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PubMed2003

[Infections by Candida sp. in intensive care. Survey of French practices].

OBJECTIVE: The isolation of Candida sp in nosocomial infections is on the increase and over the past 10 years many guidelines for "good" practices and recommendations have been published on the modalities for the management of systemic candidiasis. The aim of this paper was to assess the habits in the intensive care units in this domain in France. METHOD: A transversal survey on the habits was conducted from March to May 2001, using a questionnaire mailed to 200 intensive care units. RESULTS: One hundred eighty questionnaires (surgical reanimation: 12%, medical: 18%, medico-surgical: 70%) out of 200 (92.5%) were returned. The indirect diagnostic examinations: serology, search for antigenemia and PCR (Polymerase Chain Reaction) were never used in 21, 35 and 65% of cases. The systematic search for colonisation (a mean of 4 areas sampled) was conducted in all the patients by 19% of the investigators, in some patients by 53%, and never by 28%. An antifungal treatment was prescribed: in the presence of a positive haemoculture alone, once out of twice if the sample had been taken from a central catheter and in 2 cases out of 3 when the sample was peripheral. It was prescribed 6 times out of 10 after isolation of Candida sp following surgery or on needle aspiration of an intra-abdominal abscess, varyingly in the case of cadiduria, isolation of a Candida sp in a broncho-pulmonary sample or in abdominal draining and positive culture of a catheter, depending on the intensity of the colonisation, the severity of the clinical picture and the presence of factors of risk for Candida infection. It is still prescribed empirically depending on the same elements and the absence of explanation for worsening. When faced with candidemia in a non-neutropenic patient, a central catheter is not changed in 18% of cases. Depending on the microbiology, fluconazole is prescribed in: the identification of yeast without further precision (78% of cases), Candida sp without further precision (86% of cases), Candida non albicans without further precision (57% of cases), C. albicans (93% of cases), Candida non albicans other than C. krusei and C. glabrata (62% of cases), C. glabrata (36% of cases) with an increase in dose in 1 out of 2 cases. In the presence of C. glabrata or C. krusei, amphotericin B is the choice in respectively 51 and 75% of cases. To adapt the treatment.

Adult↗
PubMed2005

Relationship between oral Candida species and risk factors with reference to drugs with xerostomic side effects among institutionalised elderly in Aichi Pref., Japan.

OBJECTIVE: To clarify the relationship between Candida carriage and drugs which have reported xerostomic side effects in the elderly. DESIGN: Cross-sectional study. Setting Two long-term care facilities in Aichi Pref., Japan. PARTICIPANTS: Eight men and 63 women with a mean age of 86 years (range 62 to 95 years) with at least some of their natural teeth. METHOD: Oral examination by dentists, microbiological test by microbiologists, questionnaire interviews, and data obtained from medical files. The Candida species (CFU) was adopted as an objective variable with risk indicators being age, number of teeth, saliva flow rate, denture wearing, xerostomic drugs, activities of daily living (ADL), frequency of brushing and type of meals. RESULTS: Bivariate analysis confirmed that participants with a higher number of Candida species (CFU) fell into the following categories: denture wearing (p < 0.05), older age (p < 0.05), xerostomic drugs (p < 0.10), more teeth, poor ADL, soft/liquid meals, and brushing once a day. This was in contrast to the categories of no denture wearing, younger age, no xerostomic drugs, fewer teeth, good ADL, normal meals, and brushing two or more times a day, in that order of significant probability on an ascending scale. A multiple logistics regression model confirmed that the variables of older age (80 years and over) and more teeth (six or more) had statistically significant (p < 0.05) effects on the number of Candida species present (CFU). Xerostomic drugs and the other variables had no significant effect. CONCLUSION: Older age and more teeth had a significant effect on the number of oral Candida species in the elderly. The results of this study did not support a role of those drugs as a risk indicator for oral Candida carriage. Larger trials are needed to assess the effect of drugs on the presence of oral Candida.

Age Factors↗
PubMed2005

[The presence of Candida spp and rods of Enterobacteriaceae family in the vaginal swab specimens].

The aim of the present work was to determine the presence and quantity of yeasts (Candida) and rods of Enterobacteriaceae family in the ontocenosis of vagina in women. Also, we aimed at finding which species of Enterobacteriaceae accompany the yeasts. Furthermore we aimed at determining the etiological factor (Candida yeasts or Enterobacteriaceae rods) causing identical clinical symptoms such as burn, itch, leucorrhea. Vagina secretion collected from 649 patients constituted the material for examination Candida. In 137 patients (which constituted 21.1%) Candida yeasts were found (group I). These patients were additionally divided into 2 subgroups (I a and I b). Group I a consisted of 92 patients (14.2%) who exhibited the presence of Candida without the accompanying rods of Enterobacteriaceae and group I b consisting of 45 patients (6.9%), in whom Candida was found together with the rods. 171 patients (26.3%) were classified to group II, who had only Enterobacteriaceae rods in the vagina. Among Candida yeasts, the most common species were C. albicans, C. krusei, C. tropicalis. The most common rods of Enterobacteriaceae family were E. coli and P. mirabilis. The bacterium which most frequently accompanied the yeasts was E. coli. Considering the fact that patients in group I and patients in group II reported similar problems, the role of the etiological factor in the vaginal inflammatory processes should be analyzed.

Candida↗
PubMed2001

[Multifocal colonization and hydrolytic activity of Candida strains isolated from lung cancer patients].

UNLABELLED: The aim was looking for correlation between hydrolytic activity and multifocal Candida invasions in 33 lung cancer patients (LC) before treatment. Materials used in this study were pharyngeal and rectal swab, sputum, bronchial secretion and urine. Isolation and identification of fungi were performed using ID C 32 test and the hydrolytic activity using API ZYM test. RESULTS: 1/ there were only Candida strains, especially C. albicans (78,8 %) isolated 2/ Candida in more than one sample were present in 74%, in three or four in 27,7% of LC. 3/ Candida strains produced 17 among 19 investigated enzymes 4/ there were statistically significant correlations between the activity of some hydrolytic enzymes and number of Candida foci observed. CONCLUSIONS: 1/ the results confirmed the influence of Candida hydrolytic activity on the course of infection. 2/ hydrolytic enzymes activity is one of important Candida pathogenicity factors.

Adult↗
PubMedDate not supplied

Correlation between CD4 count and intensity of Candida colonization in the oropharynx of HIV-infected/ AIDS patient.

AIM: To know the correlation between CD4 count and intensity of Candida colonizations in the oropharynx of HIV-infected/AIDS patients, to get the prevalence of oropharyngeal candidiasis (OPC), and to know what kind of Candida species that causes oropharynx candidiasis of HIV-infected/AIDS patients. METHODS: A cross-sectional study was conducted in HIV-infected/AIDS patients who came as outpatients and inpatients in Cipto Mangunkusumo Hospital. The patients were interviewed, physically examined, their CD4 counts were checked, and their mouth rinse samples were taken to be cultured. Candida species was identified in CHROMagar media, and data were processed. RESULTS: From September 2004 until January 2005, 60 HIV-infected/AIDS patients were included in this study. There were 86.7% males and 13.3% females. Majority of the patients were from 20-30 years age group (85%). The most frequent transmission was among drug users (75%) followed by sexual contact (18.3%). The median of CD4 counts was 100 cells/il, ranged from 2 to 842 cells/il. Proportion of the OPC was 63.3% (CI 95% = 51.1 - 75.5). From 59 Candida isolates in this study, 74.58% were C. albicans. Candida non C. albicans species that were found in this trial were C. krusei, C. parapsilosis and C. tropicalis. There was significant correlation between low CD4 counts and high intensity of Candida colonization on the oropharynx of the subjects (r = -0.756). CONCLUSION: There was strong negative correlation (r = -0.756) between CD4 count and intensity of Candida colonization in the oropharynx of HIV-infected/AIDS patients. Proportion of OPC in this study was 63.3%. The most frequent species found in the oropharynx of the subjects was C. albicans.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

[Disk diffusion method for fluconazole susceptibility testing of Candida spp. isolates].

In order to standardize and evaluate a disk diffusion method with visual reading to detect in vitro fluconazole susceptibility of yeast, 1193 clinical isolates were tested. These included 584 Candida albicans, 196 Candida parapsilosis, 200 Candida tropicalis, 113 Candida glabrata, 50 Candida krusei and 50 Candida spp. and other opportunistic yeasts. The disks were manufactured in the INEI-ANLIS "Dr. Carlos G. Malbrán. The disk diffusion method results were compared to MIC results obtained by the reference CLSI M27-A2 broth microdilution method modified by EUCAST. The interpretative breakpoints for in vitro susceptibility testing of fluconazole were established at: zone diameter > or =16 mm for MIC < or =8 microg/ml (susceptible isolates), between 9 and 15 mm for MIC = 16-32 microg/ml (susceptible dose-dependent isolates), and < or =8 mm for MIC > or =64 microg/ml (resistant isolates). Overall agreement between the two methods was 94.7%, with 0.2% very major errors, and 0.3% major errors. Inter - and intralaboratory agreement was good. The disk diffusion method for drug susceptibility testing of Candida spp. isolates is inexpensive, reliable and reproducible. However, when the inhibition zone diameter is < or =15 mm, it is advisable to test the isolate by the reference microdilution method.

Antifungal Agents↗
PubMedDate not supplied

Detection of Candida antigen in bronchoalveolar lavage fluid.

While bronchoalveolar lavage is frequently performed to evaluate immunocompromised hosts for infection, the significance of rare yeasts found on the cytologic examination of lavage fluid is unclear. This study used the latex agglutination method to test lavage fluids for Candida antigen to assess its usefulness in distinguishing Candida pneumonia from Candida colonization of the respiratory tract or oral contamination of the lavage specimen. Ninety-seven specimens from 87 patients were categorized on the basis of historical, microbiologic, cytologic and serologic data. Bronchoalveolar lavage fluids were positive for Candida antigen in 0 of 20 specimens from normal controls, 0 of 14 specimens from patient controls, 5 (36%) of 14 specimens from patients with Pneumocystis carinii pneumonia, 0 of 5 specimens from patients with gastrointestinal candidiasis, 0 of 9 specimens contaminated by oral-derived yeasts, 2 (10%) of 19 specimens from patients with probable Candida colonization and 15 (94%) of 16 specimens from patients with clinical and laboratory evidence of Candida pneumonia. We conclude that this test assists in the differentiation of Candida pneumonia from other situations in which yeasts are recovered by bronchoalveolar lavage.

Antigens, Fungal↗
PubMed1986

Candida and perforated peptic ulcers.

Patients with perforated peptic ulcers who have Candida isolated from peritoneal culture have been noted to have a poor prognosis. Therefore treatment of such patients with systemic antifungal agents has been considered. Because of the toxicity and expense of such therapy, a review of the association was performed. During 1980 to 1985, 48 patients were operated on for benign perforated ulcer. The mean age of the patient group was 66 years. Intraoperative cultures were obtained in 38 patients. Microorganisms were isolated in 28 (74%) patients. Candida was isolated in 16 (57%) of the positive cultures. The overall mortality rate was 16.7%. The mortality rate for patients 65 years of age or older was 25% compared with 0% for those younger than 65 years old. The mortality rate for patients with Candida in their peritoneal fluid was 18.8%. No patient was treated with systemic antifungal agents. No patient developed candidiasis. Of the 16 patients in whom Candida was isolated, it was the only organism in 10 patients and was found in mixed culture with bacteria in six. The mortality rate for patients with Candida alone was 0%. The mortality rate for patients with mixed cultures was 50%. The presence of mixed cultures correlated strongly with both advanced patient age and shock. These factors have previously been correlated with death. It is concluded that the association between peritoneal Candida and excessive death from perforation is linked by an intervening association to advanced age and shock. In this setting, Candida does not appear to be normally pathogenic and does not require systemic antifungal therapy.

Adolescent↗
PubMed1984

Clinical comparison of microscopic and culture techniques in the diagnosis of Candida vaginitis.

This study compares potassium hydroxide (KOH), Microstix-Candida, and Nickerson's medium with Sabouraud agar in the isolation of Candida. Of 204 symptomatic and asymptomatic women, 36 had Sabouraud cultures positive for Candida. The KOH preparation demonstrated both poor sensitivity and poor predictive value in the isolation of Candida, while Microstix-Candida and Nickerson's medium were statistically indistinguishable from Sabouraud agar. The use of either Microstix-Candida or Nickerson's medium is recommended in the evaluation of Candida vaginitis when the KOH preparation is negative.

Adult↗
PubMed2004

Invasive Candida infections: the changing epidemiology.

Candida is recognized as the fourth most common cause of bloodstream infection in the United States, with a high attributable mortality rate. While Candida albicans remains the most common pathogen, non-albicans Candida species, including Candida glabrata and Candida krusei, with greater resistance to triazoles are being increasingly isolated. These epidemiologic changes are attributable to a combination of factors, such as the use of fluconazole prophylaxis, changes in patient demographics and underlying diseases, and use of therapeutic strategies that may pose unique risks. Of particular concern is the increased prevalence of species that are resistant to the azole antifungals. Candida glabrata, for example, is often resistant to fluconazole, and its ability to become cross-resistant to newer azole antifungals is a recent concern. Increasing evidence underscores the need to carefully evaluate antifungal treatment options, according to both host and therapeutic risks for drug resistance.

Antifungal Agents↗
PubMed1988

Candida. A decreasing problem for the burned patient?

Multiple recent reports have suggested that Candida wound infection and sepsis are major complications of severe burn injury. Our current burn treatment plans include aggressive early burn excision and grafting, avoidance of invasive monitoring and central hyperalimentation lines, enteral nystatin, and judicious use of antibiotics. A retrospective review of 168 severely burned patients admitted to the Intensive Care Unit of the University of Washington Burn Center, Seattle, during the 18-month period from June 1984 through December 1985 was undertaken. Thirteen percent of these patients had one or more cultures positive for Candida from any site. Three patients (1.8%) developed Candida sepsis, which was diagnosed on the basis of clinical signs of sepsis, a positive blood culture for Candida, and at least two additional culture sites positive for Candida. All three patients were treated with amphotericin B. One of these patients died of Candida sepsis, for an overall mortality of 0.6%. Therefore, Candida septicemia was not a major cause of morbidity or mortality in our burn patients in the Intensive Care Unit during this 18-month period under the current management regimen.

Adult↗
PubMed1983

Candida esophagitis.

Candida esophagitis is being increasingly recognized in the practice of clinical gastroenterology. The widespread use of corticosteroids, immunosuppressive drugs, and cancer chemotherapy, combined with the frequent use of endoscopy for the evaluation of esophageal symptoms, often leads to the identification of Candida infection in this part of the gastrointestinal tract. The salient clinical features of Candida esophagitis include odynophagia and dysphagia, although gastrointestinal bleeding may occasionally be the sole presenting symptom. While the radiological signs of Candida esophagitis are nonspecific, the endoscopic appearance is quite characteristic. Demonstration of tissue invasion by fungal mycelia on mucosal biopsy of the esophagus is diagnostic. The role of serology in the diagnosis of Candida esophagitis is not well defined. Oral nystatin therapy has been extensively used to control Candida infection of the esophagus. More recently amphotericin-B, 5-fluorocytosine and imidazole derivatives have been effectively used to treat recalcitrant cases of Candida esophagitis.

Antifungal Agents↗
PubMed2005

Oral nystatin prophylaxis of Candida spp. colonization in ventilated critically ill patients.

OBJECTIVE: Colonization of multiple body sites is a leading risk factor for Candida spp. infection in intensive care unit (ICU) patients. We evaluated whether oral nystatin prophylaxis reduces Candida spp. colonization in ventilated ICU patients. DESIGN AND SETTING: Prospective, randomized, open-label study with blinded assessment of the objective primary evaluation criterion in the medical-surgical ICU of a teaching hospital. PATIENTS: The study included 98 consecutive patients mechanically ventilated for at least 48 h (mean age 58+/-19 years; mean SAPS II 40+/-11), assigned to either treatment group (n=51) or control group (n=47). Study groups were comparable for age, SAPS II, reason for admission, and immune status. INTERVENTIONS: Patients were randomized to receive oral nystatin (treatment group; 3x10(6) U per day) or no nystatin (control group). Multiple body sites (trachea, stomach, rectum, urine, groin, and blood) were tested for Candida spp. on admission and then every 3 days by mycologists blinded to group assignment, and the colonization index was determined. RESULTS: Colonization by Candida spp. developed in 25% of controls but in none of the treated patients. In multivariate analysis, the absence of nystatin prophylaxis and ICU length of stay were independently associated with Candida spp. colonization. No invasive candidiasis was diagnosed in either study group. CONCLUSIONS: Oral nystatin prophylaxis efficiently prevented Candida spp. colonization in ICU patients at low risk of developing invasive candidiasis. Further studies are needed to determine whether this strategy remains efficient in reducing Candida spp. infections in higher risk ICU patients.

Administration, Oral↗
PubMed2006

Early presumptive therapy with fluconazole for occult Candida infection after gastrointestinal surgery.

The objective of this retrospective comparative study was to improve the outcome of patients with suspected occult Candida infection after gastrointestinal surgery by early presumptive therapy. It was conducted in the National Cheng Kung University Hospital in Taiwan. A total of 36 patients with prolonged ileus with fever after gastrointestinal tract surgery between January 1995 and December 2002 were examined for two time periods: those treated before and those treated after January 1999. One set of patients did not receive early presumptive therapy (EPT) until Candida infection was confirmed, and they were designated EPT(-). Another group of patients with suspected occult Candida infection received EPT and were designated EPT(+). Fluconazole, 400 mg/day, was given as EPT. Urine, wound, intraperitoneal drainage, and blood specimens were obtained from patients for fungus culture before starting treatment and weekly until symptoms subsided. The primary endpoints were the frequency of candidiasis and the persistence of candidemia; the secondary endpoint was the efficiency of EPT in the clinical outcome. There was no difference in Candida peritonitis, wound colonization, or urine colonization in the two treatment groups. Candida albicans accounted for 87.5%% of the isolated Candida species: 84.6%% in the EPT(+) group and 89.5%% in the EPT(-) group. In the EPT(+) group, the positive blood culture rate was 66.7%%. The fever subsided rapidly in 17 patients (94%%), the hospital stay and intensive care unit stay were shorter, and the mortality decreased significantly: 11%% vs. 78%%, P < 0.001. Persistent gastrointestinal ileus was the main cause of breakthrough candidemia. We concluded that EPT with fluconazole improves the prognosis of patients with occult Candida infection after gastrointestinal surgery. Surgical intervention was required in patients with breakthrough candidemia.

Adult↗
PubMed1990

Hierarchical pattern of mucosal candida infections in HIV-seropositive women.

PURPOSE: Candida is the most common cause of opportunistic mucosal infections in human immunodeficiency virus (HIV)-positive women. We had observed an apparent correlation between the severity of immunodeficiency and the site of mucosal candida infection. The current study was designed to determine whether significant correlations existed between the sites of mucosal candida infection and the degree of immunodeficiency, as determined by subsets of lymphocyte populations. PATIENTS AND METHODS: The subjects in this study are 66 HIV-seropositive women evaluated by members of the Brown University Acquired Immunodeficiency Syndrome (AIDS) Program during the 3-year period, September 1, 1986, through August 30, 1989. All patients had thorough clinical evaluations and relevant laboratory studies at defined intervals. All patients with CD4 lymphocyte counts below 0.2 X 10(9)/L received zidovudine therapy as soon as it became available. After July 1988, all patients with CD4 counts below 0.2 X 10(9)/L received prophylaxis against Pneumocystis carinii pneumonia. All patients were counseled about HIV infection, its modes of transmission, and the early symptoms of opportunistic infections. RESULTS: The longitudinal data demonstrated that candida often infected vaginal mucosa when there was no significant reduction in CD4 lymphocyte counts. Candida infection of the oropharyngeal mucosa was associated with highly significant reductions in CD4 lymphocyte counts. Esophageal candidiasis occurred only with advanced immunodeficiency associated with CD4 counts below 0.1 X 10(9)/L. CONCLUSIONS: Candida mucosal infections occur in a hierarchical pattern in women with HIV infection. Determination of the basis for the differences in susceptibility to candida of the vaginal, oropharyngeal, and esophageal mucosal surfaces will require further studies.

Adolescent↗
PubMed1988

Incidence and treatment of candida esophagitis in patients undergoing renal transplantation. Data from the Minnesota prospective randomized trial of cyclosporine versus antilymphocyte globulin-azathioprine.

Of 224 consecutive renal transplant patients in a prospective, randomized immunosuppressive trial, candida esophagitis developed in 5 despite nystatin prophylaxis. No differences were noted between cyclosporine and antilymphocyte globulin-azathioprine immunosuppressive treatment. All patients were diabetic, and four were recipients of cadaver kidneys. Candida esophagitis occurred within 6 months after transplantation, and only one patient had recurrence. All patients responded to treatment consisting of 2 to 6 days of intravenous amphotericin B (0.2 to 2 mg/kg total dose). The prevalence of candida esophagitis was not related to rejection episodes. Three of five patients eventually died, one 2 weeks after resolution of candida esophagitis from a hypoglycemic episode, one from acute exacerbation of pulmonary failure and relapsing pancreatitis in association with candida esophagitis and therapy-resistant candidemia, and one 17 months after candida esophagitis from pulmonary edema. Our findings show that candida esophagitis by itself is an easily managed complication, but is also a sign of potentially increased morbidity in these patients.

Adult↗
PubMed1983

Fatal candida pneumonia in a non-immunosuppressed host.

An 83-year-old previously well non-immunosuppressed woman developed invasive fatal candida pneumonia, apparently caused by aspiration. Diagnosis was suggested by the presence of sheets of budding yeasts and pseudohyphae on Gram-stained expectorated sputum and confirmed by an open lung biopsy which demonstrated candida invading lung tissue. Culture of material obtained by open lung biopsy yielded Candida albicans. At autopsy the patient had extensively invasive bilateral candida pneumonia. No other pathogens were isolated from sputum, open lung biopsy or at the time of autopsy. Evidence of disseminated candidiasis was not seen at autopsy. To our knowledge, this is only the fourth documented case of aspiration candida pneumonia in a non-immunosuppressed adult. While candida pneumonia in an immunocompetent adult is very rare, it should be considered in an elderly patient who is not responding to antibiotic therapy. Diagnosis requires aspiration or biopsy of lung, with preferably both histological and cultural evidence of candida infection.

Adult↗
PubMed1999

Invasive yeast infections other than Candida spp. in acute leukaemia.

During the last two decades, the treatment of leukaemia has changed significantly; increasing intensity of chemotherapy and bone marrow transplantation have lead to profound immunosuppression, prolonged stays in hospital, vascular catheterization, administration of broad spectrum antimicrobial agents and extensive use of prophylactic antifungal drugs. All but the last of these risk factors have increased the incidence of fungal infections in leukaemic patients and have significantly changed the spectrum of pathogens in favour of non-Candida species. In major haematological centres in Europe and the US, the proportion of non-Candida yeast isolated from patients increased from 1 to 5% in 1980 to 10 to 25% after 1990. However, there are not enough data to assess whether mortality due to these species is higher than that due to Candida spp. (30-40%) or filamentous fungi (50-70%). In this article, specific risk factors and therapeutic outcome of yeast infections other than Candida spp. in leukaemia such as Malassezia furfur, Trichosporon spp., Blastoschizomyces capitatus, Rhodotorula rubra, Saccharomyces cerevisiae, Clavispora lusitaniae, Cryptococcus laurentii and Hansenula anomala are reviewed. An analysis of risk factors from the National Cancer Institute, Bratislava has shown that non-Candida yeast infections (N = 15) in cancer patients are associated with leukaemia and neutropenia (P = < 0.002, 0.005), more often fatal than those caused by C. albicans (N = 51) (P < 0.006) but not non-albicans Candida (N = 34) and are associated with quinolone (P < 0.0001) and itraconazole prophylaxis (P < or = 0.05, 0.015) compared to both C. albicans or non-albicans Candida respectively.

Acute Disease↗