Mary S. Mathews

Epidemiology of systemic mycoses among renal-transplant recipients in India

Background. Systemic mycoses have a high impact on tropical renal-transplant recipients. Methods. Data from 1,476 primary renal-transplant recipients was prospectively recorded from 1986 to 2000 at a single center. Cumulative incidence of systemic mycoses, its time of occurrence, risk factors, outcome, and postmortem findings in 30 patients with systemic mycoses were analyzed. Results. A total of 110 episodes of systemic mycoses occurred in 98 patients. The fungal genera Aspergillus, Cryptococcus, and Candida constituted 61% of pathogens, 45% localizing to the lungs. Cytomegalovirus (CMV) disease caused a 5-fold and chronic liver disease a 2-fold increase in systemic mycoses. Tuberculosis (TB) with or without nocardiosis was a significant coinfection. Cyclosporine (CsA) was associated with nearly a 4-fold risk of systemic mycoses less than 6 months from the time of transplantation as compared with prednisolone+azathioprine (PRED+AZA) therapy. Overall, the probability of survival with systemic mycoses was 73.4%, 60.8%, 39.5%, and 25.6% and was 92.5%, 87.5%, 80.0%, and 75.5% without systemic mycoses at 1, 2, 5, and 10 years, respectively (P <0.0001). An extended Cox model with time-independent and dependent covariates showed greater than 15 times the risk of death among those who develop systemic mycoses. Similarly, Posttransplantation (postTX) TB±Nocardiosis, preTX TB, CMV disease, diabetes mellitus, PTDM, chronic liver disease (>40 months), and Pred+AZA immunosuppression (>2 years) had 3.5, 1.5, 2.9, 1.9, 1.4, 1.6, 2.3 times the risk for death, respectively, as compared with those who did not have those risk factors. Conclusions. There is a recent predominance of Aspergillus among the transplant recipients. The risk factors for systemic mycoses are CMV disease, chronic liver disease, and hyperglycemia, and TB is an important coinfection. Systemic mycoses increased in the early postTX period with CsA. The risk factors for death are systemic mycoses, CMV disease, chronic liver disease (>40 months), diabetes mellitus, and Pred+AZA immunosuppression (>2 years). Overall, the probability of survival with systemic mycoses was poor; however, survival has recently improved.

Mycological profile of fungal sinusitis: An audit of specimens over a 7-year period in a tertiary care hospital in Tamil Nadu.

BACKGROUND Fungi are being increasingly implicated in the etiopathology of rhinosinusitis. Fungal sinusitis is frequently seen in diabetic or immunocompromised patients, although it has also been reported in immunocompetent individuals. Invasive fungal sinusitis, unless diagnosed early and treated aggressively, has a high mortality rate. AIM Our aim was to look at the mycological and clinical aspects of fungal sinusitis in a tertiary referral center in Tamil Nadu. DESIGN This is a retrospective audit conducted on fungal culture positive sinus samples submitted to the Microbiology department from January 2000 to August 2007. Relevant clinical and histopathological details were analysed. RESULTS A total of 211 culture-positive fungal sinusitis samples were analysed. Of these, 63% had allergic fungal sinusitis and 34% had invasive fungal sinusitis. Aspergillus flavus was the most common causative agent of allergic fungal sinusitis and Rhizopus arrhizus was the most common causative agent of acute invasive sinusitis. A significant proportion of these patients did not have any known predisposing factors. CONCLUSION In our study, the etiology of fungal sinusitis was different than that of western countries. Allergic fungal sinusitis was the most common type of fungal sinusitis in our community. Aspergillus sp was the most common causative agent in both allergic and chronic invasive forms of the disease.

Emergence of Candida tropicalis as the major cause of fungaemia in India.

Summary. The fungal isolates (n= 191) from 1970 consecutive blood cultures over a 9‐year period were identified. Candida tropicalis was the predominant isolate accounting for 66% of all isolates whereas Candida albicans ranked only a distant second with 21%. The difference was highly significant (P < 0.00001) The other isolates included C. parapsilosis (5.8%), C. glabrata (2.1%), C. pelliculosa (1.2%), C. lipolytica (1.0%) C. krusei (1.0%) and Trichosporon beigelii (2.6%). The isolates were obtained predominantly from postoperative patients on therapy with more than one antibiotic.

Changing profile of prostatic abscess

PURPOSE To compare the clinical presentation of prostatic abscess and treatment outcome in two different time frames with regards to etiologies, co-morbid factors and the impact of multidrug resistant organism. MATERIALS AND METHODS We retrospectively assessed the charts of 48 patients with the diagnosis of prostatic abscess from 1991 to 2005. The period was divided arbitrarily into two different time frames; phase I (1991-1997) and phase II (1998-2005). Factors analyzed included presenting features, predisposing factors, imaging, bacteriological and antibiotic susceptibility profile, treatment and its outcome. RESULTS The mean patient age in phase I (n = 18) and phase II (n = 30) were 59.22 +/- 11.02 yrs and 49.14 +/- 15.67 respectively (p = 0.013). Diabetes mellitus was most common predisposing factor in both phases. Eleven patients in phase II had no co-morbid factor, of which nine were in the younger age group (22 - 44 years). Of these eleven patients, five presented with pyrexia of unknown origin and had no lower urinary tract symptoms LUTS. Two patients with HIV had tuberculous prostatic abscess along with cryptococcal abscess in one in phase II. Two patients had melioidotic prostatic abscess in phase II. The organisms cultured were predominantly susceptible to first line antibiotics in phase I whereas second or third line in phase II. CONCLUSION The incidence of prostatic abscess is increasing in younger patients without co-morbid factors. The bacteriological profile remained generally unchanged, but recently multi drug resistant organisms have emerged. A worrying trend of HIV infection with tuberculous prostatic abscess and other rare organism is also emerging.

Clinicopathological and mycological spectrum of allergic fungal sinusitis in South India

Summary.  In the present study, we describe characteristic clinicopathological and radiological features as well as fungal culture results in a series of 24 patients with allergic fungal sinusitis (AFS). Nasal obstruction and discharge with nasal polyposis was the commonest (95.8%) clinical presentation. Allergic mucin was uniformly present in all patients. Aspergillus species were the commonest fungal isolates (95.8%). One case of mixed Aspergillus and Curvularia sinusitis as well as one case of Drechslera sinusitis were also identified. Typical computerized tomography scan features of hyperdense areas interspersed with soft tissue densities in the affected sinuses were seen in all patients. Application of appropriate diagnostic criteria is essential to establish the diagnosis of AFS and distinguish it from invasive fungal sinus infections.

Nocardiosis in tropical renal transplant recipients

Background: The epidemiology of nocardiosis in the tropics among renal transplant recipients has not been reported.

Chronic meningitis caused by Trichosporon beigelii in India

Summary. A 36‐year‐old woman developed fatal meningitis following a myelogram. Trichosporon beigelii could be grown from the cerebro‐spinal fluid (CSF) on two occasions. This represents the first culture‐proven case of meningitis due to Trichosporon beigelii.

Cunninghamella pneumonia in postbone marrow transplant patient: first case report from India

Cunninghamella bertholletiae, a rare causative agent of mycosis among immunocompromised patients has been reported with increased frequency from western countries in recent years. We report a case of C. bertholletiae pulmonary infection in a 42‐year‐old male patient who developed graft‐vs.‐host disease following bone marrow transplantation. In spite of intensive antifungal chemotherapy following clinical diagnosis, he died of pulmonary failure. To our knowledge this is the first report from India and third report of post‐BMT C. bertholletiae infection ever published.

Blastoschizomyces capitatus infection after contamination of fluids for intravenous application

Summary. A six‐month‐old child died after infusion of fluids containing Blastoschizomyces capitatus. This represents a fatality due to this organism in a human with no proven immunosuppression.

Bilateral Bipolaris keratomycosis in a borderline lepromatous patient.

This is a report of an unusual case of Bipolaris mycotic keratitis infecting the corneas of both eyes in a cured, immunocompetent patient with previous borderline lepromatous disease. Bipolaris keratomycosis is probably more common than is generally appreciated, and is probably often overlooked in patients with Hansens Disease.