ORIGINAL_ARTICLE
Epidemiological characterization of dermatophytes at a tertiary care hospital in Eastern Uttar Pradesh, India
Background and Purpose: Superficial mycosis is more prevalent in tropical and subtropical countries, such as India. Regarding this, the present study was conducted to determine the epidemiology of superficial mycosis and identify the most common dermatophytic species in this region. Materials and Methods: For the purpose of the study, a total of 220 skin scraping, nail, and hair root specimens were collected. Direct microscopic examination was performed using potassium hydroxide mount. Additionally, the samples were inoculated onto Sabouraud dextrose agar (SDA) and dermatophyte test medium (DTM). The fungal colony of each isolates was stained with lactophenol cotton blue mount, and observed under microscope for species identification. Results: Out of 220 isolates, 172 samples, obtained from 108 males 64 females, were positive for skin fungal infections by either KOH mount or culture. Furthermore, 113 isolates were identified as dermatophytes, while 59 samples were found to be non-dermatophytes. Among the dermatophytes isolated from different clinical samples, Trichophyton verrucosum (42/113, 38%) was the most common species, and Tinea corporis was the most common infection (36.2%). Conclusion: As the findings indicated, dermatophytes had an isolation rate of 78%, which is higher than normal. This can be due to the fact that the majority of the patients were from a rural background (71.7%) with a low socioeconomic status and poor personal hygiene who were exposed to climatic changes.
https://cmm.mazums.ac.ir/article_90403_6d6ed52954f53b39b4447befc40b0e50.pdf
2019-03-01
1
6
10.18502/cmm.5.1.530
dermatophytes
Trichophyton verrucosum
Lactophenol cotton blue (LCB)
Sabouraud’s dextrose agar medium
Tinea corporis
Vandana
Upadhyay
dr.vandana027@gmail.com
1
Department of Microbiology, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India
AUTHOR
Ankur
Kumar
a2kankur@gmail.com
2
Department of Microbiology, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India
LEAD_AUTHOR
Amresh K
Singh
amresh.sgpgi@gmail.com
3
Department of Microbiology, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India
AUTHOR
Jayesh
Pandey
jayeshquxitic@gmail.com
4
Department of Microbiology, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India
AUTHOR
ORIGINAL_ARTICLE
Detection of ERG11 point mutations in iranian fluconazole-resistant Candida albicans isolates
Background and Purpose: Candidiasis is referred to a group of superficial and deep-tissue fungal infections often caused by Candida albicans. The superficial infections affect the oral, oropharynx, esophagus, and vaginal mucosa. The treatment of choice for these infections is the use of azoles, such as fluconazole. However, the increased use of these antifungal agents has led to the emergence of azole-resistant isolates of C. albicans. Different mechanisms have been suggested for the development of drug resistance, such as mutations in the encoding gene ERG11. Mutations in ERG11 result in changes in the ERG11p spatial construction and reduce the affinity between the protein and azole. This study aimed to determine the susceptibility profile of C. albicans clinical isolates to fluconazole using microdilution method. The present research was also targeted toward the detection of mutations that might be related to fluconazole resistance by the amplification and sequencing of ERG11 gene. Materials and Methods: This study was conducted on a total of 216 clinical isolates obtained from Mashhad, Isfahan, and Tehran cities in Iran, during 2016-2018. The clinical isolates were identified using molecular techniques. Furthermore, minimum inhibitory concentration (MICs) was determined according to the clinical and laboratory standards institute M27-A3 and M27-S4 documents. The concentration range for fluconazole was obtained as 0.063-64 μg/ml. In the resistant strains, ERG11 genes were amplified by specific primers. Subsequently, cycle sequencing reactions were performed on purified polymerase chain reaction (PCR) products in forward and reverse directions. Finally, the results were analyzed by MEGA (version 7) and Gene Runner software (version 6.5.30). Results: Out of 216 strains, 100 (46.3%) species were identified as C. albicans. The MIC values for fluconazole had a range of 0.125-16 μg/ml with the MIC50 and MIC90 values of 0.5 and 1 μg/ml, respectively. Totally, 41 nucleotide changes were detected among 4 resistant isolates. In this regard, 4 out of 41 mutations in codons caused changes in ERG11p; however, these mutations did not lead to fluconazole resistance. Conclusion: Fluconazole resistance among clinical isolates is not merely due to the changes in ERG11p. This resistance may be also related to some other mechanisms, such as the prevention of the intracellular accumulation of the antifungal agent and alteration of the target enzyme to diminish drug binding.
https://cmm.mazums.ac.ir/article_90404_57777a2595f8cd21cebc7f0908fedb30.pdf
2019-03-01
7
14
10.18502/cmm.5.1.531
candida albicans
ERG11 gene
Fluconazole
Minimum inhibitory concentration
Ali
Sardari
a.sardary@yahoo.com
1
Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
AUTHOR
Hossein
Zarrinfar
zarrinfarh@mums.ac.ir
2
Department of Parasitology and Mycology, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Rasoul
Mohammadi
dr.rasoul_mohammadi@yahoo.com
3
Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
LEAD_AUTHOR
ORIGINAL_ARTICLE
Clinico-mycological profile of tinea capitis and its comparative response to griseofulvin versus terbinafine
Background and Purpose: Tinea capitis is the most common superficial mycosis in children. This disease is a contagious infection with worldwide distribution and is occasionally associated with permanent alopecia. The treatment of this infection usually requires the administration of appropriate oral antifungal agents. The current study was conducted to evaluate the clinico-mycological profile of tinea capitis and compare the efficiency of oral griseofulvin and terbinafine in the treatment of this disease. Materials and Methods: This study was conducted on 69 patients, including 23 females (33.3%) and 46 males (66.7%), clinically suspected of tinea capitis. After the confirmation of tinea capitis diagnosis through direct examination, the subjects were randomly assigned into two groups of griseofulvin and terbinafine. Demographic data, clinical and mycological characteristics, and therapeutic outcome were recorded for both groups. Results: According to the results, tinea capitis was more common in children younger than 15 years (73.9%), athletes (37.7%), and males (66.7%), and those with frontal involvement (34.8%), non-inflammatory type (68.1%), endothrix (69.6%), and Trichophyton tonsurans species (41.7%). The griseofulvin and terbinafine groups had the treatment success rates of 90.9% and 80.6%, respectively (P=0.311). The griseofulvin group had a shorter therapeutic course than the terbinafine group (P=0.129). Conclusion: Although our findings demonstrated that both griseofulvin and terbinafine were effective in the treatment of tinea capitis, griseofulvin showed a little higher efficacy in this regard. Consideration of some variables, such as age, associated risk factors, clinical type, hair involvement pattern, and dominant pathogenic species, is important in the determination of the drugs.
https://cmm.mazums.ac.ir/article_90405_f5150fa9fcfbdf55719781a54aba09ed.pdf
2019-03-01
15
20
10.18502/cmm.5.1.532
Dermatophyte
Ectothrix
Endothrix
Griseofulvin
Terbinafine
Tinea capitis
Ali
Mikaeili
hkawosi@kums.ac.ir
1
Kermanshah University of Medical Sciences (KUMS)
AUTHOR
Hossein
Kavoussi
dramikaeili@kums.ac.ir
2
Kermanshah University of Medical Sciences (KUMS)
LEAD_AUTHOR
Amir Hosein
Hashemian
dr.ahashemian@kums.ac.ir
3
Kermanshah University of Medical Sciences (KUMS)
AUTHOR
Mahdokht
Shabandoost Gheshtemi
shabandoostmahdokht@gmail.com
4
Kermanshah University of Medical Sciences (KUMS)
AUTHOR
Reza
Kavoussi
kavoussi_1387@yahool.com
5
Kermanshah University of Medical Sciences (KUMS)
AUTHOR
ORIGINAL_ARTICLE
Molecular identification and antifungal susceptibility pattern of Candida species isolated form HIV infected patients with candidiasis
Background and Purpose: Opportunistic fungal infections have been on a growing trend since the last two decades. Among the opportunistic fungal agents, Candida species, Cryptococcus neoformans, and Aspergillus fumigatus account for most of the life-threatening infections in immunocompromised individuals. Regarding this, the present study aimed to investigate the molecular identification and antifungal susceptibility pattern of Candida species isolated from HIV-infected patients. Materials and Methods: This study was conducted on 80 clinical samples collected from HIV-infected patients with suspected candidiasis referring to Tagore Medical College and Hospital, Rathinamangalam and Government Hospital of Thoracic Medicine, in Chennai, India, for 18 months (i.e., May 2016-December 2017). Phenotypic and molecular identification was accomplished using internal transcribed spacer region 1 (ITS1) and ITS4 primers. The antifungal susceptibility pattern of the isolates against four antifungal agents was also determined by both disk diffusion and broth dilution methods. Results: In the present study, the prevalence of candidiasis was obtained as 75% (n=60). Candida tropicalis was the predominant identified species. All the emerging species (i.e., Kodamaea ohmeri, Hanseniaspora opuntiae, and C. orthopsilosis) were identified through molecular identification since the phenotypic identification was inconclusive. In terms of the susceptibility pattern, 63.3% and 18.3% of the isolates were resistant to fluconazole and voriconazole, respectively. Candida albicans was also found to be resistant to amphotericin B. Conclusion: Molecular assay led to the identification of K. ohmeri, H. opuntiae, and C. orthopsilosis, which were multidrug-resistant. This study highlighted the need for the prompt and timely identification of clinical yeast isolates given the emergence of many rare species and their capability of causing life-threatening infections and outbreaks. In the laboratories where molecular diagnostic methods are not available, alternative services of reference laboratories can be utilized as cost-effective measures. With regard to the growing prevalence of antifungal drug resistance, antifungal susceptibility testing should be made mandatory for effective patient management.
https://cmm.mazums.ac.ir/article_90406_3d4bd97d96ed9b9040a8f1de0bc95e2a.pdf
2019-03-01
21
26
10.18502/cmm.5.1.533
Antifungal agents
Antifungal Resistance
Antifungal Susceptibility testing
Candida species
Candidiasis
Molecular identification
Sony
Paul
sonymarypaul@tagoremch.com
1
Tagore Medical College
LEAD_AUTHOR
I
Kannan
dr.ikannan@tagoremch.com
2
Tagore Medical College
AUTHOR
ORIGINAL_ARTICLE
Disseminated fusariosis with ecthyma gangrenosum-like lesions in a refractory acute myeloid leukemia patient
Background and Purpose: Fusarium species is an opportunistic mold that causes disseminated infections in immunocompromised patients. Given the high mortality rate of this infection, it is important to make a definite diagnosis when encountering suspected cases. Case report: Herein, we presented a 35-year-old man diagnosed with acute myeloid leukemia with a prolonged febrile neutropenic period and ecthyma gangrenosum-like lesions, along with fungemia and disseminated fusariosis. The patient died despite receiving combination therapy, perhaps due to the nonrecovery of neutrophil. Conclusion: Ecthyma gangrenosum-like lesions due to disseminated fusariosis might be easily misdiagnosed. Consequently, more attention should be paid to the cutaneous lesions in immunocompromised patients.
https://cmm.mazums.ac.ir/article_90407_717d4d2ba4d719da6aeac56b0b11cf56.pdf
2019-03-01
27
31
10.18502/cmm.5.1.534
Disseminated fusariosis
Ecthyma gangrenosum-like lesions
Fungemia
Masoud
Mardani
drmasoudmardani@yahoo.com
1
Infectious diseases and tropical medicine research center , Shahid Beheshti university of medical sciences,Tehran, Iran
AUTHOR
Rozita
Khodashahi
rkhodashahi@yahoo.com
2
Infectious diseases and tropical medicine research center , Shahid Beheshti university of medical sciences,Tehran, Iran
AUTHOR
Ensieh
Lotfali
ensiehlotfali@sbmu.ac.ir
3
Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
AUTHOR
Sara
Abolghasemi
saraabolghasemi1@gmail.com
4
Infectious diseases and tropical medicine research center , Shahid Beheshti university of medical sciences ,Tehran, Iran
LEAD_AUTHOR
Mojdeh
Hakemi-Vala
mojdeh_hakemi@yahoo.com
5
Department of microbiology, Medical school,Shahid Beheshti university of medical sciences , Tehran, Iran
AUTHOR
ORIGINAL_ARTICLE
Candidemia due to Candida guilliermondii in an immunocompromised infant: a case report and review of literature
Background and Purpose: Candidemia is a life-threatening fungal infection with significant mortality and morbidity in neutropenic individuals, immunosuppressive chemotherapy recipients, and broad-spectrum antibiotics consumers. The epidemiology and antifungal susceptibility testing of non-albicans Candida species have been poorly studied. These species are characterized by low susceptibility to azoles and echinocandins. Herein, we report the first pediatric case of candidemia due to C. guilliermondii in Iran and review the literature on fungemia caused by C. guilliermondii. Case report: We presented the first candidemia case due to Candida guilliermondii in a 4-month-old male infant with neuroblastoma in Iran. This study also involves a comprehensive literature review on fungemia caused by C. guilliermondii during a period of 18 years (i.e., 2000-2018) to discuss the epidemiology, clinical features, and treatment of this disease. The literature review resulted in the identification of 501 cases of candidemia caused by C. guilliermondii. Most of the patients were adults and had multiple risk factors. However, the main risk factors were significantly related to cancer chemotherapy, followed by central venous catheter use and Intensive Care Unit admission. Mortality rate due to this disease had a range of 3.4-66.6%; in this regard, the patients with cancer had the highest mortality rate. Conclusion: Given the high mortality of candidemia, the early diagnosis of this infection and timely initiation of antifungal therapy significantly improve the patients’ survival rate and result in better outcomes. Consequently, it is highly recommended to monitor the local epidemiology of this life-threatening infection and raise awareness in this regard.
https://cmm.mazums.ac.ir/article_90408_88ca525d30c3cf42574cabb53374ed7e.pdf
2019-03-01
32
36
10.18502/cmm.5.1.535
Candida guilliermondii
Candidemia
cancer
Pediatric
Fatemeh
Ahangarkani
fkani63@gmail.com
1
Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
AUTHOR
Hamid
Badali
badalii@yahoo.com
2
Department of Medical Mycology, Invasive Fungi Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
AUTHOR
Mohammad Sadegh
Rezai
drmsrezaii@yahoo.com
3
Pediatric Infectious Diseases Research Center, Mazandaran University of Medical Sciences, Sari, Iran
AUTHOR
Tahereh
Shokohi
shokohi.tahereh@gmail.com
4
Department of Medical Mycology, Invasive Fungi Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
AUTHOR
Zahra
Abtahian
abtahiann@yahoo.com
5
Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
AUTHOR
Hasan
Mahmoodi
mahmoodi86@yahoo.com
6
Babol University of Medical Sciences, Babol, Iran
AUTHOR
Hossein
Karami
karami.oncology@yahoo.com
7
Pediatric Infectious Diseases Research Center, Mazandaran University of Medical Sciences, Sari, Iran
AUTHOR
Emmanuel
Roilides
roilides@gmail.com
8
Thalassemia Research Center, Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
AUTHOR
Ahmad
Tamadoni
tamadoni.oncology@gmail.com
9
Babol University of Medical Sciences, Babol, Iran
LEAD_AUTHOR
ORIGINAL_ARTICLE
Fatal Rhinocerebral mucormycosis in a patient with ulcerative colitis receiving azathioprine and corticosteroid
Background and Purpose: Rhinocerebral mucormycosis is a rare fatal fungal infection which is on a growing trend, particularly among immunocompromised patients. Immunosuppressive drugs, including corticosteroids and antimetabolites, increase the risk of this infection. Herein, we reported the case of fulminant rhinocerebral mucormycosis in a patient with ulcerative colitis receiving azathioprine and corticosteroid. Case report: A 58-year-old woman was admitted to the hospital in a state of coma with an extensive necrosis in her nose. She was afflicted with intestinal bleeding after 1 month of fasting and was treated with azathioprine and a high dose of prednisolone for ulcerative colitis 2 months prior to hospital admission. The direct microscopic examination of the necrotic tissues of the paranasal sinuses showed several non-septate hyphae consistent with Mucorales. Culture media yielded Rhizopus species, which was identified as Rhizopus oryzae by internal transcribed spacer polymerase chain reaction sequencing. Despite the implementation of surgical and pharmaceutical (liposomal amphotericin B) treatments, the patient expired after 2 weeks of admission. Conclusion: The gastroenterologists should be aware of the adverse effect of immunosuppressive drugs they prescribe for the treatment of inflammatory bowel disease.
https://cmm.mazums.ac.ir/article_90409_634aeb2abebd4c05067cb2ebb8790eb8.pdf
2019-03-01
37
41
10.18502/cmm.5.1.536
Azathioprine
corticosteroid
Inflammatory bowel disease
Mucormycosis
Rhinocerebral
Ulcerative colitis
Narges
Najafi
1
Department of Infectious Diseases, andAntimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Sari, Iran
AUTHOR
Firoozeh
Kermani
kermani.f94@gmail.com
2
Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
AUTHOR
Nahid
Gholinejad Ghadi
3
Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
AUTHOR
Seyed Reza
Aghili
aghili70@yahoo.com
4
Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
AUTHOR
Zahra
Seifi
zhrseifi@gmail.com
5
Department of Infectious Diseases, andAntimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Sari, Iran
AUTHOR
Emmanuel
Roilides
roilides@gmail.com
6
3rd Department of Pediatrics, Infectious Diseases Section, Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
AUTHOR
Tahereh
shokohi
shokohi.tahereh@gmail.com
7
Invasive Fungi Research Centre (IFRC), Mazandaran University of Medical Sciences, Sari, Iran.
LEAD_AUTHOR
ORIGINAL_ARTICLE
A review on hypersensitivity reactions to fungal aeroallergens in patients with allergic disorders in Iran
Fungal agents account for the clinical manifestation of allergic disorders. The aim of the present study was to review the prevalence of hypersensitivity reactions to fungal aeroallergens in patients with allergic disorders, including allergic rhinitis, asthma, urticaria, and eczema, in Iran. The initial literature search resulted in the identification of 50 records, 26 cases of which met the inclusion criteria. Regarding the methods adopted for the detection of fungal allergens, serum-specific IgE and skin prick tests were used in 6 and 20 studies, respectively. Aspergillus fumigatus and Alternaria alternata sensitization was the most common allergic sensitization among the patients with allergic disorders. According to the reviewed studies, despite the humid climate of the north of Iran, fungal sensitization has a prevalence range of 5-70% in this region. In other regions, such as central and southern Iran, which have a dry and warm climate, fungal sensitization reportedly has a prevalence range of 5-65%. The prevalence of fungal sensitizations varies in different allergic disorders due to the factors related to geographic and genetic issues, gender, sample size, test operator, and assessment method.
https://cmm.mazums.ac.ir/article_90410_2bea85bbe034bf7bd72c76a8517cfe53.pdf
2019-03-01
42
47
10.18502/cmm.5.1.537
Allergic Rhinitis
Asthma
Atopic Dermatitis
Fungus
Mold
Urticaria
zeinab
Nazari
zinabnazari@yahoo.com
1
Department of Gynecology, Mazandaran University of Medical Sciences, Sari, Iran
AUTHOR
javad
Ghaffari
javadneg@yahoo.com
2
Pediatric Infecious Diseases Research Center, Mazandaran University of Medical Sciences, Sari, Iran
LEAD_AUTHOR
negar
ghaffari
negarghaffari96@gmail.com
3
Mazandaran University of Medical Sciences, Sari, Iran
AUTHOR
Fatemeh
Ahangarkani
fkani63@gmail.com
4
Invasive Fungi Research Center, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
AUTHOR