Evaluation of Microbiological Culture and Antibiogram of the Patient with Corneal Ulcer due to Exposure Keratitis in the Intensive Care Unit in Sina Farshchian Hospital (2019-2020)

Background: Since patients admitted to the intensive care unit have a compromised im-mune system and are more prone to infection than other patients, timely diagnosis and treatment of corneal ulcers among this group of patients can prevent vision loss. Therefore, it is necessary to treat eye infections and corneal ulcers promptly and economize prohibitive costs. Objective(s): Appropriate treatment with the most effective antibiotic before the answer is available to prevent corneal ulcer complications and blindness. Method(s): This study was conducted from November 2019 to November 2020 and after approval by the ethics committee of Hamedan University of Medical Sciences with the code of ethics: IR.UMSHA.REC.1398.716. First, the corneal secretions of 121 patients admitted to the intensive care unit of Sina Hospital are prepared by an ophthalmologist (after anesthetizing the cornea with tetra-caine drops and sterile swabs) and culture in four growth mediums (blood agar, chocolate agar, thio-glycolate, and EMB). Microbial cultures are examined after 48 hours and a fungal culture is examined one week later. Disc diffusions are placed in positive microbial cultures. Antibiotic susceptibility or resistance of the antibiogram was recorded. Other demographic data, including patients' age and sex, are extracted from ICU files. Also, test results and patient identifications are recorded in a checklist designed for this purpose. Result(s): Of all the antibiotics used against common bacteria, vancomycin (84%), colistin (80.43%), cefazolin (80%), and levofloxacin (60%) had the highest sensitivity and gentamicin (93.75%), ceftazidime (86.42%) Erythromycin (85%) had the highest resistance against isolated bacteria. Conclusion(s): The data obtained from this study showed that the most common microorganisms in the age group under the age of 30 years were Acinetobacter Baumannii, in the group of 30-60 years old was Klebsiella pneumonia, and age group over 61 years old was Staphylococcus aureus, and the most sensitive antibiotics in the age group under 30 years were vancomycin and levofloxacin and the age group30-60 were colistin and vancomycin and in the age group over 61 years were vancomycin and cefazolin.Copyright © 2023 Bentham Science Publishers.

Disseminated Mucormycosis in a patient on long term immunosuppression: Severe fungal infections as multi-system disorders

Introduction: Mucormycosis is a rare, severe fungal infection with an incidence of 0.005 to 0.17 per million.1 but incidence has risen recently, particularly in the Asian subcontinent, due to use of immunosuppression for Covid19.2 Presentations can vary and are classified into: rhino-orbito-cerebral, pulmonary, cutaneous, disseminated, renal and gastrointestinal. Risk factors include diabetes, immunosuppression, iron overload, malnutrition, and prematurity.1,3 Although mucormycosis has an extremely high mortality rate and disseminated infection is usually fatal, treatment options exist if diagnosed early and surgical debridement may be curative. Objective(s): We present a case of mucormycois in a female patient in her 40s who was immunosuppressed with methotrexate for rheumatoid disease. This case is discussed to increase awareness of critical illness caused by opportunistic invasive fungal infections in immunosuppressed patients and promote timely identification and management. Method(s): We detail the clinical context and management of a patient with mucormycosis and discuss relevant literature. Result(s): A female patient in her 40s who had been experiencing upper respiratory tract symptoms for several weeks, including cough and brown sputum, was admitted with a presumptive diagnosis of methotrexate toxicity after a full blood count performed by the general practitioner demonstrated pancytopenia. Initially, National Early Warning System 2 score (NEWS2) was 2 but became intensely hypertensive during blood transfusion and then profoundly shocked with an escalating NEWS2. Broad-spectrum antibiotics and fluconazole were commenced for neutropenic sepsis and the patient was referred to critical care in multiple organ failure. Computerised tomography (CT) scan of the chest, abdomen and pelvis showed "left upper lobe consolidation, which with neutropenia might represent an angioinvasive aspergillosis". She had multiple areas of skin discolouration and desquamation. Haematology and Infectious Diseases opinions were sought, and a bone marrow biopsy was performed which showed severe toxic effects consistent with sepsis/life threatening infection. Progressive proptosis was noted, and CT scan of her head was requested. Sadly, she was never stable enough for CT transfer. Beta D Glucan and aspergillus antigen serology was negative. Broncho-alveolar lavage demonstrated Candida albicans and then, later, Rhizopus arrhizus was isolated and anti-fungal treatment changed to voriconazole and then amphotericin B. Upon reviewing the notes in light of the positive culture for Rhizopus, the patient had likely been exhibiting symptomatic Mucormycosis sinus infection for some time prior to this admission with disseminated infection. The patient's condition continued to deteriorate and she sadly died. Conclusion(s): * The Early Warning Score significantly underestimated how unwell the patient was upon arrival in ED, a systems-based assessment would have demonstrated that the patient had multiple system dysfunction and significant potential to deteriorate suddenly despite having stable observations * The methotrexate level has no clinical value in diagnosing or refuting a diagnosis of methotrexate toxicity * A full examination of the immunosuppressed patient including ENT is a necessity when searching for a source of infection * Invasive fungal infections can cause multi-system symptoms and atypical presentations * As a greater proportion of patients have received systemic immunosuppression for Covid-19, vigilance for more unusual pathogens, including Mucormycosis by clinicians is advised.

Synthesis and evaluation of imidazole-bearing chalcones as a potential treatment for pulmonary aspergillosis

Pulmonary aspergillosis (PA) is a category of respiratory illnesses that significantly impacts the lives of immunocompromised individuals. However, new classifications of secondary infections like influenza associated aspergillosis (IAA) and COVID-19 associated pulmonary aspergillosis (CAPA) only exacerbate matters by expanding the demographic beyond the immunocompromised. Meanwhile anti-fungal resistant strains of Aspergillus are causing current treatments to act less effectively. Symptoms can range from mild (difficulty breathing, and expectoration of blood) to severe (multi organ failure, and neurological disease). Millions are affected yearly, and mortality rates range from 20-90% making it imperative to develop novel medicines to curtail this evolving group of diseases. Chalcones and imidazoles are current antifungal pharmacophores used to treat PA. Chalcones are a group of plant-derived flavonoids that have a variety of pharmacological effects, such as, antibacterial, anticancer, antimicrobial, and anti-inflammatory activities. Imidazoles are another class of drug that possess antibacterial, antiprotozoal, and anthelmintic activities. The increase in antifungal resistant Aspergillus and Candida species make it imperative for us to synthesize novel pharmacophores for therapeutic use. Our objective was to synthesize a chalcone and imidazole into a single pharmacophore and to evaluate its effectiveness against three different fungi from the Aspergillus or Candida species. The chalcones were synthesized via the Claisen-Schmidt aldol condensation of 4-(1H-Imizadol-1-yl) benzaldehyde with various substituted acetophenones using aqueous sodium hydroxide in methanol. The anti-fungal activity of the synthesized chalcones were evaluated via a welldiffusion assay against Aspergillus fumigatus, Aspergillus niger, and Candida albicans. The data obtained suggests that chalcone derivatives with electron-withdrawing substituents are moderately effective against Aspergillus and has the potential for further optimization as a treatment for pulmonary aspergillosis. This project was supported by grants from the National Institutes of Health (NIH), National Institute of General Medicine Sciences (NIGMS), IDeA Networks of Biomedical Research Excellence (INBRE), Award number: P20GM103466. The content is solely the responsibility of the authors and do not necessarily represent the official views of the NIH.Copyright © 2023 The American Society for Biochemistry and Molecular Biology, Inc.

Synthesis of new 3-(4-methyl-2-arylthiazol-5-yl)-5-aryl-1,2,4-oxadiazole derivatives as potential cytotoxic and antimicrobial agents

Globally cancer is the second leading cause of death;a drug that can cure cancer with the utmost negligible side effects is still a distant goal. Due to increasing antibiotic resistance, microbial infection remains a grave global health security threat. The ongoing coronavirus pandemic increased the risk of microbial and fungal infection. A new series of 3-(4-methyl-2-arylthiazol-5-yl)-5-aryl-1,2,4-oxadiazole (7a-t) have been synthesized. The structure of synthesized compounds was confirmed by the spectrometric analysis. The newly synthesized compounds were screened for cytotoxic activity against breast cell lines MCF-7 and MDA-MB-231. Against the MCF-7 cell line compounds 7f, 7 g and 7n showed excellent activity with GI50 0.6 muM to <100 nM concentration. Compound 7b showed good activity against MDA-MB-231 cell line with GI50 47 muM. The active derivatives 7b, 7e, 7f, 7 g and 7n were further evaluated for cytotoxicity against the epithelial cell line derived from the human embryonic kidney (HEK 293) and were found nontoxic. The thiazolyl-1,2,4-oxadiazole derivatives were also screened to evaluate theirs in vitro antimicrobial potential against Escherichia coli (NCIM 2574), Proteus mirabilis (NCIM 2388), Bacillus subtilis (NCIM 2063), Staphylococcus albus (NCIM 2178), Candida albicans (NCIM 3100) and Aspergillus niger (ATCC 504). Amongst the 7a-t derivatives, six compounds 7a, 7d, 7f, 7n, 7o, 7r showed good antifungal activity against C. albicans and eight compounds 7c, 7d, 7 g, 7h, 7i, 7k, 7l and 7o showed good activity against A. niger. The potential cytotoxic and antifungal activity suggested that the thiazolyl-1,2,4-oxadiazole derivatives could assist in the development of lead compounds for the treatment of cancer and microbial infections.Copyright © 2022 The Authors

Epidemiology analysis of bacterial co-infections in SARSCoV-2 community-acquired pneumonia (CAP)

Background: SARS-CoV-2 infection is still remaining menacing infection with pandemic spread. Epidemiology of SARS -CoV-2 is still underestimated and meaning of bacterial or fungal co-infections needs to be studied. Aim(s): to characterize and compare bacterial/fungal co-infections at admission in hospitalized patients with SARSCoV-2. Method(s): A retrospective cohort study of bacterial co-infections at admission in SARS-CoV-2-positive adult patients with CAP admitted to Vladivostok Regional Hospital, from year 2020 to 2021. There were estimated length of stay, ICU-admission and 30-day mortality was compared in patients with and without bacterial co-infection. Result(s): the estimated mortality rate was about 65% (1105/1700). Fungal and/ or bacterial infections were diagnosed in 802 patients from the lethal cases (72%). The risk of death was increased by bacterial (OR: 11.28) and fungal (OR: 10.97) coinfections. Coinfections increased the risk of death if patients suffered from cardiovascular disease (OR: 14.53), diabetes (OR: 8.00) or obesity (OR: 7.60) in comparison with patients with these comorbidities but without pathogen isolation. The increased risk of death was detected for coagulase-negative Staphylococcus (OR: 25.39), Candida non-albicans (OR: 11.12), S. aureus (OR: 10.72), Enterococcus spp. (OR: 4.77), and C. albicans (OR: 3.97). Conclusion(s): apparently co-infections are the basic problem in SARS-CoV-19 infection mortality and first of all they need to be estimated in view of predisposing factors in patients with co-morbidity.

A Comprehensive Review on the Medicinal Benefits of Honey with an Emphasis on Unani Medicine

Background: Honey has been used medicinally in folk medicine since the dawn of civili-zation. It is a necessary component of medicine and food in a wide variety of cultures. It has been used in Unani Medicine for centuries to treat a variety of ailments. Objective(s): This review article aims to explore the medicinal characteristics of honey in view of Unani and modern concepts, highlight its potential in the treatment of the ailments stated in Unani medical literature, and also explore the relevant evidence-based phytochemistry, pharmacological, and clinical data. Method(s): The authors searched classical texts exhaustively for information on the temperament (Mizaj), pharmacological activities, mechanism of action, and therapeutic benefits of honey. Addition-ally, a comprehensive search of internet databases was conducted to compile all available information on the physicochemical, phytochemical, and pharmacological properties of this compound. Result(s): Evidence suggests that honey contains about 180 different types of various compounds, including carbohydrates, proteins, enzymes, flavonoids, and other chemical substances. In Unani classical literature, it exerts important pharmacological actions besides its immense nutritional signifi-cance. Unani physicians advocated many tested/experimented prescriptions and formulations, which still have their relevance in the amelioration of various diseases. Conclusion(s): This analysis concludes that honey has been successfully utilized in Unani medicine for centuries to treat a variety of maladies and is a potential natural source of remedy for a variety of medical disorders. Future research on honey should include a combination of Unani and modern principles.Copyright © 2023 Bentham Science Publishers.

Primary factors that determine the severity of various infections and effective nutraceutical intervention strategies

Current agricultural practices, food processing, and extensive availability of unhealthy "fast foods” impose a broad spectrum of degenerative disorders including bacterial, viral, parasitic, fungal, and yeast infections, all of which became a leading cause of death. An infection is defined as "The invasion and growth of germs in the body.” Several of these germs are opportunistic anaerobic organisms, while their propagation and proliferation potentiate the anaerobic bio-environment alarmingly. An ideal therapeutic objective is to restore a healthier cellular "aerobic” metabolic environment. This chapter will extensively focus on three important infectious disorders (i) COVID-19 infection, (ii) Herpesvirus infection, and (iii) Candida albicans yeast infections. Disease etiology, mechanisms, and pathology will be extensively discussed. Prevention and the potential of therapeutic interventions by structurally diverse nutraceuticals, phytopharmaceuticals, probiotics, and micronutrients will be extensively reviewed. © 2023 Elsevier Inc. All rights reserved.

Clinico-etiological Profile of COVID-19 Cases with Cavitary Lung Lesions

Background: Pulmonary cavitation as a radiological finding in COVID-19 has been documented in case reports and small case series with a variety of etiologies deemed responsible. However, there is no large data addressing the issue. Hence, we present the data of forty-two COVID-19 patients at our institute, who were diagnosed and evaluated for cavitary lung lesions. Methodology: Records of consecutive COVID-19 patients, diagnosed and evaluated for cavitary lung lesions over a period of three months from April to June 2021, were reviewed retrospectively. Result(s): 42 patients were diagnosed with cavitary lung lesions during study duration, 19 (45%) during the course of admission and 23 (55%) on readmission. Majority of patients (n=36, 86%) were detected with cavitary lung lesion between 4th to 7th week from symptom onset, while only 6 patients (14%) were detected in 2nd and 3rd week. Mean duration between symptom onset and evidence of cavity on chest tomography was 18 and 32 days in the course and readmission group, respectively. Mucor species, Aspergillus fumigatus and Candida albicans among fungal organisms and Acinetobacter baumannii and Klebsiella pneumoniae among bacterial organisms were predominantly associated with cavitary lesions. Conclusion(s): Cavitary lung lesions associated with COVID-19 are not uncommon and can be detected during the absorptive phase of disease itself or much later during readmission. We found that bacterial and fungal infections are commonly associated. Hence, prompt diagnosis and management should be initiated keeping these etiologies in mind to prevent further morbidity and mortality due to COVID-19.

Oral Candidiasis in Adult and Pediatric Patients with COVID-19.

Oral Candidiasis (OC) is an opportunistic fungal infection of the oral cavity, frequently reported under local and systemic predisposing circumstances. While the recurrence of OC HIV-infected subjects has been well described and reported, the association between oral candidiasis and the SARS-CoV-2 infection is a recent finding that still is worthy of further study. The present paper focuses on this novel association, reporting the incidence and prevalence of OC occurring during and after COVID-19 and the possible etiopathogenic mechanisms underlying the onset of OC in COVID-19 subjects. The work found that the immune inflammatory hypo reactions and immunosuppression found in children and adults with COVID-19 could favor the proliferation colonization of Candida species and the following infection. At the same time, poor oral hygiene and iatrogenic causes seem to be the main risk factors.

Development of thermosensitive hydrogel of Amphotericin-B and Lactoferrin combination-loaded PLGA-PEG-PEI nanoparticles for potential eradication of ocular fungal infections: In-vitro, ex-vivo and in-vivo studies.

The most prevalent conditions among ocular surgery and COVID-19 patients are fungal eye infections, which may cause inflammation and dry eye, and may cause ocular morbidity. Amphotericin-B eye drops are commonly used in the treatment of ocular fungal infections. Lactoferrin is an iron-binding glycoprotein with broad-spectrum antimicrobial activity and is used for the treatment of dry eye, conjunctivitis, and ocular inflammation. However, poor aqueous stability and excessive nasolacrimal duct draining impede these agens' efficiency. The aim of this study was to examine the effect of Amphotericin-B, as an antifungal against Candida albicans, Fusarium, and Aspergillus flavus, and Lactoferrin, as an anti-inflammatory and anti-dry eye, when co-loaded in triblock polymers PLGA-PEG-PEI nanoparticles embedded in P188-P407 ophthalmic thermosensitive gel. The nanoparticles were prepared by a double emulsion solvent evaporation method. The optimized formula showed particle size (177.0 ± 0.3 nm), poly-dispersity index (0.011 ± 0.01), zeta-potential (31.9 ± 0.3 mV), and entrapment% (90.9 ± 0.5) with improved ex-vivo pharmacokinetic parameters and ex-vivo trans-corneal penetrability, compared with drug solution. Confocal laser scanning revealed valuable penetration of fluoro-labeled nanoparticles. Irritation tests (Draize Test), Atomic force microscopy, cell culture and animal tests including histopathological analysis revealed superiority of the nanoparticles in reducing signs of inflammation and eradication of fungal infection in rabbits, without causing any damage to rabbit eyeballs. The nanoparticles exhibited favorable pharmacodynamic features with sustained release profile, and is neither cytotoxic nor irritating in-vitro or in-vivo. The developed formulation might provide a new and safe nanotechnology for treating eye problems, like inflammation and fungal infections.

Lower Concentrations of Amphotericin B Combined with Ent-Hardwickiic Acid Are Effective against Candida Strains.

Life-threatening Candida infections have increased with the COVID-19 pandemic, and the already limited arsenal of antifungal drugs has become even more restricted due to its side effects associated with complications after SARS-CoV-2 infection. Drug combination strategies have the potential to reduce the risk of side effects without loss of therapeutic efficacy. The aim of this study was to evaluate the combination of ent-hardwickiic acid with low concentrations of amphotericin B against Candida strains. The minimum inhibitory concentration (MIC) values were determined for amphotericin B and ent-hardwickiic acid as isolated compounds and for 77 combinations of amphotericin B and ent-hardwickiic acid concentrations that were assessed by using the checkerboard microdilution method. Time-kill assays were performed in order to assess the fungistatic or fungicidal nature of the different combinations. The strategy of combining both compounds markedly reduced the MIC values from 16 µg/mL to 1 µg/mL of amphotericin B and from 12.5 µg/mL to 6.25 µg/mL of ent-hardwickiic acid, from isolated to combined, against C. albicans resistant to azoles. The combination of 1 µg/mL of amphotericin B with 6.25 µg/mL of ent-hardwickiic acid killed all the cells of the same strain within four hours of incubation.

Can Procalcitonin Values Track the Presence of Secondary Infections in Covid-19 Patients?

INTRODUCTION: We set out to analyse the efficacy of Procalcitonin in identifying secondary infections in Covid-19 patients. METHOD(S): In this Retrospective Observational Study, inclusion criteria comprised patients admitted to the Grange University Hospital intensive care unit with SARS-CoV-2 infection throughout the second and third waves of the pandemic. Data collected included daily biomarkers of inflammation such as white blood cell (WBC) counts and C-Reactive Protein (CRP) values and the presence of microbiologically proven secondary infections, quantifying the clinical burden of co-infections in these patients and calculating the microorganism prevalence. Continuous variables are presented as median (interquartile ranges). Differences in continuous variables were analysed using independent Mann-Whitney-U tests and one-way Analysis of Variances (ANOVA). RESULT(S): 121 patients were analysed in Wave 2 and 118 in Wave 3. Of these patients, 69 (57%) tested positive for an infection in Wave 2 and 52 (44%) in Wave 3. The median Procalcitonin levels (ng/mL) on Day 0 were 0.21 (IQR 0.1-1.44) in the No infection Group, compared to 0.24 (0.1-0.44) in the Infection Group for Wave 2. For Wave 3, the Procalcitonin levels (ng/mL) on Day 0 were 0.23 (0.1-.5325) in the No infection Group, compared to 0.14 (0.09-0.44) in the Infection Group. There was no significant difference between the two cohorts over the 14 days period. Similarly, no significant difference was observed in Wave 3 between the Infection vs No infection group. WCB and CRP values were also almost identical in the groups in both waves. Length of ICU stay was higher in the Infection Group in both Wave 2 (median 15 [IQR 0-48]) and Wave 3 (12.05 [0-72.5]) compared to the No Infection Group (Wave 2: 5 [0.08-23.8], Wave 3: 4 [0.6-12.9]). The mean 1st day of infection was Day 6 (SD 3.9) in Wave 2 and Day 4 (SD 3) in Wave 3. The most common pathogen associated with a bloodstream infection was Escherichia Coli (ECOL) in Wave 2 (n=3) and Staphylococcus Aureus (SAUR) in Wave 3 (n=3). The most common pathogen found in sputum culture results was Candida Albicans (CALB) in both Wave 2 (n=32) and Wave 3 (n=19). CONCLUSION(S): Despite initial promise, absolute Procalcitonin values failed to indicate the emergence of critical care-acquired infection in COVID-19 Patients.

Severe Suppurative Sialadenitis in a Covid-19-Positive Patient

INTRODUCTION: The COVID-19 virus has infected over 560 million people and caused over 6 million deaths worldwide. While it is mostly recognized as a pulmonary illness, COVID-19 is now known to be a multi-systemic disease involving several systems, some of which are often overlooked. Here, we present a case of severe sialadenitis associated with COVID-19 infection. DESCRIPTION: A 79-year-old-man with recent hospitalization for end-stage-renal-disease was admitted to an inpatient rehabilitation unit. Rapid response was called due to acute respiratory distress and lethargy. On exam, the patient was febrile 38.9degreeC, tachycardic at 110bpm, and tachypneic at 27bpm. Bilateral swelling and tenderness of the neck and diffuse inspiratory wheezing was noted. Patient was intubated for airway protection and suspected upper airway obstruction and admitted to the Intensive Care Unit. Repeat SARS-CoV-2 PCR was positive. Computed tomography of the neck revealed significant enlargement and swelling of the bilateral parotid and right submandibular glands. Stensen's duct drainage elicited from massage showed polymicrobial growth with methicillin-resistant Staphylococcus aureus, Klebsiella pneumoniae, Enterococcus faecium, Echerichia coli and Candida albicans. However, culture from endotracheal aspirate showed similar pathogens so contamination of the sample was considered. Patient received intravenous vancomycin, ampicillin/sulbactam, high dose steroids, warm compresses, and daily parotid massage, with resolution of symptoms within one week. DISCUSSION: An increasing number of orofacial symptoms have been reported in COVID-19 patients. This manifestation is especially worth noting as high viral loads of COVID-19 are persistently found in saliva samples and genetic studies demonstrate the ability of the virus to infect the epithelial cells of the oral mucosa. While SARS-CoV-2 has previously been associated with non-suppurative sialadenitis, this case highlights the possibility of suppurative infection. Sialadenitis, parotitis and other orofacial symptoms may potentially be notable presentations of COVID-19, though more studies are necessary to further comprehend the otolaryngologic implications of the virus.

Evaluation of anti-Candida activity of Cinnamaldehyde using mice model

Objective: Vaginal candidiasis is a frequent infection afflicting the female population. Candida co-infections are reported in escalating frequency and can be associated with severe health hazards or even death. People with severe COVID-19, malig-nancies, AIDS, and organ transplants are particularly vulnerable to invasive vaginal candidiasis. Due to the high frequency of infections associated with recurrence, vaginal candidiasis poses a significant medical problem worldwide.Treatments of vaginal candidiasis are limited due to drug resistance, side effects, and toxicity. CIN is a natural compound and its antifungal activity is widely reported. The introduction of cinnamaldehyde (CIN) as the anti-Candidal agent will revolutionize the treatment of vaginal candidiasis. In this study, we investigated the anti-Candida activity of CIN against vaginal candidiasis in Swiss albino mice (C3HHC-Strain). Method(s): Vaginal candidiasis in mice (Swiss albino) was induced under conditions of pseudo-estrus. Persistent vaginal infection wasfound inestrogenized mice aftervaginal challenge withC.albicans.The mice weretreated orallyafter confirmation of infection in mice.The efficacy of CIN treatment was investigated phenotypically by colony-forming unit (CFU) counts in the vaginal smear, fungal load determination in the blood, the ovarian and vaginal tissues and periodic acid-Schiff (PAS) staining of histopathological sections of the vaginal tissues. The hematological parameters of the experimental mice were also evaluated. Result(s): The pseudohyphae and spores of C. albicans were present in the vaginal smear of experimentally infected mice. After treatment, no C. albicans colonies were found in the vaginal lavage of infected mice. The fungal burden was significantly higher inthe vaginaand the ovaries of infectedmice.However, a dose of262.5 mg/kgBW of CINreduced thenumber ofCFUin the vagina and ovaries in treated mice.The histopathology revealed the absence of C.albicans in the vaginal tissue of the treated mice. Nonetheless, the vaginal sections of infected mice exhibited pathological changes. The hematological parameters such as RBC count, WBC count, and percentage of hemoglobin showed significant differences in the treatment groups compared to the infected group. Conclusion(s): Cinnamaldehyde showed good in vivo antifungal potential against vaginal candidiasis. However, evaluation of its pharmacodynamic and pharmacokinetic parameters and complete elucidation of its mode of action are desirous.

Public health treatment due to rise in Candida auris candidemia infection

Introduction: Isolation of Candida spp. from a blood sample in patients is known as candidemia. Candida albicans is the most common causative agent of candidemia globally while C.tropicalis is the most common causative agent in India.Candida parapsilosis complex, C.glabrata, and C.krusei are the other three common causative agents of candidemia.Candida auris was described in 2009 and is a public health treatment. It is multidrug-resistant and causes localized hospital outbreaks. Objective(s): To determine the fungal profile of candidemia in a tertiary care hospital. Method(s): Institute ethics approval was taken. All patients admitted to the Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India from January 2020 to January 2021, whose blood culture samples yielded yeast were included in the study. The patient's demographic details were recorded. Yeast isolates were identified by Matrix-Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrometry (MALDI-T OF MS) as per the manufacture's instruc-tion. The antifungal susceptibility testing (AFST) was performed by microbroth dilution method for fluconazole, voriconazole, amphotericin B, and casp ofungin as per Clinical and Laboratory Standards Institute (CLSI) M27 and interpreted by CLSI M59 and M60 document.AFST of C.auris was interpreted as per Centers for Disease Control and Prevention (CDC) criteria.Results were expressed in percentages. Result(s): A total of 248 blood culture samples yielded yeast cells during the study period. Approximately 63% of samples were obtained from male patients, while 37% were obtained from female patients. Most of the patients were between 41 to 60 years or under 10 years of age. A total of 52/240 (15.8%) were diabetic, and 30 (15.2%) were positive for severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2). Candida tropicalis (34.7%) was the most common causative agent. It was followed by C. parapsilosis complex (20.2%). Candida auris (16.5%), C. albicans (13.3%), C. glabrata (6.5%), and other C. spp. (8.9%). Candida krusei is no longer observed as one of the top five agents of candidemia and it is replaced by C. auris. The rise of candidemia due to C.auris is a cause of concern, and its prevalence is observed more than that of C.albicans in our tertiary care hospital.The antifungal resistant pattern of the top four candidemia isolates is depicted in Figure 1.The antifungal resistance was maximum in C.auris isolates, followed by C.parapsilosis complex isolates.A total of 12.2% of C.auris isolates were resistant to amphotericin B, and azoles and 4.9% of C. auris isolates were multidrug-resistant. Conclusion(s): Candida tropicalis was the most common causative agent of candidemia. But the increased prevalence of C. auris over C. albicans is a cause of concern as 4.9% of C. auris isolates were multidrug-resistant.

Prevalence and antifungal susceptibility of Candida spp. from the sputum sample of patients in a tertiary care hos-pital in Sikkim

Objectives: The role of Candida in sputum culture is unclear and is generally not treated when present in sputum samples. The objective of this study is to describe the clinical findings of patients with Candida spp. in sputum and their antifungal susceptibility pattern to know the local epidemiology of antifungal resistance. Method(s): Patients with respiratory symptoms attending the tertiary care hospital during the study period of 6 months from June 2021 to December 2021. A total of 23 sputum samples were processed in the microbiology laboratory. Samples were processed following conventional mycological procedures including direct microscopy (visualization of budding yeast cell on grams stain), growth on sabouraud dextrose agar, Germ tube test, and CHROMagar. The isolates were identified by rapid identification (ID) of yeast and yeast-like organisms in the BD PhoenixTM Automated Microbiology System. Antifungal Susceptibility Testing (AFST) was carried outby disk diffusion susceptibility testing, Zone interpretation criteria as per M44/A2 protocol of CLSI were used.Antifungal used were amphotericin B (20 mcg), itraconazole (10 mcg), fluconazole (25 mcg), and voriconazole (1 mcg). Results of tests done on 23 isolates were collated and analyzed retrospectively. Clinical pr ofile of the patients was taken retrospectively from record section and analyzed. Result(s): Of the 23 patients, most common presentation was fever followed by cough and dyspnea.A total of 34% patients were receiving some form of steroid (injectable or inhalational). Only 2 patients were COVID positive by RT-PCR and 7 (30%) patients had some radiological findings like consolidation, emphysematous changes, etc. Immunodeficiency condition was seen in 4 (17%) patients like tuberculosis and diabetes mellitus. Of the 23 samples, C. albicans showed prevalence of 91% as compared with C. tropicalis (5%) and C. glabrata (4.8%). AFST showed Candida spp. was found to be mostly sensitive to voriconazole and fluconazole. Resistance to amphotericin B was seen in most Candida spp. Itraconazole was not susceptible to even one isolate only 4 samples were intermediate (Fig. 1). Conclusion(s): Infections with Candida spp. are usually of low virulence and are associated with a few well-defined risk factors as immunocompromised state, malignancy, and steroid therapy. Understanding these risk factors, identifying the species with changing trends in antifungal resistance, instituting infection control practices to reduce morbidity and mortality in critical care areas can improve outcomes. Surveillance of the rates of Candida infection in critical areas, reporting of outbreaks and continuous monitoring of an-tifungal susceptibility patterns will help in choosing the best therapeutic management of complicated cases. Comparison of trends in infection rates amongst hospitals between various Indian cities and their resistance patterns can reveal vital informa-tion regarding the breakdown of infection control measures. Most Candida infections are of low virulence and only become significant in the vulnerable critical care areas. With the rise in prevalence of inherently azole-resistant species and rising use of echinocandins in ICUs, identifying risk factors and controlling the infection early can improve patient outcomes.

Candidemia in a tertiary care hospital: Epidemiology, speciation and antifungal susceptibility pattern

Objective: The incidence of bloodstream fungal infection is on the rise and Candida species remains responsible for the majority of the cases. Candidemia is frequently associated with a high rate of mortality and morbidity. The purpose of this study was to characterize Candidemia, its epidemiology, species distribution, and antifungal susceptibility pattern in a tertiary care hospital. Methods and Material: Candida species isolated from the blood culture of 51 patients in a tertiary care hospital during the period from 2016 to 2021 were included in the study. The growth on SDA was confirmed by Gram staining and speciation and antifungal susceptibility were performed with Automated system VITEK 2.0. Result(s): Out of51 isolates, Candida auris wasthe most common speciesaccounting for about 37.2% followedby C.albicans 19.7%, C. tropicalis 17.6%, and C. famata 9.8%. Candida auris has emerged as the predominant species during severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) pandemic.The incidence has risen from 22% to 60% during the pandemi C. Candida specieswere foundto be96.08% sensitiveto flucytosine, 94.12% tovoricanazole, 90.19%to casp ofungin/micafungin, 60.78% to amphoterecin B, and 56.86% to fluconazole. Conclusion(s): Candida auris has emerged as the predominant species in ICU setup and during SARS-CoV-2 pandemi C. Empirical treatment with echinocandines would be appropriate in high-risk patients with suspected Candidemia.

Inhibitory Activity of Saussurea costus Extract against Bacteria, Candida, Herpes, and SARS-CoV-2.

Medicinal herbs have long been utilized to treat various diseases or to relieve the symptoms of some ailments for extended periods. The present investigation demonstrates the phytochemical profile, molecular docking, anti-Candida activity, and anti-viral activity of the Saussurea costus acetic acid extract. GC-MS analysis of the extract revealed the presence of 69 chemical compounds. The chemical compounds were alkaloids (4%), terpenoids (79%), phenolic compounds (4%), hydrocarbons (7%), and sterols (6%). Molecular docking was used to study the inhibitory activity of 69 identified compounds against SARS-CoV-2. In total, 12 out of 69 compounds were found to have active properties exhibiting SARS-CoV-2 inhibition. The binding scores of these molecules were significantly low, ranging from -7.8 to -5.6 kcal/mol. The interaction of oxatricyclo [20.8.0.0(7,16)] triaconta-1(22),7(16),9,13,23,29-hexaene with the active site is more efficient. Furthermore, the extract exhibited significant antimicrobial activity (in vitro) against Candida albicans, which was the most susceptible microorganism, followed by Bacillus cereus, Salmonella enterica, Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa, respectively. On the other hand, its antiviral activity was evaluated against HSV-1 and SARS-CoV-2, and the results showed a significant positive influence against HSV-1 (EC50 = 82.6 g/mL; CC50 = 162.9 g/mL; selectivity index = 1.9). In spite of this, no impact could be observed in terms of inhibiting the entry of SARS-CoV-2 in vitro.