pedram haddadi

Fungal infections are one of the most important causes of morbidity and mortality in patients with hematological disorders. The frequency of these infections has increased during the past decades.
The rate of fungal infections was investigated in pediatric patients with hematological disorders, using traditional and real-time PCR methods, in order to establish proper management of these patients.
Over a 13-month period, 86 patients with hematological disorders were admitted and were kept under observation for the development of fungal infections. Fungal colonization was determined and clinical samples were examined by direct microscopic examination and culture. Blood specimens were cultured by bedside inoculation into a BACTEC medium. The results of the pathology smear were collected from the patients’ records. Real-time PCR was performed on all patients’ sera to diagnose invasive candidiasis and aspergillosis.
Candida colonization was seen in 42 (48.8%) and oral candidiasis was diagnosed in 7 (8%) patients. The incidence of invasive fungal infections was 16.3% (14/86) with a mortality rate of 50% in pediatric patients. The etiologic agents were Candida albicans in 5 cases, Aspergillus flavus in 3, and Aspergillus fumigatus, Fusarium, Alterneria and Mucor, each in 1 case. In 2 cases with liver abscess, only Candida PCR was positive. Fungemia was observed in 4 patients.
The rate of invasive fungal infections in our study was high. Early and accurate detection of these infections could result in a better outcome. In critical ill cases where only blood samples are available, molecular methods such as PCR could be more effective than culture for the detection of etiologic agents.

Pediatric patients with neutropenia are vulnerable to invasive Candida infections. Candida is the primary cause of fungal infections, particularly in immunosuppressed patients. Candida albicans has been the most common etiologic agent of these infections, affecting 48% of patients. The aim of this study was to identify Candida spp. isolated from children with neutropenia and determine the antifungal susceptibility pattern of the isolated yeasts..Patients and In this study 188 children with neutropenia were recruited, fungal surveillance cultures were carried out on nose, oropharynx, stool, and urine samples. Identification of Candida strains was performed using germ tube and chlamydospore production tests on an API 20 C AUX system. Susceptibility testing on seven antifungal agents was performed using the agar-based E-test method.. A total of 229 yeasts were isolated. Among those, C. albicans was the most common species followed by C. krusei, C. parapsilosis, C. glabrata, C. tropicalis, C. famata, C. dubliniensis, C. kefyr, and other Candida species. C. glabrata was the most resistant isolated yeasts, which was 70% resistant to fluconazole and 50% to itraconazole, 7.5% to amphotericin B and 14% to ketoconazole. All the tested species were mostly sensitive to caspofungin.. Knowledge about the susceptibility patterns of colonized Candida spp. can be helpful for clinicians to manage pediatric patients with neutropenia. In this study, caspofungin was the most effective antifungal agent against the colonized Candida spp. followed by conventional amphotericin B..

Because resistance to antifungal drugs is seen in patients, susceptibility testing of these drugs aids in choosing the appropriate drug and respective epidemiology. This study has investigated and compared susceptibility patterns of the Aspergillus specie sisolated from patients by the Clinical and Laboratory Standards Institute (CLSI) reference broth microdilution (MD) assay and Etest method. The minimum inhibitory concentrations (MICs) of various antifungal agents (amphotericin B, ketoconazole, itraconazole, and voriconazole) for 108 Aspergillus species isolated from patients were determined by CLSI M38-A broth MD and Etest. The isolates were obtained from clinical samples that included tissues, sputum, bronchoalveolar lavage, abdominal tap, and cerebrospinal fluid. As revealed by the MD method, 63.9% of the isolates were sensitive to amphotericin B and 36.1% were resistant.Etest revealed that 61.1% were sensitive to amphotericin B and 38.9% were resistant. As for ketoconazole, 108 isolates (100%) were shown to be sensitive through the MD method; while the Etest revealedan 88.9% sensitivity and 11.1% were resistant. All species were susceptible to voriconazole, according to both methods. The measure of agreement (Kappa Index) for these three drugs was satisfactory (≥0.6). According to the MD method, 69.4% of the species were susceptible to itraconazole, whereas 30.6% were not. For this drug, the Etest showed 86.1% susceptible and 13.9% resistant. Voriconazole was the most effective agent against isolates. Using RPMI agar, we found the Etest to behelpful, readily available, and easy to use for determining invitro susceptibilities of Aspergillus species to voriconazole, amphotericin B, ketoconazole, and itraconazole in the region of this study.