is an opportunistic infection caused primarily by Candida albicans. However, in recent years, species of non-albicans Candida have been implicated more frequently in mucosal infection. Candida species usually reside as commensal organisms and are part of normal oral microflora. Determining exactly how transformation from commensal to pathogen takes place and how it can be prevented is continuous challenge for clinical doctors. Candidal adherence to mucosal surfaces is conside...
Bokor-Brati? Marija B.
Hepatosplenic candidiasis (HSC) is a form of invasive fungal infection that occurs most commonly in patients with acute leukemia treated with chemotherapy and requires protracted antifungal therapy. Immune reconstitution inflammatory syndrome (IRIS) is best characterized as a dysregulated inflammatory responses triggered by rapid resolution of immunosuppression.We present a child diagnosed with standard-risk precursor B cell-acute lymphoblastic leukemia who developed HSC an...
Cengiz Bayram; Ali Fettah; Nese Yarali; Abdurrahman Kara; Fatih Mehmet Azik; Betül Tavil; Bahattin Tunc
Full Text Available Background and Objectives: Vaginal candidiasis is a common disease in women during their lifetime and occurs in diabetes patients, during pregnancy and oral contraceptives users. Although several antifungals are routinely used for treatment; however, vaginal candidiasis is a challenge for patients and gynecologists. The aim of the present study was to evaluate terbinafine (Lamisil on Candida vaginitis versus clotrimazole.Materials and Methods: In the present study women suspected to have vulvovaginal candidiasis were sampled and disease confirmed using direct smear and culture examination from vaginal discharge. Then, patients were randomly divided into two groups, the first group (32 cases was treated with clotrimazole and the next (25 cases with Lamisil. All patients were followed-up to three weeks of treatment and therapeutic effects of both antifungal were compared.Results: Our results shows that 12 (37.5% patients were completely treated with clotrimazole during two weeks and, 6(18.8% patients did not respond to drugs and were refereed for fluconazole therapy. Fourteen (43.8% patients showed moderate response and clotrimazole therapy was extended for one more week. When Lamisil was administrated, 19 (76.0% patients were completely treated with Lamisil in two weeks, and 1 (4.0% of the patients did not respond to the drug and was refereed for fluconazole therapy. Five (20.0% of our patients showed moderate response and Lamisil therapy was extended for one more week.Conclusion: Our results show that vaginal cream, 1% Lamisil, could be suggested as a first-line treatment in vulvovaginal candidiasis.
Gas-liquid chromatography was used to quantitate the arabinitol concentration in the sera of patients with candidiasis and in that of control patients. Serum arabinitol was elevated in 59% (n = 34) of patients with Candida sepsis, in 39% (n = 38) with Candida colonization, in 14% (n = 62) with bacterial sepsis, and in 0% (n = 11) of normal persons. The above patients were subsequently divided on the basis of renal function. Of those with decreased renal function, serum arabinitol was elevated...
Three latex agglutination test procedures for detecting Candida antigen in human serum were compared in a retrospective study of 69 patients and 20 normal volunteers. Untreated human serum was reacted with two different latex reagents; one reagent also was reacted with serum treated with protease and heat. The test procedure with treated serum was best, detecting serum antigen in 17 of 21 patients (81%) with disseminated candidiasis. Judging by autopsy-proven cases, there was an increase in p...
Bailey, J. W.; Sada, E.; Brass, C.; Bennett, J. E.
Alterations in the autochthonous vaginal microflora can predispose women to recurring attacks of Candida vaginitis. Quantitative aerobic and anaerobic cultures were obtained from 24 premenopausal women with acute recurrent vulvovaginal candidiasis and from 21 healthy asymptomatic premenopausal women. Lactobacillus species constituted the predominant flora in both groups, with a mean log10 CFU/ml of 8.7, a total isolation rate of 96%, and a mean of 1.6 Lactobacillus species isolated per patien...
Sobel, J. D.; Chaim, W.
We assessed the potential of lactoferrin (LF), a multifunctional milk protein, for treatment of oral candidiasis with immunosuppressed mice, which have local symptoms characteristic of oral thrush. Oral administration of bovine LF in drinking water starting 1 day before the infection significantly reduced the number of Candida albicans in the oral cavity and the score of lesions on the tongue on day 7 after the inoculation. The symptomatic effect of LF was confirmed by macroscopic and microsc...
Takakura, Natsuko; Wakabayashi, Hiroyuki; Ishibashi, Hiroko; Teraguchi, Susumu; Tamura, Yoshitaka; Yamaguchi, Hideyo; Abe, Shigeru
Full Text Available Nathan P Wiederhold1, Jason M Cota2, Christopher R Frei11University of Texas at Austin College of Pharmacy, Austin, Texas, USA; 2University of the Incarnate Word Feik School of Pharmacy, San Antonio, Texas, USAAbstract: Micafungin is an echinocandin antifungal agent available for clinical use in Japan, Europe, and the United States. Through inhibition of ?-1,3-glucan production, an essential component of the fungal cell wall, micafungin exhibits potent antifungal activity against key pathogenic fungi, including Candida and Aspergillus species, while contributing minimal toxicity to mammalian cells. This activity is maintained against polyene and azole-resistant isolates. Pharmacokinetic and pharmacodynamic studies have demonstrated linear kinetics both in adults and children with concentration-dependent activity observed both in vitro and in vivo. Dosage escalation studies have also demonstrated that doses much higher than those currently recommended may be administered without serious adverse effects. Clinically, micafungin has been shown to be efficacious for the treatment of invasive candidiasis and invasive aspergillosis. Furthermore, the clinical effectiveness of micafungin against these infections occurs without the drug interactions that occur with the azoles and the nephrotoxicity observed with amphotericin B formulations. This review will focus on the pharmacology, clinical microbiology, mechanisms of resistance, safety, and clinical efficacy of micafungin in the treatment of invasive candidiasis and invasive aspergillosis.Keywords: micafungin, echinocandin, Candida, Aspergillus, invasive candidiasis, invasive aspergillosis
Nathan P Wiederhold
Many patients with oral candidiasis respond very slowly or not at all to therapy with amphotericin. Strains of Candida albicans were collected from 17 patients clinically resistant and from 15 who responded to a normal course of amphotericin treatment. Minimal inhibitory concentrations (MIC) determined on diagnostic sensitivity test agar plates gave values of: amphotericin 0-5 mg/l; nystatin 50 i.u./ml; chlorhexidine 12.5 mg/l. No clear MIC could be determined with plates containing miconazole. No difference was noted in MIC values between the 2 groups of patients. Tube-dilution tests in Sabouraud's broth gave MIC values of: amphotericin 0.25 mg/l; nystatin 12.5 i.u./ml; chlorhexidine 1.5 mg/l; miconazole 8-32 mg/l; ketonazole 64 mg/l. Persistence of oral candidiasis is not an indication of infection with resistant organisms. Despite difficulties in in vitro sensitivity testing of miconazole a clinical trial of the drug for treating oral candidiasis is indicated. PMID:392486
Holbrook, W P; Kippax, R
Eleven patients with acute non-lymphocytic leukemia developed hepatosplenic candidiasis following the termination of chemotherapy. Five who did not receive amphoteicin B (AMPH) died of liver failure, whereas the other six who received AMPH and/or miconazole or fluconazole were cured. The features of hepatosplenic candidiasis included prolonged high fever not responsive to antibiotics and hepatomegaly with right-sided hypochondrial pain developing after severe neutropenia. Even if the neutropenia recovered, these symptoms did not subside. In addition, elevation of the serum alkaline phosphatase and total bilirubin levels were observed at onset. CT scan revealed multiple low-density areas of varying size that showed no contrast enhancement. Ultrasonography also demonstrated hypoechoic or hyperechoic lesions, and a so-called "target sign appearance" in the liver and spleen. The clinical diagnosis for hepatosplenic candidiasis is not so difficult because of the uniform symptoms, signs and laboratory abnormalities. The importance of the early administration of antifungal agents to obtain a cure is discussed in this article. PMID:1919111
Miyazaki, S; Miura, A B
Full Text Available Jose A VazquezDivision of Infectious Diseases, Henry Ford Hospital, Wayne State University School of Medicine, Detroit, MI, USAAbstract: Mucocutaneous candidiasis is frequently one of the f irst signs of human immunodeficiency virus (HIV infection. Over 90% of patients with AIDS will develop oropharyngeal candidiasis (OPC at some time during their illness. Although numerous antifungal agents are available, azoles, both topical (clotrimazole and systemic (fluconazole, itraconazole, voriconazole, posaconazole have replaced older topical antifungals (gentian violet and nystatin in the management of oropharyngeal candidiasis in these patients. The systemic azoles, are generally safe and effective agents in HIV-infected patients with oropharyngeal candidiasis. A constant concern in these patients is relapse, which is dependent on the degree of immunosuppression commonly seen after topical therapy, rather than with systemic azole therapy. Candida esophagitis (CE is also an important concern since it occurs in more than 10% of patients with AIDS and can lead to a decrease in oral intake and associated weight loss. Fluconazole has become the most widely used antifungal in the management of mucosal candidiasis. However, itraconazole and posaconazole have similar clinical response rates as fluconazole and are also effective alternative agents. In patients with fluconazole-refractory mucosal candidiasis, treatment options now include itraconazole solution, voriconazole, posaconazole, and the newer echinocandins (caspofungin, micafungin, and anidulafungin.Keywords: oropharyngeal candidiasis, esophageal candidiasis, HAART, antifungal agents, HIV, AIDS
Jose A Vazquez
The spectrum of disseminated candidiasis includes both an acute and chronic presentation. In contrast to the acute form, chronic disseminated candidiasis (hepatosplenic candidiasis) often occurs late after granulocytopenic episodes in patients undergoing chemotherapy, usually for acute leukemia. We discuss a female patient who underwent extensive successful chemotherapy for acute myelogenous leukemia (FAB type 6) and who developed chronic hepatosplenic candidiasis 19 months later. Therapy with amphotericin B and flucytosine was not successful and a cure was effected only after long-term oral fluconazole treatment. Diagnostic problems, possible reasons for the observed failure of amphotericin B treatment, and the current use of fluconazole in disseminated candidiasis are discussed. PMID:8668982
Keiser, G; Schmid, M; Ishak, K G; Wirth, W; Vogt, M
Previously we showed that antibodies specific for the glycan ?-1,2-mannotriose [?-(Man)3] on the cell surface of Candida albicans protect mice against disseminated candidiasis (H. Xin, S. Dziadek, D. R. Bundle, and J. E. Cutler, Proc. Natl. Acad. Sci. U. S. A. 105:13526–13531, 2008). Furthermore, six 14-mer peptides that are within the N-terminal portion of C. albicans wall proteins were conjugated to the glycan in an attempt to create immunogenic glycopeptide conjugates. By a dendritic c...
Xin, Hong; Cutler, Jim E.
Full Text Available
Hepatosplenic candidiasis (HSC is a form of invasive fungal infection that occurs most commonly in patients with acute leukemia treated with chemotherapy and requires protracted antifungal therapy. Immune reconstitution inflammatory syndrome (IRIS is best characterized as a dysregulated inflammatory responses triggered by rapid resolution of immunosuppression.We present a child diagnosed with standard-risk precursor B cell-acute lymphoblastic leukemia who developed HSC and Candida-related IRIS during recovery of neutropenia associated with induction chemotherapy. Addition of corticosteroid therapy to antifungal treatment is associated with the resolution of the clinical symptoms and laboratory findings
Two cage birds, a two-month-old Fisher's lovebird (Agapornis fischeri) and a one-year-old budgerigar (Melopsittacus undulatus), manifested clinical symptoms with general weakness, loss of appetite and ruffled feathers, then died. Pathological findings revealed a large quantity of yellowish-white pseudomembrane on the mucosal membrane of the esophagus and crop in these two birds. Histopathologically, blastospores (5.5 microm long x 3.4 microm wide) and pseudohyphae were detected in the lesions of conspicuous parakeratosis and moderate acanthosis in the stratified squamous epithelium. These two birds were diagnosed as having had candidiasis. PMID:11558556
Sato, Y; Aoyagi, T; Kobayashi, T; Inoue, J
In a multicentre open prospective study itraconazole was evaluated in the treatment of acute vaginal candidiasis. Two dosage regimens were tested--200 mg twice a day for 1 day and 200 mg twice a day for 2 days. There were no statistically significant differences between these dosages, and cure rates at 7 and 28 days after treatment were 83% and 75% respectively. These are marginally lower than those produced by longer courses of oral ketoconazole (Nizoral; Janssen) and vaginal econazole nitrate but the advantages are better patient compliance and greater cost-effectiveness. PMID:2829371
Bloch, B; Barnard, P G; Burger, G D; Meyer, J S; Parkes, J R; Smythe, E
Critically ill patients in the intensive care unit (ICU) are at increased risk of encountering bloodstream infections (BSIs) with Candida spp., associated with an elevated crude mortality rate. This supports the significance of early detection of infection and identification of the most effective management approach. A review of the various antifungal treatments and an evaluation of the diverse management approaches for invasive candidiasis in critically ill patients is necessary for guiding evidence-based decision-making. Different early detection schemes for invasive candidiasis are well documented in the literature. Other than the common use of blood cultures, new methods entail the use of risk prediction scores and biomarker tests. Regarding management strategies, different options are currently supported. These include prophylaxis, empirical therapy, pre-emptive therapy, and treatment of culture-documented infections. The choice of treatment is greatly dependent on several factors related to the patient and/or to the surrounding environment. Attention needs to be given to previous exposure to azoles, epidemiological data on dominant Candida spp. in local ICUs, severity of illness and associated morbidities. This paper summarises the most recent literature as well as the guidelines issued by the Infectious Diseases Society of America. The objective is to identify the best diagnosis and management approaches for serious Candida infections in critically ill patients. In addition, this article addresses an important aspect associated with managing candidaemia in critically ill patients pertaining to the decision for intravenous catheter removal. PMID:23664579
Chahoud, Jad; Kanafani, Zeina A; Kanj, Souha S
Hepatosplenic candidiasis is traditionally diagnosed by blood culture, magnetic resonance imaging (MRI), and histological analysis. The limitations of these methods include: low sensitivity (blood culture) and failure to isolate the organism (MRI/histology). This report describes a case of hepatosplenic candidiasis diagnosed by simultaneous polymerase chain reaction (PCR) analysis of liver biopsy and serum. PCR of biopsy and/or serum may offer a sensitive and specific diagnostic test for hepatosplenic candidiasis. Candida species can be identified, which helps guide antifungal chemotherapy, an important aspect in this difficult to treat infection. PMID:15220373
Kirby, A; Chapman, C; Hassan, C; Burnie, J
Background. According to the limited studies reporting new treatments for vulvovaginal candidiasis, this study was designed to compare the combination of fluconazole and oral protexin with fluconazole in the treatment of vulvovaginal candidiasis. Methods. A double-blind clinical trial was conducted, involving 90 women who were referred to the gynecology clinic. Vulvovaginal candidiasis was diagnosed with itching, cheesy vaginal discharge, and any one of the following: dysuria, pH protexin and fluconazole-placebo, were equally effective in reduction of complaints and symptoms, but fluconazole-oral protexin combination elicited a better therapeutic response (?(2) = 0.01, P = 6.7). In addition, fluconazole-oral protexin combination treatment demonstrated better recovery time (t = -2.04, P = 0.04). Conclusion. This study demonstrated that complementary treatment with probiotic Lactobacillus increased the efficacy of fluconazole in treatment of vulvovaginal candidiasis. Further research is recommended. PMID:23119175
Nouraei, S; Amir Ali Akbari, S; Jorjani, M; Alavi Majd, H; Afrakhteh, M; Ghafoorian, A; Tafazzoli Harandi, H
Hepatosplenic candidiasis is an increasingly recognized infectious complication in patients who have an underlying malignancy and/or have chemotherapy-induced neutropenia. Only six cases of hepatosplenic candidiasis in non-neutropenic patients have been described to date, to which we add a seventh. Our patient had many of the classically described manifestations of hepatosplenic candidiasis, and responded well to therapy with amphotericin B. Retrospective comparative analysis of cases of hepatosplenic candidiasis reveals that non-neutropenic patients seem to respond well to medical therapy that is less intensive than that given to neutropenic subjects (total dosage of amphotericin B 0.84 g vs. 2.70 g, respectively) and tend to have a better prognosis (mortality rate 33% vs. 44%, respectively). PMID:18611749
Spindel, S J; Darouiche, R O; Saeed, Z A
Neonatal candidiasis is an increasingly common occurrence causing significant morbidity and mortality and a higher risk of dissemination to the central nervous system (CNS) than that seen with older patients. The current understanding of optimal antifungal therapy in this setting is limited. We have developed a model of disseminated candidiasis with CNS involvement in juvenile mice to assess the efficacy of the echinocandin caspofungin relative to amphotericin B (AmB). Juvenile mice were inoc...
Background: Th17 cells play a major role in coordinating the host defence in oropharyngeal candidiasis. In this study we investigated the involvement of the Th17 response in an animal model of vulvovaginal candidiasis (VVC). Methods: To monitor the course of infection we exploited a new in vivo imaging technique. Results: i) The progression of VVC leads to a strong influx of neutrophils in the vagina soon after the challenge which persisted despite the resolution of infection; ii) IL-17, prod...
Pietrella, Donatella; Rachini, Anna; Pines, Mark; Pandey, Neelam; Mosci, Paolo; Bistoni, Francesco; D Enfert, Cristophe; Vecchiarelli, Anna
Cell-mediated immunity by Th1-type CD4+ T cells is the predominant host defense mechanism against mucosal candidiasis. However, studies using an estrogen-dependent murine model of vaginal candidiasis have demonstrated little to no change in resident vaginal T cells during infection and no systemic T-cell infiltration despite the presence of Candida-specific systemic Th1-type responses in infected mice. The present study was designed to further investigate these observations by characterizing ...
Wormley, Floyd L.; Chaiban, Joseph; Fidel, Paul L.
Autoimmune polyendocrinopathy candidiasis ectodermal dystrophy (APECED) is a rare autosomal recessive disease, caused by mutations of a single gene named autoimmune regulator gene (AIRE) which results in a failure of T cell tolerance within the thymus. Chronic mucocutaneous candidiasis, chronic hypoparathyroidism, and Addison's disease are the hallmarks of the syndrome. APECED is also characterized by several autoimmune endocrine and nonendocrine manifestations, and the phenotype is often com...
Hepatosplenic candidiasis is traditionally diagnosed by blood culture, magnetic resonance imaging (MRI), and histological analysis. The limitations of these methods include: low sensitivity (blood culture) and failure to isolate the organism (MRI/histology). This report describes a case of hepatosplenic candidiasis diagnosed by simultaneous polymerase chain reaction (PCR) analysis of liver biopsy and serum. PCR of biopsy and/or serum may offer a sensitive and specific diagnostic test for hepa...
Kirby, A.; Chapman, C.; Hassan, C.; Burnie, J.
OBJECTIVE--To determine the comparative efficacy and cost benefit of prophylactic monthly (perimenstrual) clotrimazole, versus empiric self-treatment with the same agent at the onset of symptoms in recurrent vulvovaginal candidiasis. DESIGN--Prospective, randomised, open cross-over study of women with proven recurrent vulvovaginal candidiasis. Clinical and microbiological assessments were done every two months for 12 months. SETTING--Women's Clinic of a University Teaching Hospital. SUBJECTS-...
Fong, I. W.
OBJECTIVE--To determine the comparative efficacy of oral itraconazole versus intravaginal clotrimazole in suppressing recurrent episodes of vulvovaginal candidiasis. DESIGN--Prospective randomised open study of women with recurrent vulvovaginal candidiasis. Clinical and microbiological assessments were made monthly for 12 months. SETTING--Women's Clinic of a University teaching hospital. SUBJECTS--Forty-four otherwise healthy, non-pregnant women, with at least four proven episodes of candida ...
Fong, I. W.
Recurrent Vulvovaginal Candidiasis (RVVC) is a fungal infection of the vagina and vulva that occur usually = 4 episodes in a year. Our object was to compare the efficacy and safety of a single oral dose of fluconazole (150 mg) weekly with clotrimazole vaginal cream 150 mg twice weekly for 6 months as treatment of recurrent VVC. We conducted a clinical trial study among 124 women with Recurrent Vulvovaginal Candidiasis (RVVC) among patients presenting to the Obstetrics and Gynecology Clinics o...
Zahra Fardy Azar; Shahram Habib Zadeh
Autoimmune polyendocrinopathy-candidiasis-ectodermal-dystrophy (APECED), also known as autoimmune polyendocrine syndrome type 1 (APS-1), is a very rare disease. Diagnosis requires the presence of at least two of three major clinical features: chronic mucocutaneous candidiasis, chronic hypoparathyroidism, and Addison's disease. Design: In this study, we analyzed Autoimmune Regulator (AIRE) gene mutations and genotype-phenotype correlation in APECED patients originating from Calabria, a re...
Betterle, C.; Ghizzoni, L.; Cassio, A.; Baronio, F.; Cervato, S.; Garelli, S.; Barbi, E.; Tonini, G.
Infants treated in neonatal intensive care units suffer an increased risk for invasive candidiasis, but the diagnosis is sometimes difficult. d-arabinitol is a metabolite of most pathogenic Candida species. An elevated urine d-arabinitol/l-arabinitol (DA/LA) ratio is a sensitive sign of invasive candidiasis in children with cancer, but the method has not been previously evaluated for newborn infants. We therefore enrolled 117 infants in a neonatal intensive care unit, and 411 urine samples we...
Full Text Available Voichita Ianas1, Kathryn R Matthias2, Stephen A Klotz11Section of Infectious Diseases and Department of Medicine, 2School of Pharmacy, University of Arizona, Tucson, Arizona, USAAbstract: Posaconazole is the newest azole antifungal approved by the US Food and Drug Administration, and possesses a broad spectrum of activity against numerous yeasts and filamentous fungi. It is available as an oral suspension and is generally well tolerated by patients, but gastrointestinal absorption is sometimes inadequate and remains a clinical concern in treating deep-seated infections. It is used routinely and effectively for the prophylaxis of invasive fungal infections in immunosuppressed hosts and is an effective treatment of oropharyngeal candidiasis, including azole-resistant disease.Keywords: posaconazole, azole, yeasts, filamentous fungi
Two pediatric leukemic patients with hepatosplenic candidiasis during multidrug antileukemic chemotherapy successfully underwent bone marrow transplantation (BMT) after aggressive antifungal chemotherapy employing fluconazole and amphotericin B with or without splenectomy. One patient received allogeneic marrow graft and the other received an autologous graft. One patient has been disease-free for more than 21 months after BMT without any recurrence of Candida infection. The other patient showed tentative reactivation of hepatic lesions just after BMT by CT scanning, but these lesions disappeared again by continuous administration of the antifungal agents. The second patient died of leukemia relapse without recurrence of fungal infection. Our cases indicate the possibility of successful BMT once a fungal infection is well controlled by antifungal chemotherapy and surgical resection. PMID:8018905
Katayama, K; Koizumi, S; Yamagami, M; Tamaru, Y; Ichihara, T; Konishi, M; Maekawa, S; Seki, H; Taniguchi, N
Candida infections are the most frequent infections in neutropenic patients. Hepatosplenic candidiasis (HSC) is a part of disseminated Candida infection that occurs most commonly in patients with hematologic malignancies treated with chemotherapy and requires protracted antifungal therapy. During invasive mycosis with rapid resolution of immunosuppression, immune reconstitution inflammatory syndrome (IRIS) which mimics treatment failure, drug toxicity or breakthrough infections may occur. Manifestation period, histopathologic findings and favorable effect of steroids to its inflammatory symptoms strongly suggest that HSC belongs to the invasive fungal infection induced IRIS. We present a child with B cell-acute lymphoblastic leukemia who developed HSC and addition of corticosteroid therapy to antifungal treatment achieved rapid resolution of the clinical symptoms and laboratory findings. PMID:22550563
Bayram, Cengiz; Fettah, Ali; Yarali, Nese; Kara, Abdurrahman; Azik, Fatih Mehmet; Tavil, Betul; Tunc, Bahattin
Hepatosplenic candidiasis (HSC) is an increasingly recognized complication of treatment with chemotherapeutic agents. The true incidence of HSC is not known, but most experts agree that there has been an increase in its occurrence during the past 15 years, and most of them attribute this rise to the use of more intensive chemotherapeutic regimens in the treatment of hematologic malignancies, especially, acute leukemia. The most recognizable risk factor predisposing for this complication is prolonged neutropenia. The diagnosis of HS requires high clinical suspicion and expertise in the interpretation of the histopathologic and radiologic data. Most importantly, treatment of the condition requires prolonged administration of antifungal drugs and continuous monitoring using combination of clinical, laboratory and radiologic tests in order to ascertain eradication of the infection. In this minireview I will present a summary of the data available in the literature in combination with our prospective experience in the investigation of HSC. PMID:10216488
Nine patients with hematologic malignancies developed fungal infections, predominantly involving the liver and spleen. Eight patients had biopsy-documented progressive candidiasis and one had an unclassified fungus. The patients were treated with liposomal-amphotericin B (L-AmpB) after their fungal infection progressed during treatment with standard intravenous (IV) AmpB (Fungizone; E. R. Squibb & Son, Princeton, NJ) and/or other antifungals. Eight patients (88.8%) were cured of their fungal infection, and one showed improvement after treatment. Minor acute toxicity and no chronic toxicity were associated with the administration of L-AmpB. L-AmpB is a safe and effective therapeutic method for treating fungal infections that have invaded the liver and spleen even when they are refractory to conventional anti-fungal therapy. PMID:3806172
Lopez-Berestein, G; Bodey, G P; Frankel, L S; Mehta, K
Full Text Available Background and objectives: Genital tract infections are among the mostcommon causes of patients referred to therapeutic centers. Nearly 75% ofwomen suffer from genital Candida infection, at least once in their lifetime.The aim of present study was detection of Candida species causing vaginitisand the evaluation of antimycotic effects of ketoconazol, clotrimazole andfluconazole against Candida species.Material and Methods: In this study, 210 vaginal samples were obtainedfrom the patients suspected of Vaginal Candidiasis. Direct examination andculture were carried out for all specimens to detect the yeast. The isolatedyeast species were then identified, using various different tests such as cultureon corn meal agar, tween-80, germ tube test, and assimilation test by API 20Ckit by using Sabouraud Dextrose Agar and microdilution broth, MIC90 andMIC50 of drug were measured and determined their drug resistance.Results: In the present study, 100 yeast colonies were isolated from patients;%80 are C. albicans and the rest are C. parapsilosis(2%, C. tropicalis(6%, C.glabrata(4%, C. krusei(2%, C. guilliermondii (3%, C.stellatoidea(3%. Interms of drug resistance test MIC50 and MIC90 of fluconazole for candidaalbicans are 5.33 and 35.27?g/ ml, respectively, and for non-albicans candidaare 3 and 21.4?g/ml, respectively. Clotrimazole MIC for Candida albicans(MIC50, MIC90 0.97 and 4.9?g/ml, respectively, and for non-albicans 0.63and 3.4/ml, respectively. Kectoconazole MIC for Candida albicans 2.43 and16.45?g/ml, respectively, and for non-albicans 1.12 and 6.6?g/ml,respectively.Conclusion: Clotrimazole has been better than the two other drugs forCandida species on the whole, non albicans species are more sensitive thanalbicans species in the presence of the drugs used in this study.Key words: Candida, vaginal candidiasis, Resistance drug , Tonekabon.
Nasrollahi omran A
Full Text Available Curtis D Collins1, Sarah Cookinham2, Jeannina Smith21Department of Pharmacy Services, 2Department of Medicine, Division of Infectious Disease, University of Michigan Health System, Ann Arbor, MI, USAAbstract: Oropharyngeal candidiasis is a very common localized infection of the mucus membranes of the oropharynx that is most commonly caused by the patient's own commensal Candida albicans. It is the most common opportunistic infection affecting patients with the human immunodeficiency virus (HIV and is also quite common in patients with hematological malignancies. Effective treatment options are of high importance given the worldwide incidence of these disease states and the potential for development of oropharyngeal candidiasis in these patients. Various systemic and topical treatment options for patients with oropharyngeal candidiasis have existed for many years. Miconazole buccal tablets have recently been approved by the US Food and Drug Administration for the treatment of oropharyngeal candidiasis. Clinical trials have demonstrated noninferiority in the treatment of oropharyngeal candidiasis when compared with clotrimazole troches in patients with HIV and against miconazole gel in patients with head and neck cancer. Miconazole buccal tablets exhibit few drug interactions because of low systemic absorption and are generally well tolerated with a safety profile similar to comparators. The once-daily dosing schedule may improve patient adherence compared with topical alternatives; however, the cost of therapy may be a barrier for some patients and should be considered by prescribers compared with alternative treatments.Keywords: esophageal candidiasis, miconazole, antifungal agents
The Cand-Tec Candida detection system and enzyme immunoassay for serum mannan were retrospectively compared in a controlled collaborative evaluation of antigen detection in 32 patients with candidiasis proven by biopsy or culture from a normally sterile site and with sera drawn within 7 days of inclusion. With a threshold titer of 1/8, which excluded false-positive results in 17 hospitalized patients without candidiasis, sensitivities for all 32 patients with candidiasis were 44% for the Cand...
Three proposed quantitative markers for candidiasis, arabinitol, mannose, and mannan in serum, are compared in 50 normal blood donors and 38 high-risk patients, 23 with and 15 without invasive candidiasis. Arabinitol concentrations in serum, the arabinitol/creatinine ratio, and mannose concentrations in serum were significantly greater in the 15 patients without candidiasis than in the normal blood donors (P less than 0.05). The sensitivities and specificities were 26 and 87% for arabinitol, ...
Repentigny, L.; Marr, L. D.; Keller, J. W.; Carter, A. W.; Kuykendall, R. J.; Kaufman, L.; Reiss, E.
Vaginal candidiasis (VC) continues to be a health problem to women worldwide. Although the majority of VC cases are caused by Candida albicans (C. albicans), non-albicans Candida spp. like C. glabrata and C. tropicalis are emerging as important and potentially resistant opportunistic agents of VC. The objective of this study was to evaluate the prevalence and epidemiology of VC in the UAE through retrospective analysis of pertinent data compiled by the microbiology and infection control unit at Latifa Hospital, Dubai between 2005 and 2011. The incidence of VC significantly increased from 10.76% in 2005 to 17.61% in 2011; average prevalence was 13.88%. C. albicans occurred at a frequency of 83.02%, C. glabrata at 16.5% and C. tropicalis at 1.2%. A single C. dubliniensis isolate was identified in the sample population. The percentage of C. albicans significantly decreased from 83.02% in the sample population as a whole to 60.8% in subjects over 45 years of age (P < 0.01) and that of C. glabrata, C. tropicalis and C. krusei significantly increased from 13.88%, 0.9% and 0.03% to 29.7%, 6.7% and 1.4% (P < 0.05) respectively. The incidence of VC in the UAE is on the rise and the frequency of non-albicans Candida spp. is noticeably increasing especially in postmenopausal women. PMID:24102778
Hamad, Mawieh; Kazandji, Norair; Awadallah, Samir; Allam, Hilda
Full Text Available A total of 150 patients with cutaneous candidiasis were studied. A detailed clinical history was taken. Scrapings were examined in 10% KOH, and the material cultured on Sabouraud?s agar. Species were identified by the serum germ tube test, sugar fermentation and sugar assimilation tests. Of 150 patients 79 were females. The commonest presentation was intertrigo (75, vulvovaginitis (19 and paronychia (17. A history of chronic exposure to water was obtained in 94 cases, all had erosio interdigitalis blastomycetica and/or paronychia. Diabetes melltius as a predisposing factor was observed in 22 patients. The 10 cases of balanoposthitis had associated diabetes mellitus. Smear and culture were positive in all the patients. C. albicans was isolated in 136 cases, C. tropicalis in 12, and C. guillermondi in 2. The cultures of C. albicans had positive serum germ tube test. The 6 patients in the paediatric age group having perianal/genital involvement had a stools culture positive for C. albicans.
Full Text Available Abstract Working by a distinct cell wall-specific mechanism of action, the echinocandin class of antifungals has substantially expanded the range of available treatments for invasive Candida infections. Anidulafungin, caspofungin and micafungin were investigated versus drugs from earlier antifungal classes in large clinical trials that demonstrated their excellent clinical and microbiological efficacy in the primary treatment of invasive candidiasis. Therefore, and supported by a number of favourable pharmacological characteristics, the echinocandins rapidly became established in guidelines and clinical practice as primary treatment options for moderately to severely ill patients with invasive candidiasis. This article reviews the relevant clinical evidence that forms the basis for the use of echinocandins in the management of invasive candidiasis, and discusses their current role in the context of recent guideline recommendations and treatment optimization strategies.
Focal hepatosplenic candidiasis has been recognized with increasing frequency in recent years. We reviewed the cases of eight patients seen between 1982 and 1985, and information on 60 patients whose cases have been reported in the world literature. The characteristics of focal hepatosplenic candidiasis include persistent fever in a neutropenic patient whose leukocyte count is returning to normal, often coupled with abdominal pain; an elevated alkaline phosphatase level; and less commonly, rebound leukocytosis. The characteristic "bull's eye" lesions seen with hepatic ultrasound examination or computed tomography generally are not detectable until neutrophil recovery has occurred. Diagnosis can be established only by biopsy evidence of yeasts or pseudohyphae in the granulomatous lesions. Cultures are frequently negative, however, especially in patients who have been pretreated with antifungal agents. We review the evolving nature of hepatosplenic candidiasis, focusing on diagnosis and treatment. PMID:3276268
Thaler, M; Pastakia, B; Shawker, T H; O'Leary, T; Pizzo, P A
Full Text Available SUMMARY. The rare case is presented of a patient who developed multiple abscesses from Candida albicans after transurethral resection of the prostate gland for benign prostatic hyperplasia. The abscesses developed in the urogenital system, the anorectal region and the lungs, and also subcutaneously. They were treated both surgically and with medication. Solitary abscess as a manifestation of candidiasis is well documented, but to the best of the authors’ knowledge this is the first report of multiple, synchronous abscesses in different systems in a patient with systemic candidiasis. Pneumon 2009, 22(4:331-336.
The significance of Candida mannoprotein serum detection in 15 patients with haematological malignancies and proven (six cases) or probable (nine cases) hepatosplenic candidiasis was retrospectively evaluated. Circulating mannoprotein antigen was detected in three of six and in one of two serum samples from two patients with probable infection. The antigen was not detected in 38 serum samples of 13 (87%) patients. Thus, in contrast to other deep-seated Candida infections, mannoprotein is infrequently detectable during focal hepatosplenic candidiasis and does not appear to be of diagnostic value. PMID:14729929
Girmenia, Corrado; Martino, Pietro; De Bernardis, Flavia; Boccanera, Maria; Cassone, Antonio
Aspergillosis, candidiasis, and zygomycosis were diagnosed in tissues from three lovebirds (Agapornis roseicollis) using indirect enzyme-immunohistochemical techniques. In these techniques, the first antibody was raised against fungal antigen. A second antibody, which was raised in another animal species, was added to link the first antibody to enzyme-immunocomplexes. The reactivity of specific monoclonal and polyclonal antibodies was visualized by immunoreactivity of alkaline phosphatase anti-alkaline phosphatase and peroxidase anti-peroxidase immunocomplexes. All three birds examined had dermal candidiasis. In addition, one of the birds was diagnosed with concomitant acute ocular aspergillosis, and another bird was diagnosed with chronic zygomycotic myocarditis. PMID:8257396
Carrasco, L; Bautista, M J; de las Mulas, J M; Jensen, H E
Abstract Working by a distinct cell wall-specific mechanism of action, the echinocandin class of antifungals has substantially expanded the range of available treatments for invasive Candida infections. Anidulafungin, caspofungin and micafungin were investigated versus drugs from earlier antifungal classes in large clinical trials that demonstrated their excellent clinical and microbiological efficacy in the primary treatment of invasive candidiasis. Therefore, and supporte...
PCR fingerprinting was used to type 177 yeast isolates obtained from two medical institutions. Candida albicans was the predominant species found, followed by C. tropicalis, C. glabrata, C. parapsilosis, C. guilliermondii, and C. krusei, which accounted for over 20% of the strains isolated. This survey represents the first study of molecular epidemiology of candidiasis in Portugal.
Correia, Alexandra; Sampaio, Paula; Pais, Judite Almeida And Ce?lia
Full Text Available SciELO Venezuela | Language: Spanish Abstract in spanish Resumen La Candidiasis bucal, causada principalmente por Candida albicans, es de gran importancia estomatológica, por su frecuencia y variedad clínica. Estas infecciones se observan frecuentemente en personas con distintos tipos de factores predisponentes. Las formas clínicas de Candidiasis bucal es [...] variable y se han usado diferentes clasificaciones. Se presenta un caso clínico de paciente femenina, con lesión eritematosa en el dorso de la lengua y paladar, la cual refería dolor y ardor bucal. Se le realizó toma de muestra de las lesiones para ser cultivadas y posteriormente se identificó la presencia de C. albicans, lo que confirmó el diagnóstico clínico de Candidiasis Eritematosa. Se le realizó terapia antimicótica (Nistatina), el control a las dos semanas reveló mejoría de la lesión y luego a las cuatro semanas se pudo evidenciar total remisión de la lesión así como de la sintomatología. Abstract in english Abstract Oral Candidosis, caused maily by Candida albicans,has an important stomatological repercussion, because of his frequency and clinical variety. These infections are frequently observed in persons with different types of predisposing factors. The clinical characteristics of oral candidosis is [...] variabke, and different classifications have been used.this is a case report,female of sexty-five yeasr old with red lesion on the dorsal tongue and hard palate, patient may complain of a burning sensation. Epithelial smears and imprint cultures were obtained and subjeted to species identificacion of Candida albicans, diagnostic Erythematous Candidiasis were confirmed.
L J, Lazarde; B I, Avilán.
We studied the incidence among, risk factors for, and survival of adult patients with acute leukemia and hepatosplenic candidiasis during the period 1980 to 1993. Of 562 adult patients with acute leukemia, 38 (6.8%) had hepatosplenic candidiasis. The incidence of infection increased fivefold during the study period. The incidence was higher among patients with acute lymphatic leukemia (11.3%) than among those with acute myeloid leukemia (5.1%) (P = .01). The median survival was 9.5 months, and by the end of follow-up, 74% of patients had died. Patients whose leukemia was in remission before the last cytotoxic treatment preceding hepatosplenic candidiasis survived longer than did patients with newly diagnosed or refractory or relapsed leukemia (P = .0065). Eleven patients died within 3 months after the diagnosis of the infection: 7 of 16 with newly diagnosed leukemia, 4 of 10 with refractory or relapsed leukemia, and 0 of 12 with leukemia in remission (P = .028). In all of the patients who died within 3 months, infection was found at autopsy. In conclusion, the incidence of hepatosplenic candidiasis has significantly increased since 1980, and the outcome for patients with this infection is related to the stage of leukemia. PMID:9114188
Anttila, V J; Elonen, E; Nordling, S; Sivonen, A; Ruutu, T; Ruutu, P
First described in HIV-infected patients who recently initiated highly active antiretroviral therapy, the immune reconstitution inflammatory syndrome (IRIS) is best characterized as a collection of inflammatory disorders triggered by rapid resolution of immunosuppression. Treatment of IRIS is a clinical challenge due to the variety of clinical presentations and the presence of multiple pathogens capable of causing the syndrome. Hepatosplenic candidiasis, an uncommon form of invasive Candida species infection, was recently suggested to belong to the spectrum of fungus-related IRIS. We report 2 cases of probable hepatosplenic candidiasis according to the guidelines of the European Organization for Research and Treatment of Cancer and the Mycosis Study Group, occurring in pediatric patients with acute leukemia during rapid neutrophil recovery after cytotoxic chemotherapy. In both cases, abdominal computed tomography scan revealed multiple hepatic micronodules, and liver biopsy showed nonspecific granulomatous lesions. Hepatosplenic candidiasis symptoms (fever, nausea and vomiting, abdominal pain) resolved within 2 days after adjunction of corticosteroid therapy to antifungal treatment. Inflammatory markers and related radiologic abnormalities decreased or disappeared within 1 month. Recovery of neutrophil count in a context of hepatosplenic candidiasis may result in a heightened inflammatory response. Corticosteroid therapy in this setting is associated with prompt resolution of the symptoms. PMID:19770685
Saint-Faust, Marie; Boyer, Corinne; Gari-Toussaint, Martine; Deville, Anne; Poiree, Maryline; Weintraub, Mickael; Sirvent, Nicolas
Full Text Available Systemic candidiasis caused by Candida tropicalis is potentially fatal in human but studies relating the histological characteristics with C. tropicalis induced acute systemic candidiasis are few in number. Hence, this study was undertaken to establish and to characterize the distinctive histopathological features of acute systemic candidiasis by varying the inoculum size of C. tropicalis injected in mice. Thirty BALB/c mice were divided into three groups and were injected with either 1x105 or 1x107 C. tropicalis cells. On observation, the histopathological findings and the fungal burden load following intravenous injection were similar to the previously reported mouse model for Candida albicans. Viable yeast cells in the kidneys reached approximately 22.5 log10 cfu g-1 at day 7 post-infection. Compared with the control group, the infected mice group developed acute pyelonephritis characterized by infiltration of large masses of neutrophils within the infected nephrons. Similarly, foci of acute renal inflammation within the kidney were more pronounced when the C. tropicalis inoculum was increased. Interestingly, we also observed infection of mice with a higher inoculum of C. tropicalis resulted in more severe invasiveness. In conclusion, these results suggest that the BALB/c mouse is highly susceptible to C. tropicalis dissemination and represents a significant model system of acute systemic candidiasis.
Shiran Mohd Sidik
Oropharyngeal candidiasis (OPC) is the most common oral infection in HIV+ persons. Previous studies suggest a role for CD8+ T-cells against OPC when CD4+ T-cells are lost, but enhanced susceptibility to infection occurs when CD8+ T-cell migration is inhibited by reduced tissue E-cadherin.
Quimby, K.; Lilly, E. A.; Zacharek, M.; Mcnulty, K.; Leigh, J. E.; Vazquez, J. E.; Fidel, P. L.
Refractory or recurrent infections of skin, nails, and the mucous membranes are clinical signs of chronic mucocutaneous candidiasis, frequently associated with immunological defects. Here we describe a 39-years-old female patient, with familial CMC, that presented with an extensive infection caused by an azole-resistant Candida albicans isolate, successfully treated with posaconazole.
Davide Firinu; Orietta Massidda; Maria Maddalena Lorrai; Loredana Serusi; Monica Peralta; Maria Pina Barca; Paolo Serra; Paolo Emilio Manconi
Refractory or recurrent infections of skin, nails, and the mucous membranes are clinical signs of chronic mucocutaneous candidiasis, frequently associated with immunological defects. Here we describe a 39-years-old female patient, with familial CMC, that presented with an extensive infection caused by an azole-resistant Candida albicans isolate, successfully treated with posaconazole. PMID:21197459
Firinu, Davide; Massidda, Orietta; Lorrai, Maria Maddalena; Serusi, Loredana; Peralta, Monica; Barca, Maria Pina; Serra, Paolo; Manconi, Paolo Emilio
Fifty consecutive patients with respiratory diseases who developed oropharyngeal candidiasis were assessed clinically and microbiologically before and after seven days' treatment with nystatin suspension or pastilles (a new formulation). In 45 patients in whom microbiology yielded positive results there was frequent associated use of oral corticosteroids, antibiotics, sedatives, and inhaled corticosteroid, while in a few patients atropine analogues may have predisposed to infection. Dentures ...
Thompson, P. J.; Wingfield, H. J.; Cosgrove, R. F.; Hughes, B. O.; Turner-warwick, M. E.
Caspofungin is a potent antifungal inhibiting glucan synthesis in Candida species. However, caspofungin is not 100% curative in candidiasis. Therefore, we evaluated combinations of fluconazole with caspofungin for murine candidemia. We could not show any benefit of combined therapy over individual antifungal drugs.
Graybill, John R.; Bocanegra, Rosie; Najvar, Laura K.; Hernandez, Steve; Larsen, Robert A.
Full Text Available Denture stomatotos os a common problem of the denture wears, and its etiology is not clear from the literatures. Some studies show that the aetiology is candida albicans, while other reports point out the other agents including candida albicans. The present study was designed to evaluate the prevalence of oral candidiasis in patients using complete denture with different datas. 50 subjects all wearing complete denture participated in this study. The palatal mucosa was swabbed and swabs were cultured in Sabourauds medium containing 0.005% chloramphenicol then cultures were tested with common mycological lab tests. In 80% of patients oral candidiasis have been diagnosed. In the investigation a direct relation between the oral candidiasis and removal of denture at night, denture cleanliness, presence of any suction and symptoms of denture stomatitis was shown. No relation between the oral candidiasis and sex, smoking habit, succeptible disease, angular cheilitis; the recent condition of denture and the retention of denture were found. The findings of our investigation indicates that candida albicans is the causative agent of denture stomatitis while other factors such as denture cleanliness, removal of denture at night and presence of any suction may be considered as well.
Nine immunocompromised cancer patients with tissue-proved candidiasis underwent a total of eight serial abdominal US studies and 53 CT examinations. Four US patterns of hepatic and splenic candidiasis were recognized. Type 1 was a ''wheel within a wheel'', or a central hypoechoic nidus surrounded by a dense band, in turn surronded by a rim of hypoechoic tissue. Type 2 was the classic ''bull's eye'' lesion. Type 3, the most common, was a uniformly hypoechoic lesion, 1-4 cm in diameter. Type 4 was a small, dense, echogenic focus with no surrounding lucency and varying amounts of posterior shadowing. Types 1,2 and 3 were seen early in infection; types 3 and 4 were present later. Lesion types 2,3 and 4 were also identified on CT scans. In addition, periportal linear areas of increased attenuation, possibly calcified, were identified on follow-up, non-contrast-enhanced CT. Some abscesses were better seen on non-contrast-enhanced CT scans, while others became visible only after iodinated contrast medium was administered intravenously. Although lesions not seen on US were often seen on CT, the opposite was also true. In two cases pathologic proof of candidiasis was established even when all imaging studies were negative. Patients should be studied by US and by CT before and after contrast agent administration for maximum sensitivity. Even when both US and CT are negative, if there is a strong clinical suspicion of candidiasis, open biopsy is recommended
Full Text Available SciELO Spain | Language: English Abstract in english Oral candidiasis represents a serious problem for children with cancer. The mortality rate of this infection has increased due to fungal septicemia, associated with a primary buccal infection. Objective: Identify the Candida spp. in buccal lesions of patients with cancer, establish the predominant s [...] pecies and correlate them to age and sex of the patient, clinical presentation, type of neoplasic disease and cytostatic therapy received. Study design: 62 patients, between 0-16 years, were investigated in a cross sectional study. Sample inclusion criteria: Patients with malignant neoplasic disease that were receiving cytostatic treatment and had suspicious lesions of oral candidiasis. Patients with antifungal therapy, active caries, calculus or intraoral appliances were excluded. A clinical evaluation was carried out. The lesion sample was taken and studied by direct exam and culture in CHROMagar-Candida and Sabouraud-Dextrose Agar with chloramphenicol. The identification of the isolated yeast was done by the filamentation test, carbohydrate fermentation and assimilation. Results: Most of the cases (69.35%) were positive to oral candidiasis, C. albicans was the most frequent species found, followed by C. parapsilosis (14.89%), C. tropicalis (12.77%), C. krusei (4.26%), C. glabrata (2.13%) and C. lusitaniae (2.13 %). In some cases more than one specie were isolated (9.30%). The most frequent location of the lesion was in the tongue (72.70%). The pseudomembranous candidiasis was the most frequent clinical presentation found (78.71%). There were not significant statistically differences with regard to sex and age of the patient, type of neoplasic disease and cytostatic agent received. Conclusion: The results suggest that oral candidiasis is a frequent complication in the pediatric oncological population, being C. albicans the main etiological agent, however, there is an important participation of other Candida species.
Haylen, González Gravina; Evelyn, González de Morán; Olga, Zambrano; María, Lozano Chourio; Sofía, Rodríguez de Valero; Sandra, Robertis; Luz, Mesa.
A retrospective study of hepatosplenic candidiasis in patients with acute leukemia from a single centre was performed. The significance of age, sex, type of leukemia, dose of cytosine arabinoside (Ara-C), duration of neutropenia, steroid use and period of therapeutic antibiotics in the development of hepatosplenic candidiasis was analyzed, using logistic regression analysis. Nine of 51 patients had hepatosplenic candidiasis. Ara-C use was highly associated with the development of hepatosplenic candidiasis (p = 0.001); with a high association with a higher dose (p < 0.0001). On the basis of these results consideration should be given to further trial of antifungal prophylaxis for patients receiving high dose Ara-C. PMID:9477128
Woolley, I; Curtis, D; Szer, J; Fairley, C; Vujovic, O; Ugoni, A; Spelman, D
The etiology of recurrent vulvovaginal candidiasis in otherwise healthy women of child-bearing age remains an enigma. To date, results from both clinical studies and a murine model of vaginal candidiasis indicate that Candida vaginitis can occur in the presence of Candida-specific Th1-type cell-mediated immunity expressed in the peripheral circulation. The present study was designed to determine the role of circulating CD4 and CD8 cells in primary and secondary vaginal infections with Candida...
Fidel, P. L.; Lynch, M. E.; Sobel, J. D.
The therapeutic efficacy of intermittent, monthly, postmenstrual prophylaxis with a single 500 mg clotrimazole vaginal tablet (n = 33) was compared with placebo tablets (n = 29) in 62 woman (age 28.1, SD 7.2 years) with recurrent vulvovaginal candidiasis. The number of episodes of acute vulvovaginal candidiasis experienced during the year prior to inclusion was 6.3, SD 1.9. The cumulative recurrence frequency after 6 months intermittent prophylaxis with clotrimazole (30.3%) was lower (p less ...
Roth, A. C.; Milsom, I.; Forssman, L.; Wa?hle?n, P.
OBJECTIVE--To evaluate whether quantitative or qualitative IgA deficiencies in cervicovaginal secretions can be identified in patients with recurrent vulvovaginal candidiasis. DESIGN--Prospective and controlled study. SETTING--Department of Dermatology, University of Vienna. SUBJECTS--30 patients with symptomatic and recurrent vulvovaginal candidiasis at the time of their presentation. 30 healthy women as a control group. INTERVENTION--Blood samples were drawn for measurement of serum IgA lev...
We previously reported that Candida albicans cell surface protein Hyr1 encodes a phagocyte killing resistance factor and active vaccination with a recombinant N-terminus of Hyr1 protein (rHyr1p-N), significantly protects immunocompetent mice from disseminated candidiasis. Here we report the marked efficacy of rHyr1p-N vaccine on improving the survival and reducing the fungal burden of disseminated candidiasis in both immunocompetent and immunocompromised mice using the FDA-approved adjuvant, ...
Luo, Guanpingsheng; Ibrahim, Ashraf S.; French, Samuel W.; Edwards, John E.; Fu, Yue
Background: Autoimmune polyendocrinopathy-candidiasis-ectodermal-dystrophy (APECED), also known as autoimmune polyendocrine syndrome type 1 (APS-1) (OMIM 240300), is a very rare disease. Accepted criteria for diagnosis require the presence of at least 2 of 3 major clinical features: chronic mucocutaneous candidiasis (CMC), chronic hypoparathyroidism (CH), and Addison's disease (AD). Aim: We analyzed AIRE gene mutations and genotype-phenotype correlation in APECED patients originating fro...
Full Text Available "nThe increasing incidence of systemic candidiasis, which parallels the use of invasive and immunosuppressive medical procedures, necessitates development of rapid and cost effective tests for diagnosis of systemic candidiasis. Therefore in this study 85 mice were first immunosuppressed by cyclophosphamide and then infected by Candida albicans NCPF 3153. Other 85 mice were employed as control. The case and control mice were bled and then autopsied. Hearts and kidneys were checked by direct, histopathological and cultural examination for systemic candidiasis. The 85 sera from histological proven cases and 85 control mice were adsorbed with heat killed blastospores of same strain of C. albicans. Anti-Candida albicans germ tube antibodies were detected by indirect immunofluorescence assay for diagnosis of invasive candidiasis in case and control mice. In addition, sera from 35 mice with proven cryptococcosis were also tested. While 84 mice with proven systemic candidiasis (100% had anti-germ tube antibodies, these antibodies were absent in all controls and mice with cryptococcosis. The specificity was 100%, indicating a high degree of discrimination was possible between systemic candidiasis and cryptococcosis in the mice studied. It must be concluded that anti-germ tube responses did not appear to be significantly reduced in immunocompromised mice.
Oral candidiasis as a clinical marker of highly active antiretroviral treatment failure in HIV-infected patients / La candidiasis bucal como marcador clínico de falla a la terapia antirretroviral altamente efectiva en pacientes infectados con VIH/sida
Full Text Available SciELO Colombia | Language: English Abstract in spanish Introducción: La candidiasis bucal es una infección oportunista fácilmente detectable en la clínica, por lo que se ha utilizado para valorar tanto el estado inmunológico de los pacientes con VIH como la efectividad de la terapia antirretroviral, altamente efectiva debido a que se encuentra sujeta a [...] diversos factores para lograr el éxito terapéutico. Objetivo: Determinar la frecuencia de candidiasis bucal entre indicadores asociados al éxito de la terapia antirretroviral. Material y método: Estudio transversal, analítico en donde inicialmente se realizaron grupos de acuerdo al uso o no de la terapia antirretroviral para proseguir con un interrogatorio que incluía preguntas sobre otros factores relacionados con la infección por cándida, así como la medición del flujo salival y la evaluación clínica de la cavidad bucal para determinar la frecuencia de la candidiasis. Resultados: La diferencia en la frecuencia de la candidiasis bucal entre los grupos con y sin terapia antirretroviral fue significativa, además de obtener una OR = 2,6 (1,58-4,48) y la asociación con la disminución en el conteo de linfocitos de CD4. Discusión: La resistencia a la terapia antirretroviral constituye uno de los problemas fundamentales en el éxito del tratamiento, en los pacientes infectados con virus de la inmunodeficiencia humana, al igual que las toxicidades y los problemas de adherencia. Los sensores clínicos como la candidiasis bucal son parámetros de fácil acceso para la detección temprana de falla en la terapia. Abstract in english Introduction: Oral candidiasis is an opportunistic infection that is readily detectable in the clinic. It has been used to assess the immune status of HIV patients as well as the effectiveness of highly active antiretroviral therapy. Objective: To determine the frequency of oral candidiasis infectio [...] n among various indicators associated with antiretroviral therapy effectiveness. Material and methods: Cross-sectional and analytical study, in which groups were initially created based on the use or not of antiretroviral therapy. Participants were subjected to questions on factors related to Candida infection, salivary flow measurements and a clinical examination of the oral cavity to determine the frequency of candidiasis Results: The difference in the frequency of oral candidiasis between groups with and without antiretroviral therapy was significant (OR 2.6 IC95% 1.5-4.4). There were also a significant association with decreased number of CD4 lymphocytes.. Discussion: Resistance to anti-retroviral therapy constitutes one of the fundamental barriers to a successful treatment in patients infected with the human immunodeficiency virus, as do toxicities and adherence problems. Clinical markers such oral candidiasis is an easily and accesible parameter for the early detection of treatment failure.
Sandra, Lopez-Verdin; Amalia, Torrecilla-Ramirez; Ana Cristina, Horta-Sandoval; Jaime Federico, Andrade-Villanueva; Ronell, Bologna-Molina.
Full Text Available SciELO Brazil | Language: English Abstract in english Chronic mucocutaneous candidiasis is a rare disorder characterized by persistent and recurrent infections by Candida due to changes in cellular immunity and may be associated with autoimmune endocrine disorders. It is refractory to the usual antifungal treatments, which merely control it with imidaz [...] ole derivatives. This reports the case of a 50-year-old female patient who referred vaginal discharge associated with vulvar ulcerated lesions and whitish plaques on oral and genital mucous membranes of onset in adolescence besides cutaneous horns in nipples. The clinical picture, family history, culture and anatomopathological studies were consistent with chronic infection by candida. Treatment with systemic antifungals obtained partial response of lesions characterizing a clinical picture of Chronic Mucocutaneous Candidiasis.
Antônio, Chambô Filho; João Basilio de, Souza Filho; Christine Chambô, Pignaton; Ingrid, Zon; Alan Santos, Fernandes; Lia Quintaes, Cardoso.
Two cases of hepatosplenic candidiasis (HSC) are reported occurring after protracted episodes of neutropenia, induced by chemotherapy for acute leukemia in one case and drug hypersensitivity in the other. The disease presented with persistent or recurrent fever after correction of the neutropenia and with splenomegaly. The alkaline phosphatases were elevated. The diagnosis was strongly suggested by abdominal ultrasonography, CT scan and MRI, which showed multiple hepatosplenic defects. It was confirmed by serologic tests for candidiasis, the presence, in 1 case, of circulating candida antigens, and the rapid response to amphotericin B. The diagnosis of HSC should be considered in patients with persistent fever after an episode of neutropenia. Ideally, histologic confirmation is desirable, but this is often obtainable only by open liver biopsy, an aggressive procedure in such patients. Failing this, our 2 cases stress the diagnostic value of noninvasive imaging techniques, serological testing (in particular the discovery of circulating candida antigens) and the response to amphotericin B. PMID:2644620
Fenaux, P; Lemaitre, L; Ajana, F; Colcher-Plantier, I; Jouet, J P; Bauters, F
Three children with acute leukemia presented with prolonged fever and neutropenia after cytostatic therapy, which was followed by abdominal pain, hepatomegaly, and hepatic dysfunction with raised serum alkaline phosphatase. Abdominal CT scan and ultrasound demonstrated multiple small lesions compatible with the hepatosplenic candidiasis syndrome. Liver biopsies showed microabscesses with a granulomatous appearance, but evidence of yeasts and pseudohyphae was present in 1 case only. Cultures were negative. Treatment with amphotericin B and 5-fluorocytosine was successful in two children. At autopsy, one child had signs of active infection. We reviewed the literature on 27 children with hepatosplenic candidiasis. Abdominal symptomatology and prolonged fever, despite antibiotic therapy, in a patient with previous or present neutropenia after cytotoxic exposure, should lead to a careful evaluation, including noninvasive imaging studies, open liver biopsy, and prompt aggressive antifungal treatment, the response to which requires close follow-up. PMID:2204407
Carstensen, H; Widding, E; Storm, K; Ostergaard, E; Herlin, T
Sertaconazole is a useful antifungal agent against mycoses of the skin and mucosa, such as cutaneous, genital and oral candidiasis and tinea pedis. Its antifungal activity is due to inhibition of the ergosterol biosynthesis and disruption of the cell wall. At higher concentrations, sertaconazole is able to bind to nonsterol lipids of the fungal cell wall, increasing the permeability and the subsequent death of fungal cells. Fungistatic and fungicidal activities on Candida are dose-dependent. The antifungal spectrum of sertaconazole includes deramophytes, Candida, Cryptococcus, Malassezia and also Aspergillus, Scedosporium and Scopulariopsis. Sertaconazole also shows an antimicrobial activity against streptococci, staphylococci and protozoa (Trichomonas). In clinical trials including patients with vulvovaginal candidiasis, a single dose of sertaconazole produced a higher cure rate compared with other topical azoles such as econazole and clotrimazole, in shorter periods. Sertaconazole has shown an anti-inflammatory effect that is very useful for the relief of unpleasant symptoms. PMID:23566144
Carrillo-Muñoz, Alfonso Javier; Tur-Tur, Cristina; Giusiano, Gustavo; Marcos-Arias, Cristina; Eraso, Elena; Jauregizar, Nerea; Quindós, Guillermo
Full Text Available Film dosage forms (FDs containing miconazole (MCZ for the treatment of oral candidiasis were prepared using water-soluble polysaccharides, and the dissolution profiles of MCZ from the FDs were investigated. In addition, the forms were modified by the addition of a surface active agent to accelerate the drug dissolution rate. Circular films incorporating MCZ were obtained using each polysaccharide. Most FDs were easy to handle and resistant to tearing. No diffraction peaks were observed in the X-ray diffractograms of FDs. FDs prepared with sodium alginate or pullulan immediately swelled and disintegrated in aqueous medium, whereas MCZ incorporated in the FD gradually dissolved. A marked acceleration in the MCZ dissolution rate was observed when FD was prepared with polysaccharide containing a surfactant. These results confirmed that modified FDs are useful for treating localized conditions in the oral cavity, such as oral candidiasis, and that FDs can simplify the administration of drugs to patients.
Autoimmune polyglandular syndromes are rare autoimmune endocrinopathies that are associated with nonendocrine autoimmunopathies. Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED), also named autoimmune polyglandular syndrome type 1 (APS-1), is distinguished from autoimmune polyglandular syndrome 2 (APS-2). Major disease components of APECED are adrenal insufficiency, hypoparathyroidism, and candidiasis. The diagnosis is established by the presence of two out of the three components. Minor clinical features include autoimmune hepatitis, which occurs in up to 20% of APECED patients, and ranges from a mild to a fulminant course. The disease mostly affects juvenile patients from Sardegna, Italy, Finland, and Iran (Iranian Jews), but it also occurs in other ethnic groups. The AIRE gene responsible for APECED is expressed in cells involved in induction and maintenance of immune tolerance. Genetic alterations of the single gene are associated with APECED. Because a specific therapy is not currently available, treatment consists of hormone replacement and caring for clinical symptoms. PMID:19676003
Lankisch, Tim O; Jaeckel, Elmar; Strassburg, Christian P
Much has been learnt about the mechanisms of thymic self-tolerance induction from work on both the rare autosomal recessive disease autoimmune polyendocrinopathy candidiasis ectodermal dystrophy (APECED) and the autoimmune regulator (AIRE) protein mutated in this disease. Normally, AIRE drives low-level expression of huge numbers of peripheral tissue-specific antigens (TSAgs) in medullary thymic epithelial cells (mTECs), leading to the deletion of TSAg-reactive thymocytes maturing nearby. The very recently discovered neutralizing autoantibodies (autoAbs) against Th17-related cells and cytokines in two autoimmunity-related syndromes associated with AIRE-mutant thymi or AIRE-deficient thymomas help to explain the chronic mucocutaneous candidiasis (CMC) seen in both syndromes. The surprising parallels between these syndromes also demand new hypotheses and research into the consequences of AIRE deficiency and the ensuing autoimmunizing pathways, and suggest more appropriate treatment regimens as discussed in this review. PMID:21574164
Kisand, Kai; Lilic, Desa; Casanova, Jean-Laurent; Peterson, Pärt; Meager, Anthony; Willcox, Nick
The therapeutic efficacy of CS-758, a novel triazole, was evaluated against experimental murine oropharyngeal candidiasis induced by Candida albicans with various susceptibilities to fluconazole. Against infections induced by strains with various susceptibilities to fluconazole, the efficacy of fluconazole was strongly correlated with the MIC of fluconazole, as measured by the NCCLS method, and agreed with the NCCLS interpretive breakpoints, suggesting that the efficacies of new drugs could b...
Kamai, Yasuki; Kubota, Mikie; Fukuoka, Takashi; Kamai, Yoko; Maeda, Naoyuki; Hosokawa, Tsunemichi; Shibayama, Takahiro; Uchida, Katsuhisa; Yamaguchi, Hideyo; Kuwahara, Shogo
A study was performed to assess the in vivo relevance of the in vitro antagonism between fluconazole and amphotericin B against Candida albicans. Combinations of fluconazole and amphotericin B were explored for their efficacies against acute (100% mortality in 2 to 5 days) or less acute (100% mortality in 30 days) invasive candidiasis infections in mice with healthy immune systems and immunocompromised mice. Treatment efficacy was assessed by protection from mortality and/or a reduction in th...
Sugar, A. M.; Hitchcock, C. A.; Troke, P. F.; Picard, M.
The first fully synthetic glycopeptide vaccines against a fungal disease have been used to combat disseminated candidiasis in mice. Six T cell peptides found in Candida albicans cell wall proteins were selected by algorithm peptide epitope searches; each was synthesized and conjugated to the fungal cell wall ?-mannan trisaccharide [?-(Man)3] by novel saccharide-peptide linker chemistry to create glycopeptide conjugates. The six proteins were selected because of expression during human candi...
Xin, Hong; Dziadek, Sebastian; Bundle, David R.; Cutler, Jim E.
It has been postulated that systemic cell-mediated immunity (CMI) is an important host defense factor against recurrent vaginal infections caused by Candida albicans. Using an estrogen-dependent murine model of vaginal candidiasis, we have previously shown that mice inoculated vaginally with C. albicans acquire a persistent vaginal infection and develop Candida-specific Th1-type systemic CMI. In the present study, experimental vaginitis was monitored in the presence of preinduced systemic Can...
Fidel, P. L.; Lynch, M. E.; Sobel, J. D.
The role of systemic cell-mediated immunity (CMI) as a host defense mechanism in the vagina is poorly understood. Using a murine pseudoestrus model of experimental vaginal candidiasis, we previously found that animals given a vaginal inoculum of viable Candida albicans blastoconidia acquired a persistent vaginal infection and developed Candida-specific delayed-type hypersensitivity (DTH) responses. The present study was designed to characterize the peripheral CMI reactivity generated from the...
Fidel, P. L.; Lynch, M. E.; Sobel, J. D.
Candida norvegensis is an emerging fluconazole-resistant pathogen isolated in most cases from skin and mucous membranes of immunocompromized patients. Documented invasive candidiasis (IC) due to C. norvegensis has been rarely reported, thus the clinical features of patients at risk for this pathogen are poorly defined. We report a liver transplant patient who developed IC due to C. norvegensis and review other cases of C. norvegensis IC published in the literature. PMID:25002960
Musso, Maria; Giannella, Maddalena; Antonini, Mario; Bordi, Eugenio; Ettorre, Giuseppe Maria; Tessitore, Loretta; Mariano, Andrea; Capone, Alessandro
DNA fingerprinting was assessed as an improved typing system for Candida albicans aimed at speeding the implementation of cross infection control measures in outbreaks of systemic candidiasis. The study was carried out with 45 previously characterised isolates from five different outbreaks and with 96 unrelated isolates from a mixed control population. Sixteen different genotypes were produced. Results were obtainable within days, reproducibility was high, and there was good discrimination am...
Matthews, R.; Burnie, J.
Itraconazole is a new orally active triazole antifungal agent with enhanced activity against Candida species. In the clinical trial described in this paper, we compared the efficacy and safety of itraconazole capsules with those of clotrimazole vaginal tablets and placebo oral capsules for women with acute vulvovaginal candidiasis. Ninety-five patients were randomized in a 2:1:1 fashion to receive itraconazole (200 mg/day), clotrimazole (200 mg/day), or placebo (two capsules per day) for 3 co...
Stein, G. E.; Mummaw, N.
A total of 80 patients were equally randomized to receive a single dose of 6.5% tioconazole ointment or a 3-day course of 100-mg clotrimazole vaginal tablets for the treatment of vulvovaginal candidiasis. Of the 32 evaluable patients treated with tioconazole, 27 (84%) remained asymptomatic 4 weeks posttreatment, compared with 28 of 33 patients (85%) treated with clotrimazole. A total of 34 patients in each group could be evaluated for mycological response based on culture results 1 and 4 week...
Stein, G. E.; Gurwith, D.; Mummaw, N.; Gurwith, M.
Invasive candidiasis (IC) is a significant cause of morbidity and mortality. Diagnosis relies on culture-based methods, which lack sensitivity and delay diagnosis. We conducted a systematic review assessing the diagnostic accuracy of PCR-based methods to detect Candida spp. directly in blood samples. We searched electronic databases for prospective or retrospective cohort and case-control studies. Two reviewers abstracted data independently. Meta-analysis was performed using a hierarchical lo...
Avni, Tomer; Leibovici, Leonard; Paul, Mical
Two extremely preterm infants undergoing intensive care who developed systemic candidiasis are reported. Each was treated initially with intravenous miconazole. One child initially responded, but relapsed after the miconazole was stopped. The second child showed evidence of progression of the disease during treatment. Both infants responded to a combined course of amphotericin B and 5-fluorocytosine. We consider that miconazole is not the drug of first choice in the treatment of neonatal syst...
Mcdougall, P. N.; Fleming, P. J.; Speller, D. C. E.; Daish, P.; Speidel, B. D.
A passive hemagglutination inhibition assay was studied by using a hyperimmune serum from rabbits immunized with whole yeast cells (Candida albicans group A). This technique was effective at detecting small amounts of laboratory-prepared mannan or a whole-cell extract of C. albicans. Of 32 patients with documented disseminated candidiasis that were tested, 19 showed evidence of circulating antigen by passive hemagglutination inhibition. Three of these patients showed only partial, rather than...
Meunier-carpentier, F.; Armstrong, D.
Oral candidiasis is closely associated with changes in the oral fungal flora and is caused primarily by Candida albicans. Conventional methods of fungal culture are time-consuming and not always conclusive. However, molecular genetic analysis of internal transcribed spacer (ITS) regions of fungal rRNA is rapid, reproducible and simple to perform. In this study we examined the fungal flora in patients with oral candidiasis and investigated changes in the flora after antifungal treatment using length heterogeneity-polymerization chain reaction (LH-PCR) analysis of ITS regions. Fifty-two patients with pseudomembranous oral candidiasis (POC) and 30 healthy controls were included in the study. Fungal DNA from oral rinse was examined for fungal species diversity by LH-PCR. Fungal populations were quantified by real-time PCR and previously-unidentified signals were confirmed by nucleotide sequencing. Relationships between the oral fungal flora and treatment-resistant factors were also examined. POC patients showed significantly more fungal species and a greater density of fungi than control individuals. Sixteen fungi were newly identified. The fungal populations from both groups were composed predominantly of C. albicans, though the ratio of C. dubliniensis was significantly higher in POC patients than in controls. The diversity and density of fungi were significantly reduced after treatment. Furthermore, fungal diversity and the proportion of C. dubliniensis were positively correlated with treatment duration. These results suggest that C. dubliniensis and high fungal flora diversity might be involved in the pathogenesis of oral candidiasis. We therefore conclude that LH-PCR is a useful technique for diagnosing and assessing the severity of oral candidal infection.
Ieda, Shinsuke; Moriyama, Masafumi; Takashita, Toru; Maehara, Takashi; Imabayashi, Yumi; Shinozaki, Shoichi; Tanaka, Akihiko; Hayashida, Jun-Nosuke; Furukawa, Sachiko; Ohta, Miho; Yamashita, Yoshihisa; Nakamura, Seiji
Oral candidiasis represents a serious problem for children with cancer. The mortality rate of this infection has increased due to fungal septicemia, associated with a primary buccal infection. Objective: Identify the Candida spp. in buccal lesions of patients with cancer, establish the predominant species and correlate them to age and sex of the patient, clinical presentation, type of neoplasic disease and cytostatic therapy received. Study design: 62 patients, between 0-16 years, were invest...
Bee Venom (BV) is a natural substance, reported to booster the immune system. This study aimed at evaluating the effects of bee venom in stimulation of the immune system in mice infected with intracerebral Candidiasis probing for its possible use in treatment of this ailment. In vivo study included three groups of mice; bee venom-treated Candida infected group, untreated Candida-infected group and control group. Mice in the first two groups received intracerebral (...
Saleh, Nermine K. M.; Elsayed, Abeer A.
Film dosage forms (FDs) containing miconazole (MCZ) for the treatment of oral candidiasis were prepared using water-soluble polysaccharides, and the dissolution profiles of MCZ from the FDs were investigated. In addition, the forms were modified by the addition of a surface active agent to accelerate the drug dissolution rate. Circular films incorporating MCZ were obtained using each polysaccharide. Most FDs were easy to...
Abstract Background Vaginitis is a common complaint in primary care. In uncomplicated candidal vaginitis, there are no differences in effectiveness between oral or vaginal treatment. Some studies describe that the preferred treatment is the oral one, but a Cochrane's review points out inconsistencies associated with the report of the preferred way that limit the use of such data. Risk factors associated with recurrent vulvovaginal candidiasis still remain controversial. <...
Del-Cura González Isabel; García-de-Blas González Francisca; Cuesta Teresa; Fernández Jesús; Del-Alamo Rodríguez Justo M; Escriva Ferrairo Rosa A; del Canto De-Hoyos Alonso M; Arenas Laura; Barrientos Ricardo; Wiesmann Elisa; De-Alba Romero Cristina; Díaz Yolanda; Rodríguez-Moñino Ana; Teira Blanca; del Pozo Marta
Full Text Available SciELO Brazil | Language: English Abstract in english Carvacrol and eugenol, the main (phenolic) components of essential oils of some aromatic plants, were evaluated for their therapeutic efficacy in the treatment of experimental oral candidiasis induced by Candida albicans in immunosuppressed rats. This anticandidal activity was analyzed by microbiolo [...] gical and histopathological techniques, and it was compared with that of nystatin, which was used as a positive control. Microbiologically, carvacrol and eugenol significantly (p
N., Chami; F., Chami; S., Bennis; J., Trouillas; A., Remmal.
Carvacrol and eugenol, the main (phenolic) components of essential oils of some aromatic plants, were evaluated for their therapeutic efficacy in the treatment of experimental oral candidiasis induced by Candida albicans in immunosuppressed rats. This anticandidal activity was analyzed by microbiological and histopathological techniques, and it was compared with that of nystatin, which was used as a positive control. Microbiologically, carvacrol and eugenol significantly (p<0.05) reduced the ...
Chami, N.; Chami, F.; Bennis, S.; Trouillas, J.; Remmal, A.
To further elucidate the importance of T- and B-lymphocyte-mediated responses in host defense against systemic infection with Candida albicans, we studied this infection in a murine model of severe combined immunodeficiency (SCID). The course of inoculation candidiasis in these mice, which lack functional T and B lymphocytes, was compared with that in immunologically normal BALB/c mice. Mice were inoculated intravenously with 10(5) yeast cells. Quantitative cultures of liver, spleen, and kidn...
Mahanty, S.; Greenfield, R. A.; Joyce, W. A.; Kincade, P. W.
Systemic candidiasis is a rare but life threatening complication in immunosuppressed patients undergoing allogeneic SCT. Combination of new antifungal agents may improve outcome in this patient population. Here, triple anti-mycotic therapy is described in an relapsed ALL patient in urgent need of allogeneic bone marrow transplantation. The patient with T-cell acute lymphoblastic leukemia of thymic differentiation achieved remission after treatment according to the German ALL protocol 07/03. Two months after the consolidation therapy relapse occurred requiring high dose chemotherapy with allogeneic stem cell transplantation. One day after start of the conditioning regimen the patient showed skin manifestations typical for septic mycosis and blood cultures became positive for Candida krusei while on fluconazole prophylaxis. Because of the limited sensibility of fluconazole resistant candida species to liposomal amphotericin B and the high mortality rate in patients with systemic candidiasis, voriconazole was added immediately to liposomal amphotericin B. Since fever did not resolve and the conditioning therapy for allogeneic transplantation was not yet completed caspofungin was added. Skin manifestation responded to this triple anti-mycotic combination and peripheral blood stem cells from an unrelated donor were transplanted. With the triple antifungal therapy the patient finally became afebrile, skin manifestations showed complete resolution and blood cultures became negative. Three months after the onset of systemic candidiasis the patient was fully active with no signs of fungal infection and in haematological and molecular remission. Mycotic sepsis at the start of myeloablative conditioning therapy in heavily pretreated acute leukemia patients is usually considered as not allowing successful allogeneic transplantation. Thus this case demonstrates, that allogeneic stem cell transplantation is feasible in patients presenting with systemic candidiasis if combined antifungal therapy with liposomal amphotericin B, caspofungin and voriconazole is given. PMID:17933709
Gahn, B; Schub, N; Repp, R; Gramatzki, M
Previous in vivo studies have reported caspofungin dose escalation to be effective against Candida glabrata with reduced susceptibility. We hypothesized that higher doses of caspofungin would be effective against invasive candidiasis caused by the more virulent species Candida albicans, including isolates resistant to this echinocandin. Immunocompetent mice were inoculated with one of three C. albicans isolates, including one susceptible and two resistant isolates with different FKS1 hot spot...
Wiederhold, Nathan P.; Najvar, Laura K.; Bocanegra, Rosie A.; Kirkpatrick, William R.; Patterson, Thomas F.
The in vivo efficacy of the echinocandin antifungal caspofungin acetate (caspofungin; MK-0991) was evaluated in models of disseminated aspergillosis and candidiasis in mice with cyclophosphamide (CY)-induced immunosuppression. Caspofungin is a 1,3-?-d-glucan synthesis inhibitor efficacious against a number of clinically relevant fungi including Aspergillus and Candida species. Models of CY-induced transient or chronic leukopenia were used with once daily administration of therapy initiated 2...
Abruzzo, George K.; Gill, Charles J.; Flattery, Amy M.; Kong, Li; Leighton, Claire; Smith, Jeffrey G.; Pikounis, V. Bill; Bartizal, Ken; Rosen, Hugh
Psychological stress has been found to suppress cell-mediated immune responses that are important in limiting the proliferation of Candida albicans. Since anxiolytic drugs can restore cellular immunity in rodents exposed to stress conditions, we designed experiments conducted to evaluate the effects of alprazolam (1 mg/kg of body weight/day), a central benzodiazepine anxiolytic agonist, on the development of oral candidiasis in Sprague-Dawley rats exposed to a chronic auditory stressor. Anima...
Nu?n?ez, M. J.; Balboa, J.; Riveiro, P.; Lin?ares, D.; Man?a?, P.; Rey-me?ndez, M.; Rodri?guez-cobos, A.; Sua?rez-quintanilla, J. A.; Garci?a-vallejo, L. A.; Freire-garabal, M.
We compared the efficacies of cilofungin and amphotericin B treatment in a murine model of disseminated candidiasis. Three different dosages of each drug plus controls were evaluated. Statistically improved survival was noted only among mice treated with 1 mg of amphotericin B per kg of body weight (P less than 0.05). While all amphotericin B regimens and the two lower-dosage cilofungin regimens significantly reduced yeast cell counts in kidneys compared with the controls, the amphotericin B-...
Smith, K. R.; Lank, K. M.; Cobbs, C. G.; Cloud, G. A.; Dismukes, W. E.
Candida vaginitis is one of the most frequent infection of the female genital tract with a high incidence. Approximately 75% of sexually active women suffer at least one episode of Candida vaginitis and 10% of them have recurrent episodes. Pregnancy, diabetes mellitus and antibiotic treatment are the most common predisposing factors, C. albicans is the etiologic agent most frequently found. The widespread reports of fluconazole resistance in Candida species and the selection of non Candida albicans prompted the study of species distribution of vulvovaginal candidiasis and their in vitro susceptibility against current antifungal agents. A total of 314 women with vaginal infection were studied. Yeasts were isolated from 104 patients with vulvovaginal candidiasis. The following species were identified: C. albicans 87.5%, C. glabrata 8.6% and 3.9% included C. krusei, C. famata, C. tropicalis and S. cerevisiae. The minimal inhibitory concentration (MIC) was determined for nystatin, isoconazole, fluconazole and ketoconazole, using a broth microdilution method based on NCCLS procedure. Although most of the isolates were C. albicans, the high percentage of C. glabrata recovered suggests the need to identify the yeasts isolated. Fluconazole resistant C. albicans were isolated in 13.46% of the cases. Thus, further studies are required to correlate the possible role of these strains in recurrent vulvovaginal candidiasis. PMID:11833253
Saporiti, A M; Gómez, D; Levalle, S; Galeano, M; Davel, G; Vivot, W; Rodero, L
The insensitivity of blood cultures for diagnosing invasive candidiasis fuels prophylactic and preemptive antifungal treatment. Assays like serum ?-D-glucan or mannan/anti-mannan detection can identify blood culture-negative invasive candidiasis, but their roles in guiding antifungal therapy are undefined. We propose that non-culture tests can be incorporated into rational management strategies, based on clinical setting. As an example, ?-D-glucan sensitivity/specificity for blood culture-negative, deep-seated candidiasis is approximately 60/75%. In intensive care units with 99% and 6/98%, respectively. With pre-test likelihoods of 10 and 33%, positive/negative predictive values are 20/94% and 54/79%, respectively. Based on these data, negative and positive ?-D-glucan results likely will be most useful for discontinuing prophylaxis among low-risk to moderate-risk patients (pre-test likelihoods ?3-10%), and triggering preemptive therapy among moderate-risk to high-risk patients (pre-test likelihoods ?10-25%), respectively. In extremely high-risk patients, universal prophylaxis is likely to be the best strategy. PMID:24850393
Clancy, Cornelius J; Nguyen, Minh Hong
Oropharyngeal candidiasis (OPC; thrush) is an opportunistic fungal infection caused by the commensal microbe Candida albicans. Immunity to OPC is strongly dependent on CD4+ T cells, particularly those of the Th17 subset. Interleukin-17 (IL-17) deficiency in mice or humans leads to chronic mucocutaneous candidiasis, but the specific downstream mechanisms of IL-17-mediated host defense remain unclear. Lipocalin 2 (Lcn2; 24p3; neutrophil gelatinase-associated lipocalin [NGAL]) is an antimicrobial host defense factor produced in response to inflammatory cytokines, particularly IL-17. Lcn2 plays a key role in preventing iron acquisition by bacteria that use catecholate-type siderophores, and lipocalin 2(-/-) mice are highly susceptible to infection by Escherichia coli and Klebsiella pneumoniae. The role of Lcn2 in mediating immunity to fungi is poorly defined. Accordingly, in this study, we evaluated the role of Lcn2 in immunity to oral infection with C. albicans. Lcn2 is strongly upregulated following oral infection with C. albicans, and its expression is almost entirely abrogated in mice with defective IL-17 signaling (IL-17RA(-/-) or Act1(-/-) mice). However, Lcn2(-/-) mice were completely resistant to OPC, comparably to wild-type (WT) mice. Moreover, Lcn2 deficiency mediated protection from OPC induced by steroid immunosuppression. Therefore, despite its potent regulation during C. albicans infection, Lcn2 is not required for immunity to mucosal candidiasis. PMID:24343647
Ferreira, Maria Carolina; Whibley, Natasha; Mamo, Anna J; Siebenlist, Ulrich; Chan, Yvonne R; Gaffen, Sarah L
Full Text Available SciELO Venezuela | Language: Spanish Abstract in spanish Se estudiaron 40 pacientes que acudieron al Servicio de Clínica Estomatológica de la Facultad de Odontología. U.C.V., quienes presentaron signos clínicos y microbiológicos de Candidiasis atrófica crónica. El 40% de los pacientes pertenecían al rango de edades de 51 a 60 años, y el 97.5% pertenecían [...] al sexo femenino. Al evaluar la presencia de prótesis dental en éstos pacientes, se pudo evidenciar que el 67.5% usaban prótesis total y el 32.5% prótesis parcial removible. Con respecto a la identificación de las especies de Candida, se pudo demostrar que el 72.5% correspondió a C. albicans, el 15% a C. tropicalis, el 2% a T. glabrata y C. famata, C. parapsilosis, C. rugosa representaron el 1% respectivamente. Es necesario realizar un correcto diagnóstico clínico y micológico con la identificación exacta de las levaduras con fines de establecer pautas terapéuticas correctas y evitar la resistencia a los antimicóticos. Abstract in english A group of denture wearing patients with erythematous candidiasis was investigated by age and sex, clinical symptoms and signs of the disease were recorded.There were 39 women and 1 man, and ranged in age from 51 a 60 years old. Six species of Candida were isolated, with C. albicans as the dominant [...] species (72.5%).
L, J, Lazarde; A, Pacheco.
Full Text Available SciELO Costa Rica | Language: Spanish Abstract in spanish La sobrevida de los pacientes con enfermedades crónicas así como de aquellos expuestos a terapias médicas y quirúrgicas agresivas ha aumentado. entre otras cosas, gracias al empleo de antibiáticos de amplio espectro, al uso de nutrición parenteral, a la aplicación de medicamentos inmunomoduladores, [...] al transpiante de órganos y al desarrollo de las unidades de cuidado intensivo. No obstante, esto ha conllevado a la aparición de complicaciones como son las infecciones por hongos. Dentro de éstas, en los últimos años se ha demostrado que las diversas especies de cándida tienen un papel importante. La candidiasis sistémica puede ser una complicación severa en estos pacientes, con una alta morbimortalidad. En nuestro medio, desconocemos estudios donde se analice esta patología, razón por la cual se llevó a cabo este trabajo. Se estudiaron retrospectivamente los pacientes con candidiasis sistémica diagnosticados en el Hospital San Juan de Dios, hospital nacional de aproximadamente 700 camas, entre los meses de enero de 1996 a diciembre de 1998. Se analizaron 48 episodios de candidiasis sistémica en 47 pacientes. La edad promedio fue de 53 años, 60% fueron hombres. La mortalidad fue de 36%. En 77% de los pacientes se logró identificar alguna patología de base (enfermedad hematooncológica, diabetes mellitus, cirugía abdominal, enfermedad por VIH, quemaduras extensas). Los principales factores de riesgo demostrados fueron el uso previo de antibióticos de amplio espectro (87%), presencia de catéter venoso central (72%), candidiasis en otros sitios (64%), cirugía abdominal previa (25%),empleo de nutrición parenteral (23%) y uso de corticoesteroides (23%). En todos los pacientes se logró identificar al menos un factor de riesgo. Las principales especies de cándida aisladas fueron C albicans (47%), C tropicalis (19%), C parapsilosis (11%), C krusei (4%) y C glabrata (2%). Se analizó la relación entre la especie aislada y los factores de riesgo. Se encontró que C krusei y C parapsílosís se relacionaron con el uso previo de antimicóticos azoles. La mortalidad fue mayor en aquellos pacientes no tratados con antimicóticos. Se discuten estos hallazgos y se correlacionan con lo publicado en la literatura médica, llamándose la atención sobre el aumento en la incidencia de candidiasis sistémicas por candidas no aibicans. Abstract in english The mortality of patients with chronic diseases and those with agressive medical and surgical therapies has decreased in recent years, specially due to the use of broad spectrum antibiotics, parenteral nutrition, immunosupressives therapies, organ transpiantation and management of those patients in [...] intensive care units. However, new infectious diseases have emerged in this population, for example candidal infections. We do not have reports in Costa Rica about this problem. The objective of this study was to analized, retrospectiviy, demographic characteristics, risk factors, microbiologic findings, mortaiity and treatment of patients with candidal bloodstream infections between January 1996 and December 1998, in the Hospital San Juan de Dios, a costarrican reference hospital. Forty seven patients with 48 systemic candidiasis episodes met the criteria to be included in our study. Sixty percent were men and the mean age was 53 years oid. The mortality rate was 36%. All the patients presentes at least, one risk factor.The most common were the use of broad spectrum antibiotics (87%), the presence of central venous catheter(72%), candidiasis in other anatomic site (64%), previous abdominal surgery (25%),use of parenteral nutrition (23%) and neutropenia (17%). The species isolated were: C albicans (47%), C tropicalis (19%), C parapsilosis (11%), C krusei (4%) and C glabrata (2%). The last two species were related to the previous use of antimycotic azoles. The use of an early specific antimycotic treatment was related with low mortaiity rate. We discussed our data and we found simila
Ernesto, Caballero; Ricardo, Boza; Kenneth, González.
Dynamic contrast-enhanced computed tomography (CT) was compared with 1.5-T magnetic resonance (MR) imaging with FLASH (fast low-angle shot), gadolinium-enhanced FLASH (Gd-FLASH), and T2-weighted fat-suppression (T2FS) sequences in 11 patients with hematologic malignancies, five with biopsy-confirmed hepatosplenic candidiasis treated with antifungal chemotherapy and six with a clinical history suggestive of acute hepatosplenic candidiasis. CT and MR images were separately interpreted in a prospective fashion. MR imaging showed lesions compatible with candidiasis in the liver in six patients, the spleen in five, and the kidneys in one. CT showed candidiasis-compatible lesions in the liver in three patients and the spleen in one; no renal lesions were shown. Differences between acute and treated candidal lesions were observed. Gd-FLASH images showed the most liver lesions (n = 106), followed by FLASH (n = 85), T2FS (n = 20), and CT (n = 18). MR imaging performed better than CT in distinguishing candidal hepatic lesions from recurrent lymphoblastic lymphoma in one patient and from hepatic infarcts in another. The results suggest that MR imaging may be superior to CT in detecting lesions of hepatosplenic candidiasis. PMID:1627870
Semelka, R C; Shoenut, J P; Greenberg, H M; Bow, E J
We report on the efficacy of the genetically engineered Candida albicans tet-NRG1 strain as an experimental live, attenuated vaccine against disseminated candidiasis in both immunocompetent and immunodeficient mice mostly dependent on T-cell immunity. This experimental vaccination model may represent an important tool to unravel the mechanisms of protective immunity during candidiasis.
The aim of this study was to determine the impact of bethanechol administration concomitant to radiotherapy (RT) on oral mucositis, candidiasis and taste loss. We performed a secondary analysis of a previously conducted prospective randomized trial which evaluated the effect of bethanechol on salivary gland dysfunction before, during, and after RT for head and neck cancer (HNC), in comparison to artificial saliva. Mucositis, candidiasis and taste loss were analyzed in 36 patients. Mucositis was scored using the World Health Organization (WHO) method; candidiasis was diagnosed by means of clinical examination, whereas taste loss was assessed by the patients' subjective report of absence of taste. No significant differences were observed between groups in relation to frequency and severity of mucositis or frequency of candidiasis and taste loss. In conclusion, bethanechol does not appear to reduce the incidence of mucositis, candidiasis, and taste loss when administered during RT. (author)
Full Text Available SciELO Brazil | Language: English Abstract in english The objective of this study was to evaluate the incidence, anatomic localization and yeast species isolated from each clinical type of oral candidiasis. The clinical samples were obtained from 67 patients with AIDS with CD4 cell counts below 200 cells/mm³ and hospitalized in a public hospital (Eduar [...] do de Menezes Hospital) in the city of Belo Horizonte, MG, Brazil. Yeasts were isolated using Chromagar® Candida. The results show that 50.7% of these patients had oral candidiasis. The pseudomembranous form was the most frequent clinical manifestation of oral candidiasis, followed by the erythematous and angular cheilite forms. The most common site of these clinical forms of oral candidiasis was the tongue. Candida albicans was the most common yeast species isolated from the lesions. However, other species were also found to be associated with these forms of oral candidiasis.
Ilanna G., Gableri; Anne C., Barbosa; Raquel R., Velela; Sandra, Lyon; Carlos A., Rosa.
Full Text Available Abstract Background Although the connection between ascending infection and preterm birth is undisputed, research focused on finding effective treatments has been disappointing. However evidence that eradication of Candida in pregnancy may reduce the risk of preterm birth is emerging. We conducted a pilot study to assess the feasibility of conducting a large randomized controlled trial to determine whether treatment of asymptomatic candidiasis in early pregnancy reduces the incidence of preterm birth. Methods We used a prospective, randomized, open-label, blinded-endpoint (PROBE study design. Pregnant women presenting at Candida were randomized to 6-days of clotrimazole vaginal pessaries (100mg or usual care (screening result is not revealed, no treatment. The primary outcomes were the rate of asymptomatic vaginal candidiasis, participation and follow-up. The proposed primary trial outcome of spontaneous preterm birth Results Of 779 women approached, 500 (64% participated in candidiasis screening, and 98 (19.6% had asymptomatic vaginal candidiasis and were randomized to clotrimazole or usual care. Women were not inconvenienced by participation in the study, laboratory testing and medication dispensing were problem-free, and the follow-up rate was 99%. There was a tendency towards a reduction in spontaneous preterm birth among women with asymptomatic candidiasis who were treated with clotrimazole RR = 0.33, 95%CI 0.04-3.03. Conclusions A large, adequately powered, randomized trial of clotrimazole to prevent preterm birth in women with asymptomatic candidiasis is both feasible and warranted. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR: ACTRN12609001052224
Oropharyngeal candidiasis (OPC), caused by the commensal fungus Candida albicans, is an opportunistic infection associated with infancy, AIDS, and IL-17-related primary immunodeficiencies. The Th17-associated cytokines IL-23 and IL-17 are crucial for immunity to OPC, but the mechanisms by which they mediate immunity are poorly defined. IL-17RA-deficient humans and mice are strongly susceptible to OPC, with reduced levels of CXC chemokines and concomitantly impaired neutrophil recruitment to the oral mucosa. Paradoxically, humans with isolated neutropenia are typically not susceptible to candidiasis. To determine whether immunity to OPC is mediated via neutrophil recruitment, mice lacking CXCR2 were subjected to OPC and were found to be highly susceptible, although there was no dissemination of fungi to peripheral organs. To assess whether the entire neutrophil response is IL-17 dependent, IL-17RA(-/-) and IL-23(-/-) mice were administered neutrophil-depleting Abs and subjected to OPC. These mice displayed increased oral fungal burdens compared with IL-17RA(-/-) or IL-23(-/-) mice alone, indicating that additional IL-17-independent signals contribute to the neutrophil response. WT mice treated with anti-Gr-1 Abs exhibited a robust infiltrate of CD11b(+)Ly-6G(low)F4/80(-) cells to the oral mucosa but were nonetheless highly susceptible to OPC, indicating that this monocytic influx is insufficient for host defense. Surprisingly, Ly-6G Ab treatment did not induce the same strong susceptibility to OPC in WT mice. Thus, CXCR2(+) and Gr-1(+) neutrophils play a vital role in host defense against OPC. Moreover, defects in the IL-23/17 axis cause a potent but incomplete deficiency in the neutrophil response to oral candidiasis. PMID:24442441
Huppler, Anna R; Conti, Heather R; Hernández-Santos, Nydiaris; Darville, Toni; Biswas, Partha S; Gaffen, Sarah L
The safety, tolerance, and pharmacokinetics of amphotericin B lipid complex (ABLC) were studied in a cohort of pediatric cancer patients. Six children with hepatosplenic candidiasis (HSC) received 2.5 mg of ABLC/kg of body weight/day for 6 weeks for a total dosage of 105 mg/kg. Mean serum creatinine (0.85 +/- 0.12 mg/dl at baseline) was stable at the end of therapy at 0.85 +/- 0.18 mg/dl and at 1-month follow-up at 0.72 +/- 0.12 mg/dl. There was no increase in hepatic transaminases. Mean plas...
Walsh, T. J.; Whitcomb, P.; Piscitelli, S.; Figg, W. D.; Hill, S.; Chanock, S. J.; Jarosinski, P.; Gupta, R.; Pizzo, P. A.
We report a retrospective study of 24 patients with haematological malignancy and hepatosplenic candidiasis. Clinical and biological features were similar to previous reports. No patient previously received antifungal prophylaxis. Liver or spleen histological examination revealed yeasts in 6/24 patients (25%) on direct examination but all cultures were negative. After a median duration of 7 months, antifungal treatment was discontinued in 58% of the patients with no relapse. Eleven (46%) patients died during follow up. After multivariate analysis, independent factors associated with death were the duration of neutropenia (p 0.022) and relapsing haematological malignancy (p 0.015). PMID:22458883
De Castro, N; Mazoyer, E; Porcher, R; Raffoux, E; Suarez, F; Ribaud, P; Lortholary, O; Molina, J-M
A controlled triple open clinical study on three vaginal tablets--Econazole nitrate, Miconazole and Nystatin, was carried out. Seventy-five patients, aged between 18 and 45 years, presenting with mycologically proven cases of vaginal candidiasis, met certain set criteria and were admitted into the study. Twenty-five patients were randomly assigned to each of the three treatment groups. Results of the study showed that at the 4th week after treatment, Econazole was comparable in antifungal action to Miconazole (x2 = 0.2128; p > 0.05) but significantly more antifungal than Nystatin (x2 = 8.8540; P 0.05). PMID:10821079
Emele, F E; Fadahunsi, A A; Anyiwo, C E; Ogunleye, O
The activity of liposomal nystatin (L-Nys) against subacute disseminated candidiasis was investigated in persistently neutropenic rabbits. Antifungal therapy was administered for 10 days starting 24 h after intravenous inoculation of 103 blastoconidia of Candida albicans. Responses to treatment were assessed by the quantitative clearance of the organism from blood and tissues. Treatments consisted of L-Nys at dosages of 2 and 4 mg/kg of body weight/day (L-Nys2 and L-Nys4, respectively) amphot...
Groll, Andreas H.; Petraitis, Vidmantas; Petraitiene, Ruta; Field-ridley, Aida; Calendario, Myrna; Bacher, John; Piscitelli, Stephen C.; Walsh, Thomas J.
Environmental illness, a hypothesized disease caused by exposure to substances such as combustion products, pesticides, food additives, and Candida albicans, is discussed. The case of a patient with environmental illness and systemic candidiasis for six weeks with ketoconazole, liver enzyme concentrations increased. One month after discontinuation of ketoconazole, the liver enzyme concentrations decreased; however, over the next five months, liver enzymes and bilirubin increased. The patient developed encephalopathy and eventually was transferred to a medical center for possible liver transplant. A review of the literature pertaining to ketoconazole hepatotoxicity is also presented.16 references.
Brusko, C.S.; Marten, J.T. (Purdue University School of Pharmacy and Pharmacal Sciences, Lafayette, IN (United States))
Disruption of both alleles of the Candida albicans FAS2 gene abolishes the ability of the organism to establish infection in a murine model of systemic candidiasis. Within 72 h all mice inoculated with 10(6) CFU of the parental C. albicans strain had died. In contrast, all animals inoculated with the mutant strain CFD2 survived for the course of the experiment (21 days). Animals infected with either mutant strain CFD1 or CFD3, in which only one FAS2 allele was disrupted, also succumbed to inf...
Zhao, X. J.; Mcelhaney-feser, G. E.; Sheridan, M. J.; Broedel, S. E.; Cihlar, R. L.
The animal models available for studying the immune response to genital tract infection require induction of a pseudo estrous state, usually achieved by administration of 17-?-estradiol. In our experimental model of vaginal candidiasis, under pseudo estrus, different strains of mice were used. We observed major differences in the clearance of Candida albicans infection among the different strains, ascribable to differing susceptibility to estradiol treatment. In the early phase of infection CD1, BALB/c, C57BL/6 albino and C57BL/6 mice were colonized to similar levels, while in the late phase of infection, BALB/c mice, which are considered genetically resistant to C. albicans infection, exhibited greater susceptibility to vaginal candidiasis than CD1 and C57BL/6 albino strains of mice. This was because estradiol induced "per se" enlarged and fluid-filled uteri, more pronounced in infected mice and consistently more evident in BALB/c and C57BL/6 mice than in CD1 mice. Unlike CD1, BALB/c and C57BL/6 mice showed a heavy fungal colonization of the uterus, even though C57BL/6 mice apparently cleared C. albicans from the vagina. The presence of C. albicans in the vagina and uterus was accompanied by a heavy bacterial load. Collectively these observations prompted us to carry out a careful analysis of estradiol effects in a mouse model of vaginal infection. PMID:23054331
Mosci, Paolo; Pietrella, Donatella; Ricci, Giovanni; Pandey, Neelam; Monari, Claudia; Pericolini, Eva; Gabrielli, Elena; Perito, Stefano; Bistoni, Francesco; Vecchiarelli, Anna
The purpose of this study was to evaluate the in vitro anticandidal activity of a methanolic extract of Syngonanthus nitens scapes against different Candida species and clinical isolates from patients with vulvovaginal candidiasis (VVC), and its effect in vivo in the treatment of vaginal infection. Chemical characterization of the extract was performed by HPLC-UV analyses and showed the presence of flavones derivatives. The extract was effective against several Candida strains from our collection and species recovered from VVC patients, and was able to inhibit the yeast-hyphal transition. No cytotoxic activity against human female reproductive tract epithelial cells and no hemolytic activity against human red blood cells were observed. In the in vivo model of VVC, we evaluated the efficacy of the intravaginal treatment with a cream containing the extract at doses of 0.5, 1.0 and 2.0%. The treatment eradicated the vaginal fungal burden in infected rats after 8 days of treatment. S. nitens extract could be considered as an effective and non-toxic natural antifungal agent in the treatment of vulvovaginal candidiasis. PMID:23758104
de Freitas Araújo, Marcelo Gonzaga; Pacífico, Mariana; Vilegas, Wagner; Dos Santos, Lourdes Campaner; Icely, Paula Alejandra; Miró, Maria Soledad; Scarpa, Maria Virginia Costa; Bauab, Tais Maria; Sotomayor, Claudia Elena
Full Text Available Abstract Background This report describes the results of radiological, histological and molecular examination of three farm-reared red-legged partridges (Alectoris rufa affected by candidiasis. Case presentation Three juvenile farm-reared red-legged partridges in a batch of 100 of the same species were sent for clinical and pathological investigations. The owner referred of a sudden isolation of the sick animals, with apathy, diarrhea, ruffled plumage and respiratory rattles. Post mortem total body lateral projection radiograph showed an increased perihilar interstitial pattern and air bronchogram signs due to lung edema. At necropsy, carcasses showed cachexia; the pericloacal region was soiled by diarrheic fecal material. From the mouth to the intestine, a mucous yellowish fluid was present on a slightly reddish mucosa. Histopathology showed slight edema and congestion with different free fungal elements, referable to blastospores, hyphae and pseudohyphae. Biomolecular exam identified the most similar sequences as belonging to Leucosporidium scottii. Conclusion To our knowledge, this case report describes for the first time this fungal species as a causative agent of candidiasis in birds.
To assess the value of laparoscopy in the diagnosis of suspected hepatosplenic candidiasis in patients with acute leukemia, a retrospective analysis of 28 laparoscopies was conducted. In all but two cases, imaging of the liver showed focal lesions before laparoscopy. Diagnosis of hepatic candidiasis was established significantly more often when the biopsy was targeted at white nodules (in 12 of 22 laparoscopies) than when targeted randomly or at scars (0 of 6 laparoscopies) (p = 0.017, chi-square test). Yeast was detected more often if the laparoscopy was performed during the three-week period after recovery from neutropenia (in 8 of 12 laparoscopies) than when performed later (in 4 of 16 laparoscopies) (p = 0.028, chi-square test). In addition to the 12 laparoscopically diagnosed patients, eight (29%) patients were diagnosed with disseminated Candida infection by other methods. In another eight (29%) patients the causative agent was not identified. No bleeding or other problems occurred after the laparoscopy. Laparoscopy-guided liver biopsy is most useful if biopsies are targeted to macroscopic lesions and if laparoscopy is performed soon after recovery from neutropenia. PMID:9352255
Anttila, V J; Färkkilä, M; Jansson, S E; Taavitsainen, M; Kaukoranta-Tolvanen, S S; Nordling, S; Koukila-Kähkölä, P; Ruutu, T; Ruutu, P
The case of a granulocytopenic patient with acute undifferentiated leukaemia and hepatosplenic candidiasis who was refractory to conventional deoxycholate amphotericin B (AmpB) and 5-flucytosine therapy is reported. He experienced severe AmpB-related side-effects, and was subsequently successfully treated with a pharmaceutical preparation of AmpB (5.7 g) entrapped in sonicated liposomes, composed of lecithin, cholesterol and stearylamine in a molar ratio of 4:3:1. Three months later, during maintenance chemotherapy, liposomal AmpB (5.1 g) was reinstituted due to the finding of biopsies positive for Candida albicans at bronchoscopy. After healing of the patient's fungal infection a left upper lobe resection was performed, which showed advanced fibrosis with signs of inflammation, but no evidence of fungal disease. Since no acute side-effects and only moderate hypokalaemia were observed, it appears that liposomal AmpB is superior to conventional AmpB treatment in granulocytopenic patients with hepatosplenic candidiasis and unbearable therapy-related side-effects. PMID:1865169
Björkholm, M; Kållberg, N; Grimfors, G; Eklund, L H; Eksborg, S; Juneskans, O T; Udén, A M
Full Text Available Recurrent Vulvovaginal Candidiasis (RVVC is a fungal infection of the vagina and vulva that occur usually = 4 episodes in a year. Our object was to compare the efficacy and safety of a single oral dose of fluconazole (150 mg weekly with clotrimazole vaginal cream 150 mg twice weekly for 6 months as treatment of recurrent VVC. We conducted a clinical trial study among 124 women with Recurrent Vulvovaginal Candidiasis (RVVC among patients presenting to the Obstetrics and Gynecology Clinics of Tabriz University of Medical Sciences from 2002-2004. There was no significant difference in the therapeutic response as the recurrence rate during 12 months between the two groups. The drug side effects in the fluconazole group were significantly more than clotrimazole group. The satisfactory from the drug in the fluconazole group was significantly less than clotrimazole group. Due to the fewer side effects and more satisfactory of local treatment, we recommend profilactic use of Azole vaginal creams for treatment of RVVC especially in women who are pregnant or have systemic problems.
Full Text Available Disturbance on the immune system and deficiency of Zn is two factors which often trigger vaginal candidiasis patient. The aim of the research was to study the effect of virgin coconut oil (VCO enriched with Zn to the amount of neutrophil and lymphocyte subset cells, and the level of IL-2 and IgG in vaginal candidiasis patient. Thirty women were grouped into three (ten women in each group: A, B and C, and intervened for two months. Women in A group were intervened with two tablespoon/day; those in B group were intervened with one tablespoon/day; while those in C group served as control (placebo. Blood was sampled at baseline time, one and two months after intervention. Hematological test by Micros-OT was done on a part of blood, and the plasma was used for IL-2 and IgG level tests using ELISA. The virgin coconut oil enriched with Zn maintained the number of neutrophil and NK cells, but increased Tc cells from 521 to 649 cells/mm3, increased Th cells from 1.090 to 1.380 cells/mm3. The enriched VCO also increase level of IL-2 from 0.25313 to 0.27337 pg/ml, while the IgG level changed from equivocal to negative. The recommended dosage was one tablespoon each day.
Candidaemia and invasive candidiasis (IC) complicate modern medical therapy, contributing to high morbidity and mortality. Managing candidiasis is costly, with an additional healthcare expenditure of nearly US$300 million annually. Recent consensus guidelines have suggested the use of newer antifungal agents, such as echinocandins, for the treatment of candidaemia and IC owing to promising clinical outcomes compared with older-generation antifungal agents, but at higher drug acquisition and administration costs. Comprehensive cost-effectiveness data for echinocandins in treating candidaemia and IC remain relatively scant, underlining the need for more studies to incorporate robust economic analyses into clinical decisions. Assessment of the cost efficiencies of these expensive antifungal agents is essential for maximising health outcomes within the constraints of healthcare resources. This review will explore the epidemiology of candidaemia and IC in the context of clinical and economic aspects of the antifungal agents used to treat IC, especially the echinocandins. Standardising the outcome measure, methodology and reporting of results used in economic studies is central to ensure validity and comparability of the findings. Future studies comparing the economic advantages of all available antifungal treatment options and in the context of new diagnostic tools for fungal infections are anticipated. PMID:24670423
Neoh, Chin Fen; Slavin, Monica; Chen, Sharon C-A; Stewart, Kay; Kong, David C M
Full Text Available Carvacrol and eugenol, the main (phenolic components of essential oils of some aromatic plants, were evaluated for their therapeutic efficacy in the treatment of experimental oral candidiasis induced by Candida albicans in immunosuppressed rats. This anticandidal activity was analyzed by microbiological and histopathological techniques, and it was compared with that of nystatin, which was used as a positive control. Microbiologically, carvacrol and eugenol significantly (p<0.05 reduced the number of colony forming units (CFU sampled from the oral cavity of rats treated for eight consecutive days, compared to untreated control rats. Treatment with nystatin gave similar results. Histologically, the untreated control animals showed numerous hyphae on the epithelium of the dorsal surface of the tongue. In contrast no hyphal colonization of the epithelium was seen in carvacrol-treated animals, while in rats treated with eugenol, only a few focalized zones of the dorsal surface of the tongue were occupied by hyphae. In the nystatin treated group, hyphae were found in the folds of the tongue mucosa. Thus, the histological data were confirmed by the microbiological tests for carvacrol and eugenol, but not for the nystatin-treated group. Therefore, carvacrol and eugenol could be considered as strong antifungal agents and could be proposed as therapeutic agents for oral candidiasis.
Full Text Available The immunosuppressive activity of estrogen was further investigated by assessing the pattern of expression of CD25, CD28, CD69, and CD152 on vaginal T cells during estrogen-maintained vaginal candidiasis. A precipitous and significant decrease in vaginal fungal burden toward the end of week 3 postinfection was concurrent with a significant increase in vaginal lymphocyte numbers. During this period, the percentage of CD3+, CD3+CD4+, CD152+, and CD28+ vaginal T cells gradually and significantly increased. The percentage of CD3+ and CD3+CD4+ cells increased from 43% and 15% at day 0 to 77% and 40% at day 28 postinfection. Compared with 29% CD152+ vaginal T cells in naive mice, > 70% of vaginal T cells were CD152+ at day 28 postinfection. In conclusion, estrogen-maintained vaginal candidiasis results in postinfection time-dependent changes in the pattern of expression of CD152, CD28, and other T-cell markers, suggesting that T cells are subject to mixed suppression and activation signals.
We have used a mouse model of vaginal candidiasis to determine the effect of neutrophil depletion on (a) the clearance of Candida albicans and (b) the degree of inflammation associated with infection. No differences in recoverable yeast number or rate of clearance were observed between normal and neutrophil-depleted mice; however, vaginal inflammation was significantly decreased in neutrophil-depleted animals.
Black, C. Allen; Eyers, Fiona M.; Russell, Adrian; Dunkley, Margaret L.; Clancy, Robert L.; Beagley, Kenneth W.
We developed an experimental model of candidiasis in rabbits with prolonged neutropenia. Rabbits were made neutropenic with cytosine arabinoside (Ara-C) administered through an indwelling silastic catheter that had been surgically implanted in the external jugular vein. Neutropenia was sustained with intravenous Ara-C, and bacterial complications were prevented with parenteral ceftazidime plus ampicillin. Candidiasis was established by intravenously administering Candida albicans or Candida tropicalis (1-2 x 10(5) colony-forming units) and resulted in hepatic and splenic lesions that mimicked those associated with hepatosplenic candidiasis in humans. The kidney proved to be the site most refractory to eradication of Candida spp. and offered a target organ for assessing antifungal therapy. We evaluated amphotericin B, 5-flucytosine, ketoconazole, and rifampin, alone and in combination. Although each agent reduced the colony counts of Candida in the liver, spleen, and lung, the combination of amphotericin B and 5-flucytosine was the only regimen effective in eradicating renal candidiasis. PMID:3392423
Thaler, M; Bacher, J; O'Leary, T; Pizzo, P A
Perfil epidemiológico de la candidiasis invasora en unidades de pacientes críticos en un hospital universitario Epidemiologial profile of invasive candidiasis in intensive care units at a university hospital
Full Text Available La epidemiología de candidiasis invasora (CI ha cambiado, lo cual no ha sido suficientemente estudiado en Chile. Objetivo: Describir el perfil epidemiológico y microbiológico de CI en pacientes críticos. Métodos: Estudio observacional prospectivo entre octubre 2001 y agosto 2003, en pacientes críticos adultos con sospecha o confimnación de CI. Resultados: 53 pacientes cumplieron criterios de CI. De ellos, 18 (33,9% tuvieron candidemia, 22(41,5% CI diseminada y 13(24,5% CI local. Entre las candidemias, hubo 8 C. albicans (44,4% y 10 Candida no albicans (55,6%, predominando C. tropicalis (27,7%. Un 88,8% de las candidemias fueron susceptibles a fluconazol. La mortalidad hospitalaria global fue 24,5%, significativamente menor en pacientes con candidemias vs CI diseminada (16,6 vs 31,8%, p = 0,02. Conclusiones: Se observó una mayor proporción de Candida no albicans en candidemias de pacientes críticos. Sin embargo, la mayoría de estas cepas fue susceptible a fluconazol. La mortalidad global fue menor en candidemias.Invasive candidiasis (IC epidemiology has changed in critically ill patients and limited data are available in Chile. Objective: To describe the epidemiological and microbiological profile of IC in critically ill patients. Methods: Observational prospective study conducted from October 2001 to August 2003 in critically ill adults with suspected or confirmed IC. Results: 53 patients met criteria for IC, finding 18 (33.9% candidemias, 22 (41.5% disseminated IC, and 13 (24.5% local IC. We identified 8 (44.4% C. albicans and 10 (55.6% non-albicans Candida in candidemias. C. tropicalis was the predominant non-albicans species (27.7%. An 88.8 % of Candidas sp recovered in candidemias were fluconazole susceptible. Overall hospital mortality was 24.5%. Mortality in candidemia was significantly lower than in disseminated IC (16.6 vs 31.8%, p = 0.02. Conclusions: A higher proportion of non-albicans Candida was observed in candidemias from critically ill patients. However, most of these strains were fluconazole susceptible. A lower overall mortality was observed in candidemias.
M. Cristina Ajenjo H
Perfil epidemiológico de la candidiasis invasora en unidades de pacientes críticos en un hospital universitario / Epidemiologial profile of invasive candidiasis in intensive care units at a university hospital
Full Text Available SciELO Chile | Language: Spanish Abstract in spanish La epidemiología de candidiasis invasora (CI) ha cambiado, lo cual no ha sido suficientemente estudiado en Chile. Objetivo: Describir el perfil epidemiológico y microbiológico de CI en pacientes críticos. Métodos: Estudio observacional prospectivo entre octubre 2001 y agosto 2003, en pacientes críti [...] cos adultos con sospecha o confimnación de CI. Resultados: 53 pacientes cumplieron criterios de CI. De ellos, 18 (33,9%) tuvieron candidemia, 22(41,5%) CI diseminada y 13(24,5%) CI local. Entre las candidemias, hubo 8 C. albicans (44,4%) y 10 Candida no albicans (55,6%), predominando C. tropicalis (27,7%). Un 88,8% de las candidemias fueron susceptibles a fluconazol. La mortalidad hospitalaria global fue 24,5%, significativamente menor en pacientes con candidemias vs CI diseminada (16,6 vs 31,8%, p = 0,02). Conclusiones: Se observó una mayor proporción de Candida no albicans en candidemias de pacientes críticos. Sin embargo, la mayoría de estas cepas fue susceptible a fluconazol. La mortalidad global fue menor en candidemias. Abstract in english Invasive candidiasis (IC) epidemiology has changed in critically ill patients and limited data are available in Chile. Objective: To describe the epidemiological and microbiological profile of IC in critically ill patients. Methods: Observational prospective study conducted from October 2001 to Augu [...] st 2003 in critically ill adults with suspected or confirmed IC. Results: 53 patients met criteria for IC, finding 18 (33.9%) candidemias, 22 (41.5%) disseminated IC, and 13 (24.5%) local IC. We identified 8 (44.4%) C. albicans and 10 (55.6%) non-albicans Candida in candidemias. C. tropicalis was the predominant non-albicans species (27.7%). An 88.8 % of Candidas sp recovered in candidemias were fluconazole susceptible. Overall hospital mortality was 24.5%. Mortality in candidemia was significantly lower than in disseminated IC (16.6 vs 31.8%, p = 0.02). Conclusions: A higher proportion of non-albicans Candida was observed in candidemias from critically ill patients. However, most of these strains were fluconazole susceptible. A lower overall mortality was observed in candidemias.
M. Cristina, Ajenjo H; Andrés, Aquevedo S; Ana María, Guzmán D; Helena, Poggi M; Mario, Calvo A; Claudia, Castillo V; Eugenia, León C; Max, Andresen H; Jaime, Labarca L.
Full Text Available Se realizó un estudio de candidiasis oral a 25 pacientes VIH positivos y SIDA. La forma clínica de presentación predominante fue la pseudomembranosa y las especies de levadura más frecuentes en los aislamientos fueron Candida albicans (54,1 %, Candida tropicalis (8,1 % y Torulopsis glabrata (8,1 %. Se demostró que los pacientes con infecciones recurrentes suelen tener colonización de la cavidad oral por múltiples cepas y/o especies de levaduras con mayor frecuencia (30,8 % que los que cursan por su primer episodio de candidiasis oral (12,5 %. De los 3 medios de cultivo utilizados para el aislamiento inicial, la combinación del agar papa dextrosa (APD y el agar Sabouraud trifeniltetrazolium (AST permitió obtener el máximo de aislamiento y de diferenciación entre cepas. El agar Sabouraud (AS, el medio más utilizado para estos fines internacionalmente, fue menos útil que los anteriores. El AST resultó ser, además, un medio de gran utilidad para estudios de tipificación fenotípica de la mayoría de las especies de levaduras aisladas y especialmente de C. albicans, lo cual permitirá abordar estudios epidemiológicos.A study of oral candidiasis was conducted among 25 HIV-positive and AIDS patients. The predominant clinical form of presentation was the pseudomembranous one, whereas the most frequently yeast species found in the isolations were: Candida albicans (54.1 %, Candida tropicalis (8.1 %, and Torulopsis glabrata (8.1 %. It was demonstrated that patients with recurrent infections have colonization of the oral cavity by multiple strains and/or yeast species more often (30.8 % than those through their first episode of oral candiadisis (12.5 %. Of the 3 culture media used for the initial isolation, the combination of the potato-dextrose agar (PDA with Sabouraud triphenytletrazolium agar (STA allowed to obtain the maximum isolation and differentiation among strains. The Sabouraud agar (SA, the most used medium to these ends at the international level, proved to be less useful than the previous ones. The STA was very efficient in the studies of phenotypic typing of most of the isolated yeast species and specially of C. albicans, which will make possible to approach epidemiological studies.
GERARDO MARTÍNEZ MACHÍN
Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish Se realizó un estudio de candidiasis oral a 25 pacientes VIH positivos y SIDA. La forma clínica de presentación predominante fue la pseudomembranosa y las especies de levadura más frecuentes en los aislamientos fueron Candida albicans (54,1 %), Candida tropicalis (8,1 %) y Torulopsis glabrata (8,1 % [...] ). Se demostró que los pacientes con infecciones recurrentes suelen tener colonización de la cavidad oral por múltiples cepas y/o especies de levaduras con mayor frecuencia (30,8 %) que los que cursan por su primer episodio de candidiasis oral (12,5 %). De los 3 medios de cultivo utilizados para el aislamiento inicial, la combinación del agar papa dextrosa (APD) y el agar Sabouraud trifeniltetrazolium (AST) permitió obtener el máximo de aislamiento y de diferenciación entre cepas. El agar Sabouraud (AS), el medio más utilizado para estos fines internacionalmente, fue menos útil que los anteriores. El AST resultó ser, además, un medio de gran utilidad para estudios de tipificación fenotípica de la mayoría de las especies de levaduras aisladas y especialmente de C. albicans, lo cual permitirá abordar estudios epidemiológicos. Abstract in english A study of oral candidiasis was conducted among 25 HIV-positive and AIDS patients. The predominant clinical form of presentation was the pseudomembranous one, whereas the most frequently yeast species found in the isolations were: Candida albicans (54.1 %), Candida tropicalis (8.1 %), and Torulopsis [...] glabrata (8.1 %). It was demonstrated that patients with recurrent infections have colonization of the oral cavity by multiple strains and/or yeast species more often (30.8 %) than those through their first episode of oral candiadisis (12.5 %). Of the 3 culture media used for the initial isolation, the combination of the potato-dextrose agar (PDA) with Sabouraud triphenytletrazolium agar (STA) allowed to obtain the maximum isolation and differentiation among strains. The Sabouraud agar (SA), the most used medium to these ends at the international level, proved to be less useful than the previous ones. The STA was very efficient in the studies of phenotypic typing of most of the isolated yeast species and specially of C. albicans, which will make possible to approach epidemiological studies.
MARTÍNEZ MACHÍN, GERARDO; PERURENA LANCHA, MAYDA; NÚÑEZ CARVAJAL, JOSÉ; FERNÁNDEZ ANDREU, CARLOS M.; BANDERA TIRADO, FRANCISCO.
Population-based data on sexually transmitted infections (STI), bacterial vaginosis (BV), and candidiasis reflect the epidemiological situation more accurately than studies performed in specific populations, but such data are scarce. To determine the prevalence of STI, BV, and candidiasis among women of reproductive age from a resource-poor community in Northeast Brazil, a population-based cross sectional study was undertaken. All women from seven hamlets and the centre of Pacoti municipality...
Fabíola Araújo Oliveira; Viola Pfleger; Katrin Lang; Jörg Heukelbach; Iracema Miralles; Francisco Fraga; Anastácio de Queiroz Sousa; Marina Stoffler-Meilicke; Ralf Ignatius; Ligia Franco Sansigolo Kerr; Hermann Feldmeier
Hepatosplenic candidiasis (HSC) is an emerging complication of the treatment of patients with acute leukemia. Treatment of this infection can be very difficult and data on the duration of antifungal therapy are not available. We evaluated the efficacy of amphotericin B lipid complex (ABLC) for the treatment of five patients with acute leukemia and HSC. The dose of the administered ABLC ranged between 5 and 11 mg/kg per day and the median duration of therapy was 4.3 months. Four patients had complete response to the above treatment with resolution of fever and improvement in the radiologic findings. One patient refused to continue treatment and subsequently died with relapsed leukemia and disseminated Candida infection. Preliminary data suggest that ABLC is a well-tolerated and effective treatment for HSC and should be considered for phase II trials as front line treatment for this type of deep seated fungal infections. PMID:10576503
Sallah, S; Semelka, R C; Sallah, W; Vainright, J R; Philips, D L
Hepatosplenic candidiasis (HSC) becomes clinically overt in cancer patients upon recovery from neutropenia. HSC may be a consequence of a Th1-Th2 imbalance, characterized by increased serum levels of one or more cytokines. Serum levels of two immunosuppressive cytokines, markers of the Th2 pathway, interleukin (IL)-4 and IL-10 were measured by ELISA in 10 patients with HSC (22 samples) and compared with 19 healthy blood donors, 13 patients with cancer but no infection (23 samples), and 11 patients with cancer and various bacterial infections (17 samples). IL-4 was undetectable in all controls and patients. By contrast, levels of IL-10 were increased in HSC patients compared with levels in healthy donors and cancer patients without infection (P < .001) or with bacterial infections (P < .01). These findings indicate that IL-10 but not IL-4 is increased in patients with HSC and suggest that IL-10 plays a role in the pathogenesis of this infection. PMID:9697751
Roilides, E; Sein, T; Schaufele, R; Chanock, S J; Walsh, T J
Systemic candidiasis with Candida-induced abscesses, predominantly in the liver and the spleen, was diagnosed in 27 patients with haematologic malignancies after intensive cytostatic therapy. Specific features included septic fever unresponsive to antimicrobial therapy, hepatosplenomegaly with multiple lesions in the liver and spleen (diameter up to 2 cm) as detected by computed tomography (CT) or ultrasound, and an elevation in liver enzymes. During treatment, induced neutropenia, hepatic and splenic foci were poorly defined histologically and were not identified by imaging procedures. After granulocyte recovery these foci showed characteristic histological patterns. Ultrasound and/or CT investigations of the abdomen now revealed characteristic lesions in the liver and the spleen. Gamma-GT and alkaline phosphatase were early indicators of hepatic involvement in Candida septicaemia and were often already elevated in aplasia. PMID:2337685
von Eiff, M; Essink, M; Roos, N; Hiddemann, W; Büchner, T; van de Loo, J
In the present work, we studied the in vitro immunomodulatory properties of double-stranded Candida albicans DNA and its protective effect in murine disseminated candidiasis. DNA induced the production of TNF-alpha by peritoneal macrophages and splenocytes in vitro through a chloroquine-dependent mechanism. Yeast DNA acted synergistically with IFN-gamma in triggering the secretion of nitric oxide by macrophages and enabled them to stimulate the proliferation of T cells in response to soluble anti-CD3. The effect of DNA on splenocytes is associated with an enhanced synthesis of IFN-gamma, IL-2 and IL-10. In vivo, DNA decreased the mortality and lowered the kidney contamination in mice intraperitoneally inoculated with C. albicans simultaneously with an increase in the specific proliferative response and cytokine production. The present results indicate that C. albicans DNA can provide protection against disseminated infection. PMID:15715977
Yordanov, Martin; Dimitrova, Petya; Danova, Svetla; Ivanovska, Nina
Full Text Available Leveduras do gênero Candida têm sido freqüentemente isoladas de animais domésticos e silvestres, entretanto, candidíase não tem sido reportada em primatas. Encaminhou-se à Faculdade de Veterinária, Departamento de Patologia Animal, um macaco-prego (Cebus apella para necropsia, que vinha apresentando emagrecimento profundo e lesões ulcerativas de pele e mucosas. Fragmentos de pele e órgãos foram processados para histologia e corados com H.E. e Groccot. Para micologia, coletaram-se fragmentos de órgãos, exsudato e crostas da pele, sendo realizado exame direto e cultivo a 37oC. Macroscopicamente, o animal apresentava alopecia, caquexia e ulcerações cutâneas de 1-4 cm. Histologicamente, nas ulcerações, a derme continha infiltrado de mononucleares e proliferação fibroblástica. Mediante utilização de Groccot, encontraram-se hifas e/ou pseudo-hifas e blastoconídeos intralesionais. Em cultivos de crostas e exsudato, observaram-se colônias brilhantes, com superfície lisa e coloração branca a creme. A microscopia das colônias revelou células leveduriformes ovaladas ou alongadas, com brotamento unipolar, gram-positivas. No microcultivo em fubá, observaram-se blastoconídeos globosos terminais, com parede espessa e pseudomicélio abundante e ramificado, com formação de tubo germinativo em albumina de ovo, sendo a levedura classificada como Candida albicans. O estudo aborda o risco da infecção por micoses oportunistas como a candidíase em animais silvestres em cativeiro. PALAVRAS-CHAVES: Candidiasis, Candida albicans, pele, Cebus apella. KEY WORDS: Candidiasis, Candida albicans, Cebus apella, skin.
Leveduras do gênero Candida têm sido freqüentemente isoladas de animais domésticos e silvestres, entretanto, candidíase não tem sido reportada em primatas. Encaminhou-se à Faculdade de Veterinária, Departamento de Patologia Animal, um macaco-prego (Cebus apella para necropsia, que vinha apresentando emagrecimento profundo e lesões ulcerativas de pele e mucosas. Fragmentos de pele e órgãos foram processados para histologia e corados com H.E. e Groccot. Para micologia, coletaram-se fragmentos de órgãos, exsudato e crostas da pele, sendo realizado exame direto e cultivo a 37oC. Macroscopicamente, o animal apresentava alopecia, caquexia e ulcerações cutâneas de 1-4 cm. Histologicamente, nas ulcerações, a derme continha infiltrado de mononucleares e proliferação fibroblástica. Mediante utilização de Groccot, encontraram-se hifas e/ou pseudo-hifas e blastoconídeos intralesionais. Em cultivos de crostas e exsudato, observaram-se colônias brilhantes, com superfície lisa e coloração branca a creme. A microscopia das colônias revelou células leveduriformes ovaladas ou alongadas, com brotamento unipolar, gram-positivas. No microcultivo em fubá, observaram-se blastoconídeos globosos terminais, com parede espessa e pseudomicélio abundante e ramificado, com formação de tubo germinativo em albumina de ovo, sendo a levedura classificada como Candida albicans. O estudo aborda o risco da infecção por micoses oportunistas como a candidíase em animais silvestres em cativeiro.
PALAVRAS-CHAVES: Candidiasis, Candida albicans, pele, Cebus apella.Candida spp has been frequently isolated from domestic and sylvan animals, however, Candidiasis has not been reported in primates. One Cebus apella, with progressive thinning and ulcerative skin lesions and mucous, was necropsied. Fragments of tissue were collected and processed for histology. Coloration of H.E. and Groccot was made. For mycology was collected tissue, exsudate, and skin crusts. Direct exam was made, and samples cultivated at 37oC in agar Sabouraud with cloranfenicol and agar corn. Macroscopically the animal presented; itself extremely thin with ulcerative lesions on the skin, ranging from 1 to 4 cm. Histologically, on dermis ulcerations, there was mononuclear infiltrate and fibroblastic proliferation. With Groccot, it was observed intralesionally hyphae and blastoconidia. The direct exam showed round and/or ovalate gram positive cells, compatible with yeast. The cultives showed shining colonies with a smooth surface, some of them with edges fringed and white-yellowish coloration. The colonies showed yeast cells with ovalate or alongate forms and sprouting unipolar on microscopy. With microcultive, it was found globosous blastoconidia, with wall thick and pseudohyfaes abundant and ramified. There was the formation of a germinative tube, confirming the C. albicans species. This study shows the risk of candidiasis in wildlife primates living on captivity.
KEY WORDS: Candidiasis, Candida albicans, Cebus apella, skin.
Anelise Oliveira Fonseca
Cell-mediated immunity by Th1-type CD4(+) T cells is the predominant host defense mechanism against mucosal candidiasis. However, studies using an estrogen-dependent murine model of vaginal candidiasis have demonstrated little to no change in resident vaginal T cells during infection and no systemic T-cell infiltration despite the presence of Candida-specific systemic Th1-type responses in infected mice. The present study was designed to further investigate these observations by characterizing T-cell activation and cell adhesion molecule expression during primary and secondary C. albicans vaginal infections. While flow cytometry analysis of activation markers showed some evidence for activation of CD3(+) draining lymph node and/or vaginal lymphocytes during both primary and secondary vaginal Candida infection, CD3(+) cells expressing the homing receptors and integrins alpha(4)beta(7), alpha(M290)beta(7), and alpha(4)beta(1) in draining lymph nodes of mice with primary and secondary infections were reduced compared to results for uninfected mice. At the local level, few vaginal lymphocytes expressed integrins, with only minor changes observed during both primary and secondary infections. On the other hand, immunohistochemical analysis of vaginal cell adhesion molecule expression showed increases in mucosal addressin cell adhesion molecule 1 and vascular cell adhesion molecule 1 expression during both primary and secondary infections. Altogether, these data suggest that although the vaginal tissue is permissive to cellular infiltration during a vaginal Candida infection, the reduced numbers of systemic cells expressing the reciprocal cellular adhesion molecules may preempt cellular infiltration, thereby limiting Candida-specific T-cell responses against infection. PMID:11447188
Wormley, F L; Chaiban, J; Fidel, P L
Full Text Available Bee Venom (BV is a natural substance, reported to booster the immune system. This study aimed at evaluating the effects of bee venom in stimulation of the immune system in mice infected with intracerebral Candidiasis probing for its possible use in treatment of this ailment. In vivo study included three groups of mice; bee venom-treated Candida infected group, untreated Candida-infected group and control group. Mice in the first two groups received intracerebral (i.c. inoculation of C. albicans, while the control mice were inoculated i.c. with sterile saline. Mice of first group, the BV-treated group; received thereafter SC injection of BV for 4 days. On 5th day, mice of all groups were sacrificed and Candida infection was evaluated by culture of homogenized brain tissue on Sabouraud dextrose agar. Stimulation of the immune system was assessed by determining TNF-? and IFN-? mRNA expression in splenocytes by real-time PCR (RT-PCR. In the in vitro study, direct effect of BV as antifungal agent and its effect on phagocytic function of neutrophils were evaluated. The results revealed that BV-treated mice had significantly low fungal load in the brain, with significantly high TNF-? but insignificantly high IFN-? mRNA expression in splenocytes. BV had no direct antifungal effect, but it enhanced phagocytic activity of neutrophils. It was concluded that treatment with BV could result in significant therapeutic effect in intracerebral Candidiasis and thereby could be effective in resistant life-threatening infections.
Nermine K.M. Saleh
Full Text Available BACKGROUND: Oropharyngeal candidiasis is a common infection in patient receiving radiotherapy for head and neckcancer. Accurate and rapid identification of candida species is very important in clinical laboratory, because theincidence of candidiasis continues to rise after radiotherapy. The genus Candida has about 154 species that showdifferent level of resistance to antifungal drugs and have high degree of phenotypic similarity. The aim of this study wasto investigate oral yeast colonization and infection and resistance to antifungal drugs in these patients.METHODS: Thirty patients receiving a 6-week course of radiation therapy for treatment of head and neck cancer at theOncology Unit in Shafa Hospital, in 2008, were enrolled in the study. Specimens from patients were cultured weeklyfor Candida. All isolates were plated on CHROM agar and RPMI-based medium. They were subcultured and submittedfor antifungal susceptibility testing (nystatin, fluconazole, clotrimazole and ketoconazole and molecular typing.RESULTS: Infection (clinical and microbiological evidence occurred in 50% of the patients and Candida colonization(only microbiological evidence occurred in 70% of subjects in the first week. Candida albicans alone was isolated in94.9% of patient visits with positive cultures. Candida tropicalis was isolated from 5.1% of patient visits with positivecultures. All isolates were susceptible to nystatin, but did not respond to the other antifungal drugsCONCLUSIONS: The irradiation-induced changes of the intraoral environment such as xerostomia lead to increasedintraoral colonization by Candida species. All yeast isolates were susceptible to nystatin. Thus prophylactic therapywith nystatin should be considered for these patients.
Maryam Rad DMD, MSc
Full Text Available A candidíase recorrente cutânea ou mucosa é caracterizada pela ocorrência de, no mínimo, 4 episódios de candidíase no período de um ano. Não são conhecidos os fatores que levam à recorrência desta infecção. O presente estudo avaliou a resposta linfoproliferativa e a produção de IFN-g de pacientes com candidíase recorrente. Os índices de estimulação da resposta linfoproliferativa em culturas de células de pacientes com candidíase recorrente estimuladas com antígeno de Candida albicans, PPD e TT foram respectivamente de 6±8, 17±20 e 65±30. A adição de anticorpo monoclonal anti-IL-10 às culturas de células de 6 pacientes aumentou a resposta linfoproliferativa de 735±415 para 4143±1746 cpm. A produção de IFN-g em culturas de células estimuladas com antígeno de Candida, foi 162±345pg/ml. Pacientes com candidíase recorrente apresentam uma deficiência na resposta linfoproliferativa e na produção de IFN-g, podendo a resposta imune celular ao antígeno de Candida ser restaurada parcialmente através da neutralização da IL-10 in vitro.Recurrent cutaneous or mucosal candidiasis is characterized by the occurrence of at least four candidiasis episodes within a one-year period. The factors involved in recurrence of infection are still unknown. In the present study the lymphoproliferative response and the IFN-g production by candidiasis patients were evaluated. The stimulation index of mononuclear cell cultures of candidiasis patients stimulated with Candida albicans antigen, PPD and TT were 6±8, 17±20 and 65±30, respectively. The addition of monoclonal antibody anti-IL-10 to Candida albicans antigen stimulated cultures raised the lymphoproliferative response from 735±415 to 4143±1746 cpm. The IFN-g production by cells of candidiasis patients stimulated with Candida albicans antigen was 162±345pg/ml. Candidiasis patients have an impairment in the lymphoproliferative response specific to C. albicans antigen and on IFN-g production and the lymphoproliferative response can be partially restored, in vitro, by IL-10 neutralization.
Lucas P. Carvalho
Microbiological screening of Irish patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy reveals persistence of Candida albicans strains, gradual reduction in susceptibility to azoles, and incidences of clinical signs of oral candidiasis without culture evidence.
Patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) are prone to chronic mucocutaneous candidiasis, which is often treated with azoles. The purpose of this study was to characterize the oral Candida populations from 16 Irish APECED patients, who comprise approximately half the total number identified in Ireland, and to examine the effect of intermittent antifungal therapy on the azole susceptibility patterns of Candida isolates. Patients attended between one and four clinical evaluations over a 5-year period, providing oral rinses and\\/or oral swab samples each time. Candida was recovered from 14\\/16 patients, and Candida albicans was the only Candida species identified. Interestingly, clinical diagnosis of candidiasis did not correlate with microbiological evidence of Candida infection at 7\\/22 (32%) clinical assessments. Multilocus sequence typing analysis of C. albicans isolates recovered from the same patients on separate occasions identified the same sequence type each time. Fluconazole resistance was detected in isolates from one patient, and isolates exhibiting a progressive reduction in itraconazole and\\/or fluconazole susceptibility were identified in a further 3\\/16 patients, in each case correlating with the upregulation of CDR- and MDR-encoded efflux pumps. Mutations were also identified in the ERG11 and the TAC1 genes of isolates from these four patients; some of these mutations have previously been associated with azole resistance. The findings suggest that alternative Candida treatment options, other than azoles such as chlorhexidine, should be considered in APECED patients and that clinical diagnosis of oral candidiasis should be confirmed by culture prior to the commencement of anti-Candida therapy.
McManus, Brenda A
The MICs of fluconazole for strains of Candida species and the levels of fluconazole in serum were determined at day 0 and day 14 for 23 human immunodeficiency virus-infected patients with oral candidiasis who were treated orally with 100 mg of fluconazole per day for 14 days. Among the 23 patients, 11 (48%) were not clinically cured and had persistent isolation of Candidiasis albicans (n = 10) and/or presence of non-C. albicans (n = 6). Clinical response could be predicted by the susceptibility of the strain to fluconazole determined at day 0. All 12 patients who were cured were infected with a strain for which the MIC was 3.12 mg/liter experienced clinical failure. These data suggest that a C. albicans strain could be defined as being susceptible when the MIC of fluconazole is 3.12 mg/liter.
Lacassin, F; Damond, F; Chochillon, C; Longuet, P; Lebras, J; Vilde, J L; Leport, C
Tumor necrosis factor ? is important for the host defense against intracellular pathogens. We tested the effect of mouse analogs of human TNF-? antagonists, the rat anti-mouse TNF-? monoclonal antibody (XT22) and the soluble mouse 75 kDa TNF-? receptor fused to the Fc portion of mouse IgG1 (p75-Fc), on the susceptibility of mice to hematogenously disseminated candidiasis (HDC) and oropharyngeal candidiasis (OPC). Both XT22 and p75-Fc significantly reduced mice survival, increased kidney fungal burden, and reduced leukocyte recruitment during HDC. However, only XT22 significantly increased the oral fungal burden and reduced leukocyte recruitment during OPC. This result suggests that XT22 and p75-Fc affect host susceptibility to different types of Candida albicans infections by different inhibitory mechanisms. PMID:25007095
Park, Hyunsook; Solis, Norma V; Louie, James S; Spellberg, Brad; Rodriguez, Natalie; Filler, Scott G
A quantitative real-time RT-PCR system was established to identify which secreted aspartyl proteinase (SAP) genes are most highly expressed and potentially contribute to Candida albicans infection of human epithelium in vitro and in vivo. C. albicans SC5314 SAP1–10 gene expression was monitored in organotypic reconstituted human epithelium (RHE) models, monolayers of oral epithelial cells, and patients with oral (n=17) or vaginal (n=17) candidiasis. SAP gene expression was also analysed in ...
Naglik, Julian R.; Moyes, David; Makwana, Jagruti; Kanzaria, Priya; Tsichlaki, Elina; Weindl, Gu?nther; Tappuni, Anwar R.; Rodgers, Catherine A.; Woodman, Alexander J.; Challacombe, Stephen J.; Schaller, Martin; Hube, Bernhard
Oropharyngeal and esophageal candidiasis (OPEC) is a frequent opportunistic mycosis in immunocompromised patients. Azole-resistant OPEC is a refractory form of this infection occurring particularly in human immunodeficiency virus (HIV)-infected patients. The procedures developed by the Antifungal Subcommittee of the National Committee for Clinical Laboratory Standards (NCCLS) are an important advance in standardization of in vitro antifungal susceptibility methodology. In order to further und...
Walsh, Thomas J.; Gonzalez, Corina E.; Piscitelli, Steven; Bacher, John D.; Peter, Joanne; Torres, Richard; Shetti, Daiva; Katsov, Victoria; Kligys, Kristina; Lyman, Caron A.
Echinocandins have become a first-line therapy for invasive candidiasis (IC). Using phase 3 trial data for patients with IC, pharmacokinetic-pharmacodynamic (PK-PD) relationships for efficacy for micafungin were examined. Micafungin exposures were estimated using a population pharmacokinetic model, and univariable and multivariable logistic regressions were used to identify factors associated with outcome, including the micafungin area under the concentration-time curve (AUC)/MIC ratio. Monte...
Andes, David; Ambrose, Paul G.; Hammel, Jeffrey P.; Wart, Scott A.; Iyer, Varsha; Reynolds, Daniel K.; Buell, Donald N.; Kovanda, Laura L.; Bhavnani, Sujata M.
Previous studies using in vivo candidiasis models have demonstrated that the concentration-associated pharmacodynamic indices, the maximum concentration of a drug in serum/MIC and 24-h area under the curve (AUC)/MIC, are associated with echinocandin treatment efficacy. The current investigations used a neutropenic murine model of disseminated Candida albicans and C. glabrata infection to identify the 24-h AUC/MIC index target associated with a stasis and killing endpoint for the echinocandin,...
Andes, D. R.; Diekema, D. J.; Pfaller, M. A.; Marchillo, K.; Bohrmueller, J.
Thirty-nine adult patients with human immunodeficiency virus infection and oral candidiasis were randomly assigned to receive either one fluconazole capsule (100 mg) or five clotrimazole troches (10 mg each) daily for 14 days. Among 36 evaluable patients, clinical resolution rates were 100 and 65%, respectively (P = 0.018). Mycological eradication rates were 75 and 20%, respectively (P = 0.004). Fluconazole-treated patients were more likely to remain disease free during follow-up than those t...
Koletar, S. L.; Russell, J. A.; Fass, R. J.; Plouffe, J. F.
OBJECTIVE--To determine whether in vitro resistance of Candida albicans to the imidazoles (ketoconazole, clotrimazole and itraconazole) is associated with recurrence of candida vaginitis. DESIGN--Candida isolates were collected before, during and after treatment from women with recurrent vaginal candidiasis (> or = 4 episodes/year), randomised into two prospective studies: (1) 56 women treated with ketoconazole 400 mg/daily for 7 days; (2) 44 women randomised to receive itraconazole 200 mg or...
Fong, I. W.; Bannatyne, R. M.; Wong, P.
Se realizó un ensayo clínico terapéutico para cuatro antifúngicos, dos tópicos (clotrimazol y nistatina) y dos sistémicos (ketoconazol e itraconazol), en 97 pacientes VIH+/SIDA, con candidiasis orofaringea, que acudieron espontáneamente al servicio de CISIDA del estado de Puebla, México.Los grupos, por tipo de tratamiento, fueron homogéneos en edad, sexo, y número de episodios previos. La mayoría de los pacientes presentó la forma clínica pseudomembranosa (93.8%), con episodios a...
Morphogenetic conversions contribute to the pathogenesis of Candida albicans invasive infections. Many studies to date have convincingly demonstrated a link between filamentation and virulence; however, relatively little is known regarding the role of the filament-to-yeast transition during the pathogenesis of invasive candidiasis. We previously identified the C. albicans pescadillo homolog (PES1) as essential during yeast growth and growth of lateral yeast on hyphae but not during hyphal gro...
Uppuluri, Priya; Chaturvedi, Ashok K.; Jani, Niketa; Pukkila-worley, Read; Monteagudo, Carlos; Mylonakis, Eleftherios; Ko?hler, Julia R.; Lopez Ribot, Jose L.
In leukopenic mice with severe systemic candidiasis, single-dose treatment (5 mg of amphotericin B [AMB]/kg of body weight) with long-circulating polyethylene glycol-coated AMB liposomes (PEG-AMB-LIP) resulted in zero mortality and a significant reduction in the number of viable Candida albicans in the kidney, whereas 70% mortality was seen in mice treated with five daily doses of AmBisome (5 mg of AMB/kg . day). When the first ...
Etten, E. W. M.; Snijders, S. V.; Vianen, W.; Bakker-woudenberg, I. A. J. M.
This research was conducted to investigate the amount of Candida albicans in vaginal secretion of Vaginal Candidiasis patients administered with Zn-enriched virgin coconut oil. Thirty respondents were selected based on several criteria as follows: the number of C. albicans colonies in the vaginal secretion was more than 105 cfu.ml-1, voluntary, healthy, willing to sign the informed consent and resided in Purwokerto. In Group A, 10 women were administered 2 tablespoons per day of Zn-enriched v...
The incidence of invasive candidiasis caused by non-albicans Candida (NAC) spp. is increasing. The aim of this analysis was to evaluate the efficacy of micafungin, caspofungin and liposomal amphotericin B in patients with invasive candidiasis and candidaemia caused by different Candida spp. This post hoc analysis used data obtained from two randomised phase III trials was conducted to evaluate the efficacy and safety of micafungin vs. caspofungin and micafungin vs. liposomal amphotericin B. Treatment success, clinical response, mycological response and mortality were evaluated in patients infected with C. albicans and NAC spp. Treatment success rates in patients with either C. albicans or NAC infections were similar. Outcomes were similar for micafungin, caspofungin and liposomal amphotericin B. Candida albicans was the most prevalent pathogen recovered (41.0%), followed by C. tropicalis (17.9%), C. parapsilosis (14.4%), C. glabrata (10.4%), multiple Candida spp. (7.3%) and C. krusei (3.2%). Age, primary diagnosis (i.e. candidaemia or invasive candidiasis), previous corticosteroid therapy and Acute Physiology and Chronic Health Evaluation II score were identified as potential predictors of treatment success and mortality. Micafungin, caspofungin and liposomal amphotericin B exhibit favourable treatment response rates that are comparable for patients infected with different Candida spp. PMID:23786573
Cornely, Oliver A; Vazquez, Jose; De Waele, Jan; Betts, Robert; Rotstein, Coleman; Nucci, Marcio; Pappas, Peter G; Ullmann, Andrew J
Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy syndrome (APECED) or autoimmune polyendocrine syndrome type 1 (APS-1) is a rare autosomal recessive disease caused by mutations of the AutoImmune REgulator (AIRE) gene, an important mediator of tolerance to self-antigens. It is characterized by two out of three major components: chronic mucocutaneous candidiasis, hypoparathyroidism and Addison's disease. We present an 11-year-old girl suffering from recurrent episodes of mucocutaneous candidiasis and onychomycosis from 1 to 6 years of age, and transient alopecia at the age of 4 years. Hypoparathyroidism and dental enamel hypoplasia were diagnosed at 8 years. Autoantibodies to thyroid and adrenal glands were not detected and all other endocrine functions have remained normal. Genetic analysis revealed that the patient was homozygous for the mutation T16M in exon 1 of the AIRE gene (p.T16M, c.47C>T). This is the first APECED case reported for carrying this mutation in homozygous form. Parents were third cousins and heterozygous carriers of this mutation. PMID:21932610
Kollios, Konstantinos; Tsolaki, Anastasia; Antachopoulos, Charalampos; Moix, I; Morris, Michael A; Papadopoulou, Maria; Roilides, Emmanuel
Full Text Available Abstract Background In Tanzania, little is known on the species distribution and antifungal susceptibility profiles of yeast isolates from HIV-infected patients with primary and recurrent oropharyngeal candidiasis. Methods A total of 296 clinical oral yeasts were isolated from 292 HIV-infected patients with oropharyngeal candidiasis at the Muhimbili National Hospital, Dar es Salaam, Tanzania. Identification of the yeasts was performed using standard phenotypic methods. Antifungal susceptibility to fluconazole, itraconazole, miconazole, clotrimazole, amphotericin B and nystatin was assessed using a broth microdilution format according to the guidelines of the Clinical and Laboratory Standard Institute (CLSI; M27-A2. Results Candida albicans was the most frequently isolated species from 250 (84.5% patients followed by C. glabrata from 20 (6.8% patients, and C. krusei from 10 (3.4% patients. There was no observed significant difference in species distribution between patients with primary and recurrent oropharyngeal candidiasis, but isolates cultured from patients previously treated were significantly less susceptible to the azole compounds compared to those cultured from antifungal naïve patients. Conclusion C. albicans was the most frequently isolated species from patients with oropharyngeal candidiasis. Oral yeast isolates from Tanzania had high level susceptibility to the antifungal agents tested. Recurrent oropharyngeal candidiasis and previous antifungal therapy significantly correlated with reduced susceptibility to azoles antifungal agents.
Rijs Antonius JMM
Full Text Available SciELO Spain | Language: Spanish Abstract in spanish Objetivo: Determinar la validez de la candidiasis oral (CO) como marcador clínico de evolución en los pacientes infectados por el Virus de la Inmunodeficiencia Humana. Diseño del estudio: En 1992, se efectuó una exploración oral a un colectivo de 200 pacientes infectados por VIH, con una edad media [...] de 36,8±7 años (rango 25-46 años) para establecer el diagnóstico de CO. Se registraron las variables edad, sexo, tiempo de evolución de la enfermedad, conducta de riesgo, número de linfocitos CD4/µL, estadio clínico y tratamiento antirretroviral. De los 200 pacientes del grupo de estudio, 157 no cumplían criterios de SIDA en el momento de la exploración basal y a éstos se les efectuó un seguimiento semestral hasta que cumplieron dichos criterios, concluyendo el estudio al final de 2001. Resultados: De los 157 pacientes seleccionados, 71 (45,2%) no presentaron CO y de éstos el 28,7% evolucionó a SIDA durante el período de seguimiento. De los 86 (54,8%) pacientes con CO, el 48,2% evolucionó a SIDA (RR=2,71). Al trasladar el origen del estudio al año 1997 cuando se inició la administración de la terapia antirretroviral de alta eficacia (TAAE), no se observaron diferencias en el porcentaje de pacientes que evolucionaron a SIDA en relación a la existencia o no de CO en la exploración basal. El análisis multivariante demostró que la asociación de la variable de exposición CO con la evolución a SIDA no alcanzó un valor predictivo. Conclusiones: El valor pronóstico a largo plazo de la CO, no se ha determinado en pacientes que reciben terapia antirretroviral de alta eficacia (TAAE). La recuperación inmunológica y la disminución de enfermedades oportunistas observadas tras la administración de TAAE, hacen que muchos pacientes que alcanzaron la condición de SIDA no cumplan en la actualidad dichos criterios, lo que obliga a renovar la propia definición del síndrome para poder evaluar marcadores de pronóstico. Abstract in english Objective: To determine the validity of oral candidiasis (OC) as a clinical marker of progression in patients with human immunodeficiency virus infection. Study design: In 1992, an oral examination was carried out on a group of 200 HIV-infected patients with a mean age of 36.8 ± 7 years (range 25-46 [...] years) to establish the diagnosis of OC. The following variables were recorded: age, sex, duration of the disease, risk behaviour, CD4 lymphocyte count, clinical stage and antiretroviral treatment. Of the 200 patients in the group evaluated, 157 did not fulfil the criteria for AIDS at the time of the baseline examination; these patients constitute the study group and underwent 6-monthly follow-up until they fulfilled these criteria. The study was concluded at the end of 2001. Results: Of the 157 patients selected, 71 (45.2%) did not present OC and, of these, 28.7% progressed to AIDS during the follow-up period. Of the 86 (54.8%) patients with OC, 48.2% progressed to AIDS (RR= 2.71). If the start date of the study was taken as 1997, when highly active antiretroviral therapy (HAART) was introduced, no differences were found in the percentage of patients who progressed to AIDS with respect to the presence or absence of OC at the baseline examination. Multivariate analysis demonstrated that the association of the presence of OC with progression to AIDS did not reach a predictive value. Conclusions: The long-term prognostic value of OC has not been established in patients receiving highly active antiretroviral therapy (HAART). The immunological recovery and the reduction in the number of opportunistic diseases observed after the administration of HAART means that many patients who developed AIDS do not currently satisfy these criteria, making a review of the definition of the syndrome itself a necessity in order to be able to evaluate prognostic markers.
Javier, Fernández Feijoo; Pedro, Diz Dios; Xosé Luis, Otero Cepeda; Jacobo, Limeres Posse; Javier de, la Fuente Aguado; Antonio, Ocampo Hermida.
Candida albicans is a commensal fungus that can cause systemic disease in patients with breaches in mucosal integrity, indwelling catheters, and defects in phagocyte function. Although circulating human and murine monocytes bind C. albicans and promote inflammation, it remains unclear whether C-C chemokine receptor 2 (CCR2)- and Ly6C-expressing inflammatory monocytes exert a protective or a deleterious function during systemic infection. During murine systemic candidiasis, interruption of CCR2-dependent inflammatory monocyte trafficking into infected kidneys impaired fungal clearance and decreased murine survival. Depletion of CCR2-expressing cells led to uncontrolled fungal growth in the kidneys and brain and demonstrated an essential antifungal role for inflammatory monocytes and their tissue-resident derivatives in the first 48 hours postinfection. Adoptive transfer of purified inflammatory monocytes in depleted hosts reversed the defect in fungal clearance to a substantial extent, indicating a compartmentally and temporally restricted protective function that can be transferred to enhance systemic innate antifungal immunity. PMID:23922372
Ngo, Lisa Y; Kasahara, Shinji; Kumasaka, Debra K; Knoblaugh, Sue E; Jhingran, Anupam; Hohl, Tobias M
Invasive candidiasis (IC) is associated with high mortality in intensive care unit (ICU) patients. Timely diagnosis of this potentially fatal condition remains a challenge; on the other hand, the criteria for initiating empirical antifungal therapy in critically ill patients are not well defined in different patient population and ICU settings. Alongside the international guidelines, reaching regional and local consensus on diagnosis and management of IC in ICU setting is essential. This report summarizes our present status of IC management in ICU, considered by a group of Iranian experts in the fields of intensive care and infectious diseases. A round table of 17 experts was held to review the available data and discuss the optimal treatment strategies for IC in critical care setting. Comparative published data on the management of IC were analytically reviewed and the commonly asked questions about the management of IC in ICU were isolated. These questions were interactively discussed by the panel and audience responses were taken to consolidate point-to-point agreement with the panel arriving at consensus in many instances. The responses indicated that patients’ risk stratification, clinical discretion, fungal diagnostic techniques and the empirical therapy for IC are likely to save more patients. Treatment options were recommended to be based on the disease severity, prior azole exposure, and the presence of suspected azole-resistant Candida species. This report was reviewed, edited and discussed by all participants to include further evidence-based insights. The panel expects such endorsed recommendations to be soon formulated for implementation across the country.
Ahmadi, Arezoo; Ardehali, Seyed Hossein; Beigmohammadi, Mohammad Taghi; Hajiabdolbaghi, Mahboubeh; Hashemian, Seyed Mohammad Reza; Kouchek, Mehran; Majidpour, Ali; Mokhtari, Majid; Moghaddam, Omid Moradi; Najafi, Atabak; Nejat, Reza; Niakan, Mohammad; Lotfi, Amir Hossein; Amirsavadkouhi, Ali; Shirazian, Farzad; Tabarsi, Payam; Taher, Mahshid Talebi; Torabi-Nami, Mohammad
Vulvovaginal candidiasis is the second cause of vaginal infection in the USA. Clinical treatment of C. albicans infections is routinely performed with polyenes and azole derivatives. However, these drugs are responsible for undesirable side effects and toxicity. In addition, C. albicans azole and echinocandin resistance has been described. Propolis is a bee product traditionally used due to its antimicrobial, anti-inflammatory, and other properties. Therefore, the present work aimed to evaluate different propolis presentations in order to evaluate their in vitro and in vivo efficacy. The methodologies involved antifungal evaluation, chemical analysis, and the effects of the rheological and mucoadhesive properties of propolis based gels. The obtained results demonstrated the fungicide action of propolis extracts against all three morphotypes (yeast, pseudohyphae, and hyphae) studied. The highest level of fungal cytotoxicity was reached at 6-8 hours of propolis cell incubation. Among the based gel formulations developed, the rheological and mucoadhesive results suggest that propolis based carbopol (CP1%) and chitosan gels were the most pseudoplastic ones. CP1% was the most mucoadhesive preparation, and all of them presented low thixotropy. Results of in vivo efficacy demonstrated that propolis based gels present antifungal action similar to clotrimazole cream, suggesting that future clinical studies should be performed. PMID:23997797
Berretta, Andresa Aparecida; de Castro, Patrícia Alves; Cavalheiro, Amanda Henriques; Fortes, Vanessa Silveira; Bom, Vinícius Pedro; Nascimento, Andresa Piacezzi; Marquele-Oliveira, Franciane; Pedrazzi, Vinícius; Ramalho, Leandra Naira Zambelli; Goldman, Gustavo Henrique
Vulvovaginal candidiasis is the second cause of vaginal infection in the USA. Clinical treatment of C. albicans infections is routinely performed with polyenes and azole derivatives. However, these drugs are responsible for undesirable side effects and toxicity. In addition, C. albicans azole and echinocandin resistance has been described. Propolis is a bee product traditionally used due to its antimicrobial, anti-inflammatory, and other properties. Therefore, the present work aimed to evaluate different propolis presentations in order to evaluate their in vitro and in vivo efficacy. The methodologies involved antifungal evaluation, chemical analysis, and the effects of the rheological and mucoadhesive properties of propolis based gels. The obtained results demonstrated the fungicide action of propolis extracts against all three morphotypes (yeast, pseudohyphae, and hyphae) studied. The highest level of fungal cytotoxicity was reached at 6–8 hours of propolis cell incubation. Among the based gel formulations developed, the rheological and mucoadhesive results suggest that propolis based carbopol (CP1%) and chitosan gels were the most pseudoplastic ones. CP1% was the most mucoadhesive preparation, and all of them presented low thixotropy. Results of in vivo efficacy demonstrated that propolis based gels present antifungal action similar to clotrimazole cream, suggesting that future clinical studies should be performed.
de Castro, Patricia Alves; Fortes, Vanessa Silveira; Bom, Vinicius Pedro; Nascimento, Andresa Piacezzi; Marquele-Oliveira, Franciane; Pedrazzi, Vinicius; Ramalho, Leandra Naira Zambelli; Goldman, Gustavo Henrique
The antifungal activity of sertaconazole (SZ), 1-(2-[(7-chlorobenzo[b]thien-3-yl)methoxyl]- 2-(2,4-dichlorophenyl)ethyl)-1H-imidazole, has been assessed in vivo in comparison with miconazole (MZ) in a murine vaginal candidiasis model. Mice (eight per group) were maintained in oestrus by subcutaneous injection of oestradiol benzoate (25 mg/kg) 5 days before and 2 days after inoculation intravaginally with 5 x 10(4) blastospores of C. albicans (strain No. 17) in 0.05 ml. Animals were treated with 0.03 ml of the appropriate 2% cream formulation 1 h after infection (single dose regimen) or on days 3, 4 and 5 post-infection (three-dose regimen). The efficacy was measured in each test group by Sabouraud agar plate count of vaginal specimens and expressed as % reduction in the number of yeast cells with regard to the control group (infected and untreated). The two treatments indicated a significant reduction (according to the non-parametric method of Mann-Whitney) (p greater than 0.05) for both SZ (97.9% and 93.6%) and MZ (77.5% and 76.9%) groups. When the values from SZ and MZ were compared, SZ proved more active than MZ in the single dose regimen. PMID:2100249
Palacin, C; Sacristán, A; Ortiz, J A
Oropharyngeal candidiasis (OPC) is the most common oral infection in HIV+ persons. Previous studies suggest a role for CD8+ T-cells against OPC when CD4+ T-cells are lost, but enhanced susceptibility to infection occurs when CD8+ T-cell migration is inhibited by reduced tissue E-cadherin. Objective Conduct a longitudinal study of tissue CD8+ T-cells and E-cadherin expression before, during, and after episodes of OPC. Methods Oral fungal burden was monitored and tissue was evaluated for CD8+ T-cells and E-cadherin over a one-year period in HIV+ persons with a history of, or an acute episode of OPC. Results While longitudinal analyses precluded formal interpretations, point prevalence analyses of the dataset revealed that when patients experiencing OPC were successfully treated, tissue E-cadherin expression was similar to patients who had not experienced OPC, and higher numbers of CD8+ T-cells were distributed throughout OPC? tissue under normal expression of E-cadherin. Conclusion These results suggest that 1) reduction in tissue E-cadherin expression in OPC+ patients is not permanent, and 2) high numbers of CD8+ T-cells can be distributed throughout OPC? tissue under normal E-cadherin expression. Together these results extend our previous studies and continue to support a role for CD8+ T-cells in host defense against OPC.
Quimby, K.; Lilly, E.A.; Zacharek, M.; McNulty, K.; Leigh, J.E.; Vazquez, J.E.; Fidel, P.L.
In a randomized, single-blind, parallel study the safety and efficacy of 2% butoconazole nitrate cream used for 3 days were compared with those of 1% econazole nitrate cream used for 7 days at night in patients with vulvovaginal candidiasis. Patients in both treatment groups had positive potassium hydroxide smears and fungal cultures, and were similar in age, disease duration and history, obstetric history and contraceptive use. Of the 75 patients enrolled, 63 with a Candida albicans infection were included in the efficacy analyses. Evaluations were made at the start of the study (visit 1), after 10-23 days (visit 2) and after 24-45 days (visit 3). Both drugs significantly reduced all signs and symptoms, and at visits 2 and 3 the percentages of patients considered microbiologically, clinically and therapeutically cured were consistently higher for butoconazole- than for econazole-treated patients, although differences were not statistically different. Although both drugs were safe and well tolerated, it is concluded that butoconazole because of its much shorter regimen and superior clinical and microbiological performance was the drug of choice. PMID:2257961
Ruf, H; Vitse, M
We developed a liposome-intercalated preparation of amphotericin B by using small, unilamellar vesicles 0.06 to 0.1 micron in diameter. In contrast to previously described liposomal preparations of amphotericin B, these vesicles have the advantage that they are small enough to be filter sterilized. We compared the efficacy of liposomal amphotericin B with that of the commercial drug given as an intravenous bolus every other day for 13 days (seven doses) in mice with disseminated candidiasis. Survival rates were similar for the two preparations at each dosage of amphotericin B; however, the highest survival rates occurred at dosages of liposomal amphotericin B which would be lethal to these animals if administered as the commercial drug. Viable colony counts of fungi in various organs, particularly the kidneys, tended to be lower with increasing dosage of the drug. However, some organisms persisted even after 13 days. These studies indicate that liposomal formulations of amphotericin B merit further investigation because of their improved therapeutic margins. PMID:6385839
Tremblay, C; Barza, M; Fiore, C; Szoka, F
Isolates of Candida africana and C. dubliniensis were recovered from patients with vulvovaginal candidiasis (VVC). The isolates were initially identified as C. albicans through use of the API Candida System. We retrospectively reexamined 1014 vaginal isolates presumptively determined to be C. albicans at the Department of Obstetrics and Gynecology of Peking University Shenzhen Hospital from 1 January 2003 through 31 December 2012. Our objective was to determine, via detection of the HWP1 gene, if any of the isolates were C. africana or C. dubliniensis. One and a half percent of these isolates (15/1014) were found to be C. africana, whereas C. dubliniensis was not detected. The 15 C. africana isolates were susceptible to nystatin, fluconazole, itraconazole, miconazole, and clotrimazole. Candida africana could not be recovered from clinical vaginal specimens from the 15 patients at follow-up on days 7-14 and days 30-35 when treated with different antifungal agents. We conclude that C. africana, but not C. dubliniensis, was present in the vaginal samples of patients with VVC. The C. africana isolates were susceptible to the tested antifungal agents. VVC caused by C. africana appears to respond well to current therapies. PMID:25023482
Shan, Yingying; Fan, Shangrong; Liu, Xiaoping; Li, Jianling
Purpose: The aim of this pharmaco-epidemiological study was to evaluate the prevalence of oropharyngeal candidiasis (OPC) in cancer patients treated with chemotherapy and/or radiotherapy. Methods and Materials: Signs and symptoms of OPC were noted for all patients. Antifungal therapeutic management was recorded in OPC patients. Patients receiving local antifungal treatments were monitored until the end of treatment. Results: Enrolled in the study were 2,042 patients with solid tumor and/or lymphoma treated with chemotherapy and/or another systemic cancer treatment and/or radiotherapy. The overall prevalence of OPC was 9.6% (95% confidence interval, 8.4%-11.0%] in this population. It was most frequent in patients treated with combined chemoradiotherapy (22.0%) or with more than two cytotoxic agents (16.9%). Local antifungal treatments were prescribed in 75.0% of OPC patients as recommended by guidelines. The compliance to treatment was higher in patients receiving once-daily miconazole mucoadhesive buccal tablet (MBT; 88.2%) than in those treated with several daily mouthwashes of amphotericin B (40%) or nystatin (18.8%). Conclusion: OPC prevalence in treated cancer patients was high. Local treatments were usually prescribed as per guidelines. Compliance to local treatments was better with once-daily drugs.
Four strains of Candida albicans, isolated from two patients with AIDS who had undergone prolonged fluconazole therapy for oral candidiasis, were studied in a model of disseminated murine candidiasis. Pre- and posttreatment isolates from each patient were genetically related, and the fluconazole MICs for the strains had increased significantly, from 0.25 to 32 micrograms/ml for the strains isolated from patient 1 and from 1.0 to 16 micrograms/ml for the strains isolated from patient 2. Mice w...
Barchiesi, F.; Najvar, L. K.; Luther, M. F.; Scalise, G.; Rinaldi, M. G.; Graybill, J. R.
The protective roles of different lymphocyte subsets were investigated in a rat vaginal candidiasis model by adoptive transfer of vaginal lymphocytes (VL) or sorted, purified CD3+ T cells, CD4+ or CD8+ T cells, or CD3? CD5+ B cells from the vaginas of naïve or immune rats following three rounds of Candida albicans infection. The adoptive transfer of total VL from nonimmune animals did not alter the course of vaginal candidiasis of the recipient rats. In contrast, the animals receiving tota...
Santoni, Giorgio; Boccanera, Maria; Adriani, Daniela; Lucciarini, Roberta; Amantini, Consuelo; Morrone, Stefania; Cassone, Antonio; Bernardis, Flavia
Background: Vaginal candidiasis (VC) is one of the most common fungal diseases. Candida albicans is the most common causative fungus and has been isolated from more than 80% of specimens obtained from women with VC. Ketoconazole is the first orally active antifungal, the dosage for VC is 200 mg twice daily for 5 days. Fluconazole is the newer oral antifungal, its dosage for VC is a single oral dose of 150 mg. Since fluconazole 150 mg is considerably expensive, a single...
Jan Susilo; Arini Setiawati; Iwan Darmansjah; Junita Indarti; Fitriyadi Kusuma
Fungal infections are an increasing cause of morbidity and mortality in patients with haematological malignancies. The organism most often responsible are Candida spp., particurarly Candida Albicans. This report describes our experience in a 63-year-old man who developed symptoms of hepatosplenic candidiasis caused by Candida tropicalis after treatment for acute myeloid leukaemia (AML). The fungal infection was successfully controlled using fluconazole, and the patient has been disease-free for more than 11 months after antileukemic chemotherapy without any recurrence of Candida infections. Our experience suggests that AML and chemotherapy associated fungal infections can be controlled with an appropriate therapeutic regimen. PMID:11524268
Quintini, G; Barbera, V; Gambino, R; Spadola, V; Minardi, V; Mariani, G
Full Text Available Abstract Background Prevention of preterm birth remains one of the most important challenges in maternity care. We propose a randomised trial with: a simple Candida testing protocol that can be easily incorporated into usual antenatal care; a simple, well accepted, treatment intervention; and assessment of outcomes from validated, routinely-collected, computerised databases. Methods/Design Using a prospective, randomised, open-label, blinded-endpoint (PROBE study design, we aim to evaluate whether treating women with asymptomatic vaginal candidiasis early in pregnancy is effective in preventing spontaneous preterm birth. Pregnant women presenting for antenatal care The study protocol draws on the usual antenatal care schedule, has been pilot-tested and the intervention involves only a minor modification of current practice. Women who agree to participate will self-collect a vaginal swab and those who are culture positive for Candida will be randomised (central, telephone to open-label treatment or usual care (screening result is not revealed, no treatment, routine antenatal care. Outcomes will be obtained from population databases. A sample size of 3,208 women with Candida colonisation (1,604 per arm is required to detect a 40% reduction in the spontaneous preterm birth rate among women with asymptomatic candidiasis from 5.0% in the control group to 3.0% in women treated with clotrimazole (significance 0.05, power 0.8. Analyses will be by intention to treat. Discussion For our hypothesis, a placebo-controlled trial had major disadvantages: a placebo arm would not represent current clinical practice; knowledge of vaginal colonisation with Candida may change participants' behaviour; and a placebo with an alcohol preservative may have an independent affect on vaginal flora. These disadvantages can be overcome by the PROBE study design. This trial will provide definitive evidence on whether screening for and treating asymptomatic candidiasis in pregnancy significantly reduces the rate of spontaneous preterm birth. If it can be demonstrated that treating asymptomatic candidiasis reduces preterm births this will change current practice and would directly impact the management of every pregnant woman. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12610000607077
Rickard Kristen R
In leukopenic mice with severe systemic candidiasis, single-dose treatment (5 mg of amphotericin B [AMB]/kg of body weight) with long-circulating polyethylene glycol-coated AMB liposomes (PEG-AMB-LIP) resulted in zero mortality and a significant reduction in the number of viable Candida albicans in the kidney, whereas 70% mortality was seen in mice treated with five daily doses of AmBisome (5 mg of AMB/kg · day). When the first of five daily doses of AmBisome was combined with a single low d...
Etten, Els W. M.; Snijders, Susan V.; Vianen, Wim; Bakker-woudenberg, Irma A. J. M.
This study was a non-comparative multicenter clinical trial to evaluate the efficacy and tolerability of itraconazole oral solution 200 mg/day (100 mg twice a day in the fasting state) for the treatment of oropharyngeal candidiasis in AIDS patients. We included 50 patients who were treated and followed for up to 3 weeks after ending therapy in the analysis. Mycological cures at the end of therapy occurred in 20/50 patients (40%), but colonization by Candida sp. was recorded in 42/50 (84%) by ...
Flávio de Queiroz-Telles; Nanci Silva; Carvalho, Miriam M.; Ana Paula Alcântara; Daniel da Matta; Barberino, Maria G.; Sergio Bartczak; Arnaldo Lopes Colombo
The safety, tolerance, and pharmacokinetics of amphotericin B lipid complex (ABLC) were studied in a cohort of pediatric cancer patients. Six children with hepatosplenic candidiasis (HSC) received 2.5 mg of ABLC/kg of body weight/day for 6 weeks for a total dosage of 105 mg/kg. Mean serum creatinine (0.85 +/- 0.12 mg/dl at baseline) was stable at the end of therapy at 0.85 +/- 0.18 mg/dl and at 1-month follow-up at 0.72 +/- 0.12 mg/dl. There was no increase in hepatic transaminases. Mean plasma concentrations over the dosing interval (C(ave)) and area under the curve from 0 to 24 h (AUC(0-24h)) increased between the first and seventh doses but were similar between doses 7 and 42, suggesting that steady state was achieved by day 7 of therapy. Following the final (42nd) dose of ABLC, mean AUC(0-24h) was 11.9 +/- 2.6 microg h/ml, C(ave) was 0.50 +/- 0.11 microg/ml, maximum concentration of the drug in whole blood was 1.69 +/- 0.75 microg/ml, and clearance was 3.64 +/- 0.78 ml/min/kg. Response of hepatic and splenic lesions was monitored by serial computerized tomographic and magnetic resonance imaging scans. The five evaluable patients responded to ABLC with complete or partial resolution of physical findings and of lesions of HSC. During the course of ABLC infusions and follow-up, there was no progression of HSC, breakthrough fungemia, or posttherapy recurrence. Hepatic lesions continued to resolve after the completion of administration of ABLC. Thus, ABLC administered in multiple doses to children was safe, was characterized by a steady state attainable within 1 week of therapy, and was effective in treatment of HSC. PMID:9303390
Walsh, T J; Whitcomb, P; Piscitelli, S; Figg, W D; Hill, S; Chanock, S J; Jarosinski, P; Gupta, R; Pizzo, P A
Autoimmune polyendocrinopathy-candidiasisectodermal dystrophy (APECED; also called APS-1,) is a rare autosomal recessive disorder that is more frequent in certain isolated populations. It is characterized by two of the three major clinical symptoms that may be present: Addison's disease, and/or hypoparathyroidism and/or chronic mucocutaneous candidiasis. We have recently identified the gene for APECED, which we termed AIRE (for autoimmune regulator). AIRE is expressed in thymus, lymph nodes and fetal liver, and encodes a protein with two putative zinc fingers and other motifs suggestive of a transcriptional regulator. Seven mutations have been described to date, including R257X, the predominant Finnish and northern Italian APECED allele, which has also been observed in other patients of diverse origin on different haplotypes. A 13-bp deletion (1094-1106del) has also been observed in several patients of different geo-ethnic origin. The other described mutations appear to be rare. We present mutational analyses of the AIRE gene in ten Sardinian APECED families and show that there is a mutation, R139X, associated with one predominant haplotype unique to the Sardinian patients (18/20 independent alleles). The carrier frequency of R139X in Sardinia is 1.7%, giving an estimated population frequency of APECED of 1/14,400. Using linkage disequilibrium data, the estimated age of the R139X mutation is between 20 and 25 generations. A previously described 13-bp deletion was also observed on an allele of one patient. The identification of a single common Sardinian APECED mutation will facilitate its genetic diagnosis. Given the carrier frequency of R139X in the Sardinian population, AIRE may be implicated in the pathogenesis of other autoimmune diseases in the Sardinian population, particularly those affecting the endocrine system. PMID:9856486
Rosatelli, M C; Meloni, A; Meloni, A; Devoto, M; Cao, A; Scott, H S; Peterson, P; Heino, M; Krohn, K J; Nagamine, K; Kudoh, J; Shimizu, N; Antonarakis, S E
Susceptibilidad antifúngica de Candida albicans recuperadas de pacientes con SIDA y candidiasis orofaríngea y esofágica: Experiencia con Etest® / Antifungal susceptibility testing of Candida albicans isolates from AIDS patients with oropharyngeal and esophageal candidiasis: Experience with Etest®
Full Text Available SciELO Chile | Language: Spanish Abstract in spanish [...] Abstract in english Background: Oropharyngeal candidiasis (OPC) and esophageal candidiasis (EPC) are frequent complications in AIDS patients. The use of Fluconazole, an effective and a low toxicity drug, has been associated to the emergency of secondary resistant strains. For this reason, in vitro antifungal susceptibi [...] lity tests are necessary to predict a therapeutic failure. Etest® is an easy to perform alternative test, that has showed a good agreement with the broth microdilution reference method (NCCLS, document M27-A). Aim: To measure the susceptibility of C. albicans isolates from AIDS patients complicated with OPC and EPC to Amphotericin B (AmB) and Fluconazole (Flu) using Etest®. Material and methods: Twenty strains from 20 AIDS patients were studied. AmB was tested in RPMI 1640 agar and Flu in Casitone agar. Results: All studied strains showed minimal inhibitory concentrations (MICs) 256 mg/mL) was isolated from a patient previously treated with Flu. Conclusions: In AIDS patients with OPC and EPC, the susceptibility to Flu of the isolates should be screened, to detect resistant strains. Etest®; is a reliable alternative in these cases, for laboratories that cannot use the reference method (Rev Méd Chile 2003; 131: 515-19).
Cecilia, Tapia P; Patricia, González A; Angélica, Pereira A; Jorge, Pérez G; Luis M, Noriega R; Elizabeth, Palavecino R.
Susceptibilidad antifúngica de Candida albicans recuperadas de pacientes con SIDA y candidiasis orofaríngea y esofágica: Experiencia con Etest® Antifungal susceptibility testing of Candida albicans isolates from AIDS patients with oropharyngeal and esophageal candidiasis: Experience with Etest®
Full Text Available Background: Oropharyngeal candidiasis (OPC and esophageal candidiasis (EPC are frequent complications in AIDS patients. The use of Fluconazole, an effective and a low toxicity drug, has been associated to the emergency of secondary resistant strains. For this reason, in vitro antifungal susceptibility tests are necessary to predict a therapeutic failure. Etest® is an easy to perform alternative test, that has showed a good agreement with the broth microdilution reference method (NCCLS, document M27-A. Aim: To measure the susceptibility of C. albicans isolates from AIDS patients complicated with OPC and EPC to Amphotericin B (AmB and Fluconazole (Flu using Etest®. Material and methods: Twenty strains from 20 AIDS patients were studied. AmB was tested in RPMI 1640 agar and Flu in Casitone agar. Results: All studied strains showed minimal inhibitory concentrations (MICs 256 mg/mL was isolated from a patient previously treated with Flu. Conclusions: In AIDS patients with OPC and EPC, the susceptibility to Flu of the isolates should be screened, to detect resistant strains. Etest®; is a reliable alternative in these cases, for laboratories that cannot use the reference method (Rev Méd Chile 2003; 131: 515-19.
Cecilia Tapia P
The aim of this study was to demonstrate that the addition of a bioadhesive polymer to econazole, which increases the duration of the active drug at the site of infection, leads to a greater frequency of negative culture after treatment and probably reduces the recurrence rate of vaginal candidiasis.180 women with vaginal candidiasis were treated with 150 mg vaginal ovules econazole nitrate with (group A) or without (group B) polycarbophil. After 3 days of treatment the negative culture of Candida albicans reached 98.6% in group A and 84.8% in B group, while the overall persistence (C. albicans, C. glabrata, C. krusei, and C. parapsilosis) was 5.6% and 30%, respectively. During a 60-day follow-up, only one case out of 85 (1.2%) in group A reported recurrence while in group B there were 6 out of 63 (9.5%) recurrences. We conclude that, since the women were treated with the same amount of econazole, the better clinical and microbiological results can be attributed to polycarbophil, as confirmed by a significant reduction of recurrences. PMID:18606589
Furneri, P M; Corsello, S; Masellis, G; Salvatori, M; Cammarata, E; Roccasalva, L S; Mangiafico, A; Tempera, G
Micafungin (FK463) is an echinocandin that demonstrates potent in vitro antifungal activities against Candida and Aspergillus species. However, little is known about its comparative antifungal activities in persistently neutropenic hosts. We therefore investigated the plasma micafungin pharmacokinetics and antifungal activities of micafungin against experimental disseminated candidiasis and invasive pulmonary aspergillosis in persistently neutropenic rabbits. The groups with disseminated cand...
Petraitis, Vidmantas; Petraitiene, Ruta; Groll, Andreas H.; Roussillon, Kristin; Hemmings, Melissa; Lyman, Caron A.; Sein, Tin; Bacher, John; Bekersky, Ihor; Walsh, Thomas J.
Full Text Available Oral candidiasis is associated with defects in cell-mediated immunity and is commonamong patients undergoing cytotoxic chemotherapy, or corticosteroid or antibiotic therapy,and those patients seropositive for AIDS and HIV (human immunodeficiency virus. Thispaper demonstrates the important role of cell-mediated immunity in oral candidiasis in 2cases of thymoma associated with myasthenia gravis. Both suffered from recurrent oral candidiasisafter a thymectomy, radiotherapy, and chemotherapy. There was an initial goodresponse to conventional antifungal therapy, which later became refractory. Lymphocytesubset quantitation showed a T cell deficiency and a decreased CD4/CD8 ratio. Levamisole,an immunomodulator, or an immunopotentiating drug was added as adjunctive therapy incombination with oral nystatin treatment. Oral candidiasis responded favorably, and substantialrelief was obtained with a concurrent increase in T cells and the CD4/CD8 ratio.These findings clearly demonstrate a significant role of cell-mediated immunity in oral candidiasis,and that eradication of infection is dependent on the host defense mechanism.
The combined effect of terpinen-4-ol, the main component of tea tree oil, and capric acid against mycelial growth of Candida albicans and murine oral candidiasis was evaluated in vitro and in vivo. Mycelial growth of C. albicans was estimated by the Cristal violet method. Combination of these compounds revealed a potent synergistic inhibition of growth. Therapeutic efficacy of the combination was evaluated microbiologically in murine oral candidiasis, and its application of the compounds clearly demonstrated therapeutic activity. Based on these results, the combined agent of terpinen-4-ol and capric acid was discussed as a possible candidate for oral candidiasis therapy. PMID:23292030
Ninomiya, Kentaro; Hayama, Kazumi; Ishijima, Sanae; Takahashi, Miki; Kurihara, Junichi; Abe, Shigeru
Full Text Available Abstract Background Vaginal candidiasis is a frequent and common distressing disease affecting up to 75% of the women of fertile age; most of these women have recurrent episodes. Essential oils from aromatic plants have been shown to have antimicrobial and antifungal activities. This study was aimed at assessing the anti-fungal activity of essential oil from Mentha suaveolens (EOMS in an experimental infection of vaginal candidiasis. Methods The in vitro and in vivo activity of EOMS was assessed. The in vitro activity was evaluated under standard CLSI methods, and the in vivo analysis was carried out by exploiting a novel, non-invasive model of vaginal candidiasis in mice based on an in vivo imaging technique. Differences between essential oil treated and saline treated mice were evaluated by the non-parametric Mann-Whitney U-test. Viable count data from a time kill assay and yeast and hyphae survival test were compared using the Student's t-test (two-tailed. Results Our main findings were: i EOMS shows potent candidastatic and candidacidal activity in an in vitro experimental system; ii EOMS gives a degree of protection against vaginal candidiasis in an in vivo experimental system. Conclusions This study shows for the first time that the essential oil of a Moroccan plant Mentha suaveolens is candidastatic and candidacidal in vitro, and has a degree of anticandidal activity in a model of vaginal infection, as demonstrated in an in vivo monitoring imaging system. We conclude that our findings lay the ground for further, more extensive investigations to identify the active EOMS component(s, promising in the therapeutically problematic setting of chronic vaginal candidiasis in humans.
Full Text Available Abstract Background The diagnosis of invasive candidiasis is difficult because there are no specific clinical manifestations of the disease and colonization and infection are difficult to distinguish. In the last decade, much effort has been made to develop reliable tests for rapid diagnosis of invasive candidiasis, but none of them have found widespread clinical use. Results Antibodies against a recombinant N-terminal fragment of the Candida albicans germ tube-specific antigen hyphal wall protein 1 (Hwp1 generated in Escherichia coli were detected by both immunoblotting and ELISA tests in a group of 36 hematological or Intensive Care Unit patients with invasive candidiasis and in a group of 45 control patients at high risk for the mycosis who did not have clinical or microbiological data to document invasive candidiasis. Results were compared with an immunofluorescence test to detect antibodies to C. albicans germ tubes (CAGT. The sensitivity, specificity, positive and negative predictive values of a diagnostic test based on the detection of antibodies against the N-terminal fragment of Hwp1 by immunoblotting were 27.8 %, 95.6 %, 83.3 % and 62.3 %, respectively. Detection of antibodies to the N-terminal fragment of Hwp1 by ELISA increased the sensitivity (88.9 % and the negative predictive value (90.2 % but slightly decreased the specificity (82.6 % and positive predictive values (80 %. The kinetics of antibody response to the N-terminal fragment of Hwp1 by ELISA was very similar to that observed by detecting antibodies to CAGT. Conclusion An ELISA test to detect antibodies against a recombinant N-terminal fragment of the C. albicans germ tube cell wall antigen Hwp1 allows the diagnosis of invasive candidiasis with similar results to those obtained by detecting antibodies to CAGT but without the need of treating the sera to adsorb the antibodies against the cell wall surface of the blastospore.
Full Text Available Background: Vaginal candidiasis (VC is one of the most common fungal diseases. Candida albicans is the most common causative fungus and has been isolated from more than 80% of specimens obtained from women with VC. Ketoconazole is the first orally active antifungal, the dosage for VC is 200 mg twice daily for 5 days. Fluconazole is the newer oral antifungal, its dosage for VC is a single oral dose of 150 mg. Since fluconazole 150 mg is considerably expensive, a single dose of 100 mg ketoconazole and 40 mg fluconazole in combination has been tested for the treatment of VC. The results showed that from 11 women with confirmed VC, 1-2 weeks after drug administration, the mycological culture was negative in 8 women, positive in 1 woman, and 2 woman lost to follow-up. This promising result led to the present study with the objective to confirm the efficacy and safety of the above combination in a formal clinical trial.Methods: A total of 165 female patients, aged 18 years or older, with the diagnosis of VC from clinical symptoms (pruritus or burning or excessive discharge and positive microscopic smear (pseudohyphae and/or yeast cells were randomized to receive a single dose of either keto-fluco combination (n = 85 or fluconazole (n = 80, and returnedfor follow-up visit on day 8.Results: Among these patients, 39 patients had negative baseline culture, leaving 126 patients eligible for efficacy evaluation. The mycological eradication in the keto-fluco group was 74.5% (41 patients from a total of 55 patients with available mycological culture, while that in the fluconazole group was 70.2% (40 patients from 57 patients with available culture and this difference was not significant. The clinical favorable response (clinical cure and clinical improvement in the keto-fluco arm (n = 60 was 98.3%, while that in the fluconazole group (n = 66 was 100%. Adverse events were found in 5 patients, 3 patients in the keto-fluco group (3/85 = 3.5% and 2 patients in the fluconazole group (2/80 = 2.5%.Conclusion: The present study showed that the efficacy and safety of ketoconazole 100 mg and fluconazole 40 mg combination was not inferior compared to fluconazole 150 mg in single doses for the treatment of vaginal candidiasis. (Med J Indones 2011; 20:205-11Keywords: fluconazole, low-dose ketoconazole-fluconazole combination, single dose, vaginal candidiasis
In leukopenic mice with severe systemic candidiasis, single-dose treatment (5 mg of amphotericin B [AMB]/kg of body weight) with long-circulating polyethylene glycol-coated AMB liposomes (PEG-AMB-LIP) resulted in zero mortality and a significant reduction in the number of viable Candida albicans in the kidney, whereas 70% mortality was seen in mice treated with five daily doses of AmBisome (5 mg of AMB/kg . day). When the first of five daily doses of AmBisome was combined with a single low dose of Fungizone (0.1 mg of AMB/kg), the efficacy was equal to that of PEG-AMB-LIP. PMID:9736577
van Etten, E W; Snijders, S V; van Vianen, W; Bakker-Woudenberg, I A
Full Text Available Se evaluó un medio de cultivo que contenía peptona, glucosa, extracto de levadura y suero para favorecer el desarrollo de la fase micelial en Candida albicans y se comparó con el medio comercial TC 199; no se encontró diferencia significativa entre ellos. Se obtuvieron antígenos somáticos de la fase levaduriforme y micelial, que se caracterizaron por PAGE-SDS; en ambos antígenos se expresaron las proteínas reportadas como de alto valor diagnóstico. Mediante inmunotransferencia, se determinó que las proteínas antigénicas predominantes en la fase micelial tenían pesos moleculares de 19, 21, 27 y 58 kDa. Se estandarizó la inmunotransferencia, para la detección de anticuerpos en pacientes con candidiasis sistémica, por esta técnica se evaluaron 24 sueros positivos y fue comparada con la técnica ELISA, que resultó ser más sensible y menos específica. Las proteínas más reconocidas fueron las de 136 y 21 kDa y el complejo de 42 a 45 kDa.A culture media containing peptone, glucose, yeast extract and serum was evaluated to promote the development of the mycelium formation in Candida albicans and it was compared with the commercial media Tc 199. No signficant difference was found between them. Somatic antigens characterized by PAGE-SDS were obtained from yeast and mycelial forms. Proteins reported as having high diagnostic value were expressed in both antigens. It was determined by immunotransference that the antigenic proteins predominating in the mycelium formation had molecular weights of 19, 21, 27 and 57 Kda. The immunotransference was standardized for detecting antibodies in patients with systemic candidiasis. 24 positive sera were evaluated by this technique and it was compared with the ELISA technique, which proved to be more sensitive and less specific. The most recognized proteins were those of 136 and 21 Kda and the complex from 42 to 45 Kda.
Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish Se evaluó un medio de cultivo que contenía peptona, glucosa, extracto de levadura y suero para favorecer el desarrollo de la fase micelial en Candida albicans y se comparó con el medio comercial TC 199; no se encontró diferencia significativa entre ellos. Se obtuvieron antígenos somáticos de la fase [...] levaduriforme y micelial, que se caracterizaron por PAGE-SDS; en ambos antígenos se expresaron las proteínas reportadas como de alto valor diagnóstico. Mediante inmunotransferencia, se determinó que las proteínas antigénicas predominantes en la fase micelial tenían pesos moleculares de 19, 21, 27 y 58 kDa. Se estandarizó la inmunotransferencia, para la detección de anticuerpos en pacientes con candidiasis sistémica, por esta técnica se evaluaron 24 sueros positivos y fue comparada con la técnica ELISA, que resultó ser más sensible y menos específica. Las proteínas más reconocidas fueron las de 136 y 21 kDa y el complejo de 42 a 45 kDa. Abstract in english A culture media containing peptone, glucose, yeast extract and serum was evaluated to promote the development of the mycelium formation in Candida albicans and it was compared with the commercial media Tc 199. No signficant difference was found between them. Somatic antigens characterized by PAGE-SD [...] S were obtained from yeast and mycelial forms. Proteins reported as having high diagnostic value were expressed in both antigens. It was determined by immunotransference that the antigenic proteins predominating in the mycelium formation had molecular weights of 19, 21, 27 and 57 Kda. The immunotransference was standardized for detecting antibodies in patients with systemic candidiasis. 24 positive sera were evaluated by this technique and it was compared with the ELISA technique, which proved to be more sensitive and less specific. The most recognized proteins were those of 136 and 21 Kda and the complex from 42 to 45 Kda.
Elba, Álvarez; Beatriz, Rodríguez; Ileana, Rosado; Marisol, González.
Due to the epidemiological alteration in distribution of Candida species as well as significant increasing trend of either intrinsic or acquired in resistance of some of these fungi, the precise identification of Candida species is necessary for effective antifungal therapy and also for prevention of nosocomial infections. PCR-RFLP method is indicated to be a reliable, rapid and simple technique which is able to differentiate the Candida species. In the present study, we applied this method to evaluate the distribution of Candida species in patients affected with cutaneous candidiasis in the Guilan province. 896 clinical cutaneous samples were collected from different parts of skin and nail of suspected patients referred to clinical centers all over the Guilan province during 24 months. Samples were examined directly with 15% KOH and cultured on fungal specific media. Genomic DNA was extracted and the restriction enzyme Msp1 was applied for polymorphism analysis. Totally, 47 yeast strains were successfully isolated from different clinical samples and identified by conventional as well as PCR-RFLP methods. The results indicated that Candida albicans (36.17%) was the most frequent species followed by C. parapsilosis (25.53%), C. tropicalis (19.14%), C. guilliermondii (14.89%), C. famata (2.12%) and C. krusei (2.12%). Female finger nails were the most common location to be affected by Candida species. In conclusion, PCR-RFLP method was successfully used for recognition of clinical Candida species within the Guilan province and obtained results revealed C. albicans as the predominant causative agent of cutaneous candidiasis. However, distribution of other Candida species did not completely consist with the reported distribution of Candida species in other parts of Iran with different climate to the Guilan province. PMID:24390951
Fallahi, Ali Akbar; Korbacheh, Parivash; Zaini, Farideh; Mirhendi, Hossein; Zeraati, Hojjat; Noorbakhsh, Fatemeh; Moazeni, Maryam; Andonian, Laris; Nazeri, Mehdi; Rezaie, Sassan
Background: Vaginal candidiasis is a common gynecological finding among women worldwide. This study was carried out to determine the prevalence of vulvovaginal candidiasis (VVC) along with speciation of Candida with special reference to its antifungal susceptibility pattern to fluconazole and also to evaluate the risk factors responsible for VVC in patients attending our tertiary care hospital in Puducherry, India. Materials and Methods: This study was carried out in the tertiary care hospital in Puducherry during the period of August 2010 to September 2012.The study group consisted of 180 women between the age group of 15 to 56 years with the complaints of excessive vaginal discharge, pruritis and pain. Materials used for this study consisted of high vaginal swabs from patients with relevant history, attending Obstetrics & Gynecology department. High vaginal swabs were subjected to direct 10% KOH wet mount microscopy, Gram stain, culture onto Sabouraud’s dextrose agar (SDA) & 5% sheep blood agar and susceptibility testing to fluconazole was performed using E-test. Results: Candida was isolated in 40 (22.2 %) women & these consisted of C. albicans 26 (65%), C. glabrata 9 (22.5%), C.tropicalis 3 (7.5%) & C. parapsilosis 2 (5%). Susceptibility test carried out on the 40 isolates revealed that 35 (87.5%) Candida isolates were sensitive to fluconazole, 3 (7.5%) were moderately sensitive and 2 (2.5%) were resistant. Thirty one percent patients had itching as the presenting complaints followed by vaginal discharge (29.4%). Conclusion: The high frequency with which C. albicans was recovered in our study and its susceptibility to fluconazole supports the continued use of azole agents for empirical therapy of uncomplicated candidal vulvovaginitis in the community.
Poongothai, G.K; Sinazer, Annie Rofeena; Kannaiyan, Kavitha; Gurumurthy, Hemalatha; Jaget, Nirmala; Kuthalaramalingam, Sethumadhavan
Oropharyngeal candidiasis (OPC) is caused by the opportunistic fungi Candida albicans and is prevalent in immunocompromised patients, individuals with dry mouth, or patients with prolonged antibiotic therapies that reduce oral commensal bacteria. Human salivary histatins, including histatin 5 (Hst 5), are small cationic proteins that are the major source of fungicidal activity of saliva. However, Hsts are rapidly degraded in vivo, limiting their usefulness as therapeutic agents despite their lack of toxicity. We constructed a conjugate peptide using spermidine (Spd) linked to the active fragment of Hst 5 (Hst 54-15), based upon our findings that C. albicans spermidine transporters are required for Hst 5 uptake and fungicidal activity. We found that Hst 54-15-Spd was significantly more effective in killing C. albicans and Candida glabrata than Hst 5 alone in both planktonic and biofilm growth and that Hst 54-15-Spd retained high activity in both serum and saliva. Hst 54-15-Spd was not bactericidal against streptococcal oral commensal bacteria and had no hemolytic activity. We tested the effectiveness of Hst 54-15-Spd in vivo by topical application to tongue surfaces of immunocompromised mice with OPC. Mice treated with Hst 54-15-Spd had significant clearance of candidal tongue lesions macroscopically, which was confirmed by a 3- to 5-log fold reduction of C. albicans colonies recovered from tongue tissues. Hst 54-15-Spd conjugates are a new class of peptide-based drugs with high selectivity for fungi and potential as topical therapeutic agents for oral candidiasis. PMID:24247141
Tati, Swetha; Li, Rui; Puri, Sumant; Kumar, Rohitashw; Davidow, Peter; Edgerton, Mira
To determine the prevalence of HIV and correlates of HIV infection among female sex workers (FSWs) in Soc Trang province, Vietnam, a survey of 406 FSWs in Soc Trang province was conducted between May and August, 2003. The participants were interviewed, using a standardized interview, to obtain information about sociodemographic and behavioral characteristics, and gynecologic and sexually transmitted infection (STI) history. The prevalence of HIV was 3.3%. An increased risk for HIV was associated with ever using illicit drugs, direct sex work, early sexual debut, age of FSWs, and infection with candidiasis and trichomoniasis. Reduced likelihood of HIV was only associated with withdrawal as a contraceptive method. A strong association of HIV with drug use and candidiasis and trichomoniasis infection among FSWs was found. Needle/syringe exchange, STI treatment, and methadone programs targeting FSWs should be implemented, and should include 100% condom use promotion.
Nguyen, Thuong Vu; Khuu, Nghia Van; Truong, Phong Hoai; Nguyen, Anh Phuong; Truong, Lien Xuan Thi
We report a 26-year-old male patient with acute myelocytic leukemia and hepatosplenic candidiasis during his clinical course. His hepatosplenic candidiasis was refractoty to itraconazole and fluconazol. He developed serious side-effect such as renal dysfunction, when conventional amphotericin B was given. Then he was treated with liposomal amphotericin B (Abelcet). This therapy was safe and effective for him. He was able to be treated with 3075 mg of a liposomal amphotericin B. This was ten times as much as the dose of conventional amphotericin B which was given earlier until amphotericin B was stopped because of renal dysfunction. Liposomal amphotericin B seems to be a safe and effective therapy for systemic fungal infectin and should be considered more in Japan. PMID:9695475
Hasegawa, T; Hiyoshi, M; Aoyama, Y; Sakamoto, C; Ohta, K; Yamane, T; Hino, M; Tatsumi, N
Successful intensive chemotherapy followed by autologous hematopoietic cell transplantation in a patient with acute myeloid leukemia and hepatosplenic candidiasis: case report and review of literature.
Hepatosplenic candidiasis (HSC) in patients with acute leukemia poses management challenges because the therapeutic limitations of the present antifungal armamentarium may adversely impact on treatment outcomes of the underlying leukemia. We report a patient with acute myeloid leukemia who developed HSC during post-remission consolidation chemotherapy and was treated with a prolonged course of caspofungin followed by fluconazole. The stabilization of infection permitted further chemotherapy and autologous hematopoietic cell transplant (HCT) without breakthrough fungemia and further dissemination of candidiasis. The favorable outcome provides further evidence that with optimal treatment, the presence of stable or non-progressive HSC is not an absolute contraindication for HCT. The use of caspofungin in the primary treatment of HSC appears to be a promising approach. The favorable outcome seen in this case is encouraging, although further study on its efficacy is warranted. PMID:19228346
Poon, L-M; Chia, H-Y; Tan, L-K; Liu, T-C; Koh, L-P
Secreted aspartyl proteinases (Saps) contribute to the ability of Candida albicans to cause mucosal and disseminated infections. A model of vaginal candidiasis based on reconstituted human vaginal epithelium (RHVE) was used to study the expression and role of these C. albicans proteinases during infection and tissue damage of vaginal epithelium. Colonization of the RHVE by C. albicans SC5314 did not cause any visible epithelial damage 6 h after inoculation, although expression of SAP2, SAP9, ...
Schaller, Martin; Bein, Matthias; Korting, Hans C.; Baur, Stefan; Hamm, Gerald; Monod, Michel; Beinhauer, Sabine; Hube, Bernhard
Candida albicans secreted aspartyl proteinases (Saps) are considered virulence-associated factors. Several members of the Sap family were claimed to play a significant role in the progression of candidiasis established by the hematogenous route. This assumption was based on the observed attenuated virulence of sap-null mutant strains. However, the exclusive contribution of SAP genes to their attenuated phenotype was not unequivocally confirmed, as the Ura status of these mutant strains could ...
Correia, Alexandra; Lermann, Ulrich; Teixeira, Luzia; Cerca, Filipe; Botelho, Sofia; Gil Da Costa, Rui M.; Sampaio, Paula; Ga?rtner, Fa?tima; Morschha?user, Joachim; Vilanova, Manuel; Pais, Ce?lia
The effects of the hematoregulatory peptide SK&F 107647 were examined in a persistently and profoundly neutropenic rabbit model of disseminated candidiasis in order to determine its potential to enhance resistance against infection and its role as an adjunct to conventional antifungal chemotherapy. In healthy animals, SK&F 107647 elicited a time-dependent increase in CD11b-positive monocytes and neutrophils. When administered to neutropenic rabbits infected with Candida albicans, no significa...
Lyman, Caron A.; Gonzalez, Corina; Schneider, Mark; Lee, James; Walsh, Thomas J.
Invasive candidiasis is a frequent life-threatening complication in critically ill patients. Early diagnosis followed by prompt treatment aimed at improving outcome by minimizing unnecessary antifungal use remains a major challenge in the ICU setting. Timely patient selection thus plays a key role for clinically efficient and cost-effective management. Approaches combining clinical risk factors and Candida colonization data have improved our ability to identify such patients early. While the ...
Eggimann, Philippe; Marchetti, Oscar
The protective capacity of a parenterally administered beta-glucan-conjugate vaccine formulated with the human-compatible MF59 adjuvant was assessed in a murine model of vaginal candidiasis. To monitor infection, an in vivo imaging technique exploiting genetically engineered, luminescent Candida albicans was adopted, and compared with measurements of colony forming units. The vaccine conferred significant protection, and this was associated with production of serum and vaginal anti-beta-gluca...
Pietrella, Donatella; Rachini, Anna; Torosantucci, Antonella; Chiani, Paola; Brown, Alistair J. P.; Bistoni, Francesco; Costantino, Paolo; Mosci, Paolo; D Apos Enfert, Christophe; Rappuoli, Rino; Cassone, Antonio; Vecchiarelli, Anna
Better prognostic predictors for invasive candidiasis (IC) are needed to tailor and individualize therapeutic decision-making and minimize its high morbidity and mortality. We investigated whether molecular profiling of IgG-antibody response to the whole soluble Candida proteome could reveal a prognostic signature that may serve to devise a clinical-outcome prediction model for IC and contribute to known IC prognostic factors. By serological proteome analysis and data-mining procedures, serum...
Pitarch, Aida; Nombela, Ce?sar; Gil, Concha
Abstract Invasive fungal infections are on the rise. Echinocandins are a relatively new class of antifungal drugs that act by inhibition of a key enzyme necessary for integrity of the fungal cell wall. Currently there are three available agents: caspofungin, micafungin and anidulafungin. While the individual echinocandin antifungals have a different spectrum of licensed indications, basically all of them are available for the treatment of candidemia and invasive candidiasis. ...
Fungi are common causes of infection in immunocompromised patients. Candida species are frequently involved in these cases. In order to investigate candidiasis in pediatric patients with cancer, clinical samples were collected from one hundred and twenty two patients interned in the Oswaldo Cruz University Hospital in Recife, Brazil. Yeasts were isolated from thirty-four clinical samples. The species isolated were: Candida albicans (fourteen isolates), C. parapsilosis (nine isolates), C. guil...
Ana Maria Rabelo De Carvalho Parahym; Luciana Resende Bandeira de Melo; Vera Lúcia Lins De Morais; Rejane Pereira Neves
Efficacy, Plasma Pharmacokinetics, and Safety of Icofungipen, an Inhibitor of Candida Isoleucyl-tRNA Synthetase, in Treatment of Experimental Disseminated Candidiasis in Persistently Neutropenic Rabbits
Icofungipen (formerly PLD-118) is a synthetic derivative of the naturally occurring ?-amino acid cispentacin that blocks isoleucyl-tRNA synthetase, resulting in the inhibition of protein synthesis and growth of fungal cells. We investigated the efficacy, plasma pharmacokinetics, and safety of icofungipen in escalating dosages for the treatment of experimental subacute disseminated candidiasis in persistently neutropenic rabbits. Icofungipen was administered for 10 days starting 24 h after th...
INTRODUCTION: Timely diagnosis of invasive candidiasis (IC) remains difficult as the clinical presentation is not specific and blood cultures lack sensitivity and need a long incubation time. Thus, non-culture-based methods for diagnosing IC have been developed. Mannan antigen (Mn) and anti-mannan antibodies (A-Mn) are present in patients with IC. On behalf of the Third European Conference on Infections in Leukemia, the performance of these tests was analysed and reviewed. METHODS: The litera...
Mikulska, Ma?gorzata; Calandra, Thierry; Sanguinetti, Maurizio; Poulain, Daniel; Viscoli, Claudio
Licorice (the root of Glycyrrhizae plant) has been used as an oriental herbal medicine for thousands of years. The licorice flavonoid components are reported to possess immunomodulatory activities. In this present study, we investigated the immunomodulatory effects of liquiritigenin (LG) and liquiritin (LQ), licorice flavonoid components, against disseminated candidiasis due to Candida albicans, a dimorphic fungus, that causes severe disease via hematogenous dissemination and local diseases such as vaginitis and thrush. Results showed that direct interaction of LG or LQ with C. albicans yeast cells resulted in no growth-inhibition, in vitro. When tested in a murine model of disseminated candidiasis, mice given LQ intraperitoneally before intravenous challenge with live C. albicans yeast cells had similar mean survival times (MST) as untreated mice groups. On the contrary, mice given LG in the same manner as LQ above had longer MST than the untreated mice groups (P < 0.05). In one experiment, 3 out of 5 LG-treated mice survived during the entire period of the 55-day observation. Furthermore, the 3 survivors were cured -- shown by a lack of CFU (colony forming unit) in the kidneys. This protection was nulled when mice were pretreated with anti-CD4+ antibody before LG-treatment and challenge with the yeast. However, the protection was transferable by the CD4+ T cells isolated from LG-treated mice not infected with the yeast. In addition, mice given CD4+ T cells that were pre-treated with LG, in vitro were also protected against disseminated candidiasis. ELISA analysis revealed that in LG-treated mice IFNgamma and IL-2 were dominantly produced compared to IL-4 and IL-10. When LG-given mice were treated with anti-mouse IFNgamma, the protection was again nulled. Combined together, these results indicate that LG protects mice against disseminated candidiasis by the CD4+ Th1 immune response. PMID:19264152
Lee, Ju Young; Lee, Jue-Hee; Park, Ji Hye; Kim, Song-Yi; Choi, Ji Young; Lee, Seung Ho; Kim, Yeong Shik; Kang, Sam Sik; Jang, Eui-Chan; Han, Yongmoon
Full Text Available Population-based data on sexually transmitted infections (STI, bacterial vaginosis (BV, and candidiasis reflect the epidemiological situation more accurately than studies performed in specific populations, but such data are scarce. To determine the prevalence of STI, BV, and candidiasis among women of reproductive age from a resource-poor community in Northeast Brazil, a population-based cross sectional study was undertaken. All women from seven hamlets and the centre of Pacoti municipality in the state of Ceará, aged 12 to 49 years, were invited to participate. The women were asked about socio-demographic characteristics and genital symptoms, and thereafter examined gynaecologically. Laboratory testing included polymerase chain reaction (PCR for human papillomavirus (HPV, ligase chain reaction (LCR for Chlamydia trachomatis and Neisseria gonorrhoeae, ELISA for human immunodeficiency virus (HIV, venereal disease research laboratory (VDRL and fluorescent treponema antibody absorption test (FTA-ABS for syphilis, and analysis of wet mounts, gram stains and Pap smears for trichomoniasis, candidiasis, and BV. Only women who had initiated sexual life were included in the analysis (n = 592. The prevalences of STI were: HPV 11.7% (95% confidence interval: 9.3-14.7, chlamydia 4.5% (3.0-6.6, trichomoniasis 4.1% (2.7-6.1, gonorrhoea 1.2% (0.5-2.6, syphilis 0.2% (0.0-1.1, and HIV 0%. The prevalence of BV and candidiasis was 20% (16.9-23.6 and 12.5% (10.0-15.5, respectively. The most common gynaecological complaint was lower abdominal pain. STI are common in women in rural Brazil and represent an important health threat in view of the HIV pandemic.
Fabíola Araújo Oliveira
Pharmacokinetic and pharmacodynamic studies were conducted in a murine model of systemic candidiasis to determine the pharmacodynamic parameter linked with caspofungin efficacy. Additional studies defined the importance of persistent tissue drug concentrations to treatment outcome. The pharmacokinetics of caspofungin were determined in the serum and kidneys of infected mice over 96 h. Population pharmacokinetic analysis demonstrated a serum terminal half-life (t1/2) for caspofungin of 20.2 h ...
Louie, Arnold; Deziel, Mark; Liu, Weiguo; Drusano, Michael F.; Gumbo, Tawanda; Drusano, George L.
Invasive candidiasis in patients who are immunocompromised or in intensive care units (ICUs) presents both diagnostic and therapeutic problems. We previously described antibodies that were directed against Candida albicans cell wall fragments (CW), periodate-treated CW (CWIO4), phosphopeptidomannan (PPM), and ?(1-3) glucan. In this study, circulating fungal antigens [mannan and ?(1-3) glucan] and immunoglobulin G (IgG) subclass antibodies to these cell wall antigens (anti-CW) were analyzed ...
A child with acute myeloid leukemia presented with multiple liver lesions mimicking hepatosplenic candidiasis during the neutropenic phase following the induction chemotherapy. All the available diagnostic tools showed repeatedly negative results, including galactomannan. An enzyme-linked immunospot (ELISPOT) assay showed a high number of Aspergillus-specific T cells producing interleukin-10 [TH2(IL-10)] and a low number of Aspergillus-specific T cells producing gamma interferon [TH1(IFN-?)]...
Potenza, Leonardo; Barozzi, Patrizia; Rossi, Giulio; Palazzi, Giovanni; Vallerini, Daniela; Riva, Giovanni; Cellini, Monica; Morselli, Monica; Volzone, Francesco; Venturelli, Claudia; Quadrelli, Chiara; Di Pancrazio, Luciana; Cano, Maria Carmen; Paolucci, Paolo; Torelli, Giuseppe
Full Text Available This study was design to evaluate the anti-candidal activity of Astragalus verus Olivier, Fabaceae (Av. The GC/MS analysis of essential oils of Av showed that aqueous extract contains thymol while hexadecanoic acid, 1,2-benzenedicarboxylic acid, diisooctyl ester and phytol were found as major components of methanol and acetone extracts. The aqueous extract showed anti-candidal activity in the concentration 320 mg/mL using disc diffusion method and its minimum inhibitory concentration (MIC was 160 mg/mL. To induce cutaneous candidiasis, the dorsum of immunocompromised guinea pigs was infected with Candida albicans and animals were divided into five groups (n=5 for each: NC, received a vehicle; PC, received topical ketoconazole 2% and three other groups which received topical 10, 20 and 40% aqueous extract of Av. On ninth day postinfection, skins were cultured and colony forming unite per gram (CFU/g skin was recorded. Systemic candidiasis was obtained by intravenous inoculation of C. albicans, 4000 CFU/g body weight. Here, animals have been divided into five groups like cutaneous candidiasis but their medications have been delivered in drinking water for ten days before induction of infection. On second day postinfection, all internal tissues were taken for determining CFU/g tissue. The aqueous extract (40% prevented heavy burden of C. albicans in tissues and skin in oral and topical application, respectively. The results indicate that Av represents a potential source of anti-candidal drug.
Crude and attributable mortality rates in patients with candidemia and invasive candidiasis remain unacceptably high. It is important to reach a more complete understanding of the risk factors underlying poor outcomes in patients with invasive Candida infections. Micafungin therapy has been assessed in two phase 3 trials compared to either liposomal amphotericin B or caspofungin. The availability of this large dataset allows the analyses of non-drug factors associated with survival and treatment success. A multivariate regression analysis was performed on data from the two trials separately and as a pooled analysis (N = 1,070). Analysis outcomes were survival at 42 days post-initiation of therapy and treatment success. For the pooled analysis, treatment success was significantly more likely for candidemia than invasive candidiasis. Both survival and treatment success were significantly less likely for the non-removal of catheter versus removal, Asian-Indians versus Caucasians, APACHE II score >20 to 30 versus or=70 years versus <50 years, baseline corticosteroids, and persistent neutropenia. Survival was also significantly less likely for treatment in other regions versus North America and for patients with renal failure at baseline. These findings help to define non-antifungal drug factors that may impact survival and treatment success in invasive candidiasis or candidemia. PMID:20013016
Horn, D L; Ostrosky-Zeichner, L; Morris, M I; Ullmann, A J; Wu, C; Buell, D N; Kovanda, L L; Cornely, O A
Full Text Available Abstract Background Oral lichen planus (OLP is seen frequently in patients with hepatitis C virus (HCV infection. The aim of this study was to evaluate the occurrence of oral candidiasis, other mucosal lesions, and xerostomia during interferon (IFN therapy for HCV infection. Methods Of 124 patients with HCV-infected liver diseases treated with IFN therapy in our hospital, 14 (mean age 56.00 ± 12.94 years who attended to receive administration of IFN once a week were identified and examined for Candida infection and other oral lesions and for the measurement of salivary flow. Serological assays also were carried out. Results Cultures of Candida from the tongue surfaces were positive in 7 (50.0% of the 14 patients with HCV infection at least once during IFN therapy. C. albicans was the most common species isolated. The incidence of Candida during treatment with IFN did not increase above that before treatment. Additional oral mucosal lesions were observed in 50.0% (7/14 of patients: OLP in three (21.4%, angular cheilitis in three (21.4% and recurrent aphthous stomatitis in one (7.1%. OLP occurred in one patient before treatment with IFN, in one during treatment and in one at the end of treatment. 85.7% of the oral lesions were treated with topical steroids. We compared the characteristics of the 7 patients in whom Candida was detected at least once during IFN therapy (group 1 and the 7 patients in whom Candida was not detected during IFN therapy (group 2. The prevalence of oral mucosal lesions (P=0.0075 and incidence of external use of steroids (P=0.0308 in group 1 were significantly higher than in group 2. The average body weight of group 1 decreased significantly compared to group 2 (P=0.0088. Salivary flow decreased in all subjects throughout the course of IFN treatment and returned at 6th months after the end of treatment. In group 1, the level of albumin at the beginning of the 6th month of IFN administration was lower than in group 2 (P=0.0550. According to multivariate analysis, one factor, the presence of oral mucosal lesions, was associated with the detection of Candida. The adjusted odds ratio for the factor was 36.00 (95% confidence interval 2.68-1485.94. Conclusion We should pay more attention to oral candidiasis as well as other oral mucosal lesions, in patients with weight loss during IFN treatment.
Micafungin was non-inferior to liposomal amphotericin B (LAmB) for the treatment of candidaemia and invasive candidiasis (IC) in a major clinical trial. The present study investigated the economic impact of micafungin vs. LAmB in treating candidaemia and IC. A decision analytical model was constructed to capture downstream consequences of using micafungin or LAmB as primary definitive therapy. The main outcomes were treatment success and treatment failure due to mycological persistence, or death. Outcome probabilities were derived from key published sources. Resource used was estimated by an expert panel and cost inputs were from the latest Australian resources. The analysis was from an Australian hospital perspective. Sensitivity analyses using Monte Carlo simulation were conducted. Micafungin (AU$61 426) had a lower total cost than LAmB (AU$72 382), with a total net cost-saving of AU$10 957 per patient. This was primarily due to the lower cost associated with initial antifungal treatment and shorter length of stay for patients in the micafungin arm. Hospitalisation was the main cost driver for both arms. Results were robust over a wide range of variables. The uncertainty analysis demonstrated that micafungin had a 99.9% chance of being cost-saving compared with LAmB. Micafungin was associated with cost-saving relative to LAmB in the treatment of candidaemia and IC in Australia. PMID:23496163
Neoh, Chin Fen; Liew, Danny; Slavin, Monica A; Marriott, Debbie; Chen, Sharon C-A; Morrissey, Orla; Stewart, Kay; Kong, David C M
Full Text Available The limited solubility, and therefore bioavailability, of the antimycotic drug,itraconazole, used for the treatment of intestinal Candidiasis in immunocompromisedindividuals, has been well documented. Therapeutic regimen in these patients mayinclude daily administration of multiple doses of various drugs. Hence, improving theresidence time of therapeutic agents, would ensure a high continuous concentration inthe body and help decrease the dosing frequency. In our current study, we haveinvestigated a novel method of drug delivery, developed by utilizing the concept ofmucoadhesiveness, for the sustained release of the drug, itraconazole. Mucoadhesivebeads were prepared using two natural polymers, isabghula husk and alginate. Theminimum inhibitory concentration of itraconazole for Candida was found to be1.5milligram per millilitre. Accordingly, beads were prepared by ionic gelation methodusing calcium chloride as a crosslinking agent. Marked improvement in solubility of thedrug was noted after entrapment. Prepared beads were subjected to various evaluationsincluding particle size, swelling behaviour and mucoadhesivity. At pH 7.4, goodmucoadhesive property was exhibited up to 7 hours. Maximum swelling of beads wasobserved at 4hours in phosphate buffer after which the beads showed slight erosion.Fresh cock intestinal mucosa was used to assess the sustained release of itraconazolefrom the drug loaded beads and the reduction in candidal cells adhering to the mucosawas verified by the viable count technique. The results of our present study indicate thatmucoadhesive intestinal retentive isabghula- alginate beads could represent a promisingvehicle for drug delivery and help improve therapeutic efficacy and patient compliancein the future.
We aimed to determine the frequency of oropharyngeal candidiasis and its clinical correlates in the asthmatic patients who use fluticasone propionate (FP) as a dry powdered inhaler. We selected four groups of patients: 62 asthmatic patients who were taking 200 microg/d FP, 122 asthmatics who were taking 500 microg/d FP, 50 asthmatic patients who had not been on inhaled corticosteroid (ICS) treatment and 40 normal non-asthmatic subjects. The frequency of positive swabs for Candida colonization was higher in 500 microg/d FP group than asthmatics without ICS use (chi2 = 6.8, p < 0.05) and normal controls (chi2 = 4.9, p < 0.05), whereas it wasn't different in the 200 microg/day FP group when compared to controls. When we considered patients who used ICS, the most effective variables affecting the occurrence of Candida colonization were washing of the throat by the patients (OR = 9.4, 95 % Confidence Interval [CI] = 3.9-22.7, p < 0.0001) and duration of ICS use more than 12 months (OR = 2.5, 95 % CI = 1.1-2.6, p < 0.05). The present study showed that in the patients who use ICS, the most important determinants on colonization were not washing the throat regularly and duration of ICS use for more than 12 months. PMID:18261428
Kurt, E; Yildirim, H; Kiraz, N; Orman, A; Metintas, M; Akgun, Y; Erginel, S
Hepatosplenic candidiasis (HSC) is a morbid complication encountered in immunocompromised individuals, especially, those being treated with intensive chemotherapy protocols for acute leukemia. Immediate recognition of this complication and initiation of appropriate treatment is crucial in order to control the infection, decrease the morbidity and mortality, and avoid delays in treatment of the underlying condition. The definitive diagnosis requires either positive blood cultures for yeasts in the presence of abnormal findings on imaging studies consistent with HSC, or liver biopsy demonstrating yeast forms or pseudohyphae. We describe our experience in the evaluation of 15 patients with HSC using magnetic resonance imaging (MRI) as a diagnostic and follow-up tool. The diagnosis of HSC was established by liver biopsy in 11 patients (73%), and by positive blood cultures for Candida in 4 patients (27%). All patients had MRI findings consistent with HSC during the study period. Amphotericin B was administered intravenously to all 15 patients (median duration of treatment, 62 days). Repeat MR images were obtained at 2 weeks, 6 weeks and then at monthly intervals until the resolution of abnormalities. The median time for the disappearance of MRI lesions was 9 weeks. Alterations in the appearance of lesions on MRI were noted throughout chemotherapy in all the 13 (86.6%) responding patients. Our results suggest that MRI when used in patients with high clinical suspicion for HSC provide an alternative for liver biopsy or other invasive diagnostic procedures and that appropriate response to treatment can be safely monitored by obtaining sequential MRI studies. PMID:9792936
Sallah, S; Semelka, R; Kelekis, N; Worawattanakul, S; Sallah, W
Chronic mucocutaneous candidiasis disease (CMCD) may be caused by autosomal dominant (AD) IL-17F deficiency or autosomal recessive (AR) IL-17RA deficiency. Here, using whole-exome sequencing, we identified heterozygous germline mutations in STAT1 in 47 patients from 20 kindreds with AD CMCD. Previously described heterozygous STAT1 mutant alleles are loss-of-function and cause AD predisposition to mycobacterial disease caused by impaired STAT1-dependent cellular responses to IFN-?. Other loss-of-function STAT1 alleles cause AR predisposition to intracellular bacterial and viral diseases, caused by impaired STAT1-dependent responses to IFN-?/?, IFN-?, IFN-?, and IL-27. In contrast, the 12 AD CMCD-inducing STAT1 mutant alleles described here are gain-of-function and increase STAT1-dependent cellular responses to these cytokines, and to cytokines that predominantly activate STAT3, such as IL-6 and IL-21. All of these mutations affect the coiled-coil domain and impair the nuclear dephosphorylation of activated STAT1, accounting for their gain-of-function and dominance. Stronger cellular responses to the STAT1-dependent IL-17 inhibitors IFN-?/?, IFN-?, and IL-27, and stronger STAT1 activation in response to the STAT3-dependent IL-17 inducers IL-6 and IL-21, hinder the development of T cells producing IL-17A, IL-17F, and IL-22. Gain-of-function STAT1 alleles therefore cause AD CMCD by impairing IL-17 immunity. PMID:21727188
Liu, Luyan; Okada, Satoshi; Kong, Xiao-Fei; Kreins, Alexandra Y; Cypowyj, Sophie; Abhyankar, Avinash; Toubiana, Julie; Itan, Yuval; Audry, Magali; Nitschke, Patrick; Masson, Cécile; Toth, Beata; Flatot, Jérome; Migaud, Mélanie; Chrabieh, Maya; Kochetkov, Tatiana; Bolze, Alexandre; Borghesi, Alessandro; Toulon, Antoine; Hiller, Julia; Eyerich, Stefanie; Eyerich, Kilian; Gulácsy, Vera; Chernyshova, Ludmyla; Chernyshov, Viktor; Bondarenko, Anastasia; Grimaldo, Rosa María Cortés; Blancas-Galicia, Lizbeth; Beas, Ileana Maria Madrigal; Roesler, Joachim; Magdorf, Klaus; Engelhard, Dan; Thumerelle, Caroline; Burgel, Pierre-Régis; Hoernes, Miriam; Drexel, Barbara; Seger, Reinhard; Kusuma, Theresia; Jansson, Annette F; Sawalle-Belohradsky, Julie; Belohradsky, Bernd; Jouanguy, Emmanuelle; Bustamante, Jacinta; Bué, Mélanie; Karin, Nathan; Wildbaum, Gizi; Bodemer, Christine; Lortholary, Olivier; Fischer, Alain; Blanche, Stéphane; Al-Muhsen, Saleh; Reichenbach, Janine; Kobayashi, Masao; Rosales, Francisco Espinosa; Lozano, Carlos Torres; Kilic, Sara Sebnem; Oleastro, Matias; Etzioni, Amos; Traidl-Hoffmann, Claudia; Renner, Ellen D; Abel, Laurent; Picard, Capucine; Maródi, László; Boisson-Dupuis, Stéphanie; Puel, Anne; Casanova, Jean-Laurent
Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED; APS-1) is an autosomal recessive autoimmune disease, caused by mutations in the AIRE (autoimmune regulator) gene. Due to the proposed role of AIRE in central immune tolerance, the immune investigation of four females diagnosed with APECED, their siblings, parents and 14 age-matched controls was performed. The parameters analyzed included immunoglobulins, autoantibodies, cellular immunity and production of cytokines IFNgamma, IL-4 and IL-10, reflecting Th1xTh2 balance. Low IFNgamma levels (455 +/- 191 pg/ml) were detected in all affected girls compared to controls (910 +/- 406 pg/ml). Two girls with homozygous R257X mutations showed similarly marked elevation of IgM and increase of CD3+CD4+ lymphocytes. Positive autoantibodies against smooth muscle were found in one affected girl; another girl and her mother had antibodies against gastric parietal cells. Interestingly, all fathers had dramatically elevated levels of IgA and activated T lymphocytes. High frequency of abnormal immune results among parents is a novel finding which might suggest a subclinical immune deficit in heterozygotes with AIRE mutations. PMID:12503856
Sedivá, Anna; Ciháková, Daniela; Lebl, Jan
Chronic mucocutaneous candidiasis disease (CMCD) may be caused by autosomal dominant (AD) IL-17F deficiency or autosomal recessive (AR) IL-17RA deficiency. Here, using whole-exome sequencing, we identified heterozygous germline mutations in STAT1 in 47 patients from 20 kindreds with AD CMCD. Previously described heterozygous STAT1 mutant alleles are loss-of-function and cause AD predisposition to mycobacterial disease caused by impaired STAT1-dependent cellular responses to IFN-?. Other loss-of-function STAT1 alleles cause AR predisposition to intracellular bacterial and viral diseases, caused by impaired STAT1-dependent responses to IFN-?/?, IFN-?, IFN-?, and IL-27. In contrast, the 12 AD CMCD-inducing STAT1 mutant alleles described here are gain-of-function and increase STAT1-dependent cellular responses to these cytokines, and to cytokines that predominantly activate STAT3, such as IL-6 and IL-21. All of these mutations affect the coiled-coil domain and impair the nuclear dephosphorylation of activated STAT1, accounting for their gain-of-function and dominance. Stronger cellular responses to the STAT1-dependent IL-17 inhibitors IFN-?/?, IFN-?, and IL-27, and stronger STAT1 activation in response to the STAT3-dependent IL-17 inducers IL-6 and IL-21, hinder the development of T cells producing IL-17A, IL-17F, and IL-22. Gain-of-function STAT1 alleles therefore cause AD CMCD by impairing IL-17 immunity.
Liu, Luyan; Okada, Satoshi; Kong, Xiao-Fei; Kreins, Alexandra Y.; Cypowyj, Sophie; Abhyankar, Avinash; Toubiana, Julie; Itan, Yuval; Audry, Magali; Nitschke, Patrick; Masson, Cecile; Toth, Beata; Flatot, Jerome; Migaud, Melanie; Chrabieh, Maya; Kochetkov, Tatiana; Bolze, Alexandre; Borghesi, Alessandro; Toulon, Antoine; Hiller, Julia; Eyerich, Stefanie; Eyerich, Kilian; Gulacsy, Vera; Chernyshova, Ludmyla; Chernyshov, Viktor; Bondarenko, Anastasia; Maria Cortes Grimaldo, Rosa; Blancas-Galicia, Lizbeth; Madrigal Beas, Ileana Maria; Roesler, Joachim; Magdorf, Klaus; Engelhard, Dan; Thumerelle, Caroline; Burgel, Pierre-Regis; Hoernes, Miriam; Drexel, Barbara; Seger, Reinhard; Kusuma, Theresia; Jansson, Annette F.; Sawalle-Belohradsky, Julie; Belohradsky, Bernd; Jouanguy, Emmanuelle; Bustamante, Jacinta; Bue, Melanie; Karin, Nathan; Wildbaum, Gizi; Bodemer, Christine; Lortholary, Olivier; Fischer, Alain; Blanche, Stephane; Al-Muhsen, Saleh; Reichenbach, Janine; Kobayashi, Masao; Rosales, Francisco Espinosa; Lozano, Carlos Torres; Kilic, Sara Sebnem; Oleastro, Matias; Etzioni, Amos; Traidl-Hoffmann, Claudia; Renner, Ellen D.; Abel, Laurent; Picard, Capucine; Marodi, Laszlo; Boisson-Dupuis, Stephanie
Full Text Available This research was conducted to investigate the amount of Candida albicans in vaginal secretion of Vaginal Candidiasis patients administered with Zn-enriched virgin coconut oil. Thirty respondents were selected based on several criteria as follows: the number of C. albicans colonies in the vaginal secretion was more than 105 cfu.ml-1, voluntary, healthy, willing to sign the informed consent and resided in Purwokerto. In Group A, 10 women were administered 2 tablespoons per day of Zn-enriched virgin coconut oil. In Group B, 10 women were administered 1 tablespoon per day of Zn-enriched virgin coconut oil; and in Group C, 10 women served as control group. Vaginal secretions were taken 3 times, before intervention (at baseline time, at 1 month and 2 months after intervention. Samples were taken by collecting vaginal secretions from the vaginal proximal region using a sterile cotton bud, which was then put into a tube containing sterile carrier media. The vaginal secretions were tested for the number of total C. albicans using Pour Plate Method. Two months after treatment, the number of colonies decreased from 4.4x106 to 2.5x106 cfu ml-1 (p=0.03 in Group A. There was no significant difference in the number of colonies between Group A and Group B, the number of C. albicans colonies was still above the normal range. Therefore, the recommended dosage of intervention with Zn-enriched virgin coconut oil is one tablespoon a day.
Full Text Available SciELO Brazil | Language: English Abstract in english This study was design to evaluate the anti-candidal activity of Astragalus verus Olivier, Fabaceae (Av). The GC/MS analysis of essential oils of Av showed that aqueous extract contains thymol while hexadecanoic acid, 1,2-benzenedicarboxylic acid, diisooctyl ester and phytol were found as major compo [...] nents of methanol and acetone extracts. The aqueous extract showed anti-candidal activity in the concentration 320 mg/mL using disc diffusion method and its minimum inhibitory concentration (MIC) was 160 mg/mL. To induce cutaneous candidiasis, the dorsum of immunocompromised guinea pigs was infected with Candida albicans and animals were divided into five groups (n=5 for each): NC, received a vehicle; PC, received topical ketoconazole 2% and three other groups which received topical 10, 20 and 40% aqueous extract of Av. On ninth day postinfection, skins were cultured and colony forming unite per gram (CFU/g) skin was recorded. Systemic candidiasis was obtained by intravenous inoculation of C. albicans, 4000 CFU/g body weight. Here, animals have been divided into five groups like cutaneous candidiasis but their medications have been delivered in drinking water for ten days before induction of infection. On second day postinfection, all internal tissues were taken for determining CFU/g tissue. The aqueous extract (40%) prevented heavy burden of C. albicans in tissues and skin in oral and topical application, respectively. The results indicate that Av represents a potential source of anti-candidal drug.
Mikaeili, Ali; Karimi, Isaac; Shamspur, Tayebeh; Gholamine, Babak; Modaresi, Masoud; Khanlari, Ali.
Candidíase laríngea isolada em paciente imunocompetente: relato de caso e revisão literária pertinente / Isolated laryngeal candidiasis in a immunocompetent patient: a case report and a literature review
Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Através de revisão de literatura, confirma-se que infecção laríngea por cândida é uma entidade rara e usualmente associada a infecção pulmonar ou candidíase disseminada¹. Candidíase em laringe de forma isolada (C.L.I.) é uma patologia ainda mais rara, e comumente relacionada a pacientes imunodeficie [...] ntes². Sabe-se que à laringoscopia direta, a candidíase pode apresentar achados físicos pobres como simples hiperemia local ou mesmo leucoplasia, mimetizando patologias como DRGE até neoplasias, fazendo, pois, parte do diagnóstico diferencial. Encontramos e documentamos em nosso serviço um caso de infecção por cândida de forma isolada em laringe (C.L.I.) em paciente imunocompetente. Havia comprometimento laríngeo importante, inclusive com lesão deformante em epiglote, simulando processo neoplásico. O diagnóstico foi estabelecido por videolaringoscopia e 2 biópsias da lesão encontrada, sendo os materiais obtidos submetidos a 2 estudos histopatológicos. Tomamos o cuidado de afastar síndromes imunodeficitárias, inclusive de etiologia viral, através de pesquisa sorológica e investigação sobre abuso de corticoesteróides ou antibióticos sistêmicos. Fizemos o follow-up do paciente "per" e pós tratamento com antifúngico sistêmico, acompanhando evolução e melhora através da endoscopia e sinais clínicos. Abstract in english After a literature revision it is confirmed that the larynx candidiasis is rare and usually associated with lungs infection or systemic candidiasis. The larynx isolated form is more rare and seldom associated to immunological disease. It is known that through endoscopic examination, the candidiasis [...] of larynx can show a single local erythema or leucoplasy, simulating G.E.R.D. or even neoplasia, which are the main differential diagnosis. We reported in our hospital an immunocompetent patient with isolated laryngeal candidiasis. There was an important involvement of larynx with degenerative lesions on epyglote, simulating a neoplasic process. The diagnosis was confirmed by biopses and histophatologic analyses. We crossed off hypotheses corticosteroids and antibiotics abuse. We followed up during and after the treatment with antifungeal by the use of endoscopic and clinical improvement.
Perazzo, Paulo S. L.; Martin, Luiz Ricardo L.; Moura, Milton Pamponet da Cunha; Melo, Max Adrian M.; Carvalho, Márcio da Silva.
The LightCycler system (two-step reverse transcription-PCR–fluorescent hybridization [LC RT-PCR–FH]) was used to quantify Candida albicans actin mRNA as a means of assessing its viability in a reconstituted skin model of cutaneous candidiasis following the application of an antimycotic. A 192-bp ACT exon fragment was ligated into the pCR2.1 plasmid vector, and dilutions of the cloned insert (pACT; 4.092 kb) were used as the standard reference template. The LC RT-PCR–FH system could dete...
Okeke, Charles N.; Tsuboi, Ryoji; Ogawa, Hideoki
Quantitative real-time PCR (qPCR) is considered one of the most sensitive methods to detect low levels of DNA from pathogens in clinical samples. To improve the design of qPCR for the detection of deeply invasive candidiasis, we sought to develop a more comprehensive understanding of the kinetics of DNA released from Candida albicans in vitro and in vivo. We developed a C. albicans-specific assay targeting the rRNA gene complex and studied the kinetics of DNA released from C. albicans alone, ...
Kasai, Miki; Francesconi, Andrea; Petraitiene, Ruta; Petraitis, Vidmantas; Kelaher, Amy M.; Kim, Hee-sup; Meletiadis, Joseph; Sein, Tin; Bacher, John; Walsh, Thomas J.
The secretion of hydrolytic enzymes is a fundamental virulence factor of Candida albicans to develop disease. The objective of this study was to characterise the virulence of 148 clinical isolates of C. albicans from oral candidiasis by assessing the expression of phospholipase (PL) and secreted aspartyl proteinase (SAP). Isolates were obtained from healthy subjects (HS) and diabetics (DOC) and non-diabetics with oral candidiasis (NDOC). An aliquot (5 ?l) of each cell suspension was inoculated on PL and SAP agar plates and incubated. Enzymes secretion was detected by the formation of an opaque halo around the colonies and enzymatic activity (PZ) was determined by the ratio between colony diameter and colony diameter plus the halo zone. Statistical comparisons were made by a one-way anova followed by Tukey's post hoc test (? = 0.05). The clinical sources of C. albicans had significant effect (P < 0.001) on the PZ values of both enzymes. For PL, clinical isolates from NDOC and DOC had highest enzymatic activity than those from HS (P < 0.05), with no significant differences between them (P = 0.506). For SAP, C. albicans from NDOC showed the lower enzymatic activity (P < 0.001). There were no significant differences between isolates from HS and DOC (P = 0.7051). C. albicans isolates from NDOC and DOC patients showed an increased production of PL. PMID:24329754
Sanitá, Paula Volpato; Zago, Chaiene Evelin; Pavarina, Ana Cláudia; Jorge, Janaina Habib; Machado, Ana Lúcia; Vergani, Carlos Eduardo
Anidulafungin compared with fluconazole for treatment of candidemia and other forms of invasive candidiasis caused by
Abstract Background Candida albicans is the most common cause of candidemia and other forms of invasive candidiasis. Systemic infections due to C. albicans exhibit good susceptibility to fluconazole and echinocandins. However, the echinocandin anidulafungin was recently demonstrated to be more effective than fluconazole for systemic Candida infections in a randomized, double-blind trial among 245 patients. In that trial, most infections were caused ...
Reboli Annette C; Shorr Andrew F; Rotstein Coleman; Pappas Peter G; Kett Daniel H; Schlamm Haran T; Reisman Arlene L; Biswas Pinaki; Walsh Thomas J
Background.?Invasive candidiasis is the third most common bloodstream infection in the intensive care unit (ICU) and is associated with morbidity and mortality. Prophylaxis and preemptive therapy are attractive strategies for this setting. Methods.?We conducted a multicenter, randomized, double-blind, placebo-controlled trial of caspofungin as antifungal prophylaxis in 222 adults who were in the ICU for at least 3 days, were ventilated, received antibiotics, had a central line, and had 1 additional risk factor (parenteral nutrition, dialysis, surgery, pancreatitis, systemic steroids, or other immunosuppressants). Subjects' (1,3)-?-d-glucan levels were monitored twice weekly. The primary endpoint was the incidence of proven or probable invasive candidiasis by EORTC/MSG criteria in patients who did not have disease at baseline. Patients who had invasive candidiasis were allowed to break the blind and receive preemptive therapy with caspofungin. The preemptive approach analysis included patients all patients who received study drug, including those positive at baseline. Results.?The incidence of proven/probable invasive candidiasis in the placebo and caspofungin arms was 16.7% (14/84) and 9.8% (10/102), respectively, for prophylaxis (P = .14), and 30.4% (31/102) and 18.8% (22/117), respectively, for the preemptive approach (P = .04); however, this analysis included patients with baseline disease. There were no significant differences in the secondary endpoints of mortality, antifungal use, or length of stay. There were no safety differences. Conclusions.?Caspofungin was safe and tended to reduce the incidence of invasive candidiasis when used for prophylaxis, but the difference was not statistically significant. A preemptive therapy approach deserves further study. Clinical Trials Registration.?NCT00520234. PMID:24550378
Ostrosky-Zeichner, Luis; Shoham, Shmuel; Vazquez, Jose; Reboli, Annette; Betts, Robert; Barron, Michelle A; Schuster, Mindy; Judson, Marc A; Revankar, Sanjay G; Caeiro, Juan Pablo; Mangino, Julie E; Mushatt, David; Bedimo, Roger; Freifeld, Alison; Nguyen, Minh Hong; Kauffman, Carol A; Dismukes, William E; Westfall, Andrew O; Deerman, Jeanna Beth; Wood, Craig; Sobel, Jack D; Pappas, Peter G
Etiología de la candidiasis vulvovaginal recidivante en la Atención Primaria de Salud en Santa Catarina, Brasil / Etiology of recurrent vulvovaginal candidiasis in the National Health System in Santa Catarina, Brazil / Etiologia da candidíase vulvovaginal recorrente na Atenção Primária à Saúde em Santa Catarina, Brasil
Full Text Available SciELO Argentina | Language: Spanish Abstract in portuguese O objetivo do presente trabalho foi destacar as características epidemiológicas que possam subsidiar a Atenção Primária à Saúde (APS) em mulheres portadoras de candidíase vulvovaginal (CVV) e candidíase vulvovaginal recorrente (CVVR), a partir de estudos realizados em três municípios do sul do Brasi [...] l. Através do exame micológico da secreção vaginal de 300 mulheres com suspeita clínica de CVV ou CVVR foram identificadas as espécies prevalentes de Candida, correlacionando os achados com os principais fatores de risco mencionados na literatura. Foram detectadas leveduras em 90 (30%) dos casos, resultando as espécies mais frequentes C. albicans (61,1%), C. krusei (16,7%), C. tropicalis (6,7%), C. glabrata (4,4%) e Candida spp. (11,1%). Nos casos de CVVR, C. albicans foi a espécie mais encontrada, com uma prevalência superior à observada nos casos de CVV. C. krusei apareceu como a segunda espécie mais prevalente em todas as amostras, ressaltando a importância do diagnóstico em nível de espécie, devido à resistência intrínseca ao fluconazol. As informações epidemiológicas deste estudo são úteis para que os gestores da Atenção Primária à Saúde (APS) e os profissionais da Saúde Pública possam ter subsídios adicionais para atuar preventivamente nos casos de candidíases vulvovaginais. Abstract in spanish El objetivo del presente trabajo fue destacar las características epidemiológicas que puedan subsidiar la Atención Primaria de Salud (APS) en mujeres portadoras de candidiasis vulvovaginal (CVV) y candidiasis vulvovaginal recidivante (CVVR), a partir de estudios realizados en tres municipios del sur [...] de Brasil. A través del examen micológico de la secreción vaginal de 300 mujeres con sospecha clínica de CVV o CVVR se identificaron las especies prevalentes de Candida, correlacionándose los hallazgos con los principales factores de riesgo mencionados en la literatura. Fueron confirmadas levaduras en 90 (30%) casos, resultando las especies más frecuentes C. albicans (61,1%), C. krusei (16,7%), C. tropicalis (6,7%), C. glabrata (4,4%) y Candida spp. (11,1%). En los casos de CVVR, C. albicans fue la especie más encontrada, con una prevalencia superior a la observada en la CVV. C. krusei apareció como la segunda especie más prevalente en todas las muestras, resaltando la importancia del diagnóstico a nivel de especie, dada la resistencia intrínseca al fluconazol. Las informaciones epidemiológicas del estudio son útiles para que los gestores de la Atención Primaria de Salud (APS) y los profesionales de la Salud puedan tener subsidios adicionales para actuar preventivamente en el caso de candidiasis vulvovaginales. Abstract in english The main purpose of this work was to highlight epidemiological characteristics serving as subsidies to health promotion activities for vulvovaginal candidiasis (VVC) and recurrent vulvovaginal candidiasis (RVVC) by the national health system, in three cities in southern Brazil. Through the mycologic [...] al examination of vaginal secretions of 300 women with clinical suspicion of VVC or RVVC, Candida-prevalent species were identified and they were correlated with the main risk factors mentioned in the literature. Yeasts were confirmed in 90 (30%) cases, resulting in C. albicans 61.1%, C. krusei 16.7%, C. tropicalis 6.7%, C. glabrata 4.4% and others 11.1%. C. albicans was the species most commonly found in cases of RVVC, with levels higher than the prevalence of the species in the VVC. C. krusei prevailed as the second most prevalent species in both samples, emphasizing the importance of diagnosing the species level, due to its intrinsic resistance to fluconazole. The epidemiological information of the study is useful for managers of the National Health Care System, as well as direct health professionals, who can have new subsidies to act preventively against vulvovaginal candidiasis.
Rangeli, Basso; Nelci, Lopes da Silva; Karina, Braccini Pereira; Adelina, Mezzari; Alexandre, Meneghello Fuentefria.
A child with acute myeloid leukemia presented with multiple liver lesions mimicking hepatosplenic candidiasis during the neutropenic phase following the induction chemotherapy. All the available diagnostic tools showed repeatedly negative results, including galactomannan. An enzyme-linked immunospot (ELISPOT) assay showed a high number of Aspergillus-specific T cells producing interleukin-10 [TH2(IL-10)] and a low number of Aspergillus-specific T cells producing gamma interferon [TH1(IFN-gamma)], revealing invasive aspergillosis (IA) before the confirmatory biopsy. A progressive skewing from the predominance of TH2(IL-10) to a predominance of TH1(IFN-gamma) was observed close to the complete resolution of the infection and foreshadowed the outcome. The ELISPOT assay holds promise for diagnosing pediatric IA. PMID:18667632
Potenza, Leonardo; Barozzi, Patrizia; Rossi, Giulio; Palazzi, Giovanni; Vallerini, Daniela; Riva, Giovanni; Cellini, Monica; Morselli, Monica; Volzone, Francesco; Venturelli, Claudia; Quadrelli, Chiara; Di Pancrazio, Luciana; Cano, Maria Carmen; Paolucci, Paolo; Torelli, Giuseppe; Luppi, Mario
A child with acute myeloid leukemia presented with multiple liver lesions mimicking hepatosplenic candidiasis during the neutropenic phase following the induction chemotherapy. All the available diagnostic tools showed repeatedly negative results, including galactomannan. An enzyme-linked immunospot (ELISPOT) assay showed a high number of Aspergillus-specific T cells producing interleukin-10 [TH2(IL-10)] and a low number of Aspergillus-specific T cells producing gamma interferon [TH1(IFN-?)], revealing invasive aspergillosis (IA) before the confirmatory biopsy. A progressive skewing from the predominance of TH2(IL-10) to a predominance of TH1(IFN-?) was observed close to the complete resolution of the infection and foreshadowed the outcome. The ELISPOT assay holds promise for diagnosing pediatric IA.
Potenza, Leonardo; Barozzi, Patrizia; Rossi, Giulio; Palazzi, Giovanni; Vallerini, Daniela; Riva, Giovanni; Cellini, Monica; Morselli, Monica; Volzone, Francesco; Venturelli, Claudia; Quadrelli, Chiara; Di Pancrazio, Luciana; Cano, Maria Carmen; Paolucci, Paolo; Torelli, Giuseppe; Luppi, Mario
Full Text Available Background: Candida is the most common agent causing leucorrhoea affecting the women of all strata. It is becoming difficult to completely eradicate the infection mainly due to recurrence caused by non-albican species of Candida. Most of the non-albican species of Candida are resistant to commonly used antifungal agent - azole. Therefore, studying the Incidence of Candida species in vaginal secretion is of great significance. Objective: To study the incidence of Candidiasis in patients of leucorrhoea and identification of different species of candida found in leucorrhoea and to study the effect of pregnancy and age on infection rate in women Attending in OPD of Gynecology and Obstetrics, Department, Gurugobind Singh Hospital, Jamnagar, Gujarat, India. Materials and Methods: The study was conducted on 300 patients with specific complaints of leucorrhea. Discharge was examined by direct wet preparation by KOH mount, Gram staining, and Culture on Sabouraud’s dextrose agar. Species differentiation was done by Germ tube formation, Sugar assimilation and Sugar Fermentation test. Results: In 19% of the women the leucorrhea was due to Candida infection with highest incidence in women of age (21-30 years. Incidence of candidiasis was higher in Pregnant(22.5% compared to non-pregnant(16.6%. Candida albicans was the most common strain identified and Candida krusei was the least common one. Conclusion: Highest incidence found between 21-30 years age group, in pregnant women, in women from lower socio-economic class. Among candida species C.albicans was commonest followed by C.glabrata, C.tropicalis, C.krusei.
Payal Jaydeep Mankodi
Susceptibility of Germfree Phagocyte Oxidase- and Nitric Oxide Synthase 2-Deficient Mice, Defective in the Production of Reactive Metabolites of Both Oxygen and Nitrogen, to Mucosal and Systemic Candidiasis of Endogenous Origin
Mice deficient for phagocyte oxidase (Phox) and nitric oxide synthase 2 (NOS2) (gp91phox?/?/NOS2?/?), defective in the production of both reactive oxygen intermediates (ROI) and reactive nitrogen intermediates (RNI), were used to investigate the role of phagocytic cells during mucosal and systemic candidiasis of endogenous origin. The alimentary tracts of germfree mice were colonized with Candida albicans wild type or each of two hyphal signaling-defective mutants (efg1/efg1 and efg1/...
Balish, Edward; Warner, Thomas F.; Nicholas, Peter J.; Paulling, Emily E.; Westwater, Caroline; Schofield, David A.
Full Text Available Na odontologia, a fitoterapia já vem sendo utilizada com sucesso há vários anos. Trata-se de um meio terapêutico que apresenta como vantagem sobre as medicações alopáticas o fato de apresentar reações adversas mínimas. A Uncaria tomentosa é uma planta indígena da floresta Amazônica e de outras áreas tropicais da América do Sul e Central. Tem aplicação no tratamento de diversas patologias, entre elas a candidose. Este trabalho avalia clínico e laboratorialmente a ação do gel da Uncaria tomentosa em pacientes portadores de candidose na cavidade oral. Foram selecionados 20 pacientes que apresentaram clínico e laboratorialmente infecção pelo Candida. Os mesmos foram divididos em 2 grupos. O grupo-teste (Uncaria tomentosa/Imuno-Max Gel, composto por 10 pacientes, foi orientado a utilizar o gel da Uncaria tomentosa, sobre as lesões na cavidade oral, 3x ao dia por um período de 14 dias. O grupo-controle (Miconazol/Daktarin Gel utilizou a medicação da mesma forma prescrita para o grupo-teste. Após o período de tratamento, os pacientes retornaram para nova avaliação clínica e laboratorial. A Uncaria tomentosa mostrou ser um fitofármaco promissor na odontologia, apresentando vantagem sobre o miconazol de não ter provocado reações adversas nos pacientes, uma vez que, 40% dos pacientes do grupo-controle, apresentaram reações indesejáveis.In dentistry, the phytotherapy is already being used successfully for some years now. It is about a promising therapeutical way in the pharmaceutical field, having as advantage on pharmacotherapy medications the fact to present minimum adverse reactions. The Uncaria tomentosa is an aboriginal plant of the Amazonian forest and other tropical areas of the South and Central America. It has application in the treatment of several pathologies, including candidiasis. This work evaluates, clinical and laboratorial, the action of the Uncaria tomentosa gel in the oral cavity candidiasis patients. Twenty patients which presented clinical and laboratorial signs of Candida infection were selected. They were divided in 2 groups. The test-group (Uncaria tomentosa/IMUNO-MAX Gel, with 10 patients, was told to use the Uncaria tomentosa gel, on the oral cavity injuries, 3 times a day for a period of 14 days. The control-group (Miconazol/DAKTARIN Gel used the prescribed medication in the same way of the test-group. After the treatment period, the patients returned for a new clinical and laboratorial evaluation. The Uncaria tomentosa showed to be a promising phytotherapeutical medication in dentistry, in the field of the anti-fungi treatment, presenting as advantage on the Miconazol not causing adverse reactions in the patients, once 40% of the control-group patients showed undesirable reactions.
Leonardo Costa de Almeida Paiva
Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Na odontologia, a fitoterapia já vem sendo utilizada com sucesso há vários anos. Trata-se de um meio terapêutico que apresenta como vantagem sobre as medicações alopáticas o fato de apresentar reações adversas mínimas. A Uncaria tomentosa é uma planta indígena da floresta Amazônica e de outras áreas [...] tropicais da América do Sul e Central. Tem aplicação no tratamento de diversas patologias, entre elas a candidose. Este trabalho avalia clínico e laboratorialmente a ação do gel da Uncaria tomentosa em pacientes portadores de candidose na cavidade oral. Foram selecionados 20 pacientes que apresentaram clínico e laboratorialmente infecção pelo Candida. Os mesmos foram divididos em 2 grupos. O grupo-teste (Uncaria tomentosa/Imuno-Max Gel), composto por 10 pacientes, foi orientado a utilizar o gel da Uncaria tomentosa, sobre as lesões na cavidade oral, 3x ao dia por um período de 14 dias. O grupo-controle (Miconazol/Daktarin Gel) utilizou a medicação da mesma forma prescrita para o grupo-teste. Após o período de tratamento, os pacientes retornaram para nova avaliação clínica e laboratorial. A Uncaria tomentosa mostrou ser um fitofármaco promissor na odontologia, apresentando vantagem sobre o miconazol de não ter provocado reações adversas nos pacientes, uma vez que, 40% dos pacientes do grupo-controle, apresentaram reações indesejáveis. Abstract in english In dentistry, the phytotherapy is already being used successfully for some years now. It is about a promising therapeutical way in the pharmaceutical field, having as advantage on pharmacotherapy medications the fact to present minimum adverse reactions. The Uncaria tomentosa is an aboriginal plant [...] of the Amazonian forest and other tropical areas of the South and Central America. It has application in the treatment of several pathologies, including candidiasis. This work evaluates, clinical and laboratorial, the action of the Uncaria tomentosa gel in the oral cavity candidiasis patients. Twenty patients which presented clinical and laboratorial signs of Candida infection were selected. They were divided in 2 groups. The test-group (Uncaria tomentosa/IMUNO-MAX Gel), with 10 patients, was told to use the Uncaria tomentosa gel, on the oral cavity injuries, 3 times a day for a period of 14 days. The control-group (Miconazol/DAKTARIN Gel) used the prescribed medication in the same way of the test-group. After the treatment period, the patients returned for a new clinical and laboratorial evaluation. The Uncaria tomentosa showed to be a promising phytotherapeutical medication in dentistry, in the field of the anti-fungi treatment, presenting as advantage on the Miconazol not causing adverse reactions in the patients, once 40% of the control-group patients showed undesirable reactions.
Leonardo Costa de Almeida, Paiva; Rodrigo Alves, Ribeiro; Jozinete Vieira, Pereira; Neuza Maria Cavalcante, Oliveira.
Full Text Available Abstract Invasive fungal infections are on the rise. Echinocandins are a relatively new class of antifungal drugs that act by inhibition of a key enzyme necessary for integrity of the fungal cell wall. Currently there are three available agents: caspofungin, micafungin and anidulafungin. While the individual echinocandin antifungals have a different spectrum of licensed indications, basically all of them are available for the treatment of candidemia and invasive candidiasis. Antifungal treatment modalities basically include in therapy for suspected or proven infection and prophylaxis. All three drugs are comparatively expensive. Therefore a systematic review of the literature was performed to investigate the following aspects: • General aspects of cost-effectiveness in the treatment of invasive fungal infections • Cost-effectiveness of the treatment with the above-mentioned antifungals • Cost-effectiveness in two settings: therapy and prophylaxis Early initiation of antifungal therapy, adjustment after availability of microbiological results, duration of therapy, success and occurrence of severe complications (e.g renal failure are the most important cost drivers in antifungal therapy. Considering the specific antifungals, for caspofungin the best evidence for cost-effectiveness is found in treatment of invasive candidiasis and in empiric therapy of suspected infections. Favourable economic data are available for micafungin as a cost-effective alternative to LAmB for prophylaxis in patients with hematopoietic stem cell transplantation (HSCT. For anidulafungin, cost-effectiveness was demostrated in a pharmacoeconomic model. Net savings - yet not significant - were observed in a retrospective chart review of 234 patients. Generally, however, most analyses are still based on pharmacoeconomic modelling rather than direct analysis of trial data or real-life clinical populations. As an overall conclusion, using caspofungin, micafungin, or anidulafungin is not more expensive than using other established therapies. Micafungin has proven to be cost-effective in prophylaxis if the local fungal epidemiology indicates a high level of resistance to fluconazole. Switch strategies involving early initiation of broadly active therapy with switch to cheaper alternatives according to microbiology results and clinical status and early initiation of an appropriate therapy have been proven to be cost-efficient independent of the antifungal agent.
Etiologia dos casos de candidíase cutânea atendidos no serviço de micologia da Universidade Federal Fluminense, Brasil / Etiología de casos de candidiasis cutánea atendidos en el servicio de micología de la Universidad Federal Fluminense, Brasil / Etiology of cutaneous candidiasis cases seen at the mycology service of the Universidade Federal Fluminense, Brazil
Full Text Available SciELO Venezuela | Language: Portuguese Abstract in portuguese Neste trabalho foram estudadas 64 amostras oriundas de 56 pacientes com suspeita clínica de candidíase cutânea, coletadas de novembro de 2008 a agosto de 2009, no serviço de Diagnóstico Micológico Humano e Veterinário do Departamento de Microbiologia e Parasitologia, Instituto Biomédico da Universid [...] ade Federal Fluminense. Foram isoladas espécies de Candida em 58 amostras de 51 pacientes, trinta e oito mulheres e treze homens, com a seguinte distribuição: 15 C. parapsilosis, 11 C. famata, 9 C. albicans, 7 C. haemulonii, 5 C. ciferrii, 4 C. guilliermondii, 4 C. lipolytica e 3 C . tropicalis. As onicomicoses representaram mais de 75% das manifestações clínicas. Nos casos em que não foi Candida isolada como o agente etiológico, foram identificados dois Cryptococcus laurentii, um Trichosporon mucoides e um Trichosporon asahii. Este trabalho é uma contribuição para o entendimento da etiologia de candidíase cutânea no serviço de Micologia da Universidade Federal Fluminense. Abstract in spanish En este trabajo se estudiaron 64 muestras procedentes de 56 pacientes con sospecha clínica de candidiasis cutánea, recolectadas entre noviembre de 2008 a agosto de 2009 en el servicio de Diagnóstico Micológico Humano y Veterinario del Departamento de Microbiología y Parasitología, Instituto Biomédic [...] o de la Universidad Federal Fluminense. Se aislaron especies del género Candida en 58 muestras de 51 pacientes, treinta y ocho mujeres y trece hombres, con la siguiente distribución: 15 C. parapsilosis, 11 C. famata, 9 C. albicans, 7 C. haemulonii, 5 C. ciferrii, 4 C. guilliermondii, 4 C. lipolytica y 3 C . tropicalis. Las onicomicosis representaron más del 75% de las manifestaciones clínicas. En los casos donde no se aisló Candida como agente etiológico se identificaron dos Cryptococcus laurentii, un Trichosporon mucoides y un Trichosporon asahii. Este trabajo es una contribución al conocimiento de la etiología de la candidiasis cutánea en el Servicio de Micología de la Universidad Federal Fluminense. Abstract in english This work corresponds to the study of 64 samples from 56 patients with clinical suspicion of cutaneous candidiasis, collected between November 2008 and August 2009 at the Human and Veterinarian Diagnostic Service of the Department of Microbiology and Parasitology of the Instituto Biomédico of the Un [...] iversidad Federal Fluminense, Brazil. Candida genus species were isolated in 58 samples from 51 patients (38 women and 13 men), with the following distribution: C. parapsilosis 15, C. famata 11, C. albicans 9, C. haemulonii 7, C. guilliermondii 4, C. ciferrii 5, C. lipolytica 4, and C. tropicalis 3. Onicomycoses represented over 75% of the clinical manifestations. In cases where Candida was not isolated as etiologic agent, two Cryptococcus laurentii, one Trichosporum mucoides, and one Trichosporum asahii were identified. This work is a contribution to the knowledge of the etiology of cutaneous candidiasis at the Mycology Service of the Universidade Federal Fluminense.
Silva Barbedo, Leonardo; Pereira Brito, Simone Cristina; de Oliveira Kegele, Fabíola Cristina; Alves Cordeiro, Jânio; Carvalhaes de Oliveira, Jeferson; da Graça Sgarbi, Diana Bridon.
Saponin SC-2 from Solanum chrysotrichum showed antifungal activity, demonstrated in vitro, which inhibited the growth of dermatophytes, and in vivo, to be effective in the treatment against tinea pedis and pityriasis capitis. Fungistatic and fungicidal activity of saponin SC-2 on Candida albicans and other Candida species, fluconazole and ketoconazole resistaent strains was demostrated. SC-2-associated ultrastructural alterations in several Candida species were observed. An exploratory clinical, randomized, double-blind, and controlled ketoconazole study of ketoconazole was conducted with the aim of assessing the effectiveness and tolerability of an herbal medicinal product containing SC-2, on women with Vulvovaginal candidiasis (VVC). The results exhibited a percentage of therapeutic clinical effectiveness similar to that of ketoconazole (X(2), p ?0.30), but obtained a smaller percentage of mycological effectiveness, and 100% tolerability. In conclusion, saponin SC-2 possesses fungicidale and fungistatic activity on Candida albicans and other multi resistant Candida species, causes morphological changes and fungal death, and it is an alternative therapy for the treatment of VVC. PMID:24146467
Herrera-Arellano, Armando; López-Villegas, Edgar O; Rodríguez-Tovar, Aida V; Zamilpa, Alejandro; Jiménez-Ferrer, Enrique; Tortoriello, Jaime; Martínez-Rivera, M Angeles
Introduction. We sought to determine the association between HIV-induced immunosuppression, virologic correlates, and vulvovaginal candidiasis (VVC). Methods. This is a retrospective cohort study, where HIV infected and uninfected women were studied with VVC being the primary outcome. Ninety-seven HIV-infected and 101 HIV-uninfected women were enrolled between June and December 2011. Cases of VVC were confirmed. HIV RNA load was determined by RT-PCR and CD4 counts were obtained from medical records. Results. Fifty-two of 97 (53.6%) HIV-infected and 38/101 (37.6%) HIV-uninfected women were diagnosed with VVC (P = 0.032). The relative risk for VVC amongst HIV-infected patients was 1.53 (95% CI: 1.04–2 P = 0.024). Cases of VVC increased at CD4+ T cell count below 200?cells/mm3 (P < 0.0001) and plasma HIV RNA load above 10 000?copies/mL (P < 0.0001). VVC was associated with increased genital shedding of HIV (P = 0.002), and there was a linear correlation between plasma HIV load and genital HIV shedding (r = 0.540; R2 = 0.292; P < 0.0001). Women on HAART were 4-fold less likely (P = 0.029) to develop VVC. Conclusion. CD4 counts below 200?cells/mm3 and plasma HIV loads ?10 000?copies/mL were significantly associated with VVC.
Carr, William H.; Sturm, Willem A.; Moodley, Prashini
Candida albicans strain delineation by karyotyping. NotI restriction pattern analysis, hybridization with specific probe 27A, and PCR fingerprinting with the phage M13 core sequence were performed with 30 isolates from the oral cavities of 30 human immunodeficiency virus (HIV)-infected patients and 8 reference strains. Within the panel of clinical isolates, 20 were geographically related, although 10 isolates were susceptible to fluconazole and 10 isolates were resistant to fluconazole. The remaining isolates used in this study were fluconazole resistant and geographically unrelated. A composite DNA type was defined for each of the strains as the combination of types obtained by the four molecular methods. By this procedure, a great diversity of DNA types was found among isolates from the oropharynges of HIV-infected individuals with oral candidiasis. This diversity was not reduced when isolates were evaluated on the basis of whether they came from the same geographical locale and whether they were fluconazole resistant. These data refute the idea of a clonal origin for fluconazole-resistant strains among HIV-positive patients. Karyotyping was the least discriminatory method, yielding 19 DNA types among the 38 strains analyzed. Conversely, hybridization with the 27A probe showed a unique DNA pattern for each of the strains examined in this study. Our results demonstrate that at least two different molecular methods are needed for Candida albicans typing and that there is a great deal of strain variation within the species, irrespective of place of origin or antifungal resistance patterns. PMID:9157142
Díaz-Guerra, T M; Martínez-Suárez, J V; Laguna, F; Rodríguez-Tudela, J L
To determine the efficacy and safety of a single-dose (1200 mg) soft gel insert (vaginal ovule) with miconazole nitrate (2%) topical cream compared with Monistat 7 (miconazole nitrate 2%) Vaginal Cream (Advanced Care Products, North Brunswick NJ) in treating vulvovaginal candidiasis (VVC), two randomized, single-blind, multicenter, controlled, comparative phase III studies were performed. Five hundred fifty-eight patients received either a single-dose miconazole nitrate (1200 mg) ovule or seven consecutive doses of Monistat 7. Ovule arm patients also received miconazole nitrate 2% cream for symptom relief, as needed, up to twice daily. The primary end point was a therapeutic cure. Also evaluated were time to complete symptom relief, safety, and patient preference. The ovule had overall cure rates of 71.7% (71 of 99 patients) and 61.5% (64 of 104 patients). Monistat 7 had overall cure rates of 70.1% (68 of 97 patients) and 61.1% (55 of 90 patients). A significantly greater proportion of patients experienced complete symptom relief by day 3 with the ovule (p = 0.008 and p = 0.025), and time to complete relief was significantly faster (median 4 versus 5 days and 3 versus 4 days). Overall safety results were consistent between groups in both studies. Miconazole nitrate vaginal ovule is as safe and efficacious in curing VVC as Monistat 7 while providing complete symptom relief significantly faster. Patients preferred the ovule to prior therapy. PMID:10868615
Upmalis, D H; Cone, F L; Lamia, C A; Reisman, H; Rodriguez-Gomez, G; Gilderman, L; Bradley, L
This analysis describes the epidemiology and outcomes of invasive candidiasis caused by non-albicans species of Candida in patients enrolled in the Prospective Antifungal Therapy Alliance (PATH Alliance) registry from 2004 to 2008. A total of 2,496 patients with non-albicans species of Candida isolates were identified. The identified species were C. glabrata (46.4%), C. parapsilosis (24.7%), C. tropicalis (13.9%), C. krusei (5.5%), C. lusitaniae (1.6%), C. dubliniensis (1.5%) and C. guilliermondii (0.4%); 111 infections involved two or more species of Candida (4.4%). Non-albicans species accounted for more than 50% of all cases of invasive candidiasis in 15 of the 24 sites (62.5%) that contributed more than one case to the survey. Among solid organ transplant recipients, patients with non-transplant surgery, and patients with solid tumors, the most prevalent non-albicans species was C. glabrata at 63.7%, 48.0%, and 53.8%, respectively. In 1,883 patients receiving antifungal therapy on day 3, fluconazole (30.5%) and echinocandins (47.5%) were the most frequently administered monotherapies. Among the 15 reported species, 90-day survival was highest for patients infected with either C. parapsilosis (70.7%) or C. lusitaniae (74.5%) and lowest for patients infected with an unknown species (46.7%) or two or more species (53.2%). In conclusion, this study expands the current knowledge of the epidemiology and outcomes of invasive candidiasis caused by non-albicans species of Candida in North America. The variability in species distribution in these centers underscores the importance of local epidemiology in guiding the selection of antifungal therapy.
Pfaller, Michael A.; Andes, David R.; Diekema, Daniel J.; Horn, David L.; Reboli, Annette C.; Rotstein, Coleman; Franks, Billy; Azie, Nkechi E.
An Evaluation of Butoconazole Nitrate 2% Site ReleaseÃ‚Â® Vaginal Cream (Gynazole-1Ã‚Â® Compared to Fluconazole 150 mg Tablets (DiflucanÃ‚Â® in the Time to Relief of Symptoms in Patients With Vulvovaginal Candidiasis
Full Text Available Background. It is estimated that as many as 13 million cases of vulvovaginal infection occur in the United States annually, the majority of which are the result of Candida albicans infection. The symptoms of vulvovaginal infections are often painful and distressing to the patient. The objective of this study was to compare the time to symptomatic relief of vulvovaginal candidiasis (VVC with butoconazole nitrate 2% Site ReleaseÃ‚Â® vaginal cream (Gynazole-1Ã‚Â® and oral fluconazole 150 mg tablets (DiflucanÃ‚Â®.
Campbell K. Skokos
Candida parapsilosis isolates occasionally display resistance in vitro to echinocandins and cause breakthrough infections to echinocandins. The degree of the in vivo cross-resistance among echinocandins and the fitness loss associated with caspofungin (CAS) resistance of C. parapsilosis are not well studied. We compared the activities of CAS and anidulafungin (ANF), each given at 2 dosing schedules (high dose or low dose) in a nonneutropenic mouse model of invasive candidiasis (IC) caused by ANF-susceptible isolates of C. parapsilosis with different degrees of susceptibility to CAS (CAS resistant [CAS-R], MIC, >16 mg/liter; CAS intermediate [CAS-I], MIC, 4 mg/liter; and CAS susceptible [CAS-S], MIC, 2 mg/liter). We analyzed tissue fungal burden, histopathology, and weight loss patterns. Increasing CAS resistance was associated with reduced virulence of C. parapsilosis isolates (mortality rates for CAS-S versus CAS-I versus CAS-R, 100% versus 11.1% versus 0%, respectively; P < 0.001). High doses of either echinocandin were active against infection with the CAS-I isolate when assessed by fungal burden reduction and weight gain. In contrast to CAS-S and CAS-I isolates, there was no reduction in fungal burden in mice infected with the CAS-R isolate following treatment with either echinocandin, each given at a high or low dose. Nevertheless, mice infected with the CAS-R isolate had reduced disease severity following echinocandin treatment, suggesting that echinocandins have activity in vivo, even against echinocandin-resistant strains. A complex interplay of residual echinocandin activity, decreased virulence, and/or fitness of isolates with altered cell wall and possible immunomodulatory effects can be encountered in vivo during infection with CAS-resistant C. parapsilosis isolates. PMID:24145540
Dimopoulou, Dimitra; Hamilos, Georgios; Tzardi, Maria; Lewis, Russell E; Samonis, George; Kontoyiannis, Dimitrios P
Background Chronic mucocutaneous candidiasis disease (CMCD) may result from various inborn errors of interleukin (IL)-17-mediated immunity. Twelve of the 13 causal mutations described to date affect the coiled-coil domain (CCD) of STAT1. Several mutations, including R274W in particular, are recurrent, but the underlying mechanism is unclear. Objective To investigate and describe nine patients with CMCD in Eastern and Central Europe, to assess the biochemical impact of STAT1 mutations, to determine cytokines in supernatants of Candida-exposed blood cells, to determine IL-17-producing T cell subsets and to determine STAT1 haplotypes in a family with the c.820C>T (R274W) mutation. Results The novel c.537C>A (N179K) STAT1 mutation was gain-of-function (GOF) for ?-activated factor (GAF)-dependent cellular responses. In a Russian patient, the cause of CMCD was the newly identified c.854 A>G (Q285R) STAT1 mutation, which was also GOF for GAF-dependent responses. The c.1154C>T (T385M) mutation affecting the DNA-binding domain (DBD) resulted in a gain of STAT1 phosphorylation in a Ukrainian patient. Impaired Candida-induced IL-17A and IL-22 secretion by leucocytes and lower levels of intracellular IL-17 and IL-22 production by T cells were found in several patients. Haplotype studies indicated that the c.820C>T (R274W) mutation was recurrent due to a hotspot rather than a founder effect. Severe clinical phenotypes, including intracranial aneurysm, are presented. Conclusions The c.537C>A and c.854A>G mutations affecting the CCD and the c.1154C>T mutation affecting the DBD of STAT1 are GOF. The c.820C>T mutation of STAT1 in patients with CMCD is recurrent due to a hotspot. Patients carrying GOF mutations of STAT1 may develop multiple intracranial aneurysms by hitherto unknown mechanisms.
Soltesz, Beata; Toth, Beata; Shabashova, Nadejda; Bondarenko, Anastasia; Okada, Satoshi; Cypowyj, Sophie; Abhyankar, Avinash; Csorba, Gabriella; Tasko, Szilvia; Sarkadi, Adrien Katalin; Mehes, Leonora; Rozsival, Pavel; Neumann, David; Chernyshova, Liudmyla; Tulassay, Zsolt; Puel, Anne; Casanova, Jean-Laurent; Sediva, Anna; Litzman, Jiri; Marodi, Laszlo
Anidulafungin compared with fluconazole for treatment of candidemia and other forms of invasive candidiasis caused by Candida albicans: a multivariate analysis of factors associated with improved outcome
Full Text Available Abstract Background Candida albicans is the most common cause of candidemia and other forms of invasive candidiasis. Systemic infections due to C. albicans exhibit good susceptibility to fluconazole and echinocandins. However, the echinocandin anidulafungin was recently demonstrated to be more effective than fluconazole for systemic Candida infections in a randomized, double-blind trial among 245 patients. In that trial, most infections were caused by C. albicans, and all respective isolates were susceptible to randomized study drug. We sought to better understand the factors associated with the enhanced efficacy of anidulafungin and hypothesized that intrinsic properties of the antifungal agents contributed to the treatment differences. Methods Global responses at end of intravenous study treatment in patients with C. albicans infection were compared post-hoc. Multivariate logistic regression analyses were performed to predict response and to adjust for differences in independent baseline characteristics. Analyses focused on time to negative blood cultures, persistent infection at end of intravenous study treatment, and 6-week survival. Results In total, 135 patients with C. albicans infections were identified. Among these, baseline APACHE II scores were similar between treatment arms. In these patients, global response was significantly better for anidulafungin than fluconazole (81.1% vs 62.3%; 95% confidence interval [CI] for difference, 3.7-33.9. After adjusting for baseline characteristics, the odds ratio for global response was 2.36 (95% CI, 1.06-5.25. Study treatment and APACHE II score were significant predictors of outcome. The most predictive logistic regression model found that the odds ratio for study treatment was 2.60 (95% CI, 1.14-5.91 in favor of anidulafungin, and the odds ratio for APACHE II score was 0.935 (95% CI, 0.885-0.987, with poorer responses associated with higher baseline APACHE II scores. Anidulafungin was associated with significantly faster clearance of blood cultures (log-rank p p Conclusions In patients with C. albicans infection, anidulafungin was more effective than fluconazole, with more rapid clearance of positive blood cultures. This suggests that the fungicidal activity of echinocandins may have important clinical implications. Trial registration ClinicalTrials.gov: NCT00058682
Reisman Arlene L
Candida is a saprophytic yeast that is frequently recovered from the respiratory tract. Most mycetoma lesions are due to Aspergillus species growing inside an existing cavity. The saprophytic nature of the Candida species in the human respiratory tract obscures diagnosis of Candida pulmonary infections. Only a few cases of mycetoma due to Can-dida have been reported. We report a case of mycetoma caused by Candida albicans in a diabetic immunocompromised tuberculous patient. Diagnosis was confirmed by biopsy and certain points strongly favoured the diagnosis. The patient was immunocompromised due to uncontrolled diabetes mellitus. Candida albicans was grown from bronchial and repeatedly from sputum samples and Candida antigen was positive from blood in high titre. There was a good clinical as well as radiological response to antifungal therapy and Candida antigen became negative. We emphasize that in the immunosuppressed host, a mycetoma-like lesion may be caused by Candida pulmonary infection. PMID:21264087
Bachh, Arshad Aitaf; Haq, Inaamul; Gupta, Rahul; Varudkar, Hg; Ram, Mohan B
Candida is a saprophytic yeast that is frequently recovered from the respiratory tract. Most mycetoma lesions are due to Aspergillus species growing inside an existing cavity. The saprophytic nature of the Candida species in the human respiratory tract obscures diagnosis of Candida pulmonary infections. Only a few cases of mycetoma due to Can-dida have been reported. We report a case of mycetoma caused by Candida albicans in a diabetic immunocompromised tuberculous patient. Diagnosis was conf...
Bachh Arshad; Haq Inaamul; Gupta Rahul; Varudkar H; Ram Mohan B
Candida is a saprophytic yeast that is frequently recovered from the respiratory tract. Most mycetoma lesions are due to Aspergillus species growing inside an existing cavity. The saprophytic nature of the Candida species in the human respiratory tract obscures diagnosis of Candida pulmonary infections. Only a few cases of mycetoma due to Can-dida have been reported. We report a case of mycetoma caused by Candida albicans in a diabetic immunocompromised tuberculous patient. Diagnosis was confirmed by biopsy and certain points strongly favoured the diagnosis. The patient was immunocompromised due to uncontrolled diabetes mellitus. Candida albicans was grown from bronchial and repeatedly from sputum samples and Candida antigen was positive from blood in high titre. There was a good clinical as well as radiological response to antifungal therapy and Candida antigen became negative. We emphasize that in the immunosuppressed host, a mycetoma-like lesion may be caused by Candida pulmonary infection.
Bachh, Arshad Aitaf; Haq, Inaamul; Gupta, Rahul; Varudkar, HG; Ram, Mohan B
Full Text Available Candida is a saprophytic yeast that is frequently recovered from the respiratory tract. Most mycetoma lesions are due to Aspergillus species growing inside an existing cavity. The saprophytic nature of the Candida species in the human respiratory tract obscures diagnosis of Candida pulmonary infections. Only a few cases of mycetoma due to Can-dida have been reported. We report a case of mycetoma caused by Candida albicans in a diabetic immunocompromised tuberculous patient. Diagnosis was confirmed by biopsy and certain points strongly favoured the diagnosis. The patient was immunocompromised due to uncontrolled diabetes mellitus. Candida albicans was grown from bronchial and repeatedly from sputum samples and Candida antigen was positive from blood in high titre. There was a good clinical as well as radiological response to antifungal therapy and Candida antigen became negative. We emphasize that in the immunosuppressed host, a mycetoma-like lesion may be caused by Candida pulmonary infection.
A case of well differentiated lymphocytic lymphoma complicated by Candida tropicalis ileocolic infection is reported. Candida tropicalis is a saprophytic organism, less abundant in man than the more commonly known Candida albicans. These organisms may be the source of infection in debilitated or immune-deficient patients. A 55-year-old man presented to Emory Hospital 7 months before admission with weight loss. At that time the diagnosis of well differentiated lymphocytic lymphoma was made by bone-marrow biopsy
A case of well differentiated lymphocytic lymphoma complicated by Candida tropicalis ileocolic infection is reported. Candida tropicalis is a saprophytic organism, less abundant in man than the more commonly known Candida albicans. These organisms may be the source of infection in debilitated or immune-deficient patients. A 55-year-old man presented to Emory Hospital 7 months before admission with weight loss. At that time the diagnosis of well differentiated lymphocytic lymphoma was made by bone-marrow biopsy.
The ability of Candida albicans to infect thermally injured mice was studied. Female mice were either left unburned or given a 20% total body surface area 2-s or 7-s scald burn. The wound or skin surface was then inoculated with a human burn wound isolate of C. albicans. At 4 h postburn, approximately 10(2) to 10(3) CFU/g of tissue could be recovered from the skin of burned and unburned animals. Unburned mice cleared the organisms from the skin by 72 h, whereas in 7-s-burned animals, the cand...
Prevalence of Candida albicans and non-albicans isolates from vaginal secretions: comparative evaluation of colonization, vaginal candidiasis and recurrent vaginal candidiasis in diabetic and non-diabetic women / Prevalência de Candida albicans e não albicans isoladas de secreção vaginal: avaliação comparativa entre colonização, candidíase vaginal e candidíase vaginal recorrente em mulheres diabéticas e não diabéticas
Full Text Available SciELO Brazil | Language: English Abstract in portuguese CONTEXTO E OBJETIVO: Candidíase vulvovaginal (CVV) é causada pelo crescimento anormal de fungos do tipo leveduras na mucosa do trato genital feminino. Pacientes com diabetes mellitus (DM) são mais susceptíveis a infecções fúngicas, incluindo por espécies de Candida. O presente estudo investigou a f [...] requência de isolamento total de Candida spp. vaginal, e diferentes quadros clínicos (CVV e CVV recorrente- CVVR) em mulheres com DM tipo 2 comparadas às não diabéticas. A razão de cura do tratamento com fluconazol também foi avaliada. TIPO DE ESTUDO E LOCAL: Estudo transversal realizado no sistema público de saúde de Maringá, Paraná, Brazil. MÉTODO: O estudo envolveu 717 mulheres de 17-74 anos de idade e, destas, 48 (6,7%) tinham DM 2 (média de 53,7 anos), independentemente de sinais e sintomas de CVV. As leveduras foram isoladas e identificadas por métodos fenotípicos clássicos. RESULTADOS: No grupo de não diabéticas (controle), leveduras vaginais totais foram isoladas em 79 (11,8%) mulheres, e no grupo de diabéticas, em 9 (18,8%) (P = 0,000). O grupo de diabéticas mostrou mais mulheres sintomáticas (CVV + CVVR = 66,66%) do que colonizadas (33.33%), e significativamente mais colonização, CVV e CVVR, que as controle. A razão média de cura com fluconazol foi de 75.0% no grupo diabéticas e 86.7% no controle (P = 0.51). CONCLUSÃO: Nós encontramos que DM 2 em mulheres brasileiras associou-se com colonização vaginal por leveduras, CVV e CVVR, razão similar de isolamento de C. albicans e espécies não albicans. Boa taxa de cura foi obtida com fluconazol em ambos os grupos. Abstract in english CONTEXT AND OBJECTIVE: Vulvovaginal candidiasis (VVC) is caused by abnormal growth of yeast-like fungi on the female genital tract mucosa. Patients with diabetes mellitus (DM) are more susceptible to fungal infections, including those caused by species of Candida. The present study investigated th [...] e frequency of total isolation of vaginal Candida spp., and its different clinical profiles - colonization, VVC and recurrent VVC (RVVC) - in women with DM type 2, compared with non-diabetic women. The cure rate using fluconazole treatment was also evaluated. DESIGN AND SETTING: Cross-sectional study conducted in the public healthcare system of Maringá, Paraná, Brazil. METHODS: The study involved 717 women aged 17-74 years, of whom 48 (6.7%) had DM type 2 (mean age: 53.7 years), regardless of signs and symptoms of VVC. The yeasts were isolated and identified using classical phenotypic methods. RESULTS: In the non-diabetic group (controls), total vaginal yeast isolation occurred in 79 (11.8%) women, and in the diabetic group in 9 (18.8%) (P = 0.000). The diabetic group showed more symptomatic (VVC + RVVC = 66.66%) than colonized (33.33%) women, and showed significantly more colonization, VVC and RVVC than seen among the controls. The mean cure rate using fluconazole was 75.0% in the diabetic group and 86.7% in the control group (P = 0.51). CONCLUSION: We found that DM type 2 in Brazilian women was associated with yeast colonization, VVC and RVVC, and similar isolation rates for C. albicans and non-albicans species. Good cure rates were obtained using fluconazole in both groups.
Luciene Setsuko Akimoto, Gunther; Helen Priscila Rodrigues, Martins; Fabrícia, Gimenes; André Luelsdorf Pimenta de, Abreu; Marcia Edilaine Lopes, Consolaro; Terezinha Inez Estivalet, Svidzinski.
An Evaluation of Theraphy with Fluconazole 150 mg Tablets Compared to Fluconazole 150 mg Tablets Plus Dermoxen Lenitiva Cream in The Time to Reduce Simptomatology in Women with Vulvovaginal Candidiasis
Full Text Available Aim of the study. Authors investigated first of all the time to onset of ?rst relief of symptoms. Secondary measures included the time to overall relief of symptoms and the reoccurrence rate over the ?rst 45 days after the first visit. Methods. A randomized, open-label, parallel study evaluated 47 women with moderate to severe symptoms of Vulvo Vaginal Candidiasis (VVC. Patients were divided into two groups of treatment: group 1 followed a therapy with Fluconazole 150 mg tablets, while group 2 had a therapy based on Fluconazole 150 mg tablets coadjuvated by Dermoxen Lenitiva cream. Results. The time at which 50% of patients experienced ?rst relief of symptoms was 24.6 hours for Group 1, while for Group 2 it was 12.4 hours (P<0.05. There were signi?cant differences between the two groups in respect to the time of first relief of symptoms and reoccurrence of infection within 45 days of treatment. Conclusions. Combined treatment with Fluconazole 150 mg tablets and by Dermoxen Lenitiva cream provides statistically signi?cant improvement in the time of ?rst relief of symptoms, complete relief of symptoms and relapse time in the treatment of VVC compared to ?uconazole 150 mg tablets only.
Glossite rombóide mediana associada a candidíase esofagiana: uma possível relação etiológica com a Candida albicans Median rhomboid glossitis associated with esophagic candidiasis: a possible etiologic relation with Candida albicans
Full Text Available A glossite rombóide mediana é doença inflamatória que ocorre na superfície da língua. Apresenta-se como placa avermelhada ou vermelho-esbranquiçada no dorso da língua, na localização mediana. A etiologia é desconhecida. Acredita-se que possa haver relação com a má formação dos arcos branquiais durante a embriogênese. Fatores infecciosos relacionados à Candida albicans também são aventados. Os autores apresentam o caso clínico de uma paciente de 60 anos, com glossite rombóide mediana associada a esofagite candidiásica, ambas responsivas ao tratamento com itraconazol e fluconazol oral. Discute-se se a cândida não seria um dos fatores implicados na etiologia da doença lingual.Median rhomboid glossitis is an inflammatory disease involving the surface of the tongue. It develops clinically as an erythematous or white-erythematous area on the dorsal median surface of the tongue. Etiologic factors are unknown. One of the possible etiologic theories suggests a relation between median rhomboid glossitis and malformation of bronchial arches during embriogenesis. Candida albicans as an infectious etiologic factor has also been suggested. The study presents the case of a 60-year-old patient with median rhomboid glossitis associated with esophagic candidiasis. Both pathologies responded well to therapy with oral itraconazole and fluconazole. The authors argue in favor of the possibility of an etiologic relation between Candida albicans and median rhomboid glossitis .
Rubens Marcelo Souza Leite
Vaginal epithelial cell-derived S100 alarmins induced by Candida albicans via pattern recognition receptor interactions are sufficient but not necessary for the acute neutrophil response during experimental vaginal candidiasis.
Vulvovaginal candidiasis (VVC), caused by Candida albicans, affects women worldwide. Animal and clinical studies suggest that the immunopathogenic inflammatory condition of VVC is initiated by S100 alarmins in response to C. albicans, which stimulate polymorphonuclear neutrophil (PMN) migration to the vagina. The purpose of this study was to extend previous in vitro data and determine the requirement for the alarmin S100A8 in the PMN response and to evaluate pattern recognition receptors (PRRs) that initiate the response. For the former, PMN migration was evaluated in vitro or in vivo in the presence or absence of S100 alarmins initiated by several approaches. For the latter, vaginal epithelial cells were evaluated for PRR expression and C. albicans-induced S100A8 and S100A9 mRNAs, followed by evaluation of the PMN response in inoculated PRR-deficient mice. Results revealed that, consistent with previously reported in vitro data, eukaryote-derived S100A8, but not prokaryote-derived recombinant S100A8, induced significant PMN chemotaxis in vivo. Conversely, a lack of biologically active S100A8 alarmin, achieved by antibody neutralization or by using S100A9(-/-) mice, had no effect on the PMN response in vivo. In PRR analyses, whereas Toll-like receptor 4 (TLR4)- and SIGNR1-deficient vaginal epithelial cells showed a dramatic reduction in C. albicans-induced S100A8/S100A9 mRNAs in vitro, inoculated mice deficient in these PRRs showed PMN migration similar to that in wild-type controls. These results suggest that S100A8 alarmin is sufficient, but not necessary, to induce PMN migration during VVC and that the vaginal PMN response to C. albicans involves PRRs in addition to SIGNR1 and TLR4, or other induction pathways. PMID:24478092
Yano, Junko; Palmer, Glen E; Eberle, Karen E; Peters, Brian M; Vogl, Thomas; McKenzie, Andrew N; Fidel, Paul L
Identificação de espécies de Candida e susceptibilidade antifúngica in vitro: estudo de 100 pacientes com candidíases superficiais Identification of Candida species and antifungal susceptibility in vitro: a study on 100 patients with superficial candidiasis
Full Text Available FUNDAMENTO: Leveduras do gênero Candida determinam colonização, infecções superficiais e infecções sistêmicas em imunodeprimidos. As várias apresentações da doença levam à necessidade de utilizar diferentes métodos diagnósticos e tratamentos. OBJETIVOS: Diferenciar as espécies de Candida e correlacioná-las com as regiões anatômicas. Avaliar a susceptibilidade a cetoconazol, fluconazol, itraconazol e anfotericina B. MÉTODOS: Foram avaliados 100 pacientes imunocompetentes com candidíase cutânea ou mucosa atendidos na Santa Casa de S. Paulo entre maio de 1999 e julho de 2001. Correlacionou-se a região acometida e a espécie de Candida, isolada através técnica CHROMagar Candida®. Avaliou-se a susceptibilidade das espécies a cetoconazol, fluconazol, itraconazol e anfotericina B, através do Etest®. RESULTADOS: C. albicans foi isolada em 76,0% dos materiais, C. krusei em 19% e C. tropicalis em 1%. Não houve correlação significante entre a região acometida e as espécies. A maioria das amostras mostrou susceptibilidade aos antifúngicos. CONCLUSÃO: C. albicans foi a espécie mais observada. A maioria das amostras de Candida mostrou-se susceptível aos antifúngicos.BACKGROUND: Yeasts of the genus Candida create colonization, superficial infections and systemic infections in immunodeficient individuals. The presentations of the disease lead to the necessity of using various diagnostic methods and treatments. OBJECTIVES: To differentiate among the Candida species, correlate them with the anatomical region involved and evaluate in vitro susceptibility to ketoconazole, fluconazole, itraconazole and amphotericin B. METHODS: An evaluation of 100 cases of immunocompetent patients with cutaneous or mucous candidiasis attended at the Santa Casa de Sao Paulo Hospital from May 1999 to July 2001. This study attempted to correlate the site of the involvement and the Candida species, isolated using the CHROMagar Candida® technique. The species were evaluated using the Etest® antifungal susceptibility to ketoconazole, fluconazole, itraconazole and amphotericin B. RESULTS: C. albicans was isolated in 76% of the material, C. krusei in 19% and C. tropicalis in 1%. It was not possible to establish a significant correlation between the involved area and the species isolated. Most of the samples proved to be susceptible to the antifungals tested. CONCLUSIONS: C. albicans was the most commonly observed species. The majority of samples presented susceptibility to the tested antifungals.
Elisete I. Crocco
Candidíase oral e leucoplasia pilosa como marcadores de progressão da infecção pelo HIV em pacientes brasileiros / Oral candidiasis and hairy leukoplakia as progression markers of HIV infection in Brazilian patients
Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Candidíase oral (CO) e leucoplasia pilosa (LP) são importantes indicadores da progressão da infecção pelo vírus da imunodeficiência humana (HIV) para o quadro de AIDS, principalmente em locais onde exames específicos são inacessíveis. OBJETO: Relacionar CO e LP ao número de células CD4+ e à carga vi [...] ral (CV) em pacientes brasileiros HIV-positivos, confirmando-as como marcadores clínicos confiáveis de progressão da doença. FORMA DE ESTUDO: Coorte longitudinal. CASUÍSTICA E MÉTODO: Avaliamos prospectivamente 124 pacientes HIV-positivos, isentos de terapia antiretroviral. Todos foram submetidos a exame ORL, dosagem de células CD4+ e CV, sendo divididos em dois grupos: P e A, de acordo com a presença ou ausência de CO e LP. Depois de seis meses, os pacientes do grupo A foram subdivididos nos subgrupos P6 (presença de lesões) e A6. Dosamos novamente CD4+ e carga viral. Os resultados foram analisados estatisticamente. RESULTADOS: No grupo P (43 pacientes, 28 CO e 15 LP) a contagem de células CD4+ foi menor e a carga viral maior em relação ao grupo A (p Abstract in english Oral candidiasis (OC) and hairy leukoplakia (HL) are important markers of HIV (Human Imunodeficiency syndrome) infection progression for AIDS, mainly in locals where specific tests are inacessible. AIM: to intertwine OC and HL to CD4+ counting and to viral charge (VC) on HIV positive brazilian patie [...] nts, confirming them as trustworthy clinical markers of the disease progression. STUDY DESIGN: Longitudinal cohort. MATERIAL AND METHOD: we have prospectively evaluated 124 HIV+ patients not in use of antiretroviral therapy. All of them have undertaken otorrhinolaringologic examination and CD4+ and VC counting, being divided in two groups: P and A, accordingly to presence or absence of OC and HL. After six months, patients belonging to the A group were re-divided on groups P6 (presence of lesions) and A6 (absence of lesions). Again, CD4+ and VC were counted. The results were statistically evaluated. RESULTS: on the P group, (43 patients, 28 OC, 15 HL) the CD4+ counting was smaller with greater viral charge when compared to A group (P
Miziara, Ivan Dieb; Lima, Adriana da Silva; Cortina, Rodrigo Antonio Cataldo de la.
Candidíase oral e leucoplasia pilosa como marcadores de progressão da infecção pelo HIV em pacientes brasileiros Oral candidiasis and hairy leukoplakia as progression markers of HIV infection in Brazilian patients
Full Text Available Candidíase oral (CO e leucoplasia pilosa (LP são importantes indicadores da progressão da infecção pelo vírus da imunodeficiência humana (HIV para o quadro de AIDS, principalmente em locais onde exames específicos são inacessíveis. OBJETO: Relacionar CO e LP ao número de células CD4+ e à carga viral (CV em pacientes brasileiros HIV-positivos, confirmando-as como marcadores clínicos confiáveis de progressão da doença. FORMA DE ESTUDO: Coorte longitudinal. CASUÍSTICA E MÉTODO: Avaliamos prospectivamente 124 pacientes HIV-positivos, isentos de terapia antiretroviral. Todos foram submetidos a exame ORL, dosagem de células CD4+ e CV, sendo divididos em dois grupos: P e A, de acordo com a presença ou ausência de CO e LP. Depois de seis meses, os pacientes do grupo A foram subdivididos nos subgrupos P6 (presença de lesões e A6. Dosamos novamente CD4+ e carga viral. Os resultados foram analisados estatisticamente. RESULTADOS: No grupo P (43 pacientes, 28 CO e 15 LP a contagem de células CD4+ foi menor e a carga viral maior em relação ao grupo A (pOral candidiasis (OC and hairy leukoplakia (HL are important markers of HIV (Human Imunodeficiency syndrome infection progression for AIDS, mainly in locals where specific tests are inacessible. AIM: to intertwine OC and HL to CD4+ counting and to viral charge (VC on HIV positive brazilian patients, confirming them as trustworthy clinical markers of the disease progression. STUDY DESIGN: Longitudinal cohort. MATERIAL AND METHOD: we have prospectively evaluated 124 HIV+ patients not in use of antiretroviral therapy. All of them have undertaken otorrhinolaringologic examination and CD4+ and VC counting, being divided in two groups: P and A, accordingly to presence or absence of OC and HL. After six months, patients belonging to the A group were re-divided on groups P6 (presence of lesions and A6 (absence of lesions. Again, CD4+ and VC were counted. The results were statistically evaluated. RESULTS: on the P group, (43 patients, 28 OC, 15 HL the CD4+ counting was smaller with greater viral charge when compared to A group (P<0.001. After 6 months, 15 of the 81 patients from the A group were excluded as they have initiated antiretroviral therapy. Eighteen patients (11 OC and 7 HL were included on the P6 group. The others, who were free of lesions, were allocated on the A6 group. Again, CD4+ counting on the P6 group was smaller compared to the A6 group (P<0.001. The opposite occurred to the viral charge. DISCUSSION AND CONCLUSIONS: OC and HL indicate CD4+ counting below 300 cells/mm³ and increased VC, thus being trustable clinical markers of the disease progression.
Ivan Dieb Miziara
The hormonal status of rats affected vaginal infection with Candida albicans. Four hours after infection viable counts were higher and germ tubes were longer in those animals in estrous than in other animals. However, the infection was not maintained with the change in epithelial cell type which occurred as part of the estrous cycle. Estrogen dosing following ovariectomy predisposed toward infection, while progesterone dosing did not. In rats injected with progesterone, germ tube clumping was...
Kinsman, O. S.; Collard, A. E.
... and treat them with the correct medication. For healthcare providers: the most up-to-date clinical practice guidelines for the treatment of VVC are available at the Infectious Diseases Society of America website. Print page Get email updates Contact Us: ...
Full Text Available BACKGROUND: Pustular psoriasis is a rare form of psoriasis in childhood. The prevalence of psoriasis in various parts of the world varies from 0.1% to 3% and the most frequently observed variant is the plaque type, followed by the guttate psoriasis. CASE REPORT: A 4-year-old boy with a history of repeated self-limited arthritis, onycholysis, recurrent erythematous skin, diaper rash, fever and pustular lesions, had several hospital admissions with no benefits. After a 2-year delay in the diagnosis, he was treated as a case of pustular psoriasis which was shown by skin biopsy.
BACKGROUND: Pustular psoriasis is a rare form of psoriasis in childhood. The prevalence of psoriasis in various parts of the world varies from 0.1% to 3% and the most frequently observed variant is the plaque type, followed by the guttate psoriasis.
CASE REPORT: A 4-year-old boy with a history of repeated self-limited arthritis, onycholysis, recurrent erythematous skin, diaper rash, fever and pustular lesions, had several hospital admissions with no benefits. After a 2-year delay in the diagnosis, he was treated as a case of pustular psoriasis which was shown by skin biopsy.
KEY WORDS: Pustular psoriasis, arthritis, children.
Abstract The epidemiology of Candida infections has changed over the last two decades: The number of patients suffering from such infections has increased dramatically and the Candida species involved have become more numerous as Candida albicans is replaced as an infecting agent by various non-C. albicans species (NAC). At the same time, additional antifungal agents have become available. The different Candida species may vary in their susceptibi...
Ac, Rodloff; Koch D; Schaumann R
Evaluation of the supply of antifungal medication for the treatment of vaginal thrush in the community pharmacy setting: a randomized controlled trial / Evaluación del suministro de medicación antifúngica para el tratamiento de la candidiasis vaginal en la farmacia comunitaria: ensayo controlado aleatorizado
Full Text Available SciELO Spain | Language: English Abstract in spanish Antecedentes: La Sociedad Farmacéutica de Australia ha desarrollado una "guía" para el suministro de varios medicamentos sin prescripción al público general. Se ha publicado poca investigación evaluando el efecto de estas guías sobre la provisión de medicación en la práctica de la farmacia. Objetivo [...] s: Evaluar el suministro apropiado de antifúngicos sin receta para el tratamiento de candidiasis vaginal en farmacias comunitarias, con y sin guía. Un objetivo secundario fue describir la evaluación y el consejo proporcionado a los pacientes cuando solicitaban esta medicación. Métodos: Se realizó un ensayo controlado aleatorizado donde dos pacientes simulados condujeron visitas a 100 farmacias comunitarias aleatoriamente seleccionadas en una región metropolitana. Se comparó una solicitud de un producto con fluconazol (antifúngico oral que tiene guía) con una solicitud de un producto con clotrimazol (un antifúngico tópico sin guía). Los mismos datos de los pacientes fueron usados en ambas solicitudes. Las medidas de resultados en las visitas fueron la adecuación del suministro y la remisión al médico. Resultados: Un total de un 16% (n=16) de las visitas produjeron resultados apropiados; 10% (n=5) de fluconazol comparadas con el 22% (n=11) de clotrimazol (chi-square= 2,68, p=0,10). Hubo una diferencia significativa en el tipo de evaluación realizada por el personal de la farmacia entre las visitas del fluconazol y del clotrimazol. La solicitud de clotrimazol produjo un aumento significativo en la frecuencia de la evaluación de la causa de la solicitud (chi-square = 8,57, p=0,003), localización de los síntomas (chi-square= 8,27, p=0,004), e historia previa (chi-square = 5,09, p=0,02). Conclusiones: En general la práctica fue pobre, con la mayoría de las farmacias suministrando inadecuadamente la medicación antifúngica. Se requieren nuevas estrategias para mejorar la práctica actual de las farmacias comunitarias en el suministro de antifúngicos sin receta para la candidiasis vaginal. Abstract in english Background: The Pharmaceutical Society of Australia have developed "guidance" for the supply of several medicines available without prescription to the general public. Limited research has been published assessing the effect of these guidelines on the provision of medication within the practice of p [...] harmacy. Objectives: To assess appropriate supply of non-prescription antifungal medications for the treatment of vaginal thrush in community pharmacies, with and without a guideline. A secondary aim was to describe the assessment and counseling provided to patients when requesting this medication. Methods: A randomized controlled trial was undertaken whereby two simulated patients conducted visits to 100 randomly selected community pharmacies in a metropolitan region. A product-based request for fluconazole (an oral antifungal that has a guideline was compared to a product-based request for clotrimazole (a topical antifungal without a guideline). The same patient details were used for both requests. Outcome measures of the visits were the appropriateness of supply and referral to a medical practitioner. Results: Overall 16% (n=16) of visits resulted in an appropriate outcome; 10% (n=5) of fluconozaole requests compared with 22% (n=11) of clotrimazole requests (chi-square=2.68, p=0.10). There was a difference in the type of assessment performed by pharmacy staff between visits for fluconazole and clotrimazole. A request for clotrimazole resulted in a significant increase in frequency in regards to assessment of the reason for the request (chi-square=8.57, p=0.003), symptom location (chi-square=8.27, p=0.004), and prior history (chi-square=5.09, p=0.02). Conclusions: Overall practice was poor, with the majority of pharmacies inappropriately supplying antifungal medication. New strategies are required to improve current practice of community pharmacies for provision of non-prescription antifungals in the treatment of va
Schneider, Carl R.; Emery, Lyndal; Brostek, Raisa; Clifford, Rhonda M..
Correlação entre os resultados laboratoriais e os sinais e sintomas clínicos das pacientes com candidíase vulvovaginal e relevância dos parceiros sexuais na manutenção da infecção em São Paulo, Brasil Relationship of laboratory results with clinical signs and symptoms of patients with vulvovaginal candidiasis and the significance of the sexual partners for the maintenance of the infection
Full Text Available OBJETIVO: relacionar as leveduras identificadas aos sinais e sintomas clínicos das pacientes com candidíase vulvovaginal e investigar a importância dos parceiros sexuais na reincidência da infecção. MÉTODOS: foi desenvolvido estudo prospectivo de julho de 2001 a julho de 2003 com uma amostra de mulheres residentes na Grande São Paulo. Foram avaliadas 179 pacientes com suspeita clínica de vaginite fúngica, com idade entre 18 e 65 anos. Os critérios para exclusão foram: gravidez, comprometimento imunológico intrínseco e extrínseco, incluindo AIDS, diabetes, imunossupressão, pacientes em terapia com corticosteróides, antibióticos ou hormônios, em pós-menopausa, em uso de dispositivo intra-uterino e duchas vaginais ou espermicidas. Amostras de secreções vaginais ou da glande dos parceiros sexuais de pacientes com vaginite de repetição foram coletadas para microscopia e cultura de fungos. Colônias fúngicas isoladas em CHROMagar Candida foram identificadas por provas clássicas. O teste exato de Fisher foi usado para correlacionar o quadro clínico com as leveduras isoladas das pacientes. RESULTADOS: os sinais e sintomas clínicos mais relevantes na candidíase vulvovaginal foram prurido e corrimento, seguidos por eritema e edema, estatisticamente independente do agente etiológico. Leveduras foram diagnosticadas por microscopia direta em 77 pacientes com vulvovaginites, sendo obtidos 40 cultivos de Candida spp. Candida albicans (70%, C. glabrata (20%, C. tropicalis (7,5% e C. guilliermondii (2,5% foram identificadas. As leveduras prevalentes nos parceiros foram C. albicans e C. glabrata. As mesmas espécies foram detectadas nas companheiras e parceiros em 87% dos casos. CONCLUSÕES: as vulvovaginites fúngicas foram mais freqüentes em mulheres entre 18 e 34 anos de idade. Não foi observada correlação entre as espécies de leveduras detectadas e a sintomatologia clínica. Os parceiros sexuais podem ser importantes reservatórios de Candida spp e estar relacionados à manutenção da candidíase vulvovaginal.PURPOSE: to relate yeasts identified by laboratory tests to clinical signs and symptoms in patients with vulvovaginal candidiasis, and to investigate the importance of the sexual partners in the recurrence of the infection. METHODS: from July 2001 to July 2003, a sample of 179 patients aged from 18 to 65 years old, with clinical suspicion of fungal vaginitis were analyzed in a prospective study in Great São Paulo. Exclusion criteria included: pregnancy, impaired intrinsic or extrinsic immune response (including Aids, diabetes or immunosuppression; patients undergoing corticosteroid, antibiotic or hormone therapy, in post menopause, with intrauterine device (IUD or making use of vaginal douches or spemicides. Samples of vaginal and penis secretions from partners of patients with relapse of vaginitis episodes were collected for microscopy and fungal culture. Fungal colonies isolated in CHROMagar Candida were identified by classical methods. Fisher's exact t-test was used to correlate the clinical picture with the yeasts isolated from patients. RESULTS: the most relevant clinical signs and symptoms were pruritus and vaginal discharge followed by erythema and edema, statistically independent from the etiological agent. Direct microscopy revealed yeasts in 77 patients with vulvovaginitis, and 40 Candida spp cultures were obtained. Candida albicans (70%, C. glabrata (20%, C. tropicalis (7,5% and C. guilliermondii (2,5% were identified. The yeasts prevalent in partners were C. albicans and C. glabrata. The same species were detected in female and male sex partners in 87% of the cases. CONCLUSIONS: fungal vulvovaginitis was more frequent in women between 18 and 34 years old. No correlation was observed between the species of yeast detected and clinical symptomatology. Sexual partners are important Candida spp reservoirs and may be related to the maintenance of the vulvovaginal candidiasis.
Humberto Fabio Boatto
Micafungin is an echinocandin antifungal agent available for clinical use in Japan, Europe, and the United States. Through inhibition of ?-1,3-glucan production, an essential component of the fungal cell wall, micafungin exhibits potent antifungal activity against key pathogenic fungi, including Candida and Aspergillus species, while contributing minimal toxicity to mammalian cells. This activity is maintained against polyene and azole-resistant isolates. Pharmacokinetic and pharmacodynamic ...
Wiederhold, Nathan P.; Cota, Jason M.; Frei, Christopher R.
Nathan P Wiederhold1, Jason M Cota2, Christopher R Frei11University of Texas at Austin College of Pharmacy, Austin, Texas, USA; 2University of the Incarnate Word Feik School of Pharmacy, San Antonio, Texas, USAAbstract: Micafungin is an echinocandin antifungal agent available for clinical use in Japan, Europe, and the United States. Through inhibition of ?-1,3-glucan production, an essential component of the fungal cell wall, micafungin exhibits potent antifungal activity against key pat...
Wiederhold, Nathan P.; Cota, Jason M.; Frei, Christopher R.
Two distinct cases of maxillary actinomycosis and maxillary candidosis in immunocompetent hosts are reported; These infections are rare and similar to mycotic extramucosal non allergic sinusitis. Microbiology and microscopic examination are mandatory to prompt and successful management. Endoscopic endonasal surgery by middle meatotomy seems to be an adequate treatment for these particular entities. PMID:9770038
Rombaux, P; Degols, J C; Hamoir, M; Garbar, C; Bertrand, B; Eloy
Full Text Available The purpose of this study was to identify infections causing Candida spp. and to examine their susceptibility to antifungal drugs. The study examined 30 isolates of Candida spp. grown from blood culture samples of neonates. Clinical histories revealed that all 30 infants had received systemic broad-spectrum antibiotic therapy, 27/30 were low birth weight, 21/30 suffered from respiratory distress syndrome and 23/30 were preterm. The three species of Candida isolated were Candida albicans (16/30, 53.3%, C. tropicalis (7/30,23.3%, and C. krusei (7/30, 23.3%. Antifungal susceptibility tests against fluconazole and amphotericin B were done based on the NCCLS guidelines for antifungal susceptibility testing. The fluconazole resistance pattern was as follows: 1/16 (6.25% strain of C. albicans was susceptible, 12/16 (75% strains were dose dependent susceptibles, and 3/16 (18.75% were resistant to fluconazole. Among Candida tropicalis, 2/7(29% strains were susceptible, 4/7 (55.5% dose dependent susceptible and 1/7 (14.5% were resistant. All strains of C. krusei were resistant to fluconazole. There was no resistance to amphotericin B.
Colony counts and light microscopy were used to assess the capacity of Candida albicans to colonize, infect the alimentary tract, and cause disseminated disease in athymic (nu/nu), euthymic (nu/+), beige (bg/bg), black (bg/+), beige athymic (bg/bg nu/nu), or beige euthymic (bg/bg nu/+) germfree mice. The alimentary tracts of all six genotypes of germfree mice were quickly colonized after exposure to yeast-phase C. albicans. Only bg/bg nu/nu mice showed obvious morbidity and mortality after mu...
Cantorna, M. T.; Balish, E.
A twenty five year old female, presented with burning in throat, Odynophagia and characteristic history of falling of granules, He had a verrucous type granular lesion right retromolar area., tonsil & its fossa, Lingual Surface Epiglottis & Hypoharyngeal wall, Right Aryepiglottic fold & ventricular fold Oedmatous and Scattered granules on both vocal folds & right Posterolateral border of tongue. Candida was detected in 10% Potassium Hydroxide, gram stained smear, prepared from tissue scrappin...
During antibiotic treatment for E.coli urinary tract infection and meningitis, a male new born developed a Candida albicans urinary tract infection with a mycotic kidney abcess and pelvicalyceal fungus balls diagnosed by US investigations and confirmed by radiology. Three weeks later a perirenal urinoma with arterial hypertension developed. After surgical treatment of the urinoma the arterial pressure returned to normal.
Sirinelli, D.; Schmit, P.; Biriotti, V.; Bensman, A.; Lupold, M.
Abstract Objectives It is thought that widespread use of “over-the-counter” azoles may increase the incidence of resistant Candida species such as C glabrata. Infections with species other than C. albicans frequently do not respond to standard azole treatments. Intravaginal nystatin is an option but is no longer available in the UK. In this paper, we review the prevalence of non-albicans candida over the past five years, and assess the efficacy of amphotericin and flucytosin...
Full Text Available Aikaterini Flevari,1 Maria Theodorakopoulou,1 Aristea Velegraki,2 Apostolos Armaganidis,1 George Dimopoulos1 1Department of Critical Care, University Hospital Attikon, Medical School, 2Mycology Laboratory, Department of Microbiology, Medical School, University of Athens, Athens, Greece Abstract: Fungi are major causes of infections among immunocompromised or hospitalized patients with serious underlying diseases and comorbidities. Candida species remain the most important cause of opportunistic infections worldwide, affecting predominantly patients over 65 years old, while they are considered to be the fourth most common cause of nosocomial bloodstream infections. The rapidly growing elderly population has specific physiological characteristics, which makes it susceptible to colonization and subsequent infection due to Candida species. Comorbidities and multidrug use should be taken into account any time the therapeutic regimen is under consideration. Different classes of antifungal drugs are available for the treatment of invasive fungal infections but echinocandins, apart from their activity against resistant strains (Candida glabrata and Candida krusei, seem to be safe, with limited adverse events and minimal drug–drug interactions in comparison to the other regimens. Therefore, these agents are strongly recommended when dealing with elderly patients suffering from an invasive form of Candida infection. Keywords: emerging fungal infections, elderly patients, treatment
Full Text Available Introducción. En la mujer embarazada, factores como la carga hormonal y los altos niveles de glucogéno favorecen la colonización y la infección vaginal por levaduras. Objetivo. Determinar la prevalencia de levaduras del género Candida, aisladas de muestras de flujo vaginal de un grupo de mujeres embarazadas de la ciudad de Medellín y evaluar la sensibilidad a los antifúngicos. Materiales y métodos. Estudio descriptivo en el cual se estudiaron 300 mujeres gestantes que acudieron a los programas de control prenatal de diferentes IPS de Medellín, en el período de febrero de 2006 a junio de 2007. Se determinó la prevalencia de Candida spp. mediante cultivo e identificación de las levaduras obtenidas, y se determinó la sensibilidad a fluconazol e itraconazol por el método comercial del ATB fungus. A las cepas en las que se evidenció crecimiento residual en fluconazol por dicho método, se les realizó antibiograma por los métodos avalados por el Clinical and Laboratory Standards Institute (CLSI microdilución M27-A y método de difusión en disco M-44P. Resultados. La prevalencia de Candida spp. fue de 33,3% (C. albicans, 77%; C. parapsilosis, 11%; C. tropicalis, 5%; C. glabrata, 3%; C. guillermondii, 2%; C. kefyr, 1%, y C. famata, 1%. Todos los aislamientos mostraron sensibilidad al fluconazol. Se halló resistencia al itraconazol en 9% de los aislamientos de C. albicans y en 100% de los de C. glabrata. El 2,5% de los aislamientos de C. albicans y el 100% de los de C. kefyr resultaron sensibles dependiente de la dosis a dicho antifúngico. Conclusiones. C. albicans fue la levadura más frecuentemente aislada de flujo vaginal, seguida por patógenos emergentes, como C. parapsilosis y C. tropicalis. En la población estudiada, las levaduras del género Candida son aún ampliamente sensibles a los antifúngicos. Se recomienda la identificación de la levadura a nivel de especie y hacer pruebas de sensibilidad en el caso de falla terapéutica y en infecciones recidivantes.During pregnancy, risk factors such as the high hormonal load and high levels of glucogen allow vaginal colonization and infection by yeasts. Objective: To determine the prevalence of Candida spp. isolated from samples of vaginal discharge from pregnant women in Medellín and to test their sensitivity to antimycotic agents. Materials and methods: Descriptive study in which 300 pregnant women were tested between February 2006 to June 2007. The prevalence of Candida spp. was determined by culture, the yeasts were identified, and the sensitivity to fluconazole and itraconazole was determined by the ATB fungus method; the strains with residual growth in fluconazole by such method were submitted to antibiogram by the methods approved by the CLSI. Results: The prevalence of Candida spp. was 33.3% (C. albicans, 77%. All the isolations showed sensitivity to fluconazole. Resistance to itraconazole was found in 9% of C. albicans isolates, and in 100% of C. glabrata; 2.5% of the isolates of C. albicans and 100% of C. kefyr resulted sensitive dose-dependent to such antymicotyc. Conclusions: C. albicans was the yeast most frequently isolated from vaginal discharge, followed by emergent pathogens such as C. parasilopsis and C. tropicalis. In the studied population, yeasts from the Candida gender were still very sensitive to antimycotic agets. It is recommended to identify the yeast to its gender and to perform sensitivity tests in case of therapeutic failure or in recurrent infections.
Clara María Duque
Full Text Available SciELO Colombia | Language: Spanish Abstract in spanish Introducción. En la mujer embarazada, factores como la carga hormonal y los altos niveles de glucogéno favorecen la colonización y la infección vaginal por levaduras. Objetivo. Determinar la prevalencia de levaduras del género Candida, aisladas de muestras de flujo vaginal de un grupo de mujeres emb [...] arazadas de la ciudad de Medellín y evaluar la sensibilidad a los antifúngicos. Materiales y métodos. Estudio descriptivo en el cual se estudiaron 300 mujeres gestantes que acudieron a los programas de control prenatal de diferentes IPS de Medellín, en el período de febrero de 2006 a junio de 2007. Se determinó la prevalencia de Candida spp. mediante cultivo e identificación de las levaduras obtenidas, y se determinó la sensibilidad a fluconazol e itraconazol por el método comercial del ATB fungus. A las cepas en las que se evidenció crecimiento residual en fluconazol por dicho método, se les realizó antibiograma por los métodos avalados por el Clinical and Laboratory Standards Institute (CLSI) microdilución M27-A y método de difusión en disco M-44P. Resultados. La prevalencia de Candida spp. fue de 33,3% (C. albicans, 77%; C. parapsilosis, 11%; C. tropicalis, 5%; C. glabrata, 3%; C. guillermondii, 2%; C. kefyr, 1%, y C. famata, 1%). Todos los aislamientos mostraron sensibilidad al fluconazol. Se halló resistencia al itraconazol en 9% de los aislamientos de C. albicans y en 100% de los de C. glabrata. El 2,5% de los aislamientos de C. albicans y el 100% de los de C. kefyr resultaron sensibles dependiente de la dosis a dicho antifúngico. Conclusiones. C. albicans fue la levadura más frecuentemente aislada de flujo vaginal, seguida por patógenos emergentes, como C. parapsilosis y C. tropicalis. En la población estudiada, las levaduras del género Candida son aún ampliamente sensibles a los antifúngicos. Se recomienda la identificación de la levadura a nivel de especie y hacer pruebas de sensibilidad en el caso de falla terapéutica y en infecciones recidivantes. Abstract in english During pregnancy, risk factors such as the high hormonal load and high levels of glucogen allow vaginal colonization and infection by yeasts. Objective: To determine the prevalence of Candida spp. isolated from samples of vaginal discharge from pregnant women in Medellín and to test their sensitivit [...] y to antimycotic agents. Materials and methods: Descriptive study in which 300 pregnant women were tested between February 2006 to June 2007. The prevalence of Candida spp. was determined by culture, the yeasts were identified, and the sensitivity to fluconazole and itraconazole was determined by the ATB fungus method; the strains with residual growth in fluconazole by such method were submitted to antibiogram by the methods approved by the CLSI. Results: The prevalence of Candida spp. was 33.3% (C. albicans, 77%). All the isolations showed sensitivity to fluconazole. Resistance to itraconazole was found in 9% of C. albicans isolates, and in 100% of C. glabrata; 2.5% of the isolates of C. albicans and 100% of C. kefyr resulted sensitive dose-dependent to such antymicotyc. Conclusions: C. albicans was the yeast most frequently isolated from vaginal discharge, followed by emergent pathogens such as C. parasilopsis and C. tropicalis. In the studied population, yeasts from the Candida gender were still very sensitive to antimycotic agets. It is recommended to identify the yeast to its gender and to perform sensitivity tests in case of therapeutic failure or in recurrent infections.
Duque, Clara María; Uribe, Olga Lucía; Soto, Andrés Felipe; Alarcón, Juan.
Secreted aspartyl proteinases are putative virulence factors in Candida infections. Candida albicans possesses at least nine members of a SAP gene family, all of which have been sequenced. Although the expression of the SAP genes has been extensively characterized under laboratory growth conditions, no studies have analyzed in detail the in vivo expression of these proteinases in human oral colonization and infection. We have developed a reliable and sensitive procedure to detect C. albicans ...
Naglik, Julian R.; Newport, George; White, Theodore C.; Fernandes-naglik, Lynette L.; Greenspan, John S.; Greenspan, Deborah; Sweet, Simon P.; Challacombe, Stephen J.; Agabian, Nina
The aim of the present study was to investigate the efficacy of treatment with a combination of fluconazole and human recombinant interleukin-1 alpha (IL-1 alpha) in normal or neutropenic mice with systemic Candida albicans infection. Six hours after intravenous injection of 5 x 10(4) CFU of C. albicans organisms, oral treatment twice daily with 2.5 or 10 mg of fluconazole per kg of body weight, a single intraperitoneal injection of 80 ng of IL-1, or a combination of the two was started. IL-1...
Kullberg, B. J.; T Wout, J. W.; Poell, R. J.; Furth, R.
Se han desarrollado y optimizado dos nanoemulsiones que contienen Nistatina (N1 y N2) para su aplicación en piel y mucosa oral, respectivamente. Estas formulaciones tuvieron un tamaño de gota nanométrico y resultaron ser estables a lo largo del tiempo. Adicionalmente se determinó el comportamiento reológico de ambos sistemas resultando ser fluidos newtonianos.
[spa] Se han desarrollado y optimizado dos nanoemulsiones que contienen Nistatina (N1 y N2) para su aplicación en piel y mucosa oral, respectivamente. Estas formulaciones tuvieron un tamaño de gota nanométrico y resultaron ser estables a lo largo del tiempo. Adicionalmente se determinó el comportamiento reológico de ambos sistemas resultando ser fluidos newtonianos.
Background: The leaves of Eucalyptus globulus (eucalyptus) are used for treatment of diabetes mellitus in traditional medicine. The aim of this study was to evaluate the effects of eucalyptus in treatment of established systemic infection with Candida albicans in normal and streptozotocin-induced diabetic rats. Methods: Sixty normoglycemic male Wistar rats, weighing 200-250 g, were selected and randomly divided into six groups (n= 10): normal control, control + C. albicans, control + eucalyptus + C. albicans, diabetic control, diabetic + C. albicans, diabetic + eucalyptus + C. albicans. Diabetes was induced after a single intraperitoneal injection of streptozotocin (60 mg/kg body weight) and eucalyptus was added to the diet (62.5 g/kg) and drinking water (2.5 g/L) of treated animals for 4 weeks. The concerned groups were inoculated with C. albicans 15 days after diabetes induction. At the end of one month experiment, fasted rats were killed by cervical decapitation. Blood was collected from neck vein for estimation of glucose. C. albicans concentrations were estimated in liver and kidneys using serial dilution culture of tissue homogenates. Results: Eucalyptus administration significantly improved the hyperglycemia, polydipsia, polyphagia, and it also compensated weight loss of diabetic rats (P<0.05). Moreover, eucalyptus caused a significant reduction in C. albicans concentration in liver and kidney homogenates (P<0.01). Conclusion: The results revealed that eucalyptus improves Candidia infection in normal and diabetic rats that in some ways validates the traditional use of this plant in treatment of diabetic patients.
Bokaeian, Mohammad; Nakhaee, Alireza; Moodi, Bita; Ali Khazaei, Hossein
Vaginal epithelial cell (VEC) anti-Candida albicans activity, despite being measured in vitro, is considered an innate host defense mechanism. This was supported further by the fact that women protected from symptomatic infection following a live intravaginal Candida challenge had increased VEC anti-Candida activity compared to those who acquired a symptomatic infection.
Barousse, Melissa M.; Espinosa, Terri; Dunlap, Kathleen; Fidel, Paul L.
Echinocandins exhibit concentration-dependent effects on Candida species, and preclinical studies support the administration of large, infrequent doses. The current report examines the pharmacokinetics/pharmacodynamics of two multicenter, randomized trials of micafungin dosing regimens that differed in both dose level and dosing interval. Analysis demonstrates the clinical relevance of the dose level and area under the concentration-time curve (AUC). Better, although not statistically significant (P = 0.056), outcomes were seen with higher maximum concentrations of drug in serum (Cmax) and large, infrequent doses. The results support further clinical investigation of novel micafungin dosing regimens with large doses but less than daily administration. (These studies have been registered at ClinicalTrials.gov under registration no. NCT00666185 and NCT00665639.). PMID:23959319
Andes, David R; Reynolds, Daniel K; Van Wart, Scott A; Lepak, Alexander J; Kovanda, Laura L; Bhavnani, Sujata M
Causative agent in majority of VVC is Candida albicans, but infection due to non-C. albicans is common. Use of empiric antifungal therapy in Brazil due to syndromic management of vulvovaginitis could act as risk factor for increase resistance among VVC causative agents. From Mato Grosso patients, 160 with culture-proved among 404 women who had clinical symptoms of VVC, were enrolled in this study. 70 non-pregnant women and 90 pregnant women were included. Candida albicans was the most prevale...
Luciana Basili Dias; Márcia de Souza Carvalho Melhem; Maria Walderez Szeszs; José Meirelles Filho; Rosane Christine Hahn
We studied the pharmacokinetics and in vivo antifungal action of SCH39304, a new antifungal azole compound, in rabbits. It crossed the blood-cerebrospinal fluid barrier in the presence or absence of meningeal inflammation, reaching approximately 60% of the simultaneous concentrations in serum. In the treatment of experimental cryptococcal meningitis, SCH39304 was as effective as fluconazole in reducing yeast counts in the subarachnoid space. SCH39304 and fluconazole both were highly effective...
Severe Candida esophagitis (CE) may lead to development of strictures, hemorrhage, esophagotracheal fistula, and a consequent decrease in quality of life. Although the severity of CE has been classified based on macroscopic findings on endoscopy, the clinical significance remains unknown. The aim of the study was to elucidate the predictive clinical factors for endoscopic severity of CE. Patients who underwent upper endoscopy and answered questionnaires were prospectively enrolled. Smoking, alcohol, human immunodeficiency virus (HIV) infection, diabetes mellitus, chronic renal failure, liver cirrhosis, systemic steroids use, proton pump inhibitor use, H2 blocker use, and gastrointestinal (GI) symptoms were assessed on the same day of endoscopy. GI symptoms including epigastric pain, heartburn, reflux, hunger cramps, nausea, dysphagia, and odynophagia were assessed on a 7-point Likert scale. Endoscopic severity was classified as mild (Kodsi's grade I/II) or severe (grade III/IV). Of 1855 patients, 71 (3.8%) were diagnosed with CE (mild, n?=?48; severe, n?=?23). In the CE patients, 50.0% (24/48) in the mild group and 23.1% (6/23) in the severe group did not have any GI symptoms. In HIV-infected patients (n?=?17), a significant correlation was found between endoscopic severity and declining CD4 cell count (Spearman's rho?=?-0.90; P?0.01). Multivariate analysis revealed that GI symptoms (odds ratio [OR], 3.32) and HIV infection (OR, 3.81) were independently associated with severe CE. Patients in the severe group experienced more epigastric pain (P?=?0.02), reflux symptoms (P?=?0.04), dysphagia (P?=?0.05), and odynophagia (P?0.01) than those in the mild group. Of the GI symptoms, odynophagia was independently associated with severe CE (OR 9.62, P?=?0.02). In conclusion, the prevalence of CE in adults who underwent endoscopy was 3.8%. Silent CE was found in both mild and severe cases. Endoscopic severity was associated with characteristic GI symptoms and comorbidity of HIV infection. A decline in immune function correlated with CE disease progression. PMID:23826847
Asayama, N; Nagata, N; Shimbo, T; Nishimura, S; Igari, T; Akiyama, J; Ohmagari, N; Hamada, Y; Nishijima, T; Yazaki, H; Teruya, K; Oka, S; Uemura, N
Candida lusitaniae may cause life-threatening infections in the immunocompromised host and may be resistant to amphotericin B. Flucytosine (5-FC) is very active against C. lusitaniae isolates in vitro, while the in vivo response of murine infection to 5-FC is not as good. To evaluate the hypothesis that this discrepancy may be primarily due to the short half-life of 5-FC in mice, we compared the same total dosage of 75 mg of 5-FC per kg of body weight per day given by bolus injections or infu...
Karyotakis, N. C.; Anaissie, E. J.
Full Text Available Causative agent in majority of VVC is Candida albicans, but infection due to non-C. albicans is common. Use of empiric antifungal therapy in Brazil due to syndromic management of vulvovaginitis could act as risk factor for increase resistance among VVC causative agents. From Mato Grosso patients, 160 with culture-proved among 404 women who had clinical symptoms of VVC, were enrolled in this study. 70 non-pregnant women and 90 pregnant women were included. Candida albicans was the most prevalent, representing 72.9% in the non-pregnant group and 92.3% in the pregnant group. Differences in species distribution were noted between the two groups, being C. parapsilosis the second more prevalent species among non-pregnant women. Susceptibility testing revealed high susceptibility to fluconazole (except for C. krusei, itraconazole, ketoconazole, and amphotericin B regardless the species (C. albicans, C. parapsilosis, C. tropicalis, C. glabrata, C. krusei analyzed.
Luciana Basili Dias
The authors have developed radioimmunoassays to the Candida carbohydrate, mannan, and to an Aspergillus cell wall carbohydrate. They evaluate these radioimmunoassays with sera from rabbit models of disseminated mycoses, and further evaluate the radioimmunoassays for their diagnostic usefulness in a panel of patient sera. (Auth.)
The incidence of serious fungal infections has increased substantially in the past decades, incident to increased prevalence of susceptible hosts. Candidemia, in particular, is associated with high morbidity and mortality. This thesis outlines results from a nationwide study, conducted in Iceland from 1980 to 2006, of the incidence of candidemia. In addition, antifungal susceptibility of the pathogens was studied, as well as national consumption of antifungal agents. The clinical characterist...
Gel dosage forms are successfully used as drug delivery systems to control drug release and protect the medicaments from a hostile environment. The main objective is to formulate and evaluate in situ oral topical gels of clotrimazole based on the concept of pH triggered and ion activated systems. The system utilizes polymers that exhibit sol-to-gel phase transition due to change in specific physico-chemical parameters. A pH triggered system consisting of carbopol 934P (0.2-1.4% ...
Harish N; Prabhu P; Charyulu R; Gulzar M; Subrahmanyam E.V.S
Full Text Available Gel dosage forms are successfully used as drug delivery systems to control drug release and protect the medicaments from a hostile environment. The main objective is to formulate and evaluate in situ oral topical gels of clotrimazole based on the concept of pH triggered and ion activated systems. The system utilizes polymers that exhibit sol-to-gel phase transition due to change in specific physico-chemical parameters. A pH triggered system consisting of carbopol 934P (0.2-1.4% w/v and ion triggered system using gellan gum (0.1-0.75% w/v along with hydroxylpropylmethylcelluose E50LV was used to prolong the release of clotrimazole (0.1% w/v. Formulations were evaluated for gelling capacity, viscosity, gel strength, bioadhesive force, spreadability, microbiological studies and in vitro release. The use of carbopol as in situ gel forming system was substantiated by the property to transform into stiff gels when the pH was raised, whereas in gellan gum this transformation occurred in the presence of monovalent/divalent cations. Effect of calcium carbonate and other process parameters optimized and found that increase in calcium ions produced stronger gels. The drug content, clarity, and pH of the formulation were found to be satisfactory. The viscosity was found to be in the range 5 to 85 centipoise for the sol, whereas for the gels it was up to 16000 centipoise. The formulation showed pseudoplastic flow with thixotrophy. The maximum gel strength (using texture analyzer and bioadhesion was found to be up to 6.5 g and 4 g, respectively. The optimized formulations were able to release the drug up to 6 h. The formulation containing gellan gum showed better sustained release compared to carbopol based gels.
Cutaneous Candida infections may occur in patients with HIV/AIDS, cancer, receiving chemotherapy and solid organ transplantation. A 32-year-old woman was admitted to the department suffering from pruritic and erythematous plaque on left side of her face for the past two months. The patient was HIV positive, diagnosed five years previously, and had been on antiretroviral therapy (tenofovir/emtricitabine and lopinavir/ritonavir) for a year. She was not compliant with the medication. Elevated HIV RNA load and decreased CD4+ lymphocyte count were observed. Fungal elements were detected from the skin scraping sample taken from the facial plaque. Fluconazole-sensitive Candida glabrata was isolated from this sample. Topical clotrimazole ointment and systemic fluconazole 400 mg/day were used. After systemic fluconazole therapy was continued for two months, the plaque was cured. C. glabrata rarely causes cutaneous infection without involving the mucous membranes. Presentation of cutaneous fungal infections in HIV patients with decreased CD4+ T lymphocyte counts can be atypical and require extensive antifungal treatment. PMID:23970580
Demiraslan, Hayati; Alabay, Selma; Kilic, Aysegul Ulu; Borlu, Murat; Doganay, Mehmet
Gel dosage forms are successfully used as drug delivery systems to control drug release and protect the medicaments from a hostile environment. The main objective is to formulate and evaluate in situ oral topical gels of clotrimazole based on the concept of pH triggered and ion activated systems. The system utilizes polymers that exhibit sol-to-gel phase transition due to change in specific physico-chemical parameters. A pH triggered system consisting of carbopol 934P (0.2-1.4% w/v) and ion t...
Harish, N. M.; Prabhu, P.; Charyulu, R. N.; Gulzar, M. A.; Subrahmanyam, E. V. S.
Cervical mucins are glycosylated proteins that form a protective cervical mucus. To understand the role of mucin glycans in Candida albicans infection, oligosaccharides from mouse cervical mucins were analyzed by liquid chromatography-mass spectrometry. Cervical mucins carry multiple ?(1,2)fucosylated glycans, but ?(1,2)fucosyltransferase Fut2-null mice are devoid of these epitopes. Epithelial cells in vaginal lavages from Fut2-null mice lacked Ulex europaeus agglutinin-1 (UEA-I) staining f...
Domino, Steven E.; Hurd, Elizabeth A.; Thomsson, Kristina A.; Karnak, David M.; Holme?n Larsson, Jessica M.; Thomsson, Elisabeth; Ba?ckstro?m, Malin; Hansson, Gunnar C.
The gold standard laboratory tests used to diagnose invasive Candida infection (ICI) are based on the in vitro culture of blood or samples from other sterile sites. However, these tests have limited sensitivity (Se) and are generally not diagnostic until late in the infectious process. The Serion Candida mannan kit was evaluated for the diagnosis of ICI at Grenoble University Hospital (France) between 2007 and 2011. The results were then compared with worldwide data published between 1997 and 2011. This retrospective study was based on follow-up from the investigation of 162 patients of whom 91 had proven ICI; 13 had Candida colonization index (CCI) scores ?0.42, positive mannan tests, with nonconcomitant infections; and 58 had no evidence of Candida infection. Candida albicans, C. glabrata, C. tropicalis, and C. parapsilosis were the etiologic agents in 104 patients. For patients with or without ICI, the 12-week mortality rates were 35/104 (33.7%) and 6/58 (10.3%), respectively. The mannan diagnostic specificity was 51% and Se was 77%. However, in the metaanalysis (n = 1,536), values were 86% and 62%, respectively. Positive mannan test results may appear early (median 6 days) in the development of candidemia and have moderate diagnostic value for ICI, with a negative predictive value of 83%. In patients at risk of ICI with negative candidemia, the combination of Candida mannan test data with a CCI score ?0.42 may improve the diagnosis of probable ICI. PMID:24934805
Chumpitazi, Bernabé F F; Lebeau, Bernadette; Faure-Cognet, Odile; Hamidfar-Roy, Rebecca; Timsit, Jean-François; Pavese, Patricia; Thiebaut-Bertrand, Anne; Quesada, Jean-Louis; Pelloux, Hervé; Pinel, Claudine
Forty female Sprague-Dawley rats were randomly divided into two groups. Group 1 animals received tetracycline solution (0.1% during week 1 and 0.01% thereafter) as drinking water, as in previous studies. Group 2 animals received double-distilled demineralized water. Animals in both groups were inoculated orally with an equal number of viable, mucosally pathogenic Candida albicans organisms. After 20 weeks, inspection of the tongues showed gross lesions in 16 of the 20 animals in group 1 and 1...
Allen, C. M.; Beck, F. M.; Lurie, F. A.; Pinsky, H. M.
A 41-year-old nulliparous woman, with a medical history of unexplained infertility and multiple in vitro fertilisation (IVF) cycles with immunosuppressive therapy, was admitted to our tertiary obstetrics unit with sepsis at 18 weeks of pregnancy with dichorionic diamniotic twins. Candida glabrata was grown from her blood cultures, then subsequently from the liquor and placentae. She was treated with intravenous ambisome (amphotericin), but unfortunately, the infection resulted in the rupture of her membranes, preterm labour and the demise of her twins. She delivered both twins at 23 weeks, 3 days apart. The antifungal agent was changed to high-dose fluconazole after delivery for 2 weeks and she is now well. Women undergoing IVF-embryo transfer with immunomodulation therapy have a potential risk of developing candidal chorioamnionitis and sepsis. PMID:24686802
Akhanoba, Folasade; MacDougall, Jane; Mathur, Raj; Hassan, Wassim
The aim of the present investigation was to prepare and evaluate novel bioadhesive vaginal tablets containing clotrimazole loaded microspheres in order to provide long-term therapeutic activity at the site of infection. Tablets were prepared by incorporating drug loaded microspheres and using bioadhesive polymers hydroxypropylmethylcellulose, sodium carboxymethylcellulose and Carbopol. Microspheres were prepared by the spray drying technique using Eudragit RS-100 and Eudragit RL-100. Microspheres were characterized by SEM, DSC, FTIR, particle size analysis and evaluated for percentage yield, drug loading, encapsulation efficiency and in vitro drug release. To achieve bioadhesion to the mucosal tissue, optimized microspheres were incorporated into bioadhesive tablets and were evaluated for in vitro drug release, in vitro and in vivo mucoadhesion. FTIR and DSC studies showed that no chemical interaction occurred between the drug and polymers. The sphericity factor indicated that the prepared microspheres were spherical. Formulation Mt6 indicated a controlled in vitro drug release and good bioadhesive strength. The in vivo images confirmed the bioadhesion and retention property of tablets up to 24 h. The results indicated that this drug delivery system can be explored for controlled intravaginal drug release. PMID:24152896
Gupta, Naresh Vishal; Natasha, Shirodker; Getyala, Anil; Bhat, Ramnath Sudeendra
D-Arabinitol was identified by mass spectrometry as a metabolite of Candida albicans and Candida tropicalis. For quantification, serum was deproteinized with acetone, the supernatant was evaporated to dryness, the silyl derivative was formed, and a portion was injected into a combined gas chromatograph-mass spectrometer system. Erythritol or 2-deoxy-galactitol was the internal standard. The protonated molecular ions, obtained in chemical ionization with isobutane, were monitored. For 39 norma...
Roboz, J.; Suzuki, R.; Holland, J. F.
Adjuvant effect mediated by polysaccharide (PPSB) isolated from the fruits of Physalis alkekengi L. in DNA vaccine was evaluated in mice. Recombinant plasmid containing epitope C (LKVIRK) from heat shock protein 90 (HSP90) of Candida albicans (C. albican) was used as DNA vaccine (pD-HSP90C). The results indicated that PPSB significantly enhanced specific antibody titers IgG, IgG1, IgG2b, and concentration of IL-2 and IL-4 in sera of mice immunized with pD-HSP90C (p<0.05). More importantly, it was found that the mice immunized with pD-HSP90C/PPSB not only had fewer CFU (colony forming unites) in the kidneys than mice immunized with pD-HSP90C, but also a statistically significant higher survival rate over PBS-injected group (p<0.05) when the immunized mice were challenged with living C. albican cells. However, no statistically significant difference in survival rate was observed between pD-HSP90C-immunized group and PBS-injected group. Therefore, PPSB can be considered as a promising adjuvant eliciting both Th1 and Th2 responses to enhance the efficacy of DNA vaccines. PMID:24815404
Yang, Huimin; Han, Shuying; Zhao, Danyang; Wang, Guiyun
Shortly after birth a preterm infant suffering from aspiration syndrome and subsequent Pseudomonas aeruginosa sepsis showed signs of renal insufficiency and mycotic infection: Yeast cells were identified in several urinalyses; there was also an increasing anti-Candida IgM antibody titer. At the same time sonographic examinations revealed an increasing echogenicity of the renal cortex and echogenic masses of variable size which did not cause acoustic shadows in both enlarged kidneys. A few days later, we found a right-sided hydronephrosis caused by an intraureteric prevesical mass of equal echogenicity. As we could observe sonographically, the aggressive antimycotic therapy was successful. Eleven weeks later there were signs of cardiac insufficiency. An angiographically demonstrated filling defect within the pulmonary artery showed the same sonographic findings as the previously found intrarenal masses. The baby underwent embolectomy and recovered. The thrombotic material contained yeast cells giving evidence of systemic Candidasis. Provided appropriate equipment is available, ultrasound today is an excellent non-invasive screening and followup method not only for echoencephalography, but also for more complicated neonatologic problems as seen here. The detailed observation of a changing echogenicity of the renal cortex and pelvis is important and often allows a decisive diagnostic clue before other radiological methods become conclusive. (orig.)
Oophorectomized, estrogen-treated rats were immunized by the intravaginal or intranasal route with a mannoprotein extract (MP) or secreted aspartyl proteinases (Sap) of Candida albicans, with or without cholera toxin as a mucosal adjuvant. Both routes of immunization were equally effective in (i) inducing anti-MP and anti-Sap vaginal antibodies and (ii) conferring a high degree of protection against the vaginal infection by the fungus. These data suggest that appropriate fungal antigens and a...
Bernardis, Flavia; Boccanera, Maria; Adriani, Daniela; Girolamo, Antonietta; Cassone, Antonio
The effect of micafungin dose scheduling on the treatment of candidemia is unknown. Neutropenic mice with disseminated Candida glabrata infection were treated with single intraperitoneal micafungin doses of 0 to 100 mg/kg of body weight and sacrificed 7 days later. The maximal decline in kidney fungal burden was 5.8 log10 CFU/g. A 1-week pharmacokinetic-pharmacodynamic study revealed a micafungin serum half-life of 6.13 h. In mice treated with ?50 mg/kg, there was maximal fungal decline wit...
Gumbo, Tawanda; Drusano, George L.; Liu, Weiguo; Kulawy, Robert W.; Fregeau, Christine; Hsu, Vasha; Louie, Arnold
A large majority of new chemical entities and many existing drug molecules exhibit poor aqueous solubility, which may limit their potential use in developing drug formulations, with optimum bioavailability. One of the approaches to improve the solubility of a poorly water soluble drug and eventually its bioavailability is complexation with agents like humic acid (HA), fulvic acid (FA), ?-cyclodextrin (?-CD), 2-hydroxypropyl-?-cyclodextrin (HP-?-CD) and caffeine (Caff). The...
Mohammad Aamir Mirza; Mohammad Akhlaquer Rahman; Sushama Talegaonkar; Zeenat Iqbal
Background: I Infections due to Candida spp. have increased dramatically in recent years through a rising number of predisposing factors and immunocompromised hosts. Although Candida albicans is the most prevalent and important causative agent of Candida infections, the importance of C. parapsilosis, C. tropicalis, C. krusei, C. glabrata, C. guilliermondii and C. kefyr have increased significantly as they tend to be more resistant to antifungal agents. Therefore, it is critical that infecting...
Mh, Afsarian; Zaini F; Kordbacheh P; Mahmoudi M; Rezaii S; Safara M
Abstract Background Complementary and alternative medicines are used by many consumers, and increasingly are being incorporated into the general practitioner's armamentarium. Despite widespread usage, the evidence base for most complementary therapies is weak or non-existent. Post-antibiotic vulvovaginitis is a common problem in general practice, for which complementary therapies are often used. A recent study in Melbourne, Australia, found that 40% of women with a past histo...
Pirotta Marie; Gunn Jane; Chondros Patty; Grover Sonia; Hurley Susan; Garland Suzanne
Adherence of blastoconidia to epidermal corneocytes is an early event in Candida colonization and infection of the skin. Pathogenic species adhere more avidly than nonpathogenic species, transform to hyphal growth, and invade the stratum corneum of the skin. Adherence was studied by scanning electron microscopy of experimental murine cutaneous Candida infections, using six species of Candida. Candida albicans and C. stellatoidea blastoconidia, applied to newborn mouse skin, adhered to the str...
Ray, T. L.; Payne, C. D.
Multilamellar vesicles containing nystatin (NYS) were compared with vesicles containing the free drug for toxicity to erythrocytes and for antifungal activity in vitro. Liposomal nystatin was as active as free NYS was against a wide variety of yeasts and fungi. The antifungal activity against Candida albicans was maintained with different liposome compositions and without sterols. Liposome encapsulation also protected the erythrocytes from the toxicity of free NYS.
Mehta, R. T.; Hopfer, R. L.; Gunner, L. A.; Juliano, R. L.; Lopez-berestein, G.
Full Text Available Abstract Background Complementary and alternative medicines are used by many consumers, and increasingly are being incorporated into the general practitioner's armamentarium. Despite widespread usage, the evidence base for most complementary therapies is weak or non-existent. Post-antibiotic vulvovaginitis is a common problem in general practice, for which complementary therapies are often used. A recent study in Melbourne, Australia, found that 40% of women with a past history of vulvovaginitis had used probiotic Lactobacillus species to prevent or treat post-antibiotic vulvovaginitis. There is no evidence that this therapy is effective. This study aims to test whether oral or vaginal lactobacillus is effective in the prevention of post-antibiotic vulvovaginitis. Methods/design A randomised placebo-controlled blinded 2 × 2 factorial design is being used. General practitioners or pharmacists approach non-pregnant women, aged 18–50 years, who present with a non-genital infection requiring a short course of oral antibiotics, to participate in the study. Participants are randomised in a four group factorial design either to oral lactobacillus powder or placebo and either vaginal lactobacillus pessaries or placebo. These interventions are taken while on antibiotics and for four days afterwards or until symptoms of vaginitis develop. Women self collect a vaginal swab for culture of Candida species and complete a survey at baseline and again four days after completing their study medications. The sample size (a total of 496 – 124 in each factorial group is calculated to identify a reduction of half in post-antibiotic vulvovaginitis from 23%, while allowing for a 25% drop-out. An independent Data Monitoring Committee is supervising the trial. Analysis will be intention-to-treat, with two pre-specified main comparisons: (i oral lactobacillus versus placebo and (ii vaginal lactobacillus versus placebo.