bluuebunny/crossref_metadata_2025 huggingface dataset:
P051 A case of recalcitrant sporotrichosis by infection of Sporothrix globosa
Authors: Jeong Eunhye , Yim Jeongeun , Kwon Hyeongmok , Choi Jongsoo , Shin Donghoon , Kim Jayoung
Published: September 2022

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM

 

Objectives

Sporotrichosis is the leading subcutaneous mycosis caused by the Sporothrix (S.) schenckii complex. S. globosa is the causative organism of fixed sporotrichosis in Korea. The preferred regimen of cutaneous sporotrichosis is itraconazole for 3-6 months, however, there were few studies for recalcitrant sporotrichosis.

Methods

In 2018, we performed a histological examination of a patient who suffered sporotrichosis for 3 years and cultured part of the specimen. Despite various regimens for years, improvement and exacerbation were repeated, so we took another skin biopsy and cultured it in 2021. Isolates from the 2018 and 2021 lesions were identified as S. globosa by ribosomal DNA ITS sequencing (GenBank accession number: MH499862 and MH499863). The in vitro antifungal sensitivity tests were performed by broth microdilution method according to CLSI M38-A2 guidelines or Sensititre YeastOne® manufacturer's instructions. They were incubated at 30°C in a non-CO2 incubator for 7 days.

Results

In 2018, histologically, we observed chronic inflammatory granuloma comprising lymphocytes, histiocytes, and giant cells, and several spores with periodic acid-Schiff (PAS) staining. Microscopic findings and ITS sequences of rRNA gene were identical with S. globosa. The antifungal susceptibility profile in 2018 revealed sensitive to terbinafine (0.125 μg/ml), and moderate to high MIC values for amphotericin B (2 μg/ml), itraconazole (>16 μg/ml), voriconazole (>16 μg/ml), and echinocandins (>16 μg/ml). Treatment with terbinafine, itraconazole, or amphotericin B, the skin lesions were partially improved, but were not cured. In 2021, we took another skin biopsy and culture specimen. Histopathological and mycological examination results were the same as before. The antifungal susceptibility profile revealed sensitive to itraconazole (0.5/ml), and high MIC for others. Clinically, skin lesions were not improved with the use of itraconazole 200 mg/d. Itraconazole 400 mg/d with local heating induced moderate improvement. There was no evidence of immune deficiency.

Conclusion

We experienced recalcitrant sporotrichosis that did not respond to itraconazole and terbinafine, and the sensitivity of antifungal was changed. In this case, the combination treatment including local heating, saturated KI may be considered, and frequent antifungal susceptibility tests are needed.
P054 Two effects of curcumin to Candida albicans
Authors: Kajiwara Susumu , Lee Yean Sheng , Widiyanto Tria Widiasih , Chen Xinyue , Orihara Kanami , Shibata Hiroyuki
Published: September 2022

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM

 

Objectives

Candida albicans is a pathogenic yeast that causes candidiasis in immunocompromised patients. The overuse of antifungal drugs has led to the development of resistance to such drugs by this fungus, which is a major challenge in antifungal chemotherapy. The utilization of natural products is a significant trial for the development of new antifungals. Curcumin, one such natural product, has been widely studied as a drug candidate and is reported to exhibit antifungal activity against C. albicans. Although studies of the mechanism of curcumin against human cancer cells have shown that it inhibits heat shock protein 90 (Hsp90), little is known about its molecular function against C. albicans. In this work, we investigated the relationship between curcumin and Hsp90 of C. albicans.

Methods

For the molecular genetical analyses of C. albicans Hsp90, a doxycycline-mediated HSP90 strain and a HSP90-overexpressing strain of this fungus were constructed. The effect of curcumin on the gene expression of HSF1, AHR1, HOG1, and CDR1 as well as HSP90 was analyzed. Moreover, the stress responses to high temperature and osmotic pressure and the drug efflux of these strains were investigated.

Results

Curcumin reduced the transcription of HSP90 at the post-transcriptional level and it was suggested to lead to the decrease in Hsp90. This phenomenon resulted in the downregulation of HOG1 and CDR1. In addition, we confirmed curcumin also inhibited Cdr1 efflux activity in C. albicans.

Conclusion

Curcumin was suggested to influence not only HSP90 expression but also Cdr1 activity in C. albicans.
P076 The promising antimycotic activities of a novel cyclic antifungal lipopeptide against Human Dermatophyte Isolates
Authors: Ramesh Swetha , Shaw Dipika , Madduri Madhuri , Rudramurthy Shivaprakash M , Roy Utpal
Published: September 2022

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM

 

Objectives

To determine the minimum inhibitory concentrations (MICs) of a novel antifungal lipopeptide against clinical isolates of dermatophytes of human origin.

Methods

To perform antifungal susceptibility testing (AFST) by CLSI microbroth dilution method, a reversed-phase high-performance liquid chromatography (RP-HPLC) purified lipopeptide of 1071.4 Da from a wild-type soil isolate Bacillus subtilis was used and compared with the standard allylamine terbinafine MICs. Briefly, 1200 ml of cell-free culture supernatant was extracted using a solvent mixture and silica gel (230-400 mesh size)-based adsorption chromatography. The semi-preparative RP-HPLC system consisted of an Agilent quaternary pump and a variable wavelength detector equipped with a Phenomenex Luna C18 column (10 mm × 250 mm, 5 μm). The solvent system for RP- HPLC was (A) water with 0.1% trifluoroacetic acid (TFA) and (B) acetonitrile containing 0.1% TFA. The gradient of solvent B used for purification was as follows: 0%-54% for 0-20 min at the flow rate of 1 ml/min, 54%-60% from 20-48 min at 0.5 ml/min, 60%-100% from 48-58 min at 0.5 ml/min, 100%-0% from 58-65 min at 1 ml/min and monitored at 210 nm.

Results

Superficial skin infections are caused by dermatophytes including Trichophyton spp. Nowadays, resistance to terbinafine in Trichophyton spp. isolates with higher MICs have been documented in India. We report here the antifungal prowess of a novel small antifungal lipopeptide against 20 clinical isolates of Trichophyton spp. of human origins (from human skin scrapings and nails) with the clinical diagnosis of tinea corporis/cruris and tinea unguium. The representative photographs of T. tonsurans, T. rubrum, and T. mentagrophytes complex are provided below. A total of 6 isolates of T. mentagrophytes and T. rubrum carry point mutations at F397L of squalene epoxidase (SQLE) protein. The in vitro antifungal efficacies determined by AFST revealed that the lipopeptide showed less or equivalent MICs (100% inhibition) in the case of five dermatophytes. The lipopeptide drug has exhibited improved MICs against two T. mentagrophytes complex and two T. rubrum isolates with amino acid substitution F397L in SQLE protein. Trichophyton mentagrophytes complex and T. rubrum with F397L mutations were inhibited at MICs 4-32 μg/mL of terbinafine. In comparison, the lipopeptide showed 4-16 μg/ml (100% inhibition). In the case of all four Trichophyton tonsurans, the MICs ranged between 2-4 μg/ml for the lipopeptide.

Conclusions

The broad-spectrum lipopeptide showed promising antifungal activity against dermatophytes and may be considered for nano-emulsion formulation and tested for topical application in a mice model.
P092 Otilonium bromide is a potent antifungal agent against fluconazole- and flucytosine-resistant Cryptococcus neoformans strains
Authors: Zhen Cheng , Lu Hui , Jiang Yuan-ying , Yang Feng
Published: September 2022

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM

 

Objectives

Cryptococcus neoformans is a worldwide threat causing global pulmonary and systemic infections in humans. However, only three drugs are available for the treatment of cryptococcosis: fluconazole, amphotericin B, and flucytosine. Drug repurposing, the process of using a drug for an indication different from the initial indication, is an emerging approach in the discovery of new antifungal drugs. We've set out to identify repurposable drugs for cryptococossis.

Methods

We screened the United States FDA-approved drugs for antifungal activity against C. albicans lab strain SC5314. We tested the antifungal profile against major human fungal pathogens including C. neoformans. In order to uncover the mechanism of action against C. neoformans, lab strain H99 was used to evolve drug resistant adaptors. Next-generation sequencing technology was used to investigate the genome change of drug resistant adaptors. SNP calling was also performed to identify possible mutations causing drug resistance.

Results

Here we found that otilonium bromide (OTB), which is extensively used to treat patients affected by the irritable bowel syndrome, had broad-spectrum antifungal activity. OTB was active against fluconaozle-resistant and flucotysine-resistant C. neoformans strains. Furthermore, we found resistance to OTB was mostly due to duplication of chromosome 6. Further work will be on the identification of the Candidate gene on chromosome 6 which is required OTB resistance.

Conclusion

This study highlights the potential application of OTB as a new antifungal drug against C. neoformans strains susceptible or resistant to commonly used antifungal drugs.
P093 A novel GAL4-like transcriptional regulator modulate the azoles sensitivity of Exophiala dermatitidis
Authors: Zhu Yutang , Zhang Jie , Li Xiaotong , Sun Yi , Gao Lujuan
Published: September 2022

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM

 

Objectives

Exophiala dermatitidis is an emerging opportunistic pathogen among the ever-increasing numbers of immunocompromised hosts. Understanding its transmission mechanism, pathogenicity, and potential azole-resistant mechanism is important for better understanding of this fatal pathogen and benefits future diagnosis, and treatment.

By using a PCR-based fragment fusion approach, we applied phosphotransferase (HPH) resistance gene which amplified from pAN7-1 as a selective gene for generating replacement cassettes. Combined with electroporation transformation and screening on selection medium containing 50 μg/ml HMB, we obtained the gene knockout strain Δ GAL4, a novel GAL4-like transcriptional factor (XP_009154426.1) encoding gene (GeneID:20 306 783) accurately deleted.

Methods

Growth curve determination: Take 200 μL of 2 × 10⁴ CFU/ml bacterial suspension and 200 μL liquid sabourand medium in EP tubes. Shaking at 200 rpm 37°C for 0 h, 1 h, 2 h, 3 h, 4 h, 8 h, 12 h, 16 h, 18 h, 24 h, 30 h, 36 h, 48 h. Then add 200 μL cultured bacterial suspension to a 96-well plate and repeat three times. Meanwhile set up blank medium control wells. By using an enzyme marker to measure the absorbance at 504 nm, analyzing with SPSS, and then graphing with GraphPad software.

Morphological observations: Activated strains on Sabourand microcultures and incubated at 37 °C for 3d. Observe morphology by using fluorescent microscopy to compare the different strains of wild and knockout strains, and using lactic acid cotton phenol blue/fluorescent dye filming observe the morphology of conidia.

E-test drug sensitivity method: Spread fresh bacterial suspension of ΔGAL4 and ATCC34100 containing 1 × 10⁶CFU/ml spores on RPMI 1640 agar plates with sterile cotton swabs, and place drug sensitivity test strips [itraconazole (Itraconazole Liofilchem, ICZ 92148), posaconazole (Posaconazole Liofilchem (PCZ 92152), voriconazole (Mérieux, VRC 532800)] in the center plate, after sealing with a parafilm, incubating in 37°C for 36-48 h, and read the values at the tangent of the drug susceptibility strip and the antibacterial circle.

Results

The results revealed that the ΔGAL4 showed almost no difference in growth and morphology compared with wild strain, but its sensitivity to azoles was altered. We applied E-test to evaluate the MIC changes of azoles. The MIC of itraconazole, voriconazole, and posaconazole against ΔGAL4 was 0.5 μg/ml, 0.125 μg/ml, and 0.25 μg/ml; against ATCC34100 was 2 μg/ml, 0.19 μg/ml, and 0.38 μg/ml, respectively. △GAL4 MIC suggests that ∆GAL4 showed more sensitivity to azoles compared to its wild-type strain.

Conclusion

The present results suggested that a novel GAL4-like transcriptional factor may play an important role in azole sensitivity of E. dermatitidis, which may be through modulating efflux pumps or Cyp51A. Further investigation of this GAL4 related modulating pathway is needed.
P102 Nuclear magnetic resonance -based identification of metabolites in dermatophytes
Authors: Das Anupam , Baishya Bikash , Ahirwar Suresh Chandra , Singh Vikramjeet , Sen Manodeep , Mittal Vineeta , Agarwal Jyotsna
Published: September 2022

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM

 

Objectives

Nuclear magnetic resonance (NMR) spectroscopy provides a holistic snapshot of the metabolome of an organism. There is a dearth of studies till date that had exploited NMR metabolomic platform to study dermatophytes, despite its potential for rapid identification and subsequent application of the knowledge in performing faster antifungal susceptibility of dermatophytes. Here we attempted to study the frequency of various species of dermatophytes in clinically suspected cases of dermatophytosis and perform NMR-based identification of metabolites in the culture suspensions/cell extracts of T. mentagrophyte and T. rubrum.

Methods

This was a hospital-based prospective study conducted in the isolates obtained from clinically suspected cases of Dermatophytosis in the patients. Skin, nails, and hair samples of patients suspected with superficial fungal infections were processed for dermatophytes using conventional microbiological methods. NMR-based identification of metabolites was carried out in cell extracts prepared from the culture suspensions of T. mentagrophytes and T. rubrum obtained during the study from a subset of the clinical isolates from the samples.

Results

Dermatophytes were isolated in 85.88% (219/255) cases, with T. mentagrophyte being isolated in 65% (143/219) of isolates, followed by T. rubrum in 31.5% (69/219) isolates. In NMR study was done in the standard ATCC strains (T. mentagrophyte ATCC9533 and T. rubrum ATCC28188) and representative clinical isolates of both the species. Overall, 24 metabolites were identified in T. rubrum and 23 metabolites in T. mentagrophyte amongst which 22 metabolites were common to both fungus, however, ‘4-hydroxyproline’ and ‘acetate’ was found specific to T. rubrum, and ‘allantoin’ was found specific to T. mentagrophyte.

Conclusion

T. mentagrophyte was the predmominant dermatophyte species in the study. Amongst the number of metabolites detected in T. rubrum and T. mentagrophyte, ‘4-hydroxyproline’ and ‘acetate’ was found specific to T. rubrum, and ‘allantoin’ was found specific to T. mentagrophyte. These specific metabolites could be useful for as early identification of these dermatophytes as well early determination of antifungal susceptibility by using metabolic endpoints, further large-scale study will be helpful in this regard.
P106 A dermoscopic finding of Tinea capitis caused by Microsporum canis
Authors: Jeong Eunhye , Yim Jeongeun , Kwon Hyeongmok , Shin Donghoon , Choi Jongsoo
Published: September 2022

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM

 

Objectives

Tinea capitis is a relatively common disease, and the mycological examination is the gold standard for diagnosis. However, the probability of false negative on the KOH test is up to 40% and culture examination takes a long time for diagnosis. The characteristic pattern of dermoscopy not only aids in diagnosis, but also enables early treatment.

Methods

We evaluated six patients who were diagnosed with tinea capitis through clinical and dermoscopic findings. The images of the lesions were taken with a digital camera (Nikon, HB-42) and photographed with dermoscopy (Dermlite Foto 2 Pro) from the patients. The pictures were obtained by taking multiple focal points with dermoscopy. The comma, corkscrew, Morsecode-like, zig-zag, and bent hairs were observed as the main findings.

Results

The dermoscopic finding was seen with overlapping of various findings in each of the patients. Upon dermoscopy, the most common findings were the corkscrew hair (66%) and the bent hair (66%). The comma hair (33%) and the proximal white shaft hair (33%) were less frequently observed and zigzag hair and Morse-code like hair were not seen in six patients. In the photograph taken with a camera, findings considered to be dermoscopic features such as corkscrew hair or comma hair were not observed.

Conclusion

It is important for dermatologists to consider that abnormal findings in dermoscopy can play an important role in diagnosing Tinea capitis. And it will help in early treatment and prevent the progression of complications. Here in, we report specific dermoscopic findings which can narrow down the differential diagnosis.
P137 Remote inoculation mycosis: Rip Van Winkle wakes up
Authors: Soman Rajeev , Chakraborty Sourabh , Jeloka Tarun , Joe Geethu , Ramchandani Nandini , Kaur Harsimran
Published: September 2022

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM

 

Objective

After immunosuppression, a remotely inoculated organism may be activated to produce clinical disease. We describe such a case with infection due to Medicopsis romeroi, a rare mold.

Patient and Methods

A 54-year-old male, diabetic, hypertensive, status post-live related donor renal transplantation, done in February 2021. The patient was on standard triple immunosuppressant regimen. He developed a painless nodule on his thumb over 5 months which did not respond to multiple courses of antibiotics. The swelling was excised and sent for various tests. Review of USG after infectious disease referral, showed a small foreign body, like a wooden splinter in the wall of the lesion (Fig. 1). On inquiry, a 3 mm wooden splinter in the lesion was noted during surgery and there was an injury at the same site, 20 years ago when the patient used to work on a farm. Organisms derived from soil or thorn injury including bacterial and fungal organisms were considered in the differential diagnosis. Bacterial organisms were considered less likely as there was no response to antibiotics.

Results

Histopathology showed brownish septate hyphae with constrictions at the areas of septations (Fig. 2). The excised tissue grew a dematiaceous mold. In Lactophenol Cotton Blue (LPCB) mount branched, septate hyphae with sparse conidia were seen. MALDI- TOF MS was unable to identify the mold. Sequencing identified it as M. romeroi. There are no ECOFFs or break points (BP) available for M. romeroi. Minimum inhibitory concentration (MIC) of Voriconazole (VCZ) is reportedly low and hence was chosen for treatment with an appropriate dose adjustment of Tacrolimus.

Conclusion

This case underscores that remote inoculation, when the patient was immunocompetent, could have introduced a mold, which remained latent and reactivated after immunosuppression. Sending excised tissue for appropriate tests is rewarding. Medicopsis romeroi is a rare mold with only 12 cases reported so far. It is difficult to identify except with sequencing. There is no standard guidance on treatment. Surgical excision along with prolonged treatment with one of the new azoles is beneficial.
P148 Emerging and cryptic Aspergillus species isolated from hospitalized patients with underlying primary immunodeficiencies
Authors: Aneke Chioma , Youn Jung-Ho , Khil Pavel , Seyedmousavi Phd Amir
Published: September 2022

Poster session 2 September 22 2022 12:30 PM - 1:30 PM

 

Objectives

Although Aspergillus fumigatus is the most common etiologic agent of invasive aspergillosis multiple poorly recognized non-fumigatus species have been reported from patients with iatrogenic immunosuppression and individuals with underlying primary immunodeficiencies (PIDs). The species-level identification of causative agents and the determination of antifungal susceptibility patterns can play significant roles in the outcome of aspergillosis. In the current study we aimed to investigate the frequency of non-fumigatus Aspergillus species isolated from hospitalized patients with PIDs at National Institutes of Health (NIH) Clinical Center Bethesda MD USA.

Methods

In a prospective study between January 2019 and December 2021 a total of 279 Aspergillus species were isolated from NIH hospitalized patients with underlying PIDs. The species-level identification of each isolate was attempted by colony morphology microscopic characteristics matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF) and PCR-sequencing of the internal transcribed spacer (ITS) region of ribosomal DNA the β-tubulin and Calmodulin (CaM) genes.

Results

Overall members of Aspergillus section Fumigati were the most common group (71%) followed by section Veriscolores (7%) section Usti (4%) section Tanneri (4%) section Terrei (3%) section Nigri (3%) and section Nidulantes (3%). Aspergillus species belong to sections Falvi Clavati Flavipedes and Circumdati were less frequent and each counted for only 1% of the total isolates identified.

Notably cryptic and non-fumigatus members of section Fumigati comprised only 12% of the isolates including A. felis A. udagawae A. lentulus A. thermomutatus A. viridinutans, and A. pseudoviridinutans while A. fumigatus was the dominant species (88%).

MALDI-TOF assay was able to properly differentiate sections of Aspergillus from each other. However PCR-sequencing of the β-tubulin gene was the most reliable target to separate the cryptic species of each section.

Conclusion

Our study shows that frequency of rare and cryptic Aspergillus species that primarily affect patients with PIDs may significantly differ from those with acquired immunodeficiencies.

Due to their lower susceptibility to available antifungal agents than A. fumigatus correct and prompt identification at the species level is critical for appropriate therapy to improve patient outcomes.

In addition DNA sequence-based species identification targeting β-tubulin gene is more accurate than ITS and CaM genes and using MALDI-TOF to differentiate the emerging and cryptic Aspergillus species.
P150 Profile of Candidemia in a national level HAI Surveillance Network of India
Authors: Srivastav Sharad , Puraswani Mamta , Tewari Prachi , Mathur Purva
Published: September 2022

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM

 

Background

Candida is responsible for roughly 96% of all opportunistic mycoses and is a major cause of bloodstream infections (BSIs). The potential for nosocomial spread of Candidemia infections is a new concern concurrent with the rapid expansion of intensive care facilities for COVID-19 patients. With the pandemic of COVID-19 now moving into 2022, it is understood that critically ill COVID-infected patients in the ICUs are commonly infected with highly resistant bacterial and fungal infections.

Objective

To estimate the incidence rates and compare the epidemiology of candidemia in COVID infected and non-infected patients requiring ICU care.

Methodology

In this 2-year retrospective multicentric study, we present the findings on candidemia from the Healthcare-Associated Infections (HAI) surveillance network which includes 40 hospitals across India and with special emphasis on differences in the epidemiology of Candidemia in COVID infected and non-infected patients in the pre-COVID (April 2019 to April 2020) and COVID times (April 2020 to April 2021) across this network. We compared the incidence of candidemia between COVID infected and non-infected patients using Poisson regression analysis. Chi-squared (χ2) test was used to test for differences in variables such as gender and 14-day mortality between the patients and Wilcoxon rank-sum (Mann-Whitney) test was used to compare median between the patients.

Results

A total of 628 patients with candidemia were screened from HAI Surveillance Database where 68 patients are COVID infected and 560 non-infected patients from both pre-COVID and COVID periods. Incidence of Candida-associated BSI increased significantly from 1.47 (95% CI, 1.35-1.60) to 3.08 (95% CI, 2.38-3.92) in non-infected and COVID-infected patients respectively, while in CLABSI the rates increased from 2.62 (95% CI, 2.34-2.92) in non-infected to 5.99 (95% CI, 4.30-8.12) in COVID-infected patients. COVID infected patients in the age group (>60 years) were significantly more prone to candidemia compared to non-infected patients. During the COVID period, the maximum time for candidemia to develop (from the time of ICU admission) in COVID-infected patients was shorter (<65 days) than in non-infected patients (>90 days).

Conclusion

We observed an increased incidence of candidemia in hospitalized patients during the COVID period compared with the same during the pre-COVID period.
P155 A Mexican case series of COVID-19 - associated pulmonary aspergillosis
Authors: Perales-Martinez Diana , Ruiz-Quiñones Jesus , de Jesús Barrientos-Flores Corazón , Aguilar-zapata Daniel
Published: September 2022

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM

The pandemic coronavirus disease 2019 (COVID-19) has been in the scope for invasive pulmonary aspergillosis (IPA) after the first reports worldwide, now known as CAPA.

Objective

to describe a case series of CAPA documented in four intensive care units while treating patients with severe COVID-19 pneumonia in order to describe clinical characteristics, cultures result and MICs from Aspergillus isolations, and treatments.

Methods

A prospective and descriptive study was performed from March 2020 to February 2022 in four tertiary level hospitals that treated COVID-19 patients in Mexico. We followed every single culture coming from the COVID-19 ICU, Aspergillus positive cultures had morphologic identification, and the MICs were obtained by broth microdilution. We did not interfere in the treatment.

Results

During 24 months of follow-up of patients with severe COVID-19 we found 17 adult cases with a mold identification, from those, 14 patients fit in the possible CAPA definition according to ECMM/ISHAM, and the remaining 3 were treated after expert opinion. The baseline characteristics of overall 47% had diabetes, and 41% were obese. Of the 14 cases included as a possible CAPA all of them had acute severe respiratory syndrome (average PaO2/FiO2 134 mmHg), 64% were in prone position, 78% had steroids at ICU admission, 92% had antibiotics at ICU. The computed tomography pattern predominantly associated were pulmonary infiltrates, nodules and cavitation. Only 2 patients (14%) had a positive galactomannan (>4.5) from non-bronchoscopic lavage. We had 9 Aspergillus fumigatus isolations and 4 A. niger, 1 A. flavus, 6 patients received voriconazole, 3 patients received isavuconazole, 1 anidulafungin and liposomal amphotericin B were used in 1 patient each respectively. The predominant MIC from isolations were ≥64 μg/ml for fluconazole, and <0.5 μg/ml for voriconazole, also all of them had MIC equal or <0.75 μg/ml for isavuconazole and 0.015 μg/ml for anidulafungin. A total of 50% of the patients had a CAPA-related death.

Conclusions

CAPA is still a difficult entity to think of for diagnosis and treatment in severely ill COVID-19 patients. What predominates like other series were obesity, use of steroids, and ARDS. The contribution of small Mexican series like ours (based on the new guidelines) will allow to understand that CAPA could be no longer a rare fungal infectious disease complication in severely ill COVID-19 patients. An extended consensus must be made for those possible CAPA definition cases.
P158 Epidemiology of aspergillosis in Kuwait: a nationwide study
Authors: Alobaid Khaled , Asadzadeh Mohammad
Published: September 2022

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM

 

Objectives

Aspergillus is the most common filamentous fungi involved in human infections. It is characterized by causing various forms of clinical presentations, ie, invasive, chronic, and allergic forms. It is associated with considerable morbidity and mortality. In spite of this, the epidemiology of Aspergillus infections is scarce in Kuwait. This study aims to describe the epidemiology of aspergillosis in Kuwait on a national scale.

Methods

This is a 2-year retrospective observational study designed to analyze the demographic and mycological data on all Aspergillus isolates derived from clinical samples processed or submitted to the Mycology reference laboratory (MRL) by all government microbiology laboratories in Kuwait. Using the Mycology reference laboratory surveillance system, the required data was collected. It covers patients’ age, gender, type of clinical samples, care settings (outpatient, wards, or ICU), the name of the Aspergillus species, and antifungal susceptibility for Aspergillus fumigatus. Species-level identification of Aspergillus was mostly based on morphological characteristics, except in a few cases where MALDI-TOF or PCR-sequencing of rDNA were performed. Antifungal susceptibility testing was done using Etest method according to manufacturer instructions. EUCAST clinical breakpoints were followed for the interpretation of antifungal susceptibility results for A. fumigatus species.

Results

In total, 327 Aspergillus isolates from 277 patients were found. A total of 34/277 patients had 2 or more samples yielding either the same Aspergillus spp. (n = 17) or a different species (n = 17). The most prevalent type of clinical specimens was respiratory sample (n = 196, 60%), followed by ear swabs (n = 64, 19.6%), and nails (n = 24, 7.3%). A. niger (n = 147) was the most isolated species, involving 45% of aspergillosis cases followed by four other species including A. fumigatus (n = 64), A. flavus (n = 55), A. terreus (n = 38), and A. nidulans (n = 13). A total of 10 cases were caused by rare Aspergillus spp. All A. fumigatus isolates were susceptible to voriconazole. Itraconazole also exhibited excellent in vitro activity against nearly all A. fumigatus except 4 isolates that were resistant.

Conclusions

This study reveals the epidemiology of aspergillosis from several perspectives. It gives some insights on the burden of Aspergillosis in Kuwait, especially during the COVID-19 pandemic. Respiratory samples were the predominant positive samples suggesting high rates of pulmonary aspergillosis. A. niger, not A. fumigatus or A. flavus, is the most prevalent agent of aspergillosis in Kuwait. Azole resistance is rare among A. fumigatus. Further studies are needed to explore the spectrum of clinical presentations with special emphasis on pulmonary aspergillosis.
P166 Traumatic implantation keratitis with Schizophyllum commune in Central India
Authors: Bhadade Arati , Tadepalli Karuna , Maurya Anand Kumar , Sharma Bhavana
Published: September 2022

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM

 

Objectives

Documentation and dissemination of findings of difficult-to-treat fungal isolate in cases of Keratitis.

Methods

Both the cases received in 2019 and 2021 were followed and consent from the patient was obtained for documentation.

Case 1: A 30-year-old farmer from Raisen, Madhya Pradesh was admitted to AIIMS, Bhopal on December 16, 2019. He presented with eye ache, watering of eyes, and diminution of vision for 15 days. On day0 (D0) December 2, 2019 trauma to the eye by husk, diminution of vision and other symptoms and consulted nearby hospital, and started medication on D06. With symptoms worsening on D14 he was admitted to AIIMS Bhopal. Same day corneal scrapping on KOH mount showed branched septate hyaline hyphae. Culture showed on D20 whitish wooly growth with central pale to pinkish growth. On LBCB mount hyaline septate hyphae with no sporulation and clamp connections observed. Based on whitish growth with raised fanning hairy structures and on microscopy some spicules tear drop like structures and resemblance as clamp connections no other sporulation provisional diagnosis of Schizophyllum species was given. Patient's condition worsened with no response to azoles and therapeutic keratoplasty was done.

Case 2: A 56-year-old female sufffered trauma with a leaf. Around D10 was admitted in ophthalmology department of AIIMS, Bhopal with left corneal ulcer and hypopyon. Corneal scrapping was sent but no fungal elements were seen. After 15 days white fluffy growth was observed on SDA with chloramphenicol. On LPCB mount it showed no sporulation and parallel hyphae with clamp connections were observed. Therapeutic keratoplasty was done. Graft failed and condition worsened. No response to intracameral voriconazole. Patient lost vision in both eyes. Case was identified as fungal keratitis with suspected Basidiomycetes Schizophyllum species.

Both the isolates were confirmed from PGIMER Reference Center at Chandigarh.

Result

In both cases surgical intervention was essential but therapeutic keratoplasty failed.

Conclusion

Recently surge in cases with Schizophyllum commune is observed with difficult management, Failure of therapeutic keratoplasty and infection of graft is a challenge.
P167 Fungemia in neonatal ICU of a pediatric hospital in NE India
Authors: Bidyalakshmi Microbiology Yendrembam , Ratankumar Kh , Priyolakshmi N. , Reena K. , Aindrilla
Published: September 2022

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM

 

Objectives

To determine the prevalence of fungemia in a neonatal intensive care unit (NICU) during a period of 4 years and 4 months (January 2018 to April 2022) and to identify the causative fungal pathogens and analyze the associated risk factors.

Methods

A retrospective study was conducted by collecting records of neonatal fungemia occurring in 17 bedded NICU of Mother's Care Children Hospital and Research Centre, Imphal. Cases were identified by searching of computerized microbiology blood culture database. Blood cultures were carried out using automated BacT/ALERT(Biomerieux). Whenever flagged positive, immediate gram staining and subculture were carried in Blood agar, SDA, and MacConkey agar. The isolates were identified by their morphology, germ tube test, and biochemical test in VITEK-2 (Biomeriux) system. Antifungal susceptibility testing too was carried out in VITEK-2.

Results

A total of 2621 blood samples in pediatric blood culture bottles were received from NICU during this period of 4 years and 4 months. 21 samples showed growth of yeast cells. The isolates include Candida parapsilosis (10), C. albicans (7), Wickerhaemomyces anomalas (3), and C. krusei (1). Low birth weight, premature rupture of membrane, antibiotic therapy, and prolonged hospital stay were main risk factors. Majority of the neonates recovered with antifungal treatment.

Conclusion

Candida parapsilosis was isolated with highest frequency. Fungemia is more common in low birth weight babies.
P173 PK PD rationale and efficacy of isavuconazole treatment after failure of amphotericin B and posaconazole for COVID-19 associated cranial Mucormycosis
Authors: Soman Rajeev , Chakraborty Sourabh , Joe Geethu , Purandare Bharat , Joshi Rasika , Patwardhan Sampada
Published: September 2022

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM

 

Objective

This case series describes our experience of using isavuconazole (ISVCZ), along with TDM, after the failure of treatment with Amphotericin B (AmB) and Posaconazole (PCZ) due to the better PK PD properties of ISVCZ.

Patients and methods

There were 6 patients with ROCM who had disease progression despite surgical debridement and adequate treatment with AmB and PCZ. Anti-fungal treatment was switched to ISVCZ which achieves levels in brain (1.86x)R and in bone-marrow (3x)R as compared to serum levelsR.

Results

PK PD considerations for ISVCZ treatment considering the likely levels in brain and bone-marrow and the MIC of majority of Mucoralean molds as ≤4R

Table 1

Table 2

Results of treatment

Conclusion

Treatment with ISVCZ may mitigate some of the challenges in ROCM due to its PK PD properties. TDM for ISVCZ is not routinely recommended, but could be used to ensure high plasma exposures and enhanced penetration to the site of infection. Our results are encouraging although there are several limitations of a case series, confounding variables involved, and the use of ISVCZ as salvage after failure of previous treatment.

Clinical success in this series suggests that extrapolative PK PD considerations in using ISVCZ for such ‘difficult to treat’ patients may be justified.
P177 A Psittacine bite and subcutaneous Zygomycosis in immune competent: Case with therapeutic challenge
Authors: Choubey Shivani , Karuna Tadepalli , Asati Dinesh P. , Khadanga Sagar , Garg Rahul
Published: September 2022

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM

 

Objectives

Primary objective: To document a case of subcutaneous zygomycosis following a Psittacine bite in an immune-competent in India.

Secondary objective: To follow-up the case till microbiological and clinical cure.

Method

A case report entry prospectively carried out during 1.5 years of hospital visit of the patient with subcutaneous zygomycosis. This had ethical approval and patient consent obtained. A detailed account of case progression from date of first hospital admission to final cure was noted. A 56-year-old female from Vidisha in Madhya Pradesh India, apparently well 2 years back following a wild parrot bite on her back, causing an initial ulcer on infrascapular area gradually spreading bilaterally visited outpatient department of AIIMS, Bhopal. With prominent weight loss and non-healing ulcer; asymptomatic initially, ruptured spontaneously formed sinuses with exudate. Nodules and spontaneous rupture of nodule were mentioned. Provisional clinical differential diagnoses were nocardiosis, deep fungal infection, and Phagedenic ulcer. Tissue biopsy sent for microbiological and histopathological evaluation showed broad pauciseptate hyphae with right angle branching and bulging on direct microscopy suggesting subcutaneous zygomycosis. Histopathology H&E, and PAS showed similar morphology. A second sample sent was exudate from infrascapular region and showed broad pauciseptate hyphae with buildings on KOH mount. The patient was treated and discharged with some relief. Noncompliance to prescribed antifungal led to progression and horizontal spread forming plaque within months. A saturated solution of potassium iodide (SSKI) and itraconazole started. Lesions improved. The patient was again non-compliant and the lesions increased in size. The patient was reviewed again for the exacerbation and worsening. Around Day 10; SDA with chloramphenicol showed whitish growth with satellite colonies and LPCB showed broad quasi-septate hyaline hyphae, sporangia elongated, and beak with rounded zygospores suggesting Basidiobolus species. The patient received itraconazole, SSKI, and terbinafine. Species confirmation as Basidiobolus ranarum from PGIMER Chandigarh Mycology Reference center India was done.

Results

After 1.5 years, clinical improvement and final biopsy showed no growth and microscopy negative. The patient is on regular follow-up.

Conclusion

This study highlights the traumatic implantation and zoonotic potential of fungal species. Clinical suspicion of fungal etiology and timely mycology laboratory diagnostic support is key to address such cases.
P195 Factors related to outcome of bloodstream infections due to Candida parapsilosis complex: A single center observation study from Central India
Authors: Garg Rahul , Das Padma , Wankhade Archana B. , Agarwala Pragya , Behera Sibani
Published: September 2022

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM

 

Objectives

Candida parapsilosis infection has recently emerged as an important antifungal-resistant nosocomial pathogen having the unique ability to grow on inanimate objects and surfaces. Very limited studies from low and middle-income countries are available on the association of risk factors and antifungal susceptibility testing (AFST) of this species. The aim of this study was to analyze the predisposing conditions, outcome, and antifungal susceptibility pattern of candidemia due to C. parapsilsosis complex.

Methods

A single-center retrospective observational study from January 2019 to December 2021 of all cases of candidemia was carried out at an 890-bedded University Hospital in central India. Data regarding demographic characteristics and clinical risk factors were collected from the patient's medical records. Antifungal susceptibility testing was performed; MIC results were interpreted according to CLSI breakpoints (M27-A3). Risk factors and outcome association at the species level were analyzed by using Fisher's exact test. Variables with a P ≤ .05 at the descriptive analysis were analyzed by Cox regression. A P-value of ≤ .05 was considered to represent the statistical significance and all statistical tests were two-tailed.

Results

Of 211 patients diagnosed with Candidemia during the study period, 53 (25.1%) were infected with C. parapsilosis which represented the second most frequently isolated yeast after C. albicans (n = 98; 46.4%). A total of 26 (49%) C. parapsilosis isolates were non-susceptible to fluconazole (NSF), which included resistant (n  =  20) and susceptible dose-dependent (n  =  06) isolates. The median patient age was 63 years.15.3% were neonates. The majority of patients (90%) suffered from multiple comorbidities, diabetes mellitus (43%) being the commonest. A total of 55% of patients underwent surgical intervention within 30 days from the onset of candidemia. Univariate logistic regression revealed that ICU admission [odds ratio (OR) 2.45], central venous catheter use (OR 2.46), renal impairment (OR 1.687) were more common among NSF isolates than fluconazole-susceptible (FS) isolates (all P <.05). The overall crude mortality at 30 days was 36%; higher in patients infected with FNS isolates than FS isolates.

Conclusion

There is an increase in the absolute number of invasive infections by C.parapsilosis observed over the past 2 years. At this moment, the percentage of fluconazole non-susceptible C. parapsilosis is very high and poses a threat to infected patients and has a clinical impact in our hospital. Being able to identify and treat infections caused by this pathogen is important to prevent clinical outbreaks.
P212 Fatal invasive aspergillosis in a child with Chronic Granulomatous disease; a case report
Authors: Ahmadi Bahram , Sarvestani Hasti Kamali , Ansari Saham
Published: September 2022

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM

 

 

In this article, we have reported a case of invasive aspergillosis in an 8-year-old boy with chronic granulomatous disease, who presented with pleural effusion and pneumonia, cerebral venous sinus thrombosis, and unusual skin lesions (Fig. 1) caused by Aspergillus fumigatus (Fig. 2). The patient received recombinant human interferon-γ subcutaneously (1-2 doses in even days) and antimicrobial prophylaxis, including itraconazole (100 mg/d), cotrimoxazole (5 mg trimethoprim/kg body weight/d), and ofloxacin (3 times a week, 200 mg), during hospitalization.

It is noteworthy that treatment was immediately started according to the direct examination results. Due to the MRI findings suggestive of brain abscesses and brain edema, empirical amphotericin and voriconazole were started. The in vitro antifungal susceptibility tests (AFST) of A. fumigatus utilized the microbroth dilution method of the Clinical and Laboratory Standards Institute (CLSI) M38-A2 protocol for five antifungal agents including; voriconazole, itraconazole, fluconazole, caspofungin, and amphotericin B, that the minimum inhibitory concentrations (MIC) of antifungal agents were 0.25, 1, 16, 0.125, and 4 mg/L, respectively. Voriconazole and caspofungin were shown to be the most potent antifungal drugs against this A. fumigatus strain. On the other hand, the IDSA protocols recommend voriconazole as the initial therapy of invasive aspergillosis in most patients. So, in response to the results of antifungal susceptibility testing, treatment was switched to voriconazole at the dose of 100 mg twice a day (taken every 12 h), and interferon-γ subcutaneously (1-3 doses in even days) was introduced. Unfortunately, the patient passed away due to cerebral venous sinus thrombosis (CVST), and intracerebral hemorrhage (ICH) following increased intracranial pressure (ICP) after 1 month.

In conclusion, we have reported a case in which a patient who came with pleural effusion and pneumonia in the chest x-ray, CVST, and unusual skin lesion caused by A. fumigatus expired after one month. Our report suggests the importance of early diagnosis in children presenting with invasive fungal infections particularly, those involving the central nervous system.
P219 Fungal keratitis caused by Pseudallescheria boydii: Clinical and mycological characteristics
Authors: Khodavaisy Sadegh , Izadi Alireza , Soleimani Mohammad , Santos Claudy Oliveira dos , Tehupeiory-Kooreman Marlou C. , Mousavi Seyed Amin Ayatollai , Ghazvini Roshanak Daie , Hashemi Seyed Jamal , Aminizadeh Mehdi , Abedinifar Zohre , Verweij Paul E.
Published: September 2022

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM

 

Objectives

Pseudallescheria boydii keratitis is rare but important type of fungal keratitis because of the inherently resistance of the organism to many existing antifungal agents. We present the clinical characteristics, risk factors, treatment, and prognosis of patients with P. boydii keratitis, and also present the antifungal sensitivities of the isolated strain.

Methods

Slit-lamp and confocal microscopy were used for clinical examinations. Fungal isolates were identified based on morphological characteristics and DNA sequence of the internal transcribed spacer region (ITS). In vitro antifungal susceptibility testing for fungal isolates was performed according to the Clinical and Laboratory Standards Institute (CLSI).

Results

Pseudallescheria boydii was identified in four patients. All patients had a history of ocular trauma. In clinical examination hypopyon was seen in three patients. The main antifungal medications were oral and topical voriconazole. After treatment the visual activity of all patients improved in 2-3 weeks.

Conclusion

These patients bold the importance of determining causative organism of fungal keratitis and their antibiotic susceptibility. Culture findings are limited in identifying organisms. Sequencing of polymerase chain reaction-amplified DNA is good for accurate and rapid identification of species that can be helpful for optimizing treatment.