RESUMO
Candida auris is a pathogenic yeast frequently exhibiting multidrug resistance and thus warrants special attention. The prompt detection and proper identification of this organism are needed to prevent its spread in healthcare facilities. The authors of this paper had previously developed LAMPAuris, a loop-mediated isothermal amplification assay, for the specific detection of C. auris. LAMPAuris is evaluated in this report for its ability to identify C. auris from five clades and to detect it from clinical specimens. A total of 103 skin swab samples were tested in comparison with a culture-based method and C. auris-specific SYBR green qPCR. The results show that the LAMPAuris assay had specificities ranging from 97 to 100% and sensitivities ranging from 66 to 86%. The lower sensitivity could be attributed to DNA degradation caused by the prolonged storage of the samples. In conclusion, LAMPAuris proved to be a rapid and reliable method for identifying C. auris and for detecting it in clinical specimens. Fresh specimens should ensure better yield and higher sensitivities.
Assuntos
Candida auris , Candidíase , Técnicas de Diagnóstico Molecular , Técnicas de Amplificação de Ácido Nucleico , Sensibilidade e Especificidade , Humanos , Técnicas de Diagnóstico Molecular/métodos , Técnicas de Amplificação de Ácido Nucleico/métodos , Candidíase/diagnóstico , Candidíase/microbiologia , Candida auris/genética , Candida auris/isolamento & purificação , Pele/microbiologia , Fatores de Tempo , Candida/isolamento & purificação , Candida/genética , Candida/classificaçãoRESUMO
Fungal pathogens within the urine, specifically Candida species, are a common finding amongst hospitalized patients. Risk factors for the development of candiduria involve patients with indwelling urinary drainage devices, surgical patients, patients undergoing urologic instrumentation, and diabetic patients. Candiduria often presents with an asymptomatic course but can also be a severe life-threatening process. This article will review the epidemiology and risk factors associated with fungal urinary tract infections, and the diagnosis and categorization of these infections along with a review of current medical and surgical treatments for this condition.
Assuntos
Antifúngicos , Infecções Urinárias , Humanos , Infecções Urinárias/terapia , Infecções Urinárias/diagnóstico , Infecções Urinárias/microbiologia , Infecções Urinárias/epidemiologia , Antifúngicos/uso terapêutico , Candidíase/epidemiologia , Candidíase/diagnóstico , Candidíase/terapia , Fatores de RiscoAssuntos
Balanite (Inflamação) , Candida albicans , Foliculite , Humanos , Balanite (Inflamação)/microbiologia , Balanite (Inflamação)/diagnóstico , Balanite (Inflamação)/patologia , Foliculite/microbiologia , Foliculite/patologia , Foliculite/diagnóstico , Candida albicans/isolamento & purificação , Masculino , Candidíase/microbiologia , Candidíase/diagnóstico , Antifúngicos/uso terapêutico , AdultoRESUMO
This case report discusses a rare instance of polymicrobial pericarditis in a man in his early 60s with a history of substance abuse. The patient presented with chest pain and shortness of breath, later diagnosed as pericarditis caused by Streptococcus anginosus, S. intermedius and Candida glabrata, likely originating from a large adjacent oesophageal ulcer. The condition led to critical illness, requiring pericardiocentesis, antibiotic and antifungal therapy. Despite initial improvement, the patient experienced recurrence and ultimately underwent pericardectomy. The article emphasises the rarity and severity of polymicrobial pericarditis, often associated with high mortality. It underscores the importance of prompt recognition, broad-spectrum antibiotics and source control, particularly when the gastrointestinal tract is implicated. The case highlights the challenges in managing such cases and the potential need for surgical intervention for optimal outcomes.
Assuntos
Candida glabrata , Candidíase , Doenças do Esôfago , Pericardite , Úlcera , Humanos , Masculino , Pericardite/microbiologia , Pericardite/diagnóstico , Candidíase/complicações , Candidíase/diagnóstico , Candidíase/microbiologia , Candidíase/tratamento farmacológico , Úlcera/microbiologia , Candida glabrata/isolamento & purificação , Doenças do Esôfago/microbiologia , Streptococcus anginosus/isolamento & purificação , Antibacterianos/uso terapêutico , Pessoa de Meia-Idade , Streptococcus intermedius/isolamento & purificação , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Antifúngicos/uso terapêutico , Translocação Bacteriana , Coinfecção , Pericardiocentese , PericardiectomiaRESUMO
Hepatosplenic candidiasis (HSC) is a rare type of candidiasis that can occur in patients with hematologic malignancies, hematopoietic stem cell transplantation. At present, there is still a lack of studies on HSC in patients with hematologic disorders. Based on The Chinese Guidelines for the Diagnosis and Treatment of Invasive Fungal Disease in Patients with Hematological Disorders and Cancers (the 6th revision), We retrospectively analyzed the clinical characteristics and prognosis of patients with HSC treated in Peking University Institute of Hematology from 2008 to 2022. Finally, eighteen patients were included, with 1 (5.6%) proven, 2 (11.1%) probable, and 15 (83.3%) possible HSC. Among them, 3 (16.7%) patients occurred after haploid hematopoietic stem cell transplantation and 15 (83.3%) patients occurred after chemotherapy. 6 (33.3%) patients had positive blood cultures, including 4 cases of Candida tropicalis and 2 cases of Candida albicans. At 4 weeks of antifungal therapy, 10 (58.8%) patients achieved partial response (PR), At 8 weeks, 1 (6.3%) patients achieved complete response and 10 (62.5%) patients achieved PR. At 6 months after diagnosis, 3 (16.7%) patients died of hematopoietic recurrence, and none of them died of HSC. As a rare fungal infection disease, HSC has a low positive rate of microbiological and histological examinations, a persistent treat cycle, and has difficulty in remission, reminding us of the need for vigilance in patients with hematopoietic disorders and persistent fever.
Assuntos
Candidíase , Esplenopatias , Humanos , Estudos Retrospectivos , Prognóstico , Masculino , Feminino , Pessoa de Meia-Idade , Candidíase/diagnóstico , Adulto , Adulto Jovem , Esplenopatias/diagnóstico , Esplenopatias/microbiologia , Esplenopatias/etiologia , Adolescente , Idoso , Transplante de Células-Tronco Hematopoéticas , Doenças Hematológicas/complicações , Hepatopatias/microbiologia , Hepatopatias/diagnósticoRESUMO
Candida auris is considered a nosocomial pathogen of high concern and is currently spreading across the United States. Infection control measures for C. auris focus mainly on healthcare facilities, yet transmission levels may already be significant in the community before outbreaks are detected in healthcare settings. Wastewater-based epidemiology (culture, quantitative PCR, and whole-genome sequencing) can potentially gauge pathogen transmission in the general population and lead to early detection of C. auris before it is detected in clinical cases. To learn more about the sensitivity and limitations of wastewater-based surveillance, we used wastewater-based methods to detect C. auris in a southern Utah jurisdiction with no known clinical cases before and after the documented transfer of colonized patients from bordering Nevada. Our study illustrates the potential of wastewater-based surveillance for being sufficiently sensitive to detect C. auris transmission during the early stages of introduction into a community.
Assuntos
Candida auris , Candidíase , Águas Residuárias , Humanos , Utah/epidemiologia , Candidíase/epidemiologia , Candidíase/microbiologia , Candidíase/transmissão , Candidíase/diagnóstico , Águas Residuárias/microbiologia , Candida auris/genética , História do Século XXI , Vigilância Epidemiológica Baseada em Águas Residuárias , Sequenciamento Completo do Genoma , Candida/genética , Candida/isolamento & purificação , Candida/classificaçãoRESUMO
INTRODUCTION: Candida auris is an emerging pathogen and human health threat. However, diagnosis and treatment of fungal infection due to C. auris are challenging. OBJECTIVE: This narrative review provides a focused overview of C. auris for the emergency clinician. DISCUSSION: C. auris was first identified in 2009 and is currently present on all continents except Antarctica. C. auris possesses multiple genetic factors resulting in antimicrobial resistance, increased virulence and survival within the host, and environmental adaptation. It is readily transmitted from person to person and from the environment to a person, resulting in colonization. Infection may develop days to months following colonization, most commonly in those with immunocompromised state, significant comorbidities or other underlying conditions, healthcare exposure, and recent antimicrobial therapy. Candidemia, device infection (e.g., central venous catheter), soft tissue or wound infection, burn infection, osteomyelitis, myocarditis, meningitis, and urinary tract infection have been associated with C. auris. Samples should be obtained from the suspected site of infection for microbiological culture. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) with reference databases to differentiate C. auris from other species is optimal for diagnosis, though other molecular testing methods are available. Treatment is challenging due to antifungal resistance, with over 90% resistant to fluconazole. Echinocandins are most commonly used as the first line therapy. Prevention of colonization and infection are vital and include screening in high-risk populations and strict adherence to infection prevention practices with contact precautions and hand hygiene, as well as appropriate decontamination of patient areas. CONCLUSION: An understanding of C. auris can assist emergency clinicians in the care of infected or colonized patients.
Assuntos
Antifúngicos , Candida auris , Candidíase , Humanos , Antifúngicos/uso terapêutico , Candidíase/tratamento farmacológico , Candidíase/diagnóstico , Candidíase/microbiologia , Candida auris/efeitos dos fármacosAssuntos
Abscesso , Candida albicans , Candidíase , Stents , Humanos , Stents/efeitos adversos , Candidíase/microbiologia , Candidíase/diagnóstico , Candida albicans/isolamento & purificação , Abscesso/microbiologia , Abscesso/diagnóstico por imagem , Masculino , Nefropatias/microbiologia , Tomografia Computadorizada por Raios X , Pessoa de Meia-IdadeRESUMO
Here we present the case of a 23-year-old female with a history of onychomycosis and oral thrush since childhood. She presented with a gradual onset of headache, and cerebrospinal fluid (CSF) analysis on admission revealed an elevated mononuclear cell count. Hydrocephalus was observed on brain MRI. Candida albicans (C. albicans) was detected in the CSF, and antifungal treatment was initiated to diagnose of Candida meningitis. Due to an insufficient therapeutic response, intraventricular administration of liposomal amphotericin B initiated; however, the lesions persisted. Subsequently, the patient experienced repeated occlusions of the ventriculoperitoneal shunt tube, ultimately dying from a bacterial shunt infection. Autopsy findings revealed diffuse fungal proliferation on the surface of the brainstem and ventricular walls. Genetic testing confirmed a diagnosis of CARD9 deficiency. Although CARD9 deficiency is a rare disease, genetic testing should be considered when primary immunodeficiency is suspected.
Assuntos
Autopsia , Proteínas Adaptadoras de Sinalização CARD , Candida albicans , Meningite Fúngica , Humanos , Feminino , Meningite Fúngica/diagnóstico , Meningite Fúngica/etiologia , Proteínas Adaptadoras de Sinalização CARD/genética , Proteínas Adaptadoras de Sinalização CARD/deficiência , Adulto Jovem , Candida albicans/isolamento & purificação , Candida albicans/genética , Evolução Fatal , Candidíase/diagnóstico , Candidíase/complicações , Doenças da Imunodeficiência Primária/complicações , Doenças da Imunodeficiência Primária/diagnóstico , Derivação Ventriculoperitoneal , Anfotericina B/administração & dosagem , Doenças Raras , Imageamento por Ressonância MagnéticaRESUMO
Fungi rarely cause infective endocarditis but when they do, they are often associated with poor outcomes. Candida tropicalis accounts for only 10% of Candida endocarditis cases. A case of a 30-year-old male with a history of intravenous drug abuse was reported to the emergency department in August, 2021 with right-sided leg pain and fever for 3 days. A trans-thoracic echocardiogram showed a vegetation on the aortic valve and a computed tomography angiogram showed complete nonopacification of the right-sided common iliac artery and the superficial femoral artery just distal to its branching of the right profunda femoris artery. An emergent right iliofemoral embolectomy was done. Candida tropicalis was isolated from tissue and blood cultures. The patient was successfully treated with aortic valve replacement and intravenous caspofungin. The other reported cases of Candida tropicalis were reviewed and findings were compared with those reported in patients with Candida albicans and Candida parapsilosis endocarditis.
Assuntos
Antifúngicos , Candida tropicalis , Candidíase , Endocardite , Humanos , Candida tropicalis/isolamento & purificação , Masculino , Adulto , Antifúngicos/uso terapêutico , Candidíase/diagnóstico , Candidíase/microbiologia , Candidíase/tratamento farmacológico , Endocardite/microbiologia , Endocardite/diagnóstico , Endocardite/tratamento farmacológico , Caspofungina/uso terapêutico , Abuso de Substâncias por Via Intravenosa/complicações , Implante de Prótese de Valva Cardíaca , Embolectomia/métodos , Valva Aórtica/cirurgia , Valva Aórtica/microbiologia , Valva Aórtica/diagnóstico por imagem , Artéria Femoral/cirurgia , Artéria Femoral/microbiologia , Artéria Femoral/diagnóstico por imagemRESUMO
PURPOSE: This study aimed to develop a double antigen sandwich ELISA (DAgS-ELISA) method for more efficient, accurate, and quantitative detection of total antibodies against Candida albicans enolase1 (CaEno1) for diagnosing invasive candidiasis (IC). METHODS: DAgS-ELISA was developed using recombinant CaEno1 and a monoclonal antibody as the standard. Performance evaluation included limit of detection, accuracy, and repeatability. Dynamic changes in antibody levels against CaEno1 in serum from systemic candidiasis mice were analyzed using DAgS-ELISA. Patient serum samples from IC, Candida colonization, bacterial infections, and healthy controls were analyzed with DAgS-ELISA and indirect ELISA. RESULTS: DAgS-ELISA outperformed indirect ELISA in terms of linear range and test background. In systemic candidiasis mice, a distinctive 'double-peak' pattern in dynamic antibody levels was observed. Additionally, there was a high level of consistency in the positive rates of CaEno1 antibodies detected by both DAgS-ELISA and indirect ELISA. While the positivity rates differed among patient groups, no significant variations in antibody levels were detected among the various positive patient groups. CONCLUSIONS: DAgS-ELISA offers a reliable novel approach for IC diagnosis, enabling rapid, accurate, and quantitative detection of CaEno1 antibodies. Further validation and optimization are needed for its clinical application and effectiveness.
Assuntos
Anticorpos Antifúngicos , Candida albicans , Ensaio de Imunoadsorção Enzimática , Fosfopiruvato Hidratase , Ensaio de Imunoadsorção Enzimática/métodos , Animais , Fosfopiruvato Hidratase/imunologia , Fosfopiruvato Hidratase/sangue , Candida albicans/imunologia , Anticorpos Antifúngicos/sangue , Camundongos , Humanos , Candidíase Invasiva/diagnóstico , Candidíase Invasiva/imunologia , Candidíase Invasiva/sangue , Feminino , Candidíase/diagnóstico , Candidíase/sangue , Candidíase/imunologia , Antígenos de Fungos/imunologia , Antígenos de Fungos/sangue , Sensibilidade e Especificidade , Proteínas Fúngicas/imunologia , Anticorpos Monoclonais/imunologia , Camundongos Endogâmicos BALB CRESUMO
Due to large outbreaks observed worldwide, Candida auris has emerged as a major threat to healthcare facilities. To prevent these phenomena, a systematic screening should be performed in patients transferred from regions where the pathogen is highly endemic. In this study, we recorded and analyzed French mycologists' current knowledge and practice regarding C. auris screening and diagnosis. Thirty-six centers answered an online questionnaire. Only 11 (30.6 %) participants were aware of any systematic screening for C. auris for patients admitted to their hospital. In the case of post-admission screening, axillae/groins (n = 21), nares (n = 7), rectum (n = 9), and mouth (n = 6) alone or various combinations were the body sites the most frequently sampled. Only six centers (8.3 %) reported using a commercially available plate allowing the differentiation of C. auris colonies from that of other Candida species, while five laboratories (13.8 %) had implemented a C. auris-specific qPCR. Considering the potential impact on infected patients and the risk of disorganization in the care of patients, it is crucial to remember to biologists and clinicians the utmost importance of systematic screening on admission.
Assuntos
Candida auris , Candidíase , Programas de Rastreamento , Humanos , França/epidemiologia , Inquéritos e Questionários , Candidíase/diagnóstico , Candidíase/epidemiologia , Candidíase/microbiologia , Programas de Rastreamento/métodos , Candida auris/efeitos dos fármacos , Candida auris/genética , Candida auris/isolamento & purificação , Conhecimentos, Atitudes e Prática em Saúde , Micologia/métodos , Sociedades Médicas , Candida/isolamento & purificação , Candida/efeitos dos fármacos , Candidíase InvasivaRESUMO
A 6-month-old male intact miniature Australian Shepherd presented for surgical consultation for a previously diagnosed patent ductus arteriosus. Echocardiogram revealed a patent ductus arteriosus and a hyperechoic oscillating lesion within the main pulmonary artery. Blood cultures and eventual post-mortem examination revealed Candida tropicalis endocarditis. This case report highlights a rare case of fungal endocarditis with both echocardiographic and post-mortem findings.
Assuntos
Candida tropicalis , Candidíase , Doenças do Cão , Permeabilidade do Canal Arterial , Permeabilidade do Canal Arterial/veterinária , Permeabilidade do Canal Arterial/complicações , Animais , Masculino , Candida tropicalis/isolamento & purificação , Doenças do Cão/microbiologia , Doenças do Cão/diagnóstico , Doenças do Cão/diagnóstico por imagem , Cães , Candidíase/veterinária , Candidíase/diagnóstico , Endocardite/veterinária , Endocardite/diagnóstico , Endocardite/microbiologia , Endocardite/diagnóstico por imagem , Ecocardiografia/veterinária , Evolução FatalRESUMO
Candida auris is a multidrug-resistant fungal pathogen with a propensity to colonize humans and persist on environmental surfaces. C. auris invasive fungal disease is being increasingly identified in acute and long-term care settings. We have developed a prototype cartridge-based C. auris surveillance assay (CaurisSurV cartridge; "research use only") that includes integrated sample processing and nucleic acid amplification to detect C. auris from surveillance skin swabs in the GeneXpert instrument and is designed for point-of-care use. The assay limit of detection (LoD) in the skin swab matrix was 10.5 and 14.8 CFU/mL for non-aggregative (AR0388) and aggregative (AR0382) strains of C. auris, respectively. All five known clades of C. auris were detected at 2-3-5× (31.5-52.5 CFU/mL) the LoD. The assay was validated using a total of 85 clinical swab samples banked at two different institutions (University of California Los Angeles, CA and Wadsworth Center, NY). Compared to culture, sensitivity was 96.8% (30/31) and 100% (10/10) in the UCLA and Wadsworth cohorts, respectively, providing a combined sensitivity of 97.5% (40/41), and compared to PCR, the combined sensitivity was 92% (46/50). Specificity was 100% with both clinical (C. auris negative matrix, N = 31) and analytical (non-C. auris strains, N = 32) samples. An additional blinded study with N = 60 samples from Wadsworth Center, NY yielded 97% (29/30) sensitivity and 100% (28/28) specificity. We have developed a completely integrated, sensitive, specific, and 58-min prototype test, which can be used for routine surveillance of C. auris and might help prevent colonization and outbreaks in acute and chronic healthcare settings. IMPORTANCE: This study has the potential to offer a better solution to healthcare providers at hospitals and long-term care facilities in their ongoing efforts for effective and timely control of Candida auris infection and hence quicker response for any potential future outbreaks.
Assuntos
Candida auris , Candidíase , Sensibilidade e Especificidade , Humanos , Candidíase/diagnóstico , Candidíase/microbiologia , Candida auris/genética , Controle de Infecções/métodos , Monitoramento Epidemiológico , Pele/microbiologia , Limite de Detecção , Sistemas Automatizados de Assistência Junto ao Leito , Técnicas de Amplificação de Ácido Nucleico/métodos , Técnicas de Diagnóstico Molecular/métodos , Candida/isolamento & purificação , Candida/genética , Candida/classificaçãoRESUMO
Candida auris (C. auris) was first discovered in Japan in 2009 and has since spread worldwide. It exhibits strong transmission ability, high multidrug resistance, blood infectivity, and mortality rates. Traditional diagnostic techniques for C. auris have shortcomings, leading to difficulty in its timely diagnosis and identification. Therefore, timely and accurate diagnostic assays for clinical samples are crucial. We developed a novel, rapid recombinase-aided amplification (RAA) assay targeting the 18S rRNA, ITS1, 5.8S rRNA, ITS2, and 28S rRNA genes for C. auris identification. This assay can rapidly amplify DNA at 39 °C in 20 min. The analytical sensitivity and specificity were evaluated. From 241 clinical samples collected from pediatric inpatients, none were detected as C. auris-positive. We then prepared simulated clinical samples by adding 10-fold serial dilutions of C. auris into the samples to test the RAA assay's efficacy and compared it with that of real-time PCR. The assay demonstrated an analytical sensitivity of 10 copies/µL and an analytical specificity of 100%. The lower detection limit of the RAA assay for simulated clinical samples was 101 CFU/mL, which was better than that of real-time PCR (102-103 CFU/mL), demonstrating that the RAA assay may have a better detection efficacy for clinical samples. In summary, the RAA assay has high sensitivity, specificity, and detection efficacy. This assay is a potential new method for detecting C. auris, with simple reaction condition requirements, thus helping to manage C. auris epidemics.
Assuntos
Candida auris , Técnicas de Amplificação de Ácido Nucleico , Recombinases , Técnicas de Amplificação de Ácido Nucleico/métodos , Humanos , Recombinases/metabolismo , Candida auris/genética , Candidíase/diagnóstico , Candidíase/microbiologia , Limite de Detecção , DNA Fúngico/genética , DNA Fúngico/análiseRESUMO
Invasive candidiasis (IC) is a notable healthcare-associated fungal infection, characterized by high morbidity, mortality, and substantial treatment costs. Candida albicans emerges as a principal pathogen in this context. Recent academic advancements have shed light on the critical role of exosomes in key biological processes, such as immune responses and antigen presentation. This burgeoning body of research underscores the potential of exosomes in the realm of medical diagnostics and therapeutics, particularly in relation to fungal infections like IC. The exploration of exosomal functions in the pathophysiology of IC not only enhances our understanding of the disease but also opens new avenues for innovative therapeutic interventions. In this investigation, we focus on exosomes (Exos) secreted by macrophages, both uninfected and those infected with C. albicans. Our objective is to extract and analyze these exosomes, delving into the nuances of their protein compositions and subgroups. To achieve this, we employ an innovative technique known as Proximity Barcoding Assay (PBA). This methodology is pivotal in our quest to identify novel biological targets, which could significantly enhance the diagnostic and therapeutic approaches for C. albicans infection. The comparative analysis of exosomal contents from these two distinct cellular states promises to yield insightful data, potentially leading to breakthroughs in understanding and treating this invasive fungal infection. In our study, we analyzed differentially expressed proteins in exosomes from macrophages and C. albicans -infected macrophages, focusing on proteins such as ACE2, CD36, CAV1, LAMP2, CD27, and MPO. We also examined exosome subpopulations, finding a dominant expression of MPO in the most prevalent subgroup, and a distinct expression of CD36 in cluster14. These findings are crucial for understanding the host response to C. albicans and may inform targeted diagnostic and therapeutic approaches. Our study leads us to infer that MPO and CD36 proteins may play roles in the immune escape mechanisms of C. albicans. Additionally, the CD36 exosome subpopulations, identified through our analysis, could serve as potential biomarkers and therapeutic targets for C. albicans infection. This insight opens new avenues for understanding the infection's pathology and developing targeted treatments.
Assuntos
Biomarcadores , Antígenos CD36 , Candida albicans , Candidíase , Exossomos , Macrófagos , Exossomos/metabolismo , Biomarcadores/metabolismo , Macrófagos/metabolismo , Macrófagos/microbiologia , Macrófagos/imunologia , Antígenos CD36/metabolismo , Candidíase/diagnóstico , Candidíase/microbiologia , Candidíase/metabolismo , Candidíase/imunologia , Humanos , Animais , CamundongosRESUMO
Candida auris is a multidrug-resistant fungal pathogen that is associated with nosocomial outbreaks in patients with extensive health care exposure and treatment outside the United States. The Ohio Department of Health recommends C auris screening in high-risk patients. However, this can be operationally difficult for many health care facilities. This report describes a C auris and carbapenem-resistant Enterobacterales inpatient screening program done in collaboration with state public health.
Assuntos
Candida auris , Candidíase , Infecção Hospitalar , Pacientes Internados , Humanos , Candidíase/tratamento farmacológico , Candidíase/diagnóstico , Candidíase/microbiologia , Ohio , Infecção Hospitalar/microbiologia , Candida auris/efeitos dos fármacos , Programas de Rastreamento/métodos , Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/diagnóstico , Infecções por Enterobacteriaceae/microbiologiaRESUMO
The aetiology of chronic aseptic meningitis is difficult to establish. Candida meningitis in particular is often diagnosed late, as cerebrospinal fluid (CSF) work-up and imaging findings are nonspecific. A 35-year-old patient with chronic aseptic meningitis, for which repeated microbiological testing of CSF was unrevealing, was finally diagnosed with Candida albicans (C. albicans) meningitis with cauda equina involvement using metagenomic next-generation sequencing (mNGS). This report highlights the diagnostic challenges and the difficulties of treating shunt-associated fungal meningitis.
Assuntos
Candida albicans , Sequenciamento de Nucleotídeos em Larga Escala , Meningite Fúngica , Metagenômica , Humanos , Adulto , Candida albicans/genética , Candida albicans/isolamento & purificação , Meningite Fúngica/diagnóstico , Meningite Fúngica/microbiologia , Meningite Fúngica/tratamento farmacológico , Metagenômica/métodos , Candidíase/diagnóstico , Candidíase/microbiologia , Candidíase/líquido cefalorraquidiano , Masculino , Doença Crônica , Antifúngicos/uso terapêutico , Meningite Asséptica/diagnósticoRESUMO
Candida auris is a multidrug-resistant opportunistic fungal pathogen capable of causing serious infections and healthcare-associated outbreaks. Screening for colonization with C. auris has become routine and is recommended in many hospitals and healthcare facilities as an infection control and prevention strategy. Subsequently, and since there are currently no FDA-approved tests for this purpose, clinical microbiology laboratories have become responsible for developing protocols to detect C. auris using axial and inguinal screening swabs. In a College of American Pathologists-accredited large academic healthcare center setting, we implemented a laboratory-developed nucleic-acid amplification test for the detection of C. auris DNA. Our test validation evaluated the performance of the DiaSorin C. auris primer set used in a real-time qualitative PCR assay on the LIAISON MDX thermocycler with the Simplexa Universal Disc. The assay was highly sensitive and specific, with a limit of detection of 1-2 CFU/reaction, with no observed cross-reactivity with other Candida spp., bacterial skin commensal organisms or commonly encountered viruses. When run in parallel with a culture-based detection method, the PCR assay was 100% sensitive and specific. The assay was precise, with low variability between replicates within and between runs. Lastly, pre-analytical factors, including swab storage time, temperature, and transport media, were assessed and found to have no significant effect on the detection of C. auris at variable concentrations. Taken together, this study expands the available options for nucleic acid detection of C. auris and characterizes pre-analytical factors for implementation in both high- and low-volume laboratory settings. IMPORTANCE: This study overviews the validation and implementation of a molecular screening tool for the detection of Candida auris in a College of American Pathologist-accredited clinical laboratory. This molecular laboratory-developed test is both highly sensitive and specific and has significant health-system cost-savings associated with significantly reduced turn-around-time compared to traditional standard-of-care culture-based work up. This method and workflow is of interest to support clinical microbiology diagnostics and to help aid in hospital inpatient, and infection prevention control screening.