Trabajo de Investigación Requisito para optar al Título de Cirujano Dentista / Introducción: El cáncer es una enfermedad poco frecuente en niños. En Chile, cada año se diagnostican aproximadamente 500 casos nuevos en pacientes de 5 a 15 años. El tratamiento adecuado para el cáncer infantil incluye diferentes protocolos que combinan cirugía, radioterapia y quimioterapia, los cuales son capaces de producir diversas alteraciones en la cavidad oral, tales como hiposialia, mucositis y aumento en la predisposición de la mucosa a ser colonizada por Candida spp. Esta levadura corresponde a un patógeno oportunista y C. albicans representa más del 80% de los aislados a partir de infecciones fúngicas en humanos, sin embargo, el porcentaje restante está compuesto por numerosas especies que presentan diferentes grados de resistencia frente a los fármacos antifúngicos. Por lo tanto, se aconseja la identificación de especies de levaduras aisladas de muestras clínicas, con el fin de realizar un adecuado tratamiento para el paciente. Materiales y métodos: Los aislados de levaduras fueron obtenidos de saliva de una muestra de 50 pacientes pediátricos entre 6 y 18 años con distintos tipos de cáncer y sometidos a diferentes tratamientos antineoplásicos. Las levaduras fueron recuperadas en placas de Agar Sabouraud y se realizó la re-identificación presuntiva en Chromoagar Candida TM . Posteriormente se identificaron las especies de levaduras del género Candida a través de distintos métodos microbiológicos (crecimiento diferencial a distintas temperaturas), bioquímicos (API ID32C, prueba alfa-glucosidasa, MALDI-TOF MS) y genético-moleculares (PCR para gen de pared, RFLP de región ITS1-4, secuenciación región ITS1-4), finalmente se determinó la susceptibilidad a miconazol de las cepas aisladas de C. albicans a través de ensayos de difusión en discos. Resultados: De la muestra total, 24 pacientes resultaron ser portadores de levaduras del género Candida, el 75% de los pacientes presentó colonias de C. albicans, siendo la especie más aislada, seguida por C.parapsilopsis, C. guilliermondii y C. lusitaniae, presentes en un 12 % cada una, y en una menor proporción se aisló C. intermedia en un 4% (1 paciente). Todas las cepas aisladas de C. albicans resultaron ser susceptibles a miconazol. Conclusiones: Pacientes pediátricos oncológicos sometidos a diversos esquemas terapéuticos antineoplásicos presentan con mayor frecuencia levaduras de la especie C. albicans en saliva. El recuento total de levaduras del género Candida spp. se asocia significativamente con los esquemas terapéuticos antineoplásicos. La susceptibilidad a miconazol de las cepas de C. albicans no parece verse afectada por el esquema terapéutico empleado. / Financiamiento :Proyecto URED-2014-007.

Trabajo de Investigación Requisito para optar al Título de Cirujano Dentista / Introducción: El término «cáncer infantil» generalmente se utiliza para designar distintos tipos de cáncer que pueden aparecer en los niños antes de cumplir los 15 años. Los distintos tratamientos antineoplásicos a los que se ven sometidos estos pacientes pueden provocar compromiso secundario, alteración del tejido salival y disminución de la inmunidad mediada por células, factores importantes que contribuyen al desarrollo de una infección fúngica. Candida albicans es la especie de levadura más predominantemente aislada en este tipo de pacientes. Las técnicas de cultivo en CHRomoagar Candida TM no permiten diferenciar con certeza absoluta Candida albicans de otras especies del género presentes en la colonización y/o infección. El empleo de la biología molecular permite una mejor diferenciación de las especies, procedimiento necesario para un correcto diagnóstico y tratamiento en casos de infección en pacientes inmunosuprimidos con cáncer. Materiales y Métodos: Los aislados de levaduras fueron obtenidos de una muestra de saliva de 50 pacientes pediátricos con distintos tipos de cáncer y sometidos a diferentes tratamientos antineoplásicos. Se realizó la identificación presuntiva en Chromoagar Candida TM , identificación de especies del género por diversos métodos moleculares y bioquímicos y ensayos de susceptibilidad a fluconazol en discos. Resultados: Las muestras de saliva de 50 pacientes fueron incluidas en el estudio, obteniéndose un total de 101 aislados de levaduras. El 63% de los aislados correspondió a Candida albicans, siendo la especie más aislada, seguida por C. guilliermondi y C. parapsilosis, ambas encontradas en un 8% de los casos respectivamente. C.lusitaniae y una especie de Candida No Candida albicans fueron encontradas en un 4% de los aislados y en 12,5% de los aislados se encontró más de una especie, siendo C. albicans encontrada en cada una de ellas. La susceptibilidad a fluconazol se mantuvo dentro de rangos normales. Conclusiones: El tipo de cáncer no influye en ninguna de las variables consideradas en este estudio. Candida albicans, fue la levadura más frecuentemente encontrada en los pacientes inmunosuprimidos. La asociación de C. albicans con otras especies de levaduras fue un hallazgo importante en este estudio, que se relacionó de forma inversa con la variable flujo salival. La susceptibilidad a fluconazol permaneció dentro de rangos normales / Financiamiento :Proyecto URED-2014-007

M.Dip.Tech. / Please refer to full text to view abstract

Le goéland leucophée endémique dans la région méditerranéenne française. Son mycobiote intestinal n'a jamais été étudié. Ce travail visait à décrire le rôle de ces oiseaux comme réservoir et disséminateur de champignons pathogènes pour l’homme. Nous avons collecté 177 guano de goélands dans cinq sites sur le littoral méditerranéen français; La Grande-Motte, Palavas-les-Flots, Pierre-Blanche, Frioul and Riou archipels. Nous avons identifié dix-sept espèces de levure; les plus fréquentes étant Candida krusei, Galactomyces geotrichum, C. glabrata et C. albicans. On notait d’une part une augmentation de la fréquence des espèces anthropiques de levures C. glabrata et C. albicans avec l’anthropisation des biotopes des colonies de goélands dont d’isolats résistants aux antifongiques. Nous avons analysé les communautés de champignons filamenteux aérocontaminants isolés à partir des mêmes échantillons. Nous avons identifié 16 genres de champignons filamenteux. la faible diversité et abondance de champignons filamenteux dans les zones urbaines par rapport aux suburbains ou à un environnement peu affecté par l'anthropisation et l’association claire entre certaines espèces fongiques et des environnements particuliers. nous avons analysé la génétique des populations de la levure C. glabrata. Nous avons typé par MLVA, 111 isolats de goélands et 79 isolats collectés chez des patients des hôpitaux de Nîmes, Montpellier et Marseille. Nous avons observé une diversité génétique similaire entre les populations de C. glabrata isolées chez le goéland ou chez l’homme. Les isolats de C. glabrata résistants au fluconazole se distribuaient uniformément dans les deux populations. / The yellow-legged gull is endemic in the French Mediterranean area. Their gut mycobiota has never been studied. This work aimed to describe their role in the spreading of potentially human pathogenic fungi with antifungal resistance. Therefore, we sampled 177 yellow-legged gull’s faecal samples in five sites along the Mediterranean littoral South of France; La Grande-Motte, Palavas-les-Flots, Pierre-Blanche, Frioul and Riou archipelagos. We identified seventeen yeast species; the most frequent were Candida krusei, Galactomyces geotrichum, C. glabrata, C. albicans and Saccharomyces cerevisiae. The frequency of the anthropic yeast species C. glabrata and C. albicans increased with the synanthropy of the gull’s colonies and antifungal resistance was found in each of the five most frequent yeast species. We further analyzed the airborne filamentous fungi species isolated from the same sample cultures. We identified 35 filamentous fungi species in 16 genera including 35 species. Both fungal diversity and abundance were low in urban area when compared to suburban ecocline or environments that were little affected by anthropogenic impact and particular fungal species were clearly associated with distinct environments. Finally, we analyzed the population genetic of the human pathogenic yeast C. glabrata, which were isolated from gulls (111 isolates) and from patients (79 isolates) in Nimes, Montpellier and Marseille hospitals, via MLVA analysis. We found that the C. glabrata populations isolated from gulls or humans shared a similar genetic diversity. Antifungal-resistant C. glabrata isolates were evenly distributed in both gull and human populations.

Dissertation submitted in partial compliance with the requirements of the Master's Degree in Technology: Homoeopathy, Technikon Natal, 2002. / The purpose of this study was to determine the effect of herbal extracts of certain Labiatiae species (Rosmannus officinalis, Salvia officinalis and Thymus vulgaris) in the inhibition of in vitro growth of Candida albicans as compared to ethanol as a control and nystatin in terms of the disc diffusion test. / M

Orientador: Jose Antonio Simões / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-04T01:21:43Z (GMT). No. of bitstreams: 1 Camargo_RodrigoPauperioSoaresde_D.pdf: 459473 bytes, checksum: ffbdc002a0d713fadd1c6d9780989133 (MD5) Previous issue date: 2004 / Resumo: OBJETIVO: Determinar a segurança do ACIDFORM gel intravaginal por cinco dias consecutivos e comparar os índices de cura com o mesmo regime de metronidazol gel para o tratamento de vaginose bacteriana (VB). METODOLOGIA: O estudo foi um ensaio clínico piloto, Fase II, duplo-cego, randomizado com 30 mulheres avaliadas em 3 consultas (admissão, uma semana e um mês após o tratamento). O diagnóstico de VB foi realizado utilizando-se os critérios de Amsel e Nugent. Outras infecções cervicovaginais concomitantes foram afastadas através de culturas e exames específicos. A formulação testada foi o ACIDFORM gel, um novo microbicida vaginal com formulação bioadesiva e tampão-ácida e o controle ativo foi o metronidazol gel. As variáveis estudadas foram: cura objetiva, cura subjetiva, aceitabilidade geral, irritação vulvovaginal, cultura positiva para andida sp. e eventos adversos (EA) após o uso dos produtos Testes não-paramétricos foram usados para as comparações estatísticas que aplicou o teste qui-quadrado com correção de continuidade, o teste exato de Fisher e o teste de Mann-Whitney. O nível de significância estatística ré-estabelecido foi de 5%. RESULTADOS: Após uma semana do final do tratamento o índice de cura objetiva do ACIDFORM foi de 23% e do metronidazol foi de 88% e (p<0,001). Após um mês do tratamento o índice de cura objetiva do ACIDFORM foi de 8% e do metronidazol foi de 53% (p<0,01). A cura subjetiva foi referida por todas as mulheres que relataram cura parcial ou total após o tratamento e, portanto, não se correlacionou bem com a cura objetiva. A aceitabilidade geral do tratamento foi de 92% para o ACIDFORM e de 100% para o metronidazol (p=0,433). Durante o uso dos produtos, 31% das mulheres tratadas com ACIDFORM e 6% das tratadas com metronidazol perceberam alguma irritação vulvovaginal (p=0,138). A cultura para Candida sp. positiva foi semelhante entre os grupos, após o tratamento da VB. A ocorrência de EA foi de 4 casos para o grupo ACIDFORM e 4 casos para o grupo metronidazol, sendo que não ocorreu nenhum EA sério nos dois grupos. CONCLUSÃO: O ACIDFORM gel intravaginal teve um índice de cura para VB significativamente inferior ao metronidazol tanto a curto-prazo (uma semana) quanto a longo-prazo (um mês após o tratamento) e mostrou-se ineficaz como tratamento alternativo para a VB. Entretanto, o ACIDFORM gel intravaginal por cinco dias consecutivos mostrou-se seguro e com boa aceitabilidade geral neste estudo piloto / Abstract: OBJECTIVE: To determine the security of ACIDFORM gel intravaginaly for five consecutive days and to compare the cure rates of the same regime of metronidazole gel for the treatment of bacterial vaginosis (BV). METHODS: This study was a Phase II pilot clinical trial, double-blinded and randomized study with 30 women evaluated in 3 visits (admission, one week and one month after treatment). The diagnosis of BV was based on the Amsel's and the Nugent's criteria. Other cervicovaginal infections were also ruled out through specific cultures and tests. The test product was ACIDFORM gel, a new bioadesive acid-buffer vaginal microbicide. The active control was metronidazole gel. The following variables were evaluated: objective cure rates, subjective cure rates, overall acceptability, vulvovaginal irritation, presence of a positive culture Candida sp. and adverse events (AE) after product use. Non-parametric tests were applied for statistical comparison as the Qui-Square test, the Fisher¿s exact test and the Mann- Whitney test. The statistical significant level was established as 0.05. RESULTS: After one week of treatment the cure rates for the ACIDFORM group was 23% and for the metronidazole group was 88% (p<0.001). After one month, the cure rates for the ACIDFORM group was 8% and for the etronidazole group was 53% (p<0.01). The subjective cure was reported by all women whom related partially or totally cured. However, there was no correlation between the subjective and the objective cure rates. The overall acceptability was 92% for the ACIDFORM group and 100% for the metronidazole group (p=0.433). During the product use, 31% of women treated with ACIDFORM and 6% treated with metronidazole reported some vulvovaginal irritation (p=0.138). The positive culture of Candida sp. was quite similar in both groups after treatment. AE occurred in four women of ACIDFORM group and in four women of the metronidazole group. There was no serious AE in either of both groups. CONCLUSION: Intravaginal ACIDFORM gel had a significantly lower cure rate when compared to metronidazol cure rate for one week and one month after treatment. Nevertheless, ACIDFORM gel intravaginally for five consecutive days had showed to be safe and with a good overall acceptability in this pilot study / Doutorado / Tocoginecologia / Doutor em Tocoginecologia

The Candida genus is full of fungi that are subtle parts of the human microbiome, but they can cause complications if they overgrow within the body—specifically the mouth and throat, the genitalia, and the entire body through infection of the bloodstream. Candida species are a rising problem for many across the world, and this can be seen in the recent threat of Candida auris hospitalizing patients and being regularly resistant to anti-fungal medications. Beyond C. auris, Candida albicans is the most common Candida species that humans must combat because it causes the most infections in humans—mostly vaginal yeast infections. C. albicans does have natural competitors that can either inhibit its growth or kill it in general, and the competition that we took advantage of was with the Alcaligenes species. Alcaligenes faecalis and Alcaligenes viscolactis have been shown to at least inhibit C. albicans growth and maybe even kill the fungus. This rate of infection from C. albicans places it at the forefront of Candida research, and we attempted to further this research by utilizing both A. faecalis and A. viscolactis to create a co-infection model for Caenorhabditis elegans—a simple nematode lifeform. It is known that A. faecalis and A. viscolactis do not commonly adversely affect humans, so little research has been done concerning their clinical effects. We were looking to find a possible answer to C. albicans infections beyond antifungal drugs because we know that antibiotic resistance is on the rise. We performed liquid assays to test the survivability of C. elegans nematodes in various bacterial/fungal circumstances. We subjected batches of C. elegans to E. coli OP50 as a control, A. faecalis, A. viscolactis, C. albicans, A. faecalis and C. albicans, and A. viscolactis and C. albicans. This procedure was followed in order to determine the viability of using the Alcaligenes species to either help the C. elegans survive the infection or prevent them from getting infected at all. After following through with the project, we found that there was a noticeable increase in the survivability of C. elegans when subjected to both one of the Alcaligenes species and C. albicans as opposed to the C. albicans alone. The data, although early, shows the possibility of Alcaligenes species being used to combat C. albicans infections in lifeforms.

This study was undertaken to determine the clinical significance of detecting candida on Pap smear. Clinical information was obtained from a questionnaire sent to the health care provider whenever candida was identified during the study period. Candida was identified in 309 (3.0%) of the 10,370 Pap smears examined. Completed questionnaires were returned on 137 (44.3%) patients. All 137 smears were reviewed. Ninety-nine (72%) patients were asymptomatic, 29 (21%) had symptoms typical of candida infection, and nine (7%) had nonspecific symptoms. Forty-four (32%) patients had been treated for candida during the original clinic visit. After the Pap smear reported candida, 19 (20%) of the 93 nontreated patients were contacted and treated, while 10 (11%) were scheduled for further evaluation. No action was taken on the remaining 64 (69%) patients. There was a significant association between having initial symptoms and receiving immediate treatment (P < 0.001) and undergoing subsequent treatment or further evaluation after the Pap smear report (P < 0.001). Marked inflammation was statistically associated with symptoms (P = 0.014), but the form or number of candida organisms was not. In conclusion, the identification of Candida on Pap smear does not necessarily indicate a symptomatic infection, although the Pap smear results had a direct impact on the treatment of 21% of patients in this study and served as a confirmation for clinical treatment in another 32% who had received such treatment at the time of the original visit.

Coincident with an increased use of cardiac rhythm management devices (CRMD) has been an increase in the number of pacemaker and cardioverter-defibrillator infections. CRMD endocarditis accounts for about 10% of all device-related infections, and cardiac infection caused by Candida sp. is a rare event. To date, only sporadic reports of this unusual and life-threatening event have been reported. By describing a case of CRMD-related Candida endocarditis and conducting a literature review, we provide a detailed characterisation of this unusual clinical entity with an emphasis on diagnosis, management and treatment. A case of CRMD-related Candida endocarditis is presented and a computer search for confirmed cases of CRMD-Candida endocarditis was conducted. Current recommendations for management and treatment were documented. From 1969 to 2009, 15 patients with CRMD-Candida endocarditis (12 pacemaker and three implanted cardioverter-defibrillator) were documented. All were males, non-albicans Candida sp. were frequently recovered, a major fungal embolus occurred in 27% of patients and two of 10 patients who received defined antifungal therapy and device explantation expired. CRMD Candida endocarditis is a rare and serious clinical event; isolates can include Candida albicans and other Candida sp., and treatment involves both targeted antifungal therapy and device removal.

The glycolytic enzyme enolase is an abundant, immunodominant antigen of the fungal pathogen Candida albicans. A C. albicans enolase cDNA was used to study the genetic organization and expression of enolase genes. Experimental results were consistent with a model predicting four enolase genes per diploid genome. Enolase steady state mRNA levels increased during logarithmic growth, but were unaffected by pH, growth form or carbon source.