Experimental murine model of intra-abdominal infections caused by some non-albicans Candida species

Background: Even though intra-abdominal candidiasis (IAC) has been increasingly recognized, with associated high morbidity and mortality rates, its pathogenesis remains poorly understood. This model aims to study the pathogenicity and invivo susceptibility of non-albicans Candida species associated with IAC in human in order to predict the frequency of infections, outcome of clinical disease and response to antifungal therapy. Methodology: Both immunosuppressed and immunocompetent female CD-1 mice were challenged intraperitoneally with 5 x 108 CFU/ml inoculum of five non-albicans Candida strains; Candida glabrata, Candida parapsilosis, Candida lipolytica, Candida tropicalis and Candida guilliermondii. Mice were closely observed for symptoms. Treated groups received voriconazole (40 mg/kg/day) or micafungin (10 mg/kg/day) 24 hours after infection depending on invitro susceptibility results. Survival rate, mean survival time and fungal tissue burdens were recorded for all groups. Results: All infected groups developed hepatosplenomegaly, peritonitis and multiple abscesses on intra-abdominal organs and mesenteries. C. glabrata and C. lipolytica represented the most and the least virulent strains respectively in terms of survival rate, mean survival time and fungal burden in both immunosuppressed and immunocompetent models. Following treatment, all immunocompetent animals survived the entire duration of experiments (0% mortality rate), while mortality rate was relatively high (20-60%) in immunosuppressed mice. Treatment failed to eradicate the infection in immunosuppressed mice despite significant decrease of the fungal burden and increase mean survival time. Conclusion: This study reports an increasing pathogenicity of non-albicans Candida species, with persistent infection among immunosuppressed animals

Research of the yeasts Candida non-albicans on various medical devices in the service of resuscitation of the Teaching hospital of Tlemcen, Algeria

Background and aim: The fungic infections, more particularly the Candidiasis are frequent in the intensive care units. This had a relation with the heaviness of the pathologies, presented by the patients and the quasi-systematic recourse to various medical devices. In addition, we observe more and more and more the emergence of numerous species of Candida non- albicans in these hospital structures. That's why we undertook this study which concerns the evaluation of the incidence of the sepathogenic on medical devices implanted during 48hours and more on patients hospitalized in the resuscitation service of CHU of Tlemcen. Methods:After isolation of yeast son selective mediums, the strains obtained were identified by using chromogenic mediums (CHROMagar®Candida) and the Api identification Candida galleries (BioMérieux®).Results:The results showed that among100 samples are taken, 15% been altered by yeasts of Candida non-albicans.Conclusion: It appears from this study that the fungal infections on medical devices are widely present in hospitals especially in the intensive care unit. The presence of Candida non- albicans yeasts is not negligible; they are 15% on the level of the various medical devices implanted

Sensibilite aux antifongiques des Candida spp isoles dans les candidoses digestives chez les sujets seropositifs au VIH a Yaounde-Cameroun

Les mycoses digestives sont habituellement retrouvees chez les sujets immunodeprimes en particulier les patients atteints de SIDA; Le but de cette etude etait de contribuer a une meilleure prise en charge des candidoses digestives chez les sujets positifs au VIH. L'objectif principal etait d'etudier le profil de sensibilite aux antifongiques des Candida spp isoles chez ces patients.MeTHODES Il s'agit d'une etude transversale et descriptive realisee de septembre 2011 a janvier 2012. Apres avoir obtenu le consentement des patients; un ecouvillonnage du muguet buccal et les selles ont ete ensemences sur milieu selectif Candichrom II. Le test de filamentation a permis de discriminer C. albicans de C. dublinensis. L'antifongigramme a ete realise par methode de diffusion sur gelose casitone. Les antifongiques testes etaient : amphotericine B; fluconazole; ketoconazole; miconazole; nystatine; itraconazole. Le logiciel EPI info 7 a ete utilise pour l'analyse des donnees et Excel pour les graphiques. ReSULTATS Nous avons identifie 4 especes : Candida albicans; Candida glabrata; Candida dublinensis et Candida tropicalis avec une predominance de Candida albicans (45;65) et Candida glabrata (44;92). La quasi-totalite des souches 99 etaient sensibles au miconazole; 87 au ketoconazole; 62 a l'itraconazole; 38 au fluconazole; 5a l'amphotericine B. L'espece ayant presente le plus de resistance aux antifongiques etait Candida glabrata. CONCLUSION :Les derives azoles sont plus actifs que les polyenes. L'activite du fluconazole est limitee. Nous recommandons aux prescripteurs de preconiser l'utilisation du ketoconazole qui est plus actif et peut etre une alternative au fluconazole

Distribution of Candida Species among HIV-Positive Patients with Oropharyngeal Candidiasis in Accra; Ghana

Introduction: Oropharyngeal candidiasis is a common occurrence in the course of human immunodeficiency virus (HIV) disease progression. Changes in the clinical severity of oropharyngeal candidiasis and type of Candida species profile may be a reflection of immunological changes in patients. The aim of this study was to undertake a baseline Candida species identification for future reference. Methodology: Oral swabs of 267 HIV-infected patients with oropharyngeal candidiasis were cultured and Candida species were identified by API 32 C. Results: A total of 201 (75.3) Candida species and 10 (3.7) non candida fungi were identified. Twenty different Candida species were isolated. Candida albicans was the most prevalent species (68.5) followed by C. tropicalis (7.4); C. krusei (6.4); C. parapsilosis (3.0) and C. sake (2.5). Other species ranged from 0.5 to 1.5.Positive culture was independent of whether patients were on anti-retroviral therapy or not. Conclusion: of all Candida isolates; 68.5 were identified as C. albicans. Since other uncommon species were also isolated; it may be necessary in this group of patients to identify Candida species causing severe infections

Antibiotic Prescribing Patterns in a Neonatal Intensive Care Unit

An outbreak of invasive candidiasis in the neonatal intensive care unit (NICU) of the Dr George Mukhari Academic Hospital in Ga-Rankuwa necessitated evaluation of the antibiotic prescribing practices in the unit. A selective randomised sample of 100 patients was followed up over a nine-month period to evaluate prescribing patterns. The existing antibiotic policy was used to compare the prescription practices and use of antibiotics. The frequency of use; number of antibiotics per patient and duration of use were documented. Of the 100 patients followed; 95 were prescribed intravenous antibiotics. All prescribed antibiotics for 77 patients are listed in the antibiotic policy. Nineteen different antibiotics were prescribed; and 11 of the 19 prescribed antibiotics appear in the antibiotic policy. Most patients received more than two antibiotics during their stay; as the average number of antibiotics used per patient during the study period was 3.4. The average duration of use for all antibiotics; except cefepime and ceftriaxone; was for longer than seven days. Although antibiotics were used according to the ward protocol in the majority of patients; deviations from the protocol were associated with patients' clinical condition and/or results from blood cultures. The duration of antibiotic use needs to be monitored to prevent unnecessary prolonged use; as in this investigation. An antibiotic policy may be useful to guide and measure rational antibiotic therapy in a NICU

Oral Lesions in HIV-Infected Patients; Before and After Antiretroviral Treatment

Oral lesions cause considerable morbidity in HIV-infected patients. Antiretroviral therapy (ART) reconstitutes the immune system and reduces the incidence of opportunistic infections and malignan-cies. The aim of the present study was to determine the prevalence and range of oral lesions in patients before and after starting ART in Harare; Zimbabwe. A longitudinal; prospective study of oral lesions presenting in HIV-infected patients at baseline and three and six months after the initiation of ART was conducted. The study was undertaken at three hospitals in Harare. Two hundred and ten patients were enrolled; 96 (46) and 49 (23) patients presented for follow-up at three and six months; respectively. Two-thirds of the patients who completed follow-up were female; median age was 36 years. At six months of ART; the overall prevalence of oral lesions declined significantly (p 0.05). Oral candidiasis was the most common finding and showed the most significant reduction on ART. In contrast; the incidence of facial warts increased from baseline to three and six months. ART was effective in reducing the overall prevalence of oral lesions in HIV-infected patients; although incidence was variable depending on the type of lesion. Unmasking immune reconstitution inflammatory syndrome to human papillomavirus (HPV) is the likely cause for the increase in facial warts

Candiduria in HIV Infected Patients in Yaounde; Cameroon

Objective: To detect Candida species in the urine of patients living with human immuno-deficiency virus (HIV); and correlate the presence of candiduria and CD4 counts. Patients and Methods: The study population consisted of 105 hospitalized patients from the Military and Central Hospitals of Yaounde; who either were HIV positive or already suffering from AIDS. The patients consisted of 63 females (60) and 42 males (40) giving a male to female ratio of 1:1.5. Midstream urine samples were collected from all patients and mycological examination of the centrifuged sediments was done. Patients with CD4 counts 499 lymphocytes/mm3 were a proxy control group. Results: 38 of 105 (36.2) subjects had candiduria. 71of the cases were asympto-matic. The percentage of patients positive versus negative for candiduria increased progressively from stage-A (5) to B (32) to C (63) HIV infection. There was thus a correlation between candiduria and the CDC disease stage. Its presence heralded an advanced immuno-suppressed state of the AIDS patient. Conclusion: In resource-poor communities; where viral copy and CD4 count determination are expensive; candiduria may serve as one of the indicators for anti-retroviral therapy. We recommend routine detection of candiduria in this high-risk group of HIV/AIDS patients

In-Vitro Susceptibility Pattern of Candida isolated from Women with Vaginal Candidiasis to four Anti-fungal Agents in Dar es Salaam; Tanzania

Objective: To determine anti-fungal susceptibility pattern of Candida species (n = 272) isolated from women with vaginal candidiasis (VC) in Dar es Salaam; Tanzania against varying concentrations (0.05 to 12.8 g/ml) of miconazole; clotrimazole; ketoconazole and nystatin using agar dilution and broth macro-dilution methods. Test isolates and reference strains: Clinical isolates and reference strains; Candida albicans (ATCC 32354); Candida krusei (ATCC6258); Candida parapsilosis (ATCC22019) and Candida glabrata (ATCC2001).Methods: Determination of minimum inhibitory concentration ranges; and MIC50 and MIC90 (required to inhibit 50and 90of the isolates); respectively. MIC for nystatin was least concentration that prevented visible growth while for the azoles MIC was the concentration that caused 80growth inhibition compared with drug free control. Results: The MIC for Candida albicans; Candida famata; Candida krusei; Candida lusitaniae; Candida parapsilosis and Candida norvegensis were between 0.05 to 0.2 g/ml against all four anti-fungal drugs tested. Some Candida tropicalis and Candida glabrata isolates had moderately high (MIC =6.4) and high MICs (12.8 g/ml); especially with the azole anti-fungal drugs. The overall agreement between the results of the two methods were 88; and for individual antifungals the agreement was 90.8; 91.3; 80and 88for clotrimazole; ketoconazole; miconazole and nystatin; respectively. C. glabrata and C. parapsilosis gave low agreement (68- 75) for the azole antifungals. Conclusions: i) most of the clinical isolates had low MIC values to all the four anti-fungal drugs tested; indicating susceptibility; ii) some strains of C. tropicalis and C. glabrata had high MIC values; and; iii) there was a good overall agreement ( 88) between agar dilution and broth macro-dilution methods. There is a need for a follow-up in-vivo study to determine clinical response following treatment with the investigated anti-fungals

Sensibilite aux antifongiques des souches de Candida responsables de Candidose oropharyngee chez des sujets vivant avec le VIH

Cette etude menee en 1997 en milieu hospitalier senegalais se propose d'identifier les differentes especes de Candida isoles chez 60 sujets vivant avec le VIH et porteurs de Candidose oropharyngee. Par la meme occasion; elle tente de determiner leur sensibilite aux antifongiques ainsi que l'impact d'un traitement antifongique anterieurLes resultats de l'etude font ressortir que d'une part le serotype VIH1 favorise l'emergence des levures saprophytes de la muqueuse buccale par rapport au serotype VIH2; d'autre part; et que l'utilisation intempestive des antifongiques diminue la sensibilite de C. albicans aux polyenes. Une meilleure maitrise de ce phenomene contribuerait a ameliorer l'etat clinique des personnes vivant avec le VI

Etiologies fongique et parasitaire des vulvo-vaginites a Abidjan. [lettre]

Une etude retrospective d'une annee d'activite allant de janvier 1989 a decembre 1989 du laboratoire de parasitologie-mycologie de la Faculute de Medecine d'Abidjan; portant sur 124 prelevements vaginaux; a permis aux auteurs de trouver un taux de positivite globale de 56;45 pour cent. Par ordre de frequence; ils ont trouve Candida albicans a un taux de 38;70 pour cent; Candida tropicalis 5;64 pour cent; puis Candida guillermondii 0;80 pour cent. Au cours de cette meme etude; Trichomonas vaginalis a ete mis en evidence 17 fois par l'examen direct; soit une prevalence de 13;70 pour cent

Candida and syphilis infection in an HIV-1 infected population

Candida carriage and syphilis antibodies were investigated in rural; urban and high risk populations in the Mara Region. Over 10 percent of subjects were oral Candida albicans carriers; 6 percent of subjects were confirmed as positive for syphilis antibodies. In the largely rural subjects where correlation is possible so far; there is no association between candida carriage or syphilis antibodies and HIV-1 infection

Candida and syphilis infection in an HIV-1 infected population

Candida carriage and syphilis antibodies were investigated in rural; urban and high risk populations in the Mara Region. Over 10 percent of subjects were oral Candida albicans carriers; 6 percent of subjects were confirmed as positive for syphilis antibodies. In the largely rural subjects where correlation is possible so far; there is no association between candida carriage or syphilis antibodies and HIV-1 infection