Galactomannan Antigen Research Articles

Aspergillus Galactomannan Titer as a Diagnostic Marker of Invasive Pulmonary Aspergillosis in Lung Transplant Recipients: A Single-Center Retrospective Cohort Study

Invasive pulmonary aspergillosis (IPA) can occur in immunocompromised patients, and an early detection and intensive treatment are crucial. We sought to determine the potential of Aspergillus galactomannan antigen titer (AGT) in serum and bronchoalveolar lavage fluid (BALF) and serum titers of beta-D-glucan (BDG) to predict IPA in lung transplantation recipients, as opposed to pneumonia unrelated to IPA. We retrospectively reviewed the medical records of 192 lung transplant recipients. Overall, 26 recipients had been diagnosed with proven IPA, 40 recipients with probable IPA, and 75 recipients with pneumonia unrelated to IPA. We analyzed AGT levels in IPA and non-IPA pneumonia patients and used ROC curves to determine the diagnostic cutoff value. The Serum AGT cutoff value was 0.560 (index level), with a sensitivity of 50%, specificity of 91%, and AUC of 0.724, and the BALF AGT cutoff value was 0.600, with a sensitivity of 85%, specificity of 85%, and AUC of 0.895. Revised EORTC suggests a diagnostic cutoff value of 1.0 in both serum and BALF AGT when IPA is highly suspicious. In our group, serum AGT of 1.0 showed a sensitivity of 27% and a specificity of 97%, and BALF AGT of 1.0 showed a sensitivity of 60% and a specificity of 95%. The result suggested that a lower cutoff could be beneficial in the lung transplant group. In multivariable analysis, serum and BALF AGT, with a minimal correlation between the two, showed a correlation with a history of diabetes mellitus.

Retrospective Multicenter Evaluation of the VirClia Galactomannan Antigen Assay for the Diagnosis of Pulmonary Aspergillosis with Bronchoalveolar Lavage Fluid Samples from Patients with Hematological Disease.

Galactomannan (GM) testing of bronchoalveolar lavage (BAL) fluid samples has become an essential tool to diagnose invasive pulmonary aspergillosis (IPA) and is part of diagnostic guidelines. Enzyme-linked immunosorbent assays (ELISAs) (enzyme immunoassays [EIAs]) are commonly used, but they have a long turnaround time. In this study, we evaluated the performance of an automated chemiluminescence immunoassay (CLIA) with BAL fluid samples. This was a multicenter retrospective study in the Netherlands and Belgium. BAL fluid samples were collected from patients with underlying hematological diseases with a suspected invasive fungal infection. Diagnosis of IPA was based on the 2020 European Organisation for Research and Treatment of Cancer (EORTC)/Mycoses Study Group Education and Research Consortium (MSGERC) consensus definitions. GM results were reported as optical density index (ODI) values. ODI cutoff values for positive results that were evaluated were 0.5, 0.8, and 1.0 for the EIA and 0.16, 0.18, and 0.20 for the CLIA. Probable IPA cases were compared with two control groups, one with no evidence of IPA and another with no IPA or possible IPA. Qualitative agreement was analyzed using Cohen's κ, and quantitative agreement was analyzed by Spearman's correlation. We analyzed 141 BAL fluid samples from 141 patients; 66 patients (47%) had probable IPA, and 56 cases remained probable IPA when the EIA GM result was excluded as a criterion, because they also had positive culture and/or duplicate positive PCR results. Sixty-three patients (45%) had possible IPA and 12 (8%) had no IPA. The sensitivity and specificity of the two tests were quite comparable, and the overall qualitative agreement between EIA and CLIA results was 81 to 89%. The correlation of the actual CLIA and EIA values was strong at 0.72 (95% confidence interval, 0.63 to 0.80). CLIA has similar performance, compared to the gold-standard EIA, with the benefits of faster turnaround because batching is not required. Therefore, CLIA can be used as an alternative GM assay for BAL fluid samples.

Serum Cytokine Biomarkers for Use in Diagnosing Pulmonary Tuberculosis versus Chronic Pulmonary Aspergillosis.

Aspergillus fumigatus-induced chronic pulmonary aspergillosis (CPA), the most common pulmonary tuberculosis (TB) sequela, tends to occur after pulmonary infection with the intracellular pathogen Mycobacterium tuberculosis (Mtb). Timely and accurate detection of A. fumigatus infection of pulmonary TB patients would undoubtedly greatly improve patient prognosis. Currently, the galactomannan (GM) antigen test is commonly used to detect A. fumigatus infection but has poor sensitivity that renders this assay inadequate for use in clinical practice. Given the fact CPA and TB induce different host immune responses, we evaluated serum cytokine level profiles of CPA, TB patients and patients with both diseases (CPA-TB) for multiple cytokines and cytokine combinations. The results revealed significantly higher serum levels of numerous proinflammatory cytokines, including IL-1β, IL-6, IL-8, IL-12p70, IFN-α, IFN-γ and TNF-α, in peripheral blood of CPA-TB patients versus that of TB patients. IL-8 levels alone provided the best discriminatory performance for distinguishing between TB and either CPA-TB patients (AUC = 0.949) or CPA patients (AUC = 0.964). Moreover, both IL-8 and TNF-α (AUC = 0.996) levels could be used to distinguish between TB and CPA-TB patients. Likewise, IL-8, TNF-α and IL-6 levels together could be used to distinguish between CPA-TB and TB patients. In this study, multiple cytokines were identified that may serve as potential biomarkers for use in detecting TB patients with CPA. Furthermore, our results should enhance understanding of how immune system dysfunctions influence susceptibility to Mtb and/or A. fumigatus infections.

Comparison of the Results of Galactomannan and Beta Glucan Antigen Tests in the Suspicion of Invasive Pulmonary Aspergillosis

Opportunistic fungal infections are an important cause of morbidity and mortality in immunocompromised patients. Invasive aspergillosis (IA) has an important place among these infections with ~ 250.000 cases annually. Reducing the mortality rate due to invasive aspergillosis is possible with early diagnosis and treatment of the disease. Because of the low sensitivity in microscopic examination, the time consuming of culture growth, and the difficulties in distinguishing colonization/infection, serological methods are frequently used in the diagnosis of invasive aspergillosis. The aim of this study was to determine the diagnostic performance of galactomannan and beta glucan tests for the diagnosis of invasive pulmonary aspergillosis (IPA). Sixty patients, followed up with the suspicion of invasive pulmonary aspergillosis in Gazi University Hospital were included in the study. The clinical classification of the patients was made according to the revised European Organization for Research and Treatment of Cancer and the Mycoses Study Group (EORTC/MSG) criteria. A total of 10 patients were classified as probable invasive aspergillosis and 20 patients were classified as possible invasive fungal disease. Demographic data of the patients and various risk factors were recorded. One hundred and thirty serum and nine bronchoalveolar lavage (BAL) fluid samples were studied with Plateliaᵀᴹ Aspergillus Ag (Bio-Rad, France), Dynamiker Aspergillus Galactomannan and Dynamiker Fungus (1-3)-beta-D-Glucan (Dynamiker, China) kits. Sensitivity and specificity values were calculated according to U.S. Food and Drug Administration (FDA) approved Plateliaᵀᴹ Aspergillus Ag test. According to this study, the most important risk factors in the development of IPA were the use of steroids and immunomodulatory drugs. The sensitivity of the galactomannan test in the probable group was 77.8%, the specificity was 96.7%, the sensitivity of the beta glucan test was 61.1%, and the specificity was 92.6%. When these two tests were evaluated together, it was observed that the sensitivity in the probable group increased to 83.3% and the specificity decreased to 89.3%. The combined use of galactomannan and beta glucan tests increases the diagnostic sensitivity. Although the presence of prolonged neutropenia is an important risk factor for IA, the use of steroids and immunomodulatory drugs should be kept in mind in non-neutropenic patients.

Infection due to Aspergillus flavus and Rhizopus oryzae complex in a patient with diabetes mellitus

Fungal sinusitis is a pathology that can occur in patients with diabetes mellitus and be associated with a hyperglycemic crisis. It is an aggressive entity with local complications that include involvement of the orbit or the central nervous system, and vascular involvement. Despite surgical and antifungal treatment, mortality raises up to 75%. We report the case of a female patient with a diagnosis of diabetic ketoacidosis and signs of unilateral ophthalmoplegia, which led to the study with magnetic resonance imaging of the central nervous system, finding signs of sinusitis, meningitis, and cerebritis. Initial microbiological studies were negative, and biomarkers such as serum galactomannan and Cryptococcus antigen were also negative. After surgical management and the identification of Aspergillus flavus and Rhizopus spp. in sinus tissue, the patient received treatment with posaconazole and after two months of follow-up she presented clinical improvement. Dual fungal infection and infection by A. flavus are uncommon and clinically relevant entities, with no cases previously reported in our country, therefore this corresponds to a case of clinical interest.

Characterization of Aspergillus spp. isolated from patients with coronavirus disease 2019

IntroductionInvasive pulmonary aspergillosis (IPA) is an important complication of coronavirus disease 2019 (COVID-19), and while there are case reports and epidemiological studies, few studies have isolated Aspergillus strains from patients. Therefore, we analyzed the strains, sensitivities, and genetic homology of Aspergillus spp. Isolated from patients with COVID-19. MethodsWe investigated the Aspergillus strains detected from patients with COVID-19 hospitalized in Osaka Metropolitan University Hospital from December 2020 to June 2021. A molecular epidemiological analysis of Aspergillus spp. was performed using drug susceptibility tests and TRESPERG typing, and data on patient characteristics were collected from electronic medical records. ResultsTwelve strains of Aspergillus were detected in 11 of the 122 patients (9%) with COVID-19. A. fumigatus was the most common species detected, followed by one strain each of Aspergillus aureolus, Aspergillus nidulans, Aspergillus niger, and Aspergillus terreus. A. aureolus was resistant to voriconazole, and no resistance was found in other strains. All A. fumigatus strains were genetically distinct strains. Six of the 11 patients that harbored Aspergillus received antifungal drug treatment and tested positive for β-D-glucan and/or Aspergillus galactomannan antigen. The results indicated that Aspergillus infections were acquired from outside the hospital and not from nosocomial infections. ConclusionStrict surveillance of Aspergillus spp. is beneficial in patients at high-risk for IPA. When Aspergillus is detected, it is important to monitor the onset of IPA carefully and identify the strain, perform drug sensitivity tests, and facilitate early administration of therapeutic agents to patients with IPA.

Clinical characteristics, diagnosis, outcomes and lung microbiome analysis of invasive pulmonary aspergillosis in the community-acquired pneumonia patients

BackgroundInvasive pulmonary aspergillosis (IPA) remains underestimated in patients with community-acquired pneumonia (CAP). This study aims to describe clinical features and outcomes of IPA in CAP patients, assess diagnostic performance of...

Long-Term Kinetics of Serum Galactomannan during Treatment of Complicated Invasive Pulmonary Aspergillosis

Several studies have evaluated the serum galactomannan (GM) antigen assay in pediatric patients, and there is convincing evidence for its usefulness as a diagnostic tool for invasive Aspergillus infections in patients with acute leukemias or post allogeneic hematopoietic cell transplantation (HCT). Less is known about the utility of the assay in monitoring responses to treatment in patients with established invasive aspergillosis (IA). Here, we present the long-term kinetics of serum galactomannan in two severely immunocompromised adolescents with invasive pulmonary aspergillosis (IPA) who were cured after complicated clinical courses. We also review the utility of the GM antigen assay in serum as a prognostic tool around the time of diagnosis of IA and as a biomarker to monitor disease activity in patients with established IA and assess responses to systemic antifungal therapy.

Aspergillosis of the brain: diagnostic difficulties. Case report

Background: Neuroaspergillosis has nonspecific clinical manifestations and a severe course. Cases of central nervous system aspergillosis are becoming more frequent. Its lifetime diagnosis is very difficult. At the same time, a timely diagnosis makes it possible to conduct an adequate specific therapy and save the patient's life.
 Clinical case description: We report a clinical case of a patient with a lethal damage to the brain by filamentous fungi, who did not have the risk factors described in the literature human immunodeficiency virus (HIV), neutropenia, organ and tissue transplantation, long therapy with immunosuppressive drugs or corticosteroids.
 Conclusion: One needs to consider a possibility of this pathology in patients even in the absence of a fever and immunodeficiency conditions. A specific study of biological fluids for the presence of the galactomannan antigen may allow one to establish a timely correct diagnosis and apply an adequate treatment.

Specific Parameters of Detection of Fungi of the Genus <i>Aspergillus</i> in Respiratory Organs of Pulmonary Tuberculosis Patients

The objective: to study specific parameters of detection of fungi of the genus Aspergillus in respiratory organs of pulmonary tuberculosis patients.Subjects and Methods. In 2019-2021, the samples of sputum or bronchoalveolar lavage of 520 patients above 18 years old with confirmed pulmonary tuberculosis and HIV-negative status were tested for molds. Also, all patients had their sputum or BAL tested for acid fast mycobacteria (AFB), cultures of M. tuberculosis (MBT), and DNA of tuberculous mycobacteria.Results. Positive culture results for fungi were obtained in 50/520 (9.62%; 95% CI 7.37-12.45, Wilson test) pulmonary tuberculosis patients. Species identification revealed fungi of the genus Aspergillus in 46/50 (92%) of them.In 37/46 (80.43%; 95% CI 66.83-89.35) patients, a single type (one species of Aspergillus) was identified, in 9/46 (19.57%; 95% CI 10.65-33.17) two types were identified. A. fumigatus (16/37 isolates, 43.24%) and A. niger (13/37 isolates, 35.14%) prevailed among single types of cultures. A. niger + A. flavus (3/9 isolates, 33.33%) was the most frequent combination. The ratio of the effectiveness of methods for detecting fungi such as culture/direct microscopy/galactomannan antigen in serum and BAL was 100/84.78/4.35% and 67.39%, respectively. Thus, BAL is more preferable than serum for detection of galactomannan antigen in patients with tuberculosis.Only in 8/46 (17.4%) patients, bacterial excretion was detected by culture, which is typical for the active phase of the course of tuberculosis. In the remaining 38 (82.6% 95% CI 69.28-90.91) patients, no tuberculous mycobacteria were detected by culture, which was typical of stabilization and cure of tuberculosis.

Options appraisal of various β‒D‒glucan assay systems for a diagnostic microbiology laboratory

Invasive fungal infections (IFIs) have become a substantial concern in immunocompromised cancer patients, diabetics, hematopoietic stem cell transplant and solid organ transplant recipients with significant morbidity and mortality, Amongst IFIs, Candida and Aspergillus continue to be the most frequently reported, along with Fusarium and Zygomycetes. The need for tissue samples and the time required for cultures and histological investigation has made diagnosing IFIs problematic in the past. The detection of IFIs non-invasively by measuring biological markers such as the galactomannan antigen and the fungal wall component (1-3)-β-D-Glucan (BDG) have emerged as excellent options. In view of multiple kits available for detection and quantification of the fungal wall component (1-3)-BDG, it becomes essential to perform the options appraisal to find out the best available test option for a microbiology laboratory. Our work focuses on comparing various (1-3)-BDG detection systems available in the market.

900: A REPORT OF DISSEMINATED HISTOPLASMOSIS IN AN IMMUNOCOMPROMISED PATIENT FOLLOWING COVID-19 INFECTION

Introduction: Histoplasmosis results from spore inhalation of Histoplasma capsulatum, an endemic fungus in the soil of the Ohio and Mississippi River Valleys of the United States. While the majority of infections with H. capsulatum are asymptomatic and self-limited, immunosuppressed patients may develop severe, disseminated disease. Few reports have described disseminated histoplasmosis following SARS-CoV-2 (COVID-19) infection such as described in this case. Description: A 69-year-old female was evaluated for shortness of breath. Her medical history was significant for rheumatoid arthritis on methotrexate and recent COVID-19 infection treated with dexamethasone. Initial CT-angiography of the chest showed patchy bilateral ground glass opacities. She had leukopenia with white blood cell count of 1.3 K/uL and elevated procalcitonin of 5.88 ng/mL. Broad spectrum empiric antibiotics were initiated. On day 6, the patient decompensated and required ICU transfer. Urine histoplasma antigen, M and H precipitin bands, and serum galactomannan antigen returned positive. Amphotericin B was initiated. The patient underwent bronchoscopy with bronchoalveolar lavage showing atypical reactive macrophages with rare intracellular organisms suspicious for fungi. Repeat CT of the chest, abdomen, and pelvis showed extensive bilateral ground glass opacities, bilateral pulmonary calcifications consistent with granulomas, and calcifications in the spleen and liver. On hospital day 10, the patient required intubation due to hypoxemic respiratory failure. Despite appropriate antifungal therapy, she had worsening encephalopathy, leukocytosis, erythema nodosum, and renal failure. She passed away on day 19. Discussion: This case highlights the development of disseminated histoplasmosis in an immunocompromised adult following COVID-19 infection. It was not until treatment with high dose glucocorticoids that the patient developed disseminated disease and declined. It is important to be aware of the impact that the COVID-19 pandemic has on the emergence of infectious disease and the role its treatment plays in immune suppression. Disseminated histoplasmosis is a consideration for immunocompromised patients in high risk, H. capsulatum endemic areas who are being treated for COVID-19 with high doses of steroids for prolonged periods.

161. Assessing Trends in 1,3-β-D Glucan and Aspergillus Galactomannan Antigen Ordering to Improve Use

Abstract Background 1,3-β-D Glucan (BDG) and Aspergillus galactomannan antigen (GM) are commonly ordered. Overutilization of these tests increases the incidence of false positive results, potentially leading to unnecessary follow up testing, procedures, and treatment. The aim of this quality improvement (QI) study was to improve our understanding of BDG and GM utilization at our institution. Methods The test orders for BDG and GM were modified within our electronic medical record (EMR) to provide education and require selection of ordering reason from a list of criteria. Educational sessions were provided to non-transplant provider groups who order BDG and GM frequently. Total number of tests, test results, patient immunosuppressed status, ordering location, and provider specialty were compared for a 3-month period pre/post intervention. Ordering criteria was collected post-intervention. SPSS software was used for chi square tests comparing groups. Results BDG and GM ordering practices were compared in the pre- and post-intervention timeframes (Table 1). There were no significant differences in the total number of tests, immune status of patients, ordering location or test results for BDG or GM. A significant decrease in hospitalist ordering was found (n=79 (pre), n=48 (post), p=0.006). Positive GM tests were rare in both periods (1.96%, 6/306 and 3.34%, 10/299). Ordering criteria for both tests were also evaluated in the post-intervention period (Table 2). The most common ordering criteria selected for BDG and GM were disseminated fungal infection 275/435 (63%) and invasive aspergillosis 241/299 (81%), respectively. Conclusion Most BDG and GM tests were ordered utilizing appropriate ordering criteria and were among immunosuppressed patients. However, selection of an appropriate reason does not necessarily correlate to obtaining in the appropriate clinical setting. This QI project improved our understanding of how BDG and GM are utilized, and by whom. In the future, these results will be used to provide more targeted education to specific provider groups. In addition, further EMR order entry modifications will focus on potential false positive results to further optimize BDG and GM test utilization. Disclosures All Authors: No reported disclosures.

Lateral flow assay (LFA) in the diagnosis of COVID-19-associated pulmonary aspergillosis (CAPA): a single-center experience

BackgroundInvasive pulmonary aspergillosis (IPA) is seen during coronavirus-2019 (COVID-19), has been reported in different incidences, and is defined as COVID-19-associated pulmonary aspergillosis (CAPA). Detection of galactomannan antigen is an important diagnostic step in diagnosing IPA. Enzyme-linked immunoassay (ELISA) is the most frequently used method, and lateral flow assay (LFA) is increasingly used with high sensitivity and specificity for rapid diagnosis. The present study aimed to compare the sensitivity of LFA and ELISA in the diagnosis of CAPA in COVID-19 patients followed in our hospital's ICU for pandemic (ICU-P).MethodsThis study included patients with a diagnosis of COVID-19 cases confirmed by polymerase chain reaction and were followed up in ICU-P between August 2021 and February 2022 with acute respiratory failure. The diagnosis of CAPA was based on the European Confederation of Medical Mycology (ECMM) and the International Society for Human and Animal Mycology 2020 (ECMM/ ISHAM) guideline. Galactomannan levels were determined using LFA and ELISA in serum samples taken simultaneously from the patients.ResultsOut of the 174 patients followed in the ICU-P, 56 did not meet any criteria for CAPA and were excluded from the analysis. The rate of patients diagnosed with proven CAPA was 5.7% (10 patients). A statistically significant result was obtained with LFA for the cut-off value of 0.5 ODI in the diagnosis of CAPA (p < 0.001). The same significant statistical relationship was found for the cut-off value of 1.0 ODI for the ELISA (p < 0.01). The sensitivity of LFA was 80% (95% CI: 0.55–1.05, p < 0.05), specificity 94% (95% CI: 0.89–0.98, p < 0.05); PPV 53% (95% CI: 0.28–0.79, p > 0.05) and NPV was 98% (95% CI: 0.95–1.01, p < 0.05). The risk of death was 1.66 (HR: 1.66, 95% CI: 1.02–2.86, p < 0.05) times higher in patients with an LFA result of ≥ 0.5 ODI than those with < 0.5 (p < 0.05).ConclusionsIt is reckoned that LFA can be used in future clinical practice, particularly given its effectiveness in patients with hematological malignancies and accuracy in diagnosing CAPA.

Aspergillus pleural empyema in a chronic smoker – A case report and review of literature

Aspergillus species are ubiquitous saprophytic fungi that are present in the air, water, soil, and decaying vegetables. Clinical features of Aspergillus infection largely depend on the interplay between the fungi and the host immune status. We present a case of a chronic smoker with shortness of breath who was found to have diffuse bronchiectatic changes and empyema of the right lung. Emphysema was also noticed in the left lung. Rare Aspergillus fumigatus was identified in the pleural fluid, while the acid-fast stain and bacterial cultures were negative. The patient's serum Aspergillus fumigatus IgG antibody and galactomannan antigen were negative; however, the pleural galactomannan antigen was elevated. He was treated with video-assisted thoracoscopic surgery (VATS) and partial decortication of the right lung, along with intravenous voriconazole. Despite aggressive therapeutic measures, he died after a prolonged hospital stay. Aspergillus pleural empyema is rare but can be fatal; however, it is not included in the classification for pulmonary aspergillosis. Clinicians should be vigilant to evaluate for fungal empyema in patients with chronic obstructive pulmonary diseases, even without profound immunosuppression.

TUMOR NECROSIS FACTOR (TNF) ALPHA INHIBITORS, ASPERGILLOSIS, AND GALACTOMANNAN: THE PERILS OF BEING MISLED BY AN INSENSITIVE TEST

TUMOR NECROSIS FACTOR (TNF) ALPHA INHIBITORS, ASPERGILLOSIS, AND GALACTOMANNAN: THE PERILS OF BEING MISLED BY AN INSENSITIVE TEST

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

RAPID DEVELOPMENT AND PROGRESSION OF INVASIVE PULMONARY ASPERGILLOSIS

RAPID DEVELOPMENT AND PROGRESSION OF INVASIVE PULMONARY ASPERGILLOSIS

P457 Clinical correlation of beta galactomannan with culture and patient outcome in a tertiary care center in south india

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM BackgroundInvasive aspergillosis has increased in the last decade. They mainly occur in neutropenic patients (following anticancer treatment) and in patients treated with immunosuppressants and corticosteroids. The galactomannan antigen in serum appears to be a serological method able to aid in the diagnosis of invasive aspergillosis also the antigen detection in bronchoalveolar lavage has proven to be advantageous for the diagnosis of invasive aspergillosis.ObjectivesTo perform galactomannan test on BAL and Serum samples.To correlate the galactomannan results with culture.To correlate the galactomannan positive patients with the clinical outcome.MethodsA total of 175 samples were collected from patients suspected to have fungal infections from the period of January 2018 to March 2022 from a tertiary care center in South India. The galactomannan assay and culture were done for these samples. Data of age, sex, gender, diagnosis, underlying conditions, antifungal treatment, and outcomes were collected.ResultsOut of 175 samples collected from patients suspected with Aspergillosis, 120 were males and 55 were females (7 were repeat samples).The major underlying conditions were diabetes and hypertension, coronary artery disease (CAD), and Hematopoetic malignancy such as B Cell lymphomas, ALL, and AML (Fig. 1).The samples sent for galactomannan assay were serum (107 samples), Bronchial wash (74 samples), BAL (4 samples), and tracheal aspirates (3 samples). The test was performed and cultured (Table 1). The cutoff titer for BAL/sera was taken as an index >0.50A total of 90 patients were galactomannan positive. In which, 13 patients were only KOH positive and 6 were KOH and culture positive.In all, 6 cultures grew Aspergillus sp (1), Aspergillus flavus (2), Aspergillus terreus (1), Aspergillus fumigatus (2).A total of 36 patients out of 90 with galactomannan positive were treated with antifungals like liposomal amphotericin B, voriconazole, itraconazole, and fluconazole.In all, 30 patients were discharged, 10 were discharged at request, 86 left against medical advice, 38 patients succumbed to infection, and 12 were outpatients lost to follow-up.ConclusionGalactomannan alone cannot be taken as a diagnostic marker. Clinical correlation, radiologic findings, as well as underlying risk factors play a major role for decision on the initiation of empiric treatment.

P210 Fungal isolates of the respiratory tract in symptomatic patients hospitalized in pulmonary units: A mycological and molecular epidemiologic study

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectiveFungal respiratory infections are being recognized with increasing frequency in parallel with an expanding population of immunocompromised patients. In most cases, colonization is the first step in the progression to pulmonary fungal infection. This study was designed to evaluate the distribution of fungal elements in the respiratory tract of symptomatic patients hospitalized in pulmonary units.MethodsThis descriptive cross-sectional study was carried out over a period of 2 years, from October 2017 to October 2019 in Guilan province, located in Iran's northern region. In the current study, bronchoalveolar lavage or sputum specimens were collected. All samples were analyzed by direct microscopy using KOH 10% and culture. Fungal identification was accomplished by internal transcribed spacer (ITS) and beta-tubulin sequencing. Also, in patients suspected of invasive pulmonary aspergillosis, BAL specimens were tested for galactomannan (GM) antigen.ResultsA total of 384 lung specimens [192 bronchoalveolar lavage (BAL) and 192 sputum samples] were obtained from symptomatic patients hospitalized in pulmonary units. Of these, 137 (35.67%) were positive in direct examination and culture. Among the 137 positive cases, most isolates were from male patients 86 (62.77%) and most of them were between 46 and 72 years. Candida albicans (37.22%) and C. tropicalis (21.89%) represent the two most commonly isolated species in the current study. Cough (94.16%), dyspnea (81.02%), purulent sputum (62.04%), and weight loss (56.2%) were the predominant symptoms and tuberculosis (24.81%), chemotherapy (21.89%), and diabetes mellitus (19.70%) were the predominant underlying conditions. Also, 5 cases of invasive pulmonary aspergillosis and 1 case of mucormycosis were diagnosed.Conclusion Candida albicans was the most common fungal species isolated from symptomatic patients hospitalized in pulmonary units. Tuberculosis, chemotherapy and diabetes mellitus were important underlying conditions for pulmonary fungal colonization and/or infection.