Avani Koticha

Identification and speciation of Malassezia in patients clinically suspected of having pityriasis versicolor

Background: Malassezia is a lipid-dependent yeast known to cause Pityriasis versicolor, a chronic, recurrent superficial infection of skin and present as hypopigmented or hyperpigmented lesions on areas of skin. If not diagnosed and treated, it may lead to disfigurement of the areas involved and also result in deep invasive infections. Aim: The aim of the present study was to identify and speciate Malassezia in patients clinically suspected of having Pityriasis versicolor. Materials and Methods: Total 139 patients suspected of having Pityriasis versicolor were evaluated clinically and diagnosis was done by Woods lamp examination, confirmed mycologically by using KOH, cultivation on Sabourauds dextrose agar and modified Dixon agar at a tertiary care hospital in Mumbai. The total duration of study was 12 months. Results: Majority of the patients were males (59.71%) in the age group of 21-30 years (33.81%) who were students (30.21%) by profession. The incidence of Malassezia in Pityriasis versicolor was 50.35%. The most common isolate was M. globosa (48.57%), followed by M. furfur (34.28%). Majority of the patients had hypopigmented lesions, with M. globosa as the predominant isolate. Neck was the most common site affected; 88.48% were Woods lamp positive of which 56.91% of Malassezia isolates grew on culture. KOH mount was positive in 82.01% of which 61.40% Malassezia isolates grew on culture. Conclusions: The procedure of culture and antifungal testing is required to be performed as different species of Malassezia are involved in Pityriasis versicolor and susceptibility is different among different species. Thus, it would help to prevent recurrences and any systemic complications.

Chronic Giardiasis in a Case of Common Variable Immunodeficiency (CVID): A Case Report.

Common Variable Immunodeficiency (CVID) is a primary immunodeficiency characterized by low antibody levels and recurrent infections. This makes an individual more prone to recurrent respiratory and gastrointestinal tract infections. In cases where there is persistent positive finding of intestinal parasites in stool, a high index of suspicion should be raised to rule out immunodeficiency state. Early diagnosis of such cases will help in reducing the morbidity and better management of the patient. A case of CVID in 18-year-old male with recurrent lower respiratory tract infection and chronic diarrhoea due to Giardia lamblia is reported herewith.

Gastrodiscoides hominis infestation of colon: endoscopic appearance

A 15-year-old girl from rural North India was seen with a 7-month history of dull aching, periumbilical abdominal pain. Barium examination revealed a contracted cecum with an irregular outline (Fig. 1). Colonoscopy showed multiple parasites with sucking discs in the cecum and ascending colon. The parasites were adherent to the mucosa, which bled on removal of the parasites. The parasites were from 8 to 10 mm in length, with an expanded circular end having a large sucker adherent to the mucosa and a motile end, which was narrowed and conical. A diagnosis of Gastrodiscoides hominis was made at histology of the parasite. The organism is a trematode, infesting

Isospora induced diarrhea in a pemphigus vulgaris patient.

Sir, A 50‐year‐old woman with pemphigus vulgaris for four years was treated with oral steroids and five pulses of methylprednisolone for one year before she was seen at our institution and started on intravenous dexamethasone‐cyclophosphamide pulse therapy. She received intravenous dexamethasone 100 mg for three days along with cyclophosphamide 500 mg on the second day; the cycle was repeated every 28 days with daily cyclophosphamide 50 mg and supplementary oral steroids (starting with tablet prednisolone 30 mg/day and tapered after every pulse). Her lesions improved but smouldered on and she received 23 pulses monthly for two years. Since the disease was recalcitrant, she was then given four doses of injection rituximab 375 mg/m2 body surface area every week for 3 weeks followed by a fourth dose given three months after the first dose. Her lesions healed and oral steroids were tapered and stopped over a period of three months. The disease was then under control, and she was continued on modified dexamethasone‐cyclophosphamide pulse therapy practiced at our institution i.e. dexamethasone 48 mg and cyclophosphamide 500 mg without additional oral steroids.