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1.
J Card Surg ; 37(9): 2845-2848, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1971110

ABSTRACT

BACKGROUND: Candida Parapsilosis is an unusual agent of prosthetic endocarditis in immunocompetent individuals but Coronavirus disease 2019 is reported to be associated with a transient immunodeficency that exposes patientes to opportunistic infections. CASE REPORT: We describe a dreadful case of Candida Parapsilosis endocarditis in a transient immunosuppressed patient recently infected with severe acute respiratory syndrome-Coronavirus 2019. CONCLUSION: Considering that the symptoms of Candida Parapsilosis infection and the symptoms of Coronavirus disease-2019 may overlap, it is important never to understimate the non-specific symptoms to improve patient outcome, especially in patient with previous Coronavirurs disease-2019 infection and with prosthetic material grafting.


Subject(s)
Abscess , COVID-19 , Candida parapsilosis , Candidiasis , Endocarditis , Heart Valve Prosthesis , Abscess/etiology , Abscess/microbiology , Abscess/surgery , COVID-19/complications , COVID-19/immunology , Candida parapsilosis/isolation & purification , Candidiasis/etiology , Candidiasis/microbiology , Endocarditis/etiology , Endocarditis/microbiology , Endocarditis/surgery , Heart Valve Prosthesis/adverse effects , Heart Valve Prosthesis/microbiology , Humans , Immunocompromised Host , Reoperation , Risk Factors , SARS-CoV-2
2.
Int J Mol Sci ; 23(14)2022 Jul 07.
Article in English | MEDLINE | ID: covidwho-1963999

ABSTRACT

Oral candidiasis has a high rate of development, especially in immunocompromised patients. Immunosuppressive and cytotoxic therapies in hospitalized HIV and cancer patients are known to induce the poor management of adverse reactions, where local and systemic candidiasis become highly resistant to conventional antifungal therapy. The development of oral candidiasis is triggered by several mechanisms that determine oral epithelium imbalances, resulting in poor local defense and a delayed immune system response. As a result, pathogenic fungi colonies disseminate and form resistant biofilms, promoting serious challenges in initiating a proper therapeutic protocol. Hence, this study of the literature aimed to discuss possibilities and new trends through antifungal therapy for buccal drug administration. A large number of studies explored the antifungal activity of new agents or synergic components that may enhance the effect of classic drugs. It was of significant interest to find connections between smart biomaterials and their activity, to find molecular responses and mechanisms that can conquer the multidrug resistance of fungi strains, and to transpose them into a molecular map. Overall, attention is focused on the nanocolloids domain, nanoparticles, nanocomposite synthesis, and the design of polymeric platforms to satisfy sustained antifungal activity and high biocompatibility with the oral mucosa.


Subject(s)
Candidiasis, Oral , Candidiasis , Antifungal Agents/pharmacology , Antifungal Agents/therapeutic use , Biocompatible Materials/pharmacology , Biocompatible Materials/therapeutic use , Biofilms , Candidiasis/drug therapy , Candidiasis, Oral/drug therapy , Candidiasis, Oral/microbiology , Fungi , Humans
3.
Microb Pathog ; 169: 105677, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1936991

ABSTRACT

Patients admitted to the hospital with coronavirus disease (COVID-19) are at risk for acquiring mycotic infections in particular Candidemia. Candida albicans (C. albicans) constitutes an important component of the human mycobiome and the most common cause of invasive fungal infections. Invasive yeast infections are gaining interest among the scientific community as a consequence of complications associated with severe COVID-19 infections. Early identification and surveillance for Candida infections is critical for decreasing the COVID-19 mortality. Our current study attempted to understand the molecular-level interactions between the human genes in different organs during systematic candidiasis. Our research findings have shed light on the molecular events that occur during Candidiasis in organs such as the kidney, liver, and spleen. The differentially expressed genes (up and down-regulated) in each organ will aid in designing organ-specific therapeutic protocols for systemic candidiasis. We observed organ-specific immune responses such as the development of the acute phase response in the liver; TGF-pathway and genes involved in lymphocyte activation, and leukocyte proliferation in the kidney. We have also observed that in the kidney, filament production, up-regulation of iron acquisition mechanisms, and metabolic adaptability are aided by the late initiation of innate defense mechanisms, which is likely related to the low number of resident immune cells and the sluggish recruitment of new effector cells. Our findings point to major pathways that play essential roles in specific organs during systemic candidiasis. The hub genes discovered in the study can be used to develop novel drugs for clinical management of Candidiasis.


Subject(s)
COVID-19 , Candidiasis , Candida albicans , Candidiasis/microbiology , Gene Expression , Humans , Systems Biology
4.
J Infect Dev Ctries ; 16(6): 1025-1029, 2022 06 30.
Article in English | MEDLINE | ID: covidwho-1924349

ABSTRACT

INTRODUCTION: Multi-organ dysfunction caused by thromboembolic complications may complicate the course of SARS-CoV-2 infection. Most patients require anticoagulant therapy which predisposes them to the development of hemorrhagic syndrome. In critically ill COVID-19 patients secondary infections due to opportunistic pathogens are associated with a high mortality rate. CASE REPORT: Herein, we present a COVID-19 patient with severe hemorrhage at unusual sites complicated with invasive candidiasis and an extensively drug-resistant (XDR) strain of Klebsiella enterobacter. CONCLUSIONS: Clinicians should be aware of the possibility for invasive fungal infections in severely ill patients with SARS-CoV-2 infection due to pre-existing conditions, risk factors, and COVID-19 associated pathological mechanisms. Management of invasive candidiasis is challenging because of the high prevalence of comorbidities, risk of toxicities, and drug interactions.


Subject(s)
COVID-19 , Candidiasis, Invasive , COVID-19/complications , Candidiasis , Candidiasis, Invasive/drug therapy , Hemorrhage , Humans , Klebsiella , SARS-CoV-2
7.
AACN Adv Crit Care ; 33(2): 165-172, 2022 Jun 15.
Article in English | MEDLINE | ID: covidwho-1879534

ABSTRACT

Critically ill patients are at high risk for organ failure, including that of the integumentary system. Nurses working in intensive care are adept at performing comprehensive assessments that include the skin. Although pressure injury is a well-known complication associated with critical illness, patients may also have debilitating and life-threatening dermatoses. Conditions such as skin failure and medical adhesive-related skin damage are commonly seen in the critically ill. Infectious processes, such as Fournier gangrene, invasive candidiasis, mucormycosis, and herpetic lesions, can result in severe or superimposed critical illness and elude detection. Similarly, cutaneous manifestations of COVID-19 may develop prior to commonly recognized symptoms of infection. Nurses and providers caring for critically ill patients should be aware of common, but less widely known, skin conditions to facilitate early detection and treatment.


Subject(s)
COVID-19 , Candidiasis , Critical Care , Critical Illness , Humans , Intensive Care Units
8.
Future Microbiol ; 17: 673-682, 2022 06.
Article in English | MEDLINE | ID: covidwho-1809250

ABSTRACT

Background: The aim of this study was to evaluate reinfection and fungal infections among 785 patients with COVID-19 disease admitted to Baqiyatallah Hospital in Northeastern Iran after the onset of the COVID-19 epidemic. Materials & Methods: In this descriptive-analytic study (20 February-21 July 2020), reinfection and fungal infections among 785 patients were investigated using epidemiological questionnaire, clinical trials, Real-time PCR and CT scan (chest computed tomography) from the hospital HIS (hospital's information system) and collected samples. Results: Reinfection and one oral candidiasis were diagnosed in one 68-year-old man and one 47-year-old man 63 and 42 days after the initial infection, respectively. Conclusion: The research results showed that exposure to COVID-19 may not establish long-term protective immunity to all patients.


Subject(s)
COVID-19 , Candidiasis , Mycoses , Humans , Male , RNA, Viral/genetics , Reinfection
9.
Microb Pathog ; 166: 105520, 2022 May.
Article in English | MEDLINE | ID: covidwho-1778376

ABSTRACT

Coronavirus disease 2019 (COVID-19), which is attributable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been causing a worldwide health issue. Airways colonization by Candida spp. is prevalent among patients on automatic ventilation in intensive care units (ICUs). This research aimed to ascertain the risk factors and roles of Candida spp. respiratory tract colonization, and Candida lung infection during the progression of COVID-19 pneumonia in critically ill patients. In total, Candida spp. were recovered in 69 from 100 immunosuppressed patients with COVID-19. Bronchoscopy was used to collect the Bronchoalveolar lavage (BAL) specimens. For the identification of Candida spp. PCR sequencing was done using the ITS1 and ITS4 primers. The amplification of the HWP1 gene was conducted to identify the Candida albicans complex. The antifungal activities of fluconazole, itraconazole, voriconazole, amphotericin B and caspofungin against Candida spp. were evaluated using the Clinical and Laboratory Standards Institute M60. In 63.77% of the patients, Candida respiratory colonization at D0 and D14 had no impact on the severity of COVID-19. In comparison to C. albicans strains, Candida respiratory disorder with C. glabrata had influenced the severity of COVID-19 for critically ill patients following adjustment for the risk factors of COVID-19 (P < 0.05). Amphotericin B and caspofungin showed superior activity against all Candida spp. All antifungal agents showed 100% sensitivity against the two C. africana strains. Our observation on patients who used automatic ventilation, respiratory colonization by Candida spp. was not seen to influence the infection or death caused by COVID-19. Amphotericin B and caspofungin showed superior activity against all Candida spp. and were recommended for the treatment regime of pulmonary candidiasis associated with COVID-19 infection. Although "Candida pneumonia" is rarely being reported in critically ill patients, Candida airway colonization mainly by Candida albicans is common especially among patients with diabetes, malignancies, and kidney disorders.


Subject(s)
COVID-19 , Candidiasis , Pneumonia , Amphotericin B , Antifungal Agents/pharmacology , Antifungal Agents/therapeutic use , Candida/genetics , Candida albicans , Candida glabrata , Candidiasis/microbiology , Caspofungin/therapeutic use , Critical Illness , Fluconazole/therapeutic use , Humans , Lung , Microbial Sensitivity Tests , Pneumonia/drug therapy , SARS-CoV-2
10.
Acta Medica (Hradec Kralove) ; 64(4): 218-223, 2021.
Article in English | MEDLINE | ID: covidwho-1743011

ABSTRACT

BACKGROUND: The second wave of COVID-19 has emerged with the addition of vivid types of oral manifestations. Immunosuppression caused by COVID-19 results in an exacerbation of pre-existing infections. Recently, in the backdrop of COVID-19 expression, a notable rise in the incidence of secondary infections, both fungal and bacterial, have been reported either during the disease or as a post-COVID manifestation. CASE PRESENTATION: A 70-year-old male diabetic COVID-19 patient reported with a chief complaint of pain in the right side maxillary region for 3 months and the passage of content from the oral cavity into the nose. Intraoral examination revealed missing teeth i.r.t. 12 to 17, denuded mucosa with exposed necrotic bone and an oroantral opening. Sequestrectomy was done and the tissue was sent for histopathological examination which revealed necrotic bone interspersed with broad aseptate fungal hyphae branched at right angles along with actinomycotic colonies and Candidal hyphae in few areas. Based on histopathological findings, a final diagnosis of mixed infections leading to Maxillary Osteomyelitis was given. No recurrence was noticed after 3 months of follow up. CONCLUSIONS: The occurrence of oral infections even after the remission period of COVID-19 signifies an alarming sign both for the patient and clinicians monitoring the oral health status during the follow-up period. To our knowledge, this is the first such case (three oral infections as a post covid manifestation in a single diabetic patient) reported in the literature till date.


Subject(s)
Actinomycosis , COVID-19 , Candidiasis , Coinfection , Diabetes Mellitus , Mucormycosis , Osteomyelitis , Aged , COVID-19/complications , Candidiasis/complications , Coinfection/complications , Humans , Male , Mucormycosis/complications , Osteomyelitis/microbiology , SARS-CoV-2
11.
Curr Microbiol ; 79(5): 127, 2022 Mar 14.
Article in English | MEDLINE | ID: covidwho-1739302

ABSTRACT

The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is threatening public health. A large number of affected people need to be hospitalized. Immunocompromised patients and ICU-admitted patients are predisposed to further bacterial and fungal infections, making patient outcomes more critical. Among them, COVID-19-associated candidiasis is becoming more widely recognized as a part of severe COVID-19 sequelae. While the molecular pathophysiology is not fully understood, some factors, including a compromised immune system, iron and zinc deficiencies, and nosocomial and iatrogenic transmissions, predispose COVID-19 patients to candidiasis. In this review, we discuss the existing knowledge of the virulence characteristics of Candida spp. and summarize the key concepts in the possible molecular pathogenesis. We analyze the predisposing factors that make COVID-19 patients more susceptible to candidiasis and the preventive measures which will provide valuable insights to guide the effective prevention of candidiasis in COVID-19 patients.


Subject(s)
COVID-19 , Candidiasis , Candida/genetics , Causality , Humans , SARS-CoV-2
12.
Antimicrob Resist Infect Control ; 11(1): 12, 2022 01 21.
Article in English | MEDLINE | ID: covidwho-1643184

ABSTRACT

BACKGROUND: Despite the adoption of strict infection prevention and control measures, many hospitals have reported outbreaks of multidrug-resistant organisms (MDRO) during the Coronavirus 2019 (COVID-19) pandemic. Following an outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB) in our institution, we sought to systematically analyse characteristics of MDRO outbreaks in times of COVID-19, focussing on contributing factors and specific challenges in controlling these outbreaks. METHODS: We describe results of our own CRAB outbreak investigation and performed a systematic literature review for MDRO (including Candida auris) outbreaks which occurred during the COVID-19 pandemic (between December 2019 and March 2021). Search terms were related to pathogens/resistance mechanisms AND COVID-19. We summarized outbreak characteristics in a narrative synthesis and contrasted contributing factors with implemented control measures. RESULTS: The CRAB outbreak occurred in our intensive care units between September and December 2020 and comprised 10 patients (thereof seven with COVID-19) within two distinct genetic clusters (both ST2 carrying OXA-23). Both clusters presumably originated from COVID-19 patients transferred from the Balkans. Including our outbreak, we identified 17 reports, mostly caused by Candida auris (n = 6) or CRAB (n = 5), with an overall patient mortality of 35% (68/193). All outbreaks involved intensive care settings. Non-adherence to personal protective equipment (PPE) or hand hygiene (n = 11), PPE shortage (n = 8) and high antibiotic use (n = 8) were most commonly reported as contributing factors, followed by environmental contamination (n = 7), prolonged critical illness (n = 7) and lack of trained HCW (n = 7). Implemented measures mainly focussed on PPE/hand hygiene audits (n = 9), environmental cleaning/disinfection (n = 9) and enhanced patient screening (n = 8). Comparing potentially modifiable risk factors and control measures, we found the largest discrepancies in the areas of PPE shortage (risk factor in 8 studies, addressed in 2 studies) and patient overcrowding (risk factor in 5 studies, addressed in 0 studies). CONCLUSIONS: Reported MDRO outbreaks during the COVID-19 pandemic were most often caused by CRAB (including our outbreak) and C. auris. Inadequate PPE/hand hygiene adherence, PPE shortage, and high antibiotic use were the most commonly reported potentially modifiable factors contributing to the outbreaks. These findings should be considered for the prevention of MDRO outbreaks during future COVID-19 waves.


Subject(s)
Acinetobacter Infections/prevention & control , Acinetobacter baumannii , COVID-19/complications , COVID-19/epidemiology , Candidiasis/prevention & control , Pandemics , SARS-CoV-2 , Acinetobacter Infections/complications , Acinetobacter baumannii/drug effects , Aged , Candidiasis/complications , Carbapenems/pharmacology , Cross Infection/prevention & control , Disease Outbreaks/prevention & control , Drug Resistance, Multiple, Bacterial , Female , Humans , Infection Control/methods , Male , Middle Aged , Retrospective Studies , Switzerland/epidemiology
13.
J Mycol Med ; 32(2): 101236, 2022 May.
Article in English | MEDLINE | ID: covidwho-1586953

ABSTRACT

Candida kefyr (Kluyveromyces marxianus), an ascomycetous environmental yeast, occasionally isolated from dairy products, represents an uncommon but emerging pathogen in immunocompromised patients. Herein, we present a case of C. kefyr pyelonephritis in a 41-year-old, previously immunocompetent, patient who was hospitalized in an COVID-19 ICU. Pyelonephritis was associated with caliectasis and obstruction due to possible fungus ball formation. Predisposing factors included ICU stay, use of broad spectrum antibiotics and steroids, central venous catheterization, mechanical ventilation and urologic manipulation. Susceptibility testing revealed high MIC values to amphotericin B. Infection was effectively controlled by prolonged administration of fluconazole without further surgical intervention. COVID-19 complicated with invasive candidiasis is an increasingly observed clinical situation that warrants high suspicion index and careful evaluation of laboratory data.


Subject(s)
COVID-19 , Candidiasis, Invasive , Pyelonephritis , Adult , Antifungal Agents/therapeutic use , COVID-19/complications , Candida , Candidiasis , Candidiasis, Invasive/diagnosis , Candidiasis, Invasive/drug therapy , Fluconazole/therapeutic use , Humans , Intensive Care Units , Kluyveromyces , Pyelonephritis/diagnosis , Pyelonephritis/drug therapy
14.
Ann Intern Med ; 174(11): 1622-1623, 2021 11.
Article in English | MEDLINE | ID: covidwho-1561980
15.
Mycopathologia ; 187(1): 121-127, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1544530

ABSTRACT

Candida auris, a multidrug-resistant nosocomial pathogen, has emerged globally with high morbidity and mortality among immunocompromised individuals and COVID19 hospitalized patients. Five major clades of C. auris have been previously described. The fifth clade is exclusively found in Iran where C. auris isolates are genetically distinct from other clades by > 200,000 single-nucleotide polymorphisms. The origin of C. auris remains unclear, and limited clinical data are available at present regarding clade V infection or colonization. Herein, another case of otomycosis in Iran caused by an isolate of C. auris belonging to the fifth clade is reported. Genotyping revealed that the obtained C. auris isolate from Isfahan clustered with earlier clade V isolates from Babol, cities around 600 km separated, which indicates that C. auris clade V is established in Iran. C. auris is thought to exist more commonly in Iran, given that limited diagnostic capacity in the country has probably curbed the identification of more C. auris cases. Therefore, surveillance of the environment, patients and healthcare facilities in different geographical regions in Iran is urgently required.


Subject(s)
COVID-19 , Candidiasis , Otomycosis , Antifungal Agents/pharmacology , Antifungal Agents/therapeutic use , Candida/genetics , Candidiasis/diagnosis , Candidiasis/drug therapy , Humans , Iran , Otomycosis/drug therapy , SARS-CoV-2
16.
Mycoses ; 65(2): 134-139, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1537846

ABSTRACT

Candida meningitis is a rare life-threatening yeast infection mostly involving immunocompromised or paediatric patients undergoing neurosurgical procedures or shunt placement. Due to difficulties in diagnosis because of diverse clinical manifestations, the number of patients affected is most likely underestimated. Therefore, the correct diagnosis may be delayed for months, and accurate species identification is highly recommended for administering appropriate antifungal therapy. We report the first case of fluconazole-resistant Candida auris meningitis in a paediatric patient in Iran. This strain was probably imported, as it genotypically belonged to Clade I from South Asia. Furthermore, we include a literature review of C auris meningitis cases, as the number of cases with C auris meningitis has increased with reports from the United Kingdom, India and Iran. This problem might increase further in the era of COVID-19 due to attrition of experienced healthcare personnel and a high workload of hospital healthcare workers. To understand the precise prevalence of this emerging multidrug resistance pathogen, epidemiological surveillance studies are urgently warranted.


Subject(s)
Candidiasis/diagnosis , Meningitis , Antifungal Agents/therapeutic use , Child , Humans , Iran , Meningitis/diagnosis , Meningitis/microbiology , Microbial Sensitivity Tests
18.
Mycoses ; 65(2): 222-225, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1501484

ABSTRACT

BACKGROUND: Since the first report of Candida auris in 2016, the Colombian Instituto Nacional de Salud (INS) has implemented a national surveillance of the emerging multidrug-resistant fungus. OBJECTIVES: This report summarises the findings of this laboratory-based surveillance from March 2016 to December 2020. RESULTS: A total of 1720 C. auris cases were identified, including 393 (23%) colonisation cases and 1327 (77%) clinical cases. Cases were reported in 20 of 32 (62%) departments of Colombia and involved hospitals from 33 cities. The median age of patients was 34 years; 317 (18%) cases were children under 16 years, 54% were male. The peak number of cases was observed in 2019 (n = 541). In 2020, 379 (94%) of 404 cases reported were clinical cases, including 225 bloodstream infections (BSI) and 154 non-BSI. Among the 404 cases reported in 2020, severe COVID-19 was reported in 122 (30%). Antifungal susceptibility was tested in 379 isolates. Using CDC tentative breakpoints for resistance, 35% of isolates were fluconazole resistant, 33% were amphotericin B resistant, and 0.3% isolates were anidulafungin resistant, 12% were multidrug resistant, and no pan-resistant isolates were identified. CONCLUSION: For five years of surveillance, we observed an increase in the number and geographic spread of clinical cases and an increase in fluconazole resistance. These observations emphasise the need for improved measures to mitigate spread.


Subject(s)
Candidiasis , Adult , Antifungal Agents/therapeutic use , COVID-19 , Candida auris , Candidiasis/drug therapy , Candidiasis/epidemiology , Child , Colombia/epidemiology , Drug Resistance, Fungal , Female , Fluconazole , Humans , Male , Microbial Sensitivity Tests
19.
Mycopathologia ; 186(6): 883-887, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1474058

ABSTRACT

Candida auris has been reported worldwide, but only in December 2020, the first strain from a COVID-19 patient in Brazil was isolated. Here, we describe the genome sequence of this susceptible C. auris strain and performed variant analysis of the genetic relatedness with strains from other geographic localities.


Subject(s)
COVID-19 , Candidiasis , Nanopores , Antifungal Agents , Brazil , Candida/genetics , Humans , Microbial Sensitivity Tests , SARS-CoV-2
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