Deep Candida Infection Research Articles

Risk Factors for Deep Candida Infection in Acute Abdominal Surgery Patients

Risk Factors for Deep Candida Infection in Acute Abdominal Surgery Patients

Liposomal amphotericin B (AmBisome): efficacy and safety of low-dose therapy in pulmonary fungal infections.

A prospective study of the treatment of fungal infections with low-dose AmBisome enrolled 36 of 52 patients with thoracic malignancies who developed pulmonary fungal infections in the National Cancer Centre, Milan, over a 3.5 year period. Thirty-three high-risk patients had received standard prophylaxis with iv fluconazole. In these patients, symptoms indicating deep mycosis were detected after 7-9 days of primary prophylactic therapy. Another three patients, not treated with fluconazole, showed similar symptoms. Bronchoalveolar lavage, blood culture and/or CT scan of chest diagnosed invasive aspergillosis in 29 patients and deep invasive Candida infection in seven. AmBisome was given at 1-2.2 mg/kg/day i.v. for 10 days to avoid or decrease toxicity normally induced by amphotericin B. The fungal infection was eradicated in all 36 patients. Negative cultures were obtained after 5 or 6 days of antifungal treatment. No adverse reactions attributed to AmBisome were detected. After a follow up of 5-48 months, 30 patients were still alive. Six patients had died, two due to adult respiratory distress syndrome and four due to progression of cancer. No mycotic relapses or reinfections were detected during follow up. In a subset of critically ill patients with thoracic malignancies, the administration of low-dose liposomal amphotericin B (AmBisome) resulted in complete eradication of pulmonary Aspergillus and Candida infections, and was remarkably well tolerated.

Sequential treatment of deep fungal infections with amphotericin B deoxycholate and amphotericin B colloidal dispersion.

Amphotericin B colloidal dispersion (ABCD) is a novel lipid formulation of amphotericin B designed to diminish toxic effects of the drug. In the following report, nine cases of suspected (n = 4) and proven (n = 5) deep Candida infection, treated sequentially with amphotericin B deoxycholate and ABCD, are presented. The treatment was successful in seven cases. During treatment with amphotericin B deoxycholate, a rise in serum creatinine was observed in seven patients, hypokalemia in five, and metabolic acidosis in four. After replacing amphotericin B deoxycholate with ABCD, laboratory parameters improved in four of the seven patients with increased creatinine, in four of the five patients with hypokalemia, and in two of the four patients with metabolic acidosis. Infusion-related rigors were observed in four patients receiving amphotericin B deoxycholate and in one patient treated with ABCD. Reversible elevation of liver enzymes was found in one patient receiving ABCD. In this study ABCD proved less toxic than amphotericin B deoxycholate. The efficacy of ABCD alone cannot be assessed because of previous treatment with amphotericin B deoxycholate, but sequential treatment of deep Candida infections with amphotericin B deoxycholate and ABCD seems to be an effective therapeutic modality, especially in patients requiring prolonged administration of amphotericin B.

Deep Candida infection in children with leukaemia: clinical presentations, diagnosis and outcome

To analyse the clinical features associated with deep Candida infection (DCI) and the outcome in children with leukaemia, and to evaluate various diagnostic methods. Serum samples were analysed to determine Candida IgA, IgM and IgG antibodies and defect free C. albicans glucoprotein antigen and C. enolase antigen in eight children who had nine episodes of DCI and six with suspected DCI. DCI occurred shortly after the leukaemia diagnosis (median 40 days) or after the leukaemia relapse (median 30 days). Children with DCI had fever (100%), skin lesions/exanthema (45%), oral thrush (45%), oesophagitis (22%) and laryngo-tracheitis (22%). Candida endocarditis, arthritis and hepatic candidosis were diagnosed in one patient each. Two children with disseminated candidosis died in leukaemia relapse. In patients with C. albicans infections serology had a sensitivity of 83%. However, in patients with C. parapsilosis infection antibody detection was negative. As the patients were cured of their Candida infection, the IgG antibodies disappeared and the IgM and IgA antibodies fell within the normal range for age. DCI in children occurs shortly after the leukaemia diagnosis or shortly after relapse of leukaemia. The clinical features are many. Candida serology may help to diagnose or confirm DCI. The dynamics of antibody titres may help to establish the efficacy of antifungal treatment.

Deep Candida infection in child liver transplant recipients: serological diagnosis and incidence

Nineteen children who received 22 orthotopic liver grafts on 20 occasions were studied with regard to Candida infection. Serum samples were analysed to determine Candida, IgA, IgM and IgG antibodies and detect free C. albicans glucoprotein antigen. Five children (25%) had a confirmed deep C. albicans infection (DCI) during the first 2 weeks after transplantation. In all children with DCI, serology was positive, a median of 6 days (range 2-9 days) before Candida infection was verified by fungal culture, direct microscopy and/or autopsy. The positive predictive values for Candida IgG, IgM and IgA antibodies in children with DCI were 100%, 78% and 100%, respectively, and for free C. albicans antigen, 45%. Pathological titres of IgM and IgA antibodies against Candida before liver transplantation were present in three of four children who later developed a DCI and in no child without infection. In conclusion, regular screening by Candida serology is recommended both before and after liver transplantation.

Management of deepCandida infection in surgical and intensive care unit patients

DeepCandida infections are increasing in incidence, especially in non-neutropenic, intensive care patients including neonates. The attributable mortality of candidaemia andcandida peritonitis is 37–38% with a 57% overall mortality. The BSAC set up a working party to develop recommendations for management in the absence of controlled trials. These recommendations focus on the role of the microbiology laboratory, management strategies, the respective roles of amphotericin B, flucytosine and fluconazole and long-term maintenance therapy. The indications for initiation of therapy are given special consideration.

Protective effect of human granulocyte colony stimulating factor (hG‐CSF) on Candida, infections in normal and immunosuppressed mice

Prophylactic treatment with human granulocyte colony stimulating factor (hG-CSF) affords significant protection against systemic infections caused by C. albicans in cyclophosphamide-treated but not in cortisone-treated mice. Localized candidosis in neutropenic mice does not respond to hG-CSF. Our data show that granulocytes play an important role in the immune defence against deep mycoses, but not against local infections. From our data it is reasonable to assume that prophylactic treatment with hG-CSF may augment the resistance of immunosuppressed patients to deep Candida infection, but it would be of little help against oral candidosis of HIV patients.

Serological studies of Actinomyces israelii by crossed immunoelectrophoresis: taxonomic and diagnostic applications.

Crossed immunoelectrophoresis (CIE) with intermediate gel was applied to the serological analysis of Actinomyces israelii to develop a test with high efficiency in the laboratory diagnosis of human actinomycosis and classification of A. israelii. Recently developed standard antigen-antibody systems for A. israelii by CIE were used as reference. The reference systems were based on standard preparations of cytoplasmic and whole cell-associated antigens of A. israelii and a standard immunoglobulin G pool purified from rabbit antisera to formalin-treated whole cells and cell lysates of A. israelii. The specificity of the standard antigens for A. israelii was evaluated in CIE studies by screening for antibodies to components of the antigens in rabbit antisera raised against related bacteria. The standard system for A. israelii based on cytoplasmic antigens formed species-specific precipitins whereas antisera raised against A. naeslundii and/or Propionibacterium acnes precipitated components of the other standard antigens. As a result of these analyses, the standard system for A. israelii based on 10 cytoplasmic antigens was used as reference for CIE studies to detect humoral antibodies to A. israelii in sera from nine patients with actinomycosis. All the sera from the patients formed at the time of diagnosis one or more precipitins in terms of the 10 reference precipitins. Up to five precipitins were found in single sera. Follow-up studies covering a period of one-half year after treatment showed a gradually decreased precipitin response in the course of time. In control sera from patients with newly diagnosed tuberculosis, nocardiosis, deep Candida infection, and aspergillosis, and in sera from healthy blood donors, no antibodies were detected with specificity for the reference antigens.

Crossed Immunoelectrophoretic Analysis of Precipitins to Candida albicans in Deep Candida Infection

By means of crossed immunoelectrophoresis with intermediate gel the precipitins to C. albicans in sera from 18 patients with deep Candida infection were compared with the findings in a control material consisting of sera from 169 'normal' controls (mainly healthy blood donors), 25 patients with oral candidiasis, 14 patients with vaginal candidiasis, and 6 persons without candidiasis giving false positive reactions by the double diffusion method. Up to 20 different precipitins were found in individual sera, and precipitins were demonstrated in all sera except in 6 'normal' controls. Of 692 precipitins 682 (98%) were identified and titrated in terms of the 78‐component reference system described earlier for C. albicans. No free Candida antigens were found, but would have been detected by the method. The best criterion for discrimination between sera from patients and controls was the precipitin score, which accounts for number of precipitins and for titres. A precipitin score of more than 6 1/2 had a diagnostic sensitivity of 88.9% and a specificity of 99.5%. Eleven precipitin specificities were found solely in the patients' sera, but the highest sensitivity for a single precipitin was 33%. Until more evidence has accumulated in favour of a monospecific immunoassay it is therefore rational to use a complex antigen extract for further evaluations of diagnostic Candida serology and a short cut to standardization would be the introduction of the method used in the present study.

Diagnosis of Deep Infection With Candida

The potential diagnostic value of the Candida precipitin test was evaluated in the population of 133 hospitalized patients suspected of having deep infection with Candida organisms. Precipitins were found in 26 patients and in 24 (92%) of them deep Candida infection was documented. Multiple surgery and leukemia were the most frequent underlying conditions among the 26 patients with deep infection with Candida . There were two (2%) false-negative reactions among the 107 patients in whom precipitins were not found. Candida precipitins were not found in 87 control subjects or individuals with other fungal diseases. Fifteen (57%) of the 26 patients with deep Candida infection received antifungal therapy and survived. Nine (81%) of the eleven patients who died had not received adequate therapy. The precipitin test may be useful in the early diagnosis of deep infection with Candida .