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

The inhibitory effects of Satureja Khozistanica on LDL oxidation induced-CuSO4 in vitro

Background : Oxidation of lipids such as low-density lipoprotein (LDL) has been strongly suggested as a key factor in the pathogenesis of atherosclerosis. Thus the inclusion of some anti-oxidant compounds such as vitamin E and Satureja Khozistanica Essential oil (SKE) in daily dietary food stuff may inhibit the production of oxidized LDL and may decrease both the development and the progression of atherosclerosis. The aim of this research is to study inhibitory effects of different concentrations of essential oil Satureja Khozistanica on LDL oxidation in vitro. Materials and Methods:Fasting blood samples from normal people after an overnight fasting were collected and then isolated LDL was incubated without CuSO4 as control and incubated with CuSO4 and several concentration of SKE (50, 100 and 200 mg/ml) and vitamin E as positive control (100 µM). Then the formation of conjugated dienes, lag time and thiobarbituric acid reactive substances (TBARS)were measured. Inhibition of this Cu-induced oxidation was studied in the presence of several concentration of SKE and vitamin E. Results: The results showed that SKE induced LDL oxidation and decrease the resistance of LDL against oxidation in vitro. SKE at concentrations of 50, 100 and 2000 µg/ml, and vitamin E (100 µM) showed an increase rate of 33.33, 66.66, 100.00 and 111.11% respectively, against oxidation in vitro. The inhibitory effects of the SKE on LDL oxidation were dose-dependent at concentrations of 50, 100 and 200 µg/ml. Conclusion: This study showed that Satureja Khozistanica prevented the oxidation of LDL in vitro and it may suggest that it has the similar effects in vivo

Invasive Aspergillosis in COVID-19: A Review Study and Recommendations for Diagnostic Approaches

Background and purpose: COVID-19 is an emerging viral disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Bacterial or fungal superinfections of the lung may cause complications in clinical manifestations, treatment, and increase the mortality rate. In this article, we reviewed previous studies on invasive aspergillosis (IA) in viral infections and in adjustment with COVID-19. Also, the necessity of IA diagnosis to increase the survival rate in involved patients is discussed. Materials and methods: Electronic databases, including Pubmed, Google Scholar, and Web of Science were searched using the following keywords: COVID-19, SARS-CoV-2, influenza, invasive aspergillosis, and invasive fungal infections. Results: Reports from China showed 3.2% to 27.1% fungal co-infection in COVID-19 patients. Patients with COVID-19 who developed severe pneumonia were found with considerably higher rates of viral, bacterial, and fungal co-infections than those with mild pneumonia. Also, intestinal normal fungal flora was reported to be significantly different between COVID-19 patients and normal subjects. Conclusion: While the main focus of physicians is on bacterial superinfection control in COVID-19, ignoring life threatening fungal infections may increase the mortality rate. Therefore, we profoundly recommend early diagnosis of invasive fungal infections in COVID-19 patients

Evaluation Eucalyptus camaldulensis Contaminations with Cryptococcus gattii in Tehran

Background and Aims: Cryptococcosis is an infection caused by Cryptococcus species. Cryptococcus gattii is mostly isolated from Eucalyptus trees and is acquired via inhalation of basidiospores. The present study was performed to isolate Cryptococcus sp. from Eucalyptus trees and evaluate C. gatti contamination of the Eucalyptus camaldulensis trees in some parks of Tehran and Varamin. Materials and Methods: 88 trees (leaves, stalk, fruit and soil) were collected from different areas of Tehran, Varamin and Shahr Ray in 2014-2015 during spring and fall. Identification of Cryptococcus sp. were performed based on colony color on niger seed agar medium, urease production, india ink test and pseudohyphae formation on corn meal agar with tween 80. Specific differentiation of Cryptococcus sp. were performed using sugar assimilation by API 20C AUX, disk approaches, colony color on Canavanine Glycine Bromothymol Blue and Cycloheximide-Phenol Red Agar medium. Results and Conclusions: 6 out of 88 samples of Eucalyptus trees were identified as Cryptococcus sp. Accordingly, four species were identified as Cryptococcus albidus while species of two other isolates were not detectable by used methods. Although Cryptococcus gattii was not isolated from the collected samples, this does not mean that Eucalyptus trees of Tehran are not contaminated

Candidemia among Iranian Patients with Severe COVID-19 Admitted to ICUs

As a novel risk factor, COVID-19 has led to an increase in the incidence of candidemia and an elevated mortality rate. Despite being of clinical importance, there is a lack of data regarding COVID-19-associated candidemia (CAC) among Iranian patients. Therefore, in this retrospective study, we assessed CAC epidemiology in the intensive care units (ICUs) of two COVID-19 centers in Mashhad, Iran, from early November 2020 to late January 2021. Yeast isolates from patients’ blood were identified by 21-plex polymerase chain reaction (PCR) and sequencing, then subjected to antifungal susceptibility testing according to the CLSI M27-A3 protocol. Among 1988 patients with COVID-19 admitted to ICUs, seven had fungemia (7/1988; 0.03%), among whom six had CAC. The mortality of the limited CAC cases was high and greatly exceeded that of patients with COVID-19 but without candidemia (100% (6/6) vs. 22.7% (452/1988)). In total, nine yeast isolates were collected from patients with fungemia: five Candida albicans, three C. glabrata, and one Rhodotorula mucilaginosa. Half of the patients infected with C. albicans (2/4) were refractory to both azoles and echinocandins. The high mortality of patients with CAC, despite antifungal therapy, reflects the severity of the disease in these patients and underscores the importance of rapid diagnosis and timely initiation of antifungal treatment

Distribution of non-tuberculosis mycobacteria strains from suspected tuberculosis patients by heat shock protein 65 PCR–RFLP

The genus Mycobacterium contains more than 150 species. Non-tuberculosis mycobacteria (NTM) often cause extrapulmonary and pulmonary disease. Mycobacteria detection at species level is necessary and provides useful information on epidemiology and facilitates successful treatment of patients. This retrospective study aimed to determine the incidence of the NTM isolates and Mycobacterium tuberculosis (Mtb) in clinical specimens collected from Iranian patients during February 2011–December 2013, by PCR–restriction fragment length polymorphism analysis (PRA) of the hsp65 gene. We applied conventional biochemical test and hsp65–PRA identification assay to identify species of mycobacteria in specimens from patients suspected of having mycobacterial isolates. This method was a sensitive, specific and effective assay for detecting mycobacterial species and had a 100% sensitivity and specificity for Mtb and Mycobacterium avium complex (MAC) species. Using PRA for 380 mycobacterial selected isolates, including 317 Mtb, four Mycobacterium bovis and of the 59 clinical isolates, the most commonly identified organism was Mycobacterium kansasii (35.6%), followed by Mycobacterium simiae (16.9%), Mycobacterium gordonae (16.9%), Mycobacterium fortuitum (5.1%), Mycobacterium intracellulare (5.1%), Mycobacterium avium (5.1%), Mycobacterium scrofulaceum (3.4%), Mycobacterium gastri (3.4%), Mycobacterium flavescens (3.4%), Mycobacterium chelonae (3.4%) and Mycobacterium nonchromogenicum (1.7%). PRA method, in comparison with classical methods, is rapid, useful and sensitive for the phylogenetic analysis and species detection of mycobacterial strains. Mycobacterium kansasii is the most common cause of infection by NTM in patients with non-HIV and HIV which demonstrated a high outbreak and diversity of NTM strains in our laboratory. Keywords: Non-tuberculosis mycobacteria, Heat shock protein 65, PCR–RFL

Pervasive but Neglected: A Perspective on COVID-19-Associated Pulmonary Mold Infections Among Mechanically Ventilated COVID-19 Patients.

Background: Recent studies from multiple countries have shown a high prevalence of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) among severely ill patients. Despite providing valuable insight into the clinical management of CAPA, large-scale prospective studies are limited. Here, we report on one of the largest multicenter epidemiological studies to explore the clinical features and prevalence of COVID-19-associated pulmonary mold infections (CAPMIs) among mechanically ventilated patients. Methods: Bronchoalveolar lavage (BAL) and serum samples were collected for culture, galactomannan (GM), and β-D-glucan (BDG) testing. Patients were classified as probable CAPMI based on the presence of host factors, radiological findings, and mycological criteria. Results: During the study period, 302 COVID-19 patients were admitted to intensive care units (ICUs), among whom 105 were mechanically ventilated for ≥4 days. Probable CAPMI was observed among 38% of patients (40/105), among whom BAL culture of 29 patients turned positive for molds, while galactomannan testing on BAL (GM index ≥1) and serum (GM index >0.5) samples were positive for 60% (24/40) and 37.5% (15/39) of patients, respectively. Aspergillus (22/29; 75.8%) and Fusarium (6/29; 20.6%) constituted 96.5% of the molds isolated. Diaporthe foeniculina was isolated from a COVID-19 patient. None of the patients who presented with CAPMI were treated with antifungal drugs. Conclusion: Despite being prevalent, the absence of appropriate antifungal treatment highlights that CAPMI is a neglected complication among mechanically ventilated COVID-19 patients admitted to ICUs. CAPMI can be caused by species other than Aspergillus

Pervasive but Neglected: A Perspective on COVID-19-Associated Pulmonary Mold Infections Among Mechanically Ventilated COVID-19 Patients.

Background: Recent studies from multiple countries have shown a high prevalence of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) among severely ill patients. Despite providing valuable insight into the clinical management of CAPA, large-scale prospective studies are limited. Here, we report on one of the largest multicenter epidemiological studies to explore the clinical features and prevalence of COVID-19-associated pulmonary mold infections (CAPMIs) among mechanically ventilated patients. Methods: Bronchoalveolar lavage (BAL) and serum samples were collected for culture, galactomannan (GM), and β-D-glucan (BDG) testing. Patients were classified as probable CAPMI based on the presence of host factors, radiological findings, and mycological criteria. Results: During the study period, 302 COVID-19 patients were admitted to intensive care units (ICUs), among whom 105 were mechanically ventilated for ≥4 days. Probable CAPMI was observed among 38% of patients (40/105), among whom BAL culture of 29 patients turned positive for molds, while galactomannan testing on BAL (GM index ≥1) and serum (GM index >0.5) samples were positive for 60% (24/40) and 37.5% (15/39) of patients, respectively. Aspergillus (22/29; 75.8%) and Fusarium (6/29; 20.6%) constituted 96.5% of the molds isolated. Diaporthe foeniculina was isolated from a COVID-19 patient. None of the patients who presented with CAPMI were treated with antifungal drugs. Conclusion: Despite being prevalent, the absence of appropriate antifungal treatment highlights that CAPMI is a neglected complication among mechanically ventilated COVID-19 patients admitted to ICUs. CAPMI can be caused by species other than Aspergillus