bluuebunny/crossref_metadata_2025 huggingface dataset:
M1.2 Human pythiosis
Authors: Plongla Rongpong , Chindamporn Ariya
Published: September 2022

Meet the expert session, September 22, 2022, 8:00 AM - 9:00 AM

Human pythiosis is a rare, life-threatening infection, which is generally caused by Pythium insidiosum, a fungal-like oomycete. Four forms of human pythiosis are described: 1) vascular pythiosis affecting the patient's arteries causing arteritis, thrombosis, and gangrene; 2) ocular pythiosis, mainly causing infections of the cornea; 3) skin and soft tissue infections (cutaneous and subcutaneous pythiosis); and 4) disseminated pythiosis. Vascular pythiosis is associated with high morbidity and has a mortality rate of 10%-40%, which attributes to difficulties in diagnosis of the infection and the lack of effective standard treatment. Rice farmers and patients with thalassemia are at risk for vascular infection. Early diagnosis of Pythium infection requires a high index of clinical suspicion and is essential for good treatment results. Microscopic morphology of Pythium spp. resembles other non-septate hyphae, such as agents of mucormycosis. Definite laboratory diagnosis includes tissue cultivation with zoospore induction, polymerase chain reaction (PCR), and detection of Pythium antibodies. Radical surgery together with immunotherapy, and anti-fungal agents (e.g., terbinafine and itraconazole) have previously been used for the treatment of human pythiosis. However, patients with incomplete surgical resection had almost 100% mortality. A novel therapeutic approach and reliable biomarkers are needed to improve patient outcomes.

 

There are several studies demonstrating excellent in vitro activity of antibacterial agents, especially macrolides, tetracyclines, and oxazolidinone against P. insidiosum. There are also evidences of synergy among antibacterial classes such as tetracyclines and macrolides. In 2019, Susaengrat, et al. reported successful treatment of two patients, who had inoperable intra-abdominal vascular pythiosis, with adjunctive antibacterial agents as salvage therapy. The medications included itraconazole in combination with doxycycline and azithromycin or clarithromycin. This case report also confirmed the result of a previous study by Worasilchai, et al. (2018) that serum 1,3-beta-D-glucan (BDG) is useful for monitoring disease activity. The ongoing multicenter prospective study is conducted to evaluate the use of antibacterial agents (azithromycin and doxycycline) with itraconazole and surgery in vascular pythiosis and to evaluate the alternative markers such as erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP). Torvorapanit, et al. (2021) reported preliminary results of 10 patients, which demonstrated favorable outcomes. It was shown that 2/4 patients with the residual disease could successfully be treated with mediations. ESR and CRP declined over time after treatment and Spearman's correlation between ESR and BDG was 0.65, and between CRP and BDG was 0.6. The study aims to recruit 50 patients, which should attest the usefulness of antibacterial agents and these markers in patients with vascular pythiosis.
P057 All- cause mortality in patients with invasive Candidiasis or candidemia from an interim analysis of a Phase 3 Open-label Study (FURI)
Authors: Prattes Juergen , King Thomas , Azie Nkechi , Angulo David
Published: September 2022

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

 

Background

There are limited oral treatment options for patients with high-mortality fungal infections such as candidemia or invasive candidiasis who fail currently available antifungals or have an infection caused by resistant organisms. Ibrexafungerp is an investigational broad-spectrum glucan synthase inhibitor with activity against Candida species, including azole- and echinocandin-resistant strains. A Phase 3 open-label, single-arm study of ibrexafungerp (FURI; NCT03059992) is ongoing for the treatment of patients intolerant of, or with invasive fungal disease refractory to, standard antifungal therapy. We present an interim analysis of all-cause mortality within 30 days post-treatment from the FURI study by fungal disease type for patients with candidemia or invasive candidiasis, who completed therapy up until October 2021.

Methods

FURI patients are eligible for enrolment if they have proven or probable: severe mucocutaneous candidiasis or invasive candidiasis, or candidemia, with documented evidence of failure, intolerance, or toxicity related to a currently approved standard-of-care antifungal treatment; or patients who cannot receive approved oral antifungal options (eg, due to susceptibility), and continued IV antifungal therapy is clinically undesirable or unfeasible. Patients were followed through 30 days post-treatment for all-cause mortality.

Results

Out of the 113 patients who completed therapy in the FURI study through October 2021, 56 (50%) had invasive candidiasis or candidemia and were treated with ibrexafungerp. The most common infections in this group were candidemia (15/56, 26.8%), intra-abdominal infection (13/56, 23.2%), and bone infection (10/56, 17.9%).

Overall survival within 30 days post-treatment in this group of 56 patients was 94.6%. Of the 56 patients with candidemia or invasive candidiasis, three (5.3%) died within 30 days after completion of treatment with ibrexafungerp, a fourth died at 31 days, a fifth died at 50 days, and a sixth died at 56 days. The mean age of the expired patients was 56 years. All 4 patients had candidemia (3 with C. parapsilosis and 1 with C. albicans), and 2 had intra-abdominal candidiasis, (both with C. glabrata). The average time on therapy with ibrexafungerp was 15.7 days. The mean time to death post-treatment for these patients was 27 days (median, 21 days). In five cases, the deaths were due to causes other than the underlying fungal disease. For the other case, the cause of death was not disclosed.

Conclusions

Analysis of all-cause mortality in these patients from the FURI study indicates that oral ibrexafungerp provides a favorable therapeutic response in patients with challenging fungal diseases and limited treatment options.
P062 Identification of Octenidine (dihydrochloride) inhibiting fungal filamentation by the repurposing approach
Authors: Fang Ting , Ji Zhe , Lu Hui , Jiang Yuanying
Published: September 2022

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

 

Objectives

Hyphal formation is an important virulence factor of opportunistic pathogenic fungi and plays a vital role in invasive fungal infections. Therefore, hyphae can act as a specific target against invasive fungal infections and it is a new attempt to focus on identification of compounds inhibiting hyphal growth. Amphotericin B has potent inhibitory effect on the growth of hyphae, but its high toxicity limits its clinical use. To address this question, we performed a high-throughput screen of an FDA-approved compound library (HY-L022, MCE®) to identify compounds with mycelial inhibitory function.

Methods

We performed a high-throughput screen of an FDA-approved compounds library to identify potentially novel compounds for inhibiting hyphal growth and used amphotericin B (1.56 μm) as a positive control drug. The screening schematic is shown in Figure 1a. Firstly, we investigated the mycelial inhibitory activity of each compound at 100 μm in RPMI 1640 medium with Candida albicans SN152 strain. Secondly, micro checkboard dilution method was applied to determine the minimum hyphae-inhibiting concentration of compounds. The compound being included in the next round could inhibit the hyphal formation when its concentration was ≤12.5 μm. Lastly, we expanded medium to YPD containing 10% FBS, YPD containing 5 mm N-acetylglucosamine (GlcNAc), and Spider medium. The final Candidate compound was determined due to its minimum hyphae-inhibiting concentration was ≤3.125 μm in four mediums.

Results

We screened a library of FDA-approved compound and identified 117 Candidate compounds that inhibit hyphal growth (≤100 μm). We excluded 14 compounds with known antifungal activity, and finally 103 compounds were included in the next step of mycelial inhibitory activity screening (Fig. 1a). We further identified that 14 of 103 Candidate compounds (red square) could significantly inhibit the growth of mycelium at a concentration not higher than 12.5 μm in RPMI 1640 medium (Fig. 1b). We then expanded the types of media that induce mycelial growth (such as YPD medium with 10% FBS, YPD medium with 5 mm GlcNAc, and Spider medium) and used amphotericin B (1.56 μm) as a positive control drug and found that Octenidine (dihydrochloride) still has a significant inhibitory effect on mycelial growth in various mycelial induction media when it is as low as 3.125 μm (Figs. 2a and b).

Conclusion

Our study demonstrates that Octenidine (dihydrochloride) has a potent hyphal inhibitory activity and is helpful to open the way for the development of new antifungal therapeutics targeting filamentous formation.
P080 Comparison of efficacy of innovator molecule of itraconazole with generic forms of itraconazole in treatment naïve subjects with chronic pulmonary aspergillosis
Authors: Sehgal Inderpaul , Vinay Keshavamurth , Agarwal Ritesh , Rudramurth Shivaprakash
Published: September 2022

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

 

Objective

Itraconazole capsule has a variable and unpredictable bioavailability. Whether generic brands of itraconazole are as effective as the innovator molecule in the treatment of subjects with chronic pulmonary aspergillosis (CPA) is unclear. We compared the proportion of subjects who achieved therapeutic drug levels with the generic and the innovator itraconazole at 2 weeks after treatment initiation.

Methods

In this retrospective study, we compared the proportion of subjects with CPA achieving therapeutic drug levels (≥ 0.5 mg/l) with the generic and the innovator itraconazole at 2 weeks after treatment initiation. We performed a multivariate logistic regression analysis to ascertain if the trough itraconazole levels affected the treatment outcomes. We also performed morphometric analysis of different brands of itraconazole by video dermoscopy.

Results

A total of 193 [generic brands (n = 94) and innovator itraconazole (n = 99)] subjects of CPA were enrolled. The median (IQR) age of the study population [54% (105/194) men] was 42 (32-55) years. The proportion of subjects who achieved therapeutic trough itraconazole levels was significantly (P <.0001) higher with the innovator than the generic brands [72/99 (73%) vs. 27/94 (29%)]. The median trough itraconazole level at 2-weeks was also higher with the innovator brand than the generic brands [0.8 (0.5-1.6) vs. 0 (0.0.5) mg/l]. The average trough itraconazole levels and the trough itraconazole levels >1 mg/l independently predicted favorable treatment response after adjusting for age, gender, and CPA severity. The generic brands had a variable number, size, and a larger pellet size on the morphometric analysis. Two brands had dummy particles.

Conclusion

Significantly higher proportion of subjects achieved therapeutic drug levels with the innovator brand of itraconazole than the generic brands. Importantly, the serum itraconazole levels independently predicted a favorable response to treatment in CPA.
P087 A clinicomycological study of dermatophyte infection including antifungal susceptibility testing in patients attending a tertiary care hospital in north-western state of rajasthan
Authors: Charan Manisha , Rastogi Vijyalatha , Verma Pushpanjali , Lakhawat Rajendra Singh , Chaturvedi Parul , Jhorawat Bhawna , Mehta Mahesh
Published: September 2022

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

 

Objectives

Treatment-resistant ermatophytosis caused by Trichophyton rubrum (T. rubrum) or Trichophyton mentagrophytes (T. mentagrophytes)/Trichophyton indotineae have recently emerged as a global public health issue. This phenomenon is spreading, and is particularly important in endemic areas such as India. However, due to lack of focused studies on dermatophyte prevalence, there is paucity of such data from Rajasthan. Hence, for better understanding of the prevalence, antifungal susceptibility, and resistance pattern to enable best empiric treatment the present study was done.

Materials & Methods

A total of 100 patients attending Dermatology and Venereology outpatient department during the period of December 2019-October 2020 were enrolled under this prospective study. Samples were subjected to KOH, culture examination, and identified by standard techniques at the mycology section of department of microbiology. Antifungal susceptibility testing was performed by Microbroth dilution as per CLSI guidelines (M38-A2) with the following drug concentration ranges—amphotericin B 0.0313-16 μg/ml; flucytosine 0.125-64 μg/ml, ketoconazole 0.0313-16 μg/ml. Itraconazole and voriconazole 0.0078-4 μg/ml, fluconazole 0.0625-32 μg/ml, caspofungin 0.0313-16 μg/ml and terbinafine 0.0156-8 μg/ml.

Results

Among 100 clinical samples tested, culture positivity was found to be 63%, including dermatophytes (76.1%), non-dermatophytes molds (19.04%), and yeasts (∼ 4%). Among dermatophytes, T. mentagrophyte was the predominant isolate (33.3%) followed by T. rubrum (29.1%). Most common clinical type was tinea cruris (53%) followed by tinea corporis (23%). Itraconazole and voriconazole were found to be most effective at MIC range of 0.0078-4 μg/ml for T. mentagrophyte and at 0.0078-1 μg/ml for T. rubrum, mostly corroborating with clinical outcome. Itraconazole resistance was highest (57%) in T. rubrum, whereas terbinafine resistance (>0.2 μg/ml) was seen in ∼ 31-37% of these two major species.

Conclusion

It is important for clinicians to emphasize upon microbiological diagnosis of dermatophytosis as these infections have many mimics, highlighting the need of confirmation by culture. High prevalence of terbinafine resistance in both T. mentagrophyte and T. rubrum and itraconazole resistance in T. rubrum is of concern and highlights the need to routinely perform antifungal drug susceptibility testing as a necessary adjunct to treatment and for surveillance.
P089 Candidemia: prevalence, species characterization ,and the antibiotic susceptibility profile from a tertiary care hospital in north india
Authors: William Ashish , Kaur Ravinder , Rawat Deepti , Kumar Pradeep
Published: September 2022

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

 

Objectives

The aim of this study was to characterize the Candida spp. isolated from blood cultures and determine the antifungal susceptibility pattern of the Candida species prevalent in a tertiary care hospital in North India.

Methods

This retrospective study was conducted in Department of Microbiology of a tertiary care hospital in North India from April 2020 to March 2022. All blood cultures received in the department during this period were included in the study. Candida species isolated were identified and antifungal susceptibility testing was performed by VITEK as per standard protocol, The susceptibility pattern of 50 isolates was also performed by the broth microdilution method as per Clinical and Laboratory Standards Institute guidelines (CLSI) and the results were compared with VITEK results.

Results

Out of 21 804 blood cultures received during this period, 177 grew Candida species. Therefore, the overall prevalence of Candida species was 0.81% in our study. The incidence of bloodstream infection caused by non-albicans Candida species (80%) was higher than C. albicans (20%). Among NAC species, C. tropicalis (45%) was the most common, followed by C. pelliculosa (15%).

Candidemia was predominantly observed in ICU patients. Resistance was seen in 14.1% isolates to voriconazole and fluconazole, 4.2% to flucytosine and 3.9% to caspofungin and amphotericin-B. No resistance was seen to micafungin. A total of 15% of the isolates were resistant to more than one drug.

Conclusion

There was a predominance of non-albicans Candida over C. albicans. Maximum resistance was seen to voriconazole followed by fluconazole. Continuous surveillance is necessary to follow trends and monitor changes in epidemiological and resistance patterns in different geographical regions, especially in critically ill patients.
P128 Chronic pulmonary aspergillosis in a Tuberculosis c enter of Assam—a 2-year study
Authors: K Aishwarya , Nath Reema , Deori Pranjal , Bora Pranami , Goswami Priyam , Phukan Chimanjita
Published: September 2022

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

 

Objectives

Chronic pulmonary aspergillosis is a slow and progressive lung disease that occurs in apparently immune-competent patients. Pulmonary tuberculosis is considered to be a major predisposing factor. Early diagnosis of the condition can improve morbidity and mortality. As the number of studies to detect this disease in India is sparse, this study was undertaken in District Tuberculosis center attached to Assam Medical College and Hospital, Dibrugarh to find out the occurrence of chronic pulmonary aspergillosis in treated pulmonary TB patients.

Methods

This prospective hospital-based cross-sectional study was done in Assam Medical College and Hospital, Dibrugarh from December 2015-November 2017. Every consecutive pulmonary TB case after completion of intensive therapy attending the outpatient department with respiratory symptoms was included in the study. Cases were identified with clinical, serological/mycological, and radiological criteria.

Results

A total of 26 cases of CPA were confirmed out of 211 enrolled cases. Positivity rate of CPA in the enrolled patients was 12.3% (95% CI 8.19-17.51%). The hospital-based occurrence rate was found to be 6/1000 (95% CI 3.8-8.5) in the outdoor attendants in DTC, Dibrugarh. Most of the cases (88.46%) were late cases presenting with aspergilloma. Majority (51.72%) of the aspergilloma cases were detected within 5 years of diagnosis of PTB. Very few (15.38%, n = 4) early cases were detected. The sensitivity of the ELISA test (DRG, Germany) was found to be 72.72% as compared with reference Immunocap method used in this study. A section (37.90%) of the patients with fungal ball was seronegative by Aspergillus fumigatus serological test. Two of them were positive for Aspergillus flavus in sputum culture.

Conclusion

A serological test to detect Aspergillus flavus IgG may complement the Aspergillus fumigatus IgG test in detecting CPA. CPA is a neglected disease with a high morbidity and mortality. Routine follow-up protocol for the cavitary patients in tuberculosis center by a sensitive serological test for a minimum period of 5 years may be necessary for early detection of cases in PTB high prevalence countries.
P135 Immunological correlation with clinicomycological aspects of fungal rhinosinusitis during COVID-19 pandemic
Authors: Vashistha Mohan
Published: September 2022

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

 

Background and Objectives

To determine the relation between disease spectrum, etiology, and immunological markers of fungal rhinosinusitis.

Material and Methods

Diagnostic nasal endoscopy was used for the collection of sinus and nasal tissue samples which were processed as per standard mycological procedure for microscopy, culture and histopathological examination (HPE). Enzyme-linked immunosorbent assay was used for total IgE, serum IL-6, IL-10, TNF-α levels detection.

Results

Out of 148 samples, 70% were diagnosed as FRS. COVID-19 infection 46.9% was the most common comorbid condition. Use of steroid therapy 46.9% was the most common predisposing factor. Nasal obstruction 62.2% was the most common clinical feature but headache (P-value .002) and eye discharge were statistically significant (P-value .005). KOH mount revealed findings in 84.69% patients in this study. Combination of KOH, HPE, and fungal culture revealed findings in 62.2% cases. Rhizopus arrhizus 27.6% was the most common isolate Aspergillus flavus and Rhizopus arrhizus were statistically significant (P-value .003, .026 respectively). IL-6 59.2% was the most common serological marker raised in this study. PNS imaging revealed that 100% of the patients had single or multiple sinus involvement and maxillary sinus (P-value .038) was significantly associated. Acute invasive fungal rhinosinusitis 75.5% was the most common type of FRS. Mortality was 17.34% in this study.

Conclusion

FRS is an important emerging public health problem and a cause of mortality and morbidity, particularly in immunocompromised patients. Furthermore, in the current scenario of COVID-19 pandemic, FRS has become more fatal and an entity of immediate and grave concern than ever before.
P140 Saksenaea vasiformis infection: case report of extensive abdominal wall necrotizing fasciitis with systematic review and analysis of 64 cases
Authors: K Karthick
Published: September 2022

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

 

Introduction

Saksenaea vasiformis is a rarely reported Mucorales causing mucormycosis in both immunocompromised and immunocompetent individuals. Due to few reported cases, the clinical characteristics and optimal management strategy for this rare agent are not clearly described. Therefore, we conducted a combined analysis of a case of extensive abdominal wall necrotizing fasciitis from our center with individual patient data extracted from other reports in world literature to give an overview of clinical and demographic profiles as well as factors affecting outcomes in this rare infection.

Methods

We systematically reviewed Medline, Embase, and CINHAL for studies on S. vasiformis infections reported till January 1, 2022, and 57 studies (63 patients) were retrieved. We also describe clinical and demographic characteristics and outcomes of a case of extensive abdominal wall necrotizing fasciitis managed at our institution.

Results

Of the 64 included cases, the majority were reported from India (26.6%). The most common risk factors for infection were accidental trauma (31.3%), health-care-related wounds (14.1%), and animal/insect bites (12.5%). Subcutaneous infection was the most common clinical presentation (60.9%) followed by rhino-orbito-cerebral mucormycosis (ROCM) (14%), necrotizing fasciitis (10%), and disseminated infection (9.3%), pulmonary (3.2%) and osteomyelitis (1.6%). Mortality was observed in 24 (37.5%) patients and healthcare-related injuries were significantly associated with higher mortality (P .001). The use of posaconazole (P .019) and surgical intervention (P: .032) was associated with significantly better survival.

See Figures 1 and 2 below.

Discussion

In this study, we describe the largest compendium of mucormycosis due to S. vasiformis and can be useful in increasing awareness regarding this rare Mucorales in addition to guiding patient management.
P185 Epidemiology of human fusariosis in Greece: results from a 16-year nationwide multicenter survey
Authors: Drogari-Apiranthitou Maria , Mpakosi Alexandra , Siopi Maria , Argyropoulou Athina , Vrioni Georgia , Mamali Vasiliki , Christofidou Myrto , Meletiadis Joseph , Orfanidou Maria , Mastrogiannaki-Marini Alexandra , Skiada Anna , Petrikkos Georgios
Published: September 2022

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

 

Objectives

Fusariosis in humans comprises a vast array of rare but serious and difficult-to-treat infections, ranging from keratitis and onychomycosis in immunocompetent hosts to life-threatening systemic infections in immunocompromised patients such as those with hematologic malignancies. We aimed to assess the disease burden and baseline epidemiology of fusariosis in Greece.

Methods

From 2004 through 2020 a prospective, nationwide, multicenter survey took place. Demographic and clinical data of fusariosis cases were recorded. Fusarium strains isolated were identified to species level with molecular methods and/or MALDI-TOF MS, and tested for antifungal susceptibility in vitro with the EUCAST methodology.

Results

A total of 54 cases were registered. The most frequent infection was keratitis (n = 21, 39%), followed by bloodstream infections in patients with hematologic malignancy (n = 12, 22.2%). Other infections involved the respiratory tract (n = 3, 5.5%), and sinuses (n = 3, 5.5%) in immunocompromised patients, soft tissues after trauma (n = 5, 9.3%), or diabetic foot (n = 2, 3.7%), and onychomycosis (n = 8, 14.8%). The estimated incidence of invasive Fusarium infections was 2.9 cases/year (0.027 cases/100 000 population). The most frequently isolated species were: F. solani species complex (SC) (n = 13, 24%), F. oxysporum SC (13, 24%), F. fujikuroi SC (n = 12, 22.2%, of which 6 F. verticillioides and 6 F. proliferatum). Other SCs included F. brachygibbosum, F. chlamydosporum, and F. dimerum. In keratitis cases, F. solani was associated with infection secondary to injury with plant material, whereas F. fujikuroi with soft contact lens wear. Fusarium oxysporum was more frequently isolated from nails or soft tissue infections (53.8%). Antifungal MICs were high, with no clear interspecies differences (geometric mean 1.6, 2.5, 3.2 mg/l for amphotericin B, voriconazole, and posaconazole, respectively, median values 2, 4, 8 mg/L, respectively). Fluconazole and the echinocandins showed no activity (MIC >32 mg/l). The most frequently used antifungals were amphotericin B and voriconazole, usually in combination. Treatment failure in keratitis was 38.5%. In patients with hematologic malignancy the crude mortality rate was 71.4%, usually related to the underlying disease. Soft tissue infections complicating diabetic foot or trauma were treated surgically, with favorable outcomes.

Conclusion

Fusarium infections in Greece remain rare, but with considerable morbidity and mortality in the immunocompromised. Early diagnosis and initiation of the appropriate treatment were critical for a successful outcome in keratitis cases, despite moderately high MICs of the antifungals used.
P187 Paratracheal abscess by plant fungus Chondrostereum purpureum. First case report of human infection
Authors: Dutta Soma , Ray Ujjwayini
Published: September 2022

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

 

Objective

To identify the etiological agent of paratracheal abscess applying molecular techniques.

Methods

A 61-year-old male, plant Mycologist, who specially works with mushrooms presented to the OPD with hoarseness of voice and difficulty in swallowing for the last 3 months. CT scan demonstrated the presence of a right paratracheal abscess. CT-guided aspiration of the abscess was performed. The pus was sent for microbiological evaluation.

Results

The pus culture done on Sabouraud dextrose agar grew a creamy pasty colony with buff-colored pigmentation on reverse side (Fig. 1). On LCB mount preparation it was found to be a yeast-like structure with slender hyphae as shown in Fig. 2. The fungus could not be identified phenotypically, so it was sent to the ‘WHO Collaborating Centre for Reference and Research on Fungi of Medical importance’. It was identified as Chondrostereum purpureum by DNA sequencing. Patient was treated with oral voriconazole following drainage of the pus and the outcome was favorable. The patient denied having worked with such a plant pathogen but he confirmed d that he was working with decaying material and other plant fungi for a long time as part of his research activities.

Conclusion

Silver leaf is a fungal disease of trees caused by the fungus plant pathogen Chondrostereum purpureum. The disease is progressive and often fatal for the plants. It is spread by airborne spores landing on freshly exposed sapwood. No human infection was reported till date. The case report demonstrates the crossover of plant pathogens into humans when working in close contact with plant fungi.
P211 Fungal and bacterial co-infections of the respiratory tract among patients with COVID-19 hospitalized in intensive care units
Authors: Sarvestani Hasti Kamali , Khansari Mahmoud , Rafat Zahra , Abdollahi Alireza
Published: September 2022

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

 

Backgrounds

The pandemic of COVID-19 has created a global public health crisis. ICU patients with COVID-19 are prone to infections of bacterial and/or fungal origins due to several risk factors. Consequently, the current study was conducted to evaluate the frequency, demographic characteristics, underlying conditions, and etiologic agents of fungal and bacterial co-infections of the respiratory tract among ICU patients with COVID-19 in Iran.

Materials and Methods

From May to October 2020, sputa and endotracheal aspirates were collected from ICU patients hospitalized with COVID-19 who also were suspected of bacterial and/or fungal co-infections according to inclusion criteria. The etiologic agents of bacterial co-infections were identified using the VITEK 2 identification method. For fungal identification, all samples were analyzed by direct microscopy using KOH 10% and culture. Furthermore, all isolates were subjected to the sequencing method.

Results

A total of 73 lung specimens were obtained from patients who met the inclusion criteria. Of these, in 15 cases (20.54%) fungal and/or bacterial co-infections were confirmed. Males were more infected (73.33%) and all of them were between 49 and 79 years. Candida albicans (n = 8, 61.53%) and Klebsiella pneumonia (n = 5, 38.46%) were the most frequent etiologic agents related to fungal and bacterial co-infections, respectively. Pneumonia (n = 15, 100%) and diabetes mellitus (n = 8, 53.33%) were documented as the most prevalent underlying conditions. In the current study, 3 out of 15 patients (20%) died.

Conclusion

The frequency of bacterial co-infections of the respiratory tract in ICU patients hospitalized with COVID-19 was relatively high. According to the results, one of the causes of death in these patients could be a secondary infection.
P215 Investigation of an outbreak of neonatal Candida emia in the NICU of a 300 -bedded hospital in North India
Authors: Kaur Tripta , Garbyal Karan
Published: September 2022

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

 

Objectives

Neonatal Candidaemia causes significant morbidity and mortality in very low birth weight neonates. We report the occurrence of an outbreak of neonatal Candidaemia due to Candida krusei in the neonatal intensive care unit (NICU) of a 300-bedded hospital in North India.

Methods

A total of 96 blood cultures from 80 neonates admitted in the NICU from October 2020 to April 2021 were received and processed manually in the Microbiology lab. A total of 5 among the 47 yeast isolates were sent to a teaching hospital for identification and antifungal susceptibility testing by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF). Clinical parameters (very low birth weight, gestational age, birth asphyxia, broad-spectrum antimicrobial therapy, intra-uterine growth restriction, and total parenteral nutrition), lab parameters (CRP, platelet count), and patient outcome were evaluated. A total of 26 environmental samples and hand swabs from six health care workers were collected to trace the source of the outbreak. The samples were inoculated on 5% sheep blood agar and MacConkey agar. Regular rounds of the NICU and training sessions were conducted by the infection control team to intensify the infection control measures.

Results

Blood culture results: In all, 57 neonates (71.25%; 57/80) admitted to the NICU had positive blood cultures. A total of 47 blood cultures yielded non-albicans Candida spp. (82.45%; 47/57). The other microorganisms isolated from blood cultures were Pseudomonas aeruginosa (4), MRSA (3), Klebsiella pneumoniae (4) and Acinetobacter baumanni (1). Polymicrobial bloodstream infections were detected in two neonates. All the yeast isolates subjected to MALDI-TOF were identified as Candida krusei and had similar MICs of 0.25, 4, 16, 1, 0.25 and 16 μg/ml for voriconazole, itraconazole, posaconazole, caspofungin, micafungin and fluconazole respectively.

Culture results of environmental sampling: Yeast could not be isolated from any environmental sample and hand swabs of health care workers. However, MRSA was isolated from the hands of one health care worker.

Observation during the infection control rounds:

Conclusion

We report the occurrence of a massive outbreak of neonatal Candidaemia in the NICU of our hospital with a positivity rate of 58.75% (47/80). Identification of yeast and determination of antifungal susceptibility is important for prompt treatment. Though the source of the outbreak could not be traced but intensifying infection control practices could control the outbreak. This study emphasizes the value of educating healthcare workers and regular monitoring of disinfection practices to prevent health-care-associated infections.
P221 Deep dermatophytosis presented as multiple exophytic masses caused by Trichophyton rubrum in immunocompromised patient with rheumatoid arthritis; a case report
Authors: Hong Seong Min , Jang Seung Hee , Ahn Sang Woo , Choi Jong Soo , Shin Jeong Hwan , Kim Jayoung , Seol Jung Eun , Kim Hyojin
Published: September 2022

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

 

 

Dermatophyte invades the stratum corneum and infects the skin, nails, and hair, mostly resulting in superficial infection. Deep dermatophytosis involving dermis and subcutaneous layer was rarely reported in immunocompromised state. Herein, we report a case with deep dermatophytosis caused by Trichophyton (T.) rubrum. A 71-year-old woman presented with multiple erythematous exophytic and subcutaneous nodules located on both lower legs. She was taking immunosuppressive agents for rheumatoid arthritis and had taken antifungal agents for tinea pedis and onychomycosis, which was improperly ceased. Histopathologic examination revealed pseudoepitheliomatous epidermal hyperplasia with microabscess formation in epidermis and diffuse granulomatous inflammation consisting of multinucleated giant cells, lymphocytes, neutrophils, and histiocytes in dermis. Imuunohistochemical staining with periodic acid-schiff (PAS) and Gomori methenamine silver (GMS) showed septate and branched fungal hyphae in dermis. Trichophyton rubrum was identified in fungal culture with tissue and confirmed through phylogenetic analysis of internal transcribed spacer (ITS) and large subunit regions (LSU) in ribosomal RNA. Prior to identification of causative organism, her condition deteriorated into septic shock. Amphotericin B was administered empirically for 6 days in order to prevent hematogenous dissemination and skin lesions were simultaneously resolved. Since deep dermatophytosis appears in various clinical manifestations, it is easy to be mistaken for another disease. If treatment is delayed, immunocompetent patients can progress to severe disease courses like hematogenous dissemination, so clinicians should differentiate this disease and conduct treatment at an appropriate time.
P229 Three cases of easy to be misdiagnosed tinea of vellus hair
Authors: Liu Wentao
Published: September 2022

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

 

Vellus hair, also known as fine hair, is generally accepted that tinea of vellus hair is caused by dermatophyte infection of the vellus hair and fungal microscopy reveals the presence of mycelium and/or spores inside and outside the vellus hair. Different types of dermatophytes can cause different types of lesions. Therefore, tinea of vellus hair is easy to underdiagnose or misdiagnose in clinical practice. We report three cases of tinea of vellus hair caused by Microsporum canis. Case 1: A 24-year-old male patient with bilateral erythema with pruritus on the upper extremities for more than 1 year (A1). The patient was diagnosed with tinea of vellus hair by positive dermatoscopy (A2), fungal fluoroscopy (A3), and fungal culture of M. canis. after 9 weeks of treatment (oral itraconazole 0.2 g, 2 times/day, topical amorolfine cream 1 time/day, terbinafine cream 1 time/day), the skin of bilateral forearms basically returned to normal, and it is currently under follow-up. Case 2: A 5-year-old female patient with a rash on the root of the nose for 2 weeks (B1). She was also diagnosed with tinea of vellus hair by positive dermatoscopy (B2) and fungal fluoroscopy (B3) and fungal culture of M. canis. After 2 weeks of treatment (oral itraconazole 0.1 g, 2 times/day, topical terbinafine cream once a day), the lesions improved significantly. After 4 weeks of treatment, a few scales and scabs were still visible on the skin at the root of the nose. After 2 weeks of continued treatment, the patient's skin at the root of the nose was completely restored to normal. Case 3: 2-year-old male patient with a recurrent facial rash with scales for more than 3 months (C1). He was diagnosed with tinea of vellus hair by positive dermatoscopy (C2), fungal fluoroscopy(C3), and fungal culture of M. canis. After 2 weeks of treatment (oral itraconazole 0.1 g once every other day, bifonazole cream 1 time/d), the lesions are in improvement from the previous. And this case is still being followed up. The above three cases have been misdiagnosed as tinea simplex or eczema, and the efficacy of treatment only with topical medicines or short-term oral drugs is not good. Therefore, we take oral medicines and topical medicines for treatment, the course of treatment is long, and there are still spores and hyphae inside and outside the hair many times during the treatment period, so it is recommended that tinea of vellus hair should be treated according to the treatment plan of tinea capitis.
P252 A rare case of fungal liver abscess in an immunocompetent patient from India
Authors: Hallur Vinaykumar , Padmanaban Harishni , Mohanty Srujana , Panigrahi Manas Kumar
Published: September 2022

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

 

Objectives

To report a case of hepatic abscess caused by Candida albicans, which is a less common cause of hepatic abscesses in a non-onco-hematologic population. Fungal infections represent <2% of the total isolates in pus from hepatic abscesses in patients without onco-hematologic malignancies.

Methods

A 68-year-old adult male diabetic patient came with complaints of fever with chills and rigor and right upper abdominal pain and yellowish discoloration of eyes and urine. His LFT, PT-INR, RFT were deranged. CBC report shows anemia and Leukocytosis. His CECT showed irregular multiseptated hypodense lesions in segment V, VI, VII of liver. Direct and mycological and bacterial culture examination was performed.

Results

Direct examination of pus sample showed budding yeast cells with pseudohyphae and in SDA culture at 37°C it showed white pasty colonies. The species was identified by VITEK 2 system as C. albicans. The MICs obtained of antifungals were (ug/mL): fluconazole (≤0.5); voriconazole (≤0.12); caspofungin (≤0.12); micafungin (≤0.06); amphotericin b (1); flucytosine (≤1). The patient was started on caspofungin and improved symptomatically. Then oral fluconazole was started and continued until the resolution of lesion on imaging during the follow-up.

Discussion

Colonization of the gastrointestinal tract is thought to be the main origin of the dissemination of Candida; neutropenia facilitates the spread of Candida from the gastrointestinal tract to the liver. The likely source of infection is GIT in this case.

Conclusion

We describe a case of fungal liver abscess in an immunocompetent patient caused by Candida albicans which was successfully treated with caspofungin.
P261 Candida species in the bloodstream of patients from a tertiary hospital in southern Brazil
Authors: Wilot Leandre , Benelli Jessica , Basso Rossana , Poester Vanice , Sanchotene Karine , Klafke Gabriel , Xavier Melissa
Published: September 2022

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

Candidemia in hospitalized patients, especially those admitted to intensive care units (ICUs), is responsible for prolonged periods of hospitalization and antifungal therapy, resulting in higher hospital costs and in high mortality rates. The knowledge of the local prevalence of Candida species in the bloodstream and its susceptibility profile is necessary for appropriate therapeutic and surveillance interventions.

Objectives

This study aims to evaluate the prevalence of candidemia in a tertiary hospital in southern Brazil over a period of around one and a half years, its etiology, and the susceptibility profile of the isolates to antifungal drugs.

Methods

A retrospective study was carried out at the University Hospital of Rio Grande (HU-FURG/EBSERH), which has 218 beds. All cases of candidemia, diagnosed by the isolation of yeasts in blood cultures (automated culture system—Bactec®) between January 2021 and April 2022, were included. Databases were analyzed to collect data regarding the total of blood cultures examined in the same period, as well as the etiology and its susceptibility profile to fluconazole (FLU) and amphotericin B desoxicolate (AMB) (microdilution assay according to M27-A3, CLSI).

Results

During the sixteen months of the study, 368 patients were examined by blood cultures in our hospital, being 216 from ICUs (n = 101 adult; n = 115 neonatal/pediatric). A total of 21 were diagnosed with candidemia, resulting in a prevalence rate of 5.7%. The majority of the candidemia cases (66.6% - 14/21) occurred in ICUs, including pediatric/neonatal ICU (6/115; 5.2%) and adult ICU (8/101; 7.9%). C. albicans was associated with 52.3% of the cases (n = 11). Among the non-albicans species (n = 10), four were identified through MALDI-TOF (C. parapsilosis: n = 3; C. krusei: n = 1). Antifungal susceptibility showed that 62.5% of the non-albicans isolates tested (6/8) were resistant to FLU or AMB.

Conclusions

Candida species are important pathogens associated with sepsis in our hospital, corresponding to around 5% of the bloodstream infections in patients hospitalized, independently of their unit of origin. These data raise awareness of the need for early diagnosis, surveillance of resistance and prevention of this bloodstream infection to optimize the treatment, and promote a better prognosis for critical patients.
P265 Phaeohyphomycosis caused by Rhinocladiella similis mimicking Sporotrichosis
Authors: Taneja Juhi , Ranjan Rahul , Chatterjee Kuhu , Ramesh V , Das Bhabatosh
Published: September 2022

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

 

Objective

A case of phaeophyphomycosis caused by Rhinocladiella similis with a clinical picture simulating sporotrichosis is described.

Methods

A 34-year-old male patient, employed in a textile factory presented with multiple subcutaneous nodules on the lateral aspect of the dorsum of the left hand and left forearm. There was a history of mechanical trauma 1 year back. On examination, three to four verrucous ulcerative nodules clustered on the dorsum of the left hand were observed. A preliminary diagnosis of sporotrichosis was made and a punch biopsy was performed from the lesion and subjected to KOH examination, fungal culture, and histopathological examination. ITS sequencing was done to confirm the identity of the isolate.

Results

The skin punch biopsy from the lesion on the dorsum of the hand showed marked hyperkeratosis, papillomatosis, parakeratosis, acanthosis, and irregular elongation of rete ridges. No fungal structures and neutrophils were seen. On examination with 40% Potassium hydroxide round yeast-like cells were seen. An initial diagnosis of sporotrichosis was established. After 5 days, white to grayish colonies with aerial hyphae were observed on Sabouraud's dextrose agar which eventually turned greenish black on further incubation. Lactophenol cotton blue (LPCB) mount of the slide culture showed thin, hyaline, septate hyphae with oval conidia arranged in a bottle brush pattern around erect conidiophores and also directly arising from the hyphae. The pathogen was confirmed by ITS sequencing as R. similis. Patient was started on itraconazole 200 mg twice daily for 12 weeks. The patient is on regular follow-up and has shown gradual regression of the lesions indicating response to therapy.

Conclusion

Rhinocladiella similis infections have been reported chiefly from Brazil causing chromoblastomycosis. There have been no reports of infections due to this pathogen from the Indian subcontinent. This report presents the first case of R. similis as an agent of phaeohyphomycosis and calls for the need of a thorough evaluation of these cases so as to manage cases appropriately. It also underlines the need to study and redefine the ecological niche of this pathogen as well as its clinical spectrum.
P275 Dematiaceous fungi as a rare cause of fungal sinusitis in a tertiary care center
Authors: Kumar K.V.P Sai Kiran , Xess Immaculata , Singh Gagandeep , Sachdev Janya , Thakar Alok
Published: September 2022

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

 

Objectives

To discuss the occurrence and diagnosis of dematiaceous fungi as a causative organisms of fungal sinusitis in patients at a tertiary care center in North India. Since there is limited data on its prevalence, this study was aimed to know the non-Aspergillus causes of fungal sinusitis focusing on the dematiaceous fungi.

Methods

A total of 451 nasal biopsy samples, from the department of pulmonary medicine ward and ICU were received over a period of 3 years, from January 2019 to December 2021. The samples were subjected to conventional mycological diagnostic techniques including direct epifluorescence and light microscopy, culture on solid media and visual identification of growth in culture using lactophenol cotton blue mounts.

Results

Out of 451 samples, no fungi were isolated from 299 samples (66.29%), Aspergillus spp from 63 samples (13.96%), dematiaceous fungi from 10 samples (2.21%), and other fungi from 79 samples (17.5%). Among the dematiaceous fungi isolated, 7 isolates were identified as Alternaria spp. (70%) and 3 isolates were identified as Curvularia species (30%) and described.

Conclusion

Most reported cases of allergic and invasive sinusitis were attributed to Aspergillus spp. However, in the current study, dematiaceous ‘black’ fungi like Alternaria and Curvularia, were also identified as causes of fungal sinusitis in both immunocompromised and immunocompetent individuals, showing an increasing pathogenic spectrum. Hence a high index of clinical suspicion and appropriate laboratory diagnosis assists in initiating appropriate treatment such as surgical debridement, reducing immunosuppression, and antifungal treatment with newer azoles.