Here we described a rare case of malignant endovascular papillary angioendothelioma (Dabska tumor) in an adult female. On fine needle aspiration, the smear showed many small clusters of tumor cells with rosettoid arrangement along with papillary fragments with fibrovascular core and hobnail like arrangement of the cells. Histopathological examination revealed a vascular tumor in the form of papillary projection into the vascular lumina, lined by atypical endothelial cells.

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Drug resistance among gram positive aerobic cocci poses a significant problem in management of patients with skin and soft tissue infections (SSTI's). S. aureus is the most common organism that causes mild skin and soft tissue infections to serious infections such as sepsis and toxic shock syndrome. Enterococcus and Streptococcus species have also emerged as a cause of skin and soft tissue infections and health care associated infections (HAI's). SSTI's is an inflammatory microbial invasion of epidermis, dermis and subcutaneous tissue. It is classified according to the layer of infection, severity of infection and microbiologic etiology. The practice guidelines of the Infectious Disease Society of America (IDSA) for the diagnosis and management of skin and soft tissue infection classifies SSTI's into five categories comprising superficial and complicated infections which include impetigo, erysipelas, cellulitis, necrotizing fasciitis, surgical site infection. Risk factors associated with development of SSTI's include poor hygiene, overcrowding, co- morbidities like diabetes, immunocompromised state, overuse of antibiotics, prolonged hospital stay, burn patients etc. Prompt recognition, timely surgical debridement or drainage with appropriate antibiotic therapy is the mainstay treatment for SSTI's. Empirical therapy includes penicillin, cephalosporins, clindamycin and cotrimoxazole. Multi-Drug resistance is of major concern commonly caused by MRSA (Methicillin resistant staphylococcus aureus) which includes CA-MRSA (Community acquired methicillin resistant Staphylococcus aureus), HA-MRSA (hospital acquired methicillin resistant Staphylococcus aureus), VRSA (vancomycin resistant staphylococcus aureus) & VRE (vancomycin resistant Enterococci). HA-MRSA is generally susceptible to clindamycin, vancomycin, Linezolid & trimethoprim- sulfamethoxazole. In contrast, CA-MRSA is usually sensitive to these former antibiotics as well as broader range of oral antimicrobial agents like clindamycin, linezolid, quinolones, daptomycin, tigecycline etc. These empirical therapeutic agents provide coverage for both S. aureus, Streptococcus species and Enterococcus species. Therefore, demographic knowledge of antimicrobial agents and their resistance pattern plays a significant role in management of SSTI's.

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM Introduction: Invasive fungal infection is a leading cause of morbidity and mortality in COVID patients as a secondary infection. Invasive fungal infections are often rapidly life-threatening and require specialist consultation for prompt diagnosis and therapy. The reporting of these invasive fungal infections (Mucormycosis, Aspergillosis, and candidiasis) is less than its occurrence. Objective: This study was undertaken to diagnose invasive fungal infections in COVID patients during the first, second, and third COVID-19 pandemic waves by conventional methods. Materials and Methods: From March 2020 to December 2020 was considered the first wave pandemic, March 2021 to May 2021 was the second wave pandemic and December 2021 to February 2022 was considered the third wave pandemic era for this region. A total of 42, 168, and 87 samples were collected from patients clinically suspected to have invasive fungal infections during three pandemic waves from Covid indoor patients of RIMS, Ranchi. Among a total 24 were tissue samples, 13 BAL and 260 were nasal swabs/scrapes collected from suspected patients. KOH screening of all samples was done followed by culture on SDA media. Results A total of 83/297 (27.94%) cases were positive for KOH screening. In all, 91/297 (30.64%) samples showed culture positivity. A majority of growth was for Mucorales (48.2%), Aspergillus species (24.1%), Candida species (15%), and mixed growth (12.7%). Among Mucorales, Rhizopus was identified in 64% followed by Mucor (28%), Absidia (5%), and Rhizomucor (3%). Among Aspergillus species, majority were A. flavus (48%) followed by A. niger (37%), and A. fumigatus (15%). Maximum positivity for invasive fungal infections was observed during the second wave pandemic (62%) followed by the third wave (27%), and the first wave (11%) respectively. Discussion: Maximum cases were observed during and after the second wave COVID pandemic era due to excessive use of steroids during COVID treatment and cases were decreased during the third wave as compared with second wave timeframe due to the use of COVID vaccine, and many asymptomatic cases and home quarantine policy. Conclusion Early diagnosis and treatment of invasive fungal infections with antifungal therapy and surgical debridement are necessary to reduce mortality and end-organ damage.

Background: Hydatid cyst is a parasitic infection caused by Echinococcus granulosus and human is an accidental host. Liver and lungs are the most widely recognized organ of association but relatively low in other organs. Orbital involvement of the hydatid cyst is rare. Case Description: The case was a 47-year-old lady presented in the late stage of disease when corneal ulcer had developed and with complete vision loss along with headache, proptosis, and pain in the left eye. Cystic lesion in the retro-orbital region of the left eye was revealed by Computed tomography scan and magnetic resonance imaging. The patient underwent surgery. Hundreds of daughter cysts were seen intraoperatively and cyst wall sent for histopathological examination to confirm the diagnosis. The patient was further treated with albendazole for 3 months. Conclusion: Although hydatid cyst is uncommon, it ought to be considered in the differential diagnosis of cystic lesion of orbital locale, more so in the endemic territories.