BACKGROUND: Candida species are one ol the major pathogens causing opportunistic infection. The need for a standardized. and clinically relevant method for antifungal susceptibility testing has become more increased because resistance to antifungal agents is now being reported with increasing frequency. The purposes of this study were to measure the minimal inhibitory concentrations actions amphotericin B, flucytosine and fluconazole of clinical isolates of Candida species, and to evaluate broth microdilution method as a more efficient test method, compared with NCCLS standard broth macrodilution. METHODS: The minlmal Inhibitory concentrations of C. parapsilosis ATCC 90018, C, albicans ATCC 90028 and 32 Candida isolates from Korea University Hospital were evaluated against amphotericin B, flucytosine and fluconazole by broth macrodilution and microdilution methods. RESULTS: The minimal inhibitory concentrations of Candida species ranged 0.25 to 1.0 microgram/mL for amphotericin B, 0.125 to 2.0 microgram/mL for flucytosine and 0.125 to 64 microgram/mL for fluconazole. The percent of agreement between NCCLS standard broth macrodilution and microdilution was highest when inoculum size was 0.5-2.5x103 CFU/mL and incubation time was 48 hours, and one fold dilution agreement was 100% for amphotericin B, 100% for flucytosine and 88-96% for fluconazole. CONCLUSIONS: This study showed good agreement of results of broth microdilution test with those of macrodilution, and suggested that broth microdilution method is an accessible and useful method and can be substituted for broth macrodilutlon method with the expectation of good results.
Amphotericin B ; Antifungal Agents ; Candida* ; Fluconazole ; Flucytosine ; Korea ; Opportunistic Infections

BACKGROUND: Because of recently increasing reports of resistance of Candida (C.) species to antifungal agents, it is necessary to perform antifungal susceptibility testing. ATB FUNGUS 2 (bioMerieux, France) is an easy-to-perform in-vitro antifungal susceptibility test. OBJECTIVE: The purpose of the study was to investigate the minimal inhibitory concentration (MIC) of antifungal agents against Candida species isolated from skin lesion using ATB FUNGUS 2. METHODS: Eighty two clinical isolates of Candida species (including 56 C. albicans, 14 C. parapsilosis, 7 C. guilliermondii, 5 C. glabrata) were testeding ATB FUNGUS 2. MICs against itraconazole (ICZ), fluconazole (FCZ), flucytosine (FC) and amphotericin B (AMP) were read after 24 hours incubation. RESULTS: MIC of ICZ was <0.125microgram/ml on 73 (89.0%) clinical isolates of Candida species except > or =2.0microgram/ml on four strains (3 C. albicans, 1 C. glabrata) and 0.25~0.5microgram/ml on five strains (1 C. parapsilosis, 3 C. guilliermondii, 1 C. glabrata). MIC of FCZ was <8microgram/ml on 78 (95.1%) Candida species except >128microgram/ml on 3 C. albicans and 16microgram/ml on 1 C. parapsilosis. MIC of FC was <0.5microgram/ml on 76 (92.7%) Candida species except >64microgram/ml on 6 C. albicans. MIC of AMP was all (100.0%) <0.5microgram/ml. CONCLUSION: ATB FUNGUS 2 represented a simple and valuable method for antifungal susceptibility testing of Candida species.
Amphotericin B ; Antifungal Agents ; Candida* ; Fluconazole ; Flucytosine ; Fungi* ; Itraconazole ; Skin

No abstract available.
Child, Preschool ; Cryptococcosis/drug therapy* ; Cytosine/analogs & derivatives* ; Female ; Flucytosine/therapeutic use* ; Human

BACKGROUND: There is no guideline for the appropriate wavelength at which to measure the optical density (OD) value in broth microdilution antifungal susceptibility testing, although a spectrophotometric reading method is commonly used. The present study aimed to analyze the difference in the OD values over the range of visible light and to ascertain the optimal wavelength for the spectrophotometric method of microdilution testing. METHODS: We measured the OD of background blank controls of broth medium, antifungal agents, and inocula of five type strains using a Synergy HT multi-detection microplate reader at 5-nm intervals from 380 nm to 760 nm. We also estimated the OD differences between the 50% of growth control and blank control. RESULTS: The OD of the blank control showed a parabola shape with two peaks and steadily decreased at longer wavelengths. The curves of the antifungal agent were similar to those of blank controls, and the influence of each antifungal agent on the OD was minimal. For the difference in OD between 50% of growth control and the blank control, the curve was the opposite of the blank control, and the OD increased steadily at the wavelengths above 600 nm. CONCLUSIONS: The range between 600 nm and 700 nm was the optimal wavelength for broth microdilution antifungal susceptibility testing, although any wavelength within the visible light spectrum can be used.
Antifungal Agents/*chemistry ; Azoles/*chemistry ; Culture Media/*chemistry ; Flucytosine/*chemistry ; Microbial Sensitivity Tests ; Spectrophotometry/*methods

Ommaya reservoir implantation has been used for sterile assessment into ventricular CSF or direct chemotherapy of chronic meningitis and meningeal involvement of malignancy since 1963. We experienced two cases with chronic meningitis, one was tuberculous meningitis with obstructive hydrocephalus which was not improved by repetitive shunt and the other was cryptococcal meningitis which was not improved by traditional chemotherapy of intravenous amphotericin B and oral flucytosine. Ommaya reservoir was implanted for daily CSF drainage of intractable hydrocephalus in the first patient and for direct injection of amphotericin B into ventricle in the second patient. Both of two cases were successfully managed by the reservoir. Therefore, Ommaya reservoir could be useful in patients with chronic meningitis which are not improved by traditional management.
Amphotericin B ; Drainage ; Drug Therapy ; Flucytosine ; Humans ; Hydrocephalus ; Meningitis ; Meningitis, Cryptococcal ; Tuberculosis, Meningeal

This is the first case report to describe the tumor regressive effect of systemic human neural stem cell (NSC)/5-fluorocytosine (5-FC) therapy on canine metastatic lung tumor. The therapeutic effects appeared approximately two weeks after 5-FC administration. Thoracic radiographs revealed a reduced number of lung nodules and decreased nodule size. However, there were no significant antitumor effects on primary lesions in abdominal organs. In conclusion, human NSC/5-FC prodrug therapy can secure patient quality of life with the same or more therapeutic effects and fewer side effects than other recommended chemotherapies.
Drug Therapy ; Flucytosine* ; Genetic Therapy ; Humans ; Lung* ; Neural Stem Cells* ; Quality of Life ; Therapeutic Uses

Cryptococcal meningoencephalitis is one of the most cornInon fungal infections of the central nervous system, which mainly affects immunocompromised hosts, especially AIDS patients and patients with long-term steroid therapy. In advanced cases, it causes various complications such as encephailitis, hydrocephalus, and even death if not treated or inadequately treated. Authors have treated a case of cryptococcal meningoencephalitis with focal cerebellar lesion, whose primary infection sources were thought to be right frontal sinus and the ethmoidal sinus, with combination chemotherapy of amphotericine B and flucytosine.
Amphotericin B ; Central Nervous System ; Drug Therapy, Combination ; Flucytosine ; Frontal Sinus ; Humans ; Hydrocephalus ; Immunocompromised Host ; Meningoencephalitis*

Primary cutaneous cryptococcosis of ulcers and plaques developed on the face of an otherwise healthy 7-year-old boy. Lesions were successfully treated with 10% 5-fluorocytosine ointment under occlusive dressing, Cultures for the organism from the involved area became negative after 10 weeks of treatment but the organism was observed under microscope until 10 weeks after treatment. The extensively ulcerated granulomatous lesions healed with scar formation in 15 weeks. The patient had completed 20 weeks of treatment. Follow-up examination for 1 year showed no evidence of recurrence.
Child ; Cicatrix ; Cryptococcosis* ; Flucytosine* ; Follow-Up Studies ; Humans ; Male ; Occlusive Dressings ; Recurrence ; Ulcer

BACKGROUND: The VITEK-2 yeast susceptibility test (AST-YS01; bioMerieux, Hazelwood, MO, USA) has recently been introduced as a fully automated, commercial antifungal susceptibility test system that determines MIC endpoints spectrophotometrically, thereby eliminating subjective errors. We compared the ATB FUNGUS 2 (bioMerieux) and VITEK-2 (AST-YS01) systems to the CLSI M27 method for susceptibility testing of Candida isolates. METHODS: We tested 59 Candida species that were isolated from blood cultures at Wonju Christian Hospital between September 2008 and August 2009. We compared MIC results for amphotericin B, flucytosine, fluconazole and voriconazole using the ATB FUNGUS 2 and VITEK-2 (AST-YS01) tests to those obtained by the CLSI M27 broth microdilution method. RESULTS: Within two-fold dilutions of MICs, the agreement of the ATB FUNGUS 2 and VITEK-2 (AST-YS01) tests with the CLSI method according to antifungal agents were: amphotericin B, 100% vs. 100% flucytosine, 100% vs. 100% fluconazole, 83.6% vs. 98.3% and voriconazole, 83.6% vs. 96.7%, respectively. The categorical discrepancies for fluconazole and voriconazole were 20.4% and 18.6% for ATB FUNGUS 2, and 6.8% and 0% for VITEK-2 (ASTYS01). There were no major errors for fluconazole and voriconazole in either ATB FUNGUS 2 or VITEK-2 (AST-YS01) tests. CONCLUSION: The VITEK-2 system (AST-YS01) appears to be rapid and highly correlative with the CLSI method, suggesting that it is effective for antifungal susceptibility testing for Candida species in clinical settings.
Amphotericin B ; Antifungal Agents ; Candida ; Fluconazole ; Flucytosine ; Fungi ; Pyrimidines ; Triazoles ; Yeasts

PURPOSE: To report a case of cryptococcal chorioretinitis in the renal transplant patient. MATERIALS AND METHODS: A 31-year old male patient was admitted with visual disturbance, high fever and general weakness. On initial evaluation, visual acuity was 0.9 in the right eye and 0.3 in the left. On fundus exam, right eye showed the lesions which were expanded into posterior pole and equator and left eye showed several yellow white lesions which were larger than optic disc, and some of them were near the fovea. RESULT: Cryptococcus grew in CSF. The ocular diagnosis was cryptococcal chorioretinitis and intra-venous amphotericin B and oral flucytosine were given. In spite of 2-month treatment, the visual acuity of left eye was 0.04 due to the expansion of the lesion toward fovea. The patient refused the treatment after 4 months of treament, and he expired 1 month later.
Adult ; Amphotericin B ; Chorioretinitis* ; Cryptococcus ; Diagnosis ; Fever ; Flucytosine ; Humans ; Male ; Visual Acuity