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Candida Albicans Infection in Autism

Authors:

Abstract

Autism children were reported to have gastrointestinal problems that are more frequent and more severe than in children from the general population. Although many studies demonstrate that GI symptoms are common in autism, the exact percentage suffering from gastrointestinal (GI) problems is not well known, but there is a general consensus that GI problems are common in autism. The observation that antifungal medications improve the behavior of autism children, encourage us to investigate their intestinal colonization with yeasts. Aim of the work: The purpose of this work was to investigate the intestinal colonization with yeasts in autistic patients and to assess the role of yeast as a risk factor to cause autism behavior. Patients and methods: The study included 83 cases diagnosed as autistic children referred from the neuro-pediatric clinic and 25 normal children as a control group. All children under the study came to Phoniatric clinic, during the period from 2010 to 2012, complaining of delayed language development with autistic features. Children in this study were classified into 2 groups; control and study groups. All children were subjected to interview, E.N.T examination, language assessment, Childhood Autistic Rating Score (CARS), stool culture for Candida albicans, complete audiological and psychometric evaluation. Results: There was significant relation between the autistic children and heavy growth of Candida albicans in stool culture. Conclusion: The high rate of Candida albicans intestinal infection in autistic children may be a part of syndrome related to immune system disorders in these patients.
americanscience.orgjofhttp://www.) 122012;8( Journal of American Science
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Candida Albicans Infection in Autism
Emam AM 1, Mamdouh M. Esmat 2, and Abdelrahim A. Sadek 3
1 Phoniatrics unit, E.N.T Department, Faculty of Medicine, Sohag University, Egypt
2Medical Microbiology and Immunology Department, Faculty of Medicine Sohag University, Egypt
3 Neurology Unit, Department of Pediatric Medicine, Faculty of Medicine Sohag University, Egypt
mmesmat2000@yahoo.com
Abstract: Background: Autism children were reported to have gastrointestinal problems that are more frequent and
more severe than in children from the general population. Although many studies demonstrate that GI symptoms are
common in autism, the exact percentage suffering from gastrointestinal (GI) problems is not well known, but there is
a general consensus that GI problems are common in autism. The observation that antifungal medications improve
the behavior of autism children, encourage us to investigate their intestinal colonization with yeasts. Aim of the
work: The purpose of this work was to investigate the intestinal colonization with yeasts in autistic patients and to
assess the role of yeast as a risk factor to cause autism behavior. Patients and methods: The study included 83
cases diagnosed as autistic children referred from the neuro-pediatric clinic and 25 normal children as a control
group. All children under the study came to Phoniatric clinic, during the period from 2010 to 2012, complaining of
delayed language development with autistic features. Children in this study were classified into 2 groups; control
and study groups. All children were subjected to interview, E.N.T examination, language assessment, Childhood
Autistic Rating Score (CARS), stool culture for Candida albicans, complete audiological and psychometric
evaluation. Results: There was significant relation between the autistic children and heavy growth of Candida
albicans in stool culture. Conclusion: The high rate of Candida albicans intestinal infection in autistic children
may be a part of syndrome related to immune system disorders in these patients.
[Emam AM, Mamdouh M. Esmat and Abdelrahim A. Sadek. Candida Albicans Infection in Autism ]Journal of
American Science 2012;8(12):739-744]. (ISSN: 1545-1003). http://www.americanscience.org. 103
Keywords: childhood atutism, childhood autistic rating score, Candida albicans, immune system .
1. Introduction:
Autism spectrum disorders (ASDs) are a group
of severe neurodevelopmental conditions, referred to
a broader extent as pervasive developmental
disorders, characterized by a triad associating
impairments in social interactions, communication
deficits and restricted repetitive and stereotyped
behaviors and interests with an onset in infancy or
early childhood (before 3 years). The estimated
prevalence of ASD was 2–5/10000 with a ratio four
times higher in males than in females (Smalley,
1997). In the last decades, a significant increase (6–
10 folds) of prevalence has been noticed, partially
explained by improvements in case ascertainment,
making ASD a public health priority (Fombonne,
2003).
Candida albicans is a yeast-like fungus which
inhabits almost all humans. It lives on the moist dark
mucous membranes which line the mouth, vagina and
intestinal tract. Ordinarily it exists only in small
colonies, prevented from growing too rapidly by the
human host's immune system, and by competition
from other microorganisms in and on the body's
mucous membranes.
Many species are harmless commensals of hosts
including humans, but other species, or harmless
species in the wrong location, can cause disease.
Candida albicans can cause infections (candidiasis or
thrush) in humans and other animals, especially in
immunocompromised patients (Fugelsang and
Edwards, 2010).When something happens to upset
this delicate natural balance, candida can grow
rapidly and aggressively, causing many unpleasant
symptoms to the host. Some of the symptoms are
widely known and acknowledged. Vaginal yeast
infections primarily caused by candida, present the
most common case in point. Thrush, the white yeast
infection of the mouth and tongue which is common
in infants, is another well-known example of candida
overgrowth. Systemic infections of the bloodstream
and major organs, particularly in
immunocompromised patients, affect over 90,000
people a year in the U.S., with 40–50% mortality
(dEnfert and Hube, 2007, Tarlan and Rick, 2010)
In recent years a minority of physicians have
begun to try to persuade their colleagues, and the
public, that candida may present consequences far
more devastating to human well-being than vaginitis
and thrush. They cite Japanese studies showing that
candida is able to produce toxins which cause severe
long-term disruption of the immune system and may
also attack the brain. In extreme cases, they claim,
severe disorders, totally resistant to conventional
treatment, can occur as a result of candidiasis. These
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740
include depression, schizophrenia and, in some cases,
autism (Bernard, 1998).
Aim of the work:
The purpose of this work was to investigate the
intestinal colonization with yeasts in autistic patients
and to assess the role of yeast as a risk factor to cause
autism behavior.
2. Methodology:-
The study involved 83 children, diagnosed
as autism and 25 normal children as control group.
Their ages ranged from 36 months to 54 months with
means age (39.5 ± 6.1 months). The study group
included 68 boys and 15 girls. The control group
included 15 boys and 10 girls. Exclusion criteria
include:
1- Children under antifungal treatment.
2- Children under cytotoxic or
immunosuppressive drugs.
3- Children with abnormal routine laboratory
investigations; blood sugar, kidney function
and liver function tests.
The children in this study underwent CRAS
testing and stool culture for Candida albicans. The
study composed of 2 groups; control group; 25
normal children without autistic feature and study
group; 83 children diagnosed as autism and were
subdivided into 3 subgroups according to stool
culture result for Candida albicans growth, which
included no growth group, minimal growth group,
and heavy growth group.
All patients were subjected to:
Patient interviews (personal history, family
history of consanguinity, hearing loss, DLD),
prenatal, perinatal, postnatal period and
developmental history.
E.N.T examination,
Language evaluation (eye contact, response to
examiner, eye head coordination), assessment of
passive and active vocabulary.
Childhood Autism Rating Scale (CARS) and the
degree of autistic disorders were done as 30
serving as a cut off for a diagnosis of autism,
mild-moderate autism (30-37) and severe autism
(> 37) (Eric et al., 1988).
Psychometric evaluation, using Stanford–Binet
Intelligence Scales (Terman et al .,1960). &
Vineland Adaptive Behavior Scales (Sparrow et
al., 2004).
Neurological examination.
Audiological evaluation including
(Immittancemetry, tympanometery & acoustic
reflex) and auditory brain stem evoked
potentials.
Stool culture on Sabaroud Dextrose Agar (SDA)
for isolation of Candida species and
identification as follows:
1. Random stool samples were collected in sterile
containers.
2. Immediate culture on SDA plate was done and
incubated at 37οC.
3. Cultures were examined after 24-48 hours of
incubation for candida growth characterized by
paste like colonies.
4. Gram stained smears were done using (Gram
stain from EDM Company) and examined by
ordinary light microscope for the Gram-positive
yeast cells.
5. Germ tube test was done for identification of C.
albicans using human serum. Small colony was
taken by sterile loop and emulsified in 0.5 ml
serum, then incubated at 37οC for 2-4 hours and
examined microscopically for the germ tube
formation which is continuous with the cell (a
cell wall separates the tube from the cell in C.
tropicalis). The ability of C. albicans to produce
a pseudo germ tube in serum is shared only with
C. stellatoidea which is very much less common
(Mackie & McCartney, 1989).
We considered the stool samples yielded no
colonies or scanty small colonies (like that of the
control group) as negative growth. Samples yielded
colonies all over the lines of plating out were
considered as heavy growth. Samples yielded
colonies more than scanty and less than heavy were
considered as minimal growth.
3. Results:
The demographic characteristics of the study
and control groups are summarized in table (1). The
study group included 83 children, 68 males (81.9 %)
and 15 females (18.1 %), with mean age 47.44± 7.41
months. The control group included 25 children, 15
males (60 %) and 10 females (40 %), with mean age
44.19 ± 6.25 months. Stool culture on Sabaroud
Dextrose Agar (SDA) was done for all children, 68
(81.9 %) cases were positive for Candida albicans
growth and 15 (18.1 %) cases were negative in study
group. Seven (28 %) cases were positive for Candida
albicans growth from the control group.
Cases with negative growth of Candida
albicans were statistically significantly increased (P
< 0.001) in control group when compared with
autistic group; while there was statistically significant
increase (P < 0.001) in cases of heavy growth of
Candida albicans in autistic group compared with the
control group.
Characteristics of the autistic group as regards
the gender and degree of autism were summarized in
table 2. There were statistically non-significant
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differences between males and females as regards the
severity of autism (P < 0.05).
Relations between stool culture results and
severity groups of autism were summarized in table
3. Number of patients with negative stool culture
growth was statistically significantly increased (P =
0.027) in mild-moderate group compared with severe
group; while there was statistically non-significant
difference in number of minimal and heavy stool
culture cases in both mild-moderate and severe
autism (P = 0.873 & 0.064, respectively).
There was non-significant negative correlation
between age and gender, and the total score of CARS
test (R= -0.105, -0.044 & P= 0.343, 0.636
respectively), while there was significant positive
correlation between stool culture results of the
patients and the total score of CARS test (R= 0.110 &
P= 0.210) (Table 4).
Table (1): Demographic data
Group
Parameter
Autism
n= (83)
Control
(n= 25)
P
value
%
N
o
%
Gender
Male
68
81.9%
15
60.0%
0.025
Female
15
18.1%
10
40.0%
Stools examination
Negative
growth
15
18.1%
18
72.05
0.000
Minimal
22
26.5%
4
16.05
0.058
Heavy
46
55.4%
3
12.0%
0.000
Age
(months)
(mean ±
SD)
47.44± 7.41
44.19 ± 6.25
0.031
S
core (mean ± SD)
40.23± 8.29
19.12 ± 3.26
0.000
Table (2): Relation between gender and autism severity.
Gender
Autism degree
Male
n= (68)
Female
(n= 15)
P value
Mild -moderate 32 (47.1%) 9 (60.0%) 0.065
Severe 36 (52.9%) 6 (40.0%) 0.065
Total (n= 83) 68 (81.9%) 15 (18.1%)
Table 3: Relations between stool culture results and severity groups of autism.
Autism severity
Stools culture
Mild
-
moderate
n= (41)
Severe
(n= 42)
P
value
N
o
%
N
o
%
Negative
growth
10
24.4%
5
11.9%
0.027
Minimal
11
26.8%
11
26.2%
0.873
Heavy
20
48.8%
26
61.9%
0.064
Table (4): Correlations between CARS socre and other parameters.
Parameter
R
P
value
Age
-
0.105
0.343
Gender
-
0.044
0.636
Stool examination
0.110
0.210
4. Discussion:
Exact etiology of autism remains largely
unknown, although it is likely to result from a
complex combination of environmental, neurological,
immunological, and genetic factors. Strong genetic
links have been shown for cases with Fragile X,
neurofibromatosis, and chromosomal abnormalities
(Rutter, 2000, Wiznitzer, 2004, Cohen et al., 2005).
Dykens and Volkmar, 1997 noted that there
was also evidence that a genetic link to autisum may
be a result of a weakened immune system. One of the
questions raised in early literature from the 1960’s
about autism was the possibility of an infectious
etiology to the syndrome. Although this notion has
advanced, concerns remain that a child’s weakened
immune systems and susceptibility to psychological
illness may contribute to the disorder. These early
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studies portrayed concerns regarding pre- and post-
natal infectious diseases and the impact on children’s
immune systems as a result of these infections.
Studies were conducted that investigated whether
children who experienced pre- or post- natal
infections and/or a suppressed immune system
developed autistic disorders (Kennedy et al., 2004).
Recently, increasing research has focused on the
connections between the immune system and the
nervous system, including its possible role in the
development of autism. These neuro-immune
interactions begin early during embryogenesis and
persist throughout an individual’s lifetime, with
successful neurodevelopment contingent upon a
normal balanced immune response. Many immune
aberrations consistent with a non regulated immune
response, which so far, have been reported in autistic
children could participate in the generation of
neurological dysfunction characteristic of autisum (J
Leukoc Biol., 2006).
Gastrointestinal (GI) symptoms have been
described in a number of autisum patients, in whom
symptoms include abdominal pain, bloating, diarrhea,
and constipation (Horvath et al., 1999, Afzal et al.,
2003). The exact prevelance of GI symptoms in
autism is unknown. Two retrospective studies, which
analyzed representative populations of children with
autism, reported GI symptoms in 20% of young
children previously diagnosed with autism
(Fombonne et al., 2001). In contrast, prospective
reports from pediatric gastroenterology and general
autism clinics have described GI symptoms in 46–
84% of patients with autism (Horvath et al., 1999).
However, prevalence estimates from population-
based epidemiologic studies are largely lacking.
Further investigation of gut-brain interactions
in this cohort of children with autism and GI
symptoms is necessary to clarify the potential links
with the intestinal pathology and the effect on it. It is
interesting that mucosal lymphocytes isolated from
the duodenum, ileum, and colon as well as peripheral
lymphocytes of autistic patients with GI symptoms
showed increased, spontaneous production of
proinflammatory, intracellular cytokines, most
notably TNF, when compared with aged-matched
controls, including those with similar symptoms of
constipation (Ashwood et al., 2004, Ashwood and
Wakefield 2006). These data support the hypothesis
that there is mucosal immune deregulations with a
proinflammatory lymphocyte cytokine profile in
autism children. These findings have since been
confirmed in peripheral blood, where
proinflammatory cytokines were increased upon
stimulation with dietary proteins in similarly affected
autistic children compared with controls (Jyonouchi
et al., 2005).
In some studies, circulating antibodies to food
substances, namely the casein and gliadin, have been
found (Lucarelli et al., 1995, Vojdani et al., 2002).
However, these antibodies are also found with similar
frequency to that in the general population.
Furthermore, antibodies to neuronal-specific antigens
in the sera of children with autism could cross-react
with dietary peptides, including milk butyrophilin,
Streptococcus M protein, and Chlamydia
pneumoniae, suggesting that bacterial infections and
milk antigens may modulate an autoimmune response
in autism (Vojdani et al., 2002).
Knivsberg et al., 2002 reported that
exacerbation of GI and behavioral symptoms in
autism induced by certain foods, particularly those
containing gluten and casein, has been shown
through dietary intervention and their removal from
the diet. Autistic children on gluten and casein-free
diets also showed significantly lower eosinophil
infiltrate in intestinal biopsies compared with those
on a conventional diet (Sandler et al., 2000). The
significance of this finding is still unclear. However,
it has been proposed recently that immune responses
associated with allergy may contribute to the
pathogenesis of autoimmune diseases of the CNS in
humans and in animal models (Pedotti et al., 2003).
Zagon and McLaughlin, 1991 hypothesized the
increased passage of exorphins and/or opioids from
the diet such as gliadomorphin and casomorphin into
the body, where they may interact with the CNS,
could play a role in inducing the behavioral features
of autism. Opioid peptides and opioid receptors are
important modulators of neural development,
influencing migration, proliferation, and
differentiation within the CNS. Peripherally, opioid
peptides are contained and/or produced by the gut,
lung, placenta, testis, lymphoid tissue, and immune
cells, but also another important source of opioids is
from the diet. The endogenous opiates and
endorphins can directly influence the immune
response, enhancing generation of cytotoxic T cells
and NK cells, and antibody synthesis and act as
chemoattractants for monocytes and neutrophils
(Weigent and Blalock, 1997).
Wakefield et al., 2002 has been hypothesized
that an excess of opioid peptides will have
detrimental effects on brain development and
behavior, and that autism may result from abnormal
levels or activity of opioid peptides. Casemorphine-7,
an opioid exclusively of dietary origin, has been
shown to be present in patients with psychoses
including autism. Indeed, the beneficial effects on
autistic behavior following dietary exclusion therapy
are thought, in part, to be a result of reduced opioid
intake. Furthermore, therapeutic trials using the oral
opioid antagonist naltrexone in some patients with
americanscience.orgjofhttp://www.) 122012;8( Journal of American Science
743
autisum have shown improvements in behavioral
characteristics such as repetitive stereotypes,
hyperactivity, social contact, and self-injurious
behavior (Symons et al., 2004).
In our study there was increased rate of
infection by Candida albicans in autism versus
control group, 68 (81.9 %) cases versus 7 (28 %)
cases respectively. This in agreement with Horvath
and Perman (2002), who reported that there was
increased rate of positive fungal culture for yeast in
the duodenal juice (43%) of children with autism
undergoing endoscopies more than had the age-
matched controls with other gastrointestinal problems
requiring endoscopies (23%).
Also, in our study there was statistically
significant increase (P < 0.001) in cases of heavy
growth of Candida albicans in autistic group
compared with the control group, and this is near to
the study of Campbell (1983), who reported that
autism was associated with GIT infection with
Candida albicans; a sign of impaired immune
functions resulting in the overgrowth of yeast in the
body.
The survey by the Autism Research Institute of
over 25,000 parents’ reports that parents find
antifungal to be one of the most effective medications
for improving behavior. It is possible that children
with autism are more sensitive to even a normal level
of yeast. Also, it is possible that antifungal have other
effects, such as reducing inflammation (Edelson,
2010).
Whiteley et al., 1999 supported our results.
They reported; there was a decrease of autistic
symptoms after the patient is placed on a gluten
and/or casein free diet. Both gluten and casein can
increase quantities of yeast in the gastrointestinal
tract of patients, which increase autism symptoms.
MacFabe et al., 2007, reported that propionic
acid (C3H6O2) can induce an ‘‘autistic-like state’’ in
laboratory rats. Propionic acid is produced in the
human body through the breakdown of amino acids.
It is also a rather common food preservative. Reichelt
and Knivsberg (2009) hypothesized Candida
albicans, the yeast which when present in excess has
been to be correlated with autism, produces ammonia
(NH3) as a metabolite. If propionic acid presents with
ammonia metabolites in the gastrointestinal tract, it
could be converted to beta-alanine (C3H9NO2),
which is structurally comparable to the inhibitory
neurotransmitter GABA, gamma-aminobutyric acid
(C4H9NO2). The proposed final structure for beta-
alanine is almost identical to GABA, with the
exception of an additional carbon atom present in
GABA.
In contrast to our findings, Adams et al., 2011
reported that yeast was only rarely observed by
culture in the autism or typical groups, and the
difference between the two groups was not
significant.
Conclusion:
Candida albicans infection may be a part of
syndrome related to the immune system and depends
on genetic basis of autism, or Candida albicans may
be etiological factor lead to excessive ammonia in gut
which is responsible of autistic behavior in children.
More researches are needed to clarify the exact
mechanism by which Candida albicans affects
autistic children.
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... However, Kantarcioglu et al. [61] reported the presence of Candida sp. in a large percentage of ASD patients (81.4%) compared to controls (19.6%). Emam et al. [63] also showed an increased rate of infection by yeast in the autisticgroup (81.9%) versus the control group (28%). Moreover, there was a significant relationship between autistic children and the heavy growth of C. albicans in stool cultures [63]. ...
... Emam et al. [63] also showed an increased rate of infection by yeast in the autisticgroup (81.9%) versus the control group (28%). Moreover, there was a significant relationship between autistic children and the heavy growth of C. albicans in stool cultures [63]. Similarly, El-Shouny et al. [64] found a heavy growth of yeast in the autistic group in comparison with the control group. ...
... Some research suggested that Candida sp. are cancausenot only severe, long-term disruptions of the immune system but also attack the brain [63]. Candida has evolved the capacity to cross the blood-brain barrier and adhere to brain tissue [119,120]. ...
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The purpose of this review is to summarize the current acquiredknowledge of Candida overgrowth in the intestine as a possible etiology of autism spectrum disorder (ASD). The influence of Candida sp. on the immune system, brain, and behavior of children with ASD isdescribed. The benefits of interventions such as a carbohydrates-exclusion diet, probiotic supplementation, antifungal agents, fecal microbiota transplantation (FMT), and microbiota transfer therapy (MTT) will be also discussed. Our literature query showed that the results of most studies do not fully support the hypothesis that Candida overgrowth is correlated with gastrointestinal (GI) problems and contributes to autism behavioral symptoms occurrence. On the one hand, it was reported that the modulation of microbiota composition in the gut may decrease Candida overgrowth, help reduce GI problems and autism symptoms. On the other hand, studies on humans suggesting the beneficial effects of a sugar-free diet, probiotic supplementation, FMT and MTT treatment in ASD are limited and inconclusive. Due to the increasing prevalence of ASD, studies on the etiology of this disorder are extremely needed and valuable. However, to elucidate the possible involvement of Candida in the pathophysiology of ASD, more reliable and well-designed research is certainly required.
... 4 Although it is often a benign member of the skin and mucous flora, it has polymorphic abilities and it can transform into a pathogenic and invasive fungal form in some cases. 5 Emam et al. 6 revealed that an intense development of Candida albicans was seen in the stool culture of autistic children. Iovene et al. 7 showed that Candida albicans growth was measured higher in children with ASD via a simple cultural approach. ...
... The odds ratios were ranging from 3.45 to 35.10. It was seen that the presence of Candida albicans increased the risk of autism approximately 12 times in the study of Emam et al. 6 , 35 times in the study of Iovene et al. 7 , 3.5 times in the study of Hughes and Ashwood 8 and 6 times in the study of Koceski and Trajkovski 9 (Figure 2). Therefore, we conducted a meta-analysis to provide more consistent information about the relation between the presence of Candida albicans and autism. ...
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Objective Due to the high increase in rate of autism, it has gained great importance to determine the etiology of autism spectrum disorder. The purpose of our study was to assess the role of Candida albicans as a risk factor to cause autism behavior. Methods We searched Scopus, PubMed, Web of Science and PsycINFO for articles up to December, 2021. The studies involving children diagnosed with autism spectrum disorder were included. Children' outcomes were selected as Candida albicans (positive) and Candida albicans (negative). Odds ratios were reported using fixed-effect and random-effect meta-analysis. The heterogeneity was assessed by the Chi-square test and Higgins' I² test. The publication bias was examined via funnel plot and Hegger's test. Results Our meta-analysis was conducted based on 254 diagnosed with Autism Spectrum Disease cases and 161 healthy cases from 4 studies. Compared to the healthy cases, the odds of presence of Candida albicans (OR=7.21; 95% CI: 3.75-13.85; p<0.001) were higher in those diagnosed with autism spectrum disorder. Conclusion This study as a whole showed that children diagnosed with autism spectrum disorder have higher frequency of the presence of the fungus Candida albicans. Therefore, Candida albicans may be an etiological factor for the autistic behavior in children.
... Our studies have shown no significant differences between groups. However, some investigators report substantial growth of Candida, particularly Candida albicans, in ASD patients 26,54,77,78 , Contrary to these results, Adams et al. did not confirm these findings 28 . The potential role of the Candida species in ASD etiology is unclear, and further studies are needed. ...
... It is believed that an overgrowth of Candida spp. may induce autistic behavior through excessive production of ammonia which then is converted to beta-alanine, a non-essential amino acid structurally similar to the inhibitory neurotransmitter GABA 78,79 . Additionally, a high abundance of yeast may impair the absorption of both carbohydrates and mineral elements, as well as affect the release and accumulation of toxins 77,79 . ...
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The early-life modifications of intestinal microbiota may impact children's subsequent emotional and cognitive development. Studies show that some bacteria species in gut microbiota, and the lack of others, may play a key role in autism spectrum disorders (ASD) development. Fecal samples were obtained from three groups of children: 16 healthy, 24 with allergies (ALG), and 33 with ASD (probiotics and non-probiotics users). The analysis was carried out according to the KyberKompakt Pro protocol. We observed a significantly higher level of Klebsiella spp. in the healthy children from the non-probiotics group, considering three groups. In the same group, Bifidobacterium spp . the level was lower in ASD compared to neurotypical individuals. In healthy children who did not use probiotics, strong positive correlations were observed in E. coli and Enterococcus spp . and Bacteroides and Klebsiella spp., and a negative correlation for Akkermansia muciniphila with both Klebsiella spp . and Bacteroides spp . In the ASD group who take probiotics, a strongly negative correlation was observed in Lactobacillus spp., and both Faecalibacterium prausnitzii and Akkermansia muciniphila levels . In the ALG group, the strongest, negative correlation was found between Enterococcus spp . and Lactobacillus spp . as in Akkermansia muciniphila and Bifidobacterium spp. The simple commercial test revealed minor differences in the composition of intestinal microorganisms between children with autism spectrum disorders and neurotypical peers.
... Doreswamy et al. (2020) found much higher yeast counts in the autistic group than the control group [86]. Iovene et al. (2017) also identified aggressive forms (pseudohyphae) of Candida spp. in stool samples from 57% of children with ASD [87] In the work of Emam et al. [88], the Candida spp. counts were also much higher in individuals with ASD (81.9%) than in healthy controls (28%), but the observed differences were not statistically significant [89,90]. ...
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Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects several areas of mental development. The onset of ASD occurs in the first few years of life, usually before the age of 3 years. Proper nutrition is important to ensure that an individual’s nutrient and energy requirements are met, and it can also have a moderating effect on the progression of the disorder. A systematic database search was conducted as a narrative review to determine whether nutrition and specific diets can potentially alter gastrointestinal symptoms and neurobehavioral disorders. Databases such as Science Direct, PubMed, Scopus, Web of Science (WoS), and Google Scholar were searched to find studies published between 2000 and September 2023 on the relationship between ASD, dietary approaches, and the role of dietary components. The review may indicate that despite extensive research into dietary interventions, there is a general lack of conclusive scientific data about the effect of therapeutic diets on ASD; therefore, no definitive recommendation can be made for any specific nutritional therapy as a standard treatment for ASD. An individualized dietary approach and the dietician’s role in the therapeutic team are very important elements of every therapy. Parents and caregivers should work with nutrition specialists, such as registered dietitians or healthcare providers, to design meal plans for autistic individuals, especially those who would like to implement an elimination diet.
... Organizmada Candida albicans mantar cinsinin fazla olmasının hiperaktivite ve saldırganlık gibi otizm semptomlarında artışa yol açtığı yönündeki bulgulara dayanarak beslenmeden Candida albicans türünün artmasına yönelik yaklaşımların elimine edilmesi esasına dayanır. Bu doğrultuda, gluten (mısır ve pirinç dahil) ve kazein içeren, şeker ve nişasta içeriği yüksek besinler, asit-baz dengesini korumak amaçlı salisalat içeren besinler (domates, elma, üzüm vs) ve renklendirici içeren besinler beslenmeden elimine edilir (Emam, Mamdouh & Abdelrahim.,2012;Önal & Uçar., 2017). ...
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Yetersiz beslenme ve engellilik durumu birçok ortak noktası nedeniyle yakından ilişkili iki kavramdır. Besine ulaşmanın zor olduğu durumlarda ya da yüksek düzeyde besin çeşitliliğinin bulunduğu fakat yetersiz beslenmenin yaygın olduğu ülkelerde yaşamını sürdüren çocuklarda gelişimsel bozukluklar, gecikmeler ve engellilik oranlarının yüksek olduğu bildirilmektedir. Bu oranların açıklayıcısı veya iki kavramın bağının oluştuğu noktalar ise yetersiz beslenmenin çocuklarda çeşitli farklı engellilik durumlarına neden olması veya katkıda bulunması ile birlikte; engellilik durumlarının da yetersiz beslenmeye neden olması veya katkıda bulunmasıdır. Özel gereksinimli çocuklarda beslenmenin önemi, gebelik döneminde annenin beslenmesine kadar dayandırılmaktadır. İlk 1000 gün boyunca, yani gebelikten 2. doğum gününe kadar optimal düzeyde beslenmenin, yeni doğanın sağlıklı gelişimi ve yaşamı için kritik öneme sahip olduğu yönünde görüş birliği vardır .......
... Organizmada Candida albicans mantar cinsinin fazla olmasının hiperaktivite ve saldırganlık gibi otizm semptomlarında artışa yol açtığı yönündeki bulgulara dayanarak beslenmeden Candida albicans türünün artmasına yönelik yaklaşımların elimine edilmesi esasına dayanır. Bu doğrultuda, gluten (mısır ve pirinç dahil) ve kazein içeren, şeker ve nişasta içeriği yüksek besinler, asit-baz dengesini korumak amaçlı salisalat içeren besinler (domates, elma, üzüm vs) ve renklendirici içeren besinler beslenmeden elimine edilir (Emam, Mamdouh & Abdelrahim.,2012;Önal & Uçar., 2017). ...
Chapter
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OSB, yaşamın ilk yıllarında ortaya çıkmakta ve etiyolojisi kesin olarak bilinmemektedir. OSB oluşumunda tek bir faktörden çok, genetik ve çevresel faktörlerin çoklu mekanizmalar halinde etkili olduğu ileri sürülmektedir (Risch & ark.,2014). Bir meta-analizde, genetik faktörlerin OSB oluşumunda %74-93 oranında katkıda bulunmakla birlikte yine de tek başına yeterli olmadığı belirlenmiştir (Tick & ark.,2016). Ebeveyn yaşının ileri olması, endokrin bozucu kimyasal ve radyasyon maruziyeti, ilaç alımı, civa/kurşun/alimünyum gibi çevresel toksinlerin OSB oluşumunda etkili olabileceği bildirilmiştir (Lyall vd., 2017 & Cekici ve Sanlier., 2019). Prematüre doğum, annenin gebelik boyunca başta folik asit olmak üzere yeterli vitamin ve mineral alamaması, bozulmuş otoimmünitenin OSB oluşumunda etkili mekanizmalar arasında sayılmaktadır (Lyall & ark., 2017; Cekici & Sanlier., 2019). Anne-çocuk arasındaki psikososyal bağın yetersiz olmasının da OSB gelişiminde etkili olabileceği düşünülmektedir (Özeren,2013). İlk 6 ay ve 2. yaşa kadar elzem olan anne sütü tüketiminin, OSB riskini azalttığını gösteren bulgular mevcuttur (Say, Babadağı & Karabekiroğlu, 2015; Huang & ark., 2021)...........
... The finding that a significant relation between the autistic children and heavy growth of Candida albicans in stool culture concluding that a high rate of Candida albicans intestinal infection in autistic children may be a part of syndrome related to immune system disorders in these patients (10), with the possibility for improving the core symptoms of autism by relieving the gastrointestinal symptoms in ASD (2). This concise with the present study that 54.1% of the studied sample before the intervention was having Candida stool culture positive, Table 1. ...
Chapter
Along with the issues of inflated social and financial burden associated with autism spectrum disorder (ASD), specific treatment for this disorder has also not been developed. Having a thorough look at previous trials done to treat autism, we find that nutrition intervention had been used frequently as a complementary form of therapy. Indeed, an early diagnosis of nutrition deficiency and metabolic disorders done concomitantly with accurate therapeutic interventions can be a cornerstone for improving cognitive and behavioral aptitudes of people with autism. Several studies have showed that increasing the intake of specific nutrients can reduce the symptoms and comorbidities associated with autism. Consequently, nutrition intervention and appropriate supplementation can be crucial in managing and treating autism. This paper will discuss recent literature on the significance of metabolic aspects in autistic disorder and highlight the influence of nutrition intervention on the symptoms of autism.
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Pendahuluan: Autisme merupakan suatu gangguan perkembangan yang mempengaruhi fungsi normal otak, perkembangan interaksi sosial dan kemampuan berkomunikasi. Anak autisme memiliki kepedulian yang rendah terhadao diri sendiri, sensitif terhadap bulu sikat dan pasta gigi, cenderung mengkonsumsi makanan kariogenik, dan memiliki kelainan motorik lidah. Keterbatasan yang dimiliki anak autisme tersebut menyebabkan anak autisme lebih berisiko terhadap penyakit periodontal dan karies gigi. Karies merupakan penyakit jaringan keras gigi akibat aktivitas mikroorganisme dalam suatu karbohidrat yang dapat diragikan dan penyakit periodontal adalah penyakit pada jaringan pendukung gigi yang faktor penyebab utamanya adalah mikroorganisme, kedua penyakit tersebut erat kaitan terjadinya dengan kondisi rongga mulut salah satunya adalah saliva. Tujuan penelitian ini adalah untuk mengetahui perbedaan jenis dan jumlah koloni mikroorganisme pada saliva anak autisme dan anak normal yang mengalami karies. Metode: Penelitian ini menggunakan pendekatan cross sectional, subjek penelitian anak autisme yang berada di SLB Autisma YPPA Kota Padang dan anak normal yang berada di SD N 05 Sawahan Kota Padang. Sampel penelitian berupa saliva dilakukan pembiakkan mikroorganisme pada media agar darah. Data dianalisis menggunakan uji Mann-Whitney. Hasil: Terdapat perbedaan jenis mikroorganisme pada saliva anak normal dan anak autisme. jenisMikroorganisme pada saliva anak autisme yaitu Streptococcus sp, Neisseria sp, Staphylococcus aureus, dan Candida sp, sementara pada saliva anak normal jenis Streptococcus sp dan Neisseria sp. Hasil uji statistik perbedaan jumlah Streptococcus sp didapatkan nilai p=0,001, pada Neisseria sp didapatkan nilai p=0,012. Kesimpulan: Terdapat perbedaan jenis dan jumlah koloni mikroorganisme pada saliva anak normal dan anak autisme.
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The continuing and rapid increase in the number of fully sequenced genomes is creating new opportunities for comparative studies. However, although many genomic databases store data from multiple organisms, for the most part they provide limited support for comparative genomics. We argue that refocusing genomic data management to provide more direct support for comparative studies enables systematic identification of important relationships between species, thereby increasing the value that can be obtained from sequenced genomes. The principal result of the paper is a methodology, in which comparative analyses are constructed over a foundation based on sequence clusters and evolutionary relationships. This methodology has been applied in a systematic study of the fungi, and we describe how comparative analyses have been implemented as an analysis library over the e-Fungi data warehouse.
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The opioid-excess hypothesis of autism suggests that autism is the consequence of the incomplete breakdown and excessive absorption of peptides with opioid activity (derived from foods which contain gluten and casein), causing disruption to biochemical and neuroregulatory processes. Biochemical evidence has indicated the presence of increased levels of peptides in the urine of people with autism, and previous behavioural studies have demonstrated a connection between the long term exclusion of gluten and casein from the diet and improvements in the behaviour of some children with autism. The introduction of a gluten-free diet to children with autism and associated spectrum disorders (n 5 22) was monitored over a 5 month period using a battery of parental and teacher interview/questionnaire sessions, observation reports, psychometric tests and urinary profiling. Results suggested that participants on a gluten-free diet showed an improvement on a number of behavioural measures. However there was no signi
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Children with autism have often been reported to have gastrointestinal problems that are more frequent and more severe than in children from the general population. Gastrointestinal flora and gastrointestinal status were assessed from stool samples of 58 children with Autism Spectrum Disorders (ASD) and 39 healthy typical children of similar ages. Stool testing included bacterial and yeast culture tests, lysozyme, lactoferrin, secretory IgA, elastase, digestion markers, short chain fatty acids (SCFA's), pH, and blood presence. Gastrointestinal symptoms were assessed with a modified six-item GI Severity Index (6-GSI) questionnaire, and autistic symptoms were assessed with the Autism Treatment Evaluation Checklist (ATEC). Gastrointestinal symptoms (assessed by the 6-GSI) were strongly correlated with the severity of autism (assessed by the ATEC), (r = 0.59, p < 0.001). Children with 6-GSI scores above 3 had much higher ATEC Total scores than those with 6-GSI-scores of 3 or lower (81.5 +/- 28 vs. 49.0 +/- 21, p = 0.00002).Children with autism had much lower levels of total short chain fatty acids (-27%, p = 0.00002), including lower levels of acetate, proprionate, and valerate; this difference was greater in the children with autism taking probiotics, but also significant in those not taking probiotics. Children with autism had lower levels of species of Bifidobacter (-43%, p = 0.002) and higher levels of species of Lactobacillus (+100%, p = 0.00002), but similar levels of other bacteria and yeast using standard culture growth-based techniques. Lysozyme was somewhat lower in children with autism (-27%, p = 0.04), possibly associated with probiotic usage. Other markers of digestive function were similar in both groups. The strong correlation of gastrointestinal symptoms with autism severity indicates that children with more severe autism are likely to have more severe gastrointestinal symptoms and vice versa. It is possible that autism symptoms are exacerbated or even partially due to the underlying gastrointestinal problems. The low level of SCFA's was partly associated with increased probiotic use, and probably partly due to either lower production (less sacchrolytic fermentation by beneficial bacteria and/or lower intake of soluble fiber) and/or greater absorption into the body (due to longer transit time and/or increased gut permeability).
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We have shown that urine peptide increase is found in autism, and that some of these peptides have a dietary origin. To be explanatory for the disease process, a dietary effect on the brain must be shown to be possible and probable. Diagnosis was based on DSM-III and DSM-IV criteria. We ran first morning urine samples equivalent to 250 nm creatinine on high-performance liquid chromatography (HPLC) reversed phase C18 columns using trifluoroacetic acid acetonitrile gradients. The elution patterns were registered using 215 nm absorption for largely peptide bonds, 280 nm for aromatic groups, and 325 nm for indolyl components. We referred to a series of published ability tests, including Raven's Progressive Matrices and the Illinois Test of Psycholinguistic Ability, which were administered before and after dietary intervention. The literature was also reviewed to find evidence of a gut-to-brain connection. In autistic syndromes, we can show marked increases in UV 215-absorbing material eluting after hippuric acid that are mostly peptides. We also show highly significant decreases after introducing a gluten- and casein-free diet with a duration of more than 1 year. We refer to previously published studies showing improvement in children on this diet who were followed for 4 years and a pairwise matched, randomly assigned study with highly significant changes. The literature shows abundant data pointing to the importance of a gut-to-brain connection. An effect of diet on excreted compounds and behavior has been found. A gut-to-brain axis is both possible and probable.
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Autism and Pervasive Developmental Disorders - edited by Fred R. Volkmar January 2019
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