Successful treatment of a <i>Candida albicans</i> sepsis with a combination of flucytosine and fluconazole

Scheven, M.; Jiinemann, K.; Schramm, H; Hühn, W.

doi:10.1111/j.1439-0507.1992.tb00886.x

Cited by 16 publications

(3 citation statements)

References 6 publications

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“…In this regard, combination of two or more drugs has been suggested and tested for C. albicans and other Candida species and found to be synergistic for amphotericin B/ketoconazole, 5-FC/ketoconazole, and other combinations as well [151, 152]. The drug combination therapy was also tested in mice model and patients [153, 154]. In a recent study, Tavanti et al have shown that clinical isolates of C. glabrata (low susceptibility to azole drugs) are susceptible to human cationic peptide hepcidin (Hep-20) (100–200 μ g/mL).…”

Section: Discussionmentioning

confidence: 99%

CandidaInfections and Their Prevention

Kabir

Ahmad

2013

ISRN Preventive Medicine

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Infections caused by Candida species have been increased dramatically worldwide due to the increase in immunocompromised patients. For the prevention and cure of candidiasis, several strategies have been adopted at clinical level. Candida infected patients are commonly treated with a variety of antifungal drugs such as fluconazole, amphotericin B, nystatin, and flucytosine. Moreover, early detection and speciation of the fungal agents will play a crucial role for administering appropriate drugs for antifungal therapy. Many modern technologies like MALDI-TOF-MS, real-time PCR, and DNA microarray are being applied for accurate and fast detection of the strains. However, during prolonged use of these drugs, many fungal pathogens become resistant and antifungal therapy suffers. In this regard, combination of two or more antifungal drugs is thought to be an alternative to counter the rising drug resistance. Also, many inhibitors of efflux pumps have been designed and tested in different models to effectively treat candidiasis. However, most of the synthetic drugs have side effects and biomedicines like antibodies and polysaccharide-peptide conjugates could be better alternatives and safe options to prevent and cure the diseases. Furthermore, availability of genome sequences of Candida albicans and other non-albicans strains has made it feasible to analyze the genes for their roles in adherence, penetration, and establishment of diseases. Understanding the biology of Candida species by applying different modern and advanced technology will definitely help us in preventing and curing the diseases caused by fungal pathogens.

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Section: Discussionmentioning

confidence: 99%

CandidaInfections and Their Prevention

Kabir

Ahmad

2013

ISRN Preventive Medicine

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“…We chose the combination of FLCZ and 5-FC as the initial antifungal therapy in the present case based on the antifungal activity against both Cr. neoformans and C. albicans infection (44,45). On the other hand, if a non-albicans Candida species e.g., C. glabrata or C. krusei, had been identified, these antifungal agents would have been changed to LFAmB.…”

Section: Discussionmentioning

confidence: 99%

Concurrent Subcutaneous Candidal Abscesses and Pulmonary Cryptococcosis in a Patient with Diabetes Mellitus and a History of Corticosteroid Therapy

et al. 2014

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A 50-year-old man with a history of long-term corticosteroid treatment following adrenalectomy for Cushing's syndrome and uncontrolled diabetes mellitus was admitted for an examination of an abnormal thoracic shadow. Cryptococcal serum antigens were positive, and the histopathology of a lung biopsy showed encapsulated yeast resembling Cryptococcus neoformans. On admission, the serum β-D-glucan level was approximately twice the cutoff value, several nodules were observed on both legs and magnetic resonance imaging revealed subcutaneous abscesses. Candida albicans was identified from needle aspirates, and the patient was successfully treated with fluconazole and flucytosine. We herein report the first case of concurrent C. albicans skin abscesses and pulmonary cryptococcosis.

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“…The combination of antifungals flucytosine (5FC) and amphotericin B (AMB) is recommended by the Infectious Diseases Society of America for Candida infections ( Pappas et al, 2015 ) due to the high rate of resistance developed during 5FC monotherapy ( Barchiesi et al, 2000 ). Other combinations between two antifungals have been put through clinical trials ( Scheven et al, 1992 ; Ghannoum & Elewski, 1999 ; Rex et al, 2003 ; Pachl et al, 2006 ), but so far only the 5FC + AMB combination therapy has a clinical role ( Pappas et al, 2015 ). Common combinations studied are between a commercial antifungal and a specific inhibitor of a protein of interest; for example, antifungals combined with Hsp90 inhibitors ( Cowen, 2013 ; Veri & Cowen, 2014 ) or protein kinase C inhibitors ( LaFayette et al, 2010 ).…”

Section: Introductionmentioning

confidence: 99%

Synergistic and antagonistic effects of immunomodulatory drugs on the action of antifungals againstCandida glabrataandSaccharomyces cerevisiae

Tome

Zupan

Tomičić

et al. 2018

PeerJ

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Candidemia and other forms of invasive fungal infections caused by Candida glabrata and to a lesser extent Saccharomyces cerevisiae are a serious health problem, especially if their steadily rising resistance to the limited range of antifungal drugs is taken into consideration. Various drug combinations are an attractive solution to the resistance problem, and some drug combinations are already common in the clinical environment due to the nature of diseases or therapies. We tested a few of the common antifungal-immunomodulatory drug combinations and evaluated their effect on selected strains of C. glabrata and S. cerevisiae. The combinations were performed using the checkerboard microdilution assay and interpreted using the Loewe additivity model and a model based on the Bliss independence criterion. A synergistic interaction was confirmed between calcineurin inhibitors (Fk506 and cyclosporine A) and antifungals (fluconazole, itraconazole, and amphotericin B). A new antagonistic interaction between mycophenolic acid (MPA) and azole antifungals was discovered in non-resistant strains. A possible mechanism that explains this is induction of the Cdr1 efflux pump by MPA in C. glabrata ATCC 2001. The Pdr1 regulatory cascade plays a role in overall resistance to fluconazole, but it is not essential for the antagonistic interaction. This was confirmed by the Cgpdr1Δ mutant still displaying the antagonistic interaction between the drugs, although at lower concentrations of fluconazole. This antagonism calls into question the use of simultaneous therapy with MPA and azoles in the clinical environment.

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Successful treatment of a Candida albicans sepsis with a combination of flucytosine and fluconazole

Cited by 16 publications

References 6 publications

CandidaInfections and Their Prevention

CandidaInfections and Their Prevention

Concurrent Subcutaneous Candidal Abscesses and Pulmonary Cryptococcosis in a Patient with Diabetes Mellitus and a History of Corticosteroid Therapy

Synergistic and antagonistic effects of immunomodulatory drugs on the action of antifungals againstCandida glabrataandSaccharomyces cerevisiae

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