Umamaheswari K

Abstract

Background: Unusual Ascomycetes yeasts are frequently reported in obstinate infections among the cancer population. Emergence of resistance among the non-albicans yeasts towards promising first-line azoles queries over treatment options. The present study probes on the recent trends in incidence of and emerging non- albicans yeasts in cancer patients and to determine the species-wise antifungal susceptibility towards first-line Triazoles and Echinocandin. Materials and Methods: A total of 53 isolates recovered from the clinical specimens collected from 87 cancer patients were presumptively identified on CHROMagar and speciated by sequencing internal transcribed spacer (ITS) target. The species-wise antifungal susceptibility were determined for the first-line triazoles (Fluconazole, Voriconazole, Posaconazole) and Echinocandin (Anidulafungin) following CLSI guidelines. Results: The proportion of Candida isolates were predominantly non-albicans Candida (NAC) species (85%) and (15%). All isolates were speciated using ITS sequencing and the spectrum of NAC species isolated were dominated with (17) followed by (9), (5), C. tropicalis (4), (3), (3), (2) and one isolate of each and The unusual NAC species showed varied resistance profile towards first-line azoles and were susceptible to Anidulafungin. Conclusion: The changing spectrum, high prevalence and pattern of low level azoles susceptibility among unusual NAC species recovered from the cancer population are alarming.   Keywords: Candida metapsilosis, Wickerhamiella pararugosa, Yarrowia lipolytica. Susceptibility testing, Anidulafungin

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Abstract

Background: The incidence of opportunistic fungal infection, mucormycosis associated with high mortality rate is steadily increasing. Pulmonary mucormycosis though rare, it relatively affects individuals with diabetes mellitus and other immunosuppressive conditions. The present study reports on case of pulmonary mucormycosis caused by Rhizopus microsporus. Materials and Methods: Sputum sample was collected from a 47-year-old male with diagnosed with tuberculosis with spontaneous left sided pneumothorax and diabetes mellitus. The positive fungal culture was characterized by phenotypic and genotypic methods and antifungal susceptibility of the isolate was tested against azoles and amphotericin B. Results: The etiological agent was identified as R. microsporus based on phenotypic features and molecular sequencing of ITS. The isolate was susceptible to all the tested antifungal and the patient responded well to Amphotericin B with strict glycemic control and combination of anti-infective therapy. Conclusion: Though pulmonary mucormycosis is relatively rare; it share its clinical picture with pulmonary tuberculosis and aspergillosis, hence clinical suspicion for mucormycosis in susceptible high risk patients is warranted for early diagnosis and appropriate therapy.   Keywords: Pulmonary mucormycosis, Diabetes mellitus, Rhizopus microsporus, Amphotericin B

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