Multicenter Candida auris outbreak caused by azole-susceptible clade IV in Pernambuco, Brazil.

BACKGROUND: Candida auris is an emerging multidrug-resistant yeast, frequently causing outbreaks in health care facilities. The pathogen persistently colonises human skin and inanimate surfaces such as catheters, aiding to its spread. Moreover, colonisation is a risk factor to develop invasive infection. OBJECTIVES: We investigated 61 C. auris strains isolated from non-sterile human body sites (n = 53) and the hospital environment (n = 8), originating from four different centres in a single Brazilian state. MATERIALS AND METHODS: Antifungal susceptibility testing (AFST) against common antifungals was performed, and resistance-associated genes were evaluated. Genetic relatedness was investigated with short tandem repeat (STR) genotyping and validated with whole-genome sequencing (WGS) single nucleotide polymorphism (SNP) analysis. RESULTS: Antifungal susceptibility testing demonstrated that all isolates were susceptible to azoles, echinocandins and amphotericin B. No mutations were detected in ERG11 and FKS1 genes. With STR typing, isolates were allocated to clade IV and appeared closely related. This was confirmed by WGS SNP analysis of 6 isolates, which demonstrated a maximal difference of only 41 SNPs between these strains. Furthermore, the Brazilian isolates formed a distinct autochthonous branch within clade IV, excluding recent introductions from outside the country. A molecular clock analysis of clade IV isolates from various countries suggests that early in the previous century there was a unique event causing environmental spread of a C. auris ancestor throughout the Latin-American continent, followed by human introduction during the last decades. CONCLUSION: We report the emergence of C. auris patient colonisation in multiple centres by fluconazole-susceptible clade IV close-related strains in Pernambuco State, Brazil.

Emergence of cryptic species and clades of Meyerozyma guilliermondii species complex exhibiting limited in vitro susceptibility to antifungals in patients with candidemia.

Members of the Meyerozyma guilliermondii species complex are able to cause superficial and life-threatening systemic infections with low susceptibility to azoles and echinocandins. We tested 130 bloodstream M. guilliermondii complex isolates collected from eight Latin American medical centers over 18 years (period 1 = 2000-2008 and period 2 = 2009-2018) to investigate trends in species distribution and antifungal resistance. The isolates were identified by rDNA ITS region sequencing, and antifungal susceptibility tests were performed against fluconazole, voriconazole, anidulafungin, and amphotericin B using the CLSI microbroth method. M. guilliermondii sensu stricto (s.s.; n = 116) was the most prevalent species, followed by Meyerozyma caribbica (n = 12) and Meyerozyma carpophila (n = 2). Based on rDNA ITS identification, three clades within M. guilliermondii sensu stricto were characterized (clade 1 n = 94; clade 2 n = 19; and clade 3 n = 3). In the second period of study, we found a substantial increment in the isolation of M. caribbica (3.4% versus 13.8%; P = 0.06) and clade 2 M. guilliermondii s.s. exhibiting lower susceptibility to one or more triazoles. IMPORTANCE Yeast-invasive infections play a relevant role in human health, and there is a concern with the emergence of non-Candida pathogens causing disease worldwide. There is a lack of studies addressing the prevalence and antifungal susceptibility of different species within the M. guilliermondii complex that cause invasive infections. We evaluated 130 episodes of M. guilliermondii species complex candidemia documented in eight medical centers over 18 years. We detected the emergence of less common species within the Meyerozyma complex causing candidemia and described a new clade of M. guilliermondii with limited susceptibility to triazoles. These results support the relevance of continued global surveillance efforts to early detect, characterize, and report emergent fungal pathogens exhibiting limited susceptibility to antifungals.

Farnesol as a potentiator of antimicrobial photodynamic inactivation on Enterococcus faecalis.

Enterococcus faecalis is related to the recurrence of endodontic infections and approaches to intracanal disinfection are necessary. Farnesol, an alcohol commonly found in propolis, has antimicrobial properties, and can enhance the efficacy of some antibiotic therapies. The objective was to evaluate whether farnesol can increase the efficacy of the antimicrobial photodynamic inactivation (aPDI) on E. faecalis, investigating its action on planktonic growth, biofilms, and cell permeability. Planktonic cells and biofilms of E. faecalis were pre-treated with farnesol (0.25 mM) 2 h before aPDI. Methylene blue (1 mg/mL) and laser (660 nm) were employed in the aPDI. As a result, farnesol was able to increase the antimicrobial activity of aPDI in both planktonic and biofilm stages, reaching cell reductions of 4.6 to 6 log10 CFU and 1.3 to 3 log10 CFU, respectively, when compared to aPDI isolated. The efficacy of farnesol in enhancing the anti-biofilm activity of aPDI was also confirmed by electron microscopy, in which a smaller number of bacterial cells and extracellular matrix were verified in the combined therapy compared to aPDI alone. The potentiating action of farnesol was associated with its effects in increasing the cell permeability and methylene blue uptake by the bacterial cells. Therefore, farnesol can be a promising potentiator of aPDI against E. faecalis.

Antifungal and anti-biofilm effect of the calcium channel blocker verapamil on non-albicans Candida species.

Candida is a human fungal pathogen that causes a wide range of diseases. Candida albicans is the main etiologic agent in these diseases; however, infections can be caused by non-albicans Candida species. Virulence factors such as biofilm production, which protect the fungus from host immunity and anti-fungal drugs, are important for the infection. Therefore, available antifungal drugs for candidiasis treatment are limited and the investigation of new and effective drugs is needed. Verapamil is a calcium channel blocker with an inhibitory effect on hyphae development, adhesion, and colonization of C. albicans. In this study, we investigated the effect of verapamil on cell viability and its antifungal and anti-biofilm activity in non-albicans Candida species. Verapamil was not toxic to keratinocyte cells; moreover, C. krusei, C. parapsilosis, and C. glabrata were susceptible to verapamil with a minimal inhibitory concentration (MIC) of 1250 µM; in addition, this drug displayed fungistatic effect at the evaluated concentrations. After treatment with verapamil, reduced viability, biomass, and mitochondrial activity were observed in biofilms of the non-albicans Candida species C. krusei, C. glabrata, and C. parapsilosis. These findings highlight the importance of the study of verapamil as an alternative treatment for infections caused by non-albicans Candida species.

Development of Probiotic Formulations for Oral Candidiasis Prevention: Gellan Gum as a Carrier To Deliver Lactobacillus paracasei 28.4.

Probiotics might provide an alternative approach for the control of oral candidiasis. However, studies on the antifungal activity of probiotics in the oral cavity are based on the consumption of yogurt or other dietary products, and it is necessary to use appropriate biomaterials and specific strains to obtain probiotic formulations targeted for local oral administration. In this study, we impregnated gellan gum, a natural biopolymer used as a food additive, with a probiotic and investigated its antifungal activity against Candida albicansLactobacillus paracasei 28.4, a strain recently isolated from the oral cavity of a caries-free individual, was incorporated in several concentrations of gellan gum (0.6% to 1% [wt/vol]). All tested concentrations could incorporate L. paracasei cells while maintaining bacterial viability. Probiotic-gellan gum formulations were stable for 7 days when stored at room temperature or 4°C. Long-term storage of bacterium-impregnated gellan gum was achieved when L. paracasei 28.4 was lyophilized. The probiotic-gellan gum formulations provided a release of L. paracasei cells over 24 h that was sufficient to inhibit the growth of C. albicans, with effects dependent on the cell concentrations incorporated into gellan gum. The probiotic-gellan gum formulations also had inhibitory activity against Candida sp. biofilms by reducing the number of Candida sp. cells (P < 0.0001), decreasing the total biomass (P = 0.0003), and impairing hyphae formation (P = 0.0002), compared to the control group which received no treatment. Interestingly, a probiotic formulation of 1% (wt/vol) gellan gum provided an oral colonization of L. paracasei in mice with approximately 6 log CFU/ml after 10 days. This formulation inhibited C. albicans growth (P < 0.0001), prevented the development of candidiasis lesions (P = 0.0013), and suppressed inflammation (P = 0.0006) compared to the mice not treated in the microscopic analysis of the tongue dorsum. These results indicate that gellan gum is a promising biomaterial and can be used as a carrier system to promote oral colonization for probiotics that prevent oral candidiasis.

Two sporulated Bacillus enhance immunity in Galleria mellonella protecting against Candida albicans.

The aim of this study was to evaluate the effects of Bacillus subtilis and Bacillus atrophaeus on Galleria mellonella immunity challenged by Candida albicans. Firstly, we analyzed the susceptibility of G. mellonella to bacilli (vegetative and sporulating forms). It was found that both vegetative and sporulating forms were not pathogenic to G. mellonella at a concentration of 1 × 104 cells/larva. Next, larvae were pretreated with two species of Bacillus, in the vegetative and sporulating forms, and then challenged with C. albicans. In addition, the gene expression of antimicrobial peptides (AMPs) such as Gallerimycin, Gloverin, Cecropin-D and Galiomicin was investigated. Survival rates increased in the Bacillus treated larvae compared with control larvae inoculated with C. albicans only. Cells and spores of Bacillus spp. upregulated Gloverin, Galiomicin and Gallerimycin genes in relation to the control group (PBS + PBS). When these larvae were infected with C. albicans, the group pretreated with spores of B. atrophaeus and B. subtilis showed a greater increase in expression of Galiomycin (49.08-fold and 13.50-fold) and Gallerimycin (27.88-fold and 68.15-fold), respectively, compared to the group infected with C. albicans only (p = 0.0001). After that, we investigated the effects of B. subtilis and B. atrophaeus on immune system of G. mellonella evaluating the number of hemocytes, quantification of melanization, cocoon formation and colony forming units (CFU) count. Hemocyte count increased in response to stimulation by Bacillus, and a higher increase was achieved when larvae were inoculated with B. subtilis spores (p = 0.0011). In the melanization assay, all groups tested demonstrated lower production of melanin compared to that in the phosphate-buffered saline (PBS) group. In addition, full cocoon formation was observed in all groups analyzed, which corresponded to a healthier wax worm. Hemolymph culture revealed higher growth of B. atrophaeus and B. subtilis in the groups inoculated with spores. We concluded that spores and cells of B. atrophaeus and B. subtilis stimulated the immune system of G. mellonella larvae and protected them of C. albicans infection.

Galleria mellonella as an experimental model to study human oral pathogens.

The oral cavity is home to a microbial community of more than 800 species. This important microbiome is formed by commensal and opportunistic bacteria, fungi and viruses. Several distinct habitats within the mouth support heterogeneous microbial communities that constitute an important link between oral and general health. The use of animal models for in vivo studies in microbial pathogenicity is well established in the scientific community. Galleria mellonella as a model host has increased in use significantly in the last few years. This invertebrate model provides studies on a large scale, serving as screens for studies on vertebrate animals, such as mice and rats. In this review, different studies of microbial genera of dental importance (Enterococcus, Candida, Lactobacillus, Porphyromonas and Streptococcus) are discussed, highlighting the use of G. mellonella as a suitable model for studying pathogenesis, efficacy of antimicrobial compounds, and immune responses.

Desenvolvimento de formulações probióticas para a prevenção da candidose bucal: estudo in vitro e in vivo / Development of probiotic formulations for prevention of oral candidiasis: in vitro and in vivo study

Os probióticos são considerados uma alternativa potencial para o controle da candidose, no entanto, existe uma falta de produtos probióticos direcionados para a cavidade bucal. Neste estudo, desenvolvemos formulações probióticas usando gellan gum, um biopolímero natural usado como aditivo alimentar, e investigamos os efeitos dessas formulações em Candida albicans. Para isso, Lactobacillus paracasei 28.4, uma cepa recentemente isolada da cavidade bucal, foi incorporada em várias concentrações de gellan gum (1 a 0,6%). Todas as concentrações testadas foram capazes de incorporar as células de L. paracasei, mantendo a viabilidade bacteriana. As formulações probióticas permaneceram estáveis por 7 dias quando armazenadas à temperatura ambiente ou a 4°C. Entretanto, o armazenamento a longo prazo das formulações probióticas foi conseguido apenas quando L. paracasei 28.4 foi liofilizado. As formulações probióticas proporcionaram uma liberação de células de L. paracasei por 24 horas, o que foi suficiente para inibir o crescimento de C. albicans com efeitos dependentes das concentrações celulares incorporadas no gellan gum. As formulações probióticas também tiveram atividade inibitória contra os biofilmes de Candida, reduzindo o número de células de Candida (p<0,0001), diminuindo a biomassa total (p=0,0003) e prejudicando a formação de hifas (p=0,0002) em relação ao grupo controle não tratado. Contudo, a formulação probiótica de gellan gum a 1% proporcionou uma colonização oral de L. paracasei em camundongos com aproximadamente 6 log de UFC/mL após 10 dias. Essa formulação inibiu o crescimento de C. albicans (p<0,0001), impediu o desenvolvimento de lesões de candidose (p=0,0013) e suprimiu a inflamação (p = 0,0006) quando comparada aos camundongos não tratados. Estes resultados indicam que o gellan gum pode ser um biomaterial promissor como sistema transportador de probióticos para prevenir a candidose oral(AU)

Probiotics are considered a potential alternative for the control of candidiasis, however there is a lack of probiotic products targeted for the oral cavity. In this study, we developed probiotic formulations using gellan gum, a natural biopolymer used as a food-additive, and investigated the effects of this delivery method on Candida albicans. Lactobacillus paracasei 28.4, a strain recently isolated from the oral cavity, was incorporated in several concentrations of gellan gum (1 to 0.6%). All tested concentrations could incorporate L. paracasei cells while maintaining bacterial viability. Probiotic-gellan formulations were stable for 7 days when stored at room temperature or 4°C. Long-term storage of bacterial impregnated gellan gum could be achieved when L. paracasei 28.4 was lyophilized. The probiotic-gellan formulations provided a release of L. paracasei cells over 24 hours that was sufficient to inhibit the growth of C. albicans with effects dependent on the cell concentrations incorporated into gellan gum. The probiotic-gellan formulations also had inhibitory activity against Candida biofilms by reducing the number of Candida cells (p < 0.0001), decreasing the total biomass (p = 0.0003) and impairing hyphae formation (p = 0.0002) in relation to the control group, not treated. However, only probiotic formulation of gellan gum 1% provided an oral colonization of L. paracasei in mice with approximately 6 log of CFU/mL after 10 days. This formulation inhibited the C. albicans growth (p < 0.0001), prevented the development of candidiasis lesions (p = 0.0013), and suppressed the inflammation (p = 0.0006) when compared to the mice not treated. These results indicate that gellan gum is a promising biomaterial as a carrier system of probiotics to prevent oral candidiasis(AU)

Recent Advances in the Use of Galleria mellonella Model to Study Immune Responses against Human Pathogens.

The use of invertebrates for in vivo studies in microbiology is well established in the scientific community. Larvae of Galleria mellonella are a widely used model for studying pathogenesis, the efficacy of new antimicrobial compounds, and immune responses. The immune system of G. mellonella larvae is structurally and functionally similar to the innate immune response of mammals, which makes this model suitable for such studies. In this review, cellular responses (hemocytes activity: phagocytosis, nodulation, and encapsulation) and humoral responses (reactions or soluble molecules released in the hemolymph as antimicrobial peptides, melanization, clotting, free radical production, and primary immunization) are discussed, highlighting the use of G. mellonella as a model of immune response to different human pathogenic microorganisms.

Inhibitory effect of probiotic Lactobacillus supernatants from the oral cavity on Streptococcus mutans biofilms.

Probiotics can release bioactive substances that can inhibit the growth and biofilm formation of pathogenic microorganisms such as Streptococcus mutans. In this context, we evaluated whether the supernatants of Lactobacillus strains isolated from caries-free subjects can inhibit S. mutans, one of the most important bacteria for dental caries. First, the supernatants of 22 Lactobacillus strains were screened for antibacterial activity against S. mutans in planktonic cultures. All 22 Lactobacillus strains studied (100%) showed antibacterial activity. Thereafter, the Lactobacillus strains with the greatest reductions in the planktonic S. mutans cultures were tested on biofilms. The L. fermentum 20.4, L. paracasei 11.6, L. paracasei 20.3 and L. paracasei 25.4 strains could significantly reduce the number of S. mutans cells in biofilms formed in hydroxyapatite (p < 0.05). This reduction was also confirmed by scanning electron microscopy analysis and was not caused by the decreased pH value in the medium (p > 0.05). In addition, the supernatants of these probiotic strains could also reduce the total biomass of S. mutans biofilms (p < 0.05). In conclusion, most of the Lactobacillus strains tested have some antibacterial activity against S. mutans. L. fermentum 20.4, L. paracasei 11.6, L. paracasei 20.3 and L. paracasei 25.4 produce bioactive substances that caused a significant reduction in S. mutans biofilms.

Candida tropicalis affects the virulence profile of Candida albicans: an in vitro and in vivo study.

Candida albicans and Candida tropicalis are commensal microorganisms occurring in the oral cavity of approximately 50%-70% of healthy individuals. However, these microbes can become pathogenic through changes in the environment or weakened host immune system. Thus, the aim of this investigation was to evaluate the interaction between species of the genus Candida in the biofilm formation, filamentation, gene expression and virulence in Galleria mellonella. Coincubation of C. albicans with C. tropicalis cells after 48 h resulted in significant reduction of biofilm formation by decreasing viable cell counts, metabolic activity and hyphal growth. The C. albicans genes (BCR1, CPH1, EFG1, UME6, HWP1, ALS3, SAP5 and PLB2) were quantified by quantitative real-time polymerase chain reaction and most of genes were downregulated. Regarding in vivo assay, the groups that the larvae received C. albicans and C. tropicalis had a significant survival increase compared to the control group of C. albicans (P = 0.0001) in agreement with the in vitro results. In conclusion, C. tropicalis colonization was associated with a decrease in the growth of C. albicans, suggesting an antagonistic relation between these two species. Therefore, C. tropicalis by reducing C. albicans virulence profile may limit the ability of this pathogenic fungus to cause infection.

Lactobacillus paracasei 28.4 reduces in vitro hyphae formation of Candida albicans and prevents the filamentation in an experimental model of Caenorhabditis elegans.

The objective of this study was to evaluate the influence of microbe-microbe interactions to identify a strain of Lactobacillus that could reduce the filamentation of Candida albicans ATCC 18804 using in vitro and in vivo models. Thus presenting a probiotic effect against the fungal pathogen. First, we analyzed the ability of 25 clinical isolates of Lactobacillus to reduce filamentation in C. albicans in vitro. We found that L. paracasei isolate 28.4 exhibited the greatest reduction of C. albicans hyphae (p = 0.0109). This reduction was confirmed by scanning electron microscopy analysis. The influence of C. albicans filamentation was found to be contributed through reduced gene expression of filament associated genes (TEC1 and UME6). In an in vivo study, prophylactic provisions with L. paracasei increased the survival of Caenorhabditis elegans worms infected with C. albicans (p = 0.0001) by 29%. Prolonged survival was accompanied by the prevention of cuticle rupture of 27% of the worms by filamentation of C. albicans, a phenotype that is characteristic of C. albicans killing of nematodes, compared to the control group. Lactobacillus paracasei isolate 28.4 reduced the filamentation of C. albicans in vitro by negatively regulating the TEC1 and UME6 genes that are essential for the production of hyphae. Prophylactic provision of Lactobacillus paracasei 28.4 protected C. elegans against candidiasis in vivo. L. paracasei 28.4 has the potential to be employed as an alternative method to control candidiasis.

Antifungal activity of clinical Lactobacillus strains against Candida albicans biofilms: identification of potential probiotic candidates to prevent oral candidiasis.

This study isolated Lactobacillus strains from caries-free subjects and evaluated the inhibitory effects directly on three strains of C. albicans, two clinical strains and one reference strain. Thirty Lactobacillus strains were isolated and evaluated for antimicrobial activity against in vitro C. albicans biofilms. L. paracasei 28.4, L. rhamnosus 5.2 and L. fermentum 20.4 isolates exhibited the most significant inhibitory activity against C. albicans. Co-incubation between these microorganisms resulted in deterrence of biofilm development and retardation of hyphal formation. The hindrance of biofilm development was characterized by the downregulated expression of C. albicans biofilm-specific genes (ALS3, HWP1, EFG1 and CPH1). L. paracasei 28.4, L. rhamnosus 5.2 and L. fermentum 20.4 demonstrated the ability to exert antifungal activity through the inhibition of C. albicans biofilms.

Influência de Lactobacillus rhamnosus na patogenicidade e na expressão de genes de virulência de Candida albicans: estudo invitro e in vivo / Influence of Lactobacillus rhamnosus on pathogenicity and the expression of virulence genes of Candida albicans: a study in vitro and in vivo

A alta incidência de candidoses causadas por Candida albicans e a capacidade de adaptação desta espécie, assim como resistência aos antifúngicos impulsionam o desenvolvimento de pesquisas com terapias alternativas para controle dessa infecção. O objetivo desse trabalho foiavaliar a influência de Lactobacillus rhamnosus e produtos do seumetabolismo contra C. albicans, avaliando-se a patogenicidade e aexpressão de genes que regulam a formação do biofilme de C. albicans,in vitro e in vivo em modelo invertebrado de Galleria mellonella. Foram utilizadas cepas de C. albicans ATCC 18804 e L. rhamnosus ATCC 9595 (provenientes do Laboratório de Microbiologia do Instituto de Ciências e Tecnologia de São José dos Campos / UNESP). Para o estudo forampreparadas duas suspensões de L. rhamnosus, uma contendo a porçãocelular e a outra com o sobrenadante da cultura, livre de células. O estudoda patogenicidade in vitro de C. albicans foi avaliado pelos testes de formação de biofilme e quantificação de UFC/mL de C. albicans, análise da atividade metabólica pelo método do XTT e filamentação de C.albicans. A análise da curva de sobrevivência de Galleria mellonella foiutilizada para a avaliação in vivo da influência de L. rhamnosus na infecção causada por C. albicans. Os genes, BCR1, EFG1, CPH1, HWP1, ALS1 e ALS3 de C. albicans foram quantificados pela RT-PCR após a interação em modelo de biofilme. No estudo in vitro L. rhamnosus foi capaz de inibir a formação do biofilme, filamentação e reduzir a atividade metabólica de C. albicans. Esses efeitos também foram observadosquando utilizado a suspensão do sobrenadante da cultura de L.rhamnosus, apontando possível produção de substâncias com efeito inibitório. Os resultados obtidos in vivo apontam que L. rhamnosus e seu sobrenadante protegeram G. mellonella da infecção por C. albicans, porém a suspensão do sobrenadante apresentou melhores resultados, visto que aumentou a sobrevivência da lagarta G. ...

The high incidence of candidiasis caused by Candida albicans and the adaptability of this species, as well as resistance to antifungal drive the development of research on alternative therapies to control this infection. The aim of this study was to evaluate the influence of Lactobacillus rhamnosus and products of their metabolism against C. albicans,evaluating the pathogenicity and the expression of genes that regulate theformation of C. albicans biofilms in vitro and in vivo in invertebrate modelGalleria mellonella. Strains of C. albicans ATCC 18804 and L. rhamnosus ATCC 9595 were used (from the Microbiology Laboratory of the Institute of Science and Technology of São José dos Campos / UNESP). For the study were prepared from L. rhamnosus two suspensions, one containing the serving cell and the other with the culture supernatant free cells. The study of in vitro pathogenicity of C. albicans was assessed by biofilmformation testing and quantitation of CFU / ml of C. albicans, analysis of metabolic activity by XTT method and C. albicans filamentation. The analysis of the Galleria mellonella survival curve was used to evaluate in vivo the influence of L. rhamnosus in infection caused by C. albicans. Genes, BCR1, EFG1, CPH1, HWP1, ALS1 and ALS3 of C. albicans were quantified by RT-PCR after interacting in biofilm model. In vitro evaluation L. rhamnosus was able to inhibit biofilm formation, filamentation and reduce the metabolic activity of C. albicans. These effects were alsoobserved when using the suspension culture supernatant of L. rhamnosus,indicating the possible of production substances with inhibiting effect. Theresults obtained in vivo indicate that L. rhamnosus and its supernatantprotected G. mellonella of C. albicans infection, but the suspension of thesupernatant showed better results, as it increased the survival caterpillarG. mellonella. The results of gene expression have shown that L.rhamnosus negatively regulated...