The resident microbiota in the human body, such as the oral cavity, gastrointestinal tract and genitourinary tract, is able to provide resistance to disease. However, imbalances in the microbial components can promote the growth of opportunistic microorganisms, such as yeasts of genus Candida. Fungal infections present as a major cause of infectious diseases and the microorganisms of genus Candida are the most frequently isolated pathogenic fungi in human fungal infections. Bacillus spp. and Lactobacillus spp. are bacteria that have probiotic effects used in commercially available products and in studies that aim for the development of probiotics able to inhibit the microbial pathogenicity and restore the balance of resident microbiota. Thus, with increasing fungus resistance to the use of antifungal agents, which are capable of causing serious side effects to the host organism unable to destroy the target microorganism, it becomes important to develop therapeutic and/or prophylactic alternatives that have a different and an effective mechanism of action with capacity to combat fungal infections without harming the patient. Probiotic bacteria provide an alternative strategy for the prevention and treatment of candidiasis and other infectious diseases.
- Candida spp.
- Bacillus spp.
- Lactobacillus spp.
- prevention and treatment
The incidence of fungal infections has increased significantly in the past 25 years . Human beings are colonized by a diverse and complex collection of microorganisms, contributing all of them to host nutrition, development of the immune system, response to pathogens and mucosal cell differentiation and proliferation .
Probiotic bacteria are also used in human and animal nutrition to influence beneficially the balance of intestinal microbiota of the host. Probiotics have several beneficial effects related to increasing digestion, strengthening the immune system and stimulating the production of vitamin. The use of probiotics is aimed to reduce the use of antibiotics and improve animal growth, as well as feed conversion .
Infectious diseases along with multidrug resistance are the major public health problem in developing countries with increased mortality and morbidity [4, 5]. Apart from the threat of multidrug resistance, several studies have confirmed that the continuous use of antibiotics can damage human commensal microbiota [5, 6]. Thus, an alternative and effective research focus is necessary to combat these pathogens with no effect on normal microbiota. In this regard, the use of probiotics and their natural metabolic compounds can be a substitute in various food and pharmaceutical industries .
There are around 600 pathogenic fungal species for humans and this group includes the fungi that cause infection of skin (e.g.,
Under certain conditions of immunosuppression, such as individuals with acquired immunodeficiency syndrome (AIDS), oral manifestations are the most important and earliest indicators of infection. The oral candidiasis is accepted internationally as a cardinal sign of HIV infection and is present in 50% of patients with HIV infection and in 80% of patients with AIDS [13, 14].
In Brazil during the period among 1996–2006, candidiasis was the second cause of deaths in HIV-positive patients due to fungal infections, being responsible for an average of 39 annual deaths . Moreover, oral candidiasis remains clinically relevant in these individuals, where treatment is difficult and recurrent episodes are frequent, requiring multiple antifungal treatments, which may lead to resistance selection [16, 17]. Due to this,
Due to the high recurrence of
The history of probiotics began with the history of man; cheese and fermented milk were well known to the Greeks and Romans who recommended their consumption, especially for children and convalescents. The first association of probiotics and health benefits was made at the turn of the century when the Russian scientist, Elie Metchnikoff, systematically studied the composition of the microbiota and suggested that the ingestion of fermented milk would improve this so-called autointoxication .
Probiotics play an important role in human health. There is general agreement on the important role of the gastrointestinal microbiota in the health and well-being status of humans and animals . Probiotics are defined as live microorganisms, which when administered in adequate amounts confer a health benefit on the host. This term is defined by a United Nations and World Health Organization Expert Panel .
There was an increase in the number of searches, both in vivo and in vitro, related to the benefits of probiotics on health and described in the literature for the treatment of infectious diseases caused by fungi, viruses, and bacteria or diarrhea associated with the use of antibiotics, alleviation of inflammatory chronic bowel disease, decreased risk of colon cancer, reduced allergies, effect on intestinal microbiota , and anticancer therapies .
Other beneficial effects of probiotics include lowering serum cholesterol level [24–27], improving lactose intolerance, increasing the utilization of nutrients, decreasing the use of antibiotics [24, 27], and antidiabetic treatments [26, 28, 29]. In the context linking food and health, probiotics have been the subject of numerous scientific studies and publications demonstrating their therapeutic effectiveness on both systemic and gastrointestinal tract  (Figure 1).
3.1. General characteristics
In 1907, Elie Metchnikoff won the Nobel Medicine Prize because he noticed that the daily consumption of Bulgarian yogurt (known for its rich composition in lactic acid bacteria) is beneficial to health. Metchnikoff worked at the Pasteur Institute in Paris and he discovered
Lactobacillus as probiotics and its mechanism of action
The main characteristics that a
According to Reid and Bruce , not all probiotic strains have the same mechanisms of action and each has characteristics suitable for your application. For example,
In a recent study, Abedin-Do et al.  showed that some
Members of our group evaluated the capacity of
In order for probiotic strains to have a satisfactory action, they must remain alive against stress challenges along the entire gastrointestinal tract, including the presence of bile in the small intestine. Bile is highly toxic to microorganisms not adapted to intestinal conditions. Moreover, some lactobacilli developed specific mechanisms to resist the deleterious effects caused by these compounds . Among these mechanisms, we can cite the efflux pump that actively removes the acids and accumulated bile salts within the cytoplasm and the enzymatic activity of hydrolases, which are capable of neutralizing deleterious effect of bile [56–58].
According to FAO WHO , the ideal characteristics of a probiotic strain of
Stable in acid and in the presence of bile;
Adhesion ability in human mucosa;
Colonize the intestine;
Remain viable during storage and use;
Have beneficial physiological effects and safe.
Lactobacillus in prevention and treatment of Candida infection
In vitro assays are important to evaluate the antifungal activity of each strain and characterization of the mechanisms of action, performing as a screening to in vivo tests with experimental models.
Sookkhee et al.  isolated and identified different species of lactic acid bacteria from the oral cavity of 130 volunteers in Thailand and they studied probiotic action against
Noverr and Huffnagle  examined the effect of living cultures, heat-killed cultures, and supernatants of probiotic bacteria (
Coman et al.  evaluated the antifungal activities of two probiotic strains,
Parolin et al.  identified 17 clinical strains of
Some in vivo studies also show the effectiveness of probiotics in
Matsubara et al.  evaluated the oral colonization by
Deng et al.  evaluated the probiotic action in vitro and the anticolonization capacity of
Although mice and rats are the gold standard for
Among the large number of probiotic products in use today are bacterial spore formers, mostly of the genus
Used primarily in their spore form, these products have been shown to prevent gastrointestinal disorders and the diversity of species used and their applications are astonishing , then, demonstrating that exert immune stimulation, antimicrobial activity, and competitive exclusion. Studies have shown that these bacteria are able to grow inside the intestinal tract and could be considered temporary residents. This is important because it indicates that they are not exogenous microorganisms but may have unique symbiotic relationship with the host .
4.1. General characteristics
The members of genus
4.2. Spores as probiotics
Bacterial spore formers are being used as probiotic supplements for use in animal feeds, for human dietary supplements, as well as in registered medicines . The use of spore-based products raises a number of questions. Since the bacterial species being used are not considered resident members of the gastrointestinal microbiota, how do they exert a beneficial effect? According to Cutting , while often considered soil organisms this conception is misplaced and Bacilli should be considered as gut commensals. Therefore, in fact, the question to be answered is what produces the probiotic effect: the vegetative cells (spores germinated) or the spores themselves? The natural life cycle of spore-forming microorganisms involves spore germination, sporulation, and re-proliferation when nutrients are scarce . According to these authors, although it is unlikely that they are true commensals, a unique dual life cycle of spore formers in the environment and within the gut of animals could represent a mechanism that may be responsible for probiotic action.
The research efforts and the search for new perspectives for clinical and nutritional applications with probiotic preparations that last comparatively more than other pharmaceutical drugs are justified because the spores are more resistant than the vegetative cells. This allows for greater reliability in the treatment method with probiotics and reduces the cost of production .
4.3. Mechanism of action of
Before a bacterial strain can be considered probiotic, some criteria must be assessed as inhibition capacity in the growth of harmful microorganisms, not toxic, not pathogenic, and be tolerant to acid, bile salt conditions, and pancreatic secretions in order to reach the small and large intestines, its ability to adhere to intestinal epithelial cells [82, 97–99], remain viable during transport and storage, exert beneficial effects on the host, stabilize the intestinal microbiota, adhere to the intestinal epithelial cell lining, and produce antimicrobial substances toward pathogen [82, 98].
Many authors have proposed that the properties of adhesion are a decisive factor for the selection of new probiotic strains. The mechanisms of action of probiotics against gastrointestinal pathogens consist principally on the following:
Competition for nutrients and sites of accession;
Changes in environmental conditions;
The principal mechanism by probiotics is the production of antimicrobials that inhibit pathogenic microorganisms.
Stimulation of the immune system or immunomodulation is considered an important mechanism to probiotics. Studies in humans and animal models have provided that the oral administration of spores stimulates the immune system, and this confirms that spores are neither innocuous gut passengers nor treated as a food. Helper lymphocyte (Th1) responses are important for IgG synthesis but more importantly for cytotoxic T-lymphocyte recruitment, and for the destruction of intracellular microorganisms, and involve presentation of antigens on the surface of the host cell by a class I major histocompatibility complex (MHC)-processing pathway .
Studies have shown that small amount of inoculum of
Different mechanisms have been proposed for competitive exclusion agents including competition for host-mucosal receptor sites, secretion of antimicrobials, production of fermentation by-products, such as volatile fatty acids, competition for essential nutrients, and stimulation of host immune functions  (Figure 2).
4.4. Studies with
Bacillus spp. as probiotics
In literature, there are in vivo and in vitro studies of
Lee et al.  studied the potential probiotic characteristics of
Studies performed by Thirabunyanon and Thongwittaya  investigated the activity of isolates of
Rhee et al.  studied the effect of bacteria administered orally on the development of the gut-associated lymphoid tissue (GALT) in infant rabbits and
Pinchuk and colleagues  demonstrated that a probiotic strain
In the human and animal consumption, the spores of
Ghelardi and colleagues  aimed to investigate the survival and persistence of
The use of
Therefore, if the results are promising and not only the bacteria are becoming superbacteria, but also other microorganisms such as fungi, why not apply the probiotic properties of
5. Conclusion and future perspective
This chapter sought to provide the reader knowledge about the probiotic action of bacteria
The high prevalence of
Infectious diseases along with the resistance of microorganisms to drugs represent serious problem in health. The knowledge of microorganisms that have characteristics capable of influencing the pathogenicity of
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