bluuebunny/crossref_metadata_2025 huggingface dataset:
P070 Antimicrobial peptides from the Coleoptera family Scarabaeidae against Candida and Cryptococcus pathogenic yeasts.
Authors: Toro Lily J. , Rodriguez Melissa , Gómez Beatriz L. , Firacative Carolina , Andreu David , Valle Javier , Santiago Bruno Rivas , Tellez German A. , Henao Diana C. , Castaño Jhon C. , Muñoz Julian E.
Published: September 2022

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

 

Objectives

Host defense peptides (HDP) are produced by a diversity of beetles. The aims of this work were (1) to find new promising peptides from the Coleoptera family Scarabaeidae with potential biomedical applications, (2) to modify physicochemical and structural characteristics of one of the most promissory peptides in order to improve its antimicrobial properties, and (3) to evaluate the in vitro activity of the HDPs against reference strains of pathogenic Candida and Cryptococcus yeasts.

Materials and Methods

From the Scarabaeidae family transcriptome, 14 promising HDPs were identified. Subsequently, we designed 19 new sequences from Act8 peptide modifying the net charge, hydrophobic angle, and the general composition of amino acids, among other properties, in order to improve the HDPs antifungal activity. The in vitro antifungal susceptibility of the 33 HDPs against C. albicans SC5314, C. krusei, ATCC 6558, C. parapsilosis ATCC 22019, C. glabrata ATCC 2001, C. tropicalis ATCC 750, C. neoformans H99, and C. gattii H0058-I-2029 isolates were evaluated by broth microdilution, with a concentration ranging from 0.19 to 50 μg/ml.

Results

All 14 peptides identified showed in vitro activity against C. krusei, C. parapsilosis, and C. glabrata. One peptide showed in vitro activity against C. albicans, 6 against C. tropicalis, 11 against C. neoformans and 13 against C. gattii. As well the 19 modified peptides showed in vitro activity against C. krusei, C. parapsilosis, C. tropicalis, C. neoformans, and C. gattii. A total of 15 modified peptides showed in vitro activity against C. albicans, and 3 against C. glabrata. MIC ranges per species and per peptide are shown in Table 1.

Conclusions

The HDPs herein analyzed showed a significant in vitro antifungal activity against six Candida and two Cryptococcus pathogenic species. Our findings encourage further work with in vivo experimental models in order to better understand the action mechanisms of these antimicrobial peptides. HDPs from different species are becoming a promising therapeutic alternative in the control of fungal infections.
P081 Azole-resistant Aspergillus fumigatus among NIH hospitalized patients with underlying primary immunodeficiencies
Authors: Seyedmousavi Amir , Youn Jung-Ho , Khil Pavel , Shahegh Sherin , Kwon-Chung K.J. , Zelazny Adrian , Lionakis M
Published: September 2022

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

 

Objectives

Aspergillus fumigatus causes a variety of diseases in humans. The drugs recommended for treatment of Aspergillus diseases are the mold-active azole antifungals. However, a wide range of mutations in A. fumigatus confers azole resistance, which commonly involves modifications in the cyp51Agene, the target for azole antifungal drugs.

Methods

We investigated 255 clinical A. fumigatus isolates obtained from patients hospitalized at National Institutes of Health Clinical Center, Bethesda, Maryland, USA. The species-level identification of each isolate was evaluated by colony morphology, microscopic characteristics, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF), and PCR-sequencing of the β-tubulin gene. We also studied sequence-based analysis of the Cyp51A gene for the azole-resistant isolates.

The azole antifungal susceptibility profile of each isolate was initially evaluated using 4-well triazole screen plates (Microbiology Associates LLC, Rockville, MD, USA) containing itraconazole (4 μg/ml), voriconazole (2 μg/ml), posaconazole (0.5 μg/ml), and growth control. The full array of antifungal susceptibility was confirmed using microbroth dilution method according to Clinical and Laboratory Standards Institute CLSI M38-A3 guidelines.

Results

Of 255 A. fumigatus isolates, 12 grew on the wells containing azoles, indicating an azole-resistant phenotype. The results were read and recorded after 24 and 48 h of incubation at 35-37°C. Majority of our isolates had visible growth at 24 h. Sequence analysis of the CYP51A gene indicated the presence of M220K mutation in all 12 isolates and no mutations in the other isolates.

The fact that the azole resistance was found in A. fumigatus isolated from patients with previous azole exposure, underscores the possibility that prevalence of azole-resistance might be underestimated in various patient populations because in-vitro susceptibility testing of A. fumigatus is not routinely performed.

Conclusion

In conclusion, prevalence of azole resistance in clinical A. fumigatus isolates obtained from NIH patients underlying primary immunodeficiencies was 4.7%; all the resistant isolates exhibited azole-resistance mutation in Cyp51A gene.

Our finding adds to the growing list of regions where acquired resistance in A. fumigatus of is documented. Our results also indicate that 4-well triazole screen plates are a reliable tool for azole-resistance screening and the selection of isolates that require a full panel of antifungal susceptibility testing.
P100 Potent inhibition of dermatophyte fungi by Australian native jarrah honey
Authors: Fernandes Kenya , Guttentag Annabel , Susantio Daniel , Carter Dee
Published: September 2022

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

 

Objectives

Honey has been used as a remedy for multiple ailments, and the antibacterial activity of many different floral honeys has been extensively explored. The capacity of honey to inhibit fungi is much less well understood. Here we investigate the inhibition of dermatophyte species by native Australian jarrah honey.

Methods

Jarrah honey was sourced from beekeepers and commercial suppliers. Artificial honey, made from glucose (22.9%), fructose (20.7%), and sucrose (1.6%), was used to control for osmolarity. Hydrogen peroxide production by honey was assessed using horseradish peroxidase (HRP)/ο-dianisidine colorimetric test. Dermatophytes included Microsporum canis, M. nanum, Nannizzia gypsea, Trichophyton interdigitale, T. rubrum, and T. tonsurans. Minimum inhibitory concentrations (MICs) and minimum fungicidal concentrations (MFCs) for honey were assessed using CLSI methods. Fluorescent and scanning electron microscopy were used to visualize the effect of honey on fungal conidia and hyphae.

Results

Jarrah honey inhibited all of the dermatophyte species with MICs ranging from 1.5-3.5% w/v, and MFCs from 2-5% w/v. No antifungal activity was seen with the artificial honey indicating this was not due to osmolarity. Microscopy revealed honey treatment prevented the germination of conidia and caused hyphae to bulge and collapse. While the inhibitory action of jarrah honey was greatly reduced by the addition of catalase suggesting hydrogen peroxide production was responsible for inhibition and killing, microscopy revealed hyphae were still damaged suggesting there are agents within honey that augment antifungal activity. REDOX fluorophores failed to detect internal oxidative stress within hyphae, indicating that damage likely occurs on the hyphal surface.

Conclusion

Jarrah honey is a non-toxic agent that may have utility in the treatment of superficial fungal infections caused by dermatophyte fungal species.
P159 The impact of COVID-19 pandemic on invasive Candida auris infections in Kuwait
Authors: Al-Wathiqi Faten , Alabdallah Alaa , Alobaid Khaled
Published: September 2022

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

 

Objectives

To evaluate the impact of the coronavirus disease (COVID-19) pandemic on the incidence of Candida auris invasive infections at a national level.

Methods

This is a laboratory-based, three years-period retrospective study. The demographic and mycological data were obtained from the mycology reference laboratory (MRL) active surveillance system. The number of C. auris blood isolates was retrieved for the following years: 2019, 2020, and 2021. C. auris blood isolates from all hospitals were sent to the MRL as part of patient care. Species-level identification was confirmed by chromogenic media, VITEK 2 yeast identification system, and/or MALDI-TOF MS (VITEK MS). Antifungal susceptibility was performed using Etest according to manufacturer instructions. The following antifungal agents were tested: amphotericin B, fluconazole, voriconazole, and caspofungin. If the strain was resistant or intermediate to caspofungin, other echinocandins (micafungin or anidulafungin) were tested for confirmation. Since there were no established clinical breakpoints for C. auris, tentative minimum inhibitory concentrations were used based on experts’ opinions. Incidence rates of COVID-19 during the years 2020 and 2021 (COVID-19) were obtained from the World Health Organization website. All data were numerically coded and labelled for each variable using Microsoft Excel (Version 16.57, 2021), then analyzed by SAS 9.4 (SAS Institute., USA). P-value <.05 was considered statistically significant.

Results

A total of 307 samples isolated from invasive infections were reported with C. auris in this study (50 in 2019, 102 in 2020, and 155 in 2021). The number of patients reported with C. auris invasive infection increased significantly (P <.05) from 50 in 2019 (pre-COVID-19) to 155 in 2021 (post-COVID-19). This was associated with the waves of the COVID-19 pandemic in Kuwait. Of 307 C. auris isolates tested, all were resistant to fluconazole. Resistance to amphotericin B and caspofungin was 29/307 (9%) and 3/285 (1%) respectively.

Conclusion

Patients infected with COVID-19 are at considerable risk of invasive candidiasis especially critically ill patients staying in ICU. The significant increase in C. auris invasive infections as seen during this pandemic clearly demonstrates the great ability of this opportunistic pathogen to cause secondary lethal infections among COVID-19 patients. In addition, the spread of C. auris among patients in care facilities results in outbreaks, which further compromises the health care services and threatens patient safety. Therefore, a greater understanding of its epidemiology and awareness among healthcare staff about its identification methods, antifungal resistance profile and infection control measures are essential to improve outcomes and prevent further hospital transmission.
P198 Persistent Fungemia with Candida auris in a patient with enterocutaneous fistula
Authors: Gohel Swati
Published: September 2022

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

 

Objective

Candida auris (C. auris) is a major emerging threat to the healthcare sector in view of the difficulty in early identification by standard methods, multidrug resistance, and ease of spread in healthcare settings. Here, we report a case of persistent C. auris fungemia (>2 months) in a patient with enterocutaneous fistula.

Methods

A 57-year-old man without any comorbidities underwent surgery for diverticular perforation which was complicated by intra-abdominal abscesses, anastomotic leak, and multidrug-resistant bacteremia requiring higher antibiotics, total parenteral nutrition, and prolonged ICU stay. Patient was admitted to our center with sepsis and blood culture grew C. auris. Patient was managed with injection of caspofungin (in the absence of sensitivity breakpoints). Patient continued to grow C. auris in the blood so flucytosine was added as a part of combination antifungal therapy. On dual antifungal therapy for 28 days there was a transient clearance of fungemia. Work up for endocarditis, intrabdominal collection, and endophthalmitis were negative. But Patient was continued on total parenteral nutrition via central line in view of enterocutaneous fistula. Patient developed a recurrence of fungemia after 4 days of stopping antifungal treatment. Patient was started on injection of mycafugin and voriconazole (in view of on treatment resistance to flucytosine), on which cultures turned sterile and patient improved. Plan was made to give total 6 weeks of parenteral combination antifungal therapy.

Results

C. auris management complexities stem from multiple factors. The above case emphasizes the urgent need for C. auris specific minimum inhibitory concentration breakpoints and standard guidelines for treatment. Currently, treatment is based on the Center for Disease Control's proposed breakpoints (extrapolated from other Candida spp.). Upfront combination antifungal treatment might be the answer till further studies.

Conclusion

Management of invasive C. auris infection presents a major therapeutic challenge to clinicians and a major threat to healthcare sector even after timely identification.
P217 Pelvic mycoses— an unusual presentation of Rhizopus arrhizus in an ommunocompetent patient
Authors: Khatod Yash , Tr Neetha , Rathod Kirti Kumar , Jain Vidhi , Didel Siyaram , Meena Durgashankar
Published: September 2022

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

 

Introduction

The rare but increasingly identified infections caused by Mucorales are always detrimental to the patient due to rapid vascular invasion and the need for thorough surgical debridement and definitive antifungal therapy for its cure. Among the Mucorales, maximum cases have been reported among Mucor spp. and Rhizopus spp.

Case: Here we present a case of a 9-year-old immunocompetent child presenting with abdominal pain and distension of 1-month duration followed by swelling of bilateral lower limbs, which was gradual in onset. Ultrasonography of the abdomen and pelvis was done which revealed a pelvic mass on the left side. The child developed acute urinary retention during the hospital stay, which was evaluated to reveal a fistulous connection between urethra and rectum for which transverse colostomy was done. The USG-guided biopsy of the left pelvic mass showed broad aseptate hyphae in Hematoxylin and Eosine staining whereas the KOH mount and culture were negative. The follow-up imaging with CT showed circumferential thickening of the recto-sigmoid region and involvement of the posterior bladder wall. Considering the rapidity of the spread of the infection, injection liposomal Amphotericin B at the dose of 5 mg/kg/d, i.v. was started and given for one week with minimal improvement. However, with this clinical picture and patient profile the diagnosis was strongly suspected to be of Basidiobolomycosis of rectosigmoid region. Treatment also was revised to injection of voriconazole at a dose 8 mg/kg/d, i.v. after loading dose which was later shifted to oral dose after 7 days. A repeat USG-guided biopsy was planned for gene sequencing, which identified the organism as Rhizopus arrhizus. On follow-up, patient showed no clinico-radiological improvement and in view of the mycological evidence, the anti-fungal was changed from voriconazole after 2 weeks to oral isavuconazole at the dose of 200 mg/d following the loading after which significant improvement was achieved and patient was discharged.

Conclusion

Mold infection in the form of spreading rectosigmoid mass in an immunocompetent child usually suggests the picture of Basidiobolomycosis. Treating patients only on clinical grounds without mycological confirmation may lead to overlooking of Mucormycosis and may result in adverse outcomes. The diagnosis of Mucormycosis should always be considered as a differential for a fungal infection in the form of mass lesion in abdomen.
P255 Facial Tinea incognito: a clinical, dermoscopic, and mycological study
Authors: Park Jin , Lee Sang-Kyung , Nam Kyung-Hwa , Yun Seok-Kweon
Published: September 2022

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

 

Objectives

Tinea incognito (TI) occurring on the face is the most frequently misdiagnosed cutaneous fungal infection; however, very limited information is available on facial TI. This study aimed to characterize the clinical, dermoscopic, and mycological features of facial TI.

Methods

We retrospectively evaluated 38 patients with mycologically proven facial TI at a single institution in Korea between July 2014 and July 2021.

Results

The patients had a mean age of 59.6 ± 20.4 years and showed a slight female predominance (male-to-female ratio, 1:1.5). The most common clinical presentation was an eczema-like pattern (47.3%), followed by rosacea-like (15.7%), psoriasis-like (10.5%), lupus erythematosus-like (10.5%), cellulitis-like (7.8%), and folliculitis-like (7.8%) patterns. The mean duration from disease onset to diagnostic confirmation was 3.4 months. Overall, 78.9% of the patients had accompanying chronic systemic diseases and 57.9% had concurrent tinea infections on other skin sites, mainly on the feet and toenails. Among the 23 (60.5%) cultured specimens, Trichophyton (T.) rubrum was the most frequently detected causative species, followed by Microsporum (M.) canis. T. mentagrophytes and T. verrucosum were also isolated from one case each. On dermoscopy, scales (92.1%) and dilated vascular patterns (arborizing vessels and telangiectasia, 76.3% and 63.2%) were commonly observed in glabrous skin, with follicular patterns such as black dots, broken hairs, and empty follicles. The characteristic trichoscopic features were comma hairs, corkscrew hairs, Morse code-like hairs, and translucent hairs.

Conclusion

The clinical characteristics and distinct dermoscopic features described in this article can aid in the differential diagnosis of facial TI while reducing diagnostic delays and unnecessary treatments.
P273 Diagnostic dilemmas in Pneumocystis pneumonia in case of long COVID -19
Authors: Shah Arpit
Published: September 2022

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

 

Background

To diagnose Pneumocystis pneumonia in an underlying COVID-19 infection is difficult because of the clinical and radiological indistinguishableness of the presentation.

Case Presentation

We report the case of a 67-year-old male background of type 2 diabetes mellitus (DM) and hypertension (HTN), who presented to the emergency department for severe dyspnea for 6 days. He is treated with corticosteroid and other supportive therapy. Initially, the patient responded with that treatment but suddenly his hypoxia is increasing and getting intubated. All possible causes of deterioration hypoxia were evaluated and came negative. Later stage, BAL was done and immunofluorescence test for PCP came positive. Systemic, cotrimoxazole started and gradually hypoxia improved and extubated.

Conclusion

Pneumocystis and COVID-19 co-infection needs serious consideration, particularly for patients with long-term COVID-19, even if patients do not have conventional risk factors for Pneumocystis pneumonia.
P276 Molecular epidemiology of clinical filamentous fungi in Qatar beyond Aspergillus and Fusarium
Authors: Mohamed Husam Eldin , Houbraken Jos , Boekhout Teun , Almaslaman Muna , Taj-Aldeen Saad
Published: September 2022

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

 

Objectives

Due to an increasing number of patients at risk, (ie, with a highly compromised immune system and/or receiving aggressive chemotherapy treatment), invasive fungal infections (IFI) are increasingly being reported. They are associated with significantly high mortality rates. Aspergillus spp., particularly A. fumigatus, is the major cause of mold-related IFI around the world followed by Fusarium spp., however, other molds are emerging as human pathogens. The aim of this study was to explore the epidemiology and prevalence of the non-Aspergillus and non-Fusarium molds in human clinical samples over 11 years period in Qatar based tertiary hospital using molecular techniques.

Methods

A total of 91 clinical specimens positive for molds belonging to 90 patients were recorded in about 11 years (September 2003 to November 2014). The isolates were identified based on morphological characteristics and by sequencing the internal transcribed spacer (ITS) gene. To confirm the identifications, a phylogenetic tree based on ITS sequences was constructed.

Results

Most patients were males (72%), 6% were immunocompromised, 12% had IFI, and 7% died within 30 days of diagnosis. The fungal isolates were recovered from a variety of clinical samples, including nails, skin, hair, scalp, nasal cavity, wounds, respiratory samples, body fluids, eye, ear, tissue, abscess, and blood specimens. Dematiaceous fungi were overall the most isolated (33/91, 36%), followed by dermatophytes (25/91, 27%), Mucorales (16/91, 18%), and other hyaline molds (17/91, 19%) (Fig. 1). Curvularia was the most isolated genus (22/91, 24%) and Mucorales were the major cause of IF (5/11, 45.5%) (Table 1). Superficial mycoses were caused by dermatophytes (66%) and non-dermatophytes (34%). Furthermore, rare fungi that are not commonly known to cause human disease were recovered such as Rhytidhysteron rufulum, Subramaniula asteroids, Dothichiza pimprina, and Quambalaria cyanescens.

Conclusion

The current study highlights the epidemiology and spectrum of mold genera, other than Aspergillus and Fusarium, recovered from human clinical samples in Qatar, which can aid in surveillance of uncommon and emerging mycoses other than aspergillosis and fusuriosis.
P296 The role of Candida in acute pancreatitis: A disregarded pathogen
Authors: Srivastava Smriti , Sharad Neha , Ningombam Aparna , Kiro Vandana , Varma Sharin , Malhotra Rajesh , Mathur Purva
Published: September 2022

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

 

Background

Acute pancreatitis is often complicated by infection of peri-pancreatic necrotic tissue. The infectious etiology commonly involves gram negative enteric bacilli and enterococci. Role of Candida species has remained debatable, despite being isolated in pure or mixed cultures in specimens. We evaluated patients with acute pancreatitis with Candida infection over a duration of 4 years for assessment of risk and prognostic factors.

Objectives

To determine the prevalence and role of Candida infection in patients of acute pancreatitis and ascertain the species distribution and risk factors.

Methods

This study was conducted including adult patients who were admitted to gastro-surgery department and had clinical suspicion of peri-pancreatic fungal infection. Specimens included peri-pancreatic fluid collection obtained intra-operatively or aspirated USG-guided, drain fluid and blood. In addition to aerobic bacterial culture, fungal cultures were performed availing standard mycological procedures. Candida infections were categorized into true and possible as per Chakraborty et al. with some modifications.

True Candida infection of pancreatic tissue was considered when yeast cells were seen and grown in pure or mixed culture from

Possible Candida infection of pancreatic tissue was considered when Candida spp were isolated from

Relevant patient information was obtained from hospital information system. Data were analyzed by SPSS 20 statistical software and MS Excel.

Results

A total of 14 cases were identified amongst which 6/14 (42.9%) had true Candida infection whereas possible Candida infection was seen in 8/14 (57.1%) patients. Out of these, C. tropicalis was the predominant species seen in 9/14 (64.3%) whereas C. albicans was seen in 4/14 (28.6%). One isolate of C. auris was identified. Patients with C. tropicalis infection showed higher mortality (6/9, 66.7%) as compared with patients with other Candida species, in whom 20% (1/5) mortality was noted. Acknowledging limitations inherent to retrospective data extraction, we delineated some of the possible risk factors predisposing to Candida infection, given in Table 1.

Conclusion

Role of Candida species in the pathogenesis of adjacent tissues in case of acute pancreatitis has been neglected in past, but now being increasingly recognized. C. tropicalis is the commonest isolate in our study and carries very high mortality. Screening for Candida spp should be carried out in these patients in view of starting antifungal treatment at the earliest possible so that proper diagnosis and management can be undertaken.
P327 Prevalence of orofacial Mycoses in COVID-19patients: experience from a tertiary care center in Northern India
Authors: Agrawal Sonu Kumari , Tarai Bansidar , Somani Madhuri
Published: September 2022

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM

 

Objective

Due to coronavirus disease (COVID-19) a new group of patients at risk emerged with COVID-19-associated mycoses (CAM). The studies, evaluating the prevalence of CAM are missing in India.

Method

To assess CAM prevalence in a tertiary care hospital in India, we applied direct microscopy, fungal culture, and histopathology on respiratory specimens of 285 critically ill COVID-19 patients admitted between September 2020 and March 2022.

Result

Among the 285 patients, 187 were male, and 98 were female. A total of 34.03% had mucor (33.01% Rhizopus arrhizus;1.02% R. microsporus), 59.51% had Aspergillus (50% Aspergillus flavus; 41.17% A. fumigatus; 2.94% A. terreus; 2.35% A. niger), 3.04% had both (Rhizopus arrhizus + Aspergillus flavus), and 3.01% (Schizophyllum sps 5; Fusarium 1, Paecilomyces variotii 1) had other types of mycosis on fungal smear and culture.

Conclusion

Consistent with others, our findings underline the importance of microbiological/pathological assessment in patients with predispositions for COVID-19-associated mycoses but due to the low prevalence, a routine screening seems not to be indicated currently. However, multicenter studies are desirable for substantiation of findings. A high index of clinical suspicion, diagnosis at an early stage, and use of antifungal agents are essential for a successful outcome.
P334 Fungal infections in patients with COVID-19 in 1-year pandemic 2020-2021 from Cote d'Ivoire
Authors: Koffi David , Toure Andre , Ira Valerie , Kouadjo M. Francis , M'boh Reine , Sylla Karidia , Dosso Mireille
Published: September 2022

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM

 

Background and Objectives

The COVID-19 pandemic has caused significant public health problems both in Côte d'Ivoire and around the world. Among the different causes of morbidity and mortality in COVID-19 patients, the frequency and impact of co-infections are still little studied, especially in patients with acute respiratory distress syndrome (ARDS).

However, people with severe COVID-19 infection are particularly vulnerable to bacterial and fungal infections. This study aims to determine the frequency and susceptibility profile of isolated fungi in severe COVID-19 patients living in west Africa.

Methodology

We conducted a retrospective observational study of COVID-19 patients who were tested for invasive fungal infections (IFI) between 2020 and 2021 in the laboratory of mycology at Pasteur Institute of Cote d'Ivoire.

Results

We received a total of 77 samples (from superficial specimens, deep sites, urine) collected from 35 patients admitted for severe COVID-19. The patients were predominantly female (n = 21, 60%) and had a median age of 54,5 years (range16-79 years).

The mycological analysis for IFI diagnosis showed 20% of samples positive only for yeasts, 66.7% of which were Candida albicans and responsible for 90% of invasive infections in COVID-19 patients. No difference in fungal species was found regarding of the sex, age of the patients, and waves of the pandemic. Antifungal susceptibility testing revealed no resistance to antifungals (fluconazole, voriconazole, itraconazole, amphotericin B, and flucytosine) among Candida isolates.

Conclusion

These data show significant Candidiasis infection associated with the severe form of COVID-19. Given this prevalence of 20%, it is important for clinicians to remain vigilant and take proactive measures to prevent candidemia in patients with COVID-19. The widespread surveillance for fungal co-infections is still essential to reduce mortality associated with COVID-19.
P339 A study of environmental risk factors in chronic rhinosinusitis
Authors: Singha S. Krishna , Mona Henam , Das Shukla , Gupta Neelima , Vaid Lakshmi , Ghosh Chirashree , Singh N.P
Published: September 2022

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM

 

Objectives

Chronic rhinosinusitis (CRS) is a complex disease that incorporates many different conditions. Our aim is to determine the role of environmental risk factors in chronic rhinosinusitis.

Methods

This was a case-control study where forty cases of CRS in the age group of 18-62 years were recruited from the ENT-OPD of UCMS and GTB Hospital, Delhi, a tertiary care hospital, along with 40 age-appropriate healthy controls. Informed and written consent was obtained from all the subjects. Detailed history and examination along with routine blood and radiological investigations were done. Subjective assessment of disease was done using visual analog scales of SNOT 22 questionnaire, environmental questionnaire, and saccharine test. Objective assessment was done using endoscopic grading according to Lund and Kennedy scoring. CT scores were also obtained using Lund and Mackay staging system. Passive air sampling was done by the settle plate method and Anderson six-stage cascade impactor was used for active air sampling. Blood agar and Sabouraud dextrose agar plates were inserted on the six stages of the cascade impactor, which were later incubated at 35°C and 25°C respectively, for 18-24 hours. Bioaerosol concentrations were calculated and MicroScan WalkAway system was used to identify bacterial and fungal growth. The correlation between total bioaerosol concentration and the symptom score was done by spearman's correlation coefficient; a comparison of mean total bioaerosol concentration between the case and control groups was done by Mann-Whitney U-test.

Results

The mean total bio-aerosol concentration from active air sampling in the case group was 458.52 CFU/m3 and 437.63 CFU/m3 in control, which was not significant. It was found to be negatively correlated, but not significant with various parameters in case groups like SNOT 22 score, environmental exposure score, saccharine test, smoking, and endoscopic score. A positive but insignificant correlation was found between total bioaerosol concentration and absolute eosinophilic count and CT score. The mean CFU/100 mm3 counted after passive air sampling between case and control group was 34.03 and 30.88 CFU/100mm3 which was not significant. Fungal growths were mostly Aspergillus flavus and A. Niger followed by Cladosporium spp.

Conclusion

The fungal burden was high in all the households of the case as well as control groups, although, a significant correlation could not be established. The environmental conditions found in this study were found to be conducive to future risk of exacerbation of preexisting fungal infections for which, indoor air quality needs to be monitored.
P346 Pulmonary fungal infection in Sudan, a retrospective study from the Mycology Reference Laboratory
Authors: Ismail Mawahib , Gabr Aida , Zhou Shaoqin , Mahgoub Elsheikh , Ahmed Sarah
Published: September 2022

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM

 

Objectives

Pulmonary fungal infections are life-threatening diseases, if not diagnosed and properly treated can lead to serious complications. In chronic cases, the condition might mimic tuberculosis and may be misdiagnosed. The aim of this retrospective study is to determine the frequency of fungi among the respiratory samples received at the mycology reference laboratory over 5 years period and to provide a view of the burden of pulmonary fungal diseases in the country.

Methods

A total of 713 sputum samples received at the Mycology Reference Laboratory, Khartoum, Sudan, between 2015-2019 were analyzed. These samples were collected from different health care centers in Khartoum state. For every sample, direct microscopy using 20% KOH and methylene blue stain was performed. In addition, cultures were made by inoculating every sample in three tubes of Sabouraud dextrose gar (SDA) containing chloramphenicol. Tubes were incubated at 37°C for 2 and up to 7 days. Isolated fungi were identified phenotypically using the Atlas of Clinical Fungi guidelines.

Results

Out of the 713 samples, 235 (33%) were positive for fungi; both in the direct microscopy and culture. Cultures were identified as Aspergillus species 38 (16%), while 197 (84%) were found to represent Candida species.

Conclusion

Our study showed a high number of fungi is associated with pulmonary conditions in Sudan. Risk factors might include post tuberculosis, Asthma, HIV, and COPD.
P362 Seasonal trend of fungal flora in water of tertiary care hospital in North India
Authors: Mahajan Monika , Kaur Harsimran , Rudramurthy Shivaprakash M , Biswal Manisha , Ray Pallab
Published: September 2022

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM

 

Objectives

The study was conducted to assess the seasonal variation of fungal flora in hospital water of a tertiary care hospital in North India.

Methods

A total of 200 water samples from the main reservoir, overhead and underground tanks, and taps of critical care units of the hospital were collected. The water samples were filtered by membrane filtration technique (0.22 micron) and cultured on dichloran rose-Bengal chloramphenicol agar with and without benomyl. The plates were incubated for upto 15 days and fungal colonies recovered were sub-cultured on Sabouraud Dextrose Agar and identified by phenotypic methods. Yeasts were identified by Matrix Assisted Laser Desorption Ionization Time of Flight (MALDI-TOF-MS).

Results

Mycelial fungi were isolated from 100% of the water samples which included Alternaria, Curvularia, Nigrospora, Penicillium, Aspergillus, Paecilomyces, Scytillidium, and Mycelia sterilia as depicted in Figure 1. Different fungi were prevailing in different water storage units like: Advance eye center— A. fumigatus, A. flavus, Fusarium solani, Alternaria spp. Rhizopus arrhizus, Ustilago spp., mycelia sterilia, Trichosporon spp.; Advance trauma Center—Cladophaialophora spp., Alternaria alternata, Penicillium, spp. A. flavus, A. nidulans, A. fumigatus, F. solani, Rhodotorula spp.: Bone marrow transplant unit— Alterneria alternata, A. niger, A. flavus, A. versicolor, Cladosporium spp., Fonsecaea pedrosoi, Fusarium spp., Nigrospora spherica, Penicillium spp., Rhodotorula spp., Trichosporon ashaii. The seasonal variation of fungal isolation is depicted in Figure 2. Isolation rate of Aspergillus species was 35% in winters, 31% in post-monsoon, 25% in summers. Isolation rate of Penicillium species was 19% in post-monsoon, 16% in winter and 15% in summers. Maximum number of dematiaceous fungi were isolated in summer season with isolation rate of 30% in summers as compared with 21.5% in post-monsoon and 19% in winters. Few yeasts isolated were Rhodotorula, Trichosporon, and Ustilago. Mucorales isolated rarely included Rhizopus, Absidia, Syncephalastrum, and Mucor species. Fungal colony forming units in the water samples ranged from 50 to 450 colony forming units/liter of water.

Conclusion

The distribution of fungi in hospital water showed diversity and seasonal variability. Aspergillus species were isolated in maximum number in the winter season, Penicillium species in post-monsoon season and dematiaceous fungi in the winter season. Water as a source of fungal infection in critical care units, remains a relatively neglected area. Water supply could be a source of nosocomial fungal infections. Improving the quality of water by regular testing for fungal contamination and appropriate action to reduce its burden may reduce the hospital-acquired fungal infections.
P391 Research on molecular diagnostic methods and clinical application of common pathogenic dermatophytes in tinea capitis
Authors: Zhu Peiqiu , Shao Jin , Wang Ruojun , Song Yinggai , Wan Zhe , Li Ruoyu , Yu Jin
Published: September 2022

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM

 

Objective

The main objective of this study was to design and develop a detection system based on qRT-PCR that can quickly and accurately identify the pathogenic fungi of tinea capitis, in order to improve the diagnostic ability of tinea capitis.

Methods

Results

Conclusions

The seven single-tube qRT-PCR assays validated in this study can rapidly detect a variety of pathogenic fungi causing tinea capitis, with a high level of sensitivity and specificity. The combination of qRT-PCR and traditional mycological identification methods can further improve the diagnostic efficacy of tinea capitis.
P433 Identification of Candida species isolated from hospitalized patients with candiduria
Authors: Nabili Mojtaba , Moazeni Maryam
Published: September 2022

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM

 

Background and objectives

The incidence of candiduria caused by Candida spp. has increased in recent years, particularly in hospitalized patients. Candiduria is most commonly caused by C. albicans; however, an increase in the prevalence of non-albicans species has been observed during last decades. This study aimed at molecular identification of Candida species isolated from candiduria in hospitalized patients.

Methods

This cross-sectional study was conducted on 530 hospitalized patients in two hospitals in the Mazandaran Province, Iran. Midstream urine specimens were collected and then cultured on CHROMagar Candida medium. Molecular identification of common Candida species was carried out using the polymerase chain reaction-restriction fragment length polymorphism method after enzymatic digestion with MspI. C. albicans and Candida parapsilosis species complexes were identified by amplification of the HWP1 and intein-containing vacuolar ATPase precursor genes, respectively.

Results

The frequency of candiduria was estimated at 14% among hospitalized patients. Of 74 samples positive for candiduria, 65 (87.8%) were isolated from females. The most common predisposing factor to candiduria was diabetes (n = 36; 48.6%). The most frequent isolates were C. albicans complex (n = 44; 59.4%), followed by C. glabrata (n = 16; 21.6%), C. tropicalis (n = 10; 13.5%), C. krusei (n = 3; 4%), and C. parapsilosis (n = 1; 1.3%).

Conclusion

Based on the results, the conventional and molecular methods produced similar results for the identification of Candida species. However, accurate identification of Candida spp. requires the use of molecular techniques such as PCR-RFLP, HWP1, and intein-containing vacuolar ATPase precursor genes. Nevertheless, chromogenic methods such as CHROMagar Candida can be used for the diagnosis of Candida spp. in laboratories with limited resources.
P447 Galactomannan lateral flow assay for the diagnosis of invasive Aspergillosis among clinically suspected patients in tertiary care center, Jodhpur, Rajasthan
Authors: Priya Hari , Kothari Nikhil , Jain Vidhi , Kumar Deepak , Khichar Satyendra , Rohila Amit Kumar , Mokta Mohan Lal
Published: September 2022

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM

 

Introduction

Invasive aspergillosis is one of the potentially life-threatening diseases in immunocompromised patients. Early diagnosis and prompt treatment improve patient survival. The gold standard method—conventional microscopy and culture have low sensitivity and a long turnaround time. Serum Galactomannan (GM), a polysaccharide that forms a major component of Aspergillus cell wall and is released by the fungus during invasive growth is established as a reliable biomarker, which is available as Enzyme Linked Immunoassay (ELISA). The limitations of ELISA are high cost, expertise, and difficulty in assay standardization. To overcome these limitations, a qualitative Galactomannan Lateral Flow Assay (GM-LFA) a sandwich immunochromatographic test, recently approved by European CE, is evaluated in our study.

Objective

To establish the diagnosis of Invasive Aspergillosis according to EORTC/MSGERC Definitions of Invasive Fungal Diseases 2021 guidelines and comparison of GM-LFA with conventional microscopy and culture.

Method

We performed a retrospective study from October 2021 to March 2022 on serum and bronchoalveolar lavage fluid (BAL) samples. GM-LFA (IMMY sōna Aspergillus Galactomannan LFA) was performed and the results are read after 10 mins with a cube reader according to the manufacturer’s instructions and compared with conventional microscopy and culture.

Result

During the 6 months study period, 185 samples (14 BAL and 171 Serum) were collected from 148 patients. A total of 17/185 (9.18%) samples from 16 patients were positive by GM-LFA, of those 5 (29.41%) are BAL, and 12 (70.58%) are serum samples. One patient tested positive for Galactomannan on both BAL and serum.

Among Assay positive samples, 3/17 (17.64%) samples were positive by microscopy and culture, which grew 2 Aspergillus fumigatus and 1 Aspergillus niger.

Treatment details of 5 patients could be traced, of which 4 patients improved clinically and radiologically after Inj. voriconazole and 1 patient died before starting treatment.

According to EORTC/MSGERC Definitions of Invasive Fungal Diseases 2021 guidelines, 17 patients belong to the proven and probable Invasive aspergillosis category, in which 16 patients were GM-LFA-positive and the remaining 131 patients had no evidence of invasive aspergillosis disease.

Conclusion

GM-LFA is a cost-effective, easy, convenient, and rapid procedure. We recommend its use for the diagnosis of invasive Aspergillosis in routine healthcare settings, especially where GM-ELISA is not available or affordable.
S1.4b Challenges in diagnosing and management of invasive fungal infections during the pandemic
Authors: Chayakulkeeree Methee
Published: September 2022

S1.4 Fungal infections in Asia, bringing it out of the dark, September 21, 2022, 11:00 AM - 12:30 PM

Invasive fungal diseases have been increasing in Asian countries. Recent advances in novel medical care such as solid organ and stem cell transplantations, chemotherapy for cancer treatment, and corticosteroid therapy, resulted in the increased prevalence of invasive mycoses. Invasive aspergillosis, mucormycosis, and endemic mycoses are among the most common mold infections in Asia. Non-classical and novel risk factors of invasive fungal diseases have been increasingly recognized in Asia. In contrast to the classical neutropenic patients, most of the patients with invasive mycoses who had non-classical risk factors are mostly non-neutropenic and may present with an atypical clinical manifestation. These novel risk factors include biologic agents or small molecule kinase inhibitors used for cancer treatment, and severe viral pneumonia such as influenza pneumonia or coronavirus disease 2019 (COVID-19) pneumonia. Recently, COVID-19-associated aspergillosis (CAPA) and COVID-19-associated mucormycosis (CAM) have been described. These particular mold infections had high mortality. Treatment of CAPA and CAM are similar to those who had mold infections without COVID-19. However, the interaction between triazole and drugs used for the treatment of COVID-19 must be taken into consideration.

 

Timely and accurate diagnoses are crucial for the management of invasive fungal infections. Conventional fungal cultures from sterile clinical samples or blood are useful but they are time-consuming. Nevertheless, the diagnosis of invasive mold infections is challenging as the imaging is non-specific and the serological tests are not widely available in Asian countries. In some circumstances such as those with non-classical risk factors, serology revealed relatively low sensitivities. Molecular diagnostic tests are also the unmet needs among Asian countries for timely and accurate diagnosis of invasive fungal diseases. Several factors should be considered for the appropriate choice of antifungal agents, including antifungal coverage, adverse effects, underlying conditions, drug-drug interactions, and cost. Recently, novel antifungal agents such as novel triazoles or new classes of antifungal agents have been studied and may be a promising choice for the treatment of invasive fungal diseases.
S10.4a New mechanism and detection methods for azole-resistant Aspergillus fumigatus
Authors: Watanabe Akira , Arai Teppei , Majima Hidetaka
Published: September 2022

S10.4 Emerging antifungal resistant fungi, September 24, 2022, 10:30 AM - 12:00 PM

The most studied azole-resistant mechanism of Aspergillus fumigatus is decreased affinity of the drug for CYP51A, the drug target molecule, due to its amino acid substitutions. Typically, each azole-resistance caused by the designated amino acid substitution of CYP51A has a specific pattern depending on the substitution site. While uncovering non-cyp51A mechanisms responsible for azole resistance should be essential for developing novel methods for prompt diagnosis and effective drug treatment. In our previous study, we reported results that mutation of hmg1, which codes HMG-CoA reductase, the rate-limiting enzyme in ergosterol biosynthesis, would be the mechanism conferring azole-drugs resistance (EID 2018). On the other hand, different azole susceptibility patterns have been reported even among the strains possessing the same mutation in CYP51A. In this way, the overall picture of molecular mechanisms inducing azole resistance remains unclear.

 

We performed a comparative genomic analysis among the strains with the same cyp51A mutation isolated from the same patient but with different azole resistance patterns. To investigate the association between the novel mutation and azole resistance, the mutant allele was replaced with the wild-type allele by the CRISPR-Cas9 system. Antifungal susceptibility tests were performed according to the CLSI-M38.

 

As a result of genome comparison analysis between these two strains using the HiSeq sequencing system (Illumina), another mutation was found in the insulin-induced protein (INSIG) of the multiazole-resistant strain. The INSIG mutation contributes additively to azole resistance in collaboration with the CYP51A mutation but does not alone itself.

 

We have already reported simple and rapid detection methods for A. fumigatus possessing CYP51A mutation using an endonuclease (AAC 2020). Furthermore, using MALDI-TOF-MS, we are developing a discriminant model to detect azole-resistant A. fumigatus.