Antibiotic susceptibility testing ofCandida albicans by flow cytometry

A flow cytofluorometric susceptibility test (FCST) for in vitro antifungal drug testing ofCandida albicans was developed. Membrane damage was indicated by increased cellular fluorescence owing to propidium iodide or rose bengal uptake. Ketoconazole caused an exponential dose-response effect, best defined by E_max, at therapeutically achievable concentrations (0.02–0.2 µg/ml). This effect was not comparable to the conventional minimum inhibitory concentration (MIC) effect elicited by higher antibiotic concentrations. Amphotericin B, on the other hand, did not elicit E_max, but caused a >1 log dose-response effect which did correspond to the MIC. 5-Fluorocytosine susceptibility was also measurable. Other cytometric data indicating abnormal growth and growth inhibition, as well as conventional growth inhibition testing, confirmed that the 10-h FCST measured useful parameters of in vitro susceptibility.     

Routine Identification of Yeasts with the Aid of Molybdate-Agar Medium

A large number of yeasts, including a variety of species other than Candida albicans, were isolated from clinical specimens. C. tropicalis and Torulopsis glabrata were each found one-third as frequently as C. albicans. A schema is presented which made possible, by simple procedures, the identification of the great majority of the isolated yeasts. Preliminary isolation and differentiation was aided by the use of molybdate-agar medium. The use of the schema by diagnostic bacteriological laboratories is discussed.     

In vitro susceptibility to 5-fluorocytosine and nystatin of common clinical yeast isolates

The sensitivity to nystatin, 5-fluorocytosine (5-FC) or both was studied for 131 clinical isolates of Candida albicans, 47 of Candida parapsilosis, 34 of Candida tropicalis, 7 of Candida guilliermondii, 28 of Torulopsis glabrata and 1 of Torulopsis Candida.All strains were inhibited by concentrations of nystatin within the usual range of sensitivity except one strain of T. glabrata and another of T. Candida whose minima inhibitory concentrations (MICs) were respectively 250 U/ml and > 20000 U/ml.In respect to 5-FC it was found, after 7 days of incubation at 37 °C, the following frequencies of resistance: C. albicans 28/106 (26%), C. parapsilosis 11/47 (23%), C. tropicalis 24/34 (71%), C. guilliermondii 1/7, T. glabrata 1/28 (4%) and T. candida 0/1. It was particularly striking the activity of 5-FC against T. glabrata.     

Amphotericin B synergy testing by the FCST

The flow cytofluorometric susceptibility test (FCST) was incorporated into two in vitro synergy assays of amphotericin B-drug combinations. The FCST checkerboard assay and the FCST concentration-effect assay were developed to detect subtle modulation of amphotericin B fungicidal effects onCandida albicans andCryptococcus neoformans. Amphotericin B × cyclosporine A was a synergistic fungicidal combination against bothC. albicans andC. neoformans. Amphotericin B×gentamicin and amphotericin B×ketoconazole were synergistic combinations againstC. neoformans. In all cases tested, the synergy was effective when 0.50–0.62 g amphotericin B/ml was used with>-0.50 g of the other drug/ml. The fungicidal effect of 1.00 g amphotericin B/ml overwhelmed the synergistic effects. A number of other drug combinations were additive, autonomous, or antagonistic.     

Immunochemical studies on mannans of the genusSaccharomyces

Antigenic mannans isolated from the cells ofSaccharomyces fermentati, Saccharomyces rosei,Saccharomyces delbrueckii, Torulopsis colliculosa, Candida albicans andSaccharomyces cerevisiae were examined for their reactivity withSaccharomyces fermentati andCandida albicans antisera. Mannans ofTorulaspora as well asCandida albicans showed high cross-reactivity with the investigated antisera, which could be due to the presence of long side chains established by the partial acetolysis method. The low specific rotations ofSaccharomyces fermentati, Saccharomyces rosei andTorulopsis colliculosa mannans indicate a predominance of β-glycosidio linkages, whereasSaccharomyces delbrueckii andCandida albicans mannans possess predominantly α-linkages.Saccharomyces cerevisiae mannan showed different structural and immunological properties.     

Incidencia de levaduras aisladas de boca y cepillo de dientes en Venezuela

117 yeast strains from the mouth, and 69 from toothbrushes of 229 patients from the Hospital Universitario of Caracas (Venezuela) were studied. Candida albicans was found to be the most frequent yeast in both materials with 56.4%, and 52.1% in the mouth and toothbrushes, respectively. C. tropicalis with 16.2%, and C. parapsilosis with 7.6% followed C. albicans in the mouth. In the toothbrushes C. parapsilosis with 11.5%, and C. tropicalis with 6.0% followed C. albicans. The incidence of other yeasts was not significative. Torulopsis glabrata was not found in the material studied.     

Two unlike cousins: Candida albicans and C. glabrata infection strategies

Candida albicans and C. glabrata are the two most common pathogenic yeasts of humans, yet they are phylogenetically, genetically and phenotypically very different. In this review, we compare and contrast the strategies of C. albicans and C. glabrata to attach to and invade into the host, obtain nutrients and evade the host immune response. Although their strategies share some basic concepts, they differ greatly in their outcome. While C. albicans follows an aggressive strategy to subvert the host response and to obtain nutrients for its survival, C. glabrata seems to have evolved a strategy which is based on stealth, evasion and persistence, without causing severe damage in murine models. However, both fungi are successful as commensals and as pathogens of humans. Understanding these strategies will help in finding novel ways to fight Candida, and fungal infections in general.     

Untersuchungen über Antigengemeinschaften zwischen hefeartigen Pilzen

Zusammenfassung An einer willkürlichen Auswahl von Stämmen aus den GeneraCandida, Torulopsis, Saccharomyces undSchizosaccharomyces konnten mit Hilfe der Immunelektrophorese außer bekannten Beziehungen der Polysaccharidantigene noch einige gemeinsame Eiweißantigene nachgewiesen werden.Übereinstimmungen bestehen mitTsuchiya in Bezug auf die enge Verwandtschaft vonC. albicans, C. tropicalis undC. stellatoidea, sowie zwischenS. cerevisiae undC. robusta.Bei Berücksichtigung aller Antigene fanden wir zusätzlich Antigengemeinschaften zwischenT. glabrata undS. rouxii, sowie weitere antigene Beziehungen beiC. krusei, C. utilis, T. famata undS. cerevisiae, die auf gemeinsamen Eiweißantigenen beruhen.Es wurde der Versuch unternommen, einige Eiweißantigene ausC. albicans zu isolieren. Nach Fällung des größten Teils der Antigene mit Universalpuffer verblieben im Rückstand 2 Eiweißantigene, mit denen Kaninchen immunisiert wurden. Von den beiden induzierten Antikörpern gegen Eiweißantigen vonC. albicans reagierte der eine nur mitC. tropicalis, der andere nur mitC. stellatoidea, jedoch nicht mit anderen Hefen.

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Summary The serologic relationships of various yeast strains, arbitrarily selected from the generaCandida, Torulopsis, Saccharomyces, andSchizosaccharomyces, were investigated by means of immunoelectrophoretic technique. In addition to serologic crossings ofC. albicans, C. tropicalis, andC. stellatoidea as well as ofS. cerevisiae, andC. robusta, which had previously been reported byTsuchiya and other investigators, we have found, that protein antigens are shared by various strains, i.e.C. krusei, C. utilis, T. famata, andS. cerevisiae. Taking into account the overall picture of their antigenic patterns,T. glabrata andS. rouxii were found to stand particulary close to each other.Attempts were made to isolate some of these proteide antigens fromC. albicans. After partial precipitation of the crude homogenate by the addition ofJohnson &Lindsay's Universal Buffer followed by centrifugation, the supernatant was used to immunize rabbits. Two types of antibodies could be detected; while both reacted in the immunoelectrophoresis withC. albicans antigens, one also precipitatedC. tropicalis and the otherC. stellatoidea. None of the 10 other yeasts which have been tested showed any activity with these rabbit sera.

     

Response to Oxidative Stress in Eight Pathogenic Yeast Species of the Genus <Emphasis Type="Italic">Candida</Emphasis>

In the course of an infection, the formation of reactive oxygen species by phagocytes and the antioxidant defense mechanisms of microorganisms play a crucial role in pathogenesis. In this study, isolates representing 8 pathogenic Candida species—Candida albicans, Candida dubliniensis, Candida famata, Candida glabrata, Candida guilliermondii, Candida krusei, Candida parapsilosis and Candida tropicalis—were compared with regard to their resistance to oxidative stress in vitro. We evaluated degree of resistance, induction of oxidative damage, capacity to adapt, and induction of antioxidant enzymes. The species showed variable sensitivity to oxidative attack. C. albicans, C. glabrata, and C. krusei were more resistant to oxidative stress under the conditions tested; C. parapsilosis and C. tropicalis presented medium resistance; and C. dubliniensis, C. famata, and C. guilliermondii were more sensitive. The overall greater resistance to oxidative stress of C. albicans and C. glabrata may provide an advantage to these species, which are the major causative agents of candidiasis.     

Epidemiology and Antifungal Susceptibilities of Yeasts Causing Vulvovaginitis in a Teaching Hospital

Vulvovaginal candidiasis is one of the most common mycosis. However, the information about antifungal susceptibilities of the yeasts causing this infection is scant. We studied 121 yeasts isolated from 118 patients with vulvovaginal candidiasis. The isolates were identified by phenotypic and molecular methods, including four phenotypic methods described to differentiate Candida albicans from C. dubliniensis. Antifungal susceptibility testing was performed according to CLSI documents M27A3 and M27S4 using the drugs available as treatment option in the hospital. Diabetes, any antibacterial and amoxicillin treatment were statistically linked with vulvovaginal candidiasis, while oral contraceptives were not considered a risk factor. Previous azole-based over-the-counter antifungal treatment was statistically associated with non-C.albicans yeasts infections. The most common isolated yeast species was C. albicans (85.2 %) followed by C. glabrata (5 %), Saccharomyces cerevisiae (3.3 %), and C. dubliniensis (2.5 %). Fluconazole- and itraconazole-reduced susceptibility was observed in ten and in only one C. albicans strains, respectively. All the C. glabrata isolates showed low fluconazole MICs. Clotrimazole showed excellent potency against all but seven isolates (three C. glabrata, two S. cerevisiae, one C. albicans and one Picchia anomala). Any of the strains showed nystatin reduced susceptibility. On the other hand, terbinafine was the less potent drug. Antifungal resistance is still a rare phenomenon supporting the use of azole antifungals as empirical treatment of vulvovaginal candidiasis.     

Itraconazole vs amphotericin B: in vitro comparative evaluation of the minimal inhibitory concentration (MIC) against clinically isolated yeasts

Itraconazole is a triazole compound which, following several clinical trials, has begun to be used for therapy of mycotic infections. This new drug, with a broad-spectrum antifungal activity, can be orally administered. The Authors studied the in vitro susceptibility to amphotericin B and itraconazole of the following clinical isolates of pathogenic yeasts: 100 Candida albicans, 20 C. tropicalis, 20 C. parapsilosis, 8 C. guilliermondii, 6 C. pseudotropicalis, 24 Torulopsis glabrata and 16 Cryptococcus neoformans.Serial two-fold dilutions, from 100 g/ml to 0.04 g/ml, of each drug were prepared in Yeast Nitrogen Base + Glucose 5%, after dissolving the itraconazole in dimethylsulfoxide (DMSO) and amphotericin B in 5% glucose solution. Amphotericin B (MIC₉₀: 3.12 g/ml) was found to have an average in vitro MIC six-fold lower than itraconazole (MIC₉₀: 25 g/ml).Thus, even though itraconazole is active, amphotericin B remains one of the most effective of the antifungal drugs.     

Strain differentiation of pathogenic yeasts by the killer system

High sensitivity rates to the activity of killer toxins produced by 25 species of yeasts belonging to the genera Candida, Hansenula, Pichia, Rhodotorula, Saccharomyces and Trichosporon have been observed among 112 yeast isolates (25 Cryptococcus neoformans, 29 C. glabrata, 16 C. parapsilosis, 20 C. pseudotropicalis and 22 C. tropicalis). The highest sensitivity has been observed among the C. parapsilosis isolates, the lowest in C. glabrata strains. Genera Pichia and Hansenula proved to have the greatest killer activity. A killer system, formerly used for differentiating C. albicans isolates within the species, proved to be valid as epidemiological marker when applied to 112 strains of pathogenic yeasts.     

In Vitro Investigation of Antifungal Activity of Allicin Alone and in Combination with Azoles Against <Emphasis Type="Italic">Candida</Emphasis> Species

Candidiasis is a term describing infections by yeasts from the genus Candida, and the type of infection encompassed by candidiasis ranges from superficial to systemic. Treatment of such infections often requires antifungals such as the azoles, but increased use of these drugs has led to selection of yeasts with increased resistance to these drugs. In this study, we used allicin, an allyl sulfur derivative of garlic, to demonstrate both its intrinsic antifungal activity and its synergy with the azoles, in the treatment of these yeasts in vitro. In this study, the MIC₅₀ and MIC₉₀ of allicin alone against six Candida spp. ranged from 0.05 to 25 μg/ml. However, when allicin was used in combination with fluconazole or ketoconazole, the MICs were decreased in some isolates. Our results demonstrated the existing synergistic effect between allicin and azoles in some of the Candida spp. such as C. albicans, C. glabrata and C. tropicalis, but synergy was not demonstrated in the majority of Candida spp. tested. Nonetheless, In vivo testing needs to be performed to support these findings.     

New milk medium for germ tube and chlamydoconidia production byCandida albicans

A new medium consisting of UHT milk, tween 80 and agar is described for the development of both germ tube and chlamydoconidia byCandida albicans. In total 172 isolates from clinical specimens, includingC. albicans (112),C. guilliermondii (4),C. krusei (3),C. parasilopsis (16).C. tropicalis (28),Torulopsis glabrata (6) andTrichosporon beigellii (3), were examined in this medium by using the standard method. A higher percentage (98.2%) of germ tube production byC. albicans was found in this medium than in undiluted serum (90.2%). In addition, onlyC. albicans was found to be able to produce a high percentage of chlamydoconidia (95.5%) after 48 hours' incubation. In comparison with the conventional medium, corn meal tween 80 agar (21.4%), this new medium gives a significantly higher percentage and abundance of chlamydoconidia production. Being simple, cheap and easy to prepare, the new milk medium is proposed as very practical in the clinical mycology laboratory.     

Vulvovaginal candidiasis is associated with the production of germ tubes by <Emphasis Type="Italic">Candida albicans</Emphasis>

Twenty Candida albicans strains isolated from women attended at the Teaching and Research in the Laboratory of Teaching and Research in Clinical Analysis of the State University of Maringa, Paraná, Brazil, have been analyzed. Yeasts were identified by classical methods and patients subdivided into asymptomatic, vulvovaginal candidiasis(VVC) and recurrent vulvovaginal candidiasis (RVVC) groups. Yeasts were incubated in RPMI + fetal calf serum to analyze germ tubes every two hours, up to 10 h. In vitro sensitivity to fluconazole, itraconazole, ketoconazole, amphotericin B and nystatin was analyzed according to NCCLS-M27-A microdilution assay. Yeast isolated from symptomatic women produced significantly more germ tubes than asymptomatic women (P < 0.05). However, no significant difference between yeasts from VVC and RVVC occurred (P > 0.05). Variation between MIC₅₀ and MIC₉₀ of tested antifungal agents was slight among isolated yeasts, while no resistant yeasts were detected. Nevertheless, VVC yeasts were more DDS (reduced dose-dependent susceptibility) for nystatin and RVVC were more DDS for ketoconazole. Results suggest that colonization by yeast in the vagina and lack of symptoms may be partially explained by the yeast’s sparse capacity to form germ tubes, On the other hand, RVVC was not associated with antimicrobial resistance. DDS high frequency for nystatin and ketoconazole indicates that identification, and susceptibility of antifungals tests are important to management of VVC.     

Antifungal activity of some mediterranean algae

Summary The antifungal activity of 15 mediterranean algae species on some dermatophyte strains (Epidermophyton floccosum, Microsporum canis, M. gypseum and Trichophyton mentagrophytes) and pathogenic yeasts (Candida albicans, C. guillermondii, C. krusei, C. tropicalis and Torulopsis glabrata) has been tested following a modification of Aubert's technique.Among the algae species studied, Falkenbergia rufolanosa is the most active in front of all the fungi tested.     

In vitro evaluation of adherence of Candida albicans,Candida glabrata,and Streptococcus mutans to an acrylic resin modified by experimental coatings

This study evaluated the effect of experimental coatings, containing zwitterion or hydrophilic monomers, on the adherence of Candida albicans, Candida glabrata, and Streptococcus mutans to an acrylic resin. Acrylic samples (smooth or rough surfaces) were left untreated (control) or coated with one of the following experimental coatings: 3-hydroxypropylmethacrylate (HP) or sulfobetaine methacrylate (S), at concentrations of 25, 30, or 35%. Half of the specimens were coated with saliva. The adhesion test was performed by incubating specimens in C. albicans, C. glabrata, and S. mutans suspensions at 37°C for 90?min. The number of adhered microorganisms was determined by metabolic activity (XTT) and by cell viability (CFU). All coated specimens exhibited lower absorbance and CFU values compared to control specimens. Saliva and roughness did not promote microorganism adherence. An XPS analysis confirmed the modification in the chemical composition of the coatings in the experimental samples. These experimental coatings significantly reduced the adherence of C. albicans, C. glabrata and S. mutans to acrylic resin.     

Fungal diseases of the respiratory tract

The proportion ofCandida and non-Candida species in the clinical material from patients. with respiratory-tract diseases was determined.C. albicans was isolated in 102 cases. An additional 89 strains of yeasts, isolated in association with respiratory diseases, belonged to 10 non-albicans Candida spp. andCryptococcus spp. The prevailing species, which occurred in 47 cases, wasC. parapsilosis. C. tropicalis, C. glabrata, andC. guilliermondii were isolated in 12, 10, and 9 cases, respectively. Four strains ofC. krusei and three strains ofC. lusitaniae and one strain each ofC. freyschussii, C. robusta, C. zeylanoides, andCryptococcus neoformans were also isolated.     

Molecular typing of clinical Candida strains using random amplified polymorphic DNA and contour‐clamped homogenous electric fields electrophoresis

Aims: This report describes an investigation into the genetic profiles of 38 Candida albicans and 19 Candida glabrata strains collected from a dental hospital of Monastir (Tunisia) and the Laboratory of Parasitology, Farhat Hached Hospital of Sousse (Tunisia), using two typing methods: random amplified polymorphic DNA (RAPD) and contour‐clamped homogenous electric fields (CHEF). Methods and Results: The two methods (RAPD and CHEF electrophoresis) were able to identify clonal‐related isolates from different patients. RAPD method using two primers (CA1 and CA2) exhibited the highest discriminatory power by discriminating 22 genotypes for C. albicans with CA1 oligonucleotides and 19 genotypes with CA2 primer. For C. glabrata, 17 genotypes were obtained when both primers CA1 and CA2 were combined. The CHEF karyotyping of C. albicans has discriminated only 17 different karyotypes. Conclusion: The genotype of each isolate and genotypic difference among C. albicans and C. glabrata isolates were patient specific and not associated with the site of infection, geographic origin or date of isolation. Significance and Impact of the Study: Identification of relatedness between Candida species using molecular approaches with high discriminatory power is important in determining adequate measures for interruption of transmission of this yeast.