Candida auris is an emerging multi-drug resistant pathogen with high mortality rate; nosocomial infections have been reported worldwide, causing a major challenge for clinicians and microbiological laboratories. The study aims to describe new cases of C. auris and detect drug resistance-associated mutations of C. auris by the sequencing of ERG11 and FKS1 genes. A total of six specimens were collected from blood, urine, ear swab, and groin screening samples. Isolates were incubated for 48 h on Sabouraud Dextrose agar (SDA) at 42 °C, then confirmed by MALDI-TOF MS. Furthermore, antifungal susceptibility testing was performed using the Vitek 2 system to detect Minimum Inhibitory Concentrations (MICs) of six antifungals. Sequences of 18S rRNA gene and ITS regions from isolates and phylogenetic analysis were performed. Gene sequencing was analysed to detect drug resistance-associated mutations by FKS1 and ERG11 genes sequencing. All C. auris isolates were confirmed by MALDI-TOF MS, and evolutionary analyses using sequences of 18S rRNA gene and ITS region. Antifungal susceptibility testing showed that all isolates were resistant to fluconazole. Sequencing of ERG11 and FKS1 genes from the isolates revealed the presence of two (F132Y and K143R) drug resistance-associated mutations in ERG11, however, FKS1 gene was devoid of mutations. The study sheds light on a public health threat of an emerging pathogen, and the hospital implemented strict contact screening and infection control precautions to prevent C. auris infection. Finally, there is a critical need to monitor the antifungal resistance in different geographical areas and implementation of efficient guidelines for treatment.

Clostridioides difficile infection (CDI) has become a threatening public health problem in the developed world. In the kingdom of Saudi Arabia, prevalence of CDI is still unknown due to limited surveillance protocols and diagnostic resources. We used a two-step procedure to study and confirm C. difficile cases. We also studied toxin profiles of these isolates. Stool samples were collected from symptomatic patients and clinically suspected of CDI for almost 12 months. Isolates were confirmed by culture method followed by 16S rRNA sequencing. Multiplex PCR was performed for the identification of toxin A, toxin B and binary toxin genes and compared to Gene Expert results. Out of the 47 collected samples, 27 were successfully grown on culture media. 18 samples were confirmed as C. difficile by both culture and 16S rRNA sequencing. Interestingly, the rest of the isolates (9 species) belonged to different genera. Our results showed 95% of samples were positive for both toxin A and B ( tcdA, tcdB ) and all samples exhibited the toxin gene regulator tcdC . All samples were confirmed negative for the binary toxin gene ctdB and 11% of the isolates were positive for ctdA gene. Interestingly, one isolate harbored the binary toxin gene ( cdtA + ) and tested negative for both toxins A and B. We believe that combining the standard culture method with molecular techniques can make the detection of C. difficile more accurate.

Background: Candida auris is an emerging multi-drug resistant pathogen with high mortality rate, several cases and nosocomial infections have been reported worldwide causing a major challenge for clinicians and microbiological laboratories. Objectives: The study aim to, describe new cases of C. auris from different sites of infection confirmed by MALDI TOF MS and ribosomal sequencing, develop the phylogenetic analysis of these isolates, detect resistant strains of C. auris to both azole and echinocandin by amplification of ERG11 and FKS1 genes. Methods: A total of six specimens were collected from blood, urine, ear swab and groin screening sample during the period from November 2018 to March 2019. Isolates were incubated for 48 hours on Sabroud agar at 42℃, then confirmed by Matrix-Assisted Laser Desorption/Ionization-Time of Flight mass spectrometry (MALDI-TOF MS). Sequences of 18S rRNA gene from isolates and phylogenetic analysis were performed. Finally, molecular analysis of resistance genes was performed to detect the efficacy of treatment. Results: Clinical isolates were identified by the growth on Sabroud agar at 42℃ and confirmed by MALDI-TOF MS analysis. Evolutionary analyses were conducted in MEGA7 and sequences of 18S rRNA gene were submitted to GenBank. All samples were positive for both ERG11 and FKS1 which confer azole- and echinocandin-resistant strains. Conclusions: This study shed light on a public health threat of an emerging pathogen. Therefore, the hospital implemented strict contact screening and infection control precautions to prevent C. auris infection. Finally, there is a critical need to monitor the antifungal resistance in different geographical areas and implementation of efficient guidelines for treatment.

Background: Since the introduction of the AllergoOncology term that investigates the relationship between allergy and cancer diseases, this relationship has gained intense interest. Additionally individual molecules that play key role in the allergic conditions had gain attention. However, researches had led to conflict results. Objective: The aim of this work is to find out the relation between the allergy and solid cancer. Methodology: This study included 50 cancer patients suffered from solid tumors and 50 healthy controls. Cancer was diagnosed and staged according to the NCCN guidelines. We diagnosed allergic conditions according to the international guidelines. To determine allergen sensitization, we performed skin prick testing (SPT) and measured serum-Specific IgE whenever SPT could not be preformed. Results: The incidence of allergy in control group was significantly higher than that in the patient group groups (P=0.009). Odds ratios between allergy and cancer specific site were insignificant. Conclusion: Allergy may be protective against solid tumors. However, no specific relation between allergy and cancer specific site has been detected.

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