Mycological Characteristics Research Articles

Foliar blight, leaf spot, and stem blackening diseases caused by Stemphylium beticola, Alternaria alternata, and Alternaria atra on dragon's head (Lallemantia iberica) in Iran

Dragon's head, Lallemantia iberica, is an oilseed crop adapted to be grown in cold-dry areas. In the growing season of 2022–23 a severe foliar blight, leaf spot, and stem blacking symptoms were observed in commercial fields in northern and northwestern Iran, leading to more than 50 % yield loss. Infected samples were collected and transferred to the laboratory. Following the isolation of fungal agents, five representative isolates were selected for further studies. Morphological studies, based on conidial shape, conidiation, and other mycological characteristics, were carried out on a pure culture established from a single spore. Furthermore, multigene phylogenetic analyses were performed using sequences of translation elongation factor 1-α (TEF1), glyceraldehyde 3-phosphate dehydrogenase (GAPDH), RNA polymerase II second largest subunit (RPB2), and Internal Transcribed Spacer (ITS) rDNA genes for Alternaria isolates, along with calmodulin (cmdA) for the Stemphylium isolate. The morphological and molecular studies identified the fungal isolates as Alternaria atra, Alternaria alternata, and Stemphyliium beticola. Pathogenicity tests on the commercial cultivar ‘Sara’ indicated that all isolates were pathogenic to dragon's head, but they differed significantly in aggressiveness. To the best of our knowledge, this is the first report of the association of these fungal species with an important foliar disease on this crop in Iran and worldwide.

Clinical Profile and Mycological Profile of Dermatophytosis: A Cross-sectional Study at a Tertiary Care Hospital in Southern India

Abstract Background: This cross-sectional observational study aimed to analyze the clinical and mycological characteristics of dermatophytosis in patients visiting the outpatient clinic of the department of dermatology at a tertiary care hospital in Telangana. Methodology: The study was conducted from November 2017 to July 2019, involving patients clinically diagnosed with dermatophytosis. Data collection included detailed demographic and clinical information and laboratory investigations such as direct microscopy, fungal culture, and hematological examinations. Specimens were collected from skin lesions, nails, and hair, processed using appropriate methods, and subjected to culture and microscopic examination. Descriptive statistics was performed to present the findings. Results: A total of 100 participants were recruited, with a median age of 24 years. The majority were male (n = 75, 75%) and students (n = 47, 47%). Most participants (n = 71, 71%) presented with extensive tinea followed by tinea corporis and tinea capitis. Trichophyton mentagrophytes was the most isolated variant (n = 42, 97.7%) among positive cultures. Conclusion: Young male populations are the most common victims in this region. The significant number of tinea cases and the high prevalence of T. mentagrophytes underscore the necessity for precise diagnosis and effective management strategies in treating dermatophytosis.

21-plex PCR and Antifungal Susceptibility Aspects of Fungemia Agents in Pediatric Patients with Hematological Malignancies: A Single-Center Experience

Background: Fungemia is a life-threatening infection which requires an early diagnosis and use of appropriate antifungal agents to be treated effectively. Objectives: Here, we describe the clinical-epidemiological characteristics as well as the antifungal susceptibility patterns of fungal agents in pediatric patients with malignancy. Methods: Two hundred and five blood samples were cultured to detect infection. The infectious agents were identified by phenotypic methods and 21-plex PCR. Antifungal susceptibility testing was performed using an E-test and disc diffusion test based on CLSI standard M27-A3 protocol. The demographic data of the studied population were extracted and analyzed. Results: In total, 36 out of 205 patients (17.6%) were positive for fungemia. 32 (88.9%) and 4 (11.1%) cases were found to be caused by Candida and Rhodotorula species, respectively. The patient's age ranged from 1 to 14 years. The majority of the patients were males (28; 77.8%) and were hospitalized for more than seven days (33; 91.7%). Non-Candida albicans species were the most common agents of fungemia (27 patients; 75%), with C. parapsilosis (77.8 %) as the dominant agent. Fever, central venous catheters, and broad-spectrum antibiotic therapy were observed in all cases. Itraconazole resistance was observed in a species of C. orthopsilosis. While the Candida isolates were susceptible to fluconazole, C. parapsilosis showed a significant rate of resistance to caspofungin, followed by itraconazole and amphotericin B. Overall, no mortality was reported among the fungemia cases. Conclusions: This study identified acute lymphoblastic leukemia (ALL) as a hematologic malignancy associated with fungemia. The increase of non-C. albicans species, including C. parapsilosis, along with reduced susceptibility to antifungal drugs, maybe a warning sign in pediatric patients with malignancies. Furthermore, fluconazole was the most effective antifungal agent against the recovered isolates. Therefore, the best strategy for the management of fungemia is to increase knowledge based on local epidemiological and mycological characteristics.

Filamentous fungi associated with the brown mussel, Perna perna (Bivalvia: Mytilidae), off the coast of Rio de Janeiro, Brazil

ABSTRACT Bivalves are known to be infected by filamentous fungi, many of which have pathogenic and toxicogenic properties, and may represent a risk to human health. The present study investigated the mycological characteristics of Perna perna obtained from Guanabara Bay, Brazil. The mussels were sealed individually in sterile bags, weighed and measured, and the internal organs were examined. The organs were grown in different culture media. All but one of the 31 mussels (96.7%) examined contained fungi, and a total of 84 fungal colonies were isolated. The genera identified were Aspergillus (40.5%), Didymella (35.7%), Penicillium (10.7%), Aureobasidium (1.2%), Cladosporium (1.2%) and Phaeoisaria (1.2%). The molecular sequences obtained 99.8 and 100% identity with Didymella sp., Phaeoisaria sp. and Aureobasidium pullulans, and were deposited in GenBank. This is the first record of Didymella and Phaeoisaria in a bivalve. The digestive gland was the organ with the greatest diversity of fungi genera. A number of the fungi identified here, as Aspergillus awamori, Aspergillus japonicus, Aspergillus niger, Aspergillus versicolor and Aspergillus sydowii, are known to produce mycotoxins and others are opportunistic forms, which reinforces the need for the systematic monitoring of the study area to guarantee the safe exploitation of these bivalves for human consumption.

Clinical Analysis of Patients Diagnosed with Cutaneous Sporotrichosis in China.

This study aimed to improve the understanding of sporotrichosis by analyzing the epidemiological characteristics, clinical manifestations, mycological features, and pathological characteristics of the disease in eastern China. Clinical data of 49 patients diagnosed with cutaneous sporotrichosis in dermatology clinics over a 20-year period were collected and analyzed retrospectively. The analysis included patient demographics, occupations, clinical types, lesion sites, misdiagnosis rates, laboratory investigations, treatment and outcomes. The study included 22 male and 27 female patients, with a mean age of 52.4 years. Farmers (42.86%) and manual workers (28.57%) had a higher risk of infection. The most common clinical types were lymphocutaneous (30.61%) and fixed (69.39%), predominantly affecting the face and upper limbs. Misdiagnosis as other infectious skin diseases occurred in 35 patients (71.43%). Fungal culture and histopathological examination were important diagnostic tools. Treatment with oral itraconazole for three months led to relief and regression of the skin lesions in most patients, although a few experienced recurrences. Cutaneous sporotrichosis mainly affects individuals working in agriculture and manual labour, with lymphocutaneous and fixed types being the predominant clinical manifestations. The high misdiagnosis rate emphasizes the importance of early recognition, accurate diagnosis and standardized treatment for the prognosis and cure of sporotrichosis. Fungal culture and histopathological examination are essential for diagnosis, and oral itraconazole is an effective treatment option.

Prevalence and risk factors for onychomycosis in acute care dermatology wards.

We conducted a cross-sectional study on the clinical and mycological features of onychomycosis in patients in the dermatology ward of Iwate Medical University Hospital, an acute care hospital. Of the 226 hospitalized patients, 73 (32.3%) had onychomycosis and 61 (26.9%) were diagnosed after admission. The toenail was the most common site of onychomycosis (94.5%), while toenail plus fingernail and fingernail only sites were 4.1% and 1.4%, respectively. The most common clinical form of onychomycosis was distal and lateral subungual onychomycosis (79%) with Trichophyton rubrum (66.7%) and T. interdigitale (27.8%) as the main causative species. Patients who were older, or had neurological diseases, or needed stretcher transfer had onychomycosis significantly more frequently than those who were obese, had diabetes, cancer, needed an escort for moving, or could move independently. Our study suggests that there is likely to be a significant number of untreated and undiagnosed patients with onychomycosis in acute care hospitals. Therefore, it is necessary to increase awareness of onychomycosis in hospitals.

Acute Invasive Pulmonary Aspergillosis: Clinical Presentation and Treatment.

Among all clinical manifestations of pulmonary aspergillosis, invasive pulmonary aspergillosis (IPA) is the most acute presentation. IPA is caused by Aspergillus hyphae invading the pulmonary tissue, causing either tracheobronchitis and/or bronchopneumonia. The degree of fungal invasion into the respiratory tissue can be seen as a spectrum, going from colonization to deep tissue penetration with angio-invasion, and largely depends on the host's immune status. Patients with prolonged, severe neutropenia and patients with graft-versus-host disease are at particularly high risk. However, IPA also occurs in other groups of immunocompromised and nonimmunocompromised patients, like solid organ transplant recipients or critically ill patients with severe viral disease. While a diagnosis of proven IPA is challenging and often warranted by safety and feasibility, physicians must rely on a combination of clinical, radiological, and mycological features to assess the likelihood for the presence of IPA. Triazoles are the first-choice regimen, and the choice of the drug should be made on an individual basis. Adjunctive therapy such as immunomodulatory treatment should also be taken into account. Despite an improving and evolving diagnostic and therapeutic armamentarium, the burden and mortality of IPA still remains high. This review aims to give a comprehensive and didactic overview of the current knowledge and best practices regarding the epidemiology, clinical presentation, diagnosis, and treatment of acute IPA.

Invasive aspergillosis in adult patients in Australia and New Zealand: 2017–2020

New and emerging risks for invasive aspergillosis (IA) bring the need for contemporary analyses of the epidemiology and outcomes of IA, in order to improve clinical practice. The study was a retrospective, multicenter, cohort design of proven and probable IA in adults from 10 Australasian tertiary centres (January 2017-December 2020). Descriptive analyses were used to report patients' demographics, predisposing factors, mycological characteristics, diagnosis and management. Accelerated failure-time model was employed to determine factor(s) associated with 90-day all-cause mortality (ACM). Of 382 IA episodes, 221 (in 221 patients) fulfilled inclusion criteria - 53 proven and 168 probable IA. Median patient age was 61 years (IQR 51-69). Patients with haematologic malignancies (HM) comprised 49.8% of cases. Fifteen patients (6.8%) had no pre-specified immunosuppression and eleven patients (5.0%) had no documented comorbidity. Only 30% of patients had neutropenia. Of 170 isolates identified, 40 (23.5%) were identified as non-Aspergillus fumigatus species complex. Azole-resistance was present in 3/46 (6.5%) of A.fumigatus sensu stricto isolates. Ninety-day ACM was 30.3%. HM (HR 1.90; 95% CI 1.04-3.46, p=0.036) and ICU admission (HR 4.89; 95% CI 2.93-8.17, p<0.001) but not neutropenia (HR 1.45; 95% CI 0.88-2.39, p=0.135) were associated with mortality. Chronic kidney disease was also a significant predictor of death in the HM subgroup (HR 3.94; 95% CI 1.15-13.44, p=0.028). IA is identified in high number of patients with mild/no immunosuppression in our study. The relatively high proportion of non-A.fumigatus species complex isolates and 6.5% azole-resistance rate amongst A.fumigatus sensu stricto necessitates accurate species identification and susceptibility testing for optimal patient outcomes. This work is unfunded. All authors' financial disclosures are listed in detail at the end of the manuscript.

A Review of Chemical Composition and Bioactivity Studies of the Most Promising Species of Ganoderma spp.

This paper presents the current state of knowledge on the biological activity and possible medicinal applications of selected species of the genus Ganoderma: Ganoderma adspersum (Schulzer) Donk, Ganoderma applanatum (Pers.) Pat., Ganoderma carnosum Pat., Ganoderma lucidum (Curtis) P. Karst., Ganoderma pfeifferi Bres., Ganoderma resinaceum Boud. These inedible, wood-decaying fungi are pathogens that cause the enzymatic decomposition of wood. They are a valued natural medicinal resource and have been used in traditional Far Eastern medicine for centuries. Research conducted on these species using modern analytical methods has led to advances in knowledge of the potential therapeutic use of compounds isolated not only from basidiocarps but also from biomass obtained by in vitro methods. Recent pharmacological studies have confirmed the known traditional uses of these species, elucidated previously unknown mechanisms of biological action, and found evidence of new biological activities, such as anticancer, cytotoxic, antiallergic, and neuroprotective activities. Furthermore, the article updated the state of knowledge on the general mycological characteristics of these species.

First morphological and molecular isolation of Talaromyces marneffei in beech marten (Martes foina) in Portugal

Talaromyces marneffei is a zoonotic fungus that mostly infects immunocompromised individuals. For the first time, this fungus was isolated in an adult beech marten (Martes foina) hit by a car, found dead in Penamacor, Portugal. During the necropsy, different samples (skin, fur, lymph nodes, lung, spleen, kidneys, and brain) were collected and processed for microbiology (including mycology) and molecular biology. T. marneffei was identified through its mycological characteristics and confirmed by PCR in hair samples. No other lesions or alterations were reported, except a concomitant presence of M. avium subsp. paratuberculosis in lung, kidney and brain samples. To the authors' knowledge, this is the first description of this fungus beech marten, as well as the first case of co-infection with M. avium subsp. paratuberculosis in wildlife fauna. These results suggest a sylvatic life-cycle of T. marneffei, involving beech martens, in Portugal.

Clinical and Mycologic Characteristics of Emerging Mucormycosis Agent Rhizopus homothallicus.

We retrospectively reviewed consecutive cases of mucormycosis reported from a tertiary-care center in India to determine the clinical and mycologic characteristics of emerging Rhizopus homothallicus fungus. The objectives were ascertaining the proportion of R. homothallicus infection and the 30-day mortality rate in rhino-orbital mucormycosis attributable to R. homothallicus compared with R. arrhizus. R. homothallicus accounted for 43 (6.8%) of the 631 cases of mucormycosis. R. homothallicus infection was independently associated with better survival (odds ratio [OR] 0.08 [95% CI 0.02-0.36]; p = 0.001) than for R. arrhizus infection (4/41 [9.8%] vs. 104/266 [39.1%]) after adjusting for age, intracranial involvement, and surgery. We also performed antifungal-susceptibility testing, which indicated a low range of MICs for R. homothallicus against the commonly used antifungals (amphotericin B [0.03-16], itraconazole [0.03-16], posaconazole [0.03-8], and isavuconazole [0.03-16]). 18S gene sequencing and amplified length polymorphism analysis revealed distinct clustering of R. homothallicus.

Isolation of Terbinafine-Resistant Trichophyton rubrum from Onychomycosis Patients Who Failed Treatment at an Academic Center in New York, United States.

Onychomycosis is a common nail infection. Terbinafine-resistant dermatophyte infections pose an emerging global public health concern, but few cases have been described in the United States. We retrospectively reviewed and characterized clinical, histopathological, and mycological features of patients with mycologically confirmed onychomycosis who failed oral terbinafine treatment for onychomycosis at a U.S. academic nail referral center and ascertained for terbinafine-resistant isolates. During 1 June 2022-31 January 2023 at Weill Cornell Medicine in New York City, USA, 96 patients with mycologically confirmed onychomycosis were treated with oral terbinafine. Among 64 patients with adequate follow-up, 36 had clinical or complete cure. Of 28 patients who failed treatment, 17 underwent terbinafine resistance testing. Trichophyton rubrum with terbinafine resistance-conferring mutations was isolated from two patients. Overall, terbinafine failures for onychomycosis were relatively common, with some cases associated with terbinafine-resistant T. rubrum infections. These findings underscore the need for a clinical awareness of this emerging problem and public health efforts to monitor and prevent spread. We highlight the importance of diagnostic testing and species identification for onychomycosis patients and the increasingly important role of fungal identification and susceptibility testing to guide therapy.

Epidemiology and Clinical Findings of Tinea Capitis: A 23-Year Retrospective, Single-Center Study in Guangzhou, China.

Tinea capitis (TC) is one of the most common public health concerns due to its high incidence in preadolescent children. The epidemiological and clinical characteristics of TC vary depending on geographical regions and have changed over the past decades. This study aimed to identify epidemiological changes in recent decades, including the prevalence and clinical and mycological characteristics of TC in southern China. We conducted a retrospective study at the Department of Dermatology of Sun Yat-sen Memorial Hospital, Sun Yat-sen University from June 1997 to August 2020. We retrospectively evaluated 401 TC patients. Of these, 157 patients (39.2%) were preschool children aged 3-7years and the majority were males. However, the prevalence in children under 3years old is on the rise (from 19.67% during 1997-2010 to 32.49% during 2011-2020). Grey patches were the most common clinical pattern and mostly occurred in children (71.3%), while the proportion of grey patches and black dots was almost the same in adults. Although Microsporum canis (76%) was the most common causative organism, the number of the T. mentagrophytes complex, as a zoophilic fungus, has increased more than that of the anthropophilic fungi T. violaceum in the recent decade. There was a significant difference in the portion of sex among different age groups, and the gender difference was more notable in the adult group, which showed that the TC prevalence in females was 9 times that in males. In males, M. canis and the T. mentagrophytes complex were the two most common causative fungi, while M. canis and T. violaceum were the two most common causative fungi in females. Additionally, approximately 61.7% of black dot TCs occurred in females. For treatment, oral antifungal therapeutics were widely used in most patients with different treatment durations, although without a significant difference in efficacy (P = 0.106). In the last decade, the prevalence of TC in children under 3years old increased, and boys dramatically outnumbered girls. In adults, the TC prevalence in females is nine times that in males, and most TCs occurring in females are presented as black dots. Moreover, the zoophilic T. mentagrophytes complex has replaced T. violaceum and is now the second most prevalent organism, followed by M. canis of TC.

Retrospective Analysis of Tinea Capitis in Xinjiang, China.

Tinea capitis is a cutaneous infection of dermatophytes and predominant in children. It is one of common infectious diseases of children in Xinjiang, particularly in the southern Xinjiang. The aim of this study is to analyze the clinical and mycological characteristics of patients with tinea capitis in Xinjiang China. Medical records from 2010 to 2021, Mycology Laboratory Department of Dermatology in the First Affiliated Hospital of Xinjiang Medical University, retrospectively investigated the clinical and mycological characteristics of 198 patients with tinea capitis. Hairs have been obtained for fungal examination, and analysis with 20% KOH and Fungus Fluorescence Staining Solution has been conducted. Identification of fungi was using of morphological and molecular biological methods. Among total number of 198 patients, 189 (96%) were children with tinea capitis, of which 119 (63%) were male and 70 (37%) were female; 9 (4%) were adult patients with tinea capitis, of which 7 were female and 2 were male. Preschool children between the ages of 3 and 5years had the highest distribution (54%), followed by those between the ages of 6 and 12years (33%), the ages under 2years (11%) and the ages of 13-15years (2%) respectively. Among all patients, 135 (68.18%) were Uygur, 53 (26.77%) were Han, 5 (2.53%) were Kazak, 3 (1.52%) were Hui, 1 (0.5%) was Mongolian and nationality information of 1 patient (0.5%) is unknown. The indentification results of the isolates showed that 195 (98%) patients had single-species infections and 3 (2%) patients had double mixed infections. Among single-species infection patients, Microsporum canis (n = 82, 42.05%), Microsporum ferrugineum (n = 56, 28.72%) and Trichophyton mentagrophytes (n = 22, 11.28%) were the most prevalent species. Other dermatophytes included Trichophyton tonsurans (n = 12, 6.15%), Trichophyton violaceum (n = 10, 5.13%), Trichophyton schoenleinii (n = 9, 4.62%) and Trichophyton verrucosum (n = 4, 2.05%). Among 3 cases of mixed infections, 1 was M. canis + T. tonsurans (n = 1), and the other 2 were M.canis + T.mentagrophytes (n = 2). In conclusion, the majority of tinea capitis patients in Xinjiang, China are Uygur male children aged 3-5years. M. canis was the most prevalent species causing tinea capitis in Xinjiang. These results provide useful information for the treatment and prevention of tinea capitis.

Clinico-Mycological Study of Onychomycosis in Indian Diabetic Patients

Background: Onychomycosis (OM) is the most common nail disorder accounting for 40–50% of all onychopathies. Onychomycosis is caused by dermatophytes in majority, mostly Trichophyton (T.) rubrum followed by T. mentragrophytes var. interdigitale. However, there is a variation in the etiological profile with the subset of population, time, and geographical location. In immunocompromised hosts, non-dermatophytic molds (NDMs) and yeasts like Candida albicans and Candida parapsilosis are the main causative agents. Diabetes mellitus (DM) is a well-established risk factor for OM. Aim and Objectives: This study was conducted to determine the clinical and mycological characteristics of OM in diabetic patients and to evaluate the clinico-etiological correlation, if any. Materials and Methods: Three hundred consecutive diabetic patients were screened, of whom 102 (34%) patients were diagnosed with OM based on clinical, mycological, dermoscopic, and histological criteria. Results: Distal lateral subungual onychomycosis was the most common clinical variant seen in 80 (78.43%) patients. Fungal culture was positive in 57 (55.88%) of which NDMs constituted approximately half (47.61%) of the isolates, followed by Candida species (30.15%) and dermatophytes (22.22%). The clinico-mycological correlation was performed to look for the association of various fungi with the clinical type of OM. Distal lateral subungual onychomycosis was majorly caused by NDMs (51.02%), followed by Candida species (28.57%), and dermatophytes (20.40%). Conclusion: Non-dermatophytic molds are increasingly incriminated as the causative organisms for OM in DM and must be considered as potential pathogens in the present scenario, thus necessitating the change in the treatment options accordingly.

Tinea Capitis in Children Younger than Two Years Old: A Retrospective Study and Treatment Recommendations.

Tinea capitis (TC) is a dermatophytosis of the scalp and hair, which occurs less common in children younger than two years of age, and the data of TC in this age group are still unknown. We aimed to reveal the epidemiological, clinical and mycological characteristics of TC in children under two years old. We retrospectively analyzed all reported cases of TC in children in their first two years of life from 1991 to 2022, by searching PubMed, Embase, Web of Science, CNKI, Wanfang and Weipu databases. A total of 47 articles involving 126 cases of pediatric TC were enrolled in this study. The sex ratio (M/F) was 1.28:1. The age of the children ranged from ten days old to two years old with a median age of three months. The main clinical manifestations were alopecic patches (40 cases, 31.7%) and scaling (39 cases, 31.0%) on the scalp, and 29 infants (23.0%) appeared kerion. The most common sources of contagion were animals (35 cases, 27.78%) and humans (31 cases, 24.60%). The leading pathogens were Microsporidium canis (64 cases, 50.79%), followed by Trichophyton violaceum (13 cases, 10.32%), T. mentagrophytes complex (12 cases, 9.52%) and T. tonsurans (10 cases, 7.94%). Ninety-five children (75.40%) were treated with systemic antifungal drugs and 22 patients (17.46%) were only treated with topical therapy. Except for 10 patients with unknown final prognosis, all the other cases were cured after treatment. There was one child (0.79%) relapsed after treatment with griseofulvin and one case (0.79%) presented with gastrointestinal symptoms from griseofulvin. The principal clinical symptoms of TC in children less than two years old were alopecic patches and scaling. The top four pathogens were M. canis, T. violaceum, T. mentagrophytes complex and T. tonsurans. Oral treatment for pediatric TC had achieved good therapeutic effects, and topical therapy can be an alternative choice.

Study of Clinico-mycological profile of onychomycosis at a tertiary care hospital

Abstract Introduction: Onychomycosis (OM) is a common nail disorder caused by dermatophytes, non-dermatophyte moulds and yeasts. The increased prevalence of OM along with the wide range of associated fungi necessitates the accurate laboratory isolation and identification of the causative fungus for optimal management strategies. The aim of the study was to evaluate clinical, epidemiological and mycological characteristics of OM at a tertiary care hospital in Karimnagar. Materials and Methods: The study was conducted at Department of Microbiology for a period of one year. 109 patients clinically diagnosed as OM were subjected to detailed history, clinical examination and investigations. Nail clippings and subungual debris of OM patients were subjected to KOH preparation and culture. Isolates were identified by colony characters, pigment production, microscopic morphology. Results: The maximum number of OM cases belonged to the age group 21-30 years with a male preponderance. Higher incidence was noted in males (71.5%) than females (28.4%). Direct microscopy of the nail clippings in 40% KOH solution was positive in 56.8% and culture was positive in 75.2% cases. The common etiological agent was dermatophytes (45.12% cases) followed by yeasts (34.14% and non dermatophyte molds (20.7% cases). T.rubrum was the commonest among dermatophytes and Candida albicans among the yeasts. Conclusions: Although onychomycosis is not life threatening, it can cause a significant negative impact on the quality of life of infected patients. Early diagnosis and treatment is important to prevent distortion of the nails which can prevent loss of working efficiency of the commonly affected population.

Clinical, epidemiological, and mycological features of patients with candidemia: Experience in two tertiary referral centers in Iran.

Candidemia is a major cause of morbidity and mortality among patients receiving immunosuppressive therapy and those hospitalized with serious underlying diseases. Here, we investigated the epidemiological, clinical, and mycological features of candidemia in Tehran, Iran. A prospective observational study of all patients diagnosed with candidemia was performed at two referral teaching hospitals in Tehran, Iran, from February to December 2018. Demographic characteristics, underlying diseases, risk factors, clinical symptoms, and laboratory analyses of candidemic patients with positive culture were mined. Candida isolates were molecularly identified by sequencing of the internal transcribed spacer region (ITS1-5.8S-ITS2). The antifungal susceptibility testing for fluconazole, itraconazole, voriconazole, posaconazole, amphotericin B, caspofungin, micafungin, and anidulafungin against the isolates was performed using CLSI broth microdilution reference method (M27-A3). A total of 89 episodes were identified, with an incidence of 2.1 episodes/1000 admissions. The common underling disease were malignancy (46%), renal failure/dialysis (44%), and hypertension (40%). The overall crude mortality was 47%. C. albicans (44%) was the most frequent causative agent, followed by C. glabrata (21%), C. parapsilosis complex (15%), C. tropicalis (11%), and C. lusitaniae (3.5%). All the isolates were susceptible to amphotericin B. The activity of all four azoles was low against non-albicans Candida species, especially C. tropicalis. The increase in non-albicans Candida species with reduced susceptibility to antifungal drugs might be alarming in high-risk patients. Therefore, accurate knowledge of predisposing factors and epidemiological patterns in candidemia are effective steps for managing and decreasing the mortality rate in candidemia.

P441 Molecular identification, genotyping, and antifungal susceptibility of Trichosporon species isolated from clinical samples of patients at various parts of the Indian subcontinent

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMObjectives(1) To study mycological characteristics of strains belonging to Trichosporon and its related genera obtained from clinical samples of patients from India. (2) Molecular identification by intergenic spacer (IGS) region 1 sequencing of the rDNA locus. (3) Genotyping of the major causative agent, T. asahii, and its in vitro drug susceptibility testing.Materials and Methods: A total of 55 clinical isolates of Trichosporon species were collected from NCCPF (National culture collection of pathogenic fungi) PGIMER, Chandigarh along with different health institutions of India. These isolates were recovered from urine, blood, sputum, nail, tissue biopsy, pleural fluid, hair, BAL, and wound discharge over a period of 12 years (2006–2018). The isolates were molecularly characterized and genotyped using IGS-1 region sequencing. In vitro drug susceptibility testing of the isolates was performed against amphotericin-B, fluconazole, itraconazole, voriconazole, and posaconazole according to the CLSI M27-A3 guidelines (CLSI 2008).ResultsPredominant underlying risk factors identified were presence of an indwelling catheter, use of broad-spectrum antibiotics, and presence of comorbid conditions such as diabetes, hypertension, and anemia. A total of 47 (85%) of the 55 isolates were identified as T. asahii, 6 were T. inkin (11%), and 2 were Cutaneo Trichosporon dermatis (3.6%). Trichosporon asahii genotype III (22; 41%) was the most common type, followed by genotype IV (12; 22%), I (8; 15%), and VII (2; 4%). In addition to the 15 known T. asahii genotypes, one novel genotype was identified in this study. Indian T. asahii isolates showed high MIC ranges to amphotericin B (0.06-4 μg/l) and fluconazole (0.25-64 μg/l). Relatively low MIC ranges were found in the case of voriconazole (0.03-1 μg/l), Posaconazole (0.06-1 μg/l), and itraconazole (0.06-1 μg/l). Voriconazole appeared to be the most active drug in maximum T. asahii isolates. The MICs for all the drugs were comparatively lower in the case of non-T. asahii strains.Conclusion Trichosporon asahii remains the most common etiology of Trichosporonosis in India and presents a challenge for both diagnosis and treatment. With increasing drug resistance, therapeutic options are limited, and antifungal regimens with triazoles especially voriconazole appear to be the best. Accurate timely identification, removal of indwelling catheters/central venous lines, and voriconazole-based treatment along with control of underlying conditions were associated with favorable outcomes. Identification of the novel genotype has epidemiological implications and requires further work up.

P255 Facial Tinea incognito: a clinical, dermoscopic, and mycological study

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectivesTinea incognito (TI) occurring on the face is the most frequently misdiagnosed cutaneous fungal infection; however, very limited information is available on facial TI. This study aimed to characterize the clinical, dermoscopic, and mycological features of facial TI.MethodsWe retrospectively evaluated 38 patients with mycologically proven facial TI at a single institution in Korea between July 2014 and July 2021.ResultsThe patients had a mean age of 59.6 ± 20.4 years and showed a slight female predominance (male-to-female ratio, 1:1.5). The most common clinical presentation was an eczema-like pattern (47.3%), followed by rosacea-like (15.7%), psoriasis-like (10.5%), lupus erythematosus-like (10.5%), cellulitis-like (7.8%), and folliculitis-like (7.8%) patterns. The mean duration from disease onset to diagnostic confirmation was 3.4 months. Overall, 78.9% of the patients had accompanying chronic systemic diseases and 57.9% had concurrent tinea infections on other skin sites, mainly on the feet and toenails. Among the 23 (60.5%) cultured specimens, Trichophyton (T.) rubrum was the most frequently detected causative species, followed by Microsporum (M.) canis. T. mentagrophytes and T. verrucosum were also isolated from one case each. On dermoscopy, scales (92.1%) and dilated vascular patterns (arborizing vessels and telangiectasia, 76.3% and 63.2%) were commonly observed in glabrous skin, with follicular patterns such as black dots, broken hairs, and empty follicles. The characteristic trichoscopic features were comma hairs, corkscrew hairs, Morse code-like hairs, and translucent hairs.ConclusionThe clinical characteristics and distinct dermoscopic features described in this article can aid in the differential diagnosis of facial TI while reducing diagnostic delays and unnecessary treatments.