bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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 &lt;.01), which was 2.1 times higher than controls (95%CI: 1.8-2.5, 12:89%, P &lt;.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 &lt;.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.
P307 Clinical profile of fusarium infections: case series from a tertiary care hospital
Authors: Vineeth VK , Sethuraman Nandini , Gopalakrishnan Ram 
Published: September 2022

Abstract

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

Objective
To study the clinical profile of patients with Fusarium infections diagnosed at our tertiary care center during the study period from February 2017 to March 2022.

Methods
We conducted a retrospective case study wherein all consecutive patients with Fusarium infections between February 2017 to March 2022 were accessed. The diagnosis was categorized based on either fungal culture alone or fungal culture with histopathology findings.

Results
A total of 12 patients with Fusarium infections were encountered during this period. The mean age was 49. In all, 5 were females and 7 were males, and 5 patients had diabetes as a risk factor. Other risk factors included were chemotherapy for multiple myeloma (1) and lymphoma (1), polytrauma (1), and surgery after pituitary macroadenoma. A total of 8 (66.7%) patients were on antifungal prophylaxis at the time of diagnosis.
A total of 6 (50%) had localized infections whereas, remainder 6 (50%) had disseminated infection, and 25% presented with onychomycosis. Seven patients were diagnosed based on fungal culture and five were diagnosed based on histopathology findings collaborated with a fungal culture. There was one patient with Fusarium blood stream infection, who expired within 2 weeks of hospitalization.
A total of 10 patients had F. solani whereas, 2 had F. oxysporum isolated in fungal cultures. In all, 42% of patients in the study had high Beta- D-Glucan (BDG) and 67% of the patients underwent source control of the involved region. A total of 9 patients (75%) received voriconazole as antifungal treatment and 3 patients received Amphotericin B. Four patients expired, three were lost to follow up and five did not develop relapse on follow-up.

Conclusion
Fusarium is an opportunistic human pathogen severely affecting immunocompromised patients, especially patients with hematological malignancies, prolonged neutropenia, and post-hematopoietic stem cell transplantation. Our study records a notable number of Fusarium infections among diabetics and onychomycosis was a common presentation. A high index of suspicion is of utmost importance in patients with risk factors and serum BDG may help in suspicion of invasive Fusarium infections. The 33% mortality in our study stresses the need for early diagnosis and treatment.
P313 A retrospective analysis of COVID-19 - associated Mucormycosis in a tertiary care center in Northern India
Authors: Yadav Sukriti , Bora Ishani , Mohi Gursimran Kaur , Shivaprakash M R , Singh Mini P , Ratho R K , Muralidharan Manjul 
Published: September 2022

Abstract

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

Objectives

Methods
This is a retrospective observational study with (n = 433) samples. Nasopharyngeal and oropharyngeal swabs were collected from clinically suspected cases of mucormycosis. These were then subjected to Xpert® Xpress SARS-CoV-2 test. Those samples which tested positive were included in this study. A history sheet form was designed and filled up for 238 patients who were admitted and could be traced properly.

Results
Total number of SARS CoV-2 positive samples was 296 out of 433 samples. Among the tested 66% (287/433) were male and 34% (146/433) were female. Relative positivity was higher among women 74% (107/144) than men 66% (189/285). Amongst 238 admitted patients, 83.1% patients (198/238) completed treatment and were discharged while 13.9% (33/238) succumbed during management. Diabetes was found to be most common risk factor at 88.65% (211/238) followed by hypertension 36.5% (87/238), and corticosteroid use 26.89% (64/238). Type 2 DM was the most frequent with 96% (203/211) and only 4% (8/211) patients having Type 1 DM. Amongst the diabetics, 74.8% (158/211) were on medication (oral hypoglycemic agent/insulin/both), and 16.6% (35/158) of them were non-compliant to treatment. Most common clinical presentation was facial swelling 66.8% (159/238) followed by facial pain 52.52% (125/238) and headache 34.45% (82/238). Microscopy findings either nasal or palatal scraping was positive in 69.75% (166/238) cases with aseptate hyphae in 95% (157/166) patients while septate hyphae were seen in 3% (5/166). Both aseptate and septate hyphae were present in 2% (4/166 patients).
Amongst the deceased patients 91% (30/33) had diabetes mellitus exclusively of Type 2 and among them, 33% (10/30) were not on any anti-diabetic medication. It was also observed that among the deceased people who were on anti-diabetic medication, 45% (9/20) were non-compliant to the treatment. Combinedly 63.33% (19/30) diabetics were on inadequate blood sugar level control which might be strongly contributing to mortality.

Conclusion
Percentage of clinically suspected mucor patients who were COVID-19 positive was 67%. Although male patients were twice more tested than females but females were proportionately more positive for SARS-CoV2. Type 2 diabetes mellitus was the lead risk factor, with facial swelling being the predominant presentation. Interestingly, fungal smear was positive in 166 out of 238 patients. Despite the best management, the mortality rate was 13.86% in such patients. It was also seen that untreated or non-compliance to anti-diabetic treatment resulted in increased mortality. Hence, it's necessary to review cases of COVID-19-associated mucormycosis for prompt management and to reduce morbidities and mortality.
P377 Study of the prevalence of candidemia and its antifungal susceptibility pattern in a tertiary care hospital
Authors: Sharma Alisha , Patel Ankita , Mahajan Pooja , Bahal Ashish , Ninawe Sandeep , Bhatt Puneet , Grover Naveen 
Published: September 2022

Abstract

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

Objectives
Study of the prevalence of candidemia and its resistance pattern in a tertiary care hospital.

Methods

Results

Conclusion
Candida spp. are a part of the normal flora of healthy hosts but are also found to be a major cause of invasive fungal infections which is now found to be one of the leading causes of mortality in hospitalized patients. The emergence of unusual and relatively unknown Candida species as nosocomial pathogens with increasing treatment failure, emphasizes the need to isolate and identify all species and to start early definitive treatment according to the susceptibility pattern reported to decrease mortality and morbidity rates.