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An Ex vivo Assay to Study Candida albicans Hyphal Morphogenesis in the Gastrointestinal Tract
Published on: July 1, 2020
Diagnosis and Treatment of Invasive Candidiasis
Natalia Barantsevich1, Elena Barantsevich1
1Almazov National Madical Research Centre, Research Department of Microbiology and Nosocomial Indfections, Akkuratova, 2, 197341 Saint-Petersburg, Russia.
Abstract:
Candida species, belonging to commensal microbial communities in humans, cause opportunistic infections in individuals with impaired immunity. Pathogens encountered in more than 90% cases of invasive candidiasis include C. albicans, C. glabrata, C. krusei, C. tropicalis, and C. parapsilosis. The most frequently diagnosed invasive infection is candidemia. About 50% of candidemia cases result in deep-seated infection due to hematogenous spread. The sensitivity of blood cultures in autopsy-proven invasive candidiasis ranges from 21% to 71%. Non-cultural methods (beta-D-glucan, T2Candida assays), especially beta-D-glucan in combination with procalcitonin, appear promising in the exclusion of invasive candidiasis with high sensitivity (98%) and negative predictive value (95%). There is currently a clear deficiency in approved sensitive and precise diagnostic techniques. Omics technologies seem promising, though require further development and study. Therapeutic options for invasive candidiasis are generally limited to four classes of systemic antifungals (polyenes, antimetabolite 5-fluorocytosine, azoles, echinocandins) with the two latter being highly effective and well-tolerated and hence the most widely used. Principles and methods of treatment are discussed in this review. The emergence of pan-drug-resistant C. auris strains indicates an insufficient choice of available medications. Further surveillance, alongside the development of diagnostic and therapeutic methods, is essential.
Insights
Invasive candidiasis, often caused by Candida species, presents diagnostic and treatment challenges. New non-cultural diagnostic methods and antifungal therapies are crucial, especially with rising drug resistance.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Clinical Microbiology
Background:
- Candida species are opportunistic pathogens causing invasive infections, particularly candidemia, in immunocompromised individuals.
- Commonly implicated species include Candida albicans, Candida glabrata, Candida krusei, Candida tropicalis, and Candida parapsilosis.
- Hematogenous spread from candidemia frequently leads to deep-seated infections.
Purpose of the Study:
- To review current diagnostic and therapeutic strategies for invasive candidiasis.
- To highlight limitations in existing diagnostic methods and the need for improved techniques.
- To discuss the challenges posed by emerging drug-resistant Candida strains.
Main Methods:
- Review of current literature on invasive candidiasis diagnostics and therapeutics.
- Analysis of diagnostic test performance, including blood cultures and non-cultural assays (beta-D-glucan, T2Candida).
- Discussion of available antifungal drug classes and treatment principles.
Main Results:
- Blood culture sensitivity for invasive candidiasis is limited (21-71%).
- Non-cultural methods like beta-D-glucan and procalcitonin show promise for excluding invasive candidiasis.
- Current therapeutic options are mainly limited to four classes of antifungals, with azoles and echinocandins being widely used.
Conclusions:
- There is a significant need for more sensitive and precise diagnostic techniques for invasive candidiasis.
- The development of novel diagnostic and therapeutic strategies is essential to combat rising antifungal resistance, exemplified by pan-drug-resistant Candida auris.
- Continued surveillance and research are critical for managing invasive candidiasis effectively.
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