Estimated burden of serious human fungal diseases in Turkey

Seyedmousavi, Seyedmojtaba/0000-0002-6194-7447; Denning, David/0000-0001-5626-2251; Hedayati, Mohammad T./0000-0001-6415-4648; Ilkit, Macit/0000-0002-1174-4182WOS: 000453770400004PubMed: 30107069The current number of fungal infections occurring each year in Turkey is unknown. We estimated the burden of serious human fungal diseases based on the population at risk, existing epidemiological data from 1920 to 2017 and modelling previously described by the LIFE program (). Among the population of Turkey (80.8 million in 2017), approximately 1 785 811 (2.21%) people are estimated to suffer from a serious fungal infection each year. the model used predicts high prevalences of allergic fungal rhinosinusitis episodes (312 994 cases) (392/100 000), of severe asthma with fungal sensitisation (42 989 cases) (53.20 cases/100 000 adults per year), of allergic bronchopulmonary aspergillosis (32 594 cases) (40.33/100 000), of fungal keratitis (26 671 cases) (33/100 000) and of chronic pulmonary aspergillosis (5890 cases) (7.29/100 000). the estimated annual incidence for invasive aspergillosis is lower (3911 cases) (4.84/100 000 annually). Among about 22.5 million women aged 15-50 years, recurrent vulvovaginal candidiasis is estimated to occur in 1 350 371 (3342/100 000) females. the burden of three superficial fungal infections was also estimated: tinea pedis (1.79 million), tinea capitis (43 900) and onychomycosis (1.73 million). Given that the modelling estimates reported in the current study might be substantially under- or overestimated, formal epidemiological and comprehensive surveillance studies are required to validate or modify these estimates

Determinants of fluconazole resistance and the efficacy of fluconazole and milbemycin oxim combination against Candida parapsilosis clinical isolates from Brazil and Turkey

Fluconazole-resistant Candida parapsilosis (FLZR-CP) outbreaks are a growing public health concern and have been reported in numerous countries. Patients infected with FLZR-CP isolates show fluconazole therapeutic failure and have a significantly increased mortality rate. Because fluconazole is the most widely used antifungal agent in most regions with outbreaks, it is paramount to restore its antifungal activity. Milbemycin oxim (MOX), a well-known canine endectocide, is a potent efflux pump inhibitor that significantly potentiates the activity of fluconazole against FLZR C. glabrata and C. albicans. However, the FLZ-MOX combination has not been tested against FLZR-CP isolates, nor is it known whether MOX may also potentiate the activity of echinocandins, a different class of antifungal drugs. Furthermore, the extent of involvement of efflux pumps CDR1 and MDR1 and ergosterol biosynthesis enzyme ERG11 and their link with gain-of-function (GOF) mutations in their transcription regulators (TAC1, MRR1, and UPC2) are poorly characterized among FLZR-CP isolates. We analyzed 25 C. parapsilosis isolates collected from outbreaks in Turkey and Brazil by determining the expression levels of CDR1, MDR1, and ERG11, examining the presence of potential GOF mutations in their transcriptional regulators, and assessing the antifungal activity of FLZ-MOX and micafungin-MOX against FLZR and multidrug-resistant (MDR) C. parapsilosis isolates. ERG11 was found to be universally induced by fluconazole in all isolates, while expression of MDR1 was unchanged. Whereas mutations in MRR1 and UPC2 were not detected, CDR1 was overexpressed in three Brazilian FLZR-CP isolates, which also carried a novel TAC1L518F mutation. Of these three isolates, one showed increased basal expression of CDR1, while the other two overexpressed CDR1 only in the presence of fluconazole. Interestingly, MOX showed promising antifungal activity against FLZR isolates, reducing the FLZ MIC 8- to 32-fold. However, the MOX and micafungin combination did not exert activity against an MDR C. parapsilosis isolate. Collectively, our study documents that the mechanisms underpinning FLZR are region specific, where ERG11 mutations were the sole mechanism of FLZR in Turkish FLZR-CP isolates, while simultaneous overexpression of CDR1 was observed in some Brazilian counterparts. Moreover, MOX and fluconazole showed potent synergistic activity, while the MOX-micafungin combination showed no synergy

Erkek öğrenci yurdunda epidermophyton floccosum' un etken olduğu Tinea cruris epidemisi

This study aimed at investigating on outbreak of Tinea cruris in a male student dormitory. Among male students staying in the university dormitory Tinea cruris was prediagnosed clinically in 29. Mycological studits from these 29 patients yielded positive-culture in 18 (62%); Epidermophyton flaccosum was isolated from 84% and Trichophyton rubrum from 16%. the control group consisted of 36 students residing outside with prediagnosis of Tinea cruris. of the control students 23 (64%) were culture-positive; T. rubrum was isolated from 60% and E. floccosum from 40%. the high prevalance of E. floccosum among dormitory students was an indication of an outbreak (p;lt;0.01).Erkek öğrenci yurdunda kalan öğrencilerin sıklıkla Tinea cruris ile başvurduğu gözlemlenmiş, olası bir epidemi varlığını saptayabilmek için mantar araştırması yapılmıştır. Yurtta kalan 29 Tinea cruris' li olgunun 18'inde (%62) mikolojik üreme pozitif, üremenin pozitif olduğu olguların %84'ünde Epidermophyton floccosum. %16'sında Trichophyton rubrum saptandı. Öğrenci yurdu dışında kalan 36 Tinea cruris'li kontrol olgusunun 23 'ünde (%64) mikolojik üreme pozitif idi. Üremenin pozitif olduğu olguların %60'ında T. rubrum. %40'ında E. floccosum bulundu. Yurtta kalan öğrenciler arasında E. floccosum oranının bu denli yüksek olması, bu etkenin bir epidemi yaptığını göstermektedir (p0.01)

Maya Mantarlarının Hızlı Tanımlanmasında Lizis Filtrasyon Sonrası MALDI TOF-MS Yönteminin Kullanımı

Amaç: İnvazif kandidozda erken tanı çok önemlidir ve mortalite oranını düşürmek için kısa sürede ve güvenilir sonuç veren yöntemlere ihtiyaç duyulmaktadır. Bu çalışmada, Candida türlerinin daha hızlı tanımlanabilmesi için lizis filtrasyon sonrası MALDI-TOF MS yönteminin uygunluğu araştırılmıştır. Yöntem: Bu çalışmada, Ege Üniversitesi, Tıp Fakültesi, Tıbbi Mikrobiyoloji Laboratuvarına gönderilen kan kültürlerinden izole edilen 100 Candida kökeni, Dalmau plak, MALDI-TOF MS ve lizis filtrasyon sonrası MALDI-TOF MS yöntemleriyle araştırıldı ve elde edilen sonuçlar karşılaştırıldı. Bulgular: Çalışmamızda konvansiyonel ve MALDI-TOF MS tanımlama yöntemlerine göre; 37 Candida albicans, 23 Candida parapsilosis, 17 Candida tropicalis, dokuz Candida glabrata, altı Candida kefyr, üç Candida guilliermondii, üç Candida dubliniensis, üç Candida krusei olarak identifiye edilmiştir. Lizis filtrasyon sonrası MALDI-TOF MS yönteminde ise identifikasyon sonuçları; 26 C. albicans, dokuz C. parapsilosis, 13 C. tropicalis, dokuz C. glabrata, iki C. kefyr, üç C. dubliniensis, iki C. krusei olarak belirlenmiştir. MALDI-TOF MS yöntemi ve Dalmau plak ile lizis filtrasyon sonrası MALDI-TOF MS yöntemi 64 kökende uyumlu bulunmuştur. Uyumsuzluğun yanlış tanımlamadan değil, spektrum yetersizliğinden kaynaklandığı gözlemlenmiştir. Sonuç: “Spektrum yetersizliği” olarak tanımlanmayan suşlar veri tabanında yer alan türlerden oluşmaktadır. Altmış dört Candida türünün standart yöntemlerle %100 uyumlu olacak şekilde tanımlama yaptığı ve bu yöntemin subkültür gerektiren MALDI-TOF MS yöntemine göre en az 48 saat, Dalmau plak yöntemine göre de en az 72 saat avantaj sağladığı görülmüştür