Digvijay Singh

Sporotrichosis in Sub-Himalayan India

Sporotrichosis is endemic in the Sub-Himalayan belt, which ranges from the northern to the north-eastern Indian subcontinent. Similar to many parts of the developing world, sporotrichosis is commonly recognized clinically in this region however consolidated epidemiological data is lacking. We report epidemiological, clinical and microbiological data from a hundred culture positive cases of sporotrichosis. Out of 305 clinically suspicious cases of sporotrichosis, a total of 100 isolates were identified as Sporothrix schenckii species complex (S. schenckii) on culture. Out of the culture proven cases 71% of the cases presented with lymphocutaneous type of lesions while 28% had fixed localized type and 1% had disseminated sporotrichosis. Presentation with lesions on hands was most frequently seen in 32% with arm (23%) and face (21%) in that sequence. The male to female ratio was 1∶1.27. Age ranged from 1 ½ years to 88 years. Mean age was 43.25 years. Disease was predominantly seen in the fourth to sixth decade of life with 58% cases between 31 and 60 years of age. Since the first report from the region there has been a steady rise in the number of cases of sporotrichosis. Seasonal trends reveal that most of the patients visited for consultation in the beginning of the year between March and April. This is the first study, from the most endemic region of the Sub-Himalayan belt, to delve into epidemiological and clinical details of such a large number of culture proven cases over a period of more than eighteen years which would help in the understanding of the local disease pattern of sporotrichosis.

Scrub typhus presenting as acute abdomen.

Scrub typhus, a zoonosis, is a systemic febrile illness with diverse clinical manifestations. It may also present with signs and symptoms of acute abdomen. We present two serologically confirmed cases of scrub typhus presenting with acute abdomen that were managed conservatively with antibiotics.

Group B streptococcal meningitis in children beyond the neonatal period in sub-Himalayan India.

Objectives: To evaluate clinicolaboratory profile and the outcomes in children (1 to 59 months) diagnosed with Group B streptococcus (GBS) meningitis over a period of 1 year. Materials and Methods: Cerebrospinal fluid (CSF) samples of 250 pediatric patients (1 to 59 months) admitted with suspected acute bacterial meningitis(ABM)were subjected to cell count, biochemical profile, culture, latex particle agglutination (LPA) and polymerase chain reaction (PCR).They were also evaluated for complications and were followed-up till 6 months after discharge. Results: Forty patients (25 boys and 15 girls), 16% of total suspected cases of ABM were diagnosed with GBS by LPA method and 30 (75%) out of these were above 3 months of age. The median duration of hospital stay was 7 days (range 1 to 72 days). State of coma was observed in two (5%) and one (2.5%) died, while 20 (50%) patients recovered completely. Conclusion: GBS should be considered as an important cause of ABM in Indian children beyond the neonatal period and further studies are warranted to determine the actual problem of the disease in our country.

Influenza A(H1N1)pdm09 cases in sub-Himalayan region, 2014-2015 India.

Current influenza A(H1N1)pdm09 strain severely involved many parts of the country. The study was conducted to analyze the clinicoepidemiological trend of influenza A(H1N1)pdm09 cases from October 2014 to March 2015. Samples processing was done as per the Center for Disease Control guidelines. A total of 333 specimens were processed out of which influenza A(H1N1)pdm09 constituted 24% (81) of total, 5% (18) cases were seasonal influenza A virus strains. Mean age group involved was 49 years with case fatality rate of 20%. Patients died were 63% males and 44% had comorbidities, and among them, 38% patients died within 24 h of hospitalization. The mean age of comorbid patients who died was 59 years; whereas the mean age of patients died having no co-morbidities was 41 years (P < 0.005). Mortality was seen among 81% (13) of patients who were on ventilator support. Added mortality in specific human group demands continuous surveillance monitoring followed by the detection of mutation, even in susceptible animal population.

Clinico-Epidemiological Profile, Pandemic Influenza A H1N1/2009 and Seasonal Influenza, August 2009-March 2013, Himachal Pradesh, India

Background: Novel influenza A (H1N1) virus emerged in April, 2009, spread rapidly to become pandemic by June, 2009. Objective: To study the clinco-epidemiological profile of pH1N1and seasonal influenza (SI) from 2009 to 2013. Materials and Methods : Retrospective, hospital-based study was done by reviewing medical records for collecting demographic and clinical profile of the study samples. Result: Out of 969 samples, positivity and case fatality for pH1N1 and SI was 9.39 and 20.87% vs 11.76 and 7.89%, respectively. Among pH1N1and SI, sex distribution, mean age, and age group involved were 54.95% females, 37.10 years, and 20-29 years (23.08%) vs 43.86% females, 40.32 years, and 20-29 years (22.81%), respectively. Mortality shift was observed from younger to older and healthier, 75% to comorbid, 100% from 2009-2010 to 2012-13 for pH1N1. Conclusion: We observed seasonal variation, cocirculation, similar clinical features, decreased virulence, and community spread with respect to pH1N1 and SI from 2009-2013.

Are We Neglecting Nontuberculous Mycobacteria Just as Laboratory Contaminants? Time to Reevaluate Things

Objectives Nontuberculous mycobacteria (NTM) incidences are on the rise worldwide, including the tuberculosis endemic areas. They should be identified rapidly to the species level and should be carefully differentiated as contamination, colonization, or disease. This study was aimed at determining the prevalence and clinicoepidemiological profile of mycobacteriosis cases. Materials and Methods Cultures were made on liquid and solid media. NTM were identified by polymerase chain reaction (PCR) restriction analysis (PRA) and gene sequencing. Data was analyzed using Epi-info 7. Results Out of the 1042 processed specimens, 16% were positive for M. tuberculosis complex and 1.2% for clinically significant NTM. M. intracellulare was the commonest species isolated. NTM were treated mainly on outdoor basis (92%), involving more extrapulmonary system (62%) and higher age-group of 41-60 years (69%). No significant factor was seen to be associated clinically, radiologically, and biochemically with the NTM infections. Conclusions Our study highlights the importance of early diagnosis and differentiation among Mycobacterium tuberculosis and NTM so that these NTM are not underestimated in routine diagnostic procedures merely as environmental or laboratory contaminants.

Group A streptococcal meningitis in a previously healthy infant

We report a case of a previously healthy two month old infant with Group A streptococcal meningitis. The case should alert pediatricians regarding its possibility and treatment as early as possible to prevent fatal outcome.

Biometric Studies on Frieswal Heifers Born Under Field Conditions

A total of 58 Frieswal heifers from five different artificial insemination (A.I.) centres were selected to study 14 biometric traits. The overall least- squares means for 58 heifers were 117.3 ± 2.1 cm for BL, 109.7 ± 1.5 cm for HAW, 141.4 ± 2.8 cm for CG, 146.4 ± 3.1 cm for PG, 40.9 ± 0.9 cm for FL, 27.9 ± 1.0 cm for FW, 18.1 ± 0.4 cm for EPL, 65.7 ± 1.2 cm for HE, 34.3 ± 1.6 cm for HK, 105.7 ± 1.5 cm for HPB, 110.7 ± 1.7 cm for HHB, 4.61 ± 0.26 mm for ST, 224.3 ± 11.3 kg for BW and 3.02 ± 0.09 m2 for BSA respectively. Higher values for various biometric traits were observed in Pantnagar A.I. centre. Higher values for various traits were observed in heifers reared by farmers having herd size up to 3 AUE, and also for the heifers reared by landless farmers. Land holding also had a significant effect on FW. However, there was no significant effect of AI centre, education level and season of birth on any of the traits and the majority of the heifers of this age group were pregnant.

Community‐acquired cutaneous ulcer in a child caused by Serratia marcescens

Introduction: Serratia marcescens is a Gram-negative, aerobic, motile bacillus belonging to the family Enterobacteriaceae. S. marcescens has been implicated in different types of infections including urinary tract infection, septicaemia, meningitis and wound infections. Very few cases of skin infections caused by this organism have been reported in the medical literature. S. marcescens is an important nosocomial pathogen but has rarely been implicated as a cause of community-acquired soft-tissue infections. Case presentation: We present a rare case of a community-acquired spontaneous cutaneous ulcer in an immunocompetent child from a sub-Himalayan region. Infections caused by S. marcescens may be difficult to treat because of its ability to produce a β-lactamase, which confers resistance to broad-spectrum, β-lactam antibiotics. Conclusion: In our patient, the treatment was modified to ceftazidime and amikacin after sensitivity testing and the patient’s condition improved. This necessitated isolation by culture and antimicrobial susceptibility testing to ensure appropriate therapy.

Prevalence of HBV infection in immunocompromised patients on ART nearly equals HBV mono infection in individuals not infected with HIV, Shimla Northern India

Results A total of 10,134 cases were screened for detection of HBV infection and among these 1650(16.3%) were receiving ART (anti retroviral therapy) while HIV status was not divulged in 8484 (83.7%). HBsAg positive in 324/10134 (3.20%) cases, out of these HBV mono infection was seen in 264 (2.6%) and coinfection with HIV in 60 (0.6%).The concomitant HIV infections were seen in 3.64% (95 %confidence interval 2.8-4.7) while in HBV mono infections were in 3.1% (95 % confidence interval 2.8-3.4). There is no statistical difference among the two groups (p value >0.05). Among the pediatric age group 0.95% had concomitant HIV infections as against 5.2% with HBV infection alone. The mean age of presentation was 40.39 years. Males had higher prevalence rate of co infection (4.5:1). Conclusion Nearly identical prevalence of HBV infection irrespective of HIV infection strongly indicates HIV screening for Hepatitis B infected patients. The presence of undetected co infection shall result in missed cases, incomplete or partial treatment and suboptimal clinical follow up.