ABSTRACT
The aim of this work is the application of pectin coatings containing Cryptococcus laurentii as a method of biocontrol of Penicillium expansum for postharvest protection of apples. For this purpose, the yeast was incorporated into a pectin matrix, and its viability and biocontrol activity in vitro and in vivo against P. expansum was evaluated over time. In addition, the influence of the sterilization process on coating thickness was studied. Results showed that pectin coating with C. laurentii enhanced mycelial growth inhibition in vitro studies, while no significant differences were observed in disease incidence and severity reduction in vivo studies. The sterilization process reduced the viscosity of the pectin solution, resulting in coating thicknesses ranging from 0.5 to 1 µm. As a general evaluation, in vitro and in vivo, biocontrol assays were useful in demonstrating better postharvest protection of the yeast at 7 °C concerning 25 °C.
Subject(s)
Cryptococcus , Food Preservation , Malus , Pectins , Penicillium , Penicillium/growth & development , Penicillium/drug effects , Malus/microbiology , Pectins/pharmacology , Cryptococcus/growth & development , Cryptococcus/drug effects , Food Preservation/methods , Plant Diseases/microbiology , Plant Diseases/prevention & controlABSTRACT
RI76 is a novel 2-thiazolylhydrazone compound with reported antifungal activity. In preclinical drug development, it is fundamental to know the impurity profile and to understand degradation mechanisms of the molecule. In our study, RI76 was subjected to forced degradation conditions, and a stability-indicating HPLC-DAD method was developed and validated. Separation was carried out on a C18 column (150 × 4.6 mm i.d., 5 µm) maintained at 40°C using a 1 mL/min flow rate of 2 mM ammonium acetate with 0.1% formic acid (pH 3.0) and acetonitrile in gradient mode. The method was linear in the range of 0.7-91 µg/mL for RI76 and 0.7-25 µg/mL for its degradation product PD76. The formation of a major degradation product was quickly observed when RI76 was in aqueous solution. The chemical structure of this product, named PD76, was proposed based on LC-UV-MS experiments, synthesized in-house, and confirmed by NMR spectroscopy and chromatographic analysis. In vitro antifungal activity assays demonstrated that this resultant product shows a promising activity against clinically important Candida and Cryptococcus strains, matching or surpassing the activity of its precursor and of well-established antifungal drugs.
Subject(s)
Antifungal Agents/analysis , Antifungal Agents/pharmacology , Antifungal Agents/chemistry , Antifungal Agents/pharmacokinetics , Candida/drug effects , Chromatography, High Pressure Liquid/methods , Cryptococcus/drug effects , Drug Stability , Limit of Detection , Linear Models , Reproducibility of ResultsABSTRACT
The objective of this study was to evaluate the effects of nanoparticles (nanospheres and nanocapsules) of the promising antifungal 2-amino-thiophene (6CN10) and 6CN10 complexed with 2-hydroxypropyl-ß-cyclodextrin (6CN10:HP-ß-CD) in vitro and compared with free drug against Candida and Cryptococcus, using a microdilution method to measure susceptibility. The Candida and Cryptococcus clinical strains were identified using phenotypic methods and matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF). To measure in vitro antifungal susceptibility, we used microdilution trials. Serial drug or nanoparticle dilutions were prepared according to the CLSI M27-A3 guidelines. Anti-biofilm activity was verified for Cryptococcus neoformans. All Candida isolates were sensitive to the free drug (MIC = 41.66-333.33 µg/mL) and were able to grow even at the higher concentration tested for all 6CN10 nanoparticles. However, the Cryptococcus neoformans strains presented MIC values of 0.32-83.33 µg/mL for 6CN10 nanoparticles, and MIC values of 0.1-0.2 µg/mL for 6CN10:HP-ß-CD nanoparticles, i.e., 3333 times more active than the free drug (MIC values 166.66-333.33 µg/mL), and presenting activity greater than that of the reference drug amphotericin B (MIC = 0.5-0.125 µg/mL). 6CN10:HP-ß-CD nanosphere also showed high anti-biofilm potential. The in vitro study showed that the nanoparticles allowed better drug efficiency against Cryptococcus than did the free drug. These results suggest that 6CN10-loaded nanoparticles may become a future alternative for cryptococcosis and candidiasis therapy. In vivo experiments are essential prior to clinical use.
Subject(s)
Antifungal Agents/pharmacology , Fungi/drug effects , Nanoparticles/chemistry , Thiophenes/chemistry , Thiophenes/pharmacology , Antifungal Agents/chemistry , Candida/drug effects , Cryptococcus/drug effects , Cyclodextrins/chemistry , Humans , Microbial Sensitivity TestsABSTRACT
Cryptococcosis is a life-threatening fungal infection, and its current treatment is toxic and subject to resistance. Drug repurposing represents an interesting approach to find drugs to reduce the toxicity of antifungals. In this study, we evaluated the combination of N-acetylcysteine (NAC) with amphotericin B (AMB) for the treatment of cryptococcosis. We examined the effects of NAC on fungal morphophysiology and on the macrophage fungicidal activity 3 and 24 hours post inoculation. The therapeutic effects of NAC combination with AMB were investigated in a murine model with daily treatments regimens. NAC alone reduced the oxidative burst generated by AMB in yeast cells, but did not inhibit fungal growth. The combination NAC + AMB decreased capsule size, zeta potential, superoxide dismutase activity and lipid peroxidation. In macrophage assays, NAC + AMB did not influence the phagocytosis, but induced fungal killing with different levels of oxidative bursts when compared to AMB alone: there was an increased reactive oxygen species (ROS) after 3 hours and reduced levels after 24 hours. By contrast, ROS remained elevated when AMB was tested alone, demonstrating that NAC reduced AMB oxidative effects without influencing its antifungal activity. Uninfected mice treated with NAC + AMB had lower concentrations of serum creatinine and glutamate-pyruvate transaminase in comparison to AMB. The combination of NAC + AMB was far better than AMB alone in increasing survival and reducing morbidity in murine-induced cryptococcosis, leading to reduced fungal burden in lungs and brain and also lower concentrations of pro-inflammatory cytokines in the lungs. In conclusion, NAC + AMB may represent an alternative adjuvant for the treatment of cryptococcosis.
Subject(s)
Acetylcysteine/therapeutic use , Amphotericin B/toxicity , Antifungal Agents/therapeutic use , Cryptococcosis/drug therapy , Deoxycholic Acid/toxicity , Kidney/drug effects , Amphotericin B/pharmacology , Amphotericin B/therapeutic use , Animals , Antifungal Agents/pharmacology , Antifungal Agents/toxicity , Brain/drug effects , Brain/microbiology , Creatinine/blood , Cryptococcosis/microbiology , Cryptococcus/drug effects , Deoxycholic Acid/pharmacology , Deoxycholic Acid/therapeutic use , Disease Models, Animal , Drug Combinations , Drug Repositioning , Female , Kidney/microbiology , Lung/drug effects , Lung/microbiology , Macrophages/drug effects , Macrophages/microbiology , Mice , Mice, Inbred C57BL , Microbial Sensitivity Tests , Reactive Oxygen SpeciesABSTRACT
Cryptococcosis is a disseminated infection caused mainly by C. neoformans and C. gattii. Limitations for the treatment involve the selection of isolates resistant to conventional antifungal drugs, prolonged treatment time and drugs side effects. This study evaluated the combined effect of histone deacetylase inhibitors (HDACi) and photodynamic therapy (PDT) on the growth of C. neoformans and C. gattii in vitro. Results showed that PDT inhibited yeasts proliferation and enhanced the HDACi-mediated cell viability impairment in Cryptococcus spp.
Subject(s)
Cryptococcus/drug effects , Histone Deacetylase Inhibitors/pharmacology , Indoles/pharmacology , Organometallic Compounds/pharmacology , Photochemotherapy/methods , Photosensitizing Agents/pharmacology , Cell Cycle/drug effects , HumansSubject(s)
Cross Infection/microbiology , Cross Infection/urine , Cryptococcosis/microbiology , Cryptococcosis/urine , Cryptococcus/isolation & purification , Adult , Aged , Aged, 80 and over , Antifungal Agents/therapeutic use , Cross Infection/drug therapy , Cryptococcosis/drug therapy , Cryptococcus/drug effects , Female , Fluconazole/therapeutic use , Humans , Itraconazole/therapeutic use , Male , Mexico , Middle Aged , Retrospective StudiesABSTRACT
Aim: This study aimed to evaluate the effects of proton pump inhibitors (PPIs) on growth and melanin production by Cryptococcus spp. Materials & methods: Minimum inhibitory concentrations (MICs) of omeprazole, esomeprazole, rabeprazole, pantoprazole and lansoprazole against Cryptococcus spp. were determined and the effect of PPIs on melanin production was evaluated, in the presence or absence of copper sulfate or glutathione. Results: PPIs showed MICs ranging from 125-1000 µg/ml and decreased melanization by Cryptococcus cells. Addition of copper sulfate or gluthatione restored melanogenesis of cells grown in the presence of PPIs. The presence of PPIs and glyphosate decreased copper sulfate toxicity (1 mM). Conclusion: PPIs inhibited melanogenesis of Cryptococcus spp., possibly by chelating copper or inhibiting copper ATPase transport.
Subject(s)
Antifungal Agents/pharmacology , Cryptococcus/drug effects , Cryptococcus/metabolism , Melanins/biosynthesis , Proton Pump Inhibitors/pharmacology , Adenosine Triphosphatases , Copper , Copper Sulfate/metabolism , Cryptococcus/growth & development , Culture Media/chemistry , Esomeprazole/pharmacology , Glutathione/metabolism , Glycine/analogs & derivatives , Humans , Lansoprazole/pharmacology , Microbial Sensitivity Tests , Omeprazole/pharmacology , Pantoprazole/pharmacology , Rabeprazole/pharmacology , GlyphosateABSTRACT
Lippia species share various pharmacological activities and are used in traditional cooking and medicine worldwide. Combined chromatographic techniques such as column chromatography, high-performance liquid chromatography, and countercurrent chromatography led to the purification of two new antifungal phenylpropanoid glycosides, lippiarubelloside A (1) and lippiarubelloside B (2), by bioactivity-directed fractionation of an ethanol-soluble extract from Lippia rubella, in addition to the known active related compounds forsythoside A (3), verbascoside (4), isoverbascoside (5), and poliumoside (6). The structures of compounds 1 and 2 were determined by comparison of their NMR spectroscopic data with the prototype active compound 4. Cryptococcus neoformans, which causes opportunistic lung infections, was sensitive to compounds 1-6 in the concentration range of 15-125 µg/mL. A synergistic effect (FICindex = 0.5) between 3 and amphotericin B was demonstrated. The glycosylated flavonoids pectolinarin (7), linarin (8), and siparunoside (9) were also isolated.
Subject(s)
Antifungal Agents/pharmacology , Glycosides/pharmacology , Lippia/chemistry , Phenylpropionates/pharmacology , Antifungal Agents/chemistry , Candida/drug effects , Cryptococcus/drug effects , Glycosides/chemistry , Phenylpropionates/chemistry , Plant Extracts/chemistry , Plant Extracts/pharmacology , Spectrum Analysis/methodsABSTRACT
Cryptococcus species are an encapsulated fungal pathogen that cause cryptococcal meningitis. There are limited therapeutic options for this infection. The management includes the use of different antifungals such as amphotericin B, flucytosine, or fluconazole, either alone or in combination. However, numerous therapeutic failures, as well as the limited effectiveness of such therapeutics, have been described. Diphenyl diselenide is a chemically synthesised molecule with was found to have antimicrobial activity. In this study, we evaluated the antifungal activities of fluconazole, amphotericin B and flucytosine, in combination with diphenyl diselenide against 30 clinical isolates of Cryptococcus spp. using CLSI M27-A3 method and the checkerboard microdilution technique. Our results show that the combination of flucytosine and diphenyl diselenide displayed 100% of synergism. However, when we analysed (PhSe)2 plus AMB or FLZ we observed around 70% of indifference. Our results suggest that the combination of diphenyl diselenide with other antifungal agents deserves attention as a new option for the development of alternative therapies for cryptococcosis.
Subject(s)
Amphotericin B/pharmacology , Antifungal Agents/pharmacology , Benzene Derivatives/pharmacology , Cryptococcus/drug effects , Drug Synergism , Fluconazole/pharmacology , Flucytosine/pharmacology , Organoselenium Compounds/pharmacology , Cryptococcosis/microbiology , Humans , Microbial Sensitivity TestsABSTRACT
Cryptococcosis is an opportunistic or primary fungal infection considered to be the most prevalent fatal fungal disease worldwide. Owing to the limited number of available drugs, it is necessary to search for novel antifungal compounds. In the present work, we assessed the antifungal efficacy of three thiazole derivatives (1, 2, and 3). We conducted in vitro and in vivo assays to investigate their effects on important virulence factors, such as capsule and biofilm formation. In addition, the phagocytosis index of murine macrophages exposed to compounds 1, 2, and 3 and the in vivo efficacy of 1, 2, and 3 in Galleria mellonella infected with Cryptococcus spp. were evaluated. All compounds exhibited antifungal activity against biofilms and demonstrated a reduction in biofilm metabolic activity by 43-50% for C. gattii and 26-42% for C. neoformans. Thiazole compounds promoted significant changes in the capsule thickness of C. gattii compared to that of C. neoformans. Further examination of these compounds suggests that they can improve the phagocytosis process of peritoneal murine macrophages in vitro, causing an increase in the phagocytosis rate. Survival percentage was examined in the invertebrate model Galleria mellonella larvae, and only compound 3 could increase the survival at doses of 5 mg/kg after infection with C. gattii (P = .0001) and C. neoformans (P = .0007), similar to fluconazole at 10 mg/kg. The results demonstrated that thiazole compounds, mainly compound 3, have potential to be used for future studies in the search for new therapeutics for cryptococcosis.
Subject(s)
Antifungal Agents/pharmacology , Biofilms/drug effects , Cryptococcosis/microbiology , Cryptococcus/drug effects , Cryptococcus/pathogenicity , Thiazoles/pharmacology , Virulence Factors/antagonists & inhibitors , Animals , Antifungal Agents/chemistry , Biofilms/growth & development , Cells, Cultured , Cryptococcosis/immunology , Disease Models, Animal , Fungal Polysaccharides/biosynthesis , Larva/microbiology , Larva/physiology , Macrophages/drug effects , Macrophages/microbiology , Mice , Molecular Structure , Moths , Phagocytosis/drug effects , Survival Analysis , Thiazoles/chemistryABSTRACT
The endophytic fungus Mycosphaerella sp. (UFMGCB2032) was isolated from the healthy leaves of Eugenia bimarginata, a plant from the Brazilian savanna. Two novel usnic acid derivatives, mycousfuranine (1) and mycousnicdiol (2), were isolated from the ethyl acetate extract, and their structure was elucidated by NMR and MS analyses. Compounds 1 and 2 exhibited moderate antifungal activities against Cryptococcus neoformans and Cryptococcus gattii, each with minimum inhibitory concentration values of 50.0 µg/mL and 250.0 µg/mL, respectively.
Subject(s)
Antifungal Agents/pharmacology , Ascomycota/chemistry , Benzofurans/pharmacology , Antifungal Agents/analysis , Ascomycota/pathogenicity , Benzofurans/analysis , Cryptococcus/drug effects , Eugenia/microbiologyABSTRACT
INTRODUCTION: Cryptococcosis is one of the most devastating human fungal infections. Despite its impact, none of the standard antifungals were developed after 1990. New, improved, less toxic, affordable and widely available treatment is, therefore, imperative. AREAS COVERED: This review offers an insight into technological developments for cryptococcosis disclosed in patent literature. From a broad search of patent documents claiming cryptococcosis treatment and having earliest priority between 1995 and 2015, we selected and summarized compounds/molecules (i) revealed in documents disclosing in vivo activity against Cryptococcus spp. or (ii) found in the pipeline of companies that appeared as assignees in our patent search. This information was complemented with data on compounds under development for this indication from the database Integrity (Clarivate Analytics). EXPERT OPINION: This review demonstrates that drug development against cryptococcosis is discrete. However, it also shows that the existing development is not focused on a single class of molecules, but on different types of molecules with distinct fungal targets, reflecting the complexity of generating novel anti-cryptococcal tools. Given the intrinsic difficulties and high costs of drug development and the evident market failure in this field, we consider drug repurposing the most promising avenue for cryptococcosis treatment.
Subject(s)
Antifungal Agents/pharmacology , Cryptococcosis/drug therapy , Drug Design , Animals , Antifungal Agents/toxicity , Cryptococcosis/microbiology , Cryptococcus/drug effects , Drug Repositioning , Humans , Patents as TopicABSTRACT
The objective of this study was to analyze mycelial growth under different culture conditions and antimicrobial activity of Pleurotus ostreatus (Jacq.: Fr.) Kumm. (DPUA 1533) and P. ostreatus (Jacq.: Fr.) Kumm. cv. Florida (DPUA 1534) against fungi and bacteria of medical importance. The growth of Pleurotus species was evaluated in natural and complex media, with and without light, at 25°C and 28°C for 8, 15, and 30 days. Candida albicans (DPUA 1336), Cryptococcus laurentii (DPUA 1501), Aspergillus flavus (DPUA 1836), Escherichia coli (DAUPE 224), and Mycobacterium smegmatis (ATCC 607) were used to test antibiosis. Under all growth conditions in vitro, Pleurotus species evidenced growth and high density of mycelia on potato dextrose agar and Sabouraud agar with yeast extract; mycelial growth but lesser mycelial density was observed on rice bran extract agar. Organic mycelial extracts of Pleurotus species exhibited potential antibacterial and antifungal activity, and were selective for the tested microorganisms.
Subject(s)
Anti-Bacterial Agents/pharmacology , Antifungal Agents/pharmacology , Culture Media/pharmacology , Mycelium/growth & development , Pleurotus/chemistry , Anti-Bacterial Agents/isolation & purification , Antifungal Agents/isolation & purification , Aspergillus flavus/drug effects , Aspergillus flavus/physiology , Bacteria/drug effects , Candida albicans/drug effects , Candida albicans/physiology , Cryptococcus/drug effects , Cryptococcus/physiology , Culture Media/chemistry , Escherichia coli/drug effects , Escherichia coli/physiology , Light , Microbial Sensitivity Tests , Mycelium/drug effects , Mycobacterium smegmatis/drug effects , Mycobacterium smegmatis/physiology , Pleurotus/drug effects , Pleurotus/growth & development , Pleurotus/physiology , Temperature , Time FactorsABSTRACT
In the search for new antifungal agents, a novel series of fifteen hydrazine-thiazole derivatives was synthesized and assayed in vitro against six clinically important Candida and Cryptococcus species and Paracoccidioides brasiliensis. Eight compounds showed promising antifungal activity with minimum inhibitory concentration (MIC) values ranging from 0.45 to 31.2⯵M, some of them being equally or more active than the drug fluconazole and amphotericin B. Active compounds were additionally tested for toxicity against human embryonic kidney (HEK-293) cells and none of them exhibited significant cytotoxicity, indicating high selectivity. Molecular modeling studies results corroborated experimental SAR results, suggesting their use in the design of new antifungal agents.
Subject(s)
Antifungal Agents/chemistry , Antifungal Agents/pharmacology , Candida/drug effects , Cryptococcus/drug effects , Paracoccidioides/drug effects , Thiazoles/chemistry , Thiazoles/pharmacology , Antifungal Agents/chemical synthesis , Candidiasis/drug therapy , Cryptococcosis/drug therapy , HEK293 Cells , Humans , Microbial Sensitivity Tests , Models, Molecular , Paracoccidioidomycosis/drug therapy , Structure-Activity Relationship , Thiazoles/chemical synthesisABSTRACT
Cryptococcosis is a fungal disease of global significance for which new effective treatments are needed. The conjugation of the synthetic antimicrobial peptide fragment UBI 31-38 to a coumarin derivative showed to be an effective approach for the design of a novel anticryptococcal agent. In addition to antifungal activity, the conjugate exhibited intense fluorescence, which could be valuable for mechanistic investigations of this molecule. In this work, we studied the photophysical properties of the conjugate and confocal scanning laser microscopy was used to inspect the distribution of the peptide-coumarin conjugate in Cryptococcus cell. The synergism of this compound with amphotericin B or fluconazole against C. gattii and C. neoformans strains was also investigated. The results indicated that the fluorescent conjugate alone as well as its combination with amphotericin B are promising tools against cryptococcosis.
Subject(s)
Amphotericin B/pharmacology , Antifungal Agents/pharmacology , Coumarins/pharmacology , Cryptococcosis/drug therapy , Cryptococcus/drug effects , Peptide Fragments/pharmacology , Amphotericin B/chemistry , Antifungal Agents/chemical synthesis , Antifungal Agents/chemistry , Coumarins/chemistry , Cryptococcus/cytology , Dose-Response Relationship, Drug , Drug Synergism , Humans , Microbial Sensitivity Tests , Molecular Structure , Peptide Fragments/chemical synthesis , Peptide Fragments/chemistry , Photochemical Processes , Structure-Activity RelationshipABSTRACT
ABSTRACT Fluconazole is extensively used for the treatment of candidiasis and cryptococcosis. Among other factors, successful treatment is related to appropriate fluconazole levels in blood and cerebrospinal fluid. In the present study, fluconazole levels were determined in 15 patients, 14 of whom had AIDS and 13 had neurocryptococcosis. The only selection criterion was treatment with fluconazole, which was performed with a generic or similar form of the drug. Fluconazole level was determined by high performance liquid chromatography and the susceptibility profile of Cryptococcus spp. isolated from the patients was assessed by broth microdilution. Blood and cerebrospinal fluid fluconazole levels were found to be related to the fluconazole daily dose, and exceeded the minimum inhibitory concentration of this antifungal for the Cryptococcus spp. isolates. A good correlation was observed between serum and cerebrospinal fluid drug concentration. In conclusion, treatment with non-original fluconazole under usual medical practice conditions results in appropriate blood and cerebrospinal fluid levels of the drug for inhibiting Cryptococcus spp. susceptible to this antifungal drug. The relatively common failures of neurocryptococcosis treatment appear not to be due to insufficient fluconazole levels in the cerebrospinal fluid, especially with the use of daily doses of 400-800 mg.
Subject(s)
Humans , Adult , Middle Aged , Fluconazole/cerebrospinal fluid , Fluconazole/blood , Cryptococcosis/drug therapy , Antifungal Agents/cerebrospinal fluid , Antifungal Agents/blood , Reference Values , Candidiasis/cerebrospinal fluid , Candidiasis/drug therapy , Candidiasis/blood , Microbial Sensitivity Tests , Fluconazole/administration & dosage , Chromatography, High Pressure Liquid , Treatment Outcome , AIDS-Related Opportunistic Infections/drug therapy , Statistics, Nonparametric , Cryptococcosis/cerebrospinal fluid , Cryptococcosis/blood , Cryptococcus/isolation & purification , Cryptococcus/drug effects , Dose-Response Relationship, Drug , Histoplasmosis/cerebrospinal fluid , Histoplasmosis/drug therapy , Histoplasmosis/blood , Antifungal Agents/administration & dosageABSTRACT
The purpose of this study was to evaluate the influence of intracranial hypertension in the cerebrospinal fluid (CSF) levels of amphotericin B and fluconazole levels of patients with cryptococcal meningitis. CSF samples and intracranial pressure were obtained by means of routine punctures performed at days 1, 7, and 14 of therapy, respectively. Amphotericin B and fluconazole CSF levels were measured by HPLC method as previously described. The minimum inhibitory concentration for amphotericin B, fluconazole, 5Îflucytosine, and voriconazole of each Cryptococcus isolate was performed according to CLSI. The predominant Cryptococcus species found was C. neoformans, and the major underlying condition was AIDS. Only one CSF sample had a detectable level for amphotericin B during the 14 days of therapy. Fluconazole CSF levels progressively increased from day 1 to day 14 of therapy for most cases. Fluconazole levels in the CSF were above the minimum inhibitory concentrations (MICs) for Cryptococcus during the initial 14 days of antifungal therapy. Variations of intracranial pressure did not affect amphotericin B and fluconazole levels in the CSF. The generalized estimating correlation (GEE) and Spearman correlation test (SCT) showed no significant correlation between the amphotericin B or fluconazole concentrations in the CSF and intracranial pressure (P = .953 and P = .093, respectively for GEE test and P = .477 and P = .847, respectively, for SCT). Combination therapy of amphotericin B with fluconazole was effective in 60% of the patients considering CSF cultures were negative in 9 of 15 patients after 14 days of therapy. Further studies are necessary to evaluate the role of intracranial hypertension on the therapeutic efficacy of different antifungal agents in patients with cryptococcal meningitis.
Subject(s)
Amphotericin B/cerebrospinal fluid , Cryptococcus/drug effects , Fluconazole/cerebrospinal fluid , Intracranial Pressure/drug effects , Meningitis, Cryptococcal/drug therapy , Meningitis, Cryptococcal/physiopathology , AIDS-Related Opportunistic Infections/complications , AIDS-Related Opportunistic Infections/microbiology , Adult , Aged , Amphotericin B/pharmacology , Amphotericin B/therapeutic use , Antifungal Agents/cerebrospinal fluid , Antifungal Agents/pharmacology , Antifungal Agents/therapeutic use , Brazil , Child , Cryptococcus/isolation & purification , Drug Therapy, Combination , Female , Fluconazole/pharmacology , Fluconazole/therapeutic use , Flucytosine/pharmacology , Follow-Up Studies , Humans , Male , Meningitis, Cryptococcal/cerebrospinal fluid , Meningitis, Cryptococcal/microbiology , Microbial Sensitivity Tests , Middle Aged , Tertiary Care Centers , Treatment Outcome , Voriconazole/pharmacologyABSTRACT
Fluconazole is extensively used for the treatment of candidiasis and cryptococcosis. Among other factors, successful treatment is related to appropriate fluconazole levels in blood and cerebrospinal fluid. In the present study, fluconazole levels were determined in 15 patients, 14 of whom had AIDS and 13 had neurocryptococcosis. The only selection criterion was treatment with fluconazole, which was performed with a generic or similar form of the drug. Fluconazole level was determined by high performance liquid chromatography and the susceptibility profile of Cryptococcus spp. isolated from the patients was assessed by broth microdilution. Blood and cerebrospinal fluid fluconazole levels were found to be related to the fluconazole daily dose, and exceeded the minimum inhibitory concentration of this antifungal for the Cryptococcus spp. isolates. A good correlation was observed between serum and cerebrospinal fluid drug concentration. In conclusion, treatment with non-original fluconazole under usual medical practice conditions results in appropriate blood and cerebrospinal fluid levels of the drug for inhibiting Cryptococcus spp. susceptible to this antifungal drug. The relatively common failures of neurocryptococcosis treatment appear not to be due to insufficient fluconazole levels in the cerebrospinal fluid, especially with the use of daily doses of 400-800mg.
Subject(s)
Antifungal Agents/blood , Antifungal Agents/cerebrospinal fluid , Cryptococcosis/drug therapy , Fluconazole/blood , Fluconazole/cerebrospinal fluid , AIDS-Related Opportunistic Infections/drug therapy , Adult , Antifungal Agents/administration & dosage , Candidiasis/blood , Candidiasis/cerebrospinal fluid , Candidiasis/drug therapy , Chromatography, High Pressure Liquid , Cryptococcosis/blood , Cryptococcosis/cerebrospinal fluid , Cryptococcus/drug effects , Cryptococcus/isolation & purification , Dose-Response Relationship, Drug , Fluconazole/administration & dosage , Histoplasmosis/blood , Histoplasmosis/cerebrospinal fluid , Histoplasmosis/drug therapy , Humans , Microbial Sensitivity Tests , Middle Aged , Reference Values , Statistics, Nonparametric , Treatment OutcomeABSTRACT
Heavy metals at elevated concentrations are a major threat to agricultural and human health. Typically, human activities tend to release these metals to the environment in aqueous solutions, generating high levels of pollution due to the mobility of the heavy metals. The aim of the present work was to assess heavy metal tolerance in yeasts isolated from Río Agrio - Lake Caviahue volcanic acidic aquatic environment and to evaluate the capacity of selected strains to capture metals in acidic culture media conditions. The ability of three yeast species, Cryptococcus agrionensis, Cryptococcus sp. 2, and Coniochaeta fodinicola, to tolerate and capture metals in live cultures has been evaluated. These three yeast species showed high tolerance to low pH and elevated concentrations of metals, thus implying their autochthonous status. Minimal inhibitory concentration (MIC) for growth obtained for these isolates showed elevated tolerance to the six heavy metals evaluated and were significantly higher than those registered for other microorganisms. C. agrionensis was able to capture 15.80 mg (g biomass)-1 of Cu2+ (MIC: 0.22 g L-1 ), Cryptococcus sp. 2 was able to capture 36.25 and 65.28 mg (g biomass)-1 of Ni2+ and Zn2+ , respectively (MIC: 0.56 and 1.68, respectively), and C. fodinicola was able to capture 67.11 mg (g biomass)-1 of Zn2+ (MIC: 3.75). This work reported the ability of yeasts to capture metals in acidic conditions for the first time. We hope that it represents the step-stone for future researches in the ability and metabolism of yeasts form acidic aquatic environment related to metal tolerance and capture.
Subject(s)
Cryptococcus/metabolism , Metals, Heavy/metabolism , Volcanic Eruptions , Yeasts/metabolism , Argentina , Biodegradation, Environmental , Biomass , Cryptococcus/drug effects , Cryptococcus/isolation & purification , Humans , Hydrogen-Ion Concentration , Metals, Heavy/pharmacology , Microbial Sensitivity Tests , Yeasts/drug effects , Yeasts/isolation & purificationABSTRACT
The second cause of death among systemic mycoses, cryptococcosis treatment represents a challenge since that 5-flucytosine is not currently available in Brazil. Looking for alternatives, this study evaluated antifungal agents, alone and combined, correlating susceptibility to genotypes. Eighty Cryptococcus clinical isolates were genotyped by URA5 gene restriction fragment length polymorphism. Antifungal susceptibility was assessed following CLSI-M27A3 for amphotericin (AMB), 5-flucytosine (5FC), fluconazole (FCZ), voriconazole (VRZ), itraconazole (ITZ) and terbinafine (TRB). Drug interaction chequerboard assay evaluated: AMB + 5FC, AMB + FCZ, AMB + TRB and FCZ + TRB. Molecular typing divided isolates into 14 C. deuterogattii (VGII) and C. neoformans isolates were found to belong to genotype VNI (n = 62) and VNII (n = 4). C. neoformans VNII was significantly less susceptible than VNI (P = 0.0407) to AMB; C. deuterogattii was significantly less susceptible than VNI and VNII to VRZ (P < 0.0001). C. deuterogattii was less susceptible than C. neoformans VNI for FCZ (P = 0.0170), ITZ (P < 0.0001) and TRB (P = 0.0090). The combination FCZ + TRB showed 95.16% of synergistic effect against C. neoformans genotype VNI isolates and all combinations showed 100% of synergism against genotype VNII isolates, suggesting the relevance of cryptococcal genotyping as it is widely known that the various genotypes (now species) have significant impact in antifungal susceptibilities and clinical outcome. In difficult-to-treat cryptococcosis, terbinafine and different antifungal combinations might be alternatives to 5FC.