Purpose To present the different clinical manifestations of rhino-orbital mucormycosis (ROM) co-infection in severe COVID-19 patients. Study design Prospective observational clinical study Methods Among 32,814 patients hospitalized with the diagnosis of COVID-19 between March 2020 and December 2020 in our center, eleven microbiologically confirmed ROM co-infection cases in severe COVID-19 patients were evaluated. Results There were nine men and two women with a mean age of 73.1 ± 7.7 years. Eight patients had uncontrolled type 2 diabetes with a mean diagnosis duration of 12.1 ± 4.4 years. All patients had COVID-19-associated acute respiratory distress syndrome and received corticosteroids. The mean time interval between COVID-19 diagnosis and ROM diagnosis was 14.4 ± 4.3 days. Seven patients (63.6%) had orbital apex syndrome, and four patients (36.4%) presented with orbital cellulitis. Endophthalmitis was detected in 54.5% of patients, and two of these patients developed retinoschisis. CT scan/MRI revealed sino-orbital involvement in all patients, and three of these had cerebral involvement at initial presentation. All patients received intravenous and retrobulbar liposomal amphotericin B and had undergone radical debridement of involved sinuses. Intravitreal liposomal amphotericin B injected in patients with endophthalmitis. Despite all measures, 63.6% of patients expired. Conclusions Severe COVID-19 is associated with a significant incidence of ROM with higher mortality rates due to immune dysregulation and the widespread use of steroids. Physicians should be aware of the possibility of this infection in patients with COVID-19. An aggressive multidisciplinary approach can help to reduce mortality. Supplementary Information The online version contains supplementary material available at 10.1007/s10384-021-00845-5.

Candida parapsilosis, although a human commensal, acts as an opportunistic pathogen associated with nosocomial infections, with a rising incidence worldwide. Its ecological characteristics are poorly understood. Human-made environments within dwellings, such as dishwashers and water distribution systems, represent major sources of fungi such as C. parapsilosis. Here, we investigated the presence of members of the C. parapsilosis complex in 99 washing machines in various dwellings in the city of Mersin, Turkey. We sampled three sites in each washing machine: (i) the washing powder drawers, (ii) fabric softener drawers, and (iii) rubber seals around the washing machine doors. Additionally, we recorded the type of cleanser used by each customer. Of note, 25.3% of sampled washing machines harbored C. parapsilosis strains, later identified as the members of the C. parapsilosis sensu stricto via internal transcribed spacer (ITS) sequencing. Out of the 29 isolates obtained, biofilm-forming ability and proteinase and esterase activities were recorded in 14, 11, and 4 of the isolates, respectively. Our results suggest that the washing machines investigated abundantly harbored C. parapsilosis sensu stricto; however, no single preferred isolation site or association with cleanser type was observed (P > .05). Furthermore, C. parapsilosis isolates grew at temperatures ranging from 10°C to 37°C, at pH values ranging from 4 to 10, and were found to tolerate 5-10% NaCl. Domestic laundry appliances as a potential source of C. parapsilosis infections are discussed.

Clinically relevant members of the fungal genus, Fusarium, exhibit an extraordinary genetic diversity and cause a wide spectrum of infections in both healthy individuals and immunocompromised patients. Generally, Fusarium species are intrinsically resistant to all systemic antifungals. We investigated whether the presence or absence of the ability to produce biofilms across and within Fusarium species complexes is linked to higher resistance against antifungals. A collection of 41 Fusarium strains, obtained from 38 patients with superficial and systemic infections, and three infected crops, were tested, including 25 species within the Fusarium fujikuroi species complex, 14 from the Fusarium solani species complex (FSSC), one Fusarium dimerum species complex, and one Fusarium oxysporum species complex isolate. Of all isolates tested, only seven strains from two species of FSSC, five F. petroliphilum and two F. keratoplasticum strains, recovered from blood, nail scrapings, and nasal biopsy samples, could produce biofilms under the tested conditions. In the liquid culture tested, sessile biofilm-forming Fusarium strains exhibited elevated minimum inhibitory concentrations (MICs) for amphotericin B, voriconazole, and posaconazole, compared to their planktonic counterparts, indicating that the ability to form biofilm may significantly increase resistance. Collectively, this suggests that once a surface adherent biofilm has been established, therapies designed to kill planktonic cells of Fusarium are ineffective.

NAC species were the most common causative agent for candidemia. Genotyping showed low transmission of C. albicans strains, but transmission of C. parapsilosis was high. In candidemia, several Candida virulence factors may be responsible at the same time. However, different genotypes of Candida strains showed different virulence activity.

The aim of this investigation was to determine the bacterial load on used instruments and to evaluate the relationship between the bacterial load and the holding time prior to cleaning. Thirty six sets were evaluated to establish the average number of bacteria per square centimeter. For the experimental study, three different bacteria were prepared in sheep blood and used to contaminate sterile stainless steel pieces with the surface of 10 cm 2 . After incubation at room temperature for 2, 4,6,8, 12, 24, 36, and 48 h, colonies were counted and compared to time zero. Bacterial counts were between 10 and 250 CFU/cm 2 , depending on the operation site. Bacterial load was found to have increased after 6 h. An increase of 3log 10 CFU/cm 2 was measured after 12 h. It is imperative to clean surgical instruments in the first 6 h to ensure effective disinfection and sterility.