Months Of Antifungal Treatment Research Articles

PULMONARY MUCORMYCOSIS; CHALLENGES IN DIAGNOSIS AND TREATMENT

Pulmonary mucormycosis is an angio-invasive fungal infection by mucorales with high mortality and morbidity. This pulmonary infection is caused by inhalation of spores and seen mostly in immunocompromised patients. In TB endemic country like India, pulmonary mucormycosis pose a diagnostic dilemma due to similar clinical presentation. Our 49-year-old female patient presented with characteristic symptoms and started on anti TB drugs. As patient was not having symptomatic relief, patient was investigated. On bronchoscopy, fungal mass seen and biopsy of which shown organisms consistent with mucormycosis. Patient underwent lobectomy and received 5 months of antifungal treatment.

P119 Dysregulated IL-23R and CD25 T cells in post -COVID-19 Rhino-Orbital Mucormycosis patients

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM ObjectivesTo study the IL-23R (Th17) and CD25+ (Treg) in CD4 + T cell populations in rhino-orbital mucormycosis post-COVID-19 patients and in healthy controls.MethodsThe study included 20 cases of mucormycosis and 20 healthy controls. Nasal crust, collected post-surgery was subjected to KOH/culture for mycological identification. Venous blood sample (3 ml) was collected in EDTA vials from cases and controls and stained with different monoclonal antibodies such as CD3, CD4, CD25, and IL-23R for analyzing the expression of Th17 and Treg cells by flow cytometry. The assays were performed at the time of enrolment of patients and repeat blood samples were taken from each patient for staining 3 months later after treatment prescribed by Otorhinolaryngologists. Statistical analysis was done using SPSS software and the P-value ≤ .05 considered as significant. All the data are expressed as the mean ± SD.ResultsAll the cases were found positive by KOH and confirmed for Rhizopus arrhizus by culture.The flow cytometry analysis showed that the percentage of CD4 + IL-23R+ (Th17) cells was significantly high in patient before treatment compared to healthy controls and found to be lower post 3 months of antifungal treatment. The percentage positivity of CD4 + CD25+ (Tregs) cells was decreased in patients (before treatment) as compared to controls and after treatment groups. The percentage positivity of CD4 + CD25 + cells was significantly increased in patients after treatment.ConclusionWe observed a noticeable immune imbalance, with elevated CD4 + IL-23R Th17 and diminished CD4 + CD25 + T regulatory cells. The findings imminently indicate the mechanism of immune dysregulation involving Th17 and Treg pathways in mucormycosis and provide evidence that restoration of Th17/Treg may be considered as a therapeutic option for long-term benefit. Recovery of CD4 + CD25 + T cells after treatment indicated a favorable phenotype outcome.

Mucormycosis causing massive lower gastrointestinal bleeding: a case report

BackgroundLower gastrointestinal bleeding (LGIB) is very common in the hospital setting. Most bleedings stop spontaneously, but rare infectious causes of LGIB may lead to rapid and serious complications if left untreated and are sometimes very difficult to diagnose preoperatively.Case presentationWe described a young man with poorly controlled Type I diabetes mellitus and chronic alcohol abuse who presented with acute altered mental status. During his hospitalization for treatment of diabetic ketoacidosis, acute renal failure, and sepsis, he suddenly developed massive hematochezia of 1500 mL. Colonoscopy was performed and a deep ulcer covered with mucus with peripheral elevation was noted at the transverse colon. Biopsy of the ulcer later revealed nonpigmented, wide (5–20 µm in diameter), thin-walled, ribbon-like hyphae with few septations and right-angle branching suggestive of mucormycosis demonstrated by Periodic acid–Schiff stain. He received 2 months of antifungal treatment. Follow up colonoscopy post-treatment was normal with no ulcer visualized.ConclusionsEarly diagnosis and treatment of gastrointestinal (GI) mucormycosis infection is critical but can be challenging, especially in the setting of massive hematochezia. Therefore, clinical awareness for immunocompromised patients and prompt antifungal prophylaxis in cases with high suspicion of infection are essential.

Evaluation of (1→3)-β-D-glucan assay for diagnosing paracoccidioidomycosis.

Paracoccidioidomycosis (PCM) is highly prevalent in Latin America, but no commercial system is available for diagnosing this endemic mycosis. To check the performance of (1→3)-β-D-glucan assay (BDG) for diagnosing PCM in 29 patients with proven fungal disease and compared with double immunodiffusion assay for detecting anti-Paracoccidioides antibodies. We selected 52 serum samples sequentially obtained from 29 patients with active PCM (12 chronic and 17 acute form). Samples were collected at baseline, and for16patients, additional serum levels were obtained after 3 and 6months of antifungal treatment. Detection of BDG in serum was performed by using the Fungitell® assay. For the double immunodiffusion assay, Paracoccidioides exoantigen was used in latex agglutination tests to detect serum anti-Paracoccidioides antibodies. Despite exhibiting good sensitivity in the diagnosis of patients with PCM, we failed to demonstrate any correlation between the postdiagnosis kinetic profile of BDG serum levels and clinical response to antifungal therapy. This finding may be related to the maintenance of quiescent foci of fungal infection in several organs and tissues, a phenomenon that has been previously reported by other authors and helps to understand why so many relapses are documented in patients treated for short periods of time. Finally, we did not find any correlation between BDG quantification and specific anti-P brasiliensis antibodies serum titres in patients with PCM. In conclusion, BDG is detected in serum samples of most patients with PCM but is probably not useful for predicting clinical response to antifungal therapy.

Unusual Course of Crystalline Keratopathy in a Patient with Graft-Versus-Host Disease.

We present a case of infectious crystalline keratopathy in a patient with Graft-versus-Host disease (GVHD) who developed satellite fungal keratitis. A 51-year-old man was referred for bilateral total persistent corneal epithelial defects with severe dry eye. Although persistent epithelial defect healed with medical therapy, he developed stromal keratitis with satellite lesions confirmed to be secondary to Candida albicans. After three months of antifungal treatment and debridement, improvement of the infiltrates was obtained. Crystalline keratopathy is an important clinical entity which may develop due to several causes. The microbial causes include not only bacteria but fungi as well. Careful investigation must be performed, especially for immune-compromised patients, in order to provide appropriate and timely treatment.

Laryngeal histoplasmosis: an occupational hazard

Isolated laryngeal histoplasmosis is a very rare entity. It has variable clinical presentations that might mimic both benign and malignant lesions, and is usually associated with pulmonary and other disseminated forms of histoplasmosis. Herein, we report a case of primary laryngeal histoplasmosis without the involvement of other systems in a 70-year-old Chinese man, who previously worked as a miner. He presented with a history of hoarseness for two months, with no other associated symptoms. Direct laryngoscopy revealed irregularity of the posterior one-third of both vocal folds. Histopathological examination revealed the presence of Histoplasma capsulatumon periodic acidSchiff and Grocott's methenamine silver staining. The lesion resolved after one month of oral itraconazole treatment. However, the patient had to complete six months of antifungal treatment to prevent recurrence.

Disseminated mycotic infection caused by Westerdykella species in a German Shepherd Dog

A 5-year-old 34.3-kg (75.5-lb) neutered male German Shepherd Dog was evaluated because of chronic azotemia that was unresponsive to typical medical management. Urinalysis revealed pyuria and fungal hyphae. Fungal culture of a urine sample grew a sterile mold that was identified as Westerdykella spp via PCR assay. TREATMENT AND OUTCOME-: he dog was treated empirically with itraconazole orally and amphotericin B IV for 5 weeks. Because of progressive azotemia, treatment was modified to oral administration of posaconazole. The dog improved but then developed progressive azotemia, hyperphosphatemia, and suspected diskospondylitis. Treatment was again modified to oral administration of terbinafine on the basis of results of antifungal susceptibility testing. The dog was euthanized after 5 months of antifungal treatment because of a deteriorating clinical condition and progressive azotemia. Westerdykella spp are filamentous hyphal organisms from the family Sporomiaceae and had not previously been reported to cause infections in dogs. Fungal PCR assay and antifungal susceptibility testing may be useful for a patient with a suspected fungal infection that does not respond to empirical treatment or when traditional culture methods for fungal identification are unsuccessful. Westerdykella spp should be considered as a possible etiologic agent when systemic mycosis is diagnosed.

Not Just a Simple Pneumothorax

Not Just a Simple Pneumothorax

Cryptococcal meningitis in an immunocompetent child

An immunocompetent child infected with cryptococcal meningitis was cured without any sequelae or relapse with six months of antifungal treatment. An 11-year old Japanese boy who presented with headache and vomiting without high fever was admitted to a local hospital with a diagnosis of aseptic meningitis and discharged after symptomatic relief. Cryptococcus neoformans was later detected in the cerebrospinal fluid (CSF) culture and he was referred to our hospital. His physical and neurological examination was unremarkable except for a mild stiff neck. Cryptococcus neoformans was detected in an India ink stain and culture of the CSF upon admission (Fig. 1), and the cryptococcal antigen with latex agglutination was positive. CSF revealed leukocytosis, increased protein and high opening pressure with normal glucose (53 mg/dl) (Fig. 2). Blood leukocyte count was 7600/ll. Although chest Xray was normal, CT revealed mild peribronchial inflammation in the left lower lobe (S7). An enhanced head MR imaging was negative. The initial treatment with intravenous amphotericin B (AMPH-B) and oral flucytocin (FC) was discontinued after ten days due to fever and skin rash: fluconazole (FLCZ) was administered orally for six months thereafter (Fig 2). No relapses or sequelae have been observed. A detailed developmental and medical history was unremarkable except that he had a history of repeated hospitalizations for asthma until eight years of age. It is noteworthy that he had occasionally been exposed to guano of wild pigeons. His humoral and cellular immunological parameters (CD4 900/ll, CD4/8 2.25), complement and neutrophil functions were normal. Anti-HIV antibody was negative. Although cryptococcal meningitis is uncommon among HIV-negative patients [1, 2, 6, 7, 8], severe pediatric cases have been reported [3, 4]. We infer that, in the case reported here, a pulmonary cryptococcal infection was the primary lesion preceding meningitis because of the exposure to guano of pigeons, repeated