Incidence of infections in patients with pemphigus vulgaris

Background:Pemphigus is a rare, chronic autoimmune blistering disease of skin and mucous membranes. Autoimmune process and immunosuppressive therapy of pemphigus vulgaris would predispose the patients to infections. Therefore, the objective of this study was to isolate and identify the pathogens in admitted patients suffering from pemphigus vulgaris.Methods:This was a retrospective observational study based on 68 diagnosed cases of pemphigus vulgaris (PV) admitted during January1999 to April 2018 in SRN hospital, MLN medical college Prayagraj. Patients who had PV and required admission owing to development of severe symptoms were included while patients with mild symptoms were excluded from the study. These admitted patients, along with routine and radiological examination, were also examined for microbiological examinations of sputum, throat swab, blood, body fluids, skin scrapings, stool and urine when necessary.Results:Out of the 68 patients, 66.17% patients developed bacterial infections while 33.83% developed fungal infections. The prevalence of bacterial and fungal pathogens in urinary tract is 72.42% and 27.58%, pneumonitis is 29.42% and 70.58%, septicaemia is 81.82% and 18.18% and skin and soft tissue is 87.50% and 12.50% respectively. In meningitis and pulmonary tuberculosis no traces of fungi were recorded. Mortality was seen in 7.35% patients, which wasdue to bacterial meningitis, septicaemia and fungal pneumonitis.Conclusions:The present study clearly states that the occurrence of the disease is uncommon but secondary infections are associated with worse prognosis. Therefore, the best regimen for each type of patients should base on the extent of disease and patient’s comorbidities.

Paronychia: incidence during Magh Mela

Background: Prevalence of complications in malaria continues to grow even with reducing number of malaria cases. Complications associated with malaria can involve multiple organs. There is paucity of literature on factors associated with multi organ dysfunction in different types of malaria.Methods: Our aim was to study the clinical profile of complications in different types of malaria with specific focus on multi-organ dysfunction (MODS). In this cross-sectional study confirmed cases of malaria were enrolled.Results: Plasmodium vivax malaria was the predominant type seen in 74.1% cases. The overall prevalence of thrombocytopenia was 61.5%, hepatic dysfunction 58%, cerebral malaria 16.1%, Hypoglycemia 7.5%, bleeding 34.5%, acute respiratory distress syndrome (ARDS) 5.7% and acute kidney injury (AKI) 49.4%. Hypoglycemia was significantly higher in mixed malaria (0.025, p = 0.025). Hepatic dysfunction and hyperbilirubinemia were significantly higher in mixed malaria (p=0.001). Mortality was seen in mixed malaria (p = 0.007). Only those with mixed malaria died (13%). Patients with MODS had higher prevalence of rashes (p <0.0001) and cerebral malaria (p = 0.000). Serum levels of urea, creatinine, Bilirubin, Serum glutamic oxaloacetic transaminase (SGOT) and Serum glutamic pyruvic transaminase (SGPT) were significantly higher in patients with MODS (p<0.0001 for all variables). On evaluating factors associated with multi-organ dysfunction presence of cerebral malaria [OR: 6.4 (95% CI): 2.4 to 17.4; p<0.0001], type of malaria (Vivax or Falciparum or both) [1.77 (1.03 to 3.03); p=0.0038], and hypoglycemia [4.4 (1.08 to 17.8); p=0.038] were statistically significant on multivariate analysis.Conclusions: The present study demonstrates the factors associated with multi organ dysfunction and its impact on clinical outcome in different types of malaria.

Tinea: Incidence during Magh Mela

Background: Dermatophytosis refer to superficial fungal infection of keratinized tissues caused by keratinophilic dermatophytes. It is common in tropics and may present in epidemic proportions in areas with high rates of humidity.Methods: The retrospective study was carried out from January 2018 to February 2018 at Allahabad. Gram stain, KOH examination and culture were carried out in 300 cases.Results: Out of the 300 suspected cases authors identified, 263 cultures tested positive. The macroscopic examination of the scalp, skin and the nails of these 36 patients further revealed 50.20% Tinea corporis, 17.87% Tinea cruris, 11.02 % Tinea mannum, 8.74% Tinea pedis, 7.99% onychomycosis, 3.42% Tinea versicolor and 0.76% Tinea capitis. Culture examinations revealed 52.47% Trychophyton mentagrophyte, 34.98% Trichyopyton rubrum, 3.80% Trychophyton violaceum, 3.43% Malessesia, 2.28% Scopulariopsis brevicaulis, 1.52% Trichophyton verrucosum, 0.76% Microsporum canis and 0.76% Epidermophyton flucossum.Conclusions: The study concludes that in a short period of Magh Mela authors got a large number of skin patients because of their belief that the holiness Ganga water will cure skin problems by itself. Some of the patients were found infected from the beginning and some gather infections during their stay in the mela period. Therefore, a prompt recognition of skin lesions and the identification of these superficial fungi are required for judicious management.