|
| ||
|
|
||
Candida Infections (candida + infections)
Selected AbstractsFungemia Associated with Left Ventricular Assist Device SupportJOURNAL OF CARDIAC SURGERY, Issue 6 2009M.P.H., Natasha G. Bagdasarian M.D. While relatively uncommon, fungal infections present a serious concern given a high association with adverse events including death. We sought to further characterize the epidemiology of fungemias during LVAD support. Methods: Retrospective review of 292 patients receiving LVAD support from October 1996 to April 2009 at the University of Michigan Health System was done. Results: Seven cases of LVAD-associated fungemia were observed during the study period (0.1 infections/1000 days of device support). Five patients had infection with Candida species and two with Aspergillus species. The two patients with Aspergillus infection presented with disseminated disease, quickly dying of multiorgan failure, and sepsis. All five patients with Candida infections were successfully treated with systemic antifungal therapy along with transplantation in four of five patients. The fifth patient is receiving mechanical support as destination therapy. He remains on long-term suppression with high-dose fluconazole. Conclusions: Fungal infections appear to be a rare but serious complication of LVAD support. Future studies should aim to improve our understanding of risk factors for fungal infection during mechanical support, especially disseminated Aspergillus. Short-term perioperative antifungal prophylaxis with fluconazole appears to be an effective and reasonable approach to prevention. [source] The changing face of epidemiology of invasive fungal disease in EuropeMYCOSES, Issue 3 2009Cornelia Lass-Flörl Summary Invasive fungal diseases (IFDs) are an increasingly common complication in critically ill patients in Europe and are frequently fatal. Because of changes in treatment strategies and the increased use of antifungal prophylaxis, the epidemiology of IFDs has changed substantially in recent years and infections due to Candida species are no longer the majority in many institutions. In contrast, the emergence of non- Candida IFDs such as aspergillosis, zygomycosis and fusariosis has increased. European surveys indicate that Candida albicans is responsible for more than half the cases of invasive candidaemia; however, the occurrence of non- albicans -related IFDs appears to be increasing. Rates of IFD-related mortality in Europe depend on the pathogen, geographical location and underlying patient characteristics, with rates ranging from 28 to 59% for Candida infections and from 38 to 80% for invasive aspergillosis. Early initiation of antifungal therapy is critical for improving outcomes; however, this is complicated by the difficulty in diagnosing IFDs rapidly and accurately. The introduction of new extended-spectrum azole antifungal agents (e.g. voriconazole, posaconazole) and echinocandins (e.g. micafungin, caspofungin, anidulafungin) has increased the number of therapeutic options for early therapy. Choice between agents should be based on a variety of factors, including spectrum of activity, adverse events, drug interactions, route of administration, clinical efficacy of individual agents and local epidemiology. [source] Chlamydospore formation in Candida albicans and Candida dubliniensis, an enigmatic developmental programmeMYCOSES, Issue 1 2007Peter Staib Summary Chlamydospore formation has served for a long time for identification of the human fungal pathogen Candida albicans, but the biological function of these structures still remains a secret. They have been proposed to allow survival in harsh environmental conditions, but this assumption remains to be proven. Chlamydospores are produced only by the two closely related species C. albicans and Candida dubliniensis, whose natural habitats are humans and warm-blooded animals, but not by other Candida species that are also found outside animal hosts. However, no role in the pathogenesis of Candida infections has been assigned to these unusual cells and only a limited number of studies have been conducted in the past to unravel their function. The development of new molecular tools and the recent discovery of mating in C. albicans have also restimulated investigations to understand the morphogenesis and function of chlamydospores. The finding that chlamydospore formation is differentially controlled by certain environmental signals in C. albicans and C. dubliniensis has opened new approaches to study the regulation of this morphogenetic programme. These studies have already identified genes and signalling pathways that are required for chlamydospore production and should lead to a detailed understanding of this fascinating developmental process. [source] Hydrolytic enzymes as virulence factors of Candida albicansMYCOSES, Issue 6 2005Martin Schaller Summary Candida albicans is a facultative pathogenic micro-organism that has developed several virulence traits enabling invasion of host tissues and avoidance of host defence mechanisms. Virulence factors that contribute to this process are the hydrolytic enzymes. Most of them are extracellularly secreted by the fungus. The most discussed hydrolytic enzymes produced by C. albicans are secreted aspartic proteinases (Saps). The role of these Saps for C. albicans infections was carefully evaluated in numerous studies, whereas only little is known about the physiological role of the secreted phospholipases (PL) and almost nothing about the involvement of lipases (Lip) in virulence. They may play an important role in the pathogenicity of candidosis and their hydrolytic activity probably has a number of possible functions in addition to the simple role of digesting molecules for nutrition. Saps as the best-studied member of this group of hydrolytic enzymes contribute to host tissue invasion by digesting or destroying cell membranes and by degrading host surface molecules. There is also some evidence that hydrolytic enzymes are able to attack cells and molecules of the host immune system to avoid or resist antimicrobial activity. High hydrolytic activity with broad substrate specificity has been found in several Candida species, most notably in C. albicans. This activity is attributed to multigene families with at least 10 members for Saps and Lips and several members for PL B. Distinct members of these gene families are differentially regulated in various Candida infections. In future, prevention and control of Candida infections might be achieved by pharmacological or immunological tools specifically modulated to inhibit virulence factors, e.g. the family of Saps. [source] Onychomycosis in children: a survey of 46 casesMYCOSES, Issue 6 2005C. Romano Summary This is a retrospective study of the agents, clinical aspects, sources of infection and therapy of onychomycosis in children. In the period 1989,2000, we observed 46 consecutive children, until 16 years of age with onychomycosis (29 boys, 17 girls, mean age 10.8 years). Dermatophytes were isolated in 30 cases (Trichophyton rubrum in 22 cases, Trichophyton mentagrophytes in five, Epidermophyton floccosum in two and Trichophyton violaceum in one) and Candida spp. in 16, associated with Trichophyton rubrum in two. Moulds were isolated in three children (Fusarium oxysporum in one, Scopulariopsis brevicaulis in another and Aspergillus fumigatus associated with Trichophyton rubrum in a third). The commonest features were distal and distolateral subungual hyperkeratosis in dermatophyte infections (93%) and onychodystrophy and paronychia in Candida infections (56% and 50% respectively). Forty patients achieved clinical and mycological recovery. It is appropriate to suspect onychomycosis in children, perform microbiological diagnosis and undertake early treatment. An approach of this kind may help to prevent nail dystrophy and the spread of infection. [source] New molecular methods to study gene functions in Candida infectionsMYCOSES, Issue 9-10 2002S. Theiß Candida; Molekulargenetik; Genfunktion; Genexpression; ABC-Transporter Summary.Candida albicans has become a model system for human pathogenic fungi in clinical research, mainly due to the increasing number of Candida infections. Molecular techniques to study C. albicans virulence properties have been improved over the last few years, despite difficulties in genetic manipulation of this fungus. Some of the recent achievements from our own laboratory or from other groups are described in this article. The molecular analysis of the recently identified ATP-dependent transporter Mlt1 using the green fluorescent protein (GFP) as reporter for protein localization and the dominant MPAR gene as a selection marker for gene inactivation provides an example for the study of gene functions in C. albicans. Zusammenfassung.Candida albicans ist für die klinische Forschung zu einem Modellsystem zur Untersuchung humanpathogener Pilze geworden, was nicht zuletzt auf die steigende Zahl an Candida -Infektionen zurückzuführen ist. Trotz der Schwierigkeiten, die eine genetische Manipulation dieses Pilzes mit sich bringt, konnten in den letzten Jahren molekularbiologische Techniken zur Erforschung der Virulenzfaktoren von C. albicans weiterentwickelt werden. Einige dieser neuen Methoden, zum Teil aus unserer Arbeitsgruppe, aber auch aus anderen Laboratorien, werden in diesem Artikel beschrieben. Zudem gibt die Analyse des kürzlich isolierten, ATP-abhängigen Transporters Mlt1 ein Beispiel für die Studie von Genfunktionen, wobei das GFP (green fluorescent protein) als Reporter für Proteinlokalisation und der dominante Selektionsmarkers MPAR zur Geninaktivierung verwendet wurden. [source] Mannose-binding lectin gene polymorphism and resistance to therapy in women with recurrent vulvovaginal candidiasisBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 10 2008GGG Donders Precis, Women with recurrent vulvovaginal candidiasis (RVC) due to a polymorphism in codon 54 of the MBL2 gene respond better to fluconazole maintenance therapy than do women with other underlying causes. Objective, To explain differences in response rates to maintenance therapy with fluconazole in women suffering from RVC by evaluating associations with a polymorphism in the gene coding for mannose-binding lectin (MBL). Design, Follow-up study, neted case-control group. Setting, Women attending vulvoginitis clinic for RVC. Population, Women participating in a multicentric study in Belgium with a degressive dose of fluconazole for RVC (the ReCiDiF trial) were divided into good responders, intermediate responders and nonresponders according to the number of relapses they experienced during therapy. From 109 of these women with adequate follow-up data, vaginal lavage with 2 ml of saline were performed at the moment of a proven acute attack at inclusion in the study, before maintenance treatment was started. A buccal swab was obtained from 55 age-matched women without a history of Candida infections, serving as a control group. Methods, Extracted DNA from buccal or vaginal cells was tested for codon 54 MBL2 gene polymorphism by polymerase chain reaction and endonuclease digestion. Main outcome measures, Frequency of MBL2 condon 54 allele B in women with optimal or poor response to maintenance therapy in composition with controls. Results, Women (n = 109) suffering from RVC were more likely to carry the variant MBL2 codon 54 allele B than control women (20 versus 6.6%, OR 3.4 [95% CI 1.3,8.2], P = 0.01). B alleles were present in 25% of the 36 women not suffering from any recurrence during the maintenance therapy with decreasing doses of fluconazole (OR 4.9 [95% CI 1.9,12.5], P = 0.0007 versus controls), in 20% of the 43 women with sporadic recurrences (OR 3.6 [95% CI 1.4,9.2], P = 0.007 versus controls) and in 15% of the 30 women who had to interrupt the treatment regimen due to frequent relapses (P = 0.097 versus controls). Conclusions, The MBL2 codon 54 gene polymorphism is more frequent in Belgian women suffering from RVC than in controls. The presence of the B allele is associated with a superior response to fluconazole maintenance therapy as compared with RVC patients without this polymorphism. We conclude that RVC due to deficient MBL production is more easily helped with antifungal medication than is RVC due to some other mechanism. [source] Candida albicans proteinases and host/pathogen interactionsCELLULAR MICROBIOLOGY, Issue 10 2004Julian Naglik Summary Candida infections are common, debilitating and often recurring fungal diseases and a problem of significant clinical importance. Candida albicans, the most virulent of the Candida spp., can cause severe mucosal and life-threatening systemic infections in immunocompromised hosts. Attributes that contribute to C. albicans virulence include adhesion, hyphal formation, phenotypic switching and extracellular hydrolytic enzyme production. The extracellular hydrolytic enzymes, especially the secreted aspartyl proteinases (Saps), are one of few gene products that have been shown to directly contribute to C. albicans pathogenicity. Because C. albicans is able to colonize and infect almost every tissue in the human host, it may be crucial for the fungus to possess a number of similar but independently regulated and functionally distinct secreted proteinases to provide sufficient flexibility in order to survive and promote infection at different niche sites. The aim of this review is to explore the functional roles of the C. albicans proteinases and how they may contribute to the host/pathogen interaction in vivo. [source] Chronic mucocutaneous candidiasis may cause elevated gliadin antibodiesACTA PAEDIATRICA, Issue 10 2009Florian Brinkert Abstract We present a 4-year-old boy admitted to the hospital due to the typical symptoms of celiac disease with severe dystrophy, anaemia and elevated gliadin IgG antibodies. Upper endoscopy ruled out celiac disease but showed severe Candida esophagitis. Due to an impaired T-cell function especially following Candida antigen stimulation in vitro, plus recurrent Candida infections of the skin, the diagnosis of chronic mucocutaneous candidasis (CMC) was made. Under the treatment with fluconazol, trimethoprim/sulfmethoxazole and IVIG, the child improved impressively. Gliadin antibodies declined steadily. Conclusion:, The common symptoms growth retardation, anaemia and elevated gliadin antibodies are suggestive for celiac disease but very unspecific. The rare immunodeficiency CMC may cause elevated gliadin antibodies. [source] | ||||||||||