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Background: The recent emergence of fungal resistance strains has caused concern in medical settings. Medicinal plants continue to be viable sources of bioactive chemicals with therapeutic potential. These compounds can be extracted in different techniques using various solvents that give rise to a wide variety of extracted bioactive compounds that act as anti-fungal. The research aimed to evaluate the effect of fenugreek seed extracts on resistant isolates of Candida spp. isolated from sever COVID-19 patients.Methodology: The study was conducted from August 2021 to November 2022 at Al-Imam Al -Hussein Medical City and Al-Hayat Respiratory Diseases Units. Under a specialist's physician's supervision, severe COVID-19 cases were collected. The collected 455 sputum samples were examined directly and cultured on Sabouraud ' s Dextrose agar (SDA) media;growth colonies were distinguished and used Grams stain with the API system before the antifungal susceptibility test was performed in accordance with clinical and laboratory standards institute (CLSI 2020) by disc diffusion method to differentiate the resistance microorganism. The extraction process was conducted using the soxhlet technique (100 grams of seed powder and 800 milliliters of solvents (chloroform, methanol, and water) for eight hours. Electrical rotatory evaporators were used to evaporate the extract to get the concentrated crude extracts. FTIR and GC -MS instruments used to detection of bioactive compounds in crude fenugreek seed extracts(aqueous, methanol, and chloroform). Then, different concentrations of each extract (25, 50, 100, and 150 mg/ml) and their effect against the tested resistance study isolated were examined by well diffusion method and Minimum inhibitory concentration was measured.Results: A 455 were enrolled in this study. Patients' ages ranged from 20 to 91 years (mean 52.23, SD 15.009). This study indicated that more than half of the samples were males [(262) 57.6%] and [(193) 42.4%] were females. The FTIR and GC-MS showed the methanolic extract potent the most bioactive compounds, followed by the chloroform and water extracts. Evaluation of antimicrobial effects at 50 mg/ml, the methanolic extract showed the greatest effect, with a mean inhibition zone of 9.33 mm and a significant value of 0.01;at 100 mg/ml, the chloroform extract showed the next greatest effect, with a mean inhibition zone of 10.33 mm and a significant value of 0.005. At 150 mg/ml, the aqueous extracts showed the least effect, with a mean inhibition zone of 8.33 mm and a non-significant value of 0.024.Conclusions: Candida spp. were most frequent isolated yeast from sputum of patients with severe COVID-19. Methanol extract was the most effective anti-candida, followed by chloroform extract, and the aqueous extract was the least effective. The most effective anti-candida drug is ketoconazole.
ABSTRACT
Candidiasis is an opportunistic fungal infection resulting from an imbalance between the host immune system and crucial virulence factors of Candida species. The Candida spp., are one of the major constituents of the human mycobiome as well as the main cause of invasive fungal infections, particularly in immunocompromised patients. They affect the cases who consume a wide-spectrum antibiotic/steroid and those who have prolonged ICU stays and central venous catheters, transplant patients, chemotherapy/ radiotherapy, patients under invasive or noninvasive ventilation, and diabetic individuals with high-rate mortality. In recent decades, Candida species are considered the fourth cause of bloodstream infections;however, the epidemiology of candidemia has been linked to different geographical areas. On the other hand, the emergence of multidrug-resistant Candida spp. named Candia auris, as a global challenge in different countries over recent years in the world, leads to lethal as well as invasive infections with a high rate of spread among patients. At the beginning of the novel coronavirus disease 2019 (COVID-19) pandemic with causative agent of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), invasive yeast infections (IYFs), especially Candidiasis, are dramatically increasing in those individuals as the major groups under immunosuppressed condition. Although echinocandins and azoles are the most common antifungals used for the treatment of IYFs, the increased therapeutic failures exerted by multidrug-resistant Candida spp. such as C. auris and C. glabrata, calling for the discovery of novel antifungal agents with therapeutic approaches seems necessary. Here, we attempt to focus on the acquisition of knowledge associated with pathogenicity of Candida spp., particularly the indispensable role of virulence factors (germination, adherence, biofilm formation, phospholipase and proteinase production), genes that contribute to drug resistance and the related mechanisms, new therapeutic strategies for the treatment of Candidiasis includes combination therapies, application of biomaterials for drug delivery, antibodies, and vaccination, photodynamic therapy, probiotics, and new antifungal products to overcome Candida infections. © 2023 Nova Science Publishers, Inc.
ABSTRACT
Background: The recent emergence of fungal resistance strains has caused concern in medical settings. Medicinal plants continue to be viable sources of bioactive chemicals with therapeutic potential. These compounds can be extracted in different techniques using various solvents that give rise to a wide variety of extracted bioactive compounds that act as anti-fungal. The research aimed to evaluate the effect of fenugreek seed extracts on resistant isolates of Candida spp. isolated from sever COVID-19 patients. Methodology: The study was conducted from August 2021 to November 2022 at Al-Imam Al-Hussein Medical City and Al-Hayat Respiratory Diseases Units. Under a specialist's physician's supervision, severe COVID-19 cases were collected. The collected 455 sputum samples were examined directly and cultured on Sabouraud's Dextrose agar (SDA) media;growth colonies were distinguished and used Grams stain with the API system before the antifungal susceptibility test was performed in accordance with clinical and laboratory standards institute (CLSI 2020) by disc diffusion method to differentiate the resistance microorganism. The extraction process was conducted using the soxhlet technique (100 grams of seed powder and 800 milliliters of solvents (chloroform, methanol, and water) for eight hours. Electrical rotatory evaporators were used to evaporate the extract to get the concentrated crude extracts. FTIR and GC-MS instruments used to detection of bioactive compounds in crude fenugreek seed extracts(aqueous, methanol, and chloroform). Then, different concentrations of each extract (25, 50, 100, and 150 mg/ml) and their effect against the tested resistance study isolated were examined by well diffusion method and Minimum inhibitory concentration was measured. Result(s): A 455 were enrolled in this study. Patients' ages ranged from 20 to 91 years (mean 52.23, SD 15.009). This study indicated that more than half of the samples were males [(262) 57.6%] and [(193) 42.4%] were females. The FTIR and GC-MS showed the methanolic extract potent the most bioactive compounds, followed by the chloroform and water extracts. Evaluation of antimicrobial effects at 50 mg/ml, the methanolic extract showed the greatest effect, with a mean inhibition zone of 9.33 mm and a significant value of 0.01;at 100 mg/ml, the chloroform extract showed the next greatest effect, with a mean inhibition zone of 10.33 mm and a significant value of 0.005. At 150 mg/ml, the aqueous extracts showed the least effect, with a mean inhibition zone of 8.33 mm and a non-significant value of 0.024. Conclusion(s): Candida spp. were most frequent isolated yeast from sputum of patients with severe COVID-19. Methanol extract was the most effective anti-candida, followed by chloroform extract, and the aqueous extract was the least effective. The most effective anti-candida drug is ketoconazole.Copyright © 2022.
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Introduction: Surveillance of Candida species isolates from blood cultures (BCs) in Europe is considered fragmented, unable to allow the definition of targets of antifungal stewardship recommendations especially during the SARS-CoV-2 pandemic. Methods: We performed a multicentric retrospective study including all consecutive BC Candida isolates from six Southern European tertiary hospitals (1st January 2020 to 31st December 2021). Etiology, antifungal susceptibility patterns, and clinical setting were analyzed and compared. Results: C. albicans was the dominant species (45.1%), while C. auris was undetected. Candida species positive BC events increased significantly in COVID-19 ICUs in 2021 but decreased in other ICUs. Resistance to azole increased significantly and remained very high in C. albicans (fluconazole from 0.7% to 4.5%, p = 0.03) and C. parapsilosis complex (fluconazole up to 24.5% and voriconazole up to 8.9%), respectively. Resistance to caspofungin was remarkable in C. tropicalis (10%) and C. krusei (20%), while resistance to at least one echinocandin increased in 2021, especially in C. parapsilosis complex (from 0.8% to 5.1%, p = 0.05). Although no significant differences were observed over the study period, fluconazole and echinocandin resistance increased in COVID-19 ICUs by up to 14% and 5.8%, respectively, but remained undetected in non-intensive COVID-19 wards. Conclusions: Antifungal stewardship activities aimed at monitoring resistance to echinocandin in C. tropicalis and C. krusei, and against the spread of fluconazole resistant C. parapsilosis complex isolates are highly desirable. In COVID-19 patients, antifungal resistance was mostly present when the illness had a critical course.
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BACKGROUND: Studies evaluating outcomes of COVID-19 patients with candidemia are limited and have only evaluated a single timepoint during the pandemic. OBJECTIVES: To compare the prevalence and outcomes associated with candidemia in patients based on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) status and through the various pandemic waves (1 March 2020-5 March 2022). PATIENTS/METHODS: Multicentre, retrospective cohort analysis of data from 248 US medical facilities using the BD Insights Research Database (Becton, Dickinson and Company, Franklin Lakes, New Jersey, USA). Eligible patients were adults aged ≥18 years who were hospitalised for >1 day, had a SARS-CoV-2 test and a positive blood culture for Candida spp. RESULTS: During the study time frame, there were 2,402,879 hospital admissions; 234,903 (9.7%) and 2,167,976 (90.3%) patients were SARS-CoV-2 positive and negative, respectively. A significantly higher rate of candidemia/1000 admissions was observed in SARS-CoV-2-positive patients compared to SARS-CoV-2-negative patients (3.18 vs. 0.99; p < .001). The highest candidemia rate for SARS-CoV-2-positive patients was observed during the Alpha SARS-CoV-2 wave (June 2020-August 2020) with the lowest candidemia rate during the Omicron wave. Hospital mortality was significantly higher in SARS-CoV-2-positive patients compared to SARS-CoV-2-negative patients with candidemia (59.6% vs. 30.8%; p < .001). When evaluating the mortality rate through the various pandemic waves, the rate for the overall population did not change. CONCLUSIONS: Our study indicates high morbidity and mortality for hospitalised patients with COVID-19 and candidemia which was consistent throughout the pandemic. Patients with COVID-19 are at an increased risk for candidemia; importantly, the magnitude of which may differ based on the circulating variant.
Subject(s)
COVID-19 , Candidemia , Adult , Humans , Adolescent , SARS-CoV-2 , Candidemia/epidemiology , COVID-19/epidemiology , Pandemics , Retrospective Studies , Hospitals , MorbidityABSTRACT
The appointment of antibacterial agents for the treatment of pneumonia that develops with COVID-19 is one of the treatment regimens. Antibacterial agents are prescribed only in the case of the presence of confirmed bacterial co-infec-tion but can be appointed empirically. This approach promotes the development of antibiotic resistance of opportunistic and saprophytic microflora of almost all habitats, including the oropharynx, which can lead to dysbiosis with activation of fungal flora. The aim of the study was to analyze the composition of the oropharyngeal microbiome of patients with viral and bacterial pneumonia who took antibiotics, as well as the sensitivity of fungi of the genus Candida to antifungal drugs for effective treatment of the underlying disease. Methods. The results of the bacteriological examination of 113 patients treated with a diagnosis of COVID-19 were analyzed. Microbiological examination of oropharyngeal swabs was performed by the classical bacteriological method with dosed seeding of suspended material on differential diagnostic media (in particular Sabouraud agar was used for selection of fungi of the genus Candida) and genus identification by morphological, cultural, biochemical properties. Results. PCR tests were performed for all patients in the clinical trial to confirm the diagnosis of viral and bacterial pneumonia. According to the results of the bacteriological examination, fungi of the genus Candida were found in 52 (46.0%) patients with pneumonia associated with COVID-19. The analysis of prescriptions showed that only 14 (26.9%) patients were treated with one antibiotic, two antibiotics were prescribed to 31 (59.6%) patients, and three — to 7 (13.5%). In the structure of antibiotic therapy, the lion’s share were cephalosporins of the third generation (ceftriaxone, hepacef) — 33 (63.5%), and macrolides (azithromycin) — 16 (30.8%) patients. In the structure of the oropharyngeal microbiome, according to the results of the bacteriological research, fungi of the genus Candida significantly prevailed, which were found in 52 (46.0%), and in 29 patients (25.7%) S. pneumonia was found. The sensitivity of fungi of the genus Candida to antifungal agents was analyzed, and the maximum number of resistant strains was detected to nystatin and amphotericin — 38.5% and 26.9%, with only 8 (15.3%) fungi of the genus Candida sensitive to nystatin. Conclusions. All patients with viral-bacterial pneumonia associated with COVID-19 received antibiotic therapy with the lion’s share of third-generation cephalosporins (63.5%) and macrolides (30.8%). According to the results of the bacteriological examination of the oropharyngeal microbiome after antibiotic therapy, fungi of the genus Candida predominated (46.0%), followed by S. pneumoniae (25.7%). Isolated strains of fungi of the genus Candida showed resistance to nystatin (38.5%) and amphotericin (26.9%). Antifungal agents of the imidazole subgroup have shown high efficiency and a low percentage of resistant strains, which allows us to recommend them for the treatment of complications of COVID-19 caused by fungi of the genus Candida. © Publisher PH «Akademperiodyka» of the NAS of Ukraine, 2022. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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Oral fungal infections are a worldwide healthcare problem. Although Candida albicans is still the most common yeast involved in the infections of oral cavity, non-Candida albicans Candida species (NCACs) have been highly related to these infections, particularly in older, immunosuppressed or patients with long exposure to antimicrobial drugs. The goal of this work was to perform a quick epidemiological and mycological study on the oral samples collected from a laboratory of a hospital in Slovakia, for 60 days. The samples' identification was performed by Germ-tube formation test, CHROMID® Candida, Auxacolor 2, ID 32C automated method, and the antifungal susceptibility testing determined by E-test®. Results confirm that comparing with bacteria, yeasts still occur in the lower number, but there is a high rate of antifungal resistance (81.6%)-to, at least one drug-among the collected samples, particularly to azoles and 5'-FC, which is clinically noteworthy.
Subject(s)
Antifungal Agents , Candida , Aged , Antifungal Agents/pharmacology , Antifungal Agents/therapeutic use , Fluconazole , Hospitals , Humans , Microbial Sensitivity Tests , Prevalence , Slovakia/epidemiologyABSTRACT
BACKGROUND: The increasing azole drug resistance in fungal pathogens poses a pressing threat to global health care. The coexistence of drug-resistant Candida albicans with tuberculosis patients and the failure of several drugs to treat C. albicans infection extend hospital stay, economic burden, and death. The misuse or abuse of azole-derived antifungals, chronic use of TB drugs, different immune-suppressive drugs, and diseases like HIV, COVID-19, etc., have aggravated the situation. So it is vital to understand the molecular changes in drug-resistant genes to modify the treatment to design an alternative mechanism. METHOD: C. albicans isolated from chronic tuberculosis patients were screened for antifungal sensitivity studies using disk diffusion assay. The multidrug-resistant C. albicans were further screened for molecular-level changes in drug resistance using MDR1 gene sequencing and compared with Gen bank data of similar species using the BLAST tool. RESULTS: The investigation proved that the isolated C. albicans from TB patients are significantly resistant to the action of six drugs. The molecular changes in MDR1 genes showed differences in seven nucleotide base pairs that interfered with the efflux pump.