Cause Of Invasive Fungal Infections Research Articles

Evaluation of Epidemiological Pattern of Candida Species Associated with Candidemia from A Tertiary Care Facility in South India

Candidemia ranks the 4th most prevalence cause of bloodstream infections and stands out as the primary cause of invasive fungal infections among hospitalized patients. Its incidence varies globally from 0.33 to 6.51 episodes per 1000 admissions, representing a major public health burden due to its increasing incidence and high mortality rates. The present research work has been conducted to identify the distribution of Candida species among septicemic patients and to determine the patterns of antifungal susceptibility of Candida species isolates from them in a tertiary care center in South India. Among the 88 Candida isolates, 13 (14.8%) were speciated and identified as C. albicans and 75 (85.2%) were Candida non-albicans. Of them, C. tropicalis (42%) ranks more prevalent. The distribution of virulence factors among 88 Candida isolates revealed that 49 isolates (55.7%) exhibited phospholipase activity, hemolysin production was detected in 68.2% of isolates, biofilm production was demonstrated in 73.9% isolates and coagulase activity was observed in 46.7% isolates. In the present study, Candida species were most sensitive to Amphotericin B (94.3%), which is followed by Caspofungin (93.2%), Voriconazole (92%), Micafungin (90.9%), and the least was observed with Flucytosine (78.4%) and Fluconazole (71.5%). Thus, in order to improve treatment responses, the insights acquired from this research will aid in clinical management and the development of antifungal stewardship recommendations.

Vaccination with O-linked Mannans Protects against Systemic Candidiasis through Innate Lymphocyte Populations.

Candida spp. are the fourth leading cause of bloodstream infections in hospitalized patients and the most common cause of invasive fungal infection. No vaccine against Candida spp. or other fungal pathogens of humans is available. We recently discovered the Blastomyces Dectin-2 ligand endoglucanase 2 that harbors antigenic and adjuvant functions and can function as a protective vaccine against that fungus. We also reported that the adjuvant activity, which is mediated by O-mannans decorating the C terminus of Blastomyces Dectin-2 ligand endoglucanase 2, can augment peptide Ag-induced vaccine immunity against heterologous agents, including Cryptococcus, Candida, and influenza. In this article, we report that the O-linked mannans alone, in the absence of any antigenic peptide, can also protect against systemic candidiasis, reducing kidney fungal load and increasing survival in a Dectin-2-dependent manner. We found that this long-term glycan-induced protection is mediated by innate lymphocyte populations including TCR-γδ+ T cells, innate lymphoid cells, and NK cells that subsequently activate and release reactive oxygen species from neutrophils and monocytes. Our findings suggest that Blastomyces O-mannan displayed by Eng2 induces a form of protective trained immunity mediated by innate lymphocyte populations.

A rare case of fatal sepsis caused by Trichosporon asahii in an immunocompetent chronic obstructive pulmonary disease patient

Trichosporon asahii is an yeast-like organism that is emerging as an important cause of invasive fungal infection in immunocompromised patients, especially in patients with cancer and neutropenia. Invasive infections due to T.asahii in immunocompetent patients are rarely reported. We describe a 62-year-old COPD (chronic obstructive pulmonary disease) patient who contracted severe sepsis from T.asahii without any prior history of immunosuppression. He was successfully treated with voriconazole and was discharged from the hospital.

Identification of novel inhibitors against Med15a KIX domain of Candida glabrata

Candida glabrata, the second most common cause of invasive fungal infections, exhibits multi-drug resistance to commonly used antifungal drugs. To counter this resistance, there is a critical need for novel antifungals. This study identifies small molecule inhibitors that target a three-helix bundle KIX domain in the Med15a Mediator subunit of Candida glabrata (CgMed15a KIX). This domain plays a crucial role by interacting with the Pleiotropic Drug Resistance transcription factor Pdr1, a key regulator of the multidrug resistance pathway in Candida glabrata. We performed high throughput computational screening of large chemical datasets against the binding sites of the CgMed15a KIX domain to identify novel inhibitors. We selected six potential candidates with high affinity and confirmed their binding with the CgMed15a KIX domain. A phytochemical compound, Chebulinic acid binds to the CgMed15a KIX domain with a KD value of 0.339 μM and shows significant inhibitory effects on the growth of Candida glabrata. Molecular dynamics simulation studies further revealed the structural stability of the CgMed15a KIX-Chebulinic acid complex. Thus, in conclusion, this study highlights Chebulinic acid as a novel potential antifungal compound against Candida glabrata.

Novel Antifungals and Aspergillus Section Terrei with Potpourri Susceptibility Profiles to Conventional Antifungals.

The epidemiology of invasive fungal infections (IFIs) is currently changing, driven by aggressive immunosuppressive therapy, leading to an expanded spectrum of patients at risk of IFIs. Aspergillosis is a leading cause of IFIs, which usually affects immunocompromised patients. There are a limited number of antifungal medications available for treating IFIs, and their effectiveness is often hindered by rising resistance rates and practical limitations. Consequently, new antifungals, especially those with novel mechanisms of action, are increasingly required. This study assessed the activity of four novel antifungal agents with different mechanisms of activity, namely, manogepix, rezafungin, ibrexafungerp, and olorofim, against 100 isolates of Aspergillus section Terrei, containing amphotericin-B (AmB)-wildtype/non-wildtype and azole-susceptible/-resistant strains, according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) method. In general, all tested agents showed potent and consistent activity against the tested isolates, exhibiting geometric mean (GM) and minimum effective concentration (MEC)/minimum inhibitory concentration (MIC) ranges, respectively, as follows: manogepix (0.048 mg/L, 0.032-0.5 mg/L), rezafungin (0.020 mg/L, 0.016-0.5 mg/L), ibrexafungerp (0.071 mg/L, 0.032-2 mg/L), and olorofim (0.008 mg/L, 0.008-0.032 mg/L). In terms of MIC90/MEC90, olorofim had the lowest values (0.008 mg/L), followed by rezafungin (0.032 mg/L), manogepix (0.125 mg/L), and ibrexafungerp (0.25 mg/L). All the antifungals tested demonstrated promising in vitro activity against Aspergillus section Terrei, including A. terreus as well as azole-resistant and AmB-non-wildtype cryptic species.

Antifungal Stewardship Programs in Children: Challenges and Opportunities.

Antifungal Stewardship Programs in Children: Challenges and Opportunities.

Neuroaspergillosis: Challenging Diagnosis and Management (P10-10.002)

<h3>Objective:</h3> N/A <h3>Background:</h3> Invasive fungal infections are associated with increased morbidity and mortality among immunocompromised patients, particularly due to non-specific symptoms, difficulty and delay in diagnosis, and limited therapeutic options. Aspergillosis is the leading cause of invasive fungal infections. Neuroaspergillosis commonly arises from hematogenous dissemination from invasive lung infection in immunocompromised patients and can lead to brain abscess, meningitis, and stroke from angioinvasion. Cerebral aspergillosis has a poor prognosis. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> A 62-year-old man with history of chronic lymphocytic leukemia and SARS-CoV-2 pneumonia presented with acute onset right-sided weakness. Head CT exhibited bilateral hypodensities concerning for emboli or metastases. Brain MRI revealed numerous bihemispheric T2 hyperintensities with vasogenic edema. Some lesions demonstrated restricted diffusion and contrast enhancement. At this point, differential diagnosis included septic emboli, abscess, and metastatic disease. TTE did not show signs of infective endocarditis. CT of the chest, abdomen, and pelvis revealed an irregular, centrally necrotic opacity. Bronchoscopy with bronchial lavage was performed, and biopsies were negative for malignancy and positive for Aspergillus species. The patient was started on amphotericin and was switched to voriconazole due to poor tolerance. Because of mental status fluctuation caused by edema, glucocorticoids were used concurrently with antifungal treatment. He had serial head CTs which initially revealed increasing edema and increasing effacement of the left lateral ventricle and third ventricle with development of early hydrocephalus. Neurosurgery was consulted, and family declined any surgical intervention. He was managed with dexamethasone 4 mg daily, and he demonstrated improvement in symptoms and edema on imaging in 1 week. <h3>Conclusions:</h3> In immunocompromised patients found to have multiple brain enhancing lesions with unrevealing preliminary work-up, invasive <i>Aspergillosis</i> infection must be considered. Here, we present a case of aspergillus managed concurrently with steroids and voriconazole. Despite the infectious source, there appears to be a role for steroids in the management of neuroaspergillosis. <b>Disclosure:</b> Dr. Jaworski has nothing to disclose. Dr. Reyes has nothing to disclose. Dr. Yacoub has nothing to disclose.

Mucormycosis in this COVID times- A case series

Mucorales are fast-growing thermostat fungi that are ubiquitous in environment. Most common form is rhino-orbito-cerebral mucormycosis. It is the third most common cause of invasive fungal infections following asperigillosis and candidiasis. Their incidence has increased in recent times, especially in the 2 wave of COVID-19 in India. COVID-19 is caused by non-segmented negative sense RNA virus, which causes profound lymphopenia. Glucocorticoid has emerged as main treatment of choice for COVID-19 patients with severe symptoms. The patients of COVID-19 are increasingly affected with mucormycosis because of decreased immunity, impaired defense mechanisms, dysfunctional lymphocytes and neutrophils, and injudicious use of glucocorticoids. Diabetes mellitus is an independent risk factor for both mucormycosis and severe COVID-19. Hyperglycemia due to diabetes and glucocorticoid increases the incidence of infection due to greater availability of glucose to the pathogen, lower response of T cells, and acidic Ph. This fungus has predilection to invade blood vessels leading to extensive necrosis (black eschar). The overall mortality rate is 56%. Mortality depends upon underlying health condition of patient and the part of the body affected.In this retrospective study, we present an interesting case series of 15 patients with mucormycosis. Association with diabetes, with uncontrolled glycemic index was found in all the cases. COVID-19 associated mucormycosis was seen in 10 patients.Excessive use of corticosteroid in a patient with COVID-19 has aggravated the scenario. An early foresight about the condition and judicious use of steroids is useful. So, an early diagnosis and prompt treatment of mucormycosis can decrease the fatality and morbidity in patients.

Identification of the target site of antimicrobial peptide AMP-17 against Candida albicans

Candida albicans is one of the major causes of invasive fungal infections and a serious opportunistic pathogen in immunocompromised individuals. The antimicrobial peptide AMP-17 has prominent anti-Candida activity, and proteomic analysis revealed significant differences in the expression of cell wall (XOG1) and oxidative stress (SRR1) genes upon the action of AMP-17 on C. albicans, suggesting that AMP-17 may exert anti-C. albicans effects by affecting the expression of XOG1 and SRR1 genes. To further investigate whether XOG1 and SRR1 genes were the targets of AMP-17, C. albicans xog1Δ/Δ and srr1Δ/Δ mutants were constructed using the clustered regulatory interspaced short palindromic repeats-associated protein 9 (CRISPR/Cas9) system. Phenotypic observations revealed that deletion of two genes had no significant effect on C. albicans growth and biofilm formation, whereas XOG1 gene deletion affected in vitro stress response and mycelium formation of C. albicans. Drug sensitivity assay showed that the MIC80 values of AMP-17 against xog1Δ/Δ and srr1Δ/Δ mutants increased from 8 μg/mL (for the wild type C. albicans SC5314) to 16 μg/mL, while the MIC80 values against srr1Δ/Δ: : srr1 revertants decreased to the level of the wild type SC5314. In addition, the ability of AMP-17 to inhibit biofilm formation of both deletion strains was significantly reduced compared to that of wild type SC5314, indicating that the susceptibility of the deletion mutants to AMP-17 was reduced in both the yeast state and during biofilm formation. These results suggest that XOG1 and SRR1 genes are likely two of the potential targets for AMP-17 to exert anti-C. albicans effects, which may facilitate further exploration of the antibacterial mechanism of novel peptide antifungal drugs.

An Unusual Case of Early Cytomegalovirus Retinitis with UTI, Invasive Pulmonary Aspergillosis, Klebsiella Pneumonia in a Renal Allograft Recipient

Cytomegalovirus (CMV) remains the most common opportunistic infection after a kidney transplant. CMV retinitis is a rare manifestation of CMV invasive disease and is potentially threatening to vision in immunocompromised individuals. Invasive aspergillosis (IA) is one of the major causes of invasive fungal infection in kidney transplant recipients. Posttransplant CMV significantly increases the risk of IA in solid organ transplants. However, simultaneous or superadded opportunistic infections are rare and often delay the diagnosis. We report a case of early CMV retinitis in a renal transplant recipient, who initially developed extended-spectrum beta-lactamase-positive Escherichia coli cystitis at 2 weeks posttransplant. At 4 weeks posttransplant, he developed CMV retinitis managed with intravenous and intravitreal ganciclovir. At around 6 weeks, he developed persistent low-grade fever and pancytopenia without any specific systemic symptoms with initial sterile cultures sterile and normal imaging except for high-resolution computed tomography chest, which was suggestive of fungal pneumonia. Bronchoscopy and bronchoalveolar lavage were done, which came positive for aspergillus colonies. The patient improved with Amphotericin B, which was later changed to oral voriconazole. A few days later, the patient again deteriorated with new-onset fever, cough, and expectoration, which were diagnosed with Klebsiella pneumonia by imaging supported by sputum culture, which was managed by appropriate antibiotics. CMV and IA are both uncommon opportunistic infections and simultaneous or superadded infection with bacterial pneumonia is very rare. In the presence of persistent symptoms, early suspicion of another infection is crucial for patient management and long-term prognosis.

Molecular epidemiology of clinical filamentous fungi in Qatar beyond Aspergillus and Fusarium with notes on the rare species

Due to an increasing number of patients at risk (i.e., those with a highly compromised immune system and/or receiving aggressive chemotherapy treatment), invasive fungal infections (IFI) are increasingly being reported and associated with high mortality rates. Aspergillus spp., particularly A. fumigatus, is the major cause of IFI caused by filamentous fungi around the world followed by Fusarium spp., however, other fungi are emerging as human pathogens. The aim of this study was to explore the epidemiology and prevalence of the non-Aspergillus and non-Fusarium filamentous fungi in human clinical samples over an 11-year period in Qatar using molecular techniques. We recovered 53 filamentous fungal isolates from patients with various clinical conditions. Most patients were males (75.5%), 9.4% were immunocompromised, 20.7% had IFI, and 11.3% died within 30 days of diagnosis. The fungal isolates were recovered from a variety of clinical samples, including the nasal cavity, wounds, respiratory samples, body fluids, eye, ear, tissue, abscess, and blood specimens. Among the fungi isolated, 49% were dematiaceous fungi, followed by Mucorales (30%), with the latter group Mucorales being the major cause of IFI (5/11, 45.5%). The current study highlights the epidemiology and spectrum of filamentous fungal genera, other than Aspergillus and Fusarium, recovered from human clinical samples in Qatar, excluding superficial infections, which can aid in the surveillance of uncommon and emerging mycoses.

Exploring Cryptococcus neoformans CYP51 and Its Cognate Reductase as a Drug Target.

Cryptococcus remains a leading cause of invasive fungal infections in immunocompromised people. Resistance to azole drugs has imposed a further challenge to the effective treatment of such infections. In this study, the functional expression of full-length hexahistidine-tagged Cryptococcus neoformans CYP51 (CnCYP51-6×His), with or without its cognate hexahistidine-tagged NADPH-cytochrome P450 reductase (CnCPR-6×His), in a Saccharomyces cerevisiae host system has been used to characterise these enzymes. The heterologous expression of CnCYP51-6×His complemented deletion of the host CYP51 and conferred increased susceptibility to both short-tailed and long-tailed azole drugs. In addition, co-expression of CnCPR-6×His decreased susceptibility 2- to 4-fold for short-tailed but not long-tailed azoles. Type 2 binding of azoles to CnCYP51-6×His and assay of NADPH cytochrome P450 reductase activity confirmed that the heterologously expressed CnCYP51 and CnCPR are functional. The constructs have potential as screening tools and use in structure-directed antifungal discovery.

Comparison of Indirect Fungal Diagnostic Tests in Patients With Proven Histoplasmosis.

Histoplasmosis is a common cause of invasive fungal infection in endemic regions and accurate diagnosis is difficult without direct tissue culture or pathology. Indirect fungal antigen testing for various fungal pathogens are typically performed to assist with diagnostic workup, though cross-reaction can lead to difficulty in interpreting results. We aimed to compare indirect fungal diagnostic tests and evaluate prevalence of positive antigen testing for non-Histoplasma fungal pathogens in patients with proven histoplasmosis. We performed a single-center retrospective review of adult patients with proven histoplasmosis diagnosed by fungal culture and/or cytology from January 2010 to March 2018. Patient demographics, clinical characteristics, and results of fungal antigen testing for Histoplasma, Blastomyces, Aspergillus, Cryptococcus, and (1→3)-β-D-glucan were evaluated. Two different urine Histoplasma antigen assays were used during the study period. Fifty-seven of 182 (31.3%) patients reviewed had proven histoplasmosis and presented with acute pulmonary (n = 10), chronic pulmonary (n = 7), and disseminated (n = 40) disease. Forty-one (72%) of these patients were immunosuppressed. Urine Blastomyces antigen (93%) and serum (1→3)-β-D-glucan (88%) were commonly positive in patients with histoplasmosis, whereas Aspergillus antigen was detected in 50% of patients and Cryptococcus antigenemia was rare (5%). In patients with disseminated disease, the MiraVista urine Histoplasma antigen assay had higher sensitivity than the Viracor urine Histoplasma antigen assay (86% vs 50%, respectively; P = .019). Noninvasive fungal antigen assays are helpful diagnostic tools; however, given their low specificity, clinicians must be aware of the various clinical presentations of invasive fungal infections and be aware of the limitations of these tests.

Targeting Virulence Factors of Candida albicans with Natural Products.

Natural products derived from natural resources, including nutritional functional food, play an important role in human health. In recent years, the study of anti-fungal and other properties of agri-foods and derived functional compounds has been a hot research topic. Candida albicans is a parasitic fungus that thrives on human mucosal surfaces, which are colonized through opportunistic infection. It is the most prevalent cause of invasive fungal infection in immunocompromised individuals, resulting in a wide variety of clinical symptoms. Moreover, the efficacy of classical therapeutic medications such as fluconazole is often limited by the development of resistance. There is an ongoing need for the development of novel and effective antifungal therapy and medications. Infection of C. albicans is influenced by a great quantity of virulence factors, like adhesion, invasion-promoting enzymes, mycelial growth, and phenotypic change, and among others. Furthermore, various natural products especially from food sources that target C. albicans virulence factors have been researched, providing promising prospects for C. albicans prevention and treatment. In this review, we discuss the virulence factors of C. albicans and how functional foods and derived functional compounds affect them. Our hope is that this review will stimulate additional thoughts and suggestions regarding nutritional functional food and therapeutic development for patients afflicted with C. albicans.

P200 Lodderomyces elongisporus fungemia in a late post-operative patient with ventricular septal defect: case report

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectivesTo report a case of Lodderomyces elongisporus fungemia in a late post-operative patient with the ventricular septal defect.MethodsInformed consent was obtained from the parents of the child. Clinical history was collected. Routine biochemical tests were conducted. Blood samples were sent to the bacteriology and mycology laboratory for culture. Radiological examination of the head was done to ascertain the cause of neurological manifestations.ResultsAn 11-year-old boy, previously diagnosed as a case of ventricular septal defect (VSD) and severe aortic regurgitation, had undergone VSD closure in December 2010 and aortic valve replacement in January 2011. He was discharged on oral anticoagulants. However, he did not follow up.In August 2018, he presented with fever and right-sided hemiparesis. Hemogram was within normal limits except for decreased hemoglobin. Bacteriological blood culture was sterile, but I.V. antibiotics were administered empirically. However, the patient started to have epileptic attacks and therefore was intubated and antiepileptics were administered. An NCCT of the head revealed a large intraparenchymal bleed. Echocardiography revealed intra-cardiac vegetation measuring 8 × 7 mm and moderate aortic regurgitation.Fungal blood culture inoculated in BACTEC Mycosis IC/F bottle flagged positive after 5 days of incubation. A smear and Gram stain from the same revealed budding yeast cells. Sub-culture was done on Sabouraud dextrose agar and HiCromeTM Candida Differential Agar, and blue-tinged colonies were observed on the latter. The isolate was identified as L. elongisporus when subjected to MALDI-TOF analysis. Identification was confirmed by sequencing the internal transcribed spacer (ITS) region of the ribosomal DNA.Antifungal susceptibility test was performed by broth microdilution as per CLSI guidelines. Antifungal therapy was initiated with liposomal amphotericin B, but he continued to have fever even after 1 week and consequently developed status epilepticus. CT scan of the brain revealed massive intracranial hemorrhage. Parents were advised neurosurgery, but they requested discharge against medical advice. The patient was lost to follow-up.Conclusions Lodderomyces elongisporus is a rare cause of invasive bloodstream infections and should not be ignored as a contaminant when isolated from sterile sites. It is often misidentified as Candida parapsilosis by conventional methods and commercially available systems but can be distinguished from it using chromogenic culture media and MALDI-TOF-MS. The current case report highlights the significance of L. elongisporus as a rare cause of invasive fungal infections, the difficulties faced in the identification of this pathogen, and the importance of newer diagnostic methods in identifying it.

P377 Study of the prevalence of candidemia and its antifungal susceptibility pattern in a tertiary care hospital

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMObjectivesStudy of the prevalence of candidemia and its resistance pattern in a tertiary care hospital.MethodsRetrospective observational studyStudy period—January 1, 2020-December 31, 2021Blood culture bottles (aerobic and anaerobic) were received in the laboratoryIncubated in BacT Alert 3D (Biomerieux) for 5 daysAfter flagging positive, a direct gram stain was prepared from the culture bottle and informed to the clinician. Culture plating was done on Blood agar and Mac Conkey Agar which were incubated for 18-24 h at 37°C.After 24 h, growth was obtained on the culture plate and identification was done by using MALDI-TOF MS (Biomerieux) and Susceptibility Testing was done using VITEK 2 Compact (Biomerieux).Antifungal sensitivity testing was done using VITEK 2 Compact for fluconazole, voriconazole, caspofungin, micafungin, amphotericin B, and flucytosine.ResultsDuring the study period, 18 235 blood culture bottles were received, and 1652 blood culture bottles were flagged positive. The most common organism causing bloodstream infection belonged to Burkholderia spp. Candida sp (4%) was found to be the sixth most common organism causing bloodstream infection.Among Candida spp most common isolate was C. tropicalis 42% followed by C. parapsilopsis 21%, C. albicans 21%, and C. auris 12%, and the least isolated species was C. glabrata 4%.Maximum number of Candida spp were isolated from intensive care units.Susceptibility testing was given by VITEK 2 compact for all Candida spp except for Candida auris.The isolated Candida spp showed the least susceptibility to fluconazole (resistant rate R 30.6%) as compared to micafungin, caspofungin, flucytosine, and amphotericin B (R 13.9%, 13.9%, 22.2%, and 5.6%,) respectively. Candida glabrata showed less sensitivity toward caspofungin as compared to other antifungals.Conclusion Candida spp. are a part of the normal flora of healthy hosts but are also found to be a major cause of invasive fungal infections which is now found to be one of the leading causes of mortality in hospitalized patients. The emergence of unusual and relatively unknown Candida species as nosocomial pathogens with increasing treatment failure, emphasizes the need to isolate and identify all species and to start early definitive treatment according to the susceptibility pattern reported to decrease mortality and morbidity rates.

P333 Candidemia due to Candida pelliculosa in neonates admitted in SNCUs of district hospitals of Chhattisgarh: first state-wide study from secondary-level health care facilities in Central India

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM ObjectivesTo study the Candida pelliculosa isolates, from the blood culture of neonates admitted to district hospital SNCUs in the state of Chhattisgarh, their antifungal susceptibility pattern, risk factors, and clinical co-relation. Although Candida species remain the leading cause of invasive fungal infections (IFI), there are certain rare species like C. pelliculosa, that can cause fungemia. Various studies reveal that infants, children, and immunocompromised individuals are more susceptible to bloodstream infections of C. pelliculosa. Few cases of fungemia caused by this rare species of Candida have been reported worldwide. We have found a few cases of C. pelliculosa bloodstream infection in neonates admitted to special newborn care units (SNCUs).MethodsThis is an observational study on the Candida isolates from blood cultures of neonates admitted in SNCUs of the state of Chhattisgarh, over a period of 4 years from March 2018 till March 2022. Blood culture isolates of Candida were identified and their AFST was performed on an automated Bacterial ID-AST system by BioMerieux (VITEK -2) and also manually using standard laboratory protocols. Demographic and clinical data of the patients having Candida pelliculosa candidemia were taken from laboratory records.ResultsPaired blood culture samples of total 4997 SNCU neonates were received in the laboratory. Out of these 25% were found positive for bacteria and or Candida spp. Among these positive blood cultures, Candida spp. was isolated in 18.76% patients. Amongst the isolates of Candida, C. pelliculosa was found to be the predominant Candida spp., isolated in 60 neonates, thus comprising of 25.64% of all Candida spp. Further analysis of neonates having C. pelliculosa infection revealed that 40% (24/60) neonates were either low birth weight, very low birth weight (VLBW), or extremely low birth weight (ELBW) babies, 25% cases had respiratory distress, 21.6% neonates were premature and 10% cases had hypoglycemia, as risk factors.Antifungal susceptibility pattern showed 99% isolates of C. pelliculosa as susceptible to amphotericin B, 100% being susceptible to voriconzole, and 95% and 100% isolates were susceptible to fluconazole and flucytosine respectively. More resistance was observed for Echinocandins. Caspofungin was found to be least susceptible in 88.9% of isolates. Various indications for blood culture were also analyzed. Only one neonate, out of 60, succumbed to C. pelliculosa infection.Conclusion Candida pelliculosa is found to be an emerging pathogen responsible for candidemia among neonates in SNCUs, which has shown relatively poor in-vitro susceptibility to Echinocandins. It is of extreme clinical importance that neonates of secondary-level health care facilities should also have access to quality laboratory support in the form of culture and sensitivity, so that pathogen profile and antibiogram data are available from such high-risk units as well, which would prove useful in timely institution of targeted therapy, thereby reducing neonatal mortality.

POS-106 PROFILE OF CRYPTOCOCCAL INFECTIONS IN RENAL TRANSPLANT RECIPIENTS IN A TERTIARY CARE HOSPITAL IN NORTH INDIA

Cryptococcosis is a life-threatening opportunistic fungal infection, being the third most common cause of invasive fungal infections in solid organ transplant (SOT) recipients, primarily caused by C. neoformans and C. gattii. The incidence in SOT recipients is 0.2-5%, associated with high morbidity and mortality of up to 30-50% in the acute setting. It is primarily considered to be reactivation of latent infection, occurring usually in the late post-transplantation period (>6 months after transplantation).

CANDIDEMIA: A POST COVID CO-INFECTION

Background: Candida species are major constituents of the human mycobiome and the main cause of invasive fungal infections, with a high mortality rate and recognized as a complication of severe COVID-19. The present study is an attempt to identify the etiological agents in blood samples of critically ill Covid positive patients so that timely interventions can be helpful to reduce morbidity and mortality in such patients. Material and method: This retrospective observational study was conducted at Tejas Microdiagnostics during 30 April 2021 to 30 June 2021. A total of 126 Covid positive patients requiring admission in SRN Hospital, Prayagraj were included. Blood specimen collected in FA and FAN bottles were sent for culture and antibiogram to Tejas Microdiagnostics within eight hours of admission. Blood culture of 89 (70%)Results: patients was positive while 37 (30%) patients did not show any growth. Fungi were isolated in 24(26.96%) cases while bacterial growth was identied in 65(73.04%) cases. Candida tropicalis was the most predominat species while Aspergillus fumigates and Penicillium were isolated among dimorphic fungi. Mortality was observed in 15% cases. Our study illustrates the predominance of Candida tropicalis fromConclusion: blood samples of Covid positive patients. This statistics may be the tip of the iceberg. The reason for such a high incidence can be the wide spread use of empirical antibiotics and steroids which may increased the risk of fungal infections in patients with COVID-19. Isolation and identication of pathogens are prudent and may reduce the morbidity and mortality of the patients.

Identification and antifungal susceptibility profile of filamentous fungi isolated from cases of healthcare associated infections

Although, bacteria have been considered as most common cause of healthcare associated infections (HCAI), however recent years have witnessed increased isolation of fungal pathogens. species, Mucorales, spp., spp. and spp. are predominant fungal pathogens isolated from cases of HCAI. As compared to bacterial nosocomial infections, fungal infections are generally difficult to diagnose and treat. Nosocomial mycoses are associated with high mortality and morbidity. The present study was conducted in the tertiary care academic hospital with an aim to identify filamentous fungal pathogen isolated from HCAI and study its antifungal susceptibility profile. Filamentous fungi isolated from cases of HCAI from intensive care unit (MICU) were included. They were identified by standard mycological techniques and antifungal susceptibility profile was studied. Out of 50 fungal pathogens, spp. were isolated from 21 (42%) cases, whereas 29 (58%) isolates were filamentous fungi. spp. (51.7%) were predominant among filamentous fungal pathogen. (27.6%) was the predominant isolate. Use of broad-spectrum antibiotics followed by neutropenia and presence of indwelling medical devices were common risk factors associated with HCAI due to filamentous fungi. Amphotericin B resistance was observed in 6.9% of isolates whereas 33.3% were resistant to fluconazole. Invasive fungal infection (IFI) though less common is associated with increased morbidity and mortality in patients admitted to ICU. Neutropenia and use of broad spectrum antibiotics are important risk factors for IFI. is the most common filamentous fungus cause of IFI. More emphasis should be given on rapid diagnosis, prompt treatment and strict compliance with infection prevention and control practices.