Candida sp. infections in patients with Diabetes mellitus

Candidiasis has increased substantially worldwide over recent decades and is a significant cause of morbidity and mortality, especially among critically ill patients. Diabetes mellitus (DM) is a metabolic disorder that predisposes individuals to fungal infections, including those related to Candida sp., due to a immunosuppressive effect on the patient. This review aims to discuss the latest studies regarding the occurrence of candidiasis on DM patients and the pathophysiology and etiology associated with these co-morbidities. A comprehensive review of the literature was undertaken. PubMed, Scopus, Elseviers ScienceDirect, and Springers SpringerLink databases were searched using well-defined search terms. Predefined inclusion and exclusion criteria were applied to classify relevant manuscripts. Results of the review show that DM patients have an increased susceptibility to Candida sp. infections which aggravates in the cases of uncontrolled hyperglycemia. The conclusion is that, for these patients, the hospitalization periods have increased and are commonly associated with the prolonged use of indwelling medical devices, which also increase the costs associated with disease management.This study was supported by the Portuguese Foundation for Science and Technology (FCT) under the scope of: the strategic funding of UID/BIO/04469/2013 unit, COMPETE 2020 (POCI-01-0145-FEDER-006684) and BioTecNorte operation (NORTE-01-0145-FEDER-000004) funded by the European Regional Development Fund under the scope of Norte2020-Programa Operacional Regional do Norte, financially supported by project UID/EQU/00511/2019 - Laboratory for Process Engineering, Environment, Biotechnology and Energy – LEPABE funded by national funds through FCT/MCTES (PIDDAC), and by Célia F. Rodrigues’ [SFRH/BD/93078/2013] PhD grant and M. Elisa Rodrigues [SFRH/BPD/95401/2013] post-doc grant.info:eu-repo/semantics/publishedVersio

DNA Extraction and Identification of Trichophyton rubrum by Real-Time Polymerase Chain Reaction from Direct Nail Scraping Specimens of Patients with Onycomycosis

Trichophyton rubrum is the most frequently encountered dermatophyte species causing onichomycosis. The routine diagnosis of dermatophytes depends on the direct microscopic examination (DME) and culture methods, however due to the phenotypic identification problems related to those agents, the molecular methods come into question. The aim of this study was to evaluate the diagnostic performance of real-time polymerase chain reaction (RT-PCR) for the identification of T.rubrum by comparing to DME and culture methods, from nail samples of patients with the complaints of onychomycosis. A total of 90 patients of whom 58 were male who were admitted to the dermatology outpatients clinics of our hospital with the complaints of color/shape changes in the nails and thickening of the nail, were included in the study, together with the 20 healthy volunteer subjects as controls. The nail scraping samples obtained from the patients and controls were examined with direct microscopy using 15% potassium hydroxide, dimethyl sulphoxide and chlorazole black mixture and cultivated onto Sabouraud dextrose agar with and without cycloheximide. For DNA isolation, after the disruption of nail samples with a steel tool, phenol-chloroform-isoamyl alcohol purification method were used. The amplification and demonstration of the T.rubrum DNA have been performed by using specific primers and probes following TaqMan protocol of RT-PCR (Light Cycler-Roche, USA) method. Seventy-two of the patients yielded positive and 18 yielded negative results with DME. Growth of molds was detected in the cultures of 20 (27.8%) of the 72 DME positive patients and all of the isolates were identified as T.rubrum. No fungal growth was seen in the samples of 18 patients who were DME negative. In DME positive group, 67 (93%) patients were found to be positive in RT-PCR, while 8 (44.4%) patients were RT-PCR positive in DME negative group. All of the culture positive samples (n= 20) were also found positive in RT-PCR. All of the samples from the control group with healthy nails yielded negative results in DME, culture and RT-PCR methods. The performance of PCR method were compared to direct microscopy that had higher sensitivity than culture and the sensitivity, specificity, positive and negative predictive values of RTPCR assay were estimated as 93%, 56%, 89% and 67%, respectively. In conclusion RT-PCR was thought to be an efficient and rapid assay in the diagnosis of onichomycosis. Although RT-PCR seems more expensive than culture, for the centres which already have support for the molecular methods, the difference in total cost doesn't count much. In conclusion, by the use of molecular methods DNA isolation was successfully done from a relatively difficult clinical specimen, namely nail scraping, a protocole that could easily be applied in routine laboratory was established and species-level identification in a short time was accomplished in this study

Infective Keratitis Caused by Acremonium spp. and Pseudomonas mesophilica (A Case Report)

Acremonium spp. (previously known as Cephalosporium) and Pseudomonas mesophilica were isolated from a patient who had infective keratitis caused by corneal trauma. In this case, clinical and microbiological findings of Acremonium spp. and P. mesophilica are presented

Yeast vaginitis during pregnancy: Susceptibility testing of 13 antifungal drugs and boric acid and the detection of four virulence factors

PubMedID: 22369624A higher prevalence of vulvovaginal candidiasis (VVC) is seen in pregnant women compared with those who are not pregnant. Recurrence is also more common in pregnant women, and therapeutic responses are reduced. In this investigation, 207 vaginal yeast isolates recovered from pregnant women were tested for susceptibility to 13 antifungal drugs and boric acid and through these studies four virulence factors were also determined. The isolates were recovered from vaginal samples of patients with acute VVC [AVVC, (n = 73)], symptomatic recurrent VVC [RVVC, (n = 89)], asymptomatic RVVC (n = 27), and those without signs and symptoms (n = 18). Candida albicans was the most common species found (59.9%), followed by C. glabrata (19.8%), other Candida spp., (19.8%), and Saccharomyces cerevisiae (0.5%). Antifungal susceptibility testing was performed as described in CLSI document M27-A3. Additionally, we examined phospholipase and proteinase production, adhesion to vaginal epithelial cells and hemolytic activity. Notably, the MIC values of Candida spp. isolates derived from patients with VVC were no different from those of the controls (P > 0.05). In addition, Candida isolates derived from patients with AVVC or RVVC produced significantly higher amounts of phospholipase and proteinase compared with the controls (P <0.05). Antifungal testing and the determination of virulence factors may lead to the effective and prompt treatment of VVC, particularly in pregnant women. © 2012 ISHAM.Funding was received from both Ç ukurova University, Adana, Turkey (Project No: TF2010BAP1) and Gazi University, Ankara, Turkey. Additionally, we appreciate and give our sincere thanks to two anonymous reviewers for their critical comments on earlier drafts of this paper

Candida vaginitis in non-pregnant patients: A study of antifungal susceptibility testing and virulence factors

PubMedID: 23654320Vulvovaginal candidosis (VVC) is a major problem for the female population worldwide, and considerably little is known about the difference between acute VVC (AVVC) and recurrent VVC (RVVC). We investigated the susceptibility to six antifungal agents and boric acid of Candida spp. isolated from vaginal cultures, as described in the CLSI document M27-A3, from 228 non-pregnant sexually active women (aged 18-49 years), and the virulence factors of these isolates. The isolates were derived from patients with AVVC (n = 64), those with RVVC (n = 125) and those without signs or symptoms (n = 39). In total, C. albicans was the most commonly isolated species (50%), followed by C. glabrata (35.5%) and other Candida spp. (14.5%). We observed slightly different minimum inhibitory concentration (MICs) for various antifungals among the species and study groups that could have potential therapeutic benefits for the treatment. Analysis of the virulence factors revealed that haemolytic activity is not involved in VVC pathogenesis but that germ-tube formation, adhesion to VECs, and proteinase and phospholipase production may be important in the pathogenesis of VVC. © 2013 Informa UK, Ltd

In Vitro Susceptibility of Clinical Candida lusitaniae Isolates Against Amphotericin B: A Multicenter Study

Amaç: Amfoterisin B (AmB) invazif mantar enfeksiyonlarının tedavisinde kullanılan poliyen grubu bir antifungaldir. Klinikte Candida lusitaniae ile oluşan mantar enfeksiyonlarının AmB tedavisine yanıt vermediği, in vitro duyarlılık testlerinde kökenlerin dirençli bulunduğu bildirilmiştir. AmB ile karşılaşma sonrasında minimum inhibitör konsantrasyon (MİK) değerlerinin yükseldiği ile ilgili çalışmalar bulunduğu gibi, tersine kökenlerin bütünüyle AmB'ye duyarlı olduğunu bildiren çalışmalar da bulunmaktadır. Bu çalışmanın amacı, C. lusitaniae kökenlerinin AmB duyarlılığının gösterilmesidir.Gereç ve Yöntem: Bu çalışma kapsamında dört ayrı merkezden tür düzeyinde tanımlanmış 60 C. lusitaniae kökeni toplanmıştır. Toplanan kökenlerin tür düzeyinde tanımlanmaları üç merkezde klasik mikolojik yöntemler ile yapılmıştır. Acıbadem Üniversitesi Tıp Fakültesi, Tıbbi Mikrobiyoloji Anabilim Dalı'nda tür tanımı MALDI-TOF cihazı ile gerçekleştirilmiştir. Gazi Üniversitesi Tıp Fakültesi, Tıbbi Mikrobiyoloji Anabilim Dalı'nda kökenlere in vitro duyarlılık testi uygulanmıştır. Clinical and Laboratory Standards Institute (CLSI) mikrodilüsyon yöntemi ve E-test yöntemi ile MİK değerleri elde edilmiştir. Bulgular: Mikrodilüsyon yönteminden elde edilen MİK değerlerine göre MİK aralığı 0.125-2 ?g/ml, MİK50 değeri 0.5 ?g/ml, MİK90değeri 1 ?g/ml olarak hesaplanmıştır. E-test sonucunda elde edilen MİK değerlerine göre MİK aralığı 0.012-2 ?g/ml, MİK50 değeri 0.25 ?g/ml, MİK90 değeri 0.75 ?g/ml olarak hesaplanmıştır. Mikrodilüsyon yöntemi sonuçlarına göre 60 kökenden 8 tanesinden (%13), E-test sonuçlarına göre 6 tanesinden (% 10) >= 1 ?g/ml MİK değerleri elde edilmiştir. Mikrodilüsyon ile iki, E-test ile bir köken için MİK değeri 2 ?g/ml olarak bulunmuştur. Sonuç: Bu in vitro çalışma, AmB'ye intrensek dirençli olduğu ileri sürülen C. lusitaniae kökenlerinin in vitro duyarlı olduğunu, bu nedenle C. lusitaniae enfeksiyonlarında AmB kullanımı seçeneğinin yeniden gözden geçirilmesi gerektiğini ortaya çıkarmıştır. Sonuçlarımız in vivo modeller ile desteklendiğinde daha kesin yargılara varılabilecektirAim: Amphotericin B (AmB) is a wide spectrum antifungal drug which is used for the treatment of invasive fungal infections. Among the fungal pathogens, Candida lusitaniae has been reported to be resistant to AmB in-vitro. Therefore, AmB is not recommended for the treatment of C. lusitaniae infections. There are conflicting data on this subject in the literature. Some of the studies showed that minimal inhibitory concentration (MIC) values increased following exposure to AmB, while the others indicated that all C. lusitaniae were fully susceptible to AmB. The aim of the present study was to evaluate the AmB susceptibility of the C. lusitaniae strains.Materials and Methods: The study included 60 C. lusitaniae strains obtained from four different teaching hospitals in Turkey. The strains were identified at species level by using conventional methods in three of the centers and by MALDI-TOF method in one center. In vitro susceptibility testing was performed by E-test and Clinical and Laboratory Standards Institute (CLSI) reference microdilution method. Results: AmB MIC range was found as 0.125-2 ?g/ml, MIC50 value was 0.5 ?g/ml, and MIC90 value was 1 ?g/ml by microdilution method. MIC range, MIC50, and MIC90 values were 0.012-2 ?g/ml, 0.25 ?g/ml, and 0.75 ?g/ml by E-test method, respectively. The number of isolates with MIC &gt;=1 ?g/ml were 8 (13%), and 6 (10%), for microdilution and E-test methods, respectively. MIC value was 2 ?g/ml for two strains by microdilution method, and one strain by E-test method. Conclusion: Our results showed that C. lusitaniae strains which were considered as intrinsically resistant, were susceptible to AmB. Although, more definite conclusions achieved by in vivo studies are required, this study indicated that AmB could be a good choice for the treatment of infections caused by C. lusitania

Protective Effect of Beta Glucan on Pulmonary Aspergillosis Model in Neutropenic Rats

Objective: Pulmonary aspergillosis is a serious opportunistic infection which might be fatal in immunocompromised patients. Immunity against aspergillosis requires the coordinated action of components of the innate and adaptive immune systems. Beta-glucan is one of the immunomodulatory agents which got much attention in recent years. It was used as a preventive agent for the development of infections. However, information about its the possible protective effect on fungal infections are limited. The aim of this study aimed to investigate the possible protective effects of beta-glucan against Aspergillus fumigatus infection. Material and Methods: We evaluated oral beta glucan administration for its ability to enhance resistance of the rats to experimentally induced pulmonary aspergillosis. Fifty-eight rats were divided into three groups: Thirty five rats were immunosuppressed and infected with Aspergillus fumigatus (infected group); 15 were immunosuppressed, infected and treated with oral beta-glucan (beta-glucan group); and eight were healthy controls. Rats were sacrificed on the tenth day of the experiment and tissue specimens were cultured. Chitin, galactomannan antigen and glucan levels were detected. Results: Beta-glucan enhanced the resistance against Aspergillus infection. The survival rates were 62.9% and 93.4% in the infected and beta-glucan groups, respectively (p<0.05). Beta glucan also limited the fungal burden. Conclusion: Our results suggested that Aspergillus invasion did not develop in beta-glucan group in spite of the occurence of fungal colonization in neutropenic rats. Beta-glucan was able to improve the resistance against A. fumigatus infection.WoSScopu

Molecular Investigation Of A Fungemia Outbreak Due To Candida Parapsilosis In An Intensive Care Unit

We investigated a nosocomial cluster of four Candida parapsilosis fungemia episodes that occurred in a neurological intensive care unit over a two-week period. The four infected patients had received parenteral nutrition through central lines, and all four had catheter-related candidemia. All of the isolates were susceptible to all of the antifungals tested, including amphotericin B, fluconazole, voriconazole, and caspofungin. They had strictly related fingerprints, based on randomly amplified polymorphic DNA analysis. Additional DNA sequencing data revealed that they were same strain. Although no isolate of Candida parapsilosis was recovered from other clinical, surveillance, or environmental samples, nosocomial spread of this yeast ceased, following the reinforcement of infection-control measures. Candida parapsilosis may require an intravascular foreign body to cause fungemia, but this outbreak shows that it can be transmitted nosocomially and can cause epidemics.Wo