Evaluation of candida infection after six months of transplantation in pediatric liver recipients in Iran

Liver transplantation [LT] is the standard treatment of end-stage liver diseases [ESLD]. Invasive fungal infection is one of the important causes of morbidity and mortality after transplantation. To determine the incidence of late-onset [after 6 months of LT] Candida infection in recipients. A retrospective study was conducted to evaluate 50 pediatric patients after LT for 8 years at the LT Unit of Nemazee Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. We followed the patients until 6 months post-LT for episodes of Candida infection proven by culture. One recipient [2%] developed late-onset esophageal candidiasis with improvement after intravenous amphotricin therapy but finally expired with a diagnosis of post-transplant lymphoproliferative disorder [PTLD]. The incidence of late-onset Candida infection is not significant in pediatric liver recipient, but it still remains a significant problem. Control of Candida colonization would reduce the risk of invasive fungal infections and possibly more fatal complications

Susceptibility of clinical Candida species isolates to antifungal agents by E-test, Southern Iran: a five year study

The incidence of fungal infections in immunocompromised patients, especially by Candida species, has increased in recent years. This study was designed to identify Candida species and determine antifungal susceptibility patterns of 595 yeast strains isolated from various clinical specimens. Identification of the isolates were determined by the API 20 C AUX kit and antifungal susceptibilities of the species to fluconazole, amphotericin B, ketoconazole, itraconazole, voriconazole, and caspofungin were determined by the agar-based E-test method. Candida albicans [48%] was the most frequently isolated species, followed by Candida kruzei [16.1%], Candida glabrata [13.5%], Candida kefyr [7.4%], Candida parapsilosis [4.8%], Candida tropicalis [1.7%] and other species [8.5%]. Resistance varies depending on the species and the respective antifungal agents. Comparing the MIC90 for all the strains, the lower MIC90 was observed for caspofungin [0.5 microg/ml]. The MIC90 for all Candida species were 64 microg/ml for fluconazole, 0.75 microg/ml for amphotericin B, 4 microg/ml for ketoconazole, 4 microg/ml for itraconazole, and 2 microg/ml for voriconazole. Species definition and determination of antifungal susceptibility patterns are advised for the proper management and treatment of patients at risk for systemic candidiasis. Resistance to antifungal agents is an alarming sign for the emerging common nosocomial fungal infections

Susceptibility of Candida species isolated from immunocompromised patients to antifungal agents

This study was carried out from October 2003 to March 2007 to investigate susceptibility patterns to antifungals of Candida strains isolated from 410 immunocompromised patients in Shiraz, Islamic Republic of Iran. Patients were checked for systemic candidiasis. Fungal colonization was determined and clinical samples collected from those patients with clinical signs of infections were examined. The carbohydrate assimilation patterns of all 354 isolates were studied. Susceptibility of the isolates to antifungal agents was determined using the reference broth microdilution method. Candida Candida albicans was the species most often isolated. Voriconazole was highly active against all the isolates. Major resistance to itraconazole was observed in all Candida spp. Regular investigations into antifungal resistance in medical centres is highly recommended as this will result in more efficient management of invasive candidiasis in immunocompromised patients

Molecular identification and in-vitro susceptibility andida albicans and C. dubliniensis isolated from immunocompromised patients

Yeasts are increasingly implicated in serious systemic infections. The aim of this study was to identify Candida albicans and C. dubliniensis from isolates of immunocompromised patients and evaluate the in vitro antifungal activities of them against antifungal agents. One hundred and seventy eight C. albicans were isolated by routine methods from 403 immunocompromised patients. All isolated C. albicans were inoculated on CHRO Magar Candida medium. The carbohydrate assimilation patterns of all the isolates were studied, using the API 320 system. To identify C. albicans and C. dubliniensis, PCR was done by specific primers. The susceptibility test for the isolates was performed by a broth microdilution assay, according to the Clinical and Laboratory Standard Institute. Of 178 isolates C. albicans, six were C. dubliniensis with PCR assay, and 7% were resistant to amphotericin B, 4.6% to fluconazole, 7% to itraconazole, 1% to nystatin, 2.3% to voriconazole, and 7% to ketoconazole. Non of the C. dubliniensis isolates were resistant to the six anti-fungal agents. It would be convenient to carry out antifungal susceptibility studies in order to establish the in-vitro activities of antifungal agents against local isolates and also to detect shifts toward resistance as early as possible