Blastomycosis in a South Indian patient after visiting an endemic area in USA.

We describe a case of blastomycosis in a diabetic patient from South India who had visited Milwaukee, Wisconsin, an endemic area for blastomycosis in the USA. After his return to Bangalore, India, the patient developed intermittent fever of moderate to high grade, cough, loss of weight and appetite, and abscesses in the left cubital fossa and thigh regions. Systemic examination at our hospital revealed that he had dullness to percussion over the chest region and decreased breath sounds. Direct examination of Gram-stained smears of the pus from an abscess showed many broad-based budding yeast cells and culture yielded a dimorphic fungus later identified as Blastomyces dermatitidis. Histologic examination of the curettage tissue slides stained with hematoxylin and eosin, periodic acid Schiff's reagent, and Gomori's methenamine silver stain procedures showed many broad-based budding cells characteristic of B. dermatitidis. The patient was successfully treated, initially with amphotericin B, followed by oral itraconazole for a period of 6 months. Blastomycosis cases in India are reviewed and the likely source of infection in this patient is discussed.

Occurrence and characterisation of uropathogenic Escherichia coli in urinary tract infections.

PURPOSE: To study the occurrence of Uropathogenic Escherichia coli (UPEC) in cases with urinary tract infections. METHODS: A total of 220 cases from urinary tract infections and 50 stool samples from apparently healthy individuals were included. The colonies identified as Escherichia coli were screened for virulence factors namely haemolysin, Mannose Resistant and Mannose Sensitive Haemagglutination (MRHA, MSHA), Cell surface hydrophobicity and Serum resistance by recommended methods. RESULTS: Among 220 cases 91(41.36%) were haemolytic, 68(30.9%) showed MRHA, 58(26.36%) were cell surface hydrophobicity positive and 72(32.72%) were serum resistant. In 50 controls 3(6%) were haemolytic, 6(12%) showed MRHA, 9(18%) showed cell surface hydrophobicity and 12(24%) were serum resistant. The difference between cases and controls for haemolysis and MRHA were significant (p< 0.001 and p< 0.01 respectively). A total of 14 atypical Escherichia coli were isolated from urine and all showed the presence of one or the other virulence markers. Out of 18 mucoid Escherichia coli isolated 10 were serum resistant. Interestingly among the 15 Escherichia coli isolated from patients with pyelonephritis 8 were UPEC. CONCLUSIONS: Out of 220 urinary isolates, 151 could be labelled as UPEC.

A hospital based study of hepatitis E by serology.

Hepatitis E virus is recently recognised as an important cause of non-A, non-B hepatitis. A total of 569 serum samples were screened for HEV between April 1997 and March 2000, by a commercially available HEV IgM capture ELISA. The diagnosis was invariably acute viral hepatitis for differential diagnosis of jaundice. The percentage of seropositivity was found to be 18.8% in confirmed Hepatitis E cases.

Human ocular dirofilariasis in Kerala Southern India.

A twenty-six year old female presented to the Ophthalmology OPD with swelling of the upper eyelid. On excision, two long, thin, dead worms were removed. Microscopic and HPE showed the worms to belong to the Dirofilaria species.

Non-specific reactions in enzyme linked immunosorbent assays for serum antibody to entamoeba histolytica and Giardia lamblia in non-endemic areas.

Serum samples from 20 Indian children with diarrhoea were compared with those from 20 children resident in the United Kingdom who had been diagnosed as having ulcerative colitis, or Crohn's disease, or indeterminate colitis using enzyme linked immunosorbent assays specific for Entamoeba histolytica and Giardia lamblia. More than 50% of the United Kingdom patients had high IgG responses in ELISAs for E histolytica and G lamblia. A confirmatory ELISA showed that the British sera reacted specifically to bovine serum proteins rather than to protozoal antigens. Prior incubation of sera with 5% bovine serum prohibited this reaction. Bovine serum is an integral part of the crude soluble antigen used in most ELISAs for E histolytica and G lamblia and needs to be replaced with purified antigen preparations. The British sera also reacted to other commonly used blocking agents such as bovine serum albumin, casein, and normal sheep serum. These reactions were attributed to uptake of dietary antigens or an enhanced immunological response to these antigens in patients with inflammatory bowel disease.