Candidozyma auris (C. auris) is an emerging multidrug-resistant fungal pathogen that poses a serious public health threat due to diagnostic challenges, high antifungal resistance rates, and prolonged environmental persistence, which facilitate outbreaks in healthcare settings. This study aimed to evaluate the epidemiological characteristics, risk factors, identification methods, antifungal susceptibility profiles, and infection control measures associated with C. auris cases detected over a four-month period (October 2024-January 2025). Clinical, screening and environmental samples were analyzed. Clinical samples consisted of blood cultures, while screening samples included axillary swabs. Isolate identification was performed using VITEK 2 YST, the BD Phoenix system V7.51A, and VITEK MS PRIME. Antifungal susceptibility testing was performed using the Sensititre™ฏ YeastOne YO10 system. A total of 14 clinical cases were identified, along with two environmental isolates and four axillary screening isolates, one of which was associated with a clinical case. The mean age of clinical cases was 64.8 years (SD 29.2; range 15-95), and the mortality rate was 71.4%. According to the Centers for Disease Control and Prevention (CDC) tentative breakpoints, all clinical isolates were resistant to fluconazole. Amphotericin B minimum inhibitory concentration (MIC) values were 2 µg/mL in 50% of isolates. One isolate showed high MIC values for echinocandins (micafungin and anidulafungin >8 µg/mL). This study reports the first locally documented cases of C. auris in our center and was conducted as part of an ongoing surveillance program. It highlights the clinical and environmental burden of C. auris, underscores its resistance profile, and emphasizes the critical importance of accurate identification and stringent infection control measures. Although clinical cases have continued to occur at a decreasing frequency, no further C. auris has been detected in environmental samples after the implementation of the infection control protocol, suggesting sustained effectiveness in limiting environmental contamination.

Invasive infections due to Magnusiomyces/Saprochaete species are an emerging problem in immunocompromised patients and are often underrecognized because of misidentification and intrinsic resistance to some antifungals. This multicenter study investigated the species distribution, antifungal susceptibility patterns, and key virulence traits of clinical isolates from Türkiye. A total of 133 clinical isolates collected between 2010 and 2024 from 18 hospitals in 10 cities were identified by MALDI-TOF MS and ITS/LSU sequencing. MICs of amphotericin B, fluconazole, voriconazole, itraconazole, posaconazole, and flucytosine were determined using the EUCAST broth microdilution method. Biofilm formation and esterase, caseinase, secreted aspartyl proteinase, phospholipase, and hemolysin activities were assessed phenotypically. Sequencing identified 107 isolates (80.4%) as Magnusiomyces capitatus and 26 (19.6%) as Magnusiomyces clavatus, MALDI-TOF MS identified 106 (79.7%) as M. capitatus and 27 isolates (20.3%) as M. clavatus. There was 99.2% agreement between MALDI-TOF MS and sequencing results. Voriconazole, amphotericin B, and posaconazole showed the lowest MICs, whereas fluconazole displayed wide MIC ranges and limited activity. Overall, 97.7% of isolates were strong biofilm producers, with significantly higher biofilm production in M. capitatus. In contrast, M. clavatus showed higher caseinase and esterase activity. This study provides the most extensive multicenter dataset on Magnusiomyces/Saprochaete in Türkiye and underscores their considerable pathogenic potential through strong biofilm formation and tissue-degrading enzyme activities. Accurate species-level identification using MALDI-TOF MS supported by molecular methods is essential, and limited fluconazole activity suggests that voriconazole and amphotericin B should be prioritized in species-guided treatment strategies.

Objective:To investigate the nasal carriage of Cryptococcus-related and other opportunistic yeasts in dogs, molecularly characterize the recovered isolates, and evaluate the epidemiological characteristics of Naganishia albida carriage. Methods:Nasal swab samples were collected from July through December 2023 from 100 dogs receiving boarding or hospitalization services at private veterinary clinics and animal hospitals in 4 provinces of Türkiye. Yeast isolates were identified using phenotypic methods, internal transcribed spacer 2 sequencing, and matrix-assisted laser desorption ionization-time-of-flight mass spectrometry. The 1-year clinical history of dogs carrying N albida was retrospectively reviewed. Results:A total of 79 isolates representing 31 yeast species were identified from 59 dogs. Cryptococcus neoformans/gattii species complex organisms were not isolated from any dog. Naganishia albida and Papiliotrema laurentii were isolated from 12% and 1% of dogs, respectively. Naganishia albida carriage was detected in both clinically healthy and clinically affected dogs, with higher frequencies observed among dogs presenting with respiratory, dermatological, or systemic clinical findings. However, no significant associations were identified between N albida carriage and the evaluated epidemiological variables. Conclusions:Dogs may harbor diverse opportunistic yeasts, including Cryptococcus-related yeasts, within the nasal cavity. Clinical Relevance:Opportunistic yeasts can colonize the nasal cavities of both clinically healthy and clinically affected dogs. These findings provide baseline epidemiological data for interpreting fungal culture results and contribute to a better understanding of opportunistic fungal carriage in companion animals.

Objectives: This study aimed to investigate the species distribution, molecular characteristics, antifungal susceptibility profiles, resistance-associated genes, and virulence properties of azole-resistant C. parapsilosis complex isolates in Kayseri, Türkiye. Methods: Thirty C. parapsilosis complex isolates, initially identified from clinical specimens by conventional methods and MALDI-TOF MS over a two-year period, were analyzed. Whole-genome sequencing (WGS) was performed for species-level re-identification, phylogenetic analysis, and resistance gene mapping. Antifungal susceptibility testing was conducted using broth microdilution and gradient strip methods in accordance with CLSI and EUCAST guidelines. Virulence-related phenotypes, including phospholipase, proteinase, and esterase activity, and biofilm formation, were evaluated. Results: Of the 30 isolates, 28 were re-identified as C. parapsilosis sensu stricto and two as C. orthopsilosis using WGS. Most isolates (84%) were obtained from intensive care unit (ICU) patients, predominantly in the pediatric age group (67%). Blood was the most common source of isolates (90%). Isolates were resistant to (100%) fluconazole and itraconazole, and (70%) voriconazole, and susceptible to amphotericin B and caspofungin. High rates of proteinase (92.8%), phospholipase (71.4%), esterase activity (64.3%), and biofilm formation (78.6%) were observed among isolates. The most frequently detected resistance-associated genes were ERG3 (60%), HOG1 (56.6%), PDR16 (53.3%), ERG5 (53.3%), ERG27 (50%), and FKS1 (46.6%). Phylogenetic analysis revealed genetic diversity, with evidence of close evolutionary relationships among some isolates. Conclusion: Universal fluconazole resistance and the high virulence potential of these isolates, especially in pediatric ICUs, highlight a critical clinical challenge. The presence of diverse resistance-associated genes, even in the absence of canonical ERG11 mutations in some strains, suggests complex, multi-pathway resistance mechanisms. WGS provided higher discriminatory resolution than conventional methods for distinguishing cryptic species within the C. parapsilosis complex. WGS data were analyzed to determine phylogenetic relationships and identify resistance-associated genes using the ResFungi database.

Drone larvae (DL) has many biological activities thanks to the bioactive components it contains, but there are very few studies on its antimicrobial activity. The aim of this research was to determine the antifungal activity of DL (raw and lyophilised) water and ethanol extracts against fluconazole (FLU) sensitive and resistant yeast strains. The 87 fungal strains obtained from clinical samples were identified by phenotypic and molecular methods, and broth microdilution test was used for antifungal activity. All DL extracts had antifungal activity. The ethanolic extract of lyophilised DL showed higher antifungal activity. Total phenolic substance content and antioxidant activity of lyophilised DL ethanolic extract were found to be higher than other extracts. According to these results, the observed antifungal activity of DL extracts can be attributed not only to phenolic components, but also to synergistic effect of phenolic components with other bioactive components it contains.

Candida dubliniensis, Candida albicans ile birçok fenotipik özelliği ortak olan patojenik bir Candida türüdür. Flukonazole karşı hızla direnç geliştirebilmesi açısından doğru olarak tanımlanması önem arz etmektedir. Bu iki türün doğru bir şekilde ayırt edilmesi için çeşitli fenotipik testler geliştirilmiş, ancak tek başına yeterlilikleri konusunda farklı görüşler bildirilmiştir. Bu çalışmanın amacı, iki türün güvenilir bir şekilde ayırt edilmesi için ksiloz bazlı agar (XAM) besiyerinin kullanımının araştırılmasıdır. Çalışmada, 95 C. albicans ve 10 C. dubliniensis stok izolatı test edilmiştir. Tüm izolatlar XAM besiyerine inoküle edilmiş, 28°C’de inkübe edilmiş ve yedi güne kadar gözle görülür üreme açısından incelenmiştir. Flukonazol, vorikonazol, amfoterisin B ve kaspofungin için antifungal duyarlılık testleri gradient strip test yöntemi ile gerçekleştirilmiş ve European Committee of Antimicrobial Susceptibility Testing (EUCAST) klinik sınır değerlere göre değerlendirilmiştir. Bu besiyerinde 95 C. albicans izolatının tümü 48 saatlik inkübasyonda üreme gösterirken, 10 C. dubliniensis izolatının hiçbiri inkübasyon süresi yedi güne uzatıldığında bile gözle görülür üreme göstermemiştir. C. dubliniensis izolatlarının flukonazol için MİK aralığı 0.005-0.5 mg/L olarak bulunmuştur. Sonuç olarak, XAM besiyerini, C. dubliniensis'in germ tüp pozitif izolatlardan ayırt edilmesinde, imkânı olmayan laboratuvarlarda tek başına etkin bir fenotipik yöntem olarak önermekteyiz.

Cryptococcus neoformans is an environmental fungus that can frequently cause life-threatening meningitis and fungemia in acquired immunodeficiency syndrome patients. In recent years, cases of these fungal infections are increasingly identified in HIV-negative patients especially in solid organ transplant (SOT) patients. Cryptococcal fungemia can often clinically present as life-threatening disseminated disease from subclinical colonization. This is a factor that affects survival, especially in patients with decompensated liver cirrhosis and SOT recipients. Early diagnosis and appropriate treatment are important for the course of the disease. This report describes the cryptococcal fungemia that developed in an HIV-negative patient after SOT due to alcohol-related liver cirrhosis.

Invasive fungal infections are important causes of mortality and morbidity in immunodeficiencies, hematological malignancies, and transplant recipients. There is scarce information in the literature about the diagnosis, treatment methods, and management. Herein, a unique involvement site of invasive fungal infection caused by Aspergillus flavus in the nadir of the induction chemotherapy of a 13-year-old boy with the diagnosis of acute lymphoblastic leukemia is presented. Despite prolonged intravenous antifungal therapy, the patient exhibited an inadequate response. As a result, intra-articular antifungal treatment was implemented alongside curettage and joint space irrigation. These additional interventions led to significantly improved clinical outcomes. Since fungal osteomyelitis can be an important cause of mortality and morbidity in immunosuppressed patients, prompt diagnosis and multidisciplinary treatment are crucial.

Bee pollen, which is filled into the cells of the honeycomb by honeybees to use in nutrition, is enriched with digestive enzymes and organic acids from honey and salivary gland secretions of honeybees. Lactic acid fermentation takes place in the comb cell under anaerobic conditions and bee bread is formed. We have limited knowledge about which bacteria and yeasts are involved in fermentation process. Samples of bee bread collected from 8 different beehives in the same apiary and samples of bee bread that were dried for 3 months and stored in the deep freezer were analyzed microbiologically. The 34 strains were isolated from fresh perga samples. No microorganism was growth in dried perga samples. The isolated strains were identified by conventional and MALDI-TOF MS methods. The 34 strains were identified as Aspergillus spp. (12), Rhizopus oryzae (6), Mucor circinelloides (1), Bipolaris (2), Trichoderma (3), Paecilomyces variotii (1), Penicillium chrysogenum (1), Kodamaea ohmeri (1), Bacillus altitudinis/pumilus (3), Bacillus licheniformis (1), B. megaterium (1), Micrococcus luteus (1) and Serratia marcescens (1). MICs values of itraconazole, voriconazole, anidulafungin and caspofungin for Mucor and Rhizopus strains had high (≥32 μg/ml) except amphotericinB, posaconazole. MICs values of drugs for Aspergillus strains (n:9/12) were low (1 μg/ml). Trichoderma strains had low MIC values (≤0.50 μg/ml) for other drugs except itraconazole. P.chrysogenum was found to have low MIC value (≤0.25 μg/ml) for posaconazole, anidulafungin, caspofungin. Bipolaris, P.variotii and K.ohmeri was had low MIC values to all antifungals. The determination of the microbiological load in bee bread samples analyzed as soon as they are collected from the hive allows us to discuss the beneficial and harmful aspects of these microorganisms, while the absence of microbial load in bee bread samples stored under appropriate conditions is striking.

In this study, it was aimed to evaluate the molecular epidemiology, virulence factors, and antifungal susceptibility of clinical Candida inconspicua isolates. All isolates were identified by phenotypic methods and sequence analysis of ITS 1-2, D1/D2, EF-1 alpha. Proteinase, phospholipase, and esterase activities, biofilm formation, and antifungal susceptibilities were determined. All thirty isolates identified as Candida norvegensis by phenotypic methods were reidentified as C. inconspicua by sequence analysis, demonstrating the inadequacy of phenotypic methods to differentiate these 2 species. The gene regions examined in terms of determining evolutionary relatedness did not show intraspecies nucleotide variations. Therefore, different molecular approaches are needed to evaluate molecular epidemiology. Esterase, phospholipase, and biofilm formation were found to be positive in 100%, 100%, and 36.6% of the strains, respectively. The MIC50/MIC90 values for fluconazole and flucytosine were found to be higher than the other tested antifungals, which should be taken into account in the treatment.

Cryptococcal meningitis (CM) is often associated with human immunodeficiency virus (HIV). Recently, this microorganism has been increasingly identified in HIV-negative patients. CM cases are encountered in HIV-negative individuals, especially secondary to liver disease, solid organ transplantation (SOT), tuberculosis, lymphoproliferative diseases with T-cell-mediated immunological disorders, long-term corticosteroid use, malignancies, diabetes mellitus, and sarcoidosis. Our patient is an HIV-negative, SOT case with CM. It should be considered that CM can also occur in HIV-negative patients. As in our case, patients receiving long-term immunosuppressive therapy should be evaluated for CM, and renal functions should be closely monitored during treatment. There is a need for more case reports on the subject, especially in CM detected HIV-negative patients, due to the different treatment protocols and challenging clinical conditions compared to HIV-positive cases.

Objectives: Cyberlindnera fabianii is an opportunistic pathogen isolated from clinical specimens. It can be incorrectly identified as Candida utulis by phenotypic methods. This study aimed to accurately identify Cy.fabianii strains isolated from the urinary tract, and to determine their molecular characterization and antifungal susceptibilities as well.Methods: Twenty-nine yeast strains isolated from urinary tract samples were studied. Strains were identified by phenotypically, sequence analysis and MALDI-TOF MS. Sequence analysis using different gene regions (ITS1-2,D1/D2,EF-1-alpha) in ribosomal DNA was performed for the molecular analysis. Phylogenetic analysis was done by the neighbor-joining method. Antifungal susceptibilities of strains were determined for nine antifungals by reference broth microdilution and the Sensititre YeastOne broth microdilution method (Sensititre (TM) YeastOne (TM) AST Plate, Thermo Fisher Scientific (TM),USA) according to CLSI M60-Ed2 recommendations.Results: All strains were identified as C.utulis phenotypically by conventional methods, however all strains were identified as Cy.fabianii by sequence analysis and MALDI-TOF MS. It was observed that the gene regions examined in terms of determining evolutionary relatedness did not show intraspecies nucleotide variations. In all strains, the MIC50/MIC90 values for fluconazole were higher than the other antifungals tested.Conclusion: Cy.fabianii should be considered in fluconazole-resistant urinary tract yeast infections. Although conventional phenotypical methods were insufficient to identify Cy.fabianii, it could be correctly identified with sequence analysis using different gene regions (ITS1-2,D1/D2,EF-1-alpha) in ribosomal DNA and MALDI-TOF MS.(c) 2023 Published by Elsevier Masson SAS on behalf of SFMM.

Amaç: Mycobacterium tuberculosis tanısında Ehrlich-Ziehl Neelsen (EZN) gibi aside dirençli boyama yöntemleri hızlı ve uygulaması kolay yöntemler olmasına rağmen kesin sonuç vermemektedir. Kültür yöntemleri altın standart olarak kabul edilmesine rağmen zaman alıcı yöntemlerdir. Nükleik asit amplifikasyon testleri ise sonuç verme süreleri kısa olduğu için tüberkülozun hızlı tanısında çok sık olarak kullanılmaktadır. Bu çalışmada, tüberküloz şüpheli klinik örneklerde GeneXpert MTB/RIF yöntemi ve artus® MTB-PCR yönteminin değerlendirilmesi amaçlanmıştır. Yöntem: Erciyes Üniversitesi Tıp Fakültesi, Tıbbi Mikrobiyoloji Anabilim Dalı Mikobakteriyoloji Laboratuvarına Ocak-Aralık 2013 tarihleri arasında gönderilen 432 klinik örnek EZN yöntemiyle boyanmıştır. Örnekler homojenize ve dekontamine edildikten sonra, BACTEC MGIT 960 kültür şişeleri ile eş zamanlı olarak Löwenstein-Jensen besiyerlerine ekim yapılmıştır. Nükleik asit amplifikasyon testi olarak örneklerin 196’sında GeneXpert MTB/RIF yöntemi, 236’sında da artus® MTB-PCR yöntemi kullanılmıştır. Bulgular: Toplam 432 klinik örneğin 8’i (%1.9) EZN yöntemi ile, 20’si (%4.6) kültür yöntemleri ile pozitif olarak bulunmuştur. Kültür yönteminin altın standart kabul edildiği bu çalışmada, EZN boyama, artus® MTB-PCR ve GeneXpert MTB/RIF yöntemlerinin duyarlılığı sırasıyla %35, %42.9 ve %83.3; özgüllüğü sırasıyla %99.7 %99.1 ve %97.9 olarak saptanmıştır. Sonuç: Bu çalışmada GeneXpert MTB/RIF ile artus® MTB-PCR yöntemleri tüberküloz tanısında benzer özgüllüğe sahiptir. Fakat GeneXpert MTB/RIF yönteminin yüksek duyarlılığı ve hızlı sonuç vermesi dikkat çekmektedir. Bu iki yöntemin eş zamanlı olarak karşılaştırılmasının, herhangi bir analitik tutarsızlığı kontrol etmeyi mümkün kılacağını değerlendirmekteyiz.

OBJECTIVE: The aim of this study was to evaluate the demographic data, molecular epidemiology, and in vitro antifungal susceptibility results of patients with Aspergillus isolated from various clinical specimens.METHODS: A total of 44Aspergillusstrains were studied. The definition of invasive aspergillosis in patients was made according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) criteria. Strains were phenotypically and molecularly identified. Demographic characteristics of patients and genotypes of strains were evaluated. Phylogenetic analysis was done by the The Unweighted Pair-Group Method with Arithmetic Mean (UPGMA). Antifungal susceptibility of strains was determined according to The Clinical and Laboratory Standards Institute (CLSI)-M61-Ed2 and The European Committee on Antimicrobial Susceptibility Testing (EUCAST).RESULTS: A total of 11 patients were classified as proven and 33 as probable invasive aspergillosis. There was a statistically significant difference in age groups, subdisease, neutropenic, and receiving chemotherapy between groups. A total of 23 strains were identified as Aspergillus fumigatus, 12 as Aspergillus niger, 6 as Aspergillus flavus, and 3 as Aspergillus terreus. Phylogenetic analysis revealed five different genotypes. No statistical difference was found in the comparisons between patients groups and genotype groups. There was a statistically significant difference between genotype groups and voriconazole, posaconazole, and itraconazole Minimum Inhibition Concentration (MIC).CONCLUSION: Accurate identification of strains and antifungal susceptibility studies should be performed due to azole and amphotericin B resistance. Genotyping studies are important in infection control due to identifying sources of infection and transmission routes.

ABSTRACT Purpose In the present study, antifungal activity of ozonated olive oil (OZO) and ozonated distilled water (ODW) in the treatment of experimentally induced keratitis with C. albicans in rabbits were investigated. Methods The Groups were composed of as 1, 2, 3, 4, 5, 7 (n = 5 rabbits, 10 eyes/in each group) and Group 6 (n = 10 rabbits, 20 eyes/in the group). Fourty-eight hours after C. albicans inoculation; Group 1 received fluconazle (FLU)+OZO drops, Group 2 received FLU drop, Group 3 received OZO drop, Group 4 received FLU+ODW drops, Group 5 received ODW drop, Group 6 (infected control group) and Group 7 received PBS drop (negative control group). Treatment continued in all groups for 22 days for every 8 hours. Results Cornea cultures made 24 days post inoculation revealed statistically significant differences (p < 0,05) with concern to C. albicans amounts between Group 6 and Group 1–5. Statistical comparison of corneal opacity and corneal ulcer and conjunctivitis values among the Group 6 and Group 1–5 were also different significantly (p < 0,05) on days 20 and 24 post inoculation. Conclusion OZO and ODW were found to be effective in treating C. albicans keratitis in the present study. It has also been proven by this study that ODW contain 26 μg/ml was the most effective in the treatment of C. albicans keratitis.

OBJECTIVES:Aspergillus fumigatus causes several diseases in humans and azole resistance in A. fumigatus strains is an important issue. The aim of this multicentre epidemiological study was to investigate the prevalence of azole resistance in clinical and environmental A. fumigatus isolates in Turkey.METHODS:Twenty-one centres participated in this study from 1 May 2018 to 1 October 2019. One participant from each centre was asked to collect environmental and clinical A. fumigatus isolates. Azole resistance was screened for using EUCAST agar screening methodology (EUCAST E.DEF 10.1) and was confirmed by the EUCAST E.DEF 9.3 reference microdilution method. Isolates with a phenotypic resistance pattern were sequenced for the cyp51A gene and microsatellite genotyping was used to determine the genetic relationships between the resistant strains.RESULTS:In total, resistance was found in 1.3% of the strains that were isolated from environmental samples and 3.3% of the strains that were isolated from clinical samples. Mutations in the cyp51A gene were detected in 9 (47.4%) of the 19 azole-resistant isolates, all of which were found to be TR34/L98H mutations. Microsatellite genotyping clearly differentiated the strains with the TR34/L98H mutation in the cyp51A gene from the strains with no mutation in this gene.CONCLUSIONS:The rate of observed azole resistance of A. fumigatus isolates was low in this study, but the fact that more than half of the examined strains had the wild-type cyp51A gene supports the idea that other mechanisms of resistance are gradually increasing.

Objective: A positive relationship exists between high blood glucose levels and infection prevalence in patients with diabetes. Hyperglycemia may predispose to fungal infections. This study was conducted to compare the frequency of fungal infections and antifungal agent resistance of culture strains in children with type 1 diabetes mellitus (T1DM) with those in healthy controls and to assess the relationship between fungal infection and hemoglobin A1c (HbA1c) levels. Materials and Methods: The study population included 67 girls with T1DM and 63 girls without T1DM, immunodeficiency, or chronic drug use. Blood and urine samples were collected, and genital smear sampling was performed. Samples were evaluated in a mycology laboratory, and fluconazole sensitivity of culture samples was determined. Results: Genital complaints were more common among patients with diabetes. Fungal agents were isolated in 55.22% of patients with diabetes, where Candida glabrata was the most common strain isolated (46.0%). Meanwhile, Candida albicans was more common in the control group (40.0%). All strains were fluconazole-sensitive, as strains with native resistance were excepted. For serum HbA1c levels, a cutoff value of 8.9 was identified and was related to fungal growth with a reliability of 80%. Patients with diabetes for more than 12 months had a higher risk of fungal infection. Conclusion: Patients with serum HbA1c levels of more than 8.9 and a diabetes duration of more than 12 months should be assessed for fungal infections, and genital smear samples should be obtained periodically during follow-up.

The combination of Mannan antigen and anti-mannan antibody (Ag / Ab) test is a specific diagnostic test for the diagnosis of invasive Candida (IC) infections. In this study, it was purposed to determine the roles of Ag and Ab in the diagnosis of IC in pediatric intensive care unit patients. Nineteen patients with candidiasis treated for various reasons in the pediatric intensive care unit, 25 patients colonized with Candida spp without candidemia, and 15 patients with neither candidemia nor colonized with a total number of 59, were included in the study. In colonized patients to consider colonization; cervical, nasal, throat, axillary, perineal and rectal swab cultures and urine culture were obtained every week throughout admission and Candida colonization index (CI) was calculated. Blood samples were stored at -80°C after seperated to serum form till the tests performed. Candida mannan and anti-mannan (Ab) tests were performed in duplicate in a total of 59 serum samples. Serum was assayed with Candida mannan antigen (Ag) and anti-mannan antibody (Ab) with Platelia TM Candida Ag Plus and Platelia TM Candida Ab Plus (Bio-Rad, Marnes las Coquette, France). The Ag and Ab values of the candidemia and colonized group were higher than the non infected and non-colonized group (p <0.001). The antigens were evaluated for threshold values of 125, 250 and 500 pg / ml while 10 IU /ml was the cut off value for antibody. Although the rate of Ag positive patients (48%) in the colonized group was significantly higher than the group with candidemia (21%) for threshold 125, this difference was not statistically significant. When the threshold value Ag > 125 was accepted, antigen positivity for C. albicans (12/22) was found to be higher than that of C.parapsilosis strains (1/4) (p> 0.05). The most compatible combination to detect IC was the combination of Ag 500 and Ab usage with a sensitivity of 57.8% and specificity of 80%. On the era of this combination, PPV was 42.8 and NPV was 80. The use of Candida mannan Ag and Ab together in children increases the diagnostic value in showing invasive candidiasis. Although concomitant use increases the diagnostic value, they need to provide higher NPV in order to exclude invasive candidiasis.

Background/Aim: C. albicans remains the most common pathogen responsible for invasive candidiasis. On the other hand, increased rates of candidiasis have been reported worldwide, caused by other Candida species (such as K. marxianus and C. lusitaniae). Considering these uncommon yeasts may be crucial pathogens in the future, it is preferable to describe the in-vitro activities of antifungal agents as potential options for their treatments. This study aimed to evaluate the in-vitro activity of nine different antifungal agents that are routinely used to contribute to the treatment of the infections caused by K. marxianus and C. lusitaniae. Methods: The study included 21 K. marxianus and eight C.lusitaniae strains isolated from various clinical specimens of patients with suspected invasive fungal infection. Conventional identification was confirmed using the molecular methodology of DNA sequencing analysis. Antifungal susceptibilities of the isolates were tested using the Sensititer Yeast One Test Panel Y06 kit, a colorimetric microdilution test. Results: For K. marxianus, amphotericin B had the highest geometric mean MIC (1 μg/mL) and voriconazole had the lowest geometric mean MIC (0.010 μg/mL). For C. lusitaniae, flucytosine had the highest geometric mean MIC (8 μg/mL) and voriconazole had the lowest geometric mean MIC (0.011 μg/mL). Conclusion: Considering that these two species, rare causes of invasive candidiasis nowadays, may become important pathogens in the future, it is reasonable to investigate the in-vitro activities of antifungal agents that can be used in their treatment.

Background/aim: The differences in molecular mechanisms during a stable period and the changes in the inflammatory responses during exacerbations between distinct severe asthma phenotypes remain unclear. In this study, we aimed to characterize stable and exacerbation period serum cytokine and periostin levels of 5 different predefined severe asthma phenotypes with real-life data. Changes in the viral infection-induced exacerbations were also analyzed. Materials and methods: Serum levels of 8 cytokines and periostin were measured from the sera obtained from the adult patients with five different severe asthma phenotypes based on the presence/absence of aeroallergen sensitivity, peripheral eosinophilia and chronic rhinosinusitis with nasal polyposis (CRSwNP) during stable and exacerbation periods, and from the matched controls. Results: Serum IL-13, IL-25, TSLP, and periostin levels were similar between the patient and the control groups during stable and exacerbation periods. Serum IL-25 and TSLP levels, and peripheral eosinophil count and periostin level showed a strong correlation. Stable period periostin levels were significantly higher in eosinophilic patients, and eosinophilic patients without long-term systemic steroid therapy had higher IL-13 levels. Compared to stable period, exacerbation period serum periostin levels found significantly lower [5853 (2309-8427) pg/mL vs. 4479 (2766-6495) pg/mL; p = 0.05] and periostin levels were much lower in viral infection-induced exacerbations [2913 (893-4770) pg/mL vs. 7094 (4782-9596) pg/mL; p = 0.022]. Conclusion: Our study showed that serum periostin levels were decreased in viral infection-induced exacerbations and increased in the presence of eosinophilia independent from atopy and it can help to differentiate eosinophilia even if the patient is under long-term systemic steroid therapy. Also, serum IL-13 levels may reflect peripheral eosinophilia in patients without long-term systemic steroid use.