Osteoarticular infection by Candida albicans in an infant with cystic fibrosis

Radike, Kerstin; Kunzmann, Steffen; Abele‐Horn, Marianne; Beer, Meinrad; Hebestreit, Helge

doi:10.1099/jmm.0.031757-0

Cited by 6 publications

(2 citation statements)

References 9 publications

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“…1, 2, and 3). 5-FC has also been successfully used to treat fungal infections in CF patients, including a case of pulmonary candidiasis, without causing side effects (24,25). These issues raise the possibility that currently recommended 5-FC dosing regimens would also be effective as antivirulence therapy against P. aeruginosa.…”

Section: Discussionmentioning

confidence: 99%

Repurposing the antimycotic drug flucytosine for suppression ofPseudomonas aeruginosapathogenicity

Imperi

Massai

Facchini

et al. 2013

Proc. Natl. Acad. Sci. U.S.A.

135

144

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Section: Discussionmentioning

confidence: 99%

Repurposing the antimycotic drug flucytosine for suppression ofPseudomonas aeruginosapathogenicity

Imperi

Massai

Facchini

et al. 2013

Proc. Natl. Acad. Sci. U.S.A.

135

144

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“…A total of 286 patients were described. There were 52 papers describing 139 single cases, one open-label, noncomparative, clinical trial involving a total of 29 patients and one randomized clinical trial involving a total of 118 patients [ 43 , 44 , 45 , 46 , 47 , 54 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , …”

Section: Resultsmentioning

confidence: 99%

Antifungal Combinations against Candida Species: From Bench to Bedside

Fioriti

Brescini

Pallotta

et al. 2022

JoF

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Candida spp. is the major causative agent of fungal infections in hospitalized patients and the fourth most common cause of nosocomial bloodstream infection (BSI). The availability of standardized methods for testing the in vitro activity of antifungals along with the expanding of antifungal armamentarium, the rising of drug-resistance and the persistence of a high mortality rate in systemic candidiasis have led to an increased interest in combination therapy. Therefore, we aimed to review the scientific literature concerning the antifungal combinations against Candida. A literature search performed in PubMed yielded 92 studies published from 2000 to 2021: 29 articles referring to in vitro studies, six articles referring to either in vitro and in vivo (i.e., animal models) studies and 57 clinical articles. Pre-clinical studies involved 735 isolates of Candida species and 12 unique types of antifungal combination approaches including azoles plus echinocandins (19%), polyenes plus echinocandins (16%), polyenes plus azoles (13%), polyenes plus 5-flucytosine ([5-FC], 13%), azoles plus 5-FC (11%) and other types of combinations (28%). Results varied greatly, often being species-, drug- and methodology-dependent. Some combinatorial regimens exerted a synergistic effect against difficult-to-treat Candida species (i.e., azoles plus echinocandins; polyenes plus 5-FC) or they were more effective than monotherapy in prevent or reducing biofilm formation and in speeding the clearance of infected tissues (i.e., polyenes plus echinocandins). In 283 patients with documented Candida infections (>90% systemic candidiasis/BSI), an antifungal combination approach could be evaluated. Combinations included: azoles plus echinocandins (36%), 5-FC-combination therapies (24%), polyenes plus azoles (18%), polyenes plus echinocandins (16%) and other types of combination therapy (6%). Case reports describing combination therapies yielded favorable response in most cases, including difficult-to-treat fungal infections (i.e., endocarditis, osteoarticular infections, CNS infections) or difficult-to-treat fungal pathogens. The only randomized trial comparing amphotericin-B deoxycholate (AMB) plus FLU vs. AMB alone for treatment of BSI in nonneutropenic patients showed that the combination trended toward improved success and more-rapid clearance from the bloodstream. In summary, antifungal combinations against Candida have produced great interest in the past two decades. To establish whether this approach can become a reliable treatment option, additional in vitro and clinical data are warranted.

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Candida Arthritis: Analysis of 112 Pediatric and Adult Cases

Gamaletsou

Rammaert

Bueno

et al. 2015

Open Forum Infectious Diseases

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Background. Candida arthritis is a debilitating form of deeply invasive candidiasis. However, its epidemiology, clinical manifestations, management, and outcome are not well understood.Methods. Cases of Candida arthritis were reviewed from 1967 through 2014. Variables included Candida spp in joint and/or adjacent bone, underlying conditions, clinical manifestations, inflammatory biomarkers, diagnostic imaging, management, and outcome.Results. Among 112 evaluable cases, 62% were males and 36% were pediatric. Median age was 40 years (range, <1–84 years). Most patients (65%) were not pharmacologically immunosuppressed. Polyarticular infection (≥3 joints) occurred in 31% of cases. Clinical manifestations included pain (82%), edema (71%), limited function (39%), and erythema (22%) with knees (75%) and hips (15%) most commonly infected. Median erythrocyte sedimentation rate was 62 mm/hr (10–141) and C reactive protein 26 mg/dL (0.5–95). Synovial fluid median white blood cell count was 27 500/µL (range, 100–220 000/µL) with 90% polymorphonuclear neutrophils (range, 24–98). Adjacent osteomyelitis was present in 30% of cases. Candida albicans constituted 63%, Candida tropicalis 14%, and Candida parapsilosis 11%. Most cases (66%) arose de novo, whereas 34% emerged during antifungal therapy. Osteolysis occurred in 42%, joint-effusion in 31%, and soft tissue extension in 21%. Amphotericin and fluconazole were the most commonly used agents. Surgical interventions included debridement in 25%, irrigation 10%, and drainage 12%. Complete or partial response was achieved in 96% and relapse in 16%.Conclusion. Candida arthritis mainly emerges as a de novo infection in usually non-immunosuppressed patients with hips and knees being most commonly infected. Localizing symptoms are frequent, and the most common etiologic agents are C albicans, C tropicalis, and C parapsilosis. Management of Candida arthritis remains challenging with a clear risk of relapse, despite antifungal therapy.

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Osteoarticular infection by Candida albicans in an infant with cystic fibrosis

Cited by 6 publications

References 9 publications

Repurposing the antimycotic drug flucytosine for suppression ofPseudomonas aeruginosapathogenicity

Repurposing the antimycotic drug flucytosine for suppression ofPseudomonas aeruginosapathogenicity

Antifungal Combinations against Candida Species: From Bench to Bedside

Candida Arthritis: Analysis of 112 Pediatric and Adult Cases

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