Health officials in the United Kingdom said late last week that an emerging drug-resistant fungus has been identified in England, just 7 days after US officials warned about the same pathogen. The pathogen, , is a type of yeast that was first isolated from the ear of a Japanese patient in 2009, and since then has been reported in eight other countries, including Great Britain. The pathogen has most commonly caused healthcare-associated invasive infections such as bloodstream infections, wound infections, and ear infections. According to a report from Public Health England (PHE), sporadic cases of outbreak involving more than 40 patients."The hospital outbreak has been difficult to control, despite enhanced infection control interventions, including regular patient screening, environmental decontamination and ward closure," PHE said in its Jul 1 report. Prolonged hospital outbreaks of isolates in the United Kingdom and other countries where it has been detected has indicated that the pathogen is resistant to fluconazole, an antibiotic that is commonly used to treat fungal infection. But testing has also demonstrated varying levels of resistance to the three main classes of antifungal drugs (azoles, echinocandins, and polyenes), which is raising concerns that treatment options could be limited. The PHE announcement comes on the heels of a clinical alert about appears to be unlike other pathogenic yeast species in its propensity for transmission between hospital patients," PHE said in its report. The treatment of choice for thrush is fluconazole or oral nystatin suspension, although numerous antifungal agents are effective. Resistance to nystatin is rare, although the drug's contact killing makes it somewhat more difficult to use because it must be applied to all of the affected mucosal surfaces to be effective (unlike systemic therapies). Failures with nystatin are more common than with fluconazole. In older children and adults, antifungal medications should be swished around in the oral cavity and swallowed. Failure to do so may provide ineffective treatment for lesions in the posterior pharynx and esophagus. In younger patients, instruct parents to apply 1-2 m L of the solution to the inside of each cheek during each administration. Medication can also be directly applied to the lesions with a nonabsorbent swab or applicator.
A note from The Body.com: The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information! The encouraging news is that we are making steady progress in treating -- and preventing -- the opportunistic infections that develop in people with advanced HIV disease. The distinctly discouraging news is that we still have real trouble controlling one of the most frequently seen of these infections -- oral candidiasis, commonly known as thrush. At first, candida infections respond very well to drug therapy, and for a time it is possible to prevent recurrent infections through daily prophylaxis. But as people with HIV live longer, they develop forms of thrush that do not respond to the drugs we use to treat this infection. To triazoles is uncommon with short term treatment but has been increasingly reported in immunocompromised patients, including those with HIV infection who are receiving long term systemic or maintenance therapy. Vaginal triazole resistant in an otherwise healthy woman. The patient was a 28 year old woman who presented with symptoms of vulval pruritis and profuse vaginal discharge for six months. She was not taking regular medication but had used clotrimazole and fluconazole several times in the preceding months with no clinical improvement. On examination, the vulva looked healthy but the vagina was erythematous and white plaques were noted. The cervix appeared normal and bimanual pelvic examination was unremarkable. The patient declined HIV serology but was fit and well with no stigmata of HIV infection and no risk factors.
More information Christina Popp et al. Evolution of Fluconazole-Resistant Candida albicans Strains by Drug-Induced Mating Competence and Parasexual Recombination, mBio 2019. OBJECTIVE As a result of high recurrence rates of Candida albicans vaginitis, successful suppressive fluconazole is widely used, and drug resistance is.