bluuebunny/crossref_metadata_2025_split huggingface dataset:
P102 Nuclear magnetic resonance -based identification of metabolites in dermatophytes
Authors: Das Anupam , Baishya Bikash , Ahirwar Suresh Chandra , Singh Vikramjeet , Sen Manodeep , Mittal Vineeta , Agarwal Jyotsna 
Published: September 2022

Abstract

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

Objectives
Nuclear magnetic resonance (NMR) spectroscopy provides a holistic snapshot of the metabolome of an organism. There is a dearth of studies till date that had exploited NMR metabolomic platform to study dermatophytes, despite its potential for rapid identification and subsequent application of the knowledge in performing faster antifungal susceptibility of dermatophytes. Here we attempted to study the frequency of various species of dermatophytes in clinically suspected cases of dermatophytosis and perform NMR-based identification of metabolites in the culture suspensions/cell extracts of T. mentagrophyte and T. rubrum.

Methods
This was a hospital-based prospective study conducted in the isolates obtained from clinically suspected cases of Dermatophytosis in the patients. Skin, nails, and hair samples of patients suspected with superficial fungal infections were processed for dermatophytes using conventional microbiological methods. NMR-based identification of metabolites was carried out in cell extracts prepared from the culture suspensions of T. mentagrophytes and T. rubrum obtained during the study from a subset of the clinical isolates from the samples.

Results
Dermatophytes were isolated in 85.88% (219/255) cases, with T. mentagrophyte being isolated in 65% (143/219) of isolates, followed by T. rubrum in 31.5% (69/219) isolates. In NMR study was done in the standard ATCC strains (T. mentagrophyte ATCC9533 and T. rubrum ATCC28188) and representative clinical isolates of both the species. Overall, 24 metabolites were identified in T. rubrum and 23 metabolites in T. mentagrophyte amongst which 22 metabolites were common to both fungus, however, ‘4-hydroxyproline’ and ‘acetate’ was found specific to T. rubrum, and ‘allantoin’ was found specific to T. mentagrophyte.

Conclusion
T. mentagrophyte was the predmominant dermatophyte species in the study. Amongst the number of metabolites detected in T. rubrum and T. mentagrophyte, ‘4-hydroxyproline’ and ‘acetate’ was found specific to T. rubrum, and ‘allantoin’ was found specific to T. mentagrophyte. These specific metabolites could be useful for as early identification of these dermatophytes as well early determination of antifungal susceptibility by using metabolic endpoints, further large-scale study will be helpful in this regard.
P106 A dermoscopic finding of Tinea capitis caused by Microsporum canis
Authors: Jeong Eunhye , Yim Jeongeun , Kwon Hyeongmok , Shin Donghoon , Choi Jongsoo 
Published: September 2022

Abstract

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

Objectives
Tinea capitis is a relatively common disease, and the mycological examination is the gold standard for diagnosis. However, the probability of false negative on the KOH test is up to 40% and culture examination takes a long time for diagnosis. The characteristic pattern of dermoscopy not only aids in diagnosis, but also enables early treatment.

Methods
We evaluated six patients who were diagnosed with tinea capitis through clinical and dermoscopic findings. The images of the lesions were taken with a digital camera (Nikon, HB-42) and photographed with dermoscopy (Dermlite Foto 2 Pro) from the patients. The pictures were obtained by taking multiple focal points with dermoscopy. The comma, corkscrew, Morsecode-like, zig-zag, and bent hairs were observed as the main findings.

Results
The dermoscopic finding was seen with overlapping of various findings in each of the patients. Upon dermoscopy, the most common findings were the corkscrew hair (66%) and the bent hair (66%). The comma hair (33%) and the proximal white shaft hair (33%) were less frequently observed and zigzag hair and Morse-code like hair were not seen in six patients. In the photograph taken with a camera, findings considered to be dermoscopic features such as corkscrew hair or comma hair were not observed.

Conclusion
It is important for dermatologists to consider that abnormal findings in dermoscopy can play an important role in diagnosing Tinea capitis. And it will help in early treatment and prevent the progression of complications. Here in, we report specific dermoscopic findings which can narrow down the differential diagnosis.
P137 Remote inoculation mycosis: Rip Van Winkle wakes up
Authors: Soman Rajeev , Chakraborty Sourabh , Jeloka Tarun , Joe Geethu , Ramchandani Nandini , Kaur Harsimran 
Published: September 2022

Abstract

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

Objective
After immunosuppression, a remotely inoculated organism may be activated to produce clinical disease. We describe such a case with infection due to Medicopsis romeroi, a rare mold.

Patient and Methods
A 54-year-old male, diabetic, hypertensive, status post-live related donor renal transplantation, done in February 2021. The patient was on standard triple immunosuppressant regimen. He developed a painless nodule on his thumb over 5 months which did not respond to multiple courses of antibiotics. The swelling was excised and sent for various tests. Review of USG after infectious disease referral, showed a small foreign body, like a wooden splinter in the wall of the lesion (Fig. 1). On inquiry, a 3 mm wooden splinter in the lesion was noted during surgery and there was an injury at the same site, 20 years ago when the patient used to work on a farm. Organisms derived from soil or thorn injury including bacterial and fungal organisms were considered in the differential diagnosis. Bacterial organisms were considered less likely as there was no response to antibiotics.

Results
Histopathology showed brownish septate hyphae with constrictions at the areas of septations (Fig. 2). The excised tissue grew a dematiaceous mold. In Lactophenol Cotton Blue (LPCB) mount branched, septate hyphae with sparse conidia were seen. MALDI- TOF MS was unable to identify the mold. Sequencing identified it as M. romeroi. There are no ECOFFs or break points (BP) available for M. romeroi. Minimum inhibitory concentration (MIC) of Voriconazole (VCZ) is reportedly low and hence was chosen for treatment with an appropriate dose adjustment of Tacrolimus.

Conclusion
This case underscores that remote inoculation, when the patient was immunocompetent, could have introduced a mold, which remained latent and reactivated after immunosuppression. Sending excised tissue for appropriate tests is rewarding. Medicopsis romeroi is a rare mold with only 12 cases reported so far. It is difficult to identify except with sequencing. There is no standard guidance on treatment. Surgical excision along with prolonged treatment with one of the new azoles is beneficial.
P148 Emerging and cryptic Aspergillus species isolated from hospitalized patients with underlying primary immunodeficiencies
Authors: Aneke Chioma , Youn Jung-Ho , Khil Pavel , Seyedmousavi Phd Amir 
Published: September 2022

Abstract

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

Objectives
Although Aspergillus fumigatus is the most common etiologic agent of invasive aspergillosis multiple poorly recognized non-fumigatus species have been reported from patients with iatrogenic immunosuppression and individuals with underlying primary immunodeficiencies (PIDs). The species-level identification of causative agents and the determination of antifungal susceptibility patterns can play significant roles in the outcome of aspergillosis. In the current study we aimed to investigate the frequency of non-fumigatus Aspergillus species isolated from hospitalized patients with PIDs at National Institutes of Health (NIH) Clinical Center Bethesda MD USA.

Methods
In a prospective study between January 2019 and December 2021 a total of 279 Aspergillus species were isolated from NIH hospitalized patients with underlying PIDs. The species-level identification of each isolate was attempted by colony morphology microscopic characteristics matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF) and PCR-sequencing of the internal transcribed spacer (ITS) region of ribosomal DNA the β-tubulin and Calmodulin (CaM) genes.

Results
Overall members of Aspergillus section Fumigati were the most common group (71%) followed by section Veriscolores (7%) section Usti (4%) section Tanneri (4%) section Terrei (3%) section Nigri (3%) and section Nidulantes (3%). Aspergillus species belong to sections Falvi Clavati Flavipedes and Circumdati were less frequent and each counted for only 1% of the total isolates identified.
Notably cryptic and non-fumigatus members of section Fumigati comprised only 12% of the isolates including A. felis A. udagawae A. lentulus A. thermomutatus A. viridinutans, and A. pseudoviridinutans while A. fumigatus was the dominant species (88%).
MALDI-TOF assay was able to properly differentiate sections of Aspergillus from each other. However PCR-sequencing of the β-tubulin gene was the most reliable target to separate the cryptic species of each section.

Conclusion
Our study shows that frequency of rare and cryptic Aspergillus species that primarily affect patients with PIDs may significantly differ from those with acquired immunodeficiencies.
Due to their lower susceptibility to available antifungal agents than A. fumigatus correct and prompt identification at the species level is critical for appropriate therapy to improve patient outcomes.
In addition DNA sequence-based species identification targeting β-tubulin gene is more accurate than ITS and CaM genes and using MALDI-TOF to differentiate the emerging and cryptic Aspergillus species.
P150 Profile of Candidemia in a national level HAI Surveillance Network of India
Authors: Srivastav Sharad , Puraswani Mamta , Tewari Prachi , Mathur Purva 
Published: September 2022

Abstract

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

Background
Candida is responsible for roughly 96% of all opportunistic mycoses and is a major cause of bloodstream infections (BSIs). The potential for nosocomial spread of Candidemia infections is a new concern concurrent with the rapid expansion of intensive care facilities for COVID-19 patients. With the pandemic of COVID-19 now moving into 2022, it is understood that critically ill COVID-infected patients in the ICUs are commonly infected with highly resistant bacterial and fungal infections.

Objective
To estimate the incidence rates and compare the epidemiology of candidemia in COVID infected and non-infected patients requiring ICU care.

Methodology
In this 2-year retrospective multicentric study, we present the findings on candidemia from the Healthcare-Associated Infections (HAI) surveillance network which includes 40 hospitals across India and with special emphasis on differences in the epidemiology of Candidemia in COVID infected and non-infected patients in the pre-COVID (April 2019 to April 2020) and COVID times (April 2020 to April 2021) across this network. We compared the incidence of candidemia between COVID infected and non-infected patients using Poisson regression analysis. Chi-squared (χ2) test was used to test for differences in variables such as gender and 14-day mortality between the patients and Wilcoxon rank-sum (Mann-Whitney) test was used to compare median between the patients.

Results
A total of 628 patients with candidemia were screened from HAI Surveillance Database where 68 patients are COVID infected and 560 non-infected patients from both pre-COVID and COVID periods. Incidence of Candida-associated BSI increased significantly from 1.47 (95% CI, 1.35-1.60) to 3.08 (95% CI, 2.38-3.92) in non-infected and COVID-infected patients respectively, while in CLABSI the rates increased from 2.62 (95% CI, 2.34-2.92) in non-infected to 5.99 (95% CI, 4.30-8.12) in COVID-infected patients. COVID infected patients in the age group (&gt;60 years) were significantly more prone to candidemia compared to non-infected patients. During the COVID period, the maximum time for candidemia to develop (from the time of ICU admission) in COVID-infected patients was shorter (&lt;65 days) than in non-infected patients (&gt;90 days).

Conclusion
We observed an increased incidence of candidemia in hospitalized patients during the COVID period compared with the same during the pre-COVID period.
P155 A Mexican case series of COVID-19 - associated pulmonary aspergillosis
Authors: Perales-Martinez Diana , Ruiz-Quiñones Jesus , de Jesús Barrientos-Flores Corazón , Aguilar-zapata Daniel 
Published: September 2022

Abstract

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM
The pandemic coronavirus disease 2019 (COVID-19) has been in the scope for invasive pulmonary aspergillosis (IPA) after the first reports worldwide, now known as CAPA.

Objective
to describe a case series of CAPA documented in four intensive care units while treating patients with severe COVID-19 pneumonia in order to describe clinical characteristics, cultures result and MICs from Aspergillus isolations, and treatments.

Methods
A prospective and descriptive study was performed from March 2020 to February 2022 in four tertiary level hospitals that treated COVID-19 patients in Mexico. We followed every single culture coming from the COVID-19 ICU, Aspergillus positive cultures had morphologic identification, and the MICs were obtained by broth microdilution. We did not interfere in the treatment.

Results
During 24 months of follow-up of patients with severe COVID-19 we found 17 adult cases with a mold identification, from those, 14 patients fit in the possible CAPA definition according to ECMM/ISHAM, and the remaining 3 were treated after expert opinion. The baseline characteristics of overall 47% had diabetes, and 41% were obese. Of the 14 cases included as a possible CAPA all of them had acute severe respiratory syndrome (average PaO2/FiO2 134 mmHg), 64% were in prone position, 78% had steroids at ICU admission, 92% had antibiotics at ICU. The computed tomography pattern predominantly associated were pulmonary infiltrates, nodules and cavitation. Only 2 patients (14%) had a positive galactomannan (&gt;4.5) from non-bronchoscopic lavage. We had 9 Aspergillus fumigatus isolations and 4 A. niger, 1 A. flavus, 6 patients received voriconazole, 3 patients received isavuconazole, 1 anidulafungin and liposomal amphotericin B were used in 1 patient each respectively. The predominant MIC from isolations were ≥64 μg/ml for fluconazole, and &lt;0.5 μg/ml for voriconazole, also all of them had MIC equal or &lt;0.75 μg/ml for isavuconazole and 0.015 μg/ml for anidulafungin. A total of 50% of the patients had a CAPA-related death.

Conclusions
CAPA is still a difficult entity to think of for diagnosis and treatment in severely ill COVID-19 patients. What predominates like other series were obesity, use of steroids, and ARDS. The contribution of small Mexican series like ours (based on the new guidelines) will allow to understand that CAPA could be no longer a rare fungal infectious disease complication in severely ill COVID-19 patients. An extended consensus must be made for those possible CAPA definition cases.
P158 Epidemiology of aspergillosis in Kuwait: a nationwide study
Authors: Alobaid Khaled , Asadzadeh Mohammad 
Published: September 2022

Abstract

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

Objectives
Aspergillus is the most common filamentous fungi involved in human infections. It is characterized by causing various forms of clinical presentations, ie, invasive, chronic, and allergic forms. It is associated with considerable morbidity and mortality. In spite of this, the epidemiology of Aspergillus infections is scarce in Kuwait. This study aims to describe the epidemiology of aspergillosis in Kuwait on a national scale.

Methods
This is a 2-year retrospective observational study designed to analyze the demographic and mycological data on all Aspergillus isolates derived from clinical samples processed or submitted to the Mycology reference laboratory (MRL) by all government microbiology laboratories in Kuwait. Using the Mycology reference laboratory surveillance system, the required data was collected. It covers patients’ age, gender, type of clinical samples, care settings (outpatient, wards, or ICU), the name of the Aspergillus species, and antifungal susceptibility for Aspergillus fumigatus. Species-level identification of Aspergillus was mostly based on morphological characteristics, except in a few cases where MALDI-TOF or PCR-sequencing of rDNA were performed. Antifungal susceptibility testing was done using Etest method according to manufacturer instructions. EUCAST clinical breakpoints were followed for the interpretation of antifungal susceptibility results for A. fumigatus species.

Results
In total, 327 Aspergillus isolates from 277 patients were found. A total of 34/277 patients had 2 or more samples yielding either the same Aspergillus spp. (n = 17) or a different species (n = 17). The most prevalent type of clinical specimens was respiratory sample (n = 196, 60%), followed by ear swabs (n = 64, 19.6%), and nails (n = 24, 7.3%). A. niger (n = 147) was the most isolated species, involving 45% of aspergillosis cases followed by four other species including A. fumigatus (n = 64), A. flavus (n = 55), A. terreus (n = 38), and A. nidulans (n = 13). A total of 10 cases were caused by rare Aspergillus spp. All A. fumigatus isolates were susceptible to voriconazole. Itraconazole also exhibited excellent in vitro activity against nearly all A. fumigatus except 4 isolates that were resistant.

Conclusions
This study reveals the epidemiology of aspergillosis from several perspectives. It gives some insights on the burden of Aspergillosis in Kuwait, especially during the COVID-19 pandemic. Respiratory samples were the predominant positive samples suggesting high rates of pulmonary aspergillosis. A. niger, not A. fumigatus or A. flavus, is the most prevalent agent of aspergillosis in Kuwait. Azole resistance is rare among A. fumigatus. Further studies are needed to explore the spectrum of clinical presentations with special emphasis on pulmonary aspergillosis.
P166 Traumatic implantation keratitis with Schizophyllum commune in Central India
Authors: Bhadade Arati , Tadepalli Karuna , Maurya Anand Kumar , Sharma Bhavana 
Published: September 2022

Abstract

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

Objectives
Documentation and dissemination of findings of difficult-to-treat fungal isolate in cases of Keratitis.

Methods
Both the cases received in 2019 and 2021 were followed and consent from the patient was obtained for documentation.
Case 1: A 30-year-old farmer from Raisen, Madhya Pradesh was admitted to AIIMS, Bhopal on December 16, 2019. He presented with eye ache, watering of eyes, and diminution of vision for 15 days. On day0 (D0) December 2, 2019 trauma to the eye by husk, diminution of vision and other symptoms and consulted nearby hospital, and started medication on D06. With symptoms worsening on D14 he was admitted to AIIMS Bhopal. Same day corneal scrapping on KOH mount showed branched septate hyaline hyphae. Culture showed on D20 whitish wooly growth with central pale to pinkish growth. On LBCB mount hyaline septate hyphae with no sporulation and clamp connections observed. Based on whitish growth with raised fanning hairy structures and on microscopy some spicules tear drop like structures and resemblance as clamp connections no other sporulation provisional diagnosis of Schizophyllum species was given. Patient's condition worsened with no response to azoles and therapeutic keratoplasty was done.
Case 2: A 56-year-old female sufffered trauma with a leaf. Around D10 was admitted in ophthalmology department of AIIMS, Bhopal with left corneal ulcer and hypopyon. Corneal scrapping was sent but no fungal elements were seen. After 15 days white fluffy growth was observed on SDA with chloramphenicol. On LPCB mount it showed no sporulation and parallel hyphae with clamp connections were observed. Therapeutic keratoplasty was done. Graft failed and condition worsened. No response to intracameral voriconazole. Patient lost vision in both eyes. Case was identified as fungal keratitis with suspected Basidiomycetes Schizophyllum species.
Both the isolates were confirmed from PGIMER Reference Center at Chandigarh.

Result
In both cases surgical intervention was essential but therapeutic keratoplasty failed.

Conclusion
Recently surge in cases with Schizophyllum commune is observed with difficult management, Failure of therapeutic keratoplasty and infection of graft is a challenge.
P167 Fungemia in neonatal ICU of a pediatric hospital in NE India
Authors: Bidyalakshmi Microbiology Yendrembam , Ratankumar Kh , Priyolakshmi N. , Reena K. , Aindrilla  
Published: September 2022

Abstract

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

Objectives
To determine the prevalence of fungemia in a neonatal intensive care unit (NICU) during a period of 4 years and 4 months (January 2018 to April 2022) and to identify the causative fungal pathogens and analyze the associated risk factors.

Methods
A retrospective study was conducted by collecting records of neonatal fungemia occurring in 17 bedded NICU of Mother's Care Children Hospital and Research Centre, Imphal. Cases were identified by searching of computerized microbiology blood culture database. Blood cultures were carried out using automated BacT/ALERT(Biomerieux). Whenever flagged positive, immediate gram staining and subculture were carried in Blood agar, SDA, and MacConkey agar. The isolates were identified by their morphology, germ tube test, and biochemical test in VITEK-2 (Biomeriux) system. Antifungal susceptibility testing too was carried out in VITEK-2.

Results
A total of 2621 blood samples in pediatric blood culture bottles were received from NICU during this period of 4 years and 4 months. 21 samples showed growth of yeast cells. The isolates include Candida parapsilosis (10), C. albicans (7), Wickerhaemomyces anomalas (3), and C. krusei (1). Low birth weight, premature rupture of membrane, antibiotic therapy, and prolonged hospital stay were main risk factors. Majority of the neonates recovered with antifungal treatment.

Conclusion
Candida parapsilosis was isolated with highest frequency. Fungemia is more common in low birth weight babies.
P173 PK PD rationale and efficacy of isavuconazole treatment after failure of amphotericin B and posaconazole for COVID-19 associated cranial Mucormycosis
Authors: Soman Rajeev , Chakraborty Sourabh , Joe Geethu , Purandare Bharat , Joshi Rasika , Patwardhan Sampada 
Published: September 2022

Abstract

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

Objective
This case series describes our experience of using isavuconazole (ISVCZ), along with TDM, after the failure of treatment with Amphotericin B (AmB) and Posaconazole (PCZ) due to the better PK PD properties of ISVCZ.

Patients and methods
There were 6 patients with ROCM who had disease progression despite surgical debridement and adequate treatment with AmB and PCZ. Anti-fungal treatment was switched to ISVCZ which achieves levels in brain (1.86x)R and in bone-marrow (3x)R as compared to serum levelsR.

Results
PK PD considerations for ISVCZ treatment considering the likely levels in brain and bone-marrow and the MIC of majority of Mucoralean molds as ≤4R
Table 1
Table 2
Results of treatment

Conclusion
Treatment with ISVCZ may mitigate some of the challenges in ROCM due to its PK PD properties. TDM for ISVCZ is not routinely recommended, but could be used to ensure high plasma exposures and enhanced penetration to the site of infection. Our results are encouraging although there are several limitations of a case series, confounding variables involved, and the use of ISVCZ as salvage after failure of previous treatment.
Clinical success in this series suggests that extrapolative PK PD considerations in using ISVCZ for such ‘difficult to treat’ patients may be justified.