Prospective screening in liver transplant recipients by panfungal PCR-ELISA for early diagnosis of invasive fungal infections.

Invasive fungal infections after liver transplantation (LT) have resulted in high mortality and potentially fatal complications. This study was undertaken to determine the accuracy of the panfungal polymerase chain reaction enzyme link immunosorbent assay (PCR-ELISA) method in early diagnosis of invasive fungal infections in liver transplant recipients (LTRs). A total of 48 liver recipients (cadaver donors) were followed for fungal infections for a period of at least 6 months. All clinical samples were cultured and a direct microscopic examination was performed. Blood samples were cultured by bedside inoculation onto BACTEC medium. Whole blood specimens were collected prospectively once per week and were evaluated for any invasive fungal infections by panfungal PCR and PCR-ELISA. Among 48 transplant recipients between September 2004 and January 2006 (22 females, 28 males, mean age = 34.4 yr), 40 recipients (83.3%) had Candida colonization in different sites of their body before LT. In proven and probable recipients for panfungal PCR-ELISA, the sensitivity, specificity, and positive and negative predictive values were 83.3%, 91.7%, 76.9%, and 94.3%, respectively. By PCR assay, fungal infections were diagnosed in 10 recipients (20.8%). The mean interval time from transplantation to development of fungal infection was 61.4 days (range, 20-150 days) and time of infection in blood before any clinical signs was 7-70 days with mean of 21.4 days. The etiologic agents were Candida albicans (9 cases) and Aspergillus fumigatus (1 case). Use of PCR-ELISA in LTRs may not only improve the ability of early diagnosis of invasive fungal infections (IFIs) when positive results are obtained, but also would provide more confidence to exclude a diagnosis of IFIs when negative results are obtained.

In vitro antifungal activities of Allium cepa, Allium sativum and ketoconazole against some pathogenic yeasts and dermatophytes.

By using an agar dilution assay, the antifungal activity of aqueous extracts prepared from Allium cepa (onion; AOE) and Allium sativum (garlic; AGE) were evaluated against Malassezia furfur (25 strains), Candida albicans (18 strains), other Candida sp. (12 strains) as well as 35 strains of various dermatophyte species and compared with the activity of a known antifungal drug, ketoconazole (KTZ). All the AOE, AGE and KTZ were found to be able to inhibit growth of all fungi tested in a dose-dependent manner with maximum of 100% at defined concentrations. The results indicate that onion and garlic might be promising in treatment of fungal-associated diseases from important pathogenic genera Candida, Malassezia and the dermatophytes.

Fungal infections in solid organ recipients.

BACKGROUND: Fungal infections are a major cause of morbidity and mortality after organ transplantation. The incidence of these infections has increased considerably over the last decade. OBJECTIVES: The aim of this study was to evaluate the incidence of fungal infections, to identify the most common fungal pathogens, and to determine the associated risk factors in solid organ recipients. METHODS: One hundred twenty renal and 50 liver recipients were transplanted at the organ transplant unit of Nemazi Hospital in Shiraz, Iran, from September 2004 to August 2005 and were followed for fungal infections for at least 6 months. On admission to the hospital, all patients were evaluated for fungal colonization by mouth, vagina, urine, and rectal swabs cultured in Sabouraud Dextrose Agar. Samples of sputum, bronchoalveolar lavage, urine, cerebrospinal fluid (CSF), pleural tap, and tissue biopsy were evaluated by direct microscopic examination and were cultured for any clinical signs of fungal infections. RESULTS: Fifty-four kidney recipients (45%) had Candida colonization in different sites of their bodies. Fungal infections presented in 13 of 120 recipients (10.8%). Five recipients had invasive fungal infections (3 had fungal pneumonitis and 2 had severe esophagitis), and 8 patients had cutaneous and mucocutaneous infections. All of the recipients with invasive fungal infections were colonized with Candida, and 2 of them died. Forty-two (84%) liver recipients had Candida colonization in different sites of their bodies. Fungal infections presented in 6 liver recipients. In 4 patients, invasive fungal infections occurred (2 fungal pneumonitis, 1 meningitis, and 1 severe esophagitis), 2 patients showed mucocutaneous infections. Three recipients with invasive fungal infections had Candida colonization. The mean time to diagnosis was 70 days after transplantation. The most common etiologic agent for fungal infections was Candida albicans. CONCLUSIONS: Renal and liver recipients with Candida colonization are at high risk for fungal infections and therefore, control of fungal colonization in liver and renal transplant candidates would reduce the risk of invasive fungal infections after transplantation.