BACKGROUND Non-albicans Candida prosthetic joint infections (PJIs) are rare. Optimal treatment involves a two-stage revision surgery in combination with an antifungal agent. However, no clear guidelines have been deve...BACKGROUND Non-albicans Candida prosthetic joint infections (PJIs) are rare. Optimal treatment involves a two-stage revision surgery in combination with an antifungal agent. However, no clear guidelines have been developed regarding the agent or treatment duration. Hence, a broad range of antifungal and surgical treatments have been reported so far. AIM To clarify treatment of non-albicans Candida PJIs. METHODS A literature review of all existing non-albicans Candida PJIs cases through April 2018 was conducted. Information was extracted about demographics, comorbidities, responsible species, duration and type of antifungal treatment, type of surgical treatment, time between initial arthroplasty and symptom onset, time between symptom onset and definite diagnosis, outcome of the infection and follow-up. RESULTS A total of 83 cases, with a mean age of 66.3 years, were located. The causative yeast isolated in most cases was C. parapsilosis (45 cases;54.2%), followed by C. glabrata (18 cases;21.7%). The mean Charlson comorbidity index was 4.4 ± 1.5. The mean time from arthropalsty to symptom onset was 27.2 ± 43 mo, while the mean time from symptom onset to culture-confirmed diagnosis was 7.5 ± 12.5 mo. A two stage revision arthroplasty (TSRA), when compared to one stage revision arthroplasty, had a higher success rate (96% vs 73%, P = 0.023). Fluconazole was the preferred antifungal agent (59;71%), followed by amphotericin B (41;49.4%). CONCLUSION The combination of TSRA and administration of prolonged antifungal therapy after initial resection arthroplasty is suggested on the basis of limited data.展开更多
Purpose: To evaluate the profile of in vitro susceptibility of yeasts isolated from cases of primary and espisodic vulvovaginitis to two antifungal agents. Methods: 40 Candida isolates from episodes of vulvovaginal ca...Purpose: To evaluate the profile of in vitro susceptibility of yeasts isolated from cases of primary and espisodic vulvovaginitis to two antifungal agents. Methods: 40 Candida isolates from episodes of vulvovaginal candidiasis were identified by classic methodologies. The susceptibility testing of the in vitro fluconazole and ketoconazole activity against the isolates was accessed by E-test. Results: C. albicans was the most common species identified in 70% of the occurrences followed by C. glabrata (20%), C. tropicalis (7.5%), and C. guilliermondii (2.5%). In the susceptibility profile to antifungal agents, 12.5% and 16.7% of the isolates obtained from primary and episodic vulvovaginal candidiasis were resistant to fluconazole, respectively. To ketoconazole, we found that 6.25% and 12.5% of the isolates respectively from primary vulvovaginal candidiasis (PVVC) and episodic vulvovaginal candidiasis (EVVC) had high MIC values. Conclusions: E-test is a reliable method for the susceptibility testing of Candida spp. due to its simplicity, reproducibility, and lack of specialized equipment. Resistant strains and non-albicans species were verified more in cases of EVVC than in PVVC. Clinical and mycological cure of patients with episodic vulvovaginal candidiasis or complicated cases occurred after prolonged treatment and sometimes with multiple antifungals use.展开更多
Objective: To evaluate the alpha-defensin (α-DF) genes polymorphism in women with vulvovaginal candidiasis and recurrence. Methods: This observational study included clinical vaginal secretion samples collected over ...Objective: To evaluate the alpha-defensin (α-DF) genes polymorphism in women with vulvovaginal candidiasis and recurrence. Methods: This observational study included clinical vaginal secretion samples collected over four years from 88 women, ranging in age from 18 to 65 years, from medical centers of Sao Paulo and Mogi das Cruzes, Brazil. Thirty-six of these women were asymptomatic (control group) and 52 presented clinical condition compatible with vulvovaginitis (38 primary or episodic as non-recurrent forms, and 14 recurrent vulvovaginal candidiasis). A portion of each sample was plated on Sabouraud dextrose agar with chloramphenicol and grown on CHROMagar Candida for presumptive characterization. The identification of the species was obtained by sequencing of the ITS1 region of rDNA. α-DF genes were amplified for subsequent evaluation of polymorphisms by endonuclease restriction assay. Results: From 88 samples were isolated 60 Candida albicans and 28 non-albicans Candida spp. Resistant C. albicans strains and non-albicans Candida spp. were more prevalent in recurrence. In all groups, the number of resistant non-albicans Candida spp. was most high than susceptible strains. α-DF1, α-DF3 and α-DF1/α-DF3 genotypes were found in 32 (36.4%), 17 (19.3%), 6 (6.8%) vaginal samples, respectively. About 33 samples were not amplified. Recurrence and severe disease were more observed in homozygous population. Conclusions: Non-albicans Candida spp. and homozygotic α-DF genotipes (α-DF1 and α-DF3) were more related with severe clinical signs and recurrence. Further studies about vulvovaginal candidiasis and α-DF genes are necessary to access the more comprehensive role of defensins in clinical manifestations.展开更多
Non-albicans candida meningitis is a relatively rare disease,with nonspecific clinical manifestation,which makes the misdiagnosis occur sometimes,especially in the early stage of the disease.Abuse of broad-spectrum an...Non-albicans candida meningitis is a relatively rare disease,with nonspecific clinical manifestation,which makes the misdiagnosis occur sometimes,especially in the early stage of the disease.Abuse of broad-spectrum antibiotics,corticosteroids,central vein cannulas,senility,big operation,malignancy,and total parenteral alimentation were all the susceptible factors of non-albicans candida infection.We present a case of this type of non-albicans infection in a 42-year-old woman who was early misdiagnosed as tuberculous meningitis and was treated with antibiotics and antituberculosis agents.The diagnosis of non-albicans infection was confirmed by fungus culture of the cerebrospinal fluid(CSF)with a low detectable rate.This case reminds us that the non-albicans candida meningitis had a nonspecific clinical presentations and laboratory data,and was difficult to differentiate from tuberculosis meningitis.Hence,we should highly suspect this disease if central nervous system infections with uncertain pathogens.Test cell counts;protein and fungus culture of CSF should be used to confirm the diagnosis.Once the diagnosis was established,the patients should receive antifungal treatment based on drug sensitivity tests as early as possible.展开更多
Objective:To evaluate the prevalence of Candida species in cancer patients with candidemia around the world,and to identify related risk factors and their antifungal resistance,with an emphasis on non-albicans Candida...Objective:To evaluate the prevalence of Candida species in cancer patients with candidemia around the world,and to identify related risk factors and their antifungal resistance,with an emphasis on non-albicans Candida species(NACs).Methods:The published papers related to the subject were systematically searched in databases of MEDLINE(including PubMed),Web of Science,Scopus,Science Direct,and Google Scholar between the 1st January 2000 and 21st April 2021.Results:Among the 4546 records,69 studies met the inclusion criteria.The pooled prevalence of NACs in cancer patients with candidemia was 62%(95%CI 58%-67%;I2=94.85%,P=0.00).Based on type of cancer,the pooled prevalence of NACs in hematologic and solid cancer patients were 68%(95%CI 65%-70%)and 52%(95%CI 49%-54%),respectively.Among NACs,Candida(C.)parapsilosis was the most frequently isolated organism followed by C.tropicalis and C.glabrata.In addition,the therapeutic usage of antibiotics was found as the most common risk factor,accounting for 85%(95%CI 81%-89%)and central venous catheter accounting for 69%(95%CI 62%-77%).Conclusions:The incidence of Candida bloodstream infections among cancer patients is a growing concern,especially when the etiologic agents of candidemia tend to shift towards NACs.展开更多
目的了解STD门诊复发性外阴道念珠菌病(RVVC)和外阴阴道念珠菌病(VVC)的致病菌种分布及对常用抗真菌药物的敏感状况,为临床治疗提供参考。方法用沙氏琼脂培养基分离纯化菌株,然后用ATB ID 32C酵母菌鉴定系统和ATB Fungus3药敏系统进行...目的了解STD门诊复发性外阴道念珠菌病(RVVC)和外阴阴道念珠菌病(VVC)的致病菌种分布及对常用抗真菌药物的敏感状况,为临床治疗提供参考。方法用沙氏琼脂培养基分离纯化菌株,然后用ATB ID 32C酵母菌鉴定系统和ATB Fungus3药敏系统进行菌种鉴定与药物敏感试验。结果 280份标本中检出白色念珠菌201株,占71.79%;非白色念珠菌79株,占28.21%,其中光滑念珠菌42株,占15%。VVC组与RVVC组抗真菌药物比较,VVC组对氟康唑的敏感率高于RVVC组,差异有统计学意义(P<0.05)。结论 STD门诊患者阴道念珠菌病检出菌种仍以白色念珠菌为主,但RVVC组非白色念珠菌比例高于VVC组。非白色念珠菌中光滑念珠菌占比例最高。VVC组氟康唑的敏感率高于RVVC组。展开更多
Background: Candida vulvovaginitis is one of the most frequently diagnosed conditions in women’s care practices. Historically, 90% of cultured yeast species were C. albicans. However, due to a variety of intervention...Background: Candida vulvovaginitis is one of the most frequently diagnosed conditions in women’s care practices. Historically, 90% of cultured yeast species were C. albicans. However, due to a variety of interventions, the proportion of non-albicans Candida (NAC) infections appears to be increasing. We sought to estimate the current prevalence of Candida vulvovaginitis and the species-specific distribution of such infections in recurrent cases. Methods: Women with recurrent vulvovaginal symptomatology referred to an Obstetrics and Gynecology practice were tested by genital fungus culture, Candida-specific polymerase chain reaction (PCR), or both between July 2010 and February 2013. Results: A total of 103 women were tested. Mean age was 45.6 years. Including only their most recent positive test result, 29.1% (30/103) of women tested positive for Candida by any of the above testing measures. Of those, 50% (15/30) tested positive for C. albicans and 50% (15/30) tested positive for a NAC species. Across all visits, 60% (18/30) tested positive for C. albicans, 56.7% (17/30) tested positive for NAC, and 16.7% (5/30) tested positive for both a C. albicans and a NAC species. Among all isolated NAC species, 28.6% (6/21) were determined to be C. glabrata, 23.8% (5/21) C. krusei, 23.8% (5/21) C. parapsilosis, and 23.8% (5/21) other Candida species. Conclusion: Approximately 30% of women with recurrent vulvovaginal symptomatology have detectable Candida strains and it appears that NAC species may cause half of all these infections. This is imperative because NAC infections are usually more difficult to diagnose and are resistant to most treatments.展开更多
文摘BACKGROUND Non-albicans Candida prosthetic joint infections (PJIs) are rare. Optimal treatment involves a two-stage revision surgery in combination with an antifungal agent. However, no clear guidelines have been developed regarding the agent or treatment duration. Hence, a broad range of antifungal and surgical treatments have been reported so far. AIM To clarify treatment of non-albicans Candida PJIs. METHODS A literature review of all existing non-albicans Candida PJIs cases through April 2018 was conducted. Information was extracted about demographics, comorbidities, responsible species, duration and type of antifungal treatment, type of surgical treatment, time between initial arthroplasty and symptom onset, time between symptom onset and definite diagnosis, outcome of the infection and follow-up. RESULTS A total of 83 cases, with a mean age of 66.3 years, were located. The causative yeast isolated in most cases was C. parapsilosis (45 cases;54.2%), followed by C. glabrata (18 cases;21.7%). The mean Charlson comorbidity index was 4.4 ± 1.5. The mean time from arthropalsty to symptom onset was 27.2 ± 43 mo, while the mean time from symptom onset to culture-confirmed diagnosis was 7.5 ± 12.5 mo. A two stage revision arthroplasty (TSRA), when compared to one stage revision arthroplasty, had a higher success rate (96% vs 73%, P = 0.023). Fluconazole was the preferred antifungal agent (59;71%), followed by amphotericin B (41;49.4%). CONCLUSION The combination of TSRA and administration of prolonged antifungal therapy after initial resection arthroplasty is suggested on the basis of limited data.
文摘Purpose: To evaluate the profile of in vitro susceptibility of yeasts isolated from cases of primary and espisodic vulvovaginitis to two antifungal agents. Methods: 40 Candida isolates from episodes of vulvovaginal candidiasis were identified by classic methodologies. The susceptibility testing of the in vitro fluconazole and ketoconazole activity against the isolates was accessed by E-test. Results: C. albicans was the most common species identified in 70% of the occurrences followed by C. glabrata (20%), C. tropicalis (7.5%), and C. guilliermondii (2.5%). In the susceptibility profile to antifungal agents, 12.5% and 16.7% of the isolates obtained from primary and episodic vulvovaginal candidiasis were resistant to fluconazole, respectively. To ketoconazole, we found that 6.25% and 12.5% of the isolates respectively from primary vulvovaginal candidiasis (PVVC) and episodic vulvovaginal candidiasis (EVVC) had high MIC values. Conclusions: E-test is a reliable method for the susceptibility testing of Candida spp. due to its simplicity, reproducibility, and lack of specialized equipment. Resistant strains and non-albicans species were verified more in cases of EVVC than in PVVC. Clinical and mycological cure of patients with episodic vulvovaginal candidiasis or complicated cases occurred after prolonged treatment and sometimes with multiple antifungals use.
基金This study was financially supported by the Brazilian National Council for Scientific and Technological Development(CNPq,Brazil)We thank to Claudia R.C.Porto for support in laboratory tests.
文摘Objective: To evaluate the alpha-defensin (α-DF) genes polymorphism in women with vulvovaginal candidiasis and recurrence. Methods: This observational study included clinical vaginal secretion samples collected over four years from 88 women, ranging in age from 18 to 65 years, from medical centers of Sao Paulo and Mogi das Cruzes, Brazil. Thirty-six of these women were asymptomatic (control group) and 52 presented clinical condition compatible with vulvovaginitis (38 primary or episodic as non-recurrent forms, and 14 recurrent vulvovaginal candidiasis). A portion of each sample was plated on Sabouraud dextrose agar with chloramphenicol and grown on CHROMagar Candida for presumptive characterization. The identification of the species was obtained by sequencing of the ITS1 region of rDNA. α-DF genes were amplified for subsequent evaluation of polymorphisms by endonuclease restriction assay. Results: From 88 samples were isolated 60 Candida albicans and 28 non-albicans Candida spp. Resistant C. albicans strains and non-albicans Candida spp. were more prevalent in recurrence. In all groups, the number of resistant non-albicans Candida spp. was most high than susceptible strains. α-DF1, α-DF3 and α-DF1/α-DF3 genotypes were found in 32 (36.4%), 17 (19.3%), 6 (6.8%) vaginal samples, respectively. About 33 samples were not amplified. Recurrence and severe disease were more observed in homozygous population. Conclusions: Non-albicans Candida spp. and homozygotic α-DF genotipes (α-DF1 and α-DF3) were more related with severe clinical signs and recurrence. Further studies about vulvovaginal candidiasis and α-DF genes are necessary to access the more comprehensive role of defensins in clinical manifestations.
文摘Non-albicans candida meningitis is a relatively rare disease,with nonspecific clinical manifestation,which makes the misdiagnosis occur sometimes,especially in the early stage of the disease.Abuse of broad-spectrum antibiotics,corticosteroids,central vein cannulas,senility,big operation,malignancy,and total parenteral alimentation were all the susceptible factors of non-albicans candida infection.We present a case of this type of non-albicans infection in a 42-year-old woman who was early misdiagnosed as tuberculous meningitis and was treated with antibiotics and antituberculosis agents.The diagnosis of non-albicans infection was confirmed by fungus culture of the cerebrospinal fluid(CSF)with a low detectable rate.This case reminds us that the non-albicans candida meningitis had a nonspecific clinical presentations and laboratory data,and was difficult to differentiate from tuberculosis meningitis.Hence,we should highly suspect this disease if central nervous system infections with uncertain pathogens.Test cell counts;protein and fungus culture of CSF should be used to confirm the diagnosis.Once the diagnosis was established,the patients should receive antifungal treatment based on drug sensitivity tests as early as possible.
文摘Objective:To evaluate the prevalence of Candida species in cancer patients with candidemia around the world,and to identify related risk factors and their antifungal resistance,with an emphasis on non-albicans Candida species(NACs).Methods:The published papers related to the subject were systematically searched in databases of MEDLINE(including PubMed),Web of Science,Scopus,Science Direct,and Google Scholar between the 1st January 2000 and 21st April 2021.Results:Among the 4546 records,69 studies met the inclusion criteria.The pooled prevalence of NACs in cancer patients with candidemia was 62%(95%CI 58%-67%;I2=94.85%,P=0.00).Based on type of cancer,the pooled prevalence of NACs in hematologic and solid cancer patients were 68%(95%CI 65%-70%)and 52%(95%CI 49%-54%),respectively.Among NACs,Candida(C.)parapsilosis was the most frequently isolated organism followed by C.tropicalis and C.glabrata.In addition,the therapeutic usage of antibiotics was found as the most common risk factor,accounting for 85%(95%CI 81%-89%)and central venous catheter accounting for 69%(95%CI 62%-77%).Conclusions:The incidence of Candida bloodstream infections among cancer patients is a growing concern,especially when the etiologic agents of candidemia tend to shift towards NACs.
文摘Background: Candida vulvovaginitis is one of the most frequently diagnosed conditions in women’s care practices. Historically, 90% of cultured yeast species were C. albicans. However, due to a variety of interventions, the proportion of non-albicans Candida (NAC) infections appears to be increasing. We sought to estimate the current prevalence of Candida vulvovaginitis and the species-specific distribution of such infections in recurrent cases. Methods: Women with recurrent vulvovaginal symptomatology referred to an Obstetrics and Gynecology practice were tested by genital fungus culture, Candida-specific polymerase chain reaction (PCR), or both between July 2010 and February 2013. Results: A total of 103 women were tested. Mean age was 45.6 years. Including only their most recent positive test result, 29.1% (30/103) of women tested positive for Candida by any of the above testing measures. Of those, 50% (15/30) tested positive for C. albicans and 50% (15/30) tested positive for a NAC species. Across all visits, 60% (18/30) tested positive for C. albicans, 56.7% (17/30) tested positive for NAC, and 16.7% (5/30) tested positive for both a C. albicans and a NAC species. Among all isolated NAC species, 28.6% (6/21) were determined to be C. glabrata, 23.8% (5/21) C. krusei, 23.8% (5/21) C. parapsilosis, and 23.8% (5/21) other Candida species. Conclusion: Approximately 30% of women with recurrent vulvovaginal symptomatology have detectable Candida strains and it appears that NAC species may cause half of all these infections. This is imperative because NAC infections are usually more difficult to diagnose and are resistant to most treatments.
