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1.
Antonie Van Leeuwenhoek ; 113(1): 55-69, 2020 Jan.
Article in English | MEDLINE | ID: mdl-31432290

ABSTRACT

Khanthuli peat swamp forest (PSF) is one of a few fertile peat swamp forests that remain in Thailand. It is composed of primary PSF and some areas which have been degraded to secondary PSF due to drought, wildfires and land conversion, which have resulted in a decrease in peat layers and change in the species of the plant community. In this study, diversity of yeasts in peat from both primary and secondary PSF areas of the Khanthuli PSF was determined based on culture-dependent approaches, using dilution plate and enrichment techniques. A total of 66 yeast isolates were identified by the analysis of sequence similarity of the D1/D2 region of the large subunit rRNA gene or the combined analysis of sequence of the D1/D2 region and internal transcribed spacer region and confirmed by phylogenetic analysis of the D1/D2 region to belong to 22 known yeast species and six potential new species in the genera Candida (Kurtzmaniella, Lodderomyces, Ogataea, Pichia and Yamadazyma clades), Clavispora, Cyberlindnera, Galactomyces, Hanseniaspora, Metschnikowia, Saturnispora, Schwanniomyces, Cryptotrichosporon, Pichia, Curvibasidium, Papiliotrema, Rhodotorula, and Saitozyma. The most prevalent yeasts in the primary PSF were Cyberlindnera subsufficiens and Galactomyces candidus, while Saitozyma podzolica was the most frequently found in peat from the secondary PSF. Common yeast species in both, primary and secondary PSF, were Cy. subsufficiens, G. candidus and Rhodotorula mucilaginosa.


Subject(s)
Forests , Soil Microbiology , Soil , Wetlands , Basidiomycota/classification , Basidiomycota/genetics , Biodiversity , Candida/classification , Candida/genetics , Candida glabrata/classification , Candida glabrata/genetics , Candida glabrata/immunology , Candidiasis/classification , Candidiasis/genetics , Cryptococcus/classification , Cryptococcus/genetics , DNA, Fungal/genetics , Metschnikowia/classification , Metschnikowia/genetics , Pichia/classification , Pichia/genetics , Saccharomyces/classification , Saccharomyces/genetics , Thailand , Torulaspora/classification , Torulaspora/genetics , Yarrowia/classification , Yarrowia/genetics
2.
BMC Vet Res ; 14(1): 251, 2018 Aug 29.
Article in English | MEDLINE | ID: mdl-30157847

ABSTRACT

BACKGROUND: Candida spp. is the vital pathogen involved in mycotic mastitis of cows. However the epidemiology and infection of Candida species in mycotic mastitis of cow in Ningxia province of China has not been explored. In the present study, the epidemiology, antimicrobial susceptibility and virulence-related genes of non-albicans Candida (NAC) species were investigated. METHODS: A total of 482 milk samples from cows with clinical mastitis in four herds of Yinchuan, Ningxia were collected and used for the isolation and identification of mastic pathogens by phenotypic and molecular characteristics, and matrix-assisted laser desorption ionization-time of flight mass spectrometry. The antimicrobial susceptibility to antifungal agents was also determined by a disk diffusion assay. The presence of virulence-related genes was determined by polymerase chain reaction (PCR). RESULTS: A total of 60 isolates from nine different Candida species were identified from 256 (60/256, 23.44%) milk samples. The most frequently identified species in cows with clinical mastitis groups were Candida krusei (n = 14) and Candida parapsilosis (n = 6). Others include Candida lipolytica, Candida lusitaniae, Cryptococcus neoformans. But no Candida albicans was identified in this study. Interestingly, All C. krusei isolates (14/14) were resistant to fluconazole, fluorocytosine, itraconazole and ketoconazole, 2 out of 14 C. krusei were resistant to amphotericin, and 8 out of the 14 were resistant to nystatin. Similarly, all six C. parapsilosis isolates were resistant to fluorocytosine, but susceptible to fluconazole, ketoconazole and nystatin; two of the six were resistant amphotericin and itraconazole. Molecularly, all of the C. parapsilosis isolates carried eight virulence-related genes, FKS1, FKS2, FKS3, SAP1, SAP2, CDR1, ERG11 and MDR1. All of the C. krusei isolates contained three virulence-related genes, ERG11, ABC2 and FKS1. CONCLUSION: These data suggested that Candida species other than C. albicans played a pathogenic role in mycotic mastitis of cows in Yinchuan, Ningxia of China. The high incidence of drug-resistant genes in C. parapsilosis and C. krusei also highlighted a great concern in public and animal health in this region.


Subject(s)
Candida/classification , Candidiasis/veterinary , Cattle Diseases/microbiology , Mastitis/veterinary , Animals , Antifungal Agents , Candida/genetics , Candida/pathogenicity , Candidiasis/classification , Candidiasis/epidemiology , Cattle , Cattle Diseases/epidemiology , China/epidemiology , Drug Resistance, Fungal , Female , Mastitis/epidemiology , Mastitis/microbiology , Microbial Sensitivity Tests , Milk/microbiology , Virulence/genetics
3.
Mem. Inst. Oswaldo Cruz ; 112(5): 370-375, May 2017. tab, graf
Article in English | LILACS | ID: biblio-841790

ABSTRACT

BACKGROUND Infective endocarditis is a disease characterised by heart valve lesions, which exhibit extracellular matrix proteins that act as a physical barrier to prevent the passage of antimicrobial agents. The genus Candida has acquired clinical importance given that it is increasingly being isolated from cases of nosocomial infections. OBJECTIVE To evaluate the activity of caspofungin compared to that of liposomal amphotericin B against Candida albicans in experimental infective endocarditis. METHODS Wistar rats underwent surgical intervention and infection with strains of C. albicans to develop infective endocarditis. Three groups were formed: the first group was treated with caspofungin, the second with liposomal amphotericin B, and the third received a placebo. In vitro sensitivity was first determined to further evaluate the effect of these treatments on a rat experimental model of endocarditis by semiquantitative culture of fibrinous vegetations and histological analysis. FINDINGS Our semiquantitative culture of growing vegetation showed massive C. albicans colonisation in rats without treatment, whereas rats treated with caspofungin showed significantly reduced colonisation, which was similar to the results obtained with liposomal amphotericin B. CONCLUSIONS The antifungal activity of caspofungin is similar to that of liposomal amphotericin B in an experimental model of infective endocarditis caused by C. albicans.


Subject(s)
Animals , Female , Rats , Candida albicans , Candidiasis/classification , Candidiasis/complications , Amphotericin B/therapeutic use , Echinocandins/therapeutic use , Antifungal Agents/therapeutic use , Rats, Wistar
4.
Emerg Infect Dis ; 21(11): 1942-50, 2015 Nov.
Article in English | MEDLINE | ID: mdl-26488845

ABSTRACT

Many uncommon Candida species that cause bloodstream infections (BSIs) are not well-characterized. We investigated the epidemiology, antifungal use, susceptibility patterns, and factors associated with all-cause death among cancer patients in whom uncommon Candida spp. BSIs were diagnosed at a cancer treatment center during January 1998­September 2013. Of 1,395 Candida bloodstream isolates, 79 from 68 patients were uncommon Candida spp. The incidence density of uncommon Candida spp. BSIs and their proportion to all candidemia episodes substantively increased during the study period, and the rise was associated with increasing use of echinocandin antifungal drugs. Thirty-seven patients had breakthrough infections during therapy or prophylaxis with various systemic antifungal drugs for >7 consecutive days; 21 were receiving an echinocandin. C. kefyr (82%), and C. lusitaniae (21%) isolates frequently showed caspofungin MICs above the epidemiologic cutoff values. These findings support the need for institutional surveillance for uncommon Candida spp. among cancer patients.


Subject(s)
Candida/classification , Candidemia/epidemiology , Candidiasis/epidemiology , Neoplasms/microbiology , Antifungal Agents/therapeutic use , Candidemia/classification , Candidemia/microbiology , Candidiasis/classification , Candidiasis/microbiology , Culture Media , Education, Medical, Continuing , Humans , Incidence , Microbial Sensitivity Tests/statistics & numerical data , Neoplasms/complications , Neoplasms/epidemiology , Neoplasms/immunology , Risk Factors , Texas/epidemiology
5.
Dis Esophagus ; 27(3): 214-9, 2014 Apr.
Article in English | MEDLINE | ID: mdl-23826847

ABSTRACT

Severe Candida esophagitis (CE) may lead to development of strictures, hemorrhage, esophagotracheal fistula, and a consequent decrease in quality of life. Although the severity of CE has been classified based on macroscopic findings on endoscopy, the clinical significance remains unknown. The aim of the study was to elucidate the predictive clinical factors for endoscopic severity of CE. Patients who underwent upper endoscopy and answered questionnaires were prospectively enrolled. Smoking, alcohol, human immunodeficiency virus (HIV) infection, diabetes mellitus, chronic renal failure, liver cirrhosis, systemic steroids use, proton pump inhibitor use, H2 blocker use, and gastrointestinal (GI) symptoms were assessed on the same day of endoscopy. GI symptoms including epigastric pain, heartburn, reflux, hunger cramps, nausea, dysphagia, and odynophagia were assessed on a 7-point Likert scale. Endoscopic severity was classified as mild (Kodsi's grade I/II) or severe (grade III/IV). Of 1855 patients, 71 (3.8%) were diagnosed with CE (mild, n = 48; severe, n = 23). In the CE patients, 50.0% (24/48) in the mild group and 23.1% (6/23) in the severe group did not have any GI symptoms. In HIV-infected patients (n = 17), a significant correlation was found between endoscopic severity and declining CD4 cell count (Spearman's rho = -0.90; P < 0.01). Multivariate analysis revealed that GI symptoms (odds ratio [OR], 3.32) and HIV infection (OR, 3.81) were independently associated with severe CE. Patients in the severe group experienced more epigastric pain (P = 0.02), reflux symptoms (P = 0.04), dysphagia (P = 0.05), and odynophagia (P < 0.01) than those in the mild group. Of the GI symptoms, odynophagia was independently associated with severe CE (OR 9.62, P = 0.02). In conclusion, the prevalence of CE in adults who underwent endoscopy was 3.8%. Silent CE was found in both mild and severe cases. Endoscopic severity was associated with characteristic GI symptoms and comorbidity of HIV infection. A decline in immune function correlated with CE disease progression.


Subject(s)
Candidiasis/classification , Candidiasis/diagnosis , Deglutition Disorders/microbiology , HIV Infections/complications , Laryngopharyngeal Reflux/microbiology , Abdominal Pain/microbiology , Alcohol Drinking , Candidiasis/complications , Esophagoscopy , Female , Heartburn/microbiology , Humans , Male , Middle Aged , Prospective Studies , Severity of Illness Index , Smoking , Surveys and Questionnaires
6.
J Chemother ; 23(2): 97-101, 2011 Apr.
Article in English | MEDLINE | ID: mdl-21571626

ABSTRACT

In vitro susceptibility of 141 clinical isolates of Candida species to caspofungin and anidulafungin is reported. the Etest was performed according to recommended procedure and minimum inhibitory concentrations (MICs) were read after 24 h of incubation at 35 °C. Applying a breakpoint of <2 mg/ml, all Candida spp. isolates, except those belonging to C. parapsilosis complex, were susceptible. The geometric mean for caspofungin and anidulafungin for different Candida spp. were as follows: Candida parapsilosis, 0.438 and 3.355 µg/ml; Candida orthopsilosis, 0.210 and 1.456 µg/ml; Candida albicans, 0.049 and 0.007 µg/ml; Candida dubliniensis, 0.077 and 0.009 µg/ml; Candida tropicalis, 0.061 and 0.027 µg/ml; Candida glabrata, 0.120 and 0.032 µg/ml; and Candida krusei, 0.288 and 0.052 µg/ml, respectively. Anidulafungin was significantly more active than caspofungin (p <0.001) except for C. parapsilosis complex spp. isolates. In conclusion, our Etest MICs compared well with epidemiological cutoff values derived from a large number of Candida spp. isolates tested by CLSI method in previous studies. However, considering the differences in MICs of the two echinocandins for C. parapsilosis complex isolates, the Etest needs further evaluation for its suitability.


Subject(s)
Antifungal Agents/pharmacology , Candida/drug effects , Echinocandins/pharmacology , Anidulafungin , Antifungal Agents/therapeutic use , Candida/classification , Candida/isolation & purification , Candidiasis/blood , Candidiasis/classification , Candidiasis/drug therapy , Candidiasis/microbiology , Caspofungin , Drug Resistance, Fungal/physiology , Echinocandins/therapeutic use , Humans , Lipopeptides , Microbial Sensitivity Tests/methods , Retrospective Studies
7.
Gastroenterol. latinoam ; 21(2): 302-304, abr.-jun. 2010.
Article in Spanish | LILACS | ID: lil-570030

ABSTRACT

La Candidiasis esofágica es una entidad frecuente en pacientes con VIH, cáncer, usuarios de corticoides, algorra orofaringea. La Candida es un organismo comensal y puede infectar al ser humano. Existe una serie de factores locales y sistémicos del huésped que favorecen la infección por Candida. El cuadro clínico se presenta frecuentemente con odinofagia, disfagia y dolor retroesternal. El diagnóstico de certeza es histológico. El estudio endoscópico entrega un estudio de alta calidad, altamente sensible y permite diferenciar distintas causas de esofagitis. La candidiasis esofágica debe ser tratada con terapia sistémica. El fármaco más recomendado es el fluconazol.


Esophageal candidiasis is a frequently occurring entity in corticoid users, patients with HIV and oropharyngeal involvement. Candida is a commensal organism, and it can infect humans. There are many local and systemic factors of the host that favor Candida infection. Frequently clinical manifestations are odynophagia, dysphagia and retrosternal pain. Diagnostic certainty reached by histological assays. Endoscopic studies provide high-quality and highly-sensitive results that allow to differentiate esophagitis causes. Esophageal Candidiasis must receive systemic treatment. The most recommended drug is Fluconazol.


Subject(s)
Humans , Candidiasis/diagnosis , Candidiasis/microbiology , Candidiasis/therapy , Esophageal Diseases/diagnosis , Esophageal Diseases/microbiology , Esophageal Diseases/therapy , Antifungal Agents/therapeutic use , Candidiasis/classification , Diagnosis, Differential , Esophageal Diseases/classification
8.
J Wound Care ; 18(3): 103-4, 106, 108, 2009 Mar.
Article in English | MEDLINE | ID: mdl-19247230

ABSTRACT

OBJECTIVE: To evaluate the ability of two new diagnostic methods to detect and accurately identify yeast associated with chronic wound infections. METHOD: Fungal tag-encoded FLX amplicon pyrosequencing (fTEFAP), a universal fungal identification method, bacterial tag-encoded FLX amplicon pyrosequencing (bTEFAP), a universal bacterial identification method, and a new quantitative polymerase chain reaction (qPCR) wound pathogen panel were used to evaluate three chronic wounds suspected to contain yeast. RESULTS: Forty wound samples were analysed in addition to the three samples suspected of containing yeast. The qPCR panel, which targets Candida albicans, detected this yeast in two of the three wound samples. In contrast, fTEFAP detected yeast in each of the three samples: two showed Candida albicans and the third Candida parapsilosis. fTEFAP also identified a lower level of Candida tropicalis in one of the wounds that was positive for Candida albicans. The qPCR wound panel results were returned within two hours, while the fTEFAP results were returned within 24 hours. CONCLUSION: Two new molecular methods have been developed to aid wound pathogen diagnostics. The quantitative PCR wound panel is rapid but is limited to major wound-associated bacteria and yeasts. The universal fTEFAP and bTEFAP methods take 24 hours to return results but are able to detect the relative contribution of any bacteria of yeast in a chronic wound diagnostic sample. DECLARATION OF INTEREST: Southwest Regional Wound Care Center is a clinical wound-care provider seeking to improve the ability of wound care practitioners to help patients. The Research and Testing Laboratory develops molecular methods including fTEFAP, bTEFAP and the quantitative PCR wound panel.


Subject(s)
Biofilms , Candidiasis/diagnosis , Mycological Typing Techniques/methods , Polymerase Chain Reaction/methods , Wound Infection/microbiology , Bacterial Infections/classification , Bacterial Infections/diagnosis , Candidiasis/classification , Chronic Disease , Diabetic Foot/microbiology , Humans , Surgical Wound Infection/diagnosis , Surgical Wound Infection/microbiology
10.
Bol. micol ; 22: 75-80, dic. 2007. tab, graf
Article in Spanish | LILACS | ID: lil-598293

ABSTRACT

Con el objeto de conocer las especies causantes de candidosis humanas en pacientes HIV positivos o con otras inmunodeficiencias secundarias y la incidencia de especies con capacidad de resistencia a antifúngicos, se estudiaron 76 aislamientos de Candida procedentes de 61 casos de candidosis superficiales y profundas de niños y adultos. Obtenidas desde piel, anexos, mucosas, abscesos, catéteres y secreciones diversas, entre otras. La identificación de las especies fue realizada por estudios de características morfológicas, cromogénicas y bioquímicas (CHROMagar , Candifast, API 20 y API 32). Los resultados revelan predominio de especies noalbicans (52.7 por ciento), obteniéndose las siguientes frecuencias de aislamientos: C.albicans (47,3 por ciento), C. parapsilosis: 15,8 por ciento, C. glabrata: 13,2 por ciento, C. krusei: 11,8 por ciento, C. tropicalis: 10,6 por ciento y C. dubliniensis: 1,3 por ciento. Algunas de ellas pueden presentar resistencia primaria o secundaria a algunos antifúngicos de uso habitual, por lo cual es necesario incluir estudios de sensibilidad a estos, para una mejor conducta terapéutica.


In order to find out species causing human candidosis in positive HIV patients or in individuals suffering from other secondary immunodeficiencies and the incidence of species bearing a resistance ability to antifungal agents, 76 Candida isolations obtained from 61 cases of superficial and deep candidosis in children and adults were studied. Samples were collected from skin, annexa, mucosities, abscesses, catheters and diverse secretions, among others. The identification of species was carried out through studies on morphological, chromogenic and biochemical characteristics (CHROMagar, Candifast, API 20 and API 32). Results reveal a predominance of non-albican species (52,7 percent), and the following frequencies of isolation: C.albicans (47.3 percent), C. parapsilosis: 15.8 percent, C.glabrata: 13.2 percent, C. krusei: 11.8 percent, C. tropicalis: 10.6 percent and C. dubliniensis: 1.3 percent. Some of them may exhibit some primary or secondary resistance to certain antifungal agents of common use, this is why it is necessary to include studies on sensitivity of them so as to attain a better therapeutical behaviour.


Subject(s)
Humans , Male , Adult , Female , Child , AIDS-Related Opportunistic Infections , Antifungal Agents/antagonists & inhibitors , Antifungal Agents/therapeutic use , Candidiasis/classification , Candidiasis/etiology , Candidiasis/genetics , Candidiasis/microbiology , Candidiasis/prevention & control , Candidiasis/therapy , Candidiasis/transmission , Argentina , Immune System Diseases/complications
12.
J Infect ; 55(2): 174-8, 2007 Aug.
Article in English | MEDLINE | ID: mdl-17560655

ABSTRACT

OBJECTIVES: To describe the species distribution and antifungal susceptibility trends for documented episodes of candidemia at the Royal Hospitals, Belfast, 2001-2006. METHODS: Laboratory-based retrospective observational study of all episodes of candidemia. RESULTS: There were 151 episodes of candidemia. The species recovered were: 96 C. albicans; 26 C. glabrata; 18 C. parapsilosis; five C. tropicalis; four C. guilliermondii; one C. famata and one C. dubliniensis. We separated the data into two periods 2001-2003 and 2004-2006; contrary to the findings of other investigators, there was a notable trends toward increasing frequency of C. albicans and decreasing frequency of non-albicans species over time. Although the proportion of C. albicans, C. parapsilosis and C. tropicalis isolates susceptible to fluconazole was unchanged over time, a trend of decreased susceptibility of C. glabrata to fluconazole was noted over the six-year period. Overall, 73% and 7.7% of C. glabrata isolates had susceptible-dose-dependent and resistant phenotypes, respectively. The percentage of C. glabrata isolates susceptible to fluconazole (MIC <8 microg/ml) decreased from 36% in 2001-2003 to 0% in 2004-2006. Flucytosine resistance was detected in only 4 (2.7%) isolates. None of the isolates had an amphotericin B MIC <1 microg/ml. CONCLUSION: A shift towards increasing dominance of C. albicans contrasts both with reports from other countries and previous data from Northern Ireland. Upwards fluconazole MIC drift among C. glabrata has important implications for empirical therapeutic decisions.


Subject(s)
Antifungal Agents/pharmacology , Candida/drug effects , Candidiasis/classification , Candida/classification , Candida/isolation & purification , Candida glabrata/drug effects , Candidiasis/drug therapy , Candidiasis/epidemiology , Hospitals, University/statistics & numerical data , Humans , Medical Records Systems, Computerized , Microbial Sensitivity Tests , Northern Ireland/epidemiology , Prevalence , Retrospective Studies
13.
Clin Infect Dis ; 44(12): e109-14, 2007 Jun 15.
Article in English | MEDLINE | ID: mdl-17516389

ABSTRACT

BACKGROUND: Fungemia has been historically considered to be a disease caused by a single Candida species; the detection of >1 species of yeast in circulating blood was distinctly uncommon using traditional microbiological procedures. We describe episodes of mixed fungemia (MF), detected between 1985 and 2006, in a large teaching hospital. METHODS: The study was divided into 2 periods that were separated by the introduction, in January 2005, of the CHROmagar Candida medium (CHROMagar) for the routine subculturing of blood cultures in which yeast has been identified. Overall, we documented 747 cases of fungemia. During the first period (1985-1994), we identified 217 episodes of fungemia and no single episode of MF; during the second period (1995-2006), 15 episodes of MF were detected among 530 episodes of fungemia (2.8%). Candida albicans was isolated in 13 patients, non-albicans species of Candida in 16 patients, and Saccharomyces cerevisiae in 1 patient. Each episode of MF was compared with 2 control episodes of monomicrobial fungemia. RESULTS: Patients with MF had more frequently experienced organ transplantation (13% vs. 0%) and surgery (60% vs. 27%), had less frequently received parenteral nutrition (40% vs. 70%) or had intravenous lines (80% vs. 100%), and had a lower incidence of shock (6% vs. 37%) and a lower mortality (20% vs. 53%). CONCLUSIONS: Despite the introduction of chromogenic agar, MF is still an uncommon disease and has a less severe outcome than does monomicrobial candidemia.


Subject(s)
Candidiasis/classification , Candidiasis/mortality , Fungemia/microbiology , Fungemia/mortality , Adolescent , Adult , Aged , Aged, 80 and over , Candida/classification , Candida/pathogenicity , Candidiasis/complications , Child , Child, Preschool , Female , Hospital Mortality , Hospitals, Teaching/statistics & numerical data , Humans , Infant , Male , Microbial Sensitivity Tests , Middle Aged , Retrospective Studies , Risk Factors , Saccharomyces cerevisiae/pathogenicity , Spain/epidemiology
14.
Rev. iberoam. micol ; 23(1): 8-11, ene. 2006. tab
Article in Es | IBECS | ID: ibc-044995

ABSTRACT

La infección invasora por Candida spp. en pacientes no neutropénicos ingresadosen las unidades de cuidados intensivos puede dividirse en infecciones focalesy sistémicas. Ambos tipos de infección suele producirse tras un episodio decandidemia, aunque existen infecciones invasoras focales exógenas, como lasrelacionadas con traumatismos o instrumentación. El espectro clínico de lasinfecciones profundas por Candida spp. incluye las infecciones focales urinarias,abdominales, oculares, respiratorias, renales y hepatobiliares y las infeccionessistémicas, como la candidemia y la candidiasis diseminada con afectación multiorgánicamediante siembra hematógena. El aislamiento de Candida spp. enmuestras consideradas “significativas”, como el líquido articular, el líquido cefalorraquídeoy los hemocultivos, implica infección probada. Sin embargo, el diagnósticode infección invasora basado en muestras no significativas, como losdrenajes quirúrgicos y exudados del tubo digestivo, requiere tener en cuenta elnúmero de aislamientos en muestras diferentes, factores de riesgo para estetipo de infección, así como la respuesta clínica y el estado de gravedad delhuésped. La presentación clínica de la infección invasora sistémica por Candidaspp. es completamente inespecífica en cuanto a signos de infección, indistinguiblede la peritonitis bacteriana, de la infección urinaria por bacterias, o de la bacteriemia.Estas infecciones pueden acompañarse de signos de sepsis, de sepsisgrave, shock séptico o disfunción multiorgánica. En el futuro es necesario realizarestudios clínicos multicéntricos descriptivos y alcanzar acuerdos para definircon mayor claridad algunos de los criterios clínicos diagnósticos y de clasificaciónde las infecciones invasoras por Candida spp. en pacientes críticos noinmunodeprimidos


Invasive Candida spp. infections in non-neutropenic critically ill patients admittedto intensive care units can be classified as focal and systemic. Both types ofinfection usually occur after episodes of candidemia, although some focal infectionsmay be of exogenous development, like those occurring after trauma or bedevice-related. The clinical spectrum of invasive Candida spp. infections includesfocal urinary tract, abdominal, ocular, respiratory tract, renal and hepato-biliaryinfections, as well as systemic infections like candidemia and acute systemiccandidiasis with multiorgan involvement after hematogenous seeding. Candidaspp. isolates in “significant” samples, like synovial fluid, cerebrospinal fluid andblood cultures, represent true infection. However, the diagnosis of invasive infectionbased on “non-significant” samples, like surgical drains and digestive tractexudates, requires additional criteria. The total number of isolates from differentsites, the presence of risk factors, the clinical host response, as well as severityof illness need to be taken into account for the diagnosis of invasive candidiasis


Subject(s)
Humans , Candidiasis/microbiology , Critical Illness , Candida/pathogenicity , Candidiasis/classification , Candidiasis/transmission , Candida/isolation & purification , Intensive Care Units , Cross Infection/microbiology , Sepsis/microbiology
15.
Med. clín (Ed. impr.) ; 126(supl.1): 3-6, ene. 2006. tab
Article in Spanish | IBECS | ID: ibc-144036

ABSTRACT

En este trabajo se consideran equivalentes las denominaciones micosis superficiales y dermatomicosis. Éstas engloban, por tanto, todas las infecciones fúngicas de localización cutánea y cutaneomucosa. Las clasificamos según sus agentes etiológicos, y distinguimos 2 grandes apartados, según estén ocasionadas por levaduras o por hongos filamentosos. El primero comprende 2 grupos: las candidiasis, producidas por especies de género Candida, la piedra blanca, por Trichosporon spp., y la pitiriasis versicolor, por levaduras basidiosporadas lipofílicas, singularmente Malassezia globosa. El segundo apartado incluye a su vez 4 subgrupos: las dermatofitosis o tiñas, ocasionadas por hongos queratinofílicos que conocemos como dermatófitos, la piedra negra, por Piedraia hortae, la tinea nigra, por Hortaea werneckii, las infecciones dermatofitosis-like ocasionadas por Scytaldium dimidiatum y, por último, las infecciones, de localización ungueal en su mayor parte originadas por distintos mohos (Scopulariopsis brevicaulis, Onychocola canadensis, Aspergillus spp., Fusarium spp., Alternaria spp., Acremonium spp., Curvularia spp.). Se aborda también la posición taxonómica del Regnum fungi en el marco de los seres vivos, y las características de sus taxones principales; se indica la situación en éstos de los hongos implicados como agentes etiológicos en las micosis superficiales (AU)


In the present study the terms superficial mycoses and dermatomycoses are used as equivalents. These terms include, therefore, all cutaneous and mucocutaneous fungal infections. These are classified according to their etiological agents, distinguishing two main types, according to whether they are produced by yeast or by filamentous fungi. The first type includes 2 groups: candidiasis, produced by species of the Candida genus, white piedra, produced by Trichosporon spp, and tinea versicolor, produced by lipophilic basidiomycetous yeasts, especially Malassezia globosa. The second type includes 4 subgroups: the dermatophytoses or tineas, caused by keratinophilic fungi, known as dermatophytes, black piedra, produced by Piedraia hortae, tinea nigra, produced by Hortaea werneckii, dermatophytosis-like infections produced by Scytaldium dimidiatum and, lastly, infections with mainly ungual localization, caused by distinct molds (Scopulariopsis brevicaulis, Oncychocola canadensis, Aspergillus spp, Fusarium spp, Alternaria spp, Acremonium spp, Curvularia spp…). The taxonomic position of the Regnum fungi within the context of living organisms is also discussed, as well as the characteristics of its main taxa, and the situation of the fungi implicated as etiological agents in superficial mycoses within these taxa is indicated (AU)


Subject(s)
Female , Humans , Male , Mycoses/classification , Dermatomycoses/classification , Candida/classification , Candida/isolation & purification , Candidiasis/classification , Candidiasis, Cutaneous/classification , Candidiasis, Cutaneous/diagnosis
16.
Lancet ; 366(9495): 1435-42, 2005.
Article in English | MEDLINE | ID: mdl-16243088

ABSTRACT

BACKGROUND: Voriconazole has proven efficacy against invasive aspergillosis and oesophageal candidiasis. This multicentre, randomised, non-inferiority study compared voriconazole with a regimen of amphotericin B followed by fluconazole for the treatment of candidaemia in non-neutropenic patients. METHODS: Non-neutropenic patients with a positive blood culture for a species of candida and clinical evidence of infection were enrolled. Patients were randomly assigned, in a 2:1 ratio, either voriconazole (n=283) or amphotericin B followed by fluconazole (n=139). The primary efficacy analysis was based on clinical and mycological response 12 weeks after the end of treatment, assessed by an independent data-review committee unaware of treatment assignment. FINDINGS: Of 422 patients randomised, 370 were included in the modified intention-to-treat population. Voriconazole was non-inferior to amphotericin B/fluconazole in the primary efficacy analysis, with successful outcomes in 41% of patients in both treatment groups (95% CI for difference -10.6% to 10.6%). At the last evaluable assessment, outcome was successful in 162 (65%) patients assigned voriconazole and 87 (71%) assigned amphotericin B/fluconazole (p=0.25). Voriconazole cleared blood cultures as quickly as amphotericin B/fluconazole (median time to negative blood culture, 2.0 days). Treatment discontinuations due to all-cause adverse events were more frequent in the voriconazole group, although most discontinuations were due to non-drug-related events and there were significantly fewer serious adverse events and cases of renal toxicity than in the amphotericin B/fluconazole group. INTERPRETATION: Voriconazole was as effective as the regimen of amphotericin B followed by fluconazole in the treatment of candidaemia in non-neutropenic patients, and with fewer toxic effects. RELEVANCE TO PRACTICE: There are several options for treatment of candidaemia in non-neutropenic patients, including amphotericin B, fluconazole, voriconazole, and echinocandins. Voriconazole can be given both as initial intravenous treatment and as an oral stepdown agent.


Subject(s)
Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Candidiasis/drug therapy , Fluconazole/therapeutic use , Pyrimidines/therapeutic use , Triazoles/therapeutic use , APACHE , Adolescent , Adult , Aged , Aged, 80 and over , Amphotericin B/adverse effects , Antifungal Agents/adverse effects , Candidiasis/classification , Candidiasis/mortality , Drug Therapy, Combination , Female , Fluconazole/adverse effects , Humans , Male , Middle Aged , Pyrimidines/adverse effects , Treatment Outcome , Triazoles/adverse effects , Voriconazole
18.
Chest ; 124(6): 2244-55, 2003 Dec.
Article in English | MEDLINE | ID: mdl-14665507

ABSTRACT

STUDY OBJECTIVES: To develop and prospectively validate models of independent predictors of candidemia and candidemia-related death in cardiothoracic ICU (CICU) patients. DESIGN: (1) An initial, prospective, one-center, case-control, independent predictor-model determining study; and (2) a prospective, two-center, model-validation study. SETTING: The initial study was performed at the 14-bed CICU of the Onassis Cardiac Surgery Center, Athens, Greece; the model-validation study was performed at the Onassis Cardiac Surgery Center CICU and the 12-bed CICU of Henry Dunant General Hospital, Athens, Greece. PATIENTS: In the initial study, 4,312 patients admitted to the Onassis Center CICU between March 1997 and October 1999 were considered for enrollment; 30 candidemic and 120 control patients (case/control ratio, 1/4) matched according to potential confounders were ultimately enrolled. In the model-validation study, 2,087 patients admitted to the Onassis and Henry Dunant CICUs between November 1999 and May 2002 were prospectively enrolled. MEASUREMENTS AND RESULTS: Models of predictors of candidemia and associated death were constructed with stepwise logistic regression and subsequently validated. Independent candidemia predictors were ongoing invasive mechanical ventilation (IMV) > OR =10 days, hospital-acquired bacterial infection and/or bacteremia, cardiopulmonary bypass duration > 120 min, and diabetes mellitus. Model performance was as follows: sensitivity, 53.3%/57.9%; specificity, 100%/100%; positive predictive value (PPV), 100%/100%; negative predictive value (NPV), 88.9%/99.6%; and accuracy, 90.1%/99.6% (initial/model-validation study values, respectively). IMV > or =10 days and hospital-acquired bacterial infection/bacteremia were the two strongest candidemia predictors. APACHE (acute physiology and chronic health evaluation) II score > or =30 at candidemia onset independently predicted candidemia-related death with 80.0%/85.7% sensitivity, 80%/75% specificity, 66.7%/66.7% PPV, 88.9%/88.9% NPV, and 80.0%/78.9% accuracy (initial/model-validation study values, respectively). CONCLUSIONS: We provided a set of easily determinable independent predictors of the occurrence of candidemia in CICU patients. Our results provide a rationale for implementing preventive measures in the form of independent predictor control, and initiating antifungal prophylaxis in high-risk CICU patients.


Subject(s)
Candidiasis/mortality , Intensive Care Units , Logistic Models , APACHE , Antifungal Agents/therapeutic use , Blood Glucose , Candidiasis/blood , Candidiasis/classification , Case-Control Studies , Comorbidity , Female , Fluconazole/therapeutic use , Greece , Humans , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Risk Factors
19.
J Clin Microbiol ; 41(11): 5250-3, 2003 Nov.
Article in English | MEDLINE | ID: mdl-14605175

ABSTRACT

We identified 29 yeast isolates from 22 patients using the API ID32C panel. Twenty-eight of these isolates were Candida norvegensis and one was C. inconspicua. Although C. norvegensis is considered a pseudohypha-producing species, only one isolate produced pseudohyphae. Restriction enzyme analysis of PCR-amplified ribosomal DNA with four different enzymes proved that all isolates were C. inconspicua.


Subject(s)
Candida/classification , Candida/genetics , Candidiasis/diagnosis , DNA, Ribosomal/genetics , Candida/isolation & purification , Candidiasis/classification , Humans , Inpatients , Outpatients , Polymorphism, Restriction Fragment Length , Reproducibility of Results , Restriction Mapping/methods
20.
Transplantation ; 75(12): 2023-9, 2003 Jun 27.
Article in English | MEDLINE | ID: mdl-12829905

ABSTRACT

BACKGROUND: This study determines whether the spectrum, risk factors, and outcome of invasive candidiasis in liver transplant recipients have changed. METHODS: Thirty-five consecutive liver transplant recipients with invasive candidiasis were prospectively studied in a case-controlled, multicenter study. One control was matched with the case for duration of hospitalization and the other for antibiotic use so that risk factors unique in liver transplantation could be elicited. RESULTS: In matched-pair analysis, antibiotic prophylaxis for spontaneous bacterial peritonitis (odds ratio [OR] 8.3, P=0.002), posttransplant dialysis (OR 7.6, P=0.0009), and retransplantation (OR 16.4, P=0.0018) were independently significant predictors of invasive candidiasis. Candida spp. included C. albicans in 65% of patients, C. glabrata in 21%, C. tropicalis in 9%, C. parapsilosis in 3%, and C. guilliermondii in 3%. Patients with C. albicans infections were less likely to have received antifungal prophylaxis than those with non-albicans Candida infections (13.6% vs. 50%, P=0.04). The mortality rate was 36.1% for the cases and 2.8% for the controls (OR 25.0, 95% confidence interval, 6.2-100.5, P=0.0002). Non-albicans Candida infections (P=0.04) and prior antifungal prophylaxis (P=0.05) correlated with poorer outcome in the cases. CONCLUSIONS: Our study has identified predictors for Candida infections in the current era that have implications relevant for targeting the prophylaxis toward the high-risk patients. Routine use of antifungal prophylaxis warrants concern given the emergence of non-albicans Candida spp. as significant pathogens after liver transplantation and higher mortality in patients with these infections.


Subject(s)
Candidiasis/epidemiology , Liver Transplantation/adverse effects , Postoperative Complications/microbiology , Anti-Bacterial Agents/therapeutic use , Antifungal Agents/therapeutic use , Bacterial Infections/prevention & control , Blood Transfusion , Candida/classification , Candidiasis/classification , Candidiasis/drug therapy , Female , Humans , Liver Diseases/classification , Liver Diseases/surgery , Male , Middle Aged , Odds Ratio , Predictive Value of Tests , Prospective Studies , Regression Analysis , Risk Factors , Treatment Outcome
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