Cladophialophora bantiana is a phaeoid fungus that only rarely has been isolated from sources other than the human brain. It has a particular tropism for the central nervous system (CNS). We have integrated and updated large-scale data related to several aspects of C. Bantiana and reviewed all the available reports on its cerebral infections, focusing on their geographical distribution, infection routes, immune status of infected individuals, type and location of infections, clinical manifestations and treatment and outcome, briefly looking over the spectrum of other disease entities associated with C. bantiana, that is, extra-cerebral and animal infections and on the environmental sources of this fungus. Among the agents of phaeohyphomycosis, a term used to describe an infection caused by a dark pigmented fungus, C. bantiana has some significant specific features. A total of 120 case reports were identified with a significantly higher percentage of healthy subjects than immune-debilitated patients (58.3% vs. 41.7%). Infections due to C. bantiana occur worldwide. The main clinical manifestations are brain abscess (97.5%), coinfection of brain tissue and meninges (14.2%) and meningitis alone (2.5%). Among immunocompetent patients, cerebral infection occurred in the absence of pulmonary lesions. The mortality rate is 65.0% regardless of the patient's immune status. The therapeutic options used include surgery or antifungals alone, and the combination of both, in most cases the fatal outcome being rapid after admission. Since the fungus is a true pathogen, laboratory workers should be made aware that BioSafety Level-3 precautions might be necessary.

Autism spectrum disorder (ASD) is a general term for a group of complex neurodevelopmental disorders of brain development that limits a person's ability to function normally. Etiology has not been clearly defined up to date. However, gut microbiota and the bidirectional communication between the gastrointestinal tract and brain, the so-called microbiota-gut-brain axis, are hypothesized, which may be involved in the etiology of several mental disorders. Recent reports suggest that Candida, particularly Candida albicans, growth in intestines may cause lower absorption of carbohydrates and minerals and higher toxin levels which are thought to contribute autistic behaviors. The aim of this study was to identify the 3-year deposited yeasts isolated from stool samples of children with diagnosed or suspected ASD and to determine in vitro activity of nystatin and fluconazole against these isolates using Clinical Laboratory Standards Institute M27-A3 guidelines. A 17-year retrospective assessment was also done using our laboratory records. Among the species identified, intrinsically fluconazole-resistant Candida krusei (19.8 %) and Candida glabrata (14.8 %) with elevated MICs were remarkable. Overall, C. albicans (57.4 %) was the most commonly isolated species in 17 years. The species identification and/or antifungal susceptibility tests have to be performed using the strain isolated from stool sample, to select the appropriate antifungal agent, if antimycotic therapy is needed.

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We tracked and documented the time of positivity of blood cultures by using the BACTEC 9120 (Becton Dickinson Diagnostic Instrument Systems) blood culture system over a 5-year study period. A 7-day protocol of the incubation period was selected, and a total of 11,156 blood cultures were evaluated. The clinically significant microorganisms (32.95%) were isolated in 3,676 specimens. Gram-positive and -negative bacterial isolation rates were found to be 41.07 and 44.88%, respectively. Yeasts were found in 14.03% of all pathogens. Both the false-positivity and -negativity rates were very low (0.1 and 0.3%, respectively). The mean detection times for all of the pathogens were determined to be 19.45 h. Yeasts, nonfermentative gram-negative bacteria, and Brucella melitensis strains were isolated within 5 days. By taking these data into account, we decided to establish a 5-day-incubation protocol in our laboratory instead of the 7 days that are commonly used.Bloodstream infection is one of the most serious problems in all infectious diseases. Despite recent developments, like nucleic acid probes, PCR, and other molecular techniques for microbiological diagnosis, blood cultures still remain the most practical and reliable method in the diagnosis of bloodstream infections. Blood culture is one of the most important tools in the clinical microbiology laboratory. Rapid isolation and identification of the microorganisms in blood samples and directing of the treatment accordingly are critically important in order to reduce the mortality rate (2). The fact that conventional methods are not sufficient for a low mortality rate has resulted in the extensive usage of various continually monitored blood culture systems in many clinical microbiology laboratories over the past 25 years. In the end, these systems were proven to be highly reliable. One of these, BACTEC 9120, is based on the monitoring of the CO 2 concentration produced by growing microorganisms with a fluorescent sensor located at the bottom of each bottle (8). The aim of this study was to determine the detection times and the distribution of the bacteria and yeasts isolated from the blood samples by using BACTEC 9120 (Becton Dickinson Diagnostic Instrument Systems, Sparks, Md.) over a 5-year period. We also had it in mind to analyze the data to decide which incubation protocol would be more suitable for practical purposes.This study was conducted in the Clinical Microbiology Laboratory of Osmangazi University Medical Faculty Hospital from August 1996 to December 2001. Most of the patients were adults from intensive care and hematology units. Two bottles were used in the culturing for every patient. All of the phlebotomies were performed with peripheral sticks, and the blood samples were drawn by a clinician by the bedside after cleansing the skin with 70% isopropyl alcohol and applying 10% povidone-iodine for 1 min. The blood samples were inoculated at a volume of 1 to 5 ml into BACTEC Peds Plus/F and a volume of 10 ml into PlusϩAerobic/F blood culture bottles and wer...

Otomycosis is worldwide in distribution and most commonly caused by Aspergillus species. Amphotericin B, itraconazole and voriconazole are used for the treatment of aspergillosis, but recently an increase in resistance to these agents has been reported. We aimed at investigating the in vitro activities of amphotericin B, voriconazole and itraconazole against Aspergillus isolates causing otomycosis. Mycological analysis of samples from the ear canals of patients was performed by culturing onto Sabouraud Dextrose Agar and by evaluating microscopically. Aspergillus species were identified with colony morphology and microscopic appearance, and tested for susceptibilities to amphotericin B, itraconazole and voriconazole by the CLSI reference broth microdilution method (M38-A document). A total of 120 isolates from 120 patients, comprising 57 Aspergillus niger, 42 Aspergillus fumigatus, nine Aspergillus flavus, six Aspergillus nidulans and six Aspergillus terreus strains were tested. No resistance was determined against amphotericin B and voriconazole, while six A. fumigatus and three A. niger isolates were resistant to itraconazole. In vitro data obtained in this study showed the resistance to itraconazole, while all of the isolates were susceptible to voriconazole and amphotericin B. Voriconazole seemed to be an alternative in the treatment of infections related to Aspergillus spp. but further studies are needed to learn more about the antifungal resistance of different species of Aspergillus to different agents.