Pestalotiopsis, a rare cause of mycetoma; A case report.

Pestalotiopsis is an appendage-bearing, well-known plant pathogen, and very few species are associated with human infections. To best of our knowledge, this is first report of Pestalotiopsis spp. isolated from mycetoma patient in India. A 66-year-old male farmer, having a history of twig prick, presented with a swollen foot and multiple discharging sinuses. 10 % KOH mount of tissue and grain showed fragmented fungal elements. White to pale honey-colored colonies with undulated edges and shiny black granules grew on potato dextrose agar. Characteristic fusiform, 5-celled conidia with 2-3 apical appendages seen on LPCB mount. Patient was treated with systemic Itraconazole successfully.

Clinicomycological Study of the Spectrum of Pulmonary Aspergillosis at a Tertiary Care Hospital in Central India.

Knowing the spectrum, prevalence, and modes of diagnosis of pulmonary aspergillosis (PA) will be beneficial to clinicians for its early diagnosis and management. This study aims to estimate the prevalence, spectrum, and role of serological tests and radiological findings in the diagnosis of PA. A total of 150 patients were suspected of having PA after obtaining relevant clinical history and radiological imaging. The patients were grouped into each spectrum of PA as invasive PA (IPA), chronic necrotizing PA (CNPA), aspergilloma, allergic bronchopulmonary aspergillosis (ABPA) based on predisposing factors, clinical and radiological findings, and the guidelines of the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG). Samples (bronchoalveolar lavage (BAL), sputum, blood) were collected from these patients and processed in a microbiology lab. BAL and sputum were subjected to microscopy by potassium hydroxide mount, calcofluor white mount, and culture. The serum was separated from blood by centrifugation and subjected to specific serological tests based on the spectrum of PA that the patient was suspected to have. For IPA, serum and BAL galactomannan antigen enzyme-linked immunosorbent assay (ELISA) was performed. For CNPA and aspergilloma, the anti-Aspergillus IgG antibody ELISA was performed. For ABPA, the tests performed were total immunoglobulin E (IgE) ELISA, Aspergillus fumigatus-specific IgE ELISA, and anti-Aspergillus immunoglobulin G (IgG) antibody ELISA. After compiling the clinical, radiological, culture, and serological findings, patients were diagnosed to have a particular spectrum of PA. The prevalence of IPA was 1.4%, CNPA was 4%, ABPA was 3.2%, and aspergilloma was 2.9%. CNPA was the predominant spectrum of PA in our study. Culture positivity for Aspergillus species was seen the highest in aspergilloma patients, followed by IPA, ABPA, and CNPA patients. A. fumigatus was the most common causative agent of PA, except for IPA for which Aspergillus flavus was the most common causative. Aspergillus niger and Aspergillus terreus were less the frequent causes of PA. A combination of radiological, microbiological, and serological tests along with clinical correlation is needed to confirm the diagnosis of PA.

Morphological Diagnosis of Blastomycosis Clinically Presenting as Mycetoma in a Young Immunocompetent Indian Patient; A Diagnostic Dilemma.

Primary cutaneous blastomycosis is very rare in non-endemic regions like India. Only few cases have been reported from India. Herein, we are reporting a rare case of chronic cutaneous blastomycosis in a young immunocompetent male presenting as mycetoma with multiple discharging sinuses in the anterior abdominal wall with no significant travel history.

Monotherapy with topical Natamycin to treat Scedosporium keratomycosis: A rare case from Central India.

Keratomycosis is common in Indian subcontinent. Diagnosis of the causal agent and successful management is a challenge for the clinician. Scedosporium is a rare fungus species, and it is relatively rare in causing keratomycosis. We report the case of a 29-year-old male who presented with complaints of redness, watering, and white lesion over his left eye. He sustained an injury in the left eye with vegetative matter. Corneal scraping was sent for potassium hydroxide staining and culture; fungal colony was seen in culture. Colony characters on Sabouraud dextrose agar and lactophenol cotton blue enabled a diagnosis of Scedosporium species. The patient was treated with topical Natamycin 5%, and complete resolution was seen at the end of 4 weeks. This case report highlights good response of keratitis caused by Scedosporium to topical Natamycin therapy.

Satellite Epidemic of Covid-19 Associated Mucormycosis in India: A Multi-Site Observational Study.

BACKGROUND: Sudden upsurge in cases of COVID-19 Associated Mucormycosis (CAM) following the second wave of the COVID-19 pandemic was recorded in India. This study describes the clinical characteristics, management and outcomes of CAM cases, and factors associated with mortality. METHODS: Microbiologically confirmed CAM cases were enrolled from April 2021 to September 2021 from ten diverse geographical locations in India. Data were collected using a structured questionnaire and entered into a web portal designed specifically for this investigation. Bivariate analyses and logistic regression were conducted using R version 4.0.2. RESULTS: A total of 336 CAM patients were enrolled; the majority were male (n = 232, 69.1%), literate (n = 261, 77.7%), and employed (n = 224, 66.7%). The commonest presenting symptoms in our cohort of patients were oro-facial and ophthalmological in nature. The median (Interquartile Range; IQR) interval between COVID diagnosis and admission due to mucormycosis was 31 (18, 47) days, whereas the median duration of symptoms of CAM before hospitalization was 10 (5, 20) days. All CAM cases received antifungal treatment, and debridement (either surgical or endoscopic or both) was carried out in the majority of them (326, 97.02%). Twenty-three (6.9%) of the enrolled CAM cases expired. The odds of death in CAM patients increased with an increase in HbA1c level (aOR: 1.34, 95%CI: 1.05, 1.72) following adjustment for age, gender, education and employment status. CONCLUSION: A longer vigil of around 4-6 weeks post-COVID-19 diagnosis is suggested for earlier diagnosis of CAM. Better glycemic control may avert mortality in admitted CAM cases.

Acanthamoeba species from a post-covid patient with CSF rhinorrhea; a next possible post covid menace? A case report.

A case of Acanthamoeba rhinorrhea in a 32 years female, who was recently recovered from COVID-19 infectionat a tertiary care institute in India. Though, there was no standard treatment protocol for management of amoebic-meningo encephalitis. The patient was managed successfully with combination therapy of amphotericin B and miltefosine. Agents having trophicidal and cysticidal activities are used for treatment of CNS Acanthamoeba infection. COVID 19 infection, steroid therapy anddiabetes mellitus which lead to low immunitywere found to be associated contributing factors.

A case control investigation of COVID-19 associated mucormycosis in India.

BACKGROUND: Increased occurrence of mucormycosis during the second wave of COVID-19 pandemic in early 2021 in India prompted us to undertake a multi-site case-control investigation. The objectives were to examine the monthly trend of COVID-19 Associated Mucormycosis (CAM) cases among in-patients and to identify factors associated with development of CAM. METHODS: Eleven study sites were involved across India; archived records since 1st January 2021 till 30th September 2021 were used for trend analysis. The cases and controls were enrolled during 15th June 2021 to 30th September 2021. Data were collected using a semi-structured questionnaire. Among 1211 enrolled participants, 336 were CAM cases and 875 were COVID-19 positive non-mucormycosis controls. RESULTS: CAM-case admissions reached their peak in May 2021 like a satellite epidemic after a month of in-patient admission peak recorded due to COVID-19. The odds of developing CAM increased with the history of working in a dusty environment (adjusted odds ratio; aOR 3.24, 95% CI 1.34, 7.82), diabetes mellitus (aOR: 31.83, 95% CI 13.96, 72.63), longer duration of hospital stay (aOR: 1.06, 95% CI 1.02, 1.11) and use of methylprednisolone (aOR: 2.71, 95% CI 1.37, 5.37) following adjustment for age, gender, occupation, education, type of houses used for living, requirement of ventilatory support and route of steroid administration. Higher proportion of CAM cases required supplemental oxygen compared to the controls; use of non-rebreather mask (NRBM) was associated as a protective factor against mucormycosis compared to face masks (aOR: 0.18, 95% CI 0.08, 0.41). Genomic sequencing of archived respiratory samples revealed similar occurrences of Delta and Delta derivates of SARS-CoV-2 infection in both cases and controls. CONCLUSIONS: Appropriate management of hyperglycemia, judicious use of steroids and use of NRBM during oxygen supplementation among COVID-19 patients have the potential to reduce the risk of occurrence of mucormycosis. Avoiding exposure to dusty environment would add to such prevention efforts.

Subcutaneous Cyst Due to a Novel Fungus, Aquastroma magniostiolata: A Case Report.

Various kinds of fungal agents have been observed in the environment. Fungi can enter the human body by penetration following trauma and are responsible for various types of subcutaneous mycotic lesions. In this case report, we present the case of a 47-year-old female patient who presented with swelling on the lateral aspect of the left lower leg above the lateral malleolus. Aspirate from the site was sent for histopathological examination for detection of the fungus. After microbiological investigation, a rare fungus isolated in this patient was identified as Aquastroma magniostiolata by carrying out sequencing at a reference center.

Epidemic in pandemic: Fungal sinusitis in COVID-19.

Objective: To describe the clinical pattern of invasive fungal sinusitis in COVID-19 and post-COVID-19 cases. Methods: All patients affected by COVID-19 or having a history of COVID-19 infection with an invasive fungal lesion (mucormycosis/aspergillosis) of the paranasal sinuses, orbit, palate, brain, lung, skin/cheek, and dental has been evaluated for possible description in tertiary care hospital in May 2021. Results: Twenty-four patients presented with clinical signs and symptoms of fungal infection with a history of COVID-19. Paranasal sinuses were involved in all patients. Palatal involvement was seen in seven cases. Intraorbital extension was seen in 13 cases. Intracerebral involvement was seen in three cases. Comorbid type 2 diabetes was seen in 20 patients. The use of steroids was noticed in 16 cases. Our observation revealed that uncontrolled diabetes, overuse of steroids, increased ferritin levels, and low hemoglobin percentage are the main factors aggravating mucormycosis.

Detection of a Lophomonas, a rare pathogen in Bronchoalveolar lavage.

Lophomonas infection is an emerging parasitic disease-causing respiratory infection. Although common in immunocompromised patient, it has been observed also in some immunocompetent cases. We report the case of a 45-year-old male who presented with productive cough, fever, and chest pain, with marked eosinophilia and cavitary lesion in the X-ray chest. KOH preparation and acid-fast bacilli microscopy of bronchoalveolar lavage (BAL) were negative. Direct microscopic examination of BAL accidentally showed a large number of living Lophomonas species with the movement of flagella. Methylene blue and Giemsa staining showed the plume of flagella and the nucleus. The patient was managed conservatively with metronidazole and get cured. It was concluded that the patient presented with signs and symptoms of pneumonia must be evaluated for rare events also if the patient was not responding with typical management of pneumonia. We reported the first case of this rare entity in Chhattisgarh state in an immunocompetent young Indian male.

Membranoproliferative glomerulonephritis: A rare presentation of occult filariasis.

Parasitic infections do not usually present with rapidly progressive renal failure but can provoke glomerular lesions which are mostly proliferative. In filarial infection, glomerular involvement is usually mild and transient, and presentation with renal failure is rare. We report occult filariasis presenting as rapidly progressive renal failure due to immune-complex mediated membranoproliferative glomerulonephritis. Our patient responded to treatment with diethylcarbamazine and a short course of steroid. This case highlights the importance of thorough workup to identify the cause and consideration of filariasis in an endemic area.