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Casagrande Pierantoni D, Corte L, Casadevall A, Robert V, Cardinali G, Tascini C. How does temperature trigger biofilm adhesion and growth in Candida albicans and two non-Candida albicans Candida species? Mycoses 2021; 64:1412-1421. [PMID: 33894074 PMCID: PMC8597170 DOI: 10.1111/myc.13291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Biofilm formation on biotic and abiotic surfaces is finely regulated by genetic factors but also by oxygen concentration, pH, temperature and other environmental factors, already extensively explored for bacterial biofilms. Much less is known about fungal biofilm, that is considered a virulence factor for Candida pathogenic species among the few fungal species able to grow and survive at high temperatures such as 37°C as well as those induced by fever. The resistance to high temperatures coupled with the ability to form biofilm are threatening factors of these fungal species that could severely impact at an epidemiological level. OBJECTIVES In this framework, we decided to study the thermal tolerance of biofilms formed by three medical relevant species such as Candida albicans and two non-Candida albicans Candida species. METHODS Thirty nosocomial strains were investigated for their ability to adhere and grow in proximity and over body temperature (from 31 to 43°C), mimicking different environmental conditions or severe febrile-like reactions. RESULTS Candida sessile cells reacted to different temperatures showing a strain-specific response. It was observed that the attachment and growth respond differently to the temperature and that mechanism of adhesion has different outputs at high temperature than the growth. CONCLUSIONS This strain-dependent response is probably instrumental to guarantee the best success to cells for the infection, attachment and growth to occur. These observations reinforce the concept of temperature as a major trigger in the evolution of these species especially in this period of increasing environmental temperatures and excessive domestic heating.
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Affiliation(s)
| | - Laura Corte
- Department of Pharmaceutical SciencesUniversity of PerugiaPerugiaItaly
| | - Arturo Casadevall
- Johns Hopkins Bloomberg School of Public HealthJHSPH Molecular, Microbiology & Immunology; JHUSOM,BaltimoreMDUSA
| | - Vincent Robert
- Westerdijk Fungal Biodiversity InstituteAD UtrechtThe Netherlands
| | | | - Carlo Tascini
- University Hospital "S. Maria della Misericordia" – Clinic of Infectious DiseasesUdineItaly
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2
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A Mouse Model of Candidiasis. Methods Mol Biol 2021. [PMID: 34048008 DOI: 10.1007/978-1-0716-1488-4_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
The intravenous challenge model of Candida albicans infection in mice is a well-established procedure that mirrors disseminated candidiasis in humans. In this model, in which the fungus is delivered into the bloodstream causing a systemic infection, the kidneys are the primary target organs. Mice develop renal failure and septic shock that recapitulates the progressive sepsis seen in humans during severe clinical cases. This model is used to study inflammation and the host immune response against fungal infection. This chapter describes the intravenous candidiasis infection protocol, detailing different steps from the preparation of the inoculum, injection of Candida, monitoring of animals, collection of tissue from infected mice, sample preparation and analysis of several parameters related to infection and the inflammatory response.
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3
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An approach to develop clinical prediction rule for candidemia in critically ill patients: A retrospective observational study. J Crit Care 2021; 65:216-220. [PMID: 34252648 DOI: 10.1016/j.jcrc.2021.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/26/2021] [Accepted: 06/30/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE Early detection of candidemia in critically ill patients is important for preemptive antifungal treatment. Our study aimed to identify the independent risk factors for the development of a new candidemia prediction score. METHODS This single-centre retrospective observational study evaluated 2479 intensive care unit (ICU) cases from January 2016 to December 2018. A total of 76 identified candidemia cases and 76 matched control cases were analyzed. The patients' demographic characteristics and illness severity were analyzed, and possible risk factors for candidemia were investigated. RESULTS Multivariate logistic regression analysis identified renal replacement therapy (RRT) (odds ratio [OR]: 52.83; 95% confidence interval [CI]: 7.82-356.92; P < 0.0001), multifocal Candida colonization (OR: 23.55; 95% CI: 4.23-131.05; P < 0.0001), parenteral nutrition (PN) (OR: 63.67; 95% CI: 4.56-889.77; P = 0.002), and acute kidney injury (AKI) (OR: 7.67; 95% CI: 1.24-47.30; P = 0.028) as independent risk factors. A new prediction score with a cut-off value of 5.0 (80.3% sensitivity and 77.3% specificity) was formulated from the logit model equation. CONCLUSIONS Renal replacement therapy, AKI, PN, and multifocal Candida colonization were the independent risk factors for the new candidemia prediction score with high discriminatory performance and predictive accuracy.
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Soulountsi V, Schizodimos T, Kotoulas SC. Deciphering the epidemiology of invasive candidiasis in the intensive care unit: is it possible? Infection 2021; 49:1107-1131. [PMID: 34132989 DOI: 10.1007/s15010-021-01640-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/08/2021] [Indexed: 12/12/2022]
Abstract
Invasive candidiasis (IC) has emerged in the last decades as an important cause of morbidity, mortality, and economic load in the intensive care unit (ICU). The epidemiology of IC is still a difficult and unsolved enigma for the literature. Accurate estimation of the true burden of IC is difficult due to variation in definitions and limitations inherent to available case-finding methodologies. Candidemia and intra-abdominal candidiasis (IAC) are the two predominant types of IC in ICU. During the last two decades, an increase in the incidence of candidemia has been constantly reported particularly in the expanding populations of elderly or immunosuppressed patents, with a parallel change in Candida species (spp.) distribution worldwide. Epidemiological shift in non-albicans spp. has reached worrisome trends. Recently, a novel, multidrug-resistant Candida spp., Candida auris, has globally emerged as a nosocomial pathogen causing a broad range of healthcare-associated invasive infections. Epidemiological profile of IAC remains imprecise. Though antifungal drugs are available for Candida infections, mortality rates continue to be high, estimated to be up to 50%. Increased use of fluconazole and echinocandins has been associated with the emergence of resistance to these drugs, which affects particularly C. albicans and C. glabrata. Crucial priorities for clinicians are to recognize the epidemiological trends of IC as well as the emergence of resistance to antifungal agents to improve diagnostic techniques and strategies, develop international surveillance networks and antifungal stewardship programmes for a better epidemiological control of IC.
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Affiliation(s)
- Vasiliki Soulountsi
- Department of Intensive Care Medicine, George Papanikolaou General Hospital, Thessaloniki, Greece.
| | - Theodoros Schizodimos
- Department of Intensive Care Medicine, George Papanikolaou General Hospital, Thessaloniki, Greece
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5
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Roles for Structural Biology in the Discovery of Drugs and Agrochemicals Targeting Sterol 14α-Demethylases. J Fungi (Basel) 2021; 7:jof7020067. [PMID: 33498194 PMCID: PMC7908997 DOI: 10.3390/jof7020067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/08/2021] [Accepted: 01/17/2021] [Indexed: 02/06/2023] Open
Abstract
Antifungal drugs and antifungal agrochemicals have significant limitations. These include several unintended consequences of their use including the growing importance of intrinsic and acquired resistance. These problems underpin an increasingly urgent need to improve the existing classes of antifungals and to discover novel antifungals. Structural insights into drug targets and their complexes with both substrates and inhibitory ligands increase opportunity for the discovery of more effective antifungals. Implementation of this promise, which requires multiple skill sets, is beginning to yield candidates from discovery programs that could more quickly find their place in the clinic. This review will describe how structural biology is providing information for the improvement and discovery of inhibitors targeting the essential fungal enzyme sterol 14α-demethylase.
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6
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Dai T, Guo Y, Peng L, Manatunga A. Nonparametric estimation of broad sense agreement between ordinal and censored continuous outcomes. Stat Med 2020; 39:1952-1964. [PMID: 32207170 DOI: 10.1002/sim.8523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/14/2020] [Accepted: 01/17/2020] [Indexed: 11/08/2022]
Abstract
The concept of broad sense agreement (BSA) has recently been proposed for studying the relationship between a continuous measurement and an ordinal measurement. They developed a nonparametric procedure for estimating the BSA index, which is only applicable to completely observed data. In this work, we consider the problem of evaluating BSA index when the continuous measurement is subject to censoring. We propose a nonparametric estimation method built upon a derivation of a new functional representation of the BSA index, which allows for accommodating censoring by plugging in the nonparametric survival function estimators. We establish the consistency and asymptotic normality for the proposed BSA estimator. We also investigate an alternative approach based on the strategy of multiple imputation, which is shown to have better empirical performance with small sample sizes than the plug-in method. Extensive simulation studies are conducted to evaluate our proposals. We illustrate our methods via an application to a Surgical Intensive Care Unit study.
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Affiliation(s)
- Tian Dai
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA
| | - Ying Guo
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA
| | - Limin Peng
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA
| | - Amita Manatunga
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA
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7
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Jainlabdin MH, Batra A, Sánchez Paredes E, Hernández Hernández F, Fu G, Tovar-Torres J. Single-tube, dual channel pentaplexing for the identification of Candida strains associated with human infection. Sci Rep 2019; 9:14692. [PMID: 31604994 PMCID: PMC6788996 DOI: 10.1038/s41598-019-51198-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 09/23/2019] [Indexed: 12/29/2022] Open
Abstract
Invasive candidiasis is one of the most common nosocomial fungal infections worldwide. Delayed implementation of effective antifungal treatment caused by inefficient Candida diagnosis contributes to its notoriously high mortality rates. The availability of better Candida diagnostic tools would positively impact patient outcomes. Here, we report on the development of a single-tube, dual channel pentaplex molecular diagnostic assay based on Multiplex Probe Amplification (MPA) technology. It allows simultaneous identification of C. auris, C. glabrata and C. krusei, at species-level as well as of six additional albicans and non-albicans pathogenic Candida at genus level. The assay overcomes the one-channel one-biomarker limitation of qPCR-based assays. Assay specificities are conferred by unique biomarker probe pairs with characteristic melting temperatures; post-amplification melting curve analysis allows simple identification of the infectious agent. Alerting for the presence of C. auris, the well-characterised multi-drug resistant outbreak strain, will facilitate informed therapy decisions and aid antifungal stewardship. The MPA-Candida assay can also be coupled to a pan-Fungal assay when differentiation between fungal and bacterial infections might be desirable. Its multiplexing capacity, detection range, specificity and sensitivity suggest the potential use of this novel MPA-Candida assay in clinical diagnosis and in the control and management of hospital outbreaks.
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Affiliation(s)
- Mohd Hanif Jainlabdin
- Department of Biological Sciences, Royal Holloway University of London, Egham, Surrey, United Kingdom.,Faculty of Nursing, International Islamic University Malaysia, Kuala Lumpur, Malaysia
| | - Ambalika Batra
- Department of Biological Sciences, Royal Holloway University of London, Egham, Surrey, United Kingdom
| | | | | | | | - Jorge Tovar-Torres
- Department of Biological Sciences, Royal Holloway University of London, Egham, Surrey, United Kingdom.
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8
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Wang K, Hsueh K, Kronen R, Lin C, Salazar AS, Powderly WG, Spec A. Creation and assessment of a clinical predictive model for candidaemia in patients with candiduria. Mycoses 2019; 62:554-561. [PMID: 31025417 DOI: 10.1111/myc.12917] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/19/2019] [Accepted: 04/20/2019] [Indexed: 12/28/2022]
Abstract
Candidaemia is the most common clinical presentation of invasive candidiasis and is a major cause of morbidity and mortality. Candiduria is a predictor for candidaemia; however, patient characteristics that are associated with concurrent candidaemia in the setting of candiduria are unclear. Identifying these characteristics could aid in the early detection of systemic disease. We performed a retrospective cohort analysis of hospitalised patients with candiduria at our institution over a 13-year period. Our evaluation of patient characteristics included demographics, comorbidities, medications, procedures, devices, vital signs and laboratory values. We developed a multivariable logistic model to identify factors associated with candidaemia in patients with candiduria. We identified 4240 patients with candiduria, 263 (6.2%) of whom had candidaemia. Predictors for increased risk of candidaemia with candiduria included hospitalisations > 12 days, central venous catheter, parenteral nutrition, haematological and gynaecological malignancy, and receipt of β-lactam/β-lactamase inhibitors. Vital signs and laboratory values associated with candidaemia included elevated heart rate, temperature and creatinine, along with neutropenia and neutrophilia. Factors that demonstrated a decreased risk of candidaemia included diabetes mellitus, gastrostomy and urinary catheter with antibiotic use. The c-statistic was 0.741 (95% CI, 0.710-0.772). We identified a set of clinical characteristics that can predict the presence of candidaemia with candiduria.
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Affiliation(s)
- Katie Wang
- Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Kevin Hsueh
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - Ryan Kronen
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Charlotte Lin
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - Ana S Salazar
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - William G Powderly
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - Andrej Spec
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
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9
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Bassetti M, Vena A, Russo A. Management of patients with septic shock due to Candida infection. Hosp Pract (1995) 2018; 46:258-265. [PMID: 30170000 DOI: 10.1080/21548331.2018.1518104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Septic shock represents a serious complication occurring between 6% and 30% of all hospitalized patients; Candida septic shock represents a challenge for clinicians due to the absence of specific risk factors, diagnostic tests, and management. Identification of specific risk factors and use of biomarkers are useful tools considering that differentiation of Candida from bacterial septic shock is demanding. Early effective antifungal treatment, preferably with echinocandins with an adequate source control, represents the best approach for improving survival of patients with septic shock due to Candida. Given the importance of adequate therapy and source control in septic shock attributable to Candida clinical strategies and pathways are needed. This review will focus on epidemiology of septic shock in patients with invasive candidiasis with special attention to diagnostic pathways and treatment strategies.
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Affiliation(s)
- Matteo Bassetti
- a Dipartimento di Area Medica , Università degli studi di Udine , Udine , Italy
| | - Antonio Vena
- a Dipartimento di Area Medica , Università degli studi di Udine , Udine , Italy
| | - Alessandro Russo
- a Dipartimento di Area Medica , Università degli studi di Udine , Udine , Italy
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10
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Fidler G, Leiter E, Kocsube S, Biro S, Paholcsek M. Validation of a simplex PCR assay enabling reliable identification of clinically relevant Candida species. BMC Infect Dis 2018; 18:393. [PMID: 30103686 PMCID: PMC6090785 DOI: 10.1186/s12879-018-3283-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 07/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fungal bloodstream infections (BSI) may be serious and are associated with drastic rise in mortality and health care costs. Candida spp. are the predominant etiological agent of fungal sepsis. The prompt and species-level identification of Candida may influence patient outcome and survival. The aim of this study was to develop and evaluate the CanTub-simplex PCR assay coupled with Tm calling and subsequent high resolution melting (HRM) analysis to barcode seven clinically relevant Candida species. METHODS Efficiency, coefficient of correlation and the limit of reliable detection were estimated on purified Candida EDTA-whole blood (WB) reference panels seeded with Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis, Candida krusei, Candida guilliermondii, Candida dubliniensis cells in a 6-log range. Discriminatory power was measured on EDTA-WB clinical panels on three different PCR platforms; LightCycler®96, LightCycler® Nano, LightCycler® 2.0. Inter- and intra assay consistencies were also calculated. RESULTS The limit of reliable detection proved to be 0.2-2 genomic equivalent and the method was reliable on broad concentration ranges (106-10 CFU) providing distinctive melting peaks and characteristic HRM curves. The diagnostic accuracy of the discrimination proved to be the best on Roche LightCycler®2.0 platform. Repeatability was tested and proved to be % C.V.: 0.14 ± 0.06 on reference- and % C.V.: 0.14 ± 0.02 on clinical-plates accounting for a very high accuracy. Reproducibility was % C.V.: 0.11 between reference- and % C.V.: 0.12between clinical-panels which is highly acceptable. CONCLUSION Our assay demonstrates recent advances on Tm calling and HRM analysis for the molecular identification of relevant Candida species. This unique, simplex PCR assay may be capable to outperform conventional phenotypic methods by reducing time and providing accurate and reliable results directly from blood (2 h) or from whole blood culture bottles (12-24 h).
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Affiliation(s)
- Gabor Fidler
- Faculty of Medicine, Department of Human Genetics, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4032, Hungary
| | - Eva Leiter
- Faculty of Science and Technology, Department of Biotechnology and Microbiology, University of Debrecen, Debrecen, Hungary
| | - Sandor Kocsube
- Faculty of Science and Informatics, Department of Microbiology, University of Szeged, Szeged, Hungary
| | - Sandor Biro
- Faculty of Medicine, Department of Human Genetics, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4032, Hungary
| | - Melinda Paholcsek
- Faculty of Medicine, Department of Human Genetics, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4032, Hungary.
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11
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Alsina-Beauchamp D, Escós A, Fajardo P, González-Romero D, Díaz-Mora E, Risco A, Martín-Serrano MA, Del Fresno C, Dominguez-Andrés J, Aparicio N, Zur R, Shpiro N, Brown GD, Ardavín C, Netea MG, Alemany S, Sanz-Ezquerro JJ, Cuenda A. Myeloid cell deficiency of p38γ/p38δ protects against candidiasis and regulates antifungal immunity. EMBO Mol Med 2018; 10:e8485. [PMID: 29661910 PMCID: PMC5938613 DOI: 10.15252/emmm.201708485] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 03/12/2018] [Accepted: 03/19/2018] [Indexed: 12/27/2022] Open
Abstract
Candida albicans is a frequent aetiologic agent of sepsis associated with high mortality in immunocompromised patients. Developing new antifungal therapies is a medical need due to the low efficiency and resistance to current antifungal drugs. Here, we show that p38γ and p38δ regulate the innate immune response to C. albicans We describe a new TAK1-TPL2-MKK1-ERK1/2 pathway in macrophages, which is activated by Dectin-1 engagement and positively regulated by p38γ/p38δ. In mice, p38γ/p38δ deficiency protects against C. albicans infection by increasing ROS and iNOS production and thus the antifungal capacity of neutrophils and macrophages, and by decreasing the hyper-inflammation that leads to severe host damage. Leucocyte recruitment to infected kidneys and production of inflammatory mediators are decreased in p38γ/δ-null mice, reducing septic shock. p38γ/p38δ in myeloid cells are critical for this effect. Moreover, pharmacological inhibition of p38γ/p38δ in mice reduces fungal burden, revealing that these p38MAPKs may be therapeutic targets for treating C. albicans infection in humans.
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Affiliation(s)
| | - Alejandra Escós
- Department of Immunology and Oncology, Centro Nacional de Biotecnología/CSIC, Madrid, Spain
| | - Pilar Fajardo
- Department of Immunology and Oncology, Centro Nacional de Biotecnología/CSIC, Madrid, Spain
| | - Diego González-Romero
- Department of Immunology and Oncology, Centro Nacional de Biotecnología/CSIC, Madrid, Spain
| | - Ester Díaz-Mora
- Department of Immunology and Oncology, Centro Nacional de Biotecnología/CSIC, Madrid, Spain
| | - Ana Risco
- Department of Immunology and Oncology, Centro Nacional de Biotecnología/CSIC, Madrid, Spain
| | | | - Carlos Del Fresno
- Immunobiology of Inflammation Laboratory Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
| | - Jorge Dominguez-Andrés
- Department of Immunology and Oncology, Centro Nacional de Biotecnología/CSIC, Madrid, Spain
| | - Noelia Aparicio
- Department of Immunology and Oncology, Centro Nacional de Biotecnología/CSIC, Madrid, Spain
| | - Rafal Zur
- Department of Immunology and Oncology, Centro Nacional de Biotecnología/CSIC, Madrid, Spain
| | - Natalia Shpiro
- Medical Research Council Protein Phosphorylation Unit, Sir James Black Building, School of Life Sciences, University of Dundee, Dundee, UK
| | - Gordon D Brown
- Aberdeen Fungal Group, Institute of Medical Sciences, Medical Research Council Centre for Medical Mycology at the University of Aberdeen, Aberdeen, UK
| | - Carlos Ardavín
- Department of Immunology and Oncology, Centro Nacional de Biotecnología/CSIC, Madrid, Spain
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Susana Alemany
- Instituto de Investigaciones Biomédicas Alberto Sols, CSIC-UAM, Madrid, Spain
| | | | - Ana Cuenda
- Department of Immunology and Oncology, Centro Nacional de Biotecnología/CSIC, Madrid, Spain
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12
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Shi D, Li D, Wang Q, Kong X, Mei H, Shen Y, Liu W. Silencing SOCS1 in dendritic cells promote survival of mice with systemic Candida albicans infection via inducing Th1-cell differentiation. Immunol Lett 2018; 197:53-62. [PMID: 29581081 DOI: 10.1016/j.imlet.2018.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 03/21/2018] [Indexed: 11/19/2022]
Abstract
Enhancing the immunity conferred by dendritic cells (DCs) to fungal infection represents a promising strategy in the number of immunocompromised individuals. In a previous study, we demonstrated that suppressor of cytokine signaling 1 (SOCS1) silencing can promote the maturation of DCs and induce an immune response against Candida albicans (C. albicans) in vitro. Herein, the effectiveness of SOCS1 suppression administered by SOCS1-siRNA-treated DCs is further evaluated in systemic candidiasis mouse model. The SOCS1-silenced DCs increase mouse survival and significantly decrease fungal colonization in the kidneys. We confirm that the serum IFN-γ levels in SOCS1-siRNA-treated mice are higher than in all other infected groups at the early stages of infection, which correlates with a higher differentiation of IFN-γ+CD4+ T cells (Th1) in the spleen. Meanwhile, the differentiation of IL-4-producing CD4+ T (Th2) or IL-17-producing CD4+ T cells (Th17 cells) remain unaffected under the same treatment, suggesting that SOCS1-silenced DCs significantly affect the IFN-γ-producing CD4+ T cells (Th1). However, at the late stages of infection when the differentiation of Th1, Th2 and Th17 cells decreases in SOCS1-silenced-DCs-treated mice, all the serum cytokines (IFN-γ, IL-4 and IL-17) are also reduced. In summary, treatment of mice with SOCS1-silenced DCs can protect mice from systemic infection during the early stages and thereby increase overall survival. We conclude that the increase in Th1 response in early stages avoids the cascade inflammatory response in later stages that is known to place such a large fungal load on the kidneys and cause subsequent death.
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Affiliation(s)
- Dongmei Shi
- Department of Dermatology, Jining No. 1 People's Hospital, Shandong, PR China.
| | - Dongmei Li
- Georgetown University Medical Center, Washington D.C., USA
| | - Qiong Wang
- Department of Mycology, Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu, PR China
| | - Xue Kong
- Department of Dermatology, Jining No. 1 People's Hospital, Shandong, PR China
| | - Huan Mei
- Department of Mycology, Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu, PR China
| | - Yongnian Shen
- Department of Mycology, Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu, PR China
| | - Weida Liu
- Department of Mycology, Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu, PR China.
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13
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14
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Matzaraki V, Gresnigt MS, Jaeger M, Ricaño-Ponce I, Johnson MD, Oosting M, Franke L, Withoff S, Perfect JR, Joosten LAB, Kullberg BJ, van de Veerdonk FL, Jonkers I, Li Y, Wijmenga C, Netea MG, Kumar V. An integrative genomics approach identifies novel pathways that influence candidaemia susceptibility. PLoS One 2017; 12:e0180824. [PMID: 28727728 PMCID: PMC5519064 DOI: 10.1371/journal.pone.0180824] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 06/21/2017] [Indexed: 11/18/2022] Open
Abstract
Candidaemia is a bloodstream infection caused by Candida species that primarily affects specific groups of at-risk patients. Because only small candidaemia patient cohorts are available, classical genome wide association cannot be used to identify Candida susceptibility genes. Therefore, we have applied an integrative genomics approach to identify novel susceptibility genes and pathways for candidaemia. Candida-induced transcriptome changes in human primary leukocytes were assessed by RNA sequencing. Genetic susceptibility to candidaemia was assessed using the Illumina immunochip platform for genotyping of a cohort of 217 patients. We then integrated genetics data with gene-expression profiles, Candida-induced cytokine production capacity, and circulating concentrations of cytokines. Based on the intersection of transcriptome pathways and genomic data, we prioritized 31 candidate genes for candidaemia susceptibility. This group of genes was enriched with genes involved in inflammation, innate immunity, complement, and hemostasis. We then validated the role of MAP3K8 in cytokine regulation in response to Candida stimulation. Here, we present a new framework for the identification of susceptibility genes for infectious diseases that uses an unbiased, hypothesis-free, systems genetics approach. By applying this approach to candidaemia, we identified novel susceptibility genes and pathways for candidaemia, and future studies should assess their potential as therapeutic targets.
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Affiliation(s)
- Vasiliki Matzaraki
- Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - Mark S. Gresnigt
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martin Jaeger
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Isis Ricaño-Ponce
- Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - Melissa D. Johnson
- Duke University Medical Center, Durham, North Carolina, United States of America
| | - Marije Oosting
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lude Franke
- Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - Sebo Withoff
- Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - John R. Perfect
- Duke University Medical Center, Durham, North Carolina, United States of America
| | - Leo A. B. Joosten
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bart Jan Kullberg
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank L. van de Veerdonk
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Iris Jonkers
- Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - Yang Li
- Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - Cisca Wijmenga
- Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands
- K.G. Jebsen Coeliac Disease Research Centre, Department of Immunology, University of Oslo, Oslo, Norway
| | - Mihai G. Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- Human Genomics Laboratory, Craiova University of Medicine and Pharmacy, Craiova, Romania
| | - Vinod Kumar
- Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
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Activity of Combined Antifungal Agents Against Multidrug-Resistant Candida glabrata Strains. Mycopathologia 2017; 182:819-828. [PMID: 28493006 DOI: 10.1007/s11046-017-0141-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
Abstract
In this study, we evaluated the in vitro activity of echinocandins, azoles, and amphotericin B alone and in combination against echinocandin/azole-sensitive and echinocandin/azole-resistant Candida glabrata isolates. Susceptibility tests were performed using the broth microdilution method in accordance with the Clinical and Laboratory Standards Institute document M27-A3. The checkerboard method was used to evaluate the fractional inhibitory concentration index of the interactions. Cross-resistance was observed among echinocandins; 15% of the isolates resistant to caspofungin were also resistant to anidulafungin and micafungin. Synergistic activity was observed in 70% of resistant C. glabrata when anidulafungin was combined with voriconazole or posaconazole. Higher (85%) synergism was found in the combination of caspofungin and voriconazole. The combinations of caspofungin with fluconazole, posaconazole and amphotericin B, micafungin with fluconazole, posaconazole and voriconazole, and anidulafungin with amphotericin B showed indifferent activities for the majority of the isolates. Anidulafungin combined with fluconazole showed the same percentage of synergism and indifference (45%). Antagonism was detected in 50% of isolates when micafungin was combined with amphotericin B. Combinations of echinocandins and antifungal azoles have great potential for in vivo assays which are required to evaluate the efficacy of these combinations against multidrug-resistant C. glabrata strains.
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Kaaniche FM, Allela R, Cherif S, Algia NB. Invasive candidiasis in critically ill patients. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2016. [DOI: 10.1016/j.tacc.2016.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Scudeller L, Bassetti M, Concia E, Corrao S, Cristini F, De Rosa FG, Del Bono V, Durante-Mangoni E, Falcone M, Menichetti F, Tascini C, Tumbarello M, Venditti M, Viale P, Viscoli C, Mazzone A. MEDical wards Invasive Candidiasis ALgorithms (MEDICAL):Consensus proposal for management. Eur J Intern Med 2016; 34:45-53. [PMID: 27495949 DOI: 10.1016/j.ejim.2016.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/06/2016] [Accepted: 07/08/2016] [Indexed: 01/27/2023]
Abstract
INTRODUCTION A majority of invasive Candida infections occur in medical wards; however, evidence for management in this setting is scarce and based primarily on the intensive care or surgical setting. On behalf of the Italian Society for Anti-Infective Therapy (SITA) and the Italian Federation of Associations of Hospital Doctors on Internal Medicine (FADOI), the MEDICAL group produced practical management algorithms for patients in internal medicine wards. METHODS The MEDICAL group panel, composed of 30 members from internal medicine, infectious disease, clinical pharmacology, clinical microbiology and clinical epidemiology, provided expert opinion through the RAND/UCLA method. RESULTS Seven clinical scenarios were constructed based on clinical severity and probability of invasive candidiasis. For each scenario, the appropriateness of 63 different diagnostic, imaging, management, or therapeutic procedures was determined in two Delphi rounds. The necessity for performing each appropriate procedure, was then determined in a third Delphi round. Results were summarized in algorithms. DISCUSSION The proposed algorithms provide internal medicine physicians and managers with an easy to interpret tool that is exhaustive, clear and suitable for adaption to individual local settings. Attention was paid to individual patient management and resource allocation.
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Affiliation(s)
- Luigia Scudeller
- Clinical Epidemiology Unit, Scientific Direction, IRCCS, Policlinico San Matteo Foundation, Pavia, Italy.
| | - Matteo Bassetti
- Infectious Diseases Division, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Ercole Concia
- Section of Infectious Diseases, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata, Policlinico G B Rossi, Verona, Italy
| | - Salvatore Corrao
- Department of Internal Medicine, National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, Palermo, Di.Bi.M.I.S., University of Palermo, Italy
| | - Francesco Cristini
- Infectious Diseases Unit, Teaching Hospital Policlinico S. Orsola-Malpighi Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | | | - Valerio Del Bono
- Clinic of Infectious Diseases, IRCCS San Martino-IST, University of Genova, Genova, Italy
| | - Emanuele Durante-Mangoni
- Internal Medicine Section, Department of Cardiothoracic Sciences, and Division of Infectious and Transplant Medicine, Second University of Naples at Monaldi Hospital, Napoli, Italy
| | - Marco Falcone
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | | | - Carlo Tascini
- Infectious Disease Department, Cisanello Hospital, Pisa, Italy
| | - Mario Tumbarello
- Infectious Diseases Institute, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, Teaching Hospital Policlinico S. Orsola-Malpighi Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Claudio Viscoli
- Clinic of Infectious Diseases, IRCCS San Martino-IST, University of Genova, Genova, Italy
| | - Antonino Mazzone
- Internal Medicine Department, Hospital of Legnano, Legnano, Italy
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Ungureanu A, Gaman AE, Turculeanu A, Mitroi M, Drocas AI, Dobritoiu M, Alexandru DO, Vasile C. Incidence and Antifungal Susceptibility of Candida Albicans Infections. CURRENT HEALTH SCIENCES JOURNAL 2016; 42:164-168. [PMID: 30568828 PMCID: PMC6256162 DOI: 10.12865/chsj.42.02.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/25/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Candida albicans is the most common inhabitant of the skin, mouth, vagina and gastro intestinal tract of human beings. One of the major reasons for the increase in Candida infection is the development of its resistant strains due to drugs used in the treatment of candidiasis. MATERIALS AND METHODS We studied 4027 samples collected from patients in various wards of the Emergency County Hospital Craiova, Romania between 2014-2015. The specimens were: pharyngeal exsudates, sputum, tracheal secretions, skin secretions, stools, ear secretions, urine, vaginal secretions. All the specimens were transported to the microbiology laboratory and cultured within 3 to 4 h of collection. Among the 4027 samples, 652 showed culture characteristics similar to Candida albicans.The samples were inoculated under sterile conditions using Sabouraud culture media, a medium designed to inhibit bacterial growth and allow the development of fungi. Antifungal Susceptibility Testing was performed by disc diffusion according to CLSI 2014 guidelines using: clotrimazole, ketoconazole, miconazole, econazole, amphotericine B, fluorocytozine, nistatin. RESULTS AND DISCUSSION In our study group the urocultures and dermatological products have a high infection rate, between 100% to 70%, in contrast, we find evidence of secretion ear (3.13%) and the throat swab (9.33%). Various resistant levels were detected against antifungal drugs but, complete resistance to 5 - Fluorocitozina (100%), and the organisms showed highly sensitive to Cotrimazol şi Ketoconazol (100%). In the case of Miconazol 256 (39, 26%), Econazol, 215 (32,98%), Amphotericinei B, 230(35,28%). Nystatin 329 (50,46%). CONCLUSIONSElucidating these mechanisms may provide new foundations for antifungal chemotherapy and can present an exciting challenge for the future investigations. Candida albicans infections are present and diverse clinical pathology.
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Affiliation(s)
- A Ungureanu
- Department of Bacteriology-Virusology- Parasitology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova
| | - A E Gaman
- Department of Bacteriology-Virusology- Parasitology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova
| | - A Turculeanu
- Department of Bacteriology-Virusology- Parasitology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova
| | - M Mitroi
- Department of Otorhinolaryngology. Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova
| | - A I Drocas
- Department of Urology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova
| | - M Dobritoiu
- Department of Oncology, Emergency County Hospital Craiova
| | - D O Alexandru
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova
| | - C Vasile
- Student, Faculty of Medicine, University of Medicine and Pharmacy of Craiova
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Inhibiting the immunoproteasome exacerbates the pathogenesis of systemic Candida albicans infection in mice. Sci Rep 2016; 6:19434. [PMID: 26776888 PMCID: PMC4726078 DOI: 10.1038/srep19434] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 12/14/2015] [Indexed: 12/01/2022] Open
Abstract
Apart from its role in MHC class I antigen processing, the immunoproteasome has recently been implicated in the modulation of T helper cell differentiation under polarizing conditions in vitro and in the pathogenesis of autoimmune diseases in vivo. In this study, we investigated the influence of LMP7 on T helper cell differentiation in response to the fungus Candida albicans. We observed a strong effect of ONX 0914, an LMP7-selective inhibitor of the immunoproteasome, on IFN-γ and IL-17A production by murine splenocytes and human peripheral blood mononuclear cells (PBMCs) stimulated with C. albicans in vitro. Using a murine model of systemic candidiasis, we could confirm reduced generation of IFN-γ- and IL-17A-producing cells in ONX 0914 treated mice in vivo. Interestingly, ONX 0914 treatment resulted in increased susceptibility to systemic candidiasis, which manifested at very early stages of infection. Mice treated with ONX 0914 showed markedly increased kidney and brain fungal burden which resulted in enhanced neutrophil recruitment and immunopathology. Together, these results strongly suggest a role of the immunoproteasome in promoting proinflammatory T helper cells in response to C. albicans but also in affecting the innate antifungal immunity in a T helper cell-independent manner.
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In Vivo Microdialysis To Determine Subcutaneous Interstitial Fluid Penetration and Pharmacokinetics of Fluconazole in Intensive Care Unit Patients with Sepsis. Antimicrob Agents Chemother 2015; 60:827-32. [PMID: 26596947 DOI: 10.1128/aac.02461-15] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 11/14/2015] [Indexed: 12/22/2022] Open
Abstract
The objective of the study was to describe the subcutaneous interstitial fluid (ISF) pharmacokinetics of fluconazole in critically ill patients with sepsis. This prospective observational study was conducted at two tertiary intensive care units in Australia. Serial fluconazole concentrations were measured over 24 h in plasma and subcutaneous ISF using microdialysis. The concentrations in plasma and microdialysate were measured using a validated high-performance liquid chromatography system with electrospray mass spectrometer detector method. Noncompartmental pharmacokinetic analysis was performed. Twelve critically ill patients with sepsis were enrolled. The mean in vivo fluconazole recovery rates ± standard deviation (SD) for microdialysis were 51.4% ± 16.1% with a mean (±SD) fluconazole ISF penetration ratio of 0.52 ± 0.30 (coefficient of variation, 58%). The median free plasma area under the concentration-time curve from 0 to 24 h (AUC0-24) was significantly higher than the median ISF AUC0-24 (340.4 versus 141.1 mg · h/liter; P = 0.004). There was no statistical difference in median fluconazole ISF penetration between patients receiving and not receiving vasopressors (median, 0.28 versus 0.78; P = 0.106). Both minimum and the maximum concentrations of drug in serum (Cmax and Cmin) showed a significant correlation with the fluconazole plasma exposure (Cmax, R(2) = 0.86, P < 0.0001; Cmin, R(2) = 0.75, P < 0.001). Our data suggest that fluconazole was distributed variably, but incompletely, from plasma into subcutaneous interstitial fluid in this cohort of critically ill patients with sepsis. Given the variability of fluconazole interstitial fluid exposures and lack of clinically identifiable factors by which to recognize patients with reduced distribution/exposure, we suggest higher than standard doses to ensure that drug exposure is adequate at the site of infection.
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Pfaller MA, Castanheira M. Nosocomial Candidiasis: Antifungal Stewardship and the Importance of Rapid Diagnosis. Med Mycol 2015; 54:1-22. [PMID: 26385381 DOI: 10.1093/mmy/myv076] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 07/20/2015] [Indexed: 01/12/2023] Open
Abstract
Candidemia and other forms of candidiasis are associated with considerable excess mortality and costs. Despite the addition of several new antifungal agents with improved spectrum and potency, the frequency of Candida infection and associated mortality have not decreased in the past two decades. The lack of rapid and sensitive diagnostic tests has led to considerable overuse of antifungal agents resulting in increased costs, selection pressure for resistance, unnecessary drug toxicity, and adverse drug interactions. Both the lack of timely diagnostic tests and emergence of antifungal resistance pose considerable problems for antifungal stewardship. Whereas antifungal stewardship with a focus on nosocomial candidiasis should be able to improve the administration of antifungal therapy in terms of drug selection, proper dose and duration, source control and de-escalation therapy, an important parameter, timeliness of antifungal therapy, remains a victim of slow and insensitive diagnostic tests. Fortunately, new proteomic and molecular diagnostic tools are improving the time to species identification and detection. In this review we will describe the potential impact that rapid diagnostic testing and antifungal stewardship can have on the management of nosocomial candidiasis.
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Affiliation(s)
- Michael A Pfaller
- T2Biosystems, Lexington, Massachusetts JMI Laboratories, North Liberty, Iowa University of Iowa College of Medicine College of Public Health, Iowa City, Iowa
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Wiersma P, Schillie S, Keyserling H, Watson JR, De A, Banerjee SN, Drenzek CL, Arnold KE, Shivers C, Kendrick L, Ryan LG, Jensen B, Noble-Wang J, Srinivasan A. Catheter-Related Polymicrobial Bloodstream Infections among Pediatric Bone Marrow Transplant Outpatients—Atlanta, Georgia, 2007. Infect Control Hosp Epidemiol 2015; 31:522-7. [DOI: 10.1086/651668] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective.To identify risk factors for polymicrobial bloodstream infections (BSIs) in pediatric bone marrow transplant (BMT) outpatients attending a newly constructed clinic affiliated with a children's hospital.Methods.All 30 outpatients treated at a new BMT clinic during September 10-21, 2007, were enrolled in a cohort study. The investigation included interviews, medical records review, observations, and bacterial culture and molecular typing of patient and environmental isolates. Data were analyzed using exact conditional logistic regression.Results.Thirteen patients experienced BSIs caused by 16 different, predominantly gram-negative organisms. Presence of a tunneled catheter (odds ratio [OR], 19.9 [95% confidence interval {CI}, 2.4-∞), catheter access (OR, 13.7 [95% CI, 1.8-∞]), and flushing of a catheter with predrawn saline (OR, 12.9 [95% CI, 1.0-766.0]) were independently associated with BSI. The odds of experiencing a BSI increased by a factor of 16.8 with each additional injection of predrawn saline (95% CI, 1.8-827.0). Although no environmental source of pathogens was identified, interviews revealed breaches in recommended infection prevention practice and medication handling. Saline flush solutions were predrawn, and multiple doses were obtained from single-dose preservative-free vials to avoid delays in patient care.Conclusion.We speculate that infection prevention challenges in the new clinic, combined with successive needle punctures of vials, facilitated extrinsic contamination and transmission of healthcare-associated pathogens. We recommend that preservative-free single-use vials not be punctured more than once. Use of single-use prefilled saline syringes might prevent multiuse of single-use saline vials. Storage of saline outside a medication supply system might be advisable. Before opening new clinic facilities, hospitals should consider conducting a mock patient flow exercise to identify infection control challenges.
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Bassetti M, Righi E, Ansaldi F, Merelli M, Trucchi C, Cecilia T, De Pascale G, Diaz-Martin A, Luzzati R, Rosin C, Lagunes L, Trecarichi EM, Sanguinetti M, Posteraro B, Garnacho-Montero J, Sartor A, Rello J, Rocca GD, Antonelli M, Tumbarello M. A multicenter study of septic shock due to candidemia: outcomes and predictors of mortality. Intensive Care Med 2014; 40:839-45. [PMID: 24807083 DOI: 10.1007/s00134-014-3310-z] [Citation(s) in RCA: 184] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 04/15/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE Candida is the most common cause of severe yeast infections worldwide, especially in critically ill patients. In this setting, septic shock attributable to Candida is characterized by high mortality rates. The aim of this multicenter study was to investigate the determinants of outcome in critically ill patients with septic shock due to candidemia. METHODS This was a retrospective study in which patients with septic shock attributable to Candida who were treated during the 3-year study period at one or more of the five participating teaching hospitals in Italy and Spain were eligible for enrolment. Patient characteristics, infection-related variables, and therapy-related features were reviewed. Multiple logistic regression analysis was performed to identify the risk factors significantly associated with 30-day mortality. RESULTS A total of 216 patients (mean age 63.4 ± 18.5 years; 58.3 % males) were included in the study. Of these, 163 (75 %) were admitted to the intensive care unit. Overall 30-day mortality was 54 %. Significantly higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, dysfunctional organs, and inadequate antifungal therapy were compared in nonsurvivors and survivors. No differences in survivors versus nonsurvivors were found in terms of the time from positive blood culture to initiation of adequate antifungal therapy. Multivariate logistic regression identified inadequate source control, inadequate antifungal therapy, and 1-point increments in the APACHE II score as independent variables associated with a higher 30-day mortality rate.
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy,
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25
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Romani L, Puccetti P. Controlling pathogenic inflammation to fungi. Expert Rev Anti Infect Ther 2014; 5:1007-17. [DOI: 10.1586/14787210.5.6.1007] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bal AM, Shankland GS, Scott G, Imtiaz T, Macaulay R, McGill M. Antifungal step-down therapy based on hospital intravenous to oral switch policy and susceptibility testing in adult patients with candidaemia: a single centre experience. Int J Clin Pract 2014; 68:20-7. [PMID: 24341299 DOI: 10.1111/ijcp.12231] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 06/07/2013] [Indexed: 11/29/2022] Open
Abstract
AIMS Echinocandins are recommended for the treatment of candidaemia in moderately severe to severely ill patients. Step-down or de-escalation from echinocandin to fluconazole is advised in patients who are clinically stable but data in relation to step-down therapy are sparse. Using our hospital intravenous to oral switch therapy (IVOST) policy to guide antifungal de-escalation in patients with candidaemia, we aimed to determine what proportion of patients are de-escalated to fluconazole, the timescale to step-down, associated reduction in consumption of echinocandins and antifungal cost savings. METHODOLOGY Patients with candidaemia were followed from April 2011 to March 2013. RESULTS A total of 37 episodes of candidaemia were documented during the study period. Twenty-seven patients were commenced on an echinocandin or voriconazole and 19 (70.3%) were de-escalated to fluconazole based on the IVOST policy. The mean and median number of days to de-escalation of therapy was 4.6 and 5 days, respectively. One patient whose therapy was de-escalated relapsed. The overall 30 day crude mortality was 37.1%. The step-down approach led to significant saving in antifungal drug cost of £1133.88 per candidaemic episode and £2208.08 per de-escalation. CONCLUSION Implementation of IVOST policy led to streamlining of antifungal therapy.
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Affiliation(s)
- A M Bal
- Department of Microbiology, University Hospital Crosshouse, Kilmarnock, UK
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Rodrigues CF, Silva S, Henriques M. Candida glabrata: a review of its features and resistance. Eur J Clin Microbiol Infect Dis 2013; 33:673-88. [PMID: 24249283 DOI: 10.1007/s10096-013-2009-3] [Citation(s) in RCA: 178] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 10/22/2013] [Indexed: 11/30/2022]
Abstract
Candida species belong to the normal microbiota of the oral cavity and gastrointestinal and vaginal tracts, and are responsible for several clinical manifestations, from mucocutaneous overgrowth to bloodstream infections. Once believed to be non-pathogenic, Candida glabrata was rapidly blamable for many human diseases. Year after year, these pathological circumstances are more recurrent and problematic to treat, especially when patients reveal any level of immunosuppression. These difficulties arise from the capacity of C. glabrata to form biofilms and also from its high resistance to traditional antifungal therapies. Thus, this review intends to present an excerpt of the biology, epidemiology, and pathology of C. glabrata, and detail an approach to its resistance mechanisms based on studies carried out up to the present.
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Affiliation(s)
- C F Rodrigues
- IBB-Institute for Biotechnology and Bioengineering, Centre of Biological Engineering, University of Minho, 4710-057, Braga, Portugal
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Abstract
Invasive fungal infections are an increasingly frequent etiology of sepsis in critically ill patients causing substantial morbidity and mortality. Candida species are by far the predominant agent of fungal sepsis accounting for 10% to 15% of health-care associated infections, about 5% of all cases of severe sepsis and septic shock and are the fourth most common bloodstream isolates in the United States. One-third of all episodes of candidemia occur in the intensive care setting. Early diagnosis of invasive candidiasis is critical in order to initiate antifungal agents promptly. Delay in the administration of appropriate therapy increases mortality. Unfortunately, risk factors, clinical and radiological manifestations are quite unspecific and conventional culture methods are suboptimal. Non-culture based methods (such as mannan, anti-mannan, β-d-glucan, and polymerase chain reaction) have emerged but remain investigational or require additional testing in the ICU setting. Few prophylactic or pre-emptive studies have been performed in critically ill patients. They tended to be underpowered and their clinical usefulness remains to be established under most circumstances. The antifungal armamentarium has expanded considerably with the advent of lipid formulations of amphotericin B, the newest triazoles and the echinocandins. Clinical trials have shown that the triazoles and echinocandins are efficacious and well tolerated antifungal therapies. Clinical practice guidelines for the management of invasive candidiasis have been published by the European Society for Clinical Microbiology and Infectious Diseases and the Infectious Diseases Society of North America.
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Affiliation(s)
- Julie Delaloye
- Infectious Diseases Service; Department of Medicine; Centre Hospitalier Universitaire Vaudois and University of Lausanne; Lausanne, Switzerland
| | - Thierry Calandra
- Infectious Diseases Service; Department of Medicine; Centre Hospitalier Universitaire Vaudois and University of Lausanne; Lausanne, Switzerland
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Filler SG. Can host receptors for fungi be targeted for treatment of fungal infections? Trends Microbiol 2013; 21:389-96. [PMID: 23796589 DOI: 10.1016/j.tim.2013.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 05/23/2013] [Accepted: 05/24/2013] [Indexed: 11/19/2022]
Abstract
The invasion and stimulation of normally non-phagocytic host cells, such as epithelial and endothelial cells, is a key step in the pathogenesis of many fungal infections. In most cases, host cell invasion and/or stimulation of a proinflammatory response is induced when proteins or carbohydrates on the fungal cell surface bind to receptors on the host cell. Although many of these fungal-host cell interactions have only been investigated in vitro, the therapeutic efficacy of blocking the host cell receptors for Candida albicans and Rhizopus oryzae has been demonstrated in experimental animal models of infection. We summarize recent studies of the fungal receptors on normally non-phagocytic host cells and the therapeutic implications of blocking these receptors.
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Affiliation(s)
- Scott G Filler
- Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA.
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Sardi JCO, Scorzoni L, Bernardi T, Fusco-Almeida AM, Mendes Giannini MJS. Candida species: current epidemiology, pathogenicity, biofilm formation, natural antifungal products and new therapeutic options. J Med Microbiol 2013. [DOI: 10.1099/jmm.0.045054-0] [Citation(s) in RCA: 730] [Impact Index Per Article: 66.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- J. C. O. Sardi
- Department of Clinical Analysis, Laboratory of Clinical Mycology, Faculty of Pharmaceutical Sciences, UNESP, Araraquara, Brazil
| | - L. Scorzoni
- Department of Clinical Analysis, Laboratory of Clinical Mycology, Faculty of Pharmaceutical Sciences, UNESP, Araraquara, Brazil
| | - T. Bernardi
- Department of Clinical Analysis, Laboratory of Clinical Mycology, Faculty of Pharmaceutical Sciences, UNESP, Araraquara, Brazil
| | - A. M. Fusco-Almeida
- Department of Clinical Analysis, Laboratory of Clinical Mycology, Faculty of Pharmaceutical Sciences, UNESP, Araraquara, Brazil
| | - M. J. S. Mendes Giannini
- Department of Clinical Analysis, Laboratory of Clinical Mycology, Faculty of Pharmaceutical Sciences, UNESP, Araraquara, Brazil
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Majer O, Bourgeois C, Zwolanek F, Lassnig C, Kerjaschki D, Mack M, Müller M, Kuchler K. Type I interferons promote fatal immunopathology by regulating inflammatory monocytes and neutrophils during Candida infections. PLoS Pathog 2012; 8:e1002811. [PMID: 22911155 PMCID: PMC3406095 DOI: 10.1371/journal.ppat.1002811] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 06/05/2012] [Indexed: 12/17/2022] Open
Abstract
Invasive fungal infections by Candida albicans (Ca) are a frequent cause of lethal sepsis in intensive care unit patients. While a contribution of type I interferons (IFNs-I) in fungal sepsis remains unknown, these immunostimulatory cytokines mediate the lethal effects of endotoxemia and bacterial sepsis. Using a mouse model lacking a functional IFN-I receptor (Ifnar1−/−), we demonstrate a remarkable protection against invasive Ca infections. We discover a mechanism whereby IFN-I signaling controls the recruitment of inflammatory myeloid cells, including Ly6Chi monocytes and neutrophils, to infected kidneys by driving expression of the chemokines CCL2 and KC. Within kidneys, monocytes differentiate into inflammatory DCs but fail to functionally mature in Ifnar1−/− mice, as demonstrated by the impaired upregulation of the key activation markers PDCA1 and iNOS. The increased activity of inflammatory monocytes and neutrophils results in hyper-inflammation and lethal kidney pathology. Pharmacological diminution of monocytes and neutrophils by treating mice with pioglitazone, a synthetic agonist of the nuclear receptor peroxisome proliferator-activated receptor-γ (PPAR-γ), strongly reduces renal immunopathology during Ca infection and improves mouse survival. Taken together, our data connect for the first time the sepsis-promoting functions of IFNs-I to the CCL2-mediated recruitment and the activation of inflammatory monocytes/DCs with high host-destructing potency. Moreover, our data demonstrate a therapeutic relevance of PPAR-γ agonists for microbial infectious diseases where inflammatory myeloid cells may contribute to fatal tissue damage. Inflammation constitutes a major host response in many microbial infections. Innate immune cells orchestrate the inflammatory response to kill pathogens and clear infections. However, invasive infections by pathogenic microbes including the fungus Candida albicans, can result in an uncontrolled hyper-inflammatory response, leading to severe host damage and sepsis. Type I interferons constitute a hallmark of protective innate immunity in viral and bacterial infections, but at the same time have been notoriously known for their sepsis-promoting effects in numerous experimental inflammation models. Here, we show that type I interferon-signaling mediates the lethal hyper-inflammatory response during systemic mouse infections with C. albicans. Following fungal infections, type I interferons promote the recruitment and activation of inflammatory monocytes and neutrophils to infected organs. The high abundance and activity of inflammatory phagocytes lead to fatal tissue damage. Remarkably, we show that the pharmacological suppression of these inflammatory cells with the drug pioglitazone reduces immunopathology and sepsis-related lethality, suggesting a novel therapeutic option to combat fungal sepsis. In conclusion, our data couple the sepsis-promoting role of type I interferons to the host-destructive activity of inflammatory monocytes and neutrophils. We propose that therapeutic approaches dampening hyper-inflammation might be of general importance in microbial diseases where deleterious immunopathology occurs.
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Affiliation(s)
- Olivia Majer
- Medical University Vienna-Max F. Perutz Laboratories, Christian Doppler Laboratory for Infection Biology, Campus Vienna Biocenter, Vienna, Austria
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C-type lectin receptors and cytokines in fungal immunity. Cytokine 2012; 58:89-99. [DOI: 10.1016/j.cyto.2011.08.031] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 08/20/2011] [Indexed: 12/29/2022]
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Tragiannidis A, Fegeler W, Rellensmann G, Debus V, Müller V, Hoernig-Franz I, Siam K, Pana ZD, Jürgens H, Groll A. Candidaemia in a European Paediatric University Hospital: a 10-year observational study. Clin Microbiol Infect 2012; 18:E27-30. [DOI: 10.1111/j.1469-0691.2011.03720.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Romanowski K, Zaborin A, Valuckaite V, Rolfes RJ, Babrowski T, Bethel C, Olivas A, Zaborina O, Alverdy JC. Candida albicans isolates from the gut of critically ill patients respond to phosphate limitation by expressing filaments and a lethal phenotype. PLoS One 2012; 7:e30119. [PMID: 22253901 PMCID: PMC3258262 DOI: 10.1371/journal.pone.0030119] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 12/09/2011] [Indexed: 12/29/2022] Open
Abstract
Candida albicans is an opportunistic pathogen that proliferates in the intestinal tract of critically ill patients where it continues to be a major cause of infectious-related mortality. The precise cues that shift intestinal C. albicans from its ubiquitous indolent colonizing yeast form to an invasive and lethal filamentous form remain unknown. We have previously shown that severe phosphate depletion develops in the intestinal tract during extreme physiologic stress and plays a major role in shifting intestinal Pseudomonas aeruginosa to express a lethal phenotype via conserved phosphosensory-phosphoregulatory systems. Here we studied whether phosphate dependent virulence expression could be similarly demonstrated for C. albicans. C. albicans isolates from the stool of critically ill patients and laboratory prototype strains (SC5314, BWP17, SN152) were evaluated for morphotype transformation and lethality against C. elegans and mice during exposure to phosphate limitation. Isolates ICU1 and ICU12 were able to filament and kill C. elegans in a phosphate dependent manner. In a mouse model of intestinal phosphate depletion (30% hepatectomy), direct intestinal inoculation of C. albicans caused mortality that was prevented by oral phosphate supplementation. Prototype strains displayed limited responses to phosphate limitation; however, the pho4Δ mutant displayed extensive filamentation during low phosphate conditions compared to its isogenic parent strain SN152, suggesting that mutation in the transcriptional factor Pho4p may sensitize C. albicans to phosphate limitation. Extensive filamentation was also observed in strain ICU12 suggesting that this strain is also sensitized to phosphate limitation. Analysis of the sequence of PHO4 in strain ICU12, its transcriptional response to phosphate limitation, and phosphatase assays confirmed that ICU12 demonstrates a profound response to phosphate limitation. The emergence of strains of C. albicans with marked responsiveness to phosphate limitation may represent a fitness adaptation to the complex and nutrient scarce environment typical of the gut of a critically ill patient.
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Affiliation(s)
- Kathleen Romanowski
- Department of Surgery, University of Chicago, Chicago, Illinois, United States of America
| | - Alexander Zaborin
- Department of Surgery, University of Chicago, Chicago, Illinois, United States of America
| | - Vesta Valuckaite
- Department of Surgery, University of Chicago, Chicago, Illinois, United States of America
| | - Ronda J. Rolfes
- Department of Biology, Georgetown University, Washington, D. C., United States of America
| | - Trissa Babrowski
- Department of Surgery, University of Chicago, Chicago, Illinois, United States of America
| | - Cindy Bethel
- Clinical Microbiology/Immunology Laboratories, University of Chicago, Chicago, Illinois, United States of America
| | - Andrea Olivas
- Department of Surgery, University of Chicago, Chicago, Illinois, United States of America
| | - Olga Zaborina
- Department of Surgery, University of Chicago, Chicago, Illinois, United States of America
| | - John C. Alverdy
- Department of Surgery, University of Chicago, Chicago, Illinois, United States of America
- * E-mail:
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MacCallum DM. Hosting infection: experimental models to assay Candida virulence. Int J Microbiol 2011; 2012:363764. [PMID: 22235206 PMCID: PMC3253448 DOI: 10.1155/2012/363764] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 10/13/2011] [Indexed: 02/01/2023] Open
Abstract
Although normally commensals in humans, Candida albicans, Candida tropicalis, Candida parapsilosis, Candida glabrata, and Candida krusei are capable of causing opportunistic infections in individuals with altered physiological and/or immunological responses. These fungal species are linked with a variety of infections, including oral, vaginal, gastrointestinal, and systemic infections, with C. albicans the major cause of infection. To assess the ability of different Candida species and strains to cause infection and disease requires the use of experimental infection models. This paper discusses the mucosal and systemic models of infection available to assay Candida virulence and gives examples of some of the knowledge that has been gained to date from these models.
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Affiliation(s)
- Donna M. MacCallum
- Aberdeen Fungal Group, School of Medical Sciences, Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
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Guzman JA, Tchokonte R, Sobel JD. Septic shock due to candidemia: outcomes and predictors of shock development. J Clin Med Res 2011; 3:65-71. [PMID: 21811532 PMCID: PMC3140925 DOI: 10.4021/jocmr536w] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2011] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The present report describes the outcomes of a cohort of patients with Candida induced septic shock. METHODS Retrospective analysis of individuals who had at least one positive blood culture for Candida species ≥ 48 h after ICU admission. Data from patients that developed septic shock within 48 hr of the positive blood culture were compared to non-shock candidemic patients. Patients with a concomitant bacteremia and/or endocarditis were excluded. RESULTS Fifteen patients with Candida induced septic shock were studied and compared to 35 candidemic patients without shock. Overall mortality was 76% (87 % among those who had shock). A high proportion of non-albicans Candida species causing fungemia (74%) was observed. All patients with shock were receiving antibiotics but not antifungal treatment at the time of shock development, eight were on parenteral nutrition, six on steroids and nine had a cancer history. High dose fluconazole was the most common initial treatment provided. Four patients died before receiving any antifungal treatment. Time in ICU before the development of candidemia was identified as a predictor of shock development (higher chance if fungemia developed < 7 days after ICU admission). CONCLUSIONS Septic shock due to invasive candidiasis is a near fatal condition. No conventional risk factors were identified to predict shock development other than time (shorter) spent in ICU before the development of candidemia. We encourage clinicians to consider the initiation of appropriate empiric antifungal treatment in high-risk patients who develop septic shock while on antimicrobial treatment. KEYWORDS Septic shock; Candidemia; Outcome; Predictor.
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Affiliation(s)
- Jorge A Guzman
- Section of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, USA
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Ruhnke M, Rickerts V, Cornely OA, Buchheidt D, Glöckner A, Heinz W, Höhl R, Horré R, Karthaus M, Kujath P, Willinger B, Presterl E, Rath P, Ritter J, Glasmacher A, Lass-Flörl C, Groll AH. Diagnosis and therapy of Candida infections: joint recommendations of the German Speaking Mycological Society and the Paul-Ehrlich-Society for Chemotherapy. Mycoses 2011; 54:279-310. [PMID: 21672038 DOI: 10.1111/j.1439-0507.2011.02040.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Invasive Candida infections are important causes of morbidity and mortality in immunocompromised and hospitalised patients. This article provides the joint recommendations of the German-speaking Mycological Society (Deutschsprachige Mykologische Gesellschaft, DMyKG) and the Paul-Ehrlich-Society for Chemotherapy (PEG) for diagnosis and treatment of invasive and superficial Candida infections. The recommendations are based on published results of clinical trials, case-series and expert opinion using the evidence criteria set forth by the Infectious Diseases Society of America (IDSA). Key recommendations are summarised here: The cornerstone of diagnosis remains the detection of the organism by culture with identification of the isolate at the species level; in vitro susceptibility testing is mandatory for invasive isolates. Options for initial therapy of candidaemia and other invasive Candida infections in non-granulocytopenic patients include fluconazole or one of the three approved echinocandin compounds; liposomal amphotericin B and voriconazole are secondary alternatives because of their less favourable pharmacological properties. In granulocytopenic patients, an echinocandin or liposomal amphotericin B is recommended as initial therapy based on the fungicidal mode of action. Indwelling central venous catheters serve as a main source of infection independent of the pathogenesis of candidaemia in the individual patients and should be removed whenever feasible. Pre-existing immunosuppressive treatment, particularly by glucocorticosteroids, ought to be discontinued, if feasible, or reduced. The duration of treatment for uncomplicated candidaemia is 14 days following the first negative blood culture and resolution of all associated symptoms and findings. Ophthalmoscopy is recommended prior to the discontinuation of antifungal chemotherapy to rule out endophthalmitis or chorioretinitis. Beyond these key recommendations, this article provides detailed recommendations for specific disease entities, for antifungal treatment in paediatric patients as well as a comprehensive discussion of epidemiology, clinical presentation and emerging diagnostic options of invasive and superficial Candida infections.
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Affiliation(s)
- Markus Ruhnke
- Medizinische Klinik m S Onkologie u Hämatologie, Charité Universitätsmedizin, Charité, Campus Mitte, Berlin, Germany.
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Pratikaki M, Platsouka E, Sotiropoulou C, Douka E, Paramythiotou E, Kaltsas P, Kotanidou A, Paniara O, Roussos C, Routsi C. Epidemiology, risk factors for and outcome of candidaemia among non-neutropenic patients in a Greek intensive care unit. Mycoses 2011; 54:154-61. [DOI: 10.1111/j.1439-0507.2009.01787.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Muñoz P, Giannella M, Fanciulli C, Guinea J, Valerio M, Rojas L, Rodríguez-Créixems M, Bouza E. Candida tropicalis fungaemia: incidence, risk factors and mortality in a general hospital. Clin Microbiol Infect 2010; 17:1538-45. [PMID: 20718804 DOI: 10.1111/j.1469-0691.2010.03338.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The risk factors and clinical features of patients with Candida tropicalis fungaemia have not been fully defined. We performed a case-control study comparing 59 cases of C. tropicalis fungaemia with 177 episodes of fungaemia caused by other species of Candida in our hospital over a 24-year period (January 1985 to December 2008). Patients with C. tropicalis fungaemia were more likely to be older (median age, 67 vs. 56 years; p 0.01), to have cancer (45.5% vs. 31.6%, p 0.04), and to have the abdomen as the portal of entry (32.2% vs. 11.9%, p 0.001), and had a higher in-hospital mortality rate (61% vs. 44%, p 0.03). Multivariate analysis showed that the independent risk factors for C. tropicalis fungaemia were cancer (OR 4.5; 95% CI 1.05-3.83; p 0.03) and the abdomen as the portal of entry (OR 13.6; 95% CI 1.9-8.2; p <0.001). When survivors were compared with non-survivors, the risk factors associated with a poor outcome were neutropenia (19.4% vs. 0; p 0.03), corticosteroid treatment (36% vs. 13%; p 0.07), and septic shock (50% vs. 17.4%; p 0.01). The independent risk factors for mortality in the multivariate analysis were corticosteroid treatment (OR 8.2; 95% CI 0.9-27.7; p 0.04) and septic shock (OR 14.6; 95% CI 2.4-90.2; p 0.004), whereas urinary tract infection (OR 0.07; 95% CI 0.01-0.8; p 0.03) and catheter removal (OR 0.06; 95% CI 0.01-0.4; p 0.002) were protective factors. C. tropicalis is the fourth most common cause of fungaemia in our hospital. It is associated with underlying malignancy, the abdomen as the portal of entry, and poor outcome.
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Affiliation(s)
- P Muñoz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
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40
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Assessment of the in vitro kinetic activity of caspofungin against Candida glabrata. Antimicrob Agents Chemother 2009; 54:522-5. [PMID: 19841143 DOI: 10.1128/aac.01339-08] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Echinocandins have become the drug of choice in infections caused by Candida glabrata. The objective of this study was to evaluate the in vitro activity of caspofungin alone and in combination against C. glabrata. In vitro assays demonstrated that caspofungin alone showed excellent fungicidal activity against C. glabrata, including fluconazole-resistant strains. The combination of caspofungin and azole antifungals showed potential synergy against C. glabrata. Overall, caspofungin demonstrated excellent in vitro activity, alone and in combination, against strains of C. glabrata.
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Abstract
Protective immunity against fungal pathogens is achieved by the integration of two distinct arms of the immune system, the innate and adaptive responses. Innate and adaptive immune responses are intimately linked and controlled by sets of molecules and receptors that act to generate the most effective form of immunity for protection against fungal pathogens. The decision of how to respond will still be primarily determined by interactions between pathogens and cells of the innate immune system, but the actions of T cells will feed back into this dynamic equilibrium to regulate the balance between tolerogenic and inflammatory responses. In the last two decades, the immunopathogenesis of fungal infections and fungal diseases was explained primarily in terms of Th1/Th2 balance. Although Th1 responses driven by the IL-12/IFN-gamma axis are central to protection against fungi, other cytokines and T cell-dependent pathways have come of age. The newly described Th17 developmental pathway may play an inflammatory role previously attributed to uncontrolled Th1 responses and serves to accommodate the seemingly paradoxical association of chronic inflammatory responses with fungal persistence in the face of an ongoing inflammation. Regulatory T cells in their capacity to inhibit aspects of innate and adaptive antifungal immunity have become an integral component of immune resistance to fungi, and provide the host with immune defense mechanisms adequate for protection, without necessarily eliminating fungal pathogens which would impair immune memory--or causing an unacceptable level of tissue damage. The enzyme indoleamine 2,3-dioxygenase and tryptophan metabolites contribute to immune homeostasis by inducing Tregs and taming overzealous or heightened inflammatory responses.
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Affiliation(s)
- Luigina Romani
- Microbiology Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Italy.
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Boneberger S, Korting H. Therapeutische oder prophylaktische Vakzination bei Pilzinfektionen. Hautarzt 2008; 59:828-32. [DOI: 10.1007/s00105-008-1582-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Romani L, Zelante T, De Luca A, Fallarino F, Puccetti P. IL-17 and therapeutic kynurenines in pathogenic inflammation to fungi. THE JOURNAL OF IMMUNOLOGY 2008; 180:5157-62. [PMID: 18390695 DOI: 10.4049/jimmunol.180.8.5157] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Largely viewed as proinflammatory, innate responses combine with adaptive immunity to generate the most effective form of antifungal resistance, and T cells exercise feedback control over diverse effects of inflammation on infection. Some degree of inflammation is required for protection, particularly in mucosal tissues, during the transitional response occurring between the rapid innate and slower adaptive response. However, progressive inflammation worsens disease and ultimately prevents pathogen eradication. IDO, tryptophan catabolites ("kynurenines"), and regulatory T cells help to tame overzealous and exaggerated inflammatory responses. In this context, IL-23 and the Th17 pathway, which down-regulate tryptophan catabolism, may instead favor pathology and serve to accommodate the seemingly paradoxical association of chronic inflammation with fungal persistence. Recent data support a view in which IL-23/IL-17 antagonistic strategies, including the administration of synthetic kynurenines, could represent a new means of harnessing progressive or potentially harmful inflammation.
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Affiliation(s)
- Luigina Romani
- Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy.
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Bar K, Wisplinghoff H, Wenzel RP, Bearman GML, Edmond MB. Systemic inflammatory response syndrome in adult patients with nosocomial bloodstream infections due to enterococci. BMC Infect Dis 2006; 6:145. [PMID: 17002792 PMCID: PMC1592497 DOI: 10.1186/1471-2334-6-145] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Accepted: 09/26/2006] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Enterococci are the third leading cause of nosocomial bloodstream infection (BSI). Vancomycin resistant enterococci are common and provide treatment challenges; however questions remain about VRE's pathogenicity and its direct clinical impact. This study analyzed the inflammatory response of Enterococcal BSI, contrasting infections from vancomycin-resistant and vancomycin-susceptible isolates. METHODS We performed a historical cohort study on 50 adults with enterococcal BSI to evaluate the associated systemic inflammatory response syndrome (SIRS) and mortality. We examined SIRS scores 2 days prior through 14 days after the first positive blood culture. Vancomycin resistant (n = 17) and susceptible infections (n = 33) were compared. Variables significant in univariate analysis were entered into a logistic regression model to determine the affect on mortality. RESULTS 60% of BSI were caused by E. faecalis and 34% by E. faecium. 34% of the isolates were vancomycin resistant. Mean APACHE II (A2) score on the day of BSI was 16. Appropriate antimicrobials were begun within 24 hours in 52%. Septic shock occurred in 62% and severe sepsis in an additional 18%. Incidence of organ failure was as follows: respiratory 42%, renal 48%, hematologic 44%, hepatic 26%. Crude mortality was 48%. Progression to septic shock was associated with death (OR 14.9, p < .001). There was no difference in A2 scores on days -2, -1 and 0 between the VRE and VSE groups. Maximal SIR (severe sepsis, septic shock or death) was seen on day 2 for VSE BSI vs. day 8 for VRE. No significant difference was noted in the incidence of organ failure, 7-day or overall mortality between the two groups. Univariate analysis revealed that AP2>18 at BSI onset, and respiratory, cardiovascular, renal, hematologic and hepatic failure were associated with death, but time to appropriate therapy >24 hours, age, and infection due to VRE were not. Multivariate analysis revealed that hematologic (OR 8.4, p = .025) and cardiovascular failure (OR 7.5, p = 032) independently predicted death. CONCLUSION In patients with enterococcal BSI, (1) the incidence of septic shock and organ failure is high, (2) patients with VRE BSI are not more acutely ill prior to infection than those with VSE BSI, and (3) the development of hematologic or cardiovascular failure independently predicts death.
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Affiliation(s)
- Katharine Bar
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Hilmar Wisplinghoff
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
| | - Richard P Wenzel
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Gonzalo ML Bearman
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Michael B Edmond
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
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