Jaya Garg

Evaluation of Pan-Dermatophyte Nested PCR in Diagnosis of Onychomycosis

ABSTRACT In this study, nested PCR using novel primers targeting the pan-dermatophyte-specific sequence of the chitin synthase 1 gene (CHS1) was compared with KOH microscopy, culture isolation, and single-round PCR for diagnosis of 152 patients with clinically suspected onychomycosis. Results indicate that nested PCR may be considered the gold standard for the diagnosis of cases of onychomycosis for which the etiological agents are dermatophytes.

Evaluation of the RAPIDEC CARBA NP Test Kit for detection of Carbapenemase Producing Gram Negative Bacteria

ABSTRACT Recently, bioMérieux, France, introduced the Rapidec Carba NP test kit for rapid detection of carbapenemase-producing Gram-negative bacteria. This kit was evaluated in this study, and we report sensitivity, specificity, and positive and negative predictive values of 92.6%, 96.2%, 95.83%, and 92.6%, respectively. The test was easy to perform and interpret and relatively inexpensive (

Nosocomial cutaneous zygomycosis in a patient with diabetic ketoacidosis

5/Rs 300 per test) and provides a practical solution for early detection of carbapenemase-producing, multidrug-resistant Gram-negative bacteria.

Fulminant necrotizing fasciitis caused by zygomycetes

Zygomycosis is an opportunistic fungal infection with a fulminant course. Varying clinical forms have been described, including cutaneous zygomycosis, which is mainly observed in diabetic and burns patients. We report herein a case of cutaneous zygomycosis of the nose in a 26-year-old female patient with diabetic ketoacidosis, developing secondary to the application of non-elasticized adhesive tape probably contaminated with fungal spores.

Loktak notified Wetland ecosystem and its catchment

To the Editor, Necrotizing fasciitis (NF) is a progressive, rapidly spreading, inflammatory infection located in the deep fascia, with secondary necrosis of the subcutaneous tissues. Most cases are bacterial in origin, caused by mixed aerobic and anaerobic organisms (70%), anaerobes (20%) and aerobes (10%). It is commonly associated with severe systemic toxicity and high mortality in the range of 25–70%. Opportunistic fungal infections are an important cause of cutaneous necrotizing infections in immunocompromised patients, and zygomycosis in the debilitated patient is the most acute and fulminant fungal infection known. Percutaneous risks for developing infection with these fungi are well described, and here in, we present a case of fulminant NF caused by zygomycetes following an intramuscular injection. A 23-year-old female presented in casualty with high-grade fever and a deep ulcer involving the right gluteal region, extending to her thigh and lower back. She gave a history of an unknown intramuscular injection 1 month back. Two weeks later, she had developed a painful ulcer at the site of the injection. She had received some local treatment (details unknown) from a private medical practitioner, but as the lesion started extending, she was referred to our hospital. On examination, patient was febrile, toxic and had a large soft tissue infection spreading along the fascial planes producing necrosis of overlying skin. The area involved included the right gluteal region, thigh and lower back. (Fig. 1A) A clinical diagnosis of NF was established, and an emergency surgical debridement was carried out, and broad-spectrum antibiotics active against both aerobic and anaerobic bacteria ware started. Laboratory studies revealed hemoglobin of 3 gm/ dl, total white cell count of 15,000/mm with raised neutrophils. Serum biochemistry showed deranged renal function test with urea and creatinine 80 and 3 mg/dl, respectively, urine analysis showed proteinuria. Bacterial culture of excised tissue showed growth of Proteus mirabilis, susceptible to third generation cephalosporins and aminoglycosides. In spite of aggressive management, the patient continued to deteriorate. The diagnosis was reviewed, and considering a possibility of cutaneous mycosis, surgically excised tissues were sent for mycological evaluation. KOH wet mount showed broad, nonseptate hyphae (Fig. 1B), and in sections of resected tissue stained by hematoxylin and eosin (Fig. 1C), periodic acid-Schiff (Fig. 1D) and Grocott methenamine silver stains broad hyphae of varying diameters with minimal septation and irregular branching were seen. Fungal culture on Sabouraud’s dextrose agar showed no growth. Amphotericin-B could not be started because patient was in renal failure, and the clinical condition of patient kept on deteriorating despite surgical debridement and intensive medical management. The patient and her family denied further treatment and took leave against medical advice. Zygomycetes class of fungi includes three orders that are Mucorales, Mortierellales and Entomophthorales. The majority of human illness is caused by the Mucorales. Zygomycosis is an emerging cause of NF, and in a recent study, zygomycosis was responsible for 31.03% cases of NF. Early diagnosis is the corner stone of successful treatment of zygomycosis. Treatment of zygomycosis requires several simultaneous approaches: surgical intervention, antifungal therapy and correction of the underlying predisposing condition. Surgical debridement of grossly necrotic tissue is always required; in addition, antifungal agents such as Amphotericin B/posaconazole should be coadministered. Hyperbaric oxygen, Granulocyle colony stimulating factor and interferong might give some benefit, as adjunctive treatment and their role require further evaluation. Continued expansion of the wound despite broadspectrum antibiotic therapy, failure to isolate bacterial organisms and demonstration of ribbon like, aseptate hyphae in tissue section are some of features that are helpful in the early diagnosis of NF of fungal etiology. Rapid progression and unacceptably high mortality

A Study on Japanese Encephalitis in and around Kanpur, Uttar Pradesh, India

Conservation of wetland is considered paramount in view of its ecological significance. The availability of reliable and up-to-date data on seasonal water spread, tropic state of wetland and bio-physical parameters besides the landuse/cover of the catchment area is a prerequisite for ‘wise use’ of any wetland ecosystem. The present study is carried out to identify the above parameters of Loktak notified wetland through visual interpretation of 1RS IA/IB LISS II FCC of 1990 and 1994/95. It indicates that the water spread of the lake is showing a declining trend and an increasing trend for aquatic vegetation. In 1990 post-monsoon data water spread was 15441 ha which become 11166 ha in October 1994. The extent of water spread further decreases by pre-monsoon season and was found to be 7875 ha in the IRS LISS II data of March 1995. Like-wise area under aquatic vegetation and associated marshy/ swamps was 10499 ha in October 1990 and 13506 ha in October 1994. Catchment of Loktak lake (104872 ha) is highly degraded and forest covers only 7205 ha area. Agriculture is the main land use (35576 ha) in the catchment and substantial area is also under land with or without scrub. Thus, there is a need to rehabilitate the catchment by way of planting trees for reducing silt load in the Loktak lake and ensuring its ‘wise use’.

Wound infections secondary to snakebite.

A Study on Japanese Encephalitis in and around Kanpur, Uttar Pradesh, India Japanese encephalitis (JE), is mosquito borne viral disease, caused by arbovirus; a member of the family Flaviviridae and is transmitted to humans through a pig-culex mosquito-pig cycle. Humans are an incidental host and most infections of JE virus are asymptomatic. The ratio of unapparent to apparent infection is 200:1 to 300:1 but if clinical illness develops, it causes significant morbidity and mortality. Approximately 3 billion people and 60 per cent of the world population live in JE-endemic regions, and inspite of being a vaccine preventable disease there are approximately 50,000 cases and 15,000 deaths per annum notified from wide geographical range, and half of the survivors suffer severe neuropsychiatric sequelae of the disease.