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The epidemiology of Candida fungal infections is growing, due to the increasing size of the people at risk. Candida species are the fourth main cause of bloodstream infections; however, significant geographic differences have been reported. Although, in some instances, these changes may be related to medical interventions, such as the use of antifungal agents in prophylaxis, in the majority of cases, they seem to be a consequence of changes in the host, such as more-severe immunosuppression or different types of immunosuppression impacting both risk periods and the infections that occur. Discussion of surveillances and reports will be critical to improve our understanding of the importance of invasive Candida infections, and to facilitate the prioritization of the investigation as well as the prevention efforts.
Jundishapur Journal of Microbiology (2009); 2(1): 1-6 1
Review article
Invasive candidiasis; a review article
Majid Zarrin1, Ali Zarei Mahmoudabadi1,2
1Department of Medical Mycoparasitology, School of Medicine, and 2Infectious and Tropical
Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Received: March 2009 Accepted: March 2009
The epidemiology of Candida fungal infections is growing, due to the increasing size of
the people at risk. Candida species are the fourth main cause of bloodstream infections;
however, significant geographic differences have been reported. Although, in some
instances, these changes may be related to medical interventions, such as the use of
antifungal agents in prophylaxis, in the majority of cases, they seem to be a consequence
of changes in the host, such as more-severe immunosuppression or different types of
immunosuppression impacting both risk periods and the infections that occur.
Discussion of surveillances and reports will be critical to improve our understanding of
the importance of invasive Candida infections, and to facilitate the prioritization of the
investigation as well as the prevention efforts.
Keywords: Candidiasis, Invasive candidiasis, Candida albicans
The epidemiology of invasive fungal
infection has changed during the last two
decades. The frequency of the disease has
increased, and the population of patients at
risk has expanded to include those with an
extensive list of medical conditions, such as
solid organ and hematopoietic stem cell
transplantation (HSCT), receipt of
immunosuppressive therapy, human
immunodeficiency virus (HIV) infection,
premature birth, advanced age, surgery and
cancer [1]. Moreover, the etiology of
invasive mycoses has also changed. In the
1980s, yeasts (mainly Candida albicans)
were the most frequent causative agents of
invasive fungal infections. Despite of its
benefits, medical development has led to a
susceptible population with suppressed
immunological defenses against fungal
infection. These factors heighten the risk for
many invasive fungal infections, including
candidiasis, aspergillosis, cryptococcosis,
and mucormycosis [2].
Epidemic of HIV is a major factor that
has contributed to a remarkable increase in
the frequency of invasive candidiasis. Before
the extensive use of highly active anti-
retroviral therapy (HAART) in developed
countries, 80% of HIV-infected patients
developed mucosal candidiasis, while others
developed cryptococcosis, pneumocystosis
and other lethal mycoses, for example,
penicilliosis [2,3]. Candidiasis, a main cause
of death in patients with leukemia and solid
organ transplants or recipients of stem cell,
is currently observed more frequently among
patients in intensive care units (ICUs). The
species of Candida causing infection are
more diverse. C. albicans is the most
frequent pathogen followed by C. glabrata,
C. tropicalis and C. parapsilosis.
Jundishapur Journal of Microbiology (2009); 2(1): 1-6 2
Candida invasive infections
Bloodstream infection by Candida species
(candidemia) is the most frequent clinical
manifestation of invasive candidiasis, and is
a significant cause of morbidity and
mortality in hospitalized patients. Candida
species are the fourth most widespread cause
of hospital-acquired bloodstream infections
in the United States [4-5], with a frequency
of 1.5 cases per 10,000 patients days [6]. In
a comparable European survives, the
frequency is slightly lower, at 0.5-0.7 cases
per 10,000 patients days [7-10]. Currently,
the highest reported incidence of healthcare
related candidemia (3.7 cases per 10,000
patients days) comes from an eleven-center
sentinel observation plan in Brazil [11].
While the reasons for this high rate of
infection are not obvious, several factors
could be involved, including the availability
of less resources for medical care and
training programs, difficulties in the
achievement of infection control programs
in hospitals of developing countries, limited
numbers of health-care staffs, and less
effective practices of antifungal drug
treatment in high-risk patients.
Candidemia is usually connected with
infection outside of bloodstream. In
numerous patients the yeast spreads from the
gastrointestinal tract to other organs and this
helps to elucidate why Candida bloodstream
infection is similar to a devastating disease.
In the United States, the mortality rate for
candidemia in medical centers from1997 to
2001 was 49% [12], which was 11% higher
than that detected in the same hospital from
1983 to 1986 [13]. Analysis of the
epidemiological researches that evaluates the
varying incidence of Candida bloodstream
infection over time is complicated.
However, it is necessary to find important
dissimilarities in the results coming from
various countries or various centers.
In the Netherlands, the incidence rate of
candidemia among hospitalized patients rose
from 0.37 to 0.72 cases per 10.000 patient
days between 1987 and 1995 [14]. But in
Switzerland, the rate remains approximately
permanent between 1991 and 2000 (median
incidence: 0.5 cases per 10,000 patient days)
[3]. In Iran 45% of kidney recipients and
84% of liver recipients had Candida
colonization in different sites of their bodies
[15]. A research in Iran showed that
disseminated candidiasis was the second
common cause of invasive fungal infections
[16]. In the past years, the main groups at
risk for serious Candida diseases were cases
that were neutropenic, had received
transplants, or had been treated with
cytotoxic or corticosteroids drugs. At
present, the patients who are in the ICU, are
the most susceptible to show severe Candida
infections. The most high risk patients are
those who have a central venous catheter,
are receiving patenteral nutrition or are on
broad-spectrum antibiotics and have high
Acute Physiology and Chronic Health
Evaluation scores [17-19]. The fourth most
frequent cause of nosocomial bloodstream
infection among ICU patients is Candida
species. Moreover, these yeasts are the third
most widespread cause of nosocomial
bloodstream infections [5]. The mortality of
candidemia remains about 40% [12].
Etiologic agents
There are now approximately 200 species of
Candida, but only a few have been involved
in human infection. Ninety percent of all
Candida bloodstream infection globally
have been caused by five species: C.
albicans, C. glabrata, C. parapsilosis, C.
tropicalis, and C. Krusei [6,9,11,20]. The
remaining diseases have been caused by
several other Candida, including C.
dubliniensis, C. famata, C. guilliermondii,
C. lusitaniae, C. norvegnesis, C. pelliculosa,
and C. rugosa [9,11,20,21]. Though these
species are unusual causes of candidiasis,
some of them are recognized to happen in
nosocomial clusters, or display innate, or
even obtained resistance to antifungal drugs
Candida albicans remains the
predominant cause of candidemia
worldwide. The frequency of invasive
Jundishapur Journal of Microbiology (2009); 2(1): 1-6 3
candidiasis which is recovered from blood
samples varies according to geographical
setting, and demographics of the population
studied. Broad use of fluconazole for
treatment of HIV-infected cases with
persistent oropharyngeal candidiasis resulted
in the selection of Candida species
essentially less sensitive to azoles in the
early 1990s. The azole-drug resistant strains
in these patients emerged because of
acquisition of resistance with previously
sensitive strains of C. albicans [24]. This
occurrence has led to the concern that
extensive fluconazole use in broader patient
populations could cause related selections
for species and strains that possess inherent
or acquired azole resistance. Nevertheless,
the frequency of fluconazole resistance
among C. albicans bloodstream isolate,
gathered in population-based and sentinel
surveillance programs worldwide, stays
insignificant [6,9,11].
A new trend noted in numerous
hospitals is an enhancement in the frequency
of C. glabrata as serious Candida infections
[25,26]. There are some reasons for this
increase, including the living habitat, age
and type of the patients, and use of
fluconazole. C. glabrata is usually noted in
persons older than 60 years [26] and in
patients who have leukemia or received a
stem cell transplant, and those who are
associated with increasing use of
fluconazole [27]. The significance of this
epidemiologic trend is that C. glabrata is
frequently resistant to fluconazole, the drug
used most often for the treatment of
candidemia. Though candidemia is the main
type of invasive candidiasis, broad visceral
invasion with Candida can happen by
persistently negative blood cultures. Almost
all organs can be infected, although the
kidneys, eyes, liver, spleen, and brain are
most frequently involved. Signs of invasive
infection that ought to be clinically
diagnosed are endophthalmitis or
chorioretinitis as well as the emergence of
painless skin lesions.
The patients with confirmed candidemia or
invasive candidiasis must be treated with an
antifungal drug [28]. The elevated rate of
spreading to main organs, once Candida
obtains entrance to the bloodstream, offers
the basis for this approach. There are
primarily two goals in the treatment of
candidiasis, interference with Candida
proliferation in the body and the reduction of
the factors providing favorable environment
for growth of Candida.
Several antifungal drugs are available
for the treatment of candidiasis. These
consist of fluconazole, voriconazole,
caspofungin, amphotricin B, and lipid
formulations of amphotricin B. Studies
confirm that fluconazole, caspofungin, and
voriconazole are as valuable as amphotricin
B deoxycholate in the treatment of
candidemia [29]. Fluconazole is the
preferred treatment of candidemia.
Fluconazole is effective against most species
of Candida. The drug has been revealed to
be as useful as amphotricin B in
nonneutropenic patients. Nevertheless,
fluconazole has restricted activity against C.
glabrata and is not effective against C.
krusei. Combination therapy may be used to
cope with treatment failures [30-34].
Doctors should become aware of the most
frequent species of Candida causing
bloodstream invasive infection at their
centers. Vascular catheter removal enhances
the clearance of Candida from the blood
[35]. Daily blood culture is required to
confirm that the problem of fungemia is
resolved, and treatment must continue for
two weeks following the date of the primary
negative blood culture.
Laboratory diagnosis
The disease is very difficult to diagnose
because some of the etiologic agents of
disease are also commonly observed in
healthy people. As a result, laboratories have
an important role in detection of diseases
and identification of etiologic agents of
them. In addition, they can help with the
Jundishapur Journal of Microbiology (2009); 2(1): 1-6 4
selection and the monitoring of antifungal
therapy. Information that is essential for
laboratory workers is as follows; the clinical
history of patients, occupation, the source of
the samples, any prior treatment with
antifungal, anti-microbial and immuno-
suppressive drugs, the method by which the
samples were collected and types of
transport medium.
The patients must not take any
antifungal drugs three days before sampling.
For urinary sampling, 10 ml of midstream or
catheter specimens should be collected in a
sterile test tube. Cerebrospinal fluid (CSF)
samples provide good specimens for patients
with candidal meningitis. CSF are usually,
collected by a clinician using a routine
lumbar puncture technique. In candidemia
20 ml of blood from adults or 1-5 ml from
children is collected and directly inoculated
into the blood culture medium (Biphasic
medium). Suitable specimens for respiratory
candidiasis are early morning sputum and
bronchial washing collected in a sterile
screw-cap container. The samples should be
digested by KOH or N-acetyl cysteine or
pancratein before preparing smears and
cultures. Another method for sampling from
candidiasis is biopsy from organs.
Direct examination of specimens and
observation of fungal elements in clinical
materials is a very important part of
laboratory diagnosis. As a result, a correct
report can help the clinician prescribe
suitable treatment. Furthermore, in acute
diseases, such as Candida meningitis and
systemic candidiasis in AIDS patients, rapid
direct microscopy can play a very important
role in suitable treatment. For liquid
specimens, such as urine, saliva, sputum,
and CSF, firstly, centrifuge and then
microscope slides can be prepared from their
sediments. The microscope slides should be
stained by Gram, Giemsa or methylene blue
stains. Tissue sections should be stained
using Periodic Acid Schiff, Grocott’s
methenamine silver or Gram stain. Ovoid
yeast cells, budding cells (3-7m in
diameter), true hyphae, pseudohyphae or
both are the morphological forms of
Candida species that are usually seen in
clinical materials. Positive direct microscopy
from a biopsy or a sterile site, such as blood,
CSF and vitreous and joint fluid, are
significant, whether of yeast or
pseudohyphae. According to Talwar et al.
[36] the presence of mycelial forms of
Candida in direct microscopy is as a
diagnostic marker for candidiasis; however,
when C. glabrata is the etiologic agent of
disease, pseudohyphae is not be observed in
All clinical materials are cultured on the
suitable culture medium. There are a number
of culture media for isolation of Candida
species from clinical materials but the
selective medium most often used is
Sabouraud’s dextrose agar (SDA) with
chloramphenicol or other anti-bacterial
agents. Many species of Candida (C. krusei,
C. parapsilosis and C. tropicalis) are
sensitive to cycloheximide, which is why
media with cycloheximide should not be for
isolation of Candida species. SDA is
recommended for isolation and culture of
Candida species. CHROMagar Candida is a
new medium that is used for isolation and
identification of some clinically important
Candida species. The incubation
temperature for cultures is 30-37C for 24-
72 h (37,38).
Invasive candidiasis is recognized as a cause
of infection with increased incidence in the
past two decades. This expected increase
reflects several factors, such as changes in
hosts at risk and progress in diagnostic
methods. The appearance of Candida with
variable susceptibilities to antifungal agents
emphasizes the clinical importance of
establishing fungal diagnoses. Changes in
hosts sensitive to Candida infection,
diagnostic approaches, practice patterns, and
probable changes in climatic influences, will
possibly continue to amend the
epidemiology for years to come.
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Address for correspondence:
Majid Zarrin, Department of Medical
Mycoparasitology, School of Medicine, Ahvaz
Jundishapur University of Medical Sciences,
Ahvaz, Iran
Tel: +98611 3330074; Fax: +98611 3332036
... In vulvo vaginitis, the patient might have serious tingling and disturbance in the vagina and vulva, and a burning sensation during urination [1]. Candidiasis prompts passing in patients having leukemia and solid organ transplantation or recipients of stem cells [4]. Invasive Candidiasis happens when individuals recovering from surgery, individuals admitted to intensive care unit, low ...
... A recent study reveals that pediatric patients are mostly affected because neonates have immaturity of defense mechanisms against infections and in elderly patients, defense mechanisms get weakened. In the United States, 1.4 million patients are affected with candidiasis every year [4]. ...
... Research done in Iran said that "disseminated candidiasis" is the second clinical appearance of invasive fungal infection. Disseminated candidiasis: Deep-seated tissue candidiasis and interior organs are affected [4]. There are two species that significantly cause candidemia in pediatric patients such as C. albicans, and C. parapsilosis [7]. ...
Full-text available
Candidiasis is a fungal infection caused by the genus Candida. It is otherwise called moniliasis, thrush, and candidosis. Candida albicans is the most one to cause an infection in humans and other species such as Candida auris, Candida tropicalis, Candida glabrata, Candida parapsilosis, C. parapsilosis, and Candida lusitaniae. It is categorized into oral candidiasis, invasive candidiasis, vulvovaginal, and genital candidiasis. In general, Candida yeasts are present in the human body and their growth is limited by the human immune system. When an imbalance, colonization of Candida occurs finally leads to an infection. It is mainly affected in immune compromised patients followed by risk factors such as diabetes, stem cell transplantation, organ transplantation, and prolonged use of antibiotics, and steroids. It can be diagnosed to overcome this infection by direct examination of smear, culture, and biopsy. Fluconazole is the first line drug to treat candidiasis and Amphotericin-B, Caspofungin, Voriconazole also used.
... They have the ability to cause superficial and invasive infections in people with low immunity [23]. The incidence of this infection has increased rapidly across the globe [24]. It is a common infection in seriously ill patients and is linked to significant morbidity and mortality [25]. ...
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Coronavirus disease 2019 (COVID-19) infection is currently a great cause of concern for the healthcare sector around the globe. SARS-CoV-2 is an RNA virus that causes a serious infection that is associated with numerous adverse effects and multiple complications associated with different organs and systems during its pathogenic cycle in humans. Individuals affected by COVID-19, especially elderly populations and immunocompromised people, are greatly vulnerable to opportunistic fungal pathogens. Aspergillosis, invasive candidiasis, and mucormycosis are widespread fungal coinfections in COVID-19 patients. Other fungal infections that are rare but are exhibiting increased incidence in the current scenario include infections caused by Pneumocystis jirovecii, Histoplasma sp., Cryptococcus sp., etc. By producing virulent spores, these pathogens increase the severity of the disease and increase the morbidity and fatality rates in COVID-19 patients globally. These infections generally occur in patients recovering from COVID-19 infection, resulting in rehospitalization. Older and immunocompromised individuals are at higher risk of developing opportunistic fungal infections. This review focuses on understanding the opportunistic fungal infections prevalent in COVID-19 patients, especially elderly people. We have also highlighted the important preventive methods, diagnostic approaches, and prophylactic measures for fungal infections.
... Candida terlihat tidak berbahaya karena termasuk flora normal namun ditemukan terlibat dalam infeksi. Resiko infeksi Candida meningkat dengan pada orang dengan imunitas yang rendah (Santos et al., 2018;Zarrin & Mahmoudabadi, 2009). Jenis infeksi yang sering ditimbulkan diantaranya adalah vaginal candidiasis, multidrug-resistant fungi, dan penyakit nosokomial (Ciurea et al., 2020). ...
Ampas tahu merupakan limbah yang banyak diproduksi seiring meningkatnya kebutuhan akan tahu. Kelebihan dari limbah ampas tahu yaitu kandungan nutrisi yang tinggi, murah dan mudah didapatkan. Hasil samping dari industry tahu ini masih memiliki kandungan protein 26,6%, lemak 18,3%, dan karbohidrat 41,3% pada setiap 100gramnya. Berdasar hal tersebut, ampas tahu berpotensi digunakan untuk bahan baku media pertumbuhan Candida spp, menggantikan media gold standardnya yaitu Potato Dextrose Agar. Kemampuan media tepung ampas tahu dalam mendukung pertumbuhan Candida spp. perlu diuji lebih lanjut untuk jumlah maupun morfologi koloni Candida spp. Tujuan penelitian ini adalah untuk mengetahui apakah media ampas tahu dapat dimanfaatkan sebagai subtitusi media Potato Dextrose Agar untuk pertumbuhan Candida albicans dan Candida spp. Penelitian ini merupakan penelitian eksperimental dengan rancangan Acak Lengkap (RAL). Komposisi media tepung ampas tahu yang digunakan meliputi tepung ampas tahu (0, 1, 2, 3, 4, 5gr); gula dextrose 2gr; agar 1,5gr; dan aquadest 100mL. Metode inokulasi Candida uji pada media tepung ampas tahu dan Potato Dextros Agar menggunakan cawan gores. Pengamatan meliputi jumlah koloni dan morfologi koloni Candida uji. Jumlah koloni Candida albicans dan Candida sp yang tumbuh pada media tepung ampas tahu jauh lebih besar dibandingkan pada media control, namun ukuran dari koloni sangat kecil. Media tepung ampas tahu dengan perbandingan 5 gr tepung ampas tahu dan 2gr dextrose menunjukkan rata-rata pertumbuhan koloni 222,5 CFU/10uL untuk Candida albicans dan 148 CFU/10Ul untuk Candida sp. Hasil pertumbuhan Candida uji pada media gold standard yaitu 54,5CFU/10uL untuk Candida albicans dan 50 CFU/10uL untuk Candida sp. Berdasarkan hasil penelitian ini, media tepung ampas tahu mampu mendukung pertumbuhan Candida spp dalam segi jumlah namun belum mampu memberikan ukuran koloni yang besar seperti pada media gold standard. Untuk penelitian selanjutnya dapat digunakan metode yang berbeda dalam membuat media ataupun menambahkan bahan tambahan untuk sumber nitrogen dalam media.
... This difference might be due to the variations of seasons, locations, as well as environmental settings (Kim et al., 2016). Other investigators (Zarrin & Mahmoudabadi, 2009) argued that the increasing occurrence of non-albicans Candida, such as C. tropicalis, is due to the increasing administration of fluconazole which is potent to C. albicans but not to non-albicans. Additionally, in this study, the MIC values of C. tropicalis (0.74 µg/mL) was higher than C. albicans (0.5 µg/mL) (Table 5) leading to the elimination of the C. albicans was more likely to occur whereas C. tropicalis survived and remained colonializing during the empirical therapy of fluconazole explaining the more prevalence of C. tropicalis. ...
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Candidiasis has become increasingly widespread in the community alongside with the developing resistance of Candida sp. to some antifungals. A prevalence study in the present research is required to surveil the distribution of Candida-related infections to administrate the appropriate antifungal treatments. The objective of this research was to determine the species distribution of candidiasis with their antifungal susceptibility isolated from clinical specimens at the Zainoel Abidin Hospital (ZAH) Banda Aceh, Indonesia. The clinical specimens were from inpatients and outpatients in the hospital during January to June 2019. The identification of Candida species and antifungal sensitivity assay were conducted by using VITEK® 2 Compact. Of a total of 68 isolates, there were six species of Candida with the highest species prevalence was Candida tropicalis (52.94%). Additionally, the highest prevalence of candidiasis came from urine specimen (54.41%) and mostly from inpatients in the internal medicine unit (54.41%). Candidiasis occurred predominantly in men (58.82%) and during adulthood (55.88%). The antibiogram of Candida sp. shows a high percentage of sensitivity towards some antifungals including fluconazole (100%), voriconazole (100%), caspofungin (100%), micafungin (100%), amphotericin B (99.5%), and flucytosine (100%). From this result, it can be concluded that candidiasis cases in the ZAH Banda Aceh, Indonesia has prevalently occurred with the few antifungal therapies for candidiasis of were still effective empirically and definitively. This is an initial study of Candida prevalence within different clinical samples in Banda Aceh and the study is expected to be a basis for prevention and control of Candida-related infections in the area.
... Although the relationship between fungi and CD has not been clearly established, there is some evidence for the possible role of Candida albicans in the processes leading to or maintaining inflammation. In numerous patients, the yeast spreads from the gastrointestinal tract to other organs, which explains why a Candida bloodstream infection can lead to devastating disease [4]. CD is chiefly managed using nonoperative treatment. ...
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Purpose: The aim of this study was to determine whether a connection exists between Crohn disease and fungi, specifically Candida albicans, because one possible cause of disease is thought to be the presence of fungi in the intra-abdominal cavity. The diagnosis of invasive candidiasis is difficult due to the lack of specific clinical manifestations of the disease. A retrospective evaluation of the presence of invasive candidiasis was done in a group of 54 patients with Crohn disease and in a group of 31 patients who received surgery primarily for right-sided cancer of the colon. Methods: Culture samples were obtained from the wall of the extraluminal portion of the terminal ileum and the adjacent mesenterium, and then sent to the microbiology laboratory for further investigation. Sabouraud agar (SGC2) and chromID Candida agar (CAN2) were used for both short-term (48 hours) and long-term (10 days) cultivation. Results: Pearson chi-square test revealed a statistically significant difference in the prevalence of fungi and yeast between the 2 groups of patients (χ2 = 4.3873, P < 0.05). Conclusion: Patients with Crohn disease had a significantly higher prevalence of fungi and yeasts in the intra-abdominal cavity compared with cancer patients.
... The presence of multiple intracranial (micro) abscesses has also been reported [53]. Mouse studies have revealed adhering and binding of Candida albicans to the endothelium of cerebral blood vessels followed by the invasion of the brain parenchyma [55,56], which might explain intracranial abscesses. Autopsy studies demonstrated that the supratentorial grey-white joint at the level of the basal ganglia is the most affected area in CNS candidiasis [57]. ...
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Purpose Miliary enhancement refers to the presence of multiple small, monomorphic, enhancing foci on T1-weighted post-contrast MRI images. In the absence of a clear clinical presentation, a broad differential diagnosis may result in invasive procedures and possibly brain biopsy for diagnostic purposes. Methods An extensive review of the literature is provided for diseases that may present with miliary enhancement on T1-weighted brain MR images. Additional disease-specific findings, both clinical and radiological, are summarized and categorized by the presence or absence of perivascular space involvement. Results Miliary pattern of enhancement may be due to a variety of underlying causes, including inflammatory, infectious, nutritional or neoplastic processes. The recognition of disease spread along the perivascular spaces in addition to the detection or exclusion of disease-specific features on MRI images, such as leptomeningeal enhancement, presence of haemorrhagic lesions, spinal cord involvement and specific localisation or systemic involvement, allows to narrow the potential differential diagnoses. Conclusion A systematic approach to disease-specific findings from both clinical and radiological perspectives might facilitate diagnostic work-up, and recognition of disease spread along the perivascular spaces may help narrowing down differential diagnoses and may help to minimize the use of invasive diagnostic procedures.
... The most common species of Candida is C. albicans which is isolated from both healthy individuals and patients. [22,23] The studies carried out over the last two decades have revealed that >80% of all forms of human candidiasis isolates were C. albicans. On the other hand, particularly in recent years, the infections due to other non-albicans Candida have been to be on the rise. ...
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Given the increasing incidence of yeast infections and the presence of drug-resistant isolates, accurate identification of the pathogenic yeasts is essential for the management of yeast infections. In this review, we tried to introduce the routine and novel techniques applied for yeast identification. Laboratory identification methods of pathogenic yeast are classified into three categories; I. conventional methods, including microscopical and culture-base methods II. biochemical/physiological-processes methods III. molecular methods. While conventional and biochemical methods require more precautions and are not specific in some cases, molecular diagnostic methods are the optimum tools for diagnosing pathogenic yeasts in a short time with high accuracy and specificity, and having various methods that cover different purposes, and affordable costs for researchers. Nucleotide sequencing is a reference or gold standard for identifying pathogenic yeasts. Since it is an expensive method, it is not widely used in developing countries. However, novel identification techniques are constantly updated, and we recommend further studies in this field. The results of this study will guide researchers in finding more accurate diagnostic method(s) for their studies in a short period of time.
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The main objectives of this research were to isolat and identify endophytic fungi antagonists of Candida albicnas from galanga rhizomes. Samples of galanga rhizome were collected from Gitgit plantation in Gitgit village, Buleleng regency. Isolation and identification were conducted in Food Microbiology Laboratory, Faculty of Agriculture, Udayana University. There were three isolates identified with inhibitory persentage againts Candida albicans i.e. Trichoderma viridae (26.07±3.76%), Trichoderma harzianum (45.11±5.84%) and Fusarium oxyforum (20.11±5.61%).
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When and how to treat invasive fungal infections (IFIs) is discussed in this review, with a focus on the two most prevalent non-endemic IFIs, namely invasive aspergillosis and invasive candidiasis. Early treatment initiation in patients with IFIs has a profound impact on mortality rates, but reliable diagnostic measures are lacking. This situation has led to the parallel use of different treatment strategies, e.g. prophylaxis, empirical and pre-emptive treatment, as well as targeted treatment in response to a definite diagnosis of IFI. Identifying high-risk patients is the first step in reducing IFI-related mortality. Patients at risk of invasive aspergillosis comprise (i) those with acute myelogenous leukaemia (AML) or myelodysplastic syndrome (MDS) during remission induction chemotherapy; (ii) patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT); (iii) recipients of solid organ transplants; and (iv) those with other conditions of severe and prolonged immunosuppression. Patients at high risk of invasive candidiasis are less well defined. Risk factors are diverse and include haematological malignancy, neutropenia, age <1 month or >65 years, and recent abdominal surgery. The individual risk further depends on the presence of a variety of other risk factors, including central venous catheters, use of broad spectrum antibacterials, prolonged intensive care unit (ICU) stay, total parenteral nutrition, mucosal Candida spp. colonization and renal failure.Extensive research has been conducted to facilitate the best possible treatment strategies for these severe infections. Optimal timing and choice of antifungal agents largely remain a matter of controversy. After having reviewed the major clinical trials, we conclude that comparisons between different treatment strategies cannot be made, neither at present nor in the near future. The complexity of the clinical problem leads to an eclectic treatment approach to reduce morbidity and mortality from IFIs without compromising tolerability. We recommend prophylaxis with posaconazole for allogeneic HSCT recipients, patients receiving induction chemotherapy for AML or MDS, and those undergoing immunosuppressive therapy for graft-versus-host disease after allogeneic HSCT. For the empirical treatment of persistently febrile neutropenia, caspofungin is our first- and liposomal amphotericin B deoxycholate (LAmB) our second-line choice. Once a diagnosis of invasive aspergillosis has been established, voriconazole should be the preferred treatment option, with LAmB being an alternative. Fluconazole prophylaxis for invasive candidiasis should remain restricted to high-risk ICU patients. Once a diagnosis has been established, the drug of choice for adequate treatment depends largely on neutrophil count and haemodynamic stability. In non-neutropenic patients, an echinocandin should be considered the first-line treatment option, while patients with susceptible Candida spp. may be switched to fluconazole. In neutropenic patients, caspofungin or micafungin might be preferred to anidulafungin as first-line treatment. LAmB is a second-line treatment option in both settings.Early diagnosis of IFIs is imperative to facilitate treatment success. In all patients at risk for IFIs, blood cultures, galactomannan antigen and diagnostic imaging should be rigorously enforced.
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The aim of this study was to identify retrospectively trends in fungal bloodstream infections in The Netherlands in the period from 1987 to 1995. Results of over 395,000 blood cultures from five Dutch university hospitals were evaluated. Overall, there were more than 12 million patient days of care during the nine-year study period. The rate of candidemia doubled in the study period, reaching an incidence of 0.71 episodes per 10,000 patient days in 1995. The general increase in candidemia was paralleled by an increase in non-Candida albicans bloodstream infections, mainly due to Candida glabrata. However, more than 60% of the infections were caused by Candida albicans. Fluconazole-resistant species such as Candida krusei did not emerge during the study period. The increasing rate of candidemia found in Dutch university hospitals is similar to the trend observed in the USA, but the rate is lower and the increase is less pronounced.
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Candida species are the fourth most frequent cause of nosocomial bloodstream infections, and 25%–50% occur in critical care units. During an 18-month prospective study period, all patients admitted for ⩾72 hours to the surgical (SICUs) or neonatal intensive care units (NICUs) at each of the participant institutions were followed daily. Among 4,276 patients admitted to the seven SICUs in six centers, there were 42 nosocomial bloodstream infections due to Candida species (9.8/1,000 admissions; 0.99/1,000 patient-days). Of 2,847 babies admitted to the six NICUs, 35 acquired a nosocomial bloodstream infection due to Candida species (12.3/1,000 admissions; 0.64/1,000 patient-days). The following were the most commonly isolated Candida species causing bloodstream infections in the SICU: Candida albicans, 48%; Candida glabrata, 24%; Candida tropicalis, 19%; Candida parapsilosis, 7%; Candida species not otherwise specified, 2%. In the NICU the distribution was as follows: C. albicans, 63%; C. glabrata, 6%; C. parapsilosis, 29%; other, 3%. Of the patients, 30%–50% developed incidental stool colonization, 23% of SICU patients developed incidental urine colonization, and one-third of SICU health care workers' hands were positive for Candida species.
Candida rugosa has been rarely reported Lis a human pathogen. We retrospectively evaluated a cluster of Candida rugosa candidemia cases occurring in six hospitalized patients front a tertiary care teaching hospital in Sao Paulo, Brazil. Genetic relatedness among the six C. rugosa outbreak isolates was characterized by RAPD assay using 3 different 10-mer primers and by pulsed field gel electrophoresis. The Source of the outbreak was not identified. All patients had been subjected to invasive medical procedures, including central venous catheterization, surgery or dialysis. Two patients were undergoing amphotericin B therapy prior to the onset of candidemia. The Crude mortality rate was very high, despite antifungal therapy. C. rugosa may represent an emerging pathogen associated with invasive medical procedures, able to infect immunocompetent hosts causing serious systemic infection refractory to amphotericin B therapy. paired right arrows 2003 Elsevier Inc. All rights reserved.
Trends in the species of yeast causing fungaemia over a 12-year period at a large tertiary care medical centre were reviewed. A total of 966 unique episodes of fungaemia occurred in 898 patients. There was an overall trend toward fewer fungaemic episodes due to Candida albicans and more due to Candida glabrata and Candida parapsilosis. However, C. albicans remained the predominant species causing fungaemia, and the proportion due to other species varied from year to year. Candida glabrata was disproportionately isolated from older adults, whereas C. parapsilosis was common among neonates and infants. The trends of increasing isolation of C. glabrata and decreasing isolation of C. albicans were associated with increasing usage of fluconazole, but changes in the proportion of fungaemias due to other species appeared to have no association with fluconazole usage. Zusammenfassung. U¨ber eine 12-Jahresperiode hin wurden in einer Großklinik die Hefeisolate von Funga¨mie-Patienten statistisch erfasst. Bei 898 Patienten wurden 966 Funga¨mie-Episoden beobachtet. Insgesamt zeigte sich ein Trend zu weniger Funga¨mie-Episoden durch Candida albicans und zu mehr durch Candida glabrata und Candida parapsilosis. Trotzdem blieb C. albicans die dominante Art als Funga¨mie-Erreger; der Anteil anderer Hefearten variierte von Jahr zu Jahr. Candida glabrata wurde relativ ha¨ufiger von a¨lteren Patienten isoliert, C. parapsilosis ha¨ufiger von Neugeborenen und Kindern. Die Trends zunehmender Isolierung von C. glabrata und sinkender Isolierungsha¨ufigkeit von C. albicans waren mit dem steigenden Einsatz von Fluconazol assoziiert. A¨nderungen in den Anteilen der Funga¨mie-Fa¨lle durch andere Arten zeigten jedoch keine Beziehung zum Fluonazol-Einsatz.
The prophylactic use of fluconazole is common in blood and marrow transplant (BMT) recipients. To evaluate how fluconazole has influenced the development of azole resistance and candidemia, weekly mouthwashings were done, and fluconazole susceptibility was determined for 1475 colonizing and invasive isolates obtained from patients undergoing BMT. Of 585 patients, 256 (44%) were colonized with Candida species during the course of BMT. Of these, 136 patients (53%) had at least 1 mouthwashing sample that yielded Candida species other than C. albicans on culture. Only 4.6% of patients developed candidemia. Overall, C. albicans was the most common colonizing isolate, but it caused only 7% of cases of candidemia. About 5% of colonizing C. albicans strains and 100% (2 of 2) invasive C. albicans strains were fluconazole-resistant. Colonization, cytomegalovirus disease, and bacteremia are risk factors for the development of candidemia. The use of prophylactic fluconazole is associated with a low incidence of candidemia and attributable mortality, despite colonization with azole-resistant Candida species in BMT recipients.
In vitro interaction of fluconazole and baicalein (BE) was investigated against 30 fluconazole-resistant clinical isolates of Candida albicans. Synergistic activities were determined using the checkerboard microdilution assay based on the fractional inhibitory concentration indices. Organisms were also tested against the 2 drugs singly and in combination using time-kill methods. Both fluconazole and BE showed weak antifungal activity when tested alone. However, the combination of fluconazole and BE showed strong antifungal activity against most of the fluconazole-resistant isolates tested. The findings of time-kill curves confirmed the interaction. Yeast cells grown in the presence of BE exhibited a reduced extrusion of Rhodamine 6G, which indicates the inhibition of efflux pumps by BE. This novel synergism of fluconazole and BE that can overcome drug-resistance in yeast may prove useful in combined treatment of fungal infections.
Organ transplant recipients, on long-term graft preserving immunosuppressive therapy, are at increased risk for life threatening opportunistic fungal infections. In order to evaluate the incidence of invasive fungal infections (IFIs) and to identify the most common fungal pathogens, we conducted a retrospective study on 2410 ESRD cases undergone living kidney transplantation in three transplant centers between 1998 and 2008. IFIs developed in 21 recipients (0.87%), 17 male and 4 female. Their immunosuppression was cyclosporine based. The mean age of patients was 48+/-10 (ranged from 32 to 67) years. Diagnosis was made by radiological findings, positive blood or bronchoalveolar lavage (BAL) cultures and tissue biopsies. Mucormycosis was the most common cause of IFIs in population studied (n=11), followed by disseminated candidiasis (n=4), aspergillosis (n=3), nocardiasis (n=2) and histoplasmosis (n=1). Pulmonary involvement was dominant (47.6%). The treatment was successful in only 10 patients and the rest died. In our large series of kidney transplant recipients, mucormycosis was found to be the most common cause of invasive fungal infection. Prompt diagnosis and treatment are necessary to avoid the life threatening complications and may greatly improve prognosis.
A total of 854 patients (640 children and 214 adults) admitted with acute or chronic diarrhoea suspected of non-invasive overgrowth of fungi in intestine were screened during a period of 3 years. Fungal proliferation was noted in 54.8% of these patients (53.6% in children, 58.4% in adults). The predominant fungal species isolated were Candida albicans (64.5%), followed by C. tropicalis (23.3%) C. krusei (6.9%). Torulopsis glabrata (1.6%). Trichosporon sp. and Geotrichum sp. were found to be responsible in 2.3% of adults. As seen in bacterial diarrhoea, higher incidence was noted in children from April to August. No such seasonal variation was noted in adults.