Mycological Evaluation Research Articles

Studying Microbial Ecology of Diabetic Foot Infections: Significance of PCR Analysis for Prudent Antimicrobial Stewardship.

This study presents a comprehensive investigation into the microbial ecology of diabetic foot infections (DFIs), using molecular-polymerase chain reaction (PCR) analysis to accurately identify the causative agents. One hundred DFI patients were recruited and classified using the Depth Extent Phase and Associated Etiology (DEPA) score according to their severity. Results revealed polymicrobial infections in 75% of cases, predominantly featuring Staphylococcus epidermidis (83%) and Staphylococcus aureus (63%). Importantly, 20% of samples exhibited facultative anaerobes Bacteroides fragilis or Clostridium perfringens, exclusively in high DEPA score ulcers. Candida albicans coinfection was identified in 19.2% of cases, underscoring the need for mycological evaluation. Empirical antimicrobial therapy regimens were tailored to DEPA severity, yet our findings highlighted a potential gap in methicillin-resistant Staphylococcus aureus (MRSA) coverage. Despite an 88% prevalence of methicillin-resistant Staphylococci, vancomycin usage was suboptimal. This raises concerns about the underestimation of MRSA risk and the need for tailored antibiotic guidelines. Our study demonstrates the efficacy of molecular-PCR analysis in identifying diverse microbial communities in DFIs, influencing targeted antibiotic choices. The results advocate for refined antimicrobial guidelines, considering regional variations in microbial patterns and judiciously addressing multidrug-resistant strains. This research contributes crucial insights for optimizing DFIs management and helps the physicians to have a fast decision in selection the suitable antibiotic for each patient and to decrease the risk of bacterial resistance from the improper use of broad-spectrum empirical therapies.

Mycological, Aflatoxin and Heavy Metals Composition of Dried Fish from Idi-ape Markets in Ilorin, Nigeria

Fish is a cherished and highly sort after food that is widely eaten among many communities in Nigeria and the world at large, with good nutritional values. This study is aimed at evaluating the mycological flora, aflatoxin, proximate composition and heavy metals content in different dried fish samples. A total of three samples were used in this study which are; Salvetinus fortinacis, Heterotis niloticus and Malapterurus electricus. Aflatoxin detection in samples were carried out using High Performance Liquid Chromatography. The proximate analysis was carried out to determine the percentage nutritional value in each of the samples. Heavy metals detection was carried out using Atomic Absorption Spectrometer Buck scientific model 230. The result of the mycological evaluation revealed that the mean fungal count of all samples ranged from 1.5 ± 0.71 to 22.5 ± 4.95 (x102 CFU/g). With H. niloticus having the highest while M. electricus had the least. The proximate analysis results revealed percentage moisture of samples ranged from 4.382 ± 0.02 to 6.869± 0.009 (%) with H. niloticus having the highest and S. fortinacis having least value. Ash ranged from 3.518 ±0.18 to 4.424 ± 0.06 (%) with H. niloticus having the highest and S. fortinacis having the least. Percentage carbohydrate ranged from 14.179 ± 0.26 to 15.728 ± 0.33 (%) with H. niloticuss having the highest and S. fortinacis having the least. Calorific value ranged 1270.115 ± 1.12 to 1407.66 ± 1.87 (KJ/100g) with H. niloticus having the highest and S. fortinacis having the lowest. Percentage lipid ranged from 10.549 ± 0.08 to 14.293 ± 0.10(%) with H. niloticus having the highest and S. fortinacis having the least. Percentage Crude fibre ranged from 22.389 ± 0.19 to 29.310± 0.03 (%) with S. fortinacis having the highest and H. niloticus having the least. Percentage Protein ranged from 35.529 ± 0.00 to 38.062 ± 0.00(%) with S. fortinacis having the highest and M. electricus having the least. The presence of mycotoxin producing fungi in the different dried fish samples led to the presence of different Aflatoxins (known carcinogenic toxin) in the samples which is of a threat to human health.

Morphological, molecular investigation of fungi isolated from layers poultry and their environment with their mycotoxins profile in Wasit province

A total of 150 samples were collected from seven layers poultry farms IN Wasit Province of Iraq. Fifty (50) from layers poultry and hundred (100) from farm premises including poultry feed, surfaces associated with feed container and water drinkers indicating isolation of 60 (40%) mold and yeast based on morphological characteristics and diagnosed to species by using sequencing of the internal transcribed spacer region. Aspergillus versicolor recorded higher isolation rate 20/60 (33.3%), followed by Candida albicans 16/60 (26.6%), Aspergillus wlwitschiae 12/60 (20%), Diutina catenulata 10/60 (16.6%), and the lowest percentage was observed for Lichtheimia ramose 2/60 (3.3%). The analyses of Mycotoxins in poultry feed conducted by Enzyme Linked Immunosorbent Assay (ELISA), revealed aflatoxins B1 (AFB1) in all feed samples (70) with total range (6.945 ppb), and for each: soybean (8.060 ppb), corn (3.287 ppb) and wheat (3.287 ppb). While 60 (85%) out of 70 sample were contaminated with ochratoxin in feed samples with total range (2.658 ppb), for soybean, corn and wheat as (1.122 ppb), (2.596 ppb) and (1.068 ppb) respectively (permissible ratios <20 ppb). Also about 14 (57%) out of 70 samples were contaminated with T2 toxin with total feed range (33.629%) as (113.321 ppb) for corn, (99.817 ppb) for soybean and (64.486 ppb) for wheat samples (permissible ratios <100). This study indicates the importance of continuous mycological evaluation of poultry feed production, hen’s fungal infections and Mycotoxins contamination may directly threaten the industry and harm the consumers at the same time.

Mycological evaluation of frozen meat with special reference to yeasts.

Fungi can play beneficial and detrimental roles in meat products; however, the diversity and significance of fungi in meat products are poorly understood. This study aimed to isolate and characterize fungal species from frozen beef samples collected from retail stores in the Qena Governorate, Egypt. A total of 70 frozen beef samples were collected from retail stores in Qena, Egypt. All samples were subjected to mycological examination. Fungal colonies were identified using conventional approaches, as well as the VITEK 2 system and DNA sequencing of the internal transcribed spacer region. Analyses of enzymatic activity, biofilm formation ability, and the antimicrobial resistance profiles of the isolated yeasts were also conducted. Molds and yeasts were isolated from 40% and 60% of meat samples, respectively. Mold isolates were dominated by Aspergillus, Penicillium, and Cladosporium spp., whereas yeast isolates were identified as Candida albicans, Candida parapsilosis, Yarrowia lipolytica, Saccharomyces cerevisiae, and Rhodotorula mucilaginosa. Compared to other yeast species, the highest production of lipase and protease was observed in Candida species. The strongest ability to form biofilms was observed in Candida spp., followed by S. cerevisiae, Y. lipolytica, and R. mucilaginosa. The results of antimicrobial susceptibility testing revealed that all yeast isolates showed notable resistance to fluconazole and itraconazole. A significant correlation between antimicrobial resistance and biofilm formation was observed in several species. This study highlights the importance of the dangers of yeasts in food products and the extent of their impact on public health.

Study of Co-existence of Fungal infection in Diabetic Foot ulcers in Delhi Population

Background: Diabetic foot ulcers are common diseases in long standing type-II DM patients. Moreover in mostchronic diabetic foot ulcers (DFU) fungal infections were also observed which are difficult to diagnose in earlystages and patients end up with amputations if not treated aggressively.Method: 50 (fifty) known type-2 DM were studied – Tissue biopsy was collected from DFU and studiedmicrobiologically gram stain, gram’s Iodine test were done, LQCB test was done to rule out fungal infection.Results: 50 (Fifty) adults patients aged between 30 to 75 years having DFU were studied. Duration of DFU were 15(30%) were 3 months to 35 (70%) from 13 months to 36 months. Duration of DM 20 (40%) were 2 years to 5 years,30 (60%) were 6 to 10 years. HBALC – 14 (28%) was 6-7% and 36 (72%) had 8-15% RBS, 23 (46%) had 200-300, 27(54%) had 321 to 670, 17 (54%) had grade-II DFU, 22 (44%) had grade-III DFU, 11 (22%) had grade-IV DFU. Apartfrom Bacterial flora, 12 (24%) fungal infections were noted.Conclusion: Present study signifies the need of mycological evaluation of non-healing DFU. Apart fromantibacterial therapy, foot care, introduction of anti fungal treatment helps to heal the DFU in early stages andavoid the risk of amputation.

Eumycetoma infection of the hand: A case report

Mycetoma is a chronic granulomatous infection of cutaneous and subcutaneous tissues caused by filamentous bacteria (actinomycetoma) or fungi (eumycetoma). The most common site of infection is the foot, followed by the hand, but sometimes other body parts may also be infected. The patients present with a painless hard and swelling subcutaneous mass, multiple sinuses, and the pathognomonic discharge of grains. A 42-year-old male patient, presented pain and swelling in his right hand and also complained of swelling in his right forearm. The swelling later involved his whole right hand and wrist joint. Physical examination revealed multiple discharging sinuses with serosanguineous exudates and black grains. Swelling and local erythema were present, lymph nodes were not palpable. The patient complained of constant mild pain which is relieved by pain medications. The serohematic discharge was witnessed with conglomerates of small and firm blackish pellets, evoking eumycetomaSaline dressing was applied overnight and next morning grains were directly collected from sinuses. Tissue and black grain samples were analyzed for bacterial and mycological evaluation. Direct microscopy was performed using Gram stain showed thicker hyphae of eumycetoma. Modified ZN stain showed no acid fast bacilli. LPCB was helpful in confirming thicker hyphae of eumycetoma. Here, on clinical diagnosis (classical triad that is, painless soft tissue swelling, draining sinuses and extrusion of grains) with microbiological investigation, we concluded it a case of “Eumycetoma”.

Fungal Contamination and Toxigenicity of Aspergillus flavus on Postharvest Cacao Beans in Northern Sumatera, Indonesia

The study was carried out to enumerate fungal contamination, and toxigenicity of Aspergillus flavus strains on cacao beans during drying and storage. As many as 3500 g cacao beans during drying and storage were purchased from smallholder farmers on the plantation areas at Karo Regency, Northern Sumatera. The percentage of the beans contaminated by fungi was conducted using direct plating. Fungal populations on soil and beans were determined using dilution followed by pour plated in dichloran 18% glycerol agar (DG18) and Aspergillus flavus and parasiticus agar (AFPA). The mycological evaluation was carried out based on morphological characteristics. Results showed eighteen genera of soil fungi were isolated at the cacao plantation; genera of Aspergillus sp., A. niger, A. flavus, and Penicillium citrinum were the most important contaminants. Six species of the fungi were associated with contamination on cocoa beans during drying i.e. Aspergillus sp., Candida tropicalis, Saccharomyces sp., A. niger, Penicillium spp., and Fusarium spp. Whereas three fungal species were associated during storage i.e. A. niger, A. flavus, and P. citrinum. The percentage of cacao contaminated during drying and storage was dominated (>40%) by Aspergillus sp. Fusarium sp. A. niger, A. flavus, and P. citrinum, respectively. Among 21 strains of A. flavus, 3 strains (15%) were isolated from soil, and 18 strains (85%) were isolated from beans during storage. Among toxigenic A. flavus, both strain scaf6 isolated from soil and strain cbaf5 isolated from beans during storage were the highest aflatoxin producers (30.0 ppb). Preventing soil contamination during harvesting, drying, and storage of cacao beans was a prerequisite to minimise fungal contamination.

P235 Rhino sinusoidal Lasiodiplodia theobromae: a clinical and diagnostic dilemma

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM ObjectivesTo disseminate and discuss a rare case of rhino sinusoidal Lasidiploidea theobromae in a known diabetic.MethodA case study was prospectively done since 2021 following a hospital visit of a 56-year-old male patient presenting with rhino sinusitis mimicking mucormycosis. Ethical approval and patient consent were obtained for this study. A detailed account of case progression from the date of first hospital admission to the final cure was noted. A 56-year-old male from Madhya Pradesh, in central India, presented to the outpatient department of Otolaryngology (ENT) -Head and Neck Surgery. The patient was a known case of diabetes for 5 years. He presented with a headache for 10 days, throbbing pain over the left cheek and upper teeth with nasal discharge and crusting for one week. Nasal crusting and sample from left maxillary meatus were sent suspecting rhino sinusoidal mucormycosis. Mycological evaluation by KOH wet mount showed melanized hyphae and short fragments appearing broad pauciseptate. After 10 days, a grey fluffy growth was observed at 37°C and 25°C on SDA with chloramphenicol. On SDA with cycloheximide there was no growth. LPCB mount of the growth showed some hyaline hyphae with immature hyaline conidia and at places brownish dark walled single septate conidia. Phenotypic identification was inconclusive. Debridement surgery was done and amphotericin B was initiated. The patient was discharged after 10 days with the mention of routine follow-up. The isolate was sent to PGIMER Chandigarh Mycology Reference Center India for species confirmation. After almost 3 months the species was confirmed as L. theobromae.ResultsAfter almost 1-year clinical improvement was observed.ConclusionThis study addresses the diagnostic dilemma both for the clinicians as well as clinical mycologists. Also, it emphasizes the need for molecular diagnostic workflow in such a scenario.

A Clinical Significance of Fungal Infections in Diabetic Foot Ulcers.

Background: Diabetic foot ulcers (DFUs) are the most common and serious complications in uncontrolled diabetes. Infections are predominantly polymicrobial, with aerobic Gram-positive, anerobic, and fungal infections. Early detection of fungal infection and initiation of appropriate treatment in DFUs may lead to better healing and avoid amputations. The primary objective was to find out the prevalence of DFUs getting infected with fungus and the secondary objective was to identify the appropriate methodology for the detection of the fungus in DFUs.Materials and methods: This was a cross-sectional observational study carried out in a tertiary care hospital with a sample size of 60 DFUs. Microbiological analysis was done by swab culture and deep tissue culture. Observational data were collected and the significance level was statistically analyzed.Results: In the present study, the prevalence of fungal infections in DFUs was 31.7%. Only fungal tissue was positive in 15%, the fungal swab was positive in 8.33%, and both tissue and swab were positive in 8.33%. All these patients were treated with antifungal treatment as per the culture report in addition to appropriate antimicrobial therapy.Conclusion: A fungal culture should be done in all patients with non-healing DFUs. Both fungal swab and tissue culture testing should be advocated in patients with DFUs for better mycological evaluation. The addition of antifungal medications may provide better outcomes in selected cases.

Culturable Filamentous Fungi in the Air of Recreational Areas and Their Relationship with Bacteria and Air Pollutants during Winter

One of the greatest environmental health problems to arise in recent years is air pollution. Inorganic and organic particles are important components of air aerosol. The potential of air microbiota as an indicator of air quality is gaining increasing research interest. The aim of the present study was to determine the relationship between the level of fungal contamination and the levels of bacteria and smog particles in outdoor air in recreational areas during the heating season. A quantitative and qualitative mycological evaluation and quantitative bacteriological evaluation of air quality in 10 selected parks were performed. The numbers of microorganisms in the air were correlated with smog levels. The mean prevalence of fungi was 18.96 ± 15.43–23.30 ± 26.70 CFU/m3 of air and the mean bacterial count was 74.06 ± 130.89–268.04 ± 126.10 CFU/m3. Among the isolated fungi, clinically significant species were identified: four species belonged to Risk Group 2, and 17 to Risk Group 1. The predominant genera were Aspergillus, Penicillium and Alternaria. The total number of bacteria demonstrated a positive correlation with the size of the park, air temperature and ozone level during sampling, and a negative correlation with humidity, pressure and smog parameters (CO, NO, NO2 and NOx). The qualitative and quantitative composition of bioaerosols can be used as a bioindicator for environmental monitoring. There is a need for more efficient monitoring of airborne pollutants and microorganisms to learn about the structure of the air biota, the mechanisms regulating their occurrence, and to identify potential threats to human health.

A Study on Efficacy of Oral Itraconazole in the Treatment of Seborrheic Dermatitis

Seborrheic dermatitis is a common chronic disease. Malassezia yeasts have been implicated in the pathogenesis of this disease. Antifungal agents are known to be effective in the treatment of Malassezia yeast infections. This study was done to evaluate the efficacy of itraconazole in the treatment of seborrheic dermatitis. Sixty patients with Seborrheic dermatitis were evaluated in an open non-comparative study. Patients were treated with itraconazole capsule 100 mg twice a day for a week; then after a 3-week interval 100 mg capsule was given twice a day for 2 days of following months for two consecutive months. Four clinical parameters (Itching, burning erythema, scaling, and seborrhea) were assessed using a 0 to 3-point (0= absent, 1 = mild, 2 = moderate, 3 = severe) score. Mycological evaluation determined the presence of Malassezia spores in the scales using a direct smear. At the end of the initial treatment significant improvement was reported in four clinical parameters: Itching, burning erythema, scaling, and seborrhea. Maintenance therapy led to further improvement slightly. Burning sensation mildly improved during the treatment. The quantity of Malassezia spores present in the direct smear decreased throughout the treatment period. Blood test abnormalities were not found during the treatment. So initial treatment with itraconazole is beneficial in patients with seborrheic dermatitis. Faridpur Med. Coll. J. 2021;16(1):21-24

The Spectrum of Fungal Colonization and Their Attributable Effects on Cystic Fibrosis Patients with Rare CFTR Genetic Mutations

Chronic airway colonization by bacteria and fungi is very common in CF patients, causing irreversible lung damage. It is known that rates of fungal infections are much lower than those of bacterial infections, however they can worsen the medical condition of CF patients. In this study, we identify the most common fungal species isolated from 31 adult CF patients in Qatar and analyze their correlation with lung function, pulmonary exacerbations, bronchial asthma, and pancreatic insufficiency. Mycological evaluation, as well as medical records, were reviewed for the patients regularly under the adult CF service at Hamad General Hospital in the period between 2017–2019. All CF patients included in this study carry rare CFTR mutations. The majority of those patients (n = 25) carried the c.3700A>G; I1234V mutation, whereas three patients carried the heterozygous mutation (c.1657C>T and c.1115A>T) and the remaining three carried the homozygous mutation (c.920G>A). Twenty-two of the adult CF participants (70.9%) were colonized with fungal species regardless of the type of the CFTR mutation. Candida and Aspergillus species were the most common, colonizing 81% and 45% of the patients, respectively. For Candida colonized patients, Candida dubliniensis was the most frequently reported species (55.6%), whereas Aspergillus fumigatus colonization was the most common (50.0%) among Aspergillus colonized patients. These identified fungal pathogens were associated with poor lung function, pancreatic insufficiency, and asthma in this cohort. Such colonization could possibly aggravate the most known CF complications, notably pulmonary exacerbations, asthma, and pancreatic insufficiency.

Treatment Approach for Oral Candidiasis: Two Case Reports

Candida infections are acute and / or chronic infections of the skin, mucosa, internal organs and systems which may be seen at any age. The purpose of this study is to present diagnostic and therapeutic approach for patients who applied to our clinic with the diagnosis of pseudomembranous candidiasis. Both patients who referred to our clinic were using inhaler due to Chronic Obstructive Pulmonary Disease (COPD). Intraoral examination revealed pseudomembranous candidiasis localized on both the border of soft palate and through pharynx of a 60 year-old female patient and on the midline of hard palate of a 70-year-old male patient. Cultures were taken for mycological evaluation of the patients after clinical examination. Antifungal treatment was administered to both patients for 10 days. Healing was observed as a result of the treatment. No recurrence was observed at monthly follow-up assessments performed for patients. In cases of oral candidiasis, antifungal agents should be used locally in the form of suspension or pomade, evaluation of mycological culture should be performed to support clinical diagnosis and the etiological factors that may cause the disease should be studied.

Comparative Evaluation of Ketoconazole 400 mg Single Dose Versus Ketoconazole 200 mg Daily for Five Days in Pityriasis Versicolor

Introduction: Many treatments have been attempted in pityriasis versicolor with different reports of success. No direct comparative study between Ketoconazole 400 mg single dose against Ketoconazole 200 mg od for 5 days have been made earlier. The aim of this study was to study and compare the therapeutic efficacy of oral ketoconazole 400 mg single dose with oral ketoconazole 200 mg once daily for 5 days in pityriasis versicolor.
 Methods: This was a randomized controlled trial. Patients were randomized to receive either ketoconazole 400 mg single dose (group A) or ketoconazole 200 mg daily for 5 days (group B). Altogether 80 patients were taken, 40 in each group. Patients were assessed after 8 weeks and both clinical and mycological evaluation was done. The treatment success (mycological cure) was defined by a negative KOH at 8 weeks post treatment. Chi-square test was used to identify the significance of the variables.
 Results: The mycological cure at 8 weeks was 46% in group A and 74% in group B and the result was significant. No significant adverse event was noted in any of the groups.
 Conclusions: There was significant difference in the treatment outcome in both the groups. Ketoconazole 200 mg daily for 5 days had superior efficacy than ketoconazole 400 mg single dose. There was no significant difference in the adverse events.
 
 Key words: Ketoconazole, Pityriasis versicolor

Utility of Chicago Sky Blue Stain in Rapid Diagnosis of Mycotic Infections

Introduction: Diagnosis of fungal infection is mostly relied on clinical skills assisted by array of diagnostic methods. Culture and molecular testing are specific but lacks sensitivity and are labour intensive, time consuming, expensive and not readily available. Direct examination using Potassium Hydroxide (KOH) mount is most often practiced but lacks contrast and requires a skilled eye to interpret. Chicago Sky Blue 6B (CSB) stain has shown a promising result providing coloured contrast and better sensitivity and specificity. Aim: To evaluate the rapid diagnosis of fungal infections using CSB stain over conventional KOH mounts. Materials and Methods: This cross-sectional analytical study was done at RIMS, Raipur catering to rural and tribal population in Chhattisgarh in Central India over a period of 10 months after due approval from Institutional Ethics Committee. Clinically, suspected cases of mycosis belonging to all ages of either gender attending Outpatient Department (OPD) of Dermatology and Ophthalmology Department, who were advised mycological evaluation by physician but not on treatment were included in study. The samples were processed with KOH mount and CSB stain and were observed by two independent observers. The data was managed in Microsoft office Excel and was analysed using tests of proportion and Pearson’s Chi-square test for significance. Results: A total of 128 participants were involved in the study with a male preponderance of 96/128 (75%) as against 32/128 (25%). A total of 110 patients were diagnosed using CSB 6B stain whereas 80 patients were diagnosed using KOH mount. CSB 6B was evaluated against the conventional KOH mount using a Chi-square test and was found to be highly significant with Chi-square value of 39.74 with 1 degree of freedom and p-value of <0.001. Conclusion: This study brought out the significance of CSB 6B stain over conventional KOH mount with better sensitivity, specificity, Negative Predictive Value (NPV) and Positive Predictive Value (PPV) and ease and rapidity of diagnosis with better colour contrast helping clinicians with prompt initiation of treatment with a laboratory confirmation.

Therapeutic response time of topical voriconazole 1% and intrastromal voriconazole 0.05% versus topical natamycin 5% monotherapy in Fusarium keratitis in rabbit.

Fungal keratitis can be more difficult to treat than bacterial keratitis with worse outcomes. To evaluate the therapeutic response time of topical voriconazole combined with intrastromal voriconazole, and topical natamycin on Fusarium keratitis. The stroma of corneas of twelve New Zealand White rabbits was inoculated with Fusarium sp spores. Seven days after inoculation, they were divided into 2 groups randomly. Group A was treated with topical natamycin 5% for 21days. Group B was treated with intrastromal voriconazole 0.05% single injection at the beginning of treatment, continued with topical voriconazole 1% for 21days. Clinical evaluations for epithelial defect size and clinical scores in each group were performed on 1st, 3rd, 7th, 10th, 14th and 21st days after treatment. Mycological examinations were performed before and after the treatment. After treatment, there was no statistically significant difference between natamycin and voriconazole in reducing epithelial defect size at first, second or third week after treatment (P=.15; P=.39; and P=.90). The clinical scores on both groups also showed no statistically significant differences at first, second and third weeks after treatment (P=.24; P=.09; and P=.32). Qualitative mycological evaluation before and after the treatment showed no statistically significant difference in KOH examination (P=1; P=1) and culture in Sabouraud dextrose agar (P=1; P=1). Intrastromal voriconazole injection combined with topical voriconazole seems to give similar response time but not earlier in improving clinical presentation of Fusarium keratitis as topical natamycin.

DIFFICULT DIAGNOSIS AND MANAGEMENT OF FUNGAL INJURY

A 56-year-old smoker had asymptomatic lesions on the hard palate and reported osteopenia, asthma, and chronic allergic rhinitis with "odors" and continued use of bronchodilators and antiallergics. Initial treatment was nystatin oral solution for 15 days and subsequent incisional biopsy for histopathologic and mycological evaluation. The histopathologic report pointed to infection by fungal agent–producing sporangia and endospores, being a case of difficult diagnosis because of the rarity of the infection, suggesting the possibility of rhinosporidiosis, but the mycological report did not observe fungal structures in the sample. The patient opted for systemic antifungal treatment with itraconazole (Sporanox (Janssen-Cilag)) rather than the surgical treatment of choice. After 6 months the lesion did not regress, corroborating with the literature, which shows that the systemic treatment for this type of lesion is not ineffective. Surgical resection becomes necessary for resolution of the condition. A 56-year-old smoker had asymptomatic lesions on the hard palate and reported osteopenia, asthma, and chronic allergic rhinitis with "odors" and continued use of bronchodilators and antiallergics. Initial treatment was nystatin oral solution for 15 days and subsequent incisional biopsy for histopathologic and mycological evaluation. The histopathologic report pointed to infection by fungal agent–producing sporangia and endospores, being a case of difficult diagnosis because of the rarity of the infection, suggesting the possibility of rhinosporidiosis, but the mycological report did not observe fungal structures in the sample. The patient opted for systemic antifungal treatment with itraconazole (Sporanox (Janssen-Cilag)) rather than the surgical treatment of choice. After 6 months the lesion did not regress, corroborating with the literature, which shows that the systemic treatment for this type of lesion is not ineffective. Surgical resection becomes necessary for resolution of the condition.

Fungi Associated With Persistent Cough In Immunocompromised Hosts In Jos And Environ

This study was conducted to determine the fungi associated with persistent cough in immunocompromised patients attending Jos University Teaching Hospital (JUTH) and Vom Christian Hospital both in Plateau State. Hundred (100) immunocompromised patients with persistent cough were selected by random sampling. The sputum samples were collected and assayed for fungi using standard methods. The degree of disparity was analyzed using statistical method. Four different fungi were isolated from sputum of 37 (37%) immunocompromised patient with persistent cough, with Candida albicans been the highest 18 (48.6%) followed by Aspergillus niger 12 (32.4%), Cryptococcus neoformans 5 (13.5%) and Penicilium species 2(5.4%). Male subjects 22 (22%) were more susceptible to fungi associated cough than female 15(15%) with significant difference (P value 0.026). HIV, Tuberculosis and co-infection of both (HIV and TB) and prolong use of antibiotics were more predisposing factor associated with fungi related cough. These isolates were tested on 5 antifungal drugs. Ketoconazole and intraconazole were most susceptible to 83.8% of isolates, Amphotericin B had 54.1% susceptible while Griseofulvin and Vericonazole were 18.9% susceptible to the isolates. However, in managing the immunocompromised patient, there is a need for antifungal prophylaxis and sending of sample of immunocompromised host with persistent cough not only for bacteriological analysis but also mycological evaluation.

Species Diversity of Micromycetes Associated with Epipactis helleborine and Epipactis purpurata (Orchidaceae, Neottieae) in Southwestern Poland

The Orchidaceae family is a diverse family of flowering plants that occur naturally in most parts of the world. However, fungal communities inhabiting different parts of orchids are not sufficiently described. The aim of the study was to conduct a mycological evaluation of Epipactis helleborine and E. purpurata (Orchidaceae), which grow naturally in Lower Silesia (SW Poland), by identifying the species composition of the culturable micromycetes fungi on the surfaces of the plants and from the inner layers of the tissues. Fungi were identified based on a phenotypic and genotypic analysis. To our knowledge, this is the first such analysis. This study showed that more species of micromycetes were cultured from E. helleborine compared with E. purpurata. The flowering plants of E. helleborine were inhabited by the largest number of culturable fungal species (13 species), and the fewest species were isolated from the flowering plants of E. purpurata (eight species). Some of these fungal species may be pathogens of the plants. The surface tissues of the orchids were mainly inhabited by Mucor moelleri and/or Penicillium biourgeianum. The inner layers of these plants were the most colonized by Alternaria tenuissima and/or Arthrinium arundinis and/or Fusarium sporotrichioides. The relative dominance of these fungal species depended mainly on the development phase of the plants.

308-nm excimer laser: a hopeful and optional therapy for pityriasis versicolor

Background Pityriasis Versicolor (PV) is known as a superficial fungal infection. It is suggested that resistant strains to azoles may be developed and hence, the treatment would be difficult. This study aimed to evaluate the efficacy of excimer laser (308 nm) as an alternative therapy for PV. Materials and methods This is a prospective intra-patient left-to-right, randomized, placebo-controlled study conducted on 26 patients with bilateral lesions which are not responding to the PV standard treatment. Patients were randomly assigned to right or left-side therapy for a duration of 8 weeks with either excimer laser (308 nm three times weekly) or topical placebo. Clinical assessment and mycological evaluation were performed before the initiation of treatment and at the fourth and eighth week of therapy. Results A decrease in the mean clinical score of cases was recorded from 7.1 at the baseline evaluation to 1.56 after 4 weeks and to 1.96 after 8 weeks of treatment. At week 4, there was a statistically significant reduction in the clinical scores compared with pretreatment scores and with the placebo group (p < .001). Conclusion 308-nm excimer laser can be considered as a hopeful and optional therapy for PV.