Opportunistic Fungal Disease Research Articles

Development and validation of supervised machine learning multivariable prediction models for the diagnosis of Pneumocystis jirovecii pneumonia using nasopharyngeal swab PCR in adults in a low-HIV prevalence setting.

The global burden of the opportunistic fungal disease Pneumocystis jirovecii pneumonia (PJP) remains substantial. Polymerase chain reaction (PCR) on nasopharyngeal swabs (NPS) has high specificity and may be a viable alternative to the gold standard diagnostic of PCR on invasively collected lower respiratory tract specimens, but has low sensitivity. Sensitivity may be improved by incorporating NPS PCR results into machine learning models. Three supervised multivariable diagnostic models (random forest, logistic regression and extreme gradient boosting) were constructed and validated using a 111-person Australian dataset. The predictors were age, gender, immunosuppression type and NPS PCR result. Model performance metrics such as accuracy, sensitivity, specificity and predictive values were compared to select the best-performing model. The logistic regression model performed best, with 80% accuracy, improving sensitivity to 86% and maintaining acceptable specificity of 70%. Using this model, positive and negative NPS PCR results indicated post-test probabilities of 84% (likely PJP) and 26% (unlikely PJP), respectively. The logistic regression model should be externally validated in a wider range of settings. As the predictors are simple, routinely collected patient variables, this model may represent a diagnostic advance suitable for settings where collection of lower respiratory tract specimens is difficult but PCR is available.

Risk Factors for Candidiasis among Patients Referred to Medical Mycology Laboratory of the Special Clinical of Kermanshah University of Medical Sciences

Introduction: Candidiasis is undoubtedly one of the most important and common diseases of opportunistic fungi in human. Factors such as: age, physiological changes, long-term use of antibiotics, diabetes, immune deficiency, cardiovascular disease can make a person prone to candidiasis. In this study, risk factors contributing to candidiasis in the patients referred to the mycology laboratory of the special clinic of Kermanshah University of Medical Sciences in 2013 to 2018 were investigated. Methods: In a descriptive study, to show the effective factors in the development of candidiasis as an opportunistic fungal disease, all patients during 2013 to 2018 that referred to the mycology laboratory of the special clinic of Kermanshah University of Medical Sciences were examined. In this study, demographic characteristics such as age, gender, occupation, and residence were collected. The results of direct microscopic observation and mycological culture of patient samples were determined. The results were expressed as descriptive statistics. Results: In this study, 26.98% of 541 people had cutaneous candidiasis, 72.08% had nail candidiasis, and 0.92% had systemic candidiasis. The most common species is Candida albicans. The highest frequency of skin candidiasis is related to the age group of 40-49 years (20.54%). It was more common in patients with a history of cardiovascular disease and diabetes and 47% of patients mentioned excessive contact with water. The highest frequency of nail candidiasis is related to the age group of 30- 39 years and women. It is more common among housewives. It is more prevalent in patients with a history of cardiovascular disease and diabetes, respectively. 75% of patients with systemic mucosal candidiasis had immunodeficiency. Conclusion: The most important factor in preventing candidiasis is public health. For age group of 20-29 years, when suffering from chronic diseases such as diabetes, cardiovascular and immunodeficiency disease.

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

A Case Report of a Misdiagnosed Mycormucosis: Uncommun Clinical Presentation

Background: Invasive mycormucosis is a rare opportunistic fungal disease with high morbidity and mortality rates, predominantly affecting immunosuppressed patients. An increasing incidence has recently been described particularly among corona virus epidemic. Dentists should be aware of this possible diagnosis instead of just instituting some useless and devastating treatments, and to ovoid the delay that can cost the patient ‘life juste like our case. Clinical presentation: An unusual clinical manifestation of mucormycosis in a 42–year-old _man, diabetic who was referred by his Otorhinolaryngologist, to our dental surgery unit of the university hospital FARHAT HACHED Tunisia, suspecting a facial cellulitis related to dental infection. Before consulting his Otorhinolaryngologist, the patient was suffering from severe dental pain for two months, without any signs of relief despite dental treatments and the pain killers prescribed by his dentist. He was successfully treated by a combination of surgical intervention and antifungal treatment: Amphotericin B. Conclusion: Invasive mycormucosis is an emerging infection and is probably related to an increase in immunosuppressed patients. Accurate oral examination may lead to early diagnosis avoiding further damages of this agressive disease.

Vitamin A Deficiency, COVID-19, and Rhino-Orbital Mucormycosis (Black Fungus): An Analytical Perspective.

Mucormycosis is a rare but serious opportunistic fungal disease characterized by rhino-orbito-cerebral and pulmonary involvement. It is mainly seen in people with secondary immunosuppression, isolated vitamin A deficiency, measles, and AIDS patients. It showed a rise during the second wave of the COVID-19 epidemic in the spring of 2021 in India, especially in diabetic COVID-19 patients. Vitamin A deficiency is known to cause nutritional immunodeficiency and hence leading the way to increased opportunistic fungal, bacterial, and viral infections. In the eye, it causes keratitis, night blindness, xerophthalmia, conjunctivitis, Bitot spots, keratomalacia, and retinopathy. It also causes decreased tear secretion and deterioration of the anatomical/physiological defense barrier of the eye. The negative impact of vitamin A deficiency has been previously demonstrated in measles, AIDS, and COVID-19. We think that mucormycosis in COVID-19 might be rendered by vitamin A deficiency and that vitamin A supplementation may have preventive and therapeutic values against mucormycosis and other ocular symptoms associated with COVID-19. However, any vitamin A treatment regimen needs to be based on laboratory and clinical data and supervised by medical professionals.

Manifestations of Mucormycosis and Its Complications in COVID-19 Patients: A Case Series Study.

Mucormycosis is an opportunistic fungal disease that affects immunocompromised patients. With the advent of SARS-CoV-2, this opportunistic disease has increased. A case series of 47 patients with COVID-19 associated mucormycosis have been analyzed. Demographic information, signs, symptoms, laboratory investigations, imaging studies, and their association with ICU admission and 30-day mortality were assessed. Total number of 47 consecutive rhino-orbital cerebral mucormycosis (ROCM) cases were analyzed. Periorbital swelling was the most common sign among patients. Majority of cases had diabetes. All patients received liposomal Amphotericin B. Debridement was performed for all cases. SARS-CoV-2 increases the susceptibility to mucormycosis infection in various ways. Uncontrolled level of HbA1c in all patients, even non-diabetic individuals, indicates hyperglycemia over the past three months. Diabetes, orbital exenteration, ptosis, periorbital swelling, DKA, LOC, brain involvement, and mechanical ventilation all correlated with a higher rate of ICU admission and 30-day mortality. In addition, a higher white blood cell count is related to the higher probability of ICU admission. While considering all of the inflammatory laboratory data and HbA1c could help predict 30-day mortality.

P465 Aspergillosis in free-ranging Magellanic penguins

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMAspergillosis is an opportunistic fungal disease caused by the Aspergillus genus, mostly by Aspergillus section Fumigati. Captive Magellanic penguins are vulnerable to Aspergillus infection, being this mycosis a limiting factor during the process of rehabilitation with a mortality rate of around 50%.ObjectivesGiving the scarce data regarding the occurrence of aspergillosis in non-captive penguins, we aimed to evaluate the proportional mortality by aspergillosis in free-ranging Magellanic penguins during their migration and reproductive season.MethodsCarcasses of Magellanic penguins were collected from the Southern coast of Brazil between June 2017 and October 2019 between Barra do Chui beach (Southern RS, Brazil - 33°44'19.9‘S 53°21'56.3’W) and the isthmus with the Lagoa do Peixe (Southern RS, Brazil - 31°26' S, 51°10' W 31°14'S, 50°54'W). In addition, in January 2019, penguins found dead in the reproducing colony in four islands localized in Puerto Deseado City (Santa Cruz, Patagonian, Argentina - 47°45′00″S 65°55′00″W) were collected. All animals were necropsied, and macroscopic alterations were observed. Samples of macroscopic lesions and/or respiratory systems were collected for histopathology and mycological culture. Only proven aspergillosis cases, defined by suggestive lesions at necropsy, associated with hyaline, septate, and 45° branched hyphae in histopathological slides and isolation of Aspergillus sp. in the culture were computed. Fungal isolates were identified by molecular techniques.ResultsA total of 98 Magellanic penguins were included in our study, being 80 recovered on the Southern RS beach, and 18 from the Patagonian colony. Two penguins collected in Southern Brazil were diagnosed with aspergillosis, both juveniles, one showing nodules in the lung parenchyma, and the other nodules and fungal colonies at the lung and air sac, resulting in a proportionate mortality rate of 2.5%. Both isolates were identified as A. fumigatus sensu stricto. Regarding the carcasses collected from the reproductive colony (Patagonian islands), no penguin had anatomopathological or mycological evidence of aspergillosis.ConclusionGiven the already known importance of aspergillosis in seabirds undergoing rehabilitation, these data suggest that penguins may already arrive in these centers infected by Aspergillus spp. The absence of aspergillosis cases in the reproductive period could be attributed to the low number of carcasses included. Our study is an initial step to demonstrate aspergillosis as one of the causes of mortality also in free-living penguins, especially during the migration process, instigating more studies, in other routes of migration, as well as in reproductive colonies.

Severe pulmonary mucorales superinfection in three influenzapatients with and without influenza-associated aspergillosis

Mucormycosisis an opportunistic fungal disease which affects immunocompromised hosts including patients with haematologic malignancies and poorly controlled diabetes mellitus. Mucorales grow invasively and are associated with high mortality even if promptly diagnosed. Viral infection like influenza can cause severe pneumonia and is associated with pulmonary aspergillosis. Here we report three separate cases of Mucorales super infection in critically-ill patients with influenza infection, one of them histologically confirmed. Two patients also had influenza-associated pulmonary aspergillosis. Two patients had fatal clinical outcome despite intensive care. The simultaneous detection of these two rare mold infections in patients with severe influenza is highly remarkable and calls for increased awareness.

Testing for Cryptococcosis at a Major Commercial Laboratory-United States, 2019-2021.

BackgroundCryptococcosis is a serious opportunistic fungal disease, and the proportion of cases among patients with immunosuppressive conditions other than HIV or organ transplant has increased. Understanding laboratory testing patterns for cryptococcosis is useful for estimating its true burden and developing testing guidance.MethodsWe identified cryptococcosis tests (cryptococcal antigen [CrAg], cryptococcal antibody, and fungal cultures) performed at a major national commercial laboratory ordered during March 1, 2019–October 1, 2021, and analyzed test results, patient and provider features, reasons for testing, geography, and temporal trends.ResultsAmong 29 180 serum CrAg tests, 4422 (15.2%) were positive, and among 10 724 cerebrospinal fluid (CSF) CrAg tests, 492 (4.6%) were positive. Frequent reasons for serum CrAg testing in nonhospital settings (10 882 tests) were HIV (44.6%) and cryptococcosis (17.0%); other underlying conditions were uncommonly listed (<10% total). Serum CrAg positivity declined from 25.6% in October 2019 to 11.3% in September 2021. The South had the highest positivity for serum CrAg tests (16.6%), CSF CrAg tests (4.7%), and fungal cultures (0.15%). Among 5009 cryptococcal antibody tests, 5 (0.1%) were positive.ConclusionsFew outpatient serum CrAg tests were performed for patients with immunocompromising conditions other than HIV, suggesting potential missed opportunities for early detection. Given the high positive predictive value of CrAg testing, research is needed to improve early diagnosis, particularly in patients without HIV. Conversely, the low yield of antibody testing suggests that it may be of low value. The decline in CrAg positivity during the COVID-19 pandemic warrants further investigation.

Oral Candidiasis and Nutritional Status in Hospitalized Aged Patients: A Cross-sectional Study in Cuenca-Ecuador

Background: Oral candidiasis (OC) is an opportunistic fungal disease related to various local and systemic factors. Hospitalized aged patients are considered susceptible hosts with several adverse clinical outcomes, including OC and undernutrition.&#x0D; Aims: The aim of this study was to determine the prevalence of oral candidiasis among hospitalized aged patients who attended on the inpatient units of Vicente Corral Moscoso Hospital and Jose Carrasco Arteaga Hospital of Cuenca-Ecuador. And also, to evaluate the association between OC and nutritional status in hospitalized aged patients.&#x0D; Methods and materials: This study was performed with two hundred and twenty subjects; convenience sampling was applied for seven months. Demographic data were collected by a questionnaire. OC diagnosis was accomplished by oral examination; clinical lesions suggestive were analyzed with swabbed culture tests. OC was diagnosed when patients exhibited oral suggestive lesions synchronously with positive culture results. Nutritional assessment was performed with Controlling Nutritional Status (CONUT) system. Statistical analysis was performed with IBM_SPSS-20 software; associations were analyzed using Chi-square test, or Fisher’s exact test, and multiple logistic regression. For all tests, ???? ≤ 0.05 was considered as a statistically significant result.&#x0D; Results: Out of 220 hospitalized aged patients, 62 (28.1%) were diagnosed with oral candidiasis. The mean age was 78.3±7.8 years The Demographic/clinical variables (sex, age, residence area, education, use of dental prostheses) indicated no correlation with oral candidiasis. Nutritional variables (hypoalbuminemia and severe undernutrition were significantly correlated with oral candidiasis (p=0.009; p=0.007).&#x0D; Conclusions: 28.1 % of the hospitalized aged patients had oral candidiasis. Hypoalbuminemia and severe undernutrition are risk factors associated with oral candidiasis.

An innovative 'Prop technique' of mouth opening in post-COVID-19 mucormycosis maxillectomy: Finding a new way with minimal efforts.

General anaesthesia is associated with damage to teeth, particularly during laryngoscopy. Dental injury is more probable when pre-existing dental pathology or risk factors are present. Post-coronavirus disease -2019 mucormycosis is a rare, fulminant, lethal, angio-invasive, opportunistic fungal disease and is increasingly recognised in diabetic and immunocompromised patients. Since the flange of the laryngoscope blade appears to be the source of tooth injury, alternate methods of wide mouth opening during laryngoscopy should be examined, especially when mouth opening is limited. In this case series, we have studied 12 cases of maxillectomies with an aim to improve restricted mouth opening by using the 'Prop technique' resulting in a minimum hinging force of the flange of the blade on teeth. Preoperatively, patients were warned about the possibility of dental injuries during anaesthesia or surgery.

Imaging of Endemic and Opportunistic Fungal Pulmonary Disease

Imaging of Endemic and Opportunistic Fungal Pulmonary Disease

Neuromeningeal cryptococcosis among people living with HIV in Lubumbashi, Democratic Republic of Congo

Neuromeningeal cryptococcosis (NMC) is a most common opportunistic fungal disease in people living with HIV/AIDS (PLWHA). This infection is caused by Cryptococcus neoformans, a yeast-fungus, encapsulated, cosmopolitan and living in several ecological niches very frequent in Africa because of climatic and ecological conditions. This study aims to describe the sociodemographic, clinical, and outcome features of NMC among PLWHA in Lubumbashi in the Democratic Republic of Congo.

Overview on the Prevalence of Fungal Infections, Immune Response, and Microbiome Role in COVID-19 Patients.

Patients with severe COVID-19, such as individuals in intensive care units (ICU), are exceptionally susceptible to bacterial and fungal infections. The most prevalent fungal infections are aspergillosis and candidemia. Nonetheless, other fungal species (for instance, Histoplasma spp., Rhizopus spp., Mucor spp., Cryptococcus spp.) have recently been increasingly linked to opportunistic fungal diseases in COVID-19 patients. These fungal co-infections are described with rising incidence, severe illness, and death that is associated with host immune response. Awareness of the high risks of the occurrence of fungal co-infections is crucial to downgrade any arrear in diagnosis and treatment to support the prevention of severe illness and death directly related to these infections. This review analyses the fungal infections, treatments, outcome, and immune response, considering the possible role of the microbiome in these patients. The search was performed in Medline (PubMed), using the words “fungal infections COVID-19”, between 2020–2021.

Epitope-Based Immunoinformatic Approach on Heat Shock 70 kDa Protein Complex of Cryptococcus neoformans var. grubii.

Introduction Cryptococcosis is a ubiquitous opportunistic fungal disease caused by Cryptococcus neoformans var. grubii. It has high global morbidity and mortality among HIV patients and non-HIV carriers with 99% and 95%, respectively. Furthermore, the increasing prevalence of undesired toxicity profile of antifungal, multidrug-resistant organisms and the scarcity of FDA-authorized vaccines were the hallmark in the present days. This study was undertaken to design a reliable epitope-based peptide vaccine through targeting highly conserved immunodominant heat shock 70 kDa protein of Cryptococcus neoformans var. grubii that covers a considerable digit of the world population through implementing a computational vaccinology approach. Materials and Methods A total of 38 sequences of Cryptococcus neoformans var. grubii's heat shock 70 kDa protein were retrieved from the NCBI protein database. Different prediction tools were used to analyze the aforementioned protein at the Immune Epitope Database (IEDB) to discriminate the most promising T-cell and B-cell epitopes. The proposed T-cell epitopes were subjected to the population coverage analysis tool to compute the global population's coverage. Finally, the T-cell projected epitopes were ranked based on their binding scores and modes using AutoDock Vina software. Results and Discussion. The epitopes (ANYVQASEK, QSEKPKNVNPVI, SEKPKNVNPVI, and EKPKNVNPVI) had shown very strong binding affinity and immunogenic properties to B-cell. (FTQLVAAYL, YVYDTRGKL) and (FFGGKVLNF, FINAQLVDV, and FDYALVQHF) exhibited a very strong binding affinity to MHC-I and MHC-II, respectively, with high population coverage for each, while FYRQGAFEL has shown promising results in terms of its binding profile to MHC-II and MHC-I alleles and good strength of binding when docked with HLA-C∗12:03. In addition, there is massive global population coverage in the three coverage modes. Accordingly, our in silico vaccine is expected to be the future epitope-based peptide vaccine against Cryptococcus neoformans var. grubii that covers a significant figure of the entire world citizens.

State of Medical Mycology at German Academic Medical Centres: A Survey of the German-Speaking Mycological Society (DMYKG) and the Paul-Ehrlich-Society for Chemotherapy (PEG).

Little is known about the infrastructure to translate advances in the management of patients at risk to develop invasive opportunistic fungal diseases. To assess the current state of Medical Mycology support in Germany, we conducted a survey among all 36 academic medical centres. The survey consisted of a 3-pages questionnaire sent out in the first half of 2019. Information included details of infrastructure, education and teaching; consultation services and interdisciplinary conferences; research activities and participation in network groups; radiology, microbiology and pharmacology support; publication activity; and European Confederation for Medical Mycology (ECMM) Excellence Center designation, if assigned. Information was returned from 24 centres (67%). Thirteen institutions (54%) reported an independent infectious disease, and two a separate Medical Mycology department (8%); a Medical Mycology working group was reported for nine institutions (38%). An infectious disease consultation service was existent in 16 institutions (67%) and a multidisciplinary conference in 13 (54%). Fifteen institutions reported a separate study office with activities in infectious disease studies (63%). Laboratory capability for fungal identification and susceptibility testing was confirmed by all 24 institutions; testing of galactomannan by 23 (96%), cryptococcal antigen by 21 (88%), ß-D-Glucan by 9 (38%), and panfungal and Pneumocystis PCR by 21 and 22 (88% and 92%), respectively. Therapeutic drug monitoring of voriconazole was reported to be available in 15 (63%) institutions with a turnaround of ≤24h during weekdays in 10 (42%). Two of the 24 University hospitals (8%) reported ECMM Diamond Excellence Status. The results of this survey document the continuing need to improve the availability of specialised Medical Mycology support in German academic medical centres.

Management of fulminant mucormycosis of the maxillary sinus and orbit with an uncontrolled diabetic

Introduction. Mucormycosis of paranasal sinuses is a rare life-threatening opportunistic fungal disease that requires urgent treatment. The commonly involved are the immunosuppressed and immunocompetent patients. Patients are presented with facial or orbital cellulitis, necrotic palate, paresthesia of facial or trigeminal nerves and loss of vision, signs of meningitis. Radiological examinations are not sensitive in the early stages of infection. Definitive diagnosis is established by biopsy and histological examination of the necrotic tissue. Case outline. In August 2017, a 52-year-old female diabetic was admitted to the Clinic for Maxillofacial surgery due to the swelling and pain in the right side of the face, headache, fever, restriction of ocular movements, purulent rhinorrhea lasting for one week. Computed tomography examination showed spreading cellulitis of the right side of the face, total right maxillary end ethmoid sinus heterogeneous occupation and osteitis of the maxillary walls. Radical surgical debridement was performed. Histopathology and microbial tests were consistent with the finding of invasive mucormycosis. Liposomal amphotericin B 5mg/kg per day for four weeks was administered and patient?s glucose levels were controlled with injectable insulin and local status significantly improved. Patient was reoperated later due to the defect of the right maxilla. Conclusion. Early diagnosis and multidisciplinary approach including microbiology, pathology, radiology, surgery, hematology, infectious disease, intensive care and pharmacology is essential. Treatment of mucormycosis of paranasal sinuses requires prompt and aggressive treatment with antifungal agents, surgical debridement and control of predisposing factors.

Evaluation of a rapid immunochromatographic test for the detection of Candida species from oropharyngeal samples

Oropharyngeal candidiasis is the most common opportunistic fungal infectious disease. Culture methods and microscopy are used to detect the presence of Candida species in clinical specimens. We have previously developed an immunochromatographic test (ICT) to enable the simple and rapid diagnosis of candidiasis. In this study, we evaluated the performance of the ICT for the detection of Candida species from pharyngeal swabs and compared the results with those of the culture method. The isolated Candida species were identified using polymerase chain reaction-restriction fragment length polymorphism, and viable cell counts were determined using selective chromogenic agar. The detection rate of C. albicans was 63.3% and 0% among ≤102 and ≥ 106 colony-forming units (CFU)/mL of viable Candida cells from pharyngeal swabs, respectively. The detection rate of nonC. albicans Candida species, especially C. glabrata, increased commensurately from 16.7% at ≤102 CFU/mL to 75.0% at ≥106 CFU/mL. Among the 300 pharyngeal swabs analyzed, 59 cultures detected Candida species at a count of >103 CFU/mL (53 were ICT-positive). Of the remaining 241 culture-negative specimens, 219 were ICT-negative. The sensitivity, specificity, and accuracy of the ICT were 89.8%, 90.9%, and 90.7%, respectively. Taken together, the ICT evaluated can be made readily available for clinical use in detecting Candida.

Molecular identification of Candida isolates by Real-time PCR-high-resolution melting analysis and investigation of the genetic diversity of Candida species.

Background Candida species are considered as the cause of one of the most important opportunistic fungal diseases. Accurate identification of Candida species is important because of antifungal susceptibility patterns are different among these species, so proper identification helps in the selection of antifungal drugs for the prevention and treatment. Phenotypic methods for identification of Candida species, which are widely used in clinical microbiology laboratories, have some limitations. Real‐time PCR followed by the high‐resolution melting analysis (HRMA) is a novel approach for the rapid recognition of pathogenic fungi. Molecular phylogeny is essential for obtaining a better understanding of the evolution of the genus Candida and the identification of the relative degree of the Candida species. The purpose of this study was molecular identification of Candida isolates by Real‐time PCR‐high‐resolution melting analysis and investigation of the genetic diversity of Candida species.MethodsTwo hundred and thirty‐two Candida isolates including 111 Candida isolates obtained from 96 HIV/AIDS patients and 121 Candida isolates obtained from 98 non‐HIV persons were identified by real‐time PCR and high‐resolution melting curve analysis. To evaluate genetic diversity and relationships among Candida species, PCR products of nine clinical Candida isolates, as a representative of each kind of species, were randomly selected for DNA sequence analysis.ResultsIn HIV/AIDS patients, six species of Candida spp. were identified as follows: C albicans (n = 64; 57.7%), C glabrata (n = 31; 27.92%), C parapsilosis (n = 9; 8.1%), C tropicalis (n = 4; 3.6%), C krusei (n = 2; 1.8%), and C kefyr (n = 1; 0.90%). In non‐HIV persons, we identified eight species of Candida including C albicans (n = 46; 38.33%) followed by C glabrata and C krusei (each one, n = 18; 15%), C tropicalis (n = 13; 10.83%), C lusitaniae (n = 12; 5.17%), C parapsilosis (n = 10; 4.31%), and C kefyr and C guillermondii (each one, n = 2; 1.66%). Also, the phylogenetic analysis showed the presence of two main clades and six separate subclades. Accordingly, about 88.9% of the isolates were located in clade I and 11.10% of the studied isolates were in clade II.ConclusionsReal‐time PCR followed by high‐resolution melting analysis (HRMA) is known as a reliable, fast, and simple approach for detection and accurate identification of Candida species, especially in clinical samples.

Opportunistic Invasive Fungal Diseases: Types, Symptoms, Treatment, and Laboratory Diagnosis

Opportunistic Invasive Fungal Diseases: Types, Symptoms, Treatment, and Laboratory Diagnosis