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Silva PA, Souza AA, de Oliveira GM, Ramada MHS, Hernández NV, Mora-Montes HM, Bueno RV, Martins-de-Sa D, de Freitas SM, Felipe MSS, Barbosa JARG. An improved expression and purification protocol enables the structural characterization of Mnt1, an antifungal target from Candida albicans. Fungal Biol Biotechnol 2024; 11:5. [PMID: 38715132 PMCID: PMC11077754 DOI: 10.1186/s40694-024-00174-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/22/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Candida albicans is one of the most prevalent fungi causing infections in the world. Mnt1 is a mannosyltransferase that participates in both the cell wall biogenesis and biofilm growth of C. albicans. While the cell wall performs crucial functions in pathogenesis, biofilm growth is correlated with sequestration of drugs by the extracellular matrix. Therefore, antifungals targeting CaMnt1 can compromise fungal development and potentially also render Candida susceptible to drug therapy. Despite its importance, CaMnt1 has not yet been purified to high standards and its biophysical properties are lacking. RESULTS We describe a new protocol to obtain high yield of recombinant CaMnt1 in Komagataella phaffii using methanol induction. The purified protein's identity was confirmed by MALDI-TOF/TOF mass spectroscopy. The Far-UV circular dichroism (CD) spectra demonstrate that the secondary structure of CaMnt1 is compatible with a protein formed by α-helices and β-sheets at pH 7.0. The fluorescence spectroscopy results show that the tertiary structure of CaMnt1 is pH-dependent, with a greater intensity of fluorescence emission at pH 7.0. Using our molecular modeling protocol, we depict for the first time the ternary complex of CaMnt1 bound to its two substrates, which has enabled the identification of residues involved in substrate specificity and catalytic reaction. Our results corroborate the hypothesis that Tyr209 stabilizes the formation of an oxocarbenium ion-like intermediate during nucleophilic attack of the acceptor sugar, opposing the double displacement mechanism proposed by other reports. CONCLUSIONS The methodology presented here can substantially improve the yield of recombinant CaMnt1 expressed in flask-grown yeasts. In addition, the structural characterization of the fungal mannosyltransferase presents novelties that can be exploited for new antifungal drug's development.
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Affiliation(s)
- Patrícia Alves Silva
- Laboratório de Biofísica Molecular, Departamento de Biologia Celular, Instituto de Ciências Biológicas, Universidade de Brasília, Brasília, 70910-900, Brazil
| | - Amanda Araújo Souza
- Laboratório de Biofísica Molecular, Departamento de Biologia Celular, Instituto de Ciências Biológicas, Universidade de Brasília, Brasília, 70910-900, Brazil
| | - Gideane Mendes de Oliveira
- Laboratório de Biofísica Molecular, Departamento de Biologia Celular, Instituto de Ciências Biológicas, Universidade de Brasília, Brasília, 70910-900, Brazil
| | - Marcelo Henrique Soller Ramada
- Programa de Pós-graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brasília, 70790-160, Brazil
| | - Nahúm Valente Hernández
- Departmento de Biologia, División de Ciencias Naturales y Exactas, Universidad de Guanajuato, Guanajuato, 36050, Mexico
| | - Héctor Manuel Mora-Montes
- Departmento de Biologia, División de Ciencias Naturales y Exactas, Universidad de Guanajuato, Guanajuato, 36050, Mexico
| | - Renata Vieira Bueno
- Laboratório de Biofísica Molecular, Departamento de Biologia Celular, Instituto de Ciências Biológicas, Universidade de Brasília, Brasília, 70910-900, Brazil
| | - Diogo Martins-de-Sa
- Laboratório de Biofísica Molecular, Departamento de Biologia Celular, Instituto de Ciências Biológicas, Universidade de Brasília, Brasília, 70910-900, Brazil
- Genesilico Biotech, Brasília, DF, Brazil
| | - Sonia Maria de Freitas
- Laboratório de Biofísica Molecular, Departamento de Biologia Celular, Instituto de Ciências Biológicas, Universidade de Brasília, Brasília, 70910-900, Brazil
| | - Maria Sueli Soares Felipe
- Programa de Pós-graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brasília, 70790-160, Brazil
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Amin M, Babadi F, Baghipour N, Sadeghi-Nejad B. Evaluation of the effect of Jaftex herbal mouthwash on the growth of Candida albicans and Candida tropicalis. J Family Med Prim Care 2021; 10:3815-3819. [PMID: 34934685 PMCID: PMC8653495 DOI: 10.4103/jfmpc.jfmpc_1067_21] [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: 02/04/2021] [Revised: 05/12/2021] [Accepted: 07/23/2021] [Indexed: 11/04/2022] Open
Abstract
Background Increased resistance of Candida albicans to standard antifungal agents has caused special attention to medicinal plants. The aim of this study was to evaluate the effect of Jaftex mouthwash on the growth of C. albicans and Candida tropicalis. Methods and Material In this in vitro study, standard strains of C. albicans and C. tropicalis were used. Jaftex mouthwash was prepared with the active ingredient (10g/100cc) of aqueous extract of oak fruit hull (Jaft), Zataria multiflora, and Satureja bachtiarica. The mouthwash was diluted in half, 8 different concentrations were obtained. 10 μl volume of each dilution was poured on discs mounted linearly on the culture medium inoculated with the target fungus. After 24 h, due to the slow growth rate of these fungi, the Petri dishes were incubated at 37°C and the mean minimum inhibitory concentration (MIC) was determined for each fungus. The modified E. test method was used to measure the MIC of Jaftex mouthwash for the two fungi. The experiment was repeated three times for each fungus and the mean value was measured. Results The mean value of MIC for C. albicans and C. tropicalis was 0.0625 (mg/mL) and 0.0833 (mg/mL), respectively. Candida albicans appeared to be more sensitive to Jaftex, but no statistically significant difference was observed. Conclusion Jaftex mouthwash inhibits the growth of C. albicans and C. tropicalis. The use of this mouthwash is recommended for treatment of oral candidiasis.
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Affiliation(s)
- Mansour Amin
- Department of Microbiology, School of Medicine, Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz, Iran
| | - Fatemeh Babadi
- Oral and Maxillofacial Medicine, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Najme Baghipour
- Dental Student, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Zimmermann ES, Ferreira LM, Denardi LB, Sari MHM, Cervi VF, Nogueira CW, Alves SH, Cruz L. Mucoadhesive gellan gum hydrogel containing diphenyl diselenide-loaded nanocapsules presents improved anti-candida action in a mouse model of vulvovaginal candidiasis. Eur J Pharm Sci 2021; 167:106011. [PMID: 34537375 DOI: 10.1016/j.ejps.2021.106011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/07/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022]
Abstract
The aim of this study was to evaluate the in vitro antifungal action of a diphenyl diselenide-loaded poly(ε-caprolactone) nanocapsules suspension (NC-1) and incorporate it into a gellan gum hydrogel formulation in order to assess its in vivo efficacy in an animal model of vulvovaginal candidiasis. Nanocapsules suspensions containing the compound (NC-1 ∼ 5 mg/mL) or not (NC-B) were prepared by the interfacial deposition of preformed polymer method. To estimate in vitro antifungal effect, the broth microdilution test was applied. The results showed that NC-1 had equal or lower MIC values when compared to free compound against fifteen Candida strains. Following, the hydrogel was prepared by direct thickening of the nanocapsules suspension by gellan gum addition. The animal model of vulvovaginal candidiasis was induced by infecting female Swiss mice with Candida albicans strains. The animals were topically treated with 20 µL of hydrogels (NC-1 and free compound - 0.1 mg of diphenyl diselenide/once a day for seven days) and then the total fungal burden was assessed after the euthanasia. The results showed that the hydrogels presented pH in the acidic range, compound content close to theoretical value, homogeneous particle distribution with nanometric size, high physicochemical and microbiological stability as well as great bioadhesive property. The nano-based presented superior pharmacological action in comparison to the hydrogel containing non-encapsulated diphenyl diselenide. The results demonstrated that the nanoencapsulation maintained the effective antifungal action of diphenyl diselenide. The nano-based hydrogel formulation may be considered a promising approach against vulvovaginal candidiasis.
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Affiliation(s)
- Estevan Sonego Zimmermann
- Programa de Pós-Graduação em Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brasil
| | - Luana Mota Ferreira
- Programa de Pós-Graduação em Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brasil
| | - Laura Bedin Denardi
- Programa de Pós-Graduação em Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brasil
| | - Marcel Henrique Marcondes Sari
- Programa de Pós-Graduação em Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brasil
| | - Verônica Ferrari Cervi
- Programa de Pós-Graduação em Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brasil
| | - Cristina Wayne Nogueira
- Programa de Pós-Graduação em Bioquímica Toxicológica, Centro de Ciências da Saúde, Universidade Federal de Santa Maria (UFSM), RS, Brasil
| | - Sydney Hartz Alves
- Programa de Pós-Graduação em Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brasil
| | - Letícia Cruz
- Programa de Pós-Graduação em Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brasil.
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Copsey AC, Barsottini MRO, May B, Xu F, Albury MS, Young L, Moore AL. Kinetic characterisation and inhibitor sensitivity of Candida albicans and Candida auris recombinant AOX expressed in a self-assembled proteoliposome system. Sci Rep 2021; 11:14748. [PMID: 34285303 PMCID: PMC8292455 DOI: 10.1038/s41598-021-94320-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 07/05/2021] [Indexed: 02/07/2023] Open
Abstract
Candidemia caused by Candida spp. is a serious threat in hospital settings being a major cause of acquired infection and death and a possible contributor to Covid-19 mortality. Candidemia incidence has been rising worldwide following increases in fungicide-resistant pathogens highlighting the need for more effective antifungal agents with novel modes of action. The membrane-bound enzyme alternative oxidase (AOX) promotes fungicide resistance and is absent in humans making it a desirable therapeutic target. However, the lipophilic nature of the AOX substrate (ubiquinol-10) has hindered its kinetic characterisation in physiologically-relevant conditions. Here, we present the purification and expression of recombinant AOXs from C. albicans and C. auris in a self-assembled proteoliposome (PL) system. Kinetic parameters (Km and Vmax) with respect to ubiquinol-10 have been determined. The PL system has also been employed in dose-response assays with novel AOX inhibitors. Such information is critical for the future development of novel treatments for Candidemia.
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Affiliation(s)
- Alice C Copsey
- Biochemistry and Biomedicine, School of Life Sciences, University of Sussex, Falmer, Brighton, BN1 9QG, UK
| | - Mario R O Barsottini
- Biochemistry and Biomedicine, School of Life Sciences, University of Sussex, Falmer, Brighton, BN1 9QG, UK
| | - Benjamin May
- Biochemistry and Biomedicine, School of Life Sciences, University of Sussex, Falmer, Brighton, BN1 9QG, UK
- Theradex (Europe) Ltd, 2nd Floor, The Pinnacle, Station Way, Crawley, RH10 1JH, UK
| | - Fei Xu
- Biochemistry and Biomedicine, School of Life Sciences, University of Sussex, Falmer, Brighton, BN1 9QG, UK
- Applied Biotechnology Center, Wuhan University of Bioengineering, Wuhan, China
| | - Mary S Albury
- Biochemistry and Biomedicine, School of Life Sciences, University of Sussex, Falmer, Brighton, BN1 9QG, UK
| | - Luke Young
- Biochemistry and Biomedicine, School of Life Sciences, University of Sussex, Falmer, Brighton, BN1 9QG, UK
| | - Anthony L Moore
- Biochemistry and Biomedicine, School of Life Sciences, University of Sussex, Falmer, Brighton, BN1 9QG, UK.
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Update 2016-2018 of the Nationwide Danish Fungaemia Surveillance Study: Epidemiologic Changes in a 15-Year Perspective. J Fungi (Basel) 2021; 7:jof7060491. [PMID: 34205349 PMCID: PMC8235436 DOI: 10.3390/jof7060491] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 01/11/2023] Open
Abstract
As part of a national surveillance programme initiated in 2004, fungal blood isolates from 2016–2018 underwent species identification and EUCAST susceptibility testing. The epidemiology was described and compared to data from previous years. In 2016–2018, 1454 unique isolates were included. The fungaemia rate was 8.13/100,000 inhabitants compared to 8.64, 9.03, and 8.38 in 2004–2007, 2008–2011, and 2012–2015, respectively. Half of the cases (52.8%) involved patients 60–79 years old and the incidence was highest in males ≥70 years old. Candida albicans accounted for 42.1% of all isolates and Candida glabrata for 32.1%. C. albicans was more frequent in males (p = 0.03) and C. glabrata in females (p = 0.03). During the four periods, the proportion of C. albicans decreased (p < 0.001), and C. glabrata increased (p < 0.001). Consequently, fluconazole susceptibility gradually decreased from 68.5% to 59.0% (p < 0.001). Acquired fluconazole resistance was found in 4.6% Candida isolates in 2016–2018. Acquired echinocandin resistance increased during the four periods 0.0%, 0.6%, 1.7% to 1.5% (p < 0.0001). Sixteen echinocandin-resistant isolates from 2016–2018 harboured well-known FKS resistance-mutations and one echinocandin-resistant C. albicans had an FKS mutation outside the hotspot (P1354P/S) of unknown importance. In C. glabrata specifically, echinocandin resistance was detected in 12/460 (2.6%) in 2016–2018 whereas multidrug-class resistance was rare (1/460 isolates (0.2%)). Since the increase in incidence during 2004–2011, the incidence has stabilised. In contrast, the species distribution has changed gradually over the 15 years, with increased C. glabrata at the expense of C. albicans. The consequent decreased fluconazole susceptibility and the emergence of acquired echinocandin resistance complicates the management of fungaemia and calls for antifungal drug development.
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Nishimoto AT, Sharma C, Rogers PD. Molecular and genetic basis of azole antifungal resistance in the opportunistic pathogenic fungus Candida albicans. J Antimicrob Chemother 2021; 75:257-270. [PMID: 31603213 DOI: 10.1093/jac/dkz400] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Candida albicans is an opportunistic yeast and the major human fungal pathogen in the USA, as well as in many other regions of the world. Infections with C. albicans can range from superficial mucosal and dermatological infections to life-threatening infections of the bloodstream and vital organs. The azole antifungals remain an important mainstay treatment of candidiasis and therefore the investigation and understanding of the evolution, frequency and mechanisms of azole resistance are vital to improving treatment strategies against this organism. Here the organism C. albicans and the genetic changes and molecular bases underlying the currently known resistance mechanisms to the azole antifungal class are reviewed, including up-regulated expression of efflux pumps, changes in the expression and amino acid composition of the azole target Erg11 and alterations to the organism's typical sterol biosynthesis pathways. Additionally, we update what is known about activating mutations in the zinc cluster transcription factor (ZCF) genes regulating many of these resistance mechanisms and review azole import as a potential contributor to azole resistance. Lastly, investigations of azole tolerance in C. albicans and its implicated clinical significance are reviewed.
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Affiliation(s)
- Andrew T Nishimoto
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Cheshta Sharma
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - P David Rogers
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
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7
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Computational Drug Repurposing Resources and Approaches for Discovering Novel Antifungal Drugs against Candida albicans N-Myristoyl Transferase. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2021. [DOI: 10.22207/jpam.15.2.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Candida albicans is a yeast that is an opportunistic fungal pathogen and also identified as ubiquitous polymorphic species that is mainly linked with major fungal infections in humans, particularly in the immunocompromised patients including transplant recipients, chemotherapy patients, HIV-infected patients as well as in low-birth-weight infants. Systemic Candida infections have a high mortality rate of around 29 to 76%. For reducing its infection, limited drugs are existing such as caspofungin, fluconazole, terbinafine, and amphotericin B, etc. which contain unlikable side effects and also toxic. This review intends to utilize advanced bioinformatics technologies such as Molecular docking, Scaffold hopping, Virtual screening, Pharmacophore modeling, Molecular dynamics (MD) simulation for the development of potentially new drug candidates with a drug-repurpose approach against Candida albicans within a limited time frame and also cost reductive.
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8
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Camp I, Spettel K, Willinger B. Molecular Methods for the Diagnosis of Invasive Candidiasis. J Fungi (Basel) 2020; 6:jof6030101. [PMID: 32640656 PMCID: PMC7558065 DOI: 10.3390/jof6030101] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 12/19/2022] Open
Abstract
Invasive infections caused by members of the genus Candida are on the rise. Especially patients in intensive care units, immunocompromised patients, and those recovering from abdominal surgery are at risk for the development of candidemia or deep-seated candidiasis. Rapid initiation of appropriate antifungal therapy can increase survival rates significantly. In the past, most of these infections were caused by C. albicans, a species that typically is very susceptible to antifungals. However, in recent years a shift towards infections caused by non-albicans species displaying various susceptibly patterns has been observed and the prompt diagnosis of the underlying species has become an essential factor determining the therapeutic outcome. The gold standard for diagnosing invasive candidiasis is blood culture, even though its sensitivity is low and the time required for species identification usually exceeds 48 h. To overcome these issues, blood culture can be combined with other methods, and a large number of tests have been developed for this purpose. The aim of this review was to give an overview on strengths and limitations of currently available molecular methods for the diagnosis of invasive candidiasis.
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Wahab AT, Ilyas Q, Farooq S, Javaid S, Ahmed S, Rahman AU, Choudhary MI. In-vitro and in-vivo anticandidal activity of Trachyspermum ammi (L.) sprague seeds ethanolic extract and thymol-containing hexanes fraction. Nat Prod Res 2020; 35:4833-4838. [DOI: 10.1080/14786419.2020.1731738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Atia-tul- Wahab
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center of Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Qibtiya Ilyas
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center of Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Saba Farooq
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center of Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Sumaira Javaid
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center of Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Shakil Ahmed
- Industrial Analytical Center, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Atta-ur- Rahman
- H. E. J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - M. Iqbal Choudhary
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center of Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
- Industrial Analytical Center, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
- H. E. J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
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Silva LN, de Mello TP, de Souza Ramos L, Branquinha MH, Dos Santos ALS. New and Promising Chemotherapeutics for Emerging Infections Involving Drug-resistant Non-albicans Candida Species. Curr Top Med Chem 2020; 19:2527-2553. [PMID: 31654512 DOI: 10.2174/1568026619666191025152412] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 02/13/2019] [Accepted: 02/16/2019] [Indexed: 02/06/2023]
Abstract
Fungal infections are a veritable public health problem worldwide. The increasing number of patient populations at risk (e.g. transplanted individuals, cancer patients, and HIV-infected people), as well as the use of antifungal agents for prophylaxis in medicine, have favored the emergence of previously rare or newly identified fungal species. Indeed, novel antifungal resistance patterns have been observed, including environmental sources and the emergence of simultaneous resistance to different antifungal classes, especially in Candida spp., which are known for the multidrug-resistance (MDR) profile. In order to circumvent this alarming scenario, the international researchers' community is engaged in discovering new, potent, and promising compounds to be used in a near future to treat resistant fungal infections in hospital settings on a global scale. In this context, many compounds with antifungal action from both natural and synthetic sources are currently under clinical development, including those that target either ergosterol or β(1,3)-D-glucan, presenting clear evidence of pharmacologic/pharmacokinetic advantages over currently available drugs against these two well-known fungal target structures. Among these are the tetrazoles VT-1129, VT-1161, and VT-1598, the echinocandin CD101, and the glucan synthase inhibitor SCY-078. In this review, we compiled the most recent antifungal compounds that are currently in clinical trials of development and described the potential outcomes against emerging and rare Candida species, with a focus on C. auris, C. dubliniensis, C. glabrata, C. guilliermondii, C. haemulonii, and C. rugosa. In addition to possibly overcoming the limitations of currently available antifungals, new investigational chemical agents that can enhance the classic antifungal activity, thereby reversing previously resistant phenotypes, were also highlighted. While novel and increasingly MDR non-albicans Candida species continue to emerge worldwide, novel strategies for rapid identification and treatment are needed to combat these life-threatening opportunistic fungal infections.
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Affiliation(s)
- Laura Nunes Silva
- Laboratorio de Estudos Avancados de Microrganismos Emergentes e Resistentes, Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Goes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thaís Pereira de Mello
- Laboratorio de Estudos Avancados de Microrganismos Emergentes e Resistentes, Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Goes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lívia de Souza Ramos
- Laboratorio de Estudos Avancados de Microrganismos Emergentes e Resistentes, Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Goes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marta Helena Branquinha
- Laboratorio de Estudos Avancados de Microrganismos Emergentes e Resistentes, Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Goes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - André Luis Souza Dos Santos
- Laboratorio de Estudos Avancados de Microrganismos Emergentes e Resistentes, Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Goes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Programa de Pós-Graduação em Bioquímica, Instituto de Química, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Barac A, Cevik M, Colovic N, Lekovic D, Stevanovic G, Micic J, Rubino S. Investigation of a healthcare-associated Candida tropicalis candidiasis cluster in a haematology unit and a systematic review of nosocomial outbreaks. Mycoses 2020; 63:326-333. [PMID: 31930592 DOI: 10.1111/myc.13048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 12/30/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Non-albicans Candida spp. are an emerging cause of hospital-acquired bloodstream infections, associated with high mortality due to the challenges in diagnosis and delayed treatment. OBJECTIVES We aimed to investigate a cluster of healthcare-associated invasive candidiasis caused by C tropicalis and review the literature of healthcare-associated outbreaks or clusters caused by C tropicalis. METHODS An investigation was performed to determine clinical presentation, treatment outcomes and the factors contributing to C tropicalis candidemia occurrence. We searched the Medline database via PubMed and Ovid using the keywords of "Candida tropicalis" combined with "outbreak" or "clustering" or "clusters," and we limited the search to studies conducted from January 1989 to January 2019. RESULTS We report two related cases of C tropicalis candidemia among patients with AML following a period of neutropenia, who had erythematous skin rash as a first manifesting sign of candidiasis. C tropicalis was isolated from blood and skin cultures of both patients, which were identical by pulsed-field gel electrophoresis typing. Our systematic review of outbreaks caused by C tropicalis suggests that (a) most reported outbreaks have occurred in neonatal and adult ICUs; (b) patients who receive total parenteral therapy, antibiotics and those who have indwelling catheters and recent surgery are at high risk of infection; and (c) environmental and healthcare personnel surveillance suggest that cross-contamination is a major risk factor. CONCLUSION Control of nosocomial outbreaks caused by C tropicalis should include better infection control measures, education of healthcare professionals especially working in adult and neonatal intensive care and haematology units.
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Affiliation(s)
- Aleksandra Barac
- Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Muge Cevik
- Division of Infection and Global Health Research, School of Medicine, University of St Andrews, St Andrews, UK.,NHS Lothian, Infection Service, Western General Hospital, Edinburgh, UK
| | - Natasa Colovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Haematology, Clinical Center of Serbia, Belgrade, Serbia
| | - Danijela Lekovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Haematology, Clinical Center of Serbia, Belgrade, Serbia
| | - Goran Stevanovic
- Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Micic
- Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia
| | - Salvatore Rubino
- Microbiology Unit, Department of Biomedical Science, University of Sassari, Sassari, Italy
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Faria DR, Sakita KM, Capoci IRG, Arita GS, Rodrigues-Vendramini FAV, de Oliveira Junior AG, Soares Felipe MS, Bonfim de Mendonça PDS, Svidzinski TIE, Kioshima ES. Promising antifungal activity of new oxadiazole against Candida krusei. PLoS One 2020; 15:e0227876. [PMID: 31935275 PMCID: PMC6959663 DOI: 10.1371/journal.pone.0227876] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/31/2019] [Indexed: 02/06/2023] Open
Abstract
Candida krusei is one of the most common agents of invasive candidiasis and candidemia worldwide, leading to high morbidity and mortality rates. This species has become a problem due to its intrinsic resistance and reduced susceptibility to azoles and polyenes. Moreover, the number of antifungal drugs available for candidiasis treatment is limited, demonstrating the urgent need for the discovery of novel alternative therapies. In this work, the in vivo and in vitro activities of a new oxadiazole (LMM11) were evaluated against C. krusei. The minimum inhibitory concentration ranged from 32 to 64 μg/mL with a significant reduction in the colony forming unit (CFU) count (~3 log10). LMM11 showed fungicidal effect, similar to amphotericin, reducing the viable cell number (>99.9%) in the time-kill curve. Yeast cells presented morphological alterations and inactive metabolism when treated with LMM11. This compound was also effective in decreasing C. krusei replication inside and outside macrophages. A synergistic effect between fluconazole and LMM11 was observed. In vivo treatment with the new oxadiazole led to a significant reduction in CFU (0.85 log10). Furthermore, histopathological analysis of the treated group exhibited a reduction in the inflammatory area. Taken together, these results indicate that LMM11 is a promising candidate for the development of a new antifungal agent for the treatment of infections caused by resistant Candida species such as C. krusei.
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Affiliation(s)
- Daniella Renata Faria
- Department of Clinical Analysis and Biomedicine, Laboratory of Medical Mycology, State University of Maringá, Maringá, Paraná, Brazil
| | - Karina Mayumi Sakita
- Department of Clinical Analysis and Biomedicine, Laboratory of Medical Mycology, State University of Maringá, Maringá, Paraná, Brazil
| | - Isis Regina Grenier Capoci
- Department of Clinical Analysis and Biomedicine, Laboratory of Medical Mycology, State University of Maringá, Maringá, Paraná, Brazil
| | - Glaucia Sayuri Arita
- Department of Clinical Analysis and Biomedicine, Laboratory of Medical Mycology, State University of Maringá, Maringá, Paraná, Brazil
| | | | | | - Maria Sueli Soares Felipe
- Department of Cell Biology, Laboratory of Molecular Biology, University of Brasília, Brasília, Distrito Federal, Brazil
| | | | | | - Erika Seki Kioshima
- Department of Clinical Analysis and Biomedicine, Laboratory of Medical Mycology, State University of Maringá, Maringá, Paraná, Brazil
- * E-mail:
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Yeast Engineering for New Antifungal Compounds: A Contextualized Overview. Fungal Biol 2020. [DOI: 10.1007/978-3-030-41870-0_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Mushi MF, Bader O, Bii C, Groß U, Mshana SE. Virulence and susceptibility patterns of clinical Candida spp. isolates from a tertiary hospital, Tanzania. Med Mycol 2019; 57:566-572. [PMID: 30380077 DOI: 10.1093/mmy/myy107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/12/2018] [Accepted: 10/05/2018] [Indexed: 12/17/2022] Open
Abstract
Despite the increased burden of human immunodeficiency virus (HIV) and other comobidities in developing countries, information regarding antifungal susceptibility patterns of Candida spp. and their virulence potential are still limited. Here, we report the virulence and antifungal susceptibility patterns of Candida spp. from varieties spectrum of candidiasis in a tertiary hospital, Tanzania. The study was conducted from March to December 2017. Candida spp. from clinical samples were characterized. Antifungal susceptibility patterns based on EUCAST guidelines and virulence activities (phospholipase, protease, hemolysin, and coagulase activity) were determined. A total of 399 Candida spp. isolates were obtained, of these, 278, 51 and 47 were C. albicans, C. tropicalis, and C. glabrata, respectively. Phospholipase 193/268, protease 32/51 and coagulase 25/47 were the most frequently detected virulence activities in C. albicans, C. tropicalis, and C. glabrata, respectively. Protease and phospholipase were frequently detected virulence activities from C. albicans from blood and esophageal brushes. The median zone diameter of protease activities was significantly larger among C. tropicalis than C. albicans. C. albicans, and C. tropicalis isolates were 100% sensitive to caspofungin. The proportions of C. albicans isolate resistant to fluconazole, voriconazole and posaconazole were 3.1, 3.6%, and 1.8%, respectively. In conclusion, the majority of Candida spp. isolates were sensitive to fluconazole. There are different phenotypes of C. albicans, C. glabrata and C. tropicalis based on susceptibility and virulence activities patterns, necessitating further molecular characterizations to place them in global perspective. Routine antifungal susceptibility testing to guide clinical therapy should be encouraged in developing countries.
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Affiliation(s)
- Martha F Mushi
- Department of Microbiology and immunology, Weill Bugando School of Medicine, Catholic University of Heath and Allied Sciences Mwanza, Tanzania
| | - Oliver Bader
- Institute of Medical Microbiology, University Medical Center Gottingen, Germany
| | - Christine Bii
- Kenya Medical Research Institute, Center for Microbiology Research
| | - Uwe Groß
- Institute of Medical Microbiology, University Medical Center Gottingen, Germany
| | - Stephen E Mshana
- Department of Microbiology and immunology, Weill Bugando School of Medicine, Catholic University of Heath and Allied Sciences Mwanza, Tanzania
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Modiri M, Khodavaisy S, Barac A, Akbari Dana M, Nazemi L, Aala F, Salehi M, Rezaie S. Comparison of biofilm-producing ability of clinical isolates of Candida parapsilosis species complex. J Mycol Med 2019; 29:140-146. [PMID: 30871787 DOI: 10.1016/j.mycmed.2019.02.003] [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: 12/13/2018] [Revised: 01/28/2019] [Accepted: 02/14/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Candida parapsilosis is one of the main emerging non-Candida albicans species leading to superficial and systemic fungal infections in humans. Candida has the ability to produce biofilms associated with pathogenesis. The aim of the study was to estimate biofilm-producing ability of clinical isolates of C. parapsilosis sp. complex. METHODS Clinical samples of C. parapsilosis complex have been analyzed. Crystal violet (CV) staining and tetrazolium reduction assay (MTT) have been used to analyze the clinical isolates ability to produce biofilms. The biofilm's structural characteristics have been assessed by using scanning electron microscopy. RESULTS All 65 isolates were able to form biofilm. In addition, no significant difference was found between biofilm quantification based on two assays at different time intervals (24h, 48h, 72h, 96h) (P>0.05), with the exception of Candida orthopsilosis, which exhibited higher metabolic activity at 24h time point (P<0.05). Moreover, metabolic activity and production of biofilm biomass demonstrated statistically significant correlation (r=0.685, P<0.01). According to microscopic observations, the investigated clinical strains formed the similar surface topography with the slight differences in morphology; in addition, there was no statistically significant difference between efficiency of two assays to quantify biofilm. CONCLUSION It was shown that, similar to C. parapsilosissensu stricto, two cryptic identified species (C. orthopsilosis and Candida metapsilosis) obtained from different clinical samples, were biofilm producers, while C. parapsilosissensu stricto exhibited the highest biofilm production.
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Affiliation(s)
- M Modiri
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - S Khodavaisy
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Zoonoses Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - A Barac
- Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - M Akbari Dana
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - L Nazemi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - F Aala
- Department of Medical Mycology and Parasitology, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - M Salehi
- Department of Infectious Diseases, School of Medicine, Tehran University of Medical Sciences, Imam Khomeini Hospital, Tehran, Iran
| | - S Rezaie
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Update from a 12-Year Nationwide Fungemia Surveillance: Increasing Intrinsic and Acquired Resistance Causes Concern. J Clin Microbiol 2018; 56:JCM.01564-17. [PMID: 29212705 DOI: 10.1128/jcm.01564-17] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 11/30/2017] [Indexed: 12/18/2022] Open
Abstract
New data from the years 2012 to 2015 from the Danish National Fungemia Surveillance are reported, and epidemiological trends are investigated in a 12-year perspective (2004 to 2015). During 2012 to 2015, 1,900 of 1,939 (98%) fungal bloodstream isolates were included. The average incidence was 8.4/100,000 inhabitants, and this appears to represent a stabilizing trend after the increase to 10.1/100,000 in 2011. The incidence was higher in males than females (10.0 versus 6.8) and in patients above 50 years, and those changes were mainly driven by an increasing incidence among 80-to-89-year-old males (65.3/100,000 in 2014 to 2015). The proportion of Candida albicans isolates decreased from 2004 to 2015 (64.4% to 42.4%) in parallel with a doubling of the proportion of Candida glabrata isolates (16.5% to 34.6%, P < 0.0001). C. glabrata was more common among females (34.0% versus 30.4% in males). Following an increase in 2004 to 2011, the annual drug use stabilized during the last 2 to 3 years of that time period but remained higher than in other Nordic countries. This was particularly true for the fluconazole and itraconazole use in the primary health care sector, which exceeded the combined national levels of use of these compounds in each of the other Nordic countries. Fluconazole susceptibility decreased (68.5%, 65.2%, and 60.6% in 2004 to 2007, 2008 to 2011, and 2012 to 2015, respectively, P < 0.0001), and echinocandin resistance emerged in Candida (0%, 0.6%, and 1.7%, respectively, P < 0.001). Amphotericin B susceptibility remained high (98.7%). Among 16 (2.7%) echinocandin-resistant C. glabrata isolates (2012 to 2015), 13 harbored FKS mutations and 5 (31%) were multidrug resistant. The epidemiological changes and the increased incidence of intrinsic and acquired resistance emphasize the importance of continued surveillance and of strengthened focus on antifungal stewardship.
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Macedo-Viñas M, Denning DW. Estimating the Burden of Serious Fungal Infections in Uruguay. J Fungi (Basel) 2018; 4:E37. [PMID: 29562641 PMCID: PMC5872340 DOI: 10.3390/jof4010037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 12/19/2022] Open
Abstract
We aimed to estimate for the first time the burden of fungal infections in Uruguay. Data on population characteristics and underlying conditions were extracted from the National Statistics Institute, the World Bank, national registries, and published articles. When no data existed, risk populations were used to estimate frequencies extrapolating from the literature. Population structure (inhabitants): total 3,444,006; 73% adults; 35% women younger than 50 years. Size of populations at risk (total cases per year): HIV infected 12,000; acute myeloid leukemia 126; hematopoietic stem cell transplantation 30; solid organ transplants 134; COPD 272,006; asthma in adults 223,431; cystic fibrosis in adults 48; tuberculosis 613; lung cancer 1400. Annual incidence estimations per 100,000: invasive aspergillosis, 22.4; candidemia, 16.4; Candida peritonitis, 3.7; Pneumocystis jirovecii pneumonia, 1.62; cryptococcosis, 0.75; severe asthma with fungal sensitization, 217; allergic bronchopulmonary aspergillosis, 165; recurrent Candida vaginitis, 6323; oral candidiasis, 74.5; and esophageal candidiasis, 25.7. Although some under and overestimations could have been made, we expect that at least 127,525 people suffer from serious fungal infections each year. Sporothrichosis, histoplasmosis, paracoccidioidomycosis, and dermatophytosis are known to be frequent but no data are available to make accurate estimations. Given the magnitude of the burden of fungal infections in Uruguay, efforts should be made to improve surveillance, strengthen laboratory diagnosis, and warrant access to first line antifungals.
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Affiliation(s)
- Marina Macedo-Viñas
- Sistema Nacional de Investigadores, Agencia Nacional de Investigación e Innovación, Montevideo 11500, Uruguay.
| | - David W Denning
- National Aspergillosis Centre, Wythenshawe Hospital and The University of Manchester, Manchester M13 9PL, UK.
- Leading International Fungal Education (LIFE), Cheshire SK10 9AR, UK.
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Ghaleb A, Aouidate A, Ghamali M, Sbai A, Bouachrine M, Lakhlifi T. 3D-QSAR modeling and molecular docking studies on a series of 2,5 disubstituted 1,3,4-oxadiazoles. J Mol Struct 2017. [DOI: 10.1016/j.molstruc.2017.05.065] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sony P, Kalyani M, Jeyakumari D, Kannan I, Sukumar RG. In vitro antifungal activity of cassia fistula extracts against fluconazole resistant strains of Candida species from HIV patients. J Mycol Med 2017; 28:193-200. [PMID: 28838629 DOI: 10.1016/j.mycmed.2017.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 07/31/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Candida species is the fourth common cause of blood stream infections all over the world which is life threatening. Invasive candidiasis leads to increased mortality and morbidity especially in immunosuppressed. The antifungal resistance pattern in high-risk patients is major concern. PURPOSE The present study was to access the anticandidal activity of leaves, bark and seeds of Cassia fistula against fluconazole resistant Candida species, C. albicans, C. glabrata, C. krusei, C. tropicalis, C. kefyr and C. parapsilosis isolated from HIV patients. The predominant phytochemical component responsible for fungicidal activity was to be accessed. MATERIAL AND METHODS Ethanol, chloroform, petroleum ether and aqueous extracts of leaves, bark and seeds of C. fistula linn. was evaluated against Microbial type culture collection (MTCC) Candida strains and 21 fluconazole resistant clinical isolates. Antifungal activity was evaluated by agar diffusion and broth dilution techniques. The active phytochemical component present in the ethanol extract of seeds was accessed by high performance thin layer chromatography. The docking study was done with lanosterol 14-alpha demethylase, the azole drug target with the predominant phytochemical from the extract having antifungal activity. RESULTS All the extracts of C. fistula showed excellent anticandidal activity. Ethanol extract of C. fistula seed exhibited the most inhibitory activity. C. krusei and C. parapsilosis were the most inhibited and C. kefyr was the least inhibited species. The predominant phytochemical active component of the ethanol extract of seed was gallic acid. Gallic acid showed excellent binding with lanosterol 14-alpha demethylase. CONCLUSION The present study reports the antifungal activity of various extracts of Cassia fistula for the first time against fluconazole resistant Candida isolates. We can conclude that the polyphenolic compound gallic acid is a potent natural antifungal agent. Further research is needed to assess the pharmacokinetic property.
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Affiliation(s)
- P Sony
- Department of microbiology, Tagore medical college and hospital, Melakottaiyur Street, 600127 Rathinamangalam, Chennai, Tamil Nadu, India.
| | - M Kalyani
- Department of microbiology, Saveetha medical college, 602105 Thandalam, Chennai, India
| | - D Jeyakumari
- Department of microbiology, Tagore medical college and hospital, Melakottaiyur Street, 600127 Rathinamangalam, Chennai, Tamil Nadu, India
| | - I Kannan
- Department of microbiology, Tagore medical college and hospital, Melakottaiyur Street, 600127 Rathinamangalam, Chennai, Tamil Nadu, India
| | - R G Sukumar
- Department of microbiology, Tagore medical college and hospital, Melakottaiyur Street, 600127 Rathinamangalam, Chennai, Tamil Nadu, India
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Lin L, Zhao CH, Yin XY, Chen YL, Zhai HY, Xu CW, Wang Y, Ge FJ, Xu JM. Aspergillus niger bloodstream infection in gastric cancer after common hepatic artery embolization: A case report. Exp Ther Med 2017; 14:1427-1432. [PMID: 28810606 PMCID: PMC5526131 DOI: 10.3892/etm.2017.4693] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 05/05/2017] [Indexed: 11/05/2022] Open
Abstract
The present case study reported on a 62-year-old male patient with gastric cancer-associated Aspergillus (A.) niger bloodstream infection. The patient presented with massive hemorrhage in the gastrointestinal tract 3 months after total gastrectomy for gastric cancer. Conservative treatment consisting of blood transfusion to supplement blood volume loss was ineffective. Digital subtraction angiography indicated gastroduodenal artery bleeding. The first attempt of performing arterial embolization using gelatin sponges failed, while the second attempt of performing common hepatic artery embolization using gelatin sponges and micro-coil springs stopped the bleeding. Four weeks after angiography, the patient presented with the complication of A. niger bloodstream infection, which was cured using intravenous and oral voriconazole. Clinicians should be aware of the possibility of A. niger bloodstream infection after invasive operations in immunocompromised patients and apply timely antifungal treatment.
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Affiliation(s)
- Li Lin
- Department of Gastrointestinal Oncology, Affiliated Hospital Cancer Center, Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - Chuan-Hua Zhao
- Department of Gastrointestinal Oncology, Affiliated Hospital Cancer Center, Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - Xiu-Yun Yin
- Department of Clinical Laboratory, Affiliated Hospital, Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - Yu-Ling Chen
- Department of Gastrointestinal Oncology, Affiliated Hospital Cancer Center, Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - Hong-Yan Zhai
- Department of Infection Control, Affiliated Hospital, Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - Chun-Wei Xu
- Department of Pathology, Affiliated Hospital, Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - Yan Wang
- Department of Gastrointestinal Oncology, Affiliated Hospital Cancer Center, Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - Fei-Jiao Ge
- Department of Gastrointestinal Oncology, Affiliated Hospital Cancer Center, Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - Jian-Ming Xu
- Department of Gastrointestinal Oncology, Affiliated Hospital Cancer Center, Academy of Military Medical Sciences, Beijing 100071, P.R. China
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Sarma S, Upadhyay S. Current perspective on emergence, diagnosis and drug resistance in Candida auris. Infect Drug Resist 2017; 10:155-165. [PMID: 28652784 PMCID: PMC5476417 DOI: 10.2147/idr.s116229] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Candida auris is an emerging fungus that presents a serious threat to global health. The organism is difficult to identify using conventional biochemical methods. C. auris has also attracted attention because of its reduced susceptibility to azoles, polyenes, and echinocandins, with a few strains even resistant to all three classes of antifungals. In this review paper we discuss the trends in emergence of C. auris in different parts of the world, associated risk factors, drug resistance, and diagnostic challenges. Strategies for prevention and therapeutic options for such infections is also addressed.
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Affiliation(s)
- Smita Sarma
- Department of Microbiology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Shalini Upadhyay
- Department of Microbiology, Medanta - The Medicity, Gurgaon, Haryana, India
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Datcu R, Boel J, Jensen IM, Arpi M. Comparison of BACTEC™ blood culture media for the detection of fungemia. Eur J Clin Microbiol Infect Dis 2016; 36:131-137. [PMID: 27677278 DOI: 10.1007/s10096-016-2781-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 09/05/2016] [Indexed: 02/05/2023]
Abstract
The aim of the present study was to investigate whether addition of the BACTEC™ Mycosis bottle to the standard BACTEC™ aerobic and anaerobic bottles contributed to a higher detection rate and a faster time to detection (TTD) of fungi. This was a retrospective cohort study of all patients with a positive blood culture with Candida species delivered to the Department of Clinical Microbiology, Herlev and Gentofte Hospital, Denmark in the 8-year period 2006 through 2014. The patients had at least one BACTEC™ aerobic and one Mycosis bottle sampled at the same time and at least one of the bottles yielded growth of fungi. Among 184 patients included, 173 were examined using BACTEC™ aerobic, anaerobic and Mycosis bottles. The anaerobic vial generally had the lowest detection rate and the longest TTD. The detection rate of BACTEC™ aerobic plus anaerobic with the BACTEC™ Mycosis bottle was significantly higher than the detection rate of BACTEC™ aerobic plus anaerobic without BACTEC™ Mycosis bottle for all species after 1-5 days, and specially for Candida glabrata at 2, 3, 4 and 5 days. TTD for C. glabrata was significantly shorter for BACTEC™ Mycosis than TTD for BACTEC™ aerobic or anaerobic bottles after ½ to 4 days. When combining "first or only" detection, the BACTEC™ Mycosis bottle had a significantly higher detection as compared to the aerobic bottle. Addition of the BACTEC™ Mycosis bottle to the standard BACTEC™ aerobic and anaerobic bottles significantly contributed to a higher detection rate and a faster TTD of fungemia.
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Affiliation(s)
- R Datcu
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark.
| | - J Boel
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - I M Jensen
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - M Arpi
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
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Mortensen KL, Denning DW, Arendrup MC. The burden of fungal disease in Denmark. Mycoses 2016; 58 Suppl 5:15-21. [PMID: 26449502 DOI: 10.1111/myc.12383] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/27/2015] [Accepted: 05/29/2015] [Indexed: 12/17/2022]
Abstract
The aim of this study is to calculate the burden of fungal disease in Denmark. We identified all published epidemiology papers reporting fungal infection rates in Denmark. Where no data existed, we used numbers of specific populations at risk and fungal infection frequencies in those populations to estimate national incidence or prevalence. Approximately, one in six Danes will suffer from a fungal infection each year, most of which are skin or mucosal diseases causing disability but no deaths. Good data exist on candidaemia where a national voluntary reporting system is in place and have shown a high rate (9.6 per 100,000 inhabitants) compared other European countries. We present estimates of invasive aspergillosis and chronic pulmonary aspergillosis with rates of 4.4 per 100,000 and 3.1 per 100,000 inhabitants, respectively. Further studies are needed in order to better ascertain high-burden fungal infections such as recurrent vulvovaginal candidiasis (~1350 cases in 100,000 women) as well as allergic bronchopulmonary aspergillosis (~131 cases in 100,000 inhabitants) and severe asthma with fungal sensitisation (cases in 100,000 inhabitants). In conclusion, more than 93,000 Danes or about 2% of Denmark's population will have a non-trivial fungal infection during 1 year, which underscores the magnitude of the fungal burden.
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Affiliation(s)
- Klaus L Mortensen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - David W Denning
- The University of Manchester, Manchester Academic Health Science Centre and National Aspergillosis Centre, University Hospital of South Manchester, Manchester, UK
| | - Maiken C Arendrup
- Unit of Mycology, Department Microbiology & Infection Control, Statens Serum Institut, Copenhagen, Denmark
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Mohammadi R, Ataei B. Candidiasis in Pediatrics; Identification and In vitro Antifungal Susceptibility of the Clinical Isolates. IRANIAN JOURNAL OF PEDIATRIC HEMATOLOGY AND ONCOLOGY 2016; 6:43-51. [PMID: 27222702 PMCID: PMC4867171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 10/12/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Candida species are normal microflora of oral cavity, vagina, and gastrointestinal tract. They are the third most prevalent cause of pediatric health care-associated bloodstream fungal infection. This study aimed to provide an epidemiological feature of candidiasis and also presents an antifungal susceptibility profile of clinical Candida isolates among children. MATERIALS AND METHODS During July 2013 to February 2015, 105 patients from different hospitals of Isfahan, Iran, were examined for candidiasis by phenotypic tests. Samples were obtained from nail clippings, blood, thrush, BAL, urine, oropharynx, skin, and eye discharge. The age range of patients was between 18 days to 16 years. Genomic DNA of isolates was extracted and ITS1-5.8SrDNA-ITS2 region was amplified by ITS1 and ITS2 primers. The PCR products were digested using the restriction enzyme MspI. Minimum inhibitory concentration (MICs) was determined using microdilution broth method according to the clinical and laboratory standards institute (CLSI) M27-A3 and M27-S4 documents. RESULTS Forty-three patients (40.9%) had Candida infection.The most clinical strains were isolated from nail infections (39.5%), and candidemia (13.9%). Candida albicans was the most prevalent species (46.5%). MICs ranges for amphotericin B, fluconazole, and itraconazole were (0.025-0.75 µg/ml), (0.125-16 µg/ml), and (0.094-2 µg/ml), respectively. CONCLUSION Due to high incidence of Candida infections among children, increasing of fatal infection like candidemia, and emersion of antifungal resistance Candida isolates, early and precise identification of the Candida species and determination of antifungal susceptibility patterns of clinical isolates may lead to better management of the infection.
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Affiliation(s)
- R Mohammadi
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - B Ataei
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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Singh U, Bukhari MN, Anayutullah S, Alam H, Manzoor N, Hashmi AA. Synthesis, Characterization and Biological Evaluation of Metal Complexes with Water-Soluble Macromolecular Dendritic Ligand. Pharm Chem J 2016. [DOI: 10.1007/s11094-016-1387-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abadio AKR, Kioshima ES, Leroux V, Martins NF, Maigret B, Felipe MSS. Identification of New Antifungal Compounds Targeting Thioredoxin Reductase of Paracoccidioides Genus. PLoS One 2015; 10:e0142926. [PMID: 26569405 PMCID: PMC4646694 DOI: 10.1371/journal.pone.0142926] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 10/28/2015] [Indexed: 11/27/2022] Open
Abstract
The prevalence of invasive fungal infections worldwide has increased in the last decades. The development of specific drugs targeting pathogenic fungi without producing collateral damage to mammalian cells is a daunting pharmacological challenge. Indeed, many of the toxicities and drug interactions observed with contemporary antifungal therapies can be attributed to “nonselective” interactions with enzymes or cell membrane systems found in mammalian host cells. A computer-aided screening strategy against the TRR1 protein of Paracoccidioides lutzii is presented here. Initially, a bank of commercially available compounds from Life Chemicals provider was docked to model by virtual screening simulations. The small molecules that interact with the model were ranked and, among the best hits, twelve compounds out of 3,000 commercially-available candidates were selected. These molecules were synthesized for validation and in vitro antifungal activity assays for Paracoccidioides lutzii and P. brasiliensis were performed. From 12 molecules tested, 3 harbor inhibitory activity in antifungal assays against the two pathogenic fungi. Corroborating these findings, the molecules have inhibitory activity against the purified recombinant enzyme TRR1 in biochemical assays. Therefore, a rational combination of molecular modeling simulations and virtual screening of new drugs has provided a cost-effective solution to an early-stage medicinal challenge. These results provide a promising technique to the development of new and innovative drugs.
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Affiliation(s)
| | - Erika Seki Kioshima
- Department of Clinical Analysis and Biomedicine, State University of Maringá, Maringá, Paraná, Brazil
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Marty M, Bourrat E, Vaysse F, Bonner M, Bailleul-Forestier I. Direct Microscopy: A Useful Tool to Diagnose Oral Candidiasis in Children and Adolescents. Mycopathologia 2015; 180:373-7. [PMID: 26329143 DOI: 10.1007/s11046-015-9933-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 08/24/2015] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Oral candidiasis is one of the most common opportunistic fungal infections of the oral cavity in human. Among children, this condition represents one of the most frequent affecting the mucosa. Although most diagnoses are made based on clinical signs and features, a microbiological analysis is sometimes necessary. We performed a literature review on the diagnosis of oral candidiasis to identify the techniques most commonly employed in routine clinical practice. MATERIALS AND METHODS A Medline-PubMed search covering the last 10 years was performed. RESULTS Microbiological techniques were used in cases requiring confirmation of the clinical diagnosis. In such cases, direct microscopy was the method most commonly used for diagnosing candidiasis. CONCLUSION Direct microscopy appears as the method of choice for confirming clinical diagnosis and could become a routine chair-side technique.
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Affiliation(s)
- Mathieu Marty
- Department of Pediatric Dentistry, Toulouse Dental School, University of Toulouse III, Toulouse, France.
| | | | - Frédéric Vaysse
- Department of Pediatric Dentistry, Toulouse Dental School, University of Toulouse III, Toulouse, France
| | - Mark Bonner
- International Institute of Periodontology, Nice, France
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Ng KP, Kuan CS, Kaur H, Na SL, Atiya N, Velayuthan RD. Candida species epidemiology 2000-2013: a laboratory-based report. Trop Med Int Health 2015. [PMID: 26216479 DOI: 10.1111/tmi.12577] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe a prospective laboratory-based surveillance of Candida species that were collected from different anatomical sites of patients admitted to the University of Malaya Medical Centre, Malaysia, from the year 2000 to 2013. METHODS Conventional (culture, microscopic examination and carbohydrate assimilation test) and molecular (PCR amplification and DNA sequencing) techniques were used to identify Candida species. RESULTS A total of 16 Candida species isolated from 34 392 clinical samples were from the oral cavity (oral swabs and throat swabs), blood, respiratory tract (sputum, tracheal secretions, nasopharyngeal aspirates, bronchoalveolar lavage), high vaginal swab, pus and urine. C. albicans (66.70%, 22 941/34 392), C. glabrata (11.71%, 4029/34 392), C. parapsilopsis (10.74%, 3692/34 392), C. tropicalis (9.19%, 3162/34 392) and C. krusei (1.15%, 396/34 392) were the five predominant Candida species. C. albicans was the predominant species isolated from the oral cavity, respiratory tract and high vaginal swab; while the Candida species isolated from blood, urine and pus were predominant non-albicans Candida. Uncommon Candida species, such as C. lusitaniae, C. haemulonii, C. humicola, Pichia ohmeri and C. ciferrii, were also isolated in this study. CONCLUSION Our study expands the current knowledge of the epidemiology of non-invasive and invasive candidiasis in Malaysia. The variability of the Candida species distribution from different anatomical sites highlights the significance of local epidemiology in disease management and selection of antifungal agents.
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Affiliation(s)
- Kee Peng Ng
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Sian Kuan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Harvinder Kaur
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shiang Ling Na
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nadia Atiya
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Rukumani Devi Velayuthan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Hesstvedt L, Gaustad P, Andersen CT, Haarr E, Hannula R, Haukland HH, Hermansen NO, Larssen KW, Mylvaganam H, Ranheim TE, Sandven P, Nordøy I, Kanestrøm A, Grub C, Onken A, Thielsen C, Skaare D, Tofteland S, Sønsteby LJ, Hjetland R, Hide R, Vik E, Kümmel A, Åsheim S. Twenty-two years of candidaemia surveillance: results from a Norwegian national study. Clin Microbiol Infect 2015; 21:938-45. [PMID: 26093076 DOI: 10.1016/j.cmi.2015.06.008] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 06/04/2015] [Accepted: 06/06/2015] [Indexed: 01/10/2023]
Abstract
Several studies have reported an increased incidence of candidaemia and a redistribution of species, with a decrease in the number of Candida albicans isolates. In Norway, a prospective, national surveillance study of candidaemia has been ongoing since 1991. Data from the period 1991-2003 have been published previously. The aim of this study was to follow up the incidence, species distribution and antifungal susceptibility of Candida species isolates from blood cultures in the period 2004-2012, and compare them with the corresponding findings from the period 1991-2003. Blood culture isolates of Candida species from all medical microbiological laboratories in Norway were identified and susceptibility tested at the Norwegian Mycological Reference Laboratory. A total of 1724 isolates were recovered from 1653 patients in the period 2004-2012. Comparison of the two periods showed that the average incidence of candidaemia episodes per 100 000 inhabitants increased from 2.4 (1991-2003) to 3.9 (2004-2012). The increase in incidence in the latter period was significantly higher in patients aged >40 years (p 0.001), and a marked increase was observed in patients aged >60 years (p < 0.001). In conclusion, the average incidence in Norway over a period of 22 years modestly increased from 2.4 to 3.9 per 100,000 inhabitants, this being mainly accounted for by candidaemia in the elderly. The species distribution was stable, and the rate of acquired resistance was low.
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Affiliation(s)
- L Hesstvedt
- Department of Microbiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Research Institute for Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | - P Gaustad
- Department of Microbiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - C T Andersen
- Department of Microbiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - E Haarr
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
| | - R Hannula
- Department of Infectious Diseases, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Microbiology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - H H Haukland
- Department of Microbiology, University Hospital of Northern Norway, Tromsø, Norway
| | - N-O Hermansen
- Department of Microbiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - K W Larssen
- Department of Microbiology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - H Mylvaganam
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - T E Ranheim
- Department of Microbiology, Akershus University Hospital, Lørenskog, Norway
| | - P Sandven
- Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway
| | - I Nordøy
- Research Institute for Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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Population-based epidemiology and microbiology of community-onset bloodstream infections. Clin Microbiol Rev 2015; 27:647-64. [PMID: 25278570 DOI: 10.1128/cmr.00002-14] [Citation(s) in RCA: 189] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Bloodstream infection (BSI) is a major cause of infectious disease morbidity and mortality worldwide. While a positive blood culture is mandatory for establishment of the presence of a BSI, there are a number of determinants that must be considered for establishment of this entity. Community-onset BSIs are those that occur in outpatients or are first identified <48 h after admission to hospital, and they may be subclassified further as health care associated, when they occur in patients with significant prior health care exposure, or community associated, in other cases. The most common causes of community-onset BSI include Escherichia coli, Staphylococcus aureus, and Streptococcus pneumoniae. Antimicrobial-resistant organisms, including methicillin-resistant Staphylococcus aureus and extended-spectrum β-lactamase/metallo-β-lactamase/carbapenemase-producing Enterobacteriaceae, have emerged as important etiologies of community-onset BSI.
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Sow D, Fall B, Ndiaye M, Ba BS, Sylla K, Tine R, Lô AC, Abiola A, Wade B, Dieng T, Dieng Y, Ndiaye JL, Hennequin C, Gaye O, Faye B. Usefulness of MALDI-TOF Mass Spectrometry for Routine Identification of Candida Species in a Resource-Poor Setting. Mycopathologia 2015; 180:173-9. [DOI: 10.1007/s11046-015-9905-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
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Garcia-Cuesta C, Sarrion-Pérez MG, Bagán JV. Current treatment of oral candidiasis: A literature review. J Clin Exp Dent 2014; 6:e576-82. [PMID: 25674329 PMCID: PMC4312689 DOI: 10.4317/jced.51798] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 07/26/2014] [Indexed: 12/29/2022] Open
Abstract
Candidiasis or oral candidosis is one of the most common human opportunistic fungal infections of the oral cavity. This pathology has a wide variety of treatment which has been studied until these days. The present study offers a literature review on the treatment of oral candidiasis, with the purpose of establish which treatment is the most suitable in each case. Searching the 24 latest articles about treatment of candidiasis it concluded that the incidence depends on the type of the candidiasis and the virulence of the infection. Although nystatin and amphotericin b were the most drugs used locally, fluconazole oral suspension is proving to be a very effective drug in the treatment of oral candidiasis. Fluconazole was found to be the drug of choice as a systemic treatment of oral candidiasis. Due to its good antifungal properties, its high acceptance of the patient and its efficacy compared with other antifungal drugs. But this drug is not always effective, so we need to evaluate and distinguish others like itraconazole or ketoconazole, in that cases when Candida strains resist to fluconazole.
Key words:Candidiasis, treatment, miconazole, fluconazole, nystatin.
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Affiliation(s)
| | | | - Jose V Bagán
- Chairman of Oral Medicine. Oral Medicine Unit. Department of Stomatology. University of Valencia. Head of the Department of Stomatology and Maxilofacial Surgery. Valencia University General Hospital
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Wang L, Tong Z, Wang Z, Xu L, Wu Y, Liu Y, Wu L. Single-center retrospective study of the incidence of, and risk factors for, non-C. albicans invasive candidiasis in hospitalized patients in China. Med Mycol 2014; 52:115-22. [PMID: 24626056 DOI: 10.3109/13693786.2013.805441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aims of this study were to establish the incidence of invasive candidiasis (IC) in a Beijing hospital, to identify risk factors associated with IC caused by non-C. albicans Candida (NAC), and to determine risk factors for infection caused by NAC species not susceptible to fluconazole. Clinical data from 141 patients admitted to Beijing Chaoyang Hospital (from 2001-2010) diagnosed with IC were retrospectively analyzed. The incidence of IC increased during the 10-year period, but the proportion due to NAC did not change significantly in that of 141 cases, 55 (39%) were due to NAC and 86 (61%) to C. albicans (CA). The NAC species isolated included C. tropicalis (25 of 141, 18%), C. glabrata (14 of 141, 9.9%), C. parapsilosis (eight of 141, 5.7%), C. krusei (three of 141, 2.1%) and C. lusitaniae (one of 141, 0.71%); other Candida species accounted for four of the 141 cases (2.8%). Twenty-one isolates (38%) of NAC were not susceptible to fluconazole. Total parenteral nutrition (TPN) (OR 4.2; 95% CI 3.5-58; P < 0.001) and previous fluconazole therapy (OR 7.7; 95% CI 2.2-27; P = 0.001) were risk factors for invasive NAC candidiasis, whereas patient age ≥65 years (OR 0.37; CI 0.16-0.88; P = 0.025) and invasive mechanical ventilation (OR 0.22; CI 0.069-0.70; P =0.010) were connected with invasive CA candidiasis. Prior fluconazole therapy was a risk factor (P = 0.007) for infections caused by NAC not susceptible to fluconazole. In conclusion, TPN and prior fluconazole therapy are independent risk factors for NAC infection, while prior fluconazole therapy is a risk factor for infection due to NAC not susceptible to fluconazole.
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Affiliation(s)
- Ling Wang
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Rodrigues ME, Silva S, Azeredo J, Henriques M. Novel strategies to fight Candida species infection. Crit Rev Microbiol 2014; 42:594-606. [PMID: 25383647 DOI: 10.3109/1040841x.2014.974500] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In recent years, there has been a significant increase in the incidence of human fungal infections. The increase in cases of infection caused by Candida species, and the consequent excessive use of antimicrobials, has favored the emergence of resistance to conventional antifungal agents over the past decades. Consequently, Candida infections morbidity and mortality are also increasing. Therefore, new approaches are needed to improve the outcome of patients suffering from Candida infections, because it seems unlikely that the established standard treatments will drastically lower the morbidity of mucocutaneous Candida infections and the high mortality associated with invasive candidiasis. This review aims to present the last advances in the traditional antifungal therapy, and present an overview of novel strategies that are being explored for the treatment of Candida infections, with a special focus on combined antifungal agents, antifungal therapies with alternative compounds (plant extracts and essential oils), adjuvant immunotherapy, photodynamic therapy and laser therapy.
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Affiliation(s)
- Maria Elisa Rodrigues
- a CEB -- Centre of Biological Engineering, LIBRO -- Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho , Braga , Portugal
| | - Sónia Silva
- a CEB -- Centre of Biological Engineering, LIBRO -- Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho , Braga , Portugal
| | - Joana Azeredo
- a CEB -- Centre of Biological Engineering, LIBRO -- Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho , Braga , Portugal
| | - Mariana Henriques
- a CEB -- Centre of Biological Engineering, LIBRO -- Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho , Braga , Portugal
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Gedik H, Simşek F, Kantürk A, Yildirmak T, Arica D, Aydin D, Demirel N, Yokuş O. Bloodstream infections in patients with hematological malignancies: which is more fatal - cancer or resistant pathogens? Ther Clin Risk Manag 2014; 10:743-52. [PMID: 25258539 PMCID: PMC4172031 DOI: 10.2147/tcrm.s68450] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The primary objective of this study was to report the incidence of bloodstream infections (BSIs) and clinically or microbiologically proven bacterial or fungal BSIs during neutropenic episodes in patients with hematological malignancies. Methods In this retrospective observational study, all patients in the hematology department older than 14 years who developed febrile neutropenia during chemotherapy for hematological cancers were evaluated. Patients were included if they had experienced at least one neutropenic episode between November 2010 and November 2012 due to chemotherapy in the hematology ward. Results During 282 febrile episodes in 126 patients, 66 (23%) episodes of bacteremia and 24 (8%) episodes of fungemia were recorded in 48 (38%) and 18 (14%) patients, respectively. Gram-negative bacteria caused 74% (n=49) of all bacteremic episodes. Carbapenem-resistant Gram-negative bacteria (n=6) caused 12% and 9% of Gram-negative bacteremia episodes and all bacteremia episodes, respectively. Carbapenem-resistant Gram-negative bacteria included Acinetobacter baumannii (n=4), Pseudomonas aeruginosa (n=1), and Serratia marcescens (n=1). Culture-proven invasive fungal infection occurred in 24 episodes in 18 cases during the study period, with 15 episodes in ten cases occurring in the first study year and nine episodes in eight cases in the second study year. In 13 of 18 cases (72%) with bloodstream yeast infections, previous azole exposure was recorded. Candida parapsilosis, C. glabrata, and C. albicans isolates were resistant to voriconazole and fluconazole. Conclusion BSIs that occur during febrile neutropenic episodes in hematology patients due to Gram-negative bacteria should be treated initially with non-carbapenem-based antipseudomonal therapy taking into consideration antimicrobial stewardship. Non-azole antifungal drugs, including caspofungin and liposomal amphotericin B, should be preferred as empirical antifungal therapy in the events of possible or probable invasive fungal infections with an absence of pulmonary findings due to increase azole resistance.
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Affiliation(s)
- Habip Gedik
- Department of Infectious Diseases and Clinical Microbiology, Ministry of Health Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Funda Simşek
- Department of Infectious Diseases and Clinical Microbiology, Ministry of Health Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Arzu Kantürk
- Department of Infectious Diseases and Clinical Microbiology, Ministry of Health Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Taner Yildirmak
- Department of Infectious Diseases and Clinical Microbiology, Ministry of Health Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Deniz Arica
- Department of Hematology, Ministry of Health Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Demet Aydin
- Department of Hematology, Ministry of Health Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Naciye Demirel
- Department of Hematology, Ministry of Health Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Osman Yokuş
- Department of Hematology, Ministry of Health Okmeydanı Training and Research Hospital, Istanbul, Turkey
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Alcazar-Fuoli L, Mellado E. Current status of antifungal resistance and its impact on clinical practice. Br J Haematol 2014; 166:471-84. [PMID: 24749533 DOI: 10.1111/bjh.12896] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/17/2014] [Indexed: 11/30/2022]
Abstract
Mortality linked to invasive fungal diseases remains very high despite the availability of novel antifungals and new therapeutic strategies. Candida albicans and Aspergillus fumigatus account for most invasive mycosis produced by yeast or moulds, respectively. Other Candida non-albicans are increasingly being reported and newly emerging, as well as cryptic, filamentous fungi often cause disseminated infections in immunocompromised hosts. Management of invasive fungal infections is becoming a challenge as emerging fungal pathogens generally show poor response to many antifungals. The ability of reference antifungal susceptibility testing methods to detect emerging resistance patterns, together with the molecular characterization of antifungal resistance mechanisms, are providing useful information to optimize the effectiveness of antifungal therapy. The current status of antifungal resistance epidemiology with special emphasis on the molecular resistant mechanisms that have been described in the main pathogenic fungal species are reviewed.
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Affiliation(s)
- Laura Alcazar-Fuoli
- Mycology Reference Laboratory, Centro Nacional de Microbiologia, Instituto de Salud Carlos III, Madrid, Spain
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38
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Guinea J. Global trends in the distribution of Candida species causing candidemia. Clin Microbiol Infect 2014; 20 Suppl 6:5-10. [PMID: 24506442 DOI: 10.1111/1469-0691.12539] [Citation(s) in RCA: 421] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Only five species account for 92% of cases of candidemia (Candida albicans, C. glabrata, C. tropicalis, C. parapsilosis, and C. krusei); however, their distribution varies in population-based studies conducted in different geographical areas. C. albicans is the most frequent species, but considerable differences are found between the number of cases caused by C. glabrata and C. parapsilosis. Studies from Northern Europe and the USA reported a high number of cases caused by C. glabrata, whereas studies from Spain and Brazil demonstrated a lower number of cases caused by C. glabrata and a higher number of cases attributed to C. parapsilosis. Globally, the frequency of C. albicans is decreasing, while that of C. glabrata and C. krusei is stable, and C. parapsilosis and C. tropicalis are increasing. Patient characteristics and prior antifungal therapy also have a considerable influence on the distribution and frequency of Candida spp., regardless of the geographical area. C. albicans is more frequent in patients aged up to 18 years, the frequency of C. parapsilosis decreases with age, and C. glabrata is more common in the elderly. Finally, the presence of horizontal transmission of Candida spp. isolates (reported mainly in patients from the adult medical and post-surgical ICU, patients from oncology-haematology units, and neonates) can affect species distribution.
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Affiliation(s)
- J Guinea
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBER RES CB06/06/0058), Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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Echinocandins in the treatment of candidaemia and invasive candidiasis: clinical and economic perspectives. Int J Antimicrob Agents 2014; 43:207-14. [DOI: 10.1016/j.ijantimicag.2013.08.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 08/23/2013] [Indexed: 12/29/2022]
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Orasch C, Marchetti O, Garbino J, Schrenzel J, Zimmerli S, Mühlethaler K, Pfyffer G, Ruef C, Fehr J, Zbinden R, Calandra T, Bille J. Candida species distribution and antifungal susceptibility testing according to European Committee on Antimicrobial Susceptibility Testing and new vs. old Clinical and Laboratory Standards Institute clinical breakpoints: a 6-year prospective candidaemia survey from the fungal infection network of Switzerland. Clin Microbiol Infect 2013; 20:698-705. [PMID: 24188136 DOI: 10.1111/1469-0691.12440] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 10/28/2013] [Accepted: 10/29/2013] [Indexed: 12/01/2022]
Abstract
We analyzed the species distribution of Candida blood isolates (CBIs), prospectively collected between 2004 and 2009 within FUNGINOS, and compared their antifungal susceptibility according to clinical breakpoints defined by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) in 2013, and the Clinical and Laboratory Standards Institute (CLSI) in 2008 (old CLSI breakpoints) and 2012 (new CLSI breakpoints). CBIs were tested for susceptiblity to fluconazole, voriconazole and caspofungin by microtitre broth dilution (Sensititre® YeastOne™ test panel). Of 1090 CBIs, 675 (61.9%) were C. albicans, 191 (17.5%) C. glabrata, 64 (5.9%) C. tropicalis, 59 (5.4%) C. parapsilosis, 33 (3%) C. dubliniensis, 22 (2%) C. krusei and 46 (4.2%) rare Candida species. Independently of the breakpoints applied, C. albicans was almost uniformly (>98%) susceptible to all three antifungal agents. In contrast, the proportions of fluconazole- and voriconazole-susceptible C. tropicalis and F-susceptible C. parapsilosis were lower according to EUCAST/new CLSI breakpoints than to the old CLSI breakpoints. For caspofungin, non-susceptibility occurred mainly in C. krusei (63.3%) and C. glabrata (9.4%). Nine isolates (five C. tropicalis, three C. albicans and one C. parapsilosis) were cross-resistant to azoles according to EUCAST breakpoints, compared with three isolates (two C. albicans and one C. tropicalis) according to new and two (2 C. albicans) according to old CLSI breakpoints. Four species (C. albicans, C. glabrata, C. tropicalis and C. parapsilosis) represented >90% of all CBIs. In vitro resistance to fluconazole, voriconazole and caspofungin was rare among C. albicans, but an increase of non-susceptibile isolates was observed among C. tropicalis/C. parapsilosis for the azoles and C. glabrata/C. krusei for caspofungin according to EUCAST and new CLSI breakpoints compared with old CLSI breakpoints.
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Affiliation(s)
- C Orasch
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
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Maly J, Szarszoi O, Netuka I, Dorazilova Z, Pirk J. Fungal infections associated with long-term mechanical circulatory support-diagnosis and management. J Card Surg 2013; 29:95-100. [PMID: 24279890 DOI: 10.1111/jocs.12258] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Left ventricular assist devices (LVADs) are increasingly used as a treatment option for advanced heart failure. Fungal infections present a serious concern given the high association with major adverse events including death in this group of patients. The objective of this review is to summarize the incidence, risk factors, method for diagnosis, complication rate, and outcomes in patients with VADs who develop fungal infections.
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Affiliation(s)
- Jiri Maly
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; Department of Cardiovascular Surgery, Second Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
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Quindós G. Epidemiology of candidaemia and invasive candidiasis. A changing face. Rev Iberoam Micol 2013; 31:42-8. [PMID: 24270071 DOI: 10.1016/j.riam.2013.10.001] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/09/2013] [Accepted: 10/01/2013] [Indexed: 12/11/2022] Open
Abstract
Invasive candidiasis is a leading cause of mortality. Candidaemia is the most common clinical presentation of invasive candidiasis but more that 30% of these infections do not yield positive blood cultures. Candida albicans remains the predominant aetiology, accounting for 50% of all cases. However, there has been an epidemiological shift in the last decades. Some species of Candida different to C. albicans have emerged as an important cause of severe candidaemia as they can exhibit resistance to fluconazole and other antifungal agents. Moreover, there is a different distribution of non C. albicans Candida species in relationship to patients' and hospital characteristics. Thus, Candida parapsilosis has been associated to candidaemia in neonates and young adults. This species usually has an exogenously origin and contaminates medical devices, causing central venous catheter-associated candidaemias. Candida glabrata, Candida tropicalis and Candida krusei are isolated in blood cultures from older patients (>65 years) with important risk factors, such as major abdominal surgery, solid tumours and haematologic malignancies, transplants, and/or prolonged treatment with corticoids. Moreover, important geographical differences in the distribution of the Candida species different to C. albicans causing invasive candidiasis have been reported: C. parapsilosis predominates in Australia, Latin America and Mediterranean countries of Africa, Asia and Europe. In contrast, C. glabrata has an important aetiological role in USA and Central and Northern Europe. Finally, an important and worrying issue is that mortality due to invasive candidiasis remains unacceptably high. This manuscript is part of the series of works presented at the "V International Workshop: Molecular genetic approaches to the study of human pathogenic fungi" (Oaxaca, Mexico, 2012).
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Affiliation(s)
- Guillermo Quindós
- Departamento de Inmunología, Microbiología y Parasitología, UFI11/25 (Microbios y Salud), Facultad de Medicina y Odontología, Universidad del País Vasco/Euskal Herriko Unibertsitatea, Bilbao, Spain.
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Flevari A, Theodorakopoulou M, Velegraki A, Armaganidis A, Dimopoulos G. Treatment of invasive candidiasis in the elderly: a review. Clin Interv Aging 2013; 8:1199-208. [PMID: 24043935 PMCID: PMC3772869 DOI: 10.2147/cia.s39120] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Fungi are major causes of infections among immunocompromised or hospitalized patients with serious underlying diseases and comorbidities. Candida species remain the most important cause of opportunistic infections worldwide, affecting predominantly patients over 65 years old, while they are considered to be the fourth most common cause of nosocomial bloodstream infections. The rapidly growing elderly population has specific physiological characteristics, which makes it susceptible to colonization and subsequent infection due to Candida species. Comorbidities and multidrug use should be taken into account any time the therapeutic regimen is under consideration. Different classes of antifungal drugs are available for the treatment of invasive fungal infections but echinocandins, apart from their activity against resistant strains (Candida glabrata and Candida krusei), seem to be safe, with limited adverse events and minimal drug-drug interactions in comparison to the other regimens. Therefore, these agents are strongly recommended when dealing with elderly patients suffering from an invasive form of Candida infection.
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Affiliation(s)
- Aikaterini Flevari
- Department of Critical Care, University Hospital Attikon, Medical School, Athens, Greece
| | - Maria Theodorakopoulou
- Department of Critical Care, University Hospital Attikon, Medical School, Athens, Greece
| | - Aristea Velegraki
- Mycology Laboratory, Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | - Apostolos Armaganidis
- Department of Critical Care, University Hospital Attikon, Medical School, Athens, Greece
| | - George Dimopoulos
- Department of Critical Care, University Hospital Attikon, Medical School, Athens, Greece
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Arendrup M, Dzajic E, Jensen R, Johansen H, Kjaldgaard P, Knudsen J, Kristensen L, Leitz C, Lemming L, Nielsen L, Olesen B, Rosenvinge F, Røder B, Schønheyder H. Epidemiological changes with potential implication for antifungal prescription recommendations for fungaemia: data from a nationwide fungaemia surveillance programme. Clin Microbiol Infect 2013; 19:E343-53. [DOI: 10.1111/1469-0691.12212] [Citation(s) in RCA: 157] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 01/24/2013] [Accepted: 02/24/2013] [Indexed: 01/18/2023]
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Brown GD, Denning DW, Gow NAR, Levitz SM, Netea MG, White TC. Hidden killers: human fungal infections. Sci Transl Med 2013; 4:165rv13. [PMID: 23253612 DOI: 10.1126/scitranslmed.3004404] [Citation(s) in RCA: 2741] [Impact Index Per Article: 249.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Although fungal infections contribute substantially to human morbidity and mortality, the impact of these diseases on human health is not widely appreciated. Moreover, despite the urgent need for efficient diagnostic tests and safe and effective new drugs and vaccines, research into the pathophysiology of human fungal infections lags behind that of diseases caused by other pathogens. In this Review, we highlight the importance of fungi as human pathogens and discuss the challenges we face in combating the devastating invasive infections caused by these microorganisms, in particular in immunocompromised individuals.
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Affiliation(s)
- Gordon D Brown
- Aberdeen Fungal Group, Institute of Medical Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK
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Population-based survey of filamentous fungi and antifungal resistance in Spain (FILPOP Study). Antimicrob Agents Chemother 2013; 57:3380-7. [PMID: 23669377 DOI: 10.1128/aac.00383-13] [Citation(s) in RCA: 178] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
A population-based survey was conducted to investigate the epidemiology of and antifungal resistance in Spanish clinical strains of filamentous fungi isolated from deep tissue samples, blood cultures, and respiratory samples. The study was conducted in two different periods (October 2010 and May 2011) to analyze seasonal variations. A total of 325 strains were isolated in 29 different hospitals. The average prevalence was 0.016/1,000 inhabitants [corrected]. Strains were identified by sequencing of DNA targets and susceptibility testing by the European Committee for Antimicrobial Susceptibility Testing reference procedure. The most frequently isolated genus was Aspergillus, accounting for 86.3% of the isolates, followed by Scedosporium at 4.7%; the order Mucorales at 2.5%; Penicillium at 2.2%, and Fusarium at 1.2%. The most frequent species was Aspergillus fumigatus (48.5%), followed by A. flavus (8.4%), A. terreus (8.1%), A. tubingensis (6.8%), and A. niger (6.5%). Cryptic/sibling Aspergillus species accounted for 12% of the cases. Resistance to amphotericin B was found in 10.8% of the isolates tested, while extended-spectrum triazole resistance ranged from 10 to 12.7%, depending on the azole tested. Antifungal resistance was more common among emerging species such as those of Scedosporium and Mucorales and also among cryptic species of Aspergillus, with 40% of these isolates showing resistance to all of the antifungal compounds tested. Cryptic Aspergillus species seem to be underestimated, and their correct classification could be clinically relevant. The performance of antifungal susceptibility testing of the strains implicated in deep infections and multicentric studies is recommended to evaluate the incidence of these cryptic species in other geographic areas.
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Epidemiology of candidemia in Latin America: a laboratory-based survey. PLoS One 2013; 8:e59373. [PMID: 23527176 PMCID: PMC3601956 DOI: 10.1371/journal.pone.0059373] [Citation(s) in RCA: 243] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 02/14/2013] [Indexed: 02/01/2023] Open
Abstract
Background The epidemiology of candidemia varies depending on the geographic region. Little is known about the epidemiology of candidemia in Latin America. Methods We conducted a 24-month laboratory-based survey of candidemia in 20 centers of seven Latin American countries. Incidence rates were calculated and the epidemiology of candidemia was characterized. Results Among 672 episodes of candidemia, 297 (44.2%) occurred in children (23.7% younger than 1 year), 36.2% in adults between 19 and 60 years old and 19.6% in elderly patients. The overall incidence was 1.18 cases per 1,000 admissions, and varied across countries, with the highest incidence in Colombia and the lowest in Chile. Candida albicans (37.6%), C. parapsilosis (26.5%) and C. tropicalis (17.6%) were the leading agents, with great variability in species distribution in the different countries. Most isolates were highly susceptible to fluconazole, voriconazole, amphotericin B and anidulafungin. Fluconazole was the most frequent agent used as primary treatment (65.8%), and the overall 30-day survival was 59.3%. Conclusions This first large epidemiologic study of candidemia in Latin America showed a high incidence of candidemia, high percentage of children, typical species distribution, with C. albicans, C. parapsilosis and C. tropicalis accounting for the majority of episodes, and low resistance rates.
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Nonnemann B, Tvede M, Bjarnsholt T. Identification of pathogenic microorganisms directly from positive blood vials by matrix-assisted laser desorption/ionization time of flight mass spectrometry. APMIS 2013; 121:871-7. [PMID: 23331371 DOI: 10.1111/apm.12050] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 12/03/2012] [Indexed: 11/28/2022]
Abstract
Matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) is a promising and fast method for identifying fungi and bacteria directly from positive blood cultures. Various pre-treatment methods for MALDI-TOF MS identification have been reported for this purpose. In-house results for identification of bacterial colonies by MALDI-TOF MS using a cut-off score of 1.5 did not reduce the diagnostic accuracy compared with the recommended cut-off score of 1.8. A 3-month consecutive study of positive blood cultures was carried out in our laboratory to evaluate whether the Sepsityper™ Kit (Bruker Daltonics) with Biotyper 2.0 software could be used as a fast diagnostic tool for bacteria and fungi and whether a 1.5 cut-off score could improve species identification compared with the recommended score of 1.8. Two hundred and fifty-six positive blood vials from 210 patients and 19 blood vials spiked with fungi were examined. Using the cut-off score of 1.8, 81% Gram-negative bacteria were identified to the species level compared to 84% using a cut-off score of 1.5. For Gram-positive bacteria 44% were identified to the species level with a cut-off of 1.8 compared to 55% with the value of 1.5. The overall identification rate was 63% (cut-off 1.5) and 54% (cut-off 1.8). Seventy-seven per cent of fungal species were identified with both log scores. MALDI-TOF MS was in this study found to be a powerful tool in fast diagnosis of Gram-negative bacteria and fungi and to a lesser degree of Gram positives. Using 1.5 as cut-off score increased the diagnosis for both Gram-positives and -negatives bacteria.
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Affiliation(s)
- Bettina Nonnemann
- Department of Clinical Microbiology, Rigshospitalet, University Hospital of Copenhagen
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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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Lai CC, Chu CC, Wang CY, Tsai HY, Cheng A, Lee YC, Huang YT, Liao CH, Hsueh PR. Association between incidence of candidaemia and consumption of antifungal agents at a medical centre in Taiwan. Int J Antimicrob Agents 2012; 40:349-53. [DOI: 10.1016/j.ijantimicag.2012.05.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Revised: 05/25/2012] [Accepted: 05/28/2012] [Indexed: 12/18/2022]
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