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The precise etiology of oral lichen planus(OLP)is still unclear,but the existing evidence suggests that drug intake,virus infection,fungal infection,psychological disorders,and immunodeficiency are closely associated with the pathogenesis of OLP.We report a case of OLP accompanied with candidiasis induced by long-term use of antimicrobials for recurrent aphthous ulcer(RAU)and update the literature,to discuss the possible association between OLP and misuse of antimicrobials,and to inform general dentists and pharmacists the importance for practice with optimal antimicrobial stewardship.In this case,a 42-year-old man presented to Xiangya Stomatological Hospital with white reticular patterns spreading in the oral cavity for almost 1 year.He was diagnosed with OLP via histopathological examination.He had a 5-year history of RAU which occurred every 1-2 months,and he was given antimicrobials ingested or injected whenever the ulcers came up.Satisfactory treatment results were obtained by stopping the abuse of antimicrobials and local antifungal therapy.Meanwhile,the exacerbation and alleviation of OLP was closely related to the administration of antimicrobials.Combined with literature review,antimicrobial might contribute to the development of OLP by inducing candidiasis,a common side-effect of misuse of antimicrobials.Considering the seriousness of antimicrobial resistance and opportunistic infection,dentists should prescribe antimicrobials judiciously according to guidelines and evidence-based indications.Appropriate prescribing of antimicrobials is a professional responsibility to all dentists.
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Objective: In this study our main goal is to evaluate thefrequency of candida infection in post chemotherapy febrileneutropenia patient with acute leukemia.Method: This prospective type of observation study carried outat Department of Haematology of Bangabandhu Sheikh MujibMedical University (BSMMU) from September 2016 to August2017. A total 63 patients of acute leukaemia (AML and ALL)were admitted in the Department of Haematology in BSMMU.Patients were selected by purposive sampling. A typedquestionnaire was supplied to all patients and those who gavethe written consent were selected as cases.Results: In the study, it was found that 19 (30.2%) patientsbelonged to age ≤20 years followed by 19 (30.2%) of 21-30years, 13 (20.6%) 31-40 years, 6 (9.5%) 41-50 years and 6(9.5%) >50 years of age. Immunophenotypically AML wasfound in 35 patients which was 55.6% of study population, BALL in 9 (14.3%), T ALL in 5 (7.9%) and APL in 2 (3.2%)patients. Majority of the patients 28 (44.4%) were found inconsolidation phase of chemotherapy followed by 26 (41.3%)in induction phase, 5 (7.9%) in relapse, 3 (4.8%) in re-inductionand 1 (1.6%) in palliative phase. 6 (9.5%) patients were foundpositive for throat swab for Candida in this study and bloodculture were negative for candida. Among the AML patients 4(66.7%) patients were found positive for candida in throat swaband 36 (64.3%) were found negative.Conclusion: In the study, it was found that among candida inthroat swab were more common in AML than ALL. Cause wasunknown but might be due to Reduce duration of neutropeniaby applying G-CSF and empirical local and systemic antifungaltherapy.
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Objective Studies are rarely reported on the correlation of the Toll-like receptor (TLR) gene polymorphisms with fungal infection in the Chinese Han population. This study aims to explore the association between TLR gene polymorphisms and pulmonary candida infection (PCI) and candida colonization (CC) in patients with chronic obstructive pulmonary disease (COPD) in the Guizhou Han population. Methods Using the polymerase chain reaction-direct sequencing (PCR-SBT) method, we genotyped six single nucleotide polymorphisms (SNP) of the TLR1, TLR2 and TLR4 genes in 344 Guizhou Han patients with COPD, including 80 cases complicated by PCI (the PCI group), 103 cases complicated by CC (the CC group), and 161 negative controls. We analyzed the correlation of the SNPs with PCI and CC in the COPD patients in different genetic models with the SNPstats online software, measured the levels of IL-6, IL-8, IL-1β and TNF-α proteins in the plasma of the patients by ELISA, and assessed the functional consequences of these polymorphisms. Results The polymorphisms of rs5743611, rs5743708, rs4986790 and rs4986791 were found in none of the patients. The genotype frequency of rs4833095 was significantly different between the PCI and control groups in the codominant, dominant and overdominant models (P < 0.05), with the dominant model as the best genetic pattern. No statistically significant difference was observed either in the rs4833095 genotype frequency between the CC and control groups (P > 0.05) or in the rs5743618 genotype frequency between any two groups (P > 0.05). In the PCI group, the T allele of the rs4833095 polymorphism significantly decreased the levels of IL-6, IL-8 and IL-1β in the plasma (P < 0.05), and that of TNF-α as well, though with no statistically significant difference (P > 0.05). Conclusion The rs4833095 polymorphism of the TLR1 gene is associated with PCI in COPD patients. The T allele of rs4833095 may affect the function of TLR1, decrease the levels of IL-6, IL-8 and IL-1β proteins in the plasma. Neither rs4833095 nor rs5743618 gene polymorphism is correlated with the susceptibility to candida colonization.
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Objective To discuss the therapeutic significance of granulocyte colony stimulating factor (G-CSF) in the treatment of invasive Candida infections in congenital immunodeficiency,especially in cases with low level of interleukin 17(IL-17). Methods Therapeutic processes of 2 children suffering from invasive Candida infections secondary to congenital immunodeficiency were retrospectively studied,further-more,the related literatures were also reviewed. Results Whole-exome sequencing revealed CARD9 muta-tion in the first patient, who suffered from Candida albicans meningoencephalitis, while the other patient revealed STAT1 mutation suffering from recurrent lung abscess caused by Candida albicans,and both of them showed low level of blood IL-17. Routine antifungal drugs were insufficiency,even treatment period had pro-longed for several months. But after the G-CSF adjuvant therapy,their symptoms,signs and images recov-ered. With 5 to 10 months follow-up,no recurrent infections were found. Conclusion Antifungal drugs com-bined with G-CSF can effectively improve the treatment effect in invasive fungal infections secondary to immunodeficiency. Further more,genetic screening especially whole-exome sequencing can be suggested to find unusual immunodeficiency,which helps more individualized treatment.
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Objective Rapid elevation of the IgG antibody against Candida Enolase ( Eno ) has been observed in patients with invasive candidosis in an early stage .The present study was to confirm the association of Candida colonization with humoral im-mune anamnestic response of the dominant antigen . Methods Twenty-four mice were randomized into group 1 treated by oral Candi-da colonization plus intraperitoneal infection ( immunocompetent , n=8) , 2 treated with immunosuppressant in addition to the treatment of group 1 ( immunocompromised , n=8) , 3 treated by oral Candida colonization only ( immunocompetent , n=4) and 4 treated by in-traperitoneal injection only( immunocompetent, n=4).The number of Eno-specific memory B-cells in the spleen and the levels of IgG , IgM and IgA antibodies were determined in the peripheral blood of the immunocompetent and immunocompromised invasive candidiasis mice . Results At 7 days after invasive infection , there were significantly more Eno-specific memory B-cells in the mice of groups1 ( 47.25 ± 13.81) and 2 (43.14±15.95) than in groups 3 (8.00±3.74) and 4(8.50±2.38) (P0.05).Eno-IgG antibodies were detected in the serum of the mice of the first two groups in the early stage of invasive infection and positively corre -lated with antigen-specific memory B-cells (r=0.737,P <00.1 ). Conclusion Rapid elevation of the Eno-IgG antibody level in the early stage of invasive infection after Candida colonization may be attributed to the rapid proliferation of humoral immune memory cells.
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Objective To evaluate the clinical application of disk diffusion method(ROSCO company of Denmark) for testing the susceptibility of candida species isolated from patients with cancer with the using broth microdilution method ((NCCLS) M27-A of America Committee for clinical laboratory standards) as the gold standard in order to find the better method for clinical laboratory.Methods Antifungal susceptibility (5-flucytosine,amphotericin B,fluconazole and itraconazole) of 78 strains of Candida species were tested both by ROSCO disk diffusion method and ATB FUNGUR2 broth microdilution method.The microdilution method NCCLS as the gold standard.The sensitivity,specificity,positive and negative predictive values of two methods was calculated.Results The Kappa value was reached to 0.89 in term of disk diffusion method for detecting susceptibility of candida to 5-flucytosine,amphotericin B,fluconazole and itraconazole,suggesting that no serious errors was seen in terms of sensitive and resistant another method.Of 78 strains of candida,they had the high susceptibility to 5-flucytosine,amphotericin B,which were 88.20％ and 89.17 ％.The lower susceptibility of 78 strains of candida was fluconazole and itraconazole (56.34％ and 52.12％).Candida glabrata and candida krusei were proved to suspect to four kinds of antifungal agents(90.95％,85.71％).And the lowest positivity was 67.50％ and 41.67％ regarding of candida glabrata and candida krusei.Conclusion The higher consistency was seen in terms of detecting candida susceptibility to antibiotics by disk diffusion method and microdilution method,suggesting disk diffusion method can replace microdilution method.In bur hospital,candida species are susceptibility to amphotericin B at the highest sensitivity and courtyard albicans at lower sensitivity.Antifungal agents works to candida albicans and lower inhibition rate to candida kruse.
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Objective To study the distribution of Candida infection and drug tolerance in intensive care unit(ICU). Methods A retrospective study was conducted. The critical patients admitted from January 2011 to December 2013 in ICU of the First Hospital of Jiaxing in Zhejiang Province were enrolled,and their clinical data with positive Candida culture and drug susceptibility results in specimens of sputum,urine,blood,ascites,bile, etc were collected. In the study of these 3 years in ICU,the situation of Candida infection,the distribution of positive specimen,the condition of distribution of different strains of Candida,and the Candida tolerance to antifungal drugs were analyzed. Results From 2011 to 2013,2 412 times of patients(including one patient had admitted into ICU for more than one time)were admitted into ICU in which 407 cases were of Candida infection(16.9%),and the rate of Candida infection was rising gradually in the 3 years〔2011 to 2013 Candida positive rates were 13.4%(77/573), 16.1%(146/907),19.7%(184/932)〕,the difference being statistically significant(P<0.01). In the 407 strains of Candida,166 strains(40.8%)were isolated from sputum,157(38.6%)from urine,53 strains(13.0%)ascites, 13 strains(3.1%)blood,11 strains(2.7%)bile,7 strains(1.7%)from other specimens. The strain distribution of Candida was mainly as follows:Candida albicans(174 strains),Candida glabrata(131 strains),Candida tropicalis (83 strains),Candida parapailosis(5 strains),Candida krusei(12 strains),and 2 strains of rare Candida portugal and Lipolztica. From 2011 to 2013,the highest tolerance of Candida albicans,Candida glabrata,Candida tropicalis to fluconazole,itraconazole,Fushita Yasu and other antifungal drugs was in 2013,and the lowest was in 2012,the rates of tolerance of the above 3 strains of Candida to amphotericin B being 0,to itraconazole being the highest(10.9%, 27.8%,9.6%,respectively),to Fushita Yasu the secondary(6.6%,11.0%,0,respectively)and to fluconazole the last(4.7%,7.4%,1.9%,respectively),and the rates of tolerance of Candida parapsilosis,Candida krusei,Candida Portugal,Candida lipolztica to amphotericin B,fluconazole,itraconazole,Fushita Yasu were all 0. Conclusion In ICU,the Candida infection is mainly in the respiratory tract and urinary tract,its rate of infection has a tendency of rising,and the rate of Candida tolerance to itraconazole is the highest.
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PURPOSE: We wanted to review the clinical results of staged reimplantation in patients who had candidal infection after total knee arthroplasty. MATERIALS AND METHODS: We reviewed five patients who had a candidal prosthetic knee infection, as was assessed by synovial fluid culture. Amphotericin B was intravenously administrated to all five patients during the postoperative period for six weeks and followed for at least twelve months. We carried out two-stage re-implantations with using antifungal agent-impregnated bone cement. Whether or not infection recurred was evaluated according to the symptoms and radiologic and hematologic studies. The clinical results were analyzed on the basis of the range of motion and hospital for special surgery (HSS) score. RESULTS: The final review showed that all of the symptoms disappeared. We could not find any loosening on the radiologic studies and all five patients had normal C-reactive protein values on serological exams. The mean postoperative range of motion was 1degrees (range: 0~5)~99degrees (range: 70~130) and the mean HSS score improved from 49.4 (range: 44~64) points to 73 (range: 65~90) after the re-implantation. CONCLUSION: We successfully controlled five candidal prosthetic knee infections by removing the components in conjunction with using an antifungal- impregnated bone cement and staged re-implantation after a 6 week course of intravenous antifungal drugs.
Subject(s)
Humans , Amphotericin B , Arthroplasty , C-Reactive Protein , Candida , Knee , Postoperative Period , Range of Motion, Articular , Replantation , Synovial FluidABSTRACT
A deep infection following a prosthetic joint replacement is a serious complication with an incidence ranging from 1 to 2% of patients undergoing total prosthetic surgery. The common invading organisms are staphylococci, streptococci and gram negative bacillus. A candida infection after a prosthetic joint replacement is very rare, and a diagnosis is difficult because of the indolent nature of the clinical symptoms and signs as well as its rarity. We report a case of candida infection after a TKA, which was treated successfully by a staged reimplantation.
Subject(s)
Humans , Bacillus , Candida albicans , Candida , Diagnosis , Incidence , Joints , ReplantationABSTRACT
Candida infections after total knee replacement are extremely rare and show no specific symptoms and signs, thus make it difficult to diagnose. It is desirable to perform fungi culture from the beginning in case of persistent swelling and burning sensation in patients after total knee replacement with risk factors such as intraarticular steroid injection, intravenous drug abuse, immunosuppressive therapy, malignant hematologic tumor, etc. Positive culture of candida should never be considered as contaminated study, and be treated immediately. We report a case of candida infection after total knee arthroplasty, which was treated with staged reimplantation.