bluuebunny/crossref_metadata_2025 huggingface dataset:
P118 Pentraxin-3 interacts with Aspergillus fumigatus conidia to regulate pro-inflammatory cytokine production
Authors: Dellière Sarah , Wong Sarah , Chauvin Camille , Bayry Jagadeesh , Carvalho Agostinho , Inforzato Antonio , Aimanianda Vishukumar
Published: September 2022

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

 

Objectives

Long pentraxin-3 (PTX3) is a soluble pattern-recognition receptor secreted by phagocytes and non-immune cells at sites of inflammation. It has been reported to have a nonredundant role in the immune response against Aspergillus fumigatus. Indeed, PTX3 knock-out mice show an increased susceptibility to invasive pulmonary aspergillosis (IPA) with a higher mortality rate. In humans, PTX3 genetic deficiency or single nucleotide polymorphism has also been associated with an increased risk of IPA. However, the way in which PTX3 interacts with A. fumigatus and its mechanism of action has yet to be elucidated. The aim of the study was to investigate potential A. fumigatus ligands for PTX3 and the impact of A. fumigatus opsonization by PTX3 on modulating the immune response.

Methods

Aspergillus fumigatus conidia, the infective morphotype, were incubated with PTX3 with or without human serum, stained with anti-PTX3 antibody, and studied by immunofluorescence. Identification of potential fungal ligands for PTX3 was performed by ELISA. Fixed conidia and germinated conidia were opsonized with different serum factors and co-incubated with human monocyte-derived macrophages (hMDM) for 24 h at 37°C. Culture supernatants were collected, and pro-/anti-inflammatory cytokines were measured by sandwich ELISA.

Results

PTX3 did not bind A. fumigatus conidia directly but in the presence of human serum, purified collectins [surfactant protein D (SP-D) or C1q], and complement products (C3b). Pre-opsonization of conidia with these complement proteins or SP-D stimulated proinflammatory cytokine secretion by hMDM upon interaction (Fig. 1a). In contrast, secondary opsonization of complement proteins or SP-D opsonized conidia with PTX3 significantly reduced pro-inflammatory cytokines and increased anti-inflammatory cytokine secretion from hMDM. PTX3 opsonized PFA-fixed germinating conidia significantly reduced pro-inflammatory cytokine and increased anti-inflammatory cytokines secretion from hMDM (Fig. 1b).

Conclusion

PTX3 is an acute phase protein expressed in response to pro-inflammatory stimuli during infection and that is increased in bronchoalveolar lavage of patients with aspergillosis. Our recent data with A. fumigatus suggest that PTX3 is an immunoregulatory protein that reduces pro-inflammatory response. Although an inflammatory response is necessary to fight against fungal pathogens, the tissue damage associated with enhanced inflammation can be deleterious and facilitate A. fumigatus infection.
P123 Study of naïve and memory T helper cell response in patients of chronic rhinosinusitis with nasal polyposis (CRSwNP) after in vitro exposure to Aspergillus flavus
Authors: Das Shukla , Rai Gargi , Ansari Mohammad Ahmad , Singh Praveen Kumar , Dar Sajad Ahmad , Gupta Neelima , Sharma Sonal
Published: September 2022

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

 

Objectives

To study the CD45RA (naive) and CD45RO (memory) in CD4 + T cell population after in vitro stimulation to Aspergillus flavus antigen in CRSwNP patients and healthy controls.

Methods

The study included 30 cases of CRSwNP (before and after six months of treatment) and 30 healthy controls. Postoperatively biopsies (polyp tissues) were subjected to KOH and culture for mycological investigation. Preoperatively, blood sample (4 ml) was collected from cases and controls for peripheral blood mononuclear cells (PBMCs) separation. PBMCs were treated in vitro by Aspergillus flavus antigen (20 μg/ml) and Phytohemagglutinin and incubated for 18 h at 37°C in CO2 incubator. Cells were harvested after incubation and stained with different monoclonal antibodies such as CD3, CD4, CD45RA, and CD45RO for flow cytometry analysis. Statistical analysis was done using SPSS software. Data were expressed as mean ± SD and the significance level was considered at probability below 0.05.

Results

The profiles of various CRSwNP patients and healthy controls were studied. The mean age and duration of disease of the patients were recorded as 28.92 years and 9.08 months. A total of 24/30 (80%) cases were found positive for Aspergillus flavus from KOH/culture investigation. The percentage positivity of CD3 + CD4 + T cells was significantly increased after A. flavus stimulation in patients as compared with healthy controls. Decreased levels of CD45RA + CD4 + T cells were analyzed in patients before and after treatment as compared with healthy controls. The percentage of CD45RO + CD4 + T cells was found to be increased upon A. flavus stimulation in patients compared with the healthy control group.

Conclusion

The continuous exposure to fungal spores may induce unusual immune responses to Aspergillus flavus spores, triggering an allergic immunological reaction with increased CD4 + T cell responses. Increased levels of CD4 + CD45RO + T cells may transform the pathogenic reaction and highlight the chances of A. flavus reactive T cells involvement in initiating inflammation in cases of CRSwNP.
P124 Cryptococcus neoformans-and Cryptococcus gattii-specific antibodies vary among children and adults with cryptococcosis and healthy from Colombia
Authors: Becerra-Alvarez Paola , Escandón Patricia , Lizarazo Jairo , Quirós-Gómez Óscar , Firacative Carolina
Published: September 2022

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

 

Background

Cryptococcus neoformans (Cn), predominantly, and Cryptococcus gattii (Cg) cause cryptococcosis, a life-threatening systemic mycosis of global distribution affecting mainly immunocompromised adults.

Objectives

This study aimed to determine total and specific antibodies against C. neoformans and C. gattii antigens in sera from patients with cryptococcosis and from healthy individuals from Colombia, which will help to elucidate sero-epidemiological variations in the incidence of the disease in the country.

Methods

Sera from child and adult patients with cryptococcosis (n = 109) and sera from healthy children and adults from Colombia (n = 119) were studied. Using ELISA, total and Cn- and Cg-specific levels of immunoglobulin (Ig)G, IgA, and IgM were determined in sera.

Results

Total IgG, IgA, and IgM levels were higher in HIV + compared with HIV− patients with cryptococcosis. Specific IgG, IgA, and IgM levels tended to be higher in cryptococcosis patients than in healthy controls and to be higher in adults than in children, with a positive correlation between antibody reactivity and age. All serum immunoglobulins were more reactive against Cn-proteins than Cg-proteins. Including all samples, a positive correlation between total and specific IgG, IgA, and IgM levels was found.

Conclusions

In cryptococcosis patients from Colombia, serum immunoglobulins levels differ depending on HIV status, as reported previously. However, this study shows for the first-time variations in immunoglobulin production among adults and children with cryptococcal disease and between Cn and Cg-protein antigens. The observation of differential antibody reactivity with cryptococcal proteins encourages further studies of the humoral immunity for host defense against cryptococcosis.
P131 Optimization of MTT assay protocol in Pythium insidiosum zoospores incubated together with neutrophils
Authors: Medhasi Sadeep , Sriwarom Apichaya , Chindamporn Ariya , Worasilchai Navaporn
Published: September 2022

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

 

Objectives

The tetrazolium-based MTT assay is widely used to assess cell viability. This colorimetric assay measures cell viability through the enzymatic reduction of MTT, a yellow water-soluble tetrazolium dye, to purple-colored formazan crystals. The zoospores of Pythium insidiosum are the infective form causing pythiosis. There remains a lack of standardized protocol for P. insidiosum zoospore viability assay. Here, we optimized the MTT assay to assess the activity of neutrophils on zoospores.

Methods

Neutrophils and zoospores were incubated for 2 h, 4 h, and overnight at 37°C. Neutrophils were lysed in water (pH = 11), MTT was added to each well and incubated at 37°C for 2 h. Then, SDS-HCl solution was added to each well, and absorbance at 570 nm was measured using a microplate reader. The percentage of viable zoospores was then determined.

Results

The viable zoospores metabolized MTT to insoluble purple formazan product. The zoospores germinated into hyphae when incubated for ˃2 h. Because of the rapid germination of zoospores into hyphae, reliable results would be obtained with an optimum incubation time of 2 h for the zoospores.

Conclusion

The simplicity and low cost of the assay make it a valuable tool for zoospore viability studies, with a focus on immunology and immunotherapy.
P141 Study of prevalence, antifungal profile and predictors of mortality in chronic pulmonary Aspergillosis in a cohort of liver disease patient
Authors: Kale Pratibha , Bhattacharyya Debajyoti , Khillan Vikas , Sarin Shiv Kumar
Published: September 2022

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

 

Objectives

Chronic pulmonary aspergillosis (CPA) is a neglected cause of respiratory disease even in high-TB burden countries like India. It is a term that includes simple aspergilloma, chronic cavitary pulmonary aspergillosis which is the most common variant that presents with formation of lung cavities with or without an aspergilloma or nodules, and chronic fibrosing pulmonary aspergillosis. CPA is a chronic progressive infection that destroys lung tissue in non-immunocompromised patients. So, we studied the prevalence of CPA in liver disease patients with respect to spectrum of infections, fungus isolated, and outcome.

Methods

A cohort of 2250 liver disease patients with isolation of Aspergillus in respiratory samples, was analyzed retrospectively for the diagnosis of CPA, from June 2018 to June 2020. The demographic characteristics, clinical, radiological, and laboratory objective and subjective variables including age, sex, previous pulmonary conditions, dyspnea score, quality of life, serum albumin, ESR, etc were assessed using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards modeling. In samples of patients, retrospective review of time from likely onset of CPA to referral and cause of death were also investigated.

Results

CPA was diagnosed in 16% of the patients. Survival was 72%, at 1 year. Increased mortality was associated with chronic obstructive pulmonary disease (hazard ratio 2.57; P = .029), nontuberculous mycobacterial infection (2.04; P <.001), increasing age (1.03, P <.001), lower albumin (0.92, per g/L), underlying chronic liver disease (2.07; P <.001) were significantly associated with CPA. The Aspergillus species isolated were A. flavus (66%), A. fumigatus (31%), Aspergillus nidulans (1%), A. terreus (1%), and other Aspergillus species (1%). All the isolates were sensitive to echinocandins and amphotericin B. Azole-resistance was detected in 3% isolates. Multiple pulmonary lesions were more common (73%) than single cavitary lesion. Mortality was seen in 64% of cases.

Conclusion

CPA pulmonary aspergillosis is a common complication and cause of mortality in post-cavitary pulmonary disease. Several factors impact on mortality of CPA, and can be evaluated as tools to assess CPA prognosis. Underlying liver disease is an important predictor of mortality. As there is a rise in azole-resistance, appropriate diagnosis, and antifungal sensitivity testing should be done in all suspected cases. Early diagnosis and treatment can prevent mortality in CPA patients.
P151 Molecular epidemiology of environmental strains of Cryptococcus isolated from Varanasi, Uttar Pradesh, India
Authors: Tirkey Neha Nidhi , Singh Karuna
Published: September 2022

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

 

Objectives

Cryptococcosis affects more than one million people per year worldwide. Despite the worldwide emergence of this ubiquitous infection, little is known about the global molecular epidemiology of this fungal pathogen. The ecological niche of the etiological agents of C. neoformans and C. gattii are not well established yet in various parts of India.

Methodology

The present study was performed on the C. neoformans isolated from the Eucalyptus terreticornis at Varanasi, India. A total of 265 samples including flowers, leaves, bark, and nearby soil of E. terreticornis. The fungal pathogens were identified by both the conventional and molecular methods. The isolates were also grown in Staib's and tobacco agar medium. In addition, all isolates were identified on the basis of different biochemical tests such as urease test and canavanine-glycine-bromothymol blue (CGB). Further, molecular characterization was carried out by using PCR and DNA sequence analyses.

Results

Conclusion

In spite of a major Eucalyptus growing region of India, there is no report of C. neoformans/C. gattii-Eucalyptus association from Eastern Uttar Pradesh. Therefore, the current study would certainly be helpful in the establishment of molecular epidemiology of Cryptococcus in this area.
P157 Entomophthoromycosis: a rare fungal infection case series
Authors: Ahmed Jaweed , Xess Immaculata , Singh Gagandeeep , Chaudhary Souradeep , Thakar Alok
Published: September 2022

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

 

Objectives

To present a case series of entomophthoromycosis (a rare fungal infection of the skin and subcutaneous tissue with a protracted and chronic clinical evolution), which would aid in the early recognition and management of this condition.

Materials and Methods

A total of 7 laboratory-confirmed cases of entomophthoromycosis, diagnosed and treated between May 2018 and March 2022 at our center, were included in the series. Diagnostic criteria were based on the results of conventional mycological diagnostic methods, including direct epifluorescence microscopy and visual identification of isolates obtained by culture on solid media. Clinical histories were collected retrospectively by chart review and correlated with laboratory findings.

Results

Of the seven patients, six were male and one was female, with ages ranging from 2.5 to 42 years. Most of the patients presented with chronic progressive nasal or rhinofacial swelling and nasal obstruction. Aseptate or pauciseptate hyphae were observed in direct epifluorescence microscopy of tissue samples from all the patients. Conidiobolus spp was isolated from samples from five patients, and Basidiobolus spp from the remaining two. Although growth in culture was obtained several days after sample inoculation, specific antifungal treatment for entomophthoromycosis (using a combination of potassium iodide and itraconazole) was initiated early based on concurrence between clinical features, typical fungal elements seen in direct microscopy and histopathological findings. All the patients improved rapidly and made full recoveries.

Conclusion

Entomophthoromycosis is a rare condition whose identification requires a high index of clinical suspicion. The treatment for this condition is specific and different from the treatment for other clinically significant invasive fungal infections, but confirmation of diagnosis by culture may take weeks. Therefore, early diagnosis supported by a combination of suggestive clinical features as well as mycological and histopathological evidence, is vital to ensure successful outcomes.
P160 Paracoccidioidomycosis severe: Bizarre presentation in the face
Authors: Azevedo Conceicao De Maria , Holanda Rodrigo , Marques Sirlei , Silva Raimunda Ribeiro , Nunes Natália , Wittlin Bernardo , Santos Daniel Wagner
Published: September 2022

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

 

Introduction

Paracoccidioidomycosis is a systemic mycosis caused by the dimorphic fungus Paracoccidioides brasiliensis. The disease is restricted to Latin America. It is the principal systemic mycosis in Brazil, with higher incidences in the southern, southeastern and central regions.

Objectives

It's to report a case of paracoccioidomycosis with a bizarre presentation on the face.

Case Report

A 54-year-old male farmer from Açailândia, Maranhão, with a history of an extensive ulcerated lesion that started in the right wing of the nose. After 6 months of evolution, the lesion had already spread reaching the nasal and oral mucosa, evolving with acute respiratory failure, requiring tracheostomy (Fig.1). He was referred to the Cancer Hospital for a biopsy, which was referred for pathological examination, showing an intense inflammatory infiltrate consisting of lymphocytes, histiocytes, neutrophilis with giant, multinucleated cells that phagocytize refrigerant bodies, compatible with paracoccidioidomycosis. Material sent for direct examination and culture, showed positive for Paracoccidioides sp. After PCR amplification of the genetic material and sequencing, P. brasiliensis was identified. Chest tomography showed sparse ground-glass attenuation, but affecting both lungs and radiodense striations in the lower lobes bilaterally. Treatment was established with liposomal amphotericin B, with a good therapeutic response (Fig. 2). The patient was discharged from the hospital using itraconazole and still upper outpatient follow-up, with good healing of the lesions.

Conclusion

Paracoccidioidomycosis can get a severe presentation, distancing the physician from the diagnosis, showing that in all these situations, simple tests, such as the direct examination of lesional material or sputum can elucidate the diagnosis. We need to think about it in endemic area.
P161 Epidemiological trends of Candida species in urine culture— a retrospective study in a tertiary care hospital in Punjab
Authors: Bansal Lavisha
Published: September 2022

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

 

Objectives

The presence of Candida species in the urine (Candiduria) is a typical clinical observation, especially in hospitalized patients. It is more common in immunocompromised persons, in bone marrow transplant unit (BMTU) patients, and in those who are in intensive care units (ICUs). Urinary tract infections (UTIs) can be caused by any Candida species. Now, non-albicans Candida species prevail in many locations around the world. Urinary tract instrumentation, past antibiotic usage, lengthy hospital stay, extremes of age, diabetes mellitus, female gender, and immunosuppressive medication are all risk factors for candiduria. Candiduria represents colonization in the majority of adult patients in critical care settings, and antifungal medication is not necessary. The presence of yeast in the urine, on the other hand, can indicate a widespread illness. Candiduria often indicates widespread candidiasis in severely unwell newborns and is followed by blocking fungus ball development in the urinary tract.

Methods

A retrospective study was conducted at Christian Medical College and Hospital, Ludhiana from March 1, 2020 to March 31, 2022. The acquired urine samples were promptly processed in the microbiological laboratory using a semi-quantitative culture technique in accordance with normal protocols. All of the yeast isolates were processed further on Corn meal agar (CMA) for further speciation.

Results

Out of the 9729 urine samples received, there was culture growth for Candida species in 511 (5.25%) samples. Amongst the patients who had candiduria, 180 (35.22%) patients were immunocompromised. Out of 511 Candida isolates, 122 (23.87%) were Candida albicans and 389 (76.12%) were non-albicans Candida. Further speciation of non-albicans Candida indicated the prevalence of C. glabrata, C. tropicalis, C. krusei, C. parapsilosis, and C. guielliermondii as 98 (19.17%), 89 (17.41%), 78 (15.26%), 78 (15.26%) and 46 (9%) respectively.

Conclusion

The most prevalent healthcare-associated infection is nosocomial UTI. Candida species is becoming a more common cause of nosocomial urinary tract infections. C. albicans was the most common species isolated from the urinary system for many years. Now, non-albicans Candida species have emerged as a result of the introduction and widespread usage of fluconazole. These non-albicans species may be more difficult to remove than C. albicans because they are more adapted to the kidney and collecting system. With controlling underlying diabetes, daily assessment of need of urinary catheterization, early removal of catheter, surgical removal of obstruction of urinary tract and timely de-escalation of antibiotics can prevent candiduria in most of the cases. Thus, we can avoid antifungal therapy which may contribute to the resistance.
P165 Mycological profile of keratitis from tertiary care center in the state of Chattisgarh, India
Authors: Keche Archana , Behera Sibani , Tigga Richa , Sahu Vijaya , Mishra Neeta
Published: September 2022

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

 

Objective

To assess the burden of fungal etiology of clinically suspected mycotic keratitis amongst the patient presented to the Ophthalmology department in a tertiary care hospital in Chhattisgarh.

Methods

This is a laboratory-based retrospective study of the corneal scrapings received for mycological processing between January 2020-December 2021. Demographic data were collected from patients and from their medical records. Corneal scrapings were aseptically collected from the margins of the ulcer using a sterile Kimura blade in the Ophthalmology department and the samples were processed by following the standard microbiology protocol. A wet mount examination with 10% KOH was done. Samples were also smeared onto a sterile slide for Gram stain. Samples were inoculated in a C-shaped manner on media on blood agar, chocolate agar, and Sabouraud's dextrose agar supplemented with chloramphenicol. Media were incubated in a 25°C aerobic incubator and observed for growth daily for a week and thereafter on alternate days. Blood agar was incubated at 37°C. Fungi were identified by the conventional method by Lactophenol cotton blue microscopy (LPCB) and slide culture. Antifungal susceptibility testing for Voriconazole with E-test was performed for Aspergillus and Fusarium species.

Results

A total of 37 patients with suspected mycotic keratitis were included in the duration of the study period. The demographic details hinted more predisposition of keratitis in females than in males; with a mean age of 49 ± 2 years and a range from 21 to 80 years. The predominant predisposing factor was trauma with organic matter in agricultural background. Amongst the total 37.8% (14/37) were positive for both KOH and culture, while 5.4% (2/37) were KOH negative but culture positive. There were 5 isolates that could hint toward low sample load or certain technical logistic issues could not be culture. Amongst culture-positive isolates, Fusarium species (37.5%) was the most common isolate showing predominance of Fusarium oxysporum, followed by Acremonium species and Aspergillus species 19%, with rare isolation of Colletotrichum dematium and Scedosporium species.

Conclusion

Culture remained the gold standard for the detection of fungal agents which will help to know the epidemiology of the local areas and guide the clinicians to prevent and treat the affected patients effectively. The tropical environment and agricultural occupation in Chhattisgarh present variability in the etiology of mycotic keratitis. With the predominance of Fusarium species, unusual fungal isolates of C. dematium and Scedosporium species from corneal ulcers were observed. Early detection is essential to initiate appropriate antifungal therapy and to minimize preventable ocular complications like blindness.
P169 Systemic Pythiosis: presumably, the first human case in India
Authors: Joe Geethu , Soman Rajeev , Chakraborty Sourabh , Kothawade Hrishita , Ramchandani Nandini , Chakrabarti Arunaloke
Published: September 2022

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

 

Objectives

This is the first human case of systemic disease due to Pythium insidiosum reported from India. The case highlights difficulty in diagnosis and management.

Methods

A 44-year-old male patient had a peri-esophageal and peri-gastric inflammatory lesion which showed inflammation along with sparsely septate hyphae (Fig. 1), and partially responded to voriconazole (VCZ). After 1.5 years, he developed a massive liver lesion (Fig. 2), and hepatic venous thrombosis which was refractory despite restarting therapy with posaconazole (PCZ). As a desperate measure, surgical excision of the large liver lesion was undertaken.

Results

Serum BDG was positive and Serum Galactomannan was negative. There was no tidy explanation for the insidious clinical course of the illness over 1.5 years, partial response to VCZ for the esophageal lesion and inadequate response of the subsequent lesion to PCZ. The liver biopsy specimen showed a flat, feathery growth on SDA which was identified at PGI, Chandigarh by ITS as P. insidiosum. P. insidiosum and additionally Rhizopus microsporus were identified by molecular sequencing from the surgical specimen as well. The patient succumbed to carbapenem-resistant Klebsiella bacteremia in the postoperative stage.

Conclusion

The case underscores the insidious course of systemic pythiosis, diagnostic, and management challenges.
P171 Pneumocystis Jirovecii Pneumonia in non-HIV immunosuppressed patients: Acase series
Authors: Chakraborty Sourabh , Soman Rajeev , Joe Geethu
Published: September 2022

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

 

Objective

Increased usage of immunosuppressive medications and lack of guidance about when to initiate primary Pneumocystis Jirovecii Pneumonia (PCP) prophylaxis has led to a rising incidence of PCP in non-HIV immunosuppressed patients. The objective of this case series is to review clinical challenges in diagnosis and management of these patients.

Patients, methods, and results

This is a retrospective case series of all 6 cases which were seen at Jupiter Hospital from January 2020 to October 2021 (Table 1).

Conclusion

The presence of the above-mentioned predisposing factors should raise the suspicion of PCP. Non-invasive investigations like serum LDH, BDG, PET CT scan/HRCT scan of chest can help in the diagnosis. This can be confirmed by BAL PCR, which is both, more sensitive and specific than immunofluorescence microscopy. Trimethoprim- sulfamethoxazole (TMP- SMX), the standard treatment, cannot be used in some circumstances and alternate treatment may have to be used.

Guidance about prophylaxis, antimicrobial therapy for PCP, and adjuvant steroid therapy in non-HIV patients is unavailable, which is an unmet clinical need.
P172 First report of Aspergillus tamarii producing influenza associated invasive pulmonary Aspergillosis
Authors: Sahu Monalisa , Chakraborty Sourabh , Joe Geethu , Doshi Rahul , Soman Rajeev
Published: September 2022

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

 

Objective

Multiple infections can occur after 2009, pandemic influenza, including fungal and bacterial infections, but data from India are limited. To our knowledge, this is the first reported case of influenza-associated invasive pulmonary aspergillosis (IAPA), caused by Aspergillus tamarii, after infection with pandemic (H1N1) 2009 which was preceded by COVID-19, 20 months before.

Methods and Results

A 33-year-old male, known asthmatic, had been hospitalized elsewhere in August 2020 with COVID-19 pneumonia for 50 days and had been on mechanical ventilation for 37 days. He had no residual respiratory symptoms 3 months after recovery from COVID-19. He was admitted to Jupiter Hospital in April 2022 with fever, cough, and dyspnea for 8 days, which developed after a cold bath in a temple. HRCT (chest) showed ground glass opacities (GGOs), crazy paving, nodules, and traction bronchiectasis. Review of previous HRCT showed that only GGOs were present (Fig. 1).

At admission, the nasopharyngeal swab was positive for pandemic (H1N1) 2009 in the filmarray respiratory panel and no other pathogen was detected. He was treated with oseltamivir. Expectorated sputum examination showed a heavy load of thin septate hyphae, with acute angle branching, resembling Aspergilllus species (Fig. 2). Serum galactomannan was positive (1.8). Based on these features he was diagnosed as a case of probable IAPA and initiated posaconazole (PCZ) treatment. Sputum fungal culture was positive and was identified by MALDI TOF MS as A. tamarii. A. tamarii has been rarely encountered as a human pathogen. Case reports of its involvement in eyelid infection, keratitis, invasive sinonasal infection, and onychomycosis exist. Sensititre MICs were 0.0625 mcg/ml, 0.125 mcg/ml, 0.0625 mcg/ml, and 0.125 mcg/mL for itraconazole, voriconazole, PCZ, and for isavuconazole (ISVCZ) respectively.

The usually obtained PCZ trough level with standard dose is 1.2 mg/l which generates AUC of 200R. The usually obtained ISVC) trough level with standard dose is 3 mg/l which generates AUC of 100R. The PKPD index, AUC/MIC of 100, is needed with both these azoles for a therapeutic effectR. Therefore, it would be possible to treat this infection with any of these azoles.

PCZ was continued in view of the easy availability of therapeutic drug monitoring (TDM) to assure adequate drug exposure, lower cost, and clinical improvement which had already occurred.

Conclusion

An infection due to a rare Aspergillus species needs correct identification, MIC determination, and PKPD consideration for appropriate drug selection and management.
P182 Mucormycosis in Northwest Iranian cases with a history of delta COVID-19, a brief report
Authors: Diba Kambiz , Samarei Reza , Nejadrahim Rahim , Namaki Atefeh
Published: September 2022

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

 

Objectives

Mucoral fungi are the opportunistic organisms causing invasive or localized infections in persons with conditions such as diabetes mellitus, immune suppression, and corticosteroid therapy. During the recent surge of delta-type Coronavirus disease 2019 (COVID-19) in Iran, the rate of invasive mucormycosis considerably increased as a cluster in society. COVID-19-associated mucormycosis (CAM) immerged as a severe and life-threatening infection. The present report includes demographic, clinical and laboratory diagnostic information about newly emerged CAM in Northwest of Iran.

Methods

During three months, from August to October 2021, about 65 cases with clinical manifests suspected of mucormycosis and a history of recent severe COVID-19 and corticosteroid therapy with dexamethasone were studied. Clinical specimens obtained from sinuses and upper respiratory tract, transported to Clinical Mycology Center, UMS University, Urmia, Iran for the detection of and molecular identifications of mucoral and other agents. Our subjects were the clinical specimens including 31 nasal biopsies, 24 paranasal sinus biopsies, 2 facial and palate biopsies, skin and sutures, one each. Also, two samples of bronco-alveolar lavage were used for investigating fungi in the respiratory tract.

Results

More than 52% of the patients were men and the most frequent age range was 50-60 years. Most frequent clinical specimens were sent from ENT wards and ICUs, 22 (33.8%) and 12 (18.5%) respectively. Among all confirmed cases of CAM, 18 (27.7%) suffered from a background of diabetes but 46 (70.8%) had no underlying diseases. Our findings of direct examination showed 55 (84.6%) mucoral elements. The suspected cases of CAM showed clinical manifests including acute sinusitis, rhino-sino-cerebral 25 (38.5%), rhino-sino-orbital 7 (10.8%), and sino-facial 3 (4.6%), involvements. The culture and identification resulted in Rhizopus oryzae as the most frequent isolate (44.6%) and Candida yeasts (albicans and non-albicans Candida species) 6.2%-7.7% respectively. Aspergillus species were detected 5 (7.7%) as well. A considerable number of cultures, 20 (30.8%) could result no growth for any fungi.

Conclusion

As a conclusion, delta-type Coronavirus causing a considerable increased invasive Mucormycosis in the recorded COVID-19 cases in the north west of Iran. Although, opportunistic candida and aspergillus were identified in lower frequencies as well.
P188 An uncommon case of subcutaneous basidiobolomycosis in a young adult — a case report
Authors: Elumalai Arthi , Asir Johny , Livingstone David , George Nimmy , Nair Shashikala
Published: September 2022

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

Basidiobolomycosis is an uncommon fungal infection of the subcutaneous tissue of the lower limbs caused by Babsidiobolus ranarum. It presents as chronic granulomatous inflammation of the skin and subcutaneous tissues affecting the immunocompetent young adults.

 

We report a 23-year-old male who presented with soft tissue swelling of the left lower limb for the past 4 months. He had consulted a private hospital previously where he underwent incision and drainage and was prescribed multiple antibiotics. As there was no resolution of the symptoms, he presented to us with swelling of the thigh and 1 × 1 cm size non-healing ulcer over the posterolateral aspect at the site of incision with inflammation of the surrounding tissues. On examination, the surrounding tissues also showed induration and warmth. The routine blood investigations were normal and serology for HIV was also negative. The pus aspirate was cultured in Saborauds's Dextrose agar and incubated at 25°C showed growth of creamy, glabrous, heaped up, radially furrowed colonies after 4 days. On microscopic examination with lactophenol cotton blue preparation broad, aseptate hyphae with numerous thick-walled beaked zygospores were observed as characteristic of B. ranarum. Based on the culture results diagnosis of basidiobolomycosis was made and the patient was started on oral itraconazole. There was a marked reduction in the size of swelling and healing of the ulcer following 10 weeks of oral itraconazole therapy.

 

This report highlights the need for awareness of this disease for the correct diagnosis of this disfiguring condition which is treatable.
P205 Uncommon Aspergillus species encountered in human infections
Authors: Gupta Prakriti , Kaur Harsimran , Agnihotri Sourav , Ghosh Anup , Rudramurthy Shivaprakash M.
Published: September 2022

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

 

Objective

Aspergillus species are ubiquitously found in environment and have propensity to infect both immunocompromised as well as immunocompetent individuals. Though the most common species implicated in human illness include Aspergillus fumigatus and A. flavus, many uncommon Aspergillus species are increasingly being reported. Moreover, these Aspergillus species have the potential to afflict varied organ systems and can thereby, be implicated in a wide array of infections. Here, we describe three patients infected by rare Aspergillus species viz. A. sclerotium, A. cristatus, and A. japonicum causing brain abscess, corneal ulcer and chronic dacrocystitis.

Methods

Uncommon Aspergillus species were isolated from clinical samples (nasal scraping, corneal scraping, and brain biopsy). Samples were inoculated on Sabouraud dextrose agar (incubated at 37°C and 25°C) and brain heart infusion agar (incubated at 25°C), followed by slide culture and lactophenol cotton blue (LCB) mount. The isolates were further subjected to molecular identification using polymerase chain reaction (PCR) targeting ITS region, followed by sequencing. Demographic details, clinical characteristics, risk factor, and management profile associated with these Aspergillus species were evaluated. We conducted systematic review using the search terms ‘A. sclerotium’ AND ‘humans’, ‘A. cristatus’ AND ‘humans’ and ‘A. japonicum’ AND ‘humans’.

Results

We isolated three newer Aspergillus species from nasal scraping, corneal ulcer and brain biopsy. Direct microscopy using potassium hydroxide-calcofluor mount from all these clinical samples showed hyaline septate hyphae in background of pus cells. After 3-5 days of incubation, yellow-green mycelia were observed on the obverse in all the isolates. However, their microscopic features did not relate with the typical lactophenol cotton blue (LCB) picture of A. flavus, owing to which these were sub-cultured on Czapek Dox agar. After 4-5 days of incubation, LCB of these isolated again failed to divulge any specific picture and these isolates were subjected to molecular identification.

The systematic literature review didn't yield any results of infection caused by these species in humans.

Conclusion

This is the first report of isolation of A. sclerotium, A. japonicum, and A. cristatus from human tissue, though these fungi have been isolated from ambient air and environment. The present report highlights the emergence of uncommon Aspergillus species causing invasive infections even in immunocompetent patients and the requisite of molecular modalities to aid in identification of these rare, emerging species.
P209 First report of Mycetoma due to Madurella fahalii from India
Authors: Hallur Vinaykumar , Gahlot Pritika , Sirka Chandra Sekar , Sahu Supriya , Tudu Malati
Published: September 2022

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

 

Objective

To describe the first case report of Madurella fahalii from India.

Methods

A 70-year-old non-diabetic man from Bhadrak Odisha who worked as a soldier in past came to us with a history of pus discharge containing black grains the size of mustard seeds from multiple sinuses in the posterior aspect of the thigh for last 5 years. He had been operated 2 years back for the same complaints, however, finding no relief he visited us. On examination, a depressed lesion measuring 10 × 10 cm, containing 6-8 sinuses which discharged pinkish yellow colored pus containing black grains measuring 0.5 × 1 cm was found on the posterior aspect of the thigh. The lesion was painless, doughy in consistency, and associated with enlarged and non-matted and non-tender inguinal lymph nodes measuring 2 × 2 cms. General physical examination and routine hematological laboratory examination revealed no abnormalities. Serological tests did not reveal the presence of HIV, Hepatitis B, or Hepatitis C infection. A clinical diagnosis of black grain mycetoma was made and the patient was sent to mycology laboratory for fungal culture. Black hard grains were found on KOH mount and culture on inhibitory mold agar grew a brown colony which diffused a brown pigment into the medium after 15 days of incubation. LPCB examination showed brown non-sporulating mold. DNA was extracted using phenol-chloroform isoamyl alcohol after grinding the mycelial mat in liquid nitrogen and subjected to PCR using ITS4 and ITS5 primers as described previously. The product was subjected to sanger sequencing and subjected to blast and it showed 99.45% similarity to M. fahalii (MF980633). The patient was started on Itraconazole in lieu of voriconazole as the patient could not afford the drug. While there is no reduction in the size of the lesion the patient reported symptomatic relief and is still on follow-up.

Conclusion

To the best of our knowledge this is the first case of Mycetoma due to M. fahalii from India.
P248 Fungal meningitis in an immunocompetent individual
Authors: Ningthoujam Priyolakshmi , Khuraijam Ranjana , Konjengbam Ojita , Bhattacharjee Subhrajit
Published: September 2022

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

 

Objective

Fungal meningitis is commonly seen in individuals who are immunocompromised. It's a significant cause of morbidity and mortality in people living with HIV worldwide. Among HIV-infected patients of Manipur, it is the most common cause of meningitis and Cryptococcus neoformans is the only species identified so far both in HIV infected population and non-HIV patients in Manipur. The aim of this paper is to highlight the detection of C. gattii meningitis in the high HIV prevalence state of India.

Method

A 53-year-old male, mechanic by profession residing in a village in Thoubal district of Manipur attended Medicine OPD with complaints of intractable headache, aggravated by sound and light, generalized weakness, hiccups, vomiting, and decreased appetite for 2 weeks. There was no history of altered sensorium. He is a known case of hypertension and was recently diagnosed with T2DM, not on medication.

Results

An MRI brain (Fig.1) showed a tiny sub-centric lesion in the bilateral centrum semiovale. Cerebrospinal fluid examination by India Ink preparation revealed capsulated budding yeast cells suggestive of Cryptococcus sps. Cryptococcal antigen testing (CryptoPS, Biosynex) was positive with a high titer. Culture on SDA and BSA showed growth of Cryptococcus sps. For phenotypic identification and antifungal susceptibility testing, the isolate was processed in VITEK 2(Biomerieux) system which identified it as C. gatti (94% probability). The isolate was sensitive to amphotericin B (mic: 0.5 μg/ml) and flucytosine (mic: 2 μg/ml). He tested negative for HIV on two occasions and his CD4 + count was 888 cell/mm3. Blood sugar was 225 mg/dl, with urine glucose leakage in traces. Blood and urine were collected for fungal culture which showed no growth. The patient was put on liposomal amphotericin B 200 mg daily. After 1 week, patient's condition was not deteriorating, although the improvement was minimal. The isolate was sent to the National Culture Collection of Pathogenic Fungi, PGIMER, Chandigarh, and it was confirmed as Cryptococcus gattii by MALDI-TOF assay.

Conclusion

Detection of C. gattii in an immunocompetent patient in Manipur state, with a high prevalence of HIV is alarming because cryptococcal meningitis is the commonest form of meningitis in this population. In future, whenever Cryptococcus sps is isolated, it will be pertinent to keep in mind the possibility of other species of Cryptococcus to be the causative pathogen. We emphasize the importance and need for surveillance to detect its environmental niche.
P289 A teenage with Pythium keratitis—a case report
Authors: Welagedara PGRIS , Sigera Liyanage Shamithra Madhumali , De Silva SC , Dayawansa KR , PI PI Jayasekara
Published: September 2022

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

 

Introduction

Pythium is an oomycete found in an aquatic environment and is considered to be a plant pathogen. However, it is able to cause ocular and systemic infections in humans and animals. Keratitis or corneal ulceration caused by Pythium species closely resembles fungal keratitis and is known as a pseudo-fungal infection. It is associated with high ocular morbidity owing to the difficulty in diagnosis and treatment.

Case Report

A 13-year-old adolescent from rural Sri Lanka presented with pain and tearing from left eye for 3 weeks’ duration. He was previously healthy and had no history of trauma to the eye. He had bathed in a lake recently. On examination, visual acuity was only perception of light and there was a corneal ulcer in the left eye. Since the ulcer had a poor response to medical therapy, penetrating keratoplasty was performed twice with failure of the graft.

Direct smear of both corneal buttons revealed broad aseptate filaments with occasional branches at right angles that mimic fungi of zygomycetes. Culture on Sabouraud Dextrose Agar yielded expanding white submerged colonies. In the tease mount, hyaline, occasionally septate broad fungal filaments were visible. Therefore, the organism was identified as Pythium species in the Mycology Reference Laboratory.

Repeated intracameral and intrastromal antifungal and topical and systemic antibiotic treatment resulted in a quiet, vascularized eye with the retained perception of light.

Discussion

Pythium keratitis carries a significant challenge in laboratory diagnosis due to its mycelial-like appearance. Nested PCR has higher accuracy than standard culture identification. Not being a true fungus, Pythium lacks ergosterol. Therefore, it is usually resistant to many commonly used antifungal agents which target ergosterol. High degree of suspicion is important for accurate identification in the laboratory and the clinicians should be informed for early, aggressive surgical intervention along with antimicrobial therapy in order to achieve a satisfactory outcome.
P305 Cirrhosis and fungal infections-a cocktail for catastrophe: a systematic review and meta-analysis with machine learning
Authors: Verma Nipun , Singh Shreya , Roy Akash , Valsan Arun , Garg Pratibha , Pradhan Pranita , Chakrabarti Arunaloke , Singh Meenu
Published: September 2022

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

 

Objectives

We evaluated the magnitude and factors contributing to poor outcomes among cirrhosis patients with fungal infections (FIs).

Methods

We searched PubMed, Embase, Ovid, and WOS and included articles reporting mortality in cirrhosis with FIs. We pooled the point and relative-risk (RR) estimates of mortality on random-effects meta-analysis and explored their heterogeneity (I2) on subgroups, meta-regression, and machine learning (ML). We assessed the study quality through New-Castle-Ottawa-Scale and estimate-asymmetry through Eggers regression (CRD42019142782).

Results

Of 4345, 34 studies (2134 patients) were included (good/fair/poor quality: 12/21/1). Pooled mortality of FIs was 64.1% (95%CI: 55.4-72.0, 12: 87%, P <.01), which was 2.1 times higher than controls (95%CI: 1.8-2.5, 12:89%, P <.01). Higher CTP (MD: +0.52, 95%CI: 0.27-0.77), MELD (MD: +2.75, 95% CI: 1.21-4.28), organ failures, and increased hospital stay (30 vs. 19 days) was reported among cases with FIs. Patients with ACLF (76.6%, RR: 2.3), and ICU-admission (70.4%, RR: 1.6) had the highest mortality. The risk was maximum for pulmonary-FIs (79.4%, RR: 1.8), followed by peritoneal-FIs (68.3%, RR: 1.7) and fungemia (55%, RR: 1.7). The mortality was higher in FIs than bacterial (RR: 1.7) or no-infections (RR: 2.9). Estimate-asymmetry was evident (P <.05). Up to 8 clusters and 5 outlier studies were identified on ML, and the estimate-heterogeneity was eliminated on excluding such studies.

Conclusions

A substantially worse prognosis, poorer than bacterial infections in cirrhosis patients with FIs indicates an unmet need for improving fungal diagnostics and therapeutics in this population. ACLF and ICU admission should be included in host criteria for defining IFIs.