Multiple facial candidal abscesses after self-administered acupuncture in a patient with undiagnosed diabetes mellitus: a case report.

BACKGROUND: Facial abscess caused by Candida albicans infection is a rare condition even in immunocompromised patients, and only a few cases have been reported. To our knowledge, this is the first case of multiple facial candidal abscesses caused by self-administered acupuncture in an undiagnosed diabetes mellitus patient. CASE PRESENTATION: A 57-year-old woman who had self-acupuncture treatment 2 weeks previously, presented with a 1-week history of progressive left eyelid swelling, erythema, and pain. Despite the antibiotic treatment, the lesion progressed. Surgical incision and drainage was performed and Candida albicans was isolated from the obtained pus culture. The patient was diagnosed with type 2 diabetes mellitus based on a random serum glucose level of 350 mg/dl and 9.2% HbA1c. The abscess resolved after seven incision and drainage cycles and 4 weeks of intravenous fluconazole treatment with an appropriate control of diabetes mellitus. CONCLUSION: Unusual organisms and underlying immunocompromised condition should be suspected in cases of recurrent abscess showing an inadequate response to antibiotic treatment.

Ozone Treatment Unveils the Veil of Candida parapsilosis Infection in the Knee Joint: A Case Report and Literature Review.

Candida infection is common, while Candida parapsilosis infection in the knee joint is rare. Local symptoms of Candida infections in the knee are atypical, rarely associated with systemic symptoms, and difficult to distinguish from other types of knee arthritis. We here report a special case of C. parapsilosis infections in the knee joint. A patient had previously undergone knee puncture in a private clinic for the treatment of osteoarthritis and developed a left knee joint infection with C. parapsilosis. However, the patient only showed more severe local knee symptoms, and there was no systemic manifestation associated with any Candida infection. Surprisingly, after receiving ozone lavage, the patient showed symptoms of a systemic infection such as fever and chills. There was no positive finding in the blood cultures. Finally, the synovial fluid cultures showed a C. parapsilosis infections. After antifungal treatment and another knee ozone therapy, the patient did not experience recurrence of the infections. It is suggested that in this special case, the strong sterilization with ozone caused the destruction of C. parapsilosis, leading to a transient systemic toxin reaction. In addition, we reviewed the 17 cases of C. parapsilosis infections that have been reported thus far.

Quinine Improves the Fungicidal Effects of Antimicrobial Blue Light: Implications for the Treatment of Cutaneous Candidiasis.

BACKGROUND AND OBJECTIVE: Candida albicans is an opportunistic fungal pathogen of clinical importance and is the primary cause of fungal-associated wound infections, sepsis, or pneumonia in immunocompromised individuals. With the rise in antimicrobial resistance, it is becoming increasingly difficult to successfully treat fungal infections using traditional antifungals, signifying that alternative non-traditional approaches must be explored for their efficacy. STUDY DESIGN/MATERIALS AND METHODS: We investigated the combination of antimicrobial blue light (aBL) and quinine hydrochloride (Q-HCL) for improved inactivation of C. albicans, in vitro and in vivo, relative to either monotherapy. In addition, we evaluated the safety of this combination therapy in vivo using the TUNEL assay. RESULTS: The combination of aBL (108 J/cm2 ) with Q-HCL (1 mg/mL) resulted in a significant improvement in the inactivation of C. albicans planktonic cells in vitro, where a 7.04 log10 colony forming units (CFU) reduction was achieved, compared with aBL alone that only inactivated 3.06 log10 CFU (P < 0.001) or Q-HCL alone which did not result in a loss of viability. aBL + Q-HCL was also effective at inactivating 48-hour biofilms, with an inactivation 1.73 log10 CFU at the dose of 108 J/cm2 aBL and 1 mg/mL Q-HCL, compared with only a 0.73 or 0.66 log10 CFU by aBL and Q-HCL alone, respectively (P < 0.001). Transmission electron microscopy revealed that aBL + Q-HCL induced morphological and ultrastructural changes consistent with cell wall and cytoplasmic damage. In addition, aBL + Q-HCL was effective at eliminating C. albicans within mouse abrasion wounds, with a 2.47 log10 relative luminescence unit (RLU) reduction at the dose of 324 J/cm2 aBL and 0.4 mg/cm2 Q-HCL, compared with a 1.44 log10 RLU reduction by aBL alone. Q-HCL or nystatin alone did not significantly reduce the RLU. The TUNEL assay revealed some apoptotic cells before and 24 hours following treatment with aBL + Q-HCL. CONCLUSION: The combination of aBL + Q-HCL was effective at eliminating C. albicans both in vitro and in vivo. A comprehensive assessment of toxicity (cytotoxicity and genotoxicity) is required to fully determine the safety of aBL + Q-HCL therapy at different doses. In conclusion, the combination of aBL and Q-HCL may be a viable option for the treatment of cutaneous candidiasis. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Novel Therapies for Biofilm-Based Candida spp. Infections.

The presence of fungal infections continue to grow worldwide, mostly in immunosuppressed patients, and in individuals with continued antimicrobial treatments. Candida spp. are the most common yeasts involved in these disorders, being associated with a high rate of antifungal resistance and an increased ability to form biofilms, which make the treatment of these infections difficult. This review aims to present and discuss the main biofilm-related infections cause by several Candida spp. and novel therapies that are currently available in the clinical, scientific and academic environment. New drugs with promising antifungal activity, natural approaches (e.g. probiotics, essential oils, plant extracts, honey) and a final consideration on alternative methodologies, such as photodynamic therapy are presented and discussed.

Inhibition of Candida albicans morphogenesis by chitinase from Lactobacillus rhamnosus GG.

Lactobacilli have been evaluated as probiotics against Candida infections in several clinical trials, but with variable results. Predicting and understanding the clinical efficacy of Lactobacillus strains is hampered by an overall lack of insights into their modes of action. In this study, we aimed to unravel molecular mechanisms underlying the inhibitory effects of lactobacilli on hyphal morphogenesis, which is a crucial step in C. albicans virulence. Based on a screening of different Lactobacillus strains, we found that the closely related taxa L. rhamnosus, L. casei and L. paracasei showed stronger activity against Candida hyphae formation compared to other Lactobacillus species tested. By exploring the activity of purified compounds and mutants of the model strain L. rhamnosus GG, the major peptidoglycan hydrolase Msp1, conserved in the three closely related taxa, was identified as a key effector molecule. We could show that this activity of Msp1 was due to its ability to break down chitin, the main polymer in the hyphal cell wall of C. albicans. This identification of a Lactobacillus-specific protein with chitinase activity having anti-hyphal activity will assist in better strain selection and improved application in future clinical trials for Lactobacillus-based Candida-management strategies.

Synergistic Antifungal Effect of Amphotericin B-Loaded Poly(Lactic-Co-Glycolic Acid) Nanoparticles and Ultrasound against Candida albicans Biofilms.

Candida albicans is a human opportunistic pathogen that causes superficial and life-threatening infections. An important reason for the failure of current antifungal drugs is related to biofilm formation, mostly associated with implanted medical devices. The present study investigated the synergistic antifungal efficacy of low-frequency and low-intensity ultrasound combined with amphotericin B (AmB)-loaded poly(lactic-co-glycolic acid) (PLGA) nanoparticles (AmB-NPs) against C. albicans biofilms. AmB-NPs were prepared by a double-emulsion method and demonstrated lower toxicity than free AmB. We then established biofilms and treated them with ultrasound and AmB-NPs separately or jointly in vitro and in vivo The results demonstrated that the activity, biomass, and proteinase and phospholipase activities of biofilms were decreased significantly after the combination treatment of AmB-NPs with 42 kHz of ultrasound irradiation at an intensity of 0.30 W/cm2 for 15 min compared with the controls, with AmB alone, or with ultrasound treatment alone (P < 0.01). The morphology of the biofilms was altered remarkably after joint treatment based on confocal laser scanning microscopy (CLSM), especially in regard to reduced thickness and loosened structure. Furthermore, the same synergistic effects were found in a subcutaneous catheter biofilm rat model. The number of CFU from the catheter exhibited a significant reduction after joint treatment with AmB-NP and ultrasound for seven continuous days, and CLSM and scanning electron microscopy (SEM) images revealed that the biofilm on the catheter surface was substantially eliminated. This method may provide a new noninvasive, safe, and effective therapy for C. albicans biofilm infection.

Efectividad de la tintura de propóleos al 10 % en pacientes con estomatitis subprótesis / Effectiveness of 10 % propolis tinction in patients with subprosthesis stomatitis

Se efectuó un estudio de intervención terapéutica en 50 pacientes con estomatitis subprótesis, quienes acudieron a la consulta de prótesis de la Clínica Estomatológica Ramón Guevara Montano de Baracoa, provincia de Guantánamo, desde abril del 2015 hasta junio del 2016, con vistas a determinar la efectividad del tratamiento con tintura de propóleos al 10 por ciento en los afectados. Se conformaron 2 grupos: uno de estudio (A) y otro de control (B), con 25 integrantes cada uno; el primero fue tratado con propóleos y el segundo con medicina alopática (nistatina en suspensión). La evaluación se realizó a los 4, 8 y 12 días. Al finalizar la terapia se observó que en 100,0 por ciento de los pacientes del grupo A se eliminó la lesión; por tanto, esta alternativa terapéutica resultó efectiva. Se recomendó extender dicha aplicación a otras afecciones bucales.

A study of therapeutic intervention was carried out in 50 patients with subprosthesis stomatitis who went to the Prosthesis department of "Ramón Guevara Montano" Stomatological Clinic in Baracoa, Guantánamo province, from April, 2015 to June, 2016, aimed at determining the effectiveness of the treatment with 10 percent propolis tinction in the affected patients. Two groups were formed: a study group (A) and a control group (B), with 25 members each; the first one was treated with propolis tinction and the second with allopathic medicine (nystatin in suspension). The evaluation was carried out at 4.8 and 12 days. When concluding the therapy it was observed that in 100.0 percent of the patients of the group A the lesion was eliminated; therefore, this therapeutic alternative was effective. It was recommended to extend this procedure to other oral disorders.

An in Vitro Study on the Effect of Combined Treatment with Photodynamic and Chemical Therapies on Candida albicans.

Candida albicans is the most commonly encountered human fungal pathogen, and it is traditionally treated with antimicrobial chemical agents. The antimicrobial effect of these agents is largely weakened by drug resistance and biofilm-associated virulence. Enhancement of the antimicrobial activity of existing agents is needed for effective candidiasis treatment. Our aim was to develop a therapy that combined biofilm disruption with existing antimicrobial agents. Photodynamic therapy (PDT) utilizing curcumin and blue light was tested as an independent therapy and in combination with fluconazole treatment. Viability assays and morphology analysis were used to assess the effectiveness of C. albicans treatment. Results showed that fluconazole treatment decreased the viability of planktonic C. albicans, but the decrease was not as pronounced in adherent C. albicans because its biofilm form was markedly more resistant to the antimicrobiotic. PDT effectively eradicated C. albicans biofilms, and when combined with fluconazole, PDT significantly inhibited C. albicans to a greater extent. This study suggests that the addition of PDT to fluconazole to treat C. albicans infection enhances its effectiveness and can potentially be used clinically.

Future therapies targeted towards eliminating Candida biofilms and associated infections.

INTRODUCTION: Candida species are common human commensals and cause either superficial or invasive opportunistic infections. The biofilm form of candida as opposed to its suspended, planktonic form, is predominantly associated with these infections. Alternative or adjunctive therapies are urgently needed to manage Candida infections as the currently available short arsenal of antifungal drugs has been compromised due to their systemic toxicity, cross-reactivity with other drugs, and above all, by the emergence of drug-resistant Candida species due to irrational drug use. Areas covered: Combination anti-Candida therapies, antifungal lock therapy, denture cleansers, and mouth rinses have all been proposed as alternatives for disrupting candidal biofilms on different substrates. Other suggested approaches for the management of candidiasis include the use of natural compounds, such as probiotics, plants extracts and oils, antifungal quorum sensing molecules, anti-Candida antibodies and vaccines, cytokine therapy, transfer of primed immune cells, photodynamic therapy, and nanoparticles. Expert commentary: The sparsity of currently available antifungals and the plethora of proposed anti-candidal therapies is a distinct indication of the urgent necessity to develop efficacious therapies for candidal infections. Alternative drug delivery approaches, such as probiotics, reviewed here is likely to be a reality in clinical settings in the not too distant future.

Novel strategies to fight Candida species infection.

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.

Actividad antimicrobiana in vitro de Pteris vittata L / In vitro antimicrobial activity of Pteris vittata L

Introducción: las hojas de Pteris vittata L (helecho) son utilizadas por la población para el tratamiento de la candidiasis y en enfermedades producidas por bacterias en la piel. Objetivo: identificar preliminarmente las familias de metabolitos secundarios presentes en las hojas de la planta y evaluar su posible actividad antimicrobiana. Métodos: se recolectaron las hojas de Pteris vittata L. El material vegetal fue lavado, desinfectado, secado y seguidamente se procedió a su pulverización. Este polvo se utilizó en la elaboración de los diferentes extractos y tintura. La tintura obtenida se concentró y se fraccionó sucesivamente con n-hexano, cloroformo y acetato de etilo. A estos extractos se les realizó el tamizaje fitoquímico, ensayos microbiológicos y cromatografía de capa fina. Resultados: las pruebas in vitro efectuadas a los extractos obtenidos a partir de la tintura 20 por ciento, demostraron que éstos presentan actividad antimicrobiana frente a Escherichia coli, Staphylococcus aureus, destacándose los resultados obtenidos frente a Candida sp para los extractos de acetato de etilo y clorofórmico. En estas fracciones están presentes en mayor proporción alcaloides y quinonas, que podrían ser los responsables de esta actividad, lo cual se corrobora con la identificación de estos metabolitos secundarios mediante la cromatografía de capa fina y el tamizaje fitoquímico realizado. Conclusiones: el estudio combinado mediante la cromatografía de capa fina y el tamizaje fitoquímico de los extractos hexánico, acetato de etilo y clorofórmico permite inferir que la actividad antimicrobiana puede deberse a la presencia de quinonas y alcaloides(AU)

Introduction: Pteris vittata L. leaves (fern) are used by people on the candidiasis treatment and some skin illnesses caused by bacteria. Objective: to identify preliminarily the secondary metabolites present in the leaves of the plant and to evaluate their possible antimicrobial activity. Methods: Pteris vittata L. leaves were collected. The plant material was washed, disinfected, dried and pulverized. The powder obtained was used to make the various extracts and the tincture. The latter was concentrated and successively fractionated with n-hexane, chloroform, and ethyl acetate. The extracts underwent phytochemical screening, microbiological assays and thin-layer chromatography. Results: in vitro tests performed in the obtained extracts from the 20 percent tincture proved that they have antimicrobial activity against Escherichia coli and Staphylococcus aureus, emphasizing the accomplished results against Candida of the ethyl and chloroform acetate extracts. Alkaloids and quinones, which are found in large proportion in the extracts, would be responsible of the above- mentioned antibacterial activity. This was corroborated by the identification of these secondary metabolites through thin-layer chromatography and phytochemical screening. Conclusions: the combined study through thin-layer chromatography and phytochemical screening of the ethyl and chloroform acetate extracts showed that the antimicrobial activity could be possible due to the alkaloids and quinones presence(AU)

Candidiasis: a fungal infection--current challenges and progress in prevention and treatment.

Despite therapeutic advances candidiasis remains a common fungal infection most frequently caused by C. albicans and may occur as vulvovaginal candidiasis or thrush, a mucocutaneous candidiasis. Candidiasis frequently occurs in newborns, in immune-deficient people like AIDS patients, and in people being treated with broad spectrum antibiotics. It is mainly due to C. albicans while other species such as C. tropicalis, C. glabrata, C. parapsilosis and C. krusei are increasingly isolated. OTC antifungal dosage forms such as creams and gels can be used for effective treatment of local candidiasis. Whereas, for preventing spread of the disease to deeper vital organs, candidiasis antifungal chemotherapy is preferred. Use of probiotics and development of novel vaccines is an advanced approach for the prevention of candidiasis. Present review summarizes the diagnosis, current status and challenges in the treatment and prevention of candidiasis with prime focus on host defense against candidiasis, advancements in diagnosis, probiotics role and recent progress in the development of vaccines against candidiasis.

Probiotic lactobacillus and estrogen effects on vaginal epithelial gene expression responses to Candida albicans.

BACKGROUND: Vaginal epithelial cells have receptors, signal transduction mechanisms, and cytokine secretion capabilities to recruit host defenses against Candida albicans infections. This research evaluates how probiotic lactobacilli affect the defensive epithelial response. METHODS: This study used quantitative reverse transcription-polymerase chain reaction assay (qRT-PCR), flow cytometry, and a multiplex immunoassay to observe changes in the regulation of gene expression related to cytokine responses in the VK2 (E6/E7) vaginal epithelial cell line treated with 17ß-estradiol, exposed to probiotic Lactobacillus rhamnosus GR-1® and Lactobacillus reuteri RC-14® and challenged with C. albicans. Data were statistically evaluated by repeated measures analysis of variance and paired t-tests where appropriate. RESULTS: C. albicans induced mRNA expression of genes related to inflammatory cytokine responses associated with nuclear factor-kappa B (NF-κB) and mitogen-activated protein kinase (MAPK) signal transduction pathways. 17ß-estradiol suppressed expression of interleukin-1α (IL-1α), IL-6, IL-8, and tumor necrosis factor alpha (TNFα) mRNA. Probiotic lactobacilli suppressed C. albicans-induced nuclear factor-kappa B inhibitor kinase kinase alpha (Iκκα), Toll-like receptor-2 (TLR2), TLR6, IL-8, and TNFα, also suggesting inhibition of NF-κB signaling. The lactobacilli induced expression of IL-1α, and IL-1ß mRNA, which was not inhibited by curcumin, suggesting that they induce an alternate inflammatory signal transduction pathway to NF-κB, such as the mitogen activated protein kinase and activator protein-1 (MAPK/AP-1) signal transduction pathway. Curcumin inhibited IL-13 secretion, suggesting that expression of this cytokine is mainly regulated by NF-κB signaling in VK2 cells. CONCLUSIONS: The results suggest that C. albicans infection induces pro-inflammatory responses in vaginal epithelial cells, and estrogen and lactobacilli suppress expression of NF-κB-related inflammatory genes. Probiotic lactobacilli may induce IL-1α and IL-1ß expression by an alternate signal transduction pathway, such as MAPK/AP-1. Activation of alternate signaling mechanisms by lactobacilli to modify epithelial cell cytokine production may be a mechanism for probiotic modulation of morbidity in vulvovaginal candidiasis.

The level of arabinitol in autistic children after probiotic therapy.

OBJECTIVE: The level of D-arabinitol (DA) and the ratio of D-/L-arabinitol (DA/LA) in the urine of children with autism were investigated. The changes in DA/LA after probiotic treatment in urine samples of children with autism were studied. METHODS: DA and LA and the DA/LA ratio were identified by capillary gas chromatography/mass spectrometry in urine before and after the probiotic therapy. RESULTS: The level of DA is significantly higher (P < 0.05) in the urine of autistic children before (A) and after probiotic supplementation (A1) (160.04 ± 22.88 µmol/mmol creatinine and 89.53 ± 37.41 µmol/mmol creatinine, respectively). Nonetheless, the probiotic supplementation let to a significant decrease in DA and DA/LA and to a significant improvement in ability of concentration and carrying out orders. CONCLUSION: The use of probiotics seems to be helpful in reducing the level of DA and the ratio of DA/LA in the urine of children with autism.

Candidíase crônica / Chronic candidiasis: case-report

Introdução: Paciente de 62 anos, primeira consulta em outubro de 2006, com diagnóstico de candidíase crônica. Durante o primeiro ano de tratamento foram prescritos Natrum muriaticum 1MFC, 10MFC, 50MFC (dose única) sem melhora; Ignatia amara 50CH, 60CH, 70CH (dose única) sem melhora e Pulsatilla pratensis 12LM, (diariamente durante 1 mês) sem melhora. Em agosto de 2007 foi prescrito o medicamento Cyclamen europaeum com resolução do quadro. Os sintomas utilizados para repertorização foram: 1) Ilusão que negligenciou seu dever; 2) Sensação deabandono.

Candidíase crônica / Chronic candidiasis: case-report

Introdução: Paciente de 62 anos, primeira consulta em outubro de 2006, com diagnóstico de candidíase crônica. Durante o primeiro ano de tratamento foram prescritos Natrum muriaticum 1MFC, 10MFC, 50MFC (dose única) sem melhora; Ignatia amara 50CH, 60CH, 70CH (dose única) sem melhora e Pulsatilla pratensis 12LM, (diariamente durante 1 mês) sem melhora. Em agosto de 2007 foi prescrito o medicamento Cyclamen europaeum com resolução do quadro. Os sintomas utilizados para repertorização foram: 1) Ilusão que negligenciou seu dever; 2) Sensação deabandono.

Potential of anti-Candida antibodies in immunoprophylaxis.

The need for new options for the treatment of invasive candidiasis has fuelled the use of antibodies in combination with conventional antifungal therapy. After a long period of time in which antibodies were considered irrelevant in the resistance against invasive candidiasis, it was demonstrated that a number of antibodies or their engineered derivatives directed against Candida albicans cell-wall polysaccharides and glycopeptides, as well as against some protein epitopes, confer protection against invasive candidiasis. This has confirmed this approach as a new strategy for the prophylaxis of invasive candidiasis. Of particular interest is Mycograb, a human recombinant monoclonal antibody that inhibits heat shock protein 90, and has been administrated in combination with lipid-associated amphotericin B to patients with invasive candidiasis, and the fungicidal anti-beta-glucan antibodies induced by the glycoconjugate vaccine composed of a beta-glucan polysaccharide conjugated with the diphtheria toxoid CRM 197. However, despite the promising data obtained in vitro and in animal models, at present there is very little clinical experience on the use of antibodies in Candida immunoprophylaxis.

Invasive candidiasis in the intensive care unit.

Invasive fungal disease by Candida spp. is on the rise in the modem era of prolonged patient survival by virtue of improved critical care measures, novel chemotherapy regimens, and increasing immunosuppression following organ transplants. Invasive candidiasis (IC) in the setting of an intensive care unit results in prolonged hospital stay and increased morbidity. Clinical suspicion plays a major role in the diagnosis of IC, as current laboratory methods are not very sensitive. Various serum markers and molecular techniques are under development to improve diagnostic strategies. Treatment options involve an expanding spectrum of antifungals. Knowledge of local epidemiology and the risk factors that predispose patients to this disease are essential for effective patient care in an intensive care setting.