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Mucormycosis, an opportunistic fungal infection, is on the increase. Individuals at risk are those with diabetes mellitus, haematological malignancy, etc. Infections are uncommon in human immunodeficiency virus (HIV). Clinical presentations include rhinocerebral, pulmonary or disseminated forms. Risk factors should alert clinicians to a high index of suspicion. Prompt diagnosis, facilitated by radiological imaging and tissue sampling, with appropriate medical and surgical intervention can potentially improve patient outcomes. Here we describe a rare case of renal mass in a patient living with HIV presenting to casualty department with abdominal pain and fever. Radiological imaging showed a renal mass whilst histopathological findings were suggestive of mucormycosis. Management included antifungal therapy and subsequent nephrectomy. The patient improved significantly and was discharged home.

Fungal infections of the central nervous system are fatal and rare clinical entities observable in immunosuppressed patients from varying causes. They carry higher risks of morbidities and mortality as compared to viral, bacterial or parasitic central nervous system infections. This study describes clinicopathological description of the central nervous system fungal infections with antemortem diagnostic challenges. This is a 9-year retrospective study of six cases composed of three females and three males with a mean age of 29.3 years. All six decedents presented with signs of meningeal irritation. They all suffered from immunodeficiency of varying causes. The gross and microscopic features revealed cryptococcosis, candidiasis and mucormycosis as the cause of the central nervous system infection. Early diagnosis and appropriate medical treatment are of paramount importance in improving the overall survival of patients with central nervous system mycosis. A few autopsy cases with fungal infection of the central nervous system have been described; therefore, more autopsies studies are needed to re-enforce on the existing epidemiology of these fatal infections. Moreover, this will assist in further elucidating the varying gross features and tissue reaction patterns associated with them.

Cryptococcosis is an opportunistic infection with high mortality if not diagnosed and treated in time. The objective of this study was to review the clinicopathological information of decendents with final autopsy diagnosis of disseminated cryptococcal infection. This study collected data from 4 decendents who presented to an academic hospital/laboratory between 1 January 2015 to 31 December 2018. Their clinical, radiological and pathological findings including treatment were reviewed. Two decendents presented with respiratory symptoms whilst the other 2 presented with meningeal symptoms. Three were confirmed HIV positive. One decendent was on ART, one had defaulted treatment and one was ART naïve. Two decendents were diagnosed with cryptococcal meningitis, one with bacterial pneumonia and one with pulmonary tuberculosis. Three decendents died in emergency unit and one in the ward whilst on antifungal therapy. The autopsy findings confirmed disseminated cryptococcal infection in all cases. A high index of suspicion should be maintained in the right clinical context. Multi-organ involvement should be suspected in all patients and be actively sought out.

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Background: The Anyplex TM MTB/MDR/XDR (Seegene) detection assay is a real-time multiplex PCR that can detect Mycobacterium tuberculosis (M.tb) and resistance to first line drugs (Rifampicin (RIF) and Isoniazid (INH)) and second-line drugs (Fluoroquinolone and injectables). Currently rapid diagnosis of drug resistance is performed through molecular assays that have limited detection probes. Anyplex assay has a high number of probes that are used to detect first and second-line drugs. We compared the performance of Anyplex TM MTB/MDR/XDR with culture and Genotype MTBDRplus 2.0 (Hain Lifescience)for detection of M.tb drug-resistance to first and second-line drugs. Methods & Materials: We retrospectively sampled 34 culture isolates and prospectively collected 51 clinical sediments. The 34 culture strains were tested for RIF, INH, OFL (Ofloxacin) and kanamycin (KAN). Of the 51 clinical sediments evaluated, microscopy results were positive (45), negative (2) and scanty (1) while 3 had no results. The clinical sediments were further tested on Genotype MTBDRplus. DNA sequencing was performed on gyrA and eis genes detected by Anyplex TM MTB/MDR/XDR assay. Results: The concordance between culture and Anyplex TM MTB/MDR/XDR respectively for INH, RIF, OFL and KAN was 26/26 (100%), 26/27 (96.0%), 15/16 (81.25%) and KAN (63.6%). Clinical specimens had a concordance between Genotype MTBDRplus and Anyplex TM MTB/MDR/XDR for INH and RIF was 4/4 (100%) and 16/17 (85.7%). The specificity for RIF and INH in clinical sediments was 95.0% and 95.3% respectively. Analysis of discordant results of KAN resistant samples revealedeis-C12T mutation not detected by Anyplex TM MTB/MDR/XDR assay. Conclusion: Anyplex TM MTB/MDR/XDR has good overall performance for detection of drug resistance in culture and clinical sediments. High sensitivity and specificity for detection of INH makes it an alternative method to Genotype MTBDRplus which is based on conventional PCR.

Introduction: South Africa has one of the top ten tuberculosis burdens in the world, only lagging behind countries with significantly larger populations. Increased awareness of extrapulmonary tuberculosis, specifically spinal tuberculosis, is necessary, because of the HIV epidemic.Case presentation: This report describes the case of a 9-year-old male patient who was suspected of having multidrug-resistant (MDR) tuberculosis, based on failure to recover clinically and radiologically after 6 months on first-line anti-tuberculosis treatment. Pus samples were sent to an accredited academic laboratory for histopathology, microscopy, culture, line-probe assay (MTBDRplus assay) and phenotypic MGIT 960 drug susceptibility tests. Second-line MDR tuberculosis treatment was introduced. Clinical, radiological, physical processes and more laboratory tests were conducted to document whether or not there was improvement in the patient.Management and outcome: After laboratory diagnosis of MDR tuberculosis, the patient was started on MDR tuberculosis treatment. The patient started improving remarkably after the introduction of anti-tuberculosis treatment and rehabilitation, although he also required surgery to stabilise the spine. Neurological improvement was observed in the patient and he fully recovered.Discussion: Although the diagnosis of spinal MDR tuberculosis may not be achieved easily by culture, the well-known gold standard method of tuberculosis diagnosis, it is of great importance to rapidly initiate an effective anti-tuberculosis treatment of drug-resistant strains to reduce the deformity of the spine.