Antifungal susceptibility testing practices in mycology laboratories in France, 2018

Can We Improve Antifungal Susceptibility Testing?

Systemic antifungal agents are increasingly used for prevention or treatment of invasive fungal infections, whose prognosis remains poor. At the same time, emergence of resistant or even multi-resistant strains is of concern as the antifungal arsenal is limited. Antifungal susceptibility testing (AFST) is therefore of key importance for patient management and antifungal stewardship. Current AFST methods, including reference and commercial types, are based on growth inhibition in the presence of an antifungal, in liquid or solid media. They usually enable Minimal Inhibitory Concentrations (MIC) to be determined with direct clinical application. However, they are limited by a high turnaround time (TAT). Several innovative methods are currently under development to improve AFST. Techniques based on MALDI-TOF are promising with short TAT, but still need extensive clinical validation. Flow cytometry and computed imaging techniques detecting cellular responses to antifungal stress other than growth inhibition are also of interest. Finally, molecular detection of mutations associated with antifungal resistance is an intriguing alternative to standard AFST, already used in routine microbiology labs for detection of azole resistance in Aspergillus and even directly from samples. It is still restricted to known mutations. The development of Next Generation Sequencing (NGS) and whole-genome approaches may overcome this limitation in the near future. While promising approaches are under development, they are not perfect and the ideal AFST technique (user-friendly, reproducible, low-cost, fast and accurate) still needs to be set up routinely in clinical laboratories.

Mucormycosis of Paranasal Sinuses of Odontogenic Origin Post COVID19 Infection: A Case Series

The Severe acute respiratory syndrome and the Middle East respiratory syndromes emerged in 2002 and 2012 respectively. Currently the world is witnessing a global pandemic caused by a novel coronavirus, the severe acute respiratory syndrome coronavirus 2 (SARS CoV- 2) causing the Coronavirus 2019 (COVID-19). Mucormycosis is a fungal infection primarily affecting individuals with an immunocompromised state like diabetes mellitus, malignancies etc. Patients who have or have had COVID-19 infection with pre-existing uncontrolled Type 2 Diabetes mellitus are presumably more vulnerable for emergence of fungal infections cases. This article presents a report of 6 cases with histopathological proven mucormycosis associated with COVID-19 and uncontrolled Diabetes mellitus.