Common Fungal Infection Research Articles

The preliminary study on the antifungal effect of Kaffir lime (Citrus hystrix DC) peel extract against Malassezia furfur

Pityriasis versicolor is one of the most common fungal infections on the skin caused by Malassezia furfur. Kaffir lime fruit (Citrus hystrix DC), especially its peels’ contents in secondary metabolite, may play a healing role against such infections. Therefore, the aim of this study was to determine the antifungal potential of Kaffir lime peel extract against Malassezia furfur. Ethanol extracts of the peels of Kaffir lime were tested for its antifungal properties against Malassezia furfur at different tested concentrations, namely 25%, 50%, 75%, and 100%. Every treatment was performed with 4 replications. Inhibition zone formed surrounding the paper disc measured after 24 hours of incubation using the caliper method. Data were subjected to the Kruskal-Wallis test and the Mann-Whitney Post hoc test. The study revealed that the kaffir lime fruit extract gave a significant effect on the inhibition zone (p< 0.05). The results showed that the higher inhibition zone was found at control group and it was different significantly from other treatments. However, among the tested concentrations, the best treatment was detected at a concentration of 100%, which was significantly different from other concentrations. Kaffir lime peel has an antifungal effect against Malassezia furfur and the best tested concentration was 100%.

A dermatological odyssey: Levamisole\'s Triumph over warts, vitiligo, dermatophytosis, and pityriasis versicolor in a young patient

In our case, we observe the presence of various conditions within the same patient, including prevalent benign lesions caused by the human papillomavirus (HPV) known as warts. These warts, occurring in both mucosal and skin regions, can contribute to significant morbidity for affected individuals. Additionally, the patient exhibits vitiligo, a common acquired skin disorder characterized by well-demarcated white patches resulting from the loss of melanocytes in the epidermis. Although different theories exist regarding the pathogenesis of vitiligo, the exact etiology remains unknown. Alongside, the patient presents with two common fungal infections, namely pityriasis versicolor and dermatophytosis. The coexistence of all these dermatological conditions in a single patient highlights the complexity of the case.

PREVALENCE, TYPING, AND ASSOCIATED FACTORS OF ORAL CANDIDA COLONIZATION IN DENTURE WEARING AND FIXED ORTHODONTIC APPLIANCE COMPARING TO NORMAL TEETH INDIVIDUALS

Background and objectives: Oral Candida colonization (OCC) is one of the most common opportunistic fungal infections among people who wear dentures and have FOA. The prevalence of OCC and Candida among denture patients and FOA patients may change due to the presence of these dental appliances. This study aims to identify the different Candida species, determine the prevalence of OCC in 3 groups of individuals with removable or fixed dentures and fixed orthodontic appliances (FOA) compared with a control group of people with natural teeth and study the risk factors associated with contracting oral Candida species among these groups. Subjects and methods: The investigational group was selected from denture and orthodontic patients who were clinically examined at the earliest time to obtain basic information before any effective treatment of dental infection. The group included 104 dental patients; 104 fixed orthodontic appliance (FOA) patients and 102 controls. The oral mucosa of each participant was first swabbed and then placed in a liquid medium. Then, after creating successive dilutions and applying them to Sabouraud dextrose agar, the isolates were diagnosed by culturing them on Candida agar with color, observing the colony characteristics of the species, in addition to studying the biochemical reactions to confirm the species. Results: Of the 108 persons with OCC, 44 (34.8%) had a positive OCC. 148 oral Candida spp. were found in 108 OCC patients. C. albicans (49.1%) was the most frequently isolated species, followed by C. glabrata (35.2%) and C. dubliniensis (13%). C. kefyr, C. krusei, C. famata, C. africana, and C. stellatoidea were initially isolated for the first time in the oral cavities of Yemeni dentistry patients. A higher rate of colonization was observed in the male group (48.5%) versus 25% in the female group, with odds ratio equal to 2.8, CI=1.7–4.6, X2=18, and p<0.001. Also there was association of denture wearing (44.2%, OR= 1.8, p =0.01) and older ages, (52.5%, OR= 2.3, p=0.01) with high rate of oral candida colonization. Conclusion: Candida colonization remains a major problem in the oral cavity. Although the prevalence of non-albicans Candida (NAC) species is increasing, C. albicans was still the dominant species. A higher rates and significant risk factors of OCC were observed in the male group, denture patients and the elderly. Peer Review History: Received 2 December 2023; Revised 29 January 2024; Accepted 28 February; Available online 15 March 2024 Academic Editor: Dr. Iman Muhammad Higazy, National Research Center, Egypt, imane.higazy@hotmail.com Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. Vanina Doris Edo’o, University of Yaounde I, Yaounde, Cameroun, vanina_edoo@yahoo.com Dr. Taiwo O Elufioye, University of Ibadan, Nigeria, toonitaiwo@yahoo.com

Antifungal Potential of Bioactive Metabolites Produced by Pseudomonas aeruginosa against Candida Species

Abstract: Background: The frequency of fungal infections targeting immune-suppressed patients has been prominently rising day by day. Among these infections, Candidiasis is one of the most common life-threatening systemic fungal infections in recent years. These infections are challenging to treat because of the inconvenience of effective antifungal drugs. Therefore, the insufficiency of current drug regimens coupled with constant mutations by the fungi to develop drug resistance can pose a potential problem for future anti-fungal treatments. This frequent increase in drug-resistant fungi has directed attention toward the use of alternative therapy from natural sources. Objective: This study aimed to evaluate Pseudomonas aeruginosa for its antifungal potential against Candida species. Materials and Methods: This study was conducted at the Federal Urdu University of Arts, Science and Technology, Karachi, Pakistan during 2021-2022. For the detection of the antifungal compound, a clinical isolate P. aeruginosa HS 28 (identified conventionally as well as by 16S r RNA analysis) was screened for its bioactivity against Candida species by using agar well diffusion technique. The growth kinetics as well as the effect of different physical and chemical factors were also determined in the study. The compound was also partially purified by ammonium sulfate precipitation. Result: This antifungal compound showed good inhibitory activity against Candida species such as Candida albicans, C. glabrata, C. tropicalis, C. krusei, etc. This compound retained its stability at a high range of temperatures, and varying pH. Moreover, its bioactivity was also conserved when treated with organic solvents, chloroform vapors, metal salts, and different surfactants/detergents. The growth kinetics analysis illustrated that the maximum production of antifungal compounds occurred in the log phase of growth and extended supreme until the late log phase. Furthermore, the highest saturation of this protein was achieved at the concentration of 60% ammonium sulfate. Conclusion: The overall results indicated the promising antifungal potential of the compound produced by Pseudomonas aeruginosa HS 28 against Candida species.

Ozone Therapy on Fungi that Cause Onychomycosis

ABSTRACT Onychomycosis is a common fungal infection of the nails, predominantly caused by dermatophytes and is a notoriously difficult condition to treat. Thus, the objective of the present study was to evaluate and compare, in vitro, the efficacy of different applied ozone dosages against the main fungi that cause onychomycosis. Dermatophyte fungi Trichophyton rubrum (ATCC 28,188) and Microsporum gypseum (ATCC 24,102) were incubated at 28 °C for 14 days. Treatments were divided into nine experimental groups according to applied ozone dosages: Control Group 0 mg/m2: fungi were cultured but received no treatment; cultured fungi that received ozone therapy for 157, 314, 471, 628, 785 943, 1100 and 1257 mg/m2. The main results indicate that topical ozone therapy effectively reduced the germination percentage of T. rubrum and M. gypseum in all experimental periods, achieving a complete eradication with a treatment time of 628 and 1257 mg/m2, respectively. In conclusion, ozone therapy used topically with an applied ozone dosage of 628 mg/m2 for T. rubrum and 1257 mg/m2 for M. gypseum promoted antifungal action on the main dermatophytes responsible for critical complications of onychomycosis. Therefore, ozone therapy can be proposed as an adjuvant for dermatological treatments

Safety of Secukinumab from 1Million Patient-Years of Exposure: Experience from Post-Marketing Setting and Clinical Trials.

Secukinumab is an anti-interleukin (IL)-17A monoclonal antibody indicated for multiple immunological disorders. Here, we aim to summarize secukinumab safety in clinical trials (CTs) and post-marketing setting (PMS) until 25June2022. Adverse events (AEs) were summarized with crude reporting rate (RR) per 100 patient-years (PY) in PMS for all reported indications and with exposure-adjusted incident rates (EAIR) per 100 PY in pooled 47 CTs for approved indications. Secukinumab exposure totaled 1,159,260 PY in PMS and 27,765 PY in CTs. AEs were mostly (> 80%) non-serious in PMS. EAIR for serious AEs was 7.0/100 PY. Nasopharyngitis (RR 0.59/100 PY, EAIR 16.08/100 PY) and pneumonia (RR 0.14/100 PY, EAIR 0.17/100 PY) were the most common infection and serious infection, respectively. Candida infections (RR 0.20/100 PY, EAIR 2.16/100 PY) were the most common fungal infections. Inflammatory bowel disease (IBD) was observed in PMS (0.14/100 PY) and CTs (0.26/100 PY). Most (76%) patients with prior IBD did not report IBD flare during CTs. PMS monitoring identified paradoxical skin reactions including dyshidrotic eczema (RR 0.006/100 PY) and pyoderma gangrenosum (RR 0.003/100 PY). Secukinumab safety profile with increased patient exposure remained favorable. Paradoxical skin reactions were identified in post-marketing monitoring.

Clinicopathologic Spectrum and Outcomes of Infections Diagnosed on Graft Biopsies and Nephrectomy in Live Renal Allograft Recipients: An Institutional Experience.

Modern immunosuppressive regimens have reduced rejection episodes in renal allograft recipients but have increased the risk of opportunistic infections. Infections are considered to be the second leading cause of death after cardiovascular complications in renal allograft recipients. Data on opportunistic infections affecting the allograft itself are scarce. The present study describes the spectrum of renal opportunistic infections and their outcomes diagnosed on renal allograft biopsies and nephrectomy specimens. Our retrospective observational study was conducted from December 2011 to December 2021. We analyzed infectious episodes diagnosed on renal allograft biopsies or graft nephrectomy specimens. We obtained clinical, epidemiological, and laboratory details for analyses from hospital records. BK virus nephropathy was the most common opportunistic infection affecting the allograft, accounting for 47% of cases, followed by bacterial graft pyelonephritis (25%). Mucormycosis was the most common fungal infection. The diagnosis of infection from day of transplant ranged from 14 days to 39 months. Follow-up periods ranged from 1 to 10 years. Mortality was highest among patients with opportunistic fungal infection (62%), followed by viral infections, and graft failure rate was highest in patients with graft pyelonephritis (50%). Among patients with BK polyomavirus nephropathy, 45% had stable graft function compared with just 33% of patients with bacterial graft pyelonephritis. BK polyoma virus infection was the most common infection affecting the renal allograft in our study. Although fungal infections caused the highest mortality among our patients, bacterial graft pyelonephritis was responsible for maximum graft failure. Correctly identifying infections on histology is important so that graft and patient life can be prolonged.

Seaweed Calliblepharis jubata and Fucus vesiculosus Pigments: Anti-Dermatophytic Activity

Seaweeds have been explored as a natural resource of compounds of interest due to their bioactivities. Although many studies report the interest and the application of seaweeds in various areas, from food or human health to the economy, these data mostly focus on raw extracts and not on specific compounds, such as seaweed pigments. Fungal infections of the skin, nails, and hair caused by dermatophytes are the most common fungal infections worldwide. These pathologies require long periods of topical and/or systemic treatment associated with adverse effects and increased antifungal resistance. So, this study had two objectives: the first was to isolate and characterize the pigments of the seaweeds Calliblepharis jubata and Fucus vesiculosus; the second was to assess their antifungal activity. The extraction of pigments was performed using a method of extraction by exhaustion, and the purification was achieved via column chromatography. Three techniques were used to characterize the pigments: thin-layer chromatography (TLC), UV–visible spectrophotometry, and Fourier-transform infrared spectroscopy (FTIR). The antifungal activity against the three most common dermatophytes, Trichophyton rubrum, Trichophyton mentagrophytes, and Microsporum canis, was evaluated using a microdilution methodology, following the EUCAST international standards. It was possible to observe that the extracts obtained from the seaweed C. jubata, corresponding to the purified pigment phycobiliprotein, and the crude extract (an enriched extract) showed antifungal activity against the three fungal agents of human skin infection.

Risk Factors and Environmental Preventive Actions for Aspergillosis in Patients with Hematological Malignancies.

(1) Background: Aspergillus spp. is a widely distributed filamentous fungus in the environment due to its high sporulation capacity. Currently, invasive aspergillosis (IA) is the most common invasive fungal infection in patients with hematologic malignancies, with high rates of mortality and morbidity. The multifactorial nature of the disease requires appropriate risk stratification to enable the most appropriate preventive measures to be adapted and implemented according to the characteristics of the patient. In this sense, the present research aims to identify recent risk factors and environmental control measures against invasive aspergillosis to establish preventive actions to reduce the incidence of invasive aspergillosis in hospitals. (2) Methods: We conducted a qualitative systematic review of the scientific literature on environmental risk factors and preventive measures for invasive aspergillosis in patients with hematologic malignancies. The Medline, Cochrane, and Scopus databases were consulted, following the PRISMA and STROBE guidelines. (3) Results: Adequate implementation of environmental control measures is presented as the most efficient intervention in terms of prevention to decrease the incidence of invasive aspergillosis in hospitals. Neutropenia, fungal contamination, insufficient environmental control measures in hospital and home settings, length of hospital stay, and anemia, are identified as independent risk factors. We show that HEPA, LAF, and Plasmair® systems are suitable methods to reduce the concentration of airborne fungal spores. Antifungal prophylaxis did not significantly influence IA reduction in our study. (4) Conclusions: Proper professional training and environmental control measures in hospitals are essential for the prevention of invasive aspergillosis. We should optimize risk stratification for patients with hematologic malignancies. Antifungal prophylaxis should be complementary to environmental control measures and should never be substituted for the latter. Studies should also be undertaken to evaluate the efficiency of environmental control measures against IA at patients' homes.

Study of prescription pattern of antifungal drugs from tertiary care hospital

Background: The most common superficial fungal infections are tinea corporis, tinea cruris, tinea capitis, tinea pedis, tinea unguium, and tinea facie and cutaneous Candida albicans infections such as oral thrush, oropharyngeal candidiasis, vaginal candidiasis, and onychomycosis. Aims and Objectives: (i) Analysis of prescription pattern of antifungal drugs and (ii) to study common adverse effects. Materials and Methods: A retrospective, observational study conducted in B. K. L. Walawalkar Hospital, Sawarde, Ratnagiri. A total of 993 case papers were analyzed after getting approval from the institutional ethics committee and permission from dermatology department. The frequency with percentage was used for the analysis of data. Results: In 993 patients with superficial fungal infections, 523 (52.7%) were males and 470 (47.3%) were females. Majority of patients were belonged to 21–40-year age group, i.e., 439 (44.2%) followed by 41–60 years, i.e., 244 (24.6%). Our study shows that the most common superficial fungal infections with single lesion were tinea corporis (22.3%), tinea cruris (14.6%), and pityriasis versicolor (13.9%). In Candida albicans, the most common infection was onychomycosis 14 (1.4%). The most common antifungal prescribed was luliconazole (20.84%) followed by itraconazole (20.58%). The most common route was topical route (68.26%). Combination of drugs was not prescribed. Different prescription indicators were that the average number of drugs prescribed per encounter was 3.4 and average number of drugs prescribed per encounter was 2.7. Conclusion: Most commonly prescribed newer antifungal was luliconazole. Next most commonly prescribed by oral route was itraconazole. No use of combination of drugs and many drugs selected from essential medicinal list. Based on these finding we concluded prescriptions where rational approach.

Invasive fungal infections in critically ill children: epidemiology, risk factors and antifungal drugs.

Invasive fungal infections (IFIs) are important infectious complications amongst critically ill children. The most common fungal infections are due to Candida species. Aspergillus, Zygomycetes and Fusarium are also emerging because of the empirical use of antifungal drugs. This updated review discusses the epidemiology of IFIs as well as antifungal drugs, dosing and potential adverse effects in critically ill children. A PubMed search was conducted with Clinical Queries using the key terms "antifungal", "children", "critical care" AND "paediatric intensive care unit" OR "PICU". The search strategy included clinical trials, randomized controlled trials, meta-analyses, observational studies and reviews and was limited to the English literature in paediatrics. Candida and Aspergillus spp. are the most prevalent fungi in paediatric IFIs, causing invasive candidiasis infections (ICIs) and invasive aspergillosis infections (IAIs), respectively. These IFIs are associated with high morbidity, mortality and healthcare costs. Candida albicans is the principal Candida spp. associated with paediatric ICIs. The risks and epidemiology for IFIs vary if considering previously healthy children treated in the paediatric intensive care unit or children with leukaemia, malignancy or a severe haematological disease. The mortality rate for IAIs in children is 2.5-3.5-fold higher than for ICIs. Four major classes of antifungals for critically ill children are azoles, polyenes, antifungal antimetabolites and echinocandins. Antifungal agents are highly efficacious. For successful treatment outcomes, it is crucial to determine the optimal dosage, monitor pharmacokinetics parameters and adverse effects, and individualized therapeutic monitoring. Despite potent antifungal medications, ICIs and IAIs continue to be serious infections with high mortality rates. Pre-emptive therapy has been used for IAIs. Most guidelines recommend voriconazole as initial therapy of invasive aspergillosis in most patients, with consideration of combination therapy with voriconazole plus an echinocandin in selected patients with severe disease. The challenge is to identify critically ill patients at high risks of ICIs for targeted prophylaxis. Intravenous/per os fluconazole is first-line pre-emptive treatment for Candida spp. whereas intravenous micafungin or intravenous liposomal amphotericin B is alternative pre-emptive treatment.This article is part of the Challenges and strategies in the management of invasive fungal infections Special Issue: https://www.drugsincontext.com/special_issues/challenges-and-strategies-in-the-management-of-invasive-fungal-infections.

Cutaneous Manifestations of Diabetes Mellitus in a Tertiary Care Hospital in Eastern India: A Cross-sectional Study

Background: Diabetes mellitus is a chronic metabolic disorder and is a major public health problem worldwide. Skin diseases can appear as the first sign of diabetes or can develop at any time in the course of the illness. Purpose: This study aimed to determine the pattern and prevalence of skin manifestations in patients with diabetes mellitus. Methods: An observational cross-sectional study was done on 80 Type 1 and Type 2 diagnosed diabetes mellitus patients and with informed consent, they were thoroughly examined for their respective skin disorders. Results: Among 80 patients, 35% of patients had infectious skin lesions, whereas 20% had noninfectious dermatosis only. More than one type of dermatosis was seen in 45% of patients. Candidal balanoposthitis was the most common fungal infection. Limitation: Limited sample in a single center. Conclusion: Infections were more prevalent compared to noninfectious disease in a population with uncontrolled diabetes mellitus. Pruritus was the most common disorder among the other diabetic complications.

Frequency of the Most Common Fungal Infection in Biopsies of Patients, Presenting to Pathology Department King Edward Medical University Mayo Hospital, Lahore, Keeping the Pas Stain as Gold Standard

Frequency of the Most Common Fungal Infection in Biopsies of Patients, Presenting to Pathology Department King Edward Medical University Mayo Hospital, Lahore, Keeping the Pas Stain as Gold Standard

Antifungal Selection for the Treatment of Onychomycosis: Patient Considerations and Outcomes.

Onychomycosis, a common fungal nail infection, affects >20% of adults over age 60 and >50% of people over age 70. Onychomycosis may cause pain, psychosocial problems, and secondary infections, therefore meriting treatment. This review describes the range of treatment modalities, including FDA-approved systemic drugs and topical therapies. Additionally, new and emerging oral and topical therapies are discussed. We emphasize the importance of tailoring onychomycosis therapy to individual patient characteristics, comorbidities, preferences, extent of nail involvement, and fungal species, such that physicians may optimize treatment outcomes, patient satisfaction, and safety.

Uro-pathogens: Multidrug resistance and associated factors of community-acquired UTI among HIV patients attending antiretroviral therapy in Dessie Comprehensive Specialized Hospital, Northeast Ethiopia.

Urinary tract infections are common bacterial and fungal infections in humans, occurring both in the community and in immunocompromised patients in healthcare settings. Urinary tract infections have a significant health impact on HIV-infected patients. Nowadays, drug-resistant pathogens are widespread poses a serious clinical risk, and causes urinary tract infection. The common agents of bacteria and fungi that cause urinary tract infection are Escherichia coli followed by Klebsiella pneumonia, Staphylococcus saprophyticus, Enterococcus faecalis, group B streptococcus, Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus aureus and Candida. albicans. This study aimed to investigate uro-pathogen, multidrug resistance pattern of bacteria, and associated factors of community-acquired urinary tract infection among HIV-positive patients attending antiretroviral therapy in Dessie comprehensive specialized hospital, Northeast Ethiopia from February 1, 2021, to March 30, 2021. An institutional-based cross-sectional study was conducted at Dessie Comprehensive Specialized Hospital. Socio-demographic and clinical data were collected by using structured questionnaires from HIV patients suspected of community-acquired urinary tract infections. About 10 ml of clean-catch midstream urine was collected and inoculated into Blood agar, MacConkey, and Cysteine lactose electrolyte deficient media. Yeasts were identified by using Gram stain, germ tube test, carbohydrate fermentation, assimilation tests, and chromogenic medium. Gram stain and biochemical tests were performed to identify isolates and an antimicrobial susceptibility pattern was performed on disc diffusion techniques. Data were entered and analyzed using SPSS version 25. Both bivariate and multivariable logistic regression analysis was performed and a P value of < 0.05 with an adjusted odds ratio with their 95% confidence interval (CI) was used as statistically significant associations. From the total 346 study participants, 92 (26.6%) were culture positive 75 (81.52%) were bacterial and 17 (18.48%) were fungal pathogens. From a total of 75 bacteria isolates 51(68%) were Gram-negative bacteria and the most commonly isolated bacteria were E. coli 16 (21.33%) followed by K. pneumoniae 11(14.67%) and enterococcus species 10(10.87. Of the 17 fungal isolates of fungi, 8(47.1%) were represented by C. tropicalis. Of the isolated bacteria, 61(81.3%) were resistant to three and above classes of antibiotics (drug classes). About 13 (81.3%) of E. coli, 9(81.8%) of K. pneumoniae, 8(80%) of Enterococcus species, 7 (77.8%) of P. aeruginosa, and CoNs 7(87.5%) were the most frequently exhibited three and above classes of antibiotics (multi-drug resistance). Amikacin and gentamicin were effective against Gram-negative Uro-pathogens. Participants aged>44year, female, being daily labor, being farmer, unable to read and write, patients with CD4 count of ≤ 200 cells/mm3 and CD4 count of 201-350 cells/mm3, who had chronic diabetics, patients having a history of hospitalization and who had urgency of urinations were statistically significant association with significant urinary tract infections. The burden of community-acquired urinary tract infections among HIV patients is alarmingly increased. Therefore, behavior change communications might be considered for promoting the health status of HIV patients. Moreover, CD4 level monitoring and therapeutics selection based on microbiological culture are quite advisable for the management of urinary tract infections of HIV patients.

Antifungal Properties of Grape Seed Extract on Various Species of Candida Organisms: An In vitro Study

Purpose: Oral candidiasis is one of the most common fungal opportunistic infections in the mouth caused by a fungus called Candida, and it presents as commensals in all humans. Over the last few decades, the increasing incidence of Candida infections parallels the growing numbers of immunocompromised patients. This trend is aggravated by the fact that there is a reckless use of antifungals. To combat this trend, the use of natural antifungals which have fewer side effects is recommended. Black grape seed extract (GSE) has shown a promise in this regard. Materials and Methods: Candida species such as Candida krusei, Candida glabrata, Candida tropicalis, and Candida albicans were used in the study. Fungal strains were passaged in the agar Sabouraud dextrose environment from 24 h to have live and fresh strains for the test. Black GSE was obtained. Minimum inhibitory concentration (MIC), of GSE, amphotericin B and fluconazole drugs on the included fungi was examined using disc diffusion method. Then, the plates were incubated for 24 h at 37°C. Finally, growth inhibitory zone was examined. Results: The analysis of the results revealed that the growth of C. albicans and C. krusei had been stopped at the concentration of 6.25 μg/mL, but the growth of C. glabrata and C. tropicalis was inhibited at a concentration of 12.25 μg/mL and 0.8 μg/mL respectively. Conclusion: The results obtained from the present study showed that both disc diffusion method and the maximum inhibitory concentration of MIC (Macro dilution) confirms the antimicrobial susceptibility of four species of candida to GSE. We conclude the possibility of GSE as an effective alternative measure for commercial antifungal agents, especially among immunocompromised patients, However, more laboratory and clinical studies need to be conducted to validate our findings.

Dermoscopic Perspective of Pityriasis Versicolor in a Cross-Sectional Study.

Pityriasis versicolor is a common superficial fungal infection which is usually easily diagnosed with Wood's lamp examination and 10% potassium hydroxide mount. However, these modalities have varying sensitivity and specificity. This study aimed to ascertain the dermoscopic features of pityriasis versicolor lesionally as well as perilesionally using dermoscopy, a non-invasive diagnostic tool. In this cross-sectional study, consecutive patients with pityriasis versicolor underwent dermoscopic examination of lesions and 2 cm around lesions, noting lesional and perilesional features. Semi-objective grading of pigmentation, scaling, and vascularity was done. The association between parameters was determined using heat maps and violin plots with Kolmogorov-Smirnov test. Lesional analysis was performed since lesions at different sides showed disparate features. A total of 353 lesions from 233 patients (males = 150/233; 64.38% and females = 84/234; 36.05%) were studied. On lesional dermoscopy, pigmentary and scaling abnormalities were universal. 258/353 (73.1%) of lesions showed vascular abnormalities. Perilesionally, scaling (223/353; 63.17%) followed by pigmentation (205/353; 58.07%) and vascular changes (111/353; 31.44%) constituted the most common dermoscopic abnormalities and were noted in 294/353 (83.29%) of lesions overall. Increased disease duration corresponded with increased intensity of perilesional pigmentation alterations, perifollicular (P = 0.04), and follicular scales (P = 0.02). Awareness of dermoscopic features could improve the diagnostic accuracy in doubtful cases of pityriasis versicolor. Vascular findings are common and may point to an underlying inflammatory pathogenesis. Perilesional findings constitute early dermoscopic features of pityriasis versicolor and hint at the need for treatment beyond the confines of lesions. Larger follow-up studies and research into immunopathogenesis may be of further benefit.

Editorial

From Editor’s Desk… Fungal diseases remain a major medical concern, posing a global hazard to human health and affecting about one billion people. The second wave of COVID-19 has hit particularly hard, drastically increasing the incidence of invasive fungal infections in countries like India. Fungal infections linked to COVID-19, primarily caused by Aspergillus and Candida species, as well as fungus belonging to the order Mucorales, have been documented in multiple countries as posing a serious threat to the healthcare system. Individuals with COVID-19 who are hospitalized are more likely to have fungal co-infections, which can worsen their prognosis by misdiagnosing the illness, which frequently leads to treatment failure and a high death rate. Elderly, critically ill, and immunocompromised patients are more prone to opportunistic fungal diseases. Other rare but increasingly common fungal infections include those caused by Pneumocystis jirovecii, Histoplasma sp., Cryptococcus sp., and others. Fungal-related hospitalizations rose by 8.5% annually in the US between 2019 and 2021, per data that was released. Compared to patients with non-COVID-19 associated fungal infections (12.3%), hospitalized patients with COVID-19 linked fungal infections had greater in-hospital mortality rates (48.5%). More surveillance for fungal diseases is required, especially during pandemics of respiratory viruses. Given the enormous worldwide devastation caused by the COVID-19 pandemic, it is imperative that we get more ready for infectious disease outbreaks in the future and conduct thorough public health surveillance for fungal illnesses in order to characterize disease epidemiology and direct efforts to prevent illness and death. Healthcare professionals should be more informed and ready, particularly when it comes to high-risk patients. More research, improved treatment techniques, and quicker diagnosis are required to manage these fungal infections. Dr. Khalid Mohammed Alabdulwahhab Editor in Chief

Characteristic of Subcutaneous Mycosis Patients at Prof. Dr. I.G.N.G Hospital, Denpasar, Bali: An Observational Retrospective Study

Introduction: Subcutaneous mycosis infections can occur in tropical and subtropical countries. Indonesia’s geographic location is in a tropical country and is a developing country with the majority of its population working in agriculture, which is a risk factors associated with subcutaneous mycosis. Methods: This is a retrospective observational descriptive study with a cross-sectional design. Data were obtained through medical records from all patients who came for treatment in Prof IGNG Ngoerah General Hospital Denpasar from January 2018 to December 2023. The inclusion criteria in this study were all patients diagnosed with subcutaneous mycosis. The variables studied were age, gender, occupation, comorbidities, first symptoms, skin efflorescence, dermatoscopy finding, and type of mycosis based on yeast culture. Results: A total of 21 cases of subcutaneous mycosis within 5 years. The majority of patients were female, (67%), with the most common age group being 45-64 years (57%). Based on occupation, farmers account for at most (33%). The majority of patients had itchiness (33%) and redness (33%) as the first symptoms, nodule erythema was the most common skin efflorescence (57%), and the most common dermatoscopy finding was yellow dots (57%). The most common fungal infection based on culture was chromoblastomycosis (71%). Conclusion: The majority of patients of subcutaneous mycosis were female, with age group 45-64 years old, and farmers. Itchiness and redness were the common symptoms of the disease. On examination, nodule erythema is the most common skin efflorescence. Chromoblastomycosis was the most common type of infection.

A Novel Mitochondrial Targeted Compound Phosundoxin Showing Potent Antifungal Activity against Common Clinical Pathogenic Fungi.

The current increase in resistance to antifungal drugs indicates that there is an urgent need to explore novel antifungal drugs with different mechanisms of action. Phosundoxin is a biphenyl aliphatic amide using a TPP-targeting strategy which targets mitochondria. To provide insights into the antifungal activities of phosundoxin, the antifungal susceptibility testing of phosundoxin was conducted on 158 pathogenic fungi and compared to that of traditional azole drugs. Phosundoxin displayed a broad-spectrum antifungal activity on all the tested yeast-like and filamentous fungi ranging from 2 to 16 mg/L. In particular, azole-resistant clinical isolates of Candida albicans were susceptible to phosundoxin with the same MICs as azole-susceptible C. albicans. Transcriptome analysis on azole-resistant C. albicans identified 554 DEGs after treatment with phosundoxin. By integrating GO and KEGG pathway enrichment analysis, the antifungal activity of phosundoxin was related to impairment of mitochondrial respiratory chain function. Acute oral and percutaneous toxicity of phosundoxin to rats showed that the compound phosundoxin were mild toxicity and LD50 was above 5000 mg/kg body weight in rats. This study demonstrated the potential of phosundoxin as an antifungal agent for the treatment of common fungal infection and contributed to providing insights into the mechanisms of action of phosundoxin against C. albicans.