Journal of Clinical and Diagnostic Research aims to publish findings of doctors at grass root level and post graduate students, so that all unique medical experiences are recorded in literature.

Background: Phenotypically identified Candida parapsilosis is actually a complex of 3 member species named Candida parapsilosis sensu stricto (CPSS), Candida orthopsilosis (CO), and Candida metapsilosis (CM), which can be identified only by molecular methods and automated methods such as MALDI-TOF mass spectrometry (MS). This study was undertaken to evaluate the VITEK MS, which uses the principle of MALDI-TOF MS for the identification of member species of C. parapsilosis complex (CPC). Methods: In this cross-sectional study, 126 presumptively identified and stocked isolates of CPC were included. Definite identification to species level was done by VITEK MS and PCR as the gold standard method. Clinico-demographic characters and risk factors were analyzed. Antifungal susceptibility testing was performed for fluconazole and voriconazole. Results: Twelve isolates were not identified as CPC either by VITEK MS or PCR and hence were excluded from the analysis. Out of 114 CPC isolates, 89 (78.1%), 18 (15.8%), and 7 (6.1%) isolates were identified as CPSS, CO, and CM, respectively, by VITEK MS. PCR identified 84 (79.2%), 15 (14.2%), and 7 (6.6%) isolates as CPSS, CO, and CM, respectively. However, PCR did not detect 8 isolates of CPSS detected by VITEK MS. VITEK MS showed 95.3% agreement in species identification and showed a kappa coefficient of 0.87, which is almost perfect agreement. Predominant isolations of all 3 species were from blood. Resistance was observed more in CPSS for both the azoles. Conclusion: MALDI-TOF MS can be used as a rapid, reliable, cost-effective method to identify the species of CPC.

Osseous involvement occurs in 5-10% of patients with disseminated cryptococcosis. We are reporting an unusual case of disseminated cryptococcosis involving the sternum and lumbar vertebra with the formation of psoas abscess with pulmonary tuberculosis. The patient presented with fever for 3 months. A diagnosis of pulmonary tuberculosis was made on thoracic contrast-enhanced computerized tomography and she was put on antituberculosis treatment. She was immunocompetent with negative human immunodeficiency virus. She conceived subsequently and had complaints of backache and swelling over the sternum. Magnetic resonance imaging showed destruction of L5 vertebra with psoas abscess. Vertebral cryptococcosis may mimic tuberculosis and malignancy. She had a bad obstetric history and experienced five, first-trimester spontaneous abortions in each successive year since 2001. This pregnancy again resulted in spontaneous abortion. Cryptococcus neoformans was isolated from two different sites: pus-involving the sternum and ultrasound-guided psoas abscess aspirate. Serum latex agglutination test for cryptococcal capsular polysaccharide antigen was positive. The diagnosis of cryptococcosis was delayed because the patient was diagnosed as a case of pulmonary tuberculosis, wherein clinical signs, symptoms and radiological findings in both the conditions are similar. Amphotericin B was started but she developed varicella infection and expired due to cardiac failure.

Chronic obstructive pulmonary disease (COPD) patients often experience acute exacerbations requiring hospitalization. Recently, attention has focused on Aspergillus sensitization in the airways of these COPD patients. This study aimed to assess the prevalence of chronic pulmonary aspergillosis (CPA) in COPD patients with acute exacerbations and identify associated risk factors. A cross-sectional descriptive study was conducted at the Jawaharlal Institute of Postgraduate Medical Education and Research from January 2021 to June 2022. Sixty-one COPD patients presenting with acute exacerbations were included. Demographic details, blood investigations, and sputum examinations were performed for all patients. A high-resolution computed tomography thorax was conducted for eligible patients. The prevalence of CPA among patients with an acute exacerbation of COPD was found to be 9.8%, with chronic cavitary pulmonary aspergillosis being the most common presentation (50%). Among post-tubercular COPD patients, the prevalence of CPA was significantly higher at 22.7%. Hemoptysis (p<0.001) and a previous history of tuberculosis (p=0.008) were associated with Aspergillus sensitization. This study highlights the substantial prevalence of CPA in COPD patients with acute exacerbations, particularly in those with a history of tuberculosis. Early recognition and targeted management of CPA in COPD patients may improve outcomes and reduce hospitalization rates. Further large-scale multi-center studies are needed to validate these findings and comprehensively address the impact of CPA on all COPD patients.

Background and Purpose: Purpureocillium lilacinum (previously known as Paecilomyces lilacinus) and Paecilomyces variotii cause hyalohyphomycosis.Case report: In this study, we present a case of multiple subcutaneous abscesses of the lower limbs due to Purpureocillium lilacinum in a patient with myasthenia gravis and uncontrolled diabetes. Subcutaneous involvement of the lower limbs with this fungus is an unusual presentation. Pus aspirate collected on multiple occasions revealed hyaline septate hyphae under microscopic examination and Purpureocillium lilacinum grew on Sabouraud Dextrose Agar. The patient was initially treated by surgical excision and itraconazole therapy. Swelling regressed but discharge was noticed from the excision site after three months of itraconazole therapy. Culture from the discharge material yielded the same fungal growth. Treatment was changed to ketoconazole and he responded. Conclusion: This case report emphasizes the importance of identifying Purpureocillium lilacinum at an unusual site like the lower limbs in an immunocompromised patient. Ketoconazole may be used as an alternative treatment option for hyalohyphomycosis caused by Purpureocillium lilacinum. Keywords: Hyalohyphomycosis, Immunocompromised patient, Myasthenia gravis, Purpureocillium lilacinum, Purpureocillium lilacinum