Candiduria: Prevalence, Identification of Isolated Candida Species and Trends in Antifungal Susceptibility in Hospitalized Patients

Background: Urinary tract candidiasis is known as the most frequent nosocomial fungal infection worldwide. Some of the predisposing factors of candiduria are extensive use of broad-spectrum anti-fungal agents, diabetes mellitus, indwelling urinary catheter, corticosteroids and, immunosuppressive drugs. There are some antifungal agents available for the treatment of candiduria. In recent years, resistance to antifungal agents has been increased. The aim of this study was to evaluate different Candida species (sp.) that cause candiduria and their susceptibility pattern to antifungal agents in patients admitted to educational hospitals.Materials and Methods: Urine samples (n=200) were obtained; they were spread onto Sabouraud Dextrose Agar plates. Plates were incubated at 37°C. Only specimens were considered as candiduria, which have a colony count of ≥104 CFU/mL colonies. Urine sediment was cultured in the CHROM agar Candida medium and incubated at 35°C for 48h. The cultures were evaluated based on color. PCR-RFLP was performed for a definite identification of Candida sp. In vitro antifungal susceptibility test of the Candida isolates against amphotericin B, fluconazole and itraconazole was performed using the microdilution method, according to the standard CLSI guidelines, document M27-S3.Results: Molecular findings confirmed the result of the morphological method. Candiduria rate was 11.5% among our patients. According to CHROM agar Candida and PCR-RFLP, the most common species isolated was C. albicans (74%), followed by C. glabrata (26%). In vitro susceptibility tests of urinary Candida isolates to antifungals have been evaluated. All species were sensitive to amphotericin B. None of C. glabrata isolates were sensitive to fluconazole and itraconazole.Conclusion: This study demonstrates the importance of Candida sp. in urine samples from hospitalized patients. It was concluded that Candida sp. obtained from candiduria in patients had excellent activity against Amphotericin B. Whereas, resistance against Itraconazole (21.7%) and especially Fluconazole (26%) was significant

Coinfection of Toenail Onychomycosis Caused by Rhodotorula mucilaginosa and Candida glabrata in an Immunocompromised Adult: A Case Report and Literature Review

Background: Rhodotorula mucilaginosa and Candida glabrata have emerged as potential pathogens,particularly in immunosuppressed hosts. This study aimed to present a case of coinfection of Candida glabrataand Rhodotorula mucilaginosa in a 35-year-old immunosuppressed female with onychomycosis on the first andsecond left toenails.Cases Report: Causative agents were identified according to morphology, microscopic studies, culture, andDNA molecular analysis. Candida glabrata demonstrated high minimum inhibitory concentrations against thetested antifungals except itraconazole. Moreover, Rhodotorula mucilaginosa had shown low minimuminhibitory concentrations against clotrimazole and ketoconazole at a dilution of 0.25 μg/ml. Itraconazole isadministered at 200 mg twice daily for one week for toenails and as pulse treatment (for one week a month) at5 mg/kg daily with topical clotrimazole.Conclusion: Clinical improvement was noted in the patient's clinical examination after ten months. Informationabout the increasing resistance to antifungal agents helps decide antifungal prophylaxis and select the empiricaltherapy for cancer patients

The effect of involved Aspergillus species on galactomannan in bronchoalveolar lavage of patients with invasive aspergillosis

PURPOSE: The detection of galactomannan (GM) in bronchoalveolar lavage (BAL) fluid is an important surrogate marker for the early diagnosis and therapeutic monitoring of invasive aspergillosis (IA), regardless of the involved species of Aspergillus. Here, we utilized the Platelia Aspergillus GM enzyme immunoassay (Bio-Rad) to evaluate the GM index in BAL fluid samples from patients with proven, probable or putative IA due to Aspergillusflavus versus Aspergillusfumigatus. METHODOLOGY: In a prospective study between 2009 and 2015, 116 BAL samples were collected from suspected IA patients referred to two university hospitals in Tehran, Iran. KEY FINDINGS: According to European Organization for Research and Treatment of Cancer and Mycoses Study Group and Blot criteria, 35 patients were classified as IA patients, of which 33 cases tested positive for GM above 0.5 and, among these patients, 22 had a GM index >/=1. Twenty-eight were culture positive for A. flavus and seven for A. fumigatus. The GM index for A. flavus cases was between 0.5-6.5 and those of A. fumigatus ranged from 1 to 6.5. The sensitivity and specificity of a GM index >/=0.5 in cases with A. flavus were 86 and 88 % and for A. fumigatus patients were 100 and 73 %, respectively. CONCLUSION: Overall, the mean GM index in patients with A. fumigatus (3.1) was significantly higher than those of A. flavus (1.6; P-value=0.031) and the sensitivity of GM lower for A. flavus when compared to A. fumigatus. This finding has implications for diagnosis in hospitals and countries with a high proportion of A. flavus infections

Emergence of Terbinafine Resistant Trichophyton mentagrophytes in Iran, Harboring Mutations in the Squalene Epoxidase (SQLE) Gene

Introduction: Trichophyton mentagrophytes and T. interdigitale are important causative agents of superficial mycoses, demonstrating emergent antifungal drug resistance. We studied the antifungal susceptibility profiles in Iranian isolates of these two species. Methods: A total of 96 T. interdigitale and 45 T. mentagrophytes isolates were subjected to molecular typing by ribosomal ITS region. Antifungal susceptibility profiles for terbinafine, griseofulvin, clotrimazole, efinaconazole, luliconazole, amorolfine and ciclopirox were obtained by CLSI broth microdilution method. The squalene epoxidase (SQLE) gene was subjected to sequencing for mutations, if any, in isolates exhibiting elevated MICs for terbinafine. Results: Luliconazole and efinaconazole showed the lowest MIC values against T. mentagrophytes and T. interdigitale isolates. There were five isolates with terbinafine MICs >= 32 mu g/mL in our sample. They belonged to T. mentagrophytes type VIII and harbored two alternative SQLE gene sequence variants, leading to Phe397Leu and Ala448Thr or Leu393Ser and Ala448Thr substitutions in the enzyme. All terbinafine resistant strains could be inhibited by luliconazole and efinaconazole. Conclusion: This study documented a step in the global spread of resistance mechanisms in T. mentagrophytes. However, treatment alternatives for resistant isolates were available. Keywords:Trichophyton mentagrophytes; SQLE; terbinafine; antifungal drug resistance; Ira

The Effect of Chenopodium Album and Apium Nodiflorum on the Expression of the Regulatory Gene (aflR) that Produces Aflatoxin in Aspergillus parasiticus

Background and Aim: Aflatoxins which are mainly produced by Aspergillus parasiticus are among the highly toxic secondary metabolites. This species often contaminates food and agricultural products including cereals, peanuts, and crops in the field. Recently, a number of studies have been carried out on the elimination of aflatoxin, and the antifungal effects of medicinal herbs, such as Chenopodium album  (36HYU2385) and Apium nodiflorum (36HYU2362). In this study, the effects of C. album and A. nodiflorum as natural compounds were examined on Aspergillus parasiticus growth, aflatoxins production and the aflR gene expression. Materials and Methods: The antifungal susceptibility testing of C. album and A. nodiflorum were performed according to CLSI document M38-A2. Quantitative changes in aflR gene level of expression were analyzed by Real-time PCR method. Results: Results indicated that minimal inhibitory concentration (MIC) in the extracts of C. album and A. nodiflorum against A. parasiticus growth were 100 mg/ml and 120 mg/ml respectively. Extracts of Chenopodium album and Apium nodiflorum have antitoxic properties. Moreover, they effectively decrease aflatoxin production. The level of aflR gene expression was decreased significantly after the exposure of fungal cells to the extracts. The highest inhibition was observed in MIC= 100 mg/ml of C. album. Conclusion: According to the results, it can be suggested that these herbal extracts may have antifungal potential to be used in medicine or agriculture

Is human dectin-1 Y238X gene polymorphism related to susceptibility to recurrent vulvovaginal candidiasis?

Background and Purpose: Vulvovaginal candidiasis is a frequent disease affecting approximately more than %75 of all childbearing women at least once in their lifetime by overgrowth of opportunistic Candida species. Recurrent vulvovaginal candidiasis (RVVC) is common in otherwise healthy individuals. Several risk factors were reported to contribute to RVVC susceptibility. A polymorphism in Dectin-1 (Y238X, rs16910526 ) was identified in patients with RVVC and hypothesized that genetic factors play an important role in susceptibility to RVVC. Herein, we aimed to survey the polymorphisms in the Dectin-1 gene, linked to susceptibility to RVVC. Materials and Methods: In the current study, blood samples were obtained from 25 patients who had frequent vulvovaginal candidiasis relapses and were diagnosed as RVVC. In addition, blood cultures were obtained from control group comprising of healthy individuals (n=25) with no history of RVVC, vaginal discharge, or itching on the day of examination. Dectin-1 Y238X gene polymorphism was investigated using Bi-PASA and DNA sequencing. Results: The analysis revealed that all of the patients were wild-type homozygous for Dectin-1 Y238X polymorphisms. None of the individuals showed heterozygous or mutant homozygous Dectin-1 polymorphism. Conclusion: No significant correlations were observed between the susceptibility to RVVC and Dectin-1 Y238X polymorphism in the Iranian population, which was not previously studied

Molecular Identification and Epidemiological Aspects of Dermatophytosis in Tehran, Iran

Background: Dermatophytes are the most common fungal agents causing superficial skin infections in worldwide. Species identification of these fungi is important for therapeutic and epidemiological apects. The purpose of this study was identification and epidemiology of dermatophytosis in patients referring to medical mycology laboratory of Razi hospital in Tehran, during 2014. Materials and Methods: In this study, 610 clinical specimens were collected from patients with suspected dermatophytosis. Direct microscopy and culture examinations were performed for all samples. DNA was extracted from fungal colony using phenol chloroform. Then ITS1-5.8s-ITS2 region of ribosomal DNA (rDNA) was amplified by the universal fungal primers ITS1 and ITS4 and digested with enzymes mva1. Results: In the present study, 236 subjects (38.6%) were positive for dermatophytosis. Among the patients, 64.8% were male and 35.2% female. The most frequent dermatophytes isolated were Trichophyton interdigitale (40.3%), Trichophyton rubrum (22.9%) and Trichophyton tonsurans (18.7%) respectivly. Also 58 samples were improperly diagnosed by morphological method, they were re-identified as Trichophyton interdigitale and Trichophyton rubrum by using PCR-RFLP. Conclusion: The survey showed that PCR-RFLP is a rapid and reliable method for discrimination of dermatophytes. We suggest using of PCR-RFLP as a valuable method along with morphological examination for diagnostic dermatophytes particularly in clinical and epidemiological settings

In vitro antifungal susceptibility of Candida speciesisolated from diabetic patients

Abstract INTRODUCTION This study aims to evaluate the antifungal susceptibility of different species of Candida isolated from diabetic patients against eight antifungal agents. METHODS Susceptibility testing of 111 clinical isolates of Candida species was performed against 8 antifungals using the M27-A3 protocol of the Clinical and Laboratory Standards Institute (CLSI). RESULTS Voriconazole, lanoconazole, and caspofungin showed the highest in vitro activity against all the isolates of C. albicans. Resistance against the tested antifungals was only observed in the C. albicans isolates. CONCLUSIONS Our finding revealed that resistance against amphotericin B, itraconazole, ketoconazole, posaconazole, and fluconazole can be observed in C. albicans

In vitro activities of luliconazole, lanoconazole, and efinaconazole compared with those of five antifungal drugs against melanized fungi and relatives

The in vitro activities of novel azoles compared to those of five antifungal drugs against clinical (n 28) and environmental (n 102) isolates of black mold and melanized yeast were determined. Luliconazole and lanoconazole had the lowest geometric mean MICs, followed by efinaconazole, against tested isolates compared to the other drugs. Therefore, it appears that these new imidazole and triazole drugs are promising candidates for the treatment of infections due to melanized fungi and their relatives

Otomycosis in the South of Iran with a High Prevalence of Tympanic Membrane Perforation: A Hospital-Based Study

Introduction Otomycosis is a superficial infection of the external ear caused by fungal pathogens. The genera Aspergillus and Candida are considered the main fungal causative agents, with the predominance of Aspergillus section Nigri. The present study aimed to evaluate the clinical symptoms of patients with otomycosis and predisposing factors and to identify fungal etiological agents using molecular approaches. We also present an overview of published papers on tympanic membrane perforation (TMP) secondary to otomycosis. Materials and Methods An otorhinolaryngologist collected specimens from external ear canals of patients with suspected otomycosis based on the patient’s history and clinical examinations. The specimens were collected using sterile swabs. Fungal isolates were confirmed in clinical specimens by direct microscopy and culture methods. Fungal isolates were identified based on molecular approaches. Results In total, specimens from 211 patients with suspected otomycosis were examined. The presence of fungi was confirmed in about 51% of patients based on fungal elements in direct microscopy and culture-positive fungi. Aspergillus tubingensis was the most commonly isolated species (52.77%), followed by Aspergillus niger (25.92%). Otomycosis due to infection with Candida species was observed in 16% of cases. Of note, in 36.11% of cases, otomycosis was associated with TMP. Conclusion A mycological examination is indispensable for a correct diagnosis in patients with otitis extern. TMP should be considered in patients with otomycosis, as it appears to be relatively common in this population