Fungal Infection Study Forum (FISF)

Welcomes

ALL DELEGATES

to

MYCOCON - 2014

th th th14 , 15 & 16 November, 2014

Venue : Science City, Kolkata

http://www.fisftrust.com

Background: In terms of numbers, our population of 1.2 billion is plagued by 2.4 million HIV-AIDS patients, 50.7 million

diabetics, 31 million TB patients, 12 million COPD patients and 17.5 million cancer patients. We are witnessing an unprecedented

surge in solid organ and hematopoietic stem cell transplants, alcoholic liver disorders, critical-care services, and high risk

surgeries. These populations are highly vulnerable to invasive fungal infections and their sheer quantum reects the

unrecognized burden of fungal infections. Though we have limited studies available in India, the reports indicate a unique

epidemiology of opportunistic fungal infections in this country: a phenomenal high incidence, new risk factors, wide spectrum of

fungi causing these infections. Among the three major fungal infections in our hospitals, candidemia rate (300-500 cases/year) at

any tertiary care institute (~1500 beds), which is more than the annual candidemia rate of entire Australia put together. Neonatal

candidemia rate was ~45 cases/1000 admission in tertiary care centers in India, which is nearly three times higher than the

incidence reported by National Nosocomial Infection Surveillance in USA. Recent study on ICU acquired candidemia covering 27

ICUs across India, reported 6.5 cases/1000 ICU admission. Multiple outbreaks due to rare yeast have been reported from different

parts of the country. The high incidence and outbreaks may be linked to sub-optimal hospital care practices in majority centers in

India, high cost of disposables and the high (~50%) yeast carriage rate in the hands of health care providers. Similarly, a very high

incidence of mucormycosis has been reported in diabetics (1.6 cases/1000 diabetics) from India. Analyzing the reported literature

and development of a computational model, we projected the prevalence rate of mucormycosis at 0.14 cases per 1000 population

in India, which 70 times higher than generally accepted rates. Autopsy data from a tertiary care center recorded invasive

aspergillosis in 1% of all deaths, which represents 42% of all invasive fungal infections in those deceased. Therefore, opportunistic

fungal infections are serious problem in the management of immunocompromised and seriously ill patients in India.

Besides these, the average healthy individual also remains prone to several fungi which team in our overcrowded, unhygienic,

tropical environs. Fungi thrive in tropical environments. Up to 60% of invasive infections eventually kill the patient, majority of

which can be prevented with timely diagnosis and appropriate treatment. But our challenge with fungal infections goes beyond

mere numbers. The majority of our clinicians are poorly trained to recognize and manage these infections; most microbiology labs

across the country lack even basic infrastructure and training to provide diagnostic support or monitor antifungal resistance; most

antifungal drugs remain prohibitively expensive and out of reach of the poor majority; and hardly any research innovations are

forthcoming to tackle this burden.

In this background, Fungal Infection Study Forum (Trust) was launched by physicians from related specialties with a common

vision of increasing awareness by education and research on fungal infections in India.

Bengals tryst with Fungal infection ( historical aspect)

The study of mycoses in India started in India with British medical ofcers on mycetoma in 1850s (Madura foot by Gill in Madurai

district) and on ringworm by Powel in Assam in 1900. However, the establishment of School of Tropical Medicine, Calcutta in 1921

gave the real impetus to study on Medical Mycology in this subcontinent. Acton, McGuire & Panja in 1925-27 worked on

blastomycosis, pityriasis versicolor. Later in 1947, Ghosh et al did pioneering work on dermatophotosis and sporotrichosis. In due

course STM became the primer center in India for diagnosis, teaching and research in medical mycology. Histoplasmosis was

diagnosed by Panja rst time in India. Histoplasma capsulatum from environment was rst isolated by Sanayal and Thammayya

at STM. Maximum work in mycoses happened in Calcutta in post-independence era on histoplasmosis, sporotrichosis,

mycetoma, chromoblastomycosis.

Penicilliosis - endemic area in north-east part of India

From the FISF Chairman’s Desk

2

Dr. Arunaloke Chakrabarti

Chairman - FISF

FISF Declaration: The trust is a non-protable scientic, educational and non-political organization specializing in

the development of health, science and education in the country relevant to the eld of fungal diseases.

The vision, aims and objectives for which the society is established are as under:

Vision of the trust: To be the leader in promoting development of knowledge based science in the eld of medical

mycology and research leading to improvement of quality of health of patients with fungal infections.

Aims, objectives and function of the trust:

Aims: To undertake epidemiological and clinical studies maintaining the scientic integrity and validity, propose

country-specic management guidelines, and organize education activities.

Objectives and function:

To conduct educational activities including CMEs, Master Classes, Workshops independently or part of any

scientic bodies – Increasing awareness and competence either independently or with scientic bodies

To undertake epidemiological studies on Invasive Fungal Infections (IFIs) independently or become part of other

studies

To conduct studies on the development or validation of diagnostic tests for IFIs

To conduct sound clinical studies including trials for IFIs independently as investigator initiated project (with

Industry or Government or Institutional support)

Development of country specic management and other guidelines for IFIs independent of any particular

industry

To encourage and assist in the publication of monographs and text in the eld of fungal infections.

To prepare, edit, publish, issues, magazines, journals, books, text books, periodicals, circulars, and other literary

work and undertakings in the eld of fungal infections

To afliate the trust to other international organizations engaged in similar activities

To establish, provide, maintain and conduct research with other institutes and laboratories within and outside

Union of India for education and research

To apply to the Government, public bodies, urban, local municipal, district and other bodies, corporation,

companies, or other persons for and to accept grants of money, donations, gifts and other assistance with a view

to promote the objectives of the society

To secure good relations, assist, and give guidance to the members of the trust

To carry out the aforesaid objectives and function, the trust is empowered to do or to perform in the following:

o Attract funding from Government, Corporate or Private Bodies, Industries, and Institutions

o Explore joint initiatives with national and international bodies

o Maintaining its independent opinion & existence irrespective of amount & support from any funding

3

About FISF Trust

agencies

o To maintain the independence, the air tickets/venue etc. for the meeting will be organized by the group itself

o Fund will be utilized for maintenance of infrastructure of the working group, education, and to conduct the

specic projects.

Activities in the current year

Two regional conferences with national faculty at SGPGI Lucknow and Chirayu Medical college , Bhopal.

Research Projects on mucormycosis and invasive candidiasis discussed

First International Annual Conference at Science City Kolkata

Future Plans

Two regional and one annual congress Yearly

Conduction of research projects

Dr. Arunaloke Chakrabarti

Chairman - FISF

4

Dear Friends,

Welcome to MYCOCON 2014 and Mycology masterclass, the rst thematic international congress on invasive

fungal infection to be held at Kolkata ,science city from 14th till 16th November 2014. This congress is held under

the auspices of Fungal Infection Study Forum , a not for prot trust dedicated to education and research on

invasive fungal infections of medical importance .This trust and the congress is the brainchild of Prof. Arunaloke

Chakrabarti who has put in a tremendous effort in bringing Indian mycology to the international level.

Success of a congress depends on the breadth and depth of its scientic content and choice of Faculty. We were

blessed to have a number of international faculty, whose passion for this subject is reected by their presence in

the congress after taking time out from their extremely busy schedule and traveling on their own expense. We are

also fortunate enough to have a galaxy of national faculty consisting of Microbiologist, Intensivist,

Pulmonologist, Hemato Oncologist etc.

Our scientic program has been constructed keeping in mind diversity of our delegates which will span from

post graduates to consultant from all allied specialities.

I would like to thank the industry to come out generously to help this maiden venture of FISF trust, during a

trying time for them.

Wish you all a happy festive season and "Think Fungus"

Dr. Subhash Kr. Todi

Organising Chairperson

MYCOCON 2014

From Organising Chairman’s Desk

5

It gives me immense pleasure to organise rst MYCOCON 2014 at Kolkata at Science City Complex from 14th

November to 16th November 2014. I am delighted to welcome you here, in our city with great heritage, the city of

Rabindranath Tagore, Swami Vivekananda, Mother Teresa, Satyajit Ray and Amartya Sen.

As we know, invasive fungal infection is an extremely important subject relevant to all medical practitioners and

so national and international delegates are joining the conference to extend their views and opinions about the

solution of the said problem. We have tried to plan the academic session with the current concept on the subject

I acknowledge with gratitude the contribution of the speakers and faculty members and the industry who has

helped us in arranging the conference successfuly. I must confess that myself along with the whole team tried our

best to make the conference a grand success. Still there may have been quite a few loop holes, and lacunae on our

part which I hope will be taken in good spirit.

Hope you will enjoy our hospitality and the conference programme and the aromas of Kolkata environment.

Thanking you,

Dr. Tapas Chakraborty

Organising Sectretary

MYCOCON 2014

From the Secretary’s Desk

6

MYCOCON 2014 - Organising Committee

Organising Chairperson

Dr. S. K. Todi

Organising Secretary

Dr. Tapas Chakraborty

Organising Committee Members

Dr. Ajoy Sarkar

Dr. Animesh Gupta

Dr. Anish Banerjee

Dr. Anuradha Agarwal

Dr. Arpita Bhakta

Dr. Arunabha Chaudhuri

Dr. Ashish Kumar

Dr. Avik Sarkar

Dr. Basab Bijoy sarkar

Dr. Bhaskar Narayan Chaudhuri

Dr. Bibhuti Saha

Dr. Debkishore Gupta

Dr. Dipnarayan_Mukherjee

Dr. Gourav Goel

Dr. Indranil Roy

Dr. Joydeep Chakrabartty

Dr. Manideepa Sengupta

Dr. Mayur Bahan Mukherjee

Dr. Mohit Kharbanda

Dr. Mohua Bhattacharyya

Dr. Parthasarathi Bhattacharya

Dr. Pinaki Dutta

Dr. Rimita Dey

Dr. Sanjay Bhattacharya

Dr. Saptarshi Banerjee

Dr. Saswati Sinha

Dr. Shankar Sengupta

Dr. Shelley Sharma Ganguly

Dr. A. Sobhana

Dr. Soham Mazumder

Dr. Sudip Roy

Dr. Sushmita Basu

Dr. Tapas Chakraborty

Dr. Ujjwayini Ray

Course Co-ordinator

Mr. Tapas Kayal

Ofce Staffs

Ms. Nandini Mukherjee

Mr. Amit Mondal

7

Dr. A. K. Baronia Professor and Head, Department of Critical Care

Medicine, SGPGIMS, Lucknow

Dr. Arunaloke Chakrabarti Professor and Head, Department of Medical

Microbiology, Postgraduate Institute of Medical

Education and Research, Chandigarh, India

Dr. Atul Patel Director; Dept of Infectious Diseases, Sterling

Hospital & VEDANTA Inst of Med Sciences

Visiting Assistant Prof in Medicine, Division of

Infectious Diseases, University of South Florida,

Tampa. FL, USA

Dr. Lavanya Nutankalva Consultant Infectious Disease, Hyderabad

Dr. M R Shivaprakash Additional Professor, Mycology Division

(WHO Collaborating Center, Center of Advanced

Research in Medical Mycology), Department of

Medical Microbiology, Postgraduate Institute of

Medical Education and Research, Chandigarh

Dr. Pradip Bhattacharyya Director Emergency and Critical Care Services

Chirayu Medical College and Hospital

Bhopal, Madhya Pradesh

Dr. Prakash Shastri

Vice Chairman, Critical Care

Sir Ganga Ram Hospital, New Delhi

Dr. Purnima Parthasarathi Consultant Infectious Disease , Singapore

Dr. Rajeev Soman Consultant Physician, P D Hinduja National

Hospital, Veer Savarkar Marg, Mahim, Mumbai

Hon. Physician, Shushrusha Citizens' Cooperative

Hospital, Dadar, Mumbai.

Dr. Ram Gopalakrishnan Senior Consultant, Institute of Infectious Diseases

Apollo Hospitals and Apollo Childrens Hospital

Adjunct Professor- Dr MGR Medical University,

Tamil Nadu. President – Clinical ID Society

Dr. Randeep Guleria Consultant Pulmonologist

Department of Pulmonary and Sleep Medicine

All India Institute of Medical Sciences , New Delhi

Dr. Shirish Prayag Chief Consultant in Critical Care, Shree Medical

Foundation, Prayag Hospital, Pune, Maharashtra

Past President, ISCCM

Dr. Subash C. Varma Consultant Hematologist, Postgraduate Institute

of Medical Sciences, Chandigarh

Dr. Subhash Todi Director Critical Care & Emergency Department

Advanced Medicare & Research Institute , Kolkata

Dr. Tanu Singhal Department of Pediatrics, Kokilaben Dhirubhai

Ambani hospital & Medical Research Institute

Dr. V. Ramasubramanian Consultant, Infectious Disease, Apollo Hospital,

Chennai

National Faculty

8

Dr. Ritesh Agarwal Consultant Pulmonologist, Post Graduate Medical

Education and Research , Kolkata

Dr. Dhruva ChaudhryDean , Faculty of Medical Superspeciality

Senior Professor and Head , PCCM

University of Health Sciences , Rohtak, Haryana

Dr. Niranjan Nayak Consultant Microbiologist, New Delhi

Dr. B. L. Sherwal Director Professor, Department of Microbiology,

Lady Hardinge Medical College, New Delhi

Dr. Anup Ghosh Assist. Professor, Dept of Medical Microbiology,

Mycology Division, Postgraduate Institute of

Medical Education and Research, Chandigarh -

Dr. Mammen ChandyConsultant Hematologist

Tata Medical Centre , Kolkata

Dr. Suresh Ramasubban Consultant Intensivist and Pulmonologist

Department of Pulmonary and Critical Care

Medicine , Apollo Gleneagles Hospital, Kolkata

Dr. Prasanta Kumar Maiti Consultant Microbiologist, IPGME&R, Kolkata

Dr. Rabin ChakrabartiConsultant Cardiologist , Department of

Cardiology, Apollo Gleneagles Hospital , Kolkata

Dr. Ajoy Sarkar Consultant Pulmonologist, Dept. of Pulmonary

and Critical Care, Peerless Hospital , Kolkata

Dr. SanjayBhattacharyaSenior Consultant (Microbiology), Tata Medical

Centre, Kolkata

Dr. Bhaskar Narayan Chaudhuri Consultant Microbiologist, Quality Manager of

Lab , Infec t ion Contro l Ofcer , FORTIS

HOSPITALS, Kolkata

Dr. Shankar Sengupta Chief Clinical Quality and Academics, MRI and

CK Birla Group of Hospitals , Professor

(Microbiology)- Institute of Child Health, Kolkata

Dr. Parthasarathi BhattacharyaConsultant Pulmonologist

Institute of Pulmonary Medicine, Kolkata

Dr. Bibhuti Saha Head, Department of Tropical Medicine,

Dean, Students' affairs, School of Tropical

Medicine,Kolkata

Dr. Dipnarayan MukherjeeDepartment of Microbiology

Woodlands Hospital Kolkata

Dr. Ashim DasDepartment of Pathology, Post Graduate Institute

of Medical Sciences, Chandigarh

Dr. Vivek Nangia Consultant Infectious disease and Intensivist

Fortis Hospital, New Delhi

9

International Faculty

Dr. Andrew J. Ullmann

Universitatsklinikum Wuzburg

Department of Internal Medicine II

Division of Infectious Diseases

Wuzburg, Germany

Dr. Annette W.Fothergill

Department of Pathology

University of Texas Health Sciences Centre at San Antonio

San Antonio, Texas

Dr. Cornelia Lass-Floerl

Head of Division of Hygiene and Medical Microbiology

Innsbruck Medical University, Austria

Dr. Dimitrios Kontoyiannis

Frances King Black Endowed Professor, Infectious Diseases

Deputy Head, Division of Internal Medicine University of Texas MD Anderson Cancer Center

Adj Professor Baylor College of Medicine

Adj Professor University of Houston

Dr. Donald Sheppard

Director, Division of Infectious Diseases

Associate Professor, Departments of Medicine; Microbiology and Immunology,

McGill University, Montreal, Canada

10

Dr. H. R Ashbee

Director, Ashbee Healthcare Consultancy Ltd

Visiting Lecturer, School of Molecular and Cellular Biology, University of Leeds, Leeds, West

Yorkshire, United Kingdom

Dr. Jacques F. Meis

Department of Medical Microbiology and Infectious Disease Canisius Wilhelmina Hospital

Consultant microbiologist, Canisius Wilhelmina Hospital, Nijmegen, Netherlands

Honoray consultant, Radboud University Medical Center

Past-President of the Dutch Society for Medical Mycology

Past-President of the European Confederation for Medical Mycology

Past-Chairman of the External Quality Control Program in Bacteriology and Mycology in the

Netherlands

Dr. Johan Willem Mouton

Unit head Research and Development, Dept Medical Microbiology and Infectious Diseases,

Erasmus Medical center, Rotterdam

Professor of Medical Microbiology, spec.Pharmacokinetics & pharmacodynamics, Radboud

University Nijmegen (RUN)

Dr. Oliver A. Cornely

Professor of Medicine

Chief, Translational and Clinical Research, University Hospital of Cologne

Dr. Tania Christine Sorrell

Professor of Clinical Infectious Diseases

Director Sydney Institute for Emerging Infectious Diseases & Biosecurity Medicine

Westmead Clinical School

Australia

11

Chairpersons

Dr. A Sobhana

Dr. A. K. Baronia

Dr. Abhijit Bhattacharya

Dr. Ajoy Sarkar

Dr. Animesh Gupta

Dr. Anshuman Mukherjee

Dr. Anuradha Agarwal

Dr. Arghya Majumdar

Dr. Arpita Bhakta

Dr. Arunaloke Chakrabarti

Dr. Ashish Kumar

Dr. Basab Bijoy Sarkar

Dr. Bhaskar Narayan Chaudhuri

Dr. Bibhuti Saha

Dr. Debkishore Gupta

Dr. Dhruva Chowdhury,

Dr. Dipanjan Bandopadhyay

Dr. Dipankar Sarkar

Dr. Dipnarayan Mukherjee

Dr. Gourav Goel

Dr. Hema Chakraborty

Dr. Hindol Dasgupta

Dr. Indranil Roy

Dr. Jayanta Roy

Dr. Johan Mouton

Dr. Joydeep Chakrabarty

Dr. M R Shivaprakash

Dr. M. Chandy

12

Dr. Mahuya Bhattacharya

Dr. Maitreyi Bhattacharya

Dr. Manideepa Sengupta

Dr. Mohit Kharbanda

Dr. Niranjan Nayak

Dr. P. K. Maiti

Dr. Parthasarathi Bhattacharya

Dr. Prabhash Prasun Giri

Dr. Pradip Bhattacharya

Dr. Purnima Parthasarathy

Dr. Ram Gopalkrishnan

Dr. Randeep Guleria

Dr. Rimita Dey

Dr. Ritesh Agarwal

Dr. Sanjay Bhattacharya

Dr. Sankar Sengupta

Dr. Saswati Sinha

Dr. Sharmila Chandra

Dr. Shelly Sharma Ganguly

Dr. Soumen Meur

Dr. Subhanon Ray

Dr. Subhash Varma

Dr. Sumit Sengupta

Dr. Sushmita Ghoshal

Dr. Susrata Banopadhyay

Dr. Tanu Singhal

Dr. Tapas Chakrabarti

Dr. Ujjwayini Roy

Program Schedule of International Conference of Fungal Infection Study Forum, MYCOCON 2014, Kolkata

13

FISF MYCOCON 2014 –

SCIENTIFIC PROGRAM (DAY –

1 -

FRIDAY 14TH

NOVEMBER, 2014)

8:00 AM

Registration

8:45 AM

Welcome

: Dr Subhash Todi & Dr. Arunaloke Chakrabarti

9:00 –

9:30 AM

(30 mins)

KEY NOTE LECTURE Introduction to Medical Mycology & Magnitude of the problem - Dr. Jacques Meis Chairpersons: Dr. Arunaloke Chakrabarti & Dr. Dimitrios Kontoyiannis

9:35 – 11:00 AM (25 mins each)

PLENARY LECTURE Host Defence against fungi

Dr. Dimitrios Kontoyiannis Genetic Predisposition to Fungal infection

- Dr. Johan Mouton Endemic mycoses in India

-

Dr. Arunaloke Chakrabarti

Chairpersons:

Dr. Niranjan Nayak & Dr. P. K. Maiti

11:00 –

11:15 AM

Tea break

TIME

MINI AUDITORIUM

SEMINAR HALL -

A

SEMINAR HALL –

B

Session

GUIDELINES

(15+5 mins each)

YEAR IN REVIEW

(Invasive Fungal Infection)

MICROBIOLOGIST FORUM

(1 hour)

11:15 –

12:15 PM

(15+5 mins each)

Chairpersons: Dr. Parthasarathi Bhattacharya & Dr. Mohit Kharbanda

Chairpersons: Dr. Bhaskar Narayan Choudhry

& Dr. Basab Bijoy Sarkar

Intraabdominal candida infection

-

Dr. Arunaloke Chakrabarti

Invasive candidiasis

-

Dr. Oliver Cornely

Invasive pulmonary aspergillosis

-

Dr. Donald Sheppard

Candidemia

-

Dr. Subhash Kr. Todi

Aspergillosis

-

Dr. Pradip Bhattacharyya

Mucormycosis

-

Dr. Arunaloke Chakrabarti

Identification of mycelial fungi

-

Dr. H.R. Ashbee

Session

THEMATIC

Fungal infections in HIV

THEMATIC

ICU/Perioperative/Trauma/ Burn

THEMATIC

Febrile Neutropenia

12:20 -

1:00 PM

(15 + 5 mins each)

Chairpersons:

Dr. Bibhuti Saha &

Dr. Dipanjan Bandopadhyay

Chairpersons:

Dr. Ajoy Sarkar & Dr. Animesh Gupta

Chairpersons:

Dr. Subhash Varma & Dr. Oliver Cornely

Present status after HAART

-

Dr. Purnima Parthasarathy

Cryptococcosis –Management

-

Dr. Atul Patel

Early identification of Fungal sepsis in critically ill

-

Dr. Arvind Baronia

When to start Empiric/Preemptive therapy in ICU

-

Dr. Shirish Prayag

EORTC/MSG guideline for diagnosis of IFI

(12:20-12:40)

-

Dr. Rajeev Soman

Guideline for management of Invasive fungal infection

-

-

Dr. Mammen Chandy

1:00 –

2:00 PM

Lunch (Badge and Coupon required)

TIME

MINI AUDITORIUM

2:00 –

2:30 PM

(30 mins)

Key Note Lecture: Global collaboration in Fungal Research : The way ahead

-

Tania Sorrell

Chairpersons: Dr. Arunaloke Chakrabarti, Dr. Dimitrios Kontoyiannis

2:30 –

3:00 PM

(30 mins)

Panel Discussion: India specific Guidelines on Fungal infection

Moderator –

Dr. Rajeev Soman

Panellists: Dr. Lavanya Nutankalva, Dr. Purnima parthasarathy, Dr. Prakash Shastri, Dr. S. Prayag, Dr. Dipnarayan Mukherjee

3:00 –

4:00 PM

(30 mins each)

Interactive Case Discussion

Moderator: Dr. Dhruva Choudhry, Dr. Cornelia Lass-Florl

Presenters -

1. Dr. Atul Patel

2. Dr. Rajeev Soman

4:00 –

4:15

Tea Break

Program Schedule of MYCOCON 2014, Kolkata

14

TIME MINI AUDITORIUM SEMINAR HALL - A SEMINAR HALL – B

Session CONTROVERSIES HOT TOPICS Emerging fungal infections & challenges

4:15 – 5:15 PM (15 + 5 mins each)

Chairpersons: Dr. Johan Mouton & Dr. Saswati Sinha

Chairpersons: Dr. Rimita Dey & Dr. Susrata Banopadhyay

Chairpersons: Dr. Bhaskar Narayan Chaudhuri, Dr. Manideepa Sengupta

Eichanocandin : first line therapy in invasive candidiasis

- Dr. Ram Gopal Krishnan Vascular lines should be removed in candidemics

- Dr. Vivek Nangia Place of Conventional Amphotericin B Deoxycholate

- Dr. Subhash Varma

Source Control in Invasive fungal sepsis – Dr. Shirish Prayag

Combination antifungal therapy - Dr. Ram Subramaniam

Role of probiotics - Dr. Lavanya Nutankalva

Fusarium and Scedosporium infections - Dr. Dimitrios Kontoyiannis

Fungal infection of bone and joint - Dr. Oliver Cornely

Subcutaneous Mycosis - Dr. P. Maiti

Session THEMATIC HOT TOPICS Challenging Fungal infections

5:15 – 6:00 PM (15 + 5 mins each)

Chairpersons: Dr. Sumit Sengupta & Dr. Hindol Dasgupta

Chairpersons: Dr. Joydeep Chakrabarty, Dr. Arghya Majumdar

Chairpersons: Dr. Pradip Bhattacharya, Dr. Ajoy Sarkar

IRIS (Immune Reconstitution Syndrome) - Dr. Purnima Parthasarathy

Pneumocystis - Dr. Dhruva Chowdhury

Epidemiology of fungal infections in trans-plant

- Dr. Subhash Varma Role of bronchoscopy and imaging in Invasive fungal infection

- Dr. Randeep Gulleria

Candida peritonitis - Dr. Prakash Shastri

Central line fungal sepsis - Dr. Shirish Prayag

6:00 – 6:30 PM Tea Break

6:30 – 8:30 PM Cultural Program

8:30 PM Dinner (Badge & coupon required)

FISF MYCOCON 2014 –

SCIENTIFIC PROGRAM (DAY –

2 -

SATURDAY 15 TH

NOVEMBER, 2014)

9:00 –

9:30 AM (30 mins)

KEY NOTE LECTURE (MINI AUDITORIUM) Future of Antifungal Therapy

-

Dr. Oliver Cornely Chairpersons:

Dr. A. K. Baronia & Dr. Randeep Guleria

9:30 –

10:00 AM

(30 mins)

PANEL DISCUSSION Research on fungal infection in India

Moderator: Dr. Subhash Todi Panellists : Dr. A. K. Baronia, Dr. B L Shrewal, Dr. Arunaloke Chakrabarti, Dr. Atul Patel

TIME

MINI AUDITORIUM

SEMINAR HALL –

A

SEMINAR HALL –

B

Session

INTERACTIVE CASE DISCUSSION

MICROBIOLOGIST FORUM

10:00 –

11:00 AM (30 mins each)

Moderator : Dr. Dimitrios Kontoyiannis & Dr. Joydeep Chakrabartty

Chairpersons:

Dr. Sanjay Bhattacharya & Dr. Hema Chakraborty

Case Discussion

-

Dr. Rajeev Soman

-

Dr. A. Sobhana

Histopathology in diagnosis

-

Dr. Ashim Das Molecular identification techniques

-

Dr. M R Shivaprakash

11 – 11:15 Tea break

Session ORGAN SPECIFIC INFECTION ANTIFUNGAL PROPHYLAXIS CONTROVERSIES 11:15 – 12:15 PM (15+5 mins each)

Chairpersons: Dr. Jayanta Roy & Dr. Subhanon Ray

Chairpersons: Dr. Tapas Chakrabarti & Dr. Sharmila Chandra

Chairpersons: Dr. M R Shivaprakash & Dr. Anuradha Agarwal

CNS fungal infections - Dr. Pradip Bhattacharya

Fungal endocarditis - Dr. Rabin Chakrabarti

Fungal endophthalmitis - Dr. Niranjan Nayak

Neutropenics - Dr. Subhash Varma

ICU/Perioperative/Burn/ Trauma - Dr. Randeep Gulleria

Transplant: Solid organ / BMT - Dr. Mammen Chandy

Fungal growth in respiratory tract speci-mens – significance

- Dr. Ritesh Agarwal Fungal growth in urine – significance

- Dr. Tanu Singhal Fungi in air of hospital – Is there any cut off value?

- Dr. Sankar Sengupta

Program Schedule of MYCOCON 2014, Kolkata

15

TIME MINI AUDITORIUM SEMINAR HALL – A SEMINAR HALL – B

Session MEET THE EXPERT

HOW I MANAGE

BIOMARKERS

12:15 –

1:00 PM

(15+5 mins each)

Chairpersons: Dr. Niranjan Nayak &

Dr. Prabhash Prasun Giri Chairpersons:

Dr. Cornellia Lass Florl &

Dr. Maitreyi Bhattacharya

Setting up a fungal lab

-

Dr. H R Ashbee

Training to be a mycologist

-

Dr. HR Ashbee

Mucormycosis

-

Dr. Dimitrios Kontoyiannis

IFI in children

-

Dr. Tanu Singhal

Mannans

-

Dr. Vivek Nangia

B-d Glucan

-

Dr. V. Ram Subramaniam

1 –

2 pm

Lunch

TIME

MINI AUDITORIUM

2:00 –

2:30 PM

(30 mins)

KEY OTE LECTURE (MINI AUDITORIUM)

Biofilm And Quorum sensing: novel therapeutic targets

-

Dr. Tania Sorrell

Chairpersons: Dr. N. Nayak & Dr. M. Chandy

2:30 –

3:00 PM

(30 Mins)

PANEL DISCUSSION

Rational use of diagnostics in fungal sepsis

Moderator : A.K.Baronia

Panellists: Dr. Jacques Meis, Dr. Ashim Das, Dr. V. Ram Subramaniam & Dr.

Sanjay Bhattacharya,

3:00 –

4:00 PM

(30 mins each)

Interactive Case Discussion

-

Dr. Bibhuti Saha

-

Dr. Dhruva Choudhry

Chairpersons: Dr. Sushmita Ghoshal & Dr. Ritesh Agarwal

4:00 –

4:15 PM

Tea Break

TIME

MINI AUDITORIUM

SEMINAR HALL –

A

SEMINAR HALL –

B

Session

ANTIFUNGAL DRUGS

ORGAN SPECIFIC INFECTION

DIAGNOSTICS (LABORATORY)

4:15 –

5:15 PM

(15+5 mins each)

Chairpersons: Dr. Purnima Parthasarathy,

Dr. Dipankar Sarkar

Chairpersons:

Dr. Debkishore Gupta, Dr. Ujjwayini Roy

Chairpersons: Dr. Sankar Sengupta &

Dr. Shelly Sharma Ganguly

Liposomal Amphotericins and look alikes : are they same

-

Dr. Atul Patel

Use of TDM (Therapeutic drug monitoring) in prescribing Azoles

-

Dr. Bhaskar Narayan Chaudhuri

Are all echinocandins same?

-

Dr. Donald Sheppard

Malassezia

-

Dr. H R Ashbee

Fungal rhinosinusitis

-

Dr. Ashim Das

Fungal sepsis in pancreatitis :myth or reality

-

Dr. Prakash Shastri

Conventional diagnosis

-

Dr. Sanjay Bhattacharyya

Identification of yeast

-

Dr. Anup Ghosh

PCR in diagnosis –

pitfalls

-

Dr. Conelia Lass-Florl

Session

ANTIFUNGAL DRUGS

DIAGNOSTICS (BIOMARKERS) IN IFI

DIAGNOSTICS (LABORATORY)

5:15 –

6:00 PM

(15 + 5 mins each)

Chairpersons: Dr. Pradip Bhattacharya,

Dr. Dipnarayan Mukherjee

Chairpersons:

Dr. Mahuya Bhattacharya, Dr. A Sobhana

Chairpersons:

Dr. Sanjay Bhattacharya,

Dr. Ram Gopalkrishnan

PK/PD for beginners –What is it

-

Dr. Johan Mouton

Application of pK/Pd principles in prescribing antifungal drugs

-

Dr. Johan Mouton

Role of Procalcitonin

-

Dr. Ajoy sarkar

Newer biomarkers

-

Dr. Lavanya Nutankalva

MALDI in diagnosis of fungal infections

-

Dr. Anup Ghosh

Antifungal susceptibility testing

-

Dr. Anup Ghosh

Banquet

6:30 pm onwards

NICCO PARK RESORTS : WET O WILD

Badge, Coupon & Invitation Card Re-quired. Invitation Card for

non Faculty/Delegate

Program Schedule of MYCOCON 2014, Kolkata

16

FISF MYCOCON 2014 – SCIENTIFIC PROGRAM (DAY – 3 - SUNDAY 16 TH NOVEMBER, 2014)

9:00 –

9:30 AM

(30 mins)

KEY NOTE LECTURE

Antifungal Stewardship

-

Dr. Andrew Ullmann

Chairpersons:

Dr. Ram Gopalkrishnan & Dr. Tanu Singhal

9:30 –

10:00 AM

(30 mins) PANEL DISCUSSION

Non culture based diagnosis of fungal infection

Moderator: Dr. Cornelia Lass-Florl

Panelist: Dr. Suresh Ramasubban, Dr. B L Sherwal, Dr. P K Maiti, Dr. M. R.Shivaprakash, Dr. Ram Gopal Krishnan

TIME

MINI AUDITORIUM

SEMINAR HALL –

A

SEMINAR HALL –

B

Session

INTERACTIVE CASE DISCUSSION

MICROBIOLOGIST FORUM

10:00 –

11:00 AM

(30 mins each)

Chairpersons:

Dr. Donald Sheppard, Dr. Soumen Meur

Chairpersons:

Dr. Gourav Goel, Dr. Indranil Roy

Interactive Case Discussion

-

Dr. Ram Gopalkrishnan

-

Dr. Tanu Singhal

Fungal outbreak investigation

-

Dr. Sanjay Bhattacharya

Molecular epidemiology

-

Dr. M.R.Shivaprakash

11:00 –

11:15 AM

Tea break

Session

ICU/Perioperative/Trauma/Burn

New Horizons

Aspegillus and Lung

11:15 –

12:15 PM

(15+5 mins each)

Chairpersons:

Dr. Abhijit Bhattacharya, Dr. Ashish Kumar

Chairpersons:

Dr. Arunaloke Chakrabarti,

Dr. Arpita Bhakta

Chairpersons:

Dr. Dhruva Chowdhury,

Dr. Anshuman Mukherjee

Candida score

-

Dr. Arvind Baronia

Presumed fungemia: culture negative –

Management approach

-

Dr. Tania Sorrell

Diagnosing invasive fungal infection in Burn patients

-

Dr. Suresh Ramasubban

Fungi & cystic fibrosis

-

Dr. Jacques Meis

Antifungal resistance in systemic candidiasis

-

Dr. Cornelia Lass-Florl

Antifungal resistance in aspergillosis

-

Dr. Jacques Meis

Invasive pulmonary aspergillosis

-

Dr. Andrew Ullmann

Allergic Bronchopulmonary Aspergillosis

-

Dr. Ritesh Agarwal

Chronic pulmonary Aspergillosis

-

Dr. Parthasarathi Bhattacharya

12:15 –

-2:00 PM

Lunch

P01 - Rapid Diagnosis of Invasive Fungal

Infections in Haematological Malignancy

patients with febrile neutropenia by

Galactomannan antigen ELISA and PCR.

Shikha Puri, Malini R Capoor, Gaurav Kaushik, Sujoy, D. K

Gupta.

Department of Microbiology, Haematology, VMMC and

Safdarjung Hospital, Delhi.

Introduction: In view of the growing incidents and high

mortality of invasive fungal infection, adequate diagnostic

techniques permitting timely onset of the treatment is of

paramount importance, in immunocompromised patients.

Objective: The purpose of the study was to access the

potential of molecular screening by a highly sensitive

broad spectrum pan-fungal PCR assay in patients with

haematological malignancies carrying a high risk of

invasive fungal infection over a period of two years.

Material & Method: Whole blood (5ml) was collected in

EDTA Vacutainer for PCR Assay. All blood samples were

stored at -80°C until DNA extraction (By Qiagen QIAamp

DNA extraction kit) followed by PCR run ( By real time

PCR instrument-Roter Gene™ 6000, corbett research,

Australia). A real time Pan fungal PCR assay based on Taq

man technology targeting 18 S ribosomal RNA gene was

used to screen whole blood specimen obtained from series

of haematology mal ignancy pat ients for IFIs .

Galactomannan antigen ELISA (Biorad Laboratories) was

also put up.

Results: The clinical and laboratory data were analysed

and the patients were classied as per the EORTC/MSG

criteria into proven, probable and possible categories. Out

of a total of 134 cases 26 were proven, 48 were probable and

60 were possible. In the proven cases, sensitivity and

specicity was 88.8 % and 100%, respectively. In the

probable cases the sensitivity and specicity was 83.3%

and 90.9%, respectively.

Conclusion: The molecular screening by RT Pan-fungal

PCR is rapid, reliable and cost effective way for the

identication of fungaemia in Haematology patients and

helps in preventing unnecessary antifungal therapy.

Pan fungal PCR aids in differentiating colonisation with

invasive infection as it was negative in 69.2% patients with

colonisation with Candida species.

P02 - The diagnostic dilemma in an

i m m u n o s u p p r e s s e d p a t i e n t w i t h

meningoencephalitis - A Case Report

Dr. A. Shobhana*, Dr. Darsha Sen**, Dr. Hrishikesh

Kumar***

*Consultant Cri t ical care & Stroke,** Cl inical

Microbiologist, ***Consultant Neurologist

I n s t i t u t e o f N e u r o s c i e n c e s , K o l k a t a . E m a i l :

docshobhana@yahoo.com

Introduction: Cryptococcal disease has increased in the

last few decades with increases in the number of

immunosuppressed individuals and advances in

diagnostic techniques.

We report a case of cryptococcal meningitis in a patient on

corticosteroids which was evading diagnosis for a long

period.

Case Report: A fty-one year old lady was admitted to our

hospital in end February,2014 with a history of severe

headache of one month's duration. Initially there was no

fever, loss of consciousness or vomiting. She had been

admitted to another health care facility where a CSF

picture was like aseptic meningitis. MRI brain then was

essentially normal. This lady had been diagnosed to have

sarcoidosis two years ago and had been on oral steroids

Abstracts

17

Professors walk round and poster presentation on 14th & 15th November, 2014 - 1:00 - 1:30 PMPoster Display: Seminar Hall Complex First Floor

since then. Apart from a treated pulmonary Koch's

infection she had no signicant past history nor any other

medical comorbidities. On admission she was found to

have Cushingoid habitus. She was conscious, cooperative

,ambulatory and apart from severe headache she had no

complaints .There were no signs of meningism and aprt

from disc hyperemia there was no frank papilloedema on

fundoscopy.Initial blood biochemistry, hematology, CRP,

Procalcitonin were normal. Her family members were

refusing a CSF study again. Now the dilemma was where

she had an infective meningitis or inammatory

meningitis due to sarcoidosis itself. She was started on

intravenous Methylprednisolone along with ceftriaxone in

meningitis dose.S he had been started on antitubercular

drugs from another facility and these were continued. A

serum cryptococcal antigen (CRAg) came negative.The

patient's symptoms were worsening. A Contrast CT brain

showed meningeal enhancement. On the seventh day of

admission she deteriorated with severe vomitimg,

photophobia and she was shifted to the ITU. The family

agreed to a lumbar puncture.CSF pressure was slightly

raised. Although CSF showed lymphocytic pleocytosis

with raised protein ,the routine gram stains and India Ink

preparation as well as CSF CRAg was negative.The patient

was going downhill, not responding to steroids and had a

convulsion leading to invasive mechanical ventilation.

Clearly she was not responding to treatment. CSF picture

was not consistent with any bacterial infection. The

suspicion of fungal meningitis was high. She was started

on empirical amphotericin B and acyclovir. A rpeat CSF

study was done. This time CSF CRAg came to be positive.

She was treated with amphotericin b and Flucytosine. She

recoverd steadily and was discharged home on oral

uconazole.

Conclusion: This case underscores the importance of high

index of suspicion of cryptococcal meningoencephalitis

which is associated with high mortality and morbidity in

an immunosuppressed patient and the diagnostic

difculties as well as CRAg as a diagnostic tool in this

infection.

03 - Therapeutic Drug Monitoring of Anti-

fungal Azoles: A laboratory experience

1,2 2 1 1A.J Dherai , P.K.Chawla , R.V.Lokhande , P.R.Naik , 3 1,2R.Soman , T.F.Ashavaid .

1 2Department of Laboratory Medicine, Research 3Laboratories, Department of General Medicine, P. D.

Hinduja Hospital, Mahim, Mumbai-400 016.

Introduction: Triazoles like voriconazole, posaconazole,

itraconazole etc are commonly used for prophylactic or

anaphylactic treatment of invasive fungal infections. These

drugs due to their wide inter-individual variability

mandate drug monitoring in majority of patients. We

present our data of plasma levels of these drugs analysed

in our centre since May 2012. The inuence of dose, clinical

condition and other interacting factors on plasma levels

are also correlated to highlight the importance of TDM in

patient management.

Methods: Pre dose drug levels of antifungals –

Voriconazole, Posaconazole and Itraconazole were

d e t e r m i n e d u s i n g h i g h p e r f o r m a n c e l i q u i d

chromatography. We analysed baseline plasma samples

received from 50 patients for voriconazole, 20 for

posaconazole and 3 for itraconazole levels.

Results: It was observed that 17, 8 and 2 samples each for

voriconazole, posaconazole and itraconazole levels were

in the subtherapeutic range while 8 samples of

voriconazole were in the toxic range. The drug levels

correlated with clinical outcome of the patients and

required appropriate dose adjustments for therapeutic

efcacy. The major factors contributing to variability of

voriconazole were drug-drug interaction (n=2), CYP2C19

genotype (n=43), and drug dose (n=12) for voriconazole

while only drug dose in posaconazole (n=5) and

itraconazole (n=2) therapy patients.

Conclusion: Voriconazole is monitored more often than

other azoles. Several factors inuence these drug levels

however we need to assess a larger sample size to obtain a

meaningful correlation affecting posaconazole and

itraconazole levels. Monitoring of plasma levels assists in

achieving desired therapeutic outcome.

18

04 - External validation of four risk

prediction scores for candidemia in critically

ill patients

Dr. Syed Nabeel Muzaffar

Senior Resident (2nd year DM student), Department of

Critical care medicine, Sanjay Gandhi Postgraduate

Institute of Medical Sciences, Lucknow

Objectives: To perform external validation of four risk

prediction models for candidemia in critically ill patients.

Materials and Methods: A prospective observational

study conducted in a 12 bedded general purpose ICU of a

tertiary care centre of North India. Hundred consecutive

critically ill non- neutropenic adults were enrolled.

Patients' characteristics, severity of illness and risk factors

for colonisation and candidemia were noted. Microbiology

samples were collected (urine, tracheal aspirates,

pharyngeal aspirates, rectal swab, axillary swab, blood) at

admission, 3rd day and then weekly for 3 weeks. Patients

were divided into two groups (Group1- No Candidemia,

Group 2- Candidemia). Statistical tests included Student's

t-test and Mann Whitney test.

Results: Mean age was 45.2+15.77 and sex ratio (M/F) was

60/40. Median admission APACHE II was 16 (range 3-39)

and SOFA was 9 (range 2-20). There were 90 patients in

group 1, and 10 patients in group 2. Rate of candidemia

was 10%.

Mean duration of ICU stay was 19.7+19.37 in group1 and

39.50+ 20.12 days in group 2, which was signicantly

different (p =0.003).Overall survival rate was 50%.There

was no difference in survival among the two groups.

Out of 10 candidemia cases 8 showed positive blood

culture at admission while two were positive at 3rd week.

Four risk prediction models (Candida score, colonization

index, corrected colonization index and Ostrosky' clinical

prediction rule) for invasive candidiasis were compared at

admission and at 3rd week. All the models showed poor

positive predictive value (PPV 8% to 12%) and good

negative predictive value (NPV 92% to 95%).Among the

four models tested Corrected colonization index had the

best performance (PPV 12.82%, NPV 95.08%, sensitivity

62.5%, specicity 63.04%).

Conclusions: Currently available risk prediction models

for invasive candidiasis have good NPV but poor PPV.

There is need for multicentric studies.

05 - Cladophialophora bantiana brain

abscess - Report of two cases.

Ujjwayini Ray*, Soma Dutta**

*Consultant Microbiology, **Registrar Microbiology,

Apollo Gleneagles Hospitals , Kolkata

Email:dr_uray@rediffmail.com

Introduction: The incidence and prevalence of human

mycotic infection is on the rise in the current era.Some of

these fungi are darkly pigmented due to melanin

production and traditionally have been named

'dematiaceous' The melanized fungi cause a wide array of

clinical syndromes ranging from supercial to deep-seated

in fec t ions . The neurotrophic so i l saprophyte

Cladophialophora bantiana is the most commonly isolated

agent of cerebral phaeohypomycosis and has been widely

reported from India.

Objectives: We present two cases of brain abscess caused

by Cladophialophora bantina in patients with underlying

renal disease with diverse outcome.

Case Reports

Case - 1

A 49 year old female patient on triple immuno-

suppressant therapy following renal transplantation

presented with history of occasional fall, weakness and

headache since four months. CAT scan showed a

hypodense space occupying lesion (30 x 30 mm)

suggestive of abscess in the left frontal region. The patient

was operated through left frontal craniotomy and a well

encapsulated mass was removed en block. The pus

aspirated from the lesion showed brown pigmented

branching hyphae along with many round bodies. After

about 6 days of incubation fungal colonies with olive grey

velvety appearance with a black undersurface was isolated

in culture. The fungus was identied as C. bantiana based

on morphological appearance in LCB mount and

biochemical properties (growth at 37°C and urease

19

positive reaction). The patient was advised Posaconazole

(200mg oral TDS ). The patient improved remarkably and

remained well without evidence of recurrence at 1 year

follow up.

Case - 2

A 66 old diabetic, hypertensive patient with chronic

kidney disease on maintenance haemodialysis presented

with confusion and cognitive dysfunction. CAT scan of the

brain revealed focal temporal lesion of the left side with

gross edema. Left temporal burr hole was performed and

pus was aspirated. The pus sample showed presence of

light brown hyphae and subsequently C. bantiana was

isolated in culture after 5 days. The patient was initially

treated with Micafungin and Voriconazole. The patient

continued to be drowsy and his vital parameters

deteriorated further and had to be transferred to the ICU.

On 6th post operative day voriconazole was replaced with

posaconazole. The patient developed nosocomial blood

stream infection with MDR Esch.coli and succumbed 4

days later.

Conclusion: CNS infection due to Cladophialophora

bantiana is a serious entity with grave prognosis.

Complete resection as opposed to partial removal or

aspirat ion is associated with bet ter outcome.

Microbiological identication of the etiological agent is

essential for therapeutic decision. Brown pigmented

fungal hyphae on a direct KOH wet mount provide a clue

to the diagnosis. In case 1 complete resection followed by

antifungal therapy resulted in a favorable outcome. In case

2 only aspiration was performed followed by anti fungals

but the patient deteriorated and expired a few days later.

Thus complete excision of the lesion should be attempted

wherever possible. The azole antifungal posaconazole

seems to be effective against this infection but further

studies are require to establish this.

The optimum antifungal agent and duration of therapy is

not known. Morphological, physiological and biochemical

characters are used for the identication once the fungus is

recovered in culture. According to various published

literature posaconazole with or without

06 - Caspofungin MIC distribution amongst

commonly isolated Candida species in a

tertiary care centre in India

Rajarshi Gupta, Shashir Wanjare, Sunil Kuyare, Preeti

Mehta

Seth G.S. Medical College and K.E.M Hospital, Mumbai

Introduction: The clinical breakpoints for echinocandins,

determined by 24-h CLSI broth microdilution methods

have been revised by CLSI in 2012. This is because of

emerging data suggesting that the earlier breakpoint

dening criteria in Candida species. to echinocandins

(MIC ≤2 μg/ml) missed some FKS hot spot gene

mutations. New CLSI breakpoints dening sussceptibility

to caspofungin are as follows, Candida albicans(≤0.25

μg/ml), Candida glabrata(≤0.12 μg/ml), Candida

tropicalis(≤0.25 μg/ml) and Candida parapsilosis(≤2

μg/ml).

Antifungal susceptibility by Etest is a simple and

reproducible method. The strips contain a predened and

continuous gradient of drug which enables quantitative

MIC determination. Caspofungin MIC by Etest and found

it to be concordant with broth microdilution method

within 1-2 fold higher dilutions.

There are reports of emerging azole resistance among

C a n d i d a s p e c i e s . T h i s w a r r a n t s t h e u s e o f

echinocandindins, mostly caspofungin in the

management of invasive candidiasis.

Aims and Objectives: As no substantial report on

antifungal susceptibility pattern to echinocandins exist in

our clinical setup, a study was initiated to perform

antifungal susceptibility of Candida isolates to

caspofungin by Etest.

Materials and methods: MIC determination by

Caspofungin Etest was performed using RPMI 1640 agar

medium supplemented with 2% glucose and MOPS and

the results were interpreted after 24 hours.

Observation and Results: Amongst 60 isolates of Candida

species evaluated, there were 30 Candida albicans, 12

Candida glabrata, 10 Candida parapsilosis and 8 Candida

tropicalis. Number of sensitive strains as per new CLSI

20

breakpoint criteria were 24(80%), 8(75%), 10(100%) and

6(75%) for Candida albicans, Candida glabrata, Candida

parapsilosis and Candida tropicalis respectively. 10

isolates were interpreted as intermediate. 2 isolates of

Candida albicans were resistant as they showed no zone of

inhibition.

Discussion: MICs determined by Etest for caspofungin

might be 1-2 fold higher than those detremined by 24-h

CLSI broth dilution leading to interpretation of sensitive

isolates as intermediate or resistant. Candida parapsilosis

exhibits intrinsically high MICs for caspofungin but in our

study no resistance was encountered. Although

caspofungin resistance is detected in 2 isolates of Candida

albicans, it should be interpreted with clinical outcome.

Conclusion: Etest is a simple method for MIC

determination of Candida species. Majority of Candida

isolates are sensitive to caspofungin with emerging

resistance only amongst Candida albicans.

07 - Candida lipolytica causing post-

traumatic gluteal abscess in a healthy young

patient: case report and review of literature

Dr Sayan Bhattacharyya*, Dr Asim Sarfraz, Dr

Mohammad Aftab Alam Ansari, Mr Nitesh Kumar Jaiswal

Department of Microbiology, All India Institute of Medical

Sciences, Patna-801505, Bihar.

Candida lipolytica is a yeast pathogen with ubiquitous

presence in soil. It is industrially important as a source of

lipase enzyme . We here describe a case of subacute gluteal

abscess in a young healthy, immunocompetent patient

following fall from tree, caused by Candida lipolytica. The

isolate was identied by dry, cerebriform colonies on

Blood agar and Saboraud's dextrose agar, urease and

lipase positivity on Egg yolk agar, yeast cells at tip of

pseudohyphae and true hyphae but no along its length by

Dalmau technique and in vitro susceptibility to

Fluconazole by Disc diffusion method on Mueller-Hinton

agar supplemented with 2% glucose and 0.5 µg./ml

Methylene blue. The case highlights the clinical and

epidemiological importance of proper identication of

rare yeast isolates from purulent lesions .

08 - Plasma Voriconazole levels in immuno-

compromised patients.

1,2 2 1 1A.J Dherai , P.K.Chawla , S.R.Nanday , R.V.Lokhande , 1 3 1,2P.R.Naik , R.Soman , T.F.Ashavaid .

1Department of Laboratory Medicine, 2Research

Laboratories, 3Department of General Medicine, P. D.

Hinduja Hospital, Mahim, Mumbai-400 016.

Introduction: Therapeutic efcacy of voriconazole is

attributed to factors like clinical condition, co-

administered drugs, CYP2C19 gene polymorphism etc

leading to a large intra and inter individual variability. In

the present study we have assessed the inuence of these

factors on plasma voriconazole levels.

Method: A detailed clinical & drug history was obtained

from patients (n=60) referred for plasma voriconazole

level and CYP2C19 genotype. Voriconazole estimation

was done by high performance liquid chromatography

while CYP2C19 polymorphism *2 &*3 (poor metabolizers)

& *17 (ultra rapid metabolizers) genotype was performed

by molecular methods.

Results: All patients were either on prophylactic or

empirical therapy for invasive fungal infections. The

plasma levels were within therapeutic range (3.7 + 0.9

mg/l) only in 47 % of patients while sub therapeutic (0.95 +

0.5 mg/L) and toxic levels (9.1 + 4.4 mg/L) were seen in 33

% & 20% respectively. Two patients had level > 30 mg/L.

Major inuencing factors causing sub-therapeutic level

were found to be co-medication with rifampicin (n=2),

CYP2C19 *2/*17 (n=6) & CYP2C19*1/*17 (n=6)

polymorphism and sub optimal weight matched doses in 6

patients. Toxic levels were obtained in patients with

genotype CYP2C19 *1/*2 (n= 4), *2/*2 (n=3), renal/ liver

impairment (n=3), high dose (n=2) and random time point

sample collection (n=11). Therapeutic efcacy with

desired voriconazole level was achieved in these patients

by appropriate dose adjustments.

Conclusion: Plasma voriconazole level is inuenced by

several factors and hence monitoring of plasma level with

CYP2C19 genotype may assist in achieving desired patient

outcome.

21

09 - Cladophialophora bantiana brain

abscess

Suthar Mitesh, Soman Rajeev, Shetty Anjali, Rodrigues

Camilla

Department of Medicine and Department of Microbiology,

P D Hinduja National Hospital & MRC, Mumbai

Introduction: Cerebral phaeohyphomycosis caused by

Cladophialophora bantiana is a relatively rare disease. 5

cases were seen at our institute from 2003 to 2014 of which 2

patients were on maintenance HD, 2 post kidney

transplant recipients and 1 post liver transplant recipient.

Methods: Diagnosis was made based on the microscopy,

culture and histopathology of the biopsy specimen.

Treatment was given in form combination of surgical

excision and followed by antifungal therapy.

Results:

Conclusion:

1. It is a rare disease.

2. Many patients are treated with empirical antibiotics

before procedure without response.

3. Biopsy is necessary to established diagnosis.

Identication of dematiaceous fungi is crucial.

4. Treatment is difcult. Combination of surgical and

medical management is required. There are issue for

PK/PD parameters of antifungal drugs like blood brain

barrier penetration, interaction with antiepileptic drugs,

may be lifelong therapy.

10 - A case of health-care associated chest

wall mucormycosis

Chaudhari Piyush, Kulkarni Deepti, Soman Rajeev,

Rodrigues Camilla, Shetty Anjali

Department of Medicine and Department of Microbiology,

P. D. Hinduja National Hospital & Medical Research

Centre, Mumbai

Background: We report a case with chest wall

mucormycosis possibly resulting from shaving for

subclavian catheterization followed by use of an adhesive

drape. The patient had multiple co-morbidities like long

standing poorly controlled diabetes mellitus, CKD,

multiple bacterial infections, longstay in ICU.

Case Report: A 65-yr old man with history of long-

standing poorly controlled diabetes mellitus, astrocytoma

(post surgery and radiotherapy), chronic kidney disease,

urosepsis had undergone DJ stenting prior to presenting to

us. He had been in the ICU for one and a half month for

sepsis with MODS and was being treated with multiple

antibiotics. He needed a subclavian catheter which was

inserted after skin shaving and using an adhesive drape.

He developed an induration at the site after 4 days of the

procedure. It went on to involve the surrounding area

showing necrosis extending up to deep muscles of pectoral

region. Wide aseptate, right angle branching fungal

l a m e n t s w e r e d e m o n s t r a t e d o n s m e a r a n d

histopathology from the surgical debridement specimen.

A presumptive diagnosis of mucormycosis was made.

Patient was treated with systemic Amphotericin B

deoxycholate along with local instillation but succumbed

to his multiple illnesses and MODS.

Discussion: Our case highlights the importance of infection

control in hospital settings especially in relation to articles

not usually suspected to be the source like the adhesive

drape in our case. It is vital to change in practice of skin

shaving to use of depilation or clipping. The dressing used

for CVC should be ensured to be sterile. The catheter site

should be inspected daily and when infection like mucor is

suspected because of dark necrotic areas, an early biopsy

and surgical debridement should be planned. The patient

requires surgical as well as medical treatment in form of IV

Amphotericin B and correction of underlying predisposing

conditions. In spite of these measures the outcome remains

poor due to the multiple co-morbid conditions.

2

22

11 - Disseminated Histoplasmosis in

immunocompetent individual: a single

centre experience from a tertiary care

Hospital in Eastern India

Authors: Dr. Dibyendu De*, Prof P. Chakrabarti**, Dr.

Uttam Kumar Nath***, Dr. Priyanka Samal*, Dr. Dipanjan

Haldar*

Institute: Institute of Haematology and Transfusion

Medicine, Medical College, Kolkata

Introduction: Histoplasmosis is a rare fungal disease

caused by dimorphic fungi Histoplasma capsulatum. The

causative fungus is present in soil, infects through

inhalation and manifests in three main types-acute

primary, chronic cavitary and progressive disseminated

Histoplasmosis. Disseminated Histoplasmosis (DH) is

dened as a clinical condition where fungus is present in

more than one locat ion. Among the forms of

histoplasmosis, DH is the rarest and generally found in

immune-compromised individual.

Here we are presenting our experiences of the series of

cases of Disseminated Histoplasmosis in immune-

competent individuals who have been diagnosed in our

institute in last 5 years.

Materials and Methods: This is a single centre

retrospective observational study, from May 2009 to April

2014. Only cases with Disseminated Histoplasmosis in

otherwise healthy immune-competent individuals were

included in the study. The Histoplasmosis is conrmed by

either presence of Histoplasma in biopsy specimen from

extra-pulmonary organ or by positive growth in fungal

culture.

Result: Total seven patients met the inclusion criteria. Five

out of 7 patients were male. The mean age was 35 years.

Five of the 7 patients presented with fever for long

duration. Six patients complained of signicant weight

loss before diagnosis. On examination, one patient had

skin nodules, ve patients had hepato-splenomegaly, and

two patients had lymphadenopathy.

The laboratory investigation revealed anaemia in six out of

7 patients, and pancytopenia in 3 patients. Two patients

had features of hemophagocytic syndrome in the bone

marrow.

All of the patient had undergone treatment with

conventional amphotericine B deoxy-cholate and azole

antifungal. One patient with adrenal involvement died in

hospital. The patient with skin nodule had recurrent

relapses. The other patients had resolution of symptoms

and clinically cured.

Conclusion: Disseminated Histoplasmosis is not an

uncommon etiology of fever of prolonged duration even in

immuno-competent individual, and should be kept as a

differential diagnosis. Targeted investigation with early

bone marrow biopsy and fungal culture may help in

diagnosis of DH. Imaging study to exclude adrenal

involvement prevents case fatality in DH. Cytopenia may

be due to secondary hemophagocytic syndrome, which

improves with anti-fungal therapy. Treatment with either

amphotericine B or itraconazole gives excellent outcome,

though therapy may have to given for prolonged period in

case of relapses.

12 - Aspergillus isolates from Broncho-

Alveolar Lavage (BAL) Samples of Patients

with Refractory Bronchospasm: A One-Year

Study in a Tertiary Care Hospital of Kolkata.1 2 3Authors: R. Shyam Krishnan , Adrito Basu , Samim Khan ,

4 5Raja Dhar , Bhaskar Narayan Chaudhuri1 2Resident, Pulmonary Medicine, AMS Research Assistant

3& Junior Microbiologist, Clinical Associate, Pulmonary 4 5Medicine, Consultant Pulmonologist, Consultant

Microbiologist, Fortis Hospital, Anandapur, Kolkata

Aims & Objectives:

1.) To establish the role of Aspergillus infection in patients

with obstructive airway disease presenting with refractory

wheeze not responding to standard asthma treatment.

2.) To determine the role of HRCT and BAL in recognition

of Aspergillus infections.

3.) To determine the role of voriconazole in treatment of

bronchospasm in those patients with Aspergillus

infection.

23

Methods: The period of study was for 1 year: September,

2013 – August, 2014.

All the patients with suspected obstructive airway disease

having refractory bronchospasm not responding to

standard asthma therapy had HRCT done, followed by

bronchoscopy with broncho-alveolar lavage (BAL), where

indicated.

27 of the BAL samples sent for fungal culture to the

Microbiology laboratory showed growth of Aspergillus

sp. 78% patients (n =21) presented with refractory wheeze,

which despite instituting standard asthma treatment

responded sub-optimally.

All those 21 patients were treated with the standard dose of

voriconazole. Post-discharge spirometry and a through

clinical evaluation were performed during follow up.

Results: 25 of the 27 Aspergillus isolates were Aspergillus

fumigatus, 1 Aspergillus avus and 1 Aspergillus niger.

Average time to positivity was 3.9 days.

23 of the patients were inpatients (5 of whom were in

intensive care units at the time of diagnosis) and 4

outpatients. 15 were male and 12, females. Mean age of the

patients was 62 ± 7 years. 48% (n=13) had diabetes mellitus,

33.3% (n=9) had an underlying heart disease, 22% (n=6)

had a history of pulmonary tuberculosis. 74% (n=20) had

HRCT changes of new infection.

81% (n=17) patients responded very well to the treatment,

as assessed by post discharge spirometry, clinical

evaluation and quality of life. The overall mortality was

19% (n=4).

Conclusions: This study shows that most cases of

pulmonary aspergillosis are caused by Aspergillus

fumigatus. A high index of suspicion is needed for

Aspergillus infections in patients with obstructive airway

disease presenting with severe bronchospasm not

responding to asthma treatment. Bronchoscopy should be

performed in such patients and BAL sent for fungal culture

among other investigations. Voriconazole therapy is

indeed useful to achieve control over the refractory

bronchospasm in these patients. A bigger prospective

study would be needed to clarify whether this is a clinical

variant of pulmonary aspergillosis, which has not been

described previously.

13 - Case Report: CNS Aspergilloma in a

Immunocompetent patient in a tertiary care

hospital.

Dr. Minakshi Karmakar, Dr. Dipendra Pradhan, Dr. Mona

Tiwari, Dr. A. Shovona, Dr. Barsha Sen

A 48 yrs old male patient presented to the OPD with

intermittent episodes of seizure for last 6 months. He was

non-diabetic, non-hypertensive. Serology was negative.

Brain magnetic resonance imaging (MRI) showed an

irregular ring-enhancing lesion in the left occipital region

with focal meningeal enhancement. MRS showed a high

choline peak. OT was done and intraoperative squash

cytology revealed a lymphoproliferative lesion. The rst

impression was that of a neoplasm. Proper histopathology

examination proved it to be a fungal infection,

morphologically resembling Aspergilloma. Since CNS

fungal infection is rare in a immunocompetent patient,

retrospective analysis started. A chest x-ray done 1 yr back

showed pleural effusion, but the TB workup done at that

point of time was completely negative. No history of ATD

intake could be elicited. Present chest x-ray showed

increased bronchovascular markings, no other signicant

ndings. CT scan of the paranasal sinuses were

unremarkable. Routine CSF study was within normal

range. Blood culture and CSF culture for fungus were

negative. But, serum aspergillus IgG antibody and IgM

antibody, both were positive, which corroborated the

histopathological diagnosis of CNS aspergilloma.

Amphotericin B and Voriconazole was started promptly.

He was discharged after 10 days. currently he is on

medication and is doing well.

14 - Matrix-Assisted Laser Desorption

I o n i z a t i o n - T i m e o f F l i g h t M a s s

Spectrometry for the rapid identication of

yeasts causing blood stream infections

Anup K Ghosh, Sa ikat Paul , Shivaprakash M

Rudramurthy Amit Rajbanshi, Joseph Jillwin, and

Arunaloke Chakrabarti

24

Department of Medical Microbiology, Postgraduate

Institute of Medical Education and Research (PGIMER),

Chandigarh - 160012, India

Few studies have systematically standardized and

evaluated matrix-assisted Laser desorption ionization-

time of ight mass spectrometry (MALDI-TOF MS) for

identication of yeasts from blood-stream infections. This

is rapidly becoming pertinent given the increasing burden,

high mortality, emergence of new pathogens and

increasing antifungal resistance in Candida spp. and non-

Candida blood-stream infections. We employed 354 yeast

strains identied by PCR-sequencing for standardization

and 367 blind clinical strains for validation of our MALDI-

TOF MS protocols. We also evaluated the most efcient

method for MALDI-TOF MS sample preparation. The on-

plate formic acid extraction method was most cost and

time-efcient extraction protocol. Further standardization

of our MALDI-TOF assay yielded a 98.97% (95% CI: 97.13-

99.69%) sensitivity as compared to PCR-sequencing.

Novel main spectrum projections (MSP) were developed

for C. auris, C. viswanathii and Kodamaea ohmeri which

were missing from the Bruker MALDI-TOF MS database.

Species-specic analysis yielded 100% sensitivity,

specicity, positive and negative predictive values,

accuracy, area under ROC curve, and efciency (kappa) for

13 species, as compared to sequencing. Spectral cut-offs

computed by ROC analysis showed 100% specic

identication at ≥1.70 for C. tropicalis, C. pelliculosa, C.

orthopsilosis, C. albicans, C. rugosa, C. guilliermondii, C.

lipolytica, C. metapsilosis, and C. nivariensis. The cut-off

analysis also revealed the eight species which need greater

representation in our MALDI-TOF MS database for better

diagnostic efciency. Comparison of species-specic

spectral scores between standardization strains and blind

validation strains showed no statistical difference in assay

performance and further identied new species missing in

the manufacturer's database. We conclude that MALDI-

TOF MS is a rapid, accurate and reliable tool for

identication of blood-stream yeasts. With proper

standardization, validation and regular database

expansion its efciency can be further enhanced at no

signicant additional cost.

15 - The role of DNA sequencing in

determination of fungal etiology of keratitis

in a tertiary care ophthalmology hospital in

Eastern India

Anjan Mukherjee, Soumen pramanik, *Ravi D. Barbhaya,

+R. Gayathri, *Mona Bhargava

Department of Microbiology and *cornea services,

Sankara Nethralaya, Kolkata and +Vision Research

Foundation Referral Laboratory, Sankara Nethralaya,

Chennai

Objective: In our institution, scraping from all patients of

corneal ulcer is routinely examined microscopically and

subjected to culture for identication of etiological agent.

Methods: Scraping from the corneal ulcer of the left eye of

YK, a 62 year old lady on examination with calcouor

white under uorescent microscope revealed numerous

septate hyphae. On the second day, all the culture plates

grew fungus. The fungus that grew in culture was

examined under microscope (40X) after preparation of

LPCB mount. However, there were only fungal hyphae

and no fruiting structures present in the mount. The fungal

culture was subjected to repeated subcultures in CMA

which yielded sporulating structures and the fungus was

presumptively identied. In order to conrm the

morphological nding, the culture was thus subjected to

DNA sequencing.

Results: The fungus was presumptively identied as

Scedosporium apiospermum based on its morphology

under LPCB mount. DNA sequencing conrmed the

morphological identication

Conclusions: Mycotic keratitis is often caused by

saprophytic fungi, which may not be a common etiological

agent or may be difcult to identify based on morphology

only. It is important to maintain a high index of suspicion

which will enable the ocular microbiologist to seek and

identify an uncommon fungal agent.

16 - Species distribution and susceptibility

prole of yeasts isolated from blood cultures

25

from a tertiary care centre in Kolkata

Soma Dutta*Ujjwayini Ray**, Mrinal Das***

*Registrar Microbiology, **Consultant Microbiology, ***

Clinical Pharmacologist, Apollo Gleneagles Hospitals ,

Kolkata

Blood stream infections due to yeast are serious afictions

in critically ill patients and carries a grave prognosis.

Aims and Objectives: The study presents data on species

distribution and antifungal proles of the candida species

and non-candidal yeasts isolated from blood stream

infections between Jan 2012 and August 2014.

Results: During this period 109 candida species and other

non candidal yeasts (Cryptococcus neoformans,

Saccharomyces cerevisiae and Trichosporon asahii) were

isolated accounting for 5.25% of all pathogens isolated

from blood stream infections. 78 %of the candida species

were non albicans and Candida albicans accounted for

17% of the isolates. Speciation by VITEK 2 was performed

for 84 isolates. Candida tropicalis (25% n=21) was the

leading pathogen followed by Candida albicans (17%

n=14),Candida parapsilosis (15% n=13), Candida

haemulonii(11%,n=9), Candida famata (11% ,n=9),

C a n d i d a g l a b r a t a ( 8 % , n = 6 ) , C a n d i d a k r u s e i i

(4%,n=3),Candida guillermondi(2%n=2), Cryptococcus

neoformans (2%, n=2) and other Candida sp. and non

Candida yeasts (Candida pelliculosa, Candida catenulate,

Saccharomyces cerevisiae, Tricosporon asahii Candida

ciferii ,n=5) accounted for the rest 5 % . Up to 16% of our

candida isolates were resistant to uconazole. The

Cryptococcus neoformans strains were isolated from non

HIV patients post mortem. The Saccharomyces cerevisiae

was isolated from a critically ill patient who was on

probiotics containing Saccharomyces boulardii.

Discussion and Conclusion: Thus Candida tropicalis is the

most frequently isolated Candida species from blood

culture.

Candida haemulonii ( these are possibly Candida auris as

two of the strains identied in the VITEK system as

Candida haemulonii were identied as Candida auris after

sequence analysis) which are drug resistant strains having

poor susceptibility against Fluconazole and Amphotericin

B is on the rise and accounted for about 11% of the all the

isolates.

Invasive crytococcal infection, once considered an AIDS

dening illness is now being frequently reported in other

groups of patients as well and in our case both the strains

were isolated from non HIV patients, one from a patient of

chronic liver disease due to Hepatitis B and the other from

a patient of Chronic heart disease with COPD on long term

steroids.

Candida glabrata and Candida kruseii accounted for

around 12% of the isolates. The former exhibits high MIC

to uconazole and the later is intrinsically resistant to

uconazole. None of the Candida tropicalis and Candida

albicans were uconazole resistant.

Thus speciation of Candida and non candidal yeast isolates

are important for therapeutic as well as epidemiological

purposes.

17 - 'Investigating the role of excretory

secretory proteins of Zygomycetes as

immunodominant antigens and their

characterization using MALDI TOF TOF'.

Sheeba Charles Chandy, Varghese K. Geroge, M.R.

Shivaprakash, Arunaloke Chakrabarti

Post Graduate Institute of Medical Education & Research,

Chandigarh.

Introduction: Zygomycetes cause fatal infections in

immunocompromised hosts in both developed and

developing countries. Clinical diagnosis of Zygomycosis is

difcult as signs and symptoms are not specic for this

disease. Demonstration of the fungus in tissue and culture

conrms the diagnosis. However these methods are time

consuming and early diagnosis is essential. Molecular or

serological tests are not available for invasive

zygomycosis.

Aim: To investigate the role of excretory secretory proteins

of medically important Zygomycetes as immunodominant

antigens and their characterization.

M e t h o d s : E x c r e t o r y s e c r e t o r y p r o d u c t s o f

Apophysomyces elegans, Lycthimia corymbiferra, Mucor

26

cercinelloides, Rhizomucor pusillus and Rhizopus oryzae

were collected using 100% Ammonium Sulphate

precipitation which were puried by dialysis and

lyophilization. SDS-PAGE (1-dimensional and 2-

dimensional) and subsequent western blot analysis was

carried out of each protein against Zygomycosis patient

sera and healthy control sera. In-solution digestion was

carried out of each protein and subjected to MALDI TOF-

TOF.

Results: In Western blot analysis following SDS-PAGE

the Zygomycosis patient sera reacted with the secretory

proteins while upon probing with healthy control sera no

reaction was detected. In-solution digestion and MALDI-

TOF-TOF showed well dened peaks of m/z ranging from

1200 to 3300 in each Zygomecete. However no existing

proteins in the current database were found to be identical

with these proteins.

Conclusion: We could identify immunodominant

antigens through the Western blot analysis which look

promising in the development of Serodiagnosis technique

for Zygomycosis. The common antigens are currently

being analyzed for further characterization.

1 8 - U n u s u a l i s o l a t i o n o f C a n d i d a

haemulonii isolates from bloodstream

Candida infection patients: A retrospective

analysis

Rimita Dey, Sourabh Dutta,Manas Sarkar, Deb Kishore

Gupta, Ajoy Krishna Sarkar

Background: Candidaemia is an established cause of

mortality worldwide. In the recent past there has been a

change in the epidemiology of candida infections, a shift

from Candida albicans to non albicans species. Studies in

India also have reported higher isolation rates of non

albicans species Candida tropicalis being the commonest

species by far . In our centre we observed higher incidence

of Candida haemulonii isolation in the blood cultures than

those reported in other studies. Hence we conducted a

study to understand the demographics, risk factors,

sensitivity and overall outcome of such infections.

Materials & Methods: Data of patients admitted to this

hospital from June 2013 to July 2014 with proven blood

stream candida infection were collected retrospectively

and analysed. Species identication was done using Vitek

2 YST identication card (bioMerieux, France). Sensitivity

for amphotericin B, uconazole, voriconazole &

caspofungin was done using ASTYS06 (bioMerieux,

France).

Results: Candida haemulonii was found in 44% of total

isolated candida blood stream infections (12 /23). Median

age of the patients was 52 years. Most of them were

critically ill . 6/11 had mechanical ventilation. Only 4/11

were on haemodialysis. 9 out of 11 patients had central

venous catheter. All the patients were non neutropenic and

none of them had malignancy. All patients received broad

spectrum antibiotics. Minimum days of antibiotic

exposure was 11 days. Only 3/ 11 patients were on total

parenteral nutrition. 5/11 patients received inhaled

corticosteriods and 3/11 patients received systemic

corticosteroids. All the isolates were sensitive to

caspofungin. All but one was sensitive to voriconazole.

Sensitivity for uconazole was ‹50%(5/11). Candida

haemulonii infection had an overall mortality of around

45.5%. 33.3%(2/6) patients died even after treatment with

echinocandins while mortality of patients treated with

azoles was higher i.e 60% (3/5).

Conclusions: Blood stream infection caused by so called

rare yeast isolate Candida haemulonii may not be a rare

phenomenon in India. More studies are needed to have a

better understanding of the epidemology and the

associated risk factors. Though most of the patients got

treated with either uconazole or caspofungin, after

considering the sensitivity patterns, treatment with azoles

other than uconazole remains a fertile ground for future

research.

1 9 - D i s s e m i n a t e d F u s a r i o s i s I n

Immunocompromised Host: Report of two

cases1 2Krishnendu Das , Arpita Bhattacharyya , Mammen

3 1 1Chandy , Gaurav Goel , Sanjay Bhattacharya , Paromita

27

4 5Roy , Arunaloke Chakrabarti 1 2Departments of Microbiology , Pediatric Oncology ,

3 4Clinical Hematology , Pathology , Tata Medical Center,

Kolkata; Department of Microbiology, Mycology Division, 5PGIMER, Chandigarh

Fusarium is a hyaline hyphomycetes fungus which may

cause localized infection like keratitis and onychomycosis

and disseminated infections in immunocompromised

hosts. The organism has been detected in air and water and

the natural habitat is said to be plants and soil. Here we

report 2 cases of disseminated fusariosis from an oncology

center in eastern India.

The rst case refers to a 3 year old child with acute

lymphoblastic leukemia, who presented while on

chemotherapy and steroids with black necrotic lesions at

the back in September-2011. Histopathology showed

acutely branching fungal hyphae and Fusarium solani was

isolated from culture. The isolate showed high minimum

inhibitory concentration (MIC) against the azoles. The

lesion relapsed after an initial treatment with liposomal

Amphotericin B, but the patient eventually survived with

31 days of liposomal Amphotericin B and 71 days of

Voriconazole treatment.

The second case refers to a 22 year male with aplastic

anemia, who had a haplo identical transplant in August-

2013. Patient developed onychomycosis while on

Posaconazole prophylaxis. Blood culture grew Fusarium

species with high MIC to azoles. Patient eventually died

despite being on treatment with liposomal Amphotericin B

for 26 days, Voriconazole for 29 days and caspofungin for

10 days.

The cases highlight the importance of optimal diagnosis

and treatment of this condition which is usually associated

with high mortality.

2 0 - U r i n a r y T r a c t I n f e c t i o n w i t h

Trichosporon Species

Harshita, R Tilak, R G Singh1Department of Microbiology, Insitute of Medical Sciences,

Banaras Hindu University,Varanasi2Department of Microbiology,Institute of Medical

Sciences,Banaras Hindu University,Varanasi,2210053Department of Nephrology,Institute of Medical

Sciences,Banaras Hindu University,Varanasi,221005

Trichosporon is a Basidiomycetes yeast and is among the

most common of the non-Candida, non-Cryptococcus

yeasts isolated from clinical specimens throughout the

world. In immunocompetent host Trichosporon species

are known to cause white piedra, onychomycosis and

disseminated invasive infection in immuno-compromised

host. Trichosporon causing invasive urinary tract infection

is rare. We report a case of urinary tract infection caused by

Trichosporon species in a 73 year old diabetic male who

presented with retention of urine for 15 days and fever for 5

days. Trichosporon species was isolated from urine culture

on two subsequent days. Antifungals showed good

response.

21 - Community Acquired Ocular Infection: a

pilot study

1 2 3Ragini Tilak , Harshita , Abhishek Chandra1Department of Microbiology,Institute of Medical

Sciences,Banaras Hindu University,Varanasi,2210052Department of Microbiology,Institute of Medical

Sciences,Banaras Hindu University,Varanasi,221005

Introduction: Ocular mycoses are important cause of

worldwide morbidity and blindness, fungal keratitis being

a common etiology. Fungal keratitis comprises up to 40%

of microbial keratitis cases especially for people living in

the agricultural communities of the developing world. In

India the estimated incidence of fungal keratitis is 113 per

100,000.

Objective: Objective of this study was to isolate and

identify the fungal pathogens.

Materials and Methods: This study was done in 3 months

period. Corneal scraps, vitreous tap and aqeous humor

were taken from 16 patients with a clinical picture

consistent with fungal keratitis. 10% KOH preparation and

gram stain was performed on all the samples and culture

was done on SDA and BA. Identication was done

according to standard guidelines.

28

Result: 16 keratitis cases were taken in this study, 7 were

diagnosed to be positive for fungal keratitis. 5 out of 7 cases

showed growth in culture and 2 cases were only positive

by KOH preparation. Most common fungal isolate was

Aspergillus. One sample shows free living structures in

wet mount and culture yielded growth of Acanthamoeba.

Conclusion: Globally, there is an increase in incidence of

fungal keratitis and early diagnosis can improve ocular

morbidity and prevent further complications.

22 - Invasive Trichosporonosis: Rare cause

of blood stream fungal infection

Challapilla Meera, Patel Bhargav, Suthar Mitesh, Shetty

Anjali, Rodrigues Camila, Soman Rajeev

Department of Microbiology and Department of Medicine,

P D Hinduja National Hospital & MRC, Mumbai

Introduction: Invasive infections due to Trichosporon

species are considered rare so far, but during past two

decades they have emerged as important opportunistic

pathogens in immunocompromised individuals.

However, very few case series have been reported so far.

Methods: All patients with blood culture positive for

Trichosporon species from January 2012 to August 2014 at

PDHNH & MRC, Mumbai were evaluated. In vitro

susceptibility testing was performed using the reference

broth micro-dilution method.

Results: Nine patients were found to have blood culture

positive for Trichosporon species. Various predisposing

factors previously reported to be associated with invasive

trichosporonosis were also considered in present study.

All the cases were associated with either renal failure

requiring dialysis via hemodialysis catheter or use of

central venous catheter. Underlying malignancy was

found only in one patient. Susceptibility testing has been

performed for 5-FC, amphotericin B & Azoles. Azoles had

good in vitro activity, whereas amphotericin B had higher

MIC values. The all-cause mortality rate was 33.33%.

Conclusion: This study highlights association of central

venous catheter & hemodialysis catheter with

Trichosporon fungemia and its high mortality. Therefore,

strict infection control measures while handling these

devises are recommended to prevent these infections.

Species identication & susceptibility testing are to be

attempted for all relevant clinical isolates in view of

demonstrable resistance to certain antifungal drugs.

Echinocandins are not effective in treatment of

trichosporon infection. Amphotericin B should also be

avoided. Azoles in-particular, Voriconazole is the drug of

choice.

23 - Abstract Title: Standardization of

efcient method for DNA extraction from

Candida sp. in a medical laboratory setup

Parijat Das, Anusha Harishankar, Mammen Chandy,

Sanjay Bhattacharya

Department of Microbiology and Clinical Hematology,

Tata Medical Center, Rajarhat, Kolkata.

Aim: The detection of invasive candidiasis in clinical

samples by PCR requires the use of extraction methods

that efciently lyse fungal cells and recover DNA suitable

for amplication. We tried to recover DNA from ve

medically important Candida sp. subjected to three DNA

extraction methods.

Methods: Total genomic DNA was extracted from

overnight culture broth (veried by spectrophotometer,

Bio-Rad Lab, SmartSpec Plus, 108cells/ml) of ve

medically important candida sp. (Candida albicans,

Candida tropicalis, Candida parapsilosis, Candida

glabrata, Candida krusei) strains by means of the

following 3 procedures: Protocol A used extraction with

chemical treatment like Sodium dodecyl sulphate (SDS) or

β-mercaptoethanol (BME) prior to commercial kit

extraction; Protocol B physical sharing like bead beating

using (Biospec Mini Bead Beater, Unigenetics, India) along

with thermal shock treatment followed by kit extraction

and Protocol C used standard extraction protocol guided

by DNA mini kit (Qiagen, Valencia, CA). Comparisons

were made in terms of yield obtained and purity of the

yield checked by NanoDrop 2000 (Thermo Scientic, MA

USA), 0.8% agarose gel band intensity. Finally efciency of

extraction of the obtained product was checked in real-

time PCR (Rotor-Gene Q, Hilden, Germany).

29

Result: Comparing DNA sample quantication from

culture, we observed that the extraction with Protocol B

gave the highest DNA concentration (± 20-100 μg/ μl), as

compared with Protocols A, and C. In terms of purity the

260/280 ratio were satisfactory (±1.2-2.0) whereas the

260/230 ratio showed some variation depending upon the

extraction protocols. TaqMan based real-time PCR showed

satisfactory sensitivity and specicity for rst C. albicans,

C. tropicalis and C. parapsilosis.

Conclusion: Data from this study indicate that the new

DNA extraction method using physical sharing prior to

use of commercial Qiagen kit produced high quality DNA

as compare to other two methods. Our TaqMan real-time

PCR data also reveals desirable sensitivity and specicity

for three candida sp.

24 - Clinico mycological study of supercial

mycosis in a tertiary care hospital at Kolkata

Dr Asim Sarkar, Dr Sampurna Biswas Pramanik, Prof

Sougata Ghosh,Prof Manideepa SenGupta

Department of Microbiology, Medical College, Kolkata.

Introduction: Supercial mycosis is an infection involving

the supercial layers of skin ie only the cornied layer of

epidermis or suprafollicular portions of hair and do not

penetrate into deeper anatomical sites. It is mostly caused

by dermatophytes & some non dermatophytes like

Candida spp. etc.

Objective: To nd out the prevalence of different species

of fungi causing supercial mycosis.

Material and Methods: Samples were collected from skin ,

nail and hair and processed accordingly. Samples were

divided in 3 parts , one for direct KOH mount, one for

culture on SDA at 37 ºC and another for culture on SDA at

25ºC .Growth on SDA were further processed by LCB

mount, slide culture etc for species identication .

Result: Total number of samples were 47 . Out of the total

samples KOH positive were 39(82.97%) ,culture positive

were 30(63.82%) . Among culture positive samples

28(93.33%) were dermatophytes and 2(6.6%) were

Candida sp .Among 28 dermatophytes,14(50%) were

Trichophyton sp, 10(35.71%) were Epidermophyton sp

and 4(14.28%) were Microsporum sp.

Conclusion : Supercial mycosis is a common

manifestation in dermatology OPD .Empirical use of

antifungals has resulted in development of resistant

strains. The present study,thus helps us to detect

prevalence of different species causing supercial

mycosis.

25. Analysis of the intergenic spacer region 1

of the rRNA gene diversity in Malassezia

species

Prasanna Honnavar*, Shivaprakash M Rudramurthy*,

Sunil Dogra¶, Sanjeev Handa¶, Arunaloke Chakrabarti*.

*Mycology Division, Dept. of Medical Microbiology,

PGIMER, Chandigarh.

¶Dept. of Dermatology, Venerology and Leprosy,

PGIMER, Chandigarh.

Background: Malassezia are commensal yeasts and have

been implicated in variety of human skin diseases. Due to

difculty in accurate identication of Malassezia by

phenotypic methods, molecular methods are essential to

conrm the species. The sequencing of D1/D2 domains of

the 26S rDNA and the ITS region have been widely used

for the identication of Malassezia. Sequence diversity and

presence of short sequence repeats (SSR) in the intergenic

spacer region 1 of the rRNA (IGS1) gene has been used for

strain differentiation within M. globosa, M. restricta and

M. pachydermatis. However this gene has not been

utilized as a genetic tool among other Malassezia species

due to non-availability of sequence data in public

database.

Objectives: To verify the sequence diversity and SSR's in

IGS1 region among standard strains of Malassezia, and

application of IGS1 gene diversity in differentiating M.

restricta and M. arunalokei

Materials & methods: Genomic DNA of all the standard

and clinical (6 M. arunalokei and 5 M. restricta isolated from

seborrhoeic dermatitis patients) strains were extracted by

phenol/chloroform method. Amplication and

sequencing of IGS1 region were performed with 26SF and

5SR primer pairs. Nucleotide sequence differences in the

IGS1 region were analyzed by ClustalX bioinformatics tool.

30

Results and discussion: The following are the SSRs which

can be used for strain differentiation Viz M. globosa (CT)n

and (GT)n; M. restricta (CT)n, (AT)n, (GT)n and (CA)n; M.

arunalokei (CT)n, (AT)n, (GT)n and (CA)n; M.

pachydermatis (CT)n, (GT)n and (CA)n; M. cuniculi (GT)n

and (CA)n; M. caprae (GT)n and (AT)n; M. dermatis (CT)n,

(AT)n, (GT)n and (CA)n. Due to less number of SSRs, the

IGS1 region may not be suitable for strain differentiation

among M. nana, M. japonica, M. furfur and M.

sympodialis. The more variable IGS1 regions are less

suitable as an identication tool of fungal species. IGS1

region clearly differentiated (~25% nucleotide variation)

the isolates of M. restricta and M. arunalokei.

26. An unusual blood pathogen Candida

utilis in neonatal ICU: An enigma.

Shamanth. A.S*, Deepak Juyal¶, Prasanna Honnavar*,

Shivaprakash M.R*, Chakrabarti A*.

*Mycology Division, Dept. of Medical Microbiology,

PGIMER, Chandigarh.

¶Dept. of Microbiology and Immunology, VCSGMSRI,

Srinagar- Uttarakhand.

Introduction: Candida species are increasingly being

noted as important causative agent of blood stream

infection (BSI). Among Candida species Non Candida

albicans Candida species (NCAC) is emerging. Along with

the advancement of the yeast identication many new

species are being reported as pathogen. Here we describe

seven cases of candidemia in neonatal intensive care unit

caused by rare candida species, Candida utilis

Materials and Methods: Clinical details of 7 candidemia

cases caused by C.utilis in neonatal intensive care unit

were noted. Identication of the organism was conrmed

by sequencing D1/D2 regions of rDNA and MALDI ToF

biotyper. Molecular typing of the isolates was performed

u s i n g u o r e s c e n t a m p l i e d f r a g m e n t l e n g t h

polymorphism (FAFLP) technique. Anti fungal

susceptibility testing was performed against amphotericin

B, uconazole, itraconazole, voriconazole, posaconazole

and caspofungin as per M27-A3 protocol of CLSI.

Results: Blood culture of seven neonates' yielded C. utilis.

Five of seven neonates were born before completion of

gestational term. Respiratory distress and intra uterine

growth restriction was major reasons for admission into

ICU. All neonates acquired infection after admission into

ICU. Antibiotics were administered for 5 neonates. Co-

infection with Staphylococcus aureus and Klebsiella

pneumoniae was found in two neonates respectively. Four

neonates expired, two were successfully treated and one

left against medical advice. Amphotericin B and

uconazole were used for treating the patient. D1/D2

sequence of the isolates showed >99% similarity when

compared to standard strain of Candida utilis. MALDI

biotyper identied all the isolates at the species level as

Candida utilis with score ≥ 1.9. The FAFLP analysis

showed that all Candida utilis had > 80% similarity. MIC's

of all the isolates were in susceptible range or low.

Conclusion: This is the rst case series reporting Candida

utilis candidemia in Indian neonatal intensive care unit.

Rare and emerging pathogen like Candida utilis are

missed in most resource constrained hospital setup.

31

Candida Score

Dr. Arvind K Baronia and Dr. Armin Ahmed

Department of Critical Care Medicine, SGPGIMS, Lucknow

Introduction

Ability to predict a critical event is one the most important

skill of critical care. Fungal sepsis is one such critical event

which requires early recognition and prompt intervention.

Fungal infections in critically ill patients are associated

with increased mortality, morbidity and cost of care.

Candida is the commonest cause of the invasive fungal

infections in non neutropenic critically ill patients. Various

risk factors have been found to be associated with

increased of invasive candidiasis. These factors have been

grouped together to form risk prediction scores/ models

for Invasive candidiasis. Candida score is one such score

which was developed by Leon et al in the year

2006.Current article highlights the salient features for

Candida score.

Derivation of the score

The Candida score was derived on a cohort of 1,699

critically ill intensive care unit (ICU) patients.1 The data

was derived from EPCAN (Estudio de Prevalencia de

CANdiasis) project database. EPCAN was a prospective

observational surveillance study of fungal infections and

colonization conducted in seventy three medical/surgical

ICUSs of 70 tertiary care hospitals of Spain between the

year 1998 to 1999.Adult patients with more than 7days of

ICU stay were enrolled in the study. Weekly surveillance

cultures were obtained from various body sites (urine,

trachea, gastric aspirates).Other samples from wounds,

drains surgical site were obtained as per physician's

discretion. On the basis on culture report patients were

classied into three groups; non colonized non infected

(n=719), colonized with Candida species (n= 883) and

proven Candida infection (n= 97). Candida score was

derived on the basis of Logit method. Four factors were

found to be independently associated with proven

candidal infection, namely surgery on ICU admission,

multifocal colonization with candida, severe sepsis and

total parenteral nutrition (TPN).

Calculation of the score

Severe sepsis=2 points

Multifocal colonization (more than 1 site)= 1point

Surgery= 1point

TPN=1 point

Candida score= sum of all points

Authors reported sensitivity of 81% and specicity of 74%

with a cut-off of 2.5 score

External validation

To the best of our knowledge the score has been validated

in three studies described below.

Leon et al in 2009 assessed the usefulness of candida score

in 1,107 non neutropenic adult ICU patients in a

multicentric study conducted in Spain, France and

Argentina.2 For identifying high risk group for invasive

candidiasis a cut-off value of >3 was taken. They reported

an area under curve (AUC) of 0.774, positive predictive

value (PPV) of 13.8% and negative predictive value (NPV)

of 97.7%.

Leroy et al in 2011 conducted a prospective, observational

multicenter study in ve ICUs of France.3 Out of 94

patients enrolled in the study 5(5.3%) developed invasive

candidiasis. A cut off of >3 showed a NPV of 100% and

PPV of 23.8%.

Hall et al in 2013 studied three risk prediction scores

(candida score, candida colonization Index and Ostrosky's

clinical prediction rule) in 101 patients of severe acute

pancreatitis.4 Out of the three tested score Candida

32

colonization index had the best discriminatory power

(AUC of 0.79).Candida score >3 was taken as positive.

Candida Score showed PPV of 39%, NPV of 72% and AUC

of 0.62

Conclusion

Candida score shows a high NPV and low PPV in all

validation studies. Therefore it can be concluded that it is a

good tool to differentiate patients who are not likely to

benet from antifungal therapy and thus prevent

indiscriminate use of antifungal therapy. It is important to

note that cut off used for Candida score is different in

various studies.

References

1. León C, Ruiz-Santana S, Saavedra P, Almirante B,

Nolla-Salas J, Alvarez-Lerma F, et al .EPCAN Study

Group: A bedside scoring system (“Candida score”)

for early antifungal treatment in nonneutropenic

critically ill patients with Candida colonization. Crit

Care Med 2006;34:730-7.

2. León C, Ruiz-Santana S, Saavedra P, Galván B, Blanco

A, Castro C, et al .Cava Study Group .Usefulness of

the "Candida score" for discriminating between

Candida colonization and invasive candidiasis in

non-neutropenic critically ill patients: a prospective

multicenter study. Crit Care Med 2009;37:1624-33.

3. Leroy G, Lambiotte F, Thévenin D, Lemaire C,

Parmentier E, Devos P, et al. Ann Evaluation of

"Candida score" in critically ill patients: a

prospective, multicenter, observational, cohort

study. Intensive Care 2011;1:50.

4. Hall AM, Poole LA, Renton B, Wozniak A, Fisher M,

Neal T, et al. Prediction of invasive candidal infection

in critically ill patients with severe acute pancreatitis.

Crit Care 2013;17:R49.

33

Early identication of fungal sepsis in critically ill

Dr. Arvind K Baronia and Dr. Armin Ahmed

Department of Critical Care Medicine, SGPGIMS, Lucknow

Introduction

Recent development in various life support modalities has

increased the chances of survival of patients who were

previously considered unsalvageable. With improved

management of critically ill patients, more and more

patients with multiple co morbidities are able to survive

critical events in the natural course of their illness. These

patients are frequently exposed to broad spectrum

antibiotics which favour colonization with fungal

pathogens, mainly Candida. Over a period of time

colonization can lead to invasive infection. Invasive fungal

infections are not only difcult to treat but also difcult to

diagnose. Blood culture which is considered gold standard

for diagnosis of invasive candidiasis has poor sensitivity

(around 50%) and slow turn-around time.1 Therefore

waiting for positive blood culture may cause signicant

delay in initiation of appropriate antifungal therapy.

Invasive fungal infections are associated with increased

mortality and so prophylactic and empirical therapies

have become the main stay of antifungal treatment in high

risk groups.

Risk prediction scores

Various risk prediction scores have been designed by

researchers to help in early identication of invasive

candidiasis. These scores can be classied as under

1) Scores based on microbiological parameters2

a. Colonization Index

b. Corrected Colonization index

2) Scores based on Clinical risk factors

a. Paphitou clinical prediction rule3

b. Ostrosky clinical prediction rule4

c. Dupont's score for isolation of yeast from

peritoneal uid of surgical patients5

d. Michalopoulos's model for candidemia in

cardiothoracic ICU patients6

3) Scores based on both microbiological as well as clinical

risk factors

a. Candida score7

Nonculture base techniques for early identication of

Fungal infections in Critically ill

Beta D Glucan7

Beta D glucan (BDG) is cell wall component of most

pathogenic fungi with the exception of Zygomycetes and

Cryptococci. BDG is a pan fungal test and acts as a serum

marker for early detection of invasive fungal infection. The

aqueous extract of blood cells (amoebocytes) from the

horseshoe crab, Limulus polyphemus is called as Limulus

amebocyte lysate. The test is based on BDG mediated

activation of Factor G (a serine protease of the Limulus

amebocyte lystae). Activation of factor G of Limulus

amebocyte lystae in turn causes activation of coagulation

cascade which is measured by colorimetric or

turbidimetric methods. A recently published meta

–analysis reported the sensitivity of this test as 76.8% and

specicity as 85.3%.High cost and false positive results due

to multiple factors are the major limiting factors of the test.

Causes of false positivity of BDG

Antibiotics like Piperacillin/tazobactam

Cellulose containing hemodialysis lters

Glucan containing surgical gauze

Use of immunoglobulins, albumin etc

Bacteremia

PCR assay (detection of fungal DNA by PCR assay)8

PCR based techniques have high sensitivity but lack of

standardization and multicenter validation limits their use

34

in general clinical practice. A meta-analysis of 54 studies

showed pooled sensitivity of 95% and specicity of 92%.

Galactomannan Detection9

Galactomannan (GM) is a type of cell wall polysaccharide

which is realised during the hyphal growth of Aspergillus

spp and various other fungi. GM is not released by

Aspergillus (conidia) spores, therefore GM positivity

represents invasive disease.GM test has used on

bronchoalveolar lavage uid (BAL), Cerebrospinal uid

(CSF)) and urine samples besides serum. False positive

results can occur due to use of antibiotics like

Piperacillin/tazobactam and Amoxicillin/clavulanate,

colonization og gut with Bidobacterium in neonates,

gluconate containing intravenous uids etc.

Mannan and Antimannan10

Mannan is another polysaccharide constituent of Candida

cell wall besides beta d glucan. It is highly immunogenic

and combined mannan/anti-mannan antibody assays

(Patelia, Bio-Rad) can be used for early diagnosis of

invasive candidiasis. Sensitivity and specicity of

combined assays has been reported to be 83% and 86%

respectively.

Recent Advances

Recently Matrix-assisted laser desorption/ionization-time

of ight mass spectrometry (MALDI-TOF MS) has come

up as a promising technology for early identication of

various pathogens including pathogenic fungi. The

technology is based on protein nger prints. The base

–composition of the pathogen is compared with the

signature reference standards for identication.

References

1. Clancy CJ, Nguyen MH.Finding the "missing 50%"

of invasive candidiasis: how nonculture diagnostics

will improve understanding of disease spectrum

and transform patient care. Clin Infect Dis. 2013

May;56(9):1284-92.

2. P i t te t D , Monod M, Suter PM, Frenk E ,

Auckenthaler R. Candida colonization and

subsequent infections in critically ill surgical

patients. Ann Surg 1994;220:751-8

3. Paphitou NI, Ostrosky-Zeichner L, Rex JH. Rules for

identifying patients at increased risk for candidal

infections in the surgical intensive care unit:

approach to developing practical criteria for

systematic use in antifungal prophylaxis trials. Med

Mycol 2005;43:235-43.

4. Ostrosky-Zeichner L, Sable C, Sobel J, Alexander

BD, Donowitz G, Kan V, et al. Multicenter

retrospective development and validation of a

clinical prediction rule for nosocomial invasive

candidiasis in the intensive care setting. Eur J Clin

Microbiol Infect Dis 2007;26:271-6.

5. Dupont H, Bourichon A, Paugam-Burtz C, Mantz J,

Desmonts JM. Can yeast isolation in peritoneal uid

be predicted in intensive care unit patients with

peritonitis? Critical Care Med 2003;31:752-7.

6. Michalopoulos AS, Geroulanos S, Mentzelopoulos

SD. Determinants of candidemia and candidemia-

related death in cardiothoracic ICU patients. Chest

2003;124:2244-55

7. Wright WF , Overman SB, Ribes JA. (1–3)-β-D-

Glucan Assay: A Review of its Laboratory and

Clinical Application.(2011) LabMedicine, 42, 679-

685

8. Avni T, Leibovici L, Paul M. PCR diagnosis of

invasive candidiasis: systematic review and meta-

analysis. J Clin Microbiol 2011; 49: 665-670.

9. Guo YL, Chen YQ, Wang K, Qin SM, Wu C, Kong JL.

Accuracy of BAL galactomannan in diagnosing

invasive aspergillosis.a bivariate metaanalysis and

systematic review. Chest 2010 Oct; 138(4):817-24.

10. Mikulska M, Calandra T, Sanguinetti M, Poulain D,

Viscoli C;The use of mannan antigen and anti-

mannan antibodies in the diagnosis of invasive

candidiasis: recommendations from the Third

European Conference on Infections in Leukemia.

Crit Care. 2010;14(6):R222

35

Sponsored Sessions

36

Intraabdominal candida infection

Invasive candidiasis

Invasive pulmonary aspergillosis

Present status after HAART

Cryptococcosis – Management

CNS fungal infections

Fungal endocarditis

Fungal endophthalmitis

Antifungal prophylaxis

- Neutropenics

- ICU/Perioperative/Burn/ Trauma

- Transplant: solid organ /BMT

Invasive pulmonary aspergillosis

Allergic Bronchopulmonary Aspergillosis

Chronic pulmonary aspergillosis

Antifungal Stewardship

Candidemia

Panel Discussion : India specific Guidelines on Fungal infection

Candida peritonitis

Mucormycosis

MALDI in diagnosis of fungal infections

Antifungal susceptibility testing

Eichanocandin : first line therapy in invasive candidiasis

Central line fungal sepsis