Laboratory Mycological Study of Visceral Fungal Infection in Tehran, Iran

Visceral fungal infections due to petriellidium boydii (allescheria boydii): In vitro drug sensitivity studies

Therapy-related acute myelogenous leukemia (t-AML) is a generally fatal disease with a very poor response to conventional chemotherapy. Allogeneic stem cell transplantation (allo-SCT) has been reported in patients with chemotherapy- responsive t-AML. However its use is limited owing to complications from previous treatments. Nonmyeloablative conditioning provides rapid hematologic engraftment and it is a feasible option for patients who are at increased risk for conventional SCT. There are few data on their use in patients with t-AML. We describe the case of a boy who developed visceral fungal infection with liver abscesses after induction chemotherapy for t-AML. He received allo-SCT with a nonmyeloablative regimen, plus amphotericin B during the transplant procedure. The patient is alive and free of both leukemia and fungal infection 2 years after allo-SCT. Nonmyeloablative allo-SCT may provide durable remission in patients with t-AML, preexisting invasive fungal infections, and a high risk of adverse effects from standard chemotherapy and prolonged cytopenia, without resurgence of the fungal infection.

Streptomyces belongs to the Actinomycetes group of bacteria which are gram-positive non acid-fast bacilli, widely recognised for their potential to produce antimicrobials active against bacterial, mycobacterial, parasitic and fungal infections. They commonly cause cutaneous infections following traumatic inoculation. Visceral infections are relatively rare and limited to immunocompro-mised hosts. We describe a case of Streptomyces pneumonia in a healthy immunocompetent female, who when investigated for voluntary kidney donation, resulted in the isolation of Streptomyces species from bronchial wash cultures. Streptomyces, a potential pathogen in immunocompetent hosts is frequently underdiagnosed. Once isolated, both physicians and microbiologists should pay attention to differentiate true infection from contamination.

Conidiobolomycosis (also known as rhinoentomophthoramycosis) is a rare cutaneous/mucosal fungal infection seen mainly in the tropical rain forest regions of the world that can be associated with disfiguring facial elephantiasis, and rarely, death. To present an exemplary case report and perform a systematic review of the world's literature to more accurately describe the natural history and the effect of therapy on outcome in conidiobolomycosis. Case report and meta-analysis of published case reports and series of conidiobolomycosis to determine which clinical, pathologic, mycologic, and treatment factors impact on prognosis. We document delay in diagnosis of conidiobolomycosis in a young Malaysian woman, whose biopsy showed pathognomonic features-massive tissue eosinophilia and Splendore-Hoeppli phenomenon surrounding broad hyphae. These findings coexisted with granuloma faciale-like changes (fibrosing leukocytoclastic vasculitis) and lymphedema. Treatment with multiple antifungals was followed by complete resolution. For the meta-analysis, pooled data from 199 cases (162 with full outcome data) from 120 reports revealed a similar course for most cases: a disease affecting healthy young adults who present with progressive nasal symptoms (eg, nasal obstruction) and central facial swelling and show improvement or cure after surgical excision and/or treatment with one or more antifungal agents in 83%. Persistent-progressive facial disease occurred in 11%, and 6% died rapidly of fungal infection. Presentation with facial elephantiasis correlated with persistent-progressive rhinoentomophthoramycosis and a longer duration of disease before diagnosis (P = 0.02). Lethal infections were significantly associated with nonstereotypical presentation (eg, orbital cellulitis), visceral infection, absence of the Splendore-Hoeppli phenomenon, presence of comorbidities (eg, immunosuppression, hematolymphoid malignancy), infection with Conidiobolus incongruus or Conidiobolus lamprauges (not Conidiobolus coronatus), lack of response to amphotericin B, and female sex (all P ≤ 0.002). The few sensitivity studies performed demonstrated in vitro multidrug resistance of Conidiobolus species to most available antifungal agents. Publication bias, reporting heterogeneity, and data deficits may affect results. Conidiobolomycosis should be included in the differential diagnosis of patients who present with nasal symptoms and painless centrofacial swelling. Massive tissue eosinophilia and Splendore-Hoeppli material coating thin-walled hyphae confirms the clinical diagnosis. The granuloma faciale-like histology found in this case can explain the onset of facial lymphedema by fibroinflammatory destruction of lymphatic vessels; the duration of disease and severity of inflammation likely predicts whether the lymphedema is reversible or not. Although rhinoentomophthoramycosis ostensibly responds in vivo to most available antifungal agents, routine culture and susceptibility testing is recommended to better define the efficacy of these therapeutic agents.

We reviewed 355 autopsies performed between 1990 and 1994 at a major marrow transplant center to determine whether fluconazole prophylaxis prevented visceral fungal infection. Fluconazole prophylaxis was defined by a minimum of 5 prophylactic doses. Fungal infection (any site) was found in 40% of patients transplanted and autopsied at the center. Overall, the proportion of autopsies with any fungal infection was not different for those patients receiving no fluconazole prophylaxis versus those with prophylactic fluconazole. With fluconazole prophylaxis, candidal infections were less frequent, decreasing from 27% to 8%, while Aspergillus infections were more frequent, increasing from 18% to 29%. No increase in deaths related to non-albicans Candida infections was seen. Of the 329 patients with livers examined, hepatic infection caused by Candida species was significantly less common in patients who had received fluconazole. Fungal liver infection was found in 31 patients (9%), 16% of those who were not treated with fluconazole and 3% of those who were treated with fluconazole. Since patients with candidal infections died earlier after marrow transplant than patients with mold infections, we speculate that a longer length of survival may dispose toward acquisition of mold infections. Fluconazole prophylaxis in this cohort of marrow transplant patients undergoing autopsy resulted in a significant reduction in infection caused by Candida species and an increase in mold infections.

A case of invasive gastrointestinal Basidiobolus ranarum infection involving the cecum, appendix, right colon, liver and abdominal lymph nodes is reported in a 12-year-old child. This is the second case of culture-proved gastrointestinal B. ranarum infection reported to date in a pediatric patient.

is a ubiquitous filamentous fungus commonly isolated from soil, polluted water bodies and sewage. Recently, the prevalence of cutaneous and visceral infection caused by these fungi has increased among immunocompromised patients. Various opportunistic fungal infections have been reported among COVID-19 recovered patients. In this study, a rare case of lymphocutaneous infection due to in an immunocompromised post COVID -19 diabetic man is reported.

Rhinoentomophthoromycosis: A rare case report

Tineas—Superficial Dermatophyte Infections

Context: Today, the emergence of fungal infections in public places has become a focus, especially in developing countries. Objectives: The present study aimed to study the literature on fungal infections in public places in Iran to find a variety of fungal infections. Study Selection: A search was performed to identify relevant studies in PubMed, Web of Science, Scopus, Scientific Information Database (SID), and Magiran databases from 2010 to 2022 using special keywords and equivalents. Overall, 25 studies met the inclusion criteria. Finally, the required information was extracted and discussed. Results: The research findings indicate that the research design of most of the papers was cross-sectional. Most of the studies in the field of fungal infections in public environments in Iran have been carried out in places such as swimming pools, schools, some health-related environments, cultivation environments, and soil. Different species of Aspergillus, Penicillium, Mucor, and Mucormycosis were identified in the environments. Conclusions: Examination of different species showed a combination of superficial, skin, mucosal, and visceral fungal infections observed in public places. Prevention and environmental analysis should be given more attention by health policy-makers in order to reinforce public health.

We reviewed the hospital admissions of 168 patients with acute leukemia to determine the incidence of persistent fever following recovery from chemotherapy-induced granulocytopenia. This phenomenon was observed during 26 (15.5%) hospital admissions. The microbiologically and/or clinically documented causes identified in 23 instances included viral infection (two patients), perirectal abscess (two patients), Hickman catheter-related bacteremia (two patients), intraabdominal infection (four patients), and nine fungal infections (five resolving pneumonia, one disseminated candidiasis, three focal hepatic and/or splenic mycosis). One patient had both cholecystitis and a pneumonia of uncertain origin and three patients had drug reactions. Although overall the source of fever was usually readily apparent, focal hepatic and/or splenic mycosis produced protracted fevers that were difficult to diagnose. Visceral fungal infection should be a leading diagnostic consideration in patients with leukemia who remain persistently febrile following recovery from chemotherapy-induced granulocytopenia.

Rationale:Meningoencephalomyelitis and visceral dissemination infection are rare but life-threatening complications of either the primary infection or reactivation of varicella-zoster virus (VZV) in immunocompromised patients. To date, few studies have reported the co-existence of VZV meningoencephalomyelitis and the visceral dissemination of VZV infection.Patient concerns:A 23-year-old male was diagnosed with lupus nephritis class III and was being treated with oral prednisone and tacrolimus. The patient exhibited herpes zoster 21-day after the initiation of therapy and experienced unbearable abdominal pain and generalized seizures 11 days after the onset of a zoster rash. Magnetic resonance imaging showed progressive lesions in the cerebrum, brainstem, and cerebellum, as well as meningeal thickening and thoracic myelitis. Computed tomography showed pulmonary interstitial infiltration, partial intestinal dilatation, and effusion. Metagenomic next-generation sequencing revealed 198,269 and 152,222 VZV-specific reads in the cerebrospinal fluid and bronchoalveolar lavage fluid, respectively.Diagnoses:Based on the clinical and genetic findings, this patient was finally diagnosed with VZV meningoencephalomyelitis and visceral disseminated VZV infection.Interventions:The patient received intravenous acyclovir (0.5 g every 8 hours) combined with plasma exchange and intravenous immunoglobulin. Treatment against secondary bacterial and fungal infections, organ support therapy and rehabilitation training were given simultaneously.Outcome:The patient’s peripheral muscle strength did not improve and repeated metagenomic next-generation sequencing showed the persistence of VZV-specific reads in the cerebrospinal fluid. The patient finally abandoned therapy due to financial constraints at the 1-month follow-up.Lessons:Patients with autoimmune diseases receiving immunosuppressive therapy should be warned about the possibility of developing serious neurological infections and visceral disseminated VZV infections as side effects. Early diagnosis and the early initiation of intravenous acyclovir therapy are important for such cases.

Laboratory Mycological Study of Visceral Fungal Infection in Tehran, Iran

Background: Human immune deficiency virus (HIV), the causative agent of Acquired Immune Deficiency Syndrome (AIDS) has remained a global cankerworm, with more impact in the sub-Saharan Africa. This virus destroys and depletes the human CD4 cells, leading to immune deficiency state and making the individual susceptible to opportunistic infections. Fungal opportunistic infections are among the common pathogens seen earlier in HIV positive individuals and may present as respiratory diseases like Pneumocystis jiroveci pneumonia and pulmonary cryptococcosis. This study aimed at understanding the pattern of fungal opportunists in the sputa of HIV positive individuals in our locality, to understand the demographics among those with the fungal isolates and to correlate CD4 level of the patients with the isolated opportunistic fungal pathogens. Methods: This was a prospective study in design, study area was Federal Medical Centre Owerri, Imo state, Nigeria, and study population included HIV positive individuals who were older than fifteen (15) years who developed cough lasting for more than fourteen (14) days). The hospital is the largest in the state and serves some neighbouring states like Rivers, Anambra and Abia state. The sample size was seventy three (73). Samples were collected, processed and organisms identified and results tabulated. Results: Out of the seventy three (73) sputa sample, 50 (68.5%) showed positive growth while twenty three 23 (31.5%) did not show any growth. Males with opportunistic fungal infections had a lower frequency (40%) than females (60%). 40/50 (80%) of the grown organisms were Candida organism and 23/40 (57.5%) of them were albicans. Candida albican had the highest incidence 23/50 (46%) and seen more in the age bracket (25-34). It was also rarely seen when the CD4 cell count was more than 500 cell/mm3 but very common when count was <400 cells/ mm3. Cryptococcus neoformans had 5/50 (10%) and isolated in individual with CD4 count<100 cells/mm3, Aspergillus flavus and A. fumigatus were isolated at 56 and 367 cells/mm3 with incidences of 2.0% respectively (Figure 1). The Penicillium marneffi reported as the emerging fungal infection among HIV clients in Southeast Asia was not seen in our series. Conclusions: Most pulmonary fungal opportunistic infection in the setting of HIV often mimics pulmonary tuberculosis. Candida albicans has the highest incidence in our study. However, knowledge of fungal opportunistic infections pattern in HIV patients will help clinicians in the appropriate management of the clients—in terms of prophylaxis and therapeutics.

Actinomycosis is the most common visceral mycotic infection in man. As early as 1899, ten years after the first description of the disease in man by Israel, Ruhrah1presented statistics on 1,094 cases. In 1925 Sanford and Voelker2were able to collect reports of 670 cases in the United States alone. In about 15 per cent of these cases the infection occurred in the thorax. This figure has been corroborated by other observers, but, as pointed out by Kaufmann,3involvement of the heart and pericardium is distinctly rare. Kasper and Pinner4found it to occur in less than 2 per cent of 470 cases of actinomycosis. In his recent excellent monograph on actinomycosis Cope5made only one general statement concerning cardiac actinomycosis, namely, extension by continuity may take the fungus into the pericardium or the very substance of the heart. The following case is an