ABSTRACT
A case of hepato-splenic-renal candidiasis will be discussed with the aim to track down the causative organism and its likely susceptibility. The role of BDG, selection of the antifungal agent, and duration of therapy will be discussed. Acase ofan HIV-infected patient withcryptococcal meningitis, pulmonaryinfection, and pulmonary IRISwillbe discussed. Acase ofCandida auris fungemiaand organ infectionin aliver transplant recipientwho developed seriallyincreasing MIC will bepresented. The relevanceof MIC, tentativebreakpoints, and selectionof antifungal agentsbased on PKPDconsiderations will be discussed. Talamycosis is usually seen in HIV-infected individuals from North East India. Here we discuss a 3-year-old girl with acute lymphoblastic leukemia from Western India who developed cavitary pneumonia and multiple brain abscesses due to talaromyces. The case posed significant management challenges pertaining to both the fungal infection and cancer. Renal mucormycosis in healthy immunocompetent hosts is an entity generally reported only from India and China. We discuss the case of a previously healthy 3-month-old infant who presented with acute renal failure and renal mucormycosis. The case is unique with respect to the source of infection and management strategy. Treatment of fungal infections involving the draining system of the kidney is challenging mainly due to limited antifungal drug penetration at the site of infection. Challenges in the treatment of amphotericin-resistant Aspergillus terreus pelvicalyceal infections will be discussed. CAPA is a well-known complication of coronavirus disease 2019 (COVID-19), but usually involves the lung alone and rarely disseminates when treated. This case illustrates a rare complication of COVID-19, namely endocarditis caused by As-pergillus. Rhinosporidiosis is a well-known disease that usually involves mucosal surfaces in the head and neck. This case illustrates a rare occurrence, namely dissemination to multiple areas and mimicking the clinical presentation of other cutaneous mycoses.
ABSTRACT
Objectives: To study the susceptibility patterns in blood isolates of Candida parapsilosis at a tertiary care center. Method(s): This was a retrospective observational study of nine cases of candidemia due to C. Parapsilosis over a period of 1 year. Data were collected using the hospital's electronic health records. Species identification was done using Matrix-Assisted Laser Desorption and Ionization-Time of Flight Mass Spectrometry (MALDI-T OF-MS) (Bruker Biotyper Sirius-Bruker Dalton-ics, Bremen, Germany). Antifungal susceptibility was performed by broth microdilution method using Sensititre TM YeastOne TM YO1O AST Plates (Therm ofisher Scientific, USA). Result(s): All patients with C. parapsilosis bloodstream infection had central venous access and all patients had received broad-spectrum antibiotics atthe time of developing candidemia.Fourpatients developed C.parapsilosis candidemiain the post coronavirus disease 2019 (COVID 19) setting.Out of the 9 isolates, 7 (77.7%) were resistant to fluconazole, 2 were resistant to voriconazole and posaconazole, and 1 isolate was resistant to amphotericin.A total of 4/9 patients were started on fluconazole prior to antifungal susceptibility testing;3 of these needed to be switched to an echinocandin due to fluconazole resistance. Conclusion(s): Fluconazole resistance in this study was seen in 7/9 (77.7%) isolates which is more than what has been previously described for C. parapsilosis. This makes fluconazole a poor choice for the treatment of C. parapsilosis in our institute. These findings may have an implication in the selection or de-escalation of antifungal treatment for C. parapsilosis.