In the past two decades standardized in vitro antifungal susceptibility testing has been developed in responsive to increasing invasive fungal infections. Until now, antifungal susceptibility testing is not considered as a routine testing procedure in many laboratories. However, cumulative antifungal susceptibility data of fungi show that, because of the fungal organisms' different susceptibilities to antifungal agents, knowledge of the infecting fungal species is highly predictive of likely susceptibility and can be used as a guide to therapy. Recently, routine use of fluconazole susceptibility testing for Candida species is becoming recognized as a useful aid in optimizing treatment of candidiasis. This testing may be particularly useful in patients with recurrent mucosal candidiasis, and candidemia or invasive candidiasis who have been previously treated with azole antifungals, those whose infections are not responding to treatment, and those with infections caused by non-albicans species of Candida. As several new antifungal drugs have been or will be licensed in the next few years, it is very important for the clinicians to choose antifungal agents appropriately, while considering changing epidemiology and susceptibility trends.
Antifungal Agents ; Candida ; Candidemia ; Candidiasis ; Candidiasis, Invasive ; Danazol ; Epidemiology ; Fluconazole ; Fungi ; Humans

BACKGROUND: The incidence of candidemia has increased, and an early differentiation of transient or central venous catheter (CVC)-related candidemia from deep-seated invasive candidiasis is often difficult. The Pastorex Candida antigen assay (Sanofi Diagnostics Pasteur, Marnes-la-Coquette, France) is known to be an useful and specific tool for the diagnosis of invasive candidiasis. We assessed the clinical significance of Pastorex Candida antigen assay in patients with candidemia. METHODS: Eighty-five sera from 27 patients with candidemia and 42 control sera (32 patients with superficial Candida colonization and 10 healthy subjects) were tested. The Pastorex Candida latex agglutination test was performed to evaluate the presence of Candida mannan antigen. Candidemia was divided into 3 categories; (i) transient, (ii) CVC-related, and (iii) non-CVC-related persistent types. RESULTS: Thirty-two patients with superficial Candida colonization and 10 healthy subjects were negative for the Pastorex Candida antigen. Of the 85 sera from 27 patients with candidemia, 14 (16.4%) were positive for the Pastorex Candida antigen. The Pastorex Candida antigen was detected neither in 6 patients with transient candidemia nor 15 patients with CVC-related candidemia. Conversely, it was detected in at least one serum sample of 5 of the 6 (83.3%) patients with non-CVC-related persistent candidemia. Of the 24 sera from 6 patients with non-CVC-related persistent candidemia, 14 (58.3%) were positive for the Pastorex Candida antigen. Overall, the sensitivity and specificity of the Pastorex Candida antigen assay for the diagnosis of non-CVC-related persistent candidemia were 83.3% and 100%, respectively. CONCLUSIONS: Our data suggest that the Pastorex Candida antigen assay has a potential for the differential diagnosis of non-CVC-related persistent candidemia from transient or CVC-related candidemia.
Candida* ; Candidemia* ; Candidiasis, Invasive ; Central Venous Catheters ; Colon ; Diagnosis ; Diagnosis, Differential ; Humans ; Incidence ; Latex Fixation Tests ; Mannans ; Sensitivity and Specificity

We purified enolase from Candida albicans KNIH10 strain which was isolated from a clinical specimen in Korea. The purified enolase was used to detect anti-Candida antibodies in sera of patients with invasive candidiasis. For purification of enolase from the crude extract prepared by French pressure at 20,000 PSI, the fast performance liquid chromatography (FPLC) using DEAE-sepharose column was used. The elutes at 0.3-0.4 M NaCl in FPLC was purified with homogenity in SDS-PAGE and its enzymatic activity was confirmed in sera of invasive candidiasis with candidemia patient by immunoblotting. The purified enolase indicated no siggnal (100% specificity) in 40 normal human sera and 75% (6/8) sensitivity in sera of candidemic patients with suspicious invasive candidiasis by immunoblotting.
Antibodies ; Candida albicans* ; Candida* ; Candidemia ; Candidiasis, Invasive ; Chromatography, Liquid ; Electrophoresis, Polyacrylamide Gel ; Humans ; Immunoblotting ; Immunologic Tests* ; Korea* ; Phosphopyruvate Hydratase*

PURPOSE: We evaluated epidemiological and clinical features of candidemia in neonates and children. MATERIALS AND METHODS: We retrospectively reviewed the medical charts of hospitalized neonates and children with positive blood cultures for Candida species from September 1, 2000 through August 31, 2006. RESULTS: Among 39 total neonates and children with candidemia, the median age was 4 months (interquartile range, 1-28) and overall mortality was 33%. Candida species included: Candida albicans (56%), Candida parapsilosis (23%) and Candida glabrata (15%). There was a tendency of proportional increase of candidemia due to non-albicans species (13% in 2001 vs 91% in 2006; P=0.01). Compared with children older than 1 month of age, the proportion of C. parapsilosis was significantly higher in neonates with candidemia (58% vs 7%; P=0.001). C. albicans was isolated more commonly from those who had undergone surgical intervention before candidemia (55% vs 18%; P<0.05). C. parapsilosis was isolated more commonly from premature neonates (78% vs 27%; P=0.015). C. glabrata was isolated more commonly from those who had neutropenia before candidemia (67% vs 12%; P=0.011). CONCLUSION: Candidemia by C. albicans was more commonly in surgical patients; by C. parapsilosis in premature neonates; by C. glabrata in neutropenic patients.
Candida ; Candida albicans ; Candida glabrata ; Candidemia* ; Candidiasis, Invasive ; Child* ; Epidemiology* ; Humans ; Infant, Newborn* ; Mortality ; Neutropenia ; Retrospective Studies ; Risk Factors

PURPOSE: We evaluated epidemiological and clinical features of candidemia in neonates and children. MATERIALS AND METHODS: We retrospectively reviewed the medical charts of hospitalized neonates and children with positive blood cultures for Candida species from September 1, 2000 through August 31, 2006. RESULTS: Among 39 total neonates and children with candidemia, the median age was 4 months (interquartile range, 1-28) and overall mortality was 33%. Candida species included: Candida albicans (56%), Candida parapsilosis (23%) and Candida glabrata (15%). There was a tendency of proportional increase of candidemia due to non-albicans species (13% in 2001 vs 91% in 2006; P=0.01). Compared with children older than 1 month of age, the proportion of C. parapsilosis was significantly higher in neonates with candidemia (58% vs 7%; P=0.001). C. albicans was isolated more commonly from those who had undergone surgical intervention before candidemia (55% vs 18%; P<0.05). C. parapsilosis was isolated more commonly from premature neonates (78% vs 27%; P=0.015). C. glabrata was isolated more commonly from those who had neutropenia before candidemia (67% vs 12%; P=0.011). CONCLUSION: Candidemia by C. albicans was more commonly in surgical patients; by C. parapsilosis in premature neonates; by C. glabrata in neutropenic patients.
Candida ; Candida albicans ; Candida glabrata ; Candidemia* ; Candidiasis, Invasive ; Child* ; Epidemiology* ; Humans ; Infant, Newborn* ; Mortality ; Neutropenia ; Retrospective Studies ; Risk Factors

Invasive Candida infections (ICI) have become the third most common cause of late-onset infection among extremely preterm infants in the neonatal intensive care unit. Candida colonization of the skin and gastrointestinal tract is an important first step in the pathogenesis of invasive disease. Factors such as exposure to broad spectrum antimicrobials, especially third generation cephalosporin, parenteral nutrition including lipid emulsion, central venous catheter, and abdominal surgery increase the risk of invasive infection. A definite diagnosis of ICI requires isolation the organism from blood or other sterile body fluid. Thrombocytopenia is very common in neonatal candidiasis, but it is also often seen in babies with bacteremia. Candida is capable of invading all vital organs and following candidemia, therefore a thorough evaluation to rule out end organ dissemination is important. Amphotericin-B is the drug of choice for treating ICI. Antifungal susceptibility test is increasingly used to manage ICI, especially in situations refractory to initial antifugal therapy. Invasive candidiasis among extremely preterm infants is associated with chronic lung disease, severe retinopathy of prematurity, and neurodevelopmental impairment at infancy.
Bacteremia ; Body Fluids ; Candida ; Candidemia ; Candidiasis ; Candidiasis, Invasive ; Central Venous Catheters ; Colon ; Gastrointestinal Tract ; Humans ; Infant ; Infant, Extremely Premature ; Infant, Newborn ; Intensive Care, Neonatal ; Lung Diseases ; Parenteral Nutrition ; Resin Cements ; Retinopathy of Prematurity ; Skin ; Thrombocytopenia

Invasive fungal infections (IFIs) are an important cause of morbidity and mortality in patients with acute leukemia who are receiving chemotherapy. Primary prophylaxis with antifungal agents has become the standard of care in this setting; as a result, invasive candidiasis has shown a significant reduction. However, broad use of antifungal prophylaxis has led to an increase in breakthrough candidiasis with reduced susceptibility or resistance to fluconazole. In addition, an increase in breakthrough mucormycosis has been reported in studies of voriconazole prophylaxis. We report on a case of disseminated candidiasis and subsequent breakthrough pulmonary mucormycosis in a patient with acute myeloid leukemia undergoing consolidation chemotherapy. To the best of our knowledge, in Korea, this is the first report of these two independent IFIs occurring in a single patient.
Antifungal Agents ; Candidiasis ; Candidiasis, Invasive ; Consolidation Chemotherapy ; Fluconazole ; Humans ; Korea ; Leukemia ; Leukemia, Myeloid, Acute ; Mucormycosis ; Pyrimidines ; Standard of Care ; Triazoles

Candida albicans is a dimorphic yeast which is responsible for 70 percent to 80 percent of all candidial infection, and is the most common cause of superficial and systemic candidiasis. Invasive candidiasis occurs under certain circumstances such as immunosuppression, prolonged hospitalization, and previous antibiotics use. We report a case of candidiasis with a unusual presentation of subcutaneous abscess. A 54 year-old woman came to our clinic with painful erythematous swelling plaques and nodules on the face and arms. She was hospitalized with generalized edema and weakness of both leg. She had a history of herbal medication for 1 year and was finally diagnosed with iatrogenic Cushing syndrome in department of the endocrinology. Biopsy of the lesion revealed chronic inflammation in dermis and subcutis and budding yeasts with pseudohyphae were shown in Gomoris Methenamine silver stain. And Candida albicans was identified by fungus culture.
Abscess ; Anti-Bacterial Agents ; Arm ; Biopsy ; Candida albicans ; Candidiasis ; Candidiasis, Invasive ; Cushing Syndrome ; Dermis ; Edema ; Endocrinology ; Female ; Fungi ; Hospitalization ; Humans ; Immunosuppression ; Inflammation ; Leg ; Methenamine ; Porphyrins ; Saccharomycetales ; Yeasts

BACKGROUND: Micafungin, a potent inhibitor of 1,3-beta-D-glucan synthase, is a novel antifungal agent of the echinocandin class. In vitro study showed that micafungin was effective against Aspergillus species as well as Candida species, but clinical data on the prophylactic efficacy against invasive fungal infections (IFIs) other than candidiasis are still lacking. MATERIALS AND METHODS: We identified 60 consecutive adult hematopoietic stem cell transplantation (HSCT) recipients who received at least 3 doses of micafungin during neutropenic period. Micafungin was started as an alternative in patients who were intolerant or had adverse events (AEs) to primary prophylactic antifungal agents. We retrospectively reviewed the medical records and analyzed the efficacy and safety of micafungin for prophylaxis against IFIs. RESULTS: The patients either had autologous (n=9) or allogeneic (n=51: 1 syngeneic, 24 sibling, 26 unrelated donor) HSCT. Itraconazole oral solution (n=58) was the most frequently used first line antifungal agent for prophylaxis and was administered for median 11 days. The most frequent cause of switch to micafungin was vomiting (n=42). The duration of neutropenia and micafungin administration was median 13 and 12 days, respectively. A successful outcome was achieved in 45 (75%) patients. Empirical antifungal therapy was initiated in 13 (22%) patients. There were 2 cases (3.3%) of breakthrough fungal infections which comprised a probable invasive pulmonary aspergillosis and a possible invasive fungal sinusitis. There was no case of invasive candidiasis. A total of 53 (88%) patients experienced at least one AE regardless of causality during micafungin administration. The most frequent AEs were hypokalemia, vomiting, diarrhea, and elevated serum aspartate aminotransferase or alanine aminotransferase. Among the aforementioned AEs, only 1 case of diarrhea could be classified as a probable relation with micafungin when causality was assessed. There was no AEs that caused discontinuation of micafungin. CONCLUSIONS: Micafungin seems to be a safe and effective agent for prophylaxis of IFIs including aspergillosis as well as candidiasis in HSCT recipients. However, further large, prospective, and randomized comparative studies are warranted for aspergillosis.
Adult ; Alanine Transaminase ; Antifungal Agents ; Aspartate Aminotransferases ; Aspergillosis ; Aspergillus ; Candida ; Candidiasis ; Candidiasis, Invasive ; Diarrhea ; Echinocandins ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Humans ; Hypokalemia ; Invasive Pulmonary Aspergillosis ; Itraconazole ; Lipopeptides ; Medical Records ; Mycoses ; Neutropenia ; Retrospective Studies ; Siblings ; Sinusitis ; Vomiting

In the past decades there has been a dramatic increase in the number of opportunistic fungal infections. Establishing the diagnosis of opportunistic fungal infections in compromised patients is not simple. The laboratory diagnostic tests include microscopic examination, culture and serological tests. Although the most reliable method is the histologic examination, various opportunistic fungal agents can reveal similar histologic morphology. Culture should be attempted, however, the isolation of these organisms from cultures must be interpretated with caution, because the causing agents for opportunistic fungal infections are common laboratory contaminants. Serology for fungal infections has limited value except cryptococcal antigen: the usefulness of detection of antigenemia in invasive candidiasis and invasive aspergillosis has been limited by the rapid clearance of Candida mannan and Aspergillus galactomann from serum, which results in only moderate sensitivity for the disease. Therefore, it should be appreciated that every laboratory test, for the diagnosis of opportunistic infections, has its limitations and should be interpreted with caution.
Aspergillosis ; Aspergillus ; Candida ; Candidiasis, Invasive ; Clinical Laboratory Techniques* ; Diagnosis ; Diagnostic Tests, Routine ; Fungi ; Humans ; Mannans ; Opportunistic Infections ; Serologic Tests