COVID-19 Infection as an Exacerbated Factor of Oral Candidiasis in HIV/AIDS Patient.

Introduction: Oral candidiasis is an oral mucosal infection caused by Candida sp. This infection can appear in patients with HIV/AIDS associated with immunodeficiency. Another factor that can aggravate the occurrence of oral candidiasis is the COVID-19 infection caused by the SARS-CoV-2 virus as a current pandemic condition. This case report aims to explain the mechanism of COVID-19 infection as a factor that can aggravate the condition of oral candidiasis in HIV/AIDS patients. Case: A 56-year-old male patient was consulted from the COVID-19 isolation unit to the Department of Oral Medicine with complaints of sore and uncomfortable mouth related to white plaque covering the surface of the tongue. The patient was diagnosed with HIV/AIDS and had a COVID-19 infection. The management instructions were to maintain oral hygiene, administration of antifungal drugs such as nystatin oral suspension and fluconazole, chlorhexidine gluconate 0.2% mouthwash, and vaseline album. Discussion: Generally, HIV/AIDS patient has dysregulation of the immune system which can suppress host immunity to fight pathogens, making it easy for opportunistic infections such as oral candidiasis. The COVID-19 infection can cause lymphopenia conditions that further reduce the host's ability to fight pathogens. The SARS-CoV-2 virus can also directly attack various tissues in the oral mucosa which can contribute to exacerbating the severity of oral candidiasis in HIV/AIDS patients. Conclusion: The COVID-19 infection is a factor that can exacerbate the condition of oral candidiasis in HIV/AIDS patients by further decreasing the host's immunity and damaging various tissues in the oral mucosa.

Bioinformatics analysis to identify intersection genes, associated pathways and therapeutic drugs between COVID-19 and Oral candidiasis.

BACKGROUND: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has a serious threat to human health. Oral candidiasis (OC) may be one of the causes of morbidity in severe COVID-19 patients. However, there is currently no treatment for oral candidiasis and COVID-19 (OC/COVID-19). The purpose of this study was to use text mining and data analysis to investigate the target genes for treatment and explore potential therapeutic drugs for OC/COVID-19. METHODS: We used the text mining tool pubmed2ensembl to detect genes associated with OC, and the dataset GSE164805 was used for the data analysis. Then, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed on the two intersection genes using the Database of Annotation, Visualization and Integrated Discovery (DAVID) platform. The protein-protein interaction (PPI) networks were constructed by STRING software, and gene module analysis was performed using Molecular Complex Detection (MCODE), a plug-in in Cytoscape. The most significant genes were selected as hub genes and their functions and pathways were analyzed using Metascape. We revealed the upstream pathway activity of the hub genes. The drug-gene interaction database (DGIdb) and the traditional Chinese medicines integrated database (TCMID) were used to discover potential drugs for the treatment of OC/COVID-19. RESULTS: The analysis indicated that there were 2869 differentially expressed genes (DEGs) in GSE164805. We identified 161 unique genes associated with oral candidiasis through text mining. A total of 20 intersection genes were identified as the therapeutic targets for OC/COVID-19. Based on the bioinformatics analysis, nine genes (TNF, IL1B, IFNG, CSF2, ELANE, CCL2, MMP9, CXCR4, and IL1A) were identified as hub genes that were mainly enriched in the IL-17 signaling pathway, TNF signaling pathway, AGE-RAGE signaling pathway in diabetic complications and NOD-like receptor signaling pathway. We identified four of the nine genes that target five existing drugs, including BKT140, mavorixafor, sivelestat, canakinumab, and rilonacept. Furthermore, twenty herb ingredients were also screened as potential drugs. CONCLUSION: In this study, TNF, IL1B, IFNG, CSF2, ELANE, CCL2, MMP9, CXCR4, and IL1A were potentially key genes involved in the treatment of OC/COVID-19. Taken together five drugs and twenty herb ingredients were identified as potential therapeutic agents for OC/COVID-19 treatment and management.

Teledentistry in pediatric dentistry: review and presentation of a clinical case.

OBJECTIVES Teledentistry is a telematics approach validated in the literature that allows the remote diagnosis and management of various oral health problems, avoiding direct face-to-face contact with the patient. This study aims to present a review of the scientific literature to analyze in which fields of pediatric dentistry teledentistry has found application and with what results;in addition, a case of unconventional oral candidiasis in a child, diagnosed and managed through the use of teledentistry during the SARS-CoV-2 pandemic in April 2020, is presented. MATERIALS AND METHODS The literature search was performed through PubMed (using keyword and MeSH terms), Scopus and Embase databases, evaluating observational, interventional, case reports and case series studies, published in English between 1999 and 2021 and conducted in children. The clinical case presented was diagnosed and managed through photographs that the pediatric dentist received from the patient's mother via a multi-platform messaging application. Through the same application, the mother was able to provide informed consent to take care of the patient remotely, after acceptance of possible critical issues regarding teledentistry, and receive a prescription for home treatment of oral candidiasis. RESULTS After exclusion of duplicates and articles that did not meet the inclusion criteria, 14 studies were selected. Teledentistry was applied in four different areas: oral health promotion, with 2 studies examining smartphone applications to improve home oral hygiene, diagnosis/follow-up/treatment in orthodontics with 4 studies, caries and other hard and soft tissue diseases of the oral cavity with 7 studies, and finally dental traumatology with a single study. With regard to the promotion of oral health, two applications for the improvement of home oral hygiene were examined. They showed promise for motivation and education. In orthodontics, the studies evaluated in this review reported that teledentistry is useful and valuable for follow-up and orthodontic consultations that can be obtained quickly;doubts remain regarding expense, intervention time and operator compensation. In addition, remotely supervised interceptive treatment appears to reduce the severity of malocclusions. About caries and other hard and soft tissue diseases of the oral cavity, results indicate that teledentistry can reduce waiting lists and the need for face-to-face examinations. Teledentistry is considered valid, efficient and potentially cost-effective for screening and follow-up of caries, being comparable to traditional clinical examination. Teledentistry has proven to be comparable to clinical examination for the diagnosis of dental trauma. CONCLUSIONS The data collected allow us to conclude that teledentistry, thanks to advances in technology, can be a useful means for pediatric dentists to improve the oral health of young patients and to provide better access to oral health services by effectively replacing face-to-face dentistry in various situations. The presented clinical case confirms the conclusions obtained from the literature search. CLINICAL SIGNIFICANCE Teledentistry can replace face-to-face visits in several areas of pediatric dentistry and ensuring safe care during any future pandemics.Copyright © 2023 EDRA SpA. Tutti i diritti riservati.

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.

Evaluation of oral mucositis, candidiasis, and quality of life in patients with head and neck cancer treated with a hypofractionated or conventional radiotherapy protocol: a longitudinal, prospective, observational study.

BACKGROUND: Due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, recently, Radiotherapy (RT) protocols requiring fewer sessions (hypofractionated) have been used to shorten RT treatment and minimize patient exposure to medical centers, and decrease the risk of SARS-CoV-2 infection. METHODS: This longitudinal, prospective, observational study aimed to compare the quality of life (QoL) and the incidence of oral mucositis and candidiasis in 66 patients with head and neck cancer (HNC) who undergo a hypofractionated RT protocol (GHipo), total of 55 Gy for 4 weeks, or a conventional RT protocol (GConv), total of 66 - 70 Gy for 6 - 7 weeks. PURPOSE: To assess the incidence and severity of oral mucositis, the incidence of candidiasis, and QoL were evaluated using the World Health Organization scale, clinical evaluation, and the QLC-30 and H&N-35 questionnaires, respectively, at the beginning and the end of RT. RESULTS: The incidence of candidiasis did not show differences between the two groups. However, at the end of RT, mucositis had a higher incidence (p < 0.01) and severity (p < 0.05) in GHipo. QoL was not markedly different between the two groups. Although mucositis worsened in patients treated with hypofractionated RT, QoL did not worsen for patients on this regimen. CONCLUSIONS: Our results open perspectives for the potential use of RT protocols for HNC with fewer sessions in conditions that require faster, cheaper, and more practical treatments.

HIV-Associated Mycobacterium Avium Complex, Oral Candida, and SARS-CoV-2 Co-Infection: A Rare Case Report.

Background: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread rapidly to become a global pandemic. Opportunistic infections (OIs) are common in patients with acquired immunodeficiency syndrome (AIDS). Mycobacterium avium complex (MAC) and oral candidiasis (OC) are frequently responsible for such infections. Here, we describe a patient with a recent history of COVID-19 who was also diagnosed with human immunodeficiency virus (HIV), MAC, and OC. Case Presentation: The patient was a 23-year-old woman with a past medical history of HIV infection who was diagnosed with SARS-CoV-2 infection 6 days prior to her referral to hospital. Her chief complaints were chest distress and continuous fever with a background of a 5-month history of anemia and tuberculosis (TB). Chest X-ray showed bilateral parenchymal infiltrates suspicious for COVID-19. She was treated with oxygen, empiric antibacterial and antiretroviral therapy. Further workup showed MAC and OC infection. She was started on ethambutol, rifampin and antifungal treatment for influenzas and her symptoms resolved in 8 weeks. Follow-up chest computed tomography scanning showed that the lung lesions disappeared within a short period of time. Conclusion: A thorough history and clinical examination are vital to arriving at the correct diagnosis or diagnoses. With the COVID-19 pandemic, clinicians caring for immunosuppressed patients need to remain vigilant of the simultaneous presence of OIs. This report highlights the importance of the treatment and prevention of OIs in HIV-infected persons, which may reduce adverse consequences after infection with SARS-CoV-2.

Oral Candidiasis Infections Associated with Covid-19 Patients in West of Iraq

Coronavirus is a devastating global public health disaster in the last years. It affected a large proportion of people around the world. Some of the co-infections associated with the global COVID-19 pandemic are the secondary my cotic infections that following COVID-19 disease. There are genetic and environmental factors that are involved in these infections. In this research, the main goal is to study the my cotic infection of 87 COVID-19 patients of those with comorbidities diseases such as DM, Hypertension, and other chronic disease. Also, to observe the relationship between the my cotic infections and the patients which treated with corticosteroid and broad-spectrum antibiotics. As well as identification of Candida by using an efficient and sensitive molecular method for the Internal transcribed spacer (ITS) gene associated with contagion. Fungal DNA was extracted from patients according to well-established procedures. Then, DNA was amplified by PCR techniques using specific primers for ITS exons. The results of this study indicate a significant association between species of fungi, (P-value = 0.000) and [Chi-square = 54.76). Also, this study shows a significant association between species of Candida, (P-value = 0.000) and [Chi-square = 19.32). As well as the study mentions a significant association between species of fungi and recipient broad-spectrum antibiotics with an increased risk for COVID-19 contagion, (P-value = 0.044). In addition, our outcomes proved no significant association between fungi with smoking, DM, and hypertension, (P-value = 0.143), (P-value = 0.568), and (P-value = 0.070), respectively. Finally, no significant association appeared between fungi with an increased risk for COVID-19 contagion, (P-value = 0.170), [Chi-square = 0.053) about corticosteroid therapy. In conclusion the oral candidiasis was the most frequent infection among COVID-19 patients. However, our findings need more replication in the Arabic countries to confirm these outcomes. © 2022, ResearchTrentz Academy Publishing Education Services. All rights reserved.

Multiple Candida strains causing oral infection in COVID-19 patients under corticosteroids and antibiotic therapy: An observational study.

Introduction: The occurrence of oral candidiasis (OC) is expected in patients with COVID-19, especially those with moderate to severe forms of infection who are hospitalized and may be on long-term use of broad-spectrum antibiotics or prolonged corticosteroid therapy. We aimed to characterize clinical conditions, the prevalence profile of Candida species, and outcomes of COVID-19 patients with OC. Methods: In this observational study, oral samples were obtained from COVID-19 patients suspected of OC admitted to Razi teaching hospital. Patients with OC were monitored daily until discharge from the hospital. Species identification was performed by a two-step multiplex assay named YEAST PLEX, which identifies 17 clinically important uncommon to common yeast strains. Results: Among the 4133 patients admitted with COVID-19, 120 (2.90%) suffered from OC. The onset of signs and symptoms of OC in patients was, on average (2.92 ± 3.596 days) with a range (of 1-29 days). The most common OC presentation was white or yellow macules on the buccal surface or the tongue. In (39.16%) of patients suffering from OC multiple Candida strains (with two or more Candida spp.) were identified. The most common Candida species were C. albicans (60.57%), followed by C. glabrata (17.14%), C. tropicalis (11.42%), C. kefyr (10.83%) and C. krusei (3.42%). Notably, OC caused by multiple Candida strains was more predominant in patients under corticosteroid therapy (P <0.0001), broad-spectrum antibiotics therapy (P = 0.028), and those who used nasal corticosteroid spray (P <0.0001). The majority of patients who recovered from OC at the time of discharge were patients with OC by single Candida species (P = 0.049). Discussion: Use of corticosteroids and antimicrobial therapy in COVID-19 patients increases risk of OC by multiple Candida strains.

Molecular Mapping of Antifungal Mechanisms Accessing Biomaterials and New Agents to Target Oral Candidiasis.

Oral candidiasis has a high rate of development, especially in immunocompromised patients. Immunosuppressive and cytotoxic therapies in hospitalized HIV and cancer patients are known to induce the poor management of adverse reactions, where local and systemic candidiasis become highly resistant to conventional antifungal therapy. The development of oral candidiasis is triggered by several mechanisms that determine oral epithelium imbalances, resulting in poor local defense and a delayed immune system response. As a result, pathogenic fungi colonies disseminate and form resistant biofilms, promoting serious challenges in initiating a proper therapeutic protocol. Hence, this study of the literature aimed to discuss possibilities and new trends through antifungal therapy for buccal drug administration. A large number of studies explored the antifungal activity of new agents or synergic components that may enhance the effect of classic drugs. It was of significant interest to find connections between smart biomaterials and their activity, to find molecular responses and mechanisms that can conquer the multidrug resistance of fungi strains, and to transpose them into a molecular map. Overall, attention is focused on the nanocolloids domain, nanoparticles, nanocomposite synthesis, and the design of polymeric platforms to satisfy sustained antifungal activity and high biocompatibility with the oral mucosa.

Candida Infection Associated with Salivary Gland-A Narrative Review.

Candida species are common global opportunistic pathogens that could repeatedly and chronically cause oral mucosa infection and create an inflammatory environment, leading to organ dysfunction. Oral Candida infections may cause temporary or permanent damage to salivary glands, resulting in the destruction of acinar cells and the formation of scar tissue. Restricted function of the salivary glands leads to discomfort and diseases of the oral mucosa, such as dry mouth and associated infection. This narrative review attempts to summarize the anatomy and function of salivary glands, the associations between Candida and saliva, the effects of Candida infection on salivary glands, and the treatment strategies. Overall, clinicians should proactively manage Candida infections by educating patients on oral hygiene management for vulnerable populations, conducting frequent checks for a timely diagnosis, and providing an effective treatment plan.

Oral candidiasis caused by ciclesonide in a patient with COVID-19 pneumonia: A case report and literature review.

Steroid has recently been reported as a treatment for new coronavirus disease (COVID-19). The incidence of oropharyngeal candidiasis due to the inhaled steroid ciclesonide is lower than that due to other inhaled steroids. We report the first case of oral candidiasis with COVID-19 pneumonia using ciclesonide. A 75-year-old man was hospitalized for COVID-19 pneumonia. After admission, an oral combination of lopinavir/ritonavir was administered, and ciclesonide was inhaled for 7 days. On the 14th day of hospitalization, white plaque was found in his oral mucosa. Candida albicans was identified by oral bacterial tests, and amphotericin B was initiated. On the 35th hospital day, negative result for C. albicans was confirmed. Intraoral monitoring and intervention by dental care workers are considered important for the prevention of infectious complications induced by corticosteroids.

Oral Manifestations of COVID-19 in Hospitalized Patients: A Systematic Review.

BACKGROUND: COVID-19 disease first appeared in 2019 and quickly spread worldwide, causing a global pandemic. The oral cavity represents a target of SARS-CoV-2, and oral lesions are observed in both non-hospitalized and hospitalized patients. This systematic review aims to investigate the frequency of oral manifestations in COVID-19 hospitalized patients. METHODS: An electronic search was conducted in PubMed, Scopus, and Web of Science databases, including articles published up to September 2021. The review protocol was based on PRISMA-P. The risk of bias of the studies was assessed using the Joana Briggs Institute. The certainty of evidence was assessed using the GRADE instrument. RESULTS: Fifty-nine articles were included: 19 case reports, 17 case series, 2 case-control studies, 13 cross-sectional studies, 4 observational studies, and 4 retrospective studies. Oral ulcers, cheilitis, and tongue lesions were more common in patients before hospitalization, while perioral pressure ulcers, macroglossia, blisters, and oral candidiasis were more recurrent in patients during hospitalization. The first could be related directly to COVID-19, while the latter could be caused by medical devices, treatments, prone position, and immunological impairment. CONCLUSIONS: An accurate oral examination during the hospital admission of all confirmed COVID-19 cases is encouraged to recognize oral early manifestations and to apply appropriate treatments.

Mycotic infections - mucormycosis and oral candidiasis associated with Covid-19: a significant and challenging association.

INTRODUCTION: Bacterial and fungal secondary infections following COVID-19 disease are widely being reported and are an area that should receive careful attention. Mucormycosis is a fatal fungal condition affecting immunocompromised patients caused by a group of mold mucoromycetes. Candida albicans (C. albicans) is an oral commensal present in almost 40-65% of healthy oral cavities in adults. Several cases of mucormycosis and oral candidiasis have been reported lately in COVID-19 patients, and it may elevate the associated risks of morbidity and mortality. MATERIALS AND METHODS: Articles were taken from a period of 2020 to April 2021 using search sources such as Cochrane, PubMed, Fungiscope and Mycobank using keywords mucormycosis, Black fungus, oral candidiasis, white fungus, COVID-19, Sars-Cov-2. DISCUSSION: The development of oral mucocutaneous lesions, such as mucormycosis and candidiasis in COVID-19 patients could be due to inhaling spores resulting in pulmonary and/or sinus congestion and prolonged mechanical ventilation in the ICU settings and the long-term use of broad-spectrum antibiotics respectively. The onset of candidiasis after the emergence of COVID-19 clinical signs and symptoms varied considerably and is reported within 1-30 days in most of the cases reported in the literature. Biofilms present on the denture surfaces are predisposing factors to oral candidiasis. We aim to summarize the limited data available regarding diagnosis, clinical presentation, and therapeutic approaches for the management of Mucormycosis and oral candidiasis in COVID-19 patients. CONCLUSION: Careful monitoring of oral lesions should be instituted through interdisciplinary telemedicine and teleconsultation to aid in primary diagnosis, thereby avoiding personal attendance during the pandemic. Dental practitioners should be included among the interdisciplinary teams for exhaustive intraoral examination and reduce the risk of morbidity and mortality.

Prevalence of candidiasis and oral candidiasis in COVID-19 patients: a cross-sectional pilot study from the patients' registry in a large health center.

OBJECTIVE: Candida albicans in considered to be a marker of immunosuppression in serious chronic condition such as HIV and cancer patients on immunosuppresion medications. The new COVID-19 pandemic has caused acute respiratory distress syndrome in many patients, which poses a risk of super-infections including Candida strains causing oral candidiasis as well as invasive fungal infections. The aim of the study was to examine the association between COVID-19 and oral and general candidiasis. METHOD AND MATERIALS: The i2b2 data repository platform was used to analyze the interrelations between COVID-19, oral candidiasis, and total candidiasis in a hospital population. ICD diagnoses codes were used to generate queries on total numbers and demographic data on COVID-19, oral candidasis, total candidasis, and COVID-19 with each form of candidasis. RESULTS: From the 889 patients diagnosed with COVID-19, 106 (12%) were diagnosed with candidiasis at large and 14 (1.6%) had oral candidiasis. The odds ratio (OR) for COVID-19 in the presence of oral candidiasis was 2.01 (95% CI 1.1870 to 3.4143, P = .094) and the OR for COVID-19 in the presence of candidiasis was 3.73 (95% CI 3.0419 to 4.5847, P < .0001 ). African American were disproportionally affected and comprised about 40% of the COVID-19/candidiasis groups. CONCLUSIONS: Total candidiasis was significantly associated with increased risk for COVID-19, whereas oral candidiasis showed an insignificant trend. The dental practitioner should be aware of the importance of unexplained oral and systemic candidiasis as a potential harbinger of T and B cell immunosuppression associated with viral in-fections. COVID-19 may be a risk factor for total candidiasis.

Oral Candidiasis and COVID-19 in Users of Removable Dentures: Is Special Oral Care Needed?

Elderly patients with systemic disorders and immunocompromised patients seem to have a higher risk of developing morbidity from COVID-19. Candida albicans (C. albicans) is a potentially dangerous pathogen for these patients, especially for denture wearers with prosthetic stomatitis who require mechanical ventilation. C. albicans infection, the main candidiasis infection associated with denture wear, can complicate COVID-19 and increase the associated morbidity and mortality. Therefore, early diagnosis of C. albicans infection in COVID-19 patients is important to establish more effective antifungal treatment methods and prophylaxis strategies. Hospitalized COVID-19 patients should undergo an oral examination to assess their oral health, and those with poor oral health should receive the appropriate care and monitoring.

COVID-19-Associated Candidiasis (CAC): An Underestimated Complication in the Absence of Immunological Predispositions?

The recent global pandemic of COVID-19 has predisposed a relatively high number of patients to acute respiratory distress syndrome (ARDS), which carries a risk of developing super-infections. Candida species are major constituents of the human mycobiome and the main cause of invasive fungal infections, with a high mortality rate. Invasive yeast infections (IYIs) are increasingly recognized as s complication of severe COVID-19. Despite the marked immune dysregulation in COVID-19, no prominent defects have been reported in immune cells that are critically required for immunity to Candida. This suggests that relevant clinical factors, including prolonged ICU stays, central venous catheters, and broad-spectrum antibiotic use, may be key factors causing COVID-19 patients to develop IYIs. Although data on the comparative performance of diagnostic tools are often lacking in COVID-19 patients, a combination of serological and molecular techniques may present a promising option for the identification of IYIs. Clinical awareness and screening are needed, as IYIs are difficult to diagnose, particularly in the setting of severe COVID-19. Echinocandins and azoles are the primary antifungal used to treat IYIs, yet the therapeutic failures exerted by multidrug-resistant Candida spp. such as C. auris and C. glabrata call for the development of new antifungal drugs with novel mechanisms of action.

Oropharyngeal candidiasis in hospitalised COVID-19 patients from Iran: Species identification and antifungal susceptibility pattern.

BACKGROUND: Emergence of coronavirus disease 2019 (COVID-19) is a major healthcare threat. Apparently, the novel coronavirus (SARS-CoV-2) is armed by special abilities to spread and dysregulate the immune mechanisms. The likelihood of oropharyngeal candidiasis (OPC) development in COVID-19 patients with a list of attributable risk factors for oral infections has not yet been investigated. OBJECTIVES: We here aim to investigate the prevalence, causative agents and antifungal susceptibility pattern of OPC in Iranian COVID-19 patients. PATIENTS AND METHODS: A total of 53 hospitalised COVID-19 patients with OPC were studied. Relevant clinical data were mined. Strain identification was performed by 21-plex PCR and sequencing of the internal transcribed spacer region (ITS1-5.8S-ITS2). Antifungal susceptibility testing to fluconazole, itraconazole, voriconazole, amphotericin B, caspofungin, micafungin and anidulafungin was performed according to the CLSI broth dilution method. RESULTS: In 53 COVID-19 patients with OPC, cardiovascular diseases (52.83%) and diabetes (37.7%) were the principal underlying conditions. The most common risk factor was lymphopaenia (71%). In total, 65 Candida isolates causing OPC were recovered. C albicans (70.7%) was the most common, followed by C glabrata (10.7%), C dubliniensis (9.2%), C parapsilosis sensu stricto (4.6%), C tropicalis (3%) and Pichia kudriavzevii (=C krusei, 1.5%). Majority of the Candida isolates were susceptible to all three classes of antifungal drugs. CONCLUSION: Our data clarified some concerns regarding the occurrence of OPC in Iranian COVID-19 patients. Further studies should be conducted to design an appropriate prophylaxis programme and improve management of OPC in critically ill COVID-19 patients.

Initial Real-Life Experience from a Designated COVID-19 Centre in Athens, Greece: a Proposed Therapeutic Algorithm.

We report our initial experience with the management of a mixed group of patients with COVID-19 infection, admitted and treated in a designated COVID-19 centre in the Athens Metropolitan area over a 4-week period. The SARS-CoV-2 pandemic presented a huge challenge to the Greek National Healthcare System and healthcare workers. Their response so far has been miraculously effective. Since there are essentially no therapeutic guidelines yet for this disease, we relied mainly on our medical intuition, our empathy for our patients and team work to do the best possible for 49 people with this infection. We present the therapeutic algorithm we gradually developed (on the job) and applied in our patients, based on continuous creative brainstorming and monitoring of the literature.