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Background: The burden of cryptococcosis in mainland China is enormous. However, the in vitro characterization and molecular epidemiology in Guangdong, a key region with a high incidence of fungal infection in China, are not clear. Methods: From January 1, 2010, to March 31, 2019, clinical strains of Cryptococcus were collected from six medical centres in Guangdong. The clinical information and characteristics of the strains were analysed. Furthermore, molecular types were determined. Results: A total of 84 strains were collected, mostly from male and young or middle-aged adult patients. Pulmonary and cerebral infections (82.1%) were most common. All strains were Cryptococcus neoformans, grew well at 37°C and had capsules around their cells. One melanin- and urea-and one melanin+ and urea- variants were found. Although most strains exhibited a low minimum inhibitory concentration (MIC) value for voriconazole (mean: 0.04 µg/mL) and posaconazole (mean: 0.12 µg/mL), the results for these isolates showed a high degree of variation in the MIC values of fluconazole and 5-fluorocytosine, and resistance was observed for 4 out of 6 drugs. A significant proportion of these strains had MIC values near the ECV values, particularly in the case of amphotericin B. The proportion of strains near the clinical breakpoints was as follows: fluconazole: 3.66%; voriconazole: 3.66%; itraconazole: 6.10%; posaconazole: 13.41%; amphotericin B: 84.15%; 5-fluorocytosine: 2.44%. These strains were highly homogeneous and were dominated by the Grubii variant (95.2%), VNI (94.0%), a mating (100%), and ST5 (89.3%) genotypes. Other rare types, including ST4, 31, 278, 7, 57 and 106, were also found. Conclusion: Phenotypically variant and non-wild-type strains were found in Guangdong, and a significant proportion of these strains had MIC values near the ECV values towards the 6 antifungal drugs, and resistance was observed for 4 out of 6 drugs. The molecular type was highly homogeneous but compositionally diverse, with rare types found. Enhanced surveillance of the aetiology and evolution and continuous monitoring of antifungal susceptibility are needed to provide references for decision-making in the health sector and optimization of disease prevention and control. [ABSTRACT FROM AUTHOR]

Candida species cause systemic candidiasis in immunocompromised cancer patients. Currently, a large proportion of bloodstream infections are due to non-albicans Candida species (Candida species other than C. albicans), with Candida tropicalis and Candida parapsilosis being the most isolated Candida species from cancer patients. In this study, 52 Candida isolates were collected from cancer patient at the Apeksha Hospital, Maharagama, Sri Lanka. Molecular identification of isolated Candida samples employed a multiplex PCR technique utilizing specific primer pairs for two strains of both Candida tropicalis and Candida parapsilosis. Furthermore, to determine the susceptibility of the identified isolates, antifungal susceptibility testing was conducted using the disk diffusion method on Mueller-Hinton agar medium. Six antifungal drugs, including Fluconazole, Itraconazole, Clotrimazole, Miconazole, Ketoconazole, and Amphotericin B, were utilized in the susceptibility testing. In this study 38% of the strains were identified as Candida tropicalis II while, 31% were identified as Candida parapsilosis II. According to this study Fluconazole was the most susceptible drug against both species and Amphotericin B was the least susceptible drug. Ketoconazole, Clotrimazole, Itraconazole and Miconazole showed varying degrees of susceptibility patterns. The study concludes that multiplex PCR is a better approach for the identification of both Candida tropicalis and Candida parapsilosis for clinical and diagnostic purposes and Fluconazole is the best antifungal drug against Candida parapsilosis, while caution is advised when using Amphotericin B as a treatment option since its' low susceptible rates. [ABSTRACT FROM AUTHOR]

Sporotrichosis is a neglected subcutaneous fungal infection that affects humans and animals worldwide caused by species belonging to the genus Sporothrix. This study aims to examine the range of genetic variations, assess molecular epidemiology significance, and explore potential modes of transmission of the Sporothrix species associated with the current sporotrichosis outbreaks in Espírito Santo, Brazil. In this investigation, 262 samples were evaluated, including 142 from humans and 120 from felines, collected between 2016 and 2021. The isolates were identified based on morphological and molecular characteristics. Sexual idiomorphs were determined by mating-type PCR using primers specific to the MAT1-1 and MAT1-2 loci. Amplified fragment length polymorphism (AFLP) was employed to assess the genetic variability of Sporothrix spp. Finally, antifungal susceptibility testing was performed following the CLSI M38-A2 protocol. Of the 142 human samples, 125 were identified as S. brasiliensis and 17 as S. schenckii s. str. The presence of S. brasiliensis was overwhelming (100%) during outbreaks, highlighting the significant role of domestic cats in the emergence of this species. Heterothallism was the only observed mating strategy. However, the MAT1-2 idiomorph was predominant in cases of cat-transmitted sporotrichosis (χ2 = 202.976; p < 0.0001). Our AFLP results show significant intraspecific variability observed among S. brasiliensis isolates in Espírito Santo. Different genotypes forming subgroups within the same population suggest that these isolates do not originate from a single ancestor, indicating multiple emergences. Furthermore, terbinafine was the antifungal with the best results in vitro. However, in clinical practice, itraconazole remains the primary treatment choice. Sporotrichosis continues to advance in the state; therefore, the health system must outline one-health strategies to contain the disease to prevent future epidemics. [ABSTRACT FROM AUTHOR]

Background: Candidemia is one of the common health care associated Blood Stream Infections (BSI). Frequency of isolation of various Candida species causing candidemia and their antifungal drug resistance trends in a health care setting can help in timely institution of appropriate empirical antifungal treatment. Aim and Objectives: To observe the species distribution of various Candida species isolated from suspected cases of BSI and their antifungal susceptibility pattern in a tertiary care hospital from western Uttar Pradesh. This study was conducted to speciate Candida isolates isolated from blood culture samples and their antifungal susceptibility testing. Material and Methods: This study was conducted in the Department of Microbiology, Subharti Medical College and associated Chhatrapati Shivaji Subharti Hospital, Meerut for a period of one year. Blood culture was done by BacT/Alert automated blood culture system from BioMerieux, France. Candida isolates recovered from blood culture were further processed for speciation using conventional morphological and biochemical characteristics and antifungal susceptibility testing by Kirby Bauer disk diffusion method. Results: Out of total 70 Candida isolates isolated during the study period C. tropicalis was the predominant isolate accounting for 34.28% followed by C. parapsilosis. The occurrence of candidemia was higher in Intensive Care Units (ICUs) patients (70.83%). Antifungal drug voriconazole was found to be sensitive against all the Candida isolates. Conclusion: Mycological shift towards the isolation of NAC species indicates a changing trend and changing antifungal drug resistance profile accordingly have to be considered before initiation of empirical antifungal treatment.

Introduction: The incidence of fungal infections and resistant isolates has risen exponentially due to multiple factors. This makes the isolation of fungi, performing identification, and susceptibility testing a necessary routine microbiological procedure. Assessing the burden and analysing the epidemiologic trends of fungal infections is critical for patient management. Aim: To determine the prevalence of various fungal infections affecting the lower respiratory tract. Materials and Methods: In this cross-sectional study conducted at Department of Microbiology, Netaji Subhash Chandra Bose (NSCB) Medical College Jabalpur, Madhya Pradesh, India specimens from 400 patients with suspected Lower Respiratory Tract Infection (LRTI) were processed following standard microbiological methods for fungal culture and sensitivity testing. All the fungal isolates were obtained and their antifungal susceptibility pattern were recorded. The data entry was done in a Microsoft Excel spreadsheet, and the final analysis was performed using the Statistical Package for Social Sciences (SPSS) software, version 25.0, developed by IBM in Chicago, USA. Results: The majority of the assessed specimens were sputum (285, 71.2%). Out of the 115 Candida isolates, C.albicans (61, 53%) was the most common species isolated. Among the Non-Candida albicans Candida (NCAC) group, C. tropicalis (32, 27.8%) was the predominant isolate, followed by C. glabrata (16, 13.9%) and C. krusei (6, 5.2%). C. albicans was found to be the most prevalent in the elderly population (>60 years of age), whereas NCAC was prevalent in the 46-60 years age group. Regarding the antifungal drug susceptibility pattern, significantly higher drug resistance was seen in the NCAC group compared to C. albicans towards agents such as ketoconazole, fluconazole, itraconazole, voriconazole, amphotericin-B, and nystatin. None of the fungal isolates demonstrated resistance to caspofungin. Conclusion: Fungal aetiology is a significant problem in patients with LRTI, which often remains underdiagnosed, increasing morbidity and mortality. Therefore, it should be kept in mind while managing a patient with LRTI.

Phaeohyphomycosis, which is caused by the opportunistic black yeast-like fungus Exophiala dermatitidis, has been reported in humans and dogs. However, no previous studies describing E. dermatitidis infections in cats have been published. Herein, we report a case of subcutaneous phaeohyphomycosis caused by E. dermatitidis. A 12-year-old, castrated male Japanese domestic short-haired cat presented with a solitary subcutaneous abscess on the left side of the neck, where an esophageal tube for force-feeding had been placed previously. The cat was diagnosed with hepatitis and was treated with prednisolone. The subcutaneous abscess was incised using a scalpel blade and the pus was excreted. The cytology of the pus revealed hyphae with neutrophil and macrophage infiltration. Although the cat was treated with oral itraconazole or an infusion of topical ketoconazole cream applied to the lesion, it died. The fungal culture of the pus specimen developed dark-green, waxy, smooth, yeast-like colonies. Sequencing of the internal transcribed spacer 1–4 regions of the ribosomal DNA of the pus specimen showed 100% identity with that of the standard strains of E. dermatitidis. Based on these results, the cat was diagnosed with subcutaneous phaeohyphomycosis caused by E. dermatitidis. The antifungal susceptibility test revealed that the fungus showed low or moderate susceptibility to the antifungal drugs examined, except for amphotericin B, which exhibited high in vitro antifungal activity. This is the first case report to provide definitive evidence of E. dermatitidis infection in cats and antifungal susceptibility test results against clinically isolated E. dermatitidis.

Background: Oral candidiasis is an infection that follows colonization of oral cavity by Candida species mostly Candida albicans. About 90% of HIV-infected persons develop this disease during the course of HIV infection and could serve as early sign of HIV-related immunodeficiency. Treatment involves the use of antifungal drugs. The objectives of this study are to determine the prevalence of oral candidiasis and the susceptibility of isolated Candida species to available antifungal agents among selected HIV-infected patients in a mission hospital, southeast Nigeria. Methodology: This was a descriptive cross-sectional study of 150 consecutively selected HIV-infected patients attending the Heart-to-Heart clinic of Iyi-Enu mission hospital Ogidi, Anambra State, Nigeria, between December 2022 and February 2023. Demographic information of each participant was obtained using structured questionnaire. Five milliliters of whole blood were drawn from the antecubital vein of each participant for CD4+ estimation. Mouth specimens were collected using two sterile cotton swabs for microscopy and culture on Sabouraud Dextrose Agar, and Candida species were identified after subculture on CHROMAgar. Antifungal susceptibility testing was performed by Kirby-Bauer disk diffusion method using fluconazole, clotrimazole, ketoconazole, and nystatin disks, and results interpreted according to the guidelines of the Clinical and Laboratory Standards Institute. Results: A total of 98 (65.3%) HIV-infected participants were positive for oral candidiasis, with 4 species of Candida isolated; Candida albicans (62.2%), Candida glabrata (18.4%), Candida tropicalis (12.2%) and Candida krusei (7.1%). Fifty-nine (60.2%) of the 98 participants had CD4+ cell count ˂ 200, 33 (33.7%) had counts in the range of 200-399, and 6 (6.1%) had counts in the range of 400-499 cells/µL (p=0.001). The prevalence of candidiasis was not significantly different between the female (67.0%, 65/97) and male (62.3%, 33/53) participants (p=0.6598), but the prevalence was significantly higher (p<0.05) in participants age group 21-30 years (80.7%, 42/52), divorced (100%, 1/1) and married (75%, 45/60), those with primary school level education (73.7%, 42/57), civil servants (85.7%, 18/21), and those who performed mouth hygiene once daily (71.9%, 69/96). Nystatin (77.6%, 76/98) showed the highest while fluconazole and ketoconazole (68.4%, 62/98) showed the lowest in vitro antifungal activity Conclusion: Oral candidiasis is prevalent among HIV-infected patients in the study population, with evidence of in vitro resistance of the Candida isolates to available antifungal drugs. Proper diagnosis, susceptibility testing and treatment of infection will be helpful in managing oral candidiasis infection among HIV infected patients. [ABSTRACT FROM AUTHOR]

The epidemiology of invasive fungal infections (IFIs) is currently changing, driven by aggressive immunosuppressive therapy, leading to an expanded spectrum of patients at risk of IFIs. Aspergillosis is a leading cause of IFIs, which usually affects immunocompromised patients. There are a limited number of antifungal medications available for treating IFIs, and their effectiveness is often hindered by rising resistance rates and practical limitations. Consequently, new antifungals, especially those with novel mechanisms of action, are increasingly required. This study assessed the activity of four novel antifungal agents with different mechanisms of activity, namely, manogepix, rezafungin, ibrexafungerp, and olorofim, against 100 isolates of Aspergillus section Terrei, containing amphotericin-B (AmB)-wildtype/non-wildtype and azole-susceptible/-resistant strains, according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) method. In general, all tested agents showed potent and consistent activity against the tested isolates, exhibiting geometric mean (GM) and minimum effective concentration (MEC)/minimum inhibitory concentration (MIC) ranges, respectively, as follows: manogepix (0.048 mg/L, 0.032–0.5 mg/L), rezafungin (0.020 mg/L, 0.016–0.5 mg/L), ibrexafungerp (0.071 mg/L, 0.032–2 mg/L), and olorofim (0.008 mg/L, 0.008–0.032 mg/L). In terms of MIC90/MEC90, olorofim had the lowest values (0.008 mg/L), followed by rezafungin (0.032 mg/L), manogepix (0.125 mg/L), and ibrexafungerp (0.25 mg/L). All the antifungals tested demonstrated promising in vitro activity against Aspergillus section Terrei, including A. terreus as well as azole-resistant and AmB-non-wildtype cryptic species. [ABSTRACT FROM AUTHOR]

Introduction: Dermatophyte infection has become extremely resistant and widespread in all parts of India during the past decade. A change in the major causative organism has been identified to be a major factor behind the change in the character of the infection. The epidemiological shift has been accompanied by large scale antifungal resistance. This review aims to take a look at the current status of evidence regarding the effectiveness of major antifungal molecules, with particular reference to the current epidemic-like scenario of resistant dermatophytosis in India. Methods: We have searched and included the relevant literature on “Dermatophytosis” from the PubMed, Scopus, and Google Scholar. Results: The current situation has also brought into focus the glaring lack of evidence-based guidelines for the management of dermatophytosis. The guidelines available previously had mostly been based on the western literature with the scarcity of studies from tropical countries such as India. Conclusion: The current guidelines of the management of dermatophytosis have lost their relevance in the present scenario and need to be replaced. However, without adequate studies we do not have robust data to formulate the new guidelines.

Background: Candidemia is one of the common health care associated Blood Stream Infections (BSI). Frequency of isolation of various Candida species causing candidemia and their antifungal drug resistance trends in a health care setting can help in timely institution of appropriate empirical antifungal treatment. Aim and Objectives: To observe the species distribution of various Candida species isolated from suspected cases of BSI and their antifungal susceptibility pattern in a tertiary care hospital from western Uttar Pradesh. This study was conducted to speciate Candida isolates isolated from blood culture samples and their antifungal susceptibility testing. Material and Methods: This study was conducted in the Department of Microbiology, Subharti Medical College and associated Chhatrapati Shivaji Subharti Hospital, Meerut for a period of one year. Blood culture was done by BacT/Alert automated blood culture system from BioMerieux, France. Candida isolates recovered from blood culture were further processed for speciation using conventional morphological and biochemical characteristics and antifungal susceptibility testing by Kirby Bauer disk diffusion method. Results: Out of total 70 Candida isolates isolated during the study period C. tropicalis was the predominant isolate accounting for 34.28% followed by C. parapsilosis. The occurrence of candidemia was higher in Intensive Care Units (ICUs) patients (70.83%). Antifungal drug voriconazole was found to be sensitive against all the Candida isolates. Conclusion: Mycological shift towards the isolation of NAC species indicates a changing trend and changing antifungal drug resistance profile accordingly have to be considered before initiation of empirical antifungal treatment. [ABSTRACT FROM AUTHOR]

Introduction: Dermatophyte infection has become extremely resistant and widespread in all parts of India during the past decade. A change in the major causative organism has been identified to be a major factor behind the change in the character of the infection. The epidemiological shift has been accompanied by large scale antifungal resistance. This review aims to take a look at the current status of evidence regarding the effectiveness of major antifungal molecules, with particular reference to the current epidemic-like scenario of resistant dermatophytosis in India. Methods: We have searched and included the relevant literature on "Dermatophytosis" from the PubMed, Scopus, and Google Scholar. Results: The current situation has also brought into focus the glaring lack of evidence-based guidelines for the management of dermatophytosis. The guidelines available previously had mostly been based on the western literature with the scarcity of studies from tropical countries such as India. Conclusion: The current guidelines of the management of dermatophytosis have lost their relevance in the present scenario and need to be replaced. However, without adequate studies we do not have robust data to formulate the new guidelines. [ABSTRACT FROM AUTHOR]

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Background and Purpose: Scedosporium spp. is a saprophytic fungus that may cause invasive pulmonary infection due to the aspiration of contaminated water in both immunosuppressed and immunocompetent hosts.Case report: Herein, we report a fatal case of pulmonary infection caused by Scedosporium species associated with a car crash and near-drowning in a sewage canal.Scedosporium aurantiacum isolated from bronchoalveolar lavage was identified by PCR-sequencing of β-tubulin genes. The minimum inhibitory concentration values for amphotericin B, itraconazole, posaconazole, isavuconazole were >16 µg/ml, and >8 µg/ml for anidulafungin, micafungin, and caspofungin. Voriconazole was found to be the most active agent with a MIC of 1 µg/ml.Conclusion: This report, as the first case of pulmonary scedosporiosis after near-drowningin Iran, highlights the importance of high suspicion in near-drowning victims, promptidentification of Scedosporium spp., and early initiation of appropriate antifungal therapy.

The epidemiology of invasive fungal infections (IFIs) is currently changing, driven by aggressive immunosuppressive therapy, leading to an expanded spectrum of patients at risk of IFIs. Aspergillosis is a leading cause of IFIs, which usually affects immunocompromised patients. There are a limited number of antifungal medications available for treating IFIs, and their effectiveness is often hindered by rising resistance rates and practical limitations. Consequently, new antifungals, especially those with novel mechanisms of action, are increasingly required. This study assessed the activity of four novel antifungal agents with different mechanisms of activity, namely, manogepix, rezafungin, ibrexafungerp, and olorofim, against 100 isolates of Aspergillus section Terrei, containing amphotericin-B (AmB)-wildtype/non-wildtype and azole-susceptible/-resistant strains, according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) method. In general, all tested agents showed potent and consistent activity against the tested isolates, exhibiting geometric mean (GM) and minimum effective concentration (MEC)/minimum inhibitory concentration (MIC) ranges, respectively, as follows: manogepix (0.048 mg/L, 0.032–0.5 mg/L), rezafungin (0.020 mg/L, 0.016–0.5 mg/L), ibrexafungerp (0.071 mg/L, 0.032–2 mg/L), and olorofim (0.008 mg/L, 0.008–0.032 mg/L). In terms of MIC90/MEC90, olorofim had the lowest values (0.008 mg/L), followed by rezafungin (0.032 mg/L), manogepix (0.125 mg/L), and ibrexafungerp (0.25 mg/L). All the antifungals tested demonstrated promising in vitro activity against Aspergillus section Terrei, including A. terreus as well as azole-resistant and AmB-non-wildtype cryptic species.

Background and Purpose: Radiation therapy in patients with head and neck malignancies predisposes them to oral Candida colonization and infection due to damage of oral mucosa and destruction of the salivary gland. This study aimed to determine the prevalence of oropharyngeal candidiasis (OPC) in patients with head and neck cancer (HNC) undergoing radiotherapy (RT), identify the yeasts isolated from them, and determine their antifungal susceptibility. Materials and Methods: This cross-sectional study was conducted from December 2018 to June 2019 at two referral radiotherapy centers in northern Iran. Yeast strains that were isolated from patients with HNC were identified using conventional and molecular methods. The in vitro activities of eight common antifungal drugs against 55 isolates were investigated according to the guidelines of the Clinical and Laboratory Standard Institute (M27-A3 and M27-S4) broth microdilution document. Results: Among 59 patients receiving RT, the prevalence of OPC was 21 (35.59%) and 15 (25.42%) patients were diagnosed with colonization. The mean age of the patients was 55.32±13.3 years (within the range of 27-87 years). In this study, the pseudomembranous form was reported as the most clinical type of OPC. Candida albicans with the frequency of 60% was the most common type of Candida spp. that was observed in this study, although non-albicans Candida spp., such as C. glabrata (27.27%), C. tropicalis (5.45%), C. parapsilosis (3.63%), C. krusei (1.83%), and C. kefyr (1.83%) were also isolated. Considering the low minimum inhibitory concentration range of amphotericin B, compared to fluconazole, administration of this agent is a more suitable antifungal drug for extensive oral candidiasis in these patients. Among azoles,clotrimazole had low efficacy and several studied isolates (65.5%) showed resistance. Conclusion: Correct diagnosis as well as determining drug sensitivity and risk factors are the effective steps in reducing the complications related to oral candidiasis in people undergoing RT.

Background: Despite an increasing trend of onychomycosis caused by Candida species in recent years, there is a scarcity of published data. Objective: To determine the epidemiological and clinical characteristics of Candida onychomycosis, to identify the prevalent, and perform in-vitro antifungal susceptibility testing (AFST) of the isolates. Methodology: A total of 506 consecutive patients with a clinical suspicion of onychomycosis were included in a cross-sectional clinical study. Nail scrapings and clippings were subjected to KOH examination and culture. Species identification and antifungal drug sensitivity testing were done for Candida isolates using Vitek 2YST Compact system using Vitek 2 cards. Results: Out of 384 (75.88%) culture-positive cases, dermatophytes were isolated in 58.08%, yeast in 26.30%, and NDM in 12.24%. Of the yeast, Candida albicans was isolated in 59.4% and non-albicans species in 40.59%. AFST showed that most of Candida species exhibited 100% susceptibility to most of the antifungal drugs tested, while intermediate resistance to fluconazole and flucytosine was seen in some non-albicans species (C. krusei, C. glabrata, and C. guilliermondii). Time taken for species identification was 14–18 h (average 15.5 h), while determination of minimum inhibitory concentration took 9–27 h (average 13 h). Conclusions: Our study showcases the present scenario of Candida distribution and the resistance patterns of various species afflicting the nail unit. Furthermore, our findings clearly indicate that the carriage of this pathogenic yeast is seen in both healthy individuals as well as with immunosuppression.

Keshav Lamichhane,1,* Nabaraj Adhikari,1,* Anup Bastola,2 Lina Devkota,2 Parmananda Bhandari,2 Binod Dhungel,1 Upendra Thapa Shrestha,1 Bipin Adhikari,3 Megha Raj Banjara,1 Komal Raj Rijal,1 Prakash Ghimire1 1Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal; 2Sukraraj Tropical and Infectious Disease Hospital, Teku, Kathmandu, Nepal; 3Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK*These authors contributed equally to this workCorrespondence: Komal Raj RijalCentral Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, NepalEmail rijalkomal@gmail.comIntroduction: Oropharyngeal candidiasis are the commonest fungal infections among HIV-positive patients. The main objective of this study was to explore biofilm-producing Candida species causing oropharyngeal infections among HIV patients attending Sukraraj Tropical and Infectious Diseases Hospital (STIDH) in Kathmandu, Nepal.Methods: Oropharyngeal swabs were collected from the HIV-positive patients between July and December 2019. A total of 174 oropharyngeal swabs were cultured on Sabouraud Dextrose Agar (SDA). All samples were inoculated on SDA slants supplemented with chloramphenicol and underwent incubation at 37°C for 24– 48 hours. Any visible growth reported was processed for the identification of the species. Candida species were differentiated based on the growth and colour of the isolates on CHROM agar candida. Biofilm production in Candida species was determined by the microtiter plate method (MPM). Antifungal susceptibility testing was performed using the disc diffusion method.Results: Among 174 oropharyngeal samples, 23.6% (n=41/174) of them had oropharyngeal infections and 36.6% of the oropharyngeal infections (15/41) had CD4 T-lymphocytes count below 200 cells/mm3 who were also active tobacco users (p< 0.05). Among Candidial growth, 61% (25/41) were Candida albicans and 39% (16/41) were non-albicans. Of 41 Candida spp., 65% (27/41) were biofilm producers. An equal proportion of Candida albicans (4 isolates) and non-albicans (4 isolates) were strong biofilm producers. C. albicans isolates were sensitive towards clotrimazole (96%; 24/25) and fluconazole (92%; 23/25), whereas sensitivity towards ketoconazole was only 48% (12/25). Non-albicans Candida was highly sensitive to amphotericin-B (62.5%; 10/16) followed by clotrimazole (56.2%; 9/16). The biofilm-producing Candida isolates showed the highest resistivity (51.9%; 14/27) to ketoconazole and lowest (22.2%; 6/27) to clotrimazole.Conclusion: Oropharyngeal candidiasis is a common opportunistic infection among HIV-infected individuals. The majority of cases of oropharyngeal candidiasis are caused by biofilm producers Candida albicans and non-albicans Candida. Biofilm producers Candida were more resistant towards commonly used antifungal drugs.Keywords: oral candidiasis, HIV, Candida albicans, biofilm, antifungal susceptibility test

Background and Purpose: Candida glabrata is the second cause of candidiasis. The mortality rate of C. glabrata infections is about 40%; accordingly, it may be life threatening, especially in immunocompromised hosts. Regarding this, the current study was conducted to evaluate the regional patterns of the antifungal susceptibility of clinical C. glabrata isolated from the patients referring to the health centers located in Ahvaz, Iran. Materials and Methods: In this study, a total of 30 clinical strains of C. glabrata isolates were recovered from different body sites (i.e., vagina, mouth, and urine). Phenotypic characteristics and molecular methods were used to identify the isolates. The minimum inhibitory concentration (MIC) was determined according to the European Committee on Antimicrobial Susceptibility Testing. Results: Our findings demonstrated that 20%, 80%, and 6.7% of the isolates were resistant to amphotericin B, terbinafine, and posaconazole, respectively, while all the isolates were found to be fluconazole susceptible dose dependent and susceptible to voriconazole and caspofungin. Conclusion: Our study suggested that voriconazole had high potency against C. glabrata isolates. Consequently, this antifungal agent can be an alternative drug in the treatment of resistant patients. These results can be helpful for the successful treatment of patients in different regions.

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

Invasive fungal infections caused by Cyberlindnera fabianii have recently increased. However, biochemical kits such as API 20 C AUX and Vitek-2C have misidentified this species as other Candida spp. such as C. pelliculosa or C. utilis due to no information of Cy. fabianii in yeast database. During our 2016–2017 surveys, eleven isolates of Cy. fabianii were obtained in International St. Mary’s Hospital in Korea. Here, we describe its morphological and molecular characteristics and tested its antifungal susceptibility against nine antifungal agents. The sequences of the ITS region and the D1/D2 region of LSU revealed 100% identity with the sequences of Cy. fabianii. In comparison with the results from MALDI-TOF mass spectrometry, we found that Cy. fabianii can be distinguished from other species. In antifungal susceptibility test, voriconazole and echinocandins exhibited good antifungal activities against the majority of Cy. fabianii isolates despite the absence of standard criteria.

Background and Aim: Onychomycosis is an infection caused by yeast, filamentous and non-filamentous fungi, due to diverse conditions. This study aimed to investigate the pattern of azole susceptibility of candidate species isolated from Iranian patients in Tehran. Methods: After sampling from patients, identification of the isolated strains were performed with Candida chrom agar medium and PCR-sequencing test. Drug Susceptibility pattern of the species to fluconazole, itraconazole and ketoconazole were determined by CLSI-M27-A3/S4 standard method. Results: In this study, 34 candidate isolates were identified, of which 26 isolates (76.5%) were Candida albicans and 8 isolates (23.5%) were Candida glabrata. In fluconazole, 4 (11%) of the isolates were dose-dependent sensitive and the others were sensitive. In itraconazole, 21 (61%) dose- dependent isolates and 2 (5%) resistant isolates were identified, and in ketoconazole, all isolates were sensitive. The geometric mean (GM) of the minimum inhibitory concentration for fluconazole, itraconazole and ketoconazole was 0.32, 0.21 and 0.15 μg/mL, respectively. In this study, the most frequently isolated species was C. albicans. According to the GM values, the most effective azoles was ketoconazole. Conclusion: The prevalence and pattern of susceptibility of Candida species to azole may vary in different populations of patients. Therefore, it is recommended that the clinicians pay attention to the results of drug susceptibility tests and then treat patients by considering drug interactions and side effects. [ABSTRACT FROM AUTHOR]

Background: Despite an increasing trend of onychomycosis caused by Candida species in recent years, there is a scarcity of published data. Objective: To determine the epidemiological and clinical characteristics of Candida onychomycosis, to identify the prevalent, and perform in-vitro antifungal susceptibility testing (AFST) of the isolates. Methodology: A total of 506 consecutive patients with a clinical suspicion of onychomycosis were included in a cross-sectional clinical study. Nail scrapings and clippings were subjected to KOH examination and culture. Species identification and antifungal drug sensitivity testing were done for Candida isolates using Vitek 2YST Compact system using Vitek 2 cards. Results: Out of 384 (75.88%) culture-positive cases, dermatophytes were isolated in 58.08%, yeast in 26.30%, and NDM in 12.24%. Of the yeast, Candida albicans was isolated in 59.4% and non-albicans species in 40.59%. AFST showed that most of Candida species exhibited 100% susceptibility to most of the antifungal drugs tested, while intermediate resistance to fluconazole and flucytosine was seen in some non-albicans species (C. krusei, C. glabrata, and C. guilliermondii). Time taken for species identification was 14–18 h (average 15.5 h), while determination of minimum inhibitory concentration took 9–27 h (average 13 h). Conclusions: Our study showcases the present scenario of Candida distribution and the resistance patterns of various species afflicting the nail unit. Furthermore, our findings clearly indicate that the carriage of this pathogenic yeast is seen in both healthy individuals as well as with immunosuppression. [ABSTRACT FROM AUTHOR]

Malassezia yeasts are commensal microorganisms occurring on the skin of humans and animals causing dermatological disorders or systemic infections in severely immunocompromised hosts. Despite attempts to control such yeast infections with topical and systemic antifungals, recurrence of clinical signs of skin infections as well as treatment failure in preventing or treating Malassezia furfur fungemia have been reported most likely due to wrong management of these infections (e.g. due to early termination of treatment) or due to the occurrence of resistant phenomena. Standardized methods for in vitro antifungal susceptibility tests of these yeasts are still lacking, thus resulting in variable susceptibility profiles to azoles among Malassezia spp. and a lack of clinical breakpoints. The inherent limitations to the current pharmacological treatments for Malassezia infections both in humans and animals, stimulated the interest of the scientific community to discover new, effective antifungal drugs or substances to treat these infections. In this review, data about the in vivo and in vitro antifungal activity of the most commonly employed drugs (i.e. azoles, polyenes, allylamines, and echinocandins) against Malassezia yeasts, with a focus on human bloodstream infections, are summarized and their clinical implications are discussed. In addition, the usefulness of alternative compounds is discussed. [ABSTRACT FROM AUTHOR]

Background: Epidemiological cut-off values and clinical interpretive breakpoints have been developed for a number of antifungal agents with the most common Candida species that account for the majority of infections due to pathogenic yeasts species. However, less-common species, for which susceptibility data are limited, are increasingly reported in high-risk patients and breakthrough infections.Methods: The UK National Mycology Reference Laboratory performs routine antifungal susceptibility testing of clinical yeast isolates submitted from across the UK. Between 2002 and 2016, >32 000 isolates representing 94 different yeast species were referred to the laboratory. Here we present antifungal susceptibility profiles generated over this period for amphotericin B, fluconazole, voriconazole, itraconazole, anidulafungin and flucytosine against 35 species of uncommon yeast using CLSI methodologies. MIC data were interpreted against epidemiological cut-off values and clinical breakpoints developed with Candida albicans, in order to identify species with unusually skewed MIC distributions that potentially indicate resistance.Results: Potential resistance to at least one antifungal agent (>10% of isolates with MICs greater than the epidemiological cut-off or clinical breakpoint) was evidenced for 29/35 species examined here. Four species exhibited elevated MICs with all of the triazole antifungal drugs against which they were tested, and 21 species exhibited antifungal resistance to agents from at least two different classes of antifungal agent.Conclusions: This study highlights a number of yeast species with unusual MIC distributions and provides data to aid clinicians in deciding which antifungal regimens may be appropriate when confronted with infections with rarer yeasts. [ABSTRACT FROM AUTHOR]

Invasive fungal infections caused by Cyberlindnera fabianii have recently increased. However, biochemical kits such as API 20 C AUX and Vitek-2C have misidentified this species as other Candida spp. such as C. pelliculosa or C. utilis due to no information of Cy. fabianii in yeast database. During our 2016–2017 surveys, eleven isolates of Cy. fabianii were obtained in International St. Mary's Hospital in Korea. Here, we describe its morphological and molecular characteristics and tested its antifungal susceptibility against nine antifungal agents. The sequences of the ITS region and the D1/D2 region of LSU revealed 100% identity with the sequences of Cy. fabianii. In comparison with the results from MALDI-TOF mass spectrometry, we found that Cy. fabianii can be distinguished from other species. In antifungal susceptibility test, voriconazole and echinocandins exhibited good antifungal activities against the majority of Cy. fabianii isolates despite the absence of standard criteria. [ABSTRACT FROM AUTHOR]

Aspergillus species are widely distributed throughout the world and can develop parasitic and saprophytic ways of life, allowing Aspergillus to infect living hosts, including plants, insects, birds and mammals. The most common form of aspergillosis in poultry and other birds is respiratory infection. Clinical manifestations depend on the infective dose, pre-existing diseases, and the immune response of the host. The aim of the present research was to study aspergillosis in domestic and wild birds from Argentina. We carried out morphological and molecular identification, and determination of antifungal susceptibility against seven antifungal drugs. Six birds from different cities of Buenos Aires Province of Argentina were studied. Three of the samples belonged to broiler chicks, while the other three belonged to an eagle, a pheasant, and a kelp gull. Two isolates were identified as Aspergillus fumigatus by morphological characteristics and growth at 50 °C. Morphology and BenA sequencing enabled us to identify three isolates as Aspergillus flavus, and one as Aspergillus sydowii. All antifungal drugs tested showed low MIC values, ranging from 0.008 to 1 mg/L. Aspergillosis in birds causes high economic losses and could be controlled by sanitation, avoidance of moldy food, nest and litter and reducing stress factors.

Background: The burden of cryptococcosis in mainland China is enormous. However, the in vitro characterization and molecular epidemiology in Guangdong, a key region with a high incidence of fungal infection in China, are not clear., Methods: From January 1, 2010, to March 31, 2019, clinical strains of Cryptococcus were collected from six medical centres in Guangdong. The clinical information and characteristics of the strains were analysed. Furthermore, molecular types were determined., Results: A total of 84 strains were collected, mostly from male and young or middle-aged adult patients. Pulmonary and cerebral infections (82.1%) were most common. All strains were Cryptococcus neoformans , grew well at 37°C and had capsules around their cells. One melanin- and urea- and one melanin+ and urea- variants were found. Although most strains exhibited a low minimum inhibitory concentration (MIC) value for voriconazole (mean: 0.04 μg/mL) and posaconazole (mean: 0.12 μg/mL), the results for these isolates showed a high degree of variation in the MIC values of fluconazole and 5-fluorocytosine, and resistance was observed for 4 out of 6 drugs. A significant proportion of these strains had MIC values near the ECV values, particularly in the case of amphotericin B. The proportion of strains near the clinical breakpoints was as follows: fluconazole: 3.66%; voriconazole: 3.66%; itraconazole: 6.10%; posaconazole: 13.41%; amphotericin B: 84.15%; 5-fluorocytosine: 2.44%. These strains were highly homogeneous and were dominated by the Grubii variant (95.2%), VNI (94.0%), α mating (100%), and ST5 (89.3%) genotypes. Other rare types, including ST4, 31, 278, 7, 57 and 106, were also found., Conclusion: Phenotypically variant and non-wild-type strains were found in Guangdong, and a significant proportion of these strains had MIC values near the ECV values towards the 6 antifungal drugs, and resistance was observed for 4 out of 6 drugs. The molecular type was highly homogeneous but compositionally diverse, with rare types found. Enhanced surveillance of the aetiology and evolution and continuous monitoring of antifungal susceptibility are needed to provide references for decision-making in the health sector and optimization of disease prevention and control., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Wang, Li, Gao, Tang, Zheng, Wu, Wang, Guo and Ye.)

Objectives Understanding the epidemiology of invasive Candida infections is essential to patient management decisions and antifungal stewardship practices. This study characterized the species distribution and antifungal susceptibilities of prospectively collected isolates of Candida species causing bloodstream infections (BSIs) in patients admitted to tertiary care hospitals located in 14 cities across 8 of the 10 Canadian provinces between 2011 and 2016. Methods Antifungal susceptibility testing was performed by broth microdilution using CLSI methods, breakpoints and epidemiological cut-off values. DNA sequencing of fks loci was performed on all echinocandin-non-susceptible isolates. Results Candida albicans (49.6%), Candida glabrata (20.8%) and Candida parapsilosis complex (12.0%) were the most common species out of 1882 isolates associated with BSIs. Candida tropicalis (5.2%), Candida krusei (4.3%), Candida dubliniensis (4.1%), Candida lusitaniae (1.4%) and Candida guilliermondii (1.1%) were less frequently isolated. Between 2011 and 2016, the proportion of C. albicans significantly decreased from 60.9% to 42.1% (P  < 0.0001) while that of C. glabrata significantly increased from 16.4% to 22.4% (P  = 0.023). C. albicans (n  = 934), C. glabrata (n  = 392) and C. parapsilosis complex (n  = 225) exhibited 0.6%, 1.0% and 4.9% resistance to fluconazole and 0.1%, 2.5% and 0% resistance to micafungin, respectively. Mutations in fks hot-spot regions were confirmed in all nine micafungin non-susceptible C. glabrata. Conclusions Antifungal resistance in contemporary isolates of Candida causing BSIs in Canada is uncommon. However, the proportion of C. glabrata isolates has increased and echinocandin resistance in this species has emerged. Ongoing surveillance of local hospital epidemiology and appropriate antifungal stewardship practices are necessary to preserve the utility of available antifungal agents. [ABSTRACT FROM AUTHOR]

Objectives: The emergence of fluconazole resistance in Candida parapsilosis healthcare-associated infections has recently been increasingly reported. Antifungal susceptibility profiles and mechanisms of fluconazole resistance in C. parapsilosis (n = 199) from nine hospitals in India collected over a period of 3 years were studied. Further, clonal transmission of fluconazole-resistant isolates in different hospitals was investigated.Methods: Antifungal susceptibility testing of five azoles, amphotericin B and 5-flucytosine was performed by the CLSI microbroth dilution method. The azole target ERG11 gene was sequenced, and the significance of a novel ERG11 mutation in C. parapsilosis was determined using a gap-repair cloning approach in Saccharomyces cerevisiae. In addition, microsatellite analysis was performed to determine the clonal lineage of C. parapsilosis-resistant strains circulating among different hospitals.Results: A total of 64 (32%) C. parapsilosis isolates were non-susceptible to fluconazole, which included resistant (n = 55; MIC >4 mg/L) and susceptible dose-dependent (n = 9) isolates. Of these 64 non-susceptible isolates, a novel K143R amino acid substitution was noted in 92%, and the remaining five isolates had the Y132F substitution. Elevated azole MICs (≥16-fold) were detected in S. cerevisiae upon expression of C. parapsilosis ERG11 alleles carrying Y132F or K143R substitutions. Two major clusters of non-susceptible isolates were circulating in seven Indian hospitals.Conclusions: We report a novel K143R amino acid substitution in ERG11p causing fluconazole resistance in C. parapsilosis. Fluconazole-non-susceptible C. parapsilosis isolates carrying the novel K143R amino acid substitution should be identified in clinical microbiology laboratories to prevent further clonal transmission. [ABSTRACT FROM AUTHOR]

Abstract 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. [ABSTRACT FROM AUTHOR]

Aspergillus caninus (synonym: Phialosimplex caninus) is an anamorphic fungus species associated with systemic infections in dogs that has been transferred from the genus Phialosimplex to Aspergillus. Here, we report the first case of canine A. caninus infection in Japan. A castrated Japanese Shiba Inu (6 years old; weight, 12.5 kg) was referred to the Yamaguchi University Animal Medical Center, Yamaguchi, Japan, in June 2017 showing vitality loss and depression. Computed tomography revealed iliac and splenic hilum lymphopathies, and histologic examination of an iliac lymph node by biopsy revealed granulomatous lesions with numerous oval to round yeast-like fungal cells. Aspergillus caninus was isolated from the biopsy samples, and in vitro susceptibility tests of the isolate to the antifungal drugs amphotericin B (AMB), fluconazole (FLZ), itraconazole (ITZ), voriconazole (VRZ), and micafungin (MCF) were performed by the E-test method. The isolate from this dog exhibited a minimal inhibitory concentration of < 0.002 µg/ml to AMB, > 256 µg/ml to FLZ, < 0.002 µg/ml to ITZ, < 0.002 µg/ml to VRZ, and < 0.002 µg/ml to MCF, indicating that the isolate was not susceptible to FLZ and susceptible to AMB, ITZ, VRZ, and MCF. Since the response of the patient dog to ITZ and VRZ treatments was poor, more aggressive management using combination therapies of ITZ with other antifungals may be necessary for treating canine A. caninus infection in dogs. [ABSTRACT FROM AUTHOR]

Triazoles are the major group of antifungals for treating Aspergillus infections. The morbidity and mortality associated with these infections is high and rate of treatment failure is more in patients infected with azole resistant Aspergillus. The azole resistant Aspergillus isolates have been recovered from both azole treated and azole naive patients. Thus, there may be an environmental route of exposure to azole resistant Aspergillus. The present study was envisaged for the isolation and enumeration of environmental isolates of Aspergillus resistant to medically available antifungal azole drugs in North Indian environment. A total of 25 soil samples were collected from North Indian agricultural farms where azole pesticides were being used. The soil samples were screened for Aspergillus isolates by serial dilution pour plate method. Further, their drug susceptibility testing was performed using disc diffusion, E- strip and micro-broth dilution method against medically available triazoles: itraconazole, ketoconazole, fluconazole and voriconazole. A total of 41 Aspergillus species were isolated from the soil samples. Based on conventional microscopic assay, 13 of them were identified as Aspergillus fumigatus, 9 as Aspergillus niger, 5 as Aspergillus terreus, 3 as Aspergillus nidulans, 1 as Aspergillus flavus and 9 as other Aspergillus species. Resistance for all tested antifungal drugs was detected in 7.3% Aspergillus isolates and 43.7% isolates were resistant to any of the tested azole drugs. The results demonstrated that Aspergillus isolates resistant to medical triazoles are present in the agricultural farms. [ABSTRACT FROM AUTHOR]

Background: Candida auris has emerged globally as an MDR nosocomial pathogen in ICU patients. Objectives: We studied the antifungal susceptibility of C. auris isolates (n = 350) from 10 hospitals in India collected over a period of 8years. To investigate azole resistance, ERG11 gene sequencing and expression profiling was conducted. In addition, echinocandin resistance linked to mutations in the C. auris FKS1 gene was analysed. Methods: CLSI antifungal susceptibility testing of six azoles, amphotericin B, three echinocandins, terbinafine, 5-flucytosineand nystatin was conducted. Screening for amino acid substitutions in ERG11 and FKS1 was performed. Results: Overall, 90% of C. auris were fluconazole resistant (MICs 32 to >64 mg/L) and 2% and 8% were resistant to echinocandins (≥8 mg/L) and amphotericin B (≥2 mg/L), respectively. ERG11 sequences of C. auris exhibited amino acid substitutions Y132 and K143 in 77% (n = 34/44) of strains that were fluconazole resistant whereas WT genotypes, i.e. without substitutions at these positions, were observed in isolates with low fluconazole MICs (1-2 mg/L) suggesting that these substitutions confer a phenotype of resistance to fluconazole similar to that described for Candida albicans. No significant expression of ERG11 was observed, although expression was inducible in vitro with fluconazole exposure. Echinocandin resistance was linked to a novel mutation S639F in FKS1 hotspot region I. Conclusions: Overall, 25% and 13% of isolates were MDR and multi-azole resistant, respectively. The most common resistance combination was azoles and 5-flucytosine in 14% followed by azoles and amphotericin B in 7% and azoles and echinocandins in 2% of isolates. [ABSTRACT FROM AUTHOR]

Background: Invasive fungal infections, including those caused by yeasts, moulds and endemic organisms, can be significant causes of morbidity and mortality in immunocompromised hosts, those with multiple comorbidities and occasionally immunocompetent hosts. Current antifungal agents are often limited by drug toxicities, drug interactions or the development of resistance. VT-1598 is a novel tetrazole that has greater specificity for fungal Cyp51 than currently available triazoles and thus the potential for clinically significant drug interactions is reduced. We measured the in vitro activity of VT-1598 against clinical isolates of Candida and Cryptococcus species, endemic fungi, including Coccidioides, Blastomyces and Histoplasma, Aspergillus species and Rhizopus arrhizus.Methods: Antifungal susceptibility testing was performed by broth microdilution or macrodilution methods per CLSI standards. Clinical isolates of each species were used and clinically available antifungal agents were tested against each isolate.Results: VT-1598 demonstrated in vitro activity against yeasts and moulds that was similar to or greater than that of clinically available antifungal agents, including amphotericin B, fluconazole, caspofungin, voriconazole and posaconazole. The in vitro activity of VT-1598 was also maintained against resistant isolates, including fluconazole-resistant Candida isolates. In vitro activity was also observed against endemic fungi, including Blastomyces, Histoplasma and both Coccidioides immitis and Coccidioides posadasii.Conclusions: VT-1598 demonstrated in vitro activity against yeasts, moulds and endemic fungi, which was maintained against isolates that had reduced susceptibility to other antifungals. Further studies are warranted to evaluate the in vivo efficacy of VT-1598 against various fungal pathogens. [ABSTRACT FROM AUTHOR]

Summary Paecilomyces variotii ( P. variotii ) is an extremely rare cause of continuous ambulatory peritoneal dialysis (CAPD) peritonitis. When diagnosed, it usually portends poor prognosis. Patient's survival depends on early laboratory diagnosis and proper treatment. We herein report a P. variotii peritonitis in a patient on CAPD which is a quite rare clinical entity. Laboratory diagnosis was confirmed via both morphological analysis and DNA sequencing. Antifungal susceptibility tests were performed and interpreted according to the Clinical Laboratory Standards Institute M38-A2 guidelines. After laboratory diagnosis, the patient was treated succesfully with liposomal amphotericin B and itraconazole combination and the peritoneal catheter was removed. This case is worthy of reporting since P. variotii is an uncommon cause of peritonitis and leads to dilemmas in both laboratory diagnosis and treatment strategies. [ABSTRACT FROM AUTHOR]

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Aim: to evaluate the performance of Vitek2 compact machine (Biomerieux Inc. ver 04.02, France) in reference to manual methods for susceptibility test for Candida resistance among HIV/AIDS patients. Methods: a comparison study to evaluate Vitek2 compact machine (Biomerieux Inc. ver 04.02, France) in reference to manual methods for susceptibility test for Candida resistance among HIV/AIDS patient was done. Categorical agreement between manual disc diffusion and Vitek2 machine was calculated using predefined criteria. Time to susceptibility result for automated and manual methods were measured. Results: there were 137 Candida isolates comprising eight Candida species with C.albicans and C. glabrata as the first (56.2%) and second (15.3%) most common species, respectively. For fluconazole drug, among the C. albicans, 2.6% was found resistant on manual disc diffusion methods and no resistant was determined by Vitek2 machine; whereas 100% C. krusei was identified as resistant on both methods. Resistant patterns for C. glabrata to fluconazole, voriconazole and amphotericin B were 52.4%, 23.8%, 23.8% vs. 9.5%, 9.5%, 4.8% respectively between manual diffusion disc methods and Vitek2 machine. Time to susceptibility result for automated methods compared to Vitex2 machine was shorter for all Candida species. Conclusion: there is a good categorical agreement between manual disc diffusion and Vitek2 machine, except for C. glabrata for measuring the antifungal resistant. Time to susceptibility result for automated methods is shorter for all Candida species.

We assessed fluconazole susceptibility in 52 Candida tropicalis clinical strains using seven antifungal susceptibility methods, including broth microdilution (BMD) [standard M27 A3 (with neutral and acid pH), ATB Fungus 3, Vitek 2 system and flow cytometric analysis] and agar-based methods (disk diffusion and E-test). Trailing growth, detection of cell-associated secreted aspartic proteases (Saps) and morphological and ultrastructural traits of these clinical strains were also examined. The ranges of fluconazole 24 h-minimum inhibitory concentration (MIC) values were similar among all methods. The essential agreement among the methods used for MIC determinations was excellent and all methods categorised all strains as susceptible, except for one strain that showed a minor error. The presence of the trailing effect was assessed by six methods. Trailing positivity was observed for 86.5-100% of the strains. The exception was the BMD-Ac method where trailing growth was not observed. Morphological and ultrastructural alterations were detected in C. tropicalis trailing cells, including mitochondrial swelling and cell walls with irregular shapes. We tested the production of Saps in 13 C. tropicalis strains expressing trailing growth through flow cytometry. Our results showed that all of the C. tropicalis strains up-regulated surface Sap expression after 24 h or 48 h of exposure to fluconazole, which was not observed in untreated yeast strains. We concluded that C. tropicalis strains expressing trailing growth presented some particular features on both biological and ultrastructural levels.

Candida albicans is a common cause of bloodstream fungal infections in hospitalized patients. To investigate its epidemiology, multilocus sequence typing (MLST) was performed on 285 C. albicans bloodstream isolates from patients in Chang Gung Memorial Hospital at Linkou (CGMHL), Taiwan from 2003 to 2011. Among these isolates, the three major diploid sequence types (DSTs) were 693, 659, and 443 with 19, 16, and 13 isolates, respectively. The 179 DSTs were classified into 16 clades by unweighted pair-group method using arithmetic averages (UPGMA). The major ones were clades 1, 4, 3, and 17 (54, 49, 31, and 31 isolates, respectively). Further analyses with eBURST clustered the 285 isolates into 28 clonal complexes (CC). The most common complexes were CC8, CC20, and CC9. DST 693 that had the highest number of isolates was determined to be the cluster founder of CC20, which belonged to clade 3. So far, 33 isolates worldwide including 29 from Taiwan and 4 from Korea, are CC20, suggesting that CC20 is an Asian cluster. Two fluconazole-resistant isolates belonging to CC12 and CC19 were detected. All other CGMHL isolates were susceptible to 5-flucytosine, amphotericin B, anidulfungin, caspofungin, fluconazole, itraconazole, micafungin, posaconazole, and voriconazole. However, CC20 isolates exhibited significantly lower susceptibility to fluconazole. In conclusion, the 285 CGMHL C. albicans isolates displayed geographically clustering with Asian isolates, and most of them are susceptible to common antifungal drugs. Isolates of DST 693, a Taiwanese major genotype belonging to MLST clade 3, were more resistant to fluconazole than other isolates. [ABSTRACT FROM AUTHOR]

Culture-based identification and antifungal susceptibility take 48–72 hours after positivity. We analyzed the performance of Vitek2 directly from 40 yeast-positive blood-cultures; agreement of 100% was observed for the tested antifungals; identification showed the same species in 31/40. The method reduces time (13 to 18 h) for preliminary results. [ABSTRACT FROM AUTHOR]

Background: Candidiasis is the most common opportunistic infection in human immunodeficiency virus (HIV) seropositive patients, starting from asymptomatic colonization to pathogenic forms and gradual colonization of non-albicans in patients with advanced immunosuppression leads to resistance for azole group of antifungal drugs with high rate of morbidity and mortality. Objectives: To isolate the Candida species and determine of antifungal drug susceptibility against fluconazole, itraconazole, nystatin, amphotericin B, and clotrimazolein HIV seropositive and control individuals, with or without clinical oropharyngeal candidiasis (OPC). Materials and Methods: Includes samples from faucial region of 70 subjects with and without clinical candidiasis in HIV seropositive and controls were aseptically inoculated onto Sabaraud's Dextrose Agar media and yeasts were identified for the specific species by Corn Meal Agar, sugar fermentation and heat tolerance tests. Antifungal drug susceptibility of the isolated species was done against above-mentioned drugs by E-test and disc diffusion method. Results: The commonly isolated species in HIV seropositive and controls were Candida albicans, Candida glabrata and Candida tropicalis Candida guilliermondii and Candida dubliniensis isolated only in HIV seropositive patients. Susceptibility against selected antifungal drugs was observed more in HIV-negative individuals whereas susceptible dose-dependent and resistance were predominant in HIV-positive patients. Conclusion: Resistance is the major problem in the therapy of OPC, especially in HIV seropositive patients due to aggressive and prolonged use of antifungal agents, therefore, our study emphasizes the need for antifungal drug susceptibility testing whenever antifungal treatment is desired, especially in HIV-infected subjects. [ABSTRACT FROM AUTHOR]