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Resistance (AMR) in Candida glabrata reaching epic proportions

January 28 2014

Chinese researchers this month report a 14% rate of caspofungin resistance in Candida glabrata, an organism that is also fluconazole resistant. In 67 intensive care units in China, 389 isolates of Candida from 244 patients were susceptibility testing using CLSI M27-A3 methodology. 50 isolates were C. glabrata and over 50% had fluconazole MICs of > 4mg/L (all either susceptible dose-dependent or resistant) and 14% had elevated caspofungin MICs (0.25mg/L). These multidrug resistant isolates would be clinically responsive to amphotericin B (and possibly flucytosine) only. These data mirror the emergence of fluconazole and echinocandin resistant C. glabrata in the US, well illustrated by the experience at Duke University hospital. Over several years resistance to the echinocandins in C. glabrata climbed to 13% (figure below showing caspofungin resistance rates).
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Epidemiology of candidemia in Qatar using MALDI-TOF mass spectrometry

January 23 2014

Blood stream infections due to Candida species are the predominant group of hospitalised fungal infections often with high morbidity where there is serious underlying disease. Candida species other than C. albicans are increasingly implicated. Identification of the species is crucial as there is a large difference in antifungal resistance amongst Candida species. The epidemiology, risk factors, demographics and clinical outcomes were analysed for patients with candidaemia admitted to a tertiary-care hospital in Qatar. This was the largest epidemiological study of its kind in the Gulf region, and the third ever in the Middle East. The retrospective analysis applied to patients admitted between 2004 and 2010 to a single centre, utilising novel molecular identification and MALDI-TOF mass spectrometry. There was excellent correlation and concordance between results obtained with molecular identification and MALDI-TOF when compared to conventional identification methods.
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Study confirms that Mycology research in UK is badly underfunded

January 14 2014

The first study to present detailed, systematically collected data and rigorously quantify funding, related to mycology research investments made to UK institutions from 1997-2010, has just been published in the BMJ Open journal (Head M et al). The results highlight clear gaps in the UK research portfolio and illustrate some priority areas for funders and policymakers. Of 6165 funded ‘infection’ studies, 171 studies related to mycology (total investment £48.4 million, 1.9% of all infection research, with mean annual funding £3.5 million). Studies related to global health represented 5.1% of this funding (£2.4 million, compared with 35.6% of all infectious diseases). Leading funders were the Biotechnology and Biological Sciences Research Council (£14.8 million, 30.5%) and Wellcome Trust (£12.0 million, 24.7%). Preclinical studies received £42.2 million (87.3%), with clinical trials, intervention studies and implementation research in total receiving £6.2 million (12.7%). By institution, University of Aberdeen received most funding (£16.9 million, 35%). Studies investigating antifungal resistance received £1.5 million (3.2%).
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RT PCR evaluation proves to be a sensitive method for detecting H. Capsulatum

January 08 2014

A recent publication reports the accuracy of seven different RT-PCR protocols to detect Histoplasma capsulatum DNA, in a multicenter study based on both unicopy or multicopy targets. Fungal DNA was isolated from isolated an clinical strain (CNM-CM-2721). Histoplasmosis is an infection acquired by the inhalation of Histoplasma capsulatum conidia present in soils rich in organic matter, particularly guano of bats or birds. Although this fungus has a global distribution, the most endemic regions are found in the American continent: Mississippi, Ohio, and Missouri river valleys in United States of America, and Central and South America 4/7 protocols were able to detect tiny amounts of fungal DNA - 100 fg/ul. The overall specificity of the seven PCR methods was 100% with sensitivity at 86%. One protocol based on a unicopy target (SCAR 220) had a lower sensitivity of 43% but retained 100% specificity. All protocols tested were highly reproducible , sensitive and specific, with no false positives or cross reactions. The study concludes that any of the RT PCR methods could be an efficient means of detecting histoplasma capsulatum in clinical material, but observes that the protocols based on multicopy targets are the most efficient when using very small amounts of DNA.
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Oral garlic is ineffective in preventing recurrent vulvovaginal candidiasis

January 04 2014

Many women resort to alternative complementary medicines to attempt to manage recurrent vulvovaginal candidiasis. recently published Research from Melbourne (Watson et al ) has investigated whether oral garlic has an effect on vaginal candida colony counts . In vitro, garlic is effective against Candida species . This study measured vaginal candida colony counts, measured in the second half of the menstrual cycle, in asymptomatic women known to be colonised with candida sp. There was no evidence of a difference in colonies in the garlic and placebo groups and therefore no evidence to suggest using garlic in clinical practice for vaginal candidiasis.
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