bluuebunny/crossref_metadata_2025_split huggingface dataset:
P237 Molecular epidemiology of Cryptococcosis—over 14 years using Whole Genome Sequencing and Multi-Locus Sequence Typing
Authors: Michael Joy Sarojini 
Published: September 2022

Abstract

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

Objectives
Cryptococcus neoformans/Cryptococcus gatti causes Cryptococcosis—a systemic fungal disease in immunocompromised as well as immunocompetent individuals.
Whole genome sequencing (WGS) technology provides insights into the molecular epidemiology of Cryptococcus species. The main objective of this study was to analyze the genetic variations between the Cryptococcal species isolated in our center from patients from different parts of India using WGS and Multi-Locus Sequence Typing (MLST).

Methods
This was a study done on 56 strains of Cryptococcus that had been previously identified as C. neoformans from patients who were treated at Christian Medical College from 2007-2020. The organisms were identified by conventional colony morphology and microscopy and species identification by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). To determine the genetic diversity of C. neoformans isolates and the genetic structures of their populations, these Cryptococcus species isolates were further subjected to whole genome sequencing (WGS) using the Illumina platform followed by MLST using seven different housekeeping genes for genotyping the isolates. Based on the analysis, the Cryptococcus species isolates were characterized into Molecular types and clonal types, and their prevalence calculated.

Results
In this study out of the 56 Cryptococcal isolates, 50 were C. neoformans and 6 were C. gattii. A total of 46% of the patients from whom the Cryptococcus species were isolated from Eastern states of India and 42% were from South India. Out of the 50 C. neoformans 24 (48%) were isolated from patients infected with Human immunodeficiency virus (HIV), (14%) from those with autoimmune disorders, 6 (12%) from patients with post renal transplant on immunosuppressants. A total of 5/6 C. gatti patients were immunocompetent. The most common clinical presentation was meningoencephalitis with the CSF being the most common clinical sample from which the organism was isolated. The phylogenetic tree was constructed to identify the genetic similarities between the isolates. A total of 49/50 C. neoformans belonged to molecular type VNI (98%) and one was type VII (2%). They were also sub-typed into 11 sequence types including one novel sequence type (ST). A total of 44% of them belonged to the sequence type (ST) 93 followed by ST 5 (14%). WGS analysis of C. gattii is ongoing.

Conclusion
Molecular epidemiology of Cryptococcus species WGS and MLST is an important tool to understand the genetic diversity of Cryptococcus isolates in India over the years. Further studies on identifying the virulence factors and drug resistance mutations are needed to further understand the molecular mechanisms of disease pathogenesis.
P243 Case series of Cryptococcal Meningitis—Experience in North Western India over 1 year (2021–22)
Authors: Naguthevar Santhanam , Garg MK , Bohra Gopal Krishna , Jain Vidhi , Kumar Deepak , Midha Naresh Kumar , Meena Durga Shankar , Sharma Shivang , R Akshatha , Singh Kuldeep , Kombade Sarika P 
Published: September 2022

Abstract

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

Objective
Cryptococcosis is an opportunistic fungal infection causing high morbidity and mortality in patients, preferentially affecting immunocompromised. It can cause a wide array of clinical manifestation, which includes meningitis, pulmonary, as well as disseminated infection. Cryptococcus neoformans causes more than 90% cases of cryptococcal meningitis.

Methodology
We performed a retrospective review of patients with confirmed cryptococcal meningitis during 1 year period from 2021 to 2022 in tertiary care center, AIIMS Jodhpur. We assessed clinical, radiological, microbiological, and biochemical parameters along with treatment provided and outcomes of the patient.

Results
Of 189 patients screened for suspected cryptococcal meningitis, 6 were microbiologically confirmed positive. All the patients were immunocompromised, of which four were HIV positive and one was a solid organ transplant recipient on immunosuppression and one was old TB Meningitis. Most common symptom was headache and altered sensorium (100%). Radiological findings showed 30% had no significant abnormality. CSF examination revealed average CSF protein 97.6 (63-163), CSF chloride 103.3 (108-132), sugar 36.33 (1-68), with predominant lymphocytes. All the patients were microbiologically confirmed by CSF cryptococcal latex test. A total of 4/5 patients received amphotericin B (3 mg/kg) with fluconazole (1200 mg) for 2 weeks in the induction phase followed by fluconazole consolidation phase and maintenance phase. Of the five patients, four patients survive with a good response to the treatment with one fatality.

Conclusion
Through our case series we emphasize the fact that Cryptococcal meningitidis may present with non-significant radiological features. Thus, the differential diagnosis of C. meningitidis must always be thought of when an immunocompromised patient presents with headaches and other signs and symptoms involving the central nervous system.
P244 Catheter-associated blood stream infections due to Wickerhamiella pararugosa in a patient with acute myeloid leukemia: Review of lit eratures
Authors: Nasri Elahe , Fakhim Hamed , Vaezi Afsane , Mirhendi Hossein , Rizi Mahnaz Hosseini , Shelerangkon Mahsa , Ghafel Safiyeh , Badali Hamid 
Published: September 2022

Abstract

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

Objectives
This report aims to present a case of Candida pararugosa bloodstream infection, review previous cases with C. pararugosa infections, and provide a concise review of the clinical background, risk factors, and brief the management of infections.

Methods
A 3-year-old boy with a history of acute myeloid leukemia was hospitalized in Omid Hospital, Isfahan, Iran. Two consecutive blood cultures were taken from the peripheral vein and port catheter; after that empirically meropenem was administered.

Results
Candida pararugosa were isolated from blood based on conventional and molecular assays. Furthermore, the antifungal susceptibility profiles of the isolate were determined, which exhibited resistance to fluconazole (8 μg/ml). Antifungal therapy with caspofungin and removing the patient's port led to a significant clinical improvement of the patient's conditions. So far, in the literature review, 10 cases of clinical C. pararugosa isolates were found, of which 5 points had bloodstream infections.

Conclusion
Infections caused by uncommon Candida species have dramatically increased in recent decades, mostly among hematological malignancies. Most patients with C. pararugosa infection presented with specific underlying conditions, such as malignancy, sarcoma, surgery, and adult acute myeloid leukemia. Patients with indwelling catheters run a high risk of acquiring C. pararugosa bloodstream infection. Therefore, special consideration should be given to opportunistic fungal infections in immunocompromised individuals using catheters.
P245 Arthrinium species, a filamentous ascomycetes isolated from samples of human cutaneous infections-report from a medical mycology laboratory of Assam, North-East India
Authors: Nath Reema , Gogoi Navonil , Barua Shyamanta 
Published: September 2022

Abstract

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

Objectives
This study aims to report the isolation of closely related Arthrinium species from superficial skin lesions of five cases from a medical mycology laboratory of Assam, North East India.

Methods
The lesions were decontaminated with 70% ethanol and skin scrapings were collected on a sterilized glass plate. Direct mounts were prepared in 10%-20% KOH and cultures were put in Saboraud's Dextrose Agar with antibiotics, 5% sheep blood agar, and dermatophyte test medium (Himedia, India). Plates and tubes were incubated as per standard mycological techniques described. Molecular identification was done using ITS sequence analysis using ITS1 and ITS4 universal primers.

Results
Direct mount showed presence of hyphae with arthrospores in 3/5 cases. In one case, fungal hyphae was seen along with spore-like oval or round structures of about 3-4 μm diameter. Pure growth was seen after 7-14 days in multiple culture tubes in all five cases. Colonies were white, downy initially becoming white, and floccose on further incubation. Subculture on PDA in all the cases for 15-20 days revealed black, round, and oval spores of 3-5 μm suggesting Arthrinium spp.
The taxonomical identification was done by constructing a phylogenetic tree of the ITS sequences of the Arthrinium isolates of this study along with reference Arthrinium strains and Seiridium phylicae as the outgroup taxa.
The phylogenetic analysis clustered the isolates of this study into closely related Arthrinium species.

Conclusion
The genus Arthrinium belonging to the family Apiosporaceae, class Sordariomycetes which comprises of a group of filamentous ascomycetes fungi is rarely reported from human infections. We are reporting closely related Arthrinium spp from five cases of skin lesions from Assam, North East India. Three of the 5 cases hailed from tea garden areas of Assam. Arthrinium isolation in clinically significant cases and in multiple tubes may not be disregarded as a contaminant.
P246 Neglected keratitis caused by Exserohilum rostratum from the arid region of north-west India leading to vision loss—a case report
Authors: Netar Suresh , Choudhary Meenu , Verma Pushpanjali , Rastogi Vijyalatha , Gupta Mansi 
Published: September 2022

Abstract

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

Objectives
To report a case of complete loss of vision due to delay in diagnosis of fungal keratitis caused by Exserohilum rostratum in an immunocompetent patient from the arid area of north-west India.

Method
A 65-year-old female farmer was admitted to ophthalmology with a history of pain, redness, watering, and foreign body sensation in the left eye for 2 months. She had a history of trauma by splinters 2 months back. On ocular examination, a large corneal ulcer of about 7 × 8 mm size at 2-8‘o’ clock position in the left eye was present with diffuse corneal edema. She had no history of diabetes mellitus, hypertension, tuberculosis, COVID-19, and steroid eye drops instillation. There was no relevant previous history of any ocular surgery also. She was negative for hepatitis-B and human immune deficiency virus on serology. All her hematological parameters were within normal limits.
Patient was treated with moxifloxacin, carboxy methyl cellulose eye drops, and Neosporin eye ointment for around 2 months at primary health care facilities and later referred to our hospital for further management.
Corneal scraping of the patient was sent to our laboratory for potassium hydroxide mount and culture identification.

Results
Fungus was identified as E. rostratum on the basis of gross, macroscopic, and microscopic morphology. Gram's staining was bacteriologically negative while true fungal hyphae were seen. In KOH mount pigmented, septate, and branched true hyphae were seen. Bacterial culture was reported sterile.
Lactophenol cotton blue mount of culture revealed dematiaceous hyphae along with 4-9 septate elongated, ellipsoid macroconidia of 14-90 μm with prominent dark conspicuous hilum and geniculate conidiophore arranged sympodially. On the basis of these characteristics, it was diagnosed as E. rostratum.
After the diagnosis patient was switched over to topical natamycin 5% two hourly and oral itraconazole 200 mg BD from moxifloxacin and neosporin. To which the patient responded symptomatically. Ulcer healed in a month leaving behind a lateral scar. However, vision is permanently compromised and the patient is advised for therapeutic penetrating keratoplasty (TPK).

Conclusion
Exserohilum rostratum is generally regarded as a pathogen in hot and humid climates. However, the isolation of this organism in our area highlights the pathogenic potential of this emerging fungus in arid climates also. Ophthalmologists need to be made aware of the significance of prompt mycological identification to prevent vision loss.
P269 Managing prosthetic valve endocarditis due to Sarocladium kiliense: Finding a way through uncertainties
Authors: Rege Sujata , Soman Rajeev , Shetty Anjali 
Published: September 2022

Abstract

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

Objective
To discuss the challenges in a case of recurrent/refractory prosthetic valve endocarditis due to Sarocladium kiliense.

Methods and Results
Timeline of events (Fig. 1).
AUC/MIC is associated with efficacy. Recent clinical studies have incorporated the MIC into targets for TDM, wherein Trough/MIC target of 2-5 may be usedR.
In this case
Voriconazole trough—3.1/MIC-0.25 = 12.5
Usual posaconazole trough—1.2/MIC 0.5 = 2.4, which is at the lower limit of the PKPD index
Hence voriconazole was used.
Drug interactions of voriconazole with acenocoumarol, clopidogrel were considered.
Beta D-Glucan was used to assess infection of the newly implanted valve as well as improvement and need for continuing treatment.
Since it is difficult to be certain of a cure, the patient was advised voriconazole as lifelong chronic suppressive therapy with periodic follow-up.
R: reference available.

Conclusions
The patient's status of the third mitral prosthetic valve necessitated all efforts to avoid further surgery. Therefore, the most efficacious agent had to be selected based on PK PD considerations and the likelihood of major long-term adverse effects.
Careful management of DDI was needed.
BDG may help to assess recurrence and response to treatment.
P274 COVID-associated invasive pulmonary aspergillosis (CAPA) — a case report
Authors: Sahoo Asish , Shastri Prakash 
Published: September 2022

Abstract

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

COVID-associated pulmonary aspergillosis (CAPA) is a severe fungal infection with a high mortality rate. The incidence of CAPA is on the rise possibly due to the prescription of corticosteroids and tocilizumab two repurposed drugs used for treating SARS COV-2. Diagnosis is challenging due to the non-specific nature of symptoms. Voriconazole is the mainstay of therapy. We present a case of a 42-year-old male presenting with left hydro pneumothorax post recovery from COVID infection, and later succumbed to this complication. Patients developing pulmonary aspergillosis after short-term steroid therapy is uncommon. The possibility of aspergillosis in immunocompetent patients should be considered in those on systemic steroids and deteriorating pulmonary functions.
P278 Brain abscess caused by dematiaceous fungi in apparently immunocompetent hosts: Acase series
Authors: Savaj Pratik , Shah Vitrag , Thakor Bhaumik , Jain Kalpesh , Bhuptani Simple , Master Ricky , Munim Frenil 
Published: September 2022

Abstract

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

Objective
Dematiaceous or melanized fungi, can cause CNS involvement even in apparently immunocompetent hosts because of the intense neurotropism of the fungus. We present a series of 4 such cases.

Methods
Case series

Results
Figs. 1 and 2

Conclusion
The diagnosis of the disease is challenging due to its rarity, lack of specific signs and symptoms, and radiological findings of the disease. Radiologic reports should give a DD rather than name a specific condition. This prevents a biopsy procedure and leads to the use of empiric, ineffective, toxic, expensive therapy and disease progression. In our case series, the mean days to diagnosis from symptom onset was 49 days. Although, less than what is reported in the literature which is 115 days, it is still late to be of meaningful value to the patient. There are many factors like antifungal DST, interpretation of MIC when there is no BP available, cost of antifungal therapy, therapeutic drug monitoring, need for repeat surgery, active follow-up, and awareness among surgical colleagues remain a major concern in Indian settings. Combination of antifungal drugs for life long along with wide surgical resection with frequent follow-ups which includes TDM, radiological assessment, need for repeat surgery, and management of adverse drug reactions of antifungal drugs are the unmet clinical needs.
P290 Public health treatment due to rise in Candida auris candidemia infection
Authors: Singh Rakesh 
Published: September 2022

Abstract

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

Introduction
Isolation of Candida spp. from a blood sample in patients is known as candidemia. Candida albicans is the most common causative agent of candidemia globally while C. tropicalis is the most common causative agent in India. Candida parapsilosis complex, C. glabrata, and C. krusei are the other three common causative agents of candidemia. Candida auris was described in 2009 and is a public health treatment. It is multidrug-resistant and causes localized hospital outbreaks.

Objective
To determine the fungal profile of candidemia in a tertiary care hospital.

Methods
Institute ethics approval was taken. All patients admitted to the Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India from January 2020 to January 2021, whose blood culture samples yielded yeast were included in the study. The patient's demographic details were recorded. Yeast isolates were identified by Matrix-Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS) as per the manufacture's instruction. The antifungal susceptibility testing (AFST) was performed by microbroth dilution method for fluconazole, voriconazole, amphotericin B, and caspofungin as per Clinical and Laboratory Standards Institute (CLSI) M27 and interpreted by CLSI M59 and M60 document. AFST of C. auris was interpreted as per Centers for Disease Control and Prevention (CDC) criteria. Results were expressed in percentages.

Results
A total of 248 blood culture samples yielded yeast cells during the study period. Approximately 63% of samples were obtained from male patients, while ∼37% were obtained from female patients. Most of the patients were between 41 to 60 years or under 10 years of age. A total of 52/240 (15.8%) were diabetic, and 30 (15.2%) were positive for severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2). Candida tropicalis (34.7%) was the most common causative agent. It was followed by C. parapsilosis complex (20.2%). Candida auris (16.5%), C. albicans (13.3%), C. glabrata (6.5%), and other C. spp. (8.9%). Candida krusei is no longer observed as one of the top five agents of candidemia and it is replaced by C. auris. The rise of candidemia due to C. auris is a cause of concern, and its prevalence is observed more than that of C. albicans in our tertiary care hospital. The antifungal resistant pattern of the top four candidemia isolates is depicted in Figure 1. The antifungal resistance was maximum in C. auris isolates, followed by C. parapsilosis complex isolates. A total of 12.2% of C. auris isolates were resistant to amphotericin B, and azoles and 4.9% of C. auris isolates were multidrug-resistant.

Conclusion
Candida tropicalis was the most common causative agent of candidemia. But the increased prevalence of C. auris over C. albicans is a cause of concern as 4.9% of C. auris isolates were multidrug-resistant.
P297 Disseminated histoplasmosis from skin to adrenals a cosmetic
catastrophe—a rare case report
Authors: R NEETHA T , Khatod Yash , Samantaray Subhashree , Khichar Satyendra , Bohra Gopal Krishna , Kumar Deepak , Garg Mahendra Kumar 
Published: September 2022

Abstract

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

Background
The varying presentations of histoplasmosis is always a diagnostic dilemma for clinicians. Cases of disseminated histoplasmosis can present in multiple specialties like dermatology, medicine, endocrinology, with skin, and mucosal hyperpigmentation as the only major symptom.

Case Report
Here we present a case of a 54-year-old male with hyperpigmentation all over the body with multiple specialty consultations done in the past 2 years. There was a significant history of loss of weight over a period of 2 years. His cortisol levels were low which explained the focus in the adrenals, with bilateral adrenomegaly found in imaging studies. His diagnostic work-up for TB and possible malignancy was ruled out. The provisional diagnosis of histoplasmosis was made and confirmed with biopsy and culture. Definitive treatment with antifungals was initiated, which showed improvement on follow-up.

Conclusion
Histoplasmosis is always underreported, because of a lack of information regarding the various clinical presentations. Early diagnosis and prompt treatment may save the patient from catastrophic adrenal insufficiency. The diagnosis of adrenal histoplasmosis should be considered in patients presenting with constitutional symptoms and adrenal masses with or without adrenal insufficiency. Adrenal histoplasmosis can be the only possible presentation in disseminated histoplasmosis.