Common Invasive fungal infections in Iran

The morbidity and mortality rate of the invasive fungal infection in immunocompromised patients remains high despite improvements in prophylaxis, diagnosis, and treatment. Aspergillosis and candidiasis are two major fungal infections. Timely diagnosis and prompt clinical suspicion of these infections remain a challenge. The sensitivities for direct smear and culture were reported 73.3% (specificity 77.7%) and 41.7% (specificity42.5%), respectively. Isolated fungi from non-sterile sites cultures are mainly colonization. Blood cultures become positive in only 50% of the cases, however, fungal blood culture remains the gold standard for the diagnosis of fungal infections. Non-culture-based diagnostic tools such as 1,3 -b-D-glucan, mannan-antigen plus anti-mannan-antibody measurement, fluorescent in situ hybridization (FISH), matrix-assisted laser desorption ionization-time of flight mass-spectroscopy (MALDITOF-MS) and Pan-fungus PCR can help as the clinical value in fungal infection diagnosis. The prevalence of recurrent vulvovaginal candidiasis in adult women, invasive fungal infections, tinea capitis in Iran were reported 12.3%, 8.3%, and 13.3%, respectively. According to EORTC/MSG criteria, the rate of proven and possible mucormycosis in the south of Iran were 14.6% and 85.4%, respectively. The recent increase in antifungal-resistant Candida and Aspergillus species (multi-resistant phenotype) have reported in the literature which is an emerging problem in patient’s treatment.Conclusion: Successful management of fungal infections requires early diagnosis and prompt treatment with antifungal agents. Diagnosis of new species in Iran like Candida auris, lichtheimia corymbifera, Apophysomyces elegans, Sporodiniella umbellata and determination of the susceptibility patterns of the isolated species needs to the specific laboratory.