ABSTRACT
Objectives: Invasive fungal infection is estimated to cause around 1.5 million deaths each year. But the true burden is estimated to be even more due to the lack of reliable diagnostic methods.Invasive fungal sinusitis (IFS) is the emerging infection leading to high morbidity and mortality (80%). Both clinical suspicion and reliable diagnostic tests available to diagnose an IFS are less. As a result, most patients are diagnosed only in the later stages. Nasal swabs for IFS are less useful and the most appropriate sample for the diagnosis will be the deep tissues involved, which are obtained after an invasive procedure.The gold standard test for diagnosis of IFS is the isolation of fungus in culture media but its sensitivity is 50%. Hence a non-invasive procedure to help in the diagnosis of invasive fungal sinusitis is needed. The role of Interleukins (IL) in fungal infections, especially IL-10 and IL-17 has been documented in various research in the past. Hence this research was carried out to study the role of IL-10 and IL-17 in invasive and non-invasive fungal sinusitis (NIFS). Method(s): The study wascarried out in the Department of Microbiology, SRIHER, Chennai. Atotal of 60 samples collected from patients suspected to have fungal sinusitis and sent to the laboratory for fungal culture were considered for the study. All the samples which grew fungus were categorized as IFS and NIFS. ELISA was performed with the serum samples of patients for IL-10 and IL-17 based on manufacturer's instruction (Human IL-10 ELISA Kit, Therm ofisher and Human IL-17 ELISA Kit, Therm ofisher), and reading is taken in a spectrophotometer (Thermo Fisher Scientific). Result(s): Among the 60 serum samples tested, 30 were categorized as IFS and the rest as NIFS.A total of 90% (n = 27/30) of IFS patients expressed interleukins in serum samples whereas none of the NIFS expressed both the interleukins tested.Among IFS, IL-10 was seen in 63.3% (n = 19/30) patients, IL-17 in 46.7% (n = 14/30) patients and 20% (n = 6/30) patients expressing both IL-10 and IL-17. In IFS the mean value of IL-10 and IL-17 were 6.657 and 4.259 respectively. Among the 30 IFS, 13 were positive for COVID-19. IL-17 was expressed in 84.6% (n = 11/13) of COVID-19 positive IFS patients. But only 23.1% (n = 3/13) of COVID-19 positive IFS patients expressed IL-10. A total of 15.4% (n = 2/13) of the COVID-19 positive patients did not express any interleukins. Surprisingly the expression of IL-10 among COVID-19 negative IFS was 94.1% (n = 16/17). The specificity of both IL-10 and IL-17 was 100% in the case of IFS. Conclusion(s): Thus, interleukins look to be a promising biomarker for IFS. Further studies will help in establishing inter-leukins as a potential non-invasive biomarker for IFS. IL-17 can be used as a biomarker for COVID-19 patients suspected to have IFS.Also looking for more than one cytokine preferably a combination of IL-10 and IL-17 should be done in patients with NIFS, which will help in the early prediction of patients progressing into IFS and can be managed accordingly.
ABSTRACT
Background: Candida infection is on the rise with an increasing number of nonalbicans species. Therefore, the need to speciate Candida rapidly and accurately is of the utmost importance. The purpose of this study was to speciate Candida using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), to analyze the correlation of the isolates with the clinical condition, and to study the outcome of the patient. Materials and Methods: PCR-RFLP using universal primers ITS1 and ITS4 was done to speciate all isolates of Candida;patient details were collected to analyze the clinical condition and the outcome of the patient. Results: The most common species of Candida isolated was Candida tropicalis 14 (56%) followed by Candida albicans 5 (20%), Candida auris 3 (14%), Candida parapsilosis 1 (4%), Candida orthopsilosis 1 (4%), and Candida kefyr 1 (4%). Majority of the samples that were collected were urine samples 15 (60%). The average duration of hospital stay was found to be 13.8 days. A number of underlying risk factors were present such as patients with diabetes, sepsis, malignancy, covid19 infection, surgical patients, preterm patients, elderly patients, and patients on long-term steroids. Conclusion: Candidemia is on the rise nowadays with nonalbicans species responsible for the majority of the infections. Since the outcome of the patient depends on rapid diagnosis and prompt initiation of antifungal agents PCR-RFLP proves to be a rapid and reliable test to identify most of the prevailing species of Candida. © 2021 Journal of Medical Society ;Published by Wolters Kluwer-Medknow.