Regulation of ERG3, ERG6, and ERG11 genes in antifungal-resistant isolates of candida parapsilosis

Background: Candida parapsilosis is one of the five common strains of yeasts involved in invasive candidiasis. The expression analysis of sterol biosynthesis pathway genes, which are associated with resistance, can assist the better understanding of antifungal resistance mechanisms

Methods: The antifungal susceptibility of 120 clinical C. parapsilosis isolates was examined. The changes in the gene expression related to resistance were analyzed

Results: Eight strains were resistant to fluconazole [FLC], itraconazole [ITC], and amphotericin B [AMB]. The regulation variations included increased mRNA levels of ERG3, ERG6, and ERG11 and decreased mRNA levels of ERG3 and ERG6 in response to FLC. ERG11 mRNA level increases in response to ITC and AMB

Conclusion: The mechanism of resistance to azoles in C. parapsilosis is very similar to C. Albicans. This feature may help to design new treatment strategy for candidiasis

Camparison of oral candida flora in patients with coronary atherosclerosis and healthy people

Coronary atherosclerosis is a common disorder of the arteries and may block the arteries and cause heart disease. Recently several studies have indicated a role of infectious agents in atherosclerosis and obstructive coronary artery disease. Candida species are normal flora of the human oral cavity and can enter in the blood stream and damage inner walls of coronary arteries by several mechanisms. Thus this study was done to compare the oral candida flora in healthy people and patient with coronary atherosclerosis. In this study, we compared oral candida flora in 90 patients with coronary atherosclerosis and 90 healthy people. All specimens were obtained from oral cavity by swab and cultured on CHOROMagar Candida medium. Identification of isolated colonies was done by RapID yeast plus system. The data were analyzed using the chi-square test. In this study 55.4% [N=61] of patient and 44.6% [N=49] of control group had candida colonization in their oral cavity. Candida albicans was the most common species isolated in both groups. Candida glabrata, Candida krusei, Candida tropicalis and Candida parapsilosis were the most common non albicans species. Although no significant difference was observed between candida colonization in patients and controls, the differences between isolated colony numbers in patient and healthy group were significant [p=0.001]. Hypercolonization of candida species in oral cavity may lead to invasion and enter the organism in the blood stream and damage the coronary arteries

molecular epidemiological survey of clinically important dermatophytes in Iran based on specific RFLP profiles of betatubulin gene

Surveillance of dermatophytosis is essential to determine the likely changes in etiological trends and distribution profile of this infection. In this study beta tubulin gene [BT2], was used as the first time in a PCR-RFLP format to clarify the distribution of dermatophytosis agents in some parts of Iran. A total of 603 clinical isolates was obtained from 500 patients in Tehran, Isfahan, Mazandaran and Guilan provinces. The isolates were identified using macro/micro-morphological criteria and electrophoretic patterns of PCR amplicons of BT2 after digestion with each of the restriction enzymes. FatI, Hpy CH4V, MwoI and Alw21L. Among the patients, 59.2% were male and 40.8% female. The most prevalent clinical form was tinea pedis [42.4%], followed by tinea cruris [24.2%], tinea unguium [12.3%], tinea corporis [10.8%], tinea faciei [4%], tinea manuum [3.14%], tinea capitis [3%] and tinea barbae [0.16%], respectively. Trichophyton interdigitale ranked the first, followed by T.rubrum, Epidermophyton floccosum, Microsporum canis, T. tonsurans, T. erinacei and T. violaceum [each 0.49%] and the less frequent species were T. schoenleinii, M. gypseum and T. anamorph of Arthroderma benhamiae [each 0.16%]. A case of scalp infection by E. floccosum was an exceptional event in the study. No case of T.verrucosum was found. Trichophyton species and E. floccosum are yet the predominant agents of infection in Iran, while Microsporum species are decreasing. T.interdigitale and Tinea pedis remain as the most causal agent and clinical form of dermatophytosis, respectively. it seems that BT2 can be a useful genetic marker for epidemiological survey of common pathogenic dermatophytes

[Microscopic examination in quantifying of Malassezia yeast in scalp and rapid diagnosis of fungi invasive condition: a brief report]

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. 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 characteristics, yeast quantification and mycelium detection were done by direct microscopic examination. 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 quantification 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]. Application of an accessible, easy and inexpensive method and a determinated 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 proliferation and invasive condition in order to initiate a proper antifungal treatment.

Pneumocystis jirovecii colonization in non-HIV-infected patients based on nested-PCR detection in bronchoalveolar lavage samples

Pneumocystis jirovecii causes Pneumocystis pneumonia [PCP] in immunocompromised patients with a high rate of morbidity and mortality. Colonization with this fungus may stimulate pulmonary inflatnmation or lead to PCP in susceptible patients. The epidemiology of this infection and routs of its transmission has poorly studied in Iran. We examined Pnaumocystis colonization in patients with various lung underlying diseases. Bronchoalveolar lavage [BAL] fluids of 458 patients with different underlying diseases or pulmonary signs were collected between August 2010 and January 2012. Patients were divided into four groups: transplant recipients, malignant patients, immunosuppressive drug recipients and patients with other different lung diseases. A sensitive nested-PCR method targeted 18S ribosomal UNA gene was used for investigating P. jirovecii in the specimens. P. jirovecii DNA was detected in 57 out of 458 [12.5%] BAL samples by nested-PCR. Colonization rate in malignant patients, transplant recipients, immunosuppressive therapy recipients and patients with other various lung diseases was 21.7%, 20.3%, 12.7% and 7.3%, respectively. The enzyme BanI cuts all PCR products producing fragments with the size of 228 and 104 base pair. This finding as well as sequencing of four random positive samples validated and reconfirmed the PCR results. P. jirovecii cysts were found in 5 out of 57 PCR positive samples. A significant number of patients with pulmonary diseases were colonized by P. jirovecii that can develop to PCP in these patients or they may transmit the fungus to other susceptible patients

In-vitro activity of 10 antifungal agents against 320 dermatophyte strains using microdilution method in Tehran

Dermatophyte fungi are the etiologic agents of skin infections commonly referred to as ringworm. These infections are not dangerous but as a chronic cutaneous infections they may be difficult to treat and can also cause physical discomfort for patients. They are considered important as a public health problem as well. No information is available regarding the efficacy of antifungal agents against dermatophytes in Tehran. Therefore, in this study we evaluated the efficacy of 10 systemic and topical antifungal medications using CLSI broth microdilution method [M38-A]. The antifungal agents used included griseofulvin, terbinafine, itraconazole, ketoconazole, fluconazole, voriconazole, clotrimazole, ciclopiroxolamine, amorolfine and naftifine.Fifteen different species of dermatophytes which were mostly clinical isolates were used as follows; T. mentagrophytes, T. rubrum, E. floccosum, M. canis, T. verrucosum, T. tonsurans,M. gypseum, T. violaceum, M. ferruginum,M. fulvum, T. schoenleinii, M. racemosum, T. erinacei,T.eriotriphon and Arthrodermabenhamiae. The mean number of fungi particles [conidia] inoculated was 1.25 x 10[4] CFU/mL. Results were read after 7 days of incubation at 28 °C. According to the obtained results,itraconazole and terbinafine showed the lowest and fluconazole had the greatest MIC values for the most fungi tested. Based on the results, it is necessary to do more research and design a reliable standard method for determination of antifungal susceptibility to choose proper antibiotics with fewer side effects and decrease antifungal resistance and risk of treatment failure

In vitro susceptibility of aflatoxigenic and non-aflatoxigenic aspergillus flavus strains to conventional antifungal agents

Presently appearance of resistance to antifungal agents among Aspergillus species is dramatically increasing. The objective of this study was to look at the in vitro activities of antifungal drugs against Iranian clinical [from nail, bronchoalveolar lavage, paranasal sinus] isolated A. flavus strains. The susceptibility of 45 aflatoxigenic and non-aflatoxigenic Aspergillus flavus strains were evaluated to six antifungal agents [caspofungin, itraconazole, amphotericin B, ketoconazole, fluconazole, nystatin] using CLSI M38-A2 broth microdilution method. The results indicated that 57.1%, 28.6% of aflatoxigenic and 25.8%, 6.5% of nonaflatoxigenic isolates were susceptible to caspofungin, amphotericin B respectively. All isolates but one aflatoxigenic strain were sensitive to ketoconazole. All 45 strains showed to be resistant to nystatin. Also 64.28%, 92.9% of aflatoxigenic and 64.51%, 100% of non-aflatoxigenic isolates were resistant to fluconazole and itraconazole in ranking order. There was no statistically significant difference between the susceptibilities of aflatoxigenic and non-aflatoxigenic strains of A. flavus to tested antifungal agents

Isolation of Candida species from the bronchoalveolar tavage in patients with pulmonary diseases

Definite diagnosis of Candida pneumonia remains a problem in medicine. Although, isolation of'Candida spp. from the bronchoalveolar lavage is not diagnostic by itself, it may be helpful in early diagnosis of pulmonary candidiasis in immunocompromised or critically ill patients and prompt antifungal therapy. In a cross- sectional study, bronchoalveolar lavage was obtained from 144 patients with pulmonary diseases and different predisposing factors. All specimens were examined by direct microscopy and inoculated on CHOROM agar Candida plates. Corn-meal agar medium and API 20C diagnostic kit also were used for identification of different stains of'Candida. Candida spp. was isolated from 74 [51.3%] specimens. The most common isolated species was Candida albicans with frequency of 69.7%, followed by C.glabrata [20.2%], C.kefyr [5.6%], C.krusei [2.25] and C.tropicalis [1.2%]. Hypercolonization [>/= 10[3] CFU/mL] was found in 10 patients. This report implies the high frequency [30.3%] of non- albicans Candida spp. isolated from respiratory tract, necessity the application of other diagnostic methods and following up the patients. Less susceptibility ofnon- albicans Candida spp. to present anti- fungal drugs must be noted and hypercolonization of respiratory tract with Candida spp. should be considered as a initiating factor for invasive candidiasis

Surveying respiratory infections among Iranian Hajj pilgrims

The annual Hajj pilgrimage to Mecca brings over two million people together in a small confined area. Respiratory involvement is the most common disease during this ceremony, and up to now no unique cause has been identified. The present study was conducted to determine the incidence and types of respiratory diseases and their associated etiologic agents. During this prospective study, seroconversion was assessed for bacteria, viruses and fungi on 170 Iranian pilgrims prior to departure and 2 weeks after convalescence and returning from the Hajj pilgrimage. Meanwhile, sputum specimens of 252 patients were cultured. The following viruses were detected: influenza type A and B [21.5%], adenovirus [36.2%], and RSV [1.9%]. Among bacteria isolates, beta-haemolytic Streptococcous [9.7%], Haemophilus species [9.1%], Gram negative bacilli [20.6%], Legionella pneumophila [6.3%], Mycoplasma pneumonia [0.8%], and Chlamydia [32%] were more common, however, no fungal seroconversion was noted. We suggest administration of Fluvaccin for high risk groups, adenoviral vaccine for volunteer pilgrims, erythromycin or azithromycine for empiric bacterial therapy, and Oseltamivir or Zanamivir for prophylaxis or treatment of influenza like illness