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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Autoimmune polyglandular syndromes are rare autoimmune endocrinopathies, which can be also associated with non endocrine autoimmune diseases. The autoimmune polyglandular syndrome type I (autoimmune polyendocrinopathy-candidiasis ectodermal dystrophy; APECED) is distinguished from autoimmune polyglandular syndrome type 2 (APS-2). Main symptoms of APECED are adrenal insufficiency, hypoparathyroidism and candidiasis. The diagnosis is established when two out of three of these symptoms are present. APECED is associated with mutations of the autoimmune regulator gene (AIRE) and predominantly affects juvenile patients with a family background from Sardinia, Finland and Iranian Jews. The APS-2 is not AIRE associated. It is characterized by the presence of autoimmune thyroid disease, adrenal insufficiency and/or diabetes mellitus type I. APS-2 is more common than APECED and mainly affects adult women without any preference of a certain ethnic group. Therapy consists of hormone replacement therapy and treatment of clinical symptoms. In some APECED patients immunosuppressive therapy seems to be promising.
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PMID:[Autoimmune polyglandular syndromes]. 1594 1

Superficial fungal infection of the mucous membranes (thrush) isolated to the larynx is neither widely reported nor well recognized clinically. Therefore, it is often associated with ineffective treatment and delay in diagnosis, and sometimes associated with unneeded surgical intervention. Eight cases of thrush isolated to the larynx, with no oral or oropharyngeal manifestations, are presented. Four of these were isolated to the vocal folds alone. All patients were adults, and 4 were smokers. Hoarseness was always present. Pain was present inconsistently, and there was no dysphagia or odynophagia, in contrast to other forms of upper aerodigestive tract candidiasis. On average, diagnosis was not made until 6 months after the onset of symptoms. Possible causative factors included use of systemic steroids (3 cases), broad-spectrum antibiotics (1 case), or inhaled steroids (5 cases); diabetes (2 cases); and neutropenia (1 case). In 3 cases, all with thrush isolated to the vocal folds, inhaled steroids were the only causative factor identifiable--a feature reported only twice previously. Three patients underwent surgical procedures that might have been avoided had an accurate diagnosis been made. All patients responded readily to oral fluconazole and removal of predisposing factors where possible. The signs, symptoms, predisposing factors, and treatment are compared to those of 14 cases reported in the literature over 35 years.
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PMID:Laryngeal thrush. 1596 23

The high rates of invasive candidiasis among intensive care unit (ICU) patients suggest that antifungal prophylaxis might be of value, but rules identifying patients who would best benefit are not established. Based on a retrospective study of 327 patients who stayed in a surgical ICU for > or = 4 days and had an 11.0% rate of invasive candidiasis, we sought to identify useful predictive rules. As prior work suggests that prompt initiation of prophylaxis is of value, we required our rules to be based on patient data routinely available during the week prior to ICU admission through the third day of the ICU stay. Patients with any combination of diabetes mellitus, new onset hemodialysis, use of total parenteral nutrition, or receipt of broad-spectrum antibiotics had an invasive candidiasis rate of 16.6% versus a 5.1% rate for patients lacking these characteristics (P = 0.001). Fifty-two percent of patients staying > or = 4 days in the ICU met this rule and the rule captured 78% of the patients who eventually developed invasive candidiasis. Risk-stratified antifungal prophylaxis in the ICU is possible. Validation of these results in other types of ICU is now needed.
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PMID:Rules for identifying patients at increased risk for candidal infections in the surgical intensive care unit: approach to developing practical criteria for systematic use in antifungal prophylaxis trials. 1601 Aug 50

Cronkhite-Canada Syndrome is a non-inherited, non-congenital disease characterized by juvenile hamartomatous gastrointestinal polyps with a typically late onset. In the case described herein the disease was diagnosed in a 17-year-old male with type I diabetes and thalassaemia minor, in coincidence with severe symptomatic intestinal candidiasis. Following the disappearance of the mycosis and correction of the protein and electrolyte imbalance, the ectodermal abnormalities returned to normal and the patient remained asymptomatic during a 7-year follow-up period, despite proteinuria resulting from membranous glomerulopathy. The concept that Cronkhite-Canada Syndrome is a late-onset disease should probably be reconsidered as it may remain asymptomatic, and thus not diagnosed, for a long a time.
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PMID:Is Cronkhite-Canada Syndrome necessarily a late-onset disease? 1614 64

In this study the prevalence of vulvovaginal candidiasis (VVC), antifungal susceptibility and proteinase production of isolated Candida species were investigated. Vaginal swabs were collected from symptomatic women with vulvovaginitis attending the Obstetrics and Gynecology Clinic of Kocaeli University, Turkey. The relation between risk factors, such as pregnancy, diabetes mellitus, antibiotic and corticosteroid use, history of sexually transmitted diseases and contraceptive methods, was recorded. Candida spp. were identified by conventional methods, then evaluated for proteinase secretion in a medium containing casein. Antifungal susceptibility was determined according to the NCCLS microdilution method. The prevalence of women with vulvovaginitis was 35.7% (170/6080) and 16% (28/170) of them were diagnosed as VVC. Candida albicans was the dominant species: 21 (75%), followed by 4 C. glabrata (14%), 2 C. tropicalis (7%), and one C. krusei (3.5%). All isolates were susceptible to fluconazole, itraconazole and amphotericin B, except one C. krusei, one C. glabrata and one C. albicans that were resistant to fluconazole. Proteinase production was determined in 19 (90.5%) C. albicans and in all C. tropicalis isolates. Proteinase activity was not associated with antifungal resistance. No association was found between risk factors and VVC.
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PMID:Prevalence, susceptibility profile and proteinase production of yeasts causing vulvovaginitis in Turkish women. 1651 51

Mutations in the autoimmune regulator (AIRE) gene cause a recessive Mendelian disorder autoimmune polyendocrinopathy syndrome type 1 (APS-1 or autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy). APS-1 patients develop multiorgan autoimmune diseases including type 1 diabetes (prevalence 12%). The AIRE protein controls the central tolerance induction in the thymus by regulating the expression levels of tissue-specific peripheral antigens, such as insulin. We hypothesized that the insulin gene (INS) polymorphisms together with the AIRE variations may predispose individuals to diabetes. The role of the AIRE gene was tested both independently and on the condition of the INS risk genotype in the Finnish type 1 diabetes sample. A total of 733 type 1 diabetic cases and 735 age- and sex-matched healthy controls were used in the analysis. Five common single nucleotide polymorphisms (SNPs) in the AIRE gene were selected from the public database (dbSNP). The -23HphI polymorphism was used as a surrogate marker for the INS gene promoter repeat. The five genotyped SNPs in the AIRE gene showed no evidence of association with type 1 diabetes. As expected, the INS gene polymorphism -23HphI was significantly associated with susceptibility to type 1 diabetes (P=6.8 x 10(-12), chi(2) test). When the subclass of patients carrying the homozygote genotype of the INS gene was used in the analysis, the AIRE polymorphisms showed no association with the disease. In conclusion, the AIRE gene does not seem to contribute to disease susceptibility in Finnish type 1 diabetic patients, whereas the insulin gene represents a notable risk factor for disease in this population.
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PMID:Association analysis of the AIRE and insulin genes in Finnish type 1 diabetic patients. 1655 13

Invasive fungal infections are major medical complications in immunocompromised patients. The recent rise in the incidence of cancer and the increased use of newer medical treatment modalities, including organ transplantations, have resulted in growing numbers of highly immunosuppressed individuals. Although aspergillosis and candidiasis are among the most common invasive mycoses in such patients, there is evidence that the incidence of infectious diseases caused by Zygomycetes has risen significantly over the past decade. Patients with diabetes, malignancies, solid organ or bone marrow transplants, or iron overload and those receiving immunosuppressive agents, deferoxamine therapy, or broad-spectrum antimicrobial drugs are at highest risk for zygomycosis. This review details the emergence and importance of zygomycosis in current clinical practice and its manifestations and management. The etiologic species, pathogenesis and risk factors for zygomycosis are reviewed and updated. The clinical spectrum of zygomycosis is now broader, and it can be difficult to distinguish between mucormycosis and enthomophthoramycosis, both of which can manifest as disease ranging from a superficial infection to an angioinvasive infection with high mortality. Finally, the three-part treatment strategy (antifungal drugs, surgery, control of underlying diseases) is reviewed. Lipid formulations of amphotericin B are the antifungal agents of choice for treatment of zygomycosis. A novel antifungal triazole, posaconazole, has been developed and may become approved for treatment of zygomycosis. The clinical experience with adjunctive treatments like colony-stimulating factors, interferon-gamma, and hyperbaric oxygen therapy is still limited.
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PMID:Zygomycosis: the re-emerging fungal infection. 1656 97

Candida esophagitis in elderly patients is an entity that has not been investigated. We studied candida esophagitis in a population older than 65 years comparing them with an age and sex matched control sample. Diagnosis was made by histological identification of candida associated with inflammation from biopsy material taken during endoscopy. Fifty-six cases and 56 controls were analysed aiming to identify presentation, upper gastrointestinal pathologies associated with candida esophagitis, risk associations and to see whether it was a marker of poor outcome. Classical features clinically associated with esophageal disease were relatively uncommon: dysphagia 14%, oropharyngeal candidiasis 2%, dyspepsia 2%, while anaemia and loss of weight were the main indications for endoscopy (70%). No gastrointestinal pathologies were significantly associated with candida esophagitis. Malignancy, chronic obstructive pulmonary disease and antibiotic use were significantly associated, while there was no association between candida esophagitis and diabetes mellitus, stroke disease or dementia. Survival was significantly less in those with candida esophagitis with a mortality at 6 months of 47% compared to 5% in controls and a 1 year survival of 38% compared to 93% in the control sample. This was independent of disability measured by the modified Rankin scale and patients' residence.
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PMID:A study of candida esophagitis in elderly patients attending a district general hospital in the UK. 1672 97

Invasive infections caused by Candida spp. are an important problem in immunocompromised patients. There is scarce data on the epidemiology of blood stream candidiasis in Salvador, Brazil. This study evaluates the risk factors associated with candidemia, among patients admitted to three tertiary, private hospitals, in Salvador, Brazil. We conducted a case-control, retrospective study to compare patients with diagnosis of candidemia in three different tertiary hospitals in Salvador, Brazil. Patients were matched for nosocomial, acquired infections, according to the causal agent: cases were defined by positive blood cultures for Candida species. Controls were those patients who had a diagnosis of systemic bacterial infection, with a positive blood culture to any bacteria, within the same time period (+/- 30 days) of case identification. The groups were compared for the main known risk factors for candidemia and for mortality rates. A hundred thirty-eight patients were identified. Among the 69 cases, only 14 were diagnosed as infected by Candida albicans. Candida species were defined in only eight cultures: C. tropicalis (4 cases), C. glabrata, C. parapsilosis, C. guillermondi, C. formata (1 case each). The main risk factors, identified in a univariate analysis, were: presence of a central venous catheter (CVC), use of parenteral nutrition support (PNS), previous exposure to antibiotics, and chronic renal failure (CRF). No association was detected with surgical procedures, diabetes mellitus, neutropenia or malignancies. Patients were more likely to die during the hospitalization period, but the rates of death caused by the infections were similar for cases and controls. The length of hospitalization was similar for both groups, as well as the time for a positive blood culture. Blood stream infection by Candida spp. is associated with CVC, PNS, previous use of antibiotics, and CRF. The higher mortality rate for cases probably better reflects the severity of the underlying diseases, than as a direct consequence of Candidemia.
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PMID:Evaluation of blood stream infections by Candida in three tertiary hospitals in Salvador, Brazil: a case-control study. 1676 14

A 69-year-old man was transferred to our hospital because of fever and acute renal failure. 5 weeks prior to admission, he was admitted to another hospital and treated with several antibiotics including vancomycin, but fever did not subside and renal dysfunction showed rapid progression. On admission, laboratory findings revealed pyuria, inflammatory changes, acute renal failure, and disseminated intravascular coagulation (DIC). Computed tomography showed left ureteral stone and hydronephrosis. Gallium scintigraphy showed avid uptake in the left kidney. Serum concentration of vancomycin was 57.4 micro/ml. Candida glabrata was isolated from blood, sputum and urine. Under the diagnosis of fungemia and left pyelonephritis, he was treated with micafungin (150 mg/day), gabexate mesilate and insertion of a double-ended pigtail catheter. The above treatment produced regression of systemic inflammation, DIC and acute renal failure. At the last follow-up 3 weeks after discharge, ureteroscopy showed that the ureter stone had already passed but a soft white-yellowish bezoar was detected in the ureter. In this case, neurogenic bladder, poorly controlled diabetes, and long-term antibiotic treatment probably enhanced the development of C. glabrata infection. Antifungal treatment with micafungin is useful in patients with non-albicans Candida infection.
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PMID:Candida glabrata fungemia in a diabetic patient with neurogenic bladder: successful treatment with micafungin. 1699 45


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