Reema Nath

Mycotic corneal ulcers in upper Assam

Purpose: To study the association of various risk factors and epidemiological variables of mycotic keratitis treated at a tertiary referral hospital of upper Assam. Materials and Methods: In this hospital-based prospective study a total of 310 consecutive corneal ulcer cases attending the ophthalmology outpatient department of Assam Medical College were enrolled between April 2007 and March 2009. After clinical and slit-lamp biomicroscopic examination in all suspected cases, smears and culture examination for fungus was done to establish the etiology. Demographic information and associated probable risk factors of individual cases were noted in a predesigned questionnaire. Results: In 188 (60.6%) cases fungal etiology could be established. Out of them 67.6% were males. The most commonly affected age group was 41-50 years (25.5%). The maximum (23.4%) cases were reported during the paddy harvesting season in Assam (January and February). Fungal element could be demonstrated in 65.2% cases in direct potassium hydroxide (KOH) mount. The commonest predisposing factor was corneal injury (74.5%). While diabetes was a significant systemic predisposing factor in mixed bacterial and fungal infections in 11.1% cases, blocked naso-lacrimal duct was the local predisposing factor in 11.1% of cases. Fusarium solani (25%) was the commonest isolate followed by Aspergillus species (19%), Curvularia species (18.5%) and Penicillium species (15.2%). Yeasts were isolated in 2.7% (n=5) cases. Conclusions: Ocular trauma was the commonest cause of fungal corneal ulcer in Assam and Fusarium solani was the commonest species responsible for it. Most of the mycotic ulcer cases come from rural areas including the tea gardens.

Prevalence and antimicrobial susceptibility pattern of methicillin-resistant Staphylococcus aureus in Assam.

Aims: Methicillin-resistant Staphylococcus aureus (MRSA) has become a serious problem in intensive care units, because of development of multiresistance, and also intrinsic resistance to β-lactam antibiotics. The present study was carried out to investigate the prevalence of MRSA and their rate of resistance to different antistaphylococcal antibiotics. Materials and Methods: Between January 2007 and February 2008, the clinical specimens submitted at the microbiology laboratory were processed and all S. aureus isolates were included in this study. All isolates were identified morphologically and biochemically by standard laboratory procedures and antibiotic susceptibility pattern was determined by modified Kirby Bauer disc diffusion method. Results: Methicillin resistance was observed in 34.78% of isolates, of which 37.5% were found to be resistant to all commonly used antibiotics. In MRSA isolates, 50% had constitutive resistance, 9.38% had inducible MLSB resistance and 18.75% had MS phenotype. Conclusions: There is a progressive increase in MRSA prevalence in the country but the present rate is still low in comparison to values found in some other institutes. The rate of inducible MLSB resistance was also lower in comparison with findings from other parts of the country.

Isolation of Shewanella algae from rectal swabs of patients with bloody diarrhoea.

Shewanella algae is an emerging bacteria rarely implicated as a human pathogen. It was infrequently recovered from clinical specimens probably because of inadequate processing of non-fermenting oxidase-positive gram-negative bacilli. We report here isolation of S. algae in pure culture and mixed with E. coli from two cases of acute gastroenteritis with bloody mucous containing diarrhea occurring at the same time. As this organism is not a normal flora of the gut, the possible source of infection may be fish contaminated with the organism. Whether this bacterium can be considered an enteric pathogen needs to be evaluated. The cases were clinically diagnosed as acute bacillary dysentery. The bacterium was identified by 16S r-RNA gene sequence analysis.

Atypical cutaneous lesions of Penicillium marneffei infection as a manifestation of the immune reconstitution inflammatory syndrome after highly active antiretroviral therapy

Penicillium marneffei infections normally manifest as molluscum contagiosum like skin lesion in HIV-infected persons. We report a case with verrucous lesions over nose and face due to Penicillium marneffei infection after HAART treatment. A 28-year-old man presented, after two weeks of HAART treatment, with multiple erythematous, scaly, papules and nodules with central necrosis predominantly in face and both extremities and scrotum. Microbiological investigations confirmed the diagnosis of Penicillium marneffei infection. This is perhaps the first case report with such manifestation due to Penicillium marneffei infection.

Sexually transmitted diseases in Assam: an experience in a tertiary care referral hospital.

BACKGROUND Sexually transmitted diseases (STDs) including AIDS are becoming a major public health problem in developing countries worldwide. AIMS All the adult patients attending VCTC and STD clinics of Assam Medical College between May 2002 and December 2005 were enrolled in the study. METHODS Records of patients with high-risk sexual behavior and presence of STD on clinical examination were recorded in a predesigned proforma. RESULTS Of 479 individuals, 186 (38.8%) had evidence of STD and 70 were positive for HIV. Most (64%) were in the age group of 15 to 30 years. Candidiasis (vulvovaginal candidiasis in women and candidal balanitis/balanoposthitis in men) was the most common finding on clinical examination (21.5%) followed by syphilis (17.2%), genital warts (15%), herpes genitalis (11.3%), non-gonococcal urethritis (10.8%), and gonococcal urethritis (7%). CONCLUSION High percentage of unmarried people (>45%) reporting with STD, which points to potential danger of HIV transmission in the region.

Ocular thelaziasis in Assam: A report of two cases

Small, white, thread-like, motile worms were recovered from the conjunctival sac of a 13-year-old girl and a 50-year-old woman from Dibrugarh district, Assam, India. They were identified as thelazia species. These two cases have been reported due to their rarity in India and elsewhere.

Species distribution & antifungal susceptibility pattern of oropharyngeal Candida isolates from human immunodeficiency virus infected individuals

Background & objectives: The changing spectrum of Candida species in causation of oropharyngeal candidiasis and their antifungal susceptibility pattern among the HIV infected individuals has made the identification to species level mandatory and detection of drug resistance necessary for patient care. The present study was carried out to determine the species distribution and antifungal susceptibility profile of oral Candida isolates colonizing or infecting both HIV seropositive and seronegative individuals. Methods: A case-control study was conducted including 141 consecutive, non-repeat HIV-seropositive individuals and an equal number of sex and age matched HIV-seronegative control. Speciation of the oropharyngeal Candida isolates was done using standard yeast identification protocol. Antifungal susceptibility testing was done by the disk-diffusion method as well as by Fungitest method. Results: From the 59 culture positive HIV seropositive cases, 61 Candida isolates were recovered; Candida albicans (n=47, 77.0%), C. dubliniensis (n=9, 14.7%), C. parapsilosis (n=2, 3.2%), C. glabrata (n=2, 3.2%), and C. famata (n=1, 1.6%). Candida colonization in HIV-seropositive individuals was significantly higher than that of HIV-seronegative (control) group. Antifungal susceptibility testing revealed (n=6, 9.3%) C. albicans isolates resistant to voriconazole and fluconazole by disk-diffusion method whereas no resistance was seen by Fungitest method. Interpretation & conclusions: C. albicans was the commonest Candida species infecting or colonizing HIV seropositive individuals. Oropharyngeal Candida isolates had high level susceptibility to all the major antifungals commonly in use. Increased level of immunosuppression in HIV-seropositives and drug resistance of non-albicans Candida species makes identification and susceptibility testing of Candida species necessary in different geographical areas of the country.

Estimation of biofilm, proteinase & phospholipase production of the Candida species isolated from the oropharyngeal samples in HIV-infected patients

Background & objectives: Candida, the most common opportunistic infection in acquired immunodeficiency syndrome (AIDS), attributes its pathogenicity to its virulence factors, mainly the biofilms, the proteinases and the phospholipases. There is a significant interplay of these factors during the HIV infection. This study was aimed to estimate the biofilm, proteinase and phospholipase production in Candida species isolated from the oropharyngeal samples in the HIV-infected patients. Methods: A total of 126 consecutive HIV-positive patients were screened for Candida growth using oropharyngeal swabs. Identification was done by Gram staining, germ tube test, chlamydospore identification, chromagar and biochemical tests on Vitek 2. Biofilm production was observed on Sabourauds dextrose broth with glucose, phospholipase production in egg yolk agar medium and proteinase production in bovine serum albumin agar medium. Results: Of a total of 126 patients, 53 (42.06%) showed Candida growth: Candida albicans (n=46, 86.8%) was most common followed by the non-albicans Candida (NAC) (n=7, 13.93%). Of a total 33 (62.3%) biofilm positive isolates, significant production was observed in the NAC species (P <0.05). C. albicans reported the highest phospholipase (n=37/41, 90.24%) and proteinase (n=37/43, 86%) activities in a total of 41 (77%) phospholipase positive and 43 (81.1%) proteinase positive isolates. Interpretation & conclusions: Although C. albicans was the most common Candida species identified in HIV positive patients, the emergence of NAC was of special concern. Virulence factors such as biofilms, proteinases and phospholipases were noted in both these groups. Further research is required for better understanding of the pathogenic role of Candida species so as to aid in therapeutic interventions.

Cryptococcus neoformans var. grubii Infection in HIV-Seronegative Patients from Northeast India: Report of Two Cases with Review of Literature.

Cryptococcus neoformans infection can occur in a wide range of hosts ranging from those who are severely immunosuppressed to those who are apparently immunocompetent. Two apparently immunocompetent HIV-seronegative patients with cryptococcal meningitis and multiple skin lesions, both due to C. neoformans var. grubii, are reported. Pregnancy was found as an associated factor in cryptococcal meningitis in a 20-year-old female patient from Arunachal Pradesh. Multiple skin lesions were the presenting feature of an 18-year-old male patient from Dibrugarh, eastern Assam. The organism was identified both phenotypically and by sequencing of ITS1 and ITS2 regions of rRNA gene. The cases are reported because of rarity of this infection in non-HIV-infected patients.

Human subcutaneous dirofilariasis in Assam

Human subcutaneous dirofilariasis is caused by filarial worms of the genus Dirofilaria. The parasites are transmitted to man by mosquitoes. We report three cases of human subcutaneous dirofilarias caused by Dirofilaria repens from Dibrugarh, Assam, north east India. The cases presented as subcutaneous nodules, on the chest, cheek and the anterior abdominal wall. Noting the frequency of the cases reported within 6 months, it is emphasized that subcutaneous dirofilariasis is a potentially emerging zoonosis in Assam and should be included in the differential diagnosis of patients presenting with subcutaneous nodules in Assam.