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

Adana bölgesinde çocuk populasyonunda hepatit E virüsü enfeksiyonlarının seroepidemiyolojik incelenmesi

TEZ1992Tez (Doktora) -- Çukurova Üniversitesi, Adana, 1995.Kaynakça (s. 31-39) var.40 s. ; 30 cm.

Human Herpesvirus-8

DNA sequence of novel herpesvirus was recently discovered in biopsy samples of AIDS-associated Kaposi’s sarcoma. HHV-8 was also found in classic, endemic, as well as AIDS-associated KS biopsies suggesting that this viral agent might be associated with immuno-defiency in general. HHV-8 has already been tentatively associated with two diseases, KS and AIDS-related body-cavity-based lymphoma. Available DNA sequence analyses shows that HHV-8 has a high degree of homology, with HVS and EBV, members of the Gammaherpesvirinae subfamily

A TINEA INCOGNITO CASE CAUSED BY TRICHOPHYTON RUBRUM WITH CLINICAL AND MYCOLOGICAL CURE AND REVIEW OF THE LITERATURE

WOS: 000275480700020PubMed ID: 20455412Tinea incognito is the result of lack of diagnosis of dermatophyte infection of the glabrous skin and the misuse of steroids or calcineurin inhibitors. In this case report a 20-years-old female patient diagnosed as tinea incognito and Trichophyton rubrum isolated from her skin lesions, was presented. The patient suffered from an itchy skin lesion on her neck and right breast. Physical examination revealed and plaques with erythema and papules on neck and breast area. The patient had used several corticosteroids suggested by dermatologists for 10 months. Direct microscopic examination of the skin scrapings with 10% potassium hydroxide preparation revealed fungal elements and Trichophyton rubrum was isolated in culture. Use of corticosteroids was ceased and terbinafine (250 mg tb and cream) therapy was initiated to continue for four weeks. Following treatment, total clinical and mycological cure was established. It was concluded that tinea incognito which was not a rare clinical entity, could be presented in various clinical forms and usually resulted from the wrong treatmeril: modalities. Thus atypical erythematous plaques should be investigated in terms of presence of fungi and treated accordingly to establish total clinical and mycological cure

Comparison of 12 liquid media for germ tube production of Candida albicans and C-tropicalis

WOS: 000247263400007PubMed ID: 17576320Infections caused by yeast of the genus Candida are the most common fungal infections, being Candida albicans the most common isolated species among them. The rapid identification of this yeast is mostly based on the production of germ tube in human or animal serum. This study describes the use of 12 different liquid media for germ tube production at 2, 2.5, 3 and 4 h. We examined 193 yeasts, including 157 (81.3%) C. albicans and 36 (18.7%) Candida tropicalis for the production of germ tube. The germ tube production of C. albicans was mostly observed in human serum (98%) followed by rabbit serum (89.8%), brain heart infusion broth (84%) and sheep serum (74.5%) at 2 h. An incubation time exceeding 2 h i.e. 2.5 h or later, C. tropicalis strains were observed to produce germ tubes. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for germ tube production of human serum at 2 h were 98%, 100%, 100% and 92.3% respectively. In all tested sera, an incubation period of more than 2 h improves the sensitivity, but decreases the specificity as well as PPV and NPV of germ tube test (GTT). In conclusion, human serum was observed to be the most appropriate medium to be preferred for GTT, with an incubation period of 2 h

Majocchi's granuloma: current perspectives

Majocchi's granuloma (MG) is a rare fungal infection of the dermis that is mainly caused by dermatophytes (in >= 95% of cases); the most frequently identified cause is anthropophilic Trichophyton rubrum. In the rest of the cases, the causes are non-dermatophytic fungi such as Aspergillus species. This review aimed to provide information about the current perspectives on MG regarding its clinical characteristics, predisposing factors, laboratory diagnosis, and treatment strategies. Although the lower extremities were reported to be the most common site of infection, facial involvement has been predominant in the past 5 years. Our literature research showed that the most common predisposing factor (55%) is the use of topical steroid creams without potassium hydroxide examination during treatment of erythematous squamous dermatoses. A reliable diagnosis of MG is based on histopathological examination, including fungal culture and molecular analyses. MG should be treated not only with topical agents but also with systemic antifungal agents that are continued until the lesions are completely resolved. In systemic treatment, the most preferred drug is terbinafine, because of its efficacy, side effects, and safety

Epidemiological characteristics of Malassezia folliculitis and use of the May-Grunwald-Giemsa stain to diagnose the infection

WOS: 000322687500010PubMed ID: 23706503Various bacterial, fungal, parasitic, and viral pathogens can cause folliculitis, which is often mistakenly treated with antibiotics for months or even years. A laboratory diagnosis is required before therapy can be planned. Here, we describe the prevalence and risk factors, as well as the clinical, cytological, and mycological characteristics, of patients with Malassezia folliculitis (MF) in Adana, Turkey. We also report the treatment responses of the MF patients and describe the Malassezia spp. using culture-based molecular methods. Cytological examinations were performed in 264 folliculitis patients, 49 of whom (18.5%) were diagnosed with MF. The positivity of the May-Grunwald-Giemsa (MGG) smear was higher (100%) than that of the potassium hydroxide test (81.6%). Using Wood's light, yellow-green fluorescence was observed in 66.7% of the MF patients. Identification using the rDNA internal transcribed spacer region revealed that Malassezia globosa was the most common species, followed by Malassezia sympodialis, Malassezia restricta, and Malassezia furfur. The MF patients were treated with itraconazole capsules (200 mg/d) for 2 weeks. Complete recovery was observed in 79.6% of the patients. These novel findings help improve our current understanding of the epidemiological characteristics of MF and establish MGG as a practical tool for the diagnosis of MF. (c) 2013 Elsevier Inc. All rights reserved

Investigation of tinea pedis and toenail onychomycosis prevalence in patients with psoriasis

Psöriaziste onikomikoz prevalansına ilişkin çelişkili veriler bulunmaktadır. Bu çalışmada, psöriazisli hasta ve kontrol grubunda onikomikoz ve tinea pedis prevalansının araştırılması amaçlanmıştır. Çalışmaya, hastanemiz dermatoloji anabilim dalı polikliniğinde psöriazis tanısı ile izlenen 60 olgu (27'si erkek, 33'ü kadın; yaş ortalaması: 40.8 ± 17.6 yıl) ile psöriazis dışı nedenlerle izlenen 60 kontrol birey (27'si erkek, 33'ü kadın; yaş ortalaması: 42.8 ± 17.3 yıl) dahil edilmiştir. Normal görünümde veya mantar enfeksiyonu ile uyumlu klinik bulguları olan ayak tırnağı ve ayak parmak arası kazıntı örnekleri direkt mikroskobik olarak ve mantar kültürü ile incelenmiştir. Psöriazisli hastaların 5'inde onikomikoz, 1 'inde tinea pedis olmak üzere toplam 6 olguda (%10), kontrol grubunun ise 5'inde onikomikoz, 3'ünde tinea pedis olmak üzere toplam 8 olguda (%13.3) ayak dermatofitozu saptanmıştır (p> 0.05). Psöriazisli hasta ve kontrol gruplarında etken olarak yalnızca dermatofitlerden Trichophyton rubrum (%75) ve Trichophyton inter-digitale (%25) izole edilmiştir. Psöriazis grubunda onikomikozun erkeklerde daha baskın olarak saptandığı izlenmiştir (p= 0.01). Psöriazisli olgularda klinik olarak hem distero-lateral subungual onikomikoz (DLSO) hem de total distrofik onikomikoz gözlenirken, kontrol grubunda yalnızca DLSO saptanmıştır. Psöriazisli hastaların tırnaklarında rastlanılan en tipik bulgunun çukurlaşma olduğu belirlenmiştir (p= 0.04). Ayak dermatofitozunun bulaşında ortak duş alanlarının kullanımın kolaylaştırıcı bir etmen olduğu saptanmıştır (p= 0.04). Çalışmamızda elde edilen veriler, tırnağın mantar enfeksiyonlarında psöriazisin kolaylaştırıcı bir etmen olmadığını göstermekle birlikte, psöriatik tırnaklarda onikomikozun önemli bir sorun olması nedeniyle ayırıcı tanıda mikolojik incelemelerin yapılmasının yararlı olacağı açıktır. Sonuç olarak, halen önemli bir halk sağlığı sorunu olan dermatomikozların önlenmesinde, iyi ayak bakımı ve duş alanlarında çıplak ayakla yürünmemesi gibi konularda olguların eğitiminin büyük önem taşıyacağı düşüncesindeyiz.The data about the prevalence of onychomycosis in patients with psoriasis is contradictory. In this study, we investigated the prevalence of onychomycosis and tinea pedis in patients with psoriasis compared to control group. A total of 60 patients with psoriasis (27 male, 33 female; mean age: 40.8 + 17.6 years) and 60 subjects without psoriasis (27 male, 33 female; mean age: 42.8 ± 17.3 years) who were admitted to dermatology outpatient clinics of our hospital were included to the study. Scrapinqs from both normal and abnormal toenails as well as toewebs were examined using microscopy and fungal culture. Foot dermatomycosis was diagnosed in 6 (5 onychomycosis and 1 tinea pedis) patients with psoriasis (10%) and in 8 (5 onychomycosis and 3 tinea pedis) control subjects (13.3%) (p> 0.05). The only dermatophyte fungi isolated in both patients with psoriasis and control group were Trichophyton rubrum (75%) and Trichophyton interdigitale (25%). Onychomycosis was more predominant in male psoriatic patients (p= 0.01). Both distero-lateral subungual onychomycosis (DLSO) and total dystrophic onychomycosis were detected in patients with psoriasis, however, DLSO, was the only clinical type in the control group. Pitting is the most typical lesions in nails in patients with psoriasis (p= 0.04). The use of common showers play a role in transmission of foot dermatomycosis (p= 0.04). In this study, psoriasis was not found as a risk factor for onychomycosis. However, onychomycosis is a major problem in psoriatic nails, and mycological methods would be useful in differential diagnosis. Since dermatomycosis is still an important public health problem, it may be controlled by education of the patient about proper foot hygiene and avoiding walking barefooted in shower areas