Cryptococcal Antigenemia in HIV-Infected Patients with CD4+ T-cell Count ≤ 200 cells/μl: A study from a tertiary care hospital

Introduction: Cryptococcal meningitis is one of the leadingopportunistic infections associated with high mortality. Thepresent study was carried out to determine the prevalence ofcryptococcal antigenemia in HIV-infected patients with CD4+T-cell count ≤ 200 cells/μl.Material and methods: A cross-sectional study includinga total of 100 blood samples of HIV-infected patients withCD4+ T-cell count ≤ 200 cells/μl was carried out in a tertiarycare hospital. The Cryptococcal Antigen Latex AgglutinationTest was performed on serum separated from blood samplesincluded in the study group. A positive cryptococcalantigenemia was diagnosed by positive latex agglutinationtest of cryptococcal polysaccharide antigen in serum. BMI ofall patients included in the study group was calculated andWHO clinical staging of all patients was noted.Results: Three cases out of 100 were positive for cryptococcalantigenemia. The positive cases showed correlation with lowBMI and WHO Clinical stage II and III of HIV disease. Inthe present study, 33.33% and 66.67% of positive cases hadCD4+ T-cell count within the range of 0-100cells/μl and101-200cells/μl respectively.Conclusion: It is important to implement routine screeningfor cryptococcal antigen among HIV-infected cases withCD4+ T-cell count ≤ 200 cells/μl for early detection ofcryptococcal antigenemia. It will help in identifying the riskof subsequent cryptococcal meningitis and initiation of preemptive antifungal treatment.

Subconjunctival dirofilariasis caused by Dirofilaria repens: A case report with short review.

Human dirofi lariasis is a rare infection caused by fi larial worms of genus Dirofi laria. Subconjunctival dirofi lariasis has been reported from Asia, Europe, Italy and Africa. In India majority cases are from Kerala, Karnataka and very few from Maharashtra. We report the rare case of subconjunctival dirofi lariasis caused by Dirofi laria repens from Maharashtra, western India.

Determination of a reference interval in a population.

The reference interval is the most widely used medical decisionmaking tool that separates healthy from diseased individuals. We briefly discuss the methods used to determine reference interval and its limitations.

Tubercular Brain Abscess - case report.

Central Nervous System (CNS) tuberculosis is a serious form of extra-pulmonary tuberculosis. CNS tuberculosis can present as meningitis, arachnoiditis, tuberculoma and brain abscess. Tubercular Brain Abscess (TBA) is a rare manifestation of central nervous system tuberculosis. With the advent of AIDS, more cases are being diagnosed, but very few have been reported in immunocompetent HIV negative patients. We present a case of TBA in a 23-year-old immunocompetent patient. The patient was given anti-tubercular treatment along with surgical excision. He showed significant improvement in all symptoms after weeks.

Leptospiral pneumonia.

Severe leptospirosis rarely presents with primary pulmonary manifestations, without any associated jaundice or renal dysfunction. The authors report a nine-year-old boy who presented with complaints of abrupt onset of high fever; with myalgia, headache, and pain in right chest region, productive cough with hemoptysis and vomiting developing over the past 72 hours. Chest radiograph showed consolidation in the right upper lobe with air bronchogram. A history of contact with sewage water and presence of conjunctival suffusion in a child with pneumonia made us suspect leptospirosis. Following prompt initiation of parenteral penicillin therapy the child's complaints resolved over the next five days. Dri-Dot test to detect anti-Leptospira antibodies was positive. The diagnosis of leptospirosis was confirmed by a positive microagglutination test to Leptospira interrogans serovar Australis by a fourfold rise in antibody titer in paired sera collected during convalescence. Leptospirosis presenting with pulmonary hemorrhage has been associated with significant mortality but it can be successfully treated with early clinical suspicion of alveolar hemorrhage and prompt therapy.

Determination of antibacterial activity of polyenzyme preparations Gumseb using in vitro methods.

A novel polyenzyme formulation Gumseb developed by Advanced Enzyme Technologies Ltd, Thane and Speciality Biochemicals Co., USA, was tested for antibacterial properties using ATCC strains and clinical isolates of Salmonella typhi, Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus, Streptococcus pyogenes and Streptococcus pneumoniae. A modified antibiotic susceptibility test was used for the purpose. S. aureus, S. pyogenes and S. pneumoniae were found to be sensitive to the formulation at the chosen concentration. Next, to study the interaction between Gumseb and currently used antibiotic, a checkerboard Minimum Inhibitory Concentrations (MIC) was carried out for each organism. The assay was carried out with the aim of establishing whether the polyenzyme formulation had any potentiating effect on the antibiotic of choice. Synergistic effect was established when Gumseb was used in conjunction with penicillin against S. pyogenes. Partial synergy was established when it was used in conduction with Ceftazidime against P. aeruginosa and with Ciprofloxacin against methicillin sensitive, coagulase positive S. aureus. Antagonism was established when it was used in conjunction with Ampicillin against E. coli, with Ciprofloxacin against S. typhi and coagulase negative staphylococcal strain. The results indicate that Gumseb can be used in conjunction with those antibiotics with which a synergistic or a partially synergistic effect could be shown, as in the case of P. aerugionosa and S. aureus. These findings have particular importance since these organisms are responsible for hospital based infections and are notorious for antibiotic resistance. In cases where antagonism was established, it should not be used in combination with that particular antibiotic. However, it can be used individually since it has proved to have antibacterial activity and MIC could be determined for all five commonly encountered pathogens. Therefore, it has the potential of being a novel broad range antibacterial drug. These findings are significant given the alarming rise in incidence of antibiotic resistance in most clinically important pathogens.

Factors associated with drug resistance in pulmonary tuberculosis.

BACKGROUND: Drug-resistant tuberculosis is becoming a formidable foe for the mankind as it is difficult to manage. The present study was aimed at studying the factors associated with drug resistance in tuberculosis. METHODS: One-hundred and nine patients from whom mycobacterial growth was obtained on culture were studied. RESULTS: Treatment default was found to be the most important factor associated with drug resistance. Forty-five of the 48 isolates from patients with history of default showed drug resistance. Travel to a different place was the reason for default in 19 of 45 patients with drug resistance. Symptom relief in 12, cost of treament in two and adverse drug effect in 12 patients were the other commonly observed reasons for default. A history of relapse was also found to be associated with drug resistance. Nineteen of the 34 isolates obtained from these patients showed drug resistance. In contrast, drug resistance was seen in only four of the 27 new, untreated patients with mycobacterial growth. CONCLUSIONS: Drug-resistant tuberculosis is a major problem in the control of tuberculosis. Its resurgence should be controlled by scrupulously monitoring and ensuring patient compliance.

Role of IgM specific indirect immunofluorescence assay in diagnosing an outbreak of leptospirosis.

The study was conducted during a suspected epidemic of leptospirosis in Maharashtra. A total of 13 acute phase blood samples, collected at 5-6 days from the onset of symptoms, and 10 convalescent phase samples, colected at around 20 days from the onset of symptoms were obtained from 13 patients. Sera were separated and the samples were subjected to Microagglutination Test (MAT) and IgM-Indirect Immunofluorescence assay (IFA) to detect antibodies against leptospira. In the acute phase sera, only one sample was positive by MAT while seven were positive by IFA. In the convalescent samples, six were positive by MAT and seven were positive by IFA. IFA is a rapid test and can be used for early diagnosis of leptospirosis.