https://cmm.mazums.ac.ir/ Current Medical Mycology en daily 1 Sun, 01 Feb 2026 00:00:00 +0330 Sun, 01 Feb 2026 00:00:00 +0330 https://cmm.mazums.ac.ir/article_150762.html Background and Purpose: Although the distribution of Candida species has shifted over the past three decades, Candida albicans remains the leading cause of nosocomial bloodstream infections.Materials and Methods: This study examined the genetic diversity and antifungal susceptibility of 174 independent C. albicans bloodstream isolates obtained from intensive care unit patients in Turkey. Microsatellite analysis across five loci identified 21 allelic genotypes for elongation factor 3 (CEF3), 12 for carbonic anhydrase III (CAIII), 11 for LOC4, 11 for zinc finger transcription factor-1 (ZNF1), and 9 for killer toxin-resistance protein-6 (KRE6). The multiplex analysis yielded 104 different multi-loci allelic combinations for the 174 strains analyzed, resulting in a discriminatory power of 0.98.Results: Locus-by-locus microsatellite analysis revealed that certain C. albicans strains from the intensive care unit shared identical genotypes. The geometric mean minimum inhibitory concentrations of antifungal agents, in ascending order, were 0.02 mg/L for itraconazole, voriconazole, and posaconazole, 0.03 mg/L for anidulafungin, 0.13 mg/L for caspofungin, 0.20 mg/L for flucytosine, 0.62 mg/L for fluconazole, and 0.67 mg/L for amphotericin B.Conclusion: Our study showed considerable genetic diversity among bloodstream C. albicans isolates, while antifungal resistance remained uncommon. No significant association was observed between antifungal susceptibility and the genotypes analyzed. The presence of identical genotypes among certain strains points to an endogenous origin and a potential common source of infection within the hospital, warranting further investigation.    https://cmm.mazums.ac.ir/article_150769.html Objectives:Invasive fungal infections (IFIs) are the second leading cause of infection in hematopoietic stem cell transplant (HSCT) recipients. Although knowledge of the local epidemiology of breakthrough IFIs should be considered in terms of guiding organizational effective antifungal prophylaxis strategy, however, institutional approach for ongoing surveillance of the rates and epidemiology of IFIs in high-risk patients like HSCT has been less appreciated. Therefore, this study was aimed to investigate the prevalence, risk factors, and outcome of IFIs in HSCT patients. Method:A prospective study was carried out between March 2021 and March 2022 in HSCT wards of an educational – medical hospital of Tehran University of Medical Sciences to rate the incidence of IFIs. All HSCT recipients were enrolled except those who had incomplete files, had a history of previous corticosteroids receipt for rheumatologic or immunologic disorders, or did not consent. Upon suspicion of IFIs, the appropriate sample was collected for mycological assay. Those with proven/ probable IFIs according to the consensus criteria defined by EORTC/MSG were only counted for evaluation the prevalence, risk factor and outcome of the IFIs. Results:A total of 330 HSCT recipients were enrolled. The prevalence of IFIs was 9.6 %, with aspergillosis as the most frequent one being observed in 97 % of the cases. Pulmonary involvement was the most frequent clinical presentation (78.1 %). Most of IFIs were developed before engraftment (90.6%). CMV infection and acute myeloid leukemia (AML) significantly raised the odds ratio of IFIs development (odds ratios of 1.07 and 12.6; p-values of 0.002 and < 0.001, respectively). The mortality rate was 12.5 %. CMV infection, lower age and HLA-mismatch related donor were factors significantly associated with fatality of IFIs (odds ratios of 15.5, 1.07 and 10.70; p-values of 0.005, 0.002 and 0.016 respectively).Conclusion: IFIs were found to be relatively common complication of allogenic HSCT and continue to be associated with poor prognosis. CMV infection can be independently associated with IFIs and unfavorable outcomes, while HSCT HLA mismatch donors increase the risk of unfavorable outcomes. As a result, tailoring antifungal prophylaxis in these group of high risk hosts is crucial. https://cmm.mazums.ac.ir/article_150755.html Background and Purpose: Candidiasis is a common fungal infection, with increasing cases caused by resistant non-albicans species, such as Candida krusei and Candida glabrata. These species present remarkable clinical treatment challenges due to their resistance, particularly with azole antifungals, like fluconazole (FLZ). This study aimed to evaluate the antifungal potential of thyme (Thymus vulgaris) essential oil nanoemulsion (TEONE) against these resistant Candida strains, focusing on its impact on resistance gene expression and the enhancement of conventional treatment efficacy. Materials and Methods: TEONE was formulated by combining thyme EO with Tween 80 and water using the antisolvent precipitation method to create a stable nanoemulsion. The TEON was characterized by using Scanning Electron Microscopy for morphology, dynamic light scattering for particle size, and zeta potential for stability and surface charge assessment. The antifungal activity of TEONE, Thyme EO, and FLZ was assessed against Candida strains using disk diffusion, microdilution, and checkerboard assays. The quantitative reverse transcription polymerase chain reaction was employed to evaluate the expression of resistance genes (ABC1, CDR1, and ERG11) following treatment. Results: The Scanning Electron Microscopy revealed a predominantly spherical morphology with minimal rod-shaped particles, while Dynamic Light Scattering confirmed a mean droplet size of 134.3 nm and a polydispersity index of 0.402, indicating good dispersion. Zeta potential analysis showed a value of -78.6 mV, suggesting strong stability of nanoemulsion. The TEONE demonstrated significant antifungal activity, reducing minimum inhibitory concentration values by up to 50%, compared to Thyme EO (p<0.05). Disk diffusion tests showed larger inhibition zones for TEONE (20-25 mm), compared to Thyme EO (15-18 mm) (p<0.01). The quantitative reverse transcription polymerase chain reaction revealed that TEONE reduced CgCDR1 expression by up to 49% in Candida glabrata and downregulated ERG11 and ABC1 in Candida krusei (p<0.05). Conclusion: While FLZ alone tended to increase resistance gene expression, combining TEONE with FLZ mitigated this effect and enhanced antifungal efficacy, indicating an additive interaction. TEONE represents a promising natural approach for enhancing antifungal treatment strategies against resistant Candida infections, offering potential benefits as an alternative or complementary therapy to conventional antifungal agents. These nanoemulsions may also allow for a reduction in the dosage of traditional drugs such as FLZ, potentially minimizing side effects and the development of resistance.   https://cmm.mazums.ac.ir/article_150770.html Background and Purpose: The optimal cut-off level for serum Aspergillus-specific IgG (SAfIgG) in the diagnosis of chronic pulmonary aspergillosis (CPA) remains to be established for different countries. This study aimed to establish a cut-off level for SAfIgG in CPA diagnosis and validate its diagnostic accuracy in the Iranian population. Materials and Methods: Diagnostic performance of SAfIgG was evaluated in patients with chronic obstructive pulmonary disease (COPD) suspected of having CPA who had referred to the two reference centers for pulmonary diseases in Iran, during 2021-2023. Levels of SAfIgG were measured using an enzyme-linked immunosorbent assay. Optimal cut-off point for SAfIgG was determined using the receiver operating characteristics (ROC) curve and Youden's index and was subsequently validated. Results: In total, 30 (15.3%) out of 196 COPD patients were diagnosed with CPA. The ROC curve analysis yielded an area under the curve of 0.632 (95% CI: 0.421-0.843; p=0.114), with an optimal cut-off value of 23.5 U (sensitivity: 71.4%; specificity: 61.4%). The SAfIgG levels were significantly higher in CPA patients (median [IQR], 39 [31-55] U) compared with non-CPA patients (20 [15-24] U; p<0.001). Conclusion: The findings indicated that SAfIgG, with a cut-off value of 23.5 U, provided moderate sensitivity and specificity for screening and may be used in combination with the culture method to confirm the diagnosis of CPA in COPD patients. However, the variability in cut-off values across different populations highlights the need for standardized guidelines to improve diagnostic consistency and reliability. https://cmm.mazums.ac.ir/article_150772.html Background and Purpose: Cryptococcus neoformans is an important opportunistic fungus that causes severe infections, including cryptococcal meningitis, especially in immunocompromised patients. One of its key characteristics is the ability to produce melanin from melanin precursors. This pigmentation serves as a useful marker to distinguish fungus colonies from other yeasts when grown on selective media, such as bird seed agar (BSA). However, the complicated preparation of medium and high cost of commercial BSA restrict its routine application. This study aimed to present and assess a new culture medium prepared from black seed (Nigella sativa) meal extract (NSME) as an affordable and more accessible alternative to BSA for the identification of C. neoformans.Materials and Methods: Various NSME-based media formulations, with and without N. sativa oil (NSO), were prepared and tested against type strains, clinical and environmental isolates of Cryptococcus species, and other medically relevant yeasts. Growth rate and melanin-associated pigmentation of the yeast colonies were assessed during 14 days of incubation.Results: The NSME media effectively promoted the growth and melanin production of C. neoformans with colony pigmentation ranging from light to dark brown depending on NSME concentration. In contrast, NSO had minimal impact on growth or pigmentation. Addition of 1% glucose to newly developed media enhanced growth rates, aligning colony sizes with those observed on Sabouraud dextrose agar. Non-melanin producer yeasts, such as Candida spp. and Saccharomyces cerevisiae, showed limited growth and no pigmentation, facilitating species differentiation.Conclusion: The NSME-based culture media offer a reliable, low-cost alternative for the growth and preliminary identification of C. neoformans, with promising potential for use in routine diagnostics, especially in low-resource settings. https://cmm.mazums.ac.ir/article_150771.html Background and Purpose: Hot and humid climate of Vietnam favors fungal infections; however, data on toenail onychomycosis in this region remain limited. In this regard, the present study aimed to investigate risk factors, clinical features, and causative agents of toenail onychomycosis in Vietnam. Materials and Methods: This cross-sectional study was conducted in Nghe An province, Vietnam, from March 2021 to August 2022. Toenail samples from female traders with suspected onychomycosis underwent direct examination and culture. Isolates were identified using conventional and molecular techniques, including restriction fragment length polymorphism analysis and sequencing of the internal transcribed spacer region. Results: Based on findings, 45.5% of 224 participants were diagnosed with onychomycosis. The identified risk factors for onychomycosis were water contact (odds ratio (OR) 2.434; 95% confidence interval (CI) 1.098–5.383) and nail grooming (OR: 2.096; 95% CI: 1.002–4.384). Distal and lateral subungual onychomycosis was the most common form (84.3%), followed by superficial white (8.8%) and proximal subungual form (6.9%). Most cases were classified as mild (35.3%) or moderate (40.2%) infections, with an average onychomycosis severity index (OSI) score of 10.25 ± 8.09. Yeasts accounted for 70.6% of cases, and Candida was the leading genus (54.9%), followed by Trichosporon (13.7%) and Geotrichum (1.9%). Most mold-related cases were caused by non-dermatophyte fungi, including Aspergillus (16.7%), Penicillium (5.9%), Curvularia (2.9%), Fusarium (2.0%), and Talaromyces (1%), while dermatophyte (Trichophyton) was identified in only one case (1%). Compared with yeast infections, mold-related cases were more associated with older participants and a higher rate of severe cases (43.3% vs. 16.7%, p = 0.010) as well as OSI score (13.6 ± 8.2 vs. 8.8 ± 7.7, p = 0.006). Conclusion: Both behavioral and occupational factors were risks for toenail onychomycosis, which was mostly mild to moderate and associated with yeasts. Non-dermatophyte molds were less frequent but linked to more severe cases. Targeted prevention and tailored treatment strategies are needed. https://cmm.mazums.ac.ir/article_150764.html Background and Purpose: Fungal Keratitis (FK) is a sight-threatening corneal infection resulting in monocular blindness. FK occurs more frequently in warm, humid tropical and subtropical regions, particularly those with an agriculture-based economy. The present study aims to check the spectrum of organisms causing FK and analyze the associated clinical features. Antifungal susceptibility patterns also determined with isolated organisms in a tertiary care center in North India. Materials and Methods: This study was conducted on suspected FK cases recruited from January 2020 through December 2023 in the Advanced Eye Centre (AEC) Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh. The routine mycological laboratory data, including direct microscopy (KOH mount) and culture on Sabouraud’s Dextrose agar media (SDA), were collected. The clinical data and etiological factors were analysed by retrieving medical records. Further, the preserved isolates were subjected to antifungal susceptibility testing as per the Clinical and Laboratory Standards Institute (CLSI) broth microdilution method (M38-A2) for a panel of antifungals, including VRCZ (voriconazole), ITRA (itraconazole), PSCZ (posaconazole), LLCZ (luliconazole), MCZ (miconazole), KTZ (ketoconazole), AMB (amphotericin-B), NTM (natamycin), and TFH (terbinafine-hydrochloride). Results: Of a total of 2891 suspected cases, 677 were found to be positive by either microscopy or culture. Of the 677 positive cases, 470 were culture-positive, 383 (56.57%) were both microscopy as well as culture-positive, 206 (30.42%) were culture-negative but microscopy-positive, and 87 (12.85%) were culture-positive but microscopy-negative.In the geographical zones from , Punjab was leading with 39.29% of cases, followed by Haryana (26.14%), Uttar Pradesh (14.33%), and Himachal Pradesh (14.03%).Aspergillus spp. was found to be the predominant etiologic agent accounting for (N=198/470) 42.12%, followed by Fusarium spp. (N=173/470) 36.80%, dematiaceous fungi (N=71/470) 15.10%. Clinical details of all 677 patients were successfully retrieved and found that vegetative trauma was the major associated etiological factor causing FK. Other etiological factors involved animal tails, dust, insects, foreign bodies, chemicals, or iron piece injuries. AFST results revealed that VRCZ, ITRA, and LLCZ exhibit low MIC values against Aspergillus spp. and Fusarium spp. VRCZ exhibits a median MIC range of 0.25µg/ml among Aspergillus spp. and 0.5µg/ml among Fusarium spp. and the dematiaceous group of fungi. Conclusion: Aspergillus spp. represents the predominant etiology causing FK, followed by Fusarium spp., but dematiaceous fungi seem to pose a significant threat in causing FK. In-vitro susceptibility results revealed that with VRCZ, LLCZ can also be a promising antifungal drug for the treatment of FK. https://cmm.mazums.ac.ir/article_150774.html Background and Purpose: Fusarium species are causative agents of a wide range of opportunistic infections, ranging from superficial to disseminated forms, particularly in nosocomial settings. Children with haematological malignancies may develop severe fungal infections, such as fusariosis, that have proven notoriously challenging to diagnose and treat, with high mortality rates. Case Presentation: This report aimed to describe an invasive Fusarium bloodstream infection in an eleven-year-old male patient treated for high-risk acute lymphoblastic leukaemia. The patient presented with neutropenic fever and necrotic papular skin lesions. Fusarium solani complex was identified in blood cultures. Initial empirical therapy with voriconazole led to partial improvement, but therapeutic drug monitoring showed persistently low plasma levels. Genetic analysis revealed CYP2C19*17 polymorphism, classifying the patient as an ultrarapid metabolizer. Treatment was switched to liposomal amphotericin B, resulting in clinical recovery. Conclusion: This case highlighted the importance of early diagnosis, targeted antifungal treatment, therapeutic drug monitoring, and pharmacogenetic testing in pediatric Fusarium infections. https://cmm.mazums.ac.ir/article_150775.html Background and Purpose: Invasive aspergillus stomatitis and vaginitis are relatively rare in a patient with Oral Lichen planus and a history of steroid and antibiotic use. Case Presentation: A 49-year-old female diagnosed with lichen planus presented with severe stomatitis and cheilitis and was treated with fluconazole as the clinical appearance resembled thrush. Recurrence of her symptoms despite adequate treatment led to culture from the lesions, which repeatedly grew Aspergillus spp., an unlikely pathogen at this site. Sequencing further identified the isolate as Aspergillus versicolor. Antifungal treatment was initiated, first with micafungin and then with voriconazole. The patient responded and was discharged, only to return with a relapse of symptoms. Environmental samples from her house revealed the same Aspergillus spp. The patient responded to isavuconazole and was discharged home after thorough house decontamination, with no recurrence of lesions on follow-up. Conclusion: Aspergillosis should be considered a differential diagnosis in mucosal lesions that are difficult to treat in both immunocompetent as well as immunocompromised individuals.   https://cmm.mazums.ac.ir/article_150766.html Background and Purpose: Favus, a severe form of tinea capitis, is primarily caused by Trichophyton schoenleinii and can lead to permanent scarring alopecia if untreated. Although its prevalence has declined globally, outbreaks persist in regions with socioeconomic challenges and immigrant populations.Case Presentation: We report an 8-year-old Afghan boy residing in Iran who presented with diffuse alopecia and erythematous, purulent scalp lesions. Direct microscopy, culture, and ITS-PCR confirmed infection with T. schoenleinii. The isolate exhibited high susceptibility to itraconazole, ketoconazole, and terbinafine, with reduced activity for fluconazole. Treatment with topical ketoconazole and oral itraconazole (5 mg/kg/day for six months) resulted in clinical resolution.Conclusion: Early recognition of favus, coupled with accurate identification and susceptibility-guided therapy, is crucial to prevent long-term complications. Surveillance of T. schoenleinii in vulnerable populations, including immigrants, remains vital to inform public health strategies and mitigate the risk of re-emergence. https://cmm.mazums.ac.ir/article_150767.html Background and Purpose: Disseminated cryptococcosis is an opportunistic infection in immunocompromised individuals. Chronic idiopathic chylothorax and chylous ascites can cause immunodeficiency via loss of immunoglobulin and lymphocytes in the late stage. Case presentation: This study aimed to present a case of disseminated cryptococcosis shortly after duodenal perforation in an immunocompetent patient with idiopathic chylothorax and chylous ascites that had been treated with a Denver peritoneo-venous shunt. Diagnosis of dissemination was confirmed by positive cryptococcal culture of blood, pleural effusion, ascites, and the removed shunt. The patient had low CD4+ lymphocytes and hypogammaglobulinemia at the onset of cryptococcosis. Conclusion: It should be noted that cryptococcosis can also occur in cases of idiopathic chylothorax and chylous ascites with low CD4+ or gamma globulin levels. Keywords: Denver peritoneo-venous shunt, Disseminated cryptococcosis, Duodenal perforation, Chylothorax, Chylous ascites https://cmm.mazums.ac.ir/article_150768.html Background and Purpose: Parathyridaria percutanea is an emerging human fungal pathogen that primarily causes subcutaneous phaeohyphomycosis. Molecular sequencing is an accurate and definitive method for identification. Treatment can be achieved through either surgical intervention or antifungal therapy. Case Presentation: This study aimed to report a rare case of Parathyridaria percutanea subcutaneous phaeohyphomycosis in a 62-year-old diabetic woman presenting with a forearm swelling. Diagnosis was confirmed by molecular sequencing after culture yielded non-sporulating hyphae. The patient underwent surgical excision followed by short-course itraconazole, with complete resolution and no recurrence on one-year follow-up. Conclusion: This case highlighted that P. percutanea subcutaneous phaeohyphomycosis is a rare organism isolated from a clinical case. In cases where non-sporulating morphology delays diagnosis, molecular tools provide reliable identification, while surgical excision with itraconazole ensures effective management. https://cmm.mazums.ac.ir/article_150781.html Background and PurposeFungal keratitis remains a major cause of corneal blindness, particularly in individuals with ocular trauma or environmental exposure. Accurate and timely identification of the etiologic agent is important for appropriate treatment. This report describes a case of keratitis caused by an uncommon dematiaceous fungus, identified using a sequencing-based approach, highlighting the role of molecular diagnostics in clinical practice.Case presentationA 25-year-old male presented with redness and pain in the right eye after exposure to dust. On slit lamp examination, a 5 mm × 3 mm superficial corneal infiltrate was noted, and the best-corrected visual acuity in the affected eye was 20/50. Corneal scrapings were obtained and examined microscopically, revealing septate fungal filaments. Sample was cultured on Sabouraud Dextrose Agar, which produced rapidly growing, initially colourless colonies that later developed black pigmentation at the margins. To accurately identify the fungal species, DNA was extracted from the culture and analysed using Oxford Nanopore Sequencing targeting the ITS gene.ResultsThe colonies observed on culture suggested the presence of a dematiaceous fungus. Sequencing confirmed the organism as Podospora bulbillosa, a rare fungal species not commonly associated with ocular infections. The patient was started on 5% natamycin eye drops administered topically. Over the course of treatment, the infiltrate showed gradual resolution. Complete clinical recovery was achieved with restoration of visual acuity and no residual scarring or complications noted on follow-up examination.ConclusionThis case highlights the utility of molecular diagnostic techniques in the identification of rare fungal pathogens in keratitis. Incorporating sequencing tools can aid in precise pathogen detection and guide targeted therapy. Podospora bulbillosa should be considered as a potential etiological agent in cases of fungal keratitis, especially in settings where exposure to environmental contaminants occurs. Early recognition and appropriate antifungal treatment can result in successful outcomes, even in infections caused by rare fungal species. https://cmm.mazums.ac.ir/article_150773.html Background and Purpose: Mucormycosis is a rare fungal infection which can cause acute, disfiguring, and angioinvasive infections in immunocompromised patients with high mortality and morbidity rates. However, this study aimed to present the case of a healthy 7-year-old female. Case presentation: An immunocompetent female with orbital mucormycosis caused by Saksenaea loutrophoriformis from Mashhad, Iran was admitted to the hospital. This rare infection was the consequence of an injury due to a tree branch. The causative agent was identified by histopathology, routine mycological methods, and DNA sequencing of the Internal Transcribed Spacer 1 and 2 regions, including the intervening 5.8S gene and the partial large subunit region D1 and D2. Results: The patient was successfully treated with surgical debridement and antifungal treatment of amphotericin B and oral posaconazole. Conclusion: Molecular diagnosis is crucial in the absence of sporulation to avoid misidentification and late diagnosis. This report of a rare infection in an immunocompetent host is valuable for awareness of clinicians. https://cmm.mazums.ac.ir/article_150757.html Background and Purpose: Candida auris, a globally emerging multidrug-resistant pathogen, was first isolated from the external ear canal of a Japanese patient. Subsequently, most cases were reported from invasive or non-ear infections, while in Iran, the increasing numbers of otologic infections as the dominant clinical form of C. auris infections are being reported.Materials and Methods: In this study, the clinical, microbiological, and outcome of 4 C. auris otomycotic cases that have been identified during our previous large-scale survey on 1,029 patients/specimens in a single center have been described alongside a literature review of C. auris cases reported till 2023 from Iran.Results: Six culture-proven C. auris cases were reported, of which, four belonged to clade V and two to clade I. Three culture negative PCR-identified cases also were documented. The clinical table of the infection in Iran where shows different clade of C. auris is differed from other countries where other clades and other clinical forms like candidemia are predominated. No case of candidemia was noted. Although fluconazole resistance was documented in 50% of the isolates, no resistance to echinocandins and amphotericin B were noted.Conclusion: This review highlights several notable points; (a) C. auris infection is a challenging condition which usually misdiagnosed or diagnosed untimely, (b) the clinical table and cladal distribution of C. auris in Iran is different from other countries, (c) cases with C. auris may provide negative culture, underscoring the importance of utilization of specific direct PCR for ruling out/in C. auris, particularly in cases with chronic otomycosis, (d) ongoing patient follow-up and antifungal susceptibility testing in patients who does do not respond to antifungal drug are recommended, (e) relying on non specific, insensitive, and time-consuming approaches such as culture, not only would postpone the detection, but it could be also misleading for the isolation of C. auris in a setting where molds are predominated. https://cmm.mazums.ac.ir/article_150765.html Despite the application of surgery and antifungal therapy, rhino-orbital-cerebral mucormycosis is a severe and life-threatening fungal infection with high morbidity and mortality, particularly in immunocompromised patients. This review focuses on the current evidence on the perioperative anesthetic management of rhino-orbital-cerebral mucormycosis, emphasizing the unique challenges its aggressive, angioinvasive nature poses. Key issues include difficult airway management due to fungal debris and supraglottic edema, hemodynamic instability, renal dysfunction because of nephrotoxic antifungal therapy (e.g., amphotericin B), and the critical need for glycemic control in diabetic patients. Case studies illustrate the complexities of managing comorbidities such as post-COVID-19 sequelae, uncontrolled diabetes, and immunosuppression. Preoperative optimization, judicious fluid and electrolyte management, and the use of video laryngoscopy for difficult intubation are highly recommended. By addressing these challenges, this article provides a practical framework for anesthesiologists to enhance perioperative care in patients with ROCM, ultimately improving survival and reducing complications. Awareness of these procedures may help clinicians choose the most effective treatment regimens. However, further studies are warranted to correlate these findings with clinical outcomes. https://cmm.mazums.ac.ir/article_150782.html Background and Purpose: Volvariella volvacea is an edible mushroom that has been demonstrated to exhibit various biological activities and contain numerous biochemical compounds. However, it was reported to cause invasive infection in immunocompromised patients, affecting their body organs in the process. Infective nature of V. volvacea has not yet been fully elucidated. Although its bioactivities and compounds are considered pharmacologically beneficial, they were examined in this bifaceted review to provide a preliminary explanation for the harmful opportunistic behavior of the fungus.Materials and Methods: Published articles retrieved from Google Scholar were comprehensively consolidated, evaluated, and summarized. Specific keywords, relative to infection reports, biological activities, and compounds of V. volvacea, as well as infective mechanisms of some medically significant fungal pathogens, were used to collect and select studies for this review.Results: Related studies describing the mechanisms of opportunistic and true pathogenic fungal species, as well as other disease-related biological processes, were used as the basis for this review. Based on these findings, V. volvacea may induce systemic infection through its bioactivities and compounds. Overall, these properties may contribute to the growth, survival, proliferation, pathogenicity, and virulence of the fungus during infection. The antioxidant activity may help evade the defense mechanisms of the host, such as the induction of oxidative stress during an infection. Immunomodulatory mechanisms, through increased immunological cells and pro-inflammatory genes, may exacerbate damage within the tissues of the host. Similarly, cytotoxicity may also help worsen the fungal infection by impeding division of healthy cells. Meanwhile, the antimicrobial activity of V. volvacea may aid the outgrowth of both beneficial and pathogenic microorganisms within the host microbiota, resulting in harmful dysbiosis. The initiation of platelet aggregation, which is a defense mechanism against infection, may also be evaded by the fungus through its antiplatelet property. Moreover, the biological compounds of V. volvacea, namely phenols, flavonoids, and β-glucan, may also contribute to infection through their association with the aforementioned biological activities, in addition to their toxicological properties.Conclusion: This review may serve as a basis for future studies to provide a deeper understanding of the infective behavior of V. volvacea, paving the way for improved diagnosis, prognosis, and treatment strategies. In the meantime, adherence to precautionary and biosafety measures when handling V. volvacea, as well as maintaining overall health, is highly encouraged, especially for individuals with frequent exposure to the mushroom. https://cmm.mazums.ac.ir/article_150756.html Background and Purpose: Streptomyces, a genus of Actinobacteria, is recognized for its ability to produce diverse bioactive compounds with significant antimicrobial properties. Candida biofilms pose a major clinical challenge due to their high resistance to antifungal agents and evasion of host immune responses. This systematic review evaluated the efficacy and mechanisms of Streptomyces-derived compounds in inhibiting Candida biofilms, with a focus on their potential clinical applications.Materials and Methods: A comprehensive literature search was performed using PubMed, Scopus, ScienceDirect, and LILACS databases, covering studies published between 2016 and 2024. The selection was limited to in vitro studies assessing the effects of Streptomyces-derived compounds on Candida biofilms. Articles were screened based on predefined inclusion and exclusion criteria following PRISMA guidelines. Risk of bias was evaluated using standardized tools.Results: Nine studies met the eligibility criteria. Several Streptomyces species were reported to produce compounds, such as pyrrolo[1,2-a]pyrazine-1,4-dione, bafilomycin derivatives, and sorbicillin, which exhibited strong antibiofilm activity. These compounds have been shown to interfere with biofilm formation through various mechanisms, including disruption of cell membranes and inhibition of hyphal adhesion and development. Notably, Streptomyces olivaceus and Streptomyces chrestomyceticus strains produced secondary metabolites that significantly reduced biofilm formation of Candida species.Conclusion: Compounds derived from Streptomyces offer promising antifungal strategies against biofilm-associated Candida infections. Further research is needed to explore their clinical application in combating antifungal resistance and improving treatment outcomes in healthcare settings. https://cmm.mazums.ac.ir/article_150776.html Background and Purpose: Recent advancements in biomedical science have introduced advanced triazole agents for the targeted treatment of pulmonary diseases, including various respiratory fungal infections. Opelconazole (PC945) is an innovative triazole-based antifungal compound that functions as a potent inhibitor of the CYP51 enzyme. It is strategically engineered for inhalation administration to achieve elevated local concentrations within the lungs while minimizing systemic exposure. In vitro studies have demonstrated the exceptional antifungal potency of opelconazole against various fungal strains, including antifungal drug-resistant fungal species. Furthermore, in vivo experiments using murine models of invasive pulmonary aspergillosis and candidiasis have revealed the superior efficacy of inhaled opelconazole, compared to conventional systemic antifungal therapies. Materials and Methods: A systematic search was conducted in ScienceDirect, ClinicalTrials.gov, PubMed, and Scopus for studies published up to May 2025 using the terms "opelconazole" OR "PC945" OR "Pulmocide" OR "inhaled opelconazole". Inclusion criteria were studies reporting on opelconazole for human pulmonary fungal infections with clinical or mycological outcomes. Study selection, data extraction, and synthesis were conducted in accordance with the PRISMA guidelines. Results: Among 141 identified records, 10 studies met the inclusion criteria. Most studies focused on invasive aspergillosis. Based on the findings, inhaled opelconazole demonstrated favorable efficacy, reducing fungal burden and improving clinical outcomes, with a generally good safety profile and minimal adverse events. Conclusion: Inhaled opelconazole is a promising, well-tolerated option for pulmonary fungal infections, including those resistant to conventional therapy. According to the study results, this agent could be an effective treatment option for patients who do not respond to or cannot tolerate other treatments. However, larger randomized controlled trials are needed to confirm these results. https://cmm.mazums.ac.ir/article_150778.html Background and Purpose: Mucormycosis, a formidable invasive fungal infection linked to Mucorales fungi, poses a significant threat to individuals. Rapid initiation of suitable antifungal therapy within five days of diagnosis has shown a noteworthy reduction in mortality rates, emphasizing the critical importance of timely identification. However, the diagnostic landscape is marred by the limited sensitivity of routine tools, including direct examination, histology, and culture. In this context, this study aimed to scrutinize the diagnostic performance of the commercially available pan-mucorales real-time polymerase chain reaction (PCR) assay, MucorGenius® (Pathonostics), on both pulmonary and extra-pulmonary specimens. Its efficacy was compared with that of conventional mycology methods to address the pressing need for more accurate and timely mucormycosis diagnosis. Materials and Methods: In total, 27 clinical specimens were included in the study, 17 of which were obtained from patients clinically suspected to have invasive mucormycosis. The remaining 10 specimens were from patients with microbiologically confirmed pulmonary tuberculosis, who had no evidence of fungal infection; these served as non-fungal controls and were included specifically to assess assay specificity. The DNA extraction from all samples was performed using the Qiagen DNA minikit, and real-time PCR was conducted with the MucorGenius® kit, targeting Rhizomucor spp., Lichtheimia spp., and Mucor/Rhizopus spp. Results: Of the 27 clinical cases, 17 were classified as either proven or probable mucormycosis based on EORTC/MSGERC criteria. The MucorGenius® PCR assay demonstrated an overall sensitivity of 76.47% and a specificity of 100% for detecting mucormycosis. Conclusion: The MucorGenius® Real-Time PCR assay exhibited promising diagnostic performance for mucormycosis, particularly in cases eluding conventional methods. Its sensitivity and specificity make it a valuable tool for early diagnosis, aiding clinical intervention in patients with a high index of suspicion. https://cmm.mazums.ac.ir/article_150736.html Background and Purpose: Candida albicans is a major fungal pathogen with increasing drug resistance. This study aimed to investigate the antifungal potential and mechanisms of undecanal against C. albicans.Materials and Methods: A range of quantitative techniques were employed, including minimum inhibitory concentration determination, cell cycle dynamics analysis, biofilm inhibition assays, microscopic observation of yeast-to-hyphal transitions, scanning electron microscopy of biofilm structures, ergosterol inhibition assays, and cell membrane damage assessment. Additionally, reactive oxygen species formation was quantified, gene expression studies were performed via qRT-PCR, and synergistic effects were evaluated using the checkerboard assay.Results: Undecanal effectively inhibited planktonic growth, adhesion, yeast-to-hyphal transition, and biofilm formation at concentrations of 0.125 mg/ml, 1 mg/ml, 0.125 mg/ml, and 0.020 mg/ml, respectively, in C. albicans ATCC 90028 and ATCC 10231. In the C1 isolate, inhibition occurred at 0.5 mg/ml, 2 mg/ml, and 0.04 mg/ml. Reactive oxygen species accumulation led to oxidative stress and cell cycle arrest in all tested strains. Gene expression analysis revealed significant downregulation of virulence-related genes during biofilm formation, such as RAS1 (13.96-fold), PDE2 (1.40-fold), CEK1 (6.19-fold), and TEC1 (8.55-fold). Stress-response genes, like SOD1, SOD2, CAP1, CAT1, and MCA1 were markedly upregulated in C. albicans ATCC 90028 following undecanal treatment. Undecanal also exhibited fungicidal properties. When combined with amphotericin B, synergistic activity was demonstrated with fractional inhibitory concentration indices between 0.062 and 0.048. Furthermore, undecanal exhibited minimal hemolytic activity and cytotoxicity at effective concentrations.Conclusion: The results highlight the potential of undecanal as an antifungal agent. By targeting key virulence factors and enhancing the efficacy of existing antifungal agents, undecanal could serve as a foundation for new therapies against drug-resistant C. albicans. https://cmm.mazums.ac.ir/article_150758.html Background and Purpose: Invasive aspergillosis is commonly discussed in the setting of immunocompromised individuals. Not much has been stated about its occurrence in the immunocompetent, particularly in children. Thus, its cognizance in a non-immunocompromised child is pertinent as it may be considered an unlikely differential in such a setting, leading to preventable morbidities. Materials and Methods: We conducted a systematic literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. All articles with primary data on Aspergillus infection in immunocompetent children were eligible for inclusion.Results: We identified 34 cases of aspergillosis in non-immunocompromised children across the globe. Invasive aspergillosis (n=29, 85.3%) was the predominant clinical phenotype. Others were primary cutaneous aspergillosis (n=4, 11.8%), and non-invasive bronchial Aspergillus colonization (n=1, 2,9%). Risk factors were identified in only 13 (38.2%): trauma (n=1), surgeries (n=7), aspiration of foreign body (n=1), near drowning (n=1), congenital abnormalities (n=3), the use of arterial lines and adhesives (n=2). No known risk factors were associated with the other cases (n=21, 61.8%). Of the 34 cases, 29 (85.3%) recovered, 4 (11.8%) died and a cure was not achieved in one (2.9%). Conclusion: Aspergillosis may present as an unexpected clinical entity in immunocompetent children, resulting in fatal outcomes, particularly when the diagnosis and or the initiation of appropriate therapy is delayed. In addition, the preponderance of the invasive forms affirms the need for a high index of suspicion of aspergillosis in children regardless of immune status. Therefore, the attending clinician's awareness of this clinical entity is crucial to ensure favourable outcomes. https://cmm.mazums.ac.ir/article_150763.html Background Candida auris presents a serious global health threat over the past decade due to its intrinsic multidrug resistance and frequent misidentification with closely related Candida species. Alternative therapeutic strategies involving natural compounds are urgently needed. Objective To evaluate the antifungal efficacy of vanillin (Van), a food flavouring agent with known medicinal properties, against C. auris, and elucidate its underlying mechanisms of action. Methods Cell wall analysis assessed compositional changes in chitin, glucan, and mannan by calcofluor white, aniline blue and ConA-fluorescein conjugate staining respectively. Vacuole integrity was examined by vacuolar acidification and morphology through Quinacrine and FM4-64 staining respectively. Crystal violet staining and metabolic activity by MTT assay and biomass measurement were used to evaluate biofilm formation. THP-1 macrophage model was used to study immune evasion and macrophage-mediated killing while Caenorhabditis elegans model was used to test antifungal efficacy and survival outcomes. Key words: Candida; cell wall; vacuole; biofilm; macrophage; C. elegans https://cmm.mazums.ac.ir/article_150777.html Invasive candidiasis (IC) continues to be a leading cause of healthcare-associated bloodstream infections, carrying substantial mortality rates. While historically dominated by Candida albicans, a global epidemiological shift toward non-albicans Candida (NAC) species is currently complicating treatment due to their variable and often reduced susceptibility to azoles, the most common antifungal class.-This study hypothesizes that significant antibiotic pressure is a key driver behind the emergence of resistant NAC species in Iranian healthcare settings. To investigate this, a systematic literature search was conducted across international databases, including PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar, alongside Iranian national databases such as SID, Magiran, and IranMedex, for relevant studies published between January 2015 and December 2024. Our analysis of 30 eligible studies confirms a critical epidemiological shift in Iran, where NAC species collectively account for 55–65% of clinical isolates in recent reports, thereby superseding C. albicans as the most prevalent pathogens. Among these, C. glabrata and C. tropicalis have emerged as the predominant NAC species, exhibiting alarmingly high fluconazole resistance rates of 30–40% and 20–25%, respectively. Furthermore, the emergence of the multidrug-resistant C. auris has been documented, with these trends being most pronounced in clinical settings with high antibiotic use, such as Intensive Care Units (ICUs), underscoring a strong link between antibiotic pressure and the selection of resistant fungal pathogens. These findings suggest that the landscape of invasive candidiasis is undergoing a dangerous transformation. This crisis demands an urgent, multifaceted national response, including the immediate implementation of robust antimicrobial stewardship programs, the establishment of a national fungal surveillance network, and the revision of empiric antifungal therapy guidelines in favor of echinocandins in high-risk settings. Additionally, significant investment in advanced diagnostic capacity for rapid species identification and antifungal susceptibility testing is essential to mitigate this escalating public health threat. https://cmm.mazums.ac.ir/article_150779.html Background and Purpose Invasive candidiasis (IC) is a life-threatening fungal infection predominantly affecting critically ill and immunocompromised patients. Its diagnosis remains challenging because clinical features are nonspecific and conventional culture methods often show low sensitivity and delayed positivity. Consequently, there is a growing need for rapid, reliable, and non-culture-based diagnostic tools. The Candida mannan IgM antibody assay has recently emerged as a potential biomarker for early detection of IC. This study aimed to assess the diagnostic performance of the Candida mannan IgM antibody test in comparison with, and as an adjunct to, fungal culture for the detection of invasive candidiasis in patients with septicaemia admitted to a tertiary care hospital in New Delhi, India. Materials and Methods A prospective observational study was conducted from October 2023 to August 2024, enrolling 100 patients with clinical suspicion of IC. Blood, urine, and tracheal aspirate samples were obtained for fungal culture, and corresponding serum samples were tested for Candida mannan IgM antibodies using the FungiXpert® Candida Mannan IgM Antibody Detection K-Set. Culture was considered the reference standard. Diagnostic indices like sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. The association between antibody detection and culture results was analyzed using the chi-square test, with a p-value <0.05 considered statistically significant. Results Among the 100 patients evaluated, 58% were culture positive for Candida species. The Candida mannan IgM antibody test demonstrated a sensitivity of 31% (95% CI: 21.4–42.6%), specificity of 83.3% (95% CI: 69.2–91.6%), PPV of 72% (95% CI: 52.4–85.7%), and NPV of 46.6% (95% CI: 36.4–57.0%). A significant association was observed between antibody positivity and culture positivity (p = 0.037). Conclusion The Candida mannan IgM antibody assay, while limited in sensitivity, exhibited high specificity and a significant correlation with culture results. These findings indicate that the test may serve as a valuable adjunct to conventional fungal culture for diagnosing invasive candidiasis, particularly in septic patients where early identification is critical. Incorporating serological testing alongside culture could enhance diagnostic accuracy and facilitate timely antifungal intervention in resource-constrained healthcare settings. https://cmm.mazums.ac.ir/article_150780.html Background and Purpose: Cryptococcal meningitis (CM) remains a serious opportunistic infection, particularly among individuals living with HIV/AIDS. Fluconazole (FLC), favored for its accessibility and cost-effectiveness, faces growing resistance globally, especially in low-resource settings like India where antifungal susceptibility data are scarce. The study aimed to assess the prevalence of reduced fluconazole susceptibility among Cryptococcus neoformans clinical isolates in North India and to evaluate its clinical implications in the management of CM. Materials and Methods: We analyzed 21 cases of Cryptococcal Meningitis diagnosed between 2022 and 2024. Clinical features, demographic data, laboratory parameters, and antifungal susceptibility profiles were assessed, with subgroup comparisons between HIV-positive and HIV-negative patients. Antifungal susceptibility testing for amphotericin B, fluconazole, itraconazole, and voriconazole was performed using broth microdilution as per CLSI guidelines (M27-A3 document). Results: A total of 21 patients with CM were included; 12 (57.1%) were HIV-positive and 9 (42.9%) HIV-negative. Cases showed seasonal clustering with peaks during May–August, highest in July 2024. Antifungal susceptibility testing was performed for 17 clinical isolates. Fluconazole MICs ranged from 1–16 µg/mL with MIC50/MIC90 of 8/8 µg/mL (geometric mean 6.4 µg/mL). Amphotericin B MICs ranged from 0.25–2 µg/mL (MIC50: 1 µg/mL; MIC90: 2 µg/mL; geometric mean: 1.18 µg/mL). Itraconazole and voriconazole showed low MICs (itraconazole 0.0625–0.125 µg/mL; voriconazole 0.03–0.25 µg/mL). Univariate analysis revealed no significant association between elevated FLC MIC (≥8 µg/mL) and age, gender, HIV status, or mortality. Conclusions: The findings underscore rising fluconazole MICs in C. neoformans isolates in North India, necessitating enhanced antifungal surveillance and stewardship to optimize CM treatment outcomes. https://cmm.mazums.ac.ir/article_150783.html Background and purpose: Immunocompromised patients, particularly those with cancer, are at heightened risk for fungal infections. In Pakistan, limited diagnostic capacity and surveillance hinder efforts to monitor and control these infections effectively. The current study aimed to examine six-year trends in fungal infections and species distribution among patients at a tertiary care cancer hospital in Pakistan. Methods: A retrospective review of laboratory-confirmed fungal isolates was conducted from January 2018 to December 2023. Data on demographics, specimen types and fungal species were extracted from the hospital information system and descriptively analyzed. Results: A total of 1,815 fungal isolates were identified, with yeasts predominating (72.8%), mainly Candida albicans. Non-albicans species such as C. tropicalis, C. parapsilosis, and C. glabrata were also frequent. Among molds (27.2%), Aspergillus flavus was the leading species. The most common specimen sources were urine (50.3%), blood (12.1%), and wound swabs (7.3%). Conclusion: Candida albicans remains the most common organism; amongst non-albicans variants, Candida tropicalis, Candida parapsilosis, and Candida glabrata figure prominently. Aspergillus flavus is commonly seen mold in this setting. These findings underscore the need for strengthened diagnostic capacity and data standardization in cancer care in Pakistan. https://cmm.mazums.ac.ir/article_150784.html Background and Purpose. Chromoblastomycosis is a neglected tropical disease endemic to tropical and subtropical zones worldwide, affecting individuals living in low-income re-gions of Asia, Africa, and Latin America. The main clinical etiological agents belong to a well-supported clade within the order Chaetothyriales, family Herpotrichiellaceae, and gen-era Fonsecaea, Cladophialophora, Phialophora, Rhinocladiella, and Exophiala. These spe-cies share similar physiological and morphological features, making them difficult to distin-guish by conventional mycological methods. This study aimed to perform an ITS-based phylogenetic analysis of the major causative agents of chromoblastomycosis from Mexico and Venezuela, in the context of a global reference dataset. Materials and Methods. This study aimed to perform a phylogenetic analysis based on ITS (ITS1-5.8S-ITS2) sequences from 75 strains associated with chromoblastomycosis. This da-taset included 37 strains from Mexico and Venezuela previously identified phenotypically and molecularly by our group, comprising one new clinical isolate of Fonsecaea monophora from northern Mexico characterized in the present study, together with 36 strains of Clado-phialophora carrionii, Fonsecaea pedrosoi, and Rhinocladiella aquaspersa (outgroup) re-ported in our previous studies. The remaining 38 reference sequences were retrieved from GenBank, representing strains from other geographic regions. Sequence alignments were used to build a phylogenetic tree using the Neighbor-Joining (NJ) method with bootstrap analysis of 1,000 replicates, implemented in MEGA 6.06 software. Results. Cladophialophora carrionii clustered in a geographically-related manner, whereas Fonsecaea pedrosoi and F. monophora clustered in a species-specific manner, regardless of geographic origin, when compared against the global reference dataset. Conclusion. This is the first molecular report of chromoblastomycosis caused by F. monophora in northern Mexico, and the first ITS-based phylogenetic analysis placing the major causative agents of chromoblastomycosis from Mexico and Venezuela within a global reference context. https://cmm.mazums.ac.ir/article_150785.html Abstract Background and Purpose: Polymicrobial keratitis involving emerging pathogens presents a significant diagnostic challenge for conventional microbiology. Inaccurate etiology identification often leads to inappropriate antimicrobial therapy and adverse clinical outcomes. To bridge these diagnostic gaps, molecular techniques are playing a vital role in culture-independent detection of coinfecting rare bacterial and fungal pathogens, facilitating early, targeted antimicrobial intervention. Material and Methods: An 80-year-old woman with the history of traumatic implantation of soil presented with right eye conjunctival hyperaemia, photophobia, foreign body sensation, whitish lesion on the cornea with diminution of vision lasting for one month. A total of three corneal scrapping collected successively on different timeline and examined by Gram stain and potassium hydroxide (KOH) wet mount. Blood agar (BA), Sabouraud dextrose agar (SDA) and non-Nutrient agar (NNA) were used for isolation of etiological agents. The antibiotic susceptibility testing was done on BA by Kriby Bauer disc diffusion method. Results: The culture-based isolation of two consecutive corneal scrapings and automated identification using the VITEK® 2 system, revealed Kocuria kristinae as the bacterial isolate. The fungal etiological agents such as Schizophyllum commune and Peroneutypa scoparia were confirmed by molecular characterization through Sanger sequencing. The underlying host-related factors, delayed identification of rare etiological agents, and the absence of definitive evidence-based treatment guidelines complicated the clinical course. There was a gradual regression of infection occurred after a protracted course of approximately 8 months and no recurrence documented. Conclusion: The present case is the first documented report on concurrent triple infections involving Kocuria kristinae, Schizophyllum commune and Peroneutypa scoparia. To our knowledge, this represents the second reported global case of Peroneutypa scoparia keratitis. Importantly, complete clinical resolution was achieved through medical therapy alone without surgery, despite the challenge of treating an elderly patient with multiple comorbidities. Key words: Polymicrobial keratitis, Kocuria kristinae, Schizophyllum commune, Peroneutypa scoparia, Vitek-2.