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Background and Objectives: Airway fungal infection is a severe clinical problem, especially in patients with compromised immune functions. Here, we examined the distribution and antifungal susceptibility profiles of fungal agents isolated from respiratory tract of symptomatic patients hospitalized in pulmonary units. Materials and Methods: This descriptive cross-sectional study took place from 2023 to 2024, involving 360 patients. Bronchoalveolar lavage (BAL) or sputum specimens were collected and analyzed using mycological and molecular methods for this study. Antifungal susceptibility testing (AFST) was carried out using the broth micro dilution method. Results: Of a total of 360 respiratory specimens, 114 (31.6%) were positive. The male-to-female ratio was 63:51 (1.3%). Candida albicans and Aspergillus flavus were the most common yeast and mold species. Chronic obstructive pulmonary disease (COPD) had the highest rate of colonization with fungal agents (47/114, 41%). The isolates associated with COPD in this study included Aspergillus species (4/12, 3.5%), Candida species (41/96, 36%), and other fungal species (2/6, 1.5%). Coughing (87%) was the predominant symptom, and malignancy (52%) was the predominant comorbidity factor. The result of AFST for antifungal agents showed that 9 (22.5%) Candida isolates were resistant, and the highest rate of resistance was related to voriconazole agent (5/9, 55.5%). Resistance to antifungal agents was not observed among Aspergillus isolates. Conclusion: This study showed a significant relationship between the frequency of Aspergillus and Candida species in patients with underlying lung diseases. In addition, voriconazole was more effective than itraconazole, especially against Aspergillus flavus. [ABSTRACT FROM AUTHOR]

In vitro interactions between tacrolimus, a calcineurin inhibitor, and fluconazole, itraconazole, caspofungin, or anidulafungin were evaluated against Candida auris, C. albicans, C. parapsilosis , and C. glabrata (each five strains). Tacrolimus–itraconazole, tacrolimus–caspofungin, and tacrolimus–fluconazole combinations resulted in synergistic interactions against 95%, 90%, and 60% of Candida isolates, respectively. However, tacrolimus–anidulafungin resulted in only a 35% synergistic effect. A combination of tacrolimus and itraconazole was most potent with synergy against 100% of C. auris, C. parapsilosis , and C. glabrata isolates. Of note, no antagonistic interaction was found. [ABSTRACT FROM AUTHOR]

Background: In natural conditions, inhaled fungi are considered a part of the microflora of nasal cavities and sinuses. However, subsequent to the protracted use of corticosteroids and antibacterial agents, suppression of the immune system by chemotherapy, and poor ventilation, these fungi can become pathogens. Fungal colonization in the nose and paranasal sinuses is a prevalent medical issue in immunocompetent and immunosuppressed patients. In this study, we aimed to categorize fungal rhinosinusitis (FRS) among immunocompetent and immunosuppressed patients and identified the etiologic agents of disease by molecular methods. Materials and Methods: A total of 74 cases were evaluated for FRS. Functional endoscopic sinus surgery was performed for sampling. The clinical samples were examined by direct microscopy with potassium hydroxide 20% and subcultured on Sabouraud Dextrose Agar with chloramphenicol. Polymerase chain reaction sequencing was applied to identify causative agents. Results: Thirty-three patients (44.6%) had FRS. Principal predisposing factors were antibiotic consumption (n = 31, 93.9%), corticosteroid therapy (n = 22, 66.6%), and diabetes mellitus (n = 21, 63.6%). Eyesore (n = 22, 66.6%), proptosis (n = 16, 48.5%), and headache (n = 15, 45.4%) were the most common clinical manifestations among patients. Rhizopus oryzae (n = 15, 45.4%) and Aspergillus flavus (n = 10, 30.3%) were the most prevalent fungal species. Conclusion: Diagnosis and classification of FRS are crucial, and a lack of early precise diagnosis can lead to a delay in any surgical or medical management. Since there are a variety of treatments for FRS, accurate identification of etiologic agents should be performed based on phenotypic and molecular methods. [ABSTRACT FROM AUTHOR]

Diaphragm paralysis may be either idiopathic or associated with several medical conditions including viral and bacterial infection. The association of phrenic nerve palsy with viral infections is rare but well-appreciated in several case reports. Neuropathy, both central and peripheral, is a common neurological consequence of COVID-19. Here, we describe a case of diaphragm paralysis in a woman who was admitted to the hospital because of COVID-19 pneumonia. Post-COVID-19 unilateral paralyzed diaphragm was diagnosed with a chest X-ray for her and the disorder was attributed to COVID-19 because no other etiology was found to be associated. So far, phrenic neuropathy and diaphragmatic paralysis in a COVID-19-affected patient have not been reported from Iran. [ABSTRACT FROM AUTHOR]

At a time when the COVID-19's second wave is still picking up in countries like India, a number of reports describe the potential association with a rise in the number of cases of mucormycosis, commonly known as the black fungus. This fungal infection has been around for centuries and affects those people whose immunity has been compromised due to severe health conditions. In this article, we provide a detailed overview of mucormycosis and discuss how COVID-19 could have caused a sudden spike in an otherwise rare disease in countries like India. The article discusses the various symptoms of the disease, class of people most vulnerable to this infection, preventive measures to avoid the disease, and various treatments that exist in clinical practice and research to manage the disease. Keywords: Black fungus, coronavirus, COVID-19, fungal infection, mucormycosis, pandemic Forough Rezvani, Mehrnoush Maheronnaghsh, Rasoul Mohammadi 1 Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran, 2 Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran Background: Adhesion of Candida to host cell receptors, hemolysin production, and proteinase activity are assumed as principal virulence factors and infection establishment. These virulence factors are essential for colonization, biofilm formation, and attack on the host cells. Materials and Methods: A total of 97 Candida albicans isolates obtained from gastroesophageal lesions and urinary tract infections were included in the study. Adhesion assay, proteinase activity, and hemolysin production were measured. Statistical analysis was performed using the independent t-test and Chi-square test to compare quantitative and qualitative data between the two groups. Results: The adherence ability to the buccal epithelial cells was the same in the two groups. Proteinase activity was seen in all clinical isolates. Hemolytic activities were not statistically significant in the two groups. Conclusion: Our results recommend that the pathogenicity of C. albicans in the mucous membranes cannot be connected to the infected site. [ABSTRACT FROM AUTHOR]

Cerebral mucormycosis (CM) is a life-threatening manifestation of mucormycosis, an angioinvasive fungal infection caused by Mucorales. We sought to systematically review all available case reports to describe epidemiologic features, clinical manifestations, predisposing factors, and diagnostic and treatment strategies of CM. A systematic search was conducted using a combination of the following keywords: "Mucor", "Zygomycetes", "mucormycosis", "cereb*", "brain", "central nervous system", and "intracranial", separately and in combination until December 31st 2018. Data sources included PubMed, Scopus, EMBASE, Web of Science, Science Direct, and Proquest without limiting the time of publication. We included 287 articles corresponding to 345 cases of CM. Out of the 345 cases, 206 (60%) were male with a median age of 44 years; 130 (38%) were reported from North America; 87 (25%) from Asia; and 84 (24%) from Europe. The median time from onset of symptoms to presentation was 3-7 days (65/345, 65%). The highest mortality was observed among patients with diabetes mellitus (P=0.003). Debridement of infected brain tissue was associated with improved survival in CM cases (OR 1.5; 95% CI 01.3-1.8; P<0.0001). The use of liposomal amphotericin B (L-AMB) was significantly associated with patients' recovery (OR 2.09; 95% CI 1.2-3.4; P=0.003). The combination of L-AMB and posaconazole (12.5%) was more effective than the monotherapy treatment of CM cases (P=0.009). Clinicians should consider DM as an important risk factor for CM. Moreover, surgical debridement and antifungal combination therapy could be an effective approach in the management of CM patients. [ABSTRACT FROM AUTHOR]