Treatment of Vulvovaginal Candidiasis with A Strategy Based on Phototherapy (M.A.C.® Scar Acceleration Method)

Candidiasis, also known as candidiasis vulvovaginitis, is an infection caused by different types of Candida fungi, the most frequent being Candida albicans. The present study reports an effective strategy, which opens new avenues for the treatment of this public health problem. The MAC® Methodology, conventional laser light-emitting (LLLT)/LED) methods are based on the biphasic response demonstrated many times in LLLT research and as with other forms of drugs, a “drug” (irradiation parameters) and a “dose” (irradiation times) and the “Arndt-Schulz Law” is often cited as a suitable model to describe the dose-dependent effects of LLLT. This method uses photopharmaceuticals, cell markers and the use of correct parameters for each case to induce the acceleration of tissue repair. The present study shows a case of a 32-year-old patient diagnosed with recurrent candidiasis 4 years ago. Eighteen sessions were performed (every other day) using a photoactivated component (Methylene blue 1% + Clotrimazole 1%) and LED phototherapy (red, blue and violet) with emission times of 60 - 260 seconds for each applicator, according to the dose recommendations of the scar acceleration method (MAC®). At the sixth treatment session there was a noticeable decrease in the itching sensation reported by the patient. In session 11 she reported feeling a great improvement, indicating that she no longer felt itching in any area after 18 sessions. The present case demonstrates new methodologies to treat common problems in the population that have a positive impact on the quality of life. This methodology has a promising future because it is non-invasive and requires a great biological transformation for inflammatory, fungal and viral control.

Alpha Defensins Genes and Vulvovaginal Candidiasis:A Study of Cases

Objective: To evaluate the alpha-defensin (α-DF) genes polymorphism in women with vulvovaginal candidiasis and recurrence. Methods: This observational study included clinical vaginal secretion samples collected over four years from 88 women, ranging in age from 18 to 65 years, from medical centers of Sao Paulo and Mogi das Cruzes, Brazil. Thirty-six of these women were asymptomatic (control group) and 52 presented clinical condition compatible with vulvovaginitis (38 primary or episodic as non-recurrent forms, and 14 recurrent vulvovaginal candidiasis). A portion of each sample was plated on Sabouraud dextrose agar with chloramphenicol and grown on CHROMagar Candida for presumptive characterization. The identification of the species was obtained by sequencing of the ITS1 region of rDNA. α-DF genes were amplified for subsequent evaluation of polymorphisms by endonuclease restriction assay. Results: From 88 samples were isolated 60 Candida albicans and 28 non-albicans Candida spp. Resistant C. albicans strains and non-albicans Candida spp. were more prevalent in recurrence. In all groups, the number of resistant non-albicans Candida spp. was most high than susceptible strains. α-DF1, α-DF3 and α-DF1/α-DF3 genotypes were found in 32 (36.4%), 17 (19.3%), 6 (6.8%) vaginal samples, respectively. About 33 samples were not amplified. Recurrence and severe disease were more observed in homozygous population. Conclusions: Non-albicans Candida spp. and homozygotic α-DF genotipes (α-DF1 and α-DF3) were more related with severe clinical signs and recurrence. Further studies about vulvovaginal candidiasis and α-DF genes are necessary to access the more comprehensive role of defensins in clinical manifestations.

Treatment of chronic vulvovaginal candidiasis with posaconazole and ciclopiroxolamine

Therapy of chronic recurrent vulvovaginal can- didiasis (VVC) caused by Candida glabrata is still rare in comparison to C. albicans infection, but therapy remains more difficult. Combination therapy with topical antifungals may improve therapy outcome, but still standard agents as fluconazole or itraconazole often fail. Posaconazole is a new systemic triazole with a wide antifungal spectrum including rare Candida species. Up to now, no clinical trials with posa- conazole in chronic recurrent VVC have been undertaken. Here, first results of the application of a new therapy regimen consisting of oral posaconazole in combination with topical ciclopiroxolamine are presented. 15 patients with chronic recurrent VVC caused by C. glabrata have been treated. 14 of these patients experienced successful therapy, clinical and mycological cure 30 days after begin of therapy has been observed. Long-term results are promising, as in 4 patients clinical and mycologic cure persists for more than 1 year up to now.

Polyhexamethylene Biguanide in Vaginal Solution Is Effective in the Treatment of Vulvovaginal Candidiasis: A Pilot Study

Vaginitis is one of the most recurrent conditions that afflict women and require medical care. Vulvovaginal candidiasis (VVC) is frequently related to vaginal carriage of Candida albicans, an opportunistic polymorphic fungus, which colonizes the human skin, the mucosa and the reproductive tract. Actually, standard treatments to counteract vaginitis include several topical and oral treatments. The aim of this study was to evaluate the efficacy of a new biguanide compound, polyhexamethylene biguanide (PHMB) in avaginal solution, in women affected by vaginal candidiasis. For this reason, 40 women showing the symptoms previously ascribed to vaginal candidiasis were recruited and treated with a single PHMB dose of vaginal solution. After a single dose of treatment, 80% of them had a complete resolution of the fungal infection;furthermore, all of them reported clinical benefits, statistically significant reduction in both clinical signs and symptoms of candidiasis and a score’s reduction of 50%.

Use of the Scar Acceleration Method - Mac^®in the Treatment of Vulvovaginal Candidiasis: A Proposal for Treatment in Public Health in Sus, Brazil

Vulvovaginal candidiasis is an infection of the genital mucosa, which involves the vulva and vagina caused by yeast. It is considered a recurrent pathology and a public health problem that causes discomfort by the triggers and that, when left untreated, can lead to health problems. The present study is a report of two cases treated with the MAC® - Scar Acceleration Method - (MAC®) methodology at the Physiotherapy School Clinic of Teaching Center of Campos Gerais (CESCAGE) as a pilot for the proposal to implement the protocol at the Municipal Center for Women’s Health—CMM in the municipality of Ponta Grossa—PR, Brazil. The patients were referred by Basic Health Units in the city with complaints of pruritus, vaginal discharge and local burning with the diagnosis of candidiasis evidenced by culture and antibiogram. Patients were treated with photodynamic therapy using the MAC® method for 14 consecutive days with 660 nm red laser phototherapy, 100 mW of power, 9 joules of energy, photosensitizing the drug Turmeric Long in one of the participants and propolis in the other, using 1% methylene blue dye. Both patients and researchers did not have access to which drug was being used for each participant. Photodynamic therapy potentiated the effects of drugs considering that patients showed gradual improvement with the applied application, which was proven in the analysis of sample secretions performed before and after treatment. The MAC® method had a positive effect in the protocol used and is strengthened as a possibility for treatments aimed at women’s health with regard to vulvovaginal diseases. It is suggested and intended to carry out further research with a greater number of patients using the referred method.

How Vaginal Infections Impact Women’s Everyday Life <br/>—Women’s Lived Experiences of Bacterial Vaginosis and Recurrent Vulvovaginal Candidiasis

Reoccurring symptoms and persistent problems that continue post treatment can be characteristic of the vaginal infections Bacterial Vaginosis (BV) and recurrent vulvovaginal candidiasis (RVVC). The purpose of this study was to describe women’s life experiences in managing the symptoms of bacterial vaginosis and Candida. Sixteen women were recruited and participated in an interview study when they contacted a Swedish gynecology clinic with vaginal complaints that ranged from and included abnormal discharge, irritation itching along with serious malodor. An interpretive phenomenological approach was used with an individual interview to get a more intimate understanding of the women experiencing these problems. The finding of this study shows that managing the recurrent symptoms of the infections remains to be a challenge for women as it has a clearly negative impact on the quality of their lives. Four themes developed: frustration and mood disorders, intimacy changes in the relationship, exposure, hope and relief. The women had high hopes of eliminating the symptoms within the six-month study period. The treatment program, with its well-developed guidelines and continuity of care within the context of the study greatly improved the quality of life of these women. Women had feelings of frustration and anxiety when nothing could cure their problem while they had also a great hope to get rid of the symptoms with a long striking treatment. Well-developed guidelines and continuity of care can help these women to have an improved quality of life.

Long COVID and gut candidiasis:What is the existing relationship?

Since the beginning of the coronavirus disease(COVID)2019 pandemic,thou-sands of articles on the topic have been published,and although there is a growing trend of research on another associated condition,long coronavirus disease,important points still remain to be clarified in this respect.Robust evidence has suggested a relevant link between new clinical discoveries and molecular mechanisms that could be associated with the manifestations of different signs and symptoms involving cases of long COVID.However,one of the existing gaps that requires further investigation concerns a possible rela-tionship between gut candidiasis and long COVID.While recent studies also suggest an interplay between the occurrence of these two conditions,it is not yet fully clear how this may happen,as well as the specifics regarding the possible pathophysiological mechanisms involved.In this connection and with the advent of a potential strengthening of the body of evidence supporting the hypothesis of a link between gut candidiasis and long COVID,a better understanding of the clinical presentation,pathophysiology and clinical management of such a relationship should be essential and useful for both,additional advances towards more targeted research and appropriate case management.Knowing more about the signs,symptoms,and complications associated with cases of long COVID is essential in order to more effectively mitigate the related burden and provide a higher quality of care and life for the affected population.In light of this and the need for better outcomes,here we review and discuss the content on different aspects of long COVID,including its pathophysiology and the existing evidence of a potential relationship between such a condition and gut candidiasis,as well as suggest propositions for future related research.INTRODUCTION Long coronavirus disease(COVID)is a condition characterized by the emergence of new symptoms or the persistence of existing symptoms for at least two months,three months after the initial infection[1].Although such a condition has initially been extensively studied,there are still many contradictions between the findings and methodologies of different related research articles[2,3].Within this context and since the middle of the COVID-19 pandemic,important studies have been published in the literature reporting the occurrence of fungal infections among COVID-19 patients[4,5],including mucormycosis,and oral candidiasis[6].On the other hand,evidence on a possible relationship between gut candidiasis and long COVID is still recent[7].Indeed,a marked gastrointestinal(GI)fungal dysbiosis together with perturbation of the lung-gut axis has been observed in severe COVID-19 patients.This combined with neutrophilia and an exacerbated worsening of the inflammatory response,which can be implicated in the acute and chronic immunopathology of such a viral disease[7,8].Furthermore,persistent changes in the immune system may also occur,resulting in a possible relationship with the occurrence of long COVID[7].However,more targeted evidence is still scarce and the specific topic related to gut candidiasis has been the subject of little discussion.In response to this,in this article we discuss general aspects of long COVID,the inherent pathophysiology and current evidence of a potential relationship between this condition and gut candidiasis,in addition to providing recommendations for future research.ACKNOWLEDGEMENTS Tovani-Palone MR thanks the Saveetha Institute of Medical and Technical Sciences for supporting this study.

Oral candidiasis and potential risk factors among disabled and nondisabled in Al-Baha region, Saudi Arabia

BACKGROUND Oral candidiasis(OC)is an oral health disease that could influence patients’oral health quality of life.AIM To estimate prevalence of OC among disabled and non-disabled individuals and its potential risk factors in the Al-Baha region,Saudi Arabia.METHODS An observational cross-sectional study was carried out among 148 disabled and non-disabled participants.The technique of concentrated oral rinse employing the Sabouraud Dextrose Agar medium accompanied with 0.05%chloramphenicol was conducted to assess and isolate candida.Oral examination using the World Health Organization guidelines was conducted to examine participants’oral hea-lth status.A pre-designed questionnaire was also used to evaluate sociodemo-graphic,medical history,and oral hygiene habits of the studied population.RESULTS Out of 148 participants(n=57,38%)had colonized candida.None of the studied population had visible Candida lesions.However,Candida was found in the oral rinses without the subject presenting any lesions or issues caused by Candida(asymptomatic colonization).The most common prevalent OC among participants were Candida albicans,Candida glabrata,Candida dubliniensis,Candida krusei,Candida tropicalis,and Candida parapsilosis(n=35,61%;n=8,14%;n=6,10%;n=5,9%;n=2,4%;and n=1,2%)respectively.Diabetes,smoking,poor plaque,and gingival status were key potential risk factors that significantly associated with candida’s density and presence(P=0.001,P=0.001,P=0.01,and P=0.01)respectively.Disability status had no statistically significant effect on presence and density of Candida.CONCLUSION The prevalence of OC is almost third of the studied population;thus,may provoke a need to develop preventive strategies to reduce the OC rate and establish solid treatment plans.

Features of vaginal bacteria community in women with recurrent vulvovaginal candidiasis

Objective To investigate the features of vaginal bacteria community in women with recurrent vulvovaginal candidiasis （R VVC） and its etiological risk in vaginal health. Methods Totally 237 reproductive-aged women with RVVC in an acute episode were studied. Whereas 230 healthy reproductive-aged women were enrolled as the control. The vaginal pH was evaluated, while vaginal secretions were sampled for Gram＇s staining and oilmicroscopy. By Nugent score system, the composition of vaginal communities was determined, and other micro-ecological features were approached. To describe other features of vaginal microbiota, the community＇s bacteria density, species diversity and predominant species were evaluated at 1 000 X magnification. Results The vaginal pH （4.53 ~ 0.30） and Nugent score （4.31 ___＋ O. 73） in RVVC group were significantly increased compared with vaginal pH （4.11 __＋ 0.30） and Nugent score （1.32 _＋ 1.29） in control group （P〈O.05, respectively）. The density of Lactoba- cillus in RVVC group was significantly lower than that in control group （P〈O.05）, while the densities of Gardnerella vaginalis, Gram-positive cocci and other species were significantly higher respectively than those in control group （P〈O. 05）. Species diversity of women with RVVC significantly exceeded that of control group （P〈O.05）. More than half of vaginal communities in R VVC group lost Lactobacillus-dominating and were predominated by other bacteria such as Gardnerella vaginalis and Gram-positive cocci. The prevalence of Gardnerella vaginalis-dominating and Gram-positive cocci-domi- nating communities in RVVC group （37.55% and 19.83%） were significantly higher than those in control group （1.30% and 1.73%） （P〈0.05）. Conclusion The significant changes in vaginal bacterial community were observed in RVVC women. Such variations in community might relate to vaginal biological barrier compromising and increase the risk to the recurrence of VVC. It is still controversial whether probiotics can prevent recurrences of VVC, and more randomized, doubleblind, placebo-controlled trials with a larger sample size should be carried out, so as to clarify its effects for the prophylaxis of RVVC.

Expression of Candida Albicans Secreted Aspartyl Proteinase in Acute Vaginal Candidiasis

In order to analyze the in vivo expression of Candida albicans secreted aspartyl pro- teinases (SAP) in human vaginal infection, the vaginal secretion from 29 human subjects was col- lected by vaginal swab, and the expression of SAP1–SAP6 was detected by reverse-transcriptase po- lymerase chain reaction using specific primer sets. It was found that Sap2 and Sap5 were the most common genes expressed during infection; Sap3 and Sap4 were detected in all subjects and all 6 SAP genes were simultaneously expressed in some patients with vaginal candidiasis. It was suggested that the SAP family is expressed by Candida albicans during infection in human and that Candida albi- cans infection is associated with the differential expression of individual SAP genes which may be involved in the pathogenesis of vaginal candidiasis.

Candidiasis Treatment Should Pay Attention to the Immune Changing Patients

The guideline of the Infectious Diseases Society of America (IDSA) about candidiasis is a key standard for clinical doctors to treat patients, and textbook to teach medical students. However, in the progress of clinical treatment and documents checking, the immune changing patients, who suffered candidiasis, may be mismatched to the clinical treatment guidelines. The opinion could be shown by the literature of gastrointestinal system, and respiratory system, which suffered severely fungal infection mostly, mainly connected with the outside world and inside organ systems of the human body. They could show some patients have been excess treatment, and we should pay attention to the immune changing patients.

Effectiveness of redcore lotion in patients with vulvovaginal candidiasis: a systematic review and Meta-analysis

OBJECTIVE:To summarize and evaluate the effectiveness and safety of Redcore lotion on treating vulvovaginal candidiasis(VVC)using a systematic review and Meta-analysis of randomized controlled trials.METHODS:A systematic literature search was performed in five English and three Chinese electronic databases up to October 2019.Randomized controlled trials in the treatment for VVC were included;only studies which compared the effectiveness and safety of Redcore lotion plus miconazole with miconazole alone were included.Relative risk(RR)and 95%confidence intervals(CI)were used in the Meta-analysis.RESULTS:Seven studies involving 768 patients suffering from VVC were identified;468 of the patients were pregnant women(60.9%).Combination group(Redcore lotion plus miconazole)was more effective in redu CIng symptomatic episodes of VVC than miconazole alone,with respect to cure rate(RR,1.31;95%CI,1.09-1.57;P=0.01),fungal culture negative rate(RR,1.21;95%CI,1.04-1.41;P=0.01),and effective rate(RR,1.18;95%CI,1.05-1.35;P=0.01).Subgroup analyses for pregnant women also showed that the combination group had superior outcomes with respect to VVC cure rate(RR,1.48;95%CI,1.16-1.88,P<0.01),fungal culture negative rate(RR,1.26;95%CI;1.09-1.47;P<0.01),and effective rate(RR,1.25;95%CI,1.10-1.42;P<0.01).Additionally,the observed risk of adverse events was lower in the combination medication group(RR,0.30;95%CI,0.14-0.65;P<0.01).CONCLUSIONS:Though overall quality of individual studies was low,Redcore lotion plus miconazole can significantly improve clinical effectiveness and safety compared with miconazole alone.

Local IL-23 Expression in Murine Vaginal Candidiasis and Its Relationship with Infection and Immune Status

To investigate the expression of vaginal IL-23 and its role in experimental murine vaginal candidiasis and its relationship with infection and immune status, immuno-competent （group A） and immuno-suppressed （group B） murine models of vaginal candidiasis were established in estrogentreated mice. Non-estrogen-treated mice were used as controls （group C）. The level of IL-23 p19 mRNA in murine vaginal tissue was determined by RT-PCR. Significantly increased levels of IL- 23p19mRNA were observed on the 4th, the 7th and 14th day after inoculation in immuno-competent group when compared with that in control group （P〈0.01, P〈0.05）, However, significant increase of IL-23 p19mRNA were only observed on the 7th day and the 14th day after inoculatuon in immuno-suppressed groups （P〈0. 05）. On the 4th and 7th day, the levels of IL-23 p19mRNA were significantly increased in immuno-competent group than those in immuno-suppressed group （P 〈0.05）. Local IL-23 may play a role in the pathogenesis of murine vaginal candidiasis and has a protective function during infection. Low vaginal IL-23 level may correlate with the increased susceptibility to Candida albicans in immuno-suppressed group.

Growing importance of urogenital candidiasis in individuals with diabetes:A narrative review

Both diabetes and fungal infections contribute significantly to the global disease burden,with increasing trends seen in most developed and developing countries during recent decades.This is reflected in urogenital infections caused by Candida species that are becoming ever more pervasive in diabetic patients,particularly those that present with unsatisfactory glycemic control.In addition,a relatively new group of anti-hyperglycemic drugs,known as sodium glucose cotransporter 2 inhibitors,has been linked with an increased risk for colonization of the urogenital region with Candida spp.,which can subsequently lead to an infectious process.In this review paper,we have highlighted notable virulence factors of Candida species(with an emphasis on Candida albicans)and shown how the interplay of many pathophysiological factors can give rise to vulvovaginal candidiasis,potentially complicated with recurrences and dire pregnancy outcomes.We have also addressed an increased risk of candiduria and urinary tract infections caused by species of Candida in females and males with diabetes,further highlighting possible complications such as emphysematous cystitis as well as the risk for the development of balanitis and balanoposthitis in(primarily uncircumcised)males.With a steadily increasing global burden of diabetes,urogenital mycotic infections will undoubtedly become more prevalent in the future;hence,there is a need for an evidence-based approach from both clinical and public health perspectives.

Prevalence of Non-<i>Albicans Candida</i>Infections in Women with Recurrent Vulvovaginal Symptomatology

Background: Candida vulvovaginitis is one of the most frequently diagnosed conditions in women’s care practices. Historically, 90% of cultured yeast species were C. albicans. However, due to a variety of interventions, the proportion of non-albicans Candida (NAC) infections appears to be increasing. We sought to estimate the current prevalence of Candida vulvovaginitis and the species-specific distribution of such infections in recurrent cases. Methods: Women with recurrent vulvovaginal symptomatology referred to an Obstetrics and Gynecology practice were tested by genital fungus culture, Candida-specific polymerase chain reaction (PCR), or both between July 2010 and February 2013. Results: A total of 103 women were tested. Mean age was 45.6 years. Including only their most recent positive test result, 29.1% (30/103) of women tested positive for Candida by any of the above testing measures. Of those, 50% (15/30) tested positive for C. albicans and 50% (15/30) tested positive for a NAC species. Across all visits, 60% (18/30) tested positive for C. albicans, 56.7% (17/30) tested positive for NAC, and 16.7% (5/30) tested positive for both a C. albicans and a NAC species. Among all isolated NAC species, 28.6% (6/21) were determined to be C. glabrata, 23.8% (5/21) C. krusei, 23.8% (5/21) C. parapsilosis, and 23.8% (5/21) other Candida species. Conclusion: Approximately 30% of women with recurrent vulvovaginal symptomatology have detectable Candida strains and it appears that NAC species may cause half of all these infections. This is imperative because NAC infections are usually more difficult to diagnose and are resistant to most treatments.

Susceptibility to Vaginal Candidiasis under Different Conditions in Mice

In order to study the susceptibility of murine vaginal mucosa to Candida albicans under different conditions, vaginal lavage fluid and vaginal tissue of mice were observed and compared between murine models with normal immune system （estrogen-treated mice） and immunosuppressed murine model, and between primary infection model of vaginal candidiasis and secondary infection one. The average level of colony forming unit （CFU） from the immuosuppressed group was higher than that from estrogen-treated group at each time point and the peak time was delayed. The differences between the two groups were statistically significant （P〈0.05） from the fourth day after inoculation. A significant difference existed in the average level of CFU between the control group and the estrogen-treated group （P〈0.05）, and between the control group and the immuosuppressed group （P〈0.01）. It was concluded that the vaginal mucosa from the immunosuppressed mice is more susceptible to Candida albicans and no difference is found in susceptibility between mice with primary infection and secondary infection.

An Epidemiologic Analysis of Vulvovaginal Candidiasis and Antifungal Susceptibilities

Inflammation of the vagina and vulva caused by Candida is called vulvovaginal candidiasis(VVC).Risk factors for VVC include pregnancy,diabetes mellitus,frequent oral sexual intercourse,and the use of tight synthetic underwear and systemic antibiotics.Candida albicans,which belongs to the normal flora of the vagina,is the most common cause of VVC.However,an increase in VVC episodes caused by non-albicans Candida species,including Candida glabrata,Candida tropicalis,Candida krusei and Candida parapsilosis,has been reported.In this study,a total of 100 Candida isolates obtained from patients with vaginitis symptoms were evaluated.The susceptibility of the Candida strains to amphotericin B,itraconazole,fluconazole,ketoconazole,voriconazole and caspofungin was investigated using the reference broth microdilution method.Risk factors and demographic characteristics of the patients and the identified Candida species were also investigated.Among the 100 Candida strains isolated from vaginal samples,47(47%)were C.albicans,43(43%)C.glabrata,5(5%)C.kefyr,2(2%)C.krusei,2(2%)C.tropicalis and 1(1%)was Candida guilliermondii.The incidences of Candida susceptibility to caspofungin,fluconazole,itraconazole,voriconazole,ketoconazole and amphotericin B were 75%,35%,27%,80%,97%and 100%,respectively.Also,there was a significant difference in antifungal susceptibility among patients belonging to certain risk groups,such as patients previously using antibiotics and recurrent cases.Prevalence of non-albicans Candida species and antifungal resistance,especially against azoles,are both increasing,and certain risk factors should be monitored strictly.

A Ten-year Retrospective Study of Invasive Candidiasis in a Tertiary Hospital in Beijing

Objective This study aimed to evaluate the epidemiological,clinical and mycological characteristics of invasive candidiasis(IC)in China.Methods A ten-year retrospective study including 183 IC episodes was conducted in a tertiary hospital in Beijing,China.Results The overall incidence of IC from 2010–2019 was 0.261 episodes per 1,000 discharges.Candidemia(71.0%)was the major infective pattern;70.3%of the patients tested positive for Candida spp.colonization before IC and the median time to develop an invasive infection after colonization was13.5 days(interquartile range:4.5–37.0 days).Candida albicans(45.8%)was the most prevalent species,followed by Candida parapsilosis(19.5%),Candida glabrata(14.2%)and Candida tropicalis(13.7%).C.non-albicans IC was more common in patients with severe anemia(P=0.018),long-term hospitalization(P=0.015),hematologic malignancies(P=0.002),continuous administration of broad-spectrum antibiotics(P<0.001)and mechanical ventilation(P=0.012).In vitro resistance testing showed that11.0%of the Candida isolates were resistant/non-wild type(non-WT)to fluconazole,followed by voriconazole(9.6%),micafungin(3.8%),and caspofungin(2.9%).Fluconazole was the most commonly used drug to initiate antifungal therapy both before and after the proven diagnosis(52.6%and 54.6%,respectively).The 30-day and 90-day all-cause mortality rates were 24.5%and 32.7%,respectively.Conclusion The incidence of IC has declined in the recent five years.C.non-albicans contributed to more than half of the IC cases.Fluconazole can be used as first-line therapy if resistant strains are not prevalent.Prospective,multi-center surveillance of the clinical and mycological characteristics of IC is required.

Clinical significance of isolated biliary candidiasis in patients with unresectable cholangiocarcinoma

BACKGROUND: The frequency of isolated biliary candidiasis is increasing in cancer patients. The clinical signiifcance of isolated biliary candidiasis remains unclear. We analyzed the risk factors of biliary candidiasis and outcomes of the patients with unresectable cholangiocarcinoma after percutaneous transhepatic biliary drainage (PTBD). METHODS: Among 430 patients who underwent PTBD between January 2012 and March 2015, 121 patients had unresectable cholangiocarcinoma. Bile and blood samples were collected for consecutive fungal culture. RESULTS: The study cohort included 49 women and 72 men with a median age of 71 years. Multivariate analysis showed that cancer progression (P=0.013), concurrent presence of another microorganism (P=0.010), and previous long-term (>7 days) antibiotic use (P=0.011) were potential risk factors of biliary candidiasis. Chemotherapy was not associated with overall biliary candidiasis (P=0.196), but was signiifcantly related to repeated biliary candidiasis (P=0.011). Patients with isolated biliary candidiasis showed remarkably reduced survival compared with those without (median overall sur-vival (OS): 32 vs 62 days,P=0.011)Subgroup analysis was also performed. Patients with repeated candidiasis had markedly decreased survival compared with those with transient candi-diasis (median OS: 30 vs 49 days,P=0.046). Biliary candidiasis was identiifed as a poor prognostic factor by univariate and multivariate analyses (P=0.033). Four cases of repeated can-didiasis (4/19, 21%) showedCandida species in consecutive blood culture until the end of the study, but others showed no candidemia. CONCLUSIONS: Isolated biliary candidiasis may be associ-ated with poor prognosis in patients with unresectable chol-angiocarcinoma. Especially, repeated biliary candidiasis may have the possibility of progression to candidemia. We suggest that biliary dilatation treatment or antifungal agents might be helpful for patients with biliary candidiasis.

Protective Effects of cis-2-Dodecenoic Acid in an Experimental Mouse Model of Vaginal Candidiasis

Objective To evaluate the efficacy of cis-2-dodecenoic acid(BDSF) in the treatment and prevention of vaginal candidiasis in vivo. Methods The activities of different concentrations of BDSF against the virulence factors of Candida albicans(C. albicans) were determined in vitro. An experimental mouse model of Candida vaginitis was treated with 250 μmol/L BDSF. Treatment efficiency was evaluated in accordance with vaginal fungal burden and inflammation symptoms. Results In vitro experiments indicated that BDSF attenuated the adhesion and damage of C. albicans to epithelial cells by decreasing phospholipase secretion and blocking filament formation. Treatment with 30 μmol/L BDSF reduced the adhesion and damage of C. albicans to epithelial cells by 36.9% and 42.3%, respectively. Treatment with 200 μmol/L BDSF completely inhibited phospholipase activity. In vivo mouse experiments demonstrated that BDSF could effectively eliminate vaginal infection and relieve inflammatory symptoms. Four days of treatment with 250 μmol/L BDSF reduced vaginal fungal loads by 6-fold and depressed inflammation. Moreover, BDSF treatment decreased the expression levels of the inflammatory chemokine-associated genes MCP-1 and IGFBP3 by 2.5-and 2-fold, respectively. Conclusion BDSF is a novel alternative drug that can efficiently control vaginal candidiasis by inhibiting the virulence factors of C. albicans.