Mold Infections Research Articles

The Inhibitory Effect of Sodium Bicarbonate, Phylex and Seaweed Extract Against Penicillium digitatum Causing Green Rot Disease in Local Lemon Fruits

This study was conducted in the College of Agricultural Engineering Sciences/University of Baghdad during the years 2021 and 2022. The study aimed to evaluate the biological activity of Sodium bicarbonate, Phylex and the Seaweed extract in controlling the green mold infection in the local lemon at refrigerated storage conditions (4°C). Two isolates of Penicillium digitatum were identified on Potato Dextrose Agar (PDA) and coded as L1 and L2. The results of this study confirmed the high pathogenicity of P. digitatum isolates to lemon fruits. The symptoms of green rot infection appeared on the fruits after 4 days of pathogen inoculation. The preservative and anti-fungal activity of Sodium bicarbonate, Phylex and Seaweed extract were assessed using local lemon fruits under refrigerated-storage conditions. The highest inhibitory effect was reported when 64 g/L Sodium bicarbonate, 4ml/L Phylex and 128 g/L Seaweed extract were used, preventing 100% of P. digitatum colonies growth after 6 days of treatment at 25±2°C. The data of the refrigerated-storage experiments showed that the Phylex treatment of artificial-wound fruits inoculated with the pathogen was more efficient than Sodium bicarbonate in protecting the lemon fruits from green mold infection. Phylex treatment protected the fruits from the fungal infection for 45 days storage, compared to the Sodium bicarbonate treatment, with which, the fruit infection appeared after 30 days of refrigerated-storage (at 4°C).

Enhancing the antioxidant and antifungal properties of polyphenols through encapsulation in β-lactoglobulin nanoparticles using emulsification-evaporation technique

Numerous studies have demonstrated the potential of banana blossom polyphenols as antioxidants and antifungal agents. However, their application in the food field is extremely limited due to their vulnerability to environmental conditions. This study aims to increase the stability of banana blossom polyphenols and explore their potential in food preservation, particularly against fungal infections. To achieve this, β-lactoglobulin@ferulic acid-quercetin-vanillic acid nanoparticles (N-β-LG@FA-QT-VA) with a particle size of 74.5–80.7 nm were successfully obtained using β-lactoglobulin (β-LG) as the encapsulating material, combined with protein heating modification and emulsification-evaporation techniques. The encapsulation process resulted in a significant increase in antioxidant activity, with an improvement of 42.3% over the free polyphenols. Furthermore, N-β-LG@FA-QT-VA nanoparticles displayed significantly higher antifungal activity and fruit preservation abilities compared to β-LG and FA-QT-VA mixtures. They effectively inhibited the germination and expansion of Penicillium digitatum, a common fruit pathogen. Applying this knowledge, these nanoparticles were tested on orange fruits inoculated with P. digitatum. A successful delay in green mold infection and decay was observed, demonstrating the potential of N-β-LG@FA-QT-VA nanoparticles as a natural alternative to synthetic fungicides, all while maintaining fruit quality.

Genome identification and biocontrol potential against citrus blue mold of Bacillus velezensis w176

Citrus fruit is susceptible to Penicillium mold infection. Biocontrol with utilization of antagonistic microorganisms against postharvest diseases is regarded as an effective and eco-friendly approach in citrus fruit storage. Here, the complete genome of biocontrol strain w176 was obtained with a full length of 3,929,790 bp, and it consists of 12 potential gene clusters which might be responsible for antagonistic metabolites biosynthesis, strain w176 was identified as Bacillus velezensis by genome alignments eventually. Meanwhile, strong restrictions of spore germination rate (SGR) and hyphae elongation were detected when strain w176 was co-incubated with P. italicum, the inhibitory of SGR at 6 h, 9 h and 12 h was 10.00%, 49.59% and 23.53%, respectively. And the inhibitory of hyphae elongation was 35.56% at 12 h. It was also found that strain w176 exhibited notable growth space competition in the co-incubation. Moreover, significantly enhanced activities of catalase and chitinase in citrus fruit were presented 2 d and 3 d post-inoculation with strain w176. Further, citrus fruit treated by strain w176 PDB culture (PBC) or its culture filtrate (CFS) displayed significantly reduced virulence of P. italicum contamination, the decreased disease symptoms of CFS and PBC were 30.32% and 85.22%, individually. The inhibitory disease rate of PBC was 25%. This study reveals that strain w176 has high potential to be applied as bio-pesticide in citrus preservation. The data attained in this research might be helpful for citrus blue mold control, and could provide basis for the bio-preservation study in postharvest fruit.

Improving Diagnosis of Pulmonary Mucormycosis: Leads From a Contemporary National Study of 114 Cases

Pulmonary mucormycosis (PM) is a life-threatening invasive mold infection. Diagnosis of mucormycosis is challenging and often delayed, resulting in higher mortality. Are the disease presentation of PM and contribution of diagnosis tools influenced by the patient underlying condition? All PM cases from six French teaching hospitals between 2008 and 2019 were retrospectively reviewed. Cases were defined according to updated EORTC/MSG criteria with the addition of diabetes and trauma as host factors and positive serum or tissue PCR as mycological evidence. Thoracic CT scans were reviewed centrally. One hundred and fourteen cases of PM were recorded, including 40% disseminated forms. Main underlying conditions were hematological malignancy (49%), allogeneic hematopoietic stem-cell transplantation (21%), and solid organ transplantation (17%). When disseminated, main dissemination sites were the liver (48%), spleen (48%), brain (44%), and kidneys (37%). Radiological presentation included consolidation (58%), pleural effusion (52%), reversed halo sign (RHS, 26%), halo sign (24%), vascular abnormalities (26%), and cavity (23%). Serum qPCR was positive in 42/53 patients (79%) and bronchoalveolar lavage (BAL) in 46/96 patients (50%). Transthoracic lung biopsy was diagnostic in 8/11 (73%) patients with non-contributive BAL. Overall 90-day mortality was 59%. Neutropenic patients displayed more frequently an angioinvasive presentation including RHS and disseminated disease (p<0.05). Serum qPCR was more contributive in neutropenic patients (91% vs 62%, p=0.02) and BAL in non-neutropenic patients (69% vs 41%, p=0.02). Serum qPCR was more frequently positive in patients with a >3cm main lesion (91% vs 62%, p=0.02). Overall, positive qPCR was associated with an early diagnosis (p=0.03) and treatment onset (p=0.01). Neutropenia and radiological findings influence disease presentation and contribution of diagnostic tools during PM. Serum qPCR is more contributive in neutropenic patients and BAL examination in non-neutropenic patients. Lung biopsies are highly contributive in case of non-contributive BAL.

Serial Quantitation of Plasma Microbial Cell-Free DNA Before and After Diagnosis of Pulmonary Invasive Mold Infections After Hematopoietic Cell Transplant.

Plasma microbial cell-free DNA sequencing (mcfDNA-Seq) is a noninvasive test for microbial diagnosis of invasive mold infection (IMI). The utility of mcfDNA-Seq for predicting IMI onset and the clinical implications of mcfDNA concentrations are unknown. We retrospectively tested plasma from hematopoietic cell transplant (HCT) recipients with pulmonary IMI and ≥1 mold identified by mcfDNA-Seq in plasma collected within 14 days of clinical diagnosis. Samples collected from up to 4 weeks before and 4 weeks after IMI diagnosis were evaluated using mcfDNA-Seq. Thirty-five HCT recipients with 39 IMIs (16 Aspergillus and 23 non-Aspergillus infections) were included. Pathogenic molds were detected in 38%, 26%, 11%, and 0% of samples collected during the first, second, third, and fourth week before clinical diagnosis, respectively. In non-Aspergillus infections, median mcfDNA concentrations in samples collected within 3 days of clinical diagnosis were higher in infections with versus without extrapulmonary spread (4.3 vs 3.3 log10 molecules per microliter [mpm], P = .02), and all patients (8/8) with mcfDNA concentrations >4.0 log10 mpm died within 42 days after clinical diagnosis. Plasma mcfDNA-Seq can identify pathogenic molds up to 3 weeks before clinical diagnosis of pulmonary IMI. Plasma mcfDNA concentrations may correlate with extrapulmonary spread and mortality in non-Aspergillus IMI.

Surveillance 101: Developing and Implementing Standardized Definitions for Healthcare-Associated Mold Infection Surveillance and Review

Surveillance 101: Developing and Implementing Standardized Definitions for Healthcare-Associated Mold Infection Surveillance and Review

Fatal Invasive Mold Infections after Transplantation of Organs Recovered from Drowned Donors, United States, 2011-2021.

Drowned organ donors can be exposed to environmental molds through the aspiration of water; transplantation of exposed organs can cause invasive mold infections in recipients. We describe 4 rapidly fatal cases of potentially donor-derived invasive mold infections in the United States, highlighting the importance of maintaining clinical suspicion for these infections in transplant recipients.

Unearthing the Mold: An Investigation of Hospital-Associated Mold Infections in a Medical Intensive Care Unit

Unearthing the Mold: An Investigation of Hospital-Associated Mold Infections in a Medical Intensive Care Unit

BI28 Phaeohyphomycosis in the immunosuppressed patients: the challenges of treatment

Abstract Phaeohyphomycosis is a group of multisystem mycoses owed to heterogeneous organisms called ‘dematiaceous’ or ‘melanized’ fungi. The presence of melanin in their cell walls is a distinguishing feature, likely to be acting as a virulence factor. Widely abundant in the environment, these organisms commonly infect humans through traumatic inoculation and have many clinical forms of presentation, including cutaneous, subcutaneous, systemic, and rarely disseminated. Both immunocompetent and immunocompromised hosts are affected. Diagnosis of the cutaneous infection is primarily reliant on histology and culture; treatment is not standardized and is based on clinical experience. We report a case of a 39-year-old man who presented to the dermatology clinic with ‘lumps’ on his lower limbs. His background included poorly controlled hypertension and diabetes mellitus type 2 leading to nephropathy and necessitating a renal transplant, which failed. A 5-year period of dialysis involving a sedentary lifestyle was followed by a repeat renal transplant during which time he developed multiple warty-looking nodules of varying size, with pseudomilia cysts on his lower limbs in addition to stasis changes. Histology reported a pigmented mould infection (probably phaeohyphomycosis), and there was no growth on culture. The patient was trialled on two azole antifungals at different times, but on both occasions, he dived into congestive cardiac failure needing intensive care unit admissions. Reducing immunosuppression therapy was difficult considering his previous failed renal transplant. Owing to the extent and multiplicity of the lesions on the background of immunosuppression, the surgical treatment option poses significant risks. Currently, he is managed on topical treatment with some stabilization of the lesions; however, it is unclear how these will progress in the future. Although uncommon, the number of patients with phaeohyphomycosis has increased due to awareness of melanized fungi on a background of the global COVID-19 pandemic, with SARS-CoV-2, and the use of immunosuppressive agents such as glucocorticoid therapy increasing the risk of infections of deep mycosis. Treatment for phaeohyphomycosis has largely been surgical excision for localized lesions in addition to oral antifungals. Our case highlights that, in transplant patients, therapeutics are difficult, with life-threatening complications from oral antifungals and the risks of surgical intervention including ulceration, bleeding and infections. In addition, the cosmetic appearance of the prevalent noticeable lesions for a relatively young patient is also significant and patient counselling is vital, especially when treatment options are minimal.

Non-destructive pre-symptomatic detection of gray mold infection in kiwifruit using hyperspectral data and chemometrics

Application of hyperspectral imaging (HSI) and data analysis algorithms was investigated for early and non-destructive detection of Botrytis cinerea infection. Hyperspectral images were collected from laboratory-based contaminated and non-contaminated fruits at different day intervals. The spectral wavelengths of 450 nm to 900 nm were pretreated by applying moving window smoothing (MWS), standard normal variates (SNV), multiplicative scatter correction (MSC), Savitzky–Golay 1st derivative, and Savitzky–Golay 2nd derivative algorithms. In addition, three different wavelength selection algorithms, namely; competitive adaptive reweighted sampling (CARS), uninformative variable elimination (UVE), and successive projection algorithm (SPA), were executed on the spectra to invoke the most informative wavelengths. The linear discriminant analysis (LDA), developed with SNV-filtered spectral data, was the most accurate classifier to differentiate the contaminated and non-contaminated kiwifruits with accuracies of 96.67% and 96.00% in the cross-validation and evaluation stages, respectively. The system was able to detect infected samples before the appearance of disease symptoms. Results also showed that the gray-mold infection significantly influenced the kiwifruits’ firmness, soluble solid content (SSC), and titratable acidity (TA) attributes. Moreover, the Savitzky–Golay 1st derivative-CARS-PLSR model obtained the highest prediction rate for kiwifruit firmness, SSC, and TA with the determination coefficient (R2) values of 0.9879, 0.9644, 0.9797, respectively, in calibration stage. The corresponding cross-validation R2 values were equal to 0.9722, 0.9317, 0.9500 for firmness, SSC, and TA, respectively. HSI and chemometric analysis demonstrated a high potential for rapid and non-destructive assessments of fungal-infected kiwifruits during storage.

COVID-19 associated mold infections: Review of COVID-19 associated pulmonary aspergillosis and mucormycosis.

COVID-19-associated mold infection (CAMI) is defined as development of mold infections in COVID-19 patients. Co-pathogenesis of viral and fungal infections include the disruption of tissue barrier following SARS CoV-2 infection with the damage in the alveolar space, respiratory epithelium and endothelium injury and overwhelming inflammation and immune dysregulation during severe COVID-19. Other predisposing risk factors permissive to fungal infections during COVID-19 include the administration of immune modulators such as corticosteroids and IL-6 antagonist. COVID-19-associated pulmonary aspergillosis (CAPA) and COVID-19-associated mucormycosis (CAM) is increasingly reported during the COVID-19 pandemic. CAPA usually developed within the first month of COVID infection, and CAM frequently arose 10-15 days post diagnosis of COVID-19. Diagnosis is challenging and often indistinguishable during the cytokine storm in COVID-19, and several diagnostic criteria have been proposed. Development of CAPA and CAM is associated with a high mortality despiteappropriate anti-mold therapy. Both isavuconazole and amphotericin B can be used for treatment of CAPA and CAM; voriconazole is the primary agent for CAPA and posaconazole is an alternative for CAM. Aggressive surgery is recommended for CAM to improve patient survival. A high index of suspicion and timely and appropriate treatment is crucial to improve patient outcome.

The first suspected disseminated Hormographiella aspergillata infection in China, diagnosed using metagenomic next-generation sequencing: a case report and literature review

ABSTRACT Hormographiella aspergillata is a rare and emerging cause of invasive mould infections in patients with haematological malignancies, with a mortality rate of approximately 70%. Here, we present the first reported case of suspected disseminated H. aspergillata infection in China. The patient experienced a second relapse of acute myeloid leukaemia and developed neutropenia, fever, discrepant blood pressure between limbs, and cutaneous lesions limited to the left upper extremity. Since lung tissue biopsy was not feasible, metagenomic next-generation sequencing (mNGS) and panfungal polymerase chain reaction (PCR) analysis of bronchoalveolar lavage fluid and blood samples were performed, which indicated probable H. aspergillata pulmonary infection. Histopathology of cutaneous lesions revealed numerous fungal hyphae within dermal blood vessels. mNGS of a skin biopsy sample identified H. aspergillata sequences, and the fungi was subsequently recovered from fungal culture, proving cutaneous H. aspergillata infection. Despite combined antifungal therapy, the patient died owing to disease progression. Additionally, 22 previously reported cases of invasive H. aspergillata infection were reviewed in patients with haematological malignancies. Thus, mNGS is a powerful diagnostic tool for the early and effective detection of invasive H. aspergillata infections, with the advantage of sequencing all potential pathogens, and providing results within 24 h.

Environmental factors associated with invasive mold infections at a tertiary-care hospital

Background: Invasive mold infections (IMIs) in hospitalized patients can result in significant morbidity and mortality. Environmental factors, such as hospital construction and negative air-pressure rooms (NAPRs), have been associated with hospital-acquired IMI. Increased utilization of NAPRs during the COVID-19 pandemic created a unique opportunity to examine the impact of NAPRs on IMI risk. Methods: From 2018 to present, a new pavilion was being constructed adjacent to our hospital. The Theradoc platform was used to identify positive mold cultures among adult patients hospitalized at our institution between March 1, 2017, and October 15, 2022. We performed a retrospective chart review of 262 mold isolates to determine patient demographics, timing of IMI, and their relationship to hospital construction and exposure to NAPR. IMI incidence was compared across 3 observation periods: (A) before hospital construction; (B) during hospital construction alone; and (C) during hospital construction and NAPR enhancement during the COVID-19 surge. Hospital-acquired IMI was defined as an infection that occurred &gt;72 hours after admission. A REDCap database was created for data storage and R software was used for data analysis. Results: Of the 262 mold isolates identified, 61 cases were classified as IMI, of which 29 were hospital-acquired IMI. The mean age of IMI patients was 51.8 years, and 55.2% were male. Among them, 20.7% were exposed to NAPR during admission; 65.5.% were immunocompromised; and 2 patients were diagnosed with COVID-19. The all-cause mortality rate among hospital-acquired IMI cases was 79.3% (23 of 29). Also, 82.8% of hospital-acquired IMI cases were respiratory in nature, with 83.3% of these cases due to Aspergillus spp. Yearly rates of hospital-acquired IMI were 3.0 before construction versus 5.6 during construction (periods B and C). Yearly rates of hospital-acquired IMI, respiratory IMI, and invasive pulmonary aspergillosis by period were as follows: Period A had 3 hospital-acquired IMI cases per year, 2 hospital-acquired respiratory IMI cases per year, and 3 hospital-acquired invasive pulmonary aspergillosis cases per year. Period B had 4.5 hospital-acquired IMI cases per year, 3.5 hospital-acquired respiratory IMI cases per year, and 3.0 hospital-acquired invasive pulmonary aspergillosis cases per year. Period C had 6.5 hospital-acquired IMI cases per year, 5.4 hospital-acquired respiratory IMI cases per year, and 5.0 hospital-acquired invasive pulmonary aspergillosis cases per year. Conclusions: Hospital-acquired IMI was associated with a high mortality. Our data demonstrate a &gt;2-fold increase in yearly incidence of hospital-acquired IMI before construction compared with during construction in association with increased implementation of NAPR. We have now reversed the trend in NAPR at our hospital’s designated COVID-19 units.Disclosures: None

Changes in the epidemiology of invasive fungal disease in a Pediatric Hematology and Oncology Unit: the relevance of breakthrough infections

BackgroundInvasive fungal disease (IFD) is a significant cause of morbimortality in children under chemotherapy or hematopoietic stem cell transplant (HSCT). The purpose of this study is to describe the changes in the IFD epidemiology that occurred in a Pediatric Hematology-Oncology Unit (PHOU) with an increasing activity over time.MethodsRetrospective revision of the medical records of children (from 6 months to 18 years old) diagnosed with IFD in the PHOU of a tertiary hospital in Madrid (Spain), between 2006 and 2019. IFD definitions were performed according to the EORTC revised criteria. Prevalence, epidemiological, diagnostic and therapeutic parameters were described. Comparative analyses were conducted using Chi-square, Mann-Whitney and Kruskal-Wallis tests, according to three time periods, the type of infection (yeast vs mold infections) and the outcome.ResultsTwenty-eight episodes of IFD occurred in 27 out of 471 children at risk (50% males; median age of 9.8 years old, [IQR 4.9-15.1]), resulting in an overall global prevalence of 5.9%. Five episodes of candidemia and 23 bronchopulmonary mold diseases were registered. Six (21.4%), eight (28.6%) and 14 (50%) episodes met criteria for proven, probable and possible IFD, respectively. 71.4% of patients had a breakthrough infection, 28.6% required intensive care and 21.4% died during treatment.Over time, bronchopulmonary mold infections and breakthrough IFD increased (p=0.002 and p=0.012, respectively), occurring in children with more IFD host factors (p=0.028) and high-risk underlying disorders (p=0.012). A 64% increase in the number of admissions in the PHOU (p<0.001) and a 277% increase in the number of HSCT (p=0.008) were not followed by rising rates of mortality or IFD/1000 admissions (p=0.674).ConclusionsIn this study, we found that yeast infections decreased, while mold infections increased over time, being most of them breakthrough infections. These changes are probably related to the rising activity in our PHOU and an increase in the complexity of the baseline pathologies of patients. Fortunately, these facts were not followed by an increase in IFD prevalence or mortality rates.

A Rare Systemic Fungal Infection (Cladophialophora) Masquerading Invasive Candidiasis in a Patient with B-Acute Lymphoblastic Leukaemia

Acute lymphoblastic leukaemia (ALL) is the most common malignancy in childhood and its incidence peaks during the first 2–5 years of life.The long-term survival of patients with ALL has increased to ∼90% with risk-directed therapy and improved supportive care. However, incidence of mould infections caused by Aspergillus species, and other emerging mould opportunistics, such as Zygomycetes and Fusarium species and non-albicans Candida species have progressively been noted to increase particularly in patients with ALL. Here, we present a case of B-ALL with rare fungal infection (Cladophialophora) masquerading invasive Candidiasis which led to diagnostic delay and chemotherapy interruptions, but the patient achieved good overall outcome.

Invasive Mold Infections in Children: Navigating Troubled Waters with a Broken Compass.

Incidence of invasive mold infections in children, while rare, is increasing as the population of high-risk patients expands, including premature infants, pediatric patients undergoing treatment for hematological malignancies, or recipients of allogeneic hematologic stem cell transplants. The infectious agents, including Aspergillus spp., Mucorales, and other molds, are especially difficult to treat and have serious morbidity and high mortality. Clinicians must maintain a high index of suspicion for invasive mold infections in at-risk patients. Diagnosis of invasive mold infections is complicated by difficulties isolating pathogens on culture, but progress is being made in immunological and molecular diagnostic technologies. Treatment in children is challenging; no randomized controlled trials exist. There is a growing body of data on treatment, specifically on safer antifungal agents, including indications for treatment, spectrum of coverage, pharmacokinetics for different ages, and pharmacodynamic targets associated with therapeutic success. However, pediatricians must often extrapolate from adult data. In this review, we aim to harmonize the existing body of literature on invasive mold infections in children, covering epidemiology, clinical presentations, diagnostic methods, and principles of management.

705 Evaluation of Invasive Fungal Infections in the Burn ICU

Abstract Introduction Fungal infections are increasingly associated with critical illness, especially in major burn injury. The risk factors of invasive fungal infections include central venous catheter (CVC) placement, mechanical ventilation, broad-spectrum antibiotics, renal replacement therapy (RRT), and total parental nutrition. Critically ill burn patients have additional risk factors including extensive wounds, impaired immune system, and repeated surgical intervention. Despite significant morbidity and mortality caused by invasive fungal infections, efforts to prevent them with antifungal prophylaxis have not improved outcomes. In patients who develop invasive fungal infection, appropriate empiric antifungal therapy is imperative to reduce morbidity and mortality especially in the setting of delayed culture and sensitivity data. The purpose of this study was to characterize risk factors associated with the development of invasive fungal infection, invasive fungal infection organisms and surgical and pharmacological management. Methods A retrospective chart review was completed of adult patients admitted to the burn ICU found to have an invasive fungal infection (defined as at least one positive blood or tissue fungal infection and receipt of systemic antifungal therapy). The primary outcome was to identify common fungal organisms. Secondary outcomes included susceptibility pattern of the organism, location of infection, surgical management including debridement and amputation, pharmacological management, median ICU and hospital length of stay, and in hospital mortality. Results A total of 10 patients of a goal of 100 patients with a median 54% TBSA burns were evaluated at this time. The most common yeast species included candida albicans; mold species included a variety of organisms such as fusarium, zygomycete and paecilomyces. Common risk factors among these patients included CVC access (57%), mechanical ventilation (43%), and RRT (43%). Yeast infections were primarily treated with anidulafungin and fluconazole, while mold infections were managed with systemic amphotericin as backbone in addition to voriconazole or isavuconazole. Patients underwent aggressive surgical debridement for source control. Median ICU stay was 53 days with a median hospital stay of 63 days, and 42% mortality. Conclusions Fungal infections among critically ill burn patients are associated with the high morbidity and mortality rates. Therefore, mitigation of modifiable risk factors is of utmost importance. This retrospective review of common fungal growth in our unit will inform future empiric antifungal management for patients with concern of invasive fungal infections. Applicability of Research to Practice Fungal infections present a clinical challenge for burn practitioners, especially in geographically moist areas. Prevention and informed surgical and pharmacological management are key to overcoming this infectious disease threat.

The Fragile Patient: Considerations in the Management of Invasive Mould Infections (IMIs) in India.

Invasive mould infections (IMIs), which are mostly caused by Aspergillus spp. and Mucormycetes, are opportunistic infections that impose a substantial threat to patients who are considered to be 'fragile'. There is no fixed definition for fragile patients; however, patients with cancer or acquired immunodeficiency syndrome (AIDS), patients who have undergone organ transplants, and patients being treated in the intensive care units (ICUs) were considered fragile. Management of IMIs in fragile patients is challenging, owing to their compromised immune status. The diagnostic challenges associated with IMIs due to insufficient sensitivity and specificity of the current diagnostic tests leadto delayed treatment. A widening demographicof at-risk patients and a broadening spectrum of pathogenic fungi have added to the challenges to ascertain a definite diagnosis. A recent surge of mucormycosis associated with SARS-CoV-2 infections and the resultant steroid usage has been reported. Liposomal amphotericin B (L-AmB) is the mainstay for treating mucormycosis while voriconazole has displaced amphotericin B as the mainstay for treating Aspergillus infection due to its better response, improved survival, and fewer severe side effects. The selection of antifungal treatment has to be subjected to more scrutiny in fragile patients owing to their comorbidities, organ impairment, and multiple ongoing treatment modalities. Isavuconazole has been documented to have a better safety profile, stable pharmacokinetics, fewer drug-drug interactions, and a broad spectrum of coverage. Isavuconazole has thus found its place in the recommendations and can be considered a suitable option for treating fragile patients with IMIs. In this review, the authors have critically appraised the challenges in ascertaining an accurate diagnosis and current management considerationsand suggested an evidence-based approach to managing IMIs in fragile patients.

Statistic and Network Features of RGB and Hyperspectral Imaging for Determination of Black Root Mold Infection in Apples.

Apples damaged by black root mold (BRM) lose moisture, vitamins, and minerals as well as carry dangerous toxins. Determination of the infection degree can allow for customized use of apples, reduce financial losses, and ensure food safety. In this study, red-green-blue (RGB) imaging and hyperspectral imaging (HSI) are combined to detect the infection degree of BRM in apple fruits. First, RGB and HSI images of healthy, mildly, moderately, and severely infected fruits are measured, and those with effective wavelengths (EWs) are screened from HSI by random frog. Second, the statistic and network features of images are extracted by using color moment and convolutional neural network. Meanwhile, random forest (RF), K-nearest neighbor, and support vector machine are used to construct classification models with the above two features of RGB and HSI images of EWs. Optimal results with the 100% accuracy of training set and 96% accuracy of prediction set are obtained by RF with the statistic and network features of the two images, outperforming the other cases. The proposed method furnishes an accurate and effective solution for determining the BRM infection degree in apples.

(198) Non-Aspergillus Fumigatus Mold Infections (NAFMI) in Lung Transplant (LT) Recipients, Pathogens and Risk Factors

(198) Non-Aspergillus Fumigatus Mold Infections (NAFMI) in Lung Transplant (LT) Recipients, Pathogens and Risk Factors