Ph.D. Student, Post Graduate Institute of Medical Education and Research
Candidemia due to Candida tropical among neonates
Candida tropicalis is the predominant agent causing invasive infection in tropical countries including India. Unlike western countries irrespective of low antifungal drug resistance Candida tropicalis is emerging as a primary pathogen. Advanced treatment strategies, prolonged hospital stay and indwelling catheters are considered independent risk factors responsible for Candida infection. Also, the burden of these Candida species in the environment and health care workers are usually neglected. In my study, I have evaluated the risk factors of the patients, colonization status from the day of admission till the outcome along with the environmental and health care workers hand carriage of Candida tropicalis. My findings indicated that the environmental surfaces such as sink basin, tap, bed railings and trolleys used in the intensive care unit harbored Candida tropicalis. Also, the majority of the healthcare workers such as treating doctors, nurse, and hospital attendants carried Candida tropicalis. Majority of the patients at the time of admission did not bore Candida tropicalis but gradually they colonized during the hospital stay. Mean duration of colonizing with Candida tropicalis was 4 days. Eventually, 20 of the patients developed Candidemia. Of which 6 patients developed Candida tropicalis. All the patients who developed Candida tropicalis were not colonized with Candida tropicalis at oral, rectal and skin sites except one patient. Amplified fragment length polymorphism assay carried out on colonizing strain, isolates from blood and isolates obtained from healthcare workers and environment suggested that 5 of the 6 patients who developed Candida tropicalis candidemia had similar strain as that of their colonizing strain. However, two environmental strains and strins from healthcare workers hand showed more than 98% similarity with that of the colonizing strains. Thus indicating that the Candida tropicalis from the environment and healthcare workers are being transmitted to the patients and eventually colonizing at oral, rectal and skin sites. These colonizing candida tropicalis thus cause candidemia.
Abstract: Dermatophytosis, the commonest superficial fungal infection, has gained recent attention due to its change of epidemiology and treatment failures. Despite availability of several effective antifungal agents against dermatophytes, the incidence of chronic infection, re-infection and treatment failures are on the rise.andare the two frequent clinical isolates in India. Consecutive patients (n=195) with suspected dermatophytosis during second half of 2014 were included in this study. Patients were categorized into relapse and new cases according to standard definitions. Antifungal susceptibility testing of the isolatedspecies (n=127) was carried out against 12 antifungal agents -fluconazole, voriconazole, itraconazole, ketoconazole, sertaconazole, clotrimazole, terbinafine, naftifine, amorolfine, ciclopirox olamine, griseofulvin and luliconazole. Squalene epoxidase gene was evaluated for mutation (if any) in 15 -and five -isolates exhibiting high minimum inhibitory concentration to terbinafine. T1189C mutation was observed in fourand twoisolates. This transition leads to the substitution of amino acid phenylalanine to leucine in 397position of the squalene epoxidase enzyme. In homology modelling the mutant residue was smaller than wild type and positioned in the dominant site of squalene epoxidase during drug interaction, which may lead to failure to block ergosterol biosynthesis pathway by the antifungal drug. Copyright © 2018 American Society for Microbiology.
Pub.: 14 Mar '18, Pinned: 27 Mar '18
Abstract: A systematic epidemiological study on intensive care unit (ICU)-acquired candidemia across India.A prospective, nationwide, multicentric, observational study was conducted at 27 Indian ICUs. Consecutive patients who acquired candidemia after ICU admission were enrolled during April 2011 through September 2012. Clinical and laboratory variables of these patients were recorded. The present study is an analysis of data specific for adult patients.Among 1,400 ICU-acquired candidemia cases (overall incidence of 6.51 cases/1,000 ICU admission), 65.2 % were adult. Though the study confirmed the already known risk factors for candidemia, the acquisition occurred early after admission to ICU (median 8 days; interquartile range 4-15 days), even infecting patients with lower APACHE II score at admission (median 17.0; mean ± SD 17.2 ± 5.9; interquartile range 14-20). The important finding of the study was the vast spectrum of agents (31 Candida species) causing candidemia and a high rate of isolation of Candida tropicalis (41.6 %). Azole and multidrug resistance were seen in 11.8 and 1.9 % of isolates. Public sector hospitals reported a significantly higher presence of the relatively resistant C. auris (8.2 vs. 3.9 %; p = 0.008) and C. rugosa (5.6 vs. 1.5 %; p = 0.001). The 30-day crude and attributable mortality rates of candidemia patients were 44.7 and 19.6 %, respectively. Logistic regression analysis revealed significant independent predictors of mortality including admission to public sector hospital, APACHE II score at admission, underlying renal failure, central venous catheterization and steroid therapy.The study highlighted a high burden of candidemia in Indian ICUs, early onset after ICU admission, higher risk despite less severe physiology score at admission and a vast spectrum of agents causing the disease with predominance of C. tropicalis.
Pub.: 17 Dec '14, Pinned: 27 Mar '18