Cryptic aspergillosis: a rare entity and a diagnostic challenge.

Introduction: Cryptic aspergillosis, caused by cryptic species of Aspergillus, is increasingly reported in humans and causes significant morbidity and mortality in immunocompromised individuals. The main aim of this study was to describe the occurrence of this entity at a large tertiary care centre and analyse the challenges in identifying them in a routine diagnostic laboratory. Methods: This was a retrospective case review of all patients diagnosed with cryptic Aspergillus species from April 2019 to February 2020. The isolates were identified using conventional microbiological techniques, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI- TOF MS), 28S rRNA and internal transcribed spacer (ITS) sequencing. Results: The species identified were Aspergillus tamarii, Aspergillus lentulus and Aspergillus sydowii. Identification by MALDI- TOF MS and sequencing was concordant for all except A. sydowii, with MALDI- TOF MS misidentifying it as Aspergillus thermomutans. All isolates showed low minimum inhibitory concentrations (MICs) for the panel of antifungal drugs. Conclusion: Aspergillosis caused by cryptic Aspergillus species presents a diagnostic challenge. This study confirms the importance of molecular methods for accurate identification.

Candida auris: Clinical profile, diagnostic challenge and susceptibility pattern: Experience from a tertiary-care centre in South India.

OBJECTIVES: Candida auris is an emerging, multidrug-resistant yeast transmitted in healthcare settings. Conventional methods of speciation are unable to identify C. auris to species level. Three methods, namely VITEK® MS v.3.0, VITEK®2 and target sequencing of the internal transcribed spacer (ITS) region and 28S rRNA gene, were evaluated. Antifungal susceptibility testing (AFST) was also performed, and risk factors for acquisition of C. auris candidaemia were studied. METHODS: Between November 2016 and November 2017, 203 Candida spp. were isolated from blood cultures, of which 11 isolates that were unidentifiable by conventional methods were further tested by VITEK® MS v.3.0 and VITEK®2 and were confirmed by sequencing. AFST was carried out on all 11 isolates by broth microdilution according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Clinical and epidemiological data of all patients retrieved from electronic patient records were reviewed. RESULTS: Of the 11 isolates identified as C. auris both by ITS and 28S rRNA sequencing, VITEK®2 identified only 5 as C. auris and VITEK® MS v.3.0 was not able to identify any of them as C. auris. Ten isolates (91%) were resistant to fluconazole, whereas all isolates were susceptible to amphotericin B and caspofungin. CONCLUSION: Candida auris can be misidentified in routine microbiology laboratories. Sequencing remains the gold standard if commercial identification systems are not updated.

Urinary Neutrophil Gelatinase Associated Lipocalin - A Sensitive Marker for Urinary Tract Infection in Children.

Early antibiotic treatment for urinary tract infection (UTI) in young children can prevent renal scarring. Sensitivity of pyuria and positive urine nitrite test as indicators of UTI are low, whereas results of urine culture, the gold standard for diagnosing UTI, may not be available for 48--72 h. Novel markers for rapid and accurate diagnosis of UTI would help in the early initiation of treatment in children with suspected UTI. We studied the utility of urinary neutrophil gelatinase-associated lipocalin (NGAL) as an early marker of UTI. This study included 100 children between 3 months and 5 years with suspected UTI. After parental consent, a midstream clean catch or suprapubic aspirate urine specimen was sent for culture and NGAL analysis. Sensitivity and specificity of urine NGAL as a marker of UTI were estimated. Of the 100 children evaluated, urine culture was positive in 34%. Median urine NGAL values were higher in culture-positive children than in culture-negative children (223.20 vs 13.65, P = 0.0001). Receiver operating curve analysis showed an optimal cutoff level of 27 ng/ml for urine NGAL (odds ratio, 8.2, 95% confidence interval, 3.1--22.1) correlating best with culture positivity. Sensitivity and specificity of urine NGAL estimation were significantly better (79.4% and 68.2%) when compared with urine white blood cell estimation (70.6% and 53%). Urine NGAL is a sensitive and specific marker to predict UTI in children with a cutoff level of 27 ng/ml. It may serve as a screening test for detecting simple, uncomplicated UTI in young children.

A retrospective study of the prevalence and outcomes of syphilis in pregnancy in a 5-year period.

OBJECTIVE: To determine the prevalence of syphilis in pregnancy and to assess the effect of syphilis on maternal and perinatal outcomes. METHODS: In a retrospective study, data were reviewed for pregnant women who tested positive for syphilis during routine prenatal screening at a center in India between January 2011 and December 2015. Women with both a positive venereal disease research laboratory (VDRL) test and a positive Treponema pallidum hemagglutination assay (TPHA) were considered to have syphilis, and their maternal and fetal outcomes were assessed. RESULTS: Among 51 164 pregnant women who underwent VDRL testing during the study period, 343 women were VDRL-positive (seropositivity rate 0.7%) and 18 were both VDRL- and TPHA-positive and were considered to have syphilis (seropositivity rate <0.1%). Among these 18 women, there were two stillbirths, four preterm births, and five small-for-gestational-age neonates. CONCLUSION: Although the prevalence of syphilis was low in the study population, women who were affected had adverse perinatal outcomes. Routine screening of all pregnant women for syphilis as early as possible in pregnancy, with appropriate treatment and follow-up of affected women and newborns, should be done to reduce adverse pregnancy outcomes.

Evaluation of the antimicrobial activity of daptomycin and linezolid against vancomycin-resistant Enterococcus spp. isolates in south India.

Vancomycin-resistant enterococci (VRE) have emerged as a major nosocomial pathogen. Alternatives for the treatment of infection with VRE include linezolid and daptomycin. Experience with these agents, especially daptomycin, is limited in India. The minimum inhibitory concentration of linezolid and daptomycin against 98 clinical isolates of VRE was tested by E-test. Daptomycin and linezolid showed good activity, with susceptibility rates of 93.9% and 96.9%, respectively.