Objectives 
Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive  lung disease. Fungal colonization in patients with lung  tissue damage   cause of  persistent  infection.Fungal infections  had been  studied as causitive agents in cases  with cystic fibrosis(CF)  previously.It is expected there is a association  between  fungal agents  and etiology of  IPF. This study  aimed to investigate    the isolation    and   molecular indentification of fungal  agents in IPF  patients for the first time in Iran   .
Methods
Forty   nasopharyngeal (NP) swabs or bronchoalveolar lavage (BAL) samples were obtained  from patients that were diagnosed by sophisticated practitioner from April 2015 to March 2016. Direct examination by  hydroxide potassium(KOH) carried out  for  the  presence of fungal elements.The samples cultured on Sabauroud dextrose agar (SDA) medium.Conventional  methodes ,  Polymerase Chain Reaction(PCR)  and Sequencing were used for identification of fungal species. Antifungal susceptibility testing  for yeast isolates which  was conducted  as standardized by Clinical Laboratory Standards Institute (CLSI M27- S3 and S4).
Results: 
Of 40 IPF patients ,22(55%) were female and 18(45%) were male.7(17.5%) of IPF patients were positive for fungal agents as following; 4 (10%)Candida albicans(C. albicans), 2(5%) Candida glabrata (C. glabrata)and 1(2.5%) Aspergillus fumigatus(A. fumigatus) were identified  using  conventional methods(culture) , PCR and sequencing technique. It was found the significant correlation between C.albicans  colonization in upper   respiratory system tract and  presence underlying disease in  IPF patients (P<0.05 ). Antifungal susceptibility testing showed, all C. albicans isolates were resistant to itraconazole and  it is found 3(75%)C.albicans  were resistance to amphoterecin B, Whereas 3(75%) and  1(25%)  C. albicans isolates  were susceptible dose dependant and resistant  to fluconazole respectively. Morever, C. glabrata isolates were resistant to fluconazole, itraconazole and  amphotricin B .


Conclusions: 
Taken together , Fungal agents were detected in 17.5% of iranian IPF patients. Rregarding the high resistance Candida isolates against antifungal drugs, isolation and identification of fungal agents , as well as antifungal susceptibility testing is urgent necessity in IPF patients.Also clinician should be notice the antifungal prophylaxis in susceptible IPF cases , Howere the causes of IPF require more investigation.

1 / Molecular identification  and antifungal susceptibility testing of fungal agents isolated from  patients with  idiopathic pulmonary fibrosis(IPF) in Tehran, Iran