Introduction: Trichophyton mentagrophytes and T. interdigitale are important causative agents of superficial mycoses, demonstrating emergent antifungal drug resistance. We studied the antifungal susceptibility profiles in Iranian isolates of these two species. Methods: A total of 96 T. interdigitale and 45 T. mentagrophytes isolates were subjected to molecular typing by ribosomal ITS region. Antifungal susceptibility profiles for terbinafine, griseofulvin, clotrimazole, efinaconazole, luliconazole, amorolfine and ciclopirox were obtained by CLSI broth microdilution method. The squalene epoxidase (SQLE) gene was subjected to sequencing for mutations, if any, in isolates exhibiting elevated MICs for terbinafine. Results: Luliconazole and efinaconazole showed the lowest MIC values against T. mentagrophytes and T. interdigitale isolates. There were five isolates with terbinafine MICs ≥32 µg/mL in our sample. They belonged to T. mentagrophytes type VIII and harbored two alternative SQLE gene sequence variants, leading to Phe397Leu and Ala448Thr or Leu393Ser and Ala448Thr substitutions in the enzyme. All terbinafine resistant strains could be inhibited by luliconazole and efinaconazole. Conclusion: This study documented a step in the global spread of resistance mechanisms in T. mentagrophytes. However, treatment alternatives for resistant isolates were available.

Summary The fungi Trichophyton mentagrophytes and T interdigitale account for significant amount of dermatophytosis cases worldwide. These two dermatophytes form a species complex and have a number of ribosomal internal transcribed spacer (ITS) region genotypes, allowing simultaneous species identification and strain typing. Our aim was to describe the geographic distribution of T mentagrophytes/T interdigitale ITS region genotypes and find an association between the genotypes and clinical presentations of respective infections. We performed rDNA ITS region sequencing in 397 Iranian T mentagrophytes/T interdigitale isolates and analysed all available in GenBank entries with sequences of this kind. For the study, 515 clinical annotations were available. Statistical analysis was performed by chi‐squared test and Spearman rank correlation analysis. A total of 971 sequences belonged to genotypes with at least 10 geographic annotations and were classified on the basis of exclusive occurrence in a particular region or high relative contribution to a regional sample. We discerned Asian and Oceanian (“” Type V, “” Type VIII, “”), European (“” Type III, “” Type III*, “” Type VI) and cosmopolitan (“” Type I, “” Type II, “” Type II* and “” Type XXIV) genotypes. There was statistically significant difference in the ITS genotype distribution between different affected body sites. Trichophyton mentagrophytes “” Type VIII correlated with tinea cruris, T mentagrophytes “” Type V correlated with tinea corporis, T interdigitale “” Type II correlated with tinea pedis and onychomycosis. Trichophyton mentagrophytes and T interdigitale genotypes can be associated with distinct geographic locations and particular clinical presentations.

Two hundred and seventy nine patients suspected of having fungal lesions were examined. Skin scrapping, hair samples and nail clippings were collected from patients. Direct and culture examinations were performed for all samples. About 115 cases of examined subjects had dermatophytosis. Dermatophytosis occurred mainly in adults males (20-29 years). Tinea cruris (24.3%) was the most common type of dermatophytosis followed by tinea pedis (16.5%), tinea corporis (14.8%), tinea ungium (13%), tinea capitis (11.3%), tinea faciei (11.3%), tinea manuum (7%) and tinea barbae (1.7%). Trichophyton mentagrophytes was the most prevalent species followed by Epidermophyton floccosum.

Fungal infection of the external auditory canal (otitis externa and otomycosis) is a chronic, acute, or subacute superficial mycotic infection that rarely involves middle ear. Otomycosis (swimmer's ear) is usually unilateral infection and affects more females than males. The infection is usually symptomatic and main symptoms are pruritus, otalgia, aural fullness, hearing impairment, otorrhea, and tinnitus. Fungal species such as yeasts, molds, dermatophytes, and Malassezia species are agents for otitis externa. Among molds, Aspergillus niger was described as the most common agent in the literature. Candida albicans was more prevalent than other yeast species. Otomycosis has a worldwide distribution, but the prevalence of infection is related to the geographical location, areas with tropical and subtropical climate showing higher prevalence rates. Otomycosis is a secondary infection and is more prevalent among swimmers. As a result, a higher incidence is reported in summer season, when more people interested in swimming. Incidence of otomycosis in our review ranged from 5.7 to 81 %, with a mean value of 51.3 %. Our results showed that 78.59 % of otomycosis agents were Aspergillus, 16.76 % were Candida species, and the rest (4.65 %) were other saprophytic fungi. Among Iranian patients, incidence of infection was highest in summer, followed by autumn, winter, and spring. In Iran, otomycosis was most prevalent at the age of 20-40 years and the lowest prevalence was associated with being <10 years old. The sex ratio of otomycosis in our study was (M/F) 1:1.53.

The aim of the present study was to investigate the incidence of fungal and bacterial contaminations of in-use eye drop products in the teaching department of ophthalmology, Imam Khomeini Hospital, Ahvaz. Two hundred and eighty seven eye drop bottles were randomly collected at the end of day 1, day 2, day 3, day 4 and day 7 of use. The eye drop residues, swabs from internal caps and droppers were inoculated onto MacConkey agar, blood agar and Sabouraud's dextrose agar. The identification of the recovered organisms was accomplished using standard microbial identification techniques. The incidence of microbial contamination of in-use eye drop products was 17.8%, with the highest rate (24.6%) and the lowest rate (9.0%) noted with day 1 and day 3 samples, respectively. The most contaminated part of the eye drop products was the caps (45.9%) followed by droppers (41.0%) and residual contents (13.1%). Considering mendicants contents, those with pilocarpine (41.7%) had the highest rate of contamination followed by atropine (31.8%), tropicamide (28.6%) and betamethasone (23.3%). Our study revealed the potential risk of contamination of in-use eye drop products in hospitals, but we did not find a direct relationship between usage duration and contamination rate.

Background:Otomycosis is a superficial fungal infection often involves the pinna and external auditory canal. It is a pathologic condition, with Candida and Aspergillus, the most common fungal species. It is common worldwide but more prevalent in tropical and subtropical countriesObjectives:The aim of this study was to determine the etiologic agents and local epidemiologic pattern of otomycosis in northwest Iran.Patients and Methods:A series of 140 patients with clinically symptomatic otomycosis were studied in 21 cities, towns, and villages throughout northwest Iran between 2009 and 2011. Clinical samples were collected by swabs and then assessed by mycological investigation.Results:Otomycosis was diagnosed in 129 cases (92%, 76 male, 53 female) with the highest prevalence of cases occurring in males between 21 - 40 years of age. From an etiological point of view, 116 patients (90%, 21 - 40 years old) were infected by saprophytic mold and 9 patients (7%) were infected by yeast. Three cases (2%) involved dermatophytes, and in one case (1%) the subject was infected with Eurotium (the perfect stage of Aspergillus fumigatus). Aspergillus niger was the most common mold that was isolated, followed by A. flavus, A. fumigatus, Penicillium spp., Fusarium spp., and Rhizopus spp. A total of 2 yeasts belonging to genus Candida, C. albicans and C. tropicalis, were isolated.Conclusions:Our study showed a high prevalence of otomycosis in the northwestern area of Iran. As such, proper diagnosis and treatment by aseptic techniques for this disease is urgently needed.

Fluconazole resistance was the most prevalent (85.1%) among all non-Candida albicans species and also the majority isolates of C. albicans. In addition terbinafine is presented as one of the choices for the treatment of Candida vaginitis. Background:Candida vaginitis is a common fungal infection among adult women and it has been estimated that 75% of all adult women experience at least one period of vulvovaginal candidiasis in their lifetime. Several predisposing factors, such as diabetes mellitus, using contraceptive, pregnancy, and broad-spectrum antibiotics are reported as main risk factors for the infection. While, the main etiologic agent of vulvovaginal candidiasis is Candida albicans, more antifungal resistance has been reported among non-albicans species. Objectives: The aim of the present study was to determine susceptibility patterns of vaginal isolates of Candida to eight antifungal drugs including, clotrimazole, miconazole, terbinafine, nystatin, itraconazole, fluconazole, ketoconazole, and econazole. Patients and Methods: Tested organisms were C. albicans 53 (79.1%), C. glabrata 8 (11.9%), C. tropicalis 4 (5.9%) and C. krusei 2 (2.9%) that were isolated from vaginal infected patients. Disk diffusion method was used to evaluate susceptibility patterns. Paper disks containing clotrimazole, miconazole, itraconazole, fluconazole, ketoconazole, econazole, nystatin and terbinafine were applied for susceptibility tests. Results: In the present study 2 isolates of C. krusei were sensitive to ketoconazole, clotrimazole and miconazole. In addition both isolates were resistant to fluconazole, nystatin, econazole and terfinafine. Only one isolate of C. tropicalis was sensitive to miconazole and terbinafine and two isolates to clotrimazole. Highest sensitivity of C. albicans to antifungal drugs was seen against miconazole (49 of 53 isolates) followed by, clotrimazole (41), terbinafine (28) and ketoconazole (13) whereas 43 isolates were resistant to fluconazole and econazole antifungals. Conclusions: All 8 isolates of C. glabrata were resistant to fluconazole, whereas all isolates were sensitive to miconazole. Antifungal sensitivity testing suggests that vaginal isolates of Candida were most sensitive to miconazole, clotrimazole, and terbinafine, and least sensitive to econazole and fluconazole.

Mycetomas are the subcutaneous and relatively rare chronic pustular infections. The etiologic agents of mycetomas are a group of saprophytic fungi and actinomycetes living in soil. We retrospectively discussed the overall prevalence of mycetomas and the prevalence of infective agents in Iran between 1972 and 2005. Seventy-six cases of mycetomas have been reported from various geographical locations in Iran during 33 years. Analysis of the records revealed that 84.5% were actinomycetoma and only 15.5% were eumycetoma. Disease mainly has been seen in foot, and the male to female ratio was 2:1. Mycetomas were abundant among farmers in rural areas of Iran. The commonest agents of mycetomas were Nocardia asteroids, Actinomadura madura (actinomycetoma) and Allesheria boydii (eumycetoma). The peak age of onset was between 31 and 51 years.