BACKGROUND:Chronic and recalcitrant dermatophytosis has become increasingly problematic in dermatology practice, largely due to emerging antifungal resistance, affecting not only terbinafine but also azoles. Among the causative agents, Trichophyton indotineae has emerged as a key pathogen associated with treatment failure, extensive disease, and frequent relapse, even in immunocompetent patients. OBJECTIVE:This study aimed to evaluate and compare two rapid molecular diagnostic approaches: A commercial multiplex qPCR assay (DermaGenius Resistance Multiplex PCR, DermaGenius RMP) and a T. indotineae-specific in-house qPCR assay, focusing on their practical value for early detection of recalcitrant dermatophyte infections and terbinafine resistance in routine dermatology practice. METHODS:Sixty-four dermatophyte isolates obtained from patients with chronic or treatment-resistant dermatophytosis in Türkiye wereanalysed. Species identification and detection of squalene epoxidase (SQLE) gene mutations associated with terbinafine resistance were performed using DermaGenius RMP and the in-house T. indotineae-specific qPCR assay, with confirmatory ITS/SQLE sequencing and CLSI microbroth dilution antifungal susceptibility testing. RESULTS:Overall concordance between the two qPCR methods was 93.8% (κ = 0.74, z = 5.99, p < 0.001) for T. indotineae identification. Most recalcitrant cases were caused by T. indotineae, and SQLE mutations were detected in > 90% of these isolates, consistent with the observed clinical resistance. DermaGenius RMP enabled rapid, standardised detection of terbinafine resistance-associated mutations suitable for routine diagnostics, whereas the in-house qPCR provided highly specific identification of T. indotineae. Notably, 10 T. indotineae isolates harboured the SQLE F397L substitution despite terbinafine susceptibility. CONCLUSIONS:Rapid molecular diagnostics, particularly qPCR-based assays, provide actionable information early in the course of infection. In this study, both assays showed comparable performance for T. indotineae detection. Prompt identification of T. indotineae and associated resistance mutations may help avoid ineffective antifungal therapy, reduce chronicity, and support rational treatment decisions in routine clinical practice.

Objectives Candida auris has emerged as a global public health threat because of its antifungal resistance and propensity for nosocomial transmission. This study characterized a C. auris outbreak at a tertiary care center in Türkiye and investigated its transmission dynamics and antifungal resistance. Methods Candida auris candidemia cases identified between April 2023 and September 2025 were included, and clinical data were retrospectively collected. Antifungal susceptibility testing was performed by CLSI broth microdilution against eight antifungal agents. For echinocandin-resistant isolates, hotspot region 1 of FKS1, was sequenced. Short tandem repeat genotyping was used to assess genetic relatedness. Results A total of 119 patients developed C. auris bloodstream infection, with an overall 30-day mortality rate of 54%. Cases were identified across 21 wards, most commonly in the internal medicine ICU and the anesthesia and reanimation ICU. All isolates were resistant to fluconazole. Two patients with prior echinocandin exposure were infected with echinocandin-resistant isolates harboring FKS1S639P. Genotyping assigned all isolates to clade I and identified three closely related genotypes. Epidemiological tracing, integrated with genotyping data indicated that the first identified patient was the single source of the outbreak, which subsequently spread to multiple wards without additional introductions. Conclusions Candida auris has established a presence in Türkiye, as demonstrated by this first large outbreak of invasive cases at a tertiary care center. Although fluconazole resistance was universal, the detection of echinocandin-resistant isolates underscored the need for strengthened infection prevention measures. Epidemiological and molecular typing data indicated the spread of a single strain across multiple wards.

Dermatophyte infections have evolved in both clinical presentation and etiological profiles, with chronic, recurrent, and widespread forms becoming increasingly prevalent and therapeutically challenging over the past decade. These infections are predominantly caused by Trichophyton indotineae (ITS genotype VIII), a member of the Trichophyton mentagrophytes complex. The virulence mechanisms of T. indotineae remain poorly understood. To elucidate potential pathogenic factors, we investigated hemolytic and co-hemolytic (CAMP-like) activities in dermatophytes associated with recalcitrant dermatophytosis. A total of 127 isolates (117 T. indotineae, 5 T. rubrum, 3 T. tonsurans, and 2 Microsporum canis) were examined using Columbia agar supplemented with 5

The one health perspective is an integrative and holistic approach that recognizes the interconnection and interdependence of human, animal and plant health and aims to improve each sustainably. This perspective has gained particular importance following the coronavirus disease-2019 pandemic and has been acknowledged as a component of public health. Fungal infections also pose significant risks to ecosystems, ranging from crops to animals and humans. These risks partly arise from human and animal mobility and have increased alongside climate change. Therefore, food safety has become an integral part of developing societies. Apples are the most widely consumed fruit worldwide. They are known to have multiple health benefits and have been reported to reduce the risk of chronic diseases such as cancer, diabetes, heart disease and stroke. Previous studies have shown that important human pathogens, including multidrug-resistant Candidozyma auris and Candida parapsilosis were isolated from apple peels. Moreover, although rarely, dematiaceous fungi such as Exophiala dermatitidis and Exophiala phaeomuriformis, which can also be pathogenic for humans and animals, have been identified in apples. The aims of the study were to investigate, the presence of extremotolerant Exophiala species in apples that undergo post-harvest storage processes and are sold in local markets across different regions of Türkiye, as well as the polyaromatic hydrocarbon (PAH) levels in the apples from which these isolates were obtained. Additionally, given their resistance to these molecules, the value of culturing Exophiala species on apples as a biological indicator of PAH pollution and to discuss the findings within the framework of the One Health perspective and to draw attention to this issue were aimed in the study. In the present study, the presence of dematiaceous fungi was investigated in 549 apples collected from local markets in 24 different provinces of Türkiye. Sampling was performed from apple skins using sterile swabs and inoculation was carried out on Sabouraud dextrose agar, Staib agar and Czapek media. Isolates compatible with dematiaceous fungi were subsequently identified by sequencing the rDNA internal transcribed spacer region. Antifungal susceptibility testing against five different triazoles was performed using the CLSI microdilution method. Furthermore, benzo[a]anthracene, benzo[b]fluoranthene, benzo[a] pyrene, and chrysene were measured as indicators to determine the amount of polycyclic aromatic hydrocarbons (PAHs) in the skins of apples from which dematiaceous fungi were recovered. In this study, E.phaeomuriformis was identified in four apples (0.7%). These isolates were detected in the provinces of Ankara, Antalya (Finike district), Kayseri, and Kars (Sarıkamış district). Antifungal susceptibility testing was performed for three isolates, and low MIC values were found for all triazole antifungals except fluconazole.. The levels of the four compounds, considered primary environmental pollutants were determined to be high in the skins of all four apples according to the European Union and Turkish Food Codex limits. This suggests that E.phaeomuriformis, which is known to utilize aromatic hydrocarbons as a carbon source, could be used as a biological indicator of PAH pollution. Additionally, apple skins were considered to represent an oligotrophic habitat. In conclusion, beyond food safety, the need to improve and strengthen public health services is evident.

This study investigated the treatment outcomes of 91 patients with chronic and recalcitrant dermatophytosis from 20 hospitals in Türkiye between June 2022 and March 2024, as well as the in vitro antifungal susceptibility and squalene epoxidase (SQLE) substitution profiles of the dermatophytes obtained from these patients. Molecular identification by sequencing 91 isolates, revealed 76 Trichophyton mentagrophytes ITS genotype VIII (TmVIII; also known as T. indotineae) isolates, 13 Trichophyton rubrum, one Trichophyton tonsurans, and one Microsporum canis. The Phe397Leu substitution predominated in the SQLE, and Tyr414His co-occurred in nine TmVIII isolates. Five novel substitutions were observed in TmVIII. Among 13 T. rubrum isolates, three showed different SQLE substitution patterns compared to the wild-type strain. EUCAST antifungal susceptibility testing revealed high minimum inhibitory concentrations (MICs) for terbinafine (TRB) (> 0.25 mg/L) and for fluconazole (FLZ) (≥ 16 mg/L), indicating resistance in most TmVIII isolates. Of the 91 patients, 83 responded to FLZ, itraconazole (ITZ), TRB, or voriconazole-based regimens. While adjunct therapy with FLZ and resveratrol (RES) led to improvement in 28/29 patients despite their high in vitro inhibition concentrations, ITZ and curcumin (CUR) therapy was successful in 3/3 patients. However, the in vitro efficiency of CUR could not be evaluated. These findings highlight the local occurrence of specific SQLE substitutions, underscore the importance of EUCAST MIC testing combined with SQLE sequencing for surveillance, and support further evaluation of RES and CUR as an adjunct in TRB-resistant TmVIII.

Invasive pulmonary fungal diseases (IPFD) continue to posing an increasing clinical and public health burden on immunocompromised populations. In many Asian settings, the diagnosis of IPFD faces substantial challenges driven by the high prevalence of comorbidities, including poorly controlled diabetes, tuberculosis (TB), and human immunodeficiency virus (HIV) infection, considerable heterogeneity in local pathogens, and disparities in access to diagnostic resources. To address these unmet needs, experts from 18 countries collaboratively developed this consensus, which provides a diagnostic algorithm tailored to high-burden Asian settings based on existing international and regional guidelines. When clinical manifestations are atypical or diagnostic clues are limited, the algorithm prioritizes evaluation for common and regionally prevalent IPFD, followed by stepwise expansion to other potential fungal pathogens. In addition, this consensus outlines the regional accessibility of different diagnostic modalities across Asia. This consensus focuses exclusively on optimization of the diagnostic algorithm and does not provide specific recommendations regarding antifungal therapy. Notably, improved diagnosis of IPFD through this algorithm may contribute to better patient outcomes and strengthened public health strategies in high-burden regions.

İnsan patojeni Cryptococcus neoformans; kuş dışkısı, toprak, ağaçlar ve çürümüş odun gibi çeşitli çevresel kaynaklardan izole edilmiştir. Mayanın kendi biyolojik özelliklerine ek olarak, kolonize olabileceği çevresel yapı ve özellikler, kolonizasyon sürecinde önemli rol oynar. Peloidoterapi, Ege Bölgesi'nde (Denizli, Türkiye yakınları) çok sayıda hastalığın ve kas-iskelet sistemi rahatsızlığının yönetiminde tedavi veya destekleyici yöntem olarak eski zamanlardan beri kullanılmaktadır. Peloidoterapi, hastanın havuzlara girmesi veya kurutulmuş çamurun yeniden sulandırılması ve ardından doğrudan vücuda uygulanmasıyla gerçekleştirilir. Organik içerik belirgin şekilde düşüktür. Ayrıca, ticari olarak paketlenmiş peloidoterapi çamurları, işlemden önce yüksek sıcaklıklarla işlenir ve bu da fizikokimyasal bileşimde değişikliklere neden olur. Çevresel kriptokokal kolonizasyonda organik içerik zayıf olsa bile eşeyli üreme meydana gelebilir ancak peloidler üzerinde oluşabileceğine dair henüz yeterli veri yoktur. Çalışmada, ülkemizde peloidoterapi uygulamasında kullanılan ve organik içerik bakımından zayıf çamurlarda C.neoformans'ın eşeyli üremesinin araştırılması amaçlanmıştır. Bu çalışmada, Denizli Havzası'nda bulunan üç aktif kaynaktan (Sarayköy, Gölemezli, Karahayıt) alınan ticari olarak paketlenmiş peloid örnekleri (1 g/L distile suda filtrelenmiş) ve farklı pH değerlerinde, sadece 3 g/L CaCO3 ve 1 g/L agar ilave edilerek besiyeri hazırlanmasında kullanılmıştır. Bu ortamlarda eşeyli üreme yeteneklerini doğrulamak için C.neoformans KN99 Aa ve C.neoformans KN99 Aα referans suşları test edilmiştir. Bir ay boyunca besiyerleri; filamentler, hifler, menteşe bağlantıları, bazidia ve bazidiyosporların varlığı açısından periyodik olarak incelenmiştir. Sonuç olarak, üç örnekten ikisinde eşeyli yapıların varlığı gösterilmiştir. Bu bulgular, düşük organik içeriklerine rağmen yeniden kullanılabilir ve ticari olarak temin edilebilen peloidlerin, özellikle immünsupresyon varlığında, C.neoformans için uygun olduğunu göstermektedir. Ayrıca, peloidlerin düşük organik içeriği ve bölgeler arasında yapılarında farklı minerallerin bulunması, C.neoformans gibi önemli insan patojenlerinin doğal döngüsünü etkileyen faktörleri araştırmak için uygun bir ortam sağlamaktadır.

Candidemia is a major global health challenge, with Candida albicans being the most common causative agent. Since antifungal drugs may promote resistance, regular epidemiological studies are required. Nonetheless, microbiological and clinical data on C. albicans in Türkiye are limited. Therefore, we assessed data from C. albicans cases in a tertiary care hospital in Türkiye. Among 171 enrolled patients, the overall mortality rate was 66.7%. Univariate analysis showed that age, intensive care unit (ICU) admission, central venous catheterization, mechanical ventilation, hemodialysis, diabetes mellitus, Coronavirus disease 2019 (COVID-19) infection, steroid use, and hyperalimentation were associated with mortality. Multivariate logistic regression showed that age, ICU admission, steroid use and hyperalimentation were independently associated with mortality. In Cox regression, age, ICU admission, prior antifungal use, and absence of antifungal treatment after candidemia were independently associated with decreased survival. Fluconazole (FLC) was the most frequently used antifungal, and patients treated with FLC + amphotericin B or FLC + echinocandin had the best survival rates. All 171 isolates were susceptible to all tested antifungals. Our findings show high mortality rates and reveal mortality-associated factors. Candida albicans remains susceptible to all antifungals; therefore, timely diagnosis and appropriate antifungal treatment can enhance survival and clinical outcomes.

The human pathogen Cryptococcus neoformans has been isolated from a variety of environmental sources, including avian excreta, soil, trees, and decaying wood. In addition to the biological characteristics of the yeast, the structure and properties of the external environment play a pivotal role in the process of environmental colonization. Peloidotherapy has been used since ancient times in the Aegean Region (near Denizli, T & uuml;rkiye) as a treatment or supportive therapy for pathological disorders and musculoskeletal conditions. This therapy involves either immersing patients in natural pools or rehydrating dried mud and applying it directly to the body. Notably, the organic content of these peloids is quite low. Additionally, commercially packaged peloidotherapy muds undergo high-temperature treatments, which alter their physicochemical properties. While it is possible that sexual reproduction might occur during environmental colonization by cryptococcal species, even in environments with low organic content, there is currently insufficient data to confirm this phenomenon in peloids. The aim of this study was to investigate the sexual reproduction of C.neoformans in peloids with low organic content, which are used in peloidotherapy practices in our country.The aim of this study was to investigate the sexual reproduction of C.neoformans in muds with poor organic content used in peloidotherapy in our country. In this study, commercially packaged peloid samples (1 g/L, filtered in distilled water) from three active sources in the Denizli Basin-Sarayk & ouml;y, G & ouml;lemezli, and Karahay & imath;t-were used to prepare media with varying pH levels, supplemented with 3 g/L CaCO3 and 1 g/L agar. Two reference strains, C.neoformans KN99 Aa and KN99 Act, were tested for their ability to mate on these media. Over the course of a month, the plates were periodically examined for sexual structures, including filaments, hyphae, clamp connections, basidia and basidiospores. Sexual structures were observed in two of the three samples, indicating that, despite their low organic content, reusable and commercially available peloids can support C.neoformans, particularly under conditions of immunosuppression. Moreover, the low organic content and the mineral variability of peloids across regions provide a unique environment for studying factors that influence the natural life cycle of significant human pathogens like C.neoformans.

Trichophyton indotineae, formerly known as T. mentagrophytes internal transcribed spacer (ITS) genotype VIII, has been recognized over the last decade due to its high virulence and resistance to treatment. Its accurate identification in routine mycology laboratories remains challenging, as it shares phenotypic traits and substantial rDNA ITS similarity with T. mentagrophytes and T. interdigitale. This study aimed to identify more divergent and stable sequences via whole-genome comparisons between T. indotineae and T. interdigitale to facilitate highly specific targeting of T. indotineae using a validated quantitative polymerase chain reaction (qPCR)-based method. Our whole-genome comparison revealed at least 22 unique sequences of T. indotineae compared to T. interdigitale and revealed the divergence of the former from the reference genomes of other Trichophyton species. Among these, a 499 bp segment was identified as the most genetically distinct sequence within the T. indotineae genome. Seventy-three dermatophyte strains [T. indotineae (n = 66), non-T. indotineae (n = 7)], were tested using our qPCR assay targeting the above-mentioned stable 499-bp region. Regarding analytical performance, our T. indotineae-specific qPCR assay exhibited high sensitivity (93.3

Clinical and mycological data are essential for the optimal management of patients with Candida vaginitis (CV), particularly in cases of (i) azole-resistant C. albicans vaginitis, (ii) recurrent CV, and (iii) CV in pregnant women. The present retrospective single-center study investigated the antifungal activity of six commonly used antifungals against randomly selected vaginal isolates recovered from 68 pregnant women in Adana, Türkiye, including C. albicans, petite C. glabrata, non-petite C. glabrata, and C. krusei, using the disk diffusion method at pH 4 and 7. Furthermore, the antifungal activities of fluconazole and itraconazole were also assessed using the broth microdilution method. For all isolates, the mean inhibition zone diameters were narrower for itraconazole and ketoconazole and larger for miconazole at pH 4 than pH 7 (p < 0.05). For nystatin, zone diameters were wider in C. albicans and petite C. glabrata at pH 4 (p < 0.001 and p < 0.001). Remarkably, clotrimazole was more active at pH 4 than at pH 7, except against non-petite C. glabrata isolates. Based on the broth microdilution results, the resistance rate was higher at pH 4 than at pH 7 in all isolates. Candida glabrata petite isolates exhibited MIC values 2 to 5 times higher than those of the non-petite isolates for both fluconazole and itraconazole. This study highlights the potent activity of topical antifungals (miconazole, nystatin, and clotrimazole) for the treatment of CV in pregnant women and highlights the need to identify petite and non-petite mutants of vaginal C. glabrata isolates to obtain more reliable data and for antifungal susceptibility testing prior to decision-making. The results of the two antifungal susceptibility methods were compared for C. albicans and C. glabrata isolates, and the reliability of the disk diffusion test was discussed.

Candida tropicalis frequently causes invasive infections in immunocompromised hosts. Mortality rates are high compared to other yeasts, while antifungal resistance varies between countries. To date, multicenter studies regarding C. tropicalis infections in Türkiye are limited. The current study therefore characterized C. tropicalis infections in Türkiye. In this retrospective study, 120 invasive C. tropicalis isolates were collected from four hospitals in Türkiye, mostly from blood. In vitro antifungal susceptibility testing (AFST) was performed for eight common antifungals, and short tandem repeat (STR) genotyping was applied to investigate genetic relatedness within the current population and previously genotyped isolates. Patients with invasive C. tropicalis candidiasis were mostly elderly, with a central venous line (CVL) and cancer or diabetes as underlying disease, and an overall mortality rate of 37

Vaginal candidiasis (VC) is a prevalent condition among women of reproductive age and poses a significant global public health challenge. However, the disease is often diagnosed and treated without mycological information. We investigated the epidemiology, laboratory diagnostics, and antifungal susceptibility of VC. We included 300 women from Çukurova University Obstetrics and Gynecology outpatient clinic in Adana, Türkiye. Participants underwent a health survey and provided vaginal swab samples for microscopic examination and fungal culture. The microscopic analysis involved wet-mount and gram-stained slides, whereas fungal identification involved CHROMAgar Candida, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), and real-time polymerase chain reaction high-resolution melting analysis (RT-PCR HRMA). Antifungal susceptibility tests were conducted at pH 7 and 4 using the CLSI document M44-A2. Of the 106 women with positive fungal cultures, 86.8

Drug-resistant microbes typically carry mutations in genes involved in critical cellular functions and may therefore be less fit under drug-free conditions than susceptible strains. Candida glabrata is a prevalent opportunistic yeast pathogen with a high rate of fluconazole resistance (FLZR), echinocandin resistance (ECR), and multidrug resistance (MDR) relative to other Candida. However, the fitness of C. glabrata MDR isolates, particularly in the host, is poorly characterized, and studies of FLZR isolate fitness have produced contradictory findings. Two important host niches for C. glabrata are macrophages, in which it survives and proliferates, and the gut. Herein, we used a collection of clinical and lab-derived C. glabrata isolates to show that FLZR C. glabrata isolates are less fit inside macrophages than susceptible isolates and that this fitness cost is reversed by acquiring ECR mutations. Interestingly, dual-RNAseq revealed that macrophages infected with drug-resistant isolates mount an inflammatory response whereas intracellular drug-resistant cells downregulate processes required for in-host adaptation. Furthermore, drug-resistant isolates were outcompeted by their susceptible counterparts during gut colonization and in infected kidneys, while showing comparable fitness in the spleen. Collectively, our study shows that macrophage-rich organs, such as the spleen, favor the retention of MDR isolates of C. glabrata. The fitness of drug-resistant strains of fungal pathogen Candida glabrata depends on the host niche and is relatively high in the spleen, which may thus act as a host reservoir for drug-resistant C. glabrata mutants.

Cryptococcus species are fungal pathogens that pose a serious threat to human life and can cause meningoencephalitis in immunocompromised and healthy individuals. It was estimated that approximately 112000 people die every year due to cryptococcal-related infections all over the world, especially in immunocompromised individuals. Cryptococcus species can be found in soil, bat dung, pigeon droppings, and various tree species in addition to humans. Despite the majority of Cryptococcus species being haploid opportunistic human pathogens, it is known that the ability to undergo sexual reproduction plays a significant role in the expansion of species distribution and the increase in virulence. In Cryptococcus species, sexual reproduction is governed by the mating genotype gene region called the MAT locus. Pathogenic Cryptococcus species have two mating types (MATa and MAT alpha), defined by the presence of one of two alternative alleles at a single MAT locus. In this study, various tree species (eucalyptus, olive and carob) in a total of seven regions in Mersin (Gulnar, Goksu, Narlikuyu, Aya, Kizkalesi, and Tarsus) and Hatay provinces were examined to detect Cryptococcus species. The aim of this study was to determine the environmental distribution and sexual genotypes of Cryptococcus species in these regions. In the present study, samples were collected from a total of 750 trees, including olive, eucalyptus, and carob trees. The samples were incubated on Staib agar medium containing 0.1% biphenyl and 0.5% chloramphenicol. Colonies that formed brown pigment were identified as C.neoformans using conventional and molecular methods. The sexual genotypes were determined by comparing the lengths of the STE20 gene from the isolates compared with those of reference C.neoformans strains. Growth was observed in 97 (12.9%) of 750 samples collected from eucalyptus (n= 236), olive (n= 303) and carob (n= 211) trees. All 97 isolates were determined to be C.neoformans var. grubii. The highest positivity was found in Narlikuyu (78.2%), and from carob (9.4%) and olive (3.5%) trees. Cryptococcus species was not detected in any of the samples derived from eucalyptus trees. Based on the lengths of the STE20 gene, it was determined that all C.neoformans var. grubii isolates were in the MAT A alpha genotype. The data obtained regarding the environmental distribution of Cryptococcus species and the distribution of genes involved in sexual reproduction are believed to provide valuable guidance in terms of the potential clinical implications of environmental Cryptococcus hotspots and regional species characteristics in our country.

Cryptococcus species are fungal pathogens that pose a serious threat to human life and can cause meningoencephalitis in immunocompromised and healthy individuals. It was estimated that approximately 112000 people die every year due to cryptococcal-related infections all over the world, especially in immunocompromised individuals. Cryptococcus species can be found in soil, bat dung, pigeon droppings, and various tree species in addition to humans. Despite the majority of Cryptococcus species being haploid opportunistic human pathogens, it is known that the ability to undergo sexual reproduction plays a significant role in the expansion of species distribution and the increase in virulence. In Cryptococcus species, sexual reproduction is governed by the mating genotype gene region called the MAT locus. Pathogenic Cryptococcus species have two mating types (MATa and MATα), defined by the presence of one of two alternative alleles at a single MAT locus. In this study, various tree species (eucalyptus, olive and carob) in a total of seven regions in Mersin (Gülnar, Göksu, Narlıkuyu, Ayaş, Kızkalesi, and Tarsus) and Hatay provinces were examined to detect Cryptococcus species. The aim of this study was to determine the environmental distribution and sexual genotypes of Cryptococcus species in these regions. In the present study, samples were collected from a total of 750 trees, including olive, eucalyptus, and carob trees. The samples were incubated on Staib agar medium containing 0.1% biphenyl and 0.5% chloramphenicol. Colonies that formed brown pigment were identified as C.neoformans using conventional and molecular methods. The sexual genotypes were determined by comparing the lengths of the STE20 gene from the isolates compared with those of reference C.neoformans strains. Growth was observed in 97 (12.9%) of 750 samples collected from eucalyptus (n= 236), olive (n= 303) and carob (n= 211) trees. All 97 isolates were determined to be C.neoformans var. grubii. The highest positivity was found in Narlıkuyu (78.2%), and from carob (9.4%) and olive (3.5%) trees. Cryptococcus species was not detected in any of the samples derived from eucalyptus trees. Based on the lengths of the STE20 gene, it was determined that all C.neoformans var. grubii isolates were in the MAT Aα genotype. The data obtained regarding the environmental distribution of Cryptococcus species and the distribution of genes involved in sexual reproduction are believed to provide valuable guidance in terms of the potential clinical implications of environmental Cryptococcus hotspots and regional species characteristics in our country.

Introduction: Opportunistic infections, particularly cryptococcosis, pose a significant health risk among individuals living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). Cryptococcus neoformans and Cryptococcus gattii, the pathogens responsible for this infection, are prevalent in advanced-stage HIV patients with low CD4 cell counts and are associated with a high risk of mortality. International guidelines, including those from the World Health Organization and the European AIDS Clinical Society, recommend screening for Cryptococcus antigen (CrAg) in HIV-positive individuals with CD4 counts below 100 cells/mm3 to facilitate early diagnosis of asymptomatic cryptococcal infections. This study aims to evaluate the prevalence of CrAg positivity among newly diagnosed HIV-positive individuals in T & uuml;rkiye. Materials and Methods: This retrospective study was conducted at & Ccedil;ukurova University Faculty of Medicine between January 2023 and August 2024. Serum samples from newly diagnosed HIV-positive individuals over the age of 18 were analyzed using the IMMY CrAg LFA test. Demographic data, CD4 counts, and HIV RNA levels were collected retrospectively from electronic medical records. Statistical analyses were performed using Jamovi software, with significance set at p< 0.05. Results: Among the 122 patients included in the study, 93.4% were male, with an average age of 38 +/- 12 years. CrAg positivity was detected in 3.3% (n= 4) of all patients. Among patients with CD4 counts below 100 cells/mm3, CrAg positivity was 8.6%, compared to 5.9% in those with CD4 counts between 101 and 200 cells/mm3. Two of the CrAg-positive patients died, and the mortality rate was significantly higher among CrAg-positive patients compared to CrAg-negative patients (p= 0.008). Conclusion: This study demonstrates that CrAg positivity in newly diagnosed HIV-positive individuals is associated with low CD4 counts and an increased risk of mortality. These findings underscore the importance of CrAg screening in advanced-stage HIV patients. Implementing CrAg screening programs in T & uuml;rkiye could facilitate early detection of cryptococcal infections, reduce mortality rates, and improve survival among HIV-positive individuals.