Fungal infections like subcutaneous phaeohyphomycosis are uncommon but are increasing lately, especially in tropical regions like India. Identification of correct aetiologic agent is essential as different species can have different organ tropism. Here, a rare case of nodular subcutaneous phaeohyphomycosis in an immunocompetent 62-year-old male patient who developed nodule over right dorsum of foot is reported. After various diagnostic tests a rare dematiaceous fungus Medicopsis romeroi was identified as a causative agent in the nodular material by Internal Transcribed Spacer (ITS) sequencing. Surgical excision and antifungal therapy of itraconazole proved beneficial with no recurrence during a six months of follow-up. Medicopsis romeroi has been debated for its role in human infections however, it should be considered as one of the aetiologic agents of subcutaneous phaeohyphomycosis.

Background: Nucleic acid detection has potentially revolutionized diagnosis of tuberculosis and has established as a screening test of choice. However, conclusions on its role in diagnosing extrapulmonary infection and discordance between drug susceptibility reported through culture, Xpert MTB/ RIF, line probe assay require further review. Objectives were to compare positivity rate of Xpert MTB/RIF ULTRA across various sample types; compare drug susceptibility percentage of Mycobacterium tuberculosis (M. tb) across three platforms i.e., culture, Xpert MTB/RIF and LPAMethods: A retrospective analysis of results of samples was undertaken for a period of one year for Xpert MTB/RIF ultra and three years for LPA and susceptibility through MGIT.Results: Xpert MTB/ RIF Ultra showed overall positivity of 26%, with 10% rifampicin resistance; genitourinary sample positivity was 4%. First line LPA recorded 26% Rif resistance and very few Rifampicin indeterminates. Second line LPA revealed 5.4% aminoglycoside resistance and 26% fluoroquinolone resistance. Through MGIT Rif resistance was 18.2%, multidrug resistance 17.5%, isoniazid monoresistance 6.6%, FQ resistance 18.6%, MDR with FQ resistance 18.6%, amikacin resistance 4% and streptomycin resistance 18%.Conclusions: Xpert MTB/ RIF should be used as a test of choice for detection; Rifampicin resistance should be confirmed with LPA. However, for GUN, pleural fluid and GIT tissue samples; an additional culture should be attempted on the primary sample to improve detection rates. Drug resistance detected through LPA should be phenotyped especially for fluoroquinolones. Moxifloxacin and amikacin could be empirical antibiotics of choice over ofloxacin and Kanamycin due to lower resistance percentage recorded for them.

Introduction: Candida auris has turned up as a multidrug-resistant nosocomial agent with outbreaks reported worldwide. The present study was conducted to evaluate the antifungal drug susceptibility pattern of C. auris . Methods: Isolates of C. auris were obtained from clinically suspected cases of candidemia from January 2019 to June 2021. Identification was done with matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) and panfungal DNA polymerase chain reaction (PCR), followed by sequencing. Antifungal susceptibility testing was performed with broth microdilution method. Results: Out of 50 isolates C. auris , 49 were identified by MALDI-TOF and one isolate was identified with panfungal DNA PCR followed by sequencing. For fluconazole, 84% ( n = 42) isolates were found to be resistant and 16% ( n = 8) isolates were susceptible (minimum inhibitory concentrations [MICs] range 0.5–16). Posaconazole exhibited potent activity, followed by itraconazole. For amphotericin B, only 6% ( n = 3) isolates were resistant with MICs ≥2 μg/mL. Only 4% ( n = 2) isolates exhibited resistance to caspofungin. No resistance was noted for micafungin and anidulafungin. One (2%) isolate was found to be panazole resistant. One (2%) isolate was resistant to fluconazole, amphotericin B, and caspofungin. Conclusion: Correct identification of C. auris can be obtained with the use of MALDI-TOF and sequencing methods. A small percentage of fluconazole-sensitive isolates are present. Although elevated MICs for amphotericin B and echinocandins are not generally observed, the possibility of resistance with the irrational use of these antifungal drugs cannot be denied. Pan azole-resistant and pan drug-resistant strains of C. auris are on rise.

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Schizophillum commune is a basidiomycotic fungus which grows ubiquitously on trees and rotting wood. Human infections caused by it are although of diverse presentation but are very rare. We present a case of sinusitis caused by Schizophyllum commune in a 58-years-old female patient post COVID 19 infection with a history of allergic rhinitis and diabetes mellitus type 2. CT scan findings established the clinical diagnosis of fungal maxillary sinusitis which was confirmed with culture report and PCR followed by sequencing. Patient underwent functional endoscopic sinus surgery. She was treated empirically with Itraconazole after surgical excision.