Atypical presentations of congenital cutaneous candidiasis- presenting a cohort of 8 cases.

Congenital cutaneous candidiasis is an extremely rare disorder that usually presents within the first 6 days of life. We report 8 neonates who presented with generalized skin eruptions within first 6 days of life, characterized by erythematous macules, papules, vesicles, bullae and pustules. Candida albicans was demonstrated on direct KOH smear, fungal culture and skin biopsy. The disease implies a congenital intrauterine infection and is different from neonatal candidiasis, which manifests as thrush or diaper dermatitis.Although congenital cutaneous candidiasis is a rare diagnosis and the predisposing factors like prematurity,candidial infection in the mother are not obvious, a high index of suspicion is required to diagnose the neonates with this condition and it is very evident that congenital cutaneous candidiasis has got a good prognosis. This article apart from revealing the atypical presentations of cutaneous congenital candidiasis, also emphasizes the need to screen all pregnant women for vaginal candidiasis .

Staphylococcus aureus colonization of anterior nares of school going children.

Objective. To determine the colonization rates of S. aureus in anterior nares of school going children, evaluate the antimicrobial resistance of such isolates against various antibiotics. Methods. Nasal swabs taken for S.aureus in 392 healthy school going children aged between 5 and 15 yr belonging to three schools surrounding Kamineni Institute of Medical Sciences, Narketpally, Andhra Pradesh, India. Swabs were inoculated in to Mannitol Salt Agar (MSA) and incubated at 37o C for 24hr, Staphylococcus aureus isolates were identified by standard microbiological methods such as Gram’s stain, catalase and coagulase. MICs were determined by Agar dilution technique against Vancomycin, Ciprofloxacin, Sparfloxacin, Sparfloxacin ß Cyclodextrin. Antimicrobial resistance patterns of all the isolates against Oxacillin (1 μg) Penicillin (10units), Ampicillin (10μg), Co-trimoxazole (23.75 μg), Erythromycin (15 μg), Tetracycline (30 μg) and Gentamicin (10 μg) were tested using Kirby-Bauer disk diffusion method in accordance with CLSI standards. Results. Of the 392 samples screened 63(16%) showed the growth of Staphylococcus aureus. Twelve (19%) isolates were found to be MRSA. Antimicrobial susceptibility testing using Agar dilution method against Vancomycin, ciprofloxacin , Sparfloxacin, and Sparfloxacin β Cyclodextrin revealed MICs in the range of 0.52 μg/ml, 0.51 μg/ml, 0.5 μg/ml and <0.0312- 0.250 μg/ml respectively. Disk diffusion method showed that all the isolates were resistant to Penicillin and Ampicillin. A resistance of 14.3%, 25% and 22.2% was observed against Co-trimoxazole, Erythromycin and Tetracycline respectively. Gentamiicin was the only antibiotic against which most of the isolates were sensitive. Conclusion. Our results suggest that healthy school going children under 16 yr of age are potential carriers of S. aureus and in particular MRSA and multi-drug resistant strains.

Polymerase chain reaction in rapid diagnosis of neonatal sepsis.

In a prospective study a total of hundred neonates who fulfilled the American College of Obstetrics and Gynecology's (ACOG) criteria for probable sepsis admitted to NICU of tertiary care armed forces hospital were investigated for evidence of sepsis. The investigation protocol included sepsis screen, blood culture and 1 mL of venous blood for molecular analysis by polymerase chain reaction (PCR) for bacterial DNA component encoding 16 s RNA in all cases. 100 newborns with probable sepsis were studied to evaluate the molecular diagnosis of sepsis using PCR amplification of 16 S RNA in newborns with risk factors for sepsis or those who have clinical evidence of sepsis. We compared the results of PCR with blood culture and other markers of sepsis screen (total leucocyte count (TLC), absolute neutrophil count (ANC), immature/total neutrophil count ratio (I/T ratio), peripheral blood smear, micro ESR and C reactive protein (CRP). Controls consisted of 30 normal healthy newborns with no overt evidence of sepsis. Sepsis screen was positive in 24 (24%) of cases in study group with sensitivity and specificity of 100% and 83.5% respectively. Blood culture was positive in 09(9%t) with sensitivity of 69.2% and specificity of 100%. PCR was positive in 13(13%) of cases (9% are both blood culture and sepsis screen positive and 4% are positive by sepsis screen); the sensitivity of PCR was 100% and specificity was 95.6%. Blood culture is the most reliable method for diagnosis of neonatal sepsis. Polymerase chain reaction is useful and superior to blood culture for early diagnosis of sepsis in neonates.

ECG changes in asphyxia neonatorum.

Twenty five asphyxiated neonates had ECG changes consistent with degree of asphyxia. Equivocal changes were found in mild asphyxia and changes suggestive of myocardial infarction were seen with severe asphyxia. In most cases, the changes reverted to normal within two weeks signifying great ability of the neonatal heart to withstand hypoxic insult. Four babies with severe asphyxia having ECG changes suggestive of acute myocardial infarction expired within 48 hours of birth.