Catastrophic Candida prosthetic valve endocarditis and COVID-19 comorbidity: A rare case

Background and Purpose: Coronavirus disease 2019 (COVID-19) and Candida prostatic valve endocarditis present various clinical manifestations which may overlap;hence, discrimination between them is extremely difficult.Case report: The case was a 66-year-old man with a past medical history of mitral and aortic valves replacement one year before COVID-19 co-infection. He was admitted with fever (for 7 days), shortness of breath, cough, seizure, lethargy,headache, and 85% oxygen saturation. Transesophageal echocardiography revealed multiple large-sized, highly mobile masses on both sides of the mechanical mitral valve highly suggestive of vegetation. Chest computed tomography scanning showed simulating scattered COVID-19 peripheral ground-glass opacities confirmed by reverse-transcription polymerase chain reaction. The set of blood cultures yieldedyeast colonies that were identified as Candida tropicalis. The patient died of septic shock shortly after receiving antifungal therapy.Conclusion: This case emphasized the importance of early diagnosis andimplementation of antifungal treatment, particularly in patients with prosthetic cardiacvalves, to reduce their unfavorable outcomes in COVID-19 patient

Predominance of Trichophyton tonsurans causing tinea capitis: A 12-year retrospective study in the north of Iran

Background and purpose: Among different clinical entities of dermatophytosis, tinea capitis (TC) is considered a major public health challenge in the world, especially in regions with poor health and low income. Therefore, this study aimed to provide a retrospective analysis of the patients suspected of TC who were referred to the medical mycology laboratory of Mazandaran, a northern province of Iran.Materials and Methods: A retrospective analysis was performed on the patients suspected of TC who were referred to the medical mycology laboratory from July 2009 to April 2022. Hair roots and skin scrapings were collected from the participants. The laboratory diagnosis was confirmed by direct microscopic examination and culture. Finally, 921 out of 11095 (8.3%) patients were suspected of TC.Results: Based on the findings, TC was confirmed in 209 out of 921 patients (22.7%). In terms of gender, 209 TC patients (75.1%) were male. Moreover, the male to female ratio of TC patients was 1:3.0. Trichophyton tonsurans (146/174, 83.91%) was the most etiological agent,followed by T. mentagrophytes (13/174, 7.47%), T. violaceum (9/174, 5.17%), Microsporum canis (3/174, 1.71%), T. verrucosum (2/174, 1.15%) and T. rubrum (1/174, 0.57%). Besides, endothrix (77.0%) was the most prevalent type of hair invasion.Conclusion: The results revealed the predominance of T. tonsurans, as a causative agent of TC. Despite the prevalence of TC, the absence of appropriate consideration highlights that it is a neglected complication among children

Indoor environment assessment of special wards of educational hospitals for the detection of fungal contamination sources: A multi-center study (2019-2021)

Background and Purpose: The hospital environment was reported as a real habitat for different microorganisms, especially mold fungi. On the other hand, these opportunistic fungi were considered hospital-acquired mold infections in patients with weak immune status. Therefore, this multi-center study aimed to evaluate 23 hospitals in 18 provinces of Iran for fungal contamination sources.Materials and Methods: In total, 43 opened Petri plates and 213 surface samples were collected throughout different wards of 23 hospitals. All collected samples were inoculated into Sabouraud Dextrose Agar containing Chloramphenicol (SC), and the plates were then incubated at 27-30ºC for 7-14 days.Results: A total of 210 fungal colonies from equipment (162, 77.1%) and air (48,22.9%) were identified. The most predominant isolated genus was Aspergillus (47.5%),followed by Rhizopus (14.2%), Mucor (11.7%), and Cladosporium (9.2%). Aspergillus(39.5%), Cladosporium (16.6%), as well as Penicillium and Sterile hyphae (10.4% each), were the most isolates from the air samples. Moreover, intensive care units (38.5%) and operating rooms (21.9%) had the highest number of isolated fungal colonies. Out of 256 collected samples from equipment and air, 163 (63.7%) were positive for fungal growth.The rate of fungal contamination in instrument and air samples was 128/213 (60.1%) and 35/43 (81.2%), respectively. Among the isolated species of Aspergillus, A. flavus complex (38/96, 39.6%), A. niger complex (31/96, 32.3%), and A. fumigatus complex (15/96, 15.6%) were the commonest species.Conclusion: According to our findings, in addition to air, equipment and instrument should be considered among the significant sources of fungal contamination in the indoor environment of hospitals. Airborne fungi, Hospital, Indoor air, Equipment, Sources of fungal contamination in the indoor environment of hospitals

Mucormycosis: A Lethal Phenomenon in COVID-19 Patients: A Review of Diagnostic and Therapeutic Approaches

Coronavirus disease 2019 (COVID-19) has seriously spread worldwide. One of the problems of COVID-19 patients is co-infection with other microbial infections such as fungal infections that are severely life-threatening. Mucormycosis, one of these opportunistic fungal diseases that is mistakenly known as black fungal disease, has been reported in Iran and the world. This non-systematic review is intended to review the latest studies in the world and Iran about the incidence of mucormycosis in COVID-19 patients to better understand the disease and its predisposing factors. In general, patients with COVID-19 with underlying diseases, diabetic patients, those treated with immunosuppressive drugs, ICU patients, and patients under invasive mechanical ventilation are at higher risk for mucormycosis. Therefore, early diagnosis, treatment, and prevention methods can be effective in reducing the risk of mucormycosis in COVID-19 patients

Prosthetic valve endocarditis caused by multidrug-resistant Candida albicans in a patient with myelodysplasia syndrome: A case report and literature review

Background and Purpose: Candida endocarditis is an infrequent disease with a high mortality rate, which commonly occurs in immunosuppressed patients with cardiac valve replacement. We reported a 70-year-old woman diagnosed with Candida prosthetic valve endocarditis (PVE). This study also involved a review of all published cases of Candida PVE from 1970. Case report: Herein, we reported a 70-year-old woman with the history of severe mitral stenosis and myelodysplasia syndrome. She underwent mitral valve replacement for two times. The blood cultures were positive, and phenotypic identification of the isolates at the species level was performed based on microscopic and macroscopic characteristics. In the second prosthetic valve replacement, huge fungal white and creamy vegetation was observed which was identified as Candida albicans based on the conventional and molecular methods. Despite the administration of antifungal treatments, the patient passed away probably due to the multidrug-resistant Candida PVE. Conclusion: As PVE is a late consequence of prosthetic valve replacement, extended follow-up visits, early diagnosis, repeating valve replacement surgeries, and timely selective antifungal treatments are warranted. Keywords: Amphotericin B, Antifungal resistant, Azoles, Candida endocarditis, Multi-drug resistant, Myelodysplasia syndrome, Prosthetic valve replacemen

Effects of Acetic Acid Vaginal Gel on Vulvovaginal Candidiasis: A Double Blind Randomized Controlled Trial

Background and purpose: It is estimated that 70–75% of women experience one episode of vulvovaginal candidiasis (VVC) during childbearing age and 40-50% suffer from recurrent VVC. Because of the resistance of Candida species to certain drugs, such as azoles, physicians tend to use complementary or alternative medicine such as vinegar in treatment of VVC. The current study aimed to determine the therapeutic effects of acetic acid vaginal gel on VVC. Materials and methods: A double-blind randomized clinical trial was done in women (n=41) with VVC in Sari, Iran. The patients were allocated into two treatment groups to receive either 2% acetic acid vaginal gel + 2% acetic acid intravaginal wash + clotrimazole vaginal cream (n=20) or 2% acetic acid intravaginal wash + clotrimazole vaginal cream (n=21) for 10 days. After treatment, clinical symptoms and mycological cure rate were assessed by culture of vaginal secretions. All yeast isolates were identified by molecular method. Results: Before the intervention, there were no significant differences in signs and symptoms (P= 0.703), fungal burden rate (low, medium, heavy) (P= 0.092), and causative Candida species (P= 0.188) between the two groups. After treatment, an improvement in symptoms was seen in case group but the difference was not significant (P =0.3512). A significant difference was found between the two groups in mycological cure rate (P= 0.0377). Candida albicans were the most common species causing the disease. Conclusion: The study showed that acetic acid vaginal gel could have a significant effect on the definitive cure of VVC.   (Clinical Trials Registry Number: IRCT20190309042978N3

Potential Inhibitory Effect of Miltefosine against Terbinafine-Resistant <i>Trichophyton indotineae</i>

Several prolonged and significant outbreaks of dermatophytosis caused by Trichophyton indotineae, a new emerging terbinafine-resistant species, have been ongoing in India in recent years, and have since spread to various countries outside Asia. Miltefosine, an alkylphosphocholine, is the most recently approved drug for the treatment of both visceral and cutaneous leishmaniasis. Miltefosine in vitro activity against terbinafine-resistant and susceptible T. mentagrophytes/T. interdigitale species complex, including T. indotineae, is limited. The current study aimed to assess miltefosine’s in vitro activity against dermatophyte isolates, which are the most common causes of dermatophytosis. Miltefosine, terbinafine, butenafine, tolnaftate, and itraconazole susceptibility testing was performed using Clinical and Laboratory Standards Institute broth microdilution methods (CLSI M38-A3) against 40 terbinafine-resistant T. indotineae isolates and 40 terbinafine-susceptible T. mentagrophytes/T. interdigitale species complex isolates. Miltefosine had MIC ranges of 0.063–0.5 µg/mL and 0.125–0.25 µg/mL against both terbinafine-resistant and susceptible isolates. In terbinafine-resistant isolates, the MIC50 and MIC90 were 0.125 µg/mL and 0.25 µg/mL, respectively, and 0.25 µg/mL in susceptible isolates. Miltefosine had statistically significant differences in MIC results when compared to other antifungal agents (p-value 0.05) in terbinafine-resistant strains. Accordingly, the findings suggest that miltefosine has a potential activity for treating infections caused by terbinafine-resistant T. indotineae. However, further studies are needed to determine how well this in vitro activity translates into in vivo efficacy