Clinical Mycology Research Articles

Tinea capitis, caused by Microsporum canis (felineum) : literature review and clinical cases

According to statistics, tinea capitis remains the main mycological problem in childhood. The spectrum of causative agents of tinea capitis varies depending on the continent. In epidemiological terms, the pathogenic fungus Microsporum canis (felineum)absolutely predominates on the Eurasian continent. A significant problem in the diagnosis and, in particular, in the treatment of microsporia are cases of the disease in very young children: we estimate this most problematic age from 1 to 18 months. Microsporia in children under the age of 1 year is the most relevant in pediatric clinical mycology due to the limited arsenal of topical and systemic medications approved at this age. The clinical case presented in this article demonstrates an example of successful treatment of scalp microsporia in a 7-month-old child who had contraindications to systemic therapy. It should be noted that the duration of treatment in this case was almost 4 months, while the most effective therapy regimens, including systemic drugs, lead to the elimination of pathogenic fungus from the foci on the scalp within 30–45 days.

Candida auris: An Emerging Challenge in Clinical Mycology and Public Health in Latin America

Candida auris is an emerging fungus that poses a critical challenge in clinical mycology and global public health. Identified in 2005, this pathogen has caused hospital outbreaks due to its resistance to multiple antifungals and ability to persist in hospital settings. In Latin America, C. auris has been reported since 2012 in several countries, including a case in Ecuador in 2024. Its emergence has been linked to climate change and the excessive use of antifungals, which could be favoring its proliferation. The diagnosis of C. aurisis complex and requires advanced methods such as MALDI-TOF mass spectrometry and molecular techniques due to its phenotypic variability. Another factor to be relevant to public health is resistance to conventional treatments. In addition, genomic surveillance is essential to understand the epidemiology of this pathogen and control its spread in hospital settings. Urgent prevention, detection, and treatment measures are necessary to limit the spread of C. auris in the region and minimize its impact on public health. Implementing comprehensive strategies, including genomic surveillance and advanced diagnostic techniques, is crucial to address this emerging problem in Latin America. Keywords: Candida auris, Fungal infections, Antifungal resistance, Clinical mycology, Genomic surveillance, Latin America.

A simple culture medium for phenotypic characterization and long-term storage of medically relevant fusarioid fungi

Fusarioid fungi, particularly Neocosmospora solani and Fusarium oxysporum, are emerging as significant human pathogens, causing infections ranging from localized mycoses to life-threatening systemic diseases. Accurate identification and preservation of these fungi in clinical laboratories remain challenging because of their diverse morphologies and specific growth requirements. This study evaluated a novel milk-honey and malt agar (MHM) against conventional media for cultivating and preserving 60 clinical fusarioid isolates, including Neocosmospora spp. (n = 47), Bisifusarium spp. (n = 5), and Fusarium spp. (n = 8). Compared with Sabouraud dextrose 2 % agar (SDA) and malt extract agar (ME2), MHM significantly increased conidia production (p < 0.0001, mean = 3.4 × 103, standard deviation (SD) = ±1.3 × 103), with results similar to those of carnation leaf agar (CLA). MHM facilitated superior preservation of fusarioid viability for up to one year at room temperature on slant cultures and over two years on swabs in Amies gel with charcoal, outperforming current methods such as Castellani (water) or cryopreservation. Morphological characterization of fusarioid fungi grown on MHM revealed distinct growth patterns and conidial structures for Neocosmospora, Bisifusarium, and Fusarium species, aiding in identifying these genera. The superior performance of MHM in stimulating conidiation, maintaining viability, and preserving morphology underscore its potential as a reference medium for medically relevant fusarioid fungi, with broad implications for clinical mycology laboratories and resource-limited settings.

Diagnosis and Molecular Characterization of Dermatophytosis: An Observational Study

Dermatophytes are the keratinophilic fungi which infect humans and is the most recurring type of disease. The high level of transmissibility creates an epidemiological risk and emphasises the significance of these illnesses. However, a growing number of reports describing dermatophytes can cause deep infections in diabetic and immunocompromised patients, by invading deep layers like the dermis and hypodermis. Despite the prevalence and significance of dermatophytes in clinical mycology, it is not always possible to accurately diagnose this specific infection due to its overlapping structures among species of dermatophytes. Since it is difficult to identify species that exhibit weak characteristics in the morphological highlights, identification of the dermatophyte is often relied on its morphological analysis, which is a laborious process and demands skill. The massive shift in genetic variation, the source of infection, and epidemiological research can be discovered using molecular approaches. Therefore, the development of an accurate laboratory test for dermatophyte species identification is essential for the prevention and efficient management of dermatophytoses. One such methodology allows use of PCR technology which has many methods for molecular level characterization which is rapid, efficient, and capable of producing DNA polymorphisms specific to various dermatophyte species based on distinctive band patterns seen by agarose gel electrophoresis. The RAPD-PCR approach will be used in this study protocol to molecularly characterize the dermatophytes for precise speciation of the sample. In addition to improving knowledge of fungal biology and pathology with a focus on adaptive mechanisms to combat difficult conditions from host counteractions, there is a need to improve awareness of the importance of these diseases through accurate epidemiological data. The advantages of molecular approaches for characterizing objects over traditional methods are their sensitivity and specificity.

Clinical Mycology Today: Emerging Challenges and Opportunities.

The Mycoses Study Group Education and Research Consortium is a collective of clinicians, researchers, and educators with the common goal to advance awareness, diagnosis, and management of invasive fungal diseases. Clinical Mycology Today, the Mycoses Study Group Education and Research Consortium's biennial meeting, is dedicated to discussing the most pressing contemporary issues facing the field of clinical mycology, promoting clinical, translational, and basic science collaborations, and mentoring the next generation of clinical mycologists. Here, we review the current opportunities and challenges facing the field of mycology that arose from discussions at the 2022 meeting, with emphasis on novel host risk factors, emerging resistant fungal pathogens, the evolving antifungal pipeline, and critical issues affecting the advancement of mycology research.

Epidemiology of coccidioidomycosis in Argentina, an update.

The National Reference Laboratory in Clinical Mycology of Argentina conducted a retrospective review of human coccidioidomycosis cases diagnosed by the National Mycology Laboratory Network of Argentina between 2010 and 2022 to determine the burden of the disease in the country. A total of 100 human coccidioidomycosis cases were documented, with a higher prevalence in male patients (male-to-female ratio of 1.9:1), with a median age of 41 years. Comparing the number of cases between two 10-year periods (2000-2009 and 2010-2019), the increase was 36.51% (from 63 to 86 cases). Among the 100 recorded cases, 79 tested positive using the double immunodiffusion test. Spherules were observed in 19 cases through histopathology or direct microscopic examination and the fungus was isolated in 39 cases. Thirty-six isolates were identified as Coccidioides posadasii through partial sequencing of the Ag2/PRA gene. Catamarca province had the highest number of cases, comprising 64% of the total, with an incidence rate above 1.0-2.5/100,000 inhabitants until 2018. However, there has been a recent downward trend in the region from 2018 to 2022. It is concerning that more than half of diagnosed cases were chronic pulmonary or disseminated forms, indicating a lack of early disease detection. To rectify this issue, it is imperative to conduct targeted training programs for healthcare personnel and enhance public awareness within the endemic area. This will contribute to a better understanding of the true burden of coccidioidomycosis and enable the implementation of appropriate sanitary control measures.

Study of molecular characterization for diagnosis of chronic and recurrent dermatophytosis

Dermatophytes are the keratinophilic fungi which infect humans and is the most recurring type of disease. The high level of transmissibility creates an epidemiological risk and emphasises the significance of these illnesses. However, a growing number of reports describing dermatophytes can cause deep infections in diabetic and immunocompromised patients, by invading deep layers like the dermis and hypodermis. Despite the prevalence and significance of dermatophytes in clinical mycology, it is not always possible to accurately diagnose this specific infection due to its overlapping structures among species of dermatophytes. Since it is difficult to identify species that exhibit weak characteristics in the morphological highlights, identification of the dermatophyte is often relied on its morphological analysis, which is a laborious process and demands skill. The massive shift in genetic variation, the source of infection, and epidemiological research can be discovered using molecular approaches. Therefore, the development of an accurate laboratory test for dermatophyte species identification is essential for the prevention and efficient management of dermatophytoses. One such methodology allows use of PCR technology which has many methods for molecular level characterization which is rapid, efficient, and capable of producing DNA polymorphisms specific to various dermatophyte species based on distinctive band patterns seen by agarose gel electrophoresis. The RAPD-PCR approach will be used in this study protocol to molecularly characterize the dermatophytes for precise speciation of the sample. In addition to improving knowledge of fungal biology and pathology with a focus on adaptive mechanisms to combat difficult conditions from host counteractions, there is a need to improve awareness of the importance of these diseases through accurate epidemiological data. The advantages of molecular approaches for characterizing objects over traditional methods are their sensitivity and specificity.

Development of a novel mycobiome diagnostic for fungal infection

BackgroundAmplicon-based mycobiome analysis has the potential to identify all fungal species within a sample and hence could provide a valuable diagnostic assay for use in clinical mycology settings. In the last decade, the mycobiome has been increasingly characterised by targeting the internal transcribed spacer (ITS) regions. Although ITS targets give broad coverage and high sensitivity, they fail to provide accurate quantitation as the copy number of ITS regions in fungal genomes is highly variable even within species. To address these issues, this study aimed to develop a novel NGS fungal diagnostic assay using an alternative amplicon target.MethodsNovel universal primers were designed to amplify a highly diverse single copy and uniformly sized DNA target (Tef1) to enable mycobiome analysis on the Illumina iSeq100 which is a low cost, small footprint and simple to use next-generation sequencing platform. To enable automated analysis and rapid results, a streamlined bioinformatics workflow and sequence database were also developed. Sequencing of mock fungal communities was performed to compare the Tef1 assay and established ITS1-based method. The assay was further evaluated using clinical respiratory samples and the feasibility of using internal spike-in quantitative controls was assessed.ResultsThe Tef1 assay successfully identified and quantified Aspergillus, Penicillium, Candida, Cryptococcus, Rhizopus, Fusarium and Lomentospora species from mock communities. The Tef1 assay was also capable of differentiating closely related species such as A. fumigatus and A. fischeri. In addition, it outperformed ITS1 at identifying A. fumigatus and other filamentous pathogens in mixed fungal communities (in the presence or absence of background human DNA). The assay could detect as few as 2 haploid genome equivalents of A. fumigatus from clinical respiratory samples. Lastly, spike-in controls were demonstrated to enable semi-quantitation of A. fumigatus load in clinical respiratory samples using sequencing data.ConclusionsThis study has developed and tested a novel metabarcoding target and found the assay outperforms ITS1 at identifying clinically relevant filamentous fungi. The assay is a promising diagnostic candidate that could provide affordable NGS analysis to clinical mycology laboratories.

Multicentric Study on the Clinical Mycology Capacity and Access to Antifungal Treatment in Portugal

The success of the clinical management of invasive fungal diseases (IFD) is highly dependent on suitable tools for timely and accurate diagnosis for effective treatment. An in-depth analysis of the ability of European institutions to promptly and accurately diagnose IFD was previously conducted to identify limitations and aspects to improve. Here, we evaluated and discussed the specific case of Portugal, for which, to our knowledge, there are no reports describing the national mycological diagnostic capacity and access to antifungal treatment. Data from 16 Portuguese medical institutions were collected via an online electronic case report form covering different parameters, including institution profile, self-perceived IFD incidence, target patients, diagnostic methods and reagents, and available antifungals. The majority of participating institutions (69%) reported a low-very low incidence of IFD, with Candida spp. indicated as the most relevant fungal pathogen, followed by Aspergillus spp. and Cryptococcus spp. All institutions had access to culture and microscopy, whereas 94 and 88% were able to run antigen-detection assays and molecular tests, respectively. All of the institutions capable of providing antifungal therapy declared to have access to at least one antifungal. However, echinocandins were only available at 85% of the sites. Therapeutic drug monitoring (TDM) was reported to remain a very restricted practice in Portugal, being available in 19% of the institutions, with the TDM of itraconazole and posaconazole performed in only 6% of them. Importantly, several of these resources are outsourced to external entities. Except for TDM, Portugal appears to be well-prepared concerning the overall capacity to diagnose and treat IFD. Future efforts should focus on promoting the widespread availability of TDM and improved access to multiple classes of antifungals, to further improve patient outcomes.

615. A Prospective Cohort Study to Evaluate Performance of MycoMEIA – Aspergillus: A New Urine Diagnostic for Aspergillosis

Abstract Background The MycoMEIA urine diagnostic was developed as an enzyme immunoassay, by Johns Hopkins (JH) and Pearl Diagnostics. In a retrospective study of 310 people, the assay was 90.5% (95% CI 70-99) sensitive and 89.2% (95% CI 82-94) specific. We report results of a prospective study performed at JH Hospital (JHH). Methods People with suspected invasive aspergillosis (IA) were identified by screening of diagnostic tests sent by clinicians at JHH. Urines from consented subjects were tested in the clinical mycology lab within 8 hours of collection. Results were not used to inform care. Established diagnoses were adjudicated by clinicians blinded to lab results, using consensus criteria. Performance was analyzed in evaluable subjects who had CTs within 2 weeks of suspected IA. Findings supporting proven or probable IA, or no infection defined cases and controls, respectively. MycoMEIA results in subjects with possible IA, mixed infections, or other infections (non-IA) were evaluated descriptively. Results 107 urines were tested from 72 subjects with suspected IA. 15 subjects had &amp;gt;1 samples tested. Subjects were mostly male (50, 69%), with median age of 51 (range 7 – 87 years). IA was suspected during treatment for heme malignancies (59, 82%), solid organ transplant (9), cancer (5), and rheumatologic disease (1). Of 72 subjects enrolled, 30 had possible IA (42%), 30 no infection (42%), 4 probable IA (6%), 4 mixed infections (6%) and 4 other infections, including bacterial abscess (1), fusariosis (1), fungal sinusitis (1) and otitis externa (1). The assay was 100% sensitive (95% CI 76–98) and 93% specific (95% CI 79–99) for IA, with likelihood ratio of 15. Five of 30 (16.7%) people with possible IA and 1 with fusariosis had positive MycoMEIA urine tests. Conclusion In prospective testing by the clinical lab, performance of the urine MycoMEIA – Aspergillus test appears consistent with retrospective findings and favorable compared to current blood assays. The proportion of lab confirmed diagnoses using current commercial assays was low; high negative predictive value with urine testing may support restriction of empirical antifungals. Cross reactivity amongst pathogenic Ascomycetes is biologically anticipated and requires further study. The study remains ongoing. Disclosures Nitipong Permpalung, MD, MPH, Alcimed: Advisor/Consultant|CareDx: Grant/Research Support|Cidara Therapeutics: Grant/Research Support|Clarion: Advisor/Consultant|ClearView: Advisor/Consultant|IMMY Diagnostics: Grant/Research Support|Merck: Grant/Research Support|Scynexis: Grant/Research Support Kieren Marr, MD, Cidara Therapeutics: Advisor/Consultant|Merck: Advisor/Consultant|Pearl Diagnostics: salary|Pearl Diagnostics: Ownership Interest|Sfunga Therapeutics: salary|Sfunga Therapeutics: Ownership Interest Irina Baburina, PhD, Pearl Diagnostics: salary Dana Neitzey, BS, Pearl Diagnostics: salary Patricia X. Marques, PhD, Pearl Diagnostics: salary Sean Zhang, MD, PhD, Applied BioCode: Grant/Research Support|IMMY Diagnostics: Grant/Research Support|KARIUS: Advisor/Consultant|Pearl Diagnostics: Grant/Research Support|Scanogen: Grant/Research Support|T2 biosystems: Advisor/Consultant|Vela Diagnostics: Grant/Research Support

326. Meeting an unmet need - impact of a Complex Fungal Infection Clinic in the UK

Abstract Background The WHO recently set out priority fungal pathogens of global importance which were previously neglected in terms of awareness &amp; funding(1). Accurate diagnosis of fungal infection is a challenge &amp; mortality remains high(2) as expertise and dedicated mycology services are lacking globally. Our centre provides one of the UK’s first complex fungal infection clinics, established in 2019. We sought to describe the patients attending this clinic, as a step towards understanding the landscape of clinical mycology in the UK. Methods Electronic health record systems were searched for all patients attending our clinic over 4 years from 01/04/19-01/04/23. Patients referred for consideration of a fungal diagnosis were included in the analysis. Invasive fungal infections (IFIs) were classified as per EORTC/MSGERC guidance.(3) Results 80/407 patients attending our clinic were referred for consideration of a fungal diagnosis. 31 (39%) were male. Median age was 53 (IQR 38-62). Most referrals (59/80; 74%) were received from within our institution. 41 (51%) had a fungal diagnosis confirmed prior to review. 28 were treated for invasive fungal infections (IFIs), 9 for chronic mycoses (including 5 chronic pulmonary aspergillosis &amp; 2 mycetoma), 28 for superficial mycoses (20 recurrent mucocutaneous infections &amp; 8 onychomycoses) &amp; 15 had no evidence of fungal infection. Of the IFI: 16 were proven; 8 probable; 2 possible IFI &amp; 2 did not meet diagnostic criteria. 7 IFI were caused by Aspergillus, 8 by Cryptococcus &amp; 2 each by Coccidiodes, Candida &amp; Histoplasma. The IFIs mainly affected the upper &amp; lower respiratory tract (17/28). 20/80 (25%) were immunosuppressed (commonest causes: diabetes; HIV; steroids; malignancy &amp; chemotherapy). On average (median), patients visited clinic 4 times (IQR 2-7) &amp; received 2 different antifungal drugs (IQR 1-3). The most common side-effects prompting a change in therapy were visual changes, rash &amp; diarrhoea. Conclusion Our data illustrate the need for dedicated follow-up for patients with complex fungal infections. With several new antifungal drugs currently undergoing clinical trials, complexity in therapeutic decision-making will only increase.(4) Establishing centralised complex fungal infection clinics helps to build diagnostic &amp; clinical capacity in mycology. Disclosures Hamish Houston, BA MBBCh, Gilead Sciences: Grant/Research Support Neil RH Stone, MD PhD, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|Pfizer: Honoraria|Shionogi: Honoraria

Fungal diseases in Africa: Closing the gaps in diagnosis and treatment through implementation research and advocacy.

Fungal diseases impose an escalating burden on public health in Africa, exacerbated by issues such as delayed diagnosis, inadequate therapy, and limited access to healthcare resources, resulting in significant morbidity and mortality. Effectively tackling these challenges demands a comprehensive approach encompassing research, training, and advocacy initiatives. Recent clinical mycology surveys conducted by Global Action for Fungal Infection (GAFFI) and the European Confederation of Medical Mycology/International Society for Human and Animal Mycology (ECMM/ISHAM) have underscored gaps in fungal diagnostics and the availability and accessibility of antifungal therapy in Africa. The World Health Organization (WHO) Fungal Priority Pathogens List (FPPL) identifies fungi of critical or high importance to human health, providing a roadmap for action and highlighting the urgent need for prioritizing fungal diseases and developing targeted interventions within the African context. To enhance diagnosis and treatment, it is imperative to invest in comprehensive training programs for healthcare workers across all levels and disciplines. Equipping them with the necessary knowledge and skills will facilitate early detection, accurate diagnosis, and appropriate management of fungal infections. Moreover, implementation science research in medical mycology assumes a pivotal role in bridging the gap between knowledge and practice. By identifying the barriers and facilitators that influence the adoption of diagnostic techniques and public health interventions, tailored strategies can be formulated to improve their implementation within healthcare settings. Advocacy plays a critical role in raising awareness regarding the profound impact of fungal diseases on public health in Africa. Engaging policymakers, healthcare providers, researchers, industry experts and communities underscore the importance of addressing these diseases and galvanize efforts for change. Substantial investment in surveillance, research and development specifically focused on fungal diseases is indispensable for advancing our understanding of local epidemiology, developing effective interventions, and ultimately improving patient outcomes. In conclusion, closing the gaps in diagnosing and treating fungal diseases in Africa demands concerted research and advocacy initiatives to ensure better healthcare delivery, reduced mortality rates, and improved public health outcomes.

Spectrum of sensitization to aeroallergens as one of the risk factors for uncontrolled severe asthma

BACKGROUND: Asthma is considered one of the urgent medical and social problems of the XXI century. In recent years, not only an increase in the incidence, but also an increase in the prevalence of severe forms of asthma has been noted in all countries of the world. The effect of the sensitization spectrum on the severity and level of asthma control has not been studied enough.&#x0D; AIM: Evaluate the importance of sensitization spectrum to aeroallergens in severe asthma patients as indicators for disease exacerbation risk.&#x0D; MATERIALS AND METHODS: Single-center cross-sectional study at North-Western State Medical University n.a. I.I. Mechnikov. Examined 93 severe asthma patients. Analysis covered demographic traits, comorbidities, hereditary history, living conditions, exacerbations, past-year hospitalizations, medications, spirometry, and specific IgE presence for 10 aeroallergens.&#x0D; RESULTS: Aspergillus fumigatus specific IgE notably impacted asthma control. Disease exacerbation risk was 8.4 times higher with A. fumigatus sensitization. Multivariate logistic regression revealed higher risk with A. fumigatus sensitization (4.79), fixed obstruction (6.2), systemic steroids use (5.85), indoor mold exposure (4.45), and familial asthma history (2.53).&#x0D; CONCLUSION: A. fumigatus sensitization significantly influences asthma course and control, worsening prognosis. Targeted examination of patients measuring sIgE levels for common aeroallergens is necessary to identify control obstacles. The results of the study were previously reported at the All-Russian Congress on Medical Microbiology, Clinical Mycology and Immunology and published in the form of abstracts in the journal Problems in medical mycology, 2022, Vol. 24, No 2.

Emergomycosis in Africa: Time to Pay Attention to This Emerging Deadly Fungal Infection.

Emergomycosis is an emerging deadly infectious disease caused primarily by a little-known airborne pathogen Emergomyces africanus, which can cause clinical management challenge especially in patients with advanced HIV disease. This minireview describes Es. africanus as the main cause of emergomycosis in Africa as well as considers contributing factors to the difficulties encountered in managing this infection. Emergomycosis is common in HIV-positive persons with low CD4 lymphocyte count and has an estimated fatality of 50%. The infection exhibits airborne transmission with pulmonary and extrapulmonary manifestations leading to skin lesions. However, the pathogenesis of Es. africanus is still poorly understood. The management of the infection is complicated due to lack of defined diagnostic and therapeutic guidelines. Limited expertise, poor research funding, and lack of awareness and national surveillance are thought to impact the recognition and prioritisation of the infection. These factors may ultimately assign emergomycosis a 'neglected infection status' even as it is suspected to be prevalent in more African countries than previously recognised. Increased awareness and integrated and targeted strategies such as mobilising manpower in clinical mycology are of paramount importance in managing emergomycosis in Africa and beyond.

Unveiling the Hungarian landscape of laboratory and clinical management capacities for invasive fungal infections: navigating the frontlines against fungal menaces.

Antifungal diagnostic capacity has been documented in various countries, there is a lack of comprehensive research on clinical mycology diagnostics and treatment in Hungary. We conducted an online survey encompassing questions that explored various aspects of the mycology diagnostic and antifungal therapy-related information. The survey aimed to gather details about institutional profiles, perceptions of invasive fungal infections (IFIs), and access to microscopy, culture, serology, antigen detection, molecular testing, and therapeutic drug monitoring. As of May 2023, a total of 17 institutions responded to the questionnaire. Seven participants categorized the institutional incidence of IFI as 'very low', four as 'low', and six as 'mild'. The majority of centers identified Candida spp. (94%) and Aspergillus spp. (82%) as the most prevalent fungal pathogens. Nearly half of the laboratories (47%) reported using matrix-assisted laser desorption/ionization-time of flight mass spectrometry for identification. All institutions had access to microscopy and culture-based diagnostic approaches. A significant number of centers had access to antigen detection (71%) and various molecular assays (59%). Regarding antifungal agents, all reporting sites used at least one triazole, with voriconazole (77%) being the most common mold-active azole. Furthermore, 71% of the centers applied at least one formulation of amphotericin B, and 65% to one echinocandin. However, only 18% of the centers used 5-flucytosine. Resource availability for diagnosing and treating IFI in Hungary varies across hospitals based on location. Surveys help identify gaps and limitations in this area. To address these challenges, interregional cooperation within Hungary could be a facilitating strategy.

484. Vaginal Candida albicans: High Frequency of In-vitro Fluconazole Resistance in a Select Clinical Population.

Abstract Background In vitro fluconazole resistance in vaginal C. albicans has rarely been reported in the U.S. Little is known about the characteristics of patients who demonstrate fluconazole resistance vs. sensitivity, or how likely resistant strains are to persist over time. Hence we sought to describe patterns of fluconazole resistance in clinician ordered vaginal cultures positive for C. albicans at our center. We compared patient characteristics between those with fluconazole sensitive versus resistant isolates. Methods We conducted a chart review of patients with clinician ordered vaginal cultures positive for C. albicans undergoing fluconazole susceptibility testing in our medical center’s clinical mycology lab from January 2017 to April 2021. Patient characteristics were compared using chi-square and ANOVA tests and correlated to fluconazole resistance with logistic regression models. Results Of N=92 patients with vaginal C. albicans, 3.3% were sensitive dose-dependent (SDD: minimal inhibitory concentration (MIC) =4) to fluconazole, and 30.4% were resistant (R: MIC &amp;gt; =8). Amongst those with at least 2 previous episodes of vulvovaginal candidiasis (VVC) in the past 6 months (N=45), 50% had R and 6.5% had SDD isolates. Compared to those with sensitive (S: MIC &amp;lt; =2) isolates, patients with SDD or R were younger and more likely to have the following characteristics: Black race, bacterial vaginosis (BV) in the past year, high or multi-dose azole treatment, fluconazole suppressive therapy in the past 6 months, and more VVC and BV episodes in the previous 6 months (Table 1). Of N=10 patients who had a follow-up culture with initial R isolates, 28.6% had a sensitive C. albicans vaginal isolate. Conclusion The frequency of C. albicans vaginal isolates with in vitro resistance to fluconazole in this study was high. Our findings highlight the importance of obtaining cultures and sensitivity testing in patients with recurrent or refractory VVC. However, resistant vaginal strains may not necessarily persist over time. Future, larger studies on those with recurrent VVC are needed to verify factors associated with fluconazole resistance, how frequently azole-resistant strains persist over time, and how well in vitro resistance correlates to in vivo treatment response. Disclosures Susan Tuddenham, MD, MPH, Luca Biologics: Advisor/Consultant|Medscape/WebMD: Honoraria|UpToDate: Royalties.

P182 Mucormycosis in Northwest Iranian cases with a history of delta COVID-19, a brief report

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectives Mucoral fungi are the opportunistic organisms causing invasive or localized infections in persons with conditions such as diabetes mellitus, immune suppression, and corticosteroid therapy. During the recent surge of delta-type Coronavirus disease 2019 (COVID-19) in Iran, the rate of invasive mucormycosis considerably increased as a cluster in society. COVID-19-associated mucormycosis (CAM) immerged as a severe and life-threatening infection. The present report includes demographic, clinical and laboratory diagnostic information about newly emerged CAM in Northwest of Iran.MethodsDuring three months, from August to October 2021, about 65 cases with clinical manifests suspected of mucormycosis and a history of recent severe COVID-19 and corticosteroid therapy with dexamethasone were studied. Clinical specimens obtained from sinuses and upper respiratory tract, transported to Clinical Mycology Center, UMS University, Urmia, Iran for the detection of and molecular identifications of mucoral and other agents. Our subjects were the clinical specimens including 31 nasal biopsies, 24 paranasal sinus biopsies, 2 facial and palate biopsies, skin and sutures, one each. Also, two samples of bronco-alveolar lavage were used for investigating fungi in the respiratory tract.ResultsMore than 52% of the patients were men and the most frequent age range was 50-60 years. Most frequent clinical specimens were sent from ENT wards and ICUs, 22 (33.8%) and 12 (18.5%) respectively. Among all confirmed cases of CAM, 18 (27.7%) suffered from a background of diabetes but 46 (70.8%) had no underlying diseases. Our findings of direct examination showed 55 (84.6%) mucoral elements. The suspected cases of CAM showed clinical manifests including acute sinusitis, rhino-sino-cerebral 25 (38.5%), rhino-sino-orbital 7 (10.8%), and sino-facial 3 (4.6%), involvements. The culture and identification resulted in Rhizopus oryzae as the most frequent isolate (44.6%) and Candida yeasts (albicans and non-albicans Candida species) 6.2%-7.7% respectively. Aspergillus species were detected 5 (7.7%) as well. A considerable number of cultures, 20 (30.8%) could result no growth for any fungi.ConclusionAs a conclusion, delta-type Coronavirus causing a considerable increased invasive Mucormycosis in the recorded COVID-19 cases in the north west of Iran. Although, opportunistic candida and aspergillus were identified in lower frequencies as well.

P298 SWOC analysis of a virtual clinical mycology training module of short duration conducted by iMARC laboratory at AIIMS, Bhopal

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM1 Department of Microbiology All India Institute of Medical Sciences, Bhopal2 Department of General Medicine All India Institute of Medical Sciences, Bhopal3 Department of Dermatology and Venereology All India Institute of Medical Sciences, BhopalObjectivesTo discuss the strengths, weaknesses, opportunities, and challenges of the virtual clinical mycology training module conducted for a short duration of 20 h.To identify vital areas for improvisation in the training module.MethodsA group of 15 members through small subgroup discussions collaborated across departments and branches over a period of 5 days to analyze the Karyashala Mycology training module of September 2021. The SWOC quadrant was prepared with questions by the key organizers. The group of 15 members represented faculty, residents, participants, and logistic data managers. This large group was further divided into small groups of 3-4 members in each. They were provided with flip charts and writing boards to reflect on questions in the individual component of SWOC. A flow of SWOC analysis by each small group included steps of generating ideas, prioritization of themes, and finally moving forward to selective workable or doable questions with complete clarity on internal and external factors.ResultsStrengths included the appropriate relevant topics, collaboration of mycologists with CFM and pathologists was good. Need for inclusion of clinical vignettes for demonstration of clinical, radiological, pathological, and microbiological collaboration, and approach to a given case was mentioned. The feedback of participants were analyzed by each small group and the need for similar handholding was noted. Virtual training modules uploaded online are available forever for reference to all interested. Being online 131 institutions participated.Weaknesses included the struggle in managing platforms, network issues in virtual meetings, and arranging routine logistics timely. The time management for incorporation of more participant trainer interaction immediately after each session was lacking. These were felt by the group and also participants’ feedback mentioned the same. Major weakness involves contractual technical staff with new recruitments affecting the already skilled techniques resulting in poor delivery. To overcome this faculty will take lead in all practical sessions was also decided.External attributes as opportunities for organizing standard training programs are funds provided by the Government of India research SSR and several others. Need to tap more resources mentioned by all members in terms of expertise and funds.Challenges pointed toward human resources, quality instruments, and consumables deficit due to institutional policies. To overcome this the team felt EQAS for fungal diagnostics is essential. A group of train the trainers (TOT) must be prepared for each tier of healthcare system.ConclusionThe SWOC analysis of the training module weaknesses and challenges for improvisation. Strengths and opportunities discussed for future planning of similar events.

Comparison of four diagnostic criteria for invasive pulmonary aspergillosis-A diagnostic accuracy study in critically ill patients.

In the absence of lung biopsy, there are various algorithms for the diagnosis of invasive pulmonary aspergillosis (IPA) in critically ill patients that rely on clinical signs, underlying conditions, radiological features and mycology. The aim of the present study was to compare four diagnostic algorithms in their ability to differentiate between probable IPA (i.e., requiring treatment) and colonisation. For this diagnostic accuracy study, we included a mixed ICU population with a positive Aspergillus culture from respiratory secretions and applied four different diagnostic algorithms to them. We compared agreement among the four algorithms. In a subgroup of patients with lung tissue histopathology available, we determined the sensitivity and specificity of the single algorithms. A total number of 684 critically ill patients (69% medical/31% surgical) were included between 2005 and 2020. Overall, 79% (n=543) of patients fulfilled the criteria for probable IPA according to at least one diagnostic algorithm. Only 4% of patients (n=29) fulfilled the criteria for probable IPA according to all four algorithms. Agreement among the four diagnostic criteria was low (Cohen's kappa 0.07-0.29). From 85 patients with histopathological examination of lung tissue, 40% (n=34) had confirmed IPA. The new EORTC/MSGERC ICU working group criteria had high specificity (0.59 [0.41-0.75]) and sensitivity (0.73 [0.59-0.85]). In a cohort of mixed ICU patients, the agreement among four algorithms for the diagnosis of IPA was low. Although improved by the latest diagnostic criteria, the discrimination of invasive fungal infection from Aspergillus colonisation in critically ill patients remains challenging and requires further optimization.

Performance of a Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry Testing Algorithm for the Rapid Identification of Clinical Filamentous Molds.

One of the most significant challenges in the treatment of fungal infections is the relatively long turnaround time (TAT) required for fungal species identification. The length of TAT to identification can impact patient clinical outcomes by delaying appropriate targeted therapy. Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) has demonstrated exceptional utility in the rapid identification of bacteria and yeasts in the clinical microbiology laboratory. The capability of MALDI-TOF MS for rapid identification of clinical isolates presents an opportunity for significant advancement in the identification of filamentous molds. In this study, we employed a diagnostic algorithm using MALDI-TOF MS for the rapid identification of filamentous molds in order to assess the impact of this technology on TATs. The majority of isolates included in this study were able to be identified by MALDI-TOF MS (78%). Further, these isolates were identified in less than three days from first detection of colony growth. This study demonstrates the utility of MALDI-TOF MS in the rapid identification of filamentous molds in the clinical mycology laboratory.