Journal of

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Background and Aim: Onychomycosis is the fungal infection of nails. Patient’s immune system has an important role in initiation of onychomycosis. One of the causes of the increased prevalence of onychomycosis is the increasing number of patients with local or general immune system disorders. In hormonal disorders such as diabetes mellitus, Cushing's syndrome and hypothyroidism superficial vascular disorders and individuals with immune deficiency, onychomycosis prevalent. The aim of this study was to investigate onychomycosis in individuals with underlying diseases who referred to Razi hospital in Tehran.

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Onychomycosis is a common nail disorder. If left untreated, it may cause nail deformity and nail plate dystrophy. Since nails have aesthetic importance, onychomycosis may have some impact on quality of life by causing a change in the appearance of nail and/or nail dystrophy and by interfering with fine activities carried out by hand. The aim of this review is to evaluate the quality of life in patients with onychomycosis.

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Background and Aim: The aim of the present study is rapid and precise identification of yeast species isolated from nail of patients with clinical features of onychomycosis using PCR-RFLP technique.

Methods: 50 patients with involvement of 29 fingernails and 21 toenails were enrolled in the study. Different yeast species were identified by conventional mycological. The PCR-RFLP was tested on yeast isolated and the PCR-RFLP products were separated by electrophoresis in 2% agarose gel, with DNA stain.

Results: The main causative agents were yeasts in 12 cases (24%). Candida albicans was the most commonly isolated yeast species followed by Candida parapsilosis (6%), and Candida glabrata (4 %).

Conclusion: PCR-RFLP method using ITS1-ITS4 primers and MspI restriction enzymes is a rapid, accurate and cost-effective method for specific diagnosis of the most prevalent candida spp. Its ability to detect low amounts of fungal DNA in patient samples in 6-8 hours could be useful for clinical laboratories for optimal management of these infections.

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Background and Aim: Onychomycosis is an infection caused by yeast, filamentous and non-filamentous fungi, due to diverse conditions. This study aimed to investigate the pattern of azole susceptibility of candidate species isolated from Iranian patients in Tehran.

Methods: After sampling from patients, identification of the isolated strains were performed with Candida chrom agar medium and PCR-sequencing test. Drug Susceptibility pattern of the species to fluconazole, itraconazole and ketoconazole were determined by CLSI-M27-A3/S4 standard method.

Results: In this study, 34 candidate isolates were identified, of which 26 isolates (76.5%) were Candida albicans and 8 isolates (23.5%) were Candida glabrata. In fluconazole, 4 (11%) of the isolates were dose-dependent sensitive and the others were sensitive. In itraconazole, 21 (61%) dose-dependent isolates and 2 (5%) resistant isolates were identified, and in ketoconazole, all isolates were sensitive. The geometric mean (GM) of the minimum inhibitory concentration for fluconazole, itraconazole and ketoconazole was 0.32, 0.21 and 0.15 μg/mL, respectively. In this study, the most frequently isolated species was C. albicans. According to the GM values, the most effective azoles was ketoconazole.

Conclusion: The prevalence and pattern of susceptibility of Candida species to azole may vary in different populations of patients. Therefore, it is recommended that the clinicians pay attention to the results of drug susceptibility tests and then treat patients by considering drug interactions and side effects.

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Background and Aim: Candida albicans have the ability to colonize living and non-living surfaces and form biofilms that are very resistant to common antifungals. The present study was designed to evaluate the fungicidal activity of itraconazole on Candida albicans biofilm.

Methods: The present study was conducted on 10 nail samples. Routine mycological and molecular tests were performed to identify and determine the type of fungus. Biofilm was formed in the 96-well plate and was subjected to the itraconazole. ROS accumulation was measured. ROS levels were determined in biofilms treated with itraconazole in the presence of antioxidants.The minimum inhibitory concentration of itraconazole was measured in the presence of ascorbic acid (10 mM) according to the protocol of the previous step. Annexin V-FITC apoptosis detection kit was used to investigate the possibility of apoptosis induction following itraconazole use. 

Results: Mann-Whitney showed a significant difference between biofilms treated with itraconazole and untreated biofilms for 10 tested strains. Treatment with itraconazole resulted in a significant reduction in the number of biofilms. Ascorbic acid significantly reduced ROS accumulation caused by itraconazole for biofilms of all Candida albicans strains. The findings show that itraconazole induces ROS-dependent apoptosis in a dose-dependent manner in biofilm cells.

Conclusion: In this study, it was found that the presence of intracellular ROS is the main cause of the apoptosis mechanism of itraconazole. The ability of itraconazole to induce ROS in Candida cells appears to be a very effective fungicidal strategy.