Epidemiology of candidemia in Shiraz, southern Iran: A prospective multicenter study (2016-2018).

Systematic candidemia studies, especially in southern Iran, are scarce. In the current prospective study, we investigated candidemia in three major healthcare centers of Shiraz, the largest city in southern Iran. Yeast isolates from blood and other sterile body fluids were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and subjected to antifungal susceptibility testing (AFST) using the broth microdilution method. Clinical data were retrieved from patients' medical records. In total, 113 yeast isolates were recovered from 109 patients, over 60% of whom received fluconazole. Antifungal drugs were prescribed without considering species identification or AFST. The all-cause mortality rate was 28%. Almost 30% of the patients were from intensive care units (ICUs). Candida albicans (56/113; 49.5%) was the most prevalent species followed by C. glabrata (26/113; 23%), C. parapsilosis (13/113; 11.5%), C. tropicalis (7/113; 6.2%), and C. dubliniensis (5/113; 4.4%). Only five isolates showed antifungal resistance or decreased susceptibility to fluconazole: one C. orthopsilosis isolate from an azole-naïve patient and two C. glabrata, one C. albicans, and one C. dubliniensis isolates from patients treated with azoles, who developed therapeutic failure against azoles later. Our results revealed a low level of antifungal resistance but a notable rate of azole therapeutic failure among patients with candidemia due to non-albicans Candida species, which threaten the efficacy of fluconazole, the most widely used antifungal in southern regions of Iran. Candidemia studies should not be confined to ICUs and treatment should be administered based on species identification and AFST results.

Landscape of candidemia is blurred in Iran, and only two studies from Tehran have extensively explored the epidemiology of candidemia. However, candidemia data from the other regions are notoriously scarce, which precludes from reaching a consensus regarding species distribution, the burden of antifungal resistance, and the clinical features of infected patients. Therefore, we conducted the current prospective candidemia study in Shiraz, one of the largest cities located in the south of Iran, from April 2016 to April 2018. More than 63% of the candidemia infections were treated by fluconazole and species identification and antifungal susceptibility testing were not used for decision making regarding the choice of antifungal treatment. Approximately 70% of the candidemia cases occurred in the wards outside of the ICUs. Candida albicans, C. glabrata, C. parapsilosis, C. tropicalis, and C. dubliniensis were the five leading causative agents of candidemia. Antifungal resistance was rare and fluconazole resistance and/or non-wild type phenotypes were noticed in five isolates, only one was C. albicans and the rest were non-albicans Candida (NAC) species, including C. glabrata, C. dubliniensis, and C. orthopsilosis. Except for C. orthopsilosis, which was isolated from an azole-naïve patient, the rest of isolates were recovered from patients treated with azoles and all showed therapeutic failure to azoles. Collectively, our data will complete the candidemia picture in Iran and show that, although the level of resistance was rare, the therapeutic failure was notable among NAC species, which threatens the efficacy of fluconazole, the most widely used antifungal in Southern regions of Iran. Moreover, we showed that candidemia is poorly managed in Iran since species identification tools along with antifungal susceptibility testing were not used to select appropriate antifungal treatment.

Chemical composition and antifungal activities of aromatic water of Zataria multiflora Boiss.

Background and Purpose: In Iranian culture, aromatic waters harboring a slight amount of essential oil have been popularly used for many years as a pleasant non-alcoholic drink with various medicinal properties.In this study, chemical composition of Zataria multiflora Boiss. (ZM) aromatic water was determined and its in vitro and in vivo antifungal properties were investigated. Materials and Methods: Chemical composition of the essential oil extracted from aromatic water (AW) of ZM was analyzed by Gas chromatography and gas chromatography-mass spectrometry (GC-MS). The antimicrobial activity of the AW against Candida species was determined by broth micro-dilution methods. Additionally, biofilm formation inhibition and antioxidant activity of the AW were measured using XTT reduction and DPPH methods, respectively. Antifungal activities of the AW in the prevention and/or treatment of gastrointestinal (GI) candidiasis in animal models were also evaluated. Results: The GC-MS analysis revealed that the major constituents of ZM AW were Carvacrol (46.56%) and Thymol (40.67%). The ZM AW inhibited the growth and biofilm formation of Candida species in the range of 0.25-0.5 V/V. Moreover, ZM AW significantly decreased Candida colonization in therapeutic groups (P<0.05). Conclusion: Given the wide therapeutic potential of ZM AW, including antifungal and antioxidant activities, it might be possible to use it in the management of mucocutaneous or alimentary candidiasis.

Susceptibility of Candida albicans and Candida dubliniensis to Photodynamic Therapy Using Four Dyes as the Photosensitizer.

STATEMENT OF THE PROBLEM: Oral candidiasis is the most common opportunistic infection affecting the human oral cavity. Photodynamic therapy, as one of its proposed treatment modalities, needs a distinct dye for achieving the best effect. PURPOSE: The purpose of this study was to evaluate photosensitization effects of four distinct dyes on standard suspension of Candida albicans (C. albicans) and Candida dubliniensis (C. dubliniensis) and biofilm of C. albicans considering the obtained optimum dye concentration and duration of laser irradiation. MATERIALS AND METHOD: In this in vitro study, colony forming units (CFU) of two sets of four groups of Laser plus Dye (L+D+), Dye (L-D+), Laser (L+D-) and No Laser, No Dye (L-D-) were assessed individually with different methylene blue concentrations and laser irradiation period. The photodynamic therapy effect on standard suspension of Candida species (using methylene blue, aniline blue, malachite green and crystal violet) were studied based on the obtained results. Similar investigation was performed on biofilm of C. albicans using the spectral absorbance. Data were imported to SPSS and assessed by statistical tests of analysis of variance (ANOVA) and Tukey test (α= 0.05). RESULTS: CFU among the different dye concentration and irradiation time decrease in dose- and time-dependent manner (p> 0.05), all of which were significantly lower than the control groups (p< 0.05). Among the examined photosensitizers, there was no statistically significant difference, (p> 0.05) though all of them were significantly decrease CFU compared with the control groups (p< 0.05). In L+D- and L+D+ groups, biofilm was significantly destroyed more than that of L-D- (p< 0.05). CONCLUSION: Photodynamic therapy might be used as an effective procedure to treat Candida associated mucocutaneous diseases and killing biofilm in the infected surfaces such as dentures.