Trichosporon inkin fungemia case report: clinical and laboratory management

Trichosporon species are emerging as opportunistic pathogens that mainly affect immunocompromised patients. Patients with onco-hematological diseases usually present with fungemia by Trichosporon species, especially by T. asahii. Reports of this infection by other species of the genus are uncommon. Thus, in this paper, we present a case of T. inkin fungemia in a 39-year-old female patient with intestinal obstruction and absence of malignant hematological diseases. The late mycological diagnosis, the ineffective control of her pre-existing conditions and consequent failure to start antifungal therapy were the contributing factors for the patient's death.

Responses of White Blood Cells to Killed Candida albicans as a Preventive Strategy

C. albicans is by far the most common Candida species causing infection in humans which include superficial and a life- threatening systemic infections. Despite the public health significance of candida infections, phenotypic switching of C. albicans, slow mycological diagnosis, limitation of use of antifungal agents due to toxicity, high cost and emergence of resistance have impeded effective treatment. Therefore, a need for safe and potent strategy to prevent this disease is necessary. This chapter discusses the roles of white blood cells as the first line defense mechanism against inactivated C. albicans.

Molecular Markers of Antifungal Resistance: Potential Uses in Routine Practice and Future Perspectives

Antifungal susceptibility testing (AST) has come to establish itself as a mandatory routine in clinical practice. At the same time, the mycological diagnosis seems to have headed in the direction of non-culture-based methodologies. The downside of these developments is that the strains that cause these infections are not able to be studied for their sensitivity to antifungals. Therefore, at present, the mycological diagnosis is correctly based on laboratory evidence, but the antifungal treatment is undergoing a growing tendency to revert back to being empirical, as it was in the last century. One of the explored options to circumvent these problems is to couple non-cultured based diagnostics with molecular-based detection of intrinsically resistant organisms and the identification of molecular mechanisms of resistance (secondary resistance). The aim of this work is to review the available molecular tools for antifungal resistance detection, their limitations, and their advantages. A comprehensive description of commercially available and in-house methods is included. In addition, gaps in the development of these molecular technologies are discussed.

Onychomycosis caused by the environmental mold Neoscytalidium dimidiatum in Colombia, and in vitro antifungal susceptibility evaluation

Neoscytalidium dimidiatum is a plant pathogen, but can also cause onychomycosis. We compared clinical and epidemiological data of cases of onychomycosis caused by N. dimidiatum and Trichophyton rubrum. We also evaluated the in vitro antifungal susceptibility of N. dimidiatum clinical isolates. It was not possible to establish any statistical differences between groups, except the place of residence and the number of affected nails. The results suggest that onychomycosis caused by N. dimidiatum is clinically similar to that caused by T. rubrum; besides, N. dimidiatum has been shown to have low sensitivity to itraconazole, but high to terbinafine. Lay Summary Cases of onychomycosis caused by Neoscytalidium dimidiatum were studied and compared to cases of onychomycosis caused by T. rubrum. The individuals affected were adults, and the clinical characteristics were not different between groups; accordingly, mycological diagnosis is mandatory.

Epidemiology and Diagnostic Perspectives of Dermatophytoses

Dermatophytoses affect about 25% of the world population, and the filamentous fungus Trichophyton rubrum is the main causative agent of this group of diseases. Dermatomycoses are caused by pathogenic fungi that generally trigger superficial infections and that feed on keratinized substrates such as skin, hair, and nails. However, there are an increasing number of reports describing dermatophytes that invade deep layers such as the dermis and hypodermis and that can cause deep infections in diabetic and immunocompromised patients, as well as in individuals with immunodeficiency. Despite the high incidence and importance of dermatophytes in clinical mycology, the diagnosis of this type of infection is not always accurate. The conventional methods most commonly used for mycological diagnosis are based on the identification of microbiological and biochemical features. However, in view of the limitations of these conventional methods, molecular diagnostic techniques are increasingly being used because of their higher sensitivity, specificity and rapidity and have become more accessible. The most widely used molecular techniques are conventional PCR, quantitative PCR, multiplex PCR, nested, PCR, PCR-RFLP, and PCR-ELISA. Another promising technique for the identification of microorganisms is the analysis of protein profiles by MALDI-TOF MS. Molecular techniques are promising but it is necessary to improve the quality and availability of the information in genomic and proteomic databases in order to streamline the use of bioinformatics in the identification of dermatophytes of clinical interest.

1165. Epidemiology, management and outcomes of fungal keratitis: A single center study from tertiary hospital in Thailand

Background Fungal keratitis is known as an important cause of sight threatening infection worldwide. Variation of clinical characteristics and treatment have been observed among different geographic regions. Currently, clinical data of fungal keratitis in South East Asia remain scarce. Methods A retrospective single study was conducted at King Chulalongkorn Memorial Hospital in Thailand. Medical records of patient with diagnosis of fungal keratitis between January 2016 and December 2018 were reviewed. Cases were identified using ICD-10 code. Data on demographics, clinical presentations, investigations and outcomes were collected. Mycological diagnosis was made in patients who had clinical presentation compatible with fungal keratitis and positive fungal detection in clinical specimen. Results During study period, fungal keratitis was diagnosed in 59 pts including 31 by mycological and 28 by clinical diagnosis. KOH preparation of corneal scraping was positive in 19 of 53 pts (35.8%). Culture from cornea, aqueous and vitreous yielded positive result in 18 of 53 (33.9%), 2 of 14 (14.3%), respectively. ITS sequence analysis was positive in 7 of 15 (46.7%) from cornea, 1 of 6 (16.7%) from aqueous and 2 of 2 (100%) from vitreous. Culture and molecular detection from clinical specimens provided additional mycological diagnosis in 8 and 5 cases with negative KOH preparation. Fusarium was the most common pathogen (33%) followed by Paecilomyces (9.7%), Aspergillus (6.4%), Candida (6.4%). Ten patients (32.2%) had only positive KOH preparation. All patients received treatment with topical antifungal agent, while 38 pts (64%) required systemic, 24 pts (40.7%) received intrastromal, 22 pts (37.2%) received intracameral and 3 pts (5.1%) received intravitreal antifungal therapy. Operation was performed in 21 pts (35.6%) which 6 (28.5%) required evisceration. Twenty-three patients (39%) had visual improvement after complete treatment. Conclusion Fungal keratitis is not an uncommon disease. Fusarium was the most common etiologic agent similar to study from other region. Unfavorable outcomes were observed in majority of cases. Appropriate fungal culture and molecular detection from clinical specimens can be considered as they may increase diagnostic yield in some patients. Disclosures All Authors: No reported disclosures

Pulmonary aspergillosis in critically ill patients with Coronavirus Disease 2019 (COVID-19)

Occurrence of putative invasive pulmonary aspergillosis was screened in 153 consecutive adult intensive care unit (ICU) patients with respiratory samples addressed for mycological diagnosis during a 6-week period at the emergence of coronavirus disease 2019 (COVID-19) pandemic. Positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) was observed for 106 patients (69.3%). Nineteen of them (17.9%) with positive Aspergillus results were considered as having putative invasive pulmonary aspergillosis. These observations underline the risk of pulmonary aspergillosis in COVID-19 patients, even in patients not previously known to be immunosuppressed, advocating active search for Aspergillus infection and prompt antifungal treatment. Standardized surveillance protocols and updated definitions for ICU putative invasive pulmonary aspergillosis are needed. Lay Abstract Adult ICU patients with respiratory samples addressed for mycological diagnosis were screened during the emergence of COVID-19 pandemic. Positive SARS-CoV-2 PCR was observed for 106 patients, nineteen of them (17.9%) having aspergillosis. This underlines the risk of aspergillosis in COVID-19 patients.

Prevalence of Tinea unguium (Onychomycosis) in Toe Nails of boot wearing group (The Footballers) in Owerri, Imo State. Nigeria

Foot mycoses are a frequent disease that represents a public health problem worldwide. This study aims to evaluate the epidemiology of foot mycoses among footballers in Owerri, Imo State, in order to determine the fungal etiological agents and to identify possible risk factors. To investigate the treatment and preventive measures for the susceptible groups. A total of 485 samples were collected; tinea unguium were confirmed in 88.2% of cases. A prospective study of fifty footballers was undertaken during one year (2018-2019). A complete mycological diagnosis was carried out on all footballers. The results obtained showed that out of the 50 toe nails samples of footballers examined, 28(56.0%) had positive cases of the infection on direct microscopy which served as the screening test. The causative pathogens of Onychomycosis isolated from fungal culture are dermatophytes , and the most frequent pathogen was Trichophyton rubrum 15(30.0%), yeast Candida albicans 9(18.0%). Non-dermatophyte molds were observed in 8(16.0%) cases and Fusarium sp. was the frequent genus 14(28.0%)and Aspergillus sp. 4(8.0%). The main predisposing factors of fungal foot infections were practicing ritual washing (56.6%) and frequentation of communal showers (50.5%). Confirmatory test such as germ-tube test was done on the Candida albicans isolate for proper identification. The age group 31- 35 years had the highest prevalence of onychomycosis 12(92.31%) and age group 16-20 years presented the lowest prevalence of onychomycosis 4(28.57%). Proper care of toe nails and boots is necessary to prevent the increasing rate of this infection.

Efficacy and Safety of Voriconazole in the treatment of resistant cases of Dermatophytosis

This is a descriptive type of longitudinal study conducted among Hundred clinically diagnosed cases of dermatophytes attending at skin out patients department of Zainul Haque Sikder Women’s Medical College, Bangladesh from August 2018 to August 2019 to observe the efficacy and safety of voriconazole among the resistant cases of dermatophytosis. Among 100 patients, 40 were males and 60 females between ages 20 and 65 years of all age group with clinical, mycological diagnosis of dermatophytosis. To find out antifungal resistance pattern as well as efficacy and Safety of Voriconazole among dermatophytes. (Skin, hair and nail samples were taken aseptically. All patients were resistant against present treatment options like: fluconazole, itraconazole & terbinafine etc.) All patients were treated with Voriconazole. Duration of treatment of each patient was 4 weeks. Resistance against fluconazole and terbinafine was most common, 85.33% and 58% respectively. 5% resistance against voriconazole was observed in this study. Resistance against fluconazole was noted among all species of dermatophytes, followed by terbinafine. Among 100 patients 80% was fully cure and rest of 15 % were partially cure with 5% resistant of Voriconazole which is seems to be more effective and safer against dermatophytosis.

Otomycosis at Fann Hospital in Dakar (Senegal): Prevalence and Mycological Study

Otomycosis are auricular infections caused by microscopic fungi which develop essentially in the external ear canal. Their incidence has increased these past years with the emergence of predisposing factors such as the repetitive use of broad -spectrum antibiotics. The objectives of this study were to determine the prevalence of otomycosis at Fann National University Hospital in Dakar and to identify the fungal species responsible for that. This descriptive retrospective study held from October 2011 to December 2017 at 136 patients with clinically suspected otomycosis. External auditory canal exudates collected with swabs in each patient were observed by direct microscopic examination and cultured in Sabouraud Chloramphenicol medium with and without Actidione at 30-37°C. The strains were identified on the basis of macroscopic, microscopic and physiological characteristics. The mycological examination was positive in 59 patients, that is to say, a prevalence of 43.4%. The positivity rate was significantly higher among women (52.6%) than among men (31%) (p=0.012). This rate was significantly higher among patients suffering from otalgia (75.7%) than among others (p=0.023). On the mycological plan, Aspergillus fumigatus and Candida albicans were the species the most isolated (26.3%) followed by Aspergillus niger (22.8%). These results show that fungal agents have an important place in the etiologies of the external otitis at Fann Hospital CHNU. Hence the interest of the mycological diagnosis for a better treatment of patients.