Gagandeep Singh

Introduction: Wickerhamomyces anomalus is an emerging pathogen in Indian hospitals, with limited data on antifungal resistance and its clinical impact. We aimed to explore its antifungal susceptibility, clinical outcomes, resistance mechanisms and molecular epidemiology. Materials and methods: Seventy clinical isolates of W. anomalus (2016–24) were collected from PGIMER, Chandigarh (n = 29), BHU, Varanasi (n = 33), and AIIMS, New Delhi (n = 8). Antifungal susceptibility testing (AFST) was done for amphotericin B, fluconazole, voriconazole, itraconazole, posaconazole, caspofungin, anidulafungin and micafungin. ERG11 sequencing, ERG11, MDR1 and CDR1 expression analysis (RT-qPCR), biofilm formation, ergosterol content and genetic relatedness [short tandem repeat (STR) typing] were performed. Results: The AFST (n = 70) showed that 72% isolates were non-wild-type (NWT) for fluconazole, 17% cross-resistance with voriconazole, and 1.4% with micafungin. Among fungemia cases, 53.2% occurred in neonates. Respiratory distress syndrome was the most common associated comorbidity, 26/62 (41.9%), with mortality in 31/62 (50%). ERG11 sequencing revealed four non-synonymous mutations, N41K, R420K, P485L, and T486K(novel), in 28 (55%) NWT isolates. Gene expression analysis revealed upregulation of ERG11 (12.72-fold) and CDR1 (3.08-fold) in NWT isolates without ERG11 mutations. Biofilm formation was higher in NWT versus wild-type. STR genotyping revealed 22 genotypes and 5 clusters (≥3 isolates), suggesting clonal transmission. Conclusion: This multicentre study demonstrates the emergence of fluconazole-NWT W. anomalus in Indian hospitals, predominantly affecting neonates, with a high mortality. Resistance was associated with ERG11 mutations, efflux pump overexpression and biofilm formation. These findings highlight that the drug-resistant W. anomalus fungemia is an emerging concern.

"Progressively Enlarging Lip Swelling in an Indian Child Due to Entomophthorales Infection" published on 20 May 2025 by The American Society of Tropical Medicine and Hygiene.

Background: Graft arteritis due to Candida species (GAC) is a rare but life-threatening complication in kidney transplant recipients. This systematic review examines its clinical profile and outcomes. Methods: A PRISMA-compliant systematic review was conducted. Cases of GAC in kidney transplant recipients were identified and analyzed for clinical characteristics and outcomes. Results: Sixty-one patients from 31 studies were included. Median time to infection was 30 days (IQR: 12–60 days) post-transplant. Common symptoms included fever (41.5%) and abdominal pain (33.9%). Aneurysmal rupture occurred in 49.1%, often linked to early presentation. Surgical intervention, mainly external iliac artery ligation, was required in most cases. Mortality was 22.9% and was associated with candidemia and a significantly shorter interval between transplantation and clinical presentation. Conclusions: GAC typically occurs early after kidney transplantation, with high rates of aneurysmal rupture and mortality.

A 61-year-old woman presented with progressive shortness of breath, cough with expectoration, hemoptysis, and fever for 2 months. On admission, altered parameters included low oxygen saturation, slightly elevated total leukocyte count, and elevated bilirubin and liver enzymes. Contrast-enhanced computed tomography of the chest revealed bilateral cystic bronchiectasis with multiple cavitary nodules. Ultrasonography of the abdomen revealed extrahepatic biliary obstruction, likely carcinomatous in etiology. She was started on antibiotics and percutaneous transhepatic biliary drainage was done. The patient had to be intubated owing to worsening respiratory function. Antifungals were added subsequently due to raised galactomannan levels, but the patient died due to refractory hypokalemia. Postmortem lung biopsy sample showed septate hyphae on direct microscopy. The culture of the mini-bronchoalveolar lavage sample, as well as postmortem lung biopsy, grew a dematiaceous mold. Sequencing of the internal transcribed spacer region of the 18S ribosomal DNA identified the isolate to be Acrophialophora angustiphialis.

Invasive fungal infections (IFIs) are silent killers, frequently undiagnosed and untreated. India faces significant challenges with limited diagnostic facilities, scarce data on fungal infection, and rising antifungal resistance. The COVID-associated mucormycosis surge highlighted the urgent need for stronger diagnostic infrastructure for fungal infections. Recognizing this, the Indian Council of Medical Research (ICMR) launched a network of mycology laboratories with advanced diagnostic capabilities across India using a 10-step plan described in this paper. Laboratories were selected using a three-pronged screening approach. Eight Advanced Mycology Diagnostic and Research Centers (AMDRCs) were set up in North, West, Central, South, South-Central, East, and Northeast zones from 2020 to 2022. Each AMDRC received ongoing support in training and quality assurance. The network features a digital data system, fungal repository, and clinical registry to track IFIs in ICU patients. In 2022–2023, the network identified 16.3% of fungal cases, mainly Candida spp. (56%, n = 5764/10293) and Aspergillus spp. (28%, n = 2882/10293), with 1.5% (n = 227/14861) IFIs and seven rare diseases (Eumycetoma and Chromoblastomycosis) reported in 2023. Candida auris showed high resistance to Amphotericin-B (61.2%, n = 30/49) and Fluconazole (57.1%, n = 28/49). The ICMR-MycoNet has significantly improved access to fungal diagnostics, enabling early detection and management. Comprehensive data on infection trends and resistance patterns provide valuable insights for targeted treatments and outbreak preparedness, strengthening public health efforts.