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any of the yeastlike imperfect fungi of the genus Candida

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/07/02 18:10:35」(JST)

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Candida glabrata is a haploid yeast of the genus Candida, previously known as Torulopsis glabrata. This species of yeast is non-dimorphic and no mating activity has been observed. Until recently, C. glabrata was thought to be a primarily non-pathogenic organism. However, with the ever increasing population of immunocompromised individuals, trends have shown C. glabrata to be a highly opportunistic pathogen of the urogenital tract, and of the bloodstream (Candidemia). It is especially prevalent in HIV positive people, and the elderly.

There are two widely cited potential virulence factors that contribute to the pathogenicity of C. glabrata. The first is a series of adhesins coded by the EPA (epithelial adhesin) genes. These genes, located in the subtelomeric region, can respond to environmental cues that allow them to be expressed en masse so the organism can adhere to biotic and abiotic surfaces in microbial mats. This is also the suspected mechanism by which C. glabrata forms microbial "biofilms" on urinary catheters, and less commonly in-dwelling IV catheters. It also causes problems with dental devices, such as dentures.^[1]

Diagnosis

Cultures are an effective method for identifying non-albicans vaginal infections. Urinalyses are less accurate in this process. The culture may take several days to grow, but the identification of the yeast species is quick once the yeast is isolated. Skin disease diagnosis is difficult, as cultures collected from swabs and biopsies will test negative for fungus and a special assessment is required. Listed under the 'Rare Diseases' database on the NIH web site^{[verification needed]}, Torulopsis glabrata, or Candida glabrata can also be found on the CDC's web site^{[verification needed]}. Although listed as the second most virulent yeast after Candida albicans, almost no information is available regarding treatment and identification. Although high mortality rates are listed, assessment of the critical nature of a glabrata infection is a gray area. Another promising diagnostic tool is the T2Candida Panel, which in addition to glabrata, can also identify albicans, tropicalis, kruzei and parapsilosis direct from whole blood without requiring a blood culture. The T2 Candida Panel is manufactured by T2 Biosystems, Inc and received FDA approval in September 2014.

Treatment

A major phenotype and potential virulence factor that C. glabrata possesses is low-level intrinsic resistance to the azole drugs, which are the most commonly prescribed antifungal (antimycotic) medications. These drugs, including fluconazole and ketoconazole, are "not effective in 15-20% of cases"^[2] against C. glabrata. It is still highly vulnerable to polyene drugs such as amphotericin B and nystatin, along with variable vulnerability to flucytosine and caspofungin. However intravenous amphotericin B is a drug of last resort, causing among other side effects, chronic renal failure. Amphotericin B vaginal suppositories are used as an effective form of treatment in combination with boric acid capsules as they are not absorbed into the blood stream.

A first-line treatment for vaginal infections may be the use of terconazole 7-day cream. Several courses may be needed. The cure-rate for this treatment is approximately 40%. Recurrences are common, causing chronic infections and spread to other areas such as skin and scalp. Blood infections might well be best assessed per symptoms if other areas are involved.

An experimental, but effective second-line treatment for chronic infections, is the use of boric acid. Compounding pharmacies can create boric acid vaginal suppositories. Use of Vitamin E oil may be used in conjunction to combat irritation. Amphotericin B vaginal suppositories have also been used in case studies to treat chronic infections, both symptomatic and asymptomatic. Borax and boric acid may be used for persistent scalp and skin infections.

References

^ Bethea, E. K.; Carver, B. J.; Montedonico, A. E.; Reynolds, T. B. (2009). "The inositol regulon controls viability in Candida glabrata". Microbiology 156 (2): 452–462. doi:10.1099/mic.0.030072-0.
^ Fidel F, Vazquez J, Sobel J (1999). "Candida glabrata: Review of Epidemiology, Pathogenesis, and Clinical Disease with Comparison to C. albicans". Clinical Microbiology Reviews 12 (1): 80–96. PMC 88907. PMID 9880475.

External links

Dr. Fungus's "Candida inconspicua"
Genolevures: Candida glabrata, Genome
Candida glabrata genome map

UpToDate Contents

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1. 成人におけるカンジダ菌血症および侵襲性カンジダ症 treatment of candidemia and invasive candidiasis in adults
2. カンジダ性外陰膣炎 candida vulvovaginitis
3. 成人におけるカンジダ菌血症の疫学および病因 epidemiology and pathogenesis of candidemia in adults
4. カンジダ感染症の概要 overview of candida infections
5. カンジダ性骨関節感染症 candida osteoarticular infections

English Journal

Caspofungin Dose Escalation for Invasive Candidiasis Due to Resistant Candida albicans.

Wiederhold NP, Najvar LK, Bocanegra RA, Kirkpatrick WR, Patterson TF.SourceUTHSCSA, PERC MSC 6220, 7703 Floyd Curl Drive, San Antonio, TX 78229. wiederholdn@uthscsa.edu.
Antimicrobial agents and chemotherapy.Antimicrob Agents Chemother.2011 Jul;55(7):3254-60. Epub 2011 Apr 18.
Previous in vivo studies have reported caspofungin dose escalation to be effective against Candida glabrata with reduced susceptibility. We hypothesized that higher doses of caspofungin would be effective against invasive candidiasis caused by the more virulent species Candida albicans, including is
PMID 21502632

Clinical breakpoints for voriconazole and Candida spp. revisited: review of microbiologic, molecular, pharmacodynamic, and clinical data as they pertain to the development of species-specific interpretive criteria.

Pfaller MA, Andes D, Arendrup MC, Diekema DJ, Espinel-Ingroff A, Alexander BD, Brown SD, Chaturvedi V, Fowler CL, Ghannoum MA, Johnson EM, Knapp CC, Motyl MR, Ostrosky-Zeichner L, Walsh TJ.SourceUniversity of Iowa Carver College of Medicine, Iowa City, IA 52246, USA.
Diagnostic microbiology and infectious disease.Diagn Microbiol Infect Dis.2011 Jul;70(3):330-43. Epub 2011 May 4.
We reassessed the Clinical and Laboratory Standards Institute (CLSI) clinical breakpoints (CBPs) for voriconazole. We examined i) the essential (EA: ±2 dilutions) and categorical agreement between 24-h CLSI and EUCAST methods for voriconazole testing of Candida, ii) wild-type (WT) MICs and epidemio
PMID 21546199

Japanese Journal

Antifungal Susceptibility of Candida Isolates at One Institution

Katsuragi Shinji,Sata Makoto,Kobayashi Yoshinari,Miyoshi Takekazu,Yamashita Yasuki,Neki Reiko,Horiuchi Chinami,Yamanaka Kaoru,Kamiya Chizuko,Iwanaga Naoko,Tanaka Hiroaki,Ikeda Tomoaki,Yoshimatsu Jun
Medical Mycology Journal 55(1), E1-E7, 2014
… Species distribution and antifungal susceptibility of Candida … A total of 3,832 fungal isolates were detected, including Candida albicans … 66.5%, Candida glabrata … 20.3%, Candida parapsilosis … 6.2%, Candida tropicalis … glabrata, C. …
NAID 130003397211

ER stress response mechanisms in the pathogenic yeast Candida glabrata and their roles in virulence

Miyazaki Taiga,Kohno Shigeru
Virulence 5(2), 365-370, 2014
… While the UPR is highly conserved among eukaryotes, our group recently discovered that the pathogenic yeast Candida glabrata lacks the typical fungal UPR, but possesses alternative mechanisms to cope with ER stress. … glabrata responds to ER stress and discusses the impacts of ER quality control systems on antifungal resistance and virulence. …
NAID 120005438949

Expression of neutral β-glucosidase from Scytalidium thermophilum in Candida glabrata for ethanol production from alkaline-pretreated rice straw(ENVIRONMENTAL BIOTECHNOLOGY)

Wang Xiaohui,Ike Masakazu,Shiroma Riki [他],Tokuyasu Ken,Sakakibara Yoshikiyo
Journal of bioscience and bioengineering 116(3), 362-365, 2013-09
… We successfully expressed the neutral β-glucosidase (BGL4) from Scytalidium thermophilum in the thermotolerant yeast Candida glabrata. …
NAID 110009657234

Related Pictures

Candida Glabrata, Lm Photograph by Science Source Candida glabrata 〔カンジダ・グラブラータ〕 | グラム染色: Gram Stain Genetic study uncovers fungal sex secrets, which shed light on candidiasis Resistance (AMR) in Candida glabrata reaching epic proportions | Gaffi - Global Action Everything You Need To Know About Candida Glabrata - YeastInfection.Org by Eric Bakker Candida glabrata - Wikipedia

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リンク元	「ミカファンギン」
関連記事	「Candida」

「ミカファンギン」

Candida glabrata
Scientific classification
Kingdom:	Fungi
Division:	Ascomycota
Subdivision:	Saccharomycotina
Class:	Saccharomycetes
Order:	Saccharomycetales
Family:	Saccharomycetaceae
Genus:	Candida
Species:	C. glabrata
Binomial name
	Candida glabrata; (H.W.Anderson) S.A.Mey. & Yarrow (1978)
Synonyms
	Cryptococcus glabratus H.W.Anderson (1917); Torulopsis glabrata (H.W.Anderson) Lodder & N.F.de Vries (1938)