Coronavirus 2019 (COVID-19) infection causes excessive cytokine response and a decrease in cellular immune response and this increases susceptibility to fungal co-infections. Mucormycosis is a rare, lifethreatening invasive fungal infection. In this report, two cases who developed rhino-orbito-cerebral mucormycosis shortly after having COVID-19 infection were presented. The first case was a 68-year old woman who admitted to our clinic with orbital cellulitis in her left eye and had a known diagnosis of asthma and rheumatoid arthritis. She was diagnosed with COVID-19 pneumonia 40 days ago, stayed in the intensive care unit for a long time, and received pulse steroid (1000 mg methylprednisolone), interleukin-1 (IL-1) inhibitor (anakinra) and broad-spectrum antibiotic treatments together with antiviral therapy during this period. The second case was a 63-year-old male patient with known diabetes mellitus, hypertension and retinitis pigmentosa, with a history of hospitalization in the intensive care unit due to COVID-19 pneumonia 20 days ago and received pulse steroid therapy during this period. He admitted to our clinic with the complaints of droopy right eyelid, swelling, nausea and vomiting. In both cases, paranasal sinus tomography findings were consistent with invasive sinusitis. Functional endoscopic sinus surgery was performed immediately in less than 16 hours from the first admission in both cases. Histopathological examination of the both cases revealed results consistent with mucormycosis. Mucorales spp. was isolated in sinus tissue culture of the second case taken during the operation. Both of the patients received liposomal amphotericin B. First case died on the 19th day of the treatment. Second case was discharged with full recovery after nine weeks of treatment. The suppression of cellular immunity during the COVID-19 infection, and the use of steroids and interleukin inhibitors in the treatment of severe cases may increase secondary invasive fungal infections. Therefore, clinicians should more frequently consider possible fungal infections in patients with COVID-19.

Introduction: Candida auris is a yeast that has a high mortality rate in critically ill patients and is resistant to many antifungal agents enhancing its clinical importance. Our study identifies the risk factors for C. auris invasive infection, antifungal susceptibility, and outcomes. Methodology: A total of 100 adults with C. auris isolated in any clinical specimen between 07.01.2022 and 31.12.2023 were enrolled in this retrospective cohort study. Data were obtained via retrospective screening of patient files. C. auris identification was performed by MALDI-TOF MS. Antifungal susceptibility was carried out by VITEK 2 and CDC methodology. Colonized and infected patients were compared to assess the risk factors for and outcomes of invasive infection. Results: Twenty (20%) patients developed invasive infections, with 16 (80%) having candidemia. Age, Candida score, prior antifungal agent use, number of previously used antibiotics ≥ 3, presence of central venous catheter or nasogastric catheter, and being monitored out of burn unit were the risk factors, and Candida score was identified as an independent risk factor for invasive infection development. Of the isolates, 55% were resistant to fluconazole and 100% were resistant to amphotericin B. No micafungin resistance was detected. The overall mortality rate in patients with invasive infection was 75%. Conclusions: Knowing the risk factors for invasive infection will help early initiation of empirical antifungal therapy by ensuring early identification of high-risk patients, and Candida score appears to be an effective method for this. Revealing antifungal susceptibility will also guide the selection of appropriate empirical treatment.

Multisystem inflammatory syndrome in adults (MIS-A) is a rare condition that develops after coronavirus disease 2019 (COVID-19). We present two young adult male patients, aged 25 and 24 years, who admitted to our outpatient clinic with high fever, redness in the eyes, diarrhea, and maculopapular rash four weeks after after clinically mild COVID-19 infection. Echocardiography showed global hypokinesia in both cases. Therefore, the history of COVID-19 should be questioned, and the patient should be evaluated for possible MIS-A, especially when new heart failure is detected during the pandemic.

Background: In recent years, with the aging population worldwide, the number of elderly undergoing solid organ transplantation has been steadily increasing. However, data on the effects of advanced age on infection characteristics and clinical outcomes in transplant recipients are limited. This study aimed to evaluate the effects of advanced age on infections and clinical outcomes in solid organ transplant recipients. Methods: This retrospective multicenter cohort study included patients who underwent solid organ transplantation at different transplant centers in Türkiye between 2003 and 2023 and were followed up for at least 1 year. Patients were divided into two age groups: ≥ 60 years and < 60 years. Demographic characteristics, laboratory parameters, infection episodes, and clinical outcomes were compared between the two age groups. Results: The study included 273 (27.7%) patients aged ≥ 60 years and 712 (72.3%) patients aged < 60 years, totaling 985 recipients. Male sex and liver transplantation were more common in the older age group ( p < 0.001). Hospital stay was significantly longer in patients aged ≥ 60 years ( p = 0.002). However, there was no difference between the two age groups in terms of time to first infection or number of infection episodes. The mortality rate in patients aged ≥ 60 years was 21.6%. The most common cause of death was bacterial infection, with carbapenem‐resistant pathogens detected in a substantial proportion of cases. Conclusions: Although infection incidence was similar across age groups, solid organ transplant recipients aged ≥ 60 years had higher mortality and longer hospital stays, highlighting the need for careful clinical monitoring in older transplant recipients. image