First report of Vulvovaginitis due to Cryptococcus magnus in Iran.

BACKGROUND AND PURPOSE: Cryptococcus. magnus is a non-Cryptococcus neoformans species isolated from certain plants, soil, air, and arctic glaciers. CASE REPORT: This report describes a case of a 23-year-old Iranian female with pruritus and vaginal irritation. Conventional tests and molecular analysis of the samples of vaginal discharge were performed. The mentioned analyses revealed Cryptococcus magnus as the causative agent of vaginal infection. The minimum inhibitory concentration analysis revealed that this species is susceptible to itraconazole, fluconazole, ketoconazole, and amphotericin B. The patient received 200 mg of oral ketoconazole once daily for 10 days. The patient did not show any clinical signs of vaginal infection after six months. CONCLUSION: C. magnus was found to have the ability to cause vulvovaginitis. This is the first report of successful detection and treatment of vulvovaginal infection with C. magnus.

Candidemia in Febrile Neutropenic Patients; a Brief Report.

INTRODUCTION: Febrile neutropenic patients are at risk of serious infections. The aim of the present study is to identify the frequency, species, and susceptibility patterns of candidemia in febrile neutropenic patients. METHODS: This cross-sectional study was conducted on febrile neutropenic patients suspected with candidemia who had been referred to 3 educational hospitals during 9 months. RESULTS: The blood samples of 80 febrile neutropenic patients with the mean age of 48±16.6 years were studied (60% female). Five (6.25%) episodes of candidemia were identified. The underlying disease was acute myeloid leukemia in 4 (80%) cases and all 5(100%) cases had central venous catheter and were receiving prophylactic ciprofloxacin and acyclovir. 100% of isolates were found to be susceptible to Voriconazole, 80% to Caspofungin, 60% to Amphotericin B, and 40% to Fluconazole. CONCLUSION: The frequency of candidemia among the studied febrile neutropenia patients was 6.25%, with 80% mortality rate, and the most frequently identified yeast was Candida albicans (100% susceptible to Voriconazole).

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. Method: 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.

Antifungal Susceptibility Analysis of Clinical Isolates of Candida parapsilosis in Iran.

BACKGROUND: Candida parapsilosis is an emergent agent of invasive fungal infections. This yeast is one of the five most widespread yeasts concerned in invasive candidiasis. C. parapsilosis stands out as the second most common yeast species isolated from patients with bloodstream infections especially in neonates with catheter. Recently several reports suggested that its reduced susceptibility to azoles and polyene might become a cause for clinical concern, although C. parapsilosis is not believed to be intensely prone to the development of antifungal resistance. METHODS: In the present report, One hundred and twenty clinical isolates of C. parapsilosis complex were identified and differentiated by using PCR-RFLP analysis. The isolates were then analyzed to determine their susceptibility profile to fluconazole (FLU), itraconazole (ITC) and amphotericin B. The minimum inhibitory concentration (MIC) results were analyzed according to the standard CLSI guide. RESULTS: All of isolates were identified as C. parapsilosis. No C. metapsilosis and C. orthopsilosis strains were found. Evaluation of the antifungal susceptibility profile showed that only three (2.5%) C. parapsilosis were resistant to fluconazole, three (2.5%) C. parapsilosis were resistant to itraconazole and two (1.7%) C. parapsilosis were amphotericin B resistant. CONCLUSION: Profiles in clinical isolates of C. parapsilosis can provide important information for the control of antifungal resistance as well as distribution and susceptibility profiles in populations.

Fungal Airborne Contamination as a Serious Threat for Respiratory Infection in the Hematology Ward.

BACKGROUND: Fungi existing in hospital departments may grow and produce micro-colonies. The spores arising from these micro-colonies circulate easily and could be inhaled by patients and cause infections in immune-compromised subjects. Due to the lack of an acceptable method of sampling and evaluation of microbiological quality of air in the isolation units, the purpose of this study was to determine the concentrations of airborne fungi through active and passive sampling and also identify fungi genera in the air of the isolation unit. MATERIALS AND METHODS: The air of the isolation unit was monitored through active and passive sampling. In passive sampling, the plates were placed in the room. The active sampling was performed in the hematology unit by using a slit-to-agar biological air sampler with a flow rate of 10 L/minute. Plates were incubated at 30°C for 10 days and were examined daily for fungal growth. Fungal species were identified on the basis of their macroscopic and microscopic morphological features. RESULTS: In active samples, Penicillium spp. was the predominant genus (66.8%), followed by Aspergillus spp. (23.9%) and Cladosporium spp. (2.5%). Yeast spp. accounted for only 2.2% of the isolated fungi. In passive samples, Penicillium spp. (94.4%) was the most frequently found fungi, followed by Aspergillus spp (2.2%), Cladosporium spp. (1.1%) and Yeast spp. (0.5%). The identified genera included Penicillium, Aspergillus, Alternaria, Mucorales, Cladosporium, Yeasts and other filamentous fungi. CONCLUSION: Active and passive sampling can be used for monitoring the fungal content of air. Assessment of fungal contamination profiles in hospitals may provide important information about the level of fungal concentration in the hospitals and for the control of nosocomial infections. In addition, installation of special ventilation systems equipped with HEPA filters in hematology wards could enhance the quality of air. Also, observing sanitary protocols for disinfection of the surfaces is imperative for infection control.

In vitro antifungal activities of Allium cepa, Allium sativum and ketoconazole against some pathogenic yeasts and dermatophytes.

By using an agar dilution assay, the antifungal activity of aqueous extracts prepared from Allium cepa (onion; AOE) and Allium sativum (garlic; AGE) were evaluated against Malassezia furfur (25 strains), Candida albicans (18 strains), other Candida sp. (12 strains) as well as 35 strains of various dermatophyte species and compared with the activity of a known antifungal drug, ketoconazole (KTZ). All the AOE, AGE and KTZ were found to be able to inhibit growth of all fungi tested in a dose-dependent manner with maximum of 100% at defined concentrations. The results indicate that onion and garlic might be promising in treatment of fungal-associated diseases from important pathogenic genera Candida, Malassezia and the dermatophytes.