Candidiasis Research Articles

Candida Non-albicans and Non-auris Causing Invasive Candidiasis in a Fourth-Level Hospital in Colombia: Epidemiology, Antifungal Susceptibility, and Genetic Diversity.

Increasingly common and associated with healthcare settings, Candida infections are very important, since some species of this genus can develop antifungal resistance. We contribute data on the epidemiology, antifungal susceptibility, and genetic diversity of Candida non-albicans and non-auris affecting critically ill patients in a fourth-level hospital in Colombia. Ninety-seven isolates causing invasive infections, identified by conventional methods over 18 months, were studied. Data from patients affected by these yeasts, including sex, age, comorbidities, treatment, and outcome, were analysed. The antifungal susceptibility of the isolates was determined, and the ribosomal DNA was sequenced. Candida parapsilosis, Candida tropicalis, Candida glabrata, Candida dubliniensis, and Candida guilliermondii caused 48.5% of all cases of invasive candidiasis. The species were mainly recovered from blood (50%). Patients were mostly men (53.4%), between 18 days and 93 years old, hospitalized in the ICU (70.7%). Overall mortality was 46.6%, but patients in the ICU, using antibiotics, with diabetes mellitus, or with C. glabrata infections were more likely to die. Resistant isolates were identified in C. parapsilosis, C. tropicalis, and C. glabrata. This study provides epidemiological data for the surveillance of emerging Candida species, highlighting their clinical impact, as well as the emergence of antifungal resistance and clonal dispersal.

Synergistic Inhibition of Synbiotic Cultures among Lactobacilli and Plant Extracts against Vaginal Discharge Causing Candida albicans.

Vulvovaginal candidiasis (VVC) is the most common cause of vaginal discharge among women. The present study aimed to investigate the synergistic anticandidal effect of lactobacillus cultures supplemented with plant extracts. Among 600 isolates of lactic acid bacteria, 41 isolates exhibited inhibitory activity against Candida albicans ATCC10231. Six out of 41 cell-free supernatants demonstrated the most potent antibacterial and anticandidal activities. They also inhibited the clinical isolates of C. albicans, causing VVC and non-C. albicans. The synergistic effect between Lactobacillus crispatus 84/7 and Limosilactobacillus reuteri 89/4 was demonstrated by the lowest fractional inhibitory concentration index (FICI = 0.5). The synbiotic culture of bacterial combination, cultured with Jerusalem artichoke (H. tuberosus) extract, also exhibited the strongest inhibition against the tested C. albicans. Biofilm formation decreased after 12 h of incubation in the selected cell-free supernatants of this synbiotic culture. The anticandidal activity of crude extracts was lost after treatment with proteinase K and trypsin but not with heating conditions, suggesting that it may be a heat-stable substance. In conclusion, the combination of L. crispatus 84/7 and L. reuteri 89/4 with H. tuberosus may be a promising candidate for inhibiting Candida infection and biofilm formation, with the potential use as ingredients in vaginal biotherapeutic products.

Photodynamic impact of curcumin enhanced silver functionalized graphene nanocomposites on Candida virulence

Candida species are escalating resistance to conventional antifungal treatments, intensifying their virulence, and obstructing the effectiveness of antifungal medications. Addressing this challenge is essential for effectively managing Candida infections. The overarching objective is to advance the development of more efficient and precise therapies tailored to counter Candida infections. This study focuses on developing antifungal combined drugs using curcumin-enhanced silver-functionalized graphene nanocomposites (Cur-AgrGO) to effectively target key virulence factors of C. albicans, C. tropicalis, and C. glabrata (Candida spp.). The green reduction of graphene oxide (GO) using bioentities and active molecules makes this approach cost-effective and environmentally friendly. The nanocomposites were characterized using various techniques. Combining Cur-AgrGO with photodynamic therapy (PDT) demonstrated effective antifungal and antibiofilm activity with delayed growth and metabolism. The nanocomposites effectively suppressed hyphal transition and reduced key virulence factors, including proteinases, phospholipases, ergosterol levels, and cell membrane integrity. The findings suggest that Cur-AgrGO + PDT has potential as a treatment option for Candida infections. This innovative approach holds promise for treating Candida infections.Graphical abstract

Assessment of Pregnant Women’s knowledge about Vaginal Yeast Infection in Woman's Health Hospital, Assuit University

Assessment of Pregnant Women’s knowledge about Vaginal Yeast Infection in Woman's Health Hospital, Assuit University

Secreted Aspartic Proteinases: Key Factors in Candida Infections and Host-Pathogen Interactions.

Extracellular proteases are key factors contributing to the virulence of pathogenic fungi from the genus Candida. Their proteolytic activities are crucial for extracting nutrients from the external environment, degrading host defenses, and destabilizing the internal balance of the human organism. Currently, the enzymes most frequently described in this context are secreted aspartic proteases (Saps). This review comprehensively explores the multifaceted roles of Saps, highlighting their importance in biofilm formation, tissue invasion through the degradation of extracellular matrix proteins and components of the coagulation cascade, modulation of host immune responses via impairment of neutrophil and monocyte/macrophage functions, and their contribution to antifungal resistance. Additionally, the diagnostic challenges associated with Candida infections and the potential of Saps as biomarkers were discussed. Furthermore, we examined the prospects of developing vaccines based on Saps and the use of protease inhibitors as adjunctive therapies for candidiasis. Given the complex biology of Saps and their central role in Candida pathogenicity, a multidisciplinary approach may pave the way for innovative diagnostic strategies and open new opportunities for innovative clinical interventions against candidiasis.

Photoactivated riboflavin inhibits planktonic and biofilm growth of Candida albicans and non-albicans Candida species

Fungal infections caused by Candida species pose a serious threat to humankind. Antibiotics abuse and the ability of Candida species to form biofilm have escalated the emergence of drug resistance in clinical settings and hence, rendered it more difficult to treat Candida-related diseases. Lethal effects of Candida infection are often due to inefficacy of antimicrobial treatments and failure of host immune response to clear infections. Previous studies have shown that a combination of riboflavin with UVA (riboflavin/UVA) light demonstrate candidacidal activity albeit its mechanism of actions remain elusive. Thus, this study sought to investigate antifungal and antibiofilm properties by combining riboflavin with UVA against Candida albicans and non-albicans Candida species. The MIC20 for the fluconazole and riboflavin/UVA against the Candida species tested was within the range of 0.125–2 μg/mL while the SMIC50 was 32 μg/mL. Present findings indicate that the inhibitory activities exerted by riboflavin/UVA towards planktonic cells are slightly less effective as compared to controls. However, the efficacy of the combination towards Candida species biofilms showed otherwise. Inhibitory effects exerted by riboflavin/UVA towards most of the tested Candida species biofilms points towards a variation in mode of action that could make it an ideal alternative therapeutic for biofilm-related infections.

In Vivo Evaluation of Miconazole-Nitrate-Loaded Transethosomal Gel Using a Rat Model Infected with Candida albicans.

Miconazole nitrate (MCNR), an antifungal drug, is used to treat superficial infections. The objective of the current study was to assess the antifungal effectiveness of MCNR-loaded transethosomal gel (MNTG) against Candida albicans in an in vivo rat model. The outcomes were compared with those of the miconazole nitrate gel (MNG) and marketed Daktarin® cream (2%) based on histopathological and hematological studies. The results of the skin irritation test revealed the safety profile of the MNTG. The MNTG demonstrated the greatest antifungal activity in the histological analysis and the visible restoration of the skin, and the rats revealed an apparent evidence of recovery. Compared to the untreated group, the treated group's lymphocyte and white blood cells counts increased, but their eosinophil counts decreased. In conclusion, MNTG exhibited the greatest antifungal activity, which might be connected to the improved skin permeability of the transethosome's nanosized vesicles. Therefore, it could be considered a promising carrier for topical usage and the treatment of cutaneous candidiasis. More clinical research needs to be performed in order to demonstrate its effectiveness and safe usage in humans.

Testing and Comparing Antifungal Medications to Natural Remedies

This research paper aims to test and compare natural remedies to antifungal medications to see if they can be viable replacements for the medications. It aims to offer alternatives to people who may not have access to antifungal medications and avoid the overuse of medication. Through incubation, it found that garlic was an effective antifungal and the extent of its effect was the same as the antifungal medications, while castor oil and coconut oil were not as effective. Therefore, it states that garlic is a viable alternative to antifungal medications for yeast infections and encourages further testing to find more replacements for various types of infections.

Polymeric micelle gel with luliconazole: in vivo efficacy against cutaneous candidiasis in Wistar rats.

The objective of this research was focused on the design and development of luliconazole-loaded polymeric micelle hydrogel (LUL-PM-CHG) using quality by design (QbD) principle to improve the penetration and retention of LUL in the skin. The optimization of the formulation involved the utilization of a Box-Behnken design with three factors and three levels. The impact of specific formulation variables, namely the ratio of poloxamer P123 and F127, sonication time, and the quantity of drug, was investigated in terms of particle size, micellar incorporation efficiency, and polydispersity index. The LUL-loaded P123/F127 mixed micelles involved the thin film hydration method for thin preparation. The characteristics of optimized formulation include a particle size of 226 ± 8.52nm, a polydispersity index (PDI) of 0.153 ± 0.002, a zeta potential (ZP) of 30.15 ± 2.32mV, and a micellar incorporation efficiency (MIE) of 88.38 ± 3.84%. In vitro release studies indicated a sustained release of LUL-PM-CHG for a duration of up to 8h. The MIC, GI50, and GI90 of different formulations on Candida albicans were determined using both the microtiter broth dilution method and the plate method and showed that LUL-PM-CHG exhibited the highest antifungal activity compared to the other formulations, with MIC values of 3.25 ± 0.19ng/mL, GI50 values of 37.11 ± 2.89, and GI90 values of 94.98 ± 3.41 The study also measured the % of inhibition activity and the generation of intracellular reactive oxygen species (ROS) using flow cytometry. LUL-PM-CHG showed the highest percentage of inhibition (75.5%) and ROS production (MFI-140951), indicating its enhanced activity compared to LUL-CHG and LUL. Fungal infection was induced in Wistar rats using immunosuppressant's treatment followed by exposure to C. albicans. Finally, in vivo fungal scaling and histopathological studies indicated a reduction in fungal infection in Wistar rat skin after treatment. The obtained results suggested that LUL-PM can serve as a promising formulation to enhance luliconazole antifungal activity and increase patient compliance.

Comparison of fungemia caused by Candida and non-Candida rare yeasts: a retrospective study from a tertiary care hospital.

Although Candida species are the most common cause of fungemia, non-Candida rare yeasts (NCY) have been increasingly reported worldwide. Although the importance of these yeast infections is recognized, current epidemiological information about these pathogens is limited, and they have variable antifungal susceptibility profiles. In this study, we aimed to evaluate the clinical characteristics for fungemia caused by NCY by comparing with candidemia. The episodes of NCY fungemia between January 2011 and August 2023 were retrospectively evaluated in terms of clinical characteristics, predisposing factor, and outcome. In addition, a candidemia group, including patients in the same period was conducted for comparison. Antifungal susceptibility tests were performed according to the reference method. A total of 85 patients with fungemia episodes were included: 25 with NCY fungemia and 60 with candidemia. Fluconazole had high minimal inhibitory concentration (MIC) values against almost all NCY isolates. The MIC values for voriconazole, posaconazole, and amphotericin B were ≤ 2 µg/ml, and for caspofungin and anidulafungin were ≥ 1 µg/ml against most of isolates. Hematological malignancies, immunosuppressive therapy, neutropenia and prolonged neutropenia, polymicrobial bacteremia/fungemia, preexposure to antifungal drugs, and breakthrough fungemia were associated with NCY fungemia, whereas intensive care unit admission, diabetes mellitus, urinary catheters, and total parenteral nutrition were associated with candidemia. In conclusion, the majority of fungemia due to NCY species was the problem, particularly in hematology units and patients with hematological malignancy. Preexposure to antifungal drugs likely causes a change in the epidemiology of fungemia in favor of non-albicans Candida and/or NCY.

Glycemic Control and Self-Monitoring of Blood Glucose in Type 2 Diabetic Patients on Insulin and Prevalence of Candidiasis in these Patients at Dschang District Hospital, Cameroon: A Cross-Sectional Study

Background: The number of deaths attributed to diabetes was estimated at nearly 1.5 million worldwide in 2012, making this disease one of the 15 most deadly pathologies in the world. Self-monitoring of blood glucose is not widely used in type 2 diabetics on insulin. Objective: To evaluate the level of glycemic control and identified some factors that may influence it as well as determining the prevalence of candidiasis in these patients. Methodology: A descriptive cross-sectional study was conducted on a population of type 2 diabetic patients on insulin followed at Dschang District Hospital with an average age of 58 years treated with insulin for at least 2 months and the predictors of poor glycemic control were measured (HbA1c higher than 7%) and the search for three species of Candida carried out in 3 different types of samples (urine, blood and oral cavity). Furthermore, a questionnaire was used to collect information on self-monitoring of blood glucose. Results: This study included 66 diabetic patients with a mean age of 58 years and a male predominance (51.5%). The majority of patients had been diabetic for at least 6 years with a mean duration of insulin therapy of 6 months. 90.1% of the participants reported having a glucometer and 54.5% reported performing self-monitoring of blood glucose twice a day as recommended by the physician. This study found that 78.8% of these patients had inadequate glycemic control. Factors such as Body mass index, duration of diabetes and coexistence with hypertension influenced this glycemic control. Similarly, a prevalence of 15.2%, 12.1% and 00% were recorded for urinary, oral and systemic candidiasis respectively with Candida albicans being the species most involved in these infections. Conclusion: Poor glycemic control is common among type 2 diabetic patients on insulin at Dschang District Hospital and is due to poor use and lack of training of patients on the practice of self-monitoring of blood glucose. This poor glycemic control favours the development of candida infections, especially urinary and oral.

Extremely premature infant with congenital cutaneous candidiasis

Extremely premature infant with congenital cutaneous candidiasis

The inhibitory effects of carvacrol, nystatin, and their combination on oral candidiasis isolates

BackgroundCandida, a common oral microbiota, can cause opportunistic fungal infections. With rising Candida infections and limited effective antifungals, new treatments are needed. This study investigates carvacrol essential oil’s effect on oral candidiasis, alone and with nystatin, compared to nystatin alone.Materials and methodsIn this study, oral samples were collected from dental clinic patients, especially denture users. The presence of Candida was confirmed and cultured from these samples. Candidiasis was detected by observing Candida colonies. Drug sensitivity was tested on 100 positive samples. The minimum concentration of inhibition and lethality of each isolate was evaluated using nystatin and carvacrol. The results were compared using two-way analysis of variance. Finally, the minimum inhibitory concentration (MIC) of nystatin and carvacrol was calculated individually and in combination.ResultsThe present study found that Candida albicans and non-albicans species were equally prevalent. Carvacrol showed significant biological activity against all Candida species, with an average MTT of 50.01%. The average MIC value of carvacrol was 24.96 µg/ml, indicating its potential to inhibit Candida growth. The mean Minimum Fungicidal Concentration (MFC) value of carvacrol was 23.48 µg/ml, suggesting its effectiveness in killing the fungi.ConclusionThe study’s findings reveal that the MIC of carvacrol was significantly lower than that of nystatin and the combination of nystatin and carvacrol. This suggests that carvacrol holds potential as an effective herbal remedy for candidiasis.

Comparison of Candida colonization in intensive care unit patients with and without COVID-19: First prospective cohort study from Turkey.

Candida species are the primary cause of fungal infections in intensive care units (ICUs). Despite the increasing prevalence of Candida-related infections, monitoring the progression of these infections from colonization in COVID-19 ICU patients lacks sufficient information. This study aims prospectively to compare 62 COVID-19 and 60 non-COVID-19 ICU patients from admission to discharge in terms of colonization development, rates, isolated Candida species, risk factors, and Candida infections during hospitalization. A total of 1464 samples were collected at specific time intervals from various body sites [mouth, skin (axilla), rectal, and urine]. All samples were inoculated onto CHROMagar Candida and CHROMagar Candida Plus media, and isolates identified using MALDI-TOF MS. COVID-19 patients exhibited significantly higher colonization rates in oral, rectal, and urine samples compared to non-COVID-19 patients, (p<0.05). Among the Candida species, non-albicans Candida was more frequently detected in COVID-19 patients, particularly in oral (75.8%-25%; p<0.001) and rectal regions (74.19% - 46.66%; p<0.05). Colonization with mixed Candida species was also more prevalent in the oropharyngeal region (p<0.05). Mechanical ventilation and corticosteroid use emerged as elevated risk factors among COVID-19 patients (p<0.05). Despite the colonization prevalence, both COVID-19-positive and negative patients exhibited low incidences of Candida infections, with rates of 9.67% (n=6/62) and 6.67% (n=3/60), respectively. Consequently, although Candida colonization rates were higher in COVID-19 ICU patients, there was no significant difference in Candida infection development compared to the non-COVID-19 group. However, the elevated rate of non-albicans Candida isolates highlights potential future infections, particularly given their intrinsic resistance in prophylactic or empirical treatments if needed. Additionally, the high rate of mixed colonization emphasizes the importance of using chromogenic media for routine evaluation.

Antioxidant, Anti-inflammatory, and Antimicrobial Activity of the Kalanchoe pinnata and Piper longum Formulation Against Oral Pathogens.

Background Dental caries stands out as a significant global infectious disease, with oral diseases posing substantial health concerns primarily due to bacterial, fungal, and yeast infections. Kalanchoe pinnata demonstrates antimicrobial, anticancer, antiparasitic, and hepatoprotective properties, with applications in various ailments. Piper longum exhibits potent antimicrobial effects against bacterial and viral pathogens due to the bioactive compounds within the plant. This study aims to assess the antimicrobial efficacy of P. longum and K. pinnata formulation against oral pathogens and evaluate its other biomedical potential. Methodology The agar well diffusion method was employed to assess the antimicrobial activity of the formulation containing P. longum and K. pinnata against oral pathogens. The protein leakage assay was employed to assess the ability of the prepared formulation to cause protein release from oral pathogens. The other biomedical potentials of the prepared formulation including cytotoxic effects, antioxidant, and anti-inflammatory properties were investigated using in vitro assays. Results The prepared P. longum and K. pinnata formulation demonstrated significant antimicrobial activity against tested oral pathogens, with inhibition zones observed for Staphylococcus aureus (32 mm), Streptococcus mutans (22 mm), and Candida albicans (12 mm). However, no inhibition was observed on Enterococcus faecalis at the highest concentration of 100 μL. Additionally, the formulation demonstrated significant antioxidant activity with percentages of 89.22%, 84.4%, and 86.93% in2,2-diphenyl-1-picrylhydrazyl (DPPH), hydrogen peroxide (H2O2), and ferric (Fe3+)-reducing antioxidant power assays, respectively, at the maximum concentration of 50 μL. Furthermore, the formulation exhibited potential anti-inflammatory activity, as evidenced by 79% inhibition in bovine serum albumin (BSA) denaturation assay and 77% inhibition in egg albumin (EA) denaturation assay at the highest concentration of 50 μL. Additionally, the formulation displayed low cytotoxic effects, even at the highest concentration of 80 μL. Conclusion K. pinnataandP. longumformulation demonstrated potential antimicrobial efficacy against oral pathogens and exhibited diverse therapeutic potentials. Thus, the developed formulation could be used as a potential alternative for pharmaceutical drugs against oral pathogens.

Abstract CT063: Phase Ib trial of ATR inhibitor (ATRi) tuvusertib + ATM inhibitor (ATMi) lartesertib (M4076) in patients (pts) with advanced solid tumors

Abstract Ataxia telangiectasia-mutated (ATM) and Rad3-related (ATR) protein kinases are critical in the DNA damage response. ATR and ATM genes have a synthetic lethal relationship in cancer and ATMi synergistically potentiates the efficacy of ATRi in vitro and in vivo. Here, we studied the combination potential of the highly potent, oral agents tuvusertib and lartesertib. The open-label, multicenter study DDRiver Solid Tumors 320 (NCT05396833) investigated safety, tolerability, PK and PD of tuvusertib + lartesertib in pts with advanced solid tumors refractory to standard therapy. PK samples were analyzed by a validated LC/MS method, and PD via γ-H2AX in ex vivo-stimulated CD45+ fraction by flow cytometry. As of 03.01.2024, 42 pts received ascending doses of tuvusertib + lartesertib. 5 pts experienced DLTs (Table 1). Frequent TEAEs (≥25 % of pts, any grade) were: anemia 62 %, nausea 45 %, fatigue and vomiting (43 % each). Grade ≥3 TEAEs occurred in 21 (50 %) pts; those in ≥3 pts were: anemia (n=9), decreased platelets (n=5), fatigue and decreased neutrophils (n=3 each). Preliminary steady-state PK showed rapid absorption: median Tmax of ~2-3 h (tuvusertib) and ~1-3.5 h (lartesertib); mean elimination half-life range of ~3.2-4.5 h (tuvusertib) and ~5.5-8.7 h (lartesertib); minimal accumulation. Exposure of the combination was consistent with respective monotherapies, indicating no clinically meaningful mutual drug-drug interactions. Preliminary PD showed complete or almost complete target inhibition 1-6 h after tuvusertib ≥130 mg and rebound above baseline after 24 h and target inhibition ~50 % across all time points at lartesertib ≥100 mg. 6 pts (2 ovarian, 2 uterine, 1 prostate cancer and 1 melanoma) had stable disease &amp;gt;16 weeks; 3 remain on treatment. Multiple tolerated combination doses were identified. Tuvusertib 180 mg QD + lartesertib 150 mg QD 2 w on/2 w off was selected for investigation in expansion cohorts in pts with prostate and endometrial cancer. Table 1. DLTs by ascending dose (DLT-evaluable patients) Dose (tuvusertib + lartesertib), mg N DLT DLT AE terms by cohort 2 w on/2 w off regimen 90 + 50 QD 3 No NA 130 + 50 QD 4 No NA 130 + 100 QD 3 No NA 180 + 100 QD 3 No NA 180 + 200 QD 4 Yes, in 2 pts One pt experienced febrile neutropenia Grade 3, neutrophil count decreased Grade 4, anemia Grade 3, platelet count decreased Grade 4, and candida infection Grade 2. The second pt had neutrophil count decreased Grade 4 180 + 150 QD 9 No NA 2 w on/1 w off regimen 180 + 150 QD 4 Yes, in 2 pts Both pts had platelet count decreased Grade 2 and Grade 3 180 + 100 QD 7 Yes, in 1 pt Neutrophil count decreased Grade 4 AE, adverse event; DLT, dose-limiting toxicities; N, DLT-evaluable patients; NA, not applicable; PD, pharmacodynamics; PCa, prostate cancer; PK, pharmacokinetics; pts, patients; QD, once daily, TEAE, treatment-emergent adverse event; w, week Citation Format: Lillian L. Siu, Elena Garralda Cabanas, Valentina Boni, Anthony W. Tolcher, Enrique Sanz Garcia, Jesús Fuentes-Antrás, Omar Saavedra, Deepthi S. Vagge, Giuseppe Locatelli, Burak Kürsad Günhan, Gregory Pennock, Jatinder Kaur Mukker, Ioannis Gounaris, Timothy A. Yap. Phase Ib trial of ATR inhibitor (ATRi) tuvusertib + ATM inhibitor (ATMi) lartesertib (M4076) in patients (pts) with advanced solid tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr CT063.

Prevalence of Candida species and their antifungal susceptibility patterns among patients in tertiary care setting Butwal, Nepal: A cross-sectional study

Background: Candida species, commonly present in the human body, can result in severe infections. Non-albicans Candida (NAC) species, with increasing antifungal resistance, pose a growing concern. Aims and Objectives: This study aims to evaluate candidiasis prevalence and antifungal susceptibility in isolated Candida species among suspected patients at tertiary care hospitals in Butwal, emphasizing early identification and appropriate treatment to avoid unnecessary use of toxic antifungal drugs. Materials and Methods: In a descriptive study on 303 patients with clinical symptoms of Candida infections, specimens underwent direct microscopic examination and culture on Sabouraud dextrose agar. Species identification involved phenotypic methods such as chromogenic character on CHROMagar Candida media, germ tube examination, and microscopic characteristics. Subsequently, isolated species were tested for antifungal susceptibility using the disc diffusion method. Results: Among the 303 samples tested, 80 (26.4%) were positive for candidal infection. NAC species were the most commonly isolated, with Candida albicans and Candida krusei being the most virulent. The isolates exhibited the highest sensitivity to fluconazole (77.5%) followed by itraconazole (75%), whereas amphotericin B showed the lowest effectiveness with 63.75% resistance. Conclusion: The rising prevalence of NAC species, particularly their growing resistance to Amphotericin B, has become a significant concern, as these species are frequently detected in various clinical samples. These findings underscore the importance of diligent monitoring and judicious selection of antifungal agents to ensure effective treatment strategies.

Evaluation of Oral Mucosal Lesions in Iranian Smokers and Non-smokers.

Tobacco smoking statistics are alarming and the oral mucosa is the first human part of the body that is exposed to the toxic substances of smoking. Considering the high prevalence rate of tobacco-associated problems in the oral cavity and few studies on the Iranian population regarding the effects of smoking on the oral cavity, this study aimed to evaluate the relationship between smoking and oral lesions in the Iranian population. Observational study. In this observational study, the oral cavities of 200 participants (smokers = 100 and non-smokers = 100) were examined by a trained dental student under the supervision of an oral and maxillofacial medicine expert, and the presence of coated tongue, leukoedema, leukoplakia, smoker's palate, smoker's melanosis, erythroplakia, frictional hyperkeratosis, acute pseudomembranous candidiasis, and erythematous candidiasis were recorded. Xerostomia was evaluated based on participants' self-reporting through a questionnaire. All data were analyzed using T-test, Chi-square test, odd ratio, 95% confidence interval, Fisher's exact test, and Spearman's rank correlation coefficient. The results of this study showed smoking is significantly associated with an increased risk of coated tongue (OR: 1.80, 95% CI: 1.32-3.54, P = 0.005), smoker's melanosis (OR: 6.176, 95% CI: 3.28-11.62, P = 0.00002), and frictional hyperkeratosis (OR: 1.33, 95% CI: 0.68-2.60, P = 0.005). However, no significant association was observed between smoking and leukoedema (OR: 1, 95% CI: 0.51-1.94, P = 1). None of the participants presented smoker's palate, erythroplakia, and candidiasis. This study's results showed that smokers exhibited a greater chance of developing oral lesions compared to non-smokers.

Clinical Distribution and Drug Susceptibility Characterization of Invasive Candida Isolates in a Tertiary Hospital of Xinjiang Province.

This study aims to investigate the clinical distribution characteristics and drug susceptibility profiles of invasive Candida isolates in a tertiary hospital in Urumqi. The examination was conducted on samples obtained from patients who were clinically diagnosed with invasive candidiasis in this hospital. A total of 109 strains of Candida strains were identified through the use of internal transcribed spacer (ITS) sequencing and fungal cultivation methods.The clinical distribution of the strains was analyzed. Antifungal drug susceptibility tests were performed using the Sensititre YO10 fungal drug susceptibility plate based on the micro-broth dilution method. Candida albicans had the highest percentage (51.38%) among 109 Candida isolates, followed by C. glabrata (18.35%) and C. tropicalis (15.60%). The isolates were predominantly found in the respiratory department (41.28%), intensive care unit (ICU) (31.19%), and infection department (9.17%).The results of drug susceptibility tests indicated that amphotericin B, 5-fluorocytosine, and echinocandins exhibited good in vitro antifungal activity, with a susceptibility rate of over 96%. However, the azoles demonstrated low antifungal activity, especially posaconazole and voriconazole, which had high resistance rates of 64.71% for C. tropicalis and 70% for C. glabrata, respectively. In our hospital, Candida albicans was identified as the primary causal agent of invasive candidiasis. In terms of in vitro antifungal activity, echinocandins, amphotericin B, and 5-fluorocytosine demonstrated efficacy against invasive Candida infections. However, it was important to note that C. glabrata and C. tropicalis exhibited low susceptibility to azoles.

Interleukin inhibitors and the associated risk of candidiasis.

Interleukins (ILs) are vital in regulating the immune system, enabling to combat fungal diseases like candidiasis effectively. Their inhibition may cause enhanced susceptibility to infection. IL inhibitors have been employed to control autoimmune diseases and inhibitors of IL-17 and IL-23, for example, have been associated with an elevated risk of Candida infection. Thus, applying IL inhibitors might impact an individual's susceptibility to Candida infections. Variations in the severity of Candida infections have been observed between individuals with different IL inhibitors, necessitating careful consideration of their specific risk profiles. IL-1 inhibitors (anakinra, canakinumab, and rilonacept), IL-2 inhibitors (daclizumab, and basiliximab), and IL-4 inhibitors (dupilumab) have rarely been associated with Candida infection. In contrast, tocilizumab, an inhibitor of IL-6, has demonstrated an elevated risk in the context of coronavirus disease 2019 (COVID-19) treatment, as evidenced by a 6.9% prevalence of candidemia among patients using the drug. Furthermore, the incidence of Candida infections appeared to be higher in patients exposed to IL-17 inhibitors than in those exposed to IL-23 inhibitors. Therefore, healthcare practitioners must maintain awareness of the risk of candidiasis associated with using of IL inhibitors before prescribing them. Future prospective studies need to exhaustively investigate candidiasis and its associated risk factors in patients receiving IL inhibitors. Implementing enduring surveillance methods is crucial to ensure IL inhibitors safe and efficient utilization of in clinical settings.