Medical mycology journal最新文献

{"title":"P150 Profile of Candidemia in a national level HAI Surveillance Network of India","authors":"Sharad Srivastav, Mamta Puraswani, Prachi Tewari, P. Mathur","doi":"10.1093/mmy/myac072.P150","DOIUrl":"https://doi.org/10.1093/mmy/myac072.P150","url":null,"abstract":"Abstract Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Background Candida is responsible for roughly 96% of all opportunistic mycoses and is a major cause of bloodstream infections (BSIs). The potential for nosocomial spread of Candidemia infections is a new concern concurrent with the rapid expansion of intensive care facilities for COVID-19 patients. With the pandemic of COVID-19 now moving into 2022, it is understood that critically ill COVID-infected patients in the ICUs are commonly infected with highly resistant bacterial and fungal infections. Objective To estimate the incidence rates and compare the epidemiology of candidemia in COVID infected and non-infected patients requiring ICU care. Methodology In this 2-year retrospective multicentric study, we present the findings on candidemia from the Healthcare-Associated Infections (HAI) surveillance network which includes 40 hospitals across India and with special emphasis on differences in the epidemiology of Candidemia in COVID infected and non-infected patients in the pre-COVID (April 2019 to April 2020) and COVID times (April 2020 to April 2021) across this network. We compared the incidence of candidemia between COVID infected and non-infected patients using Poisson regression analysis. Chi-squared (χ2) test was used to test for differences in variables such as gender and 14-day mortality between the patients and Wilcoxon rank-sum (Mann-Whitney) test was used to compare median between the patients. Results A total of 628 patients with candidemia were screened from HAI Surveillance Database where 68 patients are COVID infected and 560 non-infected patients from both pre-COVID and COVID periods. Incidence of Candida-associated BSI increased significantly from 1.47 (95% CI, 1.35-1.60) to 3.08 (95% CI, 2.38-3.92) in non-infected and COVID-infected patients respectively, while in CLABSI the rates increased from 2.62 (95% CI, 2.34-2.92) in non-infected to 5.99 (95% CI, 4.30-8.12) in COVID-infected patients. COVID infected patients in the age group (>60 years) were significantly more prone to candidemia compared to non-infected patients. During the COVID period, the maximum time for candidemia to develop (from the time of ICU admission) in COVID-infected patients was shorter (<65 days) than in non-infected patients (>90 days). Conclusion We observed an increased incidence of candidemia in hospitalized patients during the COVID period compared with the same during the pre-COVID period.","PeriodicalId":18325,"journal":{"name":"Medical mycology journal","volume":"1 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91317160","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":"P223 First case of Candida auris candidemia in Manipur, Northeast India","authors":"O. Konjengbam, R. Khuraijam, Priyolaxmi Ningthoujam, A. Acharjee, Hari Presanambika, Binita Thingam","doi":"10.1093/mmy/myac072.P223","DOIUrl":"https://doi.org/10.1093/mmy/myac072.P223","url":null,"abstract":"Abstract Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objective Candida auris is known as an emerging ‘superbug’ because of its intrinsic resistance to one or more, sometimes to all available antifungal drugs and spreading globally. It has the ability to cause devastating nosocomial infections. In India, C. auris infection is on the rise with reports from north, south, central and eastern India. Here we present the first case of C. auris fungemia from a tertiary care hospital of Manipur in Northeast India. Methods A 15-year-old Muslim girl was referred from a private hospital to Regional Institute of Medical Sciences (RIMS) hospital on November 19, 2021 with a history of burning epigastrium, headache, loss of appetite, shortness of breath, dry cough, fever, and generalized weakness for last 3 days. At the time of admission she was cyanotic. Family gave history of congenital heart disease and frequent visits to hospital. Echocardiogram revealed congenital cyanotic heart disease (Tetralogy of Fallot) showing large perimembranous VSD with bidirectional shunt. A complete hemogram showed neutrophilic leukocytosis with shift to left with band form, absolute monocytosis, and increased RBC count with mild anisocytosis. On November 24, 2021, 5 days after admission, her condition deteriorated and she was shifted to ICU. However, the condition of the patient deteriorated and she died on November 29, 2021 due to acute decompensated heart failure. Follow-up of other patients admitted in the same ward revealed no candidemia in next the few weeks. Results A single blood culture sent on November 29, 2021 was incubated in an automated blood culture system, BacT Alert and showed growth of budding yeast cells. Growth in SDA revealed it to be Candida sps. and Gram-stained smear examination revealed presence of budding yeast cells but no pseudohyphae. Germ tube test was negative. On CHROM agar, it produces pale yellow colonies at 24 h which progresses to light purple colonies around the rim at 48 h. Further processing in VITEK 2 (Biomerieux) identified it as C. auris. The isolate was sent to National Culture Collection of Pathogenic Fungi, WHO collaborating center, PGIMER and the isolate was confirmed as Candida auris by MALDI-TOF assay. Conclusion Candida auris is spreading irrespective of the level of health care. Blood culture before administration of antibiotics and in febrile sick patients cannot be underestimated. Rapid and accurate identification methods for timely diagnosis and stringent infection control measures with an emphasis on hand hygiene are important to prevent and control C. auris outbreaks.","PeriodicalId":18325,"journal":{"name":"Medical mycology journal","volume":"30 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75426106","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":"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":"30 1","pages":""},"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":"P404 Biofilm formation by Cryptococcus species isolated from Cerebrospinal fluid (CSF)","authors":"Priyolakshmi Ningthoujam, Robertson Sawian, R. Khuraijam","doi":"10.1093/mmy/myac072.P404","DOIUrl":"https://doi.org/10.1093/mmy/myac072.P404","url":null,"abstract":"Abstract Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM Introduction Cases of Cryptococcal meningitis have increased exponentially in the last 30 years due to the advent of AIDS, the use of immunosuppressive drugs, and chemotherapeutic agents. Among HIV-infected patients’ relapse is seen often. The ability of Cryptococcus to form biofilm may influence the clinical outcome of patients though poor adherence to ART and/or anti-fungal therapy is a known factor for relapse. Methods During a period of 2 years and 8 months (August 2019 to March 2022), 11 Cryptococcus sps. were isolated from 59 cerebrospinal fluids (CSF) collected from patients clinically suspected of meningitis. Samples were examined and processed by direct microscopy and fungal culture. Identification of cryptococcal isolates was carried out by conventional method and by using an automated VITEK-2 (Biomerieux) identification system. Biofilm production was estimated by XTT reduction assay. Statistical analysis was done in SPSS version 21 (IBM) and Fischer's exact was used to find an association between biofilm formation and relapse. Results Out of 11 Cryptococcus isolated 10 were identified as C. neoformans and one was C. gattii. Three HIV-infected patients had recurrent cryptococcal meningitis. A total of 6 (42.8%) cases reported non-adherence to ART and/or anti-fungal therapy. Biofilm was detected in 3 isolates one of which was from a patient with re-current cryptococcal meningitis but the association is not statistically significant. Discussion Non-adherence to HAART among HIV patients is known to increase the rate of hospitalization and mortality. Recurrence of cryptococcal meningitis has been thought to be due to drug resistance. But Illnait-zaragozí MT et al. based on STR typing technique, concluded that recurrence was due to co-infection with different strains or strains genetically modified during the long maintenance therapy. Biofilms produced by bacteria as well as fungus have been associated with more stubborn, recurrent, and persistent infections, especially among the immunocompromised population. Although biofilm production was detected in only one out of 3 isolates from recurrent cryptococcal meningitis, it may be a contributing factor along with non-adherence to treatment. Conclusion Non-adherence to ART and/or antifungal therapy is an important cause of relapse of cryptococcal meningitis. Biofilm production may be responsible for recurrence, especially among non-adherent patients. Further studies with a larger sample size may shed more light on the association between biofilm formation and recurrence.","PeriodicalId":18325,"journal":{"name":"Medical mycology journal","volume":"14 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78433543","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":"P385 Candida auris: a growing threat to global health","authors":"Sharin Varma, Smriti Srivastava, Neha Sharad, V. Kiro, Aparna Ningobam, P. Mathur","doi":"10.1093/mmy/myac072.P385","DOIUrl":"https://doi.org/10.1093/mmy/myac072.P385","url":null,"abstract":"Abstract Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM Background and Objectives The emerging pathogen, C. auris, has been associated with nosocomial outbreaks in recent times. The true scale of the problem is difficult to comprehend due to several issues with the identification of C. auris using both phenotypic and molecular techniques. Most commonly, these isolates have been misidentified as C. haemulonii. Biofilm formation is strongly suggested given its association with intensive care settings, especially in patients with CVCs and long-term urinary catheters. Many isolates of C. auris have also shown raised MICs to multiple classes of antifungal agents, raising the possibility of pan-drug resistance. Objective To study the demographic characteristics, risk factors, and outcomes in patients with C. auris infection. Methodology This is a retrospective study from a tertiary care hospital (JPNATC, AIIMS) including all patients from the time period of 2018-2022 that showed growth of C. auris in any site. C. auris was identified using conventional methods (pale-pink growth on chromogenic medium, no pseudohyphae on germ-tube test, growth in presence of 10% NaCl) and VITEK-2. To reduce the misidentification and the intertest variability, the results were confirmed with MALDI-TOF. The risk factors and other patient information were taken from the HIS. Statistical analysis was performed. Results During the study period, a total of 31 patients had a C. auris infection. The most common age group was 20-40 years (n = 11,44%) with a preponderance in males (n = 23,74%). A total of 74% of the infections were found in blood, which was the most common site of infection followed by urine (10%). The other sites were pus-from-wound (n = 2), groin, nailbeds, and CVP tip (n = 1). Most of the cases were ICU patients (86%). All the patients with candidemia due to C. auris (n = 17 100%) had CVC, had surgery within the past 30 days, and were on broad-spectrum antibiotics and TPN. 71% (n = 12) had a history of immunosuppression and 18% (n = 14) had a history of prior antifungal therapy. Although 100% (n = 17) had the presence of an indwelling urinary catheter, none of them had candiduria due to C. auris. No patient with C. auris infection had neutropenia. The median LOS was 34.5 days. Most of the isolates were resistant to fluconazole (n = 13,93%), amphotericin B (n = 13,93%), voriconazole (n = 6,55%), flucytosine (n = 10,71%). A total of 87% (n = 12,87%) of isolates were sensitive to caspofungin and micafungin by VITEK-2 (limitation of this study). In all, 28% (n = 7) of the patients died whereas 40% (n = 10) were discharged. A total of 75% patients had clearing of the persistent candidemia when treated with caspofungin whereas only 25% patients had clearing of the candidemia when treated with voriconazole. Conclusion Most cases of C. auris infection were found in critical patients with the most common presentation being candidemia. The risk factors are simi","PeriodicalId":18325,"journal":{"name":"Medical mycology journal","volume":"283 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75420671","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":"P428 Evaluation of Galactomannan enzyme assay in non-hematological non-neutropenic ICU admitted patients for diagnosis of Invasive Pulmonary Aspergillosis as per EORTC criteria 2019","authors":"S. Kashyap, M. Capoor, P. Lavanya, Poonam Gupta, P. Verma, Vandana Talwar, H. Sachdeva","doi":"10.1093/mmy/myac072.P428","DOIUrl":"https://doi.org/10.1093/mmy/myac072.P428","url":null,"abstract":"Abstract Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM Objective The objective of this study was to evaluate galactomannan enzyme assay in non-hematological ICU patients for diagnosis of Invasive Pulmonary Aspergillosis as per EORTC criteria 2019. Methods Galactomannan detection in serum samples was performed by enzyme-linked immunosorbent assay in 138 patients with clinically suspected pulmonary aspergillosis between January 2012 and January 2019 in patients admitted to ICUs. Patients with hematological diseases or who underwent HSCT were excluded. Control group (n = 25) was selected from patients with no obvious immunosuppression, cough/dyspnea, or any other respiratory symptoms, etc admitted for elective surgeries from surgery wards. According to the criteria of the European Organization for Research and Treatment of Cancer/Mycoses Study Group revised in 2019, the patients were categorized as proven, probable, and possible IA. Galactomannan optical density indices ≥0.5 and ≥1 were analyzed with respect to clinical, radiological, and mycological evidence. Results Amongst 138 patients 2 fulfilled the criteria of proven IA, 78 were probable IA, and the rest (58) were grouped under possible IA. In the control group, the Galactomannan optical density index was ≤ 0.5. Receiver operating characteristic curve analysis showed the serum GM detection cutoff value was 0.91 (95% CI 0.885-0.973, P-value <.0001) with Youden index J = 0.78, its diagnostic value for pulmonary aspergillosis was optimized, and the sensitivity and specificity reached 83.75% and 94.83% respectively. Other cutoffs had high variance between sensitivity and specificity for the diagnosis of IPA. Conclusion Our study highlights the usefulness of the serum GM antigen test in the early diagnosis of IA and suggests a GMI cutoff of 0.91 as it has the highest diagnostic accuracy. Also, we recommend that patients with a GM OD of ≥1.0 should be labeled as clear GM positive, whereas those with <0.5 OD should be labeled as GM negative, and in those with OD ranging from 0.5 to 1.0, repeat sampling from the patient is advisable. It seems more reasonable not to overtreat all patients with fever refractory to broad-spectrum antibiotics with antifungal agents, but rather to decide taking into account the serum GM antigen positivity. A negative GM antigen can curtail the usage of unwarranted antifungal therapy, especially in resource-poor country like India.","PeriodicalId":18325,"journal":{"name":"Medical mycology journal","volume":"1 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83404925","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":"20 1","pages":""},"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":"S1.4d Cryptococcus qPCR assays: the future for routine mycology labs and clinical trials dealing with cryptococcosis","authors":"T. Mbangiwa, Aude Sturny-Leclère, K. Lechiile, Cheusisime Kajanga, T. Chammard, O. Lortholary, F. Dromer, J. C. Hoving, David S. Lawrence, H. Mwandumba, M. Mosepele, T. Harrison, J. Jarvis, A. Alanio","doi":"10.1093/mmy/myac072.S1.4d","DOIUrl":"https://doi.org/10.1093/mmy/myac072.S1.4d","url":null,"abstract":"Abstract S1.4 Fungal infections in Asia, bringing it out of the dark, September 21, 2022, 11:00 AM - 12:30 PM Background Routine laboratory testing for cryptococcal meningitis currently consists of Cryptococcal antigen (CrAg) testing in blood and cerebrospinal fluid (CSF), CSF India ink, and CSF fungal culture. Quantitative cryptococcal culture (QCC) is labor intensive and not feasible in most settings. Objectives We evaluated quantitative (qPCR) and reverse transcriptase qPCR (RT-qPCR) assays to quantify cryptococcal load in CSF, plasma, and blood. We also investigated the dynamics of fungal DNA and RNA detection during antifungal treatment. Methods We developed a qPCR assay that can differentiate serotypes A, D, and B/C of Cryptococcus neoformans and C. gattii based on the amplification of a unique nuclear Quorum sensing protein 1 (QSP1) and a multicopy 28S rRNA gene and evaluated the assays on 205-patient samples from the AMBITION-cm trial in Botswana and Malawi (2018-2021). CSF, plasma, and whole blood samples were stored per patient and were sampled at day 0 (baseline), day 7 and 14 for CSF and at day 1, 3 and 7 for plasma and whole blood post antifungal treatment initiation. A Roche LightCycler480 and Graph pad prism were used for data analysis. Results A total of 205/209 stored patient samples (85 from Botswana; 124 from Malawi), were used. For QSP1 qPCR tested in CSF at D0, 138 (81.7%) were serotype A, 28 (16.6%) were serotype B/C and 3 (1.8%) were a mixed infection of serotype A and B/C. There was no amplification with 36 (17.6%) samples. There was no difference in fungal loads at D0, D7, and D14 between serotype A and B/C with the QSP1 qPCR assay, and QCC. QCC showed a good correlation with qPCR quantification with QSP1 qPCR (slope = 0.797, R2 = 0.73) and with 28S rRNA qPCR (Slope = 0.771, R2 = 0.778) assays. The fungal load at D0 was significantly higher in patients who died at week 2 (w2) and at week 10 (w10) as compared with patients who survived post-week 10 (P <.01), with no significant difference in initial fungal load in both treatment regimens (P >.05). Detection of Cryptococcus DNA (28S rRNA qPCR) in plasma or whole blood within the first 24 h of treatment was significantly associated with early mortality at w2 and mortality at w10 (P <.01). QSP1 RT-qPCR showed that detection of DNA was due to viable fungal cells as the quantification of QSP1 whole nucleic acids was systematically higher (X2 to 5) than that of DNA. Conclusion Quantification of C. neoformans and C. gattii load in CSF and plasma at D0 is useful in identifying patients at risk of death and may be a promising tool for monitoring treatment response in the future.","PeriodicalId":18325,"journal":{"name":"Medical mycology journal","volume":"43 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89725035","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":"P409 Study of epidemiology, risk factors and antifungal sensitivity pattern of fungal pneumonia in critically ill cirrhotics","authors":"Paras Singh, P. Kale, V. Khillan, S. Sarin","doi":"10.1093/mmy/myac072.P409","DOIUrl":"https://doi.org/10.1093/mmy/myac072.P409","url":null,"abstract":"Abstract Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM Objectives Liver cirrhosis causes immune dysregulation and increased susceptibility to fungal infections. We studied the epidemiology and risk factors, and compared the rapid diagnostic methods and biomarkers for fungal pneumonia in critically ill cirrhotics. Methods Single-center, prospective cohort study of 100 critically ill cirrhotics with fungal pneumonia between January to September 2021. Comparative analysis was done for culture, realtime PCR and biomarkers, bronchoalveolar lavage and serum Galactomannan, and serum procalcitonin measured on days 1, 3, and 7. The final outcome considered was mortality within 1 month after diagnosis or discharge. Results Aspergillus flavus was the most common species (70/100,70%). Risk factors were, neutropenia (P .03), steroids prior to ICU admission (P .02), prolonged hospitalizations ˃21 days (P .05), and culture positivity was 80%. The culture was not inferior to realtime PCR for the diagnosis of fungal pneumonia. BAL Galactomannan was an early prognostic marker with a median rise above ˃ 3.5 index value. The Median PCT level was higher from day 1in the fungal pneumonia non-survivor group (3.29 vs. 0.8 ng/ml) with higher 30-day mortality (72%). Higher PCT was associated with bacterial co-infection (48%), antibiotic (74%), antifungal therapy, and renal failure and mortality. Conclusion Fungal pneumonia complicates cirrhotics with neutropenia, prolonged hospitalization, and steroids as risk factors. Aspergillus flavus predominate in consensus with Asian epidemiology. Culture methods are reliable and a combination of molecular tests with BAL Galactomannan is useful for rapid diagnosis. Serum PCT is raised in patients with fungal pneumonia and is associated with higher mortality. In our study the baseline PCT at admission to ICU was higher in the non-survivor group, and levels on D3 and D7 were persistently higher. High serum procalcitonin level is an independent prognostic biomarker of mortality risk in fungal pneumonia.","PeriodicalId":18325,"journal":{"name":"Medical mycology journal","volume":"15 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89733436","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":"P221 Deep dermatophytosis presented as multiple exophytic masses caused by Trichophyton rubrum in immunocompromised patient with rheumatoid arthritis; a case report","authors":"S. Hong, Seung Hee Jang, Sang-Woo Ahn, J. Choi, J. Shin, Jayoung Kim, J. Seol, Hyojin Kim","doi":"10.1093/mmy/myac072.P221","DOIUrl":"https://doi.org/10.1093/mmy/myac072.P221","url":null,"abstract":"Abstract Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM   Dermatophyte invades the stratum corneum and infects the skin, nails, and hair, mostly resulting in superficial infection. Deep dermatophytosis involving dermis and subcutaneous layer was rarely reported in immunocompromised state. Herein, we report a case with deep dermatophytosis caused by Trichophyton (T.) rubrum. A 71-year-old woman presented with multiple erythematous exophytic and subcutaneous nodules located on both lower legs. She was taking immunosuppressive agents for rheumatoid arthritis and had taken antifungal agents for tinea pedis and onychomycosis, which was improperly ceased. Histopathologic examination revealed pseudoepitheliomatous epidermal hyperplasia with microabscess formation in epidermis and diffuse granulomatous inflammation consisting of multinucleated giant cells, lymphocytes, neutrophils, and histiocytes in dermis. Imuunohistochemical staining with periodic acid-schiff (PAS) and Gomori methenamine silver (GMS) showed septate and branched fungal hyphae in dermis. Trichophyton rubrum was identified in fungal culture with tissue and confirmed through phylogenetic analysis of internal transcribed spacer (ITS) and large subunit regions (LSU) in ribosomal RNA. Prior to identification of causative organism, her condition deteriorated into septic shock. Amphotericin B was administered empirically for 6 days in order to prevent hematogenous dissemination and skin lesions were simultaneously resolved. Since deep dermatophytosis appears in various clinical manifestations, it is easy to be mistaken for another disease. If treatment is delayed, immunocompetent patients can progress to severe disease courses like hematogenous dissemination, so clinicians should differentiate this disease and conduct treatment at an appropriate time.","PeriodicalId":18325,"journal":{"name":"Medical mycology journal","volume":"24 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87853377","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}