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Molecular epidemiology, diversity, and antifungal susceptibility profiles of clinical and environmental mucorales: a five-year multicenter study in Iran (2018–2023)

Summary

This research examined dangerous mold infections (Mucormycosis) that became more common after COVID-19. Scientists identified the types of molds causing these infections in Iran by testing 116 patient samples and 65 soil samples from across the country. They tested these molds against 13 different antifungal medications to find which drugs work best. The results showed that amphotericin B and posaconazole were the most effective medications, and patient samples were more susceptible to these drugs than environmental soil samples.

Background

Mucormycosis is a rare but severe opportunistic fungal infection and the third most common invasive fungal infection globally. The COVID-19 pandemic has led to a significant increase in Mucormycosis cases, particularly in Iran and other countries. Early diagnosis and appropriate antifungal selection are critical for patient outcomes.

Objective

This study aimed to identify Mucoral species through molecular analysis using ITS sequencing and evaluate their antifungal susceptibility profiles across clinical and environmental samples collected from Iran over five years. The research also examined geographical distribution, phylogenetic diversity, and climatic correlations of these isolates.

Results

Rhizopus arrhizus (67.9%) and Mucor circinelloides (23.2%) were predominant species. Clinical samples primarily included sinus biopsies (84.5%). Amphotericin B (GM MIC 0.047 μg/ml) and posaconazole (GM MIC 0.52 μg/ml) showed the lowest MIC values. Clinical isolates demonstrated greater susceptibility to amphotericin B and posaconazole compared to environmental isolates.

Conclusion

Understanding Mucorales distribution and antifungal susceptibility patterns assists clinicians in selecting appropriate antifungal therapies. Amphotericin B and posaconazole remain the most effective agents against both clinical and environmental isolates. Further studies are warranted to correlate these findings with clinical outcomes and explore resistance mechanisms in environmental populations.
  • Published in:BMC Infectious Diseases,
  • Study Type:Multicenter observational study,
  • Source: PMID: 40597699, DOI: 10.1186/s12879-025-11189-7
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