Candida tropicalis: its prevalence, pathogenicity and increasing resistance to fluconazole.

Candida tropicalis has been identified as the most prevalent pathogenic yeast species of the Candida-non-albicans group. Historically, Candida albicans has been the major species responsible for causing candidiasis in immunocompromised and immunocompetent patients. However, infections (candidiasis) due to C. tropicalis have increased dramatically on a global scale thus proclaiming this organism to be an emerging pathogenic yeast. The reasons for this organism's dominance and its resistance to fluconazole have been difficult to elucidate. In addition, the mechanism of this organism's pathogenicity and the consequent immune response remain to be clarified. This paper describes certain predisposing factors potentially responsible for these characteristics and presents a 'root cause analysis' to explain the increasing prevalence of C. tropicalis in developed and undeveloped countries, as well as the organism's acquired drug resistance. Control measures against fluconazole resistance in clinical management have also been discussed.

Kaposi's sarcoma in a patient with AIDS.

We report a case of a 40 year old HIV infected male, citizen of Somalia who presented with multiple painful, livid reddish brown plaques, papules and nodules on both lower limbs and purplish red nodules on the hard palate. The cutaneous nodular lesions on biopsy showed characteristic features of Kaposi's sarcoma. This case is reported due to paucity of Kaposi's sarcoma in Indian literature.

Kawasaki disease.

Mucocutaneous lymph node syndrome has been rarely seen or reported in India because of its rare occurrence and probably because of its close resemblance to many exanthematous conditions. It is a characteristic disease with a unique clinical presentation. Knowledge about this established disease is essential as it can involve the coronary and other medium and small sized arteries causing vasculitis in about 20% of cases. This probably accounts for a significant number of ischemic heart diseases and sudden deaths in the young, i.e. in the second and third decades, later in life for which no other cause is found then. It is a condition diagnosed entirely on clinical basis and hence the need to be aware of its characteristic features.

High occurrence of HBV among STD clinic attenders in Bombay, India.

The pattern of sexually transmitted disease (STD) is the basis for designing surveillance of specific STD, their trends and syndromic management protocols. Two hundred and fifteen consecutive first-time STD clinic attenders at a teaching hospital in Bombay were recruited for the study in October 1995. Thorough clinical examination and the following investigations were done: wet mount, Gram stain, Giemsa stain, modified Thayer-Martin (MTM) medium culture, Fontana stain, Venereal Disease Research Laboratory (VDRL), Treponema pallidium haemagglutination test (TPHA), HBsAg and HIV. Ulcerative STD constituted 73.5% of total STD while 15.8% were discharges and 10.2% were genital growths. Ulcers in decreasing order of frequency were chancroid (51.9%), genital herpes (29.1%) and syphilis (14.5). 76.5% of genital discharges were due to gonococcal infection. The high rate of ulcerative STD is possibly an important co-factor for the high HIV prevalence of 31.2% in Bombay. Of 182 patients tested for HBV, 16 (8.8%) were reactive for HBsAg, revealing a high prevalence among STD attenders. A high co-relation of HBsAg positive with either HIV or VDRL requires urgent attention for HBV intervention strategies in this population.

PIP: Analysis of the pattern of various sexually transmitted diseases (STDs) in a given region is essential to the design of surveillance programs and syndromic management protocols since the pattern varies from area to area. Enrolled in the present study were 215 consecutive, first-time STD clinic attenders at a teaching hospital in Bombay, India, in October 1995. Patients were grouped into 5 categories--genital ulcer disease, genital discharges, buboes, genital growths, and others--and tested accordingly. The mean age of the 193 male STD patients was 26.6 years, while that of the 22 female patients was 22.9 years. Genital ulcer disease constituted 73.5% of all STDs in this series, while 15.8% were discharges and 10.2% were genital growths. Ulcers were chancroid (51.9%), genital herpes (29.1%), and syphilis (14.5%). 76.5% of genital discharges were due to gonococcal infection. HIV was detected in 60 men (31.1%) and 7 women (31.8%), for an overall prevalence of 31.2%. 70.1% were infected with HIV-1, 8.9% with HIV-2, and 21% were positive for both HIV-1 and HIV-2. The high rate of ulcerative STD in this sample is a likely co-factor in the high HIV prevalence. Hepatitis B surface antigen prevalence was 8.8%, and one-quarter of these patients were also HIV-infected. This finding indicates a need for more widespread hepatitis B vaccination in India.