RESUMEN
Candidiasis is a major challenge among renal transplant recipients (RTRs) worldwide and is associated with high morbidity and mortality rates. Fluconazole is the most commonly used agent for Candida infections. However, frequent relapse and treatment failure are still reported among patients affected with this infection. In the present study, Candida species obtained from RTRs were characterized based on conventional and molecular assays. Furthermore, the antifungal susceptibility profiles of these species were determined. This study was conducted on a total of 126 RTRs within 2012-2016. The patients were categorized according to the referenced diagnostic criteria. The identification of Candida species was accomplished based on conventional examination, assimilation profile test, and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The minimum inhibitory concentrations (MICs) of amphotericin B, fluconazole, itraconazole, voriconazole, posaconazole, and caspofungin were determined based on the guidelines of Clinical and Laboratory Standards Institute. The patients with Candida infection were diagnosed with urinary tract candidiasis (nâ¯=â¯17), peritonitis (nâ¯=â¯8), intra-abdominal candidiasis (nâ¯=â¯6), candidemia (nâ¯=â¯4), hepatosplenic candidiasis (nâ¯=â¯3), and Candida pneumonia (nâ¯=â¯3). A total of 41 Candida isolates, including C. albicans (nâ¯=â¯18), C. famata (nâ¯=â¯8), C. kefyr (nâ¯=â¯4), C. tropicalis (nâ¯=â¯4), C. parapsilosis (nâ¯=â¯3), C. glabrata (nâ¯=â¯2), and C. lusitaniae (nâ¯=â¯2), were isolated from 32.5% (41/126) renal transplant recipients. Fluconazole-resistance was observed in seven isolates, entailing C. albicans (nâ¯=â¯6) and C. tropicalis (nâ¯=â¯1). Fluconazole MIC for C. lusitaniae isolates was above the epidemiologic cut-off value (4-16⯵g/ml). Furthermore, MIC range values of fluconazole against C. famata and C. kefyr were obtained as 4-32⯵g/ml and 4-8⯵g/ml, respectively. Posaconazole exhibited potent activity against Candida isolates, followed by caspofungin. The identification of Candida species, together with susceptibility testing, provides important data about the geographic trends of the fluconazole-resistance profiles of Candida species. It is necessary to maintain a consistent method for the implementation of early diagnosis and adoption of treatment regimen.
Asunto(s)
Antifúngicos/farmacología , Candida/clasificación , Candida/efectos de los fármacos , Candidiasis/microbiología , Trasplante de Riñón , Receptores de Trasplantes , Adolescente , Adulto , Candida/genética , Candida/aislamiento & purificación , Candidiasis/patología , Niño , Preescolar , Femenino , Genotipo , Humanos , Lactante , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Polimorfismo de Longitud del Fragmento de Restricción , Adulto JovenRESUMEN
AIM: The purpose of this study was to assess differences in persons of a Hot or Cold nature (according to traditional Iranian medicine), in terms of changes in their neuroendocrine and immune systems. MATERIALS AND METHODS: Thirty-seven (37) male volunteers (20-40 years old) were divided into two groups, by whether they had a Hot or Cold nature. In addition, the Warmth/Coldness ratio of all the volunteers was assessed. Plasma concentrations of epinephrine, norepinephrine and cortisol, and also the concentrations of interferon (IFN)-gamma and interleukin (IL)-4 produced by peripheral blood mononuclear cells stimulated by mitogen were measured. RESULTS: The results showed that norepinephrine/epinephrine and norepinephrine/cortisol ratios were significantly higher, and that there was a borderline significantly increased IL-4/IFN-gamma ratio in the Hot nature group compared with those in the Cold nature group. In addition, there was a significant linear positive correlation between the norepinephrine/epinephrine and Warmth/Coldness ratios and a significant nonlinear association between the IL-4/IFN-gamma and Warmth/Coldness ratios. CONCLUSIONS: It can be deduced that the persons of a Hot nature had more sympathetic nervous system activity, less adrenal sympathetic, adrenal corticosteroid, and parasympathetic nervous system activities and more deviation of the immune system toward T-helper (Th)2 responses than the persons of a Cold nature. Moreover, the activity of the sympathetic nervous system was increased and adrenal sympathetic was decreased with an increasing Warmth/Coldness ratio. Furthermore, when the person's nature veered toward extreme Warmth or extreme Coldness, the deviation of the immune system toward Th2-like responses was greater, but this increased deviation was much more marked when veering toward extreme Warmth than toward extreme Coldness.