bluuebunny/crossref_metadata_2025 huggingface dataset:
P055 Antifungal resistance of clinical Candida albicans isolates in Iran: asystematic review and meta-analysis
Authors: Kermani Firoozeh , Taghizadeh-Armaki Mojtaba , Hosseini Seyed Abdollah , Amirrajab Nasrin , Javidnia Javad , Zaghrami Mahmoud Fami , Shokohi Tahereh
Published: September 2022

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

 

Objective

Antifungal susceptibility patterns of Candida infections can play an essential and decisive role in the treatment outcome. The present systematic review and meta-analysis aimed to investigate the drug susceptibility pattern of Iranian clinical Candida albicans isolates to antifungal drugs (azoles, polyenes, and echinocandins).

Method

Six electronic databases including ‘PubMed,’ ‘Scopus,’ ‘Web of Science,’ ‘IranDoc’, ‘SID’, ‘Magiran’ were searched from May 2000 to June 2021.

Results

The susceptibility of 6322 C. albicans strains from 19 967 patients against 14 antifungal drugs was evaluated according to Clinical and Laboratory Standards Institute (CLSI) methods. The pooled prevalence of antifungal resistance ranged from 0 to 26%. The lowest resistance levels among azoles were observed in luliconazole with a frequency of 0% and voriconazole of 3.94% [95% confidence interval (CI), 2.24%-6.09%]. An increase in trend of itraconazole (7%-16.65%), voriconazole (1.4%-6.52%), and amphotericin B resistance (7.5%-9.11%) among C. albicans strains since 2006 in Iran, while a decreasing trend was observed in fluconazole resistance (23.42%-14.42%).

Conclusion

Due to the resistance of C. albicans species to common antifungal drugs, antifungal stewardship strategy combining therapeutic drug monitoring to reduce the emergence of resistant multi-drug Candida species.
P066 Candidemia in a tertiary care hospital: epidemiology, speciation and antifungal susceptibility pattern
Authors: M Rashmi , Swaminathan Subramanian
Published: September 2022

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

 

Objective

The incidence of bloodstream fungal infection is on the rise and Candida species remains responsible for the majority of the cases. Candidemia is frequently associated with a high rate of mortality and morbidity. The purpose of this study was to characterize Candidemia, its epidemiology, species distribution, and antifungal susceptibility pattern in a tertiary care hospital.

Methods and Material

Candida species isolated from the blood culture of 51 patients in a tertiary care hospital during the period from 2016 to 2021 were included in the study. The growth on SDA was confirmed by Gram staining and speciation and antifungal susceptibility were performed with Automated system VITEK 2.0.

Result

Out of 51 isolates, Candida auris was the most common species accounting for about 37.2% followed by C. albicans 19.7%, C. tropicalis 17.6%, and C. famata 9.8%. Candida auris has emerged as the predominant species during severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) pandemic. The incidence has risen from 22% to 60% during the pandemiC. Candida species were found to be 96.08% sensitive to flucytosine, 94.12% to voricanazole, 90.19% to caspofungin/micafungin, 60.78% to amphoterecin B, and 56.86% to fluconazole.

Conclusion

Candida auris has emerged as the predominant species in ICU setup and during SARS- CoV-2 pandemiC. Empirical treatment with echinocandines would be appropriate in high-risk patients with suspected Candidemia.
P067 Cumulative hospital antibiogram of AIIMS Bhopal for Candida species
Authors: Madhavan Aneesh Sethu , Tadepalli Karuna , Maurya Anand K , Bhadade Arati , Badal Rahul
Published: September 2022

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

 

Objectives

Primary Objectives:

Secondary Objectives:

Methods

Cross-sectional hospital-based study of 1-year duration 2020-2021. All samples sent to the microbiology laboratory with clinical suspicion of Candida infection and fulfilling the inclusion criteria were considered as sample size for the study period. The study population was the clinically relevant Candida isolates for which antifungal susceptibility testing was done and fulfilling the inclusion criteria. Study duration was for 1-year and was held at AIIMS, Bhopal. The data collected was entered in MS EXCEL and latest WHONET software and analyzed by WHONET software to generate antibiogram for Candida. Results are summarized in percentages and frequencies.

Results

Total 110 Candida isolates were included in the study for antifungal susceptibility testing and WHONET entry after fulfilling the inclusion criteria.

The commonest isolate across all samples processed and included was C. tropicalis 40% followed by C. glabrata 15.5%. A total of 43.6% Candida species were isolated from urine samples followed by 29% from blood samples and 10% from sputum samples. In all 54.5% of yeast isolates were from ICU followed by 40% from ward patients and at least 5.45% from OPD.

The commonest isolate across all locations was C. tropicalis 40% followed by C. glabrata 15.5%, C. albicans 14.5% and C. parapsilosis 11.8%. The predominant isolates were under the age category 19-60 years, 69% followed by 26.4% >60 years of age. The percentage susceptibility of C. tropicalis isolates showed >90% susceptibility to tested antifungals. The percentage susceptibility of C. glabrata isolates showed susceptibility to echinocandin but reduced susceptibility to fluconazole. For Candida albicans overall no azole or echinocandin resistance was noted. For Candida parapsilosis overall no azole or echinocandin resistance was noted. C. krusei showed 100% susceptibility to anidulafungin, caspofungin, micafungin, and voriconazole by BMD. C. guilliermondii percentage susceptibility available for caspofungin 33.3%.

A total of 80% of the isolates were from patients with community-acquired infections and 19% Candida species were from health care-associated infections. Among the community-acquired infections C. tropicalis was the commonest 37.5% followed by C. albicans 17%, C. glabrata 16%, and C. parapsilosis 12.5%. Among the HAI commonest isolate was C. tropicalis 47.6% followed by 14.3% each of C. auris, and C. glabrata. C. auris all isolates showed elevated MIC fluconazole(≥64 μg/ml), voriconazole (≥1 μg/ml), and caspofungin (≥1 μg/ml).

Conclusion

The study conducted just over a year period in the department of microbiology of AIIMS Bhopal has been instrumental in generating cumulative antifungal antibiogram for Candida species.
P075 Initial results of an international effort in screening new agents against Candida auris
Authors: Poester Vanice , Munhoz Lívia , Melo Aryse , Benelli Jéssica , Al-Hatmi Abdullah , Larwood David , Martinez Marife , Stevens David , Xavier Melissa
Published: September 2022

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

Candida auris is an emergent fungal pathogen. A global concern regarding this yeast is its resistance to many currently available antifungal drugs, virulence factors, capacity to spread in hospital environments, and its misidentification, resulting in high rates of morbidity, and mortality.

Objective

In response to this challenge, new effective options of antifungals against C. auris are urgent. Therefore, our consortium evaluated the in vitro activity of two agents with novel mechanisms of action, and negligible toxicity in studies to date: diphenyl diselenide (PhSe)2 and nikkomycin Z (NikZ), alone and in association with conventional antifungals (azoles, echinocandins, polyenes) against C. auris.

Methods

A total of 11 isolates of C. auris were included in this in vitro study, 10 from South Asian clade I and 1 from South Africa clade III. In vitro tests (dilution and interaction assays) were performed according to the CLSI M27-Ed4 protocol. Interactions between (PhSe)2 or nikkomycin Z, and amphotericin B (AmB), fluconazole (FCZ), micafungin (MYC), or caspofungin (CSP) were evaluated by checkerboard assays, resulting in Fractional Inhibitory Concentration Indexes (FICi). Tests were read after incubation for 48 h at 35°C. The minimal inhibitory concentration (MIC) was defined as the lowest concentration able to inhibit 100% (PhSe)2, AmB and NikZ, or 50% (FCZ, MYC, and CSP) of the fungal growth. Interaction between the drugs was classified as strong synergism when FICi <0.5, weak synergism when 0.5 <FICi <1, additive when 1 <FICi <2, indifferent when FICi = 2, or antagonistic when FICi >2.

Results

(PhSe)2 and NikZ alone were unable to inhibit C. auris even by the higher concentrations tested (32 μg/ml and 64–128 μg/ml, respectively). An additive effect of (PhSe)2 was detected with MYC against 30% of the isolates, however, its combination with AmB was antagonistic against all of the isolates, as well as against one isolate with FCZ. All of the other interactions with (PhSe)2 were indifferent. In contrast, NikZ showed strong or weak synergism in association with CSP, AmB, FLU and MYC against 100%, 90%, 30% and 14% of the C. auris isolates tested, respectively. An additive interaction of NikZ was also detected with MYC against 86% of the isolates. No antagonistic effect was detected in the combination of NikZ with the antifungals tested.

Conclusion

Although (PhSe)2 seems to not have potential as a future anti-C. auris drug, NikZ showed a productive avenue for further studies, mainly in combined therapy against this pathogen.
P077 Detection of CYP51A mutations in airborne Aspergillus spp isolates from intrahospital environments
Authors: López Angela María , Torres Susana , Zuleta Maria Camila , Ariztizabal Mariana , Jimenez Liliana , Gomez Oscar Mauricio , Hernandez Orville , Rua Alvaro Leon
Published: September 2022

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

 

Introduction

Aerobiological studies have found an increasing number of fungal taxa in the intrahospital environments, including Aspergillus species. There is a gap in knowledge on drug-susceptibility in spores circulating in intrahospital environments. In this work, we evaluated the CYP51A genome alterations and Aspergillus spore susceptibility to antifungal drugs.

Objectives

To determine the sequence of CYP51A gene in clinical and environmental Aspergillus spp. isolates from intrahospital environments in Medellín, Colombia II. To evaluate the phenotypical response of Aspergillus isolates harboring mutations in CYP51 gene from intrahospital environments.

Methods

We used Aspergillus spp. collected from air and surfaces from intrahospital environments, as well clinical samples. We performed Whole Genome Sequencing (WGS) using HiSeqXten Illumina platform for species identification. Genomes were assembled de novo using the SPADES algorithm. Genome annotation by ab initio prediction was done using the Augustus program. We extracted the sequences from the CYP51A gene and its promoter using OrthoFinder workflow. To identify previously described mutations related with drug-resistance, we performed SNPs search in Geneious software using Clustal Omega. For the determination of broth dilution minimum inhibitory concentrations (MIC) of antifungal agents, we used the Eucast method 9.4.

Results

We identified 26 Aspergillus from Fumitagi section using morphological characteristics. Three were isolates from clinical samples and twenty-three were obtained from intrahospital environments. We performed whole genome sequence for identification to species level. We identified 26 Aspergillus fumigatus using an in-house script base in BLASTn algorithm for 4 genes: internal transcribed spacer, b-tubulin, calmodulin, and RNA polymerase II. OrthoFinder workflow was performed to obtain CYP51A sequence. Clustal-Omega analysis showed two SNPs A1147G and T11167A, which constituted two non-synonymous mutations N248K and I242V respectively. A total of 8 and 3 isolates presented the changes in the CYP51A gene respectively. To determine their role in antifungal resistance, the strains were tested against 10 concentrations (0.03-8 mg/l) of voriconazole antifungal agent. We used one clinical isolate without genomic changes in the CYP51A gene as control. The MIC was 0.5 mg/l for all the tested isolates. This value suggests isolates are susceptible to voriconazole.

Conclusions

This work is the first one describing mutations and elucidating their role in the drug-resistance of airborne A. fumigatus in Medellín, Colombia.
P079 Virulence factors and azole-resistant mechanism of Candida tropicalis isolated from candidemia
Authors: Sarvestani Elahe Sasani , Yadegari Mohammad Hossein , Khodavaisy Sadegh , Rezaie Sassan , Salehi Mohammadreza , Getso Muhammad Ibrahim
Published: September 2022

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

 

Background

Limited knowledge exists on the virulence factors of Candida tropicalis and the mechanisms of azole resistance that lead to an intensified pathogenicity and treatment failure. We aimed to evaluate the virulence factors and molecular mechanisms of azole resistance among C. tropicalis isolated from patients with candidemia.

Materials and Methods

Several virulence factors, including extracellular enzymatic activities, cell surface hydrophobicity (CSH), and biofilm formation were evaluated. Antifungal susceptibility pattern and expression level of ERG11, UPC2, MDR1, and CDR1 genes of 8 (4 fluconazole resistance and 4 fluconazole susceptible) clinical C. tropicalis isolates were assessed. The correlation between the virulence factors and antifungal susceptibility patterns was analyzed.

Results

During a 4-year study, 45 C. tropicalis isolates were recovered from candidemia patients. The isolates expressed different frequencies of virulence determinants as follows: coagulase 4 (8.9%), phospholipase 5 (11.1%), proteinase 31 (68.9%), esterase 43 (95.6%), hemolysin 44 (97.8%), biofilm formation 45 (100%), and CSH 45(100%). All the isolates were susceptible to amphotericin B and showed the highest resistance to voriconazole. There was a significant positive correlation between micafungin minimum inhibitory concentrations (MICs) and hemolysin production (rs = 0.316). However, we found a negative correlation between fluconazole MICs and esterase production (rs = −0.383). We observed the high expression of ERG11 and UPC2 genes in fluconazole-resistant C. tropicalis isolates.

Conclusion

Candida tropicalis isolated from candidemia patients extensively displayed capacities for biofilm formation, hemolysis, esterase activity, and hydrophobicity. In addition, the overexpression of ERG11 and UPC2 genes was considered one of the possible mechanisms of azole resistance.
P082 Synergistic activity, anti-adherence and anti-fungal abilities of fluconazole and voriconazole combined with thymol and carvacrol against C andida species
Authors: Sharifzadeh Aghil , Shokri Hojjatollah , Nikaein Donya
Published: September 2022

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

 

Objectives

The current study aimed to assess the anti-adherence and antifungal activities of thymol and carvacrol against Candida albicans, C. glabrata, and C. krusei isolates obtained from patients with oral candidiasis concerning growth inhibition and fungal death as compared to the synthetic antifungals such as fluconazole and voriconazole.

Methods

The susceptibility assay for the test compounds was performed using the disk diffusion method against all Candida isolates. Also, anti-adherence activity was examined using a rapid and highly reproducible 96 well microtiter-based method.

Results

Both natural phenols and antifungal drugs revealed various efficacies against studied Candida species. The susceptibility to fluconazole and voriconazole were 100% for C. albicans, 50% and 90% for C. glabrata, and 0% and 100% for C. krusei isolates, respectively. The mean diameter of the inhibition zone was greater for thymol than carvacrol in C. albicans (19.89-0.80 mm vs 17.05-0.61 mm), C. glabrata (18.87-0.71 mm vs 15.77-0.57 mm), and C. krusei (15.11-0.91 mm vs 13.91-1.04 mm) isolates tested.

Thymol showed more effective inhibition on adherence of all Candida species than other treatments. The mean relative adherence ratios for C. albicans, C. glabrata, and C. krusei were 0.50, 0.60, and 0.64, respectively.

Conclusions

This study demonstrated significant inhibitory properties of thymol and carvacrol on the adherence and growth of azole susceptible- and -resistant Candida isolates. Also, thymol was more effective for preventing the adherence of yeast cells to polystyrene in comparison to carvacrol.
P083 Susceptibility pattern of fungal isolated from patients with otomycosis
Authors: Shokohi Tahereh , Roohi Behrad , Nemati Shadman , Alipour Abbas , Faeli Leila , Mayahi Sabah , Haghani Iman
Published: September 2022

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

 

Objectives

Antifungal resistance is posing several new concerns to clinicians. Increased rates of azole and echinocandin resistance in various non-albicans Candida species and azole resistance in A. fumigatus may arise due to clinical or environmental exposure to these drugs. The study evaluated the antifungal susceptibility for clinical fungal isolates causing otomycosis.

Methods

A total of 89 Aspergillus isolates containing A. niger (58 isolates), A. flavus (19 isolates), A. fumigatus (12 isolates), and 25 Candida isolates containing C. parapsilosis (14 isolates), C. orthopsilosis (6 isolates), and C. albicans (5 isolates) collected from individuals with confirmed otomycosis during October 2020-November 2021 were tested for antifungal susceptibility testing (AFST). AFST of ketoconazole, voriconazole, tioconazole, amphotericin B, miconazole, fluconazole, nystatin, and itraconazole was conducted using the broth microdilution method based on CLSI (M38-A2, M27-A3) protocols. Conidia of molds and colonies of yeasts were harvested from fungal cultures on SDA incubated at 35°C; the turbidity of the suspension was then adjusted to OD630 nm = 80%-82%T for molds and 75%-77%T for yeasts.

Results

Mainly, all antifungals examined were effective against most Aspergillus isolates, aside from tioconazole (GM = 5.54767 μg/ml) and nystatin (GM = 2.10151 μg/ml). Terbinafine (GM = 1.69824 μg/ml) had minimal in vitro effects (Table 1). Nystatin (GM = 2.94853 μg/ml) and itraconazole (GM = 1.08673 μg/ml) showed higher GM MICs against all Candida species isolates. Conversely, amphotericin B (GM = 0.07129 μg/ml) in Aspergillus, ketoconazole (GM = 0.02570), and voriconazole (GM = 0.03686 μg/ml) in Candida showed the highest antifungal activity (Table 2). Regarding the CLSI-M59 document for ECV, one A. niger (MIC 8 μg/ml), A. flavus (MIC 2 μg/ml), and A. fumigatus (MIC 2 μg/ml) isolates were non-wild type against itraconazole. A total of 3 A. niger non-wild type isolates with MIC 4 μg/ml against voriconazole were inspected (Table 1). Three C. albicans isolates with high itraconazole MICs (two 8 μg/ml and one 16 μg/ml) were observed (Table 2). Even though the MIC50 of Aspergillus niger for tolnaftate was 0.37 μg/ml, 9 isolates with high MICs (16 μg/ml) were found.

Conclusion

The foremost commonest yeast isolates in this study, C. parapsilosis, exhibit significant sensitivity to various antifungals, including ketoconazole, voriconazole, tioconazole, amphotericin B, miconazole, fluconazole, and itraconazole. However, contrary to other studies, nystatin had high MICs and is not recommended as an effective drug. Since the pattern of antifungal susceptibility is varied among the cryptic species of Aspergillus sections, we recommend that physicians request a drug susceptibility testing before antibiotic therapy to prevent the development of resistance.
P084 Trichosporon osis awakening: molecular and antifungal susceptibility study on Trichosporonosis in North India and how antifungal stewardship can contribute in control
Authors: Singh Vikramjeet , Dobhal Shipra , Das Anupam , Nath Saumya Sankar , Sen Manodeep , Agarwal Jyotsna
Published: September 2022

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

 

Background

Trichosporon spp are yeast-like organisms belonging to class Basidiomycetes which are usually commensals. It can cause diseases ranging from superficial infection, commonly known as White Piedra, to disseminated infections (Trichosporonosis). Cases of invasive Trichosporonosis have increased worldwide. It has now become the second most common cause of fungemia after Candida spp, especially in immunocompromised individuals.

Methods

We conducted a hospital-based prospective chart review of six patients with nosocomial infections caused by Trichosporon spp. Demographic data, clinical history, comorbidities, and outcomes after treatment were collected. Samples were processed using conventional media, biochemicals, and confirmed using automated system, MALDI-TOF and VITEK-2

Results

A total of 8 patients developed UTIs and 4 developed disseminated bloodstream infections. All patients had associated co-morbidities. All patients had history of treatment with antimicrobials which were ineffective. In all, 8 patients were identified to be infected with T. asahii and 4 with T. mucoides. All patients showed improvement with azoles. We also encountered a case of breakthrough Trichosporonosis.

Conclusion

Invasive Trichosporonosis developed in patients with associated risk factors. Trichosporon spp presents diagnostic and therapeutic challenges. It is usually confused with disseminated candidiasis leading to incorrect treatment and increased risk of breakthrough Trichosporonosis. Prolonged undiagnosed infection can lead to disseminated infection. New triazoles have shown to be effective against Trichosporon spp.
P090 Biofilm forming capabilities in multi-drug resistant Candida species with special emphasis on Candida auris isolated from intensive care unit patients
Authors: Yadav Harshita , Agarwal Jyotsna , Das Anupam , Nath Saumya Shankar , Srivastava Shetanshu
Published: September 2022

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

 

Objective

Methods

This is a hospital-based prospective study in which Candida isolates from urine, blood, and BAL fluid of ICU patients from March 2021 to February 2022 were included. Conventional identification methods were performed for all isolates, speciation was done by MALDI-TOF. Biofilm formation by microtiter plate method and anti-fungal susceptibility was performed by VITEK-2.

Results

In the present study, out of 360 positive fungal isolates, 20% Candida isolates (72) were obtained from the ICU patients. Candida tropicalis (45.2%) was the most common fungal isolate among all non-albicans Candida spp followed by C. parapsilosis, and C. auris. The biofilm formation was tested by microtiter plate method on Candida isolates. Candida auris showed strong biofilm formation tendency (28.5%). In this study, 16.6% of Candida isolates had resistance against fluconazole out of which 6 isolates were multiresistant to other antifungal. Use of automated machines helped in early identification of these species 24-48 h less than the conventional methods.

Conclusion

Parallel increase in number of non-albicans Candida beside C. albicans could be because of patients on prolonged antimicrobial therapy, immunosuppressive drugs, varied comorbidities and species selection in the presence of certain antifungals, given the higher level of resistance expressed by NAC. Biofilm production a probable cause for increasing antifungal resistance and therapeutic failure. NAC species are emerging as potential threats to cause infection and posing a therapeutic challenge. Early empirical antifungal therapy and further research to improve diagnostic, prevention, and therapeutic strategies are necessary to reduce the considerable morbidity and mortality.
P097 Epidemiology of dermatophytes related infections in Kuwait: a retrospective study
Authors: Al-Aryan Anoud , Al-Sabah Humoud Yousef , Al Obaid Khaled A.
Published: September 2022

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

 

Introduction and Objective

Dermatophytes are a common cause of cutaneous infections that affect a large number of healthy individuals throughout their lives. Although such infections are classically benign, they have a negative impact on patient’s physical and psychological health. We aim to explore the epidemiology of dermatophytes infections at a national level.

Methods

The study was conducted retrospectively. Demographic and microbiological data were obtained from laboratory information system in the Mycology Reference Laboratory in the year 2021. Dermatophytes were either isolated from clinical samples in mycology reference laboratory or sent from other laboratories for species identification. The clinical samples were divided into two parts. The first half was examined microscopically, and the second half was inoculated on Sabouraud agar media with and without cycloheximide and then incubated at 30°C for at least 2 weeks. Dermatophytes were identified by colonial morphology and microscopic characteristics.

Results

During the year 2021, 60 dermatophytes were found. The male to female ratio was 2:1. A total of 60% of patients were children. Half of the cases were isolated from hair specimens and the second half were from the skin. Only one dermatophyte was isolated from nail cultures. Regarding dermatophytes distribution, Microsporum species were the commonest and involved mostly M. canis (26). Other less common species included two M. audouinii and two M. praecox. A total of seven other Microsporum species were not identified to species level. On the other hand, 23 Trichophyton species were found including 5 T. tonsurans, 4 T. interdigitale, 3 T. rubrum, 1 T. simii, and 1 T. erinacei. A total of 9 other Trichophyton species were not identified to species level.

Conclusions

Higher rates of infection were seen in males compared to females. Phenotypic identification has failed in identifying a significant number of isolates. As in other types of molds, the phenotypic examination may also result in inaccurate identification, especially among uncommon and evolving species. Hence, molecular testing is essential for accurate identification and better understanding of the epidemiology of dermatophytes-related infections. The following species were reported for the first time in Kuwait, namely: T. erinaceid, T. simii, and M. praecox.
P098 Human protothecosis: Acase report in Northeastern Brazil
Authors: De Maria Azevedo Conceicao , Santos Daniel Wagner , Diniz Yankee Costa Magalhaes Yankee Costa Magalhaes , Simões-Neto Eudes Alves Simões Neto , Mendes Rafael Bezerra Rafael Bezerra , Diniz Francy Dazia Menezes Ferreira , Silva Raimunda Ribeiro , Conceição Patrícia Cristina Ribeiro , de Oliveira Melo Bruna , Marques Sirlei Garcia , Bonfim Maria Rosa Quaresma
Published: September 2022

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

 

Introduction

Protothecosis is an emergent disease caused by members of the genus Prototheca. Most such infections probably occurred by traumática inoculation into subcutaneous tissues.

Objectives

It is to report a case of human cutaneous protothecosis identified in the state of Maranhão, northeast Brazil. Case report: 75-year-old patient, Merchant, from the municipality of São Luís Island, Northeastern Brazil. He sought care referring to an erythematous and painful lesion on the left arm that started 6 months before the treatment. On examination, he presented an infiltrative, hyperemic lesion with burning pain throughout the upper limb (Fig. 1). The patient reported that a week before the onset of the condition, he suffered trauma on the arm, with a laceration in the skin, while cleaning a sewage system with clay pipes. During the healing process, he noticed a hyperemic, slightly pruritic lesion measuring 2 cm which did not improve. He sought medical assistance at the dermatological service, who suspected dermatophytosis, initiating treatment with terbinafine (250 mg, once a day), evolving with worsening of the lesion. A lesion biopsy was indicated, to histopathological examination, which showed circular, moniliform structures, diagnosed as protothecosis (Fig. 2). Treatment with itraconazole (200 mg/day) was started, with no therapeutic response and the lesion spread throughout the patient's left upper limb. Submitted to a new investigation with biopsy for direct research and culture for fungi, being identified Prototheca Wicherhamii, by Maldi-Tof®, with sensitivity to itraconazole and ampfotericin B. PCR amplification of the genetic material obtained in the clinical isolate was performed with purification of its product, and sequencing showed genetic similarity of 97,46% with Prototheca Wickerhamii. The sequence obtained was deposited in Genbank under number MZ409514. In the absence of therapeutic response to itraconazole (400 mg/day), and significant worsening of the lesion, with presentation of a secondary infection caused by Staphylococcus haemoliticus, treatment with Clindamycin (900 mg/day for 10 days) and Liposomal Amphotericin B (4 mg/kg/day for 45 days) were performed. After suspension of Liposomal Amphotericin B, the lesions recurred in 15 days, and voriconazole (200 mg 12/12 h) was prescribed for 6 months, with complete regression of the lesions. Currently, he is free of injuries, having been followed up every 6 months.

Conclusion

Rare disease caused by chlorophyllous algae may be surprising due to the severity and lack of response to antifungals that show sensitivity in vitro.
P111 A case of nail discoloration due to topical treatment of onychomycosis with luliconazole 5% nail solution
Authors: Sato Tomotaka , Fukada Norihito , Kinjo Akihiko , Hatta Mariko , Akimoto Ryota , Kobayashi Hisashi , Fukuzumi Satoshi
Published: September 2022

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

We use efinaconazole 10% topical solution and luliconazole 5% nail solution for topical treatment of onychomycosis in Japan. We show a case of onychomycosis treated with nail debridement and topical luliconazole 5% nail solution to the nail and topical luliconazole 1% cream to the foot.

 

A woman in her seventies with chronic urticaria had a nail spike color change on her left big toe (Fig. 1).

 

We opened the spike lesions with a plastic nipper and KOH direct microscopic examination showed dermatophytoma. We treated with topical luliconazole cream on the toes and soles of the foot and 5% solution on the nail. Because of the summer season, she walked outside in sandals without socks during treatment and noticed the nail yellow color change (Fig. 2). We advised the patient to protect from sun light and not to walk outside without socks. Due to the report from the production company, the reason for nail color change to yellowish is photodegradation of luliconazole. After 1 year since first visit, the fungal infection of the big toe disappeared by our topical treatment. The nail yellow color change also disappeared. We recommended avoiding sunlight exposure on the treated nail during topical treatment of luliconazole 5% nail solution.
P122 Myeloid-derived suppressor cells as a potential biomarker and therapeutic target in rhino-orbital mucormycosis patients
Authors: Singh Praveen , Das Shukla , Rai Gargi , Ansari Mohammad Ahmad , Gupta Neelima , Sharma Sonal
Published: September 2022

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

 

Background

Mucormycosis is a deadly fungal infection that emerges in patients affected with COVID-19. All fungal illnesses are caused by dysregulated adaptive immunity, but Myeloid-derived suppressor cells (MDSC) have added a new dimension to the chronic inflammatory response.

Objective

We attempted to enumerate the MDSC immune response in rhino-orbital mucormycosis patients before and after treatment and compared the data with healthy control.

Methods

A total of 3 ml of blood samples were taken in an EDTA vial from 20 patients with mucormycosis and 20 age-matched healthy control. A second blood sample was collected to examine the immune system post three months of treatment. Mycological identification was performed on nasal crust retrieved after surgery using KOH/culture. The expression of the MDSC marker was analyzed by immunostaining with the antibodies against CD14, HLA-DR, CD11b, CD33, CD66 (Biolegend). Fluorescence profiles were recorded by Flow Cytometer (BD FACSAria™ III) and analyzed by Flow Jo software (BD Biosciences). The percentage of positive cells is used to express the results. The GraphPad Prism (version 8, GraphPad software, LaJolla, CA, USA) was used to analyze the data. All of the results were considered significant when P <.05.

Results

All of the patients tested positive for Rhizopus arrhizus, which was confirmed by the culture. The percentages of Monocytic-MDSC (mMDSC: CD14 + HLA-DR-/low) cells were significantly high in patients compared to healthy control. In post-3-month treatment, the percentages of mMDSC were found significantly low and comparable with healthy control. Granulocytic MDSC (gMDSC: HLA-DR-/low CD33 + CD11b + CD66+) cell population was higher in patients compared with healthy control and patients with post-3-month treatment.

Conclusion

MDSC regulates T cells and other immune cells with a different mode of action. The findings in this study imminently indicate the mechanism of immune dysregulation involving MDSC pathways in mucormycosis and provide evidence that restoration of immune balance causes reduction of MDSC cells may be considered a therapeutic option for long-term benefit.
P146 Penicillium-like mo ld: caught red-handed, but remained unidentified
Authors: Rege Sujata , Soman Rajeev , Chavan Dipali , Dadke Mahendra
Published: September 2022

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

 

Objective

This case highlights the presence of a self-limited respiratory mycosis in an immunocompetent host and need for fungal sequencing in diagnosis of such rare cases.

Methods and Results

Ms X, a 25-year-old, apparently healthy software engineer, had an overnight journey in an air-conditioned bus from Hyderabad to Pune. The next day, she developed throat irritation followed 3 days later by fever and cough without dyspnea nor wheezing. Her chest X-ray was found to be normal at the time. Three days later she was admitted to our hospital, wherein X-ray chest and CT chest showed bilateral randomly scattered nodular shadows (Fig. 1). She was referred to ID as a case of suspected tuberculosis, but her presenting symptom being sore throat, the acuteness of symptoms, presence of nodular lung shadows which were absent on the X-ray chest done just 3 days earlier were against the diagnosis of TB. Inhalational fungal or viral pneumonitis were hence considered.

Transbronchial biopsy showed an intense alveolar inflammatory exudate, but GMS staining did not reveal any fungal hyphae. BAL Galactomannan, Xpert MTB/RIF were negative. Both BAL and CT guided lung nodule biopsy samples grew a mold. Red pigment formation in culture and its morphological appearance on LPCB mount (Fig. 2) led to a diagnosis of Penicillium species infection. MALDI TOF MS, which had only a few Penicillium spp in its 2018 database, failed to identify the organism, leading us to believe that it could be a different Penicillium species.

Since the patient was showing clinical improvement, a self-limited infection was thought of and therapy was withheld with cautious follow-up. The patient was completely asymptomatic after 10 days and CT chest done 20 days later showed complete resolution of the nodules.

We believe that this illness was due to inhalation of spores from the air-conditioning vent, eliciting a brisk inflammatory response in the alveoli. The organism grew from BAL and CT guided biopsy from viable spores, but it failed to germinate into hyphae in the human host and hence was not seen on histopathology and did not produce galactomannan which is only released from the tips of growing hyphae.

Conclusion

Fungi are often isolated from poorly maintained air conditioning vents. In this case, the Penicillium like organism failed to produce progressive disease in the immunocompetent host. If the same organism could be cultured from the AC vent, showed genetic relatedness with the clinical isolate; the source, transmission, and disease linkage could have been established in this case.
P149 Short tandem repeat genotyping of South American Candida tropicalis isolates
Authors: Spruijtenburg Bram , Baqueiro Cynthea C.S.Z. , de Almeida Jr. João Nóbrega , Colombo Arnaldo L. , de Groot Theun , Meis Jacques F.
Published: September 2022

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

 

 

Candida tropicalis is a clinically relevant yeast that causes candidemia in humans with a high mortality rate. The yeast primarily infects immunocompromised patients and causes outbreaks in health care facilities. A short tandem repeat (STR) typing scheme for C. tropicalis was applied to a collection of 217 clinical and environmental isolates from South America, predominantly from Brazil, and included nine fluconazole-resistant isolates. Application of the STR typing resulted in the identification of 153 genotypes. Typing demonstrated 11 clusters containing more than two isolates. In one cluster of six, we found three fluconazole-resistant isolates, while there were another five closely related fluconazole-resistant isolates. ERG11 mutation screening was performed on all 9 resistant isolates. The closely related resistant isolates all contained Y132F in combination with the novel Y257H/N mutation. The remaining resistant isolate did not exhibit mutations in ERG11 suggesting a different resistance mechanism. Altogether, we applied a novel STR genotyping for C. tropicalis and showed several in-hospital clusters suggesting cross-transmission.
P154 Fungal spore count in a tertiary care hospital in Mumbai, India
Authors: Naik Aparna , Rodrigues Camilla , Basu Shaoli , Agarwal Umang , Sunavala Ayesha , Prasad Ravindra , Shetty Anjali
Published: September 2022

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

 

Objectives

Fungal spores are ubiquitously present in the environment. Appropriate temperature and humidity can lead to fungal growth. It is of concern in a hospital environment. Diabetic and immunosuppressed persons are more vulnerable to such infections. The fairly humid and slightly warm climate of Mumbai is ideal for fungal growth. According to an article released in March 2021, the total fungal count in Mumbai was 16.2 CFUs. Here is a brief gist of how fungal spores were controlled within a tertiary hospital in Mumbai, India which is located near sea by simple but effective methods.

Methods

Air sampling of the Operation Theatre (OT), Central Sterile Supply Department (CSSD), Bone marrow transplant (BMT) areas is done on weekly basis in the hospital and for areas such as ICU (Intensive Care Unit), Oncology (ONCO) Ward, Cardiac Catheterization (Cath) lab and Digital subtraction angiography (DSA) lab monthly air sampling is done to check for bacterial and fungal load. Two types of air samplers are used: Heico air sampler from HiMedia and Dyanamicro air sampler. OT, BMT, CSSD have HEPA (high efficiency particulate air) filters installed for filtration of air. The other areas like ICU, ONCO ward, Cath lab, and DSA lab do not have HEPA filters.

Results

In the last 4 years there were two instances where fungal growth was observed once in BMT and once in ICU. In ICU Aspergillus niger growth was observed and in BMT there was a growth of multiple Aspergillus spp. It took nearly 3-4 months for the eradication of the fungus in BMT and 2 months to clear the fungus from ICU. Due to strict engineering control, we were able to restrict the spread within hospital.

In BMT unit the growth was observed during rainy season when because of heavy rain there was seepage in one wall of the unit and also there was a leakage of sink in the ante-room area. When these repairs were done the fungal growth was not observed afterward.

In ICU thorough cleaning of the Air Handling Unit (AHU) filter leads to resolution of the issue.

Both these episodes were uneventful as no patient had any infection due to these.

Factors that helped in controlling the fungal spores spread are:

Conclusion

Even though the hospital is situated near sea and the outside air has high humidity and high microbial load, effective engineering measures and close monitoring of the areas can help in controlling the spread of fungus within the hospital. Routine periodic checks of the air for fungal spores can also help prevent nosocomial infections.
P156 Oral Candidiasis among inpatients with COVID-19 in the North of Iran
Authors: Ahangarkani Fatemeh , Babamahmoodi Farhang , Rezai Mohammad Sadegh , Mohammadi-Kali Ali , Najafi Narges , Alizadeh-Navaei Reza , Badali Hamid
Published: September 2022

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

 

Objectives

We aimed to characterize oral candidiasis epidemiology, species distribution, and antifungal susceptibility profiles among COVID-19 patients.

Methods

This observational cross-sectional study enrolled patients ˃18 years old with confirmed oral candidiasis admitted at Razi teaching hospital (a reference infectious disease center in Mazandaran Province). Oral samples from patients with suspected oral candidiasis infection were collected and were confirmed for oral candidiasis by microscopic examination and fungal culture. Fungal isolates were identified using Multiplex polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism. In vitro susceptibility testing for amphotericin B, fluconazole, voriconazole, and micafungin of all identified isolates was performed using broth microdilution according to the Clinical and Laboratory Standards Institute (CLSI) broth microdilution guideline (M27-A3 and M60) standard.

Results

Among 4133 COVID-19 admitted patients during a year in Razi hospital, 120 patients had confirmed oral candidiasis. Totally 172 Candida isolates causing oral candidiasis isolated from these patients were identified. Most patients were infected with a single Candida species; however, it is notable that mixed Candida species caused oral candidiasis in 46 patients. Candida albicans (60.46%) was the most common species. Among non-albicans Candida species, C. glabrata (17.44%) was the most isolates, followed by C. tropicalis (11.62%), C. kefyr (7.55%), and C. krusei (2.9%). Although non-albicans Candida species, including C. glabrata and C. krusei demonstrated high minimum inhibitory concentration (MIC) against azole drugs, in terms of MIC90 values, all tested drugs exhibited superior activity against C. albicans. In terms of MIC Geometric mean, amphotericin B and micafungin were more potent than all comparator drugs.

Conclusions

Our study described the high incidence of oral candidiasis caused by non-albicans Candida species in COVID-19 patients; most of them, including C. glabrata and C. krusei exhibits intrinsic decreased susceptibility to the azole class of antifungals. Further studies should design an appropriate prophylaxis program to prevent oral candidiasis in COVID-19 patients.
P183 Monitoring of candida colonization in the respiratory tract of COVID-19 cases
Authors: Diba Kambiz , Makhdoomi Khadige , Nejadrahim Rahim , Namaki Atefeh
Published: September 2022

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

 

Objectives

Opportunistic yeasts potentially cause infection or colonization in the lower respiratory tract. Candida albicans is a common agent of yeast infections but other yeasts such as non-albicans Candida are important as resistant fungi to antifungal drugs. The predisposing factors for the overgrowth and invasion by Candida species include corticosteroid therapies, long-time hospitalization, antibiotic therapies, and primary infections by Mycobacterium tuberculosis and viral agents. The screening of Candida colonization in the lower respiratory tract of the cases with a history of COVID-19 was performed in this study at a great training hospital in Northwest of Iran.

Methods

During the pandemic COVID-19, about 445 cases with severe COVID-19 hospitalized and used dexamethasone were investigated for Candida infections and colonization by the laboratory data of Medical Mycology Center, UMS University, Urmia, Iran. Our subjects were sputum, bronco-alveolar and bronchial specimens. Candida elements including pseudo-hypha and blasto-spores microscopically were investigated. Differential cultures and PCR-RFLP were used for the identification of Candida yeasts at the level of species.

Results

Totally, 54 yeast overgrowth was detected in the clinical specimens including Candida albicans 28 (51.8%), non-albicans Candida species 24 (44.4%) and a case of Pneumocystis jirovecci. All of the cases with Candida detections were Covid-19 positive. Moreover, two cases of rhino-cerebral Mucomycosis, two cases of TB, two cases of asthma, and one case of cystic fibrosis were included.

Conclusion

As a conclusion, Fungi especially Candida yeasts be considered as the potential pathogens in cases with a history of severe COVID-19 and corticosteroid therapy during stay at the hospital.
P193 Candidemia in coronavirus disease 2019 patients in a university hospital in Buenos Aires, Argentina
Authors: Fernandez Norma B. , Farias Luciana , de Gregorio Stella Maris , Padovani Andrea , Foccoli Monica
Published: September 2022

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

It is known that the incidence and epidemiology of candidemia vary according to different geographic regions and/or hosts. Between 1998 and 2019, the incidence in a university hospital in the city of Buenos Aires Argentina, ‘HCJSM’, was 2.19/1000 discharges. The coronavirus disease 2019 (COVID-19) pandemic altered the previously recognized course of severe infections, including candidemia.

Objective

The aim of this report is to determine the incidence of candidemia in critically ill COVID-19 patients, and the clinical and microbiological aspects of these episodes hospitalized at HCJSM.

Methods

The source documents of this retrospective study are medical records from patients with Sars-Cov-2 and candidemia who were diagnosed between March 1, 2020 and June 30, 2021. At the onset of the pandemic, the HCJSM began admitting patients with COVID-19, and elective procedures were canceled. Demographic, clinical, and laboratory data were reviewed. All data were analyzed using RStudio, a statistical computing platform (version 4.0.2).

Results

During the period under review, 61 episodes of candidemia were identified: 23 episodes (39.7%) in COVID-19 patients, and 38 episodes (60,3%) in no COVID-19 patients. Incidence (x 1000 admission) in no COVID-19 patients was 2.5 (38/14 903): in COVID-19 patients 14.4 (23/1595) and in COVID-19–ICU was 42.3 (20/472). The average age of patients is of 65 years (32-84 range years). The time from admission to ICU to the development of candidemia had a median of 18 days (RIC 9-23). A total of 87.5% of the patients had been on mechanical ventilation and 100% of the patients received broad-spectrum antibiotics and had catheters. Episodes were caused by C. parapsilosis (39.7%), C. albicans (35%), C. glabrata (14%), and other species of Candida (11%). A total of 62% of COVID-19 patients who developed episodes of candidemia died during the period under examination. The survival likelihood at 30 days of COVID-19 patients who developed candidemia was higher for C. parapsilosis episodes and lower for C. glabrata episodes.

Conclusion

The incidence of candidemia showed an increase in COVID-19 hospitalized severe patients. The use of broad-spectrum antibiotics, the presence of catheters, and the use of ventilatory support in COVID-19 patients were the risk factors most associated with the development of candidemia. Although the number of episodes of candidemia is low, without the strength of statistical analysis, it is important to consider that the likelihood of survival of patients with episodes of candidemia varies according to the species recovered.