Pattern of susceptibility to azoles by E test method in candidemia patients

Background: Blood stream infections due to Candida sp have considerably increased in recent years, along with the increase of drug-resistant isolates in immunocompromised patients. This increase in resistance makes it important to determine the antifungal susceptibility profile of each Candida species isolated from blood prior to treatment. Hence, this study was done to detect the resistant strains of Candida causing candidemia.Methods: About Seventy Candida species isolated from blood cultures were used for this study. These included 27 Candida albicans, 23 Candida tropicalis, 8 Candida parapsilosis, 3 Candida krusei, 2 Candida glabrata and 7 other candida species. Minimum inhibitory concentrations (MIC) of the most commonly used azoles like fluconazole, ketoconazole, itraconazole and voriconazole were determined by E test method.Results: The resistance percentage of Candida albicans for fluconazole and itraconazole was 11.1% and 7.4%; fluconazole resistance in Candida tropicals was 8.7%. Candida parapsilosis had good activity against all azoles with only 12.5% resistance for itraconazole.Conclusions: Fluconazole had good activity against most of the Candida sp except for Candida glabrata and Candida krusei with MIC 90 > 256 µg/ml. Itraconazole was less effective for Candida albicans, Candida glabrata and Candida parapsilosis (MIC 90 >32 µg/ml). Voriconazole was found to be the most effective drug against all species of Candida with low MIC values (MIC 90 < 0.25 µg/ml). Hence it can be used to treat blood stream infections caused by Candida species.

Schizophyllum Commune a Causative Agent of Fungal Sinusitis: A Case Report

We present a case of maxillary sinusitis caused by Schizophyllum commune, in a 50-year-old female. The patient presented with nasal obstruction, purulent nasal discharge from right side of the nose, cough, headache, and sneezing. Computed tomography revealed extensive opacity of the right maxillary sinus as well as erosion of the nasal wall and maxillary bone. Functional endoscopic sinus surgery was done, and fungal debris present on right side of the maxillary sinus was removed and sent to laboratory. Potassium hydroxide (KOH) examination of the nasal discharge showed hyaline, septate hyphae. Primary isolation on Sabouraud's dextrose agar (SDA) yielded a white woolly mould. Banana peel culture after 8 weeks showed macroscopically visible fan-shaped fruiting bodies. Lactophenol cotton blue (LPCB) mount of the same revealed hyaline septate hyphae, often with clamp connections. Identification was confirmed by the presence of clamp connections formed on the hyphae and by vegetative compatibility with known isolates

Phenotypic characterization of Trichosporon species from clinical isolates

Introduction: Trichosporon spp. arepresent as normal flora of skin and perigenital area in humans. They can cause invasive trichosporonosis in immuno-compromised individuals. Trichosporon infections are difficult to treat, since they do not respond to routinely used antifungal agents. Aim: This study was undertaken to characterize clinical isolates of Trichosporonsp, using phenotypic methods. Material and Methods: Around 52 isolates of Trichosporon sp. obtained from various samples of patients in Sri Ramachandra Medical College &amp; Research Institute, Chennai, were considered for the study. The isolates were studied for macroscopic morphology of the colonies on Sabouraud Dextrose Agar (SDA), microscopic morphology by Dalmau technique &amp; Gram stain, ability to hydrolyze urea, sugar assimilation profile and growth at 37°C &amp;0.1% cycloheximide. Results and Conclusion: Two types of colony morphologies were observed, 47 isolates appeared flat with farinose covering and 5 were cerebriform with radial fissures. All isolates hydrolysed urea, and none of the isolates fermented but only assimilated sugars. The Trichosporon isolates were identified up to species level by phenotypic methods. Still the reliability of identification has to be confirmed with genotypic characterization techniques

Complicated urinary tract infection by Trichosporon loubieri

We report two cases of complicated Urinary Tract Infection, one with nephrostomy tube left in-situ and other with bladder outlet obstruction, caused by Trichosporon loubieri. Both patients responded well to antifungal treatment along with change/removal of catheters. In both the cases, correct identification of T. loubieri was done by IGS1 sequencing. Prompt identification and timely management headed to good clinical outcome. Hence, clinicians should be aware of T. loubieri as an emerging fungi causing human infections. Keywords: Trichosporon loubieri, Urinary tract infection, Nephrostomy tube, Bladder outlet obstruction, IGS1 sequencin