Widespread use of fluconazole has resulted in resistance in strains of Candida. The aim of our study was to investigate Y132H and other mutations in the ERG11 gene in conferring fluconazole resistance to C. albicans isolates. Seven fluconazole-resistant (R)/susceptible dose-dependent (SDD)/trailing and 10 fluconazole-susceptible (S) isolates were included. Restriction enzyme analysis was performed on all isolates for Y132H mutation and sequence analysis was performed for other mutations in the ERG11 gene. None of our strains had Y132H mutation. One single mutation (D153E, E266D, D116E, V437I) was detected in isolates 348, 533, 644, 1453, 2157, while the others had more than one nucleotide change. D116E and E266D, which were two mutations found in fluconazole R/SDD/trailing isolates with the highest frequency, were also detected in azole S strains. K143R, G464S, G465S and V488I mutations were determined in three of the R/SDD isolates. S412T and R469K mutations were detected only in this group of strains by sequence analysis. Mutations such as K143R, G464S, G465S, V488I, S412T and R469K in the ERG11 gene were determined to be effective mechanisms in our fluconazole R/SDD C. albicans isolates. Other mechanisms of resistance, such as overexpression of ERG11 and efflux pumps and mutations in the ERG3 gene should also be investigated.

Intestinal and oral colonization of Candida spp. and serological evidence of Candida infections were not significantly different between patients with CU and controls. Claims of triggering of CU by Candida spp. should be explored in studies that measure allergic reactivity to Candida, and also in those that include eradication therapy.

Candida spp. has been the leading microorganism isolated from the urine specimens of patients hospitalized at the Anesthesiology and Reanimation intensive care unit (ICU) of Dokuz Eylul University Hospital, Izmir, since 1998. This study was undertaken to investigate the clonal relationship of Candida urine isolates in order to find the mode of spread among the patients. Epidemiological surveillance of 38 Candida albicans, 15 Candida tropicalis and 12 Candida glabrata recovered from the urine specimens of patients who were hospitalized in the ICU between June 11, 2000 and October 15, 2001 was carried out by antifungal susceptibility testing and randomly amplified polymorphic DNA (RAPD) analysis. Two short primers [Cnd3 (5'-CCAGATGCAC-3') and Cnd4 (5'-ACGGTACACT-3')] were used for RAPD. None of the isolates had high minimal inhibitory concentration (MIC) values (>1 microg ml(-1)) against amphotericin B with MIC50 values of 0.5 microg ml(-1), 0.5 microg ml(-1) and 0.125 microg ml(-1) for C. albicans, C. tropicalis and C. glabrata isolates, respectively. However, three C. glabrata isolates were resistant and one C. albicans and five C. glabrata isolates were dose-dependent susceptible (D-DS) to fluconazole. Among C. albicans isolates 19 and 20 patterns were detected with primers Cnd3 and Cnd4, respectively. When primers Cnd3 and Cnd4 were evaluated together, three and four genotypes were identified for C. tropicalis and C. glabrata isolates, respectively. Our results suggest that the source of C. albicans isolates was mostly endogenous. It is difficult to interpret the mode of spread of C. tropicalis and C. glabrata urine isolates as we obtained insufficient banding patterns for these species.

It is obviously known that the autopsy staff are under higher risk of infectious diseases than the other staff in the hospital. Inappropriate infrastructure and ventilation system installed in autopsy room could also increase such risk efficiently. The aim of this study is to determine the presence of pathogenic bacteria and fungi in the autopsy room air, investigate the factors affecting the presence and the number of colonies of these microorganisms, and determine the extent of occupational risk in such scope. The samples for the study were obtained from the autopsy room of Morgue Department of Turkish Council of Forensic Medicine. Samples were taken from the indoor air during, before and after autopsy by means of settle plates and air sampler in summer and spring seasons. Blood Agar and Sabouraud Dextrose Agar were used for isolation of bacteria and fungi, respectively. Fourteen bacterial and 26 fungal species were cultured from the autopsy room air. Most frequently isolated bacteria were coagulase negative staphylococcus, Micrococcus spp., Bacillus spp., and diphtheroid bacillus for the gram positive, and Acinetobacter spp., Proteus mirabilis, and Eschericia coli for the gram negative groups. Most frequently isolated fungi were Penicillium spp., Alternaria spp., and Aspergillus flavus. When data obtained in the spring and summer was evaluated, it was found that the number of bacteria and fungi colonies grown in samples that were taken by using both methods, was significantly higher at the time of the autopsy than those taken pre and post-autopsy sessions. It was also determined that the autopsy room air had been contaminated with bacteria in 4 of 38 study days and with fungi in 18 of 38 study days. This study could make a contribution not only in the training of autopsy personnel but also in detection of preventive measure to be taken against infections as well as to establish a common database for similar national and/or international research studies.

Primary cutaneous aspergillosis (PCA) can rarely affect immunocompetent people. There is limited knowledge about the prevalence, diagnosis and management of the disease because there are only case reports or small case series in the literature. For this reason, the diagnosis and treatment of three immunocompetent adult patients diagnosed with PCA were discussed by reviewing the literature. In the current report, in addition to treatment with voriconazole for 8-12 weeks we performed repeated surgical debridement for the treatment of these cases. After two negative tissue cultures, the wounds were either successfully closed primarily or reconstructed using a skin graft. Management of PCA cases will become easier as more reports and further studies of PCA contribute to our shared knowledge. Currently, the most appropriate management approach is to make individualized treatment decisions according to the patients' clinical features and treatment response which includes several surgical debridement as well as antifungal therapy.