Azole-Containing Agar Plates and Antifungal Susceptibility Testing for the Detection of Azole-Resistant Aspergillus Species in Hospital Environmental Samples

The indoor environment of hospitals should be considered as an important reservoir of azole resistant Aspergillus species. In this study, we evaluated azole-containing agar plates (ACAPs) and antifungal susceptibility testing (AFST) for the detection of azole-resistant Aspergillus species in hospital environmental samples. Between September 2021 and January 2022, environmental samples (108 instruments and 12 air) were collected from different wards of 4 educational hospitals in Mazandaran province, Iran. All samples were cultured using ACAPs. Recovered Aspergillus isolates were molecularly identified at species level using partial DNA sequencing of beta-tubulin gene. AFST of Aspergillus species was performed using the Clinical and Laboratory Standards Institute M38-A3 guideline. Screening for cyp51A mutations was also done. Overall, 18 (15.0%) isolates of Aspergillus species were recovered from ACAPs, of which Aspergillus tubingensis (50%) and Aspergillus fumigatus (38.9%) were the commonest species. No isolate of Aspergillus species grew on posaconazole (PCZ)-containing agar plates. Among the 18 Aspergillus isolated species from ACAPs, 83.3% were related to samples from instruments. Of the nine isolates of A. tubingensis, 22.2% and 44.4% isolates showed minimum inhibitory concentration (MIC) = 2 μg/mL against voriconazole (VCZ) and itraconazole, respectively; and 44.4% isolates showed MIC = 1 μg/mL against PCZ. Of the seven isolates of A. fumigatus, one (14.3%) was resistant to VCZ. This isolate showed F46Y, G54E, G138C, M172V, M220I, D255E, T289F, G432C, and G448S mutation in cyp51A. Our finding showed the emergence of high MICs in cryptic and non-fumigatus species of Aspergillus such as A. tubingensis and VCZ resistance in A. fumigatus in indoor environment of hospitals.

S10.5a Fungal respiratory infections in cystic fibrosis patients in the Middle East

S10.5 Fungal respiratory infections in Cystic Fibrosis, September 24, 2022, 10:30 AM - 12:00 PM

Cystic Fibrosis (CF) is among the most common genetic disorders, which involves multiple organs including the respiratory tract. CF is thought to be an uncommon disease in the Middle East (ME). However, the prevalence is estimated at 1 in 30 000-50 000, while the incidence is estimated at 1 in 2000-5800 live births. Several studies from ME revealed that many children with CF in these populations probably remain undiagnosed due to lack of clinical suspicion and proper diagnostic facilities. According to the experts’ idea, CF may be more common in Iran than expected before.

Chronic colonization of the airways of CF patients and infections due to a wide variety of opportunistic fungal pathogens including Aspergillus, Candida, Scedosporium species, Exophiala dermatitidis, Rasamsonia argillacea complex, and Lomentospora prolificans are currently increasing. On the other hand, the resistance of these opportunistic pathogens to commonly available antifungals challenges therapeutic options and consequently endanger the CF patients’ life.

Dissimilar to bacterial colonization or infections, the epidemiology and pathogenicity of colonization and fungal respiratory infections in CF are less known. According to our recent study, the prevalence rate of respiratory colonization was reported as 73.3%. Among mold isolates, Aspergillus was also the most common genus followed by Scedosporium species. In contrast to the reports from western countries, A. flavus was also identified as the most prevalent species of Aspergillus from ME countries including Iran and India.

In some studies, allergic bronchopulmonary aspergillosis (ABPA) in CF patients from ME was evaluated. In our recent experience from Iran, of 86 patients with CF, 9 (10.5%) cases were met ABPA diagnosis. A. flavus was the most common agent followed by A. fumigatus, A. terreus and A. tubingensis.

A significant resistance of Scedosporium and Aspergillus isolates from CF patients against the main antifungal agents in invasive fungal infections therapy was reported in different studies.

According to these realities, there are a few reports on the Research Topic ‘Fungal Respiratory Infections and Colonization in CF’ from Iran and some other ME countries. Therefore, in this presentation, we are going to highlight our experiences and other published data from Iran and ME in this field including clinical presentations, fungal species involved, diagnosis strategies, and in vitro antifungal susceptibility patterns of fungal isolates from CF patients, and common treatments and prophylactic strategies.

First report of rhino-orbital mucormycosis caused by Syncephalastrum racemosum in a diabetic patient with COVID-19 in Iran and review of recent literature

Background and Purpose

Invasive mucormycosis is a rare mycosis that affects most cases of uncontrolled diabetes and has a high mortality rate. Patients with COVID-19 are at high risk of developing invasive mucormycosis due to the consumption of anti-inflammatory drugs such as corticosteroids and dexamethasone. Rhizopus species followed by Rhizomucor spp. and Mucor spp. are the main common etiological agents of rhino-orbital mucormycosis. Therefore, this study aimed to present a case of mucormycosis due to Syncephalastrum racemosum in a diabetic patient with COVID-19 for the first time in Iran.

Case report

A 73-year-old diabetic female was referred to Ayatollah Rouhani Hospital in Babol, Iran, with a confirmed COVID-19 diagnosis, based on positive RT-PCR and computed tomography of the lungs. She has received methylprednisolone due to severe lung complications. Nasal involvement and left orbital swelling were observed 20 days after the hospitalization. By sinus endoscopic surgery, debridement was done and histopathology indicated wide hyphae (without septa). The sequenced PCR products displayed Syncephalastrum racemosum. In the antifungal susceptibility test, amphotericin B showed good activity against S. racemosum and the patient survived with timely treatment.

Conclusion

This is the first case report of rhino-orbital mucormycosis due to S. racemosum in COVID-19 patient; therefore, S. racemosum can be considered one of the etiological factors of rhino-orbital mucormycosis in COVID-19 cases.

Enhancing of Wound Healing in Burn Patients through Candida albicans β-Glucan

The mortality and disability-adjusted life years (DALYs) of burn patients are decreasing over time. However, finding novel effective treatment approaches using natural agents is highly considered to reduce the burden of burn injuries. One of the recent agents used in wound healing is β-glucan, mainly extracted from fungi cell walls. This study aimed to evaluate the effect of 5% (m/m) of yeast β-glucan ointment on burn wound healing and to assess the impact of β-glucan on cytokines during the treatment. Thirty-three patients with second or third-degree burns were enrolled in this study. Two groups of twenty-three and ten patients used yeast 5% (m/m) β-glucan ointment (study group) and Stratamed ointment (control), respectively, on a daily basis, for a maximum of four weeks. The size of the burn wounds was measured before and at the end of the treatment. Blood samples of 14 and 10 patients in the β-glucan and control groups, respectively, were obtained before and after the treatment, and the enzyme-linked immunosorbent assay (ELISA) was performed to measure the serum concentration of the IL-4, IL-17, and IFN-γ cytokines. The log-binomial model was used to assess the efficacy of the β-glucan ointment on burn wound healing. ANOVA/ANCOVA was employed to assess the effects of β-glucan on the serum concentration of cytokines. After adjusting for potential confounders/covariates, patients receiving β-glucan had better wound healing (RR = 4.34; 95% CI: 0.73 to 25.67; p = 0.11). There was a significant difference in IL-4 secretion between the β-glucan and control groups after adjusting for potential confounders/covariates (MD = 77.27; 95% CI: 44.73 to 109.82; Cohen’s d = 2.21; 95% CI: 1.16 to 3.24; p = 0.0001). The results indicate that 5% (m/m) of β-glucan has efficacy in burn wound healing, and a significant difference was found in the level of IL-4 after receiving β-glucan. Further studies with a two-arm design and long-term use of ointment are needed to confirm the effect of β-glucan on wound healing and cytokine secretion.