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New Perspectives for Candidiasis

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A special issue of Journal of Fungi (ISSN 2309-608X). This special issue belongs to the section "Fungal Pathogenesis and Disease Control".

Deadline for manuscript submissions: closed (15 December 2021) | Viewed by 51055

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Special Issue Editor

Dr. Juliana Campos Junqueira

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Guest Editor

Institute of Science and Technology, São Paulo State University (UNESP), São Paulo 12245-000, Brazil
Interests: antimicrobial resistance; bacterial infections; Candida spp.; biofilms; drug discovery; photodynamic therapy; drug delivery systems; probiotics and postbiotics
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Candidiasis is a common fungal infection that results from an imbalance between the host immune system and virulence mechanisms of Candida species. Several virulence factors of Candida albicans and non-albicans Candida species have been unveiled and widely studied, such as adhesin expression, morphological switching from yeast to filamentous forms, enzyme secretion, and biofilm formation. Despite great advances in medical research, morbidity and mortality rates associated with Candida infections are still high. Currently, the biggest challenge in treating candidiasis is the emergence of antifungal drug resistance. The isolation of Candida auris strains resistant to all antifungal classes is shifting Candida infections from multidrug to pandrug resistance status. In this Special Issue, we expect to gather several studies with a focus on the pathogenicity of Candida spp. and resistance mechanisms, as well as new horizons for candidiasis treatment involving recently synthesized antifungal compounds; drug repurposing; combination therapies; biomaterials for drug delivery, antibodies, and vaccination; photodynamic therapy; probiotics; and natural antifungal products.

Dr. Juliana Campos Junqueira
Guest Editor

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Keywords

candidiasis
Candida spp.
pathogenicity
biofilms
antifungal resistance
antifungal drugs
repurposing
combination therapies
delivery systems

Published Papers (14 papers)

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Research

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19 pages, 3652 KiB

Open AccessArticle

Systemic Infection by Non-albicans Candida Species Affects the Development of a Murine Model of Multiple Sclerosis

by Thais Fernanda de Campos Fraga-Silva, Natália Munhoz-Alves, Luiza Ayumi Nishiyama Mimura, Larissa Ragozo Cardoso de Oliveira, Lívia Mara Alves Figueiredo-Godoi, Maíra Terra Garcia, Evelyn Silva Oliveira, Larissa Lumi Watanabe Ishikawa, Sofia Fernanda Gonçalves Zorzella-Pezavento, Vânia Luiza Deperon Bonato, Juliana Campos Junqueira, Eduardo Bagagli and Alexandrina Sartori

J. Fungi 2022, 8(4), 386; https://0-doi-org.brum.beds.ac.uk/10.3390/jof8040386 - 10 Apr 2022

Cited by 6 | Viewed by 2398

Abstract

Candidiasis may affect the central nervous system (CNS), and although Candida albicans is predominant, non-albicans Candida species can also be associated with CNS infections. Some studies have suggested that Candida infections could increase the odds of multiple sclerosis (MS) development. In this context, we investigated whether systemic infection by non-albicans Candida species would affect, clinically or immunologically, the severity of experimental autoimmune encephalomyelitis (EAE), which is an animal model used to study MS. For this, a strain of C. glabrata, C. krusei, and C. parapsilosis was selected and characterized using different in vitro and in vivo models. In these analysis, all the strains exhibited the ability to form biofilms, produce proteolytic enzymes, and cause systemic infections in Galleria mellonella, with C. glabrata being the most virulent species. Next, C57BL/6 mice were infected with strains of C. glabrata, C. krusei, or C. parapsilosis, and 3 days later were immunized with myelin oligodendrocyte glycoprotein to develop EAE. Mice from EAE groups previously infected with C. glabrata and C. krusei developed more severe and more prevalent paralysis, while mice from the EAE group infected with C. parapsilosis developed a disease comparable to non-infected EAE mice. Disease aggravation by C. glabrata and C. krusei strains was concomitant to increased IL-17 and IFN-γ production by splenic cells stimulated with fungi-derived antigens and with increased percentage of T lymphocytes and myeloid cells in the CNS. Analysis of interaction with BV-2 microglial cell line also revealed differences among these strains, in which C. krusei was the strongest activator of microglia concerning the expression of MHC II and CD40 and pro-inflammatory cytokine production. Altogether, these results indicated that the three non-albicans Candida strains were similarly able to reach the CNS but distinct in terms of their effect over EAE development. Whereas C. glabrata and C. Krusei aggravated the development of EAE, C. parapsilosis did not affect its severity. Disease worsening was partially associated to virulence factors in C. glabrata and to a strong activation of microglia in C. krusei infection. In conclusion, systemic infections by non-albicans Candida strains exerted influence on the experimental autoimmune encephalomyelitis in both immunological and clinical aspects, emphasizing their possible relevance in MS development. Full article

(This article belongs to the Special Issue New Perspectives for Candidiasis)

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8 pages, 1065 KiB

Open AccessCommunication

A Brazilian Inter-Hospital Candidemia Outbreak Caused by Fluconazole-Resistant Candida parapsilosis in the COVID-19 Era

by Danilo Y. Thomaz, Gilda M. B. Del Negro, Leidiane B. Ribeiro, Mirian da Silva, Gabrielle O. M. H. Carvalho, Carlos H. Camargo, João N. de Almeida, Jr., Adriana L. Motta, Rinaldo F. Siciliano, Odeli N. E. Sejas, Flávia Rossi, Edson Abdala, Tânia M. V. Strabelli and Gil Benard

J. Fungi 2022, 8(2), 100; https://0-doi-org.brum.beds.ac.uk/10.3390/jof8020100 - 20 Jan 2022

Cited by 27 | Viewed by 3740

Abstract

Horizontal transmission of fluconazole-resistant Candida parapsilosis (FRCP) through healthcare workers’ hands has contributed to the occurrence of candidemia outbreaks worldwide. Since the first COVID-19 case in Brazil was detected in early 2020, hospitals have reinforced hand hygiene and disinfection practices to minimize SARS-CoV-2 contamination. However, a Brazilian cardiology center, which shares ICU patients with a cancer center under a FRCP outbreak since 2019, reported an increased FRCP candidemia incidence in May 2020. Therefore, the purpose of this study was to investigate an inter-hospital candidemia outbreak caused by FRCP isolates during the first year of the COVID-19 pandemic in Brazil. C. parapsilosis bloodstream isolates obtained from the cancer (n = 35) and cardiology (n = 30) centers in 2020 were submitted to microsatellite genotyping and fluconazole susceptibility testing. The ERG11 gene of all isolates from the cardiology center was sequenced and compared to the corresponding sequences of the FRCP genotype responsible for the cancer center outbreak in 2019. Unprecedentedly, most of the FRCP isolates from the cardiology center presented the same genetic profile and Erg11-Y132F mutation detected in the strain that has been causing the persistent outbreak in the cancer center, highlighting the uninterrupted horizontal transmission of clonal isolates in our hospitals during the COVID-19 pandemic. Full article

(This article belongs to the Special Issue New Perspectives for Candidiasis)

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21 pages, 3367 KiB

Open AccessArticle

Genomic Analysis of Limosilactobacillus fermentum ATCC 23271, a Potential Probiotic Strain with Anti-Candida Activity

by Camilla I. dos Santos, Carmem D. L. Campos, Wallace R. Nunes-Neto, Monique S. do Carmo, Flávio A. B. Nogueira, Rômulo M. Ferreira, Ennio P. S. Costa, Laoane F. Gonzaga, Jéssica M. M. Araújo, Joveliane M. Monteiro, Cinara Regina A. V. Monteiro, Fernanda S. Platner, Isabella F. S. Figueiredo, Rodrigo A. Holanda, Silvio G. Monteiro, Elizabeth S. Fernandes, Andrea S. Monteiro and Valério Monteiro-Neto

J. Fungi 2021, 7(10), 794; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7100794 - 24 Sep 2021

Cited by 13 | Viewed by 3062

Abstract

Limosilactobacillus fermentum (ATCC 23271) was originally isolated from the human intestine and has displayed antimicrobial activity, primarily against Candida species. Complete genome sequencing and comparative analyses were performed to elucidate the genetic basis underlying its probiotic potential. The ATCC 23271 genome was found to contain 2,193,335 bp, with 2123 protein-coding sequences. Phylogenetic analysis revealed that the ATCC 23271 strain shares 941 gene clusters with six other probiotic strains of L. fermentum. Putative genes known to confer probiotic properties have been identified in the genome, including genes related to adhesion, tolerance to acidic pH and bile salts, tolerance to oxidative stress, and metabolism and transport of sugars and other compounds. A search for bacteriocin genes revealed a sequence 48% similar to that of enterolysin A, a protein from Enterococcus faecalis. However, in vitro assays confirmed that the strain has inhibitory activity on the growth of Candida species and also interferes with their adhesion to HeLa cells. In silico analyses demonstrated a high probability of the protein with antimicrobial activity. Our data reveal the genome features of L. fermentum ATCC 23271, which may provide insight into its future use given the functional benefits, especially against Candida infections. Full article

(This article belongs to the Special Issue New Perspectives for Candidiasis)

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20 pages, 7670 KiB

Open AccessArticle

Candida tropicalis Systemic Infection Redirects Leukocyte Infiltration to the Kidneys Attenuating Encephalomyelitis

by Natália Munhoz-Alves, Luiza Ayumi Nishiyama Mimura, Rosa Marlene Viero, Eduardo Bagagli, Jean Pierre Schatzmann Peron, Alexandrina Sartori and Thais Fernanda de Campos Fraga-Silva

J. Fungi 2021, 7(9), 757; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7090757 - 14 Sep 2021

Cited by 5 | Viewed by 2230

Abstract

Environmental factors, including infections, are strongly associated with the pathogenesis of multiple sclerosis (MS), which is an autoimmune and demyelinating disease of the central nervous system (CNS). Although classically associated with bacterial and viral agents, fungal species have also been suspected to affect the course of the disease. Candida tropicalis is an opportunistic fungus that affects immunocompromised individuals and is also able to spread to vital organs. As C. tropicalis has been increasingly isolated from systemic infections, we aimed to evaluate the effect of this fungus on experimental autoimmune encephalomyelitis (EAE), a murine model to study MS. For this, EAE was induced in female C57BL/6 mice 3 days after infection with 10⁶ viable C. tropicalis yeasts. The infection decreased EAE prevalence and severity, confirmed by the less inflammatory infiltrate and less demyelization in the lumbar spinal cord. Despite this, C. tropicalis infection associated with EAE results in the death of some animals and increased urea and creatinine serum levels. The kidneys of EAE-infected mice showed higher fungal load associated with increased leukocyte infiltration (CD45⁺ cells) and higher expression of T-box transcription factor (Tbx21) and forkhead box P3 (Foxp3). Altogether, our results demonstrate that although C. tropicalis infection reduces the prevalence and severity of EAE, partially due to the sequestration of leukocytes by the inflamed renal tissue, this effect is associated with a poor disease outcome. Full article

(This article belongs to the Special Issue New Perspectives for Candidiasis)

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16 pages, 8556 KiB

Open AccessEditor’s ChoiceArticle

Development of Carbazole Derivatives Compounds against Candida albicans: Candidates to Prevent Hyphal Formation via the Ras1-MAPK Pathway

by Young-Kwang Park, Jisoo Shin, Hee-Yoon Lee, Hag-Dong Kim and Joon Kim

J. Fungi 2021, 7(9), 688; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7090688 - 25 Aug 2021

Cited by 6 | Viewed by 2390

Abstract

Morphogenesis contributes to the virulence of the opportunistic human fungal pathogen Candida albicans. Ras1-MAPK pathways play a critical role in the virulence of C. albicans by regulating cell growth, morphogenesis, and biofilm formation. Ume6 acts as a transcription factor, and Nrg1 is a transcriptional repressor for the expression of hyphal-specific genes in morphogenesis. Azoles or echinocandin drugs have been extensively prescribed for C. albicans infections, which has led to the development of drug-resistant strains. Therefore, it is necessary to develop new molecules to effectively treat fungal infections. Here, we showed that Molecule B and Molecule C, which contained a carbazole structure, attenuated the pathogenicity of C. albicans through inhibition of the Ras1/MAPK pathway. We found that Molecule B and Molecule C inhibit morphogenesis through repressing protein and RNA levels of Ras/MAPK-related genes, including UME6 and NRG1. Furthermore, we determined the antifungal effects of Molecule B and Molecule C in vivo using a candidiasis murine model. We anticipate our findings are that Molecule B and Molecule C, which inhibits the Ras1/MAPK pathway, are promising compounds for the development of new antifungal agents for the treatment of systemic candidiasis and possibly for other fungal diseases. Full article

(This article belongs to the Special Issue New Perspectives for Candidiasis)

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9 pages, 2323 KiB

Open AccessArticle

In Vivo Efficacy of Lacticaseibacillus rhamnosus L8020 in a Mouse Model of Oral Candidiasis

by Rei Ito, Yuichi Mine, Yoshie Yumisashi, Reina Yoshioka, Misa Hamaoka, Tsuyoshi Taji, Takeshi Murayama and Hiroki Nikawa

J. Fungi 2021, 7(5), 322; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7050322 - 21 Apr 2021

Cited by 5 | Viewed by 3873

Abstract

Oral candidiasis presents with multiple clinical manifestations. Among known pathogenic Candida species, Candida albicans is the most virulent and acts as the main causative fungus of oral candidiasis. Novel treatment modalities are needed because of emergent drug resistance and frequent candidiasis recurrence. Here, we evaluated the ability of Lacticaseibacillus rhamnosus L8020, isolated from healthy and caries-free volunteers, to prevent against the onset of oral candidiasis in a mouse model. Mice were infected with C. albicans, in the presence or absence of L. rhamnosus L8020. The mice were treated with antibiotics and corticosteroid to disrupt the oral microbiota and induce immunosuppression. We demonstrated that oral consumption of L. rhamnosus L8020 by C. albicans-infected mice abolished the pseudomembranous region of the mouse tongue; it also suppressed changes in the expression levels of pattern recognition receptor and chemokine genes. Our results suggest that L. rhamnosus L8020 has protective or therapeutic potential against oral candidiasis, which supports the potential use of this probiotic strain for oral health management. Full article

(This article belongs to the Special Issue New Perspectives for Candidiasis)

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11 pages, 1539 KiB

Open AccessArticle

Aequorin as a Useful Calcium-Sensing Reporter in Candida albicans

by Dominique Sanglard

J. Fungi 2021, 7(4), 319; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7040319 - 20 Apr 2021

Cited by 1 | Viewed by 2266

Abstract

In Candida albicans, calcium ions (Ca²⁺) regulate the activity of several signaling pathways, especially the calcineurin signaling pathway. Ca²⁺ homeostasis is also important for cell polarization, hyphal extension, and plays a role in contact sensing. It is therefore important to obtain accurate tools with which Ca²⁺ homeostasis can be addressed in this fungal pathogen. Aequorin from Aequorea victoria has been used in eukaryotic cells for detecting intracellular Ca²⁺. A codon-adapted aequorin Ca²⁺-sensing expression system was therefore designed for probing cytosolic Ca²⁺ flux in C. albicans. The availability of a novel water-soluble formulation of coelenterazine, which is required as a co-factor, made it possible to measure bioluminescence as a readout of intracellular Ca²⁺ levels in C. albicans. Alkaline stress resulted in an immediate influx of Ca²⁺ from the extracellular medium. This increase was exacerbated in a mutant lacking the vacuolar Ca²⁺ transporter VCX1, thus confirming its role in Ca²⁺ homeostasis. Using mutants in components of a principal Ca²⁺ channel (MID1, CCH1), the alkaline-dependent Ca²⁺ spike was greatly reduced, thus highlighting the crucial role of this channel complex in Ca²⁺ uptake and homeostasis. Exposure to the antiarrhythmic drug amiodarone, known to perturb Ca²⁺ trafficking, resulted in increased cytoplasmic Ca²⁺ within seconds that was abrogated by the chelation of Ca²⁺ in the external medium. Ca²⁺ import was also dependent on the Cch1/Mid1 Ca²⁺ channel in amiodarone-exposed cells. In conclusion, the aequorin Ca²⁺ sensing reporter developed here is an adequate tool with which Ca²⁺ homeostasis can be investigated in C. albicans. Full article

(This article belongs to the Special Issue New Perspectives for Candidiasis)

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9 pages, 2064 KiB

Open AccessArticle

Epidemiology of Candidemia: Three-Year Results from a Croatian Tertiary Care Hospital

by Ivana Mareković, Sanja Pleško, Violeta Rezo Vranješ, Zoran Herljević, Tomislav Kuliš and Marija Jandrlić

J. Fungi 2021, 7(4), 267; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7040267 - 31 Mar 2021

Cited by 10 | Viewed by 2041

Abstract

Invasive candidosis is the most common invasive fungal infection in hospitalized patients and is associated with a high mortality rate. This is the first study from a Croatian tertiary care hospital describing epidemiology, risk factors and species distribution in patients with candidemia. A three-year retrospective observational study, from 2018 to 2020, was performed at the University Hospital Centre Zagreb, Zagreb, Croatia. A total of 160 patients with candidemia (n = 170 isolates) were enrolled. Candidemia incidence increased from 0.47 to 0.69 per 1000 admissions in 2018 and 2020, respectively. Ninety-five patients (58.38%) were in the intensive care unit. The main risk factors for candidemia were central venous catheter (CVC) (84.38%), previous surgical procedure (56.88%) and invasive mechanical ventilation (42.50%). Candida albicans was identified in 43.53% of isolates, followed by C. parapsilosis (31.76%) and C. glabrata (12.36%), C. krusei (5.29%), C. tropicalis (2.35%) and C. lusitaniae (2.35%). The study discovered a shift to non-albicansCandida species, particularly C. parapsilosis, and made it possible to determine the main tasks we should focus on to prevent candidemia in the hospital, these being mainly infection control measures directed towards prevention of catheter-related bloodstream infections, specifically comprising hand hygiene and CVC bundles of care. The potential benefit of fluconazole prophylaxis in certain populations of surgical patients could also be considered. Full article

(This article belongs to the Special Issue New Perspectives for Candidiasis)

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10 pages, 11769 KiB

Open AccessArticle

Environmental Clonal Spread of Azole-Resistant Candida parapsilosis with Erg11-Y132F Mutation Causing a Large Candidemia Outbreak in a Brazilian Cancer Referral Center

by Danilo Y. Thomaz, João N. de Almeida, Jr., Odeli N. E. Sejas, Gilda M. B. Del Negro, Gabrielle O. M. H. Carvalho, Viviane M. F. Gimenes, Maria Emilia B. de Souza, Amir Arastehfar, Carlos H. Camargo, Adriana L. Motta, Flávia Rossi, David S. Perlin, Maristela P. Freire, Edson Abdala and Gil Benard

J. Fungi 2021, 7(4), 259; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7040259 - 30 Mar 2021

Cited by 37 | Viewed by 3037

Abstract

Clonal outbreaks due to azole-resistant Candida parapsilosis (ARCP) isolates have been reported in numerous studies, but the environmental niche of such isolates has yet to be defined. Herein, we aimed to identify the environmental niche of ARCP isolates causing unremitting clonal outbreaks in an adult ICU from a Brazilian cancer referral center. C. parapsilosis sensu stricto isolates recovered from blood cultures, pericatheter skins, healthcare workers (HCW), and nosocomial surfaces were genotyped by multilocus microsatellite typing (MLMT). Antifungal susceptibility testing was performed by the EUCAST (European Committee for Antimicrobial Susceptibility Testing) broth microdilution reference method and ERG11 was sequenced to determine the azole resistance mechanism. Approximately 68% of isolates were fluconazole-resistant (76/112), including pericatheter skins (3/3, 100%), blood cultures (63/70, 90%), nosocomial surfaces (6/11, 54.5%), and HCW’s hands (4/28, 14.2%). MLMT revealed five clusters: the major cluster contained 88.2% of ARCP isolates (67/76) collected from blood (57/70), bed (2/2), pericatheter skin (2/3), from carts (3/7), and HCW’s hands (3/27). ARCP isolates were associated with a higher 30 day crude mortality rate (63.8%) than non-ARCP ones (20%, p = 0.008), and resisted two environmental decontamination attempts using quaternary ammonium. This study for the first time identified ARCP isolates harboring the Erg11-Y132F mutation from nosocomial surfaces and HCW’s hands, which were genetically identical to ARCP blood isolates. Therefore, it is likely that persisting clonal outbreak due to ARCP isolates was fueled by environmental sources. The resistance of Y132F ARCP isolates to disinfectants, and their potential association with a high mortality rate, warrant vigilant source control using effective environmental decontamination. Full article

(This article belongs to the Special Issue New Perspectives for Candidiasis)

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11 pages, 893 KiB

Open AccessCommunication

Candida duobushaemulonii: An Old But Unreported Pathogen

by Irene Jurado-Martín, Cristina Marcos-Arias, Esther Tamayo, Andrea Guridi, Piet W. J. de Groot, Guillermo Quindós and Elena Eraso

J. Fungi 2020, 6(4), 374; https://0-doi-org.brum.beds.ac.uk/10.3390/jof6040374 - 17 Dec 2020

Cited by 7 | Viewed by 3798

Abstract

Candidiasis caused by species of the Candida haemulonii complex (Candida haemulonii and Candida duobushaemulonii) and closely related species, Candida auris and Candida pseudohaemulonii are increasing. These species often show reduced susceptibility to antifungal drugs, such as azoles and amphotericin B or, less frequently, echinocandins. However, conventional phenotypic identification methods are unable to accurately differentiate these species and, therefore, their prevalence may have been underestimated. In this study, 150 isolates that were probably misidentified were reanalyzed using two novel PCR approaches. We found that one isolate previously identified in 1996 as Candida intermedia was C. duobushaemulonii, being one of the oldest isolates of this species described to date. We also found that this isolate had reduced susceptibility to fluconazole, itraconazole, and amphotericin B. Full article

(This article belongs to the Special Issue New Perspectives for Candidiasis)

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Review

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11 pages, 1104 KiB

Open AccessReview

Antifungal Resistance in Clinical Isolates of Candida glabrata in Ibero-America

by Erick Martínez-Herrera, María Guadalupe Frías-De-León, Rigoberto Hernández-Castro, Eduardo García-Salazar, Roberto Arenas, Esther Ocharan-Hernández and Carmen Rodríguez-Cerdeira

J. Fungi 2022, 8(1), 14; https://0-doi-org.brum.beds.ac.uk/10.3390/jof8010014 - 26 Dec 2021

Cited by 14 | Viewed by 3190

Abstract

In different regions worldwide, there exists an intra-and inter-regional variability in the rates of resistance to antifungal agents in Candida glabrata, highlighting the importance of understanding the epidemiology and antifungal susceptibility profiles of C. glabrata in each region. However, in some regions, such as Ibero-America, limited data are available in this context. Therefore, in the present study, a systematic review was conducted to determine the antifungal resistance in C. glabrata in Ibero-America over the last five years. A literature search for articles published between January 2015 and December 2020 was conducted without language restrictions, using the PubMed, Embase, Cochrane Library, and LILACS databases. The search terms that were used were “Candida glabrata” AND “antifungal resistance” AND “Country”, and 22 publications were retrieved from different countries. The use of azoles (fluconazole, itraconazole, voriconazole, posaconazole, isavuconazole, ketoconazole, and miconazole) varied between 4.0% and 100%, and that of echinocandins (micafungin, caspofungin, and anidulafungin) between 1.1% and 10.0%. The limited information on this subject in the region of Ibero-America emphasizes the need to identify the pathogens at the species level and perform antifungal susceptibility tests that may lead to the appropriate use of these drugs and the optimal doses in order to avoid the development of antifungal resistance or multi-resistance. Full article

(This article belongs to the Special Issue New Perspectives for Candidiasis)

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28 pages, 1710 KiB

Open AccessReview

New Applications of Photodynamic Therapy in the Management of Candidiasis

by Carmen Rodríguez-Cerdeira, Erick Martínez-Herrera, Gabriella Fabbrocini, Beatriz Sanchez-Blanco, Adriana López-Barcenas, May EL-Samahy, Eder R. Juárez-Durán and José Luís González-Cespón

J. Fungi 2021, 7(12), 1025; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7121025 - 29 Nov 2021

Cited by 20 | Viewed by 2820

Abstract

The most important aetiological agent of opportunistic mycoses worldwide is Candida spp. These yeasts can cause severe infections in the host, which may be fatal. Isolates of Candida albicans occur with greater frequency and variable resistance patterns. Photodynamic therapy (PDT) has been recognised as an alternative treatment to kill pathogenic microorganisms. PDT utilises a photosensitizer, which is activated at a specific wavelength and oxygen concentration. Their reaction yields reactive oxygen species that kill the infectious microorganism. A systematic review of new applications of PDT in the management of candidiasis was performed. Of the 222 studies selected for in-depth screening, 84 were included in this study. All the studies reported the antifungal effectiveness, toxicity and dosimetry of treatment with antimicrobial PDT (aPDT) with different photosensitizers against Candida spp. The manuscripts that are discussed reveal the breadth of the new applications of aPDT against Candida spp., which are resistant to common antifungals. aPDT has superior performance compared to conventional antifungal therapies. With further studies, aPDT should prove valuable in daily clinical practice. Full article

(This article belongs to the Special Issue New Perspectives for Candidiasis)

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18 pages, 905 KiB

Open AccessReview

Treating (Recurrent) Vulvovaginal Candidiasis with Medical-Grade Honey—Concepts and Practical Considerations

by Senna J. J. M. van Riel, Celine M. J. G. Lardenoije, Guy J. Oudhuis and Niels A. J. Cremers

J. Fungi 2021, 7(8), 664; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7080664 - 16 Aug 2021

Cited by 8 | Viewed by 10786

Abstract

Recurrent vulvovaginal candidiasis (RVVC) is a relapsing vaginal fungal infection caused by Candida species. The prevalence varies among age populations and can be as high as 9%. Treatment options are limited, and in 57% of the cases, relapses occur within six months after fluconazole maintenance therapy, which is the current standard of care. The pathogenesis of RVVC is multifactorial, and recent studies have demonstrated that the vaginal microenvironment and activity of the immune system have a strong influence on the disease. Medical-grade honey (MGH) has protective, antimicrobial, and immunomodulatory activity and forms a putative alternative treatment. Clinical trials have demonstrated that honey can benefit the treatment of bacterial and Candida-mediated vaginal infections. We postulate that MGH will actively fight ongoing infections; eradicate biofilms; and modulate the vaginal microenvironment by its anti-inflammatory, antioxidative, and immunomodulatory properties, and subsequently may decrease the number of relapses when compared to fluconazole. The MGH formulation L-Mesitran Soft has stronger antimicrobial activity against various Candida species than its raw honey. In advance of a planned randomized controlled clinical trial, we present the setup of a study comparing L-Mesitran Soft with fluconazole and its practical considerations. Full article

(This article belongs to the Special Issue New Perspectives for Candidiasis)

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Other

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8 pages, 487 KiB

Open AccessCase Report

Candida lusitaniae Breakthrough Fungemia in an Immuno-Compromised Adolescent: Case Report and Review of the Literature

by Athanasia Apsemidou, Miriam Antonie Füller, Evgeny A. Idelevich, Oliver Kurzai, Athanasios Tragiannidis and Andreas H. Groll

J. Fungi 2020, 6(4), 380; https://0-doi-org.brum.beds.ac.uk/10.3390/jof6040380 - 21 Dec 2020

Cited by 10 | Viewed by 3440

Abstract

Candida lusitaniae is a rare cause of candidemia that is known for its unique capability to rapidly acquire resistance to amphotericin B. We report the case of an adolescent with grade IV graft-vs.-host disease after hematopoietic cell transplantation who developed catheter-associated C. lusitaniae candidemia while on therapeutic doses of liposomal amphotericin B. We review the epidemiology of C. lusitaniae bloodstream infections in adult and pediatric patients, the development of resistance, and its role in breakthrough candidemia. Appropriate species identification, in vitro susceptibility testing, and source control are pivotal to optimal management of C. lusitaniae candidemia. Initial antifungal therapy may consist of an echinocandin and be guided by in vitro susceptibility and clinical response. Full article

(This article belongs to the Special Issue New Perspectives for Candidiasis)

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