Evidence of dengue virus in eviscerated specimens of panophthalmitis secondary to dengue fever: A possible cause-effect phenomenon

Purpose: To report a retrospective series of three cases of infectious panophthalmitis post?dengue fever with ex vivo confirmation of dengue virus ribonucleic acid (RNA) in the tissues of the eye. Methods: Four eyes of three patients, who were diagnosed with panophthalmitis following dengue fever and who underwent evisceration, were included. All demographic and clinical data were recorded. The eviscerated samples were subjected to direct microscopy, culture for bacteria, fungi, and parasites, and molecular virology (dengue virus [DENV] NS1?specific reverse transcription loop?mediated isothermal amplification (RT?LAMP) assay). Results: The time from the development of dengue fever to the occurrence of ocular symptoms was 4.33 ± 1.15 (median 5) days. DENV NS1 RNA, suggestive of the presence of the dengue virus, was confirmed in all evisceration specimens (uveal tissue, cornea). All the patients recovered completely from dengue fever and on follow?up had healthy eviscerated sockets. Conclusion: Demonstration of the DENV RNA in the eviscerated specimens of panophthalmitis following dengue fever implicates the DENV in the pathophysiology of the ocular infection.

Diagnostic utility of melanin production by fungi: Study on tissue sections and culture smears with Masson-Fontana stain.

Background: Dematiaceous fungi appear brown in tissue section due to melanin in their cell walls. When the brown color is not seen on routine H and E and culture is not available, differentiation of dematiaceous fungi from other fungi is diffi cult on morphology alone. Aims and Objective: To study if melanin production by dematiaceous fungi can help differentiate them from other types of fungi. Materials and Methods: Fifty tissue sections of various fungal infections and 13 smears from cultures of different species of fungi were stained with Masson Fontana stain to assess melanin production. The tissue sections included biopsies from 26 culture-proven fungi and 24 biopsies of fi lamentous fungi diagnosed on morphology alone with no culture confi rmation. Results: All culture-proven dematiaceous fungi and Zygomycetes showed strong positivity in sections and culture smears. Aspergillus sp showed variable positivity and intensity. Cryptococcus neoformans showed strong positivity in tissue sections and culture smears. Tissue sections of septate fi lamentous fungi (9/15), Zygomycetes (4/5), and fungi with both hyphal and yeast morphology (4/4) showed positivity for melanin. The septate fi lamentous fungi negative for melanin were from biopsy samples of fungal sinusitis including both allergic and invasive fungal sinusitis and colonizing fungal balls. Conclusion: Melanin is produced by both dematiaceous and non-dematiaceous fungi. Masson-Fontana stain cannot reliably differentiate dematiaceous fungi from other fi lamentous fungi like Aspergillus sp; however, absence of melanin in the hyphae may be used to rule out dematiaceous fungi from other fi lamentous fungi. In the differential diagnosis of yeast fungi, Cryptococcus sp can be differentiated from Candida sp by Masson-Fontana stain in tissue sections.

HIV testing among adults in a high prevalence district in India.

Background. HIV testing is a key component of HIV control efforts. We examined the distribution of HIV testing in a population-based sample from Guntur district in Andhra Pradesh, which is estimated to have one of the highest prevalence rates of HIV in India. Methods. A total of 12 994 persons (15–49 years of age) were interviewed in Guntur district. We assessed associations with the uptake of HIV test, place and reasons for undergoing HIV testing and awareness of voluntary counselling and testing centres (VCTC) among sexually active adults. Results. The age-, sex-, urban- and rural-adjusted prevalence of HIV testing was 21.1% (95% CI: 19.1–23.2). The uptake of HIV test was higher in women (27.2%) than in men (18.8%). Increasing education level, urban area residence and being in an occupation requiring mobility were significantly associated with uptake of the HIV test. A previous test for HIV was reported by 37.8% of men and 30.3% of women. The adjusted prevalence of VCTC awareness was 5.4% (95% CI: 4.3–6.4), being higher in men (9.2%) than in women (3.5%). Among those who had undergone HIV testing, 83.9% of men and 76.2% of women did so at a private sector health facility. Women were significantly more likely to under-go testing at VCTC/public sector facility (23.5%) than men (15%). More men (47.6%) than women (3.3%) reported undergoing testing voluntarily (p<0.001). Women reported pregnancy (57.4%) as the most common reason for undergoing the test. Conclusion. These population-based data highlight the patterns of HIV testing and their associations. The high proportion of HIV testing in the private sector suggests the need to strengthen counselling in this sector to enhance HIV prevention activities.

Causes and pattern of mortality in HIV-infected, hospitalized patients in a tertiary care hospital: a fourteen year study.

BACKGROUND: The introduction of highly active antiRetroviral therapy (HAART) in several centers in India has raised the expectation that many human immunodeficiency virus (HIV)-infected individuals will live longer. However, as most infected individuals remain undiagnosed till the late stage of infection; several continue to succumb to this infection even in the era of HAART. MATERIALS AND METHODS: A retrospective study was conducted over a 14 year period on 2,050 HIV-infected, hospitalized patients to evaluate the pattern of mortality and to determine proportion, risk factors and causes of death. RESULTS: A total of 145 deaths among HIV-infected patients were documented during hospitalization, with an overall mortality rate of 8.15%: 2.94% in the pre HAART era (1992-1996), 7.29% in the early HAART era (1997-2000) and 9.73% in the present HAART era (2001-2005). 11.7% (17/145) of deceased patients were aware of their HIV-infected status before getting admitted. Only five patients were on any antiretroviral treatment prior to admission. Ninety (62.07%) deaths were HIV-related (AIDS-defining conditions) and 55 (37.93%) were non HIV-related. DISCUSSION: Our study stresses the importance of early diagnosis of HIV infection to curb adult mortality, which will continue to rise unless effective treatment interventions are introduced.