Onychomycosis due to Achaetomium strumarium.

Onychomycosis is the most common infection of the toe-nails or finger-nails and it may be caused by a large variety of fungal species. Achaetomium species which belong to the phylum Ascomycota (Family Chaetomiaceae), are usually soil saprophytes or endophytic fungi which have been rarely reported as human or animal pathogens. Here, we report a case of onychomycosis caused by Achaetomium strumarium in a healthy person who showed involvement of all fingers of both hands with yellowish brown discoloration. The causative agent isolated was identified as Achaetomium species by morphology, colony morphometry and growth at high temperature and as A. strumarium from DNA sequence of ITS region. Onychomycosis from this case responded satisfactorily with per os (P. O.; oral) and topical application of Terbinafine.

Keratitis by a rare pathogen Colletotrichum gloeosporioides: A case report.

Colletotrichum species have been reported infrequently as the cause of keratitis or subcutaneous lesions. The patient we describe developed keratitis after ocular trauma. The sample from the corneal scrapings grew Colletotrichum gloeosporioides as identified from morphological characters and DNA sequence of the 'Internal Transcribed Spacer' (ITS) region. The patient underwent topical application of amphotericin-B followed by itraconazole and natamycin treatment. Simultaneous oral voriconazole regimen leads to complete regression of corneal ulcer. This report highlights the fact that early and accurate identification and therapy can resolve keratitis caused by rare pathogen C. gloeosporioides.

Hepatitis B e Antigen Negative Chronic Hepatitis in Indian Patients : A Reality.

BACKGROUND: Hepatitis B e antigen negative chronic hepatitis (e(-) CHB) with detectable levels of hepatitis B virus DNA (HBV DNA) in serum has been reported in cases from Asia. This study was undertaken to find out prevalence e(-)CHB and to correlate its presence with the clinical status and severity of the illness in cases of chronic liver disease in India. METHODS: All patients of infective hepatitis, who were hepatitis B surface antigen (HBsAg) positive by enzyme-linked immunosorbent assay (ELISA), were evaluated with liver function tests and HBeAg and antiHBe antibody studies. Polymerase chain reaction (PCR) test was carried out to detect HBV DNA qualitatively. RESULT: Out of 2064 samples tested by ELISA, 429 (20.78 %) were HBsAg positive. HBV DNA (qualitative) was performed on all 429 patients and 74 (17.2%) were HBV DNA positive. Of these only 42 (56.75 %) tested positive for HBeAg. Overall, 8.3 % of HBeAg negative patients (32/384) were viraemic with evidence of chronic liver disease/clinical cirrhosis and alteration of transaminase levels, while three cases (0.84 %) HBeAg positive cases did not show presence of HBV DNA. CONCLUSION: This study shows e(-)CHB prevalence rate of 8.3% in patients with HBV infection in India. Since HBeAg negative patients had detectable levels of HBV DNA as seen in HBeAg positive patients, benefit of antiviral therapy should be given to them. Population studies on e(-) CHB cases are needed to determine its true prevalence, natural course and response to therapy.

Acinetobacter spp as Nosocomial Pathogen : Clinical Significance and Antimicrobial Sensitivity.

Acinetobacter spp are ubiquitous aerobic Gram negative coccobacillus, that are now increasingly responsible for a large number of nosocomial infections. In our study, over a period of six months (Jan-Jun 2000) at a tertiary care hospital, 152 (12.9%) isolates of Acinetobacter spp were obtained from a total of 1175 isolates grown from all clinical specimens. Most of the isolates 126 (82.9%) were from hospitalised patients in the spinal cord injury centre, intensive care units and those on prior antibiotic therapy. Community acquired infections were also seen in 26 (17.1%) out patient department (OPD) cases. Isolates were from urine, respiratory exudates, blood and pus/burn wound swabs predominantly. They were resistant to commonly used antibiotics while being sensitive to amikacin, augmentin, piperacillin, netilmicin and cefotaxime. 69.2% isolates exhibited resistance to two or more antibiotics. Clinical co-relation must be under taken to exclude commensal contaminants, before considering it to be a pathogen and prescribing antibiotics to the patient.

DNA AMPLIFICATION OF A REPETITIVE SEQUENCE - IS 6110 IN THE EARLY DIAGNOSIS OF EXTRA PULMONARY TUBERCULOSIS.

DNA amplification by Polymerase Chain Reaction (PCR) of a repetitive sequence specific for Mycobacterium tuberculosis, from clinical samples of extra pulmonary origin were evaluated. The 123 base pair fragment of the insertion element IS 6110 in Mycobacterium tuberculosis was amplified. A total of 50 samples were analysed by PCR and compared with culture on Lowenstein-Jensen medium (LJ) and the clinical findings of the patient. Out of the total 26 samples were positive by PCR, while only seven grew the bacilli in culture. 24 samples were negative by PCR and culture. All the seven samples that grew the bacilli on culture were positive by PCR. In remaining 19 cases that were positive by PCR but did not grow the bacilli clinical features, radiological findings and Mantoux test were strongly suggestive of M. tuberculosis. All the amplification negative cases had no positive evidence of tuberculosis but were being followed up. When correlated with culture and clinical history the sensitivity of PCR for the diagnosis of active tuberculosis was 100%. However, the specifity was only 55.8% as culture on LJ (Gold Standard) was positive in only 7 samples out of 26 samples that were positive by PCR.

Polymerase chain reaction in the diagnosis of tuberculosis.

OBJECTIVES: To evaluate efficacy of polymerase chain reaction (PCR), using the insertion sequence IS6110 as target for DNA, to detect Mycobacterium tuberculosis in body fluids of children with suspected tuberculosis (TB). SETTING: Hospitalized patients. METHODS: A comparison of PCR on body fluids, Acid Fast Bacilli staining (AFB), mycobacterial culture and clinical features, with special emphasis on central nervous system (CNS) TB was done over 18 month period. A total of 80 children were evaluated, 41 with probable TB disease and 39 controls. Cases were defined by specific clinical criteria. Controls included patients free of clinical TB. PCR was done on the clinical specimens and compared with clinical findings, radiological features, Mantoux (Mx) testing, AFB staining and culture on Lowenstein-Jensen (LJ) medium. RESULTS: Sensitivity of PCR in CSF samples was 100%, in gastric aspirate samples was 20% and in pleural fluid samples was 100%. CONCLUSION: PCR technique may become a valuable diagnostic tool for the diagnosis of tuberculosis in children especially in CNS TB.

EVALUATION OF HOSPITAL ACQUIRED PSEUDOMONAS INFECTION IN PARAPLEGIC AND ORTHOPAEDIC CASES.

One hundred isolates of Pseudomonas aeruginosa from patients of the spinal cord injury and orthopaedic centre were evaluated on the basis of 2 laboratory assays; antibiotic sensitivity and pyocin typing. Antibiotic drug resistance was found in 54 per cent of the isolates. The urinary tract, pressure sores and wound swabs were the most common clinical specimens. Spinal cord injury patients showed a high rate of nosocomial colonisation. Ceftazidime, amikacin, norflox and ciprofloxacin were the most active antimicrobial agents. Gentamicin, carbenicillin and tobramycin showed high resistance. Pyocin typing with 22 strains did yield information to establish a clinico - epidemiological relationship.

A SIMPLE COLD STAINING METHOD FOR ACID FAST BACILLI.

Sputum from 105 cases of pulmonary tuberculosis were studied. Direct and post concentration smears were stained by Ziehl - Neelsen (ZN) and cold staining methods. The cold staining method is simple, because it eliminates heatingof stain. For direct smear, the correlations of cold staining procedure with conventional ZN method was 93% and for post concentration smear it was 100%.