HIV Infection as Risk Factor for Death among Hospitalized Persons with Candidemia,South Africa, 2012–2017

We determined the effect of HIV infection on deaths among persons >18 months of age with culture-confirmed candidemia at 29 sentinel hospitals in South Africa during 2012–2017. Of 1,040 case-patients with documented HIV status and in-hospital survival data, 426 (41%) were HIV-seropositive. The in-hospital case-fatality rate was 54% (228/426) for HIV-seropositive participants and 37% (230/614) for HIV-seronegative participants (crude odds ratio [OR] 1.92, 95% CI 1.50–2.47; p<0.001). After adjusting for relevant confounders (n = 907), mortality rates were 1.89 (95% CI 1.38–2.60) times higher among HIV-seropositive participants than HIV-seronegative participants (p<0.001). Compared with HIV-seronegative persons, the stratum-specific adjusted mortality OR was higher among HIV-seropositive persons not managed in intensive care units (OR 2.27, 95% CI 1.47–3.52; p<0.001) than among persons who were (OR 1.56, 95% CI 1.00–2.43; p = 0.05). Outcomes among HIV-seropositive persons with candidemia might be improved with intensive care.     

Effect of serine‐type protease of Candida spp. isolated from linear gingival erythema of HIV‐positive children: critical factors in the colonization

J Oral Pathol Med (2010) 39 : 753–760 Background: There are several kinds of oral soft tissue lesions that are common manifestations observed in human immunodeficiency virus (HIV)‐infected children; for example, linear gingival erythema (LGE) that is a distinctive fiery red band along the margin of the gingivae. The etiology and pathogenesis of LGE are questionable, but a candidal origin has been suggested. Proteases are key virulence attributes produced by a variety of pathogenic fungi, including Candida. The objective of the present study is to identify the protease production in Candida species including, C. albicans (n = 5), C. dubliniensis (n = 1) and C. tropicalis (n = 1), isolated directly from typical LGE lesions observed in six HIV‐positive children, and also to test the effect of a serine protease inhibitor on the interaction of Candida spp. and epithelial cells in vitro. Methods: The ability of Candida strains to release proteases in the culture supernatant fluids was visualized by gelatin‐SDS–PAGE. Gel strips containing 30‐fold concentrated supernatant (1.5 × 10⁸ yeasts) were incubated at 37°C for 48 h in 50 mM sodium phosphate buffer, pH 5.5. The concentrated supernatants were also incubated with fibronectin, laminin, immunoglobulin G, bovine serum albumin and human serum albumin. The effect of serine protease inhibitor on the interaction of Candida spp. and epithelial cells (MA 104) was measured after pre‐treatment of fungi with the inhibitor (phenylmethylsulphonyl fluoride, PMSF). Results: All the extracellular proteases were completely inhibited by PMSF, identifying these activities as serine‐type proteases. Interestingly, a common 62‐kDa serine protease was observed in all Candida strains. The culture supernatants, rich in serine protease activities, cleaved several soluble proteinaceous substrates. Additionally, we demonstrated that pre‐treatment of C. albicans, C. dubliniensis and C. tropicalis with PMSF diminished the interaction with epithelial cells. Conclusions: Collectively, our results show that Candida spp. isolated from LGE lesions produced and secreted serine proteases and these enzymes may be involved in the initial colonization events.     

Reduced fluconazole susceptibility of Candida albicans isolates in women with recurrent vulvovaginal candidiasis: effects of long-term fluconazole therapy

Fluconazole resistance and resultant failure to control Candida vaginitis (vulvovaginal candidiasis) remains extremely uncommon; however, long-term clinically relevant decrease in fluconazole susceptibility undoubtedly occurs and accompanies prolonged fluconazole chemoprophylaxis. Accordingly, in patients with refractory vaginitis or breakthrough infections due to Candida albicans, in vitro susceptibility testing is essential to optimally manage vaginitis.     

71株白念珠菌临床分离株微卫星基因分型

目的 建立高效、快速、简便的白念珠菌临床分离株三重保守基因微卫星分型技术。方法 以煮沸法处理的71株白念珠菌野生株为模板，三色荧光分别标记保守基因CDC3、EF3和HIS3微卫星序列引物，PCR扩增，产物行聚丙烯酰胺凝胶电泳。由基因扫描分析软件获取片段的精确长度，Genotyper软件行基因分型。结果 71株白念珠菌野生株行CDC3、EF3和HIS3基因分型分别获得5、10、8种等位基因，7、8、9种基因型，三位点联合分析共获得14种菌株基因型。结论 白念珠菌多重保守基因微卫星分型能从基因水平快速、高效的对临床分离株进行分型，对白念珠菌的流行病学研究有重要价值。     

白色念珠菌对人口腔黏膜上皮角质细胞的作用研究

目的研究白色念珠菌对人口腔黏膜上皮角质细胞的作用机制。方法将培养的口腔黏膜上皮角质细胞分别加入孢子型白色念珠菌(孢子组)和菌丝型白色念珠菌(菌丝组),另将单独培养的口腔黏膜上皮角质细胞作为阴性对照组。比较各组对口腔黏膜上皮角质细胞的黏附作用,并观察白色念珠菌对口腔黏膜上皮角质细胞的凋亡和增殖作用。结果菌丝组黏附指数(7.63±1.39)显著高于孢子组(3.47±1.04),差异有统计学意义(P<0.05);菌丝组凋亡率[(3.49±0.4)%]显著高于孢子组[(2.07±0.15)%]和阴性对照组[(1.98±0.07)%],差异有统计学意义(P<0.05),而孢子组和阴性对照组凋亡率相比差异无统计学意义(P>0.05)。菌丝组G0/G1期细胞比例[(38.17±7.83)%]显著低于孢子组[(49.47±11.41)%]和阴性对照组[(57.71±9.39)%],差异有统计学意义(P<0.05);S期[(8.54±4.03)%]、G2/M期[(20.18±9.59)%]细胞比例上升,且显著高于孢子组[(6.47±2.73)%、(10.71±3.19)%]和阴性对照组[(5.35±2.11)%、(12.38±4.35)%],差异有统计学意义(P<0.05);PI[(42.79±18.73)%]明显高于孢子组[(28.67±8.79)%]和阴性对照组[(26.87±7.64)%],差异有统计学意义(P<0.05),而孢子组和阴性对照组PI相比差异无统计学意义(P>0.05)。结论白色念珠菌能够导致口腔黏膜上皮角质细胞发生凋亡和增殖周期改变。     

Time of catheter removal in candidemia and mortality

Background

The impact of central venous catheter (CVC) removal on the outcome of patients with candidemia is controversial, with studies reporting discrepant results depending on the time of CVC removal (early or any time during the course of candidemia).

Evaluating Epidemiology and Improving Surveillance of Infections Associated with Health Care,United States

The Healthcare-Associated Infections Community Interface (HAIC), launched in 2009, is the newest major activity of the Emerging Infections Program. The HAIC activity addresses population- and laboratory-based surveillance for Clostridium difficile infections, candidemia, and multidrug-resistant gram-negative bacilli. Other activities include special projects: the multistate Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey and projects that evaluate new approaches for improving surveillance. The HAIC activity has provided information about the epidemiology and adverse health outcomes of health care–associated infections and antimicrobial drug use in the United States and informs efforts to improve patient safety through prevention of these infections.     

18例早产儿真菌败血症临床特点

目的对某院早产儿真菌败血症的临床特点进行分析,为临床诊治提供参考。方法对该院2011年1月—2013年12月18例早产儿真菌败血症的临床资料进行回顾性分析。结果 18例早产儿胎龄为27~36周,出生体重为1 050~3 100 g,其中极低出生体重儿(VLBWI)8例;均有广谱抗菌药物用药史,感染前均长时间静脉营养,10例机械通气,2例经外周静脉穿刺中心静脉置管(PICC)。临床表现以呼吸暂停、抽搐、喂养困难、反应差等为主;出现症状时间为出生后3 h~52 d。13例(72.22%)早产儿血白细胞(WBC)计数异常,12例(66.67%)血小板(PLT)100×109/L,18例(100.00%)C反应蛋白(CRP)均增高,平均CRP浓度为(41.90±26.77)mg/L。感染病原菌以假丝酵母菌属为主,共17例(94.44%),其中包括近平滑假丝酵母菌7例,白假丝酵母菌5例,白假丝酵母菌生物变种4例,无名假丝酵母菌1例。用氟康唑及两性霉素B治疗,15例治愈(83.33%),2例好转(11.11%),1例死亡(5.56%)。结论早产儿真菌败血症以假丝酵母菌感染为主,临床缺乏特异性表现,应严密观察具有高危因素的早产儿临床症状,定期检测血常规及CRP等指标,及时给予抗真菌药物治疗,有助于取得良好的治疗效果。     

特比萘酚联合氟康唑对念珠菌及新生隐球菌的体外药敏试验

目的研究特比萘酚（FCZ）和氟康唑（TBNF）对念珠菌及新生隐球菌体外联合药敏试验中的相互作用，为临床用药提供实验室依据。方法参照美国国家临床实验室标准化委员会（NCCLS）提出的标准（M27-A方案）采用棋盘微量稀释法对10株念珠菌和18株新生隐球菌进行了特比萘酚和氟康唑的体外联合药敏试验。结果联合用药时FCZ的最低抑菌浓度（MIC）几何均值从单用药时的5.124降至0.672，差异有显著性（t=5.558，P〈0.001）;TBNF从2.26降至0.291，差异有显著性（t=6.552，P〈0.001）。两种药物联用有协同或相加作用，联合抑菌指数（FICI）的平均值为0.629。结论特比萘酚和氟康唑对致病酵母菌主要表现为协同相加作用。