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Background and Objectives: Fungal burn wound infections (FBWIs) are one of the most disastrous complications in burn patients. The present study investigated the incidence and the species distribution of fungal agents isolated from burn lesions and reviewed the feautures, underlying conditions, and outcomes of patients. Materials and Methods: The wounds were swabbed and cultured on Sabouraud Dextrose Agar with chloramphenicol medium. Fungal identification was performed using internal transcribed spacer (ITS) and beta-tubulin sequencing. Results: A total of 380 swab specimens were obtained. Of these, 101 patients (26.75 %) were positive in culture. Among the 101 positive cases, most isolates were from males (n= 68, 67.33%) and most of them were over 30 years old. Flame (n=38, 37.63%) was the predominant cause of burns, and previous history of ICU admission (n=35, 34.66%), presence of central venous catheter (n=25, 24.75%), and diabetes mellitus (n=17, 16.83%) were the main underlying conditions. Candida parapsilosis complex (n=36, 35.64%), and Pichia kudriavzevii (C. krusei) (n=8, 7.92%) represent the most commonly isolated species Also, 2 out of 101 patients (2%) died. Conclusion: In the present study, non-albicans Candida species were much higher frequent than C. albicans with most cases associated with Candida parapsilosis complex.

Cryptococcal meningitis (CM) is an uncommon and severe infection that tends to affect both immunocompromised and immunocompetent hosts. To gain insights into the clinical and epidemiological characteristics of CM in Iran, this study evaluated patients with subacute or chronic meningitis referred to 15 Iranian hospitals. Relevant clinical and epidemiological characteristics of the patients were analyzed. Diagnosis of CM cases was performed by microscopic examination, culture, latex agglutination assay, lateral flow assay, and multiplex PCR on cerebrospinal fluid (CSF) samples. The isolates were processed and subjected to molecular identification and in vitro susceptibility antifungal profile. Among the 272 evaluated patients, 7 (2.6 %) CM cases were diagnosed. Out of seven CM cases, 6 (86 %) were male with a median age of 36 years. The most common neurological signs were headache (100 %), followed by nausea and vomiting (71.4 %). All CSF samples from CM patients exhibited positive results across all mycological tests conducted. The isolates were identified as Cryptococcus neoformans (86 %) and Cryptococcus gattii (14 %). All isolates were susceptible to voriconazole and fluconazole, while resistance was observed with itraconazole (MIC value of 0.5 μg/mL) and amphotericin B (MIC values of 4 and 1 μg/mL). The highest mortality (6/7, 86 %) was observed among patients. While a comprehensive study on this subject is currently lacking in Iran, the data acquired through this research play a crucial role in enhancing the clinical and epidemiological understanding of this infection, particularly within low-income countries. Moreover, these findings will serve as a cornerstone for future international comparative studies in this field.

IntroductionThis study was intended to investigate the clinical features and predisposing factors of fungal keratitis (FK), as well as molecular identification and antifungal susceptibility of causative agents in Tehran, Iran.MethodsThis cross-sectional study was carried out from April 2019 to May 2021. All fungi isolates were identified using conventional methods and were confirmed by DNA-PCR-based molecular assays. Matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) was used to identify yeast species. Minimum inhibitory concentrations (MIC) of eight antifungal agents were assessed according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) microbroth dilution reference method. ResultsFungal etiology was confirmed in 86 (7.23%) of 1189 corneal ulcers. A significant predisposing factor for FK was ocular trauma caused by plant materials. Therapeutic penetrating keratoplasty (PKP) was required in 60.4% of cases. The predominant fungal species isolated was Fusarium spp. (39.5%) followed by Aspergillus spp. (32.5%) and Candida spp. (16.2%).DiscussionThe MIC results indicate that amphotericin B may be appropriate for treating FK caused by Fusarium species. FK caused by Candida spp. can be treated with flucytosine, voriconazole, posaconazole, miconazole, and caspofungin. In developing countries such as Iran, corneal infection due to filamentous fungi is a common cause of corneal damage. In this region, fungal keratitis is observed primarily within the context of agricultural activity and subsequent ocular trauma. Fungal keratitis can be managed better with understanding the ”local“ etiologies and antifungal susceptibility patterns.

Background and Purpose: The pandemic of COVID-19 has caused a worldwide healthcrisis. Candidemia is a potentially lethal condition that has not yet been enough discussed in patients with COVID‐ 19. The current study aimed to investigate the prevalence of candidemia among Iranian COVID‐ 19 patients and characterize itscausative agents and the antifungal susceptibility pattern.Materials and Methods: The present cross-sectional survey was carried out fromMarch 2020 to March 2021 at Imam Khomeini Hospital, Tehran, Iran. Bloodspecimens were obtained from patients with confirmed coronavirus infection who alsohad criteria for candidemia and were examined for any Candida species by conventional and molecular techniques. Susceptibility of isolates to amphotericin B,voriconazole, itraconazole, fluconazole, caspofungin, and 5-flucytosine was testedusing the CLSI broth dilution technique.Results: In total, 153 patients with COVID-19 were included and candidemia wasconfirmed in 12 (7.8 %) of them. The majority of patients were ≥ 50 years of age (n=9)and female (n=8). Moreover, 6 out of the 12 patients were diabetic. The presence ofcentral venous catheters, broad-spectrum antibiotic therapy, ICU admission, andmechanical ventilation was observed in all patients. The C. albicans (n=7, 58.3 %) andC. dubliniensis (n=2, 16.7%) were the most common isolated species. Amphotericin Band 5-flucytosine were the most active drugs. Despite antifungal treatment, 4 out of 12patients (33.3 %) died.Conclusion: Due to the high mortality, the early diagnosis and proper treatment ofcandidemia are essential requirements for optimal clinical outcomes in COVID-19 patients.

Abstract Background Pseudallescheria keratitis is rare but important type of fungal keratitis because of the inherently resistance of the organism to many existing antifungal agents. Methods Slit-lamp and confocal microscopy were used for clinical examinations. Fungal isolates were identified based on morphological characteristics and DNA sequence of the internal transcribed spacer region (ITS). In vitro antifungal susceptibility testing for fungal isolates was performed according to the Clinical and Laboratory Standards Institute (CLSI, M38-A2). Result All patients had a history of ocular trauma. In clinical examination hypopion were seen in three patients. The main antifungal medications were topical voriconazole. After treatment the visual acuity of all patients improved in 2–3 weeks. Conclusion All four patients of Pseudallescheria keratitis had similar clinical features. Accurate and rapid identification of species should be helpful in treating p. boydii keratitis.

Background: Candida species are normal vaginal flora in healthy women, which can cause vulvovaginal candidiasis (VVC). The formation of biofilm is a cause of drug resistance in Candida species of vaginal origin. We aimed to specify Candida species cause VVC, detect their biofilm-forming ability, and antifungal susceptibility pattern. Methods: Overall 150 vaginal samples were collected from suspected cases of referring to Bahar Hospital of Shahroud, Iran between Jan 2018 and Jan 2019. Samples were cultured on Sabouraud dextrose agar (SDA), Chrome gar Candida and Corn meal agar (CMA). PCR-RFLP was performed to confirm the identification. Biofilm formation of the identified species was measured by the Crystal Violet method. The susceptibility to fluconazole, clotrimazole, and miconazole was determined based on the CLSI document M27-A3. Results: Of 50 women (33.3%) were suffering from VVC. C.albicans was the predominant species isolated in this study (n=39, 78%) followed by C. glabratia (n=11, 22%). In addition, in 25 (50%) of positive samples, biofilm formation was determined. The mean MIC of fluconazole and clotrimazole for C. albicans was 5.02 μg /mL and 3.92 μg /mL, respectively. Furthermore, the mean MIC related to these drugs for C. glabrata was 12.45 μg / mL and 4.1μg / mL, respectively. The mean diameter of miconazole inhibition zone for C. albicans and C. glabra isolates was 25.13 mm and 24.5mm, respectively and all of them were susceptible to this drug. Conclusion: C.albicans was the predominant Candida species isolated from patients with VVC and also was the predominant biofilm producer species.

Background and Purpose: Organ transplant recipients are vulnerable to fungal infections. The aim of this study was to determine the prevalence of fungal colonization and infections among patients who underwent various transplantations and molecularly characterize the etiological agents. Materials and Methods: This study was conducted on candidates for transplantation in Imam Khomeini Hospital, Tehran, Iran, from April 2017 to April 2018. All patients were monitored for fungal colonization or infections before and after transplantation. Isolated fungi were identified using molecular methods. Results: A total of 125 patients, including 86 males and 39 females, with the mean age of 52.2 years participated in the study (age range: 15-75 years). Out of 125 patients, 84 (67.2%) cases had fungal colonization that appeared pre- and post-transplantation in 21 and 63 cases, respectively (alone or concurrent with another infection in 55 and 29 cases, respectively). In addition, a total of 39 episodes of fungal infections were diagnosed in 36 (28.8%) recipients (alone or concurrent with colonization in 7 and 29 cases, respectively). Out of the 39 fungal infections, 9 cases appeared pre-transplantation, while the other 30 cases occurred post-transplantation. However, no fungal colonization or infection was observed in 34 (27.2%) patients. Oral candidiasis (n=20) was the most common type of infection, followed by funguria (n=7), onychomycosis (n=5), candidemia (n=3), rhinocerebral mucormycosis (n=1), cutaneous mucormycosis (n=1), cutaneous aspergillosis (n=1), and peritonitis (n=1). Six yeast species were recovered from colonization cases with the dominance of Candida albicans both before and after transplantation. The observed fungal infections were caused by 11 distinct species, including the members of Candida (i.e., C. albicans, C. glabrata, C. parapsilosis, C. tropicalis, and C. krusei), Aspergillus (i.e., A. oryzae and A. candidus), Rhizopus (i.e., R. oryzae and R. microsporus), Trichosporon asahii, and Trichophyton interdigitale. The results also indicated that the development of a fungal infection post-transplantation was associated with fungal colonization (r=0.0184; P=0.043). Conclusion: Based on the results, fungal colonization was a common finding in transplant recipients at Imam Khomeini Hospital. However, the incidence of fungal infections was comparable with those of other centers. As the oral cavity was the most common site of colonization and infection, it might be beneficial to take further care about the oral health of patients using effective mouthwash.

Background: Tracheoesophageal voice prostheses (TVPs) have been the gold standard in rehabilitation, after laryngectomy, producing faster and premier voicing towards esophageal speech. Fungal colonization shortens the device’s lifetime and leads to prosthesis dysfunction, leakage, and subsequent respiratory infection. Therefore, in the current study, we aimed to investigate the fungal colonization patterns and to propose prophylactic measures that shall increase the longevity of voice prosthesis. Methods: Failed TVPs were removed - due to leakage and/or aspiration - from 66 post laryngectomy patients and examined. They were referred to Amiralam and Rasoul Hospital, the main centers of Ear, Nose, and Throat in Tehran, Iran from April 2018 to January 2020. Fungal colonization patterns were assessed using DNA sequencing techniques. Furthermore, the susceptibility to fluconazole, amphotericin B, nystatin, and white vinegar was evaluated according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Resident fungal species from the upper airways colonized all the 66 TVPs (100%). Diabetes (31%) and smoking (98%) were the predominant underlying disease and predisposing factors, respectively. Among the 79 fungal agents isolated from the 66 TVPs, Candida glabrata (n=25, 31.7%) was the most common. A significant reduction in minimum inhibitory concentration (MIC) values were observed for white vinegar when used alone (P

Background: Candida albicans remains the main cause of candidiasis in most clinical settings. Available drugs for candidiasis treatment have many side effects. In this work, novel nitroglycerin derivatives were synthesized and their cytotoxic and antifungal effects evaluated against fluconazole susceptible and resistant clinical C. albicans isolates. Methods: This experimental study was performed in Tehran University of Medical Sciences and Baqiatallah University of Medical Sciences, Tehran, Iran between Feb to Dec 2019. The in vitro activities of two novel nitroglycerin derivatives (1b and 2b) against 25 clinical fluconazole-susceptible and resistant C. albicans isolates and four standard C. albicans strains were determined according to CLSI reference M27-A3 documents. The cytotoxicity of chemical compounds was investigated near the SNL76/7 cells by colorimetric assay. Real-time PCRs were performed to evaluate the alterations in the regulation of ERG11 and CDR1 genes under nitroglycerin derivatives-treated and untreated conditions. Results: The derivatives 1b and 2b exhibited potent antifungal activity against C. albicans isolates; MICs and MFCs varied from 18 μg/ml to 72 μg/ml and 36 μg/ml to 144 μg/ml, respectively. The cell viability evaluation demonstrated that both chemical compounds are safe within 24h. The nitroglycerin derivatives were able to reduce the transcription level of CDR1 and ERG11 genes in all susceptible and resistant C. albicans isolates. Conclusion: Considering the potential and efficacy of these compounds against clinical C. albicans isolates, the complementary in vivo and clinical trials should be investigated.

BackgroundOnychomycosis is one of the most common and recurrent dermatological diseases worldwide. The antimycotic activity of prescribed medications varies according to the causative agents, and treatment failure rates exceeding 30%. This study aimed to assess the epidemiological profile of onychomycosis in Iran. Also, the susceptibilities to conventional and new antifungals were investigated.MethodsIn this descriptive cross-sectional study, during the period of 18 months starting from September 2019 until March 2020, 594 nail specimens were obtained from patients who presented nail changes compatible with a clinical diagnosis of onychomycosis. The patients were referred from different cities, including Tehran, Kermanshah, Arak, Kashan, Rasht, Qom, Urmia, Zahedan, Hamadan, Zanjan, Borujerd, Bushehr, and Yazd. All the samples were subjected to microscopic examination and fungal culture. Fungi identified were confirmed through the PCR-sequencing method. The susceptibility to itraconazole, fluconazole, terbinafine, griseofulvin, posaconazole, ravuconazole, efinaconazole, luliconazole, and tavaborole was evaluated according to the Clinical and Laboratory Standards Institute (CLSI) guidelines, document M38-A2 for filamentous fungi, and document M27-A3 for yeasts.Results594 patients were included. Of these, in 179 cases (30.1%) (95% CI:0.3 ± 0.037) onychomycosis was confirmed. The majority of patients were ≥ 60 years of age (n=58, 32.6%) and female (n=113, 63.1%). Saprophytic fungi accounted for the vast majority of the nail isolates (n=92, 51.4%) (95% CI:0.051 ± 0.0.073), followed by dermatophytes (n=45, 25.1%) (95% CI:0.25 ± 0.063), and yeasts (n=42, 23.5%) (95% CI:0.23 ± 0.061). Diabetes mellitus (77.3%), hypothyroidism (18.2%), and solid tumors (4.5%) were documented as the most prevalent underlying conditions. Antifungal susceptibility testing was performed against 60 fungal isolates (20 each of Candida species, saprophytic fungi, and dermatophytes). Efinaconazole, ravuconazole, and luliconazole were the most active agents against Candida species. Also, luliconazole, posaconazole, and efinaconazole were most potent against dermatophytes. Luliconazole had the greatest antifungal activity against saprophytic fungi.ConclusionsThe prevalence of onychomycosis in Iranian patients was relatively high. LUL exhibited potent antifungal activity against the three groups of fungi tested, determining its broad-spectrum antimycotic activity and its probable use as the first-line therapy for onychomycosis.

Background and Purpose: Candida parapsilosis complex isolates are mainly responsible for nosocomial catheter-related infection in immunocompromised patients. Biofilm formation is regarded as one of the most pertinent key virulence factors in the development of these emerging infections. The present study aimed to compare in vitro antifungal susceptibility patterns and biofilm-related genes expression ratio in planktonic and biofilm’s cells of clinically C. parapsilosis complex isolates. Materials and Methods: The current study was conducted on a number of 17 clinical C. parapsilosis complex (10 C. parapsilosis sensu stricto, 5 C. orthopsilosis, and 2 C. metapsilosis). The antifungal susceptibility patterns of amphotericin B, fluconazole, itraconazole, voriconazole, posaconazole, and caspofungin in planktonic and biofilm forms were closely examined using CLSI M27-A3 broth microdilution method. The expression levels of biofilm-related genes (BCR1, EFG1, and FKS1) were evaluated in planktonic and biofilm’s cells using Real-time polymerase chain reaction (PCR) technique. Results: The obtained results indicated that all C. parapsilosis complex isolates were able to produce high and moderate amounts of biofilm forms. In addition, the sessile minimum inhibitory concentrations were reported to be high for fluconazole (≥ 64 μg/ml), itraconazole, voriconazole, and posaconazole (≥ 16 μg/ml), as compared to planktonic minimum inhibitory concentrations. Moreover, a significant difference was observed between antifungal susceptibility patterns for all azole antifungal agents (P Conclusion: C. parapsilosis complex isolates were found susceptible to most of the tested antifungal drugs, while biofilms demonstrated a noticeable resistant to azoles. The marked discrepancy noted in antifungal susceptibility patterns among these species should be highlighted to achieve effective therapeutic treatment.

Background and Purpose: Aspergillus fumigatus is one of the most common opportunistic fungus, which causes infection in immunocompromised and neutropenic patients. The current guidelines recommend voriconazole as the initial therapeutic and prophylactic agent for almost all cases, especially in patients with organ transplants, which leads to increased medication resistance in A. fumigatus. The aim of the present study was to evaluate the antifungal activity and effect of kombucha as a natural compound on A. fumigatus growth, as well as on the expression of cgrA and cyp51A genes. Materials and Methods: A panel of 15 A. fumigatus strains with two quality controls of CM237 and CM2627 as susceptible and resistant strains were obtained from Tehran Medical Mycology Laboratory, Tehran,Iran(TMML).Antifungal susceptibility testing assay was performed according to the Clinical and Laboratory Standards Institute (CLSI) M38-A2 document. Moreover, the mycelial dry weight of the fungus was calculated before and after being treated with kombucha. In addition, the quantitative changes in the expression of cgrA and cyp51A genes were analyzed by real-time polymerase chain reaction (real-time PCR) technique. Results: In the present study, the minimum inhibitory concentration ranges of kombucha were measured at 6,170 and 12,300 μg/mL for ten A. fumigatus azole-susceptible strains and 24,700 μg/mL for five A. fumigatus resistant strains. Moreover, changes in mycelial dry weight under kombucha treatment conditions underwent a significant reduction (P≤0.05). A coordinate down-regulation of expression in cgrA and cyp51A genes was observed in all azole-susceptible and -resistant A. fumigatus strains, after treating the fungus with different concentrations of kombucha (P≤0.05). Conclusion: According to the obtained results, kombucha as a natural antioxidant , can exert inhibitory effects against the growth and expression of some genes in A. fumigatusstrains.

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 °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

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’ 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.

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. 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

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

Background: Otomycosis is a superficial infection of the ear caused by a spectrum of various fungal agents and its epidemiology depends on geographical region and climatic condition. The aim of this study was to investigate the causal agents and clinical manifestations of otomycosis at a tertiary referral center in Tehran, Iran. Methods: From Apr 2016 to Jan 2017 a set of 412 subjects with suspicion of external otitis were included. Clinical examination and specimen collection were performed by an otorhinolaryngologist. Subsequently, direct examination and culture were performed on specimens and isolated molds were identified morphologically. Yeast isolates were identified using CHROMagar Candida medium and PCR-RFLP of ribosomal DNA whenever needed. Data were analyzed using SPSS. Results: Otomycosis was confirmed in 117 cases (28.39%) including 64 (54.7%) males and 53 (45.3%) females. Patients were within the age range of 10-75 yr and the highest prevalence was found in the age group of 46-55 yr (30.77%). Pruritus (89.74%) and auditory manipulation and trauma (83.76%) were the predominant symptom and predisposing factor, respectively. Among 133 isolates from 117 patients, Aspergillus niger (n=50, 37.59%) was the most common etiologic agent and Candida glabrata (n=25, 18.8%) was the predominantly isolated yeast. Furthermore, 16 cases of mixed infection were identified and coinfection due to A. niger and C. glabrata (seven cases) was the predominant pattern. Conclusion: Our results revealed the high prevalence of C. glabrata and mixed infections in otomycosis patients. Therefore, mycological examinations should be considered for proper treatment.

Background: Candiduria in hospitalized patients may represent contamination, colonization, or urinary tract infections. On the other hand, candidemia and upper urinary tract infection could be the complications of candiduria. The aim of this study was to determine candiduria in hospitalized patients and identify isolated Candida species by conventional and molecular methods. Methods: This cross-sectional study was conducted on hospitalized patients in Imam Khomeini and Mostafa Khomeini hospitals in Ilam, western Iran from Jan to Dec 2016. Urine samples of hospitalized patients were collected during a period of 4 months for diagnosis of candiduria. Primary identification was done by conventional methods. PCR profile was carried out using phenol-chloroform method and confirmed using restriction fragment length polymorphism (PCR-RFLP) technique by MspI restriction enzyme. Results: Candiduria was diagnosed in 18 (9.2%) cases from a total of 195 patients. Isolated yeasts were identified as C. albicans (n: 13), C. glabrata (n: 5), and C. parapsilosis (n: 1) in the one case both C. albicans and C. glabrata were isolated from a urine sample. Conclusion: Candida urinary tract infection is becoming increasingly common in hospitalized patients but, differentiation fungal colonization from infection and identification of etiologic agents for optimal treatment is necessary.

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’ 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°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.

Background: Intertrigo is an erythematous inflammatory condition with multiple etiologies including fungi and bacteria. Intertrigo manifests in different clinical forms with various complaints. This study was conducted to evaluate the causative agents of intertriginous infections with emphasize on clinical presentations. Methods: This descriptive cross-sectional study was carried out in 2015-2016, on 188 patients with clinical suspicion of superficial and cutaneous intertriginous infections in Tehran, Iran. Demographic and additional related data were obtained by questionnaire from all participants. Specimens were collected by gentle scraping of the affected areas. Direct examination and culture were performed for all specimens and grown colonies were identified based on the macroscopic and microscopic features. Supplementary tests were done whenever needed. Data were analyzed in SPSS. Results: Overall, 80 (42.5%) cases with the mean age of 43.5 yr were confirmed for intertrigo. Dermatophytosis was the predominant cause in this study with 36 (45%) cases followed by erythrasma (28 cases, 35%), tinea versicolor (10 cases, 12.5%) and candidiasis (6 cases, 7.5%). Intertrigo lesions with dermatophytic agents significantly were observed in groin in comparison to different infections among body sites (P

Background and Aim: Identification of possible animal sources of infection is applied for preventing the outbreak and progressive epidemics of infection. The aim of present study is isolation of pathogenic and opportunistic fungi from the skin of ownership dogs with emphasize on transmission risk of fungal zoonoses in rural areas of Meshkin Shahr, Ardebil province of Iran. Materials and Methods: This cross-sectional and descriptive study was performed in laboratory of Medical Mycology, School of Public Health, Tehran University of Medical Sciences from April 2011 to November 2012. Hundred and thirty dogs were studied. Collected scales and hair samples were examined by direct smear and SC, SCC and DTM culture with the aim of full coverage of whole fungal growth such as saprophytic and pathogenic fungi for 1-3 weeks. Results: From 130 examined samples, Alternaria 41 (31.5%) as the most frequent, Chaetomium 1 (0.9%) and Nattrassia 1 (0.9%) as the least frequent saprophytic agents, were isolated from the samples. Conclusion: The dogs in these areas are not the source of infection for dermatophytosis and had no role in the epidemiology of the disease

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 nanoparticles

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.

Background: Malassezia Species are often commensal of the human skin and scalp that opportunistically in exist of particular predisposing factors, their proliferation increases; as, in dandruff and seborrheic dermatitis which both togather affect more than 50% of humans, the excess proliferation of yeast in scalp, leads to scalp-flaking and causes physical and mental disorder in peaple, spacially in youth that their health and hiar hygiene and beauty is more important for them. Thus, this survey has been done for rapid, easy and inexpensive method to diagnosis of abnormal proliferation and invasive condition of Malassezia yeast and can be more benefical for proper treatment.Methods: Sampling with scalpel scraping from scalp of volunteer persons that had not bathed at least two day ago were done and preparation of direct microscopic slides and staining with methylene blue were accomplished. Then, survey of morpholgic characte-ristics, yeast quantification and mycelium detection were done by direct microscopic examination.Results: From 140 scalp samples of adult persons of both gender (male and female) with different age groups, observation of malassezia yeast in 93.5% (131) were positive and 6.5% (9) were negative in direct microscopic examination. Results of yeast quanti-fication in positive cases were: mild or normal flora 25.2%, intermediate 24.5%, severe 50.3%. Detection of mycelium in positive cases were 22.9% (30) (P=0.007 df=2).Conclusion: Application of an accessible, easy and inexpensive method and a determi-nated pattern (yeast quantification with direct microscopic examination) to distinguish normal flora from abnormal condition (excess proliferation and mycelium production) in cases of Malassezia yeasts can be more useful to rapid diagnosis of abnormal pro-liferation and invasive condition in order to initiate a proper antifungal treatment.

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.

Background and Objectives: Fungal burn wound infections (FBWIs) are one of the most disastrous complications in burn patients. The present study investigated the incidence and the species distribution of fungal agents isolated from burn lesions and reviewed the feautures, underlying conditions, and outcomes of patients. Materials and Methods: The wounds were swabbed and cultured on Sabouraud Dextrose Agar with chloramphenicol medium. Fungal identification was performed using internal transcribed spacer (ITS) and beta-tubulin sequencing. Results: A total of 380 swab specimens were obtained. Of these, 101 patients (26.75 %) were positive in culture. Among the 101 positive cases, most isolates were from males (n= 68, 67.33%) and most of them were over 30 years old. Flame (n=38, 37.63%) was the predominant cause of burns, and previous history of ICU admission (n=35, 34.66%), presence of central venous catheter (n=25, 24.75%), and diabetes mellitus (n=17, 16.83%) were the main underlying conditions. Candida parapsilosis complex (n=36, 35.64%), and Pichia kudriavzevii (C. krusei) (n=8, 7.92%) represent the most commonly isolated species Also, 2 out of 101 patients (2%) died. Conclusion: In the present study, non-albicans Candida species were much higher frequent than C. albicans with most cases associated with Candida parapsilosis complex. [ABSTRACT FROM AUTHOR]

Introduction: The fungal nail infection (onychomycosis) involves 18%-40% of all nail disorders, which, although not fatal, can cause mechanical, aesthetic, occupational, and economic problems. Drug treatments due to prolonged treatment periods, drug interactions, adverse effects, and slow progression may associate with numerous negative outcomes. This study aimed to evaluate the long-pulsed 1064-nm Nd: YAG laser effect on fungal colonies and subsequently possible change in the minimum inhibitory concentrations (MICs) of common antifungals compared with the same non-lasered colonies as a novel way to investigate laser and antifungal interaction. Methods: Sixty onychomycosis samples consisting of saprophyte (n = 20), dermatophyte (n = 20), and yeast (n = 20) duplicate colonies were isolated. A series was treated by a long-pulsed 1064-nm Nd: YAG laser. Afterward, the MIC (CLSI-M38-A2 and CLSI-M27-A3) of two series against common antifungals were compared. Results: After 1064-nm Nd: YAG laser irradiation in all 20 tested saprophytes, the MICs of terbinafine (P value < 0.035) were changed, and in all 20 tested dermatophytes, the MICs of voriconazole (P value < 0.021) were changed. Also, in all 20 tested yeasts, the MICs of caspofungin (P value < 0.037) were changed. Moreover, in saprophytes, dermatophytes, and yeasts, significant changes in the MICs of itraconazole (P value < 0.032), terbinafine (P value < 0.025), and caspofungin (P value < 0.037) were detected. Our result showed the GM MICs of the 1064-nm Nd: YAG laser in all saprophyte, dermatophyte, and yeast groups were lower than in the control group. Conclusion: The present study indicated that the long-pulsed 1064-nm Nd: YAG laser significantly changes the MICs of antifungals in onychomycosis clinical samples. [ABSTRACT FROM AUTHOR]