Fatal rabies despite post-exposure prophylaxis.

Only sporadic reports of failure of post-exposure prophylaxis for rabies exist in the published literature. We are reporting such a case in a 3-year-old boy. The child had Category III dog bite on his right thigh. He presented with progressive ascending paralysis, finally developing quadriplegia and respiratory paralysis. Typical hydrophobia and aerophobia were absent. He received four doses of antirabies cell culture vaccine. He did not receive antirabies immunoglobulin. The boy succumbed on the 23 rd day of the dog bite. Diagnosis of rabies was confirmed in the laboratory by demonstration of Negri bodies, direct fluorescent antibody test and reverse transcriptase-polymerase chain reaction either on impression smear of brain or a piece of brain taken during autopsy.

Clinical profile of dengue haemorrhagic fever from Jan 2009 to Dec 2009 in and around Aurangabad.

In present study 890 serum samples suspected of dengue fever on clinical grounds were received in department of Microbiology. Out of these 249 cases showed thrombocytopenia (platelet count < 1 lakh/cumm) and were subjected to rapid dengue serological test as well as IgM capture ELISA. 11(4%) cases were diagnosed as primary dengue infection (only IgM positive) by rapid dengue IgG/IgM bispot immunocomb test. There were 123(49%) cases with only IgG positive suggesting secondary/past dengue infection. Both IgM and IgG were seen in 24(10%) cases. Number of cases negative for both IgM and IgG were 91(37%). IgM positive cases were confirmed by IgM capture ELISA. Classical dengue fever (DF) was noted in 168 (67%) patients and dengue hemorrhagic fever (DHF) in 81(33%) cases. Common clinical presentations of DHF were fever 78 (96%), body-ache 74 (91%), arthralgia 74 (91%), retro-orbital pain 65 (80%), abdominal pain 07 (09%). Bleeding manifestation were in the form of petechiae, melena, epistaxis, hematuria, hemoptysis, hematemesis, bleeding gums and conjunctival hemorrhages. Out of 81 DHS patients 13 (16%) patients had platelet count between 50,000 and 1 lakh. 68 (84%) patients had platelet count below 50,000. Majority of these patients 47 (58%) had platelet below 20000 and were IgG positive. Thrombocytopenia correlated well with bleeding manifestations in our patients. In an epidemic setting if the patients present with fever, vomiting, musculoskeletal pain and bleeding along with low platelet count a strong possibility of DHF/DSS should be kept.

Zoonotic infections of buffalopox in India.

Four outbreaks of buffalopox in domestic buffaloes, with considerable mortality with high case fatality rates in young buffalo calves and high morbidity with significant productivity loss in terms of reduction in milk yield in adult animals along with severe zoonotic infection in milk attendants were recorded at various places in India, during 2006-2008. In buffaloes, the pox lesions were confined to udder and teats of the majority of the affected animals, and in few animals the lesions were appeared on the hindquarters, indicating generalized infection. The overall disease morbidity, mortality and case fatality rate were 6.8%, 0.7% and 11.4% respectively. Milkers developed pox-like lesions on the hands, forearms and forehead accompanied by fever, axillary lymphadenopathy and general malaise. The causative agent of the outbreaks, buffalopox virus (BPXV), was confirmed upon virus isolation in cell culture, electron microscopy, A-type inclusion (ATI) and ankyrin repeat protein (C18L) gene-specific polymerase chain reactions (PCR). Further, sequence analysis of the BPXV isolates from human and buffalo showed more identity of ATI and C18L genes sequences with that of other orthopoxviruses at nucleotide and amino acid levels and confirmed a close relationship of BPXV with Vaccinia virus (VACV) or VACV-like viruses. Considering the zoonotic impact and productivity losses of buffalopox infection, the control measures are imperative in curtailing economic and public health impact of the disease.

Study of onychomycosis: prevailing fungi and pattern of infection.

A mycological study of onychomycosis was undertaken in 88 patients. The nails were judged to be infected by their clinical appearance. Direct microscopy of the nail clips in 20% KOH solution was positive in 72 (81.8%) and culture was positive in 43 (48.8%) cases. Out of the samples cultured, dermatophytes were grown in 26 cases (29.5%), non dermatophyte moulds in 12 (13.6%) and Candida spp. in 5 (5.6%) while 45 (51.1%) samples yielded no growth. Amongst dermatophytes, T. rubrum was found to be commonest etiological agent (57.6%) followed by T. mentagrophyte. Amongst the non-dermatophyte mould (NDM), Aspergillus spp. was the most prevalent species followed by Alternaria spp, Curvularia spp. and Fusarium spp. Commonest age group affected was above 31 years. Males were predominantly affected (65%), male to female ratio being 1.8:1. Fingernails were affected more frequently than toe nails with the ratio of 3:1. Distal and lateral subungual onychomycosis (DLSO) was more common (50%) than other clinical pattern followed by proximal subungual onychomycosis (PSO) (20.4%), white superficial onychomycosis (SWO) (2%), total dystrophic onychomysosis (TDO) (14%) and paronychia (10.2%).

Bacteriological and mycological study of corneal ulcers in and around Aurangabad.

In the present study an attempt was made to find out bacteria and fungi causing corneal ulcers. Sixty cases of corneal ulcer were studied. Corneal scrapings from patient of corneal ulcer were collected and processed for isolation of bacterial and fungal agents. The commonest age group affected was 21-30 yrs. Incidence of corneal ulcer was more in males 39 (65%) as compared to females 21 (35%). Trauma was the commonest predisposing factor. Out of sixty cases of corneal ulcer positive cultures were obtained in 23 (38.33%). Bacteria were isolated in 10 (16.66%) fungi in 12 (20%) and mixed culture in 1 (1.66%) of the patients. Among the bacterial isolates commonest was Staphylococcus aureus 6 (10%). Among fungal isolates Fusarium species was the commonest isolate 4 (6.66).

Epidemiology of cholera--a five year study.

A total of 286 strains of Vibro Cholerae were isolated and tested over a period of five years. The strains were identified by standard methods and confirmed by slide agglutination tests with polyvalent, Ogawa and Inaba antisera. The non-agglutinating strains were tested with O-139 antisera. The maximum number of cases were found in the age group of 0-10 years. The number of females affected was more than the males. V. cholerae O-139 was isolated in the year 1998 and then again in 2000. V. cholerae serotype Inaba was found only in the year 1999. All of the other isolates belonged to the serotype Ogawa. The periodic shift between O1 and O-139 serogoups is reminiscent of the shifts from the Ogawa to the Inaba serotypes periodically witnessed among V. cholerae, possibly mediated by the immune pressure in the population.

Mycology of Cutaneous Fungal Infections in Ambajogai: a Rural Area.

Two hundred and eithteen cases of fungal skin infections were studied. Tinea cruris was most common (34.4%), followed by tinea corporis (23.8%) znd tinea pedis (21.6%). Tinea versicolor (8.7%) tinea manum (4.6%) tinea ungaium (3.7%) and tinea capitis (3.2%) were also seen. The male: female ratio was 4:1. The total isolates were 117. Trichophyton rubrum was the most common isolate (35%). closely followed by Epidermophyton floccosum (31.6%). Trichphyton mentagrophytes (17.9%), Malassezia furfur (13.7%) and Microsporum audouini (1.7%) were the only other isolates.