nystatin-a1 and Candidiasis--Chronic-Mucocutaneous

Invasive fungal infection is an important cause of mortality and morbidity in very preterm (< 32 weeks gestation) or very low birth weight (VLBW) infants. Clinical uncertainly exists about the effect of prophylactic oral/topical non-absorbed antifungals to reduce mucocutaneous colonisation and so limit the risk of invasive fungal infection in this population.. To assess the effect of prophylactic oral/topical non-absorbed antifungal therapy on the incidence of invasive fungal infection, mortality and morbidity in VLBW infants.. The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of the Cochrane Controlled Trials Register (The Cochrane Library, Issue 2, 2009), MEDLINE (1966 - May 2009), EMBASE (1980 - May 2009), conference proceedings, and previous reviews.. Randomised controlled trials that compared the effect of prophylactic oral/topical non-absorbed antifungal therapy versus placebo or no drug or another antifungal agent or dose regimen in very preterm or VLBW infants.. Data were extracted using the standard methods of the Cochrane Neonatal Review Group with separate evaluation of trial quality and data extraction by each review author and synthesis of data using relative risk (RR) and risk difference (RD) and weighted mean difference (WMD).. Three trials, in which a total of 1625 infants participated, have compared oral/topical non-absorbed antifungal prophylaxis (nystatin or miconazole) with placebo or no drug. These trials had various methodological weaknesses including quasi-randomisation, lack of allocation concealment, and lack of blinding of intervention and outcomes assessment. The incidence of invasive fungal infection was very high in the control groups of two of the included trials. Meta-analysis found a statistically significant reduction in the incidence of invasive fungal infection [typical RR 0.19 (95% confidence interval (CI) 0.14, 0.27); typical RD -0.19 (95% CI -0.22,-0.16)] but substantial statistical heterogeneity was detected. A statistically significant effect on mortality was not found [typical RR 0.88 (95% CI 0.72, 1.06); typical RD -0.02 (95% CI -0.06, 0.01)]. Long-term outcomes were not assessed by any of the trials.One small trial (N = 21) that assessed the effect of oral/topical non-absorbed antifungal prophylaxis (nystatin) compared with systemic antifungal (fluconazole) prophylaxis was underpowered to exclude important clinical effects.. The finding of a reduction in risk of invasive fungal infection in infants treated with oral/topical non-absorbed antifungal prophylaxis should be interpreted cautiously because of methodological weaknesses in the included trials. Further large randomised controlled trials in current neonatal practice settings are needed to resolve this uncertainty. These trials might compare oral/topical non-absorbed antifungal agents with placebo, with each other, or with systemic antifungal agents and should include an assessment of effect on long-term neurodevelopmental outcomes.

Topics: Administration, Oral; Antifungal Agents; Candidiasis; Candidiasis, Chronic Mucocutaneous; Fluconazole; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Miconazole; Nystatin; Randomized Controlled Trials as Topic

Systemic fungal infection has increased in prevalence in neonatal intensive care units (NICU) caring for very low birth weight infants. It is associated with a prolonged stay and an increase in morbidity and mortality. An assessment of the use of oral prophylactic antifungals to prevent systemic infection is needed.. To assess whether the prophylactic administration of oral antifungal agents to very preterm infants reduces the occurrence of systemic fungal infection.. The standard methods of the Cochrane Collaboration and its Neonatal Review Group were used. Searches were carried out up to July 2003 on the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library Issue 2, 2003), MEDLINE from 1966, EMBASE from 1980, CINAHL from 1992. Abstracts from SPR (1993 - 2003) and ESPR (1995 to 2002) were hand searched.. Randomized and quasi randomized controlled trials in very low birth weight or very preterm infants in which an oral antifungal agent was compared with placebo or no treatment or another oral antifungal agent. Data were extracted using the standard methods of the Cochrane Neonatal Review Group, with separate evaluation of the trial quality and data extraction undertaken by each author. Results were reported using relative risk (RR) and risk difference (RD) and weighted mean difference (WMD). 95% confidence intervals were reported.. We identified three eligible trials, one comparing nystatin with no treatment (67 infants), one comparing miconazole with placebo (600 infants), and one comparing nystatin with fluconazole (21 infants). As the two trials comparing nystatin or miconazole with placebo or no treatment were clinically quite different, meta-analysis was not performed. In the trial of nystatin versus no treatment, systemic fungal infection was significantly reduced [RR 0.19 (0.04,0.78)] in the group treated with nystatin. In the study comparing miconazole with placebo there was no significant effect on systemic fungal infection [RR 1.32 (0.46,3.75)]. Neither study found a significant effect on mortality, and there was no significant difference in the mean number of days infants received ventilation or stayed in the neonatal intensive care unit. In the small trial comparing oral fluconazole with nystatin, no significant difference in systemic fungal infection [RR 0.17 (0.01, 2.84)] or mortality [RR 0.17 (0.01, 2.84)] was reported. Adverse drug reactions were not reported in any study.. There is insufficient evidence to support the use of prophylactic oral antifungal agents in very low birth weight infants in the neonatal intensive care unit. Randomised controlled trials in current neonatal practice settings are needed, comparing oral antifungal agents with placebo and with each other and including an assessment of side effects, in order to determine whether oral antifungal agents have a role in preventing systemic fungal infections in preterm infants.

Topics: Administration, Oral; Antifungal Agents; Candidiasis; Candidiasis, Chronic Mucocutaneous; Fluconazole; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Miconazole; Nystatin; Randomized Controlled Trials as Topic

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Bone Marrow Transplantation; Candidiasis; Candidiasis, Chronic Mucocutaneous; Clinical Trials as Topic; Cryptococcosis; Double-Blind Method; Fluconazole; Humans; Itraconazole; Ketoconazole; Mucormycosis; Mycoses; Neutropenia; Nystatin; Primary Prevention; Recurrence; Retrospective Studies

Topics: Administration, Oral; Antifungal Agents; Candida albicans; Candidiasis, Chronic Mucocutaneous; Candidiasis, Oral; Caspofungin; Child; Drug Resistance, Fungal; Drug Therapy, Combination; Female; Humans; Immunoglobulins, Intravenous; Mouthwashes; Mutation; Nystatin; Phagocytes; Treatment Outcome

Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is a rare autosomal recessive disease caused by mutations in the AIRE gene. We report the case of a female patient with a 967-979del13 mutation in the AIRE gene. Her medical history included autoimmune hypoparathyroidism, Addison disease, and chronic mucocutaneous candidiasis. At the age of 40, she developed multiple white verrucous plaques on the oral mucosa. Histologically, the lesions appeared as moderately differentiated squamous cell carcinomas. The patient subsequently developed multiple local recurrences and therefore required repeated surgery. Notably, a higher incidence rate of oral and esophageal squamous cell carcinoma has been observed in this syndrome. However, the critical pathogenetic pathways implicated in squamous cell carcinoma development in APECED are far from being well understood.

Topics: Adult; Amphotericin B; Antifungal Agents; Candidiasis, Chronic Mucocutaneous; Carcinoma, Squamous Cell; Female; Humans; Nystatin; Polyendocrinopathies, Autoimmune

Chronic mucocutaneous candidiasis (CMC) is a rare disorder characterized by persistent or recurrent candidal infections of the skin, nails and mucous membranes or by a variable combination of endocrine failure as well as immunodeficiency. Oral clinicopathological features of CMC have seldom been described in detail.. Seven patients with CMC were reported in the study. The clinical and histological findings, etiological Candida species, immunological evaluation, and therapeutic pattern of oral lesions, were analyzed.. Long-standing whitish hyperplastic and nodule-like lesions with exaggerated deep fissure were the typical and characteristic oral manifestations presented by all patients. The tongue was the most common site affected. Histologically, no obvious distinction was found between CMC and other forms of candidal infection. Abnormal proportions of T-lymphocyte subsets and positive titers of autoantibody were observed in three subjects (42.9%) and one patient (14.3%) respectively. Meanwhile, four subjects (57.1%) showed decreased albumin and increased globulin, three cases (42.9%) had high levels of ESR. But no iron deficiency was found. Candida albicans was the microorganism isolated from these patients.. Multiple and widespread candidal infectious lesions can be observed on the oral cavity of CMC patients. Hyperplastic and nodule-like lesion with irremovable whitish patches and deep fissure are the most common oral manifestations of these patients. Dentists, otolaryngologists and pediatricians should be familiar with the clinical appearances of CMC to make an accurate diagnosis. Potential systemic disorders should be concerned to avoid the reoccurrence of oral candidiasis.

Topics: Adult; Antifungal Agents; Candida albicans; Candidiasis, Chronic Mucocutaneous; Candidiasis, Oral; Child; Female; Fluconazole; Humans; Male; Middle Aged; Mouth Mucosa; Nystatin

Topics: Aged; Antifungal Agents; Candidiasis, Chronic Mucocutaneous; Dental Caries; Excipients; Humans; Male; Nystatin; Sucrose; Suspensions; Tracheal Diseases; Xerostomia

Topics: Candidiasis; Candidiasis, Chronic Mucocutaneous; Child, Preschool; Humans; Ketoconazole; Male; Nystatin

Four cases of familial mucocutaneous candidiasis corresponding to two families were studied. In two of the cases (Family I), there were lesions in the mouth, vaginal mucosa, nails, palms and soles, with no other associated infections. In the other two cases (Family II) there were oral (glossitis with macroglossia), genital and inguinal folds lesions, associated to frequent bacterial infections (recurring forunculosis , pneumonia). The immunological study in the four cases showed overlapping results: anti-candida circulating antibodies at high dilutions, a negative or weakly positive candidine a negative TTL to candida in some of the cases, and not other abnormalities in T. lymphocytes. All of the cases became sensitive to DNCB. In two of them, there were low figures of ferritin (Family II); however, no improvement was obtained with an iron treatment. There were no endocrinological abnormalities in any case. All of the cases were cured with ketoconazole in a few months, and no relapse was found six months after the end of the treatment in one of them. A follow up could not be performed on the other three cases.

Topics: Adolescent; Adult; Amphotericin B; Candidiasis; Candidiasis, Chronic Mucocutaneous; Consanguinity; Female; Humans; Ketoconazole; Male; Nystatin; Pedigree

Two groups of 70 newborns each, all from diabetic mothers with and without nystatin prophylaxis, were compared, during the first three weeks of age, for incidence of mucocutaneous Candida albicans contamination (17 or 30 per cent) and for moniliasis (17 per cent in the group without prophylaxis and 71 per cent with Candida albicans contamination). Reference is made to modes of birth for comparison between pathogenesis and incidence of moniliasis and the need for prophylaxis of newborns delivered by diabetic mothers or by women with intact metabolism.

Topics: Candidiasis; Candidiasis, Chronic Mucocutaneous; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Nystatin; Pregnancy; Pregnancy in Diabetics

Topics: Achondroplasia; Amphotericin B; Bronchiectasis; Candidiasis, Chronic Mucocutaneous; Candidiasis, Cutaneous; Child; Granuloma; Humans; Injections, Intravenous; Nystatin; Organic Chemicals; Pathology