Current Medical Mycology
Volume:9 Issue: 1, Mar 2023

Morbidity and mortality of opportunistic fungal infections in COVID-19 patients are less studied and defined. The patients receiving immunosuppressive therapy, broad-spectrum antibiotics, corticosteroids, and invasive and non-invasive ventilation are the high-risk groups.

The demographic profile as well as clinical and radiological findings of all the patients with COVID-19 suspected of Mucormycosis (MM) were recorded. The tissue samples from all the patients were sent for microbiological (KOH mount and culture) and histopathological analysis for confirmation of MM.

In total, 45 COVID-19 patients suspected of MM were included in the study an MM was confirmed in 42 patients. The mean age of the patients was 50.30±14.17 years with a female: male ratio of 1.1:1. The most common symptom was headache (52.38%) followed by purulent nasal discharge (38.09%) and facial pain in 33.33% of the cases. The ocular symptoms included a diminution of vision (33.33%) and redness of the eye (2.38%).The most common site of involvement was rhino-orbital (42.85%) followed by sinonasal (23.80%) and rhino cerebral (19.04%). Majority (38.09%) of the patients were diagnosed with stage II of Rhino-orbital-cerebral Mucormycosis (ROCM) based on radiology. A history of diabetes mellitus and steroids was present in 97.61% and 85.71% of the cases, respectively. Moreover, KOH was positive for MM in 97.61% of the cases while the culture was positive in only 35.71% of the cases. In addition, on histopathology, MM was confirmed in 64.28 % of the cases. Mixed growth with Aspergillus species and Rhizopus species was observed in 14.28% of the cases in culture and 11.90% of the cases in histopathology test. Furthermore, angioinvasion was found in 23.80% of the cases according to the histopathology test.

Based on the results, the most common conditions associated with MM in COVID-19 patients were diabetes mellitus and steroid therapy. A high level of clinical suspicion aided with diagnostic tests, including KOH mount, culture, histopathology, and radiology which helped the early detection of opportunistic fungal infection in COVID-19 patients to ensure timely treatment.

The primary cause of death is cardiovascular disease, hence accurate diagnosis and treatment are urgently required. For these intents, proteases are regarded as perspective agents. High substrate specificity is a need for an effective enzyme, which makes Aspergillus micromycetes—known for producing proteases with precise action—biotechnologically promising. This study's major goal was to look at the possibilities of Aspergillus species, which had never been mentioned in terms of general proteolytics.

Every species was cultivated in two-stages submerged conditions with two different nitrogen sources, whereupon, proteolytic activity in culture fluid was determined. Using chromogenic peptide substrates and fibrin plates, these species' thrombin, plasmin, factor Xa, urokinase, protein C-like, and activating activities towards hemostasis proteins, as well as fibrinolytic and plasminogen-activating activities, were evaluated.

It was shown that A. aureolatus and A. tennesseensis are active proteolytics exhibiting plasmin-like activity (116.17 and 87.09 U×10-3, respectively), factor Xa-like activity (76.27 and 77.92 U×10-3, respectively) and urokinase activity (85.99 and 59.91 U×10-3, respectively). The thrombin-like activity was found for A. tabacinus (50.37 U×10-3), and protein C-like activity was noticeable for A. creber, A. jensenii, A. protuberus, and A. ruber (62.90, 65.51, 73.37, and 111.85 U×10-3, respectively). Additionally, more than half of species have the ability to directly activate plasminogen or operate as fibrinolytics.

New proteolytic strains were discovered, offering hope for the therapy of cardiovascular disorders. Fungal enzymes' high specificity and activity make them useful in a variety of fields, including medicine and diagnostics.

Dermatophytosis is one of the most prevalent zoonotic diseases. Increased resistance of dermatophytosis causing pathogens against antidermatophytic agents highlights the need for alternative medicine with higher efficiency and lower side effects. In the present study, the in vitro antifungal activities of different concentrations of Gracilaria corticata methanol extract against Trichophyton mentagrophytes, Microsporum canis, and Microsporum gypseum were assessed and their efficacy was evaluated in rat dermatophytosis models.

The broth microdilution and well diffusion methods were used to determine the in vitro antidermatophytic activity. The in vivo study was carried out using 40 dermatophytosis-infected adults male Wistar rats. The animals were divided into 4 groups (5% and 10% G. corticata ointment, terbinafine, and Vaseline) and treated with ointment until complete recovery. The percentage of wound closure was calculated for each group.

The results revealed that G. corticata methanol extract was effective to varying extents against the tested dermatophytes. The highest inhibitory activity of G. corticata was found against T. mentagrophytes with minimum inhibitory concentration and minimum fungicidal concentration values of 4 and 9 µg mL-1, respectively. The in vivo experiment revealed that 10% G. corticata ointment significantly accelerated skin lesions reduction and completely cured M. gypseum, T. mentagrophytes, and M. canis infections after 19, 25, and 38 days, respectively.

The methanol extract of G. corticata exhibited significant antifungal activity in vitro and in vivo, suggesting that it could be used as an alternative to antidermatophytic therapy in a dose-dependent manner.

Among different clinical entities of dermatophytosis, tinea capitis (TC) is considered a major public health challenge in the world, especially in regions with poor health and low income. Therefore, this study aimed to provide a retrospective analysis of the patients suspected of TC who were referred to the medical mycology laboratory of Mazandaran, a northern province of Iran.

A retrospective analysis was performed on the patients suspected of TC who were referred to the medical mycology laboratory from July 2009 to April 2022. Hair roots and skin scrapings were collected from the participants. The laboratory diagnosis was confirmed by direct microscopic examination and culture. Finally, 921 out of 11095 (8.3%) patients were suspected of TC.

Based on the findings, TC was confirmed in 209 out of 921 patients (22.7%). In terms of gender, 209 TC patients (75.1%) were male. Moreover, the male to female ratio of TC patients was 1:3.0. Trichophyton tonsurans (146/174, 83.91%) was the most etiological agent,followed by T. mentagrophytes (13/174, 7.47%), T. violaceum (9/174, 5.17%), Microsporum canis (3/174, 1.71%), T. verrucosum (2/174, 1.15%) and T. rubrum (1/174, 0.57%). Besides, endothrix (77.0%) was the most prevalent type of hair invasion.

The results revealed the predominance of T. tonsurans, as a causative agent of TC. Despite the prevalence of TC, the absence of appropriate consideration highlights that it is a neglected complication among children.

Species identification of Malassezia using culture-dependent methods is time-consuming due to their fastidious growth requirements. This study aimed to evaluate a rapid and accurate molecular method in order to diagnose the pityriasis versicolor (PV) and identify Malassezia species from direct clinical samples.

Skin scraping or tape samples from patients with PV and healthy volunteers as the control group were collected. Diagnosis of PV was confirmed by direct microscopic examination. The DNA extraction was performed according to the steel bullet beating method. Polymerase chain reaction-restriction fragment length polymorphism assay using HhaI restriction enzyme was applied for the identification and differentiation of Malassezia species.

The PCR method was able to detect Malassezia in 92.1% of specimens which were also confirmed with microscopic examination. Statistically, a significant association was observed between the results of the two assays (P ˂ 0.001). Moderate agreement was identified between the two methods to diagnose the PV in both populations (Kappa: 0.55). Considering microscopic examination as the gold standard method for confirmation of PV, the sensitivity, specificity, positive predictive value, and negative predictive value values of the PCR assay for recognition of PV were 85%, 75%, 92%, and 60%, respectively. M. globosa and M. restricta were the most prevalent species isolated from patients.

In this study, the two-step molecular method based on the amplification of the D1/D2 domain and digestion of the PCR product by one restriction enzyme was able to diagnose and identify Malassezia directly from clinical samples. Consequently, it can be said that the molecular-based method provides more facilities to identify fastidious species, such as M. restricta.

Wickerhamomyces myanmarensis is a new opportunistic yeast previously named Pichai myanmarensis, which belongs to the order Saccharomycetales. Since its discovery, one environmental isolate of W. myanmarensis has been reported from Myanmar, and one clinical sample from Iran.

We report a case of bloodstream infection related to an implantable venous access port. W. myanmarensis was isolated from patient's blood after chemotherapy, which was meant to control and heal T-cell lymphoblastic lymphoma. Broth dilution minimum inhibitory concentrations were performed according to the CLSI M27-A3 document. The patient recovered with intravenous voriconazole and was discharged with the recommended prescription of oral voriconazole as a maintenance drug.

So far, only one case of W. myanmarensis fungemia has been reported in the world in 2019. This is the second case of bloodstream infection with this yeast from a patient undergoing chemotherapy in Iran.

Candida auris is an emerging pathogen predominantly isolated from immunocompromised patients, hospitalized for a long time. It inhabits the skin surfaces of patients causing ear, wound, and systemic infections; when not properly treated could lead to severe mortality. Medical devices are hospital tools and components often utilized in the diagnosis and treatment of diseases associated with human skin. Apart from being a skin pathogen, C. auris colonizes the surfaces of medical devices. The mechanism of survival and persistence of C. auris on medical devices has remained unclear and is a serious concern to clinicians. The persistence of C. auris on medical devices has deterred its effective elimination,hindered the treatment of infections and increased antifungal resistance. Evidence has shown that a few surface molecules on the cell wall of C. auris and the extracellular matrix of the biofilm are responsible and exist as enablers. Due to the increased cases of ear, skin and systemic infections as well as death resulting from the spread of C. auris in hospitals, there is a need to study these enablers. This review is focused on the identification of the enablers and evaluates them in relation to their ability to induce persistence in C. auris. In order to reduce the spread or completely eliminate C. auris and its enablers in hospitals, the efficacy of disinfection and sterilization were compared.

Mucormycosis (previously called zygomycosis) is a diverse group of increasingly recognized and frequently fatal mycotic diseases caused by members of the class zygomycetes. Mucormycosis is around 80 times more common in India, compared to other developed countries, with a frequency of 0.14 cases per 1,000 population. The most frequent causative agent of mucormycosis is the following genera from the Order Mucorales: Rhizopus, Mucor, Rhizomucor, Absidia, Apophysomyces, Cunninghamella, and Saksenaea. The major risk Mucormycosis (previously called zygomycosis) is a diverse group of increasingly recognized and frequently fatal mycotic diseases caused by members of the class zygomycetes. Mucormycosis is around 80 times more common in India, compared to other developed countries, with a frequency of 0.14 cases per 1,000 population. The most frequent causative agent of mucormycosis is the following genera from the Order Mucorales: Rhizopus, Mucor, Rhizomucor, Absidia, Apophysomyces, Cunninghamella, and Saksenaea. The major risk factors for the development of mucormycosis are diabetic ketoacidosis, deferoxamine treatment, cancer, solid organ or bone marrow transplantations, prolonged steroid use, extreme malnutrition, and neutropenia. The common clinical forms of mucormycosis are rhino-orbital-cerebral, pulmonary, cutaneous, and gastrointestinal. During the second wave of COVID-19, there was a rapid increase in mucormycosis with more severity than before. Amphotericin B is currently found to be an effective drug as it is found to have a broad spectrum activity and posaconazole is used as a salvage therapy. Newer triazole isavuconazole is also found effective against mucormycosis. This article aimed to review various studies on the laboratory diagnosis and treatment of mucormycosis.