bluuebunny/crossref_metadata_2025_split huggingface dataset:
P193 Candidemia in coronavirus disease 2019 patients in a university hospital in Buenos Aires, Argentina
Authors: Fernandez Norma B. , Farias Luciana , de Gregorio Stella Maris , Padovani Andrea , Foccoli Monica 
Published: September 2022

Abstract

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM
It is known that the incidence and epidemiology of candidemia vary according to different geographic regions and/or hosts. Between 1998 and 2019, the incidence in a university hospital in the city of Buenos Aires Argentina, ‘HCJSM’, was 2.19/1000 discharges. The coronavirus disease 2019 (COVID-19) pandemic altered the previously recognized course of severe infections, including candidemia.

Objective
The aim of this report is to determine the incidence of candidemia in critically ill COVID-19 patients, and the clinical and microbiological aspects of these episodes hospitalized at HCJSM.

Methods
The source documents of this retrospective study are medical records from patients with Sars-Cov-2 and candidemia who were diagnosed between March 1, 2020 and June 30, 2021. At the onset of the pandemic, the HCJSM began admitting patients with COVID-19, and elective procedures were canceled. Demographic, clinical, and laboratory data were reviewed. All data were analyzed using RStudio, a statistical computing platform (version 4.0.2).

Results
During the period under review, 61 episodes of candidemia were identified: 23 episodes (39.7%) in COVID-19 patients, and 38 episodes (60,3%) in no COVID-19 patients. Incidence (x 1000 admission) in no COVID-19 patients was 2.5 (38/14 903): in COVID-19 patients 14.4 (23/1595) and in COVID-19–ICU was 42.3 (20/472). The average age of patients is of 65 years (32-84 range years). The time from admission to ICU to the development of candidemia had a median of 18 days (RIC 9-23). A total of 87.5% of the patients had been on mechanical ventilation and 100% of the patients received broad-spectrum antibiotics and had catheters. Episodes were caused by C. parapsilosis (39.7%), C. albicans (35%), C. glabrata (14%), and other species of Candida (11%). A total of 62% of COVID-19 patients who developed episodes of candidemia died during the period under examination. The survival likelihood at 30 days of COVID-19 patients who developed candidemia was higher for C. parapsilosis episodes and lower for C. glabrata episodes.

Conclusion
The incidence of candidemia showed an increase in COVID-19 hospitalized severe patients. The use of broad-spectrum antibiotics, the presence of catheters, and the use of ventilatory support in COVID-19 patients were the risk factors most associated with the development of candidemia. Although the number of episodes of candidemia is low, without the strength of statistical analysis, it is important to consider that the likelihood of survival of patients with episodes of candidemia varies according to the species recovered.
P196 A rare presentation of subcutaneous Entomophthoramycosis
Authors: George Nimmy Elizabeth , Philip Achu Jacob , E. Arthi , Asir Johny , Kindo Anupama Jyoti , Nair Shashikala 
Published: September 2022

Abstract

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM
Entomophthoramycosis is a chronic granulomatous type of subcutaneous infection seen mainly in immunocompetent individuals. The usual focus of Conidiobolomycosis infection is as rhinoentomophthoramycosis, characterized by chronic, indolent, and localized swelling of the nose, paranasal tissues, sinuses, cheeks, and upper lips and it infrequently affects the lower extremities.

We report a case of subcutaneous Conidiobolomycosis in a 21-year-old male with an alleged history of trauma to left foot by a wooden stake 6 months back. Primary treatment of the wound was done at a local hospital. A total of 4 months post-trauma he developed multiple pus discharging sinuses on the dorsal and plantar aspects of the left foot, for which local dressing was done in a nearby hospital. He presented to our hospital with non-healing multiple sinuses, with active serosanguinous discharge. He underwent wound debridement under spinal anesthesia and tissue was sent for fungal culture, histopathological examination.

Aerobic culture of the wound swab revealed moderate growth of Methicillin-resistant Staphylococcus aureus sensitive to clindamycin, gentamicin, and linezolid. Histopathological examination of the tissue showed a resolving abscess with granulation tissue. Direct microscopic examination of the tissue by KOH mount showed no fungal elements. It was inoculated into Sabouraud's dextrose agar with and without cycloheximide and incubated at both 25°C and 37°C. Sabouraud's dextrose agar without cycloheximide incubated at 37°C after 48 h of incubation grew cream-colored glabrous colonies adherent to surface with pale reverse. Lactophenol cotton blue preparation revealed broad, sparsely septate hyphae with primary conidia which are globose approx. 40 μm is diameter, produced singly. They have a characteristic protruding papilla on one side. The fungal isolate was identified as Conidiobolus species. Sequencing results are awaited for species identification and confirmation.

Serial wound dressings were done following strict infection control policies and he was started on tablet linezolid 600 mg twice daily, tablet itraconazole 400 mg twice daily for 1 week, followed by 400 mg once daily for 6 months.

Conidiobolus is a soil saprophyte, found in decaying vegetation in most warm climates in tropical countries. There has been only one published case report of subcutaneous entamophthoramycosis of the foot, in a 49-year-old female from Venezuela. To the best of our knowledge, we report the first case of subcutaneous entamopthoramycosis of the lower extremity in India and the second case in the world.
P208 Genetic diversity of the emerging human fungal pathogen Pichia norvegensis
Authors: Boden Sander , Haas Pieter-Jan , van Dijk Karin , Bathoorn Erik , Hagen Ferry 
Published: September 2022

Abstract

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

Objectives
Pichia norvegensis (= Candida norvegensis) is increasingly isolated from hospital settings, especially from immunocompromised patients. Understanding this rare pathogen, including its emergence and distribution, is crucial for accurate diagnosis and infection prevention. We studied the genetic diversity of a large collection of clinical P. norvegensis isolates obtained from Dutch hospitals along with a set of non-Dutch clinical and environmental isolates.

Methods
Clinical (n = 236; 90.8%) and environmental (n = 24; 9.2%) P. norvegensis isolates were subjected to Amplified Fragment Length Polymorphism (AFLP) fingerprinting and a novel six-loci microsatellite typing panel. Data were analyzed with BioNumerics and Structure. We applied a novel mating-type assay to determine the MATα locus presence/absence.

Results
AFLP fingerprinting separated the P. norvegensis isolates into three main clusters. Two clusters fully consist of clinical isolates, the third represented a mix of clinical and environmental isolates. By microsatellite typing, the overall genetic diversity was low (Simpson's D = 0.90), due to a large number of Dutch clinical isolates with similar genotypes. Minimum spanning tree analysis showed that Dutch clinical isolates fell into two clusters. Environmental and non-Dutch isolates were more distantly related. Structure analysis showed the presence of four genotypes, with signs of genetic admixture between geographic locations and environmental/clinical isolates. Nearly all isolates harbor the MATα mating-type allele.

Conclusions
The P. norvegensis isolates obtained from Dutch hospitals appeared to be largely clonal, independent of geographic origin and isolation date. The observed clonality is supported by the extensive number of MATα isolates. Microsatellite typing indicated potential admixture between clinical and environmental isolates.
P210 Fungal isolates of the respiratory tract in symptomatic patients hospitalized in pulmonary units: A mycological and molecular epidemiologic study
Authors: Hashemi Seyed Jamal 
Published: September 2022

Abstract

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

Objective
Fungal respiratory infections are being recognized with increasing frequency in parallel with an expanding population of immunocompromised patients. In most cases, colonization is the first step in the progression to pulmonary fungal infection. This study was designed to evaluate the distribution of fungal elements in the respiratory tract of symptomatic patients hospitalized in pulmonary units.

Methods
This descriptive cross-sectional study was carried out over a period of 2 years, from October 2017 to October 2019 in Guilan province, located in Iran's northern region. In the current study, bronchoalveolar lavage or sputum specimens were collected. All samples were analyzed by direct microscopy using KOH 10% and culture. Fungal identification was accomplished by internal transcribed spacer (ITS) and beta-tubulin sequencing. Also, in patients suspected of invasive pulmonary aspergillosis, BAL specimens were tested for galactomannan (GM) antigen.

Results
A total of 384 lung specimens [192 bronchoalveolar lavage (BAL) and 192 sputum samples] were obtained from symptomatic patients hospitalized in pulmonary units. Of these, 137 (35.67%) were positive in direct examination and culture. Among the 137 positive cases, most isolates were from male patients 86 (62.77%) and most of them were between 46 and 72 years. Candida albicans (37.22%) and C. tropicalis (21.89%) represent the two most commonly isolated species in the current study. Cough (94.16%), dyspnea (81.02%), purulent sputum (62.04%), and weight loss (56.2%) were the predominant symptoms and tuberculosis (24.81%), chemotherapy (21.89%), and diabetes mellitus (19.70%) were the predominant underlying conditions. Also, 5 cases of invasive pulmonary aspergillosis and 1 case of mucormycosis were diagnosed.

Conclusion
Candida albicans was the most common fungal species isolated from symptomatic patients hospitalized in pulmonary units. Tuberculosis, chemotherapy and diabetes mellitus were important underlying conditions for pulmonary fungal colonization and/or infection.
P216 Rare isolates from subcutaneous mycotic lesions; A study from tertiary care center in Chhattisgarh, India
Authors: Keche Archana , Tigga Richa , Satyaki Ganguly , Chhabra Namrata , Gupta Rakesh 
Published: September 2022

Abstract

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

Aims and Objective
To identify the causative agents of suspected subcutaneous mycosis patients attending to a tertiary care hospital, Chhattisgarh, India.

Introduction
Subcutaneous mycoses are a group of fungal infections of dermis and subcutaneous tissue caused by both melanized and hyaline molds. It often affects patients with immunosuppressive conditions. It consists of Sporotrichosis, Chromoblastomycosis, Phaeohyphomycosis, Hyalohyphomycosis, Mycetoma, subcutaneous zygomycosis, Rhinosporidiosis, Lobomycosis, and disseminated Penicilliosis. There are proven pathogenic agents causing subcutaneous mycosis though are not regularly isolated and reported. Few of them are commonly come across in the laboratory. Herewith, emphasized on the unusual clinical isolates from the patients having subcutaneous mycotic lesions with their clinical details.

Method
It is a retrospective descriptive analysis of data of subcutaneous mycosis cases of duration January 2019 to March 2022.
Total 52 clinical specimens from the suspected subcutaneous mycotic lesion were studied. Male dominance was observed amongst the patients. Amongst 52, 31% were detected positive for fungal elements by direct microscopy in 20% KOH mount, 55.7%, 25% positivity was observed in Culture and by both KOH wet mount and culture. Samples were processed and identified by using standard protocol.
The significant unusual isolates identified were Conidiobolus coronatus from subcutaneous cyst from buttocks, Medicopsis romerai from fine needle aspiration from the nodule of left thumb, Rhytidhysteron rufulum from right lateral malleolus, Aquastroma magniostiolata species from subcutaneous cyst on lateral aspect of left lower leg above lateral malleolus, Aspergillus tamorii, Aspergillus glaucus, Chetomium species, Aspergillus montevidensis, Cladosporium sphaerospermum. Phenotypically unidentified isolates were sent to NCCPF PGI, Chandigarh for final identification.

Conclusion
There is diversity in the etiological agents of subcutaneous mycoses. Every case is different and rare. With the help of molecular techniques, it became possible to identify unusual fungal isolates from subcutaneous infection. Awareness and extensive studies are required to evidence the pathogenicity and associated complication due to these fungal infections. It will also help to regulate the therapeutic management and to know the geographical distribution of unusual fungal agents.
P222 Epidemiology of Candida emia at level-1 trauma care cent er in North India
Authors: Kiro Vandana , Sharad Neha , Shrivastava Smriti , Varma Sharin , Ningombam Aparna , Mathur Purva 
Published: September 2022

Abstract

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

Objective
Patients affected by trauma who get admitted to critical care units experience prolonged hospitalization and thereby acquire several infections. This retrospective observational study was done from 2014 to 2021 to observe Candidaemia affecting this population. A total of 4816 patients admitted with traumatic injuries and hospitalized for treatment at ICU in our 190 bedded Level-1 Trauma center underwent this study.

Methods
Paired blood samples were collected from patients showing signs of sepsis and incubated and monitored regularly by the BacT/ALERT system (bioMe´rieux InC., Marcy l'Etoile, France). All the positive signal samples exhibiting budding yeast cells on Gram stain were subcultured on Chrome agar and Sabouraud dextrose agar. Pure growths obtained were subjected for identification and susceptibility by MALDI-TOF and VITEK 2 system.

Results
Out of the 4816 patients, 61 were affected by Candidaemia. Out of 61, the maximum was in the age group of 31-40 years (19.7%). Male preponderance (50/61, 82%) was exhibited compared to females. To ascertain Candidaemia, samples collected were blood (63/66, 95.5%) and CVP tip (3/66, 4.5%). Candidaemia was primarily observed in patients who suffered major orthopedic trauma (14/61, 21.2%). A total of 66 Candida species were isolated from samples of these patients. Out of these, Candida tropicalis (43.9%) was the most common, followed by C. parapsilosis (22.7%), C. albicans (21.2%), C. haemulonii (4.5%), C. glabrata (3%), C. rugosa (3%), and C. guilliermondii (1.5%). Concerning antifungal resistance, fluconazole resistance was 16.6% (11), flucytosine 1.5% (1), amphotericin B 6% (4), and micafungin 3% (2). Voriconazole was resistant to none but intermediate to 12.1% (8), caspofungin was intermediate to 3% (2), and resistant to none. A total of 47% (31/61) of patients succumbed to their injuries which were observed highest in the age group of 61-70 years (8/61, 25.8%). The most common injuries that the deceased suffered were polytrauma (9/61, 29%) and blunt trauma abdomen (9/61, 29%). Maximum mortality was also observed in patients with Candidaemia due to Candida tropicalis (15/61, 48.3%).

Conclusion
Candidaemia is usually fatal. Mortality due to Candidaemia increases in patients with severe traumatic injuries and added risk factors such as extremes of age, immunocompromised state, and broad-spectrum antibiotics. When compared to a similar study done in our center from 2009 to 2012 (3 years) on Candidaemia in ICU patients, the incidence was lower in our study (12.6% per 1000 ICU admissions vs 14.9% per 1000 ICU admissions), but the mortality rate was higher (47% vs 43.3%). Therefore, a watchful eye on early signs of sepsis, strict hospital infection control measures and antimicrobial stewardship may alter their outcome.
P224 A challenging case of pyrexia of unknown origin of adrenal mass
Authors: Kumar Arvind , Gupta Ankesh , Bhatia Oshin , Nischal Neeraj , Wig Naveet 
Published: September 2022

Abstract

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM
A familiar dictum in tropical countries is to consider the diagnosis of tuberculosis (TB) in a patient with fever of unknown origin until proven otherwise. Often, in resource-limited settings, a response to a trial of empiric anti-tuberculous therapy (ATT) is needed to prove TB. However, chronic granulomatous diseases such as invasive fungal infections and sarcoidosis have clinical features resembling extrapulmonary TB. Thus, the workup for a definitive diagnosis is necessary.

A 53-year-old male presented with low grade, intermittent fever, loss of weight and appetite for a duration of 4 months and generalized abdominal pain for the last 2 months. He has lost about 16 kg in the past 6 months. He also reported a mild cough with scanty white mucoid sputum. There was no contact with a case of TB. He developed small oval/circular copper Color patchy lesions in the trunk for the last 1 month (Fig. 1). The general examination of the patient was grossly normal except for hepatomegaly. Routine blood examination, renal and liver function test, and chest X-ray were normal and HIV ELISA was non-reactive.

With the strong suspicion of TB, the patient underwent CT scanning of the chest and abdomen was done which showed bilateral heterogeneous adrenal mass with few hypodense areas within measuring right side 3.1 × 1.8 cm and left side 3.1 × 2.5 cm in suprarenal location and liver is enlarged size 19.3 cm with normal attenuation (Fig. 2). There were no clinical features to suggest pheochromocytoma or Cushing's syndrome. The PET-CT revealed metabolically active disease involving bilateral adrenal gland, abdominal and retrosternal lymph node with diffuse hepatomegaly. Transabdominal ultrasound-guided FNA was done from adrenal lesions. The tests for tuberculosis were negative and the cytology reported necrotizing granuloma with intracytoplasmic yeast cells suggestive of histoplasmosis. The adrenal endocrine profile was normal. From skin lesions, a biopsy was done. Direct KOH from skin lesion revealed budding yeast cells while the cultures are awaited. The patient was treated with 3 mg/kg liposomal amphotericin B for 2 weeks followed by daily itraconazole for maintenance. The fever was resolved after 8 days of liposomal amphotericin B and skin lesions softened after 3 weeks of therapy.
P225 Subcutaneous phaeohyphomycosis by Phaeoacremonium species in a renal transplant recipient
Authors: Kumar Manibhushan , Kaur Harsimran , Ahmad Haseen , De Dipankar , Rudramurthy Shivaprakash M. 
Published: September 2022

Abstract

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

Objective
Phaeohyphomycosis refers to infections due to a large group of heterogenous organisms called ‘dematiaceous’ or ‘melanized’ fungi. The infection exhibits a wide spectrum of presentations such as deep local infections, pulmonary infection, cerebral infection, and disseminated disease, which are associated with high mortality. The incidence of phaeohyphomycosis among solid organ transplant recipients is 0.7%. Hereby, we report a case of phaeohyphomycosis in a post renal transplant patient who presented with a subcutaneous swelling over the right elbow region.

Method
A detailed history was obtained from the patient after informed consent. The cystic fluid was subjected to microbiological including bacterial (Gram stain, culture on blood agar incubated at 37°C) and fungal investigations [Calcofluor potassium hydroxide (KOH) mount, culture on Sabouraud dextrose agar (SDA) incubated at 37°C and 25°C and brain heart infusion agar (BHI) incubated at 25°C]. The identification of isolate was done phenotypically by preparing lactophenol cotton blue (LCB) mount from slide culture and molecular technique using Sanger's sequencing.

Result
A 61-year-old diabetic and post renal transplant (7 years) male presented with complaints of swelling over the right elbow region for 5 months duration. Swelling was insidious in onset, gradually progressive, painless, cystic, non-pulsatile, non-reducible, ∼9 × 7 cm in size, lobular in shape with irregular surface having normal overlying skin which minimally restricting the movement of the elbow. There was no history of trauma over the elbow region. Reddish purulent pus was received for mycological investigation. Calcofluor KOH mount demonstrated septate hyphae. Culture on SDA incubated at 37°C and 25°C grew cream-colored colonies, turning grayish beige to olive-brown and developed clusters of aerial hyphae with reverse tan to brown in color after 2 weeks of incubation. LCB mount showed hyaline to brownish hyphae, cylindrical phialides growing along the hyphae with slightly tapering towards the apex, hyaline, oblong, conidia, gathering in clusters at end of phialide. Phenotypically, the fungus was identified as Phaeoacremonium species and molecular identification and antifungal susceptibility are awaited. Patient was advised for surgical excision but he left against medical advice. Currently, he is not receiving any antifungals.

Conclusion
Phaeohyphomycosis is a rare and unique entity among fungal infections. Cutaneous phaeohyphomycosis predominantly occurs on the extremities with a localized solitary nodule or abscess. A high index of suspicion and the surgical approach including excision or debridement are mainly chosen.
P235 Rhino sinusoidal Lasiodiplodia theobromae: a clinical and diagnostic dilemma
Authors: Maurya Anand Kumar , Karuna Tadepalli , Behera Ganakalyan , Kumari Shweta 
Published: September 2022

Abstract

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

Objectives
To disseminate and discuss a rare case of rhino sinusoidal Lasidiploidea theobromae in a known diabetic.

Method
A case study was prospectively done since 2021 following a hospital visit of a 56-year-old male patient presenting with rhino sinusitis mimicking mucormycosis. Ethical approval and patient consent were obtained for this study. A detailed account of case progression from the date of first hospital admission to the final cure was noted. A 56-year-old male from Madhya Pradesh, in central India, presented to the outpatient department of Otolaryngology (ENT) -Head and Neck Surgery. The patient was a known case of diabetes for 5 years. He presented with a headache for 10 days, throbbing pain over the left cheek and upper teeth with nasal discharge and crusting for one week. Nasal crusting and sample from left maxillary meatus were sent suspecting rhino sinusoidal mucormycosis. Mycological evaluation by KOH wet mount showed melanized hyphae and short fragments appearing broad pauciseptate. After 10 days, a grey fluffy growth was observed at 37°C and 25°C on SDA with chloramphenicol. On SDA with cycloheximide there was no growth. LPCB mount of the growth showed some hyaline hyphae with immature hyaline conidia and at places brownish dark walled single septate conidia. Phenotypic identification was inconclusive. Debridement surgery was done and amphotericin B was initiated. The patient was discharged after 10 days with the mention of routine follow-up. The isolate was sent to PGIMER Chandigarh Mycology Reference Center India for species confirmation. After almost 3 months the species was confirmed as L. theobromae.

Results
After almost 1-year clinical improvement was observed.

Conclusion
This study addresses the diagnostic dilemma both for the clinicians as well as clinical mycologists. Also, it emphasizes the need for molecular diagnostic workflow in such a scenario.