Malini Capoor - Academia.edu (original) (raw)
Papers by Malini Capoor
Medical Mycology
Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objective Medicopsis romeroi is one of... more Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objective Medicopsis romeroi is one of the emerging dematiaceous fungi implicated in subcutaneous human infections. Despite advances in diagnostics, identification of this agent still remains delinquent owing to poor sporulation necessitating molecular modalities. Data on clinical and management profile of M. romeroi are available as case reports. In the present study, we describe an index case of M. romeroi infection and clinical risk factors and management profile of 74 cases of M. romeroi cases from India (n = 32) and those reported in the literature (n = 42) till date. Methods A detailed history was obtained from the index patient after informed consent. Aspirated fluid was subjected to microbiological investigations. Identification of isolate was done by molecular technique using Sanger's sequencing. All isolates stored at the National culture collection of pathogenic fungi as M. romeroi were retrieved and identity ...
Medical Mycology
Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objectives Lasiodiplodia theobromae is... more Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objectives Lasiodiplodia theobromae is a dematiaceous fungus, rarely reported to cause infections in humans. This case-series was conducted to identify the potential risk-factors and spectrum of diseases caused by L. theobromae. Methods We performed a retrospective analysis of all cases from which the isolates of the L. theobromae were accessioned at the National culture collection of pathogenic fungi (NCCPF), over the last 10 years (January 2012- March 2022). The isolates were retrieved and identified by conventional (colony morphology, color, and microscopic appearances) and molecular (sequencing of ITS1 region of ribosomal DNA) methods. In vitro antifungal susceptibility testing (AFST) was performed by microbroth dilution recommended by the Clinical and Laboratory Standards Institute (CLSI). (M38-A2). The clinical features, demographic details and outcome were recorded. Results In 10 years, a total of 20 patients were ide...
Mycoses, 2020
Background: The epidemiology, clinical profile and outcome of pediatric candidemia varies conside... more Background: The epidemiology, clinical profile and outcome of pediatric candidemia varies considerably by age, healthcare settings and prevalent Candida species. Despite these differences, few comprehensive studies are undertaken. This nationwide study addresses this knowledge gap. Methods: 487 children who contracted ICU-acquired candidemia at 23 Indian tertiary care centers were assessed for 398 variables spanning demography, clinical characteristics, microbiology, treatment and outcome. Results: Both neonates (5.0 days; range=3.0-9.5) and non-neonatal children (7.0 days; range=3.0-13.0) developed candidemia early after ICU admission. Majority of neonates were premature (63.7%) with low birth weight (57.1%). Perinatal asphyxia (7.3%), pneumonia (8.2%), congenital heart disease (8.4%) and invasive procedures were common comorbidities, and antibiotic use Accepted Article This article is protected by copyright. All rights reserved (94.1%) was widespread. C. tropicalis (24.7%) and C. albicans (20.7%) dominated both agegroups. Antifungal treatment (66.5%) and removal of central catheters (44.8%) lagged behind. Overall resistance was low, however, emergence of resistant C. krusei and C. auris needs attention. The 30-day crude mortality was 27.8% (neonates) and 29.4% (non-neonates). Logistic regression identified admission to public sector ICUs (OR=5.64), mechanical ventilation (OR=2.82), corticosteroid therapy (OR=8.89), and antifungal therapy (OR=0.22) as independent predictors of 30-day crude mortality in neonates. Similarly, admission to public sector ICUs (OR=3.62), mechanical ventilation (OR=3.13), exposure to carbapenems (OR=2.18), and azole antifungal therapy (OR=0.48) were independent predictors for non-neonates. Conclusions: Our findings reveal a distinct epidemiology, including early infection with a different spectrum of Candida species, calling for appropriate intervention strategies to reduce candidemia morbidity and mortality. Independent factors identified in our regression models can help tackle these challenges.
Clinical Microbiology and Infection, 2019
OBJECTIVES To describe the epidemiology, management, and outcome of subjects with mucormycosis; a... more OBJECTIVES To describe the epidemiology, management, and outcome of subjects with mucormycosis; and, to evaluate the risk factors associated with mortality. METHODS We conducted a prospective observational study involving consecutive subjects with proven mucormycosis across 12 centers from India. The demographic profile, microbiology, predisposing factors, management, and 90-day mortality were recorded; risk factors for mortality were analyzed. RESULTS We included 465 subjects. Rhino-orbital mucormycosis was the most common (315/465, 67.7%) presentation followed by pulmonary (62/465, 13.3%), cutaneous (49/465, 10.5%), and others. The predisposing factors included diabetes mellitus (342/465, 73.5%), malignancy (42/465, 9.0%), transplant (36/465, 7.7%), and others. Rhizopus species (231/290, 79.7%) were the most common followed by Apophysomyces variabilis (23/290, 7.9%), and several rare Mucorales. Surgical treatment was performed in 62.2% (289/465) of the subjects. Amphotericin B was the primary therapy in 81.9% (381/465), while posaconazole was used as combination therapy in 53 (11.4%) subjects. Antifungal therapy was inappropriate in 7.6% (30/394) of the subjects. The 90-day mortality rate was 52% (242/465). On multivariate analysis, disseminated and rhino-orbital (with cerebral extension) mucormycosis, shorter duration of symptoms, shorter duration of antifungal therapy, and treatment with amphotericin B deoxycholate (vs. liposomal) were independent risk factors of mortality. A combined medical and surgical management was associated with a better survival. CONCLUSIONS Diabetes mellitus was the dominant predisposing factor in all forms of mucormycosis. Combined surgical and medical management was associated with better outcomes. Several gaps surfaced in the management of mucormycosis. The rarer Mucorales identified in the study warrant further evaluation.
Open Forum Infectious Diseases, 2018
malignancy or hematopoietic stem cell transplant (HSCT) (11 patients), use of immunosuppressing m... more malignancy or hematopoietic stem cell transplant (HSCT) (11 patients), use of immunosuppressing medications (11 patients), and invasive procedures. (9 patients). At the time of diagnosis, only six patients were on an antifungal with mold activity. Eight patients died during hospitalization. The distribution of cases over time was compared with weather data for Colorado. A cluster of cases occurred in 2013 (6 cases) and in 2017 (8 cases). A majority of cases were diagnosed during the summer and fall months with July being the month with the most number of cases. There were higher levels of precipitation that occurred prior to or during the cluster of cases. Conclusion. Cases of mucormycosis at UCH were associated with DM, hematologic malignancy/HSCT, use of immunosuppressive therapy, and invasive procedures. The increase of cases seen 2013 and 2017 occurred in the summer and fall months after higher levels of precipitation were observed in Colorado. Providers at UCH may consider modifying antifungal prophylaxis to include mold coverage in patients with >2 risk factors for mucormycosis who are admitted during the summer and fall. Disclosures. M. Barron, Astellas Pharma: Investigator, Research support. 399. Multi-centre Observational Study on Epidemiology, Treatment, and Outcome of Mucormycosis in India
Journal of Antimicrobial Chemotherapy, 2017
To identify the risk factors associated with Candida auris candidaemia, as this fungus now poses ... more To identify the risk factors associated with Candida auris candidaemia, as this fungus now poses a global threat. Methods: We performed a subgroup analysis of a previously reported study of 27 Indian ICUs. The clinical data of candidaemia cases due to C. auris and other Candida species were compared to determine significant risk factors associated with C. auris infection. Results: Of the 1400 candidaemia cases reported earlier, 74 (5.3%) from 19 of 27 ICUs were due to C. auris. The duration of ICU stay prior to candidaemia diagnosis was significantly longer in patients with C. auris candidaemia (median 25, IQR 12-45 days) compared with the non-auris group (median 15, IQR 9-28, P , 0.001). Based on logistic regression modelling, admission to north Indian ICUs [OR 2.1 (1.2-3.8); P " 0.012], public-sector hospital [OR 2.2 (1.2-3.9); P " 0.006], underlying respiratory illness [OR 2.1 (1.3-3.6); P " 0.002], vascular surgery [OR 2.3 (1.00-5.36); P " 0.048], prior antifungal exposure [OR 2.8 (1.6-4.8); P , 0.001] and low APACHE II score [OR 0.8 (0.8-0.9); P " 0.007] were significantly associated with C. auris candidaemia. The majority (45/51, 88.2%) of the isolates were clonal. A considerable number of isolates were resistant to fluconazole (n " 43, 58.1%), amphotericin B (n " 10, 13.5%) and caspofungin (n " 7, 9.5%). Conclusions: Although C. auris infection has been observed across India, the number of cases is higher in publicsector hospitals in the north of the country. Longer stay in ICU, underlying respiratory illness, vascular surgery, medical intervention and antifungal exposure are the major risk factors for acquiring C. auris infection even among patients showing lower levels of morbidity.
Journal of the Egyptian National Cancer Institute, 2017
Background: Radiotherapy for head and neck cancers (HNC) causes alteration of oral mucosal barrie... more Background: Radiotherapy for head and neck cancers (HNC) causes alteration of oral mucosal barrier predisposing it to colonization and infection. Such infections often result in pain and burning sensation thus contributing to major morbidity. Objective: 1. To identify the fungi isolated from the patients undergoing radiotherapy for HNC. 2. To determine their antifungal susceptibility and week of colonization. 3. To find out association between oral fungal infection and severity of oral mucositis. Materials and methods: Study was done on 50 patients of HNC treated with concurrent chemoradiotherapy. Three samples (throat, urine, blood) were collected for fungal culture and sensitivity. These samples were collected before the start of radiotherapy, during radiotherapy (2nd and 6th week) and post radiotherapy (10th week). Results: Only 49 patients were available for analysis. Fungal infection was found in 27/49 patients (55.10%) out of which Non-albicans Candida was isolated in 18/49 (36.73%) and Candida albicans in 9/49 (18.36%) cases. About 66.66% (18/27) isolates were sensitive to fluconazole. Maximum isolation of yeast was during 6th week of radiotherapy. All grade 4 and 71.42% of grade 3 oral mucositis were found in patients who were positive for fungal infection. Conclusion: The spectrum of fungal species in throat swab was: Non-albicans Candida and Candida albicans observed in 36.73% and 18.36% of patients respectively. Higher rate of fungal colonization and infection was found in patients with grade 3/4 oral mucositis. Prophylactic fluconazole in HNC patients on concurrent chemoradiotherapy has the potential to reduce emerging invasive fungal infection and its associated morbidity.
Mycoses, Jan 9, 2015
We report here the first case of disseminated Emmonsia pasteuriana infection in a patient with AI... more We report here the first case of disseminated Emmonsia pasteuriana infection in a patient with AIDS in India. The patient presented with weight loss, dyspnoea, left-sided chest pain and multiple non-tender skin lesions over face and body for 3 months. Disseminated emmonsiosis was diagnosed on microscopic examination and fungal culture of skin biopsy and needle aspirate of lung consolidation. It was confirmed by sequencing internal transcribed spacer region of rDNA, beta tubulin, actin, and intein PRP8. The patient responded to amphotericin B and itraconazole therapy.
Journal of Pediatric Infectious Diseases, 2015
Blood culture remains the gold standard for diagnosing neonatal septicemia. Although automated co... more Blood culture remains the gold standard for diagnosing neonatal septicemia. Although automated continuous monitor- ing blood culture systems have generally been shown to be superior to conventional manual systems, there are few data relating to their use specifically in neonates. The aim of this study was to compare the manual method of blood culture with an automated BacT/Alert 3D system for detection of neonatal septicemia in terms of rate of recovery of pathogens and time to positivity. One hundred and one matched pairs of blood culture specimens from patients on a neonatal intensive care unit were evaluated by the two methods. The yield of significant pathogens with the BacT/Alert 3D system was 45.5%, compared with 18.8% with the manual method ( P< 0.0001). Moreover, streptococci, which are important neonatal pathogens, were detected exclusively with the automated system. The median time to positivity with the automated system was 11.5 h, compared with 24 h for the manual system. The BacT/Alert 3D system offers more sensitive and rapid detection of neonatal septicemia than a manual blood culture method. The clinical benefits of this may justify the additional cost of automated blood culture systems in developing countries where manual systems currently remain commonplace.
Mycoses, 2015
Pulmonary cryptococcosis is likely to be misdiagnosed due to relatively non-specific clinical and... more Pulmonary cryptococcosis is likely to be misdiagnosed due to relatively non-specific clinical and radiological features. It is more frequently associated with immuno-suppressed conditions especially acquired immuno-deficiency syndrome (AIDS) and pulmonary tuberculosis (PTB). Four cases of pulmonary cryptococcosis were diagnosed over a period of eleven years. All patients in this case series were human immune-deficiency virus (HIV)-negative. The predisposing factors in these patients were diabetes mellitus (DM), acute lymphoblastic leukaemia (ALL), post-partum and pregnancy in one each of the patients. Relapse was seen in two cases. All the patients survived due to strict follow-up. Pulmonary cryptococcosis is common in non-AIDS patients and it warrants rapid diagnosis, treatment and follow-up to prevent relapse.
Indian Journal of Tuberculosis, 2015
Many disorders can present as cavitating lesions in the lung. In this case report, a case of mixe... more Many disorders can present as cavitating lesions in the lung. In this case report, a case of mixed infection with drug resistant tuberculosis and invasive pulmonary aspergillosis in a post-partum patient has been presented.
Tropical Doctor, 2013
We describe a possible imported case of osteo-articular coccidioidomycosis in India. Culture of t... more We describe a possible imported case of osteo-articular coccidioidomycosis in India. Culture of the computed tomography-guided aspirate revealed the growth of Coccidioides spp., which was identified as Coccidioides posadasii by sequencing of the internal transcribed spacer (ITS) region of rDNA . He was successfully treated with amphotericin B followed by itraconazole. All the previous published reports of coccidioidomycosis cases diagnosed in India are also reviewed in order to increase the awareness of this disease in non-endemic areas.
International Journal of Dermatology, 2011
... A recalcitrant facial plaque: fixed cutaneous sporotrichosis. V Ramesh MD,; Avninder Singh MD... more ... A recalcitrant facial plaque: fixed cutaneous sporotrichosis. V Ramesh MD,; Avninder Singh MD,; Manish Pahwa MD,; Malini Capoor MD. Article first published online: 23 FEB 2011. DOI: 10.1111/j.1365-4632.2009.04354.x. © 2011 The International Society of Dermatology. Issue. ...
Intensive Care Medicine, 2014
For the SIHAM Candidemia Network. Take home message: This multicentric study from India on ICU-ac... more For the SIHAM Candidemia Network. Take home message: This multicentric study from India on ICU-acquired candidemia highlights the unique epidemiology of this country with its vast spectrum of Candida species and high rate of C. tropicalis isolation. The disease occurred comparatively early after ICU admission, even in patients with less severe physiology scores.
Mycoses, 2008
This study analysed the spectrum, antifungal susceptibility pattern, clinical course and molecula... more This study analysed the spectrum, antifungal susceptibility pattern, clinical course and molecular epidemiology of cryptococcosis. Four hundred and thirty-nine samples obtained from 378 meningitis patients were processed by standard procedures. Minimum inhibitory concentration (MIC) of fluconazole and amphotericin B for the isolates was tested by broth micro dilution and by E-strip method. Molecular analysis by random amplified polymorphic DNA-PCR of eight isolates was performed using M13 primer. Cryptococcosis was diagnosed in 35 patients [HIV-1 seropositive (19) and apparently immunocompetent (16)]. Cryptococcus neoformans var. neoformans (serotype A and D) was the predominant isolate on phenotypic identification. Three C. neoformans var. gattii were isolated from HIV-1 seropositive (2) and apparently immunocompetent (1) patients. MIC 90 for amphotericin B and fluconazole were 1 and 8 mug ml(-1) respectively. On RAPD-PCR, less diversity was seen among Indian isolates. AIDS remains the single most important risk factor for cryptococcosis. Rising MIC of the available induction and maintenance drugs is of grave concern. The DNA typing technique showed less diversity among Indian strains. Routine surveillance and application of molecular typing methods are crucial to know the baseline and existing pattern of cryptococcosis.
Mycoses, 2011
The current study was conducted to know the incidence, predisposing factors, spectrum, clinical p... more The current study was conducted to know the incidence, predisposing factors, spectrum, clinical profile and antifungal susceptibility (AFS) of fungal wound infection (FWI) in burn patients. Of a total of 71 patients, 20 (28.2%) emerged with the diagnosis of FWI. Fungal pathogens in this study were Candida tropicalis (14%), Candida parapsilosis (5.6%), Aspergillus niger (2.8%) and one each of Candida albicans (1.4%), Candida glabrata (1.4%), Syncephalestrum (1.4%) and Fusarium solani (1.4%). All patients with mould infections expired before the mycological culture results could be conveyed to clinicians. Of the yeasts isolated in the study, one each of C. tropicalis and C. albicans showed cross-resistance to azoles. All the moulds were susceptible to amphotericin B. This study depicted that fungal invasion is associated with a high mortality, burn size 30-60% and high incidence of inhalational injury. Fungal invasion was detected on an average of 14 days after injury. Association of use of four classes of drugs-aminoglycosides, imipenem, vancomycin and third generation cephalosporins and use of total parenteral nutrition was observed. Expedient laboratory diagnosis of FWI and appropriate systemic antifungal therapy guided by AFS may improve outcome for severely injured burn victims.
Medical Mycology, 2013
A 50-year-old male, bangle-maker, chronic smoker, nondiabetic, resident of Narnaul town, Haryana,... more A 50-year-old male, bangle-maker, chronic smoker, nondiabetic, resident of Narnaul town, Haryana, North India, presented with complaints of multiple plaques and nodules on his face, neck, upper arms and trunk with hoarseness. He had fever, signifi cant weight loss and generalized weakness eight months back which lasted for 5 months. He developed skin lesions 15 days after subsidence of fever, hoarseness and sudden onset of rapidly progressing dysphagia two months later. There were no other systemic complaints. He had visited Thailand 10 months before the onset of complaints where he had gone for a jungle safari, deep sea diving and had visited bat caves and a bird sanctuary where he fed pigeons. Cutaneous examination showed multiple erythematous, discrete, non-tender, fi rm papules, nodules and plaques over the face, neck, back, shoulders and chest. Papules and plaques were coalescing over his forehead, nose and earlobes giving a ' leonine facies ' appearance (Fig. 1).
Journal of the European Academy of Dermatology and Venereology, 2014
radiofrequency treatment induces neoelastogenesis and neocollagenesis. Lasers Surg Med 2009; 41: ... more radiofrequency treatment induces neoelastogenesis and neocollagenesis. Lasers Surg Med 2009; 41: 1–9. 4 Kaplan H, Gat A. Clinical and histopathological results following TriPollar radiofrequency skin treatments. J Cosmet Laser Ther 2009; 11: 78–84. 5 Elsaie ML, Choudhary S, Leiva A, Nouri K. Nonablative radiofrequency for skin rejuvenation. Dermatol Surg 2010; 36: 577–589. 6 Kwon SY, Park SD, Park K. Comparative effect of topical silicone gel and topical tretinoin cream for the prevention of hypertrophic scar and keloid formation and the improvement of scars. J Eur Acad Dermatol Venereol 2013; 19. doi: 10.1111/jdv.12242. [Epub ahead of print]. 7 Bloemen MC, van der Veer WM, Ulrich MM, van Zuijlen PP, Niessen FB, Middelkoop E. Prevention and curative management of hypertrophic scar formation. Burns 2009; 35: 463–475. 8 Meshkinpour A, Ghasri P, Pope K et al. Treatment of hypertrophic scars and keloids with a radiofrequency device: a study of collagen effects. Lasers Surg Med 2005; 37: 343–349.
Indian Journal of Medical Microbiology, 2007
Table: Comparison of susceptibility by the E-test method on RPMI-G and GMB-MHA *Interpretive crit... more Table: Comparison of susceptibility by the E-test method on RPMI-G and GMB-MHA *Interpretive criteria: amphotericin-≤1 µg/mL (sensitive), >2 µg/mL (resistant); ß uconazole-≤8 µg/mL (sensitive), ≥64 µg/mL (resistant); **C. krusei (2) and C. glabrata (1) were resistant to amphotericin B and ß uconazole on RPMI-G and GMB-MHA
Indian Journal of Medical Microbiology, 2007
This study examined the extent of cryptococcosis in clinically diagnosed cases of meningitis in H... more This study examined the extent of cryptococcosis in clinically diagnosed cases of meningitis in HIV-1 seropositive and apparently immunocompetent patients. One hundred and forty-six samples, obtained from 126 chronic meningitis patients comprised of cerebrospinal ß uid (CSF), blood, sputum and urine. The samples were processed by standard microbiological procedures. Cryptococcal isolates were identiÞ ed by microscopy, cultural characteristics, melanin production on niger seed agar and hydrolysis of urea. The isolates were further speciated on cannavanine glycine bromothymol blue (CGB) media. Cryptococcal antigen detection of CSF samples was performed by latex agglutination test (LAT). Minimum inhibitory concentration (MIC) of amphotericin B for the isolates was also tested. Cryptococcosis was diagnosed in 13 patients (eight HIV-1 seropositive and Þ ve apparently immunocompetent). Cryptococcus neoformans var. neoformans was the predominant isolate. Cryptococcal antigen was detected in all, whereas microscopy could detect yeast cells in nine patients. The isolates were sensitive to amphotericin B. CD4 cell counts ranged from 8 to 96/cu mm. The study concludes that all CSF samples with clinical diagnosis of subacute and chronic meningitis should be subjected to tests for detection of Cryptococcus in clinical laboratory irrespective of the immune status.
Medical Mycology
Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objective Medicopsis romeroi is one of... more Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objective Medicopsis romeroi is one of the emerging dematiaceous fungi implicated in subcutaneous human infections. Despite advances in diagnostics, identification of this agent still remains delinquent owing to poor sporulation necessitating molecular modalities. Data on clinical and management profile of M. romeroi are available as case reports. In the present study, we describe an index case of M. romeroi infection and clinical risk factors and management profile of 74 cases of M. romeroi cases from India (n = 32) and those reported in the literature (n = 42) till date. Methods A detailed history was obtained from the index patient after informed consent. Aspirated fluid was subjected to microbiological investigations. Identification of isolate was done by molecular technique using Sanger's sequencing. All isolates stored at the National culture collection of pathogenic fungi as M. romeroi were retrieved and identity ...
Medical Mycology
Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objectives Lasiodiplodia theobromae is... more Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objectives Lasiodiplodia theobromae is a dematiaceous fungus, rarely reported to cause infections in humans. This case-series was conducted to identify the potential risk-factors and spectrum of diseases caused by L. theobromae. Methods We performed a retrospective analysis of all cases from which the isolates of the L. theobromae were accessioned at the National culture collection of pathogenic fungi (NCCPF), over the last 10 years (January 2012- March 2022). The isolates were retrieved and identified by conventional (colony morphology, color, and microscopic appearances) and molecular (sequencing of ITS1 region of ribosomal DNA) methods. In vitro antifungal susceptibility testing (AFST) was performed by microbroth dilution recommended by the Clinical and Laboratory Standards Institute (CLSI). (M38-A2). The clinical features, demographic details and outcome were recorded. Results In 10 years, a total of 20 patients were ide...
Mycoses, 2020
Background: The epidemiology, clinical profile and outcome of pediatric candidemia varies conside... more Background: The epidemiology, clinical profile and outcome of pediatric candidemia varies considerably by age, healthcare settings and prevalent Candida species. Despite these differences, few comprehensive studies are undertaken. This nationwide study addresses this knowledge gap. Methods: 487 children who contracted ICU-acquired candidemia at 23 Indian tertiary care centers were assessed for 398 variables spanning demography, clinical characteristics, microbiology, treatment and outcome. Results: Both neonates (5.0 days; range=3.0-9.5) and non-neonatal children (7.0 days; range=3.0-13.0) developed candidemia early after ICU admission. Majority of neonates were premature (63.7%) with low birth weight (57.1%). Perinatal asphyxia (7.3%), pneumonia (8.2%), congenital heart disease (8.4%) and invasive procedures were common comorbidities, and antibiotic use Accepted Article This article is protected by copyright. All rights reserved (94.1%) was widespread. C. tropicalis (24.7%) and C. albicans (20.7%) dominated both agegroups. Antifungal treatment (66.5%) and removal of central catheters (44.8%) lagged behind. Overall resistance was low, however, emergence of resistant C. krusei and C. auris needs attention. The 30-day crude mortality was 27.8% (neonates) and 29.4% (non-neonates). Logistic regression identified admission to public sector ICUs (OR=5.64), mechanical ventilation (OR=2.82), corticosteroid therapy (OR=8.89), and antifungal therapy (OR=0.22) as independent predictors of 30-day crude mortality in neonates. Similarly, admission to public sector ICUs (OR=3.62), mechanical ventilation (OR=3.13), exposure to carbapenems (OR=2.18), and azole antifungal therapy (OR=0.48) were independent predictors for non-neonates. Conclusions: Our findings reveal a distinct epidemiology, including early infection with a different spectrum of Candida species, calling for appropriate intervention strategies to reduce candidemia morbidity and mortality. Independent factors identified in our regression models can help tackle these challenges.
Clinical Microbiology and Infection, 2019
OBJECTIVES To describe the epidemiology, management, and outcome of subjects with mucormycosis; a... more OBJECTIVES To describe the epidemiology, management, and outcome of subjects with mucormycosis; and, to evaluate the risk factors associated with mortality. METHODS We conducted a prospective observational study involving consecutive subjects with proven mucormycosis across 12 centers from India. The demographic profile, microbiology, predisposing factors, management, and 90-day mortality were recorded; risk factors for mortality were analyzed. RESULTS We included 465 subjects. Rhino-orbital mucormycosis was the most common (315/465, 67.7%) presentation followed by pulmonary (62/465, 13.3%), cutaneous (49/465, 10.5%), and others. The predisposing factors included diabetes mellitus (342/465, 73.5%), malignancy (42/465, 9.0%), transplant (36/465, 7.7%), and others. Rhizopus species (231/290, 79.7%) were the most common followed by Apophysomyces variabilis (23/290, 7.9%), and several rare Mucorales. Surgical treatment was performed in 62.2% (289/465) of the subjects. Amphotericin B was the primary therapy in 81.9% (381/465), while posaconazole was used as combination therapy in 53 (11.4%) subjects. Antifungal therapy was inappropriate in 7.6% (30/394) of the subjects. The 90-day mortality rate was 52% (242/465). On multivariate analysis, disseminated and rhino-orbital (with cerebral extension) mucormycosis, shorter duration of symptoms, shorter duration of antifungal therapy, and treatment with amphotericin B deoxycholate (vs. liposomal) were independent risk factors of mortality. A combined medical and surgical management was associated with a better survival. CONCLUSIONS Diabetes mellitus was the dominant predisposing factor in all forms of mucormycosis. Combined surgical and medical management was associated with better outcomes. Several gaps surfaced in the management of mucormycosis. The rarer Mucorales identified in the study warrant further evaluation.
Open Forum Infectious Diseases, 2018
malignancy or hematopoietic stem cell transplant (HSCT) (11 patients), use of immunosuppressing m... more malignancy or hematopoietic stem cell transplant (HSCT) (11 patients), use of immunosuppressing medications (11 patients), and invasive procedures. (9 patients). At the time of diagnosis, only six patients were on an antifungal with mold activity. Eight patients died during hospitalization. The distribution of cases over time was compared with weather data for Colorado. A cluster of cases occurred in 2013 (6 cases) and in 2017 (8 cases). A majority of cases were diagnosed during the summer and fall months with July being the month with the most number of cases. There were higher levels of precipitation that occurred prior to or during the cluster of cases. Conclusion. Cases of mucormycosis at UCH were associated with DM, hematologic malignancy/HSCT, use of immunosuppressive therapy, and invasive procedures. The increase of cases seen 2013 and 2017 occurred in the summer and fall months after higher levels of precipitation were observed in Colorado. Providers at UCH may consider modifying antifungal prophylaxis to include mold coverage in patients with >2 risk factors for mucormycosis who are admitted during the summer and fall. Disclosures. M. Barron, Astellas Pharma: Investigator, Research support. 399. Multi-centre Observational Study on Epidemiology, Treatment, and Outcome of Mucormycosis in India
Journal of Antimicrobial Chemotherapy, 2017
To identify the risk factors associated with Candida auris candidaemia, as this fungus now poses ... more To identify the risk factors associated with Candida auris candidaemia, as this fungus now poses a global threat. Methods: We performed a subgroup analysis of a previously reported study of 27 Indian ICUs. The clinical data of candidaemia cases due to C. auris and other Candida species were compared to determine significant risk factors associated with C. auris infection. Results: Of the 1400 candidaemia cases reported earlier, 74 (5.3%) from 19 of 27 ICUs were due to C. auris. The duration of ICU stay prior to candidaemia diagnosis was significantly longer in patients with C. auris candidaemia (median 25, IQR 12-45 days) compared with the non-auris group (median 15, IQR 9-28, P , 0.001). Based on logistic regression modelling, admission to north Indian ICUs [OR 2.1 (1.2-3.8); P " 0.012], public-sector hospital [OR 2.2 (1.2-3.9); P " 0.006], underlying respiratory illness [OR 2.1 (1.3-3.6); P " 0.002], vascular surgery [OR 2.3 (1.00-5.36); P " 0.048], prior antifungal exposure [OR 2.8 (1.6-4.8); P , 0.001] and low APACHE II score [OR 0.8 (0.8-0.9); P " 0.007] were significantly associated with C. auris candidaemia. The majority (45/51, 88.2%) of the isolates were clonal. A considerable number of isolates were resistant to fluconazole (n " 43, 58.1%), amphotericin B (n " 10, 13.5%) and caspofungin (n " 7, 9.5%). Conclusions: Although C. auris infection has been observed across India, the number of cases is higher in publicsector hospitals in the north of the country. Longer stay in ICU, underlying respiratory illness, vascular surgery, medical intervention and antifungal exposure are the major risk factors for acquiring C. auris infection even among patients showing lower levels of morbidity.
Journal of the Egyptian National Cancer Institute, 2017
Background: Radiotherapy for head and neck cancers (HNC) causes alteration of oral mucosal barrie... more Background: Radiotherapy for head and neck cancers (HNC) causes alteration of oral mucosal barrier predisposing it to colonization and infection. Such infections often result in pain and burning sensation thus contributing to major morbidity. Objective: 1. To identify the fungi isolated from the patients undergoing radiotherapy for HNC. 2. To determine their antifungal susceptibility and week of colonization. 3. To find out association between oral fungal infection and severity of oral mucositis. Materials and methods: Study was done on 50 patients of HNC treated with concurrent chemoradiotherapy. Three samples (throat, urine, blood) were collected for fungal culture and sensitivity. These samples were collected before the start of radiotherapy, during radiotherapy (2nd and 6th week) and post radiotherapy (10th week). Results: Only 49 patients were available for analysis. Fungal infection was found in 27/49 patients (55.10%) out of which Non-albicans Candida was isolated in 18/49 (36.73%) and Candida albicans in 9/49 (18.36%) cases. About 66.66% (18/27) isolates were sensitive to fluconazole. Maximum isolation of yeast was during 6th week of radiotherapy. All grade 4 and 71.42% of grade 3 oral mucositis were found in patients who were positive for fungal infection. Conclusion: The spectrum of fungal species in throat swab was: Non-albicans Candida and Candida albicans observed in 36.73% and 18.36% of patients respectively. Higher rate of fungal colonization and infection was found in patients with grade 3/4 oral mucositis. Prophylactic fluconazole in HNC patients on concurrent chemoradiotherapy has the potential to reduce emerging invasive fungal infection and its associated morbidity.
Mycoses, Jan 9, 2015
We report here the first case of disseminated Emmonsia pasteuriana infection in a patient with AI... more We report here the first case of disseminated Emmonsia pasteuriana infection in a patient with AIDS in India. The patient presented with weight loss, dyspnoea, left-sided chest pain and multiple non-tender skin lesions over face and body for 3 months. Disseminated emmonsiosis was diagnosed on microscopic examination and fungal culture of skin biopsy and needle aspirate of lung consolidation. It was confirmed by sequencing internal transcribed spacer region of rDNA, beta tubulin, actin, and intein PRP8. The patient responded to amphotericin B and itraconazole therapy.
Journal of Pediatric Infectious Diseases, 2015
Blood culture remains the gold standard for diagnosing neonatal septicemia. Although automated co... more Blood culture remains the gold standard for diagnosing neonatal septicemia. Although automated continuous monitor- ing blood culture systems have generally been shown to be superior to conventional manual systems, there are few data relating to their use specifically in neonates. The aim of this study was to compare the manual method of blood culture with an automated BacT/Alert 3D system for detection of neonatal septicemia in terms of rate of recovery of pathogens and time to positivity. One hundred and one matched pairs of blood culture specimens from patients on a neonatal intensive care unit were evaluated by the two methods. The yield of significant pathogens with the BacT/Alert 3D system was 45.5%, compared with 18.8% with the manual method ( P< 0.0001). Moreover, streptococci, which are important neonatal pathogens, were detected exclusively with the automated system. The median time to positivity with the automated system was 11.5 h, compared with 24 h for the manual system. The BacT/Alert 3D system offers more sensitive and rapid detection of neonatal septicemia than a manual blood culture method. The clinical benefits of this may justify the additional cost of automated blood culture systems in developing countries where manual systems currently remain commonplace.
Mycoses, 2015
Pulmonary cryptococcosis is likely to be misdiagnosed due to relatively non-specific clinical and... more Pulmonary cryptococcosis is likely to be misdiagnosed due to relatively non-specific clinical and radiological features. It is more frequently associated with immuno-suppressed conditions especially acquired immuno-deficiency syndrome (AIDS) and pulmonary tuberculosis (PTB). Four cases of pulmonary cryptococcosis were diagnosed over a period of eleven years. All patients in this case series were human immune-deficiency virus (HIV)-negative. The predisposing factors in these patients were diabetes mellitus (DM), acute lymphoblastic leukaemia (ALL), post-partum and pregnancy in one each of the patients. Relapse was seen in two cases. All the patients survived due to strict follow-up. Pulmonary cryptococcosis is common in non-AIDS patients and it warrants rapid diagnosis, treatment and follow-up to prevent relapse.
Indian Journal of Tuberculosis, 2015
Many disorders can present as cavitating lesions in the lung. In this case report, a case of mixe... more Many disorders can present as cavitating lesions in the lung. In this case report, a case of mixed infection with drug resistant tuberculosis and invasive pulmonary aspergillosis in a post-partum patient has been presented.
Tropical Doctor, 2013
We describe a possible imported case of osteo-articular coccidioidomycosis in India. Culture of t... more We describe a possible imported case of osteo-articular coccidioidomycosis in India. Culture of the computed tomography-guided aspirate revealed the growth of Coccidioides spp., which was identified as Coccidioides posadasii by sequencing of the internal transcribed spacer (ITS) region of rDNA . He was successfully treated with amphotericin B followed by itraconazole. All the previous published reports of coccidioidomycosis cases diagnosed in India are also reviewed in order to increase the awareness of this disease in non-endemic areas.
International Journal of Dermatology, 2011
... A recalcitrant facial plaque: fixed cutaneous sporotrichosis. V Ramesh MD,; Avninder Singh MD... more ... A recalcitrant facial plaque: fixed cutaneous sporotrichosis. V Ramesh MD,; Avninder Singh MD,; Manish Pahwa MD,; Malini Capoor MD. Article first published online: 23 FEB 2011. DOI: 10.1111/j.1365-4632.2009.04354.x. © 2011 The International Society of Dermatology. Issue. ...
Intensive Care Medicine, 2014
For the SIHAM Candidemia Network. Take home message: This multicentric study from India on ICU-ac... more For the SIHAM Candidemia Network. Take home message: This multicentric study from India on ICU-acquired candidemia highlights the unique epidemiology of this country with its vast spectrum of Candida species and high rate of C. tropicalis isolation. The disease occurred comparatively early after ICU admission, even in patients with less severe physiology scores.
Mycoses, 2008
This study analysed the spectrum, antifungal susceptibility pattern, clinical course and molecula... more This study analysed the spectrum, antifungal susceptibility pattern, clinical course and molecular epidemiology of cryptococcosis. Four hundred and thirty-nine samples obtained from 378 meningitis patients were processed by standard procedures. Minimum inhibitory concentration (MIC) of fluconazole and amphotericin B for the isolates was tested by broth micro dilution and by E-strip method. Molecular analysis by random amplified polymorphic DNA-PCR of eight isolates was performed using M13 primer. Cryptococcosis was diagnosed in 35 patients [HIV-1 seropositive (19) and apparently immunocompetent (16)]. Cryptococcus neoformans var. neoformans (serotype A and D) was the predominant isolate on phenotypic identification. Three C. neoformans var. gattii were isolated from HIV-1 seropositive (2) and apparently immunocompetent (1) patients. MIC 90 for amphotericin B and fluconazole were 1 and 8 mug ml(-1) respectively. On RAPD-PCR, less diversity was seen among Indian isolates. AIDS remains the single most important risk factor for cryptococcosis. Rising MIC of the available induction and maintenance drugs is of grave concern. The DNA typing technique showed less diversity among Indian strains. Routine surveillance and application of molecular typing methods are crucial to know the baseline and existing pattern of cryptococcosis.
Mycoses, 2011
The current study was conducted to know the incidence, predisposing factors, spectrum, clinical p... more The current study was conducted to know the incidence, predisposing factors, spectrum, clinical profile and antifungal susceptibility (AFS) of fungal wound infection (FWI) in burn patients. Of a total of 71 patients, 20 (28.2%) emerged with the diagnosis of FWI. Fungal pathogens in this study were Candida tropicalis (14%), Candida parapsilosis (5.6%), Aspergillus niger (2.8%) and one each of Candida albicans (1.4%), Candida glabrata (1.4%), Syncephalestrum (1.4%) and Fusarium solani (1.4%). All patients with mould infections expired before the mycological culture results could be conveyed to clinicians. Of the yeasts isolated in the study, one each of C. tropicalis and C. albicans showed cross-resistance to azoles. All the moulds were susceptible to amphotericin B. This study depicted that fungal invasion is associated with a high mortality, burn size 30-60% and high incidence of inhalational injury. Fungal invasion was detected on an average of 14 days after injury. Association of use of four classes of drugs-aminoglycosides, imipenem, vancomycin and third generation cephalosporins and use of total parenteral nutrition was observed. Expedient laboratory diagnosis of FWI and appropriate systemic antifungal therapy guided by AFS may improve outcome for severely injured burn victims.
Medical Mycology, 2013
A 50-year-old male, bangle-maker, chronic smoker, nondiabetic, resident of Narnaul town, Haryana,... more A 50-year-old male, bangle-maker, chronic smoker, nondiabetic, resident of Narnaul town, Haryana, North India, presented with complaints of multiple plaques and nodules on his face, neck, upper arms and trunk with hoarseness. He had fever, signifi cant weight loss and generalized weakness eight months back which lasted for 5 months. He developed skin lesions 15 days after subsidence of fever, hoarseness and sudden onset of rapidly progressing dysphagia two months later. There were no other systemic complaints. He had visited Thailand 10 months before the onset of complaints where he had gone for a jungle safari, deep sea diving and had visited bat caves and a bird sanctuary where he fed pigeons. Cutaneous examination showed multiple erythematous, discrete, non-tender, fi rm papules, nodules and plaques over the face, neck, back, shoulders and chest. Papules and plaques were coalescing over his forehead, nose and earlobes giving a ' leonine facies ' appearance (Fig. 1).
Journal of the European Academy of Dermatology and Venereology, 2014
radiofrequency treatment induces neoelastogenesis and neocollagenesis. Lasers Surg Med 2009; 41: ... more radiofrequency treatment induces neoelastogenesis and neocollagenesis. Lasers Surg Med 2009; 41: 1–9. 4 Kaplan H, Gat A. Clinical and histopathological results following TriPollar radiofrequency skin treatments. J Cosmet Laser Ther 2009; 11: 78–84. 5 Elsaie ML, Choudhary S, Leiva A, Nouri K. Nonablative radiofrequency for skin rejuvenation. Dermatol Surg 2010; 36: 577–589. 6 Kwon SY, Park SD, Park K. Comparative effect of topical silicone gel and topical tretinoin cream for the prevention of hypertrophic scar and keloid formation and the improvement of scars. J Eur Acad Dermatol Venereol 2013; 19. doi: 10.1111/jdv.12242. [Epub ahead of print]. 7 Bloemen MC, van der Veer WM, Ulrich MM, van Zuijlen PP, Niessen FB, Middelkoop E. Prevention and curative management of hypertrophic scar formation. Burns 2009; 35: 463–475. 8 Meshkinpour A, Ghasri P, Pope K et al. Treatment of hypertrophic scars and keloids with a radiofrequency device: a study of collagen effects. Lasers Surg Med 2005; 37: 343–349.
Indian Journal of Medical Microbiology, 2007
Table: Comparison of susceptibility by the E-test method on RPMI-G and GMB-MHA *Interpretive crit... more Table: Comparison of susceptibility by the E-test method on RPMI-G and GMB-MHA *Interpretive criteria: amphotericin-≤1 µg/mL (sensitive), >2 µg/mL (resistant); ß uconazole-≤8 µg/mL (sensitive), ≥64 µg/mL (resistant); **C. krusei (2) and C. glabrata (1) were resistant to amphotericin B and ß uconazole on RPMI-G and GMB-MHA
Indian Journal of Medical Microbiology, 2007
This study examined the extent of cryptococcosis in clinically diagnosed cases of meningitis in H... more This study examined the extent of cryptococcosis in clinically diagnosed cases of meningitis in HIV-1 seropositive and apparently immunocompetent patients. One hundred and forty-six samples, obtained from 126 chronic meningitis patients comprised of cerebrospinal ß uid (CSF), blood, sputum and urine. The samples were processed by standard microbiological procedures. Cryptococcal isolates were identiÞ ed by microscopy, cultural characteristics, melanin production on niger seed agar and hydrolysis of urea. The isolates were further speciated on cannavanine glycine bromothymol blue (CGB) media. Cryptococcal antigen detection of CSF samples was performed by latex agglutination test (LAT). Minimum inhibitory concentration (MIC) of amphotericin B for the isolates was also tested. Cryptococcosis was diagnosed in 13 patients (eight HIV-1 seropositive and Þ ve apparently immunocompetent). Cryptococcus neoformans var. neoformans was the predominant isolate. Cryptococcal antigen was detected in all, whereas microscopy could detect yeast cells in nine patients. The isolates were sensitive to amphotericin B. CD4 cell counts ranged from 8 to 96/cu mm. The study concludes that all CSF samples with clinical diagnosis of subacute and chronic meningitis should be subjected to tests for detection of Cryptococcus in clinical laboratory irrespective of the immune status.