Prevalence of Candida africana and Candida dubliniensis, in vulvovaginal candidiasis: First Turkish Candida africana isolates from vulvovaginal candidiasis.

INTRODUCTION: Candida africana and C. dubliniensis are closely related species of C. albicans. Current phenotypic methods are not suitable to accurately distinguish all the species belonging to the C. albicans complex. Several molecular-based methods have recently been designed for discriminating among closely related Candida species. The aim of this study was to establish the prevalence of C. dubliniensis and C. africana in vulvovaginal samples with phenotypic and genotypic methods. MATERIALS AND METHODS: We re-examined 376 vulvovaginal C. albicans complex isolates. All the isolates were identified with morphological features and HWP1 gene polymorphisms. ITS and D1/D2 sequencing, carbohydrate assimilation, MALDI-TOF MS profiles and antifungal susceptibilities were evaluated for C. africana and C. dubliniensis isolates. RESULTS: Of the 376 isolates, three C. africana and three C. dubliniensis isolates (0.8% and 0.8% prevalence, respectively) were identified by molecular methods (HPW1, ITS and D1/D2) Phenotypically, C. africana differed from C. albicans and C. dubliniensis by formation of no/rare pseudohyphae, absence of chlamydospores and, the development of turquoise green colonies on CHROMagar. MALDI-TOF MS and API ID 32C could not revealed C. africana isolates. C. africana and C. dubliniensis isolates showed very low MIC values for all the tested antifungals. DISCUSSION: This first report of C. africana from Turkey provides additional data for epidemiological, phenotypic features and antimicrobial susceptibility profiles. This study also highlights the importance of using genotypic methods in combination with phenotypic methods.

A case of Cryptococcus neoformans meningitis in a patient with abnormal levels of isolated immunological markers.

Cryptococcal meningitis is considered rare in immunocompetent patients and is mainly a disease of immunocompromised patients. We report a case of cryptococcal meningitis, due to Cryptococcus neoformans, in an apparently healthy individual with abnormal levels of isolated immunological markers. Regardless of the patient's immune status, the result of the disease can be serious unless the disease is diagnosed early.

The first case of fungal endophthalmitis caused by Emericella nidulans after cataract surgery.

Emericella nidulans is a species that has only rarely been implicated in human disease after cataract surgery. Here, we report the first postoperative case in the literature, as far as we know. The patient was a 50-year-old patient presented with mild anterior uveitis one week after cataract surgery, and hypopion developed over the next two days. First microbiological evaluation and the results of direct microscopy and cultures of the anterior chamber and vitreous samples were found to be negative. Despite vigorous topical and intravitreal (vancomycin and amikacin) therapy, the endophthalmitis did not improve. Anterior chamber paracentesis, vitreous tap and finally complete vitrectomy with removal of the capsular bag including the intraocular lens (IOL) were performed. The anterior chamber, vitreous fluid samples and IOL were submitted to the microbiology laboratory: the culture yielded E. nidulans growth. Ocular inflammation resolved and vision improved on intravenous, subconjunctival and long-term oral voriconazole treatment. E. nidulans can be an important cause of ocular fungal infections including endophthalmitis, and voriconazole seems to be effective for the treatment of E. nidulans endophthalmitis.

The effects of different suture materials in the nasal cavity.

OBJECTIVE: To investigate the effects of different suture materials in the nasal cavity on encrustation and micro-organism colonisation. METHODS: Four different suture materials were used to suture the nasal septum. The effects of suture materials on intranasal encrustation were evaluated with anterior rhinoscopy. The sutures were removed and evaluated in terms of micro-organism colonisation on the 7th and 21st post-operative days. RESULTS: Monofilament sutures were found to cause less encrustation and micro-organism colonisation. There was increased late-stage encrustation if an absorbable monofilament suture remained in place for a long time. The removal of a non-absorbable monofilament suture in the early or late post-operative period made no difference in terms of micro-organism growth on the suture. CONCLUSION: The material and physical characteristics of sutures placed inside the nose may indirectly affect the healing process. It may be more appropriate to use different materials depending on the length of time the suture is to remain in place.

Distribution of Malassezia species in patients with pityriasis versicolor in Turkey.

Pityriasis versicolor is a common superficial mycotic disease of the skin which is caused by different species of Malassezia genus. The aim of this study was to contribute to the knowledge of the aetiology of pityriasis versicolor (PV) with a mycological study made according to the new species and additionally, the success of the different sampling techniques, duration and recurrence history of the disease, distribution of infecting strains according to the affected body sites were also investigated. In total, 146 patients with pityriasis versicolor were included in this study. Fungal elements could only be visualized by potassium hydroxide examination in 36.4% of the samples. Specimens obtained by scraping skin surface by a sterile scalpel and/or sterile sticky plaster (OpSite) were inoculated in plates containing modified Dixon's medium. Out of 146 samples, 109 (74.7%) yielded a growth which was considered to be Malassezia spp. in culture. Species level identification of suspicious Malassezia yeasts was made according to their macroscopic and microscopic features, and their physiological characteristics. Among the identified species, Malassezia globosa (65.1%) was the most commonly isolated species, followed by Malassezia obtusa (17.4%). However, four Malassezia isolates could not be identified at species level with conventional methods. While most of the patients suffered their first episode of pityriasis versicolor (76%), back of the trunk was the mostly affected body site (39%). In conclusion, Malassezia globosa was found to be the predominant species in pityriasis versicolor patients in our region, and culture of the specimen is necessary for the epidemiologic purposes.

Candida vaginitis during contraceptive use: the influence of methods, antifungal susceptibility and virulence patterns.

No consensus exists about whether contraceptives cause an increased risk of vaginitis, including vulvovaginal candidosis (VVC). We investigated 495 women (252 who used contraceptives; 243 who did not) for the presence of VVC. Antifungal susceptibility testing was performed for five antifungal agents and for boric acid, and three virulence factors were also examined. We recovered 129 (26.1%) monofungal populations from vaginal samples of women with acute VVC (AVVC, n = 18), symptomatic recurrent VVC (RVVC, n = 22) and asymptomatic RVVC (n = 28), as well as of other contraceptive users who carried Candida in their vaginas (n = 61). It is important to note that the women who had VVC used the same contraceptive methods (p > 0.05). Candida albicans was the most common species isolated (45%), followed by C. glabrata (40.3%). Most of the vaginal yeast isolates exhibited low minimum inhibitory concentration levels for the five antifungals tested. However, this was not the case for boric acid. In addition, the yeast fungi that was derived from the AVVC and RVVC patients showed higher amounts of haemolytic activity than the yeast fungi found among the controls (p < 0.05). The use of contraception does not predispose women to VVC (p > 0.05). Also, both host- and organism-related factors were required to achieve optimal clinical treatment for VVC.

Can chitotriosidase be a surrogate marker for invasive fungal disease?

BACKGROUND: Chitotriosidase (CHT) enzyme has been known to be secreted from the activated macrophages. We infer with these data that CHT activity is an indicator for the defence. METHODS: In this study, we evaluated CHT levels in both neutropenic and non neutropenic patients. CHT enzyme activity was measured and compared to each other groups. RESULTS: Chitotriosidase levels were found to be significantly higher in neutropenic patients with candidemia. CONCLUSION: In the comparison between neutropenic and non neutropenic patients, there was a significant difference for CHT levels. The use of this enzyme as a surrogate marker for candidemias were evaluated in neutropenic and non neutropenic patients.