Cutaneous fungal infection in a renal transplantation patient due to a rare fungus belonging to order Pleosporales.

Fungal infections are being increasingly reported from immuno-compromised as well as immuno-competent patients. Transplant patients are on long term immunosuppressive therapy which makes them highly vulnerable to opportunistic fungal infections .These infections can be cutaneous or systemic. Several fungi have been reported to be the culprits such as Candida spp., Aspergillus spp., C. neoformans, P. carinii, and zygomycetes group of fungi. Cutaneous infections are most commonly caused by Pityriasis (tinea) versicolor, dermatophytes, and candida sp but these days the demtiaceous fungi are becoming more frequently reported .Here we report a case of post renal transplant cutaneous infection caused by dematiaceous fungus belonging to the order Pleosporales.

Seroprevalence of Scrub typhus at a tertiary care hospital in Andhra Pradesh.

Introduction: Scrub typhus is a rickettsial infection which is caused by Orientia tsutsugamushi and transmitted by the bite of the chigger of a mite. Delay in diagnosis can be fatal otherwise the treatment is simple, doxycycline being the drug of choice. Indirect immunofl urescence is considered gold standard but it is not used in India as it is costly and also not available. There is need for rapid, economic and simple test for the diagnosis of scrub typhus. This study was taken up to study the seroprevalence of scrub typhus in Andhra Pradesh and to compare two commonly used serological methods; rapid test and IgM ELISA. Materials and methods: This is a prospective study in which 100 serum samples from clinically suspected cases collected over a period of 3 months were processed for the detection of IgM antibodies for scrub typhus by ELISA and Rapid test. Samples were also tested for leptospirosis and dengue fever which the other common causes of fever prevalent in this region. Results: Total number of samples processed was 100 of which 52 were males and 48 females. Among the hundred samples 39 were seropositive. Positivity was higher in the age group of patients between 16 and 30 yrs of age. There was 97% correlation between ELISA and rapid method. Of the 100 samples only three samples positive by ELISA were negative by rapid method. Fever was the most common manifestation and there was no eschar and no mortality reported. Conclusion: Scrub typhus should be included in the differential diagnosis of fever of unknown origin along with dengue, malaria and leptospirosis which are the other common endemic infections in this part of the country.

Isolation, speciation, and antibiogram of clinically relevant non-diphtherial Corynebacteria (Diphtheroids).

Purpose: Coryneform or the non-diphtherial Corynebacterium species largely remains a neglected group with the traditional consideration of these organisms as contaminants. This concept, however, is slowly changing in the light of recent observations. This study has been done to find out the species distribution and antibiogram of various members of the clinically relevant Coryneform group, isolated from various clinical materials. Materials and Methods: One hundred and fourteen non-duplicate isolates of diphtheroids from various clinical isolates were selected for the study. The isolates were identified to the species level by using a battery of tests; and antimicrobial susceptibility was tested by using a combination of Clinical and Laboratory Standards Institute (CLSI) and the British Society for Antimicrobial Chemotherapy (BSAC) guidelines, in the absence of definitive CLSI guidelines. Results: Corynebacterium amycolatum was the predominant species (35.9%) in our series followed by the CDC Group G organisms (15.7%). Each of the remaining 19 species comprised of less than 10% of the isolates. More than half the total isolates were resistant to the penicillins, erythromycin, and clindamycin; while excellent activity (all the strains being susceptible) was shown by vancomycin, linezolid, and tigecycline. Chloramphenicol and tetracycline also had good activity in inhibiting more than 80% of the isolates. Multiply drug resistance was exhibited by all the species. Conclusion: This study was an attempt to establish the clinical significance of coryneform organisms. The high level of resistance shown by this group to some of the common antibacterial agents highlights the importance of processing these isolates in select conditions to guide the clinicians towards an appropriate therapy.

Isolation of Legionella pneumophila from clinical & environmental sources in a tertiary care hospital.

Background & objectives: Legionella pneumophila and other members of this genus are important respiratory pathogens but legionellosis often remains a neglected and under reported condition. Hence, this study was done to find out the presence of this organism in patients admitted to a tertiary care hospital with community-acquired pneumonia (CAP). Methods: A total of 470 lower respiratory tract samples and 24 water samples from hospital outlets were examined. Culture was done on buffered charcoal yeast extract agar with supplements and identification of the isolates was done by microscopy and biochemical tests. Results: L. pneumophila could be isolated from 12 (2.55%) patients suffering from community-acquired lower respiratory tract infection, unassociated with other aetiological agents of bacterial pneumonia. Of the 24 water samples tested, 8 (33.3%) grew the same organism. Interpretation & conclusion: Our study has shown that Legionella is present in the hospital environment and was the aetiological agent of lower respiratory tract infection in 2.55 per cent of patients. A larger study and reports from other parts of the country may help in determining the true significance of legionellosis in India.

In vitro activity of antimicrobial agents against oxacillin resistant staphylococci with special reference to Staphylococcus haemolyticus.

One hundred and sixty seven isolates of staphylococci isolated from the inpatients of a tertiary care referral hospital in South India were speciated and activity of oxacillin, glycopeptides, linezolid and quinupristin/dalfopristin against these isolates was tested by broth microdilution method. Of the 114 coagulase negative staphylococci (CoNS), 49.1 % were S. haemolyticus, isolated predominantly from urine (64.6%), while the rest belonged to 11 other species. More than half the isolates of S. aureus (52.8%) and 68.4% of the CoNS were oxacillin resistant. All the strains were uniformly susceptible to vancomycin, linezolid and quinupristin/dalfopristin; but 25.6% isolates of S. haemolyticus showed reduced susceptibility to teicoplanin (MIC: 8-16 mg/L). Our study demonstrates the high prevalence of oxacillin resistance among hospital isolates of S. aureus and CoNS in India. Vancomycin, along with the newer agents like linezolid and quinupristin/dalfopristin remains the drug of choice for treating multi drug resistant staphylococcal infections.

In vitro activity of cefpirome: A new fourth generation cephalosporin.

This study was carried out to find the efficacy of Cefpirome in an Indian setting in a tertiary care referral hospital. A total of 516 bacterial isolates from various clinical specimens were tested against cefpirome (Cpo) and compared against the activities of three other cephalosporins, namely cefazolin (Cz), cefuroxime (Cu), and cefotaxime (Ce) as representative of the other three generations. Preliminary testing was done by Kirby Bauer technique. In the gram positive group of organisms (Staphylococcus aureus and coagulase negative staphylococci); 96 strains out of 177 (54.2%) were resistant to Cpo compared to 61.0% for Cz and 72.3% for Cu. In the Enterobacteriaceae group, 66.0% of the isolates were resistant to Cpo compared to 63.2% for Ce; while for Pseudomonas and other non-fermentors, the corresponding figures were 70.7% and 50.0% for Cpo and Ce respectively. The MIC for the strains resistant to Cpo were found to be> 16mg/L to> 256mg/L. This study highlights that Cpo did not have superior activity against the organisms isolated in our laboratory. However, since its activity against gram positive and gram negative organisms is comparable to those of Cz and Ce respectively, it may be useful for mixed infections for empirical therapy.

Infectious aetiology in acute coronary syndromes.

PURPOSE: To ascertain the relationship between seropositivity to chronic infections with Helicobacter pylori, Chlamydia pneumoniae and Cytomegalovirus (CMV) and acute coronary syndromes and association of each of these infective agent with biochemical parameters and cardiovascular risk factors. METHODS: The present study was a case-control study involving 117 patients [unstable angina (UA) n=101 and chronic stable angina (CSA) n = 16] attending cardiology clinic. The cases were aged 35-79 years and they were compared with age, sex and socio-economic status matched controls without evidence of coronary artery disease (CAD). RESULTS: Fifty seven (58%) patients with UA and 9(56%) patients with CSA were seropositive for H. pylori. Sixty seven (66%) subjects with UA and 15(94%) patients with CSA subjects were seropositive for C.pneumoniae. Two (2%) patients with USA were seropositive for Cytomegalovirus (CMV). Seropositivity in normal subjects for H. pylori, C. pneumoniae and CMV was 7(43.25%), 10(62.5%) and 1(6.25%) respectively. In linear regression analysis seropositivity of CMV showed positive association with HDL-C (P< 0.05). No significant association of infective agents and coronary syndromes was observed. CONCLUSIONS: Higher levels of lipids, lipoproteins, C-reactive protein and higher percentage of coronary risk factors in patients seropositive for H. pylori in UA suggests the role of infective agents in pathogenesis of atherosclerosis.

Analysis of the activity of promoters from two photosynthesis-related genes psaF and petH of spinach in a monocot plant, rice.

The subunit III of photosystem I and ferredoxin-NADP(+)-oxidoreductase are encoded by nuclear genes, namely psaF and petH. The activity of their promoters from spinach has been evaluated in transgenic tobacco earlier. Evaluation of the activity of these Dicotyledoneae-specific promoters has been carried out in a monocot system (i.e. rice) by transient gene expression system, based on electroporation-mediated gene delivery into protoplasts from leaves and roots. It has been found that various promoter deletions show higher activity in leaf protoplasts and elements for quantitative response are widely distributed. Transgenic rice has also been produced with a petH promoter and gus reporter gene construct. Although petH promoter is a weak promoter in comparison to the 35S promoter, it expresses well in green tissues and could be useful for plant genetic engineering.

Bacteraemia in a tertiary care urban hospital in south India.

A total of 1727 blood samples were cultured aerobically over a one year period, of which 201(11.8%) were positive. The ratio of Gram positive to Gram negative bacteraemia was 1:1. The three antimicrobials having the highest activities against the Gram positive isolates were amikacin, cefotaxime, and ciprofloxacin to which 88.5, 81.7 and 80.7 percent of the strains were susceptible: and the same agents were equally effective against Gram negative organisms with 84.5, 75.3 and 70.1 percent efficacy respectively. Coagulase negative Staphylococcus spp. was the most frequent organism isolated(60; 29.8%), followed by Pseudomonas aeruginosa (40; 19.9%), and Staphylococcus aureus (34; 16.9%).

Objective evaluation of psychological abnormality in irritable bowel syndrome.

BACKGROUND: Irritable bowel syndrome (IBS) is frequently regarded as a psychological disorder. Data on objective evaluation of psychological abnormalities among IBS patients and control subjects are scanty in our country. We therefore objectively studied patients with IBS. METHODS: 42 patients satisfying the Manning's criteria and Munich workers' for diagnosis of IBS underwent psychological evaluation using the following tests: a) Eyesenck personality questionnaire. b) State and trait anxiety inventory according to Speilberger's method. c) Hamilton depression rating scale for detection of depression. d) Whitely index of hypochondriasis and discriminant function by Pilowsky's illness behavior questionnaire. RESULTS: Neuroticism was detected in 76% of IBS patients compared to 9% in control population (p < 0.01). State and trait anxiety scores were 44.5 +/- 17.1 and 49.0 +/- 15.3 respectively in IBS patients; these were higher than those in controls (35.5 +/- 7.5 and 41.2 +/- 6.1 respectively; p < 0.01). Severe depression was observed in 26% of IBS patients and 6% of control subjects (p < 0.05). Significantly higher hypochondriasis score was observed in IBS patients as compared to controls (p < 0.001). CONCLUSION: Neuroticism, hypochondriasis and depression were significantly more prevalent in IBS patients attending a clinic, compared to control population.