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PubMed1994

Short report: time course of clinical response with fluconazole for Candida oesophagitis in patients with AIDS.

BACKGROUND: Although fluconazole is increasingly utilized for the therapy of Candida oesophagitis in patients with AIDS, the time course of response has not been adequately defined. METHODS: Over a 48-month period, all HIV-infected patients undergoing upper endoscopy at a large city-county hospital were identified prospectively. Symptomatic patients with endoscopic and histopathologically confirmed Candida oesophagitis in whom oral antifungal therapy had not been received within the past three months were treated in an open-label fashion with fluconazole 200 mg on the first day followed by 100 mg daily for two weeks. All patients were followed clinically to determine the rapidity of response. RESULTS: Eighteen patients were identified; all but two were male. Candida oesophagitis was graded as severe in 13 patients (72%). A complete symptomatic response was seen by five days in seven patients (39%) and by seven days in nine additional patients (cumulative response, 89%). The two other patients had improved by at least 50% at one week, with a complete symptomatic response seen at two weeks. CONCLUSIONS: Our study confirms anecdotal experience suggesting that fluconazole results in a rapid clinical response for Candida oesophagitis in patients with AIDS. Given this rapidity, a one-week course of empiric treatment with fluconazole for HIV-infected patients with newly developed esophageal symptoms could be used as an appropriate time period to assess a response prior to further diagnostic evaluation with endoscopy.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Prevention of gram-positive and Candida albicans infections using teicoplanin and fluconazole: a randomized study in neutropenic children.

We have shown that the combination of teicoplanin (T) and ceftriaxone (C) given once daily as first-line empirical antimicrobial therapy is very effective (85%) and safe in febrile neutropenic children (ICAAC, 1988). Like others (ICAAC, 1989) we have stressed the new life-threatening problems with Streptococcus mitis and Strep. sanguis. Considering the regular sensitivity of Gram-positive organisms to T, it is possible that the introduction of the glycopeptide at the onset of aplasia may be helpful. The high incidence of fungal infection or superinfection supports the routine use of an effective antifungal agent when fever is still present or relapse occurs. Our study was designed to assess the prevention of (1) staphylococcal and streptococcal infections using T when the central catheter is being placed, and (2) candida infection by the simultaneous use of a new anti-mycotic agent fluconazole (F) administered once-daily. Patients were randomized into two arms of the study. Arm A received T 6 mg/kg/d and F 3 mg/kg/d starting when the catheter was put in place. If fever occurred, C 50 mg/kg/d and amikacin (A) 15 mg/kg/d were added and T increased to 10 mg/kg/d. If a febrile relapse occurred, amphotericin B was added. In arm B the combination of the three agents T 10 mg/kg/d, C 50 mg/kg/d and A 15 mg/kg/d was started only if there was fever. Amphotericin B was used in febrile relapses. Forty-six patients were eligible (23 in each arm; no statistically significant differences between the two groups). The mean age of the patients was 8 years and mean duration of aplasia 23 and 24 d. Results were as follows: arm A the duration of T + F alone was 10 d, 22 patients had a febrile episode with 1 Gram-positive, 11 Gram-negative and one candida strain isolated in eight patients. C + A were effective in 72% of these patients. There were no deaths. In arm B, fever occurred in all patients during the first 6 d, with eight Gram-positive and six Gram-negative organisms isolated in nine patients. C + T + A were successful in 83% of patients. A bacterial superinfection was documented in four patients, candida superinfection in seven patients and one patient died from Candida parakrusei septicaemia. When the total amount of C and A used in both arms was compared, there was a reduction in 20% of the two agents in arm A, but T was equivalent in both arms. Treatment was well tolerated in both arms.(ABSTRACT TRUNCATED AT 400 WORDS)

Acute Disease↗
PubMed1992

Oral ketoconazole prophylaxis for Candida infections during induction therapy for acute leukaemia in adults: more bacteraemias.

We determined whether ketoconazole prophylaxis might reduce Candida colonization and infections in adult patients with acute leukaemia. During first-remission induction therapy 50 patients were treated with 200 mg ketoconazole administered orally daily, while 57 patients received placebo in a double-blind, randomized trial. The duration of severe neutropenia (granulocytes less than 0.1 x 10(9) l-1) represented 36% of the study period in the ketoconazole group and 26% in the placebo group (P = 0.043). Although fewer patients presented with positive Candida surveillance cultures and serological evidence of Candida infection in the ketoconazole group compared to the placebo group, two candidaemias and one Trichosporum fungaemia were observed in the ketoconazole group. Moreover, significantly more bacteraemias were noted in the ketoconazole group (n = 37) than in the placebo group (n = 21) (P = 0.004). Thus, although oral ketoconazole prophylaxis might be associated with less Candida colonization and fewer seroconversions, it also resulted in more bacteraemias and longer duration of severe neutropenia, suggesting that caution should be exercised when ketoconazole (or related drugs) is given to this group of immunocompromised hosts.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2004

[Candida- and Aspergillus-antibody-Elisa--expected positive antibody results in sera of the clinical-mycological routine diagnostics].

Based on the ELISA results of more than 15000 serum samples of clinical mycological routine diagnostics, the expected frequency of positive antibody ELISA results within the immunoglobulin classes IgM, IgG and IgA was determined, to optimize the diagnostic assessment of first or single result of Candida or Aspergillus antibody ELISA. In general diagnostics the expected frequency of positive antibody ELISA results of the first sample within the immunoglobulin classes were as follows: Candida antibody IgM 6.1%; IgG 6.0%; IgA 2.1% and Aspergillus antibody IgM 11.4%; IgG 22.1% and IgA 5.1%, respectively. Using the Candida antibody ELISA as confirmation test only, percentages of positive antibody results in the first sample were 2.5 to 3 times higher than in general diagnostics. In follow-up examinations the Candida antibodies showed different kinetics within the immunoglobulin classes compared to those of the Aspergillus antibodies.

Antibodies, Fungal↗
PubMed1977

Disseminated arthritis and osteitis by Candida albicans in a two month old infant receiving parenteral nutrition.

The case of a two-month -old female infant, who after a severe diarrhoea treated with prolonged intravenous infusion in peripheral veins alternated with total parenteral feeding, developed a Candida albicans septicemia (accompanied by disseminated intravascular coagulation syndrome) is reported. The course of her disease was also complicated by multiple foci of osteoarthritis in both knees, in the left hip and in several long-bones. Radiographically the foci of Candida osteitis appeared as fine erosion of the cortex and minute round areas of osteolysis in the spongiosa, surrounded by a rim of perifocal sclerosis. During the acute stage of Candida sepsis a transitory cellular immunodeficiency was present. Treatment of Candida infection by 5-fluorocytosine was followed by complete recovery.

Arthritis, Infectious↗
PubMed2005

A 2-year study of Candida-associated denture stomatitis treatment in aged care subjects.

OBJECTIVE: To test the efficacy of two methods of treatment for denture stomatitis in aged care institutions. BACKGROUND DATA: Candida-associated denture stomatitis has been associated with a lack of denture hygiene. MATERIALS AND METHODS: Sixty subjects with denture stomatitis were randomly divided into three groups: sodium hypochlorite denture soak, microwaving and control. Both methods of treatment were carried out on a nightly basis for 1 week, excepting the control group. Standardised photographs of the palate and microbial samples of palate, upper and lower dentures were taken before and after treatment. RESULTS: Both hypochlorite and microwave irradiation significantly reduced the numbers of Candida and aerobic bacteria on both dentures and both methods significantly reduced Candida on the palate. However, palatal aerobic bacteria were not significantly reduced by either method and the controls showed insignificant changes at all three sites for both Candida and aerobes. CONCLUSION: While both methods of denture disinfection were successful, except for the counts of palatal aerobic bacteria, three independent observers of the clinical photographs had difficulty in identifying the controls but were more successful with the treatments. The raters also showed that there was no difference between both methods of disinfection and this agreed with the microbiological analysis.

Aged↗
PubMed1992

[A case of Candida albicans endocarditis with impaired lung function].

A 53-year-old male was admitted to the hospital because of Candida albicans endocarditis. He had had a thoracoplasty due to pulmonary tuberculosis and showed severe restructive lung function. In 1987 and '89, trachiostomy was made because of respiratory failure. The patient was well until nine months earlier, when he consulted a physician because of fever. The investigations failed in finding the cause of the fever. He was administered antituberculosis agents and antiinflammatory drugs but had a fever every day. Two months before admission, a cardiac ultrasonographic study showed evident vegetations with mitral regurgitation. From the above course and examinations, a diagnosis of Candida albicans endocarditis was made. Infusions of CEZ, TOB, PIPC and miconazole for more than one month was ineffective. In November, 1990, he was referred to our medical center for the purpose of operation. A blood culture proved Candida albicans infection. An intravenous administration of fluconazole 400 mg/day was begun. However, there was pulmonary bleeding probably due to heparin used for prevention of atrial thrombosis and he developed fever, hypoexemia, ventricular tachycardia, and hyponatremia. He underwent mitral-valve replacement with a SJM valve. Culture of the vegetated mitral valve again proved Candida albicans. After operation, hypoexemia, ventricular tachycardia, hyponatremia were improved gradually. However he had an eosinophilia, eruption, and dyspnea. We suspected a drug eruption of fluconazole. Lymphocyte stimulating test of fluconazole proved positive. After the episode, he had no symptoms and was discharged.

Candidiasis↗
PubMed2005

Delaying the empiric treatment of candida bloodstream infection until positive blood culture results are obtained: a potential risk factor for hospital mortality.

Fungal bloodstream infections are associated with significant patient mortality and health care costs. Nevertheless, the relationship between a delay of the initial empiric antifungal treatment until blood culture results are known and the clinical outcome is not well established. A retrospective cohort analysis with automated patient medical records and the pharmacy database at Barnes-Jewish Hospital was conducted. One hundred fifty-seven patients with a Candida bloodstream infection were identified over a 4-year period (January 2001 through December 2004). Fifty (31.8%) patients died during hospitalization. One hundred thirty-four patients had empiric antifungal treatment begun after the results of fungal cultures were known. From the time that the first blood sample for culture that was positive was drawn, 9 (5.7%) patients received antifungal treatment within 12 h, 10 (6.4%) patients received antifungal treatment between 12 and 24 h, 86 (54.8%) patients received antifungal treatment between 24 and 48 h, and 52 (33.1%) patients received antifungal treatment after 48 h. Multiple logistic regression analysis identified Acute Physiology and Chronic Health Evaluation II scores (one-point increments) (adjusted odds ratio [AOR], 1.24; 95% confidence interval [CI], 1.18 to 1.31; P < 0.001), prior antibiotic treatment (AOR, 4.05; 95% CI, 2.14 to 7.65; P = 0.028), and administration of antifungal treatment 12 h after having the first positive blood sample for culture (AOR, 2.09; 95% CI, 1.53 to 2.84; P = 0.018) as independent determinants of hospital mortality. Administration of empiric antifungal treatment 12 h after a positive blood sample for culture is drawn is common among patients with Candida bloodstream infections and is associated with greater hospital mortality. Delayed treatment of Candida bloodstream infections could be minimized by the development of more rapid diagnostic techniques for the identification of Candida bloodstream infections. Alternatively, increased use of empiric antifungal treatment in selected patients at high risk for fungal bloodstream infection could also reduce delays in treatment.

Adult↗
PubMed1995

Methods for detection of an intestinal secretory immunoglobulin A response to Candida spp. and their preliminary application in human immunodeficiency virus-infected patients with chronic diarrhea.

Six of 11 human immunodeficiency virus (HIV)-infected patients with chronic diarrhea, shedding only Candida spp. in their stools, elicited a Candida-specific secretory immunoglobulin A response. Similar responses were identified in only 1 of 10 HIV-positive patients with chronic diarrhea but without Candida spp. and in none of 10 HIV-negative subjects without diarrhea. Candida spp. may play a role in the etiology of chronic diarrhea associated with HIV infection.

AIDS-Related Opportunistic Infections↗
PubMed1979

Experimental hematogenous Candida endophthalmitis: diagnostic approaches.

Anterior chamber aspiration and vitreous aspiration were evaluated as diagnostic procedures for establishing a specific microbiological diagnosis in the rabbit model of hematogenous Candida endophthalmitis. Vitreous aspiration was the most successful procedure, confirming the diagnosis of hematogenous Candida endophthalmitis in 62% of eyes with documented intraocular infection. When animals with only the most severe clinical endophthalmitis were considered, vitreous aspiration confirmed the diagnosis in 89% of eyes evaluated. Vitreous aspiration correlated well with the extent of clinical endophthalmitis, as well as with postmortem, whole-vitreous cultures. Gram staining of the aspirate was additive to culture results in confirming the diagnosis. Anterior chamber aspiration was positive in only 1 of 58 eyes evaluated (1.7%). Additionally, muscle biospy was evaluated in this study as a tool for establishing a microbiological diagnosis in the rabbit model of disseminated candidiasis. Only 2 of 131 biospy specimens contained detectable Candida. Although vitreous aspiration may be associated with ocular complications, in certain clinical settings this procedure may be valuable in establishing the definitive microbiological diagnosis of hematogenous Candida endophthalmitis.

Animals↗
PubMed1986

Increased susceptibility to lethal Candida infections in burned mice preinfected with Pseudomonas aeruginosa or pretreated with proteolytic enzymes.

Lethal Candida infections in burn patients are frequently preceded by or occur concomitantly with bacterial infections, which are often due to Pseudomonas aeruginosa. In this study, we developed a burned, mixed-challenge mouse model, which was designed to determine whether and how a recent bacterial infection could influence the development of subsequent candidosis. In this model, burned mice that were preinfected with a sublethal challenge of elastase-producing P. aeruginosa strain WR-5 and then sublethally challenged with Candida albicans exhibited a mortality rate of 60%, while unburned mice challenged in the same way and burned mice that received only one challenge organism exhibited mortality rates of less than 10%. Quantitative microbial counts performed with the kidneys, livers, and eschars of burned mice challenged with both organisms indicated that the deaths were due to Candida infection. Substitution of an elastase-negative P. aeruginosa strain for strain WR-5 in the model resulted in significantly lower mortality rates and lower microbial numbers in the organs. When the Pseudomonas enzyme elastase was substituted for the elastase-positive bacteria in the model, both the mortality rates and the organ counts were comparable to the values found after preinfection with strain WR-5. Another protease, thermolysin, was substituted for the elastase and produced similar mortality results. When the protease inhibitor alpha 2-macroglobulin was given to burned mice infected with the two organisms, it prevented the deaths due to Candida infection. We concluded that this model is one way to study bacterial-fungal infections in burned mice, that recent Pseudomonas infections could predispose burned mice to fatal candidosis, and that the proteolytic activity generated by the bacteria was primarily responsible for the establishment of lethal fungal infections.

Animals↗
PubMed1998

A vaccine and monoclonal antibodies that enhance mouse resistance to Candida albicans vaginal infection.

We previously reported that a vaccine composed of liposome-mannan complexes of Candida albicans (L-mann) stimulates mice to produce protective antibodies against disseminated candidiasis. An immunoglobulin M (IgM) monoclonal antibody (MAb), B6.1, specific for a beta-1,2-mannotriose in the complexes protects against the disease, whereas MAb B6 does not. In the present study, the vaccine and MAbs B6.1 and B6 were tested for the ability to protect against Candida vaginal infection, established by intravaginal (i.vg.) inoculation of yeast cells in mice maintained in pseudoestrus. Fungal CFU in each vagina was determined to assess the severity of infection. Mice vaccinated before infection developed about 62% fewer vaginal CFU than nonimmunized controls. Naive mice that received polyclonal antiserum (from vaccinated mice) i.vg. before infection had 60% fewer CFU than controls. The serum protective factor was stable at 56 degreesC, but C. albicans cells absorbed this factor. Mice given MAb B6.1 i.vg. after infection was established had fewer Candida CFU in vaginal tissue than control mice given buffer instead of antibody. MAbs B6.1 and B6 given intraperitoneally before infection protected mice, but MAbs preabsorbed with yeast cells did not. MAb B6.1 also protected against C. tropicalis vaginal infection, but MAb B6 did not. The protective activities of MAbs B6.1 and B6 appeared to be specific because an irrelevant IgM carbohydrate-specific MAb and an irrelevant IgG protein-specific MAb were not protective; also, MAb B6.1 did not affect development of vaginal chlamydial infection. These studies show that an appropriate antibody response, or administration of protective antibodies, can help the host to resist Candida vaginal infection.

Animals↗
PubMed2001

Chlamydia trachomatis infection does not enhance local cellular immunity against concurrent Candida vaginal infection.

Although Th1-type cell-mediated immunity (CMI) is the predominant host defense mechanism against mucosal Candida albicans infection, CMI against a vaginal C. albicans infection in mice is limited at the vaginal mucosa despite a strong Candida-specific Th1-type response in the draining lymph nodes. In contrast, Th1-type CMI is highly effective against an experimental Chlamydia trachomatis genital tract infection. This study demonstrated through two independent designs that a concurrent Candida and Chlamydia infection could not accelerate or modulate the anti-Candida CMI response. Together, these results suggest that host responses to these genital tract infections are independent and not influenced by the presence of the other.

Animals↗
PubMed2006

Measurement of serum D-arabinitol/creatinine ratios for initial diagnosis and for predicting outcome in an unselected, population-based sample of patients with Candida fungemia.

D-Arabinitol (DA) is a useful diagnostic marker for candidiasis in patients with neutropenia and other high-risk groups, but its use in unselected patients with a broad range of underlying diseases and conditions has not been studied. We used an automated enzymatic fluorometric assay to measure serum DA/creatinine ratios (DA/cr's) in 30 healthy adults, 100 hospitalized controls without Candida fungemia, and 83 patients from a study of all Candida fungemias in Connecticut between October 1998 and September 1999. Sixty-three of 83 (76%) fungemic patients and 11 of 100 (11%) nonfungemic controls had serum DA/cr's >or=3.9 microM/mg/dl (mean + 3 standard deviations for 30 healthy adults). High serum DA/cr's were less frequent in patients with cancer or fungemia caused by the DA nonproducer Candida glabrata than in patients with cancer or fungemia caused by a DA producer, C. albicans, C. tropicalis, or C. parapsilosis. The serum DA/cr was first >or=3.9 microM/mg/dl before, on the same day as, or after the first positive blood culture was drawn for 30 (36%), 22 (27%), and 11 (13%) fungemia patients, respectively. Mortality did not differ significantly among the patients with high or normal initial or peak serum DA/cr's, but mortality was higher if any serum DA/cr value was >or=3.9 microM/mg/dl 3 or more days after the onset of fungemia (18/27 versus 4/24 patients, respectively; P < 0.001). We conclude that serum DA/cr's are useful both for the initial diagnosis of Candida fungemia and for prognostic purposes for unselected patients with a broad range of underlying diseases and conditions.

Adolescent↗
PubMed1982

Antenatal infections with Candida species.

The clinical, pathological, and microbiological features of 18 pregnancies complicated by intrauterine infection with Candida sp. are described. Chorioamnionitis with Candida sp. can be recognised macroscopically at birth. Penetration of the umbilical cord and membranes is associated with an intense fetal inflammatory response. The infection characteristically presents in infants of very low birthweight as pneumonia or a skin infection. In nearly every case the organism can be recovered from the gastric aspirate. A case control study showed that there is a striking association between chorioamnionitis caused by Candida sp. and the presence of a foreign body (an intrauterine contraceptive device or a cervical suture) in the mother's genital tract in pregnancy. This feature in the perinatal history of an infant of short gestation who exhibits a very high neutrophil count should alert the clinician to the possible presence of chorioamnionitis due to Candida sp.

Candidiasis↗
PubMed1988

Immunological analysis of the aqueous humour in candida endophthalmitis. II: Clinical study.

An anterior chamber paracentesis was carried out on six patients with candida endophthalmitis and on control subjects. We endeavoured to find out if there was local production of antibodies by evaluating the anti-candida antibody titres, the immunoglobulin G, and the albumin levels in the aqueous humour and in the serum. A significant difference in the level of specific antibodies between patients and controls was found. Local synthesis of anti-candida antibodies was discovered in five out of six patients with candida endophthalmitis. There would seem to be a correlation between the severity of uveitis and antibody titres.

Adult↗
PubMed2001

Echocardiographic features of Candida species endocarditis: 12 cases and a review of published reports.

OBJECTIVE: To describe the specific echocardiographic features of Candida species endocarditis. DESIGN: Retrospective review of the case records of patients with confirmed candida endocarditis. SETTING: Cases referred to three French university centres over an eight year period were studied. DESIGN: 12 patients with confirmed Candida species endocarditis infection were identified. The transthoracic (n = 12) and transoesophageal (n = 12) echocardiographic appearances were compared with the surgical findings (n = 10). RESULTS: Large dense heterogeneous vegetations were found in 11/12 cases. A hyperechogenic heterogeneous myocardial texture, observed in seven of the 12 patients, was associated with extensive myocardial damage at surgery. While it was possible to diagnose candidal cardiac infection in all patients by transthoracic echocardiography, transoesophageal echocardiography was useful for optimal assessment of the valvar and paravalvar structures. CONCLUSIONS: In the setting of endocarditis, the detection of myocardial involvement, which is characterised by a heterogeneous myocardial texture, is an argument in favour of Candida species endocarditis and may warrant early surgical intervention.

Adult↗
PubMed2005

Folsomia candida (Collembola): a "standard" soil arthropod.

Folsomia candida Willem 1902, a member of the order Collembola (colloquially called springtails), is a common and widespread arthropod that occurs in soils throughout the world. The species is parthenogenetic and is easy to maintain in the laboratory on a diet of granulated dry yeast. F. candida has been used as a "standard" test organism for more than 40 years for estimating the effects of pesticides and environmental pollutants on nontarget soil arthropods. However, it has also been employed as a model for the investigation of numerous other phenomena such as cold tolerance, quality as a prey item, and effects of microarthropod grazing on pathogenic fungi and mycorrhizae of plant roots. In this comprehensive review, aspects of the life history, ecology, and ecotoxicology of F. candida are covered. We focus on the recent literature, especially studies that have examined the effects of soil pollutants on reproduction in F. candida using the protocol published by the International Standards Organization in 1999.

Animals↗