We report the first case of Coronavirus Disease 2019 (COVID-19)-associated brain abscess caused by a rare Trichosporon species, T. dohaense . The patient was a known diabetic and had received systemic corticosteroids for the treatment of COVID-19. He underwent craniotomy and evacuation of abscess. The pus aspirate grew a basidiomycetous yeast, morphologically resembling Trichosporon species. The isolate was initially misidentified by VITEK® MS due to lack of mass spectral database of T. dohaense . Accurate identification was achieved by internal transcribed spacer-directed panfungal polymerase chain reaction. The patient had a favorable outcome following surgical intervention and antifungal therapy.

Background and Aims:Dexmedetomidine (DMT), as intrathecal adjuvant has been shown to successfully prolong duration of analgesia but delay the motor recovery. Hence, this study was designed to find out the dose of DMT which can provide satisfactory analgesia without prolonging motor block.Methods:A total of 50 patients scheduled for elective perianal surgeries were randomly allocated to Groups C or D (n = 25). Group D received hyperbaric bupivacaine 0.5% 4 mg + DMT 5 μg and Group C received hyperbaric bupivacaine 0.5% 4 mg + DMT 3 μg intrathecally. Onset and duration of sensory and motor blockade, duration of analgesia, time for ambulation and first urination were recorded. Adverse effects if any were noted.Results:Demographic characters, duration of surgery were comparable. The onset of sensory block to S1 was 9.61 ± 5.53 min in Group C compared to 7.69 ± 4.80 min in Group D (P = 0.35). Duration of sensory (145.28 ± 83.17 min – C, 167.85 ± 93.75 min – D, P = 0.5) and motor block (170.53 ± 73.44 min – C, 196.14 ± 84.28 min, P = 0.39) were comparable. Duration of analgesia (337.86 ± 105.11 min – C, 340.78 ± 101.81 min – D, P = 0.9) and time for ambulation (252.46 ± 93.72 min – C, 253.64 ± 88.04 min – D, P = 0.97) were also comparable. One patient in each group had urinary retention requiring catheterization. No other side effects were observed.Conclusion:Intrathecal DMT 3 μg dose does not produce faster ambulation compared to intrathecal DMT 5 μg though it produces comparable duration of analgesia for perianal surgeries.

BACKGROUNDVarious adjuvants are being used with local anaesthetics intrathecally for prolongation of intraoperative and postoperative analgesia. Dexmedetomidine, the highly selective alpha-2 adrenergic agonist is a new neuraxial adjuvant gaining popularity. Fentanyl is commonly used as an opioid adjuvant to local anaesthetic for spinal anaesthesia.

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Background Aureobasidium melanogenum is a ubiquitous, saprophytic, dematiaceous fungus commonly isolated from environmental sources. It has the highest virulence potential among all Aureobasidium species and is implicated in catheter-related infections, particularly in immunocompromised hosts. Case Report A 6-day-old female child was admitted to the neonatal intensive care unit (NICU), AIIMS, Jodhpur with respiratory distress, hypotension, bradycardia, and sepsis. The baby was preterm with a very low birth weight (1140 g) and was born to a 34-year-old G3P1A2 mother at 30 weeks gestation by elective caesarian section at a private hospital. The mother had a primary ovarian failure and had a history of spontaneous abortions for two consecutive times following in vitro fertilization. She also had a history of gestational diabetes mellitus and pregnancy-induced hypertension, for which she was on medication. At birth, the baby had respiratory distress (Apgar scores were 6 and 7 at 1 and 5 minutes of life, respectively), for which she was shifted to NICU and intubated. On day 2, she developed hypotension, bradycardia, hypocalcemia, and sepsis with deranged coagulation profile, for which she received inotropes, broad-spectrum antibiotics, fluconazole, and fresh frozen plasma. On day 3, the baby developed chest retractions and seizure-like episodes with intermittent myoclonic jerks and was started on anti-epileptics. She had persistently raised serum urea, creatinine, and C-reactive protein from day 3 of life. Due to clinical deterioration, she was shifted to AIIMS NICU for further management where she was continued on inotropes, broad-spectrum antibiotics, and fluconazole. After 46 h of admission at AIIMS NICU, the baby developed hypotension with cold extremities, feeble pulses, and increased ventilatory requirements. Chest X-ray showed bilateral diffuse infiltrates suggestive of acute respiratory distress syndrome. Culture of tracheal aspirate yielded Klebsiella pneumoniae, sensitive to piperacillin/tazobactam, amikacin, and carbapenems. The patient was started on intravenous meropenem and colistin. Blood culture showed growth of Gram-positive budding yeast cells after 48 h of incubation (Fig. 1). Subculture on Sabouraud dextrose agar revealed yeast-like colonies, initially cream-colored, becoming dark-brown with an olive-green feathery margin (Fig. 2a). Microscopically, the isolate had septate pigmented hyphae with ellipsoidal hyaline conidia (Fig. 2b). The morphologic features were consistent with Aureobasidium species. Sequencing the internal transcribed spacer region of rDNA confirmed the identity of the isolate as A. melanogenum. Antifungal susceptibility testing revealed the following MICs: amphotericin B, 0.5 μg/ml, itraconazole, 0.25 μg/ml, voriconazole, 0.125 μg/ml, fluconazole, 16 μg/ml, and caspofungin, 0.25 μg/ml. Despite maximum inotropic and ventilatory support, the baby had persistent desaturations and hypoxia and developed multiple organ dysfunction syndrome, following which she succumbed to death on day 3 of admission to AIIMS. Conclusion This is the first documented case of neonatal fungemia caused by the emerging yeast A. melanogenum. The patient had multiple arterial and intravenous catheters and this could be the portal of entry of the pathogen. Accurate identification is crucial for initiating appropriate antifungal therapy. Physicians should be mindful of possible A. melanogenum infection in patients with risk factors, and provide appropriate antifungal therapy with the removal of indwelling catheters whenever possible.

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is ruling the world for more than 2 years since 2020. In 2021, the second wave of COVID-19 attributed to the ‘delta variant’ swept across India, causing significant morbidity and mortality. In addition, the epidemic of COVID-19-associated mucormycosis affected the Indian subcontinent specifically, with a whopping 41 512 cases and 3554 deaths attributed to this dreadful disease. Methods The single-center retrospective cross-sectional study was aimed to determine the impact of COVID-19 on fungal brain abscess cases at a non-COVID tertiary care Neurosciences Institute in South India. The study included all cases diagnosed with fungal brain abscess microbiologically (microscopy and/or fungal culture), supported by radiological findings or by histopathological examination. Cases of brain abscess which were negative for fungal elements by microscopy, culture, and imaging were excluded from the study. Fungal culture was done on routine mycological media as per standard procedures. Fungal identification was done by microscopic morphology, MALDI-TOF MS, and ITS sequencing. Results A total of 406 cases of brain abscess were recorded between January 2020 and April 2022. Out of these, 26 (6.4%) were cases of fungal brain abscess. In 2020, three out of 153 (2%) cases had a fungal etiology, while it was 10.4% (22/211) in 2021 and 0.24% (1/42) till April 2022. Overall, a male preponderance was observed (20/26, 77% were males). The cases had an even distribution from 6 to 62 years, with no predilection in any particular age group. The most common underlying comorbidity was type 2 diabetes mellitus (13/26, 50%). Four cases had a past history of COVID-19. Radiological suspicion of fungal infection was present in all the cases. Mycological examination (wet mount and 20% KOH mount) of brain abscess pus from all the cases revealed fungal elements. Out of 26 cases, 23 cases showed hyaline, broad aseptate hyphae, 2 showed melanized septate hyphae and 1 showed budding yeast cells with pseudohyphae and arthroconidia on direct microscopy. Culture positivity was observed in 15 cases (57.7%). Out of 23 suspected cases of rhinocerebral mucormycosis based on clinical, radiological, and direct microscopic findings, fungal culture was positive in 13 cases, all of which were identified as Rhizopus arrhizus. Out of two cases that showed melanized hyphae in direct microscopy, one grew a dematiaceous mold that was identified as Cladophialophora bantiana. The other melanized fungus failed to grow in culture. The single case of brain abscess caused by a yeast-like fungus was attributed to Trichosporon dohaense, identified by ITS sequencing. It was initially misidentified as T. ovoides/T. mucoides by VITEK MS due to lack of mass spectral database for T. dohaense. Conclusions: A significant increase in the incidence of fungal brain abscess has been observed in the COVID-19 era, particularly with each new wave of infection. Clinical features along with imaging and mycological findings are crucial in making an early diagnosis and decision regarding antifungal therapy. Accurate identification to the species level is necessary to guide optimal antifungal therapy as several species exhibit emerging resistance to antifungal drugs.