bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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

Abstract

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 &lt;.001), increasing age (1.03, P &lt;.001), lower albumin (0.92, per g/L), underlying chronic liver disease (2.07; P &lt;.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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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.