Key Points
After being killed by artesunate, malaria parasites are expelled from red cells and then these pitted red cells reenter the circulation. When many pitted red cells are produced during therapy, their delayed clearance a few weeks later triggers hemolytic episodes.
These are the first 2 patients with inherited CARD9 deficiency and invasive Exophiala disease to be described. CARD9 deficiency should thus be considered in patients with unexplained invasive Exophiala species disease, even in the absence of other infections.
In order to shed light on its basic biology, we initiated a population genetic analysis of Candida glabrata, an emerging pathogenic yeast with no sexual stage yet recognized. A worldwide collection of clinical strains was subjected to analysis using variable number of tandem repeats (VNTR) at nine loci. The clustering of strains obtained with this method was congruent with that obtained using sequence polymorphism of the NMT1 gene, a locus previously proposed for lineage assignment. Linkage disequilibrium supported the hypothesis of a mainly clonal reproduction. No heterozygous diploid genotype was found. Minimum-spanning tree analysis of VNTR data revealed clonal expansions and associated genotypic diversification. Mating type analysis revealed that 80% of the strains examined are MATa and 20% MAT␣ and that the two alleles are not evenly distributed. The MATa genotype dominated within large clonal groups that contained only one or a few MAT␣ types. In contrast, two groups were dominated by MAT␣ strains. Our data are consistent with rare independent mating type switching events occurring preferentially from type a to ␣, although the alternative possibility of selection favoring type a isolates cannot be excluded.
During the previous decades, as the number of immunocompromised patients, the average age of Western populations and the widespread use of indwelling medical devices have increased concomitantly, so has the incidence of infections caused by Candida species. Candida albicans remains the most frequently isolated agent of candidiasis. However, C. glabrata now accounts for a substantial part of clinical isolates, ranking number two among the etiologic agents of either superficial or invasive candidiasis in North America and Europe. Along with C. glabrata and belonging to the Nakaseomyces clade, two new species, C. nivariensis and C bracarensis have recently been described as emerging pathogens. This review provides information on the current state of knowledge on the epidemiology, biology, identification, pathogenicity and antifungal resistance of C. glabrata, C. nivariensis and C. bracarensis.
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