Candida infection in HIV positive patients 1985–2007

Traeder, Christian; Kowoll, Susann; Arastéh, Keikawus

doi:10.1111/j.1439-0507.2008.01574.x

Cited by 28 publications

(15 citation statements)

References 10 publications

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“…Ever since the introduction of HAART, incidences of opportunistic infections such as, cerebral toxoplasmosis, Pneumocystis carinii pneumonia and others have been declining. However, the prevalence of Candidial esophegitis remained unchanged [34]. These findings suggests that HAART does not play a significant role in minimizing any fluconazole drug resistance in Candida species and still remains a challenging problem for its long-term therapeutic application in HIV-infected or immunocompromised patients.…”

Section: Discussionmentioning

confidence: 70%

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Disseminated cryptococcosis and fluconazole resistant oral candidiasis in a patient with acquired immunodeficiency syndrome (AIDS)

Kothavade¹,

Oberai

Valand

et al. 2010

J Infect Dev Ctries

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Disseminated cryptococcosis and recurrent oral candidiasis was presented in a-heterosexual AIDS patient. Candida tropicalis (C.tropicalis) was isolated from the oral pseudomembranous plaques and Cryptococcus neoformans (C. neoformans) was isolated from maculopapular lesions on body parts (face, hands and chest) and body fluids (urine, expectorated sputum, and cerebrospinal fluid). In vitro drug susceptibility testing on the yeast isolates demonstrated resistance to fluconazole acquired by C. tropicalis which was a suggestive possible root cause of recurrent oral candidiasis in this patient. Case ReportA 34-year-old heterosexual HIV-I positive male developed mucopurulent productive cough, recurrent oral plaques, occasional syncope, and neurological symptoms that included headache and dizziness. Physical examination revealed discrete erythematous maculopapular lesions on his face (Figure 1), neck, chest, and both hands. There were not any significant enlargement of the cervical lymph nodes, and oral examination revealed pseudo-membranous plaques (Figure 1). He was previously treated with antifungal drugs (fluconazole and amphotericin-B), primary anti-tuberculous drugs (isoniazid, rifampin, ethambutol, and streptomycin), and an antigiardial drug (tinidazole) for giardiasis, caused by, Giardia lamblia. The CD4+ lymphocyte count for this patient was 40 cells/μl with a CD4+/CD8+ ratio of 1:72. Despite a history of multiple unprotected sexual exposures, the patient tested negative for venereal disease.The skin biopsies and body fluids, such as, cerebrospinal fluid (CSF), urine, and mucopurulent expectorated sputum, showed encapsulated yeasts in India-ink-wet-mount preparation. The cultures for acid-fast bacilli (AFB) on Lowenstein-Jenson and non-selective Middle-brook 7H12 agar media were negative. Periodic-acid-Schiff and Grocott-Gomorimethylamine-silver-stained smears were negative for Pneumocystis carinii. Serum and CSF tested positive for capsular Cryptococcal polysaccharide antigen using the latex agglutination test with a titer of 1:1015. Skin sections revealed gelatinous troma ( Figure 2) filled with numerous encapsulated yeast cells (Figure 3). Biopsied specimens of skin and other body fluids (CSF, urine, and sputum) yielded the growth of C. neoformans on Sabouraud's dextrose agar (SDA) medium. The resultant mucoid-creamcolored colonies were negative for germ tube and positive for urease test. Colonies failed to grow on Cyclohexamide-supplemented SDA. Colonic growth at 37 o C on plain SDA was weakly positive. Microscopic examination of the Gram-stain preparation from a portion of scraped oral lesions showed Gram-positive yeasts and pseudo-hyphal forms. The remaining portion the scraped oral lesions were inoculated on SDA which then showed a typical growth of C. tropicals. Identification of C. tropicalis was further confirmed by the germ tube test; morphological characteristics were determined on cornmeal tween-80-agar and Vitek-32 and API 20C

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Section: Discussionmentioning

confidence: 70%

“…However, the reversion of isolates from azole-resistant to azolesusceptible was related to strain substitution [34]. Ever since the introduction of HAART, incidences of opportunistic infections such as, cerebral toxoplasmosis, Pneumocystis carinii pneumonia and others have been declining.…”

Section: Discussionmentioning

confidence: 99%

Disseminated cryptococcosis and fluconazole resistant oral candidiasis in a patient with acquired immunodeficiency syndrome (AIDS)

Kothavade¹,

Oberai

Valand

et al. 2010

J Infect Dev Ctries

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“…The number of available antifungal drugs is limited, and the development of drug resistance occurs frequently. [1,2] Research towards the discovery of new and effective antifungal drugs is thus urgently needed. Endophytic fungi grow symbiotically within plant living tissues and provide structurally novel and biologically active compounds, [3][4][5][6] some of which are anticancer drugs, for example, paclitaxel (Taxol) and camptothecin.…”

Section: Introductionmentioning

confidence: 99%

Curvularides A–E: Antifungal Hybrid Peptide–Polyketides from the Endophytic Fungus Curvularia geniculata

Chomcheon

Wiyakrutta

Aree

et al. 2010

Chemistry A European J

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Five new hybrid peptide-polyketides, curvularides A-E (1-5), were isolated from the endophytic fungus Curvularia geniculata, which was obtained from the limbs of Catunaregam tomentosa. Structure elucidation for curvularides A-E (1-5) was accomplished by analysis of spectroscopic data, as well as by single-crystal X-ray crystallography. Curvularide B (2) exhibited antifungal activity against Candida albicans, and it also showed synergistic activity with a fluconazole drug.

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“…Candida albicans is the most prevalent opportunistic human fungal pathogen and causes a wide variety of infections, from superficial mucosal infections to invasive disseminated disease, despite the availability of effective antifungal treatment. Moreover, the most common opportunistic infection among AIDS patients is oropharyngeal candidiasis (OPC), and chronic cases continue despite the availability of highly active antiretroviral therapy (HAART), due to poor compliance, lack of access, and failure of HAART (7)(8)(9)(10)(11).…”

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confidence: 99%

UPC2 Is Universally Essential for Azole Antifungal Resistance in Candida albicans

et al. 2014

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In Candida albicans, the transcription factor Upc2 is central to the regulation of ergosterol biosynthesis. UPC2-activating mutations contribute to azole resistance, whereas disruption increases azole susceptibility. In the present study, we investigated the relationship of UPC2 to fluconazole susceptibility, particularly in azole-resistant strains. In addition to the reduced fluconazole MIC previously observed with UPC2 disruption, we observed a lower minimum fungicidal concentration (MFC) for a upc2⌬/⌬ mutant than for its azole-susceptible parent, SC5314. Moreover, the upc2⌬/⌬ mutant was unable to grow on a solid medium containing 10 g/ml fluconazole and exhibited increased susceptibility and a clear zone of inhibition by Etest. Time-kill analysis showed higher fungistatic activity against the upc2⌬/⌬ mutant than against SC5314. UPC2 disruption in strains carrying specific resistance mutations also resulted in reduced MICs and MFCs. UPC2 disruption in a highly azole resistant clinical isolate containing multiple resistance mechanisms likewise resulted in a reduced MIC and MFC. This mutant was unable to grow on a solid medium containing 10 g/ml fluconazole and exhibited increased susceptibility and a clear zone of inhibition by Etest. Time-kill analysis showed increased fungistatic activity against the upc2⌬/⌬ mutant in the resistant background. Microarray analysis showed attenuated induction by fluconazole of genes involved in sterol biosynthesis, iron transport, or iron homeostasis in the absence of UPC2. Taken together, these data demonstrate that the UPC2 transcriptional network is universally essential for azole resistance in C. albicans and represents an attractive target for enhancing azole antifungal activity.

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Candida infection in HIV positive patients 1985–2007

Cited by 28 publications

References 10 publications

Disseminated cryptococcosis and fluconazole resistant oral candidiasis in a patient with acquired immunodeficiency syndrome (AIDS)

Disseminated cryptococcosis and fluconazole resistant oral candidiasis in a patient with acquired immunodeficiency syndrome (AIDS)

Curvularides A–E: Antifungal Hybrid Peptide–Polyketides from the Endophytic Fungus Curvularia geniculata

UPC2 Is Universally Essential for Azole Antifungal Resistance in Candida albicans

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