GLABRATA (candida) Various pieces (7) ..

[Guest guest]

HI all seeing several mentions of the Torolupsis Glabrata strain of candida yeast, thought I'd sent these on there may be something of interest.

Dee~

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1. (this is the one with new babies)

......................Both patients had been treated with surfactant, artificial ventilation, intravascular catheters (arterial and venous), broad spectrum antibiotics, and hyperalimentation, which appear to be risk factors for T glabrata fungemia.

(My note** hyperalimentation is intravenous feeding with all the necessary vitamins, minerals etc.. and I've no idea if it's because this was an infant OR if it is a risk factor for anyone who has T. Glabrata? No idea.)

A review of the literature indicates that T glabrata is susceptible to amphotericin B and 5-fluorocytosine and is 'resistant' to fluconazole (*Diflucan*) .

In addition, it is also less susceptible to ketoconazole, clotrimazole, and itraconazole than is Candida albicans.

We recommend that T glabrata infections be treated initially by reducing iatrogenic risk factors and beginning amphotericin B therapy. If necessary, 5-fluorocytosine should be added to the drug regimen.

SOURCE: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=9042184 & dopt=Citation

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2. This is one about Dr. Sobel, and in the very last line he does offer a different treatment.

DURBAN, SOUTH AFRICA -- Physicians seeking reliably effective therapy for Candida glabrata vaginitis must dust off a treatment that was in its heyday in the Crimean War era, Dr. Jack D. Sobel said at a satellite conference held in conjunction with WONCA 2001, the conference of the World Organization of Family Doctors.

Treatment with intravaginal boric acid gelatin capsules may have a 19th-century ring to it, but it also has a 70% cure rate in C. glabrata vaginitis--and that's a lot better than can be achieved with modern azole therapy.

"Candida glabrata is the Achilles' heel of azole therapy. None of the azoles do well with Candida glabrata," observed Dr. Sobel, professor of medicine at Wayne State University, Detroit.

The success rate with azole therapy in C. glabrata vaginitis is so spotty--producing cures in 50% of treated patients or less--that these agents are best skipped in women for whom an azole has previously failed.

Instead, turn to 600-mg boric acid capsules inserted into the vagina once or twice daily for 14 days, he advised at the satellite conference sponsored by Pfizer Inc.

If boric acid fails, the drug of choice is topical 4% flucytosine once daily for 14 days. The cure rate with this treatment is greater than 90%.

source: http://www.findarticles.com/p/articles/mi_m0CYD/is_15_36/ai_77611262

Note* when they say 'topical' generally from 'my' understanding and I've seen this over and over they mean direct local application BUT.. intravaginal (inside the vagina) such as those yeast creams with an applicator. Dee.

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3.

I 'don't' think this relates to many here, (but may) as these were patients with 'other' serious diseases and the T Glabrata it's more known in those who do have very compromised immune systems such as with uncontrolled diabetes, HIV, etc., but for what it's worth.

Torulopsis glabrata fungemia--a clinical pathological study.Berkowitz ID, Robboy SJ, Karchmer AW, Kunz LJ.The clinical findings, pathologic features, and outcome were investigated in 46 patients in whom Torulopsis glabrata was isolated in 131 specimens of blood.

Nineteen of the patients had only a single positive blood culture and no evidence of systemic yeast infection, while 27 patients had a clinically significant fungemia based upon the occurrence of 2 or more positive blood cultures, or the combination of a positive blood culture and isolation of the organism from a closed body cavity or demonstration of the yeast in tissue sections.

The predisposing factors for the development of fungemia included the presence of intravenous lines, indwelling Foley catheters, antibiotics and surgery, especially when the gastrointestinal tract was involved.

Only 22% of patients received either steroids or cytostatic agents. Possible portals of entry were suggested by the prior isolation of the organism from urine, sputum, wounds, and central venous catheter tips in most of the patients. Twelve of 27 patients with clinically significant 'fungemia' were treated.

The initial mode of therapy in nine patients was removal of intravenous lines because of the clinical suspicion of catheter related sepsis. Seven of the patients improved rapidly and one more after amphotericin B was subsequently administered. Amphotericin B was the initial therapy in three cases.

One patient was cured while another died of an unrelated infection. Five patients were not treated although the isolation of T. glabrata had been reported; the fact that the presence of the organism was felt to be unimportant was considered to be a factor in the delay of treatment.

In the remaining 10 patients the organism was isolated only after the patient had died!

Division of the patients into four groups based upon whether the individuals survived, died of unrelated disease, died with potentially lethal infection, or died with T. glabrata infection significantly contributing to death, revealed a spectrum of disease, certain signs of which appeared to be of predictive value as prognostic indices of survival and severity of the infection.

Seven patients with transient fungemia experienced an acute episode of high spiking fever (greater than 102.5 degrees F), rigors and/or hypotension, six of whom improved after the intravenous catheter was removed, suggesting a catheter-related sepsis. In contrast, persistent low grade fever (less than 102.5 degrees F) characterized eight of the nine patients in whom T. glabrata infection was considered either potentially lethal, or contributing significantly to death.

A deteriorating clinical course with organ failure was also associated with this latter category of patients. Catheter-induced specticemia was considered in only two patients in this category.

The autopsy and clinical findings in this investigation as well as reported experimental studies suggest that T. glabrata is an organism of low virulence. The patients' underlying disease (e.g., neoplasia) and coexisting bacterial infection are the most important factors responsible for death.PMID: 574609 [PubMed - indexed for MEDLINE]

source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstract & list_uids=574609 & query_hl=2

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4. . Again this is not likely any of us, as these patients had terminal illnesses.... BUT what I found interesting is that after an autopsy.. the T. glabrata was found in so many other places of the body that I don't think was suspected.

Cancer. 1976 Oct;38(4):1750-6.

Fungemia due to Torulopsis glabrata in the compromised host.Valdivieso M, Luna M, Bodey GP, V, Groschel D.Ten episodes of Torulopsis glabrata fungemia occurring in nine patients with terminal illnesses are described. Eight patients had underlying malignancies and one patient had a plastic anemia. Two episodes of fungemia were considered transient since they were clearly related to the administration of intravenous hyperalimentation (IVH).

Most patients were adult women and had solid tumors of the genitourinary tract. Contributory factors were: antibiotic therapy (100%), immunosuppressive drugs (75%), abdominal surgery (63%), IVH (50%), neutropenia (38%), and diabetes mellitus (13%). The clinical course was indistinguishable from a severe bacterial infection. However, endotoxic shock was not observed.

The infection was rapidly fatal in four patients. In the remaining five patients, the infection was altered favorably by the discontinuation of infected intravenous hyperalimentation catheters. However, tissue invasion by T. glabrata was found in two of these patients who died shortly thereafter from tumor progression.

At autopsy, T. glabrata was identified in tissue sections of the lungs, kidneys, and mucosas of the gastrointestinal and genitourinary tracts. In all cases there was tissue necrosis with a minor inflammatory response consisting of mononuclear cells. To our knowledge, this is the single largest series of T. glabrata fungemia ever reported. ==========================================

5..

Reported risk factors for vulvovaginal candidiasis include recent antibiotic use, uncontrolled diabetes mellitus, and HIV infection/acquired immunodeficiency syndrome. (28,29)

Although Candida albicans frequently is the cause of vaginal yeast infections, the organism can be present in asymptomatic women. Family physicians also must remember that vaginal yeast infections may be caused by species other than C. albicans, such as Candida glabrata and Candida tropicalis. Infections with these species are less common than C. albicans infection and tend to be more resistant to treatment.

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6.

This is more scientific but a good slide to show the 'strain' of Glabrata and mentions it in the blood stream.

http://cglabrata.mlst.net/ :source

CANDIDA GLABRATA

The haploid pathogenic yeast Candida glabrata ranks second only to C. albicans as a cause of bloodstream fungal infection and candidal vaginitis. One of the most notable attributes of this species is its 'decreased' susceptibility to the azole antifungal agent fluconazole. (Diflucan)

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7.

(last one)

Management of vaginitis

American Family Physician, Dec 1, 2004 by n K. Owen, L. Clenney

source: http://www.findarticles.com/p/articles/mi_m3225/is_11_70/ai_n8570537

..............<clipped> from 'very' bottom of long article on vaginitis.....

Reported risk factors for vulvovaginal candidiasis include recent antibiotic use, uncontrolled diabetes mellitus, and HIV infection/acquired immunodeficiency syndrome. Although Candida albicans frequently is the cause of vaginal yeast infections, the organism can be present in asymptomatic women.

Family physicians also must remember that vaginal yeast infections may be caused by species other than C. albicans, such as Candida glabrata and Candida tropicalis.

Infections with these species are less common than C. albicans infection and tend to be more resistant to treatment.

Patients with vulvovaginal candidiasis usually report one or more of the following: vulvovaginal pruritus (50 percent), vulvovaginal swelling (24 percent), and dysuria (33 per-cent). The characteristic vaginal discharge, when present, is usually thick and white. Because these symptoms are not specific for vulvovaginal candidiasis, family physicians also should consider other causes.

Caution should be exercised in basing treatment decisions on a patient's self-diagnosis of yeast infection. In one study, the presence of vulvovaginal candidiasis was confirmed in only 33.7 percent of women who self-diagnosed yeast infection. Therefore, the diagnosis of vulvovaginal candidiasis should rely heavily on microscopic examination of a sample taken from the lateral vaginal wall (10 to 20 percent KOH preparation). Although vaginal culture is not routinely necessary for diagnosis, it can be helpful in women with recurrent symptoms or women with typical symptoms and a negative KOH preparation.

TREATMENT

All standard treatment regimens for uncomplicated vulvovaginal candidiasis are equally efficacious, resulting in a clinical cure rate of approximately 80 percent (7) (Table 3).10,31 Various topical treatments are available without prescription. However, many women may prefer the simplicity of a single 150-mg oral dose of fluconazole (Diflucan). In women with candidal vaginitis, treatment with oral fluconazole has been shown to be safe and as effective as seven days of treatment with intravaginal clotrimazole. (31)

It is important to remember that fluconazole is a pregnancy class C agent. In some patients, fluconazole may cause gastrointestinal upset, headache, dizziness, and rash, although these side effects typically are mild.

When therapy for vulvovaginal candidiasis is considered, it is helpful to classify the infection as uncomplicated or complicated (Table 4). The practical importance of such classification is that the treatments differ.

For example, in 'complicated' vulvovaginal candidiasis, 'topical' (meaning intravaginal) therapy has been shown to be more effective than single-dose oral therapy, (28) but treatment should be extended to 10 to 14 days. (7)

If oral therapy is preferred for severe vulvovaginal candidiasis, two sequential 150-mg doses of fluconazole, given three days apart, have been shown to be superior to a single 150-mg dose. (32) Although the optimal duration of extended oral fluconazole therapy has not been determined, one older study comparing oral fluconazole with clotrimazole found that extended use of fluconazole was safe and well tolerated.

In patients with severe discomfort secondary to vulvitis, the combination of a low-potency steroid cream and a topical antifungal cream may be beneficial.

RECURRENT VULVOVAGINAL CANDIDIASIS

Recurrent vulvovaginal candidiasis is defined as four or more yeast infections in one year. The possibility of uncontrolled diabetes mellitus or immunodeficiency should be considered in women with recurrent vulvovaginal candidiasis.

When it is certain that no reversible causes are present (e.g., antibiotic therapy, uncontrolled diabetes, or oral contraceptive pill use) and initial therapy has been completed, maintenance therapy may be appropriate. (35) Selected long-term regimens are listed in Table. The role of boric acid and lactobacillus therapy remains controversial.

Culture and sensitivity results should be used to guide therapy, because non-C. albicans species often are present in women with recurrent vulvovaginal candidiasis and these species are more likely to be resistant to standard azole therapy. (35)

(7.) Sobel JD. Vaginitis. N Engl J Med 1997;337:1896-903. 8. Egan ME, Lipsky MS. Diagnosis of vaginitis. Am Fam Physician 2000;62:1095-104.

28.) Sobel JD, Faro S, Force RW, Foxman B, Ledger WJ, Nyirjesy PR, et al. Vulvovaginal candidiasis: epidemiologic, diagnostic, and therapeutic considerations. Am J Obstet Gynecol 1998;178:203-11.

32.) Sobel JD, Kapernick PS, Zervos M, BD, Hooton T, Soper D, et al. Treatment of complicated Candida vaginitis: comparison of single and sequential doses of fluconazole. Am J Obstet Gynecol 2001;185:363-9.

35.) Sobel JD. Recurrent vulvovaginal candidiasis (RVVC). Int J STD AIDS 2001;12(suppl 2):9.