Prakash Peralam Yegneswaran

Zoonotic sporotrichosis of lymphocutaneous type in a man acquired from a domesticated feline source: report of a first case in southern Karnataka, India

Background  Sporotrichosis is commonly encountered due to traumatic implantation of thorns or decayed vegetation with the dimorphic fungi, Sporothrix schenckii. Zoonotic spread of Sporotrichosis is rare and we describe here the first case of feline transmission of lymphocutaneous sporotrichiosis encountered in India.

In vitro antimicrobial activity of maleic acid and ethylenediaminetetraacetic acid on endodontic pathogens

OBJECTIVE The aim of this study was to evaluate the antimicrobial efficacy of 7% maleic acid (MA) and 17% ethylenediaminetetraacetic acid (EDTA) in elimination of Enterococcus faecalis, Candida albicans, and Staphylococcus aureus at different time intervals. STUDY DESIGN Transfer culture of microbial strains were used for inoculum preparation and determination of time-kill assay. The viability counts of 7% MA and 17% EDTA suspensions were performed at 0, 2, 4, 6, 12, and 24 hours. Assay results were analyzed by determining number of strains that yielded log(10) CFU/mL of -1 compared with counts at 0 hours, for test medicaments at time intervals. Medicaments were considered to be microbicidal at a minimum inhibitory concentration that reduced original inoculum by >3 log(10) CFU/mL (99.9%) and microbiostatic if inoculum was reduced by <3 log(10) CFU/mL. Statistical analysis was performed using chi-square and Fisher exact tests as well as Friedman test for comparison of the time interval within the MA and EDTA groups. RESULTS At all time intervals, there was no significant difference between MA and EDTA for all of the organisms (P > .05). However, within the MA and EDTA groups at various time intervals, there were significant differences (P < .001). CONCLUSIONS Equivalent antimicrobial activity was observed by MA and EDTA against all of the organisms tested at various periods.

Colletotrichum graminicola keratitis: First case report from India

Colletotrichum graminicola is a medically important fungus belonging to the order Melanconiales under the class Coelomycetes. The members of the genus Colletotrichum are primarily plant pathogens which cause anthracnoses (fungal infection in plants). In the past few decades, they are progressively being implicated as etiological agents of subcutaneous hyalohyphomycoses and keratomycoses. Of the five medically important members in the genus Colletotrichum, keratitis due to Colletotrichum graminicola is rare. We diagnosed Colletotrichum graminicola keratitis in a 44-year-old man who presented with a non-healing corneal ulcer since three weeks. Positive smears and cultures from the corneal scrapings established the causative organism as C. graminicola. The patient was treated with a combination of oral ketoconazole and topical fluconazole and natamycin. Infection resolved over 10 weeks and antimicrobials were stopped. We describe the clinical presentation and treatment outcome of Colletotrichum graminicola keratitis.

Epididymal and prostatic histoplasmosis in a renal transplant recipient from southern India.

W.W. Baig, R.P. Attur, A. Chawla, S. Reddy, S. Pillai, L. Rao, G. Rao, K. Ashok, P. Yegneswaran. Epididymal and prostatic histoplasmosis in a renal transplant recipient from southern India.
Transpl Infect Dis 2011: 13: 489–491. All rights reserved

Cunninghamella spinosum fungal corneal ulcer- first case report.

Sir, Cunninghamella species are mainly soil fungi of the Mediterranean and subtropical zones, and less commonly found in temperate regions. The genus contains seven species. However, C.bertholletiae is the only species known to cause disease in man and animals.Cunninghamella is an opportunistic fungus seen to affect diabetics and immunocompromised individuals. It can present as rhinocerebral, pulmonary, cutaneoarticular or disseminated forms.[1,2,3] Literature review did not reveal any case report of Cunninghamella spinosum causing ocular involvement till date. We report a rare case of corneal ulcer caused by Cunninghamella spinosum. A 54-year-old male presented with history of injury to the left eye with a stick 11 days ago. He complained of diminution of vision, pain, redness, watering and discharge from the left eye, five days after the injury. He was not a diabetic and there was no history suggestive of immunocompromised state. His visual acuity in left eye at presentation was hand movements. Anterior segment examination revealed a corneal ulcer with infiltrate measuring 7 × 8 mm involving central and paracentral zone of the cornea. [Figs. ​[Figs.11 and ​and2]2] There was no hypopyon, satellite lesions or endothelial plaque. Anterior chamber showed grade 3 reaction. Figure 1 Central corneal infiltrate, no hypopyon not a typical fungal ulcer on clinical appearance Figure 2 Slit beam showing the corneal infiltrate Corneal scrapings were done from the active edges of the ulcer and smears were sent for Gram stain, Giemsa stain and potassium hydroxide (KOH) mount. Material was also inoculated onto culture plates for bacterial, fungal and Acanthamoeba culture. Gram stain revealed the fungal hyphae [Fig. 3]. Sample sent for mycological processing and direct microscopy revealed broad hyaline, aseptate, branching, and filamentous fungi suggestive of zygomycete [Fig. 4]. Culture grew Cunninghamella spinosum. Figure 3 Gram stain showing hyphae (on direct smear) Figure 4 Microscopic morphology of C. spinosum (lacto phenol cotton blue ×40) The patient was started on G. Ciprofloxacin, Natamycin 5%, Fluconazole 0.3%, Atropine 1%and oral Ketoconazole 200 mg B.D. ×2 weeks. He was put on topical and systemic antiglaucoma medication for the management of secondary glaucoma. Patient was on regular follow-up and the ulcer healed well. His final best corrected visual acuity after 2 months was 6/36 in the left eye with macular grade corneal opacity [Fig. 5]. Figure 5 Healed ulcer The genus Cunninghamella is characterized by white to gray, rapidly growing colonies, producing erect, straight, branching sporangiophores ending in globose or pyriform-shaped vesicles from which several one-celled, globose to ovoid, echinulate or smooth-walled swollen sporangiola attached by denticles develop.[3] C.bertholletiae causes infections in immunocompromised patients leading to devastating results and it is known to cause infection in the bone marrow transplant patients, pneumonia and mucormycosis.[3,4] We report this rare case of fungal corneal ulcer by this opportunistic fungus C. spinosum in a patient who was not immunocompromised. It is important to note that the species C.spinosum is not known to affect human race. Although most of the systemic conditions caused by this cunninghamella species are known to cause devastating results, our patient responded well to Natamycin and Azole antifungal agents.

Distal Lateral Subungual Onychomycosis Owing to Tritirachium oryzae : A Bystander or Invader?

The genus Tritirachium is a mitosporic fungus which inhabits in soil and decaying plant material and also a notable insect pathogen. Human infections with Tritirachium species though rare were previously reported to cause corneal ulcers, otomycosis, onychomycosis, and dermatomycosis of the scalp and hence may be considered as a potential pathogen. Here we report a case of distal lateral subungual onychomycosis involving right great toenail in a 22-year-old female, wherein direct potassium hydroxide preparations, fungal cultures, and molecular sequencing of the isolate established Tritirachium oryzae as the etiological agent. Antifungal susceptibility performed by the microbroth technique of CLSI revealed increased MICs to amphotericin B and low MICs to azoles and echinocandins. The case was managed with surgical nail avulsion followed by topical application of 2% ketoconazole cream resulting regrowth of normal nail. To the best of our knowledge, this is the first report of non-dermatophytic mold T. oryzae causing onychomycosis in India.

Corneal ulcer due to a rare pleosporalean member of the genus Bipolaris following cow tail injury to the eye: A case report and review of literature

Aspergillus and Fusarium are the most common fungi causing mycotic keratitis. Injury to the eye with vegetable matter, cow tail injury, long-term use of topical steroids are some of the risk factors for mycotic keratitis. There are few case reports of keratitis caused by Bipolaris. The human pathogenic species in the genus are Bipolaris spicifera, Bipolaris hawaiiensis, Bipolaris papendorfii, and Bipolaris australiensis. Most commonly reported keratitis is caused by B. hawaiiensis, followed by B. spicifera. Literature review showed only one case report of keratitis due to B. australiensis reported from Australia. We present a first case report of keratitis due to B. australiensis (currently Curvularia australienis) from India.