Comparison of in vitro antifungal activity of novel triazoles with available antifungal agents against dermatophyte species caused tinea pedis

ObjectiveDermatophytes are a group of keratinophilic fungi that invade and infect the keratinized tissues and cause dermatophytosis. We investigated effectiveness of novel triazole (luliconazole and lanaconazole) in comparison with available antifungal agents against dermatophyte species isolated from patients with tinea pedis.Material and methodsA total of 60 dermatophytes species were isolated from the patients with tinea pedis. Identification of species was done by DNA sequencing of the ITS1-5.8S rDNA-ITS2 rDNA region. In vitro antifungal susceptibility testing with luliconazole and lanaconazole and available antifungal agent was done in accordance with the Clinical and Laboratory Standards Institute, M38-A2 document.ResultsIn all investigated isolates, luliconazole had the lowest minimum inhibitory concentration (MIC) (MIC range = 0.0005–0.004 μg/mL), while fluconazole (MIC range = 0.4–64 μg/mL) had the highest MICs. Geometric mean MIC was the lowest for luliconazole (0.0008 μg/mL), followed by lanoconazole (0.003 μg/mL), terbinafine (0.019 μg/mL), itraconazole (0.085 μg/mL), ketoconazole (0.089 μg/mL), econazole (0.097 μg/mL), griseofulvin (0.351 μg/mL), voriconazole (0.583 μg/mL) and fluconazole (11.58 μg/mL).ConclusionThe novel triazoles showed potent activity against dermatophytes and promising candidates for the treatment of tinea pedis caused by Trichophyton and Epidermophyton species. However, further studies are warranted to determine the clinical implications of these investigations.     

Physiological characterization and molecular identification of some rare yeast species causing onychomycosis

IntroductionOnychomycosis are infections with a variety of etiological agents. Although dermatophytes are responsible for most infections, yeasts are gaining importance as agents of these pathologies. The use of antifungals has increased the incidence of what had been considered rare or novel pathogens. We reidentify three rare yeasts from a culture collection of onychomycosis agents by matrix-assisted laser desorption/ionization time of flight/mass spectrometry (MALDI-TOF/MS) and sequencing the internal transcribed spacer (ITS) regions or the intergenic spacer (IGS) 1 region of ribosomal DNA (rDNA), and present their enzymatic and antifungal susceptibility profiles.Material and methodsWe performed a phenotypical characterization and molecular identification of five yeast isolates. We tested the urease, gelatinase, DNase, phospholipase, protease, and esterase activities, as well as the hemolytic activity. We evaluated the antifungal susceptibility to amphotericin B, fluconazole, anidulafungin and caspofungin.ResultsPhenotypic methods could not identify the isolates. MALDI-TOF/MS was able to properly identify Candida duobushameulonii. The five isolates were successfully identified by sequence analysis as Candida duobushaemulonii, Meyerozyma caribbica and Cutaneotrichosporon dermatis. Candida duobushameulonii showed hemolytic, phospholipase, and protease activities. Meyerozyma caribbica was positive for gelatinase and protease activities. All antifungals exhibited minimum inhibitory concentrations (MICs) ≤ 2 μg/mL against both species. The three isolates of Cutaneotrichosporon dermatis showed urease, DNase, and esterase activities, and resistance to echinocandins (MICs ≥ 8 μg/mL), while amphotericin B and fluconazole exhibited low MICs against these isolates (0.50–2 μg/mL).DiscussionSequencing of the ITS or IGS1 regions of rDNA remains the best method for identifying cryptic species over other commercially available systems. More reports are needed to define the enzymatic and antifungal profiles for these species. This is the first report of Meyerozyma caribbica and Cutaneotrichosporon dermatis as etiological agents of onychomycosis.     

Synergistic effects of tea polyphenol epigallocatechin 3-O-gallate and azole drugs against oral Candida isolates

BackgroundThe antifungal drug resistance has become an emerging problem in the management of candida infections worldwide. The objective of this study was to examine the efficacy of epigallocatechin 3-O-gallate (EGCG) alone and in combination with fluconazole/ketoconazole drugs against oral Candida isolates.MethodsMinimum inhibitory concentration (MIC) and minimum fungicidal concentrations (MFC) of EGCG against 60 oral Candida isolates and 4 ATCC strains were determined. Synergism of EGCG with azole drugs was evaluated by checkerboard micro-dilution method and calculated fractional inhibitory concentration index (FICI). Candida cells’ ultrastructure was studied by electron microscopy.ResultsMIC and MFC values of EGCG were in the range of 3.91–15.63 and 15.63–31.25 μg/mL, respectively. Minimum biofilm inhibitory concentration (MBIC) range of EGCG (62.5–125 μg/mL), was less than the ketoconazole (64–256 μg/mL) and fluconazole (128–512 μg/mL). The combination of EGCG with fluconazole/ketoconazole exhibited synergistic effects (ΣFICI ≤ 0.50). EGCG with azole drugs showed high sensitivity against the tested isolates in growth curve assays. Against the biofilm, the susceptibility of fluconazole/ketoconazole significantly increased (3 to 5 fold), after combination with EGCG (MBIC/4) (P ≤ 0.001). Electron microscopy of EGCG treated cells showed deformation of cell structure, ruptured cell wall and release of intracellular content. In molecular docking experiments, a strong interaction was observed between EGCG and fungal cell membrane molecule ergosterol.ConclusionWe conclude that EGCG synergistically enhanced the antifungal potential of azole drugs. The synergistic potential of EGCG might be helpful in preventing the development of drug resistance, in lowering the drug dosage, and thus minimizing adverse effects.     

Species distribution and antifungal susceptibility of 358 Trichosporon clinical isolates collected in 24 medical centres

ObjectivesTo provide species distribution and antifungal susceptibility profiles of 358 Trichosporon clinical isolates collected from 24 tertiary-care hospitals.MethodsSpecies identification was performed by sequencing the IGS1 region of rDNA. Antifungal susceptibility testing for amphotericin B, fluconazole, voriconazole and posaconazole followed the Clinical and Laboratory Standards Institute reference method. Tentative epidemiologic cutoff values (97.5% ECVs) of antifungals for Trichosporon asahii were also calculated.ResultsIsolates were cultured mostly from urine (155/358, 43.3%) and blood (82/358, 23%) samples. Trichosporon asahii was the most common species (273/358, 76.3%), followed by T. inkin (35/358, 9.7%). Isolation of non–T. asahii species increased substantially over the last 11 years [11/77 (14.2%) from 1997 to 2007 vs. 74/281, (26.3%) from 2008 to 2018, p0.03]. Antifungal susceptibility testing showed high amphotericin B minimum inhibitory concentrations against Trichosporon isolates, with higher values for T. faecale. The ECV for amphotericin B and T. asahii was set at 4 μg/mL. Among the triazole derivatives, fluconazole was the least active drug. The ECVs for fluconazole and posaconazole against T. asahii were set at 8 and 0.5 μg/mL, respectively. Voriconazole showed the strongest in vitro activity against the Trichosporon isolates; its ECV for T. asahii was set at 0.25 μg/mL after 48 hours' incubation.ConclusionsTrichosporon species diversity has increased over the years in human samples, and antifungal susceptibility profiles were species specific. Trichosporon asahii antifungal ECVs were proposed, which may be helpful to guide antifungal therapy.     

In vitro antifungal activity of epigallocatechin 3-O-gallate against clinical isolates of dermatophytes

Previously, we reported that epigallocatechin 3-O-gallate (EGCg) has growth-inhibitory effect on clinical isolates of Candida species. In this study, we investigated the antifungal activity of EGCg and antifungal agents against thirty-five of dermatophytes clinically isolated by the international guidelines (M38-A2). All isolates exhibited good susceptibility to EGCg (MIC₅₀, 2-4 µg/mL, MIC₉₀, 4-8 µg/mL, and geometric mean (GM) MICs, 3.36-4 µg/mL) than those of fluconazole (MIC₅₀, 2-16 µg/mL, MIC₉₀, 4-32 µg/mL, and GM MICs, 3.45-25.8 µg/mL) and flucytosin (MIC₅₀, MIC₉₀, and GM MICs, >64 µg/mL), although they were less susceptible to other antifungal agents, such as amphotericin B, itraconazole, and miconazole. These activities of EGCg were approximately 4-fold higher than those of fluconazole, and were 4 to 16-fold higher than flucytosin. This result indicates that EGCg can inhibit pathogenic dermatophyte species. Therefore, we suggest that EGCg may be effectively used solely as a possible agent or combined with other antifungal agents for antifungal therapy in dermatophytosis.     

Epidemiology and antifungal susceptibility of Candida species isolated from hospitalized patients

ObjectiveVoricanozole and caspofungin are new antifungal agents used in the treatment of Candida infections. However, the susceptibility of Candida species to these antifungal agents could be variable. The aim of this study was to investigate the distribution of the Candida species isolated from hospitalized patients and to determine their susceptibilities to some antifungal agents including voriconazole, caspofungin, fluconazole and amphotericin B.Material and MethodsA total of 164 Candida strains were isolated from clinical specimens obtained during the study period. Of 164 strains, 103 (62%) were C. albicans, followed by C. tropicalis (11%) and C. glabrata (8%). Other Candida species less frequently identified were C. parapsilosis, C. lusitaniae, C. kefyr, C. pelliculosa and C. norvegensis. Antifungal susceptibility testing of these isolates were performed according to the CLSI (formerly NCCLS) M27-A2 broth microdilution method and the results were read after 24 h.ResultsFluconazole resistance was seen in 21 (13%) isolates. All fluconazole-resistant isolates showed low MICs to caspofungin and amphotericin B. MIC values of voriconazole for Candida isolates were between 0.125 and 4 μg/ml.ConclusionAmphotericin B is still the major therapeutic agent for azole resistant Candida strains and caspofungin seems to be a good alternative.     

Multiple colony antifungal susceptibility testing detects polyresistance in clinical Candida cultures: a European Confederation of Medical Mycology excellence centers study

ObjectivesMany factors influence the outcome of in vitro antifungal susceptibility testing (AFST), including endpoint definition, inoculum sizes, time and temperature of incubation, and growth medium used. This European Confederation of Medical Mycology (ECMM) Excellence center driven study investigated multiple colony testing (MCT) of five separate colonies to investigate the prevalence of polyresistance (PR), defined as heterogeneous MICs from a same-species Candida culture irrespective of the underlying resistance mechanism.MethodsCandida spp. MCT for fluconazole and anidulafungin was performed by Etest prospectively comprising 405 clinical samples. MCT results were compared to the real-life routine MIC data and PR was assessed. Candida colonies displaying strong PR were selected for genotyping using multilocus sequence typing and random amplified polymorphic DNA assays for C. lusitaniae.ResultsCandida PR was observed in 33 of 405 samples (8.1%), with higher rates for non-albicans species (26/186, 14%) than for C. albicans (7/219, 3.2%), and for fluconazole than for anidulafungin. MCT detected acquired resistance more often than routine AFST (18/405, 4.5%) and 9 of the 161 investigated blood cultures showed PR (5.6%). Multilocus sequence typing and random amplified polymorphic DNA did not reveal a uniform genetic correlate in strains studied.ConclusionsThis study shows that Candida single MIC-values obtained in routine diagnostics may be incidental, as they fail to detect PR and resistant subpopulations reliably. The reasons for PR seem to be manifold and should be regarded as a phenotypical expression of genomic variability irrespective of the underlying resistance mechanism, which may help to interpret ambiguous and non-reproducible AFST results.     

In-vitro susceptibility testing by agar dilution method to determine the minimum inhibitory concentrations of amphotericin B, fluconazole and ketoconazole against ocular fungal isolates

Purpose: To standardize in-vitro antifungal susceptibility testing by agar dilution method to find out the minimum inhibitory concentration (MIC) of amphotericin B, fluconazole and ketoconazole on ocular fungal isolates. Methods: A total of 180 ocular fungal isolates (130 filamentous fungi and 50 yeasts) were included. The antifungal drugs such as amphotericin B (0.0625-8 μg/mL), fluconazole (0.2-819.6 μg/mL) and ketoconazole (0.025-6.4 μg/mL) were incorporated in doubling dilutions in the yeast nitrogen base medium. The MIC was determined as the lowest concentration of the antifungal drug preventing growth of macroscopically visible colonies on drug containing plates when there was visible growth on the drug - free control plates. Results: All 50 ocular isolates of yeast were susceptible to amphotericin B, while two (4%) and five (10%) strains were resistant to fluconazole and ketoconazole respectively. Of the 130 filamentous fungi tested, six (4.6%) were resistant to amphotericin B, 49 (37.7%) and 10 (7.6%) were resistant to fluconazole and ketoconazole respectively. Percentile 50 (MIC 50) and Percentile 90 (MIC 90) for all the three antifungal agents were calculated. Aspergillus niger, Aspergillus terreus and Candida krusei were found to be resistant to fluconazole and ketoconazole. Conclusion: This technique was found to be reliable, cost effective and easy to perform with consistent results.     

Comparative in vitro activities of seven antifungal drugs against clinical isolates of Candida parapsilosis complex

ObjectiveCandida parapsilosis species complex, an important set of non-albicans Candida species, is known to cause candidaemia particularly in neonates and infants. However, the incidence has increased in recent years, owing to higher numbers of at individuals at risk for these infections. Our objective was to evaluate the in vitro susceptibility of clinical isolates of C. parapsilosis complex isolates from Iran to seven antifungal drugs.Material and methodsOne hundred-one clinical isolates of C. parapsilosis species complex cultured from humans were included. Species identification had been previously confirmed by combined phenotypic characteristics, matrix-assisted laser desorption ionization-time of flight mass spectrometry-based assay and reconfirmed by DNA sequence analysis of the ITS rDNA region and D1/D2 gene. Minimum inhibitory concentrations (MICs) for amphotericin B, fluconazole, itraconazole, voriconazole, posaconazole, micafungin and anidulafungin were determined against well-characterized isolates by broth microdilution susceptibility testing according to the CLSI M27-A3 guideline.ResultsSpecies identifications were performed on 101 isolates, of which 88 (87.2%) C. parapsilosis sensu stricto and 13 (12.8%) C. orthopsilosis. Amphotericin B and posaconazole were the most active drugs with 100% of isolates being wild-type (WT). Voriconazole and micafungin, 99% of isolates were WT. The low activity was recorded for fluconazole and itraconazole with 93.1% and 89.1% of isolates being WT, respectively. At the species level, all Candida parapsilosis sensu stricto isolates were WT to amphotericin B and posaconazole and all Candida orthopsilosis isolates were WT to amphotericin B, voriconazole, posaconazole, anidulafungin and micafungin. In contrast, the highest rate of non-WT was observed in C. orthopsilosis to itraconazole (4 of 13, 30.8%).ConclusionsAlthough almost all of the tested drugs demonstrated potent activity against C. parapsilosis species complex, it seems that more especially C. orthopsilosis isolates had decreased susceptibility to itraconazole. Further studies are needed to determine how these findings may switch into in vivo efficacy.     

In vitro synergistic effect of minocycline combined with antifungals against Cryptococcus neoformans

BackgroundCryptococcus neoformans infections occur in immunocompromised patients, especially those with HIV infection, chemoradiotherapy after cancer, and organ transplantation. Infection can cause pneumonia and meningoencephalitis in severe cases with a high mortality rate if not treated. Although fluconazole and amphotericin B are the first-line treatments for cryptococcosis, the rate of fluconazole resistance has increased significantly due to long-term use. Minocycline is a derivative of tetracycline that exerts its antibacterial effect through inhibition of bacterial protein synthesis. It is also able to pass the blood-brain barrier to act on the central nervous system. The present study investigates the effects of minocycline in combination with antifungals in treating C. neoformans.ObjectiveTo determine in vitro interactions of minocycline combined with itraconazole, voriconazole, posaconazole, fluconazole and amphotericin B against C. neoformans.MethodsThe minimum inhibitory concentrations (MIC) of the antifungals were determined by the CLSI Clinical and Laboratory Standards Institute M27-A3 microdilution method. The in vitro synergistic effects of minocycline combined with itraconazole, voriconazole, posaconazole, fluconazole, and amphotericin B on C. neoformans were detected by the broth microdilution checkerboard technique and disk diffusion testing.Results and ConclusionThe working concentration ranges were 0.125–4 µg/mL for itraconazole, 0.03–0.125 µg/ml for voriconazole, 0.03–1 µg/ml for posaconazole, 0.25–16 µg/ml for fluconazole, and 0.125–2 µg/ml for amphotericin B. The synergistic rates of minocycline combinations against C. neoformans were 55% with itraconazole, 10% with voriconazole, 85% with posaconazole, 20% with fluconazole, and 70% with amphotericin B. The effective MIC value of minocycline in the synergistic combination decreased to 2–32 µg/ml, while the MIC of itraconazole decreased to 0.03–0.125 µg/ml, voriconazole 0.03–0.125 µg/ml, posaconazole 0.03–0.125 µg/ml, 0.125–4 µg/ml fluconazole, and 0.06–0.50 µg/ml amphotericin B. The disk diffusion assay showed that the plates containing minocycline and antifungal drugs produced inhibition zones with diameters larger than the single drug plates. Minocycline showed no antagonistic effect in the combinations. In conclusion, the combination of minocycline and azoles or amphotericin B has synergistic effects against C. neoformans in vitro.     

Dalbavancin exposure in vitro selects for dalbavancin-non-susceptible and vancomycin-intermediate strains of methicillin-resistant Staphylococcus aureus

ObjectivesDalbavancin is a lipoglycopeptide active against methicillin-resistant Staphylococcus aureus (MRSA). Its long half-life (8.5–16 days) allows for once-weekly or single-dose treatments but could prolong the mutant selection window, promoting resistance and cross-resistance to related antimicrobials such as vancomycin. The objective of this study was to evaluate the capacity of post-distributional pharmacokinetic exposures of dalbavancin to select for resistance and cross-resistance in MRSA.MethodsWe simulated average, post-distributional exposures of single-dose (1500 mg) dalbavancin (fCmax 9.9 μg/mL, β-elimination t_1/2 204 h) in an in vitro pharmacokinetic/pharmacodynamic (PK/PD) model for 28 days (672 h) against five MRSA strains and one methicillin-susceptible strain (MSSA). Samples were collected at least daily, and surviving colonies were enumerated and screened for resistance on drug-free and dalbavancin-supplemented medium respectively. Isolates from resistance screening plates were subjected to whole-genome sequencing (WGS) and susceptibly testing against dalbavancin, vancomycin, daptomycin, and six β-lactams with varying penicillin-binding protein (PBP) affinities.ResultsDalbavancin was bactericidal against most strains for days 1–4 before regrowth of less susceptible subpopulations occurred. Isolates with eight-fold increases in dalbavancin MIC were detected as early as day 4 but increased 64–128-fold in all models by day 28. Vancomycin and daptomycin MICs increased 4–16-fold, exceeding the susceptibly breakpoints for both antibiotics; β-lactam MICs generally decreased by two-to eight-fold, suggesting a dalbavancin–β-lactam seesaw effect, but increased by eight-fold or more in certain isolates. Resistant isolates carried mutations in a variety of genes, most commonly walKR, apt, stp1, and atl.ConclusionsIn our in vitro system, post-distributional dalbavancin exposures selected for stable mutants with reduced susceptibility to dalbavancin, vancomycin, and daptomycin, and generally increased susceptibility to β-lactams in all strains of MRSA tested. The clinical significance of these findings remains unclear, but created an opportunity to genotype a unique collection of dalbavancin-resistant strains for the first time. Mutations involved genes previously associated with vancomycin intermediate susceptibility and daptomycin non-susceptibility, most commonly walKR-associated genes.     

Interaction of carvacroland voriconazole against drug – resistant Candida strains isolated from patients with candidiasis

Objective

Terpenoid phenols, especially 5-isopropyl-2-methylphenol (carvacrol), are components of plant essential oils that exhibit potent antifungal activity against a wide range of pathogens, including Candida species. The purpose of this study was to determine the interaction activity of carvacrol in combination with voriconazole against Candida albicans (C. albicans), C. glabrata and C. krusei isolates.

Antifungal activity of nitroxoline against Candida auris isolates

ObjectivesTo investigate the in vitro activity of nitroxoline against a molecularly characterized collection of clinical Candida auris isolates.MethodsThirty-five clinical isolates of C. auris from diverse sources representing all five different C. auris clades were included in the study. Nitroxoline activity was assessed using broth microdilution. Additionally, susceptibility testing by disc diffusion was assessed on RPMI-1640 and Müller–Hinton agar plates. Minimal inhibitory concentrations of the antifungals fluconazole, voriconazole, amphotericin B and anidulafungin were determined.ResultsNitroxoline MICs ranged from 0.125 to 1 mg/L (MIC_50/90 0.25/0.5 mg/L). Compared with amphotericin B (MIC >1 mg/L in 4/35 isolates), anidulafungin (MIC >0.06 mg/L in 26/35 isolates) and fluconazole (MIC >4 mg/L in 31/35 isolates), in vitro activity of nitroxoline was high. Isolates belonging to clade I had marginally lower nitroxoline MICs (range 0.125–0.5 mg/L, mean MIC 0.375 mg/L) compared with clade III (range 0.5–1 mg/L, mean MIC 0.7 mg/L; p = 0.0094). The correlation of MIC and inhibition zones by disc diffusion was good when using RPMI-agar for disc diffusion, with a Pearson's correlation coefficient of –0.74 (95% CI –0.86 to –0.54).ConclusionsNitroxoline has excellent in vitro activity against C. auris isolates, with MICs of 0.125–1 mg/L (for comparison, the EUCAST breakpoint for uncomplicated urinary tract infection with Escherichia coli is ≤ 16 mg/L). It is an approved, well-tolerated antimicrobial that achieves high urinary concentrations after oral administration and could be a useful treatment option in C. auris candiduria.     

Correlation of the in vitro antifungal drug susceptibility with the in vivo activity of fluconazole in a murine model of cerebral infection caused by Cryptococcus gattii

Forty Cryptococcus gattii strains were submitted to antifungal susceptibility testing with fluconazole, itraconazole, amphotericin B and terbinafine. The minimum inhibitory concentration (MIC) ranges were 0.5–64.0 for fluconazole, <0.015–0.25 for itraconazole, 0.015–0.5 for amphotericin B and 0.062–2.0 for terbinafine. A bioassay for the quantitation of fluconazole in murine brain tissue was developed. Swiss mice received daily injections of the antifungal, and their brains were withdrawn at different times over the 14-day study period. The drug concentrations varied from 12.98 to 44.60 μg/mL. This assay was used to evaluate the therapy with fluconazole in a model of infection caused by C. gattii. Swiss mice were infected intracranially and treated with fluconazole for 7, 10 or 14 days. The treatment reduced the fungal burden, but an increase in fungal growth was observed on day 14. The MIC for fluconazole against sequential isolates was 16 μg/mL, except for the isolates obtained from animals treated for 14 days (MIC = 64 μg/mL). The quantitation of cytokines revealed a predominance of IFN-γ and IL-12 in the non-treated group and elevation of IL-4 and IL-10 in the treated group. Our data revealed the possibility of acquired resistance during the antifungal drug therapy.     

Candida blankii: an emerging yeast in an outbreak of fungaemia in neonates in Delhi,India

ObjectiveOutbreaks of fungal sepsis due to emerging and rare multidrug-resistant Candida species are increasingly reported in health-care settings. We report an outbreak of fungaemia due to the rare multidrug-resistant yeast Candida blankii in an Indian neonatal unit.Materials and methodsBlood cultures grew C. blankii in nine neonates in the Neonatal Intensive Care Unit of a multispecialty hospital in Delhi during a period of 7 months. Isolates were identified by internal transcribed spacer and D1/D2 region sequencing. Antifungal susceptibility testing was performed by M27-A3 CLSI broth microdilution. To determine genetic relatedness among C. blankii isolates we undertook amplified fragment length polymorphism analysis and DNA sequencing using the Illumina NextSeq500 platform.ResultsCandida blankii fungaemia occurred at 2–3 postnatal days in nine low birthweight/very low birthweight neonates. All neonates were treated with fluconazole and four of the nine neonates died, resulting in a case fatality rate of 45%. Candida blankii was misidentified or not identified by automated identification systems. Fluconazole had higher geometric mean (GM) MICs (8 mg/L) than the other azoles. Also, anidulafungin (GM-MIC 2 mg/L) had high MICs. Genome sequencing confirmed transmission of genetically mostly indistinguishable strains. The C. blankii genome showed an altered 1,3-β-d-glucan synthase protein and several larger deletions in the echinocandin target FKS1 gene, suggesting potential for development of antifungal resistance.ConclusionsThe study emphasizes the emergence of a rare and uncommon yeast, C. blankii, with reduced susceptibility to one or more antifungal agents, in nosocomial fungaemia. Genomic insights of this rare yeast are reported using whole-genome sequence typing.     

Proton pumping ATPase mediated fungicidal activity of two essential oil components

This work evaluates the antifungal activity of two essential oil components against 28 clinical isolates (17 sensitive, 11 resistant) and 3 standard laboratory strains of Candida. Growth of the organisms was significantly effected in both solid and liquid media at different test compound concentrations. The minimum inhibitory concentrations (MICs) of Isoeugenol (compound 1) against 31 strains of Candida ranged 100–250 μg/ml and those of o ‐methoxy cinnamaldehyde (compound 2) ranged 200–500 μg/ml, respectively. Insight studies to mechanism suggested that these compounds exert antifungal activity by targeting H⁺‐ATPase located in the membranes of pathogenic Candida species. At their respective MIC₉₀ average inhibition of H⁺‐efflux for standard, clinical and resistant isolates caused by compound 1 and compound 2 was 70%, 74%, 82% and 42%, 42% and 43%. Respective inhibition of H⁺‐efflux by fluconazole (5 μg/ml) was 94%, 92% and 10%. Inhibition of H⁺‐ATPase leads to intracellular acidification and cell death. SEM analysis of Candida cells showed cell membrane breakage and alterations in morphology. Haemolytic activity on human erythrocytes was studied to exclude the possibility of further associated cytotoxicity. (© 2012 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)     

Inhibition of the growth of human dermatophytic pathogens by selected australian and asian plants traditionally used to treat fungal infections

ObjectiveSyzygium australe (H.L. Wnddl. ex. Link) B. Hyland, Syzygium luehmannii (F. Muell.) L.A.S. Johnson, Syzygium jambos L. (Alston), Terminalia ferdinandiana Exell. and Tasmannia lanceolata (Poir.) A.C.Sm. are used in traditional Australian Aboriginal and Asian healing systems to treat a variety of pathogenic diseases including fungal skin infections, yet they are yet to be examined for the ability to inhibit the growth of human dermatophytes.Materials and methodsThe fungal growth inhibitory activity of extracts produced from selected Australian and Asian plants was assessed against a panel of human dermatophytes by standard disc diffusion and liquid dilution MIC methods. The toxicity of the extracts was evaluated by Artemia lethality and MTS HDF cell viability assays. The phytochemistry of the most promising extracts were examined by GC-MS headspace analysis and some interesting compounds were highlighted.ResultsThe aqueous and methanolic extracts of all plant species were good antifungal agents, inhibiting the growth of all of the dematophytes tested. The methanolic S. australe (SA) and S. luehmannii (SL) extracts were particularly potent fungal growth inhibitors. MIC values of 39 and 53 μg/mL were recorded for the methanolic SL fruit extract against T. mentagrophytes and T. rubrum respectively. Similar MICs were also noted for the methanolic SL leaf extract (88 and 106 μg/mL respectively). The methanolic SL leaf extract was a particularly good fungal growth inhibitor, with MIC values ≤ 100 μg/mL against the reference C. albicans strain (96 μg/mL), E. floccosum (53 μg/mL), and T. mentagrophytes (88 μg/mL). This extract also produced MICs ≤ 200 μg/mL against all other fungal species/strains tested. Similarly good activity was seen for the methanolic S. australe leaf and fruit extracts, as well as the S. lehmannii fruit and S. jambos leaf extracts, with MIC values 100-500 μg/mL. Interestingly, these extracts had low toxicity and high therapeutic indices, indicating their suitability for clinical use. GC-MS headspace analysis highlighted several monoterpenoids and sesquiterpenoids in the methanolic SA and SL extracts. T. ferdinandiana and T. lanceolata extracts also had promising antifungal activity, albeit with substantially higher MICs.ConclusionWhilst multiple extracts inhibited fungal growth, the methanolic S. australe and S. luehmannii leaf extracts and the S. luehmannii fruit extracts showed particularly potent activity against each of these dermatophytes, indicating that they are promising leads for the development of anti-dermatophytic therapeutics.     

Rapid antifungal susceptibility testing of fluconazole and amphotericin B by flow cytometry using FUN-1®: a preliminary study

ObjectiveThe increasing incidence of severe fungal infections and the difficulties encountered with the existing antifungal susceptibility testing methods led us to develop a new technique based on flow cytometry, using the fluorochrome FUN -1^®.Materials and methodsWe tested the susceptibility of 14 Candida spp. strains (5 reference and 9 clinical strains) to amphotericin B and fluconazole by flow cytometry versus M27-A2 CLSI reference method. Fluorescence was measured with a FACScalibur^® flow cytometer (Becton Dickinson). Amphotericin B susceptibility was studied on the 14 strains whereas fluconazole one was only performed on the five reference strains.ResultsResults were obtained after 30 min incubation for amphotericin B and 6 h for fluconazole. Reproducibility and repeatability tests have been performed on C. albicans ATCC 90028 and were > 95% and > 98%, respectively. The flow cytometry method resulted in clear-cut endpoints, which abolishes the source of variability of the M27-A2 reading. The results obtained showed that the patterns of susceptibility to amphotericin B were the same with the 2 methods used for all the strains. Our preliminary study with fluconazole gave the same results with the 5 control strains.ConclusionFUN-1^® staining seems to be a rapid alternative to conventional methods to assess susceptibility of Candida spp. clinical isolates.     

Carnosol inhibits the growth and biofilm of Candida albicans

ObjectiveThis study was to explore the inhibitory effects of carnosol on the growth and biofilm of Candida albicans.ResultsOur results showed that carnosol inhibited the planktonic growth of C. albicans with a MIC of 100 μg/mL. Carnosol can also inhibit the biofilm formation and development of C. albicans. 25–100 μg/mL of carnosol can obviously inhibit the yeast-to-hyphal transition in four kinds of hyphal-inducing media and the adhesion of C. albicans to polystyrene surfaces. Results from PI staining indicated that carnosol may disrupt cell membrane of C. albicans.ConclusionCarnosol can inhibit the planktonic growth and virulence factors of C. albicans, such as biofilm formation, adhesion and hyphal growth. The antifungal mechanism may involve the increase in cell membrane permeability.     

Susceptibility profile of Candida rugosa (Diutina rugosa) against antifungals and compounds of essential oils

Candida rugosa (recently reclassified Diutina rugosa) is an emerging pathogen affecting humans and animals. Candida resistance to existing drugs is an important factor to be monitored, as well as the need of researching alternatives to conventional antifungals. Here, we evaluated the in vitro effects of some antifungals and major components of essential oils by the broth microdilution method (CLSI M27-A3) against fifteen C. rugosa strains from animals isolated and molecular identificated. The results showed MIC₉₀ of: 0.125 μg/mL to ketoconazole and voriconazole, 0.25 μg/mL to micafungin, 0.5 μg/mL to anidulafungin, 1 μg/mL to caspofungin, 2 μg/mL to amphotericin B, itraconazole and flucytosin, 8 μg/mL to fluconazole, 16 μg/mL to nystatin and >128 μg/mL to terbinafine. The compounds carvacrol (MIC₉₀ 320 μg/mL), thimol (MIC₉₀ 320 μg/mL) and cinnamaldehyde (MIC₉₀ 160 μg/mL) demonstrated antifungal activity against the samples tested.