[In vitro antifungal susceptibility of oral candida species from Iranian HIV infected patients]

Oropharyngeal candidiasis and antifungal drug resistance are major problems in HIV positive patients. The increased reports of antifungal resistance and expanding therapeutic options prompted the determination of antifungal susceptibility profile of Candida species isolates in Iranian patients living with HIV/AIDS [PLWHA] in the present study. One hundred fifty oral samples from Iranian HIV positive patients were obtained and cultured on CHROMagar and Sabouraud's dextrose agar. All isolates were identified according to assimilation profile, germ tube, colony color and other conventional methods. Disk diffusion testing and Broth Microdilution of six antifungal agents were performed according to the methods described in CLSI. Candida albicans [50.2%] was the most frequent isolated yeast, followed by C. glabrata [22%]. Non-Candida albicans species were isolated from 71 [61%] positive cultures. 25.7% of Candida albicans isolates were resistant to fluconazole [MIC >/= 64 micro g/ml] as were 21.9% and 16.4% to ketoconazole and clotrimazole [MIC>0.125 micro g/ml], respectively. Resistance to polyene antifungals including amphotericin B and nystatin, and caspofungin were scarce. 57.7% of candida glabrata isolates were resistant to fluconazole, 31% to ketoconazole and 35% to clotrimazole. Screening for antifungal resistant candida isolates by disk diffusion or broth dilution methods in clinical laboratories is an ideal surveillance measure in the management of oral thrush in patients with HIV/AIDS. Although nystatin is widely used in clinical practice for HIV positive patients, there was no evidence of enhanced resistance to it. Regarding no resistance to caspofungin, its administration is suggested

Paranasal sinus mycosis in suspected fungal sinusitis

Fungal infections of the paranasal sinuses in the immunocompetent patients are being recognized with increasing frequency. Infections are assigned in invasive and noninvasive forms. Materials and methods: In a retrospective study, a total 39 patients with suspected fungal sinusitis were studied for causative fungal.agents between 1994 and 2001 Dinagnosis was confirmed by demonstration of fungi in direct preparations and culture techniques. Samples were biopsy specimens taken from the sinuses or exudates from deep sinus tracts. Paranasal sinuses mycoses were proven in 18 patients, including 12 men and 6 women, their age ranging from 17-58 years. The most frequently isolated organisms were Aspergillus spp. and Candida spp. Paranasal sinuses infections by Cladosporium trichoides [bantianum] and Pseudallescheria boydii are reported for the first time in Iran from Pasteur Institute, Conclusion In our series. Aspergillus flavus has been isolated more frequently than other agents. Keywords: Fungal infecrtion, Paranasal sinuses infection, Sinuses mycoses

Deep-seated fungal infections in immunocompromised patients in Iran

During the last two decades or so, the incidence of fungal infections has increased dramatically. Deep- seated mycoses are creating serious problems for clinicians working with certain populations of patients, such as those with cancer, the immunocompromised, and physiologically compromised. A study of fungal isolated for identification of deep fungal infections, risk factors and etiologic agents in immunocompromised patients was carried out in the section of Medical Mycology, Pasteur Institute of Iran from 1994 to 2001. Seventy one immunosuppressed patients with deep fungal infection were retrospectively analyzed for etiology and risk factors. They had one or more predisposing factors to disseminated fungal infections. Diagnosis was established by demonstration of fungus in direct and cultural examinations. Candida spp. were isolated in 70.4% [39.4% C. albicans and 30.9% non-albincans], and Aspergillus spp. were isolated in 14.1% of cases. The most frequent risk factors were hematologic malignancy [ALL, lymphoma, Hodgkin, multiple myeloma] and diabetes mellitus. This study suggests that in immunocompromised patients, fungal infections especially in saprophytic infections, background evaluation and clinical features, correspondence of clinical symptoms and laboratory examinations should be considered and investigation of other factors which created the infection will lead us to a clear picture of patients' situation