scholarly journals STANDARDS OF MEDICAL CARE “INVASIVE CANDIDIASIS IN NEWBORNS”

2021 ◽  
Vol 11 (4(42)) ◽  
pp. 75-87
Author(s):  
D. Dobryanskyy ◽  
O. Gulenko ◽  
T. Znamenska ◽  
O. Vorobiova
Keyword(s):  
Invasive Candidiasis ◽  
Antifungal Agents ◽  
Late Onset ◽  
Fungal Infections ◽  
Clinical Problem ◽  
Neurological Damage ◽  
Important Clinical Problem ◽  
Systemic Infections ◽  
Late Onset Infection

Candida infection (candidiasis) is an important clinical problem in newborns who need treatment in modern intensive care units. Organ and/or systemic infections caused by these fungi are called invasive candidiasis (IC). Newborns are especially vulnerable to IC, and their incidence is 3-5 times higher than the corresponding rates in children or adults. Invasive fungal infections caused by Candida are the third most common late-onset infection in infants born with a birth weight <1500 g. IC in newborns is associated with approximately 20% mortality, and about half of survivors have serious long- term neurological damage. In recent years, new data have been obtained on the diagnosis, prevention and treatment of IC in newborns, which has determined a change in treatment recommendations. Accordingly, the need arose to ensure the compliance of our clinical practice with modern evidence-based approaches. Early diagnosis of candidiasis and prompt treatment with effective antifungal agents such as fluconazole, amphotericin B, and micafungin, when indicated, are critical to improving outcomes.

scholarly journals Janus-Faced Molecules against Plant Pathogenic Fungi

2021 ◽  
Vol 22 (22) ◽  
pp. 12323
Author(s):  
Gaspar Banfalvi
Keyword(s):  
Antifungal Agents ◽  
Ethical Issues ◽  
Fungal Infections ◽  
Pathogenic Fungi ◽  
Mutagenic Effect ◽  
Human Pathogens ◽  
Short Term ◽  
High Cytotoxicity ◽  
Apoptotic Effects

The high cytotoxicity of the secondary metabolites of mycotoxins is capable of killing microbes and tumour cells alike, similarly to the genotoxic effect characteristic of Janus-faced molecules. The “double-edged sword” effect of several cytotoxins is known, and these agents have, therefore, been utilized only reluctantly against fungal infections. In this review, consideration was given to (a) toxins that could be used against plant and human pathogens, (b) animal models that measure the effect of antifungal agents, (c) known antifungal agents that have been described and efficiently prevent the growth of fungal cells, and (d) the chemical interactions that are characteristic of antifungal agents. The utilization of apoptotic effects against tumour growth by agents that, at the same time, induce mutations may raise ethical issues. Nevertheless, it deserves consideration despite the mutagenic impact of Janus-faced molecules for those patients who suffer from plant pathogenic fungal infections and are older than their fertility age, in the same way that the short-term cytotoxicity of cancer treatment is favoured over the long-term mutagenic effect.

scholarly journals Hepatotoxicity of Antimycotics Used for Invasive Fungal Infections: In Vitro Results

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Sandra Doß ◽  
Heike Potschka ◽  
Fanny Doß ◽  
Steffen Mitzner ◽  
Martin Sauer
Keyword(s):  
Liver Injury ◽  
Fungal Infections ◽  
Clinical Problem ◽  
Blue Staining ◽  
Therapeutic Drug ◽  
Drug Induced ◽  
Severe Impairment ◽  
And Function ◽  
Systemic Infections

Purpose.Drug-induced liver injury (DILI) is the most common cause of liver injury and a serious clinical problem; antimycotics are involved in approximately 3% of all DILI cases. The hepatotoxicity of many drugs, including the antimycotics, is poorly screened in human models.Methods.In a standardized assay the cytotoxicity on hepatocytes of different concentrations (Cmax, 5xCmax, and 10xCmax) of the antimycotics used for systemic infections was tested. Anidulafungin (ANI), liposomal amphotericerin B (L-AmB), caspofungin (CASPO), fluconazole (FLUCO), and voriconazole (VORI) were incubated with HepG2/C3A cells. After incubation, the viability of cells (XTT test, LDH release, trypan blue staining), the synthesis of albumin, the cytochrome 1A2 activity, and the cell death (DNA fragmentation) were determined. Kruskal-Wallis and Mann–Whitney tests were used for statistical analyses.Results.L-AmB, ANI, and CASPO showed a mild hepatotoxicity in theCmax concentrations. Higher concentrations of anidulafungin led to a severe impairment of hepatocyte viability and function. The azoles FLUCO and VORI had a higher hepatotoxic potential in all concentrations.Conclusion.Antimycotics, especially azoles, used for systemic infections should be given with caution in patient with liver insufficiency or liver failure or high risk for this; therefore, therapeutic drug monitoring should be used. Further studies with this approach are encouraged.

scholarly journals Neonatal Late Onset Infection with Severe Acute Respiratory Syndrome Coronavirus 2

2020 ◽  
Vol 37 (08) ◽  
pp. 869-872 ◽  
Author(s):  
Simonetta Costa ◽  
Danilo Buonsenso ◽  
Maurizio Sanguinetti ◽  
Paola Cattani ◽  
Brunella Posteraro ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Observational Study ◽  
Late Onset ◽  
Early Period ◽  
Key Points ◽  
Long Term Consequences ◽  
Late Onset Infection ◽  
In Pregnancy

Objective To date, no information on late-onset infection in newborns to mother with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) contracted in pregnancy are available. This study aimed to evaluate postdischarge SARS-CoV-2 status of newborns to mothers with COVID-19 in pregnancy that, at birth, were negative to SARS-CoV-2. Study Design This is an observational study of neonates born to mothers with coronavirus disease 2019 (COVID-19). Results Seven pregnant women with documented SARS-CoV-2 infection have been evaluated in our institution. One woman had a spontaneous abortion at 8 weeks of gestational age, four women recovered and are still in follow-up, and two women delivered. Two newborns were enrolled in the study. At birth and 3 days of life, newborns were negative to SARS-CoV-2. At 2-week follow-up, one newborn tested positive although asymptomatic. Conclusion Our findings highlight the importance of follow-up of newborns to mothers with COVID-19 in pregnancy, since they remain at risk of contracting the infection in the early period of life and long-term consequences are still unknown. Key Points

scholarly journals Trends in Antifungal Susceptibility of Candida Species – One Year Observation

2014 ◽  
Vol 63 (2) ◽  
pp. 217-222 ◽  
Author(s):  
M. GOŁAŚ ◽  
I. NETSVYETAYEVA ◽  
M. SIKORA ◽  
K. PISKORSKA ◽  
B. SULIK-TYSZKA ◽  
...  
Keyword(s):  
Invasive Candidiasis ◽  
Lower Respiratory Tract ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Antifungal Susceptibility ◽  
Test Method ◽  
Predominant Species ◽  
The Past ◽  
One Year ◽  
Susceptibility Tests

In the past years opportunistic fungal infections have seriously increased, mainly in immunocompromised patients. The aim of the study was to determine the prevalence of yeast-like fungi in invasive candidiasis and to estimate its susceptibility to chosen antifungal agents. One hundred and sixty strains of yeast-like fungi were cultured from various clinical material: samples from lower respiratory tract, blood, the peritoneal cavity and others. The susceptibility tests were established according to the quantitative E-test method. The Candida genus represented the main etiological factor of invasive candidiasis. The predominant species were: C. glabrata (71/160), C. albicans (34/160), C. krusei (17/160), C. tropicalis (14/160). All tested strains were the most resistant to itraconazole. Candida glabrata presented the 100% susceptibility to amphotericin B and caspofungin and was the least susceptible to itraconazole, posaconazole and voriconazole. Candida albicans was the most susceptible species to all antymicotics.

Prolonged fluconazole prophylaxis is associated with persistent protection against candidiasis-related death in allogeneic marrow transplant recipients: long-term follow-up of a randomized, placebo-controlled trial

Blood ◽  
2000 ◽  
Vol 96 (6) ◽  
pp. 2055-2061 ◽  
Author(s):  
Kieren A. Marr ◽  
Kristy Seidel ◽  
Monica A. Slavin ◽  
Raleigh A. Bowden ◽  
H. Gary Schoch ◽  
...  
Keyword(s):  
Invasive Candidiasis ◽  
Fungal Infections ◽  
Controlled Trial ◽  
Marrow Transplant ◽  
Blood And Marrow Transplant ◽  
Long Term Follow Up ◽  
Fluconazole Prophylaxis ◽  
Overall Survival Benefit

Two randomized, placebo-controlled trials previously showed that fluconazole (400 mg/d) administered prophylactically decreases the incidence of candidiasis in blood and marrow transplant (BMT) recipients. However, there exists conflicting data regarding the optimal duration of fluconazole administration, specifically whether prophylaxis through acute graft-versus-host disease (GVHD) results in improved survival in allograft recipients. Reported here are the results of long-term follow-up and a detailed analysis of invasive candidiasis and candidiasis-related death in 300 patients who received fluconazole (400 mg/d) or placebo for 75 days after BMT at the Fred Hutchinson Cancer Research Center. Patients in both treatment arms were compared for survival, causes of death, and the incidence of invasive fungal infections early (less than 110 days) and late (more than 110 days) after BMT. After 8 years of follow-up, survival is significantly better in fluconazole recipients compared with placebo recipients (68 of 152 vs 41 of 148,P = .0001). The overall incidence of invasive candidiasis was increased in patients who received placebo compared with fluconazole (30 of 148 vs 4 of 152, P < .001). More patients who received placebo died with candidiasis early (13 of 148 vs 1 of 152, P = .001) and late (8 of 96 vs 1 of 121,P = .0068) after BMT. The incidence of severe GVHD involving the gut was higher in patients who did not receive fluconazole (20 of 143 vs 8 of 145, P = .02), and fewer patients who received fluconazole died with this complication. Thus, administration of fluconazole (400 mg/d) for 75 days after BMT appears to be associated with decreased gut GVHD, a persistent protection against disseminated candidal infections and candidiasis-related death, resulting in an overall survival benefit in allogeneic BMT recipients.

Prolonged fluconazole prophylaxis is associated with persistent protection against candidiasis-related death in allogeneic marrow transplant recipients: long-term follow-up of a randomized, placebo-controlled trial

Blood ◽  
2000 ◽  
Vol 96 (6) ◽  
pp. 2055-2061 ◽  
Author(s):  
Kieren A. Marr ◽  
Kristy Seidel ◽  
Monica A. Slavin ◽  
Raleigh A. Bowden ◽  
H. Gary Schoch ◽  
...  
Keyword(s):  
Invasive Candidiasis ◽  
Fungal Infections ◽  
Controlled Trial ◽  
Marrow Transplant ◽  
Blood And Marrow Transplant ◽  
Long Term Follow Up ◽  
Fluconazole Prophylaxis ◽  
Overall Survival Benefit

Abstract Two randomized, placebo-controlled trials previously showed that fluconazole (400 mg/d) administered prophylactically decreases the incidence of candidiasis in blood and marrow transplant (BMT) recipients. However, there exists conflicting data regarding the optimal duration of fluconazole administration, specifically whether prophylaxis through acute graft-versus-host disease (GVHD) results in improved survival in allograft recipients. Reported here are the results of long-term follow-up and a detailed analysis of invasive candidiasis and candidiasis-related death in 300 patients who received fluconazole (400 mg/d) or placebo for 75 days after BMT at the Fred Hutchinson Cancer Research Center. Patients in both treatment arms were compared for survival, causes of death, and the incidence of invasive fungal infections early (less than 110 days) and late (more than 110 days) after BMT. After 8 years of follow-up, survival is significantly better in fluconazole recipients compared with placebo recipients (68 of 152 vs 41 of 148,P = .0001). The overall incidence of invasive candidiasis was increased in patients who received placebo compared with fluconazole (30 of 148 vs 4 of 152, P &lt; .001). More patients who received placebo died with candidiasis early (13 of 148 vs 1 of 152, P = .001) and late (8 of 96 vs 1 of 121,P = .0068) after BMT. The incidence of severe GVHD involving the gut was higher in patients who did not receive fluconazole (20 of 143 vs 8 of 145, P = .02), and fewer patients who received fluconazole died with this complication. Thus, administration of fluconazole (400 mg/d) for 75 days after BMT appears to be associated with decreased gut GVHD, a persistent protection against disseminated candidal infections and candidiasis-related death, resulting in an overall survival benefit in allogeneic BMT recipients.

scholarly journals Drug Resistance and Novel Therapeutic Approaches in Invasive Candidiasis

2021 ◽  
Vol 11 ◽  
Author(s):  
Sarah E. Murphy ◽  
Tihana Bicanic
Keyword(s):  
Invasive Candidiasis ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Clinical Trial Data ◽  
Mortality Rates ◽  
Antifungal Drugs ◽  
Drug Resistant ◽  
Therapeutic Approaches ◽  
Mechanisms Of Resistance ◽  
Potential Strategy

Candida species are the leading cause of invasive fungal infections worldwide and are associated with acute mortality rates of ~50%. Mortality rates are further augmented in the context of host immunosuppression and infection with drug-resistant Candida species. In this review, we outline antifungal drugs already in clinical use for invasive candidiasis and candidaemia, their targets and mechanisms of resistance in clinically relevant Candida species, encompassing not only classical resistance, but also heteroresistance and tolerance. We describe novel antifungal agents and targets in pre-clinical and clinical development, including their spectrum of activity, antifungal target, clinical trial data and potential in treatment of drug-resistant Candida. Lastly, we discuss the use of combination therapy between conventional and repurposed agents as a potential strategy to combat the threat of emerging resistance in Candida.

The Importance of Fluconazole in Treatment of Endogenous Endophtalmitis in Patients Prior Treated Using Negative Pressure Therapy for Wound Closure Contaminated with Meticillin-resistant Staphylococcus aureus

2017 ◽  
Vol 68 (7) ◽  
pp. 1598-1601 ◽  
Author(s):  
Anisia Iuliana Alexa ◽  
Roxana Ciuntu ◽  
Alina Cantemir ◽  
Nicoleta Anton ◽  
Ciprian Danielescu ◽  
...  
Keyword(s):  
Antifungal Agents ◽  
Fungal Infections ◽  
Prolonged Treatment ◽  
Endogenous Endophthalmitis ◽  
Pressure Therapy ◽  
First Case ◽  
Severe Infections ◽  
Pars Plana ◽  
Delay In Treatment ◽  
Vitreous Biopsy

Severe infections with C. albicans should be treated promptly with antifungal agents, any delay in treatment increases the risk of endophthalmitis. The systemic Amphotericin B therapy is the gold standard in the treatment of endophthalmitis, but in the case of fungal infections it has not yet been determined. Numerous studies have shown that the use of Fluconazole is effective in the treatment of fungal endophthalmitis. In this paper, we report two cases (3 eyes) that have been presented for the same accusations of significant decrease of AV (visual acuity), ocular pain and blepharospasm suddenly installed, both of which required urgent antibiotic and intravenous antifungal treatment. Both are diagnosed with endogenous endophthalmitis and vitreous biopsy + VPP (pars plana vitrectomy) are performed, with a negative result of the vitreous culture. In both situations the treatment was with antibiotic and systemic antifungals. Postoperatively, evolution was favorable in the first case and less favorable in the second one. The prognosis depends on the virulence of the microorganisms and the time elapsed until initiation of the treatment. Also, the presence of risk factors such as diabetes, sepsis, recent abdominal surgery (C. Albicans is part of the comesary flora of the digestive tract) have influenced the prognosis decisively. Severe infections with C. albicans should be promptly treated with antifungal agents, any delay in treatment increases the risk of endophthalmitis. Even when prolonged treatment of candidemia is instituted, 3% of patients can develop endogenous endophthalmitis, so ocular evaluation is particularly important for patients immobilized in anesthesia and intensive care units.

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