Candiduria: Prevalence, Identification of Isolated Candida Species and Trends in Antifungal Susceptibility in Hospitalized Patients

Background: Urinary tract candidiasis is known as the most frequent nosocomial fungal infection worldwide. Some of the predisposing factors of candiduria are extensive use of broad-spectrum anti-fungal agents, diabetes mellitus, indwelling urinary catheter, corticosteroids and, immunosuppressive drugs. There are some antifungal agents available for the treatment of candiduria. In recent years, resistance to antifungal agents has been increased. The aim of this study was to evaluate different Candida species (sp.) that cause candiduria and their susceptibility pattern to antifungal agents in patients admitted to educational hospitals.Materials and Methods: Urine samples (n=200) were obtained; they were spread onto Sabouraud Dextrose Agar plates. Plates were incubated at 37°C. Only specimens were considered as candiduria, which have a colony count of ≥104 CFU/mL colonies. Urine sediment was cultured in the CHROM agar Candida medium and incubated at 35°C for 48h. The cultures were evaluated based on color. PCR-RFLP was performed for a definite identification of Candida sp. In vitro antifungal susceptibility test of the Candida isolates against amphotericin B, fluconazole and itraconazole was performed using the microdilution method, according to the standard CLSI guidelines, document M27-S3.Results: Molecular findings confirmed the result of the morphological method. Candiduria rate was 11.5% among our patients. According to CHROM agar Candida and PCR-RFLP, the most common species isolated was C. albicans (74%), followed by C. glabrata (26%). In vitro susceptibility tests of urinary Candida isolates to antifungals have been evaluated. All species were sensitive to amphotericin B. None of C. glabrata isolates were sensitive to fluconazole and itraconazole.Conclusion: This study demonstrates the importance of Candida sp. in urine samples from hospitalized patients. It was concluded that Candida sp. obtained from candiduria in patients had excellent activity against Amphotericin B. Whereas, resistance against Itraconazole (21.7%) and especially Fluconazole (26%) was significant

Coinfection of Toenail Onychomycosis Caused by Rhodotorula mucilaginosa and Candida glabrata in an Immunocompromised Adult: A Case Report and Literature Review

Background: Rhodotorula mucilaginosa and Candida glabrata have emerged as potential pathogens,particularly in immunosuppressed hosts. This study aimed to present a case of coinfection of Candida glabrataand Rhodotorula mucilaginosa in a 35-year-old immunosuppressed female with onychomycosis on the first andsecond left toenails.Cases Report: Causative agents were identified according to morphology, microscopic studies, culture, andDNA molecular analysis. Candida glabrata demonstrated high minimum inhibitory concentrations against thetested antifungals except itraconazole. Moreover, Rhodotorula mucilaginosa had shown low minimuminhibitory concentrations against clotrimazole and ketoconazole at a dilution of 0.25 μg/ml. Itraconazole isadministered at 200 mg twice daily for one week for toenails and as pulse treatment (for one week a month) at5 mg/kg daily with topical clotrimazole.Conclusion: Clinical improvement was noted in the patient's clinical examination after ten months. Informationabout the increasing resistance to antifungal agents helps decide antifungal prophylaxis and select the empiricaltherapy for cancer patients

The effect of involved Aspergillus species on galactomannan in bronchoalveolar lavage of patients with invasive aspergillosis

PURPOSE: The detection of galactomannan (GM) in bronchoalveolar lavage (BAL) fluid is an important surrogate marker for the early diagnosis and therapeutic monitoring of invasive aspergillosis (IA), regardless of the involved species of Aspergillus. Here, we utilized the Platelia Aspergillus GM enzyme immunoassay (Bio-Rad) to evaluate the GM index in BAL fluid samples from patients with proven, probable or putative IA due to Aspergillusflavus versus Aspergillusfumigatus. METHODOLOGY: In a prospective study between 2009 and 2015, 116 BAL samples were collected from suspected IA patients referred to two university hospitals in Tehran, Iran. KEY FINDINGS: According to European Organization for Research and Treatment of Cancer and Mycoses Study Group and Blot criteria, 35 patients were classified as IA patients, of which 33 cases tested positive for GM above 0.5 and, among these patients, 22 had a GM index >/=1. Twenty-eight were culture positive for A. flavus and seven for A. fumigatus. The GM index for A. flavus cases was between 0.5-6.5 and those of A. fumigatus ranged from 1 to 6.5. The sensitivity and specificity of a GM index >/=0.5 in cases with A. flavus were 86 and 88 % and for A. fumigatus patients were 100 and 73 %, respectively. CONCLUSION: Overall, the mean GM index in patients with A. fumigatus (3.1) was significantly higher than those of A. flavus (1.6; P-value=0.031) and the sensitivity of GM lower for A. flavus when compared to A. fumigatus. This finding has implications for diagnosis in hospitals and countries with a high proportion of A. flavus infections

Emergence of Terbinafine Resistant Trichophyton mentagrophytes in Iran, Harboring Mutations in the Squalene Epoxidase (SQLE) Gene

Introduction: Trichophyton mentagrophytes and T. interdigitale are important causative agents of superficial mycoses, demonstrating emergent antifungal drug resistance. We studied the antifungal susceptibility profiles in Iranian isolates of these two species. Methods: A total of 96 T. interdigitale and 45 T. mentagrophytes isolates were subjected to molecular typing by ribosomal ITS region. Antifungal susceptibility profiles for terbinafine, griseofulvin, clotrimazole, efinaconazole, luliconazole, amorolfine and ciclopirox were obtained by CLSI broth microdilution method. The squalene epoxidase (SQLE) gene was subjected to sequencing for mutations, if any, in isolates exhibiting elevated MICs for terbinafine. Results: Luliconazole and efinaconazole showed the lowest MIC values against T. mentagrophytes and T. interdigitale isolates. There were five isolates with terbinafine MICs >= 32 mu g/mL in our sample. They belonged to T. mentagrophytes type VIII and harbored two alternative SQLE gene sequence variants, leading to Phe397Leu and Ala448Thr or Leu393Ser and Ala448Thr substitutions in the enzyme. All terbinafine resistant strains could be inhibited by luliconazole and efinaconazole. Conclusion: This study documented a step in the global spread of resistance mechanisms in T. mentagrophytes. However, treatment alternatives for resistant isolates were available. Keywords:Trichophyton mentagrophytes; SQLE; terbinafine; antifungal drug resistance; Ira

In Vitro Activity of Disinfectants against Mold Fungi Isolated from Different Environments of the Children’s Medical Center Hospital, Tehran, Iran

Introduction: Fungal aerosols cause life-threatening infections in patients hospitalized in critical wards. Antiseptics and disinfectants have broad-spectrum antimicrobial activity against the living tissue and inert surfaces microorganisms; hence, they have an essential role in controlling and preventing nosocomial infections. This study aimed to evaluate in vitro antifungal activity of benzalkonium chloride (BAC), chlorhexidine digluconate (CHX), and sodium hypochlorite (SH) against isolated fungal aerosols from the hospital environment.&#x0D; Materials and Methods: The susceptibility tests were performed on fungal aerosols isolated from various wards of Children’s Medical Center, based on broth microdilution antifungal susceptibility testing of filamentous fungi approved by the Clinical and Laboratory Standards Institute (CLSI) M38-A2 document. The isolates included Aspergillus (Aspergillus flavus (n = 14), Aspergillus niger complex (n = 12), Penicillium spp. (n = 14), and Cladosporium spp. (n = 14).&#x0D; Results: The geometric means (GM) of the Minimum Inhibitory Concentrations (MICs) of the biocides across all isolates were as follows: BAC, 3.56 µg/ml, CHX, 9.45 µg/ml, and SH, 810.35 µg/ml. The highest range of MICs was found for SH (50-12800 µg/ml), while the lowest range was for BAC (1-16 µg/ml) against all fungal isolates. Generally, BAC showed the highest in vitro activity among disinfectants tested. The lowest MIC50 and MIC90 values were 4 and 8 µg/ml for BAC, followed by 16 and 32 µg/ml for CHX, and 800 and 6400 µg/ml for SH, respectively.&#x0D; Conclusion: The findings showed that BAC was an effective disinfectant, which can  prevent resistant species and fungal pathogens and be used an alternative to other disinfectants and antiseptics.</jats:p

Fatal invasive aspergillosis in a child with chronic granulomatous disease

Patients with chronic granulomatous disease, a primary immunodeficiency, experience granulomatous complications and recurrent life-threatening opportunistic bacterial and fungal infections. In this article, we report on a case of invasive aspergillosis in an eight-year-old boy with chronic granulomatous disease, who presented with pleural effusion and pneumonia, cerebral venous sinus thrombosis, and unusual skin lesions caused by Aspergillus fumigatus. Antifungal treatment with itraconazole and other antifungal agents, along with interferon-γ, was ineffective and the patient eventually died from cerebral venous sinus thrombosis, and intracerebral haemorrhage following increased intracranial pressure after one month. The diagnosis of invasive aspergillosis should be considered early in children presenting with invasive fungal infections, particularly those involving the central nervous system. </jats:p