bluuebunny/crossref_metadata_2025 huggingface dataset:
P196 A rare presentation of subcutaneous Entomophthoramycosis
Authors: George Nimmy Elizabeth , Philip Achu Jacob , E. Arthi , Asir Johny , Kindo Anupama Jyoti , Nair Shashikala
Published: September 2022

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

Entomophthoramycosis is a chronic granulomatous type of subcutaneous infection seen mainly in immunocompetent individuals. The usual focus of Conidiobolomycosis infection is as rhinoentomophthoramycosis, characterized by chronic, indolent, and localized swelling of the nose, paranasal tissues, sinuses, cheeks, and upper lips and it infrequently affects the lower extremities.

 

We report a case of subcutaneous Conidiobolomycosis in a 21-year-old male with an alleged history of trauma to left foot by a wooden stake 6 months back. Primary treatment of the wound was done at a local hospital. A total of 4 months post-trauma he developed multiple pus discharging sinuses on the dorsal and plantar aspects of the left foot, for which local dressing was done in a nearby hospital. He presented to our hospital with non-healing multiple sinuses, with active serosanguinous discharge. He underwent wound debridement under spinal anesthesia and tissue was sent for fungal culture, histopathological examination.

 

Aerobic culture of the wound swab revealed moderate growth of Methicillin-resistant Staphylococcus aureus sensitive to clindamycin, gentamicin, and linezolid. Histopathological examination of the tissue showed a resolving abscess with granulation tissue. Direct microscopic examination of the tissue by KOH mount showed no fungal elements. It was inoculated into Sabouraud's dextrose agar with and without cycloheximide and incubated at both 25°C and 37°C. Sabouraud's dextrose agar without cycloheximide incubated at 37°C after 48 h of incubation grew cream-colored glabrous colonies adherent to surface with pale reverse. Lactophenol cotton blue preparation revealed broad, sparsely septate hyphae with primary conidia which are globose approx. 40 μm is diameter, produced singly. They have a characteristic protruding papilla on one side. The fungal isolate was identified as Conidiobolus species. Sequencing results are awaited for species identification and confirmation.

 

Serial wound dressings were done following strict infection control policies and he was started on tablet linezolid 600 mg twice daily, tablet itraconazole 400 mg twice daily for 1 week, followed by 400 mg once daily for 6 months.

 

Conidiobolus is a soil saprophyte, found in decaying vegetation in most warm climates in tropical countries. There has been only one published case report of subcutaneous entamophthoramycosis of the foot, in a 49-year-old female from Venezuela. To the best of our knowledge, we report the first case of subcutaneous entamopthoramycosis of the lower extremity in India and the second case in the world.
P208 Genetic diversity of the emerging human fungal pathogen Pichia norvegensis
Authors: Boden Sander , Haas Pieter-Jan , van Dijk Karin , Bathoorn Erik , Hagen Ferry
Published: September 2022

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

 

Objectives

Pichia norvegensis (= Candida norvegensis) is increasingly isolated from hospital settings, especially from immunocompromised patients. Understanding this rare pathogen, including its emergence and distribution, is crucial for accurate diagnosis and infection prevention. We studied the genetic diversity of a large collection of clinical P. norvegensis isolates obtained from Dutch hospitals along with a set of non-Dutch clinical and environmental isolates.

Methods

Clinical (n = 236; 90.8%) and environmental (n = 24; 9.2%) P. norvegensis isolates were subjected to Amplified Fragment Length Polymorphism (AFLP) fingerprinting and a novel six-loci microsatellite typing panel. Data were analyzed with BioNumerics and Structure. We applied a novel mating-type assay to determine the MATα locus presence/absence.

Results

AFLP fingerprinting separated the P. norvegensis isolates into three main clusters. Two clusters fully consist of clinical isolates, the third represented a mix of clinical and environmental isolates. By microsatellite typing, the overall genetic diversity was low (Simpson's D = 0.90), due to a large number of Dutch clinical isolates with similar genotypes. Minimum spanning tree analysis showed that Dutch clinical isolates fell into two clusters. Environmental and non-Dutch isolates were more distantly related. Structure analysis showed the presence of four genotypes, with signs of genetic admixture between geographic locations and environmental/clinical isolates. Nearly all isolates harbor the MATα mating-type allele.

Conclusions

The P. norvegensis isolates obtained from Dutch hospitals appeared to be largely clonal, independent of geographic origin and isolation date. The observed clonality is supported by the extensive number of MATα isolates. Microsatellite typing indicated potential admixture between clinical and environmental isolates.
P210 Fungal isolates of the respiratory tract in symptomatic patients hospitalized in pulmonary units: A mycological and molecular epidemiologic study
Authors: Hashemi Seyed Jamal
Published: September 2022

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

 

Objective

Fungal respiratory infections are being recognized with increasing frequency in parallel with an expanding population of immunocompromised patients. In most cases, colonization is the first step in the progression to pulmonary fungal infection. This study was designed to evaluate the distribution of fungal elements in the respiratory tract of symptomatic patients hospitalized in pulmonary units.

Methods

This descriptive cross-sectional study was carried out over a period of 2 years, from October 2017 to October 2019 in Guilan province, located in Iran's northern region. In the current study, bronchoalveolar lavage or sputum specimens were collected. All samples were analyzed by direct microscopy using KOH 10% and culture. Fungal identification was accomplished by internal transcribed spacer (ITS) and beta-tubulin sequencing. Also, in patients suspected of invasive pulmonary aspergillosis, BAL specimens were tested for galactomannan (GM) antigen.

Results

A total of 384 lung specimens [192 bronchoalveolar lavage (BAL) and 192 sputum samples] were obtained from symptomatic patients hospitalized in pulmonary units. Of these, 137 (35.67%) were positive in direct examination and culture. Among the 137 positive cases, most isolates were from male patients 86 (62.77%) and most of them were between 46 and 72 years. Candida albicans (37.22%) and C. tropicalis (21.89%) represent the two most commonly isolated species in the current study. Cough (94.16%), dyspnea (81.02%), purulent sputum (62.04%), and weight loss (56.2%) were the predominant symptoms and tuberculosis (24.81%), chemotherapy (21.89%), and diabetes mellitus (19.70%) were the predominant underlying conditions. Also, 5 cases of invasive pulmonary aspergillosis and 1 case of mucormycosis were diagnosed.

Conclusion

Candida albicans was the most common fungal species isolated from symptomatic patients hospitalized in pulmonary units. Tuberculosis, chemotherapy and diabetes mellitus were important underlying conditions for pulmonary fungal colonization and/or infection.
P216 Rare isolates from subcutaneous mycotic lesions; A study from tertiary care center in Chhattisgarh, India
Authors: Keche Archana , Tigga Richa , Satyaki Ganguly , Chhabra Namrata , Gupta Rakesh
Published: September 2022

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

 

Aims and Objective

To identify the causative agents of suspected subcutaneous mycosis patients attending to a tertiary care hospital, Chhattisgarh, India.

Introduction

Subcutaneous mycoses are a group of fungal infections of dermis and subcutaneous tissue caused by both melanized and hyaline molds. It often affects patients with immunosuppressive conditions. It consists of Sporotrichosis, Chromoblastomycosis, Phaeohyphomycosis, Hyalohyphomycosis, Mycetoma, subcutaneous zygomycosis, Rhinosporidiosis, Lobomycosis, and disseminated Penicilliosis. There are proven pathogenic agents causing subcutaneous mycosis though are not regularly isolated and reported. Few of them are commonly come across in the laboratory. Herewith, emphasized on the unusual clinical isolates from the patients having subcutaneous mycotic lesions with their clinical details.

Method

It is a retrospective descriptive analysis of data of subcutaneous mycosis cases of duration January 2019 to March 2022.

Total 52 clinical specimens from the suspected subcutaneous mycotic lesion were studied. Male dominance was observed amongst the patients. Amongst 52, 31% were detected positive for fungal elements by direct microscopy in 20% KOH mount, 55.7%, 25% positivity was observed in Culture and by both KOH wet mount and culture. Samples were processed and identified by using standard protocol.

The significant unusual isolates identified were Conidiobolus coronatus from subcutaneous cyst from buttocks, Medicopsis romerai from fine needle aspiration from the nodule of left thumb, Rhytidhysteron rufulum from right lateral malleolus, Aquastroma magniostiolata species from subcutaneous cyst on lateral aspect of left lower leg above lateral malleolus, Aspergillus tamorii, Aspergillus glaucus, Chetomium species, Aspergillus montevidensis, Cladosporium sphaerospermum. Phenotypically unidentified isolates were sent to NCCPF PGI, Chandigarh for final identification.

Conclusion

There is diversity in the etiological agents of subcutaneous mycoses. Every case is different and rare. With the help of molecular techniques, it became possible to identify unusual fungal isolates from subcutaneous infection. Awareness and extensive studies are required to evidence the pathogenicity and associated complication due to these fungal infections. It will also help to regulate the therapeutic management and to know the geographical distribution of unusual fungal agents.
P222 Epidemiology of Candida emia at level-1 trauma care cent er in North India
Authors: Kiro Vandana , Sharad Neha , Shrivastava Smriti , Varma Sharin , Ningombam Aparna , Mathur Purva
Published: September 2022

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

 

Objective

Patients affected by trauma who get admitted to critical care units experience prolonged hospitalization and thereby acquire several infections. This retrospective observational study was done from 2014 to 2021 to observe Candidaemia affecting this population. A total of 4816 patients admitted with traumatic injuries and hospitalized for treatment at ICU in our 190 bedded Level-1 Trauma center underwent this study.

Methods

Paired blood samples were collected from patients showing signs of sepsis and incubated and monitored regularly by the BacT/ALERT system (bioMe´rieux InC., Marcy l'Etoile, France). All the positive signal samples exhibiting budding yeast cells on Gram stain were subcultured on Chrome agar and Sabouraud dextrose agar. Pure growths obtained were subjected for identification and susceptibility by MALDI-TOF and VITEK 2 system.

Results

Out of the 4816 patients, 61 were affected by Candidaemia. Out of 61, the maximum was in the age group of 31-40 years (19.7%). Male preponderance (50/61, 82%) was exhibited compared to females. To ascertain Candidaemia, samples collected were blood (63/66, 95.5%) and CVP tip (3/66, 4.5%). Candidaemia was primarily observed in patients who suffered major orthopedic trauma (14/61, 21.2%). A total of 66 Candida species were isolated from samples of these patients. Out of these, Candida tropicalis (43.9%) was the most common, followed by C. parapsilosis (22.7%), C. albicans (21.2%), C. haemulonii (4.5%), C. glabrata (3%), C. rugosa (3%), and C. guilliermondii (1.5%). Concerning antifungal resistance, fluconazole resistance was 16.6% (11), flucytosine 1.5% (1), amphotericin B 6% (4), and micafungin 3% (2). Voriconazole was resistant to none but intermediate to 12.1% (8), caspofungin was intermediate to 3% (2), and resistant to none. A total of 47% (31/61) of patients succumbed to their injuries which were observed highest in the age group of 61-70 years (8/61, 25.8%). The most common injuries that the deceased suffered were polytrauma (9/61, 29%) and blunt trauma abdomen (9/61, 29%). Maximum mortality was also observed in patients with Candidaemia due to Candida tropicalis (15/61, 48.3%).

Conclusion

Candidaemia is usually fatal. Mortality due to Candidaemia increases in patients with severe traumatic injuries and added risk factors such as extremes of age, immunocompromised state, and broad-spectrum antibiotics. When compared to a similar study done in our center from 2009 to 2012 (3 years) on Candidaemia in ICU patients, the incidence was lower in our study (12.6% per 1000 ICU admissions vs 14.9% per 1000 ICU admissions), but the mortality rate was higher (47% vs 43.3%). Therefore, a watchful eye on early signs of sepsis, strict hospital infection control measures and antimicrobial stewardship may alter their outcome.
P224 A challenging case of pyrexia of unknown origin of adrenal mass
Authors: Kumar Arvind , Gupta Ankesh , Bhatia Oshin , Nischal Neeraj , Wig Naveet
Published: September 2022

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

A familiar dictum in tropical countries is to consider the diagnosis of tuberculosis (TB) in a patient with fever of unknown origin until proven otherwise. Often, in resource-limited settings, a response to a trial of empiric anti-tuberculous therapy (ATT) is needed to prove TB. However, chronic granulomatous diseases such as invasive fungal infections and sarcoidosis have clinical features resembling extrapulmonary TB. Thus, the workup for a definitive diagnosis is necessary.

 

A 53-year-old male presented with low grade, intermittent fever, loss of weight and appetite for a duration of 4 months and generalized abdominal pain for the last 2 months. He has lost about 16 kg in the past 6 months. He also reported a mild cough with scanty white mucoid sputum. There was no contact with a case of TB. He developed small oval/circular copper Color patchy lesions in the trunk for the last 1 month (Fig. 1). The general examination of the patient was grossly normal except for hepatomegaly. Routine blood examination, renal and liver function test, and chest X-ray were normal and HIV ELISA was non-reactive.

 

With the strong suspicion of TB, the patient underwent CT scanning of the chest and abdomen was done which showed bilateral heterogeneous adrenal mass with few hypodense areas within measuring right side 3.1 × 1.8 cm and left side 3.1 × 2.5 cm in suprarenal location and liver is enlarged size 19.3 cm with normal attenuation (Fig. 2). There were no clinical features to suggest pheochromocytoma or Cushing's syndrome. The PET-CT revealed metabolically active disease involving bilateral adrenal gland, abdominal and retrosternal lymph node with diffuse hepatomegaly. Transabdominal ultrasound-guided FNA was done from adrenal lesions. The tests for tuberculosis were negative and the cytology reported necrotizing granuloma with intracytoplasmic yeast cells suggestive of histoplasmosis. The adrenal endocrine profile was normal. From skin lesions, a biopsy was done. Direct KOH from skin lesion revealed budding yeast cells while the cultures are awaited. The patient was treated with 3 mg/kg liposomal amphotericin B for 2 weeks followed by daily itraconazole for maintenance. The fever was resolved after 8 days of liposomal amphotericin B and skin lesions softened after 3 weeks of therapy.
P225 Subcutaneous phaeohyphomycosis by Phaeoacremonium species in a renal transplant recipient
Authors: Kumar Manibhushan , Kaur Harsimran , Ahmad Haseen , De Dipankar , Rudramurthy Shivaprakash M.
Published: September 2022

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

 

Objective

Phaeohyphomycosis refers to infections due to a large group of heterogenous organisms called ‘dematiaceous’ or ‘melanized’ fungi. The infection exhibits a wide spectrum of presentations such as deep local infections, pulmonary infection, cerebral infection, and disseminated disease, which are associated with high mortality. The incidence of phaeohyphomycosis among solid organ transplant recipients is 0.7%. Hereby, we report a case of phaeohyphomycosis in a post renal transplant patient who presented with a subcutaneous swelling over the right elbow region.

Method

A detailed history was obtained from the patient after informed consent. The cystic fluid was subjected to microbiological including bacterial (Gram stain, culture on blood agar incubated at 37°C) and fungal investigations [Calcofluor potassium hydroxide (KOH) mount, culture on Sabouraud dextrose agar (SDA) incubated at 37°C and 25°C and brain heart infusion agar (BHI) incubated at 25°C]. The identification of isolate was done phenotypically by preparing lactophenol cotton blue (LCB) mount from slide culture and molecular technique using Sanger's sequencing.

Result

A 61-year-old diabetic and post renal transplant (7 years) male presented with complaints of swelling over the right elbow region for 5 months duration. Swelling was insidious in onset, gradually progressive, painless, cystic, non-pulsatile, non-reducible, ∼9 × 7 cm in size, lobular in shape with irregular surface having normal overlying skin which minimally restricting the movement of the elbow. There was no history of trauma over the elbow region. Reddish purulent pus was received for mycological investigation. Calcofluor KOH mount demonstrated septate hyphae. Culture on SDA incubated at 37°C and 25°C grew cream-colored colonies, turning grayish beige to olive-brown and developed clusters of aerial hyphae with reverse tan to brown in color after 2 weeks of incubation. LCB mount showed hyaline to brownish hyphae, cylindrical phialides growing along the hyphae with slightly tapering towards the apex, hyaline, oblong, conidia, gathering in clusters at end of phialide. Phenotypically, the fungus was identified as Phaeoacremonium species and molecular identification and antifungal susceptibility are awaited. Patient was advised for surgical excision but he left against medical advice. Currently, he is not receiving any antifungals.

Conclusion

Phaeohyphomycosis is a rare and unique entity among fungal infections. Cutaneous phaeohyphomycosis predominantly occurs on the extremities with a localized solitary nodule or abscess. A high index of suspicion and the surgical approach including excision or debridement are mainly chosen.
P235 Rhino sinusoidal Lasiodiplodia theobromae: a clinical and diagnostic dilemma
Authors: Maurya Anand Kumar , Karuna Tadepalli , Behera Ganakalyan , Kumari Shweta
Published: September 2022

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

 

Objectives

To disseminate and discuss a rare case of rhino sinusoidal Lasidiploidea theobromae in a known diabetic.

Method

A case study was prospectively done since 2021 following a hospital visit of a 56-year-old male patient presenting with rhino sinusitis mimicking mucormycosis. Ethical approval and patient consent were obtained for this study. A detailed account of case progression from the date of first hospital admission to the final cure was noted. A 56-year-old male from Madhya Pradesh, in central India, presented to the outpatient department of Otolaryngology (ENT) -Head and Neck Surgery. The patient was a known case of diabetes for 5 years. He presented with a headache for 10 days, throbbing pain over the left cheek and upper teeth with nasal discharge and crusting for one week. Nasal crusting and sample from left maxillary meatus were sent suspecting rhino sinusoidal mucormycosis. Mycological evaluation by KOH wet mount showed melanized hyphae and short fragments appearing broad pauciseptate. After 10 days, a grey fluffy growth was observed at 37°C and 25°C on SDA with chloramphenicol. On SDA with cycloheximide there was no growth. LPCB mount of the growth showed some hyaline hyphae with immature hyaline conidia and at places brownish dark walled single septate conidia. Phenotypic identification was inconclusive. Debridement surgery was done and amphotericin B was initiated. The patient was discharged after 10 days with the mention of routine follow-up. The isolate was sent to PGIMER Chandigarh Mycology Reference Center India for species confirmation. After almost 3 months the species was confirmed as L. theobromae.

Results

After almost 1-year clinical improvement was observed.

Conclusion

This study addresses the diagnostic dilemma both for the clinicians as well as clinical mycologists. Also, it emphasizes the need for molecular diagnostic workflow in such a scenario.
P237 Molecular epidemiology of Cryptococcosis—over 14 years using Whole Genome Sequencing and Multi-Locus Sequence Typing
Authors: Michael Joy Sarojini
Published: September 2022

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

 

Objectives

Cryptococcus neoformans/Cryptococcus gatti causes Cryptococcosis—a systemic fungal disease in immunocompromised as well as immunocompetent individuals.

Whole genome sequencing (WGS) technology provides insights into the molecular epidemiology of Cryptococcus species. The main objective of this study was to analyze the genetic variations between the Cryptococcal species isolated in our center from patients from different parts of India using WGS and Multi-Locus Sequence Typing (MLST).

Methods

This was a study done on 56 strains of Cryptococcus that had been previously identified as C. neoformans from patients who were treated at Christian Medical College from 2007-2020. The organisms were identified by conventional colony morphology and microscopy and species identification by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). To determine the genetic diversity of C. neoformans isolates and the genetic structures of their populations, these Cryptococcus species isolates were further subjected to whole genome sequencing (WGS) using the Illumina platform followed by MLST using seven different housekeeping genes for genotyping the isolates. Based on the analysis, the Cryptococcus species isolates were characterized into Molecular types and clonal types, and their prevalence calculated.

Results

In this study out of the 56 Cryptococcal isolates, 50 were C. neoformans and 6 were C. gattii. A total of 46% of the patients from whom the Cryptococcus species were isolated from Eastern states of India and 42% were from South India. Out of the 50 C. neoformans 24 (48%) were isolated from patients infected with Human immunodeficiency virus (HIV), (14%) from those with autoimmune disorders, 6 (12%) from patients with post renal transplant on immunosuppressants. A total of 5/6 C. gatti patients were immunocompetent. The most common clinical presentation was meningoencephalitis with the CSF being the most common clinical sample from which the organism was isolated. The phylogenetic tree was constructed to identify the genetic similarities between the isolates. A total of 49/50 C. neoformans belonged to molecular type VNI (98%) and one was type VII (2%). They were also sub-typed into 11 sequence types including one novel sequence type (ST). A total of 44% of them belonged to the sequence type (ST) 93 followed by ST 5 (14%). WGS analysis of C. gattii is ongoing.

Conclusion

Molecular epidemiology of Cryptococcus species WGS and MLST is an important tool to understand the genetic diversity of Cryptococcus isolates in India over the years. Further studies on identifying the virulence factors and drug resistance mutations are needed to further understand the molecular mechanisms of disease pathogenesis.
P243 Case series of Cryptococcal Meningitis—Experience in North Western India over 1 year (2021–22)
Authors: Naguthevar Santhanam , Garg MK , Bohra Gopal Krishna , Jain Vidhi , Kumar Deepak , Midha Naresh Kumar , Meena Durga Shankar , Sharma Shivang , R Akshatha , Singh Kuldeep , Kombade Sarika P
Published: September 2022

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

 

Objective

Cryptococcosis is an opportunistic fungal infection causing high morbidity and mortality in patients, preferentially affecting immunocompromised. It can cause a wide array of clinical manifestation, which includes meningitis, pulmonary, as well as disseminated infection. Cryptococcus neoformans causes more than 90% cases of cryptococcal meningitis.

Methodology

We performed a retrospective review of patients with confirmed cryptococcal meningitis during 1 year period from 2021 to 2022 in tertiary care center, AIIMS Jodhpur. We assessed clinical, radiological, microbiological, and biochemical parameters along with treatment provided and outcomes of the patient.

Results

Of 189 patients screened for suspected cryptococcal meningitis, 6 were microbiologically confirmed positive. All the patients were immunocompromised, of which four were HIV positive and one was a solid organ transplant recipient on immunosuppression and one was old TB Meningitis. Most common symptom was headache and altered sensorium (100%). Radiological findings showed 30% had no significant abnormality. CSF examination revealed average CSF protein 97.6 (63-163), CSF chloride 103.3 (108-132), sugar 36.33 (1-68), with predominant lymphocytes. All the patients were microbiologically confirmed by CSF cryptococcal latex test. A total of 4/5 patients received amphotericin B (3 mg/kg) with fluconazole (1200 mg) for 2 weeks in the induction phase followed by fluconazole consolidation phase and maintenance phase. Of the five patients, four patients survive with a good response to the treatment with one fatality.

Conclusion

Through our case series we emphasize the fact that Cryptococcal meningitidis may present with non-significant radiological features. Thus, the differential diagnosis of C. meningitidis must always be thought of when an immunocompromised patient presents with headaches and other signs and symptoms involving the central nervous system.
P244 Catheter-associated blood stream infections due to Wickerhamiella pararugosa in a patient with acute myeloid leukemia: Review of lit eratures
Authors: Nasri Elahe , Fakhim Hamed , Vaezi Afsane , Mirhendi Hossein , Rizi Mahnaz Hosseini , Shelerangkon Mahsa , Ghafel Safiyeh , Badali Hamid
Published: September 2022

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

 

Objectives

This report aims to present a case of Candida pararugosa bloodstream infection, review previous cases with C. pararugosa infections, and provide a concise review of the clinical background, risk factors, and brief the management of infections.

Methods

A 3-year-old boy with a history of acute myeloid leukemia was hospitalized in Omid Hospital, Isfahan, Iran. Two consecutive blood cultures were taken from the peripheral vein and port catheter; after that empirically meropenem was administered.

Results

Candida pararugosa were isolated from blood based on conventional and molecular assays. Furthermore, the antifungal susceptibility profiles of the isolate were determined, which exhibited resistance to fluconazole (8 μg/ml). Antifungal therapy with caspofungin and removing the patient's port led to a significant clinical improvement of the patient's conditions. So far, in the literature review, 10 cases of clinical C. pararugosa isolates were found, of which 5 points had bloodstream infections.

Conclusion

Infections caused by uncommon Candida species have dramatically increased in recent decades, mostly among hematological malignancies. Most patients with C. pararugosa infection presented with specific underlying conditions, such as malignancy, sarcoma, surgery, and adult acute myeloid leukemia. Patients with indwelling catheters run a high risk of acquiring C. pararugosa bloodstream infection. Therefore, special consideration should be given to opportunistic fungal infections in immunocompromised individuals using catheters.
P245 Arthrinium species, a filamentous ascomycetes isolated from samples of human cutaneous infections-report from a medical mycology laboratory of Assam, North-East India
Authors: Nath Reema , Gogoi Navonil , Barua Shyamanta
Published: September 2022

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

 

Objectives

This study aims to report the isolation of closely related Arthrinium species from superficial skin lesions of five cases from a medical mycology laboratory of Assam, North East India.

Methods

The lesions were decontaminated with 70% ethanol and skin scrapings were collected on a sterilized glass plate. Direct mounts were prepared in 10%-20% KOH and cultures were put in Saboraud's Dextrose Agar with antibiotics, 5% sheep blood agar, and dermatophyte test medium (Himedia, India). Plates and tubes were incubated as per standard mycological techniques described. Molecular identification was done using ITS sequence analysis using ITS1 and ITS4 universal primers.

Results

Direct mount showed presence of hyphae with arthrospores in 3/5 cases. In one case, fungal hyphae was seen along with spore-like oval or round structures of about 3-4 μm diameter. Pure growth was seen after 7-14 days in multiple culture tubes in all five cases. Colonies were white, downy initially becoming white, and floccose on further incubation. Subculture on PDA in all the cases for 15-20 days revealed black, round, and oval spores of 3-5 μm suggesting Arthrinium spp.

The taxonomical identification was done by constructing a phylogenetic tree of the ITS sequences of the Arthrinium isolates of this study along with reference Arthrinium strains and Seiridium phylicae as the outgroup taxa.

The phylogenetic analysis clustered the isolates of this study into closely related Arthrinium species.

Conclusion

The genus Arthrinium belonging to the family Apiosporaceae, class Sordariomycetes which comprises of a group of filamentous ascomycetes fungi is rarely reported from human infections. We are reporting closely related Arthrinium spp from five cases of skin lesions from Assam, North East India. Three of the 5 cases hailed from tea garden areas of Assam. Arthrinium isolation in clinically significant cases and in multiple tubes may not be disregarded as a contaminant.
P246 Neglected keratitis caused by Exserohilum rostratum from the arid region of north-west India leading to vision loss—a case report
Authors: Netar Suresh , Choudhary Meenu , Verma Pushpanjali , Rastogi Vijyalatha , Gupta Mansi
Published: September 2022

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

 

Objectives

To report a case of complete loss of vision due to delay in diagnosis of fungal keratitis caused by Exserohilum rostratum in an immunocompetent patient from the arid area of north-west India.

Method

A 65-year-old female farmer was admitted to ophthalmology with a history of pain, redness, watering, and foreign body sensation in the left eye for 2 months. She had a history of trauma by splinters 2 months back. On ocular examination, a large corneal ulcer of about 7 × 8 mm size at 2-8‘o’ clock position in the left eye was present with diffuse corneal edema. She had no history of diabetes mellitus, hypertension, tuberculosis, COVID-19, and steroid eye drops instillation. There was no relevant previous history of any ocular surgery also. She was negative for hepatitis-B and human immune deficiency virus on serology. All her hematological parameters were within normal limits.

Patient was treated with moxifloxacin, carboxy methyl cellulose eye drops, and Neosporin eye ointment for around 2 months at primary health care facilities and later referred to our hospital for further management.

Corneal scraping of the patient was sent to our laboratory for potassium hydroxide mount and culture identification.

Results

Fungus was identified as E. rostratum on the basis of gross, macroscopic, and microscopic morphology. Gram's staining was bacteriologically negative while true fungal hyphae were seen. In KOH mount pigmented, septate, and branched true hyphae were seen. Bacterial culture was reported sterile.

Lactophenol cotton blue mount of culture revealed dematiaceous hyphae along with 4-9 septate elongated, ellipsoid macroconidia of 14-90 μm with prominent dark conspicuous hilum and geniculate conidiophore arranged sympodially. On the basis of these characteristics, it was diagnosed as E. rostratum.

After the diagnosis patient was switched over to topical natamycin 5% two hourly and oral itraconazole 200 mg BD from moxifloxacin and neosporin. To which the patient responded symptomatically. Ulcer healed in a month leaving behind a lateral scar. However, vision is permanently compromised and the patient is advised for therapeutic penetrating keratoplasty (TPK).

Conclusion

Exserohilum rostratum is generally regarded as a pathogen in hot and humid climates. However, the isolation of this organism in our area highlights the pathogenic potential of this emerging fungus in arid climates also. Ophthalmologists need to be made aware of the significance of prompt mycological identification to prevent vision loss.
P269 Managing prosthetic valve endocarditis due to Sarocladium kiliense: Finding a way through uncertainties
Authors: Rege Sujata , Soman Rajeev , Shetty Anjali
Published: September 2022

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

 

Objective

To discuss the challenges in a case of recurrent/refractory prosthetic valve endocarditis due to Sarocladium kiliense.

Methods and Results

Timeline of events (Fig. 1).

AUC/MIC is associated with efficacy. Recent clinical studies have incorporated the MIC into targets for TDM, wherein Trough/MIC target of 2-5 may be usedR.

In this case

Voriconazole trough—3.1/MIC-0.25 = 12.5

Usual posaconazole trough—1.2/MIC 0.5 = 2.4, which is at the lower limit of the PKPD index

Hence voriconazole was used.

Drug interactions of voriconazole with acenocoumarol, clopidogrel were considered.

Beta D-Glucan was used to assess infection of the newly implanted valve as well as improvement and need for continuing treatment.

Since it is difficult to be certain of a cure, the patient was advised voriconazole as lifelong chronic suppressive therapy with periodic follow-up.

R: reference available.

Conclusions

The patient's status of the third mitral prosthetic valve necessitated all efforts to avoid further surgery. Therefore, the most efficacious agent had to be selected based on PK PD considerations and the likelihood of major long-term adverse effects.

Careful management of DDI was needed.

BDG may help to assess recurrence and response to treatment.
P274 COVID-associated invasive pulmonary aspergillosis (CAPA) — a case report
Authors: Sahoo Asish , Shastri Prakash
Published: September 2022

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

 

 

COVID-associated pulmonary aspergillosis (CAPA) is a severe fungal infection with a high mortality rate. The incidence of CAPA is on the rise possibly due to the prescription of corticosteroids and tocilizumab two repurposed drugs used for treating SARS COV-2. Diagnosis is challenging due to the non-specific nature of symptoms. Voriconazole is the mainstay of therapy. We present a case of a 42-year-old male presenting with left hydro pneumothorax post recovery from COVID infection, and later succumbed to this complication. Patients developing pulmonary aspergillosis after short-term steroid therapy is uncommon. The possibility of aspergillosis in immunocompetent patients should be considered in those on systemic steroids and deteriorating pulmonary functions.
P278 Brain abscess caused by dematiaceous fungi in apparently immunocompetent hosts: Acase series
Authors: Savaj Pratik , Shah Vitrag , Thakor Bhaumik , Jain Kalpesh , Bhuptani Simple , Master Ricky , Munim Frenil
Published: September 2022

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

 

Objective

Dematiaceous or melanized fungi, can cause CNS involvement even in apparently immunocompetent hosts because of the intense neurotropism of the fungus. We present a series of 4 such cases.

Methods

Case series

Results

Figs. 1 and 2

Conclusion

The diagnosis of the disease is challenging due to its rarity, lack of specific signs and symptoms, and radiological findings of the disease. Radiologic reports should give a DD rather than name a specific condition. This prevents a biopsy procedure and leads to the use of empiric, ineffective, toxic, expensive therapy and disease progression. In our case series, the mean days to diagnosis from symptom onset was 49 days. Although, less than what is reported in the literature which is 115 days, it is still late to be of meaningful value to the patient. There are many factors like antifungal DST, interpretation of MIC when there is no BP available, cost of antifungal therapy, therapeutic drug monitoring, need for repeat surgery, active follow-up, and awareness among surgical colleagues remain a major concern in Indian settings. Combination of antifungal drugs for life long along with wide surgical resection with frequent follow-ups which includes TDM, radiological assessment, need for repeat surgery, and management of adverse drug reactions of antifungal drugs are the unmet clinical needs.
P290 Public health treatment due to rise in Candida auris candidemia infection
Authors: Singh Rakesh
Published: September 2022

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

 

Introduction

Isolation of Candida spp. from a blood sample in patients is known as candidemia. Candida albicans is the most common causative agent of candidemia globally while C. tropicalis is the most common causative agent in India. Candida parapsilosis complex, C. glabrata, and C. krusei are the other three common causative agents of candidemia. Candida auris was described in 2009 and is a public health treatment. It is multidrug-resistant and causes localized hospital outbreaks.

Objective

To determine the fungal profile of candidemia in a tertiary care hospital.

Methods

Institute ethics approval was taken. All patients admitted to the Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India from January 2020 to January 2021, whose blood culture samples yielded yeast were included in the study. The patient's demographic details were recorded. Yeast isolates were identified by Matrix-Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS) as per the manufacture's instruction. The antifungal susceptibility testing (AFST) was performed by microbroth dilution method for fluconazole, voriconazole, amphotericin B, and caspofungin as per Clinical and Laboratory Standards Institute (CLSI) M27 and interpreted by CLSI M59 and M60 document. AFST of C. auris was interpreted as per Centers for Disease Control and Prevention (CDC) criteria. Results were expressed in percentages.

Results

A total of 248 blood culture samples yielded yeast cells during the study period. Approximately 63% of samples were obtained from male patients, while ∼37% were obtained from female patients. Most of the patients were between 41 to 60 years or under 10 years of age. A total of 52/240 (15.8%) were diabetic, and 30 (15.2%) were positive for severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2). Candida tropicalis (34.7%) was the most common causative agent. It was followed by C. parapsilosis complex (20.2%). Candida auris (16.5%), C. albicans (13.3%), C. glabrata (6.5%), and other C. spp. (8.9%). Candida krusei is no longer observed as one of the top five agents of candidemia and it is replaced by C. auris. The rise of candidemia due to C. auris is a cause of concern, and its prevalence is observed more than that of C. albicans in our tertiary care hospital. The antifungal resistant pattern of the top four candidemia isolates is depicted in Figure 1. The antifungal resistance was maximum in C. auris isolates, followed by C. parapsilosis complex isolates. A total of 12.2% of C. auris isolates were resistant to amphotericin B, and azoles and 4.9% of C. auris isolates were multidrug-resistant.

Conclusion

Candida tropicalis was the most common causative agent of candidemia. But the increased prevalence of C. auris over C. albicans is a cause of concern as 4.9% of C. auris isolates were multidrug-resistant.
P297 Disseminated histoplasmosis from skin to adrenals a cosmetic
catastrophe—a rare case report
Authors: R NEETHA T , Khatod Yash , Samantaray Subhashree , Khichar Satyendra , Bohra Gopal Krishna , Kumar Deepak , Garg Mahendra Kumar
Published: September 2022

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

 

Background

The varying presentations of histoplasmosis is always a diagnostic dilemma for clinicians. Cases of disseminated histoplasmosis can present in multiple specialties like dermatology, medicine, endocrinology, with skin, and mucosal hyperpigmentation as the only major symptom.

Case Report

Here we present a case of a 54-year-old male with hyperpigmentation all over the body with multiple specialty consultations done in the past 2 years. There was a significant history of loss of weight over a period of 2 years. His cortisol levels were low which explained the focus in the adrenals, with bilateral adrenomegaly found in imaging studies. His diagnostic work-up for TB and possible malignancy was ruled out. The provisional diagnosis of histoplasmosis was made and confirmed with biopsy and culture. Definitive treatment with antifungals was initiated, which showed improvement on follow-up.

Conclusion

Histoplasmosis is always underreported, because of a lack of information regarding the various clinical presentations. Early diagnosis and prompt treatment may save the patient from catastrophic adrenal insufficiency. The diagnosis of adrenal histoplasmosis should be considered in patients presenting with constitutional symptoms and adrenal masses with or without adrenal insufficiency. Adrenal histoplasmosis can be the only possible presentation in disseminated histoplasmosis.
P303 An unusual case of isolated gluteal abscess
Authors: Vaidya Viplov , Wagh Vikram , Sinha Seema , Konde Santosh , Arora Sohini
Published: September 2022

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

 

Background

Mucormycosis is an invasive infection caused by fungi belonging to the order Mucorales. The angioinvasive disease caused by these fungi can prove to be fatal despite appropriate treatment. We report an unusual case of a gluteal abscess caused by a probable mucormycosis in an apparently immunocompetent individual.

Case Description

A 68-year-old gentleman hailing from a rural area of Bihar, India presented with a painful swelling over the left buttock region for 4 weeks. He was a known hypertensive and had ischemic heart disease. He denied any history of fever. The lump had gradually increased in size. He was a retired school teacher with a farmland and reared livestock at home. He was a non-vegetarian and denied any addictions. He had a history of intermittent lower backache for which he used to take occasional intramuscular analgesic injections over his buttocks from a local medical practitioner.

On examination, the swelling was about 4 cm X 4 cm in size, fluctuant, with ill-defined margins over the lateral region of the left buttock. The swelling was tender, warm, and not fixed to underlying structures. Systemic examination was unremarkable. Ultrasound examination revealed an ∼7.2 × 4.2 × 7.8 cm cystic lesion with a volume of 126cC. It was located predominantly in subcutaneous fat extending into muscular plane with septa and solid components in the left gluteal region (Fig. 1). It had thick walls and fine internal echoes within. Other investigations were unremarkable except for glycosylated Hb, which was 6.2%. Incision and drainage were done.

During the procedure, it was seen as a cyst with a thick wall that was removed in toto. The contents were explored after removal and were found to be yellowish black with mucoid consistency. Histopathological examination revealed numerous broad, ribbon-like, aseptate fungal hyphae with right-angled branching infiltrating the inflamed tissue (Fig.2). There were numerous epithelioid granulomas surrounding the fungal elements in the soft tissue of the wall. The findings were consistent with a fungal abscess caused by mucormycosis. Culture of the fluid/pus was negative. Thus, a diagnosis of mucormycotic gluteal abscess was made and patient was commenced on 50 mg of amphotericin B deoxycholate in view of financial restraints. High resolution computed tomography of chest was done which was unremarkable.

He developed an acute kidney injury after 2 doses of amphotericin B deoxycholate which was then stopped. Oral posaconazole was started. He has developed bilateral leg swelling post-oral posaconazole and is commenced on oral spironolactone for the same. The postoperative wound has healed well and there is no new swelling or tenderness over the area. He is planned for further follow-up.

Conclusions
P314 Atypical clinical manifestations and epidemiology of favus in southeast China in the last 15 years and a review of case studies
Authors: Yijing Wang , Li Li , Min Zhu
Published: September 2022

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

 

Objective

We aimed to report cases of favus in southeast China in the last 15 years and evaluate clinical and epidemiological characteristics of them, and review the cases reported in the past 10 years worldwide.

Methods

Analyze the basic information, lesion characteristics, disease course, treatment, and prognosis of five cases of favus which were all diagnosed by clinical manifestations and mycological examination in Huashan Hospital of Fudan University. Searched the PubMed, Wanfang, Weipu, and CNKI databases and summarized the literature and case reports related to Trichophyton schoenleinii infection of past 10 years.

Results

There were five cases diagnosed as favus in the last 15 years in Huashan Hospital. The pathogenic fungi were all Trichophyton schoenleinii, which was confirmed by culturing and ITS sequencing identification. The five patients were all females and lived in southeast China, of which three were from Jiangxi province, one was from Zhejiang province, and one was from Shaanxi province. Favus is not only seen in children, but also in adults. Three of them were affected in childhood, and the others got in adolescence. The classical lesion of favus was a cup-shaped yellow crust on the scalp centrally pierced by dull grey hair. Affected skin is characterized by a mousy or cheesy odor. However, in these five cases, the skin lesions were without the typical clinical manifestations but often manifested as follicular pustules with underlying erythema, covered with scales and left sequelae such as alopecia and scarring. They were treated with oral terbinafine or itraconazole and achieved good efficacy. In the past 10 years, there have been 43 cases of infection with Trichophyton schoenleinii worldwide, located in Xinjiang, Kaifeng, Kunming, Guangxi region of China, Iran, Tunisia, Kosovo, Kashmir, Turkey, and Mie County in Japan. In nine individual case reports, eight were female and one was male. Four cases were without typical yellow crust. Trichophyton schoenleinii not only infected the scalp, it can also infect the face, extremity, and trunk in patients without immunodeficiency.

Conclusion

There are still a small number of infections of Trichophyton schoenleinii over the world. However, the clinical manifestations of favus in southeast China tend to be atypical due to factors such as improved sanitation and host immunity, so it has raised the difficulty to obtain proper diagnosis and treatment. Therefore, the doctors should pay great attention to this and make early identification with the help of mycological examination methods to prevent irreversible consequences such as scars and alopecia.