Patients with severe COVID-19, such as individuals in intensive care units (ICU), are exceptionally susceptible to bacterial and fungal infections. The most prevalent fungal infections are aspergillosis and candidemia. Nonetheless, other fungal species (for instance, Histoplasma spp., Rhizopus spp., Mucor spp., Cryptococcus spp.) have recently been increasingly linked to opportunistic fungal diseases in COVID-19 patients. These fungal co-infections are described with rising incidence, severe illness, and death that is associated with host immune response. Awareness of the high risks of the occurrence of fungal co-infections is crucial to downgrade any arrear in diagnosis and treatment to support the prevention of severe illness and death directly related to these infections. This review analyses the fungal infections, treatments, outcome, and immune response, considering the possible role of the microbiome in these patients. The search was performed in Medline (PubMed), using the words “fungal infections COVID-19”, between 2020–2021.

Background and Objectives: Vulvovaginal candidiasis (VVC) is a mucous membrane infection, with an increased rate of antifungal resistance of Candida species. In this study, the in vitro efficacy of farnesol alone or in combination with traditional antifungals was assessed against resistant Candida strains recovered from women with VVC. Materials and Methods: Eighty Candida isolates were identified by multiplex polymerase chain reaction (PCR), and the antifungal susceptibility to amphotericin B (AMB), fluconazole (FLU), itraconazole (ITZ), voriconazole (VOR), clotrimazole (CTZ), and farnesol was tested by the standard microdilution method. The combinations of farnesol with each antifungal were calculated based on the fractional inhibitory concentration index (FICI). Result: Candida glabrata was the predominant species (48.75%) isolated from vaginal discharges, followed by C. albicans (43.75%), C. parapsilosis (3.75%), a mixed infection of C. albicans and C. glabrata (2.5%) and C. albicans and C. parapsilosis (1%). C. albicans and C. glabrata isolates had lower susceptibility to FLU (31.4% and 23.0%, respectively) and CTZ (37.1% and 33.3%, respectively). Importantly, there was “synergism” between farnesol–FLU and farnesol–ITZ against C. albicans and C. parapsilosis (FICI = 0.5 and 0.35, respectively), reverting the original azole-resistant profile. Conclusion: These findings indicate that farnesol can revert the resistance profile of azole by enhancing the activity of FLU and ITZ in resistant Candida isolates, which is a clinically promising result.

Background Candida albicans (C. albicans) is an opportunistic fungus and the most common cause of vulvovaginal candidiasis (VVC). In recent years, the use of antifungal drugs has led to the incidence of drug-resistant C. albicans strains. The purpose of this study is twofold: to determine the pattern of drug susceptibility and the relationship between demographic factors and the incidence of drug resistance among C. albicans isolates and to investigate the expression pattern of drug-resistance genes ERG11 and TAC1 in C. albicans isolates. Methods and Results This descriptive cross-sectional study was conducted on 50 C. albicans isolates from women with VVC. Antifungal susceptibility of the isolates was tested by M27-A3/S4 broth micro dilution method following the Clinical and Laboratory Standards Institute (CLSI) guidelines. High susceptibility rates were recorded for itraconazole and voriconazole (68%), followed by ketoconazole (46%). Fluconazole had the lowest susceptibility to C. albicans with susceptibility of 36%. The change in ERG11 and TAC1 genes expression was determined by qPCR. The mean ∆Ct values of ERG11 and TAC1genes were significantly different between fluconazole-resistant and susceptible groups (p < 0.001). Interestingly, we found that 77% of fluconazole-susceptible isolates had significantly upregulated ERG11 gene (2.9–99.0 fold). In addition, the expression of TAC1 was upregulated in 44% of fluconazole-susceptible isolates (3.86–89.8 fold). Conclusion Our finding revealed that incidence of drug resistance in C. albicans is not simply controlled by genes but is a multi-factorial phenomenon, where several factors and mechanisms are involved in the process of drug resistance.

Background:The aim of this study was to investigate and then to compare the prevalence of nosocomial infections (NIs) in the patients admitted to the surgery and internal Intensive Care Units(ICU) as well as studying the risk factors involved.Methods:In this cross-sectional descriptive, patients admitted to ICUs were studied over a year .Clinical data of patients, including demographic information, length of stay, underlining disease, the rate of patient with NIs and distribution of NIs sites and pathogens were collected. Univariate and multivariate logestic regression were carried out to determine the factors associated with NIs.Results:A total of 1018 patients were studiedincluding surgical ICU (n = 665) and internal ICU (n = 353). The incidence rate of NI in surgical and internal ICUs was 67(10.1%) and 96(27.2%), respectively. The most common NI in the internal ICU were respiratory tract infections( RTI ,46.9%) and urinary tract infections (UTI, 37.5%), while in the surgical ICU, the most common infections were respiratory tract infections (RTI, 38.3%) and surgical-site infections (SSI, 22.0%), respectively. The major factors the length of stay and the use of nasogastric intubation (NG tubes) were associated with NIs in both ICUs.Conclusions:The incidence of infections in the internal ICU were more than the surgical ICU. Age, underlying diseases, the long stay, used of ventilator and NG tube were factors associated with NIs rate in internal ICU.Trial registration:This study was the result of two research works with ethics code (IR.BUMS.REC.1394-17 and IR.BUMS.REC.1394-27).

Vulvovaginal candidiasis (VVC) is a mucous membrane infection, with an increased rate of antifungal resistance of Candida species. The in vitro efficacy of farnesol alone or in combination with traditional antifungals, against resistant Candida strains recovered from women with VVC was assessed. In this study, 80 Candida isolats were identified by multi-plex PCR. Antifungal sus-ceptibility of amphotericin B (AMB), fluconazole (FLU), itraconazole (ITZ), voriconazole (VOR), clotrimazole (CTZ) and farnesol was tested by M27-A3/S4 broth micro dilution method. The combinations of farnesol with each antifungal were calculated based on the fractional inhibitor concentration index (FICI). C. glabrata was the predominant species (48.75%) isolated from vaginal discharges, followed by C. albicans (43.75%), C. parapsilosis (3.75%), mixed infection of C. albicans and C. glabrata (2.5%), C. albicans and C. parapsilosis (1%). C. albicans and C. glabrata isolates had lower susceptibility to FLU (31.4% and 23.0%, respectively) and CTZ (37.1% and 33.3%, respectively). Importantly, there was ‟synergismˮ between farnesol-FLU and farnesol-ITZ against C. albicans and C. parapsilosis (FICI= 0.5 and 0.35, respectively), reverting the original azole resistant profile. These findings indicate that farnesol is able to revert to the resistance profile of azole by enhancing the activity of FLU and ITZ in resistant isolates, which is a promising result.

Background: Vulvovaginal candidiasis (VVC) is a common fungal infection caused by Candida species in the female genital tract. Objectives: This study attempts to predict predisposition to VVC related to risk factors and clinical symptoms among vaginitis cases using the artificial neural network (ANN) model. Methods: This cross-sectional study was performed on 250 women referred to gynecology clinics in Birjand, Iran. A questionnaire was used to record participants' demographic information. Swabs were used for wet mounts and culture. Candida species were identified by morphological and physiological methods. The performance of the optimal neural network model was assessed by the sensitivity, specificity, and accuracy area under the ROC curve (AUC). Descriptive statistics were used for the statistical description of data, and chi-square test, t-test, and ANN analysis using SPSS application tools (Statistical Product and Service Solutions) version 22 software at 0.05 significant level. Results: The prevalence of vulvovaginal candidiasis was 41.0%, and Candida albicans was the most frequently identified species (55.9%). The descriptive statistics (chi-square test and t-test) revealed no significant difference between the frequencies of Candida infection with demographic factors and clinical presentations. However, factors such as abortion history, number of sexual intercourse, dyspareunia, education, natural vaginal delivery (NVD), and lower abdominal pain included in our ANN model had significant differences (P < 0.05). Conclusions: The result of the ANN model revealed that using demographic factors and clinical symptoms can predict VVC infection. Therefore, this model can identify the effect of the clinical presentations and symptoms of infection.