Tehran University Medical Journal

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Fungal infection of the nail, also known as onychomycosis, is a worldwide problem. It is estimated that onychomycosis constitutes 15-22 percent of all nail disorders. It is also known that 2-5 percent of the adult population in Europe have onychomycosis. This problem is quite common in the dermatology clinic of the countries in the Midle East, India and the Far East. The infection rates and types of fungi involved in onychomycosis vary with conditions such as age, sex, occupation, hygiene, foot wear and several environmental and climatic factors.
Methods and Materials: A retrospective study of nail infection was carried out in the section of Medical Mycology, Pasteur Institute of Iran from April 1993 to March 1999. Nineteen hundreds eighty five cases examined for toe and finger nail infections.
Results: Ranging in age were from 3 months to 84 years old. This study reports the causative agents of onychomycosis in the presented patients in the section of Medical Mycology, Pasteur Institute of Iran. The 1985 patients were examined for onychomycosis. Diagnosis was confirmed by demonstration of fungi in direct (K.OH 20 percent) and cultural examination. Onychomycosis were proven in 601 patients. Three hundreds fifty patients were females (59 percent). The fingernails were more commonly positive in females (73.5 percent) than males, while the toenail positivity rate in males was 69 percent. Among 601 isolated species, dermatophytes were 308 cases (51 percent) mainly from toenail were predominant. Candida SPP. Were isolated in 46 percent of the cases, especially from fingernails. Nondermatophytic molds were isolated only in 3 percent of the patients (18 cases). Most common isolated dermatophytes were Trichophyton rubrum (66.5 percent) and T. Mentagrophytes (24.6 percent). Other isolated dermatophytes were: violaceum, T. schoenleinii and Microsporum gypseum. Candida albicans were isolated in 40.9 percent of the yeast onychomycosis. Non- dermatophytyic molds were Aspergillos, Acromonium. Fusarium and Chrysosporium.
Conclusion: Onychomycosis represent 30 percent of all mycotic infections of the skin. Their promoting factors, clinical aspects and differential diagnosis have been reviewed. It is necessary to confirm the clinical diagnosis of onychomycosis by laboratory tests (direct microscopy and cultures).

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Oropharyngeal candidiasis is the most frequent fungal infection in HIV patients. The aims of this study were to appraise prevalence of oropharyngeal candidiasis and to determine factors associated with oropharyngeal candidiasis and oral yeast colonization among Iranian HIV patients.
Methods: The patients were composed 150 Iranian HIV positive individuals referred to Iranian Research Center for HIV & Aids (IRCHA), Imam Khomeini Hospital complex in Tehran, Iran. Oral samples were obtained and cultured on mycological media. TCD₄ lymphocyte count/percentage was measured and patients were categorized. Patients evaluated for some risk factors for oropharyngeal candidiasis and oral candida colonization.
Results: Fifty nine percent of patients were presented with oropharyngeal candidiasis and the carriage rate of yeasts was 116 (77.2%). The most frequent isolated candida species were Candida albicans (102) 50.2% and Candida glabrata (45) 22%. Thrush in 57(38%), perleche in 30(20%) and erythematous lesions in 7(4.7%) of patients were observed. Significant differences in TCD₄ count (p=0.01), gender (p=0.02), antifungal therapy (p=0.001), smoking (p=0.02), and intravenous drug use (p=0.03), between asymptomatic and symptomatic patients were observed.
Conclusion: Oral candidiasis is a frequent complication among Iranian HIV individuals. C. albicans and C. glabrata are most important etiologic agents of oral candidiasis. In Iranian HIV individuals TCD₄ count, antifungal therapy, gender, smoking and intravenous drug use are important risk factors for oropharyngeal candidiasis. Denture wearing and age are predisposing factors for oral colonization.

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Background: Oropharyngeal candidiasis and antifungal drug resistance are major problems in HIV positive patients. The increased reports of antifungal resistance and expanding therapeutic options prompted the determination of antifungal susceptibility profile of Candida species isolates in Iranian patients living with HIV/AIDS (PLWHA) in the present study.

Methods: One hundred fifty oral samples from Iranian HIV positive patients were obtained and cultured on CHROMagar and Sabouraud's dextrose agar. All isolates were identified according to assimilation profile, germ tube, colony color and other conventional methods. Disk diffusion testing and Broth Microdilution of six antifungal agents were performed according to the methods described in CLSI.

Results: Candida albicans (50.2%) was the most frequent isolated yeast, followed by C. glabrata (22%). Non-Candida albicans species were isolated from 71 (61%) positive cultures. 25.7% of Candida albicans isolates were resistant to fluconazole (MIC≥64 µg/ml) as were 21.9% and 16.4% to ketoconazole and clotrimazole (MIC>0.125 µg/ml), respectively. Resistance to polyene antifungals including amphotericin B and nystatin, and caspofungin were scarce. 57.7% of candida glabrata isolates were resistant to fluconazole, 31% to ketoconazole and 35% to clotrimazole.

Conclusion: Screening for antifungal resistant candida isolates by disk diffusion or broth dilution methods in clinical laboratories is an ideal surveillance measure in the management of oral thrush in patients with HIV/AIDS. Although nystatin is widely used in clinical practice for HIV positive patients, there was no evidence of enhanced resistance to it. Regarding no resistance to caspofungin, its administration is suggested.

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