Isolation of Candida africana in oral candidiasis: First report among cancer patients in Iran

Background and Purpose: Oropharyngeal candidiasis (OPC) is a fungal infection of the oral cavity caused by the members of C. albicans complex. Although C. africana, as a part of the complex, is considered to be mostly responsible for the development of vulvovaginal candidiasis, it may be associated with a wider clinical spectrum. Case report: This report described two cases diagnosed with oral candidiasis during the receipt of treatment for malignancies. Conventional and molecular tests were performed on the samples collected from the patients’ oral cavities. The test results revealed C. africana as the causative agent of oral candidiasis. Furthermore, in vitro antifungal susceptibility test indicated the full susceptibility of all C. africana isolates to caspofungin. However, the data were also suggestive of the resistance against fluconazole and amphotericin B. Caspofungin was used as the main antifungal agent for the treatment of oral candidiasis, resulting in the improvement of thrush in patients. The resistance of C. africana to fluconazole and amphotericin B suggests the necessity of performing in vitro susceptibility testing on the isolates for the selection of appropriate antifungal agents. Conclusion: As the findings indicated, the achievement of knowledge regarding C. africana as an emerging non-albicans Candida species and its antifungal susceptibility profile is crucial to select antifungal prophylaxis and empirical therapy for oral candidiasis in cancer patients undergoing chemotherapy.

Download Full-text

Oral Candidiasis among Cancer Patients Attending a Tertiary Care Hospital in Chennai, South India: An Evaluation of Clinicomycological Association and Antifungal Susceptibility Pattern

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2016/8758461 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 8

Author(s):

Abirami Lakshmy Jayachandran ◽

Radhika Katragadda ◽

Ravinder Thyagarajan ◽

Leela Vajravelu ◽

Suganthi Manikesi ◽

...

Keyword(s):

Cancer Patients ◽

Amphotericin B ◽

Oral Candidiasis ◽

Antifungal Susceptibility ◽

Tertiary Care ◽

Antifungal Drug ◽

Dilution Method ◽

Care Hospital ◽

Susceptibility Pattern

Oropharyngeal candidiasis is one of the common manifestations seen in cancer patients on cytotoxic therapy and invasion into deeper tissues can occur if not treated promptly. Emergence of antifungal drug resistance is of serious concern owing to the associated morbidity and mortality. The present study aims at evaluation of clinicomycological association and antifungal drug susceptibility among the 180 recruited patients with cancer on chemotherapy and/or radiotherapy with signs or symptoms suggestive of oral candidiasis. Speciation and antifungal susceptibility was done by Microbroth dilution method for fluconazole, Itraconazole, and Amphotericin B as per standard microbiological techniques. Chi-square test was used for statistical analysis (p<0.05was considered statistically significant).Candida albicanswas the predominant species isolated (94) (58%) followed byCandida tropicalis(34) (20.9%). Fluconazole and Itraconazole showed an overall resistance rate of 14% and 14.8%, respectively. All the isolates were susceptible to Amphotericin B. There was a significant association between the presence of dry mouth and isolation ofCandida(p<0.001). Such clinicomicrobiological associations can help in associating certain symptoms with the isolation ofCandida. Species level identification with in vitro antifungal susceptibility pattern is essential to choose the appropriate drug and to predict the outcome of therapy.

Download Full-text

Molecular Epidemiology and Antifungal Susceptibility of Trichophyton Isolates in Greece: Emergence of Terbinafine-Resistant Trichophytonmentagrophytes Type VIII Locally and Globally

Journal of Fungi ◽

10.3390/jof7060419 ◽

2021 ◽

Vol 7 (6) ◽

pp. 419

Author(s):

Maria Siopi ◽

Ioanna Efstathiou ◽

Konstantinos Theodoropoulos ◽

Spyros Pournaras ◽

Joseph Meletiadis

Keyword(s):

Molecular Epidemiology ◽

Antifungal Susceptibility ◽

Reference Method ◽

Cross Resistance ◽

Squalene Epoxidase ◽

In Vitro Susceptibility ◽

Type Viii ◽

In Vitro Antifungal Susceptibility ◽

Resistance Rates

Trichophyton isolates with reduced susceptibility to antifungals are now increasingly reported worldwide. We therefore studied the molecular epidemiology and the in vitro antifungal susceptibility patterns of Greek Trichophyton isolates over the last 10 years with the newly released EUCAST reference method for dermatophytes. Literature was reviewed to assess the global burden of antifungal resistance in Trichophyton spp. The in vitro susceptibility of 112 Trichophyton spp. molecularly identified clinical isolates (70 T. rubrum, 24 T. mentagrophytes, 12 T. interdigitale and 6 T. tonsurans) was tested against terbinafine, itraconazole, voriconazole and amorolfine (EUCAST E.DEF 11.0). Isolates were genotyped based on the internal transcribed spacer (ITS) sequences and the target gene squalene epoxidase (SQLE) was sequenced for isolates with reduced susceptibility to terbinafine. All T. rubrum, T. interdigitale and T. tonsurans isolates were classified as wild-type (WT) to all antifungals, whereas 9/24 (37.5%) T. mentagrophytes strains displayed elevated terbinafine MICs (0.25–8 mg/L) but not to azoles and amorolfine. All T. interdigitale isolates belonged to ITS Type II, while T. mentagrophytes isolates belonged to ITS Type III* (n = 11), VIII (n = 9) and VII (n = 4). All non-WT T. mentagrophytes isolates belonged to Indian Genotype VIII and harbored Leu393Ser (n = 5) and Phe397Leu (n = 4) SQLE mutations. Terbinafine resistance rates ranged globally from 0–44% for T. rubrum and 0–76% for T. interdigitale/T. mentagrophytes with strong endemicity. High incidence (37.5%) of terbinafine non-WT T. mentagrophytes isolates (all belonging to ITS Type VIII) without cross-resistance to other antifungals was found for the first time in Greece. This finding must alarm for susceptibility testing of dermatophytes at a local scale particularly in non-responding dermatophytoses.

Download Full-text

Voriconazole: A New Triazole Antifungal Agent

Annals of Pharmacotherapy ◽

10.1345/aph.1c261 ◽

2003 ◽

Vol 37 (3) ◽

pp. 420-432 ◽

Cited By ~ 68

Author(s):

Margaret M Pearson ◽

P David Rogers ◽

John D Cleary ◽

Stanley W Chapman

Keyword(s):

Amphotericin B ◽

Antifungal Agent ◽

Fungal Pathogens ◽

Antimicrobial Agents ◽

Case Reports ◽

Empirical Therapy ◽

Immunocompromised Patients ◽

In Vitro Susceptibility ◽

Medline Search

OBJECTIVE: To review the pharmacology, in vitro susceptibility, pharmacokinetics, clinical efficacy, and adverse effects of voriconazole, a triazole antifungal agent. DATA SOURCES: A MEDLINE search, restricted to English language, was conducted from 1990 to June 2002. Supplementary sources included program abstracts from the Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America from 1996 to 2001 and manufacturer information available through the Food and Drug Administration's Web site. DATA EXTRACTION: All published and unpublished trials and abstracts citing voriconazole were selected. DATA SYNTHESIS: Voriconazole has shown in vitro activity against many yeasts and a variety of mold and dermatophyte isolates. Voriconazole can be administered either orally or parenterally. It exhibits good oral bioavailability, wide tissue distribution including distribution into the central nervous system, and hepatic metabolism. Drug interactions occur through inhibition of the CYP2C9, CYP2C19, and CYP3A4 isoenzymes, resulting in alterations in kinetic parameters of either voriconazole or the interacting agent. Efficacy has been illustrated in open, noncomparative studies of aspergillosis in immunocompromised patients. Human case reports describe successful treatment of rare fungal pathogens. The most commonly reported adverse events include visual disturbances and elevations in liver function tests. CONCLUSIONS: Voriconazole is at least as effective as amphotericin B in the treatment of acute invasive aspergillosis in immunocompromised patients. It has similar efficacy as fluconazole in treatment of esophageal candidiasis. Voriconazole did not achieve statistical non-inferiority to liposomal amphotericin B for empirical therapy in patients with neutropenia and persistent fever, diminishing enthusiasm for use in this indication until additional trials are completed. Based on case reports and in vitro efficacy, voriconazole may prove to be a clinically useful agent in the treatment of other fungal disease.

Download Full-text

Relationship between the Antifungal Susceptibility Profile and the Production of Virulence-Related Hydrolytic Enzymes in Brazilian Clinical Strains ofCandida glabrata

Mediators of Inflammation ◽

10.1155/2017/8952878 ◽

2017 ◽

Vol 2017 ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

Maria Helena Galdino Figueiredo-Carvalho ◽

Lívia de Souza Ramos ◽

Leonardo Silva Barbedo ◽

Jean Carlos Almeida de Oliveira ◽

André Luis Souza dos Santos ◽

...

Keyword(s):

Amphotericin B ◽

Antifungal Susceptibility ◽

Hydrolytic Enzymes ◽

Antifungal Drug ◽

Clinical Strains ◽

Antifungal Drug Resistance ◽

Opportunistic Fungal Pathogen ◽

Esterase Production ◽

In Vitro Antifungal Susceptibility

Candida glabratais a facultative intracellular opportunistic fungal pathogen in human infections. Several virulence-associated attributes are involved in its pathogenesis, host-pathogen interactions, modulation of host immune defenses, and regulation of antifungal drug resistance. This study evaluated the in vitro antifungal susceptibility profile to five antifungal agents, the production of seven hydrolytic enzymes related to virulence, and the relationship between these phenotypes in 91 clinical strains ofC. glabrata. AllC. glabratastrains were susceptible to flucytosine. However, some of these strains showed resistance to amphotericin B (9.9%), fluconazole (15.4%), itraconazole (5.5%), or micafungin (15.4%). Overall,C. glabratastrains were good producers of catalase, aspartic protease, esterase, phytase, and hemolysin. However, caseinase and phospholipase in vitro activities were not detected. Statistically significant correlations were identified between micafungin minimum inhibitory concentration (MIC) and esterase production, between fluconazole and micafungin MIC and hemolytic activity, and between amphotericin B MIC and phytase production. These results contribute to clarify some of theC. glabratamechanisms of pathogenicity. Moreover, the association between some virulence attributes and the regulation of antifungal resistance encourage the development of new therapeutic strategies involving virulence mechanisms as potential targets for effective antifungal drug development for the treatment ofC. glabratainfections.

Download Full-text

Antifungal susceptibility of Candida albicans isolated from oral mucosa of patients with cancer

Revista de Odontologia da Universidade de São Paulo ◽

10.1590/s0103-06631999000300003 ◽

1999 ◽

Vol 13 (3) ◽

pp. 219-223 ◽

Cited By ~ 1

Author(s):

Lino João da COSTA ◽

Esther Goldenberg BIRMAN ◽

Sidney Hartz ALVES ◽

Arlete Emily CURY

Keyword(s):

Candida Albicans ◽

Cancer Patients ◽

Amphotericin B ◽

Oral Mucosa ◽

Antifungal Susceptibility ◽

New Drugs ◽

Local Conditions ◽

Opportunistic Fungi ◽

Sabouraud Agar

The increasing number of oral infections due to opportunistic fungi in immunocompromised patients, needs a new evaluation of the drugs in use. The susceptibility in vitro of Candida albicans strains from the oral mucosa of cancer patients to amphotericin B, ketoconazole, miconazole, fluconazole and itraconazole were evaluated. A dilution technique in YNB agar or subculture on Sabouraud agar was utilised for MIC or MFC determinations. With this methodology, the best fungicidal drug for C.albicans collected from the oral mucosa of 40 cancer patients, divided in two groups: one treated by radiotherapy and the other not, the best results were obtained with amphotericin B, presenting low values of MIC compared to azoles and MFC values. However it is important to take into consideration the utilisation in vivo of this polyenic antibiotic and the possible toxic levels necessary to achieve good results. The coexistence of other fungi and the local conditions must also be pondered with these patients, who are mostly undergoing radiotherapy. In order to achieve better results without undesirable consequences, higher levels of MIC are expected with the daily clinical use of new drugs.

Download Full-text

In Vitro Susceptibility of Talaromyces Marneffei In Malaysia: Comparison of Yeast and Mycelial Phases

10.21203/rs.3.rs-1158654/v1 ◽

2021 ◽

Author(s):

Xue Ting Tan ◽

Nurliyana binti Mohd Shuhairi ◽

Stephanie Jane Ginsapu ◽

Surianti Binti Shukor ◽

Fairuz Binti Amran

Keyword(s):

Amphotericin B ◽

Geometric Mean ◽

Antifungal Susceptibility ◽

Etiologic Agent ◽

Mycelial Form ◽

In Vitro Susceptibility ◽

Terbinafine Hydrochloride ◽

Acquired Immunodeficiency ◽

Immunodeficiency Syndrome

Abstract Talaromyces marneffei is an etiologic agent of talaromycosis. It can cause serious complications and death in immunocompromised patients, particularly in acquired immunodeficiency syndrome (AIDS) patients. This infectious disease is endemic in Southeast Asia including Malaysia. To date, published reports on the antifungal susceptibility profile of T. marneffei is very limited. The objective of this study is to determine the minimum inhibitory concentration (MIC) of T. marneffei in yeast and mycelial phases in Malaysia. In the year 2020, 27 clinical strains of T. marneffei were received from various hospitals in Malaysia. The identification was carried out using microscopic, macroscopic and molecular methods. Following that, the susceptibility of each isolate in both yeast and mycelial form to thirteen common antifungals was performed according to the broth microdilution in Clinical & Laboratory Standards Institute (CLSI) M38 method. The antifungals tested were anidulafungin, micafungin sodium, caspofungin diacetate, 5-fluorocytosine, amphotericin B and terbinafine hydrochloride, posaconazole, voriconazole, itraconazole, ketoconazole, ravuconazole, clotrimazole and isavuconazole. The geometric mean of all antifungals other than anidulafungin, micafungin sodium, caspofungin diacetate and 5-fluorocytosine against T. marneffei mould (mycelial) were >2 μg/ml. However, the geometric mean of all antifungals against T. marneffei yeast was <2 μg/ml. Our in vitro data suggests promising activities of amphotericin B, terbinafine hydrochloride, posaconazole, voriconazole, itraconazole, ketoconazole, ravuconazole, clotrimazole and isavuconazole against yeast and mould phases of T. marneffei.

Download Full-text

Molecular Identification and Antifungal Susceptibility Patterns of Candida Species Isolated from Candidemia Patients in Yasuj, Southwestern Iran

Jundishapur Journal of Microbiology ◽

10.5812/jjm.117643 ◽

2021 ◽

Vol 14 (7) ◽

Author(s):

Shaghayegh Rostami Yasuj ◽

Maral Gharaghani ◽

Seyed Sajjad Khoramrooz ◽

Marjan Salahi ◽

Ali Keshtkari ◽

...

Keyword(s):

Mortality Rate ◽

Amphotericin B ◽

Molecular Identification ◽

Candida Species ◽

Antifungal Susceptibility ◽

Hospitalized Patients ◽

Susceptibility Tests ◽

In Vitro Antifungal Susceptibility ◽

Susceptibility Patterns

Background: Candidemia is the most common systemic infection in hospitalized patients causing high mortality. Hence, the diagnosis of this infection in the early stage with appropriate antifungal therapy is paramount. Objectives: The study aimed at molecular identification of Candida species isolated from candidemia patients and evaluation of the in vitro antifungal susceptibility patterns of these strains to fluconazole, amphotericin B, and caspofungin. Methods: In the present study, 800 hospitalized patients who were suspected to have candidemia were sampled. Candida species were isolated and identified based on morphological characteristics and PCR-sequencing of the ITS1-5.8S-ITS2 region. Antifungal susceptibility tests for fluconazole, amphotericin B, and caspofungin were performed according to the Clinical and Laboratory Standards Institute protocol M27-A3. Also, clinical data were recorded from the patients' records. Results: Twenty-seven patients among the sample of hospitalized patients were found to have candidemia. A total of 33.3% of candidemia patients were treated with amphotericin B, in which case the mortality rate was 14.8%. The majority of patients (59%) were from the neonatal intensive care unit, and premature birth was the most common underlying condition. Candida albicans (n = 18; 66.6%) was the most common species isolated from blood cultures, followed by C. parapsilosis (n = 7; 25.9%), C. pelliculosa (n = 1; 3.7%), and C. tropicalis (n = 1; 3.7%). Only one C. albicans isolate resistant to fluconazole (minimum inhibitory concentration = 32 µg/mL). Conclusions: Generally, C. albicans has been the most frequent causative agent of candidemia. Resistance to antifungal drugs among candidemia agents was rare. Also, the identification of Candida isolates at the species level with in vitro antifungal susceptibility tests helps manage candidemia patients better and decrease the mortality rate among them.

Download Full-text

Accuracy in clinical examinations for the diagnosis of vulvovaginitis by CANDIDA SPP. and IN VITRO susceptibility to the main antifungals

Revista de Patologia Tropical / Journal of Tropical Pathology ◽

10.5216/rpt.v49i3.64233 ◽

2020 ◽

Vol 49 (3) ◽

Author(s):

Andressa Santana Santos ◽

Ana Laura Sene Amancio Zara ◽

Fábio Silvestre Ataídes ◽

Elisangela Gomes da Silva ◽

Vivianny Aparecida Queiroz Freitas ◽

...

Keyword(s):

Amphotericin B ◽

Clinical Diagnosis ◽

High Resistance ◽

Antifungal Susceptibility ◽

Vulvovaginal Candidiasis ◽

Vaginal Mucosa ◽

Candida Spp ◽

In Vitro Susceptibility ◽

Gynecology And Obstetrics

Vulvovaginal candidiasis (VVC) is a common infection. This work aims to determine the positive predictive value (PPV) of the clinical diagnosis of VVC and to characterize Candida species isolated from the vaginal mucosa. This cross-sectional study was conducted from February 2016 to February 2017 at the Gynecology and Obstetrics Outpatient Clinic of the Hospital das Clínicas, in Goiânia, Goiás State, Brazil. The study included samples of vaginal secretion from 55 women who complained of vaginal discharge and itching as their main symptoms. The PPV of the clinical diagnosis of VVC was estimated in comparison to the laboratory culture method. The phenotypic methods and molecular tests were performed to identify Candida spp. In vitro susceptibility of Candida spp. isolates to fluconazole, itraconazole, clotrimazole, nystatin, and amphotericin B was determined using the broth microdilution assay. Yeast growth using the enzymes protease, phospholipase, and hemolysin was carried out in media containing respectively bovine albumin, egg yolk, and sheep erythrocytes. A PPV of 61.8% (34/55) was determined. Among the 55 vulvovaginal samples collected, we identified 36 isolates in whichC. albicans was the most common species. High resistance to fluconazole and low minimal inhibitory concentration (MIC) values for clotrimazole, nystatin and amphotericin B were observed. All isolates were proteinase and hemolysin producers, while seven strains were phospholipase negative. The clinical diagnosis of VVC presented a moderate PPV, which meant that cultures had to be conducted in the laboratory to confirm infection. The high resistance to fluconazole and itraconazole indicated the importance of the in vitro susceptibility test.KEY WORDS: Vulvovaginal candidiasis; antifungal susceptibility; enzymatic activity

Download Full-text

Genetic Diversity and In Vitro Antifungal Susceptibility of 200 Clinical and Environmental Aspergillus flavus Isolates

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00004-17 ◽

2017 ◽

Vol 61 (5) ◽

Cited By ~ 15

Author(s):

Mojtaba Taghizadeh-Armaki ◽

Mohammad Taghi Hedayati ◽

Saham Ansari ◽

Saeed Mahdavi Omran ◽

Sasan Saber ◽

...

Keyword(s):

Amphotericin B ◽

Aspergillus Flavus ◽

Susceptibility Testing ◽

Antifungal Susceptibility ◽

Content Type ◽

Microdilution Method ◽

Microsatellite Genotype ◽

Broth Microdilution Method ◽

In Vitro Antifungal Susceptibility

ABSTRACT Aspergillus flavus has been frequently reported as the leading cause of invasive aspergillosis in certain tropical and subtropical countries. Two hundred A. flavus strains originating from clinical and environmental sources and collected between 2008 and 2015 were phylogenetically identified at the species level by analyzing partial β-tubulin and calmodulin genes. In vitro antifungal susceptibility testing was performed against antifungals using the European Committee on Antimicrobial Susceptibility Testing (EUCAST) broth microdilution method. In addition, genotyping was performed using a short-tandem-repeat (STR) assay of a panel of six microsatellite markers (A. flavus 2A, 2B, 2C, 3A, 3B, and 3C), in order to determine the genetic variation and the potential relationship between clinical and environmental isolates. The geometric means of the minimum inhibitory concentrations/minimum effective concentrations (MICs/MECs) of the antifungals across all isolates were (in increasing order): posaconazole, 0.13 mg/liter; anidulafungin, 0.16 mg/liter; itraconazole, 0.29 mg/liter; caspofungin, 0.42 mg/liter; voriconazole, 0.64 mg/liter; isavuconazole, 1.10 mg/liter; amphotericin B, 3.35 mg/liter; and flucytosine, 62.97 mg/liter. All of the clinical isolates were genetically different. However, an identical microsatellite genotype was found between a clinical isolate and two environmental strains. In conclusion, posaconazole and anidulafungin showed the greatest in vitro activity among systemic azoles and echinocandins, respectively. However, the majority of the A. flavus isolates showed reduced susceptibility to amphotericin B. Antifungal susceptibility of A. flavus was not linked with the clinical or environmental source of isolation. Microsatellite genotyping may suggest an association between clinical and environmental strains, although this requires further investigation.

Download Full-text