Cytodiagnostic Dilemma in a Lung Mass as the First Presentation of Testicular Mixed Germ Cell Tumor Metastasis.

Testicular mixed germ cell tumors (TMGCTs) are rare malignant tumors comprising of two or more types of germ cell tumors. Their onset may be undetectable and the patient may first present with symptoms of metastasis. We hereby report a case of a young male who presented with respiratory discomfort and had no symptoms of primary testicular tumor. CT-guided FNAC lung revealed mainly necrotic, keratinous debris with a focus of chondromyxoid stroma. Differential diagnoses of components of teratoma, squamous cell carcinoma and inclusion cyst was considered. FNAC was reported out for the possible presence of teratoma components. Retrospectively, physical examination and subsequent USG revealed testicular tumor. The case led to a diagnostic dilemma as the patient presented with no prior history suggestive of metastasis from testicular mixed germ cell tumor. The aim of the current case report is to alert the pathologists and clinicians about this uncommon clinical presentation and diagnostic relevance of FNA. It highlights that FNA lung revealing keratinous material should always be searched for the possibility of teratoma component.

Species Distribution and Antifungal Susceptibility Profile of Dermatophytes from a Tertiary Care Centre in North India.

Objective Dermatophytoses, one of the most ancient diseases, is becoming a menace in recent times. This has made the knowledge of antifungal susceptibility a priority in today's times. Material and Methods This is a prospective study conducted over 18 months including all dermatophytes isolated during the period. Dermatophytes were identified by routine phenotypic methods. Antifungal susceptibility testing was performed for griseofulvin, terbinafine, and itraconazole as per the Clinical Laboratory Standard Institute M38 A2, and minimum inhibitory concentrations (MICs) were read after 5 days. Results Patient details and associated risk factors were recorded. Fixed dose combinations with steroids were associated with 79.3% (46 out of 58) of patients with dermatophytosis of skin. Among the 72 dermatophytes isolated during the study period, 58 (80.5%) were isolated from skin scrapings and 14 (19.4%) from nail samples. Tinea corporis with cruris was the most common presentation. The most common dermatophyte isolated from skin scrapings was Trichophyton mentagrophytes complex (70.6%, 41 out of 58), while from nail samples it was Trichophyton rubrum complex (78.57%, 11 out of 14). Based on the MIC 50 and MIC 90 results, itraconazole showed the lowest MICs, followed by terbinafine and then griseofulvin. Conclusion With the changing epidemiology of species distribution and antifungal resistance, there is a need for continuous surveillance of these parameters of dermatophytes.

A Comprehensive Review of Trichosporon spp.: An Invasive and Emerging Fungus.

Trichosporon species are basidiomycetous yeast-like organisms found ubiquitous in nature. They are increasingly been recognized as opportunistic pathogens capable of causing life-threatening invasive diseases (trichosporonosis), especially in immuno-suppressed patients and rarely in immuno-competent patients too. Earlier multiple members of the genus Trichosporon were clubbed together as T. beigelli but after the advent of molecular techniques, more than 50 different subspecies and around 16 different strains causing human diseases are reported. It is known to cause a wide range of diseases, from superficial to probable and proven invasive diseases to summer hypersensitivity. The ability of Trichosporon strains to form biofilms on implanted devices, glucuronoxylomannan in their cell walls, and production of proteases and lipases lead to the virulence of this genus. This ubiquitous fungus exhibits intrinsic resistance to echinocandins, variable minimum inhibitory concentrations (MIC) for amphotericin B, and moderate susceptibility to fluconazole and Itraconazole, which are the commonly used anti-fungal agents for any invasive fungal infections which lead to the re-emergence of this notorious yet neglected pathogen and hence the reports of breakthrough infections among patients receiving these antifungals. This review is to understand the epidemiological, clinical details, and antifungal susceptibility pattern of various Trichosporon infections and it highlights the importance of early detection and treatment for this emerging yeast and also will add to the ongoing surveillance for the anti-fungal susceptibility pattern for this fungus.

Prevalence of transfusion-transmitted viral pathogens among health-care workers and risk mitigation programme in a paediatric tertiary care hospital.

The health-care workers (HCWs) are at an occupational risk of exposure to blood-borne pathogens, mainly, HIV, hepatitis B virus (HBV) and hepatitis C virus. HBV is currently the only blood-borne virus for which a vaccine is available. All health-care institutions must encourage the HCWs to undergo screening for blood-borne pathogens.

Shigella sonnei Sepsis in an Infant: A Case Report.

Shigella bacteraemia is a complication of gastroenteritis caused by Shigella spp. which occurs mainly in immunocompromised children. Other risk factors may include young malnourished children, patients with chronic disease, post transplant patients etc. We present a case of six-month-old infant who developed an episode of gastroenteritis caused by Shigella sonnei which was followed by septicaemia. The patient was managed well and he recovered. Shigella sonnei was isolated in both stool as well as blood culture. S.sonnei bacteraemia is a rare condition but we should always be vigilant. Blood cultures as well as stool cultures should be performed in patients presenting with acute febrile gastroenteritis, whether immunocompromised or not. This simple, early and prompt investigation may help in precise diagnosis, which will guide the clinician about appropriate intervention like antibiotic therapy and supportive care.

Stenotrophomonas maltophilia: An Emerging Pathogen in Paediatric Population.

INTRODUCTION: Stenotrophomonas maltophilia (formerly Pseudomonas maltophilia/Xanthomonas maltophilia), a Gram- negative, non-fermenting bacillus, is being increasingly recognized as a threatening nosocomial pathogen, associated with significant mortality. AIM: To determine the prevalence of infection, antimicrobial susceptibility pattern and clinical outcome of S. maltophilia in a paediatric population. MATERIALS AND METHODS: This was a retrospective study conducted over a period of eight months, i.e., October 2015 to May 2016. All clinical samples received in the microbiology laboratory during the study period were processed using standard microbiological procedures. S. maltophilia isolates were selected. Antibiotic susceptibility was performed for levofloxacin and trimethoprim-sulphamethoxazole by Vitek 2C system (Biomerieux, France). Average length of stay and mortality caused by S. maltophilia infection was compared with age and sex matched controls without S. maltophilia infection. RESULTS: A total of 16,234 clinical specimens were received in the microbiology laboratory in the study period, with 2,734 pathogenic bacteria isolated. A total of 1,339 (1.7% of total isolates) Gram-negative bacteria were isolated, out of which 414 were non-fermenters. Among the non-fermenters, 23 (5.5%) were S. maltophilia. Out of the 23 isolates, 15 (65.2%) were isolated from blood, 4 (17.3%) were isolated from urine and tracheal aspirate each. A total of 91.3% of strains were susceptible and 8.6% were resistant to trimethoprim-sulphamethoxazole. Total 80% of strains were sensitive and 20% had intermediate susceptibility for levofloxacin. None of the strains were resistant to levofloxacin. Average length of stay of patients with S. maltophilia infection was found out to be 23.3 days as compared to 44.8 days in controls. The average mortality of patients with S. maltophilia infection was found to be same as that of controls (35.2%). CONCLUSION: S. maltophilia is becoming an important nosocomial pathogen and its isolation rate is reported to be increasing. Trimethoprim-sulphamethoxazole still remains the drug of choice but resistance has been reported for this drug as well. As its isolation is increasing, it is important to study the epidemiology, antimicrobial susceptibility profile and clinical outcomes of these isolates.

Evaluation of risk factors in patients attending STI clinic in a tertiary care hospital in North India.

BACKGROUND: In the past few years, the interest in STDs and their management has increased tremendously because of their proven role in facilitation of HIV infection, which, in turn, also increases the risk of acquiring STIs. Sexually transmitted diseases (STDs) are a major health problem affecting mostly young people, not only in developing, but also in developed countries Male circumcision is being considered as strategy to reduce the burden of HIV/AIDS. AIMS: (i) To screen the new patients attending the STI clinic for bacterial causes of STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum and Gardnerella vaginalis) and (ii) to evaluate the role of various risk factors in the prevalence of STIs. MATERIALS AND METHODS: The present study was conducted on 200 patients attending the STI clinic. They were evaluated for the prevalence of HIV and bacterial STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum and Gardnerella vaginalis) along with the role of risk factors particularly circumcision. RESULTS: The prevalence of HIV was 7% and prevalence of other STI was 20%. The causative agents were Chlamydia 8%, Gonorrhea 7.5%, Bacterial Vaginosis 2.7% and Syphilis 2%. CONCLUSION: The factors found to be significantly associated with the prevalence of STI were circumcision, positive HIV status, education, religion, multiple sexual partners, contact with Commercial sex workers (CSW), non use of contraception, profession involving long stay away from home, and past history of STI. The present study suggests that circumcision is a protective factor for acquisition of STIs but other factors like sexual behavior, use of barrier contraceptives, drug abuse etc., also play a role.

Co-infection of human immunodeficiency virus and sexually transmitted infections in circumcised and uncircumcised cases in India.

BACKGROUND: Acquired Immunodeficiency Syndrome (AIDS), is now one of the greatest challenges facing the world. Sexual transmission is the primary route of human immunodeficiency virus infection worldwide. Male circumcision is being considered as strategy to reduce the burden of HIV/AIDS. MATERIAL AND METHODS: The present study was conducted on 200 HIV positive clients. They were screened for bacterial causes of STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum and Gardnerella vaginalis). RESULTS: There were 138 males and 62 females. The males were examined and the circumcision status was observed. In the females, circumcision status of their male partners was observed. The coinfection of HIV and STIs in circumcised and uncircumcised cases was found out. Diagnosis was made using standard tests. A total of 23% cases were diagnosed to have HIV -STI coinfection. Most common diagnosed diseases were Chlamydia (10%), Gonorrhoea (9%), Bacterial Vaginosis (4.8%) and Syphilis (2.5%). The coinfection rate in uncircumcised cases was found to be higher (29.2% in males and 39.2% in females) as compared to the circumcised cases (14.2% in males and 13.6% in females). CONCLUSION: The present study suggests that circumcision is a protective factor for acquisition of STIs in HIV positive clients but other factors like sexual behaviours, use of barrier contraceptives, drug abuse etc also play a role.