Setareh Agha Kuchak Afshari

Fluconazole resistance in Candida species is on the rise, posing a significant clinical challenge. There is a growing interest in using complementary therapies, especially those from natural sources. This study aimed to evaluate the synergistic and apoptotic effects of Bunium persicum essential oil (BPEO) and its two pure components, cuminaldehyde (CA) and γ-terpinene (γ-TPN), combined with fluconazole (FLC) on susceptible and resistant C. albicans isolates. Moreover, molecular docking was used to study the interactions between lanosterol 14-alpha-demethylase and each agent. The BPEO was prepared using the Clevenger apparatus and the hydro-distillation method. The in vitro antifungal activity was evaluated according to the Clinical and Laboratory Standards Institute guideline (M60). The checkerboard and isobologram assays assessed the interaction between BPEO, CA, γ-TPN, and FLC. The necrotic and apoptotic effects of different agents were analyzed using a flow cytometry assay. An in-silico study was performed to examine the receptor-ligand interaction. The CA showed the lowest minimum inhibitory concentrations and minimum fungicidal concentrations, compared to BPEO and γ-TPN. Statistical analyses indicated significant differences between resistant and sensitive C. albicans isolates regarding minimum inhibitory concentration values of BPEO, CA, and γ-TPN. The most synergistic effect was obtained for FLC combined with CA (n=7, 63.6%), followed by BPEO (n=6, 54.5%), and γ-TPN (n=3, 27.2%). Statistical analyses indicated the synergistic effect of FLC in combination with CA was more than γ-TPN (p=0.023). Apoptotic indicators confirmed that the tested compounds could cause cell death in yeast cells. Combination of each natural component with FLC resulted in a greater apoptosis effect than each tested agent alone. The docking study indicated that both pure compounds have interactivity with the protein residue of 14α-demethylase. The results indicated that the synergistic properties of natural products combined with synthetic antifungal agents available in the market could contribute to developing effective therapeutic strategies, particularly in resistant fungal species.

Cutaneous leishmaniasis (CL) remains a significant global public health disease, with the critical distinction and exact detection between responsive and unresponsive cases dictating treatment strategies and patient outcomes. However, image‐based methods for differentiating these groups are unexplored. This study addresses this gap by developing a deep learning (DL) model utilizing transfer learning to automatically identify responses in CL lesions. A dataset of 102 lesion images (51 per class; equally distributed across train, test, and validation sets) is employed. The DenseNet161, VGG16, and ResNet18 networks, pretrained on a massive image dataset, are fine‐tuned for our specific task. The models achieved an accuracy of 76.47%, 73.53%, and 55.88% on the test data, respectively, with a sensitivity of 80%, 75%, and 100% and specificity of 73.68%, 72.22%, and 53.12%, individually. Transfer learning successfully addressed the limited sample size challenge, demonstrating the models’ potential for real‐world application. This work underscores the significance of automated response detection in CL, paving the way for treatment and improved patient outcomes. While acknowledging limitations like the sample size, the need for collaborative efforts is emphasized to expand datasets and further refine the model. This approach stands as a beacon of hope in the contest against CL, illuminating the path toward a future where data‐driven diagnostics guide effective treatment and alleviate the suffering of countless patients. Moreover, the study could be a turning point in eliminating this important global public health and widespread disease.

Leishmaniasis is an important neglected disease among infectious diseases, which is highly affected by diverse adverse conditions. Due to the intricate nature of Leishmania , the impact of the disease remains significant. In this review, we aim to assess the role of these factors that influence disease trends and introduce preventive and control strategies, highlighting their importance in public health issues. Numerous influencing factors, such as trade and travel, civil unrest, migration, low socioeconomic status, peri‐urban settlements, ecological changes, climate variations, and many other confounding factors, play significant roles in the transmission and distribution of leishmaniasis. On the other hand, inadequate infrastructure and disruptions in the health system services are closely linked with the incidence of leishmaniasis in vulnerable populations. These circumstances contribute to the alteration of vector and reservoir compositions, land degradation, agricultural setbacks, water scarcity, and livestock depletion, resulting in increased infectious and noninfectious disease conditions. In conclusion, significant anthropic and natural environmental changes have the potential to trigger leishmaniasis outbreaks in established endemic areas and lead to the emergence/reemergence of new foci in previously unaffected regions. Consequently, enhancing public health awareness, particularly in high‐risk regions, along with implementing active and passive surveillance, ensuring early diagnosis, and providing timely and effective treatment for patients, are vital measures for controlling the disease.

In semi-arid and arid regions, mulching with various materials is one of the highly significant ways to keep soil surface coverage. This approach helps efficiently reduce drought stress and soil erosion, thus preserving soil composition and ecosystem. The research aimed to pinpoint the physicochemical alterations and fungal diversity brought on by food waste mulch (FWM) in the desert soil. An experimental field assessment was conducted from early April (spring) to late August (summer) 2021 in the soil of the Jupar desert, the main watershed of the Central Plateau, southeastern Iran. The mulch was made from a combination of clay (70%), food waste (15%), and water and sprayed in 3 plots on the Jupar desert soil surface as a case group. Moreover, 3 plots of the Jupar desert soil and clay were selected as a non-mulch-controlled surface (control groups). The physicochemical changes were studied in all groups including FWM, desert soil, and clay. Besides, the samples were cultured and checked daily to determine the growth of fungal colonies. All fungal isolates were characterized to the species level by phenotypical and molecular methods. Sequence analysis of the ITS1, 5.8S, and ITS2 regions was done. The statistical findings displayed that the physical and chemical characteristics of FWM (case group) were significantly different compared to clay and soil samples (control groups) (PAlternaria and Naganishia genera, respectively. Identified fungi are classified as growth-inducing and anti-pest fungi. This study showed that adding FWM of organic matter can cause partial variety in soil fungal diversity and stabilize the desert soil due to enriching the organic matter in eroding soils.

Candidiasis is a wide range of cutaneous/mucosal to systemic infections caused by Candida species. The prevalence of candidiasis, particularly in immunocompromised individuals, has risen in recent years. Some currently available antifungal agents have limitations, regarding the route of drug delivery, especially for local infections. On the other hand, the topical administration of antifungal agents may be inefficient due to low drug bioavailability, indicating the necessity of new treatment strategies. Using nanocarriers such as niosomes as a drug delivery system has been proven to be an interesting strategy. Encapsulation of antifungal drugs in niosomes has the potential to simplify the transport of drugs which seems to be a promising approach to enhance therapeutic efficacy. Consequently, therapy will be improved by modifying conventional antifungal formulations. Herein, we reviewed the in vitro and in vivo studies on the efficacy of niosomes as nanocarriers of antifungal agents for the treatment of C. albicans infections.

Microbiological monitoring of the air hospital is essential for prevention and control, due to the possible airborne route of infection transmission, especially in high-risk wards. This study aimed to monitor the airborne fungi during the second wave of the COVID-19 pandemic in selected wards of the biggest university educational hospital in Kerman, southeastern Iran. This study was conducted in 11 different wards, separated into the patient room and nursing station, of the Afzalipour hospital from May to August 2021. Fungal isolates were characterized to the species level by conventional and sequencing methods. Out of 93 obtained fungal colonies, 70 (75.3%) isolates were filamentous and 23 (24.7%) isolates were yeast. Aspergillus species were the predominant fungal isolates among the filamentous colonies (n=19; 27.1%), and Naganishia albida (formerly Cryptococcus albidus) was identified as the most common yeast isolate (n=13/23; 56.8%). The infectious ward was the most contaminated unit (n=19/93), while the least contaminated units were the neonatal intensive care unit (n=3/93), and oncology (n=3/93). The statistical findings displayed that the number of fungal isolates in patients' rooms is significantly higher than in nurses' stations (p-value=0.013). Our study demonstrated the presence of diverse fungal species in all wards of the hospital. Considering the presence of airborne fungi in hospitals and related public health problems is one of the critical issues for health systems management. In this regard, efficient monitoring of airborne fungi might play an influential role in hospital infection control and surveillance, particularly in high-risk hospitalization patients in critical wards.

Leishmaniasis is a neglected and old emerging/reemerging disease that has extremely increased and expanded in the different geographical areas. Cutaneous leishmaniasis (CL) is a common global public health concern in the tropics and subtropics reported from the Eastern Mediterranean Region, Africa, Latin America, and the Indian subcontinent. The presence of numerous epidemiological and clinical characteristics of the disease present a challenge in managing and controlling it. Despite wonderful efforts to control the disease in endemic areas, it appears that the burden of CL is still high. There is no comprehensive survey considering the interactive role of patients and medical services in the international CL control system. In the present study, the effective and mutual responsibility of the patients and the healthcare management in controlling the CL are reviewed, described, and discussed. Some patient-related factors that have a remarkable impact on the proper treatment and control strategies are low-socioeconomic condition, lack of sufficient knowledge about the disease, absence of personal protection, disregarding adherence to treatment, culture and incorrect beliefs about disease and therapy, depression, and lack of appropriate support from the family. On the other hand, some healthcare system-related factors that have an important effect on the suitable therapy and management of the disease are the economic burden of healthcare and drug preparation, unsuitable follow-up assessments, health education, early detection, and the right treatment, handling of unresponsive cases, active case detection, and monitoring/evaluation. Improving the socioeconomic conditions and living standards supports longstanding elimination approaches, and facilitates the wide-ranging control of the disease. Trained health staff and experienced clinicians should strengthen the building capacity for appropriate control programs throughout the healthcare system. These measures need sustained encouragement and appropriate multifunctional activities through all government segments including policymakers, the health system, clinical physicians, researchers, and also the private sector. In a suitable strategy, it is essential to understand precisely all the aspects of control strategies to respond correctly to the requests. Nevertheless, due to the complexity of the causative agent, major challenges/gaps remain, and vigorous conservative control plans should be continued until novel tools become available.

Aim Vulvovaginal candidiasis (VVC), is a common fungal infection that remains a global concern. The objectives of this study were molecular identification and assessment of the antifungal susceptibility profile of Candida species, causing VVC in southeast Iran. Methods A cross-sectional investigation was carried out on 119 nonpregnant females suspected of VVC between February 2019 and May 2021. Yeast samples were characterized to the species level by conventional and molecular methods. All Candida isolates were examined for in vitro susceptibility profile to six conventional antifungal drugs using Clinical and Laboratory Standards Institute guidelines. Results Out of 119 subjects, 52 (43.7%) cases were affected by VVC, out of whom 11 (21.15%) cases had recurrent vulvovaginal candidiasis (RVVC). The species distribution was as follows; Candida albicans (n = 21; 40.4%), C. glabrata (n = 11; 21.2%), C. tropicalis (n = 9; 17.3%), C. parapsilosis (n = 5; 9.7%), C. africana (n = 3; 5.7%), C. famata (n = 1; 1.9%), C. lusitaniae (n = 1; 1.9%), and C. dubliniensis (n = 1; 1.9%). The resistance rate of Candida isolates to fluconazole, itraconazole, and voriconazole were 15.38%, 11.5%, and 3.8%, respectively. Resistance to fluconazole was obtained in 46% (5/11) of RVVC cases but only in 7% (3/41) of VVC cases. Conclusion This study demonstrated that the majority of VVC cases were caused by non-albicans Candida species which also were resistant to some antifungal agents. Hence, our findings revealed the importance of conducting periodical epidemiological studies to determine changes in species distribution. Moreover, for effective management of treatment and infection, it is imperative to evaluate the susceptibility profiles of Candida species isolated from VVC patients.

Background: Fusarium species are significant plant and human pathogens. Current chemical agents against them are limited by their side effects and developed resistance, requiring an alternative way to overcome this problem. Objective: We aimed to assess the inhibitory effects of Streptomyces strains isolated from soil samples against Fusarium species. Methods: Totally 250 samples were collected. Morphological and physiological characterizations of the isolates were investigated. All isolates were evaluated to test their antifungal activity against Fusarium oxysporum and Fusarium solani. Molecular identification of active Streptomyces isolates was conducted using the 16S rRNA gene. Results: Fifty Streptomyces isolates were obtained. Among them, two strains showed the most antagonistic effect against Fusarium species. According to the analysis of 16S rRNA gene sequences, these isolates were identified as Streptomyces rochei. Conclusion: The obtained results of this study indicated that S. rochei could use as a potent source of bioactive compounds with antifungal activity.

Onychomycosis is the fungal infection of nails caused by yeasts, dermatophytes, and nondermatophyte molds. As a divergent set of fungi can cause onychomycosis, reliable and accurate laboratory identification of the etiological agent is crucial for choosing the proper treatment. Herein, we present a rare case of nondermatophytic onychomycosis of the toenail caused by Phoma glomerata in a 27-year-old Iranian female patient. In addition, a review of the literature on human infections caused by Phoma species is provided.