amphotericin-b and Candidiasis--Vulvovaginal

Not only have the systemic mycoses clearly increased in number but also mycoses of the skin are more common than presumed in the past. Today onychomycosis is found in up to 10% of human beings. Onychomycosis can compromise quality of life markedly. Common tinea pedis is one of the most important risk factors for erysipelas of the lower legs. The clinical presentation of oral candidosis in HIV-infected patients is changing; Candida dubliniensis has been identified as another important causative microorganism. Onychomycosis today in most cases can be cured using terbinafine or itraconazole. When choosing the ideal drug in a given case, both the benefit risk ratio and the benefit cost ratio have to be taken into account. Liposomally encapsulated amphotericin B represents a major breakthrough in the treatment of systemic mycoses or fever of unknown origin. The same applies to liposomally encapsulated econazole with respect to tinea pedis. In regard to the pathogenesis of Candida infections the family of secreted aspartic proteinases plays a major role as a virulence factor and possible future target for antimycotic treatment.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Aspartic Acid Endopeptidases; Axilla; Candida albicans; Candidiasis; Candidiasis, Cutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Case-Control Studies; Child; Clinical Trials as Topic; Dermatomycoses; Female; Humans; Liposomes; Microscopy, Immunoelectron; Multicenter Studies as Topic; Multivariate Analysis; Naphthalenes; Onychomycosis; Practice Guidelines as Topic; Prospective Studies; Risk Factors; Terbinafine; Tinea; Tinea Pedis; Trichophyton

We describe congenital cutaneous candidiasis (CCC) in a term newborn. The mother had candidal vaginitis 1 week before delivery. At birth, the infant had a generalized, intensely erythematous, papulovesicular eruption, respiratory distress and elevation of liver function tests. The child responded well to intravenous amphotericin B plus topical and oral nystatin. There have been 13 previously reported cases of CCC in infants weighing more than 1500 gm who had evidence of systemic infection. Two deaths were attributed to candidal pneumonia and sepsis. The majority of infants with CCC have infection localized to the skin, but if there is any evidence of respiratory distress or signs of sepsis the possibility of systemic candidiasis and the need for parenteral antifungal therapy must be considered.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Candidiasis, Cutaneous; Candidiasis, Vulvovaginal; Drug Therapy, Combination; Female; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Liver Function Tests; Nystatin; Pregnancy; Pregnancy Complications, Infectious; Respiratory Distress Syndrome, Newborn

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Aspergillosis; Candidiasis; Candidiasis, Oral; Candidiasis, Vulvovaginal; Child; Clinical Trials as Topic; Cryptococcosis; Drug Resistance, Microbial; Esophageal Diseases; Female; Fluconazole; Fungi; Humans; Ketoconazole; Male; Retrospective Studies

Topics: Amphotericin B; Candida; Candidiasis; Candidiasis, Cutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Cheilitis; Female; Folliculitis; Gastrointestinal Diseases; Humans; Immunologic Deficiency Syndromes; Intertrigo; Leukoplakia, Oral; Male; Nystatin; Paronychia

Vaginal yeast infection is one of the most common diseases caused by vulvovaginal candidiasis (VVC). Effective therapy for VVC is needed. A lipid-based amphotericin B gel 0.1% (LAB) was developed and evaluated for the treatment of VVC patients and those who failed to azole therapy. LAB was applied topically twice daily for 7 days to 64 moderate patients and 14 days to 55 severely infected VVC patients. Additionally, 66 patients who failed to azole therapy were treated twice daily with LAB for 14 days. A 91.5% clinical response and 93.16% mycological response was observed in VVC patients. The patients treated with LAB who failed to azole therapy showed a 75% clinical, 95.3% mycological response and 83% remission was observed.Overall, the LAB was found to be efficacious and safe for the treatment of VVC patients. Clinical Trial Registration All the trials were registered at Clinical Trial Registry of India (CTRI/2013/02/003378, CTRI/2014/02/004409).

Topics: Amphotericin B; Antifungal Agents; Azoles; Candidiasis, Vulvovaginal; Female; Humans; Lipids

Candida albicans causes debilitating, often azole-resistant, infections in patients with chronic mucocutaneous candidiasis (CMC). Amphotericin B (AMB) resistance is rare, but AMB use is limited by parenteral administration and nephrotoxicity. In this study, we evaluated cochleated AMB (CAMB), a new oral AMB formulation, in mouse models of oropharyngeal candidiasis (OPC) and vulvovaginal candidiasis (VVC) and in patients with azole-resistant CMC. OPC and VVC were modeled in

Topics: Amphotericin B; Animals; Antifungal Agents; Azoles; Candida albicans; Candidiasis; Candidiasis, Chronic Mucocutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Female; Humans; Mice

This study was undertaken to investigate whether amphotericin B vaginal suppositories would be effective in the treatment of non- albicans Candida vaginitis in women who failed conventional therapy.. Thirty-two patients were identified with non- albicans Candida vaginitis. These patients were treated with conventional antifungal agents. Ten patients had persistence of the non- albicans Candida infection after treatment. Amphotericin B 50-mg vaginal suppositories were given nightly for 14 days to this subgroup of treatment failures.. Of 10 women, 8 (80%) who were treated with amphotericin B vaginally initially showed no further infection. One of the treatment successes had 2 recurrences and responded to a second course of amphotericin B but failed a third course. If this patient is considered a treatment failure, then amphotericin B vaginal suppositories were successful in 70% of patients. The medication was well tolerated and local side effects were minimal.. Amphotericin B vaginal suppositories are a viable treatment option for refractory vaginitis caused by non- albicans Candida .

Topics: Administration, Intravaginal; Adult; Aged; Amphotericin B; Antifungal Agents; Candida; Candidiasis, Vulvovaginal; Female; Humans; Middle Aged; Treatment Outcome

The results of all the controlled trials carried out at the Department of Genito-Urinary Medicine at the Cardiff Royal Infirmary over the past 16 years are summarized. All except one of these trials were carried out with patients having acute vulvovaginal candidiasis. One trial involved treating only patients with recurring candidal infection. In all the acute trials, there were practically no mycologic relapses 7 days after completion of treatment whatever the regimen used, but at 35 days after completion of treatment the mycologic relapse rate was in the region of 20% to 25%. It is concluded that following the elimination of any known predisposing cause of vaginal candidiasis, the intravaginal application of 500 mg of an imidazole preparation is as effective a treatment as any other regimen. In recurrent cases, monthly treatment with such a dose may be adequate to control the patient's symptoms. Mycologic relapse may not be accompanied by symptoms, but in recurrent cases there is a closer relation between mycologic relapse and symptoms.

Topics: Amphotericin B; Antifungal Agents; Candidiasis, Vulvovaginal; Clinical Trials as Topic; Clotrimazole; Double-Blind Method; Drug Administration Schedule; Econazole; Female; Follow-Up Studies; Humans; Imidazoles; Miconazole; Nystatin; Pessaries; Recurrence; Vaginal Creams, Foams, and Jellies; Wales

Forty-eight neutropenic patients with acute leukaemia were randomly allocated to receive, as antifungal prophylaxis, either ketoconazole, 400 mg once daily (K), or amphotericin B tablets and lozenges (A), or both ketoconazole and amphotericin B together (K + A). Antifungal prophylaxis was considered to have failed if (1) there was evidence of increasing colonization of the oropharynx or faeces with Candida spp. or other yeasts, or (2) if systemic antifungal therapy was begun empirically. Prophylaxis failed in nine of 17 patients given K, in four of 19 given A, and in four of 12 given K + A. The differences between the three regimens were not statistically significant, neither was there any significant difference in the mean duration of neutropenia before prophylaxis failed. The absorption of ketoconazole was impaired when patients were neutropenic. We conclude that ketoconazole was neither more nor less effective than amphotericin B in the prevention of yeast colonization in neutropenic patients.

Topics: Adolescent; Adult; Amphotericin B; Antineoplastic Agents; Candidiasis, Oral; Candidiasis, Vulvovaginal; Drug Therapy, Combination; Female; Humans; Ketoconazole; Leukemia, Myeloid; Male; Middle Aged; Neutropenia; Random Allocation

Topics: Adult; Amphotericin B; Candidiasis, Vulvovaginal; Dosage Forms; Female; Humans; Middle Aged; Pharmaceutical Vehicles; Suppositories; Tablets

Topics: Adult; Amphotericin B; Candidiasis; Candidiasis, Vulvovaginal; Clinical Trials as Topic; Drug Evaluation; Exanthema; Female; Humans; Leukorrhea; Nystatin; Pregnancy; Pruritus

Topics: Amphotericin B; Candidiasis, Vulvovaginal; Clinical Trials as Topic; Clotrimazole; Drug Resistance, Microbial; Female; Humans; Imidazoles; Nystatin

Topics: Amphotericin B; Antibodies, Fungal; Candida albicans; Candidiasis, Vulvovaginal; Female; Humans; Natamycin; Pessaries; Pregnancy

Topics: Adolescent; Adult; Amphotericin B; Candidiasis, Vulvovaginal; Child; Clinical Trials as Topic; Female; Humans; Middle Aged; Ointments; Pregnancy

Topics: Amphotericin B; Candida; Candidiasis, Vulvovaginal; Drug Synergism; Female; Humans; Metronidazole; Tetracycline; Trichomonas Vaginitis

Topics: Amphotericin B; Candidiasis, Vulvovaginal; Female; Humans; Powders

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Candida; Candidiasis, Vulvovaginal; Clinical Trials as Topic; Female; Humans; In Vitro Techniques; Middle Aged; Natamycin; Nystatin; Pregnancy; Pregnancy Complications, Infectious

Vulvovaginal candidiasis (VVC) is the second most common infection of the genital tract affecting millions of women worldwide. Data concerning the distribution and antifungal resistance of Candida species responsible of VVC vary among countries and population studied.. The aim of this work was to determine the prevalence, species distribution and antifungal susceptibility patterns of Candida species among symptomatic women over a 20-year period.. A total of 5,820 unique samples were retrospectively identified. Out of them, 1,046 (18%) were diagnosed with VVC.. Women between 18 and 30 years had the highest prevalence rate of VVC (21%). Women aged less than 18 years and greater than 51 years had the highest prevalence rates of vaginal bacterial infections. Thirty-five (3.3%) women presented recurrent VVC. The most common yeast isolated was C. albicans, followed by C. glabrata, C. krusei, and C. parapsilosis. Non-Candida albicans species (NAC) were more significantly isolated among women aged 51 or above, than in women included in other groups (p < 0.01). Resistance to fluconazole and amphotericin B was infrequent in C. albicans strains. Resistance to fluconazole and amphotericin B was infrequent in C. albicans strains. NAC species presented higher resistance rates against fluconazole (30%) and voriconazole (25%). C. krusei and C. glabrata isolates showed lower MICs than most of the strains against amphotericin B (1 mg/L) and flucytosine (1 mg/L).. Our findings indicated that continued surveillance on Candida species distribution and non-susceptibility rates to antifungals should be routinely reported to help the selection of the most appropriate drug, to avoid the emergence of resistant strains, and to improve the patient's outcomes.

Topics: Amphotericin B; Antifungal Agents; Candida; Candida albicans; Candida glabrata; Candida parapsilosis; Candidiasis, Vulvovaginal; Drug Resistance, Fungal; Female; Fluconazole; Humans; Male; Microbial Sensitivity Tests; Prevalence; Retrospective Studies

Vulvovaginal candidiasis (VVC), which is most frequently caused by Candida albicans, is a common problem worldwide. Despite the fact that extensive epidemiological studies have been performed, the cause of recurrent VVC (RVVC) remains uncertain. The aims of this work were to compare the genotypes of C. albicans strains causing different conditions of VVC, and explore the relationship between the drug resistance and genotype of C. albicans strains. In our study, we collected 649 independent strains from VVC patients in China. Isolates were tested for in vitro susceptibility to fluconazole, itraconazole, voriconazole, amphotericin B and caspofungin in accordance with the Clinical Laboratory Standards Institute (CLSI) document M27-A3. Genotyping was performed using PCR targeting specific CAI locus marker. C. albicans is the main pathogen of VVC, but the proportion of non-candida albicans (NAC) infection is also increasing, and we also found increased cases of mixed infection. Some C. albicans are resistant to multiple drugs. The strains with the genotypes including 16-16, 18-18 and 22-22 was likely to be the dominant genotype of uncomplicated VVC (p < 0.05). The genotypes of complicated VVC are mainly distributed in 30-45, 33-45, 32-46 and 39-45. Strains of 30-45, 32-45, 30-47 and 30-46 genotypes showed resistance to fluconazole, itraconazole, voriconazole and amphotericin B respectively. Our work suggests that the dominant genotypes with higher repeat number of C. albicans strains were more prevalent in patients with RVVC and drug-resistant strains, however, strains with uncomplicated VVC were more likely to distribute in homozygous. Identification of specific genotypes that correlate with different conditions of VVC and drug resistant is also of diagnostic and therapeutic significance.

Topics: Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis, Vulvovaginal; Drug Resistance, Fungal; Female; Fluconazole; Genotype; Humans; Itraconazole; Microbial Sensitivity Tests; Voriconazole

Vulvovaginal candidiasis caused by. We investigated the molecular identification of 70 vaginal isolates of. Our findings showed that the most common yeast isolated from vaginal discharge was

Topics: Adult; Amphotericin B; Antifungal Agents; Biofilms; Biomass; Candida albicans; Candida glabrata; Candidiasis, Vulvovaginal; Drug Resistance, Fungal; Female; Fluconazole; Humans; Itraconazole; Microbial Sensitivity Tests; Microscopy, Electron, Scanning; Middle Aged; Polymorphism, Restriction Fragment Length; Vagina; Virulence; Voriconazole; Young Adult

Vaginal candidiasis is frequent in pregnant women and is associated with sepsis and adverse neonatal outcomes. This study determined the prevalence of candida species in symptomatic pregnant women and evaluated the antifungal susceptibility profile of the isolated Candida strains. It also aimed to explore whether Candida species predicts gestational complications and adverse neonatal outcomes.. A total of 258 pregnant women with vaginal discharge at 35 to 37 week of gestation participated in this study. Vaginal swabs from these patients were collected at various obstetrics and gynecology clinics in Lebanon for a period of 14 months. Candida isolates were identified at species level and antifungal susceptibility of Candida albicans to fluconazole (FCZ), amphotericin B (AMB), itraconazole (ICZ) and voriconazole (VCZ) was determined by the agar-based E-test method.. Among 258 women tested, 100 (39%) were positive for Candida species. C. albicans, C. glabrata and C. krusei were isolated from 42, 41 and 17% of the women, respectively. C. albicans was significantly associated only with gestational diabetes while C. krusei or C. glabrata had significant positive associations with other gestational complications. The antifungal susceptibility tests of C. albicans isolates revealed 97.5, 90, 87.5 and 97.5% susceptibility to AMB, FCZ, ICZ and VCZ, respectively.. The current study revealed high incidence of both C. albicans and non-C. albicans Candida strains causing vulvovaginitis among pregnant women in Beirut, Lebanon. Candida screening as antenatal follow up is advised to minimize the risk of adverse neonatal outcome or gestational complications.

Topics: Adult; Amphotericin B; Antifungal Agents; Candida albicans; Candida glabrata; Candidiasis, Vulvovaginal; Cross-Sectional Studies; Drug Resistance, Fungal; Female; Fluconazole; Follow-Up Studies; Humans; Incidence; Infant, Newborn; Itraconazole; Lebanon; Microbial Sensitivity Tests; Pregnancy; Prevalence; Vaginal Discharge; Voriconazole

Candida albicans is the main causative agent of vulvovaginal candidiasis (VVC), a common mycosis in women, relapses of which are difficult to manage due to biofilm formation. This study aimed at developing novel non-toxic compounds active against Candida spp. biofilms. We synthesised analogues of natural antifungal peptides LL-III (LL-III/43) and HAL-2 (peptide VIII) originally isolated from bee venoms and elucidated their structures by nuclear magnetic resonance spectroscopy. The haemolytic, cytotoxic, antifungal and anti-biofilm activities of LL-III/43 and peptide VIII were then tested. LL-III/43 and VIII showed moderate cytotoxicity to HUVEC-2 cells and had comparable inhibitory activity against C. albicans and non-albicans spp. The lowest minimum inhibitory concentration (MIC90) of LL-III/43 was observed towards Candida tropicalis (0.8 µM). That was 8-fold lower than that of antimycotic amphotericin B. Both peptides can be used to inhibit Candida spp. bio film f ormation. Biofilm inhibitory concentrations (BIC50) ranged from 0.9 to 58.6 µM and biofilm eradication concentrations (BEC50) for almost all tested Candida spp. strains ranged from 12.8 to 200 µM. Als o pro ven were the peptides' abilities to reduce the area colonised by biofilms , inhibit hyphae formation and permeabilise cell membranes in biofil ms . LL-III/43 and VIII are promising candidates for further development as therapeutics against VVC.

Topics: Amphotericin B; Antifungal Agents; Antimicrobial Cationic Peptides; Bee Venoms; Biofilms; Candida; Candidiasis, Vulvovaginal; Cells, Cultured; Female; Human Umbilical Vein Endothelial Cells; Humans; Hyphae; Microbial Sensitivity Tests

Amphotericin B (AmB) is one of the most used drugs for the treatment of systemic fungal infections; however, the treatment causes several toxic manifestations, including nephrotoxicity and hemolytic anemia. Chitosan-coated poly(lactide-co-glycolide) (PLGA) nanoparticles containing AmB were developed with the aim to decrease AmB toxicity and propose the oral route for AmB delivery. In this work, the antifungal efficacy of chitosan-coated PLGA nanoparticles containing AmB was evaluated in 20 strains of fungus isolates from patients with vulvovaginal candidiasis (01 Candida glabrata and 03 Candida albicans), bloodstream infections (04 C. albicans and 01 C. tropicalis) and patients with urinary tract infection (04 Candida albicans, 02 Trichosporon asahii, 01 C. guilhermondii, 03 C. glabrata) and 01 Candida albicans ATCC 90028. Moreover, the cytotoxicity over erythrocytes was evaluated. The single-emulsion solvent evaporation method was suitable for obtaining chitosan-coated PGLA nanoparticles containing AmB. Nanoparticles were spherical in shape, presented mean particle size about 460 nm, positive zeta potential and encapsulation efficiency of 42%. Moreover, nanoparticles prolonged the AmB release. All the strains were susceptible to plain AmB and nanostructured AmB, according to EUCAST breakpoint version 8.1 (resistant > 1 μg/mL), using broth microdilution method. In C. albicans (urine, blood, and vulvovaginal secretion isolates, and 1 ATCC), the MIC value of AmB-loaded nanoparticles varied from 0.25 to 0.5 μg/mL and EUCAST varied from 0.03 to 0.5 μg/mL. In urine and vulvovaginal secretion isolates of C. glabrata, the MIC value of AmB-loaded nanoparticles varied from 0.25 to 0.5 μg/mL and EUCAST varied from 0.03 to 0.015 μg/mL. In urine isolates of C. guilhermondii, the MIC value of AmB-loaded nanoparticles was 0.12 μg/mL and EUCAST was 0.06 μg/mL. In blood isolates of C. tropicalis, the MIC value of AmB-loaded nanoparticles was 0.5 μg/mL and EUCAST was 0.25 μg/mL. Finally, in urine isolates of T asahii, the MIC value of AmB-loaded nanoparticles was 1 μg/mL and EUCAST varied from 0.5 to 1 μg/mL. In the cytotoxicity assay, plain AmB was highly hemolytic (100% in 24 h) while AmB-loaded chitosan/PLGA nanoparticles presented negligible hemolysis.

Topics: Amphotericin B; Animals; Antifungal Agents; Candida; Candidemia; Candidiasis, Vulvovaginal; Chitosan; Drug Carriers; Female; Humans; Lactic Acid; Microbial Sensitivity Tests; Nanoparticles; Polyglycolic Acid; Polylactic Acid-Polyglycolic Acid Copolymer; Trichosporon; Urinary Tract Infections

Vulvovaginal candidiasis (VVC) is an inflammatory disease of the vulva and vagina caused by different yeasts of the genus Candida which is responsible for infection in pregnant patients who attended Maternidade Escola Januário Cicco, Rio Grande do Norte, Brazil. From 41 samples, 19 yeasts were identified phenotypically as Candida albicans and one as Candida glabrata which is reported as the non-albicans species most frequently isolated from vulvovaginitis. The susceptibility to selected antifungal agents (flucytosine, fluconazole, voriconazole, amphotericin B, caspofungin and micafungin) was determined, and the association between patient-related signs and symptoms aided the construction of an epidemiological profile. Antifungal susceptibility testing performed by automated method showed that all strains were sensitive to the drugs tested, including the C. glabrata specimen despite its known resistance or dose-dependent susceptibility to azole derivatives. Regarding patient signs and symptoms, no statistically significant association between these and the establishment of VVC was found. It can be concluded that the laboratorial diagnosis of VVC is necessary prior to the administration of treatment, since only 48·78% of the patients had VVC but for all of them antifungal therapy were prescribed.. Vulvovaginal candidiasis (VVC) is a problem that affects a significant number of pregnant women worldwide. This type of fungal infection generates great discomfort due to the symptomatology and difficulties of diagnosis and treatment. In view of the scarcity of data in the State of Rio Grande do Norte, Brazil, regarding studies carried out on fungal populations of the genus Candida associated with VVC in pregnant women, this study considered relevant, the phenotypic and genotypic identification of the species, to estimate the prevalence, to determine their susceptibility to the antifungal and to correlate with signs and symptoms.

Topics: Adolescent; Adult; Amphotericin B; Antifungal Agents; Brazil; Candida; Candida glabrata; Candidiasis, Vulvovaginal; Echinocandins; Female; Fluconazole; Humans; Lipopeptides; Micafungin; Microbial Sensitivity Tests; Pregnancy; Pregnancy Complications; Prevalence; Schools; Young Adult

Vulvovaginal candidiasis is an inflammation localized in the vulvovaginal area. It is mostly caused by Candida albicans. Its treatment is based on the systemic and local administration of antifungal drugs. However, this conventional therapy can fail owing to the resistance of the Candida species and noncompliance of patients. Amphotericin B-loaded poly(lactic-co-glycolic acid) nanofibers are single-use, antifungal, controlled drug delivery systems, and represent an alternative therapeutic scheme for the local treatment of vulvovaginal candidiasis. Nanofibers were characterized by analytical techniques and with an in vitro drug delivery study. In vitro and in vivo fungicidal activity of amphotericin B released from nanofibers was evaluated using the agar diffusion method and an experimental murine model of vulvovaginal candidiasis, respectively. Analytical techniques showed that amphotericin B was physically mixed in the polymeric nanofibers. Nanofibers controlled the delivery of therapeutic doses of amphotericin B for 8 consecutive days, providing effective in vitro antifungal activity and eliminated the in vivo vaginal fungal burden after 3 days of treatment and with only one local application. Amphotericin B-loaded poly(lactic-co-glycolic acid) nanofibers could be potentially applied as an alternative strategy for the local treatment of vulvovaginal candidiasis without inducing fungal resistance, yet ensuring patient compliance.

Topics: Amphotericin B; Animals; Antifungal Agents; Candida; Candidiasis, Vulvovaginal; Drug Delivery Systems; Female; Microbial Sensitivity Tests; Nanofibers; Polylactic Acid-Polyglycolic Acid Copolymer; Rats; Rats, Wistar

In recent years, the infection Candida albicans infection worldwide has risen, and the incidence of resistance to traditional antifungal therapies is also increasing. The aim of this study was to evaluate in vitro susceptibility of C. albicans clinical isolates to eight antifungal agents in Ouagadougou.. A cross-sectional study was conducted from January 2013 to December 2015 at Yalgado Ouédraogo University Teaching Hospital. Two hundred seven strains have been isolated from 347 symptomatic patients received in different clinical services. Samples were cultured on Sabouraud Dextrose Agar supplemented with Cloramphenicol. Isolates were diagnosed as C. albicans using germ tube test, chlamydospore formation on Corn Meal Agar, and Api-Candida test (Biomérieux). Antifungal susceptibility testing was performed by disk diffusion method and isolates classified as susceptible, susceptible dose-dependent and resistant.. Three hundred forty-seven (347) patients are included in this study. Two hundred and six (206) out of 347 collected samples (59.36%) were found positive for C. albicans. The strains were mostly isolated from vulvovaginal (49%) and oral infections (40.3%). The highest resistance rates of azoles were obtained with fluconazole (66.5%), itraconazole (52.3%) and ketoconazole (22.9%) when all clinical isolates were included. The resistance rates of fluconazole, itraconazole and ketoconazole remain highest for vulvovaginal and oral isolates. The rate of resistance to the polyene amphotericin B was 32.0% for all clinical isolates and was 56.4% for vulvovaginal strains. Resistance rate to nystatin was 6.3% for all clinical isolates. Cross-resistance analysis with data of all clinical strains revealed that the incidence of resistance to ketoconazole and itraconazole in fluconazole-resistant isolates was significantly higher than recorded for fluconazole-susceptible isolates.. In vitro C. albicans antifungal susceptibility test in this study showed relatively high resistance to commonly and widely used azoles (fluconazole, ketoconazole). Most C. albicans clinical isolates were susceptible to nystatin.

Topics: Adult; Amphotericin B; Antifungal Agents; Burkina Faso; Candida albicans; Candidiasis; Candidiasis, Oral; Candidiasis, Vulvovaginal; Cross-Sectional Studies; Drug Resistance, Fungal; Female; Fluconazole; Humans; Itraconazole; Male; Microbial Sensitivity Tests; Middle Aged

To determine the prevalence and antifungal susceptibility pattern of Candida species.. This prospective, cross-sectional study was conducted at the Quaid-e-Azam International Hospital, Islamabad, Pakistan, from January 2014 to February 2015, and comprised different clinical samples which were analysed for various types of microbial infections. Species differentiation was confirmed by biochemical and molecular methods. Antifungal susceptibility against amphotericin B, fluconazole and voriconazole was determined by Clinical and Laboratory Standards Institute M44-A disk diffusion method.. Of the 219 Candida isolates, majority of them were isolated from urine 78(35.6%) and vaginal swabs 59(26.9%). Moreover, 144(65.8%) samples were of females and 75(34.2%) were of males. Candida albicans 128(58.45%) was the most predominant species followed by Candida glabrata 30(13.69%), Candida tropicalis 26(11.87%), Candida krusei 17(7.76%), Candida parapsilosis 12(5.47%), Candida dubliniensis 3(1.37%) and Candida lusitaniae 3(1.37). All isolates were least susceptible to amphotericin B with a susceptibility rate of 213(97.26%). The highest resistance was found for voriconazole 40(18.26%) compared to fluconazole 32(14.61%).. Candida species possessed high resistance rate against various antifungal agents.

Topics: Adolescent; Adult; Amphotericin B; Antifungal Agents; Candida; Candida albicans; Candida glabrata; Candida parapsilosis; Candida tropicalis; Candidiasis; Candidiasis, Vulvovaginal; Child; Child, Preschool; Cross-Sectional Studies; Drug Resistance, Fungal; Female; Fluconazole; Humans; Infant; Infant, Newborn; Inpatients; Male; Microbial Sensitivity Tests; Middle Aged; Molecular Epidemiology; Outpatients; Pakistan; Prevalence; Prospective Studies; Respiratory Tract Infections; Tertiary Care Centers; Urinary Tract Infections; Voriconazole; Young Adult

Topics: Administration, Intravaginal; Amphotericin B; Antifungal Agents; Candidiasis, Vulvovaginal; Female; Humans; Middle Aged

Candida nivariensis is a cryptic species, phenotypically indistinguishable from Candida glabrata and identified by molecular methods. Aside its isolation from broncho-alveolar lavage, we report for the first time the etiologic role of C. nivariensis in 4 patients with vulvovaginal candidiasis. Of 100 phenotypically identified C. glabrata isolates originating from vaginal swabs, 4 were identified as C. nivariensis by polymerase chain reaction and confirmed by sequencing. All of the C. nivariensis isolates exhibited white colonies on CHROMagar. Phylogenetic analysis revealed genotypic diversity in the C. nivariensis isolates originating from within or outside of India. Barring a solitary C. nivariensis isolate with MIC, 16 μg/mL of fluconazole, the rest were susceptible to voriconazole, itraconazole, posaconazole, isavuconazole, amphotericin B, and echinocandins. The patient with high fluconazole MIC did not respond to fluconazole therapy. It is suggested that the prevalence of this species is likely to be much higher than apparent from the sporadic published reports.

Topics: Adult; Amphotericin B; Antifungal Agents; Candida; Candidiasis, Vulvovaginal; DNA, Fungal; Drug Resistance, Fungal; Echinocandins; Female; Fluconazole; Genotype; Humans; India; Itraconazole; Microbial Sensitivity Tests; Nitriles; Phenotype; Phylogeny; Polymerase Chain Reaction; Pyridines; Pyrimidines; Sequence Analysis, DNA; Tertiary Care Centers; Triazoles; Voriconazole; Young Adult

The aim of this study was to evaluate in vitro susceptibility of vaginal Candida albicans to common antifungal drugs in Abidjan, Ivory Coast.. From January to September 2008, 150 women with leucorrhoea were sampled for vaginal mycosis at the Pasteur Institute (Ivory Coast). Samples were analyzed by direct examination, Sabouraud-chloramphenicol and Sabouraud-chloramphenicol-actidione culture. C. albicans was identified after blastesis, chlamydosporulation and auxanogram tests. The susceptibility of this fungus to amphotericine B, 5-fluorocytosine, fluconazole, itraconazole and voriconazole was evaluated by a semi-solid medium microdilution technique: ATB(®) Fungus 3.. Among 62 yeasts strains isolated, C. albicans represented 45 cases or 72.6%. Vaginal itching (P=0.04) and urinary burning (P=0.002) was statistically correlated with vaginal candidosis. We observed a range of susceptibility of C. albicans strains to antifungals: 100% to amphotericine B (CMI90=0.5μg/mL); 98% to 5-fluorocytosine (CMI90=4μg/mL); 86.7% to voriconazole (CMI50=0.06μg/mL) and 80% to fluconazole (CMI50=2μg/mL and CMI90=32μg/mL). However, only 46.7% of C. albicans strains were sensitive to itraconazole (CMI50=0.125μg/mL).. These results show that vaginal C. albicans remain sensitive to the most commonly antifungal drugs used in Abidjan. However, this susceptibility should be regularly monitored.

Topics: Adolescent; Adult; Amphotericin B; Antifungal Agents; Candida; Candida albicans; Candidiasis, Vulvovaginal; Colony Count, Microbial; Cote d'Ivoire; Drug Resistance, Fungal; Female; Humans; Leukorrhea; Microbial Sensitivity Tests; Middle Aged; Triazoles; Young Adult

The treatment of vulvovaginal candidiasis (VVC) due to Candida glabrata is challenging, with limited therapeutic options. Unexplained disappointing clinical efficacy has been reported with systemic and topical azole antifungal agents in spite of in vitro susceptibility. Given that the vaginal pH of patients with VVC is unchanged at 4 to 4.5, we studied the effect of pH on the in vitro activity of 11 antifungal agents against 40 C. glabrata isolates and compared activity against 15 fluconazole-sensitive and 10 reduced-fluconazole-susceptibility C. albicans strains. In vitro susceptibility to flucytosine, fluconazole, voriconazole, posaconazole, itraconazole, ketoconazole, clotrimazole, miconazole, ciclopirox olamine, amphotericin B, and caspofungin was determined using the CLSI method for yeast susceptibility testing. Test media were buffered to pHs of 7, 6, 5, and 4. Under conditions of reduced pH, C. glabrata isolates remained susceptible to caspofungin and flucytosine; however, there was a dramatic increase in the MIC(90) for amphotericin B and every azole drug tested. Although susceptible to other azole drugs tested at pH 7, C. albicans strains with reduced fluconazole susceptibility also demonstrated reduced susceptibility to amphotericin B and all azoles at pH 4. In contrast, fluconazole-sensitive C. albicans isolates remained susceptible at low pH to azoles, in keeping with clinical observations. In selecting agents for treatment of recurrent C. glabrata vaginitis, clinicians should recognize the limitations of in vitro susceptibility testing utilizing pH 7.0.

Topics: Amphotericin B; Antifungal Agents; Azoles; Candida albicans; Candida glabrata; Candidiasis, Vulvovaginal; Drug Resistance, Fungal; Female; Humans; Hydrogen-Ion Concentration; Microbial Sensitivity Tests

A higher prevalence of vulvovaginal candidiasis (VVC) is seen in pregnant women compared with those who are not pregnant. Recurrence is also more common in pregnant women, and therapeutic responses are reduced. In this investigation, 207 vaginal yeast isolates recovered from pregnant women were tested for susceptibility to 13 antifungal drugs and boric acid and through these studies four virulence factors were also determined. The isolates were recovered from vaginal samples of patients with acute VVC [AVVC, (n = 73)], symptomatic recurrent VVC [RVVC, (n = 89)], asymptomatic RVVC (n = 27), and those without signs and symptoms (n = 18). Candida albicans was the most common species found (59.9%), followed by C. glabrata (19.8%), other Candida spp., (19.8%), and Saccharomyces cerevisiae (0.5%). Antifungal susceptibility testing was performed as described in CLSI document M27-A3. Additionally, we examined phospholipase and proteinase production, adhesion to vaginal epithelial cells and hemolytic activity. Notably, the MIC values of Candida spp. isolates derived from patients with VVC were no different from those of the controls (P > 0.05). In addition, Candida isolates derived from patients with AVVC or RVVC produced significantly higher amounts of phospholipase and proteinase compared with the controls (P < 0.05). Antifungal testing and the determination of virulence factors may lead to the effective and prompt treatment of VVC, particularly in pregnant women.

Topics: Adolescent; Adult; Amphotericin B; Animals; Antifungal Agents; Boric Acids; Candida albicans; Candida glabrata; Candidiasis, Vulvovaginal; Cell Adhesion; Epithelial Cells; Female; Fluconazole; Fungal Proteins; Hemolysis; Humans; Itraconazole; Microbial Sensitivity Tests; Middle Aged; Phospholipases; Pregnancy; Pregnancy Complications, Infectious; Recurrence; Saccharomyces cerevisiae; Vagina; Virulence Factors; Young Adult

Patients with symptomatic azole-resistant Candida albicans or non-albicans candida are difficult to manage. Treatment is largely anecdotal due to the relatively small number of patients. We present six case reports which highlight our own observation in clinical practice including four patients who were treated successfully with topical amphotericin B/flucytosine vaginal gel for 14 days (Stoke-on-Trent formula).

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Azoles; Candida albicans; Candidiasis, Vulvovaginal; Drug Resistance, Fungal; Female; Flucytosine; Humans; Middle Aged; Treatment Outcome; Vaginal Creams, Foams, and Jellies; Young Adult

A biofilm is a complex community of surface-associated cells enclosed in a polymer matrix. They attach to solid surfaces and their formation can be affected by growth conditions and co-infection with other pathogens. The presence of biofilm may protect the microorganisms from host defenses, as well as significantly reduce their susceptibility to antifungal agents. Pathogenic microbes can form biofilms on the inert surfaces of implanted devices such as catheters, prosthetic cardiac valves and intrauterine devices (IUDs). The present study was carried out to analyze the presence of biofilm on the surface of intrauterine devices in patients with recurrent vulvovaginal candidiasis, and to determine the susceptibility profile of the isolated yeasts to amphotericin B and fluconazole. Candida albicans was recovered from the IUDs and it was found to be susceptible to the antifungal agents when tested under planktonic growing conditions. These findings indicate the presence of the biofilm on the surface of the IUD as an important risk factor for recurrent vulvovaginal candidiasis.

Topics: Adult; Amphotericin B; Antifungal Agents; Biofilms; Candida albicans; Candidiasis, Vulvovaginal; Female; Fluconazole; Humans; Intrauterine Devices; Microbial Sensitivity Tests; Recurrence

It is thought that widespread use of 'over-the-counter' azoles may increase the incidence of resistant Candida species such as Candida glabrata. Infections with species other than Candida albicans frequently do not respond to standard azole treatments. Intravaginal nystatin is an option but is no longer available in the UK. In this paper, the authors review the prevalence of non-albicans candida over the past 5 years, and assess the efficacy of amphotericin and flucytosine vaginal cream in the treatment of non-albicans VVC.. Retrospective review of all vaginal yeast isolates collected from women attending a city centre sexual-health clinic between 2004 and 2008. The women prescribed amphotericin and flucytosine vaginal cream were identified through pharmacy records, and their clinical notes reviewed for treatment outcome.. Between 2004 and 2008, the number of isolates of all Candida species increased with increasing clinic workload, but the prevalence of non-albicans yeasts remained stable at between 0.87 and 1.06%. Eighteen patients were prescribed amphotericin and flucytosine vaginal cream. At follow-up, all 18 were clear of their initial yeast isolate on culture, but two had persistent symptoms and had positive cultures for C albicans.. There is no evidence of any increase in prevalence of non-albicans Candida species such as C glabrata. The authors have treated 18 women who had non-albicans VVC with amphotericin and flucytosine vaginal cream and achieved clearance of the non-albicans species in all of them.

Topics: Administration, Intravaginal; Amphotericin B; Antifungal Agents; Candidiasis, Vulvovaginal; Drug Therapy, Combination; Female; Flucytosine; Humans; Ointments; Prevalence; Retrospective Studies

Candida krusei is an uncommon cause of vaginitis and cystitis but is unique because of the management challenge it poses due to intrinsic resistance to fluconazole and flucytosine. We report a case of C. krusei vaginitis and cystitis successfully managed with topical vaginal and intravesical amphotericin B. The challenges in managing C. krusei cystitis and the role of amphotericin B bladder irrigation in the management of fungal urinary tract infections are discussed.

Topics: Administration, Topical; Amphotericin B; Antifungal Agents; Candida; Candidiasis, Vulvovaginal; Drug Resistance, Fungal; Female; Humans; Middle Aged; Treatment Outcome; Urinary Tract Infections

In this study the prevalence of vulvovaginal candidiasis (VVC), antifungal susceptibility and proteinase production of isolated Candida species were investigated. Vaginal swabs were collected from symptomatic women with vulvovaginitis attending the Obstetrics and Gynecology Clinic of Kocaeli University, Turkey. The relation between risk factors, such as pregnancy, diabetes mellitus, antibiotic and corticosteroid use, history of sexually transmitted diseases and contraceptive methods, was recorded. Candida spp. were identified by conventional methods, then evaluated for proteinase secretion in a medium containing casein. Antifungal susceptibility was determined according to the NCCLS microdilution method. The prevalence of women with vulvovaginitis was 35.7% (170/6080) and 16% (28/170) of them were diagnosed as VVC. Candida albicans was the dominant species: 21 (75%), followed by 4 C. glabrata (14%), 2 C. tropicalis (7%), and one C. krusei (3.5%). All isolates were susceptible to fluconazole, itraconazole and amphotericin B, except one C. krusei, one C. glabrata and one C. albicans that were resistant to fluconazole. Proteinase production was determined in 19 (90.5%) C. albicans and in all C. tropicalis isolates. Proteinase activity was not associated with antifungal resistance. No association was found between risk factors and VVC.

Topics: Adult; Amphotericin B; Antifungal Agents; Candida; Candidiasis, Vulvovaginal; Female; Fluconazole; Humans; Itraconazole; Microbial Sensitivity Tests; Peptide Hydrolases; Prevalence; Risk Factors; Turkey

Topics: Administration, Intravaginal; Adult; Amphotericin B; Antifungal Agents; Candidiasis, Vulvovaginal; Drug Therapy, Combination; Female; Flucytosine; Humans; Ointments; Recurrence

The purpose of the present study was to evaluate the utility of the E-test in determining the antifungal susceptibility of Candida species. A total of 50 Candida strains, including 34 Candida albicans and 16 non-albicans were isolated from vaginal swab specimens from women suffering from vaginitis. The minimum inhibitory concentrations (MICs) of amphotericin B, fluconazole and ketoconazole were detected by using broth macrodilution and the E-test. When the results of the two tests were compared, the MIC values were considered acceptable if the difference between the two assays was no more than two-fold (+/-1dilution). The acceptable rates were: 84% for amphotericin B, 97% for fluconazole and 78% for ketoconazole. Finally, MICs of C. albicans against the tested antifungal agents were generally lower than for non-albicans strains. These results suggest that the E-test can be used for the determination of MIC values for Candida species isolates.

Topics: Amphotericin B; Antifungal Agents; Candida; Candidiasis, Vulvovaginal; Female; Fluconazole; Humans; Ketoconazole; Microbial Sensitivity Tests; Vagina

Patients with vaginitis due to highly azole resistant Candida glabrata can be particularly difficult to treat. We describe three cases of longstanding vaginal candidiasis due to C glabrata. These had failed to respond to local and systemic antifungals. Flucytosine (1 g) and amphotericin B (100 mg) formulated in lubricating jelly base in a total 8 g delivered dose, was used per vagina once daily for 14 days with significant improvement, both clinically and microbiologically.

Topics: Adult; Amphotericin B; Antifungal Agents; Candidiasis, Vulvovaginal; Drug Combinations; Female; Flucytosine; Humans; Middle Aged

The need for new therapies to treat systemic fungal infections continues to rise. Naturally occurring hexapeptide echinocandin B (1) has shown potent antifungal activity via its inhibition of the synthesis of beta-1,3 glucan, a key fungal cell wall component. Although this series of agents has been limited thus far based on their physicochemical characteristics, we have found that the synthesis of analogues bearing an aminoproline residue in the 'northwest' position imparts greatly improved water solubility (> 5 mg/mL). The synthesis and structure-activity relationships (SAR) based on whole cell and upon in vivo activity of the series of compounds are reported.

Topics: Acute Disease; Amines; Amphotericin B; Animals; Anti-Bacterial Agents; Antifungal Agents; Candida; Candidiasis, Vulvovaginal; Disease Models, Animal; Dose-Response Relationship, Drug; Echinocandins; Female; Fungal Proteins; Mice; Microbial Sensitivity Tests; Peptides; Peptides, Cyclic; Proline; Solubility; Structure-Activity Relationship; Yeasts

In a woman of 26, who suffered from a vulvovaginal infection and had previously been treated for Candida vaginitis, Saccharomyces cerevisiae was cultured and identified. At her work she sold baking yeast. Topical treatment with amphotericin B 100 mg suppositories was successful. Microscopic examination (1000 x) of the discharge in saline showed haloed yeast cells. For treatment, oral ketoconazole or topical administration of amphotericin B or clotrimazole, in relatively high doses, may be applied. This yeast might be the cause of 'chronic candidiasis' more often than suspected, notably in women working in a bakery or a brewery.

Topics: Adult; Amphotericin B; Candidiasis, Vulvovaginal; Diagnosis, Differential; Female; Humans; Occupational Diseases; Saccharomyces cerevisiae; Vaginitis

An overview of the following fungal infections: thrush, vaginal candidiasis, cryptococcal meningitis, histoplasmosis, and blastomycosis is provided. The symptoms and treatment options of each infection are discussed. New information concerning the use of fluconazole in reducing the frequency of cryptococcal meningitis, esophageal candidiasis, and superficial fungal infections is included. The use of preventive treatment for fungal infections is cautioned due to the possibility of resistance to treatment.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Blastomycosis; Candidiasis, Oral; Candidiasis, Vulvovaginal; Clotrimazole; Fluconazole; Histoplasmosis; Humans; Itraconazole; Meningitis, Cryptococcal; Mycoses

Although numerous antimycotic agents are available for the treatment of yeast vaginitis there is little comparative data on the in vitro activity of these drugs. In the present two-part study, in vitro macro-broth dilution sensitivity tests were performed on a total of 377 clinical vaginal yeast isolates of nine different species. Antimycotics surveyed included amphotericin B, 5-fluorocytosine and eight azole derivatives. Results show that all vaginal Candida albicans isolates were uniformly sensitive at low concentration to all 10 antimycotics tested. However, non-albicans species, especially Candida glabrata and Saccharomyces cerevisiae, manifested several-fold increases in minimal inhibitory concentrations to all azoles tested except butoconazole. In particular, the in vitro potency of fluconazole and terconazole against species other than C. albicans was relatively poor, whereas the drugs demonstrating the best activity were itraconazole, butoconazole and saperconazole. Susceptibility testing of vaginal C. albicans isolates is not routinely indicated, even in patients with recurrent vaginitis and should be reserved for selected organisms, especially non-albicans species, in patients with clinical failure only.

Topics: Amphotericin B; Antifungal Agents; Azoles; Candida; Candida albicans; Candidiasis, Vulvovaginal; Female; Flucytosine; Humans; Incidence; Microbial Sensitivity Tests; Mycoses; Prevalence; Saccharomyces cerevisiae; Vaginitis

Six months after an attack of pyelonephritis, adnexitis and candida colpitis an 18-year-old girl developed some clouding of consciousness. On neurological examination she showed organic behavioural changes, discrete anisocoria and possible meningism. Computed tomography revealed hydrocephalus and signs of increased cerebrospinal fluid (CSF) pressure. CSF contained 2336/3 cells, while total protein was raised to 7.0 g/l and lactate concentration to 6.85 mmol/l. Glucose concentration in CSF was 51 mg/dl and 75 mg/dl in serum. As tuberculous meningitis was suspected, treatment was started with four tuberculostatic drugs, but there was no improvement. Five weeks later microscopic CSF examination showed fungal spores and nonbranching hyphae. The maximal candida haemagglutination titre in CSF was 1:2048. CSF culture grew Candida albicans. The further course was complicated by side effects to the antimycotic drugs (amphotericin B between 4.5 and 45 mg daily; flucytosine 1.7 g four times daily) and recurrent obstruction in the ventricular system requiring repeated neurosurgical interventions. However, full cure was achieved after seven months' hospital treatment.

Topics: Adolescent; Amphotericin B; Antitubercular Agents; Brain Diseases; Candida albicans; Candidiasis; Candidiasis, Vulvovaginal; Cerebrospinal Fluid; Diagnosis, Differential; Female; Flucytosine; Humans; Hydrocephalus; Pelvic Inflammatory Disease; Pyelonephritis; Tomography, X-Ray Computed; Tuberculosis, Meningeal

Congenital candida infection is a rare disease, although the incidence of candida vaginitis during pregnancy is high. We report on five cases each showing patterns considered typical for candida infection. The infective agent can cause chorioamnionitis even in the presence of intact fetal membranes. An intrauterine device (IUD) has been proved to be a risk factor for a congenital candida infection. The pathogenetic significance of contamination with candida for the fetus appears to depend largely on gestational age. A premature infant with a birth-weight less than 1500 g presented with bilateral candida endophthalmitis which was cured by intravenous Fluconazole therapy. Another premature infant weighing 800 g at birth developed a systemic candida infection. The other three more mature infants had milder symptoms, two of them presented with cutaneous candidiasis.

Topics: Adult; Amniocentesis; Amphotericin B; Candidiasis; Candidiasis, Cutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Chorioamnionitis; Drug Therapy, Combination; Endophthalmitis; Female; Fetal Membranes, Premature Rupture; Flucytosine; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Nystatin; Pregnancy

The activity of the broad-spectrum triazole antifungal terconazole was evaluated in vitro by the serial decimal dilution technique in broth media. The best correlation between in vitro and in vivo activity was found in brain-heart infusion broth and Eagle's minimum essential medium. All strains of Candida albicans, C. tropicalis, C. krusei, C. parapsilosis, C. guilliermondii, C. glabrata, and Trichosporon beigelii tested were susceptible. Terconazole blocked the morphogenetic transformation from the yeast into the filamentous form at concentrations of 0.008 to 0.05 microgram/ml. In experimental candidiasis in castrated rats with estrogen-induced permanent pseudoestrus, topical treatment with terconazole was superior to miconazole, clotrimazole, econazole, butoconazole, tioconazole, sulconazole, bifonazole, valconazole, fenticonazole, nystatin, and amphotericin B in the various schedules used. A 3-day once-daily intravaginal application of terconazole 0.8% was usually sufficient to provide a functional therapeutic period of 7 days because of prolonged high biologically active antifungal levels in the vagina. No side effects were observed at any concentration of terconazole.

Topics: Administration, Topical; Amphotericin B; Animals; Antifungal Agents; Candida; Candidiasis, Vulvovaginal; Clotrimazole; Econazole; Female; Miconazole; Microbial Sensitivity Tests; Nystatin; Rats; Rats, Inbred Strains; Triazoles

The therapeutic potential of UK-49,858, a difluorophenyl bis-triazole derivative, has been assessed by evaluating its activity against systemic infections with Candida albicans in normal mice and rats and in mice with impaired defence mechanisms, against vaginal infections with C. albicans in mice, and against dermal infections with Trichophyton mentagrophytes in guinea pigs. Orally administered ketoconazole was used as a comparative agent throughout, and parenterally administered amphotericin B was included in the study of C. albicans systemic infection in normal mice. The activity of UK-49,858 given orally to mice or rats infected systemically with C. albicans was far superior to that of ketoconazole. In addition, UK-49,858 showed activity comparable to that of amphotericin B when given parenterally, although the latter gave more prolonged protection. UK-49,858 was also effective orally in curing experimental candidal vaginitis in mice and trichophytosis in guinea pigs, against which it was approximately 10 times more active than ketoconazole. These data suggest that UK-49,858 may be of value in the treatment of both C. albicans and dermatophyte fungal infections in man.

Topics: Amphotericin B; Animals; Antifungal Agents; Candidiasis; Candidiasis, Vulvovaginal; Dermatomycoses; Female; Fluconazole; Guinea Pigs; Immunosuppression Therapy; Ketoconazole; Mice; Rats; Rats, Inbred Strains; Tinea; Triazoles

Topics: Adult; Amphotericin B; Candidiasis; Candidiasis, Vulvovaginal; Child; Cytosine; Female; Humans; Infant, Newborn; Maternal-Fetal Exchange; Pregnancy; Pregnancy Complications, Infectious

Topics: Adolescent; Adult; Amphotericin B; Bacterial Infections; Candidiasis, Vulvovaginal; Drug Combinations; Female; Genital Diseases, Female; Humans; Middle Aged; Pelvic Inflammatory Disease; Suppositories; Tetracycline; Vaginitis

Topics: Amphotericin B; Antifungal Agents; Candida; Candidiasis; Candidiasis, Cutaneous; Candidiasis, Vulvovaginal; Colon; Feces; Female; Humans

The end points of tube dilution tests for minimal inhibitory concentrations of miconazole and flucytosine against Candida albicans were difficult to evaluate because partial inhibition was noted over a wide range of antifungal concentrations. This problem was not encountered with amphotericin B. Partial inhibition of Candida arose because of reductions in yeast growth rate and of cell yield. Different sizes of yeast inocula were differentially inhibited by the same concentration of antifungal agent. An in vitro apparatus was described in which miconazole formulated as commercial creams, pessaries and medicated tampons for intravaginal application could be assessed for its inhibitory action in vitro.

Topics: Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis, Vulvovaginal; Drug Evaluation, Preclinical; Female; Flucytosine; Humans; Miconazole; Microbial Sensitivity Tests; Models, Biological

The authors present a review of the epidemiology, pathology, diagnosis and treatment of candidiasis in the child. Their studies on the favoring factors in cutaneous forms as well as their experiences in pulmonary forms are emphasized.

Topics: Amphotericin B; Candidiasis; Candidiasis, Cutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Child; Clotrimazole; Complement C5; Female; Flucytosine; Humans; Immunity, Cellular; Immunologic Deficiency Syndromes; Miconazole; Nystatin

Topics: Administration, Oral; Administration, Topical; Adult; Amphotericin B; Antifungal Agents; Candidiasis, Vulvovaginal; Digestive System; Female; Humans; Imidazoles; Injections, Intravenous; Nystatin; Recurrence

The minimal inhibition concentration of Tetracycline was tested in 177 strains of gram positive and gram negative species of bacteria from the vagina which were found to be resistant to Tetracycline in the Agardiffusion Test. 170 of the 177 strains (96%) were inhibited with a Tetracycline concentration of 512 microgram/ml. Six Klebsiella-enterobacter strains and one proteus morgaini strain needed a minimal inhibition concentration of 1024 microgram/ml. For a successful local treatment of vaginitis by Tetracycline against species highly resistant to Tetracycline local Tetracycline levels of 1000 microgram/ml or better have to be obtained. Concomitant preventive treatment of fungi for instance, with amphotericin containing drugs such as mysteclin is indicated.

Topics: Amphotericin B; Candidiasis, Vulvovaginal; Drug Resistance, Microbial; Drug Therapy, Combination; Female; Humans; Tetracycline; Vaginitis

Topics: Amphotericin B; Candidiasis, Vulvovaginal; Drug Resistance, Microbial; Female; Humans; Nystatin

Topics: Amphotericin B; Antifungal Agents; Candidiasis, Vulvovaginal; Drug Resistance, Microbial; Female; Humans

Topics: Amphotericin B; Candidiasis, Vulvovaginal; Drug Resistance, Microbial; Female; Flucytosine; Humans

21 of 41 patients developed clinically manifest or systemic Candida albicans infection 1-36 months after renal transplantation. Asymptomatic candiduria was diagnosed in all patients even before the onset of clinical symptoms. Fungal stomatitis was the most frequent clinical sign, followed by mycotic changes in the respiratory, genito-urinary (vaginitis) and gastro-intestinal tract. In five cases intrahepatic biliary stasis was diagnosed in the course of a Candida albicans septicaemia. In 12 patients with renal transplants it was possible, by treatment with nystatin, clotrimazole, flucytosine, miconazole and amphotericine B to control a generalized or clinically manifest Candida albicans infection. Three died of the septicaemia or meningoencephalitis, six as the result of bacterial superinfections. Inspection of the mouth is an important means of early diagnosing fungal infections. Antimycotic treatment should be started if fungal cultures from urine are repeatedly positive even if the clinical findings are still negative.

Topics: Adult; Amphotericin B; Candidiasis; Candidiasis, Oral; Candidiasis, Vulvovaginal; Child; Cholestasis; Clotrimazole; Female; Humans; Kidney Transplantation; Male; Meningoencephalitis; Miconazole; Middle Aged; Nystatin; Postoperative Complications; Sepsis; Transplantation, Homologous

Topics: Adult; Amphotericin B; Candidiasis, Vulvovaginal; Female; Humans; Italy; Nystatin; Pregnancy; Pregnancy Complications, Infectious

Topics: Adult; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis, Vulvovaginal; Contraceptives, Oral; Female; Humans; Natamycin; Nystatin; Recurrence; Vagina

Topics: Amphotericin B; Antifungal Agents; Balanitis; Candida albicans; Candidiasis, Cutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Coloring Agents; Contraceptives, Oral; Diabetes Complications; Female; Humans; Infant, Newborn; Male; Nails; Nystatin; Paronychia; Pregnancy; Pregnancy Complications, Infectious; Saccharomyces

Topics: Adult; Amphotericin B; Candida albicans; Candidiasis; Candidiasis, Vulvovaginal; Female; Humans; Meningitis; Pregnancy; Puerperal Disorders

Topics: Adolescent; Adult; Amphotericin B; Candidiasis, Vulvovaginal; Child; Female; Follow-Up Studies; Humans; Intrauterine Devices; Middle Aged; Pregnancy; Pregnancy Complications, Infectious

Topics: Amphotericin B; Candidiasis, Vulvovaginal; Female; Follow-Up Studies; Humans; Pregnancy; Pregnancy Complications, Infectious

Topics: Amphotericin B; Candidiasis, Cutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Contraceptive Agents; Female; Granuloma; Humans; Infant, Newborn; Infant, Newborn, Diseases; Natamycin; Nystatin; Pregnancy

Topics: Adult; Amphotericin B; Candidiasis; Candidiasis, Oral; Candidiasis, Vulvovaginal; Female; Humans; Tetracycline; Trichomonas Vaginitis

Topics: Administration, Oral; Amphotericin B; Candida; Candidiasis, Cutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Child; Child, Preschool; Drug Resistance, Microbial; Female; Humans; Male; Microbial Sensitivity Tests; Microscopy, Electron; Middle Aged

Topics: Acute Disease; Amphotericin B; Candidiasis, Vulvovaginal; Chronic Disease; Female; Humans; Vaginal Smears

Topics: Adolescent; Amphotericin B; Candidiasis; Candidiasis, Cutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Child; Child, Preschool; Chronic Disease; Female; Humans; Infant; Male; Nails; Skin Diseases

Topics: Adult; Amphotericin B; Antibody Formation; Antigens; Candida; Candidiasis; Candidiasis, Cutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Cell Migration Inhibition; Child; Female; Humans; Hypersensitivity, Delayed; Immunity, Cellular; Immunity, Maternally-Acquired; Immunization, Passive; Immunoglobulins; Immunosuppression Therapy; Lectins; Lymphocyte Activation; Lymphocytes; Macrophages; Saliva; Skin Tests; Thymidine; Tritium; Tuberculin Test

Topics: Amphotericin B; Candidiasis, Vulvovaginal; Female; Humans; Mycoses; Pregnancy; Pregnancy Complications, Infectious; Vulvovaginitis

Topics: Adult; Amphotericin B; Candidiasis; Candidiasis, Vulvovaginal; Female; Humans; Sepsis

Topics: Adult; Amphotericin B; Candida; Candidiasis; Candidiasis, Cutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Feces; Female; Humans; Infant; Male; New York City; Pyelonephritis; Sputum

Topics: Amphotericin B; Candidiasis, Vulvovaginal; Female; Humans; Nystatin; Pessaries; Pregnancy; Pregnancy Complications, Infectious

Topics: Actinomycosis; Adult; Amphotericin B; Aspergillosis; Blastomycosis; Candidiasis, Vulvovaginal; Child; Cryptococcosis; Dermatomycoses; Female; Griseofulvin; Humans; Lung Diseases, Fungal; Mycetoma; Mycoses; Nails; Nocardia Infections; Nystatin; Skin Diseases; Sporotrichosis; Stilbamidines; Thallium; Tinea Pedis

Topics: Adrenal Cortex Hormones; Amphotericin B; Anesthetics, Local; Candidiasis, Vulvovaginal; Female; Gentian Violet; Humans; Lactobacillus; Male; Metronidazole; Nystatin; Pruritus Ani; Pruritus Vulvae; Trichomonas Vaginitis; Vitamin B Complex

Topics: Amphotericin B; Anti-Bacterial Agents; Candidiasis; Candidiasis, Vulvovaginal; Female; Humans; Tetracycline; Toxicology; Triamcinolone Acetonide

Topics: Amphotericin B; Antidepressive Agents; Candidiasis, Oral; Candidiasis, Vulvovaginal; Drug Therapy; Mental Disorders; Nystatin; Oral Manifestations; Toxicology; Tranquilizing Agents; Xerostomia

Topics: Amphotericin B; Anti-Bacterial Agents; Candidiasis, Vulvovaginal; Drug Therapy; Female; Humans; Tetracycline; Toxicology

Topics: Amphotericin B; Candidiasis, Vulvovaginal; Female; Humans; Protein Synthesis Inhibitors; Tetracycline; Trichomonas Vaginitis; Vaginitis; Vulvovaginitis

Topics: Administration, Cutaneous; Adolescent; Amphotericin B; Candidiasis, Cutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Child; Female; Humans; Infant; Infant, Newborn; Nystatin