Opportunistic Strongyloides Stercoralis Infection in an Immunocompromised Patient.

Strongyloides stercoralis is an intestinal nematode that infects human percutaneously and has a complex life cycle including a direct, an autoinfective and a non-parasitic freeliving developmental cycle. Strongyloidiasis has a worldwide distribution, and usually causes mild or asymptomatic infection. However hyperinfection syndrome can cause significant morbidity and mortality in immunocompromised states such as malignancy, HIV infection, or immunosuppressive agent administration. We report a case of a 37-year old male HIV positive patient admitted in male medical ward, RIMS with severe diarrhoea, pain abdomen, generalized weakness and history of diarrhoea off and on for past one month. His CD4+ T- lymphocyte count was 116 cell/microlitre and the patient was on antiretroviral therapy. Stool examination reveals larvae of Strongyloides stercoralis. Stool culture was negative for pathogenic bacteria and fungi. Special staining for detection of intestinal coccidian parasites and microsporidiosis was also negative .The patient was successfully treated with combined therapy of albendazole(400mg) and ivermectin(6mg) daily for 3days.

Pattern of Onychomycosis - A RIMS Study.

Onychomycosis is a fungal infection of nails caused by dermatophytes, yeasts or non-dermatophytes moulds. In this study, 500 patients suspected of having onychomycosis reffered from the out patient department (OPD), Dermatology, Regional Institute of Medical Sciences(RIMS) Hospital Imphal Manipur during the period from January 2007 to December 2008 were processed in the Department of Microbiology RIMS. Nail clippings or scrapings depending on the variety of onychomycosis were collected with sterile blades under all aseptic measures. Specimens were put up for 10% KOH mount, fungal cultures on two sets of SDA (Sabouraud‘s dextrose agar) incorporated with antibiotics and lactophenol cotton blue preparation (LCB) from the cultures and examined microscopically. Slide cultures were also put up if necessary. Out of 500 samples processed, a total of 444(88.8%) were positive for the various fungi. The positive fungi were dermatophytes 258(58.1%), non-dermatophytes 139(31.3%), yeasts and yeast-like 17(3.8%) and mixed fungal isolates 30 (6.7%). Of the 230 males and 270 females studied,193(83.9%) males and 251(92.9%) females respectively were positive for various fungi causing onychomycosis. Maximum number of suspected cases were in the age group of 21-30 years.Among the dermatophytes, Trichophyton species (spp.) 250(50%) was the commonest isolate followed by Epidermophyton spp. 8(1.6%). Among the non-dermatophytes, Aspergillus spp. 70(14%) was the commonest followed by Penicillium spp. 24(4.8%), Acremonium spp. 9(1.8%), Fusarium spp. 8(1.6%), Curvularia spp. 7(1.4%), Alternaria spp. 5(1%), Scopulariopsis spp. 4(0.8%), Cladosporium spp. 4(0.8%), Nigrospora spp. 2(0.4%), Mucor spp. 1(0.2%), Paecilomyces spp. 1(0.2%), Pseudallescheria spp. (0.2%), Rhizopus spp. 1(0.2%), Verticillium spp. 1(0.2%), Exophiala jeanselmei 1(0.2%). Among the yeast and yeast-like i.e. Candida spp. 15, Geotrichum spp. 1, Rhodotorula spp. 1 were 17(3.8%), mixed fungal isolates 30(6.7%), respectively. Reports were given to the patient for follow up and treatment. Health awareness and suggestions were given for prevention and further spread of onychomycosis.

Strongyloides stercoralis infection in an HIV positive patient – A Case Report from RIMS, Imphal, Manipur.

Strongyloides stercoralis, a nematode parasite in human with free living and autoinfective cycles, is often an asymptomatic infection of the upper small intestine. If the host becomes immunocompromised, autoinfection may increase the intestinal worm burden and lead to disseminated strongyloidiasis. We report a case of a 33 year old male HIV positive patient admitted on 2/6/08 in male medical ward, Regional Institute of Medical Sciences, Imphal, Manipur with complaints of loose stools,pain abdomen, nausea, vomiting, generalized weakness, loss of appetite and loss of weight for past one month with fever off and on. Stool examination reveals larvae of Strongyloides stercoralis. The patient was successfully treated with Ivermectin 200 μgm/kg daily for 2 days.

Effect of Anti Retroviral Therapy (ART) on CD4 T Lymphocyte Count and the Spectrum of Opportunistic Infections in HIV/AIDS in Manipur.

Reports of variable response to antiretroviral therapy as indicated by CD4 count has been of concern as facilities for viral load estimation/drug resistance testing is not available everywhere. Hence the present study . was done to assess the magnitude of problem in high prevalence state of Manipur as evidenced by the CD4 T lymphocyte count. It was also prudent to study various OIs as extensive awareness campaigns about HIV and related morbidity with support system has been undertaken since the last decade. The study revealed that HAART must be used judiciously as 17.3% showed no improvement in CD4 T lymphocyte count. Among opportunistic infections, fungal infections predominatd in HIV/AIDS.

Co-infection of herpes simplex virus (HSV) with human immunodeficiency virus (HIV) in women with reproductive tract infections (RTI).

In India, HSV seroprevalence and its coinfection with HIV among female patients with reproductive tract infections (RTI) are sparse. We aim to ascertain the seroprevalence of HSV and its coinfection with HIV and common sexually transmitted infections attending Obstetrics and Gynaecology outpatient department, RIMS. The study included 92 female patients with RTI. Diagnostic serology was done for HSV-1 and HSV-2 using group specific IgM indirect immunoassay using ELISA, HIV by 3 ELISA/Rapid/Simple (E/R/S) test of different biological antigen. Diagnosis of RTI was made on clinical grounds with appropriate laboratory investigations--microscopy, Gram stain smear etc. Bacterial vaginosis was diagnosed using Nugent's criteria, Syphilis by rapid plasma reagin (RPR) card test and Chlamydia trachomatis by IgG ELISA. Out of 92 sera tested for HSV, 18 (19.6%) were IgM HSV positive and 9 (9.8%) were HIV positive. Co-infection rate of HSV in HIV positive was 16.7%. None of the patients had clinical herpes genitalis, all were subclinical cases. 55.5% of HSV positives belongs to age group 21 to 30 years. Of the HSV-1 and HSV-2 IgM positives 3 (15%) had HIV, 4 (22.2%) bacterial vaginosis, 2 (11.1%) were RPR positive, 4 (22.2%) Chlamydia trachomatis, 3 (15%) were pregnant. 16 (88.8%) were unemployed, 14 (77.7%) had education level below 10 standard. Our study suggest that every case of RTI, be it an ulcerative or nonulcerative must be thoroughly evaluated by laboratory testing for primary subclinical genital HSV coinfection as this has profound implications on their judicious management and aversion of complications. Early diagnosis and treatment of HSV infection together with prophylaxis for recurrent HSV disease will prevent progression and spread of HIV disease.

Pattern of hepatitis C virus genotypes in HIV infected patients in RIMS, Hospital, Imphal, Manipur.

The present study was carried out to find the pattern of genotype distribution of Hepatitis C virus. Twenty-three Hepatitis C virus positive serum samples in various age-groups of both sexes attending, Microbiology Department, RIMS during the period from September 2002 to December 2004 were studied for Hepatitis C genotype. These HCV positive serum samples were sent to National Institute of Cholera and Enteric Diseases, Kolkata. The serum samples were tested for HCV-RNA by qualitative RT-PCR test and then genotyped by type specific RT-PCR. Out of 23 serum samples, 22 were males. All the 23 HCV positive serum samples were also tested positive for HCV-RNA by qualitative RT-PCR. Majority of the cases belonged to the age group of 31-40 years. Higher percentage of Hepatitis C cases were Injecting Drug Users and next to it were patients with multiple sexual contacts. Among the IDUs, Hepatitis C virus 3a type was the commonest genotype (61.1%) followed by 1b (22.2%) and 3b (16.7%) respectively. Hepatitis C genotype 3a was predominant (52.2%) followed by 1b (26%) and 3b (21.8%). HCV genotype 3a occurred most commonly in the age group of 21-40 years.

Pulmonary paragonimiasis.

A 27-year-old married male from Lamdeng village of Imphal West District, Manipur presented with cough, fever, haemoptysis, anorexia and weight loss, and was treated with antituberculosis drugs continuously for one year without improvement. He also had history of ingestion of raw crabs. Chest radiograph revealed right midzone lesion with cavitation. Laboratory investigations revealed peripheral blood eosinophilia, elevated erythrocyte sedimentation rate and sputum smear revealed eggs of Paragonimus westermani. He responeded well to treatment with praziquantel 25 mg/kg, three times a day for three days and is doing well on follow-up. Pulmonary paragonimiasis must be considered in the differential diagnosis of slowly resolving pneumonias, especially in the appropriate clinical setting because effective treatment with praziquantel can be rewarding.

Helminthic infestation of the primary school-going children in Manipur.

A total of 1010 stool samples collected from the primary school-going children between the age group of 5 to 10 years from September 1998 to October 2000, were studied to find out the prevalence of intestinal helminths in this paediatric age group and in the urban and rural areas of Manipur. The samples were processed in the Microbiology Department, RIMS, Imphal by wet film, iodine preparation and concentration techniques (formol-ether concentration) to find out the presence of eggs, larvae of the intestinal parasites (helminths). A total of 248 (24.5%) were positive for various helminths. Among the positive cases, 110 (26.3%) were from the urban area (city) and 138 (23.4%) from the rural areas of Manipur. Of the 552 males and 458 females tested, 136 (24.6%) males and 112 (24.5%) females respectively were positive for various helminths. Maximum number of parasitic infection occurred in the age group of 5 to 6 years (27.0%) in both sexes. Among the parasites, Ascaris lumbricoides was the commonest (19.6%) followed by Trichuris trichiura (2.18%), Hymenolepis nana (0.99%), Tapeworm (0.19%), Hookworm (0.09%), Strongyloides stercoralis (0.09%), Enterobius vermicularis (0.09%). Mixed infection of Ascaris lumbricoides with T. trichiura (1.08), T. trichiura with E. vermicularis (0.09%) and T. trichiura with S. stercoralis (0.09) were also encountered. Antihelminthic drugs were prescribed to those who were found positive for the helminths.

Prevalence of HIV infection and AIDS symptomatology in malnourished children--a hospital based study.

One hundred and seventy five malnourished children aged between 1(1/2) and 12 years attending pediatric department of Regional Institute of Medical Sciences Hospital, Imphal from January 2001 to June 2002 were screened for human immunodeficiency virus (HIV) infection along with their biological mothers after pretest counselling and informed consent. The prevalence rate of HIV seropositivity among malnourished children was 21.7%. Children aged between 1(1/2) and 3 years had the highest seroprevalence (47.4%) and male to female ratio was 1.5: 1. Underweight children showed the highest seroprevalence (47.4%) and children with kwashiorkor showed least seroprevalence (10.5%). Mode of HIV transmission was vertical in 94.7%. The causative agent was HIV-I in all the cases. AIDS defining children features were seen more frequently among HIV seropositive malnourished children as compared to the seronegative children. Prolonged fever (p 0.001), oropharyngeal candidiasis (p<0.001), generalised lymphadenopathy (p<0.001) and disseminated maculopapular dermatitis (p<0.001) were significantly related to HIV infection. Among seronegative children 18.2% fulfilled the clinical criteria for AIDS and among seropositive children 94.7% had AIDS. The total mortality encountered among seropositive children was 34.2%. It is suggested to confirm findings based on larger community based data before recommending mandatory HIV testing in all malnourished children. Specific guidelines on the nutritional management of children with HIV/AIDS is needed in Manipur where HIV is spreading rapidly.

Head and neck manifestations of HIV infection: a preliminary study.

The study deals with evaluation of the head and neck manifestations of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). It is a preliminary, prospective study, conducted in the department of ENT and microbiology, Regional Institute of Medical Sciences, Imphal, Manipur. The clinical presentations for HIV infection and AIDS with head and neck involvement are shown in this paper. Forty patients with HIV infection and various head and neck manifestations are included in this study The median age of diagnosis was 33 years with male to female ratio of 3.4: 1. The predominant mode of transmission of HIV infection among the patients of this series was found to be intravenous drug use (IDU) in 65% of cases. Rhinosinusitis was found to be the most common presenting feature constituting 27.5% of the cases followed by oral candidiasis in 22.5% of the cases. After consideration and observation of all the facts and findings, this study concludes and proposes that it will be well for all clinicians, including otolaryngologists especially, to bear a high level of suspicion for HIV infections in their day to day practice.