Coronavirus disease 2019 (COVID-19) is a major public health problem worldwide. These patients are at increased risk of developing secondary infections due to a combination of virus- and drug-induced immunosuppression. Recently, several countries have reported an emergence of COVID-19 associated mucormycosis (CAM), particularly among patients with uncontrolled diabetes, with India reporting an alarming increase in rhino-orbito-cerebral mucormycosis (ROCM) in post-COVID cases. Hyperglycemia and diabetic ketoacidosis (DKA) are the major underlying risk factors. So far, case reports and review articles have reported CAM only in adult patients. Here, we describe the first cases of COVID-19-associated ROCM in two pediatric patients with Type 1 diabetes mellitus (DM). Both the cases had asymptomatic infection with SARS-CoV-2 and developed ROCM during the course of treatment of DKA. None of them had exposure to systemic steroids. Imaging findings in both cases revealed involvement of orbit, paranasal sinuses, and brain with cavernous sinus thrombosis. The patients underwent craniotomy with evacuation of abscess. Microbiological and histopathological findings were consistent with the diagnosis of mycormycosis, with fungal culture growing Rhizopus arrhizus . Post-operatively, the patients received liposomal amphotericin B (LAMB) and systemic antibiotics. Retrobulbar injection of LAMB was given in an attempt to halt orbital disease progression. However, it wasn't successful and both of them had to undergo orbital exenteration eventually. ROCM is a rapidly progressive disease and prompt diagnosis with aggressive surgery and timely initiation of antifungal therapy can be life-saving. Physicians should have a high index of suspicion, so as to avoid a delayed diagnosis, particularly in post-COVID patients with uncontrolled diabetes.

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Fungal brain abscess is rare with a rapidly progressive disease with fulminant course and invariably fatal outcome, unless diagnosed early and treated rapidly. We report a 56-year-old woman diagnosed to have fungal abscess who recovered completely following amphotericin B treatment. She presented with weakness of the right hand, deviation of mouth to left and aphasia for 2 days. Computed tomography of the brain revealed a left frontal capsuloganglionic hypodense lesion. Stereotactic biopsy was performed, and microbiological confirmation of non-septate fungal hyphae from pus from aspirate within 2 h helped initiate timely and appropriate treatment leading to cure. Histopathology and culture later confirmed mucormycosis.

311tributed to an increased frequency of severe fungal infections in patients with neoplastic diseases. Incidence due to filamentous fungi becomes life-threatening and their diagnosis and treatment can be challenging, especially in species with intrinsic resistance. Diagnosis of filamentous fungi in both the clinic and the laboratory remains difficult, leading to unsatisfactory treatment and high mortality rates.Methods & Materials: A total of 40 clinical specimens including surgical tissues, biopsies and wound swabs were collected from Cancer patients and cultured on fungal isolation medium. The presence of fungal elements on tissue specimens were demonstrated using PAS stain by histopathological analysis. The positive fungal isolates were presumptively identified based on macroscopic and microscopic features and species were further confirmed by PCR amplification of ITS followed by sequencing the amplicons. The Antifungal susceptibility profiles of fungal isolates to Amphotericin B and Itraconazole was determined by microbroth dilution assay as per CLSI guidelines.Results: Out of 40 specimens collected, 16 were positive for filamentous fungi. Based on phenotypic identification and ITS sequencing 9 were found to be rare isolates and were identified as Geotrichum candidum (03), Curvularia verruculosa (01), Alternaria alternata (01), Fusarium incarnatum (01), Syncephalastrum racemosum (01), Penicillium oxalicum (01) and Onychocola canadensis (01).The MIC values of Amphotericin B and Itraconazole ranged from 0.0625 to > 16 g/ml. All the isolates were found to be susceptible to Amphotericin B and Itraconazole, while G. candidum showed resistance to Itraconazole and single isolate of O. canadensis showed resistance to both the antifungals.Conclusion: The results obtained in the study showed the occurence of rare fungal isolates such as G. candidum, C. verruculosa, A. alternata, F. incarnatum, S. racemosum, P. oxalicum and O. canadensis in cancer patients. The Amphotericin B and Itraconazole were found to be more effective antifungals against all the species tested except few rare isolates with intrinsic resistance. However, therapeutic success in cases of fungal infections primarily depends on early diagnosis of the fungal infection, correct identification of the etiologic agent, and timely antifungal treatment.http://dx. Background:Cryptococcal meningitis remains one of the leading causes of morbidity and mortality among immunosuppressed individuals, particularly those with HIV infection. Globally, approximately one million cases occur each year resulting in more than six lakh deaths.

Methicillin‐resistant Staphylococcus aureus (MRSA) causes life‐threatening human infections. Bacteriophage‐encoded endolysins degrade the cell walls of Gram‐positive bacteria by selectively hydrolyzing the peptidoglycan layer and thus are promising candidates to combat bacterial infections. PlyGRCS, the S. aureus‐specific bacteriophage endolysin, contains a catalytic CHAP domain and a cell‐wall binding SH3_5 domain connected by a linker. Here, we show the crystal structure of full‐length PlyGRCS refined to 2.1 Å resolution. In addition, a serendipitous finding revealed that PlyGRCS binds to cold‐shock protein C (CspC) by interacting with its CHAP and SH3_5 domains. CspC is an RNA chaperone that plays regulatory roles by conferring bacterial adaptability to various stress conditions. PlyGRCS has substantial lytic activity against S. aureus and showed only minimal change in its lytic activity in the presence of CspC. Whereas the PlyGRCS‐CspC complex greatly reduced CspC‐nucleic acid binding, the aforesaid complex may downregulate the CspC function during bacterial infection. Overall, the crystal structure and biochemical results of PlyGRCS provide a molecular basis for the bacteriolytic activity of PlyGRCS against S. aureus.This article is protected by copyright. All rights reserved.