P355 Pitfalls in medical mycology in India

Abstract Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM   Background information There is increasing awareness of fungal infections in India. Many diagnostic medical mycology laboratories are now operating in different parts of the country. It is considered worthwhile to mention several pitfalls committed in the diagnosis of mycotic infections in India. Methods Literature on fungal infections in India was accessed through different search engines. Publications suggestive of inaccurate reporting were thoroughly read to pinpoint the pitfalls in diagnosis. For checking the accuracy of mycological illustrations, some of the publications were requested from the corresponding authors. Results Several accessed publications of Indian authors reported the unbelievably frequent occurrence of anthropophilic and zoophilic dermatophytes in soil. A few articles incorporating incorrect diagnoses of systemic infections have also been published in highly reputed journals. For instance, the article ‘Pathogenic Fungi in Soils of Jabalpur, India’ in Mycoses 1990; 33 (3): 116-125 reports 38% incidence of Microsporum (anthropophilic and zoophilic species) in 35 soils examined. Another publication in the August 2009 issue of the same journal mentions frequent isolation of Trichophyton verrucosum, Microsporum audouinii, and M. canis from Jaipur soils. Authors from several Botany departments in Indian Universities have erroneously reported a high frequency of these dermatophytes and T. rubrum from soils and also on Histoplasma capsulatum from some soils. No illustrations were provided for these fungi including H. capsulatum, nor was in vitro conversion of H. capsulatum to yeast form mentioned. There are also reports of erroneous diagnoses of systemic mycoses. In a paper in IJD 2015; 54:451-455, the authors from Kottayam, Kerala reported on African histoplasmosis as the first indigenous case from India. The diagnosis is doubtful as histopathology was not suggestive and the image of the blood agar culture of the fungus at 37°C showed septate cells resembling arthroconidia rather than yeast cells of Histoplasma. Another publication from a premier medical institute in North India [Intestinal Res 2019;17(1):149-152] reported a series of six cases of intestinal histoplasmosis the histopathological illustration was not at all suggestive of Histoplasma and there was no mention of attempting mycological culture. Conclusion Lack of knowledge and training of workers from departments of botany and biological sciences in Indian universities has led to the misidentification of human pathogenic fungi The inaccurate diagnosis of mycotic infections has resulted generally from misidentification of the causative fungi and lack of collaboration between histopathologists and medical mycologists. The need for continued training of medical mycologists and for collaboration between the pathologists and medical mycologists is emphasized to avoid erroneous diagnoses.