Oral Candida isolates in patients undergoing radiotherapy for head and neck cancer: Prevalence, azole susceptibility profiles and response to antifungal treatment

Oral pseudomembranous candidiasis and mucositis were assessed in 39 patients receiving a total dose of 39-70 Gy radiotherapy for head and neck cancer. Mucositis was scored using the Radiation Therapy Oncology Group criteria, and oral candidiasis was diagnosed on the basis of clinical evaluation and quantitative laboratory findings. Radiation-induced mucositis was observed in 9/39 patients. Only 3/39 patients discontinued radiotherapy due to acute severe mucosal effects. Candidiasis (colony-forming units 35 to ≥60/lesion) associated with mucositis was diagnosed in 30/39 patients: the most frequent aetiology of the infection was Candida albicans (n = 23), followed by Candida glabrata (n = 3), Candida krusei (n = 2), Candida tropicalis (n = 1) and Candida kefyr (n = 1). Patients with confirmed oral pseudomembranous candidiasis were treated with either fluconazole 200 mg/day or itraconazole 200 mg/day for 2 weeks. Clinical improvement and concomitant negative Candida cultures (mycologie cure) were the criteria determining a response to antifungal treatment. Etest revealed very low voriconazole MICs (0.004-0.125 μg/ml) for all isolates, and fluconazole resistance for eight C. albicans strains (MIC > 64 μg/ml) and for the C. krusei isolates (MIC > 32 μg/ml). The same strains showed itraconazole susceptibility dose dependence (MIC 0.5 μg/ml). Despite the itraconazole susceptible dose dependent MIC readings, all patients with oral pseudomembranous candidiasis caused by these strains responded to antifungal treatment with 200 mg/day itraconazole. Oral mycologie surveillance of patients undergoing radiotherapy for head and neck malignancies and susceptibility testing of isolates may be indicated in cases with mucositis-associated confirmed oral pseudomembranous candidiasis to ensure prompt administration of targeted antifungal treatment. On the basis of the low MIC values found, clinical evaluation of voriconazole is indicated for management of oral pseudomembranous candidiasis refractory to other azoles

Pivotal Role of Both TNF-α 238G/A and TCF7L2 C/T Gene Polymorphisms in Type 2 Diabetes: Pivotal role of both TNFα 238G/A and TCF7L2 C/T gene polymorphisms in Type 2 Diabetes

Single nucleotide polymorphism (SNP) studies in the promoter region of tumor necrosis factor-alpha (TNF-α (238)) have suggested its role in increased insulin resistance and also in the progression from prediabetes to type 2 diabetes (T2DM). It has been reported that genetic variations in the promoter region regulate TNF-α production and transcription, and they influence susceptibility to inflammatory-related diseases. Impairment of normal functioning of the β-cells of pancreatic islets is one of the main causative factors for the suppression of insulin secretion. TNF-α is among the main stimuli that induce the inflammation in pancreatic islets which lead to the induction of apoptosis in β-cells of pancreatic islets. Transcription factor 7-like 2 (TCF7L2) gene has been found to be one of the most risky genes for prediabetes and progression toT2DM. However, the underlying mechanism of this is still unknown. This is a review article demonstrating the possible mechanisms of both TNF-α G/A 238 and TCF7L2 C/T gene polymorphisms in prediabetes and type 2 diabetes mellitus

Reduced incidence of pneumonia in influenza-vaccinated solid organ transplant recipients with influenza disease

AbstractWhether influenza vaccination influences the severity of illness in cases of clinical failure in solid organ transplant (SOT) recipients receiving influenza vaccine has not been extensively studied. Our goal was to evaluate the frequency of influenza vaccination among SOT recipients with influenza disease and its impact on the illness severity during the 2010–2011 season. Adult SOT recipients with confirmed influenza infection were included from December 2010 to April 2011. Follow-up data were recorded and antibody titres were determined using a microneutralization assay. Sixty-four SOT recipients were included in the study, ten (15.6%) with severe disease, requiring admission to intensive care units, of whom four (6.3%) died. In all, 34 (53.1%) received the 2010–2011 seasonal influenza vaccine and 32 (50.0%) received the 2009-H1N1 pandemic vaccine, and none had detectable antibodies against influenza at the time of diagnosis of influenza infection. Twenty-three (67.6%) of the patients that received the vaccine required hospital admission and presented less dyspnoea (10, 29.4% versus 14 (50.0%), p 0.09) and pneumonia (8, 23.8% versus 15, 50.0%, p 0.03, relative risk 0.3, 95% CI 0.1-0.9) than unvaccinated patients, with relative risk reductions of 60% and 70%, respectively. Although influenza vaccination confers protection on SOT recipients against developing influenza pneumonia, the rate of clinical failure is still high. New strategies to improve influenza immunization are needed for this group of patients