Clinicomycological Study of the Spectrum of Pulmonary Aspergillosis at a Tertiary Care Hospital in Central India

Knowing the spectrum, prevalence, and modes of diagnosis of pulmonary aspergillosis (PA) will be beneficial to clinicians for its early diagnosis and management. This study aims to estimate the prevalence, spectrum, and role of serological tests and radiological findings in the diagnosis of PA. A total of 150 patients were suspected of having PA after obtaining relevant clinical history and radiological imaging. The patients were grouped into each spectrum of PA as invasive PA (IPA), chronic necrotizing PA (CNPA), aspergilloma, allergic bronchopulmonary aspergillosis (ABPA) based on predisposing factors, clinical and radiological findings, and the guidelines of the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG). Samples (bronchoalveolar lavage (BAL), sputum, blood) were collected from these patients and processed in a microbiology lab. BAL and sputum were subjected to microscopy by potassium hydroxide mount, calcofluor white mount, and culture. The serum was separated from blood by centrifugation and subjected to specific serological tests based on the spectrum of PA that the patient was suspected to have. For IPA, serum and BAL galactomannan antigen enzyme-linked immunosorbent assay (ELISA) was performed. For CNPA and aspergilloma, the anti-Aspergillus IgG antibody ELISA was performed. For ABPA, the tests performed were total immunoglobulin E (IgE) ELISA, Aspergillus fumigatus-specific IgE ELISA, and anti-Aspergillus immunoglobulin G (IgG) antibody ELISA. After compiling the clinical, radiological, culture, and serological findings, patients were diagnosed to have a particular spectrum of PA. The prevalence of IPA was 1.4%, CNPA was 4%, ABPA was 3.2%, and aspergilloma was 2.9%. CNPA was the predominant spectrum of PA in our study. Culture positivity for Aspergillus species was seen the highest in aspergilloma patients, followed by IPA, ABPA, and CNPA patients. A. fumigatus was the most common causative agent of PA, except for IPA for which Aspergillus flavus was the most common causative. Aspergillus niger and Aspergillus terreus were less the frequent causes of PA. A combination of radiological, microbiological, and serological tests along with clinical correlation is needed to confirm the diagnosis of PA.

Morphological Diagnosis of Blastomycosis Clinically Presenting as Mycetoma in a Young Immunocompetent Indian Patient; A Diagnostic Dilemma

Primary cutaneous blastomycosis is very rare in non-endemic regions like India. Only few cases have been reported from India. Herein, we are reporting a rare case of chronic cutaneous blastomycosis in a young immunocompetent male presenting as mycetoma with multiple discharging sinuses in the anterior abdominal wall with no significant travel history.

Acanthamoeba species from a post-covid patient with CSF rhinorrhea; a next possible post covid menace? A case report

A case of Acanthamoeba rhinorrhea in a 32 years female, who was recently recovered from COVID-19 infectionat a tertiary care institute in India. Though, there was no standard treatment protocol for management of amoebic-meningo encephalitis. The patient was managed successfully with combination therapy of amphotericin B and miltefosine. Agents having trophicidal and cysticidal activities are used for treatment of CNS Acanthamoeba infection. COVID 19 infection, steroid therapy anddiabetes mellitus which lead to low immunitywere found to be associated contributing factors.

P107 Spectrum of Dermatophyte infections and drug susceptibility pattern of Dermatophytes in patients visiting to tertiary care hospital in Chhattisgarh state of India

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM

 

Objectives

1. To isolate and identify various species of Dermatophytes from clinical specimens 2. To perform and analyze the antifungal susceptibility testing of isolated Dermatophytes for commonly used antifungal agents; terbinafine and itraconazole.

Methods

A prospective study was conducted from December 2019 to October 2021. Clinical specimens (skin, hair, and nail) from suspected cases of dermatophytosis were received and processed in the department of microbiology. All the samples were subjected to microscopic examination and culture by standard techniques. Their clinico-demographic profile was obtained. Specimen were processed for KOH and fungal culture. Dermatophytes were identified by studying macroscopic and microscopic characteristics of the isolates. The conidium-forming dermatophyte isolates were processed for antifungal susceptibility testing for terbinafine and itraconazole by Microbroth dilution testing following the CLSI M-38A2 guidelines.

Results

Total 248 patients with male predominance (68%) were noted in the above-mentioned study period. Predominance of study population belonged to rural area. Maximum numbers of cases were from the age group 21-30 years. Majority of patients belong to poor socioeconomic status. Out of 248 samples, 178 (72%) had a positive KOH mount amongst which 72% had positive culture results. Amongst 2 4881% were skin scraping, 17% were nail, and 1.6% hair samples were processed. Out of culture-positive samples 52% were Dermatophytes. The most clinical form of dermatophytosis was combination of both Tinea cruris and T. carporis (31%) followed by T. cruris (22%), and T. corporis (17%) for which skin scraping was processed. The most common isolate was Trichophyton tonsurans (73%) followed by T. mentagrophytes (10%), and T. verrucosum. Onychomycosis was diagnosed in 17% patients of which 59% were positive by KOH 49% were culture positive.11.5% isolates from nails were dermatophytes.

Antifungal susceptibility testing was done by Microbroth dilution method and analyzed the range. The MIC range of major isolates, i.e., T. tonsurans showed MIC ranges against terbinafine <0.03-4 μg/ml and itraconazole 0.03-2 μg/ml. Trichophyton mentagrophyte for terbinafine <0.12-4 μg/ml and for itraconazole 0.12-2 μg/ml. Four isolates of T. tonsurans had higher MIC values for terbinafine and two isolates had higher MIC for itraconazole. One isolate of T. mentagrophytes had higher MIC values of itraconazole, and one another isolate had higher MIC for terbinafine.

Conclusion

This study highlights the change in pattern of causative agents of dermatophytosis. The present study showed the predominance of T. tonsurans. More extensive studies are needed to evaluate the cut-off range of antifungal susceptibility testing of dermatophytes with clinical follow-up to see the response of respective antifungals and to guide the therapy.

P216 Rare isolates from subcutaneous mycotic lesions; A study from tertiary care center in Chhattisgarh, India

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.

P165 Mycological profile of keratitis from tertiary care center in the state of Chattisgarh, India

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

 

Objective

To assess the burden of fungal etiology of clinically suspected mycotic keratitis amongst the patient presented to the Ophthalmology department in a tertiary care hospital in Chhattisgarh.

Methods

This is a laboratory-based retrospective study of the corneal scrapings received for mycological processing between January 2020-December 2021. Demographic data were collected from patients and from their medical records. Corneal scrapings were aseptically collected from the margins of the ulcer using a sterile Kimura blade in the Ophthalmology department and the samples were processed by following the standard microbiology protocol. A wet mount examination with 10% KOH was done. Samples were also smeared onto a sterile slide for Gram stain. Samples were inoculated in a C-shaped manner on media on blood agar, chocolate agar, and Sabouraud's dextrose agar supplemented with chloramphenicol. Media were incubated in a 25^°C aerobic incubator and observed for growth daily for a week and thereafter on alternate days. Blood agar was incubated at 37^°C. Fungi were identified by the conventional method by Lactophenol cotton blue microscopy (LPCB) and slide culture. Antifungal susceptibility testing for Voriconazole with E-test was performed for Aspergillus and Fusarium species.

Results

A total of 37 patients with suspected mycotic keratitis were included in the duration of the study period. The demographic details hinted more predisposition of keratitis in females than in males; with a mean age of 49 ± 2 years and a range from 21 to 80 years. The predominant predisposing factor was trauma with organic matter in agricultural background. Amongst the total 37.8% (14/37) were positive for both KOH and culture, while 5.4% (2/37) were KOH negative but culture positive. There were 5 isolates that could hint toward low sample load or certain technical logistic issues could not be culture. Amongst culture-positive isolates, Fusarium species (37.5%) was the most common isolate showing predominance of Fusarium oxysporum, followed by Acremonium species and Aspergillus species 19%, with rare isolation of Colletotrichum dematium and Scedosporium species.

Conclusion

Culture remained the gold standard for the detection of fungal agents which will help to know the epidemiology of the local areas and guide the clinicians to prevent and treat the affected patients effectively. The tropical environment and agricultural occupation in Chhattisgarh present variability in the etiology of mycotic keratitis. With the predominance of Fusarium species, unusual fungal isolates of C. dematium and Scedosporium species from corneal ulcers were observed. Early detection is essential to initiate appropriate antifungal therapy and to minimize preventable ocular complications like blindness.

Detection of a Lophomonas, a rare pathogen in Bronchoalveolar lavage

Lophomonas infection is an emerging parasitic disease-causing respiratory infection. Although common in immunocompromised patient, it has been observed also in some immunocompetent cases. We report the case of a 45-year-old male who presented with productive cough, fever, and chest pain, with marked eosinophilia and cavitary lesion in the X-ray chest. KOH preparation and acid-fast bacilli microscopy of bronchoalveolar lavage (BAL) were negative. Direct microscopic examination of BAL accidentally showed a large number of living Lophomonas species with the movement of flagella. Methylene blue and Giemsa staining showed the plume of flagella and the nucleus. The patient was managed conservatively with metronidazole and get cured. It was concluded that the patient presented with signs and symptoms of pneumonia must be evaluated for rare events also if the patient was not responding with typical management of pneumonia. We reported the first case of this rare entity in Chhattisgarh state in an immunocompetent young Indian male.

Membranoproliferative glomerulonephritis: A rare presentation of occult filariasis

Parasitic infections do not usually present with rapidly progressive renal failure but can provoke glomerular lesions which are mostly proliferative. In filarial infection, glomerular involvement is usually mild and transient, and presentation with renal failure is rare. We report occult filariasis presenting as rapidly progressive renal failure due to immune-complex mediated membranoproliferative glomerulonephritis. Our patient responded to treatment with diethylcarbamazine and a short course of steroid. This case highlights the importance of thorough workup to identify the cause and consideration of filariasis in an endemic area.