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Aim: We report two cases of pediatric patients diagnosed and treated for pediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS) symptoms. Materials & methods: Two previously healthy 3- and 4-year-old boys were referred to the hospital after 5 days of 39°C fever, with symptoms such as erythema multiform in the lower extremities, irritability, refusal to eat, restlessness, lymphadenopathy, conjunctivitis and abnormal echocardiography. Results: After 8 days of hospitalization, the patients showed normal laboratory tests, improvement of clinical condition and were discharged from the hospital. Conclusion: This study raised several issues for physicians about SARS-CoV-2, its complications, diagnosis and treatment. Based on our results, pediatrics with PIMS-TS should be first screened for SARS-CoV-2, then treated with a combination of antivirals, anti-inflammatories, antibiotics and intravenous immune globulin.

Background Hepatic Actinomycosis (HA) is one of the infections that causes disorders in patients when diagnosed untimely and inappropriately. Methods Case reports on HA in patients published between 2000 and April 2020 were gathered by carrying out a structured search through PubMed/Medline. Results Through a survey of the Medline database, 130 studies were identified and then, 64 cases with HA were included in the final analysis. Asia had the largest share of cases with 37.5% (24 reports), followed by Europe and the Americas. Affected patients were predominantly males (64%) and the overall mortality rate was 1% with only one male patient in his 50 s dying. Nearly all patients (92%) were immunocompetent. However, in four patients, the use of immunosuppressive medication led to depression of the immune system. Most of the patients (80%) experienced complications. In terms of the complications, the most frequent ones were previous history of abdominal surgery (32%) and foreign bodies in the abdominopelvic region (20%). Actinomyces israelii was the most common pathogen isolated from patients. Abdominal pain (66%), fever (62%), weight loss (48%), night sweat, malaise, and anorexia (14%) over about 3.1 months were the most frequently reported clinical symptoms. Extension to one or more surrounding organs was evident in 18 patients (28%). Histopathologic examination confirmed infection in 67% of the patients and samples obtained from liver puncture biopsy (32%) were most frequently used in diagnosis. Surgery or puncture drainage + anti-infection was the most common method to treat patients and penicillin, Amoxicillin, Doxycycline, and ampicillin were the most frequently used drugs to control infection. Conclusion HA should be considered in patients with a subacute or chronic inflammatory process of the liver. With accurate and timely diagnosis of infection, extensive surgery can be prevented.

Background and Aim: Prevalence of drug resistance in Candida albicans hinders common treatments with conventional antifungal drugs. A stockpile of research is being done to discover novel antifungal drugs. Chitosan has emerged as a promising antimicrobial and biodegradable polymer with various medical applications. The significant antimicrobial potential of some of the secondary metabolites from plants has been confirmed in several studies. Thymol, Carvacrol, and Isothiocyanate are three plant secondary metabolites with strong antifungal properties. In this study, the synergistic effect of Thymol, Carvacrol, and Isothiocyanate with chitosan against C. Albicans was tested. Materials and Methods: The minimum inhibitory concentration and synergistic effects of chitosan with Thymol, Carvacrol, and Isothiocyanate were assessed in checkerboard assay. The minimum fungicidal concentrations against C. Albicans, time-kill assay, and growth curve were tested subsequently. Results: The results of the checkerboard test confirmed the synergistic effects of chitosan with all three investigated plant metabolites. The Chitosan- Thymol combination represented the most effective antifungal activities against C. Albicans based on the time-kill and growth curve assay results. Conclusion: Chitosan- Thymol combination can be a promising compound for control of C. Albicans. Chitosan- Thymol combination sharply declined the number of viable cells during the first two hours. This ability can be tested in further studies as a biopolymer or nano-capsulated drug.

Bacterial and fungal bioaerosols are a global concern due to nosocomial infections, especially in developing countries. Our study aimed to detect fungal and bacterial bioaerosols in different wards of an obstetrics and gynecology hospital air samples. 240 bioaerosol samples were collected by performing impaction method from different wards of a hospital in the central part of Iran, during two seasons. Fungi genera and bacteria species are recognized by cultivation. Concentrations of bacteria and fungi were ranged from 44 to 75 CFU/m3 and 8 to 22 CFU/m3, respectively. Labor Delivery and Recovery (LDR) and Emergency room had first and second most contaminated air among all the hospital wards. No significant difference between microbial load of wards which used natural ventilation and heating, ventilating, and air conditioning (HVAC) system was observed. The microbial load was not affected significantly by temperature, working shift, and Inpatient Bed Occupancy Rate (IBOR). Fungal load related significantly with relative humidity. Staphylococcus aureus (detected in 48.3% of samples) and Penicillium (27%) were the most predominant isolated bacteria and fungi, respectively. The results revealed that the level of bacteria and fungi responsible for nosocomial infections in the air of this hospital is very low. Although levels of microbial contamination are relatively low, it is important to investigate the effect of bioaerosols on nosocomial infections, especially in neonates.

Patients with diabetes are considered a high-risk group involved with cerebral mucormycosis (CM). Due to the potential of Mucorales to invade sinuses and its rapid progression into orbit and retro-orbital areas and even brain, in most cases, CM is fatal in patients with diabetes. In the last few decades, mucormycosis and background conditions responsible for the development of its infections have received a great deal of attention. Dysfunction of innate and adaptive immune system, the increased amount of available nutrition, expression of host factors, and free iron level in plasma in diabetic ketoacidosis are among the topics that have been mostly taken into account so far. Therefore, it is important to clarify the molecular mechanisms that let the Mucorales to involve the patients with diabetes, which even at early stages of diagnosis and treatment, there is minimum chance to control the disease.

In patients with hematologic malignancies due to immune system disorders, especially persistent febrile neutropenia, invasive fungal infections (IFI) occur with high mortality. Aspergillosis, candidiasis, fusariosis, mucormycosis, cryptococcosis and trichosporonosis are the most important infections reported in patients with hematologic malignancies that undergo hematopoietic stem cell transplantation. These infections are caused by opportunistic fungal pathogens that do not cause severe issues in healthy individuals, but in patients with hematologic malignancies lead to disseminated infection with different clinical manifestations. Prophylaxis and creating a safe environment with proper filters and air pressure for patients to avoid contact with the pathogens in the surrounding environment can prevent IFI. Furthermore, due to the absence of specific symptoms in IFI, rapid and accurate diagnosis reduces the mortality rate of these infections and using molecular techniques along with standard mycological methods will improve the diagnosis of disseminated fungal infection in patients with hematologic disorders. Amphotericin B products, extended-spectrum azoles, and echinocandins are the essential drugs to control invasive fungal infections in patients with hematologic malignancies, and according to various conditions of patients, different results of treatment with these drugs have been reported in different studies. On the other hand, drug resistance in recent years has led to therapeutic failures and deaths in patients with blood malignancies, which indicates the need for antifungal susceptibility tests to use appropriate therapies. Life-threatening fungal infections have become more prevalent in patients with hematologic malignancies in recent years due to the emergence of new risk factors, new species, and increased drug resistance. Therefore, in this review, we discuss the different dimensions of the most critical invasive fungal infections in patients with hematologic malignancies and present a list of these infections with different clinical manifestations, treatment, and outcomes.

Background: Pulmonary disorders caused by parasites are common in many tropical regions. Acanthamoeba is an opportunistic parasite, and most of its dangerous complications are seen in patients with immune deficiencies. Considering the high dissemination of Acanthamoeba parasite in water, soil, and fine airborne dust in Iran, this research was performed to study the rate of pulmonary secretions infection to Acanthamoeba in patients with immune system disorder. Materials and Methods: This cross-sectional study was done in one year (2017 to 2018) in Arak City. The study sample was selected from immunodeficient subjects who had chronic obstructive pulmonary disease, too. The demographic data were also collected from all study samples. The respiratory sample was obtained from each selected patient by Bronchoalveolar Lavage (BAL). Each sample was examined by smear staining, cultivation, and molecular methods. Results: Out of 64 immunocompromised patients investigated in the current research, the Acanthamoeba infection was found in 100%, 98.4%, and 0% of their BAL with culture, molecular, and direct methods, respectively. Conclusion: The outcomes of our research indicated that selecting the diagnostic method in agreement with the kind of sample has a remarkable role in recognizing the contamination. The results of this research showed that the direct microscopy test of Giemsa stained smear was not suitable for detecting this kind of parasitic infection in the BAL sample. Therefore, awareness of the occurrence of Acanthamoebiasis in immunocompromised subjects is essential for preventing the dangerous complications of this parasite.

Airborne bacteria and fungi in hospital environments are of great concern due to their potential role as a source of nosocomial infections. The aim of this study was to evaluate concentration and diversity of airborne bacteria and fungi in relation to particle mass concentration in sensitive wards of a pediatric hospital. The study was performed in the cardiac care unit (CCU), the neonatal intensive care unit (NICU), the cancer blood ward (BW), the ENT (ear, nose, throat) operation room (OT1) and the eye operation room (OT2). The air samples were collected by impaction using the single-stage Andersen sampler. The flow rate and sampling time of the pump were adjusted to 28.3 l/min for 5 min. The mean concentration of indoor airborne fungi and bacteria ranged from 0–63 to 19–356 CFU/m3, respectively. OT2 and CCU wards were the most contaminated wards for airborne bacteria and fungi, respectively (243 ± 77 vs. 30 ± 7 CFU/m3). The airborne Gram-positive cocci (Staphylococcus and Micrococcus) were the most detected bacterial genera (75%) in all indoor air samples, and the most prevalent genera in indoor environment were Cladosporium spp. (19%) followed by Penicillium spp. (16%), Aspergillus spp. (16%) and Paecilomyces spp. (10%). Results showed that the outdoor airborne bacteria and PM concentration at different sizes were significantly higher than indoors, suggesting that the indoor airborne particle may have originated from the outdoor air. There were significant positive relationships between indoor airborne fungi concentrations with indoor PM2.5 and PM10.

Aim This study aimed to develop a predictive model to predict patients' mortality with coronavirus disease 2019 (COVID-19) from the basic medical data on the first day of admission. Methods The medical data including the demographic, clinical, and laboratory features on the first day of admission of clinically diagnosed COVID-19 patients were documented. The outcome of patients was also recorded as discharge or death. Feature selection models were then implemented and different machine learning models were developed on top of the selected features to predict discharge or death. The trained models were then tested on the test dataset. Results A total of 520 patients were included in the training dataset. The feature selection demonstrated 22 features as the most powerful predictive features. Among different machine learning models, the naive Bayes demonstrated the best performance with an area under the curve of 0.85. The ensemble model of the naive Bayes and neural network combination had slightly better performance with an area under the curve of 0.86. The models had relatively the same performance on the test dataset. Conclusion Developing a predictive machine learning model based on the basic medical features on the first day of admission in COVID-19 infection is feasible with acceptable performance.

An important role has been recently reported for bacterial biofilm in the pathophysiology of chronic diseases, such as chronic rhinosinusitis (CRS). CRS, affecting sinonasal mucosa, is a persistent inflammatory condition with a high prevalence around the world. Although the exact pathological mechanism of this disease has not been elicited yet, biofilm formation is known to lead to a more significant symptom burden and major objective clinical indicators. The high prevalence of multidrug-resistant bacteria has severely restricted the application of antibiotics in recent years. Furthermore, systemic antibiotic therapy, on top of its insufficient concentration to eradicate bacteria in the sinonasal biofilm, often causes toxicity, antibiotic resistance, and an effect on the natural microbiota, in patients. Thus, coming up with alternative therapeutic options instead of systemic antibiotic therapy is emphasized in the treatment of bacterial biofilm in CRS patients. The use of topical antibiotic therapy and antibiotic eluting sinus stents that induce higher antibiotic concentration, and decrease side effects could be helpful. Besides, recent research recognized that various natural products, nitric oxide, and bacteriophage therapy, in addition to the hindered biofilm formation, could degrade the established bacterial biofilm. However, despite these improvements, new antibacterial agents and CRS biofilm interactions are complicated and need extensive research. Finally, most studies were performed in vitro, and more preclinical animal models and human studies are required to confirm the collected data. The present review is specifically discussing potential therapeutic strategies for the treatment of bacterial biofilm in CRS patients.

Background Aspergillosis of Central Nervous System (CNS) is a highly lethal infection in patients with leukemia and Stem Cell Transplantation (SCT). Methods Case reports of CNS aspergillosis in patients with leukemia and SCT published between 1990 and August 2020 were gathered using a structured search through PubMed/Medline. Results Sixty-seven cases were identified over the searches of the PubMed bibliographic database and then, 59 cases were included in the final analysis. Europe had the largest share of cases at 57.6% (34 reports), followed by Americas and Asia. Affected patients were predominantly males (58.6%) and the mean age of the patients was 36.1 years, while 62.7% of the patients were under the age of 50 years. The most common leukemia types include Acute Lymphoblastic Leukemia (ALL), Chronic Lymphocytic Leukemia (CLL), and Acute Myeloid Leukemia (AML) at 43.4%, 27.4%, and 23.5%, respectively. Furthermore, stem cell transplantation was reported in 11 cases. The overall mortality was 33%; however, the attributable mortality rate of CNS aspergillosis was 24.5%. Altered mental status, hemiparesis, cranial nerve palsies, and seizures were the clearest manifestations of infection and lung involvement reported in 57% of the patients. Histopathologic examination led to the diagnosis of infection in 57% of the patients followed by culture (23.7%), galactomannan assay (8.5%), and molecular method (3.3%). Amphotericin B and voriconazole were the most frequently used drugs for infection treatment. Good results were not obtained in one-third of the patients treated by voriconazole. Finally, neurosurgical intervention was used for 23 patients (39%). Conclusion CNS aspergillosis is a rapidly progressive infection in leukemic patients. Thus, these patients should be followed up more carefully. Furthermore, management of induction chemotherapy, use of different diagnostic methods, and use of appropriate antifungal can lead to infection control.

Background: Protozoa have the ability to replace the human lung. Over recent years, the incidence of pulmonary infections caused by these microorganisms has increased, particularly in individuals with an immunodeficiency. The use of appropriate diagnostic methods is particularly important in the identification of parasites in pulmonary secretions. Objectives: The present study aimed to evaluate and compare PCR-based diagnostic methods with the gold standard method to detect three pathogenic protozoa, including Toxoplasma, Cryptosporidium, and Microsporidia in bronchoalveolar lavage (BAL) samples obtained from immunocompromised patients with chronic obstructive pulmonary disease. Methods: A BAL sample of immunodeficient patients suffering from chronic obstructive pulmonary disease (COPD) was examined by direct microscopy and PCR methods. Results: In this study, we examined 64 patients with immunodeficiency accompanied by COPD. Microsporidia were not identified in the samples. Direct methods identified three and nine cases of Toxoplasma and Cryptosporidium, respectively. However, the molecular method identified two and two cases of pulmonary infection with these parasites. Conclusions: Determining the standard diagnostic method for parasites is dependent on factors, such as the type of specimen and the type of parasite. Based on the results of the present study, the direct microscopic method is the optimal diagnostic method for Toxoplasma and Cryptosporidium in BAL samples.

Chronic Rhinosinusitis (CRS) is a multifactorial disease, and different etiologies like metabolism and immunity disorders, bacterial superantigens, biofilms, and fungal allergens are known to develop this disease, especially the CRS with nasal polyps. Alternaria alternata (Alternaria) is one of the most prevalent airborne fungal species in the nasal discharge, which might have vigorous immunologic activities in nasal epithelial cells and play an essential role in the pathogenesis of CRS. Moreover, the interaction between this fungus and the innate and adaptive immune systems leads to the development of chronic inflammation. This inflammation may consequently instigate the CRS and nasal polyposis. The attenuation of surfactant protein synthesis or intracellular reserves and mucus hypersecretion could prevent the clearance of Alternaria from sinuses and may be correlated with colonization and re-infection of airborne fungi. Furthermore, higher expression of cathelicidin, thymic stromal lymphopoietin, toll-like receptors, and T helper 2-dominant immune responses can result in an IgE-mediated pathway activation and eosinophils degranulation. Moreover, higher local Alternaria-specific IgE was shown to be correlated with eosinophilic cationic proteins and might relate to nasal polyps. However, the role of genetic and environmental factors affecting CRS and nasal polyposis is not well studied. Likewise, further animal and clinical studies are required to better understand the role of Alternaria in CRS disease. The current article reviews the recent findings around the Alternaria-induced CRS and nasal polyposis.

Recently, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiologic agent of coronavirus disease 2019 (COVID-19), has led to a worldwide pandemic with millions of infected patients. Alteration in humans’ microbiota was also reported in COVID-19 patients. The alteration in human microbiota may contribute to bacterial or viral infections and affect the immune system. Moreover, human’s microbiota can be altered due to SARS-CoV-2 infection, and these microbiota changes can indicate the progression of COVID-19. While current studies focus on the gut microbiota, it seems necessary to pay attention to the lung microbiota in COVID-19. This study is aimed at reviewing respiratory microbiota dysbiosis among COVID-19 patients to encourage further studies on the field for assessment of SARS-CoV-2 and respiratory microbiota interaction.

Background Trichophyton tonsurans is the most common agent causing tinea gladiatorum in wrestlers and limited data on susceptibility profiles of Trichophyton tonsurans is available. Objectives We aimed to assess the in vitro activity of the common antifungal drug against a large collection of T. tonsurans. Materials/methods The in vitro activities to eight common antifungal drugs (sertaconazole, itraconazole, clotrimazole, fluconazole, butenafine, tolnaftate, terbinafine, and griseofulvin) against 128 clinical isolates of T. tonsurans strains, obtained from wrestlers with dermatophytosis, was performed according to CLSI M38-A2 broth microdilution document. Results The geometric mean minimum inhibitory concentration was the lowest for tolnaftate (0.022 µg/ml), followed by itraconazole (0.026 µg/ml), terbinafine (0.033 µg/ml), butenafine (0.088 µg/ml), griseofulvin (0.566 µg/ml), sertaconazole (2.875 µg/ml), clotrimazole (3.419 µg/ml), and fluconazole (12.540 µg/ml). Conclusions Evaluation of antifungal susceptibility of dermatophytes showed that tolnaftate and itraconazole were the most effective drugs against Trichophyton tonsurans and fluconazole had the least effect.

BACKGROUND Patients with diabetes are known as an important high-risk group for cerebral mucormycosis (CM). METHOD We conducted a structured search using PubMed/MEDLINE to collect both case reports and case series case (ie including at least two patients) onto CM in diabetic patient published between 2000 and March 2020. RESULTS Forty-five reports of individual cases and eighteen case series articles were included. India accounted for the largest share of reports with 37.7% and 38.8% of individual cases and case series, respectively. Mortality ranged from 0% to 100% in the case series. The overall mortality in the individual cases was 46.3%, and 64.2% of deaths were reported in patients with ketoacidosis diabetes. Facial swelling (53.3%), headache (44.4%), loss of vision (35.5%) and ophthalmoplegia (35.5%) were the most frequently reported clinical symptoms. In all patients except 4 (91.1%), CM was treated surgically; however, in many cases (42%), despite the use of surgery, death occurred. Amphotericin B deoxycholate (AMB) and lipid-based AMB (LAMB) were used as the first lines of treatment for all patients; however, posaconazole, echinocandins, hyperbaric oxygen therapy (HBOT) and deferasirox were used in combination for a number of patients. Posaconazole has been shown to have positive therapeutic effect; however, posaconazole, LAMB and HBOT are not commonly used in low-income and health-challenged countries. CONCLUSION Cerebral mucormycosis is a rapidly progressive infection in diabetic patients and carries immense morbidity despite early diagnosis and treatment. Low-income countries have had the highest number of reports of the disease in recent years, indicating the need to control diabetes in these countries.

Background: The heterogeneous nature of acute myeloid leukemia (AML) and the hurdle to find a suitable treatment strategy for this malignancy put this type of leukemia at the top of the list of the priorities for finding a valuable biomarker to improve its treatment and predict the outcome of the patients. Objectives: Given the involvement of the variety of signaling pathways, foremost the PI3K axis in the pathogenesis of human cancers, we aimed to investigate the expression of the most important downstream targets of this pathway to propose a plausible mechanism underlying AML pathogenesis. Methods: In this case-control study, the blood samples from 30 patients diagnosed with AML were collected and after extracting their RNAs, the expression levels of Akt, c-Myc, CIP2A, and PP2A were evaluated using qRT-PCR analysis. For the control group, we also collected blood samples from 10 healthy volunteers. Afterward, by applying statistical analysis, we determined the probable correlation between the expressions of the aforementioned genes. Results: There was a significant elevation in the expression levels of Akt, c-Myc, and CIP2A coupled with the meaningful reduction in the expression level of PP2A in AML samples. However, we failed to find any significant association between the expression level of the indicated genes and age, sex, and the percentage of the blasts. Conclusions: As the most straightforward interpretation of our results, we propose that probably the association between PI3K and c-Myc which is built through the interaction between CIP2A and PP2A may play a pivotal role in the pathogenies of AML and any component of this axis could serve as a potential new target for more profound treatment strategy. However, further detailed investigations in this field are required to clarify the exact role of this interesting testis-specific pathway in the context of hematological malignancies, in particular AML.

Background Toxoplasmosis is a parasitic infectious disease, and Toxoplasma gondii is the causative factor of this intracellular protozoan disease. Due to the lack of information about the rate of T. gondii in general papulation of Markazi Province in Iran, the current study was conducted to determine the prevalence of toxoplasmosis and the related risk factor analysis in the general population of Markazi Province. Methods This cross-sectional study was performed within 6 months on individuals who were referred to diagnostic laboratories in Markazi Province. The demographic and background information of the subjects were collected using a questionnaire. Three milliliters of blood samples was collected from the participants under sterile conditions. The sera were separated and evaluated for levels of anti-Toxoplasma IgG antibody using a commercial enzyme-linked immunosorbent assay (ELISA) method. The collected data were analyzed by the SPSS software using descriptive statistics and chi-square test. Results Out of 824 people from the general population of Markazi Province who were investigated in this study, 276 (33.5%) had anti-Toxoplasma antibodies in their blood. According to the logistic regression model, gender variables, location, marital status, and having a cat at home do not affect the chances of contracting the parasite. Furthermore, the chance of contracting the parasite in 41- to 50-year-olds is 0.85 times the one in the 20- to 30-year-olds. The prevalence of toxoplasmosis in men and women in Markazi Province was 33% and 34.5%, respectively. Conclusion The mean prevalence of T. gondii infection in the age groups of 20-40, and ≥ 40 years was estimated to be 24.7%, and 40.8%, respectively. These rates were significantly lower than the national results (44%, and 55%, respectively). Therefore, regarding to the health authorities, it is necessary to raise the level of awareness of people of the region, especially at-risk groups about the transmittance and prevention methods, and infection risk factors in order to prevent the occurrence of T. gondii infection and reduce the prevalence and incidence of the disease.

Summary Objective Dermatophytosis is one of the most common mycotic infections, which considered as a public health problem in the major of countries. This study evaluated the molecular epidemiology of dermatophytosis in patients referred to Farshchian hospital in Hamadan city with PCR-RFLP method. Materials and methods Four hundred and five specimens from clinically suspected patients of dermatophytosis were collected and analyzed by direct microscopic and culture. The isolates were identified by PCR-RFLP method using the MvaI restriction enzyme. Results Of the 405 specimens, 88 specimens were positive in direct examination and culture. Among the patients, 64.8% were males and35.2% females. Tinea pedis (31.8%) was the most common type of dermatophytosis followed by tinea corporis (22.7%), tinea cruris (20.5%), tinea capitis (10.2%), tinea manuum (5.7%), tinea faciei (4.6%) and tinea unguium (4.6%). Trichophyton interdigitale (36.4%) was the most common isolate followed by Trichophyton rubrum (27.3%), Epidermophyton floccosum (17%), Trichophyton tonsurans (11.4%), Microsporum canis (4.5%), Microsporum gypseum (2.3%) and Trichophyton benhamiae (1.1%). Conclusion Our finding showed that the anthropophilic dermatophyte species causing dermatophytosis are increasing, and molecular methods are reliable assays for accurse identification of dermatophyte species in epidemiological studies.

Summary Objective Fungal infections are common complication among hospitalized patients especially between who is immunocompromised. Wet cooling systems in the hospital environment play a critical role as a source of these infections. The aim of this study was survey of wet cooling system of hospitals for fungal contamination in Arak city. Materials and methods This study was conducted during May to September of 2016. Sampling was done as random. Samples were obtained from water and straw of 84 wet cooling systems of four hospitals in Arak city. Samples were cultured in Sabouraud dextrose agar medium contain of chloramphenicol. Identification of fungi was performed by Slide culture method. Results From 84 wet cooling systems, 32 (38.1%) were contaminated with fungi. The highest fungal contamination was found in wards of oncology and CCU. The most prevalent of fungi isolated in this study were Aspergillus spp. and Candida spp., respectively. Conclusion The findings of this descriptive cross-sectional study clearly indicate, in wards of the hospital that used wet cooling systems, there was considerable fungal contamination, particularly Aspergillus contamination. These results highlight a clear need for greater attention to the use of non-aqueous or closed circulation cooling systems, especially where susceptible patients receive medical care.

Background and Purpose: Rhino-orbito-cerebral mucormycosis (ROCM) is a rare disease with acute and fulminant manifestation. This infection is associated with high morbidity and mortality rates. Herein, we reviewed the manifestations, underlying conditions, medical treatments, and surgical interventions in ROCM patients admitted to a tertiary referral center in northern Iran over a seven-year period. Materials and Methods: In a retrospective analysis, 15 cases of ROCM were identified from 2007 to 2013 in Bu Ali Sina Hospital, Sari, Iran. All the ROCM cases were clinically diagnosed and confirmed by histopathological and/or mycological examination. The relevant demographic data, clinical, ophthalmic, and neurologic manifestations, underlying conditions, medical treatments, and surgical interventions were recorded and analyzed. Results: The mean age of the patients was 54±11 years (age range: 28–70 years); 26.7% of the patients were male and 73.3% female (male: female ratio of 1: 2.7). Uncontrolled diabetes was noted in at least 86.7% (13/15) of the cases. The maxillary sinuses were the most frequently involved sites (66.7% of the cases) followed by the ethmoid sinus. Amphotericin B in combination with surgical debridement was used in the treatment of 80% of the cases. Furthermore,73.3% of the patients who were diagnosed early and underwent medical and extensive surgical debridement of the infected tissues survived. Conclusion: Uncontrolled diabetes mellitus is considered to be the main predisposing factor for ROCM. To prevent and reduce mortality rate of this acute disease, early diagnosis based on clinical findings and biopsy is recommended. &nbsp

Background and Purpose: Sporotrichosis is a subcutaneous and chronic fungal infection that is caused by a dimorphic fungus, namely Sporothrix schenckii sensu lato. Lymphocutaneous sporotrichosis is the most clinical form, which accounts for nearly 80% of the cases of cutaneous sporotrichosis. Platelets contain several substances with antimicrobial properties. Regarding this, the present study was performed to investigate the effect of blood-based biomaterials, especially platelets in the treatment of lymphocutaneous sporotrichosis. Materials and Methods: This study was performed on 12 golden hamsters, divided into three groups of control, platelet-rich plasma, and platelet lysate. For the purpose of the study, Sporothrix conidia suspension was injected subcutaneously on the back of the animals. After the induction of subcutaneous lesions, the Gomori methenamine silver method was applied to verify lymphocutaneous sporotrichosis. Subsequently, plasma-rich platelet and platelet lysate were injected into the created lesions in the animals in 3-day intervals (due to the short lifetime of platelets). In the final sage, skin tissue samples were examined to check for the presence of yeast cells and their quantification. Results: The data were indicative of the presence of yeast cells with/without bud in the tissue of lymphocutaneous sporotrichosis lesions in the infected animals. Histological investigation revealed that each of the two biomaterials under study (i.e., plasma-rich platelet and platelet lysate) played a positive role in the removal of the yeast cells of sporotrichosis. Conclusion: The results of this study showed that both plasma-rich platelet and platelet lysate were able to effectively prevent from the progression of cutaneous sporotrichosis. Accordingly, much attention has been given to new therapies, including treatment with blood-derived biomaterials.

Background & Purpose: Humans act as an intermediate host for Toxocara canis and Toxocara cati. Toxocara may be an important risk factor for asthma in humans. The aim of the present study was to evaluate immunoglobulin G (IgG) anti-Toxocara canis antibody, using enzyme-linked immunosorbent assay (ELISA) in asthmatic patients (aged 5-15 years), referring to a clinic of pulmonary diseases in Arak, Iran. Materials & Methods: In this bi-group cross sectional study, serum samples were collected from 110 children with confirmed asthma and 70 children without asthma within one year. IgG anti-Toxocara antibody was detected via ELISA method. The collected data were analyzed, using SPSS. Results: The seroprevalence of antibodies against Toxocara species was estimated at 1.8% (two males) in asmathic children via ELISA method; however, no antibodies against Toxocara canis were detected in the control group. There was no significant correlation between the frequency of antibodies against Toxocara and variables such as age, gender, or place of residence (P>0.05). Moreover, the frequency of antibodies against Toxocara was not significantly correlated with contact with dogs, consumption of unwashed fruits and vegetables, or use of raw/undercooked sheep liver (P>0.05). Conclusion: The present study showed anti-Toxocara antibody in 1.8% of asthmatic children and determined the seroprevalence of toxocariasis in asthmatic children and adolescents in Arak, Iran. Based on the findings, the low rate of infection with Toxocara among asthmatic children may be attributed to acceptable personal hygiene and religious considerations.

Accurate identification of dermatophyte species is important both for epidemiological studies and for implementing antifungal treatment strategies. Although nucleic acid amplification-based assays have several advantages over conventional mycological methods, a major disadvantage is their high cost. The aim of this study was to develop a rapid and accurate real-time PCR-based high-resolution melting (HRM) assay for differentiation of the most common dermatophyte species. The oligonucleotide primers were designed to amplify highly conserved regions of the dermatophyte ribosomal DNA. Analysis of a panel containing potentially interfering fungi demonstrated no cross reactivity with the assay. To evaluate the performance characteristics of the method, a total of 250 clinical isolates were tested in comparison with the long-established PCR-RFLP method and the results were reassessed using DNA sequencing, as the reference standard method. The assay is able to type dermatophytes using normalised melting peak, difference plot analysis or electrophoresis on agarose gel methods. The results showed that, in comparison to PCR-RFLP, the developed HRM assay was able to differentiate at least 10 common dermatophytes species with a higher speed, throughput and accuracy. These results indicate that the HRM assay will be a useful sensitive, high throughput and cost-effective method for differentiating the most common dermatophyte species.

Objective Asymptomatic carriage is a condition of positive dermatophyte scalp culture without signs and symptoms of tinea capitis. Carriers are the source of dermatophytes that are able to transfer fungal agents to other people. The aim of this study was evaluating asymptomatic dermatophyte scalp carriage among students of primary schools in Arak city. Materials and methods Sampling by a sterilized hairbrush from scalp was performed among 3174 students. Hairbrush was inoculated onto Mycosel agar plates. Dermatophyte isolates were identified by PCR-RFLP using MvaI enzyme. In vitro antifungal susceptibility test was done according to the Clinical and Laboratory Standards Institute (CLSI) M38-A2 protocol. The antifungal drugs used included griseofulvin (GRZ), terbinafine (TER), itraconazole (ITC) and fluconazole (FLU). Results A total of 3174 schoolchildren were screened, 15 cases (0.48%) had a positive culture for dermatophytes. Asymptomatic carriers including 11 (73.3%) boys and 4 (26.7%) girls and their age range were between 7–12 years. Trichophyton tonsurans (80%), T. interdigitale (13.3%) and T. rubrum (6.7%) were the most common isolated dermatophyte. Based on the obtained antifungal susceptibility results, terbinafine had the lowest and fluconazole had the highest MIC values for all of the tested dermatophyte isolates. Conclusion In the study, T. tonsurans was the most common species isolated from asymptomatic carriers and of the four antifungals tested, terbinafine had the most active antifungal in vitro against all isolates. Identifying and treating scalp dermatophyte carriers can prevent the spread of tinea capitis in the community.

In vitro effects of vinegar on protoscolices of hydatid cyst Reza Hajihossein, Zahra Eslamirad *, dr.eslami@arakmu.ac.ir, Mahdi Mosayebi, Reza Ghasemikhah, Mojtaba Didehdar Department of Parasitology, School of Medicine, Arak University of Medical Sciences, Arak, Iran Abstract Objective To determine the effect of apple vinegar and balsamic vinegar on protoscolices of hydatid cyst. In this study, different concentrations of vinegar were tested at different exposure times. Methods Liver hydatid cysts of naturally infected sheep were obtained from Arak abattoir. Protoscolices were aspirated from cyst and were transferred into a dark container and stored at 4 °C for further use. Eight concentrations of vinegars (1%, 5%, 10%, 15%, 20%, 25%, 50% and 100% v/v) were used for 1, 2, 3, 4, 5, 10, 15, 20, 30, 40, 50 and 60 min. The viability of the protoscolices was confirmed by 0.1% eosin staining test under a light microscope. Results The scolicidal activity of apple and balsamic vinegar in concentration of ≥50% was 100%. The scolicidal activity of vinegar was dose dependent and also time dependent. Therefore, by increasing the exposure time as well as increasing the concentration of vinegar, the mortality rate increased. Conclusions The results of our study show that vinegar has scolicidal activity and its activity is related to the concentration and exposure time. ________________________________________ Keywords: Hydatid cyst; Scolicidal; Vinegar

Evaluating correlation between serum liver enzymes and toxocariasis: a case control study Hosein Miladi1 , Mojtaba Didehdar2 , Reza Hajihossein2 , Fatemeh Rafiei3 , Zahra Eslamirad2* 1 Emam Khomeini Hospital, Social Security Organisation, Arak, Iran 2 Department of Parasitology and Mycology, School of Medicine, Arak University of Medical Sciences, Arak, Iran 3 Department of Biostatic, School of Medicine, Arak University of Medical Sciences, Arak, Iran Objective: To evaluate the prevalence of toxocariasis in individuals with the normal and abnormal level of liver enzymes. Methods: In this case-control study, the serum samples were collected in the individuals referred to diagnostic laboratories of Arak in Iran. A total of 144 sera with abnormal level of liver enzymes were selected as cases and the same numbers of sera with the normal level of liver enzymes also were selected as controls. The sera were examined for anti-Toxocara IgG. Results: Twelve (4.2%) sera contained anti-Toxocara antibody and all of them were in the case group. Although the mean of all liver enzymes was significantly different in the two groups (P < 0.05), statistical test showed no relationship between the level of liver enzymes and toxocariasis. Conclusions: It was concluded that the liver enzyme alteration is not the valid indicator for predicting toxocariasis. Because the kind of liver dysfunction, that is caused by the larvae of Toxocara, is unspecified, and it seems factors such as the number of larvae can play a basic role for the emergence of alterations Keywords: Liver enzyme Toxocariasis Toxocara Diagnosis Correlation

Background: Vulvovaginal candidiasis (VVC) is a common infection, affecting up to 75% of women at least once during their lifetime. In addition, approximately 5% of patients may experience recurrent VVC. Candida albicans is the most common causative agent of VVC. Overall, precise identification of the causative agents of VVC is necessary for effective treatment. Objectives: The purpose of this study was to identify the molecular characteristics and antifungal susceptibility of Candida species, isolated from women with VVC in cities of Shoush, Dezful, and Andimeshk, Khuzestan Province, Iran. Methods: In this descriptive cross sectional study, vaginal samples were collected from 173 women with VVC, referred to gynecologists. The samples were cultured on Sabouraud dextrose agar, containing chloramphenicol. The ITS1-ITS4 region was amplified via polymerase chain reaction (PCR) assay and digested by MspI restriction enzyme. Antifungal susceptibility test was performed for 4 antifungal drugs (fluconazole, nystatin, itraconazole, and clotrimazole) via disk diffusion method. Results: Out of 173 patients, 95 (54.9%) showed VVC and 26 (27.4%) had recurrent VVC. The most common Candida species were C. albicans (70.5%), C. glabrata (20%), C. tropicalis (7.4%), and C. parapsilosis (2.1%), respectively. The antifungal susceptibility test showed resistance to fluconazole in 1 C. tropicalis, 2 C. albicans, and 3 C. glabrata isolates, while resistance to clotrimazole was detected in 1 C. albicans and 1 C. glabrata isolate. Conclusions: According to the results of this study, approximately 30% of VVC infections were caused by non-C. albicans species, which should be considered by gynecologists due to their azole resistance.

Background Toxoplasmosis is a common opportunistic infection that can be fatal in immunocompromised individuals, such as those with HIV/AIDS. Aims Considering the rising incidence of HIV/AIDS in human populations worldwide and the high risk of toxoplasmosis among these patients, the current epidemiologic study was conducted to identify the characteristics and leading risk factors of toxoplasmosis among HIV/AIDS patients in Arak City, Marzaki Province, Iran. Methods This cross-sectional study was conducted in HIV patients under the care and counselling of the local health centre of Arak City. We included a total of 49 patients with HIV/AIDS who completed a written informed consent form and a two-part questionnaire. Demographic data and information about various risk factors were collected in the questionnaire. Blood samples were collected from each patient. Anti-Toxoplasma gondii IgG and IgM antibody assays and PCR were conducted on serum samples. Logistic regression and chi-squared (χ2) tests were used for statistical analysis. P values less than 0.05 (p

Toxoplasmosis is a common zoonotic disease that can also be transmitted from the mother to the embryo, with the risk of congenital infection varying around the world. The aim of this study was to screen pregnant women and their neonates for toxoplasmosis by serologic and molecular methods and assess the impact of risk factors associated with toxoplasmosis on the rate of congenital infection. This study was conducted at a regional maternity hospital in Arak, the capital of the Markazi Province in Iran, during a period of six months. All selected pregnant women (n=261) and the corresponding cord blood samples were serologically screened for toxoplasmosis, with seropositive samples also undergoing molecular testing. Demographic data, as well as information related to the risk factors associated with the transmission of the disease, were collected from mothers and their neonates. The detection of anti-Toxoplasma antibodies and the extraction of DNA from blood samples were conducted using commercial kits. Results showed that the sera of 87 maternal blood samples (33.3%) and 40 cord blood samples (15.3%) were positive for anti-Toxoplasma antibodies (IgG and/or IgM). Molecular screening of the seropositive samples only identified one positive cord blood sample. In other words, the diagnosis of congenital toxoplasmosis was definitive in only one neonate. There was no significant association between the risk of parasite transmission and neonatal seropositivity (p >0.05). Therefore, the results showed that the prevalence of congenital toxoplasmosis in the studied area was consistent with the global rate and suggest that the implementation of newborn screening and follow-up testing could help reduce the disease risk.

Characterization of clinically important dermatophytes in North of Iran using PCR-RFLP on ITS region. Didehdar M1, Shokohi T2, Khansarinejad B3, Ali Asghar Sefidgar S4, Abastabar M5, Haghani I5, Amirrajab N5, Mondanizadeh M6. Abstract OBJECTIVE: Dermatophytosis is considered as one of the major public health problems in the world. Accurate identification of the dermatophytes species is important for recognition of the environment and animal sources of infection. In this survey, 1500 clinical specimens taken from outpatients suspected of dermatophytosis and they were examined by direct microscopy and culture. MATERIALS AND METHODS: In total, three hundred and twelve dermatophytes were isolates recovered in culture, they were identified using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method based on the ribosomal DNA internal transcribed spacer (ITS) regions. RESULTS: Tinea pedis was the most common clinical form (32.1%) followed by tinea cruris (24.4%), tinea manuum (16.4%), tinea unguium (8.3%), tinea corporis (7.3%), tinea faciei (6.4%), and tinea capitis (5.1%). Trichophyton interdigitale was the most frequent isolate (38.2%), followed by Trichophyton rubrum (29.8%), Epidermophyton floccosum (16.6%), Trichophyton tonsurans (14.8%) and Microsporum canis (0.6%). The frequency of dermatophytosis was higher in males than in females and in the age-group of 21-30 years. CONCLUSION: Our finding indicated that the incidence of dermatophytosis caused by anthropophilic dermatophytes in Mazandaran province is increasing. Also, this study provides valuable data for the prevention and control of dermatophytosis in the southern coast of the Caspian Sea. KEYWORDS: Dermatophytes; Identification moleculaire; Molecular identification; Nord de l’Iran; North of Iran