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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Invasive Fungal Infections in Acute Haematological Malignancies: A Cross-sectional Study
Correspondence Address :
Dr. Anita Nandi Mitra,
BD 173, Salt Lake, Sector 1, Kolkata, West Bengal, India.
E-mail: anitanandi20121964@gmail.com
Introduction: Fungal infections are common complications of acute haematological malignancies i.e. acute myeloid and acute lymphoblastic leukaemia. The cells in these two groups are different morphologically and immunologically. Hence, the interaction with the different types of fungi may vary.
Aim: To identify the acute leukaemia cases and fungal infection among myeloid and lymphoid groups and to find out association of types of invasive fungal infection according to cell line affected.
Materials and Methods: A cross-sectional observational hospital-based prospective study was conducted in a risk group of acute haematological malignancy over a period of six months from July 2021 to December 2021 in a tertiary care Hospital, Medical College, Kolkata, West Bengal, India. Study tools were questionnaire based on European Organisation for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria, clinical reports and standard laboratory procedures were practiced in Microbiology laboratory. The data was entered in excel spreadsheet and analysed using Statistical Package for the Social Sciences (SPSS) 28.0 version.
Results: A total of 24 cases of Invasive Fungal Infections (IFI) were observed, out of the 78 patients included in the study. This corresponds to an IFI prevalence of 30.77%. Patients with proven IFI constituted 8 (33.33%), probable IFI accounted for 15 (62.5%) where as those with possible IFI accounted for 1 (4.2%) of total IFI cases. There were age and sex wise variation in IFI. The prevalence of IFI was found to be higher in Acute Myeloid Leukaemia (AML) (48.5%) patients as compared to Acute Lymphoblastic Leukaemia (ALL) (19.14%). Of all AML patients, invasive candidiasis was the most common type followed by aspergillosis. In ALL patients, invasive candidiasis also constituted 44.44% followed by dematiaceous mycosis, followed by aspergillosis.
Conclusion: AML patients suffer more from IFI than ALL ones. Invasive non albicans candidiasis affected both types, but more incidence was seen in AML affected group. Aspergillus spp. affected lungs of both groups, but dematiaceous fungi were isolated only from ALL affected paediatric patients and in samples other than pulmonary or blood sample.
Acute lymphoblastic leukaemia, Acute myeloid leukaemia, Yeasts and moulds
The IFI are common complications of the acute haematological malignancy i.e. AML and ALL. As a result of IFI the morbidity and mortality of primary disease increases along with expenditure of treatment and hospital stay (1). The development of immunocompromised state predisposing fungal infection cannot be avoided in different phases of these diseases. So, the use of prophylactic antifungal is necessary to prevent the fungal invasion. For this purpose, knowledge of species of invading fungus is necessary to select right medicine (s). Neutrophils, plays a crucial role in the resistance to Candida infection may become dysfunctional in AML patients, making them susceptible to these opportunistic infections (2). Cell mediated immunity by lymphocytes is also an important factor for containment of the said infection. On the other hand, the reduction in alveolar macrophages (which prevents germination of conidia to tissue-invasive hyphae) leads to Aspergillosis (3). Antineoplastic drugs induce a neutropenic and lymphocytopenic state which predisposes patients to opportunistic mycoses (4),(5). Severe neutropenia is termed when the absolute neutrophil count is less than 500 cells/mm3 (6),(7). Opportunistic fungal infections tend to appear during this stage. Febrile neutropenia which includes severe neutropenia along with oral temperature >38.5°C or two consecutive readings of >38°C for two hours typically marks the onset of fungal infections (6). Studies have shown that older patients (≥65 years) with haematological malignancy have an increased risk of invasive fungal infections (7),(8). The critically ill patients, being treated with broad spectrum antimicrobials, and those on total parenteral nutrition, sepsis, renal insufficiency, prolonged stay in Intensive Care Unit (ICU), current stage of the malignancy (for patients not in remission) are more prone to contract such infections (3),(9). Prolonged ICU stay makes the patient more susceptible to such infections (9),(10),(11).
Increasing use of antifungal prophylaxis has led to a significant change in the mycological profile of infections (11). The data on IFI among paediatric population with ALL are still scarce in comparison to AML as has been reported (12). Inadequacy of diagnostic procedures in patients with unstable clinical situations or with a bleeding tendency (due to thrombocytopenia resulting from induction chemotherapy) delays treatment, and therefore might interfere with the patient’s survival. The aim of present study was, to identify the acute leukaemia cases among admitted patients in hospital ward from clinical and laboratory record. To identify phenotypically the fungus causing IFI in such cases. To determine the association between a particular type of fungus and affected cell line.
A cross-sectional observational hospital-based prospective study was done for six months (July 2021 to December 2021) in haematology indoor wards and Microbiology Departments of Medical College, Kolkata. The permission required to conduct the study was given by the Institutional Ethics Committee. (IEC) with letter number- Ref No: MC/KOLIECNON-SPON/809/09/20. Study included the patients suffering from acute haematological malignancies and admitted in hospital.
Inclusion criteria
• Consecutive non repetitive febrile patients of ALL and AML admitted in hospital were included in the study.
• Willingness to participate in the study after giving informed written consent was considered in the study.
Exclusion criteria
• Chronic cases of lymphoid and myeloid leukaemia.
• Cases of acute promyelocytic leukaemia.
• Cases of haematogical diseases other than malignancy.
• Unwillingness to participate in the study.
Sample size calculation: A total of 78 patients were studied as proposed.
Sample size n0=z2pq/e2 (p is the prevalence and q is 1-p.) The prevalence of fungal infections is taken to be 11% (rounded-off) (12). The value for Z was found in statistical table, which contains area under the normal curve. Here Z=1.96 for 95% confidence. The margin of error here is taken to be 5%.
Putting the values p=0.11, q= 0.89
Sample size=150 (for unlimited population).
However, sample size of 150 in case of period prevalence of 12 months, 75 comes for six months (from modified Cochran’s formula for smaller population).
Study tools:
• Questionnaire form prepared beforehand (Based on EORTC/MSG criteria of IFI) (13) [Annexure:1].
• Laboratory diagnostic tools for clinical and mycological assessment.
Study Procedure
Questionnaire proforma was prepared by authors, the research workers [Annexure:1]. After getting written consent, subjects were first interrogated using questionnaire prepared beforehand for selecting the cases of AML and ALL and obtaining information about fungal infection. No cell line was used for research work in the laboratory. The target population was identified from records of involved myeloid or lymphoid cell line and questionnaire helped in categorising patients to proven, probable and possible IFI (or no IFI cases) (Table/Fig 1) (13). Empirical antifungal was given in cases of febrile neutropenia for more than four days not responding to broad spectrum antibiotics. Prophylactic antifungals used in our setting was posaconazole and it was given only in selected patients (33 patients).
Clinical assessment
• The baseline data of each patient like the age, gender, the type of acute leukaemia, chemotherapeutic stage of the patient, complete blood count and drugs received by the patient were collected.
• A febrile episode is defined as oral temperature >38.5°C or two consecutive readings of >38°C for two hours. Fever was considered due to chemotherapy, if it occurred within 12 hours of starting chemotherapy and resolved spontaneously in the next 24-hour period (6).
• The febrile episode was investigated for any possible source of fungal infection by taking the sample, from the clinically suspected site of infection.
• Neutropenia is defined as an absolute neutrophil count less than 500 cells/mm3 [6,7].
• The High Resolution Computed Tomography (HRCT) of chest was done for the radiological evidence of invasive fungal infection.
Sample types
• Blood sample: Biphasic blood culture medium by using Sabouraud Dextrose Agar (SDA) slant and trypticase soy broth was used.
• Sputum sample: It was induced by using nebulised sterile hypertonic saline solution.
• Urine sample: Few paediatric patients were examined.
• Bone marrow: One bone marrow sample was examined.
• Nasal mass: Evacuated mass from maxillary sinus was examined.
Potassium Hydroxide (KOH) mount: The samples were examined for fungal element under light microscope preparing 10% or 20% KOH mount (Table/Fig 2).
Fungal culture: Samples were inoculated in SDA/Sabouraud Dextrose Chloramphenicol Agar in two sets to incubate one at 37°C and another at 25°C. For the yeasts isolates, speciation was done by VITEK 2 YST ID card. For the moulds, Lacto Phenol Cotton Blue (LPCB) tease mount was examined for morphological study (Table/Fig 3).
Statistical Analysis
The data were entered in excel spreadsheet and analysed using SPSS 28.0 version. The p-values were calculated with Chi-square test, wherever applicable.
After careful analysis of the data, 24 cases of IFI were observed, out of the 78 patients, included in the study. This corresponds to an IFI prevalence of 30.77%. Patients with probable IFI accounted for 15 (62.5%) whereas, those with proven IFI constituted 8 (33.3%) and those with possible IFI 1 (4.2%) of IFI affected population. It was seen that highest number of proven IFI was seen in 4 (16.67%) of the patients belonging to age group 12-21 years and highest probable IFI in 4 (16.67%) of the patients of age group 22-31 years (Table/Fig 4).
Out of the 78 study subjects, 49 (62.82%) were males and 29 (37.18%) were females. Among the 24 IFI cases, proven IFI was seen in 8.33% females and 25% males. Probable IFI was present in 25% females and 37.5% males. No possible IFI was present in female while 4.2% males had possible IFI (Table/Fig 5).
Two different types of acute haematological malignancies were considered in the recruited group. Out of the 78 patients, 47 had ALL, 31 had AML. The prevalence of IFI was found to be higher in (15 out of 31) AML patients (48.4%) as compared to the 9 out of 47 ALL patients (19.47%) (p-value=0.006) (Table/Fig 6)a. Among AML patients 4 (16.66%) had proven IFI, 10 (41.66%) had probable IFI and 1 (4.16%) had possible IFI. In ALL patients 4 (16.66%) had proven IFI and 5 (20.83%) had probable IFI and no cases of possible IFI (Table/Fig 6)b (p-value 0.87).
Majority 49 (36.73%) of the patients who had undergone induction therapy developed IFI. Induction chemotherapy was found out to be a significant risk factor for the development of IFI (0.01). Neutropenia was a risk factor for IFI (p=0.04) and considering the duration of neutropenic state incidence of IFI was found in 11.76% patients having neutropenia for <10 days, 23.07% patients with 10-21 days of neutropenia and 59.09% patients with >21 days of neutropenia (Table/Fig 7).
24 samples showed fungal growth after culture. Of 15 AML patients, 10 invasive Candidiasis (66.7%) was the most common type followed by Aspergillosis 5 out of 15 (33.33%). In ALL patients, invasive candidiasis constituted 4 out of 9 (44.44%) followed by dematiaceous mycosis, 3 out of 9 (33.33%) followed by Aspergillosis 2 out of 9 (22.22%). As a whole, Candidiasis were identified in 14 (58.33%), Aspergillosis in 7 (29.17%) and dematiaceous mycosis in 3 (12.5%) patients. Candidiasis and Aspergillosis cases were identified in majority of AML cases whereas dematiaceous fungi were seen mainly in ALL cases (Table/Fig 8).
Lung was the commonest site of true fungi involvement accounting for 10 (41.67%) of the IFIs. Invasive aspergillosis and non albicans candidiasis caused pulmonary infections. The other site of involvement was bloodstream, constituting 11 (45.83%) of the IFIs. All bloodstream infections were due to non albicans Candida species. One (4.16%) Alternaria spp was isolated from bone marrow and maxillary sinus tissue sample of one patient and Curvularia spp. was isolated from urine of 2 (8.33%) ALL affected paediatric patients (Table/Fig 9). The prevalence of IFI in patients with antifungal prophylaxis was lower (9.09%) than those who did not receive any antifungal prophylaxis (46.66%). However, this difference (p-value=0.004) was statistically significant (Table/Fig 10).
In the above study, the prevalence of IFI among patients with acute haematological malignancies was found to be 30.77%. This result was in agreement with previous studies showing an increased prevalence of IFI in patients with acute leukaemia affecting 11-30% in such population (1),(8),(14). Immunosuppression is seen in patients with acute leukaemia either due to disease itself or due to treatment and thus, risk of IFIs develops. The humid and warm conditions in West Bengal substantially explains this finding as similar studies yielded identical result (12),(13),(14),(15). Wasylyshyn A et al., (15) showed a prevalence of IFI as 28% with proven IFI 13%, probable IFI 21% and possible IFI 66%. The prevalence of IFI was found to be higher (16.66%) among the age groups 12-41 years as compared to those at extremes of ages in present study. This was in similar with another study which have stated that the risk of IFI was higher in those <40 years. In the study by Lien MY et al., mentioned the median age of patients was 51 (range 19-76) (16). Other studies state that patients >65 years of age were at increased risk (7),(8),(12),(14),(17),(18). However, present study sample population did not include a significant proportion of representative from that age group. So, it could not be commented. In present study, the prevalence of IFI was higher in men as compared to women although the difference was not statistically significant (p-value=0.59). In the study by Neofytos D et al., females were found to be at significant risk for developing IFIs p-value <0.006 (19). This finding was unlike from the study by Hammond SP et al., getting 17.4% prevalence in male and 8.75% in females (14). Zhang R et al., and Lien MY et al., also found males to be at significant risk for developing IFI (12),(16).
The prevalence of fungal infections was found to be higher in AML (15 out of 24;62.5%) as compared to ALL (9 out of 24;37.5%) which was similar to the study by Bhatt VR et al., getting AML in 12% and ALL in 6.5% and Zhang R et al., getting AML in 11.8% and ALL in 7.1% patients (1),(12). AML has long been thought to have a higher risk of IFI than that in ALL. The recent addition of antifungal prophylaxis to induction chemotherapy has shown to significantly reduce the prevalence of IFI in AML (17). Present study confirms the same but the prevalence of IFI was not found to be significantly lower in ALL patients in this era of antifungal prophylaxis. Neutropenia for a prolonged period (>10 days) was found to be significantly associated with invasive fungal infections (13),(20),(21),(22),(23),(24),(25). Among 24 patients with IFI, 13 (59.09%) had a duration of neutropenia >21 days whereas 9 (23.07%) patients with IFI had a duration of neutropenia >10 to <21 days and 2 (11.76%) had neutropenia <10 days. Thus, a greater proportion of patients with IFI had a prolonged duration of neutropenia.
In present study, majority of the IFIs were caused by non albicans Candida species as compared to true fungi. A Taiwanese study by Lin GL et al., had also found invasive candidiasis (Candida species 59.1%) as predominant form of IFI. The increased prevalence of non albicans Candida species as found in present study was similar to other studies by (1),(4),(5),(9),(10),(13),(20), respectively. Among these, Candida krusei infection was predominant in AML whereas Candida tropicalis invasion was seen more commonly in ALL in present study. C. glabrata and C. lucitanae infection had lower incidence rate in both AML and ALL. Neither in AML nor in ALL C. albicans was detected as agent of IFI. Hansen BA et al., mentioned of C. krusei and C. glabrata infection contributing 80% of candidiasis (20). Among the hyaline hyphae, Aspergillus fumigatus, A. flavus and A. terreus were in the list of pathogen causing pulmonary aspergillosis. In the AML patients number of cases of Aspergillosis was more than that in ALL. These fungi were isolated from induced sputum or bronchoalveolar lavage fluid. The studies have mentioned that fungus isolated from these two types of samples are to be considered as coloniser, but authors considered these as pathogen as there were radiological signs of fungal invasion in lungs. The studies by Kauffman CA and Neofytos D et al., had also found such a mycological profile in those with acute leukaemia (11),(19). Aspergillus fumigatus caused 60% (n=3) of the IFIs. This was similar to other studies (3),(6),(9),(10),(13),(16),(25) where Aspergillosis varied from 10% (10) to 81.9% (16). The unusual finding of present study work was the isolation of Alternaria and Curvularia species from three cases of ALL. The Alternaria species was isolated from bone marrow aspirate and nasal mass evacuated from maxillary sinus of a 16-year-old girl. Curvularia lunata was isolated from urine of two boys of less than 8 years and suffering from ALL. The other studies have mentioned dematiaceous fungi causing rhionosinusitis in patients with acute haematological malignancy (18),(23). Alternaria spp. was isolated from maxillary sinus as well as bone marrow aspirate of a female patient. The Curvularia lunata was isolated from urine of a 6-year-old boy on two consecutive occasions and from another boy of 8 years on one occasion. There was no history of rhinosinusitis in these two cases.
The blood stream was the predominant site (45.83%) of IFI followed by lung (41.66%) among the patients with leukaemia. Bhatt VR et al., reported that lung was the commonest site accounting for around 75% of IFI (1). Similar reports have been made by Hansen BA et al., (20) and Tang JL et al., (26). From a 16-year-old girl of ALL, Alteraria spp. was isolated from the bone marrow aspirate first and then from right maxilla which might be the primary site from where systemic dissemination occurred. Lastly, present study isolated Curvularia lunata from urine samples of two boys suffering from ALL. No study mentioned of urine samples from where dematiaceous fungi could be isolated, but present study found same fungus on two successive samples collected on different day.
In the present study, it was found that, the prevalence of IFI was lower (9.09%) in those who had received antifungal prophylaxis than those who had not (46.6%). This difference was statistically significant (p=0.004) like the study by Zhang R et al., (12). Randomised controlled trials with prophylactic antifungals need more research work to establish the efficacy in preventing morbidity due to IFIs.
Limitation(s)
One limitation was that the study did not use any novel bio-markers and invasive procedures for the diagnosis, which could have underestimated the prevalence of IFIs. Further prospective studies are, therefore, required to increase the external validity of present study results. A larger randomised control trial is needed to justify the efficacy of posaconazole which was the prophylactic antifungal used in present study setting. Present study did not perform the antifungal susceptibility of culture positive specimens as that facility was not available at our hospital setting which might have given a better picture of the drug resistant species in this era of antifungal prophylaxis.
It is evident from the present study that AML patients suffered more from IFI than ALL ones. Invasive non albicans candidiasis complicated both types but more cases were seen in AML affected group. Aspergillus spp. affected lungs of both groups and dematiaceous fungi were isolated mainly from ALL affected paediatric patients. Preponderance of either yeast or mold to a particular cell line like myeloid or lymphoid was not established in present study, except dematiaceous fungus. In cases of haematological malignancies, the antifungal agents are prescribed empirically to prevent fungal infection. The susceptibility of hyphal form to antifungal agents is different from that of yeasts. So, present study result will help in selecting right group of antifungal agent.
Authors are grateful to the Principal, Head of the Department of Haematology and Microbiology to allow us to perform this work. Authors are also thankful to the laboratory technologists who provided us different test results.
DOI: 10.7860/JCDR/2023/60309.17271
Date of Submission: Sep 18, 2022
Date of Peer Review: Oct 20, 2022
Date of Acceptance: Nov 26, 2022
Date of Publishing: Jan 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
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