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Song YK, Zheng L, Liu AX, Ma JJ. Internal transcribed spacer sequencing to explore the intrinsic composition of fungal communities in fungal esophagitis. World J Gastroenterol 2025; 31:101104. [PMID: 39991686 PMCID: PMC11755256 DOI: 10.3748/wjg.v31.i7.101104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 12/09/2024] [Accepted: 12/30/2024] [Indexed: 01/20/2025] Open
Abstract
BACKGROUND Fungal esophagitis (FE) is caused by fungal invasion of the esophageal mucosa. Under endoscopy, the esophageal mucosa shows edema, congestion, erosion, and ulceration, and bleeds easily when touched, and the surface of the mucosa is covered with small white spots like "bean curd residue". Clinical cases showing typical FE under endoscopic imaging but negative esophageal mucosal brush (referred to as suspected FE) have increased the difficulty and challenge of clinical diagnosis and treatment. At present, the esophageal fungal flora of suspected case has not been thoroughly studied. AIM To characterize the fungal flora in FE, suspected FE, and the esophageal normal controls (NCs), and to identify marker species to improve detection of FE. METHODS This was a case-control study. A total of 19 patients with FE, 16 with suspected FE, and 10 NCs were selected by endoscopy. The esophageal cell brush samples of each group were sequenced by internal transcribed spacer (ITS) 1 and analyzed by bioinformatics. RESULTS In FE and suspected FE patients, species richness, species diversity and species evenness, as measured by the Chao1 index, Shannon index and Pielou index, were lower than in the NCs, and the comparison between the FE and NCs was the most significant (P < 0.05). Compared with the NCs, the relative abundance of Candida in FE and suspected FE patients was significantly increased (P < 0.001), while the relative abundance of Yarrowia was significantly decreased (P < 0.05). Moreover, Yarrowia abundance in the FE group was significantly lower than in the NCs and suspected FE groups (P < 0.001). The area under the curve for Candida in FE and suspected FE patients was 99.5% (P < 0.05) and 81.3% (P < 0.05), respectively. Finally, compared with FE patients, the relative abundance of Ascomycota and Candida in the esophageal flora of suspected FE patients was decreased, while the relative abundance of Yarrowia, Thermomyces and Pichia was increased. CONCLUSION ITS showed that composition of the fungal community was similar in the FE and suspected FE groups. ITS can be used as an auxiliary diagnostic method for FE and provide a theoretical basis for follow-up diagnosis and treatment.
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Affiliation(s)
- Yi-Kang Song
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Hebei Clinical Research Center for Digestive Diseases, Shijiazhuang050000, Hebei Province, China
| | - Lin Zheng
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Hebei Clinical Research Center for Digestive Diseases, Shijiazhuang050000, Hebei Province, China
| | - Ai-Xin Liu
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Hebei Clinical Research Center for Digestive Diseases, Shijiazhuang050000, Hebei Province, China
| | - Jun-Ji Ma
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Hebei Clinical Research Center for Digestive Diseases, Shijiazhuang050000, Hebei Province, China
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Mattern S, Hollfoth V, Bag E, Ali A, Riemenschneider P, Jarboui MA, Boldt K, Sulyok M, Dickemann A, Luibrand J, Fusco S, Franz-Wachtel M, Singer K, Goeppert B, Schilling O, Malek N, Fend F, Macek B, Ueffing M, Singer S. An AI-assisted morphoproteomic approach is a supportive tool in esophagitis-related precision medicine. EMBO Mol Med 2025:10.1038/s44321-025-00194-7. [PMID: 39901020 DOI: 10.1038/s44321-025-00194-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/14/2025] [Accepted: 01/14/2025] [Indexed: 02/05/2025] Open
Abstract
Esophagitis is a frequent, but at the molecular level poorly characterized condition with diverse underlying etiologies and treatments. Correct diagnosis can be challenging due to partially overlapping histological features. By proteomic profiling of routine diagnostic FFPE biopsy specimens (n = 55) representing controls, Reflux- (GERD), Eosinophilic-(EoE), Crohn's-(CD), Herpes simplex (HSV) and Candida (CA)-esophagitis by LC-MS/MS (DIA), we identified distinct signatures and functional networks (e.g. mitochondrial translation (EoE), immunoproteasome, complement and coagulations system (CD), ribosomal biogenesis (GERD)), and pathogen-specific proteins for HSV and CA. Moreover, combining these signatures with histological parameters in a machine learning model achieved high diagnostic accuracy (100% training set, 93.8% test set), and supported diagnostic decisions in borderline/challenging cases. Applied to a young patient representing a use case, the external GERD diagnosis could be revised to CD and ICAM1 was identified as highly abundant therapeutic target. This resulted in CyclosporinA as a personalized treatment recommendation by the local multidisciplinary molecular inflammation board. Our integrated AI-assisted morphoproteomic approach allows deeper insights in disease-specific molecular alterations and represents a promising tool in esophagitis-related precision medicine.
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Affiliation(s)
- Sven Mattern
- Department of Pathology and Neuropathology, University of Tübingen, Tübingen, Germany
- Center for Personalized Medicine (ZPM), Tübingen, Germany
| | - Vanessa Hollfoth
- Department of Pathology and Neuropathology, University of Tübingen, Tübingen, Germany
| | - Eyyub Bag
- Department of Pathology and Neuropathology, University of Tübingen, Tübingen, Germany
| | - Arslan Ali
- Department of Pathology and Neuropathology, University of Tübingen, Tübingen, Germany
| | | | - Mohamed A Jarboui
- Core Facility for Medical Proteomics, Institute for Ophthalmic Research, Center for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Karsten Boldt
- Core Facility for Medical Proteomics, Institute for Ophthalmic Research, Center for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Mihaly Sulyok
- Department of Pathology and Neuropathology, University of Tübingen, Tübingen, Germany
| | - Anabel Dickemann
- Department of Pathology and Neuropathology, University of Tübingen, Tübingen, Germany
| | - Julia Luibrand
- Department of Pathology and Neuropathology, University of Tübingen, Tübingen, Germany
| | - Stefano Fusco
- Center for Personalized Medicine (ZPM), Tübingen, Germany
- Department of Internal Medicine I, University of Tübingen, Tübingen, Germany
| | | | - Kerstin Singer
- Department of Pathology and Neuropathology, University of Tübingen, Tübingen, Germany
| | - Benjamin Goeppert
- Institute of Pathology and Neuropathology, Hospital RKH Kliniken Ludwigsburg, Ludwigsburg, Germany
- Institute of Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
| | - Oliver Schilling
- Institute of Pathology, University Medical Center Freiburg, Faculty of Medicine - University of Freiburg, Freiburg, Germany
- Center for Personalized Medicine (ZPM), Freiburg, Germany
| | - Nisar Malek
- Center for Personalized Medicine (ZPM), Tübingen, Germany
- Department of Internal Medicine I, University of Tübingen, Tübingen, Germany
| | - Falko Fend
- Department of Pathology and Neuropathology, University of Tübingen, Tübingen, Germany
| | - Boris Macek
- Proteome Center Tübingen, University of Tübingen, Tübingen, Germany
| | - Marius Ueffing
- Core Facility for Medical Proteomics, Institute for Ophthalmic Research, Center for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Stephan Singer
- Department of Pathology and Neuropathology, University of Tübingen, Tübingen, Germany.
- Center for Personalized Medicine (ZPM), Tübingen, Germany.
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3
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Reddy CA, McGowan E, Yadlapati R, Peterson K. AGA Clinical Practice Update on Esophageal Dysfunction Due to Disordered Immunity and Infection: Expert Review. Clin Gastroenterol Hepatol 2024; 22:2378-2387. [PMID: 39436337 DOI: 10.1016/j.cgh.2024.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 07/18/2024] [Accepted: 08/09/2024] [Indexed: 10/23/2024]
Abstract
METHODS This expert review was commissioned and approved by the American Gastroenterological Association (AGA) Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the CPUC and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. These Best Practice Advice (BPA) statements were drawn from a review of the published literature and from expert opinion. Since systematic reviews were not performed, these BPA statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations. DESCRIPTION Infectious and immune-mediated esophageal disorders are poorly understood and often under-diagnosed conditions that lead to esophageal dysfunction and health care costs due to repeated procedures and a lack of understanding of their etiology and pathogenesis. Without a high index of suspicion, these disorders may be overlooked. Esophageal dysfunction may arise from active, localized infection and immune-mediated disease (ie, candida, etc.) or from an organ-specific manifestation of a more diffuse immune-mediated disease or infection (ie, systemic sclerosis, connective tissue disease, neurologic disease). These conditions can sometimes lead to neuromuscular dysfunction and subsequent esophageal dysmotility. Awareness of local and systemic processes that lead to esophageal dysfunction will improve patient outcomes by focusing therapeutics and limiting unnecessary procedures. Therefore, the purpose of this AGA Clinical Practice Update Expert Review is to provide BPA on diagnostic considerations of immune-mediated disorders that should be considered when encountering patients with dysphagia, heartburn, and odynophagia. Best Practice Advice Statements: BEST PRACTICE ADVICE 1: Gastroenterologists should be aware of the esophageal manifestations of systemic immunologic and infectious diseases to reduce diagnostic delay. Clinicians should identify if there are risks for inflammatory or infectious possibilities for a patient's esophageal symptoms and investigate for these disorders as a potential cause of esophageal dysfunction. BEST PRACTICE ADVICE 2: Once esophageal infection is identified, clinicians should identify whether accompanying signs/symptoms suggest immunocompromise leading to a more systemic infection. Consultation with an infectious disease expert will aid in guiding appropriate treatment. BEST PRACTICE ADVICE 3: If symptoms do not improve after therapy for infectious esophagitis, evaluation for refractory infection or additional underlying sources of esophageal and immunologic dysfunction should be performed. BEST PRACTICE ADVICE 4: In individuals with eosinophilic esophagitis (EoE) who continue to experience symptoms of esophageal dysfunction despite histologic and endoscopic disease remission, clinicians should be aware that some patients with EoE may develop motility disorders. Further evaluation of esophageal motility may be warranted. BEST PRACTICE ADVICE 5: In individuals with histologic and endoscopic features of lymphocytic esophagitis, clinicians should consider treatment of lymphocytic-related inflammation with proton-pump inhibitor therapy or swallowed topical corticosteroids and as needed esophageal dilation. BEST PRACTICE ADVICE 6: In patients who present with esophageal symptoms in the setting of hypereosinophilia (absolute eosinophil count [AEC] >1500 cells/uL), consider further work-up of non-EoE eosinophilic gastrointestinal (GI) disease, hypereosinophilic syndrome, and eosinophilic granulomatosis with polyangiitis (EGPA). Consultation with allergy/immunology may help guide further diagnostic work-up and treatment. BEST PRACTICE ADVICE 7: In individuals with rheumatologic diseases of systemic sclerosis (SSc), mixed connective tissue disease (MCTD), systemic lupus erythematosus (SLE), or Sjogren's disease, clinicians should be aware that esophageal symptoms can occur due to involvement of the esophageal muscle layer, resulting in dysmotility and/or incompetence of the lower esophageal sphincter. The degree of dysfunction is often especially significant in those with SSc or MCTD. BEST PRACTICE ADVICE 8: In individuals with Crohn's disease, clinicians should be aware that a minority of individuals can develop esophageal involvement from inflammatory, stricturing, or fistulizing changes with granulomas seen histologically. Esophageal manifestations of Crohn's disease tend to occur in individuals with active intestinal disease. BEST PRACTICE ADVICE 9: In individuals with dermatologic diseases of lichen planus or bullous disorders, clinicians should be aware that dysphagia can occur due to endoscopically visible esophageal mucosal involvement. Esophageal lichen planus, in particular, can occur without skin involvement and can be difficult to define on esophageal histopathology. BEST PRACTICE ADVICE 10: Clinicians should consider infectious and inflammatory causes of secondary achalasia during initial evaluation. One should query for any history of recent COVID infections, risks for Chagas disease, and symptoms or signs of eosinophilic disease.
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Affiliation(s)
- Chanakyaram A Reddy
- Center for Esophageal Diseases, Division of Gastroenterology, Baylor University Medical Center, Dallas, Texas
| | - Emily McGowan
- Division of Allergy and Immunology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Rena Yadlapati
- Division of Gastroenterology, UCSD Center for Esophageal Diseases, GI Motility Lab, University of California San Diego, GEODE Research Program, San Francisco, California
| | - Kathryn Peterson
- Division of Gastroenterology, University of Utah, Salt Lake City, Utah.
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Jin G, Liu K, Guo Z, Dong Z. Precision therapy for cancer prevention by targeting carcinogenesis. Mol Carcinog 2024; 63:2045-2062. [PMID: 39140807 DOI: 10.1002/mc.23798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/11/2024] [Accepted: 07/16/2024] [Indexed: 08/15/2024]
Abstract
Cancer represents a major global public health burden, with new cases estimated to increase from 14 million in 2012 to 24 million by 2035. Primary prevention is an effective strategy to reduce the costs associated with cancer burden. For example, measures to ban tobacco consumption have dramatically decreased lung cancer incidence and vaccination against human papillomavirus can prevent cervical cancer development. Unfortunately, the etiological factors of many cancer types are not completely clear or are difficult to actively control; therefore, the primary prevention of such cancers is not practical. In this review, we update the progress on precision therapy by targeting the whole carcinogenesis process, especially for three high-risk groups: (1) those with chronic inflammation, (2) those with inherited germline mutations, and (3) those with precancerous lesions like polyps, gastritis, actinic keratosis or dysplasia. We believe that attenuating chronic inflammation, treating precancerous lesions, and removing high-risk tissues harboring germline mutations are precision methods for cancer prevention.
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Affiliation(s)
- Guoguo Jin
- Henan Key Laboratory of Chronic Disease Management, Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan, China
- China-US (Henan) Hormel Cancer Institute, Zhengzhou, Henan, China
| | - Kangdong Liu
- China-US (Henan) Hormel Cancer Institute, Zhengzhou, Henan, China
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhiping Guo
- Henan Key Laboratory of Chronic Disease Management, Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan, China
| | - Zigang Dong
- China-US (Henan) Hormel Cancer Institute, Zhengzhou, Henan, China
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
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5
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Marschner J, Schmitt-Graeff A, Kreisel W, Decker A, Schauer F. Case report: Lichenoid esophagitis revealing an HIV infection. Front Med (Lausanne) 2024; 11:1477787. [PMID: 39512615 PMCID: PMC11540929 DOI: 10.3389/fmed.2024.1477787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Accepted: 09/06/2024] [Indexed: 11/15/2024] Open
Abstract
Esophageal lichen planus is an underrecognized manifestation of lichen planus. It is typically diagnosed based on characteristic endoscopic findings, such as hyperkeratosis, trachealization, denudation and/or stenosis, along with the presence of a lichenoid infiltrate in histopathological examination. In cases where no other manifestation of lichen planus are found and direct immunofluorescence for fibrinogen along the basement membrane is negative, the term "lichenoid esophagitis" should be preferred. This distinction is critical, as it prompts a thorough evaluation for underlying diseases, including autoimmune conditions and viral infections. We report a case of a 69-year-old male with stenosing esophagitis resembling esophageal lichen planus on endoscopic evaluation. The condition was refractory to multiple dilation procedures and high-dose proton pump inhibitor therapy. Histopathological analysis revealed a dense lymphocytic infiltrate extending into the epithelial layer, while direct immunofluorescence microscopy for fibrinogen was negative. There were no other signs of lichen planus on the skin or mucous membranes. The patient's medical history included recurrent transient ischemic attack (non-cardiac), penile cancer and recurrent mucosal candidiasis. Laboratory findings revealed Epstein-Barr virus viremia and IgG hypergammaglobulinemia, raising suspicion of immunodeficiency. Further testing confirmed an active HIV infection, classified as category C3, and antiretroviral therapy was initiated. Following the initiation of antiretroviral therapy, the patient experienced rapid clinical and histopathological improvement of the lichenoid esophageal inflammation, although the esophageal stenosis persisted. Subsequent follow-up endoscopies confirmed resolution of the inflammatory component, underscoring the positive impact of addressing the underlying HIV infection on the esophagus. This case report highlights the importance of recognizing lichenoid esophagitis as a potential diagnosis in cases of unexplained chronic esophagitis, especially when standard treatments are ineffective. The presence of lichenoid inflammation without other manifestations of lichen planus should trigger an investigation into underlying conditions.
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Affiliation(s)
- Jasmin Marschner
- Department of Dermatology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | | | - Wolfgang Kreisel
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Annegrit Decker
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Franziska Schauer
- Department of Dermatology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
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Teshon A, Reyes R, Schammel DP, Corso O, Schammel C, Kent P, Devane AM. Tracheoesophageal fistula due to Candida and Actinomyces co-infection: A case report and comprehensive review of the literature. Eur J Microbiol Immunol (Bp) 2024; 14:296-307. [PMID: 38739458 PMCID: PMC11393647 DOI: 10.1556/1886.2024.00043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 04/24/2024] [Indexed: 05/16/2024] Open
Abstract
Acquired benign tracheoesophageal fistulas and bronchoesophageal fistulas (TEF) are typically associated with granulomatous mediastinal infections, 75% of which are iatrogenic. Candida albicans and Actinomyces are commonly occurring organisms, but are uncommon etiologies of TEF. Normal colonization and the slow growth characteristics of some species of these agents rarely result in infection, mycetoma, and broncholithiasis, and thus, delays in diagnosis and treatment are likely. Few reports describe C. albicans or Actinomyces spp. as the etiology of TEF or broncholithiasis. Herein, we report a case of benign acquired TEF secondary to coinfection of Candida and Actinomyces complicated by the formation of an actinomycetoma and broncholithiasis and a comprehensive literature review to highlight the unique nature of this presentation and offer a diagnostic algorithm for diagnosis and treatment of TEFs. Following a presentation of three months of productive cough, choking sensation, night sweats, and weight loss, a bronchoscopy revealed a fistulous connection between the esophagus and the posterior right middle lobe. Pathology identified a calcified fungus ball and a broncholith secondary to the co-infection of Candida and Actinomyces. This unique presentation of Candida and Actinomyces co-infection and the associated diagnostic algorithm are presented as education and a useful tool for clinicians.
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Affiliation(s)
- A Teshon
- 1University of South Carolina School of Medicine Greenville, Greenville SC, USA
| | - R Reyes
- 1University of South Carolina School of Medicine Greenville, Greenville SC, USA
| | | | - O Corso
- 2Pathology Associates, Greenville SC, USA
| | - C Schammel
- 1University of South Carolina School of Medicine Greenville, Greenville SC, USA
- 2Pathology Associates, Greenville SC, USA
| | - P Kent
- 3Department of Internal Medicine, Division of Infectious Disease, Prisma Health Upstate, Greenville SC, USA
| | - A M Devane
- 1University of South Carolina School of Medicine Greenville, Greenville SC, USA
- 4Department of Radiology, Prisma Health Upstate, Greenville SC, USA
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Padmavathi AR, Reddy GKK, Murthy PS, Nancharaiah YV. New arsenals for old armour: Biogenic nanoparticles in the battle against drug-resistant Candidaalbicans. Microb Pathog 2024; 194:106800. [PMID: 39025380 DOI: 10.1016/j.micpath.2024.106800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/01/2024] [Accepted: 07/15/2024] [Indexed: 07/20/2024]
Abstract
Candida albicans is a common commensal fungus and fourth most frequent causative agent of nosocomial infections including life-threatening invasive candidiasis in humans. The effectiveness of present antifungal therapies using azoles, polyenes, flucytosine and echinocandins has plateaued in managing fungal infections. The limitations of these antifungal drugs are related to polymorphic morphology, biofilm formation, emergence of drug-resistant strains and production of several virulence factors. Development of new antifungal agents, which can particularly afflict multiple cellular targets and limiting evolving resistant strains are needed. Recently, metal nanoparticles have emerged as a source of new antifungal agents for antifungal formulations. Furthermore, green nanotechnology deals with the use of biosynthetic routes that offer new avenue for synthesizing antifungal nanoparticles coupled with less toxic chemical inventory and environmental sustainability. This article reviews the recent developments on C. albicans pathogenesis, biofilm formation, drug resistance, mode of action of antifungal drugs and antifungal activities of metal nanoparticles. The antifungal efficacy and mode of action of metal nanoparticles are described in the context of prospective therapeutic applications.
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Affiliation(s)
- Alwar Ramanujam Padmavathi
- Biofouling and Biofilm Processes Section, Water and Steam Chemistry Division, Bhabha Atomic Research Centre, Kalpakkam, 603 102, India; Homi Bhabha National Institute, Anushaktinagar, Mumbai, 400 094, India.
| | - G Kiran Kumar Reddy
- Biofouling and Biofilm Processes Section, Water and Steam Chemistry Division, Bhabha Atomic Research Centre, Kalpakkam, 603 102, India; Homi Bhabha National Institute, Anushaktinagar, Mumbai, 400 094, India
| | - P Sriyutha Murthy
- Biofouling and Biofilm Processes Section, Water and Steam Chemistry Division, Bhabha Atomic Research Centre, Kalpakkam, 603 102, India; Homi Bhabha National Institute, Anushaktinagar, Mumbai, 400 094, India
| | - Y V Nancharaiah
- Biofouling and Biofilm Processes Section, Water and Steam Chemistry Division, Bhabha Atomic Research Centre, Kalpakkam, 603 102, India; Homi Bhabha National Institute, Anushaktinagar, Mumbai, 400 094, India
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Ehtezazi T, Kteich A, Abdulkarim R, Anderson V, Algellay M, McCloskey AP, Carter N, Roberts M, Assi S, Al-Jumeily D, Thompson M, Mohamed FA, Sarker SD. Reducing Temperature of Fused Deposition Modelling 3D Printing for Linalool Fast Dissolving Oral Films by Increasing Printer Nozzle Diameter. J Pharm Sci 2024; 113:2374-2382. [PMID: 38621439 DOI: 10.1016/j.xphs.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 04/17/2024]
Abstract
Oral thrush and throat infections can occur in a wide range of patients. Treatments are available; however, resistance to drugs is a major problem for treating oral and throat infections. Three-dimensional printing (3DP) of fast dissolving oral films (FDFs) of linalool oil may provide an alternative solution. Linalool oil FDFs were printed by fused deposition modelling across 1-18 % w/w linalool content range with nozzle diameters of 0.4 or 1 mm at the temperature range of 150 °C-185 °C. The FDFs were evaluated for physicochemical and mechanical properties. Increasing the printer nozzle diameter to 1 mm allowed reducing the printing temperature from 185 °C to 150 °C; consequently, more linalool was quantified in the films with improved content uniformity. The higher linalool content in the films increased the film disintegration time and mechanical strength. FDFs containing 10% w/w linalool showed clear antifungal activity against Candida albicans. Raman spectroscopy suggested linalool separation from excipients at higher temperature printing. Viscoelastic measurements indicated that to achieve printing; the elastic modulus of molten filament needed to be higher than the loss modulus at low angular frequencies. In conclusion, increasing the printing nozzle diameter may avoid loss of the active ingredient by reducing the temperature of the 3DP process.
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Affiliation(s)
- Touraj Ehtezazi
- Centre for Natural Product Discovery, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, United Kingdom; School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, United Kingdom.
| | - Asmaa Kteich
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, United Kingdom
| | - Rana Abdulkarim
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, United Kingdom
| | - Vicki Anderson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, United Kingdom
| | - Marwan Algellay
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, United Kingdom
| | - Alice P McCloskey
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, United Kingdom
| | - Neve Carter
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, United Kingdom
| | - Matthew Roberts
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, United Kingdom
| | - Sulaf Assi
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, United Kingdom
| | - Dhiya Al-Jumeily
- School of Computer Science and Mathematics, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, United Kingdom
| | - Molly Thompson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, United Kingdom
| | - Fazreelia Abu Mohamed
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, United Kingdom
| | - Satyajit D Sarker
- Centre for Natural Product Discovery, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, United Kingdom; School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, United Kingdom
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Qu J, Wang Z, Zhang H, Lu Y, Jia Z, Lu S, Zhao K, Chu F, Bai B, Zheng Y, Xia Q, Li X, Wang S, Kamel IR. How to update esophageal masses imaging using literature review (MRI and CT features). Insights Imaging 2024; 15:169. [PMID: 38971944 PMCID: PMC11227487 DOI: 10.1186/s13244-024-01754-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 06/16/2024] [Indexed: 07/08/2024] Open
Abstract
MRI offers new opportunities for detailed visualization of the different layers of the esophageal wall, as well as early detection and accurate characterization of esophageal lesions. Staging of esophageal tumors including extramural extent of disease, and status of the adjacent organ can also be performed by MRI with higher accuracy compared to other imaging modalities including CT and esophageal endoscopy. Although MDCT appears to be the primary imaging modality that is indicated for preoperative staging of esophageal cancer to assess tumor resectability, MDCT is considered less accurate in T staging. This review aims to update radiologists about emerging imaging techniques and the imaging features of various esophageal masses, emphasizing the imaging features that differentiate between esophageal masses, demonstrating the critical role of MRI in esophageal masses. CRITICAL RELEVANCE STATEMENT: MRI features may help differentiate mucosal high-grade neoplasia from early invasive squamous cell cancer of the esophagus, also esophageal GISTs from leiomyomas, and esophageal malignant melanoma has typical MR features. KEY POINTS: MRI can accurately visualize different layers of the esophagus potentially has a role in T staging. MR may accurately delineate esophageal fistulae, especially small mediastinal fistulae. MRI features of various esophageal masses are helpful in the differentiation.
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Affiliation(s)
- Jinrong Qu
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, 450008, China.
| | - Zhaoqi Wang
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, 450008, China
| | - Hongkai Zhang
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, 450008, China
| | - Yanan Lu
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, 450008, China
| | - Zhengyan Jia
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, 450008, China
| | - Shuang Lu
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, 450008, China
| | - Keke Zhao
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, 450008, China
| | - Funing Chu
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, 450008, China
| | - Bingmei Bai
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, 450008, China
| | - Yan Zheng
- Department of Thoracic surgery, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, 450008, China
| | - Qingxin Xia
- Department of Pathology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, 450008, China
| | - Xu Li
- Department of Pathology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, 450008, China
| | - Shaoyu Wang
- MR Scientific Marketing, Siemens Healthineers, Shanghai, 201318, China
| | - Ihab R Kamel
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205-2196, USA
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10
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Katsipoulaki M, Stappers MHT, Malavia-Jones D, Brunke S, Hube B, Gow NAR. Candida albicans and Candida glabrata: global priority pathogens. Microbiol Mol Biol Rev 2024; 88:e0002123. [PMID: 38832801 PMCID: PMC11332356 DOI: 10.1128/mmbr.00021-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
SUMMARYA significant increase in the incidence of Candida-mediated infections has been observed in the last decade, mainly due to rising numbers of susceptible individuals. Recently, the World Health Organization published its first fungal pathogen priority list, with Candida species listed in medium, high, and critical priority categories. This review is a synthesis of information and recent advances in our understanding of two of these species-Candida albicans and Candida glabrata. Of these, C. albicans is the most common cause of candidemia around the world and is categorized as a critical priority pathogen. C. glabrata is considered a high-priority pathogen and has become an increasingly important cause of candidemia in recent years. It is now the second most common causative agent of candidemia in many geographical regions. Despite their differences and phylogenetic divergence, they are successful as pathogens and commensals of humans. Both species can cause a broad variety of infections, ranging from superficial to potentially lethal systemic infections. While they share similarities in certain infection strategies, including tissue adhesion and invasion, they differ significantly in key aspects of their biology, interaction with immune cells, host damage strategies, and metabolic adaptations. Here we provide insights on key aspects of their biology, epidemiology, commensal and pathogenic lifestyles, interactions with the immune system, and antifungal resistance.
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Affiliation(s)
- Myrto Katsipoulaki
- Department of Microbial Pathogenicity Mechanisms, Hans Knoell Institute, Jena, Germany
| | - Mark H. T. Stappers
- MRC Centre for Medical Mycology, University of Exeter, Exeter, United Kingdom
| | - Dhara Malavia-Jones
- MRC Centre for Medical Mycology, University of Exeter, Exeter, United Kingdom
| | - Sascha Brunke
- Department of Microbial Pathogenicity Mechanisms, Hans Knoell Institute, Jena, Germany
| | - Bernhard Hube
- Department of Microbial Pathogenicity Mechanisms, Hans Knoell Institute, Jena, Germany
- Institute of Microbiology, Friedrich Schiller University, Jena, Germany
| | - Neil A. R. Gow
- MRC Centre for Medical Mycology, University of Exeter, Exeter, United Kingdom
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11
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Olariu MC, Olariu MH, Iancu AM, Săndulescu O, Streinu-Cercel A, Barbu EC, Şahin GÖ, Borcan AM, Cruceru MM, Simoiu M. The spectrum of esophagitis in patients living with HIV - a scoping review. Germs 2024; 14:188-196. [PMID: 39493738 PMCID: PMC11527493 DOI: 10.18683/germs.2024.1430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 11/05/2024]
Abstract
Esophageal lesions are common findings in disorders of the digestive tract in patients living with HIV, the most typical symptoms being odynophagia and/or dysphagia. This article provides a narrative review of the spectrum of esophagitis in patients living with HIV, focusing on fungal, viral, bacterial and non-infectious etiologies, as well as co-infections with viral hepatitis viruses. The article provides a comprehensive approach to the strategy of diagnosis and the role of upper digestive endoscopy and histopathological examination in the evaluation of esophageal pathology in patients living with HIV.
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Affiliation(s)
- Mihaela Cristina Olariu
- MD, PhD, Lecturer, Department of Infectious Diseases I, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, and National Institute for Infectious Diseases "Prof. Dr. Matei Balş", No. 1 Dr. Calistrat Grozovici street, Bucharest, 021105, Romania
| | - Mihai Hristu Olariu
- MD, PhD, National Institute for Infectious Diseases "Prof. Dr. Matei Balş", No. 1 Dr. Calistrat Grozovici street, Bucharest, 021105, Romania
| | - Adela Mihaela Iancu
- MD, PhD, Associate Professor, Department of Internal Medicine, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, No 37 Dionisie Lupu Street, Bucharest, 020021, Romania
| | - Oana Săndulescu
- MD, PhD, Professor, Department of Infectious Diseases I, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, and National Institute for Infectious Diseases "Prof. Dr. Matei Balş", No. 1 Dr. Calistrat Grozovici street, Bucharest, 021105, Romania, and Academy of Romanian Scientists, Bucharest, 050044, Romania
| | - Anca Streinu-Cercel
- MD, PhD, Professor, Department of Infectious Diseases I, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, and National Institute for Infectious Diseases "Prof. Dr. Matei Balş", No. 1 Dr. Calistrat Grozovici street, Bucharest, 021105, Romania, and Academy of Romanian Scientists, Bucharest, 050044, Romania
| | - Ecaterina Constanţa Barbu
- MD, PhD, University Lecturer, Department of Pathophysiology II, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, No. 37 Dionisie Lupu Street, Bucharest, 020021 Romania
| | - Gülşen Özkaya Şahin
- MD, PhD, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, 22362, Sweden, and Laboratory Medicine, Department of Clinical Microbiology, Skåne University Hospital, Lund, 22242, Sweden
| | - Alina Maria Borcan
- MD, PhD, Department of Infectious Diseases I, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, National Institute for Infectious Diseases "Prof. Dr. Matei Balş", No. 1 Dr. Calistrat Grozovici street, Bucharest, 021105, Romania
| | - Miruna Maria Cruceru
- MD, National Institute for Infectious Diseases "Prof. Dr. Matei Balş", No. 1 Dr. Calistrat Grozovici street, Bucharest, 021105, Romania
| | - Mădălina Simoiu
- Mădălina Simoiu, MD, PhD, Department of Infectious Diseases I, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, National Institute for Infectious Diseases "Prof. Dr. Matei Balş", No. 1 Dr. Calistrat Grozovici street, Bucharest, 021105, Romania
| | - on behalf of ESCMID Study Group for Viral Hepatitis (ESGVH)
- MD, PhD, Lecturer, Department of Infectious Diseases I, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, and National Institute for Infectious Diseases "Prof. Dr. Matei Balş", No. 1 Dr. Calistrat Grozovici street, Bucharest, 021105, Romania
- MD, PhD, National Institute for Infectious Diseases "Prof. Dr. Matei Balş", No. 1 Dr. Calistrat Grozovici street, Bucharest, 021105, Romania
- MD, PhD, Associate Professor, Department of Internal Medicine, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, No 37 Dionisie Lupu Street, Bucharest, 020021, Romania
- MD, PhD, Professor, Department of Infectious Diseases I, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, and National Institute for Infectious Diseases "Prof. Dr. Matei Balş", No. 1 Dr. Calistrat Grozovici street, Bucharest, 021105, Romania, and Academy of Romanian Scientists, Bucharest, 050044, Romania
- MD, PhD, Professor, Department of Infectious Diseases I, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, and National Institute for Infectious Diseases "Prof. Dr. Matei Balş", No. 1 Dr. Calistrat Grozovici street, Bucharest, 021105, Romania, and Academy of Romanian Scientists, Bucharest, 050044, Romania
- MD, PhD, University Lecturer, Department of Pathophysiology II, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, No. 37 Dionisie Lupu Street, Bucharest, 020021 Romania
- MD, PhD, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, 22362, Sweden, and Laboratory Medicine, Department of Clinical Microbiology, Skåne University Hospital, Lund, 22242, Sweden
- MD, PhD, Department of Infectious Diseases I, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, National Institute for Infectious Diseases "Prof. Dr. Matei Balş", No. 1 Dr. Calistrat Grozovici street, Bucharest, 021105, Romania
- MD, National Institute for Infectious Diseases "Prof. Dr. Matei Balş", No. 1 Dr. Calistrat Grozovici street, Bucharest, 021105, Romania
- Mădălina Simoiu, MD, PhD, Department of Infectious Diseases I, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, National Institute for Infectious Diseases "Prof. Dr. Matei Balş", No. 1 Dr. Calistrat Grozovici street, Bucharest, 021105, Romania
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12
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Karnan A, Jadhav U, Ghewade B, Ledwani A, Beeravolu H. HIV Versus the Human Body: A Case Report of an Immunity-Compromised Patient. Cureus 2024; 16:e62942. [PMID: 39050280 PMCID: PMC11265968 DOI: 10.7759/cureus.62942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 06/23/2024] [Indexed: 07/27/2024] Open
Abstract
The immune system is the body's defense system against infection, pathogenic organisms, or foreign bodies. Human immunodeficiency virus (HIV) infection significantly reduces the number of cells involved in the immune system making the infected person prone to a greater number of infections like tuberculosis (TB). HIV infection reduces the CD4 T helper cell count and further replicates within the body. HIV-TB is a major health concern as there is more chance of progression to acquired immunodeficiency syndrome (AIDS) and the emergence of drug-resistant TB. In this case report, we see how the HIV-TB infection affects the body, significantly affecting the morbidity and mortality of the patient.
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Affiliation(s)
- Ashwin Karnan
- Pulmonary Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ulhas Jadhav
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Babaji Ghewade
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anjana Ledwani
- Pulmonary Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Harshith Beeravolu
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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13
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Shahabudin S, Azmi NS, Lani MN, Mukhtar M, Hossain MS. Candida albicans skin infection in diabetic patients: An updated review of pathogenesis and management. Mycoses 2024; 67:e13753. [PMID: 38877612 DOI: 10.1111/myc.13753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 06/16/2024]
Abstract
Candida species, commensal residents of human skin, are recognized as the cause of cutaneous candidiasis across various body surfaces. Individuals with weakened immune systems, particularly those with immunosuppressive conditions, are significantly more susceptible to this infection. Diabetes mellitus, a major metabolic disorder, has emerged as a critical factor inducing immunosuppression, thereby facilitating Candida colonization and subsequent skin infections. This comprehensive review examines the prevalence of different types of Candida albicans-induced cutaneous candidiasis in diabetic patients. It explores the underlying mechanisms of pathogenicity and offers insights into recommended preventive measures and treatment strategies. Diabetes notably increases vulnerability to oral and oesophageal candidiasis. Additionally, it can precipitate vulvovaginal candidiasis in females, Candida balanitis in males, and diaper candidiasis in young children with diabetes. Diabetic individuals may also experience candidal infections on their nails, hands and feet. Notably, diabetes appears to be a risk factor for intertrigo syndrome in obese individuals and periodontal disorders in denture wearers. In conclusion, the intricate relationship between diabetes and cutaneous candidiasis necessitates a comprehensive understanding to strategize effective management planning. Further investigation and interdisciplinary collaborative efforts are crucial to address this multifaceted challenge and uncover novel approaches for the treatment, management and prevention of both health conditions, including the development of safer and more effective antifungal agents.
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Affiliation(s)
- Sakina Shahabudin
- Faculty of Industrial Sciences and Technology, Universiti Malaysia Pahang Al-Sultan Abdullah, Kuantan, Pahang, Malaysia
| | - Nina Suhaity Azmi
- Faculty of Industrial Sciences and Technology, Universiti Malaysia Pahang Al-Sultan Abdullah, Kuantan, Pahang, Malaysia
| | - Mohd Nizam Lani
- Faculty of Fisheries and Food Science, Universiti Malaysia Terengganu, Kuala Nerus, Terengganu, Malaysia
| | | | - Md Sanower Hossain
- Centre for Sustainability of Mineral and Resource Recovery Technology (Pusat SMaRRT), Universiti Malaysia Pahang Al-Sultan Abdullah, Kuantan, Pahang, Malaysia
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14
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Peng Z, Zhang J, Zhang M, Yin L, Zhou Z, Lv C, Wang Z, Tang J. Tryptophan metabolites relieve intestinal Candida albicans infection by altering the gut microbiota to reduce IL-22 release from group 3 innate lymphoid cells of the colon lamina propria. Food Funct 2024; 15:5364-5381. [PMID: 38639049 DOI: 10.1039/d4fo00432a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Invasive candidiasis may be caused by Candida albicans (C. albicans) colonization of the intestinal tract. Preventing intestinal damage caused by Candida albicans infection and protecting intestinal barrier function have become a critical issue. Integrated analyses of the microbiome with metabolome revealed a remarkable shift of the gut microbiota and tryptophan metabolites, kynurenic acid (KynA), and indolacrylic acid (IA) in mice infected with C. albicans. The transcriptome sequencing indicated that differentially expressed genes were significantly associated with innate immune responses and inflammatory responses. The results of this study suggest that KynA and IA (KI) can alleviate intestinal damage caused by Candida albicans infection in mice by reducing intestinal permeability, increasing intestinal firmness, alleviating intestinal inflammation, and reducing the secretion of interleukin-22 (IL-22) in the 3 groups of colon innate lymphoid cells (ILC3). We performed a fecal microbiota transplantation (FMT) experiment and found that the intestinal barrier function, inflammation, and IL-22 secretion of ILC3 in the colon lamina propria of the recipient mice subjected to C. albicans infection and KI treatment were consistent with the trends of the donor mice. Our results suggest that tryptophan metabolites may directly regulate colon lamina ILC3 to promote intestinal resistance to C. albicans invasion, or indirectly regulate the ILC3 secretion of IL-22 to play a protective role in the intestinal barrier by affecting intestinal microorganisms, which may become a potential target for alleviating intestine borne C. albicans infection.
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Affiliation(s)
- Ziyao Peng
- Department of Trauma-Emergency and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Jiali Zhang
- Central Laboratory, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Meng Zhang
- Department of Pulmonary and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Liping Yin
- Department of Trauma-Emergency and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Ziyang Zhou
- Department of Trauma-Emergency and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Cuiting Lv
- Central Laboratory, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Zetian Wang
- Department of Trauma-Emergency and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Jianguo Tang
- Department of Trauma-Emergency and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
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15
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Sharma DD, Girgis P, Gandhi D, Adapa S, Karishma F, Kaur G, Balasingh GP, Ismail Elnimer MM. Contemporary Insights Into HIV Esophagitis: Pathogenesis, Therapeutic Strategies, and Prognostic Outcomes. Cureus 2024; 16:e60788. [PMID: 38903321 PMCID: PMC11189106 DOI: 10.7759/cureus.60788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/22/2024] Open
Abstract
Opportunistic infections caused by various bacteria, viruses, fungi, or parasites can cause esophagitis. The fungus Candida albicans is often believed to be the thief behind this disorder. This condition's distinctive signs include the process of inflammation and the development of esophageal ulcers. The underlying immunodeficiency condition in HIV/AIDS patients, especially those in the late stages of the disease, may lead to severe illness or even death if the lowered immune system can no longer combat common infections. These individuals are, therefore, more at risk of contracting diseases like Candidiasis since they already have weakened immune systems. Furthermore, bacteria and mycobacteria can cause esophagitis in the same way that viruses can. Tobacco use, alcohol drinking, and nutritional deficiency are three additional problems that can lead to an HIV esophagitis infection. Complaints of inability to swallow, suffocating feeling or discomfort behind the breastbone, and painful swallowing are the primary symptoms of the patients. White plaques or ulcers observed in the esophagus during an endoscopy can be biopsied for further examination. The presence of C. albicans hyphae and inflammatory infiltrates in these samples confirms the diagnosis of HIV-associated esophagitis. Treatment involves the use of antifungal medications and addressing any underlying causes of esophagitis, which is linked to AIDS. For superficial to moderate infections, fluconazole is typically used first. If the disease is severe or recurs after treatment, intravenous amphotericin B may be necessary. Patients with recurring oral symptoms of HIV esophagitis might also need to take antifungal drugs as a preventative measure.
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Affiliation(s)
| | - Peter Girgis
- Internal Medicine, Ross University School of Medicine, Bridgetown, BRB
| | - Dhruv Gandhi
- Internal Medicine, K. J. Somaiya Medical College, Mumbai, IND
| | | | - Fnu Karishma
- Internal Medicine, Ghulam Muhammad Mahar Medical College, Khairpur, PAK
| | - Gurvir Kaur
- Internal Medicine, American University of Antigua, Los Angeles, USA
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16
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Ioannou P, Baliou S, Kofteridis DP. Fungemia by Wickerhamomyces anomalus-A Narrative Review. Pathogens 2024; 13:269. [PMID: 38535612 PMCID: PMC10974086 DOI: 10.3390/pathogens13030269] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 02/11/2025] Open
Abstract
Wickerhamomyces anomalus has been previously classified as Hansenula anomala, Pichia anomala, and Candida pelliculosa and was recently reclassified in the genus Wickerhamomyces after phylogenetic analysis of its genetic sequence. An increasing number of reports of human infections by W. anomalus have emerged, suggesting that this microorganism is an emerging pathogen. The present review aimed to provide data on the epidemiology, antifungal resistance, clinical characteristics, treatment, and outcomes of fungemia by W. anomalus by extracting all the available information from published original reports in the literature. PubMed/Medline, Cochrane Library, and Scopus databases were searched for eligible articles reporting data on patients with this disease. In total, 36 studies involving 170 patients were included. The age of patients with fungemia by W. anomalus ranged from 0 to 89 years; the mean age was 22.8 years, the median age was 2.2 years, with more than 37 patients being less than one month old, and 54% (88 out of 163 patients) were male. Regarding patients' history, 70.4% had a central venous catheter use (CVC), 28.7% were on total parenteral nutrition (TPN), 97% of neonates were hospitalized in the neonatal ICU (NICU), and 39.4% of the rest of the patients were hospitalized in the intensive care unit (ICU). Previous antimicrobial use was noted in 65.9% of patients. The most common identification method was the matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) in 34.1%, VITEK and VITEK 2 in 20.6%, and ID32 C in 15.3%. W. anomalus had minimal antifungal resistance to fluconazole, echinocandins, and amphotericin B, the most commonly used antifungals for treatment. Fever and sepsis were the most common clinical presentation noted in 95.8% and 86%, respectively. Overall mortality was 20% and was slightly higher in patients older than one year. Due to the rarity of this disease, future multicenter studies should be performed to adequately characterize patients' characteristics, treatment, and outcomes, which will increase our understanding and allow drawing safer conclusions regarding optimal management.
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Affiliation(s)
- Petros Ioannou
- School of Medicine, University of Crete, 71003 Heraklion, Greece
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17
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Althunibat I, Atiyat R, Okwesili B, Hussain M, Dacosta TJ. A Complex Presentation of Esophageal Pseudodiverticulosis With Candida Albicans Esophagitis in a 68-Year-Old Female. Cureus 2024; 16:e55286. [PMID: 38558629 PMCID: PMC10981773 DOI: 10.7759/cureus.55286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Esophageal pseudodiverticulosis, a rare condition, involves small sac-like structures in the esophageal wall, stemming from dilated excretory ducts of submucosal glands. While uncommon, it can complicate Candida albicans esophagitis, a yeast infection linked to various clinical issues, including pseudodiverticula formation. This unique association underscores the importance of understanding its clinical implications and optimal management. In this case, a 68-year-old female sought medical attention for dysphagia and recurrent food impaction. The diagnostic journey revealed esophageal pseudodiverticulosis and Candida albicans esophagitis, emphasizing the complexity of esophageal disorders.
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Affiliation(s)
| | - Raed Atiyat
- Gastroenterology, Saint Michael's Medical Center, Newark, USA
| | - Byron Okwesili
- Gastroenterology and Hepatology, Saint Michael's Medical Center, Newark, USA
| | - Muhammad Hussain
- Gastroenterology and Hepatology, Saint Michael's Medical Center/New York Medical Center, Newark, USA
| | - Theodore Jr Dacosta
- Gastroenterology and Hepatology, Saint Michael's Medical Center, Newark, USA
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18
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Choi R, Pazevic A, Pak K, Skaret M, Bachmann A, Wilkerson R. A Case of Whipple's Disease With Concomitant Esophageal Candidiasis. Mil Med 2024; 189:e405-e409. [PMID: 37539465 DOI: 10.1093/milmed/usad246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/12/2023] [Accepted: 06/25/2023] [Indexed: 08/05/2023] Open
Abstract
Whipple's Disease (WD) is a rare disease caused by the infection of Tropheryma whipplei. It can lead to immunosuppression and a multitude of effects on different organ systems, resulting in a constellation of seemingly unrelated findings. Although treatment may appear straightforward, T. whipplei can be difficult to eradicate. We present the case of a 36-year-old male with months of progressively worsening watery diarrhea, migratory arthralgias, and weight loss. He had undergone an extensive evaluation for rheumatologic, oncologic, and infectious disorders without positive findings. Esophagogastroduodenoscopy and colonoscopy revealed esophageal candidiasis, Helicobacter pylori infection, and foamy macrophages in the lamina propria of the duodenum and ileum with positive polymerase chain reaction for T. whipplei. There were no other risk factors for esophageal candidiasis. He received treatment for his esophageal candidiasis and H. pylori infection and was treated for WD with ceftriaxone for 2 weeks, followed by hydroxychloroquine and doxycycline for 1 year. Symptoms resolved after 3 months of therapy. One year later, repeat bidirectional endoscopy was performed. Biopsies were negative for T. whipplei, although there were persistent foamy macrophages. There have been previously reported cases of patients with WD with concomitant esophageal candidiasis, and this association implies a likely state of relative immunosuppression associated with WD, which is thought to be the result of impaired T helper cell 1 activity. This impairment likely contributes to the high rate of relapse. Having a low threshold for repeat evaluation is advisable for recurrent symptoms, but long-term surveillance strategies are not clearly defined.
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Affiliation(s)
- Ryan Choi
- Department of Internal Medicine, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Alexander Pazevic
- Department of Internal Medicine, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Kevin Pak
- Department of Gastroenterology, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Michael Skaret
- Division of Gastroenterology, Naval Medical Center Camp Lejeune, Camp Lejeune, NC 28547, USA
| | - Angela Bachmann
- Department of Pathology, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Rashad Wilkerson
- Department of Gastroenterology, Naval Medical Center San Diego, San Diego, CA 92134, USA
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19
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Moraes GV, Santos BC, Anastácio LR, Santos NTO, Maltos AL, Barata CH, Castro SDS. Validation of the Global Leadership Initiative on Malnutrition criteria for diagnosis of malnutrition and mortality prediction for people living with HIV or AIDS. Nutrition 2024; 117:112224. [PMID: 37939455 DOI: 10.1016/j.nut.2023.112224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To validate the Global Leadership Initiative on Malnutrition (GLIM) criteria to diagnose malnutrition in hospitalized people living with HIV or AIDS (HA) considering different combinations, using the Subjective Global Assessment (SGA) as the semi-gold standard, and to assess the predictive effects of malnutrition according to the GLIM criteria on hospital length of stay and mortality. METHODS Retrospective observational study including hospitalized people living with HA aged >18 y. Forty GLIM combinations were obtained by combining the different phenotypic and etiologic criteria. The concurrent validity was assessed according to the sensitivity and specificity values, and the agreement with the SGA was tested using κ values. Multivariate logistic and Cox regression models were used to test the independent predictors for longer length of stay (LOS) and mortality, respectively. RESULTS The sample comprised 320 patients (mean age, 44.6 ± 12.1 y; 69.1% were men, and 68.4% were malnourished, according to the SGA). The prevalence of malnutrition, according to GLIM, varied from 10.3% to 69.1%. The combination of any phenotypic criteria with the etiologic criteria of low food intake and the combination of any phenotypic criteria with the etiologic criteria of disease severity were independent predictors for mortality (Hazard Ratio: 2.09 [95% CI, 1.15-3.77] and 2.09 [95% CI, 1.25-3.51], respectively). The combination of low body mass index and reduced absorption was independently associated with LOS higher than the median value (Oodds Ratio; 2.57; 95% CI, 1.21-5.45). CONCLUSIONS Nine GLIM combinations had satisfactory sensitivity and specificity values to determine concurrent validity, all of them including weight loss and low weight; two combinations were independent predictors of mortality (any phenotypic criteria and low food intake or opportunistic infections), and one combination predicted longer LOS. Combining any phenotypic criteria with low food intake resulted in adequate concurrent and predictive validity.
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Affiliation(s)
- Giselle Vanessa Moraes
- Graduate Program in Health Care, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil.
| | - Bárbara Chaves Santos
- Food Science Graduate Program, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Núbia Tomain Otoni Santos
- Graduate Program in Health Care, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - André Luiz Maltos
- Department of Clinical Pathology, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Cristina Hueb Barata
- Medical Clinic Department, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Sybelle de Souza Castro
- Graduate Program in Health Care, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
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Abdelfattah AH, Mahgoub AM. Severe Esophageal Stricture Caused by Esophageal Candidiasis in a Non-HIV Patient. Cureus 2023; 15:e46641. [PMID: 37937000 PMCID: PMC10627336 DOI: 10.7759/cureus.46641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2023] [Indexed: 11/09/2023] Open
Abstract
Esophageal candidiasis (EC) is a common opportunistic infection in immunocompromised individuals, often encountered in situations such as untreated HIV/AIDS or following organ transplantation with immunosuppressant usage. While the main manifestation of esophageal candidiasis is mucosal inflammation, its progression and severe cases may lead to esophageal complications like dysphagia, odynophagia, and weight loss. One of the rare complications is esophageal stricture (ES). Few cases have been reported in the literature to date. Esophageal candidiasis can lead to the formation of ES through chronic inflammation, tissue damage, fibrosis, scarring, and ultimately narrowing of the esophageal lumen. Patients with ES often present with dysphagia, odynophagia, and other symptoms related to impaired swallowing. Esophageal strictures related to EC could seriously affect the patient's quality of life. Malnutrition and weight loss can be easily encountered in those cases. So, prompt diagnosis and appropriate antifungal therapy are important. Management should include addressing the stricture through endoscopic dilation interventions. Timely recognition of this complication is crucial for improving patient outcomes and quality of life. We present the case of a 46-year-old male with EC complicated by severe ES, dysphagia, and weight loss of more than 30 lbs. The diagnosis was made based on the histopathological examination of the esophageal biopsies.
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Affiliation(s)
- Ahmed H Abdelfattah
- Internal Medicine, University of Kentucky College of Medicine, Lexington, USA
| | - Ali M Mahgoub
- Internal Medicine, and Gastroenterology and Hepatology, Specialized Internal Medicine Hospital, Mansoura University, Mansoura, EGY
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Ferreira DT, da Silva PV, de Oliveira Junior HCC, Rocha KAP, da Silva DR, de Souza Pitangui N, de Cássia Orlandi Sardi J. Can There Be a Relationship Between Oral Candidiasis and Candidemia in ICU Patients? CURRENT FUNGAL INFECTION REPORTS 2023; 17:195-201. [DOI: 10.1007/s12281-023-00470-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 01/03/2025]
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Lőrinczi C, Iliás Á. [Esophageal candidiasis as an indicator condition]. Orv Hetil 2023; 164:878-880. [PMID: 37270771 DOI: 10.1556/650.2023.32768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/21/2023] [Indexed: 06/06/2023]
Abstract
Esophageal candidiasis is the most common infectious disease of the esophagus. The diagnosis is based on gastroscopy, and in many cases, biopsy samples should be taken as well. If we do not know of any risk factors for an immunocompromised condition, it is a mutual responsibility to confirm or exclude any potential chronic disease in the background, thus not just the secondary complication but also the primary disease could be treated. Without this knowledge, in many cases, the correct diagnosis may be delayed for months or even years, which may risk the successful treatment. We present the case of a 58-year-old healthy woman without any chronic disease, who was referred to our clinic with dysphagia. Due to her complaints we performed a gastroscopy, upon which advanced esophageal candidiasis was diagnosed, hence she was started on oral systemic antifungal treatment. Although we could not explore any risk factors, further investigations behind the immunocompromised condition revealed a positive immunoserology test for HIV. The take-home message of our case is that in the case of esophageal candidiasis, the cause of immunosuppression must be searched for, of which HIV serology is crucial. Thanks to the prompt and correct diagnosis, we could start the suitable treatment of the underlying disease. Orv Hetil. 2023; 164(22): 878-880.
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Affiliation(s)
- Csaba Lőrinczi
- 1 Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Infektológiai Osztály Budapest Magyarország
| | - Ákos Iliás
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Onkológiai Klinika Budapest, Korányi Sándor u. 2/a, 1083 Magyarország
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23
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Chatterjee S, Elsheikh TM, Kirby DF. Esophageal Plaques in a 68-Year-Old Woman With Systemic Sclerosis. Am J Med 2023:S0002-9343(23)00255-3. [PMID: 37068577 DOI: 10.1016/j.amjmed.2023.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Affiliation(s)
- Soumya Chatterjee
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Staff, Department of Rheumatic and Immunologic Diseases, Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio 44195, U.S.A..
| | - Tarik M Elsheikh
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio 44195, U.S.A
| | - Donald F Kirby
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Director, Center for Human Nutrition, Department of Gastroenterology, Hepatology & Nutrition, Medical Director, Intestinal Transplant, Digestive Disease and Surgery Institute, Cleveland Clinic
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24
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Angelette AL, Rando LL, Wadhwa RD, Barras AA, Delacroix BM, Talbot NC, Ahmadzadeh S, Shekoohi S, Cornett EM, Kaye AM, Kaye AD. Tetracycline-, Doxycycline-, Minocycline-Induced Pseudotumor Cerebri and Esophageal Perforation. Adv Ther 2023; 40:1366-1378. [PMID: 36763302 DOI: 10.1007/s12325-023-02435-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/17/2023] [Indexed: 02/11/2023]
Abstract
Tetracyclines are a class of broad-spectrum bacteriostatic antibiotics used to treat many infections, including methicillin-resistant Staphylococcus aureus (MRSA), acne, pelvic inflammatory disease, chlamydial infections, and a host of zoonotic infections. These drugs work by inhibiting protein synthesis in bacterial ribosomes, specifically by disallowing aminoacyl-tRNA molecules from binding to the ribosomal acceptor sites. While rare, tetracycline antibiotics, particularly minocycline and doxycycline, are associated with an increased risk of developing esophageal perforation and pseudotumor cerebri (PTC, or idiopathic intracranial hypertension). Since tetracyclines are a commonly prescribed class of medications, especially in adolescents for acne treatment, it is important for clinicians to appreciate significant side effects that can result in morbidity and mortality. This paper aims to consolidate and to emphasize current research on the association between tetracycline antibiotics and the development of esophageal perforation, and PTC. PTC is a neurological syndrome consisting of increased intracranial pressure, headache, and vision changes without evidence of the contributing source, such as mass lesion, infection, stroke, or malignancy. Esophageal perforation, while rare, can be the result of pill esophagitis. Pill-induced injuries occur when caustic medicinal pills dissolve in the esophagus rather than in the stomach. Most patients experience only self-limited pain (retrosternal burning discomfort, heartburn, dysphagia, or odynophagia), but hemorrhage, stricture, and perforation may occur. Tetracycline use can lead to pill esophagitis. In summary, clinicians should appreciate the potential risks of tetracycline compounds in clinical practice.
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Affiliation(s)
- Alexis L Angelette
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Lauren L Rando
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Reena D Wadhwa
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Ashley A Barras
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Blake M Delacroix
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Norris C Talbot
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Elyse M Cornett
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Adam M Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA, 95211, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
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25
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Usefulness of Endoscopy for the Detection and Diagnosis of Primary Esophageal Motility Disorders and Diseases Relating to Abnormal Esophageal Motility. Diagnostics (Basel) 2023; 13:diagnostics13040695. [PMID: 36832183 PMCID: PMC9955791 DOI: 10.3390/diagnostics13040695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/09/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
Esophagogastroduodenoscopy (EGD) is performed to rule out organic diseases in the diagnosis of esophageal motility disorders (EMDs). Abnormal endoscopic findings can be observed during EGD, which indicate the presence of EMDs. Several endoscopic findings at both the esophagogastric junction and esophageal body that are related to EMDs have been reported. Gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EoE) could be detected during EGD, and these diseases are often associated with abnormal esophageal motility. Image-enhanced endoscopy (IEE) could improve the detection of these diseases during EGD. Although no report has been published previously on the potential usefulness of IEE in the endoscopic diagnosis of EMDs, IEE can be used to detect disorders that can be associated with abnormal esophageal motility.
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26
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Asymptomatic Esophageal Necrosis in a Patient with Recent COVID-19: The First Case Diagnosed through Autopsy. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59010154. [PMID: 36676778 PMCID: PMC9862256 DOI: 10.3390/medicina59010154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023]
Abstract
Acute esophageal necrosis is a rare condition, characterized by a distinctive endoscopic/necropsic image-circumferential black area of the esophagus. This paper presents a case of a 78-year-old patient with recent history of a severe form of COVID-19 (2 months previously), with multiple comorbidities, which presents sudden death in hospital. Anatomic-pathological autopsy showed extensive esophageal necrosis, pulmonary thromboses, and coronarian and aortic atherosclerosis. The histopathological examination revealed necrosis of the esophageal mucosa and phlegmonous inflammation extended to the mediastinum, chronic pneumonia with pulmonary fibrosis, viral myocarditis, papillary muscle necrosis, and pericoronary neuritis. Thromboses and necroses were identified also in the liver, pancreas, and adrenal glands. Post-COVID-19 thromboses can manifest late, affecting various vascular territories, including esophageal ones. Their clinical picture may be diminished or absent in elderly and/or diabetic patients.
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Khan A, Moni SS, Ali M, Mohan S, Jan H, Rasool S, Kamal MA, Alshahrani S, Halawi M, Alhazmi HA. Antifungal Activity of Plant Secondary Metabolites on Candida albicans: An Updated Review. Curr Mol Pharmacol 2023; 16:15-42. [PMID: 35249516 DOI: 10.2174/1874467215666220304143332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/24/2021] [Accepted: 12/06/2021] [Indexed: 11/22/2022]
Abstract
Fungal infections have been increasing continuously worldwide, especially in immunocompromised individuals. Fungi, regarded as eukaryotic pathogens, have many similarities to the host cells, which inhibit anti-fungal drug development progress. Various fungal model systems have been studied, and it was concluded that Candida spp. is the most common disease-causing fungus. Candida species are well known to cause infections not only in our mouth, skin, and vagina, but they are also a frequent cause of life-threatening hospital bloodstream infections. The morphological and developmental pathways of Candida have been studied extensively, providing insight into the fungus development. Candida albicans is known to be the most pathogenic species responsible for a variety of infections in humans. Conventional anti-fungal drugs, mainly azoles drugs available in the market, have been used for years developing resistance in C. albicans. Hence, the production of new anti-fungal drugs, which require detailed molecular knowledge of fungal pathogenesis, needs to be encouraged. Therefore, this review targets the new approach of "Green Medicines" or the phytochemicals and their secondary metabolites as a source of novel anti-fungal agents to overcome the drug resistance of C. albicans, their mechanism of action, and their combined effects with the available anti-fungal drugs.
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Affiliation(s)
- Andleeb Khan
- Department of Pharmacology and Toxicology, College of Pharmacy, Jazan University, Jazan, 45142, Saudi Arabia
| | | | - M Ali
- Department of Pharmacognosy, College of Pharmacy, Jazan University, Jazan, 45142, Saudi Arabia
| | - Syam Mohan
- Substance Abuse and Toxicology Research Center, Jazan University, Jazan, 45142, Saudi Arabia
- School of Health Sciences, University of Petroleum and Energy Studies, Dehradun, Uttarakhand, India
| | - Huma Jan
- Department of Clinical Biochemistry, University of Kashmir, Hazratbal, Srinagar -190006, J&K, India
| | - Saiema Rasool
- Department of School Education, Govt. of Jammu & Kashmir, Srinagar, 190001 J&K, India
| | - Mohammad A Kamal
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
- King Fahd Medical Research Center, King Abdulaziz University, P. O. Box 80216, Jeddah 21589. Saudi Arabia
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh
- Enzymoics, 7 Peterlee place, Hebersham, NSW 2770; Novel Global Community Educational Foundation, Australia
| | - Saeed Alshahrani
- Department of Pharmacology and Toxicology, College of Pharmacy, Jazan University, Jazan, 45142, Saudi Arabia
| | - Maryam Halawi
- Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan, 45142, Saudi Arabia
| | - Hassan A Alhazmi
- Substance Abuse and Toxicology Research Center, Jazan University, Jazan, 45142, Saudi Arabia
- Department of Pharmaceutical Chemistry, College of Pharmacy, Jazan University, Jazan, 45142, Saudi Arabia
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Hospenthal MAC, Nwoke C, Groner LK. Diagnostic Radiology. DIAGNOSIS AND TREATMENT OF FUNGAL INFECTIONS 2023:107-121. [DOI: 10.1007/978-3-031-35803-6_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Carbó-Bagué A, Cerón-Nasarre L, Valls-Masot L, Melendez-Munoz C, Bujons-Buscarons E, Liñan-Planas R, Barretina-Ginesta MP. Esophageal Infiltration by High-Grade Serous Ovarian Carcinoma: A Very Rare Case Report. Case Rep Oncol 2023; 16:1436-1442. [PMID: 38028570 PMCID: PMC10663043 DOI: 10.1159/000534702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Esophageal involvement in high-grade serous ovarian carcinoma is a rare phenomenon when advanced systemic disease is detected. Dysphagia is the most common guide symptom. However, diagnosis is often delayed due to its submucosal process that is not early seen in endoscopic initial evaluation, while computerized tomography (CT) scan usually shows concentric thickening of the esophageal layers and gives the suspected diagnosis. Case Presentation We present the case of a patient who died of mediastinitis caused by an esophageal perforated ulceration due to infiltration of high-grade serous ovarian carcinoma. In addition, this is the first case report of severe esophageal candidiasis associated that delayed diagnosis and subsequent oncological treatment. Conclusion Esophageal secondary infiltration must be suspected when a patient has a history of malignancy combined with consistent CT findings.
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Affiliation(s)
- Anna Carbó-Bagué
- Precision Oncology Group (OncoGIR-Pro), Institut d’Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
- Medical Oncology Department, Catalan Institute of Oncology, University Hospital Dr. Josep Trueta, Girona, Spain
| | - Laura Cerón-Nasarre
- Radiology Department, IDI Girona, University Hospital Dr. Josep Trueta, Girona, Spain
| | - Laia Valls-Masot
- Radiology Department, IDI Girona, University Hospital Dr. Josep Trueta, Girona, Spain
| | - Cristina Melendez-Munoz
- Precision Oncology Group (OncoGIR-Pro), Institut d’Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
- Pathology Department, University Hospital Dr. Josep Trueta de Girona, Girona, Spain
| | - Elisabet Bujons-Buscarons
- Medical Oncology Department, Catalan Institute of Oncology, University Hospital Dr. Josep Trueta, Girona, Spain
| | - Raquel Liñan-Planas
- Medical Oncology Department, Catalan Institute of Oncology, University Hospital Dr. Josep Trueta, Girona, Spain
| | - Maria Pilar Barretina-Ginesta
- Precision Oncology Group (OncoGIR-Pro), Institut d’Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
- Medical Oncology Department, Catalan Institute of Oncology, University Hospital Dr. Josep Trueta, Girona, Spain
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Muacevic A, Adler JR, Kono Y, Kawano S, Okada H. Multiple White Plaques in the Esophagus: A Possible Case of Esophageal Mucosal Alteration Associated With Immune-Related Adverse Events of Immune Checkpoint Inhibitors. Cureus 2022; 14:e32710. [PMID: 36686096 PMCID: PMC9848826 DOI: 10.7759/cureus.32710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
We report two cases of multiple white plaques in the esophagus that emerged after the administration of immune checkpoint inhibitors. Both patients developed enterocolitis as immune-related adverse events associated with immune checkpoint inhibitors. Esophagogastroduodenoscopy revealed duodenal involvement and multiple white plaques in the esophagus. A biopsy of the esophagus showed predominant CD3+ lymphocyte infiltration, suggesting that esophageal mucosal alterations were associated with immune-related adverse events. In addition, histopathology showed keratinized stratified squamous epithelium in the first case while increased inflammatory cell infiltration in the intraepithelial and subepithelial layers was observed in the second case. These data suggest a different pathogenesis of the multiple esophageal white plaques between the two cases. Although further investigation is needed to elucidate the significance of these observations, recognition of the esophageal plaques may be important for prompt diagnosis of immune-related adverse events when associated with immune checkpoint inhibitors.
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Diagnostic Delay in Patients With Eosinophilic Esophagitis Has Not Changed Since the First Description 30 Years Ago: Diagnostic Delay in Eosinophilic Esophagitis. Am J Gastroenterol 2022; 117:1772-1779. [PMID: 35971224 DOI: 10.14309/ajg.0000000000001950] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 08/01/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Eosinophilic esophagitis (EoE) is a chronic progressive disease. Diagnostic delay (DD) is associated with increased risk of esophageal strictures and food impactions. We aimed to assess the evolution of DD since the first description of EoE in 1993 until 2021. METHODS We analyzed data from patients prospectively included in the Swiss EoE database. DD was calculated as the time interval between the first occurrence of EoE symptoms and the confirmed diagnosis. DD was analyzed annually over time (1989-2021) and according to milestone publications in the field (1993: first description; 2007: first consensus recommendations; and 2011: updated consensus recommendations). In addition, a Cox proportional hazards model has been used to describe the relation between DD and covariates. RESULTS Complete data of 1,152 patients (857 male [74%]; median age at diagnosis: 38 years, interquartile range: 28-49, range: 1-86) were analyzed. Overall, median DD was 4 years (interquartile range: 1-11, range, 0-56), with DD ≥ 10 years in 32% of the population. Over time, DD did not significantly change, neither annually nor according to release dates of milestone publications with a persistently stable fraction of roughly one-third of all patients with a DD of ≥10 years. Both ages at diagnosis ( P < 0.001, with an increase in DD up to the age of 31-40 years) and at symptom onset (younger patients had a longer DD; P < 0.001) were significantly associated with DD. DISCUSSION DD has not changed since the first description of EoE almost 30 years ago and remains substantial. Even today, one-third of patients have a persistently high DD of ≥10 years. Substantial efforts are warranted to increase awareness for EoE and its hallmark symptom, solid food dysphagia, as an age-independent red-flag symptom among healthcare professionals and presumably the general population alike to lower risk of long-term complications.
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Rai A, Misra SR, Panda S, Sokolowski G, Mishra L, Das R, Lapinska B. Nystatin Effectiveness in Oral Candidiasis Treatment: A Systematic Review & Meta-Analysis of Clinical Trials. Life (Basel) 2022; 12:1677. [PMID: 36362833 PMCID: PMC9697841 DOI: 10.3390/life12111677] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 02/12/2024] Open
Abstract
Oral candidiasis is the most common opportunistic fungal infection caused by commensal Candida species. Since there are various local and systemic predisposing factors for the disease, the treatment also varies from topical to systemic antifungal agents. Nystatin is a common antifungal agent used topically. The aim of this systematic review was to evaluate and compare the efficacy of different antifungal agents and the safety of nystatin in the treatment of oral candidiasis. Three electronic databases were searched for randomized controlled trials comparing nystatin with other anti-fungal therapies or placebo. Clinical and/or mycological cure was the outcome evaluation. A meta-analysis and descriptive study on the efficacy, treatment protocols, and safety of nystatin was also conducted. The meta-analysis included five studies, which compared the efficacy of nystatin suspensions with photodynamic therapy. A significant difference in the colony-forming units per milliliters (CFU/mL) of Candida species was observed at 60 days intervals for both palatal mucosa and denture surfaces, with both groups favoring nystatin with low heterogeneity at a 95% confidence interval. Nystatin and photodynamic therapy were found to be equally effective for the clinical remission of denture stomatitis as well as a significant reduction of CFU/mL of Candida species from dentures and palatal surfaces of the patients.
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Affiliation(s)
- Anamika Rai
- Department of Oral Medicine & Radiology, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, India
| | - Satya Ranjan Misra
- Department of Oral Medicine & Radiology, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, India
| | - Saurav Panda
- Department of Periodontics, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, India
| | - Grzegorz Sokolowski
- Department of Prosthetics, Medical University of Lodz, 251 Pomorska St., 92-213 Lodz, Poland
| | - Lora Mishra
- Department of Conservative Dentistry & Endodontics, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, India
| | - Rupsa Das
- Department of Oral Medicine & Radiology, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, India
| | - Barbara Lapinska
- Department of General Dentistry, Medical University of Lodz, 251 Pomorska St, 92-213 Lodz, Poland
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Costa PDS, Prado A, Bagon NP, Negri M, Svidzinski TIE. Mixed Fungal Biofilms: From Mycobiota to Devices, a New Challenge on Clinical Practice. Microorganisms 2022; 10:microorganisms10091721. [PMID: 36144323 PMCID: PMC9506030 DOI: 10.3390/microorganisms10091721] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/19/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022] Open
Abstract
Most current protocols for the diagnosis of fungal infections are based on culture-dependent methods that allow the evaluation of fungal morphology and the identification of the etiologic agent of mycosis. Most current protocols for the diagnosis of fungal infections are based on culture-dependent methods that enable the examination of the fungi for further identification of the etiological agent of the mycosis. The isolation of fungi from pure cultures is typically recommended, as when more than one species is identified, the second agent is considered a contaminant. Fungi mostly survive in highly organized communities that provoke changes in phenotypic profile, increase resistance to antifungals and environmental stresses, and facilitate evasion from the immune system. Mixed fungal biofilms (MFB) harbor more than one fungal species, wherein exchange can occur that potentialize the effects of these virulence factors. However, little is known about MFB and their role in infectious processes, particularly in terms of how each species may synergistically contribute to the pathogenesis. Here, we review fungi present in MFB that are commensals of the human body, forming the mycobiota, and how their participation in MFB affects the maintenance of homeostasis. In addition, we discuss how MFB are formed on both biotic and abiotic surfaces, thus being a significant reservoir of microorganisms that have already been associated in infectious processes of high morbidity and mortality.
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Xia J, Huang W, Lu F, Li M, Wang B. Comparative Analysis of Epidemiological and Clinical Characteristics Between Invasive Candida Infection versus Colonization in Critically Ill Patients in a Tertiary Hospital in Anhui, China. Infect Drug Resist 2022; 15:3905-3918. [PMID: 35909934 PMCID: PMC9329706 DOI: 10.2147/idr.s368792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/12/2022] [Indexed: 11/26/2022] Open
Abstract
Objective Invasive infections due to Candida spp. have unique epidemiology, strain distribution, antimicrobial susceptibility, and clinical features. This study aimed to compare and evaluate these characteristic variables between invasive Candida infection and colonization of critically ill patients in local China to potentially improve differential diagnosis and therapy. Methods A total of 193 critically ill patients were recruited and followed up for the study, and 133 Candida isolates were obtained from invasive Candida-infected or -colonized subjects. The strains were identified to species level through matrix-assisted laser desorption/ionization–time-of-flight mass spectrometry, assisted by DNA sequencing. Candida susceptibility to common antifungals, including azoles, was determined by microbroth ATB Fungus 3 methodology. Azole resistance–related gene sequencing and homologous 3D-structure modeling were employed. Patient demographics and clinical risk factors were documented and comparatively analyzed from the hospital information-management system. Results Non–C. albicans Candida (56%) principally caused invasive Candida infections, while C. albicans (55.17%) contributed more to Candida colonization in critically ill patients. Additional risk factors exerted significant impact on both Candida cohorts, primarily including invasive interventions, cancers, and concurrent infections in common. Most colonized Candida spp. harbored relatively higher sensitivity to azoles. ERG11 gene mutations of T348A and A1309G, A395T and C461T, and a novel G1193T to our knowledge were identified in azole-resistant C. albicans, C. tropicalis, and C. parapsilosis respectively, and their corresponding homologous 3D-structure modeling was putatively achieved. Conclusion Distinct epidemiological and clinical characteristics existed between invasive Candida infection and colonization in critically ill patients. Multiple risk factors significantly involved both the Candida cohorts. Colonized Candida exhibited generally higher azole sensitivity than invasively infectious counterparts. ERG11 point mutations had mechanistically potential ties with local Candida resistance to azoles.
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Affiliation(s)
- Jinxing Xia
- Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Wei Huang
- Department of Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Fanbo Lu
- Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Moyan Li
- Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Bo Wang
- Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
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Maikan HK, Jabbar S, Al-Haishawi H. Isolation and Identification of Candida tropicalis as a Cause of Cutaneous Candidiasis in Kalar District, Iraq. ARCHIVES OF RAZI INSTITUTE 2022; 77:1377-1382. [PMID: 36883146 PMCID: PMC9985788 DOI: 10.22092/ari.2022.357613.2066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/06/2022] [Indexed: 03/09/2023]
Abstract
Fungal infections are currently causing health issues all over the world, among which are Candida species that cause cutaneous infection. Numerous dermatological studies concentrated on a single species. However, the virulence factors and the spread of specific candidiasis in specific areas have remained poorly understood. Therefore, the current study was designed to shed light on Candida tropicalis, which has been identified as the most prevalent yeast among Candida non-albicans species. Forty specimens were collected from patients with cutaneous fungal infection (25 females and 15 males) and underwent examination. According to conventional identification based on macroscopic and microscopic examinations, eight isolates were identified as C. tropicalis from Candida non-albicans. Molecular diagnosis for internal transcribed spacers (ITS1 and ITS4) using conventional polymerase chain reaction (PCR) yielded an amplicon of 520 bp for all isolates. Further investigation of PCR-restriction fragment length using Mitochondrial sorting protein; Msp1 enzyme revealed two bands of 340 and 180 bp. The ITS gene sequence in one isolated species was found to be 98% identical to C. tropicalis strain MYA-3404 chromosome R ATCC CP047875.1. Another isolate shared 98.02% identity with C. tropicalis strain MA6 18S ribosomal RNA gene DQ666188.1, indicating C. tropical species identity, implying that non-Candida species should be considered when diagnosing candidiasis. This study demonstrated the significance of Candida non-albicans, particularly C. tropicalis, in terms of pathogenic potential, the ability to cause potentially fatal systemic infections and candidiasis, and acquired flucozonal resistance with a high mortality rate.
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Affiliation(s)
- H K Maikan
- Department of Biology, College of Education, University of Garmian, Sulaymaniyah, Iraq
| | - S Jabbar
- Department of Biology, College of Science, University of Kirkuk, Kirkuk, Iraq
| | - H Al-Haishawi
- Department of Physiology, College of Medicine, University of Misan, Misan, Iraq
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Gurung S, Sharma TD, Rasaily SM, Singh R, Prakash PY. A six-year hospital-based surveillance study on burden of esophageal candidiasis in Gangtok, Sikkim. IRANIAN JOURNAL OF MICROBIOLOGY 2022; 14:598-605. [PMID: 36721503 PMCID: PMC9867645 DOI: 10.18502/ijm.v14i4.10247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background and Objectives Esophageal candidiasis once thought to be restricted amongst immunocompromised patients is being increasingly reported among non-immunocompromised individuals. It is debilitating and if not treated well may cause chronic long-lasting infections. The objective of this study was to identify the various species of Candida causing esophageal candidiasis and analyse their antifungal susceptibility pattern. Materials and Methods This was an observational, prospective study. Total of 108 patients who attended the Gastroenterology Department of Sir Thutob Namgyal Memorial Hospital, Govt of Sikkim, Gangtok, India between July 2012 - May 2018 were included in the study. They had complaints of upper gastrointestinal disturbances and chronic dyspeptic symptoms that required an endoscopy. Esophageal biopsy and brushings were taken and were transported to Microbiology Department. They were subjected to microscopic observation, fungal culture on Sabourauds dextrose agar. Preliminary species identification was done by chlamydospore formation and growth characteristics on CHROMagar Candida. Species confirmation and antifungal susceptibility testing was done on VITEK 2 system at Microbiology Department, Kasturba Medical College and Hospital, MAHE, Manipal, Karnataka, India. Results A total of 108 patients were screened among which 73 samples were positive for Candida species and species identification and antifungal susceptibility was performed. Forty fiveisolates were found to be C. albicans, 8 were C. glabrata, 4 were C. tropicalis, 3 were C. lusitaniae 2 were C. krusei, 2 were C. lipolyticaand 1 was C. parapsilosis. Eight isolates could not be identified and were recorded as Candida spp. C. albicans isolates were predominantly sensitive strain with susceptibility of 95% for both amphotericin B and fluconazole and 100% for caspofungin. C. glabrata showed high resistance to fluconazole with one isolate showing intermediate resistance to caspofungin. Conclusion Upper gastrointestinal symptoms even in non-immunocompromised patients need to be screened by endoscopy to rule out esophageal candidiasis. With the emergence of drug resistant non albicans Candida species diagnostic testing laboratories should include Candida species identification and antifungal susceptibility testing facility to provide effective patient care.
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Affiliation(s)
- Shrijana Gurung
- Department of Microbiology, Sir Thutob Namgyal Memorial Hospital, Gangtok, Sikkim, India,Corresponding author: Shrijana Gurung, MD, Department of Microbiology, Sir Thutob Namgyal Memorial Hospital, Gangtok, Sikkim, India. Tel: +91-7908674432 Fax: +913592297042
| | - Tara Devi Sharma
- Department of Microbiology, Sir Thutob Namgyal Memorial Hospital, Gangtok, Sikkim, India
| | - Suresh Madan Rasaily
- Department of Gastroenterology, Sir Thutob Namgyal Memorial Hospital, Gangtok, Sikkim, India
| | - Raju Singh
- Health & Family Welfare Department, Community Health Centre, Rhenock Hospital, East Sikkim, India
| | - Peralam Yegneswaran Prakash
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Sousa BR, Freitas JF, Valeriano CA, Neto LN, Neves RP, Gambarra FF, Gomes TM, da Silva Acioly JC, Lima-Neto RG. Refractory esophagitis caused by Candida nivariensis: second description of this yeast in Brazil and a literature review. Future Microbiol 2022; 17:903-915. [PMID: 35748170 DOI: 10.2217/fmb-2021-0109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Candida nivariensis caused refractory esophagitis in a 36-year-old Brazilian man coinfected with HIV and Leishmania. A literature review on this rare fungal pathogen is also presented. The diagnosis was made, and pathogen identification was performed using matrix-assisted laser desorption ionization-time of flight mass spectrometry and sequencing of the LSU/26S region. An antifungigram was performed using broth microdilution. A literature search of PubMed was performed. The causative agent, C. nivariensis, was resistant to fluconazole and voriconazole. The patient's condition worsened considerably, and he passed away. This is the second report of this Candida species in Brazil and the first case reported worldwide of refractory esophagitis in a patient coinfected with HIV and Leishmania. The case illustrates the importance of precise identification and antifungal susceptibility testing when isolating this emerging pathogen.
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Affiliation(s)
- Bruna R Sousa
- Department of Mycology, Postgraduate Program in Fungal Biology, Federal University of Pernambuco, Recife, Pernambuco, Av Professor Moraes Rêgo, s/n, 50670-901, Brazil
| | - Jucieli F Freitas
- Department of Mycology, Postgraduate Program in Fungal Biology, Federal University of Pernambuco, Recife, Pernambuco, Av Professor Moraes Rêgo, s/n, 50670-901, Brazil
| | - Carlos At Valeriano
- Department of Mycology, Postgraduate Program in Fungal Biology, Federal University of Pernambuco, Recife, Pernambuco, Av Professor Moraes Rêgo, s/n, 50670-901, Brazil
| | - Luiz Na Neto
- Department of Mycology, Postgraduate Program in Fungal Biology, Federal University of Pernambuco, Recife, Pernambuco, Av Professor Moraes Rêgo, s/n, 50670-901, Brazil
| | - Rejane P Neves
- Department of Mycology, Postgraduate Program in Fungal Biology, Federal University of Pernambuco, Recife, Pernambuco, Av Professor Moraes Rêgo, s/n, 50670-901, Brazil
| | - Fernanda F Gambarra
- Department of Health, Infectious Diseases Hospital Dr Clementino Fraga, State of Paraíba, Rua Estér Borges Bastos, s/n, Jaguaribe, João Pessoa, 58015-270, Brazil
| | - Tiago M Gomes
- Department of Health, Infectious Diseases Hospital Dr Clementino Fraga, State of Paraíba, Rua Estér Borges Bastos, s/n, Jaguaribe, João Pessoa, 58015-270, Brazil
| | - Jack C da Silva Acioly
- Department of Health, Infectious Diseases Hospital Dr Clementino Fraga, State of Paraíba, Rua Estér Borges Bastos, s/n, Jaguaribe, João Pessoa, 58015-270, Brazil
| | - Reginaldo G Lima-Neto
- Department of Mycology, Postgraduate Program in Fungal Biology, Federal University of Pernambuco, Recife, Pernambuco, Av Professor Moraes Rêgo, s/n, 50670-901, Brazil.,Department of Tropical Medicine, Center for Medical Sciences, Federal University of Pernambuco, Recife, Pernambuco, Av Professor Moraes Rêgo, s/n, 50670-901, Brazil
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Kiba T, Kotoh N, Namba Y, Nose S, Tsuboi M. Nausea and vomiting caused by candida esophagitis in an elderly frail patient. JGH OPEN 2022; 6:512-513. [PMID: 35822125 PMCID: PMC9260203 DOI: 10.1002/jgh3.12748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 04/11/2022] [Accepted: 04/18/2022] [Indexed: 12/03/2022]
Abstract
An elderly frail lady with features of malnutrition was investigated by endoscopy because of nausea and vomiting. Candida esophagitis was found, and there was symptomatic and endoscopic resolution after treatment with amphotericin B.
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Affiliation(s)
- Takayoshi Kiba
- Department of Internal Medicine Saiseikai Kibi Hospital Okayama Japan
- Department of Life Sciences, Faculty of Science Okayama University of Science Okayama Japan
| | - Naoki Kotoh
- Department of Internal Medicine Saiseikai Kibi Hospital Okayama Japan
| | - Yoichiro Namba
- Department of Neurosurgery Saiseikai Kibi Hospital Okayama Japan
| | - Soichiro Nose
- Department of Pathology Okayama Saiseikai General Hospital Okayama Japan
| | - Masahiro Tsuboi
- Department of Neurosurgery Saiseikai Kibi Hospital Okayama Japan
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Review of Treatments for Oropharyngeal Fungal Infections in HIV/AIDS Patients. MICROBIOLOGY RESEARCH 2022. [DOI: 10.3390/microbiolres13020019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
HIV and AIDS patients are susceptible to opportunistic infections. Oral candidiasis or thrush is the primary manifestation of fungal infection in these patients. The primary objective of this literature review was to summarize established and novel treatment options for oropharyngeal fungal infections in HIV/AIDS patients. Azoles and polyenes are the two primary antifungal drug classes employed for the treatment of oral candidiasis. A literature review was conducted on Medline and Google Scholar in October of 2021 using the keywords “Oral”, “Fungal”, “HIV”, and “Treatment”. Included studies were clinical trials, meta-analyses, and randomized controlled trials. Twenty-one studies regarding azoles, polyenes, and novel treatments for oropharyngeal fungal infections in HIV/AIDS patients were examined in this review. The primary concern demonstrated from these studies is increased reports of resistance to antifungals, especially development of fluconazole resistance. Additionally, studies demonstrated that fluconazole had different relapse durations comparative to other medications, and that posaconazole could possibly act as an alternate form of treatment. Nystatin was indicated as a first-line therapy for thrush in multiple studies but could be upstaged by miconazole nitrate in resource-poor settings. Amphotericin B was an effective treatment option and was shown to be resilient in terms of fungal resistance, however potent adverse side effects were reported. Alternative treatments, such as immunoglobulin antibodies and lemon grass, revealed promising antifungal effects for immunocompromised individuals. Taken together, this review provides a thorough summary of treatment options of oropharyngeal fungal infections in HIV/AIDS patients.
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Rodrigues S, Leitão Esteves V, Martins TG. Esophageal Candidiasis in a Non-HIV Patient: A Primary Care Diagnosis. Cureus 2022; 14:e24312. [PMID: 35602778 PMCID: PMC9122014 DOI: 10.7759/cureus.24312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 12/04/2022] Open
Abstract
A 74-year-old man visited his family doctor for dysphagia and was diagnosed with esophageal candidiasis. His risk factors included type 2 diabetes mellitus, long-term intake of budesonide/formoterol inhaler 160/45 µg, and pantoprazole 20 mg. He was treated with fluconazole 200 mg per day for 14 days. Other factors of immunosuppression were excluded, and his chronic medication was adapted by starting him with a proton pump inhibitor withdrawal plan and switching his inhaled device to a formoterol-only device without an inhaled corticosteroid. The patient had complete remission of the symptoms on the seventh day of treatment without relapse to date. The key point is that iatrogenic factors should be considered in the presence of esophageal candidiasis in immunocompetent patients and a therapeutic review is an important tool that should be used in every primary care appointment to refrain from long-term prescriptions without clinical indication and, consequently, to avoid adverse events.
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Armstrong AW, Blauvelt A, Mrowietz U, Strober B, Gisondi P, Merola JF, Langley RG, Ståhle M, Lebwohl M, Netea MG, Nunez Gomez N, Warren RB. A Practical Guide to the Management of Oral Candidiasis in Patients with Plaque Psoriasis Receiving Treatments That Target Interleukin-17. Dermatol Ther (Heidelb) 2022; 12:787-800. [PMID: 35167107 PMCID: PMC8941045 DOI: 10.1007/s13555-022-00687-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/22/2022] [Indexed: 12/21/2022] Open
Abstract
Plaque psoriasis is an immune-mediated inflammatory skin disease associated with the dysregulation of cytokines, especially those involved in the interleukin (IL)-23/IL-17 pathways. In recent years, there has been growing interest in developing biologic therapies that target these pathways. However, inhibition of the cytokines of the IL-23/IL-17 pathways may increase patients' risk of developing fungal infections, particularly oral candidiasis. Therefore, it is important that dermatology practitioners can effectively diagnose and treat oral candidiasis. In this review, we examine the role of the IL-23/IL-17 pathways in antifungal host defense, and provide a practical guide to the diagnosis and treatment of oral candidiasis in patients with psoriasis. Overall, while treatment with anti-IL-17 medications leads to an increased incidence of oral candidiasis in patients with psoriasis, these cases are typically mild or moderate in severity and can be managed with standard antifungal therapy without discontinuing treatment for psoriasis. If applicable, patients with psoriasis should also be advised to practice good oral hygiene and manage or control co-existing diabetes, and should be provided with information on smoking cessation to prevent oral candidiasis.
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Affiliation(s)
- April W Armstrong
- Department of Dermatology, Keck School of Medicine of USC, 1975 Zonal Ave, Los Angeles, CA, 90033, USA.
| | | | - Ulrich Mrowietz
- Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Bruce Strober
- Yale University, New Haven, CT, USA
- Central Connecticut Dermatology Research, Cromwell, CT, USA
| | | | - Joseph F Merola
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Richard G Langley
- Division of Dermatology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Mona Ståhle
- Department of Medicine, Unit of Dermatology, Karolinska Institutet, Solna, Sweden
| | - Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Richard B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, The University of Manchester, Manchester, UK
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Simultaneous Massive Esophageal Mucosal Candidiasis and Profound Cytomegaloviral Esophageal Ulcers with Recurrence of Both Infections 12 Years Later in a Patient with Long-Standing AIDS: Endoscopic, Radiologic, and Pathologic Findings. Case Rep Gastrointest Med 2022; 2022:9956650. [PMID: 35265384 PMCID: PMC8898774 DOI: 10.1155/2022/9956650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/04/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022] Open
Abstract
Immunocompromised patients with acquired immunodeficiency syndrome (AIDS) can develop opportunistic esophageal candidial and cytomegaloviral infections. A case is reported which extends the clinico-endoscopic severity of these infections. A 32-year-old bisexual man with AIDS since 1997, and intermittently compliant with antiretroviral therapy, presented (2007) with dysphagia and 32 kg-weight loss. EGD revealed a massive, cheesy, esophageal mucosal exudate from Candida albicans. Cytomegalovirus was isolated by viral culture. The patient improved after fluconazole/ganciclovir therapy. The patient re-presented (2019) with hematemesis and dysphagia. EGD revealed cheesy esophageal exudate and profound “punched out” esophageal ulcers mimicking pseudo-diverticula. Histopathology confirmed candidiasis. Viral cultures revealed cytomegalovirus. Barium esophagram revealed deep esophageal ulcers/pseudo-diverticula. Repeat EGD 8 weeks later after ganciclovir/micafungin therapy revealed mostly healed lesions. This demonstrates that AIDS patients may have massive mucosal esophageal candidiasis; that both infections can recur years after apparent eradication; and that cytomegaloviral esophageal ulcers may be profound and mimic pseudo-diverticula. A comprehensive literature review revealed only one abstract of esophageal pseudo-diverticula associated with cytomegalovirus. Simultaneous esophageal candidial and CMV infections have also been rarely reported in immunocompromised patients without AIDS.
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Prevalence, Predictors, and Outcomes of Esophageal Candidiasis in Cirrhosis: An Observational Study With Systematic Re view and Meta-Analysis (CANDID-VIEW). J Clin Exp Hepatol 2022; 12:118-128. [PMID: 35068792 PMCID: PMC8766531 DOI: 10.1016/j.jceh.2021.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/12/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Gastrointestinal candidiasis is often neglected and potentially serious infection in cirrhosis patients. Therefore, we evaluated the prevalence, risk factors, and outcomes of esophageal candidiasis (EC) in cirrhotics and did a systematic review to summarize EC's available evidence in cirrhosis. METHODS Consecutive patients with cirrhosis posted for esophagogastroduodenoscopy (EGD) at a tertiary care institute were screened for EC (cases) between January 2019 and March 2020. EC was diagnosed on EGD findings and/or brush cytology. Controls (without EC) were recruited randomly, and EC's risk factors and outcomes were compared between cases and controls.Four electronic databases were searched for studies describing EC in cirrhosis. Prevalence estimates of EC were pooled on random-effects meta-analysis, and heterogeneity was assessed by I2. A checklist for prevalence studies was used to evaluate the risk of bias in studies. RESULTS EC was diagnosed in 100 of 2762 patients with cirrhosis (3.6%). Patients with EC had a higher model for end-stage liver disease (MELD) (12.4 vs. 11.2; P = 0.007), acute-on-chronic liver failure (ACLF) (26% vs. 10%; P = 0.003) and concomitant bacterial infections (24% vs. 7%; P = 0.001), as compared with controls. A multivariable model, including recent alcohol binge, hepatocellular carcinoma (HCC), upper gastrointestinal (UGI) bleed, ACLF, diabetes, and MELD, predicted EC's development in cirrhosis with excellent discrimination (C-index: 0.918). Six percent of cases developed the invasive disease and worsened with multiorgan failures, and four patients with EC died on follow-up.Of 236 articles identified, EC's pooled prevalence from 8 studies (all with low-risk of bias) was 2.1% (95% CI: 0.8-5.8). Risk factors and outcomes of EC in cirrhosis were not reported in the literature. CONCLUSIONS EC is not a rare infection in cirrhosis patients, and it may predispose to invasive candidiasis and untimely deaths. Alcohol binge, HCC, UGI bleed, ACLF, diabetes, and higher MELD are the independent predictors of EC in cirrhosis. At-risk patients with cirrhosis or those with deglutition symptoms should be rapidly screened and treated for EC.
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Key Words
- ACLF
- ACLF, Acute-on-chronic liver failure
- AIC, Akaike's Information Criteria
- AIDS, Acquired Immunodeficiency Syndrome
- BIC, Bayesian Information Criteria
- Candida
- DM, Diabetes Mellitus
- EC, Esophageal Candidiasis
- EGD, Esophagogastroduodenoscopy
- EVL, Endoscopic Variceal Ligation
- HAART, Highly Active Anti-Retroviral Therapy
- HCC, Hepatocellular Carcinoma
- HIV, Human Immunodeficiency Virus
- IC, Invasive Candidiasis
- MELD, Model for End-stage Liver Disease
- MELD-Na, Model for End-stage Liver Disease-Sodium
- RRT, Renal Replacement Therapy
- SBP, Spontaneous Bacterial Peritonitis
- SIRS, Systemic Inflammatory Response Syndrome
- UGI, Upper Gastrointestinal
- cirrhosis
- esophagitis
- invasive fungal infections
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Velez-Hoyos A, Jimenez-tobon GA. Highlights of infectious agents in tissue. Pathology 2022; 54:217-224. [DOI: 10.1016/j.pathol.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 10/19/2022]
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Liao J, Pan B, Zhuo X, Liao G, Gao Y, Yao Z, Wang L, Wu Q, Pan W, Jiao B, Zhao Q. β-1,2-Mannan-based glycoconjugates as potential antifungal vaccines. CHINESE CHEM LETT 2021. [DOI: 10.1016/j.cclet.2021.12.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ogiso H, Adachi S, Mabuchi M, Horibe Y, Ohno T, Suzuki Y, Yamauchi O, Kojima T, Takada E, Iwama M, Saito K, Iwashita T, Ibuka T, Yasuda I, Shimizu M. Risk factors for the development of esophageal candidiasis among patients in community hospital. Sci Rep 2021; 11:20663. [PMID: 34667198 PMCID: PMC8526817 DOI: 10.1038/s41598-021-00132-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 09/17/2021] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to clarify risk factors for esophageal candidiasis (EC) in immunocompetent patients in a community hospital. 7736 patients who underwent esophagogastroduodenoscopy at our hospital from April 2012 to July 2018 were enrolled. The relationships between EC and the following factors: age, gender, body mass index, lifestyle, lifestyle-related diseases, medication, and endoscopic findings were analyzed. EC was observed in 184 of 7736 cases (2.4% morbidity rate). Multivariate analysis revealed that significant risk factors for the development of EC were: diabetes mellitus {odds ratio (OR): 1.52}, proton pump inhibitor (PPI) use (OR: 1.69), atrophic gastritis (AG) (OR: 1.60), advanced gastric cancer (OR: 4.66), and gastrectomy (OR: 2.32). When severe EC (Kodsi grade ≥ II) was compared to mild EC (grade I), the most significant risk factors were advanced gastric cancer (OR: 17.6) and gastrectomy (OR: 23.4). When considering the risk of AG and PPI use with EC development, the risk increased as follows: AG (OR: 1.59), PPI use (OR: 2.25), and both (OR: 3.13). PPI use, AG, advanced gastric cancer and post-gastrectomy are critical risk factors for the development of EC. We suggest close monitoring for EC development when PPIs are administered to patients with these factors.
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Affiliation(s)
- Hideyuki Ogiso
- Department of Gastroenterology/Internal Medicine, Gihoku Kosei Hospital, 1187-3 Takatomi, Yamagata, 501-2105, Japan
| | - Seiji Adachi
- Department of Gastroenterology/Internal Medicine, Gihoku Kosei Hospital, 1187-3 Takatomi, Yamagata, 501-2105, Japan.
| | - Masatoshi Mabuchi
- Department of Gastroenterology/Internal Medicine, Gihoku Kosei Hospital, 1187-3 Takatomi, Yamagata, 501-2105, Japan
| | - Yohei Horibe
- Department of Gastroenterology/Internal Medicine, Gihoku Kosei Hospital, 1187-3 Takatomi, Yamagata, 501-2105, Japan
| | - Tomohiko Ohno
- Department of Gastroenterology/Internal Medicine, Gihoku Kosei Hospital, 1187-3 Takatomi, Yamagata, 501-2105, Japan
| | - Yusuke Suzuki
- Department of Gastroenterology/Internal Medicine, Gihoku Kosei Hospital, 1187-3 Takatomi, Yamagata, 501-2105, Japan
| | - Osamu Yamauchi
- Department of Gastroenterology/Internal Medicine, Gihoku Kosei Hospital, 1187-3 Takatomi, Yamagata, 501-2105, Japan
| | - Takao Kojima
- Department of Gastroenterology/Internal Medicine, Gihoku Kosei Hospital, 1187-3 Takatomi, Yamagata, 501-2105, Japan
| | - Eri Takada
- Department of Gastroenterology/Internal Medicine, Gihoku Kosei Hospital, 1187-3 Takatomi, Yamagata, 501-2105, Japan
| | - Midori Iwama
- Department of Gastroenterology/Internal Medicine, Gihoku Kosei Hospital, 1187-3 Takatomi, Yamagata, 501-2105, Japan
| | - Koshiro Saito
- Department of Gastroenterology/Internal Medicine, Gihoku Kosei Hospital, 1187-3 Takatomi, Yamagata, 501-2105, Japan
| | - Takuji Iwashita
- Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takashi Ibuka
- Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Ichiro Yasuda
- Third Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Masahito Shimizu
- Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu, Japan
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Immunogenetic, Molecular and Microbiotic Determinants of Eosinophilic Esophagitis and Clinical Practice-A New Perspective of an Old Disease. Int J Mol Sci 2021; 22:ijms221910830. [PMID: 34639170 PMCID: PMC8509128 DOI: 10.3390/ijms221910830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 12/19/2022] Open
Abstract
Eosinophilic oesophagitis (EoE) is a chronic, allergic disease associated with a T-lymphocyte response inducing esophageal eosinophilic infiltration in the esophagus. Inflammation and tissue fibrosis are responsible for the main clinical symptoms such as food impaction and dysphagia. The etiopathogenesis is multifactorial in which genetic and environmental factors coexist. The most common trigger is a non-IgE-mediated food allergy to milk, wheat, egg, soybean, nuts, fish, and seafood. The second factor we focus on is the contribution of genetic variation to the risk of EoE, describing the expression profile of selected genes associated with eosinophilic oesophagitis. We raise the topic of treatment, aiming to eliminate inflammation through an elimination diet and/or use of pharmacologic therapy with the use of proton pump inhibitors or steroids and endoscopic procedures to dilate the esophagus. We demonstrate that early diagnosis and effective treatment prevent the development of food impaction and decreased quality of life. The increasing presence of EoE requires bigger awareness among medical specialists concerning clinical features, the course of EoE, diagnostic tools, and management strategies.
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New Evidence for Artemisia absinthium L. Application in Gastrointestinal Ailments: Ethnopharmacology, Antimicrobial Capacity, Cytotoxicity, and Phenolic Profile. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:9961089. [PMID: 34335850 PMCID: PMC8324356 DOI: 10.1155/2021/9961089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/13/2021] [Accepted: 07/16/2021] [Indexed: 12/29/2022]
Abstract
Artemisia absinthium L. (Asteraceae) is traditionally used for gastrointestinal ailments and disorders linked to numerous risk factors including microbial infections. We aimed to provide contemporary evidence for its ethnopharmacological use and determine its antimicrobial capacity and mode of action, cytotoxicity, and phenolic constituents. Ethnopharmacological survey was conducted using semistructured interviews. Antimicrobial and antibiofilm capacities were determined by microdilution/crystal violet assay, respectively. Modes of action tested include estimation of exopolysaccharide production (congo red binding assay) and interference with membrane integrity (crystal violet uptake and nucleotide leakage assay). Cytotoxicity was determined using crystal violet assay. Polyphenolic profiling was done by advanced liquid chromatography/mass spectrometry (UHPLC-LTQ OrbiTrap MS). Artemisia absinthium in Serbia is traditionally used for gastrointestinal disorders, among others. Further study revealed high antifungal capacity of herb ethanolic extract towards range of Candida species (MIC 0.5–1 mg/mL) along with promising antibacterial activities (MIC 0.25–4 mg/mL). Interference with membrane integrity could be observed as a possible antimicrobial mechanism. Antibiofilm potential can be considered as high (towards C. krusei) to limited (towards P. aeruginosa) and moderate based on reduction in exopolysaccharide content. In concentrations up to 400 µg/mL, no cytotoxicity was observed towards HaCaT and HGF-1 cell lines. Polyphenolic analysis revealed twenty-one different constituents. A. absinthium usage as a gastrointestinal ailment remedy has been confirmed in vitro by its antimicrobial capacity towards microorganisms whose presence is linked to the diseases and associated complications and noncytotoxic nature of the natural product. The observed activities could be attributed to the present phenolic compounds.
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Meiwandi A, Zirngibl H, Bozkurt A. Candida albicans Osteochondromyelitis after Gastroesophageal Surgery: Two Case Reports. Indian J Plast Surg 2021; 54:232-234. [PMID: 34239253 PMCID: PMC8257295 DOI: 10.1055/s-0041-1731854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Candida osteochondromyelitis is a rare complication after thoracoabdominal surgery. We herein report two such cases after uncomplicated thoracoabdominal surgery, who presented with chronic postsurgical site infection and fistula. CT scans showed fistulas reaching the costochondral areas of the fifth rib. Inflammatory parameters were not elevated. Both patients were treated successfully after the initiation of systemic antimycotic treatment and surgical debridement. We conclude that C. albicans infections should always be considered in cases of chronic postoperative surgical site infections after thoracoabdominal surgery. Additional risk factors do not need to be present. Appropriate therapy consists of the application of systemic antimycotics and surgical debridement.
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Affiliation(s)
- Abdulwares Meiwandi
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Hubert Zirngibl
- Division of Surgery II, Witten-Herdecke University, Wuppertal, Germany
| | - Ahmet Bozkurt
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Helios University Hospital Wuppertal, Wuppertal, Germany
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50
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Saidani A, Rakkeh H, Belhaj A, Debaibi M, Chebbi F. Laparoscopic Sleeve Gastrectomy Esophageal Candidiasis an Exceptional Complication of Laparoscopic Sleeve Gastrectomy: First Case Report. Obes Surg 2021; 31:3851-3853. [PMID: 33866533 DOI: 10.1007/s11695-021-05398-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/18/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Ahmed Saidani
- Universite de Tunis El Manar, Tunis, Tunisia.,Department of Digestive Surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Hichem Rakkeh
- Universite de Tunis El Manar, Tunis, Tunisia. .,Department of Digestive Surgery, Mahmoud El Matri Hospital, Ariana, Tunisia.
| | - Anis Belhaj
- Universite de Tunis El Manar, Tunis, Tunisia.,Department of Digestive Surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Mahdi Debaibi
- Universite de Tunis El Manar, Tunis, Tunisia.,Department of Digestive Surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Faouzi Chebbi
- Universite de Tunis El Manar, Tunis, Tunisia.,Department of Digestive Surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
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