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Candidiasis is the most common opportunistic yeast infection, with Candida albicans as a paramount causative species. (1,3)-β-D-glucan is one of the three main targets of clinically available antifungal agents used to treat Candida infections. It is one of the most abundant fungal cell wall components. Echinocandins represent the newest class of antifungals affecting cell wall biosynthesis through non-competitive inhibition of (1,3)-β-D-glucan synthase. Therefore, treatment with echinocandins causes defects in fungal cell integrity. In the present study, similar activity of emodin (6-methyl-1,3,8-trihydroxyanthraquinone) has been revealed. Many reports have already shown the antifungal potential of this pleiotropic molecule, including its activity against C. albicans. The aim of this report was to evaluate the activity of emodin towards a new molecular target, i.e. (1,3)-β-D-glucan synthase isolated from Candida cells. Moreover, given the identical mechanism of the activity of both molecules, interaction of emodin with caspofungin was determined. The study revealed that emodin reduced (1,3)-β-D-glucan synthase activity and increased cell wall damage, which was evidenced by both a sorbitol protection assay and an aniline blue staining assay. Furthermore, the synergy testing method showed mainly independence of the action of both tested antifungal agents, i.e. emodin and caspofungin used in combination.
Congenital candidiasis is a severe complication of candidal vulvovaginitis. It occurs in two forms, congenital mucocutaneous candidiasis and congenital systemic candidiasis. Also newborns are in age group the most vulnerable to invasive candidiasis. Congenital candidiasis should be considered as an interdisciplinary problem including maternal and fetal condition (including antibiotic therapy during pregnancy), birth age and rare genetic predispositions as severe combined immunodeficiency or neutrophil-specific granule deficiency. Environmental factors are no less important to investigate in diagnosing, treatment and prevention. External factors (e.g., food) and microenvironment of human organism (microflora of the mouth, intestine and genitalia) are important for solving clinical problems connected to congenital candidiasis. Physician knowledge about microorganisms in a specific compartments of the microenvironment of human organism and in the course of defined disorders of homeostasis makes it easier to predict the course of the disease and allows the development of procedures that can be extremely helpful in individualized diagnostic and therapeutic process.
The antimicrobial, antibacterial, antioxidant, antihyperlipidaemic, antidiabetic, anti-inflammatory and analgesic effects of Satureja khuzestanica (Lamiaceae) have been investigated in numerous studies. The antifungal effects of S. khuzestanica essential oil (SKJO) in immunosuppressed rats suffering from oral candidiasis were investigated. A fungal suspension with a density of 3×108 CFU/ml was taken from the isolate of a case with acute vaginitis. In order to achieve a medicinal formulation, accurate twice the minimum inhibitory concentration (MIC) of SKJO and 10 times MIC of nystatin was used with 0.8% agar as a base material. In this study, 35 rats divided into 5 groups each of 7 were used. The assessment of level of infection and specification of the effects of treatment were performed using microbiological and histopathological methods as well as clinical examinations. Our results show that carvacrol is the main compound of SKJ essential oil. Lesions completely disappeared in both treatment groups (SKJO and nystatin) after 8 days of treatment. Furthermore, in groups treated with SKJO and nystatin, the quantities of mean logarithm of colony forming unit (CFU) were 85.62% and 90.62%, respectively, in comparison with placebo group. Also, histopathological properties suggested no infection in groups who had clean and normal dorsal tongue mucosa. Using SKJO with twice accuracy it was concluded that MIC in immunosuppressed rats was quite successful in a time of a week and equal with that of a nystatin treatment with an accuracy of 10 times the MIC.
The frequency of severe systemic fungal diseases has increased in the last few decades. The clinical use of antibacterial drugs, immunosuppressive agents after organ transplantation, cancer chemotherapy, and advances in surgery are associated with increasing risk of fungal infections. Opportunistic pathogens from the genera Candida and Aspergillus as well as pathogenic fungi from the genus Cryptococcus can invade human organism and may lead to mucosal and skin infections or to deep-seated mycoses of almost all inner organs, especially in immunocompromised patients. Nowadays, there are some effective antifungal agents, but, unfortunately, some of the pathogenic species show increasing resistance. The identification of fungal virulence factors and recognition of mechanisms of pathogenesis may lead to development of new efficient antifungal therapies. This review is focused on major virulence factors of the most common fungal pathogens of humans: Candida albicans, Aspergillus fumigatus and Cryptococcus neoformans. The adherence to host cells and tissues, secretion of hydrolytic enzymes, phenotypic switching and morphological dimorphism contribute to C. albicans virulence. The ability to grow at 37°C, capsule synthesis and melanin formation are important virulence factors of C. neoformans. The putative virulence factors of A. fumigatus include production of pigments, adhesion molecules present on the cell surface and secretion of hydrolytic enzymes and toxins.
Vaginal candidiasis is a common problem of clinical practice. Many studies have been conducted to explain its origin but only a few have included Polish women. The aim of the study was to determine the prevalence and similarity of oral, anal and vaginal Candida albicans strains isolated from Polish women with vaginal candidiasis. The study involved 20 from 37 recruited women. Swab samples were collected from their vagina, anus, and oral cavity at two-month intervals. All the women were treated with nystatin. Yeast were recovered and identified by the germ-tube test, API /Vitek system, typed by API ZYM and RAPD-PCR. Chi-square test was used to analyze the data. A total of 170 Candida albicans isolates were recovered from 180 samples collected 3 times from 3 sites of 20 women. Positive yeast vaginal cultures were found in all patients before administration of nystatin. Vaginal yeast recovery rate was decreased statistically significant in both follow-up visits (p =0.001; p =0.003). The same and different genotypes/biotypes were found concomitantly in a few body sites and/ or repeatedly at time interval from the same body site. The results support the concept of dynamic exchange of yeast within one woman and endogenous or exogenous origin of vaginal candidiasis.
The aim of the work was the early detection of Candida spp. in clinical samples of patients with carcinoma ovariorum undergoing chemotherapy by comparing three indicators of candidiasis: presence of mannan and yeast DNA in the bloodstream and colonization of mucosal membranes by Candida species as a prognostic marker of deep candidiasis. Thirty-one women with carcinoma ovariorum, during chemotherapy without symptoms of deep fungal infections, were examined twice over a six-day period. C. albicans was the dominant organism isolated from mucosal membranes. Two serum samples were positive for mannan on the first day of examination. All these patients were previously colonized by Candida spp. on mucous membranes. Four patients were positive on the last day of examination. Three of these patients were colonized by Candida spp. C. albicans infection was detected early in 4 out of 12 clinical samples by a combination of PCR and mannan-detecting methods. Colonization increases the risk of deep candidiasis. PCR and antigen detection are fast and reliable methods for early detection of Candida in bloodstream. For patients at risk, the clinical samples must be tested by at least two independent methods.
Candida albicans is a major human fungal pathogen especially as an etiologic agent of opportunistic oral and genital infections. Moreover, C. albicans can be involved in the deep infections and recent evidence suggests that the majority of diseases produced by this pathogen are associated with biofilm growth. The aims of this study were to evaluate biofilm production ability of C. albicans strains isolated from different sources, and to evaluate the effect of serum for enhancement the growth of biofilm. The strains used in this study were obtained from three sources; 12 from feces of patients with gastrointestinal disturbances, 13 from the oral cavity of patients with oral candidiasis, and 16 from the vagina of patients with Candida vulvovaginitis (CVV). Polystyrene 96-well plates were used to grow biofilms and crystal violet (CV) staining method was used to evaluate the growth. There were no differences in biofilm growth expressed as CV absorbance between C. albicans strains from different origins neither in Yeast Nitrogen Base broth (YNB) or in bovine serum (BS) (ANOVA, P=0.1648, P=0.5106, respectively). In the BS, the biofilm production was greater than in YNB medium for all samples (ANOVA, P=0.0003).
Proteolytic activity is regarded as one of the most important virulence factors of Candida albicans. Several authors recently demonstrated that some karyotypes and genotypes harbouring a group I self-splicing intron (CaLSU) located in the gene encoding the large rRNA subunit showed a high level of proteinase production. The aim of this study was to investigate the correlation between the level of proteinase production and the presence of the CaLSU intron in C. albicans isolates originating from the blood and respiratory tracts (sputum/pharyngeal swabs) of patients with and without oropharyngeal candidosis. The results revealed statistically significant differences in genotype distribution and the level of proteinase production between the C. albicans isolates obtained from blood and from the respiratory tract. Genotype A, without the intron, was prevalent in all groups of strains and its prevalence was higher among isolates from blood (75%) and from patients with candidosis (80%) compared with strains from colonisation (as opposed to infection) (57.8%). Isolates from blood produced significantly less proteinase than isolates from the respiratory tract (p<0.02), and this difference should be attributed to lower proteinase production of genotypes B and C from blood compared with genotypes B and C from the respiratory tract (p<0.01). The higher proteinase production of genotype B than of genotype A was found among respiratory tract isolates only. The presented data indicate that the association between proteinase production and the CaLSU intron depends on the strains' population. Further study is needed on well-defined groups of clinical isolates to elucidate whether the observed diversity in proteinase production plays a role in the selection of strains inducing bloodstream infections.
Until the late eighties, clinical resistance to azole antifungals was a rare pheno­menon. Only a few cases of resistance to ketoconazole were found in patients with chronic mucocutaneous candidiasis (CMC). The spread of AIDS and the widespread prophylactic and therapeutic use of the hydrophilic azole compound fluconazole resulted both in the selection and induction of resistant strains and in a shift in the nature of the infecting organisms. Most azole antifungals such as itraconazole, ketoconazole and fluconazole are active against a variety of fungal diseases. However, the concentration needed to inhibit growth is dependent on the nature of the infecting species. Mucor spp., e.g., are almost insensitive to present available azole compounds and can be regarded as intrinsically resistant to azole treatment. Physicochemical features, such as the hydrophobicity and pKa, of a given azole, define whether or not it will be active or cross-resistant against a given species. Fluconazole is almost inactive against Candida krusei and Aspergillus fumigatus, whereas the lipophilic itraconazole is active against these species. A third type of resistance is acquired or induced resistance. This is the most contro­versial type because, even within a given species, organisms may differ in their response to the same azole. For these strains, convincing evidence can only be obtained when there is a genotypically related strain, which does not show resistance. In a limited number of biochemical or molecular biological studies the mechanisms of resistance have been investigated at the molecular level. These studies show that resistance can occur when there is an insufficient intracellular content of the azole. This can be due to impermeability problems, inactivated uptake systems or, and more likely, the presence of active multidrug resistance gene products of the P-glycoprotein type. Alteration or overexpression of the target for azole antifungals, the cytochrome P450-dependent 14 a-demethylase, also induces resistance. The nature and amount of the accumulating sterols also are of great importance for azole-induced growth inhi­bition. This may explain why mutations in other enzymes of the ergosterol bio­synthesis pathway, e.g. the A5-6 desaturase, can contribute to azole resistance.
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