Fungal Infections In Patients Research Articles

A Study on Prevalence, Profile, and Risk Factors of Developing Fungal Infection in Patients With Diabetic Foot Ulcer

Background: Many chronic nonhealing diabetic foot ulcers (DFUs) with increased rates of amputation are frequently associated with fungal infections. Purpose: To evaluate the prevalence, profile, and risk factors of developing a fungal infection in patients with DFU. Methods: This prospective observational study was carried out from October 2018 to July 2020. All adult patients with DFUs admitted to the surgery ward were recruited. Patients on antifungal therapy or who received such therapy within 6 weeks prior to admission were excluded. Three deep tissue samples were sent for bacterial culture, fungal culture, and histopathological examination of fungal elements. Results: A total of 251 patients were enrolled in the study. Of the 23.3% of patients with positive fungal growth (n = 47/202), 2% (n = 4/202) had pure fungal growth and 21.3% (n = 43/202) had mixed growth with bacteria in their ulcers (ie, non-contaminated samples). A significant association was found between wound grade (P = .027), ulcer duration (P = .028), and positive fungal growth in DFUs. Conclusions: In this study, the prevalence of fungal infection in DFUs was 23.3%; Candida tropicalis (27.08%) was the most common isolate, followed by C. albicans (20.83%). The rate of fungal infections was high in patients with mild diabetic foot infection or DFU of 7 to 14 days’ duration.

Detection of Fungal Infection in Patients on Hemodialysis with Double Lumen Catheter by Conventional and Molecular Methods

Detection of Fungal Infection in Patients on Hemodialysis with Double Lumen Catheter by Conventional and Molecular Methods

Analysis of risk factors of fungal superinfections in viral pneumonia patients: A systematic review and meta-analysis.

Infections with fungi, such as Aspergillus species, have been found as common complications of viral pneumonia. This study aims to determine the risk factors of fungal superinfections in viral pneumonia patients using meta-analysis. This study aims to determine the risk factors of fungal infection s in viral pneumonia patients using meta-analysis. We reviewed primary literature about fungal infection in viral pneumonia patients published between January 1, 2010 and September 30, 2020, in the Chinese Biomedical Literature, Chinese National Knowledge Infrastructure, Wanfang (China), Cochrane Central Library, Embase, PubMed, and Web of Science databases. These studies were subjected to an array of statistical analyses, including risk of bias and sensitivity analyses. In this study, we found a statistically significant difference in the incidence of fungal infections in viral pneumonia patients that received corticosteroid treatment as compared to those without corticosteroid treatment (p < .00001). Additionally, regarding the severity of fungal infections, we observed significant higher incidence of invasive pulmonary aspergillosis (IPA) in patients with high Acute Physiology and Chronic Health Evaluation(APACHE) II scores (p < .001), tumors (p = .005), or immunocompromised patients (p < .0001). Our research shows that corticosteroid treatment was an important risk factor for the development of fungal infection in patients with viral pneumonia. High APACHE II scores, tumors, and immunocompromised condition are also important risk factors of developing IPA. The diagnosis of fungal infection in viral pneumonia patients can be facilitated by early serum galactomannan (GM) testing, bronchoalveolar lavage fluidAspergillus antigen testing, culture, and biopsy.

In search of dermatophytes - frequency and etiology of fungal infections in patients with and without diabetes mellitus.

Onychomycosis is a frequent nail disorder, accounting for up to 50% of all nail problems. Treatment of onychomycosis is expensive and requires a long time of antifungal medications. Consequently, a proper and faster diagnosis is necessary. Especially for those patients with diabetes mellitus, where onychomycosis is among the most significant predictors of foot ulcer and possible severe complications.

Epidemiology, potential risk factors and outcome of black fungus during COVID-19 pandemic: a concurrent prospective study at a dedicated COVID-19 hospital of North India

Introduction: As the number of COVID-19 patients increased during second wave, a steep rise of patients with mucormycosis was found in all parts of India. Objectives: To determine the epidemiological factors leading to the rise in fungal infection in patients during COVID-19 pandemic as well as describe the outcome of the disease during next three months after being discharged from the hospital Methods: It was a concurrent prospective study conducted between 26 June to 25 October 2021 at ESIC Medical College &amp; Hospital, Faridabad, India. Patients positive for mucormycosis and agreed for the study were enrolled. They were interviewed telephonically after recording their consent. Results: A total of 51 patients were interviewed during our study period. During the follow-up, six patients died within three months of discharge from the hospital. The mean age of patients was 49.6years (SD=6.9 years), with the majority in the age group of 41-60 years. Most (53%) of the patients were males and 30(58.8%) were graduates and above. In the sample, 33 had a recent history of COVID-19 infection, 24 (47%) had been prescribed steroids, 16 (31.3%) had been prescribed oxygen during COVID-19 infection and 33(64.7%) were diabetic. The relationship of potential risk factors with the type of mucormycosis was not found to be statistically significant. Out of the45 patients who survived, 35 were better, three were still on oral anti-fungal treatment and seven patients required reconstructive plastic surgery. A significant association was found between patients who had a history of steroid intake and type of mucormycosis. Conclusions &amp; Recommendations: Patients admitted to hospital with mucormycosis during the COVID-19 surge mostly had a history of COVID-19 infection, suffering from diabetes or on steroids. Most of the patients survived due to treatment availability (antifungal medicines, surgery or both) and about 15% of them had undergone long debridement surgery leading to severe loss of normal contour of the face and waiting for plastic reconstructive surgery.

Cutaneous Fungal Infections in Patients Experiencing Homelessness and Treatment in Low-Resource Settings: A Scoping Review.

Patients experiencing homelessness (PEH) suffer from a high burden of cutaneous fungal infections. Preventative treatment is important as such infections can lead to harmful complications such as cellulitis and even osteomyelitis. There are sparse data regarding cutaneous fungal infections of homeless populations and management in low-resource settings. A MEDLINE search was conducted using the key terms "cutaneous," "fungal," "infections," "dermatophytes," and "homeless." The search included case-control, cohort, and randomized controlled trials published in the English language. This scoping review of studies yielded information with regard to practical treatment advice for providers in low-resource settings, including medical, hygiene, prevention, and treatment options for PEH with cutaneous fungal infections, the most common of which were tinea pedis (3-38%) and onychomycosis (1.6-15.5%). Few studies have been conducted on the differences between sheltered and unsheltered homeless patients, which can have treatment implications. Systemic antifungal therapy should be carefully considered for diffuse, refractory, or nail-based cutaneous fungal infections if there is a history of alcohol use disorder or liver disease. While PEH have a high risk of alcohol use disorder, this can make definitive treatment challenging.

Invasive mucormycosis of nasal cavity, paranasal sinuses, bones of the skull in post COVID-19 patients: prospective study

INTRODUCTION: Since 2020, the number of patients with complications after a new coronavirus infection (COVID-19) has increased, including mycoses. Mucormycosis ranks third in the frequency of detection among invasive mycoses in patients with reduced immunity. Acute and chronic invasive fungal rhinosinusitis is the most severe and dangerous variant of the disease.OBJECTIVE: To analyze the features of the osteodestructive process of invasive mucormycosis, its relationship with blood supply, the dynamics of the process under the influence of treatment.MATERIALS AND METHODS: The study evaluated changes in the bone structures of the skull, soft tissues of the facial region, brain, and thorax in a group of 10 patients (62.3±11.4 y.o.) examined in the clinic of maxillofacial surgery and the clinic otorhinolaryngology in the post- covid period. The results of cone-beam computed tomography (Sirona) of the maxillofacial region, Xray computed tomography Optima 540 CT (General Electric) of the maxillofacial region and thoracic cavity organs, magnetic resonance imaging (GE Signa HDxt) of the brain and maxillofacial region with intravenous administration of a paramagnetic contrast agent were analyzed.RESULTS: In all cases, osteolytic lesions as a classical manifestations of invasive mucormycosis, were revealed in: alveolar processes of the upper jaws and walls of the maxillary sinuses in 100% of cases; palatine processes — 90%; nasal septum, walls of the ethmoid sinuses and walls the orbits — 70%; walls of the sphenoid sinus — 50%; pterygoid processes and zygomatic bone — 40%; the body of the sphenoid bone, nasal bones, frontal bones — 30%; the alveolar part of the mandible and temporal bone — 10%. All patients underwent surgery with resection of the affected bones — 100%, while 7 out of 10 patients received antimycotic therapy. When assessing the revealed changes in dynamics in all patients in the long-term postoperative period, sclerosis of small foci of destruction, a decrease in the extent of bone defects, a decrease in the size of sequesters, hyperostosis of the walls of the paranasal sinuses, cells ethmoid sinuses of the after sequestrectomy were noted. There were no fatal cases among the 10 patients we observed at the time of publication.CONCLUSION: The combination of anatomical features and the state of blood supply contributes to the development of invasive mucormycosis of the bones of the facial skull and the RCT data help with determining treatment tactics, the volume of surgery, and assessing dynamics in the early and long-term postoperative period.

Candida albicans adhesion on buccal epitheliocytes as an indicator of microbiota homeostatic balance in children with chronic gastroduodenitis

Background. Recently, the incidence of mycoses in patients with a gastroenterological profile has grown due to an increase in the intensity of the impact on the human body of external factors that cause disturbances in the antimycotic defense system.&#x0D; Aim. To study the adhesion of Candida albicans on buccal epitheliocytes in children with chronic gastroduodenitis.&#x0D; Material and methods. 96 children (mean age 12.431.24 years) with recurrent respiratory diseases with morphologically proven chronic gastroduodenitis associated with Helicobacter pylori were examined. The adhesion of Candida, contamination of buccal epithelial cells with bacteria were studied. All children underwent paraclinical studies, instrumental methods of research, consultations of specialists were also prescribed. In the study of the adhesive reaction of C. albicans on buccal epitheliocytes, a Candida strain from the collection of the Federal Budgetary Institution of Science Nizhny Novgorod Research Institute of Hygiene and Occupational Pathology was used. 100 epitheliocytes were studied, the result was evaluated by the number of Candida in terms of 1 epitheliocyte. Registration of artificial colonization of buccal epithelial cells was carried out according to the method of D. Goldman and E. Goetzl (2003) modified by A.N. Mayansky. The children were divided into 2 groups: the main one the detected growth of C. albicans over 1000 CFU/g, and the comparative one the absence of excess growth of C. albicans. Statistical processing included the determination of the correlation coefficient, the arithmetic mean (M) and its standard error (m), differences in indicators according to Student's criteria (the level at p 0.05 was considered statistically significant).&#x0D; Results. Harmonious proportional development was observed in 55.21% of children, microbiota imbalance was noted: bloating and rumbling along the colon, (p=0.0087), unstable stool (p=0.0241) and constipation (p=0.6092). The spectrum of comorbid pathology revealed the presence of allergic diseases (p=0.0048), up to 10 episodes of acute respiratory viral infection (p=0.1702), more than 10 episodes of acute respiratory viral infection (p=0.0105), adenoid vegetations (p=0.531), chronic pyelonephritis in the stage of clinical and laboratory remission (p=0.0216). Assessment of the intestinal microbial landscape showed a significant decrease in the content of bifidobacteria in the main group (p=0.0482), and lactobacilli were comparable in both groups (p=0.0839). In the comparison group, in 88.63% of cases, the indices of adhesion of C. albicans on buccal epitheliocytes were 6.370.46, in the main group 11.860.74 (p=0.0362). A direct relationship between the parameters of artificial colonization of buccal epitheliocytes and the degree of microbiological changes in the intestine was found (r=0.58, p=0.0097).&#x0D; Conclusion. The study of adhesion of Candida albicans on buccal epitheliocytes in children with chronic gastroduodenitis revealed a unidirectional shift in the quantitative content of the obligate oral and intestinal microbiota, which can be used as a screening for the homeostatic balance of the microbiota.

Wave of Invasive Fungal Disease on the Shores of COVID-19: A Case Series of COVID-19 Associated Rhino-Orbital Fungal Rhinosinusitis and Literature Review.

Coronavirus disease 2019 (COVID-19) may be associated with a wide range of bacterial and fungal co-infections. Acute invasive fungal sinusitis is an aggressive infection affecting immunocompromised patients and high mortality rate. Here, in this case series, we have reviewed three cases of COVID-19 associated rhino-orbital invasive fungal disease. Patients with COVID-19 associated pneumonia with diabetes mellitus are at an increased risk of developing invasive pulmonary fungal infections probably due to their reduced immunological competence. Concurrent glucocorticoid therapy probably heightens the risk of mucormycosis. Physicians should be aware of and should have high index of suspicion of possible fungal infection in post COVID-19 patients. Aggressive management both medical and surgical, is required to improve outcomes of secondary invasive fungal infections in patients with COVID-19 infection.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12070-022-03213-y.

A RARE CASE OF ACUTE PULMONARY HISTOPLASMOSIS FOLLOWING COVID-19 INFECTION

SESSION TITLE: COVID-19 Case Report Posters 3SESSION TYPE: Case Report PostersPRESENTED ON: 10/19/2022 12:45 pm - 01:45 pmINTRODUCTION: The most reported fungal infections in patients with COVID-19 include aspergillosis, invasive candidiasis, and mucormycosis. We hereby present a case of a male who developed acute pulmonary histoplasmosis (APH) after COVID-19 infection.CASE PRESENTATION: 51-year-old male with PMHx of COVID-19 infection 3 weeks ago presenting with worsening shortness of breath. Patient had a complicated hospital course with COVID-19 treated with high doses of methylprednisolone. Patient was local to Arizona and lived on a ranch with livestock. CT chest suggestive of multilobar pneumonia and bilateral pleural effusions (Image 1). Coccidiomycosis serology came back negative. Urinary Histoplasma galactomannan antigen came back positive. The diagnosis of APH after COVID-19 infection was established. Patient was started on voriconazole. His symptoms significantly improved. Patient was discharged to skilled nursing facility with outpatient infectious disease follow-up.DISCUSSION: The current literature on APH in the setting of COVID-19 infection is limited. The few proposed mechanisms are: 1. Liberal use of high dose steroids in COVID-19 leading to reactivation of latent H. Capsulatum. 2. Systemic inflammation in COVID-19 causes interstitial lung damage permitting conidia to proliferate leading to acute infection. The Histoplasma urine antigen test is highly sensitive in the diagnosis of APH, especially in immunocompromised patients like our patient. With this case we would like to increase awareness of the possibility of rare fungal infections like APH in patients with COVID-19, as timely diagnosis and appropriate management can lead to improved outcomes.CONCLUSIONS: Rare fungal infections following COVID-19 have been documented and timely diagnosis and management are imperative to improve patient outcomes.Reference #1: Macedo, Priscila M, et al. APH following COVID-19. Case Report J.Fungi 2021DISCLOSURES: No relevant relationships by Ali Rajano disclosure on file for Yamin Saddouk;No relevant relationships by Parita SoniNo relevant relationships by Lyndie Wilkins Parker SESSION TITLE: COVID-19 Case Report Posters 3 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: The most reported fungal infections in patients with COVID-19 include aspergillosis, invasive candidiasis, and mucormycosis. We hereby present a case of a male who developed acute pulmonary histoplasmosis (APH) after COVID-19 infection. CASE PRESENTATION: 51-year-old male with PMHx of COVID-19 infection 3 weeks ago presenting with worsening shortness of breath. Patient had a complicated hospital course with COVID-19 treated with high doses of methylprednisolone. Patient was local to Arizona and lived on a ranch with livestock. CT chest suggestive of multilobar pneumonia and bilateral pleural effusions (Image 1). Coccidiomycosis serology came back negative. Urinary Histoplasma galactomannan antigen came back positive. The diagnosis of APH after COVID-19 infection was established. Patient was started on voriconazole. His symptoms significantly improved. Patient was discharged to skilled nursing facility with outpatient infectious disease follow-up. DISCUSSION: The current literature on APH in the setting of COVID-19 infection is limited. The few proposed mechanisms are: 1. Liberal use of high dose steroids in COVID-19 leading to reactivation of latent H. Capsulatum. 2. Systemic inflammation in COVID-19 causes interstitial lung damage permitting conidia to proliferate leading to acute infection. The Histoplasma urine antigen test is highly sensitive in the diagnosis of APH, especially in immunocompromised patients like our patient. With this case we would like to increase awareness of the possibility of rare fungal infections like APH in patients with COVID-19, as timely diagnosis and appropriate management can lead to improved outcomes. CONCLUSIONS: Rare fungal infections following COVID-19 have been documented and timely diagnosis and management are imperative to improve patient outcomes. Reference #1: Macedo, Priscila M, et al. APH following COVID-19. Case Report J.Fungi 2021 DISCLOSURES: No relevant relationships by Ali Raja no disclosure on file for Yamin Saddouk; No relevant relationships by Parita Soni No relevant relationships by Lyndie Wilkins Parker

Effect of IL-23 Receptor Gene Polymorphism (Rs1884444) on the Prevalence of Oral Fungal Infection in Patients with Type 2 Diabetes Mellitus: A Case-Control Study in Iraqi Patients.

Type 2 diabetes mellitus (T2DM) is a complex metabolic disorder linked to several genetic disorders. Over the last decade, advancements in genetic association studies have resulted in the identification of at least 75 distinct genetic loci associated with T2DM, allowing for a better understanding of the genetic architecture of this disease. Recently, there has been a positive association between the prevalence of oral fungal infection and T2DM. The current study aimed to assess the effect of single nucleotide polymorphism in IL23R (rs1884444) on oral fungal infection and the distribution of alleles in T2DM patients compared to healthy controls. A total of 150 specimens, including oral swabs and whole blood samples, were collected from the Endocrinology and Diabetes Center in Baghdad. Oral swabs were collected via AIMS transport media. Routine tests and the Vitek 2 system carried out fungal identification; moreover, the tetra-primeramplification refractory mutation system-polymerase chain reaction (ARMS-PCR) was used for molecular detection. The findings revealed that the O blood group was positively associated with T2DM and oral fungal infection. Moreover, the TT genotype for IL23R SNP (rs1884444G/T) increased significantly in patients, as compared to that in healthy control. Furthermore, the T allele was increased in patients suffering from T2DM (P<0.001). The GT and TT were more frequent in oral fungal infection in patients with T2DM. The TT and T alleles were positively associated with the risk of developing T2DM. Moreover, GT and TT were associated with oral fungal infection and T2DM.

Conventional PCR versus Culture Method to Detect Common Fungal Pathogens in Patients with Respiratory Diseases

The study aimed to assess the frequency of invasive fungal infection in patients with respiratory diseases by conventional and molecular methods. This study included 117 Broncho alveolar lavage (BAL) samples were collected from patients with respiratory disease (79 male and 38 female) with ages ranged between (20-80) years, who attended Medicine Baghdad Teaching hospital and AL-Emamain AL-Khadhymian Medical City, during the period from September 2019 to April 2020. The results in PCR versus culture methods in this study showed that out of 117 samples of fungal infections 30(25.6 %) were detected by culture method, while the 24(20.5%) samples were detected by PCR technique, the most commonly diagnosed pathogenic fungi is Candida spp. followed by Aspergillus spp. By considering the culture method as a gold standard against the PCR technique, the results show that the sensitivity and specificity of PCR were (86.6%) and (100%) respectively.

Persistent meningeal signs despite previous treatment for cryptococcal meningitis – a case report

Cryptococcal meningitis continues to be a life-threatening fungal infection in patients with HIV. Treatment involves a year of antifungal therapy, and persistent meningeal signs months after treatment initiation are uncommon. We report a case of a 29-year-old male with HIV who was diagnosed with cryptococcal meningitis ten months earlier and underwent induction, maintenance, and consolidation therapy and ART. Subsequently, he continued to have persistent headaches and developed severe meningeal signs with leptomeningeal enhancement on imaging. This case discusses the importance of keeping both immune reconstitution inflammatory syndrome and a cryptococcal meningitis relapse in the differential diagnosis for patients with persistent meningeal signs.

Cytokine profile associated with fungal infections in patients with otitis media

The current study includes a collection of (90) middle ear swabs samples from patients with middle ear infection who attended at the ENT unit at Al- Hilla Teaching Hospital and Imam Sadiq Hospital in Babylon city during the period from October 2021 to February 2022. The blood samples were collected from all patients as well as (40) apparently healthy control. The fungal isolates were identified according to cultural, biochemical tests, confirmed by VITEK 2 system compact. The results revealed that 15:90 were fungal positive culture. The most common fungal pathogen is Candida parapsilosis (10:15). Cytokine profile for patients revealed that IFN-γ and CTLA-4 increase in patients as compared to control versus IL-10 increases in control than patients.

Incidence of Invasive Fungal Infections in Patients With Previously Untreated Acute Myeloid Leukemia Receiving Venetoclax and Azacitidine.

BackgroundAcute myeloid leukemia (AML) is associated with poor prognosis, particularly in elderly patients with comorbidities. Combining azacitidine (AZA) with BCL-2 inhibitor venetoclax (VEN) demonstrated significant improvement in outcomes for newly-diagnosed AML patients compared to AZA alone. However, this regimen is myelosuppressive, and the incidence of invasive fungal infections (IFIs) and impact of antifungal prophylaxis are not well defined.MethodsThis retrospective cohort study evaluated newly-diagnosed AML patients treated with VEN/AZA at the University of Colorado Hospital from January 2014 to August 2020. Patients with history of prior IFI were excluded. Primary outcome was IFI incidence during VEN/AZA therapy. χ2 and Fisher exact tests assessed the impact of patient demographics, AML-specific risk factors, and receipt of antifungal prophylaxis on IFI incidence.Results144 VEN/AZA-treated AML patients were included in the study. 25 (17%) patients developed IFI: 8% (n = 2) “proven,” 24% (n = 6) “probable,” and 68% (n = 17) “possible” per European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium criteria. There was no statistically significant association between IFI incidence with age, sex, or European LeukemiaNet classification. 10 patients received antifungal prophylaxis; none developed IFI. IFI incidence rate per 1000 patient-days was greatest 0–9 days after starting VEN/AZA, at 8.39.ConclusionsIncidence of “proven” and “probable” IFI in our VEN/AZA-treated AML cohort was 5.6%, in-line with incidence rates reported by recent similar studies. Furthermore, IFI incidence decreased as days from starting VEN/AZA therapy increased.

P496 Effect of fluconazole prophylaxis in prevention of local fungal infections in patients of head and neck cancers receiving chemo-radiotherapy

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMObjectivesTo ascertain, in head and neck cancer patients receiving chemo-radiotherapy, the efficacy of fluconazole prophylaxis in1. Reducing the incidence of oropharyngeal fungal infections2. Reducing the incidence of severe i.e., grade 3 and 4 oropharyngeal mucositisMethodsA total of 66 cases of Stage III or IV squamous cell carcinoma of the oral cavity or oropharynx who were candidates for radical chemo-radiotherapy (CCRT) were randomly assigned between arm A (study arm) and arm B (control arm) using computer-generated algorithms. Both arms received conventionally fractionated radiation (66-70 Gy) with concurrent weekly intravenous cisplatin (40 mg/m2) along with standard measures of oropharyngeal hygiene. In addition, arm A received Tab Fluconazole 100 mg/d administered per oral after lunch from initiation to the completion of radiotherapy, while arm B received Tab Fluconazole 100 mg/d, if fungal infections appeared, for a period of 7-14 days.Weekly clinical examination for oro-pharyngeal candidiasis was done. Throat swabs for microbiological assessment of fungal colonization were done before treatment (zero week), during second and sixth week of CCRT, and 4 weeks after the completion of CCRT, and if any clinical suspicion of fungal infection was present.ResultsProportion of patients who developed fungal infection during treatment was significantly lower in group A—6/33 patients as compared with group B—27/33 patients (18.18% vs. 69.70% respectively, P-value < .0001). Candida albicans was detected in 7 patients (31.82%) while non-albicans Candida was detected in 15 patients (68.18%). Candida parapsilosis, C. tropicalis, C. krusei, and C. glabrata were detected. A total of 3 infected patients (75%) in group A were resistant to fluconazole but showed sensitivity to voriconazole, posaconazole, and caspofungin B. While in group B, 3/18 infected patients (16.66%) showed resistance to fluconazole and these were sensitive to voriconazole, amphotericin B, posaconazole, and caspofungin B. Mean week of onset of fungal infection in group A was 5.5 weeks which was significantly higher as compared with group B of 4.48 weeks (P-value = .029).Proportion of patients who developed grades 3/4 mucositis was significantly lower in group A as compared with group B of 54.55% vs. 81.82% respectively (P-value = .017). Median week of onset of grade 3/4 mucositis in group A was 5.5 weeks which was significantly higher as compared with group B of 5 weeks. (P-value = .029).Proportion of patients with treatment completion was significantly higher in group A as compared with group B—84.85% vs. 60.61% respectively (P-value = .027). Mean number of days needed for treatment completion in group B was 57.55 days which was significantly greater as compared with group A of 50.68 days (P-value =. 033). Median treatment gap in group B was 10 days which was significantly higher as compared with group A of 4 days (P-value = .003).See Figures below.ConclusionTab fluconazole 100 mg prophylaxis in head and neck cancer patients receiving chemo-radiation isAn effective way to reduce fungal infections, ideal prophylaxis beginning at the fourth week.An effective way to reduce the severity of radiation-induced oral mucositis—thereby translating into reduced morbidity, treatment interruptions, and overall treatment time, which have been shown to impact prognosis favorably.

P334 Fungal infections in patients with COVID-19 in 1-year pandemic 2020-2021 from Cote d'Ivoire

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMBackground and Objectives: The COVID-19 pandemic has caused significant public health problems both in Côte d'Ivoire and around the world. Among the different causes of morbidity and mortality in COVID-19 patients, the frequency and impact of co-infections are still little studied, especially in patients with acute respiratory distress syndrome (ARDS).However, people with severe COVID-19 infection are particularly vulnerable to bacterial and fungal infections. This study aims to determine the frequency and susceptibility profile of isolated fungi in severe COVID-19 patients living in west Africa.Methodology: We conducted a retrospective observational study of COVID-19 patients who were tested for invasive fungal infections (IFI) between 2020 and 2021 in the laboratory of mycology at Pasteur Institute of Cote d'Ivoire.ResultsWe received a total of 77 samples (from superficial specimens, deep sites, urine) collected from 35 patients admitted for severe COVID-19. The patients were predominantly female (n = 21, 60%) and had a median age of 54,5 years (range16-79 years).The mycological analysis for IFI diagnosis showed 20% of samples positive only for yeasts, 66.7% of which were Candida albicans and responsible for 90% of invasive infections in COVID-19 patients. No difference in fungal species was found regarding of the sex, age of the patients, and waves of the pandemic. Antifungal susceptibility testing revealed no resistance to antifungals (fluconazole, voriconazole, itraconazole, amphotericin B, and flucytosine) among Candida isolates.ConclusionThese data show significant Candidiasis infection associated with the severe form of COVID-19. Given this prevalence of 20%, it is important for clinicians to remain vigilant and take proactive measures to prevent candidemia in patients with COVID-19. The widespread surveillance for fungal co-infections is still essential to reduce mortality associated with COVID-19.

Exposure-Response Relationship of Posaconazole Suspension in Theprophylaxis of Invasive Fungal Infections in Patients with Acute Myeloid Leukemia.

Antifungal prophylaxis with posaconazole has demonstrated a reduction in the risk of death due to Invasive fungal infections (IFI)in patients with acute myeloid leukemia (AML) during induction therapy. However, various factors affect the plasma levels of posaconazole and can potentially limit its efficacy. Therapeutic drug monitoring (TDM) can help optimize the dose, but literature is scant from centers with a high IFI burden. This study aimed to evaluate the proportion of de-novo AML patients on induction who could achieve the target level of 700ng/mL with posaconazole prophylaxis,factors that can influence the plasma levels, and the impact of plasma posaconazole levels on incidence of IFI. Patients with AML on induction therapy with no baseline IFI were enrolled at our tertiary cancer center which has high prevalence of IFI. These patients received posaconazole suspension as prophylaxis. Daily plasma levels were measured from Day 4 till Day 12 of posaconazole prophylaxis. All patients were monitored for the development of IFI. The data on adverse events, concomitant drugs, mucositis, vomiting, and diarrhea were recorded. A total of 411 samples from fifty patients were collected. Only 177 out of 411 samples had levels > 700 ng/mL. The median trough level was 610 ng/mL (range30-3000 ng/mL). The median time to achieve target trough concentration was four days (range 4-12 days) from the start of induction.Thirty-eight (76%) patients achieved target plasma levels by day 12 of induction.The median plasma level on day 12 was 690 ng/mL (range,30-1270) in patients who achieved target levels as compared to 340 (50-560) ng/mL in those who did not. Twenty-six (52%) patients had IFI in our study, and the median time to develop breakthrough IFI was 14 days (range 4-24 days). Median and range of plasma levels were 690 ng/ml (30-2410; n = 22) in those who developed IFI, while 590 ng/mL (50-2300 n = 24) in those who did not. The odds of developing IFI in patients who did not achieve the threshold trough concentration of 700 ng/mL was 7.14 (95% CI; 1.35-37.75, p = 0.0206). Occurrence of vomiting (p = 0.02), diarrhea (p = 0.0008), mucositis (p = 0.003) had adverse impact on achievement of target plasma posaconazole levels. A significant proportion of patients receiving posaconazole prophylaxis fail to achieve target plasma levels which can result in high risk of development of IFI. Occurrence of diarrhea, vomiting and mucositis can adversely affect the achievement target plasma levels.

Basis of antifungal resistance and it’s mitigation strategies

Fungal infections are emerging now a days causing a wide spectrum of diseases in humans and animals mostly affecting patients with immunodeficiencies or chronic illness. As such now a days we can see that rise in fungal infection in patients suffering from Covid-19. It has become a measure challenge for clinicians to treat invasive fungal infections as there is only limited classes of antifungal agents are available. So this causes the over use of antifungal agents which gives opportunity to fungal pathogens to develop resistance. The main five types of antifungal use nowadays are mainly azoles, echinocandin, polyenes, alamines and pyrimidine analogues. These compounds mainly act through different mechanisms to show there fungicidal or fungistatic effect. In response to this, fungal pathogens have developedcertain mechanisms which enable them to escape or to overcome the effects of antifungals. Due to these mechanisms the resistance against this antifungal compounds as emerged worldwide.

Incidence of invasive fungal infections in patients with hematological malignancies receiving ibrutinib therapy in south-east Austria.

Since the broad implementation of ibrutinib therapy, an increasing number of studies have been reported on invasive fungal infections (IFI) associated with ibrutinib administration. We conducted a retrospective cohort study in three hospitals in south-east Austria in order to assess the local epidemiology of ibrutinib associated IFIs. A total of 113 patients with underlying hematological malignancy were included in the study. During the study period, a single IFI episode was observed, which corresponds to an IFI incidence of 2.3 cases per 100 person years (95% CI: 0.12-11.47). IFIs during ibrutinib therapy seem to be a rare event in case of absent additional risk factors for IFIs.