Tuesday, December 9, 2014

Viagra Australia: The diversity of Candida

The diversity of Candida species isolated was wide, and a high proportion of patients had more than one Candida species coexisting. CHROMagar performs as well as SABC to isolate Candida, but CHROMagar allows concurrent speciation, identifying 93% of species in this study compared with assimilation profiling. Although assimilation profiling is more accurate than CHROMagar identification, it is significantly more time consuming and expensive. The identification of germ tubes detected 84% of C albicans and C dubliniensis isolates. 



This method is rapid and inexpensive but only identifies these particular species. Very few sputum samples from the oral cavity grew Candida, suggesting that Candida grown from sputum samples represents true colonization of the bronchial tree. Fluconazole resistance was detected in one of 42 C albicans isolates and eight of 12 C glabrata isolates. This may be due to the frequent use of fluconazole in this group of patients receiving multiple courses of antibiotics for bacterial pulmonary exacerbations. 

Sensitivity of IgE detection by ImmunoCAP was less than standard SPTs, marginally for Aspergillus but markedly for Candida and Cladosporium. The cause for this is not known but has previously been reported in the literature. Alternative mechanisms of skin reactions, such as complement activation and IgG activation, do not explain the differences. It may be due to very low circulating levels of sIgE or differences in the allergen extract. ImmunoCAP has known advantages in terms of reproducibility, quantitation, and efficiency, making its use routine in many laboratories. 

However, if clinical allergy is suspected, SPTs should be used. The importance of sensitization has been debated in years past. One difficulty is that the definition of sensitization differs between studies, with variable sIgE cutoff levels being proposed. The present study defined patients with any rise in sIgE as sensitized and showed a greater FEV1 decline and increased pulmonary exacerbation rates for those sensitized to Aspergillus but not for those sensitized to Candida. 

However, it must be noted that this study was not powered to detect changes in lung function, and overall differences were small. The body of evidence appears to support reduced lung function with Aspergillus sensitization in both children and adults, with a suggestion that antifungal therapy may be beneficial. This is also true of patients who have asthma but do not have CF and has been linked to asthma control (severe asthma with fungal sensitization).

1 comment: