Candida Infections In Patients Research Articles

Invasive Candida Infection in Patients With Bacterial Infective Endocarditis.

Over 21 months, 12 patients with invasive Candida infections detected during the course of treatment of bacterial endocarditis, including 11 with candidemia, were identified. Invasive Candida infections can occur as a complication of bacterial endocarditis and may occur more frequently in patients with injection drug use and broad-spectrum antibiotic exposure.

Epidemiology of Invasive Candidiasis in Patients with Hematologic Malignancy on Antifungal Prophylaxis.

The landscape of invasive Candida infections in patients with hematologic malignancy has evolved due to the adoption of anti-fungal prophylaxis, advances in oncological therapies, and developments in antifungal therapies and diagnostics. Despite these scientific gains, the morbidity and mortality caused by these infections remain unchanged, highlighting the importance of an updated understanding of its epidemiology. Non-albicans Candida species are now the predominant cause of invasive candidiasis in patients with hematological malignancy. This epidemiological shift from Candida albicans to non-albicans Candida species is partially a consequence of selective pressure from extensive azole use. Further analysis of this trend suggests other contributing factors including immunocompromise caused by the underlying hematologic malignancy and the intensity of its associated treatments, oncological practices, and regional or institution specific variables. This review characterizes the changing distribution of Candida species in patients with hematologic malignancy, describes the causes driving this change, and discusses clinical considerations to optimize management in this high-risk patient population.

Prevalence of oral Candida infection and associated factors in hospitalized patients at Hue University Medicine and Pharmacy Hospital

Backgrounds: Candida is the most common causative agent of oral thrush, especially in patients with chronic diseases. Objectives: 1. To determine the prevalence of oral Candida infection in patients undergoing internal medicine treatment. 2. To survey clinical symptoms and associated factors of oropharyngeal candidiasis. Materials and methods: A cross-sectional study of 213 patients was performed. Patients with oral candidiasis were assessed and recorded for clinical symptoms and associated factors. Oral mucosal swabs were collected and examined with KOH 20% for determining yeast-positive samples. The positive samples were subsequently cultured on chromogenic agar to identify fungal species. Results: The rate of oral Candida infection was 16.9%. The prevalence of C. albicans and C. non albicans was 55.6% and 44.4%, respectively. Clinical signs of oropharyngeal candidiasis were dysgeusia and anorexia (47.2%), burning sensation (5.6%), creamy-white plaques (30.6%), and angular cheilitis (2.8%). Factors that favor fungal infection included: Age 60 or older, saliva pH < 7, inability to self-care, brushing teeth less than twice daily, underweight, chronic obstructive pulmonary disease, respiratory and urinary tract infections, use of inhaled corticosteroids, antibiotic therapy, combination of antibiotics, antibiotics therapy of more than seven days. Conclusion: Oral thrush should be considered in hospitalized patients with risk factors in clinical practice so that patients can be diagnosed and treated early Key words: Candida, oral thrush, related factor

Distribution of Candida infections in patients and evaluation of the synergic interactions of some drugs against emerging fluconazole- and caspofungin-resistant C. auris

Pathogenic multidrug-resistantCandidaspecies are considered some of the most important health risks. This work aimed to evaluate and monitor the prevalence of the human pathogenic Candida strains isolated from patients in King Fahd Medical City (KFMD), Riyadh, Saudi Arabia, and to evaluate the synergy of some antimicrobial agents against Candida species’ resistance to antifungal drugs. The retrospective analysis, identification using biochemical tests, minimal inhibitory concentrations using E-tests, determination of the fraction inhibitory concentration index value for synergic testing, and simulation of 100 experiments using Monte Carlo simulation methods were performed according to standard protocols. The findings showed that all age groups of males and females can be infected by Candida species; furthermore, human pathogenic Candida species can be isolated from several clinical samples and different human body sites. The minimal inhibitory concentration results showed that many multidrug-resistant Candida strains, such as C. albicans, emerged in 2020 compared to 2018. Candida albicans remains the most important pathogen among all Candia species, found in 51.7 % and 42.4 % of the isolates in 2018 and 2020, respectively. In 2018, many isolates of C albicans showed resistance to itraconazole, fluconazole, anidulafungin, amphotericin B, ketoconazole, voriconazole, caspofungin, and flucytosine. In 2018, all C. auris isolates (N = 94) were resistant to fluconazole, and more than 85 % (N = 76) of C. albicans isolates were resistant to itraconazole, while only 5.9 % (N = 2) were resistant in 2018. The study concluded that the resistance to antifungal drugs among pathogenic yeasts is increasing and constantly changing and that surveillance of these pathogens must continue. Also, the synergy between drugs remains an appropriate option for confronting this risk, especially between natural extracts and drugs. Despite the lack of evidence for any antifungal and antibacterial drug's ability to synergistically suppress the fluconazole- and caspofungin-resistant C. auris strains diagnosed in this study, the surveillance and synergic tactics continue to be viable options for dealing with these human pathogenic yeasts.

Isolation and identification of candida species from oral of diabetic patients

Diabetes increases the risk of fungal infections in the mouth and in other parts of the body. Candidiasis may occur if there is a decrease in the flow of saliva, which allows the fungi to grow. The present study aimed to determine the prevalence of Candida spp and identify the potential risk factors among diabetic and non-diabetic groups. This cross-sectional study was conducted from November 2021 to May 2022. During this period, 130 oral swabs were collected, the following tests were done: direct microscopic examination, gram stain and cultured on sabaroud dextrose agar with chloramphenicol, complimentary tests such as germ tube test, sugar assimilation test, growing on chromogenic media, were carried out to differentiate between the Candida species. Out of 130 oral swab cultured, there were 102 (78.4%) yielded Candida species. 80 (89%) were diabetics, the results showed strong statistical relationship between diabetics and Candida infections p=0.001. The frequencies of isolated Candida species including C. albicans were 41(40.2%), while C. Glabrata 23 (22.5%) C. tropicalis 26 (25.5%), and C. krusei 12 (11.8 %) The results of this study revealed a higher prevalence of Candida infections in patients with diabetes, so the study recommends continuous follow-up and the necessary tests in response to any symptoms, and recommends health education and attention to clean food and drink. Furthermore, the study underscores the necessity for further research on the correlation between Candida infections and diabetic complications.

Anti-IL-17 agents increase risk of Candida infection in patients with psoriasis

Anti-IL-17 agents increase risk of Candida infection in patients with psoriasis

P296 The role of Candida in acute pancreatitis: A disregarded pathogen

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMBackgroundAcute pancreatitis is often complicated by infection of peri-pancreatic necrotic tissue. The infectious etiology commonly involves gram negative enteric bacilli and enterococci. Role of Candida species has remained debatable, despite being isolated in pure or mixed cultures in specimens. We evaluated patients with acute pancreatitis with Candida infection over a duration of 4 years for assessment of risk and prognostic factors.ObjectivesTo determine the prevalence and role of Candida infection in patients of acute pancreatitis and ascertain the species distribution and risk factors.MethodsThis study was conducted including adult patients who were admitted to gastro-surgery department and had clinical suspicion of peri-pancreatic fungal infection. Specimens included peri-pancreatic fluid collection obtained intra-operatively or aspirated USG-guided, drain fluid and blood. In addition to aerobic bacterial culture, fungal cultures were performed availing standard mycological procedures. Candida infections were categorized into true and possible as per Chakraborty et al. with some modifications.True Candida infection of pancreatic tissue was considered when yeast cells were seen and grown in pure or mixed culture fromPeri-pancreatic fluid obtained intra-operatively, orUSG-guided aspirate, orAbdominal drain fluid and blood culture.Possible Candida infection of pancreatic tissue was considered when Candida spp were isolated fromAbdominal drain effluent (at least two samples) in postoperative patients, or Candida spp grown in only in blood culture.Relevant patient information was obtained from hospital information system. Data were analyzed by SPSS 20 statistical software and MS Excel.ResultsA total of 14 cases were identified amongst which 6/14 (42.9%) had true Candida infection whereas possible Candida infection was seen in 8/14 (57.1%) patients. Out of these, C. tropicalis was the predominant species seen in 9/14 (64.3%) whereas C. albicans was seen in 4/14 (28.6%). One isolate of C. auris was identified. Patients with C. tropicalis infection showed higher mortality (6/9, 66.7%) as compared with patients with other Candida species, in whom 20% (1/5) mortality was noted. Acknowledging limitations inherent to retrospective data extraction, we delineated some of the possible risk factors predisposing to Candida infection, given in Table 1.Table 1.Prevalence of risk factors.Predisposing factorPrevalenceUsage of broad-spectrum antibiotics100% (7/7)Presence of central venous catheter77.8% (7/9)Surgical intervention/USG guided aspiration100% (13/13)Intensive care unit (ICU) admission35.7% (5/14)ConclusionRole of Candida species in the pathogenesis of adjacent tissues in case of acute pancreatitis has been neglected in past, but now being increasingly recognized. C. tropicalis is the commonest isolate in our study and carries very high mortality. Screening for Candida spp should be carried out in these patients in view of starting antifungal treatment at the earliest possible so that proper diagnosis and management can be undertaken.

Mucormycosis and Candida Infections in Patients of COVID-19 Pneumonia: A Systematic Review

Introduction: The city of Wuhan in China reported the first case of coronavirus, termed as SARS-CoV-2, in December 2019. To date, 187,827,660 cases have been reported to the WHO (3). With current research focusing on potential therapeutic agents for the coronavirus disease and vaccines, there remain major gaps in our understanding of the pathophysiology and clinical course of this viral pneumonia. Secondary infections are one of them. In this systematic review, we analyze the outcomes of two fungal infections in patients of COVID-19, viz. Mucormycosis and candida. Methodology: A systematic review has been done on secondary infections with mucor and candida fungi in patients of COVID-19. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used. Twenty-three studies were included in the final analysis. Our review included studies from various countries across the globe. The risk of bias was analyzed using the NIH Quality Assessment Tool for Case Series Studies. This study did not require ethical approval as data was obtained from already available databases, and patients were not directly involved. Results: A total of 23 articles were included in the final review and the total number of patients included was 79 Male: female ratio was calculated to be 1.6 and the average age of patients was 52 years (ranging from 24-86 years). Various types of comorbidities were seen in the included patients, the most common being diabetes mellitus. Among the 18 patients in the cohort of mucormycosis, 7 patients died and four studies did not report patient outcomes. Among the 61 patients, 13 patients died and one patient was still ventilated at the time of publication. Conclusion: Secondary infections after COVID-19 are a cause of major concerns. Further studies and case reports are needed to better understand the various other types of secondary infections and also to formulate strategies to prevent these.

Associated Fungal Infections, Related to the Global Covid-19 Pandemic (Literature Review)

The 2019 coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has swept the globe. Based on a retrospective analysis of SARS and influenza data from China and around the world, we suggest that fungal co-infections associated with global COVID-19 may be missed or misdiagnosed. Although there are few publications, patients with COVID-19, especially severely ill or immunocompromised patients, are more likely to develop invasive mycoses. Aspergillus and Candida infections in patients with COVID-19 will require early detection by comprehensive diagnostic intervention (histopathology, direct microscopy, culture, (Arabian: 2004, Tilavberdiev: 2016) -β-D-glucan, galactomannan, and PCR assays) to ensure effective treatment. We consider it appropriate to assess risk factors, types of invasive mycoses, strengths and weaknesses of diagnostic methods, clinical conditions, and the need for standard or individual treatment.

69-Year-Old Man With Nasal Congestion and Pre-Syncope

69-Year-Old Man With Nasal Congestion and Pre-Syncope

Candida infections in patients with psoriasis and psoriatic arthritis treated with interleukin-17 inhibitors and their practical management.

Interleukin 17A (IL-17A) is a pro-inflammatory cytokine produced by helper T cells (Th17) and other cells of the immune system and exerts pleiotropic effects on multiple cell lines. The role of IL-17 in the pathogenesis of numerous inflammatory disorders is well-documented. IL-17 activates signaling through the IL-17 receptor, which induces other proinflammatory cytokines, antimicrobial peptides, and neutrophil chemokines that are important for antifungal activity. Healthy levels of IL-17 can protect the host against extracellular bacterial and fungal infections in mucous membranes and epithelia. IL-17 deficiency reduces control of certain infections, while excessive IL-17 can produce unwanted inflammatory effects. Although the efficacy of the therapeutic blockade of this cytokine has been proven in several autoimmune diseases such as psoriasis and psoriatic arthritis, this strategy could also exacerbate fungal infections in such patients. Therefore, a better understanding of IL-17-mediated immunity to Candida is necessary for the development of autoimmune therapeutics that maintain antifungal immunity. In this review, we include a study of the new anti-IL-17 biological agents (secukinumab, ixekizumab, and bromalizumab) used for moderate-to-severe psoriasis and psoriatic arthritis treatment in clinical practice, as well as pivotal trials with bimekizumab. We study the relationship of these biological agents and the appearance of candidiasis in its various clinical forms.

Epidemiological Study on Candida Species in Patients with Cancer in the Intensive Care Unit.

ObjectivesAlthough cancer survival rates have increased, serious infection complications can arise in cancer patients. Candida can occur in various tissues and has significant effects on the prognosis of patients with cancer. Thus, we conducted an epidemiological study on Candida infections in patients with cancer admitted to the intensive care unit.MethodsA retrospective study was conducted in adult patients with cancer admitted to the intensive care unit between January 1, 2013, and December 31, 2015. Candida infection status and predictive factors for mortality were examined in 634 patients.ResultsThe predictive factors for mortality included the use of steroids, use of a central venous catheter or mechanical ventilator, and identification of Candida in the blood. Patients who stayed in the surgical and intensive care unit for more than 7 days had a lower risk of death than that in those with shorter days.ConclusionThe present study shows that invasive procedures, bloodstream infections, and the use of steroids increase the risk of mortality in Candida-infected patients with cancer. To improve the quality of life and reduce mortality, further studies are needed on the factors affecting the risk of mortality associated with Candida infection.

The association between antibiotic prophylaxis and candida infection in patients with severe acute pancreatitis

The association between antibiotic prophylaxis and candida infection in patients with severe acute pancreatitis

Candida infections in patients with psoriasis and psoriatic arthritis treated with interleukin-17 inhibitors and their practical management.

The recognition of the central role of interleukin (IL)-17A in the pathogenesis of psoriasis has led to the development of several monoclonal antibodies targeting this cytokine or its receptors for therapeutic purposes. IL-17A also plays an important role in immunological protection against infections, especially those due to Candida spp., as evidenced by findings in patients with genetic defects in IL-17-related immune responses. To assess the potential of anti-IL-17 treatment to promote Candida infections, here we have systematically reviewed published clinical trials of patients with psoriasis or psoriatic arthritis. Candida infections were reported in 4·0% of patients treated with brodalumab, 1·7% with secukinumab and 3·3% with ixekizumab vs. 0·3%, 2·3% and 0·8% of those assigned to placebo, ustekinumab or etanercept, respectively. Although the incidence of Candida infection was found to be increased by only a small degree during anti-IL-17 therapy, patients undergoing such treatment should be monitored for fungal infection and treated as necessary. We propose adoption of the recently updated recommendations for the practical management of Candida infection in patients administered IL-17 inhibitors.

Micafungin: A Review in the Prophylaxis and Treatment of Invasive Candida Infections in Paediatric Patients.

Intravenous micafungin (Mycamine®; Funguard®), an echinocandin, is approved in the EU for the treatment of invasive candidiasis in children (including neonates) and adolescents (<16 years of age) and as prophylaxis against Candida infections in patients undergoing haematopoietic stem cell transplantation (HSCT) or who are expected to have neutropenia for ≥10 days. This narrative review focuses on the use of micafungin in paediatric indications approved in the EU, which may vary from those approved elsewhere in the world. Micafungin has a broad spectrum of in vitro activity against clinically relevant isolates of Candida spp. (including fluconazole-resistant Candida glabrata isolates), a low propensity for emergence of resistant isolates and a convenient once-daily regimen. In paediatric substudies and a small multinational, phase 3 trial in neonates with proven invasive candidiasis, intravenous micafungin was effective and generally well tolerated in the treatment of candidaemia and other types of invasive candidiasis and as prophylaxis against fungal infections in patients undergoing HSCT. Hence, micafungin remains an important option for the prophylaxis and treatment of invasive Candida infections in paediatric and adult patients.

Prevalence of Candida Infection in Patients with Type 2 Diabetes Mellitus in Sari, North of Iran

Prevalence of Candida Infection in Patients with Type 2 Diabetes Mellitus in Sari, North of Iran

Pathogenetic aspects of treatment of periodontitis associated with candida infection in patients with diabetes mellitus

Pathogenetic aspects of treatment of periodontitis associated with candida infection in patients with diabetes mellitus

Pathogenetic aspects of treatment of periodontitis associated with candida infection in patients with diabetes mellitus

Pathogenetic aspects of treatment of periodontitis associated with candida infection in patients with diabetes mellitus

Invasive Candida Infections in Pediatric Patients Treated on the Pilot Study of Decitabine and Vorinostat with Chemotherapy for Relapsed ALL: A Report from the Therapeutic Advances in Childhood Leukemia & Lymphoma (TACL) Consortium

▪Introduction Children and young adults with relapsed acute lymphoblastic leukemia (ALL) are at high risk for infectious complications, particularly invasive fungal infections, during their intensive re-induction therapy. We report results of a Pilot study investigating decitabine and vorinostat in combination with intensive re-induction chemotherapy for children and young adults with relapsed or refractory ALL. This study is currently open through the TACL Consortium [NCT01483690] and all patients and/or their parents or guardians signed informed consent to participate in this institutional review board approved therapeutic trial in accordance to the Declaration of Helsinki.Methods Patients 1-25 years of age with 2nd or greater relapse or refractory ALL are eligible. Seventeen patients have enrolled with a median age of 12 years (range, 19 months - 21 years). Patients received one course of therapy which included decitabine (15mg/m2 days 1-7; 15-21), vorinostat (180mg/m2 days 3-10; 17-24), vincristine (1.5mg/m2 days 10, 17, 24, 31), dexamethasone (10mg/m2/dose BID days 8-12; 22-26), mitoxantrone (10mg/m2 days 8, 9), PEG-asparaginase (2500 IU/m2 days 10, 24) and intrathecal methotrexate (dosed according to age and CNS status). Nine patients (53%) relapsed after a prior allogeneic hematopoietic cell transplant and 5 patients had refractory disease (29%) prior to enrolling on this study. Initial infection prophylaxis guidelines did not require anti-bacterial or anti-fungal therapy.Results The study was suspended after 5 patients enrolled due to 2 patients reporting a DLT [Grade 3 cholestasis/steatosis, Grade 4 bilirubin (n=1); Grade 3 delirium, Grade 4 seizure, Grade 4 somnolence (n=1)] and 4 of the 5 patients (80%) reporting non-albicans Candidemia [C. kruseii (n=2), C. lusitaniae (n=1), C. guillermondii (n=1)]. Based on this significant rate of fungal infection, despite all patients receiving prophylactic anti-fungal therapy (micafungin n=2, fluconazole n=1, amphotericin n=1), the study was amended to decrease the decitabine dose (15mg/m2 to 10mg/m2) and duration of decitabine (days 1-7; 15-21 to 1-5; 15-19) as well as require treatment dose non-azole class anti-fungal therapy (echinocandin or amphotericin) to be given to all patients on study. Twelve patients enrolled post-amendment; only 1 of 12 (8.3%) experienced a fungal infection (C. guillermondii). Of note, this infection occurred in a patient using fluconazole for prophylaxis in place of a protocol-specified agent. There have been no fungal infections reported to date for the 11 patients on study who have received echinocandin or amphotericin therapy at treatment doses. Treatment responses include 9 patients achieving a complete remission (CR) (53%), 5 with stable disease (29%), two treatment related deaths and 1 patient removed from protocol therapy on day 6 based on the physician’s decision. The median minimal residual disease (MRD) response in patients who achieved a CR and submitted bone marrow samples for end of therapy testing (n=5) was 0.056% (range, 0.00%-5%).Conclusions We report a substantial initial incidence of invasive Candida infections in patients treated with decitabine and vorinostat in combination with intensive chemotherapy despite anti-fungal prophylaxis which appears to be abrogated once the fungal prophylaxis was required at treatment doses using either an echinocandin or amphotericin class agent. As well, the lower dose and duration of decitabine may have contributed to this improvement, resulting in potentially shorter periods of neutropenia which may contribute to the risk of fungal disease. The mechanism for the unique propensity for non-albicans Candida infections in this study remains unclear. The initial response to this regimen incorporating epigenetic therapy is promising with correlative biology studies investigating methylation, acetylation and gene expression changes pending study completion. The study continues to accrue at a dose expansion cohort. DisclosuresOff Label Use: Decitabine in relapse ALL Vorinostat in relapse ALL.

Invasive Candida infections in patients of a medical intensive care unit: attempt of improving diagnosis by quantifying the colonization.

During the past decades, a steady increase in the incidence of invasive Candida infections in patients requiring intensive care has been reported. Nevertheless, the diagnosis of invasive Candida infections in the intensive care unit setting remains still difficult and is often made late in the course of disease. Additionally, prognosis worsens rapidly with delayed initiation of antifungal therapy. Clinical scoring systems such as the Candida colonization index or the four risk factor-based Candida score could be very useful tools to select patients at high risk of developing invasive Candida infections, who would benefit from the administration of systemic antifungal therapy. The main objective was to determine the incidence of invasive Candida infection among patients of a medical intensive care unit and to investigate its association with the Candida colonization index and the Candida score. A prospective, observational, single-center study was performed from December 2010 to December 2011. All patients over the age of 18 years who were admitted for at least 7 days in a medical intensive care unit were included. Demographic characteristics, underlying diseases, reasons for intensive care unit admission and presence and duration of risk factors for Candida species colonization and infection were collected for each patient. The Candida colonization index and the Candida score were calculated weekly until discharge or death. A total of 65 patients were included. Proven invasive Candida infections were diagnosed in five patients (7.7 %), i.e. two developed candidemia, two peritonitis, and one pneumonia. All of these patients were characterized by a Candida colonization index ≥ 0.5 (incidence rate: 16.7 % [5/30]) and a Candida score ≥ 2.5 (incidence rate: 29.4 % [5/17]). Mechanical ventilation (p = 0.013) and both Candida scoring systems (p = 0.013 versus p < 0.001) were statistically and significantly associated with invasive Candida infections. The mortality rate was high (80 %). Interestingly, treatment with antifungal drugs was not statistically and significantly associated with invasive candidiasis (p = 0.077) and patients outcome (p = 0.057). Both the Candida colonization index and the Candida score with cut-off values ≥ 0.5 and ≥ 2.5 are very useful tools to select patients at high risk of developing invasive Candida infections in the medical intensive care unit setting, who would benefit from early antifungal treatment.