Cryptococcal meningitis relapse in an immunocompetent patient

Cryptococcal meningitis is a common opportunistic infection in patients with underlying immunosuppressive state specially AIDS patients. However, it could be seen in immunocompetent patients mostly in tropical areas. There are scanty reports of such infection in healthy patients of non-tropical areas. We report an immunocompetent 43 years old Iranian man who was in excellent health status until 3 weeks before hospitalization when he developed headache. He experienced a 5-week delay in diagnosis of cryptococcal meningitis which led to his blindness of right eye despite treatment. We believed that the nonspecific clinical and laboratory finding of the present case and also the rarity of disease in our area especially in immunocompetent patients made his diagnosis confounding

[ study of 101 cases of onychomycosis and associate factors in patients referred to Boali Sina Hospital and Toba dermatology outpatient clinics in Sari]

Onychomycosis is a nail fungal infection caused by various species of dermatophytes, yeasts and non-dermatophytic molds and represents about 30% of cutaneous mycotic infections. The goal of this study was to investigate the frequency of onychomycosis and its associated factors in patients referred to Boali Sina Hospital and Toba dermatology outpatient clinics, Sari. In this cross-sectional study, nail specimens were collected from 101 patients suspected of onychomycosis during a 14 month period. Nail specimens were examined by direct microscopy, using potassium hydroxide [KOH] 20%, KOH + CFW, KONCPA [KOH treated nail clipping+PAS] and also culturing on sabouraud's dextrose agar, containing chloramphenicol [SC], and sabouraud's dextrose agar containing cyclohexamide and chloramphenicol [SCC] mediums. In this study, 79 [78%] of patients were female and 22 [22%] were male. Yeasts were isolated in 30% cases of onychomycosis, mainly from fingernails. Candida albicans, and C.krusei was the most prevalent species. Non-dermatophytic filamentous fungi were yielded at 24%, especially from toenails, with Aspergillus terreus being the most prevalent species. Dermatophytes were found in 7% of the samples, especially from toenails. Trichophyton mentagrophytes was the predominant species. Unknown filamentous fungi were identified in 19% of samples, while mixed infections were identified in 20% of samples. The highest prevalence rate of onychomycosis was identified in the patients within the 30 to 49 years of age group. Distal and lateral subfungual onychomycosis [DLSO] was the most prevalent clinical types with [88%], followed by WSO [5%], PSO [5%], TDO [1%] and DLSO + PSO [1%]. The results of our study showed that onychomycosis is one of the most prevalent infections in patients who are suffering from nail disorders. Yeast and yeast like organisms cause these infections more than other fungus in this region. Women are more infected, as they are in daily contact with detergents and moisture

[Identification of malassezia species isolated from patients with pityriasis versicolor and seborrhoeic dermatitis by PCR-RFLP]

Lipophilic yeast of the genus Malassezia are members of normal human cutaneous micro flora which are also associated with several skin diseases. It is strongly suspected that Malassezia species are responsible for pityriasis versicolor [PV], and seborrhoeic dermatitis [SD]. Considering various sensitivities among Malassezia species to antifungal, accurate species identification will facilitate the treatment of relevant diseases. Malassezia species can be identified through their morphological features and bio-chemical characteristics. However, these phenotypic methods are usually time consuming, and lack sufficient discriminatory power. Development of DNA- based methods for detection and identification of Malassezia species provide helpful alternatives for solving problems. The aim of this study was to examine the distribution of Malassezia species in patients with pityriasis versicolor and seborrhoeic dermatitis, using molecular methods. A total of 63 clinical isolates of Malassezia spp, 30 strains isolated from patients with PV and 33 strains isolated from patients with SD, were studied. To investigate the strains at molecular level, genomic DNA of Malassezia isolates were extracted and amplified within the ITS1 region [located between 18S and 5.8S rDNA] by polymerase chain reaction [PCR] assay. DNA sequencing of ITS1 of rDNA in Malassezia spp was performed to type the species. Restriction fragment length polymorphism [RFLP] analysis of ITS1 PCR product with two restrictive enzymes CFOI and BSTF5I, was used in subsequent species identification. In this study, 37 patients with PV [20 females, 17 males; 2 to 64 years old], 81.1% [30 case] yielded growth of Malassezia in culture, while the frequency of isolation of M. globosa was 53.3% [16 case], M .furfur 40% [12 case] and M. sympodialis 6.7% [2 case]. Of the 41 patients with SD [22 females, 19 males; 1 to 52 years old], 80.5% [33 case] yielded growth of Malassezia in culture, while the frequency of M. furfur was 42.4% [14 case], M.globosa 39. 4% [13 case], M. restrict 15.2% [5 case] and M. sympodialis 3% [1 case]. This PCR-RFLP Profile allows us to clearly identify important Malassezia species. The results of the PCR-RFLP analyses of clinical isolates were in complete agreement with those from DNA sequencing, morphological features and bio-chemical characterization. In patients with PV, the most frequently isolated species were M. globosa, followed by M .furfur. However, in patients with SD, the most frequently isolated species were M. furfur, followed by M. globosa. The PCR-RFLP system applied for the ITS1 fragment of the rDNA is a reliable, simple and rapid method for identification of the most important Malassezia species, but further work will be necessary in applying these techniques to additional patients

[ survey on myco-flora of air, book and cabinet of Mazandaran univerity of medical sciences libraries]

Grown fungi on books can be a risk factor for occupants as well as its known agents of bio-deterioration. Therefore, in this study, we surveyed the myco-flora of air, book and cabinets at Mazandaran University of Medical Sciences Libraries. Opened plates [containing Sabouraud's dextrose agar with chloramphenicole media [SC] were used for the isolation of fungi in the air of indoor environment of libraries. Pleated carpet sterile fragments were used for survey of cabinets and books contamination. Then, these fragments were cultured on SC in laboratory. A total of 939 colonies with 17 genera of fungi were identified from the environment of 4 school libraries at the Mazandaran University of Medical Sciences. The most common fungi isolated were: Penicillium [62.0%], Yeast [13.6%], sterile hyphae [7.6%] and Candida [5.6%]. The most number of colonies were isolated from the air. Penicillium, Aspergillus, Alternaria and Stachybotrys were isolated from the libraries. They are considered toxigenic, allergenic, infective and also, as book deterioration agents

Fungal keratitis in patients with coorneal ulcer in Sari, northern Iran

Fungal keratitis is a suppurative, ulcerative, and sight-threatening infection of the cornea that sometimes leads to loss of the eye. The objectives of this study were to improve facilities for laboratory diagnosis, to determine the predominant causative microorganisms, and to identify the predisposing factors of mycotic keratitis patients. A prospective study of corneal ulcer was conducted in Sari between May 2004 and March 2005. Patients who presented with clinically suspected corneal ulcer to the Ophthalmology Department of Bou-Ali Sina University Hospital in Sari were included in this study. Each patient was examined with slit lamp. Data were collected by examining and questioning the patients. Using standard techniques, corneal scraping was performed by an ophthalmologist. The specimens collected were then smeared on two slides, which were stained with Gram stain [for bacterial keratitis] and 10% potassium hydroxide with or without Calcofluor white stain [for fungal keratitis], and studied under light microscope. The specimens were also inoculated directly on blood agar, Sabouraud dextrose agar, and potato dextrose agar in C-shaped streaks. A total of 22 patients met the inclusion criteria of this study, among whom 10 [45.5%] were females and 12 [54.5%] were males. The mean +/- SD age of patients was 61.5 +/- 17.7 [range: 15 - 83] years. In direct microscopy, branching, and septate hyphae were identified in 7 [31.8%] patients. Two [28.6%] fungi [Aspergillus fumigatus and Fusarium spp.] were isolated. Five [31.8%] patients with fungal keratitis were males and 2 [28.6%] were females. The mean +/- SD age of patients with fungal keratitis was 60.4 +/- 12.1 [range: 39 - 73] years. Three [42.85%] patients with fungal keratitis were farmers. The mean interval between the onset of symptom and diagnosis was 26.4 [range: 1 - 93] days. Trauma with plant debris and straws were noted in two [28.6%] patients with fungal keratitis. Five [71.4%] patients received topical antibiotics. Analyses, using potassium hydroxide with or without Calcofluor white as the gold-standard test, revealed a sensitivity of 71.4% for potassium hydroxide, and 42.9% for Gram stain. Infections of the cornea due to filamentous fungi are frequent causes of corneal damage and should always be kept in mind. The direct microscopy method is an essential tool in the diagnosis of fungal keratitis. Therefore, wet mount preparation with potassium hydroxide with or without Calcofluor white or only KOH can be relied upon as the single most important screening test for rapid diagnosis of fungal corneal ulcer

Specific amplification of aspergillus fumigatus DNA by polymerase chain reation

Invasive aspergillosis [IA] is a life-threatening condition in immunocompromised patients. An early diagnosis is of great importance because early treatment may resolve this potentially fatal infection. Recently, the polymerase chain reaction [PCR] has been used successfully in detecting specific DNA of several pathogens. In this study, nested PCR was used to detect DNA specific for Aspergillus species isolated from bronchoalveolar lavage [BAL] fluid from patients with IA. In single PCR using the outer primers a specific 384-bp fragment was amplified. Similarly, by nested PCR with inner primers, a 357-bp fragment was amplified with DNA from Aspergillus fumigatus but not from the other microorganisms. The Southern blot hybridizations confirm the specificity of the PCR procedure for A.fumigatus using the cloned 374-bp PCR product probe. In conclusion, the nested PCR method appears to be quite rapid and specific