Despite the common, worldwide, occurrence of dermatophytes, little information is available regarding susceptibility profiles against currently available and novel antifungal agents. A collection of sixty-eight clinical Trichophyton species and Epidermophyton floccosum were previously identified and verified to the species level by sequencing the internal transcribed spacer (ITS) regions of rDNA. MICs of amphotericin B, fluconazole, itraconazole, voriconazole, posaconazole, isavuconazole, terbinafine and MECs of caspofungin and anidulafungin were performed based on CLSI M38-A2. The resulting MIC90 s of all strains were, in increasing order, as follows: terbinafine (0.063 mg l(-1) ); posaconazole (1 mg l(-1) ); isavuconazole and anidulafungin (2 mg l(-1) ); itraconazole, voriconazole, amphotericin B, and caspofungin (4 mg l(-1) ) and fluconazole (>64 mg l(-1) ). These results confirm that terbinafine is an excellent agent for treatment of dermatophytosis due to T. rubrum, T. mentagrophytes, T. verrucosum, T. schoenleinii and E. floccosum. In addition, the new azoles POS and ISA are potentially useful antifungals to treat dermatophytosis. However, the clinical effectiveness of these novel antifungals remains to be determined.

Background Pulmonary tuberculosis (PTB) is a significant risk factor for fungal infection. The cavitary lesions post PTB serves as a good reservoir for fungal colonization and subsequent infection. Furthermore, the severe immunosuppression associated with HIV and TB co-infection is another predisposition. The inadequate capacity to investigate and manage fungal infection in PTB patients increases their morbidity and mortality. The study aimed to provide serological evidence of chronic pulmonary aspergillosis (CPA) among PTB patients in Kenya. Towards this, we analysed 234 serum samples from patients presenting with persistent clinical features of PTB infections despite TB treatment in four referral hospitals. Methods This was a cross sectional laboratory based study and patients were recruited following an informed consent. Serological detection of Aspergillus fumigatus IgG was done using enzyme-linked immunosorbent assay (Bordier Affinity Products SA). Sputum samples were subjected to microscopy and standard fungal culture. The isolated fungi were subjected to macro and micro morphological identifications and confirmed by sequence analysis of calmadulin, betatubilin and ITS genes. Results Serological evidence of CPA or fungal sensitization was 46(19.7%) and equivocal or borderline was 14(6.0%). Mycological investigations of sputum resulted in 88(38%) positive for fungal culture. Aspergillus spp. accounted for 25(28%) of which A. fumigatus was 13(14.8%), A. niger 8(9.1%), A. terreus, A. flavus, A. candidus and A. clavatus 1 (1.1%) each. This was followed by Penicillium spp. 10 (11.4%), Scedosporium spp. 5 (5.7%) and Rhizopus spp. 3 (3.4%). Among the yeasts; Candida albicans accounted for 18(20.5%) followed by C. glabrata 5(5.7%). Cryptococcus spp. was isolated from 3(3.4%) of the samples while 13(14.8%) were other yeasts. Conclusion Chronic pulmonary aspergillosis is a significant co-morbidity in PTB patients in Kenya that could be misdiagnosed as relapse or treatment failures in the absence of reliable diagnostic and clinical management algorithm. It could be the cause of persistent clinical symptoms despite TB treatment often misdiagnosed as TB smear/GeneXpert MTB/RIF® negative or relapse. We recommend that all patients with persistent clinical symptoms despite TB treatment should be subjected to fungal investigations before retreatment.

BackgroundDiabetes is rapidly becoming a major cause of blindness among Kenyans, with the prevalence of any form of diabetes retinopathy (DR) ranging from 36% to 41%. Globally DR leads as a cause of vision loss in working age adults. In Kenya, specialized examinations are only available at national and some county referral hospitals through retina specialists, ophthalmologists or trained technicians. Thus, low coverage of retinal assessment and inadequate access to this service. An innovative DR fundus camera screening service run by ophthalmic nurses (ONs), ophthalmic clinical officers (OCOs) and county ophthalmologists was established since 2018.ObjectivesThe purpose of this study was to investigate the diagnostic accuracy of DR digital retinal camera screening by ONs, OCOs and county ophthalmologist against that of a retina specialist measured by sensitivity and specificity as the primary outcomes.MethodsCross sectional study conducted at 2 referral hospitals in Kenya. Using a Canon CR-2AF digital retinal camera patients with diabetes had a standard single shot of 45 degree view of the retina captured as image in each eye. This was graded for DR using the International Clinical Diabetic Retinopathy (ICDR) severity scale. All photos taken by the first graders (ON/OCO) were later assessed by the county hospital ophthalmologist who was blinded to their readings. The third grader (retina specialist) similarly was blinded to the readings of the first and second graders and assessed all the images from the 2 hospitals also using ICDR.ResultsA total of 308 patients with diabetes (median age 58 IQR 56-60, 53% female) were enrolled in the study. Sensitivity to identify any DR was (81.3%, 80.6%, and 81.54% for the OCO, ON and county ophthalmologist respectively). The corresponding specificities were 92.7%, 92.8% and 92.59%. Analysis of diagnostic accuracy of non-sight threatening DR against sight threatening DR revealed lower sensitivity for the three cadre groups although specificity remained high.ConclusionsIn this study, ON and OCO with basic training in DR screening and photo grading performed screening of DR with high specificity. However, the sensitivity to detect sight threatening DR was generally low by all the cadres which may leave severe forms of DR undetected.

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM Introduction: Water is a very vital natural resource for all life on earth as it is used widely. Water plays an important role in the world economy, the uses can be categorized into; commercial use where it is used in hostels, restaurants, offices, and other commercial activities. Fungi are ubiquitous in nature; they produce spores that are small-sized, able to stay airborne for a long duration, and transported over long distances during air dispersal. These are major sources of allergens and airway irritants that are detrimental to health. Biofilms in water distribution systems and storage containers provide favorable habitat for microorganisms as they accumulate better in solid-liquid interfaces that enable them to be embedded in the gelatinous matrix of extracellular polymers excreted by the microorganisms leading to resistance of microbes from environmental stresses. Fungi hydrophobicity and adaptability have enabled them to assemble and colonize different surfaces in domestic settings. The potential health effects caused by fungi in treated water are still not well highlighted and thus the need to carry out this study to investigate the mycoflora isolated from stored water. Methods This was a cross-sectional study conducted from 2019-2021, whereby 120 water samples were collected from stored containers in households in Nairobi county Kenya. The fungal strains were plated onto Sabouraud's dextrose agar (SDA), Potato Dextrose Agar, and Czapecks Agar media with chloramphenicol (0.05 mg/mL) (Oxoid, U.K.). The plates were incubated for 7 days at 25°C. Fungal identification was done by direct microscopy and morphological features. Results A total of 101 fungal species were isolated from water samples. Yeasts 48 (47.5%), Rhodotorula 34 (33.6%) accounted for the unicellular fungi. Among Filamentous mycoflora, the most common isolated fungi were Aspergillus species 13(12.8%), followed by Fusarium spp 4 (3.9%) with Mucor and |Rhizopus species accounting for 1 (0.9%) respectively. Yeasts species were the most common species isolated from water species and Aspergillus species were more frequently isolated from filamentous fungi. Conclusion Yeasts species were the most common species isolated from water species and the roles they play in biofilm needs to be further investigated.

Invasive trichosporonosis is a rare fungal infection, but this disease has recently increasingly been recognized in patients with hematological disorders. However, little is known about the clinical characteristics of this infectious complication. We evaluated consecutive trichosporon septicemia in 20 patients with hematological disorders at the Mie University Hospital and related hospitals for 5 years between January 2003 and December 2007. All patients were male and age ranged 23-85 years (mean, 60.3). Underlining diseases are acute myelogenous leukemia (AML) in 18, macroglobulinemia in one and aplastic anemia in one. All had a neutrophil count < 500 /l before the diagnosis of septicemia. Seventeen patients developed the sepsis after intensive chemotherapies, one during steroid treatment and two during observation. No patients examined had positive surveillance cultures for trichosporon. Nineteen patients showed breakthrough septicemia during the use of anti-fungal agents such as micafungin (MCFG) in 17, fluconazole (FLCZ) in 5, itraconazole in one and amphotericin-B (AMPH-B) in 3. Only 4 patients, who had an increase of neutrophil > 500 /l, recovered from this infection. Among them, two were treated with AMPH-B, FLCZ and miconazole, one with AMPH-B and FLCZ, and one with voriconazole only. We should pay attention to an occurrence of breakthrough trichosporonemia when we use MCFG as an empirical anti-fungal therapy for male patients with hematological disorders and neutropenia. We need to develop an effective strategy to treat this fungal infection because of rapid onset and high mortality.