Sarocladium kiliense, formerly known as Acremonium kiliense, 1 is an omnipresent soil saprophytic fungus generally found in the environment such as cereal fields and the soils of grass lands, and sporadically infecting humans and other mammals. [2][3][4] The species of Sarocladium are morphologically very homologous and in the most of the clinical cases the causative agent is reported only as a Sarocladium/Acremonium sp., which dramatically decreases the value of the investigations. 5 This is the principal cause that the actual incidence of the various species of Sarocladium in the clinical setting is unknown. Molecular identification of Sarocladium using modern DNAbased techniques is essential for a critical assessment of the reported cases. This fungus can cause opportunistic infections, such as mycetoma, onychomycosis, fungal keratitis, in immunocompetent individuals, and osteomyelitis, pneumonia, arthritis, peritonitis, endocarditis, meningitis, and sepsis in immunocompromised patients. 6,7 The main risk factors are considered as the use of catheters and prosthesis, anatomic disorders, immunosuppressive therapy, autoimmune diseases, diabetes mellitus, and malignancies. 2,8 Here, we present a systemic case of S. kiliense in a diabetic patient infected to coronavirus disease 2019 (COVID-19) from Isfahan, Iran. | CASE PRESENTATIONA 74-year-old woman with 25 years history of diabetes mellitus was referred to a private traditional medicine center
Background Fusarium species are saprophytic fungi with a worldwide distribution. These fungi cause various infections among immunocompromised patients; however, they can also involve immunocompetent individuals. Case presentation We report a case of a 41-year-old Iranian woman who presented with ulcerative lesions on her lips 10 months ago. She had a long history of anxiety but had no history of classical risk factors such as trauma, cosmetic lip tattoo, burning in her lips, smoking or use of alcohol and opium. A skin biopsy from the lower lip was performed and sent for microbiological examinations. Hyaline septate hyphae were seen on direct microscopy with potassium hydroxide. The clinical specimen was subcultured on sabouraud dextrose agar with chloramphenicol and prepared for antifungal susceptibility testing and molecular identification. Considering the minimum inhibitory concentrations (MIC) for antifungals, itraconazole (100 mg orally twice a day) was started for her, and after 2 months, the lesions were treated. She followed up for 3 months, and no signs of disease recurrence were observed. Conclusions Selecting an appropriate treatment strategy according to the laboratory assessments is essential in clinical practice and the management of rare infections to prevent related mortality and morbidity of opportunistic fungal infections.
Background: Candidemia is a fatal invasive fungal infection that involves thousands of patients annually and is associated with high mortality rate and economic burden. The incidence of candidemia is increasing due to the use of invasive medical instruments and immunosuppressive drugs. The treatment of infection is problematic because of the increased resistance of clinical strains to antifungal drugs. The aim of the present study was to identify Candida species isolated from candidemia and determination of antifungal susceptibility patterns of clinical isolates. Materials and Methods: Three thousand eight hundred BACTEC bottles suspected to candidemia were evaluated from April 2019 to June 2020. For primary identification, a positive blood culture was subcultured onto the sabouraud glucose agar and CHROMagar™ Candida . For molecular identification, ITS1-5.8SrDNA-ITS2 region was amplified by ITS1 and ITS4 primers and Msp I restriction enzyme was applied to digest polymerase chain reaction amplicons. Minimum inhibitory concentration of seven antifungals was determined against clinical isolates by broth microdilution method in accordance with the Clinical and Laboratory Standards Institute M27-A3 and M27-S4 documents. Results: Forty-six out of 3800 suspected specimens were positive for candidemia (1.2%). The age range of the patients was between 11 days and 89 years, with a median age of 34.8 years. Candida albicans was found to be the most Candida species (58.7%), followed by C. parapsilosis complex (19.6%), C. glabrata complex (8.7%), C. krusei (6.5%), C. famata (4.3%), and C. tropicalis (2.2%). Resistance to amphotericin B, fluconazole, itraconazole, and voriconazole was detected in 13.6%, 11.3%, 6.8%, and 4.5% of clinical isolates, respectively. Conclusion: The incidence of non- albicans Candida species is increasing that must be highlighted. Since resistant Candida strains are found repeatedly, consecutive tracing of the species distribution and in vitro antifungal susceptibility of clinical isolates is recommended for better management of infections.
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