Ragini Tilak

Cutaneous Cryptococcus: marker for disseminated infection.

Cryptococcosis is an infection caused by the encapsulated yeast, Cryptococcus neoformans, a dimorphic fungus recovered from pigeon excreta, soil, dust and human skin. After a primary infection in the lungs, the disease can disseminate via a haematogenous route to various organs, including the central nervous system and skin, in susceptible individuals. Cryptococcosis can present with a variety of skin and soft tissue manifestations including acneiform lesions, purpura, vesicles, nodules, abscesses, ulcers, granulomas, pustules, draining sinuses and cellulitis. We present a case of a young man with HIV infection who developed molluscum-like cutaneous lesions secondary to pulmonary cryptococcosis. The diagnosis was confirmed by Indian ink preparation of the cutaneous lesions. Primary cutaneous infection occurs rarely due to direct inoculation. Cutaneous lesions are usually secondary and act as a key marker of disseminated infection, especially in patients with impaired cell-mediated immunity, such as those infected with HIV, solid-organ transplant recipients, and those on chronic corticosteroid therapy.

White Grain Mycetoma Caused by Scedosporium apiospermum in North India A Case Report

Mycetoma is chronic granulomatous infection of skin and subcutaneous tissue caused by both bacteria and fungi. We report a case of mycetoma caused by Scedosporium apiospermum in the right foot of a 45-year-old farmer in north India. The patient had a history of trauma in the sole of the right foot followed by discharge of white granules along with proximal progression. Scedosporium apiospermum was identified based on colony characteristics and microscopic features on slide culture. Mycetoma is a progressive disease. Foot is commonly affected in persons who walk barefoot, especially in south India. Untreated mycetoma progress and involve the underlying fasciae and tissues along with bones often resulting in loss of limb. By prompt and reliable diagnosis with corresponding antimicrobial administration, we can prevent further progression and limb disability.

Multidrug-resistant Trichosporon: an unusual fungal sepsis in preterm neonates

Abstract We report a cluster of three extremely-low birth weight (ELBW), preterm neonates who developed late-onset sepsis (LOS) by Trichosporon asahii within a span of 1 week period. Two of these cases had the initial diagnosis of respiratory distress syndrome and the third one was admitted for low birth weight and prematurity. Initial sepsis screen was negative and blood culture was sterile in all. Late-onset sepsis was developed after the first week of life and the presenting features were lethargy, feeding intolerance, bleeding manifestations, positive sepsis screen and severe thrombocytopaenia. The isolates were sensitive to voriconazole but resistant to both amphotericin-B and fluconazole on all occasions. All the infants were treated with liposomal amphotericin-B before the availability of culture reports but the clinical deterioration was rapid and all three neonates succumbed to death before we could procure voriconazole. The source of the outbreak could not be identified from multiple surface cultures from the unit and screening of the health care staffs. We emphasise the need for high index of suspicion for unusual fungal pathogens, resistant to conventional antifungal drugs while treating preterm neonates with LOS.

Lymphnodal Co-infection of Cryptococcus and Histoplasma in a HIV-Infected Patient and Review of Published Reports.

Abstract Human infection with Histoplasma capsulatum and Cryptococcus runs the gamut from asymptomatic illness to disseminated disease. Though both are the most prevalent systemic mycoses in HIV-infected patients, simultaneous infection by both the pathogens rarely occurs. We document the first case from Asian subcontinent with concurrent infection with disseminated cryptococcosis and histoplasmosis infections in a HIV-infected Indian patient diagnosed by morphological examination of fine-needle aspiration cytology samples obtained from the enlarged lymph nodes on light microscopy and were later confirmed by culture studies. A prompt, accurate and timely diagnosis of the disseminated form of dual mycosis (or either of the mycosis as well) is of utmost importance which has obvious impact on early initiation of treatment. Fine-needle aspiration cytology is a rapid, cost-effective and reliable method to identify infection with Cryptococcus and Histoplasma and is comparable with the essential culture studies.

Lymphocutaneous Sporotrichosis in an Adolescent Girl Presenting as Mycetoma

A 13-year-old girl presented with multiple painless purulent ulcers with raised borders on the medial aspect of the sole of her right foot associated with inguinal lymphadenopathy for the past 4 years. There was history of local trauma at the site prior to the formation of ulcers. There were no other significant associated signs or symptoms. The patient was initially treated with multiple antibiotics with minimal improvement. Fungal cultures of biopsy specimens demonstrated the presence of colonies of Sporothrix schenckii thus confirming the diagnosis of sporotrichosis. Oral itraconazole at the dose of 100 mg twice daily was initiated with marked response at 4 weeks. This case demonstrated a rare morphological presentation of the lymphocutaneous sporotrichosis as mycetoma. The possible diagnosis of sporotrichosis should be kept in mind in such a clinical presentation not responding to antibiotics. Cutaneous sporotrichosis should be diagnosed and treated as early as possible because untreated cases may disseminate to cause visceral involvement with fatal outcome in immunocompromised patients.

Candida Blood Stream Infection in Neonates: Experience from A Tertiary Care Teaching Hospital of Central India.

ObjectivesTo assess the epidemiology of neonatal Candida blood stream infection.MethodsMedical records of neonates with Candida blood stream infection over 5 years (September 2010 to August 2015) were reviewed. Clinical details, species distribution and antifungal susceptibility were noted.Results114 neonates developed Candida blood stream infection. Commonly isolated Candida species were C. tropicalis, C. albicans and C. parapsilosis. Susceptibility for fluconazole and amphotericin B was 86.6% and 68.3%, respectively. Central line >7 days and hospital stay >28 days were independent risk factors associated with non-albicans Candida infection.ConclusionsEarly removal of central line, timely fungal culture and antifungal susceptibility are necessary for early and appropriate treatment and better outcome.