Fig 2 - uploaded by Suhail Ahmad
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WWS, type II lissencephaly (cobblestone appearance), MRI, axial cuts T2 WI. There is cortical thickening with abnormal gyri and shallow sulci (arrow). The cortex shows a bumpy surface (arrow head). Underlying white matter is abnormally hyperintense due to abnormal myelination.
Source publication
Invasive candidiasis in immune-compromised patients is associated with high attributable mortality. Early detection of candidemia and accurate identification of Candida species are essential pre-requisites for improved prognosis. Since clinical presentation is non-specific and blood culture-based methods lack sensitivity, detection of immunological...
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Introduction:
Patients with a history of chemotherapy or stem cell transplantation (SCT) and prolonged neutropenia are at risk for hepatic and/or splenic seeding of Candida. In our experience, hepatosplenic candidiasis (HSC) without documented candidemia often remains unrecognized.
Case presentations:
We describe three cases of HSC without docum...
Citations
... Species-specific identification of the infecting Candida spp. by conventional methods is time-consuming and lacks specificity as it is based on analysis of the macro-and microscopic features of yeast colonies on solid culture (usually Sabouraud dextrose agar), presence of pseudohyphae and chlamydoconidia, formation of germ tube in horse serum in 2-3 hours at 35 o C (positive for C. albicans, C. dubliniensis and C. africana), use of differential media (such as CHROMagar Candida and sunflower seed agar/tobacco agar for differentiation of C. dubliniensis from C. albicans) and evidence of assimilation or fermentation of sugars or other compounds by using automated/semiautomated systems such as Vitek2 or ID32C yeast identification systems [120,121]. The phenotypic methods occasionally lead to misidentification of closely related species, such as C. albicans, C. dubliniensis and C. africana belonging to C. albicans complex [120,121]. ...
... by conventional methods is time-consuming and lacks specificity as it is based on analysis of the macro-and microscopic features of yeast colonies on solid culture (usually Sabouraud dextrose agar), presence of pseudohyphae and chlamydoconidia, formation of germ tube in horse serum in 2-3 hours at 35 o C (positive for C. albicans, C. dubliniensis and C. africana), use of differential media (such as CHROMagar Candida and sunflower seed agar/tobacco agar for differentiation of C. dubliniensis from C. albicans) and evidence of assimilation or fermentation of sugars or other compounds by using automated/semiautomated systems such as Vitek2 or ID32C yeast identification systems [120,121]. The phenotypic methods occasionally lead to misidentification of closely related species, such as C. albicans, C. dubliniensis and C. africana belonging to C. albicans complex [120,121]. Considering the inherently variable in vitro antifungal susceptibility profiles of various Candida spp., accurate species-specific identification is crucial for therapeutic decisions including timely administration of appropriate antifungal treatment [122,123]. Studies have ...
... However, identification solely based on this test is not completely reliable due to inter-strain differences among the clinical isolates of C. albicans, C. dubliniensis and C. africana and the production of green colonies of different color intensity or shades [52,54,125]. The use of CHROMagar Candida may also be used to highlight mixed cultures during identification of yeast isolates [121]. Formation of rough/fringed colonies Complimentary Contributor Copy by germ tube positive isolates on differential media such as Niger seed agar [126], simplified sunflower seed agar [127,128], or tobacco agar [129], or ability/inability to grow in the presence of a particular organic compound as a source of carbon [130] or in hypertonic sabouraud dextrose broth containing 6.5 M NaCl [131] are often used to differentiate C. albicans from C. dubliniensis. ...
... Species-specific identification of the infecting Candida spp. by conventional methods is time-consuming and lacks specificity as it is based on analysis of the macro-and microscopic features of yeast colonies on solid culture (usually Sabouraud dextrose agar), presence of pseudohyphae and chlamydoconidia, formation of germ tube in horse serum in 2-3 hours at 35 o C (positive for C. albicans, C. dubliniensis and C. africana), use of differential media (such as CHROMagar Candida and sunflower seed agar/tobacco agar for differentiation of C. dubliniensis from C. albicans) and evidence of assimilation or fermentation of sugars or other compounds by using automated/semiautomated systems such as Vitek2 or ID32C yeast identification systems [120,121]. The phenotypic methods occasionally lead to misidentification of closely related species, such as C. albicans, C. dubliniensis and C. africana belonging to C. albicans complex [120,121]. ...
... by conventional methods is time-consuming and lacks specificity as it is based on analysis of the macro-and microscopic features of yeast colonies on solid culture (usually Sabouraud dextrose agar), presence of pseudohyphae and chlamydoconidia, formation of germ tube in horse serum in 2-3 hours at 35 o C (positive for C. albicans, C. dubliniensis and C. africana), use of differential media (such as CHROMagar Candida and sunflower seed agar/tobacco agar for differentiation of C. dubliniensis from C. albicans) and evidence of assimilation or fermentation of sugars or other compounds by using automated/semiautomated systems such as Vitek2 or ID32C yeast identification systems [120,121]. The phenotypic methods occasionally lead to misidentification of closely related species, such as C. albicans, C. dubliniensis and C. africana belonging to C. albicans complex [120,121]. Considering the inherently variable in vitro antifungal susceptibility profiles of various Candida spp., accurate species-specific identification is crucial for therapeutic decisions including timely administration of appropriate antifungal treatment [122,123]. Studies have ...
... However, identification solely based on this test is not completely reliable due to inter-strain differences among the clinical isolates of C. albicans, C. dubliniensis and C. africana and the production of green colonies of different color intensity or shades [52,54,125]. The use of CHROMagar Candida may also be used to highlight mixed cultures during identification of yeast isolates [121]. Formation of rough/fringed colonies Complimentary Contributor Copy by germ tube positive isolates on differential media such as Niger seed agar [126], simplified sunflower seed agar [127,128], or tobacco agar [129], or ability/inability to grow in the presence of a particular organic compound as a source of carbon [130] or in hypertonic sabouraud dextrose broth containing 6.5 M NaCl [131] are often used to differentiate C. albicans from C. dubliniensis. ...
Although several Candida species are opportunistic human pathogens, most invasive infections are caused by Candida albicans, a constituent of human skin and mucosal surfaces. The origin of C. albicans infections is studied by multilocus sequence typing (MLST). This study developed separate primer pairs for PCR amplification and sequencing of amplicons for each gene fragment for more efficient acquisition of DNA sequence data during MLST. The established protocol was first applied 12 C. albicans strains isolated from bloodstream or other body sites from nine candidemia patients studied previously and then to 22 C. albicans strains isolated from 21 patients. None of the isolates analyzed here were described in our previous study. All 34 isolates were identified as C. albicans by both phenotypic and molecular methods and yielded high-quality DNA sequence data and diploid sequence type (DST) for each isolate during MLST analyses. Fingerprinting of 34 C. albicans isolates from 30 patients showed that 22 isolates were unique strains while 12 isolates from eight patients clustered in 5 DSTs. All cluster isolates were obtained either from the same patient or were isolated several months apart or the patients were hospitalized in different hospitals suggesting endogenous origin of infection in most patients.
Invasive fungal infections (IFI) pose diagnostic and therapeutic challenges due to nonspecific clinical presentations and imaging, particularly in immunocompromised patients. Rapid and accurate diagnosis is crucial for optimal management. Conventional diagnostic methods are considered as “gold standard”; however, they are based on culture, phenotypic identification, and antifungal susceptibility of the isolates, which lack sensitivity and are time-consuming, resulting in delayed diagnosis and therapy. To allow for fast detection and characterization of fungal pathogens, there are sustained efforts to switch to non-culture-based diagnostic methods to provide early and appropriate antifungal treatment. Although detection of biomarkers, such as 1, 3-β-d-glucan, (BDG), galactomannan (GM), Candida mannan (Mn), and Candida-anti-mannan antibodies (A-Mn) are useful for rapid diagnosis, there are still issues associated with sensitivities, specificities, and standardization in specific cohort of patients. Histopathological examination of tissue biopsy can provide rapid diagnosis; however, invasive specimens are often not readily available due to associated comorbidities. PCR-based assays, DNA sequencing, and other molecular methods have shown great promise to be used as primary diagnostic tools alone or to complement culture-based methods; however, these tests require standardization and are yet to be incorporated as a diagnostic criterion in routine clinical laboratory. In the absence of detection of BDG and GM biomarkers, DNA-based detection methods are essential for the diagnosis of mucormycosis. T2 magnetic resonance (T2MR), a nano-platform, approved by the US FDA is a timely and important advancement in the early diagnosis of candidemia. The test has a sensitivity of 89% in patients at the time of blood culture positivity. Likewise, proteomic approaches such as matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has also been applied directly to blood specimens to identify Candida species with reduced turnaround time. Two lateral flow assays for point-of-care diagnosis of cryptococcosis and aspergillosis have also been developed.
