Clinical utility of time to positivity of blood cultures in cases of fungaemia: A prospective study.

PURPOSE: Fungaemia due to yeast is a major cause of morbidity and mortality in critically ill patients. Although, automated blood cultures have improved the time to diagnosis, very few studies have systematically evaluated the utility of blood culture time to positivity (TTP) of fungaemia in the clinical scenario. In this study, we evaluated the TTP for different yeast species to determine its clinical utility. MATERIAL AND METHODS: A prospective study including 244 consecutive patients admitted to the adult (n â€‹= â€‹76) and paediatric (n â€‹= â€‹168) intensive care units (ICUs) was conducted between December 2017 through March 2019. The clinical and demographic characteristics, BACTEC blood culture results and TTP for yeast positive blood cultures were recorded for analysis. RESULTS: A total of 244 patients with 357 episodes of candidaemia were enrolled during the study period. The TTP (mean â€‹± â€‹SD) for all yeast species was 26.8 â€‹± â€‹23.6 â€‹h while it was significantly longer in paediatric than adult patients (30.5 ± 24.7 vs. 25.2 â€‹± â€‹22.9 â€‹h; p â€‹= â€‹<0.0001). Wickerhamomyces anomalus and Cyberlindnera jadinii (previously C. utilis) were exclusively isolated from paediatric population where W. anomalus demonstrated significantly longer TTP than C. jadinii. Among adult cases, C. albicans exhibited significantly longer TTP than C. tropicalis. In paediatric cases, >80% of C. tropicalis and C. utilis flagged positive in blood culture before 24 â€‹h while majority (65.9%) of W. anomalus isolates flagged positive later than 24 â€‹h. Similarly in adult samples, 63% of C. tropicalis isolates beeped positive before 24 â€‹h. CONCLUSION: TTP for yeast may provide insight regarding the responsible yeast species before final identification among critical patients with candidaemia. Larger studies are warranted for evaluating clinical utility of TTP considering other complex factors like yeast burden, generation time, virulence and host factors, which may affect TTP.

First case of endophthalmitis by Corynespora cassiicola.

Corynespora cassiicola is an environmental phytopathogen implicated in various human infections and has been isolated from one case of keratitis. We report here the first case of endophthalmitis caused by Corynespora cassiicola in a 54-year-old diabetic patient, who developed diminished vision, redness, and watering in the right eye, six weeks after intravitreal triamcinolone acetonide for non-proliferative diabetic retinopathy and macular oedema. Direct microscopy of the vitreous tap revealed septate hyphae, and culture grew white mycelium that turned olive-grey to black within two days and was confirmed as C. cassiicola after sequencing of the ITS region of 28S rDNA. The patient was started on oral voriconazole 200 mg twice a day. The patient is on regular follow-up without recurrence. To our knowledge, this case represents the first case of endophthalmitis due to this fungus across the globe and the first case of C. cassiicola infection from India.

Residual gall bladder: An emerging disease after safe cholecystectomy.

BACKGROUNDS/AIMS: Residual gallbladder mucosa left after subtotal/partial cholecystectomy is prone to develop recurrent lithiasis and become symptomatic, which mandates surgical removal. METHODS: We retrospectively evaluated the patients with residual gallbladder referred to us from January 2011 to December 2017. Based on MRCP we classified calot's anatomy to - type I where cystic duct was seen and type II where sessile GB stump was seen. RESULTS: 21 patients with median age 38 years and M:F::1:9.5, had undergone cholecystectomy (3 months-20 years) prior, presented with recurrent biliary pain. 3 had jaundice (CBD stone, Mirizzi and biliary stricture), 1 had pancreatitis and one had malignancy of the GB. Imaging revealed type I anatomy in 14 (67%) and type II in 7 (33%). All underwent completion cholecystectomy - open in 18 and laparoscopic in 3 (one converted to open). Additional procedure was required in 5 patients - CBD exploration in 2 (10%) and one each Hepatico-jejunostomy, extended cholecystectomy and splenectomy. Median hospital stay was 1 day. There was no mortality and 10% morbidity. One patient with malignancy died at 2 years, two died of unrelated cause, one developed incisional hernia and the remaining were well at a median follow up of 29 months. CONCLUSIONS: Residual GB lithiasis should be suspected if there are recurrent symptoms after cholecystectomy. MRCP based proposed classification can guide the management strategy. Completion cholecystectomy is curative.