bluuebunny/crossref_metadata_2025_split huggingface dataset:
P177 A Psittacine bite and subcutaneous Zygomycosis in immune competent: Case with therapeutic challenge
Authors: Choubey Shivani , Karuna Tadepalli , Asati Dinesh P. , Khadanga Sagar , Garg Rahul 
Published: September 2022

Abstract

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

Objectives
Primary objective: To document a case of subcutaneous zygomycosis following a Psittacine bite in an immune-competent in India.
Secondary objective: To follow-up the case till microbiological and clinical cure.

Method
A case report entry prospectively carried out during 1.5 years of hospital visit of the patient with subcutaneous zygomycosis. This had ethical approval and patient consent obtained. A detailed account of case progression from date of first hospital admission to final cure was noted. A 56-year-old female from Vidisha in Madhya Pradesh India, apparently well 2 years back following a wild parrot bite on her back, causing an initial ulcer on infrascapular area gradually spreading bilaterally visited outpatient department of AIIMS, Bhopal. With prominent weight loss and non-healing ulcer; asymptomatic initially, ruptured spontaneously formed sinuses with exudate. Nodules and spontaneous rupture of nodule were mentioned. Provisional clinical differential diagnoses were nocardiosis, deep fungal infection, and Phagedenic ulcer. Tissue biopsy sent for microbiological and histopathological evaluation showed broad pauciseptate hyphae with right angle branching and bulging on direct microscopy suggesting subcutaneous zygomycosis. Histopathology H&E, and PAS showed similar morphology. A second sample sent was exudate from infrascapular region and showed broad pauciseptate hyphae with buildings on KOH mount. The patient was treated and discharged with some relief. Noncompliance to prescribed antifungal led to progression and horizontal spread forming plaque within months. A saturated solution of potassium iodide (SSKI) and itraconazole started. Lesions improved. The patient was again non-compliant and the lesions increased in size. The patient was reviewed again for the exacerbation and worsening. Around Day 10; SDA with chloramphenicol showed whitish growth with satellite colonies and LPCB showed broad quasi-septate hyaline hyphae, sporangia elongated, and beak with rounded zygospores suggesting Basidiobolus species. The patient received itraconazole, SSKI, and terbinafine. Species confirmation as Basidiobolus ranarum from PGIMER Chandigarh Mycology Reference center India was done.

Results
After 1.5 years, clinical improvement and final biopsy showed no growth and microscopy negative. The patient is on regular follow-up.

Conclusion
This study highlights the traumatic implantation and zoonotic potential of fungal species. Clinical suspicion of fungal etiology and timely mycology laboratory diagnostic support is key to address such cases.
P195 Factors related to outcome of bloodstream infections due to Candida parapsilosis complex: A single center observation study from Central India
Authors: Garg Rahul , Das Padma , Wankhade Archana B. , Agarwala Pragya , Behera Sibani 
Published: September 2022

Abstract

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

Objectives
Candida parapsilosis infection has recently emerged as an important antifungal-resistant nosocomial pathogen having the unique ability to grow on inanimate objects and surfaces. Very limited studies from low and middle-income countries are available on the association of risk factors and antifungal susceptibility testing (AFST) of this species. The aim of this study was to analyze the predisposing conditions, outcome, and antifungal susceptibility pattern of candidemia due to C. parapsilsosis complex.

Methods
A single-center retrospective observational study from January 2019 to December 2021 of all cases of candidemia was carried out at an 890-bedded University Hospital in central India. Data regarding demographic characteristics and clinical risk factors were collected from the patient's medical records. Antifungal susceptibility testing was performed; MIC results were interpreted according to CLSI breakpoints (M27-A3). Risk factors and outcome association at the species level were analyzed by using Fisher's exact test. Variables with a P ≤ .05 at the descriptive analysis were analyzed by Cox regression. A P-value of ≤ .05 was considered to represent the statistical significance and all statistical tests were two-tailed.

Results
Of 211 patients diagnosed with Candidemia during the study period, 53 (25.1%) were infected with C. parapsilosis which represented the second most frequently isolated yeast after C. albicans (n = 98; 46.4%). A total of 26 (49%) C. parapsilosis isolates were non-susceptible to fluconazole (NSF), which included resistant (n  =  20) and susceptible dose-dependent (n  =  06) isolates. The median patient age was 63 years.15.3% were neonates. The majority of patients (90%) suffered from multiple comorbidities, diabetes mellitus (43%) being the commonest. A total of 55% of patients underwent surgical intervention within 30 days from the onset of candidemia. Univariate logistic regression revealed that ICU admission [odds ratio (OR) 2.45], central venous catheter use (OR 2.46), renal impairment (OR 1.687) were more common among NSF isolates than fluconazole-susceptible (FS) isolates (all P &lt;.05). The overall crude mortality at 30 days was 36%; higher in patients infected with FNS isolates than FS isolates.

Conclusion
There is an increase in the absolute number of invasive infections by C.parapsilosis observed over the past 2 years. At this moment, the percentage of fluconazole non-susceptible C. parapsilosis is very high and poses a threat to infected patients and has a clinical impact in our hospital. Being able to identify and treat infections caused by this pathogen is important to prevent clinical outbreaks.
P212 Fatal invasive aspergillosis in a child with Chronic Granulomatous disease; a case report
Authors: Ahmadi Bahram , Sarvestani Hasti Kamali , Ansari Saham 
Published: September 2022

Abstract

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

In this article, we have reported a case of invasive aspergillosis in an 8-year-old boy with chronic granulomatous disease, who presented with pleural effusion and pneumonia, cerebral venous sinus thrombosis, and unusual skin lesions (Fig. 1) caused by Aspergillus fumigatus (Fig. 2). The patient received recombinant human interferon-γ subcutaneously (1-2 doses in even days) and antimicrobial prophylaxis, including itraconazole (100 mg/d), cotrimoxazole (5 mg trimethoprim/kg body weight/d), and ofloxacin (3 times a week, 200 mg), during hospitalization.
It is noteworthy that treatment was immediately started according to the direct examination results. Due to the MRI findings suggestive of brain abscesses and brain edema, empirical amphotericin and voriconazole were started. The in vitro antifungal susceptibility tests (AFST) of A. fumigatus utilized the microbroth dilution method of the Clinical and Laboratory Standards Institute (CLSI) M38-A2 protocol for five antifungal agents including; voriconazole, itraconazole, fluconazole, caspofungin, and amphotericin B, that the minimum inhibitory concentrations (MIC) of antifungal agents were 0.25, 1, 16, 0.125, and 4 mg/L, respectively. Voriconazole and caspofungin were shown to be the most potent antifungal drugs against this A. fumigatus strain. On the other hand, the IDSA protocols recommend voriconazole as the initial therapy of invasive aspergillosis in most patients. So, in response to the results of antifungal susceptibility testing, treatment was switched to voriconazole at the dose of 100 mg twice a day (taken every 12 h), and interferon-γ subcutaneously (1-3 doses in even days) was introduced. Unfortunately, the patient passed away due to cerebral venous sinus thrombosis (CVST), and intracerebral hemorrhage (ICH) following increased intracranial pressure (ICP) after 1 month.
In conclusion, we have reported a case in which a patient who came with pleural effusion and pneumonia in the chest x-ray, CVST, and unusual skin lesion caused by A. fumigatus expired after one month. Our report suggests the importance of early diagnosis in children presenting with invasive fungal infections particularly, those involving the central nervous system.
P219 Fungal keratitis caused by Pseudallescheria boydii: Clinical and mycological characteristics
Authors: Khodavaisy Sadegh , Izadi Alireza , Soleimani Mohammad , Santos Claudy Oliveira dos , Tehupeiory-Kooreman Marlou C. , Mousavi Seyed Amin Ayatollai , Ghazvini Roshanak Daie , Hashemi Seyed Jamal , Aminizadeh Mehdi , Abedinifar Zohre , Verweij Paul E. 
Published: September 2022

Abstract

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

Objectives
Pseudallescheria boydii keratitis is rare but important type of fungal keratitis because of the inherently resistance of the organism to many existing antifungal agents. We present the clinical characteristics, risk factors, treatment, and prognosis of patients with P. boydii keratitis, and also present the antifungal sensitivities of the isolated strain.

Methods
Slit-lamp and confocal microscopy were used for clinical examinations. Fungal isolates were identified based on morphological characteristics and DNA sequence of the internal transcribed spacer region (ITS). In vitro antifungal susceptibility testing for fungal isolates was performed according to the Clinical and Laboratory Standards Institute (CLSI).

Results
Pseudallescheria boydii was identified in four patients. All patients had a history of ocular trauma. In clinical examination hypopyon was seen in three patients. The main antifungal medications were oral and topical voriconazole. After treatment the visual activity of all patients improved in 2-3 weeks.

Conclusion
These patients bold the importance of determining causative organism of fungal keratitis and their antibiotic susceptibility. Culture findings are limited in identifying organisms. Sequencing of polymerase chain reaction-amplified DNA is good for accurate and rapid identification of species that can be helpful for optimizing treatment.
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

Abstract

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

Abstract

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

Abstract

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 &lt;.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

Abstract

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

Abstract

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 &gt;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.