Comparison of the Effects of Nika Vaginal Cream with Clotrimazole Cream on Vaginal Candidiasis Symptoms: A Randomized Single-Blind Clinical Trial.

BACKGROUND: The prevalence of vaginal candidiasis is high in women and proper treatment is essential in this regard. MATERIALS AND METHODS: This single-blind randomized controlled clinical trial was conducted on 120 women who were referred to Hamadan health centers in 2019. The patients were randomly divided into Clotrimazole cream and Nika vaginal cream groups each including 60 cases. The intervention group received Nika vaginal cream once a day for a week and those in the control group were given Clotrimazole vaginal cream in the same way. The clinical symptoms were studied by clinical examinations and the culture of vaginal discharge before and 7 days after the treatment to confirm the diagnosis of Candida albicans. The results were analyzed by SPSS 21.0 using an independent t test, Mann-Whitney U test, and Chi-square, Fisher's exact, and McNemar's tests, the significance level was set at 0.05. RESULTS: Most patients in both groups reported no clinical symptoms after the intervention, and no significant difference was observed between the two groups in this regard (χ2 = 2.23, p = 0.566). Conversely, a significant difference was found in Nika and Clotrimazole groups before and after the intervention regarding improving Vulvovaginal Candidiasis (VVC) symptoms χ2 = 86.01, χ2 = 99.41, respectively (p < 0.001). Finally, 84.48% and 75.86% of women in the Nika χ2 = 45.02 (p < 0.001) and Clotrimazole cream χ2 = 40.02 (p < 0.001) groups had negative culture results after the intervention. CONCLUSIONS: In general, the Nika and Clotrimazole vaginal creams have the same effects concerning improving the symptoms of vaginal candidiasis and thus can be used to treat VVC.

Fumonisin B1 contamination of cereals and risk of esophageal cancer in a high risk area in northeastern Iran.

INTRODUCTION: Fumonisin B1 (FB1) is a toxic and carcinogenic mycotoxin produced in cereals due to fungal infection. This study was conducted to determine FB1 contamination of rice and corn samples and its relationship with the rate of esophageal cancer (EC) in a high risk area in northeastern Iran. METHODS: In total, 66 rice and 66 corn samples were collected from 22 geographical subdivisions of Golestan province of Iran. The levels of FB1 were measured for each subdivision by thin layer and high pressure liquid chromatographies. The mean level of FB1 and the proportions of FB1 contaminated samples were compared between low and high EC-risk areas of the province. RESULTS: The mean of FB1 levels in corn and rice samples were 223.6 and 21.6 µg/g, respectively. FB1 contamination was found in 50% and 40.9% of corn and rice samples, respectively. FB1 level was significantly higher in rice samples obtained from high EC-risk area (43.8 µg/g) than those obtained from low risk area (8.93 µg/g) (p-value=0.01). The proportion of FB1 contaminated rice samples was also significantly greater in high (75%) than low (21.4%) EC-risk areas (p-value=0.02). CONCLUSION: We found high levels of FB1 contamination in corn and rice samples from Golestan province of Iran, with a significant positive relationship between FB1 contamination in rice and the risk of EC. Therefore, fumonisin contamination in commonly used staple foods, especially rice, may be considered as a potential risk factor for EC in this high risk region.

Clinico-epidemiological and mycological aspects of tinea incognito in Iran: A 16-year study.

BACKGROUND: Tinea incognito is a dermatophytic infection in which topical or systemic steroids have modified the clinical appearance of the mycosis and mimicking other skin diseases. OBJECTIVES: A large retrospective study was carried out to identify the clinical aspects and type of dermatophytes involved in tinea incognito cases in Iran during 1993-2008. PATIENTS: Out of 6325 subjects suspected to have dermatophytoses, 56 patients (29 males, 27 females, mean age 32.6 years) were affected with tinea incognito. METHODS: The causative agents were identified macroscopically and microscopically after the clinical samples were subjected to potassium hydroxide examination and culture isolation. RESULTS: The most common type of infection was tinea corporis (32.1%), which significantly affected male patients. The prevalence of the other tineas in decreasing order was as follows: tinea faciei (26.8%), tinea cruris (14.3%), tinea manuum (12.5%), tinea pedis (8.9%), and tinea capitis (5.4%). The clinical features were to some extent diverse, ranging from eczema-like, seborrhoeic dermatitis-like, pyoderma-like and folliculitis to alopecia on scalp, trunk and limbs. Trichophyton verrucosum was the most frequently isolated species representing 33.9% of isolates, followed by T.mentagrophytes (28.6%), T. rubrum (12.5%), Epidermophyton floccosum (10.7%), Microsporum canis (8.9%), T. violaceum (3.6%), and T. schoenleinii (1.8%). CONCLUSION: To the best of our knowledge, this is the first broad investigation dealing with tinea incognito in Iran. The etiological agents of tinea incognito in Iran are consistent with those of the general population.

Dermatophytes as a cause of epizoonoses in dairy cattle and humans in Iran: epidemiological and clinical aspects.

Zoophilic dermatophytosis is a major public and veterinary health problem globally widespread among cattle. To identify the causative agent and geographical distribution of dermatophytes involved in cattle ringworm and to establish if they would be related to human diseases in Iran, a study was carried out on 6789 heads of cows and 130 herdsmen during 2006-2007. Samples were taken from 380 cattle and 43 herdsmen with suspected dermatophytosis. The causative agents were identified macroscopically and microscopically by KOH examination and culture isolation. Only 352 cases of dermatophytosis were identified in cattle and Trichophyton verrucosum was the exclusive fungus isolated from animals. Moreover, 27 cases of human dermatophytosis were identified and T. verrucosum was the prevalent causative agent for dermatophytosis in the body, scalp, foot, nail and groin of the patients. The obtained results showed that T. verrucosum was the predominant cause of dermatophytosis in livestock and dairy farmers. There is a scarcity of information on isolation and identification of the epizoonotic agents of dermatophytoses in cattle in Iran. This study showed the occurrence of dermatophytosis in humans and cattle and confirms that the dermatozoonoses are responsible for predominant forms of the disease in people who were in contact with cattle.

A clinico-epidemiological study on tinea gladiatorum in Iranian wrestlers and mat contamination by dermatophytes.

UNLABELLED: Dermatophytosis is still being considered as one of the major public health problems in wrestlers. OBJECTIVES: To identify the prevalence, clinical pattern, aetiological agents and the predominant transmission route of dermatophytoses in Iranian wrestlers, a study was carried out in 2008. In total, 270 wrestlers from eight wrestling salons were evaluated. Classical mycological techniques were performed on 135 skin scraping samples of 110 wrestlers suspicious for dermatophytoses and 240 touch preparation samples of wrestling mats. Diagnosis of the fungus type was made based on macroscopical and microscopical characteristics of the colonies. 19.2% of the evaluated wrestlers were inflicted with tinea gladiatorum. The head and neck were the most prevalent (36.5%) areas of involvement, followed by arms and forearms (28.8%), trunk (21.2%), as well as groin and knee (13.5%). The mean age of patients was 21 years and the most frequent age group was 10-19 years (51.9%). Trichophyton tonsurans was the most frequently isolated species representing 82.7% of isolates, followed by T. rubrum (5.8%), T. mentagrophytes var. interdigitale and Epidermophyton floccosum (3.8% each), and T. mentagrophytes var. mentagrophytes and T. verrucosum (1.9% each). Of 24 wrestling mats surveyed, 33.3% were heavily contaminated with T. tonsurans. Tinea gladiatorum in Iran is a common phenomenon among wrestlers, transmission pattern of which appears to be through man-to-man and mat-to-man contact. Furthermore, the clinical features of the disease are not consistent with those of the general population of Iran.

Onychomycosis in Iran: epidemiology, causative agents and clinical features.

BACKGROUND: Onychomycosis represents the most frequently encountered nail disease, which is difficult to eradicate with drug treatment. AIM: This study was undertaken to document the clinico-mycological pattern of onychomycosis in Iran. Results of mycological tests of nail scrapings collected over a 4-year period were analyzed. METHODS: Both direct microscopy and cultures of the nail material were performed to identify the causative agents. RESULTS: The microscopic and/or cultural detection of fungi was positive in 40.2% of samples. The most common clinical type noted was distolateral subungual onychomycosis in 48.4% of cases. Etiological fungal agents were 50% dermatophytes, 46.8% yeasts, and 3.2% saprophytic moulds. The most frequently detected dermatophyte species were Trichophyton rubrum (48.4%) and T. mentagrophytes (41.9%). Among yeasts, Candida albicans (58.6) was most common, followed by C. parapsilosis (17.2%), C. glabrata (10.3%), C. krusei and C. tropicalis (each 6.9%). Aspergillus niger and A. flavus were the most frequent saprophytic moulds. Females were affected more frequently than males, and in both sexes those most infected were between 40-49 years of age. Fingernails were affected more frequently than toenails. CONCLUSIONS: The clinico-epidemiological data collected can serve as reference for future research and may be useful in the development of preventive and educational strategies.

Isolation and characterization of medically important aerobic actinomycetes in soil of iran (2006 - 2007).

The aerobic actinomycetes are a large group of soil-inhabiting bacteria that occur worldwide. Some of them are the main cause of two important diseases, nocardiosis and actinomycetoma. To identify the prevalence and geographic distribution of aerobic actinomycetes in soil of Qazvin province, a study was carried out during 2006-2007. In this study, the incidence and diversity of medically important aerobic actinomycetes was determined in 300 soil samples of different parts of Qazvin. The suspensions of superficial soil samples were prepared by adding of normal saline, streptomycin and chloramphenicol and the supernatants were cultured on brain-heart infusion agar and Sabouraud's dextrose agar contain cycloheximide. The isolated microorganisms were examined by Gram and acid-fast stains and were identified biochemically and morphologically. Of 96 aerobic actinomycetes isolates identified, Actinomadura madurae and Streptomyces somaliensis were the most frequently isolated species each representing 19.8% of isolates, followed by Nocardia asteroides (15.6%), N. otitidiscaviarum (9.4%), N. brasiliensis (7.3%), A. peletieri, S. griseus, and Nocardia spp. (each 5.2%), and N. transvalensis, Nocardiopsis dassonvillei, Actinomadura spp. and Streptomyces spp. (each 3.1%). To the best of our knowledge, this is the first report on epidemiological investigation of medically important aerobic actinomycetes in soil samples from Iran. In recent years, mycetoma and nocardiosis have been increasingly reported in Iran. The results showed that medically important actinomycetes occur in the environment of Iran and soil could be potential source of actinomycotic infections.

Dermatophytoses in outpatients attending the Dermatology Center of Avicenna Hospital in Qazvin, Iran.

Dermatophytosis is still being considered as one of the major public health problems in many parts of the world. To identify the prevalence and etiological agents of dermatophytoses, a study was carried out between 2004 and 2006. Out of 1023 subjects suspected to have cutaneous mycoses, 348 (34%) patients were affected with dermatophytoses. The causative agents were identified macroscopically and microscopically after the clinical samples were subjected to potassium hydroxide examination and culture isolation. Epidermophyton floccosum was the most frequently isolated species representing 32.8% of isolates, followed by T. rubrum (18.1%), T. verrucosum (17.2%), T. mentagrophytes var. interdigitale (15.8%), T. mentagrophytes var. mentagrophytes (6.6%) and T. violaceum, T. schoenleinii and Microsporum canis (0.9%). The most common type of infection was tinea cruris (31.9%) affecting in particular male patients. Some other most prevalent tinea types were tinea corporis (20.7%), tinea pedis (19%), and tinea unguium (11.2%). To the best of our knowledge, this is the first report on dermatophytoses in Qazvin and the first study that shows tinea cruris as a major type of superficial fungal infection in Iran. The frequency of tinea was higher in males and tinea cruris showed a remarkably increasing tendency and was an important public health issue in Qazvin.

Disseminated, fatal Trichosporon asahii infection in a bone marrow transplant recipient.

Trichosporon asahii is the most important species regularly isolated from systemic mycoses and shows a predilection for hematogenous dissemination. This report describes the first fatal case of disseminated trichosporonosis caused by T. asahii in a patient with familial aplastic anemia (AA). An 11-year-old girl with familial AA received chemoradiotherapy and immunosuppressive therapy for bone marrow transplantation. She was neutropenic and suffered from fever, cough, and severe mouth ulcers. T. asahii was repeatedly demonstrated by appropriate morphological and physiological characteristics, i.e., arthroconidium formation, urease activity, and assimilation of carbon and nitrogen compounds. T. asahii was found in samples of sputum, nose, and mouth ulcers by direct microscopy and culturing. Furthermore, postmortem histopathology study revealed vast tissue invasion of fungal hyphae characteristic of Trichosporon in the lung and liver. Disseminated trichosporonosis should be suspected in immunocompromised patients when a febrile condition does not improve after prolonged treatment with broad-spectrum parenteral antibiotics.

Incidence of Fusarium verticillioides and levels of fumonisins in corn from main production areas in Iran.

A total of 52 corn samples collected in 2000 from four main corn production provinces of Iran (Fars, Kermanshah, Khuzestan, and Mazandaran) were analyzed for contamination with Fusarium verticillioides and fumonisins (FB(1), FB(2), FB(3), and 3-epi-FB(3)). The mean incidence of F. verticillioides (percent of kernels infected) for these four areas was 26.7, 21.4, 24.9, and 59.0%, respectively. The incidence in Mazandaran was significantly (p < 0.05) above that of the other areas. All samples from Mazandaran were contaminated with fumonisins with a mean level of total fumonisins of 10674 microg/kg. In contrast, the incidence of fumonisin contamination above 10 microg/kg was 53 (8/15), 42 (5/12), and 57% (8/14) in the samples from Fars, Kermanshah, and Khuzestan, respectively, and the corresponding mean total fumonisin levels were 215, 71, and 174 microg/kg, respectively. No statistical differences (p > 0.05) were observed in the fumonisin levels of the corn samples from these three provinces, which were significantly (p < 0.05) lower than the fumonisin contamination in samples from Mazandaran.

Fumonisin production by Fusarium species isolated from freshly harvested corn in Iran.

Fifty-one strains of Fusarium verticillioides and F. proliferatum isolated from corn collected from four different geographic areas in Iran, namely Fars, Khuzestan, Kermanshah and Mazandaran (an endemic oesophageal cancer (OC) area) were evaluated for their ability to produce fumonisins B1 (FB1), B2 (FB2) and B3 (FB3) in corn culture. Fumonisin levels were determined by high-performance liquid chromatography. All tested strains of F. verticillioides and F. proliferatumproduced fumonisins within a wide range of concentrations, 197-9661 microg/g, 18-1974 microg/g, and 21-1725 microg/g for FB1, FB2, and FB3, respectively. The highest mean concentrations of FB1, FB2, and FB3 were 3897, 806 and 827 microg/g, respectively. Overall, 61% of the F. verticillioides and F. proliferatum strains produced higher levels of FB3 than FB2. The mean ratios of FB1:FB2, FB1:FB3 and FB1:total fumonisins were 8, 7 and 0.7 for F. verticillioides and 5.7, 10.7 and 0.7 for F. proliferatum, respectively. Significant differences in some of the meteorological data (rainfall, relative humidity and minimum temperature) from the four provinces were observed. Fumonisin levels produced by F. verticillioides strains isolated from Khuzestan province (tropical zone) were significantly (P < 0.01) higher than the other three provinces. This is the first report of the fumonisin-producing ability of F.verticillioides and F. proliferatum strains isolated from corn harvested from different geographic areas in Iran.

Mycoflora of Iranian maize harvested in the main production areas in 2000.

Maize is one of the most important cereals produced in, and imported into, Iran. The incidences of seed-borne fungi were determined in Iranian maize harvested in 2000 from four major production areas with different climatic conditions, namely Fars, Khuzestan, Kermanshah and Mazandaran provinces. This is the first study to compare the mycoflora of maize in the aforementioned areas. Mycological analyses showed a predominance of Fusarium species (38.5%), followed by Aspergillus species (8.7%), Rhizopus species (4.8%), Penicillium species (4.5%), Mucor species (1.1%), and four other fungal genera. Fusarium verticillioides was the most prevalent species (83% of Fusarium isolates and 52% of the total isolations), with the highest incidence in Mazandaran (59%), a region of Iran with the highest rainfall and relative humidity, high rate of esophageal cancer (EC) and high levels of fumonisins in maize. Aspergillus flavus was the most widely recovered Aspergillus species and 38% of samples were contaminated with this potentially aflatoxigenic fungus. The incidence of A. flavus was highest in Kermanshah, the province with lowest mean minimum temperature. Penicillium species were seen in all the samples and Fars had the highest incidence, with highly significant differences when compared to the other three provinces. Diplodia species were not isolated from any of the samples examined.