Post Cesarean Surgical Site Infection With Mycobacterium Abscessus Sp. Massiliense.

Objective: Surgical site infections (SSIs) owing to nontuberculous Mycobacteria (NTM) have emerged as an important cause of hospital-acquired SSI leading to great morbidity and mortality. Among NTM, Mycobacterium abscessus is reported in these sites. Epidemiology and transmission of M. abscessus in humans is noticing crux changes. Case report : We hereby describe a case of SSI after lower segment cesarean section (LSCS), presenting as a skin and soft tissue infection (SSTI) owing to a NTM. Conclusion: Clinicians should be aware of the possibility of infections caused by M. abscessus in patients who develop SSIs, particularly if they do not respond to conventional first-line antimicrobial therapy.

Mycosis of the Plantar Surface of Foot Owing to Nondermatophyte Mold Nodulisporium griseobrunneum Mimicking a Tinea Pedis.

Nondermatophyte molds (NDM) and dematiaceous molds are less frequently implicated as the etiological agents of tinea-like infections of the foot. Among the etiological agents, Hendersonula toruloidea (now, Nattrassia mangiferae), Scytalidium hyalinum, Alternaria species (spp.), and Fusarium spp. are infrequently associated with foot mycoses. Nodulisporium (N.) spp. is a mitosporic NDM, which has been implicated in human infections like cerebral phaeohyphomycosis and allergic fungal sinusitis. Here, we report N. griseobrunneum in a 9-year-old female with mycosis of the plantar surface of foot mimicking a tinea pedis. Potassium hydroxide mount of skin specimen demonstrated dichotomous branching septate hyphae. Fungal culture and molecular sequencing established N. griseobrunneum as the etiological agent. Antifungal susceptibility testing revealed lower MICs to all seven drugs tested including itraconazole (ITR). The patient was treated with ITR and topical terbinafine. To the best of our knowledge, this is the first communication depicting molecular confirmation of the etiologic agent and antifungal susceptibility data of the mycosis of the plantar surface of foot owing to N. griseobrunneum from India.

MIC and Upper Limit of Wild-Type Distribution for 13 Antifungal Agents against a Trichophyton mentagrophytes-Trichophyton interdigitale Complex of Indian Origin.

Dermatophytosis due to the Trichophyton mentagrophytes-Trichophyton interdigitale complex is being increasingly reported across India. Reports of therapeutic failure have surfaced recently, but there are no clinical break points (CBP) or epidemiological cutoffs (ECVs) available to guide the treatment of dermatophytosis. In this study, a total of 498 isolates of the T. mentagrophytes-interdigitale complex were collected from six medical centers over a period of five years (2014 to 2018). Antifungal susceptibility testing of the isolates was carried out for itraconazole, fluconazole, ketoconazole, voriconazole, luliconazole, sertaconazole, miconazole, clotrimazole, terbinafine, amorolfine, naftifine, ciclopirox olamine, and griseofulvin. The MICs (in mg/liter) comprising >95% of the modeled populations were as follows: 0.06 for miconazole, luliconazole, and amorolfine; 0.25 for voriconazole; 0.5 for itraconazole, ketoconazole, and ciclopirox olamine; 1 for clotrimazole and sertaconazole; 8 for terbinafine; 16 for naftifine; 32 for fluconazole; and 64 for griseofulvin. A high percentage of isolates above the upper limit of the wild-type MIC (UL-WT) were observed for miconazole (29%), luliconazole (13.9%), terbinafine (11.4%), naftifine (5.2%), and voriconazole (4.8%), while they were low for itraconazole (0.2%). Since the MICs of itraconazole were low against the T. mentagrophytes-interdigitale complex, this could be considered the choice of first-line treatment. The F397L mutation in the squalene epoxidase (SE) gene was observed in 77.1% of isolates with a terbinafine MIC of ≥1 mg/liter, but no mutation was detected in isolates with a terbinafine MIC of <1 mg/liter. In the absence of CBPs, evaluation of the UL-WT may be beneficial for managing dermatophytosis and monitoring the emergence of isolates with reduced susceptibility.

Naive tinea corporis et cruris in an Immunocompetent adult caused by a geophile Nannizzia gypsea susceptible to Terbinafine-Rarity in the current scenario of Dermatophytosis in India.

INTRODUCTION: Dermatophytosis caused by Nannizzia gypsea formerly Microsporum gypse um is rare in occurrence due to its geophilic adaptation and weak pathogenic potential in establishing infection in humans. The taxonomical status of N. gypsea has been controversial over the years and has now reached a concordance among mycologists. Innumerable reports of N. gypsea causing widespread infection in human immunodeficiency virus patients trails them as an important agent of consideration in an immunocompromised host. There have been sporadic reports of N. gypsea causing glabrous skin tinea and onychomycosis in healthy patients and the prevalence reports gravitate around 1-6.5  %. A variety of non-anthropophilic dermatophytes including novel species have now been implicated in causing dermatophytosis reflecting the era of crux changes in the epidemiology. CASE REPORT: We present a case of chronic dermatophytosis in a 22-year-old healthy Indian with a history of contact with a dog and soil and other factors favouring dermatophytosis. Conventional and molecular sequencing established the isolate as N. gypsea. Antifungal susceptibility test revealed a higher MIC of griseofulvin and lower MIC to azoles and terbinafine. The patient had complete clinical resolution following administration of oral terbinafine. CONCLUSION: Amidst the hyper-endemic-like scenario of tinea in India, this case report stands as a unique example of a patient infected with N. gypsea showing complete clinical resolution using terbinafine. Studies implicating N. gypsea in an immunocompetent host are rare and there is a need for more studies on geophilic dermatophytes causing tinea in the man for laying down effective preventive measures.

First report of Lasiodiplodia pseudotheobromae keratitis susceptible to voriconazole in an Indian mango grower.

The family Botriosphaeriacea comprises cosmopolitan endophytic fungi and many of the genera have frequently been implicated in causing human infections, including subcutaneous infection, sinusitis, invasive mycoses and keratitis. Among them, the genus Lasiodiplodia, which contains >30 species, is grouped as coelomycetous fungi with prototype species Lasiodiplodia theobromae as an important cause of keratitis. Several cryptic species morphologically resembling L. theobromae exist, one of which is Lasiodiplodia pseudotheobromae. We present a rare case of mycotic keratitis in an Indian mango grower following penetrating trauma to the left eye. Direct microscopy revealed retractile hyphal elements, and fungal cultures yielded a dematiaceous mould which was confirmed by sequencing as L. pseudotheobromae. Antifungal susceptibility testing revealed low MICs to amphotericin B and voriconazole and increased MICs to itraconazole and posaconazole. This is the first report of phytopathogenic L. pseudotheobromae keratitis, successfully treated with 2 % voriconazole without keratoplasty.

First Report of Concomitant Tinea Faciei and Pityriasis Folliculorum: A Dermatomicrobiological Rarity.

Tinea faciei (TF) is a common dermatomicrobiological condition caused by dermatophytes involving the skin of the face but not the mustache and beard (Tinea barbae). It poses a diagnostic dilemma with its atypical clinical presentation. Pityriasis folliculorum (PF) is a dermatological condition that results in rosacea-like skin eruptions. It was previously associated with a human ectoparasitic infestation. Demodex mites (Demodex folliculorum) is a group of obligate parasites that live on the skin of mammals. These mites have been associated with various dermatological disorders, clinically termed as demodicosis. Insects have been described as potential vectors that can carry various microorganisms and especially spores of fungi. Hence, infestation by such insects may aggravate the already present skin condition, leading to secondary infections. There has been a change in the trend of dermatophytosis worldwide and infections caused by Trichophyton mentagrophytesvar.interdigitale (T. interdigitale) are increasing. Hence, there is an urgent need for a thorough investigation of an infectious etiology among various skin disorders. This is the first report of concomitant Tinea faciei and Pityriasis folliculorum involving facial skin.

Distal Lateral Subungual Onychomycosis Owing to Tritirachium oryzae: A Bystander or Invader?

The genus Tritirachium is a mitosporic fungus which inhabits in soil and decaying plant material and also a notable insect pathogen. Human infections with Tritirachium species though rare were previously reported to cause corneal ulcers, otomycosis, onychomycosis, and dermatomycosis of the scalp and hence may be considered as a potential pathogen. Here we report a case of distal lateral subungual onychomycosis involving right great toenail in a 22-year-old female, wherein direct potassium hydroxide preparations, fungal cultures, and molecular sequencing of the isolate established Tritirachium oryzae as the etiological agent. Antifungal susceptibility performed by the microbroth technique of CLSI revealed increased MICs to amphotericin B and low MICs to azoles and echinocandins. The case was managed with surgical nail avulsion followed by topical application of 2% ketoconazole cream resulting regrowth of normal nail. To the best of our knowledge, this is the first report of non-dermatophytic mold T. oryzae causing onychomycosis in India.