bluuebunny/crossref_metadata_2025 huggingface dataset:
P258 Incidence of Histoplasmosis, Cryptococcosis, and TB Among People Living with HIV in Paraguay-Preliminary Report
Authors: Samudio Tania , Aguilar Gloria , Sued Omar , López Gladys , Jordan Alexander , Cáceres Diego H. , Ovelar Patricia , Cardozo Miguel , Vicenti Cristina , Lezcano Virgilio , Pereira José , Rios-Gonzalez Carlos , Munoz Sergio , Figueredo Juan , Taboada Aurelia , Chiller Tom , Benítez Gustavo
Published: September 2022

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

 

Objectives

Endemic fungal infections such as Histoplasmosis and Cryptococcosis as well as tuberculosis (TB) are important causes of mortality among people living with HIV (PLHIV) in Latin America. Rapid diagnostic assays (RDAs) could decrease the time to diagnosis and treatment of these infections, resulting in a reduction in mortality. The objectives of this study were to determine the incidence of Histoplasmosis, Cryptococcosis, and TB using RDAs in PLHIV with advanced HIV disease (AHD) and calculate 30-day mortality.

Methods

PLHIV 18 years and older, treated at the Institute of Tropical Medicine hospital in Asuncion, Paraguay, not receiving ART and presenting CD4 count ≤ 200 cells/μL or clinical symptoms suggestive of WHO stage 3 or 4 diseases were enrolled and followed for 30 days. Detection of Histoplasma Ag (HisAg) in urine was performed by enzyme immunoassay (EIA), Cryptococcus Ag (CrAg) detection in serum and cerebrospinal fluid specimens by lateral flow assay (LFA), and liparabinomannan (LAM) detection in urine by LFA (TB LAM) (limited to those patients with CD4 counts ≤ 100 cells/μL) and by GeneXpert (limited to patients with respiratory symptoms).

Results

From August 2021 to 25 March 2022, a total of 335 PLHIV were enrolled. Patient median age was 37 years [Interquartile Range (IQR) 16 years], median CD4 count at enrollment was 91 cells/μL (IQR 147 cell/μL). A total of 80% (n = 269) of patients were symptomatic for one or more of the three diseases being screened for. Ag positivity rate was 20% (40/196) for TB-LAM, 10% (32/314) for HisAg, and 11% (35/329) for CrAg (15 diagnosed with cryptococcal meningitis). GeneXpert testing showed a positivity of 14% (15/108), and six of these patients with positive GeneXpert also tested positive for TB-LAM.

In total, 100/335 (30%) of patients tested had a positive result and coinfections were observed among 14/335 (4.2%) patients (Table 1). Histoplasmosis + TB was the most frequent co-infection observed 12/335 (3.6%).

Mortality among those who completed 30-day follow-up was 12.6% (32/254) and 11% among those with an OI (11/102)

Conclusions

Preliminary results show that TB and fungal opportunistic infections, including co-infection were common in people with advanced HIV. Longitudinal follow-up will help to evaluate the feasibility and cost of implementing RDAs for the early detection of opportunistic infections in PLHIV with AHD in Paraguay. Early diagnosis could impact mortality reduction.
P268 Laryngeal Mucormycosis: does mucor take the voice away?
Authors: Rege Sujata , Soman Rajeev
Published: September 2022

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

 

Objective

This case aims to highlight a unique presentation of Mucormycosis.

Methods and Results

A 57-year-old retired office supervisor, presented to the ENT department with complaints of hoarseness of voice ending with almost complete dysphonia over 6 months. There were no complaints of stridor, dyspnea or dysphagia. He had no history of prior surgery or tracheal intubation. On examination, a lesion over his right vocal cord was noted (Fig. 1) and underwent surgical excision of the lesion.

HPE of the lesion (Fig. 2) showed hyperplastic stratified squamous epithelium which was partly ulcerated and covered by thick bands of necro-inflammatory material. Within the necrotic material were seen broad aseptate fungal hyphae. Beneath the necrotic material was inflamed granulation tissue with fibrosis. No tissue or vascular invasion was noted as per the report, however there was a recurrence of the lesion after 15 days.

ID team opinion was sought in view of need for antifungals. Owing to financial constraints, CT chest could not be done, but his chest X-ray was normal. His HbA1c was 7.5%, which was suggestive of newly detected diabetes mellitus (DM).

In this case, even though no angioinvasion or tissue invasion was reported, the presence of hyphae in the area of necrosis, the presence of inflammatory local tissue reaction, coupled with newly detected DM, prompted the ID team to advise treatment with amphotericin B followed by suspension posaconazole (GR was not available at the that time). The patient was not willing for treatment at the time. However, local recurrence of the lesion occurred 2 weeks later. Surgical resection along with posaconazole, TDM and close follow-up was advised. However, the patient was lost to follow-up, possibly due to loss of confidence in us?

Conclusion

The importance of sending every surgically excised tissue for histopathology and culture has been highlighted by this case. Early ID opinion and AF therapy could have averted recurrence and loss of patient confidence. Chronic Granulomatous form of mucormycosis though rare, needs timely diagnosis and treatment in the form of surgical resection as well as systemic antifungal therapy.
P277 The epidemiology, clinical manifestations and outcomes of cerebral mucormycosis: A systematic review
Authors: Salehi Mohammadreza , Khodaveisi Sadegh , Alijani Neda , Khajavirad Nasim , Manshadi Seyed Ali Dehghan
Published: September 2022

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

 

Objectives

Mucormycosis is a devastating infection caused by Mucorales order ubiquitously existing in the environment. Cerebral mucormycosis, the mortal manifested type of brain infection, is commonly seen in association with deep immunocompromised status. Despite lethality of brain mucormycosis, the lack of consensus data specifically concerning clinical manifestations, radiographical characteristics, diagnosis methods, and management are severely felt.

Methods

In this systematic review and meta-analysis, we searched PubMed and Scopus (up to December 31, 2018) using the combination of the following keywords: (‘Mucor*’ or ‘Zygomyc*’) and (‘cereb*’ or ‘brain’ or ‘central nervous system’ or ‘intracranial’) and found ∼1462 articles.

Only published case reports or case series with the definition of cerebral mucormycosis (finding the signs of this invasive mold in histopathological section or mycological examination and the presence of histopathological or radiological signs of brain involvement) were included. However, animal mucormycosis and papers in languages other than English or duplicates were excluded. Overall, 287/1462 articles were reviewed and included consisting of 345 cases of cerebral mucormycosis.

Results

A total of 206 (59.7%) patients were male. The most common risk factor was diabetes mellitus (51%), followed by hematological malignancies (23.8%). Remarkably, among hematological malignancies, acute lymphoblastic leukemia was significantly associated with cerebral mucormycosis (P <.001). In terms of reported risk factors, only 16.3% of patients had hematological malignancies till 2000, while the percentage of cases (29.7%) with this risk factor increased significantly after 2000 (P = .04). The most common clinical symptoms were orbital (46.4%) and neurological symptoms (41.2%), while headache was present in 35.9% of patients and fever only in 0.6%. Of the patients reported, 60.6% died and there was a significant correlation between mortality rate and diabetes mellitus (P = .003), while the mortality rate was not associated with other risk factors such as hematological malignancies.

Conclusions

In patients with mucormycosis, the presence of orbital clinical symptoms may suggest cerebral involvement as much as the presence of neurologic symptoms. Finally, it can be said that Cerebral Mucormycosis is a very fatal mold infection, especially if it occurs in diabetic patients.
P281 Healthy adult with arm swelling and new onset burning pain
Authors: Shah Kinjal , Patel Kamlesh , Patel Ketan , Patel Atul
Published: September 2022

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

 

Introduction

Cladosporium cladosporioides is a dematiaceous fungal agent that is known to produce a variety of clinical manifestations such as cutaneous and subcutaneous infection, corneal infection, pulmonary fungal infection, and rarely central nervous system infection. Several cases of subcutaneous mycosis have been reported from Assam, India. We are describing a similar case from Gujarat, India.

Case History

A 36-year-old healthy, and muscular male farmer residing in central Gujarat presented with painless nodular swelling with normal overlying skin over the posterior aspect of the left arm for the last 3-4 years. He noticed a gradual increase in the size of this swelling and numbness for the last 4 months and burning sensations for the last 10 days before presentation to the surgeon. Local part ultrasound showed a subcutaneous soft tissue lesion. Excision biopsy reported invasive fungal infection and patient was referred for further evaluation to an infectious disease facility (Fig. 1a). He had no other symptoms and comorbidities. Patient didn't recall any trauma in the past. Direct microscopic examination with calcofluor white stain from surgical site scrapping revealed mycelial structure (Fig. 1b) and yielded pure growth of a dematiaceous fungus on Sabouraud dextrose agar medium, brown to blackish colony (Fig. 1c) with olive color on the backside (Fig. 1d) after 6 days. Lactophenol cotton blue stain preparation of culture isolate showed mycelial elements with morphology suggestive of C. cladosporioides (Fig. 1e), which was confirmed at the National Culture Collection for Pathogenic Fungi, PGI Chandigarh. Review of histopathology revealed a nodule with dense acute on chronic inflammation composed of lymphocytes, plasma cells with many neutrophils with abscess containing brightly eosinophilic structures with many PAS positive septate, thin and thick walled, branching, irregularly shaped, bullous hyphae surrounded by neutrophilic boarder (Splendor Hoeppli phenomenon) (Fig. 1f).

Patient was treated with capsule itraconazole 200 mg three times a day for three days followed by 200 mg twice a day along with terbinafine and total surgical excision of the subcutaneous nodule. Patient achieved a therapeutic itraconazole level (1.4 mg/l) after 1 week. Patient is currently receiving treatment.

Discussion

Subcutaneous mycosis is endemic in Assam. Several cases of subcutaneous chromoblastomycosis caused by C. cladosporidiosis mainly involving the lower limbs were reported from Assam. It mostly affects males engaged actively in outdoor activities during their productive age ranged from 20 to 50 years. It affects a relatively healthy, immunocompetent host and have a long history (in years) of asymptomatic nodule/swelling before diagnosis. Treatment comprises of prolonged antifungal treatment with itraconazole along with surgical excision.
P293 Development of a multiplex PCR short tandem repeat typing scheme for Candida tropicalis
Authors: Spruijtenburg Bram , de Groot Theun , Chowdhary Anuradha , 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. Antifungal-resistant isolates have been reported. Here, we report a short tandem repeat (STR) typing scheme, for C. tropicalis to enable fast, cost-effective, and high-resolution genotyping. This novel typing approach was applied to 117 clinical isolates. For the development of the typing scheme six novel STR markers were selected, combined into two multiplex PCRs, and used to type 117 C. tropicalis isolates, resulting in the identification of 104 different genotypes. The outcome of STR typing of 10 isolates was then compared to single nucleotide polymorphism (SNP) calling from whole genome sequencing (WGS). Isolates with >111 SNPs were also differentiated by the STR assay. Two isolates that were identical according to SNP analysis were separated by STR typing in one marker. To test specificity, STR typing was applied to 15 related yeast species and we found no amplification of these targets. For reproducibility testing, two isolates were typed independently 5-times, which showed identical results in each experiment. In summary, we developed a reliable, rapid, and high-resolution STR genotyping for C. tropicalis, which was found to correlate well to SNP calling by WGS.
P309 Clonal outbreak of Trichophyton tonsurans causing tinea capitis among wrestlers in Beijing, China
Authors: Wang Qiqi , Li Ruoyu , Chen Wei , Wan Zhe , Liu Wei
Published: September 2022

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

 

Objectives

Trichophyton tonsurans, an anthropophilic dermatophyte, mostly causes tinea capitis and tinea corporis and is often associated with outbreaks among athletes involved in combat sports, such as wrestlers and judo athletes. Here, we report an outbreak of tinea capitis caused by Trichophyton tonsurans among five juvenile athletes aged ten to fourteen in a wrestling team in Beijing, China.

Methods

A total of 5 wrestlers aged 10-14 years presented with alopecia, erythema, scales, and pustule on the scalp (Fig. 1a). Scrapings from the lesions were performed by direct microscopic examination using 10% potassium hydroxide (KOH) with calcofluor white and fungal culture. The fungal pathogens were identified by morphology and sequencing of the internal transcribed spacer (ITS) regions. Multilocus genotyping analysis was performed by sequencing of the five gene loci including the ITS and non-transcribed spacer (NTS) of the ribosomal RNA (rRNA) locus, alkalineprotease-1 (ALP1), metalloprotease-5 (MEP5), carboxypeptidases Y (CarbY), which show intraspecies diversity and can be applied to epidemiological investigations and determining the route of infection transmission. Antifungal susceptibility of terbinafine (TBF), itraconazole (ITC), fluconazole (FLC), ketoconazole (KTC), and amphotericin B (AMB) against the causative fungal isolates was determined by broth microdilution method according to the Clinical and Laboratory Standards Institute (CLSI) M38-A3 document.

Results

The five patients were diagnosed with tinea capitis because of the scalp lesions, spores, and hyphae observed by direct microscopic examination (Fig. 1b), and positive fungal culture. The causative isolates were all identified as T. tonsurans by macroscopic and microscopic characteristics (Fig. 2) and sequencing of ITS regions. The sequences of ITS, NTS, ALP1, MEP5, and CarbY were identical among the five isolates, revealing a single genotype. The abovementioned sequences have been deposited to Genbank. The minimum inhibitory concentrations (MICs) of TBF, ITC, FLC, KTC, and AMB against five T. tonsurans isolates were 0.015 μg/ml, 0.015 μg/ml, 8 μg/ml, 0.06 μg/ml, and 0.5 μg/ml, respectively.

Conclusion

We report an outbreak of tinea capitis caused by T. tonsurans among wrestlers in Beijing, China. Multilocus genotyping analysis revealed that all isolates consisted of a single genotype, suggesting the outbreak may be caused by a single strain of T. tonsurans. The isolates were all susceptible to the common antifungal drugs treating tinea capitis.
P325 Trend of cryptococcal meningitis in patients attending a teaching hospital in north-east india — a single center study
Authors: Acharjee Aindrilla , Ngangom Lilavati , Presanambika R Hari , Ningthoujam Priyolakshmi , Khuraijam Ranjana
Published: September 2022

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

 

Objective

To determine the changing trend of Cryptococcal meningitis in patients attending Regional Institute of Medical Sciences Hospital, Imphal.

Methods

A total of 142 cerebrospinal fluid (CSF) samples collected from patients with suspected meningitis from January 2013 to January 2022 were analyzed in the department of Microbiology, Regional Institute of Medical Sciences, Imphal. The samples were subjected to India ink preparation (IIP), Gram stain, Cryptococcal antigen (CrAg) testing, fungal culture in Sabouraud Dextrose agar (SDA) medium, and Bird Seed Agar.

Results

Out of 142 CSF samples received, direct examination by IIP revealed Cryptococcus in 28 cases (19.7%) whereas, capsular polysaccharide antigen testing using lateral flow immunochromatography kit (CRYPTO-PS) detected a total of 40 cases (28.2%). Culture showed growth of fungus in 22 samples and all were from CrAg positive samples. Maximum number of cases were detected in the year 2019 followed by 2018. Immunosuppression (AIDS) was an important underlying factor. Recurrence was seen in three patients and two cases who were on Cycloserine succumbed while undergoing treatment.

Conclusion

Cryptococcosis continues to be a serious fungal infection among AIDS patients in spite of HAART. High index of clinical suspicion and microbiological examination is necessary to improve clinical outcomes. Whenever immunosuppressive drugs are administered in HIV patients treated earlier for cryptococcosis, monitoring the patient for likely recurrence is to be borne in mind to improve the overall clinical outcome. CrAg testing is an additional armamentarium for the diagnosis of cryptococcosis in the absence of culture positivity.
P344 Automatic detection of pneumocystis jirovecii in microscope images: adeep learning-based approach
Authors: Vera Erick Reyes , Botero-Valencia Juan , Giraldo-Escobar William , Arango Karen , Berrio Indira , Preciado Tonny Naranjo
Published: September 2022

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

 

Objective

Pneumocystis jirovecii Pneumonia is one of the diseases that most affect immunocompromised patients today, and under certain circumstances, it can be fatal. One of the most widely used techniques in diagnostic laboratories for the detection of its etiological agent is optical microscopy. However, some of the disadvantages of this technique are its low sensitivity, low accuracy, and high dependence on an expert to make the diagnosis. Then, this work aims to develop a computational tool based on a deep learning approach to automatically detect the presence of P. jirovecii Pneumonia fungus from optical images, and to increase the accuracy of this conventional technique.

Methods

The study involved 29 randomized patients, from whom respiratory samples (bronchial lavage, and bronchoalveolar lavage) were collected. Methenamine silver staining was then used to prepare the samples. Subsequently, the slides of the analyzed patients were observed using the Leica DM500 microscope using a Leica ICC50 HD camera, and the optical images were taken in at least four random positions on the specimen holder. Thus, an image dataset of 29 different patients was created to detect whether a patient is positive or negative for P. jirovecii Pneumonia. Finally, a deep learning approach based on convolutional neuronal networks (CNN) was proposed and evaluated to improve the accuracy of the microscopy technique. The proposed CNN method incorporates global and local features for pixel-wise segmentation.

Results

First, the dataset image was processed and segmented using the connected components methodology. Likewise, the segmented images were labeled with the help of an expert to train the algorithm. To validate the response of the proposed deep learning approach the obtained results were compared with the obtained conventional image classification techniques like co-occurrence matrix and K-NN. The obtained results reveal that the proposed methodology allows to increase in the accuracy in the P. jirovecii Pneumonia identification up to 98%, while the co-occurrence matrix and K-NN only achieve accuracies of 89% and 85% respectively.

Conclusion

It is possible to demonstrate that techniques based on digital image processing are a useful tool to support the processes of analysis and diagnosis of samples in medical patients with P. jirovecii Pneumonia. In addition, the obtained results demonstrate that methods based on deep learning allow us to develop more precise and accurate analysis methodologies for the analysis of patient samples with P. jirovecii Pneumonia. Our model can be improved by adding new layers, but this would introduce even more hyperparameters that should be adjusted. We intend to extend our model architecture in other areas of medical imaging with the usage of deep learning and computer vision techniques.
P348 tRNA modifications in Candida virulence
Authors: Böttcher Bettina , Leidel Sebastian , Brunke Sascha
Published: September 2022

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

Candida albicans is a normal commensal of the gastrointestinal tract, but also an important opportunistic pathogen that can cause life-threatening infections. An important pathogenicity factor of C. albicans is its ability to form hyphae, which are associated with the expression of many different virulence factors. The regulation of hypha formation has been analyzed extensively on the transcriptional and also post-translational level in the past.

 

Candida albicans has a closely related sister species, C. dubliniensis, which has a lower propensity to form hyphae and only very rarely causes more than superficial infections. We investigated the differences in the genetic setup of these two species and found a gene whose Saccharomyces cerevisiae homolog is involved in tRNA modifications.

 

We here show that this gene, Hma1, acts as a tRNA-threonyl carbamoyl adenosine dehydratase in C. albicans, and that its activity differs between C. albicans and C. dubliniensis. A deletion mutant shows specific defects in hyphae formation, invasion of host cells, and in virulence in C. albicans. Furthermore, we find that the loss of this tRNA-modifying enzyme leads to changes in ribosome occupancy at 37°C, the temperature encountered in the host.

 

With these data we link tRNA modifications to host-induced processes of one of the most important fungal pathogens of humans. We thereby add another layer of regulation, between transcription and post-translational modifications, to the virulence program of Candida yeasts.
P355 Pitfalls in medical mycology in India
Authors: Gugnani Harish
Published: September 2022

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

 

Background information

There is increasing awareness of fungal infections in India. Many diagnostic medical mycology laboratories are now operating in different parts of the country. It is considered worthwhile to mention several pitfalls committed in the diagnosis of mycotic infections in India.

Methods

Literature on fungal infections in India was accessed through different search engines. Publications suggestive of inaccurate reporting were thoroughly read to pinpoint the pitfalls in diagnosis. For checking the accuracy of mycological illustrations, some of the publications were requested from the corresponding authors.

Results

Several accessed publications of Indian authors reported the unbelievably frequent occurrence of anthropophilic and zoophilic dermatophytes in soil. A few articles incorporating incorrect diagnoses of systemic infections have also been published in highly reputed journals. For instance, the article ‘Pathogenic Fungi in Soils of Jabalpur, India’ in Mycoses 1990; 33 (3): 116-125 reports 38% incidence of Microsporum (anthropophilic and zoophilic species) in 35 soils examined. Another publication in the August 2009 issue of the same journal mentions frequent isolation of Trichophyton verrucosum, Microsporum audouinii, and M. canis from Jaipur soils. Authors from several Botany departments in Indian Universities have erroneously reported a high frequency of these dermatophytes and T. rubrum from soils and also on Histoplasma capsulatum from some soils. No illustrations were provided for these fungi including H. capsulatum, nor was in vitro conversion of H. capsulatum to yeast form mentioned. There are also reports of erroneous diagnoses of systemic mycoses. In a paper in IJD 2015; 54:451-455, the authors from Kottayam, Kerala reported on African histoplasmosis as the first indigenous case from India. The diagnosis is doubtful as histopathology was not suggestive and the image of the blood agar culture of the fungus at 37°C showed septate cells resembling arthroconidia rather than yeast cells of Histoplasma. Another publication from a premier medical institute in North India [Intestinal Res 2019;17(1):149-152] reported a series of six cases of intestinal histoplasmosis the histopathological illustration was not at all suggestive of Histoplasma and there was no mention of attempting mycological culture.

Conclusion

Lack of knowledge and training of workers from departments of botany and biological sciences in Indian universities has led to the misidentification of human pathogenic fungi The inaccurate diagnosis of mycotic infections has resulted generally from misidentification of the causative fungi and lack of collaboration between histopathologists and medical mycologists. The need for continued training of medical mycologists and for collaboration between the pathologists and medical mycologists is emphasized to avoid erroneous diagnoses.
P363 Mycoflora diversity in stored water from selected households in nairobi
Authors: Mashedi Olga , Kimani Bridgit , Waithera Leah , Okoth Shiela
Published: September 2022

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

 

Introduction

Water is a very vital natural resource for all life on earth as it is used widely. Water plays an important role in the world economy, the uses can be categorized into; commercial use where it is used in hostels, restaurants, offices, and other commercial activities. Fungi are ubiquitous in nature; they produce spores that are small-sized, able to stay airborne for a long duration, and transported over long distances during air dispersal. These are major sources of allergens and airway irritants that are detrimental to health. Biofilms in water distribution systems and storage containers provide favorable habitat for microorganisms as they accumulate better in solid-liquid interfaces that enable them to be embedded in the gelatinous matrix of extracellular polymers excreted by the microorganisms leading to resistance of microbes from environmental stresses. Fungi hydrophobicity and adaptability have enabled them to assemble and colonize different surfaces in domestic settings. The potential health effects caused by fungi in treated water are still not well highlighted and thus the need to carry out this study to investigate the mycoflora isolated from stored water.

Methods

This was a cross-sectional study conducted from 2019-2021, whereby 120 water samples were collected from stored containers in households in Nairobi county Kenya. The fungal strains were plated onto Sabouraud's dextrose agar (SDA), Potato Dextrose Agar, and Czapecks Agar media with chloramphenicol (0.05 mg/mL) (Oxoid, U.K.). The plates were incubated for 7 days at 25°C. Fungal identification was done by direct microscopy and morphological features.

Results

A total of 101 fungal species were isolated from water samples. Yeasts 48 (47.5%), Rhodotorula 34 (33.6%) accounted for the unicellular fungi. Among Filamentous mycoflora, the most common isolated fungi were Aspergillus species 13(12.8%), followed by Fusarium spp 4 (3.9%) with Mucor and |Rhizopus species accounting for 1 (0.9%) respectively. Yeasts species were the most common species isolated from water species and Aspergillus species were more frequently isolated from filamentous fungi.

Conclusion

Yeasts species were the most common species isolated from water species and the roles they play in biofilm needs to be further investigated.
P374 Fungal coinfection in patients with SARS-CoV-2: Atertiary care hospital study
Authors: Saini Vikas , Rai Gargi , Singh Praveen , Das Shukla , Singh Narendra Pal
Published: September 2022

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

 

Background

There is a high risk of developing fungal co-infections in patients infected with SARS-CoV-2, few studies have been conducted on the incidence and risk of these secondary infections. The incidence of Candida infection due to different Candida species is increasing in COVID patients.

Methods

This retrospective study comprised a total of 23 patients with upper respiratory infection investigated in the Department of Microbiology of University College of Medical Sciences (UCMS) and Guru Teg Bahadur Hospital (GTBH), Delhi from April 2021 to June 2021. Identification was done using DNA sequencing.

Results

Of the 23 cases, identification by DNA sequencing, C. albicans was present in 34.78%, C. tropicalis in 30.43%, Pichia kudriavzevii in 26.08%, C. parapsilosis in 4.3%%, and C. auris in 4.3%.

Conclusion

C. albicans is the leading pathogen in our patients, along with the rise in the incidence of P. kudriavzevii which is usually an environmental contaminant. Regular surveillance and infection control practices are future ventures to reduce the burden of infection.
P382 Scalp fungal microbiome and sebum composition in males with and without androgenetic alopecia
Authors: Sugita Takashi , Suzuki Kazuhiro , Cho Otomi
Published: September 2022

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

 

Objects

Lipophilic Malassezia species are abundant in the scalp microbiome; we investigated the scalp microbiome and sebum composition of patients with androgenic alopecia (AGA) and aimed to identify factors accelerating AGA progression.

Materials and Methods

Scalp scale samples (swabs) were collected from 55 male Japanese patients with AGA and 63 healthy individuals. Fungal rRNA genes were amplified by PCR and the amplicons were sequenced on the MiSeq platform. The extent of fungal colonization was determined by qPCR. We used gas chromatography/mass spectrometry to measure the sebum levels of free fatty acids, diglycerides, triglycerides, squalene, free cholesterol, cholesterol esters, and wax.

Results and Discussion

Malassezia restricta predominated in all AGA (64.7%) and non-AGA age groups (44.6%). qPCR revealed that Malassezia colonization was more extensive in the AGA than non-AGA group, regardless of age; the Malassezia level was significantly higher in ADA subjects aged 50–59 than 30-49 years. The TG level was significantly higher in the AGA than non-AGA group (P <.05), but the free fatty acid, squalene, and free cholesterol levels were significantly lower (all P <.05).

Conclusion

Thus, the scalp fungal microbiome and sebum composition may influence AGA development.
P408 Evaluation of fungal serum biomarkers in the diagnosis and for monitoring patients with post tuberculosis chronic pulmonary aspergillosis
Authors: Singh Shreya , Singh Inderpaul , Agarwal Ritesh , Kaur Harsimran , Chakrabarti Arunaloke , Rudramurthy Shivaprakash
Published: September 2022

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

 

Objectives

The evaluation of serum β-D-glucan, galactomannan, and Aspergillus fumigatus specific IgG in the diagnosis and clinical management of patients with chronic pulmonary aspergillosis.

Methods

Consecutive patients with a past history of pulmonary tuberculosis (PTB) with clinical suspicion of chronic pulmonary aspergillosis (CPA) attending the outpatient services of PGIMER, Chandigarh were included from August 2019 to August 2021, and CPA was defined as described by Denning et al. including both radiological and mycological evidence. Age and sex-matched post-PTB individuals selected from a population attending the chest clinic were enrolled as controls. Serum samples were obtained from all participants and testing for serum β-D-glucan (Fungitell, CapeCod), galactomannan (Platelia, BioRad) and Aspergillus fumigatus specific IgG (ImmunoCAP, Phadia) was performed as per manufacturer's instructions.

Results

A total of 105 post-TB patients with CPA and 11 controls were enrolled. Aspergillus fumigatus (n = 8) was the most commonly isolated species, followed by A. flavus (n = 4), and A. niger (n = 2). The mean A. fumigatus specific IgG levels, serum galactomannan index and BDG levels were higher among CPA cases vs. controls at 101.4 mgA/l vs. 11.8 mgA/l, P-value: .0001; 0.73 vs. 0.35, P-value: .3134; and 133.7 pg/ml vs. 32.37 pg/ml, P-value: .012, respectively (Figs. 1a, b, c). The serum BDG had an area under curve 0.834 ± 0.044 (95% CI: 0.748-0.920) on the ROC curve with a sensitivity of 57.1% and specificity of 100% at the kit cut-off of 80 pg/ml (Fig. 2a). Comparison between CPA patients with multiple (n = 38) versus single lobe (n = 67) involvement showed comparable A. fumigatus specific IgG levels (112.3 vs. 93.8; P-value: .133 respectively) while galactomannan index and BDG levels were higher in cases with multiple vs. single lobe involvement (0.94 vs. 0.57, P-value: .117), and (174.3 vs. 105.3, P-value: .0071), respectively (Fig. 1d, e, f). There was a significant association of BDG value with the severity of dyspnea (P-value: .002) and a trend of higher A. fumigatus specific IgG was also seen to correlate with the severity of dyspnea (Fig. 2b and 2c).

Conclusion

BDG assay can serve as an adjunct in the diagnosis of patients with CPA. An association of higher levels of BDG with multiple lobe involvement and severe dyspnea could be due to more extensive tissue damage associated with a greater release of antigen in circulation during progressive disease. More studies with a larger number of control samples, preferably with multi-center coordination can further improve our understanding of this test's applicability in routine practice.
P427 The value of nasal and oral clinical examination in febrile neutropenic patients for initiating anti-fungal therapy as a preemptive method
Authors: Sarvestani Hasti Kamali , Salehi Mohammadreza , Fard Elahe Samiee , Pourahmad Ramtin , Khansari Mahmoud
Published: September 2022

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

 

Background

Invasive fungal infections (IFIs) are complications that lead to mortality and morbidity in hematologic malignancies. The time of starting anti-fungal therapy is vital. Preemptive anti-fungal therapy has appeared recently as a new policy for the management of IFIs based on noninvasive ways in neutropenic patients.

Methods

We enrolled leukemia patients with neutropenia after chemotherapy in Imam Khomeini Hospital Complex, Tehran, Iran. Patients who entered the neutropenic phase were divided into two categories (empirical and preemptive) for receiving anti-fungal agents. The patients were clinically examined in the preemptive group every day to find IFIs. As soon as clinical evidence of IFIs was observed, antifungal was prescribed. The empirical group patients received antifungals based on the ward protocol. Based on the data in each group, the diagnostic and therapeutic results of cases are followed-up for 3 months. To compare percentages between the two groups, the Chi-squared test was used. And to compare two means between the two groups, the independent t-test was used. All the statistical analyses were done in the Statistical Package for the Social Sciences (SPSS) version 24 software (IBM Corporation, Armonk, New York, USA).

Results

We assessed 132 leukemic patients with inclusion and exclusion criteria. Eventually, 80 patients were enrolled. The mean age was 35.52 years. Demographic data and distribution of leukemia type show no significant differences between the two groups. Despite a higher percentage of IFIs discovered in the preemptive group than the empirical group (25 vs. 18.75%, respectively), but data show no significant differences. The average days of IFIs diagnosis since the beginning of neutropenia in the empirical group were 9.5 days while in the preemptive group, the average days were 5.4 days (P <.05). Totally, there were 15 patients with a proven IFI in each group (40% in the empirical group and 60% in the preemptive group). Results significantly show an increase in surgical sinus debridement in the empirical groups (83.3%) vs. the preemptive groups (55.5%), (P <.05). The mortality rate differed significantly among the two groups; it was 7.5% in the preemptive group and 25% in the empirical group (P <.05).

Conclusion

Daily oral and nasal cavities examination to find the symptoms of IFIs and then start preemptive antifungal agents may be able to lead to accurate diagnosis, earlier treatment, and decreasing sinus surgery debridement in leukemia patients with neutropenia.
P452 Estimation of the detection limit of extracted Candida DNA from spiked EDTA blood sample
Authors: Subramanian Anitha , Balakumar Uthra , Kindo Anupma Jyoti
Published: September 2022

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

 

Background

Candidemia caused by genus Candida, are opportunistic pathogens with life-threatening infection in immunocompromised individuals with a mortality rate being 40%–54% in patients. Blood culture is not a reliable and rapid method for the diagnosis of candidemia as its sensitivity is as low as 50%. Molecular diagnosis is an alternative to conventional culture for early detection of candidemia. An appropriate DNA isolation technique is needed to obtain high purity DNA from blood specimens and improves the sensitivity of the polymerase chain reaction (PCR). In this study, two different methods were used to extract Candida DNA from spiked EDTA blood specimens, the In-house phenol-chloroform and potassium acetate method.

Objectives

DNA extraction from the spiked blood samples

Quantification of the Candida DNA extracted from the spiked sample

Comparison of the extracted DNA by phenol-chloroform and potassium acetate method

Methods

A total of 5 ml of EDTA blood samples from healthy volunteers were spiked with 104-108 Candida albicans cells (ATCC 90028) to determine the detection limit of our extraction method. DNA was extracted from whole blood using phenol-chloroform and the potassium acetate methods which involves pretreatment with erythrocytes, leukocytes and fungal lysis buffer. DNA from C. albicans were amplified using ITS1 and ITS4 based primers. PCR products were visualized by agarose gel electrophoresis.

Results

The spiked Candida cells taken were from 104-108 yeast cells. The total extracted DNA by phenol chloroform extraction method ranged from 18.29 to 51.64 ng/μl respectively. Whereas the total extracted DNA from potassium acetate extraction method ranged from 15.58 to 32.30 ng/μl respectively. The presence of a 535 base pair (bp) product was considered positive (Figs. 1 and 2). The lowest detection limit of PCR has been determined as 106-108 Candida cells for our spiked samples.

Conclusion

In our study, till date, the extracted quantity of DNA was found to be higher by phenol-chloroform method as compared to the potassium acetate method. Greater numbers and processing are required to obtain conclusive data.
P466 Isolation of Cryptococcus neoformans and other yeast from pigeon droppings in Khartoum state, Sudan
Authors: Abdalla Wisal
Published: September 2022

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

 

Objectives

The aim of this study was to investigate the presence of Cryptococcus neoformans and other yeast species in pigeon droppings in Khartoum state, Sudan.

Methods

Sample collection A total of 120 samples were collected from pigeon droppings from Khartoum state. Pigeon droppings were collected using sterile wooden spatulas and placed directly in clean plastic bags.

Processing of sample

Approximately 2 g of pigeon droppings were added to 10 ml of sterile saline. The samples were allowed to stand for 20 min with frequent vortex.

Isolation and Identification of yeast isolates

A loopful of supernatant fluid from prepared samples was taken and streaked onto Sabouraud's dextrose agar media supplemented with 0.05 mg/ml chloramphenicol incubated at 37°C for 1-2 days. All yeast isolates were identified by direct microscopic examination using the lacto-phenol-cotton-blue stain India ink stain and Gram's stain. Further confirmatory tests were conducted using Corn Meal Agar (CMA) with tween 80, germ tube production test using horse serum, and urease test. Confirmation of identification was done using API 20C AUX and API ID 32C AUX (bioMérieux®, Madrid, Spain).

Results

Cryptococcus neoformans is the most common species isolated from pigeon droppings as shown in Table 1. Different Candida species have been isolated Figure 1.

Conclusion

The present study concluded that there is a potential role of pigeons as a reservoir for C. neoformans and other zoonotic yeasts in the environment that can affect humans and animals.
P478 Identification of clinical Candida isolates using maldi-tof-ms and their antifungal susceptibility profile—a study from tertiary care pediatric hospital in noida
Authors: Perween Naz , Nandwani Sumi , Verma Nikhil , Rai Sumit , Prakash M.R. Shiva , Saxena Krati , Dwivedi Niharika
Published: September 2022

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

 

Introduction

Objectives

Material and Methods

The study was conducted in Department of Microbiology during the period of August 2018 to August 2021.

Results

Conclusion

Rapid identification of Candida species using Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) as a reliable and rapid technique for Candida species identification as candida is an important cause of neonatal sepsis and sepsis related mortality.

Sources
P484 Expanding VGVI—evidence for distinct Cryptococcus gattii (decagattii) endemic to the American Southwest
Authors: Engelthaler David , Monroy-Nieto Juan , Sykes DVM Jane , Komatsu Ken , Meyer Wieland
Published: September 2022

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

 

Objectives

We aimed to understand the nature of autochthonous Cryptococcus gattii clinical and veterinary cases identified in Arizona, a state in the American Southwest, a locale well outside of the known endemic regions.

Methods

Whole-genome sequencing and phylogenomic comparative analyses were conducted on four unrelated isolates collected from recent cases along with other relevant C. gattii genomes.

Results

Phylogenomic analysis grouped the Arizona genomes with a previously known set of Mexican isolate genomes, labelled as VGVI or C. decagattii. These genomes are clearly delineated from the nearest major molecular type (VGIII), but show no recombination with other molecular types or species of C. gattii.

See Figures below.

Conclusion

These findings expand VGVI into a definitive clade and establish this molecular type as a clinically important and distinct population. These findings also expand the known Cryptococcus ecological range into a previously unrecognized endemic area, typified by extreme heat and aridity.
P488 Successful treatment of breakthrough invasive aspergillosis in an immunocompetent individual based on therapeutic drug monitoring: A case report
Authors: Yin Xin , Zong Zhiyong , Liu Yanbin
Published: September 2022

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

 

Background

Invasive aspergillosis (IA) is an opportunistic fungal infection in immunocompromised patients with high mortality. Aspergillus flavus is the second pathogen of IA. Breakthrough IA was defined as any IA occurring during exposure to an antifungal drug.

Case presentation

A 22-year-old female college student was admitted severely unwell with dizziness and left limb weakness. She was healthy previously and did not take any medication. Magnetic resonance imaging showed a right intracranial space-occupying lesion. The postoperative pathological and morphological examinations suggested Aspergillus flavus. The anti-fungal medication, voriconazole, was administered immediately. Unfortunately, her condition deteriorated, and she experienced coma after about 1 month of antifungal treatment. The emergency craniotomy revealed a large amount of pus and the culture of pus confirmed Aspergillus flavus. Antifungal regimen was developed by infectious disease specialists, and drug concentration was monitored continuously. This patient received antifungal treatment for 2 years. No recurrence was observed after 6 months of antifungal drug withdrawal, and she can take care of herself.

See Figures below.

Conclusion

Breakthrough IA occurs in patients who lack high risk factors, making diagnosis more difficult and leading to a higher risk of mortality. Therapeutic drug monitoring is crucial for therapeutic success. Meanwhile, multidisciplinary therapeutics can improve the survival rate.
P490 Fatal secondary fungemia due to Trichosporon asahii onychomycosis in a diabetic patient
Authors: Taj-Aldeen Saad , Francisco Elaine , Al Maslamani Muna , Theelen Bart , Vu Duong , Boekhout Teun , Hagen Ferry
Published: September 2022

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

 

Objectives

We describe a fatal case of trichosporonosis caused by Trichosporon asahii. The aim was to molecularly characterize the T. asahii strains from blood and foot tissue samples to investigate their genetic relatedness.

Case

An 85-year-old morbidly obese female with a prior cerebrovascular accident, hypertension, and diabetes mellitus was admitted to a peripheral hospital with type II respiratory failure, metabolic acidosis, and chronic anemia. Three weeks post-hospitalization the patient remained febrile, physical examination showed that the patient had paronychia, nail pigmentation, subungual onychomycosis, and a diabetic foot ulcer. Blood culture, as well as nail and ulcer samples, became positive for Trichosporon yeasts.

Methods

Trichosporon yeasts were subjected to molecular identification by sequencing the intergenic spacer (IGS1) region. Minimal inhibitory concentrations (MICs) were determined by the EUCAST microdilution method. Long-read nanopore sequencing was performed for the three clinical strains, the type-strain of T. asahii (CBS2479), and two IGS-genotype 7 strains (CBS2936, CBS7632) using the native barcoding kit v12 (SQK-LSK112; Oxford Nanopore Technologies). Raw data were basecalled with Guppy v6, Flye v2.9 was used to de novo assemble the genome of CBS2479, this was used as a reference for variant calling using the genomic reads of all strains.

Results

The three clinical strains were found to belong to the rare IGS-genotype 7 and had similar MICs for amphotericin B (4 µg/ml), 5-fluorocytosine and fluconazole (2 µg/ml), voriconazole (≤ 0.015 µg/ml), posaconazole (0.0625 µg/ml), itraconazole (0.125 µg/ml), caspofungin (8 µg/ml), anidulafungin and micafungin (> 16 µg/ml). Strains from the ulcer and nail were genetically very closely related with 10 836 SNPs differences, the blood-derived strain differed more from these two strains with 94 729 SNPs and 94 913 SNPs, respectively. Strains CBS2936 and CBS7632 were only distantly related to CBS2479 with 328 221, and 436 060 SNPs, respectively.

Conclusion

The T. Asahii IGS-genotype 7 strain causing fatal fungemia was genetically nearly identical to that obtained from nail and foot ulcers, making it highly likely that this was the port d'entrée for T. asahii.