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Zhao Y, Wang P, Sun X, Zhao M, Chen Y, Gao X. Candida albicans Infection Disrupts the Metabolism of Vaginal Epithelial Cells and Inhibits Cellular Glycolysis. Microorganisms 2024; 12:292. [PMID: 38399696 PMCID: PMC10891792 DOI: 10.3390/microorganisms12020292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
Vulvovaginal candidiasis (VVC) is a common gynecologic disorder caused by fungal infections of the vaginal mucosa, with the most common pathogen being Candida albicans (C. albicans). Exploring metabolite changes in the disease process facilitates further discovery of targets for disease treatment. However, studies on the metabolic changes caused by C. albicans are still lacking. In this study, we used C. albicans-infected vaginal epithelial cells to construct an in vitro model of VVC, analyzed the metabolites by UHPLC-Q-Exactive MS, and screened the potential metabolites based on metabolomics. The results showed that C. albicans infection resulted in significant up-regulation of D-arabitol, palmitic acid, adenosine, etc.; significant down-regulation of lactic acid, nicotinamide (NAM), nicotinate (NA), etc.; and disruption of amino acid metabolism, and that these significantly altered metabolites might be potential therapeutic targets of VVC. Further experiments showed that C. albicans infection led to a decrease in glycolytic enzymes in damaged cells, inhibiting glycolysis and leading to significant alterations in glycolytic metabolites. The present study explored the potential metabolites of VVC induced by C. albicans infection based on metabolomics and verified the inhibitory effect of C. albicans on vaginal epithelial cell glycolysis, which is valuable for the diagnosis and treatment of VVC.
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Affiliation(s)
- Yanni Zhao
- State Key Laboratory of Functions and Applications of Medicinal Plants, School of Pharmacy, Guizhou Medical University, Guiyang 550031, China
- Microbiology and Biochemical Pharmaceutical Engineering Research Center, Guizhou Provincial Department of Education, Guizhou Medical University, Guiyang 550031, China
| | - Pengjiao Wang
- State Key Laboratory of Functions and Applications of Medicinal Plants, School of Pharmacy, Guizhou Medical University, Guiyang 550031, China
- Microbiology and Biochemical Pharmaceutical Engineering Research Center, Guizhou Provincial Department of Education, Guizhou Medical University, Guiyang 550031, China
| | - Xiaodong Sun
- State Key Laboratory of Functions and Applications of Medicinal Plants, School of Pharmacy, Guizhou Medical University, Guiyang 550031, China
- Microbiology and Biochemical Pharmaceutical Engineering Research Center, Guizhou Provincial Department of Education, Guizhou Medical University, Guiyang 550031, China
| | - Mei Zhao
- State Key Laboratory of Functions and Applications of Medicinal Plants, School of Pharmacy, Guizhou Medical University, Guiyang 550031, China
- Microbiology and Biochemical Pharmaceutical Engineering Research Center, Guizhou Provincial Department of Education, Guizhou Medical University, Guiyang 550031, China
| | - Yixuan Chen
- State Key Laboratory of Functions and Applications of Medicinal Plants, School of Pharmacy, Guizhou Medical University, Guiyang 550031, China
- Microbiology and Biochemical Pharmaceutical Engineering Research Center, Guizhou Provincial Department of Education, Guizhou Medical University, Guiyang 550031, China
| | - Xiuli Gao
- State Key Laboratory of Functions and Applications of Medicinal Plants, School of Pharmacy, Guizhou Medical University, Guiyang 550031, China
- Microbiology and Biochemical Pharmaceutical Engineering Research Center, Guizhou Provincial Department of Education, Guizhou Medical University, Guiyang 550031, China
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Retnaningtyas Y, Supriyanto G, Nyoman Tri Puspaningsih N, Irawan R, Siswodihardjo S. A novel molecular imprinting polymer for the selective adsorption of D-arabinitol from spiked urine. Turk J Chem 2021; 44:1265-1277. [PMID: 33488227 PMCID: PMC7751933 DOI: 10.3906/kim-2002-56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/19/2020] [Indexed: 11/23/2022] Open
Abstract
In this research, molecular imprinting polymers (MIPs) for D-arabinitol were synthesized using a bulk polymerization method through a noncovalent approach. The MIPs were prepared by using D-arabinitol as a template, acrylamide as a functional monomer, ethylene glycol dimethacrylateas cross-linker, benzoyl peroxide as an initiator and dimethyl sulfoxideas a porogen. MIPS was synthesized in several formulas with a different molar ratio of template to functional monomers and cross-linker. Fourier-transform infrared spectroscopy (FT-IR) and scanning electron microscopy (SEM) were used to characterize the MIPs produced. A batch rebinding assay was used to test the binding efficiency of each formula. Batch rebinding test results revealed that MIPsF3 with a molar ratio of the template: monomer and crosslinker ratio respectively (1: 4: 25) had the highest binding capacity at 1.56 mgg
-1
. The results of isotherm adsorption showed that the MIPs produced followed the Freundlich equation with an R-value of 0.97. The MIPs produced was also selective toward its isomeric compounds (i.e. L-arabinitol, adonitol, xylitol, and glucose). The extraction efficiency of the MIPs against D-arabinitol was 88.98%.
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Affiliation(s)
| | - Ganden Supriyanto
- Department of Chemistry, Faculty of Science and Technology, University of Airlangga, Surabaya Indonesia
| | | | - Roedi Irawan
- Department of Pediatrics, Faculty of Medicine, University of Airlangga, Surabaya Indonesia
| | - Siswandono Siswodihardjo
- Department of Pharmaceutical Chemistry, Facultyof Pharmacy, University of Airlangga, Surabaya Indonesia
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Dabrowski M, Cieplak M, Noworyta K, Heim M, Adamkiewicz W, Kuhn A, Sharma PS, Kutner W. Surface enhancement of a molecularly imprinted polymer film using sacrificial silica beads for increasingl-arabitol chemosensor sensitivity and detectability. J Mater Chem B 2017; 5:6292-6299. [DOI: 10.1039/c7tb01407d] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Sacrificial silica beads, used for increasing the specific surface area of a molecularly imprinted polymer film, improve the performance of the chemosensor.
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Affiliation(s)
- Marcin Dabrowski
- Institute of Physical Chemistry
- Polish Academy of Sciences
- 01-224 Warsaw
- Poland
| | - Maciej Cieplak
- Institute of Physical Chemistry
- Polish Academy of Sciences
- 01-224 Warsaw
- Poland
| | - Krzysztof Noworyta
- Institute of Physical Chemistry
- Polish Academy of Sciences
- 01-224 Warsaw
- Poland
| | | | - Witold Adamkiewicz
- Institute of Physical Chemistry
- Polish Academy of Sciences
- 01-224 Warsaw
- Poland
| | | | | | - Wlodzimierz Kutner
- Institute of Physical Chemistry
- Polish Academy of Sciences
- 01-224 Warsaw
- Poland
- Faculty of Mathematics and Natural Sciences
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Xiao Y, Li Y, Ying J, Tian Y, Xiao Y, Mei Z. Determination of alditols by capillary electrophoresis with indirect laser-induced fluorescence detection. Food Chem 2015; 174:233-9. [DOI: 10.1016/j.foodchem.2014.11.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 11/03/2014] [Accepted: 11/08/2014] [Indexed: 11/16/2022]
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5
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Zimmerman KO, Smith PB. Current Epidemiology and Management of Invasive Candidiasis in Infants. CURRENT FUNGAL INFECTION REPORTS 2014. [DOI: 10.1007/s12281-013-0167-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Kałużna-Czaplińska J, Błaszczyk S. The level of arabinitol in autistic children after probiotic therapy. Nutrition 2011; 28:124-6. [PMID: 22079796 DOI: 10.1016/j.nut.2011.08.002] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 08/01/2011] [Accepted: 08/01/2011] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The level of D-arabinitol (DA) and the ratio of D-/L-arabinitol (DA/LA) in the urine of children with autism were investigated. The changes in DA/LA after probiotic treatment in urine samples of children with autism were studied. METHODS DA and LA and the DA/LA ratio were identified by capillary gas chromatography/mass spectrometry in urine before and after the probiotic therapy. RESULTS The level of DA is significantly higher (P < 0.05) in the urine of autistic children before (A) and after probiotic supplementation (A1) (160.04 ± 22.88 μmol/mmol creatinine and 89.53 ± 37.41 μmol/mmol creatinine, respectively). Nonetheless, the probiotic supplementation let to a significant decrease in DA and DA/LA and to a significant improvement in ability of concentration and carrying out orders. CONCLUSION The use of probiotics seems to be helpful in reducing the level of DA and the ratio of DA/LA in the urine of children with autism.
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Affiliation(s)
- Joanna Kałużna-Czaplińska
- Institute of General and Ecological Chemistry, Department of Chemistry, Technical University of Lodz, Lodz, Poland.
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Arendrup M, Bergmann O, Larsson L, Nielsen H, Jarløv J, Christensson B. Detection of candidaemia in patients with and without underlying haematological disease. Clin Microbiol Infect 2010; 16:855-62. [DOI: 10.1111/j.1469-0691.2009.02931.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Arendrup MC, Fisher BT, Zaoutis TE. Invasive fungal infections in the paediatric and neonatal population: diagnostics and management issues. Clin Microbiol Infect 2009; 15:613-24. [PMID: 19673972 DOI: 10.1111/j.1469-0691.2009.02909.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Invasive fungal infections in children appear to have increased over the past few decades. Especially neonates and children with primary and secondary immunodeficiencies are at risk. Candida and Aspergillus spp. are the most commonly isolated organisms. In addition, Malassezia may cause systemic infections in newborns and zygomycosis is important because of its rising incidence and high case fatality rate. Timely diagnosis and initiation of appropriate antifungal therapy is imperative for improving outcomes. However, traditional techniques are time-consuming and representative sample material, using invasive procedures, may be difficult to obtain in the paediatric setting. This review provides an overview of the advances in detection and rapid species identification, with a focus on issues relevant in these settings. Subsequently, the current antifungal treatment options for neonates and children are discussed in light of the antifungal spectrum of the available agents and the specific pharmacokinetic properties in different age groups. Although a multitude of newer antifungal compounds have become available within the last decade, further studies are necessary to clearly establish the role for each of these agents among neonates and children.
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Affiliation(s)
- M C Arendrup
- Unit of Mycology and Parasitology, Statens Serum Institut, Copenhagen, Denmark
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Anane S, Khalfallah F. Diagnostic biologique des candidoses systémiques : difficultés et perspectives. ACTA ACUST UNITED AC 2007; 55:262-72. [PMID: 16698196 DOI: 10.1016/j.patbio.2006.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2005] [Accepted: 03/22/2006] [Indexed: 11/18/2022]
Abstract
The diagnosis of systemic Candidiasis is difficult to establish and biologic diagnosis raises problems. Blood culture which is the gold standard for the diagnosis of systemic Candidiasis lacks sensitivity and usually takes several days to become positive. Early diagnostic approach is imperative to avoid delays in the initiation for treatment. Therefore, nonculture methods like test for Candida antigen detection, metabolite detection or Candida DNA detection by PCR are being developed for the laboratory diagnosis. Candida derived metabolites and antigens detection lacks sensitivity. A new strategy consisting of the combined detection of mannanemia and an antibody response was developed. The combined detection has a high specificity and sensitivity in the diagnosis of invasive candidiasis. The results of tests for the detection of yeast DNA by PCR obtained recently are promising in terms of sensitivity, specificity and identification of species of Candida.
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Affiliation(s)
- S Anane
- Département de parasitologie, faculté de médecine de Tunis, 15, rue Djebel-Lakhdar, 1007 La-Rabta, Tunisie.
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Sigmundsdottir G, Larsson L, Wiebe T, Björklund LJ, Christensson B. Clinical experience of urine D-arabinitol/L-arabinitol ratio in the early diagnosis of invasive candidiasis in paediatric high risk populations. ACTA ACUST UNITED AC 2007; 39:146-51. [PMID: 17366032 DOI: 10.1080/00365540600951267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In 2 prospective studies, we previously reported on the early and accurate diagnosis of invasive candidiasis by determining the D-arabinitol/L-arabinitol (DA/LA) ratio in urine in neutropenic children with cancer at the paediatric oncology unit (POU) and in premature infants at the neonatal intensive care unit (NICU) at our hospital. In this retrospective study at the same units, we report how the DA/LA assay was implemented in clinical practice immediately after the prospective study periods. We found that, in the POU, the recommendation of regularly monitoring urine DA/LA ratios in patients at risk and considering antifungal therapy in the case of elevated ratios had been followed. A significant decrease in the incidence of culture positive invasive candidiasis may have been attributed to the introduction of the DA/LA assay. At the NICU, where the DA/LA assay was recommended only as an adjunct to other diagnostic tools, morbidity in invasive candidiasis remained unchanged. While regular monitoring of the urine DA/LA ratio probably facilitates the early detection of invasive candidiasis in paediatric oncology, it remains to be determined if the test can be used in a similar way in neonatal intensive care.
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Affiliation(s)
- Gudrun Sigmundsdottir
- Centre for Infectious Disease Control, Directorate of Health, Department of Clinical Microbiology, Landspitali University Hospital, Iceland.
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Stradomska TJ, Bobula-Milewska B, Bauer A, Mielniczuk Z, Dabkowska M, Syczewska M, Dzierzanowska D. Urinary D-arabinitol/L-arabinitol levels in infants undergoing long-term antibiotic therapy. J Clin Microbiol 2005; 43:5351-4. [PMID: 16208016 PMCID: PMC1248520 DOI: 10.1128/jcm.43.10.5351-5354.2005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Long-term antibiotic therapy is one of the main risk factors for mycosis. The urinary D-arabinitol/L-arabinitol (D-/L-ARA) ratio (a biomarker of several Candida species) was determined by gas chromatography with an electron capture detector in samples from 51 infants undergoing long-term antibiotic therapy. Although 47 of these children had higher D-/L-ARA ratios than healthy controls (P<0.0003), their values nonetheless remained within upper-normal limits (D-/L-ARA ratio of <3.6). Four children with suspected invasive candidiasis had above-normal ratios that normalized with fluconazole treatment.
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Affiliation(s)
- Teresa J Stradomska
- Department of Laboratory Diagnostics, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-736 Warsaw, Poland.
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Brian Smith P, Steinbach WJ, Benjamin DK. Invasive Candida infections in the neonate. Drug Resist Updat 2005; 8:147-62. [PMID: 16002326 DOI: 10.1016/j.drup.2005.04.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2005] [Revised: 04/27/2005] [Accepted: 04/28/2005] [Indexed: 11/16/2022]
Abstract
Advances in medical therapy have increased premature infant survival. A rise in Candida infections in neonatal intensive care units (NICUs) has followed. Once considered a contaminant, Candida is now recognized as a major cause of mortality and morbidity within these units. We will examine what is known about the epidemiology, risk factors and end-organ involvement of Candida infections with a focus on invasive disease. In addition, diagnostic alternatives to traditional blood culture, experience with antifungal agents for prophylaxis and therapeutic options, including newer antifungal agents, will be presented.
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Affiliation(s)
- P Brian Smith
- Department of Pediatrics, Duke University, PO Box 17969, Durham, NC 27705, USA
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Bär W, Beyreiss B, Rebentisch G, Juretzek T. [Diagnosis of systemic Candida infections. Evaluation of serology, molecular biology and D-arabinitol detection]. Mycoses 2005; 47 Suppl 1:32-6. [PMID: 15667362 DOI: 10.1111/j.1439-0507.2004.01034.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In order to diagnose systemic Candida infection in ICU patients, several methods were compared. In the first round, antigens and antibodies of 104 patients were investigated. Seventeen patients were infected; in nine of these patients a positive antigen was detected; elevated antibodies were detected in 11 patients. Only 42 patients were colonized. In this group, one positive antigen and six elevated antibody titres were detected. Combining these results, the sensitivity of the antigen only (58.5%) or the antibodies only (52.9%) increased to 100%. In the second round (n = 83 patients) the D-arabinitol/L-arabinitol quotient was also determined in the urine. 18.1% of the patients had elevated antibodies and 26.5% elevated D-arabinitol/L-arabinitol quotients. In the third round, PCR was also applied (n = 27 patients). Five patients had elevated D-arabinitol/L-arabinitol quotients and one of these had a positive PCR result. In conclusion, serological methods (antigen and antibody detection) should only be applied in strictly selected patients. In uncertain cases, the addition of PCR or determination of D-arabinitol/L-arabinitol might be helpful.
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Affiliation(s)
- W Bär
- Institut für Mikrobiologie und Krankenhaushygiene, Carol-Thiem-Klinikum, Thiemstrasse 111, D-03048 Cottbus, Germany.
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Hui M, Cheung SW, Chin ML, Chu KC, Chan RCY, Cheng AFB. Development and application of a rapid diagnostic method for invasive Candidiasis by the detection of d-/l-arabinitol using gas chromatography/mass spectrometry. Diagn Microbiol Infect Dis 2004; 49:117-23. [PMID: 15183861 DOI: 10.1016/j.diagmicrobio.2004.02.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2003] [Accepted: 02/06/2004] [Indexed: 11/24/2022]
Abstract
A rapid non-culture-based diagnostic method utilizing d-/l-arabinitol (DA/LA) ratios as a chemical marker of invasive candidiasis was developed and explored. The enantiomers-ratios detection was made possible by the use of gas chromatography coupled with mass spectrometry (GC/MS). The mean DA/LA ratios +/- standard deviation (range) in urine (n = 40) and serum (n = 20) were 2.08 +/- 0.78 (0.57 to 3.55) and 1.79 +/- 0.75 (0.74 to 3.54), respectively, from patients without evidence of fungal infection or colonization; in patients (n = 7) with culture-proven invasive candida infections, the figures were 9.91 +/- 3.04 (7.24 to 16.27) and 13.58 +/- 7.31 (5.57 to 25.88) in urine and serum, respectively. The differences in DA/LA ratios between the candidemic patients and the non-candidemic patients were statistically significant (p < 0.01) in both serum and urine samples. The DA/LA ratios were not significantly affected in patients with oral or vaginal candidiasis and candiduria.
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Affiliation(s)
- Mamie Hui
- Department of Microbiology, Chinese University of Hong Kong, The Prince of Wales Hospital, Hong Kong, SAR, China.
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16
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Abstract
Neonatal candidemia is poorly understood and is a leading cause of nosocomial infectious mortality in the nursery. Prevention of candidemia has been difficult, although a combined approach of antifungal prophylaxis and targeted empirical therapy may eventually reduce morbidity and mortality. Multicenter prospective testing of an integrated approach to early diagnosis of neonatal candidemia using newer molecular techniques is also needed. Candidemia in the infant is cause for prompt removal (or replacement) of central vascular catheters and institution of antifungal therapy. End-organ evaluation is also probably warranted to guide treatment and facilitate prognostication. Given the continuing progress in clinical research infrastructure and development of new diagnostic tests and antifungal agents, substantial improvement in the prevention, diagnosis, and management of neonatal candidemia is plausible over the next decade.
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Benjamin DK, Poole C, Steinbach WJ, Rowen JL, Walsh TJ. Neonatal candidemia and end-organ damage: a critical appraisal of the literature using meta-analytic techniques. Pediatrics 2003; 112:634-40. [PMID: 12949295 DOI: 10.1542/peds.112.3.634] [Citation(s) in RCA: 143] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Neonatal candidemia is an increasing cause of infant morbidity and mortality. We evaluated the current medical literature in an effort to critique the literature and to document the reported prevalences of end-organ damage after neonatal candidemia. METHODS We analyzed all peer-reviewed articles of neonatal candidemia published in the English language; inclusion criteria included a cohort limited to all neonatal intensive care unit admissions or all episodes of candidemia in neonates. Articles that also incorporated older patients, did not define a numerator and a denominator for at least 1 form of end-organ damage, included patients from other reports, or did not include all episodes of candidemia in the source population were excluded from the analysis. RESULTS Thirty-four articles reported episodes of candidemia and mortality; 21 articles reported prevalence for at least 1 form of end-organ damage. Only 4 (19%) of 21 articles reported prevalence for >4 forms of end-organ damage from the following list: endophthalmitis, meningitis, brain parenchyma invasion, endocarditis, renal abscesses, positive cultures from other normally sterile body fluids, or hepatosplenic abscesses. The median reported prevalence of endophthalmitis was 3% (interquartile range [IQR]: 0%-17%), of meningitis was 15% (IQR: 3%-23%), of brain abscess or ventriculitis was 4% (IQR: 3%-21%), of endocarditis was 5% (IQR: 0%-13%), of positive renal ultrasound was 5% (IQR: 0%-14%), and of positive urine culture was 61% (IQR: 40%-76%). The medical literature concerning end-organ evaluation after episodes of neonatal candidemia is heterogeneous and consists largely of single-center retrospective studies. Year that the data were collected and prevalence of neonates infected with Candida albicans were associated with observed heterogeneity. CONCLUSIONS Given the heterogeneity of the medical literature, precise estimates of the frequencies of end-organ damage are not possible and a prospective multicenter trial is warranted, but the data from the published literature suggest that the prevalence of neonates with end-organ damage not only is greater than 0 but also is high enough that until such a prospective trial is completed, end-organ studies should be considered before the conclusion of antifungal therapy.
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Affiliation(s)
- Daniel K Benjamin
- Department of Pediatrics, Duke University, Durham, North Carolina, USA.
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18
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Abstract
Candida infections have become an increasingly frequent problem in neonatal intensive care units, particularly among extremely low birth weight infants. Transmission occurs both vertically and horizontally, with Candida albicans and C. parapsilosis as the predominant species. Multiple risk factors have been identified with prior antibiotic exposure, presence of a central line, endotracheal intubation, and prior fungal colonization reported most frequently. The primary site of infection can involve the bloodstream, meninges, or urinary tract, but disease is frequently disseminated to multiple organ systems. Amphotericin is the most commonly used antifungal agent, although fluconazole is being used more frequently. The potential role of antifungal prophylaxis is not yet clearly defined, but has been the topic of recent investigative efforts. The crude mortality rate among neonates with systemic candidiasis remains approximately 30%.
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Affiliation(s)
- Rachel L Chapman
- Department of Pediatrics, Yale University Medical School, New Haven, Connecticut 06520-8064, USA.
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Eisen DP, Bartley PB, Hope W, Sigmundsdottir G, Pehrson C, Larsson L, Christensson B. Urine D-arabinitol/L-arabinitol ratio in diagnosing Candida infection in patients with haematological malignancy and HIV infection. Diagn Microbiol Infect Dis 2002; 42:39-42. [PMID: 11821170 DOI: 10.1016/s0732-8893(01)00310-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Adult patients with hematologic malignancies along with HIV infected patients were prospectively studied to determine the performance of urine D-arabinitol/L-arabinitol (DA/LA) ratio in diagnosing invasive candidiasis. Ten evaluable febrile neutropenic patients had proven invasive candidiasis and elevated DA/LA ratios were found in 5. Invasive candidiasis with normal DA/LA ratios was most frequently due to Candida krusei infection. This Candida species is a non-producer of arabinitol. Only 4 of 81 febrile neutropenic patients given either antifungal prophylaxis or empiric antifungal treatment had elevated DA/LA ratios. Only 1 of 15 HIV positive patients with either oropharyngeal or esophageal candidiasis had elevated DA/LA ratios. Widespread use of fluconazole prophylaxis in bone marrow transplantation patients at the study hospital has led to an increased prevalence of C. krusei infection. This is the likely reason for the low sensitivity of the test in proven and suspected invasive Candida infections reported here.
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Affiliation(s)
- Damon P Eisen
- Infectious Diseases Unit, Royal Brisbane Hospital, Herston Road, 4029, Herston, Queensland, Australia.
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