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Competing Interests: Conflict of interest The authors declare that there is no conflict of interest.

Background: Candid a species are normal vaginal flora in healthy women, which can cause vulvovaginal candid-iasis (VVC). The formation of biofilm is a cause of drug resistance in Candida species of vaginal origin. We aimed to specify Candida species cause VVC, detect their biofilm-forming ability, and antifungal susceptibility pattern., Methods: Overall 150 vaginal samples were collected from suspected cases of referring to Bahar Hospital of Shahroud, Iran between Jan 2018 and Jan 2019. Samples were cultured on Sabouraud dextrose agar (SDA), Chrome gar Candida and Corn meal agar (CMA). PCR-RFLP was performed to confirm the identification. Bio-film formation of the identified species was measured by the Crystal Violet method. The susceptibility to fluconazole, clotrimazole, and miconazole was determined based on the CLSI document M27-A3., Results: Of 50 women (33.3%) were suffering from VVC. C.albicans was the predominant species isolated in this study (n=39, 78%) followed by C. glabratia (n=11, 22%). In addition, in 25 (50%) of positive samples, bio-film formation was determined. The mean MIC of fluconazole and clotrimazole for C. albicans was 5.02 μg/mL and 3.92 μg/mL, respectively. Furthermore, the mean MIC related to these drugs for C. glabrata was 12.45 μg / mL and 4.1μg / mL, respectively. The mean diameter of miconazole inhibition zone for C. albicans and C. glabra isolates was 25.13 mm and 24.5mm, respectively and all of them were susceptible to this drug., Conclusion: C.albicans was the predominant Candida species isolated from patients with VVC and also was the predominant biofilm producer species., Competing Interests: Conflict of interest The authors declare that there is no conflict of interest., (Copyright © 2022 Alikhani et al. Published by Tehran University of Medical Sciences.)

Background: Tracheoesophageal voice prostheses (TVPs) have been the gold standard in rehabilitation, after laryngectomy, producing faster and premier voicing towards esophageal speech. Fungal colonization shortens the device's lifetime and leads to prosthesis dysfunction, leakage, and subsequent respiratory infection. Therefore, in the current study, we aimed to investigate the fungal colonization patterns and to propose prophylactic measures that shall increase the longevity of voice prosthesis., Methods: Failed TVPs were removed - due to leakage and/or aspiration - from 66 post laryngectomy patients and examined. They were referred to Amiralam and Rasoul Hospital, the main centers of Ear, Nose, and Throat in Tehran, Iran from April 2018 to January 2020. Fungal colonization patterns were assessed using DNA sequencing techniques. Furthermore, the susceptibility to fluconazole, amphotericin B, nystatin, and white vinegar was evaluated according to the Clinical and Laboratory Standards Institute (CLSI) guidelines., Results: Resident fungal species from the upper airways colonized all the 66 TVPs (100%). Diabetes (31%) and smoking (98%) were the predominant underlying disease and predisposing factors, respectively. Among the 79 fungal agents isolated from the 66 TVPs, Candida glabrata (n=25, 31.7%) was the most common. A significant reduction in minimum inhibitory concentration (MIC) values were observed for white vinegar when used alone ( P <0.05)., Conclusion: White vinegar at a very low concentration could decrease the amount of fungal colonization on TVPs without any adverse effects; its wide accessibility and affordability ensure a decrease in the overall health cost., Competing Interests: Conflict of interest The authors declare that there is no conflict of interests., (Copyright © 2022 Kamali Sarvestani et al. Published by Tehran University of Medical Sciences.)

Background: Candida albicans remains the main cause of candidiasis in most clinical settings. Available drugs for candidiasis treatment have many side effects. In this work, novel nitroglycerin derivatives were synthesized and their cytotoxic and antifungal effects evaluated against fluconazole susceptible and resistant clinical C. albicans isolates., Methods: This experimental study was performed in Tehran University of Medical Sciences and Baqiatallah University of Medical Sciences, Tehran, Iran between Feb to Dec 2019. The in vitro activities of two novel nitroglycerin derivatives (1b and 2b) against 25 clinical fluconazole-susceptible and resistant C. albicans isolates and four standard C. albicans strains were determined according to CLSI reference M27-A3 documents. The cytotoxicity of chemical compounds was investigated near the SNL76/7 cells by colorimetric assay. Real-time PCRs were performed to evaluate the alterations in the regulation of ERG11 and CDR1 genes under nitroglycerin derivatives-treated and untreated conditions., Results: The derivatives 1b and 2b exhibited potent antifungal activity against C. albicans isolates; MICs and MFCs varied from 18 μg/ml to 72 μg/ml and 36 μg/ml to 144 μg/ml, respectively. The cell viability evaluation demonstrated that both chemical compounds are safe within 24h. The nitroglycerin derivatives were able to reduce the transcription level of CDR1 and ERG11 genes in all susceptible and resistant C. albicans isolates., Conclusion: Considering the potential and efficacy of these compounds against clinical C. albicans isolates, the complementary in vivo and clinical trials should be investigated., Competing Interests: Conflict of interest The authors declare that there is no conflict of interests., (Copyright © 2021 Rashidi et al. Published by Tehran University of Medical Sciences.)

Background: Mucormycosis is an acute and invasive fungal infection with a high mortality rate. Mucorales are less sensitive than other types of fungi to most antifungal agents. Amphotericin B (AMB) is one treatment option for this infection, but in recent studies, the antifungal activity of statins against Mucorales was shown. Therefore, therapy that combines AMB with these agents may have better effects in management of patients with mucormycosis. We evaluated the in vitro activity of AMB alone and in combination with statins, against Mucorales., Methods: Susceptibility profiles of AMB alone and in combination with two statins, atorvastatin (ATO) and lovastatin (LOV) determined against clinical (n: 15) and environmental (n: 5) Rhizopus oryzae isolates, obtained between Jan 2009 and Oct 2016 from patients with uncontrolled diabetes mellitus and cancer referred to the Department of Parasitology and Medical Mycology of Tehran University of Medical Sciences, Tehran, Iran. It was performed by microdilution method, based on the Clinical and Laboratory Standard Institute (CLSI) M38-A2 guideline., Results: All clinical and environmental isolates were susceptible to AMB (MIC≤1 μg/mL). The results of the interactions between AMB and the two statins were positive. The AMB-ATO (GM: 0.13 μg/Ml) combination produced greater activity than the AMB-LOV (GM: 0.26 μg/mL) combination. AMB, in combination with ATO and LOV, reacts positively against clinical and environmental R. oryzae isolates., Conclusion: This combination strategy may lead to more effective treatment of mucormycosis and fewer side effects using low dose of AMB., Competing Interests: Conflict of interest The authors declare that there is no conflict of interests.

Background: Otomycosis is a superficial infection of the ear caused by a spectrum of various fungal agents and its epidemiology depends on geographical region and climatic condition. The aim of this study was to investigate the causal agents and clinical manifestations of otomycosis at a tertiary referral center in Tehran, Iran., Methods: From Apr 2016 to Jan 2017 a set of 412 subjects with suspicion of external otitis were included. Clinical examination and specimen collection were performed by an otorhinolaryngologist. Subsequently, direct examination and culture were performed on specimens and isolated molds were identified morphologically. Yeast isolates were identified using CHROMagar Candida medium and PCR-RFLP of ribosomal DNA whenever needed. Data were analyzed using SPSS., Results: Otomycosis was confirmed in 117 cases (28.39%) including 64 (54.7%) males and 53 (45.3%) females. Patients were within the age range of 10-75 yr and the highest prevalence was found in the age group of 46-55 yr (30.77%). Pruritus (89.74%) and auditory manipulation and trauma (83.76%) were the predominant symptom and predisposing factor, respectively. Among 133 isolates from 117 patients, Aspergillus niger (n=50, 37.59%) was the most common etiologic agent and Candida glabrata (n=25, 18.8%) was the predominantly isolated yeast. Furthermore, 16 cases of mixed infection were identified and coinfection due to A. niger and C. glabrata (seven cases) was the predominant pattern., Conclusion: Our results revealed the high prevalence of C. glabrata and mixed infections in otomycosis patients. Therefore, mycological examinations should be considered for proper treatment., Competing Interests: Conflict of interest The authors declare that there is no conflict of interests.

Background: Dermatophytosis is known as one of the most frequent cutaneous infections that lead to public health problems to human and animals. The purpose of this study was to determine the prevalence of human dermatophytosis due to zoophilic species in Tehran, Iran from 2014 to 2015., Methods: Overall, 3989 patients with clinically suspected fungal infections were studied. Samples of skin, hair, and nails were examined by direct examination and culture. Direct microscopic examination was performed by KOH 15% for skin, KOH and DMSO for nail clippings and lactophenol for hair. Specimens were cultured on Sabouraud dextrose agar and mycobiotic agar., Results: Of 3989 patients, 755 (19%) suffered from dermatophytosis. Out of isolated dermatophytes, 716 (94.8%) anthropophilic, 35 (4.6%) zoophilic and 4 (0.5%) were geophilic species. Among of 35 patients with zoophilic dermatophyte infections, 65.7% were female. The most common type of zoophilic dermatophytosis according to anatomical areas was tinea manuum (34.3%) followed by tinea faciei (22.9%), tinea pedis (20%). Trichophyton verrucosum (57.1%) was the most commonly causative agents of zoophilic dermatophyte infections followed by Microsporum canis (42.9%)., Conclusion: Our study showed epidemiological trends in the etiology of the agents causing dermatophytosis have changed in Tehran. Although the prevalence of zoophilic species declined in recent years, due to the tendency of most people to change lifestyles and increased urbanization, promotion of public health care and identification of new preventive and therapeutic strategies are necessary., Competing Interests: Conflict of interest The authors declare that there is no conflict of interests.

Background: Intertrigo is an erythematous inflammatory condition with multiple etiologies including fungi and bacteria. Intertrigo manifests in different clinical forms with various complaints. This study was conducted to evaluate the causative agents of intertriginous infections with emphasize on clinical presentations., Methods: This descriptive cross-sectional study was carried out in 2015-2016, on 188 patients with clinical suspicion of superficial and cutaneous intertriginous infections in Tehran, Iran. Demographic and additional related data were obtained by questionnaire from all participants. Specimens were collected by gentle scraping of the affected areas. Direct examination and culture were performed for all specimens and grown colonies were identified based on the macroscopic and microscopic features. Supplementary tests were done whenever needed. Data were analyzed in SPSS., Results: Overall, 80 (42.5%) cases with the mean age of 43.5 yr were confirmed for intertrigo. Dermatophytosis was the predominant cause in this study with 36 (45%) cases followed by erythrasma (28 cases, 35%), tinea versicolor (10 cases, 12.5%) and candidiasis (6 cases, 7.5%). Intertrigo lesions with dermatophytic agents significantly were observed in groin in comparison to different infections among body sites ( P <0.05). Itching was the most common clinical presentation (57 cases, 71.3%) and also significant association between different infections and clinical manifestations were observed ( P <0.05)., Conclusion: Different clinical manifestations may be observed in infectious intertrigo. Regarding the significant association observed in this study, some clinical features can be used for presumptive diagnosis of diseases but further studies are required to make it clear., Competing Interests: Conflict of interest The authors declare that there is no conflict of interests.

Background: Aspergillus fumigatus is a major cause of allergic syndromes, aspergilloma and life-threatening invasive infections in immunocompromised hosts. To date, a wide range of mutations in A. fumigatus have been described conferring azole-resistance, which commonly involves modifications in the cyp51A -gene (substitutions at codons G54, G138, P216, F219, M220, G448 and specifically codon L98 in combination with a 34-bp tandem repeat in the promoter region of the gene), the target for azole antifungals. We investigated the prevalence of azole-resistance in clinical A. fumigatus isolates obtained from patients in Iran during 2010 to 2014., Methods: Overall, 172 clinical A. fumigatus isolates obtained from patients with underlying disease including transplantation, granulocytopenia, chronic liver disease, chronic obstructive pulmonary disease (COPD) and allergic bronchopulmonary aspergillosis (ABPA). Samples were collected between Jan 2009 and Nov 2014 from five provinces of Iran (Tehran, Shiraz, Isfahan, Khorasan razavi and East Azerbaijan). Antifungal susceptibility test was determined according to EUCAST reference method for itraconazole (ITC), voriconazole (VRC) and posaconazole (POS). All isolates were confirmed by amplification of the partial tubulin gene., Results: Of 172 A. fumigatus isolates tested, six isolates (3.5%) had high MIC values of ITC (>16 mg/L) and VRC (≥4 mg/L). All six isolates showed a multi-resistant phenotype with high MICs of ITC and VRC., Conclusion: We determined in-vitro susceptibility a profile of 172 clinically isolates of A. fumigatus against triazole in Iran. Azole-resistance is an emerging problem in A. fumigatus and international surveillance is warranted., Competing Interests: Conflict of interest The authors declare that there is no conflict of interests.

Background: Fungal rhino sinusitis (FRS) is an important infection of para nasal sinuses, which encompasses two main categories; invasive and noninvasive forms according to histopathological findings. Aspergillus spp are the most common species isolated from noninvasive form, while Mucorales are more frequently isolates from acute infections., Methods: Four hundred fifty patients suspected to fungal rhino sinusitis were investigated in a cross-sectional prospective study from June 2009 to Sep 2013. All patients under went endoscopic sinus surgery of the middle meatus. Tissue biopsies were investigated for culture, histopathology and molecular examination., Results: Totally, 87 patients were diagnosed with fungal rhinosinusitis. A. flavus was the most common etiological agent of chronic invasive form (CIFRS), allergic fungal rhino sinusitis (AFRS) and fungus ball (FB), while Rhizopus oryze (26.7%) was the most common cause of infection in acute invasive fungal rhino sinusitis (AIFR). However, a few rare species such as Shyzophyllum commune and Fusarium proliferatum were also isolated., Conclusion: Diabetes is the most important predisposing factor for patients with acute invasive form of sinusitis and the most involved sinuses were unilateral multiple sinuses and maxillary sinus.

Actinomycosis is an indolent, slowly progressive infection caused by anaerobic or microaerophilic bacteria, primarily of genus Actinomyces, which colonize the mouth, colon and vagina. Mucosal disruption may lead to infection virtually at any sites in the body. The aim of this study was to underline different features of actinomycosis and to represent total data about etiologic agents, clinical, diagnostic and therapeutic approaches these infections. From a total of 38 case reports or series, ninety one cases were obtained by using of relevant articles reported as recorded cases in Iran (1972 to 2012). Analyzed data represented 21 cases of oral-servicofacial (23.1%), 7 cases of thoracic (7.7%), 17 cases of abdominal (18.7%), 21 cases of disseminated forms (23.1%) and 25 cases of others (27.5%). Findings indicated more common of these infections in men (61.5%). Actinomyces naeslundii (21 cases) was found as the most common causative agents in comparison with A. Israeli (15 cases), A. viscosus (3 cases) and A. bovis (1 case). The most patients had been successfully treated with penicillin although some cases needed surgery along with antibiotic therapy. Since some clinical features of actinomycosis are similar to malignancies, so the differential diagnosis of invasive forms must be considered. This report emphasizes on the importance of differential diagnosis of actinomycosis from similar diseases by clinicians.