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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 factor...
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Citations
... According to epidemiological studies, more than 100 million people are infected with fungal infections of the mucosal surface annually [16]. Among fungal infections, oral candidiasis (OC) is the most common disease [17,18] and can lead to bloodstream infections, causing lethal candidemia, in transplant patients [19,20]. Previous studies have shown that C. albicans is still the most common cause of OC, while NACs, are becoming a significantly more important cause of OC in clinical settings [21]. ...
Aims: This study aimed to identify Candida species recovered from the oral cavity of patients with kidney transplantation.
Materials & methods: Two swabs were taken from the oral cavity of 40 patients before and after transplantation, cultured on SDA, and yeasts identified .Antifungal drug susceptibility testing was performed against fluconazole (FLZ) and itraconazole (ITZ).
Results: Candida glabrata was the most isolated in patients followed by C. albicans, and Rhodotorula. C. glabrata isolates from step 1 were resistant to FLZ, whereas C. albicans were fluconazole resistant in both step 1 and step 2.
Discussion: The importance of non-albicans Candida species in the oral cavity of patients shed light on performing antifungal tests for achieving the best outcome to prevent therapeutic failure.
... Dermatophytosis are common cutaneous infections in SOTRs caused by three genera of filamentous fungi: glossy palate. Patients on corticosteroid or antibacterial therapy, diabetics, and denture users are at increased risk of oral candidiasis 24 . In oral infections, clotrimazole (10 mg five times daily) is superior to nystatin (100,000 units/ml suspension: 4-6 ml four times daily). ...
Long-term exposure to immunosuppressive drugs is a significant risk factor for the development of both cancers and infections. Solid-organ transplant recipients benefit from dermatology follow-up, allowing early diagnosis and treatment of these conditions.
While there is abundant information on the development of cutaneous malignancies in these patients, there is still an underrepresentation in the literature regarding the prevalence, diagnosis, and treatment of cutaneous fungal infections. There is also more data available on cutaneous manifestations of systemic fungal infections than on superficial infections. Herein, the authors aim to present a short review of the most frequent primary fungal infections in this population, as well as to share some cases that presented to our dermatology outpatient clinic for solid organ transplant recipients.
... Invasive Candida infections, particularly bloodstream, esophageal, gastrointestinal and respiratory, are prevalent in an immediate post-transplant period in organ transplant patients [90]. The prevalence during the first 6 months after transplantation can be up to 50% depending on the type of organ transplant [91][92][93]. Up to 80% of esophageal infections in renal transplant patients were found to be due to Candida colonisation of the oral cavity and oral candidiasis [91,92]. ...
... The prevalence during the first 6 months after transplantation can be up to 50% depending on the type of organ transplant [91][92][93]. Up to 80% of esophageal infections in renal transplant patients were found to be due to Candida colonisation of the oral cavity and oral candidiasis [91,92]. Although Candida carriage may not be significantly high in transplant recipients [94,95], they carry a high number of Candida in their oral cavities. ...
Candida colonisation of the oral cavity increases in immunocompromised individuals which leads to the development of oral candidiasis. In addition, host factors such as xerostomia, smoking, oral prostheses, dental caries, diabetes and cancer treatment accelerate the disease process. Candida albicans is the primary causative agent of this infection, owing to its ability to form biofilm and hyphae and to produce hydrolytic enzymes and candialysin. Although mucosal immunity is activated, from the time hyphae-associated toxin is formed by the colonising C. albicans cells, an increased number and virulence of this pathogenic organism collectively leads to infection. Prevention of the development of infection can be achieved by addressing the host physiological factors and habits. For maintenance of oral health, conventional oral hygiene products containing antimicrobial compounds, essential oils and phytochemicals can be considered, these products can maintain the low number of Candida in the oral cavity and reduce their virulence. Vulnerable patients should be educated in order to increase compliance.
... Fungal infections are not as common as those caused by bacteria or viruses, but they are insidious and can cause severe complications, especially in patients with impaired immunity [1,4,5]. Clinical manifestations of infection may vary from a superficial or cutaneous form to a life-threatening, systemic disease [5][6][7]. ...
Oncological patients are especially predisposed to fungal infections due to multiple risk factors and immunocompromising treatment. Epidemiological research regarding pediatric oncologic patients is still insufficient, and existing data are difficult to generalize on different populations. Therefore, we aimed to analyze fungal infections and fungal epidemiology in the Department of Oncology and Hematology of the University Children’s Hospital in Krakow with help from the Clinical Microbiology Department. During the chosen period of 2005 and 2015–2020, 2342 tests were performed in our ward on 847 patients. Analyzed samples were divided into five source groups. The amount of patients with positive test results was 62.5%. The year with the highest detection level was 2005. The most frequent pathogen was Candida albicans, with a significant decrease in tendency. An increase in non-albicans species was observed. Candida parapsilosis was not frequently observed compared to similar studies. We noticed an increase in positive results from the urinary tract material. Our results confirmed that fungal infections are still an issue, and they may indicate the efficacy of prophylaxis. The majority of our results are consistent with the literature, yet we managed to emphasize data unique to our patients’ population. Our findings are helpful in clinical work and for further studies in our center.
... The number of SOT recipients is increasing annually with advances in transplant medicine [2]. The incidence of invasive fungal disease (IFD) after SOT is typically 1-2%, although occasionally as high as 10%, and that of invasive aspergillosis, the second most common IFD after SOT transplantation is 14-65% among all IFDs [3][4][5][6][7][8]. Kidney transplantation (KT) is the most frequently performed SOT worldwide. ...
Invasive pulmonary aspergillosis (IPA) is a high mortality opportunistic infection among kidney transplant recipients. This study assessed the risk factors and outcomes of IPA after KT. A retrospective study was conducted at a tertiary-care referral hospital in Korea. Electronic medical records of patients diagnosed with IPA after KT between February 1995 and March 2015 were reviewed. The control patients comprised two patients who received KT before and after each IPA case. Twenty-six cases were diagnosed with IPA among 1963 recipients at a median of 58 years old. The most common cause of end-stage renal disease was diabetic nephropathy. The median time to diagnosis was 161 days. Delayed graft function was associated with the development of IPA. The overall 12-week mortality rate of IPA was 57.5%. Serum GM level ≥ 2 and BAL GM level ≥ 5 were associated with 12-week mortality in the Kaplan-Meier survival analyses. Approximately half of IPA in KT recipients developed during the late posttransplant period (> 6 months), especially after treatment for acute rejection. Careful monitoring for IPA is required in patients with delayed graft function, DM, and who received rejection therapy. Higher serum and BAL GM were associated with 12-week mortality.
... Candidiasis may also lead to invasive infections associated with spread into the systemic circulation; this may result in esophageal, gastrointestinal, respiratory, and urinary tract infections. 1 Oral candidiasis is diagnosed frequently in children, the elderly, and patients undergoing systemic corticoid (SC) or immunosuppressive therapy due to eg, organ transplantation. 2 Earlier studies revealed that the use of inhaled corticosteroids (ICS) by adults and children with bronchial asthma could have a significant impact on the diversity of yeast species detected as well as on the incidence of candidiasis. 3 In females, systemic intake of corticoids increases not only the incidence of vulvovaginal candidiasis (VVC) but also the frequency of infections with non-Candida albicans (NCA) species that are less susceptible to commonly used antifungal drugs. ...
Background
Candida species are commonly detected as colonizers of the oral cavity; candidiasis or candidemia can develop in patients who are immunocompromised. Use of topical or inhaled glucocorticoids can alter the spectrum of Candida species and can promote oral candidiasis. The present study aims to evaluate the diversity of Candida species in the oral cavity and their susceptibility to antifungal agents in patients undergoing treatment with systemic glucocorticoids (SGCs) compared with non-users.
Methods
We conducted a descriptive, analytical, cross-sectional study that enrolled 120 patients with oral problems who were undergoing treatment with SGCs and who were admitted to the hospital of the First Affiliated Hospital, College of Medicine, Zhejiang University and Zhejiang Hospital, Hangzhou, China, between February 2019 and September 2019. One hundred and twenty age-and sex-matched patients were recruited as the SGC non-user control group. Demographic data included oral complaints and underlying diseases; symptoms of oral candidiasis were identified on physical examination. Candida species were collected using a concentrated oral rinse. Identification of fungal isolates was based on conventional phenotypic methods assisted by DNA sequence analysis of the internal transcribed spacer (ITS) rDNA gene region. Antifungal activities of anidulafungin, amphotericin B, micafungin, caspofungin, 5-flucytosine, posaconazole, voriconazole, itraconazole, and fluconazole were evaluated using the Sensititre YeastOneTM YO10 panel supplemented by the CLSI-M27-A3 protocol.
Results
Fifty-two (43.33%) out of the 120 patients undergoing with SGCs were diagnosed with oral candidiasis, compared with 14 (11.67%) of the non-users (P < 0.05). Likewise, we collected 88 strains from 73.33% of the SGC users compared with only 48 (40%) from non-users (P < 0.05). Candida albicans was detected most frequently in both groups (45.45% vs 66.67%, respectively; P = 0.033); the overall frequency of non-Candida albicans (NCA) strains isolated from patients treated with SGCs were significantly higher than that identified among non-users (51.14% vs 33.33%, respectively; P = 0.046), although there were no significant differences concerning any single species of NCA. Resistance of C. albicans to itraconazole (P = 0.004) and fluconazole (P = 0.001) was significantly higher in patients treated with SGCs than in non-users; however, echinocandins, amphotericin B, voriconazole, and posaconazole were all active against strains from both participant groups with no significant differences detected.
Conclusion
Taken together, our findings indicate that SGC therapy may result in an increased prevalence of oral candidiasis as reflected by the clinical presentations and strains isolated; these findings were also associated with an increased frequency of NCA strains. SGC therapy was also associated with an increased frequency of C. albicans strains that were resistant to both itraconazole and fluconazole. The impact of SGC therapy on Candida species in the oral cavity requires further study.
... Despite the importance of IFIs in transplant patients, little is known about the epidemiology and etiologic agents of these infections among transplant recipients in Iran [7][8][9][10][11][12] or the role of colonization in this regard. With this background in mind, the present study was conducted to determine the prevalence of fungal colonization and infections among patients undergoing various transplantations. ...
... This finding supports the role of colonization as a risk factor for fungal infections, which is in line with other reports [2,22]. Accordingly, fungal colonization, which has been found to be as high as 45-47.5% among renal transplant recipients [7,8] and 84% among liver transplant recipients [7] in Iran, should be taken into account. Furthermore, the delayed diagnosis and initiation of therapy for IFIs result in poor treatment outcomes. ...
... This finding supports the role of colonization as a risk factor for fungal infections, which is in line with other reports [2,22]. Accordingly, fungal colonization, which has been found to be as high as 45-47.5% among renal transplant recipients [7,8] and 84% among liver transplant recipients [7] in Iran, should be taken into account. Furthermore, the delayed diagnosis and initiation of therapy for IFIs result in poor treatment outcomes. ...
Background and Purpose: Organ transplant recipients are vulnerable to fungal infections. The aim of this study was to determine the prevalence of fungal colonization and infections among patients who underwent various transplantations and molecularly characterize the etiological agents.
Materials and Methods: This study was conducted on candidates for transplantation in Imam Khomeini Hospital, Tehran, Iran, from April 2017 to April 2018. All patients were monitored for fungal colonization or infections before and after transplantation. Isolated fungi were identified using molecular methods.
Results: A total of 125 patients, including 86 males and 39 females, with the mean age of 52.2 years participated in the study (age range: 15-75 years). Out of 125 patients, 84 (67.2%) cases had fungal colonization that appeared pre- and post-transplantation in 21 and 63 cases, respectively (alone or concurrent with another infection in 55 and 29 cases, respectively). In addition, a total of 39 episodes of fungal infections were diagnosed in 36 (28.8%) recipients (alone or concurrent with colonization in 7 and 29 cases, respectively). Out of the 39 fungal infections, 9 cases appeared pre-transplantation, while the other 30 cases occurred post-transplantation. However, no fungal colonization or infection was observed in 34 (27.2%) patients. Oral candidiasis (n=20) was the most common type of infection, followed by funguria (n=7), onychomycosis (n=5), candidemia (n=3), rhinocerebral mucormycosis (n=1), cutaneous mucormycosis (n=1), cutaneous aspergillosis (n=1), and peritonitis (n=1). Six yeast species were recovered from colonization cases with the dominance of Candida albicans both before and after transplantation. The observed fungal infections were caused by 11 distinct species, including the members of Candida (i.e., C. albicans, C. glabrata, C. parapsilosis, C. tropicalis, and C. krusei), Aspergillus (i.e., A. oryzae and A. candidus), Rhizopus (i.e., R. oryzae and R. microsporus), Trichosporon asahii, and Trichophyton interdigitale. The results also indicated that the development of a fungal infection post-transplantation was associated with fungal colonization (r=0.0184; P=0.043).
Conclusion: Based on the results, fungal colonization was a common finding in transplant recipients at Imam Khomeini Hospital. However, the incidence of fungal infections was comparable with those of other centers. As the oral cavity was the most common site of colonization and infection, it might be beneficial to take further care about the oral health of patients using effective mouthwash.
... Candida species are associated with vast clinical spectrum of human infections ranging from superficial infection of the skin, mucus membranes to life threatening candidemia,and hospital-acquired infections. [2] Invasive candidiasis includes severe diseases such as candidemia, disseminated infections, CNS infections, endophthalmitis, osteomyelitis. Candidemia which is a bloodstream infection by Candida species is the most common and fatal clinical manifestation of invasive candidiasis, and contribute to large number of morbidity and mortality in hospitalized patients [3]. ...
... The epidemiology of non-albicans candida has been on the rise in last few years. [2] Five species of Candida namely, C. albicans, C. glabrata, C. parapsilosis, C. tropicalis and C. krusei are reported to cause more than 90% of invasive infections, although the relative distribution of the species depends on the geographical area, patient population and predisposing conditions, local hospital related factors, and the types of antifungal agents received [5]. ...
... In our study resistance of Candida against Fluconazole was more (10.7%) in comparison to other antifungals used in this study. The study by Pfaller et al. [27] and Badiee et al. [2] had similar findings. Studies from different parts of India [29,16,25,30,6] reported higher resistance to fluconazole [ Table 7]. ...
... Because of the small sample size and little information on the median age of deaths, we considered nine valid relevant studies [32][33][34][35][36][37][38][39][40]. According to available data, the DALYs were calculated in patients with hematological disorders, SOT, ICU, and endocarditis. ...
... Our data are in concordance with those from the North Europe [42] and recent data from Western Europe [48] and Asia [49] which show the highest incidence of IA in patients receiving intensive chemotherapy for hematologic malignancy and undergoing lung transplantation. Some of the included reports [32][33][34][50][51][52] in this present study, in line with Singh and Paterson study [53], indicated that the increased incidence of IA was a major health challenge among SOT patients, of which lung transplant recipients are the population most at risk, followed by liver, kidney, heart, and heart-lung transplant recipients ( Table 5). As in other studies, the most frequently affected sites were lungs and sinuses ( Figure 6). ...
... Our data are in concordance with the multiple studies reported by Lin et al. [56] also showing that CNS localization was the most fatal form of IA. In line with Scully et al. [58], the reports from Iran indicated that contributory factors for CNS aspergillosis were liver and renal transplants, hematologic malignancy, previous surgery, and intravenous drug abuse [32,[34][35][36]59]. It is particularly striking that a high mortality rate was also observed in HSCT and liver recipients in 2010 with a higher risk of mortality in patients with allogeneic HSCT compared with autologous HSCT [37]. ...
Objectives: We aimed to study the epidemiology, prevalence, incidence, clinical manifestations, underlying diseases, survivals, treatments, outcomes and societal impact through disability-adjusted life years (DALYs) of IA in Iran
Methods: A random-effect meta-analytic model was fitted to estimate prevalence and incidence of IA in Iran. We also calculated DALYs.
Results: Out of 79 published studies during the past 25 years from Iran, 23 met the inclusion criteria. A total of 2947 patients were included, of whom 396 (13.4%) patients were diagnosed with IA according to EORTC/MSG and ICU criteria. The main underlying condition for IA was hematologic disorders (39.4%). A. flavus 86 (43%) was the most common isolate. The pooled prevalence and incidence rates were 20.5 (95% CI 12.5 to 29.9) and 4.8 (95% CI 2.3-8.2) per 100000 population, respectively. Total DALYs was estimated 164.13 per 100000 population. YLLs constitute the majority of IA burden compared to YLDs (162.80 YLLs/100000 population vs 1.33 YLDs per 100000 population). The highest YLL rates were found in people aged 45-49 (62.9 YLLs/100000 population) and 30-34 years (45.2 YLLs/100000 population), respectively.
Conclusion: This study indicates an increasing burden of IA in Iran, despite the extensive use of prophylaxis, challenging the public health, especially immunocompromised patients.
... Each preferentially infects specific sites in patients, from the lung in pulmonary aspergillosis to the brain in cryptococcal meningoencephalitis and the blood stream in systemic candidiasis, yet all employ similar mechanisms to acquire sufficient nutrients to survive and establish an infection[17][18][19]. Unlike C. neoformans and A. fumigatus, which are often found in soil, guano and decaying matter[20][21][22][23], C. albicans is a commensal species, commonly found in the gastrointestinal tract and on mucocutaneous surfaces[24,25]. While these environments are vastly different, one important class of biological compounds consistently present are the purines. ...
While members of the Kingdom Fungi are found across many of the world’s most hostile environments, only a limited number of species can thrive within the human host. The causative agents of the most common invasive fungal infections are Candida albicans, Aspergillus fumigatus, and Cryptococcus neoformans. During the infection process, these fungi must not only combat the host immune system while adapting to dramatic changes in temperature and pH, but also acquire sufficient nutrients to enable growth and dissemination in the host. One class of nutrients required by fungi, which is found in varying concentrations in their environmental niches and the human host, is the purines. These nitrogen-containing heterocycles are one of the most abundant organic molecules in nature and are required for roles as diverse as signal transduction, energy metabolism and DNA synthesis. The most common life-threatening fungal pathogens can degrade, salvage and synthesize de novo purines through a number of enzymatic steps that are conserved. While these enable them to adapt to the changing purine availability in the environment, only de novo purine biosynthesis is essential during infection and therefore an attractive antimycotic target.
