Positive Fungal Cultures Research Articles

Assessment of risk factors associated with multidrug-resistant organism infections among patients admitted in a tertiary hospital - a retrospective study

BackgroundBacterial resistance has become a global health concern. To treat suspected multidrug resistant organisms (MDROs), physicians first use broad-spectrum antibiotics; however, this increases the chance of developing antimicrobial resistance. Thus, defining the risk factors for MDROs could aid in the selection of the ideal initial antimicrobial therapy and improve clinical outcomes. ObjectiveThis study aimed to identify the common risk factors for MDRO infection among patients admitted to King Fahad Hospital (KFH) and to analyze the comorbidity factors associated with MDRO infections. MethodsThis retrospective, observational, case-control study included adult patients ≥ 18 years old admitted to KFH between 1st of January to 31st of March 2021, with positive microbial culture. Pediatric patients, outpatients, or patients with only positive fungal cultures were excluded. Data were obtained from the KFH laboratory MDRO documenting database. ResultsTwo hundred and seventy patients were included in this study: 136 in the study group and 134 in the control group. Among patients, 167 (61.9 %) were males and 184 (68.1%) were 18 to 65 years old. The use of drugs such as cotrimoxazole, amikacin, and imipenem (OR = 4.331, C. I. of OR:1.728, 10.855, p = 0.002) were significantly associated with MDRO infections, whereas cefazolin was associated with a lower risk of MDRO infections (OR = 0.080, C.I. of OR:0.018, 0.347, p < 0.001). The intensive care unit showed higher odds of significant association with MDRO infections than those of the surgical unit (odds ratio [OR] = 8.717, 95% C.I. of OR: 3.040, 24.998, p < 0.001). Patients who previously consumed acid-suppressive medications showed higher odds of developing MDRO infections (OR = 5.333, C.I. of OR: 2.395, 11.877, p < 0.001). ConclusionThe most significant comorbidities were diabetes, hypertension, antibiotic use prior to hospitalization and the use of cotrimoxazole, amikacin and imipenem among other antibtiotics was mostly associated with MRDO infections. This study revealed an increasing trend of MDRO infections and a positive correlation with the incidence of strokes and mortality, which highlights the importance of understanding the risk factors for MDRO infections.

Artificial intelligence-aided rapid and accurate identification of clinical fungal infections by single-cell Raman spectroscopy.

Integrating artificial intelligence and new diagnostic platforms into routine clinical microbiology laboratory procedures has grown increasingly intriguing, holding promises of reducing turnaround time and cost and maximizing efficiency. At least one billion people are suffering from fungal infections, leading to over 1.6 million mortality every year. Despite the increasing demand for fungal diagnosis, current approaches suffer from manual bias, long cultivation time (from days to months), and low sensitivity (only 50% produce positive fungal cultures). Delayed and inaccurate treatments consequently lead to higher hospital costs, mobility and mortality rates. Here, we developed single-cell Raman spectroscopy and artificial intelligence to achieve rapid identification of infectious fungi. The classification between fungi and bacteria infections was initially achieved with 100% sensitivity and specificity using single-cell Raman spectra (SCRS). Then, we constructed a Raman dataset from clinical fungal isolates obtained from 94 patients, consisting of 115,129 SCRS. By training a classification model with an optimized clinical feedback loop, just 5 cells per patient (acquisition time 2 s per cell) made the most accurate classification. This protocol has achieved 100% accuracies for fungal identification at the species level. This protocol was transformed to assessing clinical samples of urinary tract infection, obtaining the correct diagnosis from raw sample-to-result within 1 h.

Utility of deceased donor cultures in solid organ transplantation in preventing donor-derived bacterial and fungal infectious diseases transmission.

Deceased donor and organ perfusion fluid cultures are obtained in order to inform recipient antimicrobial management and therefore reduce the risk of donor-derived bacterial and fungal infections. However, important heterogeneity exists in laboratory practice across organ procurement organizations and clinical management of culture results across transplant centers. While not standardized, the clinical approach to donors with positive bacterial and/or fungal cultures should be informed by the risk of donor-derived infection (DDI) and the consequence of organ non-utilization and account for potential unintended effects of antimicrobial use in the recipient. In this review, we summarize the literature on bacterial and fungal DDIs, describe the significance of positive cultures by anatomic site, and summarize current guidance on the management of positive cultures from donors or preservation fluids.

Human-pet Relationship, Pet Abandonment, and Clinical Correlation for Patients Infected with Dermatophytosis of the Glabrous Skin

Objective: The study on human-pet relationship and pet abandonment among dermatophytosis patients is limited. This study aims to review these correlations. Materials &amp; Methods: A two-year retrospective cross-sectional study was conducted. Case record forms were reviewed for clinical manifestations, fungal identification, human-pet relationships, and changes in the relationships after dermatophytosis diagnosis. Results: A total of 230 dermatophytosis patients from the Dermatology outpatient clinic, Siriraj Hospital, were included. The mean age was 41.9 ± 19.1 years and 51.3% were female. Among 170 cases with positive fungal culture, zoophilic dermatophytosis from M. canis infection was identified in 15.9% which was predominately found in females and manifested as shorter duration of onset, and higher involvement on exposed areas when compared to anthropophilic dermatophytosis. Most (71%%) of patients with M. canis infection classified themselves as pet-lovers. The relationship with pets had changed after the dermatophytosis diagnosis in 41% of them which was statistically different from 8.8% in non-pet lovers (P = 0.001). The overall pet abandonment rate was 26.6%. The abandonment rate was 40.9% among non-pet lovers, while 30.6% was reported among pet lovers. Conclusion: Zoophilic M. canis infection was associated with rapid onset and on predominant-exposed areas. Some pets could be asymptomatic, so identification of the reservoirs of dermatophytosis is important in the treatment process and helps prevent future recurrence. Paying attention to human-pet relationships and pet abandonment is critical. Knowledge about dermatophytosis transmission, and appropriate pet management should be advised to decrease abandonment.

Identification of cuticle and midgut fungal microflora of phlebotomine sandflies collected in Tunisia

Phlebotomine sand flies (Diptera: Psychodidae) are the proven vectors of Leishmaniases which are widespread parasitosis in many tropical and subtropical countries. The development of infective metacyclic Leishmania (Kinetoplastida: Trypanosomatidae) promastigotes stage is restricted to the vector midgut. Recently, several studies have assessed the influence of the sand fly midgut fungal microflora on the development of invective Leishmania stage. The aim of this study was to identify the fungal microflora from the cuticle and midgut of wild caught sandflies. A total of 50 sandflies were caught in two different leishmaniasis foci of center Tunisia and analyzed using an in vitro isolation of fungi followed by a morphological and molecular identification of fungal isolates. The morphological identification of sandflies specimens revealed five Species: Phlebotomus (P.) papatasi (n = 25), P. perniciosus (n = 15) P. riouxi (n = 6), P. longicuspis (n = 3) and P. sergenti (n = 1). Forty positive fungal cultures were isolated from 34 sand flies (19 males and 15 females) distributed as following: P. papatasi (n = 16), P. perniciosus (n = 11), P. riouxi (n = 4), P. longicuspis (n = 2) and P. sergenti (n = 1). Thirty-five cultures were isolated from the cuticles and five from the guts. A total of 15 fungi genera belonging to 8 families were identified with the predominance of Aspergillus genus followed by Penicillium genus. Among the 15 fungi genera, five were common between males and females specimens. Lecytophora canina and Leishmania major co-infection was detected in the gut of a female P. papatasi. Our preliminary findings highlight the high diversity of fungal microflora from the sand flies midguts.

Wide-spectrum antibiotic prophylaxis guarantees optimal outcomes in drowned donor kidney transplantation

ABSTRACT Background Drowned victims possibly obtain various pathogens from drowning sites. Using drowned renal donors to expand the donor pool still lacks consensus due to the potential risk of disease transmission. Research design and methods This retrospective study enrolled 38 drowned donor renal recipients in a large clinical center from August 2012 to February 2021. A 1:2 matched cohort was generated with donor demographics, including age, gender, BMI, and ICU durations. Donor microbiological results, recipient perioperative infections, and early post-transplant and first-year clinical outcomes were analyzed. Results Compared to the control group, drowned donors had significantly increased positive fungal cultures (36.84% vs.13.15%, p = 0.039). Recipients in the drowned group had significantly higher rates of gram-negative bacteria (GNB) and multidrug-resistant GNB infections (23.68% vs.5.26%, 18.42% vs. 3.95%, both p < 0.05). Other colonization and infections were also numerically more frequent in the drowned group. Drowned donor recipients receiving inadequate antibiotic prophylaxis had more perioperative bloodstream infections, higher DGF incidences, and more first-year respiratory tract infections and recipient loss than those receiving adequate prophylaxis (all p < 0.05). Clinical outcomes were similar between the adequate group and the control group. Conclusions Drowned donors could be suitable options under wide-spectrum and adequate antimicrobial prophylaxis.

The Prevalence of Positive Donor Corneoscleral Rim Culture and its Association with Ocular Infection After Transplantation.

The aim of the study was to determine the prevalence of positive corneoscleral donor rim cultures and to report keratitis and endophthalmitis after keratoplasty. Eye bank records and medical records of patients who underwent keratoplasty between September 1, 2015, and December 31, 2019, were retrospectively reviewed. Patients who had routine donor-rim culture taken during surgery and followed up for at least 1 year in the post-operative period were included in the study. A total of 826 keratoplasty procedures were performed. A total of 120 (14.5%) cases had a positive donor corneoscleral rim culture. Positive bacterial cultures were obtained from 108 (13.7%) of the donors. Bacterial keratitis was observed in one patient (0.83% of recipients) who had a positive bacterial culture. Positive fungal cultures were obtained from 12 (1.45%) donors, of whom one (8.33% of recipients) developed fungal keratitis. Endophthalmitis was observed in one patient whose culture result was negative. Both bacterial and fungal culture results were similar in penetrating and lamellar surgical procedures. Although the donor corneoscleral rims have a high positive culture result, the rate of bacterial keratitis and endophthalmitis is low, the risk of infection is high in patients with a fungal positive donor rim. Closer follow-up of patients with fungal positive donor corneo-scleral rim result and initiation of aggressive antifungal treatment when infection occurs will be beneficial.

Sensitivity of KOH Mount in the Early Diagnosis of Fungal Infections of Nose and Paranasal Sinuses in COVID-19 Infected Patients Suspected with Mucormycosis

Introduction: Mucormycosis represents a group of life threatening infections caused by fungi of the order Mucorales especially in Coronavirus Disease 2019 (COVID-19). It is a highly invasive and rapidly progressive disease resulting in high grades of morbidity and increased mortality. Aim: To study the sensitivity of potassium hydroxide (KOH) mount in the early diagnosis of mucormycosis in COVID-19 infected patients. Materials and Methods: A prospective, longitudinal (single group) study was done in McGANN Teaching District Hospital, Shimoga Institute of Medical Sciences, Shivamogga, Karnataka, India, among the patients with high index of clinical suspicion of mucormycosis from May 2021 to August 2021. Specimen from the nasal cavity or the suspected lesion on hard palate, gums, skin was sent for KOH mount and fungal culture and also biopsy of the nasal mucosa sent for histopathological examination. The sample was sent both preoperatively and intraoperatively. The positive KOH report and its role in early diagnosis and management of mucormycosis suspected cases were assessed. Results: Out of 26 patients, 6 (23.1%) were females and 20 (76.9%) were males. COVID-19 positive suspected mucormycosis were 5 (19.2%) and post COVID-19 suspected mucormycosis were 21 (80.8%). Species isolated after processing the sample were rhizopus in 10 (38.5%), candida in 1 (3.8%), aspergillus in 1 (3.8%); while in 14 (53.8%) no organisms were isolated. Out of 26 patients KOH positive sample on the day of admission confirming with positive intraoperative histopathological examination were 10 (41.7%). Admission day fungal culture positivity was seen in (n=12, 46.2% ) and negativity in 14 (53.8%) cases. Intraoperative fungal culture was positive in 24 (92.3%) cases. There was 100% specificity for both fungal culture and KOH mount and sensitivity for KOH was 41.7% and 50% for fungal culture. False negativity rate for KOH was 58.3% and for fungal culture was 50%. Conclusion: The results of KOH mount can be obtained within an hour of sending nasal scrapping samples. Hence, it helps in making the early diagnosis and early initiation of treatment for suspected cases. But in the current study, even in patients presenting with high clinical suspicion of mucormycosis, the sensitivity of KOH mount on the day of admission to the hospital was 41.7%.In view of severe morbidity and mortality of mucormycosis, this sensitivity though less is of paramount importance in these patients because treatment can be started early.

Neonatal Candidiasis: Clinical Spectrum and Epidemiology at a Tertiary Care Centre, Bhopal, India

Introduction: Neonatal candidiasis is one of the leading causes of sepsis amongst newborns admitted to newborn care unit, especially premature and Low Birth Weight (LBW) babies. It is one of the significant contributors to neonatal morbidity and mortality. Aim: To describe the spectrum and epidemiology of fungal sepsis in Neonatal Intensive Care Unit (NICU) at a tertiary care level. Materials and Methods: A longitudinal study was conducted from January 2018- December 2019 in NICU of Chirayu Medical College and Hospital, a tertiary level hospital in Bhopal, Central India. All neonates, who had positive fungal blood culture were included in the study, their demographic data was analysed (age, birth weight, predisposing factors etc.,), maternal history, their response to the antifungal treatment documented and complications. Statistical analysis was done using the Chi- square test with the help of Statistical Package for Social Sciences (SPSS) software version 2.0. Results: A total of 409 neonates admitted in the NICU during the study period, were suspected clinically to have sepsis and their blood culture was done, of which 110 samples were culture positive. Amongst the 110 neonates, 41(37.2%) were positive for fungal infection {29 showed Candida albicans, 12 Non Albicans Candida (NAC)}. Total 25 neonates were preterm (60.97%). The mean age of admission was 3.02 days, 51.2% (21/41) of the neonates had a history of respiratory distress and related symptoms at birth. There was no significant maternal history. Amongst the risk factors, lower birth weight (&lt;2.5 kg), preterm (&lt;34 weeks), and presence of invasive central lines were statistically associated with morbidity. Urine for candidial hyphae was positive in 12 out of 41 cases (29.27%). Incidence of candidal meningitis was seen in four neonates (13.33%). Thrombocytopenia was the most common laboratory finding amongst these cases (32/41). Among the different regimens used the combination regimen of Lipid based amphotericin B and voriconazole was associated with a better survival. Conclusion: Candida sepsis was found to be the most common cause of septicaemia in the NICU. LBW and preterm babies are especially at greater risk of candida sepsis. Candida albicans still continues to be a dominant aetiology for fungal sepsis, as compared to non candida species.

350. Clinical impact of positive fungal blood cultures for diagnosis and treatment of fungal infections.

Abstract Background Fungal blood cultures are usually ordered when sepsis secondary to disseminated fungal infection is suspected. We aimed to analyze whether positive fungal blood cultures had an added clinical impact over other conventional microbiological tests. Methods We performed a retrospective study of all patients for whom fungal blood cultures were performed for any indication at our institution from June 2018 to March 2022. We reviewed informatics database and medical records to assess the microbiological and clinical impact of positive fungal blood cultures during the initial admission. Assessment of clinical impact was analyzed using a list of predefined positive, negative, and no impact scenarios (Table 1) based by the treating team’s decisions. Results In total, 4447 fungal blood cultures were performed in 3648 admissions during our study period. The overall positivity rate of fungal blood cultures was 6.4% (n=284), of which only 130 (2.9%) were positive for fungi. The most common isolated fungi were Candida spp. (71, 55%), followed by Histoplasma spp. (16, 12%), Cryptococcus spp. (12, 9%), and unidentified mold (9, 7%) (Table 1). The median time to positivity was 106 hours (IQR 79-177). Only 21 (16%) fungal blood cultures resulted in a change in management. Positive fungal blood cultures for fungi led to a positive clinical impact in 17 (13%), negative clinical impact in 4 (3%), and no clinical impact in 109 (84%). Most fungal blood cultures confirmed other conventional microbiological diagnosis (71, 55%) or result was not acted upon (26, 20%). Organisms where fungal blood culture had a positive impact included C. albicans (n=4), and C. parapsilosis (n=3), while Cladosporium spp. (n=2) was the most frequent fungi with a negative clinical impact. Isolated fungi that had no clinical impact because of other confirmatory tests included Candida spp. (n=57), Histoplasma spp. (n=13) and Cryptococcus neoformans (n=10). Table 1.Microbiological characteristics and clinical impact of fungal blood cultures.Abbreviations: h hours; IQR, interquartile range.*Time to positivity was defined as the time from the fungal blood culture collection until growth and preliminary identification of a fungal organism on staining by the microbiology laboratory. **Time to identification was defined as the time from the fungal blood culture collection until identification of the fungal organism by the microbiology laboratory. Conclusion Most of positive fungal blood cultures for fungi resulted in no immediate clinical impact due to other microbiological tests available sooner or isolates thought to be non-clinically significant. Further studies should evaluate the long-term impact of fungemia and identify stewardship interventions to optimize clinical utility of fungal blood cultures. Disclosures All Authors: No reported disclosures.

2102. Common co-occurence in the respiratory tract of Mucorales with Gram-negative rods in patients with hematologic malignancy and sinopulmonary mucormycosis

Abstract Background Mucorales (MCR) and Gram-negative rods (GNR) commonly infect patients (pts) with hematological malignancies (HM); however, their co-occurrence is understudied. Methods We retrospectively reviewed the records of 63 pts with HM and sinopulmonary MCR (proven or probable, EORTC/MSG criteria) at MD Anderson Cancer Center (Houston, TX) from 2008-2016. Co-occurrence was defined as a culture positive for GNR taken from sinuses or the lungs within 90 days (d) of a positive Mucorales culture or histology demonstrating Mucorales spp. Results Ninety percent of the 63 pts with MCR had leukemia or myelodysplastic syndrome (54% AML) and 10% had lymphoma/myeloma. Sixty-eight percent had undergone hematopoietic stem cell transplant. Sixty-seven percent were neutropenic at the time of MCR diagnosis. Thirty-five percent had received &amp;gt; 600mg of prednisone within 30 days (d) prior to MCR diagnosis. Thirty-five percent were admitted to the ICU during the time of MCR treatment. MCR pts had sinusitis (42.9%), pneumonia (38.1%) and disseminated sinopulmonary disease (19.0%). Nearly all pts (92%) received empiric antimicrobials with activity against Pseudomonas prior to collection of their positive fungal cultures. Twenty-three pts (37%) had concurrent detection of GNRs (Pseudomonas in 10, Stenotrophomonas in 8) in samples from the sinopulmonary tract. Eight of 23 co-isolations of GNRs and Mucorales (35%) were found in same-day samples. Demographic and clinical characteristics of pts with and without co-occurrence of GNR were comparable. Pts with co-occurrence had less frequently received antibiotics with activity against Stenotrophomonas 7 (30.4%) vs 23 (60%, p=0.024). Ninety-day all-cause mortality was high and comparable in pts with (83%) and without (78%) GNR detection (p = 0.75). Conclusion Over a third of heavily immunosuppressed pts with sinopulmonary MCR harbor GNRs in their respiratory tract, most commonly Pseudomonas. Although no impact on survival outcomes was seen in a background of high mortality, pathogenesis studies are needed to understand the mutualistic interplay of GNR and Mucorales spp. and their influence on host responses. Disclosures William R. Miller, MD, Entasis Therapeutics: Grant/Research Support|UpToDate: Royalties - Topic Contributor Dimiitrios P. Kontoyiannis, MD, ScD, PhD (hon), AbbVie: Advisor/Consultant|Astellas Pharma: Advisor/Consultant|Astellas Pharma: Grant/Research Support|Astellas Pharma: Honoraria|Cidara Therapeutics: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Gilead Sciences: Honoraria|Merck: Advisor/Consultant.

A retrospective observational study of mycotic keratitis in Saveetha Hospitals, Chennai

Aim and objective: 1. To study the manifestations of fungal corneal ulcer in different age groups and sex 2. To study the distribution of fungal corneal ulcer in relation to occupation 3. To know the effect of Natamycin and Fluconazole as anti-fungal agents. Materials and methods: This is a retrospective analysis of microbiology records of patients presenting with suspected microbial keratitis seen between January 2021 and June 2021. Patients with positive fungal cultures were analyzed in detail for the type of fungus isolated. Results: 90 patients with suspected microbial keratitis were reviewed. A microbiological diagnosis of mycotic keratitis was established 9 (10%) patients over a period of 6 months, based on positive fungal cultures. Filamentous fungi were isolated more often than yeasts. Aspergillus species followed by Fusarium species were the commonest filamentous fungi isolated. Conclusion: Over a period of 6 months, the cumulative incidence of mycotic keratitis was 10%. The pathogenic organisms most frequently responsible for mycotic keratitis were Aspergillus species. When beginning an empirical therapy for mycotic keratitis, etiological factors were helpful. Eight of the 90 patients with corneal ulcers who were admitted to the patient department for treatment had positive fungal cultures in Sabouraud’s media. The age range of 50 to 60 years had a high prevalence of illness. There were 90 total cases of corneal ulcers. Out of those there were 8 (8.8%) incidences of fungal ulcers. More men than women were impacted. Workers in agriculture are more impacted than others. The main cause of a fungus-induced corneal ulcer was trauma. Natamycin was the better option for the treatment of fungal keratitis. Filamentous fungi (Aspergillus species, fusarium, and curvularia) responded effectively to Natamycin 5% eyedrop.

Active screening of COVID-19-associated pulmonary aspergillosis with serum beta-glucan and endotracheal aspirates galactomannan and fungal culture.

Since February 2021 active screening of COVID-19-associated pulmonary aspergillosis (CAPA) has been implemented in our institution. To evaluate CAPA incidence in our centre and evaluate performance of our screening protocol. We screened once per week, collecting endotracheal aspirates for fungal culture and galactomannan (GM) and serum for 1,3-ß-D-glucan (BG). In case of positivity (GM more than 4.5, platelia assay, and/or BG >7pg/ml, wako and/or positive fungal culture), second-level investigations were performed to pursue CAPA diagnosis according to ECMM/ISHAM criteria: bronchoalveolar lavage (BAL) fungal culture and GM, chest computed tomography (CT), serum GM. A total of 102 patients were screened (median age 64 years, range 39-79; 28 (27.4%) females). Twenty-two patients were diagnosed with CAPA (21%). 12 patients were positive for serum BG, 17 patients were positive for endotracheal aspirates GM and 27 patients were positive for endotracheal aspirates fungal culture. Thirty-two BALs were performed, and 26 patients underwent CT chest. Following the second level investigations 61% of the patients with positive screening tests were diagnosed with CAPA. Serum BG above 20 pg/ml or positive serum GM were always associated with typical CT chest signs of aspergillosis. Compared with 1 single positive test, having 2 positive screening test was significantly more associated with CAPA diagnosis (p= .0004). Active CAPA screening with serum 1,3-ß-D-glucan and endotracheal aspirates galactomannan and fungal cultures and consequent second level investigations led to high number of CAPA diagnosis. Combining more positive fungal biomarkers was more predictive of CAPA diagnosis.

Clinico-mycological profile of suspected pulmonary aspergillosis cases

Abstract Introduction: Aspergillus is one of the most ubiquitous airborne saprophytic fungi. Humans constantly inhale numerous conidia of this fungus. The conidia are normally eliminated in the immunocompetent host by innate immune mechanisms. With increase in the number of immunocompromised patients, there has been a dramatic increase in severe and fatal invasive aspergillosis (IA). The present study was aimed to know the clinico-mycological profile of suspected pulmonary aspergillosis cases. Methods: The present study was a prospective study conducted over a period of 1 year in the department of microbiology in admitted cases with clinical suspicion of pulmonary aspergillosis. Samples such as sputum, bronchoalveolar lavage, endotracheal secretions, fine-needle aspiration or biopsy and blood (for serological analysis) were collected and processed as per standard protocol. Results: Over a period of 1 year, 89 cases were included in the study. Their mean age was 58.7 years. Majority were male (60.6%). The most common presentation was cough (89.9%), followed by chest pain (57.3%) and fever (56.2% most common chest X-ray finding was homogeneous haziness (40.4%). Fungal smear was positive in 55.1% and 61.8% showed fungal growth. Galactomannan (GM) and (1-3)-β-D glucan positivity were 56% and 83.3%, respectively. The mortality was observed in 21.4% of patients. Conclusions: The study demonstrated that GM assay and (1-3)-β-D glucan assay are useful diagnostic modalities with a high sensitivity and specificity for the detection of pulmonary aspergillosis in high-risk patients along with positive fungal culture. Thus, these tests are early markers for IA.

INCIDENCE, CLINICAL CHARACTERISTICS, AND OUTCOMES OF PATIENTS WITH COVID-19 AND FUNGAL COINFECTION

INCIDENCE, CLINICAL CHARACTERISTICS, AND OUTCOMES OF PATIENTS WITH COVID-19 AND FUNGAL COINFECTION

PULMONARY ASPERGILLOSIS POST-TOCILIZUMAB TREATMENT IN A PATIENT WITH COVID-19 PNEUMONIA

PULMONARY ASPERGILLOSIS POST-TOCILIZUMAB TREATMENT IN A PATIENT WITH COVID-19 PNEUMONIA

P229 Three cases of easy to be misdiagnosed tinea of vellus hair

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Vellus hair, also known as fine hair, is generally accepted that tinea of vellus hair is caused by dermatophyte infection of the vellus hair and fungal microscopy reveals the presence of mycelium and/or spores inside and outside the vellus hair. Different types of dermatophytes can cause different types of lesions. Therefore, tinea of vellus hair is easy to underdiagnose or misdiagnose in clinical practice. We report three cases of tinea of vellus hair caused by Microsporum canis. Case 1: A 24-year-old male patient with bilateral erythema with pruritus on the upper extremities for more than 1 year (A1). The patient was diagnosed with tinea of vellus hair by positive dermatoscopy (A2), fungal fluoroscopy (A3), and fungal culture of M. canis. after 9 weeks of treatment (oral itraconazole 0.2 g, 2 times/day, topical amorolfine cream 1 time/day, terbinafine cream 1 time/day), the skin of bilateral forearms basically returned to normal, and it is currently under follow-up. Case 2: A 5-year-old female patient with a rash on the root of the nose for 2 weeks (B1). She was also diagnosed with tinea of vellus hair by positive dermatoscopy (B2) and fungal fluoroscopy (B3) and fungal culture of M. canis. After 2 weeks of treatment (oral itraconazole 0.1 g, 2 times/day, topical terbinafine cream once a day), the lesions improved significantly. After 4 weeks of treatment, a few scales and scabs were still visible on the skin at the root of the nose. After 2 weeks of continued treatment, the patient's skin at the root of the nose was completely restored to normal. Case 3: 2-year-old male patient with a recurrent facial rash with scales for more than 3 months (C1). He was diagnosed with tinea of vellus hair by positive dermatoscopy (C2), fungal fluoroscopy(C3), and fungal culture of M. canis. After 2 weeks of treatment (oral itraconazole 0.1 g once every other day, bifonazole cream 1 time/d), the lesions are in improvement from the previous. And this case is still being followed up. The above three cases have been misdiagnosed as tinea simplex or eczema, and the efficacy of treatment only with topical medicines or short-term oral drugs is not good. Therefore, we take oral medicines and topical medicines for treatment, the course of treatment is long, and there are still spores and hyphae inside and outside the hair many times during the treatment period, so it is recommended that tinea of vellus hair should be treated according to the treatment plan of tinea capitis.

P397 Influence of underlying conditions on disease presentation and diagnostic strategy during pulmonary mucormycosis: Anational study of 114 cases

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM ObjectivesPulmonary mucormycosis (PM) is a life-threatening invasive fungal infection mostly affecting immunocompromised patients. We aimed to study the influence of underlying conditions on disease presentation and diagnostic strategy during PM.MethodsAll PM cases from six French teaching hospitals between 2008 and 2019 were retrospectively reviewed. Cases were defined according to EORTC/MSG 2019 criteria with the addition of diabetes and traumatism as host factors and positive serum or tissue PCR as mycological evidence. Thoracic CT scans were reviewed centrally.ResultsAmong 114 cases of PM, 52 (46%) were proven and 62 (54%) were probable, including 12 cases with a positive serum qPCR as the sole mycological criterion. Hematological malignancy was the most common risk factor (49%), followed by allogeneic hematopoietic stem-cell transplantation (21%), and solid organ transplantation (SOT, 17%). Fever was the first symptom for 66% patients and was more frequent in patients with neutropenia than in those without (97% vs 52%, P <.01). A total of 46 (40%) patients had a disseminated infection, which was more frequently reported in neutropenic patients (50% vs 25%, P <.01). Main dissemination sites were the liver (48%), spleen (48%), brain (44%), and kidneys (37%). Sinusitis was present in 13% of cases.Chest radiological presentation included consolidation (58%), pleural effusion (52%), reversed halo sign (26%), halo sign (24%), vascular abnormalities (26%), and excavation (23%). The excavation was more frequently reported in SOT patients (64%, P <.01) compared with other groups. Vascular involvement was associated with reversed halo sign and Rhizomucor infection. Neutropenic patients presented more frequently than non-neutropenic patients with ground-glass opacities (75 vs 49%, P = .01), halo sign (32% vs 10%, P = .02), and reversed halo sign (35 vs 10%, P <.01).A total of 83 (73%) patients had a positive fungal culture from any type of respiratory sample. Serum qPCR was positive for 42/53 patients (79%) and respiratory fluid qPCR for 16/21 (76%) patients. In neutropenic patients, BAL culture was less often positive (30% vs 66%, P <.01), and serum qPCR was more frequently positive (91% vs 62%, P = .02). A transthoracic lung biopsy was contributive in 8/11 (73%) patients with negative bronchoalveolar lavage (BAL). Serum qPCR was more frequently positive in patients with the main lesion of >3 cm in diameter (91% vs 62%, P = .02). Rhizomucor spp. Was identified in 31 patients (32%), Rhizopus spp. In 29 patients (30%), Lichtheimia spp. In 24 patients (25%), Mucor spp. In 10 patients (10%) and Cunninghamella spp. In 4 patients (4%). Neutropenic patients were more frequently infected with Rhizomucor (43% vs 13%, P <.01) and less frequently with Rhizopus (17% vs 50%, P <.01). Histopathological specimens were available for 48 patients (42%) and revealed Mucorales hyphae in 85% of cases. Patients with a disseminated infection and neutropenia presented more often with angioinvasion than patients with localized disease (50% vs 9%, P <.01 and 38% vs 13%, P = .10). Overall, 90-day mortality was 59%.ConclusionUnderlying conditions significantly influenced clinical and radiological presentation and diagnostic tools’ contribution. Neutropenic patients present more frequently with dissemination, fever, reversed halo sign, pathological angioinvasion, the negativity of BAL culture, the positivity of serum qPCR, and Rhizomucor infection.

P309 Clonal outbreak of Trichophyton tonsurans causing tinea capitis among wrestlers in Beijing, China

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectives Trichophyton tonsurans, an anthropophilic dermatophyte, mostly causes tinea capitis and tinea corporis and is often associated with outbreaks among athletes involved in combat sports, such as wrestlers and judo athletes. Here, we report an outbreak of tinea capitis caused by Trichophyton tonsurans among five juvenile athletes aged ten to fourteen in a wrestling team in Beijing, China.MethodsA total of 5 wrestlers aged 10-14 years presented with alopecia, erythema, scales, and pustule on the scalp (Fig. 1a). Scrapings from the lesions were performed by direct microscopic examination using 10% potassium hydroxide (KOH) with calcofluor white and fungal culture. The fungal pathogens were identified by morphology and sequencing of the internal transcribed spacer (ITS) regions. Multilocus genotyping analysis was performed by sequencing of the five gene loci including the ITS and non-transcribed spacer (NTS) of the ribosomal RNA (rRNA) locus, alkalineprotease-1 (ALP1), metalloprotease-5 (MEP5), carboxypeptidases Y (CarbY), which show intraspecies diversity and can be applied to epidemiological investigations and determining the route of infection transmission. Antifungal susceptibility of terbinafine (TBF), itraconazole (ITC), fluconazole (FLC), ketoconazole (KTC), and amphotericin B (AMB) against the causative fungal isolates was determined by broth microdilution method according to the Clinical and Laboratory Standards Institute (CLSI) M38-A3 document.ResultsThe five patients were diagnosed with tinea capitis because of the scalp lesions, spores, and hyphae observed by direct microscopic examination (Fig. 1b), and positive fungal culture. The causative isolates were all identified as T. tonsurans by macroscopic and microscopic characteristics (Fig. 2) and sequencing of ITS regions. The sequences of ITS, NTS, ALP1, MEP5, and CarbY were identical among the five isolates, revealing a single genotype. The abovementioned sequences have been deposited to Genbank. The minimum inhibitory concentrations (MICs) of TBF, ITC, FLC, KTC, and AMB against five T. tonsurans isolates were 0.015 μg/ml, 0.015 μg/ml, 8 μg/ml, 0.06 μg/ml, and 0.5 μg/ml, respectively.ConclusionWe report an outbreak of tinea capitis caused by T. tonsurans among wrestlers in Beijing, China. Multilocus genotyping analysis revealed that all isolates consisted of a single genotype, suggesting the outbreak may be caused by a single strain of T. tonsurans. The isolates were all susceptible to the common antifungal drugs treating tinea capitis.

P416 Efficient and accurate diagnosis of otomycosis using an ensemble deep learning model

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMObjectivesOtomycosis accounts for ˃15% of the cases with external otitis worldwide. And otomycosis is more frequently observed in humid regions and people enjoying the culture of ear cleaning in China. Aspergillus and Candida are the major pathogens that could cause long-term infection. Early endoscopic and microbiological examinations are important for appropriate medical treatment to otomycosis. However, accurate diagnosis always needs experts such as otologist and microbiologist. Deep learning model is a novel efficient method to provide quick diagnosis which is an automatically diagnostic program using a large database of images acquired in the cliniC. This paper puts forward a mechanic learning model to address the diagnosis of otomycosis caused by Aspergillus and Candida accurately and quickly.MethodsWe proposed a computer-aided decision system that is based on a deep learning model consisting of two subsystems, a java-based web application, and picture classification. The web application subsystem mainly provides a user-friendly page for collecting consulted pictures as well as displaying the calculation results. The picture classification subsystem mainly uses trained neural network models for end-to-end data inference. The end user only needs to upload a few pictures of the ear endoscope, and the system will return the classification results to the user in the form of category probability value.In order to accurately diagnose otomycosis, we generally kept endoscopic images and took the secretion for fungal culture for further identification. Positive fluorescence fungal staining, culture, and further DNA sequencing were taken to confirm the pathogens, Aspergillus or Candida sp. In addition, impacted cerumen, external otitis, and normal external auditory canal endoscopic images are retained for reference. We merged these four types of images into an endoscopic images gallery.ResultsIn order to achieve better accuracy and generalization ability after model training, we selected 2750 samples from nearly 4000 ear endoscopic images as training samples and 454 as validation samples. On the selection of deep neural network models, we tested the resnet, senet, and efficientnet neural network models with different numbers of layers. Considering the accuracy and operation speed, we finally chose the efficientnet-b6 model and output the probability values of the four categories of otomycosis, external otitis, impacted cerumen, and normal cases. After multiple iterative sample training, the overall validation sample accuracy reached 94.71%, and the average cross-validation accuracy of the 4 classifications reached 94.3%.ConclusionThe results suggest that the system can be used as a reference for general practitioners to make better decisions in the diagnosis of otomycosis.