Unusual presentation of entomophthoromycosis.

Rhinoentomophthoromycosis caused by Conidiobolus sp commonly presents as a chronic granulomatous lesion that affects the rhinofacial subcutaneous tissue. We present an 18-year-old girl who presented with progressive bilateral proptosis and loss of vision since 2 weeks. Biopsy and fungal cultures confirmed diagnosis of Conidiobolus sp infection of the paranasal sinuses bilaterally with orbital extension and blindness. The clinical picture was complicated by the presence of sputum-positive cavitatory pulmonary tuberculosis, which was diagnosed at the same time. To our knowledge, this is the first such case to be reported from India. We also discuss the management of entomophthoromycosis. Despite many reports of success, there remains no consensus on the treatment of Conidiobolus infections of the nose and the paranasal sinuses with antifungal agents.

Apophysomyces elegans - renal mucormycosis in a healthy host: a case report from south India.

Zygomycosis is an opportunistic fungal infection that seldom occurs in individuals with a competent immune system. Isolated involvement of any organ is rare and only a few cases of renal zygomycosis have been reported. We present an unusual case of renal zygomycosis caused by Apophysomyces elegans in a patient with no known predisposing factor. He presented with flakes in the urine and was found to have a poorly functioning right kidney. Ureterorenoscopy was performed, fungal elements removed and pathological confirmation obtained. The patient subsequently underwent nephrectomy after treatment with amphotericin B. He made an uneventful recovery.

Prevalence of inducible clindamycin resistance in gram positive organisms in a tertiary care centre.

Gram positive organisms are one of the leading pathogens causing skin and soft tissue infections. For these infections, clindamycin is a useful alternate drug in penicillin-allergic patients. This study was conducted to investigate the prevalence of erythromycin-induced clindamycin resistance in gram positive organisms in the southern part of the country. A total of 522 consecutive clinical isolates from blood, CSF, sputum, throat, pus, and urine were collected between November 2006 and April 2007 and tested for erythromycin resistance and inducible clindamycin resistance. There was a relatively higher incidence of inducible clindamycin resistance among the MRSA isolates. We conclude, therefore, that clindamycin is not a suitable alternative antibiotic for use in staphylococcal skin and soft tissue infections.

Acute abdomen: an unusual presentation of disseminated Penicillium marneffei infection.

Varied clinical presentations of Penicillium marneffei, an opportunistic pathogen in HIV disease has been rarely described in literature. We report a patient with advanced AIDS who presented to us with prolonged fever and had features of an acute abdomen. On radiologic imaging he had features of intestinal obstruction and mesenteric lymphadenitis. A diagnosis was made possible by endoscopic biopsies of the small bowel and bone marrow culture which grew P. Marneffei. He was treated with intravenous amphotericin for 2 weeks followed by oral itraconazole. This case is reported for its rarity and unusual presentation and to sensitise clinicians and microbiologists to consider this as an aetiology in patients with advanced HIV/AIDS who present with acute abdomen, more so in patients from a distinct geographic region--South-East Asia.

Emerging importance of Pneumocystis carinii among indian immunosuppressed patients.

Pneumocystis carinii is known to cause both significant morbidity and mortality in immunosuppressed individuals. In a six and a half year period starting with 1992, a total of 204 samples including bronchial aspirates, induced sputum and suction catheter tips were examined for P. carinii by direct microscopic examination of Giemsa's and toluidine 'O' stained smears. At a later stage of the investigation, immunofluorescent staining using monoclonal reagent (Meriflour, USA) was also used for examination of the specimens. In all 24 (11.8%) of 204 samples were positive for P. carinii. In addition, Pneumocystis carinii pneumonia (PCP) was diagnosed in five (33%) of 15 patients of acquired immunodeficiency syndrome (AIDS) with opportunistic infections. All these 15 patients had CD4 T cell counts of less than 500 T lymphocyte equivalent (TLE) /ml as measured by a Trax ELISA assay. Laboratories in India have to be better equipped for an early and correct diagnosis of PCP that is bound to rise with the increase in the number and variety of immunosuppressed patients.