Catastrophic Candida prosthetic valve endocarditis and COVID-19 comorbidity: A rare case

Background and Purpose: Coronavirus disease 2019 (COVID-19) and Candida prostatic valve endocarditis present various clinical manifestations which may overlap;hence, discrimination between them is extremely difficult.Case report: The case was a 66-year-old man with a past medical history of mitral and aortic valves replacement one year before COVID-19 co-infection. He was admitted with fever (for 7 days), shortness of breath, cough, seizure, lethargy,headache, and 85% oxygen saturation. Transesophageal echocardiography revealed multiple large-sized, highly mobile masses on both sides of the mechanical mitral valve highly suggestive of vegetation. Chest computed tomography scanning showed simulating scattered COVID-19 peripheral ground-glass opacities confirmed by reverse-transcription polymerase chain reaction. The set of blood cultures yieldedyeast colonies that were identified as Candida tropicalis. The patient died of septic shock shortly after receiving antifungal therapy.Conclusion: This case emphasized the importance of early diagnosis andimplementation of antifungal treatment, particularly in patients with prosthetic cardiacvalves, to reduce their unfavorable outcomes in COVID-19 patient

Candida Urinary Tract Infections; Treatment Protocol

Background and purpose: The choice of antifungal agent in treatment of Candida urinary tract infections (CUTI) is dependent on the site of infection, the underlying disease of the patient, and the pharmacokinetics/pharmacodynamics (PK/PD) of the agent. This study aimed to perform a review of antifungal therapy for CUTI. Materials and methods: Data was obtained by a search for full-text articles in Medline, PubMed, Embase, Scopus, Web of Science, Science Direct, Google Scholar, Magiran, Irandoc, and Iran Medex published from 1994 until 2016. The search keywords included urinary tract infections, Candida species, diagnosis, and treatment. Results: Fluconazole is the drug of choice for prophylaxis and treatment of CUTI due to low toxicity, high solubility, and wide tissue distribution. Although flucytosine is concentrated in urine and has potent activity against Candida species, treatment is restricted because of its toxicity and expansion of resistance when it is used alone. In addition, amphotericin B is an active drug against most Candida species (except resistant C. krusei strains). Other azoles and echinocandins are not effective for treating CUTI due to the minimum excretion of the active compound into the urine. However, a localized renal infection followed by blood spreading might be treated by echinocandins because of its effective tissue concentrations. Conclusion: We presented diagnostic tests and treatment protocols of CUTI, but new surveillance protocols and diagnostic strategies for control and prevention of CUTI in critically ill patients are essential

Comparative virulence of Candida auris with Candida haemulonii, Candida glabrata and Candida albicans in a murine model

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In Vitro Antifungal Susceptibility Profile of Miltefosine against a Collection of Azole and Echinocandins Resistant Fusarium Strains

Fusarium species are filamentous fungi that cause a variety of infections in humans. Because they are commonly resistant to many antifungal drugs currently available in clinical settings, research into alternative targets in fungal cells and therapeutic approaches is required. The antifungal activity of miltefosine and four comparators, amphotericin B, voriconazole, itraconazole, and caspofungin, were tested in vitro against a collection of susceptible and resistant clinical (n = 68) and environmental (n = 42) Fusarium isolates. Amphotericin B (0.8 μg/mL) had the lowest geometric mean (GM) MICs/MECs values followed by miltefosine (1.44 μg/mL), voriconazole (2.15 μg/mL), caspofungin (7.23 μg/mL), and itraconazole (14.19 μg/mL). Miltefosine was the most effective agent against Fusarium isolates after amphotericin B indicating that miltefosine has the potential to be studied as a novel treatment for Fusarium infections