Candidiasis In Patients Research Articles

The Incidence and Characteristics of Oral Candidiasis in Patients Hospitalized for SARS-CoV-2 Infection During the Circulation of Alpha, Beta, and Delta Variants

Background: Oral candidiasis has been documented in patients with SARS-CoV-2 infection, with varying prevalence rates across geographic regions and patient demographics. This study aimed to ascertain the incidence, characteristics, and risk factors associated with the development of oral candidiasis in patients hospitalized for SARS-CoV-2 infection in a tertiary infectious diseases hospital in Romania. Methods: A retrospective analysis was conducted on adult patients hospitalized between March 2020 and December 2022 with moderate or severe forms of SARS-CoV-2 infection, for whom a culture of lingual scrapings for Candida spp. was performed. Results: A total of 294 patients were deemed eligible for inclusion in the analysis, with an incidence rate of oral candidiasis of 17.0%. The incidence of oral candidiasis was 4.2 times higher in patients with severe forms of SARS-CoV-2 infection compared to those with moderate forms. Patients with a diagnosis of COVID-19 and oral candidiasis were more likely to receive antibiotics (98.0% vs. 86.1%, p = 0.017) and corticosteroids (100% vs. 83.6%, p = 0.003) than those without oral candidiasis. These findings were associated with a 19% higher relative risk of developing oral candidiasis for patients who received corticosteroid therapy compared to those who did not, and a 13% higher relative risk for those who were administered antibiotics compared to those who were not. The presence of respiratory insufficiency increased the odds of oral candidiasis association 4.7-fold (88.0% vs. 61.1%, p < 0.001). Conclusions: Although the data have been analyzed retrospectively, we have shown that individuals with severe forms of COVID-19 exhibited an elevated risk of developing oral candidiasis. The administration of antibiotics and corticosteroids was identified as a positive predictor for the development of oral candidiasis. The data presented here suggest that a key aspect of the therapeutic management of patients with SARS-CoV-2 infection should include the implementation of preventive measures to minimize the risk of secondary fungal infections.

The Risk of Candidiasis During Treatment with Bimekizumab for the Management of Plaque Psoriasis: A 16-Week Multicenter Real-World Experience - IL PSO (Italian Landscape Psoriasis).

Anti-interleukin (IL)17 use has been associated with a higher risk of candidiasis, as this cytokine is involved in maintaining mucosal barriers and orchestrating immune responses to fungal pathogens. We performed a real-life retrospective multicenter study aiming of assessing the risk of candidiasis in patients undergoing treatment with bimekizumab at labelled dosage for psoriasis, for at least 16 weeks.

Anti-fungal efficacy of Carvacrol against Candida glabrata clinical isolates of vulvovaginal candidiasis

Fungal infections affect over 1 billion people worldwide each year, including superficial infections like athlete's foot and more severe systemic infections. Fungal diseases are responsible for an estimated 1.5 million deaths annually, a figure comparable to or exceeding the mortality rate of diseases like malaria or tuberculosis. The limited arsenal of available antifungal drugs, coupled with the emergence of drug-resistant fungal strains, has increased this concern. Therefore, there is a significant need to explore alternative therapeutics to overcome fungal pathogens. Carvacrol, phenolic monoterpenoids, is present in essential oils of many plants and is known for its biological and pharmacological properties. In the present study, the efficacy of carvacrol was investigated against four Candida glabrata strains isolated from patients of vulvovaginal candidiasis, which have shown varying extents of susceptibility against fluconazole. Carvacrol, a phytoactive monoterpene phenol, has shown a minimum inhibitory concentration (MIC50) ranging from 75 to 125 µg/mL and minimum fungicidal concentration of 150 and 175 µg/mL for all clinical isolates, including wild-type strains. Carvacrol, in combination with fluconazole, has shown a strong synergism against wild type C. glabrata with a FIC index value of 0.156. Preliminary mechanistic investigations unveiled that exposure to carvacrol significantly reduced cell surface hydrophobicity and ergosterol content in all strains. In conclusion, carvacrol holds promising potential as an effective antifungal agent against C. glabrata, which is categorized as high priority in the first fungal pathogen priority list of the World Health Organisation released in 2022 for highlighting priority areas for action, including the development of effective therapeutic solution.

Regulation of candidalysin underlies Candida albicans persistence in intravascular catheters by modulating NETosis.

Candida albicans is a leading cause of intravascular catheter-related infections. The capacity for biofilm formation has been proposed to contribute to the persistence of this fungal pathogen on catheter surfaces. While efforts have been devoted to identifying microbial factors that modulate C. albicans biofilm formation in vitro, our understanding of the host factors that may shape C. albicans persistence in intravascular catheters is lacking. Here, we used multiphoton microscopy to characterize biofilms in intravascular catheters removed from candidiasis patients. We demonstrated that, NETosis, a type of neutrophil cell death with antimicrobial activity, was implicated in the interaction of immune cells with C. albicans in the catheters. The catheter isolates exhibited reduced filamentation and candidalysin gene expression, specifically in the total parenteral nutrition culture environment. Furthermore, we showed that the ablation of candidalysin expression in C. albicans reduced NETosis and conferred resistance to neutrophil-mediated fungal biofilm elimination. Our findings illustrate the role of neutrophil NETosis in modulating C. albicans biofilm persistence in an intravascular catheter, highlighting that C. albicans can benefit from reduced virulence expression to promote its persistence in an intravascular catheter.

Oral Candidiasis in Patients with Level CD4+ Below 50

Approximately 90% of individuals diagnosed with HIV/AIDS have encountered Oral Candidiasis during the progression of their disease, especially in patients with a reduced CD4+ 200 mm3. Oral Candidiasis is a prevalent opportunistic infection of the oral cavity. Reported a case of a patient with oral candidiasis in an HIV/AIDS with CD4+ below 50 and discussed the mechanism of molecular relationship decreasing count CD4+ with virulence of Candida Albicans. In this report, we present a case of a 35-year-old female who presented with oral candidiasis. The patient's CD4+ count test revealed a level below 50 and HIV test I-II-III reactive. Human immunodeficiency Virus causes a decrease in CD4+ count and leads to opportunistic oral candidiasis infection.

INCIDENCE OF ORAL CANDIDIASIS IN FIXED ORTHODONTIC APPLIANCES

Introductions: Oral candidiasis is most often caused by Candida albicans, followed by C. glabrata. In European countries, an analysis showed that more than half of candidiasis cases were caused by C. albicans and the infection rate caused by other candida strains was 14% for C. glabrata and C. parapsilosis, 7% for C. tropicalis and 2% for C. krusei. According to a study in Brazil, C. albicans accounted for 40.9% of cases followed by C. tropicalis (20.9%), C. parapsilosis (20.5%) and C. glabrata (4.9%). Meanwhile, in Indonesia, there is no national data regarding the epidemiology of oral candidiasis in Indonesia. Hospital Dr. Hasan Sadikin (RSHS) Bandung conducted research from 2010-2014 and found that during that period 49 patients had oral candidiasis. In general, side effects can be felt by patients who are in fixed orthodontic treatment which affects comfort and quality of life, namely 42.79% experience a sensation of pain in the area of the oral cavity, while 51.80% complain of discomfort when chewing food and this can indicate that Orthodontic appliances are mainly the patient's daily activities, the second is related to chewing food, phonetics and smile lines. The purpose of this study was to determine the incidence of candidiasis on orthodontic appliances. This study was to determine the incidence of candidiasis on fix orthodontic appliances. Material and Methods: In this study, 80 samples were obtained from the total population, namely medical students who use fixed orthodontics with metal materials. Methods with SWAB examination on the surface of the bracket and the oral mucosa that intersect with the ortho-adhesive device. The results were recorded and then data analysis was carried out. Then the specimens were put in a microbiology incubator for 48 hours at room temperature. If candida albicans grows on the petridish then it is assessed that candidiasis is present. Results: From the study, it was found that 80% incidence of candidiasis, 20% is normal. Conclussions: There is a high incidence of oral candidiasis in patients using fix orthodontics appliances.

Distribution of demographic characteristics and predisposing disease in oral candidiasis patients at Prof. Ngoerah Hospital Denpasar in 2022-2023

Oral candidiasis is an infection that occurs in the oral cavity due to invasion of Candida sp. in the superficial mucosal tissue. Oral candidiasis tends to occur in individuals with underlying predisposing diseases. This study aimed to investigate the distribution of demographic characteristics and underlying disease in oral candidiasis patients at Prof. Ngoerah Hospital, Denpasar, Bali, Indonesia. This research is a descriptive study with a cross-sectional design. The sample consisted of 53 participants with oral candidiasis that were selected through total sampling. Data for this study were collected retrospectively from medical records. Univariate analysis was performed to determine the prevalence of each variable. The average age of the samples was 41.15 ± 12.89 years with a male-to-female ratio of 1.65:1; were from Denpasar (45.3%); the educational status of most patients was high school (71.7%); and most samples were self-employed (64.2%). Based on the distribution of predisposing diseases, most patients had HIV (52.8%) and only one predisposing disease (75.5%). Among patients with HIV, the majority were at HIV stage IV (35.8%). Most patients in this study had a normal nutritional status (47,2%). This study showed that oral candidiasis is often found in individuals with predisposing diseases, such as HIV, especially in stage IV. We also found oral candidiasis in the patients with no predisposing factor identified. The presence of oral candidiasis in healthy patients with no predisposing factor identified needs direct vigilance on other factors.

Antifungal susceptibility profile of Candida species isolated from women with vulvovaginal candidiasis

Objectives: The objective of this study was to study the occurrence of vulvovaginal candidiasis (VVC) among women with vaginitis and to determine the antifungal susceptibility testing (AFST) pattern of Candida spp. isolated. Materials and Methods: A prospective study was conducted in a tertiary care setting. The two high vaginal swabs were collected and subjected to Gram’s stain, wet mount examination, and cultured on blood agar and sabouraud dextrose agar with chloramphenicol. The cultures were incubated at 37°C for 18–24 h. The Candida spp. was identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF-MS), and AFST was performed according to the Clinical and Laboratory Standards Institute guidelines M27-A3. Statistical Analysis: The data was collected in excel sheet. The qualitative variables are presented as frequencies and percentages. The quantitative variables are presented as mean with SD and median. p value of less than 0.05 was considered statistically significant. Analysis will be done by using Epi InfoTM statistical software. Results: A total of 961 women with symptoms of vaginitis were screened. Candida spp. was isolated in 108 (11.2%) patients. The median age of affected women was 29 years, and the majority belonged to 20–30 years (60.2%). Age <40 years was the significant risk factor (P = 0.016). Vaginal discharge was the most common complaint (82.4%),followed by itching (55.6%), vulvar edema, dyspareunia, and dysuria. Candida albicans was the predominant species (46.3%),followed by Candida glabrata (36.1%), Candida krusei (6.5%), and Candida tropicalis (6.5%). Ninety-six percentages of C. albicans were sensitive to fluconazole, while only 22.4% of non-albicans Candida spp (NAC) were susceptible. C. albicans showed 8% resistance to itraconazole and 8% intermediate resistance to caspofungin, whereas C. glabrata showed resistance to fluconazole, itraconazole, and caspofungin. Conclusions: The study showed a higher incidence of NAC and higher antifungal resistance leading to treatment failure. It is, hence, crucial to send fungal cultures, speciate, and perform AFST for all symptomatic patients of vulvo-vaginal candidiasis (VVC).

Biofilm Formation and Antifungal Susceptibility Profile of Candida Species Responsible for Vulvovaginal Candidiasis in Pregnant and Non-Pregnant Women visiting a Tertiary Care Hospital in Southern India

Most bacteria and fungi are capable of producing biofilms, enabling them to thrive in nature on distinct surfaces. Biofilm formation stands out as one of the most prominent virulence mechanisms that contribute to the infection’s chronicity by functioning as a defense against antimicrobials and host immune systems. Microbial isolates capable of generating biofilms have been discovered to possess higher resistance to frequently administered antifungal drugs. In this research study, 91 Candida isolates from Vulvovaginal Candidiasis (VVC) patients were tested for biofilm development. Candida species were identified, and clinical isolates were tested for antifungal susceptibility (AST). Three methods were used to screen the isolates: the Congo agar method (CRA), the visual tube method (VT), and the Microtitre plate method (MTP). Nearly 60% of the 91 clinical isolates tested were recognized as Non-Albicans Candida (NCAC) species. Itraconazole resistance was shown to be the highest in clinical isolates, followed by Amphotericin B resistance. There were 11(12.09%) isolates that formed strong biofilms, 35(38.46%) isolates that formed moderate biofilms, and 45(49.45%) isolates that formed no biofilm. Because there is a growing incidence of NCAC in the study, it is critical to speciate the Candida species as NCAC are more resistant to routinely used azole medicines. Furthermore, a spike in the prevalence of biofilm producers has been reported, implying greater pathogenicity and antifungal resistance.

Vitamin D deficiency and oral candidiasis in patients with HIV infection: A case‒control study.

Oral candidiasis is a common opportunistic infection in patients with human immunodeficiency virus (HIV). In addition, most of these patients suffer from vitamin D deficiency. This study aimed to investigate the association between vitamin D levels and oral candidiasis in patients with HIV infection. This case‒control study was conducted on HIV-infected patients. Cases were patients with oral candidiasis diagnosed based on physical examinations. Controls were age- and sex-matched individuals without oral candidiasis. The levels of 25-OH vitamin D and other laboratory markers (CD4 count and viral load) were compared between the case and control groups. A total of 104 cases and 102 controls were included in the study. The cases had significantly lower 25-OH vitamin D3 levels (MD = 33.86 ng/mL, 95% CI= (31.85, 35.87), P < 0.001) and CD4 counts (MD = 267.48 cells/mm3, 95% CI= (189.55, 345.41), P < 0.001) than the controls. In addition, viral load was significantly higher in cases than in controls (MD = 7.03 × 105 copies/mL, 95% CI= (4.46 × 105, 9.61 × 105), P < 0.001). The multivariate logistic regression analysis revealed that educational status (OR = 0.032, 95% CI= (0.002, 0.100), P < 0.001), current HAART (OR = 0.005, 95% CI= (0.001, 0.014), P < 0.001), history of oral candidiasis (OR = 20.114, 95% CI= (18.135, 21.957), P < 0.001), CD4 count (OR = 0.004, 95% CI= (0.001, 0.006), P < 0.001), viral load (OR = 12.181, 95% CI= (1.108, 133.392), P < 0.001), and vitamin D level (OR = 0.011, 95% CI= (0.008, 0.015), P < 0.001) were significantly associated with the risk of developing oral candidiasis. Based on the findings, most patients with HIV infection suffer from vitamin D deficiency, especially those with oral candidiasis. Hypovitaminosis D was significantly associated with an increased risk of oral candidiasis. Thus, vitamin D supplementation may assist HIV-positive patients in improving their oral health and preventing oral candidiasis.

A multicentre, randomized, double blind, placebo controlled pilot study to evaluate the efficacy and safety of colloidal Nano silver gel (SilverSol) in the treatment of bacterial vaginosis, vulvovaginal candidiasis and trichomoniasis

The study evaluated the efficacy and safety of colloidal nano silver gel (SilverSol Vagigel) (A patented technology from American Biotech Labs, USA) in combination with 0.2% lactic acid in the female subjects for the treatment of vaginal infections.This study was a multicenter, randomized, double-blind, placebo-controlled pilot study in which post-menarchal female subjects between 18 and 65 years of age clinically diagnosed with bacterial vaginosis and vulvovaginal candidiasis were enrolled. The participants were randomized to receive treatment with SilverSol Vagigel or placebo (vehicle) gel (both treatments as one 4 gm application inserted into the vagina with an applicator device, once daily at bedtime for internal use and 2 gm gel for local application to the vulva and vagina for external use twice daily for a period of 14 days). The primary endpoint evaluated was the proportion of subjects achieving clinical cure. The secondary endpoint was the proportion of subjects achieving microbiological cure at the end of the study visit. A total of 57 subjects were randomized in the study out of which 38 subjects were randomized in SilverSol Vagigel arm and 19 subjects were randomized in placebo arm. SilverSol Vagigel significantly improved cure rates of vaginal infections compared to placebo. The proportion of subjects achieving clinical cure of vaginal infections was higher i.e., 33 (86.84%) subjects in SilverSol Vagigel arm compared to 07 (41.18%) subjects in Placebo gel arm (p-value: 0.0009). The clinical cure rate with SilverSol Vagigel was 81.82% (P=0.1758) for bacterial vaginosis and 92.59% (P=0.0010) for vulvovaginal candidiasis patients at the end of the study. Overall SilverSol Vagigel treatment resulted in a significantly higher microbial cure of vaginal infections (P=0.0028) compared to placebo, with a microbial cure rate of 100% for bacterial vaginosis (P=0.0330) and 85.19% for vulvovaginal candidiasis (P=0.0097). No adverse events were reported in subjects treated with SilverSol Vagigel.Colloidal Nano Silver Gel (SilverSol Vagigel) was effective and safe in treating bacterial vaginosis and vulvovaginal candidiasis.

Prevalence and Antifungal Susceptibility of Candida Infections in Patients with Pulmonary Tuberculosis: A Cross-sectional Study from the Union Territory of Puducherry, India

Introduction: Pulmonary Tuberculosis (TB) is a bacterial infectious disease caused by Mycobacterium tuberculosis. Candida albicans is the most commonly isolated fungal pathogen in bronchopulmonary patients. Invasive candidiasis due to Candida species has been on the rise in recent years. However, drug sensitivity studies of C. albicans isolated from TB patients are not routinely conducted in India and other developing countries. Aim: To isolate and identify Candida albicans from patients with TB and to determine its antifungal susceptibility. Materials and Methods: This cross-sectional study was conducted on 129 patients suspected of having pulmonary TB, analysed from August 2016 to January 2018 at the Department of Chest Medicine, Aarupadai Veedu Medical College and Hospital, Puducherry, India. Sputum samples were collected and processed to identify Candida species through Gram staining, Ziehl-Neelsen staining, germ tube formation, and sugar fermentation. Antifungal resistance testing was performed using the disk diffusion method recommended by the Clinical and Laboratory Standards Institute (CLSI). The collected data were subsequently analysed using descriptive statistics and the Chi-square test to evaluate the results. Results: Candida infection was observed in 10 (7.75%) out of 129 patients with pulmonary TB. Among patients with co-infection, C. albicans was the most common, accounting for 4 (40%) cases, followed by C. krusei with 2 (20%) cases, C. tropicalis with 1 (10%) case, C. kefyr with 1 (10%) case, C. glabrata with 1 (10%) case, and C. parapsilosis with 1 (10%) case. Among the azole category, itraconazole and amphotericin B exhibited the highest sensitivity percentages against Candida. Conclusion: The current study revealed a high prevalence of coinfection between pulmonary TB and Candida spp., which may contribute to the symptoms of pulmonary lung disorders. The prevalence of Candida species could also be associated with an inadequate response to antitubercular drugs. Amphotericin B and itraconazole, two commonly used drugs in the community, are often employed as the preferred treatments for fungal infections. Early detection and treatment of this opportunistic candidiasis in patients with pulmonary TB will likely enhance outcomes for such individuals.

Nystatin Encapsulated Nanoliposomes: Potential Anti-infective against Candida Spp. Isolated from Candidiasis Patients.

Due to the pathogenic role of opportunistic fungi in immunodeficiency patients, many efforts have been made for developing effective treatment strategies to augment current practice standards. Nystatin, as one of the treatment candidates, is characterized by antifungal effects. In this study, we tried to use liposomal formulation as a nystatin carrier to increase its antifungal efficacy. A total of 87 positive culture samples of yeast agents were applied to the study. Yeast species were identified by culturing on CHROMagar medium (HiMEDIA), culturing on NigerSide agar medium, and Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP). Characterization of nanoparticles was examined by the size, zeta potential (ZP), scanning electron microscope (SEM), drug loading, and drug release rate. The standard method of broth microdilution according to CLSI M27-A and the quality control standard of Candida parapsilosis ATCC 22019 were used to evaluate the minimum inhibitory concentration (MIC) of nystatin and nystatin nanoliposomes. The particle size for liposomes containing nystatin was 100.8 ± 17.3 nm. Moreover, the ZP for liposomal formulation of nystatin was 21.14 ± 0.92 -mV. The formulation of nystatin in nanoparticles markedly increased the susceptibility of Candida species to nystatin at lower doses, which was statistically significant compared to free nystatin (P ≤ 0.05). Our results showed that liposomal formulation improves the efficiency of nystatin against albicans species. This formulation can be used to develop new antifungal agents to improve the delivery and absorption of hydrophobic drugs.

Factors Associated with Candidiasis in Pemphigus Vulgaris Patients: Results from a Retrospective Study in Two Second-Care Level Hospitals in Mexico.

Infections are a major cause of morbidity and mortality in patients with pemphigus vulgaris (PV). One of the most common infections in these patients is candidiasis. This is probably due to the use of systemic immunosuppressants, including oral and intravenous corticosteroids, mainly in megadoses (pulse therapy), although it is unknown if there are other associated factors, in addition to immunosuppressive treatment. We determine the factors associated with candidiasis in PV patients in two second-care level hospitals in Mexico. We reviewed 100 cases with PV. Cases were randomly selected from the databases of two second-care level hospitals between January 2010 and December 2019 (10 years). The primary endpoint was the incidence of candidiasis in patients with PV. One hundred patients with PV were enrolled in this retrospective study. Candidiasis was observed in 79 patients (79%). A maximum corticosteroid dose of 55 mg/day during the last year (p = 0.001) and a higher neutrophil/lymphocyte ratio were associated with candidiasis in patients with PV (p = 0.001). Risk factors favoring candidiasis in patients with PV are not only related to the use of corticosteroids, but also to demographic factors, the activity of the disease, and the systemic inflammation associated with autoimmunity.

213. Do Patients with Candidemia Need an Ophthalmology Exam?

Abstract Background Candidemia can lead to hematogenous seeding of the eye resulting in chorioretinitis or endophthalmitis. IDSA recommends a screening dilated retinal examination for patients with candidemia, whilst American Academy of Ophthalmology (AAO) recently declared this a low value practice. Using an inter-disciplinary team, we evaluated ophthalmology examination for patients with candidemia. Methods We performed a retrospective study of patients with candidemia at an academic medical center and affiliated hospitals between January 2011 – June 2022. Electronic medical records were reviewed for demographics and baseline characteristics. The primary outcome was chorioretinitis and/or endophthalmitis. The study was adjudicated by independent review from infectious disease and ophthalmology providers. Results We included 308 patients with a blood culture positive for candida species. 149 patients (48%) received an ophthalmologic exam, of which 55% (82) were asymptomatic. Abnormal ocular findings concerning for presumed ocular candida complications were found in 12 patients (8%, 12/149), of which 4 had alternative diagnoses to candida choriorentinits or endophthalmitis. All of the remaining 8 patients (5%, 8/149) had presumed candida chorioretinitis with no cases of candida endophthalmitis and this led to a change in management in 88% (7/8) of patients (Table 1). Of the 8 patients, 3 patients were asymptomatic, making the number needed to screen 28 to detect presumed candida chorioretinitis amongst asymptomatic patients. We did not identify statistically significant risk factors for development of abnormal ocular findings (Table 2). Table 1 Clinical diagnosis and management of patients with candida chorioretinitis and/or endophthalmitis Table 2 Clinical features of patients with and without ocular candidiasis Conclusion IDSA and AAO recommend ophthalmologic examination in symptomatic and intubated patients with candidemia. We found a 5% incidence of presumed ocular candidiasis in patients with candidemia. Given the limitations of our study, we could not conclude for or against screening in asymptomatic patients as this did not lead to a significant change in patient outcomes. Inter-disciplinary decisions involving ophthalmology and infectious diseases can help inform best practices for screening in asymptomatic patients. Future studies should evaluate ocular photography and teleophthalmology as screening strategies. Disclosures All Authors: No reported disclosures

Oral Candidiasis in Patients with Rheumatoid Arthritis: A Hospital-Based Cohort Study

Background: Rheumatoid (RA) arthritis is a chronic autoimmune disease characterized by symmetric polyarthritis and systemic inflammation. Systemic complications due to RA and its treatment may affect oral health. Objective: To assess the prevalence and predisposing factors for oral candidiasis in Rheumatoid Arthritis patients treated at a rheumatology referral hospital. Methods: This is a longitudinal study of a panel of repeated measures performed on patients attending the Rheumatology and Oral Diagnosis Outpatient Clinic of the General Hospital of Cuiabá. Patients were followed up between 2018 and 2019, with the information recorded in the medical records and subsequently extracted. A generalized estimation equation model was used to assess the association between oral candidiasis and RA. Results: In the final model, in crude (bivariate) analysis, the use of prednisone (OR 8.3) and tocilizumab (OR 3.7) were significantly associated with oral candidiasis. In the multivariate generalized estimation equation model, the use of prednisone (OR 9.9) and the presence of hyposalivation in male patients (OR 1.8) were the variables that remained statistically associated with oral candidiasis. Conclusion: The use of immunosuppressive drugs and the low rate of salivary flow in male patients increase the risk of oral candidiasis in patients with rheumatoid arthritis, reinforcing the importance of stomatological monitoring, a preventive approach and early diagnosis of this pathology.

Genotypes and virulence-related activities of Candida albicans derived from oral cavity of patients in Hokkaido

ObjectiveThis study aimed to elucidate the difference in virulence of Candida albicans derived from oral candidiasis and non-oral candidiasis patients, and its genotype differences in Hokkaido to obtain a clue of a platform to develop new approaches for diagnosis and treatment. DesignC. albicans strains were collected from patients who visited the Hokkaido University Hospital Dental Center. Each strain was examined to i) identify the Candida albicans genotype by PCR, ii) measure the strain’s extracellular secretory enzyme activity, iii) determine the strain’s ability to induce the production of interleukin-8, and iv) determine the strain’s ability to induce cell death. ResultsCertain virulence-related protease activities and cytotoxicity were higher in strains derived from patients with oral candidiasis compared with strains derived from patients without oral candidiasis. This is the first report on genotypes and the virulence-related activities, such as some protease secretion, IL-8 induction and cytotoxicity of C. albicans in Hokkaido. ConclusionsThe virulence-related activities of the fungal strain may influence the pathogenesis of oral candidiasis, such as production of secreted aspartyl protease and cytotoxicity. In addition, C. albicans genotype C may be important for pathogenicity in Hokkaido, because the ratio of genotype C was increased in strains derived from oral candidiasis patients.

A Review of the Latest Findings of Candida Colonization and Candidiasis in Patients with Psoriasis and Its Management

Psoriasis is an immune-mediated disease causing raised, scaly patches on the skin, especially the elbows, knees, and scalp due to systemic inflammation. The disease affects more than 125 million people worldwide. Psoriasis is associated with problems such as depression, reduced quality of life, cardiovascular diseases, stroke, lymphoma, diabetes mellitus, and metabolic syndrome. Psoriasis has a complex pathogenesis that is not yet fully understood. Many studies have shown the importance of the microbiome for the exacerbation of psoriasis. On the other hand, psoriasis and some other treatments can increase the colonization of some microbial agents in the body. Candida is commensal yeast that forms part of the natural microflora of the skin and mucous membranes. It has been shown that people with psoriasis are susceptible to candidiasis. In this review article, the causes of candidiasis, its diagnosis, and treatment in patients with psoriasis, as well as psoriasis aggravation methods by Candida species have also been investigated. To this end, keywords such as "psoriasis", "candida", " oral candidiasis", "cutaneous candidiasis", "vulvovaginal candidiasis", "epidemiology of Candida" and "balanitis" were searched. Articles published in national and international scientific databases, namely Google Scholar, PubMed/MEDLINE, Elsevier databases, Scopus, Science Direct, IranMedex, and SID from 2001 to 2023 were used. Oral candidiasis, cutaneous candidiasis, vulvovaginal candidiasis, and balanitis are diseases that affect people with psoriasis. On the other. This fungus may aggravate psoriasis through toxin production and activation of T lymphocytes independent of antigen presentation.&#x0D;

The association between Geriatric Nutritional Risk Index and the risk of Invasive Candidiasis in critically ill older adults

BackgroundInvasive candidiasis is the most common hospital-acquired fungal infection in intensive care units (ICU). The Geriatric Nutritional Risk Index (GNRI) score was developed to evaluate the nutritional status of elderly adults. We aimed to assess the association between the GNRI score and the risk of invasive candidiasis in elderly patients admitted to ICU.MethodsHospitalization information of elderly patients with invasive candidiasis was collected retrospectively from Medical Information Mart for Intensive Care (MIMIC) IV and MIMIC-III Clinical Database CareVue subset from 2001 to 2019. The main outcome of this study was the diagnosis of invasive candidiasis in patients. We employed a multivariable Cox regression and propensity score matching to balance the influence of confounding factors on the outcome. Furthermore, we conducted sensitivity analyses by categorizing the GNRI into classes based on thresholds of 98, 92, and 81.ResultsA total of 6739 patients were included in the study, among whom 134 individuals (2%) were diagnosed with invasive candidiasis. The GNRI scores of patients with invasive candidiasis upon admission to the ICU were significantly lower, measuring 88.67 [79.26–98.27], compared to the control group with a score of 99.36 [87.98-110.45] (P < 0.001). The results of the multivariable Cox regression analysis demonstrated a strong association between higher GNRI scores and a decreased risk of invasive candidiasis infection (HR: 0.98, 95% CI: 0.97–0.99, P = 0.002). Consistently, similar results were obtained when analyzing the propensity score-matched cohort (HR: 0.99, 95% CI: 0.98-1, P = 0.028). Sensitivity analyses further confirmed a significantly increased risk of invasive candidiasis infection with lower GNRI scores. Specifically, the following associations were observed: GNRI ≤ 98 (HR: 1.83, 95% CI: 1.23–2.72, P = 0.003), GNRI ≤ 92 (HR: 1.68, 95% CI: 1.17–2.4, P = 0.005), 82 ≤ GNRI ≤ 92 (HR: 1.63, 95% CI: 1.01–2.64, P = 0.046), GNRI ≤ 81 (HR: 2.31, 95% CI: 1.44–3.69, P < 0.001).ConclusionsLower GNRI score was significantly associated with an increased risk of invasive candidiasis in elderly patients in ICU. Further research is needed to validate whether improving nutrition can prevent invasive candidiasis.

Antifungal Properties of Pinus eldarica and Pinus longifolia Fruit Extracts against Candida Species Isolated from Vulvovaginal Candidiasis Patients

Introduction:Candidiasis is a disease with serious problems in women. With the increasing drug resistance and risks of the drugs, we investigated the effect of different cone extracts of Pinus eldarica and Pinus longifolia against Candida species isolated from vulvovaginal candidiasis patients.Materials and Methods::Candida species isolated from 50 patients were identified by routine mycological methods, including morphology of corn mil agar, chromium agar, germination, and biochemical methods. The anti-candida properties of the extracts and essential oils of Pinus eldarica and Pinus longifolia were investigated using agar diffusion and microdilution test. The essential oil was then analyzed by Gas chromatography-mass spectrometry (GC-MS).Results:The major constituents of Pinus longifolia essential oil included 23.16% alpha-pinene, 2.59% beta-caryophyllene, 23.61% delta-3-carene, 0.24% carcin-4-hydroxy, 13.56% m-cymene, 0.45% alpha-humulene, and 2.12% junipene. The major constituents of Pinus eldarica essential oil included 29.13% alpha-pinene, 14.22% beta-caryophyllene, 11.70% delta-3-carene, -14.22% carcin-4-hydroxy, 4.29% beta-pinene, 3.59%, alpha humulene, and 8.86% junipene. The results of antifungal tests showed that aqueous, ethanolic, and methanolic extracts had a weak anti-candida effect. By changing the solvent and using petroleum ether solvent, it was found that petroleum ether extract and cone essential oil of Pinus longifolia and Pinus eldarica exhibited a relatively strong anti-candida effect.Discussion and Conclusion:Comparison of Minimum Inhibitory Concentration (MIC) and Minimum Fungicidal Concentration (MFC) of four extracts of Pinus longifolia and Pinus eldarica against different Candida showed that the lowest MIC and MFC were related to essential oil, petroleum ether extract, methanolic extract, ethanolic extract, and aqueous extract, respectively.