Laboratory techniques for diagnosis of chlamydial infections of the eye.

Giemsa and fluorescence antibody (FA) staining were used to diagnose patients clinically suspected to be suffering from trachoma. A total of 52 controls i.e. individuals with refractive errors and no clinical trachoma and 173 cases suffering from different stages of trachoma were studied. FA was found to be 2.52 times more sensitive in confirming the presence of Chlamydia trachomatis compared to Giemsa staining. 28/52 (53.8%) and 4/52 (7.,69%) controls were also positive by FA and Giemsa staining, respectively, indicating sub-clinical infection without symptoms. Post treatment staining with both methods revealed that clinical cure of trachoma did not necessarily mean the absence of Chlamydia trachomatis in the conjunctival smears. As a corollary it can be deduced that mere presence of Chlamydia trachomatis in conjunctival epithelial cells may not cause clinical trachoma, certain host factors (local immunity etc.) may play an important role in clinical disease.

Disseminated nosocomial candidiasis in a pediatric intensive care unit.

Nosocomial disseminated candidiasis was diagnosed in 6 out of 200 (3%) children receiving pediatric intensive care over a period of 9 months. The ages of patients ranged between 20 days to 3 years; 4 were < 2 months. Therapy with broad spectrum antibiotics (in all), indwelling cannula (in all), peritoneal dialysis (in 3), low birth weight (in 3) and invasive hemodynamic monitoring were recognizable predisposing factors. The diagnosis was suspected on an average after 14 days, PICU stay (range 8-20 days). All the patients showed a secondary worsening after evidence of improvement from the primary illness. It was characterized by lethargy, fever (in 3), weight loss (in 3), loose stools (in 2) and respiratory distress (in 3), and was indistinguishable from any bacterial sepsis. Presumptive diagnosis was made on basis of KOH wet mount and Gram stained smear findings of mycelia, and was confirmed later on isolation of candida species from one or more body sites and blood culture. All the patients showed disappearance of symptoms and mycological cure within 6-14 days of oral itraconazole therapy, (10 mg/ kg/day in 2 divided doses). The therapy was continued for upto 14 days after sterile fungal blood culture, and was well tolerated. Fungal superinfection especially with candida must be looked for in hospitalized patients suspected of nosocomial infection. Early oral itraconazole is effective in disseminated candidiasis and well tolerated by children.

Niemann-Pick disease presenting as hepatic disorder.

A 2 year old female child with Niemann-Pick disease was referred as case of chronic liver disease; clinically, she had neurological involvement. Liver biopsy showed Niemann-Pick cells. Hepatic manifestations of Niemann-Pick disease as seen in nine cases reported from India are discussed.