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Effect of nordihydroguaretic acid and fluconazole on the LTC4/PGE2 ratio in the kidney of mice damaged by Candida albicans.

Kustimur S, Memis L, Kilinc M, Ercan ZS.

Department of Microbiology, Faculty of Medicine, Gazi University, Ankara, Turkey.

The kidney is a major target organ in generalized candidiasis. When mice were infected with C.albicans, prostaglandin E2 (PGE2)-like activity was found to be significantly decreased while leukotriene C4 (LTC4)-like activity increased in the kidneys within 10 days. The aim of this study is to investigate the effect of nordihydroguaretic (NDGA) and fluconazole on the LTC4/PGE2 ratio in the mice kidneys infected by proteinase (+) C. albicans. The LTC4/PGE2 ratio was found to be significantly decreased both in NDGA and fluconazole-pretreated groups. These results indicate that pretreatment with the lipoxygenase inhibitor NDGA and the antifungal drug fluconazole, protect the kidney against C. albicans infection. These results also indicate a possible role of arachidonic acid metabolites (increase LTC4 and decrease PGE2) in kidney damage due to C. albicans infection.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9150373&dopt=Abstract fluconazole Diflucan



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Comparison of four molecular typing methods for evaluating genetic diversity among Candida albicans isolates from human immunodeficiency virus-positive patients with oral candidiasis.

Diaz-Guerra TM, Martinez-Suarez JV, Laguna F, Rodriguez-Tudela JL.

Unidad de Micologia, Centro Nacional de Microbiologia, Majadahonda, Spain.

Candida albicans strain delineation by karyotyping. NotI restriction pattern analysis, hybridization with specific probe 27A, and PCR fingerprinting with the phage M13 core sequence were performed with 30 isolates from the oral cavities of 30 human immunodeficiency virus (HIV)-infected patients and 8 reference strains. Within the panel of clinical isolates, 20 were geographically related, although 10 isolates were susceptible to fluconazole and 10 isolates were resistant to fluconazole. The remaining isolates used in this study were fluconazole resistant and geographically unrelated. A composite DNA type was defined for each of the strains as the combination of types obtained by the four molecular methods. By this procedure, a great diversity of DNA types was found among isolates from the oropharynges of HIV-infected individuals with oral candidiasis. This diversity was not reduced when isolates were evaluated on the basis of whether they came from the same geographical locale and whether they were fluconazole resistant. These data refute the idea of a clonal origin for fluconazole-resistant strains among HIV-positive patients. Karyotyping was the least discriminatory method, yielding 19 DNA types among the 38 strains analyzed. Conversely, hybridization with the 27A probe showed a unique DNA pattern for each of the strains examined in this study. Our results demonstrate that at least two different molecular methods are needed for Candida albicans typing and that there is a great deal of strain variation within the species, irrespective of place of origin or antifungal resistance patterns.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9157142&dopt=Abstract fluconazole Diflucan



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[In vitro susceptibility testing of Candida species against fluconazole using the microdilution test with Alamar Blue]

[Article in German]

Schroder G, Bernhardt H, Schulz K.

Abteilung fur Klinische Mikrobiologie, Universitatsklinikum Greifswald, BR Deutschland.

The investigation of susceptibility of Candida species to fluconazole was performed in microdilution to a supplemented HR-medium. The sufficient reproducibility of the test was verified using special control isolates and isolates of patients. The excellent applicability of the method in routine diagnostics was evaluated by in vitro testing of susceptibility of 279 Candida isolates from patients being colonised or suffering from endomycoses. The Candida species showed different susceptibility against fluconazole: 96% of the C. albicans isolates were sensitive, 55% of the C. glabrata isolates had a reduced sensitivity, and 26% were resistant against fluconazole (MIC > 25 micrograms/ml). C. krusei isolates were highly resistant (9 of 11 strains).

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9198739&dopt=Abstract fluconazole Diflucan



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[Susceptibility testing of yeasts against fluconazole: proposal for a standardized agar diffusion method with 25 microgram fluconazole paper discs]

[Article in German]

Schmalreck AF, Kottmann I.

Pfizer/Mack, Mikrobiologie Forschung und Entwicklung, Illertissen, BR Deutschland.

This paper gives a proposal for a standardised agar diffusion susceptibility testing method with 25 micrograms fluconazole discs. The methodology compiles the results of several years of work to develop a reliable and reproducible routine-method for the microbiology laboratory. In this proposal, in addition, the critics and experiences of a collaborative study for susceptibility testing of fluconazole with 21 laboratories from Germany and Austria are included.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9198741&dopt=Abstract fluconazole Diflucan



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[Fluconazole and itraconazole susceptibility testing with clinical yeast isolates and algae of the genus Prototheca by means of the Etest]

[Article in German]

Blaschke-Hellmessen R.

Institut fur Medizinische Mikrobiologie und Hygiene, Universitatsklinikum Carl Gustav Carus, Technische Universitat Dresden, BR Deutschland.

Preliminary own results suggest, that the Etest (produced by AB BIODISK, Solna, Sweden) performed on casitone medium meets the requirements of a routine test of yeast susceptibility to fluconazole and itraconazole. Testing of 46 clinical yeast isolates, of 5 strains of Exophiala dermatitidis and 4 strains of algae of the genus Prototheca revealed species-, genus- and strain-specific variations of the susceptibility to fluconazole and itraconazole. Candida glabrata was less susceptible to both triazoles than the other Candida species with exception of Candida krusei. Exophiala dermatitidis was highly susceptible to itraconazole. Prototheca wickerhamii and P. zopfii were resistant to both triazoles. Casitone medium is most appropriate for the determination of susceptibility to fluconazole and itraconazole by the Etest. The results of the Etest were comparable with those of a breakpoint test (microdilution method).

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9198743&dopt=Abstract fluconazole Diflucan



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[Comparison of three antifungal susceptibility testing methods for the in vitro testing of Candida isolates from patients with HIV infection]

[Article in German]

Ruhnke M, Schmidt-Westhausen A, Trautmann M.

Virchow-Klinikum der Humboldt-Universitat, Abteilung Innere Medizin und Poliklinik, Berlin, Germany.

The MIC values of fluconazole were determined for 96 Candida isolates (56 C. albicans, 15 C. glabrata, 9 C. krusei and 10 C. tropicalis). The methods employed for antifungal susceptibility testing were: microdilution according to the protocol M27-P of the NCCLS (M 27-Pmicro) using RPMI 1640 medium or HR medium following Troke & Pye (HRmicro) as well as the agar diffusion method by means of the Etest (YNB agar). The in vitro results were compared with the clinical outcome of patients. All C. albicans isolates received from AIDS patients with fluconazole-refractory candidosis showed MICs of > or = 6.25 mg/ml (M27-Pmicro) or > or = 25 mg/ml (MRmicro) and Etest). On the other hand some MICs of C. albicans isolates from AIDS patients with fluconazole-sensitive candidosis were also beyond these breakpoints. Therefore, a possible success of a fluconazole therapy cannot unequivocally be predicted from the MIC value determined in vitro.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9198745&dopt=Abstract fluconazole Diflucan



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Amphotericin B with or without flucytosine followed by fluconazole as primary therapy for cryptococcal meningitis in patients with AIDS.

Jaruratanasirikul S.

Department of Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.

Eighteen consecutive AIDS patients with a first episode of cryptococcal meningitis were enrolled in the study to evaluate the efficacy and tolerability of amphotericin B with or without flucytosine followed by fluconazole as primary therapy for cryptococcal meningitis in patients with AIDS. The treatment consisted of intravenous amphotericin B 0.6 mg/kg daily with or without flucytosine (150 mg/kg d in four divided doses) for 2 weeks which was then followed by oral fluconazole 400 mg daily for 8 weeks. After completion of primary therapy, all patients received a maintenance dose of oral fluconazole 200 mg daily. The primary therapy was successful in 17 (94%) of the 18 patients. The median length of time to the first negative cerebrospinal fluid culture for Cryptococcus neoformans in the 17 patients with successful treatment was 3 (range 2 to 6) weeks. No patient had to discontinue the treatment due to adverse drug reactions. During a mean observation period of 26.94 weeks, no relapse case was documented among the 17 patients. Our results indicate that this regimen as primary therapy for cryptococcal meningitis in AIDS patients is effective and well tolerated.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9253873&dopt=Abstract fluconazole Diflucan



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Evaluation of the NCCLS M44-P disk diffusion method for determining susceptibilities of 276 clinical isolates of Cryptococcus neoformans to fluconazole.

Pfaller MA, Messer SA, Boyken L, Rice C, Tendolkar S, Hollis RJ, Diekema DJ.

Department of Pathology, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242, USA. michael-pfaller uiowa.edu

We evaluated the NCCLS M44-P fluconazole disk diffusion method in comparison with the NCCLS M27-A2 broth microdilution method for determining the susceptibility of 276 isolates of Cryptococcus neoformans. Disk diffusion testing was performed using Mueller-Hinton agar supplemented with 2% glucose and 0.5 microg of methylene blue/ml. Among the 276 isolates, 259 (93.8%) were susceptible, 16 (5.8%) were susceptible--dose dependent, and 1 (0.4%) was resistant to fluconazole as determined by the NCCLS broth microdilution method. The overall categorical agreement between the two methods was 86%, with 0% very major errors, 2% major errors, and 12% minor errors. The disk diffusion method using Mueller-Hinton agar supplemented with glucose and methylene blue appears to be a useful approach for determining the fluconazole susceptibility of C. neoformans.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14715784&dopt=Abstract fluconazole Diflucan