Four major clades of Candida auris have been described, and all infections have clustered in these 4 clades. We identified an isolate representative of a potential fifth clade, separated from the ...other clades by >200,000 single-nucleotide polymorphisms, in a patient in Iran who had never traveled outside the country.
Opportunistic infections due to Candida species occur frequently in cancer patients because of their inherent immunosuppression. The aim of the present study was to investigate the epidemiology of ...yeast species from the oral cavity of patients during treatment for oncological and haematological malignancies.
MALDI-TOF was performed to identify yeasts isolated from the oral cavity of 350 cancer patients. Moreover, antifungal susceptibility testing was performed in according to CLSI guidelines (M27-A3).
Among 162 yeasts and yeast-like fungi isolated from the oral cavity of cancer patients, Candida albicans was the most common species (50.6%), followed by Candida glabrata (24.7%), Pichia kudriavzevii (Candida krusei (9.9%)), Candida tropicalis (4.3%), Candida dubliniensis (3.7%), Kluyveromyces marxianus (Candida kefyr (3.7%)) and Candida parapsilosis (1%). In addition, uncommon yeast species i.e., Saprochaete capitata, Saccharomyces cerevisiae, Clavispora lusitaniae (C. lusitaniae) and Pichia kluyveri (C. eremophila) were recovered from oral lesions. Oral colonization by C. albicans, non-albicans Candida species and uncommon yeasts were as follow; 55%, 44% and 1%, whereas oral infection due to C. albicans was 33.3%, non-albicans Candida species 60.6%, and uncommon yeasts 6.1%. Poor oral hygiene and xerostomia were identified as independent risk factors associated with oral yeast colonization. The overall resistance to fluconazole was 11.7% (19/162). Low MIC values were observed for anidulafungin for all Candida and uncommon yeast species.
This current study provides insight into the prevalence and susceptibility profiles of Candida species, including emerging Candida species and uncommon yeasts, isolated from the oral cavity of Iranian cancer patients. The incidence of oral candidiasis was higher amongst patients with hematological malignancies. The majority of oral infections were caused by non-albicans Candida species which were often more resistant to anti-fungal agents. Our findings suggest that anidulafungin should be used as antifungal of choice for prophylaxis in clinically high-risk patients with documented oral colonization or infection.
Candida auris has emerged globally as a multidrug-resistant pathogen causing outbreaks in health care facilities. Whole genome sequencing (WGS) analysis has identified four major clades, while ...earlier WGS data from a single Iranian isolate suggested the existence of a potential fifth clade. Here, we confirm the existence of this fifth clade by providing WGS data of another four Iranian isolates. These clade V isolates differed less than 100 single-nucleotide polymorphisms (SNPs) between each other, while they were separated from the other clades by more than 200,000 SNPs. Two of these isolates were resistant to fluconazole and were found to harbour mutations in the TAC1b and ERG11 genes.
and
are important causative agents of superficial mycoses, demonstrating emergent antifungal drug resistance. We studied the antifungal susceptibility profiles in Iranian isolates of these two ...species.
A total of 96
and 45
isolates were subjected to molecular typing by ribosomal ITS region. Antifungal susceptibility profiles for terbinafine, griseofulvin, clotrimazole, efinaconazole, luliconazole, amorolfine and ciclopirox were obtained by CLSI broth microdilution method. The squalene epoxidase (
) gene was subjected to sequencing for mutations, if any, in isolates exhibiting elevated MICs for terbinafine.
Luliconazole and efinaconazole showed the lowest MIC values against
and
isolates. There were five isolates with terbinafine MICs ≥32 µg/mL in our sample. They belonged to
type VIII and harbored two alternative
gene sequence variants, leading to Phe397Leu and Ala448Thr or Leu393Ser and Ala448Thr substitutions in the enzyme. All terbinafine resistant strains could be inhibited by luliconazole and efinaconazole.
This study documented a step in the global spread of resistance mechanisms in
. However, treatment alternatives for resistant isolates were available.
Opportunistic fungal infections by
species arise among cancer patients due to the weakened immune system following extensive chemotherapy. Prophylaxis with antifungal agents have developed the ...resistance of
spp. to antifungals. Accurate identification of yeasts and susceptibility patterns are main concerns that can directly effect on the treatment of patients.
Over a period of three years, 325 cancer patients suspected to
infections were included in the current investigation. The clinical isolates were molecularly identified by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). All strains, were examined for
susceptibility to the amphotericin B, itraconazole, fluconazole, and anidulafungin according to the CLSI M27 document.
Seventy-four cancer patients had
infections (22.7%).
was the most common species (83.8%). Antifungal susceptibility results indicated that 100% of the
isolates were sensitive to amphotericin B; however, 17.6%, 9.4%, and 5.4% of clinical isolates were resistant to anidulafungin, fluconazole, and itraconazole, respectively.
The findings of the present work shows a warning increase in resistance to echinocandins. Since all fluconazole resistance isolates were obtained from candidemia, we recommend amphotericin B as the first line therapy for this potentially fatal infection.
In recent years, the incidence of infections caused by pathogenic fungi has increased globally, especially in immunocompromised patients, transplant patients, or patients undergoing chemotherapy in ...intensive care units. Due to the morbidity and rapid spread of infection to other organs, accurate, rapid diagnosis and treatment of fungal infections is essential. Molecular methods such as polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) have significant superiority in sensitivity and specificity compared to conventional methods. The aim of this study is to point out the limitations of common diagnostic methods and factors affecting the sensitivity and specificity of PCR-RFLP molecular diagnostic test. This article is a review study for which subject-related academic papers (before 2023) were collected and studied by searching the keywords of pathogenic fungi, and RFLP molecular diagnostic methods; in Persian databases as well as Latin electronic databases including Scopus, Web of Science, and PubMed . Reviewing numerous articles showed that PCR-RFLP is a rapid, practical, and reliable method, which can be used in laboratories to determine the genotype of specific variants of fungal species isolated from clinical samples. However, there are several limitations for PCR-RFLP method demanding for more attention. The main limitations are the need for specific restriction enzymes and the difficulty of accurately determining single nucleotide polymorphisms (SNPs) in a specific diagnostic locus.
Fungal otitis externa, an infection of the external auditory canal caused by molds and yeasts, accounts for approximately 10–20% of ear canal infections accompanying high recurrence. The purpose of ...the current study was to assess the pattern of etiological agents of otomycosis and resistance profile as well as the rate of tympanic membrane perforation. A total of 1040 patients with symptoms of fungal otitis externa, in a period of two years, were investigated. The mycological tests revealed the presence of different fungi in 237 ears (22.8%). Fungal otitis was more related to filamentous fungi of the species
Aspergillus flavus
(54.43%),
A. tubingensis
(10.97%), and
A. niger
(8.86%), followed by yeasts,
Candida orthopsilosis
(7.59%),
C. albicans
(6.75%), and
C. parapsilosis
(5.06%). Tympanic membrane perforation rate was found to be 6.75% and was more common with otomycosis caused by
A. flavus
,
A. tubingensis
and
C. albicans
. In antifungal susceptibility tests, all tested drugs showed generally good activity against most isolates of molds and yeasts, while tolnaftate, clotrimazole, nystatin, and terbinafine had lowest effects. We found that among
Aspergillus
isolates, one
A. niger
isolate was resistant to voriconazole, and one
A. flavus
isolate was resistant to amphotericin B. Furthermore, among
Candida
species, three isolates of
C. orthopsilosis
showed high MIC values to fluconazole, two
C. albicans
isolates were considered fluconazole resistant and one isolate of
C. parapsilosis
was resistant to caspofungin and 3 isolates were resistant to fluconazole. Regarding the existence of the cases with perforated tympanic membrane and emerging species causing fungal otitis in the current report, the importance of the early physical examination, precise molecular identification, and the antifungal susceptibility evaluation is highlighted.
Skin is an important organ of the body due to offering an accessible and convenient site for drug administration. One of the disadvantages of transdermal drug delivery is the low penetration rate of ...drugs through the skin. Over the past decades, nanoparticles have been used as drug delivery systems to increase therapeutic effects or reduce toxicity. Encapsulation of drugs in nanoparticulate vesicles simplifies the transports of drugs into and across the skin. Niosome nanoparticles are among these drug delivery systems, which have numerous applications in drug delivery and targeting. Niosomes are frequently used for loading drugs serving different purposes (e.g., anticancer, antiviral, and antibacterial agents). In recent years, there has been much research on the use of niosomal systems for the delivery of fungal drugs. A review of the literature investigating the advantages of niosomes in antifungal drug delivery can elucidate the efficiency and superiority of this nanocarrier over other nanocarriers.
Cutaneous fungal infections are the fourth most common health problem, which involves approximately one billion people worldwide. Drug delivery to the skin seems to be the best choice for superficial ...fungal infections. Topical formulations can release a sufficient amount of drug in therapeutical concentrations and permeate higher layers of the skin like the stratum corneum. As the outermost layer of the epidermis, the stratum corneum prevents the drug from penetrating the skin. Liposomes, especially nanosized as topical drug delivery systems to the skin, can show various functions depending on their size, lipids and cholesterol components, the percent of ingredients, lamellarity, and surface charge. Nanoliposomes can increase permeation through the stratum corneum, decrease systemic effects with their localizing actions, and overcome many dermal drug delivery obstacles. Antifungal drugs, such as croconazole, econazole, fluconazole, ketoconazole, terbinafine hydrochloride, tolnaftate, and miconazole entrapped in liposomes have indicated improved skin penetration and localizing effects. According to the literature review summarized in this paper, many studies have identified liposomes as a powerful carrier for topical antifungal drug delivery to the skin. However, a few studies introduced new generations of liposomes like ethosomes and transfersomes. This paper was conducted on almost all liposomal studies of antifungal drugs with dermal application.
Fungi of the genus
Fusarium
are well known as major plant pathogens but also cause a broad spectrum of human infections. Sixty-three clinical isolates, collected during 2014–2017, were identified ...using a part of the
TEF1
gene as barcoding marker.
Fusarium fujikuroi
species complex (FFSC,
n
= 41, 65%) showed to be the dominant etiological agent, followed by
F. solani
species complex (FSSC,
n
= 14, 22%) and
F. oxysporum
species complex (FOSC,
n
= 7, 11%). There was one strain belonging to
F. lateritium
species complex (FLSC,
n
= 1, 1.5%). For final identification, a phylogenetic tree was constructed including the type strains of each species complex. Most cases of fusariosis were due to nail infection (
n
= 38, 60.3%), followed by keratitis (
n
= 22, 34%).
Fusarium
infections are difficult to be treated due to their intrinsic resistance to different azoles; however, accurate and fast identification of etiological agents may enhance management of the infection. We present the first phylogenetic study on clinical
Fusarium
spp. from Iran.
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