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1.
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
2.
Ann Intern Med ; 174(11): 1622-1623, 2021 11.
Article in English | MEDLINE | ID: covidwho-1561980
3.
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
5.
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
6.
Mycoses ; 64(9): 1062-1072, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1358623

ABSTRACT

OBJECTIVES: To describe the first outbreak of Candida auris in Brazil, including epidemiological, clinical and microbiological data. METHODS: After the first Candida auris-colonised patient was diagnosed in a COVID-19 ICU at a hospital in Salvador, Brazil, a multidisciplinary team conducted a local C. auris prevalence investigation. Screening cultures for C. auris were collected from patients, healthcare workers and inanimate surfaces. Risk factors for C. auris colonisation were evaluated, and the fungemia episodes that occurred after the investigation were also analysed and described. Antifungal susceptibility of the C. auris isolates was determined, and they were genotyped with microsatellite analysis. RESULTS: Among body swabs collected from 47 patients, eight (n = 8/47, 17%) samples from the axillae were positive for C. auris. Among samples collected from inanimate surfaces, digital thermometers had the highest rate of positive cultures (n = 8/47, 17%). Antifungal susceptibility testing showed MICs of 0.5 to 1 mg/L for AMB, 0.03 to 0.06 mg/L for voriconazole, 2 to 4 mg/L for fluconazole and 0.03 to 0.06 mg/L for anidulafungin. Microsatellite analysis revealed that all C. auris isolates belong to the South Asian clade (Clade I) and had different genotypes. In multivariate analysis, having a colonised digital thermometer was the only independent risk factor associated with C. auris colonisation. Three episodes of C. auris fungemia occurred after the investigation, with 30-day attributable mortality of 33.3%. CONCLUSIONS: Emergence of C. auris in Salvador, Brazil, may be related to local C. auris clade I closely related genotypes. Contaminated axillary monitoring thermometers may facilitate the dissemination of C. auris reinforcing the concept that these reusable devices should be carefully cleaned with an effective disinfectant or replaced by other temperature monitoring methods.


Subject(s)
Antifungal Agents/therapeutic use , Candida/drug effects , Candidiasis/diagnosis , Candidiasis/drug therapy , Candidiasis/epidemiology , Disease Transmission, Infectious , Thermometers/microbiology , Adult , Aged , Aged, 80 and over , Anidulafungin/therapeutic use , Brazil/epidemiology , COVID-19/complications , COVID-19/microbiology , Critical Care , Disease Outbreaks , Female , Fluconazole/therapeutic use , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Prevalence , SARS-CoV-2 , Voriconazole/therapeutic use
7.
Am J Infect Control ; 49(6): 804-807, 2021 06.
Article in English | MEDLINE | ID: covidwho-1269220

ABSTRACT

BACKGROUND: Candida auris was first described in Japan in 2009 and has since been detected in over 40 countries. The yeast is concerning for multiple reasons, primarily: (1) challenges with accurate identification; (2) reported multidrug resistance; (3) published mortality rates of 30%-60%; and (4) persistence in the environment associated with human transmission. We report the emergence of a healthcare-associated cluster in the Greater Vancouver area in 2018 and describe the measures implemented to contain its transmission. METHODS: Cases were identified through passive and ring surveillance of affected wards. Positive isolates were sent to provincial and national reference laboratories for confirmation and genomic characterization. Extensive infection control measures were implemented immediately after the initial case was identified. RESULTS: Four cases were identified during the outbreak. In a 4-month period, over 700 swabs were collected in order to screen 180 contacts. Whole genome sequencing concluded that all isolates clustered together and belonged to the South Asian clade. No isolates harbored FKS gene mutations associated with resistance to echinocandins. Infection control measures, including surveillance, education, cleaning and/or disinfection, patient cohorting, isolation, and hand hygiene, effectively contained the outbreak; it was declared over within 2 months. CONCLUSIONS: The spread of C auris in healthcare facilities has not spared Canadian institutions. Our experience demonstrates that strict infection control measures combined with microbiological screening can effectively halt transmission in healthcare centers. The necessity of active prospective screening remains unclear.


Subject(s)
Candida , Candidiasis , Antifungal Agents/pharmacology , Antifungal Agents/therapeutic use , Canada/epidemiology , Candida/genetics , Candidiasis/drug therapy , Candidiasis/epidemiology , Disease Outbreaks , Humans , Japan , Prospective Studies
8.
Int J Mol Sci ; 22(9)2021 Apr 25.
Article in English | MEDLINE | ID: covidwho-1231493

ABSTRACT

Candida auris is a novel and major fungal pathogen that has triggered several outbreaks in the last decade. The few drugs available to treat fungal diseases, the fact that this yeast has a high rate of multidrug resistance and the occurrence of misleading identifications, and the ability of forming biofilms (naturally more resistant to drugs) has made treatments of C. auris infections highly difficult. This review intends to quickly illustrate the main issues in C. auris identification, available treatments and the associated mechanisms of resistance, and the novel and alternative treatment and drugs (natural and synthetic) that have been recently reported.


Subject(s)
Antifungal Agents/pharmacology , Candida/isolation & purification , Candidiasis/drug therapy , Drug Resistance, Fungal/drug effects , Antifungal Agents/chemistry , Antifungal Agents/therapeutic use , Azoles/pharmacology , Candida/drug effects , Candidiasis/microbiology , Drug Therapy, Combination , Echinocandins/pharmacology , Humans , Mycology/methods , Polyenes/pharmacology , Treatment Failure
9.
Indian J Ophthalmol ; 69(4): 987-989, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1138817

ABSTRACT

A 42-year-old male patient presented with profound impairment of vision in both eyes, just as he was recovering from COVID-19. A known diabetic and hypertensive, he suffered from COVID-19 pneumonia further complicated by ARDS, septicaemia and acute kidney injury. His vision on presentation was finger counting close to face bilaterally with multiple, yellowish lesions at the posterior pole. Based on the clinical findings and previous blood culture report, it was diagnosed as candida retinitis and treated with oral and intravitreal anti-fungals. The lesions were regressing at follow-up. This is a post COVID-19 presumed candida retinitis case report.


Subject(s)
COVID-19/diagnosis , Candidiasis/diagnosis , Eye Infections, Fungal/diagnosis , Opportunistic Infections/diagnosis , Retinitis/diagnosis , SARS-CoV-2 , Administration, Oral , Adult , Antifungal Agents/therapeutic use , Candidiasis/drug therapy , Candidiasis/microbiology , Eye Infections, Fungal/drug therapy , Eye Infections, Fungal/microbiology , Fluconazole/therapeutic use , Humans , Intravitreal Injections , Male , Opportunistic Infections/drug therapy , Opportunistic Infections/microbiology , Retinitis/drug therapy , Retinitis/microbiology , Tomography, Optical Coherence , Visual Acuity/physiology , Voriconazole/therapeutic use
10.
Emerg Infect Dis ; 26(11): 2694-2696, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-734338

ABSTRACT

In New Delhi, India, candidemia affected 15 critically ill coronavirus disease patients admitted to an intensive care unit during April-July 2020. Candida auris accounted for two thirds of cases; case-fatality rate was high (60%). Hospital-acquired C. auris infections in coronavirus disease patients may lead to adverse outcomes and additional strain on healthcare resources.


Subject(s)
Betacoronavirus , Candida , Candidiasis/virology , Coronavirus Infections/microbiology , Cross Infection/microbiology , Pneumonia, Viral/microbiology , Adult , Aged , Antifungal Agents/therapeutic use , COVID-19 , Candidiasis/drug therapy , Candidiasis/epidemiology , Coronavirus Infections/drug therapy , Coronavirus Infections/epidemiology , Critical Illness , Cross Infection/drug therapy , Cross Infection/epidemiology , Drug Resistance, Multiple , Female , Humans , India/epidemiology , Male , Microbial Sensitivity Tests , Middle Aged , Pandemics , Pneumonia, Viral/drug therapy , Pneumonia, Viral/epidemiology , SARS-CoV-2
14.
Infection ; 48(5): 773-777, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-45828

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) has been demonstrated to be the cause of pneumonia. Nevertheless, it has not been reported as the cause of acute myocarditis or fulminant myocarditis. CASE PRESENTATION: A 63-year-old male was admitted with pneumonia and cardiac symptoms. He was genetically confirmed as having COVID-19 according to sputum testing on the day of admission. He also had elevated troponin I (Trop I) level (up to 11.37 g/L) and diffuse myocardial dyskinesia along with a decreased left ventricular ejection fraction (LVEF) on echocardiography. The highest level of interleukin-6 was 272.40 pg/ml. Bedside chest radiographs showed typical ground-glass changes indicative of viral pneumonia. Laboratory test results for viruses that cause myocarditis were all negative. The patient conformed to the diagnostic criteria of the Chinese expert consensus statement for fulminant myocarditis. After receiving antiviral therapy and mechanical life support, Trop I was reduced to 0.10 g/L, and interleukin-6 was reduced to 7.63 pg/mL. Moreover, the LVEF of the patient gradually recovered to 68%. The patient died of aggravation of secondary infection on the 33rd day of hospitalization. CONCLUSION: COVID-19 patients may develop severe cardiac complications such as myocarditis and heart failure. This is the first report of COVID-19 complicated with fulminant myocarditis. The mechanism of cardiac pathology caused by COVID-19 needs further study.


Subject(s)
Bacteroides Infections/complications , Betacoronavirus/pathogenicity , Candidiasis/complications , Coronavirus Infections/complications , Myocarditis/complications , Pneumonia, Viral/complications , Acute Disease , Antiviral Agents/therapeutic use , Bacteroides Infections/diagnostic imaging , Bacteroides Infections/drug therapy , Bacteroides Infections/virology , Betacoronavirus/drug effects , Biomarkers/blood , COVID-19 , Candidiasis/diagnostic imaging , Candidiasis/drug therapy , Candidiasis/virology , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/drug therapy , Coronavirus Infections/virology , Drug Combinations , Echocardiography , Fatal Outcome , Humans , Interleukin-6/blood , Lopinavir/therapeutic use , Male , Middle Aged , Myocarditis/diagnostic imaging , Myocarditis/drug therapy , Myocarditis/virology , Pandemics , Piperacillin, Tazobactam Drug Combination/therapeutic use , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/drug therapy , Pneumonia, Viral/virology , Ritonavir/therapeutic use , SARS-CoV-2 , Stroke Volume/drug effects , Tomography, X-Ray Computed , Troponin I/blood
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