Suzana Otašević

The prevalence of Candida onychomycosis in Southeastern Serbia from 2011 to 2015.

Despite the increasing of onychomycosis caused by Candida spp., in referent literature, there is still data insufficiency about this nail infection. The objectives of this retrospective study were to determine epidemiological characteristics of Candida onychomycosis, the antifungal susceptibility of isolated species in vitro, and to compare the results of antifungal susceptibility testing with conducted treatment in period from 2011 to the end of March 2015. Out of 761 patients who were underwent clinical and mycological examinations, 137 had Candida species isolated from nails. The dominant species was Candida albicans (C. albicans) (36.59%) followed by C. parapsilosis (23.78%), C. krusei (9.76%), and C. guilliermondii (6.71%). Antifungal susceptibility in vitro testing showed good susceptibility to antimycotics, except C. krusei, which was resistance to fluconazole (FCZ) and isolates of C. tropicalis and C. glabrata which were dose dependent to itraconazole (ITZ) and fluconazole. Evaluation of medical histories determined that combined therapy, which included pulsed systemic regimen of ITZ with topical application of clotrimazole, had better clinical outcomes regarding the proscribed only topical application of clotrimazole. Multidisciplinary approach of dermatologists and mycologists is required in solving the problem of onychomycosis, which is the dominant nail disease.

Surveillance and characterization of Candida bloodstream infections in a Serbian tertiary care hospital

INTRODUCTION Candida spp. frequently cause hospital-acquired bloodstream infections (BSI) with a high mortality rate (up to 70%). We analyzed the frequency, infection characteristics, potential predisposing factors, susceptibility to antifungal drugs, biofilm production and other virulence characteristics of Candida spp. isolates obtained from a tertiary care hospital in Niš, Serbia, during a one year period. METHODS Medical histories, characteristics of isolated strains and drug susceptibility, as well as the effect on the function of isolated macrophages and other virulence features were evaluated. The obtained results were subjected to students t-test and multivariate statistical analyzes. RESULTS Herein we report an annual incidence of 3.65 cases of C. albicans, C. lusitaniae and C. lipolytica infections per 105 population. Out of eight isolated strains, two (25%) were shown to be strong biofilm producers, one (12.5%) caused hemolysis on blood agar and in two (25%) cases macrophages were able to completely eliminate the yeast colonies. Chronic kidney disease, diabetes, malignant and other diseases were present in 37.5, 62.5, 50 and 75%, respectively, in the study group. All patients with Candida BSI received antifungal therapy (amphotericin B), however, hospital mortality was observed in 25% of patients. CONCLUSIONS Evaluation of local Candida epidemiology, antifungal susceptibility and virulence factors, as well as personalized patient risk factors are important for the surveillance of Candida BSI, especially in intensive care unit patients and may contribute to the improved options and outcome for patients with Candida BSI.

Superficial mycoses in the Nis region, Southeast-Serbia

The aim of the study is to investigate the most frequent cause of superficial mycoses in patients from the territory of city Niš Southeast Serbia in the period from 1998 to 2010. A total of 3223 samples from 2887 patients with suspected dermatomycoses were examined. Superficial mycoses were diagnosed using standard microbiology techniques (conventional microscopy and cultivation). Dermatophytes were determined on the basis of their macroscopic and microscopic morphological and morphometric characteristics. Morphometric characteristics were obtained by Laboratory Universal Computer Image Analysis system (Lucia M, 1996). Species of genus Candida were identified using the test of production of germ tube in sera, by growth on comertial chromatogen medium (Chromotogenic Candida, Liofichem/Bacteriology products, Italy) and by using Auxacolor TMBioRad, France. The results were elaborated with the statistical method of descriptive and quantitative analysis (SPSS 14.0 for Windows 2003). The prevalence of superficial mycoses was 25,1%. Dermatophytes were identified in 67.6% of all positive cultures. Microsporum canis was the most prevalent (50.3%) dermatophyte isolated, followed by Trichophyton metagrophytes var. mentagrophytes (35.4%). Yeast genus Candida has become a more frequent cause of superficial fungal infection since 2001. and C. albicans was the dominant yeast (61.1%).

Candida bloodstream infections in Serbia: First multicentre report of a national prospective observational survey in intensive care units

Candida bloodstream infections (BSI) are a significant cause of mortality in intensive care units (ICU), hereof the prospective 12‐months (2014‐2015) hospital‐ and laboratory‐based survey was performed at the Serbian National Reference Medical Mycology Laboratory (NRMML). Candida identification was done by a matrix‐assisted laser desorption/ionisation time‐of‐flight mass spectrometry and a susceptibility test, according to the Clinical and Laboratory Standards Institute methodology. Among nine centres (265 beds; 10 820 patient admissions), four neonatal/paediatric (NICU/PICUs) and five adult centres (ICUs) participated, representing 89 beds and 3446 patient admissions, 166 beds and 7347 patient admissions respectively. The NRMML received 43 isolates, 17 from NICU/PICUs and 26 from adult ICUs. C. albicans dominated highly in NICU/PICUs (~71%), whereas C. albicans and C. parapsilosis were equally distributed within adults (46%, each), both accounting for ~90% of received isolates. The resistance to itraconazole and flucytosine were 25% and 2.4% respectively. In addition, the 2 C. albicans were azole cross‐resistant (4.6%). The overall incidence of CandidaBSI was ~3.97 cases/1000 patient admissions (4.93 in NICU/PICU and 3.53 in adult ICU). The 30‐day mortality was ~37%, most associated with C. tropicalis and C. glabrataBSI. Data from this national survey may contribute to improving the Balkan and Mediterranean region epidemiology of CandidaBSI within ICUs.

Streptococcus pyogenes as the cause of vulvovaginitis and balanitis in children

Streptococcus pyogenes (group A Streptococcus) is the etiological agent of perineal infection in children, consisting of perianal infection, vulvovaginitis and balanitis. If it is not properly diagnosed and treated, it can persist for many months and can cause severe complications. Furthermore, treatment with penicillin can be followed by failures and recurrences.

Subconjunctival Infection due to Dirofilaria Repens - Case Report

Summary The aim of the survey was to present the clinical course and surgical treatment of the first case of human ocular dirofilariosis on the territory of the city of Niš, in the southeast Serbia. Male patient, 57 years old, visited an ophthalmologist because of extreme swelling and redness of the eyelids of the right eye, scratches and pain in his right eye. On standard examination on biomicroscope, temporally 3 mm from the limbus, intrapalpebrally, a mobile parasite was observed in the subconjunctival space. Complete extraction of the living parasites, 13 cm long, was performed. A sample of the nematode based on morphological and morphometric characteristics was identified as Dirofilaria repens-like. The diagnosis was confirmed with molecular methods. For ocular dirofilariosis, surgical methods and complete extraction of the parasite are the only ways to achieve complete recovery.

First case of visceral Leishmaniosis/HIV Coinfection in niš - southeastern serbia

Visceral leishmaniosis (VL) has emerged as an important opportunistic parasitosis associated with human im- munodeficiency virus (HIV) infection. The aim of this paper is to report the first case of Leishmania/HIV coinfection in a patient from Nis (Southeastern Serbia). Microscopical examination of Giemsa-stained bone marrow (BM) smears show the presence of Leishmania spp. amastigotes based on their morphological characteristics. In spite of the parasitologi- cal finding, the serological test applied gave negative results. Molecular analyses confirmed the infection and allowed us to identify the leishmania species as Leishmania infantum (100% identity). VL/HIV coinfection has important clinical, diagnostic and epidemiological implications. In fact, the failure of serological tests is expected in this condition, and the application of molecular diagnostics to the blood may offer, apart from an easy and non-invasive diagnostic opportunity, the possibility of warning about the risk of possible nosocomial infections.

The dietary modification and treatment of intestinal Candida overgrowth – a pilot study

OBJECTIVE The aim of this study was to evaluate the effectiveness of an alternative treatment in a form of recommended diet modification during and after conventional treatment with antifungals in patients with a chronic form of intestinal Candida overgrowth (ICOG). METHODS The study included patients with ICOG divided in two subgroups: patients treated with nystatin and recommended diet regime (study group-SG) and the patients treated only with nystatin (control group-CG). After treatment, the mycological control examination and follow-up were performed two times: the first one within ten days after the completion of antifungal treatment, and the second one three months after the treatment initialization. RESULTS A total of 120 patients finished the study: 80 from the SG and 40 from the CG. At the first mycological control examination of SG patients stools, we noted satisfactory antifungal and symptomatic effect in 56 out of 80 (70.0%) patients and 29 out of 40 (72.5%) in CG, with no statistically significant difference. However, at the second control stool examination, significantly higher percent (85%) of cured patients was recorded after three months of the recommended diet comparing with CG-17 out of 40 (42.5%). CONCLUSION Results of this pilot study showed that patients who adhered to diet modification during and after treatment with nystatin had better outcomes of ICOG and strongly suggest the need for diet modification in these patients which recommendation could reduce excessive prescription of antifungals.

Non-culture based assays for the detection of fungal pathogens

Abstract Traditional, culture based methods for the diagnosis of fungal infections are still considered as gold standard, but they are time consuming and low sensitive. Therefore, in order to overcome the limitations, many researchers have focused on the development of new immunological and molecular based rapid assays that could enable early diagnosis of infection and accurate identification of fungal pathogens causing superficial and invasive infection. In this brief review, we highlighted the advantages and disadvantages of conventional diagnostic methods and possibility of non-culture based assays in diagnosis of superficial fungal infections and presented the overview on currently available immunochromatographic assays as well as availability of biomarkers detection by immunodiagnostic procedures in prompt and accurate diagnosis of invasive fungal infections. In addition, we presented diagnostic efficiency of currently available molecular panels and researches in this area.

First molecular detection of Babesia canis in dogs from Bosnia and Herzegovina

Babesia spp. are tick-transmitted protozoan haemoparasites of great economic, veterinary and medical impact worldwide. Herein we reported the very high prevalence of autochthonous babesiosis in symptomatic dogs from Bosnia and Herzegovina in the period from 2014 to 2016. Eighty dogs that did not leave the country were examined using parasitological and molecular analyses and babesiosis was diagnosed in 82.5% and 85.0% of them, respectively (p < 0.001). One species, Babesia canis was identified using molecular methodology (PCR and sequence analysis). Statistical analyses showed that epizootiological characteristics have no influence on the possibility of infection. Agglomerative hierarchical clustering (AHC) analyses used for comparing the symptoms and clinical signs of infection in dogs pointed out that a high degree of anemia, followed by thrombocytopenia (89%), lethargy (100%), loss of appetite (95%), fever (66%) and icterus (61%) was dominant. In addition, results of the statistical analysis performed showed that more dogs with no data of tick prophylaxis (70%) were found Babesia infected. Those results point to further intensified epizootic surveys in the territory of Bosnia and Herzegovina.