Introduction and importance: Conidiobolomycosis is a rare chronic granulomatous fungal infection affecting the rhino-facial region. It usually occurs in immunocompetent males with agricultural exposure. A high index of suspicion is required to achieve a timely diagnosis in such cases, as the infection usually responds well to early antifungal therapy. Case presentation: We share a case of this disease occurring in a 21-year-old male presenting with a right nasal mass and external nasal swelling. It could not be diagnosed correctly over 2 months at various hospitals before he visited our center, where we excised the mass via functional endoscopic sinus surgery and identified Conidiobolus coronatum as the causative agent based on histopathologic examination, and MALDI-TOF. The facial deformity resolved after 3 months of therapy with oral Voriconazole. Clinical discussion: In this report, we discuss the pathogenesis of Conidiobolomycosis, our diagnostic approach, and the use of functional endoscopic sinus surgery, which has not been reported extensively in the existing literature. Conclusion: In endemic regions, conidiobolomycosis should be considered amongst the differential diagnosis of a nasal mass associated with facial swelling. A multidisciplinary team approach is required to arrive at a timely diagnosis and begin early antifungal therapy.
Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM Objective Candida spp is the fourth leading cause of catheter-related blood stream infection (CRBSI). The standard treatment is prompt removal of the device (central venous catheter, CVC, or port or hemodialysis catheter) along with administration of systemic antifungal therapy. However, in patients with a lack of alternative intravenous access and in some critically ill patients, this standard of care is challenging. Our success with antibiotic lock solution in MDR GNB CRBSI, prompted us to consider similar therapy in Candida spp CRBSI. Methods Catheter salvage using antifungal lock therapy was tried in a total of 15 cases in two centers. In 10 cases echinocandin (9 anidulafungin, 1 micafungin) and in 5 cases amphotericin b deoxycholate (AmB-d) were used to obtain an antifungal concentration of ∼ 1000 mcg/ml in the lock solutions. All these formulations had additional NAC, heparin, and normal saline. Systemic antifungal therapy was also administered concurrently. Success was defined as clearance of candidemia at 48 h and 14 days and/or till the use of the device was needed. Some of these patients had prior/co-infections with bacterial pathogens and they were managed with appropriate systemic antibiotics with antibiotic lock therapy. Results In 11/15 episodes of CRBSI due to Candida species, catheter salvage was achieved. One case could not be assessed at 14 days as a port was removed in view of megaprosthesis in situ. In two cases this therapy failed and one patient lost to follow-up. See Figures 1 and 2 for details of all cases. Conclusions Antifungal lock therapy using echinocandins and AmB-d appears to be a promising therapy in patients where catheter removal is difficult. However, this success neither means that this can become standard practice, nor should it make clinicians and hospital staff complacent about infection control practices.
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