Medical mycology journal最新文献

{"title":"P399 Diagnostic value of Candida coloni zation index and serum Candida mannan antigen for candidemia in febrile episodes of pediatric lymphoreticular malignancies","authors":"S. Gautam, Shukla Das, R. Saha, N. Singh, S. Gomber, G. Rai, P. Singh","doi":"10.1093/mmy/myac072.P399","DOIUrl":"https://doi.org/10.1093/mmy/myac072.P399","url":null,"abstract":"Abstract Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM Objective To evaluate the diagnostic performance of Candida colonization index and serum Candida mannan antigen predicting candidemia in febrile episodes of pediatric lymphoreticular malignancies Methods It was a prospective observational study done for 18 months, from November 2018 to April 2020 at the pediatric oncology unit of a multispecialty tertiary care center. Based on our patient load, duration of the proposed study, and available resources, a sample size of 49 (n = 49) was decided and 100 febrile episodes in children with lymphoreticular malignancy were studied. Children below 12 years, receiving chemotherapy for hematological malignancy having oral or axillary temperature ˃38.3°C for ˃1 h were included in this study. Children receiving the antifungal treatment in last 7 days were excluded from the study. Blood collected on day1 and day4 was cultured in BACTEC-9120. For colonization, swabs and samples were collected and cultured on SDA on day1, day4, and day8. All Candida isolates were subcultured on SDA and subjected to Gram's stain, germ tube test followed by Microscan identification. DNA sequencing followed by phylogenetic analysis was done for all the isolates of Candida recovered from blood. Antifungal susceptibility of yeast stains was done. Serum collected on day1 was used for C. mannan antigen detection using ELISA system. Results Prevalence of candidemia was 5%. Non-albicans Candida spp were isolated from blood cultures on day 4. Candida colonization decreased from day1 to day8. Colonization index (CI) day1 showed 80% sensitivity 98.9% specificity, and 98.9% negative predictive value. Significant colonization (CI ≥0.5) was seen in a larger proportion of cases that developed candidemia. There was a significant association of Candida colonization (CI ≥0.5) with occurrence of candidemia on day1 and day4. A total of 4 (80%) of candidemia episodes were positive for serum mannan antigen while 1 (20%) was negative. Mannan antigen was detected earlier with 80% sensitivity, 92.6% specificity, and 98.9% negative predictive value. All Candida isolates were sensitive to fluconazole, amphotericin-B, and caspofungin. Receiver operator characteristic curves for diagnostic performance of various parameters in predicting candidemia show the following trends: Best parameter in terms of AUROC is the CI (Day 1). Best parameters in terms of sensitivity are the CI (Day 1), CI (Day 4), and mannan antigen level. Best parameter in terms of specificity is the CI (Day 8). Best parameter in terms of positive predictive value is the CI (Day 1). Best parameters in terms of negative predictive value are the CI (Day 1), CI (Day 4), and mannan antigen level. Best parameters in terms of diagnostic accuracy are the CI (Day 1), CI (Day 8). Conclusion The CI can predict candidemia but the threshold value needs to be explored in pediatric patients with lymphoreticular malignancies. Mannan antigen det","PeriodicalId":18325,"journal":{"name":"Medical mycology journal","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74816344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"S2.5d Exploring multidrug resistance, fitness compensation, and collateral sensitivity in Candida auris : Fight fire with fire?","authors":"Hans Carolus, Dimitrios Sofras, Poppy C. S. Sephton-Clark, Louise Goossens, Alicia Chen, Siebe Pierson, Celia Lobo Romero, Ana Subotić, J. Meis, Christina A. Cuomo, P. van Dijck","doi":"10.1093/mmy/myac072.S2.5d","DOIUrl":"https://doi.org/10.1093/mmy/myac072.S2.5d","url":null,"abstract":"Abstract S2.5 Rare yeasts, September 21, 2022, 3:00 PM - 4:30 PM Candida auris (C. auris) is a recently emerged human fungal pathogen of growing concern due to its ability to acquire extensive multidrug resistance (MDR) to all four antifungal drug classes. The unprecedented extent of MDR in C. auris, suggests accelerated resistance evolution, novel mechanisms of resistance, and/or potential fitness compensation. Despite being the first fungus to be officially considered an urgent antimicrobial resistance threat by the CDC (US), insights into the resistance mechanisms and evolutionary dynamics of C. auris are still scarce.   By using high-throughput in vitro experimental evolution with various antifungal drugs, we have obtained a library of resistant strains from four different clades. Through both genome and targeted sequencing, we have discovered novel mutations, especially for polyene resistance, which indicate new mechanisms of resistance and fitness compensation. For the validation of mutations, we have optimized a recyclable CRISPR/Cas9 tool for C. auris based on the C. albicans HIS-FLP system.   By mapping drug susceptibility responses of evolved strains across a library of several antifungals and repurposed drugs, we have discovered trends of cross-resistance and collateral sensitivity. Both phenomena have been extensively studied in tumors and bacteria but remain unexplored in fungi. In the light of these observations, we explore novel treatment schemes that prevent antifungal drug resistance development in C. auris and other pathogenic fungi.","PeriodicalId":18325,"journal":{"name":"Medical mycology journal","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73226868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P473 Genomic epidemiology of antifungal-resistant Candida auris in Colombia","authors":"Patricia Escandón, E. Misas, L. Gade, D. Cáceres, S. Hurst, A. Litvintseva, C. Duarte, N. Chow","doi":"10.1093/mmy/myac072.P473","DOIUrl":"https://doi.org/10.1093/mmy/myac072.P473","url":null,"abstract":"Abstract Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM Introduction Candida auris is a public health threat. Five major clades of C. auris have been identified (Clades I–V). In Colombia, C. auris infections were first reported in 2016 with ongoing transmission reported from multiple cities. Here, we describe C. auris genomic epidemiology in Colombia detailing cases from 2016–2021. Methods A total of 99 isolates from C. auris cases were collected between June 2016 to January 2021 in Colombia, representing 11 geographic locations. Species confirmation, antifungal susceptibility testing, and whole-genome sequencing (WGS) were performed. In all, 37 genomic sequences generated previously from isolates from C. auris cases in Colombia, Venezuela, Panama, Israel, and United States were also analyzed MycoSNP workflow was used to assess sequence quality, map reads to the reference, and identify single-nucleotide polymorphisms (SNPs). Pairwise distances and a neighbor-joining tree were generated. IQtree was used to generate a maximum-likelihood tree with bootstrap values. Results Phylogenetic analysis identified 1 493 SNP positions. Isolates from Colombia clustered to Clade IV and predominately grouped by country except for 16 fluconazole-resistant isolates from Bogota, Colombia that grouped with five isolates from Venezuela. In this cluster, 20 (95%) were resistant to fluconazole and 5 (24%) were resistant to fluconazole and the echinocandin micafungin. Remaining isolates from Bogota did not group in this cluster and were susceptible to fluconazole and micafungin. A total of 98 isolates from Colombia clustered together. Within this Colombian cluster, there were two subgroups that had bootstrap support of 100% and were separated by 13 SNPs. The first subgroup was a cluster that contained 18 isolates from the north coast; 17 (94%) isolates were resistant to amphotericin B. A second subgroup consisted of 26 isolates from Cesar and Norte de Santander, and 22 (84%) isolates were resistant to fluconazole. Conclusions Based on the phylogenetic reconstruction, C. auris in Colombia continues to be of Clade IV. Amphotericin B-resistant isolates were predominately from the north coast, fluconazole-resistant isolates were from a wider geographic area in Colombia, and echinocandin-resistant isolates were from Bogota. Within the Colombian cluster comprising two subgroups, we observed high genetic relatedness between isolates from different geographic locations suggesting transmission among cities.","PeriodicalId":18325,"journal":{"name":"Medical mycology journal","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74369558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P051 A case of recalcitrant sporotrichosis by infection of Sporothrix globosa","authors":"Eun-seon jeong, J. Yim, H. Kwon, J. Choi, Dong-Yeon Shin, Jayoung Kim","doi":"10.1093/mmy/myac072.P051","DOIUrl":"https://doi.org/10.1093/mmy/myac072.P051","url":null,"abstract":"Abstract Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM Objectives Sporotrichosis is the leading subcutaneous mycosis caused by the Sporothrix (S.) schenckii complex. S. globosa is the causative organism of fixed sporotrichosis in Korea. The preferred regimen of cutaneous sporotrichosis is itraconazole for 3-6 months, however, there were few studies for recalcitrant sporotrichosis. Methods In 2018, we performed a histological examination of a patient who suffered sporotrichosis for 3 years and cultured part of the specimen. Despite various regimens for years, improvement and exacerbation were repeated, so we took another skin biopsy and cultured it in 2021. Isolates from the 2018 and 2021 lesions were identified as S. globosa by ribosomal DNA ITS sequencing (GenBank accession number: MH499862 and MH499863). The in vitro antifungal sensitivity tests were performed by broth microdilution method according to CLSI M38-A2 guidelines or Sensititre YeastOne® manufacturer's instructions. They were incubated at 30°C in a non-CO2 incubator for 7 days. Results In 2018, histologically, we observed chronic inflammatory granuloma comprising lymphocytes, histiocytes, and giant cells, and several spores with periodic acid-Schiff (PAS) staining. Microscopic findings and ITS sequences of rRNA gene were identical with S. globosa. The antifungal susceptibility profile in 2018 revealed sensitive to terbinafine (0.125 μg/ml), and moderate to high MIC values for amphotericin B (2 μg/ml), itraconazole (>16 μg/ml), voriconazole (>16 μg/ml), and echinocandins (>16 μg/ml). Treatment with terbinafine, itraconazole, or amphotericin B, the skin lesions were partially improved, but were not cured. In 2021, we took another skin biopsy and culture specimen. Histopathological and mycological examination results were the same as before. The antifungal susceptibility profile revealed sensitive to itraconazole (0.5/ml), and high MIC for others. Clinically, skin lesions were not improved with the use of itraconazole 200 mg/d. Itraconazole 400 mg/d with local heating induced moderate improvement. There was no evidence of immune deficiency. Conclusion We experienced recalcitrant sporotrichosis that did not respond to itraconazole and terbinafine, and the sensitivity of antifungal was changed. In this case, the combination treatment including local heating, saturated KI may be considered, and frequent antifungal susceptibility tests are needed.","PeriodicalId":18325,"journal":{"name":"Medical mycology journal","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72641838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P010 Evaluation of antifungal efficacy of two novel cyclic lipopeptides of the class Bacillomycin from Bacillus subtilis RLID 12.1 in a murine model of invasive candidiasis","authors":"N. Kashyap, R. Paul, S. Rudramurthy, U. Roy, H. Kaur, Anup K. Ghosh, A. Chakrabarti","doi":"10.1093/mmy/myac072.P010","DOIUrl":"https://doi.org/10.1093/mmy/myac072.P010","url":null,"abstract":"Abstract Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM Objective To evaluate the in vivo efficacy of HPLC–purified antifungal lipopeptides (AF4 and AF5) in a murine model of disseminated candidiasis. Methods C. albicans AMR16294 isolate was used for all the in vivo experiments. A total of 6-week-old pathogen-free, female BALB/c mice, weighing 20-25 g were used for all animal experiments. For Kaplan-Mier analysis, mice were rendered neutropenic by a loading dose of 200 mg/kg cyclophosphamide three days prior (D-3) to infection and 150 mg/kg (D + 1) maintenance dose on day 1 post-infection (D + 1). A total of 60 mice were randomized into 8 different groups with 5 or 6 animals in each group. Animals were infected with 100μL of ∼ 1 × 10⁵ blastospores (corresponding to LD90) via the lateral tail vein. AF4 and AF5 were formulated in sterile PBS and administered intraperitoneally at doses of 5 mg/kg and 10 mg/kg body weight and compared with a clinically-relevant human equivalent dose of caspofungin. AF4, AF5, caspofungin, or vehicle were administered at 1 h and 24 h post-infection. The survival of the mice was monitored for 14 days post-infection. For organ fungal-burden assessment, mice from each group were euthanized by CO2 inhalation, and the organs were aseptically removed, homogenized, and cultured on SDA. Results Both the doses of AF4 significantly reduced the mortality of mice compared to vehicle-treated mice. The survival over 2 weeks in 5 mg/kg, 10 mg/kg, and caspofungin arms were similar and no death was reported in the three groups (P <.01). In contrast, the mortality in-vehicle- administered group was 80% with a median survival of 8 days. A similar survival benefit was observed in AF5-treated mice. While the median survival in the vehicle-treated arm was 5 days, the 2-week survival in 5 mg/kg and 10 mg/kg arms was 80%-100%, comparable to that in the caspofungin arm (P <.01) (Fig. 1). The median CFU/g kidney tissue in 5 mg/kg arm of AF4 was 1.3 × 10⁴ equivalent to a 4-log reduction compared to the vehicle arm (3.8 × 10⁸ CFU/g kidney, P <.0001). The in vivo efficacy was higher at a higher dose with the kidney homogenates of 10 mg/kg arm yielding sterile cultures comparable to that of CAS arm (Fig. 2). Similar organ fungal-burden reduction was noted in heart and splenic tissues with a median cfu/g tissue of 1.3 × 10⁴ in 10 mg/kg, while CAS arms yielded sterile cultures. In AF5 treated groups, the median cfu/g kidney tissue in 5 mg/kg arm was 1.3 × 10⁴, however, the heart and splenic tissue homogenates yielded less fungal burden with median (q2) cfu/g as 0, while q3 of 6.7 × 10³and 1.3 × 10⁴, respectively (Fig. 2). Conclusion Both the antifungal compounds demonstrated a remarkable in vivo efficacy against C. albicans with a significant improvement in survival and a reduction in the organ-fungal burden.","PeriodicalId":18325,"journal":{"name":"Medical mycology journal","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72535708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P337 Species distribution and biofilm profile of Candida isolated from clinical specimens at a tertiary care hospital in India","authors":"A. Samaddar, U. Tendolkar, S. Baveja","doi":"10.1093/mmy/myac072.P337","DOIUrl":"https://doi.org/10.1093/mmy/myac072.P337","url":null,"abstract":"Abstract Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM Introduction The epidemiology of invasive candidiasis (IC) is dynamically changing, given the increasing population of susceptible hosts, use of indwelling medical devices (IMD), and environmental factors. The presence of an IMD is one of the most important risk factors for persistent infection due to the possibility of biofilm formation. The biofilm cells are significantly less susceptible to antifungal drugs and are able to evade the host immune system, serving as a nidus for reinfections. Objectives To determine the species distribution of Candida isolated from clinical specimens of hospitalized patients. To evaluate biofilm formation by clinically significant and colonizing isolates of Candida species recovered from clinical specimens. Methods A total of 100 Candida isolates from patients with suspected invasive candidiasis were tested for the production of biofilm. Based on clinical history, 62% of the isolates were found to be clinically significant, while 38% represented commensals or colonizers. Species identification was done on the basis of germ tube test, CHROMagar, Dalmau plate technique, and carbohydrate fermentation and assimilation tests, and VITEK 2. Four isolates that failed to be identified by conventional methods were subjected to MALDI-TOF MS. Biofilm production was detected and graded by visual (test tube) and spectrophotometric (microtiter plate) methods. Results Non-albicans Candida (NAC) were the predominant clinically relevant isolates recovered from cases of IC (71%), while C. albicans was most commonly associated with colonization (68.4%). Among the NAC isolates, C. tropicalis was the most common isolate (23%) followed by C. glabrata (11%), C. krusei (8%), C. parapsilosis (6%), C. lusitaniae (2%), C. kefyr (2%), C. rugosa (2%), C. guilliermondii (1%), and C. famata (1%) (Fig. 1). A total of 55% of the Candida isolates produced biofilm. Biofilm positivity in clinically relevant isolates was found to be significantly higher than commensals/colonizers (P <.05). Biofilm positive Candida spp. were most commonly isolated from urine (84.6%) followed by blood (67.8%). Biofilm production by NAC (69%) was found to be significantly higher than C. albicans (31%) (P <.05). Majority of the biofilm positive isolates produced Grade 2 (moderate) biofilm (36.4%). C. tropicalis accounted for maximum biofilm production comprising 20% of Grade 4, 53.8% of Grade 3, and 50% of Grade 2 biofilm (Fig. 2). There was 72.7% concordance between the two methods in grading of biofilm. Spectrophotometric method was found to be more sensitive than a visual method for the detection of biofilm. Conclusion Our study demonstrated a paradigm shift from C. albicans to NAC with the isolation of C. tropicalis from a large number of cases, highlighting the growing importance of this pathogen. The knowledge about local epidemiological trends of Candida spp. is important to guide therapeutic choices","PeriodicalId":18325,"journal":{"name":"Medical mycology journal","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72420667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P303 An unusual case of isolated gluteal abscess","authors":"Viplov Vaidya, V. Wagh, S. Sinha, Santosh R Konde, Sohini Arora","doi":"10.1093/mmy/myac072.P303","DOIUrl":"https://doi.org/10.1093/mmy/myac072.P303","url":null,"abstract":"Abstract Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Background Mucormycosis is an invasive infection caused by fungi belonging to the order Mucorales. The angioinvasive disease caused by these fungi can prove to be fatal despite appropriate treatment. We report an unusual case of a gluteal abscess caused by a probable mucormycosis in an apparently immunocompetent individual. Case Description A 68-year-old gentleman hailing from a rural area of Bihar, India presented with a painful swelling over the left buttock region for 4 weeks. He was a known hypertensive and had ischemic heart disease. He denied any history of fever. The lump had gradually increased in size. He was a retired school teacher with a farmland and reared livestock at home. He was a non-vegetarian and denied any addictions. He had a history of intermittent lower backache for which he used to take occasional intramuscular analgesic injections over his buttocks from a local medical practitioner. On examination, the swelling was about 4 cm X 4 cm in size, fluctuant, with ill-defined margins over the lateral region of the left buttock. The swelling was tender, warm, and not fixed to underlying structures. Systemic examination was unremarkable. Ultrasound examination revealed an ∼7.2 × 4.2 × 7.8 cm cystic lesion with a volume of 126cC. It was located predominantly in subcutaneous fat extending into muscular plane with septa and solid components in the left gluteal region (Fig. 1). It had thick walls and fine internal echoes within. Other investigations were unremarkable except for glycosylated Hb, which was 6.2%. Incision and drainage were done. During the procedure, it was seen as a cyst with a thick wall that was removed in toto. The contents were explored after removal and were found to be yellowish black with mucoid consistency. Histopathological examination revealed numerous broad, ribbon-like, aseptate fungal hyphae with right-angled branching infiltrating the inflamed tissue (Fig.2). There were numerous epithelioid granulomas surrounding the fungal elements in the soft tissue of the wall. The findings were consistent with a fungal abscess caused by mucormycosis. Culture of the fluid/pus was negative. Thus, a diagnosis of mucormycotic gluteal abscess was made and patient was commenced on 50 mg of amphotericin B deoxycholate in view of financial restraints. High resolution computed tomography of chest was done which was unremarkable. He developed an acute kidney injury after 2 doses of amphotericin B deoxycholate which was then stopped. Oral posaconazole was started. He has developed bilateral leg swelling post-oral posaconazole and is commenced on oral spironolactone for the same. The postoperative wound has healed well and there is no new swelling or tenderness over the area. He is planned for further follow-up. Conclusions Isolated gluteal abscess caused by mucormycosis is rare in an apparently immunocompetent host. We assume that repeated intramuscular injections ","PeriodicalId":18325,"journal":{"name":"Medical mycology journal","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72471675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P488 Successful treatment of breakthrough invasive aspergillosis in an immunocompetent individual based on therapeutic drug monitoring: A case report","authors":"X. Yin, Z. Zong, Yanbin Liu","doi":"10.1093/mmy/myac072.P488","DOIUrl":"https://doi.org/10.1093/mmy/myac072.P488","url":null,"abstract":"Abstract Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM Background Invasive aspergillosis (IA) is an opportunistic fungal infection in immunocompromised patients with high mortality. Aspergillus flavus is the second pathogen of IA. Breakthrough IA was defined as any IA occurring during exposure to an antifungal drug. Case presentation A 22-year-old female college student was admitted severely unwell with dizziness and left limb weakness. She was healthy previously and did not take any medication. Magnetic resonance imaging showed a right intracranial space-occupying lesion. The postoperative pathological and morphological examinations suggested Aspergillus flavus. The anti-fungal medication, voriconazole, was administered immediately. Unfortunately, her condition deteriorated, and she experienced coma after about 1 month of antifungal treatment. The emergency craniotomy revealed a large amount of pus and the culture of pus confirmed Aspergillus flavus. Antifungal regimen was developed by infectious disease specialists, and drug concentration was monitored continuously. This patient received antifungal treatment for 2 years. No recurrence was observed after 6 months of antifungal drug withdrawal, and she can take care of herself. See Figures below. Conclusion Breakthrough IA occurs in patients who lack high risk factors, making diagnosis more difficult and leading to a higher risk of mortality. Therapeutic drug monitoring is crucial for therapeutic success. Meanwhile, multidisciplinary therapeutics can improve the survival rate.","PeriodicalId":18325,"journal":{"name":"Medical mycology journal","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79099949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P146 Penicillium-like mo ld: caught red-handed, but remained unidentified","authors":"Sujata Rege, R. Soman, D. Chavan, Mahendra Dadke","doi":"10.1093/mmy/myac072.P146","DOIUrl":"https://doi.org/10.1093/mmy/myac072.P146","url":null,"abstract":"Abstract Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objective This case highlights the presence of a self-limited respiratory mycosis in an immunocompetent host and need for fungal sequencing in diagnosis of such rare cases. Methods and Results Ms X, a 25-year-old, apparently healthy software engineer, had an overnight journey in an air-conditioned bus from Hyderabad to Pune. The next day, she developed throat irritation followed 3 days later by fever and cough without dyspnea nor wheezing. Her chest X-ray was found to be normal at the time. Three days later she was admitted to our hospital, wherein X-ray chest and CT chest showed bilateral randomly scattered nodular shadows (Fig. 1). She was referred to ID as a case of suspected tuberculosis, but her presenting symptom being sore throat, the acuteness of symptoms, presence of nodular lung shadows which were absent on the X-ray chest done just 3 days earlier were against the diagnosis of TB. Inhalational fungal or viral pneumonitis were hence considered. Transbronchial biopsy showed an intense alveolar inflammatory exudate, but GMS staining did not reveal any fungal hyphae. BAL Galactomannan, Xpert MTB/RIF were negative. Both BAL and CT guided lung nodule biopsy samples grew a mold. Red pigment formation in culture and its morphological appearance on LPCB mount (Fig. 2) led to a diagnosis of Penicillium species infection. MALDI TOF MS, which had only a few Penicillium spp in its 2018 database, failed to identify the organism, leading us to believe that it could be a different Penicillium species. Since the patient was showing clinical improvement, a self-limited infection was thought of and therapy was withheld with cautious follow-up. The patient was completely asymptomatic after 10 days and CT chest done 20 days later showed complete resolution of the nodules. We believe that this illness was due to inhalation of spores from the air-conditioning vent, eliciting a brisk inflammatory response in the alveoli. The organism grew from BAL and CT guided biopsy from viable spores, but it failed to germinate into hyphae in the human host and hence was not seen on histopathology and did not produce galactomannan which is only released from the tips of growing hyphae. Conclusion Fungi are often isolated from poorly maintained air conditioning vents. In this case, the Penicillium like organism failed to produce progressive disease in the immunocompetent host. If the same organism could be cultured from the AC vent, showed genetic relatedness with the clinical isolate; the source, transmission, and disease linkage could have been established in this case.","PeriodicalId":18325,"journal":{"name":"Medical mycology journal","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84603165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P262 Clinico- microbiological profile of post-COVID pulmonary fungal infections encountered during the second wave of COVID-19 pandemic at a tertiary care teaching hospital in the Himalayas","authors":"Oshin Puri, M. Bhatia, U. Rekha, Deepika Chakraborty, R. Dua, Minakshi Dhar, U. Chauhan, A. Prasad, D. Kalita, Neelam Kaistha","doi":"10.1093/mmy/myac072.P262","DOIUrl":"https://doi.org/10.1093/mmy/myac072.P262","url":null,"abstract":"Abstract Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objective The study aims to generate preliminary data about post-COVID pulmonary fungal infections in the Himalayas and analyze patients’ micro-radio-clinical profiles and outcomes. Methodology We conducted a retrospective study at a tertiary care teaching hospital in the Himalayas to generate preliminary post-COVID pulmonary fungal infection data. Sputum, Endotracheal Tube (ET), and Bronchoalveolar lavage (BAL) samples of patients sent to the Mycology laboratory were subjected to KOH mount and aerobic inoculation on Sabouraud dextrose agar plates at 37°C. The patients’ symptoms, diagnosis, clinical-radiological profile, and outcome were collected from the hospital database. Results Among n = 16 cases of post-COVID pulmonary fungal infections aged 53 +/- 13.38 years, n = 7 (43.75%) had Pulmonary Aspergillosis (n = 5 A. fumigatus, n = 1 A. flavus, n = 1 A. niger), n = 5 (31.25%) had Pulmonary Mucormycosis (Rhizopus arrhizus), and n = 4 (25%) had mixed infection. In 2 of 4 mixed infection patients, R. arrhizus was identified on KOH microscopy and A. fumigatus on SDA Agar. Both A. fumigatus and R. arrhizus were identified on KOH Microscopy of the third patient, while only A. fumigatus was cultivated on his SDA Agar. Aspergillus flavus and R. arrhizus were isolated simultaneously from the sample of the last patient, but only R. arrhizus was identified on KOH Microscopy. Clinical symptoms were similar among Pulmonary Aspergillosis and Mucormycosis patients, but hemoptysis was reported only among Pulmonary Aspergillosis patients. Pre-existing co-morbid end-organ damage, AKI, CKD, CLD, COPD, and CAD was more common among Pulmonary Mucormycosis patients and rare among Pulmonary Aspergillosis patients. Treatment requirements and clinical outcomes of patients infected with either mold were similar. The clinical profile of mixed infection patients was notably different from the others. All the patients were males, none complained of chest pain or expectoration, and none had a history of PTB, AKI, CKD, CLD, COPD, or CAD. Only 2 (50%) mixed infection patients needed supplemental high flow oxygen, unlike all (100%) patients diagnosed with single mold infection. None of the mixed infection patients required steroids. Moreover, none of the mixed infection patients died, unlike 60% mortality in cases of single-species infections. On radiological investigation, n = 6 had typical thick-walled cavitary lesions with air-fluid levels and multiple centrilobular nodules giving a tree in bud appearance, of which n = 4 had bilateral lung involvement, and n = 2 had only one lung involved. n = 1 patient had a well-circumscribed lung abscess. Conclusion COVID patients from the Himalayas had a higher prevalence of invasive pulmonary fungal infections, probably due to the dense surrounding vegetation. The immuno-compromised state following COVID-19 infection/treatment might be responsible for the progression of ","PeriodicalId":18325,"journal":{"name":"Medical mycology journal","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84873042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}