Prevalence of co-existent COVID-19-associated pulmonary aspergillosis (CAPA) and its impact on early mortality in patients with COVID-19-associated pulmonary mucormycosis (CAPM).

BACKGROUND: Data on mixed mould infection with COVID-19-associated pulmonary aspergillosis (CAPA) and COVID-19-associated pulmonary mucormycosis (CAPM) are sparse. OBJECTIVES: To ascertain the prevalence of co-existent CAPA in CAPM (mixed mould infection) and whether mixed mould infection is associated with early mortality (≤7 days of diagnosis). METHODS: We retrospectively analysed the data collected from 25 centres across India on COVID-19-associated mucormycosis. We included only CAPM and excluded subjects with disseminated or rhino-orbital mucormycosis. We defined co-existent CAPA if a respiratory specimen showed septate hyphae on smear, histopathology or culture grew Aspergillus spp. We also compare the demography, predisposing factors, severity of COVID-19, and management of CAPM patients with and without CAPA. Using a case-control design, we assess whether mixed mould infection (primary exposure) were associated with early mortality in CAPM. RESULTS: We included 105 patients with CAPM. The prevalence of mixed mould infection was 20% (21/105). Patients with mixed mould infection experienced early mortality (9/21 [42.9%] vs. 15/84 [17.9%]; p = 0.02) and poorer survival at 6 weeks (7/21 [33.3] vs. 46/77 [59.7%]; p = 0.03) than CAPM alone. On imaging, consolidation was more commonly encountered with mixed mould infections than CAPM. Co-existent CAPA (odds ratio [95% confidence interval], 19.1 [2.62-139.1]) was independently associated with early mortality in CAPM after adjusting for hypoxemia during COVID-19 and other factors. CONCLUSION: Coinfection of CAPA and CAPM was not uncommon in our CAPM patients and portends a worse prognosis. Prospective studies from different countries are required to know the impact of mixed mould infection.

Risk factors, mortality, and predictors of survival in COVID-19-associated pulmonary mucormycosis: a multicentre retrospective study from India.

OBJECTIVES: To compare COVID-19-associated pulmonary mucormycosis (CAPM) with COVID-19-associated rhino-orbital mucormycosis (CAROM), ascertain factors associated with CAPM among patients with COVID-19, and identify factors associated with 12-week mortality in CAPM. METHODS: We performed a retrospective multicentre cohort study. All study participants had COVID-19. We enrolled CAPM, CAROM, and COVID-19 subjects without mucormycosis (controls; age-matched). We collected information on demography, predisposing factors, and details of COVID-19 illness. Univariable analysis was used to compare CAPM and CAROM. We used multivariable logistic regression to evaluate factors associated with CAPM (with hypoxemia during COVID-19 as the primary exposure) and at 12-week mortality. RESULTS: We included 1724 cases (CAPM [n = 122], CAROM [n = 1602]) and 3911 controls. Male sex, renal transplantation, multimorbidity, neutrophil-lymphocyte ratio, intensive care admission, and cumulative glucocorticoid dose for COVID-19 were significantly higher in CAPM than in CAROM. On multivariable analysis, COVID-19-related hypoxemia (aOR, 2.384; 95% CI, 1.209-4.700), male sex, rural residence, diabetes mellitus, serum C-reactive protein, glucocorticoid, and zinc use during COVID-19 were independently associated with CAPM. CAPM reported a higher 12-week mortality than CAROM (56 of the 107 [52.3%] vs. 413 of the 1356 [30.5%]; p = 0.0001). Hypoxemia during COVID-19 (aOR [95% CI], 3.70 [1.34-10.25]) and Aspergillus co-infection (aOR [95% CI], 5.40 [1.23-23.64]) were independently associated with mortality in CAPM, whereas surgery was associated with better survival. DISCUSSION: CAPM is a distinct entity with a higher mortality than CAROM. Hypoxemia during COVID-19 illness is associated with CAPM. COVID-19 hypoxemia and Aspergillus co-infection were associated with higher mortality in CAPM.

An unusual recurrent case of Cryptococcal sacroiliitis in an immunocompetent elderly female in Rajasthan, India.

A 70-year-old female presented with left sided low back pain. There was no history of any co-morbidities or immunocompromised state. Skeletal cryptococcosis was confirmed bsaed on culture and histopathology, along with pulmonary involvement. After a month of oral antifungal therapy, the patient's symptoms resolved, but an abscess relapsed at the same site, which was treated with a combination of IV Amphotericin B and 5-flucytosine followed by oral fluconazole, with no recurrence or complaints reported in subsequent follow-up.

Post Covid-19 Sinonasal Candidiasis: A Crisis Within the Pandemic.

The aim of this study was to find out the association of sinonasal candidiasis and Covid-19 infection. A prospective observational study was conducted at a tertiary care centre from April to September 2021, involving all patients with invasive candidiasis of the paranasal sinuses having a history of Covid-19 infection. A total of 18 patients of covid associated sinonasal candidiasis among the 475 cases of fungal rhinosinusitis were studied. All patients had involvement of nose and sinuses and 2 patients had orbital involvement with no loss of vision, while 3 had intracranial extensions and 1 had pulmonary involvement. Mandible was involved in 1 patient alone, while the maxilla and palate were involved in 5 patients. 15 patients were hypertensive, 12 diabetics and 1 had aplastic anaemia. Cultures showed that 8 patients had C. parapsilosis, 5 had C. albicans, 3 had C. tropicalis and 2 had mixed fungal infections. All patients underwent surgical debridement and antifungal administration. They were followed up for a minimum of 3 months. There was only one mortality (with aplastic anaemia), rest 17 were disease free at the time of writing this article. This is perhaps the first case series of post covid sinonasal candidiasis in the world. Invasive sinonasal candidiasis is a newer sequela of COVID-19 infection. Uncontrolled diabetes and over-zealous use of steroids at the time of Covid-19 are few of the known risk factors. Early surgical intervention and anti-fungal treatment should be sought for management.

COVID Associated Invasive Aspergillosis.

To study the possible association between invasive fungal sinusitis (aspergillosis) and coronavirus disease. An observational study was conducted at a tertiary care centre over 6 months, involving all patients with aspergillosis of the paranasal sinuses suffering from or having a history of COVID-19 infection. 92 patients presented with aspergillosis, all had an association with COVID-19 disease. Maxillary sinus (100%) was the most common sinus affected. Intraorbital extension was seen in 34 cases, while intracranial extension was seen in 5 cases. Diabetes mellitus was present in 75 of 92 cases. All had a history of steroid use during their coronavirus treatment. New manifestations of COVID-19 are appearing over time. The association between coronavirus and aspergillosis of the paranasal sinuses must be given serious consideration. Uncontrolled diabetes and overzealous use of steroids are two main factors aggravating the illness, and both of these must be properly checked.

To study the profile of Candida isolates and antifungal susceptibility pattern of neonatal sepsis in a tertiary care hospital of North India.

AIMS AND OBJECTIVE: To study the profile of Candida infection and antifungal susceptibility (AFS) pattern in neonatal sepsis. MATERIALS AND METHODS: In this prospective observational study, 850 blood samples were collected and processed from neonates who were suspected clinically to have sepsis. The blood culture that showed growth of Candida was further processed for species identification. Antifungal susceptibility was done as per the National Committee for Clinical Laboratory Standards (NCCLS)/Clinical Laboratory Standards Institute (CLSI) M44-A-2 guidelines by disc diffusion method and automated vitek-2 compact system. Candidemia was diagnosed by isolation of Candida species from at least one positive blood culture containing pure growth of Candida species with supportive clinical features. RESULTS: Candida species were isolated in 32 specimens of the total 322 culture-positive cases. The most common isolate was Candida tropicalis (14/32; 43.75%) followed by Candida albicans (7/32; 21.87%) and Candida glabrata (6/32; 18.75%). The three most common neonatal risk factors for candidemia were low birth weight, prolonged use of intravenous antibiotics and presence of central venous line. Non-albicans Candida (NAC) showed good sensitivity to fluconazole as compared to Candida albicans. The fluconazole sensitivity of Candida tropicalis, Candida glabrata, and Candida parapsilosis was 93, 67, and 100%, respectively, whereas it was 57% in Candida albicans. The sensitivity to amphotericin B was 95% among all Candida isolates. All NAC were sensitive to amphotericin B, while only 72% Candida albicans were sensitive to amphotericin B. CONCLUSIONS: The incidence of neonatal sepsis secondary to NAC is increasing and has replaced Candida albicans as a major cause of neonatal fungal sepsis. Low birth weight is the most important risk factor for Candida sepsis. The resistance of Candida albicans is increasing for both fluconazole and amphotericin B when compared to NAC. Increasing antifungal resistance warrants its judicious use both for prophylaxis and treatment.

A clinicomycological study of cutaneous mycoses in sawai man singh hospital of jaipur, north India.

BACKGROUND: Because of the widespread prevalence of the various cutaneous mycoses in a tropical country like India, it is important to know their patterns of etiology and clinical presentations. AIM: The present study was conducted in order to identify the clinical pattern of various cutaneous mycoses and the common etiological agents affecting the study populations admitted in SMS Hospital, Jaipur, in North India. MATERIALS AND METHODS: Skin scrapings and hair and nail samples of 160 patients with clinical suspicion of dermatophytosis were collected and subjected to direct microscopy and were cultured in Sabouraud's dextrose agar. Fungal species were identified by macroscopic and microscopic examination. Data were presented as simple descriptive statistics (SPSS, Version 17.0 (Chicago Il, USA). Epi Info Version 3.5.1 (CDC, Atlanta, Georgia, USA). RESULTS: Among the 160 clinically suspected patients of cutaneous mycoses, 60 (37.5%) were confirmed by culture. Dermatophytes and non-dermatophytes (NDM) were isolated from 66.6% (40/60) and 33.3% (20/60) of the positive cultures, respectively. Tinea capitis (50%) 30/60 was the most frequent clinical pattern and genus Trichophyton violaceum 32.5% (13/40) was the most common isolate in dermatophytosis-positive samples. Among the patients positive for NDM by culture, Tinea unguium 35% (7/20) was the most common clinical presentation and Aspergillus species 40% (8/20) were the most common etiological agents isolated. CONCLUSION: Although dermatophtes have been isolated from the cases of cutaneous mycoses all over the world with various frequencies, the role of NDM in the different cutaneous infections other than those of nail infections need to be evaluated.

Clinical profile of pulmonary aspergilloma complicating residual tubercular cavitations in Northen Indian patients.

BACKGROUND: Little is known regarding the clinical profile of Aspergilloma in Indian patients. Such a study was undertaken at Hospital for Chest and TB, Jaipur. MATERIALS AND METHODS: Old, treated patients of pulmonary tuberculosis showing ball like lesion/s inside cavity/ies or a recent thickening of cavity wall were enrolled. Morning sputa samples were collected in the patients who were able to raise sputum and were examined by KOH mount and fungal culture. Serum anti-aspergillus antibodies were estimated in all the patients. Twenty normal healthy subjects were included to serve as control. All patients showing a positive or borderline positive serology were diagnosed as pulmonary aspergilloma (PA group). The remaining patients formed the non-aspergilloma group (Non PA group). RESULTS: A total of 98 study patients could be classified as PA group (54 patients by serology alone, 44 patients by serology as well as sputum culture). The remaining 152 patients were classified as non PA group. Hemoptysis alone or along with other chest symptoms was significantly more common in PA group as compared to non PA group patients (P<0.001), more so in those with ball like lesions. But chest symptoms other than hemoptysis were more common in non PA group. Within the PA group, 21 (13 with ball like lesions and 8 with thickening of cavity wall) had clinical symptoms suggestive of CNPA and two patients (one each with ball like lesions and thickening of cavity wall) had clinical symptoms suggestive of ABPA. CONCLUSION: The clinical profile of pulmonary Aspergilloma in Indian patients is very protean ranging from saprophytic disease to CNPA and less commonly to ABPA.