Actinomycosis in Iran: Short Narrative Review Article.

Actinomycosis is an indolent, slowly progressive infection caused by anaerobic or microaerophilic bacteria, primarily of genus Actinomyces, which colonize the mouth, colon and vagina. Mucosal disruption may lead to infection virtually at any sites in the body. The aim of this study was to underline different features of actinomycosis and to represent total data about etiologic agents, clinical, diagnostic and therapeutic approaches these infections. From a total of 38 case reports or series, ninety one cases were obtained by using of relevant articles reported as recorded cases in Iran (1972 to 2012). Analyzed data represented 21 cases of oral-servicofacial (23.1%), 7 cases of thoracic (7.7%), 17 cases of abdominal (18.7%), 21 cases of disseminated forms (23.1%) and 25 cases of others (27.5%). Findings indicated more common of these infections in men (61.5%). Actinomyces naeslundii (21 cases) was found as the most common causative agents in comparison with A. Israeli (15 cases), A. viscosus (3 cases) and A. bovis (1 case). The most patients had been successfully treated with penicillin although some cases needed surgery along with antibiotic therapy. Since some clinical features of actinomycosis are similar to malignancies, so the differential diagnosis of invasive forms must be considered. This report emphasizes on the importance of differential diagnosis of actinomycosis from similar diseases by clinicians

Green synthesis of silver nanoparticles: Another honor for the yeast model Saccharomyces cerevisiae

Background and Purpose: Microorganism-based synthesis of nanostructures has recently been noted as a green method for the sustainable development of nanotechnology. Nowadays, there have been numerous studies on the emerging resistant pathogenic bacteria and fungal isolates, the probable inability of bacteria and fungi to develop resistance against silver nanoparticles’ (SNPs) antibacterial, antifungal, antiviral and, particularly antibacterial activities. In this study, we aim to use the yeast Saccharomyces cerevisiae model for synthesis of SNPs and to investigate its antifungal activity against some isolates of Candida albicans. Materials and Methods: A standard strain of S. cerevisiae was grown in liquid medium containing mineral salt then, it was exposed to 2 mM AgNO3. The reduction of Ag+ ions to metal nanoparticles was virtually investigated by tracing the color of the solution, which turned into reddish-brown after 72 hours. Further characterization of synthesized SNPs was performed afterwards. In addition, antifungal activity of synthesized SNPs was evaluated against fluconazolesusceptible and fluconazole-resistant isolates of Candida albicans. Results: The UV-vis spectra demonstrated a broad peak centering at 410 nm, which is associated with the particle sizes much less than 70 nm. The results of TEM demonstrated fairly uniform, spherical and small in size particles with almost 83.6% ranging between 5 and 20 nm. The zeta potential of SNPs was negative and equal to -25.0 (minus 25) mv suggesting that there was not much aggregation. Silver nanoparticles synthesized by S. cerevisiae, showed antifungal activity against fluconazole-susceptible and fluconazole-resistant Candida albicans isolates, and exhibited MIC90 values of 2 and 4 &mug/ml, respectively. Conclusion: The yeast S. cerevisiae model demonstrated the potential for extracellular synthesis of fairly monodisperse silver nanoparticle

The study of fungal contamination in three current packed spices in the markets of Tehran: brief report

Background: Spices (flavorings) are contaminated to microbial agents such as filamentous and yeast fungi during production processing. Almost these are grown and harvested in warm and humid areas of the world where the growth of a wide variety of organisms is readily supported. The aim of this study was to assess the fungal contaminations of three current spices including turmeric, black pepper and cinnamon from some supermarkets in Tehran and evaluating of their hygienic quality. Methods: In this cross- sectional study that was performed in laboratory of Medical Mycology, School of Public Health in Tehran University of Medical Sciences from December 2012 to September 2014, 165 packed spices including 55 samples from each 11 valid brands of cinnamon, turmeric and black pepper were selected from different regions of Tehran. Culture was performed on many different fungal media from 10-1 to 10-4 dilutions of their samples. The fungal colonies obtained from cultures were studied by traditional laboratory methods. On the other hand, the number of unknown possible colonies was identified by molecular methods and then all identified colonies were counted. Results: Totally, from 165 packed spices, 4317 colonies include 29 different fungal species were isolated and identified from cinnamon (1520), turmeric (1373) and black pepper (1424). The etiologic agents were mainly including Aspergillus niger (7.3%), Penicillium spp. (4.1%), Paecilomyces spp. (2.8%) and Aspergillus flavus (2.3%), respectively. Non-parametric Kruskal-wallis test indicated that there was no significant difference statistically among brands at each level. Also the present study showed P = 0.0003 among under study spices. The most contaminated spices were cinnamon, while turmeric had the lowest contamination rate. Conclusion: The obtained results of this cross-sectional study and the available proofs in community indicate that, there are the high levels of fungal contaminations in current used spices. Therefore, it is necessary to control the production units

Identification of Candida species by molecular and mycological methods in pregnant women with vulvovaginal candidiasis

Background: Vaginal candidiasis is common in during pregnancy. It may lead to complications like abortions, premature birth, low birth weight, chorioamnionitis and fungal systemic neonatal infection. The aim of present study was identification of Candida species by mycological and molecular methods in pregnant women with vaginal candidiasis. Methods: This cross-sectional study was performed on 80 pregnant women with or without clinical symptoms of vulvovaginal candidiasis referred to Shahid Noorani Talesh Hospital, Gilan University of Medical Sciences, Iran, from April to December 2015 (8 months). All specimens were examined by direct microscopy and culture on CHROMagar Candida medium for isolation and differentiation of major clinical-significant Candida species (spp.). Cultured media were incubated at 35 &deg;C for 48 hours and evaluated based on color and number of grown colonies. If no growth was observed, the media were incubated for several additional days. Subcultures were done on Sabouraud dextrose agar (Merck, Germany) and Corn meal agar with Tween 80 media (Micromedia, Hungary) for further study. Identification of Candida spp. carried out by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Results: In this study, vulvovaginal candidiasis was observed in 20 (25%) patients. Twenty-two isolates were obtained from culture of specimens on CHROMagar Candida medium (Paris, France). The most common isolated species was Candida albicans 16 (72.8%) and followed by Candida glabrata 5 (22.7%), Candida tropicalis 3 (13.6%) and Candida krusei 1 (4.5%) cases. Two patients had mixed infection with 2 different Candida species (C. albicans and C. glabrata) While using PCR-RFLP method, the Candida species were identified as 13 (59.1%) Candida albicans, 5 (22.7%) Candida glabra, 3 (13.6%) Candida tropicalis and 1 (4.5%) Candida krusei cases, respectively. In direct examination were seen yeast budding cells and pseudohyphae in 8 culture positive specimens. In the present study, results of conventional mycological method in differentiation of Candida spp. were consistent with molecular results in 80% of cases. There was also significant correlation between vulvovaginal candidiasis with clinical symptoms (P<0.0001), including diabetes mellitus (P<0.014), and taking antibacterial drugs (P<0.003) in pregnant women. Conclusion: PCR-RFLP was able to identify correctly the Candida spp. as a complementary method

Evaluation of Malassezia yeast colonization rate in patients with seborrheic dermatitis

Background: Seborrheic dermatitis (SD) is a chronic dermatitis with 1-3% prevalence and even with 33-83% in immunocompromised patients. Often, because of some of predisposing factors, abnormal proliferation of Malassezia yeasts (as a normal flora) is seen in patients that lead to observation of clinical symptoms in their bodies. The aim of this study was to evaluate of Malassezia yeasts colonization rate in patients with seborrheic dermatitis that has key importance to appropriate treatment. Methods: This descriptive cross-sectional study was carried out during one-year period from January 2015 to February 2016 on 45 patients. According to the sample size formula, after visiting by a dermatologist and refer to the Medical Mycology Laboratory, Tehran University of Medical Sciences, patients were subjected to mycological examinations schedules. After recording the clinical symptoms and their specifications, sampling from all patients&rsquo; lesions was performed with sterile scalpel and a piece of scotch tape. Direct smears were prepared with 10% potassium hydroxide as a fungal clearing solution (KOH) and stained with methylene blue. The presence and rate of Malassezia yeast colonization was determined according to the standard procedures by direct microscopic examination. Results: From a total of 45 under studied patients, 66.7% had moderate to severe colonization of Malassezia yeast. In existence of sweating and stress factors, severe colonization with significant differences was seen (P< 0.05). In 8 cases (17.7%), mycelium form of yeast was observed. The highest mycelium observation was seen in existence of stress with significant differences (P< 0.05). Conclusion: In most of patients, yeast colonization rate was more than mild status, that emphasize on the etiological role of Malassezia yeasts at least as exacerbating factor in seborrheic dermatitis. On the other hand, the role of factors such as sweating and stress in inducing of severe colonization and invasive form of Malassezia yeasts in SD was confirmed, that should be considered to be treated as well as SD in therapeutic procedure. &nbsp

Diagnosis of fungal keratitis in patients with corneal lesions at Amiralmomenin hospital in Rasht, Iran

Background: Keratomycosis is a fungal infection of the cornea which could be sight-threatening and even causes eye loss. Considering the high humidity and the dominance of agriculture as important predisposing factors of keratomycosis in north of Iran, this study was carried out for diagnosis of fungal keratitis in patients with corneal lesions in Rasht, Gilan province, Iran.&nbsp; Methods: This descriptive cross-sectional study was conducted from July 2015 to November 2016 on 56 patients with corneal lesion suspected to keratomycosis and referred to eye emergency ward of Amiralmomenin hospital, Rasht, Iran. Corneal scraping was performed in all cases and specimens were subjected to direct examination and culture. Only colonies grown in sites of corneal scraping inoculation were considered significant. Fungal isolates were identified according to their macroscopic features of colonies and microscopic characteristics in slide cultures. Data were analyzed in SPSS software, version 21 (IBM SPSS, Armonk, NY, USA) and P<0.05 was considered significant. Results: The patients included 42 (75%) men and 14 (25%) women with the mean age of 49.5 years (9 to 90 years). Positive culture was observed in 9 cases but, only in one of these patients direct examination was positive and fungal elements were seen in 10% KOH preparation. Though, fungal keratitis was confirmed in 9 (16%) patients including seven (77.8%) men and two (22.2%) women. The majority of cases (88.9%) had a history of corneal trauma with plants and they were mainly farmer. According to statistical analysis, there was a significant association between corneal trauma and keratomycosis (P=0.007). The most common etiologic agents were Fusarium spp. (n: 4, 44.4%), followed by Aspergillus flavus (n: 2, 22.2%), Penicillium sp. (n: 1, 11.1%), Acremonium sp. (n: 1, 11.1%), and Cladosporium sp. (n: 1, 11.1%) respectively. Conclusion: In the presence of sufficient predisposing factors such as corneal injuries caused by plants, keratomycosis could be caused by a variety of fungi. Furthermore, low sensitivity of direct examination in this study, revealed the necessity of culture in diagnosis of keratomycosis

In Vitro Interaction of Geldanamycin with Triazoles and Echinocandins Against Common and Emerging Candida Species

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Drug susceptibility pattern of candida species isolated from skin of neonates to fluconazole, amphotericin B and caspofungin

Background: Candida species are opportunistic yeasts that are capable of causing different infections and diseases among immunocompromised patients. Since Candida infections are major causes and frequent of septicemia in Neonatal Intensive Care Units (NICU), and they are associated with high morbidity and mortality rates, so obtaining adequate treatment seems necessary. Low birth weight preterm infants are especially vulnerable to these devastating infections. The aim of this study was to evaluate the drug susceptibility of Candida species colonized on the skin and mucous membrane of neonates to fluconazole, amphotericin B and caspofungin. Methods: This study was carried out in the laboratory of medical mycology and serology, School of Public Health, Tehran University of Medical Sciences for the period of 7 months from June 2016 to December 2016. In this descriptive cross-sectional study, 23 isolates of Candida species including Candida parapsilosis, Candida albicans, Candida tropicalis, Candida guilliermondii and Candida krusei were studied. These under study isolates were previously isolated from skin and mucous membranes of neonates in NICU of Imam Khomeini Hospital and Children's Medical Center were identified by PCR-RFLP (Polymerase chain reaction-restriction fragment length polymorphism). Evaluation of antifungal drug susceptibility including fluconazole, amphotericin B and caspofungin was carried out. Antifungal susceptibility test was done according to the standard protocol Clinical and Laboratory Standards Institute (CLSI M27-A3) that is specific to the yeast fungi. Statistical analysis was done by using T-test in SPSS version 22 (IBM, Armonk, NY, USA) and P<0.05 was considered statistically significant. Results: In this study, C. parapsilosis, C. albicans and C. tropicalis had the most sensitivity to fluconazole. Clinical Isolates of C. guilliermondii were also sensitive to fluconazole, but in C. krusei sensitivity was dose-dependent. All isolated species were sensitive to amphotericin B and caspofungin. Conclusion: According to the results, all isolated Candida species were more sensitive to amphotericin B and caspofungin than other antifungal drugs. In final conclusion, Finally, it is emphasized that antifungal susceptibility testing is necessary to prevent treatment failure or recurrence of disease

Candida colonization and species identification by two methods in NICU newborn

Background: Over the last two decades invasive candidiasis has become an increasing problem in neonatal intensive care units (NICUs). Colonization of skin and mucous membranes with Candida spp. is important factor in the pathogenesis of neonatal infection and several colonized sites are major risk factors evoking higher frequencies of progression to invasive candidiasis. The aim of this study was to detect Candida colonization in NICU patients. Methods: This cross-sectional study was conducted on 93 neonates in NICUs at Imam Khomeini and Children Medical Center Hospitals in Tehran. Cutaneous and mucous membrane samples obtained at first, third, and seventh days of patients&rsquo; stay in NICUs during nine months from August 2013 to May 2014. The samples were primarily cultured on CHROMagar Candida medium. The cultured media were incubated at 35&deg;C for 48h and evaluated based on colony color produced on CHROMagar Candida. In addition, isolated colonies were cultured on Corn Meal Agar medium supplemented with tween 80 for identification of Candida spp. based on their morphology. Finally, polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was performed for definite identification of isolated species. Results: Colonization by Candida spp. was occurred in 20.43% of neonates. Fifteen and four patients colonized with one and two different Candida spp., respectively. Isolated Candida spp. identified as; C. parapsilosis (n: 10), C. albicans (n: 7), C. tropicalis (n: 3), C. guilliermondii (n: 2), and C. krusei (n: 1). In present study non-albicans Candia species were dominant (69.56%) and C. parapsilosis was the most frequent isolate (43.47%). Using Fisher's exact test, the correlation between fungal colonization with low birth weight, low gestational age, and duration of hospital stay was found to be statistically significant (P=0.003). Conclusion: The results of this study imply to the candida species colonization of neonates. Neonates in NICU are at the highest risk for severe infection with Candida parapsilosis. Therefore, isolation of C. parapsilosis as the most common species (43.47%) in present study was noteworthy